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Nursing Field Notes / Nursing Core · Fundamentals of Nursing

Basic Nutrition 🥦

Nutrition I — the six nutrients, the assessment, and the feeding interventions that keep clients safe

NG-005 Nursing Core ADHD-friendly visual edition

A nutritional assessment matters because the needs are different for every client. You have to account for their religious and cultural needs, their illnesses, and their allergies — and then think about how the food is actually presented to someone lying in a hospital bed.

📄 Simple Nursing original — opens in Drive →

6️⃣ Six nutrientsCarbs · Protein · Fat · Vitamins · Minerals · Water. Water counts.
🍞 Simple = spikeLow fiber, high glycemic index. Complex = most fiber, slow & steady.
🪑 High Fowler's + 1 hrSit up to eat; stay up 1 hour after. Aspiration prevention.
🥩 Protein healsGrowth · maintenance · tissue repair — the big one for a healing client.
🍽️

THE FUEL

STEP 1 · WHAT FOOD IS MADE OF

Six nutrient classes. Three of them give you calories; three of them make the machinery work.

🍽️ Build the plate before you build the meal plan

TEACHING Half the plate vegetables & fruit, a quarter lean protein, a quarter grains — and make at least half of those grains whole grains.

dairy · Ca²⁺ · protein 🥦 ½ PLATE — vegetables & fruit fiber · vitamins · minerals · water 🌾 ¼ grains 🍗 ¼ lean protein
🧠 “Half green, quarter grain, quarter gain.” Half the plate green (produce), a quarter grain, a quarter the protein that lets tissue gain back what illness took.

⭐ The six basic nutrients

  • Carbohydrates — break down into glucose for fuel.
  • Fats — provide energy & carry vitamins. No more than 35% of caloric intake.
  • Protein — growth, maintenance & tissue repair. Big one for healing clients.
  • Vitamins — necessary for metabolism.
  • Minerals — needed for the body's chemical reactions.
  • Water — critical for cell function; replaces fluid lost to sweating, elimination & respiration.
🧠 “CPF — VMW.” The first three (Carb, Protein, Fat) give calories. The last three (Vitamins, Minerals, Water) give zero calories but run the machinery.

🔢 Calories per gram — memorize these four

  • 🍞 Carbohydrate — 4 kcal/g
  • 🥩 Protein — 4 kcal/g
  • 🥑 Fat — 9 kcal/g (more than double)
  • 🍷 Alcohol — 7 kcal/g (calories with no nutrients)

That is why fat is capped: it is the most calorie-dense thing on the plate.

44 79 🍞 carb🥩 protein 🍷 alcohol🥑 fat ⚡ kcal per gram 35% max from fat ceiling, not a target
🧠 “4-4-9, alcohol is 7.” Say it as a phone number. Fat is nine because it's the naughty one.

🍞 vs 🫘 Simple carbs SPIKE · complex carbs are SLOW & STEADY

Simple carbs = less fiber → FAST sugar spikes → high glycemic index. Complex carbs = most fiber → slow, steady sugar levels → low glycemic index.

fasting range BLOOD GLUCOSE LEVEL TIME / HOURS after the meal 012 345 ⬆ HIGH GI — sharp spike white bread · white pasta · white bagels ➡ LOW GI — slow & steady beans · whole-grain bread · lentils · oats 💥 the crash — hunger, shakiness, another spike = high GI = low GI
🍞 SIMPLE carbohydrate🫘 COMPLEX carbohydrate
Less fiberMOST fiber
FAST sugar-level spikesSlow, steady sugar levels
→ High glycemic index→ Low glycemic index (usually)
White bread · white pasta · white bagels · candy · juiceBeans · lentils · whole-grain bread · oats · potatoes
Spike then crash → hunger and another spikeSteadier energy, better satiety, better glycemic control

⚠️ Careful: “complex” and “low GI” are not the same word. Potatoes are a complex carbohydrate with a fairly high glycemic index — the fiber, the processing and what else is on the plate all change the response.

🧠 “White = spike. Whole = slow.” White bread, white pasta, white bagels, white rice — stripped of fiber, straight to glucose. Anything still wearing its fiber coat lets glucose in slowly.

💊 Vitamins — the two families behave differently

  • Water-soluble (B complex, C) — not stored; excess is urinated out, so they are needed regularly. Deficiency shows up faster.
  • Fat-soluble (A, D, E, K) — stored in fat & liver, so they build up → real toxicity risk from megadoses.

