NUTRITION & DIETETICS (LEAP REVIEW) 2) ESOPHAGUS

✓ Propels the food to stomach

CONCEPT OF NUTRITION ✓ Process of swallowing
(deglutition)
NUTRITION 3) STOMACH
✓ Science of food & nutrients with their ✓ Digest the food further
interaction in the body (majority)
✓ Provision to the body of certain substances for ✓ Chyme (partially digested
homeostasis food)
✓ Cells found in Stomach:
HOMEOSTASIS a) Parietal Cells
✓ State of balance & equilibrium ❖ Produces HCl
❖ Intrinsic factor
NUTRIENTS (vitamin B12
✓ Substances primarily found in food absorption)
✓ 3 BASIC FUNCTIONS b) Chief Cells
1) Provide body with energy (FUEL) ❖ Produces Pepsin
2) Build & repair tissues and cells (protein digestion)
3) Regulate life processes c) Antral G-Cells
❖ Stimulates parietal
DIFFERENCE BETWEEN A DIETITIAN AND A cells
NUTRITIONIST d) Argentaffin Cells
➢ DIETITIAN ❖ Produces serotonin
✓ Has special knowledge on diets to (inhibit acid
promote health and prevent illness production)
✓ Design special diets e) Mucus Neck Cells
✓ E.g. in a client with DM, dietitian ❖ Produces mucus
determines what food to have and (protects stomach
what food to avoid. lining)
➢ NUTRITIONIST 4) SMALL INTESTINE
✓ Has special knowledge on nutrition ✓ Absorption and broken down
and food of molecules
✓ Knows what constitute in a balanced ✓ Catabolism is finished in this
and nutritious diet organ
✓ Determines how many calories (kcal) a) Duodenum (connected to
to take for a patient accessory digestive organs
✓ Not for specific diet or condition – gallbladder, liver,
pancreas, spleen)
METABOLISM b) Jejunum
➢ Ability to convert food to energy c) Ileum
➢ 2 PROCESSES: ✓ Secretes digestive enzymes
a) Catabolism (Breakdown) a) Lipase (Fat digestion)
− Process of breakdown of foods b) Dipeptidase (CHON
into smaller molecules digestion)
b) Anabolism (Synthesis) c) Aminopeptidase (CHON
− Once finished breaking down digestion)
of foods, it travels to special d) Amylase (Fat digestion)
areas to be synthesized. e) Bile (Fat digestion)
➢ Main ORGAN SYSTEM: GIT 5) LARGE INTESTINE
1) MOUTH (mechanical & chemical ✓ For undigested foods (fecal
breakdown) matter)
a) Mastication of food (chewing) a) Ascending Colon
b) Salivary Amylase or Ptyalin (initial b) Transverse Colon
breakdown of CHO) c) Descending Colon
c) Saliva (helps lubricate the food) d) Sigmoid Colon
 e) Rectum ❖ NO MILK!
✓ Absorb excess water (Water (including Breast
Reabsorption) Milk, Formula Milk,
✓ Contains certain bacteria (E. Soya Milk)
coli) which helps synthesize ❖ EXCEPT
vitamin K Nutramigen (milk
without galactose)
ACCESSORY DIGESTIVE ORGANS 4. SUGAR ALCOHOLS
1) LIVER − Mannitol/Sorbitol
✓ Location: RUQ 5. PENTOSE
✓ Largest Internal Organ in the Body − Ribose, Ribulose
✓ Produces bile − Found in meat &
✓ Storage of: seafood
a) Glucose b) DISACCHARIDES
b) Fats − Combination of 2
c) Amino acids monosaccharide
d) Vitamin A − One is GLUCOSE
e) Vitamin B12 − TYPES:
f) Vitamin D 1. SUCROSE
g) Iron − Cane sugar, beet sugar,
✓ Converts NH4 (byproduct of CHON table sugar
metabolism) to Urea 2. MALTOSE
2) GALLBLADDER − Malt sugar
✓ Stores bile − Derived from digestion
3) PANCREAS of starch
✓ Secretes digestive enzymes 3. LACTOSE
− Form of milk sugar
NUTRIENTS
− Glucose + galactose
1) CARBOHYDRATES (CHO)
− Ca+ absorption
✓ “sugar” or “-ose”
✓ PRIMARY source of energy − Essential for bacterial
✓ TYPES: production in the GIT
a) MONOSACCHARIDES − Has LAXATIVE effect
− Simple sugar (one sugar unit) c) POLYSACCHARIDES
− EXAMPLES: − COMPLEX CHO
1. GLUCOSE − Composed of many sugars
− Dextrose, grape sugar, − TYPES
physiologic sugar 1. STARCH
− MOST IMPORTANT for − Most abundant
energy production − Cheapest
− Food of the cells − Plant source
2. FRUCTOSE 2. DEXTRIN
− Fruit sugar, Levulose − Partially hydrated
− Sweetest sugar of all the starch
sugars 3. GLYCOGEN
3. GALACTOSE − Animal Source
− Milk sugar − Stored sugar in
− Important for brain liver & muscle
and nerve tissues tissues
− GALACTOSEMIA 4. FIBER:
❖ Unable to absorb − Relieves Constipation
galactose − Prevent colorectal
❖ S/Sx: Nervous cancer (prevalent in
system related Western countries)
defects − Reduce cholesterol
 − Aiding in weight − PKU children’s milk
management (LOFENALAC)
− Decrease elevated 7. Threonine
sugar/glucose 8. Tryptohan
− SOURCES: 9. Valine
a) Fruits & b) NON-ESSENTIAL (11 amino
Vegetables acids)
b) Pineapple 1. Arginine
c) Oats 2. Alanine
d) Legumes 3. Aspartic acid
e) Grains (Rice) 4. Aspargine
 PRINCIPAL SOURCE OF CHO 5. Cysteine
✓ PLANTS 6. Glutamine
✓ E.g. cereal grains, fruits & 7. Glutamic Acid
vegetables, nuts 8. Proline
 ONLY SUBSTANTIAL ANIMAL SOURCE 9. Glycine
− MILK 10. Serine
2) PROTEINS (CHON) 11. Tyrosine
✓ Complex organic compounds ✓ SOURCES of COMPLETE
composed of amino acids and peptide − Protein of High Biologic Value
bonds (supports growth & life)
✓ PRIMARY and MOST IMPORTANT − Contains All Essential Amino
NUTRIENT for tissue repair Acids:
✓ Regulate serum oncotic pressure or a) Animal sources
osmotic pressure (by ALBUMIN) b) Soy (ONLY plant source)
✓ Most abundant protein in the blood is ✓ SOURCES OF INCOMPLETE AMINO
ALBUMIN ACIDS
✓ PHYSIOLOGY − Protein of Low Biological
a) Fluids shift from IVC to ISC with Value (does not supports
the help of hydrostatic pressure growth & life)
(pumping of the heart) − Contains some amino acids
b) Once finished their job, the fluids a) Plant Sources
from ISC must go back to IVC with
the help of serum osmotic 3) FATS (Lipids)
pressure (d/t albumin) ✓ Stored sugars
c) LACK OF ALBUMIN causes ✓ Protects/cushions organs
decrease serum osmotic pressure ✓ Lubricant
d) Resulting fluid stasis in the ISC ✓ Carrier of vitamin ADEK (fat soluble)
(EDEMA) ✓ Can be visible → animal fats, oils,
e) ANASARCA (generalized edema) butter, lard
✓ TYPES OF AMINO ACIDS ✓ Can be invisible → milk, eggs, cheese
a) ESSENTIAL (9 amino acids) ✓ TYPES:
1. Histidine a) TRIGLYCERIDES
2. Isoleucine 1. Saturated Fats (LDL)
3. Leucine − Bad fats
4. Lysine − Solid in room
5. Methionine temperature
6. Phenylalanine − ANIMAL SOURCE
− SOURCE: Milk 2. Unsaturated Fats (HDL)
− Phenylketonuria − Good fats
(PKU) − Liquid in room
− Does not absorb temperature
phenylalanine − PLANT SOURCE
− NO MILK
 − Vegetable oil, ✓ PROBLEMS (Vitamin B3
peanut oil, olive deficiency):
oil A. PELLAGRA (4 D’s
b) PHOSPHOLIPIDS symptoms):
− Phosphate + Lipid − Dementia
− From Eggs, Peanuts, Liver − Diarrhea
c) STEROLS − Dermatitis
− MOST COMMON: − Death
Cholesterol ✓ SOURCES:
− Can be HDL or LDL − Meat
− High LDL can cause − Fish
cardiac problems − Eggs
− Whole grains
4) VITAMINS d) VITAMIN B5 (Pantothenic Acid)
✓ Support life ✓ Co-enzyme in energy
✓ CLASIIFCATION: metabolism
1. WATER SOLUBLE ✓ PROBLEMS (Vitamin B5
− Absorbs directly in blood deficiency):
a) VITAMIN B1 (Thiamine) A. FATIGUE
✓ Muscle/nerve function B. HEADACHE
✓ CHO metabolism C. NAUSEA & VOMITING
✓ PROBLEMS: ✓ SOURCES:
A. BERI-BERI (vitamin B1 − Organ meats (Liver)
deficiency) e) VITAMIN B6 (Pyridoxine)
− Difficulty walking ✓ Amino acid metabolism
− Pain ✓ Urea production
− Mental/speech ✓ Synthesize neurotransmitters
difficulties (ACh)
− Parasthesia ✓ DO NOT GIVE in patients
B. WERNICKE’S- taking TB medications
KORSAKOFF SYNDROME (specifically PYRAZINAMIDE)
(vitamin B1 deficiency d/t ✓ PROBLEMS (Vitamin B6
alcoholism) deficiency):
− Tingling sensations A. Peripheral Neuritis
on the face B. Convulsive Disorder
✓ SOURCES: C. Anemia
− Meat f) VITAMIN B7 (Biotin)
− Fish ✓ Synthesize fatty acids & amino
− Grains acids
− Cereals ✓ PROBLEMS (Vitamin B7
− Green Leafy Vegetables deficiency):
b) VITAMIN B2 (Riboflavin) A. Nausea
✓ CHO, CHON & Fats B. Anorexia
metabolism C. Depression
✓ PROBLEMS: ✓ SOURCES:
A. CHEILOSIS (Vitamin B2 − Organ meats (Liver)
deficiency) − Meat
− Crack corners of lips − Egg yolk
✓ SOURCES: − Milk
− Same as Vitamin B2 − Whole grains
c) VITAMIN B3 (Niacin) g) VITAMIN B9 (Folic Acid)
✓ Co-enzyme in energy ✓ DNA formation
metabolism ✓ Hgb formation
 ✓ PROBLEMS (Vitamin B7 ✓ Calcium & Phosphorus
deficiency): Absorption
A. MEGALOBLASTIC ANEMIA ✓ Bone mineralization
− Large RBCs ✓ PROBLEMS (Vitamin D
B. NTD DEFECTS deficiency):
− Pregnant Mother is A. RICKETS (for children)
deficient in Folic − Soft, weak, painful
Acid to infant bones
✓ SOURCES: − Deformity: Pigeon
− Liver Chest
− Glandular Organs − Bow legged
− Green Leafy Vegetables B. Osteoporosis (for adults)
− Legumes − Decalcification of
h) VITAMIN B12 (Cobalamin) bones
✓ RBC maturation ✓ SOURCES:
✓ Maintain myelin sheath − Liver
✓ PROBLEMS (Vitamin B12 − Dairy products
deficiency): − Egg yolk
A. PERNICIOUS ANEMIA − NO PLANT SOURCES
− Vitamin B12 deficiency
− No intrinsic factor c) VITAMIN E (Tocopherol)
✓ SOURCES: ✓ Antioxidant
− Animal Source ✓ Prevents cell damage
i) VITAMIN C (Ascorbic Acid) ✓ Bone mineralization
✓ Iron absorption ✓ PROBLEMS (Vitamin E
✓ Antioxidant deficiency):
✓ Promotes wound healing A. RBC & NERVE
✓ Prevents anemia DESTRUCTION
✓ Boosts immunity ✓ SOURCES:
✓ PROBLEMS (Vitamin C − Plant oils
deficiency): − Nuts
A. SCURVY − Seeds
− Swollen bleeding gums − NO ANIMAL SOURCES
− Bruising d) VITAMIN K (Phytonodione)
− Joint pain ✓ Essential for blood clotting
− Irritability formation factors
− Weakness ✓ Newborns must be
✓ SOURCES: administered Vitamin K
− Citrus rich foods − GIT is sterile, so there
2. FAT SOLUBLE is no intestinal
a) Vitamin A (Retinol) bacteria
✓ Maintain vision − No synthesis of
✓ Promote hair, nails, bones, Vitamin K
glands & epithelium growth ✓ PROBLEMS (Vitamin K
✓ PROBLEMS (Vitamin A deficiency):
deficiency): A. BLEEDING DISORDERS
A. VISUAL PROBLEMS ✓ SOURCES:
✓ SOURCES: − Liver
− Liver − Milk
− Dairy products − Green Leafy
− Mussels (tahong) Vegetables
− Green Leafy Vegetables
− Yellow-orange plants
b) VITAMIN D (Calciferol) 5) MINERALS
✓ Structural component of the body
 ✓ CLASSIFICATION: a) Salt products
1. MAJOR MINERALS (Large amounts) b) Patis
a) Calcium c) Soy sauce
b) Chloride d) Bagoong
c) Magnesium e) Processed Foods
d) Potassium f) Canned Foods
e) Sodium g) Instant foods
2. TRACE MINERALS (Small amounts) 2) POTASSIUM
a) Iron a) Fruits & Vegetables
b) Zinc b) Avocado (most accessible fruit rich in
c) Copper K+)
d) Fluoride 3) CHLORIDE
e) Iodine a) Processed foods
b) Soy products
FUNCTIONS: c) Toyo (Soy Sauce)
A. BONE FORMATION & HEALTH: 4) CALCIUM
1) CALCIUM a) Dairy products
2) PHOSPHOROUS b) Edible bones (Sardines)
3) MAGNESIUM c) Dilis (Anchovy)
d) Spinach
B. BLOOD CELL HEALTH: 5) PHOSPHORUS
1) IRON a) Meat
2) ZINC b) Fish
c) Poultry
C. DIGESTIVE HEALTH: d) Eggs
1) CHLORIDE 6) MAGNESIUM
a) Nuts
D. REPRODUCTION & METABOLISM: b) Seeds
1) IODINE c) Legumes (bean sprout)
d) Chocolate
E. MUSCLE CONTRACTIONS: 7) IRON
1) POTASSIUM a) Organ meats
2) CALCIUM b) Liver
c) Clams
F. NERVE IMPULSES d) Green Leafy Vegetables
1) SODIUM 8) ZINC
2) CALCIUM a) Meat
b) Fish
G. FLUID RETENTION c) Poultry
1) SODIUM d) Whole grains
e) Vegetables
H. ACID FORMING 9) IODINE
1) PHOSPHORUS a) Seafood
2) CHLORIDE b) Plants grown in iodine rich soil
3) SULFUR 10) FLUORIDE
a) Fluorated water
I. BASE FORMING b) Tea
1) CALCIUM
2) POTASSIUM COMMONLY ORDERED DIETS:
3) MAGNESIUM 1) REGULAR DIET
4) SODIUM a) Patients with no special dietary needs
b) NORMAL dietary caloric intake: 2000 kcal
c) Highly Seasoned diet
SOURCES: d) High in Fat
1) SODIUM e) AVOID foods difficult to digest
 1. Hard Meats ✓ NIT
2) LIGHT DIET a) Cantor (single lumen)
a) Modify regular diet b) Miller-Abott (double lumen)
b) AVOID fatty and highly seasoned foods  TECHNIQUE
c) Plainly cooked food (Nilaga) a) Inserting NGT (STERILE)
3) SOFT DIET b) Feeding/Removal (CLEAN)
a) For patients with dysphagia  PRINCIPLES:
b) For patients with difficulty chewing a) HIGH FOWLER’s Position
c) AVOID few uncooked foods b) LENGTH: From tip of nose to tip
d) EXAMPLES: of the earlobe to xiphoid
1. Eggs process (50 cm)
2. Soft pastries c) LUBRICATE: KY Jelly
3. Mashed foods d) SITE: nares with greater airflow
4. Puddings e) INSTRUCT:
5. Porridge (Lugaw) 1. Hyperextend with neck
4) FULL LIQUID DIET 2. Throat = Flex the neck
a) For patients with GI disturbances 3. Swallows sips of water
b) For patients that cannot tolerate solids while inserting
c) Mostly fluids + Iron, Fat (Milk) f) CHECK PLACEMENT:
d) Long periods (days-weeks) 1. pH level (5 or
e) Examples: lower/acidic)
1. Ice Cream 2. inject 10-15 mL of air &
2. Fruit Juice (Freshly squeezed) Auscultate (gurgling
3. Soup sounds)
4. Coffee (with creamer) 3. CONFIRMATORY (CXR)
5) CLEAR LIQUID DIET g) SECURE TUBE
a) For patients with GI disturbances 1. Tape to nasal
b) For patients from NPO bridge/cheek
c) Mostly fluids + SUGAR h) BEFORE FEEDING:
d) Short period (24-36 hours) 1. Check for
e) Examples: patency/placement
1. Water 2. If CLOGGED, wash with
2. Fruit juice (strained) warm water
3. Honey i) DURING FEEDING:
4. Popsicle 1. Osterized feeding
5. Gelatin 2. Feeding Height: 12
6. Coffee inches
7. Hard candy 3. HIGH FOWLER’s
Position
FEEDING PROCEDURES: j) AFTER FEEDING
1) ENTERAL FEEDING 1. Flush tubing with water
a) NASOGASTRIC (NGT) (30-60 mL)
b) NASOINTESTINAL (NIT) 2) TOTAL PARENTERAL NUTRITION
 CONCEPTS: (Hyperalimentation Feeding)
a) LAVAGE (Aspirate gastric ✓ SOLUTION: Hypertonic
contents) ✓ ROUTE: Large & Central Veins
b) GAVAGE (Feeding) a) Subclavian
c) DECOMPRESSION (Suction) b) Jugular
❖ Pressure: 10-20 mmHg ✓ COMPONENTS:
 TYPES OF TUBES: a) CHO = Glucose (60-70%)
✓ NGT: b) CHON = Amino acids (30-
a) Levine (single lumen) 40%)
b) Salem Sump (double lumen) c) Fats = Lipids (10-20%)
c) Sengstaken-Blakemore (3-4 d) Vitamins, Minerals, Fluids
lumens) & Electrolytes
 ✓ CONSIDERATIONS: a) CHF
a) HYPERGLYCEMIA b) Renal Failure
− IV insulin c) Cushing’s Syndrome
(Regular/Humulin d) SIADH
R) e) Meniere’s Disease
b) SEPSIS
− Antibiotics DIURETIC THERAPY
c) AIR EMBOLISM ➢ TYPES:
− Perform Valsalva a) K+ WASTING
maneuver while 1. Furosemide
replacing tube 2. Thiazide
✓ NURSING RESPONSIBILITIES: 3. High K+ Diet
a) STRICT STERILE b) K+ SPARING
TECHNIQUE 1. Spironolactone
b) Monitor V/S every 4 hours 2. Low K+ Diet
(especially
TEMPERATURE) LIVER CIRRHOSIS
c) Blood Glucose Monitoring ➢ Converts NH4 to urea
every 6 hours ➢ Too much NH4 in the blood → Hepatic
d) DO NOT STOP ABRUPTLY encephalitis
e) Wean/Taper down ➢ LOW Protein Diet
− Gradual
discontinuation CHOLECYSTITIS/CHOLELITHIASIS/PANCREATITIS
− Prevent rebound ➢ Gallbladder & Pancreas are inflamed
hypoglycemia ➢ If the inflamed gallbladder and pancreas
f) EXPIRATION: after 24 contracts, to release enzymes & bile, PAIN
hours occurs
➢ LOW Fat Diet
THERAPEUTIC DIETS IN PARTICULAR CONDITIONS
A. INFANTS RENAL FAILURE
➢ Best source with of Nutrition: Breast milk ➢ Kidney is not functioning
➢ HEALTHIEST BREAST MILK: Colostrum ➢ Kidney cannot excrete:
➢ Exclusive BF until 6 months a) Sodium
➢ Breast Milk BEST UNTIL 2 YEARS b) Potassium
c) Nitrogenous wastes
BREASTFED BOTTLEFED ➢ LOW Sodium, LOW Potassium, LOW Protein
STOOL STOOL Diet
3-5 DAYS and UP 3-5 DAYS and UP
GOLDEN YELLOW PALE-LIKE GOUTY ARTHRITIS
YELLOW ➢ Increased uric acid → joint stiffness
SWEET-SOUR ODOROUS ➢ LOW Purine Diet
SMELL ➢ AVOID organ meats, Seafood with shells
SOFT, MUSHY HARD-FORMED (Clams, crabs, shrimps, mussels)
FORM
FREQUENTLY SELDOMLY
PASSED PASSED
4-6 TIMES A DAY 2-3 TIMES A DAY

➢ LACTATING: Additional 500 kcal/day

PATIENTS TAKING MAOIs (Antidepressants)

FLUID RETENTION: ➢ Patients who consumes tyramine rich foods
➢ CAUSE: FVE can cause HYPERTENSIVE CRISIS
➢ Diet: Low Sodium Diet
 ➢ DIET: Avoid Tyramine
➢ SOURCES:
a) Cheese
b) Fermented beverages
c) Smoked and cured foods
d) Bananas

PEPTIC ULCER DISEASE (Gastric Ulcer/Duodenal

Ulcer)
➢ Increase HCl acid causing PAIN if there is
Wounds
➢ AVOID gastric irritants
1. Spicy Foods
➢ LOW Fat Diet

PATIENTS ON ANTICOAGULANT THERAPY

➢ DIET: Avoid Vitamin K rich foods

IMMUNOCOMPROMISED
➢ AVOID Fresh Plant foods (Raw foods)
➢ AVOID foods rich in Vitamin C