ALTERATIONS IN NUTRITION Jennifer B. Cowley, RN, MSN.
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Transcript of ALTERATIONS IN NUTRITION Jennifer B. Cowley, RN, MSN.
![Page 1: ALTERATIONS IN NUTRITION Jennifer B. Cowley, RN, MSN.](https://reader036.fdocuments.in/reader036/viewer/2022062423/56649e0d5503460f94af7460/html5/thumbnails/1.jpg)
ALTERATIONS IN NUTRITION
Jennifer B. Cowley, RN, MSN
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Objectives:
* Who’s at risk?* Labs? Diagnostic tests?* Assessment - What do they look like?
* Nursing Diagnoses - What’s the problem?
* Therapeutic diets - What should they eat?
* Nursing interventions - What should you do?
* Enteral & parenteral nutrition - What are the nursing implications?
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Clients with Nutritional Problems: Who’s at Risk?
Dietary history
Medical history
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Lab Values
Serum hemoglobin & hematocrit
– “H&H”
Serum albumin
Serum pre-albumin
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Hemoglobin & Hematocrit
Hgb - iron-containing pigment of the RBC’s– Normal lab values:• female - 12-16 g/100 ml
• male - 14-18 g/100 ml
Hct - % of whole blood occupied by RBC’s– Normal lab values:
• female - 37-47%
• male - 40-54%
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Albumin
Synthesized in the liver from amino acids
Accounts for > 50% total serum proteins
Indicator of prolonged protein depletion
Normal lab value:
– 3.5-5 g/dl
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Pre-albumin
A precursor to albumin
Determines protein depletion in acute
conditions
Normal lab values:
– 15-36 mg/kl
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Diagnostic Tests
Gastroscopy– direct visualization
Upper Gastrointestinal Series (UGI)– indirect x-ray exam
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Manifestations of Major
Nutritional Deficiencies…Harkreader, p.703, Table 30-1
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The nursing assessment enables the nurse to determine
whether actual or potential nutritional problems exist.
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NANDA Nursing Diagnoses
Altered Nutrition: Less than Body Requirements
Altered Nutrition: More than Body Requirements
Risk for Altered Nutrition: More than Body Requirements
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Examples of Examples of SecondarySecondary Nursing Nursing Diagnosis for Clients with Nutritional Diagnosis for Clients with Nutritional ProblemsProblems
Activity Intolerance r/t insufficient energy from
protein depletion
Altered Oral Mucous Membranes r/t oral intake
Constipation r/t inadequate dietary intake and fiber
Self-Esteem Disturbance r/t obesity
Risk for Impaired Skin Integrity r/t intake of
proteins, vitamins, and minerals
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Commonly Prescribed Therapeutic Diets
Regular Diet– Who?
• Clients who do not have special needs
– What? • 2500 cal/day, variety of food groups
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Diets: NPO
Nothing by Mouth (NPO)
– Who? • Prior to surgery/certain diagnostic test
• To rest the GI tract
• When problem has not been identified
– What?• NPO
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Diets: Clear Liquid
Clear Liquid Diet
– Who? • Surgical clients
– What?• Only liquids that keep the GI tract empty (no
residue) - i.e., apple juice, broth, carbonated beverages, gelatin. No dairy products
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Diets: Full Liquid
Full Liquid Diet
– Who?
• Primarily postoperative clients
– What?
• Consists of liquids or foods that turn to liquid at
body temperature
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Diets: Soft
Soft Diet
– Who?• For clients experiencing difficulty in chewing and
swallowing; also for those with impaired digestion/absorption
– What?• Avoid nuts, sees, raw fruits/vegetables, fried foods,
whole grain.
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Diets: Mechanical Soft
Mechanical Soft Diet
– Who?• For clients experiencing difficulty chewing - i.e.,
poorly fitting dentures
– What?• Similar to soft; however, allows clients variation -
permitting foods with different tastes, such as chili beans
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Diets: Pureed
Pureed Diet
– Who?• For clients with dysphagia
– What?• Food that has been blenderized to a smooth
consistency
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Diets: Low-Residue
Low-residue Diet– Who?
