Nursing Fundamentals Nursing Fundamentals Focus VIIIFocus VIII

Meeting Nutritional NeedsMeeting Nutritional Needs

Obje

ctiv

es

Obje

ctiv

es

List basic substances for

List basic substances for

survival. Discuss the

survival. Discuss the

significance of each in

significance of each in

order of their importance.

order of their importance.

Define the 6 food groups

Define the 6 food groups

and identify the major

and identify the major

nutrients each group

nutrients each group

provides, including the

provides, including the

recommended daily

recommended daily

allowances.

allowances. Calculated estimated

Calculated estimated

caloric need and design a

caloric need and design a

meal plan per day to

meal plan per day to

maintain adequate caloric

maintain adequate caloric

balance and ideal weight.

balance and ideal weight.

Obje

ctiv

es

Obje

ctiv

es

Compare and contrast

Compare and contrast

the situation/conditions

the situation/conditions

responsible for

responsible for nutritional problems

nutritional problemsDescribe altered means

Describe altered means

of maintaining adequate

of maintaining adequate

nutritional intake.

nutritional intake. Explain nursing

Explain nursing responsibilities for each.

responsibilities for each.

Energy Production and Physiological Energy Production and Physiological MaintenanceMaintenance

Essential Nutrients and SourcesEssential Nutrients and Sources

WaterWater

Fluid and ElectrolytesFluid and Electrolytes

NutrientsNutrients

Esse

ntia

l Esse

ntia

l

Nutrie

nts a

nd

Nutrie

nts a

nd

Source

sSource

s

NutrientsNutrients

Carbohydrates

Carbohydrates

FatsFats

ProteinsProteins

Micronutrients

Micronutrients

Vitamins and minerals

Vitamins and minerals

Food groupsFood groups

Daily allowance:Daily allowance:Bread and cerealBread and cereal

Vegetable Vegetable

FruitFruit

DairyDairy

MeatMeat

Fat and sweetFat and sweet

Food and activity!Food and activity!

Adequate caloric balanceAdequate caloric balance

Basal NeedBasal Need::

MetabolismMetabolism Anabolic reactionsAnabolic reactions

Catabolic reactionsCatabolic reactions

Basal Metabolic Rate (Basal Metabolic Rate (BMRBMR))

Adequate

calo

ric

Adequate

calo

ric

bala

nce

bala

nce Activity need:

Activity need: energy requirements are

energy requirements are

completely met by caloric

completely met by caloric

intake in food with people

intake in food with people

who who maintain their

maintain their

activity levels

activity levels without without

weight change.

weight change.

Adequate caloric balanceAdequate caloric balance

Total Caloric NeedTotal Caloric Need

Vs Vs

Total Caloric IntakeTotal Caloric Intake

Lab TestsLab TestsBUNBUN

HematocritHematocrit

HemoglobinHemoglobin

BUN : Creat ratioBUN : Creat ratio

AlbuminAlbumin

Serum CreatinineSerum Creatinine

Lymphocyte CountLymphocyte Count

Fact

ors

Aff

ect

ing

Fact

ors

Aff

ect

ing

Nutr

itio

nal S

tatu

s

Nutr

itio

nal S

tatu

s

Health status

Health statusAgeAge Socioeconomic status

Socioeconomic status Physiological factors

Physiological factorsAlcohol and drugs

Alcohol and drugsCulture and lifestyle

Culture and lifestyleMisinformation and

Misinformation and fadsfads

Factors Affecting Nutritional StatusFactors Affecting Nutritional Status

Health status:Health status:

1.1. a good appetite is a sign of health. a good appetite is a sign of health.

2. anorexia is usually a symptom of disease or 2. anorexia is usually a symptom of disease or can be a side effect of drugs.can be a side effect of drugs.

3. Nutritional support is an essential part of 3. Nutritional support is an essential part of recovery from any medical treatment.recovery from any medical treatment.

