Transcript Nutrition ppt

Good Nutrition
Nutrition
Developed by Ginger Mize RN, MN
Modified by Jill K. Ray
NUR302
Nutrition
Basic Human Need
 Changes throughout the life cycle
 Changes along the wellness-illnes
continuum.

Eating
Necessary to survive
 Source of pleasure
 Pastime
 Social event

Different meanings to different
people….
Nutrients

Specific biochemical substances used
by the body for growth, development,
activity, reproduction, lactation,
health maintenance, and recovery
from illness (p. 1413).
Essential Nutrients
Not synthesized in the body
 Made in insufficient amts
 Must be provided in the diet

Six Classes of Nutrients

3 supply energy
Carbohydrates
 Proteins
 Lipids


3 are needed to regulate body
processes
Vitamins
 Minerals
 Water

Energy Balance
Energy is derived from foods
consumed.
 Measured in form of kilocalories,
abbreviate as calories.

Energy Balance

What are the body’s sources of
energy?


Carbohydrates, protein, and fat
If a person’s daily energy intake is
equal to total daily energy
expenditure the person’s wt will
remain stable.
Carbohydrates


Main source of
energy
Glucose


Brain
Skeletal muscles
Carbohydrates




Sugars & Starches
Easy to produce and store
In some countries where grains are dietary
stable, CHO may contribute as much as 90% to
daily calorie consumption
Some sources correlate to income.
Speculating that as income increases, CHO
intake decrease and protein intake
increases.
Carbohydrates

More easily and quickly digested than
protein and fat. 90% is digested.
This percentage decreases as
____intake increases.

fiber
Fats (Lipids)

Triglycerides and fatty
acids

Saturated
or
Unsaturated fatty acids
Proteins



Synthesis of body
tissue
Collagen, hormones,
enzymes, immune
cells
Amino acids: essential
and nonessential
Nitrogen balance
Water

Comprises 60% to 70% of body
weight

Cell function depends on a fluid
environment
Sources, functions, & significance of Carbohydrates
, proteins, & fats
P.1419 Table 42-3
 Note functions that this table lists for
the nutrient.

 Which
nutrient should a patient increase in
his diet after surgery?
Sources, functions, & significance of Carbohydrates
, proteins, & fats

Note food sources of the nutrient.
 Which
of the following should this same
patient eat 1st on his lunch tray: orange,
chicken tenders, Lima beans, whole wheat
roll.
Vitamins

Water soluble (Vitamin C and the Bcomplex vitamins)
 Not
generally stored in body
 Need daily intake to prevent symptoms of
deficiency
Vitamins

Fat soluble (ADEK)
 Must
be attached to a protein to be
transported through the blood
 Secondary deficiencies can occur anytime fat
digestion or absorption is altered (i.e.
malabsorption syndromes, mega diets…)
Minerals



Some provide structure within the body
Some help regulate body processes
Macro minerals (those needed by the body
in amts greater than 100mg/day)







Calcium
Phosphorus
Sulfur
Sodium
Chloride
Potassium
magnesium
Water
Major body constituent present in
every body cell
 More vital to life than food.

Water
Provides the fluid medium necessary for
all chemical reactions,
 participates in many reactions,
 is not stored in the body.
 Acts as a solvent, aiding in digestion
 Assists in the regulation of body
temperature
 Acts as a lubricant for mucous
membranes

Water
 Accounts
for 50-60% of adult
total wt
 2/3 is contained in the body’s
cells (intracellular fluid – ICF)
 1/3 all other body fluids
(extracellular fluid – ECF) this
includes plasma and interstitial
fluid.
Basal Metabolism
Energy required to carry on the
involuntary activities of the body at
rest;
 the energy needed to sustain the
metabolic activities of cells and
tissues and to maintain circulatory,
respiratory, gastrointestinal, and
renal processes (p. 1415).

Who has the highest Basal
Metobolism Rate?
Men
 Women
 Why


Because of higher muscle mass.
Men are about 1cal/kg and
women .9 cal/kg.
What other factors increase
BMR?
Growth
 Fever
 Infections
 Emotional tension,
 Extremes in temperature
 Hormone levels (thyroid hormone,
epinephrine)

What decreases BMR?
Aging
 Prolonged fasting
 sleep

Ideal Body Weight
Body Mass Index
 Waist circumference


Formula:
BMI = wt in kg/(ht in meters) times (height in
meters)
 BMI = (wt in lbs/(ht in inches) times (height in
inches)) times 703

General Guidelines
BMI
 BMI
 BMI
 BMI

below 18.5 is underweight
of 25 – 29.9 is overweight
of 30 or greater obesity
of 40 or greater extreme obesity
Calculate BMI for a patient who weighs
100 pounds and is 5 feet tall.
 BMI
= (wt in lbs/(ht in inches) times
(height in inches)) times 703
BMI = (100/60 times 60) times 703
 BMI = (100/3600) times 703
 BMI = .027 times 703 = 19.52

19.52
BMI
 BMI
 BMI
 BMI


below 18.5 is underweight
of 25 – 29.9 is overweight
of 30 or greater obesity
of 40 or greater extreme obesity
How would you characterize this pt’s
BMI?
Weight loss

Usual wt – present wt /usual wt times 100

Significant if:




1%-2% in 1 week
5% in 1 month
7.5% in 3 months
10% in 6 months
Factors Affecting Nutrition

Food intake

Decreased food intake can be related to

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disease,
psychosocial causes,
impaired ability to smell and taste,
drug therapy,
medical treatments,
difficulty chewing and swallowing, chronic GI
problems,
certain chronic illnesses (ca)
Inadequate food budgets
Nausea
pain
Nursing Indications….

