nutritional needs of patient updated (1).pptx

nursing second semester

1. Nursing foundation  unit – 3 Nutritional needs of patients 

2. Objectives ​

3. Objectives Introduction  Importance  Factors effecting nutritional needs. Review : special diets  Review : therapeutic diets  

4. Care of patient – dysphagia ,anorexia , nausea , vomiting . Procedure –insertion of ng tube and feeding   oral, enteral:  nasogastric, orogastric . Feeds TPN.

5. Introduction …   It’s a critical part of health and development.           It’s a process by which the body Uses food . Nutrients from foods and fluids are  used by the body for growth and all body functions . ​

6. Definition of nutrition …. Nutrition is the study of nutrients  In food , how the body uses them, and the  Relationship between diet , health , and disease.

7. Nutrition is a method in which the food is consumed by the organism into the body  ​ and utilizing the nutrients from the food ​ ​ ​

8. I mportance of nutrition …. ​ Good  nutrition aids the immune system . Proper nutrition provides with energy . Good nutrition- good mood  Good health . Proper metabolism and Nourishment . A longer life – healthy life .

9. Factors effecting nutritional needs.... ​

10. Age   Gender Life style Diet choices  DNA Medication  Ethnicity , culture and  religious practices          

11. Assessment of nutritional status …. ​

12. Nutritional status …. It’s the current body status of a person  It expresses a degree to which the physiological needs and the nutrients are met . Optimal. Malnutrition. Deficiency vs overload.

13. Methods to assess nutritional status ….. Food intake assessment  Physical assessment  Anthropometric tools Clinical values 

14. Food Intake Assesment  

15. Physical assessment ….. Pale palm & conjunctiva or gets tired easily, loss of appetite indicates -  anemia, deficiency of iron, folic etc. Bitot spot ( whitish patchy triangular lesions on the side of the eyes) indicates - vitamin A deficiency. Goitre ( swelling on the front of the neck) indicates - iodine deficiency disorder. PEM (PROTEIN ENERGY MALNUTRITION) indicate protein deficiency.

16. Anthropometric tools.... Weight assessment . Height assessment . BMI.    ( Most important ) ​ ​

17. BMI  CALCULATIONS 

18. Review of special diets.... ​? Solid diet  Liquid diet Soft diet ​

19. Review of  therapeutic diets .... ​ Therapeutic diets :- Therapeutic diets are planned food routines to maintain or restore good nutrition in patient.  In most cases the therapeutic diet are used to supplement the medical or surgical treatment of the Patient  while in some instances like diabetes mellitus, a therapeutic diet is the most aspect of the patient's treatment rather the medical therapy

20. Review of  therapeutic diets .... Therapeutic Diets   Regular diet  Liquid diet  Soft diet  Diabetic diet  Calorie controlled diet  Low cholesterol diet   Fat restricted (low-fat) diet  Sodium restricted diet  Protein diet  Bland diet  Low residue diet

21. Regular diet – i.e balanced diet  Liquid diet – consists of liquid contents , mainly given to the patient who is diagnosed with severe gastro conditions , first step -post operative patient to relive from NBM status. Soft diet -   consists of soft foods like mashed potato mainly given to the patient who is diagnosed with severe gastro conditions ,second  step -post operative patient to relive from NBM status. Diabetic diet - low sugar / high protein and / fibre content . etc  

22. Written assignment on therapeutic diet  specific conditions n diet  recall.....

23. Sample diet plan  NUTRITION  FOR CARDIOVASCULAR DISEASES   Name of the diet  – low cholestrol  / low fat  High fibre diet is recommended    Objectives:   To relieve strain to the heart   To prevent further damage to the heart  To restore the damage heart 

24. Food recommended for cardiac patients :-  Skim milk paneer from skim milk  ​  Cereals and pulses  ​ Whole grain  ​  All vegetables and all fruits  ​ High fiber and soluble fiber like oat meal, ​    egg white and fish ​  Vegetable oils, sugar and jaggery ​ etc  

25. Food to be avoided:   Cholesterol rich food   Whole cream Butter & cream cheese   Indian sweet meal like puddings bakery products  Organ meat  Egg yolk, fish   oil seeds,  pickles   Fried food  Alcohol

26. Regular low cholesterol and low fat and high fiber diet:-   Energy- 1600 k  cal   ​  Fat- 40 g  ​ Protein- 65 g ​

27. SAMPLE MENU FOR CARDIOVASCULAR DISEASES     MEAL                                FOOD EARLY MORNING LEMON WATER-1 GLASS BREAK FAST MILK(SKIMMED)-1 CUP, MISSI ROTI-1, CURD-1/2 KATORI, OR BOILED EGG- 1-2 AND BREAD- 1-2 SLICE MID - MORNING FRESH FRUIT- 1 LUNCH SALAD, CHAPAT-1-3, RICE- 60 G, VEGETABLE- 250G, CURD- 1 CUP EVENING TEA TEA, SPROUTED MONG OR BLACK CHANNA-30 G, BISCUITS-3-4 DINNER VEGETABLE SOUP,  CHAPATI-2,  DAL, CHICKEN OR FISH-100G , COOKING OIL- 20G

