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Stressors that affect Nutrition NUR101 FALL 2008 LECTURE # 24 K. BURGER, MSED, MSN, RN, CNE PPP By Sharon Niggemeier RN MSN Revised 12/08 J Borrero

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Text of Stressors that affect Nutrition NUR101 FALL 2008 LECTURE # 24 K. BURGER, MSED, MSN, RN, CNE PPP By...

  • Stressors that affect NutritionNUR101FALL 2008LECTURE # 24K. BURGER, MSED, MSN, RN, CNE

    PPP BySharon Niggemeier RN MSNRevised 12/08 J Borrero

  • NutritionNutrition is interaction between an organism and the food it consumesFood & eating is a basic need, affects healthVarious factors affect nutritionNutrients substances used by the body for growth & developmentRole of nurse to teach, guide and inform on the importance of proper nutrition

  • Nursing AssessmentDietary intake and food preparationUnpleasant symptomsAllergiesTaste, chewing and swallowingAppetite and weightUse of medications

  • Nutritional health-care TeamMD NurseSocial WorkerPhysical TherapistOccupational TherapistSpeech PathologistPharmacist

  • Essential Nutrients Regulatory NutrientsWaterCarbohydratesProteinsLipidsVitaminsMinerals

  • WaterWater: present in every cellAbsorbed in small /large intestineMetabolized carbohydrates, proteins, lipids produce waterDietary intake from fluids and solid food provide waterFunction: fluid medium needed for all chemical reactions in the body

  • CarbohydratesCarbohydrates: simple or complexDigested by enzymes (amylase/lactase)Absorbed in small intestineMetabolized into glucose which is used for energy or storedStored as either glycogen or fatFunction: provide energy, spare proteins

  • Carbohydrates (CHO)Carbon Hydrogen-Oxygen1 gram carbohydrate = 4 KcalMonosaccharides simple sugars glucose, fructose, galactoseDissaccharides double sugars sucrose, lactose, maltosePolysaccharides complex forms starch, glycogen, cellulose (fiber)Recommended intake: 60% of total Kcal (300g) Fiber 25-30g daily

  • CarbohydratesWhat are some other functions of carbohydrates in our bodies?Laxative effects of:Lactose CelluloseDIETARY FIBER - Helps regulate blood sugarMay reduce risk of hyperlipidemiaMay reduce risk of some cancers

  • ProteinProteins: composed of amino acids Digested by enzymes (proteolytic) Absorbed in small intestineMetabolism includes:Anabolism=Catabolism: Nitrogen balance Function: maintain body tissue and tissue growth

  • Protein (CHON)Carbon-Hydrogen-Oxygen- Nitrogen1 gram of protein = 4 KcalComprised of 22 amino acids which can be comined by body to form over 1000 types of proteins9 essential amino acids body cannot synthesize themComplete protein = one with all 9 essential amino acids (animal sources and soy)Incomplete proteins = contain some but not all essential (plant sources)Complementary proteins = 2 proteins that when combined provide all essential amino acids.Recommended intake: 10% total Kcal ( 0.8g per 2.2lbs)

  • Proteins (CHON)What are some other functions of proteins?Fluid BalanceEx: AlbuminEnergy ( last resort) De-amination / Nitrogen stripped from CHON to create glucose CHO

  • LipidsLipids: insoluble in waterDigested by enzymes (lipase,bile) in stomach and small intestineAbsorbed in small intestineMetabolism includes conversion (by liver and small intestine) into soluble compounds called lipoproteinsFunction: energy, insulates body, absorption (fat-soluble vitamins)

  • Lipids (Fats)Carbon-Hydrogen-Oxygen1 gram of Fat = 9 KcalComposed of fatty acids: (linoleic&linolenic =essential)Saturated fat = mostly animal sourceUnsaturated fat = mostly plant and fish sourcesTriglyceride = fat in bloodstream /storage form of fat in body. Trans Fat = hydrogenated fats in processed foodsRecommended intake: 20-35% of total Kcal

  • LipidsLipoproteins - made by the body to move water-insoluble lipids (such as cholesterol) thru the bloodstream LDL (low density lipoprotein)- major carrier of cholesterol. Function is to transport cholesterol from liver into circulation. Bad cholesterolHDL (High density lipoprotein) - carries cholesterol away from tissue to liver ..high levels decrease atherosclerosis. Good cholesterolCholesterol- not essential from diet as the body produces enough.

