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Miss : Shurouq qadose

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Food habits are a product of many evolvingvariables, such as physical factors (eg,geographic location, food technology, andincome), physiologic factors (eg, health, hunger,and stage of development), and psychosocialfactors (eg, culture, religion, tradition,

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education, politics, social status, food ideology[the meaning of food for an individual].

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1- Developmental ConsiderationsThroughout the life cycle, nutrient needs changein relation to growth, development, activity, andage-related changes in metabolism and bodycomposition. Periods of intense growth anddevelopment, such as during infancy,adolescence, pregnancy, and lactation, cause an

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increase in nutrient needs. Nutrient needsstabilize during adulthood, although olderpeople may need more or less of some nutrients.

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A - InfantsThe period from birth to 1 year of age is the mostrapid period of growth. Birth weight doubles in 4 to6 months and triples by 1 year of age. Lengthincreases 50% in the first year. The iron storespresent at birth start to become depleted between 3and 4 months of age. The immune system maturesbetween 4 and 6 months of age. Breastfeeding isrecommended as the major source of nutrition forthe first 6 to 12 months of life. If the infant is notbreastfed, the infant should receive one of thecommercially prepared infant formulas that contain

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iron. Solid foods are not introduced until 6 monthsof age because solid foods given too early maytrigger allergic reactions. By 1 year of age, theinfant typically is eating table food.

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B- Toddlers and PreschoolersNutritionally, toddlers and preschoolers can feedthemselves, verbalize food likes and dislikes, andoccasionally use food to manipulate their parents.Appetite dramatically decreases and becomeserratic. Inappropriate use of food ( i.e., to punish,reward, bribe, or convey love) may lead toinappropriate food attitudes.

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C- School-Aged ChildrenNutritional implications for the school-aged childfocus on health promotion. Increasing energyrequirements need to be balanced with foods of highnutritional value. The appetite improves but stillmay be irregular.

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E- AdolescentsAdolescence is a period of rapid physical, emotional,social, and sexual maturation. The growth spurt beginsat different ages among individuals. Girls beginmenstruation and experience fat deposition, whereasmales experience an increase in muscle mass, lean bodytissue, and bones. Nutrient needs, especially for calories,protein, calcium, and iron, increase to support growth.Weight consciousness becomes compulsive in 1 of 100teenaged girls and results in anorexia nervosa, aneating disorder characterized by extreme weight loss,muscle wasting, arrested sexual development, refusal toeat, and bizarre eating habits.

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Bulimia, another eating disorder characterized bygorging followed by purging with self-inducedvomiting, diuretics, and laxatives, also becomesmore common in this age group. If a teenagepregnancy occurs, both mother and child are atincreased nutritional risk due to competition for thenutrients between the adolescent mother’s body and

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that of the infant.

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F- AdultsNutritional needs level off in adulthood, and fewercalories are required because of the decrease inBMR. If adjustments in caloric intake are not made,weight gain results.

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G- Pregnant and Lactating WomenNutrient needs during pregnancy increase tosupport growth and maintain maternalhomeostasis, particularly during the second andthird trimesters. Key nutrient needs includeprotein, calories, iron, folic acid, calcium, andiodine. Caloric needs are higher for lactation

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than pregnancy, and the nutritional quality ofbreast milk is maintained at the expense ofmaternal

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H- Older AdultsBecause of the decreases in BMR and physical activity andloss of lean body mass, energy expenditure decreases.Loss of teeth and periodontal disease may make chewingmore difficult. A decrease in peristalsis can result inconstipation. Loss of taste between sweet and salty beginsbetween 55 and 59 years of age, but discriminationbetween bitter and sour remains intact. The sensation ofthirst also decreases. Elderly people are also prone todehydration, and lack of interest in eating is common.Nutrient intake, digestion, absorption, metabolism, orexcretion may be altered because of the physiologicchanges common to this age.

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2- SexMen differ from women in their nutrientrequirements due to differences in body compositionand reproductive function. Muscle is moremetabolically active than adipose tissue (womenhave proportionately more adipose tissue). Womenof childbearing age have higher iron requirements

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related to menstruation.

