Miss : Shurouq qadose

 

Food habits are a product of many evolving variables, such as physical factors (eg, geographic location, food technology, and income), physiologic factors (eg, health, hunger, and stage of development), and psychosocial factors (eg, culture, religion, tradition, education, politics, social status, food ideology [the meaning of food for an individual].

1- Developmental Considerations Throughout the life cycle, nutrient needs change

in relation to growth, development, activity, and age-related changes in metabolism and body composition. Periods of intense growth and development, such as during infancy, adolescence, pregnancy, and lactation, cause an increase in nutrient needs. Nutrient needs stabilize during adulthood, although older people may need more or less of some nutrients.

A - Infants The period from birth to 1 year of age is the most

rapid period of growth. Birth weight doubles in 4 to 6 months and triples by 1 year of age. Length increases 50% in the first year. The iron stores present at birth start to become depleted between 3 and 4 months of age. The immune system matures between 4 and 6 months of age. Breastfeeding is recommended as the major source of nutrition for the first 6 to 12 months of life. If the infant is not breastfed, the infant should receive one of the commercially prepared infant formulas that contain iron. Solid foods are not introduced until 6 months of age because solid foods given too early may trigger allergic reactions. By 1 year of age, the infant typically is eating table food.

B- Toddlers and Preschoolers

Nutritionally, toddlers and preschoolers can feed themselves, verbalize food likes and dislikes, and occasionally use food to manipulate their parents. Appetite dramatically decreases and becomes erratic. Inappropriate use of food ( i.e., to punish, reward, bribe, or convey love) may lead to inappropriate food attitudes.

C- School-Aged Children Nutritional implications for the school-aged child

focus on health promotion. Increasing energy requirements need to be balanced with foods of high nutritional value. The appetite improves but still may be irregular.

 

E- Adolescents Adolescence is a period of rapid physical, emotional,

social, and sexual maturation. The growth spurt begins at different ages among individuals. Girls begin menstruation and experience fat deposition, whereas males experience an increase in muscle mass, lean body tissue, and bones. Nutrient needs, especially for calories, protein, calcium, and iron, increase to support growth. Weight consciousness becomes compulsive in 1 of 100 teenaged girls and results in anorexia nervosa, an eating disorder characterized by extreme weight loss, muscle wasting, arrested sexual development, refusal to eat, and bizarre eating habits.

Bulimia, another eating disorder characterized by gorging followed by purging with self-induced vomiting, diuretics, and laxatives, also becomes more common in this age group. If a teenage pregnancy occurs, both mother and child are at increased nutritional risk due to competition for the nutrients between the adolescent mother’s body and that of the infant.

F- Adults Nutritional needs level off in adulthood, and fewer

calories are required because of the decrease in BMR. If adjustments in caloric intake are not made, weight gain results.

 

G- Pregnant and Lactating Women

Nutrient needs during pregnancy increase to support growth and maintain maternal homeostasis, particularly during the second and third trimesters. Key nutrient needs include protein, calories, iron, folic acid, calcium, and iodine. Caloric needs are higher for lactation than pregnancy, and the nutritional quality of breast milk is maintained at the expense of maternal

H- Older Adults Because of the decreases in BMR and physical activity and

loss of lean body mass, energy expenditure decreases. Loss of teeth and periodontal disease may make chewing more difficult. A decrease in peristalsis can result in constipation. Loss of taste between sweet and salty begins between 55 and 59 years of age, but discrimination between bitter and sour remains intact. The sensation of thirst also decreases. Elderly people are also prone to dehydration, and lack of interest in eating is common. Nutrient intake, digestion, absorption, metabolism, or excretion may be altered because of the physiologic changes common to this age.

2- Sex Men differ from women in their nutrient

requirements due to differences in body composition and reproductive function. Muscle is more metabolically active than adipose tissue (women have proportionately more adipose tissue). Women of childbearing age have higher iron requirements related to menstruation.

3- State of Health

The alteration in nutrient requirements that results from illness and trauma varies with the intensity and duration of the stress. For instance, fevers increase the need for calories and water.

 

4- Alcohol Abuse

Alcohol can alter the body’s use of nutrients. The toxic effect of alcohol on the intestinal mucosa interferes with normal nutrient absorption; thus, requirements increase as the efficiency of absorption decreases.

 

5- Medication

Many drugs have the potential to influence nutrient requirements. Nutrient absorption may be altered by drugs that (1) change the pH of the GI tract, (2) increase GI motility, (3) damage the intestinal mucosa, or (4) bind with nutrients, rendering them unavailable to the body.

6- Mega doses of Nutrient Supplements

Because some nutrients compete against each other for absorption, an excess of one nutrient can lead to a deficiency (or increase the requirement) of another. For instance, a delicate balance exists between zinc and copper. People who take therapeutic levels of zinc run the risk of developing a copper deficiency— which is otherwise rare—unless they also increase their intake of copper.

 1- Religion

Dietary restrictions associated with religions might affect a patient’s nutritional requirements.

 

2- Economics

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

 

3- Meaning of Food

Food means different things to different people, with food playing multiple roles in the lives of most individuals. In addition to satisfying hunger and providing nutrition, food may signify a celebration, a social gathering, or a reward. Some people use various foods to indicate caring or to give comfort and reassurance during times of stress or unhappiness.

