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Chapter 44: Nutrition

Chapter 44: Nutrition. Bonnie M. Wivell, MS, RN, CNS. Scientific Knowledge Base: Nutrients. Anatomy and Physiology of the Digestive System. Dietary Guidelines. Dietary Reference Intakes Acceptable range of amounts of vitamins and minerals to avoid deficiencies for age and gender groups

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Chapter 44: Nutrition

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  1. Chapter 44: Nutrition Bonnie M. Wivell, MS, RN, CNS

  2. Scientific Knowledge Base: Nutrients

  3. Anatomy and Physiology of the Digestive System

  4. 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, andpotassium

  5. Nutrition During Growth & Development 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

  6. Factors Affecting Nutritional Status Age-related GI changes 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

  7. Alternative Food Patterns • 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 • Zen Macrobiotic • Eat brown rice, other grains, & herb teas

  8. Assessment 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

  9. Assessment Continued 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). Dietary and health history Physical examination Dyphagia (difficulty swallowing)

  10. 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

  11. Implementation • 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 • Clean and odor free environment • Oral hygiene • Social time • Music therapy

  12. 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)

  13. Enteral Tube Feeding Nasogastric Nasointestinal Gastrostomy Jejunostomy PEG PEJ Video

  14. INSERTING THE FEEDING OR ASPIRATING TUBE 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

  15. Enteral Tube Feeding Complications • Aspiration • Diarrhea • Constipation • Tube occlusion • Tube displacement • Abd. Cramping, nausea, vomiting • Delayed gastric emptying • Electrolyte imbalance • Fluid overload • Hyperosmolar dehydration

  16. Total Parenteral Nutrition • 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 • Administered to clients who are unable to digest or absorb enteral nutrition

  17. Complications From Total Parenteral Nutrition Catheter occlusion Catheter infection Electrolyte imbalance Hypo/hyperglycemia HHNC (Hperglycemic Hyperosmolar Nonketotic Coma)

  18. Medical Nutrition Therapy • GI diseases • PUD • H. Pylori • Inflammatory bowel disease • Malabsorption syndromes (celiac disease) • Diverticulitis • DM (American Dietetic Association) • CV Disease (American Heart Association) • Cancer • HIV

  19. 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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