good day everyone my name is Andrea Murdoch and today I'm going to be talking about metabolism and our nutrition they go hand in hand as you will see as we go through this lecture this is just a picture of the different food groups that we must include in our diet so let's get started what is nutrition and why is it so important H nutrition is the study of food how it affects the human body and influences Health good nutrition is essential to Wellness and poor nutrition contributes to diseases that's why patients need accurate current and appropriate nutritional information a poor nutritional status delays or prevents recovery and a good nutritional status promotes healing and Recovery some pharmaceutical agents used to treat disease also interact with nutrients and food therefore it is essential for us to thoroughly assess the medications a patient is taking when doing a nutritional assessment what is metabolism metabolism is the process by which the body changes that food that we take in into energy to be used for daily activities because good nutrition is essential to Wellness and nutrition contributes to disease our patients need accurate current and appropriate nutritional information however for us to be able to give that information we must know about the nutrients the food and about concepts related to energy that's why this course is important first we're going to look at the choosemyplate.gov choosemyplate.gov is a colorful food guide that visually illustrates a healthy meal with red for fruits green for veget vegetables orange for grains purple for protein and a separate blue section for dairy on the side the my plate website promotes Healthy nutrition based on the United States drug and Food Administration dietary guidelines for Americans and it s suggestes food choices and variety portions exercise activity and tools for a successful Nutritional Lifestyle on page 667 in volume one you can see that there's a box 24-1 for Americans for the guidelines for Americans 2025 2020 to 2025 and key points okay other groups have developed diets that vary in culture even though they are seasoned differently they all emphasize is eating fresh local and seasonal Foods remember different ethnic groups are um they have different spices and stuff that they use and also we have different diets like vegetarians and stuff like that they all have their own version of the choosemyplate.gov for instance the diabetic the American Diabetes Association offers an online interactive tool called the create your plate it is to help diabet diabetics manage blood glucose and to lose weight it emphasizes a diet higher in nine starchy carbohydrates and proteins they also have a my plate for older adult it focuses on foods and hydration for older adults there is also my vegan plate so we have a variety of different places depending on your patient remember everything that we do is patient specific right H let's look at food labels why why should we know how to read food labels it's important when educating our patients food labels it is the nutritional facts label and the US Food and Drug Administration requires this label on all package food in the United States it contains essential information about servant size servings per package total calories calories from fat a list of key nutrients and the percent of daily values the percent of daily values identifies the percentage that is serving of the food contributes to a consumer's overall intake of the nutrients listed you can refer to page 668 volume one for the components of a food labor which is pictured here it'll give you more of a breakdown of it so let's look at this food label for a second if you start from the top it says nutrition facts H serving size one cup 228 gram but the servings per this particular container is two very important to pay attention to now it says amount per serving calories 250 hm but if somebody consumes this whole container that's 500 calories because remember it has two servings in this container let's look at the total carbohydrates you have 31 grams right in one servy but if they cons if they consume this whole package that's 62 gram of carbohydrates think about your diabetics a lot of times diabetics should only only have 30 to 45 gram of carbohydrates per meal so if they consume this whole container they've already exceeded that but then also take into account the sodium sodium 470 milligrams per serving so if they consume the whole package that's what 940 that's a lot for a person who's on a sodium restricted diet so they may look at this container and say oh it's on only 470 milligram of sodium not realizing that if they consume the whole container is twice as twice that much so that's why knowing how to read a food label is so important let's talk about our energy nutrients what are energy nutrients they are required for cell and tissue growth maintenance and functioning we have macro nutrients they supply energy to the body they are needed in large amounts to provide that energy then we have our micronutrients they help manufacture repair and maintain cells they are your vitamins and your minerals and are called micronutrients because they are needed in very small amounts metabolism it is the process by which foods are converted into complex forms of chemical energy and then usable energy which is then carried to individual cells so remember the process of metabolism is that we convert the food that we consume into usable energy so that we can go about our daily activities nutrients that provide fuel or energy are the most important after water because every cell requires a continuous supply of food energy providing nutrients or your carbohy hydrates your proteins and your fats with carbohydrates being the primary energy source let's talk about carbohydrates for a minute carbohydrates are the body's primary energy source like I just said there are two basic types the simple sugars which are your simple and which are your sugars your monosaccharides and your disaccharides and then we have the complex which are your starches and your fi okay your sugars are the simplest they are water soluble and are produced Naturally by plants and animals especially your fruits your sugar cane and your sugar beets some come from animal s sources such as your lactose a combination of glucose and galacticos found in animal milk remember not all sugars have calories and not all sweeteners are sugars sugar sub substitutes are available from natural and manufactur manufactured sources and have almost no calories starches the starches are insoluable non-sweet forms of carbohydrates nearly all starches exist in naturally exist naturally in Plants such as your grains your legumes and your potatoes cereals breads FL and puddings are processed from starches fiber H it's a complex carbohydrate deriv derived from Plants IT Supplies roughage and bulk to the diet that's why it's important for your GI track humans cannot digest it it simply helps to satisfy the appetite and helps the digestive tract to function effectively and AIDS in elimination of waste a lot of times Physicians will encourage diabetics to include fiber in their diet what are some functions of carbohydrates they supply energy for muscle and organ function they are more easily and quickly digested than the proteins and lipids carbohydrates provide nearly all the energy for the the brain and the nervous system they are stored in the liver and skeletal muscles as glycogen and then convert it back into glucose for energy needs they also spare protein the presence of adequate glucose spares the breakdown of proteins from being used to make the glucose that the body needs if glycogen stores are low physical activity causes the break down of body stores of protein and lipids to use for energy however when the proteins are used for energy they are unavailable for tissue growth maintenance and repair therefore carbohydrates keep the body from having to use up that protein to save it for tissue growth and maintenance and repair okay carbohydrates also a role in nutrition and Metabolism how it enhances insulin secretion which promotes the movement of glucose into the cells for use it increases society and