Copyright © 2004 Mosby, Inc. All rights reserved.

Copyright © 2004 Mosby, Inc. All rights reserved.
Nutrition and Fluids Objective: Develop an understanding of nutrition and fluid intake, its importance, administration, and documentation. Slide 0 Copyright © 2004 Mosby, Inc. All rights reserved.

Basic Nutrition Food and water are physical needs that are necessary for life. A poor diet and poor eating habits: Increase the risk of infection Increase the risk for acute and chronic diseases Cause chronic illnesses to become worse Cause healing problems Affect physical and mental function which increases safety risk. Eating and drinking provide pleasure. A friendly, social setting for meals is important. Copyright © 2004 Mosby, Inc. All rights reserved.

Foods and fluids contain nutrients. The amount of energy provided by a nutrient is measured in calories. Nutrients include: Protein – important for tissue repair Carbohydrates - Provide energy and fiber for bowel elimination Fats - provide energy, add flavor to food, and help the body use certain vitamins. Vitamins - do not provide calories, needed for various body functions. Minerals – need for bone and tooth formation, nerve and muscle function, fluid balance. Copyright © 2004 Mosby, Inc. All rights reserved.

Factors Affecting Eating and Nutrition
Age Culture Culture influences dietary practices, food choices, and food preparation. Religion Selecting, preparing, and eating food often involve religious practices. Respect the person’s religious practices Finances Copyright © 2004 Mosby, Inc. All rights reserved.

Factors Affecting Eating and Nutrition
Appetite desire for food. Aromas and thoughts of food can stimulate the appetite. Loss of appetite (anorexia) can occur from illness, drugs, anxiety, pain, depression, and unpleasant sights, thoughts, and smells. Personal choice Illness Appetite usually decreases during illness and recovery from injuries. Nutritional needs increase at these times. A sore mouth, tooth loss, or poorly fitting dentures affect chewing. Illness can affect the ability to prepare and serve meals. Copyright © 2004 Mosby, Inc. All rights reserved.

Special Diets Physician ordered Reasons for special diets: For a nutritional deficiency or a disease Wound healing For weight control To eliminate or decrease certain substances in the diet Elimination Swallowing problems Allergies The sodium-controlled diet Heart, liver, and kidney disease, as well as hypertension and certain drugs, often require a sodium-controlled diet. Diabetes meal planning Requires a controlled amount of sugar Dysphagia diet Aspiration precautions Food thickness is changed to meet the person’s needs Copyright © 2004 Mosby, Inc. All rights reserved.

Fluid Balance An adult needs 1500 ml of water daily to survive About 2000 to 2500 ml of fluid per day are needed for normal fluid balance. Water requirements increase with hot weather, exercise, fever, illness, and excess fluid loss. Dehydration decrease in the amount of water in body tissues Edema fluid intake exceeds fluid output, tissues swell with water Copyright © 2004 Mosby, Inc. All rights reserved.

Fluid Balance Special orders Encourage fluids The person drinks an increased amount of fluid. Restrict fluids Fluids are restricted to a certain amount. Nothing by mouth (NPO) Copyright © 2004 Mosby, Inc. All rights reserved.

Intake and output (I&O) records p 438
Used to: evaluate fluid balance and kidney function To help in evaluating and planning medical treatment Measuring I&O The nurse measures and records IV fluids and tube feedings. All fluids taken by mouth are measured and recorded Output includes urine, vomitus, diarrhea, and wound drainage Mosby’s Video: Intake and Output Copyright © 2004 Mosby, Inc. All rights reserved.

Lets work together: Using the provided form, lets chart the following: 0200 Voided 300 ml 0600 Voided 500 ml 0730 Breakfast Orange juice (whole glass) Milk (1/2 Carton) Coffee (1 Cup) 0730 Voided 300 ml 1000 Water Pitcher filled 1130 Lunch Soup (whole bowl) Tea (1 Styrofoam cup) Jell-o (1 seriving) 1330 Voided 450ml 1430 Water pitcher filled 500 ml 1530 Vomitted 50 ml can of soda (whole can) 1730 Dinner Juice (whole Glass) Ice Cream (all) 1730 Voided 250ml 1830 Vomited 100 ml 1915 Voided 500 ml 2000 Milk (1 Carton) 2015 Voided 300 ml 2330 Voided 200 ml Copyright © 2004 Mosby, Inc. All rights reserved.

