NUTRITION Nursing Implications

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NUTRITIONNursing Implications

• Heather Wrenn, RN, BSN Fall 2006

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BODY WEIGHT/BODY MASS

• Ideal body weight
• Body mass index
• Percent body fat

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FACTORS AFFECTING NUTRITION

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

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FACTORS AFFECTING NUTRITION

• Health
• Alcohol abuse
• Advertising
• Psychologic factors

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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

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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

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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

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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

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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

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Factors Affecting NutritionBeliefs Preferences

• Individual likes dislikes
• Beliefs about foods
• Fad diets

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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

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Factors Affecting NutritionLifestyle

• Economic social status
• Work/activities

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Factors Affecting NutritionMedications,
Therapy, Health

• KE Table 45-1 meds
• Therapies
• Chemo, radiation
• Health
• GI disorders, viruses, oral ulcers

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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

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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

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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

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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

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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

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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

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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

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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

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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

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RISK FACTORS FOR NUTRITIONAL PROBLEMS

• Medication history
• Aspirin
• Antacid
• Antidepressants
• Antihypertensives
• Anti-inflammatory agents
• Antineoplastic agents
• Digitalis
• Laxatives
• Diuretics
• Potassium chloride

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PHYSICAL EXAM

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

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ANTHROPOMETRIC MEASUREMENTS

• Height weight
• Skinfold measurements tricep most common site

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LABORATORY DATA

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

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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

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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

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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

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IMPLEMENTINGSpecial Diets

• Vegetarian
• Vegan
• Ovo-vegetarian
• Lacto-vegetarian
• Lacto-ovo-vegetarian

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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

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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

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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

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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)

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IMPLEMENTINGSpecial Supplements

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

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IMPLEMENTINGEnteral Nutrition

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

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IMPLEMENTINGNasogastric Feeding

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

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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

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EVALUATINGEnteral Feeds

• Daily wt
• I O
• Labs
• Monitor for complications

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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

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EVALUATINGParenteral Nutrition

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

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IMPLEMENTINGSpecial Community Services

• Meals-on-Wheels
• Grocery delivery services
• Food stamp program

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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

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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?