TheRoleofNutritioninOurHealthChapter16DietandNutrition教學目標掌握：1.基本飲食、常見治療飲食的原則和方法

2.營養(yǎng)評估方法。

熟悉：飲食護理的主要措施。

了解：實驗飲食的意義、方法

Contents4Thebasicofnutrition1235

HospitaldietsGeneralnursingofnutritionWhydoweeatfood?Whatarenutrients?Whatarethefunctionsofthem?Howisenergymeasured?Whydoweeatfood?Weeatfoodbecauseourbodyneed:EnergyCompoundsforgrowth,repairandreproduction.Substancestoregulatetheproductionofenergy,growthandrepair.WhatAreNutrients?Nutrients:thechemicalsinfoodsthatarecriticaltohumangrowthandfunction.carbohydrates fatsandoils proteins vitaminsmineralswater

1.Carbohydrates（碳水化合物）Functions:Provideenergy:Primarysourceoffuelforthebody,especiallyforthebrain.CompositionofbodytissuesProtectliverfromdetoxification(保肝解毒作用)Carbohydratesarefoundingrains(wheat,rice),vegetables,fruits,andlegumes.2.Proteins（蛋白質(zhì)）Functions:CellandtissuegrowthandrepairCompositionofenzymes（酶）,hormone（激素）,andantibodys（抗體）Keepplasmcolloidosmoticpressure(血漿膠體滲透壓）ProvideenergyProteinsourcesincludemeats,dairyproducts（乳制品）,seeds,nuts,andlegumes（豆制品）3.FatsandOils（脂肪）FunctionsProvideandstoreenergyCompositionofbodytissueProvideessentialfattyacid(供給必需脂肪酸)KeeptemperatureProtectorgansAcceleratefat-solublevitaminsabsorption(促進脂溶性維生素吸收)Foundinbutter,margarine（人造黃油）,vegetableoils.4.Vitamins（維生素）Functionsassistinregulatingbodyprocesses.Fat-solublevitamins：VitaminsA,D,EandKWater-solublevitamins：VitaminC，B1

HowdowecookCarrot?5.Minerals（礦物質(zhì)）calciumphosphorusmagnesiumsodiumpotassium

ironzinccopperIodinefluoride.FunctionsMineralshavemanydifferentfunctionssuchas：

fluidregulation,bonestructure,musclemovement,andnervefunctioning.6.WaterFunctions：

Waterisinvolvedinmanybodyprocesses:fluidbalance nutrienttransportnerveimpulses removalofwastesmusclecontractions chemicalreactionsmany,manymore…

Waterisacriticalnutrientforhealthandsurvival.WhatAreNutrients?1.Macronutrients(常量元素）:nutrientsrequiredinrelativelylargeamounts.ProvideenergytoourbodiesCarbohydrates,fatsandoils,proteins2.Micronutrients（微量元素）:nutrientsrequiredinsmalleramounts.VitaminsandmineralsHowisenergymeasured?Wemeasureenergyinkilojoules(KJ)

or

kilocalories(kcal).Kilocalorie:amountofenergyrequiredtoraisethetemperatureof1gofwaterby1oC.

1Kcal=0.24KJThestandardofenergyproviding:

Adultmale：10.0~17.5MJ/d(2400~4200Kcal)Adultfemale：9.2~14.2MJ/d(2200~3400Kcal)-----ChineseNutritionInstitutionTheratioofthreemajornutrients

in

energysupply：

Protein：10～14％

Fat：20～25％

Carbohydrate：60～70％

DietaryguidelinesAslongashumankillanimals,theywillalsokillanotherhumans.——Pythagoras(畢達哥拉斯）GreekphilosopherProteinsareaprimaryenergysourceforourbodiesTrueFalseAllvitaminsmustbeconsumeddailytosupportoptimalhealth.TrueFalseSection2

HospitaldietsChapter16DietandNutritionHospitaldietsBasicdiets123Therapeutic

dietsTestdiets（selfstudy）Part1:BasicdietsGeneraldiet(普通飲食)Softdiet(軟質(zhì)飲食)Semi-liquiddiet(半流質(zhì)飲食)Liquiddiet(流質(zhì)飲食)ToclassifythefoodsbelowRiceporridge(粥）,dumpling（餃子）,bean-curd（豆腐）,noodle（面條）Steamedbread（饅頭）,fruitjuice（果汁）vegetablesoap（蔬菜湯）,Beanmilk（豆?jié){）,

