Ch.45, P&P: Nutrition

Ch.45, P&P: Nutrition

1. Biochemical Units

   • Basal Metabolic Rate (BMR)
     • Energy needed at rest to maintain life-sustaining activities for a specific amount of time -(breathing, circulation, HR and temp) Age, gender, body mass, fever, mensturuation, etc can affect this
   • Resting energy Expenditure (REE)
     • AKA resting metabolic rate -  amount of energy you need to consume over 24 hr period for your body to maintain all internal working activities while at rest Affected by illness, pregnancy, lactation, and activity level
   • Carbs
     • Main source of energy in diet. Produces 4Kcal/g and serves as main source of fuel (glucose) for Brian, skeletal muscles during exercise, erythrocyte and leukocyte production, and cell function of the renal medulla.
   • Fats
   • Water
     • Older people have less water 
   • Vitamins
     • Essential for normal metabolism- catalysts in biochemical reactions
     • Fat-Soluble
       • A, D, E, K Stored in fatty compartments of body with exception of D Hypervitaminosis=toxicity
     • Water-soluble
       • C and B Complex. Not stored, so needed in daily food intake
     • Antioxidants
       • A, C, E and beta-carotene neutralize substances called free-radicals which produce oxidative damage to cells and tissues
   • Minerals
     • inorganic elements essential to body as catalysts in biochemical reactions
     • Macrominerals 100g or more
       • Help balance pH in body, and specific amounts are necessary in blood and cells to promote acid-base balance
     • Microminerals/trace elements less than 100g needed
       • Excess of one trace mineral can cause deficiency in another

2. Anatomy and Physiology of Digestive System

   • Mouth
     • Breaksup food particles
   • Salivary Glands
     • Moistens and lubricates food amylase digests carbs
   • Pharynx
     • Swallows
   • Esophagus
     • Transports food
   • Gallbladder
     • Stores and concentrates bile
   • Stomach
     • Stores and churns food HCl activates enzymes, breaks up food, kills germs Mucus protects stomach wall Limited absorption 
   • Liver
     • Breaks down and builds up many biological molecules Stores vitamins and iron Destroys old blood cells Destroys poisons Produces bile to aid digestion
   • Pancreas
     • Hormones regulate blood glucose levels Bicarbonates neutralize stomach acid
   • Small Intestine
     • Completes digestion Mucus protects gut wall
   • Large Intestine
     • Reabsorbs some water, ions, and vitamins forms and stores feces
   • Rectum
     • Stores and expels feces
   • Anus
     • Opening for elimination
   • Metabolism Note
     • When energy requirements exceed energy supplied, stored energy used -Monoglycerides from fats converted to glucose  -Amino Acids converted to fat for energy or stored -All body cells except RBC and neurons oxidize fatty acids into keynotes for energy when carbs aren't adequete

3. Dietary Guidelines

   • Dietary Reference Intakes (DRI's)
     • Evidence Based criteria for an acceptable range of amounts of vitamins and nutrients for each gender and age group
     • Estimated Average Requirement (EAR)
       • Rec. amount of nutrient to maintain a specific body function for 50% of population based on age and gender
     • Recommended Dietary Allowence (RDA)
       • Average needs of 98% population, not exact needs of individual
     • Adequate Intake (AI)
       • Suggested intake for individual
     • Tolerable Upper Intake (UL)
       • Highest level that likely poses no risk for adverse health events
   • Food Guidelines
     • Dietary Guidelines for Americans
       • Guidelines for Americans included on table 45-2 and provides average consumtion guideline for 5 food groups: Grains, veggies, fruits, dairy, meats
     • Choose my Plate
       • Basic guide for making food choices for a healthy life style -balance calories, decrease portions, increase healthy foods and water, decreasing fats, sodium and sugar

4. Factors influencing Nutrition

   • Environment
     • Obesity is a huge problem in US due to work schedules, poor meal choices and eating away from home
     • Lack of access to full-service grocery stores
     • Expensive healthy food
     • Health Food availability
     • Lack of access to safe places to play and exercise
   • Developmental Needs
     • older adult
       • GI changes affect digestion and maitentance of nutrition
       • Chronic Illness affects nutrition intake
       • Adverse Effects of Meds
         • GI bleeding, impaired smell/taste, anorexia
         • Drug-Nutrient Interactions (see table 45-2)
       • Cognitive impairment affects ability to obtain, prepare, and eat healthy
       • Lifelong eating habits, culture, income, education level, physical function level to meet ADL's

5. Assessment

   • Patients who are malnourished upon admission are at a greater risk of life-threatening complications -Sepsis, arrhythmia, hemorrhage
   • Dietary Intake and food preferences
   • Unpleasant Symptoms/Reactions from foods
   • Allergies
   • Taste, chewing, swallowing
   • Appetite and Weight
   • Use of Meds
   • Physical Signs of Good verse poor nutrition
     • See table 45-4 for details

6. Diagnosis

   • Risk for Aspiration
   • Overweight
   • Imbalanced Nutrition: Less than body requirements
   • Readiness for Enhanced Nutrition
   • Feeding Self-Care Defecit
   • Impaired Swallowing
   • Obesity

7. Planning

   • Setting Priority Examples
     • *Deficient Knowledge regarding diet therapy will become priority if it is necessary to promote long-term and effective weight loss
     • *Managing oral pain is priority over intervention of diet education to improve nutrition if Pt is unable to swallow and maintain adequate food intake

8. Implementation

   • Health Promotion
     • *includes food Safety Awareness and teaching
       • Food Bourne disease awareness See table 45-5 and 45-9 for details
   • Acute Care
     • Advancing Diets
       • HCP order order gradual progression of Dietary Intake/therapeautic diet to manage Pt's illness
       • Example
         • Decreased amount of antibodies
           • Needs protein, Vitamins A, B6, B12, C, Folic Acid, Thiamin, Biotin, Riboflavin, Niacin
     • Promote Apetite
     • Assist with Oral Feeding
     • Enteral or Parenteral Nutrition
   • Restorative and Continuing Care
     • Medical Nutritional Therapy
       • Specific Nutritional Therapies to treat an illness, injury or condition