care of patient in nutritional needs.pptx

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1. Care of patient with nutritional problems Presented by: Watitola Longkumer

2. Introduction 2 Nutrition is a basic component of health and is essential for Normal growth and development. Tissue maintenance and repair Cellular metabolism Organ function

3. 3 Poor nutrition can lead to Reduced immunity, Increased susceptibility to diseases, Impaired physical and mental development Reduced productivity .

4. WHO definition 4 Nutrition is the intake of food, considered in relation to body’s dietary needs

5. Principles of Nutrition Nutrients : Specific biochemical components of the food. Types of nutrients Essential nutrients : Necessary for body function but must come from dietary intake. Non-essential nutrients : non-essential nutrients are those nutrients that can be made by the body. 

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7. Essential Nutrients Macronutrients C arbohydrate Proteins Fats Micronutrients Vitamins Minerals

8. Macronutrients and nutritional problem 8 Macronutrients include carbohydrates, proteins, and fats. However, too many macronutrients without associated physical activity cause excess nutrition that can lead to obesity, cardiovascular disease, diabetes mellitus, kidney disease, and other chronic diseases. Too few macronutrients result in undernutrition , which contributes to nutrient deficiencies and malnourishment.

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10. Micronutrients and nutritional problems 10 Vitamin deficiencies can be caused by various factors including poor food intake due to poverty, malabsorption problems with the gastrointestinal tract, drug and alcohol abuse, proton pump inhibitors, and prolonged parenteral nutrition

11. Terminologies 11 Malnutrition Undernutrition

12. REVIEW OF ANATOMY AND PHYSIOLOGY OF DIGESTIVE SYSTEM

13. FACTORS AFFECTING NUTRITIONAL STATUS 13 Physiological factors Cultural and religious beliefs Economic resources Drug and nutrient disorders Surgery Altered metabolic states Alcohol and drug abuse, Psychological states

14. TYPES OF NUTRITIONAL PROBLEMS 14 Protein energy malnutrition Types include: Kwashiorkor: protein malnutrition predominant Marasmus : deficiency in calorie intake Marasmic kwashiorkor: marked protein deficiency and marked calorie insufficiency signs present, sometimes referred to as the most severe form of malnutrition)

15. TYPES OF NUTRITIONAL PROBLEMS 15 Micronutrient deficiencies : (WHO)   Iron, folate and vitamins B12 and A can lead to anaemia Iodine deficiency can lead to brain damage and during pregnancy can cause a number of issues including stillbirth, spontaneous abortion and congenital anomalies Vitamin A deficiency is the leading cause of preventable blindness in children and increases the risk of disease and death from severe infections such as diarrheal disease and measles.

16. TYPES OF NUTRITIONAL PROBLEMS 16 Obesity and overweight, Overweight and obesity result from an imbalance between energy consumed and energy expended.. Diet-related non-communicable diseases (such as heart disease, stroke, diabetes and some cancers).

17. CARE OF A PATIENT WITH NURITIONAL PROBLEMS 17

18. ASSESSMENT 18 Nutritional assessment provides information about an individual’s nutritional status, as well as risk factors for nutritional imbalances: History: Diet and health history Screening Anthropometry Laboratory and biochemical tests Physical examination

19. ASSESSMENT 19 Subjective data : Information to obtain when completing a nutritional assessment Age, sex, history of illness or chronic disease, surgeries. Dietary intake including a 24-hour diet recall or food diary. Food preferences, cultural practices related to diet, normal snack and meal timings, food allergies, special diets, and food shopping or preparation activities

20. ASSESSMENT 20 Objective assessment: Information is derived from direct observation by the nurse and is obtained through inspection, auscultation, and palpation. Consider nutritional status while performing a physical examination. BMI within normal range according to their height

21. Findings during physical examination 21 General appearance: Lethargic, skin ulcerations, rashes, bruising, thinning or loss of hair, spooning of nails, obese, or underweight Eyes: Impaired night vision or dry eyes Mouth: Dry/sticky mucous membranes, oral ulcerations,  glossitis (swollen tongue), coughing while swallowing or inability to swallow, or swollen throat Extremities/ Integumentary : Tenting (poor skin turgor ), dry skin, edema, or shiny skin Neurological: Numbness or tingling, tetany , dementia, or acute confusion

22. Findings during physical examination 22 Cardiac: Bounding pulses, S3 heart tone, jugular venous distention, abnormal ECG tracing, or cardiac arrhythmias Respiratory: Crackles in lung fields, pink frothy sputum, shortness of breath, or respiratory distress Gastrointestinal: Constipation, diarrhea, nausea, or vomiting Urinary: Decreased urine output <30 mL /hr or <0.5 mL /kg/hr, concentrated urine, or burning with urination Weight: BMI <18.5 or >25,  weight gain or loss of > 1kg over 24 hrs , or severe weight loss of >10% over 6 months

23. Laboratory and biochemical tests 23 Hemoglobin ( Hgb ): Decreased levels occur due to hemorrhage or deficiencies in iron Hematocrit ( Hct ): Increased levels occur with dehydration, and decreased levels occur with fluid overload or hemorrhage. White blood cells (WBC) Increased levels occur due to infection. Decreased levels occur due to prolonged stress, poor nutrition, and vitamins C, D, and E and B-complex deficiencies. Magnesium : Decreased level with poor nutrition or alcohol abuse. Increased levels due to kidney dysfunction. .

