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Nutrition - USM NURSING 306 Nursing Fundamentals - Carrie T.
Nutrition - USM NURSING 306 Nursing Fundamentals - Carrie T.
28
Nursing
Undergraduate 4
05/20/2014

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Term
Nutrients
- nutrition
- essential
- macronutrient
- micronutrient
Definition
Nutrition - specific biomechanical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance, and recovery from illness

Essential - not synthesized by the body or made in inefficient amounts so must be provided through food or supplements

Macronutrients - carbs, fat, protein
Micronutrients - vitamins, minearls

Nonessential - do not need to be supplied through dietary sources and are not required for body functioning or are synthesized by the body in adequate amount (example excess carbs and protein into fat and stored as triglyceride)
Term
Basal Metabolism
Definition
energy required to carry on activities at rest.
- body temp, muscle tone, secretions, peristalsis, lung inflation, heart contraction. Men have a higher BMR then women

MEN = 1 cal/kg of body weight per hour
Women = .9 cal/kg

Factors effecting: growth, infection, fever, stress, temp, hormone levels such as epi and thyroid, age, and fasting
Term
Ideal Body Weight IBW
Definition
100 lb for 5' + 5lb each inch
106 lb for 5' + 6lb for each inch
add or deduct 10% based on frame size
Term
BMI
Definition
weight in kg/ height in meter x heigh in inches or

weight in pounds/ height in inches x height in inches
= X
X x 703

Guidelines:
18.5 or less = underweight
25 to 29.9 = overweight
30 or greater obesity
40 or greater extreme obesity
Term
significant weight loss formula
Definition
usual weight - present weight / usual weight x 100

significant if
1% to 2% within 1 week
5% in 1 month
7.5% in 3 months
10% in 6 months
Term
waist circumference
Definition
greater than 40 inches in men an 35 in female is a risk
Term
calculating caloric requirement
Definition
Estimate BMR
multiply healthy weight x 11 cal/lb for men and 10 cal/lb for women

i.e. Female 130lb x 10 cal/lb = 1300 a day, men 1430 cal/day

Estimate the total calories according to ususal activity level
1.2 = sedentary
1.3 light act
1.4 moderate acti
1.5 high act

Multiply BMR by number for total
1300 x 1.3 = 1690 kcal a day
Term
Carbs
Definition
50 - 60% of total kcal
- low carb intake results in ketosis
- water soluable fibers help improve glucose tolerance in diabetics
- water insoluable fiber is non-digestable and excreted, but can help relieve constipation. excess can cause gas, distention, diarrhea
Term
Protein
Definition
-RDA is .8g/kg of desired body weight or 56g for average woman and 63g for man
- 10% - 20% of total caloric intake

protein deficiency characterized by edema, retarded growth, muscle wasting, changes in hair and skin, permanent damage to physical and mental development in children, diarrhea, malabsorption and nuermous secondary deficiencies, fatty infiltration to the liver, increased risk for infection and high mortality.
Term
Fat
Definition
- 30% of total kcal intake
- high fat diets increase risk for heart disease and obesity and are correlated with an increased risk for colon and breast cancer
Term
Vitamins
Definition
organic compounds needed by the body in small amount, most are active in the form of co-enzyme which together with enzumes facilitate chemical reations.

water soluable vitamins
- Vitamin C 75-90mg/day (additional 35 mg/day for smokers)
- Vitamin B Complex: Thiamin 1.1 - 1.2mg, Riboflavin 1.1 - 1.3mg, Niacin 14 - 16 mg, B 1.3 - 1.7 mg, Folate 400 mcg, B 12 2.4 mg, Pantothenic Acid 5mg, Biotin 30 mcg.

Fat soluable Vitamins
- Vitamin A 700 - 900 mcg
- Vitamin D - 5 mcg
- Vitamin E - 15 mcg
- Vitamin K 90 - 125 mcg
Term
Minerals
Definition
inorganic elements found in all body fluids and tissue in the form of salts or combined with organic compounds.