28. Roll number 1- 5        diet plan for diabetic patient . Roll number 6-10      diet plan for renal patient . Roll number 11- 15    diet plan for hypertension.  Roll number 16 - 20  diet plan for constipation . Roll number 21- 25   diet plan for post operative patient.  Roll number 26-30   diet plan for the patient diagnosed with severe diarrhea . Roll number 31- 34  diet plan for the  patient who underwent abdominal surgery . Individual files should be submitted 

29. Care of patients with specific conditions 

30. Care of patient – dysphagia .... Swallowing  disorder . Difficulty is shallowing .

31. Care of patient with dysphagia ….. Maintain the patient in high-Fowler's position with the head flexed slightly forward during meals.   Instruct the patient not to talk while eating.  Provide verbal cueing as needed.  Avoid milk and milk products If the patient had a stroke, place food in the back of the mouth, on the unaffected side, and gently massage the unaffected side of the throat.

32. Observe for uncoordinated chewing or swallowing; coughing shortly after eating or delayed coughing. which may mean silent aspiration; pocketing of food; wet-sounding voice; sneezing when eating; delay of more than 1 second in swallowing; or a variation in respiratory patterns. ​

33. I f any of these signs are present, put on gloves, eliminate all food from oral cavity, end feedings, and consult with a speech and language pathologist and a dysphagia team. ​  Encourage high-calorie diet that involves all food groups, as appropriate. ​  Discuss the importance of exercise to enhance the muscular strength of the face and tongue to enhance swallowing  Educate patient, family, and all caregivers about rationales for food consistency and choices. ​

34. Eating disorder . Causes people to obsess over their weight leading them to starve to lose weight . It's a serious psychological disorder. Care of patient - anorexia   ….. ​

35. Care of patient with anorexia  ….. ​ NURSING MANAGEMENT: Monitor the weight of client.  Correction of nutritional deficiency by providing nutritious diet.

36. Eating must be supervised by the nurse and provide balanced diet of at least 3000 calories should be provided in 24 hrs.   The goal should to be achieving weight gain of 0.5 to 1 Kg. per week.   Monitor the serum electrolysis levels.   Control vomiting by making bathroom inaccessible for at least 2 hrs. After food.

37. Care of patient – nausea and vomiting ….. Nausea : sensation of urge to vomit. Vomiting : forcible emptying of stomach . It’s a symptom.

38. D r ink clear or ice-cold drinks. Eat light, bland foods (such as saltine crackers or plain bread)​. Avoid fried, greasy, or sweet foods​. ​ Care of patient with anorexia …...

39. Do not mix hot and cold foods.​ ​ ​ ​ Drink beverages slowly.​ ​ Eat slowly and eat smaller, more frequent  ​ ​ ​

40. Avoid activity after eating​ ​ ​ ​  Avoid brushing your teeth after eating ​ ​ ​ Choose foods from all the food groups as you can tolerate them to get adequate nutrition​ ​ ​​ ​​

41.                         MEETING NUTRITIONAL NEEDS: PRINCIPLES                                                      &                 EQUIPMENTS, PROCEDURE INDICATIONS . ..... Oral nutrition  Enteral nutrition

42. Oral nutrition ​:  The term 'oral nutrition is used here to denote eating and drinking.  Oral nutrition is the preferred and most palatable method of feeding.

43. ENTERAL NUTRITION : NASOGASTRIC/ OROGASTRIC Enteral nutrition refers to any method of feeding that uses the gastrointestinal (GD) tract to deliver nutrition and calories.

44. The term enteral feeding is most often used to mean tube feeding. Enteral nutrition is indicated for patients who have a functioning GI tract but cannot ingest enough nutrients orally because they are unable or unwilling to take oral feedings. Nutrition is delivered using a flexible tube inserted through nose, or directly into stomach or small intestine.

45. Types :- NASOGASTRIC TUBE (NG) 2. OROGASTRIC TUBE (OG)

46. 1. Naso-gastric Feeding  A nasogastric tube (NG tube) is a special tube that carries food and  medicine to the stomach through the nose.  It can be used for all feedings or for giving a person extra calories to the patient 

47. Adult 16-22 French  Child-10-14 French  Infant 4-10 French 50 

48. 2  . Oro-gastric tube  The same type of tube as a nasogastric tube, the tube is inserted into the mouth, down the throat into the esophagus and rests in the stomach.  This tube can also remain in place for up to two weeks when it must be removed or replaced with a permanent tube.​​

49. Procedures :-  1 . Ng insertion 2 .Ng tube feeding 3.I\o chart 4.Gastrostomy and Jejunostomy 

50. Total parenteral nutrition (TPN) is a way of supplying all the nutritional needs of the body by bypassing the digestive system and dripping nutrient solution/s directly into a vein. The administration of a nutritionally adequate hypertonic solution (consisting of glucose, protein hydrolysates, minerals, and vitamins) through an indwelling catheter into the superior vena cava or other main vein.  

51.   Normally TPN is administered in a hospital, but under certain conditions and with proper patient and caregiver education, it may also be used at home for long-term therapy (HPA).  ​ ​ Ideally, TPN provides all the nutrients in the correct quantities to ensure the body functions normall y .​