2/19/14

Is the sum of all the interactions between an

organism and the food it consumes.

By Sir Mark B. Samson

Nutrients are organic and inorganic

substances found in foods that are required

for the body functioning

Macronutrients nutrients needed in large

amount. Such as CHO, CHON, fats, minerals,

vitamins
Micronutrients are vitamins and minerals required
in small amounts

Natural sources GOOD

Processed CHO BAD
Types:
Sugars
Starches: polysaccharides
Fiber:

Digestions
Ptyalin (salivary amylase)
Pancreatic amylase
Disaccharidases: maltase,

sucrase and lactase

Monosaccharide

Metabolism
Glucose

Circulates in BLOOD
Energy (INSULIN)
Stored

Small intestine

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Storage and Conversion

Glycogen: mostly stored in the liver and skeletal

muscles
Fat

Complete proteins contains all of the

essential amino acids plus many nonessential

ones. Found animal protein
Incomplete proteins lacks one or more
essential amino acids usually derived in
vegetables

Amino acids
Essential Amino Acids: histidine, isoleucine,

leucine, lysine, methionine, phenylalanine,

tryptophan, threonine, valine and arginine
Nonessential Amino Acids: alanine, aspartic acid,
cystine, glutamic acid, glycine, hydroxyproline,
proline, serine and tyrosine

Digestions
Mouth: Pepsin
Small Intestine (amino peptidase and dipeptidase)

with Pancreas (proteolytic enzymes trypsin,

chymotrypsin, and carboxypeptidase)

Metabolism
Storage
Liver (synthesizes proteins: albumin, globulin,

brinogen)
Plasma proteins
Tissue

ANABOLISM: building up of tissue

CATABOLISM: breakdown in the liver
Nitrogen Balance: measure of the degree of

protein anabolism and catabolism; net result of

intake and loss of Nitrogen

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Glycerides
Triglycerides
Cholesterol

Fats
Oils

Fatty acids
Saturated
Unsaturated
Monounsaturated
Polyunsaturated

Digestions
Starts in stomach but digested mainly in
Small intestine: bile, pancreatic lipase, and enteric

lipase
Breaks down into: glycerol, fatty acids, and

cholesterol

Transported in the form of lipoprotein (liver)

Metabolism
Lipase

glycerol


fatty acids

Vitamin
Water-soluble: C, B-Complex vitamins
Cannot be stored
Must have daily supplements

Fat-soluble: A, D, E and K
Minerals
Macrominerals: calcium, phosphorus, sodium,

potassium, magnesium, chloride and sulfur

Microminerals: iron, zinc, manganese, iodine,

ouride, copper, cobalt, chromium and selenium

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Is the relationship between the energy

derived from food and the energy used by

the body
Comparing energy intake with energy output

Energy Intake
Caloric Value: amount of energy that nutrients

and food supply to the body

Small Calorie (c, cal) is the amount of heat

required to raise the temp of 1 gram of water 1

degree Celsius
Large Calorie (Calorie, kilocalorie) is the amount
of heat required to raise the temp of 1 gram of
water to 15-16 degrees Celsius

Kilojoule is the amount of energy required when a

force of 1 newton (N) moves 1 kg of weight 1 meter

distance

1 Calorie (Kcal) = 4.18 kilojoule

Ideal Body Weight is the optimal weigh

recommended for optimal health.

Body Mass Index is an indicator of changes
on the body fat stores and whether a persons
weight is appropriate for height

Metabolism refers to all biochemical and

physiological processes which the body

grows and maintains itself
Basal Metabolic Rate (BMR) the rate which
the body metabolizes food to maintain
energy requirement
Resting Energy Expenditure is the amount
of energy required to maintain basic
functions

BMI
1. Measures the persons height in meters (1

meter=3.3 ft or 39.6 inches)

2. Measure the weight in kg (1kg=2.2 pounds)

3. Use the formula:
BMI= weight in kilograms
(height in meters)2

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Other ways to measure percent of body fat:

Development
Sex
Ethnicity and Culture

underwater weighing and dual-energy x-ray

absorptiometry (DEXA)
Bioelectrical Impedance Analysis (BIA)

Beliefs in Food (Fad)

Personal Preferences
Religious Practice
Lifestyle

Economics
Medication Therapy
Health

Alcohol Consumption
Advertising
Physiological Factors

Neonate to 1 year
Breast milk or formula
Higher uid needs
NR: 80-100 ml of milk/kg
Feeding every 2.5-4 hours
Demand feeding
Burping every after feeding
Regurgitation
Solids starts at 6 months (cereals, fruits, vegetables, and

Toddler
May start feeding

themselves
By age 3 may eat adult
table food
Meals should be short
Food refusal
NR: 900-1,800 Kcal
per day

Iron, calcium, and vit C

and A

strained meat
Food are introduced one at a time (every 5 days)
Eruption of teeth (7-9 months), chewing starts
IDA
Bottle mouth syndrome

Preschooler
Eats adult food
Requires snacks between meals
Should be guided and taught to use utensils

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Adolescent

School-Age Child

Needs: protein,

NR: 2,400 Kcal/day

calcium, vit D, iron

and vit B complex
Obesity
Anorexia nervosa
Bulimia

Protein-rich food

especially during
breakfast
Independence in
feeding may lead to
malnutrition
Obesity may develop

Young Adults
Female: maintain

adequate iron intake

Calcium, vit. D and
sum exposure (15min,
3x/week) to prevent
osteoporosis
Obesity and
Hypertension are

Older Adults
Fewer calories are

needed
More ber
Decreased saliva and
gastric juice may aect
nutrition
Psychological,
Emotional and Physical
factors may change
eating habits

common

Middle-Aged Adult
Limit cholesterol and caloric intake
2-3 liters of uids
Post menopausal women: calcium, vit D to reduce

osteoporosis also antioxidants (vit A, C, E) to prevent

heart disease

Malnutrition
Overnutrition caloric intake in excess of daily

energy requirements, resulting in storage of

energy in the form of adipose tissue.
Undernutrition an intake of nutrients insucient
to meet daily energy requirements because of
inadequate food intake or improper digestion and
absorption of food
Protein-Calorie Malnutrition depressed visceral
protein

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Assessing
Nutritional Screening routine nursing history and

physical examination
Patient-Generated Subjective Global Assessment
(PG-SGA) is a method of classifying clients either

Assessing cont
Nutrition Screening Initiative (NSI) promotes

nutrition screening and improved nutritional care

for older adults

Well-nourished
Moderately malnourished
Severely malnourished

Assessing cont
Nursing History
Age, sex, and activity level
Diculty eating
Condition of the mouth, teeth, and presence of dentures
Change in appetite
Change in weight
Physical disabilities that aect purchasing, preparing and
eating food
Cultural and religious beliefs
Living arrangement and economic status
General health status and medical condition
Medication history

Assessing cont
Biochemical (Laboratory) Data
Serum Protein
Albumin (half-life of 18-20 days)
Transferrin (8-9 days)
Prealbumin

Urinary Tests
Urea
Creatinine

Assessing cont

(Physical Assessment)
Anthropometric

Measurement
Triceps Skinfold
Mid-arm Circumference
(MAC) measures fat,
muscles, and skeleton
Mid-arm Muscle Area
(MAMA) estimate lean
body mass or skeletal
muscle reserves

Assessing cont
Clinical Data (Physical Data)
Review table 47-10 p.1275
Calculating Percentage Weight Loss
Current Body Weight (CBW)
Usual Body Weight (UBW)
Weight Loss Percentage Calculation:

Usual Weight Current Weight x 100

Usual Weight

Total Lymphocyte Count

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Assessing cont
Dietary Data
24-hour food recall
F00d frequency record
Food diary (3-7 days)
Diet history

