Basic Human Needs Nutrition Nutrients The Biochemical units

Basic Human Needs Nutrition

Nutrients: The Biochemical units of nutrition Body requires fuel to provide energy for cellular metabolism and repair, organ function, growth & body movement n Food is the fuel that keeps the machine that is our body running n

Energy requirements based on: n Basal metabolic rate (BMR)-Energy needed to maintain life sustaining ( Breathing, circulation, temperature, heart rate) n Resting Energy Expenditure (REE)-measurement that accounts for BMR plus energy needed to digest food & perform mild activity. Accounts for 60 -70% of our daily needs

Nutrients Elements necessary for body processes & function n 6 Categories n Carbohydrates, Proteins, Fats, Water, Vitamins, Minerals n

Carbohydrates n n n Main source of energy (55 -60% of calories in diet) Each gram = 4 kcal Composed of carbon, hydrogen & oxygen Main source of fuel (glucose) for brain, skeletal muscle during exercise, RBC &WBC production, cell function of renal medulla Obtained from plant foods, except for lactose (milk, sugar)

Simple Carbohydrates Classified according to saccharides n Monosaccharide- glucose(dextrose), fructose, galactose (building blocks of all other CHO) n Glucose- blood sugar (normal fasting BS=70 -100 mg/ml) n Disaccharide- sucrose, lactose, maltose, n Sugar alcohols-sugar replacers n Artificial sweetners n

Complex Carbohydrates Polysaccharides are complex carbohydrates n Starches, glycogen, & fiber are polysaccharides n Starches are the major source of CHO in diet (grains, cereals, breads, pasta, starchy vegetables & legumes) n Glycogen- animal starch (found in liver & muscle tissue, provides immediate fuel for muscle action n

Dietary Fiber Plant foods that cannot be broken down by body to digest n Fiber eliminated by intestinal waste n Adds volume, no fuel or energy n Fiber in diet helps promote regularity of bowel movements, helps in regulating blood sugar, reducing cholesterol, may promote weight loss, reduce risk of colon cancer & diverticular disease n

Functions of CHO Provide fuel (CHO primary source) n Spare body protein (body can convert protein to glucose; body will break down internal protein stores before fat stores in absence of CHO) n Helps prevent ketosis (partially broken down fats accumulate in blood as ketones) n Enhance learning & memory (Glucose) n

Proteins Provide a source of energy n 4 kcal per gram n Essential for synthesis of body tissue in growth, maintenance & repair n Collagen, hormones, enzymes, immune cells, DNA, RNA are composed of protein n Blood clotting, fluid regulation, & acidbase balance require protein n

Protein Composed of carbon, hydrogen, oxygen, & nitrogen n There are essential and nonessential amino acids n Complete and incomplete proteins n Essential amino acids: isoleucine, lysine, threonine, tryptophan, methionine, histidine, valine, phenylalanine n

Protein n Albumin & Insulin are simple proteins n Lipoprotein is a complex protein (Lipid & protein) n Complete & Incomplete proteins

Protein Nitrogen balance- intake & output of nitrogen equal n When intake of nitrogen exceeds output, body is in a positive nitrogen balance (growth, pregnancy, maintenance of lean muscle mass & vital organs, wound healing n The extra nitrogen is used for building, repairing, & replacement of tissues n

Protein Negative Nitrogen balance- Body loses nitrogen faster than it gains it n Infection, Sepsis, Fever, starvation, head injury, trauma, burns n Increased nitrogen loss is the result of body tissue destruction or loss of nitrogen containing body fluids n

How protein functions in the body Provision of structure n Growth & maintenance of tissue n Regulation of body processes (hormones, enzymes, nucleoproteins) n Development of immunity n Circulation of blood and nutrients n Backup source of energy n

Fats(lipids) are the most calorically dense n Composed of carbon, hydrogen, & oxygen (basic structural unit=glycerol) n 9 kcal per gram n Composed of monoglycerides, diglycerides, & triglycerides n Lipogenesis- Synthesis of fatty acids n

