護(hù)理學(xué)臨床營(yíng)養(yǎng)學(xué)（Nursing,clinicalnutrition）Chapter1NutritionFoundationcarbohydratesnutritionsignificancesupplyingenergy(1gramsofcarbohydratescanproduce4kcalenergyinthebody)itisimportanttomaintainthefunctionofnervetissuetotakepartinconstitutinganimportantcomponentoforganismregulatebloodsugarandnitrogenandantiketogenesissources:Cereals,tubers,rootvegetables,legumes,starchynutsofthetotalcarbohydrateenergysupplywas55%-Two,proteinnutritionsignificanceconstitutethebodytissuesandimportantsubstancesprovidingthebodynitrogensourceprovidingessentialaminoacidsanimalfoodproteincontentishigh,vegetablefoodcontentislowaminoacidpattern:theratioofvariousaminoacidsproteins,high-qualityprotein:food,protein,aminoacidpatternsclosertotheaminoacidpatternofhumanproteins,teincomplementation:theessentialaminoacidpatternofanimalproteinisclosetothatofhumanaminoacidmodel,whilethecontentoflysineinriceandflourislow,andthecontentofmethionineinsoybeanislow.Ifriceorflouriseatenwithsoybean,teindigestibility:teinbiologicalvalence(BV):theextenttowhichproteinisretainedbythebodyafterabsorptionNetutilizationofprotein(NPU):theavailabilityofproteinsinthebodyProteinefficiencyratio(PER):theextenttowhichproteinsareutilizedbythebodyPER=(increaseinbodyweightpergram)/intakeoffoodproteingramsource:animalfood,suchasmeat(poultry,livestock,milk,eggs,beansandsoyproducts(thehighestcontentinsoybeans),therecommendedintakeofproteininChinagenerallyaccountsfor10%ofthetotalenergy-15%10.1gramsofproteinproductioncapacity4kcalThree,fat(fatandlipidcollectively)1.1gramsoffatoxidizedinthebodytoproduce9kcalenergyessentialfattyacids:linoleicacid(peanutfouracid)linolenicacid(twenty-twocarbonsixacidDHA)fatprovides20%ofthetotalenergy-30%,thesmallertheage,thehigherthefatsupplyratio,sothereisnolimittotheamountoffatintakeforteenagersandchildrenFour,energytheenergyneededbythehumanbodyisexpressedintermsofjouleorcokeintheworld.Inthepast,nutritionwasexpressedincalorkcaltheenergyexpenditureofthehumanbodyismainlyusedmaintainthebasalmetabolism,meetthespecialneedsofthefoodandthethreeaspectsofphysicalactivitiesbasalmetabolismisaffectedbysomefactorsP8,dietaryenergycomesfromcarbohydrates,fats,andproteinsinfoods.Thesethreenutrientsarecalledheatproducingnutrientsrecommendedenergyintakeisbasedonlaborintensity,gender,andageFivevitaminsDividedintofatsolubleandwater-solubletwomajorcategories,fatsolublevitaminsarevitaminsA,D,E,K(I)fatsolublevitamins;vitaminA(retinol)typicalmanifestationsofvitaminAdeficiency:Darkadaptationability,nightblindnessanddryeyesyndrome;mucosa,epithelium(rough,dry,andsquamouskeratosischange)thesourceofanimalfood(animalliver,egg,milkanditsproductsandCodLiverOil)andplantfoods(B-caroteneandvariouscarotenoids,greenleafyvegetables,yellowvegetablesandfruitwashigher,suchasbroccoli,spinach,peasprouts,leek,carrotetc.)vitaminDfromvitaminDintheskin,fromfoodintakeandexposuretosunlightlackofvitaminD;Causingabsorptionofcalciumandphosphorusdecreasedandserumcalciumdecreased;Effectofbonecalcification,inducedosteomalacia,ricketsininfantspronetodeformation,(FangLu,chickenbreast,pectusexcavatum,Xleg,Oleg),showedthebonesbecomesoft,tobend,deformity;Itaffectsthefunctionofnerve,hematopoiesis,immunityandotherorgantissues;Osteomalaciainadults,Butthephyticacid,oxalicacidandtanninintheplantinhibittheabsorptionofironiodineiodinedeficiencycancausegoiter(andregional,inChina'sremoteareasandmountainousareamorepopular),orcretinismcretinism:iodinedeficiencyoccursinthefetalandnewborninfantsandinfantscancausegrowthretardation,mentalretardation,andevendementia,deafmute(Note:hypopituitarism)highiodinecontentoffoodisseafoodsuchaskelp,seaweed,mussels,seacucumber,saltalsocontainsasmallamountofiodineSeven,waterThedailywaterrequirementofadultsis2500mlEight,dietaryfibernutritionsignificance(1)preventionofconstipationandcolorectaldiseases(2),preventionofcancer(3),preventionofcardiovasculardiseaseandcholelithiasis(4),preventionofobesitycomefromplantfoods,suchasrhizomesandleafygreens,fruits,Cereals,legumes,etc.ThesecondchapternutritionofhealthypopulationI.foodclassification1.cerealsandtubers2.animalfood3.beansandtheirproducts4.vegetablesandfruits5.pureenergyfoodTwo.CharacteristicsofallkindsofnutrientsP26Three.DietarystructureThedietstructureoffoodbalancebetween1.animalsandplantsisrepresentedbyJapanesedietmostofthedevelopingcountriesbelongtothiskindofdietarystructure,whichischaracterizedbylargeconsumptionofcereals,animalfoodbaseddietstructure,mostdevelopedcountriessuchasEuropeandAmericabelongtothiscategoryMediterraneandietstructureuniquetolivingintheMediterraneanresidents,isrichindietaryplantfoods,processingandlowdegreeoffreshnessofhighsaturatedfatintake;low(lowincidenceofcardiovascularandcerebrovasculardiseases)Four,dietpagodaFatsandoils25g;Dairyanddairyproducts100g,pulsesandsoyproducts50g;Meatfisheggs25-50g50g50-100gVegetablefruit100-200g400-500gCereal300-500gFive,abalanceddiet:alsoknownasreasonablediet,nutritionreferstothedietcanprovidethebodyrange,sufficientquantity,appropriateproportionofvariousnutrientsandenergy,andkeepthebalanceandtheneedofthebody.Six.Nutritionforinfantsandyoungchildren,frombirthto3yearsofageforinfantsandyoungchildren(frombirthto28daysfortheneonatalperiod,28daysto1yearsofageafterbirthforthebabyphase,1-3yearsoldforearlychildhood)advantagesofbreastfeedingbreastmilkcontainsrichnutrients,themostsuitableforinfantgrowthanddevelopment,highproteincontent,andinimmunoglobulin,toprotectthehealthofinfantsandchildrenisverybeneficialtheproteininmaturemilkismainlywheyprotein,isbeneficialtodigestionandabsorptionofbabythecompositionandproportionofessentialaminoacidssuitableforinfantsandyoungchildrenbreastmilkcontainsrichlactose,andmoreunsaturatedfattyacids,especiallylinoleicacidandDHA,haveacertaineffectonthedevelopmentofinfantilenervousnucleustheutilizationratioofironandzincinbreastmilkishigherthanthatinmilk.Thecalciumcontentinbreastisnothigh,buttheproportionofcalciumandphosphorusappropriate,anditiseasytoabsorbeffectsofvitaminnutritionalstatusanddietarystatusofnursehands,inadditiontovitaminD,canmeettheneedsofinfantsattheageofJunebreastmilkalsocontainsavarietyofbiologicallyactivesubstances,canenhancetheresistanceofinfantstodiseasebreastfeedingcanpromotethecommunicationbetweenmotherandbaby,emotionandpostpartumrehabilitationofthemother.Itiseconomical,convenientandsuitableforbreastfeeding,theadditionofauxiliaryfoodNeonatal2-4weekaddedasmallamountofvitaminD;5-6weekstoaddrichinvitaminC,fruitjuice,vegetablejuice;3-4ironcontainingfoodssuchasmeat,eggyolk,andironfortifiedlivepastematerial;5-6mayaddstarchyfoodsuchasporridge,babycakeetc.semifluidfood;6-8canaddtochewfoodtoexercise,teethandchewingmuscles;theageofediblemealwithfood(suchaswonton.Dumplingsandothermeatfood);afterthebabyisweaned,drinkatleast220mloffreshmilkeveryday;thedietofinfantsandyoungchildrenisdominatedbyCereals,andthemealsarearrangedat"twomealsandtwomeals"Seven.NutritionforchildrenOneThechildisdividedintotwostages,3-6yearsofageforpreschoolchildrenand6-12yearsforschool-agechildrenEight,teenagersnutritionenergyadolescentsneedmoreenergythanadults,anddailysupplyexceedsthoseforlightmanuallabor,theproteinneedstoincreaseespeciallyprominent,80-90gperday,ofwhichhighqualityproteinaccountedfor40%-50%Thedietshouldbefullofanimalfoodandbeansanditsproductsmineralsonthecalciumironrequirementsincrease,thedailysupplyofcalciumandphosphoruswere1000-1200mg,supplymorewomenthanmenEight,adultnutritionenergyandenergyintakeshouldbeappropriate.Theyouare,thelessenergyyouneedproteininensuringproteinsupplybasedontheproperofhigh-qualityprotein(accountingfor30%oftotalprotein),suchaspoultry,meat,fish,milk,beansandsoon,fatandcarbohydratefataccountedforenergythanin25%-30%isappropriate,cholesterol(suchasanimalintakeisnotmorethan500mgperdayisappropriateNine,theelderlynutrition(controlenergy)physiologicalcharacteristicsoftheelderlybasalmetabolicratedecreasedthephysiologicalfunctionsofvitalorgansaredecreased(brain,heart,lung,kidney,gastrointestinaltract,etc.)biochemicalmetabolism,proteincatabolismoversyntheticmetabolismlowimmunefunctionnutritionalneedsenergyshoulddecreasewithageprotein(appropriate)proteinsynthesisratedecreased,catabolismhigherthansyntheticmetabolism,pronetonegativenitrogenbalance.Therefore,theneedfortheamountofproteininelderlypatientsshouldnotbelessthantheadults,especiallytheessentialaminoacidssuchasmethionine,lysinerequirementsincrease,thegeneralelderlyprotein1.0-1.2/kgweightinthesupplyofhigh-qualityprotein,accounting1/3,12%-14%isbetterthanproteinenergy.fatintakeshouldnotbetoohigh,soastomakeup20%-25%ofthetotalenergy,theedibleoilshouldbemadeofvegetableoil,andthedietarycholesterolshouldbecontrolledat300mg/dcarbohydrates,elderlypeopleshouldnottaketoomuchsucroseandstarch,easytoeatmorefruitsandotherfructosecontainingfoodsmineralelderlyappropriatecalciumandvitaminD,otherwisepronetoosteoporosis;atthesametimeshouldattentiontosupplementwithhemeironhigherfood,intocorrectthelackofproteinandiron.Elderlypeopleshouldalsoreducetheintakeofsalt,notmorethan6GperdayisappropriatevitaminsupplementsA,C,E(anti-aging),B2,folicFundamentalsofclinicalnutritionNutritioninvestigationconsistsoffourparts:dietarysurvey,bodymeasurement,clinicalphysicalexaminationandclinicalbiochemicaltest.Two.DietarysurveymethodsWeighingmethodandweighingmethodisamethodforweighingallthefoodconsumedbyamealunitorindividual.Itisnotsuitableforlarge-scalepopulationinvestigationThemethodforlarge-scaleinvestigationofvariouscanteensAsk,nothungryforengweighingmethodorauditmethodcanbeusedwhenquestioning,askingrespondentsdailylocktonguesuchasfoodtypes,diethabits,understandtheirfoodintake,includingdietanalysis24hoursreviewmethod,diethistorymethod,chemicalThreeanthropometricmeasurements1.refertobodyweight(kg)=height(CM)-1052.BMIBMI=weight(kg)/(heightm)2]?Four,hospitalmealsP57Five、enteralandparenteralnutrition,whenthegastrointestinaltracthasfunction,firstenteralnutrition(shockdoesnotuse)enteralnutritioninfusion(1)singleinfusion(2)intermittentgravitydrip(3)continuousinfusionofp64enteralnutritionnursingp66parenteralnutrition(intravenousinfusionofnutrients)indicationsforparenteralnutrition:Patientswithseveregastrointestinaldysfunctionorfailure.Inotherwords,patientswhoneednutritionalsupportandcannotorshouldnotreceiveenteralnutritionareindicationsforparenteralnutrition.parenteralnutritionnursingp70ThefourthchapternutritionofcommondiseasesFirst,nutritionaltreatmentofhypertensionreduceorlimitintakeofsodiumproperincreaseofpotassiumandcalciumThreeControlenergy,avoidhighcarbohydrate,highfatintakeTwo.Nutritiontreatmentofpepticulcer1.,nutritioniscomprehensiveandreasonable2.,asmallamountofmeals,timingappropriatecontroloftheuseofgeneralcondimentsslowly,todevelopgoodeatinghabitschoosesoftandeasytodigest,weakstimulationandattentiontothechoiceoffoodcookingmethodsThree、nutritiontreatmentofcholecystitisandcholelithiasisChroniccholecystitisisaccompaniedbycholelithiasis.Weshouldinsistonusinglowfat,lowcholesterolandhighvitamindietforalongtime,strictlylimitfatlimitcholesterolandincreasetheintakeofphospholipidsproperlyproperenergysuitablecarbssuitableproteinrichinvitaminsasmallamountofmeals,adequatedrinkingFour,cirrhosis,nutritiontreatment:liverdamageismild,nocomplications,providing"threehigh,oneamount"diet,thatis,highprotein,highenergydensity,highvitaminsandappropriateamountoffat.,theliverfunctionseriouslydamaged,thelivercannotcleartheproteinproducedinvivoammonia,resultinginelevatedbloodammonia,causingcentralnervoussystempoisoning.Inordertoalleviatethesymptomsofpoisoningandpreventhepaticencephalopathy,weshouldstrictlylimittheintakeofprotein,andselectthefoodwithlessquantity,highqualityandlessammonia.Thesupplyofdailyproteinshouldbelimitedto50-55g,thesourceoftheheattocarbohydratebased,accountedforthetotalenergyof70%-75%,atthesametimeavoideatingrichinaromaticaminoacidfoods(suchastheskinofthechicken,pork,mutton,beef,rabbit,etc.),increasetheintakeofbranchedchainaminoacids(suchasmilk,soyabeans,reddatesetc.)cirrhosiswithascitesshouldstrictlylimittheintakesodium,ofesophagealandgastricvaricesdietshouldbesoftandeasytodigest,lessstimulation,avoidallfood,hardandtopreventvaricoseofesophagealvaricealbleeding.Five、nutritiontreatmentofacuteglomerulonephritislowproteinlimitsodiumsaltandwaterlimitpotassiumintakeproperenergyplentyofcarbsproperfatprovideadequatevitaminsandmineralsSix.NutritionaltreatmentofnephroticsyndromeAdequateheat,properproteinandfat,lowsaltorsaltfreedietSeven.Nutritionaltreatmentofirondeficiencyanemia1.,increasetheintakeofanimalfoodappropriately2.,increasetheintakeofgreenleafyvegetablesavoidfoodinterference,ironshouldbesupplementedatthesametime,copper,avoidingcalcium,zincandclothesEight,goutgoutisagroupofdiseasescausedbylong-termabnormalpurinemetabolismandincreasedserumuricacid.Theclinicalfeaturesincludehyperuricemia,acutearthritis,recurrentattacks,goutstones,jointdeformities,andgoutynephropathy.nutritionaltreatmentofgoutlimittotalenergyandreducecarbohydrateintakelimitprotein,lowfatdietstrictcontrolofpurinediet,dailypurinequantityshouldbestrictlycontrolledwithin300mg,shouldberecommendedpurinecontaininglittlefood,suchascereals,dairy,vegetables,fruits.drinkmorewater,avoiddrinking,goutpatientsshouldinsistondrinkingmorewater,dailyabout2000-3000ml,thedischargeofdiureticacidNine.Nutritiontreatmentofobesitycontrolheatenergylimitcarbohydratesproteinguarantee,strictcontroloffat,fatsupplyshouldbeatthetotalenergyof20%-30%vitaminsandtraceelementstakepartinmoresportsTen.NutritionaltreatmentofosteoporosisensurethenormalintakeofcalciuminChinarecommendeddailycalciumintakeforchildren,adultswith800mg,600-1000mg,pregnantwomenandlactating1000-1200mg,aged1000mg,dietary