table of content

1. Malnutrition
2. Carbohydrates
3. Protein
4. Fat/Lipids
5. Fat-Soluble Vitamins
a. Vitamin A
b. Vitamin D
c. Vitamin E
d. Vitamin K
6. Water-Soluble Vitamins
a. Vitamin C
b. Vitamin B
7. Electrolytes: Sodium, Potassium, Chloride, Calcium,
Magnesium, Phosphorus
8. Nutrition during Pregnancy
9. Therapeutic Diets
10. Food-Drug Interaction
11. Types of Vegetarian Diets
12. Recommended diets and disorders
13. Enteral Feeding
14. Parenteral Nutrition
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Malnutrition
Malnutrition
Malnutrition is the inadequate
intake of nutrients (nutritional
imbalance).

Factors of Malnutrition
1. Social factors: low income, lack of
access to food, age, body mass index
culture/religion. Is a measure of body fat based on
height and weight.
2. Psychological factors: Depression Body Mass Index (BMI):
and eating disorders. WEIGHT(kg)/HEIGHT (m2)

malnutrition
signs and symptoms nursing interventions
1. Body weakness 1. Malnutrition assessment.
2. Weight loss 2. Assess the factors that is
causing the malnutrition.
3. Poor wound healing 3. Listen to the client's
4. Brittle hair concerns.
5. Brittle nails 4. Identify patient's dietary
6. Edema preferences.
5. Encourage family
7. Poor concentration involvement.
6. Educate patient on the
importance of a balanced
NUTRITIONAL ASSESSMENT diet.
7. Set an eating schedule
1. Subjective Global with patient.
Assessment: an 8. Educate patient on
assessment tool that nutritional supplements.
9. Refer client to counseling
evaluates individual's if necessary.
nourishment.
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carbohydrates
carbohydrates
complex carbs Polysaccharides
Functions:
carbohydrates

1. Starch
2. Fiber 1.Energy:
3. Glycogen
carbohydrates is
the main source
of energy for the
body.
simple carbs

Monosaccharides
1. Glucose
2. Fructose
3. Galactose
2.Prevents glycogen
ketosis: with the Glycogen is stored glucose in the
Disaccharides: lack of glucose, liver and muscles. Glycogen is broken
1. Sucrose
2. Maltose ketosis can occur. down to release glucose into the
3. Lactose bloodstream.

carbohydrates
Sources of Fiber/carbs patient education
1. Bread 1. Reduce the intake of
2. Grains added sugars.
3. Nuts
4. Pasta 2. Increase the intake of
5. Oatmeal fruits and vegetables.
6. Rice 3. Reduce the intake of
7. Vegetables: potatoes,
corn foods with refined
8. Fruits: apple, banana, grains.
orange 4. Substitute refined
Fun facts grains with whole
Recommended fiber intake grains.
a. Men: 38g/day 5. Prevent dental caries
b. Women: 25g/day by reducing the intake
Carbohydrates: provide 4 of added sugars.
calories/g of energy.
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protein
protein
Amino acids are the building
blocks of proteins.
There are 9 essential amino
acids.
Complete proteins: provides all
9 essential amino acids (animal
protein).
Incomplete proteins: plant Protein synthesis
based protein (essential amino Protein synthesis is the process of
creating proteins from amino acids
acids are present in an needed to support growth and
insufficient quantity). development.

protein
SOURCES OF PROTEINS Functions
Complete Proteins 1. Metabolism
1. Meat 2. Enzymes
2. Milk 3. Nitrogen balance
3. Eggs, cheese, yogurt 4. Acid-base balance
4. Seafood, poultry 5. Wound healing
Incomplete proteins 6. Supports immune function
1. Legumes, nuts 7. Fluid balance
2. Vegetables, seeds
Protein deficiency Patient education
Protein energy 1. Consume a variety of
malnutrition(PEM): protein and protein rich foods under
calorie deficit the recommended
1. Kwashiorkor allowance.
2. Marasmus 2. Consume proteins that
Recommended dietary
is lower in fats.
allowance for protein is 0.8g/kg
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fats/lipids
fats/lipids
Fatty acids are the building
blocks of fats.
Triglycerides: a type of lipid
found in the blood
Glycerol: the backbone of
triglycerides (a 3 carbon atom
chain)
Low-density lipoprotein (LDL) FUN FACT
cholesterol-bad cholesterol Fat- 20-35% of calories
High-density lipoprotein (HDL) Consume less than 10% of
cholesterol-good cholesterol calories from saturated fatty
acids.

