The document outlines the importance of nutrition for health, including the energy requirements for maintaining bodily functions and the factors influencing dietary intake. It discusses methods for assessing nutritional status and managing nutrition through diet and enteral or parenteral feeding, especially in patients with specific health conditions. Additionally, it covers the principles of medical nutrition therapy and the various complications associated with nutritional support methods.

1. NUTRITIONAL
NEEDS

2. IMPORTANCE OF NUTRITION
● Nutrition is the basic component of health.
● It is essential for normal growth & development,
tissue maintenance & repair, cellular metabolism &
organ function.
● An adequate supply of nutrients is needed for the
essential function of cells.

3. BASAL METABOLIC RATE
● It is the energy needed to maintain life sustaining
activities (Breathing, circulation, heart rate &
temperature) for a specific period of time at rest.

4. RESTING ENERGY EXPENDITURE
● Otherwise called RESTING METABOLIC RATE
● It is the amount of energy an individual needs to
consume over a 24 hour period for the body to
maintain all its internal working activities while at rest.

5. CALORIE NEED
● One calorie per hour for each kilogram of body weight
is needed to carry on the basic body functions of
respiration, blood circulation, urine formation, & the
regulation of body temperature.
● Depending on the type of activity, the requirement for
calories changes.

7. ● 1 gm of Carbohydrate gives 4 kcal
● 1 gm of Protein gives 4 kcal
● 1 gm of Fat gives 9 kcal
● Water makes upto 60-70% of total body weight

10. FACTORS INFLUENCING DIETARY
INTAKE
● ETHNICITY & CULTURE
● AGE
● RELIGION
● ECONOMIC STATUS
● PEER GROUP
INFLUENCE
● PERSONAL
PREFERENCES
● CUSTOMS & BELIEFS
● ALCOHOL ABUSE
● FOOD
ADVERTISEMENTS
● PSYCHOLOGICAL
FACTORS
● HEALTH STATUS
● MEDICATIONS

11. FACTORS AFFECTING CALORIC NEEDS
● AGE
● BODY SIZE
● ACTIVITY
● BODY TEMPERATURE
● ENVIRONMENTAL
TEMPERATURE
● GROWTH
● GENDER
● EMOTIONAL STATUS

12. PRINCIPLES RELEVANT TO
NUTRITION
● An adequate intake of essential nutrients & energy
giving foods is required for optimal health
● An individual’s nutritional status is determined by the
adequacy of the specific nutrients & energy giving
foods taken into the body, absorbed & utilized.
● Nutritional needs depend on an individual’s age, sex,
body frame, the amount & kind of daily activity,
secretions of endocrine glands & the status of health.

13. ● Nutritional needs are usually altered in illness
● Food has a psychological meaning for people
● Food habits are learned
● Food habits are related to cultural, religious & moral
beliefs.

14. ASSESSMENT OF
NUTRITIONAL STATUS

15. 1. ANTHROPOMETRIC
MEASUREMENTS

16. 1. HEIGHT
2. WEIGHT
3. MID ARM CIRCUMFERENCE (MAC)
4. TRICEPS SKIN FOLD (TSF)
5. MID UPPER ARM MUSCLE CIRCUMFERENCE
(MAMC)
6. IDEAL BODY WEIGHT (IBW)
7. BODY MASS INDEX (BMI)

17. ● IDEAL BODY WEIGHT (IBW)
= HEIGHT - 100
Example : height of a patient is 170cm
IBW = Height - 100
= 170 - 100 = 70Kg

18. ● BODY MASS INDEX (BMI)
= WEIGHT IN Kg / HEIGHT IN METRE SQUARE
Unit is Kg / m2
Example : Height of patient is 162 cm & weight is 68 Kg
BMI = Wt in Kg / Ht in m2
= 68 Kg / (1.62 x 1.62) = 68 / 2.62
= 25.95 Kg / metre square

19. RANGES OF BMI

20. 2. DIETARY HISTORY &
HEALTH HISTORY

22. 3. SCREENING FOR
MALNUTRITION

23. DEGREE OF MALNUTRITION (DOM)
= (ACTUAL WEIGHT / EXPECTED WEIGHT) x 100
Example : actual weight = 20 kg, expected weight
= 24 kg
DOM = (20 Kg / 24 Kg) x 100 = 0.83 x 100
DOM = 83%

