nutrition nrs 129 - introduction to nursing skills
Post on 20-Dec-2015
214 views
TRANSCRIPT
NUTRITION
NRS 129 - Introduction to Nursing Skills
Nutritional Needs
Determining Your Patient Needs: Assessment History Observation - Daily Contact Anthropometry Laboratory data
Nutritional Needs: Nurses’ Role
Need to inform the doctor of assmt. findings
Investigate reasons for a decreased intake
Offer the patient alternative methods of intake and types of food
Factors that influence our Patterns of Eating: Health Status Culture & Religion Socioeconomic
Status Personal Preference Psychological Factors Alcohol & Drugs Misinformation &
Food Fads
Dietary History
Done to assess actual or potential problems
History focuses on habitual intake of food and liquids preferences allergies problems
Information Obtained for a Diet History
Name, Age Present weight Changes in Weight # meals/day,
snacks Who prepares the
meal? Problems R/T food Chewing difficulties
Information Continued …. Denture Use Usual bowel
pattern Medications Medical/Surgical
History Physical Activity Personal Crises
Measurements
Height and weight always always done unless patient is critically ill
Weigh patient at the same time, in same clothing with same scale
Rapid wt. gain reflects fluid shifts
Assessment Measurements Anthropometric: wrist, mid-arm, skin fold
measurements
Body Mass Index Weight (kg) / Height (m2)
>25 = overweight >30 = obese >35 higher medical risk for CAD, DM, HTN
Characteristics of HealthCategory Good Poor
GeneralAppearance
Alert,Responsive
Listless,apathetic,cachexia
Laboratory Data CBC: Low Hemoglobin and Red
blood cell count = anemia Serum Albumin: If value is
decreased = protein & calorie malnutrition
Negative Nitrogen Balance = catabolic state
Hgb, Hematocrit, and BUN reflect hydration
Patients at Risk for Nutritional Problems:
Condition that interferes with ingestion, digestion, and absorption
Surgical revisions of the GI tract IV intake only for > 7-10 days Poor dietary habits Patients undergoing treatment for
CA
Management of Common Problems
Vomiting How do you position your patient?
Serve small amounts frequently
Anti-emetics: time administrationappropriately
Planning & Implementation
Make sure your patient is comfortable No odors in the room Attractive tray Not in pain or needing nursing care
Mouth Care Positioned correctly
Special Diets Are they
Necessary?
Why?
Basic Types of Hospital Diets
General (Regular)
Soft vs. Mechanical Soft
Full Liquid
Clear Liquid
Basic Types of Hospital Diets
Low-Residue
High Fiber
Pureed Diet
Sodium Restricted
Dietary Modifications for Disease Conditions
Gastrointestinal disease: Diarrhea (Low residue) Acute gastritis: Liquid, bland Chronic gastritis: avoid foods causing
the problem Diverticulitis:
Acute: low residue Chronic: high fiber
Dietary Modifications. . . Peptic Ulcer:
Eat what you can tolerate
May need to avoid spices, alcohol, caffeine
Cardiovascular Disease:
Cardiac Prudent Diet Goals:
decrease stomach distention decrease weight decrease lipids
Cardiovascular Disease . . .
Atherosclerosis & Hypertension: weight, Low fat, cholesterol, and low sodium
Myocardial Infarction Avoid ice, caffeine, low fat, low
sodium, cholesterol
Diabetes with Dietary Changes
Diet, exercise Individualized Plan Control of
cholesterol, lipids, Increased use of
complex carbohydrates
CHO counting BALANCE
Dietary Modifications: Renal
Depends on disease state: Acute versus Chronic:
May Need restriction of protein, sodium,
fluids, and potassium
Nursing Interventions:Assisting with Eating
Assure patient’s diet/tray is correct Good Lighting (vision) available Remove covers Arrange food & Prepare food Offer assistance, self Evaluation of intake
Assessing the Need to Feed a Patient
Patients who should minimize oxygen needs
Patient who cannot feed self because of disease process or weakness
Nursing Interventions for Feeding
Being Fed = Loss of Independence Need to be considerate of Patient
to protect their dignity Allow patient to set pace NOT you Describe meal so patient can
determine the sequence
Nursing Interventions for Feeding
Before Starting: Evaluate comfort needs pain relief (timed appropriately) 30’ Offer bedpan Position patient as upright as possible
Good Opportunity for Nursing Assessment M/S, agility, color, tremors, etc.
Nursing Interventions for Feeding
Protect the patient’s clothing “Napkin” No Reference to “Bib” Assume a comfortable position at the
patient’s level May need a signal for indicating
additional food Offer self: “ Talk to patient”
Nursing Interventions . . .
Additional Guidelines: Stroke patient: Don’t place food on
paralyzed side Relatives may assist with feeding: Be
careful, family may view as they would only eat if they are there
Don’t scold patients who cannot eat Assure the environment is clean
afterwards
Nursing Interventions . . .
Encourage Food intake get rid of odors Make positive comments about food Breakfast usually best time of day nausea:
slow deep breaths avoid movement limit food and fluid intake
Intake and Output
Why is it important?
What is included in the measurement? All things liquid at room temperature Thin, cooked cereals Tube feedings, irrigations, IV fluids
Measurement of I and O Incorporate the pt. in the process
Need to record amounts immediately after consumption or elimination
Need to total amounts at specified times End of 8 hour shift End of 24 hours
Fluids to be counted as Output: Sum of all liquids
eliminated from the body
Urine Emesis Drainage tubes Remaining
Irrigation fluid Liquid stool Diapers Saturated
dressings
Measurement Considerations
1 pint { 475 ml } of water = 1 pound
1 ounce = 30 cc or 30 ml
Measurement of Output
Urine is chief source of output Teach patient & family need to
measure Hat may be placed in toilet Catheter drainage bag Leg Bag Bedpan/urinal
{need to measure using graduated cylinder}