Using the provided form, lets chart the following:
0200 Voided 300 ml 0600 Voided 500 ml 0730 Breakfast Orange juice (whole glass) Milk (1/2 Carton) Coffee (1 Cup) 0730 Voided 300 ml 1000 Water Pitcher filled 1130 Lunch Soup (whole bowl) Tea (1 Styrofoam cup) Jell-o (1 serving) 1330 Voided 450ml 1430 Water pitcher filled 500 ml 1530 Vomited 50 ml can of soda (whole can) 1730 Dinner Juice (whole Glass) Ice Cream (all) 1730 Voided 250ml 1830 Vomited 100 ml 1915 Voided 500 ml 2000 Milk (1 Carton) 2015 Voided 300 ml 2330 Voided 200 ml Copyright © 2004 Mosby, Inc. All rights reserved.

Meeting Food and Fluids Needs
The following factors affect appetite and the ability to eat: Weakness and illness Unpleasant odors, sights, and sounds Uncomfortable positions The need for oral hygiene The need to eliminate Pain Copyright © 2004 Mosby, Inc. All rights reserved.

Preparing for meals pg 439 You need to prepare patients and residents for meals. Patients and residents need: To eliminate and have oral care Dentures, eyeglasses, and hearing aids in place To be clean and dry (if incontinent) To be in a comfortable position for eating A setting that is free of unpleasant sights, sounds, and odors Remove unpleasant equipment from the room. Mosby’s Video: Preparing for meals Copyright © 2004 Mosby, Inc. All rights reserved.

Serving meal trays pg 441 Food is served in containers that keep foods at the correct temperature. You serve meal trays after preparing persons for meals. If a meal tray is not served within 15 minutes, recheck food temperature. If the food is not at the right temperature, get another tray. Some agencies allow reheating in a microwave oven. Copyright © 2004 Mosby, Inc. All rights reserved.

Visually impaired person
Tell the person what is on the tray. When feeding a visually impaired person, describe what you are offering. For persons who feed themselves, describe foods and fluids and their place on the tray. Use the numbers on a clock for the location of foods. Figure on page 442 Mosby’s Video: Serving Meal Trays Copyright © 2004 Mosby, Inc. All rights reserved.

Feeding the person Weakness, paralysis, casts, and other physical limits can make self-feeding impossible Serve food and fluids in the order the person prefers. Spoons are used because they are less likely to cause injury. Persons who need to be fed: Are often angry, humiliated, and embarrassed May be depressed, resentful, or refuse to eat Allow time and privacy for prayer. Meals provide social contact with others. Engage the person in pleasant conversation. Sit so you face the person. Copyright © 2004 Mosby, Inc. All rights reserved.

Snacks Providing between-meal nourishments Serve nourishments when they arrive on the nursing unit. Provide needed eating utensils, a straw, and napkin. Follow the same considerations and procedures for serving meal trays and feeding persons. Providing drinking water Patients and residents need fresh drinking water each shift. They also need water whenever the pitcher is empty. Before providing water, ask the nurse about any special orders. Practice medical asepsis. Counting calories Copyright © 2004 Mosby, Inc. All rights reserved.

Meeting Special Needs Enteral nutrition page 444 Nasogastric (NG) tube Taylor’s Video: Inserting a Nasogastric tube Gastrostomy tube Jejunostomy tube Percutaneous endoscopic gastrostomy (PEG) tube Taylor’s Video: Administering a continuous tube feeding. Copyright © 2004 Mosby, Inc. All rights reserved.

Preventing aspiration
Position the person in semi-Fowler’s position. Follow the care plan for how long the person needs to remain in that position. Avoid the left side-lying position. Copyright © 2004 Mosby, Inc. All rights reserved.

Report the following to the nurse:
Nausea Discomfort during the tube feeding Vomiting Diarrhea Distended abdomen Coughing Complaints of indigestion or heartburn Redness, swelling, drainage, odor, or pain at the ostomy site Elevated temperature Signs and symptoms of respiratory distress Increased pulse rate Complaints of flatulence Copyright © 2004 Mosby, Inc. All rights reserved.

Comfort measures The person with a tube feeding is usually NPO. Dry mouth, dry lips, and sore throat cause discomfort. Comfort measures include: Hard candy or gum, if allowed Frequent oral hygiene Lubricant for the lips Mouth rinses The nose and nostrils are cleaned every 4 hours. Feeding tubes inserted through the nose can irritate and cause pressure on the nose. Securing the tube with tape or a tube holder helps prevent these problems. Follow agency policy for securing the tube to the gown Copyright © 2004 Mosby, Inc. All rights reserved.

Intravenous (IV) therapy
Central Venous Sites - page 448 Equipment – Page 450 Flow Rate Assisting with IV therapy - page 452 Never change the position of the clamp or adjust any controls on IV pumps. You can check the flow rate. To check the flow rate, count the number of drops in 1 full minute. Tell the RN at once: If no fluid is dripping If the rate is too fast If the rate is too slow Copyright © 2004 Mosby, Inc. All rights reserved.

Copyright © 2004 Mosby, Inc. All rights reserved.

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