CHAPTER 39 - NUTRITION AND ORAL HYDRATION Flashcards
1
Q
Nutrients provide
A
energy for cellular metabolism,
tissue maintenance / repair,
organ function,
growth / development,
physical activity.
2
Q
CHAPTER 39
A
Nutrition and Oral Hydration
3
Q
most basic of all nutrients
A
Water
4
Q
water is crucial for all
A
body fluid and cellular functions
5
Q
2 things required to ensure adequate nutritional status
A
proper balance of nutrients and fluid
consideration of energy intake and requirements
6
Q
A nutritional assessment helps identify
A
areas to modify,
either through adding or avoiding specific nutrients
or by increasing or decreasing caloric intake.
7
Q
When planning a nutritional or hydration intervention, it is important to consider
A
beliefs and culture,
environment,
presentation of the food,
illnesses / allergies
8
Q
BASIC NUTRIENTS THE BODY REQUIRES
A
CARBOHYDRATES
FATS
PROTEINS
VITAMINS
MINERALS
WATER
9
Q
CARBOHYDRATES PROVIDE
A
provide most of the body’s energy and fiber
gram produces 4 kcal
glucose - burns completely and efficiently without end products to excrete
10
Q
CARBOHYDRATES SOURCES OF
A
whole grain breads,
baked potatoes,
brown rice,
11
Q
FATS PROVIDE
A
energy and vitamins.
MAX 35% of caloric intake should be from fat. gram produces 9 kcal. .
12
Q
FATS SOURCES OF
A
olive oil,
salmon,
egg yolks
13
Q
PROTEINS
A
contribute to growth / maintenance / repair of body tissues.
Each gram produces 4 kcal.
14
Q
PROTEINS SOURCES OF
A
beef,
whole milk,
poultry.
15
Q
VITAMINS
A
necessary for metabolism.
16
Q
FAT SOLUBLE VITAMINS
A
A, D, E, and K.
17
Q
WATER SOLUBLE VITAMINS
A
C and the B complex (eight vitamins)
18
Q
MINERALS
A
essential biochemical reactions in the body
19
Q
MINERALS INCLUDE
A
(calcium, potassium, sodium, iron).
20
Q
WATER
A
critical for cell function and replaces fluids the body loses
21
Q
WAYS THE BODY LOSES WATER
A
perspiration,
elimination,
respiration.
22
Q
FACTORS AFFECTING NUTRITION AND METABOLISM
A
Religious and cultural practices
Financial issues
Appetite
Negative experiences
Environmental factors
Disease and illness
Medications
Age
23
Q
Religious and cultural practices
A
guide food preparation and choices.
24
Q
Financial issues
A
prevent some clients from buying foods that are high in protein, vitamins, and minerals.
25
Appetite
decreases with illness, medications, pain, depression, and unpleasant environmental stimuli.
26
Negative experiences
with certain foods or familiarity with foods clients like help determine preferences.
27
Environmental factors
(sedentary lifestyles, work schedules, and widespread access to less healthy foods) contribute to obesity.
28
Disease and illness
can affect the functional ability to prepare and eat food.
29
Medication
s can alter taste and appetite and can interfere with the absorption of certain nutrients.
30
Age
affects nutritional requirements.
31
AGE BANDS (7)
NEWBORNS / INFANTS
TODLLERS
PRESCHOOLERS
SCHOOL AGE CHILDREN
YOUNG ADULTS
MIDDLE ADULTS
OLDER ADULTS
32
NEWBORNS / INFANTS
(birth to 1 year)
High energy requirements
● Breast milk (ideally) /formula - provide:
◯ 108 kcal/kg of weight - first 6 months
◯ 98 kcal/kg of weight - second 6 months
● Solid food - 4 to 6 months
● No cow’s milk / honey - first year
33
TODLLERS
(12 months to 3 years)
need < calories per kg of weight than infants
● need > protein - sources other than milk.
● Calcium / phosphorus - important for bone health.
● Nutrient density - more important than quantity.
34
PRESCHOOLERS
(3 to 6 years)
need < calories per kg of weight than infants
● need > protein - sources other than milk.
● Calcium / phosphorus - important for bone health.
● Nutrient density - more important than quantity.
