NUR 372 CLASS 3 NUTRITION/FEEDING Flashcards
NUTRITION
- provides energy for cellular metabolism and repair, organ function, growth and physical activity
NUTRIENT DENSITY
- ratio of nutrient content to total energy content
ENERGY BALANCE
- equal expenditure of calories in and out
CARBOHYDRATES
- provide energy, assist in fat metabolism, and production of amino acids
- ex: bread, cereal, rice.
PROTEINS
- vital to growth, development, and normal function of all body systems
- ex: meat, fish, poultry, milk, cheese, and eggs.
FATS
- provide cellular transport, insulation, protection of vital organs, and energy storage
- ex: animal and vegetable fats.
IDEAL BODY WEIGHT
- optimal weight for body health and frame size
FACTORS AFFECTING NUTRITION
- physiologic factors
- psychological State
- lifestyle, habits, and economic resources
- culture and beliefs
- drug and nutrient interactions
- gender
- illnesses and treatment, surgery
- alcohol and drug abuse
- exercise
AGING ADULT NURSING CONSIDERATIONS
- metabolic rate declines with age
- need for calories decreases, but not for vitamins and minerals
- hunger and thirst decrease
- diets are often deficient in proteins.
- need fiber to prevent constipation
- sense of taste and smell diminish.
- decreased peristalsis and blood flow to GI tract
- impaired dentition, decreased sense of thirst, and decreases saliva production.
MANIFESTATIONS OF ALTERED NUTRITION
- overweight: 25 – 29.9
- obesity: > 30
- underweight: <18.5
recent significant weight loss or gain - decreased Energy
- altered bowel patterns
- altered skin, teeth, hair, and mucous membranes
FLUID VOLUME DEFICIT CAUSES
- hypovolemia/dehydration
- GI losses (diarrhea, vomiting)
- hemorrhage
- skin losses (fever, sweating a lot)
- altered intake (not drinking enough)
FLUID VOLUME DEFICIT SUBJECTIVE ASSESSMENT SIGNS
- dizziness
- weakness
- fatigue
FLUID VOLUME DEFICIT OBJECTIVE ASSESSMENT SIGNS
- tachycardia
- hypotension
- dry mucous membranes
- skin turgor
- weight loss
- oliguria
- older: drowsiness, confusion
FLUID VOLUME EXCESS CAUSES
- hypervolemia/overhydration
- kidney failure
- heart failure
- cirrhosis
- fluid leaking out of the vascular system into the tissues
FLUID VOLUME EXCESS SUBJECTIVE ASSESSMENT SIGNS
- weight gain
- swelling
- SOB
FLUID VOLUME EXCESS OBJECTIVE ASSESSMENT SIGNS
- tachycardia
- hypertension
- ascites
- crackles
- edema
- distended neck veins
- daily weight most reliable indicator of fluid volume increase/decrease
SUBJECTIVE DATA COLLECTED IN NUTRITIONAL ASSESSMENT
- normal, risk, dysfunction patterns
- risk factors: alcohol, eating disorder, age
- # meals/day
- fluid intake
- finances
- food preferences
- 24 h diet recall
- medication use
- ROS
OBJECTIVE DATA COLLECTED IN NUTRITIONAL ASSESSMENT
- general observation
- age, body build
- anthropometric measurements
- calorie count
- mouth inspection
- swallowing evaluation (intact gag reflex)
- diagnostic tests
- labs (Hgb, HCT, cholesterol, electrolytes, albumin)
- intake and output
INDICATIONS FOR NPO
- pre-procedure or pre-surgery
- GI rest
- post-operative recovery
- mouth or facial injuries
- severe dysphagia
CLEAR LIQUID DIET
- liquid at room temperature
- prevention of dehydration and relieving of thirst
- nutritionally inadequate for long periods of time
INDICATIONS OF CLEAR LIQUID DIET
- acute illness
- reduction of fecal material
- post-operative recovery.
