NURSING NR 228 Nutrition- Week 3 nutrition edapt - Introduction to Energy

Introduction to Energy Energy can take various forms, but it must be converted to chemical energy in the human body. Whether you are sleeping, eating, exercising, or reading, the human body needs energy to perform these activities.

Upon completion of this unit, you will be able to perform the following:    

Compare and contrast the 2 energy pathways Explain the 3 main sources of energy Deconstruct and detail the processes of energy creation Identify the components of balancing energy and expenditure

Sources of Energy What are the three main sources of macronutrients that provide energy for the body? Select all that apply.

Proteins, fats, and carbohydrates are the 3 main sources of macronutrients for the body to create energy. Water is essential but it’s not a macronutrient. Fiber is also beneficial in digestion but is not a macronutrient.

Your response is correct!

Types of Fats Match the types of fats to the appropriate category to label as good or bad fats.

Good Fats Polyunsaturated fats Monosaturated fats

Bad Fats Saturated fats Trans fats

There are 4 types of fats with 2 being considered bad and 2 classified as good. The bad types of fats, saturated and trans fats, are unhealthy and can raise your Low-Density Lipoproteins (LDL or bad) cholesterol. When at room temperature, these types of fat are solid. Lard, chocolate, and margarine are examples.

Healthy fats, monounsaturated and polyunsaturated fats, can lower your LDL level when consumed appropriately. The good types of fats are often liquid at room temperature, and examples include avocados and olive oil.

Your response is correct!

Effects on Energy Expenditure Which factor affects energy expenditure more than any other single factor?

Overall body size is the single factor that most affects energy expenditure.

The heavier the person, the more energy must be used in order to perform activities.

While caloric consumption, thermic effect of food, and basal metabolic rate all play a role in the production of energy, they are complex processes that can be affected by multiple other factors.

Your response is correct!

What is Energy?

Understanding the complexities of the production of energy in the human body is essential for caring for a client. While these processes can seem daunting at first, gaining a thorough understanding will provide a firm foundation that will aid decision making in your practice. Failure to understand the effects of nutrition can jeopardize client health.

Energy in the human body must be converted from nutritional sources into chemical energy. It is the progression of associated chemical reactions that are interdependent. There are 2 main energy pathways: anabolism and catabolism. These two processes together are called metabolism. They are interdependent and are closely regulated in the body by hormones. Both energy pathways work together to produce energy for life sustaining functions.

The primary source of fuel for energy is food. The measurement of energy released from food is called kilocalories or calories. Determining the number of kilocalories produced can be calculated in 2 ways: using a bomb calorimeter or proximate composition. A bomb calorimeter is a device that measures the energy produced when a sample of food is burned, but it is more accurate and efficient than the human body.

Therefore, values that you see on nutritional labels are adjusted to represent the limitations present in humans. Proximate composition uses the total grams of carbohydrates, fats, and proteins and a calculation to represent the energy in the specified food.

Anabolic & Catabolic Pathways Anabolic Pathway

The anabolic pathway or anabolism is simply defined as building up. In this process, smaller

molecules are combined to make larger ones. It is a process that requires energy, or adenosine triphosphate (ATP), the body's source of fuel. One or more molecules change themselves into end products using enzymes.

Specifically, glucose uses energy to convert it to glycogen. Examples include the following: Glycerol + Fatty Acids = Lipids Amino Acids combine = Dipeptides A mental image that might assist in remembering this concept would be a body builder. These individuals focus on building up their muscles for competitions. Therefore, a mnemonic for this could be used. Anabolism starts with an A, so you could remember "A bodybuilder builds up muscle."

Catabolic Pathway

Catabolism, or the catabolic pathway, is very simplistically described as breaking down.

Larger molecules are broken down into smaller ones, and energy is released. In this process, glycogen is converted to glucose and produces ATP. Larger compounds become simplified. Examples: Cellular Respiration C6H12O6 (glucose) + 6O2 (Oxygen) → 6CO2 (Carbon Dioxide) + 6H2O (Water) + ATP (energy)

Simple Sugars → Disaccharides + H2O One way to remember this concept is to think of a destructive cat.

CATabolism – cats who tear things apart and break them down.

Collaboration Both the anabolic and catabolic pathways work together to supply energy, but the length and intensity of energy required, fitness level, and types of food dictates the source. We will discuss this later in this lesson after examination of the foods that supply energy.

Characteristics of Energy Pathways Match the characteristics for each energy pathway.

Characteristics

Anabolic Pathway

Catabolic Pathway

An example is glycerol + fatty acids = lipids Small molecules combined to larger ones Requires Energy Uses Short Term Energy Storage

Breaks down large molecules Produces Energy An example is cellular respiration

Anabolic pathways require energy to combine small molecules into larger ones and use short term energy to complete this task. An example is production of lipids by adding glycerol and fatty acids. Catabolic pathways produce energy as they break down large molecules into smaller ones. An example is cellular respiration, where C6H12O6 (glucose) + 6O2 (Oxygen) → 6CO2 (Carbon Dioxide) + 6H2O (Water) + ATP (energy).

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Energy Sources

In the human body, foods provide a great source of energy, but they must be transformed. After foods are ingested, the processes of digestion, absorption, and metabolism occurs. The 3 energy supplying micronutrients that we receive from food include  Carbohydrates  Fats  Proteins These 3 nutrients are essential in supplying the body's needs and we will discuss each of them in detail. As each of them are broken down (catabolism), energy is released, supplying fuel for essential functio

Carbohydrates as Energy

Carbohydr ates are a combination of carbon, oxygen, and hydrogen atoms and are converted into glucose, long chains of sugars. These types of foods are essential for body functioning, and the brain requires a steady source of glucose. Have you ever been grumpy when you are hungry, but the feeling goes away after you eat? This is because your brain needed glucose!

Carbohydrates can be classified as simple or complex, but both produce sugar when broken down. Simple carbohydrates are those that are quickly digested and synthesized to become glucose and short-term energy. Foods such as white bread, cakes, and cookies are examples.

Conversely, complex carbohydrates are those foods that take longer to be synthesized and produce energy. Conversion of carbohydrates is the most complicated of the 3 food sources. There is a 3-step process that occurs to provide energy: glycolysis, the tricarboxylic acid (TCA) cycle, and oxidative phosphorylation.

Glycolysis is the the first step, and it is an anerobic process that converts glucose to carbon compounds. When the carbon compounds are made, pyruvic acid and adenosine triphosphate (ATP) are produced. For this process to occur, the body must have adquate levels of B complex

vitamins (like niacin). The energy produced in this step is quickly produced but is used short term. Examples include exertion-based activities like sprinting and running from dangerous situations. Since this energy is used in a hurry, it does not get used completely and results in production of pyruvic acid, which is converted to lactic acid. If you've ever exerted yourself and experienced pain that caused you to stop, you have experienced a buildup of lactic acid in the muscles. After a short time, additional oxygen becomes available to break down the lactic acid, relieving the discomfort. Glycolysis occurs in 1 of 2 places in the cell – the cytoplasm or the mitochondria. The jelly like substance in the cells, the cytoplasm, is where the anerobic glycolisis happens and the short-term energy is produced.

The aerobic glycolysis requires oxygen and takes place in the powerhouse of the cell, the mitochondria. The reaction of pyruvic acid reacts with coenzyme A (CoA) and becomes acetyl CoA, moving to the TCA cycle.

Once the TCA cycle is complete, carbon dioxide and ATP are produced.

This aerobic pathway provides energy for longer lasting activities like most activities of daily living (ADL).

The final phase of making energy is oxidative phosphorylation, which is simply a fancy term for transporting a phosphate group from point a to point b. This process is very similar to a courier service, taking a product from one area to another. After this and other steps occur, water and ATP are produced.

Metabolism & Nutrition For additional explanation and review, please watch Metabolism & Nutrition, Part 1: Crash Course A&P References Grodner, M., Escott-Stump, S., & Dorner, S. (2020). Nutritional foundations and clinical applications: A nursing approach (7th ed.). Elsevier.