25. 4. PHYSICAL EXAMINATION

28. 5. LABORATORY &
BIOCHEMICAL TESTS

29. DYSPHAGIA
It refers to
difficulty
when
swallowing.

30. Causes of Dysphagia

31. SIGNS OF DYSPHAGIA
● Cough during eating
● Change in voice tone or
quality after swallowing
● Abnormal movements of
the mouth, tongue or lips
● Slow, weak, imprecise or
uncoordinated speech
● Abnormal gag
● Delayed swallowing
● Incomplete oral clearance
● Regurgitation
● Pharyngeal pooling
● Delayed or absent trigger
of swallow

32. Complications of Dysphagia
● ASPIRATION PNEUMONIA
● DEHYDRATION
● DECREASED NUTRITIONAL STATUS
● WEIGHT LOSS

33. NURSING
DIAGNOSIS

34. ● RISK FOR ASPIRATION RELATED TO DYSPHAGIA
● CONSTIPATION RELATED TO LOW FIBRE INTAKE
● DIARRHEA RELATED TO FOOD INTOLERANCE
● IMBALANCED NUTRITION LESS THAN BODY
REQUIREMENTS RELATED TO DECREASED ABILITY TO
INGEST FOOD AS A RESULT OF DEPRESSION
● OBESITY RELATED TO INTAKE OF UNHEALTHY FOOD
● OVERWEIGHT
● RISK FOR OVERWEIGHT
● IMPAIRED SWALLOWING RELATED TO TRAUMA TO
ESOPHAGUS
● FEEDING SELF CARE DEFICIT

35. IMBALANCED NUTRITION LESS THAN BODY REQUIREMENTS
RELATED TO DECREASED ABILITY TO INGEST FOOD AS A
RESULT OF DEPRESSION
● Assess the general condition of the patient
● Assess the height & weight of the patient
● Assess for any weight loss
● Perform physical examination
● Enquire about the dietary intake
● Assess the likes & dislikes of the patient
● Encourage to take small frequent meals
● Encourage fluid intake
● Plan a dietary menu for the patient
● Give health education on importance of well balanced diet

36. ACUTE CARE OF PATIENTS
WITH NUTRITIONAL NEEDS

37. 1. ADVANCING DIETS

38. ● CLEAR LIQUIDS
(coffee,tea, fruit juices)
● FULL LIQUIDS
(vegetable juice, ice
cream)
● PUREED (scrambled
eggs)
● MECHANICAL SOFT
(cooked vegetables,
mashed potatoes)
● SOFT / LOW RESIDUE
(low fibre diet)
● HIGH FIBRE
● LOW SODIUM(4gm,
2gm)
● LOW CHOLESTEROL
(300mg/day)
● DIABETIC DIET
● DASH DIET
● REGULAR

39. 2. PROMOTING APPETITE

40. ● Provide an environment that promotes nutritional
intake which includes keeping patient’s room
environment free of odors
● Provide a calm environment
● Provide oral hygiene
● Assess likes & dislikes of patient
● Plan for small frequent meals
● Plan a meal time appropriate for the patient
● Provide proper positions & comfort devices
● Plan & administer the mediactions

41. 3. ASSISTING PATIENTS
WITH ORAL FEEDING

42. ● When patients need assistance while eating, it is
important to protect the patient’s safety, independence
& dignity.
● Assess the patient’s risk for aspiration
● Provide a 30 minute rest period before eating
● Position in an upright ( High fowler’s or semi fowler's).

43. FEEDING THE HELPLESS
PATIENT

46. 4. ENTERAL TUBE FEEDING

47. ● ENTERAL NUTRITION is nutrients given in the GI tract.
● It is the preferred method of meeting nutritional needs
if the patient’s GI tract is functioning by providing
physiological, safe & economical nutritional support.
● Enteral feed patients receive formula via
NASOGASTRIC, JEJUNAL or GASTRIC TUBES.
● Patients with low risk of gastric reflux receive gastric
feeding.
● If there is a risk of gastric reflux and which leads to
aspiration, jejunal feeding is preferred.

48. TYPES OF ENTERAL FORMULAS
1. POLYMERIC FORMULA
2. MODULAR FORMULA
3. ELEMENTAL FORMULA
4. SPECIALTY FORMULA

49. POLYMERIC FORMULA
● It provides 1-2 kcal / ml
● It include milk based blenderized foods prepared by
hospital dietary staff
● For this to be effective, GI tract needs to be able to
absorb whole nutrients.

50. MODULAR FORMULA
● It provides 3.8 - 4 kcal / ml
● They are single macronutrient ( protein, glucose,
polymers or lipids) preparations & are not nutritionally
complete.
● This is usually added to other foods for meeting the
patient’s nutritional needs.

