NUTRITION

NRS 129 - Introduction to Nursing Skills

Nutritional Needs

Determining Your Patient Needs: Assessment History Observation - Daily Contact Anthropometry Laboratory data

Nutritional Needs: Nurses’ Role

Need to inform the doctor of assmt. findings

Investigate reasons for a decreased intake

Offer the patient alternative methods of intake and types of food

Factors that influence our Patterns of Eating: Health Status Culture & Religion Socioeconomic

Status Personal Preference Psychological Factors Alcohol & Drugs Misinformation &

Food Fads

Dietary History

Done to assess actual or potential problems

History focuses on habitual intake of food and liquids preferences allergies problems

Information Obtained for a Diet History

Name, Age Present weight Changes in Weight # meals/day,

snacks Who prepares the

meal? Problems R/T food Chewing difficulties

Information Continued …. Denture Use Usual bowel

pattern Medications Medical/Surgical

History Physical Activity Personal Crises

Measurements

Height and weight always always done unless patient is critically ill

Weigh patient at the same time, in same clothing with same scale

Rapid wt. gain reflects fluid shifts

Assessment Measurements Anthropometric: wrist, mid-arm, skin fold

measurements

Body Mass Index Weight (kg) / Height (m2)

>25 = overweight >30 = obese >35 higher medical risk for CAD, DM, HTN

Characteristics of HealthCategory Good Poor

GeneralAppearance

Alert,Responsive

Listless,apathetic,cachexia

Laboratory Data CBC: Low Hemoglobin and Red

blood cell count = anemia Serum Albumin: If value is

decreased = protein & calorie malnutrition

Negative Nitrogen Balance = catabolic state

Hgb, Hematocrit, and BUN reflect hydration

Patients at Risk for Nutritional Problems:

Condition that interferes with ingestion, digestion, and absorption

Surgical revisions of the GI tract IV intake only for > 7-10 days Poor dietary habits Patients undergoing treatment for

CA

Management of Common Problems

Vomiting How do you position your patient?

Serve small amounts frequently

Anti-emetics: time administrationappropriately

Planning & Implementation

Make sure your patient is comfortable No odors in the room Attractive tray Not in pain or needing nursing care

Mouth Care Positioned correctly

Special Diets Are they

Necessary?

Why?

Basic Types of Hospital Diets

General (Regular)

Soft vs. Mechanical Soft

Full Liquid

Clear Liquid

Basic Types of Hospital Diets

Low-Residue

High Fiber

Pureed Diet

Sodium Restricted

Dietary Modifications for Disease Conditions

Gastrointestinal disease: Diarrhea (Low residue) Acute gastritis: Liquid, bland Chronic gastritis: avoid foods causing

the problem Diverticulitis:

Acute: low residue Chronic: high fiber

Dietary Modifications. . . Peptic Ulcer:

Eat what you can tolerate

May need to avoid spices, alcohol, caffeine

Cardiovascular Disease:

Cardiac Prudent Diet Goals:

decrease stomach distention decrease weight decrease lipids

Cardiovascular Disease . . .

Atherosclerosis & Hypertension: weight, Low fat, cholesterol, and low sodium

Myocardial Infarction Avoid ice, caffeine, low fat, low

sodium, cholesterol

Diabetes with Dietary Changes

Diet, exercise Individualized Plan Control of

cholesterol, lipids, Increased use of

complex carbohydrates

CHO counting BALANCE

Dietary Modifications: Renal

Depends on disease state: Acute versus Chronic:

May Need restriction of protein, sodium,

fluids, and potassium

Nursing Interventions:Assisting with Eating

Assure patient’s diet/tray is correct Good Lighting (vision) available Remove covers Arrange food & Prepare food Offer assistance, self Evaluation of intake

Assessing the Need to Feed a Patient

Patients who should minimize oxygen needs

Patient who cannot feed self because of disease process or weakness

Nursing Interventions for Feeding

Being Fed = Loss of Independence Need to be considerate of Patient

to protect their dignity Allow patient to set pace NOT you Describe meal so patient can

determine the sequence

Nursing Interventions for Feeding

Before Starting: Evaluate comfort needs pain relief (timed appropriately) 30’ Offer bedpan Position patient as upright as possible

Good Opportunity for Nursing Assessment M/S, agility, color, tremors, etc.

Nursing Interventions for Feeding

Protect the patient’s clothing “Napkin” No Reference to “Bib” Assume a comfortable position at the

patient’s level May need a signal for indicating

additional food Offer self: “ Talk to patient”

Nursing Interventions . . .

Additional Guidelines: Stroke patient: Don’t place food on

paralyzed side Relatives may assist with feeding: Be

careful, family may view as they would only eat if they are there

Don’t scold patients who cannot eat Assure the environment is clean

afterwards

Nursing Interventions . . .

Encourage Food intake get rid of odors Make positive comments about food Breakfast usually best time of day nausea:

slow deep breaths avoid movement limit food and fluid intake

Intake and Output

Why is it important?

What is included in the measurement? All things liquid at room temperature Thin, cooked cereals Tube feedings, irrigations, IV fluids

Measurement of I and O Incorporate the pt. in the process

Need to record amounts immediately after consumption or elimination

Need to total amounts at specified times End of 8 hour shift End of 24 hours

Fluids to be counted as Output: Sum of all liquids

eliminated from the body

Urine Emesis Drainage tubes Remaining

Irrigation fluid Liquid stool Diapers Saturated

dressings

Measurement Considerations

1 pint { 475 ml } of water = 1 pound

1 ounce = 30 cc or 30 ml

Measurement of Output

Urine is chief source of output Teach patient & family need to

measure Hat may be placed in toilet Catheter drainage bag Leg Bag Bedpan/urinal

{need to measure using graduated cylinder}