Nutrition lecture-3.pptx

N010 Dr. Garry Johnson, DHS, RN, CCRN Updated by Tina Abraham, MSN, RN What is Nutrition? Encompasses several disciplines: Biology Chemistry Physiology Nursing Basic part of health Growth and Development Maintenance and Repair Cellular metabolism Organ Function Cultural Traditional 3 Nutrients: The...

N010 Dr. Garry Johnson, DHS, RN, CCRN Updated by Tina Abraham, MSN, RN What is Nutrition? Encompasses several disciplines: Biology Chemistry Physiology Nursing Basic part of health Growth and Development Maintenance and Repair Cellular metabolism Organ Function Cultural Traditional 3 Nutrients: The Biochemical Units of Nutrition Basal metabolic rate (BMR)  Energy needed at rest to maintain lifesustaining activities for a specific amount of time (breathing, circulation, HR, Temp Resting energy expenditure (REE)  Amount of energy needed to consume over 24hour period for the body to maintain internal working activities while at rest Nutrients  Energy necessary for the normal function of numerous body processes Biochemical Units of Nutrition Water ◻ ◻ ◻ ◻ Water is the most basic of nutrients. Water makes up largest portion of our total body weight and is crucial for all fluid and cellular function. Fluid balance is essential for optimum health and bodily functions. A balanced input/output ratio is 1:1 Nutrients Vitamins   Fat soluble A,D,E, K Minerals  Water soluble C, B complex Body doesn’t store  Macro Daily requirement 100mg or more Balance pH Trace Basic Principles ◻ ◻ Kilocalories (kcal) measure energy in foods How do we gain or lose weight? Principles of Nutrition 8 Digestion  Mechanical breakdown that results from chewing, churning, and mixing with fluid and chemical reactions in which food reduces to its simplest form  https:// www.youtube.com/ watch?v=Og5xAdC8EUI Principles of Nutrition Absorption ◻ The small intestine, lined with fingerlike projections called villi, is the primary absorption site for nutrients. Metabolism- All biochemical reactions within the cells of the body Storage Elimination-Chyme moves by peristaltic action through the ileocecal valve into the large intestine, where it becomes feces. Nutritional Objectives for Healthy People ◻ ◻ ◻ Guidelines for dietary change recommend reduced fat, saturated fat, sodium, refined sugar, and cholesterol, and increased intake of complex carbohydrates and fiber. The U.S. Department of Health and Human Services (USDHHS) and the Office of Disease Prevention and Health Promotion (ODPHP). Box 45.1 in P&P https://health.gov/healthypeople Dietary Guidelines What are your needs? Basic Metabolic Index ◻ ◻ ◻ BMI Weight Status Below 18.5 Underweight 18.5— 24.9 Normal 25.0— 29.9 Overweight 30.0 and Above Obese Wt (kg)/ht. (m)2 http://www.cdc.gov/healthyweight/assessing/ bmi/adult_bmi/english _bmi_calculator/bmi_calculator.html Dietary Guidelines ◻ https://www.myplate.gov/ Dietary Guidelines ◻ ◻ ◻ ◻ ◻ ◻ ◻ ◻ Consume nutritious foods within caloric needs Maintain weight in healthy range Regular physical activity Consume recommended amounts of fruits, vegetables, grains, & milk Keep total fat intake within 20-35% Consume alcohol in moderation Food safety Dietary reference intakes (DRIs) General Dietary Guidelines ◻ ◻ ◻ ◻ ◻ Balance Calories Decrease Portion Size Increase healthy foods Increase H2O Decrease Fat, Sugar and Sodium Consumption Are we meeting the goals? ◻ Obesity ◻ Hunger in the U.S. Medical Complications of Obesity https://www.google.com/search?q=obesity&biw=1525&bih=734&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjF75uY17bKAhVY0WMKHR7xBuUQ_AUIBygC&dpr=0.9#imgrc=EjRD-UCs-T3pXM%3A