NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
● Essential nutrients that supply energy and build tissues- carbohydrates, fats, protein
(macronutrients)
○ Not synthesized by the body
● Micronutrients (vitamins, minerals, water) are required in smaller amounts to regulate
and control body processes
Adequate Diet Selection
● Dietary Guidelines for Americans: science based strategies by the US Department of
Health and human services
○ People are encouraged to choose a healthy eating pattern at an appropriate
calorie level to help achieve and maintain a healthy body weight, support nutrient
adequacy, and reduce the risk of chronic disease.
● Dietary Reference Intakes (DRIs)
○ Looks at factors such as age, gender, weight of client
● Recommended dietary allowance: average daily dietary intake of a nutrient that is
sufficient to meet the requirement of 97-98% healthy people
● MyPlate food guide: helps consumers make better food choices to follow a healthy
eating pattern across the lifespan
● Food labeling
Factors Affecting Nutrition
● Physiologic and physical factors:
○ Stage of development
○ State of health
○ Medications
■ Steroids: increase appetite ■
Antipsychotics: increases
appetite
● Social determinants of health:
○ Economic stability
○ Health care access and quality
○ Social and community context
○ Education access and quality
○ Neighborhood and built environments
pg. 1
, NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
● Culture, religion, food ideology, and learned aversions ○ Ex: kosher, halal
Developmental Considerations
● Growth: infancy, adolescence, pregnancy, and lactation increase nutritional needs
○ Greatest nutritional needs during infancy and childhood
■ Infant should receive breast milk or iron fortified infant formula
● Activity increases nutritional needs
● Age-related changes in metabolism and body composition
● Nutritional needs level off in adulthood
● Fewer calories required in adulthood because of decrease in BMR
● Older adults need increase in protein, calcium, vitamin B12, and vitamin D
Additional Factors That Influence Nutritional Requirements
● Sex assigned at birth (Males >> females)
● State of health
○ Illness, fever, trauma increase BMR
● Alcohol use disorder
○ Binge drinking - 5+ alcoholic beverages in one sitting
● Medications
● Megadoses of nutrient supplements
Factors That Influence Food Choices
● Social determinants of health
● Religion
● Meaning of food
Food Intake
● Decreased: anorexia (lack of appetite)
○ Not the same as anorexia nervosa
● Increased: Obesity (BMI ≥30)
Components of Nutritional Assessment
● History taking
○ Dietary, medical, socioeconomic
● Physical assessments
○ Anthropometric: measurement of the body and body parts
○ clinical data (what is the patient describing? Stomach ache from eating certain
foods, fingers tingling)
● Biochemical data
○ protein status, body vitamin, mineral and trace element status
Dietary Data
● 24-hour recall method
pg. 2
, NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
● Food diaries/calorie counts
● Food frequency record
● Diet history
Biochemical Data (Need to Know)
● Hemoglobin (12-18g/dL) Decreased- anemia
● Hematocrit (46-52%) Decreased- anemia
● Prealbumin (19-38mg/dL)
○ Decreased- protein depletion, malnutrition
● Transferrin (250-425mg/dL)
○ Decreased- anemia/protein deficiency or loss
● BUN (6-20mg/dL)
○ Decreased- malnutrition, low-protein diet, overhydration
○ Increased- starvation, high-protein intake, severe dehydration
● Creatinine (0.6-1.2mg/dL)
○ Decreased- reduction in total muscle mass, severe malnutrition
○ Increased- dehydration
Actual and Potential Health Problems and Needs
● Impaired nutritional status
○ More than body requirements
○ Less than body requirements
● Impaired swallowing (dysphagia)
○ At risk for aspiration
● Body weight problem: obesity/underweight
Outcome Identification and Planning
● Attain and maintain ideal body weight
○ BMI
○ Waist circumference/ WHR
● Eat an adequate diet based on American Guidelines for Americans, DRIs, MyPlate food
guidelines.
