• Nutrition
• Skin and Wound Care
• Fluid and Electrolyte Balance

• Used for energy
• Carbohydrates
• Proteins
• Fats (Lipids)

• Vitamins
  -Fat Soluble
  -Water Soluble
• Minerals
  -Major Minerals
  -Trace Minerals
• Water 

• DRI for is 40% - 65%
• Carbohydrate contains 4 kcal/gram
• Functions include:
  -provide energy for metabolism
  -fuels energy for muscle and organ function
  -sole energy source for brain
  -helps regulate protein and fat metabolism 

• Monosaccharides
  -Glucose (blood sugar)
  -Fructose
• Disaccharides
  -Sucrose (table sugar)
  -Lactose (milk sugar) 

• Polysaccharides
• Starch
• Glycogen (stored in liver, muscles)
• Fiber (undigestible, body can't break down)
  -Soluble (lowers blood sugar, lowers cholesterol)
  -Insoluble (aids in digestion)
  (whole grains take longer to break down, 1/2 of starches should be whole grains) 

• Tissue building - Protein is the structural material of every cell in the body.
• Metabolism (Enzymes)
• Immune system (Lymphocytes, antibodies)
• Fluid Balance - Because they attract water, proteins in cells and the bloodstream help regulate fluid balance.
• Acid-Base Balance - Blood proteins function as buffers, helping to regulate acid- base balance.
• Secondary Energy Source - proteins can be broken down to provide energy when stores of the other energy nutrients are inadequate

• Amino acids are building blocks of proteins
• 20 amino acids
• Essential Amino Acids - must come from diet, body cannot manufacture
• Nonessential Amino Acids - easily synthesized in body
• Complete Proteins - contain all the essential amino acids, from animal products
• Incomplete Proteins - from nuts, grains, legumes - do not contain all the essential amino acids in one food, but can combine foods to provide all the essential amino acids (beans & rice, peanut butter on whole wheat bread)

• Nitrogen balance occurs when intake and output of nitrogen are equal.
• Positive nitrogen balance exists when nitrogen intake exceeds output, making a pool of amino acids available for growth, pregnancy, and tissue maintenance and repair.
• Negative nitrogen balance exists when nitrogen intake is lower than nitrogen loss. This occurs in illness, injury ( e. g., burns), and malnutrition.

• 4 kcal/gram
• DRI for adults is 10% - 35% of calories

• concentrated form of energy 9 kcal/gram
• supplies tissue needs (hormones, cell membrane, protection, insulation, covers nerve fibers, absorption of fat soluble vitamins)
• enhance flavor, texture, and satiety
• diet high in fat is linked to cardiovascular disease, hypertension, and diabetes mellitus
• no more than 20% - 35% of calories should come from fat (10% or less from saturated fat)

Polyunsaturated fatty acids contain two or more unfilled spots for hydrogen. At the spot( s) where the molecule does not have a hydrogen attached, it becomes kinked and does not pack together. This is why these fats are liquid at room temperature.

(found in plant oils)

• A waxlike substance needed for the formation of cell membranes, vitamin D, estrogen, and testosterone. Cholesterol is synthesized in the liver, and it is also found in animal foods.
• Very Low Density Lipoprotein (VLDL) - carries triglycerides to tissue
• Low Density Lipoprotein (LDL) - "bad" cholesterol
• High Density Lipoprotein (HDL) - "good" cholesterol, removes cholesterol and returns to liver

-the body cannot manufacture it

-its absence creates a deficiency disease

-linoleic acid (omega- 6)

-alpha- linolenic acid (omega- 3)

-help protect against heart disease

-Omega-6 fatty acid is found mainly in polyunsaturated vegetable oils, nuts, and seeds.

-Omega-3 fatty acid can be obtained in adequate amounts by eating fatty fish (e.g., tuna, shellfish) twice a week

• do not provide energy
• important for metabolism, enzyme reaction, break down nutrients
• some are water soluble, some are fat soluble

• 13 essential vitamins, build and maintain tissues
• Water Soluble
  -excreted in urine, must have every day
  -Vitamin C and B Complex
• Fat Soluble
  -stored in fat, don't need every day
  -since stored, levels can become toxic
  -Vitamins A, D, E, K 

• Pellagra: A disease caused by a deficiency of niacin and protein in the diet and characterized by skin eruptions, digestive and nervous system distrubances, and eventual mental deterioration
• Beriberi: A disease caused by a deficiency a thiamine, endemic in eastern and southern Asia and characterized by neurological symptoms, cardiovascular abnormalities, and edema
• Scruvy: A disease that occurs when you have a severe lack of vitamin C (ascorbic acid) in your diet. Causes general weakness, anemia, gum disease, and skin hemorrhages
• Rickets: A softening of bones in chidren due to deficiency or impiared metabolism of vitamn D, phosphorus or calcium, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries
• B12 and Pernicious Anemia
• Folic Acid and Megaloblastic Anemia

Function: Night and color vision, Cellular growth and maturity, Maintaining healthy skin and mucous membranes, Growth of skeletal and soft tissues, Reproduction

Sources: Fish liver oil, liver, butter, cream, egg yolk, yellow fruit, green leafy vegetables, fortified milk

Effects of Deficiency: Night blindness, xerosis, xerophthalmia, keratomalacia, skin lesions

Function: Collagen synthesis, “ Cementing” substance for capillary walls, Antioxidant, Iron absorption, Immune function

Sources: Citrus fruits, tomatoes, potatoes, green vegetables, cauliflower

Effects of Deficiency: Anemia, tissue bleeding, easy bone fracture, gingivitis, petechiae, poor wound healing, joint pain, scurvy

Function: Regulates blood calcium levels. Regulates rate of deposit and resorption of calcium in bone.

