Nutrition & Diet Therapy DIGESTION

 Nutrition is the total of all processes  Mechanical and chemical processes

involved in the taking in and utilization of converting nutrients to a physically
food substances for proper growth, absorbable state:
functioning, and maintenance of health. o Mastication–chewing
 Nutrition plays a role directly or indirectly o Deglutition–swallowing
in all body processes, and disease states. o Peristalsis–rhythmic, coordinated,
 Proper nutrition may help prevent or delay serial contractions of smooth
onset of many diseases. muscles of GI tract
 Nutrition is the most over looked part of
healthy living.
 Prevention = nutrition one of the most
important parts of health care.
Role of the Nurse in Promotion Nutrition
The nurse can promote good nutrition by:
 Helping the patient understand the
importance of the diet and encouraging
dietary compliance.
 Serving meal trays to patients in a prompt
and positive manner.
 Assisting some patients with the eating
process.
 Taking and recording patient weight.
 Recording patient intake.
ABSORPTION
 Observing clinical signs of poor nutrition
and reporting them.  The process whereby the end products of
 Serving as a communication link. digestion pass through the epithelial
 Nurse can apply nutrition to their personal membranes in small and large intestines
lives, what a better reason to understand and into blood or lymph systems.
nutrition for your  Villi–small finger-like projections that line
 own health. the small intestine. Most nutrients are
absorbed directly through the villi.
NUTRITION
METABOLISM
 All of the processes involved in
consuming and utilizing food for energy,  The conversion of nutrients into energy.
maintenance, and growth. o Anabolism–the constructive
 These processes are ingestion, digestion, process of metabolism, requires
absorption, metabolism, and excretion. energy.
o Catabolism–the destructive
INGESTION
process of metabolism, releases
 The taking of food into the digestive tract, energy.
generally through the mouth. o Basal metabolism–the energy
 In special circumstances, ingestion occurs needed to maintain essential
directly into the stomach, through a physiologic functions.
feeding tube.
EXCRETION
 The process of eliminating or removing
waste products from the body.
NUTRIENTS CARBOHYDRATE FUNCTIONS
The body must have six types of nutrients  Primary source of energy for the body.
to function efficiently and effectively:  About half-day supply stored in liver and
muscles for use as needed.
 Water
 Spares proteins from being used for
 Carbohydrates
energy.
 Fats
 Needed to oxidize fats and for synthesis of
 Proteins
fatty acids and amino acids.
 Vitamins
 Minerals Carbohydrate Absorption & Storage

Dietary Guidelines for Americans:

 Digestion begins in mouth, little takes
 These guidelines form the foundation of place in the stomach, is completed in the
U.S. federal nutrition policy and directly small intestine.
affect federal nutrition programs such as  Leave no waste for kidneys to eliminate.
food stamps, school breakfast and lunch
 Absorption takes place in the villi.
programs, and the Special Supplemental
 Excess converted to glycogen and stored
Program for Women, Infants, and Children
in the liver or stored as fat.
(WIC).
 These guidelines have been developed to DEFICIENCY AND EXCESS
address the importance of adequate
Mild deficiency can cause weight loss and fatigue.
nutrition, as well as the prevention of over
nutrition and disease. Serious deficiency can cause ketosis.
Dietary Reference Intakes: Excess can cause obesity, tooth decay, irritate the
lining of the stomach, or flatulence.
This is a set of nutrient-based values that can
be used for both assessing and planning diets. FATS
 They form the basis for daily values used  Most concentrated energy source in diet.
in the Nutrition Facts labels on foods.  Provides 9 kcal per gram.
 The DRIs are intended to help individuals  Also known as lipids.
optimize their health, prevent disease, and  Composed of carbon, hydrogen, and less
avoid consuming too much of a nutrient. oxygen than carbohydrates.
CARBOHYDRATES  Recommended: no more than 25–30% of
daily intake.
 Made of the elements carbon, hydrogen,
and oxygen (CHO) Fats (Lipids)
 Constitute the chief source of energy for  Lipids:
all body functions.  Saturated fatty acids:
 Requirements are 50–60% of total kcal  Unsaturated fatty acids:
intake per day.  Trans Fatty Acids:
 Carbohydrates:  Cholesterol:
 Simple Carbohydrates:  Digestion and Metabolism of fat:
 Complex Carbohydrates:
 Digestion and Metabolism of Summary of Fatty Acid Classification
Carbohydrates:  Saturated
 Monounsaturated
 Polyunsaturated:
 Trans:
  Plant fats–corn oil, safflower oil, olive oil,
cottonseed oil, peanut oil, palm oil, and
Classification of LDL, Total HDL, Cholesterol
coconut oil, nuts, and avocado
 LDL Cholesterol:
 Total Cholesterol:
 HDL Cholesterol: Protein

