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NR 224 Week 4 Edapts Nutrition
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NR 224 Week 4 EdaptsNutrition
Introduction to Nutrition
It is important for nurses to understand the relationship between nutrition and health in order to anticipate and
recognize cues and plan interventions. Access to adequate nutrition is essential for health maintenance. Without
appropriate nutrition, clients experience poor outcomes, delayed healing, and adverse health effects.
Bulimia Nervosa
Eating disorders often begin in adolescence. Bulimia nervosa results in episodes of binge eating in which a large amount of food
is discretely and quickly eaten, followed by self-induced vomiting or the use of laxatives or diuretics.
Anorexia nervosa results in self-restriction of food (energy) and very low body weight due to the fear of gaining weight or
appearing fat.
Malnutrition
While no one laboratory test will diagnose malnutrition, there are tests that portray nutrition status, such as albumin
and prealbumin (measures plasma proteins). Albumin is a better indicator of long-term chronic illness, whereas
prealbumin is preferred for short-term changes in acute conditions.
The signs of impaired nutritional status include receding gums, peripheral edema, and oral lesions.
TSH, BUN , and WBC are not impacted by malnutrition & Yellowing teeth and facial flushing are not signs of
impaired nutrition.
Nutritional Status
Physical signs of impaired nutrition include:
easily fatigued with no energy
obesity (or overweight or underweight)
anorexia
dull, brittle, dry hair
A BMI of 22 is within normal limits and does not indicate impaired nutrition. A soft abdomen and regular bowel habits are not
indicative of impaired nutrition.
Types of Nutrients
Nutrition is the study of nutrients and how the body utilizes the nutrients in food. Nutrients are substances that are
essential to an individual's well-being, behavior, and environment. These elements are needed for growth, maintenance,
and repair of the body.
Non-essential nutrients are those that the body can produce if adequate amounts of necessary precursors (building
blocks) are available. Essential nutrients are those that a person must obtain through food because the body cannot
make sufficient quantities to meet its needs.
Macronutrients
Macronutrients (carbohydrates, fats, protein) provide energy.
Carbohydrates are converted to glucose, which is the body’s main source of energy.
Fats, also called lipids, are broken down into fatty acids and are the most calorically dense of all the nutrients.
Protein is broken down into amino acids that are used for tissue growth and maintenance, as well as tissue repair.
Micronutrients
Micronutrients (vitamins and minerals) are used to regulate body processes.
Vitamins are either fat-soluble and more easily stored in the body or water-soluble and quickly eliminated from the
body.
, Fat-soluble vitamins: A, D, E, and K
Water-soluble vitamins: Vitamin C, choline, and the B-complex vitamins
Minerals are critical catalysts necessary for biochemical reactions in the body. They are classified as either major (more
than 100 mg required daily) or trace (less than 20 mg required daily).
Major: Calcium, chloride, magnesium, phosphorous, potassium, sodium, and sulfur
Trace: Chromium, copper, fluoride, iodine, iron, manganese, molybdenum, selenium, and zinc
Water
Water is essential for nearly every bodily function.
The total body weight is 60% to 70% water (a higher percentage in infants and a lower percentage in older adults).
Normally, fluid intake equates to fluid output (elimination, respiration, and sweating). Some clients have an increased
need for fluid, while others have a decreased ability to excrete fluid, resulting in fluid retention.
Need for Fluid
The nurse understands that a client who is ill will have an increased need for fluid but may also have a decreased ability to
excrete fluid, resulting in fluid retention.
A Healthy Diet
A healthy diet provides an adequate amount of essential nutrients needed to support growth and development, perform physical
activity, and maintain health. A nutritious diet also satisfies a variety of personal, social, and cultural needs. These factors must
be considered in diet planning.
The diets of all individuals must consist of foods that are easily attainable and affordable. People can use a variety or
combination of foods to form a healthy diet.
Make half of your plate fruits and vegetables. Focus on whole fruits and vary your vegetables.
Make half your grains whole grains.
Vary your protein routine.
Move to low-fat or fat-free dairy products (or lactose-free dairy or fortified milk alternatives).
Choose foods and beverages with less added sugars, saturated fat, and sodium.
Promoting Wound Healing
Certain foods and food groups help promote wound healing. For enhanced wound healing, the client should increase calories,
protein, zinc, and vitamins A and C.
Protein
Meats, beans, eggs, milk , and yogurt (particularly Greek yogurt), tofu, soy nuts, and soy protein products
Vitamin C
Citrus fruits and juices, strawberries, tomatoes, tomato juice, peppers, baked potatoes, spinach, broccoli, cauliflower, Brussels
sprouts, and cabbage
,Vitamin A
Dark green, leafy vegetables; orange or yellow vegetables; cantaloupe; fortified dairy products; liver; and fortified cereals
Zinc
Fortified cereals, red meats, and seafood
Nutrition Across the Lifespan
Infants Through School Age
Rapid growth and high protein, vitamin, mineral, and energy requirements mark the developmental stage of infancy.
