NUTRITIONBY

Nelson Munthali Dip/RN

Definition of nutrition. Identify the physiological value of nutrients. Describe how diet guidelines and menu

planning promotes nutrition and health. Explain how culture influences food

preferences and eating habits. Explain the impact of age related changes

on nutritional status.

OBJECTIVES

Describe the process of assessing a clients nutritional status.

Explain how food for a sick patient can be prepared.

Describe the expected outcomes of nursing interventions that promote optimum nutritional status.

Identify common nursing interventions for clients experience nutritional deficits

Describe the role of nutritional support teams in managing the care of clients with nutritional deficits.

What are the indications for different feeding methods

Nutrition is the process by which the body metabolizes and utilizes nutrients.

Nutrients are classified as energy nutrients, organic nutrients and inorganic nutrients.

Energy nutrients release energy for maintenance of homeostasis. These are carbohydrates, proteins and fats.

Organic nutrients build and maintain body tissues and regulate body processes.

DEFINITION

Examples are carbohydrates, proteins, fats and vitamins.

Inorganic nutrients provide a medium for chemical reactions, transport materials, maintain body temperature, promote bone formation and conduct nerve impulses. These are water minerals.

- Carbohydrates are converted into glucose before they reach the cells.

- Proteins are converted into aminoacids.- Fats are converted into fatty acids.TERMS TO KNOW-Digestion. - metabolism -

hyperthyroidism-mastication. -absorption -

hypothyroidism-deglutition. -peristalsis-anabolism. - catabolism

Understanding the role of basic nutrients provides the foundation for selecting foods that promote good health.

There are six categories of nutrients: water vitamins, minerals, carbohydrates, proteins and lipids(fats).

NUTRIENTS

Water The most abundant nutrient in the body 70%

in adults, 77% in infants weight. Major components of body fluids, secretions and excretions. Body water decreases as body fat increases and with aging.

VitaminsThese are organic compounds that regulate

cellular metabolism, assisting the biochemical processes

that release energy from the digested food, water soluble and fat soluble.

MineralsServe as catalysts in biochemical reactions.

Classified as macro and micro minerals. Macro have quantities of 100mg or greater eg calcium, phosphorus, and magnesium. While micro nutrients have trace elements with quantities less than 100mg eg fluoride, iodine, iron, zinc which play an essential role in metabolism.

CarbohydratesThese are organic compounds composed of

carbon, hydrogen and oxygen. They play a significant role in providing cells with energy and supporting the normal functioning of the body.

Carbohydrates are classified according to the number of saccharides(sugar units).

1. Monosacharides (simple sugar) includes glucose, galactose and fructose.

2. Disaccharides(double sugar) includes sucrose, lactose and maltose.

3. Polysaccharides(complex sugars) includes glycogen, cellulose and starch.

Glucose supplies the major source of energy needed for cellular activity such as nerve

In order to make a nursing diagnosis, the nurse must interpret the subjective and objective data and draw a conclusion.

Imbalance nutrition -less than body requirements.-more than body requirements or risk for

more than body requirements.

NURSING DIAGNOSIS

Impulse transmission, muscle contractions etc. glucose is also needed for the synthesis of fatty acids and amino acids .

Glucose metabolism is dependent on the availability of insulin.

NOTE: hyperglycemia is blood sugar level of >110mg/dl

hypoglycemia sugar level of <80mg/dl

ProteinsThese are organic compounds that contain

carbon, hydrogen and nitrogen atoms. They are important for every bodily function beginning wit the genetic control of protein synthesis, cell function and cell reproduction. The end product is amino acid 20 in number and categorized as essential and nonessential amino acids.

- Essential amino acids must be ingested in the diet because they cannot be synthesized by the body.

- Nonessential amino acids can be synthesized (manufactured) in the cells.

- Transport of amino acids into the cells is enhanced by potassium and magnesium electrolytes.

Lipids These are organic compounds insoluble in

water but soluble in organic solvents such ether and alcohol. They are classified as saturated and unsaturated fatty acids.

EXPECTED OUTCOMES FOR A CLIENT WITH IMBALANCED NUTRITION

Client maintains intake and output balance. Client consumes the proper amounts of

food from the six food groups. Client complies wit diet therapy. Client tolerates tube feeding without

experiencing nausea, vomiting and diarrhea.

