18 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.1
2
DISCUSS
• Discuss hydrolysis and the enzymes and
cofactors involved in the process of
digestion.
• Discuss the areas of the body where
digestion occurs and what happens at each
point along the digestive path.
• Discuss the effects of food processing on
the absorption of food.
• Divide the class into four groups. Assign
each group one of the following:
carbohydrates; protein; fat; or fluids,
vitamins, and minerals. Have each group
discuss digestion for its assigned nutrient. In
addition, have each group identify ways in
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
various nutrients and where digestion of
these nutrients occurs.
• Post the following discussion topic online
and have students comment. Describe the
role that a person’s psychological state can
have on digestion.
• Post the following discussion topic online
and have students comment. Compare and
contrast factors that can cause the metabolic
rate to vary from person to person.
3
DISCUSS
• Divide the class into small groups and ask
students to discuss and identify as many
macronutrients and micronutrients as they
can in 5 minutes. Next, have each group
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
difference between macronutrients and
micronutrients and give examples of each.
_______________________________________________________________________ Chapter 9 Nutrition 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.1
4
DISCUSS
• Discuss the various functions of
carbohydrates in the body.
• Discuss the five functions of lipids in the diet.
• Discuss the various roles proteins play in the
body.
• Discuss the importance of water and the role
it plays in the body.
• Have the class identify which form of
carbohydrate (glucose, lactose, glucuronic
acid, or dietary fiber) is associated with each
of the following functions.
• As a class, discuss the function of water in
the body, including:
• Providing form and structure to cells and
tissues
• Its purpose in digestion, absorption, and
excretion of metabolic and indigestible
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
function of vitamins and minerals in the
body.
• Post the following discussion topic online
and have students comment. Compare and
contrast the role of carbohydrates, lipids,
and protein in the body.
20 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.1
4
• Have students conduct Internet or library
research on one of the following functions of
proteins:
• Furnish building blocks (amino acids) to
build and repair tissue
• Serve as an energy source
• Help form enzymes, hormones, and
other body fluids and secretions
5
DISCUSS
• Discuss the different types of carbohydrates
and describe their molecular structure.
• Discuss and list food sources for each of the
carbohydrate types.
• Discuss food sources for proteins in the diet.
• In small groups, have students identify at
least five sources of protein. Have each
• As a class, discuss why unsaturated fats are
preferable to saturated fats, identifying
several sources of each.
• Have students take turns calling out food
POST AND COMMENT
• Post the following discussion topic online
and have students comment. How is the
level of serum glucose maintained in the
bloodstream?
• Post the following discussion topic online
and have students comment. What are
some common sources of fat in the diet?
_______________________________________________________________________ Chapter 9 Nutrition 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.1
6
DISCUSS
• Discuss sources of dietary fiber.
• Lead a class discussion and ask students to
answer the following questions and provide
rationales where appropriate:
• What is the major digestive role of fiber?
• What are the two types of fiber?
POST AND COMMENT
• Post the following discussion topic online
and have students comment. List five
common sources of dietary fiber.
Critical Thinking Question
A 78-year-old man whose wife died 1 year ago comes to the clinic complaining of fatigue. He
looks thin, tired, and depressed. When asked about his 24-hour dietary recall, the patient
says that yesterday for breakfast he ate a piece of toast. He skipped lunch because he
wasn’t hungry, and for dinner he had a bowl of cottage cheese. He says he just doesn’t feel
like cooking. What are some concerns the nurse may have about this patient? What are
further questions the nurse should ask?
Discussion Guidelines: The patient’s psychological state is most probably affecting his desire for
food. The nurse should be concerned about the patient’s nutritional status because in one day he
