Introduction to Medical-Surgical Nursing, 6th ed.
9
Lesson Plans for
Nutrition
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 9.1:
2. Describe how food is digested and absorbed.
4. Define macronutrient and micronutrient.
6. List possible health benefits of dietary fiber.
Lesson 9.2:
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
CHAPTER TEACHING FOCUS
• This chapter presents the concept of nutrition, including a brief review of the anatomy and physiology of
the gastrointestinal system.
• Students will have the opportunity to learn about the classification of nutrients, their functions, and their
food sources.
• Furthermore, the chapter includes information on dietary planning and nutritional assessment.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Homeostasis and Regulation
• Concept: Nutrition
• Exemplar: Anorexia Nervosa, p. 126
• Exemplar: Bulimia, p. 129
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CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Which of the following substances must be converted to simple forms to be absorbed by the body?
a) Water
b) Vitamins
c) Lipids
d) Alcohol
2) Where is the enzyme amylase (ptyalin) first secreted in the digestive process?
a) The mouth
b) The small intestine
c) The large intestine
d) The rectum
3) A 12-year-old boy has not been interested in food lately. He seems concerned about the frequent
fights his parents have been having in the past few weeks. Which factor most likely explains why the
boy has a decreased appetite?
a) Bacterial action
b) Food processing
c) Psychological state
d) Intrinsic factor
4) The basal metabolic rate is decreased from normal in which of the following persons?
a) A man living in Ecuador
b) A woman sleeping
c) A pregnant teenager
d) A child with a fever
5) Which of the following items are resistant to human digestive enzymes?
a) Carbohydrates
b) Protein
c) Fiber
d) Lipids
6) Which type of lipoprotein has been shown to decrease the risk of atherosclerosis by carrying
cholesterol from the bloodstream to the liver to be degraded and excreted?
a) HDL
b) LDL
c) VLDL
d) Triglycerides
7) One source of polyunsaturated fat is __________.
a) olive oil
b) butter
c) vegetable oil
d) corn oil
8) Which two items cannot be stored by the body and must be consumed every day?
a) Carbohydrates and lipids
b) Protein and water
c) Water and lipids
d) Protein and carbohydrates
9) A diet that excludes meat, fish, and poultry but includes dairy products and eggs is said to be a(n)
__________.
a) lacto-ovo-vegetarian diet
b) vegan diet
c) lacto-vegetarian diet
d) anorexic diet
10) Which laboratory test is used to diagnose a patient who is in a state of starvation?
a) Hemoglobin
b) Sodium level
c) Nitrogen balance
d) Anthropometric data
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
1) c
6) a
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are some foods that contain carbohydrates, protein, or fats?
Answer: Carbohydrates are found in sweets, fruits, starches (e.g., corn), vegetables, and grains. Fat can
Question: Why is water essential to all life processes in the body?
Answer: Water is the largest component in the body and body tissues. Water provides form and structure
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LESSON 9.1
Instructor Preparation
Textbook Objectives Covered
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.
6. List possible health benefits of dietary fiber.
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
Key Terms
• amino acids (p. 110)
• basal metabolic rate (p. 105)
• calorie (p. 106)
• complementary protein
(p. 110)
• complete protein (p. 110)
• incomplete protein (p. 110)
• resting energy expenditure
(p. 105)
• saturated fatty acids (p. 108)
• triglycerides (p. 108)
• unsaturated fatty acids
(p. 108)
• vitamins (p. 112)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 103-105)
2
READ – Textbook (pp. 103-104)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 2 (p. 128)
ANSWER – Study Guide
• Part IIG: 1, 3, 6-11, 13, 25 (p. 45)
3
READ – Textbook (pp. 104-105)
REVIEW
• Figure 9-1: U.S. Department of Agriculture MyPlate (p. 118)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4 (p. 128)
ANSWER – Study Guide
• Part IIH: 4, 5 (p. 45)
4
READ – Textbook (p. 104)
ANSWER – Study Guide
• Part IA: 1-16 (pp. 39-40)
• Part IB: 1, 2, (p. 40)
• Part IIH: 12, 22, 27, 28 (pp. 46-47)
• Part III I: 1, 2 (p. 47)
5
READ – Textbook (pp. 104-105)
REVIEW
• Figure 9-2: Example of a nutritional label (p. 120)
• Table 9-1: Carbohydrate content of foods (p. 107)
• Table 9-2: Hormones involved with the regulation of blood glucose (p. 108)
• Box 9-1: Fat content of some common foods (p. 111)
• Box 9-2: Protein content of some common foods (p. 112)
• Box 9-3: Comparative Kcal of energy per gram (p. 112)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5 (p. 128)
ANSWER – Study Guide
• 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)
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LESSON 9.1
6
READ – Textbook (pp. 107-112)
REVIEW
• Table 9-3: Dietary content of selected foods (p. 109)
ANSWER – Study Guide
Lecture Outline 20 minutes
Slide 1
Chapter 9
Nutrition
1
Slide 2
Gastrointestinal System (GI Tract or “Gut”)
• The long, continuous tube that receives and transports food, absorbs nutrients, and
eliminates waste products of digestion
• Primary organs
• Mouth, pharynx, esophagus, stomach, small intestine, and large intestine
• Accessory organs
2
Slide 3
Digestion and Absorption
• 92% to 97% of diet digested and absorbed
• Water, simple sugars, vitamins, minerals, and alcohol absorbed in their original form
• Lipids, proteins, and complex sugars must be converted to simple forms before they are
absorbed
Slide 4
Digestion and Absorption (cont.)