Fat in the diet is what lets A, D, E & K be absorbed at all — a very low-fat diet can create a fat-soluble vitamin problem.

📎 NG-227 Vitamins & Electrolytes for the individual deficiencies. 📎 NG-084 Diet Types for clear liquid, full liquid, soft, mechanical soft, low-residue, renal and cardiac diets.
🧠 “ADEK sticks. BC leaks.” A-D-E-K stick around (toxicity). B and C leak out in the urine (need them daily).

🔬 Where the nutrients actually get in — the villus cutaway

Nearly all absorption happens in the small intestine, across a lining folded into millions of finger-like villi. Sugars & amino acids go into the blood capillaries; most fats go into the lymphatic lacteal.

🔬 SMALL INTESTINE WALL — cutaway LUMEN — chyme (digested food + enzymes) MUCOSA (villi) → SUBMUCOSA → MUSCULARIS → SEROSA 🔴 capillary → portal vein → liver 🟦 lacteal → lymph → thoracic duct → blood glucose + amino acids ⬇ fatty acids ⬇
🧠 “Sugar takes the highway, fat takes the back road.” Glucose and amino acids ride the capillary straight to the liver; fat detours through the lymph before it ever reaches the blood.
🔎

ASSESS THE CLIENT, NOT THE FOOD

STEP 2 · GATHER

Every client's needs are different. Get the history before you get the tray.

📋 The nutritional assessment — what to actually ask

  • Dietary history. What does the client like to eat at home? Dislikes? What are they usually eating? Who cooks? How many meals a day?
  • Illnesses that change dietary needs — diabetes, kidney disease, heart disease, liver disease, GI disorders, cancer.
  • Medications that change dietary habits or cause loss of appetite — chemotherapy, opioids, digoxin, metformin, antibiotics, appetite-suppressing stimulants.
  • Culture & religion — halal, kosher, Hindu vegetarian, Lent, Ramadan fasting, hot/cold food beliefs.
  • Allergies & intolerances — and how severe.
  • Ability to eat — dentition, dentures, chewing, swallowing, hand strength, vision, positioning.
  • Access — money, transport, cooking facilities, someone to shop.
🧠 “Likes · Illness · Meds · Beliefs · Ability · Access.” Six questions, and you have a real dietary history instead of “patient eats a regular diet.”

🧪 Objective data you can chart

  • Weight trend — the single most useful number. Same scale, same time, same clothing.
  • BMI — under 18.5 underweight · 18.5–24.9 normal · 25–29.9 overweight · 30+ obese. (Standard adult categories only — they do not apply to children, pregnancy, or athletes, and BMI is a screening number, not a diagnosis. Read it alongside the weight trend and the whole clinical picture.)
  • Intake & output, and the percentage of the meal eaten.
  • Labs — albumin and prealbumin reflect protein status (both drop with inflammation too, so read them with the whole picture); hemoglobin/hematocrit, glucose, electrolytes.
  • Physical clues — hair loss, brittle nails, poor skin turgor, dry mucous membranes, slow-healing wounds, muscle wasting, pale conjunctivae.
🧠 Prealbumin has a shorter half-life than albumin — it responds to recent intake, so it's the better short-term marker of whether your feeding plan is working.

🚨 Who is at highest nutritional risk

  • Older adults — decreased appetite, taste changes, dentition, isolation, fixed income.
  • Post-op & wound-healing clients — protein demand goes up, not down.
  • NPO for repeated tests, or held for procedures again and again.
  • Cancer / chemotherapy — nausea, mucositis, taste change.
  • Dysphagia after a stroke — aspiration risk.
  • Anyone with unintentional weight loss.

Never let a client sit NPO shift after shift without escalating it — “still NPO” is not a nutrition plan.

🧠 Healing costs protein. A pressure injury or a surgical wound raises requirements — a “regular diet” may not be enough.
🛠️

INTERVENTION

STEP 3 · MAKE THE MEAL WORK

Half of hospital nutrition is not the food — it is the position, the mouth, and the room.

🪑 Position is a nursing intervention — sit up, and stay up for 1 hour

Sit up in a chair if possible. If the client cannot get out of bed, use high Fowler's position and keep that position for 1 hour after eating.

✅ HIGH FOWLER'S 60–90° · gravity does the work ≈70° STAY UP 1 HOUR after the meal 🍽️ chair > bed, whenever possible ❌ FLAT / SUPINE gravity works against you airway cutaway — the fork in the road TRACHEA → lungs ❌ ESOPHAGUS → stomach ✅ ⚠️ ASPIRATION Food + flat = reflux + aspiration → aspiration pneumonia, the complication that turns a meal into a hospital stay
🧠 “Up to eat, up to stay.” High Fowler's to swallow, and one full hour upright afterwards. The hour is the part everyone forgets — and it is the part the exam asks about.

