Table of Contents:

1. Energy Balance & Nutrients 4. Healthy Diet Education &

2. Nutritional Assessment Diet Types
3. Nutritional Considerations 5. Enteral & Parenteral Feedings

Fundamentals
Across the Lifespan 6. Obesity & Bariatric Surgery

Nutrition
1. Energy Balance & Nutrients
Nutrition supports energy
balance and metabolic function. FIGURE 1. ENERGY BALANCE
y Malnutrition: Nutrient
imbalance (undernutrition or
overnutrition)
Energy balance: Calories
consumed should balance
calories burned to maintain a
stable weight (FIGURE 1).
y Macronutrients like
carbohydrates, protein, and fat
provide energy (kcal).
y Micronutrients: Vitamins
and minerals provide no
calories but are essential for
metabolism (TABLE 1).

2. Nutritional Assessment
TABLE 1. VITAMINS & MINERALS
y Suspect malnutrition in clients with unintentional
weight loss.
Vitamins
y Assess body measurements.
Fat-soluble (stored in body fat; risk for toxicity) y Height, weight, and recent weight changes
y A: Dairy, carrots y For children, use growth charts.
y D: Fortified milk, fish oils y Calculate body mass index, which is a ratio of
y E: Vegetable oils weight to height (<18.5 kg/m² is underweight,
y K: Leafy greens >25 kg/m² is overweight).
Water-soluble (not stored; need daily intake) y Review nutritional labs.
y B1: Milk, fish
Prealbumin: Indicates short-term nutritional
y B6: Corn, meat status
y B12: Meat
Albumin: Indicates long-term nutritional status
y C: Citrus, broccoli y Hemoglobin/hematocrit:with iron and B12
deficiency anemias
Minerals y Assess for signs of nutritional deficiencies (brittle
y Calcium: Dairy, leafy greens nails and hair, poor wound healing).
y Iron: Meat, eggs y Screen for food allergies and cultural/religious
y Magnesium: Leafy greens, nuts dietary needs.
y Potassium: Bananas, citrus y Assess for barriers to adequate nutrition (finances,
y Sodium: Canned food, deli meats access to food, medical conditions).

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3. Nutritional Considerations Across the Lifespan
Nutritional needs vary by age and development (TABLE 2).

Fundamentals
TABLE 2. NUTRITIONAL CONSIDERATIONS ACROSS THE LIFESPAN

Age Group Considerations

Infants
Recommend exclusive breastfeeding until 6 months old.

y Introduce solid foods at 6 months (start with iron-fortified cereal).

No honey until 1 year old due to botulism risk
y Clients with phenylketonuria (PKU) require a low-protein, aspartame-free diet to prevent
intellectual disability.

Toddlers &
Start cow’s milk at 1 year old (<24 oz/day [710 mL/day] to prevent milk anemia).
Preschoolers y Picky eating is expected.
y Encourage small, frequent meals.
y Cut up larger round foods due to choking risk (grapes, hot dogs).
y Do not force child to finish meals or use food as a reward.

School-Age & y Limit sugary drinks.

Adolescents y Limit unhealthy snacks and fast food.
y Monitor for disordered eating (anorexia, bulimia, overeating).

Older Adults y calcium and vitamin D for postmenopausal women to osteoporosis risk.

Encourage fiber and fluids to support digestion and hydration.
y Assess for sensory loss, dental issues, and dysphagia.

Pregnant Clients y folate for women of childbearing age (see ANTEPARTUM ASSESSMENT & DISCOMFORTS OF
PREGNANCY CHEAT SHEET).

4. Healthy Diet Education & Diet Types

FIGURE 2. BALANCED PLATE FOR HEALTHY EATING
Healthy eating

Educate clients on “balanced plate” for healthy
eating (FIGURE 2).
y ½ plate: Fruits and vegetables
y ¼ plate: Protein
y ¼ plate: Whole grains

Perform dietary teaching.
y Encourage intake of water and complex
carbohydrates.
y Avoid alcohol, sugary drinks, and excess
saturated fats (meat, dairy).

 Nutritional considerations for infants  Nutritional considerations for older adults:

and toddlers: Exclusive breastfeeding is Encourage increased fiber and fluid intake to
recommended until at least 6 months old. Avoid support digestion and hydration.
honey until 1 year old due to the risk of botulism.
Limit cow’s milk to ≤24 oz/day (710 mL) in
toddlers to prevent milk anemia.

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4. Healthy Diet Education & Diet Types, Continued
Diet types
y Provide therapeutic diets as prescribed
TABLE 3. THERAPEUTIC DIETS

Fundamentals
and progress as tolerated (clear liquid 
Mechanical soft diet) (TABLE 3). Diet Considerations Examples
y Provide client education for specific
diet types. NPO: Nothing by Used pre- y No food or drink
y Cardiac: Limit sodium and mouth procedure or permitted
saturated fat toBP and with dysphagia
cholesterol. (e.g., stroke) until
y Diabetic: Limit sugar and simple swallowing ability is
carbs and encourage weight loss evaluated
as needed (see OBESITY & BARIATRIC
SURGERY). Clear liquid: Used for GI y Broth
y Renal: Limit sodium, potassium, Clear liquids upset and pre- y Water, tea
and phosphorus tokidney without solids colonoscopy y Clear gelatin
workload.
y Vegetarian: Encourage iron and
Full liquid: Used for GI upset y Milk
protein intake; risk for B12, calcium,
Thickened liquids and after surgery y Soup
and zinc deficiencies.
and pureed foods y Pudding

Implement interventions to promote
y Smoothies
adequate nutrition.
y Assess for barriers to eating, such
as missing teeth and dysphagia. Mechanical soft: Used for chewing y Chopped or
y Position client in Fowler position Soft, easy-to-chew or swallowing ground meats
while eating. and swallow foods issues y Soft fruits
y Promote independent eating and y Scrambled eggs
use adaptive utensils as needed.