fats/lipids
Sources of fats/OILS Functions
1. Milk 1. Stored energy to fuel the
2. Red meats body
3. Avocado 2. Protect organs from injury
4. Egg yolks 3. Provides insulation
5. Nuts 4. Facilitates in the absorption
6. Cheese of fat-soluble vitamins
7. Margarine 5. Hormone production

FAT deficiency Patient education

Fatty acid deficiencies are typically Educate the patient on the
rare.
health risks (heart disease,
Cholesterol intake: less than obesity, etc) when there is
300mg/day an increase intake of
Fats-provides 9 calories/gram saturated fats.
of energy
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FAT-SOLUBLE VITAMINS
solubility
Vitamin absorption, transportation,
storage, and excretion are all
determined by solubility.

FAT-SOLUBLE VITAMINS
ABSORPTION TOXICITY
Fat-soluble vitamins are High intake of fat-soluble
absorbed into the lacteals in vitamins can be toxic. Should
the small intestine via
not be consumed daily
chylomicrons, transported
through the lymphatic because it is stored in the
system, and finally released body for a long period of
into the blood stream. time.

Transportation diseases
Fat-soluble vitamins attach to Cystic fibrosis, liver disease
intracellular carrier proteins and Crohn's disease impair
the absorption of fat-
sTORAGE
Primarily stored in the liver and soluble vitamins.
adipose tissue.
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FAT-SOLUBLE VITAMINS
Vitamin A
benefits/functions
Vitamin A plays a role in maintaining
normal vision and immune function

sources
deficiency PREFORMED VITAMIN A
1. Vision disorder/loss
2. Xerophthalmia FATTY BEEF + LIVER EGG YOLK
FISH BETA-CAROTENE

CARROTS SPINACH APRICOT

Vitamin D
benefits/functions
A fat soluble vitamin that helps the
body absorb and maintain serum
calcium and phosphorus concentrations.
sources
deficiency
1. Rickets (infants & children) SUNLIGHT EGGS
2. In adults-osteomalacia
(bones become soft)
FORTIFIED FATTY
MILK FISH
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FAT-SOLUBLE VITAMINS
Vitamin E
benefits/functions
Vitamin E acts as an antioxidant &
protects the cell membranes.

sources
deficiency
1. Muscle weakness
2. Impaired reflexes VEGETABLE OIL DARK GREEN NUTS
VEGETABLES
and coordination
WHOLE GRAINS WHEAT GERM SEEDS

Vitamin K
benefits/functions
1. Aids in the synthesis of blood
clotting proteins.
2. An essential vitamin for bone health.
sources
deficiency
DARK GREEN VEGETABLES
1. Hemorrhaging (SPINACH, KALE)

CARROTS EGGS
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water-SOLUBLE VITAMINS
solubility
Vitamin absorption, transportation,
storage, and excretion are all
determined by solubility.

B vitamins (thiamin, riboflavin, niacin,

folate, B6, B12, biotin, and pantothenic
acid)

water-SOLUBLE VITAMINS
ABSORPTION TOXICITY
Absorbs directly into the Water-soluble vitamins
bloodstream
are non-toxic.

Transportation
Water-soluble vitamins
are dissolved in water consumption
and transported
Water-soluble vitamins are
throughout the body.
not stored in the body and
must be consumed each
excretion
Water-soluble vitamins are day.
excreted by the kidneys.
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water-SOLUBLE VITAMINS
Vitamin C
benefits/functions
1. Promotes iron absorption
2. Growth, development and repair of
all body tissues.
sources
deficiency
1. Scurvy- joint pain,
hemorrhaging, swollen + CITRUS FRUITS PEPPERS TOMATOES

bleeding gums
KIWIFRUIT BROCCOLI CANTALOUPE

Vitamin B COMPLEX
benefits/functions
1. Vitamin B complex aids in metabolism
2. Promotes nervous system functioning

sources
deficiency
Thiamin (Vit B1)- Beriberi
Riboflavin (Vit B2)- Glossitis,
Dermatitis, Cheilosis MEATS FISH + GREEN LEAFY
Cobalamin (Vit B12)- pernicious LEGUMES VEGETABLES
anemia
Biotin- rare (dry skin, brittle
nails, hair thinning). MILK + DIARY WHOLE-GRAIN EGGS
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ELECTROLYTES
SODIUM
Sodium helps to maintain concentration
of extracellular fluid, neuromuscular
function, sodium-potassium pump and
acid-base balance.