improve absorption of sodium and excretion of calcium the calorie count in carbohydrates is 4 Kil calories per gram now let's talk about proteins H proteins are complex molecules made up of amino acids they are needed for tissue Building Maintenance and Repair what are your types of proteins you have essential amino acids and they cannot be manufactured in the body and must be supplied as part of the protein from your diet so essential mean your body does not manufacture them so you have to get them in your diet nonessential are those that the body can manufacture they are deriv from the diet and reconstruct new ones from their basic elements so they kind of like recycle your complete proteins contain all of the essential amino acids plus many non-essential ones you're incomplete they lack one or more essential amino acids however if we combine two incompletes amino acids we can create a complete amino acid if an appropriate mixture of plant proteins is provided in the diet a balanc ratio of essential amino acids can be achieved now to take full advantage of vegetable proteins it is to eat them with a small amount of animal protein that's why a lot of times you want to have your meats and your vegetables okay protein metabolism it includes anabolism catabolism and nitrogen balance the body continuously continuously breaks down and rebuilds protein into tissue therefore think about it if the body is constantly breaking down and rebuilding protein into into tissue then a lack or deficiency in proteins then you have less of the breakdown in building rebuilding therefore a person may experience poor or slow wound healing not just wound healing but tissue healing okay what are some functions of proteins tissue building h they are the structural material of every cell in the body except for water except for water protein makes up the biggest part of the body proteins are essential for the growth maintenance and repair of body cells and tissues you're going toar let me say that over and over again metabolism they are essential for the building for building body tissue they combine with iron to form hemoglobin which is the oxygen carrier in the blood cells immune system functioning lymphocytes lymphocytes they are specialized white blood cells and antibodies which are components of our immune system that defend against foreign Invaders and patients bloodstream help regulate fluid balance so let's think about the immune system and fluid fluid balance for a minute with the immune system we have those lymphocytes and it attacks Invaders and they are proteins okay fluid balance they attract water the proteins in the cells and those in the bloodstream help to regulate fluid balance so if a person has infection or something or some type of illness the proteins work as the helps the immune system and the fluid helps to regulate the water within the cells and and the proteins within the cells we're going to talk about alumin for a second alumin it is it makes up 60% of the proteins in the body and we will learn more about that when we talk about the intracellular and extracellular fluids especially when you get into fluid and electrolytes but if a person is very adius and they start having you might see where they having fluid seeping from their body that's because the fluid is in the third space it's not intracellular or extracellular albumin being the main protein draws that fluid into the cells and into the bloodstream okay let's talk about acidbase balance they proteins function as a buffer they help regulate acidbase balance by releasing hydrogen into the blood if it's too basic and by taking hydrogen from the blood if it's to acidic then we have the it's also considered a secondary energy source they provide energy when energy nutrients are inadequate remember we talked about glucose if glucose is inadequate then the protein kicks in to um provide that energy proteins are needed in various um amounts due to a person's age there sex weight and also their health status calorie com for carbohydrates is 4 Kil calories per gram let's talk about lipids what are lipids they are organic substances that are greasy and insoluble in water but soluble in alcohol or ether we have different types of lipids we have fats which are are solid at room temperature and your oils which are liquid at room temperature so if it's sitting out and it's solid then it's a fat if it's sitting out and it becomes liquid at room temperature then it's a oil your glycer that's your true fats they're simple lipids they are the most common and have up to Three fatty acids attached your sterols they are lipids not made of fatty acids cholesterol is the most important sterile it's needed for the formation of cell membranes vitamin D estrogen and testosterone it is synthesized in the liver and is found in animal Foods phospholipids they are a key component of lipo proteins your lipo proteins are water soluble they are the major transport vehicle for lipids in in the bloodstream pay close attention to what I'm about to say those lipo proteins they wrap triglycerides with water soluble phosphates and proteins delivering nutrients to body cells we have two different types of lipo proteins the Lipo protein the low density lip lipo protein transport cholesterol to body cells and causes fatty deposits on the vessels which causes cardiovascular disease it is considered the bad cholesterol remember low density lipo proteins causes fatty buildup in the blood vessels On Your Vessel walls thereby it is considered a bad cholesterol high density lipo proteins however removes cholesterol from the bloodstream and r turns it to the liver where it is used for B production and is considered a protector against cardiovascular disease which makes it what a good cholesterol and we have our trans fatty acids which are your margarin your vegetable shs your deep fried chips and your many fast foods and most commercially baked goods what are the functions of lipids they Supply essential fatty acids and Aid and fat soluble vitamin absorption so your lipids help your body to absorb those fat soluble vitamins they primarily function as an energy Reserve is used for energy during light activity especially after the glycogens is exhausted lipids give food a creamy taste and texture and promotes what sociiety they are digested more slowly than carbs so your stomach emptying is slower lipids provide insulin I mean insulation which causes which AIDS in thermal regulation it protects vital organs and enables accurate nerve impulse transmission they are essential to cell metabolism cholesterol H it is a component of every cell in the body adds Sub sub subtleness and support AIDS and fat digestion and is a precursor to all steroid hormones including your sex hormones when lipid metabolism is disordered cholesterol leads to aosc rosis remember you're good and your bad cholesterol when lipid when the fat metabolism is disordered the cholesterol will lead to atherosclerosis the calorie count inats is 9 kilograms per kilo calories per gram which is higher than your carbohydrates and your proteins right functions of lipids um I'm sorry c table 24-2 on page 672 for types of fence their sources and their effects on blood cholesterol now let's take a moment to talk about micronutrients H what are micronutrients micronutrients are vitamins and minerals needed by the body in very small amounts they their impact on the body's health is critical and any deficiency can cause severe and even life-threatening conditions that's why it's so important that we that the Physicians or the healthc care providers do lab work on patients especially in patient vitamins are organic compounds that cannot be manufactured by the body in un needed and small quantities to catalyze metabolic processes therefore lacking them in the diet can result in metabolic deficits they are critical in building and maintaining body tissues supporting our immune system to fight disease and ensuring healthy Vision they aid in breaking down carbs proteins and lipids they are needed for rapid growth pregnancy lactation and also healing we have different types of vitamins we have fat soluble and water soluble your fat soluble vitam I mean