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320 Cards in this Set

  • Front
  • Back
Nutrition
o The study of nutrients, how they are absorbed & utilized by the human body.
o Optimal nutrition is essential to maintain
health & prevent illness.
Nutrients
• Chemical substances supplied by food
Nutrients • Utilized by the body for:
o Growth & development
o Activity
o Maintenance for health
o Recovery from illness or injury
Essential Nutrients
not manufactured by the body in adequate amounts for optimal health; must be present in the diet
2 types of Essential Nutrients
o Macronutrients
o Micronutrients
o Macronutrients
carbohydrates, fats, proteins
 Build tissue and supply energy
o Micronutrients
vitamins, minerals
 Regulate and control bodily processes
• Nonessential
either not required for body functioning or synthesized by the body in adequate amounts
o Not needed to be taken in the body through diet
 Eg: cholesterol – enough made by the liver without diet suppliment
o Do not directly supply energy
6 Classes of Nutrients
o Carbohydrates
o Protein
o Lipids
o Vitamins
o Minerals
o Water
Nutrients that Supply Energy & Build Tissue
o Carbohydrates
o Protein
o Lipids
Nutrients that Regulate & Control Body Processes
o Vitamins
o Minerals
o Water
Calories are
Measurement of energy
Measuremenst of energy
• Carbohydrates = 4 cal/gm
• Proteins = 4 cal/gm
• Fats = 9 cal/gm
• Alcohol = 7 cal/gm
Metabolism
• The sum of all physical & chemical changes that occur in the body
Basal Metabolic Rate BMR
• Amount of energy required to maintain involuntary bodily functions at rest.
BMR Accounts for
half the total energy requirements
• Men have a higher
BMR than women
Carbohydrates
• Main source of energy
• Break down rapidly
• Sugars and starches
• Organic compounds
o Composed of carbon, hydrogen and o2
• Most abundant and least expensive source of calories
• Originate from plants
o Lactose is the only animal source
• Functions of Carbohydrates
o Provide fuel & energy
o Spare body protein
 When the body does not get enough energy from carbs it breaks down proteins, therefore carbs keep this from happening
o Prevent ketosis
 When there is inefficient fat metabolism
o Enhance learning/memory
• RDA of carbohydrates
50-100g/day to prevent ketosis
o 45-65% of total calories
• Simple vs Complex carbohydrates
o Simple - monosaccharides & disaccharides
 basic sugar
o Complex - polysaccharides
 Starches, glycogen and fiber
characteristics of carbohydrates
• Easily digested
• Converted to Glucose
• Used as energy
Proteins
• Vital components of every living cell•
Amino acids
• Amino acids
o 9 Essential – must be ingested
o 13 Non-essential – made by the body
• Complete vs Incomplete protiens
o Complete –
 high quality
• contain all of the amino acids needed to support tissue growth
• Animal proteins
o Eggs
o Soy
 Not animal
o Meats
o cheese
o Incomplete –
 low quality
• deficient in 1 or more amino acids
o include plant proteins
 grains
 legumes
 peanuts
 corn
 sunflowers
 sesame seeds
Metabolism Function
o Tissue growth & repair
o Component of body framework & fluids
 Include
• Bones
• Tendons
• BL vessels
• Skin
• Hair
• Nails
• Plasma proteins
• blood

o Helps regulate fluid & acid-base balance
o Forms antibodies
o Backup source of energy
RDA of protiens
10-20% of total caloric intake
o 0.8g/kg of desire
56 gms for avg women
53 gms for avg man
d body weight
Protien deficicency
edema, retarded growth, mental apathy, atrophy, changes in hair & skin, poor wound healing
Fats / Lipids
• Insoluble in blood
• 95% triglycerides
Fats / Lipids Functions
o Insulation & temperature control
o Cushion internal organs
o Absorption of fat soluble vitamins
o Provide energy – 9 calories/gm
o Improve taste & satisfying value of food
Fats make up
• 30% or less of total daily calories
NO RDA
• Fats digested in the small intestine
Classification of Fats
• Saturated –
• Unsaturated
• Saturated
o animal fats;
 solid at room temperature
• bacon
• red meat
• egg yolks
• poultry
• seafood
• dairy
• Unsaturated –
• Unsaturated
o vegetable fats;
 liquid at room temperature
types of unsaturated fats
o Monounsaturated – olive & canola oil
o Polyunsaturated – corn & sunflower oil
Trans-fatty Acids
• Start as Unsaturated fats but are partially hydrogenated to become more solid & stable
• Increase serum cholesterol levels
• Need to be counted as saturated fats
o fried foods
o Commercial baked goods
o Margarines
o Crackers
Omega Fatty Acids
• Omega 3
• Omega 6
• Omega 9
• Omega 3
o Found in
• Ground flaxseed, flaxseed oil, salmon, tuna, mackerel, cod liver oil, walnuts
o Benefits
• Cardiovascular disease, antiinflammitory reduced risk of Alzheimer disease
• Omega 6
o Vegetable oils
• corn, safflower, sunflower
o Benefits
• Prolong blood clotting, reducing incidence of MI or DVT
• Omega 9
o Found in
• Olive oil, peanuts, almonds, avocados
Cholesterol
• Fat like substance found in animal products
• Nonessential nutrient
Cholesterol • High serum levels associated with
atherosclerosis
Cholesterol Dietary Recommendations
o Limit cholesterol intake to <300 mg / day
o Eat less total fat
 especially saturated & trans fats
o Eat more unsaturated fat
o Increase fiber intake
 Fiber helps to excrete cholesterol
Vitamins
• Organic Compounds
• Needed for normal metabolism, growth, &amp; maintenance
• Very fragile
o Destroyed be heat, light and air
Vitamins Water-soluble
– B complex & C vitamins
Vitamins Fat-soluble
– Vitamins A, D, E, & K
Minerals
• Inorganic Elements
Function of minerals
o Provide body structure
o Regulation of body processes
• Macrominerals
o bulk minerals
 Calcium
 Phosphorus
 Sulfer
 Choloride
 Mg
o >100mg/ day
• Microminerals
o trace elements
 Iron
 Iodine
 Zinc
 Chromium
 Copper
 Serlinum
 Floride
o <100mg/day
Water makes up
• 50-60% of total body weight
o 2/3 intracellular fluid
o 1/3 extracellular fluid
• Function of water
o Solvent
 Aids in digestion, circulation, absorption and secretion
o Temperature regulation of the body
o Lubricant
 Needed for mucous secretions, movement of the joints
Dietary Guidelines for Americans
• Eat a variety of nutrient dense foods
• Balance food with physical activity
• Increase fruits, vegetables, & whole grains
• Decrease saturated fats, trans fats, & cholesterol
