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Nutritional substances/ concepts

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Water Protein Carbohydrates Lipids-fats and oils Vitamins Minerals nutrient density Processes Digestion Absorption Metabolism and storage of nutrients

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What is nurtition

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Study of food and how it affects the body and influences health

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Adequate nutrition

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Essential to wellness

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Nutrients

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Building block for cells and tissues Supply energy Help manufacture, maintain, and repair cells Found in foods Changes and used in the body through metabolism Macronutrients (carbohydrates, proteins and lipids), supply the body with energy (kilocalories) - whereas others, called micronutrients (vitamins and minerals) help manufacture, repair, and maintain cells

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Anabolism

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Converting simple substances into complex substances our body's need Allows for growth, building or rebuilding body tissues, muscles, bones and other cells

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Catabolism

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Breaking down of ingested substances to smallest part If diet doesn't supply body's needs of enough energy, breaking or tearing down of body tissues, bones, muscles and other cells In illness and stress - catabolism often exceeds anabolism

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Water

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Most basic nutritional need, can't live a day without it Component of cells, body fluids Compartments of body fluids Intracellular - 2/3 of body fluid Extracellular - 1/3 - interstitial cerebral spinal fluid Percentage of body fluids varies by ages Infant 70-80% water, don't handle loss of water well Adult 40-60% Elderly - 50% Depends upon amount of muscle and fat as well

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Functions of water in the body

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Transportation Makes up large portion of blood and body fluids Carries all body substances through the circulatory and lymph systems Solvent Substance in which many chemical reactions take place Body shape - water "fills in the spaces" Regulate body temperature

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Carbohydrates Recommended amount at least 130 grams daily for children and adults Each gram provides 4 calories (4 kcal/gum) Used as glucose in the body More easily and quickly digested than proteins and lipids in the body

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Should be main source of energy 45-65% of daily caloric intake - A person's primary energy source That translates to between 225-325 gram of carbohydrates a day on a 2000 calories diet - actual amount will depend upon activity level, total caloric intake, eats. Excess stored as glycogen or fat Functions - supply energy for muscle and organ function, main source of energy for the brain, spare protein, if glycogen stores are low, the body breaks down protein to use for energy ), enhance insulin secretion, provide a sense of satiety

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Carbohydrates

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Sources: Complex Simple sugars - soda, cookies, donut Fiber - helps fullness and elimination working Half should be complex carbs. 100 calories a day of refined sugars, men 150

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Preferred choice of carbohydrate intake

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Whole grains, fruits, vegetables, legumes, low-fat milk, low-fat yogurt, nuts and seeds

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Refined grains and added sugars

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Limited since they provide calories, but not a lot of nutrients - so they are nutrient poor choices

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Men should have 9 tsp. Or 150 calories of added sugars daily

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Women should have 6 tsp. Or 100 calories from added sugars daily

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Refined sugars

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In desserts, sweets, syrups, pastries, granola bars, sodas, sugary beverages, white bread, white rice

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Fiber

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25 gr fiber female 38 gr fiber male - average gets 15 grams a day Benefits= helps prevent constipation, curb overeating, helps regulate blood sugar levels, may help prevent diabetes mellitus type II, helps prevent diverticulitis Feels full Lowers risk of colon cancer Lowers LDL or bad cholesterol Prevents diverticulosis Insoluable

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Soluble fiber

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Dissolves in water = oatmeal psyllium, apples, pears, blueberries, beans, peas, lentils

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Insoluble fiber

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Doesn't dissolve in water - whole grains, barley, whole grain couscous, brown rice, bulgur, wheat bran, nuts, seeds, carrots, cucumbers, zucchini, celery, green beans, dark leafy vegetables, raisins, nuts grapes and tomatoes.

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Proteins 0.8 grams of protein per kilogram of body weight or 0.36 grams per pound. Can only store a small amount of protein in the body so need daily intake

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10-35% of what we eat 46 gram females 56 grams males Hard on kidneys 2nd biggest part of what makes up our body after water Essential amino acid - need to get from diet, body can't make it - most in meat products Nonessential - stored in body

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Proteins Each gram contains 4 calories 4kcal/gm

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Need to get from diet, can only store a small amount

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Body cell

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Every one contains protein and 3/4 of body solids are proteins. Protein is 2nd biggest part of body, only water i shigher

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Sources

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Meat, fish, poultry, eggs, beans, lentils, nuts

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Proteins are made up of amino acids

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Essential/indispensable as complete or incomplete. If incomplete protein need to combine with other sources to form a complete protein

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Functions of proteins

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Build and repairs body tissues Play a role in maintaining fluid balance - osmotic pressure from albumin Immune function Antibody production Lymphocytes Acid-base balance Enzymes Movement If needed they will act as an energy source in the absence o f carbohydrates Making glucose from a new source-gluconeogenesis

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Nitrogen balance

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A measure of the state of proteins in the body. Protein is the only food category which contains nitrogen. The nitrogen balance in the body reflects the states of protein anabolism and catabolism Nitrogen balance exists in 3 states - equilibrium, positive or negative In positive state - in this ?