uh vitamins are stored in the body primarily in the liver and adapost tissue however there's a limit to the amount of vitamin E and K the body can store so A and D is stored very well e and K not so much fast soluble vitamins include your a d e and K the vitamin content is highest in Fresh Foods consumed soon after harvest that's why we always promoting fresh fruits and vegetables of Fresh Foods excessive supplementation can lead to toxicity yes there is such a thing as Vitamin toxicity vitamin D is needed more in those that are not exposed to sunlight and much that much also in dark skinned people and those with osteoporosis or inability to absorb dietary fat those who are obese or had gastric bypass surgery or those taking medicines that interfere with vitamin D absorption so let's think about a person who doesn't go outside that much their need for Vitamin D is higher because they're not getting it from the sunlight a person with osteoporosis vitamin D enhances calcium absorption so a person with osteoporosis they need more vitamin D okay water solu water soluble vitamins they cannot be stored by the body therefore we must get them daily in our diet they can be degraded by food processing storage and preparation that's why they say fresh is better these include your C and your B complex vitamins they are soluble and water therefore if it's soluble and water that mean we what we excrete it in our urine therefore making toxicity rare except for a person who's a dialysis patient or have a renal disease because a lot of times they do not urinate or they do not urinate sufficiently so they are not excreting those vitamins so they may um they are at a higher risk of developing toxicity minerals they are inorganic inorganic I'm sorry and occur naturally in food as additives and supplements however they are important they assist in fluid regulation energy production and nerve impulse transmission they are essential to the health of bones and blood the body absorbs more of minerals when they have a deficiency and they excrete them when they have an excess of your body excretes it when they have too much of it they also interact with each other for instance vitamin C enhances iron absorption and like I talked about earlier vitamin D enhances calcium absorption calcium and phosphorus comprise 80% of all mineral elements in the body okay then we have our microminerals these are the ones that people require daily in amount in amounts of 100 milligrams or more so your major minerals or your macro minerals we need more than 100 milligrams or greater each day that is your calcium phosphorus sodium pottassium mang magnesium chloride and sulfur then we have our trace minerals they are essential these are the ones that we require daily and amounts less than 100 milligrams they include iron zinc manganese iodine fluoride copper Cobalt chromium and selenium what are the functions of minerals they assist in fluid regulation nerve impulse transmission and energy production remember they are essential to bones and blood and helps rid the body of byproducts of metabolism okay they play a significant role in disease prevention and also disease treatment okay let's look at calcium calcium decreases the likelihood of osteoporosis remember I talked about OST a person with osteoporosis needing more vitamin D so that they can absorb the calcium because the calcium decreases the likelihood hood of osteoporosis but also keep um keeps it from uh progressing Calcium deficiency is one of the most common mineral deficiencies in the US then we have iron iron deficiency contributes to anemia which is the most common nutritional problem worldwide me magnesium magnesium may be linked to decreasing the risk of hypertension and coronary ottery disease in women so magnesium when it is deficient it increases the woman's risk of hypertension but if it's sufficient it is linked to decreasing that risk sodium H sodium in high amounts increases what your risk of hyp attention heart attacks and stroke that's why a lot of times you'll see somebody on a low sodium or sodium restricted diet like I said earlier if the body if the body has a mineral deficiency the body tends to absorb more of it and if it has a excess you will excrete it they interact with each other like I said earlier vitamin C is needed for iron absorption vitamin D is needed for calcium absorption they go hand in hand and phosphorus and calcium also go hand in hand in other words you can't have one without the other H let's talk about water why is water so essential remember outside of proteins water is the most essential water is the most essential nutrient a person can live without food but they cannot live without water why water makes up about 1 half of the total body weight it is distributed in the intracellular and extracellular components the intracellular fluid which is contained within the cells and extracellular which is is um is external to the cell membrane and it is the fluid portion of blood lmph and also in the GI track water functions are essential to life because they work water works as a solvent remember when you are educating your patient on medication especially your antibiotics and your pain medication you want to make sure that you tell them to take it with a full glass of water why because it acts as a solvent it helps to dissolve that medication so that it can be what transported throughout the body water serves as a medium for transporting oxygen nutrients and metabolic waste water also fill spaces and body tissues and transport ions into and out of cells through osmosis you will learn more about that in fluid electrolytes water maintains body temperature by what evaporation when a person gets overheated they may perspire and the perspiration turns it is evaporated so that it can cool the body off it works as a lubricant water fills our joint spaces it fills in those empty spaces in our joints so that they can move freely and it reduces friction also in the thoracic cavity it allows organs to move more freely like when you're taking a deep breath or when you coughing and stuff it's the fluid within our chest wall or our plural space that allows those organs to not stick together or to um move freely the biochemical reaction of converting carbs and proteins into energy during the digestive process is called Catalyst however keep keep in mind even though it's the most essential nutrient it all the requirement varies according to the environmental humidity and temperature a person's activity their age their overall health and the metabolic needs not every person needs the same amount of water especially a person who's obese they require more water than a person who's underweight a person who's working outside in the heat they require more water than the person who's inside in the air conditioned house just relaxing remember fluid balance what we take in we must put out so when fluid balance is maintain fluid balance is maintained when fluid intake from liquids foods and metabolic reactions equals the fluid output through urine feces respirations and sweat that's why taking accurate ey and no is essential when we caring for our patients we must document and calculate what they taking in and what they're putting out now yeah water is the most essential nutrient the body needs both food and water but without water a person can only live three to five days but a person who's not eating but drinking water they can live for weeks or a couple of months what must you know about energy balance it is the relationship between the energy derived from food and the energy used by the body the body obtains energy in the form of calories from carbohydrates proteins fats and alcohol the body uses energy for voluntary activities like walking and talking and involuntary activities such as breathing and secreting enzymes energy in carbohydrates proteins and lipids is measured in terms of calories or kilo calories remember carbohydrates is 4 kilo calories per gram proteins is 4 kilograms per kilo calories per gram and fats is 9 kilo calories per gram weight is maintained when the number of kilo kilo calories consumed equals the number of kilo calories burned so if a person takes