ATI Nutrition Book ATI Book is a great resource for describing the major nutrients needed to promote would healing. Also a great resource for hospital diets! Factors Affecting Nutrition ◻ ◻ ◻ ◻ ◻ Associations Habits Ethnic Heritage and Tradition Social Pressure Values Factors Affecting Nutrition ◻ ◻ ◻ ◻ ◻ ◻ Emotional Comfort Availability, Convenience, & Economy Medical Conditions Developmental level Gender Image Factor Affecting Nutrition Preference for certain tastes Genetics All senses come into action Sweet vs. salty Texture Sight/Smell Culturally Competent Care 2 1  Include cultural/religious/ethnic considerations See P&P Table 45.3   Dietary choices (traditional foods) Laws about food Avoid cultural stereotyping Teach dietary restrictions/changes with entire family Copyright © 2020 by Elsevier, Inc. All rights reserved. Reflection What are your cultural food behaviors and beliefs that would be difficult for you to change. Cause of Inadequate Diets ◻ ◻ ◻ ◻ ◻ ◻ Money Culture Food fads Fad Diets Loneliness Education Causes of Inadequate Diets ◻ ◻ ◻ ◻ ◻ Metabolic Physical Problems Availability Age Drugs/Alcohol Gerontologic Considerations 2 5 Physiologic changes       Oral cavity Digestion/motility Endocrine system Musculoskeletal system Vision and hearing See P&P Box 45.4 and Lewis table 39-6 Copyright © 2020 by Elsevier, Inc. All rights reserved. Medical Complications with Malnutrition Quick Quiz 2 7 A patient is admitted to a medical unit with a diagnosis of malnutrition. The student nurse asks the nurse assigned to this patient about the relationship between drugs and nutrition. What is the most appropriate response for the nurse to make? a. “Foods alter the absorption or bioavailability of all drugs.” b. “If the patient skips a meal, drugs may not be taken.” c. “Some drugs increase the requirements for essential nutrients.” d. “Drugs should be taken with food to prevent GI irritation.” Copyright © 2020 by Elsevier, Inc. All rights reserved. Answer 2 8 Answer: C “Some drugs increase the requirements for essential nutrients.” Some medications can be taken with food; other drugs must be taken without food. Food may alter the absorption or bioavailability of some drugs, but not all drugs. Copyright © 2020 by Elsevier, Inc. All rights reserved. Quick Quiz 2 9 For which patients is it most important for the nurse to refer to a dietitian for a complete nutritional assessment? a. A 38-yr-old with diabetes who is undergoing laser eye surgery b. A 55-yr-old with a history of alcohol use disorder who is hospitalized with a fractured femur from a fall c. A 24-yr-old who has been taking a burst of corticosteroid therapy for 1 week for treatment of an asthma exacerbation d. A 45-yr-old hospitalized with nausea and abdominal pain who has had no oral intake and only IV fluids of D5 ½ NS for 6 days Copyright © 2020 by Elsevier, Inc. All rights reserved. Answer 3 0 Answer: B A 55 year old with a history of alcohol use disorder who is hospitalized with a fractured femur from a fall Rationale A person who is at nutritional risk should have a full nutritional assessment. The person at greatest risk is the person with alcohol use disorder and a fractured femur. Drugs such as corticosteroids place the individual at risk for malnutrition, but the person in Option 3 is only taking the drug short-term. Patients with chronic illnesses (such as diabetes) (Option 1) are at nutritional risk but not as high risk as Option 2. The person in Option 4 is at risk for malnutrition after 10 days of only receiving intravenous fluids. Copyright © 2020 by Elsevier, Inc. All rights reserved. Hospitalization & Hospital Food ◻ ◻ ◻ ◻ ◻ Most people live and eat with family Regression Meaning of food Hours for eating Home cooking vs. institutional Hospitalization & Hospital Food ◻ ◻ ◻ ◻ ◻ ◻ Way of serving Limited activity Treatment at mealtime Manner trays served Long term boring Not culturally sensitive TYPES OF HOSPITAL DIETS ◻ ◻ ◻ ◻ ◻ ◻ ◻ Clear liquid Full liquid Pureed Soft Mechanical Soft Regular Specialty diets CLEAR LIQUID DIET ◻ Consists of foods that are clear and liquid at room temperature.  