Transcript Chapter 24 Nutrition

Health Tech Prep
Mosby’s Textbook for Nursing Assistants
Chapter 24
Nutrition
Objectives
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Define the key terms listed in this
chapter
Explain the purpose and use of the
Food Guide Pyramid
Explain how to use the Dietary
Guidelines for Americans
Describe the functions and major
sources of nutrients
Explain how to use food labels
Explain the purpose of intake and
output records
Identify what is counted as fluid
intake
Explain how to assist with food and
fluid needs
Explain how to assist with calorie
counts
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Describe factors that affect eating
and nutrition
Describe the special diets and
between-meal nourishments
Identify the signs, symptoms, and
precautions relating to
regurgitation and aspiration
Describe fluid requirements and
the causes of dehydration
Explain what to do when the
person has special fluid orders
Describe the purpose, methods,
and comfort measures for enteral
nutrition and IV therapy
Perform the procedures described
in this chapter
BASIC NUTRITION
 poor diet and poor eating habits:
• Increase the risk of infection
• Increase the risk for acute and chronic
diseases
• Cause chronic illnesses to become worse
• Cause healing problems
• Affect physical and mental function
increasing risk for accidents and injuries
APPLICATION#1 FOOD DIARY
Students will keep a food diary of their intake for 24 hrs
and bring to class. While discussing the food guide
pyramid students will try to put the foods that they
have eaten in the food guide pyramid and determine if
they have been provided with the daily value of
nutrients and servings for the day.
BASIC NUTRITION
 Nutrition
• processes involved in the ingestion, digestion,
absorption, and use of foods and fluids by the
body.
• needed for growth, healing, and body functions.
 A well-balanced diet and correct calorie intake are
necessary
 A well-balanced diet has servings from levels 1, 2,
and 3 of the Food Guide Pyramid.
 The amount of energy that a nutrient provides is
measured in calories.
 calorie =amount of energy produced when the body
burns food.
• 1 gram of fat—9 calories
• 1 gram of protein—4 calories
• 1 gram of carbohydrate—4 calories
BASIC NUTRITION
 Nutrients
• =a substance that is ingested,
digested, absorbed, and used by the
body
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Carbohydrate
Protein
Fats
Vitamins
minerals
Nutrients
 Protein
• the most important nutrient.
• needed for tissue growth and repair.
• Sources of protein
• Meat
• Fish
• Poultry
• Eggs
• Milk and milk products
• Cereals
• beans, peas, and nuts.
Nutrients
 Carbohydrates
• Provide energy and fiber for bowel
elimination
• found in fruits
• Vegetables
• Breads
• Cereals
• sugar
 The fiber in fruits, vegetables, breads,
and cereals provides the bulky part of
chyme for elimination.
Nutrients
 Fats
• Fats provide energy
• add flavor
• help the body use certain vitamins.
 Sources of fat include
• Meats
• Lard
• Butter
• shortening, oils,
• Milk
• Cheese
• egg yolks
• nuts.
 Fat that the body does not use is stored as adipose
tissue.
Nutrients
 Vitamins
• Vitamins are needed for certain body
functions.
• Vitamins do not provide calories.
 vitamins A, D, E, and K are stored by the
body
 Vitamin C and the B-complex vitamins are
not stored.
• These vitamins must be ingested daily.
 ***Table 23-1 in the textbook lists the
sources/ major functions of vitamins.
Nutrients
 Minerals
• needed for:
• (1) Bone and tooth formation
• (2) Nerve and muscle function
• (3) Fluid balance
• (4) Other body processes
 ***Table 23-2 in the textbook lists the
major functions and dietary sources
The Food Pyramid
Steps to a healthier you
- promotes wise food
choices.
-The Pyramid is for
everyone over 2 years of
age.
-It has six food groups
GRAINS
VEGETABLES
FRUITS
OILS
MILK
MEAT & BEANS
Grains
Make half of your grains whole
 6 to 11 servings are allowed a
day.
 See Box 23-3 in the textbook.
 provides
• Protein
• Carbohydrates
• iron, thiamin, niacin, and
riboflavin.
• fats and sugars are small.
Vegetables
Vary your veggies
 3 to 5 servings a day.
• See Box 23-3 in the textbook.
 Fiber
 vitamins A and C
 Carbohydrates
 minerals.
 low in fat.
 **Vegetables can become high in fat
from food preparation
Fruits
Focus on fruits
 2 to 4 fruit servings a day.
• See Box 23-3 in the textbook.
 contains some sugar and is low
in fat.
 Carbohydrates
 vitamins A and C
 potassium, and other minerals
Oils
Know your fats
 Fats, oils, and sweets
 used sparingly and as little as
possible.
• high in calories
• Nutrients are few
 Use food labels to find the fat
content of foods.