Commercial formulas and human breast milk both provide 20 kcal/ounce. A healthy infant needs approximately 100
kcal/kilogram of body weight each day.
The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life and
breastfeeding with the addition of complementary foods from 6 to 12 months (Eidelman et al., 2012).
The growth rate slows during toddlerhood, so the toddler needs fewer calories but an increased amount of protein in
relation to body weight. Their appetite decreases around the age of 18 months. Toddlers exhibit strong food preferences
and are picky eaters.
Milk consumption should be limited to 24 ounces daily to avoid iron-deficiency anemia. Toddlers need to drink
whole milk until age 2 years, then switch to low-fat milk products.
Foods that pose a choking hazard should be avoided, such as hot dogs, hard candy, nuts, grapes, raw
vegetables, and popcorn.
Preschoolers have similar dietary requirements as toddlers. They consume slightly more food and nutrient density is more
important than the quantity of food consumed.
School-aged children grow at a slower and steadier rate, with a gradual decline in energy requirements per unit of body
weight. The diet should be rich in vitamins A and C and contain adequate protein. Avoid foods high in sugar, fat, and
salt.
Adolescents
Physiological age is a better guide to nutrition needs than chronological age. Energy needs increase to meet the
metabolic demands of growth. Adequate amounts of protein, iron, and calcium are essential. Iodine supports increased
thyroid activity and B-complex vitamins support increased metabolic activity.
Concerns about body image and appearance, a desire for independence, eating fast food, peer pressure, and fad diets are
common. The onset of eating disorders, such as anorexia nervosa and bulimia nervosa, often begins in adolescence.
Recognition is essential for early intervention.
Pregnancy
Poor nutrition in pregnancy causes low birth weight in infants. Nutritional status at the time of conception is important as
well. In general, meeting the nutritional needs of the fetus is at the expense of the mother. However, if nutrition is poor, both
will suffer.
Energy and protein needs increase during pregnancy.
Adequate calcium intake is essential.
Iron supplements are often necessary to support increased blood volume, fetal blood storage, and blood loss during
delivery.
Folic acid intake is important for DNA synthesis and the growth of red blood cells. The need for folic acid increases
during pregnancy.
Lactation
, Women who are lactating need 500 extra kcal/day to support the production of milk.
Protein requirements are even higher than in pregnancy. Adequate intake of calcium and vitamins A, B, and C is
essential.
Fluid intake needs to be adequate but not excessive.
Lactating women should avoid caffeine, alcohol, and drugs that will remain present in breastmilk.
Older Adults
Older adults have a decreased need for food energy because their metabolic rate slows with age. However, vitamin and
mineral requirements remain unchanged from middle adulthood.
Age-related changes in taste, smell, and digestion affect nutrition.
Multiple factors may contribute to food insecurity.
Declining oral health may contribute to malnutrition and dehydration.
Caring for the Older Adults Losing Weight
Food insecurity may lead to a lack of nutritious foods available for consumption. Alterations in taste and smell may lead to less
food consumption. Chronic illness may cause a lack of appetite, leading to weight loss. Fad dieting may affect clients of any age.
Nutritional Screening and Assessment
Nutrition Screening
Nutrition screening is an essential part of an initial nursing assessment. This is a quick way to identify malnutrition or
the risk of malnutrition. Screening tools gather objective data, such as height, weight (BMI), weight change, primary
diagnosis, and the presence of other comorbidities. Subjective data is collected related to nutrition to screen for potential
problems. Risk factors, such as unintentional weight loss, presence of a modified diet, or presence of gastrointestinal
symptoms (e.g., nausea, vomiting, diarrhea, and constipation) require nutritional consultation.
Standardized nutritional screening tools include the Subjective Global Assessment (SGA) and the Mini Nutritional
Assessment (MNA) used for older adults.
Laboratory and Biochemical Tests
Multiple laboratory and biochemical tests are used to diagnose nutrition disorders. The most common tests measure
plasma proteins, such as albumin, transferrin, prealbumin, retinol-binding protein, total iron-binding capacity, and
hemoglobin.
Albumin level is a better indicator of malnutrition in clients with long-term chronic illness, whereas a prealbumin level
is preferred for short-term changes in acute conditions.
Diet History and Health History
Common components of a diet history include:
dietary intake and food preferences
unpleasant symptoms
allergies
taste, chewing, and swallowing
appetite and weight
use of medications
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