Nutrition Study Guide
 Essential Nutrients
 A nutrient provides nourishment and affects metabolic and nutritive process. Nutrients include:
 Carbohydrates
 Proteins
 Lipids
 Vitamins
 Minerals
 Water
 Carbohydrates
 = Source of energy; 4 kcals/gram
 _____________________: mainly from plant foods
 Fiber: soluble or nonsoluble
 Soluble: delays GI transit time (helps diarrhea)
 Nonsoluble: accelerates transit time (helps constipation)
 Proteins
 Types:
 Amino Acids = Essential proteins: cannot be manufactured in body so required in daily diet.
 Sources: meats, poultry, fish, eggs, dairy products
 Vegetarians must eat corn/bean combo to achieve essential protein
 Lipids (Fats)
 Saturated fats: animal product; solid @ room temp; should be limited in diet
 Ex: butter, meat fat
 Unsaturated fats: plant product; liquid @ room temp;
 Ex: Olive oil, canola oil
 Cholesterol: in foods and also produced by body; synthesized in the liver
 Lipids are stored as adipose tissue
 AHA recommends limiting fats to __________________ of total calories and saturated fat to 10%
 Vitamins
 Vitamins: cannot be manufactured by body and are required for metabolic processes (except for Vit K)
 Water soluble: body cannot store, must be in diet:
 Vit C: citrus fruits, broccoli, greens
 Vit B complex: meats, green leafy veggies
 Pregnancy: folic acid (B9) to prevent neuro tube defects
 Fat soluble: body can store for long periods
 Vit A,D,E,K
 Therefore should not take more than recommended amt.
 Vitamin levels are highest in fresh foods consumed ASAP after harvest
 Minerals
 Macrominerals: > 100 mg required daily
 Calcium, phosphorous, sodium, potassium, magnesium, chloride, sulfur
 Microminerals: < 100 mg required daily
 Zinc, iron, etc.
 Role: balance pH of body and promote ______________________________________
 Water
 Roles of water: transportation of nutrients and waste products, providing structure to large molecules,
participation in metabolic reactions, serving as a solvent, lubricant and cushion, regulating body
temperature and maintaining blood volume.
 Infants have the greatest percentage of total body weight as water; older adults have the least. Both are
most vulnerable to water deprivation.
 Illness can create a increased need for fluids (ex: fever) or a need to ingest less fluids (ex: cardiac or
renal disease)
 ___________________________is protective and alerts a person to the need for fluids
 Know these processes
 Digestion
 Absorption (primarily in small intestine)
 Metabolism
 BMR: energy needs of a person at rest
 If diet exceeds energy needs = gain weight
 If diet does not meet energy needs = lose weight
 Anabolism: producing substances via nutrient synthesis
 Catabolism: Breakdown of body tissues for energy
 Energy = Calories
 1 g carb = 4 calories
 1 g protein = 4 calories
 1 g fat = 9 calories
 1 g alcohol = 7 calories
 Think for dieting: what types of food can you eat in great quantities but have less calories?
 Do you know how many calories you should consume based on your height and optimal weight?
 New 2010 Food Guide MyPlate
 Specific goals of the revisions are:
 Balancing Calories
 Enjoy your food, but eat less.
 Avoid oversized portions.
 Foods to Increase
 Make half your plate fruits and vegetables.
 Make at least half your grains whole grains.
 Switch to fat-free or low-fat (1%) milk.
 Foods to Reduce
 Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower
numbers.
 Drink water instead of sugary drinks.
 New MyPlate Recommendations
 Some Healthy People 2010 Goals
 Increase healthier food access
 Child care centers and school, retail access
 Increase awareness in healthcare/worksites
 BMI measurements at appts, work incentive programs
 Decrease obesity
 Children and adults
 Decrease food insecurity
 Household and child hunger
 Educate about food consumption
 MyPlate
 Decrease iron deficiency
 Young children and pregnant females
 Vegetarians
 Plant based diet
 Vegans are susceptible to vitamin B12 and protein deficiency; must supplement diet with B12 and
carefully choose foods to ensure ingestion of essential amino acids (for example: bean/corn combo
meal)
 Other Common deficiencies
 Iron deficiency -> anemia
 Diet sources of iron: meat, spinach, kidney beans
 Calcium deficiency -> osteoporosis
 Premenopausal women: 1000 mg/day Ca recommended
 Postmenopausal women: 1500 mg/day Ca recommended
 Men variable
 Food sources: dairy products, greens, broccoli
 Nursing Assessment
 Screening: see Mini-Nutritional Assessment (MNA) tool for older adults. A score of 17 or less
indicates protein-energy malnutrition
 If you find a patient at risk for nutritional problems, a more in-depth assessment by a Registered
Dietician should be done
 May do Diet History & Medication History to determine if interactions exist (meds affect appetite,
disturb taste, interfere with nutrient absorption)
 Patients at Risk for Malnutrition
 Involuntary gain or loss of
 > 10% usual body weight within 6 months
 > 5% usual body weight in 1 month
 Current weight _____________________ under or over ideal body weight
 Presence of chronic disease or increased metabolic requirements
 Inadequate nutrient intake
 Altered diets or diet schedules
 Inability to ingest or absorb food
 Problems Associated with Poor Nutrition in Older Adults
 Difficulty chewing & swallowing
 Lowered glucose tolerance
 Decreased social interaction/living alone
 Loss of appetite
 Loss of senses of smell and taste
 Limited income
 Difficulty sleeping at night (too tired to prepare meals)
 Dysphagia
 = swallowing dysfunction; many causes
 Indicators warning of dysphagia
 Cough; change in voice tone or quality after swallowing; abnormal movements of mouth, tongue or
lips; slow, uncoordinated speech
 Usually do NOT overtly cough when food enters airway; “silent aspiration” is common cause of
complications such as pneumonia
 Dysphagia causes decreased food intake which results in malnutrition
 Nurses and CNAs are often first to detect dysphagia and can notify health care provider for followup
 See Aspiration Precautions
 Physical Exam
 Look for signs of malnutrition; skin and hair are primary areas that reflect deficiencies.
