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Textbook for Nursing Assistants
Chapter 20: Basic Nutrition
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
How Our Bodies Use Food
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutrition
• Nutrition is the process of taking in food and using it
• The process of nutrition involves:
– Ingestion
• Intake of food
– Digestion
• Breakdown of food
– Absorption
• Transfer of nutrients into the bloodstream
– Metabolism
• Conversion to energy
• Metabolism provides energy measured in units called
kilocalories, more commonly known as calories
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Nutrients
• Food taken into our bodies is broken down
into essential elements, called nutrients
• Nutrients provides us with energy
• Nutrients help our bodies to function
properly
• Energy is measured in units called
kilocalories or calories
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Types of Nutrients
• Nutrients that supply energy
– Carbohydrates
• Basis of all diets
• Are the source of the body's basic fuel= GLUCOSE
• GLUCOSE or blood sugar=carried in the body and
rapidly absorbed in every cell of the body
• Simple CHO so it is quickly passed from GI
system to the bloodstream
• 1 gram of CHO = 4 calories
– EX: breads, cereals, table sugar, fruits
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Types of Nutrients
• Proteins
– Are found in cheeses, milk, meat, fish
and poultry, beans and nuts
– They contain amino acids which are the
building block of all body cells
– Essential for growth, healing, tissue
repair
– 1 gram of Protein = 4 calories
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Types of Nutrients
• Fat (lipids)
– Found in butter, cooking oils, whole milk,
egg yolks, lard
– Fats make foods taste BETTER!
– Fat is essential to certain body functions
– Fat also protect organs and helps us stay
warm
– 1 gram fat= 9 calories
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Nutrients
• Nutrients that regulate body processes
– Vitamins
• Play a key role in body processes
• Water soluble
• Vitamin C & B-Complex
• Fat soluble
• A,D,E,K
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Nutrients
• Minerals
– Help provide structure in the body
– Fluoride- strengthens bones and teeth
– Iron-help carry O2 in RBC’s
– Other essential minerals
• Calcium
• Phosphorous
• Iron
• Iodine
• Sodium
• Potassium
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Nutrients
• Water
– Found in many foods
– Also in the form of beverages
– Provides----0 calories & 0 nutrition
– However- It many be more essential to life than food
– You can live 3-7 without water
– You can live much longer without food
– Accounts for 50-60% of your total body weight
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Water Functions in the Body
• Water forms basis for transport of all food
and nutrients in the body
• Transports waste out of the body in the form
or urine & feces
• Water keep us cool when it evaporates off
our skin in the form or sweat
• Water keeps our mucous membranes moist
• Water forms the basis of fluid that keeps or
joints moving smoothly
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Balanced Diet
• A diet that provides the body with a balanced amount of
the essential nutrients
• Obese
– Overweight
• Tools to achieve a balanced diet
– MyPyramid
• Emphasis on exercise and eating a healthy
balanced diet
• Eat whole grains, fruits, vegetables
• Fat free & low fat diary products
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MyPyramid
• MyPyramid is
– A guide for making daily food choices
• Focuses on a balance between food and physical activity
• Sections of MyPyramid include
– Grains: make half your grains whole
– Vegetables: vary your vegetables
– Fruits: focus on fruits
– Milk: get your calcium-rich foods
– Meat & Beans: go lean with protein
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Food Labels
• Nutrition label which appear on all food products
• US Congress passed the Nutritional Labeling and
Education Act in 1990
• Labels on packaged foods must contain information
about its nutritional values, serving size, and related
health claims
• Why is reading nutritional labels a good thing?
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Factors that Affect Good
Eating Habits
• Religion
– Dietary restrictions are a part of many religious beliefs
• Culture & Geography
– Culture influences what we eat
– Geography will affect the availability of certain food
items
• Finances
– Persons on fixed income may not be able to afford
certain foods
• Kitchen skills
– Persons who do not know how to cook, like to cook or
have no time to cook will eat out a lot
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Factors that Affect Good
Eating Habits
• Individual taste
– This includes personal likes and dislikes as well as
allergies
• Appetite
– The desire for food and feeling of hunger
– Your state of health may control you appetite
– External influences may also drive your hunger
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Special Diets
• Meal in health care facilities are prepared
according to the patients nutritional needs
• Dietician
– Professional who has degree in nutrition
– Uses dietary assessment and knowledge
of nutrition to plan a diet for the person
that they will enjoy eating and will keep
them healthy
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Special Diets
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Types of Special Diets
• Regular diet
– Well balanced with NO restrictions
• Mechanical Diet
– Has been changed to remove foods tha are hard to
chew or digest
• Pureed Diet/ Anti- Aspiration Diet
– Blended into a smooth consistency
• CHO Controlled Diet
– Contains limits on CHO for diabetics
– The pt. nutritional and energy requirements will
determine the amount of fat, proteins, CHO that are
allowed
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Special Diets
• Clear Liquid Diet
– Substances that can be poured and you can see
through them
• Full Liquid Diet
– Substances that can be poured and include milk, frozen
deserts, ice cream, yogurt, soups and juices
• Sodium Restricted Diet
– Salt restriction- may be a 100% restriction or modified
– Typically written at 2gmNa
• Low Cholesterol Diet
– Diet low in dietary saturated fats
– No butter,shortening, and dietray margarine
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Meal Time
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Preparing for Mealtime
• Assist with toileting
• Assist with basic hand hygiene
• Check for denture if applicable
• Position the patient upright for eating- OOB in chair is
best only if allowed
• Provide for pleasant dining experience= remove
commode bedpans, urinals, emesis basins etc.
