Nutrition and Health Quiz

Nutrition Overview

• Fundamentals of Nursing, Taylor 10th ed., Chapter 37
• Authors: Wei Liu PhD, MANP, RN, CNE; Fran Gallina MSN, RN; Susan Zori, DNP, RN, NEA-BC

Basal Metabolic Rate (BMR)

• The amount of energy needed for involuntary bodily functions
• Factors increasing BMR: growth, infection, fever, emotional tension, elevated thyroid hormone/epinephrine, and extreme environmental temperatures
• Factors decreasing BMR: aging, sleep, cold temperatures, decreased thyroid hormone, and prolonged fasting

Body Mass Index (BMI)

• Ratio of weight (kg) to height (m) squared
• Used to assess risk of diseases (heart disease, type II diabetes, hypertension, certain cancers)
• BMI classifications:
  • Underweight: <18.5
  • Normal: 18.5-24.9
  • Overweight: 25.0-29.9
  • Obesity Class 1: 30.0-34.9
  • Obesity Class 2: 35.0-39.9
  • Extreme Obesity: 40.0+
• Waist circumference is an indicator of abdominal fat and risk for diseases
  • Men > 40 inches
  • Women > 35 inches

GI System: Digestion, Absorption, Metabolism & Elimination

• Digestion begins in the mouth and ends in the small and large intestines
• Absorption primarily occurs in the intestines
• Metabolism involves anabolic and catabolic reactions, storing nutrients
• Elimination: chyme is processed into feces

Factors Influencing Nutrition (Developmental)

• Infants: high protein, vitamin, mineral, and energy needs; breastfeeding, formula or solid foods
• Toddlers & Preschoolers: slower growth rate, picky eaters
• School-aged Children: need for foods with high nutritional value
• Adolescents: increased energy needs
• Young & Middle Adults: reduced nutrient demands
• Pregnant & Lactating Women: increased nutrient and caloric needs
• Older Adults: decreased energy need

Factors Influencing Nutrition (Other Considerations)

• Sex assigned at birth/gender
• State of health
• Alcohol use disorder
• Medication (including megadoses of vitamins/supplements that may interact with other medications or herbs, vitamins, and minerals)
• Socio-cultural/psychological factors: socioeconomic resources and stability; religion; culture; meaning of food; health literacy; language barriers; caregiver support; social isolation; knowledge of cooking/food preparation to obtain and cook foods

Nursing Process: Assessment

• Mini Nutritional Assessment (MNA) tool for screening
• Screening questions
• Anthropometric measurements (height, weight, changes, BMI, waist circumference, signs of altered nutrition)
• Nutritional habits
• General condition
• Self-evaluation of dietary intake
  • 24-hour recall method
  • Food diaries/calorie counts
  • Food frequency record
  • Diet history
• Dietary and health history (health status, age, cultural background, religious food patterns, socioeconomic status, personal food preferences, psychological factors, use of alcohol/drugs/supplements, and general nutrition knowledge)
• Physical examination addressing dysphagia
  • Complications of dysphagia (e.g., aspiration pneumonia, dehydration, weight loss; altered nutrition)
• Laboratory and biochemical data:
  • Albumin (normal 3.5-5.5 g/dL), pre-albumin (19-38 mg/dL)
  • Transferrin (250-425 mg/dL), Hgb (12-18 g/dl), Hct (46-52%)
  • BUN (6-20 mg/dL), Creatinine (0.6-1.2 mg/dL)
  • 24-hour urine -Warning signs of dysphagia (coughing/choking during eating, change in voice after eating, slow/imprecise/uncoordinated speech, abnormal gag, delayed swallowing, incomplete oral clearance, pharyngeal pooling, "silent aspiration," which occurs without a cough)

Feeding Patients with Dysphagia/Aspiration Precautions

• Provide 30 minutes of rest prior to meals
• Sit upright; slightly flex head
• Monitor/check gag reflex; oral hygiene
• Avoid rushed/forced feeding
• Reduce distractions or eliminate them wherever possible
• Alternating liquids and solids
• Place food on unaffected side of the mouth
• Obtain speech therapy and nutrition consult; consider additional patient needs, such as dentures, hearing aids, etc.
• Avoid sedatives or hypnotics that might impair cough or swallowing
• Observe for coughing, gagging, or abnormal digestive processes
• Inspect oral cavity
• If necessary, position the patient upright for 30-60 minutes after meals.

