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NUTRITION Nursing Implications

NUTRITION Nursing Implications. Heather Wrenn, RN, BSN Fall 2006. BODY WEIGHT/BODY MASS. Ideal body weight Body mass index Percent body fat. FACTORS AFFECTING NUTRITION. Development Gender Ethnicity & culture Beliefs about food Personal preferences Religious practices Lifestyle

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NUTRITION Nursing Implications

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  1. NUTRITIONNursing Implications Heather Wrenn, RN, BSN Fall 2006

  2. BODY WEIGHT/BODY MASS • Ideal body weight • Body mass index • Percent body fat

  3. FACTORS AFFECTING NUTRITION • Development • Gender • Ethnicity & culture • Beliefs about food • Personal preferences • Religious practices • Lifestyle • Medications & therapy – table 45-1

  4. FACTORS AFFECTING NUTRITION • Health • Alcohol abuse • Advertising • Psychologic factors

  5. NUTRITION THRU THE LIFE CYCLE – Young & Middle Adult • Lay foundation for lifetime nutrition pattern in young adulthood • Nutrient requirements change very little • Females need to maintain/increase intake of Vit. C , Vit D, & calcium; & maintain intake of iron • Basal metabolism decreases 2-3%/decade after age 25 • Obesity, HTN , & DM may begin to form

  6. NUTRITION THRU THE LIFE CYCLE – Older Adults • Physiologic, psychosocial, economic changes • Need fewer calories • Nutrient requirements basically the same • Variety & nutrient dense foods; water • See Kosier & Erb table 45-2

  7. Factors Affecting Nutrition:Ethnicity & Culture • Native American • Starches: corn, rice • Fruits: berries • Veggies: rhubarb, mushrooms, roots • Meats: game, seafood, nuts • Milk: little used • High incidence of lactose intolerance • Encourage broiled, poached, steamed meats

  8. Factors Affecting Nutrition:Ethnicity & Culture • U.S. Southern • Starches: cornbread, biscuits, potatoes • Fruits: melons, peaches, bananas • Veggies: collards, okra, tomatoes, cabbage • Meat: pork, chicken, fish • Milk: milk, ice cream • Many foods fried, cooked with lard

  9. Factors Affecting Nutrition:Ethnicity & Culture • Mexican • Starches: tortillas, corn products • Fruits: few • Veggies: chili peppers, tomatoes, onions • Meat: beef, poultry, eggs, pinto beans • Milk: cheese; rarely drink milk

  10. Factors Affecting Nutrition:Beliefs & Preferences • Individual likes & dislikes • Beliefs about foods • Fad diets

  11. Factors Affecting Nutrition:Religious Practices • Jewish • Kosher; no pork or shellfish; cannot consume milk or dairy at same meal with meat/poultry • Christianity • Catholics • Eastern Orthodox • Mormons • Seventh Day Adventists • Islam • No pork or alcohol; daylight fasting during Ramadan

  12. Factors Affecting Nutrition:Lifestyle • Economic & social status • Work/activities

  13. Factors Affecting Nutrition:Medications, Therapy, & Health • K&E Table 45-1 – meds • Therapies • Chemo, radiation • Health • GI disorders, viruses, oral ulcers

  14. Factors Affecting Nutrition:Alcohol, Advertising, & Psych • Alcohol • Can depress appetite • Abuse can lead to malnutrition (esp Vit B) • Advertising • May influence food choices • Psych • Overeat vs. don’t eat when stressed, depressed

  15. HEALTHY PEOPLE 2010 • http://www.health.gov/healthypeople • Goals: • Increase in span of healthy life for Americans • Reduction of health disparities among Americans • Target areas: • Wt control issues; dietary intake issues; school nutrition issues;anemia in pregnancy; nutrition education, assessment, planning issues

