NU 112 Nutrition

Effects of a Well balanced diet

A healthy diet may help prevent long term diseases such as heart disease, stroke and
diabetes. It can also help us with our mental well being. It may also help with reducing
certain types of cancers and maintaining a healthy weight.

Not well balanced diets:

Anorexia: is an eating disorder that involves severe calorie restriction and often a low
body weight. It’s a complex condition that has mental, behavioral and physical symptoms.
Treatment for anorexia is essential due to its life-threatening complications.
- Leads to significant low body weight
- Usually a traumatic situation or event that caused the person to start limiting
themselves on how much they eat

Bulimia Nervosa: is a type of eating disorder in which a person regularly eats excessive
amounts of food (binge eats) and then attempts to eliminate (purge) the consequences of
overeating by vomiting, taking laxatives or diuretics, fasting or exercising excessively.
This is often referred to as “binge and purge.”
- They don't want anyone to see them eating and they hide it
- Lack of control over eating when the binge begins
- Does vigorous exercises

Healthy People 2020 Guidelines:

- Physical activity
- Increasing fruits, vegetables, and whole grains
- Limiting access of sugars and sweeteners
- Consume less than 2300 mg of sodium per day
- Choose prepared foods with little salt
- Practice safe food handling to prevent bacteria and foodborne illnesses
- Botulism: caused by the bacterium Clostridium botulinum, which produces a toxin
that can grow in certain conditions. It is a rare but serious illness caused by a toxin
that attacks the nervous system and can lead to paralysis, breathing difficulty, and
death.
- Caused by eating food that's been improperly canned or preserved, such as fruits,
vegetables, fish, spicy peppers, foil-wrapped baked potatoes, or garlic-infused oil
- Caused by a wound that's infected with the bacteria, which then produces the
toxin
 - Caused by an infant eating contaminated food, such as honey
- Caused by breathing in the pure toxin that's been released into the air

- E. coli (Escherichia coli): is a type of bacteria that can cause illness in humans.
Lives in the intestines of humans and animals, and is also found in the environment
and in food and water. Most E. coli strains are harmless and help with digestion,
vitamin production, and protecting against harmful germs. Some strains can cause
illness. It can be spread by:
- Contaminated food or water
- By contact with animals, environments, or other people
- Personal contact, especially if infected people don't wash their hands properly

- Salmonella infection (salmonellosis): is a common bacterial disease that affects

the intestinal tract. Salmonella bacteria typically live in animal and human intestines
and are shed through stool (feces). Can be caused by:
- Eating raw or undercooked meat
- Poultry, and eggs or egg products
- Drinking unpasteurized milk

A & P of the Digestive System:

Digestion: Mechanical breakdown that results from chewing, churning, and mixing with
fluid and chemical reactions in which food reduces to its simplest form.
- Absorption: The body absorbs nutrients by means of passive diffusion, osmosis,
active transport, and pinocytosis.
- Metabolism and Storage of Nutrients: All the biochemical reactions within the cells
of the body
- Elimination: Chyme moves by peristalsis action through the ileocecal valve into the
large intestine, where it then becomes feces

Anabolism: Is building more complex biochemical substances by synthesis of nutrients.

- Positive nitrogen balance: is the difference between nitrogen intake and loss
reflects gain or loss of total body protein. If more nitrogen (protein) is given to the
patient than lost, the patient is considered to be anabolic or “in positive nitrogen
balance”
- Glycogenosis: is a metabolic disorder caused by a deficiency of an enzyme or
transport protein affecting glycogen synthesis, glycogen breakdown, or glucose
breakdown, typically in muscles and/or liver cells.
Catabolism: The breakdown of biochemical substances into simple substances.
- Negative Nitrogen Balance: means that your body is losing more nitrogen than it is
taking in through diet, indicating a breakdown of muscle tissue due to insufficient
protein intake or a stressful situation like illness or injury, where the body is using
 protein faster than it can replenish it. Essentially, you are losing more protein than
you are building.
- Glycogenolysis: is a metabolic process of the breakdown of glycogen in the liver and
muscles to its monosaccharide, the glucose so that the body can use this to produce
energy or ATP. The liver is involved in breaking down the glycogen to retain blood
glucose levels.

