Ch. 39 Nutrition and Oral Hydration

What role do nutrients play in the body?

• Nutrients provide energy for cellular metabolism, tissue maintenance and repair,

• Organ function, growth and development, and physical activity.

Why is water considered a crucial nutrient?

• Water is critical for all body fluid and cellular functions.

What is the primary energy source for the body?

• Carbohydrates provide most of the body’s energy.

How many kcal does one gram of fat provide?

• 1 gram of fat = 9 kcal.

What are the fat-soluble vitamins?

• A, D, E, and K.

What age group has the highest energy requirements?

• Newborns and infants.

How much kcal/kg do infants need for the first 6 months?

• 108 kcal/kg.

What are two characteristics of anorexia nervosa?

• Significantly low body weight and

• Fear of being fat.

Describe bulimia nervosa.

• Binge eating followed by purging, such as vomiting or using diuretics.

What is considered obese in terms of BMI?

• BMI 30 or greater.

• < 18.5 is considered underweight, while a

• BMI 25 to 29.9 is classified as overweight.

• Normal BMI is between 18.5 and 24.9.

What factors can diminish appetite?

• Illness, medications, pain, depression, and unpleasant environmental stimuli.

What dietary change is important for older adults to prevent dehydration?

• Increased fluid intake.
  

Rationale: Older adults have a decreased sense of thirst, which can lead to dehydration.

What is nutrient density and why is it important for toddlers and preschoolers?

• Nutrient density is more important than quantity for their growth and development.

What should a nutritional assessment help identify?

• Areas to modify in nutrient intake or caloric intake.

Which type of diet should a client with dysphagia expect?

• A pureed diet with thickened liquids.

What are symptoms of poor nutrition?

• Nausea, vomiting, diarrhea, change in weight, and weakness.

What is the recommended action when caring for a client at high risk for aspiration?

• Instruct the client to tuck their chin when swallowing.

• Do NOT use a straw.

• Give Pureed foods and thickened liquids to help prevent aspiration.

What is the proper procedure for monitoring fluid intake and output?

• Measure and calculate all fluid intake and output in mL.

• Daily weights

• Daily I&O

• 1 kg = 1 L of fluid.

What dietary considerations should be made for adolescents?

• High protein, calcium, iron, and iodine needs due to high metabolic demands.

Which of the following options are necessary for metabolism?

• Proteins

• Fats

• Carbs

• Vitamins

• Vitamins: essential nutrients that aid in metabolic processes and overall health.

• Fat-soluble vitamins are A, D, E, and K. The water-soluble vitamins include C and the B complex (eight vitamins). QEBP

Solid foods in infants can be introduced at which age?

• Solid foods can be started at 6 months of age.

• Single-grain cereals like rice or oatmeal.

• Introduce one new food at a time and monitor for allergic reactions.

Nutrient density vs quantity in toddlers (1 to 3 yrs) and pre-schoolers (3 to 6 yrs)?

• Nutrient density is more important than quantity.

• Calcium and phosphorus are important for bone health.

Important nutritional aspects in School-age children (6 to 12 yrs) include:

• They grow at a slower & steadier rate, w/ a gradual decline in energy requirements.

• Tend to eat foods high in carbohydrates, fats, and salt.

• Need supervision to consume adequate protein and vitamins C and A.

Factors affecting nutrition in Adolescents (12- 20 yrs) include:

• Body image and appearance, fast foods, peer pressure, and fad diets influence adolescents’ diets.

• Metabolic demands are high and require more energy.

Factors affecting nutrition in Older Adults (65+) include:

• A slower metabolic rate requires fewer calories.

• Thirst sensations diminish, increasing the risk for dehydration.

• Older adults need the same amount of most vitamins and minerals as younger adults.

• Calcium is important for both men and women.

• Many older adults require carbohydrates that provide fiber and bulk to enhance gastrointestinal function.

A nurse in a senior center is counseling a group of older adults about their nutritional needs and considerations. Which of the following information should the nurse include?

• Recommended intake of daily fiber decreases due to their lower caloric intake.

• Older adults are more prone to dehydration than younger adults.

• Many older adults need calcium and supplementation (to prevent bone demineralization).

Fluid Intake and Output (I&O) measurements include:

• Fluid intake includes ALL liquids (oral fluids, foods that liquefy at room temperature, IV fluids, IV flushes, IV medications, enteral feedings, fluid instillations, catheter irrigants, tube irrigants).

• Fluid output includes all liquids (urine, blood, emesis, diarrhea, tube drainage, wound drainage, fistula drainage).

Expected Findings of Poor Nutrition include:

• Nausea, vomiting, diarrhea, and constipation

• Flaccid muscles

• Mental status changes

• Loss of appetite

• Change in bowel pattern

• Spleen and liver enlargement

• Dry, brittle hair and nails

• Loss of subcutaneous fat

• Dry, scaly skin

• Inflammation and bleeding of gums

• Poor dental health

• Dry, dull eyes

• Enlarged thyroid

• Prominent protrusions in bony areas

• Weakness and fatigue

• Change in weight

• Poor posture

Nursing interventions for patients with dysphagia or at risk of aspiration include?

• Position in high Fowler’s position or in a chair.

• Support the upper back, neck, and head.

• Have clients tuck their chins when swallowing to help propel food down the esophagus.

• Avoid the use of a straw.

• Observe for aspiration and pocketing of food in the cheeks or other areas of the mouth.

• Observe for indications of dysphagia (coughing, choking, gagging, and drooling of food).

• Keep clients in semi-Fowler’s position for at least 1 hr after meals.

• Provide oral hygiene after meals and snacks.

Types of therapeutic diets include:

• NPO (nil per os): no food or fluid at all by mouth, not even ice chips, requiring a provider’s prescription before resuming oral intake

• Clear liquid: liquids that leave little residue (clear fruit juices, gelatin, broth); can see through the glass/container.

• Full liquid: clear liquids plus liquid dairy products and all juices. Some facilities include pureed vegetables in a full liquid diet.

• Pureed: clear and full liquids plus pureed meats, fruits, and scrambled eggs

• Mechanical soft: clear and full liquids plus diced or ground foods

• Soft/low-residue: foods that are low in fiber and easy to digest (dairy products, eggs, ripe bananas)

• High-fiber: whole grains, raw and dried fruits

• Low sodium: no added salt, or 1 to 2 g sodium

• Low cholesterol: no more than 300 mg/day of dietary cholesterol

• Diabetic: balanced intake of protein, fats, and carbohydrates of about 1,800 calories

• Dysphagia: pureed food and thickened liquids

• Regular: no restrictions

For patients with a orders to “restrict oral fluid intake,” what should the nurse do to maintain strict I&Os?

• Remove water pitcher from bedside.

• Inform dietary staff of the amount of fluid to serve with each meal tray.​​​​​​​

• Inform staff of each shift of the amount of fluid clients may have in addition to what they receive with each meal tray.

• Record all oral intake, and inform the family of the restriction.

Examples of foods high in fiber (whole foods) include:

• Cooked barley (barely & oats)

• Pureed broccoli (broccoli and cabbage in coleslaw)

• Lentil soup (lentils and black beans)

Examples of low-residue diets (low fiber) include:

• Vanilla custards, yogurt

• Dairy products

• white rice, bananas, cooked carrots, eggs, and tender meats.