Nutrition and Elimination

• Nutrition


  Sum of all the interactions between an organism and the food it consumes
• Nutrition

  • Functions: Energy, Repair, Regulation
• Nutrients


  • Organic: Carbohydrates, Fats, Vitamins
  • Inorganic: Minerals, Water
• Macronutrients


  Needed in large amounts (fats, proteins, nutrients)
• Micronutrients


  Vitamins and minerals that are required in small amounts
• Carbohydrates


  • Composed of Carbon, Hydrogen, Oxygen
  • May be simple or complex
  • Stored as glycogen or fat
  • Broken down into glucose
• Types of Carbohydrates


  • Sugars
  • Starches
  • Fibers
• Proteins


  • Composed of Carbon, Hydrogen, Oxygen, Nitrogen
  • May be complete or incomplete
  • Digested from stomach to small intestine
  • Involved in anabolism and catabolism
  • Affect kidney, liver, acid-base balance
• Amino acids


  • Smallest unit of protein
  • Essential and nonessential
• Lipids


  • Fats and oils
  • Fatty acids: saturated and unsaturated
  • Glycerides and triglycerides
  • Cholesterol
  • Digested mainly in small intestine
• Vitamins


  • Organic compounds needed in small quantities to catalyze metabolic processes
  • Water-soluble and fat-soluble
• Minerals


  • Calcium and phosphorus make up 80% of all mineral elements in the body
  • Macrominerals and microminerals
• Energy Balance


  Relationship between the energy derived from food and the energy used by the body
• Energy Intake


  Amount of energy that nutrients or foods supply to the body, measured in calories
• Energy Output


  Metabolism and metabolic rate, including basal metabolic rate and resting energy expenditure
• Ideal body weight (IBW)


  Optimal weight recommended for optimal health

  
• Body Mass Index (BMI)


  Indicator of changes in body fat stores and whether an individual's weight is appropriate for height

  
• Factors affecting nutrition

  • Developments (adolescents, older adults)
  • Sex
  • Ethnicity and Culture
  • Beliefs about Food (fad diets, personal preferences, religious practices)
  • Lifestyle
  • Economics
  • Medications and Therapy
  • Health (dysphagia, disease processes)
  • Alcohol Consumption
  • Advertising
  • Psychological Factors (anorexia, bulimia)
• Nutritional variations throughout the lifecycle

  • Neonate to 1 Year (demand feeding, regurgitation, iron deficiency anemia, anemia, bottle mouth syndrome)
  • Adolescent (increased nutrient needs, obesity, anorexia, bulimia)
  • Young Adult (established habits, iron, calcium, vitamin D needs)
  • Middle-Aged Adult (protein, calcium, cholesterol, obesity, diabetes, hypertension, arthritis)
  • Older Adults (fewer calories, physical changes)
• Vitamin D


  Necessary for entry of Ca into bloodstream
• No sufficient sun exposure


  Supplements indicated
• Obesity


  • Common in sedentary adults
  • At risk of hypertension
• Healthy diet for middle-aged adults

  • Special attention to protein and calcium intake
  • Limit cholesterol and caloric intake

  
• Fluid intake for middle-aged adults

  1. 3 liters in daily diet
• Postmenopausal women


  • Need to take sufficient Ca and vitamin D to reduce osteoporosis
  • Antioxidants such as vitamins A, C, and E reduce risk of heart disease
• Middle-aged adults


  • At risk of obesity, reduce caloric intake and do regular exercise
  • At risk for DM, hypertension, and arthritis
• Nutrition for older adults

  • Require same basic nutrition as younger adult, but fewer calories due to lower metabolic rate and decrease in physical activity
  • Some may need more carbohydrates for fiber and bulk, but most nutrient requirements remain relatively unchanged
• Physical changes in older adults


  • Teeth loss
  • Impaired sense of taste and smell may affect eating habits
  • Decreased saliva and gastric juice secretion may also affect nutrition
• Psychological factors in older adults


  • Depression
  • Loss of spouse
  • Empty nest may result in poor dietary habits
• Other factors affecting nutrition in older adults

  • Lack of transportation
  • Poor access to stores
  • Inability to prepare food
  • Lowered income
• Malnutrition


  • Lack of necessary or appropriate food substances
  • Includes both undernutrition and overnutrition
• Overnutrition


  • Caloric intake in excess of daily energy requirements
  • Overweight (BMI is between 25 and 29.9 kg/m2)
  • Obese (BMI is greater than 30 kg/m2)
  • Morbid Obesity (Obesity that interferes with mobility or breathing)
• Undernutrition


  Intake of nutrients insufficient to meet daily energy requirements because of inadequate food intake or improper digestion and absorption of food
• Protein-calorie malnutrition (PCM)


  Seen in starving children of underdeveloped countries, is now also recognized as a significant problem of clients with long-term deficiencies in caloric intake
• Responsibility for nutritional assessment and support

  • Primary care provider
  • Dietitian
  • Nurse
• Nutritional Screen


  Assessment performed to identify clients at risk for malnutrition or those who are malnourished
• Components of a Nutritional Assessment

  • Nursing History
  • Anthropometric Measurements
  • Biochemical (Laboratory) Data

  
• Nursing History

  • Age, sex, and activity level
  • Difficulty eating (e.g., impaired chewing or swallowing)
  • Condition of the mouth, teeth, and presence of dentures
  • Changes in appetite
  • Changes in weight
  • Physical disabilities that affect purchasing, preparing, and eating
  • Cultural and religious beliefs that affect food choices
  • Living arrangements (e.g., living alone) and economic status
  • General health status and medical condition
  • Medication history
• Anthropometric Measurements


  Noninvasive techniques that aim to quantify body composition
• Skinfold Measurement


  • Performed to determine fat stores
  • Method to estimate body fat percentage