Nutrition Fluid Electrolytes .ppt PDF

NUTRITION Promoting Health Through Nutrition FOOD GUIDES  MyPlate  Developed by USDA—took place of Food Pyramid  5-a-day ◦ First government and private partnership ◦ Designed to increase consumption of fruits and vegetables to at least 5 servings per day  Exchange list...

NUTRITION Promoting Health Through Nutrition FOOD GUIDES  MyPlate  Developed by USDA—took place of Food Pyramid  5-a-day ◦ First government and private partnership ◦ Designed to increase consumption of fruits and vegetables to at least 5 servings per day  Exchange lists ◦ Developed for diabetics ◦ Helps control the amount of CHO CONNECTING NUTRITION TO HEALTH Physical performance—dependent on quality and quantity Intellectual function—relies on nutrition for well- functioning brain and CNS Emotional well-being—emotions harder to control when eating habits are poor Social health promoted through family meals, holiday gatherings Spiritual aspects are affected by dietary laws and restrictions PROMOTING HEALTH THROUGH NUTRITION Decrease salt consumption Decrease fat consumption Reduce iron deficiency Reduce obesity Increase physical activity Increase breastfeeding Increase dietary fiber Increase healthy food choices in restaurants Increase calcium in high risk groups ASSESSING NUTRITIONAL HEALTH Physical exam Biochemical—blood and urine samples Anthropometric measurements—height, weight, limb circumference, etc Dietary assessment tools  24 hour recall  Food record  Diet history  None are totally accurate ESSENTIAL NUTRIENTS Carbohydrates Proteins Fats Water Vitamins Water NUTRITION Carbohydrates, Protein, Fats “LIFE EXPECTANCY WOULD GROW BY LEAPS AND BOUNDS IF GREEN VEGETABLES SMELLED AS GOOD AS BACON.”—DOUG LARSON, THE ALBANY TIMES UNION CARBOHYDRATES Stored as glycogen in liver Glucose is the form used by cells Brain needs a constant source of glucose 45-65% of daily calories from CHO Functions  Energy—4 kcal/gram  Flavor/sweetness  Only source of fiber CARBOHYDRATES  Sources ◦Breads/cereals ◦Potatoes, beans, corn ◦Fruits/vegetables ◦Milk ◦Sugar, syrup, jelly  Health concerns ◦Nutrient displacement ◦Dental caries  Substitutes ◦Splenda ◦Aspartame “DID YOU KNOW M & MS WERE DESIGNED SPECIFICALLY FOR SOLDIERS HEADED TO THE BATTLEFIELDS OF EUROPE. THE MARS COMPANY CLAIMED THAT SOLDIERS WOULD GET A QUICK BOOST OF ENERGY FROM A CANDY THAT WOULD NOT ‘GUM UP’ THEIR TRIGGER FINGER.” BANCROFT, BARB. LIVE A LITTLE, LAUGH A LOT. CARBOHYDRATES Classes  Simple  Monosaccharides  Disaccharides  Complex  Starches  Fiber—need 20-35 gm/day  Glycogen Hormonal control  Insulin  Glucagon Related disorder  Diabetes mellitus “BRAIN CELLS COME AND GO, BUT FAT CELLS LIVE FOREVER.”--ANONYMOUS  FATS 25-35% of daily calories from fats Made up of fatty acids—essential and nonessential Fatty acids are classed as:  Unsaturated—mono and polyunsaturated (omega 3 fatty acids interfere with clotting to decrease risk of clots—deep water fish: tuna, salmon, sardines)  Saturated—denser, more solid Travel in blood attached to a protein called a lipoprotein  LDL--bad  VLDL—very bad  HDL--good FATS  Functions ◦Concentrated energy source—9 kcal/gram ◦Satiety and palatability ◦Nerve impulse transmission ◦Cushions and protects ◦Source of fat soluble vitamins ◦Regulates body temp  Sources ◦Major—meat, fish, nuts, dairy ◦Invisible—cheese ◦Visible—fat on meat or in bacon FATS Classifications  Phospholipids  Emulsifiers  Carry cholesterol away from arteries  Part of RBC membrane  Triglycerides  Main source is animal based  Cholesterol  Animal base only  Stored in liver  Excess amounts deposited in arteries FATS Fat-related disorders  