  16. DIETARY GUIDELINES FOR AMERICANS • Eat a variety of foods • Maintain or improve your weight • Be physically active every day • Eat diet low in trans fat, saturated fat, & cholesterol • Eat plenty of vegetables, fruits, & grains • Use sugars in moderation • Use salt & sodium in moderation • If you drink alcohol, do so in moderation

  17. FOOD GUIDE PYRAMID • Healthy Eating Pyramid • Daily exercise & weight control • Whole grains at most meals • Vegetables in abundance • Fruits 2-3 times/day • Nuts, legumes 1-3 times/day • Fish, poultry, eggs 0-2 times/day • Dairy or calcium supplement 1-2 times/day • White rice, white bread, potatoes, pasta, sweets, red meat, butter sparingly • MVI for most • Alcohol in moderation

  18. ALTERED NUTRITION • Malnutrition – lack of necessary or appropriate food substances • Overnutrition – caloric intake in excess of daily energy requirements • Overweight – BMI 26-30 • Obese – BMI > 30 • Morbid obesity – interferes with mobility or breathing

  19. ALTERED NUTRITION • Malnutrition • Undernutrition – intake of nutrients insufficient to meet daily energy requirements as a result of inadequate food intake or improper digestion & absorption of food • Dysphagia – difficulty swallowing • Anorexia – loss of appetite • Protein-calorie malnutrition

  20. ASSESSMENT • Usual eating patterns & habits • 24 hour food recall • Allergies & intolerances • Food frequency record • Brief personal & family history • Height/weight • Ideal body weight • Body mass index • Manifestations of malnutrition (table 45-4) • Social, economic, ethnic, religious factors • Other risk factors for altered nutrition

  21. RISK FACTORS FOR NUTRITIONAL PROBLEMS • Diet history • Chewing or swallowing difficulties • Inadequate food intake • Restricted or fad diets • No intake for 10 or more days • IVF • Inadequate food budget • Inadequate food preparation facilities • Physical disabilities • Living & eating alone

  22. RISK FACTORS FOR NUTRITIONAL PROBLEMS • Medical history • Unintentional wt loss or gain of 10% within 6 months • F/E imbalance • Oral or GI surgery • Dental problems • GI problems • Chronic illness • Alcohol or substance abuse • Neurologic or cognitive impairment • Catabolic or hypermetabolic condition • Adolescent pregnancy or closely spaced pregnancy

  23. RISK FACTORS FOR NUTRITIONAL PROBLEMS • Medication history • Aspirin • Antacid • Antidepressants • Antihypertensives • Anti-inflammatory agents • Antineoplastic agents • Digitalis • Laxatives • Diuretics • Potassium chloride

  24. PHYSICAL EXAM • General appearance & vitality • Weight • Skin • Nails • Hair • Eyes • Lips, tongue, gums, teeth • Heart • Abdomen • Musculoskeletal • Neurologic

  25. ANTHROPOMETRIC MEASUREMENTS • Height & weight • Skinfold measurements – tricep most common site

  26. LABORATORY DATA • Albumin & pre-albumin • Transferrin • Hgb • BUN • 24 hour urine • Total lymphocyte count

  27. DIAGNOSING • Altered nutrition: more than body requirements • Altered nutrition: less than body requirements • Altered nutrition: risk for more than body requirements • Fluid volume excess, fluid volume deficit, & risk for fluid volume deficit • Activity intolerance • Constipation • Risk for Impaired Skin Integrity

  28. PLANNING • Client will: • Maintain I&O balance • Consume proper amounts of foods from variety of food groups • Comply with diet therapy • Tolerate tube feedings • Not have any complications assoc with malnutrition

  29. IMPLEMENTING - Teaching • Use established nutritional standards • Use visualization of serving sizes to help ID accurate serving sizes • Incorporate culturally based intake patterns or restrictions • Include client & family • Collaborate with dietician

