Fundamentals for Nursing: Chapter 39 Nutrition and Oral Hydration PDF

CHAPTER 39 UNIT 4 PHYSIOLOGICAL INTEGRITY BASIC NUTRIENTS THE BODY REQUIRES SECTION: BASIC CARE AND COMFORT Carbohydrates provide most of the body’s energy and Nutriti...

CHAPTER 39 UNIT 4 PHYSIOLOGICAL INTEGRITY BASIC NUTRIENTS THE BODY REQUIRES SECTION: BASIC CARE AND COMFORT Carbohydrates provide most of the body’s energy and Nutrition and fiber. Each gram produces 4 kcal. They provide glucose, CHAPTER 39 which burns completely and efficiently without end Oral Hydration products to excrete. Sources include whole grain breads, baked potatoes, brown rice, and other plant foods. Fats provide energy and vitamins. No more than 35% of caloric intake should be from fat. Each gram produces Nutrients provide energy for cellular metabolism, 9 kcal. Sources include olive oil, salmon, and egg yolks. tissue maintenance and repair, organ function, Proteins contribute to the growth, maintenance, and growth and development, and physical activity. repair of body tissues. Each gram produces 4 kcal. Sources of complete protein include beef, whole milk, and poultry. Water, the most basic of all nutrients, is crucial Vitamins are necessary for metabolism. The fat‑soluble for all body fluid and cellular functions. vitamins are A, D, E, and K. The water‑soluble vitamins include C and the B complex (eight vitamins). The proper balance of nutrients and fluid Minerals complete essential biochemical reactions in the along with consideration of energy intake body (calcium, potassium, sodium, iron). and requirements is essential for ensuring Water is critical for cell function and replaces fluids adequate nutritional status. Early recognition the body loses through perspiration, elimination, and respiration. and treatment of clients who are malnourished or at risk can have a positive influence on client outcomes. FACTORS AFFECTING NUTRITION AND METABOLISM A nutritional assessment helps identify areas Religious and cultural practices guide food preparation and choices. to modify, either through adding or avoiding Financial issues prevent some clients from buying foods specific nutrients or by increasing or decreasing that are high in protein, vitamins, and minerals. caloric intake. Appetite decreases with illness, medications, pain, depression, and unpleasant environmental stimuli. When planning a nutritional or hydration Negative experiences with certain foods or familiarity intervention, it is important to consider beliefs with foods clients like help determine preferences. and culture, the environment, and the Environmental factors (sedentary lifestyles, work presentation of the food, as well as any illnesses schedules, and widespread access to less healthy foods) contribute to obesity. or allergies clients might have. Disease and illness can affect the functional ability to prepare and eat food. Medications can alter taste and appetite and can interfere with the absorption of certain nutrients. Age affects nutritional requirements. FUNDAMENTALS FOR NURSING CHAPTER 39 Nutrition and Oral Hydration 221  AGE Bulimia nervosa: a cycle of binge eating followed by purging (vomiting, using diuretics or laxatives, exercising Newborns and infants (birth to 1 year) excessively, fasting) High energy requirements Lack of control during binges Breast milk (ideally) or formula to provide: Average at least one cycle of binge eating and purging ◯ 108 kcal/kg of weight the first 6 months per week for at least 3 months ◯ 98 kcal/kg of weight the second 6 months Solid food starting at 4 to 6 months of age Binge‑eating disorder: repeated episodes of binge eating No cow’s milk or honey for the first year Feels a loss of control when binge eating, followed by an emotional response (guilt, shame, or depression) Toddlers (12 months to 3 years) and preschoolers Does not use compensatory behaviors (purging) (3 to 6 years) Binge‑eating episodes can range from one to multiple Toddlers and preschoolers need fewer calories per kg of times per week. weight than infants do. Clients are often overweight or obese. Toddlers and preschoolers need increased protein from sources other than milk. Calcium and phosphorus are important for bone health. Nutrient