Dietary guidelines:

Dietary Reference Intakes: (DRI): acceptable range of quantities of vitamins and

minerals for each gender and age group.
- Food Guidelines
- Daily Values - needed protein, vitamins, fats, cholesterols, fiber, sodium and
potassium

Factors influencing nutrition

- Environmental factors
- Developmental Needs
- Infants through school age:
- Breast feeding, formula, introduction to solids
Mothers breastfeeding is called lactation
- Infants should have 2 -3 stools in a 24 hr period and 6 -8 wet diapers in a 24 hr
period
- The first three days the baby is getting colostrum from the mother (thick in
protein and fats)
- The stomach is only the size of a marble in the first three days of life
- At 3-5 days old the stomach is the size of gumball
- At 5 - 7 days the stomach is the size of a walnut
- Formula fed babies will eat every 3 - 4 hours, and changes as they get older
- Newborns will start out drinking 30 mLs (1 oz) and increase from there as
tolerated. Every baby is different in how much they feed.
- Babies should NOT have whole milk until one year of age, the babies digestive
system is not fully grown and would not be able to tolerate and digest the whole
milk.
- Pregnant mothers should be increasing their vegetable intake and exercising

Nutrients: the biochemical units of nutrition

- Carbohydrates (macronutrients): they provide energy and help regulate protein
and fat metabolism. They also assist with Cardiac and CNS functioning.
- 45% - 65% of carbohydrates are accounted for an individual's calories
- 4 calorie per gram of energy to increase fiber to prevent constipation
- Women 25 grams/day
 - Men 30 grams/day
- **Glycogen: is stored carbohydrates in the liver and muscles which is released in
between meals to help regulate the blood glucose in the body**
- Proteins (macronutrients): makes up 10% - 35% of calories in an individual. It
supports tissue building, metabolism, immune function, nitrogen balance, and wound
healing.
- Complete Protein: Has all 9 amino acids (ex: animal sources or soy)
- Incomplete Protein: Does not have all 9 amino acids (ex: plant based)
- Protein Deficiency: Kwashiorkor is the most severe, it is common in developing
countries where famine and imbalance diets are common. Signs and symptoms:
- Edema
- Fatty Liver
- Skin, Hair and Nail problems
- Loss of muscle mass
- Greater risk of bone fractures
- Stunted growth in children
- Fats (macronutrients): are stored energy for the body and function as padding and
insulation, hormone absorption, and fat soluble vitamins
- 20% - 35% calorie limit in an individual
- Saturated fats consumed should be less than 10%
- Fats are a main source of cholesterol, do not want to eat too much in excess
because it can lead to heart disease
- Less than 300 per day, fat provides 9 calories/gram
- Water
- Vitamins:
- Fat soluble vitamins such as A, D, E and K have a greater risk of toxicity in the
body because they are stored in the body for a much longer period of time.
- Water soluble vitamins such as vitamin C and vitamin B complex. If a person takes
too much of these vitamins they will be excreted out through the urine.
- Minerals
Water Soluble Vitamins:

Vitamin C: creates tissue building, metabolism, and iron absorption

- If you have a patient taking an iron supplement it is recommended that they eat
foods high in vitamin C for iron absorption such as citrus fruits or juices, tomatoes,
green least vegetables, and peppers.
- Conditions that impair vitamin C absorption are cystic fibrosis, Crohn's disease, and
Celiac disease
- Scurvy: is a disease caused by a severe deficiency of vitamin C in the diet. Some
signs and symptoms are bleeding, joint pain and swollen gums
- Consequences of vitamin C toxicity are that it inhibits zinc absorption and can cause
urinary stones
Vitamin B Complex: is important for metabolism, energy and nerve function.
- Foods high in vitamin B complex are meats, milk, enriched grains, grains, legumes,
green leafy vegetables
- Beriberi syndrome: a disease caused by a vitamin B deficiency, also known as a
Thiamine deficiency. There are 2 types of this disease. Wet beriberi and dry
beriberi. Wet beriberi affects the heart and circulatory system. In extreme cases,
wet beriberi can cause heart failure.
- Alcohol disorder (ETOH)
- Cheilosis: is a condition where the corners of the mouth become inflamed and can
lead to cracking and pain
- Glossitis: inflamed tongue, swollen, red and smooth
Vitamin B 12: Helps make DNA and red blood cells
- Our bodies do not make B12, we have to get it from animal based foods or
supplements
- Patients with a B12 deficiency can have atrophic gastritis which is when the
stomach lining has thinned, Pernicious anemia which makes your body absorb B12,
Crohn's disease, celiac disease, bacterial growth or a parasite, Grave’s disease and
lupus