Fats as Energy

In our society, the term fat has a very negative connotation. Simply watching television, listening to the radio, or surfing the net will provide multiple advertisements about weight loss and how fat is bad. There are so many "fat-free" foods in the supermarket, and the general consumer can be easily confused. In nutrition, fats play a vital role and are not always bad.

It is important to understand both good and bad fats and have them in moderation, as fats are used as source of energy.

There are 4 types of fats with 2 being considered bad and 2 classified as good. The bad types of fats, saturated and trans fats, are unhealthy and can raise your Low-Density Lipoproteins (LDL or bad) cholesterol. When at room temperature, these types of fat are solid. Lard, chocolate, and margarine are examples.

Healthy fats, monounsaturated and polyunsaturated fats, can lower your LDL level when consumed appropriately. The good types of fats are often liquid at room temperature, and examples include avocados and olive oil.

The reason fats can be deposited in and detrimental to the body is they are not broken down in the liver before moving into the bloodstream. As fats are digested in the small intestine, they are absorbed into the lymphatic system . From there, fats move into the cardiovascular system

and eventually reach the liver to be broken down. Conversely, carbohydrates and proteins are absorbed via the portal vein and carried to the liver before circulation.

Once fats are consumed, they are broken down into useable forms of energy. This process begins with the breaking down of the chemical bodys by water, turning the fats into glycerol and 3 fatty acids. Glycerol is converted to pyruvic acid, which is used for energy. The 3 fatty acids are further broken down into acetyl coenzyme A (CoA) and move into the tricarboxylic acid (TCA) cycle like the acetyl CoA from glucose.

Protein as Energy Proteins are the third nutrient used for energy. Since proteins are composed of amino acids joined together by peptide bonds, it is easy to understand that they are broken down into these components using hydrolysis. Amino acid groups that contain nitrogen are processed in the liver. Other amino acids move into various parts of the protein pathway to create energy. Some are converted to pyruvic acid while others are part of the acetyl groups or part of the tricarboxylic acid cycle (TCA). Another important point to remember is that amino acids can be used for protein synthesis rather than the creation of energy. The body makes most amino acids, but there are several that humans only get from protein rich foods. Like other nutrients, it is important to eat proteins in moderation, as excessive amounts can contribute to hyperlipidemia, coronary artery disease, and renal damage.

Fuel for Body Processes What is the fuel for all body processes that traps energy and releases it from food?

Adenosine triphosphate is ATP, or the body's production of energy after using the 3 macronutrients, carbohydrates, fats, and/or proteins.

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Using & Storing Nutrients Carbohydrates, fats, and proteins can be used for creation of energy, but they can also be stored as fat throughout the body. If the body does not need the nutrients because it has met the energy needs, the excess food must be stored. Glycogen is the first stored type of energy used and is followed by energy in the adipose or fat cells. Proteins are typically stored

and used for repair of tissues and cells as needed. However, only some glycerol can result in glucose, which the brain constantly needs. Continual use of stored fat results in ketosis. A diet high in carbohydrates leads to increased glycogen storage, but the amount depends on the amount of activity level.

Macronutrients and Foods Select the foods that would be appropriate for storage of macronutrients.

Carbohydrates

Fats

Proteins

Whole wheat bread Gluten Free Pasta

Coconut oil Avocados Cashews

Chicken breast Eggs Cheese

Carbohydrates are changed into glucose and include breads and pastas.

Fats are broken down into glycerol and fatty acids and include avocados, cashews, and coconut oil. Proteins are broken down into amino acids and include eggs, cheese, and chicken breast.

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Energy Balance & Needs The amount of energy required by the body depends on various factors.

Activity level, illness, injuries, and chronic diseases are important considerations for determining the amount of nutrients for a client. The recommendations from My Plate, Healthy People 2030, and the United States Department of Agriculture dietary guidelines for Americans are a suggested guidelines for intake across the lifespan for light to moderate activity levels. It is essential to consider the activity level of the client and size of the client to determine accurate intake for healthy weight and energy needs.

To formulate a plan for each client, 3 areas should be considered for energy needs. These include total energy expenditure, physical activity, and the thermic effect of food. We will examine each of them individually and provide further clarification.

Stored Nutrients for Energy When the body has excess food intake, it must be stored and can be used for energy if needed.

Select which characteristic fits each column. Some may be used more than once.

Glycogen Stored and used first for energy Used for energy second

Adipose

x x

Reserved for tissue and cell repair Continual use for energy results in ketosis

Proteins

x

x

Glycogen is the the stored nutrient that is uesed first for energy, as the brain requires a constant supply of glucose for function. Adipose or fat tissue is used second and continual usage results in ketosis, evidenced by

ketones in the urine. Proteins are typically saved for repair of tissues and cells.

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Components of Total Energy Expenditure

M ultiple factors affect our daily energy requirements and the first is the amount of energy required to maintain essential functions such as breathing, circulation, heartbeat, and secretion of hormones. There are two ways to determine how much energy is needed. The basal metabolic rate (BMR) is the most used method, but resting energy expenditure (REE) can be utilized as well. This component accounts for 70% of the total energy used in the body. BMR/REE is the amount of energy needed to complete life-sustaining functions and is measured when the client wakes for the day before completing any physical activity. It is again completed 12-18 hours after the client's last meal. Two methods can be used to

determine BMR – measuring body heat given off by a client or using a caliometer to measure the levels of oxygen and carbon dioxide exchanged. To calculate BMR, you would need to know the client's kilocalorie per kilogram per hour. Remember, 1 pound = 2.2 kilograms.

You would multiply that number by 24 hours to get the BMR per day.

Factors affecting BMR/REE are discussed below.  Age - younger clients who are growing have higher metabolism than adults over the age of 35. With age, lean muscle mass decreases.  Gender - in general, females have slower metabolisms than men since men are typically larger.  Growth - infant and children require more energy and have a higher BMR/REE due to growth and temperature regulation.  Lean Muscle Tissue - muscle mass burns energy quickly and more efficiently than other sources.  Body Fat - higher levels of body fat burn less energy.  Hormonal Controls - controlled by the nervous and endocrine systems, BMR/REE rate can change based on these influences (ex: thyroid function – hypothyroidism or hyperthyroidism).  Genetic Influences – hereditary factors can slow or raise your BMR/REE.  Physical Activity – increased activity requires energy for the muscles and regularly exercising increases the BMR/REE, even at rest.  Diet – strict reduction of caloric intake, as often seen in fad, crash diets, starvation, and fasting slows the BMR to conserve energy.

While many see short term results on the scale or notice changes in the mirror, long term reduction in metabolism can result in weight gain. Additionally, dietary deficiencies can slow BMR/REE.  Infection or Illness – with these conditions, the body needs more energy for repair, so metabolism is increased.  Temperature – being very hot or cold requires the body to use more energy and increases the BMR/REE.  Drugs – stimulants like caffeine or nicotine can also increase metabolism.

Calculating Basal Metabolic Rate A client weighs 210 pounds. If this client has an average basal metabolic rate of 1.0 kilocalorie per kilogram per hour, what would be the client's basal metabolic rate per day?

If this client weighs 210 pounds, it must be converted to kilograms. 1 kilogram = 2.2 pounds. Therefore, 210 / 2.2 = 95.45 kilograms. If the client has basal metabolic rate of 1 kilocalorie per hour, we know that 95.45 kg x 1 kilocalorie per hour = 95.45. The next step is to take the weight in kilograms and multiply it by 24 hours (the amount of time in one day). 95.45 x 24 = 2290.9 or rounded to 2291 kilocalories.

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Physical Activity Physical activity is the second component in estimating one's energy needs and accounts for 20-30% of human's total energy expediture. The definition of physical activity is any body movement by the skeletal muscles that requires energy. As one may understand, the amount of physical activity varies from person to person, based on duration and intensity. Even moderate activity can become a means of high energy expenditure if it’s done for a long time.

Body size is the most influential factor that affects energy expenditure.

The heavier the client, the more energy it takes to complete an activity.

For example, a 110 lb client uses less energy than a 210 lb client.