Macrominerals
Calcium 1000mcg
Phosphorous 700 mcg
Magnesium 310 - 420mcg
Sulfur (adequate through protein)
Sodium 1500 mcg
Potassium 4700 mg
Chloride 2300 mg

Microminerals
Iron 8 - 18 mg
Iodine 150 mg
Zinc 8 - 11mg
Copper 900 mcg
Manganese 1.8 - 2.3 mg
Fluoride 3 - 4 mg (estimated safe)
Chromiium 25 - 35 mcg
Selenium 55 mcg
Molybdenum 45 mcg (estimated safe)
Cobalt non e
Term
sodium and potassium
Definition
less than 2300 mcg or 1 tsp of salt per day
Potassium rich foods are great.
Term
Nursing
Nutritional Assessment - Nutritional Screening: DETERMINE
Definition
DETERMINE
D = Disease
E = Eating Poorly
T = Tooth Loss/Mouth Pain
E = Economic Hardship
R = Reduced Social Contact
M = Multiple Medicines
I = Involuntary Weight Loss/Gain
N = Needs assistance in Self Care
E = Elder Years above 80
Term
Nursing
Nutritional Assessment - Older adult consideratoin
Definition
Biochemical Data
- Low serum albumin level (below 3.5 mg/dL) may be a refleciton of the aging process rather than an utritional risk factor. Albumin synthesis declines with age
- Hemoglobin levels lower htan normal may only reflect anemia observed in the elderly as part of the aging process

Anthropometric Data
- because of age related changes in body comp, skin fold measurements, if used should be taken from several body sites


Dietary data
- dietary recall may be inaccurate because fo vision and memory probs
- question use of vitamin and mineral supp
- gather information concerning medication regimen to assess for food-drug interactions and adverse effects of medicine
Term
Nursing
Nutritional Assessment: Assessing Dietary Intake Methods
Definition
Food Diary
24hr Recall Method
Food Frequency REcord
Diet History
Term
Nursing
Nutritional Assesssment: Medical and Socioeconomic Data
Definition
Medical Data:
- current illness
- medical and surgical history
- history of drug abuse/dependence
- ability to chew and swallow
- appetite, food intolerance, allergies, bowel movements

Social data:
- age, gender, family history, lifestyle
- educational background
- occupation, exercises, sleep
- religious affiliation, cultural ethnic background
- use of alcohol

Economic Data
- source of income
food budget
Term
Nursing
Nutritional Assessment: BMI & Waist Circumference
Definition
BMI - weight in kg/ height in meter x heigh in inches or

weight in pounds/ height in inches x height in inches
= X
X x 703

Guidelines:
18.5 or less = underweight
25 to 29.9 = overweight
30 or greater obesity
40 or greater extreme obesity

Waist circumfrerence - greater than 40 inches in men an 35 in female is a risk
Term
Nursing
Nutritional Assessment: Anthropometric Data
Definition
Height, Weight, skin fold, circumference measurements (appendages), visual observation of gums, teeth, body, skin, etc
Term
Nursing
Nutritional Assessment: Clinical Data
Definition
Dysphagia - difficulty swallowing

Dental issues,
Problems with sensor abilities
Term
Nursing
Nutritional Assessment: Biochemical Data
Definition
Hemoglobin & Hematocrit - tells us iron status & plasma protein

Serum albumin, transferrin, total lymphocyte count - tells us protein status.
Albumin also tells us a patients nutritional status a few weeks prior to when the blood was drawn and can identify chronic nutrition problems. Age does not effect ablumin but malnutrition, hydration and disease does

Blood glucose, blood cholesterol and blood triglycerides are relative to nutrition status

urine creatinine excretion and urine nitrogen excretion measure protein metabolism
Term
Nursing
Dx Imbalanced Nutrition as the Problem
Definition
Imbalanced Nutrition as the Problem:
- Imbalanced Nutrition: Less than Body REquirements related to NPO, inadequate tube feeding, prolonged use of a clear liquid diet, numerous food intolerance or allergies, excessive dieting, anorexia, chewing or swallowing difficulties, nausea, vomiting, chronic diarrhea, malabsorption, psychological eating disorder, alcoholism, metabolic endocrine disorders, inappropriate use of supplements

Imbalanced Nutrition: More than Body Reaquirements as related to overeating, inactivity, metabolic and endocrine disorders, inappropriate use of supplements.

