Nutrition Student

Nutrition Objective:  Describe the impact of nutrition on health, wellness, and illness.  Nutritional assessment  Fluid/Electrolyte needs  Lab values  Abnormal findings  Nursing interventions  Considerations  Precautions ...

Nutrition Objective:  Describe the impact of nutrition on health, wellness, and illness.  Nutritional assessment  Fluid/Electrolyte needs  Lab values  Abnormal findings  Nursing interventions  Considerations  Precautions  Insertion of nasogastric tubes Care and maintenance of feeding tubes Skills: Continuous enteral feedings Intermittent enteral feedings Oral feeding of clients Calculating & documenting intake & output Nutritional assessment including lab results Nutrition- PURPOSE  Provide energy for body processes and movement  Provide structural material for body tissue  Regulate body processes  Vital for health and life Scope Factors Influencing Nutrition  Religious/Cultural Practices  Financial Issues  Appetites  Negative experiences  Environmental factors  Disease and Illness  Medications  Age Developmental Considerations:  Infants  Toddlers & Preschoolers  School Age Children  Adolescents  Adults  Pregnant & Lactating Women  Older Adults Food Choice Taste Emotion Food smell Body image Food habits Perceived benefits Convenience Portion size Cost Culture/Religion Social interaction  Substances in food that Nutrients body needs for growth, maintenance, repair Body needs in large amounts, supply energy & Macronutrients build tissue Carbohydrates, proteins, fat Nutrients Vitamins, minerals in Micronutrients smaller amounts; regulate & control body processes Water: essential nutrient Carbohydrates (CHO)  Quick energy-glucose  Provides energy( for protein to do its job)  Fuels brain, neurological system and red blood cells  A diet too high in CHO may result in weight gain and nutritional deficits  A diet too low in CHO may result in ketosis Dietary Fiber: 14 grams per 1000 K calories consumed  Soluble:  Insoluble:  Slows gastric emptying (^satiety)  Promotes bowel regularity  Decrease serum cholesterol  Reduces risk of some cancers  Assists in regulating blood glucose  May reduce risk of diverticular levels disease  Food source: oatmeal, oat bran,  Food source: wheat & corn bran, barley, broccoli, apples, oranges fruit skins, nuts, hulls of seeds Proteins (Amino Acids)  Enable tissue growth  Enable tissue repair  Maintain integrity of cell wall  Vegetarians: Lentils, nuts, soybeans can provide plant based protein *Also need Zinc and Folic acid to aid in tissue repair. Clinical Challenge; A client is a vegan (exclude all animal Are there special derived foods, including concerns for growing eggs, cheese, milk). children, pregnant How will the nurse plan a women? diet to meet the protein needs?  Energy: for now & stored fat for later Insulation: maintaining body temp & padding (protecting organs) Cell membrane integrity Fats (Lipids) Taste: adds texture & flavor to food, delays gastric emptying time Aids in the absorption of fat soluble vitamins Contribute to sensory appeal-enhancing flavor, aroma, & texture of foods.   Micronutrient compounds  Regulate body functioning  Must be consumed as part of daily intake  Fat-soluble vitamins A, D, E, K  Stored in liver, tissues till needed, Vitamins deficiency symptoms slow to develop  Water-soluble vitamins B complex, C  Absorbed with water in GI tract; usually not stored in body  Excess excreted in urine  Deficiency symptoms develop quickly Vitamin s Minerals  Salts dissolved in water  Called electrolytes, carry electric charge  Maintain fluid balance  Calcium most abundant  Majority in bones, teeth  Participate in energy production  Phosphorus, magnesium, iron  Zinc, fluoride, iodine Water  60% of adult's, 75% of infant's weight  Transports nutrients, wastes  Regulates metabolic processes, body temperature  Serves as solvent  Acts as lubricant, cushion  Maintains