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Nutrition and Fluids By: Diana Blum MSN NURS 1510.

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Presentation on theme: "Nutrition and Fluids By: Diana Blum MSN NURS 1510."— Presentation transcript:


2 Nutrition and Fluids By: Diana Blum MSN NURS 1510

3 Definitions Nutrition= Sum of all the interactions between an organism and the food it consumes. Nutrients= organic and inorganic substances found in foods required for body to function

4 Functions of Nutrients Provide energy for body processes Provide structural material for body tissues Regulate body processes

5 Normal growth Tissue maintenance Tissue repair/recovery Treatment of disease Nutrition is Essential for

6 Maintain immune system Prevent medical problems Maintain normal temp Produce enzymes and hormones

7 Review of Digestive System

8 Intake of food/fluids Mechanical Digestion Chemical digestion of starches begins Mouth

9 Passageway from the mouth to the stomach Peristalsis propels food forward Esophagus

10 Turns food into chyme Adds HCL Mechanical and chemical digestion continues Food stays for 1-4 hours Stomach

11 Simple carbohydrates 1hr Complex carbohydrates 3hr Protein 5hr Fats 7hr Rationale for a variety of foods in % of intake To complete digestion

12 Chemical digestion Bile and enzymes are added Digestion completed Absorption of nutrients occurs Small intestine

13 Storage of wastes Absorption of water Elimination Synthesis of Vitamin K Large intestine

14 Psychological State-fear, anxiety Bacterial action Food processing-whole grain, raw, fried, cooked Factors affecting digestion

15 Essential nutrients

16 Carbohydrates 4 cal/gm Simple: sugars Complex: starches/fiber Natural sources: supply vital nutrients (proteins, vitamins, minerals not in processed foods) – If processed foods they are referred to as empty calories (alcohol for example)

17 Types Of Carbs Sugars – Monosaccharide 3 types – Glucose, fructose, galactose – Disaccharides 3 types – Maltase, sucrase, lactase Starches – polysaccharides Fiber

18 Carb Digestion Major players: ptyalin, pancreatic amylase and disaccharides. Enzymes: biologic catalysts that speed up chemical reactions – Desired end products are monosaccharides Absorbed by small intestine in healthy people

19 Carb Metabolism Major source of energy After carbs broken to glucose – Some circulates in blood – Rest is used or stored Example is insulin

20 Storage and conversion of Carbs Stored as glycogen and fat – Glycogen is larger Most stored in liver or skeletal muscle – Can be converted back to glucose If it is not stored it is converted to fat

21 Proteins 4cals/gm Essential Nonessential Complete Incomplete

22 Protein Digestion Begins in mouth Most of digestion in small intestine The pancreas

23 Protein Storage Absorbed by active transport via the small intestine Synthesized Used to make cell structures Stored as body tissue Metabolic pool

24 Protein Metabolism Anabolism Catabolism Nitrogen Balance

25 Lipids -- 9 cal/gm Fats and oils Fatty acids – Saturated – Unsaturated Monounsaturated polyunsaturated Glycerides Triglycerides Cholesterol

26 Lipid Digestion Begins in stomach Mainly in small intestine End products Lipoproteins

27 Lipid Metabolism Lipase 1 pound of fat provides 3500 kilocalories Brain nerves and rbcs require__________. Only the glycerol molecules can be converted to ____________.

28 Macronutrients Vitamin – Water soluble vitamins: – Fat soluble vitamins: Minerals – Macrominerals – Microminerals

29 Most essential nutrient for survival Essential for cells Sources--eating, drinking, metabolism Water

30 Sodium: Less than 2400mg Cholesterol: Less than 300mg Fat: Less than 65grams Fiber: Approximately 25-30 Grams Fluids: 3000ml / 24 hour What is adequate?

31 2000 calorie diet 60% carbohydrate 20% protein 20% fat calories 2000X60%=1200/4cal per g=300gram CHO 2000x20%= 400/4cal per g=100gramCHON 2000x20%= 400/9cal per g=44grams Fat Determine energy from nutrients

32 Represents allowances of essential nutrients by age and category, inclusive of weight and height. Represents 98% of people in general good health 55-60% carbohydate 12-20% protein <30% fat Purpose of RDA’s

33 Infants: double wgt 4-5 mo. Not able to digest or metabolize many foods Toddlers & pre-schoolers: need increase in protein r/t body wgt. School age + adolescents: generally have good appetites. Need healthy selection ed. Adults: Fruits, veg, whole grain & portion control Nutritional Needs Based on Developmental Stage

34 May have fixed income May not be able to go out and shop Decrease in taste buds Loss of teeth, poor fitting dentures Don’t enjoy eating alone Older Adult

35 Health Socio - Economic status Psychological state Culture/religion Factors influencing patterns`

36 Personal preferences Misinformation-food fads Alcohol and drug use Age and life-style Alcohol = 7calories/gram continued

37 Hgt & wgt I&O trends Body composition Edema Condition of skin, teeth, hair Dietary history Turgor Dietary diary Anthropometry Calorie count Stool characteristics Nutritional Assessment

38 Albumin-role in F&E balance Pre-albumin-more reliable Transferrin-non-hem iron->when iron Hbg-O2 carrying capacity < blood loss BUN = hydration and Creatinine Diagnostics

39 Anyone with problems with I & O, digestion and absorption of nutrients – Anorexia nervosa – Bulimia --Impaired mobility – Chemotherapy --Lengthy NPO – Chronic illness – Extensive surgery Major Nutritional Problems