Functions of Fat  Amino Acids:

 Complete proteins:
 Provides concentrated source of energy.
 Incomplete proteins:
 Needed to absorb fat-soluble vitamins.
 Vegetarian diets:
 Major component of cell membranes and
 Digestion and Metabolism of Protein:
myelin sheaths.
 Protein-Kilocalorie malnutrition:
 Improves flavor, delays emptying time.
 Protects and helps hold organs in place. Proteins
 Insulates the body.
 Made of carbon, hydrogen, oxygen, and
CLASSIFICATION nitrogen (CHON).
 The only nutrient that can build, repair,
 Triglycerides (true fats) are composed of and maintain body tissues.
one glycerol molecule attached to three
 Daily requirement for average adults is
fatty-acid molecules.
0.8g of protein for each kilogram of body
 Phospholipids (lipoids) are composed of weight.
glycerol, fatty acids, and phosphorus.
 Cholesterol (sterol) liver produces over Functions Of Proteins
1000 mg every day.
 Provide amino acids, needed to build,
Absorption and Storage repair, and maintain body tissues.
 Assist in regulating fluid balance.
 No breakdown occurs in the mouth, very
 Vital part of enzymes, hormones, blood
little digestion occurs in the stomach.
plasma.
 Digestion begins in the small intestine.
 Used to build antibodies.
 Final products of fat digestion are fatty
 Can be converted to glucose, for energy.
acids and glycerol.
 95% absorbed in small intestine. Protein Digestion and absorption
 Excess fats stored as adipose tissue.
 Begins in the stomach.
 Most digestion takes place in small
Deficiency and Excess intestine.
 End product is amino acids, absorbed into
 Deficiency occurs when fats provide less
the blood by the villi in the small intestine.
than 10% of the total daily kcal
 Excess amino acids are converted to
requirement.
glucose, glycogen, or fat for storage.
 May result in eczema, retarded growth,
weight loss. Sign of Deficiency and Excess
 Excess can lead to overweight and heart
 Muscle wasting.
disease.
 Edema.
Sources of Fat  Lethargy and depression.
 Marasmus and Kwashiorkor.
 Animal fats–lard, butter, milk, cream, egg
yolks, meat, poultry, and fish.  Excess can contribute to heart disease, and
may be linked to colon cancer,
osteoporosis, and kidney damage.
Vitamins and Minerals  Inorganic elements that help regulate body
processes and /or serve as structural
 They are needed in small amounts; toxicity
components of the body.
may occur with over consumption.
 Major minerals–more than 100 mg/day.
 They are best received from a balanced,
 Trace minerals–less than 100 mg/day.
varied diet.
 Functions are unique to each individual
 Vitamins can be destroyed by heat, light,
mineral.
and exposure to air.
 Minerals cannot be destroyed because they Classification and Sources
are single elements rather than
compounds.  Classified as major minerals or trace
minerals.
 Both vitamins and minerals can be lost
when foods are cooked in water.  Found in water and in unprocessed foods.
 Some foods are enriched—some vitamins
VITAMINS are added to them.
 Supplements may be needed during
 Organic compounds essential to life and
growth periods, some clinical situations.
health.
 Regulate body processes, needed in very Digestion