Nursing Diagnoses

• Risk for aspiration
• Readiness for enhanced nutrition
• Imbalanced nutrition: more than body requirements
• Diarrhea
• Feeding self-care deficit
• Imbalanced nutrition: less than body requirements
• Deficient knowledge
• Impaired swallowing
• Risk for imbalanced nutrition: more than body requirements

Implementation (Stimulating Appetite)

• Small, frequent meals
• Solicit food preferences and cultural/religious considerations (holidays)
• Provide a pleasant environment
• Make food attractive
• Schedule procedures and medications when they won't interfere with eating
• Administer anti-nausea meds/anti-emetics and pain meds
• Offer food alternatives
• Good oral hygiene (including well-fitting dentures)
• Organize and arrange food on meal trays to minimize clutter and allow easier access per patient limitations
• Meal time rituals
• Order a late tray if the patient misses a meal; heat up food where possible
• Do not disturb mealtime; do not interrupt

Assisting with Eating

• Offer toileting before beginning
• Involve the person and maximize independence
• Provide appropriate drinks
• Sit at eye level, making eye contact
• Engage in conversation; provide a napkin; consider dentures/hearing aids as well as assisting with opening containers, cutting meats
• Monitor patient for aspiration, or other swallowing difficulties
• Explain placement of food like a clock for visually impaired patients
• Use special plate guards and utensils as needed

Therapeutic Diets

• Nothing by Mouth (NPO)
• Clear liquid diet
• Full liquid diet
• Soft diet
• Pureed diet
• Mechanically altered diet
• Diet as tolerated
• Low residue diet
• High residue diet
• Sodium restricted
• Fat restricted
• Renal diet
• Consistent Carbohydrate Diet (Diabetic)

Enteral Tube Feeding

• Provides nutrients directly into the GI tract; an alternative to oral feeding
• Indications: Head, neck, upper GI cancers; critical illness/trauma; neurological/muscular disorders; GI disorders; Respiratory failure/prolonged intubation; Inadequete oral intake, such as anorexia, impaired chewing/swallowing, or lack of gag reflex
• Contraindications: Peritonitis, bowel obstruction, intractable vomiting, or paralytic ileus
• Enteral access tubes: Short-term (NG, nasointestinal), long-term (gastrostomy - G-tube, jejunostomy - J-tube, PEG or PEJ)

Complications of Enteral Tubing

• Aspiration
• Clogged tube; irrigate
• Nasal erosion
• Diarrhea
• Nausea, vomiting, distention
• Unplanned extubation
• Stoma site infection
• Check placement; avoid oversedation

Parenteral Nutrition (PN)

• Infuses nutrient rich hypertonic solution intravenously through a central line (central venous catheter or port)
• Used for patients with non-functioning or malnourished GI tracts or high physiological stress
• Indications: Sepsis; head injury, burns
• Types: TPN (central line) - expensive, high potential for complications; PPN (peripheral vein) - less concentrated, used for shorter term
• Complications: Air embolism; pneumothorax; catheter occlusions; central line-associated bloodstream infection(CLABSI); hyperglycemia/hypoglycemia, fluid overload, electrolyte imbalances, hyperlipidemia, Refeeding syndrome

Administering TPN, Guidelines for Nursing Care

• Use the same lumen of catheter
• Use pumps; use in-line filter on tubing
• Label tubing; Double check order for all ingredients
• Use strict aseptic technique when adding fluids
• Change tubing & bag daily
• Refrigerate solution unless immediately using
• Do not add lipids if oil droplets are present
• Never add meds to parenteral nutrition solution
• Monitor (input, output, vital signs, labs)
• Monitor IV site
• Gradually reduce TPN rate
• Wean off using 10% dextrose

Complications of TPN

• Air embolism
• Pneumothorax
• Catheter occlusions
• Central line-associated bloodstream infection (CLABSI)
• Hyperglycemia
• Hypoglycemia
• Fluid overload
• Electrolyte and acid-base imbalances
• Hyperlipidemia
• Refeeding syndrome

Evidence-Based Practice (PN)

• Early nutritional assessment
• Maintain blood glucose
• Use central venous catheter

Test your knowledge on key concepts related to nutrition and health. This quiz covers topics including Basal Metabolic Rate (BMR), Body Mass Index (BMI), and dietary needs across different life stages. Dive into the essentials of nutrition in relation to various health conditions and lifestyle factors.