blood volume  Assists to maintain healthy weight Alterations in Fluid Volume Fluid volume excess: Fluid volume deficit: Overhydration or Hypervolemia Dehydration or Hypovolemia Common in congestive heart failure or Vomiting, diarrhea, hemorrhage, decreased decreased kidney function intake Findings: Bounding pulses, hypertension, Findings: Hypothermia, dizziness, oliguria, thirst crackles, dyspnea, edema Interventions: Rehydration, monitor for Interventions: Daily weight, monitor breath orthostatic hypotension, assess LOC sounds, sodium restrictions Nutritional Assessment  24 hour recall  Food diaries/Calorie counts  Food frequency record-food groups for the last week  Diet history-looks at past and present food habits and intake  Medical, social, cultural, and economic factors may impact nutritional status   Initial assessment of nutritional status  Inspection for signs of malnutrition  Brittle hair, poor healing wounds, lack of subq fat, enlarged liver, impaired Nursing coordination Assessment  Measurement height, weight  Compare to identified norms  Eating habits, any recent changes  Ability to chew, swallow  Mini Nutritional Assessment (MNA) Body Mass Index  Ideal way to establish body weight  BMI with kilograms and meters:  BMI = Weight in kilograms (height in meters) x (height in meters)  BMI with pounds and inches:  BMI = Weight in pounds x 703 (height in inches) x (height in inches) Measure waist circumference Healthy measurements:  Men no more than 40”  Women no more than 35” Central obesity = increased health risks Waist-to-hip-ratio: difference between lower body obesity and central obesity  Predictor of coronary artery disease  Excess fat in abdomen and waist  Males: less than 0.95  Females: less than 0.8  Patient is 5’6 and 189 lbs-what is BMI? Is it a healthy BMI? Practice Patient is 5’9 and 132 lbs-what is BMI? Is it a healthy BMI? calculating Patient is 6’0 and 185 lbs-what is BMI? Is it a BMI and healthy BMI? waist/hip Patient has a waist 35in and hips 37 in. What is waist hip ratio? Is this a health waist/hip ratios ratio? Patient has hips 37 in and waist 34 in. What is waist hip ratio? Is this a health waist/hip ratio? Obesity Protective measure Risk factors: Calorie intake is prevent weight genetics, greater than loss as body Chronic condition hormones, energy accepts higher sedentary lifestyle, expenditure weight and seeks poor diet choices to maintain it Increased risk for For BMI of 40-50, Risk for diabetes, thyroid there is a perioperative disorders, gerd, decreased life complications and and fatty liver expectancy of 8-10 pregnancy disease years complications Eating disorders  Anorexia nervosa  Low body weight for age, gender, and physical health  Fear of and self perception of being fat  Restrictive food intake  Bulimia nervosa  Binge eating followed by purging and guilt  Lack of control  Usually occurs once per week  Binge-eating disorder  Loss of control when binge eating  Does not purge  Often overweight  May help with weight gain and to promote appetite in the elderly, patient with poor oral intake, or unintentional weight loss Consider in patients with dementia, anorexia, cancer patients, HIV Appetite Not considered a first line treatment Stimulants Examples: Megestrol Acetate, Mirtazapine, Dronabinol Side effects: Constipation, edema, GI upset   Beneficial for people who do not lose weight after a weight loss program  Suppress appetite which reduces food intake, should be combined with an exercise program  Orlistat: Appetite  Action: prevents the digestion of fats Suppressants  Adverse effects: Reduced food absorption, oily stools, fecal incontinence  Loraserin  Action: Curbs appetite by stimulating serotonin receptors in the brain  Adverse effects: Dry mouth, nausea, fatigue  Sodium Normal:135-145 mEq/L Too Concentrated Too Dilute (Hypernatremia)high (Hyponatremia)low sodium sodium  Impaired cerebral function,  Disorientation, thirst, (not memory loss, anorexia, older adults), decreased level of hypertension, seizures if consciousness, seizures if serum sodium greater severe, sodium less than than 145mEq/L 130mEq/L  Restrict fluid intake  Potassium K+ Normal: 3.5-5.0 mEq/L Hypokalemia Hyperkalemia  Causes: diuretics, diabetic  Causes: chronic kidney ketoacidosis (DKA), diarrhea, disease, or heavy drug and excessive alcohol use, laxative alcohol abuse that causes use, and sweating, folic acid muscles to break down. deficiency.  