o <10% from saturated fats
o <3% from cholesterol
• Diet moderate in sugar
o Too many calories
o Too few nutrients
o Causes tooth decay
• Diet moderate in salt and sodium
o <2300 mg/ day
 1 tsp total
o Hypertention
 <1500 mg/day
• Alcoholic beverages in moderation
o Women
 1 drink/day
o Men
 2 drinks/day
Factors Influencing Nutrient Requirement
• Developmental
o Children and teens in growth period
• Sex
o Gender differences
o Men can consume more calories and have higher protein needs
o Women have greater iron needs
o Folic acid prevents spina bifita for women
• State of Health
o Fever
 > calories
o Chronic diseases
o Cancer pts
 anorexia
• Alcohol Consumption
o Destroys intestinal mucosa
o Increases need for vit B and thiamin
• Medications
• Religion
• Economics
• Psychosocial
• Cultural
Nutritional Assessment
• Identification of actual/potential needs
Nutritional Assessment• Obtained through
o History – dietary, medical & socioeconomic
o Physical Assessment
o Labs (Box 42-6)
Nutritional Assessment Methods
• Dietary Intake
• Medical Data
• Physical Exam
• Laboratory Tests –
Assessment of Dietary Intake
o 24-hour recall
o Food diaries
o Food frequency
Assessment of Medical Data
o Illnesses
o Drug use/abuse
o Ability to chew/swallow
o Appetite
Assessment of nutrition with physical exam
o Anthropometric data
o Clinical data…Table 42-8
o Anthropometric data
 Height & weight
 BMI
 Waist measurement
 Triceps skinfold
 Midarm circumference
Assessment of nutrition with Laboratory Tests
o protein levels
o CBC
o 24-hour urine
o Creatinine
Obesity
• Body weight > 20% above ideal weight or BMI =/> 30
Obesity Causes include
o excess caloric intake
o decrease physical expenditure
o genetic factors
o physiologic factors
o psychological factors
Malnutrition
Poor nutrition related to malabsorption, poor diet, or overeating
Anorexia
Lack of appetite
• BMI <18.5 considered underweight
Anorexia Causes include:
o diseases
o psychological
o fear, anxiety, depression
o medications
o financial
Nutritional Support
• Appetite Stimulation
• Assisting with eating
• Appetite Stimulation
o small, frequent meals
o determine and provide food preferences
o pleasant eating environment
o control pain, anxiety, or nausea
o encourage or provide oral hygiene
• Assisting with eating
o Involve person
o Pleasant conversation
o Use napkins, not bibs
Enteral Nutrition
• The passage of a tube into the gastrointestinal tract to administer a formula containing adequate nutrients.
Short-term Nutritional Support
• Considered < 6 weeks
• Advantages
o Provides nutrional support
• Disadvantages
o High risk of aspiration
• Nasogastric (NG) or Orogastric tube (OG)
o OG is not common
o Risk of aspiration
• Nasointestinal (NI)
o Minimal risk of aspiration
 Because its going way past the stomach
o disadvantage
 Dumping syndrome
• Overdistention of SI
o Caused by pyloric bypass no slowing transit of food
• Symptoms
o Gas
o Bloating
o Cramping
o Hyperparastalsis
o Weak
o <BP
o > HR
o Can cause hypoglycemia
Long-term Nutritional Support
• Gastrostomy
• Jejunostomy
• Percutaneous Endoscopic Gastrostomy (PEG) tube
Patient Safety During Enteral Feedings
• Check tube placement!
• Avoid blue dye
• Check residual
• Assess for bowel sounds & gastric distention
• HOB elevated 30-degrees
• Prevent feeding contamination
• Medication administration
Preventing Complications of Enteral Feedings
• Aspiration
• Clogged Tube
• Diarrhea
• Unplanned Extubation
• Nasal Erosion
• Stoma Infection
• Refeeding Syndrome
• Providing Comfort Measures
• Frequent oral hygiene
• Nares clean
• Control local tube irritation
• Encourage patient verbalization of concerns
Parenteral Nutrition
• Administration of nutritional support via the intravenous route
o May be needed from
• Purpose
o Calories
o Proteins
o Carbs
o Fats
o Nutrition balance
o Nitrogen balance
o Replaces fluids
o Vitamins
o Electrolytes
o Trace elements
o Gives bowels chance to heal
Total Parenteral Nutrition (TPN)
• Highly concentrated hypertonic solution……..
o 25% glucose solution
o needs central line
o for long term use
• AKA…Hyperalimentation
Peripheral Parenteral Nutrition (PPN)
• Isotonic….
o peripheral line
 cannot tolerate highly concentrated solution
• dextrose solution is 10%<
Nursing Considerations with TPN
• Identify the line & use a pump
• Administer 10% dextrose solution if TPN interrupted
• Change bags every 24 hours
• Vital signs q4 hours
• Blood glucose q6 hours
• Aseptic technique when changing solutions, dressings, or lines
• Connections taped securely
• Daily weights….weight gain should not exceed 3 lbs/week
• Monitor serum protein and electrolytes
Vitamin A• 2 Forms:
o Preformed - Retinol
o Provitamin - Carotene
o Preformed Vitamin A
 Already in complete state in ingested food
 70-90% is absorbed if consumed with 10g fat
• Reason for not having a “no fat diet”
o Provitamin Vitamin A
 Not in complete state
• Converts to retinol in the intestine
• Precursor to complete vitamin
 Body can stores a year supply of Vitamin A
• 90% in the liver
• Excess carotene stored in adipose tissue
 Less issues because of where it is stored
• Excretion of Vit A
o 40% in feces
o 60% in urine
Vitamin A stored in
o 90% in the liver
o Excess carotene stored in adipose tissue
Vitamin A Functions. . .
o Vision
 Dim light and night vision
o Health of Epithelial Tissue
 Integrity of mucosa and surface of tissues
• Skin, surface of eye, lining of GI tract
o Believed that it plays a role in the prevention and treatment of cx
o Growth & Development of Bones & Teeth
 Children with deficiency have been noted to have a slowing of growth
o Energy Regulation
o Heat production & energy balance
Vitamin A Deficiency
• Night Blindness
• Bone Growth Ceases
o Can lead to brain & spinal injuries
• Epithelial Tissue Disorders
• Xerophthalmia
o Thickening & drying of outer surface of eye; can cause blindness
• Increased susceptibility to infection
• Xerophthalmia
o Thickening & drying of outer surface of eye; can cause blindness
Vitamin A Dietary Sources • Retinol
(animal sources)
o Liver
o Egg yolks
o Fortified Milk Products
Vitamin A Dietary Sources• Carotene
(plant sources) think yellow
o Carrots
o Sweet Potatoes
o Squash
o Spinach
o Broccoli
Vitamin A Toxicity. . .
