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Nutrition. Teresa V. Hurley. MSN, RN. Physical — geographic location, food technology, income Physiologic — health, hunger stage of development. Psychosocial — culture, religion, tradition, education. Factors Affecting Food Habits. Psycho/Social. Developmental.

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nutrition

Nutrition

Teresa V. Hurley. MSN, RN

factors affecting food habits
Physical —

geographic location,

food technology,

income

Physiologic —

health,

hunger

stage of development

Psychosocial —

culture,

religion,

tradition,

education

Factors Affecting Food Habits
human growth and development
Human Growth and Development
  • Infants through School-Age

-rapid growth with high protein, vitamin, mineral and energy demand; infant doubles birth weight in 4-5months; triples weight at 1 year

Breast Feeding encouraged

-reduces allergy risks

What other factors?

infants
Infants
  • Formula
  • Cow’s milk causes GI bleeding
  • Kidney’s unable to handle
  • Research: milk in 1st and the development of Type I Diabetes later in life
  • Honey and corn syrup maybe be source of botulism
introduction of solid food
Introduction of Solid Food
  • 4 to 6 months of age
  • Introduce one at a time 4 to 7 days apart to identify allergies
toddlers
Toddlers
  • Picky eaters around 18 months of age
  • 3 meals and 3 snacks
  • Calcium and phosphorous for bone growth

Hot dogs, candy, nuts, grapes, raw veggies, popcorn frequently lead to choking deaths

school age
School Age
  • Growth slower and steadier
  • Check for protein, vitamins A and C
  • High fat, sugar and salt intake lead to childhood obesity compounded by sedentary lifestyle
adolescents
Adolescents
  • Energy needs increase to meet the increase metabolic demands of growth
  • protein., calcium, iron (females) and muscle growth (males)
  • Fad dieting, oral contraceptive use, fast foods, skipping meals
  • Eating disorders anorexia nervosa and bulimia nervosa
young and middle age
Young and Middle-Age
  • Energy demands less
  • Fetal development affected by mother’s nutritional status and weight at time of conception; protein, calcium, iron, folic acid
  • Lactation: protein, calcium, Vitamins A, C, B; avoid caffeine, alcohol and drugs
older adults
Older Adults
  • Lifestyle
  • Income
  • Lack of teeth, dentures, thirst sensation less with resultant dehydration (confusion, weakness, hot dry skin, rapid pulse
  • Nutrient dense foods: peanut butter, cheese, eggs, cream and meat-based soups
alternative food patterns
Alternative Food Patterns
  • Vegetarian
    • Ovolactovegetarian (no meat, fish and poultry but will have milk and eggs)
    • Lactovegetarians (drink milk but no eggs)
    • Vegans (plant foods)

-A Zen vegan eats brown rice, grains, herb teas

-Fruitarians eat only fruits, nuts, honey and olive oil

religious dietary restrictions
Religious Dietary Restrictions
  • Islam (no pork, caffeine, ritual slaughter of animals; Ramadan fasting sunrise to sunset for a month)
  • 7th day Adventists (no pork, shellfish, alcohol, vegetarianism encouraged)
  • Hinduism (no meats)
  • Latter Day Saints (no alcohol, tobacco , caffeine)
risk factors for poor nutritional status
Developmental factors

State of health

Alcohol abuse

Medications

Megadoses of nutrient supplements

Risk Factors for Poor Nutritional Status
anorexia
Anorexia

Anorexia

-poor appetite related to ketosis an appetite suppressant

Surgical Procedures with resultant pain

Diagnostic testing (NPO, bowel evacuations)

promoting appetite
Promoting Appetite
  • Keep environment free of odors
  • Oral hygiene
  • Insulin, glucosteriods, thyroid hormones affect metabolism
  • Antifungals alter taste
  • Psychotropics affect appetite, nausea, alter taste
nursing interventions
Nursing Interventions
  • Risk for Aspiration
    • Assess LOC
    • Decrease or absent gag or cough reflex
    • Surgical procedures
    • Neuromuscular impairments
    • Sensory impairments
nursing interventions21
Nursing Interventions
  • Upright position
  • Food placed stronger side of mouth
  • Thickening agents
  • Rate of eating slower to provide for chewing and swallowing
  • Use clock as guide to identify food location for visually impaired
  • Use assistive devices (padded forks, spoons etc)
nursing interventions22
Nursing Interventions
  • Client to direct order and preferences of food items to eat
therapeutic diets
Therapeutic Diets
  • NPO nothing by mouth
  • Clear Liquid: broth, bouillon cubes, tea, carbonated beverages, clear fruit juices, popsicles
  • Full Liquid: add to clear liquid diet smooth textured dairy products as custard, refined cooked cereals, pureed veggies, all fruit juices
diets continued
Diets Continued
  • Pureed ( continue to add to the previous) scrambled eggs, pureed meats, veggies, fruits, mashed potatoes and gravy
  • Mechanical Soft (add to the previous) ground or diced meats, flaked fish, cottage cheese, cheese, rice, potaotes, pancakes, light breads, cooked vegetables and fruits, canned fruits, bananas, soups, peanut butter
diets continued25
Diets Continued
  • Soft Low Residue: add pastas, casseroles, moist tender meats, canned cooked fruits and vegetables, desserts, cakes, cookies without nuts or coconut
  • High Fiber: add fresh uncooked fruits, steamed veggies, bran, oatmeal, dried fruits
  • Low Sodium: 4g (no added salt) 2gm to 500mg Na diets require selective choices
medications
Medications
  • Stimulate appetite
    • Periactin
    • Megace
    • Marinol’
diets continued27
Diets Continued
  • Low Cholesterol 300mg/day in accordance with AHA guidelines for serum lipid reduction
  • Diabetic: Food exchanges with balanced intake of protein, CHO and fats and vary according to energy demands as exercise, pregnancy, illness
  • Regular NO restrictions
enteral nutrition
Short-term nutritional support

