Nutritional Needs & Diet Modification

1. Adonis K. Lomibao, R.N. 12/20/11 Nutritional Needs & Diet Modification

3. Introduction • Nutrition:process by which the body takes in food for growth and repair and uses it to maintain health. • Signs of good nutrition: -shiny hair -clear skin & eyes -well-developed body -an alert expression -p.427

4. Normal Nutrition & Essential Nutrients • Digestion:process of breaking down foods into simple substances that can be used by body cells for nourishment • Substances are essential nutrients: -Proteins-carbs-fats-minerals-vitamins-water • Supply heat & energy • Build & repair body tissue • Regulate body functions

5. Protein • The basic material of every body cell • Only nutrient that can make new cells & rebuild tissue • Made of amino acids • Foods: -meat-poultry-eggs-milk-cheese • Complete proteins:contain all the amino acids the body can't manufacture • Incomplete:DO NOT contain all the essential amino acids

6. Carbs & Fats • Energy foods used to produce heat & energy • Excess stored at fat • Foods: fruits, vegetables, grains • Supply body with fiber or roughage(cellulose) to maintain bowel regularity • Fat: comes from plants & animals • Ex: Pork,nuts,butter,cheese,egg yolk

7. Vitamins • Vitamins regulate body processes: -build strong teeth & bones -promote growth -aid normal body functioning -strengthen resistance to disease • Vitamins A,B-Complex,C,D,E,K

8. Minerals • Help build body tissues, esp. bone & teeth..also regulate chemistry oof the body fluids • Minerals include: -Calcium -Iodine -Copper -Phosphorus -Iron -Potassium

9. The Five Food Groups • Food Guide Pyramid Groups: -Grains-6oz/Daily -Vegetables-2 ½ cups/Daily -Fruits-2 cups/Daily -Oils-low -Milk-3 cups/Daily -Meat & beans-5.5oz/Daily

10. Discretionary Calories • An extra calorie that can be used on solid fats, added sugars, alcohol, or extra food. • Essential calories-the minimum calories required to meet your nutrient needs. • It is possible to use more calories than the amount required to meet your nutrient needs

11. Water • Necessary for life and all the cellular functions in the body • 2-3 Quarts Daily • required to replace fluids lost through urine, stool, sweat, and evaporation through the skin

12. Basic Facility Diets • Four common diets -Regular/General -Full liquid -Clear liquid -Soft

13. Regular/House • Normal or full diet based on 5 food groups Variety • Excludes very rich foods • Lower caloric count • May select from a menu

14. Clear Liquid Diet • Temporary b/c inadequate • Replaces fluids lost by vomiting or diarrhea • Consists of liquids that do not irritate, cause gas formation, or encourage bowel movements • Examples: -fat-free meat broths -ginger ale,7UP, clear juices -gelatin -p.431

15. Full Liquid Diet • Supplies nourishment and may be used for longer periods of time...but still temporary. • Given to patients with: -Acute infections -conditions involving digestive tract • Examples: -strained cereal -strained soups • p.432

16. Soft Diet • Usually follows the full liquir diet • Nourishes body:between-meals feedings can be given to increase calorie count • Low-residue,mildly flavored,easy to digest • Given to pts with: infection/fevers,difficulty swallowing, conditions affecting digestive tract,on progressive post-op dietary regime • Examples on p.432

17. Special Diets • Religious practices may change diet for some pts. • i.e. Jewish: -shellfish & nonkosher meats prohibited -foods can't be prepared with utensils used in non-kosher foods -p.432

18. The Diabetic Diet • For patients with Diabetes Mellitus • Proper diet and administration of insulin • Diets aim is to maintain the level of blood sugar WNL • Exchange List-method of balancing the diabetic diet based on household measurements, excludes high content sugar, divides food into 6 groups • Milk,veg,fruit,bread,meat,fat...

19. Sodium-Restricted Diet • May be ordered for pts. With chronic renal failure & cardiovascular disease • Different levels of sodium: Table 26-2 • Average American 2-6g/day • Select low-sodium foods • Low in sodium: -some cereals -vegetables -fruits

20. Calorie-Restricted • 3,500 calories=1 lb. • Prescribed for pts. That are overweight • Take consideration energy output, gen. Nutritional state, & weight goal • Balance between: -proteins: 20% -fats: 25-35% -carbs: 45-65%

21. Low-Fat/Low-Cholesterol Diet • For patients suffering from vascular, heart, liver, or gallbladder disease...or difficulty with fat metabolism • Foods baked, roasted, broiled... • Fats limited & calories balanced by increasing proteins & carbs. • Foods included: p.435

22. Mechanically Altered Diets • Consistency & texture are modified to make food easier to chew & swallow. • Mechanical soft: those who have no teeth or with serious dental problems. “consistency of ground beef” • Pureed diet: blended with gravy or liquid till its pudding consistency

23. Supplements & Nourishments • Ordered by physician or dietician to have a therapeutic value...i.e. High-protein to facilitate healing. • Not nutritionally comlete • Nourishments are substancial food items given to patients to increase nutrient intake. “between meals” • “snacks” prevent or eliminate hunger between meals • p.436

24. Calorie Counts & Food intake Studies • Food intake is analyzed for nutritional adequacy and number of calories consumed. • Info used to plan a diet to meet patient's special medical needs. • Food documentation for is prepared • Food may be weighed or measured • Inform staff & visitors

25. Dysphagia • Difficulty swallowing food & liquids • May occur in those who have: -had a stroke -neuro studies -dimentia -p/437 -those who take meds that cause sedation or reduce saliva production

26. S&S Dysphagia • Taking a long time before beginning to swallow • Swallowing 3-4x per bite of food • Lack of gag reflex or weak cough • Wet, gurgling voice • Unintentional weight loss • p.437- inform nurse

27. Dysphagia • Speech language pathology consult • Treated with swallowing exercises \, practice of proper swallowing techniques, alteration of consistency of food & beverages • Thickeners may be used -juice, nectar, honey, pudding (consistency)

28. Fluid balance • Balance between liquid intake & liquid output • Intake-2,600-3,000ml/D • Edema-excessive fluid retention • Dehydration-inadequate fluid intake • Output- 2,500ml/D -urine -perspiration -p.440

29. Fluid Balance Cont. • Record I&O • Push fluids/force fluids-encourage fluid intake • Fluid output includes: urine,emesis, drainage.

30. Alternative Nutrition • Patients that may be: -unconscious -disease of GI tract -persistent vomiting -aspiration-risk • TPN- IV Nutrition-concentrated nutrients • Enteral feedings- tubes inserted into digestive tract.

31. Alternative Nutrition Cont. • NG Tube feeding • Gastrostomy- through abdominal skin into stomach • Jejunostomy tube-tip ends in small intestine -through nose, or surgically inserted -long term...those who don't have stomach or risk for aspiration • PEG Tube-Percutaneous Endoscopic Gastrostomy-surgically inserted

32. NG Tube

33. NG Tube

34. TPN

35. TPN

36. PEG Tube

37. PEG