Nutrition

Fundamentals

Dr. Shahnaz Ayasrah

 Scientific Knowledge Base:
Nutrients
Carbohydrates Proteins
Starches and sugars Amino acids

Fats Water
Saturated, Cells depend on a fluid
monounsaturated, and environment
polyunsaturated

Vitamins Minerals
Essential to metabolism Catalysts for biochemical
Water or fat soluble reactions
 Regular Diet

⮚ No diet modification or restriction

⮚ Salt is allowed, provided with salt
packets in tray
⮚ Food may be prepared in different
ways of cooking
⮚ May have regular sugar, creamer and
other condiment
⮚ Served with regular liquids
⮚ Regular sweet
 Therapeutic/ Nutrient
Modification

⮚ Nothing per ora (NPO)

- food and fluid are prohibited
⮚ Clear liquid diet
- it is limited to water, juice, tea, hard candy….etc
- provide the client with fluid and carbohydrate but
does not supply adequate protein, fat, vitamins,
minerals or calories.
- the major objective is to remove thirst, prevent
dehydration, and minimize the stimulation for the
GIT
 Therapeutic/Nutrient Modification

⮚ Full liquid diet

- contains only liquid or food turn to liquid at
room temperature (ice cream)
- used for patients with GI disturbances or
unable to tolerate solid or semisolid food.
- it is low in iron, protein and calories
- has high cholesterol content because of the
milk offered

⮚ Soft diet
- easily chewed and digested, so it is
- appropriate for those have difficult swallowing.
It is low fiber
 Therapeutic/Nutrient Modification

⮚ Diet as tolerated
- Used when client’s appetite, ability to
eat and tolerance for certain foods
changed
 Parenteral Nutrition

• Parenteral nutrition is a specialized form of

nutritional support in which nutrients are
provided intravenously.
 Parenteral Nutrition

• Administered to clients who are unable to

digest or absorb enteral nutrition
• Peripheral or through a central line
• Before initiating PN, refer to specific health
care policy and procedures. No other fluids
can be administered in the same line with
TPNs.
 Parenteral Nutrition

• Placement of the line needs to be confirmed

by x-ray.
• Complications can occur at the site, with
tubing, with infusion rate, electrolyte
imbalances.
• Nurses need to provide continuous
monitoring, assessments, and
documentation.
 Parenteral Nutrition
• Peripheral or through a central line
• Initiating parenteral nutrition
• Preventing complications
1. Dehydration and electrolyte Imbalances.
2. Thrombosis (blood clots)
3. Hyperglycemia (high blood sugars)
4. Hypoglycemia (low blood sugars)
5. Infection.
6. Liver Failure.
7. Micronutrient deficiencies (vitamin and minerals
 Enteral Tube Feeding
• Enteral feeding delivers nutrients directly
into the GI tract. This is a preferred method
for providing nutrients. Has several types:
1. Nasogastric*
2. Nasointestinal
3. Gastrostomy
4. Jejunostomy
 Enteral nutrition
• Each one of these methods to administer
EN has specific indications, assessments,
and precautions. You will follow hospital
policy and procedures. You will learn how
to care for, insert, remove and assess
tubes, gavage (feeding), and
lavage(irrigation or washing out the
stomach content) in the nursing skills lab.
 Nasogastric tube

• Nasogastric tube is alternative feeding

method to insure adequate nutrition.
• May be firm large-bore flexible rubber or
plastic one lumen tube (Levin tube) or larger
tube to drain stomach content (Salem tube)
or smaller tube to inflow atmospheric air to
prevent vacuum.
 Nasogastric tube

⮚ Purposes of inserting Nasogastric tube is:

1. Administering feeding or medications
2. A mean of suctioning (lavage or wash) in
case of poisoning or overdose medication
3. collect samples for Laboratory analysis
4. Used for patients has intact gag and cough
reflex, has adequate stomach emptying and
require short term feeding
 Nasogastric lavage

⮚ Purposes of lavage is:

1. Clean the area and removing foreign bodies
2. Reduce inflammation
3. Relive discomfort
4. Apply medication (antiseptics)
5. Apply heat or cold
⮚ Mostly done with normal saline (unless other
specified otherwise) at body temperature using
aseptic technique.
 Nursing Diagnosis

Risk for Deficient

aspiration Diarrhea knowledge
Readiness for Feeding self- Impaired
enhanced care deficit swallowing
nutrition
Imbalanced Imbalanced Risk for
nutrition: more nutrition: less imbalanced
than body than body nutrition: more
requirements requirements than body
requirements
QUESTIONS
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 Chapter 11
Fluid, Electrolyte, and Acid-Base
Balance
 Fluid Balance

