Download Chapter 44 Nutrition

Chapter 44:
Nutrition
Bonnie M. Wivell, MS, RN, CNS
Scientific Knowledge Base: Nutrients
Carbohydrates
Proteins
Starches and sugars
Fiber
Amino acids
Fats
Water
Saturated,
monounsaturated, and
polyunsaturated
Cells depend on a fluid
environment
Vitamins
Minerals
Essential to metabolism Catalysts for
biochemical reactions
Water or fat soluble
Anatomy and Physiology of the
Digestive System
Digestion
Absorption
Begins in the mouth
and ends in the small
and large intestine
Intestine is the primary
site for absorption
Metabolism and
Storage of
Nutrients
Elimination
Anabolic and catabolic
reactions
Chyme is moved
through peristalsis into
the large intestines and
turned into feces
Dietary Guidelines
Dietary Reference Intakes
Acceptable range of
amounts of vitamins and
minerals to avoid
deficiencies for age and
gender groups
Food guidelines
Food Pyramid Guide, basic
guide for meal
preparations
Daily values
Needed protein, vitamins,
minerals, fats, cholesterol,
carbohydrates, fiber,
sodium, and potassium
Nutrition During Growth & Development
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Infants: as they grow they need protein,
vitamins, and minerals; high growth rate
Toddlers: small, frequent meals; picky eaters;
need fewer calories, higher protein
School-age: Don’t eat the required nutrients;
growth spurts
Adolescents: concerned with body image
Young and middle adults: reduced need for
nutrients as their growth periods end
Older adults – decreased need for calories
Factors Affecting Nutritional Status
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Age-related GI changes
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Changes in teeth and gums
Reduced saliva production
Atrophy of oral mucosal epithelial cells
Increased taste threshold
Decreased thirst sensation
Reduced gag reflex
Decreased esophageal and colonic peristalsis
Presence of Chronic Illness
Malnutrition
Adverse affects of meds
Cognitive impairment
Alternative Food Patterns
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Based on religion, cultural background,
ethics, health beliefs, preference
Vegetarian diet:
 Ovolactovegetarian:
eat eggs and milk
 Lactovegetarian: drink milk but avoid eggs
 Vegans: consume no animal products of any kind
 Fruitarian: eat only fruit, nuts, honey and olive oil
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Zen Macrobiotic
 Eat
brown rice, other grains, & herb teas
Assessment
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Nurses are in an excellent position to
recognize signs of poor nutrition
Pts who are malnourished are at greater risk
of life-threatening complications during
hospitalization such as arrhythmia, sepsis,
hemorrhage
A nutritional assessment is more than taking a
diet history
Screening
http://www.mna-elderly.com/user_guide.html
Assessment Continued
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Anthropometry = a systematic measurement of
the size and makeup of the body at specific
body sites
Laboratory and biochemical tests
 CBC,
albumin, pre-albumin transferrin (transferrin is
a blood plasma protein for iron), electrolytes, BUN,
creatinine, glucose, cholesterol, triglycerides, and
retinol (form of Vitamin A).
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Dietary and health history
Physical examination
 Dyphagia
(difficulty swallowing)
Nursing Diagnosis and
Planning
Select from the NANDA-I–approved
list after assessment
 Plan outcomes and goals to assist
client’s needs
 Improving a client’s diet takes care
and planning
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Implementation
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Ill, debilitated, and recovering clients often
have poor diets
Socioeconomic, psychosocial, and
environmental factors can contribute to a poor
diet
Advancing diets – see Box 44-10
Promoting appetite
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Clean and odor free environment
Oral hygiene
Social time
Music therapy
Implementation Continued
Make sure clients can feed themselves,
can swallow and are positioned properly
 If clients have visual difficulties, they
may need assistance with feeding. You
can also help clients by telling them
where food is placed, according to the
face of a clock (e.g., peas at 3 o’clock)
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Enteral Tube Feeding
Nasogastric
 Nasointestinal
 Gastrostomy
 Jejunostomy
 PEG
 PEJ
 Video
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INSERTING THE FEEDING OR
ASPIRATING TUBE
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ASSEMBLE EQUIPMENT
EXPLAIN PROCEDURE TO PATIENT
MEASURE TUBE
INSERT (will practice in lab)
INSERT 20ml AIR TO COMFIRM
PLACEMENT
ASPIRATE 5ml OF GASTRIC CONTENTS
TO TEST pH
Enteral Tube Feeding Complications
Aspiration
 Diarrhea
 Constipation
 Tube occlusion
 Tube displacement
 Abd. Cramping, nausea, vomiting
 Delayed gastric emptying
 Electrolyte imbalance
 Fluid overload
 Hyperosmolar dehydration
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Total Parenteral Nutrition
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Specialized nutrition support in which
nutrients are provided intravenously
 Must
be infused via a central catheter
 Average 50% Dextrose solution + Amino
acids, vitamins, minerals, electrolytes
 Lipids (Fat Emulsion) provide supplemental
kilocalories and prevent essential fatty acid
deficiencies
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Administered to clients who are unable to
digest or absorb enteral nutrition
Complications From Total Parenteral
Nutrition
Catheter occlusion
 Catheter infection
 Electrolyte imbalance
 Hypo/hyperglycemia
 HHNC (Hperglycemic Hyperosmolar
Nonketotic Coma)
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Medical Nutrition Therapy
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GI diseases
 PUD
 H.
Pylori
 Inflammatory bowel disease
 Malabsorption syndromes (celiac disease)
 Diverticulitis
DM (American Dietetic Association)
 CV Disease (American Heart Association)
 Cancer
 HIV
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Evaluation
To measure the effectiveness of
nutritional interventions
 To ascertain if client has met goals
and outcomes
 To amend nursing interventions
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