Thermic Effects of Food The third and final component is the thermic effect of food. This is the energy necessary to digest, absorb, metabolize, and store food that is eaten. While playing a critical role in the production of energy, it is only 710% of the body's total energy needs. After food is ingested, the body's cells increase their activities, and this is called the thermic effect of food or diet-induced thermogenesis. The increased activity to break down the food produces energy and heat, hence the name.

The body continually seeks to maintain homeostasis, and it must adjust to changes in physical and biological environmental situations. The energy used by the body to do this is called adaptive thermogenesis. Examples include physical and emotional trauma, extreme changes in diet lasting several days, and illness and recovery. As with other factors, the expenditure of energy depends on the client and the situation.

Metabolism in Lipid, Carbohydrate, and Protein Pathways Select the steps of metabolism that occur in each pathway.

Lipid Pathway Broken down into fatty acids and glycerol

Protein Pathway

x

Converted into glucose

x

Becomes amino acids Lipogenesis

Carbohydrate Pathway

x

x

Lipid Pathway

Carbohydrate Pathway

Glycolysis

x

Lactic acid production

x

Protein Pathway

Creation of urea

x

Triglycerides (lipids) are broken down into fatty acids and glycerol using processes of hydrolysis and lipogenesis in the lipid pathway.

Carbohydrates are converted into glucose and are broken down in a process called glycolysis in the carbohydrate pathway. Protein is broken down into amino acids in the protein pathway. Lactic acid is a byproduct in the carbohydrate pathway, while urea is the end product of the protein pathway.

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The most effective way to increase energy expenditure is to increase the duration and intensity of dialy activities and consume recommended number of macronutrients (fats, proteins, carbohydrates). An increase in length of exercise as well as the intensity will burn more calories which requires more energy. Decreasing duration of activities and increasing minimum macronutrients can lead to weight gain.

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Energy Requirements

Rhyann, an 18-year-old high school senior presents for her yearly check-up with the healthcare provider. She has been a member of the cross-country team at her school for 3 years. She is 5'10" and weighs 145 pounds with no underlying health conditions.

Rhyann strives to make healthy food choices and uses her smart watch to track her steps each day, because there is a family history of coronary artery disease and hyperlipidemia. She reports that she normally runs approximately 2-3 hours per day, 4-5 times per week, but she has been spending more time with her friends and going out to eat fast food. She notes that she has gained approximately 10 pounds in the last month.

While Rhyann is at an appropriate weight for her height and age, she has gained 10 pounds in one month due to decreased activity and eating fast food. Discussing healthy food choices when eating out is appropriate, but it is important to explain how to safely lose weight without making her feel uncomfortable. It is also important to note the family history of coronary artery disease in relation to food and activity.

"While your weight is still in the normal range for your age and height, you might consider making healthier choices when eating out with your friends. Increasing frequency & intensity of workouts helps to burn calories and increase endurance."

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On Saturday, Rhyann is scheduled to run in her state cross-country meet.

When she is choosing foods to eat for breakfast, select those that will provide the energy she needs for the cross-country event. Select all that apply.

Apple slices Cheese eggs Overnight oats Avocado toast Bagel with peanut butter Water All of the foods listed are appropriate for Rhyann to eat in preparation for her track meet. She will be running for a long period of time, so she needs both short term and long term energy. The diet is heavier in carbs since she will be running for longer than 90 minutes. Water is essential for hydration, but not a food.

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Concerning Findings Rhyann returns to the healthcare provider approximately 3 months later and reports that she has not experienced a menstrual cycle. Highlight the assessment findings that cause concern.

Reason for visit: No menstrual cycle in 2 months Vital Signs: Temperature: 97.4 F, Pulse: 68, Respirations: 18, Blood Pressure: 104/72 mm/Hg , O2 Saturation: 100%, Pain: 0/10 Weight: 120 pounds (previous visit 145 pounds) Notes: States she has not experienced menstrual cycle in 2 months despite no changes in medication or medical history.

Denies sexual intercourse.

Urine pregnancy test negative . Rapid

dip urinalysis was negative for WBC, blood and nitrates; positive for ketones . Reports fatigue , dizziness , and feeling cold more than usual. Denies change in diet and states, "I have been eating approximately 1200-1300 calories per day and running 4-5 days a week again." Denies recreational drug or alcohol use.

The lack of menstrual cycle, weight loss feeling cold, tired, and dizzy could mean that the client is not eating the number of calories for her height, age, and activity level. Carbohydrate loading is often recommended for sports that expend energy for over 90 minutes, like cross-country. She has ketones in her urine, which indicates that her body is converting energy from the fat storage and potentially using muscle mass. She could also have iron deficiency anemia. She needs to increase her caloric intake to meet her energy expenditure needs. Lack of proper kilocalories can also put Rhyann at risk for osteoporosis.

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Optimal Outcomes To achieve optimal outcomes for Rhyann, drag and drop the apppropriate actions and perameters to monitor due to findings from assessment data.

Actions Establish Food Log Develop Diet Plan Seek Order for urinalysis, CBC, CMP Obtain Consult from Nutritionist

Assess mental health status

Parameters to Monitor Hgb/Hct Urine for Ketones Dietary Intake Menstrual Status Exercise Type, Frequency, Quantity Serum Electrolytes Weight Evaluation

This client needs a lot of education, and it is important to have her understand how to fuel her body. She can make healthy choices and exercise doing the things she loves if done in appropriate levels. She needs a diet plan with a nutritionist and shuold be taught to keep a food journal. A full evaluation of mental health would provide insight into a possible eating disorder, as teen and young girls are at risk for this type of behavior. A full urinalysis would evaluate the level of proteinuria, complete blood count would evaluate her chemistries and complete metabolic profile would evaluate electrolytes. All of these things would need to be reevaluated on return for office reevaluation. It is important to follow her closely and treat for eating disorder, if present.

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Energy Expenditure & Caloric Intake Which energy imbalance can lead to weight gain?

When we eat too many calories and do not expend enough energy, the caloric intake must be stored in the body. While this can occur on a shortterm basis without significant weight gain, but it cannot occur for a series of days or longer. If this happens, the client will gain weight. If the energy expenditure is higher than caloric intake, it can lead to weight loss, if done moderately. Severe reduction in calories can cause the body to slow the basal metabolic rate.

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Body's Energy Expenditure Which concept represents the largest energy expenditure by the body?

Thermic effect of food, thermogenesis and physical activity have an impact on energy expenditure, but not to the degree that occurs with the basal metabolic rate. This component accounts for 70% of the total energy used in the body.

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Introduction to Weight Weight is often associated with the presence or absence of fat, but there are many factors that contribute to the concept. When you complete this unit, you will be able to do the following: Describe components of a healthy weight Explain measuring body fatness Identify methods to interpret weight Distinguish between body types and genetic influences on body size and shape  Compare appropriate essentials of weight  Determine essentials of fitness  Differentiate food requirements for athletic performance    

Body Fat Levels Select the most accurate way of measuring body fat levels.

Body mass index and bioelectric impendence analysis estimate the percentage of body fat. While they can be used to provide a view of health, neither is the most accurate way to determine body fat. For example, a bodybuilder will be considered obese when only using BMI. Calipers estimate fat based on the localized area. It also can be helpful, but it isn't the most accurate method. The most accurate way, but often unattainable method, is densitometry, underwater weighing.

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The waist to hip circumference ratio is a good determinant of fat distribution. Females should have a ratio of less than 0.8 and males 0.951. Additionally, waist measurement provides a good estimate of abdominal, visceral fat. Females shouold have a waist size of less than 35

inches and less than 40 inches for men. This type of fat is dangerous and has a higher risk associated with risk for chronic disease associated with obsesity.

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Family History and Obesity Select the most concerning family history risk factors for someone who is attempting to lose weight and not become obese. Select all that apply.

Osteoarthritis Celiac disease Sleep apnea Coronary artery disease Osteoporosis Alcoholism Obesity is associated with coronary artery disease, sleep apnea, and osteoarthritis. Having these risk factors in the family history are concerning. If the client is obese, the risk for developing these same diseases increases significantly. Alcoholism, celiac disease and osteoporosis are not related to obesity.