• Carotenemia
• Hypervitaminosis A
• Carotenemia
 excess carotene
 Causes
• Yellowing of skin;
• starts with hands & soles of feet
• Sclera is not affected
 If excess carotene is stopped s/s reverse w/in a few weeks
• Hypervitaminosis A
 excess retinol
 S/S that are similar to increased intracranial pressure –
• headache, blurred vision
 Bone & joint pain
 Dry skin
 Can result in liver failure
• Most significant result
Vitamin D Functions. . .
o Main function is to promotion of Bone Mineralization
 Happens in 3 ways
• Increases intestinal absorption of calcium & phosphorous
• Stimulates bone cells to build & maintain bone tissue
• Stimulates kidneys to return calcium to the blood
o Also have receptors around
 Heart
 BL vessels
 Tissues
 Brain
 Immune system
o Decreased urinary excretion of calcium
 One of the key factors in preventing osteoporosis
Vitamin D Deficiency . .
• o Rickets
 In children
 Bones fail to calcify & bend (bow) in an effort to support the body’s weight
 Eg: bow legged
o Osteomalacia
 Soft fragile bones
 More common in adults
 “rickets” for adults
 Decrease in the mineralization
 Most common in women
• Decreased calcium intake
• Sun exposure
o Osteoporosis
 Reduced bone density
 Normal mineralization of the bones
 Caused by vit d inadequacy
Vitamin D Sources . . .
• Sunlight
o 15 minutes exposure of face, hands, arms twice weekly without sunscreen of SPF 8 or higher
• Dietary Sources
o Fortified milk, dairy products
o Salmon, tuna, sardines
• Supplements
o Cod Liver Oil
o Vitamin supplements
Vitamin D Toxicity . . .
MOST TOXIC OF ALL VITAMINS
S/S of Hypervitaminosis D
• Calcium deposits on kidney, heart & brain
• Loss of appetite
• Polyuria – frequent urination
• Muscular weakness
• Constipation
Vitamin E
Least Known Vitamin
• ost stored in the adipose tissue
• Unclear if Vitamin E is related to the prevention of cardiovascular disease & cancer
Vitamin E Functions
o Antioxidant
 Deactivation of free radicals
 Cell membrane stability
• Able to fight them off more
o Barrier against air pollution in the lungs
o Promotes RBC stability
o Role in immunity
 Still being researched
o Helps for scar healing
Vitamin E Deficiency
• Progressive Peripheral Neuropathy
o Immune System Suppression
• Hemolytic Anemia
o RBC hemolysis
• CNS Effects
o Ataxia & changes in mental status
Vitamin E Dietary Sources
• Vegetable Oils
o Olive & Canola
• Whole Grains & Wheat Germ
• Nuts – almonds, sunflower seeds, hazelnuts
• Eggs, Meats & Fish
• Green Leafy Vegetables
Vitamin E Toxicity
• Excessive Bleeding
• Impaired Wound Healing
• Depression
Vitamin K. . .
Vitamin that Acts Like a Medication
 Prescribed to treat bleeding disorders
• INR is too high
• Prior to surgery
o Most is synthesized in intestinal tract to create bacteria
Functions of Vitamin K
• Regulates Blood Coagulation
o Necessary for liver to make prothrombin & other clotting factors
• Bone Metabolism
o Facilitates synthesis of calcium binding protein
Vitamin K Deficiency. . .
• Deficiencies associated with disease processes & medication treatment
o Fat absorption disorders interfere with absorption of Vitamin K
o Antibiotics kill bacteria needed to synthesize Vitamin K
• Symptoms of Deficiency
o Prolonged Clotting Time
o Poor Bone Health
Vitamin K Sources. . .
o Intestinal Synthesis
 About one-half body’s need
o Food Sources
 Green leafy vegetables
• Broccoli
• spinach
 Cabbage
 Liver
 Milk
 fruits
• Bananas
• Strawberries
• cantaloupes
Water Soluble Vitamins
• B Vitamins and Vitamin C
• Can be dissolved in water
• Can be stored by the body in large amounts
o Any excess is excreted in the urine
 Toxic reaction are rare because of this
 This also makes a need for daily requirements
B Complex Vitamins
• B1 Thiamin
• B2 Riboflavin
• B3 Niacin
• B6 Pyridoxine
• B9 Folic Acid
• B12 Cyanocobalamin
Thiamin. . . B1
o Functions
 Coenzyme in Carb metabolism
 Converts glucose to energy
 Important for nerve conduction
o Deficiency =
 Beriberi
• Creates a lot of neurologica symptoms
o Mental confusion
o Fatigue
 Wernickes-Korsikoff syndrome
• Cerebral beriberi
• Affects cardiac
 fatigue, paralysis
o Sources =
 Pork,
 beef,
 liver,
 whole or enriched grains
o Cronic alcoholism affects thiamine uptake
 Thiamin and folate are the two that alcoholics are deficient in
s
• Sources = Pork, beef, liver, whole or enriched grains
Riboflavin . . .B2
o Functions
 Coenzyme to protein metabolism
• And metabolism of other Vit
o Deficiency =
 mouth lesions, skin changes
 eg:
• seborrheaic dermatitis, dandruff
o Sources =
 Beef liver,
 milk,
 legumes,
 whole or enriched grains
o Turns urine bright yellow
Niacin . . . B3
o Functions
 Coenzyme in energy metabolism
• Glucose metabolism
 Involved in the synthesis of fatty acids
 Cholesterol-lowering agent
o Deficiency =
 Pellagra… (3 d’s)
• dermatitis,
• diarrhea,
• dementia
o Sources =
 meats,
 fish,
 poultry,
 liver,
 peanuts,
 coffee
Pyridoxine . . .B6
o Functions
 Coenzyme in the synthesis & catabolism of amino acids
 Metabolism of over 100 enzymes
 Synthesis of
• Epinephrine
o energy
• dopamine, & serotonin
o neurotransmitters
 Antibody production
o Deficiency =
 Unlikely
• Large amounts in a normal diet
• Birth control can remove B6
 s/s
• Anemia,
• impaired immune function,
• neurological abnormalities
o confusion
o depression
o Sources =
 Beef
• steak
 liver,
 bananas,
 potatoes,
 whole grains
• fortified ceral
Folic Acid. . .Folate…B9
o Functions
 Protein synthesis
 Formation of DNA
 RBC maturation
o Deficiency =
 r/t
• Anemia, fatigue, red, smooth, swollen tongue, heartburn, diarrhea
 Alcoholics & pregnant women are at most risk
• Linked to fetal neural tube defects
o Eg: spina bifida
o Sources =
 Beef,
 liver,
 spinach,
 asparagus,
 broccoli,
 cantaloupe,
Cyanocobalamin. . .B12
o Functions
 Use of folic acid in DNA replication & RBC production
 Maintenance of CNS including brain & spinal cord
 Known as the extrinsic factor
• Protected by the intrinsic factor produced in the stomach lining
o Deficiency –
 pernicious anemia
• Numbness/tingling of hands & feet, RBC changes, moodiness, confusion, depression
o Sources =
 meats,
 milk,
 cheese,
 eggs
o Folic acid cannot stimulate production of RBC’s with out B12
Vitamin C . . .
