护理学临床营养学（Nursing, clinical nutrition）

1、护理学临床营养学（Nursing, clinical nutrition）Chapter 1 Nutrition FoundationI. carbohydrates1. nutrition significance(1) supplying energy (1 grams of carbohydrates can produce 4kcal energy in the body)(2) it is important to maintain the function of nerve tissue(3) to take part in constituting an important co

2、mponent of the organism(4) regulate blood sugar and nitrogen and antiketogenesis2. sources: Cereals, tubers, root vegetables, legumes, and starchy nuts3. of the total carbohydrate energy supply was 55% - 60%Two, protein1. nutrition significance(1) constitute the body tissues and important substances

3、(2) providing the body nitrogen source(3) providing essential amino acids2. animal food protein content is high, vegetable food protein content is low3. amino acid pattern: the ratio of various amino acids in proteins4., high-quality protein: food, protein, amino acid patterns closer to the amino ac

4、id pattern of human proteins, the protein is more easily absorbed by the human body.5. protein complementation: the essential amino acid pattern of animal protein is close to that of human amino acid model, while the content of lysine in rice and flour is low, and the content of methionine in soybea

5、n is low. If rice or flour is eaten with soybean, the amino acids in the two foods can be added to each other.6. protein digestibility: the extent to which proteins are decomposed under the action of digestive enzymes in vivo.7. protein biological valence (BV): the extent to which the protein is ret

6、ained by the body after absorptionNet utilization of protein (NPU): the availability of proteins in the bodyProtein efficiency ratio (PER): the extent to which proteins are utilized by the bodyPER= (increase in body weight per gram) / intake of food protein gram8. source: animal food, such as meat (

7、poultry, livestock, fish), milk, eggs, beans and soy products (the highest content in soybeans)9., the recommended intake of protein in China generally accounts for 10% of the total energy - 15%10.1 grams of protein production capacity 4kcalThree, fat (fat and lipid collectively)1.1 grams of fat oxi

8、dized in the body to produce 9kcal energy2. essential fatty acids: linoleic acid (peanut four acid) and linolenic acid (twenty-two carbon six acid DHA)3. fat provides 20% of the total energy - 30%, the smaller the age, the higher the fat supply ratio, so there is no limit to the amount of fat intake

9、 for teenagers and childrenFour, energy1. the energy needed by the human body is expressed in terms of joule or coke in the world. In the past, nutrition was expressed in cal or kcal2. the energy expenditure of the human body is mainly used to maintain the basal metabolism, meet the special needs of

10、 the food and the three aspects of physical activities3. basal metabolism is affected by some factors P84., dietary energy comes from carbohydrates, fats, and proteins in foods. These three nutrients are called heat producing nutrients5. recommended energy intake is based on labor intensity, gender,

11、 and ageFive vitaminsDivided into fat soluble and water-soluble two major categories, fat soluble vitamins are vitamins A, D, E, K(I) fat soluble vitamins;1. vitamin A (retinol)(1) typical manifestations of vitamin A deficiency:Dark adaptation ability, night blindness and dry eye syndrome; mucosa, e

12、pithelium (rough, dry, and squamous keratosis change)(2) the source of animal food (animal liver, egg, milk and its products and Cod Liver Oil) and plant foods (B- carotene and various carotenoids, green leafy vegetables, yellow vegetables and fruit was higher, such as broccoli, spinach, pea sprouts

13、, leek, carrot etc.)2. vitamin D(1) from vitamin D in the skin, from food intake and exposure to sunlight(2) lack of vitamin D;Causing absorption of calcium and phosphorus decreased and serum calcium decreased;Effect of bone calcification, induced osteomalacia, rickets in infants prone to deformatio

14、n, (Fang Lu, chicken breast, pectus excavatum, X leg, O leg), showed the bones become soft, easy to bend, deformity;It affects the function of nerve, hematopoiesis, immunity and other organ tissues;Osteomalacia in adults,But the phytic acid, oxalic acid and tannin in the plant inhibit the absorption

15、 of iron3. iodine(1) iodine deficiency can cause goiter (and regional, in Chinas remote areas and mountainous area more popular), or cretinism cretinism: iodine deficiency occurs in the fetal and newborn infants and infants can cause growth retardation, mental retardation, and even dementia, deaf mu

16、te (Note: dwarf hypopituitarism)(2) high iodine content of food is seafood such as kelp, seaweed, mussels, sea cucumber, salt also contains a small amount of iodineSeven, waterThe daily water requirement of adults is 2500mlEight, dietary fiber1. nutrition significance(1) prevention of constipation a

17、nd colorectal diseases (2), prevention of cancer (3), prevention of cardiovascular disease and cholelithiasis (4), prevention of obesity2. come from plant foods, such as rhizomes and leafy greens, fruits, Cereals, legumes, etc.The second chapter nutrition of healthy populationI. food classification1

18、. cereals and tubers 2. animal food 3. beans and their products 4. vegetables and fruits 5. pure energy foodTwo. Characteristics of all kinds of nutrients P26Three. Dietary structureThe diet structure of food balance between 1. animals and plants is represented by Japanese diet2. most of the develop