• Hydrolysis
• Water splits complex molecules into smaller units
• Enzymes
• Govern the process of hydrolysis, along with bile and hydrochloric acid
• Help break down food particles to their simplest form so nutrients can be absorbed
TALKING POINTS:
• What is the meaning of the word hydrolysis?
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LESSON 9.1
Slide 5
Regulators of the Gastrointestinal Tract
• Neural control
• Managed by autonomic nervous system and nerve network in gut wall called the
enteric nervous system
• Autonomic system: sympathetic and parasympathetic nerves
• Parasympathetic nerves stimulate digestive activity
• Sympathetic nerves inhibit activity
• Parasympathetic effect conveyed by vagus nerve: acid stimulation in stomach
TALKING POINTS:
• When would you expect to see your sympathetic nervous system at work?
Parasympathetic nervous system?
Slide 6
Regulators of the Gastrointestinal Tract (cont.)
• Hormones
• Secreted into the gastrointestinal tract to help regulate gastric pH, gastric motility, and
appetite
• Stimulate the pancreas to secrete insulin and enzymes
TALKING POINTS:
• What hormones are involved in digestion?
Slide 7
Digestive Process: Mouth
• Teeth grind and crush food into small particles
• Food forms mass moistened and lubricated by saliva
TALKING POINTS:
• What are the three areas of the gastrointestinal system in which digestion of food occurs?
Digestive Process: Stomach
• The mass is mixed with gastric secretions
• Active chemical digestion is accomplished by the secretion of gastric juice
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LESSON 9.1
Slide 9
Digestive Process: Stomach (cont.)
• Normally emptied in 1 to 4 hours
• Carbohydrates leave the stomach most rapidly, followed by protein, and then fat
• Valves (sphincters) at entrance (cardiac sphincter) and exit (pyloric sphincter) of the
stomach prevent backflow of food from stomach into pharynx and from duodenum into the
stomach
TALKING POINTS:
• What happens to the emptying of the stomach when a mixed diet has been consumed?
• What is the condition called when the cardiac sphincter begins to fail?
Digestive Process: Small Intestine
• Divided into the duodenum, the jejunum, and the ileum
TALKING POINTS:
• What is the overall purpose of the small intestine?
Slide 11
Digestive Process: Large Intestine
• Water and electrolytes are absorbed, leaving a mass of wastes called feces
• Fecal mass is stored in the rectum, where it triggers the defecation reflex
• When anal sphincters relax, feces pass out of the body through the anus
TALKING POINTS:
• What is the overall purpose of the large intestine?
Slide 12
Mechanisms of Absorption
• Absorption is accomplished by the combination of the processes of diffusion and active
transport
• Diffusion
• Movement of particles from an area of higher concentration to an area of lower
concentration
• Active transport
• Requires the input of energy for the movement of particles across a membrane
Slide 13
Mechanisms of Absorption (cont.)
• Small intestine
• Primary organ of absorption
• 22 feet long and arranged in folds
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LESSON 9.1
3
Slide 14
Nutrients: Carbohydrates
• Digestion begins in the mouth, where the enzyme amylase is released
• If carbohydrates remain in the stomach long enough, hydrochloric acid reduces most
to their simplest form
• Stomach generally empties into the small intestine before this occurs, so most of
the digestion of carbohydrates occurs within the small intestine
TALKING POINTS:
• Macronutrients are essential nutrients that have a large minimum daily requirement.
• What are the names of some macronutrients?
Slide 15
Nutrients: Carbohydrates (cont.)