small amounts.
The amount of a mineral absorbed by the body is
 No fuel value but required for metabolism
influenced by:
of fats, carbohydrates, proteins.
 Functions are unique to each vitamin.  Type of food
Fat soluble:  Need of body
 Health of absorbing tissue
 A, D, E, and K.
Deficiency and Excess
 Usually carried in the fatty portion of food.
 Can be stored by the body.  Deficiency signs unique to each mineral.
Water soluble:  Excesses can lead to toxicity.
 Concentrated forms of minerals should
 B vitamins and C. be used only on advice of a physician.
 Not stored in the body; excesses excreted  Excesses can cause hair loss, changes
in the urine. in the blood, hormones, bones, muscles,
and nearly all tissues.
Digestion of Vits
Vitamins
 Vitamins do not require digestion.
 Fat-soluble vitamins are absorbed into the  Antioxidant vitamins:
lymphatic system, excesses are stored in  Vitamin A:
the liver and adipose tissue.  Vitamin C:
 Water-soluble vitamins are absorbed  Vitamin D:
directly into the circulatory system, and  Vitamin E:
excesses are excreted in urine.  Vitamin K:
Deficiency/ Excess  Folate Acid:
 Thiamine:
 Vitamin deficiencies can occur and result  Vitamin B 12:
in disease.  Riboflavin:
 Vitamins consumed in excess amounts can  Niacin:
be toxic to the body.
 Vitamin B6:
Minerals  Biotin:
 Choline:
 Pantothenic Acid:
  Vitamin C:  Liquids consumed, including water,
coffee, juice, tea, milk and soft drinks.
Mineral
 Foods consumed, especially vegetables
 Calcium and fruits.
 Phosphorus:  Metabolism, which produces water when
 Magnesium: oxidization occurs.
 Sulfur:
 Sodium:
 Potassium: WATER DIGESTION/ ABSORPTION,
 Chloride: /STORAGE
 Iron:  Water is absorbed, not digested.
 Zinc:  It is not stored and is excreted daily.
 Iodine:  Sensible loss–aware of loss of water.
 Selenium:  Insensible loss–not aware of loss of water.
 Copper:  Urine, feces, perspiration, and respiration
 Fluoride: are the four ways the body loses water.
 Chromium:
SIGNS OF
 Manganese:
WATER  Dehydration:
o Deficiency of water, can cause
 Nutrient most vital to life. death.
 Makes up approximately 60% of adult o Occurs from profuse sweating,
body weight and 80% of infant weight. vomiting,
 Provides form and structure to body o diarrhea, hemorrhage, wound
tissues. drainage,
o fever, and edema.
 Positive water balance when more water
taken in than used or excreted.
 Selected Foods with Vit. C:
 Selected Foods with Vit. D:
 Factors that affect Calcium Absorption
and Excretion:
 Factors that affect iron Absorption:

 Acts as a solvent; necessary for most

chemical processes.
 Transports nutrients and other substances.
 Lubricates and protects moving parts of
the body.
 Lubricates food and aids in digestion.
 Regulates body temperature
SOURCES OF WATER FOR THE BODY
Basic Nutrition
Diet Planning Guides
A number of guidelines have been
established in the US to help guide Americans in
healthy and balanced eating.
 My Pyramid:
o Bread, cereal, rice, and pasta
group.
o Vegetable group.
o Fruit group.
o Milk, yogurt, and cheese group.
o Meat, poultry, fish, dried beans,
eggs, and nuts group.
o Fats, oils, and sweets.

