- Carbohydrates, Proteins and Fats
- Energy for the body
- Vitamins, Minerals and Water
- Does not provide energy for the body
Which class of nutrient supplies the most dense source of energy in our diet?
How many calories in 1lb of fat?
How many calories per day would need to be cut to lose 1lb/week?
How many calories per gram of protein?
How many calories per gram of carbohydrate?
How many calories per gram of fat?
How many calories per gram of alcohol?
How do proteins contribute to bodily functions?
Essential component of tissue health (growth and repair)
What are good sources of lean essential amino acids?
- Egg whites
- Lean chicken
- Dried peas and beans
Complete vs. Imcomplete Protein Sources
- Complete: foods that supply all the essential amino acids in adequate amounts (meat, fish, poultry, eggs, milk, cheese, soy)
- Incomplete: foods that supply most but not all essential amino acids (palnts, including legumes, grains and nuts)
What percentage of our diet should be from protein?
10-20% of total daily calories
When would protein requirements increase?
- Times of stress
- Critical Illness
- Wound Healing
The balance between nitrogen intake (protein intake) and nitrogen loss (excretion from urine, urea, feces, hair, nails and skin)
Positive Nitrogen Balance: When nitrogen intake is greater than excretion (something we WANT to happen during preganancy, periods of growth, lactation and recovery from illness).
Negative Nitrogen Balance: When more nitrogen is being excreted than ingested (UNDESIREABLE state in situations such as starvation, illness, trauma or stress).
Nitrogen Balance: When there is a balance between intake and breakdown of proteins (healthy adults).
The school nurse is teaching a high school class about complete and incomplete proteins. What is the best explaination of a complete protein?
D. it contains all of the essential amino acids.
A nurse has been teaching a patient about complimentary proteins. Which of the following statements by the client indicates that the teaching has been effective?
C. "I need to combine specific incomplete proteins each day so that over the course of the day I have adequate protein intake."
Which of the following individuals is likely to have a negative nitrogen balance?
B. an elderly client with an open leg ulcer that is not healing.
- Usually solid at room temperature
- Found primarily in animal foods and palm & coconut oils
- Most correlated to coronary artery disease and build up and plaque in arteries
- Along with trans-fat, raise LDL levels
- Usually liquid at room temperature
- Found in certain vegetables, nuts and vegetable oils
- Lower levels of LDL
- Usually liquid at room temperature
- Found in certain vegetables, nuts, vegetable oils and in fatty fish
- Not a fat, but a steriod
- Travels through the blood attached to fatty acids
- Synthesized/manufactured in the liver
- No cholesterol in non-animal products. Only comes from animal products
What food sources provide cholesterol?
Organ meat (specifically liver)
Why do we need to limit cholesterol?
Although saturated fat is a larger contributor, high cholesterol does contribute to coronary artery diease
Low-density lipoprotein - bad cholesterol
High-density lipoprotein - good cholesterol
What is the recommended daily intake of fat and cholesterol?
- No more than 20-35% of total daily calories
- Less than 300mg of cholesterol per day
- **Pts with hx or family hx of hyperlipidemia or LDL higher than 130 limited to 7% or 200mg**
What is the recommended daily intake of carbohydrates?
45-65% of total daily calories 1/2 of which should be whole grain
Fat Soluble Vitamins
- A - vision
- D - absorption of calcium & phosphorus
- E - cell reptoduction; source is vegetable oil
- K - clotting
More likely to cause toxicity when consumed too much
Water Soluble Vitamins
- B complex - thiamin B1 (energy & nerve metabolism; source - pork, enriched grains & legumes) Folate (RBC synthesis; source - green leafy vegetables) Cobalamin B12 (role in nerve repair and folate metabolism but needs intrinsic factor for absorption; food of animal origin)
Less likely to be toxic, excess is filtered in the kidneys and eliminated in the urine.
How should the nurse respond to the patient who already limits trans and saturated fats and now wants to reduce cholesterol in the diet?
D. "limit the portion of foods from animal sources."
Vitamins commonly lacking in the American diet
Minerals commonly lacking in the American diet
- Iron - low intake can cause anemia
- Calcium - low intake linked to osteoporosis
- Zinc - deficiency linked to poor wound healing
A patient is taking a daily iron suppliment. Which of the following should be taken with the pill to increase absorption of iron?
C. Orange juice
The human body is composed of about 60% water - as age and/or fat increases the amount of % of water decreases.
What should sodium intake be limited to?
- NPO - Nothing by mouth.
- Clear Liquid - anything you can see through (GI patient, post-op patient).
- Full Liquid - Milk, cream soups, ice cream, yogurt, etc..
- Soft and Mechanical - Sores in mouth or cannot chew.
- Pureed - Stroke patient, dysphagia (difficulty swallowing).
- 2 gm Sodium - Reduced NaCl; kidney patient, hypertension.
- Cardiac - Low fat, low cholesterol.
Basal Metabolic Rate: Amount of calories used at rest.
- Body Mass Index
- Normal btwn 18.5 and 24.9; obesity more than 30
- Does not take muscle mass into account.
- BMR = Healthy weight x 10 (women) Healthy weight x 11 (men)
Clinical observations for Nutrional Assessment
- General appearance, behavior and energy level
- External structures - skin, hair, nails, teeth, muscle tone and tongue.
- Height/weight and body shape.
Short Term Biological Studies for Nutritional Assessment
H & H - can be associated with anemia
Long Term Biological Studies for Nutritional Assessment
- Serum Albumin: plasma protein in the liver; indicates liver problem or protein deficiency (long 1/2 life).
- Pre-albumin: better for acute changes in nutrional status
- Transferrin: Indicates iron deficiency or overload.
- Total Cholesterol: should be less than 200mg - HDL less than 40mg and LD less than 130mg
What is antropometric data?
- Waist Circumference
- Skin fold measurements
- Calorie need
- General Appearance
Which assessment data for an elderly patient is most helpful?
A. 24hr Diet Recall`
Risk factors for poor nutrition
- Chronic alcoholism or chronic illness.
- Medications - antibiotics, steroids, polypharmacy
- Difficulty swallowing, malabsorption, diarrhea
- No oral intake or receiving IVPs 5 days
- Extreme need for nutrients (fever, burns, chemo, infection)
- Decreased mobility or access to foods
- Nutrient loss from wounds, dialysis
- Depression or mental illness
What medications increase appetite?
What medications decrease appetite?
What medications can alter taste?
Nursing Process in Nutrition
- Diagnosis: nutrition altered; less than body requirements related to loss of appetite.
- Short term goal: patient will gain one pound by the end of the week.
- Intervention: Provide nutritional suppliments (Ensure) with each meal
- Evaluation: patient drank 200cc Ensure for breakfast and 150cc at lunch
- Evaluate Goals