Nutrition and FluidsNURS 1510

Normal growthTissue maintenanceTissue repair/recoveryTreatment of disease

Nutrition is Essential for

Maintain immune systemPrevent medical problemsMaintain normal tempProduce enzymes and hormones

Review of Digestive System

Intake of food/fluidsMechanical DigestionChemical digestion of starches begins

Mouth

Passageway from the mouth to the stomach

Peristalsis propels food forward

Esophagus

Turns food into chymeAdds HCLMechanical and chemical digestion continues

Food stays for 1-4 hours

Stomach

Simple carbohydrates 1hr Complex carbohydrates 3hr Protein 5hr Fats 7hr Rationale for a variety of foods in % of

intake

To complete digestion

Chemical digestionBile and enzymes are addedDigestion completedAbsorption of nutrients occurs

Small intestine

Storage of wastesAbsorption of waterEliminationSynthesis of Vitamin K

Large intestine

Psychological State-fear, anxiety

Bacterial actionFood processing-whole grain, raw, fried, cooked

Factors affecting digestion

Substance which contains elements necessary for body function

6 classes: CHO, CHON, Fat, H2O, Minerals, Vitamins

Nutrient

Provide energy

Primary plant foods

May contain fiber

Simplest form is glucose

AnabolismCatabolismConverted to adipose

Carbohydrates (CHO) 4 cal/gm

Amino acidsTissue growth/repairComplete proteinsIncomplete proteinsNitrogen balance

Proteins--4cals/gm

Fats and oilsConcentrated energy

Triglycerides

Provide insulation

Maintain temperature

Fat-soluble vitamins

Lipids -- 9 cal/gm

Most essential nutrient for survival

Essential for cellsSources--eating, drinking, metabolism

Water

Sodium: Less than 3000mg Cholesterol: Less than 300mg Fat: Less than 30 % Fiber: Approximately 30 Grams Fluids: 3000ml / 24 hour

What is adequate?

Fat soluble--A, D, E, KWater soluble-B-complex, CRegulate metabolic functions within cells

Contain antioxidants

Vitamins

Inorganic elementsServe as catalystsEssential for good healthCalcium, phosphorus, magnesium

Minerals

Infants: double wgt 4-5 mo. Not able to digest or metabolize many foods

Toddlers & pre-schoolers: need increase in protein r/t body wgt.

School age + adolescents: generally have good appetites. Need healthy selection ed.

Adults: Fruits, veg, whole grain & portion control

Nutritional Needs Based on Developmental Stage

May have fixed income May not be able to go out and shop Decrease in taste buds Loss of teeth , poor fitting dentures Don’t enjoy eating alone

Older Adult

HealthSocio - Economic statusPsychological stateCulture/religion

Factors influencing patterns`

Personal preferencesMisinformation-food fadsAlcohol and drug useAge and life-styleAlcohol = 7calories/gram

continued

Hgt & wgt I&O trends Body composition Edema Condition of skin, teeth, hair Dietary history Turgor Dietary diary Anthropometry Calorie count Stool characteristics

Nutritional Assessment

Albumin-role in F&E balance Pre-albumin-more reliable Transferrin-non-hem iron->when iron< and

< when iron > Hbg-O2 carrying capacity < blood loss BUN = hydration and Creatinine

Diagnostics

2000 calorie diet 60% carbohydrate 20% protein 20% fat calories2000X60%=1200/4cal per g=300gram

CHO2000x20%= 400/4cal per

g=100gramCHON2000x20%= 400/9cal per g=44grams

Fat

Determine energy from nutrients

Represents allowances of essential nutrients by age and category, inclusive of weight and height.

Represents 98% of people in general good health

55-60% carbohydate 12-20% protein <30% fat

Purpose of RDA’s

Anyone with problems with I & O, digestion and absorption of nutrients◦ Anorexia nervosa◦ Bulimia --Impaired mobility◦ Chemotherapy --Lengthy NPO◦ Chronic illness◦ Extensive surgery

Major Nutritional Problems

Most reliable indicator is WEIGHT Intake and output are very important and must be accurate

Nutritional Status

Provide rest to a body partAdapt to client’s ability to eat swallow, digest, absorb, or metabolize nutrients

Weight loss or gainMaintain nutritional statusCorrect deficiencies

Therapeutic diets

Consistency/textureFrequency of feedingsNumber of caloriesSpecific nutrientsFluid volume

Diet Modifications

Tea, broth, jello, waterLiquids you can see throughNutritionally inadequate

Clear liquid

Foods that are liquid at body temperature

May be nutritionally adequate if planned carefully

Full medical liquid

Foods which are easy to chew and to digest

Mechanical soft/pureed

Soft diet

Non-irritating foodsChemicallyThermallyMechanically

Bland diet

Residue has to do with fiber

Hi=increase peristalsisLow-decrease peristalsisRegulates the volume of fecal output

