Ch 27 nutrition therapy and assisted feeding PDF

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Fundamental Concepts and skills for nursing textbook...

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Chapter 27: Nutrition Therapy and Assisted Feeding • • •

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Goals are to treat and manage disease, prevent complications and restore or maintain health through appropriate diet Assist patients in meeting their nutritional goals by completing thorough nutritional data collection Assisting a patient with feeding: o Put tray in front, protect patients clothing o Ask what patient wants to begin with, alternate foods o Offer fluids o Offer hand and oral hygiene Postoperative patient o Should be well nourished preoperatively to facilitate postoperative healing and recovery o Usually, NPO 12 hours before surgery o Dec risk of vomiting while under anesthesia o Patients progress from a clear liquid diet to a full liquid diet o Clear liquids started when patient has return of bowel sounds detected by auscultation ▪ Maintained by fluid homeostasis ▪ Introduce fluids with low residu o Foods clear at room temperature o Broth adds electrolytes o Full liquid used following surgery, chewing problems ▪ Includes fluid, custards, cream, sherbert, puddings ▪ Low in iron, vitamin a, b12

Health Issues Related to Nutrition •

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Feeding and eating disorders o Anorexia nervosa o Bulimia nervosa o Binge eating Obesity o Hypertension, cv disease, stroke, diabetes o Bariatric surgery reduces stomach size Pregnancy o Reduces complications

Substance-Related and addictive disorders • • •

Individuals who use alcohol, smoking, others present with nutritional deficits when entering health care facilities Dec appetite Thiamine deficiency often present with alcohol use o Fluid and electrolyte substances, vitamin substances, liver damage bc ncreased stress of metabolizing excessive alcohol and other substances o Dietary fat should be restricted if liver function is impaired

Disease processes that benefit from nutritional therapy •

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Cardiovascular disease o Vessels, hypertension, MI (loss of blood supply to heart muscle) and heart failure (pump failure of right or left ventricle) o Nutritional therapy focused on reduction of saturated and trans fat cholesterol, sodium intake, red meats o Atherosclerosis ▪ Accumulation of fatty deposits on walls of blood vessels • Excessive saturated and trans fat intakes lead to this ▪ Narrow bv --> dec blood supply ▪ Inc workload of heart --> hypertension o High density lipoprotein: good cholesterole, cleanse vessels of fatty deposits o Low density lipoprotein: inc fatty deposits on vessel walls o Very low density lipoprotein: carrier for triglycerides in blood o Concentrated sugar plays role o Vit d prevents cv disease, and decrease inflammatory response o Control sodium ▪ Large amounts of sodium cause fluid retention ▪ Increased fluid volume in patients with HF inc workload of heart and results in inc resp distress and edema in legs and feet ▪ Inc fluid volume and edema also lead to hypertension Diabetes mellitus o Disturbance of metabolism of carbohydrates and other nutrients o Type 1 diabetes: occurs when beta cells of pancreas stop secreting insulin ▪ Insulin needed to transport glucose across the cell wall ▪ Eary age o Type 2 90 p of cases ▪ Glucose receptors on cell membrane lose sensitivity to insulin ▪ Insulin secreted in normal or extra amounts, receptor sites do not allow gluc to enter cells ▪ After 40 but getting younger ▪ Aa, mexican, am indians, hawaiins, aa higher risk for t2dm, heart disease and stroke HIV/AIDS o Human immunodeficiency virus and acquired immunodeficiency syndrome assosiated with severe diarrhea, weight loss, muscle wasting o Lose half of body weight o Replace fluid and electrolytes, weight gain, replace muscle mass through protein, stregnthen immune system o Caloric intake should increase, offer bland food wwehn mouth sore,adding thickening agetns to liquids, adding seasoning

Assisted Feeding

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Dysphagia: diffuculty swallowing More than half of patients who aspirate show no obvious signs or sympotms o May cause voice change or feeling of food ebing stuck in throat o Thicken liquids to help o Four texture levels ▪ Pureed (pudding), mechanically altered (moist and minced), advanced (moist and bite sized, no hard or cruchy) , regular (all foods) Nasogastric and enteral tubes o...