51. ELEMENTAL FORMULA
● It provides 1-3 kcal / ml
● It contains predigested nutrients that are easier for a
partially dysfunctional GI tract to absorb.

52. SPECIALTY FORMULA
● It provides 1-2 kcal / ml.
● They are designed to meet specific nutritional needs in
certain illness. ( liver failure, pulmonary disease or HIV
infection).

53. ● Tube feedings are typically started at full strength at
slow rates.
● Increase the hourly rate every 8-12 hours if no signs of
intolerance appear.
● Signs of intolerance are: high gastric residuals,
nausea, vomiting, cramping & diarrhea.
● Enteral feedings are much beneficial than parenteral
feedings.
● It reduces Sepsis, minimizes the hypermetabolic
response to trauma & maintains intestinal structure &
function.

54. ● Serious complication of enteral feeding is
ASPIRATION of formula into the tracheobronchial tree.
● This can further leads to NECROTIZING INFECTION,
PNEUMONIA, & POTENTIAL ABSCESS FORMATION.
● ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
is an outcome associated with pulmonary aspiration.
● Common conditions that can cause aspiration are:
COUGHING, NASOTRACHEAL SUCTIONING, AN
ARTIFICIAL AIRWAY, DECREASED LEVEL OF
CONSCIOUSNESS & LYING FLAT.

55. INDICATIONS FOR ENTERAL
& PARENTERAL NUTRITION

57. ● Feeding tubes are inserted through the nose
(NASOGASTRIC or NASO INTESTINAL), surgically
(GASTROSTOMY or JEJUNOSTOMY) or endoscopically
(PERCUTANEOUS ENDOSCOPIC GASTROSTOMY[PEG]
or JEJUNOSTOMY [PEJ]).
● If enteral nutrition therapy is less than 4 weeks total,
NG or NJ feeding tubes may be used.

58. INSERTION OF
NASOGASTRIC TUBE

63. NASOGASTRIC TUBE
FEEDING / GASTRIC
GAVAGE

69. Assessing pH of gastric contents
● 5-10 ml of gastric fluid is required for checking pH
● It typically ranges from 0-4
● Intestinal aspirate has a pH of 7.8 - 8

71. GASTROINTESTINAL CONTENTS

72. COMPLICATIONS OF ENTERAL TUBE FEEDING
● Pulmonary aspiration
● Diarrhea
● Constipation
● Tube occlusion
● Tube displacement
● Fluid overload
● Abdominal cramping
● Nausea/ vomiting
● Delayed gastric
emptying
● Serum electrolyte
imbalance
● Hyperosmolar
dehydration

73. 5. PARENTERAL NUTRITION
(PN)

74. ● It is a form of specialised nutrition support in which
nutrients are provided INTRAVENOUSLY
● Safe administration of PN requires appropriate
assessment of nutrition needs, meticulous
management of central venous catheter (CVC) &
careful monitoring to prevent or treat metabolic
complications.
● Adhere to principles of asepsis & infusion
management to ensure safe nutrition support.

75. ● Patients who are unable to digest or absorb enteral
nutrition benefits from PN.
● Indications for PN are patients with SEPSIS, HEAD
INJURY or BURNS.
● LIPID EMULSIONS provide supplemental kilocalories &
prevent essential fatty acid deficiencies.
● Administer these emulsions through a separate
peripheral line, through the central line by Y- connector
tubing or as an admixture to the PN solution.

76. ● The addition of lipid emulsion to the PN solution is
called 3-in -1 admixture.
● The patient receives this over a 24 hour period.
● Do not use the admixture if oil droplets or an oil or
creamy layer on the surface of the admixture is
observed.
● This indicates that the emulsion has broken into large
lipid droplets that cause fat emboli.

77. ● Lipid emulsions are WHITE & OPAQUE

79. METABOLIC COMPLICATIONS OF PN
● Electrolyte imbalance
● Hypercapnia
● Hypoglycemia
● Hyperglycaemia
● Hyperglycaemic
hyperosmolar
nonketotic
dehydration/coma
(HHNC)

80. 6. MEDICAL NUTRITION
THERAPY
{MNT}

81. ● MNT is the use of specific nutritional therapies to treat
an illness, injury or condition.
● It is necessary to assist the body's ability to metabolize
certain nutrients, correct nutritional deficiencies
related to the disease, & eliminate foods that may
exacerbate disease symptoms