carbohydrates - provide energy, only source of energy production for brain; include

monosaccharides (simple: glucose, fructose, galactose), disaccharides (sucrose,

lactose, maltose), polysaccharides (complex carbs), and fiber (nondigestible)
fats - store energy, waste products are ketone bodies; include simple lipids
(triglycerides), compound lipids (phospholipids, glycolipids, lipoproteins), derived
lipids (glycerol, steroids, fatty acids)
proteins - used to build tissue, made up of amino acids:
- essential amino acids (needed in diet)
- nonessential amino acids (body manufactures)
fat soluble vitamins - vitamins A, D, E, and K
water soluble vitamins - essential in small quantities for growth and for
transformation of food substances into tissues; vitamins C and B complex
vitamin A: sources - beta carotene foods: liver, butter, milk & cheese, egg yolk,
yellow/orange/green vegetables
vitamin A: deficiency symptoms - - night blindness, corneal desiccation & ulceration
- bronchorespiratory epithelium changes
- keritinization and xerosis of skin
- genitourinary calculi
- sweat gland atrophy
- increased CSF pressure
- impaired smell and taste secondary to keratinization
- defective remodeling of bone
- degeneration of testes and gonadal resorption
- deficiency enhances carcinogenicity in lab animals
vitamin A toxicity - - lethargy, headache, papilledema
- dry and pruritic skin, desquamation, erythema
- fatty liver, hepatic cirrhosis, portal hypertension
- gingivitis and cheilosis
- hypercalcemia, hypoprothrombinemia
vitamin A: pharmacokinetics - well absorbed in GI tract by mediation of protein
carrier; mostly stored in liver
vitamin D: sources - sunlight, fish oils, fortified dairy products

vitamin D: deficiency symptoms - rickets (uncalcified areas of bone are softened,

causing deformities of bones from physiological and gravitational stresses; growth
retardation and weakness in young
vitamin D toxicity - - hypercalcemia (weakness, vomiting, diarrhea, ECG changes)
- demineralization of bones
- renal calculi and metastatic calcification of soft tissues
vitamin D: pharmacokinetics - necessary for absorption of calcium and phosphorus
vitamin E - functions as an antioxidant that reduces harmful free radicals to
harmless metabolites
vitamin E: deficiency symptoms - - loss of deep tendon reflexes
- changes in balance and coordination
- muscle weakness, visual disturbances
vitamin E: pharmacokinetics - absorbed predominantly via lymphatics
vitamin K - functions as an essential cofactor for calcium binding in the clotting
cascade
vitamin K: sources - chloroplasts of plants, synthesized by intestinal bacteria
vitamin K: deficiency symptoms - bleeding tendency
vitamin K toxicity - - IV: chest pain, flushing, death
- parenteral: anemia, hepatic & renal damage, hemolysis
vitamin K: pharmacokinetics - given IM and absorbed via lymphatics
thiamin (vitamin B-1): sources - beef, liver, whole grains, legumes (best) or eggs
and fish (fair); can be given IV or IM
thiamin (vitamin B-1): deficiency symptoms - beriberi -- indigestion, appetite loss,
nerve irritation and deadening sensations, cardiac failure, edema
thiamin (vitamin B-1) toxicity - shock
thiamin (vitamin B-1) therapeutic uses - during times of high energy requirements
(ex. post surgery), pregnancy & lactation, growth spurts, chronic alcoholism
folic acid & cyanocobalamin (vitamin B-12): sources - liver and kidney
folic acid: deficiency symptoms - megaloblastic anemia (large, immature RBCs)
cyanocobalamin (vitamin B-12): deficiency symptoms - pernicious anemia (intrinsic
factor needed for intestinal absorption of B-12)

vitamin C - necessary for formation of cartilage in connective tissue and essential to

