NRSE 2212 Ch. 45

what is nutrition needed for?

tissue maintenance/ repair, normal growth/ development, organ function, musculoskeletal support, health promotion, and disease prevention

what diseases are treated with medical nutrition therapy?

bowel disorders (IBD, crohns, H pylori, UC), diabetes, heart disease, cancer, and obesity

diabetes MNT diet

limit lean meats to 6 oz per day

heart disease MNT diet

low sodium, fish, low sugar, fruits/ veggies

cancer MNT diet

maximize intake of good nutrients and fluids while pertaining to their preferences (note certain smells may induce nausea, and taste may be diminished)

define obesity risk factors

sedentary lifestyle, overeating, genetics

obesity BMI

> 30

overweight BMI

25-29

what does healthy people 2030 focus on?

return to the basics of eating nutrient dense foods and reducing processed foods

what must be monitoring for hydration status

sodium and electrolyte levels

normal sodium intake

< 2300 mg/day (if higher it increases risk for fluid and electrolyte imbalances)

define nutrient dense foods

proteins, diary, vegetables, fruits, whole grains, healthy fats

what do processed foods contain?

high in carbs, sugars, sodium, unhealthy fats, and chemical additives

what does healthy eating involve

eating the right amount for you, prioritize protein at every meal, consume dairy, eat veggies/ fruits throughout the day, incorporate healthy fats, focus on whole grains, limit processed foods, and limit alcohol

define islamic alternative food patterns

ramadan: fasting from sunrise-sundown for 1 month

define christianity alternative food patterns

lent: meatless fridays for 40 days before easter (fish instead)

define baptist alternative food patterns

minimal to no alcohol consumption

define Judaism alternative food patterns

restriction on pork, shellfish, certain birds, kosher preparation, 24 hr fasting rituals, no cooking of sabbath (sundown friday- sundown saturday)

define mormon alternative food patterns

no alcohol, tobacco, or caffeine (may consume soda)

define 7th day adventist alternative food patterns

no pork, fish, shellfish, alcohol, caffeine, and commonly vegetarian (may consume eggs)

what other preferences may be involved in religion/ culture?

hot/ cold foods and when they wish to consume them

define hot (food)

sign of warmth, strength, and reassurance (involved with metabolism)

define cold (food)

sign of a menacing, uncomfortable, or weak state (anti-inflammatory, detox/ elimination properties)

examples of hot foods

rice, grain cereals, alcohol, beef, chili peppers, chocolate, cooked eggs, goats milk

examples of cold foods

beans, citrus fruits, tropical fruits, dairy products, most raw vegetables, honey, chicken, fish, and goat

what are preparation guidelines?

clean, separate, cook, and chill (used to decrease risk of food borne illness)

define moderate alcohol use

1-2 drinks/ day (encourage 1-2 drinks/ week)

saturated/ trans fats should be _______ of your daily caloric intake

less than 10% (ex: sweeteners, sugars)

define age related dietary changes

decreased need for energy/ slow metabolic rate, slowed digestion/ peristalsis, decreases taste/ smell appetite, decreased intake related to lack of desire, food insecurity, health issues, oral health changes, and medication food interactions

signs of malnutrition

unintentional weight loss, fatigue, muscle weakness, changes in skin/ hair, reduced appetite, possible cognitive/ mood changes impacting diet

signs of dehydration

confusion, furrowed tongue, rapid pulse, weakness, high urine sodium

what about oral health is important for older adults?

make sure gum health is maintained, dentures fit properly, and they are free of pain/ sores

what dietary restriction should all older adults have?

no grapefruit or grapefruit juice

define aspiration risk factors

decreased LOC, dysphagia, NG tube presence, absent/ diminished cough reflex, immobile, dementia, stroke, seizure disorders, home O2 therapy, use of proton pump inhibitors, old age

what does aspiration cause?