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Weight Explained Weight is an essential component of healthcare when caring for a client.

Today's focus is on promoting and assisting clients to maintain a healthy weight. This is defined as a client who can perform basic physical activities of daily living, move comfortably, maintain a weight without restrictive diet or excessive exercise by following healthy eating guidelines, and not experience weight-related disorders. Clients can struggle with weight issues such as being underweight, overweight, or unable to maintain a healthy weight throughout the lifespan.

The human body is made of muscle, bone, and body mass as well as fat, but weight is often used to measure fatness. In healthcare, it is used as assessment criteria for clientes due to the convenience. There are several methods to determine a more accurate body composition (lean body mass plus fat) and will be discussed in the next section.

Weight can be a quick tool to provide assessment data, but it should be evaluated critically. Various factors can influence weight, so this measurement is not always a good determinant of fatness. An increase or decrease in weight do not necessarily mean that there is a change in fat.

In clients who have impaired renal function or premenstrual syndrome, fluid retention can cause a change in weight. Additionally, clients who take diuretics or visit the sauna can have a rapid reduction in fluid loss which will also affect the number on the scale and not fatness.

Body Composition Methods Alternatives to weight for evaluation of body composition include several methods, but each should be evaluated critically and understood thoroughly. In addition to weight alone, anthropometric measurements (measurements of size of the body) and/or assessments that determine the difference between fat and other body components. Let us discuss them in detail.

Densitometry or Hydrostatic Weight Bioelectric Impedance Analysis (BIA) Body Mass Index (BMI) References

Body Fat Functions

Bo dy fat serves various vital functions in the body. The most well-known function is that of storage fat, which can be utilized as needed for energy.

The minimal, protective layer under the skin is essential.

In men, essential fat accounts for approximately 3-8% of body weight, and appropriate total storage and essential fat range is 15-20% of body weight.

Measuring the waist to hip circumference ratio is a good indicator of body fat distribution in males. This ratio should be less than 0.95 to 1.

Additionally, waist circumference alone is a good indicator of fatness as well.

In females, there is a larger amount of gender specific fat. Healthy totals of essential and storage fat range from 25-35% of total body weight. A healthy hip to waist circumference ratio should be 0.8 or less.

Athletes may have fat levels below these ranges, but they should be monitored. This is especially important in women, where menstrual irregularities and amenorrhea (no menstrual cycle) is correlated with osteoporotic bone loss and fractures.

Body Mass Index (BMI) Drag and drop the appropriate BMI that goes with the classifications listed below.

Underweight 17

Overweight 28

Obese 34

Body mass index is one indicator of fatness, but it doesn't take lean muscle mass into consideration. Underweight is classified as <18.5, so the BMI of 17 is appropriate. Overweight is 28, as the range is 25-29.9, and the obese BMI is 34, which is in range of 30-34.9.

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Changes in Fatness

Android Body Types (Apples)

    

Largest around the waist, middle Common in both men and women in menopause Higher waist circumference than recommended Leads to increased risk for weight related diseases and disorders Visceral abdominal fat is dangerous and easier to lose

Gynoid Body Types (Pears)

 Fat stored in lower body (hips, thighs, buttocks)  More common in women, especially before menopause

 Higher levels of estrogen, risk of insulin resistance  Fat is more difficult to lose Despite body type, genetics and ethicity play a role in body shape and fat distribution. While exercise and activity can decrease the amount of fat, the distribution is based on your DNA. Fat is mostly stored in adipocytes, special cells that are designed to hold fat droplets. This fat is in the form of triglycerides, produced from gluclose, gluycerol, fatty acids, and amino acids. The amount of stored fat is depenendent upon energy balance. If energy is needed, the fat is broken down for transport for cells, and if it is not needed, the fat becomes stored. At birth, adipocyte numbers are relativelty low and grow during phases of development and growth.

A pound of body fat is approximately 3500 kilocalories. This means that an excess intake and positive energy balance of 3500 calories can cause a weight gain of 1 pound, and a negative energy balance or expenditure of 3500 kilocalories can cause a weight loss of 1 pound. This energy balance is determined by relationship of intake to energy expenditure.

Underweight Malnutrition While obesity is a global epidemic with 1.9 billion adults, malnutrition from being underweight is also a global problem. According to the World Health Organization (2020), "malnutrition, in all its forms, includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight, obesity, and resulting diet-related noncommunicable diseases". 462 million adults are underweight.

Kilocalories for Fat Loss In order to lose 1 pound of body fat in a week, the daily energy expenditure would have to increase by how many kilocalories?

In order to lose a pound of body fat in one week, you will need to know how many kilocalories are required to burn one pound of fat. This number is 3500. Since there are 7 days in a week, to increase expenditure evenly all week, you would divide 3500/7 = 500. Therefore, you will need to increase daily expenditure by 500 kilocalories.

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Influences on Weight Despite the size and amount of adipocytes, energy expenditure, and genetic makeup, a client's weight is significantly impacted by nutritional, psychological, economic, and social factors. All should be considered when evaluating a client's weight.

Nutritional and Financial Factors The nutritional content and financial ability to buy food can impact the client's weight. If the client lives in a food desert, does not have financial resources, or does not have transportation to access a variety of foods to meet the recommended MyPlate Guidelines, weight will be impacted. The convenience and low cost of prepackaged and fast foods are often appealing and much less expensive than foods that are rich in nutrients.

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Physical Activity vs. Sedentary Lifestyle Physical activity is a core component of maintaining a healthy weight. Just as we promote ambulation for gastrointestinal (GI) motility and recovery from illness, getting moving is essential! When you choose a sedentary lifestyle, you are putting yourself at risk for serious health consequences.

Being physically active provides a great deal of benefits for both your physical and emotional health. These concepts are included in the table below.

Benefits of Physical Activity

      

Increases muscle & bone strength Increases heart rate & respiratory effort Decreases depression Increases ability to move around Increased self esteem Promotes better sleep & rest Promotes healthy weight

Increased Risk with Sedentary Lifestyle

       

Heart disease Type 2 diabetes Depression Stroke Hypertension Hyperlipidemia Weight gain Loss of strength

Risk Factors and Weight Select the risk factors related to sedentary lifestyle and weight that can decrease when exercise is added.

Exercise Can Decrease Risk Heart Disease

x

Diabetes

x

Bipolar Disorder

Exercise has no effect

x

Exercise Can Decrease Risk Stroke

Exercise has no effect

x

While exercise can help with depression, and bipolar disorder has depression as a component, there is no risk of developing bipolar disorder from sedentary lifestyle. Exercise might improve the depression aspect, but there is much more to bipolar disorder than exercise alone can affect.

Heart disease, type 2 diabetes, and stroke are all risk factors that are seen with a sedentary lifestyle. Exercise can decrease the risk.

Your response is correct!

Wellness Approach to Weight Just as your readings, myPlate, and Healthy People 2030 provide recommended daily food intake and energy expenditure, there is no "quick fix" or magic formula that changes everyone's size or shape to that desired. The overarching goal of these recommendations is not a diet but a lifestyle and attitude change. Weight can fluctuate and no one eats and exercises perfectly all the time. Adopting a diet is often done for a short amount of time, and people return to their bad habits. Instead, wellness must be the focus for success. Fueling our bodies with the correct nutrients and being physically active provides benefits that are more than just externally visible. Strategies for success include:

Journaling about emotions and eating is an effective behavior when attempting to pay attention to hunger and satiety cues.

Your response is correct!

Replacing Glycogen Stores Select the foods that would be appropriate for replacing glycogen stores after a workout. Select all that apply.

Raw Carrots and Celery Cereal and milk Cheese and Grapes Eggs and bacon Spaghetti with meat sauce

Spaghetti and cereal are both carbohydrates which would be converted into glucose then glycogen. Eggs, bacon, cheese are proteins and fats which would not provide any glycogen. Vegetables also are not helpful.

Your response is correct!