CAD  Cancer  NIDDM  HTN No more than 300 mg cholesterol/day Quality over quantity Substitutes  Simplesse  Olestra  PROTEINS  Classified as ◦Complete—all essential amino acids—usually animal in origin, except for animal gelatin ◦Incomplete—does not have all essential amino acids —usually plant sources, except for animal gelatin  Men need 1.0 gm/kg body weight/day  Women need 0.8gm/kg body weight/day  Require more during periods of rapid growth  No more than 10-35% of daily calories  Contain nitrogen whereas CHO and Fats do not PROTEINS Functions  Tertiary energy source—4 kcal/gm  Primary—tissue repair and building  Water balance through osmotic pressure  Combines with iron to form hemoglobin which carries O2 and CO2  Defense mechanisms—lymphocytes and antibodies  Acid base balance—either as an acid or buffer  Binds with lipids to transport in blood PROTEINS Sources  Animal—complete  Plant—incomplete Vegetarian types  Lacto-ovo  Ovo  Strict vegans--without dietary supplements, will lack B12; may also have problems with obtaining all essential amino acids without careful dietary planning.  QUESTION FOR YOU “Can vegetarians eat animal crackers?” --Anonymous Bancroft, Barb. Live a Little, Laugh a Lot PROTEINS Protein-related disorders  Kwashiorkor  Marasmus  Nitrogen balance  Negative  Positive NON-ENERGY Vitamins and NUTRIENTS Minerals VITAMINS  Characteristics ◦Vital ◦Necessary in minute amounts only ◦Cannot be manufactured by the body, except for vitamin K ◦Measured in milligram or micrograms  General Functions ◦Control agent—acts as catalysts for chemical reactions ◦Tissue structure ◦Deficiency disease prevention  VITAMINS—WATER SOLUBLE  Vitamin C—ascorbic acid ◦Functions—tissue building; absorption of iron; antioxident; wound healing ◦Destroyed by light and heat; cook as little as possible with the least amount of water ◦Smoking and BCP decrease vitamin C ◦Sources—best—citrus fruits; tomatoes, cabbage; red and green peppers; strawberries, potatoes ◦Deficiency disease—Scurvy—easy bruising, pinpoint hemorrhages; poor wound healing  Vitamin B1-Thiamine ◦Functions—normal growth; metabolism of CHO; normal function of heart, nerves, and muscles ◦Major vitamin deficiency in alcoholism ◦Use little water in cooking ◦Sources—lean pork (best); potatoes with skin; beef; liver ◦Deficiency disease—beriberi—nerve damage; heart failure; fatigue VITAMINS—WATER SOLUBLE  Vitamin B3—Niacin ◦Stable to acid and heat; but can be lost in cooking water ◦BCP can decrease ◦Functions—normal growth; healthy skin; normal activity of stomach, intestines, and nervous system ◦Food sources—meat (major); peanuts; enriched grains ◦Deficiency disease—pellagra—dermatitis, diarrhea, dementia  Folate—Folic Acid ◦Do not overcook ◦Functions—growth and development of RBC; prevention of neural tube defects in fetuses; part of DNA ◦Food sources—liver; green leafy vegetables (best source) ◦Deficiency disease—megaloblastic anemia VITAMINS—WATER SOLUBLE B12—Cobalamin  Stable in cooking  Must have intrinsic factor to absorb B12 from diet  Functions—essential for heme portion of hemoglobin; transport and storage of folate  Food sources—animal sources only (vegetarians can lack)  Deficiency disease—pernicious anemia—seen more in elderly or in someone who has had all or part of stomach removed (lack the intrinsic factor); will need lifelong injections of B12 VITAMINS—FAT SOLUBLE Vitamin A—retinol  Unstable in heat  Beta carotene is a precursor to Vitamin A  Functions—allows eye to adjust to light changes; tissue strength; growth of skeletal and soft tissues  Food sources—fish liver oils(best); egg yolks; leafy green and yellow vegetables  