NUTRITION IN NURSING

DEFINITION

 Nutrition is the process by which the body

metabolizes and utilizes nutrients.
 Nutrients are chemical compounds in food that are used
by the body to function properly and maintain health.
They are classified as energy nutrients, organic nutrients
and inorganic nutrients.
 Energy nutrients release energy for
maintenance of homeostasis. These are
carbohydrates, proteins and fats.
 Organic nutrients build and maintain body
tissues and regulate body processes.
Examples are carbohydrates, proteins, fats and
vitamins.
 Inorganic nutrients provide a medium for

chemical reactions, transport materials, maintain

body temperature, promote bone formation and
conduct nerve impulses. These are water,
minerals.
 NUTRIENTS

Understanding the role of basic nutrients

provides the foundation for selecting foods
that promote good health.
There are six categories of nutrients:
Water
Vitamins
Minerals
Carbohydrates
Proteins
Lipids(fats)
SIX CLASSES OF
NUTRIENTS
Water
 The most abundant nutrient in the body 70% in
adults, 77% in infants weight.
 Major components of body fluids, secretions and
excretions.
 Body water decreases as body fat increases and
with aging.
Vitamins
 These are organic compounds that regulate
cellular metabolism, assisting the biochemical
processes that release energy from the digested
food, water soluble and fat soluble.
Minerals
Serve as catalysts in biochemical reactions.
Classified as macro and micro minerals.
Macro nutrients have quantities of 100mg or
greater e.g., calcium, phosphorus, and magnesium.
Micro nutrients have trace elements with
quantities less than 100mg e.g., fluoride, iodine,
iron, zinc which play an essential role in
metabolism.
Carbohydrates

 These are organic compounds composed of

carbon, hydrogen and oxygen.
 They play a significant role in providing cells
with energy and supporting the normal
functioning of the body.
 Carbohydrates are classified according to the
number of saccharides (sugar units).
1. Monosacharides (simple sugar) include
glucose, galactose and fructose.
2. Disaccharides (double sugar) include
sucrose, lactose and maltose.
3. Polysaccharides (complex sugars) include
glycogen, cellulose and starch.
 Glucose supplies the major source of
energy needed for cellular activity such as
nerve impulse transmission, muscle
contractions etc.
 Glucose is also needed for the synthesis
of fatty acids and amino acids.
 Glucose metabolism is dependent on the
availability of insulin.
NOTE:
hyperglycemia is blood sugar level of
> 11 0 m g / d l ( f a s t i n g )
hypoglycemia sugar level of < 8 0 m g / d l
(fasting)
 Proteins

 These are organic compounds that contain

carbon, hydrogen and nitrogen atoms.
 They are important for every bodily function
beginning with the genetic control of protein
synthesis, cell function and cell reproduction.
 The end product is amino acid, 20 in number
and categorized as essential and nonessential
amino acids.
- Essential amino acids must be ingested in the
diet because they cannot be synthesized by the
body.
- Nonessential amino acids can be synthesized
(manufactured) in the cells.
- Transport of amino acids into the cells is
enhanced by potassium and magnesium
electrolytes.
Lipids

 These are organic compounds insoluble in

water but soluble in organic solvents such
ether and alcohol.
 They are classified as saturated and
unsaturated fatty acids.
Saturated fatty acids lack double bonds
between the individual carbon atoms & tend to
be solid at room temperature and from animal
sources

Unsaturated fatty acids have at least one

double bond in the fatty acid chain & are
usually liquid and from plant sources.
FACTORS AFFECTING
NUTRITION

 Development  Health
 Sex  Alcohol consumption
 Ethnicity and culture  Advertising
 Beliefs about food  Psychological factors
 Personal preferences
 Religious practices
 Lifestyle
 Economics
 Medications and therapy
 STANDARDS FOR A HEALTHY
DIET

 THE FOOD GUIDE PYRAMID AND MYPLATE

MYPLATE
ASSIGNMENT!

