chapter 6 maintaining fluid balance and meeting nutrition needs copyright © 2012, 2008 by mosby,...

Chapter 6

Maintaining Fluid Balance and

Meeting Nutrition Needs

Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1

Lesson 6.1


Objectives

Identify the various types of nutrients. Identify the components of a healthy diet for

older adults. Describe the age-related changes in

nutritional and fluid requirements.


Nutrition and Aging


Caloric Intake

Many factors influence how many calories will be used by a person Activity patterns Gender Body size Age Body temperature Emotional status Temperature of the climate in which the person

lives


Caloric Intake (cont.)

When a person’s caloric intake is in balance with the energy needs of the body, his or her weight remains constant Caloric intake exceeds energy needs; the excess

is converted into adipose (fat) tissue for storage, and the individual gains weight

Caloric intake is less than the energy needs; the person loses weight


Audience Response SystemQuestion 1

The amount of calories for each of the following are:

A.proteins 4, carbohydrates 4, and fats 4.

B.proteins 9, carbohydrates 4, and fats 9.

C.proteins 4, carbohydrates 9, and fats 9.

D.proteins 4, carbohydrates 4, and fats 9.

E.proteins 9, carbohydrates 9, and fats 9.


Nutrients

Foods high in nutritional value and relatively low in calories must be selected to maximize the amount of nutrients the body receives while reducing the number of calories

Vital nutrients needed by all people include carbohydrates, protein, fats, vitamins, minerals, and fluids


MyPlate


Poor Nutrition Checklist


Carbohydrates

Include the familiar sugars and starches that compose approximately half of the standard American diet

A ready source of energy for the body; carbohydrates are usually divided into two categories, simple and complex


Carbohydrates (cont.)

Simple carbohydrates Used most readily by the body because their

simple bonds are easily broken Table sugar, honey, syrup, and candy are

examples Complex carbohydrates

Must be broken down into simple sugars before they can be used by the body

Vegetables, whole grains, and fruits


Proteins Composed of amino acids, essential for

tissue repair and healing Red meats, poultry, fish, eggs, and dairy

products are good sources of complete proteins, which contain all the amino acids necessary for making and repairing tissues

Plant foods such as legumes (peas and beans), nuts, and cereals (whole grains and rice) contain smaller amounts of incomplete proteins, which do not individually contain all the necessary amino acids


Fats It is recommended that fats be limited to

approximately 25% to 30% of the total daily caloric intake

A certain amount of fat is necessary and desirable in the diet to aid in the absorption of fat-soluble vitamins and to provide adequate amounts of essential fatty acids

There are three important types of lipoproteins: high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL)


Vitamins

Organic compounds found naturally in foods Needed for a variety of metabolic and

physiologic processes Fat-soluble vitamins include vitamins A, D, E,

and K Water-soluble include the B-complex vitamins

and vitamin C



All adults require supplemental vitamins, even if they consume a well-balanced diet.

A.True

B.False


Essential Vitamins

Fat-soluble vitamins A, D, E, K

Water-soluble vitamins B1, B2, niacin, B6, folacin (folic acid), B12, C


Minerals

Inorganic chemical elements that are required in many of the body’s functions

Minerals make up a small proportion of total body weight, yet a slight mineral imbalance can have serious effects

Include calcium, phosphorus, iron, sodium, potassium, and zinc


Water

Plays a role in many aspects of normal body functioning

Necessary for the formation of many of the body’s secretions, including tears, perspiration, and saliva

Aids in digestion and transportation of electrolytes and nutrients

Facilitates elimination of waste products and plays an important role in temperature regulation


Lesson 6.2


Objective

Identify age-related changes that affect nutrition, digestion, and hydration.


Malnutrition and the Elderly


Factors Affecting Nutrition in the Elderly

Physiologic risk factors Chronic health factors Alcoholism Sensory changes Pain Medications Problems with chewing, swallowing, or digesting Malabsorption


Factors Affecting Nutrition in the Elderly (cont.)



Economic risk factors Cost of food Difficulty getting transportation Obtaining an appropriate variety and sufficient

amount of food



Social risk factors Depression Loneliness or social isolation Lack of motivation


Meals-on-Wheels


Social and Cultural Aspects of Nutrition

Food is more than a means of meeting nutritional needs

Food is also used as part of religious ceremonies, in social interactions, and as a means of cultural expression

Many major religions, such as Islam, Judaism, and Catholicism, include some dietary restrictions

It is important to remember that good nutrition can be achieved in any culture


Characteristic Food Patterns of Selected Cultures

Discuss the characteristic food patterns of several different cultures.


