Fundamentals of Nutrition and Diet

Nutrition

• Nutrition involves the study of food and its impact on health
• Metabolism converts food into energy for the body

Food Components

• Macronutrients provide energy through carbohydrates, proteins, and fats
• Micronutrients aid in cell repair and maintenance with vitamins and minerals
• Water is essential for all bodily functions

Nutritional Requirements

• The body needs a balance of carbohydrates, proteins, fats, vitamins, minerals, and water

Lifespan Issues

• Nutritional needs evolve with age, such as during childhood, pregnancy, and older adulthood

Normal Lab Values

• Monitor electrolyte balance with Potassium, Sodium, Magnesium, and Calcium levels
• Blood Glucose indicates how the body processes sugar
• Albumin and Pre-Albumin are indicators of nutritional status
• A Cholesterol Panel monitors heart health, including total cholesterol, HDL, LDL, and Triglycerides

Assessing Nutritional Status

• BMI (Body Mass Index) measures body fat
• Waist Circumference helps in assessing abdominal fat
• Cultural Influences should be considered regarding food preferences and restrictions

Special Diets

• A Heart Healthy diet limits sodium and includes baked chicken and vegetables
• A High Protein diet is not suitable for kidney patients and includes fish and whey protein
• Low Carb diets are used for kidney patients
• Low-sodium diets are for hypertension

Assisting Clients with Feeding

• Utilize techniques to aid clients with eating, especially those with physical limitations or swallowing problems

Energy Nutrients

• Macronutrients provide energy
  • Carbohydrates are the primary energy source
    • Simple carbs offer quick energy, such as sugars
    • Complex carbs provide a slow release of energy, like whole grains
  • Proteins build and repair tissue
    • Essential amino acids must be obtained from food
    • Nonessential amino acids are produced by the body
    • Complete proteins contain all essential amino acids, found in animal products
    • Incomplete proteins lack one or more essential amino acids, found in plant foods
  • Lipids (Fats) serve as an energy reserve, aid brain function and benefit cell health
    • Essential nutrients from lipids need moderation to prevent health issues
• Micronutrients do not provide energy, but are essential for function
  • Vitamins aid immune function, energy production, and cell maintenance
    • Vitamins A, D, E, K are fat-soluble, important for vision and bone health
    • Vitamins B and C are water-soluble, aiding energy metabolism and iron absorption
  • Minerals support bodily functions like bone strength, muscle function, and oxygen transport
    • Excessive mineral intake can cause digestive issues, metabolic imbalances, and organ damage

Factors Affecting Nutrition Assessment/Data Collection

• BMI is a key tool for assessing body weight and fat
• Monitor food intake and eating habits using Appettite
• Elimination Patterns are to be look for for digestive issues, such as constipation
• Medication Use affects appetite or nutrient absorption
• Calories are impacted by Activity Levels
• Consider cultural preferences, beliefs, and restrictions for Religious and Cultural Influences during meal planning

Screening for Nutritional Problems

• Lab Values include:
  • Blood Glucose level should be checked
    • Hypoglycemia: Indicates insufficient food intake, with levels less than 50 mg/dL
    • Hyperglycemia: Commonly caused by diabetes, with levels greater than 127 mg/dL fasting
  • Albumin is an indicator of malnutrition or malabsorption
  • Pre-Albumin serves as a better marker for current nutritional status
  • A Cholesterol Panel tracks total cholesterol, triglycerides, HDL, and LDL

Modified Diets

• Impaired Swallowing: Requires a 90° head of bed (HOB) angle, small feedings, and HOB elevation for 30-45 minutes post-meal
• NPO (Nothing by Mouth): Requires glucose and electrolytes might be provided through IV fluids (IVF) or Total Parenteral Nutrition (TPN)
• Older Adults: Exhibit decreased caloric needs due to age-related metabolism changes, and a decreased thirst sensation, causing dehydration risk
• Nausea: Can be addressed with ice chips, bland foods, or antiemetics

Breathing Patterns

• Breathing patterns can signify health issues such as labored or irregular breathing

Gas Exchange

• The exchange of oxygen and carbon dioxide occurs between the alveoli and the blood

Oxygenation vs. Ventilation

• Oxygenation, is getting oxygen into the blood
• Ventilation, is moving air in and out of the lungs (breathing)

What Affects Ventilation?

