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
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