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3- State of HealthThe alteration in nutrient requirements that resultsfrom illness and trauma varies with the intensity andduration of the stress. For instance, fevers increasethe need for calories and water.

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4- Alcohol AbuseAlcohol can alter the body’s use of nutrients. Thetoxic effect of alcohol on the intestinal mucosainterferes with normal nutrient absorption; thus,requirements increase as the efficiency of absorptiondecreases.

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5- MedicationMany drugs have the potential to influence nutrientrequirements. Nutrient absorption may be altered bydrugs that (1) change the pH of the GI tract, (2)increase GI motility, (3) damage the intestinalmucosa, or (4) bind with nutrients, rendering themunavailable to the body.

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6- Mega doses of Nutrient SupplementsBecause some nutrients compete against each otherfor absorption, an excess of one nutrient can lead toa deficiency (or increase the requirement) ofanother. For instance, a delicate balance existsbetween zinc and copper. People who taketherapeutic levels of zinc run the risk of developinga copper deficiency— which is otherwise rare—unless they also increase their intake of copper.

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1- ReligionDietary restrictions associated with religions mightaffect a patient’s nutritional requirements.

2- Economics

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The adequacy of a person’s food budget affectsdietary choices and patterns.

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3- Meaning of FoodFood means different things to different people, withfood playing multiple roles in the lives of mostindividuals. In addition to satisfying hunger andproviding nutrition, food may signify a celebration,a social gathering, or a reward. Some people usevarious foods to indicate caring or to give comfortand reassurance during times of stress orunhappiness.

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4- CultureNutritional diversity is common among cultural orethnic groups. The variety and selections are uniqueto each group and represent their personal beliefsand customs.

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1- Decreased Food IntakeFood intake may decrease for various reasons. Anorexia,or the lack of appetite, may be related to systemic andlocal diseases; numerous psychosocial causes, such asfear, anxiety, depression, pain; and impaired ability tosmell and taste—or it may occur secondary to drugtherapy or medical treatments. Others who may havelimited food intake include those who havedifficulty chewing and swallowing, those whoexperience chronic GI problems or undergo certain

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surgical procedures, and those on inadequate foodbudgets

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2- Increased Food IntakeIncreased food intake may lead to obesity. Obesitypresents a serious health problem physically,socially, and emotionally. Obesity is defined asbody weight 20% or more above ideal weight orhaving a BMI of 30 or more.

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AssessingNutritional status has a significant impact on bothhealth and disease. serve as nutritional role modelsand are ideally situated to identify nutritional needsand assess and monitor for nutritional risks.

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Anthropometric DataAnthropometric measurements are used to determinebody dimensions. Height and weight, the mostcommon anthropometric measurements, are obtainedwhen the patient is admitted to the healthcare facilityand periodically thereafter or assessed in a home careenvironment. Additional anthropometricmeasurements include triceps skin-foldmeasurements, a measure of subcutaneous fat stores;midarm circumference, a measure of skeletal muscle

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mass; and midarm muscle circumference, a measureof both skeletal muscle mass and fat stores

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Clinical DataAlthough signs and symptoms of altered nutritionmay be observed during a physical assessment.

Biochemical DataLaboratory tests, which measure blood and urinelevels of nutrients or biochemical functions thatdepend on an adequate supply of nutrients, canobjectively detect nutritional problems in their early

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stages.

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DiagnosingAssessment data may reveal actual or potentialnutritional problems.

Imbalanced Nutrition as the ProblemThe following nursing diagnoses may be made whenimbalanced nutrition is the cause of the patient’sdisorder:

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Imbalanced Nutrition: Less Than Body Requirementsrelated to nothing by mouth (NPO), inadequate tubefeeding, prolonged use of a clear liquid diet,numerous food intolerance or allergies, excessivedieting, anorexia, chewing or swallowingdifficulties, nausea, vomiting.

Risk for Imbalanced Nutrition: More Than BodyRequirements related to inappropriate eating,closely spaced pregnancies, metabolic and

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endocrine disorders, inappropriate use ofsupplements

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Imbalanced Nutrition as the EtiologyNutritional problems may affect other areas of humanfunctioning. In the following nursing diagnoses, thenutritional problem is the cause of another problem.Activity Intolerance related to inadequate caloricintake, obesity, iron-deficiency anemia.