• Ventilation is impacted by respiratory rate, depth, lung compliance, elasticity, and airway resistance

What Affects Pulmonary Function?

• Pulmonary function changes as a person goes through Developmental Stages and is impacted by age
• Environmental factors like allergies, air quality, altitude, and stress can impact pulmonary function
• Lifestyle choices like pregnancy, exercise, substance abuse, and smoking can alter pulmonary function
• Medications can depress the central nervous system (CNS)

Conditions that Alter Gas Exchange

• Upper Respiratory Infections (URIs) include the common cold, rhinosinusitis, pharyngitis, and influenza
• Lower Respiratory Infections include RSV, acute bronchitis, tuberculosis, and pneumonia

What is Oxygen?

• Oxygen is essential for cell metabolism and energy production

Functions of Oxygen

• Oxygen helps support cellular respiration, which produces energy for the body's cells

What is Hypoxia?

• Hypoxia, is when the body or a part of the body is deprived of adequate oxygen supply
  • Early symptoms include anxiety, tachycardia, and restlessness
  • Late symptoms include extreme restlessness, bradycardia, and tachypnea

Diagnostic Tests Related to Oxygenation

• Arterial Blood Gases (ABGs) measures oxygen and carbon dioxide levels
• Chest X-ray (CXR) assesses lung conditions
• Pulse Oximetry measures blood oxygen levels
• Sputum Culture identifies infections
• Peak Expiratory Flow Rate (PEFR) measures airflow out of the lungs

Oxygen Delivery Systems

• Nasal cannula, simple face mask, non-rebreather mask, and Venturi mask.

Patient Education

• Ensure patients know how to use, and handle oxygen as well as the saftey involved.

Oxygen Safety Plan

• Home Care: Store and maintain oxygen properly, be aware of fire risks, and stay away from heat and flame sources

Pulmonary System

• Airways and Lungs
  • Upper Airway (Above the Larynx) are the nasal passages, mouth, and pharynx. Functions: Moistens, warms, and filters air
  • Lower Airway (Below the Larynx) are the trachea, bronchi, and bronchioles. Gas exchange of oxygen and carbon dioxide
• Functions of the Pulmonary System
  • Ventilation is the movement of air into and out of the lungs
  • Respiration is the exchange of gases (O2 and CO2) between the lungs and the blood
    • External Respiration occurs in the lungs (O2 enters blood, CO2 leaves)
    • Internal Respiration occurs at the tissue level (O2 diffuses into tissues, CO2 out)

Factors Affecting Ventilation

• Respiratory Rate and Depth affects better gas exchange.
• Hyperventilation is an increased breathing rate, causing decreased CO2 levels
• Hypoventilation is described as having slow or shallow breathing, and leads to CO2 retention
• Lung Compliance is the ability of lungs to expand so Surfactant helps improve compliance
• Lung Elasticity, is the abililty of the lungs to recoil after expansion
• Airway Resistance is caused from blockages or narrowing of airways

Factors Affecting Pulmonary Function

• Developmental Stage is when childrens', adults, and elderly different respiratory needs
• Poor air quality, allergens, and altitude impact breathing when it come to the Environment
• Lifestyle choices such as pregnancy, exercise habits, smoking, and substance abuse influence lung function
• Medications can depress respiratory function, for example, CNS depressants, narcotics, and sedatives

Conditions Altering Gas Exchange

• Upper Respiratory Infections cause blockage of airflow, inflammation, and impaired gas exchange
• Lower Respiratory Infections can interfere with oxygen-carbon dioxide exchange from phenomenon, tuberculosis, and RSV

Respiratory Assessment

• Assess Physical conditions to see Inspection, Palpation, Percussion, and Auscultation