ToclassifythefoodsbelowSoftdiet:Steamedbread,vegetablesoap,Semi-liquiddiet:Riceporridge,dumpling,bean-curd,noodleLiquiddiet:Beanmilk,fruitjuice1.Generaldiet1.ApplicableclientsClientswithnormaldigestiveandabsorption,withoutspecialrequest.2.Principlebalanceofnutrientsattentiontocookingmethodslessspicy,friedfood3.Methods3meals/day

9.5-11MJ/d(2300~2600Kcal/d)protein:70-90g/d2.Softdiet1.ApplicableclientsHavingdifficultyinchewing:oraldiseaseGastrointesinalfunctiondisorders（胃腸功能減弱或失調(diào)）:elders,infants,feverpatients,thoseduringpostoperationrecovery.2.Principlebalanceofnutrientseasilychewed,softnotstimulating3.Methods3-4meals/day

8.5-9.5MJ/d

(2000~2300Kcal/d)protein:60-80g/d4.Referencenoodle,dumpling,steamedbread

3.Semi-liquiddiet1.ApplicableclientsHavingdifficultyinchewingandswallowing:oraldiseaseGastrointesinalfunctiondisorders:elders,infants,patientswithfeverPatientsduringpostoperationrecovery.2.Principleunbalanceddiet,少食多餐

notstimulating,nocrudefiber,friedfoodandspicycondimenteasilychewedandswallowed,semi-liquid3.Methods5meals/day,200ml/meal

6.5-8.5MJ/d(insufficientenergy,低于正常量）(1500~2000Kcal/d)protein:50-70g/d4.Reference

riceporridge,noodle,bean-curd,chaoshou4.Liquiddiet1.ApplicableclientsHavingdifficultyinchewingandswallowing:oraldiseaseAcutegastrointesinaldisturbances:AcuteGastrointestinalIllness(gastriculcers),Duringpost-operationrecovery(gastrointesinalsurgery,majorsurgery).Incriticalconditions:patientswithultra-hyperthermia,acuteinflammation.BeforesomemajoroperationinGI.2.Principleunbalanceddiet,onlyforshorttimeusenotstimulating,nocrudefiber,friedfoodandspicycondimentliquid3.Methods6-7meals/day,200-250ml/meal

3.5-5MJ/d(低于正常量）(800~1200Kcal/d)protein:40-50g/d4.Reference

milk,beanmilk,fruitjuice,Basicdiets飲食種類適用范圍飲食原則

用法普通飲食不限飲食,病情輕或恢復期營養(yǎng)均衡,易消化蛋白質(zhì)70-90g/d,總熱量9.5-11MJ/d軟質(zhì)飲食消化功能差,術(shù)后恢復者營養(yǎng)均衡,軟易消化蛋白質(zhì)70g/d,總熱量8.5-9.5MJ/d半流質(zhì)飲食消化功能不良,咀嚼不便少食多餐,易于消化蛋白質(zhì)50-70g/d,總熱量6.5-8.5MJ/d流質(zhì)飲食病情危重,急性消化道疾病均成流體,易吞咽蛋白質(zhì)40-50g/d,總熱量3.5-5MJ/dPart2:Therapeuticdiet（治療性飲食）Highenergydiet高熱量飲食（VS:Lowenergydiet)Highproteindiet高蛋白飲食Lowproteindiet低蛋白飲食Lowfatdiet低脂肪飲食Lowcholesteroldiet低膽固醇飲食Lowsaltdiet低鹽飲食Saltfreeandlowsodiumdiet無鹽低鈉飲食Highfoodfiberdiet高膳食纖維飲食

Lowresidueorresiduefreediet少渣或無渣飲食Elementdiet要素飲食

Chosethepropertherapeuticdietforthem

Peoplewhooverweightpeoplewithhighbloodpressurepeoplewithkidneydysfunctionpeoplewhoisdiarrhea1.Highenergydiet1.Applicableclients

withdiseasesofhighconsumptionofenergy：TB，largeareaburns,liverdiseases,hyperthyroidism，hyperthermiaprotein-energymalnutrition,LowBMI,

puerperant(產(chǎn)婦），Duringpost-operationrecovery2.Principle

2moremealsaday:(inadditiontobasicdiet)milk,beanmile,egg,cake,chocolate3000kcal/d

2.Highproteindiet1.ApplicableclientsWithdiseasesoflone-termconsumption：TB，largeareaburns,Nephriticsyndrome,hypoprotein

