Transcript Chapter_06

Chapter 6
Maintaining Fluid Balance and
Meeting Nutrition Needs
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1
Lesson 6.1
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2
Objectives



Identify the various types of nutrients.
Identify the components of a healthy diet for
older adults.
Describe the age-related changes in
nutritional and fluid requirements.
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3
Nutrition and Aging
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4
Caloric Intake

Many factors influence how many calories will
be used by a person

Activity patterns
 Gender
 Body size
 Age
 Body temperature
 Emotional status
 Temperature of the climate in which the person
lives
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5
Caloric Intake (cont.)

When a person’s caloric intake is in balance
with the energy needs of the body, his or her
weight remains constant


Caloric intake exceeds energy needs; the excess
is converted into adipose (fat) tissue for storage,
and the individual gains weight
Caloric intake is less than the energy needs; the
person loses weight
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6
Audience Response System
Question 1
The amount of calories for each of the following
are:
A. proteins 4, carbohydrates 4, and fats 4.
B. proteins 9, carbohydrates 4, and fats 9.
C. proteins 4, carbohydrates 9, and fats 9.
D. proteins 4, carbohydrates 4, and fats 9.
E. proteins 9, carbohydrates 9, and fats 9.
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7
Nutrients
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
Foods high in nutritional value and relatively
low in calories must be selected to maximize
the amount of nutrients the body receives
while reducing the number of calories
Vital nutrients needed by all people include
carbohydrates, protein, fats, vitamins,
minerals, and fluids
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8
MyPlate
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9
Poor Nutrition Checklist
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10
Carbohydrates


Include the familiar sugars and starches that
compose approximately half of the standard
American diet
A ready source of energy for the body;
carbohydrates are usually divided into two
categories, simple and complex
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11
Carbohydrates (cont.)

Simple carbohydrates
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
Used most readily by the body because their
simple bonds are easily broken
Table sugar, honey, syrup, and candy are
examples
Complex carbohydrates


Must be broken down into simple sugars before
they can be used by the body
Vegetables, whole grains, and fruits
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12
Proteins



Composed of amino acids, essential for
tissue repair and healing
Red meats, poultry, fish, eggs, and dairy
products are good sources of complete
proteins, which contain all the amino acids
necessary for making and repairing tissues
Plant foods such as legumes (peas and
beans), nuts, and cereals (whole grains and
rice) contain smaller amounts of incomplete
proteins, which do not individually contain all
the necessary amino acids
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13
Fats



It is recommended that fats be limited to
approximately 25% to 30% of the total daily
caloric intake
A certain amount of fat is necessary and
desirable in the diet to aid in the absorption of
fat-soluble vitamins and to provide adequate
amounts of essential fatty acids
There are three important types of
lipoproteins: high-density lipoprotein (HDL),
low-density lipoprotein (LDL), and very-lowdensity lipoprotein (VLDL)
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14
Vitamins

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Organic compounds found naturally in foods
Needed for a variety of metabolic and
physiologic processes
Fat-soluble vitamins include vitamins A, D, E,
and K
Water-soluble include the B-complex vitamins
and vitamin C
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15
Audience Response System
Question 2
All adults require supplemental vitamins, even if
they consume a well-balanced diet.
A. True
B. False
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16
Essential Vitamins

Fat-soluble vitamins


A, D, E, K
Water-soluble vitamins

B1, B2, niacin, B6, folacin (folic acid), B12, C
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17
Minerals



Inorganic chemical elements that are required
in many of the body’s functions
Minerals make up a small proportion of total
body weight, yet a slight mineral imbalance
can have serious effects
Include calcium, phosphorus, iron, sodium,
potassium, and zinc
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18
Water



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Plays a role in many aspects of normal body
functioning
Necessary for the formation of many of the
body’s secretions, including tears,
perspiration, and saliva
Aids in digestion and transportation of
electrolytes and nutrients
Facilitates elimination of waste products and
plays an important role in temperature
regulation
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19
Lesson 6.2
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20
Objective

Identify age-related changes that affect
nutrition, digestion, and hydration.
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21
Malnutrition and
the Elderly
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22
Factors Affecting Nutrition in
the Elderly

Physiologic risk factors

Chronic health factors
 Alcoholism
 Sensory changes
 Pain
 Medications
 Problems with chewing, swallowing, or digesting
 Malabsorption
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23
Factors Affecting Nutrition in
the Elderly (cont.)
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24
Factors Affecting Nutrition in
the Elderly (cont.)

Economic risk factors



Cost of food
Difficulty getting transportation
Obtaining an appropriate variety and sufficient
amount of food
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25
Factors Affecting Nutrition in
the Elderly (cont.)

