CH24

Chapter 24: Nutritional Care and Support

Nutritional Intake Assessment

• Identifying Factors:

  • Assess allergies, special diets, and dietary preferences.

  • Consider cultural or ethnic requirements.

• Mealtime Preparation:

  • Control odors, comfort, cleanliness, and patient positioning.

Assistance with Eating

• Provide support during meals and monitor intake/output.

Supporting Patients with Nutritional Needs

Food Allergies

• Definition: Immune system reaction to allergens, prompting antibody production.

• Common Allergens:

  • Peanuts

  • Wheat

  • Dairy Products

  • Eggs

Food Intolerance

• Definition: Adverse reactions without an immune response.

Therapeutic Diets

• Types of Diets:

  • NPO: Nothing by mouth.

  • Regular diet:

    • Consistency modified diets:

      • Clear liquid

      • Full liquid

      • Mechanical soft

      • Pureed

Diets Modified for Disease

• Examples:

  • Diabetic

  • Calorie-restricted

  • Sodium-restricted

  • Fat-restricted

  • Fiber-restricted

  • Renal

  • Protein-restricted

  • High calorie, high protein

  • Small, frequent feedings

Diets Modified by Preference

• Examples:

  • Gluten-free

  • Vegan

Nursing Responsibilities

• Monitor type of diet, percentage eaten, and meal tolerance.

• Determine when to advance the diet in response to:

  • Symptoms: nausea, vomiting, abdominal distention, or diarrhea.

Dietary Considerations for Diabetic Patients

Monitoring Requirements

• Track:

  • Amount eaten

  • Meal tolerance

  • Blood glucose levels

• Hyperglycemia Symptoms:

  • Increased thirst, dry mouth, headache, frequent urination.

• Hypoglycemia Symptoms:

  • Clammy skin, shakiness, dizziness, irritability, confusion.

Eating Disorders

• Prevalence: Higher among women than men.

Types of Eating Disorders

• Anorexia Nervosa:

  • Characterized by extreme leanness (self-starvation).

• Bulimia Nervosa:

  • Involves binge eating followed by purging.

• Binge Eating Disorder:

  • Consuming excessive amounts of food.

Food-Drug Interactions

• Interactions can alter medication effects, including:

  • Effects on appetite

  • Nutrient absorption and metabolism

  • Nutrient excretion

Enteral Tubes

Types of Enteral Tubes

• Nasogastric Tubes:

  • Inserted through the nose into the stomach.

  • Single lumen (Levin) and double lumen (Salem Sump).

• Nasointestinal Tubes:

  • Inserted through the nose, into the duodenum.

Insertion Procedure for NG Tube

1. Prepare patient and supplies.

2. Insert NG tube.

3. Attach to suction & maintain patency.

4. Feeding tubes available:

• PEG

• J-tube

Tube Feeding Formulas

• Standard Formulas: Nutritionally balanced for patients who can digest and absorb nutrients.

• Hydrolyzed Formulas: Predigested for easier absorption for compromised patients.

• High-Protein Formulas: Extra protein for wounds or malnutrition.

• Diet-Specific Formulas:

  • Diabetic

  • Renal

  • Pulmonary

  • Fiber-containing

Enteral Feeding Methods

• Types:

  • Intermittent (Bolus)

  • Continuous infusion

• Monitoring:

  • Check residual gastric volume.

  • Raise head of bed to 30 degrees.

Complications Associated with Tube Feeding

• Include:

  • Nausea and diarrhea

  • Clogged tubes

  • Aspiration

  • Metabolic issues

  • Formula contamination

Parenteral Nutrition

• Definitions:

  • Complete nutrition provided via IV, includes amino acids, fats, vitamins.

  • Types:

    • Partial Parenteral Nutrition (PPN)

    • Total Parenteral Nutrition (TPN)

Monitoring Nutritional Status

• Strategies include:

  • Daily weights

  • Monitoring laboratory results:

    • Electrolyte levels

    • Prealbumin, albumin, total protein

    • Glucose levels.