Ascorbic Acid
Vitamin C Functions:
• Aids in wound, burn & fracture healing
• Antioxidant
• Synthesis of steroid hormones & neurotransmitters
• Iron absorption
• Folic acid conversion
• Collagen formation
Vitamin C………….
• Deficiency
o Sore, tender gums that bleed
o Ecchymosis
o Delayed wound healing
o Scurvy
Vitamin C • Sources
o Citrus fruits, Orange & grapefruit juice, cantaloupe, strawberries
o Peppers, broccoli, tomatoes, potatoes
Vitamin C• Smoking
Depletion of Vitamin C stores
Vitamin C• Toxicity
o Abdominal cramps, nausea & vomiting
o False positive urine glucose
o False negative guiuac testing
Vitamins as Medicine
Remember. . .nutritious foods, not supplements, are the BEST sources of vitamins !
Minerals
Major:
Calcium
Sodium
Potassium
Magnesium
Chloride
Sulfur
Calcium Functions
Structure of bones & teeth
o Metabolic functions in nervous, muscular, and cardiovascular systems
o Muscle contraction
o Blood clotting
Calcium Sources
Milk, milk products are best
o Sardines, clams, oysters, salmon
o Spinach, broccoli
Calcium Deficiency
• Osteopenia vs Osteoporosis
o causes
o risk factors
o treatment
• Hypocalcemia
• Tetany – nervousness, irritability, numbness & tingling around mouth, muscle cramps
Phosphorus• Component of:
o Bones & Teeth
o DNA, RNA,
o Storage forms of energy - ADP, ADT
o Cell structure & most enzymes
o Blood buffer system (pH 7.35-7.45)
Phosphorus• Deficiency
muscle weakness, increased calcium excretion
Phosphorus• Excess–
– tetany, convulsions, renal insufficiency
Phosphorus• Sources
lean meat, fish, poultry, milk, eggs, nuts, legumes
Sodium• Functions
o Fluid balance
o Nerve/muscle electrochemical impulse transmission
Sodium• Deficiency
irritability, muscle twitching, seizures
o related to diarrhea, vomiting, heavy sweating, kidney disease
Sodium• Excess
- increased thirst, fatigue, agitation
Sodium• Sources
o Table salt, milk & milk products, vegetables, processed foods
Potassium• Functions
o Fluid balance
o Nerve impulse conduction
o Muscle contraction (esp. the heart)
o Electrolyte & acid-base balance (pH)
o Glucose-glycogen conversion
Potassium• Sources
, cantaloupe, green vegetables, legumes, potatoes with skin
• Hypokalemia
related to diuretics, diarrhea, vomiting
• Hyperkalemia
caused by supplements or renal failure
Magnesium• Functions
o Nerve impulse transmission
o Relaxation of skeletal muscle
o Activates enzymes for CHO, protein, & glucose metabolism
o Cofactor in calcium utilization
Magnesium• Sources
o Green vegetables, whole grains, coffee
Trace Minerals
• Iron
• Iodine
• Fluoride
• Zinc
Iron• Functions
o Hemoglobin formation
o Component of myoglobin
o Component of enzymes that oxidize glucose for energy
o Synthesis of myelin & neurotransmitters serotonin & dopamine
Iron• Deficiency
fatigue & anemia
Iron• Sources
o Liver, red meats, dark green leafy vegetables
Iron• Supplements
side effects & risks
Iodine• Function
Component of thyroid hormones
Iodine• Deficiency
• Deficiency – thyroid dysfunction, goiter
Iodine• Sources
• Sources – iodized salt & saltwater seafood
Fluoride• Function
• Function –Strengthens teeth
Fluoride• Deficiency
• Deficiency – dental caries
Fluoride• Toxicity
• Toxicity – mottled discoloration of teeth, dental caries
o –Dangerous for children – bone & kidney dysfunction
Fluoride• Sources
• Sources – fluorinated water & toothpaste, seafood
Zinc• Functions
o –Component of all body tissue
o –DNA/RNA synthesis
o –Component of insulin
o –Necessary for collagen formation needed in wound healing
o –Role in immunity
Zinc• Deficiency
o –Skin lesions, hypopigmentation of hair, impaired wound healing, corneal edema, patchy alopecia
Zinc• Sources
o Shellfish, oysters, red meat, cheese, fortified cereals
Special Diets• Include:
o Nutrient Adjustments
o Caloric Adjustments
o Texture or Consistency Adjustments
o Seasoning Restrictions
Special Diets• Purpose
o Restore or maintain nutritional status
Clear Liquid Diet
• Any transparent liquid that can be poured at room temperature
o Provides energy & fluid with minimal digestive action
o Indications
o Limit undigested food in GI tract
o Fluid & electrolyte replacement in acute illness
o 1st step in reestablishing oral nutrition
Clear Liquid Diet• Foods
o Gelatin, broth, tea, coffee
o Some juices - apple, cranberry, grape juice
o Carbonated beverages – ginger ale, 7-Up
o Clear nutritional supplements – high protein broth
Full Liquid
• Foods & beverages that are liquid at body temperature
o Can be adequate in all nutrients
o Nutritional supplements – Boost, Ensure
Full Liquid• Indications
o Progression between clear liquid & soft diet
o Inability to tolerate solid foods
Full Liquid• Foods
o Milk, all fruit juices, ice cream, custard
o Thinned hot cereals (cream of wheat)
Soft Diet• Indications
o Swallowing or chewing difficulties
o Easily digested foods required
Pureed vs Mechanical Soft
o Mechanical soft – semi-solid foods easily digested
o Pureed – food run through a blender
Dysphagia Diets
• Provide graduated steps from most easily managed foods to the most difficult
o Liquids range from thick to thin
o Solids range form pureed to regular
o Liquids & solids may progress independently
o High protein/calorie supplements
• Dysphagia Level I
o Pureed to consistency of baby food
