Transcript NUTRITION Nursing Implications

NUTRITION
Nursing Implications
Heather Wrenn, RN, BSN Fall 2006
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BODY WEIGHT/BODY MASS
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Ideal body weight
Body mass index
Percent body fat
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FACTORS AFFECTING
NUTRITION
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Development
Gender
Ethnicity & culture
Beliefs about food
Personal preferences
Religious practices
Lifestyle
Medications & therapy – table 45-1
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FACTORS AFFECTING
NUTRITION
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Health
Alcohol abuse
Advertising
Psychologic factors
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NUTRITION THRU THE
LIFE CYCLE – Young & Middle Adult
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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
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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 Nutrition:
Ethnicity & Culture
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Native American
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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 Nutrition:
Ethnicity & Culture
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U.S. Southern
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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 Nutrition:
Ethnicity & Culture
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Mexican
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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 Nutrition:
Beliefs & Preferences
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Individual likes & dislikes
Beliefs about foods
Fad diets
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Factors Affecting Nutrition:
Religious Practices
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Jewish
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Christianity
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Kosher; no pork or shellfish; cannot consume milk or
dairy at same meal with meat/poultry
Catholics
Eastern Orthodox
Mormons
Seventh Day Adventists
Islam
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No pork or alcohol; daylight fasting during Ramadan
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Factors Affecting Nutrition:
Lifestyle
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Economic & social status
Work/activities
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Factors Affecting Nutrition:
Medications, Therapy, & Health
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K&E Table 45-1 – meds
Therapies
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Chemo, radiation
Health
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GI disorders, viruses, oral ulcers
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Factors Affecting Nutrition:
Alcohol, Advertising, & Psych
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Alcohol
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Advertising
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Can depress appetite
Abuse can lead to malnutrition (esp Vit B)
May influence food choices
Psych
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Overeat vs. don’t eat when stressed,
depressed
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HEALTHY PEOPLE 2010
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http://www.health.gov/healthypeople
Goals:
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Increase in span of healthy life for Americans
Reduction of health disparities among Americans
Target areas:
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Wt control issues; dietary intake issues; school
nutrition issues;anemia in pregnancy; nutrition
education, assessment, planning issues
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DIETARY GUIDELINES FOR
AMERICANS
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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
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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
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Malnutrition – lack of necessary or
appropriate food substances
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Overnutrition – caloric intake in excess of
daily energy requirements
Overweight – BMI 26-30
 Obese – BMI > 30
 Morbid obesity – interferes with mobility or
breathing
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ALTERED NUTRITION
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Malnutrition
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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
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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
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Diet history
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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
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Medical history
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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
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Medication history
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Aspirin
Antacid
Antidepressants
Antihypertensives
Anti-inflammatory agents
Antineoplastic agents
Digitalis
Laxatives
Diuretics
Potassium chloride
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PHYSICAL EXAM
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General appearance & vitality
Weight
Skin
Nails
Hair
Eyes
Lips, tongue, gums, teeth
Heart
Abdomen
Musculoskeletal
Neurologic
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ANTHROPOMETRIC
MEASUREMENTS
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Height & weight
Skinfold measurements – tricep most
common site
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LABORATORY DATA
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Albumin & pre-albumin
Transferrin
Hgb
BUN
24 hour urine
Total lymphocyte count
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DIAGNOSING
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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
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Client will:
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Maintain I&O 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
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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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IMPLEMENTING
Special Diets
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Vegetarian
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Vegan
Ovo-vegetarian
Lacto-vegetarian
Lacto-ovo-vegetarian
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IMPLEMENTING
Special Diets
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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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IMPLEMENTING
Stimulating Appetite
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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
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Reduce psychologic stress
IMPLEMENTING
Assisting with Meals
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Help client feed self when possible
Assist client to sit on side of bed or chair if possible
Check tray for client’s 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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IMPLEMENTING
Special Supplements
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Oral
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Tube Feeds
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Provide calories & nutrients
Can be liquid or powdered
Specific types
When condition prevents food intake
Impairment in upper GI tract, otherwise fx GI tract
Increased metabolic needs that oral intake can’t meet
Parenteral Nutrition
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IV nutrients (TPN, PPN)
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IMPLEMENTING
Special Supplements
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TPN
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Nonfunctional GI tract
Severely malnourished needing specific
supplements
PPN
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Nonfunctional GI tract
Moderate nutritional deficiencies
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IMPLEMENTING
Enteral Nutrition
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Enteral access devices
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NGT (short term)
Small-bore feeding tube
PEG (long term)
Parenteral
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IV
TPN - central line
 PPN – peripheral IV
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IMPLEMENTING
Nasogastric Feeding
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Types of NGT
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Levin, salem sump, corpak
Verify tube placement
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Gastric secretions
pH
Air bolus
Xray
S/S of distress
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IMPLEMENTING
Enteral Feedings
May be continuous , intermittent, or bolus
Before feeding
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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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EVALUATING
Enteral Feeds
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Daily wt
I&O
Labs
Monitor for complications
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IMPLEMENTING
Parenteral Nutrition
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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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EVALUATING
Parenteral Nutrition
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VS
I&O
Daily wt
Daily/weekly labs
Monitor for complications
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IMPLEMENTING
Special Community Services
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Meals-on-Wheels
Grocery delivery services
Food stamp program
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IMPLEMENTING
Home Care Teaching
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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
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If outcomes not achieved,
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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 client’s food preferences considered?
Is anything interfering with digestion or absorption of
nutrients?
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