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NUTRITION
NRS 129 - Introduction to Nursing Skills
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Nutritional Needs
Determining Your Patient Needs: Assessment History Observation - Daily Contact Anthropometry Laboratory data
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Nutritional Needs: Nurses’ Role
Need to inform the doctor of assmt. findings
Investigate reasons for a decreased intake
Offer the patient alternative methods of intake and types of food
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Factors that influence our Patterns of Eating: Health Status Culture & Religion Socioeconomic
Status Personal Preference Psychological Factors Alcohol & Drugs Misinformation &
Food Fads
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Dietary History
Done to assess actual or potential problems
History focuses on habitual intake of food and liquids preferences allergies problems
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Information Obtained for a Diet History
Name, Age Present weight Changes in Weight # meals/day,
snacks Who prepares the
meal? Problems R/T food Chewing difficulties
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Information Continued …. Denture Use Usual bowel
pattern Medications Medical/Surgical
History Physical Activity Personal Crises
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Measurements
Height and weight always always done unless patient is critically ill
Weigh patient at the same time, in same clothing with same scale
Rapid wt. gain reflects fluid shifts
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Assessment Measurements Anthropometric: wrist, mid-arm, skin fold
measurements
Body Mass Index Weight (kg) / Height (m2)
>25 = overweight >30 = obese >35 higher medical risk for CAD, DM, HTN
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Characteristics of HealthCategory Good Poor
GeneralAppearance
Alert,Responsive
Listless,apathetic,cachexia
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Laboratory Data CBC: Low Hemoglobin and Red
blood cell count = anemia Serum Albumin: If value is
decreased = protein & calorie malnutrition
Negative Nitrogen Balance = catabolic state
Hgb, Hematocrit, and BUN reflect hydration
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Patients at Risk for Nutritional Problems:
Condition that interferes with ingestion, digestion, and absorption
Surgical revisions of the GI tract IV intake only for > 7-10 days Poor dietary habits Patients undergoing treatment for
CA
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Management of Common Problems
Vomiting How do you position your patient?
Serve small amounts frequently
Anti-emetics: time administrationappropriately
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Planning & Implementation
Make sure your patient is comfortable No odors in the room Attractive tray Not in pain or needing nursing care
Mouth Care Positioned correctly
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Special Diets Are they
Necessary?
Why?
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Basic Types of Hospital Diets
General (Regular)
Soft vs. Mechanical Soft
Full Liquid
Clear Liquid
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Basic Types of Hospital Diets
Low-Residue
High Fiber
Pureed Diet
Sodium Restricted
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Dietary Modifications for Disease Conditions
Gastrointestinal disease: Diarrhea (Low residue) Acute gastritis: Liquid, bland Chronic gastritis: avoid foods causing
the problem Diverticulitis:
Acute: low residue Chronic: high fiber
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Dietary Modifications. . . Peptic Ulcer:
Eat what you can tolerate
May need to avoid spices, alcohol, caffeine
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Cardiovascular Disease:
Cardiac Prudent Diet Goals:
decrease stomach distention decrease weight decrease lipids
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Cardiovascular Disease . . .
Atherosclerosis & Hypertension: weight, Low fat, cholesterol, and low sodium
Myocardial Infarction Avoid ice, caffeine, low fat, low
sodium, cholesterol
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Diabetes with Dietary Changes
Diet, exercise Individualized Plan Control of
cholesterol, lipids, Increased use of
complex carbohydrates
CHO counting BALANCE
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Dietary Modifications: Renal
Depends on disease state: Acute versus Chronic:
May Need restriction of protein, sodium,
fluids, and potassium
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Nursing Interventions:Assisting with Eating
Assure patient’s diet/tray is correct Good Lighting (vision) available Remove covers Arrange food & Prepare food Offer assistance, self Evaluation of intake
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Assessing the Need to Feed a Patient
Patients who should minimize oxygen needs
Patient who cannot feed self because of disease process or weakness
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Nursing Interventions for Feeding
Being Fed = Loss of Independence Need to be considerate of Patient
to protect their dignity Allow patient to set pace NOT you Describe meal so patient can
determine the sequence
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Nursing Interventions for Feeding
Before Starting: Evaluate comfort needs pain relief (timed appropriately) 30’ Offer bedpan Position patient as upright as possible
Good Opportunity for Nursing Assessment M/S, agility, color, tremors, etc.
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Nursing Interventions for Feeding
Protect the patient’s clothing “Napkin” No Reference to “Bib” Assume a comfortable position at the
patient’s level May need a signal for indicating
additional food Offer self: “ Talk to patient”
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Nursing Interventions . . .
Additional Guidelines: Stroke patient: Don’t place food on
paralyzed side Relatives may assist with feeding: Be
careful, family may view as they would only eat if they are there
Don’t scold patients who cannot eat Assure the environment is clean
afterwards
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Nursing Interventions . . .
Encourage Food intake get rid of odors Make positive comments about food Breakfast usually best time of day nausea:
slow deep breaths avoid movement limit food and fluid intake
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Intake and Output
Why is it important?
What is included in the measurement? All things liquid at room temperature Thin, cooked cereals Tube feedings, irrigations, IV fluids
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Measurement of I and O Incorporate the pt. in the process
Need to record amounts immediately after consumption or elimination
Need to total amounts at specified times End of 8 hour shift End of 24 hours
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Fluids to be counted as Output: Sum of all liquids
eliminated from the body
Urine Emesis Drainage tubes Remaining
Irrigation fluid Liquid stool Diapers Saturated
dressings
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Measurement Considerations
1 pint { 475 ml } of water = 1 pound
1 ounce = 30 cc or 30 ml
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Measurement of Output
Urine is chief source of output Teach patient & family need to
measure Hat may be placed in toilet Catheter drainage bag Leg Bag Bedpan/urinal
{need to measure using graduated cylinder}