Nutrition in nursing

LECTURE 1
LECRURER: RONZA AL-TEETE
PRESENTED BY: AHLAM JARADAT
 Learning objectives
Upon completion of this chapter, the students will be able to:
1 Compare nutrition screening to nutrition assessment.
2 Evaluate weight loss for its significance over a 1-month or 6-month interval.
3 Discuss the validity and reliability of using physical signs to support a nutritional diagnosis of
malnutrition.
4 Give examples of nursing diagnoses that may use nutrition therapy as an intervention.
5 Demonstrate how nurses can facilitate client and family teaching of nutrition therapy.
6 Explain why an alternative term to “diet” is useful.
 Introduction
❖ Based on Maslow’s hierarchy of needs, food and nutrition rank on the same level as air in the
basic necessities of life.

❖ Food is loaded with personal, social, and cultural meanings that define our food values, beliefs,
and customs.

❖ Nutrition is not simply a matter of food or no food but rather a question of what kind, how
much, how often, and why.

❖ Merging want with need and pleasure with health are keys to feeding the body, mind, and soul.
 Role of nurses in nutrition
Nurses play a vital role in nutrition care, And intimately involved in all aspects of nutritional
care.
❖ Nurses may be responsible for screening hospitalized patients to identify patients at
nutritional risk.
❖ They serve as the contact between the dietitian and physician as well as with other members
of the health-care team.
❖ Nurses have more contact with the patient and family and are often available as a nutrition
resource when dietitians are not, such as during the evening, on weekends, and during
discharge instructions.
❖ Nurses may reinforce nutrition counseling provided by the dietitian and responsible for basic
nutrition education in hospitalized clients with low to mild nutritional risk.
 NUTRITION SCREENING
Nutrition screening: is a quick look at a few variables to identify individuals who are mal-
nourished or who are at risk for malnutrition so that an in-depth nutrition assessment can
follow.
Malnutrition: literally “bad nutrition” or any nutritional imbalance including over nutrition. In
practice, malnutrition usually means under nutrition or an inadequate intake of protein and/or
calories that causes loss of fat stores and/or muscle wasting.
common screening parameters in acute care settings include :
• Unintentional weight loss
• Appetite
• Body mass index (BMI)
• Disease severity. (Advanced age, dementia, and other factors may be considered0
 Nutrition in the nursing process
The nutrition care process. is a problem-solving method used to evaluate and treat nutrition-
related problems.
 Assessment
❖ Nutritional Assessment: an in-depth analysis of a person’s nutritional status.

❖ In the clinical setting, nutritional assessments focus on moderate- to high-risk patients with
suspected or confirmed protein–energy malnutrition.

❖ Subjective Global Assessment (SGA):a clinical method of assessing nutritional status based on
findings in a health history and physical examination.
 body mass index (BMI)
❖ is an index of a person’s weight in relation to height used to estimate relative risk of health
problems related to weight. kg/m²
 Medical History and Diagnosis
❖ The chief complaint and medical history may reveal disease-
related risks for malnutrition and whether inflammation is
present.

❖ Patients with gastrointestinal symptoms or disorders are

among those who are most prone to malnutrition, particularly
when symptoms such as nausea, vomiting, diarrhea, and
anorexia last for more than 2 weeks.
 Weight Change
❖ Unintentional weight loss is a well-validated indicator of
malnutrition (White et al., 2012).
❖ The significance of weight change is evaluated after the
percentage of usual body weight lost in a given period of time.
❖ The patient’s weight can be unreliable or invalid due to
hydration status. Edema, fluid resuscitation, heart failure, and
chronic liver or renal disease can falsely inflate weight
 Dietary Intake
A decrease in intake compared to the patient’s normal intake
may indicate nutritional risk.

For more details about dietary intake questions refer page -9

 Physical findings
❖ Loss of subcutaneous fat, such as in the triceps and chest, muscle wasting in the quadriceps
and deltoids, ankle edema, sacral edema, and ascites may be indicative of malnutrition.
❖ These abnormal findings are subjectively assessed as mild, moderate, or severe
 Nursing Diagnosis
❖ Nursing diagnosis in hospitals and long-term care facilities provide written
documentation of the client’s status and serve as a framework for the plan
of care that follows.

❖ The diagnosis relate directly to nutrition when the pattern of nutrition

and metabolism is the problem.
❖ Other nursing diagnosis, while not specific for nutrition, may involve
nutrition as part of the plan, such as teaching the patient how to increase
fiber intake to relieve the nursing diagnosis of constipation.

