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CHAPTER 15 Nutritional needs.pptx

This chapter discusses meeting nutritional needs. It covers the importance of nutrition, factors affecting nutritional status, and methods for assessing nutritional status. The chapter outlines different diets like clear liquid, full liquid, and soft diets that can be used for various conditions. It also reviews therapeutic diets for restricting sodium, protein etc. The chapter focuses on the nurse's role in ensuring patients' nutritional needs are met through oral, enteral like nasogastric tube feeding, or parenteral nutrition. Complications of total parenteral nutrition and care for gastrointestinal procedures like gastric lavage are also addressed.

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Nutritional Needs CHAPTER 15
LEARNING OBJECTIVES  Understand the importance of nutrition.  Explain the factors that affect the nutritional status of a person.  Learn how to assess the nutritional status of an individual.  Perform care of patients with different conditions.  Know how to meet nutritional requirements.
CHAPTER OUTLINE  Nutrition-its importance and factors affecting the nutritional needs  Diet- special and therapeutic  Care of patient with various conditions  Diet- oral, enteral, parenteral  Treatment related to GI system- nasogastric suction, gastric irrigation, gastric analysis.
IMPORTANCE OF NUTRITION Growth and development Prevention of deficiency diseases Illness and death Infection prevention
FACTORS AFFECTING NUTRITIONAL STATUS Physical and physiological factors Gender Cultural factors Food fads Food preferences Religion Lifestyle factors Economic conditions Heath Psychological factors
NUTRITIONAL ASSESSMENT
ANTHROPOMETRIC MEASUREMENTS
MEASURING THE TRICEPS SKINFOLD
Mid arm circumference
DIETARY METHODS
SPECIAL DIETS Full diet The regular meal without any modifications. It is a well-balanced diet, either vegetarian or nonvegetarian. Clear liquid diet The patient who is on a clear liquid diet is allowed to have drinks and beverages like water, tea, coffee, clear juices or carbonated drinks. Full liquid diet When the client isn’t able to swallow the solid food, or is on the tube feeding, the client is fed with full liquid diet. Soft diet Soft diet is easily chewable and can be digested by the body very easily. Therefore, any client with difficulty in chewing and swallowing can be put on this diet.
REVIEW OF THERAPEUTIC DIETS Low fiber diet The low-fiber diet helps during inflammation of the digestive tract and intestines since the low-fiber diet doesn’t form obstruction. high fiber Diet High-fiber or the high- residue diet is indicated in case of constipation. Cardiac Diet Cardiac diet is recommended for patients who suffer from any cardiac problem or are at risk to develop cardiac disease. Fat restricted Diet A fat-restricted diet is prescribed in conditions where the clients have malabsorption disorder, pancreatitis, gallbladder disorder, or gastroesophageal reflux.
REVIEW OF THERAPEUTIC DIETS Sodium restricted diet Sodium proves to be deleterious in case of hypertension, renal failure, heart failure, or any other cardiac disease. Therefore, sodium-restricted diet has to be prescribed in such conditions. Protein restricted Diet Protein is restricted in case a patient suffers from a renal disease or end-stage hepatic disease. Iron rich Diet A diet rich in iron is used when a client is suffering from anemia. An iron-rich diet helps in the cure of iron deficiency anemia.
NURSE’S RESPONSIBILITIES IN MEETING NUTRITIONAL NEEDS Ensure complete nutrition oThorough nutritional assessment oConsider patient’s likes oPlan according to disease process oAssist in feeding or tube feeding oAvoid painful procedures 30 minutes before or after meals Psychological support and motivation Counsel to adopt changes of dietary modification
NURSE’S RESPONSIBILITIES IN MEETING NUTRITIONAL NEEDS Heath Education Promotes compliance to the changes made in diet Provide recommendations Include education on menu planning Assisting with dietary modification Importance of fluids in diet to be emphasized Gradually bring changes in the diet Small frequent feeds Serve food in an attractive manner
CARE OF CLIENT WITH DYSPHAGIA
CARE OF CLIENT WITH ANOREXIA
NURSING CARE OF PATIENT WITH NAUSEA/VOMITING
MEETING NUTRITIONAL NEEDS Oral Nutrition Oral feeding is the process of obtaining the oral nutrition in order to meet the nutritional needs of the patient through oral nutrition
Role of nurse in providing the client with meals • Assist the client in handwashing before the meals. Moreover, the client should have maintained a good oral hygiene. Assist the client in oral care. • Provide the client a comfortable position. The client must be upright, either on bed or in chair. • A cardiac table is provided to the client. The cardiac table has to be empty so that there’s room for the plate or tray in which the food is served. • Before the plate is served, make sure that the meal belongs to the patient. Check the type of diet, name of client before the food is served. • Assist the client as per his requirement. • After the client has eaten the meal, check the amount of • food eaten by him and check how much is left. Record the observations. These observations help in the intake and output evaluation. • Help to clear the cardiac table and ask or assist the client in washing the hands after the meal. • Document if client is not eating the food.