● Follow appropriate modified diet, when necessary.
Nursing Interventions
● Teaching nutritional information
● Monitoring nutritional status
● Stimulating appetite
○ Small frequent meals
○ Offer foods they like
● Assisting with eating
● Providing oral nutrition
pg. 3
, NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
● Providing long-term nutritional support
Diets
● Therapeutic diets
○ Consistent carbohydrate
■ Patients with diabetes
○ Fat restricted
■ Patients with gallstones/ gallbladder issues due to issues with bile
■ RUQ pain after consumption of high fat foods
○ Sodium restricted
■ Kidney, cardiac, hypertensive patients
■ Where sodium goes, water goes
○ High or low fiber
■ Mainly high fiber to promote proper bowel movements
■ Low fiber for those suffering from diarrhea or inflammatory bowel
diseases such as ulcerative colitis
○ Renal
■ Low sodium, low potassium
● Modified consistency diets
○ Clear liquid: water, coffee without milk/ cream, clear broth, apple juice, gelatin
■ Any surgical procedures like colonoscopy or after anesthesia
○ Pureed: blended
○ Mechanically altered: chopped
Considerations
● Visually-impaired: Explain placement of food on plates and food tray
● Difficulty feeding self: adaptive eating utensils
○ Patients with dementia, stroke
● Alterations in cognition: offer finger foods (suicidal/manic patients), small frequent
meals, check food temp, assist PRN
● Dysphagia: speech therapy and nutritionist consult, elevate HOB, aspiration
precautions, avoid use of sedatives, check oral cavity for retained food
NPO
● Oral hygiene
● Ice chips or sips of water, if allowed
● If NPO for more than 48-72 hrs- may require nutritional support
Short-Term Nutritional Support
● Using the nasogastric or nasointestinal route (bypasses stomach into intestines)
● Confirming NG feeding tube placement
pg. 4
Chapter 37 Nutrition
NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
● Essential nutrients that supply energy and build tissues- carbohydrates, fats, protein
(macronutrients)
○ Not synthesized by the body
● Micronutrients (vitamins, minerals, water) are required in smaller amounts to regulate
and control body processes
Adequate Diet Selection
● Dietary Guidelines for Americans: science based strategies by the US Department of
Health and human services
○ People are encouraged to choose a healthy eating pattern at an appropriate
calorie level to help achieve and maintain a healthy body weight, support nutrient
adequacy, and reduce the risk of chronic disease.
● Dietary Reference Intakes (DRIs)
○ Looks at factors such as age, gender, weight of client
● Recommended dietary allowance: average daily dietary intake of a nutrient that is
sufficient to meet the requirement of 97-98% healthy people
● MyPlate food guide: helps consumers make better food choices to follow a healthy
eating pattern across the lifespan
● Food labeling
Factors Affecting Nutrition
● Physiologic and physical factors:
○ Stage of development
○ State of health
○ Medications
■ Steroids: increase appetite ■
Antipsychotics: increases
appetite
● Social determinants of health:
○ Economic stability
○ Health care access and quality
○ Social and community context
○ Education access and quality
○ Neighborhood and built environments
pg. 1
, NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
● Culture, religion, food ideology, and learned aversions ○ Ex: kosher, halal
Developmental Considerations
● Growth: infancy, adolescence, pregnancy, and lactation increase nutritional needs
○ Greatest nutritional needs during infancy and childhood
■ Infant should receive breast milk or iron fortified infant formula
● Activity increases nutritional needs
● Age-related changes in metabolism and body composition
● Nutritional needs level off in adulthood
● Fewer calories required in adulthood because of decrease in BMR
● Older adults need increase in protein, calcium, vitamin B12, and vitamin D
