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NUTRITION Nursing Implications

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NUTRITION Nursing Implications Heather Wrenn, RN, BSN Fall 2006 BODY WEIGHT/BODY MASS Ideal body weight Body mass index Percent body fat FACTORS AFFECTING NUTRITION ... – PowerPoint PPT presentation

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Title: NUTRITION Nursing Implications


1
NUTRITIONNursing Implications
  • Heather Wrenn, RN, BSN Fall 2006

2
BODY WEIGHT/BODY MASS
  • Ideal body weight
  • Body mass index
  • Percent body fat

3
FACTORS AFFECTING NUTRITION
  • Development
  • Gender
  • Ethnicity culture
  • Beliefs about food
  • Personal preferences
  • Religious practices
  • Lifestyle
  • Medications therapy table 45-1

4
FACTORS AFFECTING NUTRITION
  • Health
  • Alcohol abuse
  • Advertising
  • Psychologic factors

5
NUTRITION THRU THE LIFE CYCLE Young Middle
Adult
  • Lay foundation for lifetime nutrition pattern in
    young adulthood
  • Nutrient requirements change very little
  • Females need to maintain/increase intake of Vit.
    C , Vit D, calcium maintain intake of iron
  • Basal metabolism decreases 2-3/decade after age
    25
  • Obesity, HTN , DM may begin to form

6
NUTRITION THRU THE LIFE CYCLE Older Adults
  • Physiologic, psychosocial, economic changes
  • Need fewer calories
  • Nutrient requirements basically the same
  • Variety nutrient dense foods water
  • See Kosier Erb table 45-2

7
Factors Affecting NutritionEthnicity Culture
  • Native American
  • Starches corn, rice
  • Fruits berries
  • Veggies rhubarb, mushrooms, roots
  • Meats game, seafood, nuts
  • Milk little used
  • High incidence of lactose intolerance
  • Encourage broiled, poached, steamed meats

8
Factors Affecting NutritionEthnicity Culture
  • U.S. Southern
  • Starches cornbread, biscuits, potatoes
  • Fruits melons, peaches, bananas
  • Veggies collards, okra, tomatoes, cabbage
  • Meat pork, chicken, fish
  • Milk milk, ice cream
  • Many foods fried, cooked with lard

9
Factors Affecting NutritionEthnicity Culture
  • Mexican
  • Starches tortillas, corn products
  • Fruits few
  • Veggies chili peppers, tomatoes, onions
  • Meat beef, poultry, eggs, pinto beans
  • Milk cheese rarely drink milk

10
Factors Affecting NutritionBeliefs Preferences
  • Individual likes dislikes
  • Beliefs about foods
  • Fad diets

11
Factors Affecting NutritionReligious Practices
  • Jewish
  • Kosher no pork or shellfish cannot consume milk
    or dairy at same meal with meat/poultry
  • Christianity
  • Catholics
  • Eastern Orthodox
  • Mormons
  • Seventh Day Adventists
  • Islam
  • No pork or alcohol daylight fasting during
    Ramadan

12
Factors Affecting NutritionLifestyle
  • Economic social status
  • Work/activities

13
Factors Affecting NutritionMedications,
Therapy, Health
  • KE Table 45-1 meds
  • Therapies
  • Chemo, radiation
  • Health
  • GI disorders, viruses, oral ulcers

14
Factors Affecting NutritionAlcohol,
Advertising, Psych
  • Alcohol
  • Can depress appetite
  • Abuse can lead to malnutrition (esp Vit B)
  • Advertising
  • May influence food choices
  • Psych
  • Overeat vs. dont eat when stressed, depressed

15
HEALTHY PEOPLE 2010
  • http//www.health.gov/healthypeople
  • Goals
  • Increase in span of healthy life for Americans
  • Reduction of health disparities among Americans
  • Target areas
  • Wt control issues dietary intake issues school
    nutrition issuesanemia in pregnancy nutrition
    education, assessment, planning issues

16
DIETARY GUIDELINES FOR AMERICANS
  • Eat a variety of foods
  • Maintain or improve your weight
  • Be physically active every day
  • Eat diet low in trans fat, saturated fat,
    cholesterol
  • Eat plenty of vegetables, fruits, grains
  • Use sugars in moderation
  • Use salt sodium in moderation
  • If you drink alcohol, do so in moderation