Refer to Box 1.6 in page 10 (a lists nursing diagnoses with nutritional

significance.)
 Planning: Client Outcomes
❖ Short-term nutrition goals are to attain or maintain adequate weight and nutritional status and
(as appropriate) to avoid nutrition-related symptoms and complications of illness.

❖ Client-centered outcomes should be measurable, attainable, and specific.

❖ Whenever possible, give the client the opportunity to actively participate in goal setting, even if
the client’s perception of need differs from yours.
❖ in matters that do not involve life or death, it is best to first address the client’s concerns.

Ex: Your primary consideration may be the patient’s significant weight loss during the last 6
months of chemotherapy, whereas the patient’s major concern may be fatigue. The two issues
are undoubtedly related, but your effectiveness as a change agent is greater if you approach the
problem from the client’s perspective
 Nursing Interventions
❖ What can you or others do to effectively and efficiently help the client achieve his or her goals?
Interventions may include nutrition therapy and client teaching.
Nutrition Therapy:
❖ “Nutrition Therapy” is used in place of “Diet” because, among clients, diet is a four-letter word
with negative connotations, such as counting calories, deprivation, sacrifice, and misery.

❖ Nutrition therapy recommendations are usually general suggestions to increase/decrease,

limit/avoid, reduce/encourage, or modify/maintain aspects of the diet because exact nutrient
requirements are determined on an individual basis.
formulas for calculating calorie and protein requirements.
 Monitoring and Evaluation

Evaluation includes deciding whether to continue, change, or abolish

.the plan
 Reference
Dudek ,S .Nutrition essential for nurses practice ,. Wolters Kluwer Health | Lippincott Williams &
Wilkins. seventh edition (2014) chapter 1 .P.p (2-16)
 Carbohydrate
RONZA AL-TEETE.RN ,MSN

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L E A R N I N G OB J E C T I V E S
Upon completion of this chapter, you will be able to
1 Classify the type(s) of carbohydrate found in various foods.
2 Describe the functions of carbohydrates.
3 Modify a menu to ensure that the adequate intake for fi ber is provided.
4 Calculate the calorie content of a food that contains only carbohydrates.
5 Debate the usefulness of using glycemic load to make food choices.
6 Suggest ways to limit sugar intake.
7 Discuss the benefits and disadvantages of using sugar alternatives.

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 Introduction
➢ Sugar and starch come to mind when people hear the word “carbs,” but carbohydrates
are so much more than just table sugar and bread.
➢ Foods containing carbohydrates can be empty calories, nutritional powerhouses, or something
in between.
➢ Globally, carbohydrates provide the majority of calories in almost all human diets.

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 Carbohydrate Classifications
➢ Carbohydrates (CHO): a class of energy yielding nutrients that contain only carbon, hydrogen,
and oxygen, hence the common abbreviation of CHO.
➢ They are classified as either simple sugars or complex carbohydrates.
❖ Simple Sugars: that includes monosaccharides and disaccharides
A. Monosaccharides:
▪ single (mono) molecules of sugar (saccharide); the most common monosaccharides in foods are
hexoses that contain six carbon atoms.
▪ are absorbed “as is” without undergoing digestion.
▪ E.g glucose, fructose, and galactose.

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 Carbohydrate Classifications
B. Disaccharides : “double sugar”
▪ composed of two (di) monosaccharides.
▪ must be split into their component monosaccharides before they can be absorbed.
▪ E.g sucrose (table sugar), maltose, and lactose.

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 Carbohydrate Classifications
❖ Complex Carbohydrates (polysaccharides) : group name for starch, glycogen, and fiber;
composed of long chains of glucose molecules linked together.
➢ Despite being made of sugar, polysaccharides do not taste sweet ? because their molecules are
too large to fit on the tongue’s taste bud receptors that sense sweetness.
A. Starch. Through the process of photosynthesis, plants synthesize glucose, which they use
for energy. Glucose not used by the plant for immediate energy is stored in the form of
starch in seeds, roots, or stems. (Grains, such as wheat, rice, corn, barley, oat, potatoes)

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 Carbohydrate Classifications
B. Glycogen: storage form of glucose in animals and humans.(liver & muscles)
▪ Liver glycogen breaks down and releases glucose into the bloodstream between meals to
maintain normal blood glucose levels and provide fuel for tissues.
▪ Muscles do not share their supply of glycogen but use it for their own energy needs.
▪ There is virtually no dietary source of glycogen because any glycogen stored in animal tissue is
quickly converted to lactic acid at the time of slaughter.
▪ Miniscule amounts of glycogen are found in shellfish, which is why they taste slightly sweet
compared to other fish