MyPyramid
 U.S. Department of Agricultures, Pyramid
symbolizes a personalized approach to
health eating and physical activity.
 MyPyramid emphasizes key concepts in
physical activity and eating.
 Moderation is represented by the
narrowing of each food group.
 The wider base stands for food with little
or no solid fats or added sugars.
 The Narrower top area is food with more
added sugars and solid fats.
 Varity and proportionality is shown by
different widths of food groups.
 This pyramid can be personalized at
www.mypyramid.gov.
Life Cycle Nutrition  This is a critical time for instilling good
dietary habits.
 Nutritional needs change as a person
 At 1 year of age, appetite generally tapers
grows and develops.
off, growth slows for now.
 Changes generally based on growth needs,
 Children still need adequate nutrition.
energy needs, nutrient utilization.
 The younger the child, the smaller the
 Nutritional assessment should be
portions needed.
conducted to ascertain the nutritional
 If children are offered nutritious foods in
needs of the individual.
pleasant surroundings and in non-
Pregnancy and Lactation threatening ways.
 The parents should decide which foods to
 Nutrient needs during period of intensive
serve at what time; the child should be
growth, such as pregnancy and infancy are
able to decide what and how much to eat.
greater than any other time in life.
 However this is also the time children test
 Evidence has proven that optimal nutrition
their independence.
during pregnancy reduce risk of
complications during pregnancy and
delivery. Encouraging Good Dietary Habits
 Health diets and avoid alcohol and
 Meals at the table at regular times.
caffeine play an important role prior to
and after pregnancy.  Relaxed and enjoyable.
 Variety of foods.
Concerns in Pregnancy  Do not force children to eat or clear plates.
 Weight gain:  Small servings.
 Discomforts and complications:  New foods.
 Practices to avoid:  Nutritious snacks.
 Lactation:  Limit sweets.
 Encourage physical activity.
Infancy  Adults are to set good eating habits.
 The time from birth to 1 year of age is one Adolescence
of the rapid growth and development.
 The average infant birth weight triples by These years are of both physical and
the first birthday. emotional growth.
 Nutrition is important for proper growth  Diets are often filled with kilocalorie-rich
and development. and nutrient-poor snack foods.
 Breast Milk:  Common dietary inadequacies include iron
 Regular cow’s milk: and calcium.
 Solid foods:  Many teenagers experiment with alcohol
o Single-ingredient foods : and drugs, which have detrimental effects
o Food high in iron: on nutrition.
o Commercially prepared baby  Obesity is a common problem; weight
foods: reduction diets should be attempted only
o Juice for infants younger than 6 under the advice of a physician and with
o months: the guidance of a dietitian.
o Children having juice
Adult
bottles/cups/box:
With energy, activity decreasing, weight
Childhood gain increasing: Nutritional needs start to
This is a critical time to instill good decrease.
dietary habits.
Older Adult Considerations
 Aging may affect the eating process. Common Medications and Their Effect on
 Aroma and taste of food may change. Nutrition
 Changes in the digestion process.
 Antacids.
 Kilocalorie needs decrease .
 Antibiotics.
 Numerous medications.
 Anticoagulants.
 Social and mental changes.
 Aspirin.
 Chronic medical conditions.
 Diuretics.
Nutritional Concerns of Adults in Long Term  Laxatives.
Care Facilities
Medical Nutrition Therapy and Therapeutic
 Malnutrition is a common problem among Diets
nursing home residents and profoundly
These diets are specific nutrition as
influences physical health and quality of
needed to treat an illness, injury or condition.
life.
 Residents should be offered familiar foods Purpose of Diet Therapy
that taste good.
The dietary prescription is written for one
 Fluids should be offered to residents at all or more of the following purposes:
meals and between meals.
 Dehydration is very common and easily  Provide the client with nutrients needed
corrected in long term care facilities. for maintenance or growth.
 Nurses must understand the value of  Prepare a client for diagnostic tests.
mealtime as a pleasant, social experience.  Treat the client with a disease or condition.
 Cultural and personal preferences should
DIET THERAPY
be considered.
 Many residents need assistance or  The treatment of a disease or disorder with
encouragement. a special diet.
 Lack of adequate staffing play a large role  A client must not be given anything to eat
in patient nutrition. or drink without an order.