✅ The intervention list, in order

1
📄 Review the diet plan with the client
↓
2
🤝 Build a meal plan that works for BOTH the restrictions and the client
↓
3
🪥 Oral hygiene before AND after eating
↓
4
🌤️ Make the environment conducive to eating
↓
5
🪑 Sit up — chair, or high Fowler's + 1 hour
🧠 Oral care BEFORE the meal is the one people skip. A clean, moist mouth tastes food properly — that alone raises intake.

🌤️ “Environment conducive to eating” — what that means in practice

  • Remove bedpans, emesis basins, soiled linen and dressing supplies before the tray arrives.
  • Control odors; open the curtain, turn on the light.
  • If a client on a diet is roomed with a client who has diarrhea, ask whether a room change is possible.
  • Pain and nausea medicated before the meal, not after.
  • Open packages, cut food, position the tray in reach — and give unhurried time.
  • Encourage family to visit at mealtimes; eating is social.
🧠 Nobody eats next to a bedpan. If the room smells, the tray goes back full — and the chart says “poor appetite” when the real problem was the room.

🚨 Aspiration precautions — the safety layer under every feeding

  • Assess swallowing first in anyone post-stroke, with dysphagia, decreased LOC, or newly extubated. If in doubt, keep NPO and get the speech-language pathologist swallow evaluation.
  • Upright 60–90° to eat; chin tucked toward the chest when swallowing.
  • Small bites, slow pace, one bite at a time; check the mouth is empty before the next bite.
  • Thin liquids are the most dangerous — thickened liquids may be ordered.
  • No straws for many dysphagia clients (they deliver a fast bolus) — follow the SLP's plan.
  • Suction available; watch for coughing, throat-clearing, a wet or gurgly voice, or a low-grade fever after meals.
  • Oral care after eating — pocketed food in the cheek is aspiration waiting to happen.

Never feed a client who is lying flat, drowsy, or not fully awake.

🧠 “Chin down, sit up, go slow, look in.” Four moves, in that order, every time you feed someone with a swallowing problem.

📈 Boosting intake without a new order

  • Offer small, frequent meals rather than three large ones.
  • Serve the highest-protein item first while energy is best.
  • Honor preferences — the food they will actually eat beats the food that is technically ideal.
  • Fortify: milk powder, cheese, peanut butter, oral supplements between (not with) meals.
  • Chart % eaten, not “ate well.”
  • Involve the dietitian early — a collaborative intervention, and the right escalation.
🧠 Supplements go BETWEEN meals. Given with the tray, they just replace the food instead of adding to it.
⚡

QUICK RECALL

SAY IT OUT LOUD
6️⃣ C·P·F·V·M·WCarbs, Protein, Fat, Vitamins, Minerals, Water.
🍞 White spikesSimple = low fiber = high GI. Complex = fiber = slow.
🪑 60–90° + 1 hrHigh Fowler's to eat, upright a full hour after.
🥩 Fat ≤ 35%and fat is 9 kcal/g — carbs & protein are 4.
🎯 Cover & check — 6 rapid-fire questions
Q1: Name the six basic nutrients.
Carbohydrates, fats, protein, vitamins, minerals and water. The first three carry calories; the last three do not.
Q2: Which nutrient matters most for a client with a healing surgical wound?
Protein — growth, maintenance and tissue repair. Requirements go UP during healing. (Vitamin C and zinc support it too.)
Q3: A client must eat in bed. What position, and for how long afterwards?
High Fowler's, and keep them in that position for 1 hour after eating. Sitting up in a chair is better still if they can manage it.
Q4: Simple vs complex carbohydrate — one sentence each.
Simple = less fiber, fast sugar spikes, high glycemic index (white bread, white pasta, white bagels). Complex = most fiber, slow steady sugar levels, generally low GI (beans, whole-grain bread).
Q5: The client's roommate has diarrhea and the client is not eating. What do you do?
Ask whether a room change is possible — the environment has to be conducive to eating. Also remove bedpans/soiled items, control odors, and give oral care before the tray.
Q6: How many kcal per gram in fat, and what is the intake ceiling the source gives?
9 kcal/g, and no more than 35% of caloric intake. Carbohydrate and protein are 4 kcal/g each.