Factors Affecting Nutritional Factors Affecting Nutritional StatusStatus

AgeAge

Premature babies (32-34 weeks) <5.5 lbs Premature babies (32-34 weeks) <5.5 lbs

Adolescents the eating disorders are commonAdolescents the eating disorders are common approx 20 million sufferersapprox 20 million sufferers

Older adults Older adults Many elderly clients take Many elderly clients take a a Molotov cocktail of meds which usually Molotov cocktail of meds which usually interact with nutrientsinteract with nutrients

Fact

ors

Aff

ect

ing

Fact

ors

Aff

ect

ing

Nutr

itio

nal S

tatu

s

Nutr

itio

nal S

tatu

s

Socioeconomic status:

Socioeconomic status:1.1. Food expenses are

Food expenses are not fixednot fixed2.2. Spending varies with

Spending varies with

monies available

monies available 3.3. A lot of convenience

A lot of convenience foods and starchy

foods and starchy foodsfoods

Facto

rs Aff

ectin

g

Facto

rs Aff

ectin

g

Nutritio

nal S

tatu

s

Nutritio

nal S

tatu

sPhysiological

Physiological

FactorsFactors

IngestionIngestion

anorexiaanorexia

stomatitisstomatitis

dysphagiadysphagia

Digestion and

Digestion and

AbsorptionAbsorption

ulcerative ulcerative

colitiscolitis

lactose lactose

intoleranceintolerance

Metabolis

mMeta

bolism

liver liver

diseasedisease

infection infection

and

and

traumatrauma

Factors Affecting Nutritional StatusFactors Affecting Nutritional Status

Alcohol and drugs:Alcohol and drugs:1.1. Abuse contributes to nutritional deficiencies because money Abuse contributes to nutritional deficiencies because money

may be spent on alcohol instead of food, and alcohol may may be spent on alcohol instead of food, and alcohol may replace apart of the diet and depress appetitereplace apart of the diet and depress appetite

2.2. Excess alcohol can also affect GI organsExcess alcohol can also affect GI organs

3.3. Drugs that depress appetite can lower the intake of Drugs that depress appetite can lower the intake of essential nutrientsessential nutrients

4.4. Drugs can also deplete nutrient stores and lessen Drugs can also deplete nutrient stores and lessen absorptionabsorption

Fact

ors

Fa

ctors

Aff

ect

ing

Aff

ect

ing

Nutr

itio

nal S

tatu

s

Nutr

itio

nal S

tatu

s

Culture and lifestyle:

Culture and lifestyle:1.1. Cultural, ethnic, and religious

Cultural, ethnic, and religious

patterns and restrictions

patterns and restrictions

concerning food must be

concerning food must be

taken into account

taken into account2.2. Special foods and diets

Special foods and diets

should be given whenever

should be given whenever

possiblepossible

3.3. Older adults are more apt to

Older adults are more apt to

cling to ethnic food habits.

cling to ethnic food habits.

This tendency may be

This tendency may be

increased during illness.

increased during illness.

Factors Affecting Nutritional Factors Affecting Nutritional StatusStatus

Misinformation and fads:Misinformation and fads:

1.1. Food myths can be the result of cultural Food myths can be the result of cultural background, popular interest in natural foods, peer background, popular interest in natural foods, peer pressure, and a desire to control weight.pressure, and a desire to control weight.

2.2. Food fads often involve erroneous beliefs that Food fads often involve erroneous beliefs that certain foods are especially healthy.certain foods are especially healthy.

3.3. Nurses must make sure not to be condescending Nurses must make sure not to be condescending when teaching a client that foods may not have when teaching a client that foods may not have qualities attributed to them.qualities attributed to them.

Nutritional Assessment and Nutritional Assessment and SupportSupport

Albumin<3.5?Total lymphocyte

Count <1800 Is weight

<80% of ideal?

Assessment of Psychosocial and Physical barriers

to intake

Is Gut functioning?Gut

not functioningTPN candidate

TPN

Oral & Nutritional

supplements?

