Chapter 30: Nutrition

• Adequate intake of nutrients is essential for maintaining normal body structure
• Nutrient metabolism and absorption are also vital for normal body structure and function
• Nutritional imbalances can lead to physical and psychological alterations
• Nutritional imbalances can lead to the development of diseases
• Vitamin deficiencies contribute to conditions like osteoporosis, scurvy, and rickets
• Lack of protein or inadequate dietary intake may result in malnutrition
• Malnutrition can give rise to conditions like kwashiorkor, marasmus, and anorexia nervosa
• Imbalanced or excess intake of certain foods promotes coronary artery disease, hypertension, or diabetes
• Nutrition includes the body's intake and use of adequate amounts of necessary nutrients for tissue growth and energy production
• Nutrients consist of necessary substances obtained from ingested food
• Nutrients supply the body with energy
• Nutrients build and maintain bones, muscles, and skin
• Nutrients aid in the normal growth and function of each body system
• Malnutrition stems from an imbalance in the amount of nutrient intake and the body's needs
• Basal metabolic rate (BMR) is the minimum amount of energy to maintain body functions in a resting, awake state
• The use of energy to change simple materials into complex body substances and tissue is Anabolism
• The breaking down of substances from complex to simple, resulting in a release of energy is Catabolism
• Nutrient intake is a continuous process within the body
• It is dependent on the intake of proper nutrients

Normal Structure of Nutrients

• Carbohydrates
• Fiber
• Fats
• Protein
• Water
• Minerals
• Vitamins (fat-soluble, water-soluble)
• Antioxidants

Dietary Guidelines

• Diets should emphasize healthy choices from all food groups within calorie limits
• Diets should emphasize fruits, vegetables, whole grains, fat-free or low-fat milk, and milk products
• Diets should Include seafood, lean meats, poultry, beans, eggs, nuts, seeds, and soy products
• Diets should be low in saturated fats, trans fats, sodium, and added sugars

Altered Structure and Function

• Musculoskeletal alterations involve an imbalance of vitamins
• Musculoskeletal alterations particularly involve vitamins A and D
• Musculoskeletal alterations involve deficiencies of minerals such as calcium, phosphorus, and magnesium
• Excess dietary intake of sodium and deficiency of folate are involved with Neurologic alterations
• Substances secreted from fat cells produce most of the pathologic changes that happen with Cardiopulmonary alterations
• Conditions that affect the body's ability to process nutrients are Digestive system alterations
• Metabolic alterations include allergies and diabetes

Diabetes Mellitus

• Failure of the pancreas to produce adequate insulin to regulate glucose levels allows the accumulation of glucose in the circulatory system and its decreased diffusion, or entry, into the cells
• Type 1 diabetes is insulin-dependent
• Type 2 diabetes is non-insulin-dependent

Allergies and Intolerances

• Allergies are an Immune system response
• Intolerances are a Digestive system response

Obesity

• A BMI of 30 or higher
• Morbid obesity is a BMI of 40 or higher

Malnutrition:

• May result from absorption or digestive problems, illness, or an inadequate or imbalanced intake of calories
• Lack of just one vitamin can cause an individual to be malnourished
• Children are especially vulnerable to malnutrition

Psychological problems: Anorexia nervosa

• Limited caloric intake
• Omitting of healthy foods
• Excessive exercise routines
• Obsessive behaviors

Psychological problems: Bulimia nervosa

• Binging: excessive intake of food
• Purging: vomiting

Assessment: Nutrition history

• Nutrition histories use 24-hour recall and include food diaries
• Full nutritional assessment consists of altered nutrition, and eating disorders
• There are screeners for malnutrition for older adults
• Examples include: Mini Nutritional Assessment (MNA) and DETERMINE

DETERMINE

• D isease
• E ating poorly
• T ooth loss/mouth pain
• E conomic hardship
• R educed social contact
• M ultiple medications
• I nvoluntary weight loss/gain
• N eeds assistance in self-care
• E lderly years above age 80

Assessment : Physical Assessment

• Assessing a patient consists of Morphology and Anthropometric measurements
• Anthropometric measurements:
  • Height, weight, BMI, and waist-to-hip ratio
  • Skinfold measurements

Skin and hair

• Hair: thinning with dry, stiff texture; lack of shine; may lose all pigment and appear pale
• Skin: dry, rough appearance, pallor; may bruise easily or have petechiae; poor skin turgor; lips may be dark red and can have lesions and cracks

Dentition

• Older adults can retain their teeth with proper care
• Loss of natural dentition affects nutrient consumption

Swallow studies:

• Needed for patients with dysphagia or who are at risk for aspiration
• Normally conducted by a speech therapist
• A registered dietitian will help to determine the most appropriate food textures and means of hydration

Lab results

• Testing a patient consists of using Laboratory studies such as:
  • Prealbumin
  • Albumin
  • Transferrin
  • Hemoglobin and hematocrit
  • Blood urea nitrogen and creatinine
• Testing a patient consists of tracking Elimination patterns;
  • Constipation
  • Diarrhea

NANDA nursing diagnoses

• Lack of knowledge about diabetes is a NANDA recognized diagnosis
• Impaired/difficulty swallowing is a NANDA recognized diagnosis
• Inability to feed self is a NANDA recognized diagnosis

Planning

• Prioritize patient needs
• Identify appropriate goals and outcomes
• Decide on specific nursing actions to help the patient achieve the identified goals or outcomes
• Collaborate with the patient and other members of the health care team

Implementation and evaluation

• Dietary preferences
  • Vegetarian and vegan diets
• Using food patterns according to religion or culture helps determine
  • Food restrictions, food preparation laws, and fasting
• Assessing patient's individual dietary preferences
• Respecting cultural and religious needs is vital

Special diets consist of

• Clear liquid, full-liquid, pureed, mechanical soft, thickened liquids, regular, diabetic, cardiac, and renal

Assistance with feeding should be taken when assessing

• Patients with limited mobility in hands and arms, poor activity tolerance
• Poor cognitive or physical state
• May require assistance with feeding
• This can be delegated to unlicensed assistive personnel

Patients with NPO orders

• Nothing by mouth should be implemented
• All enteral feeding tubes are exclusively for patients who have a functional gastrointestinal tract
• Exclusively for when they cannot swallow, refuse to eat, or need additional nutrients to meet the body’s needs

Types of Enteral feeding tubes

• Enteral feeding tubes such as:
  • Nasogastric feeding tubes
  • Percutaneous endoscopic gastrostomy (PEG) tubes
• Nasogastric feeding tubes are for Short-term nutritional therapy and bowel decompression
• Percutaneous endoscopic gastrostomy (PEG) tubesare Long-term nutritional therapy in patients
• Who are neurologically impaired or have a condition that affects the stomach and its normal function
• Medications should never be added directly to a tube feeding

Implementation and Evaluation: Total parenteral nutrition (TPN) Is

• Used with a peripherally inserted central catheter (PICC) line or central venous catheter (CVC) by means of an infusion pump
• Used with patients
  • Who do not have a functioning Gl tract
  • Who are unable to ingest, digest, or absorb essential nutrients
  • Because of a specific condition
• TPN formula is individualized and many potential complications may result from parenteral nutrition