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In positive state

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In this state protein intake exceeds output Muscles and tissues are being built - growth, pregnancy, wound healing

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Equilibrium

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Is the state in which no net gain or loss of tissue - equality of intake and output

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Negative nitrogen balance

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In this state nitrogen loss exceeds nitrogen intake- more tissue is being broken down than repaired - infections, fever, burns, trauma, starvation

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Nitrogen balance

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Is measured by assessing food intake and urine output -90% of nitrogen from protein is lost through the kidney

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Lipids- fats/oil last big macronutrients

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Should be no more than 20-35 % daily caloric intake for adults for children 25-40% Less than 7 %of calories should come from saturated fat and less than 1% should be from trans-fats Each gram contains 9 calories (9 kcal/gum) Functions Back up energy source Protect internal organs Maintain body temp Absorption of fat - soluble vitamins through action of bile Provide essential fatty acids which protect against heart disease Provide flavor, promote satiety Cholesterol is an important component of every body cell -provides support and flexibility Precursor to all steroid hormones including sex hormones

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Types

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Trans fat-fried food, bakery Saturated - high fat meats, cheese Monounsaturated - olive canola, peanut, safflower and sesame oil Polyunsaturated - soybean, corn, sunflower oil, fatty fish Cholesterol - produced in the liver, meat, poultry and full fat dairy product Omega 3 and 6 - essential fatty acids - fatty fish, walnuts, flaxseed and flaxseed oil, canola oil, soybean oil These are essential fatty acids that have a heart protective function

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Fats - education for patients

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Even though you need to watch your fat intake and the types of fats ingested, your body needs some fat - the healthy fats - to function normally. If you try to avoid all fat, you risk getting insufficient amounts of fat-soluble vitamins and essential fatty acids Also, when people try to limit fats, they often replace with processed foods touted as low-fat or fat-free rather healthier and naturally lower fat foods, such as fruits, vegetables, legumes and whole grains In stead of doing away with fat in your diet, enjoy healthy fats in moderation.

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Deficiency of nutrients

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What occurs with deficiency Protein - increased risk of tissue breakdown and skin problems, increased wound healing time, prolonged time to recover Fat-thin appearance, cold or sensitive to cold temp., skin lesions, increased risk of infection, amenorrhea Carbohydrates Not enough energy to perform daily activities Breakdown of body tissues to meet needs

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Excess intake of nutrients

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Protein - weight gain, breakdown of tissue as not meant to be primary energy source, liver damage (can lead to increased ammonia levels), kidney damage (can lead to increased ammonia levels), kidney damage, increased risk of osteoporosis, can cause indigestion or nauseadamage liver and kidneys Fat- weight gain, cancer, heart disease, stroke, type II diabetes, hyperlipidemia, hypercholesterolemia, increased athrogensis, increased LDL and triglyceride levels and decreased HDL Carbohydrates - weight gain, increased risk for Type II Diabetes Mellitus, Cardiovascular disease from increased triglycerides and HDL levels, insulin resistance can develop

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Vitamin basics Organic substances BODY CANNOT make vitamins, they be from foods we eat.

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Needed for metabolism and body processes or preventing a particular deficiency disease Need to get from diet, body does not make them Critical during periods of rapid growth They are critical in building and maintaining body tissues, supporting our immune system so we can fight disease and ensuring healthy vision

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Vitamins

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Help our bodies to break down and use the energy found in carbohydrates, proteins, and lipids. Vitamins are especially critical during periods of rapid growth, pregnancy, lactation, and healing Some evidence supports the claim that certain vitamins prevent chronic illness

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Vitamins - fat soluble Stored in the body so excess can lead to toxicity Absorbed with bile and fats

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ADEK, don't need to eat every day, Vitamin E all body cells have Water soluble - C and B and comples Stored primarily in the liver and adipose tissue, exception is vitamin E which is found in all body tissues

