Nutrition and Fluids NURS 1510

1. Nutrition and FluidsNURS 1510

2. Nutrition is Essential for • Normal growth • Tissue maintenance • Tissue repair/recovery • Treatment of disease

3. Maintain immune system • Prevent medical problems • Maintain normal temp • Produce enzymes and hormones

4. Review of Digestive System

5. Mouth • Intake of food/fluids • Mechanical Digestion • Chemical digestion of starches begins

6. Esophagus • Passageway from themouth to the stomach • Peristalsis propels food forward

7. Stomach • Turns food into chyme • Adds HCL • Mechanical and chemical digestion continues • Food stays for 1-4 hours

8. To complete digestion • Simple carbohydrates 1hr • Complex carbohydrates 3hr • Protein 5hr • Fats 7hr • Rationale for a variety of foods in % of intake

9. Small intestine • Chemical digestion • Bile and enzymes are added • Digestion completed • Absorption of nutrients occurs

10. Large intestine • Storage of wastes • Absorption of water • Elimination • Synthesis of Vitamin K

11. Factors affecting digestion • Psychological State-fear, anxiety • Bacterial action • Food processing-whole grain, raw, fried, cooked

12. Nutrient • Substance which contains elements necessary for body function • 6 classes: CHO, CHON, Fat, H2O, Minerals, Vitamins

13. Carbohydrates (CHO) 4 cal/gm • Simplest form is glucose • Anabolism • Catabolism • Converted to adipose • Provide energy • Primary plant foods • May contain fiber

14. Proteins--4cals/gm • Amino acids • Tissue growth/repair • Complete proteins • Incomplete proteins • Nitrogen balance

15. Lipids -- 9 cal/gm • Provide insulation • Maintain temperature • Fat-soluble vitamins • Fats and oils • Concentrated energy • Triglycerides

16. Water • Most essential nutrient for survival • Essential for cells • Sources--eating, drinking, metabolism

17. What is adequate? • Sodium: Less than 3000mg • Cholesterol: Less than 300mg • Fat: Less than 30 % • Fiber: Approximately 30 Grams • Fluids: 3000ml / 24 hour

18. Vitamins • Fat soluble--A, D, E, K • Water soluble-B-complex, C • Regulate metabolic functions within cells • Contain antioxidants

19. Minerals • Inorganic elements • Serve as catalysts • Essential for good health • Calcium, phosphorus, magnesium

20. Nutritional Needs Based on Developmental Stage • Infants: double wgt 4-5 mo. Not able to digest or metabolize many foods • Toddlers & pre-schoolers: need increase in protein r/t body wgt. • School age + adolescents: generally have good appetites. Need healthy selection ed. • Adults: Fruits, veg, whole grain & portion control

21. Older Adult • May have fixed income • May not be able to go out and shop • Decrease in taste buds • Loss of teeth , poor fitting dentures • Don’t enjoy eating alone

22. Factors influencing patterns` • Health • Socio - Economic status • Psychological state • Culture/religion

23. continued • Personal preferences • Misinformation-food fads • Alcohol and drug use • Age and life-style • Alcohol = 7calories/gram

24. Nutritional Assessment • Hgt & wgt I&O trends • Body composition Edema • Condition of skin, teeth, hair • Dietary history Turgor • Dietary diary Anthropometry • Calorie count Stool characteristics

25. Diagnostics • Albumin-role in F&E balance • Pre-albumin-more reliable • Transferrin-non-hem iron->when iron< and < when iron > • Hbg-O2 carrying capacity < blood loss • BUN = hydration and Creatinine

26. Determine energy from nutrients • 2000 calorie diet 60% carbohydrate 20% protein 20% fat calories 2000X60%=1200/4cal per g=300gram CHO 2000x20%= 400/4cal per g=100gramCHON 2000x20%= 400/9cal per g=44grams Fat

27. Purpose of RDA’s • Represents allowances of essential nutrients by age and category, inclusive of weight and height. • Represents 98% of people in general good health • 55-60% carbohydate 12-20% protein <30% fat

28. Major Nutritional Problems • Anyone with problems with I & O, digestion and absorption of nutrients • Anorexia nervosa • Bulimia --Impaired mobility • Chemotherapy --Lengthy NPO • Chronic illness • Extensive surgery

29. Nutritional Status • Most reliable indicator is WEIGHT Intake and output are very important and must be accurate

30. Therapeutic diets • Provide rest to a body part • Adapt to client’s ability to eat swallow, digest, absorb, or metabolize nutrients • Weight loss or gain • Maintain nutritional status • Correct deficiencies

31. Diet Modifications • Consistency/texture • Frequency of feedings • Number of calories • Specific nutrients • Fluid volume

32. Clear liquid • Tea, broth, jello, water • Liquids you can see through • Nutritionally inadequate

33. Full medical liquid • Foods that are liquid at body temperature • May be nutritionally adequate if planned carefully

34. Soft diet • Foods which are easy to chew and to digest • Mechanical soft/pureed

35. Bland diet • Non-irritating foods • Chemically • Thermally • Mechanically

36. High or low residue diet • Residue has to do with fiber • Hi=increase peristalsis • Low-decrease peristalsis • Regulates the volume of fecal output

37. Other Diets • Sodium restricted: reduces fluid retention and allows heart to work less • Low fat or cholesterol: reduces the plaque formation in blood vessels, limiting CAD

38. NI to enhance intake of nutrients • Offer bathroom • Wash face/hands • Oral care • Glasses/hearing aids • Position of comfort prior to food served • Reinforce importance of intake

39. Continued-at meals • Serve food in pleasant social setting • Prepare tray • Place in reach and in visual field • Encourage social interaction • Assist with feeding if necessary • Know precautions • Protect clothing with apron-not bib

40. Continued-at meals • Allow client to empty mouth before putting more food in • Encourage client to direct speed/order • Be at eye level/face to face • Allow for rest periods • Avoid heaping food on utensils

41. After meals • Record accurate intake and output • Note % ¼ , ½ ,¾ ,or 100% • Provide oral hygiene • Offer fluids or supplements as ordered thru shift

42. Enteral Nutrition • Feedings administered through a tube directly into the stomach or small intestine • Naso-gastric tube • Gastrostomy tube • Jejunostomy tube

43. When is enteral feeding needed? • Comatose clients • Severe reflux disease • Paralysis of muscles used for swallowing • Obstruction • Weakness

44. Placement • X-ray verification • Aspirating gastric contents • Instilling air through tube while auscultating with a stethoscope • Ask client to speak

45. Maintenance and Prevention of Complications • Check placement q 4 h and prn • Check residual q 4 h and prn • Keep HOB up 30 degrees • Abdominal assessment, temp, lung sounds q shift and prn, stooling • Report N/V

46. Maintenance and preventiion, con’t • Change bag q 24 hrs • Measure and record I&O q 8 h • Flush tube with water -- institutional policy re: meds and feedings • Give meds individually!! Flush between each med • Observe rate of flow

47. IV (Parenteral) therapy

48. Parenteral Therapy • Provide hydration • Administer meds • Access circulatory system • Provide electrolytes • Give blood

49. LPN responsibilities • Observe rate and flow and correct solution • Record I&O • Check insertion site • Assess client’s fluid balance

50. Phlebitis • Edema • Fluid infuses readily • Good blood return • Inflammation of a vein • Red streak • Warmth • Pain