Nutrition and Diet 4 PDF

NUTRITION AND HYDRATION Six Basic Nutrients: Protein - Essential for tissue growth and repair Carbohydrate s- Supply fuel for body’s energy needs (complex and simple) Fats - Helps store energy, protects organs, vitamin absorption Vitamins - Needed for body and org...

NUTRITION AND HYDRATION Six Basic Nutrients: Protein - Essential for tissue growth and repair Carbohydrate s- Supply fuel for body’s energy needs (complex and simple) Fats - Helps store energy, protects organs, vitamin absorption Vitamins - Needed for body and organ function. (water soluble and fat soluble) Minerals - Needed for cell function and energy Water - Essential for all body functions Most foods contain several nutrients but no one food contains all the nutrients to maintain a healthy body. It’s important to eat a well-balanced diet. Even though caloric needs change as we age, the daily requirements for cost vitamins and minerals do not decrease. MALNUTRITION = imbalance between nutritional intake and nutritional requirements. Malnutrition affects more than one in four patients admitted to Irish hospitals Increase patient length of stay in hospital by 50% = causing unnecessary illness and death A large proportion of patients are at risk – older people, cancer , surgical and gastrointestinal patients LEVEL OF ASSISTANCE: - Independent - Usually do not require any assistance to eat or drink. All patients should be encouraged to be as independent as possible - Set Up Assistance - May need helping opening packages and seasoning food; however, can feed themselves. Check in frequently to see if they need further assistance - Partial Assistance - Will need set up assistance plus possible verbal, visual, or physical cuein - Total Assistance - Usually unable to feed themselves due to physical or mental limitation DYSPHAGIA ->medical term for swollowing difficulties Frequent coughing when being fed, especially liquids Repeated attempts to swallow or increased effort to swallow Gurgling or wet sounds or loss of voice Drooling or dribbling Continuous throat clearing Unswallow food or pocketing Spitting out pieces of food Slower eating or avoidance A feeling of fullness in the throat Watering eyes Fluid that comes up into the nose If you notice any of these symptoms you should stop feeding the resident and notify a charge nurse immediately. Swallowing problems place a resident at high risk for choking on food and drink or aspirating food into the lungs. Aspiration can lead to pneumonia and/or death. HYDRATION -> correct water ratio is maintained within the body Good hydration means maintaining an adequate water balance in the body. Because water is an essential nutrient for life, a person can only live a few days without it. It aids in the digestion and absorption of food, helps with the elimination of waste, helps maintain normal body temperature, and electrolyte balance ROLE OF FLUIDS IN THE BODY-> satisfy your thirst, regulates body temperature, carries nutrients, removes toxins and waste materials Assessing Dehydration Dry sticky mouth / mucous membranes- One of the first signs of dehydration are dry mucous membranes. Increased thirst Decreased urine output Dry skin / poor skin turgor Headache Fatigue Constipation Dizziness / light headedness Increased confusion / agitation  Vital signs can be compromised quickly - low B/P, elevated pulse rate should be reported immediately. Dehydration can become a medical emergency in a very short period of time, especially in children and the elderly. Decreased urine output or dark, concentrated urine is another good indication. Reduced Cognitive Impairment - Dehydration can result in confusion and disorientation Urinary tract infections Pressure Ulcers Pneumonia Chronic illness – Kidney failure Death FLUID BALANCE Maintaining a fluid balance is important to avoid complications such as dehydration and overhydration, which can have serious clinical consequences. The nurse caring for a particular patient ensures that fluid balance charts are recorded regularly and accurately, using the correct notation. To promote adequate hydration and promote safe effective nursing care, nurses should always report any significant abnormalities identified in patients ‘ fluid balance chart’ Encourage water intake for those at higher risk Fluid Balance Calculate overall intake & output every 24 hr Intake - Output = fluid balance Determine if patient is in a Positive or Negative fluid balance e.g. Fluid intake:1780 mlsFluid output:1450Balance: 330 -positive balance Neg or positive fluid balance? Case 1: Intake 1565, output 1780?Answer: -215 negative Case 2: Intake 1850, output 1200Answer: 650 positive Anatomy and Physiology of Breathing Ventilation(inspiration and expiration)movement of air in and out of the lungs Respiration- Inhaling oxygen from atmosphere, exhaling carbon dioxide Transport of Oxygen from lungs to body cells- > Oxygen absorbed from alveoli into blood Binds with haemoglobin in red blood cells A single molecule of haemoglobin binds with four oxygen molecules- fully saturated Oxygen released to tissue, carbon dioxide removed and dissolves in blood plasma Causes of Hypoxia-> low levels of oxygen in your body tissue Respiratory failure –Type I- hypoxia –Type II (hypoxia and hypercapnia (Co2) reduces alveoli involved in respiration) Cardiac or respiratory arrest Severe trauma – esp head or lung injury Anaemia Severe infection- increased metabolic demand Drugs that suppress the respiratory system- morphine Surgery Anaesthesia Hypoxemia: insufficient oxygen within arterial blood. –Oxygen saturations Decreased energy Need to stop talking to breath Restlessness Rapid, shallow breathing Rapid heart rate OxygenationOXYGEN -A PRESCRIBED DRUG Must be written legibly by the doctor Prescription should be dated by the doctor Doctor must indicate duration of O2 therapy The O2 % concentration must be prescribed The flow rate must be prescribed Emergency Situation: oxygen can be given by nursing staff- evidence of severe hypoxia Oxygen Therapy. 