Factors Influencing Nutrition

Factors Influencing Nutrition

• Nutrition is affected by environmental and socioeconomic factors.

Socioeconomic Status

• Lack of transportation and fixed incomes are elements of socioeconomic status that impact nutrition.

Environmental Factors

• Access to grocery stores, cost of healthy foods, availability of fast food, and access to safe exercise spaces all contribute to environmental factors affecting nutrition.

Older Adults' Nutritional Factors

• Decreased thirst sensation increases risk for dehydration.
• Reduced gag reflex and esophageal/colonic peristalsis impact nutrition.

Cultural Restrictions

• Cultural influences can assign meaning to food beyond nutrition, including "good" and "bad" associations.
• Food and special dishes may be tied to illness.

Lactose Intolerance

• Lactose intolerance is common in Asian, Pacific, African, Native American, Mexican American, and Middle Eastern populations.

Albumin

• Albumin levels affect how drugs are absorbed in the body.

BMI

• BMI helps determine if a patient is malnourished.

Altered Nutritional Symptoms

• Nausea, vomiting, diarrhea, and constipation can lead to decreased eating.
• IV fluids for more than 4-7 days can lead to malnutrition.

Low Fiber Diet

• Colonostomy bag patients often require a low-fiber diet to prevent gas.

Hinduism Dietary Restrictions

• No meat or alcohol consumption.

Judaism Dietary Restrictions

• No pork, and no mixing of meat with milk or dairy products.

Vegan Dietary Restrictions

• No meat, dairy, or eggs.

Ketogenic Diet

• Used in the management of Epilepsy

Clear Liquids

• Include broth, coffee, tea, carbonated drinks, clear fruit gelatin, and bouillon.

Tylenol

• Decreases the absorption of food.

Albuterol

• Can act as an appetite stimulant.

Medications Affecting Metabolism

• Insulin, glucocorticoids, and thyroid hormones affect metabolism.

Medications Affecting Taste

• Antifungal and psychotropic medications can alter taste perception.

Medications Causing Nausea

• Antibiotics and psychotropic medications are known to cause nausea.

Patient Feeding

• Provide positive reinforcement during feeding.

Maintaining Independence for Older Adults

• Allow patients to select their own foods.
• Allow them to direct what items to eat first and how fast.

Aspiration Risk

• Ensure oral suction is available at the bedside.

Decreasing Aspiration Risk

• Provide 30-minute rest periods before eating.
• Feed on the stronger side of the mouth, using 1/2-1 teaspoon portions.
• Inspect the mouth for pocketed food.

Warning Signs of Dysphagia

• Coughing during eating, changes in voice after swallowing, abnormal movements of the mouth or tongue, abnormal gag reflex, and delayed swallowing.

Dysphagia

• Can lead to malnutrition and aspiration pneumonia.

Visual Defects and Feeding

• For blind or visually impaired patients, use a clock format to describe the plate's contents (e.g., 9 o'clock).
• Ensure the plate is set up the same way every meal and use adaptive equipment like larger spoons.

Temporary Tubes

• NG (nasogastric), NJ (nasojejunal), and ND (nasoduodenal) tubes are temporary.

Permanent Tubes

• Gastrostomy and jejunostomy tubes are permanent.

Purpose of NG Tube

• Enteral feeding/medication administration delivering supplements or meds to the stomach or small intestine.
• Decompression removes gas, fluids, or secretions from the stomach or intestines.
• Compression applies internal pressure to stop bleeding.
• Lavage is irrigation of stomach for bleeding, poisoning or gastric dilation

Common Tube

• Dobhoff tube is commonly used.

Patient Position for GI Intubation

• High Fowler's position is required.

Measuring GI Intubation

• Measure the distance from the tip of the nose to the earlobe to the xiphoid process of the sternum.

Coughing During NG Tube Insertion

• Stop and remove the tube.

Gold Standard for NG Tube Placement

• X-ray (KUB) is the gold standard.

pH Strip

• Used to verify NG tube placement; a red result is good.

Flushing Medication in Tube

• Flush with 15-30 mL of fluid.

When to Flush Tube

• Before and during medication administration.

Temperature of Enteral Feeding

• Needs to be warm or at room temperature.

Signs of Feeding Intolerance

• High gastric residual volume (GRV), nausea/vomiting/diarrhea, and GI cramping.

Gastric Residual Volume (GRV)

• Indicates delayed gastric emptying.

Large Gastric Volumes

• Indicate a risk for aspiration.

GRV >250 mL

• Stop feeding.

Remember ABC

• Airway: ensure the patient is in Fowler's position if the residual volume is too high.

Appropriate Food for Mechanical Soft Diet

• Ground turkey.

Important Action for Patients with High Aspiration Risk

• Assessing the patient's gag reflex and alertness.

Recommended Liquid Consistency for Dysphagia

• Nectar-like liquids.

Bolus Enteral Feeding

• Involves delivering a set amount of liquid nutrition into the stomach over 15-30 minutes using a syringe or gravity drip.