Chapter 44: Nutrition

Bonnie M. Wivell, MS, RN, CNS

Scientific Knowledge Base: NutrientsScientific Knowledge Base: Nutrients

CarbohydratesCarbohydratesStarches and sugarsStarches and sugars

FiberFiber

ProteinsProteinsAmino acidsAmino acids

FatsFatsSaturated, Saturated, monounsaturated, and monounsaturated, and polyunsaturatedpolyunsaturated

WaterWaterCells depend on a fluid Cells depend on a fluid environmentenvironment

VitaminsVitaminsEssential to metabolismEssential to metabolism

Water or fat solubleWater or fat soluble

MineralsMineralsCatalysts for Catalysts for biochemical reactionsbiochemical reactions

Anatomy and Physiology of the Anatomy and Physiology of the Digestive SystemDigestive System

DigestionDigestionBegins in the mouth Begins in the mouth and ends in the small and ends in the small and large intestineand large intestine

AbsorptionAbsorptionIntestine is the primary Intestine is the primary site for absorptionsite for absorption

Metabolism and Metabolism and Storage of Storage of NutrientsNutrientsAnabolic and catabolic Anabolic and catabolic reactionsreactions

EliminationEliminationChyme is moved Chyme is moved through peristalsis into through peristalsis into the large intestines and the large intestines and turned into fecesturned into feces

Dietary GuidelinesDietary GuidelinesDietary Reference Intakes

Acceptable range of amounts of vitamins and minerals to avoid deficiencies for age and gender groups

Food guidelinesFood Pyramid Guide, basic

guide for meal preparations

Daily valuesNeeded protein, vitamins,

minerals, fats, cholesterol, carbohydrates, fiber, sodium, and potassium

Nutrition During Growth & DevelopmentNutrition During Growth & Development Infants: as they grow they need protein,

vitamins, and minerals; high growth rate Toddlers: small, frequent meals; picky eaters;

need fewer calories, higher protein School-age: Don’t eat the required nutrients;

growth spurts Adolescents: concerned with body image Young and middle adults: reduced need for

nutrients as their growth periods end Older adults – decreased need for calories

Factors Affecting Nutritional Status Age-related GI changes

Changes in teeth and gums Reduced saliva production Atrophy of oral mucosal epithelial cells Increased taste threshold Decreased thirst sensation Reduced gag reflex Decreased esophageal and colonic peristalsis

Presence of Chronic Illness Malnutrition Adverse affects of meds Cognitive impairment

Alternative Food PatternsAlternative Food Patterns Based on religion, cultural background,

ethics, health beliefs, preference Vegetarian diet:

Ovolactovegetarian: eat eggs and milk Lactovegetarian: drink milk but avoid eggs Vegans: consume no animal products of any kind Fruitarian: eat only fruit, nuts, honey and olive oil

Zen Macrobiotic Eat brown rice, other grains, & herb teas

AssessmentAssessment Nurses are in an excellent position to

recognize signs of poor nutrition Pts who are malnourished are at greater risk

of life-threatening complications during hospitalization such as arrhythmia, sepsis, hemorrhage

A nutritional assessment is more than taking a diet history

Screening http://www.mna-elderly.com/user_guide.html

Assessment Continued Anthropometry = a systematic measurement of

the size and makeup of the body at specific body sites

Laboratory and biochemical tests CBC, albumin, pre-albumin transferrin (transferrin is

a blood plasma protein for iron), electrolytes, BUN, creatinine, glucose, cholesterol, triglycerides, and retinol (form of Vitamin A).

Dietary and health history Physical examination

Dyphagia (difficulty swallowing)

Nursing Diagnosis and Nursing Diagnosis and PlanningPlanning

Select from the NANDA-I–approved list after assessment

Plan outcomes and goals to assist client’s needs

Improving a client’s diet takes care and planning

ImplementationImplementation Ill, debilitated, and recovering clients often

have poor diets Socioeconomic, psychosocial, and

environmental factors can contribute to a poor diet

Advancing diets – see Box 44-10 Promoting appetite

Clean and odor free environment Oral hygiene Social time Music therapy

Implementation Continued

Make sure clients can feed themselves, can swallow and are positioned properly

If clients have visual difficulties, they may need assistance with feeding. You can also help clients by telling them where food is placed, according to the face of a clock (e.g., peas at 3 o’clock)

Enteral Tube FeedingEnteral Tube Feeding

Nasogastric Nasointestinal Gastrostomy Jejunostomy PEG PEJ Video

INSERTING THE FEEDING OR ASPIRATING TUBE

ASSEMBLE EQUIPMENT EXPLAIN PROCEDURE TO PATIENT MEASURE TUBE INSERT (will practice in lab) INSERT 20ml AIR TO COMFIRM

PLACEMENT ASPIRATE 5ml OF GASTRIC CONTENTS

TO TEST pH

Enteral Tube Feeding Complications

Aspiration Diarrhea Constipation Tube occlusion Tube displacement Abd. Cramping, nausea, vomiting Delayed gastric emptying Electrolyte imbalance Fluid overload Hyperosmolar dehydration

Total Parenteral Nutrition Specialized nutrition support in which

nutrients are provided intravenouslyMust be infused via a central catheterAverage 50% Dextrose solution + Amino

acids, vitamins, minerals, electrolytesLipids (Fat Emulsion) provide supplemental

kilocalories and prevent essential fatty acid deficiencies

Administered to clients who are unable to digest or absorb enteral nutrition

Complications From Total Parenteral Nutrition

Catheter occlusion Catheter infection Electrolyte imbalance Hypo/hyperglycemia HHNC (Hperglycemic Hyperosmolar

Nonketotic Coma)

Medical Nutrition Therapy GI diseases

PUDH. Pylori Inflammatory bowel diseaseMalabsorption syndromes (celiac disease)Diverticulitis

DM (American Dietetic Association) CV Disease (American Heart Association) Cancer HIV

EvaluationEvaluation

To measure the effectiveness of nutritional interventions

To ascertain if client has met goals and outcomes

To amend nursing interventions