Client remains infection free while receiving parenteral nutrition.

The goal of a nursing assessment is to collect subjective and objective data regarding the nutritional status of the patient and determine what type of nutritional support is needed.

Nurses are in a unique position to recognize malnutrition or alterations related to inadequate intake, disorders of digestion, absorption or overeating.

ASSESSMENT

The assessment has the following components: nutritional history, physical examination, diagnostic and laboratory data.

A. Nutritional history. This is important in the development of a care

plan for a patient experiencing alterations in nutrition and metabolism. Several methods are used to collect subjective data; 24 hour dietary recall, food frequency questionaire ,food record and diet history

B. Physical examinationA physical assessment requires decision

making, problem solving and organization.The nurse should be aware of rapidly

proliferating tissues such as hair, skin , eyes lips and tongue that usually show nutrients deficiency sooner than other tissues . Intake and output are critical measurements and daily weight for some conditions.

C. Diagnostic and laboratory data.This is objective data which can show

alterations in nutrition.

Nutritional problems often require dietary modifications with consideration to patients culture, socioeconomic, psychologic and physiologic. Modified diets should promote effective nutrition within clients lifestyle. This requires teaching the avoidance of certain foods or adding food items to the diet.

INITIATING DIET THERAPY

NOTHING PER MOUTHThis is a diet modification as well as fluid

restriction. This intervention is prescribed prior to surgery and certain diagnostic procedures, or when a patients nutritional problems have not been identified.

CLEAR LIQUID DIETDairy products are not allowed on a clear liquid

diet. The patient is allowed to ingest only liquids that keep the GIT empty(no residues), such as water and apple juice.

TYPES OF DIETS

LIQUID DIETA full liquid diet consisting of various types of

liquids is prescribed mainly for post operative patients because of calorie and nutrient consideration. If a client tolerates a liquid diet without nausea or vomiting and has normal bowel sounds the diet is progressed to as tolerated.

SOFT DIETA soft diet promotes the mechanical digestion of

foods. It is prescribed for clients experiencing difficulties in chewing and swallowing as well as post operative patients.

LOW RESIDUE DIET it has reduced fiber and cellulose. Prescribed to

decrease GI mucosa irritation in patients with ulcerations. Foods to be avoided are raw fruits except banana, vegetables, seeds, plant fibers and whole grains

HIGH FIBER DIET.The opposite of low residue diet. It increases

the forward motion of the indigestible wastes through the colon.

BLAND DIETIt eliminates chemical and mechanical food

irritants such as fried foods, alcohol and caffeine.

Other types of diets are sodium restricted diet and fat controlled diet.

Proper nutrition in hospitalized clients is necessary for wound healing, recovery, reduction in morbidity and consequently reduction in length of stay and mortality.

Because eating is a social activity, the nurse should encourage a family member to be present during meals.

IMPORTANCE OF PROVIDING NUTRITIONAL SUPPORT

Clean patients mouth to expose the taste buds which promotes food intake.

Provide a clean and quiet environment to avoid lose of appetite due to unattractive environment.

Provide small frequent meals. They do not demand for a lot of work to finish and they are attractive.

Provide food that the patients likes if possible.

FACTORS TO CONSIDER DURING NUTRITIONAL SUPPORT.

Present meals in attractive manner as this promotes appetite

There are two routes namely enteral(EN) route and parenteral(PN) nutrition.

a) Enteral nutrition includes both the ingestion of food orally and the delivery of nutrients through a gastrointestinal tube.

b) Parenteral nutrition refers to nutrients bypassing the small intestines and entering the blood directly.

Enteral nutrition is preferred over parenteral because of decreased bacterial traslocation and reduced expense and is usually delivered through a feeding tube.

ROUTES FOR DELIVERY OF NUTRITION

Gastrointestinal function. Expected duration of therapy. Aspiration risks. The potential for or the actual development

of organ dysfunction.

Enteral feeding maintains the structural and functional integrity of the GIT. It enhances the utilization of nutrients and provide a safe and economical method of feeding

POINTS TO CONSIDER WHEN CHOSING FEEDING ROUTE

Enteral route is contraindicated in clients wit the following.