maintenance of integrity of intracellular cement in many tissues, especially capillary
walls
vitamin C: sources - citrus fruits and tomatoes, raw cabbage, young carrots, lettuce,
celery, onions, green peppers, rutabagas, strawberries, pears, plums, peaches,
apricots
vitamin C: deficiency symptoms - scurvy: sore gums, hemorrhages, anemia
vitamin C toxicity - oxalate hypersensitivity
calcium - for bone formation, muscle contraction, thrombus formation, acid-base
balance, osmotic pressure, membrane transfer of essential nutrients, and nerve and
muscle irritability
calcium: sources - milk products, green leafy vegetables, eggs
calcium: deficiency symptoms - rickets, porous bones, tetany
sodium - for osmotic pressure, acid-base balance, nerve irritability
sodium: sources - table salt, canned vegetables, milk, cured meats, processed foods
potassium - for water balance in cells, protein synthesis, heart contractility
potassium: sources - liver, oysters, leafy vegetables, apricots
flax seed: interactions - decreases the absorption of other medications
clear liquid diet - to maintain fluid balance; usually for post op patients or those with
acute vomiting or diarrhea (ex. gelatin dessert, popsicle, tea with lemon, ginger ale,
bouillon, fruit juice without pulp)
full liquid diet - to provide nutrition without chewing; usually for pts with GI upset
(ex. milkshakes, soup, custard, all clear liquids)
low-fat, cholesterol restricted diet - to reduce calories from fat and minimize
cholesterol intake; usually for pts with atherosclerosis, cystic fibrosis (ex. fruit,
vegetables, cereals, lean meats)
sodium-restricted diet - to lower body water and promote excretion; usually for pts
with heart failure, HTN, cirrhosis (ex. cold baked chicken, lettuce with sliced
tomatoes, applesauce)
high-roughage, high-fiber diet - to maximize bulk in stools; usually for pts with
constipation, large bowel disorders (ex. cracked wheat bread, minestrone soup,
apple, brussels sprouts; NO white grains)
high-protein diet - to reestablish anabolism to raise albumin levels; usually for pts
with burns, infection, hyperthyroidism (ex. skim milk, egg, roast beef sandwich)

renal diet - to keep protein, potassium, and sodium low; for pts with chronic renal
failure (ex. unsalted vegetables, white rice, canned fruits, sweets; NO beans,
cereals, citrus fruits)
average fluid requirement - 1,800 - 2,500 ml/day
enteral nutrition - liquid nourishment delivered to stomach, distal duodenum, or
proximal jejunum via a NG, percutaneous endoscopic gastrostomy (PEG) or
percutaneous endoscopic jejunostomy (PEJ) tube due to inability of GI tract use; be
cautious for aspiration
enteral nutrition: methods of placement verification - - x-ray (most reliable)
- aspirate contents (0-4 pH indicates gastric placement, 4+ pH indicates intestinal
placement, 5.5+ pH indicates lung placement)
- color (cloudy and green or off-white, tan, bloody, brown)
hold enteral (tube) feeding if... - - contents have pH of 4+ or more
- if more than 50-100 mL residual
total parenteral nurition - liquid concentrate of hypertonic glucose, amino acids,
electrolytes, vitamins, and minerals, given to selected clients through peripheral,
central, or atrial line to provide nutrition when enteral feeding is not possible or
desirable
total parenteral nutrition: nursing management - - infection and hyperglycemia are
common, fluid overload possible
- infuse at constant rate (increased rate results in hyperosmolar state and slowed
rate results in rebound hypoglycemia due to delayed pancreatic reaction to change
in insulin requirements)
wound healing diet - high in protein, fat, carbs, vitamins (A, C, E) and minerals (zine)
metabolism - foods are made available to all body cells
digestion - absorbed nutrients are able to enter the blood
lactovegetarian diet: - eggs are excluded. dairy products and plant foods are
included
vegan diet: - all animal food source including honey are excluded. (may have vit b6,
vit b12, fe, zinc, ca, riboflavin, and vit d deficiencies)
carbs - the body's main source of energy / each gram supplies 4 calories
three major forms of carbs: - simple- a metabolized form of sugar table sugar, fruit
sugar, and milk sugar
complex- foods from breads, pasta, cereal, potatoes, and rice
fiber-can not be broken down by the intestinal enzymes and juices

