Chapter 16

Stress response in the body

• Protein catabolism

  • Leads to impaired immune function, increased risk of infection, impaired or delayed wound healing, & increased mortality

lbs to kg

divide the weight in pounds by 2.2

kg to lbs

multiply the weight in kilograms by 2.2

pounds and ounces to kg (ex: 32 lbs 8 oz to kg)

1. divide ounces by 16 and add that number to pounds

   • 8/16= 0.5

   • 32 + 0.5= 32.5 lbs

2. Then divide 32.5 by 2.2 to convert to kilograms.

burns

the most severe form of metabolic stress

nutrition for burns covering < 25% of total body surface area (TBSA)

• Oral high-protein (red meat, chicken, milk, yogurt, cheese, legumes, beans, lentils), high-calorie diet can adequately meet protein & calorie requirements of most clients.

  • 3 meals a day with 2-3 snacks

• Fluid and electrolyte replacement to maintain adequate blood volume and BP is priority of the initial postburn period.

• Then priority is to meet calorie and protein needs.

  • Protein needs are typically 2.0 to 2.5 g/kg.

decreased sepsis

Early and aggressive enteral nutrition has been associated with…

enteral feedings for burn patients

• Early and aggressive enteral nutrition

• Can be started safely within hours of injury in patients of all ages

• To enhance success, begin feedings at a rate of 20–40 mL/h and try to reach the therapeutic goal rate within 24 hours

What are aspects of nutritional needs that must be considered for burn patients?

• Calorie needs and their distribution in nutrients

• Protein needs

• Micronutrients: vitamins and trace elements

How to calculate caloric needs for burn patients 16-60

(25 kcal x weight in kg) + (40 kcal x %TBSA)=

How to calculate caloric needs for burn patients over 60

(25 kcal x weight in kg) + (65 kcal x %TBSA)=

how to calculate protein needs for burn patients

weight in kg multiplied by 2.0 and 2.5 to get the appropriate range

Micronutrients important for burn healing

• Vitamin A, vitamin C, and zinc due to their crucial role in the process of wound healing

• Copper, iron, selenium, phosphorus, & manganese due to excessive loss in burn patients

• To help with this, one multivitamin with minerals should be supplemented each day

Nutrition-related complications associated with burns

malnutrition, hypermetabolism, and impaired wound healing due to insufficient vitamins and minerals. 

hypermetabolic

A state of increased and excessive metabolism (the body burns a lot of calories); this is triggered by wound healing because the body needs extra energy to heal.

enteral nutrition

• Recommended for burn clients who have functional GI tracts but are unable to orally meet their estimated calorie needs.

• Initiate 4-6 hours of injury if possible.

• Early initiation is associated with improved structure & function of GI tract & fewer episodes of infection. May also blunt hypermetabolic response to burns.

• Use PN if this is not tolerated

Cancer & HIV/AIDS

Can cause devastating weight loss and malnutrition

Nutrition for cancer PREVENTION

• 25-38 g/day of fiber depending on sex & age to lessen risk of colon cancer.

• Eliminate tobacco & exposure to asbestos to reduce risk of lung cancer.

• Limit alcohol (associated with many cancers).

• Avoid meat prepared by smoking, pickling, charcoal grilling, & use of nitrate-containing chemicals (possibly carcinogenic).

• Eat at least 2.5 cups of a variety of fruits & vegetables daily

  • linked to lower incidence of many cancers & obesity, which affects risk for cancer development.

• Consume whole grains.

• Low-fiber foods & high fat can cause a variety of cancers (lung, esophageal, pancreatic, oral cavity, cervical, kidney, bladder, liver, stomach).

• Consume polyunsaturated and monounsaturated fats (found in fish and olive oil), which might be beneficial in lowering the risk of many types of cancer.

Impact of surgery for cancer patients

• Malnourished patients prior to surgery are at higher risk of morbidity and mortality

• Postsurgical nutritional requirements:

  • Increased need for protein, calories, vitamin C, B vitamins, and iron to replenish losses and promote healing.

Impact of chemotherapy

• Damage reproductive ability of both malignant and normal cells.

