Maricris Q. Marquita-Uy R.N,M.

D
Overview
 Nutrition
 Nutrients
 Nutritive value
 Caloric value
 Small calorie
 Large calorie
 Metabolism
 BMR
 Factors Affecting Caloric Needs
 Age and Growth
 Gender
 Climate
 Sleep
 Activity
 Fever
 Illness
 ESSENTIAL NUTRIENTS

A. Macronutrients
 Carbohydrates
 Fats
 Proteins
B. Micronutrients
 Vitamins
 Minerals
Carbohydrates

 Two basic kinds:

Types of Carbohydrates

Sugars
 Monosaccharides

 Disaccharides

Starches
 Polysaccharides

Fiber
 Complex carbohydrate
Digestion of Carbohydrates

 Desired end products are monosaccharides

 Major enzymes : ptyalin, pancreatic amylase,
maltase, sucrase, lactase
 All digested carbohydrates are absorbed in
the small intestine
 Glucose transport through the cell membrane
is augmented by insulin
Carbohydrate Metabolism
 Major source of body energy
Storage and Conversion
 Stored either as glycogen or as fat

 Glycogenesis

 Glycogenolysis

 Gluconeogenesis

Energy Production (ATP)

 Glycolysis

 Citric Acid Cycle (Krebs cycle)

Proteins

 Essential AA
 Nonessential AA
 Complete proteins
 Incomplete proteins
Proteins
Digestion
 Enzyme: pepsin (mouth)

 Mostly are digested in the SI

 Proteolytic enzymes by the pancreas

Storage
 AA are absorbed by active transport

 Liver uses some AA to synthesize specific proteins

 Stored as “body tissue”

Protein Metabolism

 Anabolism
 Catabolism
 Balance
Nitrogen Balance
Positive Nitrogen Balance

 During periods of Growth

1. Childhood and adolescence
2. Pregnancy
3. Phases of physical exercise
 During periods of tissue replacement
1. Convalescence
2. After fasting
Nitrogen Balance
Negative Nitrogen Balance

 Does not consume adequate essential amino

acids and calories
 Immobilized
 Exposed to unusual stress as a result of
trauma
Lipids
 Fatty acids
1. Saturated
2. Unsaturated
3. Monounsaturated
4. Polyunsaturated
Lipids
 Classification based on chemical
structure
1. Simple lipids - Triglycerides & Glycerides
2. Compound lipids – combination of triglycerids
with other components
 Cholesterol
Lipid Digestion

 Digested mainly in the SI, primarily by bile,

pancreatic lipase and enteric lipase
 End products: glycerol, fatty acids,
cholesterol
 Lipoproteins
1. HDL
2. LDL
3. VLDL
Lipid Transport and Storage

 Absorbed into the portal blood system and

carried to the liver
 Stored in two major tissues
1. Adipose tissue
2. Liver
Micronutrients

 Vitamins
1. Fat-soluble
2. Water-soluble

 Minerals
1. Macrominerals
2. Microminerals
Digestive System
STANDARDS FOR A HEALTHY
DIET
 Dietary Guidelines for Americans
 The Food Guide Pyramid
 Canada’s Food Guide to Healthy Eating
 RDA
 VEGETARIAN DIETS

 Vegans
 Lacto-ovo-vegetarians
 Ovo-vegetarians
 Pesco-vegetarians
 Partial vegetarians
 Fruitarians
 Macrobiotic vegetarians
 DIETARY MODIFICATIONS FOR
OLDER ADULTS
 Include at least the minimal number of servings from
each group on the Food Guide Pyramid
 Reduce caloric intake
 Reduce fat consumption
 Reduce consumption of empty calories
 Reduce sodium consumption
 Ensure adequate calcium intake
 Ensure adequate vitamin D intake
 Ensure adequate iron intake
 Consume fiber-rich foods to prevent constipation
and minimize use of laxatives
 FACTORS INFLUENCING DIET
 Ethnicity and Culture  Beliefs about health
 Age effects of food
 Religion  Alcohol abuse
 Economic status  Advertising
 Peer groups  Psychologic factors
 Personal preferences  Health status
and uniqueness  Therapy
 Life-Style  Medications
 ASSESSING NUTRITIONAL STATUS

 ABCD Approach
A : Collect Anthropometric measurements
B : Look at Biochemical data
C : Examine the client for the Clinical signs of
nutritional status
D : Obtain a Dietary history
Anthropometric Measurements

Direct measurement
 Skinfold measurements :
triceps, subscapular, biceps and suprailiac

 Mid-upper arm circumference (MAC)