Diffused peritonitis. Intestinal obstruction that prohibits normal

bowel functioning. Projectile vomiting. Paralytic ileus. Severe diarrhea

CONTRAINDICATIONS

Naso enteral insertion is the simplest and most commonly used method of tube feeding.

Used as a temporary measure for clients expected to resume oral feeding.

Nutrients are in liquid form so they can easily pass through the tube, be digested and absorbed.

TUBE FEEDING

EQUIPMENT• Non sterile gloves .• Cup of water and straw.• Towel and tissue.• Hypoallergic tape and rubber band.• 20ml syringe with a small bole tube.• Water soluble lubricant.• Feeding tube.• Administration tube.

INSERTION OF A NASO GASTRIC TUBE

1. Review clients medical record, to confirm prescription for inserting a nasogastric tube, history of nasal or sinus insertion. Identify the right client.

2. Gather equipment, wash hands. This promotes efficiency and reduces transfer of microorganisms.

3. Explain the procedure to the patient and show the items to be used. This reduces anxiety and increases clients cooperation.

PROCEDURE

4. Place client in a fowlers position at least a 45 degrees angle or higher with a pillow behind the client’s shoulders, provide privacy. Place a comatose patient in semifowlers position. This facilitates passage of the tube into the esophagus and swallowing.

5. Place towel over chest, put tissues in reach . Don gloves . This prevents soiling of the gown and beddings and protects the nurse from contamination with body fluids respectively.

6.Examine nostril and assess as client breaths through each nostril to determine the most patent nostril to facilitate insertion

7. Measure length of tubing needed by using tube as a tape measure:

-measure length from bridge of patients nose to earlobe to xiphoid of sternum’

-if tube is to go below stomach(nasoduodenal or nasojujenal) add an addition 15 to 20 cm.

-place a small piece of tape on tube to mark length to appropriate length of tube needed to reach stomach.

8. Have a clients blow nose and encourage swallowing of water if level of consciousness and treatment plan permit. This clears nasal passage without pushing microorganisms into inner ear, facilitates passage of tube.

9. Lubricate first 4 inches of the tube with water soluble lubricant to facilitate passage into the nares.

10. Insert tube as follows:

- Gently pass tube into nostrils to back of throat 9client may gag; aim tube towards back of throat and down.

- When client feels tube in back of throat, use flashlight or penlight to locate tip of tube.

- Instruct client to flex head towards chest. This opens the esophagus and assists in tube insertion. Minimal trauma to mucosa is experienced.

- Instruct client to swallow, offer water and advance tube as client swallows.

-this assists in pushing tube past oropharynx.

-if resistance is met, rotate tube slowly with downward advancement towards clients closest ear, do not force tube , tube may be coiled or kinked or in the oropharynx or trachea.

11.Withdraw tube immediately if changes occurs in respiratory status, this indicates placement of tube in the bronchus or lungs.

12. Advance tube, giving clients sips of water until taped mark is reached. This assists with tube insertion.

13. Check placement of tube to ensure proper placement in the stomach by aspirating and if contents from the stomach appears it means its in the right position.

Leave syringe attached to free end of tube to prevent leakage of gastric contents.

14. Secure with tape to prevent tube from coming out or being dislodged.

15. Instruct client about movements that can dislodge the tube. This reduces anxiety and teaches clients how to prevent tugging n tube with head movement.

16gastric decompression:-remove syringe from free end of tube and

connect tube to suction tubing, set machine on type of suction and pressure as prescribed by physician.

- Observe nature and amount of gastric tube drainage.

- Assess client of nausea, vomiting and abdominal distention. This indicates effectiveness of interventions.

17. provide oral hygiene and cleanse nares with a tissue to promote comfort.

18. Remove gloves, dispose of contaminated materials in proper container and wash hands.

- This reduces transmission of microorganisms, protects other health workers from coming into contact with objects contaminated with body fluids

19. Position client for comfort.20. Document :- Reason for tube insertion.- Type of tube inserted.- Type of suctioning and pressure setting .- The nature and amount of aspirate and

drainage.

- Clients tolerance to the procedure.- The effectiveness of the interventions.

CRAVEN - FUNDAMENTALS OF NURSING.

REFERRENCES

YEBO