Nutrition and Health for Nurses

Nutrition in Patient Care

• Nutrition significantly affects patient wellness, impacting skin integrity, infection risk, mobility, and overall health.
• Proper nutrition is crucial for disease prevention and recovery, managing conditions like diabetes, hypertension, and inflammatory disorders.
• Nurses play a key role in supporting patients' nutritional needs, facilitating meal assistance and administering alternative feedings (e.g., enteral nutrition).

Factors Affecting Nutrition

• Age: Nutritional needs and challenges vary across the lifespan; older individuals have decreasing energy needs and specific vitamin/mineral requirements to prevent osteoporosis.

• Disease: Chronic or acute conditions may necessitate dietary adjustments or restrictions.

• Socioeconomic Status: Limited income and education impact access to nutritious food and dietary knowledge; interdisciplinary collaboration is vital.

• Medications: Medications may induce side effects like nausea or diarrhea; nurses must coordinate meal times with medication schedules.

• Allergies and Diet Restrictions: Dietary orders must be meticulously verified, especially for NPO (Nothing by Mouth) patients or those with allergies.

• Ability: Support patient independence in eating, and assess the required level of assistance.

• Culture, Religion, and Ethnicity: Respect cultural and religious dietary preferences and restrictions.

• Addiction and Mental Health: Address underlying issues like eating disorders or substance use that affect nutrition.

Promoting Independence and Dignity

• Support patient independence by encouraging self-feeding whenever possible.
• Provide necessary assistance without compromising patient dignity or autonomy.

Challenges in the Hospital Setting

• Specific dietary needs (e.g., vegan, paleo) may be limited by hospital resources; creative solutions are needed to accommodate preferences.
• Always verify dietary orders, consult with family/patients, and engage interdisciplinary teams for comprehensive care planning.

Impact of Poor Nutrition on the Body

• Poor nutrition affects nearly all body systems, leading to various impairments like muscle atrophy, reduced bone health, weakened immune function, and vitamin/mineral deficiencies.

Nutritional Needs in Older Adults (Specifics)

• Energy Needs: Decrease with age due to lower Basal Metabolic Rate (BMR).
• Vitamin/Mineral Requirements: Remain relatively constant, with a focus on calcium, vitamin D, and phosphorus for osteoporosis prevention.
• Age-Related Changes: Difficulty in ingestion/digestion (e.g., dental problems) and chronic diseases hinder nutrition. Socioeconomic challenges (fixed income, transportation issues, reliance on others) are also factors. Decreased thirst sensation further increases dehydration risk.
• Medication Effects: Medications can alter appetite, taste perception, or induce nausea.

Common Nutritional Issues in Older Adults

• Low Calcium and Vitamin D: Increased risk of osteoporosis.
• Poor Food Choices: Reliance on limited or unhealthy options due to habits or convenience.
• Dehydration: Reduced thirst sensation leading to further health complications.

Importance of Early Recognition and Assessment

• Statistics: 20-50% of adult patients are at nutritional risk in hospitals.
• Consequences of Malnutrition: Increased mortality, longer hospital stays, higher healthcare costs.
• Correlation: Early intervention positively affects both short- and long-term outcomes.

Nutritional Assessment in Clinical Settings

• Screening: Nutritional screening should be part of admission to identify high-risk patients.
• Intervention Steps: This involves additional assessments: body measurements (BMI, weight changes), laboratory tests (e.g., albumin, electrolytes), and a detailed health history. Physical examination should identify current effects of malnutrition. Continuous clinical observation monitors ongoing or emerging nutritional issues. Follow-up includes personalized plans and interdisciplinary support.

Key Notes on Malnutrition in Older Adults

• Prevalence and Risk: High rates, impacting approximately 90% of those in communities; 1 in 10 older adults are at risk or suffering from malnutrition.
• Contributing Factors: Age-related changes, socioeconomic challenges, comorbid conditions.

Clinical Signs of Malnutrition

• General Appearance: Listlessness, flaccid muscles, wasted appearance, difficulty walking.
• Gastrointestinal Symptoms: Anorexia, indigestion, constipation, diarrhea, splenomegaly.
• Hair & Skin: Stringy, dull hair; rough, dry, pale skin; bruising, fat loss.
• Mouth & Gums: Swollen/boggy oral membranes, bleeding gums, tongue changes, tooth loss/damage.

Barriers to Nutritional Intake in Hospitalized Patients

• Interrupted Meal Times: Tests/procedures, fatigue.
• Pain: Impacts appetite and intake, especially during eating.
• Medication Side Effects: Altering taste perception, appetite, nausea, etc, aggravated by polypharmacy (multiple meds).
• Environmental Factors: Presence of urinals, bedpans, noise.
• Mental Health: Depression affects appetite.
• Physical Limitations: Difficulty with access or independent eating.

Strategies to Promote Nutrition

• Improving Meal Enjoyment: Assess preferences, encourage family involvement, serve smaller, more frequent meals. Maintain a pleasant eating environment.
• Minimizing Barriers: Schedule procedures around meal times; control pain and nausea; enhance oral hygiene.
• Enhancing Accessibility: Arrange trays for ease of handling; offer discrete assistance as needed, especially for those with limited mobility.
• Cultural and Social Considerations: Respect ethnic, cultural, spiritual customs. Include family/caregivers. Make meals social.
• Other Interventions: Ensure food served at appropriate temperature; address underlying mental health issues if present.

