Nursing Fundamentals

Focus VIII
Meeting Nutritional Needs
  List b
surviv asic subst
a
signif al. Discus nces for
of the icance of s the
 Defin
e
ir im e
porta ach in ord
nce. er
and id the 6 foo

s
ct i v e nutrie entify the d groups
n
provi ts each g major
recomdes, includ oup
r
allow mended d ing the
Ob j e

ances.
 Calcu
aily

need lated estim

plan and design ated calo
per d
adequ ay to a meal ric
a te main
and id calori tain
eal we c balan
ight. ce
  Comp
are an
situat d
ion/co contrast t
respo nditio he
nsible ns
probl for nu
ems trition

s
al
ct i v e
 Desc
ribe a
Ob j e

main ltered
tainin means
nutrit g ade of
ional quate
nursin intake
g resp . Exp
each. onsib lain
ilities
for
 Energy Production and Physiological
Maintenance

Essential Nutrients and Sources

Water
Fluid and Electrolytes
Nutrients
 Essen
ts

t i al N
ien
Nutr drates
rbohy

a
Ca
 ts

nd So
u t r ien
Fa
 roteins

u r ces
P


ts
rients
rot
nu nerals
Mic nd m
i
minsa
Vita

 Food groups

Daily allowance:
Bread and cereal
Vegetable
Fruit
Dairy
Meat
Fat
and
swee
t
Food and activity!
 Adequate caloric balance

Basal Need:
Metabolis
m Anabolic reactions
 Catabolic
reactions

Basal Metabolic Rate

(BMR )
 balan c
Activ

ce
i
calor ity ne
ed:
energ
y req
comp u ireme
letely nts a
intak met b re
uate

e in fo y cal
oric
ma in od w
ta i n ith pe
le ve t hei r a ople
ls wi ctivi who
thout ty
Adeq

chan w
ge. eight
 Adequate caloric balance

 Total Caloric Need

Vs

 Total Caloric Intake

 Lab Tests
BUN

Hematocrit

Hemoglobin

BUN : Creat ratio

Albumin

Serum Creatinine

Lymphocyte Count
  Health s
tatus
 Age
cting
 Socioe
tus
cono
l Sta  Physiolo mic status
fe

 Alcohol gical
o rs A

facto
tiona
rs
and d
 Culture a rugs
 Misinfo nd lif
Fact
Nutri

estyl
e
rmati
on a
nd fa
ds
 Factors Affecting Nutritional Status

Health status:

1. a good appetite is a sign of health.

2. anorexia is usually a symptom of disease or can be a

side effect of drugs.

3. Nutritional support is an essential part of recovery

from any medical treatment.
 Factors Affecting Nutritional Status
Age

 Premature babies (32-34 weeks) <5.5 lbs

 Adolescents the eating disorders are common

 approx 20 million sufferers

 Older adults  Many elderly clients take a Molotov

cocktail of meds which usually interact with
nutrients
 Socio
ec onom
ic statu
s:

cting
tus
1. Food
l Sta
e xpen
e
fixed ses
f
are n
2. ot
o rs A

Spen
tiona

ding
moni varie
es av s with
3. ailab
le
Fact

A lot
Nutri

of co
foods nven
and s ience
tarch
y foo
ds
 logical
o
Physi s
Factor abo lism
Met
 liver d
isease

Fact


Nutr
gestion n
In fectio
anore
xia in


ors A


ition
t itis
stoma
 d ysphagia
and

al Sta
 stion and

ffect
a
Dige bsorption
A traum

ing
tus
tive
ulcera
 colitis
e
lactos e
 in to le ranc
 Factors Affecting Nutritional Status
Alcohol and drugs:
1. Abuse contributes to nutritional deficiencies because money
may be spent on alcohol instead of food, and alcohol may
replace apart of the diet and depress appetite

2. Excess alcohol can also affect GI organs

3. Drugs that depress appetite can lower the intake of essential

nutrients

4. Drugs can also deplete nutrient stores and lessen absorption

 Cultu
re an
d lifest
yle:
1. Cultu

cting
patte ral, ethn

tus
rn ic
conc s and res, and relig
into aerning foo trictions ious
l Sta
e ccoun d mus
t t be t
aken
f

2.
o rs A
tiona

Spec
be gi ial foods
ven w a
hene nd diets
ver p s
ossib hould
Fact
Nutri

le
3. Olde
r
cling adults ar
t
tende o ethnic
e mo
f re ap
durin n c o
y may d hab t to
o
g illn it
ess. be increa s. This
sed
Nutritional Status

1. Food myths can be the result of cultural background,

popular interest in natural foods, peer pressure, and a
desire to control weight.

2. Food fads often involve erroneous beliefs that certain

foods are especially healthy.

3. Nurses must make sure not to be condescending when

teaching a client that foods may not have qualities
attributed to them.
 Nutritional Assessment and Support
Albumin<3.5?
Total lymphocyte
Count <1800
Is weight
<80% of ideal?

Assessment of
Oral & Gut
Psychosocial and
Is Gut functioning ? Nutritional not functioning
Physical barriers
supplements? TPN candidate
to intake

Adequate Ongoing
TPN
Dietary Intake? Assessment

Tube
Feeding

Ongoing
Assessment
Clinical Situations which Artificial Nutrition
may be Necessary
 CA of the mouth, tongue,
 Inability to ingest food 
esophagus
Facial trauma
 Unconsciousness
 Severe
 stomatitis
 Dysphagia
Muscle
esophagus
weakness in mouth and

 Pancreatitis,
 CA or the stomach
 Crohn’s disease/ulcerative colitis
 absorb
Inabilityfood
to digest or  Biliary disease

 Increase resting energy

expenditure from major trauma
and surgery, burns, severe
infection
 Anorexia and Bulimia Nervosa
 Imbalanced Nutrition

Focused assessment
 what are the physical and psychosocial barriers to
nutrition?
Body weight<20% of ideal
Appetite
Medications
Ability to eat
independently
Difficulty with the mechanics of eating
GI symptoms
Physical condition
Finances
 ired
g
l owi n
I m pa
DYSPHAGIA:
Oral phase
S wa

Pharyngeal phase

Esophageal phase
 tion
spira
for A
Risk

LOOK AT RELATED FACTORS!

 Increase Nutrient Intake

Nursing Responsibilities

Providing Enteral Feedings

- Enteral nutrition
- Feeding tubes and routes of access
- Types of formulas

- Administration of feedings

- Complications of

- feedings
Home Enteral Nutrition
 Increase Nutrient Intake
Nursing Responsibilities
Enriching the Insufficient Diet
- Special populations
Managing Therapeutic
- Anorexia
Diets
- Nausea and vomiting
- Lactose Intolerance
- Malabsorption
- Diabetes
- AIDS and CA
- Heart Disease
- Kidney Disease
- Liver Disease
 Managing Impaired Swallowing:

Nursing Responsibilities
Positioning the patient

Encouraging the
appropriate foods
- Easy to swallow foods
 Reduce Risk of Aspiration
Nursing Responsibilities
Monitor for subtle cues:
change in respiratory
rate temperature
breath sounds
decrease oxygen saturation
check swallowing reflex
check for increased gastric residual volume
positioning
need for suctioning