NUTRITION NRS 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 always Height and weight 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 Health

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 administration appropriately

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}