pulmonary abscesses, airway obstruction, aspiration pneumonia

warning signs of dysphagia

cough during eating, change in voice after swallowing, abnormal tongue/ mouth/ lip movements, slow uncontrolled speech, abnormal gag, delayed swallowing, incomplete oral clearance, regurgitation

if you suspect a pt has dysphagia what should you do?

have suctioning equipment on hand + observe pt eating

types of dysphagia

myogenic, neurogenic, obstructive

define myogenic caused dysphagia

caused by aging, myasthenia gravis, or muscular dystrophy

define neurogenic caused dysphagia

caused by stroke, multiple sclerosis, parkinons, diabetic neuropathy, or cerebral palsy

nutrition interventions for dysphagia

provide 30 minute rest period prior to eating, position pt seated upright in chair or with HOB raised 90 degrees, flex head slightly forward with chin down to prevent aspiration, place food on stronger side, feed slowly with small bites, chew fully and swallow before taking another bite, allow time to empty mouth after each bite (do not rush pt)

how are pts tested for dysphagia?

seeing viscosity of liquids and diets they can consume (4 levels each)

define the 4 levels of liquids

1. thin to slightly thick

2. nectarlike

3. honeylike

4. pudding viscosity

define the 4 levels of diet

1. dysphagia puree

2. dysphagia mechanically altered

3. dysphagia advanced

4. regular

what challenges to pts with dementia face when it comes to eating?

remembering to eat, poor appetite, dysphagia, food refusal, sensory changes, restlessness, poor condition/ difficulty using utensils (increased caloric need due to movement)

what foods are recommended for dementia pts?

high calorie/ protein goods (eggs, dairy, pb), easy to chew fruits and cooked veggies, whole grains, water, juice, soups, milkshakes, and easy-to-eat snacks throughout the day

what is important to do for dementia pts?

maintain a structured routine mealtime

nutritional nursing interventions for dementia

encourage small frequent meals, finger foods, hydration reminders, modified textures, color contrast plates, minimize distractions, supervised feeding, supplements if ordered, involve family, and monitor weight regularly

when is a J tube best indicated?

if a pt is at risk for gastric reflux with enteral feeds (aspiration risk)

are enteral feeds in the hospital considered medications?

yes

what are indications for enteral nutrition?

dysphagia, stroke, neurological conditions, severe illness/ injury preventing PO intake, head/ neck/ esophageal cancers, critical care patients needing long term nutritional support, malnourished or failure to thrive pts

when is enteral nutrition used?

when a pt cannot consume adequate nutrition orally but has a functioning GI tract

what is an ENFit connector?

required for certain tube feedings (always use one if indicated)

how are tubes inserted?

a stylet is used to guide insertion into body but must be removed after placement (never reinsert a stylet after it has been removed)

what size tubes do most adults have?

french size 8-12

define standard polymeric formulas

used for pts with normal digestion and are prepackaged

define high-protein formulas

used to support wound healing, burn pts, and pressure ulcers

define calorie-dense feeds

used for pts on fluid restrictions

define fiber-enriched feeds

formulas used to promote bowel regularity

when are elemental feeds used?

for pts with GI dysfunction of malabsorption (added nutrients to prepackaged formula)

what illnesses require speciality formulas?

renal disease, diabetics, liver disease, pulmonary disease, and HIV

define the nutritional goals for enteral feeds?

meet daily caloric, protein, fluid, and nutrient needs, maintain or improve nutritional status, prevent malnutrition, dehydration, and weight loss, support wound healing and immune function, promote GI health and function

what must be done prior to a pts first enteral feed?

an x-ray to make sure the tube is placed properly

what are important safety notes when giving pts enteral feeds?

elevate HOB 30-45 degrees during/ after feeds, flush tube to prevent clogging after feeds/ meds, monitor for complications (aspiration, diarrhea, constipation, NV, tube blockage/ displacement), measure gastric residuals, and discard open formulas after 24 hrs (pre-medication may be important to aid in gastric emptying)

when is delayed gastric emptying suspected?

if gastric residual is measured and is 250 mL or more on 2 consecutive assessments 1 hour apart, or there is more than 500 mL at one time

when is gastric residual measured?

every 4-6 hrs for pts with continuous feeds and immediately before intermittent feeds

define a pt who is NPO

pts who receive only standard IV fluids for more than 5-7 days (high nutritional risk with special needs)

what are nutritional considerations for pts on NPO status?

monitor hydration (skin turgor, mucous membranes, urine output), provide IV fluids to maintain balance, reassess NPO status frequently, consider parenteral or enteral nutrition

how often must oral care be performed on NPO pts?