24. Laboratory and biochemical tests 24 Albumin : Increased with dehydration. Decreased level due to zinc deficiency, corticosteroid use, protein deficiency over several weeks, or conditions resulting in muscle wasting/muscle loss. Prealbumin : Increased levels with corticosteroid or contraceptive use. Decreased levels due to inflammation, poor immunity, protein depletion over a few weeks. Transferrin : Increased levels due to dehydration and iron deficiency. Decreased levels due to anemia; vitamin B12, folate , and zinc deficiency; protein depletion; and conditions resulting in muscle wasting/muscle loss. .

25. Laboratory and biochemical tests 25 24-hour urine creatinine : Increased levels with renal disease and muscle breakdown. Decreased levels with progressive malnutrition as muscles atrophy X-ray is used to determine the correct placement of a feeding tube or to note any excess air or stool in the colon. A barium swallow is used in conjunction with a CT scan to note any blockages in the intestines.

26. NURSING DIAGNOSES 26 Imbalanced nutrition : less than body requirements Impaired swallowing Risk for overweight Impaired self feeding Impaired low nutritional intake

27. Outcome Identification 27 Goals for patients experiencing altered nutritional status depend on the selected nursing diagnosis and specific patient situation. Typically, goals relate to resolution of the nutritional imbalance and are broad in nature

28. Planning Interventions 28 Interventions are specific to the alteration in nutritional status and should accomodate the patient’s cultural and religious beliefs.

29. Planning Interventions 29 Monitor food/fluid ingested and calculate daily caloric intake, as appropriate Monitor appropriateness of diet orders to meet daily nutritional needs, as appropriate Determine in collaboration with the dietician, the number of calories and types of nutrients needed to meet nutritional requirements, as appropriate Determine food preferences with consideration of the patient’s cultural and religious preferences Encourage nutritional supplements, as appropriate Provide patients with nutritional deficits high-protein, high-calorie, nutritious finger foods and drinks that can be readily consumed, as appropriate

30. Planning Interventions 30 Determine need for enteral tube feedings in collaboration with a dietician Administer enteral feedings, as prescribed Administer parenteral nutrition, as prescribed Structure the environment to create a pleasant and relaxing meal atmosphere Present food in an attractive, pleasing manner, giving consideration to color, texture, and variety Provide oral care before meals Assist the patient to a sitting position before eating or feeding

31. Planning Interventions 31 Implement interventions to prevent aspiration in patients receiving enteral nutrition Monitor laboratory values, as appropriate Instruct the patient and family about prescribed diets Refer for diet teaching and planning, as appropriate Give the patient and family written examples of prescribed diet

32. Assist in eating: 32 Patients may be prescribed special diets due to medical conditions or altered nutrition states.

33. 33 Providing oral nutrition : Normal diet, modified consistency diets and therapeutic diet, NPO

34. 34 Providing enteral feeding: Enteral nutrition  is administered directly to a patient’s gastrointestinal tract while bypassing chewing and swallowing. This is prescribed for patients when chewing and/or swallowing are impaired or when there is poor nutritional intake and/or malnutrition. Short term nutritional support : Nasogastric tube, nasointestinal tube Long term nutritional support : Percutaneous endoscopic gastrostomy / jejunostomy

35. 35 Providing parenteral nutrition : Parenteral nutrition  is nutrition delivered through a central intravenous line, generally the subclavian or internal jugular vein, to patients who require nutritional supplementation but are not candidates for enteral nutrition. Peripheral parenteral nutrition Total parenteral nutrition .

36. Evaluation 36 Implementing Interventions: When implementing interventions to promote good nutrition, it is vital to consider the patient’s cultural and religious beliefs. Encourage patients to make healthy food selections based on their food preferences. Evaluation: Evaluation helps the nurse and care team determine if the interventions are appropriate for the patient or if they need to be revised

37. Conclusion 37

38. Journal Review 38 Factors influencing the delivery of nutritional care by nurses for hospitalised medical patients with malnutrition; a qualitative study Objectives: To describe an insight into nursing nutritional care delivery in the hospital from the perspectives of observed nursing care and an exploration of multidisciplinary attitudes and experiences with patient participation in nutritional care. Conclusions: This study provides an understanding of the difficulties in the delivery of nursing nutritional care. Patient participation in the nutritional care process is rare. Evidence-based strategies are required to improve the knowledge and skills of nurses and patients to participate in (mal)nutrition care.

39. BIBLIOGRAPHY 39 Potter and Perry's (2021)Fundamentals of Nursing: Third South Asia Edition, publisher Elsevier. Page-949-959 Carol Taylor, Pamela Lynn and Jennifer Bartlett(2021), Fundamentals of Nursing : The Art And Science Of Person Centered Care volume, Second South Asian Edition , publisher Wolters Kluwer . Page 550-595 Rn ), O. R. for N. (Open, Ernstmeyer , K., & Christman , E. (2021). Chapter 14 Nutrition. In Nursing Fundamentals [Internet]. Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK591829/ ( Factors Influencing the Delivery of Nutritional Care by Nurses for Hospitalised Medical Patients with Malnutrition; a Qualitative Study - Van Den Berg - 2023 - Journal of Clinical Nursing - Wiley Online Library , n.d .)

40. thank you