Principles of Nutrition and Fluid Balance

1. Principles of Nutrition and Fluid Balance Nutritional needs and diet modifications

2. Nutrition • Process by which the body takes in food for growth and repair and uses it to maintain health.

3. Signs of Good Nutrition • Shiny hair • clean skin and eyes • well developed body • alert expression • pleasant disposition • health sleep patterns • appropriate appetite • regular bowel habits • body weight appropriate to height

4. Digestion • Process of breaking down foods into simple substances that can be used by the body for nourishment; the substances are call essential nutrients

5. Essential Nutrients • Body requires foods that: • supply heat and energy • build and repair body tissues • regulate body function y requires foods that • Six essential nutrients • proteins • carbohydrates • fats • minerals • vitamins • water

6. Protein sources • Meat • Poultry • Eggs • Milk • cheese

7. Carbohydrates and fats • Energy foods-used to produce heat and energy • sources include • fruit • vegetables • foods made from grains

8. Fats • Plant and animal sources • Examples of food that are rich in fat include • pork • butter • nuts • egg yolk • cheese

9. Vitamins • Substances that regulate body processes • assist with…. • Building strong teeth and bones • promoting growth • aid normal body functioning • strengthening resistance to disease Vitamins used by the body

10. Minerals • Build body tissues especially bones and teeth • help regulate body fluids such as blood and digestive juices • Mineral needed daily are Calcium, phosphorus, iodine, iron, copper, potassium

11. Five Food Groups • US Department of Agriculture recommends • Eating a variety of foods • maintain a healthy body weight • select foods low in fat, saturated fat and cholesterol • select plenty of vegetables , fruits, and grain products • use sugar in moderation • use salt and sodium in moderation • drink alcoholic beverages in moderation

12. Food Plate

13. Hospital Nutritional services • Meal trays prepared by dietary department • Includes essential nutrients • Meals prepared according to patients needs • Ordered by physician

14. Responsibilities during meals • Prepare the patient for the meal • Checking the food tray for correctness • Checking the tray card against the patients identification • Serving the tray to the patient • Assisting the patient with feeding if necessary

15. Diets • Regular- normal or full diet based on the food plate • Liquid diets • Clear liquids all components are clear i.e. tea, gelatin, or broth • Full liquids includes sherbet, eggnog, malted milk, milk and cream, plain ice cream • Soft diets are low residue, mildly flavored and requires minimal digestion. Foods included are soups, cottage cheese, crackers, fish, white meat of chicken and turkey

16. Special diets • Religious restricted • Therapeutic –prepared according to the patient’s individual health problem

17. Therapeutic Diets • Diabetic diet-prepared to maintain the patient’s blood sugar within normal limits • Sodium restricted • Calorie restricted • Low fat-limits cholesterol • Mechanically altered-consistency altered • Mechanical soft • pureed

18. Nutritional supplements • Used for patients with high nutritional demands • Provided between meals and are given for specific therapeutic purposes

19. Calorie Counts • Performed to assess a patients food intake • Food intake is recorded for three days or specified period and analyzed for nutritional adequacy and calories consumed • Must accurate document food consumed • Dietician uses data to develop a specific nutritional plan.

20. Dysphagia • Difficulty swallowing food and liquids; occurs in patients with neurological problems and some other diagnoses such as cancer • Clients who have had a stroke

21. Signs and Symptoms of Dysphagia • Taking a long time before beginning to swallow • Swallowing three or four times with each bite of food • Frequent throat clearing or coughing • Lack of a gag reflex or weak cough • Difficulty controlling liquids and secretions in the mouth

22. Dysphagia continued • Wet, gurgling voice • Refusing to eat, spitting food out, or pocketing food in cheeks • Unintentional weight loss • Tightness in the throat or chest • Feeling as if food is sticking in the esophagus or sternal area

23. Aspiration Precautions • Positioning • Upright at 60-90 degrees • Head and neck flexed at midline • Remain upright for at least 30 minutes after meals • Feeder at or below eye level of patient