Food & Athletic Performance As with any physical activity, athletes need food as a source of fuel for energy. Just as a car cannot run without fuel before it stops working, your body needs the appropriate fuel for the task. These are important components of ensuring that all nutritional needs are met when planning for the athlete.

Requirements

Steps to Meet Nutritional Needs

Kilocalories

Minimum requirements: 1800-2000 kilocalories/day with the following criteria

Hydration

(Water &/or Electrolyte Replacement Drinks)

- Carbohydrates – 45-65% of kilocalories - Protein – 10-35% of kilocalories - Fat – 20-35% of kilocalories Athletes should eat at least the minimum number of servings from each group daily.

Depending on body size, some athletes need more.

Water is the most cruicial nutrient for athletic performance. Lack of hydration can present itself in less than 1 hour. Loss of 1 pound of body weight is equivalent to 480 mL (2 cups) of water that needs to be replaced. Sports with moderate-heavy exercise and continuous activity more than 90 minutes can benefit from sports drinks with electrolytes to prevent hyponatremia from water alone.

Carbohydrates

Carbohydrates provide glycogen that delays onset of fatigue and allows for longer activity. Both simple and complex carbohydrates are needed. Carbohydrate loading, increasing the number of carbs eaten, can benefit if amount/length of training is increased, increasing glycogen stores for muscles.

Protein

With athletic activity, protein use is increased. Many athletes eat more protein than recommended so It can be broken down into amino acids then used for energy or

Requirements

Steps to Meet Nutritional Needs stored as fat.

Fat

Amount of fat used during exercise varies based on duration and intensity of the activity, prior level of training, and composition of diet.

Vitamins & Minerals

A balanced diet provides the necessary vitamins and minerals. any athletes use supplements, but it is not necessary or proven to be beneficial. Toxicity can occur if both the supplement and the proper diet is maintained.

Case Study: Rhyann Rhyann, an 18-year-old high school senior presents for her yearly checkup with the healthcare provider. She has been a member of the crosscountry team at her school for 3 years. She is 5'10" and weighs 145 pounds with no underlying health conditions. Rhyann strives to make healthy food choices and uses her smart watch to track her steps each day, because there is a family history of coronary artery disease and hyperlipidemia. She reports that she normally runs approximately 2-3 hours per day, 4-5 times per week, but she has been spending more time

with her friends and going out to eat fast food. She notes that she has gained approximately 10 pounds in the last month.

Question 1 / 3 Rhyann asks what she can do to lose weight and improve her strength and endurance to become more competitive. What is the best response by the healthcare provider?

While Rhyann is at an appropriate weight for her height and age, she has gained 10 pounds in one month due to decreased activity and eating fast food. Discussing healthy food choices when eating out is appropriate, but it is important to explain how to safely lose weight without making her feel uncomfortable. It is also important to note the family history of coronary artery disease in relation to food and activity.

Your response is correct!

Question 2 / 3 Rhyann asks the healthcare provider what types of food and how much she should eat for cross country practice, which often lasts several hours, with at least 2 hours of running. The healthcare It is important to provide detailed nutritional information to this client who is an athelete. Choosing electrolyte replacement/sports drinks are more beneficial for Rhyann because she will be running for over 90 minutes. Drinking water alone can result in hyponatremia, especially as the client sweats. This is worse during warm/hot months. The diet should be composed of Carbohydrates – 45-65% of kilocalories; Protein – 10-35% of kilocalories; and Fat – 20-35% of kilocalories.

Your response is correct!

Question 3 / 3 Rhyann voices concern about the high percentage of carbohydrates the healthcare provider recommends, stating she is afraid she "will become really fat." Which of the following would be appropriate responses from the health care provider? Select all that apply.

"When you eat recommended amounts for athletes, you cannot gain weight even if you do not expend the energy.”

"I hear your concerns, and I it would be fine to decrease the percentage of carbs and increase proteins.”

"Carbohydrates are turned into energy, which provide fuel to your muscles when you're running.”

"I know that carbohydrates get a bad name in today's dietary society, but they are necessary to fuel your body for activity.”

"Speak with your school nutritional coach about increasing the carbohydrate percentage before you compete in races or run for a long time at practice.”

Increasing carbohydrates, or carb loading, is common among athletes who are active at moderate-high intensity sports for 90 minutes or longer.

Since Rhyann is a cross country and long-distance runner, this would be an appropriate choice. It is important to explain that carbohydrates are fuel and necessary for energy to fuel the activity. Decreasing carbs is not recommended for athletes, and athletes can gain weight if they do not exercise, as caloric levels are higher to provide fuel.

Your response is correct!

Concerning Findings Rhyann returns to the healthcare provider approximately 3 months later and reports that she has not experienced a menstrual cycle. Highlight the assessment findings that cause concern.

Reason for visit: No menstrual cycle in 2 months Vital Signs: Temperature: 97.4 F , Pulse: 68, Respirations: 18, Blood Pressure: 104/72 mm/Hg, O2 Saturation: 100% , Pain: 0/10

Weight: 120 pounds (previous visit 145 pounds) Notes: States she has not experienced menstrual cycle in 2 months despite no changes in medication or medical history.

Denies sexual intercourse. Urine pregnancy test negative. Rapid dip urinalysis was negative for WBC, blood and nitrates; positive for ketones . Reports fatigue , dizziness , and feeling cold more than usual. Denies change in diet and states, "I have been eating approximately 1200-1300 calories per day and running 4-5 days a week again." Denies recreational drug or alcohol use.

The lack of menstrual cycle, weight loss feeling cold, tired, and dizzy could mean that the client is not eating the number of calories for her height, age, and activity level. Carbohydrate loading is often recommended for sports that expend energy for over 90 minutes like cross-country. She has ketones in her urine, which indicates that her body is converting energy from the fat storage and potentially using muscle mass. She could also have iron deficiency anemia. She needs to increase her caloric intake to meet her energy expenditure needs. Lack of proper kilocalories can also put Rhyann at risk for osteoporosis.

Your response is correct!

Outcomes and Parameters to Monitor To achieve optimal outcomes for Rhyann, drag and drop the appropriate actions and parameters to monitor due to findings from assessment data.

Actions

Establish Food Log Seek Order for urinalysis, CBC, CMP Develop Diet Plan Obtain Consult from Nutritionist Assess mental health status

Parameters to Monitor Hgb/Hct Exercise Type, Frequency, Quantity Serum Electrolytes Weight Diet Journal Urine for Ketones Menstrual Status

This client needs a lot of education, and it is important to have her understand how to fuel her body. She can make healthy choices and exercise doing the things she loves if done in appropriate levels. She needs a diet plan with a nutritionist and should be taught to keep a food journal. A full evaluation of mental health would provide insight into a possible eating disorder, as teen and young girls are at risk for this type of behavior. A full urinalysis would evaluate the level of proteinuria, complete blood count would evaluate her chemistries and complete metabolic profile would evaluate electrolytes. All of these things would need to be reevaluated on return for office reevaluation. It is important to follow her closely and treat for eating disorder, if present.

Your response is correct!

Fluid Loss & Replacement A gymnast begins to feel dizzy and confused after a strenuous day at the gym. The client weighed 126 pounds before practice, and now weighs 124 pounds. The athletic trainer tells the client to drink

When an athlete sweats a great deal, it is important to replace fluid lost through exercise. Thirst is not the best indicator of hydration. It is important to drink before, during, and after the activity. The athletic trainer needs to encourage adequate fluid intake before and during practice for this client. For every pound of weight lost, the client should drink 480 ml or 2 cups of water. Since this client lost 2 pounds, the appropriate amount of fluids to drink is 960 mL.

Your response is correct!

Obesity & Potential Health Concerns Potential health concerns are of greater risk in obese individuals. Drag and drop the related and unrelated health concerns.

