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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

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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Page 1: 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

Stressors that affect Nutrition

NUR101FALL 2008LECTURE # 24K. BURGER, MSED, MSN, RN, CNE

PPP BySharon Niggemeier RN MSNRevised 12/08 J Borrero

Page 2: 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

Nutrition• Nutrition is interaction between an

organism and the food it consumes• Food & eating is a basic need, affects

health• Various factors affect nutrition• Nutrients – substances used by the

body for growth & development• Role of nurse to teach, guide and

inform on the importance of proper nutrition

Page 3: 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

Nursing Assessment

• Dietary intake and food preparation

• Unpleasant symptoms

• Allergies

• Taste, chewing and swallowing

• Appetite and weight

• Use of medications

Page 4: 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

Nutritional health-care Team

• MD

• Nurse

• Social Worker

• Physical Therapist

• Occupational Therapist

• Speech Pathologist

• Pharmacist

Page 5: 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

Essential Nutrients Regulatory Nutrients

• Water

• Carbohydrates

• Proteins

• Lipids

• Vitamins

• Minerals

Page 6: 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

Water

• Water: present in every cell

• Absorbed in small /large intestine

• Metabolized carbohydrates, proteins, lipids produce water

• Dietary intake from fluids and solid food provide water

• Function: fluid medium needed for all chemical reactions in the body

Page 7: 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

Carbohydrates• Carbohydrates: simple or complex

• Digested by enzymes (amylase/lactase)

• Absorbed in small intestine

• Metabolized into glucose which is used for energy or stored…Stored as either glycogen or fat

• Function: provide energy, spare proteins

Page 8: 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

Carbohydrates (CHO)• Carbon – Hydrogen-Oxygen• 1 gram carbohydrate = 4 Kcal• Monosaccharides – simple sugars

glucose, fructose, galactose• Dissaccharides – double sugars

sucrose, lactose, maltose• Polysaccharides – complex forms

starch, glycogen, cellulose (fiber)• Recommended intake: 60% of total Kcal (300g)

Fiber 25-30g daily

Page 9: 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

Carbohydrates

• What are some other functions of carbohydrates in our bodies?

Laxative effects of:

LactoseCellulose

DIETARY FIBER - Helps regulate blood sugar

May reduce risk of hyperlipidemia

May reduce risk of some cancers

Page 10: 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

Protein• Proteins: composed of amino acids

• Digested by enzymes (proteolytic)

• Absorbed in small intestine

• Metabolism includes:

• Anabolism=Catabolism: Nitrogen balance

• Function: maintain body tissue and tissue growth

Page 11: 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

Protein (CHON)• Carbon-Hydrogen-Oxygen- Nitrogen• 1 gram of protein = 4 Kcal• Comprised of 22 amino acids which can be comined by

body to form over 1000 types of proteins• 9 essential amino acids – body cannot synthesize them• Complete 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)

Page 12: 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

Proteins (CHON)

• What are some other functions of proteins?

Fluid Balance

Ex: Albumin

Energy ( last resort)De-amination / Nitrogen stripped from CHON to create glucose CHO

Page 13: 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

Lipids• Lipids: insoluble in water• Digested by enzymes (lipase,bile) in

stomach and small intestine• Absorbed in small intestine• Metabolism includes conversion (by

liver and small intestine) into soluble compounds called lipoproteins

• Function: energy, insulates body, absorption (fat-soluble vitamins)

Page 14: 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

Lipids (Fats)• Carbon-Hydrogen-Oxygen• 1 gram of Fat = 9 Kcal• Composed of fatty acids: (linoleic&linolenic =essential)

• Saturated fat = mostly animal source• Unsaturated fat = mostly plant and fish sources• Triglyceride = fat in bloodstream /storage form of fat

in body. • Trans Fat = hydrogenated fats in processed foods• Recommended intake: 20-35% of total Kcal

Page 15: 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

Lipids• Lipoproteins - 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 cholesterol”

• HDL (High density lipoprotein) - carries cholesterol away from tissue to liver ..high levels decrease atherosclerosis. “Good cholesterol”

• Cholesterol- not essential from diet as the body produces enough.