  • Desirable Blood Lipid LevelsTotal Cholesterol < 200Triglycerides< 150LDL< 100HDL> 40 Male > 50 FemaleElevated Blood Lipid Levels (Hyperlipidemia) = increased risk for CHD, Hypertension, Stroke, MI

  • VitaminsVitamins: required in small amountswater- soluble: absorbed through intestine directly into blood stream (C, B complex folic acid)fat-soluble: absorbed with lipids into lymphatic circulation (A,D,E,K)Function: needed for metabolism of carbohydrates, lipids & proteins

  • Water-soluble vitamins text reviewVitamin C (ascorbic acid)Function: collagen formation (wound healing), antioxidant, immune systemMore prone to deficiency; not stored Deficiency: bleeding gums, scurvy, poor wound healingSource: citrus fruits, tomatoes, broccoli

  • Vitamin B Complex : thiamine, riboflavin, niacin, B6, B12

    Function: metabolism of carbs, lipids and proteins RNA, DNA synthesis (folic acid) & heme formation (B12)Deficiency:beriberi, poor wound healing, anemia, pernicious anemia Sources: Whole grains Organ meats

  • Vitamin B12 (continued)Vitamin B12 (cobalamine)Important for hemoglobin synthesisVery little found in vegetable sources (unlike other B Vitamins)Pernicious anemia = B12 deficiency or lack of intrinsic factor for B12 absorption. Susceptible population = Total Vegan Clients w/ decreased gastric acid secretion (gastric bypass, stomach cancer)Rx = B12 injections

  • Folic AcidFolic Acid (Folate)

    Folic Acid Deficiency leads to elevated Homocysteine levels which are associated with increased risk for CHD.Folic Acid Deficiency linked to neural tube defects Spina BifidaNatural folate (in foods) only as available to body as supplement folic acid1998 = mandatory fortification of breads/grainsSupplements recommended for: women of child-bearing age, gastric surgery, malabsorption (alcholic)

  • Fat-soluble Vitamins text reviewVitamin A: function- visual acuity, skin maintenancedeficiency-night blindness Dark green leafy vegs, yellow/orange vegsVitamin D: function-calcium absorption deficiency-rickets, bone malformation Fortified milk, ultraviolet lightVitamin E: function-antioxidant, heme synthesisdeficiency-RBC hemolysisWhole grains, nutsVitamin K: function-formation blood clotting proteinsdeficiency- hemorrhageDark green leafy vegs, synthesized by bacteria in sm intestineMore prone to toxicity; stored by body

  • MineralsMinerals: macrominerals or micromineralsOriginate in earths crust, arent digested or metabolized. Combine to form salts or organic compounds. Always retain their chemical properties.Function: provide structure within the body (bones/teeth, F/E and acid /base balance, nerve transmission, muscle contraction)

  • Macrominerals text reviewCalcium: bone/ teeth formation, blood clotting, nerve transmissiondeficiency-tetany, osteoporosisPhosphorous: bones, acid-base balancedeficiency- muscle weaknessMagnesium: bones, metabolism ...deficiency-muscle pain, poor cardiac functionPotassium: f/e balance, acid-base balance deficiency-muscle cramps , irregular ht. rate

  • Microminerals text reviewIron: hemoglobin formationdeficiency-anemiaIodine: thyroid hormonesdeficiency- goiterZinc: wound healing deficiency-impaired immune systemFluoride: teeth/bonesdeficiency- discolored tooth enamel

  • Energy BalanceKilocalorie- unit of heat; measures the energy in the dietBasal metabolic rate (BMR)- amount of energy needed for all the biochemical processes to occur when the body is at rest.Proper nutrition provides the energy needed to maintain health

  • Body Weight StandardsIdeal body weight IBW = balance of energy used by the body and intake of nutrientsRule of thumb Women: 100 lbs lst 5ft 5 lbs/inch over 5ft Men: 106 lbs lst 5 ft 6 lbs/inch over 5ftStandardized charts Overweight = 10% > chart Obese = 20% > chartBody mass index(BMI) 18.5 24.9 healthy > 25 = overweight > 30 = obese > 40 = morbidly obese

  • Calculate your BMI

    Weight (lbs)Height (inches) squaredX 705

  • Factors Affecting NutritionDevelopmentalGenderEthnicity & cultureFood beliefsPreferenceReligion

  • Factors Affecting NutritionLifestyleMedications & therapyHeath statusAdvertisingAlcohol ConsumptionPsychological factors

  • Adequate NutritionFood Guide PyramidDaily reference intake Food LabelingDietary guidelines

  • Dietary GuidelinesBalance / Moderation / VarietyMaintain healthy weightExerciseEat a variety of foods in moderationLow sodium / Low fat / Low simple sugarsAlcohol in moderation

  • Assessing: NutritionNursing history Physical exam24-hr. recallFood recordsAnthropometic dataLab tests Albumin & Prealbumin Hemoglobin Transferrin

  • Nursing DxImbalanced nutrition: less than body requirements R/T NPO status AEB height 56 wt 105 lbs., pt. states Ive never been this skinny before, my clothes are hanging off of meImpaired dentition R/T nutritional deficits AEB dentures not fitting properly

  • Planning- outcome criteriaPt. will:Attain and maintain ideal body weightEat a variety of foods at each mealPromote healthy nutritional practices

  • Interventions

    Monitoring food intakeAssist with feedingStimulate appetiteTeaching

  • Diet RestrictionsNPOClear liquids-see through (broth, apple juice)Full liquids foods that turn to liquid at room temp. (shakes, milk)Soft easily chewed and digestedLow residue- no seeds, raw vegetables or fruits, whole grainsHigh fiber- raw fruits, grains, vegetablesSodium restricted:Mild 2 gram Na

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