children and adults should consume how many carbs daily? - 130 g
H2O - the most essential nutrient. the adult body is 50-60% H2O by wt. and
requirement is 35ml/kg adult and 30ml/kg in the elderly
sample meal items for low fat cholesterol restricted diet - fruit, vegetables, cereals,
lean meat
sample meal items for sodium restricted diet - cold baked chicken, lettuce with
sliced tomatoes, applesauce
sample meal items for high roughage high fiber diet - cracked wheat bread,
minestrone soup, apple, brussel sprout
sample meal items for high protein diet - 30 grams powdered skim milk, roast beef
sandwich & skim milk
sample meal items for renal diet - unsalted vegetables, white rice,canned fruits,
sweets
acid ash diet - What type of diet would your pt be on if they had stones from
calcium oxalate & magnesium phosphate?
Gastrectomy - Surgical removal of all or part of stomach. Remainder of stomach is
joined to duodenum. Maintain NG tube with suction, observe drainage, amount, and
color. Encourage deep breathing and coughing. Patient will need lifelong V B12
parenterally. Teach prevention for dumping syndrome (restrict fluids with meals, lie
down after eating, eat smaller frequent meals, diet low in carbs and fiber, high in
protein and fat). Admin lax and enemas as necessary night before surgery. Insert NG
on morning of surgery. Place patient in low or semi fowlers after surgery. Monitor
blood studies daily. Two types: partial or total.
Low fat, low sodium diet - Used for conditions such as arteriosclerosis, coronary
heart disorders, obesity, cystic fibrosis. Food items include: fruits, veggies, cereal,
lean meat. NO: marbled meat, avocado, whole milk, bacon, egg yolks, butter, lunch
meat, canned food, cheese, fried foods.
Jewish Dietary Restrictions - No meat and poultry at same meal as dairy; or using
same utensils, no pork, no scavenger fish or fish without fins or scales.
Mormon Dietary Restrictions - No alcohol/caffeine or other stimulating beverages.
Jehovah's Witness Dietary Restrictions - Followers do not partake of blood - meaning
improperly bled meat, blood sausage, blood pudding, etc
Accident Prevention/Food Safety - Refrigerated foods should be stored at 40F and
frozen foods stored at 0F. Never use wooden cutting board
Vitamin E - Fat soluble vitamin, deficiencies: immune system suppression and RBC
hemolysis ; excessive in low birth weight neonates implicated in the development of
necretizing enterocolitis and sepsis. Recommended allowance: MEN 10mg, and
WOMEN 8mg. Good food sources: vegetable oils, esp soybean and corn, wheatgerm.

Vitamin B1 - Thiamine. Water soluble vitamin, used in treating beriberi, anorexia

from thiamine deficiency, alcoholism including wernick-korsakoff syndrome. Side
effects: feeling of warmth, weakness, sweating, restlessness, tightness of throat,
nausea, urticaria (hives). Nursing Considerations: given IV or IM,
TPN - Hypertonic solution that contains glucose, proteins, carbs, electrolytes,
vitamins, water, and trace elements. Will need if unable to absorb for 10 days, or
debilitating illness that lasts more than 2 weeks or loss of 10% weight, or if serum
albumin is less than 3.5, or excessive nitrogen loss from wound infection.
Albumin Lab Value - 3.5-5.0 grams
Aspiration precautions - To decrease chance, place patient in upright position or bed
at 90 degrees. Provide 30 min rest period prior to eating, chin down position,
thicken liquids, place food on stronger side of mouth. If choking occurs, suction
mouth, stop feeding, and remove food.
Low Sodium Diet - Purpose is to lower body water and promote secretion. No
lunchmeats, cheese, fried foods, milk products, canned foods, added salts.
Body Mass Index - Underweight - less than 18.5
Normal - 18.5 to 24.9
Overweight - 25 to 29.9
Obese - 30 to 39.9
Morbidly Obese - 40+
Promoting Appetite - Keep environment free of odors, provide oral hygiene before
and after meals, maintain comfort, and if possible, eliminate anything that effects
appetite (nausea or unpleasant taste caused by medications). Encourage
interactions during mealtime.
Feeding a Client - Offer toileting before beginning. Provide hygiene before and after.
Allow client to choose. Encourage self feeding if possible. Good if at least half of
meal is consumed.
Gluten Free - Diet free of vegetable albumin, a protein that can be prepared from
wheat, rye, oats, buckwheat, barley, and other grains. Avoid sauces and gravies
that may be thickened with an agent containing gluten.
IBS Diet - Eat at regular times, and eat/chew slowly, no fluids with meals. Drink
fluids between meals. Increase fiber with fluids. Decrease anxiety and stress. Avoid
alcohol and large meals, simple sugars, caffeine, excess fats and cigarettes.
Vegan Diet - Excludes all sources of animal proteins, fortified foods, and nutritional
supplements of animal sources
Dietary History - Includes cultural influences, health beliefs, personal preferences,
food intake based on religion, food allergies, eating patterns and preferred foods.