Nasogastric

nasointestinal route

Long-term nutritional support

Enterostomal tube created into

stomach (gastrostomy)

Percutaneous endoscopic gastrostomy (PEG)

jejunum (jejunostomy)

Enteral Nutrition
enteral nutrition en
Enteral Nutrition (EN)
  • Nutrients given via the GI tract
  • Formula given via NGT,PEG, PEJ
  • Initial tube placement verified by x-ray which is the most accurate indicator
  • Traditional Method for placement
    • Measure distance from tip of nose to earlobe to xiphoid process of sternum
    • Water soluble lubricant
    • Insert through naris toward posterior nasopharynx
    • Flex head toward chest after passage through posterior nasopharynx
    • Have client mouth breathe and swallow small sips of water
    • Stop advancing if client choking, coughing, cyanotic
types of tubes
Types of Tubes
  • Naso-Gastric Salem Sump
types of tubes31
Types of Tubes

Gastrostomy Tube

Jejunostomy Tube

evidence based research
Evidence Based Research
  • X-ray verification most accurate
  • X-ray method not feasible, the next best method is pH testing of gastric aspirate with readings between 0-4.
  • pH of 6 or more placement in lung, intestine
  • Ausculatory method should not be used but in some agencies still in use
gastrostomy or jejunostomy tube
Gastrostomy or Jejunostomy Tube
  • HOB elevated 45 degrees
  • Auscultate for bowel sounds
  • Verify placement by testing pH of gastric aspirate
  • Check gastric residual
    • If over 100 ml notify MD
    • Would you replace the gastric contents?
    • Would you stop the feeding?
some complications of feeding
Some Complications of Feeding
  • Aspiration
  • Tube displacement
  • Cramping from using cold formula
  • Diarrhea
  • Impaired skin integrity
  • Nosocomial infections
total parenteral nutrition
Total Parenteral Nutrition

TPN- Total Parenteral Nutrition

  • complete form of nutrition
    • protein
    • CHO
    • fat
    • vitamin
    • minerals

=

indications for tpn
Indications for TPN
  • Inability to eat
    • Ventilator dependency
    • Additional surgery
    • Altered mental status affecting ability to eat
  • Diminished nutrient intake
    • Anorexia
    • Dyspepsia from medications
    • Gastrointestinal problems including nausea, vomiting, diarrhea, and distention
  • Increased nutrient requirements
    • Hyper metabolism
    • Nitrogen loss caused by surgery and corticosteroid administration
    • Malabsorption
complications of parenteral nutrition
Insertion problems

Infection

Metabolic alterations

Fluid, electrolyte, and acid-base imbalances

Phlebitis

Complications of Parenteral Nutrition
pn complications
PN Complications
  • Electrolyte and Mineral imbalances: refeeding syndrome

-high concentrations of glucose

leads to endogeneous insulin production which leads to

-cations moving from inter to intracellular (potassium, magnesium and phosphorus) which leads to cardiac dysarrthymias, CHF. Respiratory distress, convulsions, coma, death

complications of pn
Complications of PN
  • Rapid administration of hypertonic dextrose leads to osmotic diuresis and dehydration
    • DO NOT SPEED UP IF BEHIND
    • DO NOT STOP LEADS TO HYPOGLYCEMIA
glucose testing
Glucose Testing
  • Diabetes is a metabolic disorder
    • Inadequate insulin production by pancreatic beta cells or
    • Insulin resistance whereby glucose unable to cross sell membrane
      • Cellular starvation
      • Fluid and electrolyte imbalances
diabetes
Diabetes
  • Hypoglycemia: pancreas secretes glucagon
  • Hyperglycemia: pancreas secretes insulin
    • Polyuria
    • Polydyspia
    • Polyphagia
    • Glycosuria
    • Ketones
hypoglycemia
Hypoglycemia
  • Rapid onset with BS 80 or below
  • Cool, pale, diaphoretic skin
  • Disorientation---coma
  • Shaky, dizzy, agitated
  • Pulse maybe tachy
  • B/P maybe high
  • Seizures common
  • Treat with PO or IV Glucose
hyperglycemia
Hyperglycemia
  • Gradual onset with BS 200 or above
  • Skin warm, dry, flush
  • Awake, lethargic
  • Hungry, blurred vision
  • Deep, rapid respirations
  • Pulse, weak, rapid
  • B/P maybe low
  • Breath: fruity odor
  • Dehydrated
  • Polyuria
  • Polydyspia
  • Treatment: IV, insulin and K
glucose monitoring
Glucose Monitoring
  • ac and at hs
  • Range 70-110 mg
  • Insulin Coverage
    • Regular Insulin (Rapid Acting) 3-4 hr
    • NPH/reg (Fast Acting) 30 min---24hr
    • Lente, NPH (Intermediate Acting) 1-3 hr---18-28 hr
    • Ultra-lente (Long Acting) 4-6 hr---36 hr