in 1,000 kilo calories then they must burn off 1,000 kilo calories if not they will gain weight if a person only consumes 500 kilo calories and they um work out work off 1,000 kilo calories or burn 1,000 kilo calories they will lose weight okay too few kilo calories can to weight loss and can lead to essential nutrient deficiencies which causes it weakened immune system it can cause stunted growth and also hormonal disruption a lot of times you'll see that in um athletes um especially like your gymnast and your ballerinas and stuff like that because they tend to restrict their calorie intake but they out they burn more Cal than they taking it then you have those who have who taken too many kilo calories and they gain weight or they become obese but also that puts them at a risk for chronic diseases not just chronic diseases but also overall health problems like a person who's obese or overweight they may put more weight there's more weight for them to carry which puts a strain on their joints especially their knees and also so causes more back problems as well and also kind of slows down their metabolism and their activity levels so then what happens they gain more weight so what is basil metabolic rate basil metabolic rate is a measure of the energy used while at rest in a neutral temperature environment the energy required for vital organs such as the heart liver and brain to function so that means a person that's just sitting there doing nothing what is their metabolic rate what amount of energy is needed for their heart liver and brain to function it is the rate at which the body metabolizes food to maintain the energy requirements of an individual who is awake and at rest like I said awake and just sitting there doing nothing it is the energy and food that maintains the body the Bas of metabolic rate and provides energy for activities such as running and walking what factors affect base of metabolic rate lean body tissue has greater metabolic activity than fat and Bones so a person who's more lean and has more muscle they will burn off more than a person that that is U fat so it's more like your muscle so if you see a person that's really lean and they have more muscle than fat and Bones then their basil metabolic rate is better your basil metabolic rate increases during grow certain growth periods like at five uh your adolescence your pregnancy and your lactating women basil metabolic rate also increases 7% for each one degree Fahrenheit Rising body temperature so if a person is ill or they have a um increase uh temperature then their basil metabiotic rate will increase 7% cold weather cold weather causes a slight rise in basil metabolic rate how because it generates body heat and maintain normal body temperature if a person is out in the cold or they cold they start to shiver and what happens their basil metabolic rate Rises to generate heat then you have disease price es diseases and injuries involving increased cellular activity and tissue repair such as cancer anemia cardiac function hypertension and Asthma does what it results in a elevation in the Bas of metabolic rate prolonged physical exertion prolonged physical exertion demands arise in a metabolic uh process so now we're going to take a break about 10 minutes and then we'll get back to it okay hey now that the break is over let's get back to it what factors affect nutrition the most influential factors are developmental stage a specific developmental stag is nutritional needs and eating p patterns vary according to the physiological growth activity level metabolic process disease prevention and other factors let's look at different age groups your young adults they require protein vitamins and minerals if they continue unhealthy behaviors that developed early in earlier stages it will affect them in their adulthood so that's why it's important to teach children a healthy um healthy behaviors then you have calcium vitamin D folic acid and iron they are critical especially in women for bone and reproductive Health that's your young adults your middle-aged adults the basom metabolic rate decreases and potentially results in weight gain a lot of times middle-aged adults develop diabetes hypertension obesity hypolipidemia and certain types of cancer often a result of hereditary or poor lifestyle choices so your middle-aged adults they become affected by unhealthy um unhealthy lifestyle choices or hereditary um problems modifications and exercise are essential to control these diseases then you have your older adults your older adults may require fewer calories and may need dietary changes due to the risk of coronary artery disease osteoporosis and hypertension remember your older adults they start to their appetite starts to decline their um thirst mechanism starts to de decline their basil metabolic rate starts to decrease so they require fewer calories and fewer um and so they may need dietary changes then we have our pregnant and lactating women they have an increased need for nutritional requirement especially fol folic acid folic acid in the first 13 weeks of pregnancy is needed to prevent neurot tube defect deficits I defects I'm sorry sorry you'll learn more about that in I think uh Pediatrics or Ps protein and calcium are essential for growing muscle brain and Bone tissues and iron to maintain maternal and Fetal blood supplies and stores during pregnancy supplements for folic acid and calcium may be needed lactated women need additional protein calcium and fluid remember what you giving that baby you have to replenish pregnant women need to be screened for gestational diabetes mtis then you have males they need more calories and proteins and then your females need more iron and lactation requires calories and fluid more calories and fluid because remember you're giving it to the baby okay lifestyle choices people in a hurry they tend to eat fast food or buy more convenient groceries which is not as healthy and then you have people who usually stay at home they usually prepare meals from scratch or they cook and they are more likely to have a healthy um diet and then we also have stress eaters some people eat to cope with stress which is a which can affect their nutritional St status your smokers tobacco users they use vitamin C faster than nonsmokers so they may need Vitamin C replacement alcohol consumption alcohol consumption contributes to obesity by significantly decreasing fat metabolism and replacing food for some alcohol can impair the storage of nutrients and increase nutrient metabolism and excretion a lot of times your alcoholics will choose alcohol over food the food that is the nutrients that is required in food therefore decreases or is absent and alcohol is non nutritional then we have vegetarianism it's all vegetarian diets most of all of them in exclude red meats and poultry their vegetarian diets vary however we must educate them on choosing foods that include enough of the required nutrients such as vitamins and minerals eating for health and athletic performance one should eat a diet high in Meats fish fresh fruits and veggies nuts and seeds eggs and other natural Whole Foods to be healthy remember some of the athletes they restrict certain foods from their diet and they restrict calories and different things like that so remember everything that we do is patient specific eating for weight loss we have people who go on these fat diets we must be able to educate them on them fast diets and to encourage en them to avoid them why it's a Fed fed diets they come and they go they come they work really quick but then it's not something that you can sustain over life so we stop the diet and once we stop the diet what happens we regain the weight so it's we must as a healthc care provider we should encourage life style changes and discourage fed diets the American Heart Association diet provides tips for slow sustained weight loss and it offers a variety of foods for nutrient balance it encourages physical activity and emphasizes self-monitoring cognitive strategies and behavior modification remember eating for weight loss especially to sustain the weight loss we must change our lifestyle then we have e ethnic cultural and