19、ing countries belong to this kind of dietary structure, which is characterized by large consumption of cereals3., animal food based diet structure, most developed countries such as Europe and America belong to this category4. Mediterranean diet structure unique to living in the Mediterranean residen

20、ts, is rich in dietary plant foods, food processing and low degree of freshness of high saturated fat intake; low (low incidence of cardiovascular and cerebrovascular diseases)Four, diet pagodaFats and oils 25g;Dairy and dairy products 100g, pulses and soy products 50g;Meat fish eggs 25-50g 50g 50-1

21、00gVegetable fruit 100-200g 400-500gCereal 300-500gFive, a balanced diet: also known as reasonable diet, nutrition refers to the diet can provide the body range, sufficient quantity, appropriate proportion of various nutrients and energy, and keep the balance and the need of the body.Six. Nutrition

22、for infants and young children1., from birth to 3 years of age for infants and young children (from birth to 28 days for the neonatal period, 28 days to 1 years of age after birth for the baby phase, 1-3 years old for early childhood)2. advantages of breastfeeding(1) breast milk contains rich nutrie

23、nts, the most suitable for infant growth and development, high protein content, and rich in immunoglobulin, to protect the health of infants and young children is very beneficial(2) the protein in mature milk is mainly whey protein, which is beneficial to digestion and absorption of baby(3) the comp

24、osition and proportion of essential amino acids are suitable for infants and young children(4) breast milk contains rich lactose, and more unsaturated fatty acids, especially linoleic acid and DHA, have a certain effect on the development of infantile nervous nucleus(5) the utilization ratio of iron

25、 and zinc in breast milk is higher than that in milk. The calcium content in breast milk is not high, but the proportion of calcium and phosphorus is appropriate, and it is easy to absorb(6) effects of vitamin nutritional status and dietary status of nurse hands, in addition to vitamin D, can meet t

26、he needs of infants at the age of June(7) breast milk also contains a variety of biologically active substances, can enhance the resistance of infants to disease(8) breastfeeding can promote the communication between mother and baby, emotion and postpartum rehabilitation of the mother. It is economi

27、cal, convenient and suitable for breast feeding3., the addition of auxiliary foodNeonatal 2-4 week added a small amount of vitamin D; 5-6 weeks to add rich in vitamin C, fruit juice, vegetable juice; 3-4 iron containing foods such as meat, egg yolk, and iron fortified live paste material; 5-6 may ad

28、d starchy food such as porridge, baby cake etc. semifluid food; 6-8 can add to chew food to exercise, teeth and chewing muscles; the age of edible meal with food (such as wonton. Dumplings and other meat food); after the baby is weaned, drink at least 220ml of fresh milk every day; the diet of infan

29、ts and young children is dominated by Cereals, and the meals are arranged at two meals and two mealsSeven. Nutrition for childrenOneThe child is divided into two stages, 3-6 years of age for preschool children and 6-12 years for school-age childrenEight, teenagers nutrition1. energy adolescents need

30、 more energy than adults, and the daily supply exceeds those for light manual labor2., the protein needs to increase especially prominent, 80-90g per day, of which high quality protein accounted for 40%-50%The diet should be full of animal food and beans and its products3. minerals on the calcium ir

31、on requirements increase, the daily supply of calcium and phosphorus were 1000-1200mg, iron supply more women than menEight, adult nutrition1. energy and energy intake should be appropriate. The older you are, the less energy you need2. protein in ensuring protein supply based on the proper choice o

32、f high-quality protein (accounting for 30% of total protein), such as poultry, meat, fish, milk, beans and so on3., fat and carbohydrate fat accounted for energy than in 25%-30% is appropriate, cholesterol (such as animal offal) intake is not more than 500mg per day is appropriateNine, the elderly n

33、utrition (control energy)1. physiological characteristics of the elderly(1) basal metabolic rate decreased(2) the physiological functions of vital organs are decreased (brain, heart, lung, kidney, gastrointestinal tract, etc.)(3) biochemical metabolism, protein catabolism over synthetic metabolism(4

34、) low immune function2. nutritional needs(1) energy should decrease with age(2) protein (appropriate) protein synthesis rate decreased, catabolism higher than synthetic metabolism, prone to negative nitrogen balance. Therefore, the need for the amount of protein in elderly patients should not be les

35、s than the adults, especially the essential amino acids such as methionine, lysine requirements increase, the general elderly protein 1.0-1.2/kg weight in the supply of high-quality protein, accounting for 1/3, 12%-14% is better than protein energy.(3) fat intake should not be too high, so as to mak

36、e up 20%-25% of the total energy, the edible oil should be made of vegetable oil, and the dietary cholesterol should be controlled at 300mg/d(4) carbohydrates, elderly people should not take too much sucrose and starch, easy to eat more fruits and other fructose containing foods(5) mineral elderly a

37、ppropriate calcium and vitamin D, otherwise prone to osteoporosis; at the same time should pay attention to supplement with heme iron higher food, in order to correct the lack of protein and iron. Elderly people should also reduce the intake of salt, not more than 6G per day is appropriate(6) vitami

