Transcript Nutrition and Fluid Balance Ch 14 ppx

NUTRITION AND FLUID BALANCE
Chapter 14
WEIGHT LOSS IN ELDERLY
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Malnutrition, unhealthy
weight loss, and
dehydration are serious
problems among the elderly.
Depression, less sensitivity
to taste, decreased
gastrointestinal function,
low physical activity, and
slowing of metabolism
contribute to weight loss in
elderly.
Food should look attractive,
be warm, soft, be one of
their favorite, and have
pleasant taste in order to
improve appetite in elderly.
NUTRITIONIST
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Sometimes older people
have their preference for
food and stick to certain
foods, like ice cream. We
should try to
accommodate their
choice without
compromising
nutritional value of food.
It is a challenging task,
that’s why most of
facilities have a
specialist – nutritionist
for at least part time.
NUTRITIONIST
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Monitors weight loss on
patients and
recommends
supplemental nutrition
to patients with
unstable weight.
Analyzes how much food
patients eat and what
their preferences and
makes recommendations
for their menu.
Nutritionist specialty
requires Bachelor or
Master Degree in
Nutrition.
FOOD MONITORING
Patients with weight
loss require food
monitoring.
 Nursing Assistant
responsibility is to
record how much and
what food patients ate
every meal. Then this
data goes to the
nutritionist.
 Monitoring is done in
percentage for solid
food and ml for fluids
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Bread – 50%
 Turkey – 20 %
 Vegetables – 80%
 Starch (mash
potatoes) – 100%
 Desert 50%
 Milk 240 ml
 Milk shake 120 ml
 Juice 100 ml
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INTAKE AND OUTPUT = I&O
Intake
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Intake – the amount of
liquids patient
consumed in a given
time (shift or 24 hours)
Intake and output
should be equal in a
given time
Output
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Output – the amount
of liquids patient lost
in a given time (urine,
vomiting, diarrhea)
I=O
From the previous slide
– what should be
counted toward
Intake?
FLUID BALANCE
Fluid balance occurs
when person
consumes and
eliminates equal
amount of fluid
 Count of intake and
output can be ordered
by physician for
monitoring certain
conditions as CHF –
congestive heart
failure, and ARF –
acute renal failure
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DANGEROUS SIGNS
Urine
output less
than 240 ml
in 8 hours
(one shift)
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This is a sign of acute
renal failure! Report
immediately to the
nurse and chart!
SIGNS OF FLUID MISBALANCE
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Dehydration is a
condition when there is not
enough fluid in the body:
Signs: dry mouth and
throat, thirst, dark urine,
low blood pressure.
Causes of dehydration:
Difficulty swallowing, not
drinking enough fluids
during meals, nursing
assistant not offering
fluids to resident every
time they see resident
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Fluid overload – too
much fluid in the body,
Happens to patients with
CHF, CRF, liver cirrhosis,
etc
Signs: weight gain more
then 1 pound a day,
swelling of ankles, feet,
hands, increased
abdominal grid, dyspnea
(difficulty breathing), SOB
– fast, shallow breathing
This patients require close
monitoring of their I&O
and weight, to gave
accurate data to MD to
adjust treatment
FLUID RESTRICTION
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Can be prescribed by
MD to relieve fluid
overload in patient
Know the amount of
fluids allowed to the
patient during a day. It
can be as little as
500ml, up to 2000ml per
doctor’s order
Monitor I&O closely,
count intake during the
day not to exceed the
daily allowed amount
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Diuretics (medications
increasing urinary
output) can be
prescribed by MD to the
remove excess of fluid
from the body
Urinary output in these
patients is much higher
then intake, sometimes
1000 – 3000 ml a day
LIQUIDS COUNT
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oz = 30 ml
LIQUIDS COUNT
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Average size cup:
8
oz = 240 ml
LIQUIDS COUNT
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Small cup
4
oz = 120 ml
LIQUIDS COUNT
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Big cup, or coffee mug
12
oz = 360 ml
ACTIVITY
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Get a medicine 30 ml
cup, spoon, and a mug
from our kitchen
Using spoon define how
many spoons of water fit
into the 30 ml cup.
Define what a volume of
the spoon is.
Using 30 ml cup define
how much ml is in your
chosen mug
Keep your medicine cup,
mug filled with water,
and a spoon for the next
activity.
EXERCISE – I&OS OF A PATIENT
Patient’s intake for
the day:
 Breakfast – average
size mug of coffee
 Lunch – 120 ml of
milk, 1 cup of milk
 Dinner – 120 ml of
juice, 12 oz of tea
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Output: 1200 ml of
urine through the day
Questions: Are I&Os
of this patient
balanced?
DEHYDRATION
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Remember that most
residents in the nursing
home unable to drink
without help or even
realize that they are
thirsty. You can notice
their dry mouth and lips
and low blood pressure.
That would be a sign of
dehydration.
Most of residents
unfortunately have liquids
only during their meals, so
even in case they refuse
most of their food, try to
gently encourage them to
finish their liquids.
DEHYDRATION
Some facilities have
Hydration Cards in
the hall.
 Offer fluids to
residents often.
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DYSPHASIA AND ASPIRATION
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If patient has dysphasia
(difficulty swallowing),
thickening of liquids could be
prescribed by speech therapist
(specialist in swallowing) to
ease swallowing
Liquids are the hardest thing to
swallow for patient with
dysphasia.
