Chapter 39: Wound Management and Nutrition

Nursing Interventions for Poor Nutrition

• Assist in advancing diet as prescribed by provider
• Instruct clients about appropriate diet regimen
• Maintain fluid balance
• Promote appetite (good oral hygiene, favorite foods, minimal environmental odors)
• Administer and monitor parenteral nutrition to clients unable to use their gastrointestinal tract
• Provide interventions to promote optimal independence

Fluid Intake and Output

• Weigh clients daily at same time, after voiding, and wearing same type of clothes
• Use bed scales with same amount of linen each day and reset scale to zero if possible
• Restrict oral fluid intake (maintaining strict I&O) and remove water pitcher from bedside
• Inform dietary staff of amount of fluid to serve with each meal tray
• Record all oral intake and inform family of restriction
• Encourage oral intake of fluids and provide fresh drinking water

Types of Diets

• NPO (nil per os): no food or fluid at all by mouth, requiring provider's prescription
• Clear liquid: liquids that leave little residue (clear fruit juices, gelatin, broth)
• Full liquid: clear liquids plus liquid dairy products, all juices, and some facilities include pureed vegetables
• Pureed: clear and full liquids plus pureed meats, fruits, and scrambled eggs
• Mechanical soft: clear and full liquids plus diced or ground foods
• Soft/low-residue: foods that are low in fiber and easy to digest (dairy products, eggs, ripe bananas)
• High-fiber: whole grains, raw and dried fruits
• Low sodium: no added salt or 1 to 2 g sodium
• Low cholesterol: no more than 300 mg/day of dietary cholesterol
• Diabetic: balanced intake of protein, fats, and carbohydrates of about 1,800 calories
• Dysphagia: pureed food and thickened liquids
• Regular: no restrictions

Expected Findings of Poor Nutrition

• Nausea, vomiting, diarrhea, constipation
• Flaccid muscles
• Mental status changes
• Loss of appetite
• Change in bowel pattern
• Spleen, liver enlargement
• Dry, brittle hair and nails
• Loss of subcutaneous fat
• Dry, scaly skin
• Inflammation, bleeding of gums
• Poor dental health
• Dry, dull eyes
• Enlarged thyroid
• Prominent protrusions in bony areas
• Weakness, fatigue
• Change in weight

Nutrition and Oral Hydration

• Poor nutrition can lead to various expected findings, including:
• Nausea, vomiting, diarrhea, constipation
• Flaccid muscles
• Mental status changes
• Loss of appetite
• Change in bowel pattern
• Spleen, liver enlargement
• Dry, brittle hair and nails
• Loss of subcutaneous fat
• Dry, scaly skin
• Inflammation, bleeding of gums
• Poor dental health
• Dry, dull eyes
• Enlarged thyroid
• Prominent protrusions in bony areas
• Weakness, fatigue
• Change in weight

Types of Diets

• NPO (nil per os): no food or fluid at all by mouth, requiring a provider's prescription
• Clear liquid: liquids that leave little residue (clear fruit juices, gelatin, broth)
• Full liquid: clear liquids plus liquid dairy products, and all juices
• Pureed: clear and full liquids plus pureed meats, fruits, and scrambled eggs
• Mechanical soft: clear and full liquids plus diced or ground foods
• Soft/low-residue: foods that are low in fiber and easy to digest (dairy products, eggs, ripe bananas)
• High-fiber: whole grains, raw and dried fruits
• Low sodium: no added salt or 1 to 2 g sodium
• Low cholesterol: no more than 300 mg/day of dietary cholesterol
• Diabetic: balanced intake of protein, fats, and carbohydrates of about 1,800 calories
• Dysphagia: pureed food and thickened liquids
• Regular: no restrictions

Nursing Interventions

• Assist in advancing the diet as prescribed by the provider
• Maintain fluid balance
• Provide interventions to promote appetite (good oral hygiene, favorite foods, minimal environmental odors)
• Administer IV fluids and monitor enteral feedings via nasogastric, gastrostomy, or jejunostomy tubes
• Administer and monitor parenteral nutrition to clients who are unable to use their gastrointestinal tract to acquire nutrients
• Provide education to clients about medications that can affect nutritional intake
• Inform the dietary staff of the amount of fluid to serve with each meal tray
• Assist clients with feeding to promote optimal independence
• Record all oral intake, and inform the family of the restriction
• Encourage oral intake of fluids and provide fresh drinking water
• Remind and encourage a consistent fluid intake, and ask about beverage preferences

This quiz covers various aspects of nursing care, including wound management, drainage, and nutrition. Topics include providing oral hygiene, therapeutic diets, and weighing clients.