• In the small intestine, pancreatic amylase is released to continue carbohydrate digestion
• Absorbed through the villi into the bloodstream, where carbohydrates are carried by
the portal vein to the liver
• From the liver, most of the glucose is transported to the tissues
Slide 16
Nutrients: Protein
• Digestion of protein does not begin until it reaches the stomach
• Split into smaller molecules
• Most digestion occurs in the duodenum
• Almost all of the protein is absorbed by the time it reaches the end of the jejunum
• Only 1% of ingested protein found in the feces
TALKING POINTS:
• Compare and contrast protein and carbohydrate digestion
Slide 17
Nutrients: Fat
• Digestion begins in the stomach
• Gastric lipase
• An enzyme, breaks down the triglycerides that make up fat into fatty acids and
glycerol
Slide 18
Nutrients: Fluids, Vitamins, and Minerals
• Absorbed through the intestinal mucosa
• Each day about 8 L of fluid from the body pass back and forth across gut membrane to
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LESSON 9.1
Slide 19
Factors Affecting Digestion
• Psychological state
• Look, smell, and taste of food have effect on digestion
• Emotions such as fear, anger, and worry can inhibit peristalsis and depress gastric
secretions
• Bacterial action
TALKING POINTS:
• What may cause secretions of saliva and gastric juices to increase?
• The gut is inhabited by about 100 different species of bacteria.
• A healthy person is not usually disturbed by these bacteria because they dwell in the
Slide 20
Energy Expenditure
• Measurement of energy expenditure
• Basal metabolic rate (BMR)
• Factors that can cause the metabolic rate to vary
• Body size and composition
• Periods of growth
TALKING POINTS:
• In the context of nutrition, energy refers to the way in which the body makes use of the
energy received through the food that is eaten.
• What are the three components of energy expenditure?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.1
Slide 21
Energy Expenditure (cont.)
• Energy measurements and calculations
• Calorie
• Standard unit for measuring energy
• Amount of heat energy needed to increase temperature of 1 g of water at
standard temperature by 1° C
• Measure of human energy expenditure
• Direct calorimetry
• Indirect calorimetry
• Doubly labeled water
TALKING POINTS:
• What can the measure of human energy expenditure be used to calculate?
4
&
5
Slide 22
Carbohydrates
• Organic compounds consisting of carbon, hydrogen, and oxygen
• All the sugars and starches that people eat and most types of fibers
• Plants manufacture and store carbohydrates as their chief source of energy
• Glucose is the main sugar in the blood and body’s basic fuel
• Serves as primary source of energy
TALKING POINTS:
• Most of the energy we require is consumed in the form of carbohydrates.
• What are the simplest sugars?
5
Slide 23
Carbohydrates (cont.)
• Classified according to the number of simple sugars or saccharides
• Monosaccharides
• 1 saccharide
• Disaccharides
• 2 saccharides
TALKING POINTS:
• What are some examples of each classification of sugar? Food sources?
• Which saccharides are considered simple sugars or complex sugars and why?
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LESSON 9.1
Slide 24
Carbohydrates (cont.)
• Metabolism
• Converted to glucose for immediate use by the body’s cells and to glycogen for
storage
• Serum glucose level maintained at normal through the regular intake of nutrients,
storage or breakdown of glycogen, glucogenesis, and gluconeogenesis
• Normal blood glucose levels: 70 to 100 mg/100 mL under fasting conditions
• After a meal, blood glucose level may rise to 130 mg/100 mL but returns to normal
within 2 to 3 hours
TALKING POINTS:
• During long periods of fasting or prolonged exercise, glycogenolysis may not be able to
5
&
6
Slide 25
Carbohydrates (cont.)
• Dietary fiber
• A group of polysaccharides that act differently from other carbohydrates
• Found only in plant foods and are resistant to human digestive enzymes
• Major digestive role is to help form a soft, firm stool and to aid in the process of
elimination
• Types
• Insoluble
• Soluble
TALKING POINTS:
• What fibers are insoluble?
• Insoluble fibers act as sponges to absorb many times their weight in water, swelling up in
the intestine.
5
Slide 26
Carbohydrates (cont.)
• Functions of carbohydrates
• Major source of energy to body tissues
• Sole source of energy for the brain
• Maintain functional integrity of nerve tissue
TALKING POINTS:
• What sugar remains in the intestine the longest?
• Glucuronic acid is a product of glucose metabolism that combines with toxins in the liver
and converts them to a form that is readily excreted.
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LESSON 9.1
Slide 27
• Triglycerides consist of how many fatty acids?
Lipids
• Include fats, oils, waxes, and related compounds
• May be solid or liquid forms
• Insoluble in water
• Contain carbon, hydrogen, and oxygen
• Triglycerides: most common fat found in foods of both animal and plant origin
TALKING POINTS:
Slide 28
Lipids (cont.)
