Nutrition

1. Nutrition Islamic University – Nursing College

2. Nutrition • Proper nutrition is needed for maintaining health and preventing illness. It also helps with wound healing. A well balance diet helps in the care and treatment of many diseases and conditions. The nurse needs to understand how a diet can help the client to achieve a healthy lifestyle, and help in the healing process.

3. Recommended Dietary Allowances • RDA- Amount of a nutrient need by a healthy individual. • Requirements for nutrients may be increased during illness and other times such as periods of growth, pregnancy, and physical demands or stress.

4. Nutrients • Nutrients are substances that are needed for: • Cell growth, • Cellular function, • Enzyme activity, • Carbohydrate/ fat/protein synthesis, • Muscle contractions, • Wound healing, • Immune competence, • and LIFE.

5. WATER • H2O • Water is not a nutrient but is needed for life. • A human can only live 3-5 days without water, but 10-14 days without food. • Calories: 0

6. Water -Sources • Tap water- Bottle water • Fruits • Vegetables • Juices • Some in meats, fish, graviesمرق اللحم . • IV fluids • Tea ,coffee and soda may have caffeine not good sources.

7. Water- Function in Body • It is part of body fluids: • Cellular fluids, blood, hormones, sweat, urine, tears, lymph. • Lubricant. • Adult body fluid volume: 60% • Infant (newborn) body fluid volume: 77% • Embryo: 90%

8. Adult Body Fluid Volume • Intracellular (cellular) fluid- ICF: 40% • Extra cellular fluid-ECF: 20% • Interstitial fluid (tissue spaces): 15% • Intravascular fluid (vascular fluid): 5%

9. Water- Requirements • Depends on: • Age. • Activity. • Temperature-both internal and external. • Losses.

10. Water -Requirements • Adult- 30ml/Kg/day. • Adult of 70Kg X 30 ml.= 2100 ml/day. • 6-8 glasses of water to 8-10 glasses of water per day. • Hot climates 2-3liters per day.

11. Clinical manifestations: Weight loss Dry skin Dry mucous membranes Poor skin turgor- tenting. Decrease urine output Water-Deficit (not enough) • Fluid Volume Deficit (FVD) lead to: • Dehydration

12. Normal Body Fluids Loses per day • Urine: 1000-1200 ml/day • Sweat: 400-500 ml/day • Respirations: 400-550 ml/day • Stool: 100-200 ml/day. • Tears: small amount.

13. Increase Loses of Fluid • Burns • Sweating • Fever • Diarrhea • Inadequate intake • Diabetes-( Increased blood sugar) • Caffeine • Drugs- Diuretics

14. Clinical manifestations: Weight gain. Hypertension-High B/P Edema- pitting vs Non-pitting Moist lung sounds ( crackles/ rales) Water- Excess (Too much)Toxicity • Fluid Volume Excess-(FVE). • Edema • Causes: • Excess intake usually because of IV fluids. Renal failure.

15. Nursing Interventions • Monitor intake and output ( I&0) • What goes IN the body:( I) • Oral • IV Fluids • N/G Tubes. • What goes OUT the body:( I) • Emesis • Urine • Stool • Drainage • Bleeding

16. Nursing Interventions • Diaper weight: 1 gram wt.=1 ml. • This would go for dressings or pads too: • A dressings weighing 10 grams=10 ml. of drainage or blood. • Assess weight daily. • Assess skin turgor. • Listen to lung sounds.

17. Nursing Interventions • Check for edema. • Provide fresh pitcher of water several times a day, for the client with no restrictions of fluid. • Check the doctor’s order for IV rate. • Monitor IV fluids carefully.

18. Calories- Requirements • Adult calorie requirements are based on age, sex, activity level and need. • Base adult calorie needs are: • 30-35 Calories per IBW ( Ideal body weight) Kg. (Kilograms) • example: Adult who IBW is 58 Kg.: • 58kgx 30 calories/Kg = 1740 calories/day. • 58Kgx 35 calories/Kg=2030 calories/day. • So the range would be 1740-2030 calories per day.

19. Protein (Amino Acids) • Calories: 4 calories per 1 gram

20. Protein-Food Sources • Complete: proteins come from animal sources: • Diary Products- Cheese, Milk, Yogurt, Ice Cream. • Meat. • Fish. • Chicken. • Eggs.

21. Protein- Food Sources • Incomplete: proteins from plants sources: • Beans البقوليات • Legumes • Nuts • Brown rice • Whole grains and cereals. • Soy products.

22. Protein- Food Sources • Complementary (balanced) Proteins: • Beans and Rice. • Whole grain macaroni and Cheese. • Peanut butterزبدة الفول السوداني and Whole grain bread.

23. Protein- Function in The Body • Amino acids help to build and maintain all body tissues. • Part of: • Hormones. • Blood. • Antibodies. • Albumin.

24. Protein- Function in the body • Provides energy after carbohydrate and fat supplies are exhausted. • Needed for growth and development of tissues. • Wound healing.

25. Protein- Requirements • Men: 50-60 grams per day. • Women: 40-50 grams per day. • Pregnant women: 60 grams per day. • Increase requirements of protein are needed with illness and healing process. • 10-20 % of total daily calories should be from protein.

26. Protein-Deficit ( not enough) • The lack of enough protein intake can lead to: • In children effects growth. • Anemia. • Increase infections. • Delayed wound healing.