 General Appearance: apathetic, easily fatigued
 Weight: Over or underweight
 Muscles: flaccid, poor tone, “wasted” appearance
 Nervous system: irritability, decreased reflexes, burning/tingling of hands/feet,
 Skin: Rough, dry, flaky, lack of subq fat
 Nails: brittle, ridged
 Hair: dry, dull, sparse, brittle
 Lips: Swollen, red cracks at side, fissures
 Tongue: swollen, beefy red, smooth
 Gums: swollen, inflamed, bleed easily
 Edema and _______________________
 BMI: Body Mass Index
 BMI = weight in kg
-----------------(height in meters)²
 19-24.9 recommended for good health
 Under 19= underweight
 20-24 = normal
 25-29 = overweight
 30-39 = obese

40+ = Extreme obesity
 Assessing: Lab Data
 Serum proteins (=estimate of protein stores)
 Albumin (4.0) and Prealbumin (20)
 Low levels can indicate prolonged protein depletion
 If protein depletion, then the immune system can be depressed.
 See WBC differential: lymphocyte count decreased
 Diagnosing
 Imbalanced Nutrition: More than Body Requirements
 Imbalanced Nutrition: Less than Body Requirements
 Risk for Imbalanced Nutrition
 Feeding Self Care Deficit
 Risk for Aspiration
 Planning
 Goals:
 Weight gain or loss of ½ to 1 pound per week is realistic
 Remember correction of poor dietary patterns is a long term goal
 Implementation
 Use tools like MyPlate, Food Diaries, BMIs
 Educate about food choices, food labels and their meaning
 Educate about healthy diet and exercise and help integrate changes into client’s lifestyle
 Must be designed to meet intellectual ability, motivational level, lifestyle, culture and economic
status
 Educate about food safety
 In Acute Care
 Recognize stress affects intake
 Meds can affect intake and utilization of nutrients
 Symptoms such as pain, nausea, sob have major effect on appetite
 Food presentation is a factor
 Promoting a Comfortable Environment to Stimulate Appetite
 Make sure environment is free of odors and reminders of treatments
 Provide mouth care
 Administer analgesics and antiemetics early enough before meals
 Position patient comfortably
 Reduce stress via therapeutic communication
 Assisting Clients with Feeding
 Assisting clients who are weak & debilitated but protect dignity and involve them
 If possible, help them feed themselves instead of feeding them
 Position in chair or high Fowlers position
 Be sensitive to loss of autonomy, embarrassment
 Convey unhurried attitude, sit at bedside
 Ask what order to eat food
 If visual problems: use clock method or describe food
 If cannot communicate, offer fluids every 3-4 bites
 Dysphagia Interventions
 Thickened liquids
 Modification of food texture
 Position upright
 Replacement of oral feeding with enteral tube feeding
 Remain upright 30 minutes after meal
 Special Diets
 Assisting with special diets
 NPO: nothing by mouth
 Clear liquids: you can see through
 Full liquids: All food and fluids mixed with liquid for thin consistency
 Regular: all foods, no restrictions
 Puree: Uniform “pudding like”
 Mechanically altered: moist, soft textured; forms a bolus
 Modified per disease process: Diabetic, low salt, low cholesterol
 Enteral Feedings
 Given via tube into stomach or intestinal tract; must have functional GI tract
 Types:
 NG tube (thru nostril into esophagus)
 Must have intact cough/gag reflex, adequate gastric emptying, usually short-term
 PEG/PEJ tube: puncture thru skin into stomach (PEG) or jejunum (PEJ)
 Continuous or intermittent feeding
 Must elevate HOB _____________________- to avoid aspiration
 Parenteral Nutrition
 Administration of solution containing glucose, amino acids, lipids, minerals, electrolytes and vitamins
through central venous catheter into superior vena cava
 Used when GI tract nonfunctional
 Hypertonic so only administered into high flow central veins where diluted by blood
 Goal: maintain anabolic state in clients unable to maintain normal nitrogen balance such as in severe
malnutrition, severe burns, metastatic CA, renal/hepatic failure
 Risks:
 Infection: ______________________________ Requires frequent monitoring of fluid, electrolytes, glucose
 Home Care
 Special Community Nutritional Services:
 Meals on Wheels, Food Stamps
 Evaluation
 Weight gain/loss
 Improved labs (albumin and prealbumin)
 Self-reported improved intake
 If progress does not occur:
 Were interventions not effective, not realistic, not done by patient or affected by unanticipated
factors.
 Success depends on patients willingness and ability to change behavior patterns