Social risk factors



Depression
Loneliness or social isolation
Lack of motivation
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26
Meals-on-Wheels
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27
Social and Cultural
Aspects of Nutrition
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Food is more than a means of meeting
nutritional needs
Food is also used as part of religious
ceremonies, in social interactions, and as a
means of cultural expression
Many major religions, such as Islam,
Judaism, and Catholicism, include some
dietary restrictions
It is important to remember that good nutrition
can be achieved in any culture
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28
Characteristic Food Patterns of
Selected Cultures

Discuss the characteristic food patterns of
several different cultures.
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29
Good Nutrition at Any Age
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30
Lesson 6.3
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31
Objectives




Describe methods of assessing the nutritional
status and practices of older adults.
Identify the older adults who are most at risk
for problems related to nutrition and
hydration.
Identify selected nursing diagnoses related to
nutritional or metabolic problems.
Identify interventions that will help older
persons meet their nutritional and hydration
needs.
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32
Nursing Process for
Risk for Imbalanced Nutrition
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33
Audience Response System
Question 3
A complex protein-iron molecule that is
responsible for the transport of oxygen and
carbon dioxide within the bloodstream is:
A. hematocrit.
B. hemoglobin.
C. creatinine.
D. blood urea nitrogen
E. red blood cell.
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34
Assessment



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Appetite changes
Nutritional intake
Social and cultural factors
Home care or discharge planning
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35
Risk Factors Related to Imbalanced
Nutrition in Older Adults

There are many physiologic and
psychological factors that could contribute to
imbalanced nutrition in older adults
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36
Nursing Diagnoses




Imbalanced nutrition: less than body
requirements
Imbalanced nutrition: more than body
requirements
Risk for imbalanced nutrition: more than body
requirements
Readiness for enhanced nutrition
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37
Nursing Goals/Outcomes




Maintain body weight within normal limits for
height
Obtain adequate nutrients to maintain healthy
tissue
Identify internal and external cues that
influence eating patterns
Adhere to a prescribed therapeutic diet
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38
Nursing Interventions

Hospitals or extended-care facilities
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
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
Assess the individual carefully to determine the
causes of a problem
Schedule weekly weight checks
Keep a dietary record of the amount, type, and
frequency of food intake
Explain the importance of nutrition to overall
health or disease control
Determine food likes and dislikes
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39
Nursing Interventions (cont.)

Hospitals or extended-care facilities (cont.)
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
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Monitor laboratory values
Assess the condition of the skin, hair, nails, and
mucous membranes
Consult with the dietitian
Institute measures to increase or decrease
nutritional intake
Complete a thorough documentation of nutritional
status, including assessment, interventions,
referrals, and patient response
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40
Making Meals Enjoyable
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41
Making Meals Enjoyable (cont.)
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42
Nursing Interventions (cont.)

Home
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


Assist the individual in obtaining resources such
as Meals on Wheels, food stamps, a
housekeeper, or shopping services
Involve the family in shopping and meal planning
Identify senior citizen meal programs available in
the community
Use any appropriate interventions that are used in
the institutional setting
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43
Nursing Process for Risk for
Imbalanced Fluid Volume
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44
Assessment

Deficient fluid volume
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Occurs when an individual has inadequate intake
or excessive loss of fluids
Can easily progress into dehydration which,
unless corrected, can result in death
A variety of conditions can contribute to deficient
fluid volume in older adults
Likely to manifest dry mucous membranes, thirst,
decreased skin turgor, rapid weight loss, sunken
eyes, weakness, and decreased volume or
increased concentration of urine
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45
Audience Response System
Question 4
The movement of body fluids between the cell
and plasma is affected by the levels of various:
A. electrolytes and proteins.
B. pressures within the cell.
C. fats in the bloodstream.
D. toxins digested.
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46
Excess Fluid Volume

Excessive intake or inadequate output of
fluids
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Primary indication is edema
Pulmonary edema may result in shortness of
breath, dyspnea, cough, gurgling sounds on
respiration, and frothy sputum
Weight gain can be sudden and dramatic
Hematocrit normally decreases as blood plasma
volume increases
May experience behavioral changes, including
restlessness and anxiety
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47
Nursing Diagnoses





Deficient fluid volume
Excess fluid volume
Risk for deficient fluid volume
Risk for imbalanced fluid volume
Readiness for enhanced fluid balance
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48
Nursing Goals/Outcomes
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Manifest vital signs within normal limits
Evidence of moist oral mucous membranes
and good skin turgor without edema
Maintain a stable weight within normal limits
Exhibit balanced fluid intake and output
Report no problems related to thirst or
weakness
Exhibit blood studies within normal limits
Verbalize an understanding of the
recommended dietary and fluid intake
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49
Nursing Goals/Outcomes (cont.)


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
Demonstrate behaviors necessary to
maintain appropriate fluid intake
Demonstrate selection of appropriate foods
and fluids
Verbalize an understanding of prescribed
medication(s), including the frequency and
any precautions
Verbalize signs and symptoms that should be
reported to the physician
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50
Nursing Interventions

Hospitals or extended-care facilities

Complete a thorough assessment
 Monitor vital signs
 Monitor intake and output
 Monitor laboratory values
 Weigh the patient daily before breakfast
 Measure changes in girth of body parts such as
legs and abdomen
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51
Nursing Interventions (cont.)

Hospitals or extended-care facilities (cont.)

