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Chapter 43

Nutrition

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Elements of Energy and Nutrition

• Basal metabolic rate (BMR)

• Resting energy expenditure (REE)

• Nutrient density

• Nutrients: carbohydrates, proteins, fats, water, vitamins, minerals

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Carbohydrates

• Produce 4 kcal/g

• Main source of energy

• Saccharides: simple and complex carbohydrates, fiber

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Proteins

• Produce 4 kcal/g• Essential for growth, maintenance,

and repair of body tissue• Amino acids: essential and

nonessential• Complete and complementary

proteins• Nitrogen balance

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Fats (Lipids)

• Produce 9 kcal/g

• Triglycerides and fatty acids

• Saturated or unsaturated: monounsaturated or polyunsaturated fatty acids

• Essential or nonessential fatty acids

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Water

• Comprises 60% to 70% of body weight

• Cell function depends on a fluid environment

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Vitamins

• Essential to normal metabolism

• Fat-soluble: A, D, E, K

• Water-soluble: C and B complex

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Minerals

• Inorganic elements essential as catalysts in biochemical reactions

• Macrominerals

• Microminerals or trace elements

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Digestive System

• Anatomy and physiology– Digestion– Absorption– Metabolism and storage of nutrients– Elimination

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Dietary Guidelines

• Dietary referenced intakes (DRIs)

• Food guidelines: food guide pyramid

• Daily values

• Healthy People 2010

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Nutritional Needs throughout Growth and Development

• Infants through school-age– Breast-feeding– Formulas– Solid foods– Food habits

• Adolescents– Eating disorders– Activities

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Nutritional Needs throughout Growth and Development (cont'd)

• Young and middle adults– Pregnancy– Lactation

• Older adults

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Alternative Food Patterns

• Cultural and religious practices

• Vegetarian diets

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Assessment: Diet History

• Dietary intake and pattern• Symptoms• Allergies• Taste• Chewing and swallowing• Appetite• Elimination• Medications

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Assessment

• Anthropometry

• Body mass index (BMI)

• Ideal body weight (IBW)

• Laboratory tests

• Clinical observations

• Client expectations

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Nursing Diagnoses

• Risk for aspiration

• Constipation

• Diarrhea

• Imbalanced nutrition: less than/more than body requirements

• Feeding self-care deficit

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Planning

• Goals and outcomes– Client’s daily nutritional intake meets the

minimum DRIs– Client loses ½ pound per week

• Setting priorities

• Continuity of care

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Implementation: Health Promotion

• Client education

• Meal planning

• Food storage and preparation safety

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Implementation: Acute Care

• Advancing diets

• Promoting appetite

• Assisting clients with feeding

• Enteral feeding

• Parenteral nutrition

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Enteral Feeding

• Nasogastric, jejunal, gastric tubes

• Insertion and verification of placement

• Types and preparation of formulas

• Complications

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Parenteral Nutrition

• Initiation and management of insertion site

• Types of solutions

• Rate of infusion

• Prevention of complications

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Implementation: Restorative Care

• Medical nutrition therapy for specific illnesses, conditions, or injuries– GI diseases– Diabetes– Cardiovascular diseases– Cancer– HIV

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Evaluation

• Client care

• Client expectations