38、n supplements A, C, E (anti-aging), B2, folic acidFundamentals of clinical nutritionNutrition investigation consists of four parts: dietary survey, body measurement, clinical physical examination and clinical biochemical test.Two. Dietary survey methodsWeighing method and weighing method is a method

39、 for weighing all the food consumed by a meal unit or individual. It is not suitable for large-scale population investigationThe method for large-scale investigation of various canteensAsk, not hungry for eng weighing method or audit method can be used when questioning, asking respondents daily lock

40、 tongue such as food types, diet habits, understand their food intake, including diet analysis 24 hours review method, diet history method, chemicalThree anthropometric measurements1. refer to body weight (kg) = height (CM) - 1052.BMI BMI = weight (kg) / (height m) 2?Four, hospital meals P57Five 、 e

41、nteral and parenteral nutrition1., when the gastrointestinal tract has function, first use enteral nutrition (shock does not use)2. enteral nutrition infusion(1) single infusion (2) intermittent gravity drip (3) continuous infusion of p643. enteral nutrition nursing p664. parenteral nutrition (intra

42、venous infusion of nutrients)5. indications for parenteral nutrition: Patients with severe gastrointestinal dysfunction or failure. In other words, all patients who need nutritional support and cannot or should not receive enteral nutrition are indications for parenteral nutrition.6. parenteral nutr

43、ition nursing p70The fourth chapter nutrition of common diseasesFirst, nutritional treatment of hypertension1. reduce or limit intake of sodium2. proper increase of potassium and calcium intakeThreeControl energy, avoid high carbohydrate, high fat intakeTwo. Nutrition treatment of peptic ulcer1., nu

44、trition is comprehensive and reasonable2., a small amount of meals, timing quantitative3. appropriate control of the use of general condiments4. slowly, to develop good eating habits5. choose soft and easy to digest, weak stimulation and pay attention to the choice of food cooking methodsThree 、 nut

45、rition treatment of cholecystitis and cholelithiasisChronic cholecystitis is accompanied by cholelithiasis. We should insist on using low fat, low cholesterol and high vitamin diet for a long time1., strictly limit fat2. limit cholesterol and increase the intake of phospholipids properly3. proper en

46、ergy4. suitable carbs5. suitable protein6. rich in vitamins7. a small amount of meals, adequate drinking waterFour, cirrhosis1., nutrition treatment: liver damage is mild, no complications, providing three high, one amount diet, that is, high protein, high energy density, high vitamins and appropria

47、te amount of fat.2., the liver function seriously damaged, the liver can not clear the protein produced in vivo ammonia, resulting in elevated blood ammonia, causing central nervous system ammonia poisoning.In order to alleviate the symptoms of poisoning and prevent hepatic encephalopathy, we should

48、 strictly limit the intake of protein, and select the food with less quantity, high quality and less ammonia. The supply of daily protein should be limited to 50-55g, the source of the heat to carbohydrate based, accounted for the total energy of 70%-75%, at the same time avoid eating rich in aromat

49、ic amino acid foods (such as the skin of the chicken, pork, mutton, beef, rabbit, etc.), increase the intake of branched chain amino acids (such as milk, soya beans, red dates etc.)3. cirrhosis with ascites should strictly limit the intake of sodium,4. of esophageal and gastric varices diet should b

50、e soft and easy to digest, less stimulation, avoid all food, hard and rough, to prevent varicose of esophageal variceal bleeding.Five 、 nutrition treatment of acute glomerulonephritis1. low protein2. limit sodium salt and water3. limit potassium intake4. proper energy5. plenty of carbs6. proper fat7

51、. provide adequate vitamins and mineralsSix. Nutritional treatment of nephrotic syndromeAdequate heat, proper protein and fat, low salt or salt free dietSeven. Nutritional treatment of iron deficiency anemia1., increase the intake of animal food appropriately2., increase the intake of green leafy ve

52、getables3. avoid food interference4., iron should be supplemented at the same time, copper, while avoiding calcium, zinc and clothesEight, gout1. gout is a group of diseases caused by long-term abnormal purine metabolism and increased serum uric acid. The clinical features include hyperuricemia, acu

53、te arthritis, recurrent attacks, gout stones, joint deformities, and gouty nephropathy.2. nutritional treatment of gout(1) limit total energy and reduce carbohydrate intake(2) limit protein, low fat diet(3) strict control of purine diet, daily purine quantity should be strictly controlled within 300

54、mg, should be recommended purine containing little food, such as cereals, dairy, eggs, vegetables, fruits.(4) drink more water, avoid drinking, gout patients should insist on drinking more water, daily about 2000-3000ml, with the discharge of diuretic acidNine. Nutrition treatment of obesity1. contr

55、ol heat energy2. limit carbohydrates3. protein guarantee4., strict control of fat, fat supply should be at the total energy of 20%-30%5. vitamins and trace elements6. take part in more sportsTen. Nutritional treatment of osteoporosis1. ensure the normal intake of calcium in China recommended daily calcium intake for children, adults with 800mg, 600-1000mg, pregnant women and lactating 1000-1200mg, aged