Protein-energymalnutrition,anemiaBeforeandafteroperation,pregnancyandlactation2.Principle

morehigh–proteinfood:(inadditiontobasicdiet)milk,beanmile,egg,meat1.5-2g/(kg.d),<120g/d2500-3000kcal/d

3.Lowproteindiet1.Applicableclients

Acutenephritis(急性腎炎)Uremia(尿毒癥)Hepaticcoma(肝性昏迷)2.Principle

40g/d(accordingtocondition:20-30g/d)keeptheadequateenergytaking:2200-2600kcal/d

4.Lowfatdiet1.ApplicableclientsCoronaryhearhdisease(冠心病)

Hyperlipemia(高脂血癥)Arteriosclerosis(動脈硬化)Withhepatic,cysticandpancreaticdisease

2.PrincipleTotalfatintake:<50g／d(forhepatic,cysticandpancreaticdisease:<40g，especiallyanimalfat)3.Reference

Restrictintakeofcream,animal’sbrain,yolkandfriedfoodusingvegetableoilinsteadofanimaloil5.Lowcholesteroldiet1.Applicableclients

Coronaryheartdisease(冠心病)Hypercholesterolemia(高膽固醇血癥)Arteriosclerosis(動脈硬化)2.PrincipleTotalcholesterolintake:<300g／d3.Reference

Restrictintakeofyolk,animalviscera,bacon,fat,animaloilusingvegetableoilinsteadofanimaloil6.Lowsaltdiet1.ApplicableclientsAcuteofchronicnephritis(急慢性腎炎)Cardiovasculardisease(心血管疾病)cirrhoticascites（肝硬化伴腹水）2.Principle

Totalsaltintake:<2g／d(exceptfornaturalsodiumchloride)Forbiddenallkindsofreservedorbaconfood7.Saltfreeandlowsodiumdiet（無鹽低鈉飲食）1.Applicableclientssameasthoseoflowsaltdiet,inadditiontosevereedemaclients2.Principle

Nosaltincooking,

Totalsaltintake:<0.5g／dHigh-sodiumfoodsuchasalkalinefood,soda,carbonateddrinksisforbidden.8.Highfoodfiberdiet（高膳食纖維飲食）1.ApplicableclientsConstipation便秘

Obesity肥胖癥

Hyperlipidemis

高脂血癥

Diabetes糖尿病2.Principle

Highfiberfood3.Reference

suchasleek,celery,cabbage9.Lowresidueofresiduefreediet（少渣或無渣飲食）1.Applicableclientsthoseneedtolimitthemovementofboweltorecovery:diarrhea(腹瀉）,enteritis,typhoid(傷寒）,dysentery(痢疾）,gastrointestinaloperation,rectumandanusoperationthoseneedtoreducethestimulationtopreventbleeding:

gastroesophageal

varication(食道靜脈曲張）2.Principle

Highfiberfoodandhardfoodisisforbiddenorrestricted.(Forresiduefree,forbiddenmilk,puree果泥，etc）

RestrictoilNotforlongtimeuse3.Referenceforbiddenorrestrict:roughage(粗糧）,bambooshoot,leek（韭菜）10.Elementaldiet（要素飲食）

是一種營養(yǎng)齊全、溶水后不需或稍經(jīng)消化即可吸收的無渣飲食（不含纖維素）。

completeofnutrient,dissolvable,withoutdigestion,residuefreenutrient.Applicableclients:

1.thoseneednasalfeeding2.altra-metabalismcondition:severburning/trauma/infection,etc.3.thoseneedtoimprovetheirnutrionstatus:pre-/post-operation,duringchemotherapyofradiotherapy

4.digestionorabsorptiondisturbance:enteritis,及其他digestivecanalfistula,shortbowlsyndrom.

Methods1.oral:39℃2.nasalfeeding,gastricorjejunalfeeding:（41-42℃）

Bolusfeed（分次注入）

Intermittentfeed（間歇滴注）

Continuousfeed（連續(xù)滴注）Principles:

Asepsis.Lowdensity,lowamount,lowspeed.Reservedinlowtemperature.Irrigationthetubebeforeandafterthetreatment,withwarmwater.Observethetreatreaction,assessmentnutritionstatusintime11.組件膳食

補充或強化完全膳食，以彌補完全膳食在個體差異方面的欠缺。

常見

蛋白質(zhì)組件、脂肪組件、糖類組件、維生素組件和礦物質(zhì)組件等。Part3：Testdiets(試驗飲食)

Definition:alsoknowasdiagnosticdiets,areusedtohelpdiagnosisandinsureaccuratetestingbyadjustingthecontentsofdietsinspecialtime.