Diagnostic Testing

• Key Arterial Blood Gases (ABGs) compenents help measures the pH level of blood, oxygen, and carbon dioxide and they are PO2 (Oxygen in blood), SaO2 (Oxygen saturation),PCO2 (CO2 levels), and Hemoglobin (carries oxygen)
• Pulse Oximetry is there to measure the percentage of oxygenated hemoglobin in the blood, the Ensure the patient is still, avoid polish on nails, and monitor for conditions like poor perfusion or anemia that can affect accuracy

Interventions for Optimal Oxygenation

• Positioning theElevate the head of bed (HOB) to promote lung expansion, for postural drainage place the "good" lung down to facilitate drainage
• Pulmonary Hygiene to Encourage deep breathing, coughing, and mobilizing secretions, use Incentive Spirometry toPromotes lung expansion and prevents atelectasis
• Chest Physiotherapy is postural drainage, chest percussion, and vibration to mobilize secretions, be sure to Instruct patients to breathe in slowly, hold their breath, and exhale
• Hydration and Humidification Helps thin secretions and prevent dryness

Oxygen Delivery Systems

• To help aid with breathing, use a Nasal Cannula this will provide 24-44% FiO2 at 1-6 L/min, it Safe, easy to use, and comfortable for talking and eating, a Simple Face Mask will then provide40-60% FiO2 at 5-8 L/min
• A Non-Rebreather Mask Will help help when in high oxygen needs, with a one-way valve to prevent CO2 rebreathing, and can provideΟ 60-100% FiO2 at 10-15 L/min
• When using a Tracheostomy Collar this is useed for patients with tracheostomy tubes, provides 24-100% FiO2 at 10 L/min, or when patients are claustrophobic, use a Face Tent as it Loosely covers the face and neck, used for patients' post-surgery

Oxygen Toxicity

• This is caused by: High oxygen concentrations (greater than 50%) for prolonged periods, also ensure you Monitor ABGs and reduce FiO2 as SpO2 improves.

Home Oxygen Use

• When using Oxygen It is highly combustible so avoid heat sources and smoking, ensure the oxygen area is well-ventilated and clutter-free, use water-based jelly, not petroleum-based products, for moisturizing

Key Goals for Optimal Oxygenation

• You should Hear Clear breath sounds, Normal pulse oximetry readings and maintain a Respiratory rate within normal limits, as well as have Effective cough and adequate gas exchange

What is a Medication?

• Is a chemical that changes the body, by direct route or indirect. -Perscription, is where a doctor or nurse perscribes this medication
  • Over-the-Counter Medications are available without a prescription where -Vitamins & Caffeine is there to effect your body, also without the need for a perscription

Basics of Pharmacology

• There are certain unneeded unwanted effects that you can see when starting a new medication. The definition is that the patient gets a predictable effect that they usualy grow to adapt to.

Side Effects

• The different examples of Side Effects are Nausea, vomiting, dizziness, drowsiness, dry mouth, constipation, etc.

Adverse Effects

• These effects happen to the patient, the examples are: -Cardiovascular: Orthostatic hypotension. -Hepatotoxicity/Nephrotoxicity (damage to liver/kidneys).
• Your goal with any medication is to Maintain patient safety and educate patients.

Toxic Effects

• These are sever, dangerous effects because they damage your organs and tissue,. These effects can be life threatening, or cause serious health issues.
• The example is to: Maintain client safety and educate patients.

Basics of Pharmacokinetics

• Absorption: How medication enters the body (e.g., Gl tract, muscle, skin).
• Distribution: Movement of medication via bodily fluids to its target site.
• Metabolism: The body's process of converting the drug into inactive or less active forms (mostly in the liver).
• Excretion: Elimination of the medication from the body, often via the kidneys.

Nurse's Responsibilities

• Prepare, Administer, and Evaluate Medications, you need to have proper Knowledge of Medication use as well as know Side effects, precautions, and contraindications
• Transcribe prescriptions and report errors with every time

6 Rights of Medication Administration and 4 Additional Rights

• Right Medication, Right Dose, Right Route, Right Time, Right Patient, Right Documentation, these are the critical six any drug must have checked before handing down
• Add Right Client Education: Educate the patient about the medication and its use, Right to Refuse: The patient has the right to refuse any medication, the patient also has a right to be Assessed and Evaluated.

