Transcript Nutrition Unit 26

Nutritional Needs & Diet Modification
Adonis K. Lomibao, R.N.
12/20/11
Introduction
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Nutrition:process by which the body takes in
food for growth and repair and uses it to
maintain health.
Signs of good nutrition:
-shiny hair
-clear skin & eyes
-well-developed body
-an alert expression
-p.427
Normal Nutrition & Essential Nutrients
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Digestion:process of breaking down foods into
simple substances that can be used by body cells for
nourishment
Substances are essential nutrients:
-Proteins-carbs-fats-minerals-vitamins-water
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Supply heat & energy
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Build & repair body tissue
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Regulate body functions
Protein
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The basic material of every body cell
Only nutrient that can make new cells & rebuild
tissue
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Made of amino acids
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Foods:
-meat-poultry-eggs-milk-cheese
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Complete proteins:contain all the amino acids the
body can't manufacture
Incomplete:DO NOT contain all the essential amino
acids
Carbs & Fats
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Energy foods used to produce heat & energy
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Excess stored at fat
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Foods: fruits, vegetables, grains
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Supply body with fiber or roughage(cellulose)
to maintain bowel regularity
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Fat: comes from plants & animals
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Ex: Pork,nuts,butter,cheese,egg yolk
Vitamins
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Vitamins regulate body processes:
-build strong teeth & bones
-promote growth
-aid normal body functioning
-strengthen resistance to disease
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Vitamins A,B-Complex,C,D,E,K
Minerals
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Help build body tissues, esp. bone & teeth..also
regulate chemistry oof the body fluids
Minerals include:
-Calcium
-Iodine
-Copper
-Phosphorus
-Iron
-Potassium
The Five Food Groups
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Food Guide Pyramid Groups:
-Grains-6oz/Daily
-Vegetables-2 ½ cups/Daily
-Fruits-2 cups/Daily
-Oils-low
-Milk-3 cups/Daily
-Meat & beans-5.5oz/Daily
Discretionary Calories
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An extra calorie that can be used on solid fats,
added sugars, alcohol, or extra food.
Essential calories-the minimum calories
required to meet your nutrient needs.
It is possible to use more calories than the
amount required to meet your nutrient needs
Water
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Necessary for life and all the cellular functions
in the body
2-3 Quarts Daily
required to replace fluids lost through urine,
stool, sweat, and evaporation through the skin
Basic Facility Diets
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Four common diets
-Regular/General
-Full liquid
-Clear liquid
-Soft
Regular/House
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Normal or full diet based on 5 food groups
Variety
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Excludes very rich foods
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Lower caloric count
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May select from a menu
Clear Liquid Diet
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Temporary b/c inadequate
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Replaces fluids lost by vomiting or diarrhea
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Consists of liquids that do not irritate, cause
gas formation, or encourage bowel
movements
Examples:
-fat-free meat broths
-ginger ale,7UP, clear juices
-gelatin
-p.431
Full Liquid Diet
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Supplies nourishment and may be used for
longer periods of time...but still temporary.
Given to patients with:
-Acute infections
-conditions involving digestive tract
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Examples:
-strained cereal
-strained soups
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p.432
Soft Diet
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Usually follows the full liquir diet
Nourishes body:between-meals feedings can
be given to increase calorie count
Low-residue,mildly flavored,easy to digest
Given to pts with: infection/fevers,difficulty
swallowing, conditions affecting digestive
tract,on progressive post-op dietary regime
Examples on p.432
Special Diets
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Religious practices may change diet for some
pts.
i.e. Jewish:
-shellfish & nonkosher meats prohibited
-foods can't be prepared with utensils used in
non-kosher foods
-p.432
The Diabetic Diet
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For patients with Diabetes Mellitus
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Proper diet and administration of insulin
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Diets aim is to maintain the level of blood
sugar WNL
Exchange List-method of balancing the
diabetic diet based on household
measurements, excludes high content sugar,
divides food into 6 groups
Milk,veg,fruit,bread,meat,fat...
Sodium-Restricted Diet
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May be ordered for pts. With chronic renal
failure & cardiovascular disease
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Different levels of sodium: Table 26-2
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Average American 2-6g/day
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Select low-sodium foods
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Low in sodium:
-some cereals
-vegetables
-fruits
Calorie-Restricted
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3,500 calories=1 lb.
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Prescribed for pts. That are overweight
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Take consideration energy output, gen.
Nutritional state, & weight goal
Balance between:
-proteins: 20%
-fats: 25-35%
-carbs: 45-65%
Low-Fat/Low-Cholesterol Diet
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For patients suffering from vascular, heart,
liver, or gallbladder disease...or difficulty with
fat metabolism
Foods baked, roasted, broiled...
Fats limited & calories balanced by increasing
proteins & carbs.
Foods included: p.435
Mechanically Altered Diets
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Consistency & texture are modified to make
food easier to chew & swallow.
Mechanical soft: those who have no teeth or
with serious dental problems. “consistency of
ground beef”
Pureed diet: blended with gravy or liquid till its
pudding consistency
Supplements & Nourishments
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Ordered by physician or dietician to have a
therapeutic value...i.e. High-protein to facilitate
healing.
Not nutritionally comlete
Nourishments are substancial food items
given to patients to increase nutrient intake.
“between meals”
“snacks” prevent or eliminate hunger between
meals
p.436
Calorie Counts & Food intake Studies
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Food intake is analyzed for nutritional
adequacy and number of calories consumed.
Info used to plan a diet to meet patient's
special medical needs.
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Food documentation for is prepared
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Food may be weighed or measured
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Inform staff & visitors
Dysphagia
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Difficulty swallowing food & liquids
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May occur in those who have:
-had a stroke
-neuro studies
-dimentia
-p/437
-those who take meds that cause sedation or
reduce saliva production
S&S Dysphagia
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Taking a long time before beginning to
swallow
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Swallowing 3-4x per bite of food
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Lack of gag reflex or weak cough
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Wet, gurgling voice
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Unintentional weight loss
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p.437- inform nurse
Dysphagia
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Speech language pathology consult
Treated with swallowing exercises \, practice
of proper swallowing techniques, alteration of
consistency of food & beverages
Thickeners may be used
-juice, nectar, honey, pudding (consistency)
Fluid balance
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Balance between liquid intake & liquid output
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Intake-2,600-3,000ml/D
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Edema-excessive fluid retention
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Dehydration-inadequate fluid intake
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Output- 2,500ml/D
-urine
-perspiration
-p.440
Fluid Balance Cont.
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Record I&O
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Push fluids/force fluids-encourage fluid intake
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Fluid output includes: urine,emesis, drainage.
Alternative Nutrition
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Patients that may be:
-unconscious
-disease of GI tract
-persistent vomiting
-aspiration-risk
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TPN- IV Nutrition-concentrated nutrients
Enteral feedings- tubes inserted into digestive
tract.
Alternative Nutrition Cont.
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NG Tube feeding
Gastrostomy- through abdominal skin into
stomach
Jejunostomy tube-tip ends in small intestine
-through nose, or surgically inserted
-long term...those who don't have stomach or
risk for aspiration
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PEG Tube-Percutaneous Endoscopic
Gastrostomy-surgically inserted
NG Tube
NG Tube
TPN
TPN
PEG Tube
PEG