17
FOOD GUIDE PYRAMID
  • Healthy Eating Pyramid
  • Daily exercise weight control
  • Whole grains at most meals
  • Vegetables in abundance
  • Fruits 2-3 times/day
  • Nuts, legumes 1-3 times/day
  • Fish, poultry, eggs 0-2 times/day
  • Dairy or calcium supplement 1-2 times/day
  • White rice, white bread, potatoes, pasta, sweets,
    red meat, butter sparingly
  • MVI for most
  • Alcohol in moderation

18
ALTERED NUTRITION
  • Malnutrition lack of necessary or appropriate
    food substances
  • Overnutrition caloric intake in excess of daily
    energy requirements
  • Overweight BMI 26-30
  • Obese BMI gt 30
  • Morbid obesity interferes with mobility or
    breathing

19
ALTERED NUTRITION
  • Malnutrition
  • Undernutrition intake of nutrients insufficient
    to meet daily energy requirements as a result of
    inadequate food intake or improper digestion
    absorption of food
  • Dysphagia difficulty swallowing
  • Anorexia loss of appetite
  • Protein-calorie malnutrition

20
ASSESSMENT
  • Usual eating patterns habits
  • 24 hour food recall
  • Allergies intolerances
  • Food frequency record
  • Brief personal family history
  • Height/weight
  • Ideal body weight
  • Body mass index
  • Manifestations of malnutrition (table 45-4)
  • Social, economic, ethnic, religious factors
  • Other risk factors for altered nutrition

21
RISK FACTORS FOR NUTRITIONAL PROBLEMS
  • Diet history
  • Chewing or swallowing difficulties
  • Inadequate food intake
  • Restricted or fad diets
  • No intake for 10 or more days
  • IVF
  • Inadequate food budget
  • Inadequate food preparation facilities
  • Physical disabilities
  • Living eating alone

22
RISK FACTORS FOR NUTRITIONAL PROBLEMS
  • Medical history
  • Unintentional wt loss or gain of 10 within 6
    months
  • F/E imbalance
  • Oral or GI surgery
  • Dental problems
  • GI problems
  • Chronic illness
  • Alcohol or substance abuse
  • Neurologic or cognitive impairment
  • Catabolic or hypermetabolic condition
  • Adolescent pregnancy or closely spaced pregnancy

23
RISK FACTORS FOR NUTRITIONAL PROBLEMS
  • Medication history
  • Aspirin
  • Antacid
  • Antidepressants
  • Antihypertensives
  • Anti-inflammatory agents
  • Antineoplastic agents
  • Digitalis
  • Laxatives
  • Diuretics
  • Potassium chloride

24
PHYSICAL EXAM
  • General appearance vitality
  • Weight
  • Skin
  • Nails
  • Hair
  • Eyes
  • Lips, tongue, gums, teeth
  • Heart
  • Abdomen
  • Musculoskeletal
  • Neurologic

25
ANTHROPOMETRIC MEASUREMENTS
  • Height weight
  • Skinfold measurements tricep most common site

26
LABORATORY DATA
  • Albumin pre-albumin
  • Transferrin
  • Hgb
  • BUN
  • 24 hour urine
  • Total lymphocyte count

27
DIAGNOSING
  • Altered nutrition more than body requirements
  • Altered nutrition less than body requirements
  • Altered nutrition risk for more than body
    requirements
  • Fluid volume excess, fluid volume deficit, risk
    for fluid volume deficit
  • Activity intolerance
  • Constipation
  • Risk for Impaired Skin Integrity

28
PLANNING
  • Client will
  • Maintain IO balance
  • Consume proper amounts of foods from variety of
    food groups
  • Comply with diet therapy
  • Tolerate tube feedings
  • Not have any complications assoc with malnutrition

29
IMPLEMENTING - Teaching
  • Use established nutritional standards
  • Use visualization of serving sizes to help ID
    accurate serving sizes
  • Incorporate culturally based intake patterns or
    restrictions
  • Include client family
  • Collaborate with dietician

