2. List b
surv asic su
sign ival. Dis bstance
of th ificance cuss the s for
eir im of ea
s
Defin port ch in
ance orde
c tive
and e the 6 . r
nutri iden food
prov ents tify the m groups
reco ides each gr ajor
mme, includi oup
Ob je
allow n
ancended da g the
Calc s. ily
needulated e
plan and de stimate
d
adeq per day sign a m caloric
and uate ca to main eal
idea l t
l weioric bala ain
ght. nce
3. Comp
pare
situa a
tion/ nd contr
resp cond ast th
onsib ition e
s
prob le f o s
c tive
lems r nut
rition
al
Descr
Ob je
ribe
main alter
taini ed m
ng a
nutri
tiona dequ eans of
nurs l inta ate
i ng r ke. E
each espo
. nsib xplain
ilitie
s f or
4. Energy Production and Physiological
Maintenance
Essential Nutrients and Sources
Water
Fluid and Electrolytes
Nutrients
5. Esse
Esse
ients
ntial Sources
ntial
Nut r rates
ohyd
Carb
and
and S
Fats
Nutr
Nutri
eins
Prot
ourc
utri ents erals
ients
ents
Mi cron a nd
min
mins
es
Vita
9. ic
Activ
ce
ca lo r ity ne
ed:
b alan
ener rgy re
comp quire
letely men
intak met t s ar
u at e
e in f
ood by ca e
main with loric
tain peop
leve thei le wh
l s wi r ac o
Ade q
chan thou tivity
ge. t wei
ght
12. Health
statu
Age s
g
t us
f ect in Socio
econ
l St a Physi
ologi
omic
statu
s
rs Af
Alcoh c a l fa
ctors
ti ona
ol an
Cultur d drugs
F act o
e an
Misinf d lifestyle
Nu tr i
forma
ti o n a
n d fa
ds
13. Factors Affecting Nutritional Status
Health status:
1. a good appetite is a sign of health.
2. anorexia is usually a symptom of disease or can be a
side effect of drugs.
3. Nutritional support is an essential part of recovery
from any medical treatment.
14. Factors Affecting Nutritional Status
Age
Premature babies (32-34 weeks) <5.5 lbs
Adolescents the eating disorders are common
approx 20 million sufferers
Older adults Many elderly clients take a Molotov
cocktail of meds which usually interact with nutrients
15. Soci
oeco
nom
ic sta
tus:
g
1. Foo
t us
f ect in d exp
l St a fixed ense
s are
2. Spe
rs Af
not
ti ona
nding
mon v
ies a aries wi
3. A lo
F act o
vaila th
ble
Nu tr i
t of c
food onve
s and nienc
starc e
hy f o
ods
16. l
lo gica
hysio s
P or
Fact b olism
Meta e
iseas
ver d
Fact
li
Facto
Nutri
n
Nutrit
Ing estio ction
xia infe
nore
a
is
ors A
matit
tiiona
sto
rs Aff
ia
onall
dys phag and
nd
on a tion
ffectii s
i a
igest bsorp raum
ec t n g
Statu
D t
Statu
A
e ve
ulc erati
ng
coliti
s
s
se
lacto ce
an
in toler
17. Factors Affecting Nutritional Status
Alcohol and drugs:
1. Abuse contributes to nutritional deficiencies because money
may be spent on alcohol instead of food, and alcohol may
replace apart of the diet and depress appetite
2. Excess alcohol can also affect GI organs
3. Drugs that depress appetite can lower the intake of essential
nutrients
4. Drugs can also deplete nutrient stores and lessen absorption
18. C u lt u
re an
d life
s t y le
1.. Cultu
:
g
patte ral, ethn
t us
conc rns and ic, and
f ect in into aerning fo restrictioreligious
l St a
ccou o n
nt d must b s
e tak
en
rs Af
2.
ti ona
Spec
be g ial food
iven s
when and die
F act o
ever ts sho
Nu tr i
poss u
ible ld
3. Olde
cling r adults
tend to ethni are mor
durinency ma c food h e apt to
g illn y a
ess. be increbits. This
ased
19. Factors Affecting Nutritional Status
Misinformation and fads:
1. Food myths can be the result of cultural background,
popular interest in natural foods, peer pressure, and a
desire to control weight.
2. Food fads often involve erroneous beliefs that certain
foods are especially healthy.
3. Nurses must make sure not to be condescending when
teaching a client that foods may not have qualities
attributed to them.
20. Nutritional Assessment and Support
Albumin<3.5?
Total lymphocyte
Count <1800
Is weight
<80% of ideal?