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Vitamins - Water Soluble

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Water Soluble - C and B complex (made up of a family of 8 vitamins) Not stored in the body so need to take in daily Excess is excreted Toxicity is rare except in renal disease Easily absorbed in the stomach and intestines

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Vitamin A - fat soluble

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Important for skin and mucous membrane, color visions, poor night vision, less immune , skin problems, function, cold sore,helps with growth, functions in immune system lymphocytes, helps with gene transcription Found in liver and fish oil. Also in some green leafy and yellow/orange vegetable and fruits, milk, butter, cream, eggs, and cheese Recommended: 10000 units a day Males - 900 mcg RAE Females 700 To much causes change in skin color-orange glow

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Deficiency -

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Night blindness, skin problems

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Too much

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Change in skin color, GI upset, blurred vision, and new research shows bone loss. It can reach toxic levels and the person is very ill. Excessive Vitamin A can cause birth defects

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B complex, B1 - thiamine - water soluble Used for carbohydrate metabolism -essential for glucose metabolism and energy production, co-enzyme in amino acid production, helps regulate nerve function Used to boost immune function Recommended: Males 1.2 mg daily Females 1.0=1.1 mg daily

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breaks down glucose for energy Some patients that need it are AIDS and diabetics Sources - pork, lentils, whole grains, red meats, fish, fortified cereals, yeast, asparagus, kale, cauliflower, and sunflower seeds Deficiency - peripheral neuritis, loss of muscle strength, depression, memory loss, fatigue, irritability, beriberi Excess unlikely as readily excreted

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B2-riboflavin Males - 1.3 mg Females - 1.1 mg Sources: brewer's yeast, almonds, wheat germ, soybeans, fortified cereals, whole grains, dairy products eggs, organ meals, broccoli, green leafy vegetable, and salmoon

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Energy production, growth and development, antioxidant function cellular metabolism Deficiency- elderly and alcoholics at risk, symptoms include fatigue, slowed growth, digestive problems, cracks and sores around the corners of the mouth, swollen magenta - colored tongue, inflammation of the mouth (stomatitis), poor wound healing, eye fatigue, swelling and soreness of the throat, tissue inflammation or sensitivity to ight

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Excess of B2 - Riboflavin

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Unlikely, readily excreted - high doses may discolor urine

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New research

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Shows riboflavin may help prevent cataracts, migraines, prevent eye fatigue, treat acne and help treat autism along with B6 and magnesium by decreasing amount of abnormal organic acids (dicarboxylic acid ) in the urine

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B3 - Niacin Energy production, skin health, digestive and nervous system function, production of DHEA and testosterone and cortisol (male sex hormone and stress hormone) in the adrenal glands, fatty acid production, supports over 200 chemical reactions in the body, helps metabolize alcohol

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Helps decrease LDL and increase HDL at higher doses, but treatment is usually no longer recommended as there is a greatly increased risk of stroke with prolonged us of high doses

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Sources of B3 Males - 16 mg Females - 14 mg

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Beef, brewer's yeast, beets, poultry, fish -especially salmon and tuna, peanuts, whole grains, enriched breads and lentils

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Deficiency B3

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Weakness, indigestion, fatigue, poor appetite, headache dizziness, insomnia, canker sores, vomiting, poor circulation and depression.- usually occurs in alcoholics

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Chronic deficiency of B3

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CNS damage - confusion and dementia, photosensitivity and pellagra

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Excess of B3

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Facial flushing, itching, nausea, liver damage

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B5 - Pantothenic acid Source: Plants and animals. So, most foods rich sources are organic meats, egg yolks, cashews, avocados and soybeans Men - 5mg Female 5 mg

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Influences normal growth and development, supports fatty acid metabolism - found in body as coenzyme A, needed for heme formation Deficiency - unknown Excess - unlikely

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B5-pantothenic acid

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Found in body coenzyme A Heme formation -carries o2 in rbc

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B6-pyridoxine Sources: meat, poultry, bananas, fish, cooked spinach, potatoes and wheat germ Women and men - 1.3 mgs Maximum- 100 mugs Or numbness or tingling in hands and feet will occur

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Helps the body break down protein and helps maintain the health of red blood cells, the nervous system and production of neurotransmitter, and parts of the immune system, needed for breakdown of glycogen, involved in over 100 enzyme reactions

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Deficiency B6

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Rare - readily absorbed in jejunum. Can occur in malabsorptive syndromes like Crohn's, ulcerative colitis, or celiac disease, Rash, stomatitis, seizures, peripheral neuritis, depressions