Health Concerns

Related to Obesity

Unrelated to Obesity

Colon Cancer Sleep Apnea Hypertension Osteoarthritis Cerebrovascular Accident (CVA) Cardiovascular disease

Rheumatoid Arthritis Pancreatitis Bipolar Disorder Hypotension Lung Cancer

The health risks associated with obesity are colon cancer, cardiovascular disease, hypertension, cerebrovascular accident (CVA) or stroke, sleep apnea and osteoarthritis. Poor diet, lack of nutrients, sedentary lifestyle, and increased leptin can cause cells in the colon to grow uncontrollably and create tumors. Cardiovascular disease, hypertension, and stroke are all associated with the fatty deposits within the arteries, narrowing the vessels, leading to occlusion. Sleep apnea is common as the excess weight presses down on the airway, causing it to collapse. Osteoarthritis is frequently seen, as the poor diet leads to decrease in bone density and the excess weight applies more wear and tear on the joints. Lung cancer

is related to smoking and pollutants. Depression can be linked to obesity, but not bipolar disorder. Fatty liver can occur, but pancreatitis is not common. Rheumatoid arthritis is systemic and not due to obesity.

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Normalizing Eating A nutritionist is working with a client to normalize eating. Select the appropriate behaviors that would support this goal. Select all that apply.

Choosing healthy foods when eating during emotional times.

Ensuring that all food is eaten that is on the plate.

Recognizing hunger cues and keeping meals simple.

Increasing activity, even if it is in small increments initially then progress to longer periods of time.

Using meal replacement options for breakfast and lunch with largest meal in the evening before bed.

Exploring new types of foods or varying the preparation of existing foods.

Avoiding foods that are high in kilocalories and low nutritional content.

Avoidance of foods is not a behavior that should be practiced. It does not work well to completely rid your diet of certain foods, as this leads to binging. Instead, find healthy ways to indulge in small quantities. Meals should be simple and you do not have to eat all of the food on the plate.

Recognizing satiety is more important. Keep a journal to try to avoid emotional eating and find other ways to cope. Eating the last meal as the largest of the day is not beneficial, as you tend to use more energy throughout the day. Skipping meals or using replacements such as shakes or bars is only a short term option, and it is not sustainable long term. The goal is focusing on behavior changes for life. This may mean you find new foods or try preparing foods in different manners (baked vs fried). Hunger cues can help you know when you're truly hungry and when you're full. Multiple types of food on the plate take longer to reach saiety, so keep it simple. Moving is key, even if it means starting small and

working your way towards a more active lifestyle. Changes like taking the stairs vs the elevator, parking farther away than close to the store, walking instead of driving, etc. Can make a bid difference.

Your response is correct!

Behavioral Goals When setting behavioral goals, what is the most important thing to consider for the client?

Individual habits and preferences Resources available to the healthcare provider Willingness to exercise consistently Amount of weight desired to lose It is most important to understand the client's individual habits, preferences, and lifestyle. If you plan goals that the cleint is unwilling to follow or do not match with their personal lives, it is frivolous and will not be successful. The healthcare provider should ask questions to get to know the client and make appropriate recommendations and suggestions after gaining this information.

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Introduction to the Nursing Application of Energy Nurses play a large role in client education. Promoting healthy lifestyle, weight, and energy balance is no exception. There are so many diet myths today, and the nurse can positively influence a client’s wellbeing.

Upon completion of this lesson, you will gain the following skills:

 Describe the nurse’s role in promoting healthy lifestyle and energy balance  Differentiate positive and negative lifestyle behaviors that affect energy  Assess a client’s energy level and factors that contribute to it  Explain nursing diagnoses related to energy  Plan, implement, and evaluate care for clients with energy imbalances

Macronutrients for Energy Identify the three (3) macronutrients that provide nutritional fuel that can be converted into energy for the human body.

Organic acids Proteins Sodium Chloride Carbohydrates B Complex Vitamins Fats Fats, carbohydrates, and proteins are macronutrients. Vitamins, sodium, chloride, and organic acids are micronutrients.

Your response is correct!

Energy Storage A client presents to the healthcare provider’s office and reports fatigue lasting several weeks despite an active lifestyle and healthy diet. The client does not have any new medications, changes in weight, or other new symptoms. Based on the knowledge of energy requirements, what should the nurse prepare to do after evaluation by the healthcare provider?

Development of new exercise plan Gather supplies for blood draw Schedule a follow up visit Repeat vital signs Repeat vital signs should only be done if there is an abnormality, and they should be done after the first reading. The client is already physically active, so a new exercise plan is not necessary. A follow up visit is required but determining the root cause of the fatigue is most appropriate. Drawing blood will help evaluate possible underlying factors.

Your response is correct!

Energy Needs What are factors to consider when determining a client’s energy needs?

Select all that apply.

Current Injury Chronic Illness Food preferences Past Injuries Age Pregnancy and Lactation Occupation Activity Level Age, activity level, current injuries, chronic illness, and pregnancy/lactation are important to consider and have an impact on energy. Past injuries, food preferences, and occupation are not necessarily important things to consider.

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Client Energy Sources Clients have multiple factors that influence energy levels. It is important for the nurse to complete a thorough history to obtain both subjective and objective data to gain an overall picture of health. Because humans get most energy from nutrients obtained from foods, it is essential to evaluate the client’s dietary intake and nutritional status.

Energy in the human body must be converted from nutritional sources into chemical energy. It is the progression of associated chemical reactions that are interdependent. There are 2 main energy pathways: anabolism and catabolism. These two processes together are called

metabolism. They are interdependent and are closely regulated in the body by hormones. Both energy pathways work together to produce energy for life sustaining functions. The primary source of fuel for energy is food. The measurement of energy released from food is called kilocalories or calories.

In the human body, foods provide a great source of energy, but they must be transformed. After foods are ingested, the processes of digestion, absorption, and metabolism occurs. The 3 energy supplying micronutrients that we receive from food include carbohydrates, fats, and proteins.

Energy Production in Human Body In the human body, there are two processes that comprise the metabolic

pathways: anabolism and catabolism. These two processes together are called metabolism

. They are interdependent and are closely regulated in the body by hormones

. These energy pathways work together to produce energy for life sustaining

functions. The primary source of fuel for energy

is food. The measurement of energy released from food is called kilocalories

.

Metabolism is the process that contains both anabolism and catabolism that work together to produce energy in the human body. This is regulated by hormones to ensure life-sustaining functions. Food is the primary fuel source for energy, and it is measured in units called kilocalories or calories.

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Amount of Energy Needed The amount of energy required by the body depends on various factors.

Activity level, illness, injuries, and chronic diseases are important considerations for determining the amount of nutrients for a client. The recommendations from My Plate, Healthy People 2030, and the United States Department of Agriculture dietary guidelines for Americans are a suggested guidelines for intake across the lifespan for light to moderate activity levels. It is essential to consider the activity level of the client and size of the client to determine accurate intake for healthy weight and energy needs. To formulate a plan for each client, 3 areas should be

considered for energy needs. These include total energy expenditure, physical activity, and the thermic effect of food.

Nurses’ Role in Energy Regarding energy, nurses can play a role in explaining the concept of fueling the body for energy purposes and focusing on health promotion and disease prevention. With the general population being bombarded with advertisements for multiple diets and “healthy foods,” providing accurate information is essential. The traditional approach of exercising more and eating less is not the method that is currently promoted. In the

past, dieticians have been consultants; now they are coaches and counselors, assisting clients in lifestyle change. The long-term approach is one that should be the client’s focus, rather than being on a “diet.”

Accepting genetics and the concept that wellness is the focus of health will also aid in this process. Nurses can provide support and work as part of an interdisciplinary team of dietitians, healthcare providers, behavior therapists, and psychologists. Helping clients understand that a healthy lifestyle can include enjoying food and making choices about how much, when, and where foods are eaten.

Dietary Requirements MyPlate, Healthy People 2030, and the United States Department of Agriculture dietary guidelines for Americans are suggested guidelines for intake across the lifespan. What level of physical activity are these recommendations based on?

Moderate-High Activity Sedentary Lifestyle Low-Moderate Activity Extremely High Activity These guidelines are based on low-moderate activity levels. Lower activity will result in possible weight gain and excess intake. Higher activity levels need additional nutritional servings to provide adequate energy and can result in weight loss.

