chapter 44: nutrition bonnie m. wivell, ms, rn, cns
TRANSCRIPT
Scientific Knowledge Base: NutrientsScientific Knowledge Base: Nutrients
CarbohydratesCarbohydratesStarches and sugarsStarches and sugars
FiberFiber
ProteinsProteinsAmino acidsAmino acids
FatsFatsSaturated, Saturated, monounsaturated, and monounsaturated, and polyunsaturatedpolyunsaturated
WaterWaterCells depend on a fluid Cells depend on a fluid environmentenvironment
VitaminsVitaminsEssential to metabolismEssential to metabolism
Water or fat solubleWater or fat soluble
MineralsMineralsCatalysts for Catalysts for biochemical reactionsbiochemical reactions
Anatomy and Physiology of the Anatomy and Physiology of the Digestive SystemDigestive System
DigestionDigestionBegins in the mouth Begins in the mouth and ends in the small and ends in the small and large intestineand large intestine
AbsorptionAbsorptionIntestine is the primary Intestine is the primary site for absorptionsite for absorption
Metabolism and Metabolism and Storage of Storage of NutrientsNutrientsAnabolic and catabolic Anabolic and catabolic reactionsreactions
EliminationEliminationChyme is moved Chyme is moved through peristalsis into through peristalsis into the large intestines and the large intestines and turned into fecesturned into feces
Dietary GuidelinesDietary GuidelinesDietary Reference Intakes
Acceptable range of amounts of vitamins and minerals to avoid deficiencies for age and gender groups
Food guidelinesFood Pyramid Guide, basic
guide for meal preparations
Daily valuesNeeded protein, vitamins,
minerals, fats, cholesterol, carbohydrates, fiber, sodium, and potassium
Nutrition During Growth & DevelopmentNutrition During Growth & Development Infants: as they grow they need protein,
vitamins, and minerals; high growth rate Toddlers: small, frequent meals; picky eaters;
need fewer calories, higher protein School-age: Don’t eat the required nutrients;
growth spurts Adolescents: concerned with body image Young and middle adults: reduced need for
nutrients as their growth periods end Older adults – decreased need for calories
Factors Affecting Nutritional Status Age-related GI changes
Changes in teeth and gums Reduced saliva production Atrophy of oral mucosal epithelial cells Increased taste threshold Decreased thirst sensation Reduced gag reflex Decreased esophageal and colonic peristalsis
Presence of Chronic Illness Malnutrition Adverse affects of meds Cognitive impairment
Alternative Food PatternsAlternative Food Patterns Based on religion, cultural background,
ethics, health beliefs, preference Vegetarian diet:
Ovolactovegetarian: eat eggs and milk Lactovegetarian: drink milk but avoid eggs Vegans: consume no animal products of any kind Fruitarian: eat only fruit, nuts, honey and olive oil
Zen Macrobiotic Eat brown rice, other grains, & herb teas
AssessmentAssessment Nurses are in an excellent position to
recognize signs of poor nutrition Pts who are malnourished are at greater risk
of life-threatening complications during hospitalization such as arrhythmia, sepsis, hemorrhage
A nutritional assessment is more than taking a diet history
Screening http://www.mna-elderly.com/user_guide.html
Assessment Continued Anthropometry = a systematic measurement of
the size and makeup of the body at specific body sites
Laboratory and biochemical tests CBC, albumin, pre-albumin transferrin (transferrin is
a blood plasma protein for iron), electrolytes, BUN, creatinine, glucose, cholesterol, triglycerides, and retinol (form of Vitamin A).
Dietary and health history Physical examination
Dyphagia (difficulty swallowing)
Nursing Diagnosis and Nursing Diagnosis and PlanningPlanning
Select from the NANDA-I–approved list after assessment
Plan outcomes and goals to assist client’s needs
Improving a client’s diet takes care and planning
ImplementationImplementation Ill, debilitated, and recovering clients often
have poor diets Socioeconomic, psychosocial, and
environmental factors can contribute to a poor diet
Advancing diets – see Box 44-10 Promoting appetite
Clean and odor free environment Oral hygiene Social time Music therapy
Implementation Continued
Make sure clients can feed themselves, can swallow and are positioned properly
If clients have visual difficulties, they may need assistance with feeding. You can also help clients by telling them where food is placed, according to the face of a clock (e.g., peas at 3 o’clock)
Enteral Tube FeedingEnteral Tube Feeding
Nasogastric Nasointestinal Gastrostomy Jejunostomy PEG PEJ Video
INSERTING THE FEEDING OR ASPIRATING TUBE
ASSEMBLE EQUIPMENT EXPLAIN PROCEDURE TO PATIENT MEASURE TUBE INSERT (will practice in lab) INSERT 20ml AIR TO COMFIRM
PLACEMENT ASPIRATE 5ml OF GASTRIC CONTENTS
TO TEST pH
Enteral Tube Feeding Complications
Aspiration Diarrhea Constipation Tube occlusion Tube displacement Abd. Cramping, nausea, vomiting Delayed gastric emptying Electrolyte imbalance Fluid overload Hyperosmolar dehydration
Total Parenteral Nutrition Specialized nutrition support in which
nutrients are provided intravenouslyMust be infused via a central catheterAverage 50% Dextrose solution + Amino
acids, vitamins, minerals, electrolytesLipids (Fat Emulsion) provide supplemental
kilocalories and prevent essential fatty acid deficiencies
Administered to clients who are unable to digest or absorb enteral nutrition
Complications From Total Parenteral Nutrition
Catheter occlusion Catheter infection Electrolyte imbalance Hypo/hyperglycemia HHNC (Hperglycemic Hyperosmolar
Nonketotic Coma)
Medical Nutrition Therapy GI diseases
PUDH. Pylori Inflammatory bowel diseaseMalabsorption syndromes (celiac disease)Diverticulitis
DM (American Dietetic Association) CV Disease (American Heart Association) Cancer HIV