MEETING NUTRITIONAL NEEDS Enteral nutrition Enteral feeding is a method of feeding liquid food directly to gastrointestinal system via tube (nasogastric feeding or jejunostomy feed etc.)
Procedure of nasogastric tube insertion Procedure of feeding through nasogastric tube Refer: Textbook of Foundation of Nursing" by Jyoti Kathwal
Jejunostomy Jejunostomy, also called a ‘J tube’, is defined an alternate method of enteral feeding, which is performed surgically. An opening is created in the jejunum, surgically. The opening is used for administration of food, water, and medications.
Gastrostomy Gastrostomy is defined as a surgical method in which a stoma, which is an opening, is created into the stomach . This opening serves the purpose of food and fluid administration.
Nursing management of a client with Jejunostomy and Gastrostomy • Maintain optimum nutrition status • Infection control • Skin care • Body image • Monitoring and evaluating the client
PARENTERAL NUTRITION Parenteral nutrition (PN) is the method of supplying the adequate nutrition through the IV route. In other words, the nutrition is supplied through the veins. The parenteral nutrition can either be partial parenteral nutrition (PPN) or the total parenteral nutrition (TPN).
THE TPN BAG The TPN bag consists of a mixture of proteins, carbohydrates, fats, electrolytes, vitamins, minerals and sterile water. TPN is a hypertonic solution, which helps in maintaining the positive nitrogen balance for those who are unable to maintain nitrogen balance, muscle mass, and weight.
INDICATIONS OF TPN • Severe malnourishment • Burns • Ulcerative colitis • Renal/hepatic failure • Cancer • Major surgeries • Hypermetabolic disease • Conditions due to which there is inability to ingest food orally, and the client hasn’t eaten in 7–10 days. • Patient unwilling to eat food orally.
COMPONENTS OF PARENTERAL NUTRITION
ADMINISTRATION OF PARENTERAL NUTRITION • Continuous PN The parenteral nutrition bag is administered over 24 hours without any intermission. • Intermittent or cyclic PN PN is administered in cycles, and most often, it is administered overnight.
COMPLICATIONS OF TPN Air embolism Hyperglycemia Hypervolemia Hypoglycemia Infection Pneumothorax
TREATMENT RELATED TO GASTROINTESTINAL SYSTEM Gastric Lavage or gastric irrigation Nasogastric suctioning Gastric analysis Gastric lavage, gastric irrigation or the stomach wash is defined as the procedure of washing out and irrigating the stomach using a prescribed solution Nasogastric suctioning is a procedure performed in order to suction out and remove the contents of the stomach. These contents can be solid, liquid or gases. After the nasogastric suctioning is done, the contents of the stomach are sent to the laboratory for the analysis. The analysis is called gastric analysis.
CHAPTER FOCUS POINTS • Nutrition plays an important role in one’s life. Nutrition helps in growth and development of the body, as well as helps to fight infection. • Certain factors such as gender, age, culture, and religion, etc affect the nutritional status of an individual. • The nutritional status of an individual can be assessed in terms of anthropometry, biochemical test, clinical data, and dietary habits. • There are a number of diets that can be used to recommend to the client in case of any disease condition, such as solid diet, liquid diet, semi-solid diet, etc. • Therapeutic diets such as low fiber, sodium restricted, cardiac diet can also be prescribed under the situations of a disease. • Nursing care is highly involved in the care of patient with conditions like dysphagia, anorexia, nausea and vomiting. • The nutritional needs of the client can be fulfilled using the oral, enteral and parenteral feeding. • Nursing care is involved in treating the gastric conditions. These modalities include gastric lavage, nasogastric suctioning, and gastric analysis.
“Textbook of Foundation of Nursing" by Jyoti Kathwal