35
SCHOOL AGE CHILDREN
(6 to 12 years)
● need supervision to consume adequate protein / vitamins C / A.
● eat foods high in carbohydrates, fats, / salt.
● grow at slower / steadier rate, W/ gradual decline in energy requirements.
36
ADOLESCENTS
(12 to 20 years)
● Metabolic demands - high / require more energy.
● Protein, calcium, iron, iodine, folic acid, / vitamin B needs high.
● One‑fourth dietary intake - from snacks.
● Increased water consumption - important for active adolescents.
● Body image / appearance, fast foods, peer pressure, fad diets influence adolescents’ diet.
37
YOUNG ADULTS
(20 to 35 years)
decreased need for most nutrients (except during pregnancy).
● Calcium / iron - essential minerals for women.
● Good oral health - important.
38
MIDDLE ADULTS
(35 to 65 years)
decreased need for most nutrients (except during pregnancy).
● Calcium / iron - essential minerals for women.
● Good oral health - important.
39
OLDER ADULTS
(over 65 years)
● slower metabolic rate requires fewer calories.
● Thirst sensations diminish, increasing risk dehydration.
● need same amount most vitamins / minerals as younger adults.
● Calcium - important - both men / women.
● require carbohydrates - provide fiber / bulk - enhance gastrointestinal function.
40
EATING DISORDERS
ANOREXIA NERVOSA
BULIMIA NERVOSA
BINGE EATING DISORDER
41
Anorexia nervosa
● Significantly low body weight for gender, age, developmental level, / physical health.
● Fear of being fat
● Self‑perception of being fat
● Consistent restriction of food intake / repeated behavior - prevents weight gain
42
Bulimia nervosa:
Cycle of binge eating followed by purging
● Lack of control during binges
● Average MIN one cycle (binge eating / purging) per week - at least 3 months
43
Binge‑eating disorder:
Repeated episodes - binge eating
● Feels loss of control when binge eating, followed by emotional response
● Does not use compensatory behaviors
● episodes range one - multiple times /week.
● often overweight / obese.
44
PURGING
(vomiting, using diuretics or laxatives, exercising
excessively, fasting)
45
emotional response
guilt, shame, or depression)
46
compensatory behaviors
(purging)
47
A BMI of 25 is the
upper boundary of a healthy weight,
48
BMI OF 25 to 29.9 is
overweight,
49
BMI OF 30 to 34.9 is
obesity class 1,
50
BMI OF 35 to 39.9 is
obesity class 2,
51
BMI OF 40 and above is
obesity class 3.
52
Dietary history should include the following
Number of meals / day
● Fluid intake
● Food preferences, amounts
● Food preparation, purchasing practices, access
● History of indigestion, heartburn, gas
● Allergies
● Taste
● Chewing, swallowing
● Appetite
● Elimination patterns
● Medication use
● Activity levels
● Religious, cultural food preferences / restrictions
● Nutritional screening tools
53
CLINICAL MEASURES FOR BODY WIEGHT
BMI
SKIN FOLD MEASUREMENTS
LAB VALUES
54
LAB VALUES MEASURED FOR WEIGHT / HEALTH
cholesterol,
triglycerides,
hemoglobin,
electrolytes,
albumin,
prealbumin,
transferrin,
lymphocyte count,
nitrogen balance
55
Monitor I&O for clients who have
fluid or electrolyte imbalances.
56
Measure and calculate all intake and output in
mL (1 oz = 30 mL)
57
Intake includes
all liquids
(oral fluids,
food that liquefy at room temperature,
IV fluids,
IV flushes,
IV medications,
enteral feedings,
fluid instillations,
catheter irrigants,
tube irrigants)
58
Output includes
all liquids
(urine,
blood,
emesis,
diarrhea,
tube drainage,
wound drainage,
fistula drainage)
59
Weigh clients each day HOW?
at same time, after voiding, / wearing same type clothes.
If bed scales - use same amount of linen each day, / reset scale to zero if possible.
60
EXPECTED FINDINGS OF POOR NUTRITION
Nausea, vomiting, diarrhea, constipation
● Flaccid muscles
● Mental status changes
● Loss of appetite
● Change in bowel pattern
● Spleen, liver enlargement
● Dry, brittle hair / nails
● Loss of subcutaneous fat
● Dry, scaly skin
● Inflammation, bleeding of gums
● Poor dental health
● Dry, dull eyes
● Enlarged thyroid
● Prominent protrusions in bony areas
● Weakness, fatigue
● Change in weight
● Poor posture
61
NURSING INTERVENTIONS OF POOR NUTRITION
Assist - advancing diet provider prescribes.
● Instruct - appropriate diet regimen.
● interventions to promote appetite .
● Educate - medications - can affect nutritional intake.
● Assist W/ feeding - promote optimal independence.
● Individualize menu plans according to preferences.
● Assist W/ preventing aspiration.
Remove water pitcher from bedside.
■ Inform dietary staff - amount of fluid to serve W/ each meal tray.
■ Inform staff each shift - amount of fluid CAN have in addition each meal tray.
■ Record all oral in-take, / inform family of the restriction.
ADMINISTER / MONITOR ENTERAL FEEDINGS
ADMIN / MONITOR PARENTERAL NUTRITION
RECORD I&O
PROVIDE FRESH DRINKING WATER
ENSURE BEVERAGE PREFERENCES
62
INTERVENTIONS TO PROMOTE APPETITE
(good oral hygiene, favorite foods, minimal environmental odors)
63
Assist with preventing aspiration
high Fowler’s position or chair.
◯ Support upper back, neck, / head.
◯ tuck chin when swallowing -
◯ Avoid use of a straw.
◯ Observe - aspiration / pocketing of food in cheeks / other areas mouth.
◯ Observe - indications of dysphagia
◯ semi‑Fowler’s position - at least 1 hr after meals.
◯ Provide oral hygiene after meals and snacks
64
INDICATIONS OF DYSPHAGIA
(coughing,
choking,
gagging,
drooling of food).
65
TUCK CHIN WHEN SWALLOWING HELPS W/
help propel food down the esophagus.
66
therapeutic diets.
NPO (nil per os): no food or fluid at all by mouth, not even ice chips, requiring a provider’s prescription before resuming oral intake
◯ Clear liquid: liquids that leave little residue (clear fruit juices, gelatin, broth)
◯ Full liquid: clear liquids plus liquid dairy products, all juices. Some facilities include pureed vegetables in a full liquid diet.
◯ Pureed: clear and full liquids plus pureed meats, fruits, and scrambled eggs
◯ Mechanical soft: clear and full liquids plus diced or ground foods
◯ Soft/low‑residue: foods that are low in fiber and easy to digest (dairy products, eggs, ripe bananas)
◯ High‑fiber: whole grains, raw and dried fruits
◯ Low sodium: no added salt or 1 to 2 g sodium
◯ Low cholesterol: no more than 300 mg/day of dietary cholesterol
◯ Diabetic: balanced intake of protein, fats, and carbohydrates of about 1,800 calories
◯ Dysphagia: pureed food and thickened liquids
◯ Regular: no restrictions
67
NPO
(nil per os): no food or fluid at all by mouth,
not even ice chips,
requiring a provider’s prescription before resuming oral intake
68
◯ Clear liquid:
liquids that leave little residue
(clear fruit juices, gelatin, broth)
69
◯ Full liquid:
clear liquids
plus liquid dairy products, all juices.
Some facilities include pureed vegetables in a full liquid diet.
70
◯ Pureed:
clear and full liquids
plus pureed meats, fruits, and scrambled eggs
71
◯ Mechanical soft:
clear and full liquids
plus diced / ground foods
72
◯ Soft/low‑residue:
foods that are low in fiber / easy to digest
(dairy products, eggs, ripe bananas)
73
◯ High‑fiber:
whole grains,
raw and dried fruits
74
◯ Low sodium:
no added salt or 1 to 2 g sodium
75
◯ Low cholesterol:
no more than 300 mg/day of dietary cholesterol
76
◯ Diabetic:
balanced intake of protein, fats, / carbohydrates of about 1,800 calories
77
◯ Dysphagia:
pureed food / thickened liquids
78
◯ Regular:
no restrictions
79
Administer and monitor enteral feedings via
nasogastric,
gastrostomy,
jejunostomy tubes
80
Administer and monitor parenteral nutrition to clients who are
unable to use their gastrointestinal tract to acquire nutrients.
