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HLTEN405A Implement Basic Nursing Care Nutrition Slide 2 2 Meeting nutrition needs across the life span Newborns - milk Toddlers variety, full fat Children variety, low fat & sugar Adolescents variety, low fat & sugar, increased calcium. Young adults variety. Elders Cultural Slide 3 3 Nutrition Maslow Slide 4 4 4 Slide 5 5 Basic Physiology of Nutrition : When we ingest food into our stomach, it goes through a process of digestion and absorption. A NUTRIENT is something that is ingested, digested, absorbed and then USED by the body to maintain function. A nutrient is classified as one of 3 main groups carbohydrate, fat or protein (macronutrients), and 2 other groups vitamins & minerals (micronutrients). 5 Slide 6 6 Nutrition Fats - saturated - unsaturated PUFAs, MUFAs Proteins Carbohydrates - GI Slide 7 7 VITAMINMAJOR FUNCTIONSSOURCES Vitamin AGrowth, vision, hair, skin, mucus membranes, resistance to infection. Liver, spinach, green leafy & yellow vegies, fish oils, egg yolk, butter, cream & whole milk. Vitamin B1 (thiamine)Muscle tone, nerve function, digestion, appetite, normal elimination, carbohydrate use. Pork, fish, poultry, eggs, liver, breads, pastas, cereals, oatmeal, potatoes, peas, beans, soybeans, nuts. Vitamin B2 (riboflavin)Growth, healthy eyes, protein & carb metabolism, healthy skin & mucus membranes. Dairy products, liver, green leafy vegetables, eggs, breads & cereals. Vitamin B3 (niacin)Protein, fat & carb metabolism, nervous system function, appetite, digestive system function. Meat, pork, liver, fish, peanuts, breads & cereals, green vegies & dairies. Vitamin B12Formation of red blood cells, protein metabolism, nervous system functioning. Liver, meats, fish, poultry, eggs, milk & cheese. Folic Acid.Formation of red blood cells, functioning of intestines, protein metabolism. Liver, meat, fish, poultry, green leafy vegies, whole grains. Vitamin CFormation of connective tissue, healthy blood vessels, skin, gums, teeth, wound healing, prevention of bleeding, resistance to infection. Citrus fruits, tomatoes, potatoes, strawberries, green vegies, melons. Vitamin DAbsorption & metabolism of calcium & phosphorus healthy bones. Fish oils, milk, butter, liver, exposure to sunlight. Vitamin EReproduction, formation of red blood cells, muscle function. Vegetable oils, milk, eggs, meats, cereals, green leafy vegies. Vitamin KBlood clotting.Liver, green leafy vegies, egg yolk, cheese. 7 Slide 8 8 MINERALMAJOR FUNCTIONSSOURCES CalciumFormation of teeth & bones, blood clotting, muscle contraction, heart & nerve function. Dairy products, green leafy vegetables, whole grains, eggs, dried legumes & nuts. PhosphorusFormation of bones & teeth, use of proteins, fats & carbs, nerve & muscle function. Meat, fish, poultry, dairies, nuts, egg yolks, legumes. IronAllows red blood cells to carry oxygen.Liver, meat, eggs, green leafy vegetables, breads & cereals, dried peas & beans, nuts. IodineThyroid gland function, growth & metabolism. Iodised salt, seafood & shell fish. SodiumFluid balance, nerve & muscle function.Almost all foods! PotassiumNerve function, muscle contraction, heart function. Fruits, vegetables, cereals, meats, dried legumes. 8 Slide 9 9 Assisting the client with oral nutrition Determine the type of diet that the person can tolerate (also consider cultural needs.) Assess the person's ability to swallow Determine the person's ability to self-feed Assess the person's appetite, tolerance to food, likes and dislikes Assess whether the person has food allergies Slide 10 10 Prepare the room for mealtime Remove any unpleasant odours and sights Clear over bed table Set up chair for client and for nurse Slide 11 11 Prepare patient for meals Assess need for the toilet prior to eating Person to wash hands Assist with mouth care - dentures in, mouth moist Ensure person has glasses or contacts in place Assist the person into a comfortable sitting position Ensure that person has serviette and special devices to facilitate feeding if required Slide 12 12 Prepare patient for meals Assist to sit up if lying down. Slide 13 13 Assisting with meals Let patient see and smell the meal Check the temperature of food and drinks Check for sharp bones or pips Consider individual preferences e.g use of condiments, one food at a time or meat and vegetables together Slide 14 14 Prepare patient for meals Consider cultural / individual preferences * Buddhist vegetarian * Hindu beef, pork & some fowl * Islam no pork or alcohol, meat must be Halal. Observe Ramadan. * Mormon no caffeinated or alcoholic beverages. * Orthodox Judaism Must be Kosher, with no pork or shellfish. Observe the Sabbath, Yom Kippur & Passover. Slide 15 15 Assisting with meals (cont) Sit down to feed patient Don't rush or present too much with each mouthful, use a gentle action Feed person in a manner that facilitates chewing and swallowing Elderly person: feed small amounts at a time, assessing chewing, swallowing and fatigue Neurological person: feed small amounts at a time and assess for ability to chew, manipulate tongue to form a bolus and swallow. Give small amounts of fluids