Nutrition and Nutritional Assessment

Nutrition

Definitions

  • Nutrition: The body's intake and use of adequate amounts of necessary nutrients for tissue growth and energy production.
  • Necessary Substances: Substances obtained from ingested food that supply the body with energy, build and maintain bones, muscles, and skin, and aid in the normal growth and function of each body system.
  • Nutrients: Compounds that the body requires to function effectively.
  • Malnutrition: An imbalance in the amount of nutrient intake and the body’s needs.

Normal Structure and Function

Basal Metabolic Rate (BMR)
  • Definition: Minimum amount of energy required to maintain body functions in the resting, awake state.
Major Biochemical Processes
  • Anabolism: The set of metabolic pathways that construct molecules from smaller units; it requires energy.
  • Catabolism: The set of metabolic pathways that break down molecules into smaller units; it releases energy.
  • Metabolism: A continuous process of anabolism and catabolism occurring within the body.
Nutrient Categories
Macronutrients
  • Carbohydrates: Provides 4 kilocalories per gram; can be simple or complex; includes fiber, categorized as soluble or insoluble.
  • Fats: Provides 9 kilocalories per gram; composed of lipids; includes triglycerides (most abundant lipids in food) characterized as
      - Saturated fatty acids
      - Monounsaturated fatty acids
      - Polyunsaturated fatty acids
      - Trans fatty acids
      - Unsaturated “essential” fatty acids: omega-3 and omega-6
  • Proteins: Composed of amino acids, which are the building blocks; requires daily consumption; provides 4 kilocalories of energy per gram; can be classified as complete or incomplete.
  • Water: A vital component of intracellular and extracellular fluids, important for hydration and fluid balance. Includes aspects of thirst and addresses conditions of dehydration and water intoxication.
Micronutrients
  • Fat-Soluble Vitamins: Includes Vitamin A, Vitamin D, Vitamin E, Vitamin K.
  • Water-Soluble Vitamins: Includes Vitamin C and Vitamin B Complex, specifically:
      - Vitamin B1 (Thiamine)
      - Vitamin B2 (Riboflavin)
      - Vitamin B3 (Niacin)
      - Vitamin B5 (Pantothenic Acid)
      - Vitamin B6 (Pyridoxine)
      - Vitamin B7 (Biotin)
      - Vitamin B9 (Folic Acid)
      - Vitamin B12 (Cyanocobalamin)
  • Minerals: Includes essential minerals such as potassium, sodium, chloride, calcium, phosphorus, magnesium; notable antioxidants that protect body cells against free radicals, aiming to slow or prevent oxidative processes.
Digestion Process
  • Ingestion: The intake of food.
  • Digestion: The breakdown of food, facilitated by enzymes.
  • Absorption: The process of nutrient absorption occurring through catabolism.
  • Elimination: The removal of waste products from the body.
Healthy Eating Patterns
  • Include healthy choices from all food groups within calorie limits.
  • Emphasizes consumption of fruits, vegetables, whole grains, and low-fat dairy products.
  • Incorporates lean meats, seafood, beans, eggs, nuts, seeds, and soy products while minimizing saturated/trans fats, sodium, and added sugars.

Altered Structure and Function

Musculoskeletal Alterations
  • Resulting from imbalances of vitamins (particularly A and D) and deficiencies in minerals like calcium, phosphorus, and magnesium.
Neurologic Alterations
  • Occur due to excess intake of sodium and deficiencies in folate.
Cardiopulmonary Alterations
  • Caused by secretions from fat cells leading to pathological changes.
Digestive System Alterations
  • Conditions that hinder the body's ability to process nutrients effectively.
Metabolic Alterations
  • Diabetes Mellitus: Two types:
      - Type 1: Insulin-dependent.
      - Type 2: Non-insulin-dependent.
  • Allergies: Immune response to certain foods.
  • Intolerances: Digestive system response to certain foods.
  • Obesity: Defined by a BMI of 30 or higher; morbid obesity is a BMI of 40 or higher.
  • Malnutrition: May arise from issues like poor absorption, digestive problems, illness, or inadequate intake; emphasizes that children are especially vulnerable to malnutrition.
Psychological Alterations
  • Anorexia Nervosa: Characterized by limited caloric intake, omission of healthy foods, excessive exercise, and obsessive behaviors.
  • Bulimia Nervosa: Involves binging (excessive food intake) followed by purging (vomiting).