30
IMPLEMENTINGSpecial Diets
  • Vegetarian
  • Vegan
  • Ovo-vegetarian
  • Lacto-vegetarian
  • Lacto-ovo-vegetarian

31
IMPLEMENTINGSpecial Diets
  • NPO nothing by mouth
  • Clear liquid diet water, tea, coffee, clear
    broths, gingerale, plain gelatin
  • Full liquid diet clears milk cooked cereals,
    pudding, ice cream, cream soup
  • Soft diet easily chewed digested
  • Dysphagia thickened liquids
  • Diet as tolerated

32
IMPLEMENTINGStimulating Appetite
  • Relieve illness symptoms that depress appetite
    prior to mealtime
  • Provide familiar food that person likes served at
    proper temp.
  • Select small portions
  • Avoid unpleasant or uncomfortable treatments or
    activity immediately before/after meals
  • Provide tidy, clean environment
  • Encourage or provide oral hygiene before mealtime
  • Reduce psychologic stress

33
IMPLEMENTINGAssisting with Meals
  • Help client feed self when possible
  • Assist client to sit on side of bed or chair if
    possible
  • Check tray for clients name, type of diet,
    completeness
  • which order would you like to eat?
  • Spread napkin, cut foods, shell egg, etc.
  • Do not rush client allow ample time
  • Offer fluids every 3 or 4 mouthfuls of food if
    client unable to communicate
  • Use adaptive feeding aids as needed
  • For blind person, identify placement of food as
    you would describe time on a clock

34
IMPLEMENTINGSpecial Supplements
  • Oral
  • Provide calories nutrients
  • Can be liquid or powdered
  • Specific types
  • Tube Feeds
  • When condition prevents food intake
  • Impairment in upper GI tract, otherwise fx GI
    tract
  • Increased metabolic needs that oral intake cant
    meet
  • Parenteral Nutrition
  • IV nutrients (TPN, PPN)

35
IMPLEMENTINGSpecial Supplements
  • TPN
  • Nonfunctional GI tract
  • Severely malnourished needing specific
    supplements
  • PPN
  • Nonfunctional GI tract
  • Moderate nutritional deficiencies

36
IMPLEMENTINGEnteral Nutrition
  • Enteral access devices
  • NGT (short term)
  • Small-bore feeding tube
  • PEG (long term)
  • Parenteral
  • IV
  • TPN - central line
  • PPN peripheral IV

37
IMPLEMENTINGNasogastric Feeding
  • Types of NGT
  • Levin, salem sump, corpak
  • Verify tube placement
  • Gastric secretions
  • pH
  • Air bolus
  • Xray
  • S/S of distress

38
IMPLEMENTINGEnteral Feedings
  • May be continuous , intermittent, or bolus
  • Before feeding
  • Determine allergies, assess MD order
  • Prepare client inspect/verify formula
  • Assess tube placement
  • Assess residual (q 4h)
  • Flush with water
  • Administer at room temperature
  • Feeding must infuse within 8 hours
  • Never add fresh to formula hanging
  • Tubing container change q 24h
  • Check residual q4h

39
EVALUATINGEnteral Feeds
  • Daily wt
  • I O
  • Labs
  • Monitor for complications

40
IMPLEMENTINGParenteral Nutrition
  • Continuous or intermittent
  • Refrigerate solution unless using immediately
  • Read label double check against order for all
    ingredients double check with another nurse
  • Monitor IV site dedicated line
  • New bag, tubing, filter q 24 hours
  • Aseptic technique
  • Monitor glucose levels other labs
  • Must wean off

41
EVALUATINGParenteral Nutrition
  • VS
  • I O
  • Daily wt
  • Daily/weekly labs
  • Monitor for complications

42
IMPLEMENTINGSpecial Community Services
  • Meals-on-Wheels
  • Grocery delivery services
  • Food stamp program

43
IMPLEMENTINGHome Care Teaching
  • Preparation of formula
  • Proper storage of formula
  • Administration of feeding
  • Mgmt of enteral or parenteral access device
  • Daily monitoring needs
  • S/S of complications to report
  • Who to contact with questions/problems

44
EVALUATING
  • If outcomes not achieved,
  • Was cause of problem correctly identified?
  • Was family included in teaching plan? Are they
    supportive?
  • Is client experiencing symptoms that cause loss
    of appetite?
  • Were outcomes unrealistic for this person?
  • Were clients food preferences considered?
  • Is anything interfering with digestion or
    absorption of nutrients?
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