Deficiency disease—nightblindness; xerosis (itching, inflamed eyes)  Toxicity—joint pain; jaundice; orange hue to skin VITAMINS—FAT SOLUBLE Vitamin D  Can make some through skin exposed to sunlight  functions—absorption of calcium/phosphorus; bone and teeth strength  Food sources—fortified milk; yeast and fish liver oils(only natural form); butter/margarine  Deficiency disease—rickets (in children); osteomalacia and osteoporosis in adults  Toxicity—hypercalcemia and hypercalciuria; fragile bones; calcification of soft tissues VITAMINS—FAT SOLUBLE  Vitamin E—Tocopherol ◦ Functions—antioxident; maintains cell membrane integrity ◦ Food sources—vegetable oils (richest); milk; eggs; muscle meats; leafy vegetables ◦ Deficiency—hemolytic anemia; disruption of the myelin sheath ◦ Toxicity—none known  Vitamin K ◦ Need bile to absorb from diet ◦ Sensitive to light ◦ Can be synthesized from normal GI flora ◦ Functions—blood clotting (main); bone development ◦ Food sources—dark green leafy veg; beef, pork, chicken, liver ◦ Deficiency—hemorrhage; poor wound healing ◦ Toxicity—only during therapeutic administration of vitamin K TAKING SUPPLEMENTS Read labels Large doses (especially fat soluble) can be harmful Better to get vitamins from diet Individualize doses MAJOR MINERALS Calcium, Magnesium CALCIUM—9-10.5 MG/DL  99% stored in bones  Need Vitamin D to absorb calcium from diet  Major functions—bones/teeth; clotting; heart beat  Inverse relationship with phosphorus  Food sources—milk/milk products; dark green leafy vegetables  Hypocalcemia—rickets; osteoporosis, osteomalacia; +Chvosteks and Troussea’s sign; poor clotting  Hypercalcemia—may lead to constipation and kidney stones  Hormonal control ◦ Parathormone—raises low serum calcium ◦ Calcitonin—lowers high serum calcium TREATMENT/NSG ACTIONS  Hypocalcemia  Hypercalcemia ◦Calcium carbonate orally ◦Loop diuretics to increase ◦Calcium gluconate IV for excretion of calcemia life threatening deficit ◦Force fluids 3000-4000 ◦Calcium rich foods with mL per day—increases vitamin D supplements renal excretion and ◦Do not let IV calcium decreases chance of infiltrate (will slough) renal stone ◦Never give IM— ◦Synthetic calcitonin— precipitates into the reduces GI absorption, muscles promotes renal excretion, ◦Trach tray at bedside for increases return to bones acute cases r/t ◦Steroids—decreases bone laryngospasms turnover of calcium ◦I & O ◦Weight bearing exercises MAGNESIUM—1.6-2.6 MEQ/L Functions--Regulate nerve and muscle function, especially the heart Food sources--Dark green leafy vegetables Deficiencies seen in starvation and alcoholism  Hypomagnesemia--Leg cramps, paresthesias, Esophageal/ laryngeal spasm, Tetany (neuromuscular excitability), Convulsions Toxicities are rare—usually occur with administration of magnesium  Hypermagnesemia—NV, Decreased deep tendon reflexes, Flaccid paralysis, Depressed respirations, Respiratory arrest MAGNESIUM Hypomagnesemia Hypermagnesemia  Causes:  Causes:  Severe malnutrition  Renal insufficiency  Intestinal malabsorption  Severe dehydration  Chronic alcoholism  S/S  Prolonged IV therapy, diarrhea,  Serum Mg 3.0 mEq/l or greater GI suctioning  NV  Hypoparathyroidism  Decreased deep tendon reflexes  Renal failure  Flaccid paralysis  S/S  Depressed respirations  Leg cramps  Respiratory arrest  Paresthesias  Vasodilation  Esophageal/ laryngeal spasm  Low blood pressure  Tetany (neuromuscular  Coma excitability  Arrhythmias, cardiac arrest  Convulsions TRACE MINERALS Iron TRACE MINERALS--IRON  Fe  Need vitamin C to absorb from diet  Functions: hemoglobin synthesis; antibody production; detoxification of drugs in