PowerPoint Chapter16

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2© Paradigm Publishing, Inc.

Chapter 16

Nutrition and Drugsfor Metabolism



Chapter 16

Topics

•

Physiology of Nutrition• Micronutrient Abnormalities

• Enteral and Parenteral Nutrition

• Obesity

•Herbal and Alternatie !hera"ies

#© Paradigm Publishing, Inc.



Physiology of Nutrition

Ealuating Nutrition $tatus• %oth e&ternal and internal "hysiological

"rocesses are inoled in 'eight maintenance

•

!o ealuate nutrition status, com"are (normal)body 'eight for a "atient*s age anddeelo"ment 'ith A%+

$omeone 'ithin the normal range

$ho's no signs of itamin or nutrientdeciency

Maintains an a""ro"riate body 'eightand ma-eu"

•

%est indicator of nutrition status in children isa""ro"riate gro'th including height and1© Paradigm Publishing, Inc.




I%+ Adults/• I%+ is the 'eight for a gien height that is

associated 'ith ma&imum longeity and health

•

!o assess basic nutritional status, com"are"atient*s A%+ 'ith I%+

• Many times, I%+ is used to determine "ro"er'eightbased dose sometimes A%+ can be

used/

© Paradigm Publishing, Inc. 3

To Calculate IBW in Adults

Males4 I%+ -g/ 5 36 7 2.# 8 height in inchesoer 3 feet/

9emales4 I%+ -g/ 5 13.3 7 2.# 8 height ininches oer 3 feet/




%MI• Another 'ay to assess a""ro"riate 'eight for

height

:sed to identify both undernutrition andoernutrition

• ;ue to increased muscle mass, some malesand athletes may not be considered

oer'eight until %MI reaches 2<• In children and teens, %MI must be com"ared

to aerages in gro'th for age to be inter"retedcorrectly

=© Paradigm Publishing, Inc.

To Calculate BMI

%MI 5 'eight -g/ > ?heightm/@2




alories• 0ood nutritional status is maintained through

a""ro"riate energy inta-e and e&"enditure

•

Energy inta-e is measured in calories -cal>-g/• A""ro"riate daily caloric needs de"end on age

9or adults, an inta-e of 23 -cal>-g of body'eight a day is usually adeBuate to maintain

basal metabolic rate Malnourished and critically ill "atients need

more calories

<© Paradigm Publishing, Inc.




Nutrients• In addition to calories, the body needs

a""ro"riate amounts of "rotein, carbohydrates,

Cuids, micronutrients• Protein needs ary de"ending on age, disease

state, and clinical condition

• Micronutrients include itamins and minerals

electrolytes and trace elements/D -ey role inmany metabolic "rocesses

• In 2663, federal goernment "ublished ;Is foritamins and essential trace elements

;I alues of micronutrients measured inmg, mcg, I: G© Paradigm Publishing, Inc.




Obesity and Malnutrition• Obesity is oernutritionD an obese body

com"osition has signicantly more fat than is

considered normal or healthy• Malnutrition is a lac- of adeBuate nutrient

inta-e to su""ly basic metabolic needsD relatedto t'o conditions

Oerall lac- of calorie or "roteinconsum"tion

$"ecic micronutrient itamins, minerals/deciency

• Malnutrition is most "realent inunderdeelo"ed countries and in children. © Paradigm Publishing, Inc.




Malnutrition onditions• Marasmus is a chronic condition caused by

inadeBuate caloric and "rotein inta-e oer a

"rolonged time• ache&ia is the 'asting a'ay of muscle and fat

tissue due to staration and the eects ofcancer

•

J'ashior-or is a condition in 'hich caloricinta-e is adeBuate, but "rotein inta-e isdecient

Patients a""ear 'ell nourished, but Cuidaccumulates in the abdomen and feet

K6© Paradigm Publishing, Inc.