religious practices they often determine food preferences people usually choose the traditional foods from their ethnic cultural or religious practices like your um who is it the Muslims don't eat pork um certain religions don't eat uh meat on certain days it's just different practices that those religions and um ethnic and cultural groups practice we must be cognitive of those practices and also impose them when in our care I remember I had this one guy he was not eating breakfast every morning and so one day I asked him I said why do you not eat breakfast I I was like do you not like the food or is they not sending you what you like or what and he said he was um over he was a vegetarian where he don't didn't eat a are dairy products and they kept sending him grits and eggs and everything so I said okay well I can fix that I can send a comment into the dietary into the cafeteria when I went into the computer to modify his diet put that comment in there was the diet that he like the over I can't remember the whole name of it but it had to do with eggs so I changed his diet and the man started eating breakfast every day so that's why it's important to know those ethnic cultural and religious practices and make sure that our patients are receiving those are being obliged with them then we have disease processes and functional limitations H chronic disease such as diabetes and GI disorders can alter nutrient intake digestion absorption use and excretion any health problem when accompanied with a fever remember increases your metabolic rate therefore increases the need for protein water and calories medications remember it's essential to get a list of the patients medicines that they're taking when we doing a nutritional assessment because medications can cause nausea vomiting alter appetite Disturbed taste and most importantly interfere with absorption and and excretion and affect specific nutrients chemo and radiation can cause oral ulcers so if a person have sores in their mou you think they're going to eat not so much right if a person has diarrhea it can affect the medications that causes diarrhea can affect the person's overall health especially decrease their potassium right nurses need to be aware of the nutrition effects of specific drugs so that we can evaluate a person's nutritional problems then we have special diets H many people follow a modified diet to manage their illness all impatient facilities must provide remember I say impatient must provide a provided prescribed diet the most common diets are your regular which consist of a balanced meal that supplies 2,000 kilo calories per day with vegetarian and ethnic variations being available then also we have a diet called n nothing to eat or drink by mouth a lot of times that is prescribed for a person who's having some GI issues that warrants them not to eat or drink anything um a person who is preparing to go to surgery or procedure certain procedures however we must be uh a breast as to if that person require IV fluids remember if a person is a diabetic and they cannot eat or drink anything we must closely monitor their blood glucose but also we may need to give them IV fluids that has a little glucose glucose in them a person that's dehydrated they may be n but we can give them IV fluids to replace so or to provide that hydration right if the no becomes a lengthy problem then the patient can res to receive nutrition entally through a feeding tuol which we'll talk about later or parentally through IV to prevent malnutrition which we'll talk about later then we also have some people who have dysphasia which is difficulty chewing and or swallowing we can provide them with a modified diet that is consistent for them to swallow a lot of times speech therapy will evaluate that patient for what specific textures of foods is best for them the most common diets modified for disease are calorie sodium and fat restricting diets another one is another um two other diets is your diabetic diet or your renal diet okay now let's talk about overweight and obesity this is our example problem the definition overweight or obesity is weight greater than the considered he then considered healthy for a given height and weight risk factors are genetics dietary intake set set tering lifestyle and medical conditions like a person with an endocrine condition like uh polycystic ovarian syndrome a lot of patients diagnosed with that they will be overweight or obese a person who with a seditary lifestyle who just sits on the couch and watch TV they're most likely to be overweight or obese a person who takes in more calories than they burn they at risk for obesity or overweight sometimes it's just genetic recognizing complications type 2 diabetes met iic syndrome cancer breathing problems sleeping problems gallbladder disease joint problems remember I talked about the overweight person um putting that weight on their joints especially the knees reproductive problems skin problems and they also are at a higher risk of debt they also may have poor self-esteem suffer from loneliness depression Eating Disorders hormonal changes menopause men learned behavior such as emotional eating depression a reward for good behavior Comfort when sad lonely or sometimes just to express love think about it a lot of times when we celebrating something or we going through something what do we do we eat so those are some things that contribute to overweight and obesity let's recognizing let's recognize some cues in order to recognize cues we have to do what perform a focused nutritional assessment skin fold measurements measuring circumferences to evaluate body composition that's your anop Prometric measurements let's analyze cues and come up with a diagnosis so we then analyze the cues the person is obese they overweight body nutrition ESS risk for body nutrition excess for example a diagnosis for that person would be overweight related to insufficient physical activity high fat and high sugar diet or obesity related to metabolic disorder as with your polycystic ovarian syndrome patient their medical di nursing diagnosis may be obesity related to metabolic disorder and then you also have um another endocrine um this order called um hunch hunching hunch Kings disease that's where they have the fatty deposits on their back and everything that's another um endocrine disorder now we're going to generate some solutions what do we want to see in this person what is our goal for this person weight body M weight loss Behavior nutrition ntional status food fluid and nutrient intake those are the things we're going to work on right how do we work on those things by collaborating we collaborate with um other health care providers they we may have a order for appetite suppressant which is individualized we may consult dietary or dietician we may refer them for counseling they may they may get a a gastric bypass laparoscopic laparoscopic banding gastric sleeve or vagan nerd blockade taking action we want realistic expectations we want to encourage exercise we want to suggest a food record we they can even if they have so many apps out now we can either probably refer them to app and we might do weekly weights okay now we want to teach see the teaching weight loss tips on page 707 in volume 1 and if you notice when you look at that the very first thing is the person must commit if we cannot get the patient to commit to the program or commit to losing the weight it's not going to work we can teach the my plate dietary plan reducing portion size restrict carbohydrates high fat foods and sweet drinks we can also discourage them from fed diets and quick weight loss plans we can encourage support groups exercise and also encourage and get them to understand that diet is essential to Weight Control caring I don't care what type of patient you are dealing with be caring and encouraging use patient sensitive language and do not be judgmental remember every patient is different every patient everything we do is patient specific now we're going to screen for nutritional problems a nutritional screening like I said should take place with every P impatient patient admitted into the hospital especially patients with