If a pt is NPO…what is our
responsibility as a healthcare provider
to ensure that he maintains an
adequate nutritional status?

Consider:
 Nutrients
(which ones?)
 Water balance
 Can we feed a pt that a MD has made NPO?
Factors food intake:

Increased food intake:
 Excess




wt increases the risk
for numerous medical problems
assoc with surgery
For complications during pregnancy, labor, and
delivery
Incr morbidity and mortality
 Reasons
for overeating….
Physiologic and physical factors that
influence nutrient requirements

Developmental considerations:
Throughout the life cycle nutrient needs
change in relation to growth,
development, activity, and age-related
changes in metabolism and body
composition.
 Review each area in this section of the
required reading

Gender

Men have more muscle mass and
therefore have higher caloric and
protein requirements than women.
State of Health

Trauma (major surgery, burns, crush
injuries)



Dramatically alters the body’s use of nutrients.
Nutrient requirements increase dramatically to
allow the body to preserve or replenish body
nutrient stores and to promote healing and
recovery.
Mental health problems can cause
to forget to eat, or lack
motivation to eat.
Alcohol Abuse
Affects the intestinal mucosa.
Interferes with normal nutrient
absorption, so requirements for the
nutrients increase as the efficiency of
absorption decreases.
 Need for B vitamin increases because
they are used to absorbed alcohol.

Medication

Especially drugs that
 alter
the pH of the GI tract
 Increase GI Motility,
 damage intestinal mucosa,
 bind with nutrients
Sociocultural and Psychosocial
Factors
Religion:
 Mormons: no coffee, tea, alcohol,
encouraged to limit meat
consumption
 Hindus do not eat beef, many Hindus
are vegetarians
 Kosher dietary laws: special food
preparation techniques and prohibit
the intake of pork and shellfish
Culture

See box 42-4. p. 1434.
The Nsg Process
During illness, good nutritional status
can reduce the risk for complications
and speed recovery
 Poor nutritional status can increase
the risk for illness or death and
prolong the healing process.

Assessment

Health History


Physical
Assessment
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
Dietary History
Anthropometrics
Laboratory Tests
DETERMINE
reviewed in the text
on p. 1435
24 Hour Food Recall
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Upon waking: large glass of water
OTWTW: 1 cup of coffee w/sugar & cream, large bagel
w/cream cheese
During morning: 2 coffees w/2 Danishes
Lunch: Hamburger w/fries-”supersized”, lg. sweet tea
Afternoon: pack of M&M’s
Dinner: Steak, baked potato, green beans, salad, apple pie
a la mode, lg. sweet tea
After dinner: 2 beers
Dietary Guidelines
Dietary referenced intakes (DRIs)
 Food Guide Pyramid
 Daily values
 Healthy People 2010

Food Pyramid
24 Hour-Food-Intake
Assessment

http://www.mypyramid.gov/mypyra
mid/results.html?age=54&gender=m
ale&activity=sed
Assessment of 24 Hr. Food
Recall

Grains: potato(7) bagel(2) danishes(4) bun(2),fries(6)
>19 oz.] 5oz.

Veggies: lettuce, tom, pickles, green beans, salad
cups] 2 cups

Fruits: 0 1½ cups

Milk: cream??!!!

Meat/beans: Hb(4-6), steak (8-12) [~12-18] 5 oz.
[oils] 3 cups/5 tsp oil
[~ 2
[
Intake and Output
Monitoring I and O
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Assistance
Record as soon as specimen is measured
Independent vs. dependent nursing action
All clients
Totaled and evaluated at the end of shift or
at specified times
Compare
Record all output
1.
2.
3.
4.
5.
6.
Urine
Diarrhea
Vomitus
Gastric suction
Drainage from surgical
tube and wounds
Stool if it is liquid enough
to be measured
Intake
Output
Record all intake
Liquids taken:
Oral
Enteral
Parenteral
Anthropometric Data

Height and weight. Most common.
Weigh pt on same scales at the same
time of day
 Self reported ht in the elderly is often
inaccurate

BMI and waist circumference
 Triceps Skin fold measurement

Biochemical Data
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Hemoglobin and Hematocrit
Serum albumin levels
Serum transferrin levels (iron transporting
protein)
Total lymphocyte count (reflects immune status)
Blood glucose
Blood cholesterol
Blood triglycerides
24 hour urine tests: measure protein metabolism
include urine creatinine excretion and urine urea
nitrogen (reflects the breakdown of amino acids
(protein) for energy.
DETERMINE
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Disease: any disease impacting
Eating poorly: too little or too much
Tooth loss, mouth pain:
Economic hardship:
Reduced social contact:
Multiple medicines:
Involuntary wt loss/gain:
Needs asst in self care: walking, shopping,
purchasing, cooking food help
Elder years: above age 80.
Diagnosing