Micronutrient Abnormalities

About Micronutrients• ;eciencies or e&cesses of itamins, minerals,

and essential fatty acids can cause signicant

morbidity• 9atsoluble itamins A, ;, E, and J/

accumulate in fatty tissue and can build u" inthe body oer time

•

+atersoluble itamins eight % itamins anditamin / are easily e&creted in urineDoerdose is uncommon

• Fitamin and mineral deciencies measured'ith lab tests

• Fitamins and minerals are dietary su""lementsKK© Paradigm Publishing, Inc.




Fitamin A• Part of a family of com"ounds called retinoids

• Necessary for ision, gro'th, bone formation,

re"roduction, immune system function, ands-in health

• $ources4 eggs, 'hole mil-, butter, meat, andsh

One com"ound, beta carotene, can be foundin egetables es"ecially carrots/ and fruits

• Indications4 cases of deciencyD cataractsDreducing com"lications of HIF, measles, andmalaria





!hiamin %K/

• Im"ortant coenLyme inoled in carbohydratemetabolism

• $ources4 "or-, cereal, grains, "eas, beans, andyeast

• Indications4 cases of deciency, 'hich are mostcommon during "regnancy and during alcohol

'ithdra'aliboCain %2/

• oenLyme in tissue res"iration and normal cellmetabolism

• $ources4 mil-, cereal, green egetables, and K#© Paradigm Publishing, Inc.




Niacin %#/ or Nicotinic Acid

• Essential itamin % com"le& for body reactionsthat "roduce adenosine tri"hos"hate molecule

in cellular energy "roduction/• Necessary for the regulation of cholesterol

"roduction and actiity

• $ources4 yeast, lean meats, "eanuts, "eas,

beans, 'hole grains, and "otatoes• Indications4 cases of deciency, lo'ering of

cholesterol lo'ers triglycerides and ; andraises H;/





Pantothenic Acid %3/

• Precursor of coenLyme A

• Necessary for the "ro"er metabolism of

carbohydrates, "roteins, and li"ids• $ources4 egetables, yeast, cereal, organ

meats lier, -idney, heart/

• Indications4 cases of deciency





Pyrido&ine %=/

• % itamin that the body conerts to thecoenLymes res"onsible for amino acid

metabolism• $ources4 most foods of "lant or animal origin

• Indications4 cases of deciencyD ty"es ofanemia and seiLure disordersD alcoholic

"atients 'ith nere damageD "atients 'ith !%'ho ta-e isoniaLid, 'hich de"letes %=

K=© Paradigm Publishing, Inc.




%iotin %</

• oenLyme inoled in metabolism

• ;eciencies of it are associated 'ith altered

absor"tion, such as short gut syndrome• $ources4 green leafy egetables, lier, carrots,

almonds

• Indications4 cases of deciency

K<© Paradigm Publishing, Inc.




9olate %/ or 9olic Acid

• Essential for intracellular metabolism and thebrea-do'n of homocysteine amino acid

associated 'ith F disease/D inoled inserotonin a neurotransmitter/ "roduction

• ;eciencies cause anemia and neural tubedefects in a deelo"ing fetusD deleterious

eects on the cardioascular system• $ources4 green leafy egetables, red meatD

food additie

• Indications4 cases of deciency, "regnant'omen or those "lanning to get "regnant, endstage -idney disease, de"ression, chronic KG© Paradigm Publishing, Inc.




yanocobalamin %K2/

• oenLyme necessary for cell re"roduction,normal gro'th, and red blood cell "roduction

•Necessary for "ro"er use of folate in the bodyDdeciency causes "ernicious anemia

• $ources4 meats, sh, mil-, bread

• Indications4 cases of deciency common in

elderly, strict egetarians/D "ernicious anemiaDendstage renal disease

K© Paradigm Publishing, Inc.




