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• 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
  • Protein
  • Fats
  • Vitamins
• Variable Affecting an Individual's Caloric Needs

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


  • Nurses identifies 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
  • Laboratory data
  • Anthropometric data
• BMI (Body mass index)


  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
• 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
  • Emesis
  • Retching
  • Regurgitation
  • Projectile vomiting
  • Stomach gas
  • Eructation (Belching)
  • Flatus
• Therapeutic Diets


  • Regular Diet
  • Liquid Diet
  • Clear Liquid Diet
  • Full Liquid Diet
  • Soft Diet
  • Diet as Tolerated
  • Diabetic Diet
  • Calorie Controlled Diet
  • Low Cholesterol Diet
  • Fat Restricted Diet
  • Sodium Restricted Diet
  • Protein Diet
  • Bland Diet
  • Low Residue Diet
• Regular Diet


  Balanced diet usually used for ambulatory patients
• Liquid Diet


  Nutritionally inadequate and should only be used for short periods of time
• Soft Diet


  Similar to regular diet but foods must require little chewing and be easy to digest
• Diet as Tolerated


  Include those foods which the client can tolerate after surgery or after GI distress
• Management of Nutrition

  • Meal Trays
  • Feeding Assistance
  • Feeding a visually impaired client
  • Measures to Stimulate Appetite
  • Promote comfort
  • Nursing Interventions for Client with Nausea and Vomiting
• Alternative Feeding Methods


  • Nasogastric Tubing
  • Nasoenteric Tubing
  • Gastrostomy & Jejunostomy
• Purposes of Alternative Feeding Methods

  • To provide adequate nourishment to patients who cannot feed themselves
  • To administer medications
  • To provide nourishment to patients who cannot be fed through mouth because of surgery in the oral cavity, unconscious, or comatose state
• Needed Materials in Alternative Feeding

  • Graduated Container
  • Large Syringe (usually 60 ml)
  • Distilled water
• Administering Tube Feeding; NGT

  1. Position: Semi fowlers or in sitting position

  2. Asses tube placement and patency

  3. Aspirate gastric content (yellowish or greenish in color)

  4. Introduce 5-20 ml of air into NGT and auscultate the epigastric area, gurgling sound is heard

  5. Measure Ph of The aspirated fluid (acidic)
• Procedures in Alternative Feeding

  1. Assess for residuals – if 50 ml or more verify if feeding will be given

  2. Introduce feeding slowly – to prevent flatulence crampy pain or reflex vomiting

  3. Height of feeding - 12 inches above the tube's point of insertion

  4. Instill 60 ml of water thru NGT after feeding – to cleanse the lumen of the tube

  5. Ask patient to remain in fowler's position for at least 30 minutes – prevent potential aspiration of feeding
• Problems of Tube Feeding

  • Vomiting
  • Aspiration
  • Diarrhea
  • Constipation
  • Hyperglycemia
  • Abdominal Distention
• Defecation


  The expulsion of feces from the rectum
• Scientific Knowledge Base


  • Mouth
  • Esophagus
  • Stomach
  • Small Intestine
  • Large Intestine
  • Anus
• Factors Affecting Bowel Elimination

  • Age
  • Diet
  • Fluid Intake
  • Physical Activities
  • Psychological Factors
  • Personal habits
  • Position during defecation
  • Pain
  • Pregnancy
  • Surgery Anesthesia
  • Medications
  • Diagnostic Tests
• Normal Characteristic of Stool

  • Color
  • Odor
  • Amount
  • Consistency
  • Shape
  • Frequency

  
• Abnormal Characteristics of Stool

  • Alcoholic Stool
  • Hematochezia
  • Melena
  • Steatorrhea
• Anus


  Expels feces and flatus from the rectum
• Factors Affecting Bowel Elimination

  • Age
  • Diet
  • Fluid Intake
  • Physical Activities
  • Psychological Factors
  • Personal habits
  • Position during defecation
  • Pain
  • Pregnancy
  • Surgery Anesthesia
  • Medications
  • Diagnostic Tests
• Normal Characteristics of Stool

  • Color: Yellow or Golden Brown
  • Odor: Aromatic upon defecation
  • Amount: approximately 150-300 grams per day
  • Consistency: Soft and formed
  • Shape: cylindrical
  • Frequency: Usual range 1 - 2 per day to 1 every 2-3 days
• Abnormal 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: Passage of small dry, hard stools or the passage of no stool for a period of time
  • Fecal Impaction: Mass or collection of hardened, putty-like feces in the folds of the rectum
  • Diarrhea: Frequent evacuation of watery stools
  • Flatulence: Presence of excessive gas in the intestines (also tympanites)
• Common Bowel Elimination Problems

  • Incontinence: Causes: physical conditions that impair anal sphincter function or control
  • Hemorrhoids: Causes: straining with defecation, pregnancy, heart failure, chronic liver disease
• Nursing interventions for Constipation

  • Adequate fluid intake
  • High fiber diet
  • Establish regular pattern of defecation
  • Respond immediately to the urge to defecate
  • Minimize stress
  • Adequate activity and exercise
  • Assume sitting or semi sitting position
  • Administer laxatives as ordered
• Assessment: Fecal Impaction


  • Absence of bowel movement for 3-4 days
  • Passage of liquid fecal seepage
  • Hardened fecal mass is palpated during digital examination of the rectum
  • Non-productive desire to defecate and rectal pain
  • Anorexia and body malaise
  • Subjective feeling of abdominal fullness or bloating, apparent abdominal distention
• Nursing interventions: Fecal Impaction


  • Manual extraction or fecal disimpaction as ordered
  • Increase fluid intake
  • Sufficient bulk in diet
  • Adequate activity and exercise
• Nursing interventions: Diarrhea


  • Replace fluids and electrolyte losses
  • Provide good perineal care
  • Promote rest
  • Small amount of bland foods
  • Low fiber diet
  • BRAT diet (Banana, Rice, Apple, Toast)
  • Avoid excessively hot or cold fluids and herbs and spices because these are stimulants
  • K+ rich foods and fluid (banana, gatorade)