Imbalanced nutrition as the problem:
 Could

be the only issue dealing with.
Imbalanced nutrition as the etiology:
 Could
cause other problems that the nurse
must deal with.
Outcome identification and
Planning

Maintain or restore optimal nutritional
status
Implementing



Teaching
Monitoring nutritional status
Stimulating appetite
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Allow food choices
Small frequent meals
Provide encouragement and PLEASANT environment
Control pain, nausea, depression
Good oral hygiene
Arrange so that it is within easy reach
Ask about rituals
Allow opportunity to wash hands
Assisting with eating when
necessary…last resort! Why?
 Liquid diets

 Used
frequently with transition diets
 Decision to advance diet is based on return
of gi function
 Advance as tolerated is most common
order…what do you think this means?
Diets of Modified Consistency
NPO
 Clear liquid
 Full liquid
 Pureed
 Mechanical or dental soft
 Soft/Low residue
 High Fiber

Diets of Modified Consistency

Nothing by mouth:
Patient not allowed to eat/drink.
 Preop order,
 postop often until Bowel sounds return,
 before certain procedures.
 Nsg indications:



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Encourage good oral hygiene
Lemon glycerin swaps (if no oral lesions)
Ice chips only if MD has OK’d
Avoid watching others eat…
Diets of Modified Consistency:
 Clear
liquids: food that are clear liquids
at room or body temperature
 Full
liquids: all items on a clear liquid
plus,


Milk, puddings, custards, plain frozen desserts,
pasteurized eggs, cereal gruels, vegetable juices,
milk and egg substitutes.
High calorie, high protein supplements usually
accompany this diet if used more that 3 days.
Diets of Modified consistency:
 Soft/Low
Residue diets: regular diets
that have been modified to eliminate
foods that are hard to digest and to
chew, including those that are high in
fiber, high in fat, and highly seasoned.
Also called bland or low-fiber. Adequate
in calories and nutrients and may be
used long-term.
Therapeutic Diets
Restricted fluid intake
 Sodium-restricted
 Fat-modified
 Sugar-restricted (diabetic or ADA)
 Protein-restricted (renal)

Prescribed Diet
1800 ADA
Enteral/parenteral nutrition
Enteral: administering nutrients
directly into the stomach
 Parenteral: providing nutrition via IV
therapy, nutrition

Enteral Nutrition



Oral feeding is preferred and most
effective
Enteral is next best.
Involves passing tube into the GI tract to
administer a formula containing adequate
nutrients.

Procedure: Percutaneous Endoscopic Gastrostomy
(PEG) or a surgically placed Gastrostomy tube.
Enteral Nutrition



Short-term (less than 6 weeks): use
nasogastric tube.
Nasointestinal tube (Dobhoff) (more than 6
wks): Passed through the nose and into the
small intestine. This bypasses the valve in the
stomach that controls volume entering
intestine. Results in gas, bloating.
Long-term intestinal support: enterostomal
tube placed through an opening created into
the stomach from the abdominal wall.
Nasogastric Tubes
Enteral Feeding Tubes (Nasogastric
Tubes)
Enteral Feeding Tubes (Dobhoff)
Gastrostomy Tube
Jejunostomy Tube
Safety Alert

Pt’s on tube feedings:
Head of bed is kept elevated at all times
while the tube feeding is being
instilled….why?
 The nurse will turn the feeding off about
30 minutes before lowering the head of
the bed….not you, yet!

Nasogastric tubes for
decompression

These tubes are also used when the
stomach has excess fluid that need to
be drained…
After GI surgery so the intestines can
rest
 Pt with GI complications and the
intestines are not functioning properly
 Post operative pt who is not alert enough
to “handle” their secretions. Preventing
the risk of vomiting.

Parenteral
Parenteral Nutrition




Administration of nutritional support via IV route.
Used for pts who cannot meet their nutritional
needs by the oral or enteral routes.
Can be administered centrally or peripherally.
Total Parenteral Nutrition (TPN) highly
concentrated, hypertonic nutrient solution.
Provides calories, restores nitrogen balance, etc.
Note that major nsg implication is monitoring
Blood Glucose Levels (BGL).
Fluid Volume Deficit

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Output greater than intake
Decreased blood pressure
Increased pulse
Rapid weight loss > 5%
Dry mouth
Dry skin
Tenting
Slow venous filling of dependent hands
Fluid Volume Excess
Intake greater than output
 Rapid weight gain
 Pitting edema
 Crackles heard in lungs
 Bounding pulse

Dysphagia
Monitor and assist with
feedings/meals
 Maintain high-fowler’s position
 Place food on unaffected side of
mouth
 No straws
 Verbal coaching through swallowing
process
 Thickeners