the liver; conversion of beta carotene to Vitamin A  Food Sources: ◦Heme—most absorbable iron—meat sources ◦Nonheme—plant sources; fortified cereals  Deficiency—iron deficiency anemia (known as a microcytic anemia)  Toxicity—hemosiderosis—deposits in liver; can lead to liver and heart damage and diabetes WATER FACTORS AFFECTING WATER NEEDS Temperature Activity level Functional losses—vomiting, diarrhea Metabolic needs WATER Gains  Food  Liquids  By product of metabolism Losses  Insensible  Lungs  Sweat  Stool  Sensible  Urine FLUID COMPARTMENTS Intracellular In adults—most of water is intracellular (66%) Fluid within the cells (ICF) Extracellular Interstitial—between cells (GI, CSF, Lymph) Intravascular—fluid in plasma in vessels  REGULATION Thirst mechanism—controlled by hypothalamus Kidneys—filters out excess water Hormonal  ADH—posterior pituitary gland; secreted when water levels low, blood pressure drops, or sodium increased; stimulates kidneys to conserve water  Renin—enzyme secreted by kidneys; triggers the release of aldosterone  Aldosterone -target organ is kidneys;  Keeps sodium and excretes potassium (Conserves water) MEASURING I & O Explain Instruct  All intake  All output  All parenteral End of shift measurement  1 oz. = 30 mL Document in chart FLUID VOLUME DEFICIT Causes—diarrhea, vomiting, sweating, high fever, diuretics S/S—decreased urination and skin turgor, sudden weight loss, dry mucous membranes, thirst, depressed fontanelles in infants; hypotension with tachycardia Infants and elderly at greater risk WATER Interventions for fluid volume deficit  Find and correct cause  Diarrhea—antidiarrheals  Vomiting—antiemetics  Force fluids if not contraindicated  IV fluids if oral fluids are contraindicated  Weigh daily  I & O at least every shift  Monitor skin turgor, oral mucous membranes, and characteristics of urine—fontanelles in infants under 18 months (with dehydration, would expect to be sunken)  When replacing fluids, be sure to monitor for fluid volume excess (also known as fluid overload) FLUID VOLUME EXCESS Causes—excess fluid intake (usually associated with psych disorders, but can occur when replacing fluids with plain water); excessive sodium intake S/S—sudden weight gain; edema (pitting or non-pitting, rales); HTN; water intoxication (cramping, weakness, hypotension) WATER Interventions for Fluid Volume Excess  Monitor sodium intake  I & O at least every shift  Monitor for edema and skin turgor  Peripheral  Pulmonary—auscultate breath sounds  Weigh daily  Diuretics  Monitor for fluid volume deficit—can occur, especially when diuretics are given  Monitor characteristics of urine  Monitor lab values such as hematocrit (will decrease); potassium (K) and sodium (Na)—will also decrease (dilutional effect)  Monitor fontanelles in those under 18 months—would expect to bulge “BLOOD TRANSFUSION IS LIKE MARRIAGE; IT SHOULD NOT BE ENTERED UPON LIGHTLY, UNADVISABLY, OR WANTONLY OR MORE OFTEN THAN IS ABSOLUTELY NECESSARY.”-- ANONYMOUS Bancroft, Barb. Live a Little, Laugh a Lot BLOOD TRANSFUSIONS Prior to transfusion  Type and cross match—for each unit of blood to be given  IV site—18 gauge IV catheter in large vein is preferred  Informed consent  Vital signs just prior to transfusion beginning  Two nurses verify donor blood During procedure  Frequent vital signs—follow facility protocol BLOOD TRANSFUSIONS  Nursing Interventions  Reactions ◦ Stop infusion ◦ Hemolytic ◦ Keep vein open  Usually occurs during first 15 minutes with NS (0.9%  Can die sodium chloride)  S/S include  Chills, fever ◦ Notify doctor and  Low back pain blood bank  Pruritus ◦ Return blood to  Hypotension