Maintain adequate fluid intake
 Administer medications as ordered by the
physician
 Refer to the dietitian, if appropriate
 Provide appropriate skin care
 Report and document significant findings promptly
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52
Nursing Interventions (cont.)

Home





Complete a thorough assessment
Teach the individual and his or her family
members how to monitor fluid intake
Promote wellness by reviewing the prescribed
dietary and fluid intake with the individual
Explain methods of increasing or decreasing fluid
intake
Use any appropriate interventions that are used in
the institutional setting
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53
Nursing Process for
Impaired Swallowing
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54
Assessment





Is there any history of stroke or other
neurologic disease that could interfere with
chewing or swallowing?
Is the individual alert and able to follow
directions?
Is any facial drooping or difficulty chewing
observed?
Is difficulty swallowing reported by the person
or observed by caregivers?
Does the person complain of something
sticking in the throat?
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55
Assessment (cont.)



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

Does the person cough, choke, or drool when
eating?
Does the person complain of hoarseness or
dry throat?
Does the person store food in the cheek
pockets?
Is the person’s gag reflex weak or absent?
Can the person close his or her lips?
Does the person experience problems with
any particular foods or fluids?
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56
Risk Factors for Impaired
Swallowing in Older Adults





Neurologic problems that result in paralysis or
weakness of the face, mouth, or throat
Altered level of consciousness, awareness, or
sensation
Mechanical devices such as a tracheostomy
tube or nasogastric tube
A narrowing or obstruction of the pharynx or
esophagus
Excessive fatigue
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57
Nursing Diagnosis

Impaired swallowing
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58
Nursing Goals/Outcomes



Pass food from mouth to stomach without
aspiration
Maintain adequate nutrition and hydration
Maintain or achieve appropriate body weight
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59
Nursing Interventions




Assess the individual to determine his or her
unique problems and needs
Consult with the speech therapist,
occupational therapist, and dietitian to
develop a dysphagia program
Verify that dentures fit properly and maintain
good oral hygiene
Position the person with his or her head
upright and the chin flexed slightly forward to
facilitate swallowing
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60
Nursing Interventions (cont.)





Encourage rest periods before meals
Allow adequate time for meals
Start with small amounts of food and
thickened fluids
Place foods into the unaffected or stronger
side of the mouth
Present foods in an appealing manner
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61
Nursing Interventions (cont.)



Select foods based on taste, texture,
temperature, and fluid content
Ensure that the lips are closed by applying
slight pressure or stroking
Stimulate swallowing by stroking the side of
the neck, and support the weakened side if
appropriate
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62
Nursing Interventions (cont.)





Give frequent verbal cues
Reduce distractions
Keep suction equipment available in case of
problems
Provide oral hygiene before and after
feedings
Administer tube feedings as ordered by the
physician to individuals who are unable to
achieve adequate oral intake
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63
Audience Response System
Question 5
Individuals with swallowing difficulties should be
given a moderate amount of food at a time. The
approximate volume should be:
A. less than 5 mL.
B. 5 to 10 mL.
C. 15 to 20 mL.
D. 30 to 50 mL.
E. at least 100 mL.
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64
Nursing Process for
Risk for Aspiration
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65
Assessment





Does the person have cough and gag
reflexes?
Does the person have a reduced level of
consciousness?
Does the person have a tracheostomy?
Is the person in the supine position during
feedings?
Is the person receiving feedings or
medications through a gastric tube?
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66
Assessment (cont.)





Does the person have signs of abdominal
distention?
Are the person’s stomach contents more than
150 mL before a scheduled feeding?
Is there any noise with respiration?
Is there a productive cough? What is the
consistency of the sputum?
Are the pulse and respiratory rates elevated?
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67
Risk Factors for Aspiration
in Older Adults






Neurologic problems, particularly those that
affect the cough and/or gag reflexes
Reduced level of consciousness
Continuous supine positioning
Tracheostomy tubes
Gastric tubes
Decreased gastric motility; excessive
amounts of residual gastric contents or gas
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68
Nursing Diagnosis

Risk for aspiration
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69
Nursing Goals/Outcomes


Remain free from episodes of aspiration
Maintain clear, noiseless breath sounds
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70
Nursing Interventions

Hospitals and extended-care facilities






Position the person appropriately
Assess for stomach distention
Avoid feeding too rapidly
Avoid liquids and puréed foods
Monitor respiratory sounds and respiratory rate,
and observe the amount and type of sputum
produced
Keep suction equipment available
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71
Nursing Interventions (cont.)

Hospitals and extended-care facilities



Check placement of the nasogastric tube using
the approved method
Measure stomach contents before starting
intermittent feeding; then reinstill stomach
contents
Maintain clean technique for all feeding tubes,
equipment, and formula
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72
Nursing Interventions (cont.)

Home



Explain safety precautions to the individual and
the family or caregiver
Encourage enrollment in a home safety course
that includes the Heimlich maneuver and
cardiopulmonary resuscitation
Use any appropriate interventions that are used in
the institutional setting
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73