5. Enteral & Parenteral Feedings

y Enteral nutrition delivers liquid nutrition directly into
Parenteral nutrition (TPN) is used as a last resort
the GI tract via a feeding tube. and delivers nutrition directly to the bloodstream.
y Feeding tube types (FIGURE 3) y High-glucose solutionrisk for bacterial
y NG tube: Nasogastric tube inserted through nose growth/sepsis: Administer TPN via central
into stomach for short-term feeding venous access device (CVAD) with sterile
y PEG tube: Percutaneous endoscopic gastrostomy technique and change tubing frequently.
tube inserted directly into stomach for long-term y Risk for hypo- or hyperglycemia: Monitor blood
feeding glucose every 6 hr.
y J-tube: Jejunostomy tube inserted into jejunum y Prevent hypoglycemia: Taper TPN slowly to
to bypass stomach (gastroparesis, pancreatitis) prevent rebound hypoglycemia; never stop
abruptly.

 Parenteral nutrition (TPN) safety: Administer via CVAD with sterile technique, monitor glucose
every 6 hours, and taper slowly to prevent hypoglycemia.

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5. Enteral & Parenteral Feedings, Continued
Nursing considerations
y Insert NG tube using appropriate procedure TABLE 4. NASOGASTRIC TUBE INSERTION

Fundamentals
(TABLE 4).

Confirm tube placement with X-ray before initial 1. Position client in high-Fowler position.
use to ensure the tube is in the stomach.  2. Determine tube insertion length by measuring

For NG tubes, elevate head of bed (HOB) from nose  Earlobe  Xiphoid process.
30-45 degrees during and after feeding to
prevent aspiration.
y Monitor for signs of aspiration (wheezing, coughing).
y Monitor for signs of feeding intolerance (residuals,
nausea, diarrhea); adjust rate or concentration
as needed.

Risk for life-threatening refeeding syndrome when
starting nutrition after severe malnutrition: Assess
for hypophosphatemia, hypokalemia, and fluid
overload (see EATING DISORDERS CHEAT SHEET).

FIGURE 3. FEEDING TUBE TYPES

3. Lubricate and insert tube; rotate and aim

tube towards the back of the throat and down
toward the ear.
4. Instruct client to put chin to chest and
repeatedly swallow during insertion, advancing
tube with each swallow.

If tube meets resistance or client shows
signs of respiratory distress (cyanosis),
remove tube and assess.
5. Stop insertion once the desired length is
reached.
6. Secure tube with tape.
 7. Confirm tube placement with X-ray before
utilizing (ensures tube is in stomach, not the
lungs, which would cause aspiration).
• After initial X-ray, verify tube placement
before each use by aspirating gastric
contents and testing pH of aspirated
contents.
• Return gastric contents after aspirating
to prevent electrolyte imbalances; do not
discard.

 Enteral feeding safety: Before initiating enteral nutrition, verify tube placement with an X-ray.
Elevate the HOB 30-45 degrees during and after feeding to prevent aspiration.

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6. Obesity & Bariatric Surgery
Obesity: Excessive accumulation of body fat (BMI >30) Postoperative care
y Complications include heart disease, stroke, sleep
Monitor for life-threatening anastomotic leak

Fundamentals
apnea, and type 2 diabetes. (breakdown at surgical connection causing leakage):
Interventions Tachycardia, fever, and back pain.
y Use nonjudgmental language and avoid biased
Eat small meals and lie down after eating to prevent
comments. dumping syndrome.
y Use bariatric-sized equipment. y Dumping syndrome is rapid gastric emptying,
y Measure weight privately to avoid embarrassing causing GI upset, dizziness, and tachycardia.
client. y Avoid pouch stretching: Chew foods thoroughly;
y Encourage a healthy diet and exercise. avoid drinking fluids with meals.

Bariatric surgery (e.g., gastric bypass) is performed for

FIGURE 4. BARIATRIC SURGERIES
severe obesity or ineffective weight loss despite lifestyle
changes.
y Makes stomach smaller and/or reroutes digestive
tract, limiting nutrient absorption and how much food
can be eaten (FIGURE 4)

 Dumping syndrome prevention: Rapid gastric emptying after bariatric surgery can cause GI upset,
dizziness, and tachycardia. Prevent it by eating small meals and lying down after eating to slow
digestion.

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 Fundamentals
 Exclusive breastfeeding is recommended until  Before initiating enteral nutrition, _____ must
at least ____ months old. Avoid honey until _____ be verified with _____. During and after enteral
(age?) due to the risk of _____. Cow’s milk should feeding, the HOB should be positioned _____
be limited to _____ ounces/day in toddlers to degrees to prevent _____.
prevent _____.

 In older adults, increase _____and _____ to support  What are three symptoms of dumping syndrome?
digestion and hydration. To prevent it, eat _____ meals and _____ after
meals.
 When administering TPN, give via _____, monitor
blood glucose every _____ hours, and taper the
infusion slowly to prevent _______.

5. GI upset, dizziness, tachycardia; small, lie down

Answers: 1. 6; 1 year old, botulism; ≤24, milk anemia 2. fiber, fluids 3. CVAD, 6, hypoglycemia 4. tube placement, X-ray; 30-45, aspiration

References:

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y Energy Balance: Created with BioRender.com
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y Balanced Plate for Healthy Eating: Created with BioRender.com
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J., & Carroll, J. (2022). Maternal-child nursing (6th ed.). y Feeding Tube Types: Created with BioRender.com
Elsevier Health Sciences. y NG Tube Insertion: Created with BioRender.com
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