Nutrition

1
Nutrition Electrolyte

• Lilley, Harrinton, Snyder (2006)
• Chapter 26, 52 53

2
Objectives

• Fluid balance
• Dehydration
• IV solutions
• Blood products
• Electrolytes
• Vitamins
• Minerals
• Enteral nutrition
• Hyperalimentation

3
Physiology of Fluid balance

• 60 of adult bodies are water (TBW) and is
  distributed to 3 main compartments
• Intracellular fluid 67
• Interstitial fluid 25
• Plasma volume 8

4
Fluid locations

• Intravascular
• Extra vascular
• Plasma
• Other
• Extra cellular fluid
• Intra cellular fluid

5
Regulation of volume compositions

• The daily amount of water gained should the
  daily amount of water lost.
• When Imbalances occur
• Edema
• Dehydration

6
Conditions that cause dehydration
7
Signs and Symptoms of Dehydration Mild Slightly
dry buccal mucous membranes, increased thirst,
slightly decreased urine output  Moderate Dry
buccal mucous membranes, tachycardia, little or
no urine output, lethargy, sunken eyes and
fontanelles, loss of skin turgor Severe Same as
moderate plus a rapid, thready pulse no tears,
cyanosis rapid breathing delayed capillary
refill hypotension mottled skin coma  

8
Understanding IV fluids

• ISOTONIC
• Having the same concentration of a solute as
  another solution, hence exerting the same osmotic
  pressure as that solution
• HYPOTONIC
• Having less pressure a solution with less
  osmotic pressure
• HYPERTONIC
• Having more pressurea solution with more osmotic
  pressure

9
Classification of IV solutions

• Crystalloids
• Colloids
• Lipids
• Blood blood products

10
CrystalloidsN/S, Ringers Lactate (R/L) D5W,
Plasma lyte

• Fluids that supply water and sodium to maintain
  the osmotic gradient between the extravascular
  and intravascular compartment
• Contain fluid and electrolytes that are normally
  found in the body.
• Has the capacity to expand the plasma volume
  related to its sodium content.

11
IV FluidNursing Considerations

• Administer the fluids accurately and according to
  the hospitals policy
• Monitor intake and output
• Monitor blood work (electrolytes, Hgb
• Monitor SS of fluid overload
• Communicate findings

12
CrystalloidsN/S, Ringers Lactate (R/L) D5W,
Plasma lyte

• Indications as maintenance fluids
• Replace fluids and to compensate for insensible
  fluid losses
• S/E They do not contain any large particles
  such as proteins, therefore do not stay within
  the blood vessels and can leak out of the plasma
  into the tissues and cells.
• Interactions rare

13
NACLSodium Chloride

• Available in various concentrations
• 0.9 Normal Saline (isotonic saline)
• 0.45 (Hypotonic saline)
• 3 Hypertonic saline)

14
ColloidsDextran, Albumin, Pentaspan

• Substances that increase the colloid oncotic
  pressure (COP) and effectively move fluid from
  the interstitial compartment to the plasma
  compartment by pulling the fluid into the blood
  vessels therefore ? blood volume
• This task is normally done by albumin, globulin,
  fibrinogen

15
ColloidsDextran, Albumin, pentaspan

• IndicationsThey are superior to crystalloids in
  their ability to expand the plasma volume
• Contraindications drug allergy, hypervolemia
• S/E can alter the coagulation times, have no
  oxygen carrying capacity and no clotting factors.
• Interactions rare

16
Blood Products

• Oxygen carrying resuscitation fluids.
• Only class of drug that can carry oxygen
  related to its hemoglobin content.
• Increase plasma volume
• Improve tissue oxygenation
• Natural, require human donor
• Expensive

17
Blood Products

• Costly
• Thresholds have increased
• More emphasis on blood conservation programs

18
Blood Products

• Increase the colloid oncotic pressure and the
  plasma volume
• Plasma expanders with the ability to carry O2
• Indications
• Contraindicationsno absolute contraindications
• S/E
• Interactions

19
Blood Products

• Whole blood
• Fresh Frozen Plasma
• Packed red blood cells
• Platelets

20
Blood ProductsNursing Considerations

• Patient history know your patient
• Consent
• Baseline vitals
• Double check blood with patients blood work
• Inspect the unit of blood
• Follow the institutions policy
• Monitor for SS of reaction to blood

21
Review policy procedureBlood products NBGH
22
Electrolytes

• Vital to the normal function of all systems in
  the body and are controlled by the
  rennin-angiotensin-aldosterone system, ADH
  system, SNS.
• Potassium
• Sodium
• Calcium
• Magnesium
• Chloride and phosphorus (phosphate)

23
Potassium (K)Normal 3.5-5.0 mmol

• Primary intracellular electrolyte
• Affects muscle contractions, transmission of
  nerve impulses, cardiac conduction,etc.
• In healthy adults, dietary intake is sufficient
  in maintaining adequate levels.

