Nutrition
● Special diets:
○ Regular: for clients without special nutritional needs
○ NPO
○ Diets modified for consistency (pg. 917)
○ Diets modified for disease: Calorie-restricted, fat-restricted, diabetic, sodium-
restricted, renal diets, protein controlled, antigen-avoidance diets, calorie-protein
push
● Assessment/ General Nutritional Screening
○ Height, weight, and BMI is basic
○ If risk factors are identified, a more thorough nutritional assessment is indicated
○ Focused Nutritional assessment (pg. 920)
○ 24 hour recall/ food frequency/ food record
○ Physical exam: routine head to toe
○ Anthropometric measurements: includes skinfold measurements,
circumferences, and body mass index (BMI)
○ Blood glucose: hypoglycemia/hyperglycemia
● Serum Protein Levels:
○ Albumin
○ Blood glucose: hypoglycemia/hyperglycemia
○ Serum protein levels
○ Albumin 60% of albumin synthesized in the liver; low levels indicate malnutrition, acute
and chronic liver problems, loss of protein through large burns/wounds; can be affected
by fluid imbalance
○ Prealbumin: fluctuates daily and considered a better indicator of acute change
○ Transferrin: protein that binds with iron
○ Urea: end product of protein metabolism/excreted through the kidneys; indicator of liver
and kidney function; elevation can indicate dehydration, impaired kidney function, excess
protein breakdown; decrease can indicate liver impairment, fluid overload, low protein
intake
○ Creatinine: end product of skeletal muscle metabolism, excreted through the kidneys;
increase indicates impaired kidney function
Diagnosis: Adult failure to thrive, imbalance nutrition: less or more than body requirements, risk for
imbalanced nutrition, self-care deficit (feeding)
Causes of nutritional problems
● eating disorders, chewing/swallowing problems
● NV/Diarrhea
● alcoholism,
● food intolerance
● metabolic disorders
● digestive and absorption disorders
● financial access
● lack of exercise
● endocrine disorders
● Want clients to follow general guidelines for healthy diets in addition to special instructions
tailored to the client's conditional/needs
● Nutritional counseling
● nutritious foods on a budget
, Supporting special nutritional needs
● impaired swallowing: may causes, including mechanical obstruction, neuromuscular impairment,
CVA, cerebral palsy, client is at risk for choking and aspiration
● Interventions: avoid straws, assist client upright monitor tongue movements, monitor LOC and
gag reflex, keep suction at bedside, feed in small amounts, thicken liquids
NPO
● provide oral care
● provide ice chips/ hard candy
● advise family and visitors not to eat around client
● no client should remain NPO for more than 3 days without some alternate source of nutiriton
Nausea: determine cause, assess for dehydration, provide cool fresh air, avoid using strong
perfumes/sprays/lotions; remove any food from room, provide oral hygiene, small frequent meals; cool
drinks
Severe malnutrition
● malnutrition leads to infection and other diseases r/t vitamin and mineral deficiency
● underdeveloped countries, children, older adults and chronic conditions are most at risk
● risk factors: serum albumin <3.5, NV for 3 days or more, clear liquid diet or NPO 3 days or more
● Eating disorders: anorexia, bulimia nervosa
Enteral Nutrition: alternative feeding method when client cannot meet nutritional needs through PO intake;
through GI tract, can be administered in addition to meals or in place of meals - requires a functioning
intestinal tract
Risks
● aspiration, high glucose content of feedings
● bacterial growth
● diarrhea
● NV
● nasopharyngeal trauma
● alterations in drug absorption and metabolism
● metabolic disturbances
Always label enteral lines
Short term feedings
● Nasogastric tube
● Nasoenteric tube
Long-term feedings
● gastrostomy tube (G-tube)
● percutaneous endoscopic gastrostomy tube
● jejunostomy
● gastrostomy button
Checking tube placement
● CXR is most reliable and usually done after initial insertion; must be checked prior to each access
● Aspirating gastric contents and checking gastric pH
● Respiratory secretions usually are 7 or higher