Instructor Notes/Student Feedback
22 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
Instructor Preparation
Textbook Objectives Covered
8. Describe the changes in nutrient needs as a person ages.
10. Explain factors contributing to obesity and current approaches to treatment.
12. Discuss the different types of nutritional support.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
nutrition, including:
• The anatomy and physiology of the gastrointestinal system
• The six classes of essential nutrients, their functions, and examples of foods containing
these nutrients
• Nutritional assessment and dietary planning
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
• copy of U.S. Department of
Agriculture’s Food Guide
Pyramid released in 2005
(http://www.mypyramid.gov)
Key Terms
• incomplete protein (p. 110)
• amino acids (p. 110)
• basal metabolic rate (p. 105)
• calorie (p. 106)
• lipids (p. 108)
• lipoproteins (p. 109)
• macronutrients (p. 104)
• resting energy expenditure
(p. 105)
• saturated fatty acids (p. 108)
_______________________________________________________________________ Chapter 9 Nutrition 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
Student Preparation
Assignments 2 hours
7
READ – Textbook (pp. 112-113)
REVIEW
• Table 9-4: Vitamin sources and functions (p. 114)
• Table 9-5: Minerals in human nutrition (p. 115)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7 (p. 128)
ANSWER – Study Guide
• Part IIH: 24 (p. 46)
• Part III I: 5, 10 (pp. 47-48)
8
• Part III I: 8, 12 (p. 48)
READ – Textbook (pp. 113-117)
REVIEW
• Table 9-6: Nutrition-related system changes in the older adult (p. 116)
• Table 9-7: Changes in the nutritional requirements for the older adult (p. 116)
ANSWER – Study Guide
9
READ – Textbook (pp. 117-123)
REVIEW
• Figure 9-3: Skinfold calipers measure in millimeters the thickness of subcutaneous fat
(p. 122)
• Table 9-8: Estimated calorie needs per day by age, gender, and physical activity level
ANSWER – Study Guide
• Part ID: 1, 2, 5 (pp. 41-42)
• Part IIH: 33 (p. 47)
• Part III I: 9, 16 (p. 48)
10
READ – Textbook (pp. 123-125)
ANSWER – Text
• Review Questions for the NCLEX Examination: 8 (p. 128)
ANSWER – Study Guide
• Part IC: 1-5 (pp. 40-41)
• Part IIH: 19 (p. 46)
24 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
11
READ – Textbook (p. 124)
REVIEW
• Figure 9-4: Diagram of the placement of enteral feeding tubes (p. 125)
• Table 9-9: Nutrition support indications and methods (p. 125)
• Box 9-8: Diet progression and therapeutic diet (p. 127)
ANSWER – Study Guide
• Part IG: 1, 2 (p. 45)
12
READ- Textbook (pp. 125-127)
ANSWER – Study Guide
• Part IE: 1-4 (p. 43)
• Part IIH: 21, 22 (p. 46)
• Part III I: 13-15 (p. 48)
Lecture Outline 20 minutes
7
Slide 43
Recommended Dietary Allowance
• Should contribute 10% to 35% of the macronutrients in the adult diet
TALKING POINTS:
• The recommended dietary reference intake for protein is 56 g/day for males and 46
g/day for females.
Slide 44
Vitamins
• Fat soluble
• Vitamins A, D, E, and K
• Usually absorbed in the body with other lipids
TALKING POINTS:
• Vitamins are organic compounds that the body needs for normal growth and
development.
• Can the body manufacture vitamins?
Slide 45
Minerals
• Enzyme regulation, maintain acid-base balance and osmotic pressure, and maintain
nerve and muscular irritability
• Macrominerals
_______________________________________________________________________ Chapter 9 Nutrition 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
Slide 46
Minerals (cont.)
• Ultratrace elements
• Selenium, chromium, copper, manganese, molybdenum, boron, cobalt
• Ionized forms
• Sodium, potassium
• Constituents of organic compounds
• Phospholipids, hemoglobin
TALKING POINTS:
• Minerals are involved in enzyme regulation, maintenance of acid-base balance and
Slide 47
Water
• Largest component of the body and tissues; essential to all body life processes
• Intake of water is controlled by thirst
• Also ingested through food
• The body cannot store water
• Essential that all living things replenish water daily to maintain health and efficiency
TALKING POINTS:
• What are some of the functions of water in the body?
Slide 48
Water (cont.)
• The longest that people can live without water is approximately 4 days
• Adults generally should take in about 2500 mL, or 2 to 3 quarts, per day
8
Slide 49
• Often reduce the kilocalories taken in per day
• Psychosocial factors also may lead to poor nutrition in the older person
Age-Related Changes
• Energy
• Normal decline in metabolism and common decrease in physical activity, lower
energy needs with age
TALKING POINTS:
• The recommended daily energy intake for light to moderately active older adults is 30
kcal/kg of body weight.
• What does the phrase failure to thrive mean?
26 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
Slide 50
Nutritional Care of the Older Adult
• Dietary planning
• Meals need to be appealing, taking into consideration individual likes and dislikes,
and should be tasteful and filling
• Nutrition programs
TALKING POINTS:
• Problems such as difficulty swallowing, dentures that do not fit properly, and arthritis,
which makes using utensils uncomfortable, must be considered.
• What type of special dietary needs may the older adult have?
Slide 51
Nutritional Care of the Older Adult (cont.)