4- Culture

Nutritional diversity is common among cultural or ethnic groups. The variety and selections are unique to each group and represent their personal beliefs and customs.

 

1- Decreased Food Intake Food intake may decrease for various reasons.

Anorexia, or the lack of appetite, may be related to systemic and local diseases; numerous psychosocial causes, such as fear, anxiety, depression, pain; and impaired ability to smell and taste—or it may occur secondary to drug therapy or medical treatments. Others who may have limited food intake include those who have difficulty chewing and swallowing, those who experience chronic GI problems or undergo certain surgical procedures, and those on inadequate food budgets

 

2- Increased Food Intake

Increased food intake may lead to obesity. Obesity presents a serious health problem physically, socially, and emotionally. Obesity is defined as body weight 20% or more above ideal weight or having a BMI of 30 or more.

Assessing

Nutritional status has a significant impact on both health and disease. serve as nutritional role models and are ideally situated to identify nutritional needs and assess and monitor for nutritional risks.

Anthropometric Data

Anthropometric measurements are used to determine body dimensions. Height and weight, the most common anthropometric measurements, are obtained when the patient is admitted to the healthcare facility and periodically thereafter or assessed in a home care environment. Additional anthropometric measurements include triceps skin-fold measurements, a measure of subcutaneous fat stores; midarm circumference, a measure of skeletal muscle mass; and midarm muscle circumference, a measure of both skeletal muscle mass and fat stores

Clinical Data Although signs and symptoms of altered nutrition

may be observed during a physical assessment.   Biochemical Data Laboratory tests, which measure blood and urine

levels of nutrients or biochemical functions that depend on an adequate supply of nutrients, can objectively detect nutritional problems in their early stages.

Diagnosing Assessment data may reveal actual or potential

nutritional problems.

 

Imbalanced Nutrition as the Problem The following nursing diagnoses may be made when

imbalanced nutrition is the cause of the patient’s disorder:

Imbalanced Nutrition: Less Than Body Requirements related to nothing by mouth (NPO), inadequate tube feeding, prolonged use of a clear liquid diet, numerous food intolerance or allergies, excessive dieting, anorexia, chewing or swallowing difficulties, nausea, vomiting.

  Risk for Imbalanced Nutrition: More Than Body Requirements related to inappropriate eating, closely spaced pregnancies, metabolic and endocrine disorders, inappropriate use of supplements

Imbalanced Nutrition as the Etiology

Nutritional problems may affect other areas of human functioning. In the following nursing diagnoses, the nutritional problem is the cause of another problem. Activity Intolerance related to inadequate caloric intake, obesity, iron-deficiency anemia.

Implementing

Providing proper and adequate nourishment to the patient is a team effort implemented in a variety of settings.

- Teaching Nutritional Information

- Monitoring Nutritional Status

- Providing Nutrition in Special Situations

Clear liquid diets contain only foods that are clear liquids at room or body temperature—gelatin, clear juices, 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 been modified to eliminate foods that are hard to digest and to chew, including those that are high in fiber, high in fat.

Routes of nutrition support The nutritional needs of patients are met through a

variety of delivery routes and with an array of nutritional formulation components and administration equipment.

Enteral nutrition (EN)

Long-term nutrition: Gastrostomy Jejunostomy

Short-term nutrition: Nasogastric feeding Nasoduodenal feeding Nasojejunal feeding

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

Enteral nutrition

An alternative feeding method to ensure adequate nutrition includes Enteral (through the gastrointestinal system) methods. Enteral nutrition (EN), also referred to as total enteral nutrition (TEN), is provided when the client is unable to ingest foods or the upper gastrointestinal tract is impaired and the transport of food to the small intestine is interrupted.

Enteral Access devices Enteral access is achieved by means of nasogastric

or nasointestinal ( nasoenteric ) tubes, or gastrostomy or jejunostomy tubes.

Parenteral Nutrition Parenteral Nutrition (PN) or total Parenteral

nutrition (TPN) or intravenous hyperalimentation (IVH), is provided when the gastrointestinal tract is nonfunctional because of an interruption in its continuity or because its absorptive capacity is impaired. PN is administered intravenously such as through a central venous catheter into the superior vena cava. (subclavian or internal jugular veins).

Partial Parenteral nutrition or peripheral parenteral nutrition (PPN) is prescribed for patients who require nutrient supplementation through a peripheral vein because they have an inadequate intake of oral feedings.

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

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

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 Major surgeries where nothing may be taken by

mouth for more than 5 days.

Infection control is of utmost importance during TPN therapy. The nurse must always observe surgical as aseptic technique when changing solutions, tubing, dressings, and filters.

Increased risk of fluid, electrolyte, and glucose imbalances and require frequent evaluation and modification of the TPN mixture.

Insertion problems, such as pneumothorax, air embolism, and thromboembolism.

Phlebitis

SPECIAL CONSIDERATION

TPN solutions are 10% to 50 % dextrose in water , plus a mixture of amino acids and special additives such 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 to each client’s nutritional needs.

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

When TPN is to be D/C, the TPN infusion rates are decreased slowly to prevent hyperinsulinemia and hypoglycemia. Weaning a client from TPN may take up to 48 hours but can occur in 6 hours as long as the client receives adequate carbohydrates either orally or intravenously.