1. Principles of Nutrition and Fluid Balance
Nutritional needs and diet modifications

2. Nutrition
Process by which the body takes in food for growth and repair and uses it to maintain health.

3. Signs of Good Nutrition
Shiny hair
clean skin and eyes
well developed body
alert expression
pleasant disposition
health sleep patterns
appropriate appetite
regular bowel habits
body weight appropriate to height

4. Digestion
Process of breaking down foods into simple substances that can be used by the body for nourishment; the substances are call essential nutrients

5. Essential Nutrients Body requires foods that: Six essential nutrients
supply heat and energy
build and repair body tissues
regulate body function y requires foods that
Six essential nutrients
proteins
carbohydrates
fats
minerals
vitamins
water

6. Protein sources
Meat
Poultry
Eggs
Milk
cheese

7. Carbohydrates and fats
Energy foods-used to produce heat and energy
sources include
fruit
vegetables
foods made from grains

8. Fats Plant and animal sources
Examples of food that are rich in fat include
pork
butter
nuts
egg yolk
cheese

9. Vitamins Substances that regulate body processes assist with….
Building strong teeth and bones
promoting growth
aid normal body functioning
strengthening resistance to disease Vitamins used by the body

10. Minerals Build body tissues especially bones and teeth
help regulate body fluids such as blood and digestive juices
Mineral needed daily are Calcium, phosphorus, iodine, iron, copper, potassium

11. Five Food Groups US Department of Agriculture recommends
Eating a variety of foods
maintain a healthy body weight
select foods low in fat, saturated fat and cholesterol
select plenty of vegetables , fruits, and grain products
use sugar in moderation
use salt and sodium in moderation
drink alcoholic beverages in moderation

12. Food Plate

13. Hospital Nutritional services
Meal trays prepared by dietary department
Includes essential nutrients
Meals prepared according to patients needs
Ordered by physician

14. Responsibilities during meals
Prepare the patient for the meal
Checking the food tray for correctness
Checking the tray card against the patients identification
Serving the tray to the patient
Assisting the patient with feeding if necessary

15. Diets Regular- normal or full diet based on the food plate
Liquid diets
Clear liquids all components are clear i.e. tea, gelatin, or broth
Full liquids includes sherbet, eggnog, malted milk, milk and cream, plain ice cream
Soft diets are low residue, mildly flavored and requires minimal digestion. Foods included are soups, cottage cheese, crackers, fish, white meat of chicken and turkey

16. Special diets Religious restricted
Therapeutic –prepared according to the patient’s individual health problem

17. Therapeutic Diets
Diabetic diet-prepared to maintain the patient’s blood sugar within normal limits
Sodium restricted
Calorie restricted
Low fat-limits cholesterol
Mechanically altered-consistency altered
Mechanical soft
pureed

18. Nutritional supplements
Used for patients with high nutritional demands
Provided between meals and are given for specific therapeutic purposes

19. Calorie Counts Performed to assess a patients food intake
Food intake is recorded for three days or specified period and analyzed for nutritional adequacy and calories consumed
Must accurate document food consumed
Dietician uses data to develop a specific nutritional plan.

20. Dysphagia
Difficulty swallowing food and liquids; occurs in patients with neurological problems and some other diagnoses such as cancer
Clients who have had a stroke

21. Signs and Symptoms of Dysphagia
Taking a long time before beginning to swallow
Swallowing three or four times with each bite of food
Frequent throat clearing or coughing
Lack of a gag reflex or weak cough
Difficulty controlling liquids and secretions in the mouth

22. Dysphagia continued Wet, gurgling voice
Refusing to eat, spitting food out, or pocketing food in cheeks
Unintentional weight loss
Tightness in the throat or chest
Feeling as if food is sticking in the esophagus or sternal area

23. Aspiration Precautions
Positioning
Upright at degrees
Head and neck flexed at midline
Remain upright for at least 30 minutes after meals
Feeder at or below eye level of patient