81
Parenteral nutrients include
lipids,
electrolytes,
minerals,
vitamins,
dextrose,
amino acids.
82
Maintain fluid balance (2 WAYS)
Administer IV fluids.
◯ Restrict oral fluid intake (maintaining strict I&O).
83
A nurse is caring for a client who is at high risk for aspiration. Which of the following actions should the nurse take?
A. Give the client thin liquids.
B. Instruct the client to tuck their chin when swallowing.
C. Have the client use a straw.
D. Encourage the client to lie down and rest after meals.
A. Thin liquids increase the client’s risk for aspiration.
B. CORRECT: Tucking the chin when swallowing allows food to pass down the esophagus more easily.
C. Using a straw increases the client’s risk for aspiration.
D. Sitting for an hour after meals helps prevent gastroesophageal reflux and possible aspiration of stomach contents after a meal.
84
A nurse is preparing a presentation about basic nutrients for a group of high school athletes. She should explain that which of the following nutrients provides the body with the most energy?
A. Fat
B. Protein
C. Glycogen
D. Carbohydrates
A. Although the body gets more than half of its energy supply from fat, it is an inefficient means of obtaining energy. It produces end products the body has to excrete, and it requires energy from another source to burn the fat.
B. Protein can supply energy, but it has other very essential and specific functions that only it can perform. So it is not the body’s priority energy source.
C. Glycogen, which the body stores in the liver, is a backup source of energy, not a primary or priority source.
D. CORRECT: Carbohydrates are the body’s greatest energy source; providing energy for cells is their primary function. They provide glucose, which burns completely and efficiently without end products to excrete. They are also a ready source of energy, and they spare proteins from depletion.
85
A nurse is caring for a client who requires a low‑residue diet. The nurse should expect to see which of the following foods on the client’s meal tray?
A. Cooked barley
B. Pureed broccoli
C. Vanilla custard
D. Lentil soup
A. Whole grains (barley and oats) are high in fiber and thus inappropriate components of a low‑residue diet.
B. Raw and gas‑producing vegetables (broccoli and the cabbage in coleslaw) are high in fiber and thus inappropriate components of a low‑residue diet.
C. CORRECT: A low‑residue diet consists of foods that are low in fiber and easy to digest. Dairy products and eggs (custard and yogurt) are appropriate for a low‑residue diet.
D. Legumes (lentils and black beans) are high in fiber and thus inappropriate components of a low‑residue diet.
86
A nurse is caring for a client who weighs 80 kg (176 lb) and is 1.6 m (5 ft 3 in) tall. Calculate the body mass index (BMI) and determine whether this client’s BMI indicates a healthy weight, underweight, overweight, or obese.
BMI = weight (kg) ÷ height (m2).
Step 1: Client’s weight (kg) and height (m) = 80 kg and 1.6 m
Step 2: 1.6 × 1.6 = 2.56 m2
Step 3: 80 ÷ 2.56 = 31.25
A BMI greater than 30 identifies obesity.
87
A nurse in a senior center is counseling a group of older adults about their nutritional needs and considerations. Which of the following information should the nurse include? (Select all that apply.)
A. Older adults are more prone to dehydration than younger adults are.
B. Older adults need the same amount of most vitamins and minerals as younger adults do.
C. Many older men and women need calcium supplementation.
D. Older adults need more calories than they did when they were younger.
E. Older adults should consume a diet low in carbohydrates.
A. CORRECT: Sensations of thirst diminish with age, leaving older adults more prone to dehydration.
B. CORRECT: These requirements do not change from middle adulthood to older adulthood. However, some older adults need additional vitamin and mineral supplements to treat or prevent specific deficiencies.
C. CORRECT: If older adults ingest insufficient calcium in the diet, they need supplements to help prevent bone demineralization (osteoporosis).
D. Older adults have a slower metabolic rate, so they require less energy (unless they are very active), and therefore need fewer calories.
E. M any older adults need more carbohydrates for the fiber and bulk they contain. They should, however, reduce their intake of fats and of “empty” calories (pastries and soda pop).
