adequate intake
the amount of nutrients needed to keep the human healthy
albumin
a prime ingredient of blood oncotic pressure and a carrier protein for many body and pharmacological substances
body mass index (BMI)
a guide for maintaining ideal weight for height. it is also used as a benchmark for obesity or protein-calorie malnutrition
cachexia
a highly catabolic state with accelerated muscle loss and a chronic inflammatory response. it is a distinct syndrome separate from anorexia with production of pro inflammatory cytokines that contribute to breakdown of fat and muscle protein, causing loss
calorie count
a tool that counts every calorie a patient takes in during a 24-hour period
creatinine
a serum protein that is elevated with kindey disease
dysphagia
difficulty swallowing; may be oral, pharyngeal, or esophageal in origin
electrolytes
elements needed by the body to maintain functioning
food frequency questionnaire
a tool to identify the number of times a person eats a specific food in a designated period
food pathogens
disease-causing microbes that live in the food supply
hydrogenation
the chemical processing of animal fats used by food manufacturers to extend the shelf life of products susceptible to rancidity (cookies and crackers)
intake and output
food and fluid taken into the body and urine expelled from the body
mid upper arm muscle circumference/mid upper arm muscle areas
indicators of muscle and body protein reserves
percentage of ideal body weight
calculation based on the ideal and current weight by the formula:
% of ideal body weight = current weight/ideal weight x100
percentage of usual body weight
% of usual body weight = current weight/usual weight x100
percentage of weight change
(usual weight - present weight)/usual weight x100
prealbumin
a circulating protein in the blood
primary nutrients
nutrients essential for optimal body function: carbs, proteins, fats, vitamins, minerals, water, and major electrolytes
3-day food diary
a diary kept by the patient that reviews 3 days worth of food intake
transferrin
a serum protein with a half-life of 9 days
triceps skinfold
a measurement of skin fold thickness. not representative of adipose tissue throughout the body
24 hour recall
a tool used to quantify the amount of food taken in over a 24-hour period
waist circumference
the measurement around the waist. an indicator of accumulated body fat in the abdomen; a high circumference places people at increased risk of obesity-related diseases and early mortality.
weight-for-height calculations
reference standards for height and weight
a complete nutrition assessment includes
-a history of food intake
-weight and height calculations
-laboratory data
-the use of specific nutritional tools when indicated
nutrients
building blocks for tissue maintenance and repair
vitamins and minerals play key roles in
cellular function
water
makes up more than half of the adult body weight and is essential to supporting life, serving many vital functions within the body
carbohydrates
provide the body's main source of energy
simple carbohydrates
-glucose
-dextrose
-fructose
-galactose
-sucrose
-maltose
-lactose
complex carbohydrates
-starch
-glycogen
-fiber
proteins
serves important functions in cell structure and tissue maintenance
amino acid
-building blocks of all proteins
-involved in many essential body functions such as regulating fluid and electrolyte balance, transporting molecules, and other substances throughout the blood.
what consists of protein
body tissue such as muscles, bones, teeth, skin, and hair
essential amino acids
must be obtained through dietary sources
lipids
provides essential fatty acids and promoting the absorption of fat-soluble vitamins A,D,E,K.
triglycerides
saturated fats (solid at room temp) and hydrogenated fats raise levels of LDL cholesterol.
ex: butter, cheese, fatty meats
unsaturated fats
-(liquid in room temp) are known to reduce LDL levels as well as triglycerides
-major cause of coronary heart disease
unsaturated fat forms
1. omega-3 oils: found primarily in fish and plant oils such as canola, flaxseed, walnut and hazelnut.
2. omega-6 oils: found in plant oils such as safflower, sunflower, corn, soybean and cottonseed
cholesterol
-essential to cellular maintenance and repair.
-if ingested in excess of daily requirements can lead to heart attacks and atherosclerosis.
-primarily comes from meat and egg yolks
phospholipids
-emulsifiers that occur naturally in many foods.
-transports fat soluble substances across the cell membrane
vitamins
play a key role in the metabolism of most nutrients
minerals
3 minerals that are crucial for a healthy diet (particularly for vegetarians) are iron, zinc, and calcium
why is it important for the nurse to ask about supplements
because certain drug-herb interactions may be serious and life threatening
adequate intake of water
varies depending on the gender, age, air temperature, physical activity level, and state of health
major electrolytes
sodium and potassium
sodium
-regulates fluid balance and cell permeability
-regulates acid base balance
-nerve transmission
-muscle irritability
potassium
-regulates fluid and acid-base balance
-functions in the regulation of nerve impulse transmission
-carb metabolism
-protein synthesis
-skeletal muscle contractility
sodium recommendation
-no recommended daily intake
-wide variations exist between individuals among cultures
-older you get, more salt sensitive you become
potassium recommendation
-4.7 g/day
-average consumed is 2.1-3.2 g/day
why are food-borne pathogens becoming increasingly problematic
they travel huge distances which makes them difficult to trace and that compromises the health and safety of many people in a matter of days.
