Nutrition in Nursing Chapter 1

1. Nutrition in NursingChapter 1

2. Nutritional Screening • Nutritional screen • Quick look at a few variables to judge a client’s relative risk for nutritional problems • No accepted universal tool • JCAHO mandates that screen must be done within 24 hours of admission to the hospital

3. Nutritional Screening (cont’d) • Comprehensive nutritional assessment • Moderate to high risk at screening referred to dietitian for assessment • Nutritional care process: 4 steps • Assessment • Nutritional diagnosis • Implementation • Monitoring and evaluation

4. Nutritional Screening (cont’d) • Comprehensive nutritional assessment (cont’d) • Different from nursing care plan • Dietitians can get most of information from nursing admission assessment • Dietitians interview patients and/or families to obtain a nutrition history • Helps to differentiate: • Nutrition problems caused by inadequate intake from those caused by illness or its treatments

5. Nutritional Screening (cont’d) • Comprehensive nutritional assessment (cont’d) • Dietitians • Calculate estimated calorie and protein requirements based on the assessment data • Determine nutritional diagnoses that define the nutritional problem, etiology, and signs and symptoms • May also determine the appropriate malnutrition diagnosis • Formulate nutrition interventions

6. Integrating Nutrition • Assessment • Data classified as ABCD: • Anthropometric • Biochemical • Clinical • Dietary data • Client’s medical-psychosocial history is also evaluated for its impact on nutritional status

7. Integrating Nutrition (cont’d) • Anthropometric data • Physical measurements of the body • Body mass index • “Healthy” or “normal” BMI is defined as 18.5 to 24.9 • Above or below related to health risks • “Ideal” body weight • Edema or dehydration skews accurate weight measurements • Recent weight change

8. Integrating Nutrition (cont’d) • Biochemical data • No single test is both sensitive and specific for protein-calorie malnutrition • Biochemical data may help support the diagnosis of a nutritional problem

9. Integrating Nutrition (cont’d) • Albumin • Often used to assess protein status • Serum levels may be maintained until malnutrition is in a chronic stage • Low albumin may indirectly identify patients who may benefit from nutrition assessment and intervention • Prealbumin • Thyroxin-binding protein • More sensitive indicator of protein status • More expensive to measure

10. Integrating Nutrition (cont’d) • Clinical data • Physical signs and symptoms of malnutrition observed in the client • Most signs cannot be considered diagnostic • Physical signs and symptoms of malnutrition can vary in intensity among population groups because of genetic and environmental differences • Physical findings occur only with overt malnutrition

11. Integrating Nutrition (cont’d) • Dietary data • Nurse should ask, “Do you avoid any particular foods?” • Nurse should not ask, “Are you on a diet?” • Medical psychosocial history • May shed light on factors that influence intake, nutritional requirements, or nutrition counseling

12. Integrating Nutrition (cont’d) • Medication • Both prescription and over-the-counter drugs have the potential to affect and be affected by nutritional status • At greatest risk for development of drug-induced nutrient deficiencies include those who: • Habitually consume fewer calories and nutrients than they need • Have increased nutrient requirements including infants, adolescents, and pregnant and lactating women • Are elderly • Have chronic illnesses

13. Integrating Nutrition (cont’d) • At greatest risk for development of drug-induced nutrient deficiencies include those who (cont’d): • Take large numbers of drugs (five or more), whether prescription drugs, over-the-counter medications, or dietary supplements • Are receiving long-term drug therapy • Self-medicate • Are substance abusers

14. Integrating Nutrition (cont’d) • Nursing diagnosis • Provide written documentation of the client’s status • Serve as a framework for the plan of care that follows • Planning: client outcomes • Outcomes, or goals, should be measurable, attainable, specific, and client centered • Focus on the client, not the health care provider • Keep in mind that the goal for all clients is to consume adequate calories and protein using foods they like and tolerate as appropriate

15. Integrating Nutrition (cont’d) • Nursing interventions • Nutrition therapy • Diet is a four-letter word with negative connotations • Usually general suggestions to increase/ decrease, limit/avoid, reduce/encourage, or modify/maintain aspects of the diet because exact nutrient requirements are determined on an individual basis • Nutrition theory does not always apply to practice

16. Integrating Nutrition (cont’d) • Nursing interventions (cont’d) • Client teaching • Clients in clinical settings may be more receptive to nutritional advice • Hospitalized patients are also prone to confusion about nutrition messages • Monitoring and evaluation • Monitoring precedes evaluation • Evaluation assesses whether client outcomes were achieved

17. Physical Signs & Symptoms of Malnutrition • Hair is dull, brittle, dry, or falls out easily • Swollen glands of neck and cheeks • Dry, rough, or spotty skin • Poor or delayed wound healing or sores • Thin appearance with lack of subcutaneous fat • Muscle wasting • Edema of lower extremities • Weakened hand grasp • Depressed mood • Abnormal heart rate/rhythm and BP • Enlarged liver or spleen • Loss of balance and coordination

18. Nursing Diagnoses With Nutritional Relevance • Altered nutrition: more than body requirements • Altered nutrition: less than body requirements • Altered nutrition: risk for more than body requirements • Constipation • Diarrhea • Fluid volume excess • Fluid volume deficit

19. Nursing Diagnoses With Nutritional Relevance (cont’d) • Risk for aspiration • Altered oral mucous membrane • Altered dentition • Impaired skin integrity • Noncompliance • Impaired swallowing • Knowledge deficit • Pain • Nausea