• Saturated fatty acids
• Loaded with all the hydrogen atoms they can carry
• Solid at room temperature
• Unsaturated fatty acids
• Do not have all the hydrogen atoms they can carry
• Liquid at room temperature
TALKING POINTS:
Lipid Transport and Storage
• Most are absorbed into the lymphatic system through the intestinal mucosa
• The exception is certain fatty acids that are absorbed directly into the portal blood
Slide 30
Lipid Transport and Storage (cont.)
• Once emulsified, fats can be broken down and absorbed
• Lipoproteins
• Protein that transports lipids in the bloodstream
TALKING POINTS:
• Cholesterol found in the LDLs increases the risk of atherosclerosis by contributing to
plaque buildup on the artery walls.
• HDLs carry cholesterol from the bloodstream to the liver to be degraded and excreted.
• What is the difference between white fat and brown fat?
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LESSON 9.1
Slide 31
Lipid Metabolism
• A source of energy for most body tissues except the brain, blood cells, skin, and renal
medulla
• Lipolysis
• Fat cells release glycerol and free fatty acids
• Liver converts it to triglycerides or glucose
• Free fatty acids bind to albumin for transportation in the blood and interstitial tissue
• Most lipids carried to liver for conversion to energy or for the synthesis of new triglycerides
TALKING POINTS:
• The center for lipid metabolism is the liver, which helps to regulate lipid levels in the body
by the following processes:
Slide 32
Recommended Dietary Allowance
• 20% to 35% of the adult diet should be composed of fats
• Unsaturated fats rather than saturated fats minimize the risk of heart disease
TALKING POINTS:
• Studies have shown that Americans tend to consume too much fat.
• How can consuming too much fat affect the body?
Slide 33
Food Sources of Fat
• Saturated fats
• Animal products: beef, dairy products, and eggs
• Unsaturated fats
• Vegetable oils, including corn oil, cottonseed oil, and safflower oil
TALKING POINTS:
4
&
5
Slide 34
Lipid Function
• Store energy
• Maintain healthy skin and hair
• Carry fat-soluble vitamins
• Supply essential fatty acids
• Promote satiety
TALKING POINTS:
_______________________________________________________________________ Chapter 9 Nutrition 15
LESSON 9.1
5
Slide 35
Proteins
• Basic structure of a chain of amino acids that can form many different configurations and
combine with other substances
• Contain carbon, hydrogen, oxygen, nitrogen, sulfur, and sometimes metals, acids, lipids,
polysaccharides
• Simple proteins
• Made of only amino acids
• Conjugated proteins
• Made of amino acids in combination with other substances
Slide 36
Proteins (cont.)
• Amino acids
• Nine essential: must be obtained from the diet
• Body can manufacture enough of the other amino acids from the essential amino acids
• Complete protein
TALKING POINTS:
• There are 22 common amino acids, and they can be bonded in a variety of ways to form
different proteins.
• The body uses all 22 amino acids, but only nine of them are considered essential amino
acids.
• What are the nine essential amino acids?
Slide 37
Protein Metabolism and Synthesis
• Deamination
• Protein is broken down in the small intestine to the constituent amino acids
• Protein synthesis
• Controlled by DNA in the cells
• DNA: provides the form to link up the exact combination of amino acids needed to
form a particular protein
TALKING POINTS:
• What does deamination produce?
Slide 38
• Nitrogen in the urine is a good indicator of protein levels in the body.
Protein Deficiency
• The body cannot store protein, so it needs to be eaten each day
• If protein intake is inadequate, nitrogen will be conserved by the kidneys, causing the
urine nitrogen to be low
TALKING POINTS:
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LESSON 9.1
Slide 39
Evaluation of Protein Quality
• Should include both the quantity and the quality of the protein consumed
• Eating a mixture of foods in a meal, if the quantity is sufficient, tends to provide all of the
essential amino acids
TALKING POINTS:
• The average American consumes considerably more than the RDA for protein.
4
&
Functions of Proteins
• Furnish building blocks (amino acids) to build and repair tissue
• Serve as an energy source
Slide 41
Question 1
• Which of the following is NOT a function of the gastrointestinal system?
A. Receives and transports food
B. Keeps the chemicals and water balanced
C. Absorbs nutrients
D. Eliminates waste products of digestion
TALKING POINTS:
Slide 42
Question 2
• Which of the following is NOT a function of fiber?
A. Increases the rate of digestion and absorption of nutrients
B. Promotes a sense of gastric fullness
C. Helps lower serum cholesterol
D. Promotes fermentation in the colon
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 9.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss and name the primary and
secondary organs that comprise the
gastrointestinal system and explain their
function.
• Divide the class into small groups and have
students identify the role in digestion of each
of the following organs and accessory
organs of the GI system. Then have each
group share its results with the class.
• Mouth
• Pharynx
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.