obesity and who are at risk for nutritional deficiency they should that assessment should occur within 24 to 48 hours of their admit refer to Pages 505 to 506 of volume two for a description of the following assessment tools which is your subjective Global assessment your nutrition screening initiative and the mini nutritional assessment Focus nutrition assessment refer to page 506 through 509 of volume two for a description of a focus nutrition assessment because it includes several factors dietary history that's where you're going to get a history of what the person's normal diet is what do they usually eat when do they usually eat how much they usually eat and that's when those uh diet recalls and uh 24hour diet tracking and all of that comes into play then we do a physical exam it should be correlated with other assessment data for instance you don't just do a physical exam you have to include the medical history dietary intake their measurements their height their weight lab results all of that should be included to complete and accurate and entire assessment then we assess body composition which consists of and retric measurements that I mentioned earlier it uses a technique to determine a patient's body Dimension such as their height and weight they indirectly assess the protein and fat stores of adults it assesses for obesity and also underweight they measure the skin folds the circumferences and also looks at the body mass index what physical exam finding accused to Nutri nutrient imbalances as a nurse you should assess and correlate all the previously mentioned such as physical assessment lifestyle nutritional medical history dietary intake laboratory values and anthropometric findings lab values lab values reflect the nutritional status remember we talked about vitamins and minerals and uh proteins and carbohydrates and all of that stuff that will show in a person's lab work and that's why they usually take lab work every morning of each patient to see what their not just to see what their health status is but their nutritional status as well we want to collect general knowledge about the patients eating habits like I said food attitudes their preferences look at their culture look at their use of supplements we might want to do a 24-hour recall we might even try a food frequency questionnaire and are either food record and also we have remember the measurements um then we also have to do a a gluc glucose screening and that'll show up in the blood work as well and to detect such AB abnormalities that diabetes assess and correlate physical findings diary intake measurements and lab work BL blood glucose indicates the amount of fuel available for cellular energy low albumin is associated with malnutrition remember I said albumin was the primary or comprised of more more more comprised in the body more 60% more than uh the protein in the body I'm sorry so if a person has low albumin is usually associated with malnutrition malabsorption acute and chronic liver disease and protein loss through Burns a patient who has um sustain significant Burns their albumin will be low because they losing that protein through the fluid okay Ura is an indicator of liver and kidney disease so you you have have to look at their um urine and and creatinin urine is an indicator of liver and kidney disease creatin is an indicator of liver of kidney function I'm sorry a decrease in total lymphocytes is associated with malnutrition protein deficiency alcoholism vom marrow depression and anemia a low hemoglobin May indicate inadequate iron intake remember I talked about um anemia being the most common um health problem worldwide nutrition deficit worldwide and it may indicate inadequate iron intake or chronic blood loss so if a person hemoglobin is low and but they're eating a sufficient diet to get that iron then they may want to look at internally is this person bleeding then we have weight height and IO can also can be delegated to a UAP it says may I delegate nutrition assessment no you cannot delegate a nutrition assessment you cannot delegate any kind of assessment but weight height and IO can be delegated to a unlicensed assisted assisted Personnel other nursing staff can collect nutritional history but it is the RN the assigned RN responsibility to review and interpret the findings um teaching patients about vitamin and mineral supplementation oh I'm sorry let's go back nutrition as the problem nutritional problems can be the ideology of other problems such as GI disorders Skin Integrity insomnia social impairment risk for infection and delay room healing as Healthcare Providers we should encourage acquiring micronutrients in a well balanced diet for loss of appetite we can refer I'm sorry interventions for impaired dietary intake for weight for um loss of appetite we can refer to interventions on page 695 volume 1 if n we can assist or provide oral hygiene ex visitors not not to eat or drink chips and sips a hard candy if allowed if a person is n sometime the doctor will say chips and sips meaning chips of ice and sips of water and hard candy if it's if it's if it is allowed um I remember I was visiting somebody in CCU and there's this thing in CCU and ICU where you uh visitors cannot bring any food in why because most of those patients not most of them but a lot of them cannot eat or drink anything so it's not fair to the patient for you to sit there and eat or drink anything um so some units do restrict visitors from bringing in food for a patient who is having difficulties chewing and swallowing like with dysphasia you can offer a dysphasic diet and like I said earlier most of the time the speech therapist will evaluate and determine the consistency of the food required for that patient with liquids they will also determine the thickness of the liquids so let's say um let's think about it if a person is drinking just straight liquid it goes down fast right so you but you're not you don't you don't have a problem with swallowing it so because you're not dysphasic but a person who is dysphasic or having trouble chewing and swallowing if the water is just plain water it will go down fast and it may go in in um down to the down into the lungs and cause them to aspirate so what they do is they thicken the liquid so that it goes down a little bit slower so that the patient can control where it goes okay um for dry mouth we can educate them on avoiding caffeine Alcohol Tobacco dry salted acidic Foods we can offer them hard candy gum lip moisturizer and like I said earlier chips and sips chips of ice and sips of water now if they have a decreased gastric secretions we can encourage regular meals encourage them to thoroughly chew their food we can also give them meds if needed and foods high and vitamin D for calcium absorption remember calcium is absorbed in the GI tra so if they having decreased gastric secretions then we want to uh increase their vitamin D for calcium absorption for constipation we can encourage foods high in soluble fiber allow water which allows water to remain in the stool making it softer and insoluble fiber as bulk making defecating easier and remember to encourage them to drink plenty of water for patients for under nutrient undernutrition and malnutrition risk for nutritional deficit some diagnosis could be risk for nutritional deficit due to the limited or no ability to feed themselves due to cognition muscular skeletal neural weakness pain or environment for those type of patients we can assist them with meals as needed you might have somebody who can feed themselves but they handshake they have trimers so by the time they get the food from the plate to their mouth the food can fail sometimes you may have a person who can feed themselves but the they hands do not close clo um tight enough to um manipulate the utensils so we can adapt their utensils we can put they have these different little foam types of things that they can put on the handles of the spoons and the forks and the knives so that the person can grasp it and be able to feed themselves so remember everything we do is patience specific right we can also provide Inon nutrition Inon nutrition is feedings that is supplyed through