organic food
-people are leaning more toward organic foods because of the link between herbicide and pesticide used in agriculture among certain cancers
-increased production of genetically modified foods has contributed toward the movement of organic foods
food security
food sources are sometimes continents away from where the foods are consumed , which sometimes can result in unexpected food shortages, global climatic and catastrophic events interfere with water and food production and distribution
food security about urban living
discourages people from growing and processing their own food
nutritional guidelines
-USDHHS and USDA published guidelines for healthy eating
-revised every 5 years based on current research
-dietary recommendations vary on age, gender, and activity levels
MyPlate
emphasizes needs for consuming 5 food groups and encourages wiser food choices & portion sizes
pregnant/lactating women
-require special nutritional considerations for healthy outcomes of themselves and their babies.
-additional 300 to 500 cal/day emphasis on protein sources and supplements
infants, children, and adolescents
-ensuring dietary sources of essential amino acids from protein is critical because of their rapid growth
-require different nutrients based on developmental and growth factors
older adults
BMR declines in older adults at the same time their physical activity is reduced and therefore their caloric intake decreases
what are some factors that affect nutrition in older adults
-social isolation
-depression
-reduced sense of thirst
-adults with reduced mobility
-adults receiving social assistance
-poor dentition
food preferences
learned and vary depending on tradition, geography, education, income, and employment
cultural considerations with food
some cultures believe in the healing properties of food and others follow food restrictions during illness
a nurse can avoid being ethnocentric when assessing nutritional status by
knowing what is edible and what is not, how foods are prepared and when they are eaten, & what role foods play in treating illness
food practices may be based on
religious beliefs; such as fasting or abstaining from eating certain foods
collecting nutritional data
an ongoing process because nutritional intake is an everyday activity
the responsibility of screening patients is on
nurses; they need to assess their level of nutritional risk and reinforcing dietary counseling
a complete nutrition screening assessment include
-risk assessment
-focused history of common symptoms
-comprehensive nutritional history
-physical examination
-calculated measurements
-serial laboratory values during high metabolic demand
nutritional deficits are
rarely acute (most of them develop over time)
calorie needs increase when
trauma or stress occur such as:
-surgery
-trauma
-infection
-head injury
-burns
T/F: serial laboratory values are important to assess patient nutritional status during times of high metabolic demand
true
assessment of risk factors includes
-questions about past medical and surgical histories
-medical/surgical history
-weight history
-family history
-food and fluid intake patterns
-psychosocial profile
-medications and supplements
patient teaching
-teach patients to have high nutrient density foods vs. low nutrient density foods
-read food labels
common symptoms of altered nutrition
-sudden or gradual changes in body weight
-changes in eating habits
-changes in skin, hair, or nails
-decreased energy level
signs and symptoms of malnutrition
-dull, brittle, dry or hair that falls out easily
-swollen glands of the neck and cheeks
-dry, rough, or spotty skin
-delayed healing wounds or sores
-thin appearance
-muscle wassing
-edema of lower limbs
-weakened hand grasp
-depressed mood
-abnormal hea
food records include
-24 hour recall
-3 day food diary
-food frequency questionnaires
equipment needed to collect objective data
-scale
-measuring tape
-growth charts
-skin clippers
simple screening measures in adults
-measuring BMI
-assessing for weight change
unintentional weight loss in older adults is associated with
increased risk of death
nutritional issues can effect
-all body systems
-fluid balance
-electrolytes
undernourished patients may have
-electrolyte imbalance
-delayed healing
-slowed recovery from illness
the liver synthesizes
serum proteins
low hemoglobin and hematocrit indicate
poor iron intake or absorption
lymphocyte count
malnutrition of this may compromise inflammatory response
creatinine excretion
reflects muscle mass but individual variations are wide
nitrogen balance
reflects total protein mass
skin testing
if the patient is malnourished the immune response will be reduced
lipid measurements
used to assess the status of cardiovascular health status which includes total cholesterol, HDL, LDL, and triglyceride levels
other lab tests
anemias are associated with iron, vitamin B12, folate deficiencies, sodium, potassium, magnesium, calcium, & phosphate are associated with nutritional status. because other factors can influence these values they must be considered within a cluster of dat
patients may be at risk for
fluid volume or nutritional imbalance
north americans are at most risk for
imbalanced nutrition: more than body requirements
who's at risk for malnutrition
north americans with:
-lower socioeconomic background
-minimal education
-eating disorders
T/F: the risk of excessive fluid exists
true
most pervasive cause of nutritional imbalances is
deficient knowledge
imbalanced nutrition: less than body requirements
body weight 20% or more below ideal, BMI less than 20, lack of interest in food, nausea, vomiting, diarrhea
imbalanced nutrition: more than body requirements
body weight more than 20% above ideal, BMI greater than 30, eating in response to cues other than hunger, triceps skin fold greater than 25 mm in women or greater than 25 mm in men