Assessment

Nutritional History
  • Methods used include 24-hour recalls, food diaries, and full nutritional assessments to identify eating disorders or altered nutritional status.
  • Screening for malnutrition in older adults includes the Mini Nutritional Assessment (MNA) and the DETERMINE checklist, which covers:
      - Disease
      - Eating poorly
      - Tooth loss/mouth pain
      - Economic hardship
      - Reduced social contact
      - Multiple medications
      - Involuntary weight loss/gain
      - Needs assistance in self-care
      - Elderly years above age 80.
Physical Assessment
  • Morphology: Physical body shape and composition.
  • Anthropometric Measurements: Includes height, weight, BMI, waist-to-hip ratio, and skinfold measurements.
  • Skin and Hair Assessment: Dry, rough skin appearance with potential bruising, pale pigmentation, and hair thinning with a dry texture.
  • Dentition: Care for older adults to retain teeth; loss affects nutrient intake.
  • Swallow Studies: For clients at risk for aspiration, typically conducted by a speech therapist; coordinated with registered dieticians for appropriate food texture and hydration strategies.
Laboratory Studies
  • Relevant tests include:
      - Prealbumin
      - Albumin
      - Transferrin
      - Hemoglobin and Hematocrit
      - Blood Urea Nitrogen and Creatinine
Elimination Patterns
  • Includes observations of constipation and diarrhea.

Nursing Diagnosis

  • Lack of Knowledge: Supporting data may include the lack of recognizing factors and symptoms of diabetes, such as fatigue, headaches, and increased urination.
  • Impaired Swallowing: Evidence might come from neurological damage due to CVA, gagging, or choking during oral intake attempts.
  • Impaired Self-Feeding: Identified through sensory and motor deficits due to spinal cord injuries, affecting the ability to feed oneself.

Planning

  • Prioritize Needs: Address the most immediate and critical client needs.
  • Identify Goals: Define appropriate goals and outcomes for nutritional improvement.
  • Decide on Actions: Determine specific nursing interventions to assist clients in achieving their goals.
  • Collaboration: Engage with clients and health care team members.

Implementation and Evaluation

Dietary Preferences
  • Recognize various dietary patterns including:
      - Vegetarian
      - Lacto-Ovo (includes dairy and eggs)
      - Lacto (includes dairy)
      - Ovo (includes eggs)
      - Pesco (includes fish)
      - Vegan
  • Consider cultural and religious dietary practices including restrictions, preparation laws, and fasting practices.
Special Diets
  • Examples include clear liquid, full-liquid, pureed, mechanical soft, thickened liquids, regular, diabetic, cardiac, renal diets.
  • Assistance with Feeding: Important for clients with mobility limitations; such assistance can be delegated to unlicensed personnel. Clients on NPO orders are to receive no oral intake.
Enteral Feeding Tubes
  • Indicated for clients with intact gastrointestinal function who cannot swallow or need supplementary nutrition:
      - Nasogastric Tubes: For short-term feeding and bowel decompression.
      - PEG Tubes: For long-term nutritional therapy in clients with neurological impairments or digestive system issues.
      - Medication Administration: Medications should never be added to tube feeding; they must be given separately.
Total Parenteral Nutrition (TPN)
  • Administration via peripherally inserted central catheter (PICC line) or central venous catheter (CVC) using an infusion pump.
  • Used for clients without a functioning GI tract or those unable to absorb essential nutrients due to specific conditions.
  • TPN formulas are tailored to individual needs, with an awareness of potential complications.

Evaluation

  • Evaluation focuses on whether clients meet short- and long-term goals established for nutritional intervention.
  • Responses to nursing interventions are crucial for assessment and adjustments to care plans.

Foods to Know

  • Iron Sources: Green leafy vegetables, animal meats.
  • Calcium Sources: Milk, milk products, tofu, and soy products.
  • Phosphorus Sources: Dairy products, beans, meats.
  • Vitamin C Sources: Citrus fruits, broccoli, Brussels sprouts, tomatoes.
  • Potassium Sources: Bananas, avocado, sweet potatoes, white beans.
  • Protein Sources: Lean meats, eggs, dairy, seeds, nuts, beans, legumes, soy.
  • Vitamin A Sources: Carrots, green leafy vegetables.

Knowledge Checks

  • Example Questions:
      - A nurse performing a nutritional assessment on an older adult notes signs consistent with malnutrition, such as dry skin, hair issues, and skin abnormalities.
      - Different macronutrients offer various energy contributions; fats provide the highest kilocalories per gram.
      - When advising on calcium intake to prevent osteoporosis, recommend milk products, tofu, and green leafy vegetables.