 Many patients are on restricted diets.
The Vegetarian Diet
 Pressure sore due to lack of mobility, and
nutrition.  Lacto-ovo vegetarians–use dairy products
 Nutrient-Drug interactions. and eggs but no meat, poultry, or fish.
 Lacto vegetarians–use dairy products but
Caffeine
no meat, poultry, or eggs.
 Drug  Vegans–avoid all animal foods.
o Central nervous system stimulant
Factors Influencing Diet
and diuretic.
o Nervousness  Culture
o Irritability  Religion
o Anxiety  Socioeconomics
o Insomnia  Fads
o Heart arrhythmias  Superstitions
o Palpitations
BASIC NUTRITIONAL ASSESSMENT
See Caffeine Content of Selected Beverages
 Nutritional status
and Foods.
 Height and weight
 Meal and snack pattern
 Food allergies
  Physical activity
 Cultural, ethnic, and family influences
Consistency, Texture, and Frequency
 Use of vitamin/mineral supplements Modifications
NUTRITION AND HEALTH  Liquid Diets:
 Primary nutritional disease–occurs when o Clear Liquids
nutrition is the cause of the disease. o Full Liquids
 Secondary nutritional disease–occurs as a  Soft and Low-Residue Diets.
complication of another disease or  High Fiber Diets.
condition.  Meal Frequency Modification.
WEIGHT MANAGEMENT Kilocalorie Modifications
Based on relationship between intake and use  Basal Metabolic Rate (BMR).
of kcal.  High-Kilocalorie and High Protein Diets.
 Overweight: 11%–19% above  Anorexia.
 Obesity: 20% or more above  Kilocalorie-Controlled and Low-
Kilocalorie Diets.
 Underweight: 10%–15% under
o Obesity
FOOD LABELING o Measurements of Obesity
o BMI
 Required on virtually all retail food
products. o Body Composition
 Labels must follow the approved uniform o Waist circumference
format and use standard serving sizes and o Treatment of Obesity
household measurements. Eating Disorders
 Anorexia Nervosa:
o Self-imposed starvation.
o Individuals have an intense drive
for thinness, an intense fear of
gaining weight or becoming fat,
and a distorted body image.
 Bulimia Nervosa:
o Periods of binge eating followed by
purging (self-induced vomiting,
emetics, laxatives, enemas, or
diuretics).
o Often normal weight or
overweight.
 Binge / Purge:
Comparison of Eating Disorders
Diagnoses
 Body weight and other physical indicators.
FOOD QUALITY AND SAFETY  Eating behaviors.
 Proper storage, preparation, sanitation, and  Compensatory behaviors (purging).
cooking are necessary to help prevent or  Psychologic indicators.
reduce the risk of food-borne illnesses. Carbohydrate-Modified Diets
Diabetes Mellitus:
 A disease in which the body does not produce  These diets are beneficial in reducing the
or properly use insulin. risk of atherosclerosis.
 Lowering dietary fat may assist in disease
treatment and control.
Insulin convert sugar, starches, and other
food into energy needed for daily life.
Two major types of diabetes:  Fat-Controlled Diets:
o Limits total fat, saturated fat, and
 Type 1 trans-fatty acids.
 Type 2  Low-Fat Diets:
o All fats limited, regardless of
Primary goals for medical nutrition therapy:
saturation.
 Improve metabolic control by achieving
Lowering Fat/Saturated Fat/Trans Fatty
and maintaining optimal blood glucose.
Acids/Cholesterol
 Provide adequate energy for maintenance
of a reasonable body weight.  Food Groups:
 Prevent acute and chronic complications of  Choose:
diabetes.  Go Easy on:
 Improve overall health through optimal
nutrition Protein/Electrolyte and Fluid-Modified Diets
 Carbohydrate intake should be monitored  Increased protein facilitate healing.
and controlled.  Defects in protein is seen in liver/renal
 Diabetic diet tools: disease.
o Exchange lists for meal planning  Sodium-Restricted Diets:
o Carbohydrate counting o pg 649 box 21-9
 Other nutritional considerations:  Potassium-Modified Diets:
o Hypoglycemia: consumption of  Fluid-Modified Diets:
inadequate carbohydrates causes o Fluid Restrictions
the blood sugar to drop. o Fluid Increase
Carbohydrate-Modified Diets (continued) Patient Teaching
 Dumping Syndrome:  Fluid restrictions:
o It may occur after surgery in which o Explain the rationale.
a portion or all of the stomach is o Indicated if restriction is
removed. temporary or permanent.
 Lactose Intolerance: o Educate, discuss different sources
o Intolerance occurs as a result of a
of water.
lack of the digestive enzyme o Teach how to count fluids.
lactase.
o Show the patient how much fluid is
Special Diets allowed.
o Suggest ways to alleviate thirst
 Low-residue diet
without drinking.
 High-fiber diet o Discuss the consequences of over
 Liberal bland diet consumption of fluids.
 Fat-controlled diet
 Sodium-restricted diet Nutritional Support