o Requires minimum chewing
• Dysphagia Level II
o Mechanically altered soft, moist foods
Thickened Liquids
• Nectar - similar to that of V8 juice
o Does not hold its shape if poured on a plate
• Honey – mounds a bit on a spoon
o Still drinkable from a cup
• Pudding – thick like pudding
o Holds its shape
o Served on a spoon
Aspirations Precautions
• HOB elevated during meal & 1 hour after meal
• Head tilted forward – tuck & swallow
• No straws
• Need to swallow more than 1 time
• Food gets stuck in mouth or esophagus
• Observe for signs of aspiration
o Coughing, gargling sounds
Renal Diet
• Prevention of hyperkalemia, hyperphosphatemia, & fluid overload
• Restricts potassium, sodium, phosphorus & fluid intake
• Raw vegetables & fruit
• Dairy products
• Convenience & fast foods
• Look for low-sodium versions of foods
• Everything that melts at room temperature counts as fluid intake
Low Fat Diet
• Management of chronic pancreatitis, gall bladder disease & other diseases involving fat malabsorption
• Total dietary fat restricted to 40-50 grams daily
• Prepare meats by baking, broiling, roasting, or stewing; avoid frying
• Skim milk
• Limit meat to 6 oz/ day
• Limit added fat to 3 servings / day
Fluid Restrictions
• Assist in management of fluid balance
• Excess fluid buildup causes edema, weight gain, & shortness of breath
• Fluid restrictions stated in ounces or mL per day
• Any food that is fluid at room temperature is counted
Cardiac Diet
• Aid in lowering BP & cholesterol level; prevention of fluid retention
• Sodium intake limited to 2 g/day
• Cholesterol limited to 300 mg/day
• Intake of total fat & saturated fat are reduced
• Mono- & polyunsaturated fats intake are increased
DASH Diet
• Dietary Approaches to Stop Hypertension
• Developed by US National Institutes of Health
• Goal to lower BP, reduce cholesterol, & insulin sensitivity
• Based on eating plan rich in fruits, vegetables, & low-fat or nonfat dairy
• Also includes grains, lean meats & fish, nuts & beans
Carbohydrate Controlled Diet
• Aimed to control blood glucose levels through consistent daily carbohydrate intake & weight management
• Meal frequency – every 4-5 hours
• Limit concentrated sugars
• Total amount of CHO in a feeding is more important than the source
• One CHO serving = 15 grams of CHO
• Meal planning approaches
- My Pyramid - Exchange lists
Iatrogenic Malnutrition
• Induced malnutrition
o Excessive or deficit intake of one or more nutrients induced by the oversight or omissions of health-care workers
• Prevention
• Assessment
• Communication
• Interventions
Phases of the Perioperative Period
Preoperative

Intraoperative

Postoperative
Classification of Surgical Procedures
Urgency
Level of Risk
Purpose
URGENCY
Emergency
Urgent
Elective Surgery
PURPOSE
Diagnostic
Ablative
Palliative
Re constructive
Transplant
Constructive
• ALL PATIENTS getting surgery have these things in common
o Progress through specific phase
o Require some form of anesthesia
o Give informed consent
o Preoperative
 The decision that surgery is necessary and lasts until the pt is tx to the OR bed.
o Postoperative
 From the recovery area until complete recovery
 The longest period
o Intraoperative
 The admission into the OR until the tx to the recovery area
o Emergency
 If it must be done immediately to preserve life, body part or body function
• Trauma
o Urgent
 Needs to be done within a reasonable amount of time.
 Necessary for clients health
• Eg
o Coronary bypass
o Removal of tumor
o Elective Surgery
 Preplanned. Based on pts choice to have done. Delaying will not have negative impact on pt.
 Eg
• Hip or joint replacement
• Face lift
• Degree of Risk
o Minor surgery
o Major surgery
o Minor surgery
 few complications
 usually brief
 usually outpatient
Major surgery
 higher degree of risk
 complications
 prolonged hospitalization
• PURPOSE
o Diagnostic
o Ablative
o Palliative
o Reconstructive
o Transplant
o Constructive
• Outcomes for the Surgical Patient (Association of perioperative Registered Nurses – AORN)
o Be free from injury and adverse effects
o Be free from infection
o Maintain fluid and electrolyte balance & skin integrity
o Demonstrate understanding of psychologic and physiological responses to surgery
o Participate in rehabilitation process
o Diagnostic
 To make or confirm a dx
• Eg: biopsy
o Ablative
 To remove a diseased body part
• Eg: cholecystetectomy, appendectomy, amputation
o Palliative
 Relieve or reducing the intensity of a condition. Not intended to cure. Only relieve symptoms.
• Eg: removal of tumor (pt still has cx)
o Reconstructive
 Restore function to traumatized or malfunctioning tissue
 Already had functioning tissue that then needed to be fixed.
• Eg: Breast reconstruction, skin graft
• PURPOSE
o Diagnostic
o Ablative
o Palliative
Reconstructive
Transplant
Constructive
o Reconstructive
 Restore function to traumatized or malfunctioning tissue
 Already had functioning tissue that then needed to be fixed.
• Eg: Breast reconstruction, skin graft
o Transplant
 To replace organs or structures that are diseased or malfunctioning
• Eg: hip, joint
o Constructive
 To restore function in congenital anomalies
 Was never there before
• Eg: cleft lip
o Pre-op Nursing Assessment
 VERY IMPORTANT!!
