Altered Nutrition – Flashcards
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Defining Nutritional status
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The degree of balance between nutrient intake and nutrient requirements.
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Optimal nutritional status
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Consumption of nutrients in amounts that support daily growth and any increased metabolic demands.
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Undernutrition
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Depletion of nutritional reserves or inadequate intake to meet daily requirements.
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Overnutrition
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Consumption of nutrients in excess of requirements.
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S & S of poor nutrition # 1
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Listless appearance, Apathetic appearance, Cachectic appearance,
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S & S of poor nutrition # 2
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Posture, Muscles, Nervous system, GI function, Cardiac function, General Vitality, Hair,
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S & S of poor nutrition # 3
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Skin, Face and Neck, Lips, Mouth and Oral Membranes, Gums, Tongue, Teeth, Eyes, Nails, Skeleton
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Listless
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Having or showing a lack of energy and interest
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Apathetic
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Having or showing a little or no emotion
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Cachectic
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Loss of weight and muscle mass due to disease
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Posture
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Sagging shoulders, sunken chest, humped back
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Muscles
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Flaccid, poor tone, tenderness, edema, inability to walk properly
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Nervous system
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Inattention, irritability, confusion
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GI function
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Indigestion, constipation or diarrhea
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Cardiac function
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Rapid heart rate ( > 100 beat/min), elevated blood pressure
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General vitality
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Lack of energy, falling asleep easily, tired, easy fatigued
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Hair
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Stringy, dull, brittle, dry, thin
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Skin
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Rough, pale, bruises, petechiae
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Face and neck
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Dark skin over cheeks and under eyes, greasy, scaly
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Lips
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Swollen, lesions at corners of mouth
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Mouth and Oral Membranes
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Swollen
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Gums
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Receding gum line, bleeding
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Tongue
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Swollen, scarlet
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Teeth
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Absent teeth, worn surfaces
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Eyes
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Pale conjunctiva, dryness
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Nails
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Brittle
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Skeleton
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Bowlegs, knock knees, prominent scapula and ribs
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Altered Nutrition
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-Less than body requirements: Undernutrition (malnutrition). - More than body requirements: Overnutrition (obesity)
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Nutrition in the Adult & Older Adult: Adulthood
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- influence of lifestyle factors. - importance of nutritional counselling to prevent weight gain and obesity
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Nutrition in the Adult & Older Adult :Older adult
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- at risk for undernutrition and overnutrition. - decrease of energy requirements by 5% per decade. - impact of poor dentition, visual acuity, slowed GI function, and diminished taste/ smell. - socioeconomic conditions. - vitamin D supplements recommended.
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Nutritional assessment: Nutrition screening
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-malnutrition screening tool -comprehensive nutritional assessment -24-hour food recall -food frequency questionnaire -food diaries -direct observation -Canada's Food Guide and Dietary Reference Intakes ( DRIs)
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Malnutrition screening tool
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A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q,R
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A screening
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Has food intake declined over the past 3 months due to lose of appetite, digestive problems, chewing or swallowinh difficulties?
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B screening
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Weight loss during the last 3 months
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C screening
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Mobility
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D screening
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Has suffered psychological stress or acute diseases in the past 3 months?
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E screening
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Neuropsychological problems
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F screening
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Body mass index (BMI) (weight in kg)/(height in m2)
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G assessment
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Lives independently (not in nursing home or hospital)
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H
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Takes more than 3 prescription drugs per day
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I
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Pressure sores or skin ulcers
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J
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How many full meals does the patient eat daily?
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K
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Selected consumption markers for protein intake
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L
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Consumes two or more servings of fruit or vegetables per day?
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M
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How much fluid is consumed per day?
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N
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Mode of feeding
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O
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Self view of nutritional status
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P
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In comparison with other people of the same age, how does the patient consider his/her health status?
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Q
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Mid-arm circumference (MAC) in cm
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R
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Calf circumference (CC) in cm
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Diet History: subjective # 1
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-Eating patterns, -Usual weight/recent changes, -Changes in appetite, taste, smell, chewing,swallowing, -Chronic conditions -Nausea, vomiting, diarrhea, constipation, -Food allergies or intolerances
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Diet History: subjective # 2
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-Medications and/or nutritional supplements, -Self-management behaviours/access to healthy foods, -Alcohol or illegal drug use, -Exercise and activity patterns, -Family history, -Psychological problems, -Physical impairments that limit ability to independently consume foods or liquids
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Objective data: physical exam Equipment needed
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Measurement tape, pen or pencil, nutrition assessment data form
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Objective data: physical exam Anthropometric measures
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-derived weight as percent of ideal body weight, -percent usual body weight, -recent weight change
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What can CAUSE a client to have a high-risk nutritional status
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-medication. -nutritional awareness and motivation may be poor. -presence of other diseases. -age-related gastrointestinal changes. -intake of calcium, vitamin D, and phosphorus may be dificent.
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What can CAUSE a client to have a high-risk: Age-related considerations: Malnutrition
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Older adults are particularly vulnerable: -commonly they report little or no appetite, problems with chewing or swallowing, inadequate servings of nutrients, and fewer than two meals per day. -limited incomes may cause them to restrict the number of meals eaten per day or the dietary of meals eaten. -social isolation is a problem. -functional limitations ( in preparing meals, purchasing food)
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What can CAUSE a client to have a high-risk: Dysphagia #1
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Any impairment in eating, drinking, or swallowing, the consequences of unrecognized and untreated dysphagia, can be life-threatening.