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 Carbohydrate Classifications
C. Fiber.
▪ it is considered a group name for polysaccharides that cannot be digested by human enzymes.
▪ E.g include cellulose, pectin, gums, hemicellulose, -glucans, inulin, oligosaccharides, fructans, lignin, and
some resistant starch.
▪ referred to as “roughage,” fiber is found only in plants as a component of plant cell walls or intercellular
structure.
Insoluble Fiber: nondigestible carbohydrates that do not dissolve in water. It is credited with increasing
stool size to promote laxation.
Soluble Fiber: nondigestible carbohydrates that dissolve to a gummy, viscous texture.
are credited with slowing gastric emptying time to promote a feeling of fullness, delaying and blunting
the rise in postprandial serum glucose, and lowering serum cholesterol,

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Dietary Fiber: carbohydrates and lignin that are natural and intact components of plants that
cannot be digested by human enzymes.
Functional Fiber: as proposed by the Food and Nutrition Board, functional fiber consists of
extracted or isolated nondigestible carbohydrates that have beneficial physiologic effects in
humans.
Total Fiber: total fiber = dietary fiber + functional fiber.

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 Summary of carbohydrate classification

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 Sources of Carbohydrates
❖ Sources of carbohydrates include natural sugars in fruit and milk; starch in grains, vegetables,
legumes, and nuts; and added sugars in foods with empty calories.
A. Added Sugars: caloric sugars and syrups added to foods during processing preparation or
consumed separately; do not include sugars naturally present in foods, such as fructose in
fruit and lactose in milk.
B. Grains
▪ Whole Grains and Whole Grain Flours: contain the entire grain, or seed, which includes the
endosperm, bran, and germ.
▪ Refined Grains and Refined Flours: consist of only the endosperm (middle part) of the grain and
therefore do not contain the bran and germ portions.

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 Sources of Carbohydrates
C. Vegetables
Starch and some sugars provide the majority of calories in vegetables, but the content varies widely
among individual vegetables
D. Fruits
Generally, almost all of the calories in fruit come from the natural sugars fructose and glucose. (The
exceptions to this are avocado, olives, and coconut, which get the majority of their calories from fat.)
E. Dairy
Although milk is considered a “protein,” more of milk’s calories come from carbohydrate than from
protein.
F. Empty Calories are calories that come from added sugars and syrups; these ingredients provide
calories with few or no nutrients.

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 Carbohydrate digestion

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 Carbohydrate digrstion

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 Carbohydrate Metabolism
▪ Fructose and galactose are converted to glucose in the liver.
▪ The liver releases glucose into the bloodstream, where its level is held fairly constant by the action of
hormones.
▪ A rise in blood glucose concentration after eating causes the pancreas to secrete insulin, which
moves glucose out of the bloodstream and into the cells. Most cells take only as much glucose
as they need for immediate energy needs; muscle and liver cells take extra glucose to
store as glycogen.
▪ The release of insulin lowers blood glucose to normal levels.
▪ In the postprandial state, as the body uses the energy from the last meal, the blood glucose
concentration begins to drop. Even a slight fall in blood glucose stimulates the pancreas to release
glucagon, which causes the liver to release glucose from its supply of glycogen.
▪ The result is that blood glucose levels increase to normal.

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Glycemic Response: the effect a food has on the blood glucose concentration; how quickly the
glucose level rises, how high it goes, and how long it takes to return to normal.

See book nutrition essential for nursing practice,chapter 2 .p 27-28

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 Functions of Carbohydrates
❖ The major function of carbohydrates is to provide energy, which includes sparing protein and
preventing ketosis.
❖ Glucose can be converted to glycogen, used to make nonessential amino acids, used for specific
body compounds, or converted to fat and stored in adipose tissue.

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 Tips
❖ Whole grains offer health benefits beyond the benefits of fiber. Whole grains may
decrease the risk of heart disease, certain cancers, and type 2 diabetes.
❖ Whole grains promote gastrointestinal health and weight management.
❖ Added sugar is sugar added to food during processing or preparation. It is considered a source
of empty calories. The higher the intake of empty calories, the greater is the risk of an
inadequate nutrient intake, an excessive calorie intake, or both.
❖ Acids produced from fermentation of sugars and starches in the mouth by bacteria lead
to dental decay.

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