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Assessment of Energy Energy requirements vary throughout the lifespan, among genders and also with varying medical conditions. The nurse needs to use assessment skills to determine the appropriate energy needs for the client. Estimated calorie needs are determined using Estimated Energy Requirements formula using heights and weights. There are 3 options for activity: sedentary, moderately active, and active.

Additionally, clients should be assessed to determine the following:  Typical dietary intake – identify protein-calorie malnutrition, vitamin deficiencies, or iron deficiencies  Ability to perform activities of daily living.- can the client meet his/her needs?  Perception of energy – does the client feel that he/she has adequate energy each day? Does sleep each night provide rest and energy?  Medical diagnoses – evaluate medical history to determine possible implications for change in energy. Conditions like heart failure, kidney disease, cancer, pregnancy, etc. can alter energy. Evaluate labs such as blood glucose, electrolytes, BUN, creatinine, oxygen saturation (resting and with activity)  Medications – certain medications can cause an increase or decrease in energy

 Sleep disorders – sleep apnea, insomnia, and night terrors can interfere with energy levels; amount of sleep received each night, sleep aids, etc.  Physical activity – what is the client’s activity status? What physical exercise is done and how often?  Emotional status – depression and other mental illnesses can cause alterations in energy Activity Factor (xREE)

Energy Expenditure (kcal/kg per day)

Men

1.3

31

Women

1.3

30

Men

1.6

38

Women

1.5

35

Men

1.7

41

Women

1.6

37

Level of Activity Very Light

Light

Moderate

Heavy

Level of Activity

Activity Factor (xREE)

Energy Expenditure (kcal/kg per day)

Men

2.1

50

Women

1.9

44

Men

2.4

58

Women

2.2

51

Exceptional

Diagnosis of Client Needs Formulating nursing diagnoses depends on the information obtained in the assessment. Various reasons can cause the client to not have the energy needed. Possible nursing diagnoses include  Fatigue related to nutritional deficits/chronic disease/current life stage (pregnancy, teenager, etc.)  Lack of knowledge related to healthy lifestyle and energy needs  Activity intolerance due to health conditions  Disruption in sleep patterns due to insomnia, mental stress, etc.  Impaired physical mobility due to injury, medical diagnosis  Ineffective individual coping strategies due to stressful situations, recent diagnoses, etc.

 Inability to adapt to change in health status due to diagnoses or injury  Decreased cardiac output due to heart or kidney disease  Decreased tissue perfusion due to cardiovascular, kidney, or lung disease  Excess nutrient due to intake exceeding nutritional requirements  Nutritional Deficiency due to lack of access to food, intake of nutrient poor foods, etc.

Planning & Interventions for Energy Planning and interventions for clients with energy needs include the following:  Determine client specific needs based on age and developmental stage (ex: infant – essential nutrients in formula and baby foods).

More information to follow.

 Explain nutritional needs and plan dietary consultations and healthy meal resources  Implement energy saving strategies for clients who are unable to be active due to medical conditions (ex: delegating to others, planning daily activities, organizing like tasks, etc.)  Develop and teach strategies to promote healthy sleep patterns (ex: routine, no electronics at night, resources for finding safe place to rest, etc.)  Establish assistance for stressful situations and life changes (ex: counseling, have client speak with healthcare provider about antidepressants, etc.)  Provide activities and establish a plan for clients who are unable to exercise due to medical conditions (ex: stretching, hand weights, etc.)  Establish dietary plan for each client – detailed information on portion control, moderation, focusing on healthier alternatives, etc.

Can be used for clients with excessive or inadequate intake  Determine and educate client on nutritional resources in the area for access to food like food banks, church food pantries, government assistance, etc. to meet dietary needs despite economic ability

Lack of Energy A client with heart failure, chronic obstructive pulmonary disease (COPD), air hunger, who is wheelchair bound is concerned because of lack of energy. What strategies should the nurse suggest to the client? Select all that apply.

Plan activities for the day and group like things together Consult meals on wheels to deliver food to the client Delegate activities to others in the house Suggest breathing exercises to reverse the COPD Take short naps before activities like bathing and eating Delegating activities to others can help conserve energy. Assist the client to create a plan to group activities together to prevent unnecessary

energy expenditure. Having someone deliver meals to the client will allow someone else to cook and allow this client to rest. Short naps can help restore energy before things that require energy like bathing and eating.

If the client has air hunger and struggles to breathe, exercises are not going to help, and COPD cannot be reversed.

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Specific Requirements for Energy The client will need specific nutrients in addition to the macronutrients for production of energy in different stages of life.

Life Stage

Change in Nutrient Needs

Pregnancy*

Increased requirements: energy, protein, essential fatty acids, vitamin A, vitamin C, Bvitamins ( B1, B2, B3, B5, B6, B12, folate, choline) & calcium, phosphorus,** magnesium, potassium, iron, zinc, copper, chromium, selenium, iodine, manganese, molybdenum

Lactation*

Increased requirements: energy, vitamins A, C, E, all B-vitamins, sodium, magnesium** Decreased requirements: iron

Infancy, childhood*

Increased requirements: energy, protein, essential fatty acids

Adolescence*

Increased requirements: energy, protein, calcium, phosphorus, magnesium, zinc (females only)

Early adulthood (ages 19-50)

Increased requirements for males, compared with females: vitamins C, K; B1, B2, B3, and choline; magnesium, zinc, chromium, manganese Increased requirements for females, compared with males: iron

Middle age (ages 51-70)*

Increased requirements: vitamin B6, vitamin D

Elderly (age 70+)*

Increased requirements: vitamin D Decreased requirements: energy; iron (females only)

Life Stage

Change in Nutrient Needs

* Relative to adult requirements for those 19-50 years of age (and on a per-kg basis for macronutrients).

** Applies only to individuals under age 18.

References Physicians Committee for Responsible Medicine. (2021). Nutritional requirements throughout the lifespan: A guide for clinicians. https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_G uide_for_Clinicians/1342043/all/Nutritional_Requirements_throughout_the _Life_Cycle#:~:text=While%20most%20adults%20require%2025,through %20the%20early%20formative%20years

Pregnancy & Energy Needs A nurse is providing prenatal teaching to a first time, 8 week pregnant female and includes the extra nutritional needs during pregnancy. The client responds, ”That’s a lot of supplements and things to eat. I want my baby to be healthy, but I’m afraid that all of those things will be too much and I will get really fat.” What is the appropriate response by the nurse?

”Restricting calories during pregnancy is dangerous, and you need to be concerned about the well-being of your baby. I’m sure that you won’t gain too much weight, because you’re thin. You can use supplements to get the nutrients.”

“Being pregnant is overwhelming and scary, and I understand your concerns. For you and your baby to be healthy, you need these things.

Fueling your body with nutrients and healthy food will make sure you both have enough energy.” ”You’re going to be very sick during this first trimester if you haven’t been already, so don’t worry about gaining weight. Just make sure you take your vitamins and do not eat a lot of junk food. The last thing you want to develop is gestational diabetes.”

“A nutritionally sound diet provides the macronutrients and micronutrients that your fetus needs to develop appropriately and meet the milestones throughout gestation. An appropriate amount of weight gain is approximately 20-30 pounds.”

This new client is afraid and overwhelmed. She needs reassurance and gentle education. Explaining that the healthy food and nutritional supplements help provide energy for growth and development will help her feel more comfortable. The nurse should never criticize the client for statements made, should use layman’s terms and avoid medical language, and avoid scaring the client with potential complications during pregnancy. Education needs to be done in a way to provide information but not feel threatening or scary.

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Evaluation for Energy Clients need to be followed throughout their lives for evaluation of energy intervention effectiveness. A client’s primary healthcare provider needs to encourage yearly visits to monitor routine lab values such as electrolytes, lipids, and cholesterol and to check weight and vital signs. Promoting

healthy lifestyle modifications throughout the lifespan is essential to changing the mindset to focusing on energy needs.

Nursing Assessment A 45-year-old male client states that he doesn’t have the same amount of energy that he used to have when he was younger, but it doesn’t negatively impact his life. What can the nurse assess? Select all that apply.