Milk
Get your calcium rich foods
 Included
• Milk
• Skim milk has less fat than whole
milk
• Yogurt
• Cheese
• Ice cream (although higher in fat
content)
 See Box 23-3 in the textbook.
 2-3 servings per day
 high in protein, carbohydrates, fat, calcium,
and riboflavin.
Meat and Beans
Go lean on protein
 2 to 3 servings a day.
 See Box 23-3 in the textbook.
 high in protein, fat, iron, and thiamin.
 Serving size is important.
** Culture, appetite, personal choice, and
recipe affect serving size.
 Nuts and peanut butter have the most
fat in this group
 lowest peas and cooked dry beans
THE GOAL=Better health
Follow the Dietary Guidelines for Americans
to reduce the risk for many diseases
(See Box 23-2 in the textbook.)
Negative Calorie Foods!
Are They For Real?
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Negative Calorie Foods ~
Vegetables
 asparagus
beets
broccoli
cabbage (green)
carrots
cauliflower
 celery
chicory
chili peppers
cucumbers
endive
garlic
 lettuce
onions
papayas
spinach
turnip
zucchini
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Negative Calorie Foods ~
Fruit
 apples
cranberries
grapefruit
lemons
 mangos
oranges
pineapple
 raspberries
strawberries
tangerines
APPLICATION #2:
Menu Planning
Plan a nutritious, well-balanced menu for 1 day using
the Food Guide Pyramid. Menus should include
three meals and two snacks and equal
approximately 2000 calories.
APPLICATION #3:
Food Guide Pyramid Worksheet
Food Guide Pyramid Internet
Food labels
 Figure 23-5 in the textbook
 Food labels are used to plan diets.
 contain the following;
• Serving size
• How the serving fits into the daily diet
• Calories per serving and number of calories
from fat
• The total amount of fat and the amount of
saturated fat
• Amount of cholesterol, sodium, and protein
• Total amount of carbohydrates
• Amount of vitamin A and C, calcium, and iron
Food labels
 Daily Value(DV).= How a serving fits
into the daily diet
 expressed in a percentage based on a
daily diet of 2000 calories.
 Daily Reference Values (DRVs)=
maximum daily intake values for total
 fat, saturated fat, cholesterol, sodium,
carbohydrate, and dietary fiber.
APPLICATION
FOOD LABEL ACTIVITY
FACTORS AFFECTING EATING AND
NUTRITION
 Age
• children: factors affecting eating and
nutrition
• Infants are breast-fed or bottle-fed.
(1) For bottle-fed babies, the doctor
orders the formula to use.
• Solid foods are introduced at 4 to 6
months.
(1) The nurse tells you what foods the
infant can have.
FACTORS AFFECTING EATING AND
NUTRITION
 Culture
• influences dietary practices, food choices,
and food preparation.
 Religion
• Selecting, preparing, and eating food often
involve religious practices.
 See Box 23-4 in the textbook.
FACTORS AFFECTING EATING AND
NUTRITION
 Finances
• People with limited incomes often buy the cheaper
carbohydrate foods.
 Appetite
• the desire for food.
• Aromas and thoughts of food can stimulate the appetite.
• Loss of appetite (anorexia) can occur from
• illness
• drugs
• anxiety
• pain
• depression
• unpleasant sights, thoughts, and smells.
FACTORS AFFECTING EATING AND
NUTRITION
 Personal choice
• Food likes and dislikes are personal.
• Foods served in the home influence
food preferences.
• People usually avoid foods that cause
allergic reactions, nausea, vomiting,
diarrhea, indigestion, or headaches.
FACTORS AFFECTING EATING AND
NUTRITION
 Illness
• Appetite usually decreases during illness and
recovery from injuries.
• Nutritional needs increase to fight infection,
heal tissue, and replace lost blood cells.
• Nutrients lost through vomiting and diarrhea
need replacement.
• A sore mouth, tooth loss, or poorly fitting
dentures affect chewing.
• Illness can affect the ability to prepare and
serve meals.
FACTORS AFFECTING EATING AND
NUTRITION
 Focus on home care: factors affecting eating and
nutrition
 You may be assigned to shop for groceries, plan
meals, and cook.
(1) Understand the Food Guide Pyramid, basic
nutrition, and food labels
(2) Know food preferences and eating habits
(3) Review those that are allowed on the person’s diet
(4) Consider eating and digestive problems
(5) Plan menus for a full week.
(6) Save grocery receipts for the person or family
member.
(7) Properly store foods.
FACTORS AFFECTING EATING AND
NUTRITION
 **Focus on long-term care: factors affecting eating
and nutrition
 OBRA has the following requirements for food served
in longt erm care centers:
 The person’s diet:
• Is well balanced, nourishing and tastes good
• Food is appetizing and attractive
• Hot food is served hot; cold food is served cold.
• Food is served promptly.
• Food is prepared to meet each person’s needs.