• Amount in = amount out

• Average daily intake is 2500 ml [ fluids, food and
metabolic water]
• Average daily output is 2500 ml [ urine, feces,
perspiration, insensible perspiration]
• Thirst mechanism is the primary regulator of fluid
intake (thirst center in the brain). Osmotic pressure
and vascular volume and angiotensin hormone
stimulate it
Source of Fluids for the Body

• Ingested liquids
• Food
• Metabolism
Fluid Losses (output)

• Kidneys — urine (1.5 L)

• Intestinal tract — feces (100-200ml)
• Insensible water loss (Skin 350-400ml;
lungs: 350-400ml)
• Perspiration (sweat) (350-400)
Primary Organs of Homeostasis

• Kidneys normally filter 170 L plasma, excrete

1.5 L urine (primary regulator).
• Cardiovascular system pumps and carries
nutrients and water in body.
• Lungs regulate oxygen and carbon dioxide
levels of blood.
• Adrenal glands help body conserve sodium,
save chloride and water, and excrete
potassium (ADH: anti diuretic hormone).
Primary Organs of Homeostasis
(continued)

• GI tract absorbs water and nutrients that

enter body though this route.
• Nervous system is a switchboard to inhibit
and stimulate fluid balance (thirst center and
ADH storage).
Fluid Imbalances
• Involves either volume or distribution of
water or electrolytes
• Hypovolemia — deficiency in amount of
water and electrolytes in ECF with near
normal water/electrolyte proportions
• Dehydration — decreased volume of water
and electrolyte change
• Hypervolemia — excessive retention of water
and sodium in ECF
• Edema — excessive ECF accumulates in
tissue spaces
 Chapter 12
Bowel Elimination
Process of Peristalsis

• Peristalsis is under control of the nervous

system.
• Contractions occur every 3 to 12 minutes.
• One-third to one-half of food waste is
excreted in stool within 24 hours.
 Constipation

• A change in usual bowel habits ch-ch by

decreased frequency, or passage of hard or
dry stool.
• Bowel movement less than 3 times per week
Individuals at High Risk for Constipation

• Patients on bed rest taking constipating medicines

(iron, morphine)
• Patients with reduced fluids or fiber in their diet
• Emotional disturbance (depressed patients)
• Patients with central nervous system disease or local
lesions that cause pain
• Lack of privacy
• Irregular defecation pattern
• Change in daily routine
• Prolonged use of laxatives
 Diarrhea
• Frequent passage of loose, fluid, unformed stool.
Severe ones may lead to fluid and electrolytes loss.
• Causes:
1.Allergy to food or Intolerance of food or fluid
2.Colon disease (crohn’s disease)
3.Anxiety
4.Medications (antibiotics)
5.Others (surgeries or diagnostic testing of the lower
GI tract; communicable food-borne pathogens)
 Impaction

– A Collection or mass of hardened stool in the

fold of the rectum
– The client complain of nausea and vomiting,
anorexia, abdominal distention
– Causes: unrelieved constipation
– Debilitated, confused, and unconscious more
at risk
– Continuous ooze of diarrhea is a suspect sign
• Incontinence: involuntary passage of stool
– Causes: physical conditions that impair anal
sphincter function or control (e.g. spinal trauma)
• Flatulence: not a problem just embaressing
– Causes: certain foods; decreased intestinal
motility; swallowing air; bacteria
– Can become severe enough to cause abd
distention and severe sharp pain
• Hemorrhoids = dilated, engorged veins; internal or
external
– Causes: straining with defecation; pregnancy;
heart failure; chronic liver disease
 Enema

• enema is an instrument used to introduce liquid

into the large intestine though the rectum. Put
the patient left lateral with right leg acutely
flexed to facilitate the flow of solution by gravity
into the sigmoid and descending colon
• The liquid solution in the enema will help soften and
liquefy the stool, which makes it easier to pass .
 Types of Enemas

• Cleansing: remove feces, used to prevent pass of stool

during surgery and to clean intestines before diagnostic
procedures (colonoscopy); remove fececes (constipation
& impaction); bowel training)
• Solutions:
1.Hypertonic (saline)
2.Hypotonic (tap water)
3.Isotonic (normal saline : safest solution to use)
• Could be large volume (500-1000ml) or small volume
(hypertonic)
• Could be high (clean as much colon as possible) or low
(for rectum and sigmoid colon only)
 Retention Enemas
• Oil-retention — lubricate the stool and
intestinal mucosa easing defecation, retained
for 1-3hrs
• Carminative — help expel flatus from rectum
60-80ml for adult
• antibiotic — provide medications absorbed
through rectal mucosa (treat local infection)
• Anthelmintic — destroy intestinal parasites,
worms.
 Retention Enemas
• Return-flow: used to remove flatus, 100-
200 fluid in and out the rectum and repeated
5-6 times until flatus is expelled
• Nutritive — administer fluids and nutrition
rectally
Thank you