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Excess B6

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Irreversible nerve damage, extremity numbness, difficulty walking or ataxia

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B7-biotin Sources - intestinal bacteria, bananas, brewer's yeast, strawberries, watermelon, leafy green vegetable, corn Adults - 30 mcg a day

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Hormone production, making amino acids, breakdown of protein and carbs, supports health hair and nails Deficiency = rare it is recycled Excess = rare it is easily excreted

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B9-folic acid/folate Source: green leafy vegetable, eggs, asparagus, live, citrus fruits, mushrooms, nuts, peas, dried beans, dates, avocados, and wheat bread Adults - 400 mcg daily

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Important in producing RBC and helps cells make DNA, cellular metabolism, cell division, neurotransmitters synthesis, metabolism of amino abides, health of the fetus - important for development of the spinal cord and nervous system during early pregnancy Deficiency - fatigue, megaloblastic anemia, neural tube defects Excess - increased seizure activity, hives, respiratory distress, itching, rash

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B12-cyancobalamin Need intrinsic factor to absorb Sources: eggs, meat, poultry, shell fish, milk and milk products. NOT in plants, but in some cereals 2.4 mcg daily Excess, unlikely

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Cobalamines- plays a role in the body's growth and development. helps form RBC iron absorption, maintains myelin sheath, collagen synthesis, antioxidant, immune function, and how body uses folic acid and carbs. Critical in pathways that produce cellular energyand work with DNA replication, used in brain and nervous system Deficiency - perniciouis anemia, if don't have intrinsic factor can't take it in and causes this too, irreversible nerve damage, dementia, fatigue, weakness, difficulty maintaining balance megoblastic anemia - could occur in elderly

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Vitamin c -water soluable Sources: citrus fruits, kiwi, tomatoes, broccoli, strawberries, potatoes, red and green peppers, cantaloupe, and Brussels sprouts Men - 90mcg Women - 75 mcg Smoker add 35 mg Do not exceed 2000 mg a day

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Cell cement, stabilize cell membranes, keep them intake, need for wound healing to form collagen, helps you absorb iron Deficiency- anemia, tissue bleeding, easy bone fracture, gingivitis, petechiae - red spots, poor wound healing, joint pain, scurvy - red spot Excess -stomach inflammation, diarrhea, formation of kidney stones (oxalate)

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Vitamin D - sunshine vitamin Adults 15 mcg Older adults 20 mcg Deficiency - bone weakness, osteomalacia or rickets - bone pain, muscle pain, increased risk of bone fractures, increased risk of asthma symptoms, cancer, decreased cognitive function in older adults, increased risk sudden CV death

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Maintains bone health, calcium absorption, cell growth, encoats genes, neuromuscular, and immune function Fortified foods, fish liver oils Flesh of salmon, egg yolks Excess Kidney stones, muscle weakness, mental confusion, mental retardation

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Osteomalacia or rickets

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Bone pain

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Vitamin e Sources: vegetable oil, olive oil, dry beans, nuts peanuts, corn, milk, eggs, meat, wheat and rice germ 10-15 mg Deficiency - rare, neurological symptoms, decreased reflexes (hyporeflexia) and hemolytic anemia

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Vegetable, Antioxidant function - cells that are not healthy or normal Every cell of body, decrease free radicals, helps stabilize cells, immune function, skin health, protects rbc and muscle tissue Excess - insufficient blood clotting, impaired immune function, increased risk of sudden death

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Vitamin k Male - 120 mcg Females - 90 mcg Deficiency - rare - can occur after very prolonged antibiotic use - bruising, bleeding, hemorrhage Excess - only occurs with manufactured form, hemolytic anemia and jaundice

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Blood clotting - synthesis of blood clotting factors, bone metabolism and development Sources are green leafy vegetables like lettuce, spinach or cabbage; cauliflower, cereal, soybeans, made by bacteria of the GI tract Deficiency

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Mineral basic Minerals are

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Inorganic elements found in nature. They occur in foods either naturally or as additives as well as in supplements

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Major minerals or macrominerals

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Are minerals that the body needs in amount s of 100 mg/day or greater

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Trace minerals

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Are essential, but in a lower concentration

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In U.S.