• Each person receives at least three meals a day.
• The center provides any special eating equipment
and utensils.
 -Some centers have areas where the resident can dine
with a spouse, family
SPECIAL DIETS
 Doctors may order special diets:
1. For a nutritional deficiency or a disease
2. For weight control
3. To eliminate or decrease certain substances
in the diet
 The doctor, nurses, and dietitian work together
to meet the person’s nutritional needs.
SPECIAL DIETS-Regular
 Regular diet, general diet
• no dietary limits or restrictions
 Special diets may be needed
• Person’s with certain diseases
• Wound healing
• Elimination
• Swallowing problems
• Allergies, excess weight, and other problems
SPECIAL DIETS-Sodium controlled
 Diseases that require this type
• Heart
• Liver
• kidney disease
• hypertension
 Sodium causes the body to retain water.
 Less water reduces the heart’s
workload.
SPECIAL DIETS-Regular
 See Box 23-5 in the textbook.
 2000 to 3000 mg sodium diet
• Also called: low-salt or no added- salt diet
• Sodium control is mild.
• All high-sodium foods are omitted
• A small amount of salt is used in cooking.
• Salt is not added to foods at the table.
 1000 mg sodium diet
• Food is cooked without salt.
• Foods high in sodium are omitted.
• Vegetables high in sodium are restricted in amount.
• Salt-free products are used.
• Diet planning is necessary.
SPECIAL DIETS-Diabetic
 for people with diabetes.
 involves:
• The person’s food preferences
• Limiting amounts or changing the way food is
prepared
• The same amount of carbohydrates, protein, and
fat are eaten each day.
• Eating meals and snacks at regular times
• Meal and snack times are the same from day to
day.
 The nurse will tell you what to give the person for a
snack.
***The amount of insulin given depends on daily food
intake. Tell the nurse about changes in the person’s
eating habits.***
SPECIAL DIETS-Dysphagia
 Dysphagia=difficulty swallowing
• A slow swallow =difficulty getting enough food
and fluids for good nutrition
• unsafe swallow= food enters the airway could
cause aspiration
 Food thickness is changed to meet the person’s
needs
 Diet is determined by the health team
• MD, nurse, SLP, OT
SPECIAL DIETS-Dysphagia
 safety:
• Know the signs and symptoms of dysphagia.
• See Box 23-7 in the textbook.
• Position the person’s head and neck
correctly.
• Follow the care plan.
• Feed the person according to the care plan.
• Follow aspiration precautions.
• See Box 23-8 in the textbook.
FLUID BALANCE
 Water is needed to live.
 Death can result from too much or too little water..
 Normal fluid requirements
• adult needs 1500 ml of water daily to survive.
• 2000 to 2500 ml of fluid per day are needed for normal
fluid balance.
 Water requirements increase
• hot weather
• exercise
• fever
• illness
• excess fluid loss.
FLUID BALANCE
 The amount of fluid taken in (intake) and the
amount lost (output) must be equal.
 Edema
• If fluid intake exceeds fluid output
• tissues swell with water.
 Dehydration
• decrease in the amount of water in body
tissues.
• Fluid output exceeds intake.
FLUID BALANCE
 ** Focus on children: normal fluid
requirements
• requirements vary with age.
• Infants and young children need more
fluids than adults.
• Excess fluid losses quickly cause
death in an infant or child.
FLUID BALANCE
 ** Focus on older persons: normal fluid
requirements
• The amount of body water decreases
with age.
• diseases affect fluid balance.
• drugs cause the body to lose fluids;
others cause the body to retain
water.
• increased risk for dehydration and
edema.
FLUID BALANCE -Special orders
 Found in the care plan
 Will give specific instructions on what to give the
resident
• Encourage fluids
• drinks an increased amount of fluid.
• Intake records are kept.
• given a variety of fluids.
• kept within the person’s reach.
• correct temperature.
• Fluids are offered regularly to persons
who cannot feed themselves.
FLUID BALANCE-Restrict fluids
 restricted to a certain amount.
• offered in small amounts and in small
containers.
• water pitcher is removed from the
room or kept out of sight.
• Intake records are kept.
• The person needs frequent oral
hygiene.
FLUID BALANCE-NPO
 The person cannot eat or drink anything.
 NPO is often ordered:
• Before and after surgery
• Before some laboratory tests and diagnostic
procedures
• In treating certain illnesses
 An NPO sign is posted above the bed.
 The water pitcher and glass are removed.
 Frequent oral hygiene is needed.
 Fluids are not swallowed.
FLUID BALANCE
 Intake and output (I&O) records
 order by MD for I&O measurements.
 I&O records are used:
• To evaluate fluid balance and kidney
function
• To help in evaluating and planning
medical treatment
• When the person has special fluid
orders
FLUID BALANCE-Intake and Output
 Intake
• fluids taken by mouth.