Sources: processed foods, fast foods,

SODIUM salt
HYPERNATREMIA HYPONATREMIA
1. Increased BP 1. Decreased BP
2. Edema 2. Dizziness
3. Confusion
4. Headache
PROCESSED FOODS

POTASSIUM
Potassium is mostly found in the
intracellular fluid. Potassium
participates in potassium-sodium pump
and neuromuscular function.
Sources: potatoes, bananas, avocados,
spinach (dark green vegetables)
POTASSIUM
HYPERKALEMIA HYPOKALEMIA
1. Muscle 1. Dysrhythmias
weakness, 2. Vomiting,
2. Dysrhythmias
3. Confusion 3. Decreased
peristalsis
BANANA
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ELECTROLYTES
chloride
Component of hydrochloric acid in the
stomach.
Maintains fluid and electrolyte balance

Sources: Salt
CLORIDE
Hyperchloremia Hypochloremia

Nausea/Vomiting Muscle cramps

GI disturbance

SALT

CALCIUM
Bone strength, muscle function, cardiac
conduction and participates in the
sodium-potassium pump.

Sources: Milk, cheese, diary products,

CALCIUM dark green vegetables.

HYPERCALCEMIA HYPOCALCEMIA
1. Constipation Paresthesia, muscle
2. Renal stone
formation spasms, Trousseau
3. Bone pain signs, + Chvostek
4. Lethargy signs
5. Low DTR
CHEESE
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ELECTROLYTES
magnesium
Found in the bones. Aids in nerve
function, regulates BP, and muscle
contraction.
Sources: Spinach, milk, nuts, beans,
almonds, whole grains.

MAGNESIUM Remember: Magnesium and Calcium = SAME

HYPERMAGNESEMIA HYPOMAGNESEMIA

Hypotension, Hypertension,
tachycardia,
bradycardia, low Arrhythmias,
RR, low DTR's, Hyperreflexia
drowsiness, coma Tetany,+ Chvostek
SPINACH signs,Positive Trousseau's

PHOSPHORUS
Aid in bone and teeth formation and
maintenance.

Sources: Dairy, meat, fish, eggs,

legumes, dark green vegetables.

PHOSPHORUS Remember: Calcium and Phosphate = INVERSE

Hyper- Hypo-
phosphatemia phosphatemia
You would see signs You would see signs
of hypocalcemia of hypercalcemia

CALCIUM CALCIUM
DAIRY
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NUTRITION during pregnancy

ITEM RECOMMENDATION

calories 300-500 additional calories

WEIGHT GAIN Total weight gain: 25-35lbs

Recommendation: 600
FOLIC ACID micrograms (mcg) of folic acid
daily.
Calcium supplements
Diary foods
CALCIUM Dark, leafy green vegetables
Important for fetus: Bone and
teeth formation

Recommendation: 2-3L/day
fluid intake No alcohol, Limit caffeine
Increase protein in diet.
Vitamin B12 is found in animal
PROTEIN vit b12
protein. PROTEIN
= defeciency

iron Build hemoglobin for fetus

Vitamin D: for calcium absorption

VITAMINS Increase fruits and vegetables

FIBER To prevent/reduce constipation

 4 THERAPEUTIC DIETS
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Clear- Liquid Diet FULL LIQUID DIET
A clear liquid diet is a diet consisting Clear fluids that are thicker (opaque).
of exclusively light clear liquid at
room temperature. Use: short-term diet used as a
transition step between clear liquids
Use: post-surgically and soft diet.

WATER BROTH FRUIT JUICE ICE THIN

CREAM PUDDING
CEREALS

TEA COFFEE CLEAR SODAS MILK SOUP JELLO

pureed diet MECHANICAL SOFT DIET

A puréed food diet is a texture- Foods that are easy to chew and
modified diet (requires no chewing) swallow

Use: patients who have trouble Use: patients who have trouble
chewing or swallowing chewing or swallowing

MASHED PUREED PUREED TENDER GROUND CHOPPED

POTATO PASTA RICE FRUITS MEAT FOODS

YOGURT PUMPKIN PUREE COOKED VEGES TOFU

 food-drug interaction
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Food medication
Grapefruit/Grapefruit juice: Affects some
medications, in
particular statins

STATINS
Vitamin K-Rich Foods: Antagonize the
anticoagulant
effect of Warfarin

warfarin
Dairy Products Interferes with
some antibiotics.
Recommendation:
not be consumed
until 3 hours after
a dose of
antibiotics antibiotics