Acid Ash Diet - Designed to acidify urine; includes acidic food such as meats, fish,
eggs, cheese, grains. Avoid Fruits
Low Purine Diet - Excludes foods such as liver, kidney, sweet breads, brains, heart,
anchovies, sardines, meat extracts, gravies, fish roe, herring.
Urine Creatinine Lab Value - Is source of energy for muscle contraction. Less than
1.2 mg in urine is normal. 15-25 is excreted daily by kidneys.
High Calcium Diet - Includes extra milk products, green leafy veggies, and eggs
Therapeutic Diet Hypertension - Consists of generous amounts of fruits cereals,
veggies (for fiber, vitamins and minerals), low fat dairy, lean meats (to maximize
protein intake w/o too much salt, fat, cholesterol)
Crohn's Disease - High calorie, high protein, low fat, low fiber diet
Diabetic Diet - Balanced intake of carbs fats, and proteins. Based on clients
metabolic needs. Doesn't necessarily mean consumption restriction
Alcohol - Contains calories and energy but no nutrition. Has 7kcal/gram.
High Fiber Diet - Used for clients with constipation and large bowel disorders.
Maximizes bulk in stools. Encourage fresh fruits and veggies, whole grain cereals
and breads. No white bread, pies, and cakes made with "white" flower. Good choices
are minestrone soup, lima beans, brussel sprouts, and bran muffins.
Lactose Intolerance - Inability to digest lactase: milk, seafood, orange juice, cereals,
and dark leafy green veggies. CAN have yogurt and hard cheeses.
Low Cholesterol Diet - Includes healthy food choices without the addition of animal
origin foods. You can have milk, egg yolk, organ meats
Enteral Tube Feeding - Is delivery of liquid food to stomach. Can be continuous or
intermittent. Ensure feeding is at room temp, elevate HOB to at least 30 degrees,
verify tube placement, check for gastric residual, return residual to stomach UNLESS
greater than 100 mL. Flush tube with 30 mL water before and after feeding.
Dietary Considerations: Colostomy - Should produce stool consistency not hard or
loose and watery. Avoid odor causing foods. Eat yogurt or drink buttermilk will help
reduce gas.
Water Content of Body - % of body weight = to water is generally between 60 and
70%.
Preemie Infant - 90%
Newborn - 70-80%
12 to Adult - 50-60%
Older Adults - 45-55%

Digestion - Food is broken down mechanically and chemically in GI tract and

converted into absorbable form. Starches fats and proteins must be broken into
monosaccharide's.
Dietary Considerations: Duodenal Ulcer - Dietary ingestion should focus on foods
that do not irritate the open area which is worsened by acid or anything that may
create pain or erosion of traumatized area. No alcohol, milk, tea, soda, coffee.
Stomach should not be allowed to be completely empty.
Hindu Dietary Restrictions - Followers are lacto vegetarian or vegans. No Meat
Mechanical Soft Diet - Diet of clear and full liquids, pureed foods, and finely chopped
(diced) or ground meats, fruits, veggies, sweets
Renal Diet - Low protein, potassium, and sodium diet. Diet includes unsalted
veggies, white rice, canned fruit, and sweets.
Wound Healing Diet - High in protein, carbs, fat, vitamins (esp A, C, E), and minerals
(including Zinc). Supply fruit juices and high fiber foods. Can be assessed by
monitoring urinary and bowel elimination.
High Protein High Calorie Diet - Includes extra servings of foods like fish, chicken,
pork, beef, cheese, soybeans, eggs, and some veggies; also extra servings of
carbohydrates, which are found in whole grains, veggies, legumes, tubers, fruits,
honey, starches, and refined sugar.
Iron Deficiency Anemia - s caused by inadequate intake or excessive loss of iron;
usually affects menstruating women and children; indications include palpitations,
dizziness, sensitivity to cold, dysphagia, stomatitis, brittle nails; women require 15
to 18 mg daily, men require 10 mg of this daily; average diet supplies 12 to 15
mg/day of iron; beef, lamb, and liver are good sources of iron, absorbed better when
taken with vitamin C; supplements include Feosol PO TID wit meals or Imferon IM
using Z track method.
Diet Recall - Obtaining a diet history in which client lists all foods and portion sizes
of everything eaten or drunk in the past time frame to being assessed, usually 24hrs; rarely is this record accurate; better method is a dietary diary in which
everything eaten or drunk is recorded along with portion sizes at the time ingested;
this can be done for a longer period of time, like a week or month.
absorption - transfer of nutrients from intestines into the blood