Nursing & Nutritional Needs of Patients

1. Nursing & Nutritional Needs of Patients Lisa B. Flatt, RN, MSN, CHPN

2. Terminology • Gastrointestinal system – GI system • Alimentary canal – ‘tube’ that food/fluid follow from the mouth to the anus • Peristalsis – muscles of the alimentary canal move in waves and push the food/fluid through

3. Follow the Path of the Alimentary Canal! • Mouth • Esophagus • Stomach • Small Intestine • Duodenum • Jejunum • Ileum • Large Intestine • Ascending colon • Transverse colon • Descending colon • Sigmoid Colon • Rectum • Anus

4. Anatomy & PhysiologyThe Gastrointestinal (GI) System • Mouth – dentition breaks down food into small enough pieces that enzyme-containing saliva begins breaking down the food (& fluids) • Esophagus • Stomach – secretes gastric acids to further breakdown the food • Small intestine – most of digestion happens here, the villi and microvilli line the mucosal surface, from which enzymes, acids and proteins are secreted and nutrients are absorbed

5. And then there’s more……. • Large intestine – water is absorbed and digestive wastes are converted into feces • Sigmoid (pelvic) colon – waste/feces travels through to reach rectum • Rectum – contains vertical folds (each contain an artery and vein), these folds help hold feces in the rectum • Anus – internal sphincter muscles are stimulated by the autonomic nervous system and external sphincter muscles are stimulated by the somatic nervous system

6. The Basic Four Food Groups

7. Eat Healthier! • Grains Group – ½ of grains should be whole grains • Fruits – Focus on fruits • Vegetables – Vary your veggies • Dairy – Calcium rich • Protein - Go lean with your protein • Go Red!

8. Daily Requirements Servings per day Sample diet • Fruit &Vegetables 5-10 • Meat 2-3 • Dairy 2-4 • Grains 5-12

9. What do we eat to be healthy? • Proteins - • Carbohydrates • Fats • Vitamins

10. Grains • Whole grains: Brown Rice: Buckwheat: Millet: Oatmeal: Popcorn:Bulgur (cracked wheat): Whole-wheat cereal flakes: Meuslix: Rolled oats: Quinoa: Wheat Pasta • Refined grains: corn tortillas: grits: pasta: pita: noodles: corn flakes • Examples of refined grains you have eaten today/this week? • Examples of whole grains you have eaten today/this week?

11. Fruits • Apples, Apricots, Bananas, Berries, Cherries, Grapes, Melons, Fruit cocktail, pears, mangoes, pineapple, peaches, plums, raisins, tangerines • 100% Fruit juices • Can you think of some fruits you might want someone with low potassium to eat? • What are some fruits that are high in roughage? • What does GO RED have to do with Fruits?

12. Vegetables • Dark green: spinach: kale: Mustard/turnip/collard greens • Red & orange vegetables: acorn/butternut squash: carrots: pumpkin:sweet potatoes: tomatoesbutternut squash • Beans and peas: lentils: kindey beans: soy beans • Starchy vegetables: corn: black-eyed peas (not dry) • Other Vegetables: beets: cucumbers: egg plant: turnips • People who are low in iron might eat which vegetables?

13. Dairy • Milk: Cheese: Ice Cream: Yogurt: soy milk (Calcium fortified) • What are some dairy desserts? • Why would you want to restrict dairy products with a patient who is in kidney failure?

14. Protein • Meats - lean • Seafood/ Fish/ Shellfish • Organ Meats • Poultry • Eggs • Game Meats • Soy products – bean curds • Beans • Nuts

15. Oils & Fats • Oils are fats (they are liquid at room temperature). They may come from plants and fish. They provide essential nutrients. • What are some examples of oils found in plants? • What are some nuts that may contain oil? • Oils found in plants do not contain cholesterol. • Most oils are low in saturated fats. They are high in monounsaturated and/or polyunsaturated fats. • Solid fats (solid at room temperature) for example butter and shortening. These can be made through hydrogenation. • Others are: lard, milk fat, chicken fat, meat/beef fat

16. Empty Calories Solid Fats Added Sugars • Fats that are solid at room temperature • Processed sugars added to beverages and syrups

17. Exercise • What types of physical activity do you engage in? • Give some examples that are ‘low impact’ • Give some examples of ‘aerobic’ exercises • What are some things we can do in our daily activities that are exercise? • How many times a week and how much exercise is recommended? Does it ever vary?

18. Name that Vitamin! Vitamin = what do I do? Where can I find it? • A = growth & development, tooth & bone development, epithelial tissue functions • B = • C = • D= • E= • K= • Egg yolks, butterfat from milk

19. What rises in the east? Sets in the west? Has solar flares? Creates energy? Gives us light? Is eclipsed by the moon, on rare occasions? The ancients thought this heavenly body revolved around the earth? THAT’S RIGHT!THE SUN!It’s light is absorbed through the skin and converted to which vitamin?

20. Minerals

21. Fiber & Fluid

22. Influencing Factors • Preferences • Socio-economic factors • Culture and Ethnicity • Spiritual Beliefs • Physical Activity • Work Habits • Cooking Habits • Health Habits • Psychological Factors • Peer pressure • Mental Status

23. Nutrition through the Ages • Infant • Pre-school-aged • School aged • Adolescents • Young Adults • Middle-aged adults • Elderly

24. Nutritional Disturbances • Pg 21

25. Nursing Promotions

26. Nursing Interventions

27. Special Diets

28. Laboratory Data • Complete Blood Count (CBC) • Hemoglobin (Hgb) • Hematocrit (Hct) • Total Iron Binding Capacity (TIBC) • Blood Urea Nitrogen (BUN) • Creatinine • Lymphocytes

29. Applying the Nursing Process

30. Case Scenarios

31. Creating Care Plans

32. References