and assess swallowing Slide 16 16 Assisting with meals (cont) Provide fluids as requested. Do not allow person to drink all liquids at beginning of meal Encourage independence Attend to oral hygiene and comfort needs Have patient sitting up for at least 30 minutes following meal Slide 17 17 Evaluation and documentation During meal note person's ability to swallow Assess person's tolerance to diet Assess person's fluid and food intake Assess person's ability to self-feed Weight as directed in care plan Documentation e.g. food chart, progress notes, etc Reporting Slide 18 18 BREAKFASTLUNCHDINNER Porridge, milk & honey. Toast, jam & butter. Stewed prunes. Apple juice. Roast lamb, gravy. Baked potato, pumpkin & carrots, peas. Fruit jelly & custard. Chicken & vegetable soup, whole meal bread & butter. Banana. Scrambled eggs, toast & butter. Tinned fruit. OJ. Oven fried fish, potato chips, boiled carrots & peas. Fruit & cream. Chicken salad & cheese sandwich on whole meal bread. Fresh fruit. Weet bix, milk & sugar, banana. AJ. Whole meal toast, butter, marmalade. Ravioli with parmesan. Salad. Cheese cake. Cream of chicken soup, whole meal roll, tinned apricots & custard. Poached eggs & bacon, whole meal toast, butter, prunes, AJ. Beef stew with dumplings, mashed potato, and carrots. Peach cobbler with ice cream. Egg sandwiches, tomato soup, two fruits and cream. Porridge, milk & honey. Toast, jam & butter. OJ. Fruit compote. Roast chicken & gravy, baked potatoes, sweet potato, broccoli, peas & carrots. Vanilla pudding with wafers. Tuna & cheese melts, beef & barley soup, tropical fruit & ice cream. Pancakes, bananas & syrup. AJ.Chicken schnitzel, gravy, baked tomatoes, cauliflower & cheese sauce, beans. Jelly & ice cream. Vegetable & lentil soup, bread rolls, apple strudel & cream. Porridge, milk & honey. Raisin toast & butter, OJ. Ham steaks & pineapple, scallop potatoes, steamed broccoli. Butter scotch pudding, ice cream & cream. Cream of mushroom soup, salmon sandwiches, fruit & custard. Slide 19 19 Therapeutic diets These diets are prescribed to Rectify a nutritional deficiency Decrease specific nutrients Provide modification in the texture or consistency of food May be temporary or permanent Slide 20 20 Renal failure Proteins are limited to minimise excessive amounts of uraemia complete proteins (meat, milk protein & egg white) are best Carbohydrates are increased to ensure Adequate caloric intake Provide a protein sparing effect Fluid intake is replacement of insensible loss (500ml) plus the equivalent of last 24-hours urinary output Monitor potassium intake to prevent hyperkalaemia (bananas, citrus, spinach.) Limit sodium to prevent the further retention of fluid and raising blood pressure Slide 21 21 Diabetic Satisfy hunger Provide enough energy and nutritional requirements for effective body function Maintain desirable body weight Maintain blood glucose within normal range Prevent long-term complications Three meals and three snacks per day Low GI food Slide 22 22 Diabetic Pancreas www.gopetsamerica.com Slide 23 23 Diabetic GI www.torq.ltd.uk Slide 24 24 Cardiac Limit sodium to prevent raising blood pressure Low fat (especially saturated), low cholesterol to prevent further damage to the blood vessels and increase in body weight Fat in the diet to be monosaturated and/or omega-3 fatty acids (Fish, olives, nuts, seeds, avocados.) Fluid intake may be restricted to prevent further retention of fluid and the resulting stress on the heart Slide 25 25 Modification of texture or consistency Clear fluids Broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatine, ice blocks Full liquid Plus smooth textured dairy products, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices Pureed Plus scrambled eggs, purred meats, vegetables, fruits, mashed potatoes and gravy Soft Plus tenderised meat, poultry, fish, soft casseroles, lettuce, tomatoes, soft fruit, cake, biscuits without nuts or coconut Slide 26 26 Clear fluids Patient with clear fluids. Slide 27 27 Full liquids Full liquids - www.foodsiteoftheday.com Slide 28 28 Pureed food Meat, vegies, fruit can all be pureed. www.foodsiteoftheday.com Slide 29 29 Soft diet Stews, casseroles, soft meats, fish or chicken. www.foodsiteoftheday.com Slide 30 30 Fluids and Electrolytes Slide 31 31 Body fluids Body fluids refers to both water and electrolytes Water comprises approximately 60% of body weight in adults Less in the elderly (45%), 75% of newborns, and obesity of all ages Slide 32 32 Body Fluids Body composition. users.hubwest.com Slide 33 33 Electrolytes Electrolyte an element or compound that, when melted or dissolved in water or other solvent, disassociates into ions and is able of conducting an electrical current Ion an atom or group of atoms that have acquired an electrical charge through the gain or loss of an electron or electrons Major Intracellular ions K + is major cation, PO4 - major anion Major Extracellular ions Na + is major cation and Cl - major anion There are substances in the plasma that are non electrolytes many are organic compounds e.g. glucose Slide 34 34 Functions of electrolytes Promotion of neuromuscular