Ongoing Assessment

AdequateDietary Intake?

Tube Feeding

Ongoing Assessment

Clinical Situations which Artificial Clinical Situations which Artificial Nutrition may be NecessaryNutrition may be Necessary

Inability to ingest foodInability to ingest food

Inability to digest or Inability to digest or absorb foodabsorb food

Inability to meet Inability to meet nutritional needsnutritional needs

CA of the mouth, tongue, CA of the mouth, tongue, esophagusesophagus

Facial traumaFacial trauma UnconsciousnessUnconsciousness Severe stomatitis Severe stomatitis DysphagiaDysphagia Muscle weakness in mouth Muscle weakness in mouth

and esophagus and esophagus

Pancreatitis, Pancreatitis, CA or the stomachCA or the stomach CrohnCrohn’’s disease/ulcerative s disease/ulcerative

colitiscolitis Biliary diseaseBiliary disease

Increase resting energy Increase resting energy expenditure from major expenditure from major trauma and surgery, burns, trauma and surgery, burns, severe infection severe infection

Anorexia and Bulimia NervosaAnorexia and Bulimia Nervosa

Imbalanced NutritionImbalanced Nutrition

Focused assessment Focused assessment

what are the physical and psychosocial barriers towhat are the physical and psychosocial barriers to

nutrition?nutrition?

Body weight<20% of idealBody weight<20% of ideal

AppetiteAppetite

MedicationsMedications

Ability to eat independentlyAbility to eat independently

Difficulty with the mechanics of eatingDifficulty with the mechanics of eating

GI symptomsGI symptoms

Physical conditionPhysical condition

FinancesFinances

Impair

ed

Impair

ed

Sw

allo

win

gSw

allo

win

g DYSPHAGIA:DYSPHAGIA:

Oral phaseOral phase

Pharyngeal phasePharyngeal phase

Esophageal phaseEsophageal phase

Ris

k fo

r A

spir

ati

on

Ris

k fo

r A

spir

ati

on

LOOK AT RELATED FACTORS!LOOK AT RELATED FACTORS!

Increase Nutrient IntakeIncrease Nutrient Intake

Nursing ResponsibilitiesNursing Responsibilities

Providing Enteral FeedingsProviding Enteral Feedings- - Enteral nutritionEnteral nutrition

- - Feeding tubes and routes of accessFeeding tubes and routes of access

- Types of formulasTypes of formulas

- Administration of feedingsAdministration of feedings

- Complications of feedingsComplications of feedings

- Home Enteral NutritionHome Enteral Nutrition

Increase Nutrient IntakeIncrease Nutrient IntakeNN

Nursing Responsibilities Nursing Responsibilities

Enriching the Insufficient DietEnriching the Insufficient Diet- - Special populationsSpecial populations

Managing Therapeutic DietsManaging Therapeutic Diets- AnorexiaAnorexia

- Nausea and vomitingNausea and vomiting

- Lactose IntoleranceLactose Intolerance

- MalabsorptionMalabsorption

- DiabetesDiabetes

- AIDS and CAAIDS and CA

- Heart DiseaseHeart Disease

- Kidney DiseaseKidney Disease

- Liver DiseaseLiver Disease

Managing Impaired Swallowing:Managing Impaired Swallowing:

Nursing ResponsibilitiesNursing Responsibilities

Positioning the patientPositioning the patient

Encouraging the appropriate foodsEncouraging the appropriate foods- Easy to swallow foods- Easy to swallow foods

Reduce Risk of AspirationReduce Risk of AspirationNursing Responsibilities Nursing Responsibilities

Monitor for subtle cues:Monitor for subtle cues:

change in respiratory ratechange in respiratory rate

temperaturetemperature

breath soundsbreath sounds

decrease oxygen saturationdecrease oxygen saturation

check swallowing reflexcheck swallowing reflex

check for increased gastric residual volumecheck for increased gastric residual volume

positioningpositioning

need for suctioning need for suctioning