Fat Modified Diet  Enteral nutrition–includes both the

ingestion of food orally and the delivery of
nutrients through a GI tube.
  Parenteral nutrition–the infusion of a
solution of nutrients directly into a vein to
meet the client’s daily requirements.

Tube Feedings
 Administration of nutritionally balanced
liquefied foods or formula though a tube
inserted into the stomach, duodenum, or
jejunum by way of a nasogastric tube or a
feeding ostomy.
 Indicated when a patient is unable to chew
or swallow, has no appetite, or refuses to
eat.
 Tube feeding used only when all or at least
part of the GI tract is functioning.
 Feeding given continuously or
intermittently.
Nasogastric Tube Feedings
 Checking for placement of a feeding tube
before administering medication or tube
feeding is critical to safe patient care.
 Tube may be accidentally placed in the
lung, esophagus, or even the stomach
when it should be in the small bowel.
 To test, use chest x-ray, test pH of
aspirated fluid, or use auscultatory method.
Administering Nasogastric Tube Feedings
Skill 21-1: Step 10a(1)

Administering nasogastric tube feedings.

Skill 21-1: Step 10a(2)
Administering nasogastric tube feedings.
Skill 21-1: Step 10b

Parenteral Nutrition Support

 Parenteral nutrition (hyperalimentation):
Administering nasogastric tube feedings. o Intravenous feedings.
o May be administered through
peripheral veins.
 Total parenteral nutrition (TPN):
o Administration of hypertonic
solution into a large central vein.
o Composed of glucose, amino acids,
vitamins, minerals, and
electrolytes; fats also given as a
supplement to the main formula.
o Indicated for the patient with a
nonfunctioning or dysfunctional GI
tract.
Administering nasogastric tube feedings.

Central venous catheter placement during

administration of parenteral nutrition.
Nursing Assessment
 Must be performed in a logical fashion and
should include a nutritional history,
physical examination, and the results of
laboratory tests.
Nursing Diagnosis
 Imbalanced nutrition:
o Less than body requirements
o More than body requirements
 Risk for imbalanced nutrition: more than
body requirements
 Disturbed body image
 Ineffective breastfeeding
 Impaired dentition
 Deficient knowledge (specify)
 Impaired oral mucous membrane
 Pain
 Feeding self-care deficit
 Chronic low self-esteem
 Risk for impaired skin integrity
Planning / Outcome
 A plan should be formulated by the nurse
and client to achieve mutually agreed-upon
goals.
 The plan is individualized to meet the
client’s specific needs.
Implementation
 Interventions to accomplish the goals may
include diet therapy, assistance with meals,
weight and intake monitoring, and
nutritional support.