• Provide adeqate lighting
•
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Mealtime
• Serve meals soon after delivery to your unit
• Check tray label/ patient name matches!!!
• Assist with eating as necessary
• Cut and position foods for patient with dexterity and poor
eyesight
• Allow ample time for patients to eat or to be fed
• Record amounts taken for I & O record
–
record in PERCENTAGES- the dietitian with then
convert to calories
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Assisting with Meals
A clock face is
used to
reference the
location of
food on the
tray for
people with
poor eyesight
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Measuring and Recording Food Intake
• Various methods
– Recording the portion of the total meal that was
consumed
• Inform the nurse if a patient or a resident eats
less than 70% of his or her meal
– Recording the percentage of each food eaten
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Feeding Dependent Patients and Residents
• Involve the person in the process as much as possible
• Sit down and talk to the person
• Use a spoon, not a fork, and fill it only about 1/3 full
• Give the person time to chew and swallow each bite; never
rush the person
• Offer liquids frequently between bites
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Anti- Aspiration Fluids
• Patient with DYSPAGIA as a result of stroke, injury or
dementia or neuromuscular diseases
• NEVER use a straw with patients on this restriction
• Always offer liquids slowly
• A thickener may be prescribed to add to fluids to create a
certain consistency– such as:
– Nectar
– Honey
– Pudding
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Fluid Balance
• When the amount of fluid taken into the body equals the
amount of fluid that leaves the body, a state of fluid
balance occurs
• Fluid balance is important for health
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Dehydration
• Dehydration occurs when there is too little fluid in the body
• Causes include
– Diarrhea
– Vomiting
– Hemorrhage
– Severe burns
– Excessive sweating
– Not drinking enough fluids
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Edema
• Edema occurs when there is too much fluid in the body
• Causes include
– Kidney disease
– Heart disease
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Offering Fluids
• Encourage fluid intake, unless otherwise ordered
– People are more likely to drink fluids that taste good and
are served at the proper temperature
– Keep water pitcher filled with ice water
– Offer fluids frequently to people who are bed-bound,
confused, or taking pain medications
• A person who is not allowed to have any fluids at all is said to
be on NPO status.
– No water, no ice, no food, no candy, no gum
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Other Ways of Providing
Fluids and Nutrition
• Intravenous Therapy
– Not a source of complete nutrition
– Usually contain glucose, Na, minerals and vitamins
– Fluid drips into a peripheral vein via a IV catheter
• Enteral Nutrition
– “intestine” – involves placing food into the stomach or
intestines
– Nasogastric Tube or NGT=into stomach via nose/throat
– Gastrostomy Tube or GT= into stomach via abdomen
– Jejunostomy Tube or JT=via abdomen into Jejunum
– Percutaneous endoscopic gastrostomy or PEG= inserted via
a scope and passed through the abdomen
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Alternate Methods
• Intravenous therapy
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Alternate Methods
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Other Ways of Providing
Fluids and Nutrition
• Total Parenteral Nutrition or TPN
– Hyperalimentation
– Given to patient who need additional nutritional
supplementation and are NPO / unable to tolerate
food via the GI tract
– All four classes of nutrients are delivered via an IV
line
• Fats, CHO, Proteins, minerals, vitamins, etc-– Must be administered via a central line
– PCT are NOT responsible for TPN lines
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Alternate Methods
• Total parenteral nutrition (TPN, hyperalimentation)
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TELL THE NURSE
• When caring for patient with an IV line –
Report the following:
– The tubing becomes disconnected
– The fluid bag is empty
– The IV fluid id not dripping into the drip
chamber
–
Blood has backed up into the IV tubing
– There is swelling at the IV site
– Patient complains of pain at the IV site
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TELL THE NURSE
• When caring for patient receiving enteral nutrotion
Report the following:
• Nausea, bloating or pain during feeding
• Coughing, gagging, vomiting during the feeding
• Abdominal distention
• Diarrhea
• Drainage from around the tube insertion site
• Disconnected tubing
• ****** If you are caring for a patient with enteral
feeding you must keep the HOB elevated at least 30-44
degrees at all times***** if you must place the patient flat- the NURSE
must be called to stop the feeding!!!!!
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Measuring I & O
• Recorded in ml’s or cc’s
• Must be entered into the Intake & Output Record
• Record every time a patient takes in fluid or when fluids leave the
body
• Amounts are totaled at the end of each shift and then for 24 hour
grand totals
• Record everything the patient:
– Drinks
– Jello, ice cream, popsicles, pudding
– Enteral feeding supplements & IV – NURSE’s Responsibility
• 30 ml or cc’s is equal to ONE fluid ounce
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Measuring I & O
• Output
– Urine, vomit, blood, wound drainage, diarrhea
– Measured in ml’s or cc’s
– Use graduate measuring device to measure output
from urinals, bedpans, Foley's, commodes
– Commode “hat” works best for patients using the
commode or toilet.
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Output Challenges
• If the patient vomits somewhere other than the basin
have the NURSE estimate the output
• Diarrhea if expelled into the toilet can also be estimated
• ALWAYS wear appropriate PPE when handling all output!!
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Calculate the following
1. 10 ounces
2. 5 ounces
3. 8 ounces
4. 4 ounces
5. 1 ounce
6. 6 ounces
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Answers:
1. 300 ml
2. 150 ml
3. 240 ml
4. 120 ml
5. 30 ml
6. 180 ml
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End of Presentation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins