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17.1 Nutritional Concepts

Good nutrition includes ingestion of quality macronutrients such as carbohydrates, proteins, and fats. These provide adequate calories to meet the body’s daily energy needs. Dietary patterns also need to include adequate water regulation to maintain hydration balance and sufficient quantities of micronutrients, like vitamins and minerals, to meet metabolic demands. Weight and BMI trends help track growth and development and identify early risks to nutritional health. Understanding the role of nutrition in the daily health and wellness needs of people across their life span is key to the achievement of optimal nutrition and health.

17.2 Factors Affecting Nutrition

Physiological and psychological factors significantly affect nutritional status. Physiological factors affecting nutrition include basic human factors such as age, developmental stage and activity level, biological sex, physical health, and the presence of chronic disease, pregnancy, or lactation. Physiological factors also include environmental factors such as socioeconomic status, food insecurity, and lifestyle behaviors. Psychosocial factors are highly influential because mealtimes in all cultures tend to be social events, giving food meaning beyond basic nutritional need. This meaning can be positive, connected with celebrations and traditions, but it can also result in emotional eating that leads to negative health outcomes. It is important to take a holistic view when analyzing patient cues related to nutritional status.

17.3 Specialized Diets

A healthy diet includes quality nutrients such as carbohydrates, proteins, fats, vitamins, and minerals, all in sufficient amounts to meet individual needs. Nutritional teaching should address food safety, food label reading, and healthy eating strategies, for example, by utilizing the MyPlate.gov tool. Specialized diets may be implemented to reduce health risks or optimize nutrition during acute or chronic illness. Common specialized diets include the consistent carbohydrate diet, restricted fat diet, low-sodium diet, and high-fiber diet. Kidney diets, low-fiber diets, and high-calorie, high-protein diets are less common but extremely useful in certain medical conditions. Some specialized diets modify the consistency of the food for improved consumption and/or digestion. These include the mechanical soft diet, pureed diets, and various liquid diets. Enteral nutrition and PN require strict nursing care to provide controlled nutritional intake via enteral tubes such as the NG, OG, and PEG or via central lines like PPN and TPN.

17.4 Nutritional Assessment

A nutrition assessment begins with a collection of subjective data, including a history of weight trends, nutrition intake, lifestyle behaviors, demographics, and past medical history. Objective data should include anthropometric measures and a focused physical assessment. Diagnostic and lab work results can provide important clues about a patient’s overall nutritional status and should be used in conjunction with a thorough subjective and objective assessment to provide an accurate picture of the patient’s overall health status. Common lab tests include hgb, HCT, WBC count, albumin, prealbumin, and transferrin.

Infections, inflammatory disease, metabolic conditions, and eating disorders are all medical conditions that have a direct effect on nutritional status. It is important to review every patient’s medical history and identify medical conditions and treatments that have a direct effect on nutritional status. Analyzing underlying stressors and utilizing physiological and psychological interventions are important when caring for all patients with eating disorders.

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