40 Most reliable indicator is WEIGHT Intake and output are very important and must be accurate Nutritional Status

41 Provide rest to a body part Adapt to client’s ability to eat swallow, digest, absorb, or metabolize nutrients Weight loss or gain Maintain nutritional status Correct deficiencies Therapeutic diets

42 Consistency/texture Frequency of feedings Number of calories Specific nutrients Fluid volume Diet Modifications

43 Tea, broth, jello, water Liquids you can see through Nutritionally inadequate Clear liquid

44 Foods that are liquid at body temperature May be nutritionally adequate if planned carefully Full medical liquid

45 Foods which are easy to chew and to digest Mechanical soft/pureed Soft diet

46 Non-irritating foods Chemically Thermally Mechanically Bland diet

47 Residue has to do with fiber Hi=increase peristalsis Low-decrease peristalsis Regulates the volume of fecal output High or low residue diet

48 Sodium restricted: reduces fluid retention and allows heart to work less Low fat or cholesterol: reduces the plaque formation in blood vessels, limiting CAD Other Diets

49 Offer bathroom Wash face/hands Oral care Glasses/hearing aids Position of comfort prior to food served Reinforce importance of intake NI to enhance intake of nutrients

50 Serve food in pleasant social setting Prepare tray Place in reach and in visual field Encourage social interaction Assist with feeding if necessary Know precautions Protect clothing with apron-not bib Continued-at meals

51 Allow client to empty mouth before putting more food in Encourage client to direct speed/order Be at eye level/face to face Allow for rest periods Avoid heaping food on utensils Continued-at meals

52 Record accurate intake and output Note % ¼, ½,¾,or 100% Provide oral hygiene Offer fluids or supplements as ordered thru shift After meals

53 Feedings administered through a tube directly into the stomach or small intestine Naso-gastric tube Gastrostomy tube Jejunostomy tube Enteral Nutrition

54 Comatose clients Severe reflux disease Paralysis of muscles used for swallowing Obstruction Weakness When is enteral feeding needed?

55 X-ray verification Aspirating gastric contents Instilling air through tube while auscultating with a stethoscope Ask client to speak Placement

56 Check placement q 4 h and prn Check residual q 4 h and prn Keep HOB up 30 degrees Abdominal assessment, temp, lung sounds q shift and prn, stooling Report N/V Maintenance and Prevention of Complications

57 Change bag q 24 hrs Measure and record I&O q 8 h Flush tube with water -- institutional policy re: meds and feedings Give meds individually!! Flush between each med Observe rate of flow Maintenance and preventiion, con’t

58 IV (Parenteral) therapy

59 Provide hydration Administer meds Access circulatory system Provide electrolytes Give blood Parenteral Therapy

60 Observe rate and flow and correct solution Record I&O Check insertion site Assess client’s fluid balance LPN responsibilities

61 Inflammation of a vein Red streak Warmth Pain Edema Fluid infuses readily Good blood return Phlebitis

62 Skin pale in area Skin cool Edema Firm to touch Feels “tight” or “burns” Infuses sluggishly No blood return Infiltration

63 Contains all necessary nutrients AKA Hyperalimentation Given via central line Total Parenteral Nutrition

64 Assess IV site q shift, dressing Weigh daily Record I&O Note infusion rate/ correct solution Assess fluid balance VS q 4 hr. Accu checks LPN responsibilities

65 Electrolytes: ions and carry electric charge when dissolved in fluid. + =cations=NA, K, Ca, Mg. ---anions=Cl, HCO3 Minerals: ingested compounds, help regulate body functions Cells: functional basic units of all living tissue. Cells within fluid=R and W blood cells Components of body fluids

66 Intracellular: contained within each cell =40% of body wgt Extracellular: located outside the walls of the individual cells and is divided into: – Interstitual fluid: tissue fluid (edema) – Intravascular fluid: within blood vessels – Transcellular: CSF, digestive juices, synovial Fluid Balance

67 Diffusion: Solutes move from an area of higher concentration to an area of lower concentration Osmosis: movement of (solvent) water from a solution of lower concentration to an area of greater concentration Mechanism for Movement for Normal Fluid Balance

68 Active transport: Solutes are moved across a semipermeable membrane with a source of energy. Requires metabolic activity and energy expenditure. Filtration: process by which H20 & diffusible substances move together in response to fluid pressure

69 Decrease in the extracelluar fluid (dehydration), n/v, diarrhea, hemorrhage – S/S: Dry mucous membranes, decrease in BP, increase in heart rate, elevated temp, decrease in skin turgor, sunken eyes, diminished urine output, rapid wgt loss, slow vein filling, confusion – Tx: IV, antiemetics, stop diarrhea, tx cause Fluid Volume Deficit

70 Increase in extracellular fluid (hypervolemia or anasarca) – Renal or liver failure, secondary to ds of the CV system (CHF), protein deficiency, hormonal or steroid therapy, excessive Na – S/S: Dependent edema, rapid wgt gain, HTN, polyuria, JVD, rales, ascites, orthopnea, bounding pulse Fluid Volume Excess

71 Nursing Tx: HOB elevated – Frequent Vital Signs – Daily wgt I & O – Sodium restriction Lung sounds – Skin care TCDB q 2 h Tx: 02, IV therapy, fluid restriction, diuretics, low Na diet, antiembolic hose

72 K: intracellular fluid 3.5-5.0 mEq/L. – Nerve stimulus conduction, muscle activity – Abnormal levels may cause cardiac irregular Na: regulates fluid balance 135-145 mEq/L. Ca: generally combines with phosphorus to form the mineral salts of the teeth and bone. 9.0-11.0mEq/L. Need for normal muscle activity Major Electrolytes

73 Mg: necessary for neuromuscular excitability

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