27. Protein- Excess • Increase weight gain ????. Atkins Diet • Renal/Kidney damage.

28. Nursing Interventions. • Monitor Protein intake- Do 24-48 hours dietary intake history. • Monitor Lab tests: • BUN (Blood Urea Nitrogen)- Low BUN can indicate low protein intake. • Albumin- Low Albumin can also indicate low protein intake. • Total Protein- Low Total Proteins can indicate low protein intake.

29. Carbohydrates • Calories: • Food-4 calories per 1 gram. • IV’s- 3.4 calories per 1 gram • Each gram of regular table sugar contains 4 calories. Each teaspoons of sugar contain about 4 grams.

30. Carbohydrates- Food Sources • Refine sugars- White sugars, cane sugar قصب السكر, etc. • Fruits. • Vegetables- Starchy vegetables. • Beans. البقوليات • Nuts. المكسرات الجوز والبندق وغيرها • Legumes. البقوليات • Whole grains. • Rice. • Some meats. • Fiber is indigestible carbohydrates.

31. Carbohydrates-Function in the Body • Carbohydrates are the main source of energy for the body. • Maintains protein and fat balance.

32. Carbohydrates-Requirements • Depends on: • Size. • Activity level. • Age. • Sex. • “If sweat potato a person needs less “. • A client on bedrest needs less. • 50-60% of total calories should come from carbohydrates.

33. Carbohydrates- Requirements • Carbohydrates should come from: • 2-4 servings of fruits. • 3-5 servings of vegetables. • 6-11 servings of whole grains. • Only a small amount from refined sugars.

34. Medications/ Supplements • Dietary supplements- Ensure. • IV Fluids- D5W • TPN- Total Parental Nutrition. • D5W- 5% Dextrose solution=5 gram of glucose per 100ml. So a 1000ml bag of D5W = 50 grams of glucose. • 50grams x 3.4 calories/1 gram= 170 calories per bag.

35. Carbohydrate- Deficit • A deficiency of carbohydrates in the diet can lead to: • Weight loss. • Hypoglycemia: • Headache, confusion, tired, irritability, hungry, muscle wasting, ketoacidosis, and ketones in the urine.

36. Carbohydrate-Excess • Too many carbohydrates in the diet can lead to: • Weight gain. • Hyperglycemia: • Increase thirst, hungry, increase urination, dry skin, fruity breathe. • Diabetes mellitus- increase blood sugar due to problem with insulin.

37. Carbohydrates Nursing Interventions • Assess dietary intake of carbohydrates with a 24-48 hours dietary history. • Weight the client. • IV- Check order for type of fluids. and • Check rate. Place IV on infusion device.

38. Carbohydrates Nursing Interventions • TPN- Total Parental Nutrition- Check order with two nurses. Check rate. Follow Protocol for TPN. Check blood sugars level as ordered. Place IV on infusion device. • NPO- Nothing by mouth. Are calories coming from IV’s or TPN?

39. Fats • Calories: • Food- 9 calories per 1 gram of fat. • IV fluids- Intralipids: • 10% solution=1.1calories per 1 ml. • 20% solution= 2.2calories per 1 ml.

40. Fats- Food Sources • Dietary: • Butter. • Oils- Animal sources and plant sources. • Diary Products- Milk, Cheese, etc. • Meats. • Nuts. • Avocados. • IV’s- Intralipids. • TPN-Total Parental Nutrition.

41. Fats- Function in the Body • Fat makes up part of the cell membranes. • The lining around nerves. • Steroid Hormones- Estrogen and testosterone. • If women’s body fat decreases below 18% they will stop menstruation and have fertility problems. • Fat for padding for warmth in cold climates. • Secondary source for energy.

42. Fats- Requirements • Less than 30% of total calories should come from fats. (US government). • According to AHA & ADA: • No more than 30 grams of fat per day. • People with Gall Bladder problems should have less than 20 grams of fat per day. • No one under 4 years of age should be placed on a low fat diet.

43. AHA ( American Heart Association)

44. Fats- Medications/Supplements • IV’s- Intralipids. • TPN-Total Parental Nutrition. • Dietary supplements.

45. Fat-Deficit • Lack of fat in the diet can lead to: • Weight loss. • Decrease in hormone production. • In children- neurological problems. • Labs- decrease in cholesterol levels.

46. Fats- Excess • Too much fat in the diet can lead to: • Increase weight. • High cholesterol levels and high triglycerides levels. • Cardiac diseases - Heart Disease-MI’s or CVA-Strokes.

47. Fats- Nursing Interventions • Assess dietary intake of fats with a 24-48 hour diet history. • Monitor cholesterol levels- LDL &HDL, Total cholesterol level and triglyceride levels. • Monitor IV fats- Check order, rate, site, and I&O. Place IV of infusion device. • Weigh client.

48. Vitamins • Vitamins are organic compounds required by the body in small amounts for growth and normal metabolic processes. • Vitamins Types: • Water soluble-Vitamin C and B complex. • Fat soluble-Vitamins A, D, E, and K.

49. Vitamin A • Fat soluble vitamin. • Retinol • Required for normal vision, growth, bone development, skin, and mucous membranes. Repair tissue especially epithelial cells. • Requirements Men-600-900mcg. • Women750-770mcg. Pregnancy-up to 800mcg. Lactation-1200-1300mcg.

50. Vitamin A- Food Sources • Liver-Beef, Meat, butter, Fortified Margarine, egg yolks, cheeses, Whole milk, kidneys and fish oil. • Dark green vegetables-spinach, turnip greens ورق اللفت, asparagus الهليون, and broccoli. • Bright orange vegetables and fruits-carrots, sweet potatoes, pumpkin اليقطينة, cantaloupes, apricots المشمش, and peaches الخوخ.