Diagnosing
Imbalanced Nutrition: More Than Body

Requirements

Imbalanced Nutrition: Less Than Body

Requirements

Readiness for Enhance Nutrition

Risk for Imbalanced Nutritions

Planning
Maintain or restore optimal nutrition
Promote healthy nutritional practices
Prevent complications associated with

malnutrition

Decrease weight
Regain specied weight

Clear Liquid Diet

Indication: After surgeries or in acute stages of

infection
Short term diet (24 of 36 hours)
Supplies uids and carbs but very low on protein,
fat, vitamins and minerals
Relieves thirst, prevent dehydration, and
minimize stimulation of GIT

Implementing
Assisting with Special Diets
Diets maybe modied through: texture, kilocalories,
specic nutrients, seasonings, or consistency
Clear Liquid Diet (short term: 24-36 hours)
Full Liquid Diet
Soft Diet
Diet as Tolerated
Modication for Disease

Full Liquid Diet

Indication: For client with GI disturbances or

cannot tolerate solid/semi-solid foods

Contains more on milk

Monotonous
Low in iron, protein and calories

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Soft Diet

Diet as Tolerated

Indication: For clients with diculty chewing and

Indication: For clients with appetite, ability to eat,

swallowing
Low-residue diet containing very few uncooked
foods
Pureed diet (modication type)

Modication for Disease

and tolerance for certain foods are changing

Purposes

Indication: For clients with special needs

1. To restore or maintain nutritional status

regarding their sickness

2. To administer medication

Assessment

Clinical signs of malnutrition or dehydration

Allergies on food
Presence of bowel sounds
Problems that suggest lack of tolerance on
previous feedings

Planning: Before commencing a tube feeding

determine the type, amount, and frequency of
feedings and tolerance of previous feedings.
Equipment

1.
2.
3.
4.
5.
6.
7.
8.

Correct type and amount of feeding solution

60 ml catheter tip syringe
Emesis basin
Clean gloves
pH strip
Large syringe with calibration
Measuring containers
Water 60ml

Performance:
1. Introduce. Explain.
2. Perform hand hygiene and observe other other

appropriate infection control procedures

3. Provide for client privacy
4. Assess tube placement
Apply gloves
Attach syringe. Aspirate. Check for pH
5. Assess residual feeding contents

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6. Administer feeding
Check the expiration date of the feeding.
Warm the feeding to room temperature
(Open Feeding-Syringe) Remove the plunger

Pinch or clamp the tubing to stop the ow for a

minute if the client experience discomfort.

7. Flush the feeding tube before all of the formula

has run through the tubing.

from the syringe and connect the syringe to a

pinched tube or clamped NGT.
Add the feeding to the syringe barrel
Permit the feeding to ow in slowly at the
prescribed rate. Raise or lower the syringe to
adjust the ow needed.

10. Dispose of equipment appropriately

11. Document all relevant information
12. Monitor the client for possible problems

8. Clamp the feeding tube before all the water is

instilled

9. Ensure clients comfort and safety.

Secure the tubing on clients gown
Maintain the client on Fowlers position for about
30min
Note agencys policy in changing NGTs

Presence of bowel sounds

Absence of nausea and vomiting when tube is

Evaluation: Reassess the :

Tolerance to feeding
Bowels sounds
Regurgitation and feelings of fullness
Weight gain/loss
Fecal elimination pattern
Skin turgor
Urine output and specic gravity
Glucose and acetone in urine

Implementation
Preparation
Check order
Assist the client in sitting position
Place towel or disposable pad on clients chest
Provide tissues for cleaning up after removal

Assessment
clamped

Planning: Equipment

Disposable pad/towel
Tissues
Clean gloves
50 ml syringe
Plastic trash bag

Performance
1. Introduce. Explain.
2. Perform hand hygiene and done clean gloves
3. Provide privacy
4. Detach the tube
5. Remove the NGT
1.
2.
3.
4.
5.

Instill 50 ml of air to clear the tubes

Ask the client to take a deep breath and hold it
Pinch the tube with gloved hand
Smoothly withdraw the tube
Place in plastic bag. Observe tube for intactness

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6. Ensure clients comfort

7. Dispose equipment appropriately
8. Document relevant information

Evaluation: Reassess

Presence of bowel sounds

Absence of nausea and vomiting
Intactness of tissue of nares

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