24. Aspiration precautions • Environment • Minimize distractions, adequate lighting, comfort level • Amount and Rate • ½ to 1 teaspoon at a time, pause between spoonfuls, verbal cues for additional swallows, no straws, use thickening agents, may need to decrease rate and amount of food toward end of meal • Diet • Check diet order, if patient can not tolerate stop feeding, post aspiration sigh above bed

25. Aspiration precautions continued Other • Oral hygiene before meals, periodically throughout meal check to see if patient swallowing and can clear throat • Do Not mix textures together • Check mouth to see if pocketing food • Follow recommendations by speech pathologist– chin tuck, head turn, effortful swallow, head tilt to right or left, alternate textures

26. Alternative nutrition • Total parenteral nutrition • Enteral feedings

27. Disorders requiring TPN/Enteral nutrition • Cancer • Ulcerative Colitis • Crohn’s • Alzheimer’s Disease • ALS • MS/MD • Parkinson’s Disease • Aspiration risk

28. Disorders requiring tube feeding • Cancer • Ulcerative Colitis • Crohn’s • Alzheimer’s Disease • ALS • MS/MD • Parkinson’s Disease • Aspiration risk

29. TPN

30. Total Parenteral Nutrition • Total parenteral nutrition (TPN) supplies all daily nutritional requirements. • TPN can be used in the hospital or at home • Because TPN solutions are concentrated and can cause thrombosis of peripheral veins, a central venous catheter is usually required.

31. Types of Feeding Tubes Nasogastric: Placed at bedside/OR Short-term • Actions: Check nares Mouth Care Monitor for coughing,sneezing, gagging,N/V,dysphagia HOB elevated Set-up/initiate feedings

32. Types of Feeding Tubes • Gastric Tube: Placed surgically/endoscopically Long-term usage • Actions: Check site of tube for irritation/breakdown Clamp tube when not in use Tube free of pressure Set-up/initiate feedings HOB elevated Check for complications

33. Feeding Options • Continuous Feeding: • Feedings given via pump at controlled rate ordered by MD • Administration may be 24 hrs or throughout the night only • Tube feeding formula needs to be at adequate level to ensure continuous flow (No more than two cans in bag at once) • HOB elevated • Use appropriate tubing

34. Feeding Options • Bolus: • Large amount of formula administered as ordered-- q 3- 4 hrs • Administered by staff • Accurate measurement of ordered formula • Administer at appropriate controlled rate • FINAL flush is critical • HOB elevated during and after feeding

35. Effects of Tube Feeding • Loss of dignity • Loss of sensation and texture of food • Inability to share social connection with family/friends • Inability to choose diet • Anger • Possible risk of aspiration/infection

36. Charting the I & O

37. Recording Intake and Output • Perform on patients who: • Are dehydrated • Are receiving IV infusions • Have recently had surgery • Have a urinary catheter • Are perspiring profusely or vomiting • Have a specific diagnosis requiring Intake and output

38. Fluid intake • May be either encouraged or restricted depending on patient condition • Estimate intake by knowing liquid container amounts

39. 1 0unce= 30 cc Sherbet cup or Ice cream cup= 120 cc Jello = 130 cc Popsicle = 70 cc Juice prepack =120 cc Soft drink = 360 cc Broth =180 cc Coffee= 240 cc Milk carton= 240 cc Iced tea = 240 cc Hot cereal =180 cc Intake measurements

40. Intake and output (I&O) is the measurement of the fluids that enter the body (intake) and the fluids that leave the body (output). The two measurements should be equal. (What goes in.... must come out!) The metric system is used for fluid measurement. The measurements should be recorded in ml. (milliliters). The average adult intake is 2500-3000mL. per day. The average output is 2500-3000mL. per day. To convert from ounces to ml., multiply by 30 (Ex. 6 oz. x 30ml. = 180ml.) To convert from cc/ml to ounces, divide by 30 (Ex. 240cc / 30cc = 8 oz.)