the GI tract or intravenously liquid feedings via two either short or long term for patients with functioning intestinal tract so if the patient in intestinal tract is functioning we can give them those feedings the person the patient is at risk for respiration bacterial growth nause vomiting diarrhea drug absorption and metabolic metabolism alteration and metabolic disturbances inic tubes are used for levage specimen and prevention of nasal nausea vintin and gastric distension postto and that's your um like your um iner Tobe the healthc care provider will usually order the type that is needed so if the person is having nausea vomiting or they having gastric D distension posttop the uh healthcare provider might order a NG tube to be placed and they will decide which one to use our example problem for undernutrition and Mal nutrition you can refer to Pages 694 to 695 for BMI categories because remember there's different numbers that determines if the patient is normal weight obese or underweight or malnourished okay definition undernutrition is the intake of insufficient nutrients to meet metabolic needs based on activity sex height and weight we have Eating Disorders Eating Disorders uh examples are anorexia it is C categorized by self-starvation so a person who's anorexic they will not eat a lot of times like I mentioned earlier your gymnast your alinas they will not eat and they will become they can become anorexic then you have bmia neosis these people eat and they binge eating so they may not eat for a while then they binge eat they eat a whole lot of food but then what do they do they Purge they make themselves vomited up or they take laxa tips to excrete it malnutrition is a long-term deficiency in energy nutrient and tape what are some kind applications reduce self-esteem shame guilt loneliness social isolation depression and anxiety also increased risk of early death osteoporosis remember osteoporosis comes from insufficient vitamin D to um a in calcium absorption so if the person is not eating and not taking in those minerals they are at risk for osteoporosis decrease resistance to infection remember a person that is malnourished they don't have the proteins that they need which is your lymphocytes and your antibodies um your immune def um status is uh decreased metabolic disorders um dymas remember a lack in um minerals can cause uh heart conditions dymas organ failure and ultimately so what do you want to assess on these people with malnutrition you you will see reduced physical activity weight loss reduced height abdominal enlargement and hair loss A lot of times a person who's undernourished they will lose their hair analysis and diagnosis you have body nutrition deficit these are the um you done analyzed all your data and now you're coming up with your nursing diagnosis some examples are body nutrition deficit risk for body Nutri nutrition deficit underweight related to eating disorder underweight related to digestion and absorption disorders so remember everything is patient specific but you will get a list of the different nursing diagnosis that you can choose from According to your patients um data what are the outcomes you want to see for this patient you want them to gain weight towards a goal you want to set a a goal weight and you want to work towards it the person must verbalize a willingness to take action for weight gain remember when I talked about obesity you have to get their Commitment if the person is not committed to gaining weight just like with uh losing weight they're not going to be very successful but we do not give up on them right we continue to encourage educate and try to elicit that commitment then we have to um look at their body mass their lab values and we want their weight to be within normal limits we want to um recognize contributing factors what is contributing to this malnutrition or this undernutrition what's the root problem we have to get to the root problem in order to fix the problem right they may see themselves they might have what it's called body Mor Mor morphism where they looking in the mirror and they see this fat person but in reality they're not um or they may be doing it for um athletic purposes they may be doing it to impress somebody they may be doing it because they're depressed or they just feel they have low self-esteem we we have to get to the root of the problem once we do all of that we collaborate we collaborate with other healthare providers the healthc care provider might order a appetite stimulant we might consult dietitian refer them to appropriate celing also Community Resources for food access some some people just don't eat because they don't have the means then we have the interventions what are we going to do what are we as the is going to do to help this person right we're going to offer small frequent nutrient Den meals but we're going to offer them when a person is more likely to eat or more likely to be hungry so we're not going to just keep giving them food right because they're not going to eat it we have to determine their pattern and see when they are more likely to be hungry and then offer them the foods we want to offer them high protein supplements sometimes in a nursing home you might have a person that's underweight they will give them what they call protein shakes or power shakes or something like that with their meals we may also restrict fluids with their meal because a lot of times we drink the people drink the fluids and then they get that um sensation of being full also we want to control pain before meals if a person is in pain they're most likely not going to eat we want to provide and assist with oral care we want to also provide them with a clean older free environment especially in a facility we want to encourage them to refrain from smoking one hour before meals because smoking does what it decreases the appetite right if the person is having trouble getting to the food we want to make sure that we put place the food to where they can get to it and then at the very um least we want to determine if too feeding or IV fluids are needed okay caring refer to page 690 and Page 693 for providing interon nutrition we want to encourage visitors to bring patient their food preferences I remember I worked at a nursing home and they had this little Asian lady and she wasn't eating she was losing weight of course we had to um have a care plan meeting for her come to find out she didn't like the foods or her culture did not eat those foods that they were providing her in the cafeteria so what happened we T we got with the family and the family started providing her the types of foods that she ate she had a refrigerator in her room and she began to eat and she began to gain weight so we have to encourage visitors to bring patient food preferences if they're not provided by the facility we also need to provide those Foods in different textures colors and flavors nobody wants to eat something that's unattractive or does doesn't taste good or have no texture we want to encourage meals with family or friends I worked at a nursing home where they had this one resident where his mom came breakfast lunch and dinner to eat with him and every time she came to eat with him he ate very well so we would hold his tray until mom got there if the person lives alone and we know they're not eating well or not eating much we might want to visit them a little bit more often and bring them some food sometimes it's a social economic problem so the person don't have the the means to acquire food so we may want to reach out um and provide them with the resources that's available in the community like Meals on Wheels and different things like that okay caring for patients with un well we I just talked about a lot of this assist patients with meals provide inal nutrition we have to look at the risk that is associated with um inal feedings what are some risk we talked about bacteria um because we do not clean the utensils or we do not wash our hands or we do not clean the outside of the packaging the patient may be at risk for aspiration nausea vitin diarrhea alter alteration in drug absorption and metabolism and also metabolic disorders