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Calcium deficiency is one of the most common mineral deficiencies

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Sodium Sources: table salt, celery, meat, milk, eggs, beets, carrots, baking soda, baking powder Less than 1500 mg daily Deficiency - dizziness, abdominal cramps, nausea, seizures, convulsions, coma

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Water balance, acid-base balance, nerve transmission, neurological function, helps with muscle contraction along with calcium Deficiency - dizziness, abdominal cramps, nausea, seizures, convulsions, coma Excess: thirst, fever, dry and sticky mucous membranes, increased blood pressure, restless, irritable, convulsions

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Potassium 3500-4700 mg daily Deficiency - muscle weakness - especially critical with heart and respiratory system, weak pulse, abdominal distention Excess - cardiac dysrhythmias, cardiac arrest, weakness, diarrhea, anxiety

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Intracellular fluid control, acid-base balance, nerve transmission, muscle contraction, glycogen formation, protein synthesis, energy metabolism, blood pressure regulation Sources: fruits, vegetables, molasses, dates, figs, shellfish, potatoes, avocados, milk, legumes

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Calcium Sources - milk and milk products like yogurt, ice cream or cheese, fortified OJ, salmon, sardines, dark leafy vegetables 1000 mg up as we age to 1200mg Deficiency- bone, loss, osteoporosis, rickets, tetany

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Needs vitamin D to absorb, 99% stored in bones and teeth Bone and teeth health, blood clotting, muscle contraction, nerve impulse conduction, cellular metabolism, heart action Excess - kidney stones, constipation, intestinal gas

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Iron Sources - red meat, fish, poultry, seafood, liver, these form are more readily absorbed by the body. Also found in fortified cereals and bread, eggs, spinach, beans, broccoli Females/ males- 18 mg

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Components of hemoglobin, helps prevent anemia Function - hemoglobin,myoglobin, immune function, cognitive development, part of proteins, general metabolism, drug detoxification in the live Deficiency - anemia Excess - liver and heart damage 80% of people have iron deficiency

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Phosphorus Sources - dairy products, beef, pork, beans, sardines, eggs, chicken, wheat bran, chocolate 700 mg daily

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Bone and tooth strength, overall metabolism, function of enzymes, acid-base balance Deficiency- bone loss, poor growth Excess - tetany, convulsions

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Magnesium Source - whole grains, nuts, legumes, leafy vegetable, Lima beans, squash, potatoes Males - 400 mg Females - 310 mg Deficiency - tremor, spasm, convulsions, weakness, muscle pain, poor cardiac function Excess - weakness, nausea, malaise - feeling of overall discomfort

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Aids thyroid hormone secretion, maintains, normal metabolic rate, activates enzymes for carbohydrate and protein metabolism, nerve and muscle function, cardiac function, helps decrease the risk of hypertension, in women decrease the risk of coronary artery disease

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Mineral basics

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Minerals - inorganic (found in nature not body) elements found in nature. They occur in foods either naturally or additives, as well as in supplements

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Calcium

answer

Need vitamin D to absorb?

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Phophorus

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Bone and tooth health, works with calcium

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Magnesium

answer

Helps thyroid hormone secretion, maintains normal metabolic rate, activates enzymes for carb.

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Trace minerals

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Fluoride, iodine, zinc, copper

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Copper

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Aids iron metabolism, works with many enzymes, hormone synthesis. Deficiency is rare - anemia or low WBC. Excess can cause nervous system disorders

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Zinc

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Immunity, cofactors for enzymes sexual development and reproduction, port wound healing, skin rash Excess can cause depressed immune function, diarrhea, reduced copper absorption

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Iodine

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Synthesis of thyroid hormone -thyroxine Deficiency - causes goiter, poor growth in infants, cretinism, Excess cause thyroid malfunction and skin lesions

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Flouride

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Helps resist dental carries Deficiency leads to increased dental carries Excess causes stomach upset and staining of the teeth

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Flood plate

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Half fruits and vegetables, grains, proteins, dairy

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DRI - Dietary reference intake Use serving sizes instead of allowance Limit these Less then 10% from added sugar Less than 10% from saturated fat Less than 2300 mg of sodium a day

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Recommended daily allowances-RDA Alcohol 1 a day women 2 a day men

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21/2 cups fruits and veg. A day

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3 cups low fat dairy

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Points to encourage healthy eating Vary you fruits and vegetables, they should be 2 1/2 cups a day

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Consume plenty of low fat dairy - 3 cups a day Make half your grains, whole grains Choose lean proteins Try having a meatless day each week Limit the intake of sugar, salt and fat Eat nutrient rich foods, avoid empty calories Take your time eating, enjoy your food, and use a smaller plate