• Side effects:
   Anorexia
   Nausea and vomiting
   Taste alterations
   Sore mouth or throat
   Diarrhea
   Early satiety
   Constipation

The best way to maintain or increase calorie & protein intake

• Through normal food

• Eating small frequent meals, drinking protein-enriched milk, use whole milk instead of water in recipes, using yogurt as a topping for fruit, incorporate peanut butter, and add milk, cheese, yogurt, or ice cream to meals.

• eat more on days when you are feeling better

Interventions to mitigate side effects or complications of cancer or its treatments can improve oral intake

• Sip water throughout the day, eat tart or sweet foods, chew gum, or suck on candy to increase the production of saliva if experiencing dry mouth.

• Marinating foods, eating tart food or drinks, and adding extra flavoring such as herbs, sauces, and sweeteners can help if a patient is experiencing taste alterations like loss of taste.

• Using plastic silverware can help if a patient is experiencing metallic taste.

• Individuals with stomatitis are advised to eat foods that are easy to chew and swallow like custard and scrambled eggs and cut foods into small pieces and bites.

The goals of nutrition intervention focus on

• promoting the best possible quality of life

• managing nutrition-related symptoms that cause distress.

at the end of life (for cancer patients)

Intake of food and fluids is self-restricted as part of the normal dying process

HIV

• A chronic infectious disease that attacks the immune system, specifically CD4 cells.

  • Progresses to AIDS when CD4 cell count is <200 cell/mL and/or an AIDS-defining illness is diagnosed.

• Poor nutrition can impact the course of ______; untreated _____ can have significant effects on nutritional status.

DRI’s for HIV patients

• 45%-65% calories from carbs

• 10%-35% from protein

• 20%-35% calories from fat

Nutrition for HIV

increase calories, high protein diet, multivitamin, liberal fluid intake to prevent dehydration

Interventions for immunosuppression

• Monitor effectiveness of nutrition (weight, BMI, labs).

• Watch out for potential food sources of bacteria like raw fruits & vegetables, & undercooked meat, poultry, or eggs.

• Wash fruits and vegetables. Cook foods thoroughly.

• Refrigerate perishable foods as soon as possible.

• Make food choices based on nutrition recommendations.

Nursing care for early satiety and anorexia (cancer/chemo/HIV/AIDS)

• Small amounts of high-protein, high calorie, nutrient dense foods

• Consume food in the morning when appetite is best.

• Avoid food odors.

• Eat cool or room temperature foods

nursing care for mouth sores & ulcers/stomatitis (cancer/chemo/HIV/AIDS)

• Use soft toothbrush to clean teeth after eating & at bedtime & avoid mouth washes that contain alcohol.

• Omit acidic, spicy, dry, or coarse foods.

• Cut food into small bites.

• Replace meals with high-calorie/protein drinks.

• Prepare foods that are cooked until tender and soft.

• Add gravies, broth, & a variety of mild sauces to moistened prepared foods

Nursing care for fatigue (cancer/chemo/HIV/AIDS)

• Eat a large, calorie-dense breakfast when energy level is the highest.

  • Eat small, frequent meals otherwise.

• Conserve energy by eating foods that are easy to prepare or use a meal delivery service

Nursing care for taste alterations and thick saliva (cancer/chemo/HIV/AIDS)

• Add foods that are tart (citrus juices), sauces, & seasonings for added flavor.

• Use plastic utensils for eating.

• Suck on mints, candy, or chew gum to remove bad taste in mouth.

• Sweeten meat with apple or cranberry sauce.

Nursing care for nausea & vomiting (cancer/chemo/HIV/AIDS)

o Eat cold or room-temperature foods.
o High-carbohydrate, low-fat foods, and avoid fried foods.
o Do not eat prior to chemotherapy or radiation.
o Take prescribed antiemetic medication.
o Sit up for 1 hr after a meal.
o Sip on ginger ale or ginger tea

Nursing care for diarrhea (cancer/chemo/HIV/AIDS)

• Ensure adequate intake of liquids throughout the day to replace losses.

• Avoid foods that exacerbate diarrhea (foods high in roughage).

• Consume foods high in pectin to increase the bulk of the stool and to lengthen transition time in the colon.

• Limit caffeine, hot or cold drinks, and fatty foods