and elimination

• Nutrition


  The process by which the body uses food
• Malnutrition


  A condition resulting from a lack of proper nutrients in the diet. It is chronic inadequate nutrition
• Nutrients


  • Water
  • Carbohydrates
  • Proteins
  • Fats
  • Vitamins
• Variables affecting an individual's calorie needs


  • Age
  • Gender
  • Climate
  • Sleep
  • Activity
  • Fever
  • Illness
• Nutritional Status Assessment


  • Nurses identify current or potential client problems associated with nutrition
  • Nurses obtain subjective data by asking client focused questions on a diet history
  • Nurses obtain objective data using physical assessment techniques
• Objective Data Assessment


  • Physical assessment: assessment of physique and general well-being
  • Laboratory data: used in nutritional assessment (Cholesterol)
  • Anthropometric data: measurements for body size and composition, by measuring height and weight and calculating body-mass index (BMI)
• Body Mass Index (BMI)


  Provides numeric data to compare a person's size in relation to established norms for the adult population - calculated using height and weight
• Mid-arm circumference


  Helps to determine skeletal muscle mass
• Triceps skinfold measurement


  Additional data for estimating the amount of subcutaneous fat deposits
• Abdominal measurement


  Measurement of fatty tissue
• Diet History/Subjective data


  Assessment technique for obtaining facts about a client's eating habits and factors that affect nutrition, such as level of appetite, weight loss or gain of 10 lbs in the past 6 months, and number of meals the client eats per day, food Likes and dislikes, Alcohol consumption, special diets, use of over the counter drugs. Vitamins or mineral supplements. The desire to improve nutritional intake or to gain or loose weight
• Problems interfering with Nutrition


  • Imbalanced nutrition: less than body requirements
  • Imbalanced nutrition: more than body requirements
  • Deficient knowledge: nutrition
  • Self-care deficit: feeding
  • Impaired swallowing
  • Risk for aspiration
• Other Problems interfering with Nutrition


  • Obesity
  • Emaciation
  • Anorexia
  • Nausea
  • Vomiting
  • Stomach gas
  • Eructation (Belching)
  • Flatus
• Vomiting


  Loss of stomach contents through the mouth
• Emesis


  Substance vomited
• Retching


  The act of vomiting without producing vomitus
• Regurgitation


  Bringing stomach contents to the throat and mouth without the effort of vomiting
• Projectile vomiting


  Vomiting that occurs with great force, is associated with certain diseases
• 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
• Therapeutic Diets


  • Modifications of normal diet used to improve specific health conditions
  • Normally prescribed by doctor and planned by dietician
  • May change nutrients, caloric content and/or texture
  • May seem strange and even unpleasant to the patient
• Regular Diet


  • Balanced diet usually used for ambulatory patients
  • At times is has a slightly reduced caloric content
  • Foods such as rich desserts, cream sauces, salad dressings and fried foods may be decreased or omitted
• Liquid Diets


  • Nutritionally inadequate and should only be used for short periods of time
  • Uses: After surgery or a heart attack, Pts with acute infections or digestive problems, To replace fluids lost by vomiting or diarrhea, Before some Xrays of digestive tract
• Soft Diet


  • Similar to regular diet but foods must require little chewing and be easy to digest
  • Avoid meat and shellfish with tough connective tissue, coarse cereals, spicy foods, rich desserts, fried foods, raw fruits and veggies, nuts, and coconuts
• Soft Diet


  • Include those foods which the client can tolerate after surgery or after GI distress
  • Depends on the client's appetite and the ability to eat and to tolerate food
• Management of Nutrition


  • Meal Trays: meals served at bedside or dining rooms or cafeterias
  • Feeding Assistance- assistance with eating, and for clients with dysphagia (difficulty swallowing). Remain with the client throughout eating. Place client in sitting position. Encourage the client to eat slowly. Limit distracting stimuli. Give short, simple instructions to prompt the client to eat and swallow
  • Feeding a visually impaired client
• Measures to Stimulate Appetite


  • Serve food in pleasant and attractive manner
  • Place in comfortable position
  • Provide good hygiene measures
  • Promote comfort (Relieve pain, Adequate ventilation and humidity, Remove unsightly articles, Check very tight or very loose dressing)
  • Remember that color affects appetite to eat. Include red-yellow, green-colored foods
  • Engage in pleasant conversation
  • Assist weak patient in feeding
  • Curtain the unit of patients who are on NPO or very ill
• Nursing Interventions for Client with Nausea and Vomiting

  • Position: conscious - semi fowler's; unconscious- lateral
  • Provide good oral hygiene
  • Suction the mouth as needed
  • Relieve sensation of nausea by providing any of the following: Ice chips, hot tea with lemon/calamansi, hot ginger ale, dry toast or crackers
  • Replace fluid or electrolyte losses (oral or IV)
  • Observe for potential complications: Dehydration, Acid-base balance, Hypokalemia
• Antiemetic Medications


  • Plasil (metoclopramide)
  • Tigan (Trimethobenzamide)
  • Phenergan (Promethazine)
  • Compazine (Prochlorperazine maleate)
• Enteral Feeding


  Alternative feeding methods when oral intake is inadequate
• Types of Enteral Feeding


  • NGT's (Nasogastric Tubes)
  • Nasoenteric tube
  • Gastrostomy or Jejunostomy
• NGT's


  • Used for adequate gastric emptying and short-term feeding
  • Not used for clients without intact gag and cough reflex
• Nasoenteric tube


  Inserted through the nostril down to the upper small intestine
• Gastrostomy or Jejunostomy


  • Used for long term nutritional support
  • Placed surgically or through laparoscopy through abdominal wall into the stomach or into the jejunum
• Administering Tube Feeding; NGT


  • Position: semi-fowler's or in sitting position
  • Assess tube placement and patency
  • Assess for residuals - if 50 ml or more verify if feeding will be given
  • Introduce feeding slowly - to prevent flatulence, crampy pain or reflex vomiting
  • Height of feeding: 12 inches above the tube's point of insertion
  • Instill 60 ml of water thru NGT after feeding - to cleanse the lumen of the tube
  • Ask patient to remain in fowler's position for at least 30 minutes - prevent potential aspiration of feeding
• Common Problems of Tube Feeding


  • Vomiting
  • Aspiration
  • Diarrhea (most common due to lactose intolerance)
  • Constipation
  • Hyperglycemia
  • Abdominal distention
• Defecation


  The expulsion of feces from the rectum
• Factors Affecting Bowel Elimination


  • Age
  • Diet
  • Fluid intake
  • Physical activity
  • Psychological factors
  • Personal habits
  • Position during defecation
  • Pain
  • Pregnancy
  • Surgery and Anesthesia
  • Medications
  • Diagnostic tests
• Normal Characteristics of the Stool


  • Color: Yellow or golden brown
  • Odor: Aromatic upon defecation
  • Amount: approximately 150-300 grams per day
  • Consistency: Soft, formed
  • Shape: Cylindrical
  • Frequency: Variable; usual range 1-2/day to 1 every 2-3 days
• Alteration on the Characteristics of Stool


  • Alcoholic stool: Gray, pale or clay-colored stool due to absence of stercobilin caused by biliary obstruction
  • Hematochezia: Passage of stool with bright red blood due to lower GIT bleeding
  • Melena: Passage of black, tarry stool due to upper GI bleeding
  • Steatorrhea: Greasy, bulky, foul-smelling stool. Due to presence of undigested fats like in HB-pancreatic obstructions/disorders
• Common Fecal Elimination Problems


  • Constipation
  • Fecal Impaction
  • Diarrhea
  • Flatulence