Nutritional Needs & Diet Modification

Adonis K. Lomibao, R.N.12/20/11

Introduction

Nutrition:process by which the body takes in food for growth and repair and uses it to maintain health.

Signs of good nutrition:

-shiny hair

-clear skin & eyes

-well-developed body

-an alert expression

-p.427

Normal Nutrition & Essential Nutrients

Digestion:process of breaking down foods into simple substances that can be used by body cells for nourishment

Substances are essential nutrients:

-Proteins-carbs-fats-minerals-vitamins-water Supply heat & energy Build & repair body tissue Regulate body functions

Protein The basic material of every body cell Only nutrient that can make new cells & rebuild

tissue Made of amino acids Foods:

-meat-poultry-eggs-milk-cheese Complete proteins:contain all the amino acids the

body can't manufacture Incomplete:DO NOT contain all the essential amino

acids

Carbs & Fats

Energy foods used to produce heat & energy Excess stored at fat Foods: fruits, vegetables, grains Supply body with fiber or roughage(cellulose)

to maintain bowel regularity Fat: comes from plants & animals Ex: Pork,nuts,butter,cheese,egg yolk

Vitamins

Vitamins regulate body processes:

-build strong teeth & bones

-promote growth

-aid normal body functioning

-strengthen resistance to disease Vitamins A,B-Complex,C,D,E,K

Minerals

Help build body tissues, esp. bone & teeth..also regulate chemistry oof the body fluids

Minerals include:

-Calcium

-Iodine

-Copper

-Phosphorus

-Iron

-Potassium

The Five Food Groups

Food Guide Pyramid Groups:

-Grains-6oz/Daily

-Vegetables-2 ½ cups/Daily

-Fruits-2 cups/Daily

-Oils-low

-Milk-3 cups/Daily

-Meat & beans-5.5oz/Daily

Discretionary Calories

An extra calorie that can be used on solid fats, added sugars, alcohol, or extra food.

Essential calories-the minimum calories required to meet your nutrient needs.

It is possible to use more calories than the amount required to meet your nutrient needs

Water

Necessary for life and all the cellular functions in the body

2-3 Quarts Daily required to replace fluids lost through urine,

stool, sweat, and evaporation through the skin

Basic Facility Diets

Four common diets

-Regular/General

-Full liquid

-Clear liquid

-Soft

Regular/House

Normal or full diet based on 5 food groups

Variety Excludes very rich foods Lower caloric count May select from a menu

Clear Liquid Diet Temporary b/c inadequate Replaces fluids lost by vomiting or diarrhea Consists of liquids that do not irritate, cause

gas formation, or encourage bowel movements

Examples:

-fat-free meat broths

-ginger ale,7UP, clear juices

-gelatin

-p.431

Full Liquid Diet

Supplies nourishment and may be used for longer periods of time...but still temporary.

Given to patients with:

-Acute infections

-conditions involving digestive tract Examples:

-strained cereal

-strained soups p.432

Soft Diet

Usually follows the full liquir diet Nourishes body:between-meals feedings can

be given to increase calorie count Low-residue,mildly flavored,easy to digest Given to pts with: infection/fevers,difficulty

swallowing, conditions affecting digestive tract,on progressive post-op dietary regime

Examples on p.432

Special Diets

Religious practices may change diet for some pts.

i.e. Jewish:

-shellfish & nonkosher meats prohibited

-foods can't be prepared with utensils used in non-kosher foods

-p.432

The Diabetic Diet

For patients with Diabetes Mellitus Proper diet and administration of insulin Diets aim is to maintain the level of blood

sugar WNL Exchange List-method of balancing the

diabetic diet based on household measurements, excludes high content sugar, divides food into 6 groups

Milk,veg,fruit,bread,meat,fat...

Sodium-Restricted Diet

May be ordered for pts. With chronic renal failure & cardiovascular disease

Different levels of sodium: Table 26-2 Average American 2-6g/day Select low-sodium foods Low in sodium:

-some cereals

-vegetables

-fruits

Calorie-Restricted

3,500 calories=1 lb. Prescribed for pts. That are overweight Take consideration energy output, gen.

Nutritional state, & weight goal Balance between:

-proteins: 20%

-fats: 25-35%

-carbs: 45-65%

Low-Fat/Low-Cholesterol Diet

For patients suffering from vascular, heart, liver, or gallbladder disease...or difficulty with fat metabolism

Foods baked, roasted, broiled... Fats limited & calories balanced by increasing

proteins & carbs. Foods included: p.435

Mechanically Altered Diets

Consistency & texture are modified to make food easier to chew & swallow.

Mechanical soft: those who have no teeth or with serious dental problems. “consistency of ground beef”

Pureed diet: blended with gravy or liquid till its pudding consistency

Supplements & Nourishments

Ordered by physician or dietician to have a therapeutic value...i.e. High-protein to facilitate healing.

Not nutritionally comlete Nourishments are substancial food items

given to patients to increase nutrient intake. “between meals”

“snacks” prevent or eliminate hunger between meals

p.436

Calorie Counts & Food intake Studies

Food intake is analyzed for nutritional adequacy and number of calories consumed.

Info used to plan a diet to meet patient's special medical needs.

Food documentation for is prepared Food may be weighed or measured Inform staff & visitors

Dysphagia

Difficulty swallowing food & liquids May occur in those who have:

-had a stroke

-neuro studies

-dimentia

-p/437

-those who take meds that cause sedation or reduce saliva production

S&S Dysphagia

Taking a long time before beginning to swallow

Swallowing 3-4x per bite of food Lack of gag reflex or weak cough Wet, gurgling voice Unintentional weight loss p.437- inform nurse

Dysphagia

Speech language pathology consult Treated with swallowing exercises \, practice

of proper swallowing techniques, alteration of consistency of food & beverages

Thickeners may be used

-juice, nectar, honey, pudding (consistency)

Fluid balance

Balance between liquid intake & liquid output Intake-2,600-3,000ml/D Edema-excessive fluid retention Dehydration-inadequate fluid intake Output- 2,500ml/D

-urine

-perspiration

-p.440

Fluid Balance Cont.

Record I&O Push fluids/force fluids-encourage fluid intake Fluid output includes: urine,emesis, drainage.

Alternative Nutrition

Patients that may be:

-unconscious

-disease of GI tract

-persistent vomiting

-aspiration-risk TPN- IV Nutrition-concentrated nutrients Enteral feedings- tubes inserted into digestive

tract.

Alternative Nutrition Cont.

NG Tube feeding Gastrostomy- through abdominal skin into

stomach Jejunostomy tube-tip ends in small intestine

-through nose, or surgically inserted

-long term...those who don't have stomach or risk for aspiration

PEG Tube-Percutaneous Endoscopic Gastrostomy-surgically inserted

NG Tube

NG Tube

TPN

TPN

PEG Tube

PEG