1L oxygen=4% oxygen, Atmospheric oxygen is 20% so if you delivery 4L O2 you increase the oxygen delivered to a patient to 34% Classification of oxygen delivery devices Fixed Performance Devices Venturi mask->Adapters within the tube, which are colour coded, permit only a specific amounts of room air to mix the oxygen. Used for patients on longer-term oxygen therapy Variable Performance Devices Nasal cannula-> is a hollow tube with half inch prongs that are placed in the patient's nostrils. Patients requiring low level of oxygen, allows patient to eat, drink & communicate, better tolerated Hi Flow Nasal Cannula (HFNC)-> it is not a simple nasal cannula Simple oxygen mask High concentration (non re-breathe mask) Bag valve mask resuscitator with oxygen reservoir Tracheotomy mask COLOUR CODES FOR OXYGEN MASKS: At all times, you must follow manufacturer’s instructions. 24% blue with an oxygen flow at 2 litres per minute 28% white with an oxygen flow at 4 litres per minute 35% yellow with an oxygen flow at 6 litres per minute 40% red with an oxygen flow at 8 litres per minute PARTIAL REBREATHER MASK -> -patient inhales a mixture of atmospheric air, 02 from its source, and 02 contained with in a reservoir bag.Can deliver higher concentration of oxygen than normal mask. NON-REBREATHER MASK->Designed to deliver 90-100% oxygen. Contains one-way valves that allow only oxygen from its source as well as oxygen from the reservoir bag to be inhaled.Used for patients who require high level oxygen, short temporary solution. Humidification of O2. RATIONALE–Normal air travelling through the airways is warmed, moistened and filtered by epithelial cells of the nose and nasopharynx. –The air entering the trachea will have a relative humidity of 90% and a temperature of between 32-36c A humidifier is a device that produces small water droplets and may be used during oxygen administration because oxygen is drying on the mucous membranes. In cases where a tracheostomy is present the oxygen may be warmed as well as humidified Nebuliser Nebulization involves the passage of air or oxygen through a solution of a drug This creates a fine mist that is inhaled Drugs bronchodilators, steroids, Humidify secretions COLLECTING A SPUTUM SAMPLE: Wear gloves and cover and enclose the specimen container in a clear plastic bag. If post surgery help patient support wound when coughing, may need pain relief Offer oral hygiene. Attach a label and a laboratory request form for the sample. Specimen sent to the laboratory. Record the time of the specimen collected & sent in patient record Explain that the desired specimen should be from deep within the respiratory passages, not salvia from within the mouth. Instruct the patient to take several deep breathes, attempt a forceful cough, and expectorate into the specimen container. Collect at lest 1 to 3 mls specimen The nurse should observe for C- colour O- odour C- consistency O- occurrence A- amount of mucus O2 is combustible Alcohol,oil, and inflammatory liquids should be kept separate from O2 No electrical device near O2 tent No smoking Fire extinguisher needs to be available Care with using defibrillator near high O2 concentration Physical Assessment Observation- respiration rate & dept Patient colour Pulse Oximetry Arterial blood gases Oral Hygiene>The condition of the oral cavity has a direct influence on the individuals overall state of health. Fundamental for patients comfort Complications of poor oral hygiene-> Pain and poor nutrition,Oral candidiasis, denture stomatitis, denture irritation, hyperplasia traumatic ulceration At Risk: Patients receiving intensive care Patients receiving chemotherapy Patients receiving oxygen therapy Patients receiving immunosuppressive or other medications Patients receiving radiotherapy to the head and neck area The elderly Diabetics Patients who are nutritionally compromised or have a vitamin deficiency Unconscious patient Objectives of Oral Care To maintain the oral mucosa and lips clean, soft, moist and intact To keep the natural teeth free from plaque and debris To maintain denture hygiene and prevent denture induced disease To prevent infection To prevent oral discomfort To encourage adequate nutritional intake To maintain the mouth in state of normal function Oral Hygiene Assessment Assess patients self care ability Level of assistance required Patients preferences Remove dentures etc Inspect the surface of the mouth- especially the buccal mucosa for any abnormalities Examine the condition of the teeth andgums Inspect the tongue & lips Assess patients needs for teaching May need dental referral Denture Care Dentures: improve speech, make eating easier and improve the shape of the mouth, appearance and self image Assess for fit Remove and clean with toothbrush or denture brush When not in use store in a clearly labelled container Rinse or brush oral cavity Oral Care and the Unconscious Patient 2-4 hour frequency based on assessment Patient on side, semi-fowlers (semi-sitting), or head to side- allows fluid to drain or be suctioned to prevent aspiration Use tongue depressor if necessary Do not put your fingers in the patients mouth Toothbrush and paste- use less water Clean inner surfaces Use a small syringe to gently introduce water, use v small amounts, do not use large amounts patient may aspirate on water, impaired swallow reflex Rinse and suction as necessary – when suctioning mouth v carful not to cause trauma, if available use soft plastic suction catheters rather than hard yanker suction Lubricate lips – Vaseline (individual patient tubes)