density is more important than quantity. OBESITY School‑age children (6 to 12 years) A BMI of 25 is the upper boundary of a healthy weight, 25 School‑age children need supervision to consume to 29.9 is overweight, 30 to 34.9 is obesity class 1, 35 to adequate protein and vitamins C and A. 39.9 is obesity class 2, and 40 and above is obesity class 3. They tend to eat foods high in carbohydrates, fats, and salt. They grow at a slower and steadier rate, with a gradual decline in energy requirements. Adolescents (12 to 20 years) Metabolic demands are high and require more energy. ASSESSMENT/DATA COLLECTION Protein, calcium, iron, iodine, folic acid, and vitamin B Dietary history should include the following. needs are high. Number of meals per day One‑fourth of dietary intake comes from snacks. Fluid intake Increased water consumption is important for Food preferences, amounts active adolescents. Food preparation, purchasing practices, access Body image and appearance, fast foods, peer pressure, History of indigestion, heartburn, gas and fad diets influence adolescents’ diet. Allergies Taste Young adults (20 to 35 years) and Chewing, swallowing middle adults (35 to 65 years) Appetite There is a decreased need for most nutrients (except Elimination patterns during pregnancy). Medication use Calcium and iron are essential minerals for women. Activity levels Good oral health is important. Religious, cultural food preferences and restrictions Older adults (over 65 years) Nutritional screening tools A slower metabolic rate requires fewer calories. Thirst sensations diminish, increasing the risk CLINICAL MEASURES for dehydration. Older adults need the same amount of most vitamins Height, weight to calculate BMI and ideal body weight and minerals as younger adults. BMI = weight (kg) ÷ height (m2) Calcium is important for both men and women. Many older adults require carbohydrates that provide Step 1: Determine the client’s fiber and bulk to enhance gastrointestinal function. weight in kg and height in m. Step 2: Multiply the client’s height by EATING DISORDERS itself to determine the m2 value. Anorexia nervosa Step 3: Divide the weight in kg by the height Significantly low body weight for gender, age, value from step 2. The result is the client’s BMI. developmental level, and physical health. Fear of being fat Skin fold measurements Self‑perception of being fat Laboratory values of cholesterol, triglycerides, Consistent restriction of food intake or repeated hemoglobin, electrolytes, albumin, prealbumin, behavior that prevents weight gain transferrin, lymphocyte count, nitrogen balance 222 CHAPTER 39 Nutrition and Oral Hydration CONTENT MASTERY SERIES  INTAKE AND OUTPUT Assist with preventing aspiration. ◯ Position in high Fowler’s position or in a chair. Record I&O. ◯ Support the upper back, neck, and head. Monitor I&O for clients who have fluid or ◯ Have clients tuck their chin when swallowing to help electrolyte imbalances. propel food down the esophagus. ◯ Measure and calculate all intake and output in mL ◯ Avoid the use of a straw. (1 oz = 30 mL). ◯ Observe for aspiration and pocketing of food in the ◯ Intake includes all liquids (oral fluids, food that cheeks or other areas of the mouth. liquefy at room temperature, IV fluids, IV flushes, ◯ Observe for indications of dysphagia (coughing, IV medications, enteral feedings, fluid instillations, choking, gagging, and drooling of food). catheter irrigants, tube irrigants). ◯ Keep clients in semi‑Fowler’s position for at least 1 hr ◯ Output includes all liquids (urine, blood, emesis, after meals. diarrhea, tube drainage, wound drainage, fistula ◯ Provide oral hygiene after meals and snacks. drainage). Provide therapeutic diets. Weigh clients each day at the same time, after voiding, ◯ NPO (nil per os): no food or fluid at all by mouth, not and while wearing the same type of clothes. even ice chips, requiring a provider’s prescription If using bed scales, use the same amount of linen each before resuming oral intake day, and reset the scale to zero if possible. ◯ Clear liquid: liquids that leave little residue (clear fruit juices, gelatin, broth) EXPECTED FINDINGS OF ◯ Full liquid: clear liquids plus liquid dairy