• Macronutrients
  • Micro Nutrients
  • Water

• DRI's
• USDA dietary guidelines
• US food guide pyramid
• Food labels
• Healthy people 2010
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    • Carbohydrates, Proteins, Lipids

o       Basal metabolic rate (BMR)

o       Metabolism

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    • Catabolism
    • Anabolisim
  • Nitrogen balance
    • Positive nitrogen balance
    • Negative nitrogen balance

o       Infant thru school age

o       Adolescence

o       Adult

o       Older adult

o       Pregnancy and lactation

Nutrition history

Food habits

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      • Physical factors
      • Physiologic factors
      • Psychosocial factors

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      • Inadequate intake- age, state of health, changes in appetite
      • Inadequate absorption- malabsorption diseases (Crohns, Celiac, microbial infections) and medication use
      • Inadequate utilization- medication/nutrient interactions
      • Increased losses/Increased requirements-infection, surgery, vomiting, diarrhea, trauma, chronic illness, fever, NPO status, pregnancy and lactation

·        Height & Weight

·        IBW

·        Triceps skin fold measurement

·        Mid arm circumference

·        BMI

Waist circumference

o    BMI Below 18.5: Underweight

o    BMI 18.5-24.9: Normal 

o    BMI 25-29.9: Overweight

o    BMI > 30: Obese 

o    BMI > 40: Morbidly obese

·        Values >102 cm in men and >88 cm in women may indicate increased risk for cardiovascular disease (CVD) and type 2 diabetes

·        Hemoglobin (Hb) & H ematocrit (Hct)

·        Electrolyte levels

·        Serum protein: 

o       Total protein

o       Albumin

o       Prealbumin

o       Transferrin

·        Urinary tests-24 hour urine:

o       Creatinine Height Index (CHI)

o       Urinary Urea Nitrogen (UUN)

·        Total lymphocyte count (TLC)

o       Nutrition and the immune system-see Potter and Perry, Page 1298; Table 43-8

·        May reflect nutrient deficiency

·        Changes most obvious in tissue with the fastest turnover rate

o       Skin

o       Eyes

o       Mouth

o       Muscles

o       CNS

·        24 hour recall

·        Food frequency

·        Food record or diary

·        Typical day history

·        Calorie count (protein)

Mini Nutritional Assessment of the Elderly

Malnutrition

Deficit, excess, or imbalance in essential components of balanced diet

Other terms—undernutrition and overnutrition

Overnutrition:

·        Ingestion of more food than required

Protein Calorie Malnutrition:

Most common form of undernutrition

·        Primary versus secondary

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• Primary—poor eating habits
• Ingesting food deficient in protein, vitamins, minerals
• Secondary—alteration or defect in ingestion, digestion, absorption, or metabolism
• Due to GI obstruction, surgical procedures, cancer, malabsorption syndromes, drugs, infectious diseases

·        results from concomitant deficiency in caloric and protein intake

§         Generalized loss of muscle and body fat

§         Appear emaciated but have normal serum protein levels

·        deficiency of protein intake superimposed by catabolic stress event such as:

§         GI obstruction

§         Surgery

§         Cancer

§         Malabsorption syndrome

§         Infectious disease

May appear well nourished, have low protein levels

Muscles wasted and flabby

Delayed wound healing

More susceptible to infection

Humoral and cell mediated immunity deficient

↓ in leukocytes in peripheral blood

Phagocytosis altered

Anemia

o       Disease process/condition

o       Changes in weight

o       Diet history

o       Medications

o       Laboratory test results

o       Physical examination

o       Anthropometric measurements

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  • Monitor lab values as appropriate
  • Daily weights
  • I & O’s
  • Daily calorie count
  • Ensure that adequate diet is delivered and consumed (high Kcal/protein)
  • Pleasant environment
  • Remove sources of odor
  • Encourage pt. to eat in a slow relaxed  manner
  • Provide skin care and encourage activity
  • Pharmacological interventions when gut must be bypassed
  • Depending on cause of malnutrition may give:
    • Vitamins, minerals, antiemetics, antidiarrheals, antibiotics, insulin and TPN
  • Reinforce diet teaching provided by the dietician
  • Help patient choose high-calorie, high protein foods
  • Discharge planning

Loss of appetite or desire to eat common in the hospitalized patient

Physical illness

Unfamiliar or unpalatable food

Environmental factors

Physical discomfort or pain (often accompanied by a decrease in fluid intake)

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  • Monitor food intake
  • I & O’s
  • Electrolytes
  • Daily weights

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  • Familiar food
  • Small portions
  • Unpleasant or uncomfortable treatments
  • Tidy, clean environment
  • Oral hygiene
  • Relieve illness symptoms
  • Reduce psychological stress

• Common manifestations of GI diseases
• Infectious diseases
• CNS disorders
• CV problems
• Side effects of drugs
• Stress & pain
• Pregnancy

o       Usually occurs before vomiting

o       Related to slowing of gastric motility and emptying

o       Subjective complaint

o       Usually accompanied by anorexia

o       Coordinates events related to vomiting

o       Receives input from various stimuli

o       Can occur when the GI tract becomes irritated, excited, or distended

o       Vomiting can be a protective mechanism

o       Dehydration can rapidly occur when prolonged

o       Water and essential electrolytes are lost

o       Metabolic alkalosis—from loss of gastric HCl

o       Metabolic acidosis—from loss of bicarbonate if the contents from the small intestine are vomited

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  • Determine precipitating factors/cause
  • Determine amount and frequency
  • Differentiate among vomiting, regurgitation, and projectile
  • Contents of emesis
  • Metabolic alkalosis (vomiting of stomach HCL)
  • Pulmonary aspiration-patient who is elderly, unconscious, or has conditions that impair gag reflex

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  • Accurate I and O
  • Monitor vital signs
  • IVF management
  • Monitor electrolytes/acid base balance
  • Daily weights
  • Odor free room
  • No pain or needing nursing care
  • Mouth care
  • Positioned correctly (semi-Fowler’s or side-lying)
  • Clear liquids:
  • Small frequent meals
  • Cold foods
  • Administer antiemetics as ordered
  • NGT management
  • Nondrug therapy

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    • 5 to 15 ml fluid every 15 to 20 minutes
    • Use Gatorade, broth with caution because of high sodium

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    • Acupuncture
    • Acupressure
    • Botanicals
    • Ginger
    • Peppermint oil
    • Breathing exercises

Imbalance between energy expenditure and energy intake from a long-term sedentary lifestyle and/or excessive calorie intake     

* Obesity is an abnormal increase in the proportion of fat cells    

* Has reached epidemic proportions in developed and under-developed countries    

* In the United States:  Most common nutritional problem  Affects one third of the population  Second leading cause of preventable death  Third leading reason for liver transplantation  Processes leading to obesity are very complex and still undergoing investigation

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    • Vitamins, Minerals