High-Tyramine Foods Patients taking

MAOIs: May result
in hypertensive
aged cheeses

crisis.
MAOIs

High-Potassium Foods May increase K

levels among
patients taking K-
sparing diuretics
and ACE inhibitors k-sparing
diuretics
 Types of Vegetarian Diets
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Lacto-ovo-vegetarian diet
Exclude: meat and fish
Include: eggs and dairy
products

Lacto-vegetarian diet
Exclude: meat, fish and eggs
Include: dairy products

Ovo-vegetarian diet
Exclude: meat, fish and dairy products
Include: eggs

Flexitarian diet: includes a plant-based diet and also being

flexible by incorporating meat and animal products.

Pescatarian diet
Exclude: meat (dairy and eggs depend on personal
preference)
Include: fish

Vegan diet: A vegan diet is entirely based on plant foods

 recommended diets and
disorders nursebossstore.com
Anorexia Bulimia
anemia
Nervosa Nervosa
Nutritional counseling Weigh patient daily. Increase iron, Vitamin
Supplements Nutritional B12 + Folic Acid
Small/frequent meals counseling
Weigh patient daily.
Psychological therapy Psychological
therapy

Coronary Myocardial
Artery disease Heart failure
infarction
Low fat diet Fluid restriction
Low cholesterol diet Low sodium
Low fat diet Low sodium diet
Low cholesterol

hypertension GASTRITIS peptic ulcer

disease
Avoid spicy foods, Avoid spicy foods,
Dash Diet NSAIDS, caffeine
Low sodium NSAIDS, caffeine
alcohol + smoking alcohol + smoking

Ostomies dumping syndrome gerds

Avoid nuts, seeds + Dry foods Avoid spicy + fatty
popcorn Small frequent meals. foods.
Increase fluid, protein Eat a source of protein + Avoid juice (citrus).
and calorie intake fat at each meal. Avoid alcohol,
Avoid foods that Avoid diary. caffeine and
causes gas and odor carbonated
beverages.
 recommended diets and
disorders nursebossstore.com
hepatic
celiac disease hepatic disease encephalopathy
Gluten-free diet No alcohol Low protein diet
Avoid foods that
contain barley, wheat
or rye.

CHOLECYSTITIS Inflammatory
Diverticulitis bowel disease
Acute phase: clear TPN during acute phase
Low fat diet liquid diet. Low fiber, high calorie +
Low residue diet protein diet
Avoid nuts, seeds
and popcorn.

PANCREATITIS crohns disease DIARRHEA/Vomiting

NPO during acute Low fat diet Electrolyte

pancreatitis High protein diet replacement
Low fat, high protein Low residue diet Increase fluids
diet

Constipation Lactose
stomatitis
intolerance
Increase fluid intake Lactose- Avoid hot beverages and
High fiber diet foods as well as salty,
free diet spicy, and citrus-based
foods.
 recommended diets and
disorders nursebossstore.com
hyperglycemia hypoglycemia diabetes

Assess glucose level Assess glucose level. Limit sugars/simple

Insulin administration Administer 15g of simple carbohydrate.
carbohydrates
as prescribed. Recheck blood glucose Nonfat or low-fat dairy
level in 15 minutes Increase physical
Administer 15 g of simple activity.
carbohydrates if
necessary.

Renal Calculi Acute Kidney Nephrotic

Injury Syndrome
Increase fluid intake. Protein-restricted diet. Low sodium diet
Uric acid stones: decrease
Decrease sodium + Moderate in protein
high-purine foods.
Calcium Oxalate Stones: potassium intake
decrease foods that have (depending on the
high levels of oxalate
(rhubarb, spinach). phase)

burns cystic fibrosis underweight

High protein diet Increase fluids Increase calories

High carbohydrate diet Increase protein
Increase calories intake

obesity cancer hiv/aids

Low fat diet High-protein diet Small, frequent meals
Calorie restriction High-calorie diet High-protein, high-
calorie diet
 fun facts
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1. A patient with COPD: small frequent meals,
high-calorie diet.
2. A patient with Gout: low-purine diet.
3. Addison disease: low potassium diet.
4. A patient with pressure ulcer(s): high protein
diet.
5. A patient receiving dialysis should be on a
sodium restricted diet (renal disease).
6. Patients on potassium-sparing diuretics: low
potassium diet due to the risk of hyperkalemia.