products, all POOR NUTRITION juices. Some facilities include pureed vegetables in a full liquid diet. Nausea, vomiting, diarrhea, constipation ◯ Pureed: clear and full liquids plus pureed meats, Flaccid muscles fruits, and scrambled eggs Mental status changes ◯ Mechanical soft: clear and full liquids plus diced or Loss of appetite ground foods Change in bowel pattern ◯ Soft/low‑residue: foods that are low in fiber and easy Spleen, liver enlargement to digest (dairy products, eggs, ripe bananas) Dry, brittle hair and nails ◯ High‑fiber: whole grains, raw and dried fruits Loss of subcutaneous fat ◯ Low sodium: no added salt or 1 to 2 g sodium Dry, scaly skin ◯ Low cholesterol: no more than 300 mg/day of dietary Inflammation, bleeding of gums cholesterol Poor dental health ◯ Diabetic: balanced intake of protein, fats, and Dry, dull eyes carbohydrates of about 1,800 calories Enlarged thyroid ◯ Dysphagia: pureed food and thickened liquids Prominent protrusions in bony areas ◯ Regular: no restrictions Weakness, fatigue Administer and monitor enteral feedings via nasogastric, Change in weight gastrostomy, or jejunostomy tubes. Poor posture Administer and monitor parenteral nutrition to clients who are unable to use their gastrointestinal tract to acquire nutrients. Parenteral nutrients include NURSING INTERVENTIONS lipids, electrolytes, minerals, vitamins, dextrose, and Assist in advancing the diet as the provider prescribes. amino acids. Instruct clients about the appropriate diet regimen. Maintain fluid balance. Provide interventions to promote appetite (good oral ◯ Administer IV fluids. hygiene, favorite foods, minimal environmental odors). ◯ Restrict oral fluid intake (maintaining strict I&O). Educate clients about medications that can affect Remove the water pitcher from the bedside. nutritional intake. Inform the dietary staff of the amount of fluid to Assist clients with feeding to promote serve with each meal tray. optimal independence. Inform the staff of each shift of the amount of fluid Individualize menu plans according to clients’ clients may have in addition to what they receive preferences. with each meal tray. Record all oral intake, and inform the family of the restriction. ◯ Encourage oral intake of fluids. Provide fresh drinking water. Remind and encourage a consistent fluid intake. Ask about beverage preferences. FUNDAMENTALS FOR NURSING CHAPTER 39 Nutrition and Oral Hydration 223  Application Exercises Active Learning Scenario 1. A nurse is caring for a client who is at high A nurse is preparing a presentation in a community risk for aspiration. Which of the following center on eating disorders that affect adolescents actions should the nurse take? and young adults. Use the ATI Active Learning Template: Basic Concept to complete this item. A. Give the client thin liquids. B. Instruct the client to tuck their RELATED CONTENT: List two common eating chin when swallowing. disorders and their characteristics. C. Have the client use a straw. D. Encourage the client to lie down and rest after meals. 2. A nurse is preparing a presentation about basic nutrients for a group of high school athletes. She should explain that which of the following nutrients provides the body with the most energy? A. Fat B. Protein C. Glycogen D. Carbohydrates 3. A nurse is caring for a client who requires a low‑residue diet. The nurse should expect to see which of the following foods on the client’s meal tray? A. Cooked barley B. Pureed broccoli C. Vanilla custard D. Lentil soup 4. A nurse is caring for a client who weighs 80 kg (176 lb) and is 1.6 m (5 ft 3 in) tall. Calculate the body mass index (BMI) and determine whether this client’s BMI indicates a healthy weight, underweight, overweight, or obese. 5. A nurse in a senior center is counseling a group of older adults about their nutritional needs and considerations. Which of the following information should the nurse include? (Select all that apply.) A. Older adults are more prone to dehydration than younger adults are. B. Older adults need the same amount of most vitamins and minerals as younger adults do. C. Many older men and women need calcium supplementation. D. Older adults need more calories than they did when they were younger. E. Older adults should consume a diet low in carbohydrates. 