24
Potassium (K)Normal 3.5-5.0 mmol/L

• Hypokalemia
• Hyperkalemia

25
Potassium (K)Normal 3.5-5.0 mmol/L

• Indications replacement therapy
• Contraindicationsallergy to K, hyperkalemia
• S/E PO diarrhea, NV, GI bleed
• IV pain at injection site

26
Sodium NaNormal135-145 mmol/L

• Usually obtained from the salt we eat in our diet
• Important role in the control of water
  distribution fluid and electrolyte balance and
  osmotic pressure of body fluids
• Causes diuresis

27
Sodium NaNormal135-145 mmol/L

• Hyponatremia lt134 mmol/L
• Hypernatremiagt145 mmol/L

28
Vitamins Minerals

• Vitamins an organic compound essential for
  normal physiological and metabolic function of
  the body
• Minerals an inorganic substance that is ingested
  and attaches to enzymes, play a vital role in
  regulating many body functions
• Enzymes a specialized protein that catalyzes
  chemical reactions in organic matter
• Coenzymea non-protein substance that catalyzes
  chemical reactions in organic matter

29
Vitamins

• Fat-soluble vitamins
• Vitamins A, D, E, and K
• Water-soluble vitamins
• Vitamins B and C

30
Fat-Soluble Vitamins

• Vitamins A, D, E K

31
Vitamin A

• Derived from animal fats such as those found in
  milk, butter, eggs
• Essential forvision especially night vision
• Diet should supply an adequate amount
• Indicated pregnancy, breastfeeding, night
  blindness, hyperkaratosis of skin, retarded
  infant growth, psoriasis, acne

32
Vitamin DSunshine vitamin

• Responsible for the proper utilization of calcium
  and phosphorus
• Plays a role in the normal calcification of bones
• Derived from foods such as liver, eggs, salmon,
  milk, bread
• Indications supplement, infant rickets, tetany,
  asteomalacia, to promote absorption of phosphorus
  and calcium

33
Vitamin E

• Derived from fruits, grains, cereals, vegetables
  ,oils
• Protect the cellular membranes
• Indications premature infants
• use as an antioxidant ?

34
Vitamin K

• Essential for the synthesis of blood coagulator
  factors which take place in the liver
  Synthesized by intestinal flora.
• Indicationsinfants at birth, to treat excessive
  effects of coumadin

35
Water Soluble vitamins

• B C

36
Vitamin B(Thiamine)

• Beneficial drug is useful in treating many
  disorders
• Derived from whole grain foods, liver, beans
• Indications cases of malabsorption in
  alcoholism, cirrhosis, GI disease

37
Vitamin C

• Derived fromfruits, juices, tomatoes, green
  pepper, strawberries, mangoes, liver
• Important for collagen synthesis, tissue repair,
  maintenance of bone, teeth
• Enhances the absorption of calcium
• Aid in cellular respiration and resistance to
  infection
• Indicationspregnancy, lactation, fever, stress,
  burns

38
Minerals

• Ca, Mg, Phosphorus

39
Calcium

• Most abundant mineral element in the human body
• Efficient absorption of calcium requires adequate
  amounts of vitamin D
• Essential for the normal maintenance and function
  of the nervous, muscular and skeletal system and
  for cell membrane and capillary permeability
• hypocalcemia

40
Calcium (Ca)Normal 4.5-5.8 mmol/L

• Indication replacement therapy
• Contraindications drug allergy,hypercalcemia
• S/E rare, anorexia, nv, phlebitis from IV
• Interactions none known

41
Magnesium (Mg)Normal 1.5-2.5 mmol/L

• Associated with energy metabolism, is required
  for muscle contraction and nerve physiology
• Dietary intake from vegetable is usually adequate
• Hypomagnesemia malabsorption, alcoholism,
  diuretics, long term IV feeding, metabolic
  disorders

42
Magnesium (Mg)Normal 1.5-2.5 mmol/L

• Indications supplement for TPN, anticonvulsant,
  pre-eclampsia, cardiac dysrythmias
• Contraindications hypermagnesemia, heart block,
  renal failure, adrenal gland failure

43
Phosphorus

• Readily available in diet
• Required for the building block of body
  structures, ADP, AMP
• Deficiency states are usually from malabsorption,
  diarrhea, vomiting, hyperthyroidism

44
Phosphorus

• Indications treat deficiency
• Contraindications hyperphosphatemia
• S/E diarrhea, NV

45
Nutritional Supplements

• Dietary products used to provided nutritional
  support
• Can be administered in a variety of ways
• Variety of preparations to treat a variety of
  medical conditions
• Classifications
• Enteral
• Parenteral

46
Enteral Nutrition

• Provision of nutrients via the GI tract
• Indications
• Supplement an oral diet
• Clients who are unable to consume/digest normal
  foods
• Undernourished because of disease process

47
Enteral Nutrition

• Side effects
• Aspiration
• Contraindications
• Interactions

48
Enteral Routes

• PO
• Gastrostomy
• Jejunostomy
• Nasoduodenal
• Nasojejunal
• Nasogastric

49
Parenteral Nutrition(TPN or Hyper alimentation)

• Intravenous administration
• Preferred method for clients who are unable to
  tolerate and maintain adequate enteral or oral
  intake
• Only instituted when PO or enteral feedings are
  not options
• Can be administered through a peripheral vein or
  a central vein

50
Nursing considerations

• Baseline wt
• Inspect IV site
• Monitor Blood sugar
• Monitor for fluid overload
• Monitor electrolytes
• Monitor in/out
• Monitor for diarrhea (enteral)

51
TPN

• Nutrients delivered through the clients
  circulatory system through a peripheral vein
• Temporary measure
• Most valuable in clients who dont have large
  nutritional needs, can tolerate large fluid loads
  and need nutritional supplements only

52
TPN

• Indications
• Contraindications
• S/E
• Dosages

53
Central TPN

• A large central vein is used to deliver nutrients
  directly into the clients circulation
• Usually subclavian or internal jugular artery