3 Checks Before Administering Medication

• To ensure the patients safty, you are to do 3 checks

1. First Check: Compare medication label to MAR (Medication Administration Record) when removing from storage Before perscribing any medication, or retrieving it
2. Second Check: Compare medication label to MAR when preparing the medication
3. Third Check: Compare medication label to MAR at the patient's bedside before administering during administrations

• Remember to Perform the 6 Rights during each check.

Routes of Medication Administration

• You can perscribe medicatin using any of thee routes!

1. Oral (PO)
2. Parenteral:
   • Intravenous (IV)
   • Intramuscular (IM)
   • Intradermal (ID)
   • Subcutaneous (SubQ)
3. Buccal
4. Sublingual
5. Transdermal
6. Inhalation
7. Otic (Ear)
8. Ophthalmic (Eye)
9. Enteral:

• NG Tube
• G-Tube

10. Nasal
11. Rectal
12. Vaginal

Medication Order Components

• There are different timings to all medication, depending on the type or drug to the patient.

1. Time & Frequency: Routine, Single/One-Time, STAT (immediate), NOW (within a specific timeframe), PRN (as needed),Standing orders
2. Example Medication Orders: Morphine 4mg IV for pain (missing time/frequency).,Metoprolol 25mg daily, hold for SBP<100 or HR<60 (should specify time/frequency)., or Phenergan 25mg IM q6h PRN (needs specific condition for use).

• Please do not use AMBIGOUS abreviations with medication

Medication Errors

• The cause of these erros is because of many things like:Inadequate drug knowledge, Inadequate drug knowledge, Lack of proper documentation
• Some actions to avoid erros include: Preventin Medication Erros: Identify allergies before medication administration.

Things to double check

• Clariy any perscriptions that seem innacurate, also only Administer medications you prepare! The more you have anothter set of eyes, the better, so Double-check high-alert medications (e.g., insulin, heparin) with a second
• When given Ensure you can Document medications only after they are given. Complete an incident report if a medication error occurs.

When giving a perscription:

• Ensure to always have a second RN confirm and repeat back the order when doing Telephone Orders and not face to face

Post-Medication Error Actions

• These are rules to follow in case an eror happens Ensure patient safety, Report the error immediately to a supervisor, Assess patient condition and monitor for any potential complications
• Reflect and educate on how to avoid the same error in the future with yourself or fellow nurses

Resources for Medication Questions

• Some of thee resources include:Drug Reference Books/Apps, Clinical Guidelines and any Pharmacist as well as Hospital Protocols

Rest

• Definition: Inactive or mild activity that leaves a person feeling refreshed, this can be characterised as: Relaxed, calm, free of anxiety and stress, not necessarily sleep

Sleep

• Definition: A cyclical state of altered consciousness where the body and mind experience rest and recovery.
• There are many of the stages. This includes NREM (Non-Rapid Eye Movement) Sleep as well as REM (Rapid Eye Movement) Sleep. There is also Decreased motor activity and perception happen and metabolism slows down through these cycles

Why Do We Need Sleep

• Sleep and rest are essential for physical, mental, and spiritual well-being.
• When sleeping these things happen: Reduce stress and anxiety, Regulate energy metabolism, Improve learning and adaptation, Strengthen the immune system, and Aid in tissue repair and growth. Remember, The body cannot “catch up” on lost sleep at all

Negative Effects of Sleep Deprivation

• Some Manifestations of Sleep Deprivation -Physical fatigue, Decreased mental performance, Increased accident risk
• Sleep Deprivation is also related to: Heart disease, Stroke, Infections, Obesity, Type 2 diabetes and Potentially cancer.