Vitamin & Mineral deficiencies and Toxicities in Vitamin B

Vitamin B 1 (Thiamine)
- Consequences of deficiency - Wernicke's encephalopathy which is swelling around
the brain and decreases oxygen, with neurodegeneration which is when the neurons
aren’t generating properly
- Consequences of toxicity are rare
Vitamin B 3
- Consequences in deficiency - Pellagra with the 4 D’s: dermatitis, diarrhea, dementia,
and death
- Consequences of toxicity - abnormal glucose metabolism, flushing, nausea & vomiting
Vitamin B 12
- Consequences of deficiency - Pernicious anemia and psychiatric disorders
- Consequences of toxicity - Unknown
- Patients are very tired a lot, will usually need vitamin B 12 injections

Folic acid: helps the body make new red blood cells. RBC carries oxygen throughout the
body. If the body doesn’t make enough RBCs a person can develop anemia
- Foods high in folic acid are beef liver, boiled spinach, black eyed peas, asparagus,
brussel sprouts, hard boiled eggs, bananas, avocados, orange juice, lettuce
- Conditions that impair folic acid absorption are neural tube defects such as spina
bifida (tuft of hair or dimple in coccyx area), anencephaly (brain can be outside of
the skull), and depression
 - Patients that usually will have a folic acid deficiency are people with strict vegan
diets, or pregnant women who don’t want to take their folic acid and prenatal
vitamins

Fat Soluble Vitamins:

Vitamin A: assist with vision health, skeletal, soft tissue development and strength
- Foods high in Vitamin A are orange/yellow fruits and vegetables such as carrots,
apricots, cantaloupes, fatty fish, eggs, liver and dairy products
- Deficiencies in vitamin A can cause vision issues such as xerophthalmia which can
dry out your tear ducts and eyes causing night blindness and serious cornea damage
- Consequences and toxicities are loss of appetite, bone pain, and hypercalcemia
Vitamin D: helps in absorption of calcium and phosphorus and also bone mineralization
- Calcium is needed for vitamin D to absorb or it will not absorb effectively
- Exposure to the sun is a great source of vitamin D, but sunscreen should be used
- Foods that contain high amounts of vitamin D are milk, fatty fish, and eggs
- Deficiencies in vitamin D can result in Rickett’s or bone loss, calcification of soft
tissue and hypercalcemia
Vitamin E: acts as an antioxidant and helps protect the cells in our bodies from damage
- Foods that contain vitamin E are fat vegetable oil, nuts, dark green leafy
vegetables, and whole grains
- Deficiencies in vitamin E are rare but may cause muscle pain, weakness and poor
balance
**Vitamin K: is extremely important in clotting
- Foods that are high in vitamin K are dark green vegetables, carrots and eggs
- Deficiencies in vitamin K are increased bleeding time
- Vitamin K is the antidote for Warfarin (anticoagulant) which thins the blood**

Know the Large intestine and how the structures are.

In nutrition, teach pts to increase:

- fiber
- grapes
- wheat
- cereals
- apples
- oatmeal
Anthropometry: is a systematic method of measuring the size and makeup of the body
- Lab and biochemical tests: Serum Total Protein and Serum BUN are the best
indicators
- Diet history and health history
- Physical exam: assess for malnutrition, sepsis, hemorrhage, or any skin breakdown
- Dysphagia
- They do a calculation by taking the body weight divided by the height
- Ex: 165 lbs (75 kg) and 1.8 meters tall (5’9 inches), then take 75 kg divided by 1.8
which equals 23.15
- Overweight BMI is 25 to 30
- Obese BMI is greater than 30

Momentary Test: evaluates the motility in the esophagus to see how much of it is
functioning and how much is not functioning

Nursing Diagnosis for Nutritional Problems:

- Risk for aspiration

- Overweight
- Impaired low nutritional intake
- Impaired self feeding
- Impaired swallowing

Enteral Tube Feeding:

- Enteral Nutrition (EN): Provides nutrients into the GI tract. It is physiological,
safe and economical nutritional support
- Enteral Formula:
- Polymeric
- Modular
- Elemental
- Specialty
Enteral Access Tubes: When patients are unable to ingest food but are still able to digest
and absorb nutrients, the use of enteral tube feeding is supported
- Do not discharge any feeds until patient hits at least 75% of their nutritional need
Nutritional Management:
- Insert feeding tube as ordered
- Initiate enteral feeding as prescribed
- Advance tube feeding as tolerated (monitor for tolerance)
Aspiration Precautions:
- Position the head of the patient’s bed to a minimum of 30 degrees
- Check tube placement every 4-6 hours
- Check gastric residual every 4 hours. To check this you check the pH. You put the
syringe into the tubing and put in air, then pull back 5 - 10 mL of gastric content.
Then on the pH paper it should turn yellow.