Nurse's Role in Nutrition Management

• Recognize early signs of malnutrition and initiate intervention.
• Advocate for patients with dietary restrictions/challenges.
• Monitor medication impact on nutrition/appetite.
• Educate patients/families about healthy eating.
• Collaborate with interdisciplinary team (dietitians, social workers).

Assisting with Eating: Key Considerations

• Emotional Impact: Loss of independence can negatively affect self-esteem. Patients may be reluctant to seek help due to fear or pride.
• Prevalence of Malnutrition in Hospitals: A significant risk affecting nearly 50% of hospitalized patients.

Stroke Patients: Specific Needs

• Special Assessments:Thorough swallowing assessments, collaboration with speech-language pathologists and dietitians.
• Modified Diets: Provide texture-modified foods/thickened liquids as needed.
• Patient Education: Teach safe swallowing techniques and ongoing encouragement.

Responsibilities Before, During, and After Meal Times (Key Points)

• Before: Assessment for aspiration risk, toileting, preparing the environment, confirming correct meal type.
• During: Assistance as needed (discreetly), monitoring for safety; engaging patients, clear communication regarding food.
• After: Observing and recording intake and challenges, providing feedback, evaluating referrals.

Assistive Devices and Collaboration

• Work with OTs, SLPs, and dietitians on adaptive devices (e.g., built-up utensils, plate guards, cup holders).

Assistive Eating Devices

• Sippy Cup: For patients with limited hand strength.
• Nosey Cup: For limited neck mobility.
• Plate Guard: Prevents food from sliding.
• Weighted Utensils: Provides stability.
• Built-Up Plate: Prevents food from falling off the plate.

Responsibilities After Meals

• Maintain upright position for digestion.
• Check for food pocketing.
• Perform mouth care.
• Document mealtime challenges.

Common Diets and Textures

• NPO, CF, FF, Pureed, Minced, Soft, Regular, DAT, Diabetic NAS, Healthy Heart.

Nursing Considerations for Diet Adjustments

• Nurses can downgrade but cannot upgrade diets without physician approval.
• Always consider patient preferences and consult the care team for changes to avoid restrictions.

Dysphagia Overview

• Dysphagia is difficulty swallowing, caused by physical throat issues or neurological impairments, common in stroke patients, those with cognitive impairment, or other similar conditions.

Common Causes and Risk Factors

• Stroke, neurological impairments, cancer, decreased consciousness/cognition, fatigue.

Signs and Symptoms of Dysphagia

• Pain, food pocketing, stuck food, excessive drooling, coughing, regurgitation, heartburn.

Complications of Dysphagia

• Aspiration, pneumonia.

Nursing Interventions

• Suctioning, swallowing evaluations, dietary modifications, referral to SLPs, patient/family education.

Thickening Liquids

• Different consistencies (nectar-thick, honey-thick, pudding-thick) used to reduce aspiration risk.

Supplementation and Nutritional Support

• Supplements, like Ensure or Boost, are recommended for low intake.

Enteral Feeding Overview

• Delivery of nutrients directly into the GI tract via tubes for patients unable to eat orally.

Indications for Enteral Feeding

• Dysphagia, severe burns, oral surgery/trauma, cancer, GI disorders, neurological/muscular disorders, unwillingness to eat.

Types of Enteral Feeding Tubes

• Nasogastric (NG): Short-term.
• Nasoduodenal (ND)/Nasojejunal (NJ): Short-term, preferred in stomach issues.
• Percutaneous Endoscopic Gastrostomy (PEG)/Percutaneous Endoscopic Jejunostomy (PEJ): Long-term.
• Gastric Tubes (drainage): Not for feeding.

Key Considerations for Enteral Feeding Tubes

• Aspiration risk, GI tract function, skin care around tube sites, and positioning. Tube care & monitoring (security, assessment).

Feeding Methods

• Continuous, intermittent, cyclic.

Common Feeding Complications

• Aspiration, clogged tubes, GI distress, documentation/communication.

Types of Enteral Formulas

• Polymeric, modular, elemental, specialty.

Feeding Formula Administration

• Temperature, storage, shaking, volume/rate, patient positioning for optimal results.

Tube Management

• Regular monitoring, flushing, and tube replacement to maintain patency (especially for long-term feeding).

Assessing Enteral Feeding Tubes: Best Practices and Key Considerations

• General Assessment: Bowel sounds, abdominal distension.
• Checking for Residuals: How much food is remaining in stomach.
• Lab Work and Monitoring: Glucose, albumin, electrolytes, and weight.
• Intake & Output (I&O): Track all fluids.
• Verifying Tube Placement: X-ray verification, external measurement, aspiration testing (less used now).
• Consistency in Checking Placement, aspiration tests, documentation.

Enteral Feeding Management: Residuals, Flushing, and Common Complications

• Gastric Residuals: Checking for volume and assessing characteristics, management (holding feeds if high, returning contents, flushing). Frequency of checks. Signs of intolerance (nausea, vomiting, diarrhea, abdominal pain/distension, changes in bowel sounds).
• Tube Flushing: Regular flushing protocols to prevent clogging and maintain patency, before and after various events/medications.
• Common Complications: Aspiration, tube displacement, hyperglycemia, diarrhea, abdominal discomfort (bloating, pain, cramping), fluid overload.
• Weight Monitoring: Importance and frequency (initially daily, adjusted as stable).
• Safe Feeding: Adhering to institutional protocols. Educate patients and caregivers.