Additional Factors That Influence Nutritional Requirements
● Sex assigned at birth (Males >> females)
● State of health
○ Illness, fever, trauma increase BMR
● Alcohol use disorder
○ Binge drinking - 5+ alcoholic beverages in one sitting
● Medications
● Megadoses of nutrient supplements
Factors That Influence Food Choices
● Social determinants of health
● Religion
● Meaning of food
Food Intake
● Decreased: anorexia (lack of appetite)
○ Not the same as anorexia nervosa
● Increased: Obesity (BMI ≥30)
Components of Nutritional Assessment
● History taking
○ Dietary, medical, socioeconomic
● Physical assessments
○ Anthropometric: measurement of the body and body parts
○ clinical data (what is the patient describing? Stomach ache from eating certain
foods, fingers tingling)
● Biochemical data
○ protein status, body vitamin, mineral and trace element status
Dietary Data
● 24-hour recall method
pg. 2
, NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
● Food diaries/calorie counts
● Food frequency record
● Diet history
Biochemical Data (Need to Know)
● Hemoglobin (12-18g/dL) Decreased- anemia
● Hematocrit (46-52%) Decreased- anemia
● Prealbumin (19-38mg/dL)
○ Decreased- protein depletion, malnutrition
● Transferrin (250-425mg/dL)
○ Decreased- anemia/protein deficiency or loss
● BUN (6-20mg/dL)
○ Decreased- malnutrition, low-protein diet, overhydration
○ Increased- starvation, high-protein intake, severe dehydration
● Creatinine (0.6-1.2mg/dL)
○ Decreased- reduction in total muscle mass, severe malnutrition
○ Increased- dehydration
Actual and Potential Health Problems and Needs
● Impaired nutritional status
○ More than body requirements
○ Less than body requirements
● Impaired swallowing (dysphagia)
○ At risk for aspiration
● Body weight problem: obesity/underweight
Outcome Identification and Planning
● Attain and maintain ideal body weight
○ BMI
○ Waist circumference/ WHR
● Eat an adequate diet based on American Guidelines for Americans, DRIs, MyPlate food
guidelines.
● Follow appropriate modified diet, when necessary.
Nursing Interventions
● Teaching nutritional information
● Monitoring nutritional status
● Stimulating appetite
○ Small frequent meals
○ Offer foods they like
● Assisting with eating
● Providing oral nutrition
pg. 3
, NURS 402 Exam 3 - Exam 3 Notes Professor Valesquez
Chapter 37 Nutrition
● Providing long-term nutritional support
Diets
● Therapeutic diets
○ Consistent carbohydrate
■ Patients with diabetes
○ Fat restricted
■ Patients with gallstones/ gallbladder issues due to issues with bile
■ RUQ pain after consumption of high fat foods
○ Sodium restricted
■ Kidney, cardiac, hypertensive patients
■ Where sodium goes, water goes
○ High or low fiber
■ Mainly high fiber to promote proper bowel movements
■ Low fiber for those suffering from diarrhea or inflammatory bowel
diseases such as ulcerative colitis
○ Renal
■ Low sodium, low potassium
● Modified consistency diets
○ Clear liquid: water, coffee without milk/ cream, clear broth, apple juice, gelatin
■ Any surgical procedures like colonoscopy or after anesthesia
○ Pureed: blended
○ Mechanically altered: chopped
Considerations
● Visually-impaired: Explain placement of food on plates and food tray
● Difficulty feeding self: adaptive eating utensils
○ Patients with dementia, stroke
● Alterations in cognition: offer finger foods (suicidal/manic patients), small frequent
meals, check food temp, assist PRN
● Dysphagia: speech therapy and nutritionist consult, elevate HOB, aspiration
precautions, avoid use of sedatives, check oral cavity for retained food
NPO
● Oral hygiene
● Ice chips or sips of water, if allowed
● If NPO for more than 48-72 hrs- may require nutritional support
Short-Term Nutritional Support
● Using the nasogastric or nasointestinal route (bypasses stomach into intestines)
● Confirming NG feeding tube placement
pg. 4