在特定時間內(nèi)，通過對飲食內(nèi)容的調(diào)整來協(xié)助疾病的診斷和確保實驗室檢查結(jié)果正確性一種飲食。TestdietsCholecystographytestdietOccultbloodtestdietCreatininetestdiet131I

thyroiduptaketestdietGlucosetolerancetestdiet1.Cholecystographytestdiet(膽囊造影檢查飲食)usedinpreparationofX-rayexaminationofgallbladder.1.Beforethetestday:Lunch:Highfatdiet

Supper:fatfree,lowprotein,highcarbohydratesdietAftersupper:intakingcontrast,thenNPO(noneperoral)untilthemorningoftakex-rays.2.Testday:

Breakfast:shouldnothave.

AfterthefirstX-rayexam:ifthegallbladderdevelopswell,theclientshouldhaveahighfatmeal(fat25-50g)

havethesecondX-ray30minafter2.Occultbloodtestdiet(隱血試驗飲食)UsedforpreparationofOccultbloodtesttoassistthediagnosisofgastrointestinalbleeding.1.Preparationperiod:

3－5daysForbiddenanyfoodthatcanleadtoafalsepositiveresult:suchasmeat,poultry(家禽),medicineandfoodrichiniron,andvegetables.2.Thetestsamplewillbetakenontheforthdayforthreeconsecutivedays

3.Creatininetest

diet（肌酐試驗飲食）Usedforpreparationofcheckthekidneyfiltrationfunction.1.Preparationperiod:

3daysForbidden:

meat,poultry,fish,tee,andcoffee.

Limitedprotein:to<40g/d.2.Thetestsamplewillbetakenontheforthday.4.131I

thyroiduptaketestdiet(吸碘試驗飲食)

usedtocheckthefunctionofthyroid.1.Preparationperiod:2W2.Forbiddenanyfoodandmedicinethatcanaffectthefunctionofthyroid:suchaskelp（海帶），

jellyfish(海蜇）,shrimp,iodizedsalt,iodineforskindisinfection.飲食種類適用檢查/診斷

范圍食用方法及注意事項潛血試驗飲食消化道出血前3天禁肉類,血類,含鐵劑藥物,綠色蔬菜等膽囊造影飲食肝膽疾病前日午進食高脂飲食,晚餐進食無脂低蛋白,高碳水化合物肌酐試驗飲食腎小球濾過功能試驗期禁食肉、禽、魚類,忌茶和咖啡甲狀腺131I試驗飲食甲狀腺功能禁用含碘食物及影響甲狀腺功能的藥物和食物TestdietsSection3nursingofdiets

NursingAssessmentNursingDiagnosisPlanningImplementationEvaluation1.Anthropometricmeasurementsandphysicalexam(人體測量和體格檢查）

height、weight

andskinfold(皮褶厚度)

thestandardofIBW(idealbodyweight)：

male:IBM＝〔height（cm）－100〕x0.9female:IBM（kg）＝〔height（cm）－100〕x0.85thenormalweightisintherangeof:±

10％

>20％:overweight<20％:underweight

ClinicalsignsofmalnutritionSkinNailsHairsTongue(P961)2.Labtest（實驗室檢查）

Serumproteins(血清蛋白):albumin(白蛋白),HB(血紅蛋白)

transferrin(轉(zhuǎn)鐵蛋白)

Urinarytests:ureanitrogen(尿素氮),ureacreatinine(肌酐)

Totallymphocytecount（全血淋巴細胞計數(shù)）

Others:mineraltest(Ca,P,Fe)（微量元素測定）Nursingassessment3.

Generalinformationassessment:一般飲食資料評估thefrequency,timing,regularity,methods(withorwithouteatingdifficulty)每日進餐次數(shù)、時間、規(guī)律性、方式（有無進食困難）

thefoodspecies,amount,withorwithoutdietarybiasandotherbadhabit(suchascigaretteoralcoholaddiction)攝入食物種類、數(shù)量、有無偏食,有無煙酒嗜好thesupplementofdiet(suchas:tonic)補品FoodDiary飲食日記4.Influencingfactorassessment(影響因素評估)

Physiologyfactors：age

生理因素activitylevel(活動量）

BMI（體重指數(shù)）

specialphysicalstatus(特殊生理狀況)

Pathologyfactors：illness

病理因素hypersensitiveorintolerancetocertainfood(食物過敏和不耐受)theusingofmedicineoralcohol

Psychologyfactors：congesti