Sleep Deprivation Characteristics

• Some charactersitsic's can be that the affected person has Daytime drowsiness, Difficulty performing tasks,Restlessness and irritability, Severe cases may cause delusions and paranoia is also possible

Causes of Sleep Deprivation

• Some causes can be: Illness and hospital care (especially in critical care units), Envirnmental noise and lighting or being fatigued and exhausted, and ofcource what Healthcare provider interference a patient needs

Impact of Sleep Deprivation on Nurses

• Sleep deprivaton on Nurses can manifest in Memory lapses, also Impaired judgment
• Reduced motivation with a hugeIncreased errors

Ways to Combat Sleepiness

• Follow simple steps to combat sleeplessnes:1. Sleep Hygiene establish routines, reduce distractions2. Take breaks frequently 3. Use caffeine wisely to you Plan rest days.

Circadian Rhythm and Biological Clock

• Regulated by the Hypothalamus in the brainstem. this a 24hour cycles that regulated wakefulness and sleepiness.
• Be warned that Disruptions (e.g., shift work, traveling across time zones) can impact sleep patterns and overall functioning.

Stages of Sleep

• During stages of sleep (NREM) slow delta waves occur, vital signs decrease and the person is difficult to waken

Factors Affecting Sleep

• There are several types of reasons that disturb the sleep cycle. Such Factors are Age: Sleep patterns change with age Illness as Health conditions affect the quality and duration of sleep.

Sleep Environment

• Sleep will have a massive effect on Health:Light, noise, temperature, and comfort. Or any drug intake: physical activity (can aid or disrupt sleep, Food, alcohol, nicotine, and caffeine (especially in withdrawal
• Meds can have a hugeginess with the intake of Medications (sleep aids may cause grogginess)

Sleep Assessment & Data Collection

• You will need to Assess, during administrations Usual sleeping patterns duration, Sleep environment or rituals, use of sleep aids and also Recent changes in sleep patterns
• You also need to know that they may be affected bz the sleep Diary with which some are unable to Rate Sleep Quality (0-10 scale from "worst" to "best").

Common Sleep Disorders

• Many disorder range among these: Insomnia: Inability to get enough sleep (difficulty falling or staying asleep)., and Symptoms: Daytime sleepiness, poor concentration, irritability.
• Acute insomnia: Short-term, often caused by stress where also Chronic insomnia: More than 3 nights a week and lasts more than 3 months.
• You should think to consider that sleep disorders are More common in women and older adults

Sleep Apnea

-Definition: Periods of breathing cessation during sleep (longer than 10 seconds). Types:Central Sleep Apnea, Obstructive Sleep Apnea where its been Observed as Snoring, fatigue, morning headaches, hypertension, tachycardia and needs CPAP

• There are alot of sleeping disorders that you need to know about like Narcolepsy or Hypersomnolence Disorder or Parasomnias: Sleepwalking. Night Terrors

Nursing Interventions to Promote Sleep & Relaxation

• These are the tips and rules to help when being nursed Establish bedtime routines reading, promote comfort adressing pain and Creating a quitet sleep invironment
• Avoid screen time before bed

Stress

• Changes in an individual's state of balance in response to stressors and these forces that disrupt said balance can feel either "good" or "bad"
• Eustress: Positive stress that can motivate and enhance performance.
• Distress: This Stress can lead to anxiety and cause decrease perforance

There are many different effects of Stress

• Physiological or Psychosocial: These 2 effects can result in poor muscle tension, nausea, chest pain, headaches, weight chnages, concentration, forgetfulness, irritability, substance abuse

General Adaptation Syndrome

• There are 2 phases, Alaram Stage, or Resistance Stage that are directly related to the Fight or Flight sense/Response and the Adaptation

Influences on Adaptation

• Personal perception of the stressor is understanding of stressor realistic or exaggerated

Responses to Stressors

• Physical tensions, headaches, digestive problems or Psychological: Anxiety and anger issues

Coping Strategies

• Adaptive has to do with healthy routines whileMaladaptive is self destructive behaviors

Consequences of Failed Adaptation

There are many cases when people can develop:

Cardiovascualr issues, or have a Immune suppression, or any sort of Respiratory issues (asthma exacerbation)

Nurse's Role in Managing Stress

• When taking care of a patient you need to use Therapeutic Communication, active listening and avoiding questions that trigger a "why responce"

Managing Stress in Nursing

• Always be prepared for Prevention of Burnout with Self-care, setting boundaries, seeking support.