High or low residue diet

Sodium restricted: reduces fluid retention and allows heart to work less

Low fat or cholesterol: reduces the plaque formation in blood vessels, limiting CAD

Other Diets

Offer bathroom Wash face/hands Oral care Glasses/hearing aids Position of comfort prior to food served Reinforce importance of intake

NI to enhance intake of nutrients

Serve food in pleasant social setting Prepare tray Place in reach and in visual field Encourage social interaction Assist with feeding if necessary Know precautions Protect clothing with apron-not bib

Continued-at meals

Allow client to empty mouth before putting more food in

Encourage client to direct speed/order Be at eye level/face to face Allow for rest periods Avoid heaping food on utensils

Continued-at meals

Record accurate intake and output

Note % ¼ , ½ ,¾ ,or 100%Provide oral hygieneOffer fluids or supplements as ordered thru shift

After meals

Feedings administered through a tube directly into the stomach or small intestine

Naso-gastric tube Gastrostomy tube Jejunostomy tube

Enteral Nutrition

Comatose clientsSevere reflux diseaseParalysis of muscles used for swallowing

ObstructionWeakness

When is enteral feeding needed?

X-ray verificationAspirating gastric contents Instilling air through tube while auscultating with a stethoscope

Ask client to speak

Placement

Check placement q 4 h and prn Check residual q 4 h and prn Keep HOB up 30 degrees Abdominal assessment, temp, lung sounds q shift and prn, stooling

Report N/V

Maintenance and Prevention of Complications

Change bag q 24 hrs Measure and record I&O q 8 h Flush tube with water -- institutional policy re: meds and feedings

Give meds individually!! Flush between each med

Observe rate of flow

Maintenance and preventiion, con’t

IV (Parenteral) therapy

Provide hydrationAdminister medsAccess circulatory systemProvide electrolytesGive blood

Parenteral Therapy

Observe rate and flow and correct solution

Record I&OCheck insertion siteAssess client’s fluid balance

LPN responsibilities

Inflammation of a vein

Red streakWarmthPain

EdemaFluid infuses readily

Good blood return

Phlebitis

Skin pale in area

Skin cool EdemaFirm to touch

Feels “tight” or “burns”

Infuses sluggishly

No blood return

Infiltration

Contains all necessary nutrients

AKA HyperalimentationGiven via central line

Total Parenteral Nutrition

Assess IV site q shift, dressing Weigh daily Record I&O Note infusion rate/ correct solution Assess fluid balance VS q 4 hr. Accu checks

LPN responsibilities

Electrolytes: ions and carry electric charge when dissolved in fluid. + =cations=NA, K, Ca, Mg. ---anions=Cl, HCO3

Minerals: ingested compounds, help regulate body functions

Cells: functional basic units of all living tissue. Cells within fluid=R and W blood cells

Components of body fluids

Intracellular: contained within each cell =40% of body wgt

Extracellular: located outside the walls of the individual cells and is divided into:◦ Interstitual fluid: tissue fluid (edema)◦ Intravascular fluid: within blood vessels◦ Transcellular: CSF, digestive juices, synovial

Fluid Balance

Diffusion: Solutes move from an area of higher concentration to an area of lower concentration

Osmosis: movement of (solvent) water from a solution of lower concentration to an area of greater concentration

Mechanism for Movement for Normal Fluid Balance

Active transport: Solutes are moved across a semipermeable membrane with a source of energy. Requires metabolic activity and energy expenditure.

Filtration: process by which H20 & diffusible substances move together in response to fluid pressure

Decrease in the extracelluar fluid (dehydration), n/v, diarrhea, hemorrhage◦ S/S: Dry mucous membranes, decrease in BP,

increase in heart rate, elevated temp, decrease in skin turgor, sunken eyes, diminished urine output, rapid wgt loss, slow vein filling, confusion

◦ Tx: IV, antiemetics, stop diarrhea, tx cause

Fluid Volume Deficit

Increase in extracellular fluid (hypervolemia or anasarca)◦ Renal or liver failure, secondary to ds of the CV

system (CHF), protein deficiency, hormonal or steroid therapy, excessive Na

◦ S/S: Dependent edema, rapid wgt gain, HTN, polyuria, JVD, rales, ascites, orthopnea, bounding pulse

Fluid Volume Excess

Nursing Tx: HOB elevated◦ Frequent Vital Signs◦ Daily wgt I & O◦ Sodium restriction Lung sounds◦ Skin care TCDB q 2 h

Tx: 02, IV therapy, fluid restriction, diuretics, low Na diet, antiembolic hose

K: intracellular fluid 3.5-5.0 mEq/L.◦ Nerve stimulus conduction, muscle activity◦ Abnormal levels may cause cardiac

irregular Na: regulates fluid balance 135-145

mEq/L. Ca: generally combines with

phosphorus to form the mineral salts of the teeth and bone.9.0-11.0mEq/L. Need for normal muscle

activity

Major Electrolytes

Mg: necessary for neuromuscular excitability