 Gives Baselines
 History
 Risk Factors
 Psychosocial/Teaching Needs of patient and Family
• Ambulatory Surgery
o Outpatient or Same Day
o NURSING HISTORY INCLUDES
 Developmental considerations
 Medical History
 Medications (allergies)
 Previous Surgeries
 Perceptions & Knowledge of Surgery
 Nutrition
 ETOH, Drug and Tobacco use
 ADL’s
 Occupation
 Coping Skills
 Support Systems
 Socio-cultural Needs
o Age
• Infants
 low blood volume.
 hypo/hyperthermia
 effect of medications
 Do not have highly developed liver
• At higher risk for effects from medication
o Age• Older Adults
 Chronic disease
 Physiologic changes
• < ability to handle effects of sx
 Prolonged wound healing
o Medical History
 Need both current and past illness’
 Provides Information about increased risk
• Cardiovascular
o Heart, CHF, hx of MI, CAD, hypertension, Dysrhythmia
• Pulmonary
o COPD, FV overload, pneumonia, smoking
• Kidney & Liver Function
• Endocrine
o diabetic
 Surgical risk is increased by drugs in the following categories:
• Anticoagulants
o Eg: Coumadin, heparin, aspirin, lovenox, plavix
• Diuretics
o Eg: Lasix, HTC, aldactone
o Can cause electrolyte impbalance
• Tranquilizers/sedatives
o Cause an increase hypotensive reaction
• Adrenal steroids
o Eg; predinosne
• Antibiotics in mycin group
o Can cause respiratory paralysis when combined with certain drugs
• Surgical History
o Medication History
 Medications – Need to ask about ALL
 ANY ALLERGIES (Latex, Iodine, Tape)
o Surgical History
 Previous surgeries
 Previous reactions to certain anesthetic agents from surgeries
• Eg: malignant hyperthermia
o The body’s temperature increases very high as a reaction to anesthesia.
o Is genetic
Lifestyle Nutrition
• Malnutrition
o Increase risk for alteration in fluid and electrolyte balance
o Wound healing
o Wound infection
• Obesity
o Increased
 Cardiac
 Respiratory
 GI
o Poor wound healing
 Lower blood supply in fatty tissue
Lifestyle • Alcohol
o Pt’s need to be honest!
o Stays in longer than 24 hours is at risk of DT’s7
o Increased their threshold to medications
 Pain and anesthetic agents
Higher bleeding risk
• Illicit Drugs
Lifestyle • Illicit Drugs
o At risk for drug interactions
Lifestyle• Tobacco
o Increased Risk for respiratory complications
o Smoking paralyzes cilia
 Not moving particles and mucous out. Causes chronic irritation
 Anesthesia can further irritate those agents in the mucosa
o Smoking vasoconstricts the vascular system
 Altered wound healing
 Delrium Tremens
Shaking, confusion, seizures, lethargy
o Activities of Daily Living/Occupation
 Financial concerns are the largest stress
• Preop Physical Assessment
o General Survey gathers a Baseline
 V/S
 Skin
 Chest and Lungs
 Cardiovascular
 Abdomen
 Musculoskeletal
 Neurologic
• Preoperative Diagnostic Screening
o Anything abnormal must be reported
o Urinalysis
 CBC
 Coagulation study
 Chemistry Profile/SMA6
 ECG
 CXR
o Type and cross match
 Other Tests
o Urinalysis
 Fluid imbalances
 blood
o CBC
 WBC, hematocrit, Hemoglobin, RBC, platelet
o Coagulation study
 Only done typically on people who are on anti-coagulant therapy
 PTT
o Kidney Function
 Checked with BUN and creatine
o Chemistry Profile/SMA6
 Looking at K and BUN and creatine
• Affects heart
o Type and cross match
 Know what blood type they are
 Other Tests
• Autolgis transfusion
o Take blood from self to receive back if needed after sx.
• PSYCHOLOGICAL
o Common Fears
 Waking up during sx
 Dying
 Infection
 Complications
• Paralysis
 Pain
 Surgical errors
 Body image
 DX (what will be found)
 future
• PSYCHOLOGICAL o Therapeutic Nursing Responses
 PREPARE PATIENT PSYCHOLOGICALLY
 Establish and maintain a therapeutic relationship. Allow patient to verbalize
 Use active listening skills
 Use touch as appropriate
 Be prepared to respond to common patient questions about surgery
 PREPARE PATIENT PSYCHOLOGICALLY
 Establish and maintain a therapeutic relationship. Allow patient to verbalize
 Use active listening skills
 Use touch as appropriate
 Be prepared to respond to common patient questions about surgery
preoperatively
• Things that RNs need to teach
o Surgical Events and Sensations
 Who will be in the OR and what their roles are
 Temperature
 Bright lights
 Equipment that will be used
• EKG, O2 mask
 Affects of anesthesia
 What they can bring or cannot do prior
 If intubation is required
• Will have a sore throat
 Preop medications
• Dry mouth
 Equipment when leaving
• Foley, PCBs
 Pain
 Loss feeling and or functioning temporarily
• Things that RNs need to teach
o Pain Management
 What to expect
 Know when to ask for pain
• Prior to being in TOO much pain
 Splinting r/t coughing
• A blanket or pillow is used over top of the incision while coughing to keep it from dehiscing.
 Things to reduce post op complications.
Things that RNs need to teach
o Deep breathing, coughing, incentive spirometry, leg exercises, turning in bed, use of special equipment(
 Deep breathing
• Due to alveoli collapse
o Atelaktisis
 Prevented by deep breathing.
 Coughing
• Moves mucous out
• Prevents pnsumonia
• Explain to pt will cause pain
• Try to medicate prior.
 IS
• Gives incentive to aim for as taking deep breaths
• Purpose is to help fully inhale so that the lungs are getting as much air as possible.
o Pt breathes in and tries to keep the ball at certain level
 Turning
• Prevents blood clots in legs
• Increase parastalsis
• Prevent skin breakdown
 PCBS
• Prevents blood clots
• Preoperative Patient Education
o Done preoperatively
o Assess!
 What does my pt need to know?
o Objectives
 Verbalize instructions
o Return Demonstration
Informed Consent
• The patient’s voluntary agreement to undergo a particular procedure or treatment (patient has the Right To Refuse).
• Protects the patient, physician, and the healthcare institution.
• A legal written document as well as an ethical imperative.
Informed Consent• Contains
o Description of the procedure
o The underlying disease process
o Name of person performing procedure
o Explanation of risks
o Explanation of patients rights of refusal and withdrawal
Informed Consent RN does not
• Describe procedure
• Explain risks vs benefits
Informed Consent• Who obtains
o Needs to be obtained by the person performing the procedure (usually the surgeon)
o The nurse may witness consent but needs to be sure that the patient does understand the procedure and information.
• Advance Directives
o Allows patient to make healthcare wishes known if they should become unable to communicate these wishes postoperatively.
o Can be suspended during sx
• Living Wills
o Durable power of attorney for healthcare
 A person that you have assigned that is allowed to make healthcare decisions for you.