Page 16: 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

Desirable Blood Lipid Levels

• Total Cholesterol < 200• Triglycerides < 150• LDL < 100• HDL > 40 Male

> 50 Female• Elevated Blood Lipid Levels

(Hyperlipidemia) = increased risk for CHD, Hypertension, Stroke, MI

Page 17: 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

Vitamins• Vitamins: required in small amounts

• water- 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

Page 18: 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

Water-soluble vitamins text review

Vitamin C (ascorbic acid)

• Function: collagen formation (wound

healing), antioxidant, immune system

• More prone to deficiency; not stored

• Deficiency: bleeding gums, scurvy, poor wound healing

• Source: citrus fruits, tomatoes, broccoli

Page 19: 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

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

Page 20: 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

Vitamin B12 (continued)

Vitamin B12 (cobalamine)• Important for hemoglobin synthesis• Very little found in vegetable sources (unlike other B Vitamins)

• Pernicious anemia = B12 deficiency or lack of intrinsic factor for B12 absorption.Susceptible population = Total VeganClients w/ decreased gastric acid secretion(gastric bypass, stomach cancer)

• Rx = B12 injections

Page 21: 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

Folic Acid

Folic 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 Bifida

• Natural folate (in foods) only ½ as available to body as supplement folic acid

• 1998 = mandatory fortification of breads/grains• Supplements recommended for: women of child-bearing

age, gastric surgery, malabsorption (alcholic)

Page 22: 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

Fat-soluble Vitamins text review• Vitamin A: function- visual acuity, skin maintenance…

deficiency-night blindnessDark green leafy vegs, yellow/orange vegs

• Vitamin D: function-calcium absorption… deficiency-rickets, bone malformationFortified milk, ultraviolet light

• Vitamin E: function-antioxidant, heme synthesis…deficiency-RBC hemolysisWhole grains, nuts

• Vitamin K: function-formation blood clotting proteins…deficiency- hemorrhageDark green leafy vegs, synthesized by bacteria in sm intestine

• More prone to toxicity; stored by body

Page 23: 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

Minerals• Minerals: macrominerals or microminerals

• Originate in earth’s crust, aren’t 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)

Page 24: 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

Macrominerals text review

• Calcium: bone/ teeth formation, blood clotting, nerve transmission…deficiency-tetany, osteoporosis

• Phosphorous: bones, acid-base balance…deficiency- muscle weakness

• Magnesium: bones, metabolism ...deficiency-muscle pain, poor cardiac function

• Potassium: f/e balance, acid-base balance…

deficiency-muscle cramps , irregular ht. rate

Page 25: 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

Microminerals text review

• Iron: hemoglobin formation…deficiency-anemia

• Iodine: thyroid hormones…deficiency- goiter

• Zinc: wound healing … deficiency-impaired immune system

• Fluoride: teeth/bones…deficiency- discolored tooth enamel

Page 26: 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

Energy Balance• Kilocalorie- unit of heat; measures the

energy in the diet• Basal 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

Page 27: 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

Body Weight Standards• Ideal body

weight IBW = balance of energy used by the body and intake of nutrients

• Rule of thumbWomen: 100 lbs lst 5ft

5 lbs/inch over 5ftMen: 106 lbs lst 5 ft 6 lbs/inch over 5ft

• Standardized chartsOverweight = 10% > chartObese = 20% > chart

• Body mass index(BMI) 18.5 – 24.9 healthy> 25 = overweight> 30 = obese> 40 = morbidly obese

Page 28: 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

Calculate your BMI

Weight (lbs)