Good Nutrition at Any Age


Lesson 6.3


Objectives

Describe methods of assessing the nutritional status and practices of older adults.

Identify the older adults who are most at risk for problems related to nutrition and hydration.

Identify selected nursing diagnoses related to nutritional or metabolic problems.

Identify interventions that will help older persons meet their nutritional and hydration needs.


Nursing Process for Risk for Imbalanced Nutrition



A complex protein-iron molecule that is responsible for the transport of oxygen and carbon dioxide within the bloodstream is:

A.hematocrit.

B.hemoglobin.

C.creatinine.

D.blood urea nitrogen

E.red blood cell.


Assessment

Appetite changes Nutritional intake Social and cultural factors Home care or discharge planning


Risk Factors Related to Imbalanced Nutrition in Older Adults

There are many physiologic and psychological factors that could contribute to imbalanced nutrition in older adults


Nursing Diagnoses

Imbalanced nutrition: less than body requirements

Imbalanced nutrition: more than body requirements

Risk for imbalanced nutrition: more than body requirements

Readiness for enhanced nutrition


Nursing Goals/Outcomes

Maintain body weight within normal limits for height

Obtain adequate nutrients to maintain healthy tissue

Identify internal and external cues that influence eating patterns

Adhere to a prescribed therapeutic diet


Nursing Interventions

Hospitals or extended-care facilities Assess the individual carefully to determine the

causes of a problem Schedule weekly weight checks Keep a dietary record of the amount, type, and

frequency of food intake Explain the importance of nutrition to overall health

or disease control Determine food likes and dislikes


Nursing Interventions (cont.)

Hospitals or extended-care facilities (cont.) Monitor laboratory values Assess the condition of the skin, hair, nails, and

mucous membranes Consult with the dietitian Institute measures to increase or decrease

nutritional intake Complete a thorough documentation of nutritional

status, including assessment, interventions, referrals, and patient response


Making Meals Enjoyable


Making Meals Enjoyable (cont.)



Home Assist the individual in obtaining resources such

as Meals on Wheels, food stamps, a housekeeper, or shopping services

Involve the family in shopping and meal planning Identify senior citizen meal programs available in

the community Use any appropriate interventions that are used in

the institutional setting


Nursing Process for Risk for Imbalanced Fluid Volume


Assessment

Deficient fluid volume Occurs when an individual has inadequate intake

or excessive loss of fluids Can easily progress into dehydration which,

unless corrected, can result in death A variety of conditions can contribute to deficient

fluid volume in older adults Likely to manifest dry mucous membranes, thirst,

decreased skin turgor, rapid weight loss, sunken eyes, weakness, and decreased volume or increased concentration of urine



The movement of body fluids between the cell and plasma is affected by the levels of various:

A.electrolytes and proteins.

B.pressures within the cell.

C.fats in the bloodstream.

D.toxins digested.


Excess Fluid Volume

Excessive intake or inadequate output of fluids Primary indication is edema Pulmonary edema may result in shortness of

breath, dyspnea, cough, gurgling sounds on respiration, and frothy sputum

Weight gain can be sudden and dramatic Hematocrit normally decreases as blood plasma

volume increases May experience behavioral changes, including

restlessness and anxiety


Nursing Diagnoses

Deficient fluid volume Excess fluid volume Risk for deficient fluid volume Risk for imbalanced fluid volume Readiness for enhanced fluid balance


Nursing Goals/Outcomes Manifest vital signs within normal limits Evidence of moist oral mucous membranes

and good skin turgor without edema Maintain a stable weight within normal limits Exhibit balanced fluid intake and output Report no problems related to thirst or

weakness Exhibit blood studies within normal limits Verbalize an understanding of the

recommended dietary and fluid intakeCopyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 49

Nursing Goals/Outcomes (cont.)

Demonstrate behaviors necessary to maintain appropriate fluid intake

Demonstrate selection of appropriate foods and fluids

Verbalize an understanding of prescribed medication(s), including the frequency and any precautions

Verbalize signs and symptoms that should be reported to the physician



Hospitals or extended-care facilities Complete a thorough assessment Monitor vital signs Monitor intake and output Monitor laboratory values Weigh the patient daily before breakfast Measure changes in girth of body parts such as

legs and abdomen



Hospitals or extended-care facilities (cont.) Maintain adequate fluid intake Administer medications as ordered by the

physician Refer to the dietitian, if appropriate Provide appropriate skin care Report and document significant findings promptly



Home Complete a thorough assessment Teach the individual and his or her family

members how to monitor fluid intake Promote wellness by reviewing the prescribed

dietary and fluid intake with the individual Explain methods of increasing or decreasing fluid

intake Use any appropriate interventions that are used in

the institutional setting


Nursing Process for Impaired Swallowing


Assessment Is there any history of stroke or other

neurologic disease that could interfere with chewing or swallowing?