• Important for family to discuss BEFORE surgery
Physical Preparation
• Hygiene and Skin
o Use of antimicrobial soap night before
o Pt does not shave
• Elimination
o If bowel sx go through bowel prep
o Foley cath placed
• Nutrition
o NPO
 To prevent aspiration if vomiting occurs
• Rest and Sleep
Prepare for Surgery
• Complete pre-op checklist
o Insure consents signed
o Obtain Vital Signs
o Ensure that abnormal results are reported
o Insure Identification Band in place
o Administer Pre-op Meds if any
Post Surgery ANTICIPATORY NEEDS
• Prepare the patient’s room
o Have bed made with necessary items
• Gather equipment
o IV pole, IS
• Family Needs
o Expectations
o Needs
o Length of time in OR
o Where they can wait and eat
o How they will be contacted
o Where and when they will be able to see the client again
location of pt
INTRAOPERATIVE NURSING
o Begins with the admission of the patient to the surgical area and lasts until the patient is transferred to the PACU
INTRAOPERATIVE NURSING • NURSING ROLES
o SCRUB NURSES
o CIRCULATING NURSES
o Expanded Role
 Anesthetist
 ACUTE CARE NURSE PRACTIONERS
 REGISTERED NURSE FIRST ASSISTANT
• MEMBERS OF THE SURGICAL TEAM
 Scrub person
 Circulating nurse
 Surgeon
 Anesthesiologist
 Nurse Anesthetist
 Surgeon assistant
o SCRUB PERSON
 Nurse or surgical tech
 Sets up sterile field/maintains asepsis
 Passes instruments to the surgeon
 Anticipates the surgeon’s needs
 Aware of surgeon’s preferences
o CIRCULATING NURSE
 Acts as patient advocate
 Pre surgical assessment
 Documentation on the OR record
 Assists team members
 Counts instruments, needles, sponges
INTRAOPERATIVE Journey
• In preop holding area
o Identify patient
o Assess emotional and physical status
o Verify information on pre-op checklist
• past medical history
• medications
• allergies
• surgery to be performed
• Operating Room prior to starting
o Patient transferred into OR suite
o Patient transferred onto OR table
o Patient identified
o Connected to monitors, Given O2, Anesthesiologist and nurse anesthetist present
o Documentation on the OR record by circulating RN
o Documentation on the OR record by circulating RN
 Allergies
 Physical status
 Operative procedure
 Team members
 Position
 Skin integrity
 Tourniquet location/Timing
 Drains/catheters
 Pre and post dx
 Medicines administered
 Anesthesia administered
 Counts
 Specimens sent
Anesthesia
• A drug induced state in which the CNS is altered to produce varying degrees of pain relief, depression of consciousness, skeletal muscle relaxation and diminished or absent reflexes.
• General Anesthesia
o Produces central nervous system depression
 Experiences loss of consciousness
• Has amnesia effects
 Rapid
 Requires placement of endotracheal tube
• Due to respiratory depression
o Given primarily by inhalation or intravenous routes
o Administered by an Anesthesiologist (MD) or Certified Registered Nurse Anesthetist (CRNA)
General Anesthesiao Desired effects:
 analgesia, relaxed skeletal muscles, and depressed reflexes
 can be used for any age pt and for any procedure
• used for unknown reactions
General Anesthesia Side Effects
 Dose dependent
 Respiratory depression
 Myocardial Depression
• Slow down HR
 Hypotension
 Nausea & vomiting
 Confusion
 Toxicity/overdose
 Potentiation
• Regional Anesthesia
o Renders a specific portion of the body insensitive to pain because it interferes with nerve transmission without causing loss of consciousness
o Will be responsive
Regional Anesthesia Risks
 Could rise up spinal column and cause paraylisis
 Skin integrity
 Burns
Regional Anesthesia Forms
 Nerve blocks
 Spinal anesthesia
 Caudal anesthesia
 Epidural
Regional Anesthesia Types
 Topical
 Local
 Conscious Sedation
 MAC (Monitored Anesthesia Care
 Topical anesthesia
• Applied to skin or mucous membranes
 Local anesthesia
• Applied to site
o Eg; tooth
 Conscious Sedation anesthesia
• Administered by Dr or nurse
o Eg: colonoscopy or endoscopy
• A combination of drugs that decrease the awareness of what is happening but are still conscious.
 MAC (Monitored Anesthesia Care)
• Provided by Dr or RN
• Very easily arousable sleep
• Pt maintains airway
• Usually prophol
• Positioning of the Patient during Surgery
o Supine- most common position
o Trendelenberg
o Lateral
o Prone
o Lithotomy
o Lithotomy position
 Feet up in stirrups
 Eg: gynecological, rectal or urital procedures
• Transferring the Patient to the PACU
o Transfers are critical.
o WATCH
 INCISIONS
 CARDIOVASCULAR
• Sever hypotension, arrest
 RESPIRATORY
• arrest
POST OP NURSING CARE
• TWO STAGES
o Immediate
o Ongoing
POST OP NURSING CARE Immediate Care
 From nursing home to convalescent
 Dr gives report to family
 Nursing takes over care of pt
 RESPIRATORY STATUS
Most Common PACU emergency
 Respiratory obstruction
• Respiratory obstruction can be caused by
o Secretion accumulation
o Tongue obstruction
o Laryngospasm
o Laryngeal edema
• Signs of Respiratory Distress
o Restlessness, apprehension
o Unequal Chest Expansion
o Shallow, noisy respirations
o Cyanosis
o Rapid pulse rate
• R distress interventions
o Keep airway open!
o Endotracheal tube until reflexes return
 coughing
o Proper positioning
o Humidified O2
o Pulse Oximetry
o Deep Breathing
o Suctioning
Post op o CARDIOVASCULAR
 Assess:
• Blood pressure
• Pulse
• Electrocardiogram rate and rhythm
• Skin color and condition
• Respirations
• Temperature
• Wound
 Consciousness returns in order
reverse order
Order of consciousness return
• Unconsciousness
• Response to touch and sound
• Drowsiness
• Awake but not oriented
• Awake and oriented
o Fluid Status
 Assess
• Skin turgor
• Vital signs
• intake and output
• Wound drainage
• IV intake
• Fluid, rate
o Large amt of drainage combined with other abnormal assessments may indicate
hemorrhage and hypovolemic shock
o WOUND STATUS
 Assess Wound Dressing for
• drainage:
o Amount
o Color
 Consistency
• OBJECTIVE & SUBJECTIVE signs of pain
o Objective signs
 Rapid breathing
 Protection of wound
o Subjective signs
 Pt statement of pain
• PACU to Nursing Unit
o Transfer occurs when
patient’s physical status and level of consciousness are considered stable
PACU to Nursing Unit
o Transfer Report
• Includes
name, procedure, allergies, vital signs, anesthesia, medications, I/O, wound, complications, PMH, review post op orders.