● Special diets:
○ Regular: for clients without special nutritional needs
○ NPO
○ Diets modified for consistency (pg. 917)
○ Diets modified for disease: Calorie-restricted, fat-restricted, diabetic, sodium-
restricted, renal diets, protein controlled, antigen-avoidance diets, calorie-protein
push
● Assessment/ General Nutritional Screening
○ Height, weight, and BMI is basic
○ If risk factors are identified, a more thorough nutritional assessment is indicated
○ Focused Nutritional assessment (pg. 920)
○ 24 hour recall/ food frequency/ food record
○ Physical exam: routine head to toe
○ Anthropometric measurements: includes skinfold measurements,
circumferences, and body mass index (BMI)
○ Blood glucose: hypoglycemia/hyperglycemia
● Serum Protein Levels:
○ Albumin
○ Blood glucose: hypoglycemia/hyperglycemia
○ Serum protein levels
○ Albumin 60% of albumin synthesized in the liver; low levels indicate malnutrition, acute
and chronic liver problems, loss of protein through large burns/wounds; can be affected
by fluid imbalance
○ Prealbumin: fluctuates daily and considered a better indicator of acute change
○ Transferrin: protein that binds with iron
○ Urea: end product of protein metabolism/excreted through the kidneys; indicator of liver
and kidney function; elevation can indicate dehydration, impaired kidney function, excess
protein breakdown; decrease can indicate liver impairment, fluid overload, low protein
intake
○ Creatinine: end product of skeletal muscle metabolism, excreted through the kidneys;
increase indicates impaired kidney function
Diagnosis: Adult failure to thrive, imbalance nutrition: less or more than body requirements, risk for
imbalanced nutrition, self-care deficit (feeding)
Causes of nutritional problems
● eating disorders, chewing/swallowing problems
● NV/Diarrhea
● alcoholism,
● food intolerance
● metabolic disorders
● digestive and absorption disorders
● financial access
● lack of exercise
● endocrine disorders
● Want clients to follow general guidelines for healthy diets in addition to special instructions
tailored to the client's conditional/needs
● Nutritional counseling
● nutritious foods on a budget
, Supporting special nutritional needs
● impaired swallowing: may causes, including mechanical obstruction, neuromuscular impairment,
CVA, cerebral palsy, client is at risk for choking and aspiration
● Interventions: avoid straws, assist client upright monitor tongue movements, monitor LOC and
gag reflex, keep suction at bedside, feed in small amounts, thicken liquids
NPO
● provide oral care
● provide ice chips/ hard candy
● advise family and visitors not to eat around client
● no client should remain NPO for more than 3 days without some alternate source of nutiriton
Nausea: determine cause, assess for dehydration, provide cool fresh air, avoid using strong
perfumes/sprays/lotions; remove any food from room, provide oral hygiene, small frequent meals; cool
drinks
Severe malnutrition
● malnutrition leads to infection and other diseases r/t vitamin and mineral deficiency
● underdeveloped countries, children, older adults and chronic conditions are most at risk
● risk factors: serum albumin <3.5, NV for 3 days or more, clear liquid diet or NPO 3 days or more
● Eating disorders: anorexia, bulimia nervosa
Enteral Nutrition: alternative feeding method when client cannot meet nutritional needs through PO intake;
through GI tract, can be administered in addition to meals or in place of meals - requires a functioning
intestinal tract
Risks
● aspiration, high glucose content of feedings
● bacterial growth
● diarrhea
● NV
● nasopharyngeal trauma
● alterations in drug absorption and metabolism
● metabolic disturbances
Always label enteral lines
Short term feedings
● Nasogastric tube
● Nasoenteric tube
Long-term feedings
● gastrostomy tube (G-tube)
● percutaneous endoscopic gastrostomy tube
● jejunostomy
● gastrostomy button
Checking tube placement
● CXR is most reliable and usually done after initial insertion; must be checked prior to each access
● Aspirating gastric contents and checking gastric pH
● Respiratory secretions usually are 7 or higher