Height (inches) squared

X 705

Page 29: 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

Factors Affecting Nutrition• Developmental• Gender• Ethnicity &

culture• Food beliefs• Preference• Religion

Page 30: 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

Factors Affecting Nutrition• Lifestyle• Medications &

therapy• Heath status• Advertising• Alcohol

Consumption• Psychological

factors

Page 31: 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

Adequate Nutrition• Food Guide

Pyramid

• Daily reference intake

• Food Labeling

• Dietary guidelines

Page 32: 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
Page 33: 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

Dietary Guidelines

• Balance / Moderation / Variety

• Maintain healthy weight

• Exercise

• Eat a variety of foods in moderation

• Low sodium / Low fat / Low simple sugars

• Alcohol in moderation

Page 34: 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

Assessing: Nutrition• Nursing history • Physical exam• 24-hr. recall• Food records• Anthropometic data• Lab tests – Albumin & Prealbumin

Hemoglobin Transferrin

Page 35: 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

Nursing Dx• Imbalanced nutrition: less than body

requirements R/T NPO status AEB height 5’6’’ wt 105 lbs., pt. states “ I’ve never been this skinny before, my clothes are hanging off of me”

• Impaired dentition R/T nutritional deficits AEB dentures not fitting properly

Page 36: 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

Planning- outcome criteria• Pt. will:

• Attain and maintain ideal body weight

• Eat a variety of foods at each meal

• Promote healthy nutritional practices

Page 37: 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

Interventions

• Monitoring food intake

• Assist with feeding

• Stimulate appetite• Teaching

Page 38: 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

Diet Restrictions• NPO• Clear liquids-see

through (broth, apple juice)

• Full liquids –foods that turn to liquid at room temp. (shakes, milk)

• Soft –easily chewed and digested

• Low residue- no seeds, raw vegetables or fruits, whole grains

• High fiber- raw fruits, grains, vegetables

• Sodium restricted:– Mild 2 gram Na/day– Moderate 1gram– Strict 500mg– Severe 250 mg– DASH Dietary Approaches

to Stop Hypertension

Page 39: 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

Diet Restrictions

• Calorie restrictions

• Diabetic diet

• Cholesterol

• Food textures:Thick it

• Thin

• Nectar-like

• Honey-like

• Spoon-thick

Page 40: 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

Enteral Nutrition

• Used when oral intake is inadequate, swallowing difficulty, coma

• Tube passed into gastrointestinal tract to deliver nutrients

• Maintains GI integrity preferred over parental feedings (via veins)

Page 41: 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

Enteral Nutrition

• Short term use

• Nasogastric

• Nasointestinal

• Long term use

• Gastrostomy• Percutaneous

endoscopic gastrostromy (PEG)

Page 42: 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

Enteral Formulas

• Many types of formulas

• Administered continuous or intermittent

• Use pumps to monitor intake

• Monitor Intake & Output

Page 43: 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

Enteral Precautions

• Prevent aspiration– Position fowlers/high fowlers

– Assess placement…check pH

– Note residual

– Auscultate bowel sounds

Page 44: 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

Enteral Precautions

• Preventing complications include:

• Clogged tube• Nasal erosion• Diarrhea• Infection• Dislodgement

Page 45: 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

Parental Nutrition

• Bypasses GI tract, nutrition administered IV, more complicated

• Total parental nutrition (TPN) also called (hyperalimentation)…central line

• Partial parental nutrition (PPN)..PICC line

Page 46: 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

Evaluation

• Use established outcomes to evaluate the pt’s response to care

• Pt understanding of therapeutic diet

• Reassess S&S associated with altered nutrition (wt, intake, lab results)

• Determine pt’s satisfaction with nutritional therapy

Page 47: 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

Summary• Nurses role, to understand nutrients and

how they affect nutrition• Various factors affect one’s nutritional

status• Interventions include numerous diets,

assisting with feeding, monitoring and teaching

• Nutrition can also be administered enterally or parentally