Concept_ Nutrition, elimination, fluid & electrolytes (1)

Page 1: Nutrition Overview

• Nutrition: The science of optimal cellular metabolism and its impact on health and disease.

• Continuum of Nutrition:

  • Malnutrition

  • Insufficient nutrition

  • Optimal nutrition

  • Excess nutrition

• Types of Malnutrition:

  • Insufficient Nutrition:

    • Insufficient calorie intake

    • Insufficient intake of one or more nutrients

    • Types include:

      • Starvation-related malnutrition

      • Acute disease-related malnutrition

      • Chronic disease-related malnutrition

  • Excess Nutrition:

    • Excess calorie intake

    • Excess micronutrient intake

• Glucose & Hormonal Regulation: Dependent on caloric intake for adequate metabolism.

• Nutrition Impacts:

  • Development

  • Spirituality

  • Culture

  • Glucose regulation

  • Immunity

  • Tissue integrity

  • Thermoregulation

  • Hormonal regulation

• At-Risk Populations:

  • Elderly individuals

  • Those with mental health issues

  • Residents of food deserts (urban areas with limited access to affordable, fresh foods)

  • Individuals facing communication barriers

  • Low socioeconomic status

• Factors Influencing Nutrition:

  • Mental status

  • Financial situation

  • Allergies

  • Malabsorption issues

  • Cultural factors

  • Peer influence

• Diet Progression Types:

  • Clear liquid

  • Full liquid

  • Regular diet

• Specific Diet Types:

  • Mechanical soft

  • Soft/low residue

  • High fiber

  • Low sodium

  • Low cholesterol

Page 2: Dietary Guidelines and Diagnostic Tests

• Additional Diet Types:

  • Low carb (ADA)

  • Gluten-free

  • Renal (low sodium, low potassium)

  • Fluid restricted

• Diagnostic Tests:

  • Serum albumin

    • Measures protein levels in blood; low levels indicate malnutrition.

  • Prealbumin

  • Calcium

  • Hemoglobin A1C

  • Blood glucose

  • Lipid profile

  • Electrolytes

• Primary Prevention Strategies:

  • Healthy diet

  • Physical activity (30 minutes most days)

• Secondary Prevention (Screening):

  • Lipid screening

  • Blood glucose screening

  • Body Mass Index (BMI)

  • Infant glucose levels (40+ genetically linked metabolic disorders)

• Collaborative Interventions:

  • Dietary interventions

  • Pharmacotherapy

  • Surgery

• Therapeutic Diets:

  • Low salt

  • Low fat

  • Calorie reduction

  • Increased fiber consumption

  • Dietary supplements

  • Tube feedings (enteral nutrition)

  • Parenteral nutrition (intravenous)

Page 3: Tube Feeding and Nutrition

• Total Parenteral Nutrition (TPN):

  • IV-administered nutrition, the only source for patients unable to eat.

  • Administered through a vein, providing necessary nutrients.

  • Duration varies from short-term to lifelong, depending on the patient's condition.

• Monitoring Needs:

  • Electrolytes

  • Blood glucose

• NG (Nasogastric) Tube Uses:

  • Lavage (cleaning), gavage (feeding), or decompression.

• Placement Verification for NG/NJ Tube:

  • X-ray

  • Measure pH of aspirated gastric contents.

  • Monitor for signs of improper placement: pocketing food, difficulty breathing, wet voice, increased heart rate, etc.

• Surgically Placed Tubes:

  • Gastric Tube (G tube)

  • Jejunostomy Tube (J tube)

  • Percutaneous Endoscopic Gastrostomy (PEG tube)

• Types of NG Tube Feeding:

  • Bolus: smaller amount quickly g - Cyclic: larger amount over a shorter time g - Continuous: small amount continuously

• Gastric Residual Volume (GRV):

  • Checked prior to feeding to assess absorption.

  • Returned to patient to maintain pH and electrolytes.

• Head of Bed Elevation:

  • Keep at least 30 degrees for all tube feeding patients.

• Interventions if GRV > acceptable levels:

  • Removing NG tube

  • Verification of physician's order

  • Explain procedure to the patient

  • Hand hygiene practices.

Page 4: Bowel Elimination and Health Risks

• Indications for Low-Residue Diet:

  • Patients with actively inflamed bowels (e.g., Crohn's disease)

  • Patients on TPN typically lack hunger cues.

• Concept of Bowel Elimination:

  • Large intestine: extracts water.

  • Esophagus: carries food to stomach.

  • Liver: processes nutrients.

  • Stomach and small intestine: digest and absorb nutrients.

• Risk Factors for Impaired Elimination:

  • Advanced age

  • Altered cognition

  • Impaired mobility

  • Injuries or disorders

  • Medications affecting bowel function.

• Assessment Components for Elimination Issues:

  • Patient's history, patterns, diet, medication, physical assessment.

• Diagnostic Testing Options:

  • Stool culture (identifies pathogens)

  • Occult blood testing (detects hidden blood)

  • Radiology (X-ray of kidneys, ureters, bladder)

  • Biopsies or scopes (upper and lower gastrointestinal).

• Clinical Management Strategies - Primary Prevention:

  • Healthy balanced diet

  • Adequate water intake

  • Regular exercise

  • Proper positioning

  • Avoiding nicotine use (quitting smoking).

Page 5: Clinical Management and Nursing Interventions

• Clinical Management - Secondary Prevention:

  • Utilizing scopes, screenings, and diagnostic testing.

• Collaborative Care for Incontinence:

  • Common causes: age, stroke, medication, spinal injuries.

  • Unexpected outcomes include tissue integrity issues, mental health problems, urinary tract infections (UTIs).

• Bowel Retention Causes and Management:

  • Physically unable to empty bowels, risking serious events like bowel rupture.

• Nursing Interventions for Bowel Elimination:

  • Positioning for comfort and privacy

  • Monitoring input/output

  • Medication management

  • Dietary recommendations.

• Diversions:

  • Redirecting normal waste removal processes (needed for conditions like cancer, Crohn's disease).

• Patient and Family Education:

  • Importance of appearance and function of stoma and management of appliance (bag).

  • Psychosocial support and addressing financial concerns.

Page 6: Urinary Elimination Issues

• Risk Factors for Urinary Issues:

  • Women (anatomical considerations)

  • Children

  • Elderly

• Common Causes of Urinary Problems:

  • Kidney issues

  • Trauma

  • Nervous system overstimulation

  • Narrowed/blocked urethra

  • Kidney stones

  • Infections.

• Assessment Questions for Urinary Issues:

  • Pain or discomfort

  • Frequency of urination

  • History of UTIs or surgeries

  • Medications affecting urinary function.

• Physical Assessment Elements:

  • Urine color, cloudiness, output, and clarity monitoring.

Page 7: Diagnosing and Managing Urinary Issues

• Clinical Management Approaches - Primary Prevention:

  • Proper hydration

  • Maintaining electrolyte balance

  • Appropriate hygiene practices (wiping technique).

• Secondary Prevention Methods:

  • Urinalysis for assessing electrolytes and other parameters

  • 24-hour urine collection testing

  • Renal function tests (BUN, creatinine clearance).

• Clinical and Collaborative Approaches:

  • Engage interdisciplinary team members: pharmacists, dieticians, PT/OT, and physicians.

• Urinary Diversions:

  • Rerouting the normal waste removal; educating patients from the onset of the diversion.

• Common Causes of Discomfort and Urinary Retention:

  • Identify significant risks and act on them.

Page 8: Types of Incontinence and Nursing Interventions

• Types of Urinary Incontinence:

  • Stress

  • Urge/overactive

  • Reflex

  • Functional

  • Overflow

  • Mixed

  • Transient

• Nursing Care for Incontinence:

  • Implementing specific nursing interventions for each type.

  • Collaborate on needed catheter use.

• Retention Issues:

  • Noninvasive interventions like catheterization and the importance of perineal care.

• Discomfort:

  • Coronary solutions for urinary tract infections: assessment, intervention, and prevention strategies.

Page 9: Preventing Urinary Infections

• CAUTI (Catheter-Associated Urinary Tract Infection) Prevention:

  • Employ the least invasive approaches for urinary access.

  • Insert catheters only for approved indications and maintain sterile practices.

  • Monitor catheter systems for function and safety.

• Nursing Care for Discomfort:

  • Assessment protocols for bladder health.

  • Interventions: hygiene education, fluid intake management, and educational efforts on urinary health.

Page 10: Fluid and Electrolyte Imbalances

• Fluid Volume Deficit - Iso-osmolar:

  • Loss of fluids/solutes proportionately (causes: vomiting, diarrhea).

  • Signs: decreased BP, orthostatic BP changes, increased heart rate.

  • Interventions include isotonic fluid replacement.

• Fluid Volume Deficit - Hyperosmolar:

  • High solute concentration (causes: Cdiff, prolonged vomiting).

  • Symptoms: thirst, poor skin turgor, decreased BP.

  • Management by replacing fluids cautiously.

• Fluid Volume Excess - Iso-osmolar (Hypervolemia):

  • Excess isotonic fluid due to various factors and symptoms such as edema.

  • Interventions include fluid and Na intake restrictions and addressing underlying causes.

• Fluid Volume Excess - Hypo-osmolar (Water Intoxication):

  • Interventions focus on drawing water out of cells gradually.

Page 11: Nursing Care for Fluid and Electrolyte Imbalances

• Key Nursing Practices:

  • Monitoring for weight gain (>3 lbs overnight as a red flag).

  • Comprehensive physical assessment and vital signs tracking.

  • Documenting input/output thoroughly.

  • Observing serum electrolyte levels consistently.

• IV Solutions Overview:

  • Crystalloids: solute-containing fluids.

  • Types include isotonic solutions (e.g., normal saline, D5W).

  • Colloids (plasma expanders): effectively drawing fluids from interstitial space.

Page 12: Intravenous Access and Therapies

• Purpose of Venous Access:

  • Administer fluids and medications, monitoring, and blood sampling.

• Types of Peripheral Lines:

  • Short catheter insertions (single peripheral access).

• Central Venous Access Devices:

  • Non-tunneled and PICC lines for longer-term treatments, including fluid delivery and medications.

• Complications of IV Therapy:

  • Fluid overload, site pain, and irritation, phlebitis, and risk of infections.

Page 13: Blood Products and Transfusion Procedures

• Reasons for Blood Transfusions:

  • Increase circulating blood volume, RBC counts, and replace cellular components.

• Blood Typing Systems:

  • ABO, Rh, and HLA systems for transfusion compatibility.

  • O negative: universal donor; AB positive: universal recipient.

• Administration of Blood Products:

  • Compatibility checks, baseline vitals, and infusion rate monitoring.

Page 14: Blood Transfusion Protocols and Reactions

• Transfusion Timing:

  • Administer within 4 hours; monitor for adverse reactions.

• Nursing Responsibilities:

  • Critical monitoring during the initial 15-minute period for signs of reactions.

• Types of Transfusion Reactions:

  • Acute hemolytic, febrile non-hemolytic, mild allergic, anaphylactic, fluid overload, and sepsis.