2-4 hours

what are nutritional considerations for pts with NVD?

maintain hydration/ electrolyte balance, monitor I/ O + signs of dehydration, position pt to prevent aspiration, administer antiemetic/ antidiarrheal, offer small frequent sips of water/ bland foods, avoid triggers, promote rest, oral/ skin care, education, use of PPE and hand hygiene

what should be documented regarding emesis/ diarrhea?

amount, frequency, color, consistency, thickness

what meal plan is good for nauseous pts?

small frequent meals of bland foods (toast/ crackers), ginger ale, broth, pedialyte/ gatorade

what are pts who vomit at risk for?

dehydration, electrolyte imbalances, aspiration

what are pts who have diarrhea at risk for?

fluid/ electrolyte imbalances (K+), ginger ale, skin breakdown

what foods are recommended for pts with diarrhea?

fluids with electrolytes, bland foods (bananas, rice, applesauce, toast), avoid dairy, high fats, sugary items, decrease fiber

what are signs of dehydration?

low BP, tachycardia, dry mucous membranes

define a bariatric pt

individual who is obese/ morbidly obese and has undergone or is going to undergo weight loss surgery to achieve significant weight loss

what are the bariatric procedures?

gastric bypass, sleeve gastrectomy, adjustable gastric banding

what complications are bariatric pts at risk for?

impaired mobility, skin breakdown, resp issues, and nutritional deficiency post-op

what lifelong supplements will bariatric pts need?

vitamins and minerals (iron, calcium, vit D, B12, folate, thiamine)

what is dumping syndrome?

common in gastric bypass pts when food moves too quickly from the stomach to the intestines causing abdominal discomfort, NVD, and nutritional complications

how much protein is needed for bariatric pts?

60-80 g/day

what do bariatric pts do pre-op?

placed on a weight loss diet to lose 10-15 lbs

how many oz must bariatric pts consume?

65 of a sugar-free non-carbonated fluid (small sips, avoid drinking during meals, avoid caffeine)

define normal diet progression

clear liquid-> full liquid -> mechanical soft-> soft/ low residue-> high fiber-> regular

define clear liquid foods

broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, ice, popsicles

define full liquid foods

smooth textured dairy products (ice cream), cream soups, custards, vegetable juice, pureed vegetables, all fruit juices, puddings

define mechanical soft foods

all cream soups, ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked/ canned fruits, bananas, soups, pb, eggs (not fried)

define soft/ low residue foods

addition of low-fiber easily digested foods such as pastas, canned cooked fruits or veggies, desserts, cakes, and cookies (no nuts/ coconuts)

define high fiber foods

fresh uncooked fruits, steamed fresh veggies, bran, oatmeal

500 mL = _____

1 lb

what does rapid weight gain/ weight loss signal to?

fluid shifts

what are common nutrition related nursing diagnoses?

risk of aspiration, overweight, impaired self feeding, impaired swallowing, imapired low nuritional intake

enteral feeding safety guidelines

verify ENFit connector is attached, aseptic technique, right formula, right tube, right client, label equipment (pt name, room, date), elevate HOB 30-45 degrees, no food coloring or added dye, always use infusion pump, look at guidelines for hang time

how long after a meal should a pt remain sitting up for?

30-60 minutes to prevent aspiration

define general nutritional safety guidelines

consider food allergies/ sensitivities, educate on food-borne illness and proper food prep, assess for dysphagia, watch for choking hazards, remain upright during/ after meals, monitor for signs of aspiration

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