Fitamin Ascorbic Acid/• Im"ortant in immune system function and as

an antio&idant reduce ;NA mutations that

lead to cancer/• $ources4 egetables and fruits, es"ecially citrus

fruits

• Indications4 cases of deciency scury/,

im"roement of iron absor"tion• Indications other/4 "rotein metabolism in

"remature infants, macular degeneration,seasonal allergies, "reention of the commoncold





Fitamin ;• It maintains calcium and "hos"hate leels in

the bloodD enhances intestinal absor"tion of

calcium bone health/• Possible role in cardioascular health,

deelo"ment of cancer, and res"iratorydisease

•

!'o actie forms4 ergocalciferol andcholecalciferol

Ergocalciferol is in "lants and yeastsDcholecalciferol is made in the s-in inres"onse to sunlight

• $ources4 fortied mil-, some eggs, tuna,2K© Paradigm Publishing, Inc.




Fitamin E Al"ha !oco"herol/• 9atsoluble itamin

• $ources4 egetable oils, cereals, grains, animal

fat, meat, "oultry, eggs, fruits, and egetables• Indications to"ical/4 im"roement of s-in

health

• Indications su""orted by studies/4 macular

degeneration, AlLheimer*s disease, reductionof ris- for some ty"es of cancer and dementia

• Indications controersial/4 im"roement ofimmune system function, diabetic retino"athy,

cardioascular disease 22© Paradigm Publishing, Inc.




Fitamin J or "hytonadione• oenLyme for he"atic "roduction of blood

clotting factors

•

$ources4 green leafy egetables, broccoli,brussels s"routs, "lant oils, margarine

• ;eciency can be caused by drug thera"y

• Indication4 cases of deciency, enhanced blood

clotting, reersal of the eects of 'arfarin ananticoagulant/

2#© Paradigm Publishing, Inc.




Fitamins4 $ide Eects and autions• $ide Eects4 most result from e&cess inta-e

and mimic conditions of itamin to&icity see

!able K=.1/• $ide Eects niacin "roducts, common/4

Cushing, hot Cashes, a sensation of "ric-ly s-in

• autions4 doses higher than the ;I of itaminA are category contraindicated/ in "regnant'omen

Fitamin A in e&cess of G66 mcg a day hasbeen associated 'ith birth defects




Your Turn

uestion K4 A "atient 'ho is undergoingchemothera"y and radiation says food does nottaste good, and he seldom feels hungry. He is noteating enough calories and "rotein, and his muscle

and fat tissue are disa""earing. +hat is the li-elydiagnosis of this condition

Ans'er4 !his condition is called cache&ia.

uestion 24 A "atient is trying to get "regnant. Her

"hysician recommends that she ta-e folate %/su""lements. +hat is the "ur"ose of thesesu""lements

Ans'er4 !a-ing folate as a fetus deelo"s can

greatly reduce birth defects such as neural tube 23© Paradigm Publishing, Inc.




!race Elements• Essential minerals needed for normal

"hysiologic functions

•

;I is lo'D easy to obtain from normal foodconsum"tion

• $u""lements are used mainly as addities toenteral and "arenteral nutrition formulas

!race Elements4 hromium• Part of a com"le& of molecules that hel"

regulate glucose tolerance and insulin leels

• $ources4 canned foods, meat, sh, bro'n

sugar, coee, tea, 'hole 'heat bread, rye 2=© Paradigm Publishing, Inc.




!race Elements4 o""er• atalyst and coenLyme in arious chemical

reactions

•

+ithout co""er, %s and +%s 'ould declineand cause anemia, leu-o"enia, neutro"enia

• $ources4 organ meats, seafood, nuts, seeds,'heat bran cereals, grains, cocoa

•

Indications4 cases of deciency "arenteralnutrition/

2<© Paradigm Publishing, Inc.




!race Elements4 Iodine• :sed to ma-e thyroid hormones, 'hich

regulate metabolic rates

•

$ources4 seafood, sea'eedD added to salt indeelo"ed countries

• Indications4 cases of deciency such as thyroidconditions, radiation emergencies in 'hichradioactie iodides 'ere used

2G© Paradigm Publishing, Inc.