Fats Fatty acids can be Saturated or Unsaturated, Monounsaturated, or polyunsaturated & Trans-fatty acids n Essential Fatty Acids (Linoleic, Linolenic) must be supplied by diet n Nonessential fatty acids n Necessary for metabolic processes n HDL vs LDL n

Fats Animal fats are high in saturated fatty acids n Vegetable fats are high in unsaturated and polyunsaturated fatty acids n

Functions of Fats Fuel source n Vehicle for fat soluble vitamins n Satiety value n Sources of essential fatty acids n Organ protection n Lubrication n Insulation n Cell membrane structure n

Cholesterol n n n Not a true fat, classified as a sterol Body manufactures 1000 mg day Component of bile salts, essential component of cell membrane, necessary for production of several hormones (cortisone, estrogen adrenaline, testosterone) Elevated blood levels is a major risk factor for CAD ( < 200 mg/d. L optimal) HDL vs LDL

Water Critical component of body n Cell function depends on a fluid environment n 60 -70% of body weight n Muscle contains more water than fat n Infants have higher total body water n Fluid needs met by ingesting fluids & solid food high in water content (fruits & veggies) n

Vitamins Organic substances present in small amounts in food n Essential for normal metabolism n Body depends on dietary intake n Vitamin content higher in fresh foods n Classification by solubility: water or fat n

Vitamins n n n n Fat Soluble- Vitamins A, D, E, K Can be stored in body Provided through dietary intake except for Vitamin D Antioxidant role of vitamins Water Soluble-Vitamin C, B Complex (8 vitamins) Cannot be stored in body, provided by dietary intake Vitamins are catalysts in biochemical reactions

Functions of Fat-Soluble Vitamins n n Vitamin A: vision, healthy epithelial tissue, proper bone growth, energy regulation Vitamin D: promotes normal bone mineralization, plays a role in calcium and phosphorus absoprtion Vitamin E: antioxidant role (protects Vitamin A & unsaturated fatty acids from oxidation Vitamin K: blood clotting, bone metabolism

Functions of Water-Soluble Vitamins Vitamin C: collagen synthesis, powerful antioxidant, adrenal gland function, iron absorption, folic acid conversion n B-Complex: co-enzyme in numerous metabolism mechanisms n

Minerals Inorganic elements essential to the body as catalysts in biochemical reactions n Macrominerals-Body requires 100 mg or more n Trace elements-Body needs less than 100 mg n

Minerals n Macrominerals- Calcium, Sodium, Potassium, Phosphorus, Magnesium, Sulfur, and Chloride n Trace Elements- Iodine, Fluoride, Iron, Selenium, Zinc, Copper, Selenium, Manganese, Chromium

A & P of Digestion Mechanical breakdown that results from chewing, churning, mixing with fluid, & chemical reaction till food reaches it’s simplest form n Enzymes speed up chemical reactions n

A & P of Digestion Dysphagia- Difficulty swallowing n Absorption occurs in small intestineprimary absorption site for nutrients n Main source of water absorption via intestine, small intestine reabsorbs 9. 5 L n

Metabolism Catabolism- Breakdown of biochemical substances into simpler substances (starvation) n All body cells except RBC & neurons can oxidize fatty acids into ketones for energy in the absence of dietary CHO n

Metabolism Biochemical reaction with cells n Anabolic or Catabolic n Anabolism- Building of more complex substances, occurs when lean muscle is added through diet & exercise n Amino acids are anabolized into tissue, hormones, & enzymes n

Dietary Guidelines Recommended dietary allowances n Food Guidelines-Food Pyramid n Daily values on food labels (based on 2000 kcal/day) n

Nutrition during Growth & Development Infant n School Age n Adolescents n Young-Middle Adults n Older Adults n Alternative food patterns n

Cultural Aspects of Nutrition Hot Foods n Hot foods: Rice, grain cereals, alcohol, beef, lamb, chili peppers, chocolate, cheese, eggs, peas, goats milk n Conditions that require “hot” foods: Menstruation, cancer, pneumonia, earache, colds, headache