RULE OF THUMB – anything you can see through BROTH, TEA, POP, POPSICLES, PLAIN JELL-O, JUICES- without pulp, COFFEE, WATER ◻ Avoid Caffeinated beverages CLEAR LIQUID DIET ◻ Intended use  Usually following surgery  Labor patients  Diarrhea  Vomiting  Acute GI disorders  Part of GI prep CLEAR LIQUID DIET Advantages      Leaves no residue Non gas forming Non irritating Non stimulating Do not have to chew Deficiencies ◻ ◻ ◻ ◻ Protein Minerals Vitamins Calories CLEAR LIQUID DIET ◻ Characteristics  Not nutritionally sound Usually only 1-2 days If over 48 hours, then supplement with intravenous fluids   600 calories a day Provides fluids & CHO (in form of sugar) FULL LIQUID DIET ◻ ◻ ◻ ◻ Full liquids-consists of foods that are liquid at room temperature. Offers more variety and nutritional support than a clear liquid diet. Indications-transition from liquid to soft diets, post-op recovery, gastritis, febrile conditions and/or intolerance of solid foods. Can include yogurt, pudding, soups, ice cream, etc SOFT DIET ◻ ◻ ◻ ◻ ◻ A soft diet contains whole foods that are low in fiber, lightly seasoned, and easily digested. Food textures may be vary somewhat. Fruits, vegetables, coarse breads and cereals, beans, and other potentially gas forming foods are excluded. Sometimes called mechanical soft diet Indicated for dysphagia, jaw surgery, GI surgery REGULAR or NORMAL DIET ◻ ◻ ◻ ◻ ◻ A regular diet is indicated for clients who do not need dietary restrictions They are adjusted to meet age-specific needs throughout the life cycle. Individual preferences, food habits and ethnic values can be accommodated. Some facilities have moved to on demand diet ordering Well balanced, 1800 to 2400 calories, low spice and low fat Specialty Diets ◻ ◻ ◻ ◻ ◻ ◻ ◻ Low Sodium Diabetic Diet Cardiac-Low Fat/Low Cholesterol Renal Diet-Low Protein Low Residue High Fiber Bland ◻ ◻ ◻ For Hypertension For Diabetics For Heart Patients especially CHF ◻ For ARF or CRF ◻ IBD, Diverticulitis Constipation Gastritis ◻ ◻ NURSING CONSIDERATIONS ◻ ◻ ◻ ◻ ◻ ◻ Right diet for right client Allow time to eat Prepare client for meal Appearance of tray Observe how much & what Diet restrictions, test to be done, NPO NURSING CONSIDERATIONS ◻ ◻ ◻ ◻ ◻ ◻ Chart I&O Observe teeth Conditions in room Need assistance Need extra? Position for comfort Dysphagia Difficulty swallowing What are the causes? Box 45.7  Myogenic, neurogenic, obstructive, other What are the warning signs? What are the complications? Enteral Feedings ◻ ◻ ◻ OG/NG/GT/JT Feedings Which patients receive food in this way? What are some safety issues associated with this type of feeding? Routes for Enteral Feeding 4 7 Common Enteral Feeding Locations Fig. 39-7 Copyright © 2020 by Elsevier, Inc. All rights reserved. Enteral Feeding by Tube ◻ Use:   ◻ GI tract is functioning and or patient is malnourished Short or long term use Formula Calorie Rich Fiber Rich Specialty NG/NJ/ND Tube Feedings       Short term use Protein-calorie malnutrition Reduced oral intake Acute infections Active inflammatory bowel disease Major trauma GT, JT PEG/PEJ Tube Feeding percutaneous endoscopic gastrostomy (PEG) /jejunostomy (PEJ) Long term use  Severe dysphagia  Chemo or radiation therapy  Major burns  Intestinal disorders ◻ 5 1 Percutaneous Endoscopic Gastrostomy Fig. 39-8Copyright © 2020 by Elsevier, Inc. All rights reserved. Feedings ◻ Placement   Measurement Confirm placement X-ray pH Air Method of Administration ◻ ◻ ◻ Continuous infusion Intermittent infusion Bolus Feeding Start feeding ◻ ◻ Slow rate  Increase 12-24 hours Intolerance  N&V  Cramping  Diarrhea  Residual Complications ◻ Types  GI  Mechanical  Metabolic GI Complications ◻ ◻ ◻ ◻ ◻ Diarrhea  Hyperosmolar feeding solution  Medication  Bacterial dysentery Nausea & Vomiting Cramping Distention Constipation Mechanical Complications ◻ ◻ ◻ ◻ Tube displacement Tube obstruction Pulmonary aspiration Mucosal damage Metabolic Compilations ◻ ◻ ◻ ◻ ◻ ◻ Hyperosmolar dehydration Over-hydration Hyperglycemia High or low blood levels of  Sodium, potassium, phosphorus & magnesium Rapid weight gain Respiratory insufficiency Safety Guidelines ◻ ◻ ◻ ◻ ◻ ◻ ◻ Check allergies Oral care Check bowel sounds Check for abdominal distention Check placement & residual Head of bed elevated 30-45 degrees Trace all lines and tubing back to the patient to ensure only enteralto-enteral connections/ Safety Guidelines 60 Anticoagulation and bleeding disorders pose a risk for epistaxis during nasal tube placement. Nasal tubes are associated with sinusitis, otitis, vocal cord paralysis, and medical device–related pressure injuries to the nose. Use ENFit connectors for all enteral nutrition sets, syringes, and feeding tubes. Use aseptic technique when preparing Safety Guidelines Review in the textbook: Skill 45.1 Aspiration Precautions Skill 45.2 Inserting and Removing a Small-bore Nasoenteric Tube for Enteral Feedings Skill 45.3 Administering Enteral Feedings Via Nasoenteric, Gastrostomy, or Jejunostomy Tubes Skill 45.4 Blood Glucose Monitoring Parenteral nutrition (PN) Short term intravenous nutrition support Unable to digest or absorb EN nutrition Sepsis, head injury, burns, GI obstructions or surgery Total parenteral nutrition (TPN)- central line. Also known as central PN, greater than 10% dextrose requires central line Case Study Patient Profile M.K. is a 74-year-old woman who is being transferred to the rehabilitation unit 2 weeks after ischemic stroke. M.K. is accompanied by her daughter, who expresses frustration that her mother “just will not eat.” M.K. is currently on a soft, pureed diet. Subjective Data Daughter states she is very worried about her mother’s decreased appetite and food intake since the stroke Daughter states her mother has been losing weight since the stroke Objective Data Height 5’4”, weight 114 lb, body mass index (BMI) of 19.6. Patient lost 10 lb in the past 2 weeks since being hospitalized. Alert and oriented x 3 spheres Can follow directions but has difficulty expressing herself Coughs and chokes periodically when eating or drinking. A barium swallow test was performed to rule out dysphagia, and the test results found that the patient required thickened and pureed food. Skin and mucosa are dry, with tenting Has right-sided hemiplegia Appears pale, weak, tired Case Study What concerns do you have about M.K.? What other information is needed? Who else should be involved with M.K. care? What nursing interventions are used to decrease the risk of aspiration? Apply professional standards 65        Dietary reference intakes (DRIs) USDA MyPlate dietary guidelines Healthy People 2030 American Heart Association American Diabetes Association American Cancer Society American Society for Parenteral and Enteral Nutrition