• Clients that need minimal GI irritation (diverticulitis, ulcerative colitis, Crohn’s disease)
– What?• Has reduced fiber and cellulose. Avoid raw fruits
(except bananas), vegetables, seeds, plant fiber, and whole grains. Limited dairy products (2 servings/day)
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Diets: High-Fiber
High-fiber Diet
– Who?
• To increase elimination
– What?
• Opposite of low-residue
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Diets: Bland
Bland Diet
– Who?
• Clients with gastritis and ulcers
– What?
• Eliminates chemical and mechanical food irritants,
such as fried and spicy foods, alcohol and caffeine
I don’t think so!
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Diets:Fat-Controlled
Low-Fat Diet
– Who? • Clients with heart disease, atherosclerosis, and
obesity
– What?• Decreased saturated fats (replace with
mono/polyunsaturated fats) and restricting cholesterol
Uh-oh!
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Diets: Sodium-Controlled
Low-Sodium Diet– Who?
• Clients with hypertension, heart failure, myocardial infarction/MI (heart attack), renal failure
– What?• Mild - 2-3 g
• Moderate - 1000 mg
• Strict - 500 mg
• Severe - 250 mg
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Diets: American Diabetic Association (ADA)
Diabetic Diet
– Who?• Diabetics (of course!)
– What?
• Specified number of calories, amount of fat,
carbohydrates, and protein at each meal, with snacks
included. No concentrated sweets (NCS).
A no-no!
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Any diet is only as good as the client’s willingness to follow it.
Meal plans should be individualized and developed in collaboration
with the client.
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Monitoring Intake & Output/ “I&O”
Purpose: To monitor client’s fluid status over a 24 hour period
Who should be on I&O?
Medical vs. nursing decision?
Check clinical agency policy
Inaccuracies of I&O
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I&O: Intake
Oral fluids Ice chips Foods that become liquid at room
temperature Tube feedings Intravenous fluids/medications Catheter/tube irrigants
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I&O: Output
Urine
Diarrhea
Vomitus (emesis)
Tube drainage
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I&O: Nursing Responsibilities
Client/family teaching
Documentation
Relay to others that client is on I&O
Look for trends over 48-72 hours
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The Malnourished Client: Nursing Interventions
Stimulate the appetite
Assist the client with eating
Initiate client/family counseling
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Assisting the Client with Feeding
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ENTERAL NUTRITIONENTERAL NUTRITION
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If the client will not,
should not, or cannot eat,
enteral nutrition may be provided
with nasogastric, gastric
or jejunal tubes.
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Feeding tubes: Placement
Nasoenterally Surgically
– Gastrostomy
– Jejunostomy
Endoscopically– Percutaneous endoscopic gastrostomy
(PEG)
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Placement of Enteral Nutrition
Tubes
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Nasoenteral Feeding Tubes: Types
Large-bore
Small-bore
– 90-95% of clients in hospital have small bore
– more flexible, comfortable
– stylet inserted into lumen
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Nasoenteral:Small-bore Feeding Tube
Short term
RN performs blindly at the bedside
X-ray the only reliable method of placement verification
Nasogastric, nasoduodenal, or nasojejunal
Small bowel usually preferred over stomach in acutely ill clients
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Feeding Tube: Who does what?
MD orders:
– Type of tube
– Rate and type of formula
RN:
– Inserts feeding tube
– Administers/monitors tube feeding
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Enteral Feeding Tube: Confirmation of Tube Placement
Radiologic confirmation
Bedside methods:
– Auscultatory method
– Aspiration of gastric contents
– pH method
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Gastrostomy/Jejunostomy:“G-tube/J-tube”
Long term MD performs in OR Incision through abdominal wall creating an
artificial fistula More cosmetically appealing/more
comfortable Larger lumen allows more flexibility for
feeding/medication administration
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Percutaneous endocscopic gastrostomy:“PEG” tube
Long term
MD performs at bedside or in endoscopy
room
Does not require surgery, therefore less
risky and expensive than G/J tube insertion
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Percutaneous Endoscopic Gastrostomy Tube
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PARENTERAL NUTRITIONPARENTERAL NUTRITION
Total Parenteral Nutrition
“TPN”
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Total Parenteral Nutrition
Candidates for
What’s in
Tonicity of
Complications r/t
Lipids given with
TPN
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That’s All, Folks!