Risk for Imbalanced Nutrition: More than Body requiremetns related to inappropriate eating, closely space pregnancies, metabolic and endocrine disorders, inappropriate use of supplements.
Term
Nursing
Dx Imbalanced Nutrition as the Etiology
Definition
Activity intolerance related to inadequate caloric intake, obesity, iron-deficiency anemia

Impaired Dentition related to nutritional deficits

Ineffective Health Maintenance related to lack of knowledge about adequate nutrition

Anxiety related to obesity

Constipation related to inadequate fluid or fiber intake

Diarrhea related to overeating, excessive fiber intake, excessive sorbitol intake

Deficient Fluid Volume related to inadequate fluid intake

Risk for infection related to inadequate caloric intake, inadequate protein intake


Impaired Home Maintenance Manageemtn related to inability to purchase, store or prepare food for family

Impaired skin intergirty related to protein malnutirtion, vitamin A deficiency

Deficient Knowledge related to new medical diet, nutrition misinformation, lack of interest in nutrition, intellectual deficit

- noncompliance to a particular diet order relate to lack of motivation, misinformation

Chronic Low Self Esteem related to obesity

Disturbed Sleep Pattern related to excessive caffeine intake

Social isolation related to obesity
Term
Nursing
Nutritional Outcome
Definition
General categories: Nutritional Status, Appetite, Body Weight, Knowledge about Diet, Self Care

Attain and maintain ideal body weight as indicated by BMI and waist circumference

Eat a diet adequte but not excessive in all nutrients based on the MyPyramid Food Guideline System, the rda and dietary recommendations issued from US Govt

Eat a variety of food in three or more meals

Follow the appropriate modified diet, when necessary to restore health, avoid disease recurrences and prevent or delay potential complications
Term
Nursing
Nutritional Implementing
Definition
General Categories: Nutrition Management, Therapy, Counseling, Monitoring, Exercise PRomotion, Weight Management

Teaching Nutritional Information
Monitoring Nutritional Status
Stimulating Appetite
Assist with EAting
Term
Nutritional Consideration for Patients with Dysphagia
Definition
small meals and bites
30 minute rest period prior to meals
sit upwright
consider chopping puree
alternate solids and liquids
look for signs of aspiration
Term
Enteral Nutrition (directly to stomach) considerations
- Nasogastric Tube
- Nasointestinal Tube
- Percutaneous Endoscopic Gastronomy PEG
Definition
Check tube placement before delivering any food fluid or meds
Check residual (food remaining in stomach) before each feeding or every 4 - 6hrs during a continuous feeding A residual of more than 10 - 20% above the hourly rate may indicate it should be interrupted or delayed
- assess abdomen for abnormalities
- assess bowel sounds once per shift
- Make sure patient is upright as possible during feeding
Prevent contamination
- Meds can be adminstered through a feeding tube but never give them while a feeding is being nfused.
- Provide comfort
- Monitor for complications: Aspiration, Clogged Tube, Nasal Erosion, Diarrhea, Nausea, Vomiting, Distention, Unplanned Extubation, Stoma Infection
Term
Paraenteral (IV) considerations
Definition
TPN Total Parenteral Nutrition highly concentrated hypertonic nutrient solution

PPN Peripheral Parenteral Nutrition less concentrated solution who have solution sometimes prescribed for patients who have a malfunctioing gastrointestinal tract and need short term nutrition

Complications related to use of the central venous access devices such as pneumothorax and thromboembolism

- infection and sepsis
- metabolic alterations such as hyper or hypoglycemia
- fluid, electrolyte and acid-base imbalance
- phlebitis
- hyperlipidemia
- liver and gall baldder disease
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