Cultural Aspects of Nutrition Cold Foods n Cold foods: Beans, citrus fruits, tropical fruits, dairy products, honey, chicken, fish and goat n Conditions that require cold foods: Pregnancy, fever, infections, diarrhea, rashes, liver problems, constipation, sore throats

Nursing Process & Nutrition n n n n Assessment- Anthropometry Body Mass Index Ideal Body Weight Anthropometric measurements Labs- Albumin, Transferrin, Prealbumin, Protein, Hgb, Total Lymphocyte Count Nitrogen balance Dietary & Health history Clinical Observation

Nursing Diagnosis n You tell me!!!!!!

Conditions affecting Digestion n n n n CVA GERD Hiatal Hernia Gastric Bypass H-Pylori Ulcers Obstruction Gallbladder n n n n Malabsorption syndromes Lactose Intolerance Celiac disease IBS IBD (colitis, Crohns) Diverticulosis Diarrhea/Constipation Hemorrhoids

Implementation Acute Care n n n Oral delivery of nutrients Enteral tube feedings Nasogastric, jejunal, gastric tubes Less risk for aspiration with jejunal feedings Indicated in cancer of neck & upper GI tract, GI disorders, CVA, dementia, inadequate oral intake, respiratory failure with prolonged intubation Parenteral Nutrition: Indicated in conditions with nonfunctioning GI tract, extended bowel rest,

Tube Feeding Nsg Responsibilities n n n n n Document baseline weight Check Tube placement Check residual q 4 hr Check labs I&O Daily weight Aspiration Precautions Water Flush Check for complications

Enteral Feeding Complications Pulmonary aspiration n Diarrhea n Constipation n Tube occlusion n Tube displacement n Delayed gastric emptying (check residual) n Nausea/vomiting/cramping n

Aspiration Precautions Elevate HOB > 30 degrees n Good oral care n Regular assessment of feeding tolerance n Prokinetic medications (Reglan) n Regular assessment of tube placement n X-ray most accurate Ø Mark tube (NGT/OGT) at exit site with indelible ink or tape. (AACN, 2005) Ø

Enteral Feeding Formulas Osmolite n Perative n Pulmocare n Jevity n Nepro n Hepataid n Glucerna n

Enteral Access Nose-nasogastric (Levine, Dobhoff, Flexiflo) n Surgically placed- gastroscopy, jejunostomy n Endoscopically- Percutaneous endoscopic gastroscopy (PEG) n

Parenteral Nutrition Specialized nutrition support in which nutrients are provided intravenously n Requires nutritional assessment, placement of CV line, careful monitoring for complications n

Parenteral Nutrition Clients who are unable to digest or absorb enteral nutrition benefit from TPN (Total parenteral nutrition) n Clients highly stressed physiologically (burns, sepsis, head injury) also benefit n

Parenteral Nutrition Goal is to move back to GI route n Adding lipids provides supplemental kcals & provide essential fatty acids n 10% - 20% Dextrose can be given peripherally (PPN) n >20% Dextrose requires CV line or PICC line n

TPN Monitoring Daily Weight n BGM every 6 hours n Vitals & temp every shift n. I & O n Labs n Dedicated line for infusion n

Nursing Implications n n n n TPN intravenous line requires a filter Dedicated line for infusion IV tubing changed every 24 hours Requires IV pump administration Formulas prepared by pharmacist and doubled checked by RN Special physician order sheet 10% Dextrose solution used as substitute if TPN not available

TPN Complications Pneumothorax from CV line insertion n Infection of CV line n Air embolism n Lyte & mineral imbalances n Concentrated glucose administration n

Implementation Patient Education n n n Special diets may be necessary GI disorders-Ulcer disease, IBD, Crohns, Malabsorption Syndrome, Diverticulitis, Celiac disease Diabetes (ADA diets) CV Disease & CVA Pulmonary Disease Renal Disease Cancer HIV

Usual Diet Progression NPO n Clear Liquid n Full Liquid n Pureed n Mechanical soft n Soft n Regular n