blood bank  NV  Chest pain ◦ Monitor patient  Dyspnea closely  Decreased output ELECTROLYTES Sodium, Potassium, Chloride SODIUM—135-145MEQ/L  Functions—water balance  Food sources—table salt—but is found everywhere  Controlled by hormone aldosterone  Deficiency ◦Hyponatremia—H/A, muscle cramps, weakness  Toxicity ◦Hypernatremia—thirst, edema, HTN—be careful when administering fluids to correct—can lead to fluid volume overload  Recommended daily amount—2000 mg  NURSING ACTIONS/TREATMENT Hyponatremia Hypernatremia Monitor I & O Monitor I & O Replace fluid loss Decrease sodium in with fluids diet containing sodium— Monitor water losses do not use plain water POTASSIUM—3.5-5.0 MEQ/L Functions—acid base balance, nerve impulse transmission, regulate heartbeat; insulin release Food sources—orange and yellow fruits/veg; tea, raisins, meat TREATMENT OF K+ ABNORMALITIES Hypokalemia Hyperkalelmia  IV or oral K+  Occurs most often in kidney  Should not be given if failure urine output < 30 ml/hr  Kayexalate--orally, rectally,  Always dilute IV form and NG tube liquid po form  Potassium wasting diuretics  Never given IV push by  IV insulin with dextrose RN--can cause cardiac solution arrest  IV sodium bicarbonate  Increase dietary intake of  I & O every shift K+  Hemodialysis  If on Digoxin--hypokalemia may induce digoxin toxicity  I & O every shift PATIENTS AT RISK FOR K+ DEFICIT Loop or thiazide diuretics Unable to take anything by mouth Severe anorexia (chemotherapy) Unable to chew or swallow Gastric suction applied Severe diarrhea Stress--activates aldosterone ( saves Na+ and H2O and gets rid of K+)  HOSPITAL NUTRITION HOSPITAL DIETS  Clear liquids ◦See through ◦No residue ◦Clear at room temperature ◦Rests the GI tract ◦Not nutritionally sound ◦Don’t give any red liquids after surgery like popsicles and jello ◦Foods—anything that would be liquid at room temp  Tea  Broth  Jello  Popsicles  Water HOSPITAL DIETS—FULL LIQUIDS Anything on clear liquid plus strained soups; cooked refined cereals (Cream of Wheat); milk, ice cream Provides no residue Used for surgery or injury to face and for difficulty swallowing HOSPITAL DIETS Mechanical Soft— clear and full liquids plus diced or ground foods.  Easily chewed, swallowed; useful for dysphagic clients or those with no teeth DAT—diet as tolerated; common after surgery Regular—also called house diet; anything goes Pureed—similar to soft but consistency is smoother; butter, gravies, sugar or honey added to increase caloric density Thickened liquids for dysphagic clients ALTERNATIVE FEEDING Enteral Oral Tube via NG, gastrostomy, or jejunostomy tubes  Risk for aspiration (NG highest risk) TPN—given by RNs  total parenteral nutrition; used when client cannot take anything or enough in by way of the GI tract; hyperglycemia is a problem METHODS OF ADMINISTRATION Bolus—specific amount at specified times; more manageable for the client, but increases aspiration risk Continuous—uses a pump set at an ordered rate; runs continuously; less risk of aspiration; ties client to a pump NURSING INTERVENTIONS Change feeding bag and tubing daily Keep container closed Check patency/placement of tube; check residuals before feeding/meds/flushing Flush before and after medications or bolus feedings Keep head of bed elevated (if intermittent feeding HOB elevated for 1 hour) Monitor weight TUBE FEEDING COMPLICATIONS Diarrhea—major Obstruction of feeding tube Aspiration Fluid overload FOOD ALLERGIES Milk, peanuts, fish, eggs, wheat most common s/s - n/v, dyspnea, itching, dizziness, and ha Possible anaphylaxis.  CARDIOLOGIST’S DIETARY WORDS OF WISDOM If it tastes good, spit it out.