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Nutrition- Implementation

Health
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on 1 December 2014

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Transcript of Nutrition- Implementation

Educator
As a nurse, educate families and provide information about community resources.
Telephone numbers of an RD or nurse for follow-up questions are always part of counseling.
Acute Care
Some EN/PN Interventions
Assisting
Nutrition
Implementation
Health Promotion
Including knowledge of nutrition into pt's lifestyles serves to prevent the development of many diseases.
Outpatient and community-based settings are optimal locations for nursing assessment of nutritional practices and status.
Meal Planning
Pt's with nutritional problems such as obesity often require assistance with meal planning.
Planning menus a week in advance has several benefits. It helps ensure good nutrition or compliance with a specific diet and helps a family stay within their allotted budget.
Implementation
Diet therapies are chosen on the basis of a pt's overall health status, ability to eat and digest normally, and long-term nutritional needs.
Implementation has three basic nursing fundamentals:
Health promotion - educating pt's and family caregivers about balanced nutrition and assisting them in obtaining resources to eat high quality foods.
Acute care - managing acute conditions that alter pt's nutritional status and assisting in ways to promote their appetite and ability to take nutrients.
Restorative care - assisting pt's in learning how to follow therapeutic diets necessary for recovery and treatment of chronic health condtions.
Restorative and
Continuing Care
Medical Nutrition Therapy - (MNT)
The use of nutritional therapies to treat an illness, injury, or condition.
Necessary to help the body metabolize certain nutrients
Correct nutritional deficiencies r/t the disease
Eliminate foods that may exacerbate disease symptoms
Diseases That Are Aided Through Diet
Diseases That Are Aided Through Diet
Continued,..
Diabetes Mellitus
Gastrointestinal Disease
Patients being discharged from the hospital often need education. One thing they need to be educated on is if there are any changes that have been made or need to be made to their diet. Patients coming in for routine doctor visits may also need education on how to change their diet to be appropriate for aiding in getting and/or keeping them well.
Review Questions
Food Safety
Maintain pt's safety, dignity, and independence
Raise head of bed if pt has trouble swallowing or managing saliva
Follow diet recommendations for pt's diagnosis (ie. dysphagia)
Allow visually impaired pt's to find food placement using clockwise direction
Use adaptive equipment such as, plate guards and utensils with splints or enlarged handles for pt's with physical disabilities
Promoting Appetites
Offer frequent, small meals
Encourage visitors to eat with pt
Check pt's medications for side effects including nausea, altered taste and appetite
Insulin, glucocorticoids, and thyroid hormones affect metabolism
Anti-fungals and psychotropics affect taste
Consult w/ RD for food selections
Assess pt's for the need of appetite stimulants and anti-nausea medication
In acute care, meals are often interrupted
Patients may have a loss of appetite or are too fatigued to eat
It is important to promote nutrition and to make dietary adaptions for the patient
Patients ordered NPO for 4-7 days are at nutritional risk

Assisting Con'd..
Do not hang formula for more than 4-8 hrs
Maintain head of bed at least 30
Monitor serum proteins/ electrolytes daily
To avoid hyperglycemia, do not stop abruptly
Monitor blood glucose every 6 hrs

Enteral Nutrition (EN) provides nutrients through a tube into the GI tract for patients unable to swallow
Pt's unable to digest EN benefit from Parenteral Nutrition, which allows pt's to receive nutrients through an IV
Question #1
Question #2
Treated with medications such as;
Histamine receptor antagonist's that block secretions of HCl or pump proton inhibitors.
Encourage patients to avoid foods that increase stomach acidity
and pain such as;
Caffeine
Decaffeinated Coffee
Frequent Milk Intake
Citric Acid Juices
Certain Seasonings, ( Hot Chili Peppers, Chili Powder, Black Pepper, etc)
Discourage things such as;
Smoking
Alcohol
Aspirin
Non-Steroidal Inflammatory Drugs (NSAIDs)
Type 1 requires both insulin and dietary restrictions for optimal control, with treatment beginning at diagnoses
Type 2 can be controlled by diet and exercise

Cardiovascular Disease
Choose specific foods on the basis of the dietary prescription and recommended food groups.
For families on limited budgets use substitutes.
For example:
Bean and cheese dishes can replace meat.
Have pt's modify method of preparation.
For example:
Baking vs. frying
Menu content should be
checked by nurse or RD.
A simple tip to pt's: do not
grocery shop while hungry.
Treated / Controlled with diet and exercise, balancing caloric intake to maintain a healthy body weight.
Eating a diet high in fruits, vegetables, and whole-grain high-fiber foods, eating fish at least 2X a week, and limiting food and drinks high in salt and sugar.

Diseases That Are Aided Through Diet
Continued,..
Food safety is an important public health issue.
Older adults, younger persons, and immunosuppressed individuals are most at risk.
Instruct pt's to use the four following principles:
1. clean
2. separate
3. cook
4. chill
( pg. 1016, fundamentals)
After each method has been described have the pt verbalize measures to prevent foodborne illnesses.

Cancer and Cancer Treatment
By: Samara Acosta, Vikki Mangeot, & Gina Muto
Malignant cells compete with normal cells for nutrients, increasing a patient's metabolic needs. Patients going through radiation often experience anorexia, nausea, vomiting, and taste distortion.
HIV/AIDS
Typically experience body wasting and severe weight loss. The wasting is r/t anorexia, stomatitis, oral thrush infection, nausea, or recurrent vomiting, all resulting in inadequate intake.
Question #3
Foodborne Diseases:

Botulism
E. Coli
Listeriosis
Perfringens
Salmonellosis
Shigellosis
Staphylococcus

As a nurse, it is very important to be aware of the factors related to food safety and to be knowledgeable of how to reduce the risk of foodborne illnesses.


How is Diabetes Mellitus type 1 MOST treated and controlled?
A. Diet & Exercise
B.Diet & Insulin
C. Insulin & Exercise
D. Intake & Output, & Exercise
Educator
Educate families and provide information about community resources.
Telephone numbers of an RD or nurse for follow-up questions should be included in counseling.
Questions?
The nurse is assessing a client who is suffering from diarrhea, fever, headache, abdominal pain, and nausea. The client reports haven eaten home canned tomatoes. What food-borne illness should the nurse suspect?

A. Campylobactur jejuni B. Cyclospora cayetanensis

C. Clostridium botulinum D. Listeria monocytogene
s
The nurse is caring for an elderly woman with osteoarthritis. What should the nurse include on the patient's meal tray?
A. Napkin

B. Plate guard
C. Utensils with splints

D. Utensils with large handles
Question #4
A 65 year old patient who has just had eye surgery performed on both eyes is having difficulty identifying different foods on his plate. In assisting him with this task, the nurse instructs him to find his food using which direction?
A. Use of smell
B. Counter-clockwise
C. Clockwise
D. Tell him to have persons feed him at every meal
Question #5
A patient has just been diagnosed with gastrointestinal disease. The patient was asked to write out a menu of nutritional foods related to his new condition. Which foods indicate further teaching to the client is needed? Select all that apply
A. Small tossed salad
B. Baked Chicken
C. Black Coffee

D. Blueberry Muffin
E. Glass of milk daily
F. Orange Juice
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