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Dysphagia #2
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Protein-calorie malnutrition, dehydration, acute choking episodes that may lead to airway occlusion, chronic aspiration leading to frequent chest infections, and unnecessary long-term enteral nutrition (EN) support (Dietitians of Canada, 2005)
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Nursing diagnoses that can lead to altered nutrition Examples
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-risk for aspiration, -constipation, -diarrhea, -imbalanced nutrition: less that/more than body requirements, -feeding self-care deficit,
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Promoting appetite
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-decrease offensive odors, -provide oral hygiene to decrease bad tastes -maintain patient comfort -recall that some meds alter the taste of food (e.g: some antifungal agents)
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Medication influence
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Some meds alter metabolism of food (insulin, thyroid hormones). Some meds affect appetite by causing nausea
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Feeding your patient # 1
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Do not feed a patient who is lying on their back or who has their neck arched (might cause aspiration). Keep patient in an upright position. Don't put too much food in patient's mouth at one time.
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Feeding your patient #2
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Sit in patient's line of vision, provide prompting and encouragement. Try to listen to special requests (e.g: please heat this up). Give choices (which food item do they want). Help patients with low vision to know where foods are on the plate.
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Feeding your patient #3
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Adaptive utensils for pts with motor deficit (OT). When food intake is less than usual encourage intake of nutrient dense food first. Sometimes small frequent meals are better than 3 meals per day. Keep patient sitting for 30 minutes after eating.
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Feeding your patient #4
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Advancing diets. Promoting appetite. Assisting patients with feeding. Enteral tube feeding. Parenteral nutrition.
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Nursing interventions to promote increased intake in undernourished clients: Oral nutrition #1
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High-calorie oral supplements may be used in the patient whose nutritional intake is deficient. - may include milkshakes, puddings, or commercially available products (e.g., Carnation instant breakfast anytime, ensure, boost)
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Nursing interventions to promote increased intake in undernourished clients: Oral nutrition #2
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These supplements should not be used as meal substitutes but between meals as snacks.
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the following factors may account for an increased risk of undernutrition in new immigrant families.
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Limited income results in decreased access to nutritious foods. Familiar foods may be difficult to obtain. Nutrition education resources do not provide culture-specific information. Lack of knowledge about where and how to purchase, prepare, and store available foods.
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Altered nutrition: more than body requirements
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Obesity
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Obesity ( review from nutrition class) #1
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Body mass index (BMI) - BMI of 30 to 40 kg/m2 classified as obese. - BMI of more than 40 kg/m2 classified as morbidly obese.
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Obesity ( review from nutrition class) #2
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Waist circumference. Waist-to-hip ratio (WHR)
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Classifications of body weight and obesity
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-android obesity: apple-shaped body. -genetics play an important role in determining body fat distribution patterns.
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Health risks associated with obesity
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Health problems occur at higher rates for obese patients. Mortality rate rises as obesity increases. -especially with increased visceral fat. Obese patients have a decreased quality of life. Most conditions improve with weight loss.
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Nursing diagnoses
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-imbalanced nutrition: more than body requirements. -impaired skin integrity. -ineffective breathing pattern. -chronic low self-esteem. -impaired physical mobility. -disturbed body image.
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Goals to achieve weight loss
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-modify eating patterns. -participate in a regular physical activity program. -achieve weight maintenance or loss to a specified level. -maintain weight loss to a specified level. -minimize or prevent health problems related to obesity.
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Nursing interventions: obese patients #1
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Multi pronged approach ought to be used, with attention to multiple factors,: -dietary intake, physical activity, behaviour modification and/or dry therapy.
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Nursing interventions: obese patients #2
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All opportunities for patient education should stress healthy eating and physical activity.: - decrease calorie intake: discourage fad diets. -encourage physical activity. -some patients may need to be followed by psychology for behaviour modification. -encourage patients to join support groups.
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Age-related considerations: obesity in older adults
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The number of older obese persons has risen. Obesity is more common in women than men. Decreased energy expenditure and loss of muscle mass are important contributors. Exacerbates age-relate problems.
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Therapeutic diets available in hospital:
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-clear liquid. -thickened liquid. -full liquid. -pureed. -mechanical soft. -soft or low residue. -high fiber. -low sodium. -low cholesterol. -diabetic. -regular.
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Clear liquid
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Broth, bouillon, coffee, tea, clear fruit juices, carbonated drinks, jello, popsicles.
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Thicked liquid
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All liquids need to be thickened with thickening powder so that they cannot be aspirated ( nectar, honey, pudding consistency).
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Full liquid
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To clear or thickened liquid can be added custards, cooked cereals, vegetable juice, pureed veggies, any fruit juices.
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Pureed
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All of previously mentioned foods and can also add puree meat, vegetables, fruits, mashed potatoes, scrambled eggs.
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Mechanical soft
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All of above plus: flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, cooked veggies, canned or cookec fruits, bananas, soups, peanut butter.
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Soft or low residue
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Low fiber, easily digestible: pasta, casseroles, moist tender meats, cakes and cookies with no nuts or coconut
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High fiber
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Uncooked fruits, streamed veggies, bran, oatmeal, died fruits
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Low sodium
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4g salt, no added salt
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Low cholesterol
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< 200 mg/day of cholesterol
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Diabetic
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Should use Canada's food guide
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Regular
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Means no dietary restrictions sometimes written as DAT
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Health promotion of nutrition
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Keys to healthy diet: -eat a variety of foods from all groups. -consume recommended amounts. -limit intake of saturated fats, trans fat, added sugars, starch, cholesterol, salt, and alcohol. -match calorie intake with calories expended. -engage in 30-60 minutes of moderate physical activity most days. -follow food preparation guidelines for handling, preparing, and storing foods.