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ImplementingProviding proper and adequate nourishment to thepatient is a team effort implemented in a variety ofsettings.

- Teaching Nutritional Information- Monitoring Nutritional Status- Providing Nutrition in Special Situations

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Clear liquid diets contain only foods that are clearliquids at room or body temperature—gelatin, clearjuices, carbonated beverages.

Full liquid diets contain milk, plain frozen desserts,pasteurized eggs, cereal gruels, and milk and egg.

Soft diets are usually regular diets that have beenmodified to eliminate foods that are hard to digest

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and to chew, including those that are high in fiber,high in fat.

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Routes of nutrition supportThe nutritional needs of patients are met through avariety of delivery routes and with an array ofnutritional formulation components andadministration equipment.

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Enteral nutrition (EN)

Long-term nutrition: Gastrostomy Jejunostomy

Short-term nutrition: Nasogastric feeding Nasoduodenal feeding

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Nasojejunal feeding

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Parenteral nutrition (PN) Peripheral Parenteral Nutrition (PPN) Total Parenteral Nutrition (TPN)

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Enteral nutritionAn alternative feeding method to ensure adequatenutrition includes Enteral (through thegastrointestinal system) methods. Enteral nutrition(EN), also referred to as total enteral nutrition(TEN), is provided when the client is unable toingest foods or the upper gastrointestinal tract isimpaired and the transport of food to the smallintestine is interrupted.

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Enteral Access devicesEnteral access is achieved by means of nasogastric ornasointestinal ( nasoenteric ) tubes, or gastrostomyor jejunostomy tubes.

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Parenteral NutritionParenteral Nutrition (PN) or total Parenteralnutrition (TPN) or intravenous hyperalimentation(IVH), is provided when the gastrointestinal tract isnonfunctional because of an interruption in itscontinuity or because its absorptive capacity isimpaired. PN is administered intravenously such asthrough a central venous catheter into the superiorvena cava. (subclavian or internal jugular veins).

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Partial Parenteral nutrition or peripheralparenteral nutrition (PPN) is prescribed forpatients who require nutrient supplementationthrough a peripheral vein because they have aninadequate intake of oral feedings.

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Parenteral feedings are solutions of dextrose, water,fat, proteins, electrolytes, vitamins, and traceelements, they provide all needed calories.Medications such as insulin (because TPN containslarge concentrations of glucose) and heparin (toprevent formation of a blood clot on the tip of thecatheter) may also be added to the solution.

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TPN solutions are hypertonic (highly concentrated incomparison to the solute concentration of blood),they are injected only into high – flow central veins,where they are diluted by the client’s blood.

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Indication for TPN Client with severe malnutrition Severe burns Client with bowel disease disorders (e.g., ulcerative

colitis or enteric fistula ) Acute renal failure Hepatic failure Metastatic cancer

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Major surgeries where nothing may be taken bymouth for more than 5 days.

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Infection control is of utmost importance duringTPN therap

y. The nurse must always observesurgical as aseptic technique when changingsolutions, tubing, dressings, and filters.Increased risk of fluid, electrolyte, and glucoseimbalances and require frequent evaluation andmodification of the TPN mixture.Insertion problems, such as pneumothorax, airembolism, and thromboembolism.Phlebitis

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SPECIAL CONSIDERATION

TPN solutions are 10% to 50 % dextrose in water ,plus a mixture of amino acids and special additivessuch as vitamins (e.g., B complex, C, D,K ),minerals (e.g., potassium, sodium, chloride, calcium, phosphate, magnesium), and trace elements (e.g.,cobalt, zinc, manganese).Additives are modified toeach client’s nutritional needs.

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TPN solutions are high in glucose, infusions arestarted gradually to prevent hyperglycemia, soglucose are monitored during the infusion.

When TPN is to be D/C, the TPN infusion rates aredecreased slowly to prevent hyperinsulinemia andhypoglycemia. Weaning a client from TPN may takeup to 48 hours but can occur in 6 hours as long asthe client receives adequate carbohydrates eitherorally or intravenously.

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