Nutrition Part I PDF

Nutrition Part I  Describe the role of nutrition and food metabolism in achieving and maintaining normal body structure and Learning function. Identify nutritional imbalances that can result in physical Objectives alterations, psychological dist...

Nutrition Part I  Describe the role of nutrition and food metabolism in achieving and maintaining normal body structure and Learning function. Identify nutritional imbalances that can result in physical Objectives alterations, psychological disturbances, and the development of disease. Discuss critical aspects of a thorough nutritional assessment. Identify nursing diagnoses for patients experiencing an alteration in nutrition. Determine nursing care goals and outcome criteria for patients experiencing complications from an alteration in nutrition. Explain the implementation and evaluation of interventions designed to address nutritional needs. Definitions Nutrition The body’s intake and use of adequate amounts of necessary nutrients for tissue growth and energy production Nutrients Necessary substances obtained from ingested food that supply the body with energy; build and maintain bones, muscles, and skin; and aid in the normal growth and function of each body system Malnutrition An imbalance in the amount of nutrient intake and the body’s needs  Normal Structure and Function: Metabolism Basal metabolic rate (BMR): minimum amount of energy required to maintain body functions in the resting, awake state Anabolism: use of energy to change simple materials into complex body substances and tissue Catabolism: breaking down of substances from complex to simple, resulting in a release of energy Continuous process within the body and is dependent on the intake of proper nutrients Normal Structure and Function: Nutrients Carbohydrates Fiber Fats Protein Water Vitamins (fat-soluble, water-soluble) Minerals Antioxidants  Normal Structure and Function: Dietary guidelines Healthy choices from all food groups within calorie limits Emphasize fruits, vegetables, whole grains, fat-free or low-fat milk, and milk products Include seafood, lean meats, poultry, beans, eggs, nuts, seeds, and soy products Low in saturated fats, trans fats, sodium, and added sugars  Altered Structure and Function Musculoskeletal alterations Cardiopulmonary alterations + Imbalance of vitamins, + Substances secreted from fat particularly vitamins A and D cells produce most of the + Deficiencies of minerals such as pathologic changes calcium, phosphorus, and magnesium Digestive system alterations + Conditions that affect the body’s Neurologic alterations ability to process nutrients + Excess dietary intake of sodium + Deficiency of folate Altered Structure and Function: Metabolic alterations Diabetes mellitus Allergies and intolerances + Failure of the pancreas to + Allergies: Immune system produce adequate insulin to response regulate glucose levels allows the accumulation of glucose in + Intolerances: Digestive system the circulatory system and its response decreased diffusion, or entry, into the cells + Type 1: Insulin-dependent + Type 2: Non–insulin-dependent Altered Structure and Function: Metabolic alterations Obesity Malnutrition + BMI of 30 or higher + May result from absorption or digestive problems, illness, or + Morbid obesity: BMI of 40 an inadequate or imbalanced or higher intake of calories + Lack of just one vitamin can cause an individual to be malnourished + Children are especially vulnerable to malnutrition Altered Structure and Function: Psychological alterations Anorexia nervosa Bulimia nervosa + Limited caloric intake + Binging: excessive intake of + Omission of healthy foods food + Excessive exercise routines + Purging: vomiting + Obsessive behaviors Assessment: Nutrition history 24-hour recall Food diary Full nutritional assessment + Eating disorders + Altered nutritional status Screening for malnutrition in older adults + Mini Nutritional Assessment (MNA) + DETERMINE: Disease, eating poorly, tooth loss/mouth pain, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, needs assistance in self-care, and elderly years above age 80 Assessment: Physical assessment Morphology 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 Assessment: Physical assessment 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  Assessment Laboratory studies: how do these reflect the patient’s nutritional status? + Prealbumin + Albumin + Transferrin + Hemoglobin and hematocrit + Blood urea nitrogen and creatinine Elimination patterns: how do these reflect the patient’s nutritional status? + Constipation + Diarrhea  Priority Problems (Nursing Diagnosis) Lack of knowledge about diabetes + Supporting Data: Not recognizing contributing factors and signs and symptoms of diabetes; complaints of fatigue, headache, trouble concentrating, nausea, frequent trips to the bathroom to urinate, and feeling thirsty Impaired/difficulty swallowing + Supporting Data: Residual effects of neurologic damage secondary to CVA, gagging and choking with oral intake attempts Inability to feed self + Supporting Data: Sensory and motor deficits secondary to spinal cord injury, bilateral upper- extremity paralysis, inability to self-feed 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 Special diets + Vegetarian and vegan diets + Examples: clear liquid, full-liquid, pureed, mechanical soft, thickened liquids, regular, diabetic, cardiac, and renal Food patterns according to religion or culture Assistance with feeding + Food restrictions, food preparation laws, + Patients with limited mobility in hands and fasting and arms, poor activity tolerance, or poor + Ask about patient’s individual dietary cognitive or physical state may require preferences assistance with feeding + Can be delegated to unlicensed assistive + Respect cultural and religious nutritional personnel needs Patients with NPO orders + Nothing by mouth Implementation and Evaluation: Enteral feeding tubes For patients who have a functional gastrointestinal tract but cannot swallow, refuse to eat, or need additional nutrients to meet the body’s needs Nasogastric feeding tubes + Short-term nutritional therapy and bowel decompression Percutaneous endoscopic gastrostomy (PEG) tubes + Long-term nutritional therapy in patients who are neurologically impaired or have a condition that affects the stomach and its normal function Medication administration via enteral tube + Medications are never added directly to a tube feeding Implementation and Evaluation: Total parenteral nutrition (TPN) Given using 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 GI tract + Patients are unable to ingest, digest, or absorb essential nutrients because of a specific condition + TPN formula is individualized + Many potential complications may result from parenteral nutrition