Symptoms: flaccid muscle  Symptoms: flaccid muscle weakness, cardiac weakness, abdominal dysrhythmias K+ > 5.0 mEq/L distention, constipation, NEVER GIVE K+ IV PUSH= polyuria, cardiac dysrhythmias STOPS HEART serum K+, 3.5 mEq/lL Nutrition High K+ Foods High Na+ foods  Bananas  Processed meats and  Apricots vegetables  Almonds  Salted nuts and chips  Broccoli, tomatoes, potatoes  Cured meats  French fries  Sodas  Lentils  Fast food  Orange juice  Chocolate, shakes  Cantaloupe Calcium 8.6-10 Hypocalcemia Hypercalcemia  Clinical findings: Positive Chvostek’s  Clinical findings: Constipation, sign, osteoporosis, ECG changes, lethargy, renal stones, decreased poor growth in children, tetany, deep tendon reflexes Trousseau’s sign Lab Values Affected by Inadequate Nutrition Hemoglobin normal=12-17 g/dL Hematocrit normal =36%-50% Serum albumin normal =3.5-5.0 g/dL Pre-albumin normal= 23-43 mg/dL Transferrin normal=240-480 mg/dL Lab Values Affected by Inadequate Nutrition Hemoglobin A1C Cholesterol Glucose normal= normal= less than normal= less than 70-110 7% 200 mg/dL HDL normal= greater than 45 LDL normal= less Triglycerides= 40 - mg/dL male and than 130 mg/dL 150 mg/dL greater than 55 mg/dL female   Malnutrition-daily food diary, increase caloric intake, vitamins  Obesity-low calorie diet, increase activity, set goals, dietary education  Dehydration-increase fluids, IV fluids  Over-hydration-I and O, restrict fluids Nursing  Hyponatremia-IV saline, diuretics Interventions-  Hypernatremia-IV fluids to dilute Considerations  Anemia-iron enriched foods and … medications  Hypokalemia-K+ enriched foods, PO K+, K+ to IV fluids  Hyperkalemia-restrict K+ rich foods, kaexalate to remove K+ NPO  Pre-operative  NG tube: to suction for lavage of gastric contents.  Rest the GI tract  Swallow problems: trauma, CVA, decreased LOC  Preparation for a lab or diagnostic test  Treat N/V  Collaborate with prescriber regarding:  PO medications  medications to treat blood glucose  Need for nutrients (acutely ill patient) Clear Liquid  Liquid at room temperature  Clear – not opaque  Not caffeinated beverages.  Not alcoholic beverages.  Check about carbonated beverages  Check about measurements: popsicles, ice.  “Advance as tolerated” Full Liquid  Puddings  No fiber  Includes clear liquids  All of these are included in the I&O sheet as fluid intake.  Next step after clear liquid diet.  This step is often omitted as patients are usually able to move to a regular diet. Regular Diet  For patients with no dietary restrictions  Self select menu may be provided and can be tailored to fit individual food preferences  Healthy foods and balance are encouraged ADA Diet  Low fat, low carbohydrate diet aimed to keep patient’s blood sugar from spiking  Goal is to improved blood sugar and provide weight control  Recommends several small meals throughout the day with high in protein and fiber filled foods  Limits saturated fats, sugars, and salts  Fruits, vegetables, legumes, nuts, grains, lean protein, and healthy fats can be consumed   Intended to lower the intake of fat  Reduces the calories from fat and minimize Low-fat, Cholesterol  cholesterol intake Atherosclerosis and Cystic Fibrosis (CF) restricted   Includes fruit, vegetables, cereals, lean meat. NOT marbled meats, avocados, milk, bacon, egg yolks, butter Sodium Restricted (cardiac)  To lower body water and promote excretion  Heart failure (CHF), hypertension (HTN), cirrhosis  May be set at 500-3000 mg/ day  Baked chicken, lettuce with tomatoes, applesauce  NOT preserved meats, cheese, fried foods, milk products, canned foods, or adding salt to food.  