irritability Maintenance of body fluid osmolality Regulation of acid-base balance (normal 7.35-7.45) Maintenance of body water distribution Slide 35 35 Basic functions of water Provides aqueous medium for cellular metabolism Transports material to and from the cells Acts as a solvent for electrolytes and other substances necessary for cell formation Helps to regulate body temperature Maintains physical and chemical constancy of intracellular and extracellular fluid Maintains vascular volume Aids in digestion of food Provides medium for waste excretion Slide 36 36 Composition of water 70% of body weight is intracellular 30% of body weight is extracellular fluid 24% interstitial 6% plasma 7% of body weight makes up blood volume (approx 5.6 litres for a 70kg male) Percentage is less for women Percentage is more for children The movement of body fluids between the cells and the extracellular compartments is constant. This is achieved by osmosis, diffusion and active transport. Slide 37 37 Balance of fluids and electrolytes Is dependent on: Cardiovascular system Kidneys maintain volume and regulate pH Pituitary gland releases ADH (antidiuretic hormone vasopressin) Lungs aid acid/base maintenance Parathyroid hormone (PTH) regulates calcium and phosphorous Aldosterone (steroid hormone produced by the renal cortex) increases the retention of sodium and water at the loss of potassium Hypothalamus regulates pituitary gland. Slide 38 38 Basal metabolic requirements are 1500mls of fluid to be consumed per day This means that the minimum amount of daily fluid intake for an adult is 1500mls. Slide 39 39 Changes to daily fluid requirements Increased High environmental temperatures Increased exercise Fever Body dysfunction Restrictions Cardiac Renal Slide 40 40 Fluid volume imbalance Circulatory volume depletion due to the movement of sodium and water from the circulatory system into the interstitial spaces e.g. burns, Fever Haemorrhage Diarrhoea/Vomiting Extracellular volume excess is due to a shift of sodium and water from the interstitial spaces to the plasma e.g. Cardiac Renal Hepatic failure or Excess IV of Normal saline (N/S) Slide 41 41 Fluid and electrolyte imbalance Cells do not receive adequate nourishment Accumulation of waste Acid/base imbalance Temperature regulation impaired Interruption to those activities that require transmission of electrical energy (e.g. muscle contraction, cardiac arrhythmias) Slide 42 42 Fluid balance charting Indications for a fluid balance chart Actual or potential dehydration Circulatory overload Artificial feeding Intravenous therapy Kidney and bladder problems Slide 43 43 Accurate fluid balance charting (FBC) Legible entry Correct column Measure and record in millilitres Record accurately and at the time of measuring Offer bed pans and/urinals making measurement more accurate Inform patient, staff, and relatives Include estimate of 'insensible' loss Note accidental disposal of loss Total at the end of 24hours and note negative or positive outcomes Input < Output negative; Input > Output positive Slide 44 44 Causes of altered nutrition Physical GI disorders, Mobility Dexterity Food sensitivities, Nausea/vomiting Psychological Depression Self-concept Body image Cognitive Confusion Dementia Slide 45 45 Anorexia Anorexia is a lack of appetite in the presence of a physiological need for food. It is a common symptom of gastrointestinal and endocrine disorders e.g. Appendicitis Gastritis Hepatitis Crohns disease, Ketoacidosis Hyperthyroidism Slide 46 46 Causes of anorexia Anxiety Chronic pain Increased temperature Alterations in taste or smell Alcoholism Drugs Cancer Radiation therapy Slide 47 47 Nursing interventions for anorexia Offer small meals frequently Provide food liked by the patient Suitable environment High caloric snacks Keep fat content of food to a minimum Slide 48 48 Nausea and vomiting Categorising nausea and vomiting Pathological due to disease process e.g. obstruction Iatrogenic relating to treatment e.g. chemotherapy Psychological relating to emotional response Slide 49 49 Vomiting centres Slide 50 50 Complications of vomiting Malnutrition Dehydration Electrolyte imbalance Dehiscence of wound Aspiration Slide 51 51 Signs of dehydration Loss of weight Sunken eyes Dry skin, loss of tissue turgor Dry mouth and tongue Increase in temperature Oliguria Decrease in blood pressure Irritability and confusion Thirst http://maflib.mtandao-afrika.net/MAF080111 /blessed%20-%20malaria/vc_dehydration.jpg http://i.ehow.com/images/GlobalPhoto/ Articles/2195011/dehyd-main_Full.jpg Slide 52 52 Effects of dehydration Altered mobility increase falls risk Chest infection & pneumonia Constipation, impaction & bowel obstruction Urinary tract infection Increased confusion Slide 53 53 Nursing interventions for vomiting Positioning and emesis bowl Privacy Dentures removed Place hand on forehead to provide support and comfort, splint abdomen if required Remove vomitus a.s.a.p. Remove soiled lined Wash face, hands and give oral hygiene Assist patient into position of comfort Report and record Slide 54 54 Observation of vomitus Quantity Presence of blood Odour Consistency Colour