5 Basic Physiology of Nutrition : When we ingest food into our stomach, it goes through a process of digestion and absorption. A NUTRIENT is something that is ingested, digested, absorbed and then USED by the body to maintain function. A nutrient is classified as one of 3 main groups – carbohydrate, fat or protein (macronutrients), and 2 other groups – vitamins & minerals (micronutrients). 5
9 Assisting the client with oral nutrition Determine the type of diet that the person can tolerate (also consider cultural needs.) Assess the person's ability to swallow Determine the person's ability to self-feed Assess the person's appetite, tolerance to food, likes and dislikes Assess whether the person has food allergies
10 Prepare the room for mealtime Remove any unpleasant odours and sights Clear over bed table Set up chair for client and for nurse
11 Prepare patient for meals Assess need for the toilet prior to eating Person to wash hands Assist with mouth care - dentures in, mouth moist Ensure person has glasses or contacts in place Assist the person into a comfortable sitting position Ensure that person has serviette and special devices to facilitate feeding if required
12 Prepare patient for meals Assist to sit up if lying down.
13 Assisting with meals Let patient see and smell the meal Check the temperature of food and drinks Check for sharp bones or pips Consider individual preferences e.g use of condiments, one food at a time or meat and vegetables together
14 Prepare patient for meals Consider cultural / individual preferences – * Buddhist – vegetarian * Hindu – beef, pork & some fowl * Islam – no pork or alcohol, meat must be Halal. Observe Ramadan. * Mormon – no caffeinated or alcoholic beverages. * Orthodox Judaism – Must be Kosher, with no pork or shellfish. Observe the Sabbath, Yom Kippur & Passover.
15 Assisting with meals (cont) Sit down to feed patient Don't rush or present too much with each mouthful, use a gentle action Feed person in a manner that facilitates chewing and swallowing Elderly person: feed small amounts at a time, assessing chewing, swallowing and fatigue Neurological person: feed small amounts at a time and assess for ability to chew, manipulate tongue to form a bolus and swallow. Give small amounts of fluids and assess swallowing
16 Assisting with meals (cont) Provide fluids as requested. Do not allow person to drink all liquids at beginning of meal Encourage independence Attend to oral hygiene and comfort needs Have patient sitting up for at least 30 minutes following meal
17 Evaluation and documentation During meal note person's ability to swallow Assess person's tolerance to diet Assess person's fluid and food intake Assess person's ability to self-feed Weight as directed in care plan Documentation e.g. food chart, progress notes, etc Reporting
19 Therapeutic diets These diets are prescribed to Rectify a nutritional deficiency Decrease specific nutrients Provide modification in the texture or consistency of food May be temporary or permanent
20 Renal failure Proteins are limited to minimise excessive amounts of uraemia – complete proteins (meat, milk protein & egg white) are best Carbohydrates are increased to ensure Adequate caloric intake Provide a protein sparing effect Fluid intake is replacement of insensible loss (500ml) plus the equivalent of last 24-hours urinary output Monitor potassium intake to prevent hyperkalaemia (bananas, citrus, spinach.) Limit sodium to prevent the further retention of fluid and raising blood pressure
21 Diabetic Satisfy hunger Provide enough energy and nutritional requirements for effective body function Maintain desirable body weight Maintain blood glucose within normal range Prevent long-term complications Three meals and three snacks per day Low GI food
24 Cardiac Limit sodium to prevent raising blood pressure Low fat (especially saturated), low cholesterol to prevent further damage to the blood vessels and increase in body weight Fat in the diet to be monosaturated and/or omega-3 fatty acids (Fish, olives, nuts, seeds, avocados.) Fluid intake may be restricted to prevent further retention of fluid and the resulting stress on the heart
25 Modification of texture or consistency Clear fluids Broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatine, ice blocks Full liquid Plus smooth textured dairy products, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices Pureed Plus scrambled eggs, purred meats, vegetables, fruits, mashed potatoes and gravy Soft Plus tenderised meat, poultry, fish, soft casseroles, lettuce, tomatoes, soft fruit, cake, biscuits without nuts or coconut
31 Body fluids Body fluids refers to both water and electrolytes Water comprises approximately 60% of body weight in adults Less in the elderly (45%), 75% of newborns, and obesity of all ages
32 Body Fluids Body composition. users.hubwest.com
33 Electrolytes Electrolyte – an element or compound that, when melted or dissolved in water or other solvent, disassociates into ions and is able of conducting an electrical current Ion – an atom or group of atoms that have acquired an electrical charge through the gain or loss of an electron or electrons Major Intracellular ions K + is major cation, PO4 - major anion Major Extracellular ions Na + is major cation and Cl - major anion There are substances in the plasma that are non electrolytes –many are organic compounds e.g. glucose
34 Functions of electrolytes Promotion of neuromuscular irritability Maintenance of body fluid osmolality Regulation of acid-base balance (normal 7.35-7.45) Maintenance of body water distribution
35 Basic functions of water Provides aqueous medium for cellular metabolism Transports material to and from the cells Acts as a solvent for electrolytes and other substances necessary for cell formation Helps to regulate body temperature Maintains physical and chemical constancy of intracellular and extracellular fluid Maintains vascular volume Aids in digestion of food Provides medium for waste excretion
36 Composition of water 70% of body weight is intracellular 30% of body weight is extracellular fluid 24% interstitial 6% plasma 7% of body weight makes up blood volume (approx 5.6 litres for a 70kg male) Percentage is less for women Percentage is more for children The movement of body fluids between the cells and the extracellular compartments is constant. This is achieved by osmosis, diffusion and active transport.