!race Elements4 Iron• Iron is in hemoglobin of %s and in myoglobin

of muscle

•

ofactor for neurotransmitter "roductionD "artof the functional grou"s of many im"ortantenLymes

• +ithout iron, % "roduction and o&ygencarrying ca"acity are reduced

• $ources4 red meat, "oultry, shD in someegetables but many coo-ing and storagemethods reduce its aailability/

• Indications4 anemia chronic disease and irondeciency/ 2© Paradigm Publishing, Inc.




!race Elements4 Manganese• ofactor in many metabolic and enLymatic

reactions

•

$ources4 legumes, seeds, tea, 'hole grains,green leafy egetables

• Indication4 cases of deciency

!race Elements4 $elenium• Incor"orated into amino acidsD reduces

o&idatie stress

• $ources4 broccoli, garlic, onions

• Indication4 additie "arenteral nutrition #6© Paradigm Publishing, Inc.




!race Elements4 Qinc• ofactor in many "hysiologic "rocesses,

including the synthesis of ;NA and "rotein

•

Im"ortant role in immune function, 'oundhealing, blood clotting, re"roduction, anda""ro"riate gro'th

• $ources4 meat, seafood, dairy "roducts, nuts,legumes, 'hole grains

• Indications4 cases of deciency, immunefunction booster, 'ound healing catalyst,+ilson*s disease

• Indications loLenges/4 sym"toms of commoncold #K© Paradigm Publishing, Inc.




!race Elements4 $ide Eects• Most side eects result from e&cess inta-e

• $ide eects mimic conditions of to&icity see

!able K=.1/

#2© Paradigm Publishing, Inc.



Enteral and Parenteral Nutrition

Nutritional Needs of Patients• Alternatie 'ays to su""ly nutrition must be

used 'hen a "atient cannot be fed normally

•

Malnutrition 'ill occur if a "atient goes longerthan < to K6 days 'ithout food or nutrition

Enteral Nutrition• 9eeding a "atient through a tube into the 0I

tract• iBuid nutrient is "ut through the tube in bolus

doses mimics eating a meal/ or continuously'ith enteral "um"

•

Indications4 bo'el obstruction, short gut*

##© Paradigm Publishing, Inc.




Enteral Nutrition (continued)

• Indication4 "atients in longterm care 'hocannot s'allo' food oluntarily due to stro-eor coma

• IF Cuids are usually gien in addition to enteralfeeding to maintain hydration status

• !echnicians often order enteral feedingformulas

eBuirement4 label enteral feeding"re"arations 'ith a 'arning not toadminister them through an IF

• Enteral feeding is "referred to "arenteralfeedingD -ee"s the 0I tract functional and #1© Paradigm Publishing, Inc.




#3© Paradigm Publishing, Inc.

Enteral !ube9eeding $ites• A manually inserted

N0 tube is notcomfortable D thistube is used on ashortterm basis

• A surgically "laced0 tube or R tubedeliers enteralnutrition ia the

stomach or




Parenteral Nutrition• Often called !PN

• Inoles feeding a "atient through an IF 'hen

the digestie tract cannot be used :sed for seere burns, intolerance to enteral

feeding, anore&ia nerosa, I%;, "ancreatitis,seere diarrhea

$ometimes used in "regnancy, AI;s, cancer• $u""lies all needed Cuids, electrolytes,

nutrients carbohydrates, "roteins, and fats/,itamins, minerals

•

!echnicians in s"ecialty or homeinfusionharmacies mi& !PN solutions#=© Paradigm Publishing, Inc.




Mi&ing of Parenteral Nutrition $olutions• Order of mi&ing is im"ortant

Mi& all clear ingredients before cloudy

ingredients Add some electrolytes and trace minerals

se"arating to reduce "reci"itating out ofsolution

Preci"itates occur 'hen minerals bindtogether and form s"ec-s that couldbloc- ca"illary Co'

Add itamins last, Sust before administration

•

Im"ortant to "ro"erly agitate and mi& each !PN ba#<© Paradigm Publishing, Inc.




Mi&ing of Parenteral Nutrition $olutions(continued)

#G© Paradigm Publishing, Inc.

