GI/GU: Nutrition

Nutrition is defined as the process of obtaining food and using it for maintenance, growth, and repair. It can be broken down into ingestion, or taking in food; digestion, or breaking it down into nutrients; absorption, or pulling those nutrients into the bloodstream; and, finally, metabolism, or turning these nutrients into energy.

This energy is calculated in units known as kilocalories, or simply calories. Nutrients found in food can be divided into two groups.

The first includes carbohydrates, proteins, and fat which provide energy; while the second group, including minerals, vitamins, and water, offers no energy but is still essential for normal body function.

Starting with carbohydrates which are found almost everywhere from fruits and vegetables to dairy and grains. They are one of the main sources of energy in the body, providing 4 calories per gram.

There are simple carbohydrates or sugars that the body can readily absorb and the most important of these is glucose. Complex carbohydrates, or starches, take longer to break down and absorb.

There are also dietary fibers which are found mostly in fruits, vegetables, legumes, bran and oats. Fibers are carbohydrates that intestinal enzymes can’t break down at all, so they pass through the intestine undigested and ultimately end up as bulk matter in the stool.

In this way, they help increase stool weight and prevent constipation. Next, proteins can be found in many animal products, like dairy, meat, poultry, and eggs as well as plant-based products, like beans and peas, soy, nuts, and seeds.

Just like carbohydrates, each gram of protein provides 4 calories. At the same time, though, proteins can be broken down into amino acids which we largely use to make our own proteins as well as hormones and other molecules needed for the immune response or tissue repair.

Fats or lipids are found in oils, butter, avocados, and meats. They are a major source of energy, providing 9 calories per gram but also a critical component of cells and tissues.They help absorb essential vitamins, known as fat-soluble vitamins, and can be converted into other molecules like prostaglandins which help cells communicate with one another.

Moving on to the next group of nutrients: minerals. These include calcium, phosphorus, iron, iodine, sodium, and potassium and have various roles in the body, like building strong teeth and bones, producing enzymes and hormones, and maintaining proper function of the heart, brain, and muscles.

Vitamins can be categorized as either water-soluble or fat-soluble. Water-soluble vitamins include vitamin C and B-complex vitamins which are readily absorbed into the circulation but aren’t stored anywhere.

This means any additional amount consumed can get easily excreted. On the other hand, fat-soluble vitamins include vitamins A, D, E, and K.

These are absorbed along with fat and are then stored in the body’s fatty tissue and liver for future use. But since they don’t dissolve in water, they can’t be easily excreted in the urine.

So if you take too much, they could build up and become toxic. Finally, water is essential for human life.

About 80% of our water intake comes from drinking fluids; the other 20% comes from the food we eat. It makes up for more than 50% of a person’s body weight, and it’s directly involved in every biochemical reaction in our body.

Water helps lubricate the pleural and pericardial cavities in the chest and the peritoneal cavity in the abdomen where internal organs touch and slide over one another.

It’s also needed in joints where it helps form the synovial fluid that keeps our bones from rubbing against one another.

Water is critical for digestion: The water in saliva moistens food when we chew, while gastric and intestinal juices are a fluid environment in which digestive enzymes break down our meals.

Water forms the bulk of blood which allows oxygen and nutrients to easily move around the body and plays a role in eliminating toxins from the body through urination and defecation.Water also helps regulate body temperature: When we’re hot, like during a vigorous workout, the capillaries in our skin dilate and sweat glands produce more sweat to help dissipate heat.A balanced diet is the one that supplies the body with an adequate quantity of the nutrients it requires to function properly.

This is essential for maintaining both physical and mental health, a healthy body weight, better sleep, and boosting the immune system.

It’s also essential for preventing various health conditions, such as obesity, heart disease, diabetes, some types of cancer, and bone diseases.

There are several ways to help someone keep a balanced diet, like reading the nutritional label on packaged food and referring to MyPlate which stresses the consumption of a wide variety of foods from all five major food groups: grains, fruits, vegetables, milk, and meat.Now, there are many other factors that can affect what and when a person wants to eat, ranging from personal taste, hunger, and the ability to cook to budget issues and religious or cultural traits.Now, in some facilities, a nurse carries out a dietary assessment, noting the client’s eating patterns and food likes and dislikes.

This is then used by a dietitian, meaning a nutrition specialist, to design a personalized, healthy, and sustainable diet plan.

Keep in mind for some clients: It's necessary to provide additional supplements outside regular meals. Most clients require a regular or “house” diet with no restrictions on food, spices, or sauces.

But depending on the medical condition of the client, a special diet might be required. For example, a mechanical diet avoids foods that are hard to chew and swallow, like raw veggies and steaks.

In a pureed diet, all food has been blended to become “pudding-like”: smooth and moist. This is recommended for those who have trouble chewing or swallowing, are very ill, weak, or elderly.

Next, a carbohydrate-controlled diet restricts the consumption of carbohydrates and is applied to those with diabetes. Clear liquid diets include water; gelatin; fat-free broth or bouillon; popsicles; apple, cranberry, or grape juice; clear carbonated sodas; and plain coffee or tea.

These are recommended only temporarily for certain clients, like those with nausea or vomiting or recovering from surgery, acute disease, or trauma.

Full liquid diets include clear liquids as well as milk, plain frozen desserts, cereals, strained soups, and juices. These are more nutritious than clear liquid diets but should still not be followed for more than 3 days without a liquid supplement that’s high in calories and proteins.

Sodium-restricted diets include little to no salts and are recommended for those with kidney or heart conditions or high blood pressure.

Some of these clients might be allowed to use salt substitutes instead. A high-fiber diet focuses on regular consumption of fiber-rich foods, like fruit, vegetables, legumes, bran, and oats to relieve constipation.

In contrast, a low-fiber or low-residue soft diet replaces high-fiber with low-fiber foods like white bread, pasta, and rice in order to decrease the amount of stool and give the gastrointestinal system a break.

This is usually ordered for clients with severe diarrhea, abdominal pain, or cramping. Finally, low-cholesterol diets are often ordered for individuals with heart disease.

This means replacing foods that are high in cholesterol like butter, stick margarine, mayonnaise, and coconut oil with low-fat ones like fruit, vegetables, whole grains, nuts, and seeds.Mealtime can be really challenging for clients in healthcare facilities.

This could be because they crave the foods they are used to and dislike the food being served, the way it’s cooked, or the time they’re served.

If they have to eat in their room, they may feel lonely and miss their loved ones or their familiar dining room. Their appetite might also be affected by physical factors, like digestive issues or psychological ones, like depression or anxiety.

On top of that, it’s possible that the person feels self-conscious because they can’t eat without help. Now, as a nursing assistant, you need to make sure that the client enjoys their meal time as much as possible.

To do that, first check that the meals follow the nutritional guidelines for every client and, at the same time, suit their personal preferences and religious and cultural characteristics, while avoiding any allergies or intolerances.

To maintain their appetite, it may also be a good idea to provide them with a little bit of the foods they like the most as often as possible during their day.

Make sure to serve food as soon as it’s ready, so that serving temperature is optimal. That’s important not only for food to taste good but to also keep it safe from bacteria.

Visually attractive plates also tend to be more appetizing. Whenever possible, let the client eat in the dining room together with others.

However, in some cases, like clients who feel self-conscious about chewing or have feeding difficulties, it might be best to provide a private place.

In any case, ensure they have proper oral hygiene, their position is comfortable, and their glasses or hearing aids are properly positioned if they use any.

Finally, try to create a friendly atmosphere, keep them company, and help them as much as they need.Alright, as a quick recap… Maintaining a balanced and varied diet ensures an individual receives all essential nutrients, including carbohydrates, proteins, lipids, minerals, vitamins, and water.

Eating habits may vary depending on many factors, like personal preferences and religious and cultural characteristics. These are taken into account by a dietitian when a new client is admitted to a facility in order to design an ideal meal plan.

Depending on their medical conditions and needs, some clients may need special diets, like mechanical, pureed, carbohydrate-controlled, clear- or full-liquid, sodium-restricted, or low cholesterol.

In any case, nursing assistants need to do their best to make meal time as pleasant as possible for their clients.