FOODS IN CLEAR LIQUID DIET
- water
- coffee
- tea
- clear juice
- broth
- gelatin
- ginger ale
FULL LIQUID DIET
- all foods that can become liquid at room temperature
- can supply adequate amounts of nutrition (may need protein supplements)
INDICATIONS OF FULL LIQUID DIET
- post-op recovery
- GI rest
FOODS IN FULL LIQUID DIET
- all clear liquids
- milk
- ice cream
- soup
- vegetable/fruit juices
- pureed vegetables
PUREED DIET
- liquids and foods that are pureed to liquid form
- each food is pureed separately to preserve individual flavor
INDICATIONS OF PUREED DIET
- chewing or swallowing difficulties
- oral or facial surgery
- wired jaws
FOODS IN PUREED DIET
- clear and full liquids
- pureed meats, fruits, and eggs
SOFT (LOW FIBER) DIET
- contains whole foods that are low in fiber, lightly seasoned, and easily digested
- increases risk of constipation
INDICATIONS OF SOFT (LOW FIBER) DIET
- acute infections
- chewing difficulties
- gastrointestinal disorders
FOODS IN SOFT (LOW FIBER) DIET
- smooth, creamy, crisp texture
- raw fruits and vegetables, coarse breads and cereals, beans, and other potentially gas-forming foods are excluded
MECHANICALLY SOFT DIET
- regular diet that is modified in texture
INDICATIONS OF MECHANICALLY SOFT DIET
- chewing difficulties
- dysphagia
- poorly fitting dentures
- clients with no teeth
- surgery to the head, neck, or mouth
- strictures of the intestinal tract
FOODS IN MECHANICALLY SOFT DIET
- ground meats
- canned fruit
- softly cooked vegetables
- excludes: dry fruits/veggies, nuts
DYSPHAGIA DIET
- prescribed when swallowing is impaired, such as following a stroke
LEVELS OF DYSPHAGIA DIET
- level 1: pureed - foods are totally pureed to a smooth consistency with a pudding-like texture.
- level 2: mechanically altered - soft-textured, moist, semi-solid foods that are easily chewed and swallowed.
- level 3: advanced – near-normal textured foods that are moist. hard, sticky foods are eliminated.
TYPES OF “THICKNESS” DYSPHAGIA DIET
- thin: non-restrictive; unthickened beverages and supplements.
- nectar-like: liquids that are thin enough to sip through a straw but thicker than water
- honey-like: pourable but thickened; eaten with a spoon but cannot be sipped through a straw.
- spoon-thick: liquids thickened to maintain their shape and eaten with a spoon – given to patients who are most likely to aspirate
REGULAR DIET
- no restrictions
CARDIAC DIET
- low sodium and low fat diet
- DASH diet for patient with HTN
DIABETIC DIET
- balances intake of protein, fats and carbs
RENAL DIET
- protein-restricted diets for renal impairment or liver disease to control end products of protein metabolism (nitrogenous wastes)
- low phosphorous
- low potassium
VEGETARIAN DIET
- plants for food
- fruits/vegetables
- dried beans/peas
- grains, seeds, and nuts
VEGAN DIET
- excludes all meat and animal products
- B12 and vitamin D supplementation might be needed
LACTO VEGETARIAN DIET
- includes dairy products
LACTO-OVO VEGETARIAN DIET
- includes dairy products and eggs
FEEDING PREPARATION/PRECAUTIONS
- chin tuck
- HOB 45-90 dg
- listen to patient
- follow aspiration precautions
- listen to lung sounds before/after
- provide encouragement
- careful observation
- mouth empty before providing more food or drink
- do not use straw if oral muscle weakness/cognitive deficits
- monitor rate, depth and effort every 4 hours
SIGNS/SYMPTOMS OF DYSPHAGIA
- coughing
- choking (difficulty breathing)
- eating very slowly
- swallowing several times
- “wet” voice after eating
- drooling
- decreased LOC or sleeping during meals
- spitting out food or drinks
- holding food in mouth
- pocketing food between tongue and cheek
INTAKE & OUTPUT
- measurement of fluids that enter and leave the body
- usual intake and output 2500-3000 mL
WHAT DOES INTAKE INCLUDE
- PO fluids (juices, ginger ale, gelatin)
- IV fluids/meds
- enteral feedings
- liquid meds
WHAT DOES OUTPUT INCLUDE
- urine
- stool (if liquid)
- emesis
- drainage from chest tube
- NG tube
- wound drains