  30. IMPLEMENTINGSpecial Diets • Vegetarian • Vegan • Ovo-vegetarian • Lacto-vegetarian • Lacto-ovo-vegetarian

  31. IMPLEMENTINGSpecial Diets • NPO – nothing by mouth • Clear liquid diet – water, tea, coffee, clear broths, gingerale, plain gelatin • Full liquid diet – clears; milk; cooked cereals, pudding, ice cream, cream soup; • Soft diet – easily chewed & digested • Dysphagia – thickened liquids • Diet as tolerated

  32. IMPLEMENTINGStimulating Appetite • Relieve illness symptoms that depress appetite prior to mealtime • Provide familiar food that person likes served at proper temp. • Select small portions • Avoid unpleasant or uncomfortable treatments or activity immediately before/after meals • Provide tidy, clean environment • Encourage or provide oral hygiene before mealtime • Reduce psychologic stress

  33. IMPLEMENTINGAssisting with Meals • Help client feed self when possible • Assist client to sit on side of bed or chair if possible • Check tray for client’s name, type of diet, & completeness • “which order would you like to eat?” • Spread napkin, cut foods, shell egg, etc. • Do not rush client; allow ample time • Offer fluids every 3 or 4 mouthfuls of food if client unable to communicate • Use adaptive feeding aids as needed • For blind person, identify placement of food as you would describe time on a clock

  34. IMPLEMENTINGSpecial Supplements • Oral • Provide calories & nutrients • Can be liquid or powdered • Specific types • Tube Feeds • When condition prevents food intake • Impairment in upper GI tract, otherwise fx GI tract • Increased metabolic needs that oral intake can’t meet • Parenteral Nutrition • IV nutrients (TPN, PPN)

  35. IMPLEMENTINGSpecial Supplements • TPN • Nonfunctional GI tract • Severely malnourished needing specific supplements • PPN • Nonfunctional GI tract • Moderate nutritional deficiencies

  36. IMPLEMENTINGEnteral Nutrition • Enteral access devices • NGT (short term) • Small-bore feeding tube • PEG (long term) • Parenteral • IV • TPN - central line • PPN – peripheral IV

  37. IMPLEMENTINGNasogastric Feeding • Types of NGT • Levin, salem sump, corpak • Verify tube placement • Gastric secretions • pH • Air bolus • Xray • S/S of distress

  38. IMPLEMENTINGEnteral Feedings • May be continuous , intermittent, or bolus • Before feeding • Determine allergies, assess MD order • Prepare client & inspect/verify formula • Assess tube placement • Assess residual (q 4h) • Flush with water • Administer at room temperature • Feeding must infuse within 8 hours • Never add fresh to formula hanging • Tubing & container change q 24h • Check residual q4h

  39. EVALUATINGEnteral Feeds • Daily wt • I & O • Labs • Monitor for complications

  40. IMPLEMENTINGParenteral Nutrition • Continuous or intermittent • Refrigerate solution unless using immediately • Read label & double check against order for all ingredients; double check with another nurse • Monitor IV site – dedicated line • New bag, tubing, filter q 24 hours • Aseptic technique • Monitor glucose levels & other labs • Must wean off

  41. EVALUATINGParenteral Nutrition • VS • I & O • Daily wt • Daily/weekly labs • Monitor for complications

  42. IMPLEMENTINGSpecial Community Services • Meals-on-Wheels • Grocery delivery services • Food stamp program

  43. IMPLEMENTINGHome Care Teaching • Preparation of formula • Proper storage of formula • Administration of feeding • Mgmt of enteral or parenteral access device • Daily monitoring needs • S/S of complications to report • Who to contact with questions/problems

  44. EVALUATING • If outcomes not achieved, • Was cause of problem correctly identified? • Was family included in teaching plan? Are they supportive? • Is client experiencing symptoms that cause loss of appetite? • Were outcomes unrealistic for this person? • Were client’s food preferences considered? • Is anything interfering with digestion or absorption of nutrients?

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