37 Balance of fluids and electrolytes Is dependent on: Cardiovascular system Kidneys maintain volume and regulate pH Pituitary gland releases ADH (antidiuretic hormone – vasopressin) Lungs aid acid/base maintenance Parathyroid hormone (PTH) regulates calcium and phosphorous Aldosterone (steroid hormone produced by the renal cortex) increases the retention of sodium and water at the loss of potassium Hypothalamus regulates pituitary gland.
38 Basal metabolic requirements are 1500mls of fluid to be consumed per day This means that the minimum amount of daily fluid intake for an adult is 1500mls.
39 Changes to daily fluid requirements Increased High environmental temperatures Increased exercise Fever Body dysfunction Restrictions Cardiac Renal
40 Fluid volume imbalance Circulatory volume depletion due to the movement of sodium and water from the circulatory system into the interstitial spaces e.g. burns, Fever Haemorrhage Diarrhoea/Vomiting Extracellular volume excess is due to a shift of sodium and water from the interstitial spaces to the plasma e.g. Cardiac Renal Hepatic failure or Excess IV of Normal saline (N/S)
41 Fluid and electrolyte imbalance Cells do not receive adequate nourishment Accumulation of waste Acid/base imbalance Temperature regulation impaired Interruption to those activities that require transmission of electrical energy (e.g. muscle contraction, cardiac arrhythmias)
42 Fluid balance charting Indications for a fluid balance chart Actual or potential dehydration Circulatory overload Artificial feeding Intravenous therapy Kidney and bladder problems
43 Accurate fluid balance charting (FBC) Legible entry Correct column Measure and record in millilitres Record accurately and at the time of measuring Offer bed pans and/urinals – making measurement more accurate Inform patient, staff, and relatives Include estimate of 'insensible' loss Note accidental disposal of loss Total at the end of 24hours and note negative or positive outcomes Input < Output – negative; Input > Output – positive
45 Anorexia Anorexia is a lack of appetite in the presence of a physiological need for food. It is a common symptom of gastrointestinal and endocrine disorders e.g. Appendicitis Gastritis Hepatitis Crohn’s disease, Ketoacidosis Hyperthyroidism
46 Causes of anorexia Anxiety Chronic pain Increased temperature Alterations in taste or smell Alcoholism Drugs Cancer Radiation therapy
47 Nursing interventions for anorexia Offer small meals frequently Provide food liked by the patient Suitable environment High caloric snacks Keep fat content of food to a minimum
48 Nausea and vomiting Categorising nausea and vomiting Pathological – due to disease process e.g. obstruction Iatrogenic – relating to treatment e.g. chemotherapy Psychological – relating to emotional response
50 Complications of vomiting Malnutrition Dehydration Electrolyte imbalance Dehiscence of wound Aspiration
51 Signs of dehydration Loss of weight Sunken eyes Dry skin, loss of tissue turgor Dry mouth and tongue Increase in temperature Oliguria Decrease in blood pressure Irritability and confusion Thirst http://maflib.mtandao-afrika.net/MAF080111 /blessed%20-%20malaria/vc_dehydration.jpg http://i.ehow.com/images/GlobalPhoto/ Articles/2195011/dehyd-main_Full.jpg
53 Nursing interventions for vomiting Positioning and emesis bowl Privacy Dentures removed Place hand on forehead to provide support and comfort, splint abdomen if required Remove vomitus a.s.a.p. Remove soiled lined Wash face, hands and give oral hygiene Assist patient into position of comfort Report and record
54 Observation of vomitus Quantity Presence of blood Odour Consistency Colour