Goals of Postoperative Nursing Care
• Maintenance of:
o Respiratory function
o CV function
o Neurological function
o Fluid/electrolyte, nutrition, elimination
• Promotion of:
o Comfort/safety
o Activity
o Wound healing
o Psychosocial Well Being
• Preventing PostOp Complications
• RESPIRATORY COMPLICATIONS
o Pneumonia
o Atelectasis
o Pneumonia
 Inflammation of the alveoli d/t infection or aspiration of foreign material
o Atelectasis
 Collapsed alveoli
Pneumonia s/s
• cough
• fever
• chills
Atelectasis s/s
• cynaosis
• Dyspnea
• Low pulse ox
• Anxiety and restlessness
• PREVENTION OF RESPIRATORY COMPLICATIONS
o Assess Vital Signs
o Cough
o Deep breathing
o Incentive Spirometry
o Turning in bed
o Ambulate/Positioning in bed
o Maintain hydration
o Monitor narcotic responses
• CARDIOVASCULAR
o Assess
 document Vital Signs
 Provide warmth
 Maintain Fluid Balance – Monitor I&O
 Monitor drainage
 Capillary refill
 Implement leg exercises
 Assist with ambulation
 Apply TEDS
 Administer anticoags
 Measure bilateral calf and thigh circumference
 Avoid poor positioning
o Hemorrhage
 Excessive blood loss
Hemorrhage can be
 Internal or external
Hemorrhage • Internal
o Low BP
o Bruising
o Weak, thready, rapid pulse
Hemorrhage external
o May lead to shock
o Apply pressure dressing
o Prepare for return to OR
o Shock precautions
o Shock precautions
 Maintain airway
 Place pt flat with legs raised
• More venous return
 Administer O2 and fluids IV
o HYPOVOLEMIC SHOCK
rapid loss of fluids
 Shock is
a pt has lost control of their peripheral nervous system
o HYPOVOLEMIC SHOCK s/s
• Hypotension
• Cold, clammy skin
• Weak, thready, rapid pulse
• restlessness
• Apprehension
• increasedurine output (oliguria)
• Cool, mottled extremities
• Deep, rapid respirations
• Thirst
o Thrombophlebitis
 Inflammation of a vein associated with a blood clot (thrombus formation).
• Pain and cramping at site.
• inflamation and swelling
• Elevated temp.
• Increased circulation of involved extremity
 Treatment of Thrombophlebitis
• Goal:
o Preventing a clot from breaking loose and traveling as an embolism
Thrombophlebitis • Nursing Interventions:
o TEDS, anticoagulants, antiinflammatories,
o analgesics, measuring, provide support.
• DO NOT MASSAGE OR RUB LEGS COMPLETE BED REST
• PULMONARY EMBOLUS
o An embolus lodged in the pulmonary vessels.
o PULMONARY EMBOLUS s/s
 Dyspnea
 Chest pain
 Cough
 Cyanosis
 Rapid respirations
 Tachycardia
 Anxiety/Feeling of impending doom
• Sedation Scale
• S= Sleep, easily aroused
• 1= Awake and alert
• 2= Occasionally drowsy, easy to arouse
• 3= Frequently drowsy, arousable, drifts off to sleep during conversation.
• 4= Somnolent, minimal or no response to stimuli
• RULE OF THUMB:
o 24 hours= pulmonary infection.
o 48 hours= urinary tract infection.
o 72 hours= wound infection.
o DEHISCENCE
 Partial or total disruption of wound layers
o EVISCERATION
 Typical with abdominal wounds
 Partial or total disruption of wound layers and protrusion of viscera
BMR is needed to maintain
 Circulatory
 GI
 Renal
 Cells and tissues
 Respiratory
o Involuntary functions that use BMR
 Maintain body temp
 Muscle tone
 Producing secretions
 Peristalsis
 Respritory functions
 Cardiac functions
• As the amount of physical activity decreases
the BMR increases
• Some causes of increased BMR
o Childhood growth period
o Fever
 7% / degree above 98.6
o Emotional stress
o Extreme environmental temperatures
o Elevated hormones
 Thyroid
o Pregnancy
• Decrease BMR causes
o Aging process
 Decreases as get older
o Prolonged fasting or dieting
o Sleeping
Classification of Fatty Acids
fatty acids:(2)
-saturated fats
-unsaturated fats:(2)
*polyunsaturated fats: (3)
=trans fats
=omega 3
=omega 6
* monounsaturated;(1)
=omega 9
• Metabolism of dietary proteins
o Broken down into AA in the SI
 Transported to the liver
• AA then recombined into new proteins in the blood for protein synthesis in the cells
Nutritional assessment • Dietary Intake
o 24-hour recall
o Food diaries
 Everything eaten throughout day
 Most reliable
o Food frequency
 How often are these foods eaten
Nutritional assessment • Medical Data
o Illnesses
o Drug use/abuse
 Medications that may affect appetite
o Ability to chew/swallow
 Teeth?
o Appetite
 Food intolerance
 Allergies
 Bowel patterns
Nutritional assessment • Physical Exam o Anthropometric data
 Height & weight
• Used to establish BMI
• Increase or decrease can be r/t fluid retention
 BMI
• Normal
o 19-24
• Overweight
o 25-29
• Obese
o 30-39
• Extreme Obesity
o 40+
 Waist measurement
• Men
o <40 inches
• Women
o <30 inches
 Triceps skinfold
 Midarm circumference
o Clinical data…Table 42-8
• Nutritional assessment Laboratory Tests
o protein levels
 albumin levels
• protein status
 HMG and crit
• Plasma levels
o Iron status
 Glucose
 triglycerides
o CBC
o 24-hour urine
 Creatinine
• Proportional to body muscle mass
• Low is indicative of severe malnutirion
 Urea nitrogen
Obesity
• Body weight > 20% above ideal weight or BMI =/> 30
• Causes include
o excess caloric intake
o decrease physical expenditure
o genetic factors
o physiologic factors
o psychological factors
 increased # of fat cells
 low BMR
 insulin resistant
 hormone imbalance
• stats
o 2 out of 3 adults are obese
o 9 million children are obese
o 400,000 deaths r/t obesity
o B1
Thiamin
o B2
Riboflavin
o B3
Niacin
o B6
Pyridoxine
o B9
Folic Acid
o B12
Cyanocobalamin