Sources: Fish liver oil, fish, fortified milk, sunlight exposure

Effects of Deficiency: Bone and muscle pain, weakness, softening of bone, fractures, rickets

• Function: Synthesis of clotting factors, Bone development
• Sources: Green leafy vegetables, liver (Intestinal bacteria synthesize a form of vitamin K, so deficiency is unlikely.)
• Effects of Deficiency: Increased bleeding

• Function: Cellular metabolism (producing energy from glucose and storing energy as fat), Nervous system function, Gastrointestinal system function, Cardiovascular system function
• Sources: Whole grain, enriched cereal, beef, pork,liver, peas, beans, nuts
• Effects of Deficiency: Peripheral neuritis, loss of muscle strength, depression, memory loss, anorexia, constipation, dyspnea, decreased alertness and reflexes, fatigue, irritability, beriberi

• Function: Cellular metabolism to produce energy
• Sources: Enriched breads and cereals, chicken, tuna, liver, peanuts, dairy products
• Effects of Deficiency: Weakness, poor appetite, indigestion, dermatitis, diarrhea, headache, dizziness, insomnia. Chronic: CNS damage (confusion, neuritis, dementia), pellagra

• Function: Metabolic reactions, Maintain myelin sheath, Hemoglobin synthesis
• Sources: Dairy products, meat, poultry, fish, liver, milk, cheese, eggs
• Effects of Deficiency: Pernicious anemia, irreversible nerve damage, memory loss, dementia

• Function: Cellular metabolism, Neurotransmitter synthesis, Cell division, DNA synthesis, Hemoglobin formation
• Sources: Green leafy vegetables, asparagus, liver, yeast, eggs, beans, fruits, enriched cereals
• Effects of Deficiency: Megaloblastic anemia, neural tube defects

• Function: Synthesis of hemoglobin, general metabolism (e.g.,of glucose), antibody production, drug detoxification in the liver
• Sources: Meats, eggs, spinach, seafood, broccoli, peas, bran, enriched breads, fortified cereals
• Effects of Deficiency: Small, pale RBCs, anemia

• Function: Increases resistance to dental caries
• Sources: Fluorinated water, toothpaste, dental treatment, seaweed, fish, tea
• Effects of Deficiency: Increased dental caries

• Function: Cofactor for many enzymes involved in growth, insulin storage immunity, alcohol metabolism, sexual development and reproduction
• Sources: Primarily meats and seafood; also legumes, peas, and whole grains
• Effects of Deficiency: Skin rash, diarrhea, decreased appetite, hair loss, poor growth and development, poor wound healing

• Trace minerals are essential, but in a lower concentration.
• copper, fluoride, iodine, iron, zinc

• Major minerals (macrominerals) are minerals that the body needs in amounts of 100 mg/ day or greater.
• calcium, magnesium, phosphorus, potassium, sodium

• Metabolism
  -Basal Metabolic Rate (BMR) or Resting Energy Expenditure (REE) - what is used at rest, 66% of total energy requirements are used for BMR- lean body tissue burns more at rest that fat - proteins and carbs take more energy to burn 
  -Thermic Effect of Food - The heat produced by the body after a meal
  -Physical Activity - few people burn more due to physical activity than from BMR
• A person's total energy requirement is the number of kcalories necessary to replace those used for basic metabolism plus those used for physical activity 

• Energy expenditure decreases during food restriction or starvation and calories are burned more efficiently (when you cut calories, metabolism slows down, also slows down if you are sedentary)
• BMR or REE affected by body composition, growth periods, body temperature, environmental temperature, disease processes and prolonged exercise (when someone has a fever, must supply more nutrients - "feed a fever")

• a person can be malnourished with regards to certain nutrients without being underweight
• protein-calorie malnutrition leads to muscle and fat wasting, lethargy, weight loss, weakened immunity, risk for infection, changes in mental status, edema, pressure ulcers and delayed wound healing
• The prevalence of malnutrition in hospitalized patients reported as between 37% - 62% depending on criteria used

• dietary intake
• diseases, physical limitations
• psychological
• special diets (vegetarianism, weight loss, physician ordered)
• medications, smoking, alcohol
• financial and physical limitations
• culture

• sensory deficit
• gastrointestinal
• psychological or social isolation
• financial barriers
• chronic illnesses
• increased fat deposits/decreased muscle mass