Choking, coughing, and
watering eyes during meals are
first signs of dysphasia. It is
Nursing Assistant
responsibility to report it to the
nurse or speech therapist
Thickening liquids will be
ordered for dysphasia
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http://www.youtube.com/watch?
v=wqMCzuIiPaM
http://www.youtube.com/watch?
v=1sFNMk87558&feature=rela
ted
NECTAR THICK LIQUIDS
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Nectar thick liquids
are thick as a pulp
juice, such as mango
or tomato juice
HONEY THICK LIQUIDS
Honey-thickened
liquids are defined as
liquids that coat the
spoon. They are
pourable, but not
runny.
 They thick as honey
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SPOON THICK LIQUIDS
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Stays in spoon when it
turn upside down
NPO
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NPO means nothing by
mouth
Can be ordered prior to
certain procedures and
exams
The note NPO will be
placed on the door for
staff not to give food to
the patient
Fasting – is a practice
during which food is
voluntarily given up for
a period of time
HOMEWORK
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Chapter 14 Nutrition
WB, test and 10
abbreviations #83-92
due on Friday Dec 9
$12 for BLS card
Bring your stethoscope,
if you have one, and a
watch for tomorrow and
for the rest of the week
as we will need it for a
disaster drill.
Bring canned and dry
food for the food drive –
points per leadership
paper.
SIX BASIC NUTRIENTS
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1. Water – the most essential
nutrient for life, solvent for
everything. People can’t survive
without water for more than 7 days,
vs 40 days without food
2. Fats - source of prolonged energy
3. Carbohydrates – fast source of
energy, slows down with fiber
4. Proteins – help the body to grow
new tissue, essential for immune
system.
5. Vitamins – enable chemical
reactions in the body
6.Minerals – essential for bones Ca
– calcium, fluid balance - Na
sodium, Cl chloride, neurons
conductivity - K potassium, thyroid
function – I iodine
USDA MY PLATE
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USDA – United States
Department of
Agriculture developed
the icon My Plate for
visualization of
healthy eating habits
for general public
MY PLATE
Is developed in 2011 to provide a general
guidelines to people to avoid extremes in their
diets.
 Principles:
 1. Half of your daily menu should be vegetables
and fruits
 2. Eat more plant based proteins
 3. Eat seafood twice per week
 4. Consume fat free or low-fat milk (1%)
 5. Follow your calorie recommended intake.
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WHAT IS YOUR CALORIE RECOMMENDED
INTAKE?
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http://nutritiondata.self.com/tools/calories-burned
Activity: open this site, find out your
BMI
Calorie recommended intake
Protein intake
How many calories are in an apple, a slice of pizza, a
hamburger
Recommended weight: Calculator.net
http://www.calculator.net/ideal-weightcalculator.html?ctype=standard&cage=53&csex=f&ch
eightfeet=5&cheightinch=4&cheightmeter=180&print
it=0&x=57&y=8
VARIOUS DIETS - NIH SITE
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http://www.nlm.nih.gov/me
dlineplus/diets.html
Clear liquid
Full Liquid
Bland, mechanical soft,
pureed
Cardiac
Diabetic
Renal
Hepatic
Gluten free
High fiber
Low fiber
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Vegetarian
Vegan
Vegan raw
Mediterranean
Calorie count
Low carb
Atkins
South beach
HOW TO READ NUTRITION FACTS LABEL
http://www.fda.gov/Food/ResourcesForYou/Consu
mers/NFLPM/ucm274593.htm
 Activity: How much protein do I need?
 http://exercise.about.com/cs/nutrition/a/protein_2.
htm
 http://www.cdc.gov/nutrition/everyone/basics/prot
ein.html
 What are the types of protein? Write it in your
notebook.
 http://www.cdc.gov/nutrition/everyone/basics/prot
ein.html#Types of protein
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MILK: TO DRINK OR NOT TO DRINK?
THIS IS A QUESTION…
http://www.youtube.com/watch?v=MkPnUL5xfYA
10 min
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HOW DRINKING THE DIET SODA CAN MAKE
YOU TO GAIN WEIGHT?
http://www.youtube.com/watch?v=hpoAtwVyzZI
9 min
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FEEDING THE PATIENT
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Serving meal trays:
Serve patients table by
table
Check the meal card
with the patient’s
bracelet to avoid serving
wrong food to the wrong
patient
Prepare food – open
milk cartoons, butter
cups, cut the meat in
pieces
Do only what resident
can’t do for themselves –
encourage independence
EACH PATIENT IS UNIQUE IN THEIR
EATING HABITS
Observe and the
patient to find out the
best approach to their
feeding
 Follow the aspiration
precautions:
 Be sure patient
swallowed the
previous bite before
offering another one –
observe “Adam Apple”
moving
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FEEDING THE BLIND PATIENT
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Use the imaginary
clock to explain the
position of what is in
front of them.
TEST OF CONTENT
1. Decode a diet order:
 A. Regular, Regular, Thin
 B. NAS, Regular, Nectar
 C. Regular, Mechanical soft, Honey
 D. Regular, Pureed, Spoon thick
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1. Which 8 hours shift I&O you should report
immediately?
 A. I: 1200 O: 1300
 B. I: 1500 O: 2300
 C. I: 1100 O:210
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TEST OF CONTENT
What is constipation?
 What is diarrhea?
 What is fluid restriction?
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