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Chapter 44
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Nutrition
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Elements of Energy and Nutrition
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Basal metabolic rate (BMR)Resting energy expenditure (REE)Nutrient densityNutrients: carbohydrates, proteins, fats,
water, vitamins, minerals
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Carbohydrates
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Produce 4 kcal/gMain source of energySaccharides: simple and complex
carbohydrates, fiber
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Proteins
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Produce 4 kcal/gEssential for growth, maintenance, and
repair of body tissueAmino acids: essential and nonessentialComplete and complementary proteinsNitrogen balance
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Fats (Lipids)
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Produce 9 kcal/gTriglycerides and fatty acidsSaturated or unsaturated:
monounsaturated or polyunsaturated fatty acids
Essential or nonessential fatty acids
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Water
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Comprises 60% to 70% of body weightCell function depends on a fluid
environment
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Vitamins
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Essential to normal metabolismFat-soluble: A, D, E, KWater-soluble: C and B complex
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Minerals
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Inorganic elements essential as catalysts in biochemical reactions
MacromineralsMicrominerals or trace elements
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Digestive System
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Anatomy and physiologyDigestionAbsorptionMetabolism and storage of nutrientsElimination
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Dietary Guidelines
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Dietary referenced intakes (DRI’s)Recommended range of intakeFood guidelines: food guide pyramidDaily valuesHealthy People 2010 focus areaSpecific diets: diabetic, gluten-free,
culturally specific
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Nutritional Needs throughout Growth and Development
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Infants through school-ageBreast-feedingFormulasSolid foodsFood habits
AdolescentsEating disordersActivities
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Nutritional Needs throughout Growth and Development (cont'd)
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Young and middle adultsPregnancyLactation
Older adultsLess efficient systems
Constipation, decreased absorption of nutrientsAltered [diminished] sense of tasteChewing/swallowing problems
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Alternative Food Patterns
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Cultural and religious practicesVegetarian diets
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Assessment: Diet History
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Dietary intake and patternSymptomsAllergiesTasteChewing and swallowingAppetiteEliminationMedications
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Assessment
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Anthropometry [Ht, Wt, measurement, BSA]
Body mass index (BMI)Ideal body weight (IBW)Laboratory testsClinical observationsClient expectations
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Nursing Diagnoses
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Risk for aspirationAlteration in fluid/electrolyte balanceImbalanced nutrition: less than/more
than body requirementsSelf-care deficit: Feeding Knowledge deficit
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Planning
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Goals and outcomesClient’s daily nutritional intake will meet
his needs AEB…Client will lose ½ pound per week until…Pt will choose foods that meet his
nutritional needs /fit within dietary guidelines
Education/ pt teachingContinuity of care – written plan
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Implementation: Health Promotion
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Client educationMeal planningFood storage and preparation safety
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Implementation: Acute Care
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Advancing dietsPromoting appetiteAssisting clients with feedingEnteral feeding
Can’t ingest, can digest/eliminateParenteral nutrition
Can’t ingest/digest/eliminate [any or all]
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Enteral Feeding
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Nasogastric, jejunal, gastric tubesInsertion and verification of placement
X-ray best; 2 other methods if no X-rayTypes and preparation of formulas
Complete or elemental, cal/ml orderedComplications
Aspiration, occlusion, imbalances
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Parenteral Nutrition
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Initiation and management of insertion site [surgical asepsis]PIV, PICC
Types of solutionsDextrose, TPN, Lipids
Rate of infusion – use pumpPrevention of complications
Emboli, sepsis, occlusion
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Implementation: Restorative Care
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Medical nutrition therapy for specific illnesses, conditions, or injuriesGI diseases [avoid irritants, eat often]Diabetes [carbs, limit fat, individualize]Cardiovascular diseases [limit salt, fat]Cancer [hi nutrient, flavor, digestibility]HIV [max nutrition, calories]
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Evaluation
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Short term: did pt. choose foods…...eat breakfast… go to DR
Long term: did pt. gain/lose wt?Revise goals as neededTeach pt/caregiver & involve to promote
independence and healthPass info to next setting [LTC]
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Questions?
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