 Classify nutrients.
 What is the concept of food guide
pyramid?
 ALTERED NUTRITION
 Malnutrition:

Lack of necessary or appropriate food substances but in practice

includes both under nutrition and over nutrition.
 Overnutrition:

Refers to a caloric intake in excess of daily energy requirements

resulting in storage of energy in the form of adipose tissue.
 Undernutrition:

Refers to intake of nutrients insufficient to meet daily energy

requirements because of inadequate food intake or improper
digestion and absorption of food.
 Protein-calorie Malnutrition:

Seen in starving children of underdeveloped countries, is also

now recognized as significant problem of clients with long term
deficiencies of in caloric intake.
ASSESSMENT

 The goal of a nursing assessment is to collect

subjective and objective data regarding the
nutritional status of the patient and determine
what type of nutritional support is needed.
 Nurses are in a unique position to recognize

malnutrition or alterations related to

inadequate intake, disorders of digestion,
absorption or overeating.
 The assessment has the following components:
nutritional history
physical examination
diagnostic and laboratory data
A. Nutritional History
This is important in the development of a care
plan for a patient experiencing alterations in
nutrition and metabolism. Several methods are
used to collect subjective data; 24 hour dietary
recall, food frequency questionnaire, food
record and diet history
B. Physical Examination
A physical assessment requires decision making,
problem solving and organization.
The nurse should be aware of rapidly
proliferating tissues such as hair, skin , eyes lips
and tongue that usually show nutrients
deficiency sooner than other tissues. Intake and
output are critical measurements and daily
weight for some conditions.
C. Diagnostic And Laboratory Data.
This is objective data which can show alterations
in nutrition.
BODY WEIGHT STANDARDS

The most preferable method to establish

ideal body weight include “ body mass
index”(BMI)

BMI=weight in kg /(Height in meter)²

ASSESSMENT OF NUTRITIONAL
NEEDS

ABCD method
1. A-anthropometry
2. B-biochemical/laboratory method
3. Clinical methods
4. Dietary method
1. Anthropometric-length, height, weight, head
circumference, mid arm circumference, chest circumference
2. Biochemical-blood and urine test Lab test results can be
altered by medications, hydration.
3. Clinical-
Nutritional history
Clinical examination of eye, mouth, hair, muscles, bones, nails,
skin, tongue, thyroid glands.
4. Dietary-
1. 24 hours dietary recall
2. Food frequency record
3. Food diary
4. Diet history
DIAGNOSING

 NANDA International includes the following

diagnostic labels for nutritional problems:
 Imbalanced nutrition: less than body requirements
 Obesity
 Overweight
 Readiness for Enhanced Nutrition
PLANNING

 Major goals for clients with or at risk for nutritional

problems include the following:
 Maintain or restore optimal nutritional status
 Promote healthy nutritional practices
 Prevent complications with malnutrition
 Regain specified weight
 EXPECTED OUTCOMES FOR A CLIENT
WITH IMBALANCED NUTRITION

 Client maintains intake and output balance.

 Clientconsumes the proper amounts of food
from the six food groups.
 Client complies with diet therapy.
 Client tolerates tube feeding without
experiencing nausea, vomiting and diarrhea.
 Clientremains infection free while receiving
parenteral nutrition.
IMPLEMENTATION

 Nursing interventions to promote optimal nutrition

for hospitalized clients are often provided in
collaboration with the primary care provider who
writes the diet orders and the dietitian who informs
client about special diets.
 It may include:
 Assisting with special diets
 Client teaching
 Client teaching may involve:
 Healthy nutrition
 Dietary alterations
 Discuss factors that predispose to weight
gain
 Discuss factors that contribute to
inadequate nutrition and weight loss
 INITIATING DIET THERAPY

 Nutritional problems often require dietary

modifications with consideration to patients
culture, socioeconomic, psychologic and
physiologic status.
 Modified diets should promote effective
nutrition within clients lifestyle.
 This requires teaching the avoidance of certain
foods or adding food items to the diet.
 TYPES OF DIET

 NOTHING PER MOUTH

 This is a diet modification as well as fluid restriction.
 This intervention is prescribed prior to surgery and certain
diagnostic procedures, or when patient‘s nutritional
problems have not been identified.

 CLEAR LIQUID DIET

 Dairy products are not allowed on a clear liquid diet.
 The patient is allowed to ingest only liquids that keep the
GIT empty(no residues), such as water and apple juice.
 LIQUID DIET
 A full liquid diet consisting of various types of
liquids is prescribed mainly for post operative
patients because of calorie and nutrient
consideration.
 If a client tolerates a liquid diet without nausea or
vomiting and has normal bowel sounds the diet is
progressed to as tolerated.
 SOFT DIET
 A soft diet promotes the mechanical digestion of
foods.
 It is prescribed for clients experiencing difficulties in
chewing and swallowing as well as post operative
patients.
 LOW RESIDUE DIET
It has reduced fiber and cellulose.
Prescribed to decrease GI mucosa irritation in patients
with ulcerations.
Foods to be avoided are raw fruits except banana,
vegetables, seeds, plant fibers and whole grains.
 HIGH FIBER DIET
 The opposite of low residue diet.
 It increases the forward motion of the indigestible
wastes through the colon.
 BLAND DIET

 It eliminates chemical and mechanical food

irritants such as fried foods, alcohol and caffeine.
Other types of diets are sodium restricted diet and
fat controlled diet.
 IMPORTANCE OF PROVIDING
NUTRITIONAL SUPPORT

 Proper nutrition in hospitalized clients is

necessary for wound healing, recovery,
reduction in morbidity and consequently
reduction in length of stay and mortality.
 Because eating is a social activity, the nurse
should encourage a family member to be
present during meals.
 FACTORS TO CONSIDER DURING
NUTRITIONAL SUPPORT

 Clean patients mouth to expose the taste buds

which promotes food intake.
 Provide a clean and quiet environment to avoid lose
of appetite due to unattractive environment.
 Provide small frequent meals. They do not demand
for a lot of work to finish and they are attractive.
 Provide food that the patients likes if possible.
 Present meals in attractive manner as this promotes
appetite
 ROUTES FOR DELIVERY OF NUTRITION

 There are two routes namely enteral (EN) route

and parenteral(PN) nutrition.
a) Enteral nutrition includes both the ingestion of
food orally and the delivery of nutrients through
a gastrointestinal tube.
b) Parenteral nutrition refers to nutrients
bypassing the small intestines and entering the
blood directly.
Enteral nutrition is preferred over parenteral
because of decreased bacterial traslocation and
reduced expense and is usually delivered through
a feeding tube.
POINTS TO CONSIDER WHEN CHOOSING
FEEDING ROUTE

 Gastrointestinal function.
 Expected duration of therapy.
 Aspiration risks.
 The potential for or the actual development of
organ dysfunction.
Enteral feeding maintains the structural and
functional integrity of the GIT. It enhances the
utilization of nutrients and provide a safe and
economical method of feeding
 CONTRAINDICATIONS

Enteral route is contraindicated in clients with

the following.
 Diffused peritonitis.
 Intestinal obstruction that prohibits normal
bowel functioning.
 Projectile vomiting.
 Paralytic ileus.
 Severe diarrhea
 TUBE FEEDING

 Naso enteral insertion is the simplest and

most commonly used method of tube feeding.
 Used as a temporary measure for clients
expected to resume oral feeding.
 Nutrients are in liquid form so they can easily
pass through the tube, be digested and
absorbed.
 EVALUATING

The nurse might consider the following questions:

 Was the cause of problem correctly identified?
 Was the family included in the teaching plan?
Are family members supportive?
 Is the client experiencing symptoms that cause
loss of appetite(e.g., pain, nausea, fatigue)?
 Were the outcomes unrealistic for this person?
 Were the client’s food preferences considered?
 Is anything interfering with digestion or
absorption of nutrients(e.g., diarrhea)?
 REFERENCES

 Kozier & Erb's Fundamentals of Nursing, 11th edition

 CRAVEN - FUNDAMENTALS OF NURSING.
 Taylor Lillis Lemone Lynn (2015) fundamentals of nursing,
7thedition,Wolters Klewer(pg no :1154-1173)
 Chandra Sekar(2016) Manipal manual of medical physiology, 1st
edition.
 Essentials of nutrition and dietary for nursing(2017)