Pulse rate Multivitamin intake Level of activity Oxygen saturation If this is a mild concern, the nurse can assess oxygen saturation to see if there is a change. Additionally, taking a multivitamin for males who are middle aged makes a big difference, as vitamin needs are significantly

increased during this life stage. Level of activity can be assessed to determine if the client is active at all or is working out too much.

Your response is correct!

Nutritional Needs in Lifespan Select the change in nutritional needs for each population listed.

Increased Energy

Decreased Energy

Decreased Iron

Vitamin D

B Vitamins

Increased Protein

x

x

Pregnant female

x

Lactating female

x

3-month-old

x

x

14-year-old

x

x

x

x

38-year-old male

x

60-year-old 94-year-old

x x

x

Pregnant females need a variety of additional nutritional requirements, but the ones listed are increased energy, B vitamins, and protein. A lactating female has increased energy needs and needs to decrease iron and increase B vitamins. An infant and the adolescent both need increased energy and protein. The early adult male needs B vitamins. The middle-aged clients need Vitamin D. Finally, the elderly client needs decreased energy and vitamin D.

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Nursing Interventions Match the appropriate nursing intervention with the diagnosis for a client who has issues with energy.

Fatigue

Teach activity conservation activities

Excess nutritional intake

Evaluate serum electrolytes, BUN, creatinine, glucose levels

Activity intolerance

Collaborate with physical and occupational therapy for modifications to physical activity

Disruption in sleep patterns

Evaluate for signs and symptoms of insomnia, obstructive apnea, family dynamic changes and anxiety

Impaired physical mobility

Calculate BMR, BMI and complete health history

Fatigue can be caused by a number of metabolic and chemical issues or undiagnosed illnesses within the body, so evaluation of serum electrolytes, glucose, BUN, and creatinine will provide more direction.

Excessive nutritional intake can be a teaching issue, and it can be situational. Assess the client’s recent life experiences and then calculate BMR, BMI, etc. and formulate a plan. Activity intolerance is common due to obesity or underlying diseases. It is important to teach the client about energy conservation activities that will allow them to use the energy available for important tasks. Sleep pattern disturbance can be for

various reasons. Sometimes anxiety and worry can keep people awake.

Other times it’s a new baby or loss of a family member. Additionally, health issues can prevent adequate sleep. Impaired physical mobility doesn’t mean the client avoids activity completely, but you can collaborate with PT and OT to find solutions that work for each client.

Select the change in nutritional needs for each population listed.

Increased EnergyPregnant lactating 3 month 14 yr Decreased energy94 Decreased ironlactating Vitamin D60 94 B vitaminspregnant lactating 38 Increased ProteinPregnant 3 month 14

Match the appropriate nursing intervention with the diagnosis for a client who has issues with energy.

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Change in Activity Level A middle-aged client who is an avid runner is hospitalized for breaking both legs and sustaining spinal nerve impingement in a fall from a piece of machinery at work. The recovery process is long and the client voices concern about not being able to exercise. What should the nurse suggest for this client?

Participating more than prescribed in physical therapy to speed up the recovery process and get the client back to running.

Requesting a consult for a psychologist to discuss emotional needs and the lack of ability to exercise until recovery is complete.

Encouraging the client to rest as much as possible and to enjoy the prescribed break, giving the body time to rest and gain strength for recovery.

Having physical therapy teach the client exercises to do to maintain and improve upper body and core strength for now.

While the client is used to working out, more physical therapy than prescribed can be detrimental to the recovery process. The client might need a consult for a therapist to discuss feelings and a drastic change of lifestyle, but this client needs something to do. Having the client do exercises that are not going to damper recovery and can provide exercise to maintain some sort of a normal routine will provide support and hope.

It will also keep him focused without being as discouraged as if you do not set up anything at all.

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Adolescent Energy Requirements A parent brings a 15-year-old male client to the primary healthcare provider for evaluation. The parent reports that client was an active, happy teenager who used to enjoy going to school, participating in extracurricular activities, and spending time with his friends. Lately, client is moody, sleeps a great deal, and does not seem to want to go anywhere other than his room. The parent reports daily frustration and arguments between them, ”constantly fighting to get him to go to school and do his homework.”

Question 1 / 5 What information should the nurse gather during assessment? Select all that apply.

Wrestling schedule Change in family status Recent dietary intake Activity level Mood and affect Amount of homework This client seems to have underlying issues that are causing the change in activity and mood. Assessing mood, affect, dietary intake, activity level, social factors like family dynamics will help provide a better picture.

Amount of homework and wresting schedule can be a factor if the client has too much, but it doesn’t seem to be the case. He just doesn’t want to do anything. That is more important to get information to determine the root cause of the issue.

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Question 2 / 5 When assessing the client, the nurse stops frequently due to arguing between the client and parent. The answers seem to be forced, and the nurse feels as if the client isn’t being completely forthcoming. What is the appropriate action by the nurse?

Instruct the client that since the parent is present and an adult, you need answers from the parent.

Ignore the disagreement and continue the questions in an assertive manner to redirect.

Politely ask the parent to step out of the room for a moment to continue the assessment.

Encourage the client to be honest even if hurts the parent’s feelings to hear what is said.

Teenagers can often hide things from and have hesitation in discussing personal information in front of parents. You don’t want to ignore the disagreements. This could be important. While encouraging honesty is important, in this case, having the parent step out is the best option.

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Question 3 / 5 The parent steps out of the room but does so reluctantly. The nurse follows the parent outside to explain. The parent says, “I just don’t understand why I can’t stay in there.” What is the appropriate response?

“I will send the healthcare provider out to explain while I speak with your child. It is just our policy to do this with teenagers.”

“Parents can provide pressure that teenagers do not need. It can make them nervous to have parents in the room with them, so please wait in the lobby.”

“I hear your concern but let me try to talk to your child alone. You two clearly cannot get along right now, and that negativity is not helping me do my job.”

“Sometimes teens can have trouble expressing feelings in front of parents due to fear of hurting your feelings or fearing punishment. Let me see if I can get your child to give us more information.”

Teenagers have a fear of disappointing or hurting parents, and they also fear that they will get into trouble for being honest. They are also trying to gain some independence, so often things are not completely shared with the parent. Explaining the rationale for having the parent step out will help reassure the parent and make the client feel more comfortable.”

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Question 4 / 5 When the nurse returns to question the client, he seems much more relaxed. When asked about his diet, he shares that he was eating the healthy food recommended by the team nutritionist to fuel his body for wrestling, but he had cut back because he recently broke up with his girlfriend.

The nurse notes that client’s body fat percentage is low but appropriate, as he has a great deal of lean muscle mass and defined muscles in his arms, back, chest, abdominals, and legs. He responds, “Yeah, I really wanted to be a state champion in wrestling. Last year, I won 2nd, and winning is something I always wanted to do. Right now, all I want to do is sleep and eat junk food.”

Select whether each finding below is concerning or not.

Concerning Recent breakup; relationship change

x

Increased sleeping

x

Not Concerning

Following team nutritionist diet Decreased activity

x

x

Desire to be state wrestling champ Eating junk food

x

x

The client recently suffered a breakup, and teens are beginning to navigate relationships with others. This can be very upsetting and has apparently caused a big change in the client’s behavior and diet. Sleeping a great deal, decreased activity, and eating junk food are signs of depression and should be reported to the healthcare provider.

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Question 5 / 5 The healthcare provider diagnoses AJ with depression and places him on 25 mg of sertraline once a day. After 10 days, AJ’s mom calls and reports that AJ has started being angry, argumentative, easily agitated, and seems to be more secretive. What should the nurse recommend to the parent?

Stop taking the medication immediately without weaning

Continue taking the dosage as prescribed Return to the office today for reevaluation Increase the dosage to 50 mg once a day The nurse cannot change medication dosage, as it is out of scope of practice. The client does not need stop taking the meds immediately, as they need to be weaned. While antidepressants can take 2-3 weeks to take effect, this is not the case with AJ. He is experiencing signs and symptoms of common side effects seen in teenagers, which can lead to psychosis and suicidal ideation/attempt. He needs to be evaluated in the office immediately.

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