using enic tools remember talked about that a little while ago we use those to sometimes we use those for um suctioning like to remove uh pents from the GI track to collect the specimen or to prevent nausea vomiting and distension posttop now When selecting a tube um feeding the healthc care provider will usually order the type needed a lot of times they consult the dietician before they order that because the dietitian do an overall assessment and then determine the patients nutritional needs checking feeding to placement there's a box on page 711 through 712 for methods for checking tool placement the one thing I do want you to realize to remember is that before we can use a tool there must be an X-Ray a x-ray is the most reliable and is must be um confirmed be placement must be confirmed before the first first feeding then after that you check the to placement before each feeding administering interal feedings the type of feeding depends on the patient's needs remember everything we do is patient specific you might have a basic too feeding high protein you might have elemental you might have a diabetic feeding a formula you may have a renal formula and also there's pulmonary for formulas but the healthcare provider will determine according to the patient's um health status nutritional status they will determine the type of feeding to provide feeding schedules we have some people who are on a 24-hour feeding schedule where they are fed 24 hours throughout the day then some are some may be at night where they only receive two feedings at night some of them are intermittent so and to uh supplement oral intake so you might have a patient who's eating orally but they need extra supplement or they need that extra nutrition but they're not so they're not eating all of their they're not getting all their nutrients orally but they do eat so then they may supplement it with interal feedings of of too feedings we have a open system it consists of cans of formula and a close system is usually on a pre-filled pump um bottle and it goes on a pump so the open system is cans where you clamp off the two feeding in between feedings but you bolish them which is where you give them like a whole can of of formula at one time and then you flush the tube and then you close it off and your clo system is usually in a bag kind of like an IV but it's a harder bag and it hangs on the pump and it is delivered through the system monitoring patients receiving inro nutrition we want to monitor these patients because we want to make sure that the tube is placed because if the feeding is going in and the tube is not in place then where is the food going the liquid formula going into it could be going into the lungs which can cause aspiration the last thing you want to do is have your patient aspirate and then also we have to keep the bed elevated to prevent them from aspirating um contamination I already talked about that administering medication through too feeding you will get more of this in your um medication administration lecture but when you are administering medic medication through too feedings you want to first of all make sure um confirm placement then you want to flush the too feeding with water and to see if it's clogged if it's not clogged then you can administer the medication and then after each medication you want to flush it again and then clamp it off so in other words we want to flush before and after each medication is complete um sometimes we have to reposition the patient and please please please do not flush the tube with carbonated drinks or carbonated beverages if it cannot be unclogged if it becomes clogged and you can't unclog it then you may have to it may have to be replaced which is pretty um straightforward procedure removing too feedings removing feeding tubes after the patient no longer need it so let's say the physician orders to remove it uh and that this is your NG tube um nasogastric tube referred to the procedure P um 24-4 for removing nasogastric or nasoenteric tube on page 493 through 494 Volume 2 let's talk about providing parenteral nutrition so interal nutrition is through the GI track um and parenteral is through a IV okay so parenteral nutrition also refer referred to as Total pereral Nutrition or tpn or IV infusion of dextrals water fat proteins electrolytes vitamins and trace minerals it's only given through high flow through a high flow or a large bore Central vein it is administered for sever Mal nutrition severe burns bow disorders acute renal failure hepatic failure metastatic cancer major surgeries where nothing may be taken by mouth for more than 5 days they are high in glucose so they are started slowly and discontinued slowly then we have PPN which is delivered through small peripheral veins it is short-term of a patients where the central line is contraindicated is usually used for prevention of nutritional deficits not to treat um and a v can be provided in the home parental nutrition Solutions usually contain water glucose amino acids like I said earlier these are the standard formulas and patient specific there are standard formulas and patient specific so it depends on the patient remember everything we do is patient specific your Venus excess devices due to the hyponic nature of parenteral nutrition formulas that formulas the preferred route of administration is through a large high flow vein through a central Venus access catheter that's your central line your um peripherally inserted central line or your um triple Lumin catheter you'll learn more about those and um further in the program the site of choice is usually the sub subclavian vein yet the jugular vein is preferred for tunnel catheters what are some complications of pereral nutrition infection septic shock can result from contamination of the mixture or the supplies so we must clean our supplies we must wash our hands we must use aseptic techniques when preparing and administering needs also blood clots are a high risk because the chronic use or chronic excess of the vascular system and then also liver function U namely because of the fatty liver or liver failure are not uncommon with long-term use of parenteral nutrition then we have gallbladder disease occurs due to disuse of the GI tract leading to B State because the B just sitting in the GI tract because you're not using the GI tract remember just like with the nasal gastric tube or the NG tube confirming placement for the um Venus access device must be done through chess x-ray you cannot use a Venus access device until you get an okay to use after a chest XR has confirmed that it is in the correct place now let's check your knowledge which process predominantly contributes to tissue repair glycolysis transcriptional regulation DNA replication or protein protein synthesis the correct answer is D protein synthesis which population group is at the highest risk for developing vitamin D deficiency young adults age 20 to 30 elderly individuals living in nursing homes children AG is 5 to 10 athletes engaged in intense physical training correct answer is B elderly individuals living in a nursing home why because a lot of times they just don't go outside and get that vitamin D from the sun which lipopro is lipoprotein is primarily responsible for transporting cholesterol to the body cells is a high density lipo protein low density lipo protein very low density lipo protein or intermediate density lipo protein the answer is B low density lipo proteins remember the low density lip of proteins brings cholesterol to the body cells which causes causes what fatty deposits on the vessel walls so it is your bad cholesterol which macronutrient provides the highest number of kilo calories per gram carbohydrates proteins fats or Fiber the correct answer is fats remember carbohydrates and fats only have four kilo calories per gram I mean carbohydrates and proteins only have four Kil calories per gram and fats have nine kilo calories per gram fiber doesn't have any any questions if you have any questions please do me a favor and post them in the discussion board so that everyone have access to the answers to those questions and the resources that are available That's all folks