• IV fluids
• tubefeedings.
 Output
• urine
• vomitus
• diarrhea
• wound drainage.
FLUID BALANCE-Measuring I&O
 #measured in milliliters (ml) or in cubic
centimeters(cc).
• 1 ounce equals 30 ml
• A pint is about 500 ml
• A quart is about 1000 ml
• the serving size of the bowls, dishes,
cups, pitchers, glasses, and other
containers.
FLUID BALANCE
 A container called a graduate is used to measure
fluids.
 -Plastic urinals and emesis basins often have
amount marks.
 -An I&O record is kept at the bedside.
 - Amounts are totaled at the end of the shift and
recorded in the person’s chart.
 -Remind the person:
 # Not to urinate in the toilet
 # Not to put toilet tissue into the receptacle
APPLICATION #5:
Determining intake and
output
MEETING FOOD AND FLUIDS
NEEDS
 factors affect appetite and the ability to
eat:
 Weakness and illness
 Unpleasant odors, sights, and sounds
 Uncomfortable positions
 The need for oral hygiene
 The need to eliminate
 Pain
Preparing for meals
 -Patients and residents need:
• To eliminate and have oral care
• Dentures, eyeglasses, and hearing aids in
place
• To be clean and dry (if incontinent)
• To be in a comfortable position for eating
• A setting that is free of unpleasant sights,
sounds and odors
• Remove unpleasant equipment from the
room.
Preparing the Person for Meals
 Serving meal trays
• Food is served in containers that keep foods
at the correcttemperature.
• You serve meal trays after preparing persons
for meals.
• If a meal tray is not served within 15
minutes, recheck food temperature.
• If the food is not at the right temperature,
get another tray.
• Some agencies allow reheating in a
microwave oven.
Feeding the person
 Factors affecting the ability to feed oneself
• Weakness
• Paralysis
• casts
• other physical limits /illnesses
Rules and guidelines for feeding
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Serve food and fluids in the order the person prefers.
Offer fluids during the meal.
use Spoons= less likely to cause injury.
respect the person
• Are often angry, humiliated, and embarrassed
• May be depressed, resentful, or refuse to eat
• Let them do as much as possible.
• Provide support and encouragement.
Rules and guidelines for feeding
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Allow time and privacy for prayer.
Meals provide social contact with others.
Engage the person in pleasant conversation.
Give time for chewing and swallowing.
Rules and guidelines for feeding
 Sit so you face the person.
• This is more relaxing.
• It shows the person that you
have time.
• You can see how well the
person is eating.
• You can see if the person has
problems swallowing.
Rules and guidelines for feeding
 visually impaired resident
• Tell the person what is on the tray.
• When feeding a visually impaired person,
describe what you are offering.
• If feed themselves describe foods and fluids
and their place on the tray.
• Use the numbers on a clock for the location
of foods.
*Focus on long-term care: serving meal
trays
 Nursing centers have special dining programs.
• Social dining
• Residents eat at a dining room table with
4 to 6 others.
• Food is served as it is in a restaurant.
• for persons who are oriented and can
feed themselves
Focus on long-term care: serving
meal trays
 Family dining
• Food is served in bowls and on platters.
• Residents serve themselves.
 Assistive dining
• The dining room has horseshoe-shaped
tables.
• They are for residents who need help eating.
Focus on long-term care: serving
meal trays
 Low-stimulation dining
• The program prevents distractions
during meals.
• The health team decides on the best
place for each person to sit
APPLICATION
FEEDING
A
DEPENDENT
RESIDENT
Between-meal nourishments
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.Many special diets
involve between-meal
nourishments.
Serve nourishments
when they arrive on the
nursing unit.
Provide needed eating
utensils, a straw, and
napkin.
Follow the same
considerations and
procedures for serving
meal trays and feeding
Providing drinking water
 Patients and residents need
fresh drinking water each
shift.
 They also need water
whenever the pitcher is
empty.
 ask about any special orders
before providing water
 Practice medical asepsis.
 Follow agency procedure.
APPLICATION
PASSING FRESH WATER
APPLICATION
Care Planning considerations Worksheet
IN CLASS WORK
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7
Enteral nutrition
Parenteral Nutrition (IV Therapy)
NG tube
Nasointestinal tube
Gastrostomy tube
Jejunostomy tube
PEG tube
 Provide the following information about the term from the
text. Present the information to the class.
• Definition
• How it is inserted ?( if relating to a feeding tube)
• Who inserts it?( if related to a feeding tube)
• Why it used?
• Any special precautions
• Special Needs of the patient
RESEARCH
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10.
Monosodium Glutamate
Partially hydrogenated vegetable oil
Aspartame
Splenda
Olean
Nitrates
Organic foods
Nutrisweet
Saturated/Unsaturated Fats
Mono- and Di-glycerides