Make sure you do not have salt on tray, will use salt substitute. High Roughage, High Fiber  Increased intake of foods high in fiber  Maximize bulk in stool  Constipation and large bowel disorders (IBS or diverticulosis)  Wheat bread, apples, Brussel sprouts  NOT white bread or white processed foods Low residue  Minimize intestinal activity  Limits high fiber  Used before bowel surgery, ulcerative colitis, diverticulitis, Chron’s disease.  Lamb, buttered rice, white processed foods.  NOT: whole wheat, corn, bran (anything that will increase the bulk of stool) High-Protein  Reestablish anabolism to raise albumin levels  Used with burns, infection, hyperthyroidism  Protein aids in healing  Eggs, tuna, meats Renal Diet  To keep protein, potassium, and sodium low.  Chronic renal failure (reduce workload of kidneys)  Careful protein consumption: supplement protein against their lab values (BUN) about 1 gm/kg/day  High carbohydrate and high calorie  High fat: 30 – 40% total calories  Fluid Restriction!!!! Mechanical Soft  Regular diet with modifications for texture.  Adequate in calories and nutrients  Long term use.  Used for patients with:  Poor dentition  Dysphagia: Swallowing problems  Oral lesions Thickened Liquids  Starch is added to liquids to increase the viscosity and improve the ease of a safe swallow.  Based on a swallow study.  Cannot use a straw!  Nectar thick  Honey thick  Assist swallow with a CVA patient: turn the patient’s head towards the weak side to decrease the side of the flaccid area in the throat. Critical Thinking YOUR CLIENT IS ON A CLEAR YOUR CLIENT IS ON A YOUR CLIENT IS OF THE YOUR CLIENT HAS NOT LIQUID DIET? HE HAS DIABETIC DIET. HE HAS JEWISH FAITH. HE HAS EATEN ANYTHING FROM THE REQUESTED ICE CREAM. REQUESTED A REGULAR DR. RECEIVED A PORK CHOP ON TRAY. THE FAMILY MEMBER CAN HE HAVE IT? PEPPER. CAN HE HAVE IT? HIS DINNER TRAY. WHAT IS STATES THEY ARE YOUR NSG. ACTION? VEGETARIANS. Balancing calories  Enjoy food, but eat less  Avoid oversized portions Foods to Increase  Make half your plate fruits & vegetables  Make at least half your grains whole grains  Switch to fat-free or low fat (1%)milk Foods to Reduce  Compare sodium in foods like soup, bread, and frozen meals- and choose the foods with lower numbers  Drink water instead of sugary drinks What is a serving? Food Labels  FDA has strict guidelines about claims on food labels  Look 1st for serving size, # servings per container  kCalories & kCalories from fat per serving  Nutrient amounts & % of daily values Intake and Output Worksheet Calculating Intake  Report intake in mL  1 cup = 8 oz  1 oz = 30 mL  Example:  Calculate the patient’s intake based on the following consumed in an 8 hour shift: 1 cup of tea, 6 oz soft drink, 12 oz clear gelatin, 300 mL water  1 cup of tea = 8 oz = 240mL; 6 oz soft drink = 180 mL; 12 oz clear gelatin = 360 mL  240 mL (tea) + 180 mL (soft drink) + 360 mL (gelatin) + 300 mL (water) = 1,080 mL Calculating Intake  Consumed:  1 cup of coffee  4 oz OJ from breakfast tray  5 oz flavored gelatin  Consumed:  1 cup of tea  12 oz soft drink  ½ of 900 mL water container during afternoon.  What do you document as intake on I & O sheet for 7-3 shift?  What about % of meals consumed?   72 yr old male: 6 ft tall weighs 155 lbs. Lost 15 lbs since last seen 6 months ago  BP 120/70, P 90, R 22, T 98.6 Sat 95% RA  Mucus membranes pale Case Study:  States wife died 4 months ago, “don’t feel like eating” “can’t cook, can’t operate microwave”  What further data do you need to collect?  What labs do you anticipate?  RBC = 3.9, Hgb = 13, Hct = 37 Other labs or diagnostic Case Study: tests? Nursing Goals Problems: Interventions