• Nutritional needs during prolonged illness
• Increased nutritional needs during illness
• Nasogastric tube feedings or parenteral nutrition may be required
• Nutritional care in institutional settings
• Periodic reassessment of nutritional status is critical
TALKING POINTS:
• What problems are older adults at risk for having?
Slide 52
Choose My Plate
• Based on recommendations from the 2005 USDA Dietary Guidelines for Americans
• Includes figure climbing the steps of the pyramid to emphasize exercise in addition to
nutrition
• Colored bands on the pyramid represent the recommended proportions of vegetables
Slide 53
Food Labeling
• People have expressed an increased need to be informed about what they are eating
• Many more foods are now labeled so that the average person can make determinations
about the quality and quantity of the nutrients consumed
9
Slide 54
National Guidelines for Diet Planning
• Many guidelines are available on proper nutrition to maintain health and prevent disease
_______________________________________________________________________ Chapter 9 Nutrition 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
Slide 55
Vegetarian Diets
• Many vegetarians eat all foods except red meat, although some exclude poultry and fish
as well
• Lacto-vegetarian diet
• Includes milk, cheese, and other dairy products but excludes meat, fish, poultry,
and eggs
• Lacto-ovo-vegetarian diet
• Includes dairy products and eggs but excludes meat, fish, and poultry
• Vegan
• Consumes no foods of animal origin
TALKING POINTS:
• Vegetarian diets are not new but have only gradually gained acceptance as a balanced
Slide 56
Nursing Assessment of Nutritional Status
• Dietary history
• Physical, psychological, social, and medical data that may affect nutritional status
• Anthropometric data
• Height, weight (including weight patterns), and body composition
• Laboratory data
• Serum albumin, total lymphocyte count (TLC), creatinine/height index, nitrogen
balance, mean corpuscular volume (MCV), and transferrin saturation
• Physical examination data
TALKING POINTS:
• The well-nourished person should have shiny and healthy-looking hair, bright and clear
eyes, smooth facial skin with good color, smooth lips and tongue, and healthy teeth and
gums.
• What are the signs of malnutrition?
10
&
11
Slide 57
Weight Management and Eating Disorders
• Most adults maintain a constant weight but must eat and exercise consistently on a daily
basis
• Overweight: obese if weight is 20% or more above ideal body weight
• Underweight: weight is 15% to 20% or more below accepted weight standards
• Eating disorders fairly common among teenage girls and young women, and may persist
into adulthood
TALKING POINTS:
28 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
Slide 58
Anorexia Nervosa
• An eating disorder characterized by self-imposed starvation
• Generally girls in their mid-teens, although young adult women and men sometimes
develop the disorder
• Become obsessed with weight loss; distorted body image
TALKING POINTS:
• The young person with anorexia nervosa is often a perfectionist who uses food and
Slide 59
Bulimia
• Characterized by periods of binge eating followed by purging
• May alternate with periods of fasting
• Occurs more frequently than anorexia nervosa; also seen most often in young women
TALKING POINTS:
• People with bulimia are usually of normal weight or are even overweight.
• What are the clinical signs of bulimia?
Slide 60
Binge-Eating Disorder
• The intake of excessive calories at least twice a week for 6 months
Slide 61
Nutritional Support with Supplemental Feedings
• Sometimes a person’s nutritional needs cannot be met by oral feeding and a nutritional
supplement is required
• Liquid or powdered milk, powdered whole eggs, and powdered egg albumin as
TALKING POINTS:
• Liquid feedings can meet the nutritional requirements of patients who are unable to take
solid food.
• What is the preferred method of meeting nutritional requirements?
_______________________________________________________________________ Chapter 9 Nutrition 29
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
12
Slide 62
Enteral Tube Feedings
• Bypass the mouth and deliver nutrients directly into the stomach or small intestine
through inserted tubes
• Tubes can be inserted into the stomach, duodenum, or jejunum through the nose or
through the abdominal wall
• Complications
TALKING POINTS:
• Patients who are unable to take in supplemental liquid feedings orally may require
enteral tube feedings.
• What are some conditions that interfere with taking in liquids orally?
Parenteral Nutrition
• Peripheral parenteral nutrition (PPN)
• Intravenous therapy
TALKING POINTS:
Slide 64
Parenteral Nutrition (cont.)
• Total parenteral nutrition (TPN)
• Used for patients who are unable to obtain adequate nutrition enterally or with PPN
• Can supply up to 4000 kcal/day
TALKING POINTS:
• Patients with what disorders may benefit from this form of nutritional support?