Assessment of
Oral & Gut
Psychosocial and
Is Gut functioning ? Nutritional not functioning
Physical barriers
supplements? TPN candidate
to intake
Adequate Ongoing
TPN
Dietary Intake? Assessment
Tube
Feeding
Ongoing
Assessment
21. Clinical Situations which Artificial Nutrition
may be Necessary
Inability to ingest food CA of the mouth, tongue,
esophagus
Facial trauma
Unconsciousness
Severe stomatitis
Dysphagia
Muscle weakness in mouth and
esophagus
Pancreatitis,
CA or the stomach
Inabilityfood
to digest or Crohn’s disease/ulcerative colitis
absorb Biliary disease
Increase resting energy
expenditure from major trauma
and surgery, burns, severe
infection
Anorexia and Bulimia Nervosa
22. Imbalanced Nutrition
Focused assessment
what are the physical and psychosocial barriers to
nutrition?
Body weight<20% of ideal
Appetite
Medications
Ability to eat independently
Difficulty with the mechanics of eating
GI symptoms
Physical condition
Finances
23. ire d
g
l lowi n
I mp a
DYSPHAGIA:
Oral phase
Swa
Pharyngeal phase
Esophageal phase
24. n
ra ti o
Aspi
fo r
Ri sk
LOOK AT RELATED FACTORS!
25. Increase Nutrient Intake
Nursing Responsibilities
Providing Enteral Feedings
- Enteral nutrition
- Feeding tubes and routes of access
- Types of formulas
- Administration of feedings
- Complications of feedings
- Home Enteral Nutrition
26. Increase Nutrient Intake
N
Nursing Responsibilities
Enriching the Insufficient Diet
- Special populations
Managing Therapeutic Diets
- Anorexia
- Nausea and vomiting
- Lactose Intolerance
- Malabsorption
- Diabetes
- AIDS and CA
- Heart Disease
- Kidney Disease
- Liver Disease
27. Managing Impaired Swallowing:
Nursing Responsibilities
Positioning the patient
Encouraging the appropriate foods
- Easy to swallow foods
28. Reduce Risk of Aspiration
Nursing Responsibilities
Monitor for subtle cues:
change in respiratory rate
temperature
breath sounds
decrease oxygen saturation
check swallowing reflex
check for increased gastric residual volume
positioning
need for suctioning
Editor's Notes
Water is most basic need. Carbohydrates, fats, proteins. – energy producing Micronutrients – Vitamins and Minerals = Metabolize the energy producing nutrients.
Carbs – sugars – simple carbs Starches and fiber – complex carbs Sugars – mono or di saccharides, glucose Lactose – sugar found in milk of animals Starches insoluble, nosweet forms of carbs grains, legumes, potatoes Cereals, breads, flour pudding – processed from starches Fiber from plants = outer layer of grains, bran, skin, seeds pulp of veges and fruits. Proteins = amino acids. Essential and nonessential meat, poultry, fish, dairy products, eggs = complete proteins = contain all essential aa Incomplete proteins lack one or more essential aa – from vegetables. Fats = lipids Solid at room temp. Oils – lipids that are liquid Fatty Acids are basic sturctural units of most lipids. Saturated (butter) or unsaturated. Unsat FA may be mono or poly unsaturated. Lipids are simple glycerides or compound – triglycerides Saturated or unsaturated. Saturated – butter unsaturated = olive or corn oil. Cholesterol fat like substance produced by body – found in foods of animal origin. Vitamins are water soluable (C and G complex) or fat soluble ( A, D, E, K) Fresh veggies consumed asap post harvest. Minerals – orgnaic compounds. Free ions. Macro minierals – Large over 100 mg needed - CA, PH, NA, K, MG, CL, sufur. Micro minerals – acquire daily in amounts less than 100 mg zinc, manganese, iodine, fluoride, copper, cobalt, cromium, selenium
Age: Primmies are at risk of under nutrition <5.5 lbs need monitoring are given tube feedings carefully because suck swallow reflex are not developed . Adolescents the eating disorders are common 20 million suffer from eating disorders and can grave consequences heartaches from the electrolyte changes that occur with binging and purging. Older adults there is a decrease in metabolism, increase connective tissue to functioning cell, reduced secretion on HCL acid in stomach limits absorption of calcium, iron and vitamin B12, 50% of those over 65 wear dentures if poor fitting patients have problems eating and after surgery the usually is a change in gum structure and when the dentures are put on they don ’t fit. Many elderly clients take a Molotov cocktail of meds which usually interact with nutrients Socioeconomic status: Food expenses are not fixed and spending varies with monies available 2. a lot of convenience foods and starchy foods Physiological factors : 1. factors that affects the ingestion of food are those that affect appetite , like anorexia and wasting syndrome , the mouth stomatitis lesions of the mouth and throat , and or esophagus or with swallowing, as with dysphagia, lactose intolerance, colitis, ETOH and Drugs:
