NUTRITIONAL NEEDS.pptx

this is a chapter which comes under Nursing Foundations for First year BSc Nursing students. This ppt helps you to learn about the importance of nutrition, BMR, factors influencing dietary intake, factors affecting caloric needs, principles relevant to nutrition, assessment of nutritional status, dysphagia, acute care of patients with nutritional needs, feeding helpless patients, enteral tube feeding, insertion of NG tube, parenteral feeding, medical nutrition therapy, discussion on nursing process.

1. NUTRITIONAL NEEDS

2. IMPORTANCE OF NUTRITION Nutrition is the basic component of health. It is essential for normal growth & development, tissue maintenance & repair, cellular metabolism & organ function. An adequate supply of nutrients is needed for the essential function of cells.

3. BASAL METABOLIC RATE It is the energy needed to maintain life sustaining activities (Breathing, circulation, heart rate & temperature) for a specific period of time at rest.

4. RESTING ENERGY EXPENDITURE Otherwise called RESTING METABOLIC RATE It is the amount of energy an individual needs to consume over a 24 hour period for the body to maintain all its internal working activities while at rest.

5. CALORIE NEED One calorie per hour for each kilogram of body weight is needed to carry on the basic body functions of respiration, blood circulation, urine formation, & the regulation of body temperature. Depending on the type of activity, the requirement for calories changes.

6. 1 gm of Carbohydrate gives 4 kcal 1 gm of Protein gives 4 kcal 1 gm of Fat gives 9 kcal Water makes upto 60-70% of total body weight

7. FACTORS INFLUENCING DIETARY INTAKE ETHNICITY & CULTURE AGE RELIGION ECONOMIC STATUS PEER GROUP INFLUENCE PERSONAL PREFERENCES CUSTOMS & BELIEFS ALCOHOL ABUSE FOOD ADVERTISEMENTS PSYCHOLOGICAL FACTORS HEALTH STATUS MEDICATIONS

8. FACTORS AFFECTING CALORIC NEEDS AGE BODY SIZE ACTIVITY BODY TEMPERATURE ENVIRONMENTAL TEMPERATURE GROWTH GENDER EMOTIONAL STATUS

9. PRINCIPLES RELEVANT TO NUTRITION An adequate intake of essential nutrients & energy giving foods is required for optimal health An individual’s nutritional status is determined by the adequacy of the specific nutrients & energy giving foods taken into the body, absorbed & utilized. Nutritional needs depend on an individual’s age, sex, body frame, the amount & kind of daily activity, secretions of endocrine glands & the status of health.

10. Nutritional needs are usually altered in illness Food has a psychological meaning for people Food habits are learned Food habits are related to cultural, religious & moral beliefs.

11. ASSESSMENT OF NUTRITIONAL STATUS

12. ANTHROPOMETRIC MEASUREMENTS

13. HEIGHT WEIGHT MID ARM CIRCUMFERENCE (MAC) TRICEPS SKIN FOLD (TSF) MID UPPER ARM MUSCLE CIRCUMFERENCE (MAMC) IDEAL BODY WEIGHT (IBW) BODY MASS INDEX (BMI)

14. IDEAL BODY WEIGHT (IBW) = HEIGHT - 100 Example : height of a patient is 170cm IBW = Height - 100 = 170 - 100 = 70Kg

15. BODY MASS INDEX (BMI) = WEIGHT IN Kg / HEIGHT IN METRE SQUARE Unit is Kg / m 2 Example : Height of patient is 162 cm & weight is 68 Kg BMI = Wt in Kg / Ht in m 2 = 68 Kg / (1.62 x 1.62) = 68 / 2.62 = 25.95 Kg / metre square

16. RANGES OF BMI

17. 2. DIETARY HISTORY & HEALTH HISTORY

18. 3. SCREENING FOR MALNUTRITION

19. DEGREE OF MALNUTRITION (DOM) = (ACTUAL WEIGHT / EXPECTED WEIGHT) x 100 Example : actual weight = 20 kg, expected weight = 24 kg DOM = (20 Kg / 24 Kg) x 100 = 0.83 x 100 DOM = 83%

20. 4. PHYSICAL EXAMINATION

21. 5. LABORATORY & BIOCHEMICAL TESTS

22. DYSPHAGIA It refers to difficulty when swallowing.

23. Causes of Dysphagia

24. SIGNS OF DYSPHAGIA Cough during eating Change in voice tone or quality after swallowing Abnormal movements of the mouth, tongue or lips Slow, weak, imprecise or uncoordinated speech Abnormal gag Delayed swallowing Incomplete oral clearance Regurgitation Pharyngeal pooling Delayed or absent trigger of swallow

25. Complications of Dysphagia ASPIRATION PNEUMONIA DEHYDRATION DECREASED NUTRITIONAL STATUS WEIGHT LOSS

26. NURSING DIAGNOSIS

27. RISK FOR ASPIRATION RELATED TO DYSPHAGIA CONSTIPATION RELATED TO LOW FIBRE INTAKE DIARRHEA RELATED TO FOOD INTOLERANCE IMBALANCED NUTRITION LESS THAN BODY REQUIREMENTS RELATED TO DECREASED ABILITY TO INGEST FOOD AS A RESULT OF DEPRESSION OBESITY RELATED TO INTAKE OF UNHEALTHY FOOD OVERWEIGHT RISK FOR OVERWEIGHT IMPAIRED SWALLOWING RELATED TO TRAUMA TO ESOPHAGUS FEEDING SELF CARE DEFICIT

28. IMBALANCED NUTRITION LESS THAN BODY REQUIREMENTS RELATED TO DECREASED ABILITY TO INGEST FOOD AS A RESULT OF DEPRESSION Assess the general condition of the patient Assess the height & weight of the patient Assess for any weight loss Perform physical examination Enquire about the dietary intake Assess the likes & dislikes of the patient Encourage to take small frequent meals Encourage fluid intake Plan a dietary menu for the patient Give health education on importance of well balanced diet

29. ACUTE CARE OF PATIENTS WITH NUTRITIONAL NEEDS

30. ADVANCING DIETS

31. CLEAR LIQUIDS (coffee,tea, fruit juices) FULL LIQUIDS (vegetable juice, ice cream) PUREED (scrambled eggs) MECHANICAL SOFT (cooked vegetables, mashed potatoes) SOFT / LOW RESIDUE (low fibre diet) HIGH FIBRE LOW SODIUM(4gm, 2gm) LOW CHOLESTEROL (300mg/day) DIABETIC DIET DASH DIET REGULAR

32. 2. PROMOTING APPETITE

33. Provide an environment that promotes nutritional intake which includes keeping patient ’s room environment free of odors Provide a calm environment Provide oral hygiene Assess likes & dislikes of patient Plan for small frequent meals Plan a meal time appropriate for the patient Provide proper positions & comfort devices Plan & administer the mediactions

34. 3. ASSISTING PATIENTS WITH ORAL FEEDING

35. When patients need assistance while eating, it is important to protect the patient’s safety, independence & dignity. Assess the patient’s risk for aspiration Provide a 30 minute rest period before eating Position in an upright ( High fowler’s or semi fowler's) .

36. FEEDING THE HELPLESS PATIENT

37. 4. ENTERAL TUBE FEEDING

38. ENTERAL NUTRITION is nutrients given in the GI tract. It is the preferred method of meeting nutritional needs if the patient’s GI tract is functioning by providing physiological, safe & economical nutritional support. Enteral feed patients receive formula via NASOGASTRIC, JEJUNAL or GASTRIC TUBES. Patients with low risk of gastric reflux receive gastric feeding. If there is a risk of gastric reflux and which leads to aspiration, jejunal feeding is preferred.

39. TYPES OF ENTERAL FORMULAS POLYMERIC FORMULA MODULAR FORMULA ELEMENTAL FORMULA SPECIALTY FORMULA

40. POLYMERIC FORMULA It provides 1-2 kcal / ml It include milk based blenderized foods prepared by hospital dietary staff For this to be effective, GI tract needs to be able to absorb whole nutrients.

41. MODULAR FORMULA It provides 3.8 - 4 kcal / ml They are single macronutrient ( protein, glucose, polymers or lipids) preparations & are not nutritionally complete. This is usually added to other foods for meeting the patient’s nutritional needs.

42. ELEMENTAL FORMULA It provides 1-3 kcal / ml It contains predigested nutrients that are easier for a partially dysfunctional GI tract to absorb.

43. SPECIALTY FORMULA It provides 1-2 kcal / ml. They are designed to meet specific nutritional needs in certain illness. ( liver failure, pulmonary disease or HIV infection).

44. Tube feedings are typically started at full strength at slow rates. Increase the hourly rate every 8-12 hours if no signs of intolerance appear. Signs of intolerance are: high gastric residuals, nausea, vomiting, cramping & diarrhea. Enteral feedings are much beneficial than parenteral feedings. It reduces Sepsis, minimizes the hypermetabolic response to trauma & maintains intestinal structure & function.

45. Serious complication of enteral feeding is ASPIRATION of formula into the tracheobronchial tree. This can further leads to NECROTIZING INFECTION, PNEUMONIA, & POTENTIAL ABSCESS FORMATION. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) is an outcome associated with pulmonary aspiration. Common conditions that can cause aspiration are: COUGHING, NASOTRACHEAL SUCTIONING, AN ARTIFICIAL AIRWAY, DECREASED LEVEL OF CONSCIOUSNESS & LYING FLAT.

46. INDICATIONS FOR ENTERAL & PARENTERAL NUTRITION

47. Feeding tubes are inserted through the nose (NASOGASTRIC or NASO INTESTINAL), surgically (GASTROSTOMY or JEJUNOSTOMY) or endoscopically (PERCUTANEOUS ENDOSCOPIC GASTROSTOMY[PEG] or JEJUNOSTOMY [PEJ]). If enteral nutrition therapy is less than 4 weeks total, NG or NJ feeding tubes may be used.

48. INSERTION OF NASOGASTRIC TUBE

49. NASOGASTRIC TUBE FEEDING / GASTRIC GAVAGE

50. Assessing pH of gastric contents 5-10 ml of gastric fluid is required for checking pH It typically ranges from 0-4 Intestinal aspirate has a pH of 7.8 - 8

51. GASTROINTESTINAL CONTENTS

52. COMPLICATIONS OF ENTERAL TUBE FEEDING Pulmonary aspiration Diarrhea Constipation Tube occlusion Tube displacement Fluid overload Abdominal cramping Nausea/ vomiting Delayed gastric emptying Serum electrolyte imbalance Hyperosmolar dehydration

53. 5. PARENTERAL NUTRITION (PN)

54. It is a form of specialised nutrition support in which nutrients are provided INTRAVENOUSLY Safe administration of PN requires appropriate assessment of nutrition needs, meticulous management of central venous catheter (CVC) & careful monitoring to prevent or treat metabolic complications. Adhere to principles of asepsis & infusion management to ensure safe nutrition support.

55. Patients who are unable to digest or absorb enteral nutrition benefits from PN. Indications for PN are patients with SEPSIS, HEAD INJURY or BURNS. LIPID EMULSIONS provide supplemental kilocalories & prevent essential fatty acid deficiencies. Administer these emulsions through a separate peripheral line, through the central line by Y- connector tubing or as an admixture to the PN solution.

56. The addition of lipid emulsion to the PN solution is called 3-in -1 admixture. The patient receives this over a 24 hour period. Do not use the admixture if oil droplets or an oil or creamy layer on the surface of the admixture is observed. This indicates that the emulsion has broken into large lipid droplets that cause fat emboli.

57. Lipid emulsions are WHITE & OPAQUE

58. METABOLIC COMPLICATIONS OF PN Electrolyte imbalance Hypercapnia Hypoglycemia Hyperglycaemia Hyperglycaemic hyperosmolar nonketotic dehydration/coma (HHNC)

59. 6. MEDICAL NUTRITION THERAPY {MNT}

60. MNT is the use of specific nutritional therapies to treat an illness, injury or condition. It is necessary to assist the body's ability to metabolize certain nutrients, correct nutritional deficiencies related to the disease, & eliminate foods that may exacerbate disease symptoms