24. Aspiration precautions
Environment
Minimize distractions, adequate lighting, comfort level
Amount and Rate
½ to 1 teaspoon at a time, pause between spoonfuls, verbal cues for additional swallows, no straws, use thickening agents, may need to decrease rate and amount of food toward end of meal
Diet
Check diet order, if patient can not tolerate stop feeding, post aspiration sigh above bed

25. Aspiration precautions continued
Other
Oral hygiene before meals, periodically throughout meal check to see if patient swallowing and can clear throat
Do Not mix textures together
Check mouth to see if pocketing food
Follow recommendations by speech pathologist– chin tuck, head turn, effortful swallow, head tilt to right or left, alternate textures

26. Alternative nutrition
Total parenteral nutrition
Enteral feedings

27. Disorders requiring TPN/Enteral nutrition
Cancer
Ulcerative Colitis
Crohn’s
Alzheimer’s Disease
ALS
MS/MD
Parkinson’s Disease
Aspiration risk

28. Disorders requiring tube feeding
Cancer
Ulcerative Colitis
Crohn’s
Alzheimer’s Disease
ALS
MS/MD
Parkinson’s Disease
Aspiration risk

29. TPN

30. Total Parenteral Nutrition
Total parenteral nutrition (TPN) supplies all daily nutritional requirements.
TPN can be used in the hospital or at home
Because TPN solutions are concentrated and can cause thrombosis of peripheral veins, a central venous catheter is usually required.

31. Types of Feeding Tubes Nasogastric: Placed at bedside/OR Short-term
Actions:
Check nares
Mouth Care
Monitor for coughing,sneezing, gagging,N/V,dysphagia
HOB elevated
Set-up/initiate feedings

32. Types of Feeding Tubes Gastric Tube: Placed surgically/endoscopically
Long-term usage
Actions:
Check site of tube for
irritation/breakdown
Clamp tube when not in use
Tube free of pressure
Set-up/initiate feedings
HOB elevated
Check for complications

33. Feeding Options Continuous Feeding:
Feedings given via pump at controlled rate ordered by MD
Administration may be 24 hrs or throughout the night only
Tube feeding formula needs to be at adequate level to ensure continuous flow (No more than two cans in bag at once)
HOB elevated
Use appropriate tubing

34. Feeding Options Bolus:
Large amount of formula administered as ordered-- q 3- 4 hrs
Administered by staff
Accurate measurement of ordered formula
Administer at appropriate controlled rate
FINAL flush is critical
HOB elevated during and after feeding

35. Effects of Tube Feeding
Loss of dignity
Loss of sensation and texture of food
Inability to share social connection with family/friends
Inability to choose diet
Anger
Possible risk of aspiration/infection

36. Charting the I & O

37. Recording Intake and Output
Perform on patients who:
Are dehydrated
Are receiving IV infusions
Have recently had surgery
Have a urinary catheter
Are perspiring profusely or vomiting
Have a specific diagnosis requiring Intake and output

38. Fluid intake
May be either encouraged or restricted depending on patient condition
Estimate intake by knowing liquid container amounts

39. Intake measurements 1 0unce= 30 cc
Sherbet cup or Ice cream cup= 120 cc
Jello = 130 cc
Popsicle = 70 cc
Juice prepack =120 cc
Soft drink = 360 cc
Broth =180 cc
Coffee= 240 cc
Milk carton= 240 cc
Iced tea = 240 cc
Hot cereal =180 cc

40. Intake and output (I&O) is the measurement of the fluids that enter the body (intake) and the fluids that leave the body (output). The two measurements should be equal. (What goes in.... must come out!)
The metric system is used for fluid measurement. The measurements should be recorded in
ml. (milliliters).
The average adult intake is mL. per day.
The average output is mL. per day.
To convert from ounces to ml., multiply by 30 (Ex. 6 oz. x 30ml. = 180ml.)
To convert from cc/ml to ounces, divide by 30 (Ex. 240cc / 30cc = 8 oz.)