Anthropometric Measurements

Calculated measurements
 Mid-upper arm muscle circumference

(MAMC)
 BMI

= weight in kilograms
(height in meters)²
Biochemical Data

 Hemoglobin and Hematocrit Indices

 Serum Albumin
 Transferrin
 Total Lymphocyte Count
 Nitrogen Balance
 Creatinine Excretion
Clinical Signs of Nutritional Status

 Body part or System

 Normal Signs
 Abnormal Signs
Dietary History
 Usual eating patterns and habits
 Food preferences and restrictions
 Daily fluid intake
 Use of vitamins or mineral supplements
 Any dietary problems
 Physical activity
 Health history
 Concerns related to food buying and
preparation
Identifying Clients at Risk for Nutritional
Problems
Diet History
 Chewing or swallowing  Inadequate food budget
difficulties  Inadequate food
 Inadequate food intake preparations facilities
 Restricted or fad diets  Inadequate food
 No intake for 10 or storage facilities
more days  Physical disabilities
 IV fluids  Elderly living and eating
alone
Identifying Clients at Risk for Nutritional
Problems
Medical History
 Weight 20% greater than ideal
 Weight 10% less than ideal
 Unintentional weight loss or
gain of 10% within 6 months
 Recent major illness
 Recent major surgery
 Surgery of the GI tract
 Anorexia
 Nausea
 Vomiting
 Diarrhea
 Alcoholism
 Cancer
 Liver disease
 Kidney disease
 Diabetes
 Thyroid or parathyroid problem
 Adrenal disease
 Mental disability
 Teenage pregnancy
 Multiple pregnancies
 Pancreatic insufficiency
 Radiation therapy
Identifying Clients at Risk for Nutritional
Problems
Medication History
 Aspirin  Antineoplastic agents
 Antacid  Digitalis
 Antidepressants  Laxatives
 Antihypertensives  Diuretics
 Anti-inflammatory  Potassium chloride
agents
 DIAGNOSING
 Altered nutrition : less than body
requirements
 Altered nutrition : more than body
requirements
 High risk for altered nutrition : more than
body requirements
 Altered health maintenance
(behavior modification and change in life-
style)
 DIAGNOSING

Used as Etiology of other diagnoses:

 Activity intolerance

 Constipation

 Diarrhea

 Self-esteem disturbance

 High risk for impaired skin integrity

PLANNING
 Maintaining, improving or restoring nutritional
status
 Preventing nutritional problems
 Nurse writes specific outcome criteria that will
indicate resolution of the particular problem
identified
 Nurse and client choose interventions that
are most likely to achieve outcomes, given
the etiology of the client’s problem
 IMPLEMENTING

Counseling About Nutrition

 Nurse must help clients integrate diet

changes into their life-styles and provide

strategies to motivate them to change their
eating habits
 Nurse’s major role is to support and

encourage the client

 IMPLEMENTING
Teaching About Special Diets
 Special or therapeutic diets

 Progressive hospital diets

 Regular diet

 Light diet

 Soft diet

 Pureed diet

 Full liquid diet

 Clear liquid diet

 IMPLEMENTING
Stimulating The Appetite
Requires the nurse to determine the reason for the
lack of appetite and then deal with the problem
 Relieve illness symptoms that depress appetite prior to
mealtime
 Provide familiar food that the person likes
 Select small portions so as not to discourage the
anorexic client
 Avoid uncomfortable treatments immediately before or
after meals
 Provide a tidy, clean environment that is free of
unpleasant sights and odors
 Encourage or provide oral hygiene before mealtime
 Reduce psychological stress
 IMPLEMENTING
Assisting Clients with Meals
 Check the client’s chart or Kardex for the diet
 If there is a change in the type of food the client is to receive, notify the
dietary staff
 Assist the client to the bathroom or onto a bedpan if the client needs to
urinate
 Offer assistance with handwashing and oral hygiene
 Assist the client in a comfortable position in bed
 Clear the overbed table so that there is space for the tray
 Check each tray for client’s name, type of diet and completeness
 Assist the client as required during the meal
 After the client has completed the meal, replace the food covers and
note how much and what the client has eaten and the amount of fluid
taken
 If the client is not eating, notify the nurse in charge so that other
nursing measures can be taken
 IMPLEMENTING

Alternative Feeding Methods

 Enteral
1. Nasogastric/nasointestinal feedings

2. Gastrostomy/jejunostomy feedings

3. Percutaneous endoscopic gastrostomy

 Parenteral
 EVALUATING
 Taking anthropometric measurements
 Observing the client for changes in signs of
malnutrition
 Questioning the client about dietary
alterations required
 Reviewing and discussing a dietary log or
plan of a balanced meal
 Weighing the client
 Checking laboratory data for desired changes