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Energy balance/malnutrition

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Energy in nutrients measured in calories Calories in must equal calories burned Too few calories/nutrients - undernourished Too many calories - obesity BMR = amount of energy required at rest Total energy needs - replacing calories used for BMR = physical activity

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Overweight/underweight BMI greater than 25 Obesity BMI greater than 30

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Consuming nutrients In excess of metabolic demand Rate of obesity goes up

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Underweight/undernutrition

answer

Insufficient intake of protein, fat, vitamins, minerals Consuming less calories than needed according to activity, gender, height and weight A person can be deficient in some nutrient or nutrients (malnourished)without being underweight

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Health people 2020

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Promotes health and reduction of chronic disease associated with diet and weight Examples of etiologies for overnutrition - overeating, lack of exercise, endocrine problems Examples of etiologies for undernutrition- difficulty chewing/swallowing; alcoholism; metabolic disorders, psychological concerns

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Factors that affect nutritional intake or needs

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Development Newborns-breast or bottle fed When to add solids Toddler School-age Adolescents Adults Pregnancy- Greatly increased nutritional needs-especially protein, calcium and iron, Folic acid intake is critical in the first trimester of pregnancy the first 13 weeks, to prevent neural tube defects, a daily supplement of .6 to .8 mg is recommended during pregnancy Lactation Elderly Body composition

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Factors that affect nutritional intake or needs

answer

Gender Environmental temperature Beliefs about food Anorexia nervous - fine body hair all over Bulimia nervous - teeth are awful Personal preferences type of diet and food choices Culture Education level Knowledge of nutrition

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Factors that affect nutritional intake or needs

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Ability to chew-dental impact Ability to swallow - impact of dysphasia Religious practices - affect of type of diet , food choice Lifestyle- how active - calories expended Medication/therapy - affect on appetite, taste Health - fever increase BMR

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Factors that affect nutritional intake

answer

Illness/disease Diabetes Renal disease Cardiac/cardiovascular disease GI disorders Cancer Anorexia/bulimia Alcohol intake Advertising Psychological Factors Functional Limitations

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Nursing process assessment

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Nutritional screening -several tools available Nursing history - changes in dietary intake, problems chewing or swallowing, taste alterations, cultural impacts on dietary intake, food likes and dislikes Physical exam - height weight, assess the skin, hair and nails, bowel sounds, assess for dysphagia

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Assessment

answer

Food diary Lab work -albumin 21 days, pre-albumin 3 days - protein status, iron and transferrin - iron status, vitamin levels, CBC, electrolytes, BUN and creatinine reflect kidney function

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Anthropometric measurements

answer

Skin fold, body fat, BMI, Ideal weight Diagnosis Altered nutrition Dysphasia Impaired swallowing

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Nursing Process - Planning

answer

Goal is to get patient to optimum nutritional level and lab work with normal limits

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Implementing

answer

Education Aspiration - precautions - thickened liquids, Assisting with eating: sit up, chin down, 30 min. After eating sit up Nausea - crackers little syrup coats stomach Resources Provide appropriate dietary intake - Patients with nausea or vomiting Monitoring dietary intake and adherence Helping find nutritious foods on a limited budget

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Types of diet

answer

Regular Clear liquid-coffee, tea Full liquid - ice cream, pudding, cream Puréed Mechanical soft Low residue/soft-not much fiber - no whole grains High fiber Low sodium Low cholesterol Diabetic

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Implementation

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Interventions for obesity: Calorie calculations and meal planning Encourage exercise/lifestyle changes Weigh weekly; suggest food diary Don't eat at night Some interventions for Undernutrition Psychological issue - seek counselor for eating disorder Devise strategies to client's appetite Enteral nutrition Parenteral nutrition

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Other nutrition interventions Enteral nutrition

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Tube feeding

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Parenteral nutrition

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IV feeding

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Medical nutrition therapy

answer

Dietary modifications to help treat or prevent complications of disease Peptic ulcer Inflammatory bowel disease Diabetes mellitus Cardiovascular disease Hypertension - DASH Cancer HIV/AIDS

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Special considerations Supporting clients nutritional needs

answer

NPO Older adults Clients with impaired swallowing Patients who are nauseated Assisting with meals

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Evaluation

answer

How well have we met goals Do they need revision Do we need to change the interventions or include different ones Are the nursing diagnosis still correct, do they need adjusting Is the prioritization still appropriate

question

Reflection activity

answer

Look at food plate and see if you are getting the right nutrition

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