Slide 65
Transitional Feeding
• Nutrition changed from one method to another
• Important that it be done gradually
• Nutritional recovery syndrome may occur if given food too quickly
• Moderate in carbohydrates, low in sodium, lactose-free, and supplemented with
phosphorus and potassium
TALKING POINTS:
• What may cause hypophosphatemia?
30 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
Slide 66
Transitional Feeding (cont.)
• Parenteral to oral or enteral feeding
• Continue the parenteral feeding; as patient is able to tolerate the oral or enteral
feedings, parenteral feedings can be tapered off
• Enteral to oral feedings
• Change the enteral feeding from a continuous drip to an intermittent feeding; allows
patient to get hungry
Activities
Classroom Choose from below to make 30 minutes
Online
7
DISCUSS
• Discuss the functions of dietary fiber in the
diet.
• Divide the class into small groups and have
POST AND COMMENT
• Post the following discussion topic online
and have students comment. What is the
role of dietary fiber in the diet?
8
DISCUSS
• Divide the class into small groups and ask
students to discuss and identify as many
vitamins and minerals as they can in 5
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss good
sources of the various vitamins and minerals
9
DISCUSS
• Divide the class into small groups and have
students outline a single-day meal plan for
each of the following patients. Have each
group share its plan with the class and
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
energy requirements of the older adult
versus a young adult.
10
DISCUSS
• Have the class come up with some leading
causes of obesity and discuss different
methods of treatment.
_______________________________________________________________________ Chapter 9 Nutrition 31
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.2
11
DISCUSS
• Discuss the similarities and differences
among anorexia nervosa, bulimia, and
binge-eating disorder.
• Divide the class into small groups. Present
the following scenarios to the groups and
have the groups identify the eating disorder
portrayed. Have the groups share their
answers with the class and provide their
reasoning.
• A dieting 16-year-old girl is well below
her recommended body weight but still
complains that she is fat. As a result,
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss how
eating disorders arise and how common
they are.
Critical Thinking Question
You are the nurse providing care for a patient taking dietary supplements. You are
concerned and tell the patient to monitor intake closely. The patient asks why you would be
concerned about his intake of vitamins A, D, E and K. What is the best thing to tell him?
Instructor Notes/Student Feedback
32 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
9
Assessments for
Nutrition
CHAPTER OBJECTIVES
Lesson 9.1:
1. Explain the role of the gastrointestinal system in the digestion of food.
3. List the functions of each of the six classes of essential nutrients.
5. Identify food sources of proteins, carbohydrates, fats, and dietary fiber.
7. Identify the food sources of each of the vitamins and minerals.
9. List data included in the nutritional assessment.
11. Differentiate anorexia nervosa, bulimia, and binge-eating disorder.
12. Discuss the different types of nutritional support
Assessments by Lesson & Objective
1
Evolve Instructor Resources
• Test Bank: 45
Evolve Instructor Resources
• Test Bank: 1-11, 13, 39
Evolve Student Resources
• NCLEX Review: 3, 5
• Prioritization: 5
3
Study Guide
• Part IIH: 4, 5 (p. 45)
Evolve Instructor Resources
• Test Bank: 12, 17-20, 24, 43
4
• Part III I: 1, 2 (p. 47)
Study Guide
• Part IA: 1-16 (pp. 39-40)
Introduction to Medical-Surgical Nursing, 6th ed.
• Part IF: 1-6 (p. 44)
• Part IIH: 13-15, 23, 26, 31 (pp. 46-47)
• Part III I: 3, 6, 7 (pp. 47-48)
Evolve Instructor Resources
• Test Bank: 14, 15, 21-23, 25
Evolve Student Resources
• NCLEX Review: 2, 4, 7
Evolve Instructor Resources
• Test Bank: 31, 38, 42
Lesson 9.2
7
Study Guide
• Part IIH: 24 (p. 46)
• Part III I: 5, 10 (pp. 47-48)
Evolve Instructor Resources
• Test Bank: 26-30, 41
Evolve Student Resources
• Part IIH: 33 (p. 47)
• Part III I: 9, 16 (p. 48)
Evolve Instructor Resources
• Test Bank: 16, 32
Evolve Student Resources
• NCLEX Review: 9, 10
Study Guide
Evolve Instructor Resources
• Test Bank: 40, 44
Study Guide
34 Chapter 9 Nutrition _______________________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
11
Study Guide
• Part IG: 1, 2 (p. 45)
Evolve Instructor Resources
• Test Bank: 33, 34
12
Study Guide
• Part IE: 1-4 (p. 43)
Evolve Instructor Resources
• Test Bank: 35-37
Instructor’s Notes/Student Feedback