Transcript Albumin

Nutrition
B260: Fundamentals of Nursing
Nursing Knowledge Base
• The five components of a nutrition assessment:
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Screening for malnutrition for risk factors
Anthropometry
BMI
Labs and tests
Dietary history
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Nursing Knowledge Base
• Factors influencing nutrition
– Environmental factors
– Developmental needs
• Infants through school age
• Adolescents
• Young and middle adults
• Older adults
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Nursing Knowledge Base
• Alternative Food Patterns
– Based on religion, cultural background,
ethics, health beliefs, and preference
– Vegetarian diet consists predominantly
of plant foods
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Assessment
• Screening a patient is a quick method of identifying
malnutrition or risk of malnutrition using sample tools:
– Height
– Weight
– Weight change
– Primary diagnosis
– Comorbidities
– Screening tools (3 used in practice)
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Assessment
• Assess patients for malnutrition
– Conditions that interfere with their ability to ingest, digest,
or absorb adequate nutrients.
– Congenital anomalies and surgical revisions of the GI tract
– Only IV therapy
– Chronic diseases or increased metabolic requirements
– Infants and older adults are at great risk
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Assessment
– An ideal body weight (IBW) provides an estimate of
what a person should weigh.
– Body mass index (BMI) measures weight corrected for
height and serves as an alternative to traditional
height-weight relationships.
• Laboratory
– Albumin: 3.5-5.0 g/dL (half life 21 days)
– Transferrin and total iron-binding capacity (TIBC)
– Hemoglobin (12-18%)
– Prealbumin (half life 1.9 days)
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IBW Chart and BMI Chart
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Assessment
• Dietary and health history
– Health status; age; cultural background; religious food
patterns; socioeconomic status; personal food
preferences; psychological factors; use of alcohol or
illegal drugs; use of vitamin, mineral, or herbal
supplements; prescription or over-the-counter (OTC)
drugs; and the patient’s general nutrition knowledge
• Physical examination
• Dysphagia (difficulty swallowing)
– 4 Screening tools
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Dysphagia
• Dysphagia refers to difficulty swallowing.
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Nursing Diagnosis
Risk for Aspiration r/t impaired swallowing
Outcome: Patient will maintain patent airway and clear
lung sounds.
Nursing Interventions
1. Monitor for s/s of difficulty in swallowing
1. Cough during eating; change in voice tone or quality after
swallowing; abnormal movements of the mouth, tongue,
or lips; and slow, weak, imprecise, or uncoordinated
speech.
2. Abnormal gag, delayed swallowing, incomplete oral
clearance or pocketing, regurgitation, pharyngeal
pooling, delayed or absent trigger or swallow, and
inability to speak consistently
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Nursing Diagnosis
Risk for Aspiration r/t impaired swallowing
1.
2.
3.
4.
5.
Monitor Respiratory rate, depth, and effort
Auscultate lung sounds q 4 hrs
Monitor bowel sounds q 4 hrs
Take VS q 4 hrs, esp. temp
Feed slowly with small bites and allow time for
chewing and swallowing
6. Place food on strong side of mouth (do not use straw)
7. Have patient sit upright when eating and keep HOB 3045 degrees for an hour after eating
8. Encourage patient to use chin tuck when swallowing
9. Provide rest periods
10. Consult HCP for speech consult for swallow study
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Enteral Tube Feedings
• Enteral nutrition (EN) provides nutrients into
the GI tract.
• Feedings are provided for patients who can not
swallow and have a functioning GI tract.
• Feedings can be delivered through a nasogastric
(NGT), jejunal (JT) or gastric tube (GT).
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Nursing Diagnosis
Risk for Aspiration r/t NGT feeding
Outcome: Patient will maintain patent airway and clear lung
sounds.
Nursing Interventions
1. Determine if patient is at high risk for aspiration:
coughing, hx of GERD, nasotracheal suction, an artificial
airway, decreased LOC, and lying flat.
2. Keep HOB up to 30-45 degrees at all times
3. Measure gastric residual volumes every 4-6 hrs.
– 250 ml or more on 2 consecutive assessments:
delayed gastric emptying or if 500 ml on assessment
– Discuss follow up with HCP
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Nursing Diagnosis
Risk for Aspiration r/t NGT feeding
4. Stop feedings if aspiration occurs
5. Administer metoclopramide (Reglan) if
ordered
6. Monitor for nausea, vomiting, cramping and
diarrhea and tube occlusion.
7. Increase rate per order
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Acute Care Considerations
• The nutritional care of acutely ill patients requires monitoring.
– Patients are interrupted at meal time
– NPO status
– Poor appetites
– Fatigued or feel uncomfortable
– Patient who are NPO and receive only IV fluids for more
than 4-7 days are at nutritional risk.
– Parental or Enteral feeding
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Diets Orders
Box 44-10 pg 1017
• Clear liquids: broth, coffee, tea, clear soda & juice,
jello, popsicle
• Full: above + smooth dairy
• Pureed: above + scrambled eggs, pureed meat –
vegetables –fruits, mashed potatoes
• Mechanical soft: above + diced meats, flaked fish,
cottage cheese, rice, potatoes, etc.
• Soft/low residue: low fiber foods, pasta, tender
meat, canned fruits/vegetables
This is the same order that we advance diets
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Nutrition: Types of Diets
• High fiber: fresh fruit, steamed vegetables, bran,
oatmeal, dried fruit
• Low sodium: 4 g, 2 g, 1 g
• Low cholesterol: 300 mg/day
• Diabetic: usually 1800 cal/day
• Regular: no restrictions
Nursing Diagnosis
Imbalanced Nutrition: less than body requirements r/t poor
appetite
Outcome: Patient will eat 50% of breakfast, lunch and dinner.
Nursing Interventions
1. Monitor food intake; recorded percentages of
served food that is eaten
2. Monitor patient ability to eat (time involved, motor
skills, visual acuity, and ability to swallow)
3. Offer small frequent meals
4. Assist with ordering meals, encouraging familiar
foods
5. Avoid interruptions during mealtimes
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Nursing Diagnosis
Imbalanced Nutrition: less than body requirements r/t poor
appetite
6. Provide a calm, peaceful, pain free, odor free
environment
7. Provide social interaction by encouraging family to
visit during meal times.
8. Encourage or provide oral care prior to meal time
9. Provide rest periods before meals
10. Consult with HCP for a Dietary consult
11. Teach the importance of having good nutrition during
the time of an illness.
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