ENTERAL FEEDING
1. Enteral feeding: intake of food via GI tract
2. Nutrition through a tube that goes into the stomach or
intestines
indications:
1. Impaired swallowing
2. Inability to consume adequate nutrients
3. Critical illnesses
4. Prolonged anorexia

Nasogastric tube: gastrostomy tube:

A tube from the nose to to the A tube placed through the abdomen
stomach. into the stomach
THE BASICS OF

PN
parenteral
nutrition
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Parenteral Nutrition
Parenteral Nutrition (PN) is the administration of nutrients through
the veins (central vein)
types
Partial Total
Parenteral Parenteral
Nutrition Nutrition

provide only part of provide all daily

daily nutritional nutritional
requirements requirements

nutrients
1. Proteins (amino acids)
2. Carbohydrates (dextrose)
3. Fats
4. Minerals & Electrolytes
5. Vitamins

Parenteral nutrition is directly given through an IV catheter into the

blood stream (vein) and bypasses the normal GI digestion.
INDICATIONS
1. Impaired food intake
2. Impaired nutrients digestion
3. Impaired absorption
4. Gastrointestinal trauma
5. Bowel obstruction
Oral + NG tube feeding are
6. GI surgeries
alternatives to be considered before
parenteral nutrition is initiated.
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Parenteral Nutrition
nutrients
Carbohydrates:
Concentration depends on patient. Carbs provide 60-70% of
energy needs

Lipids:
Lipids provide 30% of energy needs

Protein (amino acids):

Proteins provide 15-20% of energy needs. Concentration
range from 3.5%-20%

Vitamins
contains standard multivitamin mix/concentration

Minerals
Available in different concentrations

Water
The amount of water is determined by the fluid requirement

Electrolytes
The electrolyte requirement varies based on the individual

Insulin
Insulin may be added to control the blood glucose level

Heparin
Heparin may be added to prevent/reduce clots
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Parenteral Nutrition
COMPLICATIONs
Hyperglycemia: Hypoglycemia:
Causes: Causes:
1. Too much dextrose in the solution 1. Solution discontinued suddenly
2. Solution being administered quickly

Nursing Actions:
Nursing Actions: se
se 1. Notify physician o
1. Slow the infusion rate
ro xtr
2. Monitor blood glucose
ext 2. Administer IV dextrose De
3. Administer insulin D 3. Monitor blood glucose

Hypervolemia: Infection:
Causes: Causes:
1. Administering a large fluid volume 1. Poor aseptic technique
2. Administering fluid rapidly
Nursing actions:
Nursing Actions: 1. Notify physician
1. Stop infusion 2. Remove the catheter
2. Administer diuretics 3. Obtain blood cultures
3. Fluid restriction 4. Administer antibiotics

Pneumothorax: Adverse reactions to lipid emulsions :

Causes: Causes:
1. Improper catheter placement 1. Lipids emulsions should not be
given to patients allergic to eggs
Nursing Actions:
1. Notify physician Signs and Symptoms:
2. Obtain chest xray 1. Chest pain, Chills
3. Depending on the pneumothorax, a 2. Dyspnea, Vertigo, nausea, vomiting
chest tube may be required 3. Flushing, Fever
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Parenteral Nutrition
types of administration
Continuous Intermittent
Infused continuously >24hours Over an intermittent period. Monitor
for hypoglycemia

Continuous
Intermittent
Mostly used among patients Mostly used among patients in
in the hospital long term parenteral nutrition

Nursing Considerations
1. Check the PN solution against the doctor's orders
2. PN solution should be administered within 24 hours after preparation
3. Monitor blood glucose level
4. Monitor fluid and electrolytes
5. Monitor renal and liver function lab values
6. Monitor for signs of complications
7. When a nurse is waiting for a new solution and the IV bag is empty,
10% dextrose (as prescribed) should be infused to prevent
hypoglycemia

Discontinuing Therapy
1. Nutritional status must be evaluated by a nutritionist
2. Remember: sudden discontinuation can cause hypoglycemia. The rate
should be decreased gradually
3. Monitor oral intake
 references

Dudek, S. G. (2017). Nutrition essentials for nursing

practice. LWW.
John, S. (2016). Essentials of nutrition and dietetics for
nursing. Wolters kluwer india Pvt.
Silvestri, L. A., & CNE, A. E. (2019). Saunders
comprehensive review for the NCLEX-RN examination.
Saunders.
Tucker, S. B., & Dauffenbach, V. (2011). Nutrition and diet
therapy for nurses. Prentice Hall.