!'oinoneMi&tures

• ontain "roteins amino acids/ andcarbohydrate de&trose/

• 0ood for 2K days if refrigerated and< days at room tem"erature

!hreeinone

Mi&tures

• ontain "roteins, carbohydrates,li"ids fats/

• i"ids are cloudyD can hide"reci"itates

• ess stable solutions as t'oinone

• 0ood for < days if refrigerated and

21 hours at room tem"erature



Obesity

About Obesity• !he ; estimates that a""ro&imately #1T of

adults in the :nited $tates are obese

Obesity in males4 A%+ is 23T or more aboeI%+

Obesity in females4 A%+ is #3T or moreaboe I%+

•

Morbid obesity is 'hen A%+ is more than t'iceI%+

• auses of obesity4 enironmental, genetic,"hysiological, and "sychological factors

•

Obesity is associated 'ith serious health ris-sand mortalit see !able K=.3/#© Paradigm Publishing, Inc.



Obesity

About Obesity (continued)

• entrally distributed fat is adi"ose tissue thataccumulates in the abdominal area s. in thehi"s, thighs, or buttoc-s

in-ed to heart disease and diabetes

• Obese "eo"le hae more de"ression and"sychological disturbances

;rugs for Obesity• Preferred treatment for obesity is lifestyle and

dietary changesD changes must be "ermanentto control 'eight

•

Indication "rescri"tion/4 %MI oer #6 or oer 16© Paradigm Publishing, Inc.



Obesity

;rugs for Obesity4 A""etite $u""ressants• Mechanism of Action4 stimulate N$D stimulate

do"amine and nore"ine"hrine and "reentreu"ta-e of serotoninD signal sense of fullnessand satisfaction

• oute4 oralD all N$ stimulants are controlledsubstances

• $ide Eects common/4 headache,stomachache, insomnia, nerousness,irritability

• $ide Eects other/4 diUculty urinating,consti"ation

• aution4 do not ta-e 'ith other drugs that also1K© Paradigm Publishing, Inc.



Obesity

;rugs for Obesity4 i"ase Inhibitor• Mechanism of Action4 "reents enLymes in the

intestines from brea-ing do'n fats into a formthat can be absorbed

9at then "asses through intestines out of therectum

• Indication4 "atients 'ho are oer'eight

•

outes4 all are oral• $ide Eects common/4 fatty or oily stools,

fecal incontinence or urgency, gas, diarrhea

• aution4 "otential itamin deciencies

!echnicians can hel" "atients locate a




Your Turn

uestion K4 +hat is the reason enteral feeding is"referred to "arenteral feeding

Ans'er4 Enteral feeding -ee"s the 0I tractfunctional and "reents abdominal infections.

uestion 24 A "hysician is 'riting an order for drugthera"y for a morbidly obese "atient 'ho 'ants tolose 'eight. !he "atient is already ta-ing anantide"ressant that 'or-s by increasing the amount

of serotonin in the brain. +hat drug thera"y 'ill notbe "rescribed +hy

Ans'er4 An a""etite su""ressant 'ill not be"rescribed. If ta-en 'ith the antide"ressant,

serotonin syndrome, a serious side eect, couldresult.1#© Paradigm Publishing, Inc.



Herbal and Alternatie !hera"ies

• 9iber is a natural substance in fruits andegetables

reates a sense of fullness and s"eeds 0ImotilityD this limits fat and calorie absor"tion

Produces la&atie eects, lo'ers cholesterol,"romotes colon health

• E"hedra also -no'n as ma huang/ is bannedfrom sale in the :nited $tates

It is a N$ stimulant 'ith anore&iant eects

$erious eects, and een death, occurredfrom O! use




ummar!• Estimate body com"osition by com"aring A%+

to a calculated I%+ or by determining %MI

•

ecommended daily inta-e alues are"ublished for all itamins and minerals

• A lac- of itamins can cause illness

• !o&icity can occur 'ith e&cess of fatsoluble

itamins or some minerals• Enteral and "arenteral nutrition used for

malnutrition

• A""etite su""ressants and li"ase inhibitors are

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