Is the individual alert and able to follow directions?

Is any facial drooping or difficulty chewing observed?

Is difficulty swallowing reported by the person or observed by caregivers?

Does the person complain of something sticking in the throat?


Assessment (cont.) Does the person cough, choke, or drool when

eating? Does the person complain of hoarseness or

dry throat? Does the person store food in the cheek

pockets? Is the person’s gag reflex weak or absent? Can the person close his or her lips? Does the person experience problems with

any particular foods or fluids?


Risk Factors for Impaired Swallowing in Older Adults

Neurologic problems that result in paralysis or weakness of the face, mouth, or throat

Altered level of consciousness, awareness, or sensation

Mechanical devices such as a tracheostomy tube or nasogastric tube

A narrowing or obstruction of the pharynx or esophagus

Excessive fatigue


Nursing Diagnosis

Impaired swallowing



Pass food from mouth to stomach without aspiration

Maintain adequate nutrition and hydration Maintain or achieve appropriate body weight



Assess the individual to determine his or her unique problems and needs

Consult with the speech therapist, occupational therapist, and dietitian to develop a dysphagia program

Verify that dentures fit properly and maintain good oral hygiene

Position the person with his or her head upright and the chin flexed slightly forward to facilitate swallowing



Encourage rest periods before meals Allow adequate time for meals Start with small amounts of food and

thickened fluids Place foods into the unaffected or stronger

side of the mouth Present foods in an appealing manner



Select foods based on taste, texture, temperature, and fluid content

Ensure that the lips are closed by applying slight pressure or stroking

Stimulate swallowing by stroking the side of the neck, and support the weakened side if appropriate



Give frequent verbal cues Reduce distractions Keep suction equipment available in case of

problems Provide oral hygiene before and after

feedings Administer tube feedings as ordered by the

physician to individuals who are unable to achieve adequate oral intake



Individuals with swallowing difficulties should be given a moderate amount of food at a time. The approximate volume should be:

A.less than 5 mL.

B.5 to 10 mL.

C.15 to 20 mL.

D.30 to 50 mL.

E.at least 100 mL.


Nursing Process for Risk for Aspiration


Assessment

Does the person have cough and gag reflexes?

Does the person have a reduced level of consciousness?

Does the person have a tracheostomy? Is the person in the supine position during

feedings? Is the person receiving feedings or

medications through a gastric tube?


Assessment (cont.)

Does the person have signs of abdominal distention?

Are the person’s stomach contents more than 150 mL before a scheduled feeding?

Is there any noise with respiration? Is there a productive cough? What is the

consistency of the sputum? Are the pulse and respiratory rates elevated?


Risk Factors for Aspiration in Older Adults

Neurologic problems, particularly those that affect the cough and/or gag reflexes

Reduced level of consciousness Continuous supine positioning Tracheostomy tubes Gastric tubes Decreased gastric motility; excessive

amounts of residual gastric contents or gas


Nursing Diagnosis

Risk for aspiration



Remain free from episodes of aspiration Maintain clear, noiseless breath sounds



Hospitals and extended-care facilities Position the person appropriately Assess for stomach distention Avoid feeding too rapidly Avoid liquids and puréed foods Monitor respiratory sounds and respiratory rate,

and observe the amount and type of sputum produced

Keep suction equipment available



Hospitals and extended-care facilities Check placement of the nasogastric tube using the

approved method Measure stomach contents before starting

intermittent feeding; then reinstill stomach contents

Maintain clean technique for all feeding tubes, equipment, and formula



Home Explain safety precautions to the individual and

the family or caregiver Encourage enrollment in a home safety course

that includes the Heimlich maneuver and cardiopulmonary resuscitation

Use any appropriate interventions that are used in the institutional setting


chapter 6 maintaining fluid balance and meeting nutrition needs copyright © 2012, 2008 by mosby,...

Documents

affiliate of elsevier

persons caloric intake

caloric intake cont

constantcaloric intake

caloric intakemany factors

various types of nutrients

fluid requirements

nutritional value