224 CHAPTER 39 Nutrition and Oral Hydration CONTENT MASTERY SERIES  Application Exercises Key Active Learning Scenario Answer 1. A. Thin liquids increase the client’s risk for aspiration. Using the ATI Active Learning Template: Basic Concept B. CORRECT: Tucking the chin when swallowing allows RELATED CONTENT food to pass down the esophagus more easily. C. Using a straw increases the client’s risk for aspiration. Anorexia nervosa D. Sitting for an hour after meals helps prevent Significantly low body weight for gender, age, gastroesophageal reflux and possible aspiration developmental level, and physical health. of stomach contents after a meal. Fears being fat NCLEX® Connection: Reduction of Risk Potential, Potential for Self‑perception of being fat Complications of Diagnostic Tests/Treatments/Procedures Consistent restriction of food intake or repeated behavior that prevents weight gain 2. A. Although the body gets more than half of its energy supply Bulimia nervosa from fat, it is an inefficient means of obtaining energy. It Cycle of binge eating followed by purging (vomiting, produces end products the body has to excrete, and it using diuretics or laxatives, exercise, fasting) requires energy from another source to burn the fat. Lack of control during binges B. Protein can supply energy, but it has other very essential Average of at least one cycle of binge eating and and specific functions that only it can perform. So purging per week for at least 3 months it is not the body’s priority energy source. Binge-eating disorder C. Glycogen, which the body stores in the liver, is a backup source of energy, not a primary or priority source. Repeated episodes of binge eating D. CORRECT: Carbohydrates are the body’s greatest energy Feels a loss of control when binge eating, followed by an source; providing energy for cells is their primary function. emotional response (guilt, shame, or depression) They provide glucose, which burns completely and efficiently Does not use compensatory behaviors (purging) without end products to excrete. They are also a ready Binge‑eating episodes can range from 1 source of energy, and they spare proteins from depletion. to more than 14 times per week. NCLEX® Connection: Health Promotion and Maintenance, Clients are often overweight or obese. Health Promotion/Disease Prevention NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 3. A. Whole grains (barley and oats) are high in fiber and thus inappropriate components of a low‑residue diet. B. Raw and gas‑producing vegetables (broccoli and the cabbage in coleslaw) are high in fiber and thus inappropriate components of a low‑residue diet. C. CORRECT: A low‑residue diet consists of foods that are low in fiber and easy to digest. Dairy products and eggs (custard and yogurt) are appropriate for a low‑residue diet. D. Legumes (lentils and black beans) are high in fiber and thus inappropriate components of a low‑residue diet. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration 4. BMI = weight (kg) ÷ height (m2). Step 1: Client’s weight (kg) and height (m) = 80 kg and 1.6 m Step 2: 1.6 × 1.6 = 2.56 m2 Step 3: 80 ÷ 2.56 = 31.25 A BMI greater than 30 identifies obesity. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration 5. A. CORRECT: Sensations of thirst diminish with age, leaving older adults more prone to dehydration. B. CORRECT: These requirements do not change from middle adulthood to older adulthood. However, some older adults need additional vitamin and mineral supplements to treat or prevent specific deficiencies. C. CORRECT: If older adults ingest insufficient calcium in the diet, they need supplements to help prevent bone demineralization (osteoporosis). D. Older adults have a slower metabolic rate, so they require less energy (unless they are very active), and therefore need fewer calories. E. Many older adults need more carbohydrates for the fiber and bulk they contain. They should, however, reduce their intake of fats and of “empty” calories (pastries and soda pop). NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration FUNDAMENTALS FOR NURSING CHAPTER 39 Nutrition and Oral Hydration 225