Nutrition Care
Proper nutrition care is essential for healing, growth, and overall health. For patients with specific nutritional needs, understanding common nutritional problems. And how to address them is a critical part of patient care. Healthcare professionals must also be equipped with knowledge on feeding procedures, both enteral and parenteral, to ensure that patients receive the necessary nutrients in a safe and effective manner.
By the end of this section, you should know about:
- The major nutritional problems and describe patients at risk.
- A plan of care to meet the nutritional needs of a patient.
- The procedure for initiating and maintaining enteral feedings.
- The methods for avoiding complications of enteral feedings.
- The methods for avoiding complications of parenteral nutrition.
Let’s take a closer look at them.
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Nutrition Care: Major nutritional problems and describe patients at risk.
Physical examination
A complete physical examination is important for assessing nutritional status. Overview for signs such as abnormal weight, asana, muscle tone and nerve function can detect nutritional problems. Nutrition care shortages often manifest in skin, hair and oral conditions, so nurses should monitor problems such as dry skin, brittle hair and swollen gums.
Dysphagia
Dysphagia, or difficulty swallowing, is often linked to complications like aspiration pneumonia, malnutrition, and dehydration. It can lead to prolonged hospital stays and increased mortality. Nurses should watch for warning signs of dysphagia, such as coughing while eating, changes in voice, or difficulty swallowing. Screening for dysphagia using reliable tools helps identify patients at risk and improve care quality.
Nursing Diagnosis
Nurses should analyze assessment data to identify suitable nursing diagnosis related to nutrition. Grants such as unbalanced nutrition or risk of aspiration require analog intervention. Diagnosis as “unbalanced nutrition: Less than body requirements” may be associated with various factors, including financial loss or food swallowing. In addition, “risk of being overweight” should focus on convertible factors such as poor eating habits or lifestyle. Nutrition treatment includes general diagnosis includes unbalanced nutrition, reduced swallowing, obesity and preparedness for increased nutrition.
Assessment and Diagnosis
The planning process begins with a comprehensive evaluation of the patient’s nutritional state. When it comes to Mrs Cooper, my food intake is minimal, only with current juice, coffee and a sandwich, often leaves dinner due to lack of interest. She also experiences social isolation, which reduces her motivation to eating. Physically, she shows signs of malnutrition, such as significant weight loss, stopping attitude and poor skin and hair conditions.
Nursing Diagnosis
Primary nursing diagnosis “Unbalanced nutrition: Less than body requirements,”, which belongs to its low food ability due to depression, side effects of serturelines (anorexia) and insufficient food intake.
Planning and Goal Setting
In the planning phase, the average goal is set for Mrs Cooper, such as getting 1-2 pounds per month, until she reaches 130 pounds and uses 1900 kg of calories daily with 50 grams of protein takes. Other goals include addressing biochemical indicators of malnutrition and restoring the nutritional status through collaboration with health professionals, including a dietist. Mrs Cooper focuses on improving food intake, especially through social support and food scheme that matches her preferences.
Acute Care
Nutrition treatment for seriously ill patients needs to assess various factors affecting food intake. Processes and clinical studies often interfere with the patient’s food ability, and some should avoid eating or drinking (NPOS) while preparing or recycling tests. Intense care patients often have poor appetite, fatigue or discomfort, which makes it important to continuously assess their nutritional status and to take measures to support normal intake, digestion and metabolism. The use of standard IV fluids for long-term NPO conditions or for more than 4-7 days can put patients with nutritional risk.
Nutrition Care: Advancing Diets
Acute and chronic position can affect the immune system and nutritional needs. Patients with a weak immune system (eg caused by cancer, chemotherapy, HIV/AIDS or organ implants) require special diets that reduce microorganisms risk and cause specific nutrients at high levels. People who are ill have performed surgery, or are voluntary organizations for extended periods, they also need a special diet.
Nutrition Care: Promoting Appetite
In order to encourage nutritional intake, health professionals can help offer oral hygiene and maintain the patient’s comfort. Small, more frequent foods can help, and the side effects of the drug (eg insulin, thyroid hormones or psychotropic medications) can affect the use of appetite or nutrients. Medications such as cyprooptadine or mettrol can stimulate appetite, but consultation with health care professionals is necessary to determine appropriate medical intervention. Social interaction during meals, including encouraging visitors or other employees to join the patient, is also useful for promoting hunger.
Assisting Patients with Oral Feeding
When a patient needs help to eat, it is necessary to ensure their safety, dignity and freedom. For people who are exposed to ambition, such as people with dysphagia, it is important to assess and help with food. Speech -language pathologists (SLP) play a role in assessing and recommending appropriate food organizations. Special ideas are necessary for patients with visual deficit patients or patients who require customized food equipment.
Enteral Tube Feeding
Enteral nutrition (EN) is used when a patient is not a patient or takes nutrients oral, but it has an employer species (GI). Pipe feeding may be necessary for patients who need nutritional help in the long term. This can be done through nasogastric, germ or stomach, where different formulas are available depending on the patient’s specific requirements. Whenever possible, its physical benefits and feeding of adults are preferred due to low risk of complications compared to parenting (PN). However, ambitions may be complications such as pneumonia, so carefully monitoring is necessary.
Enteral Access Tubes
For patients unable to ingest food but with functioning GI tracts, enteral feeding tubes are necessary. These can be inserted through the nose (nasogastric or nasoistinal), surgical (gastrostomy or gjunostomy), or endoscopic (PEG or PEJ). Short -term feeding can use nasogastric or nasogenal pipes, while prolonged feeding often requires surgical or endoscopic location for more comfortable and reliable access. Small pipes are usually used to reduce discomfort, and confirmation of appropriate pipe placements is needed before you start feeding. The use of standard contacts helps to reduce the risk of tubes that are missing and improves the patient’s safety.
Verification of Feeding Tube Placement
Historically, the nurses used the fluctuation method to verify feeding pipe placement by injecting the air into the tube for the sound of the stomach thundering or talking to the patient. However, research has shown that the fluctuation is not effective in detecting incorrect pipe placements, for example when a pipe is accidentally placed in the lungs. It cannot distinguish between gastric and intestinal placements. The current most reliable method of verifying the location is the X-ray film exam, while the ph. test of aspirated fluid is also an effective non-radiological method.
Procedural Guidelines for pH Measurement
Delegation Considerations
The skill of measuring pH in gastrointestinal aspirates should not be delegated to nursing assistive personnel.
Equipment
Asepto syringe or cone-tipped syringe, pH test paper (scale 1.0–11.0), paper towel, small medication cup, clean gloves.
Steps for Measurement
- Verify tube placement: Test the placement before feeding in intermittently fed patients (after at least 4 hours since the last feeding). In continuously tube-fed patients, check every 4 to 6 hours, using tube position markers and x-ray verification if needed. Wait at least an hour after medication administration before testing.
- Hand hygiene and glove application.
- Draw 30 mL of air into the syringe and flush the tube before aspirating fluid. Repositioning the patient may help in obtaining fluid.
- Aspirate 5–10 mL of gastric content and test its pH. Gastric fluid typically has a pH between 1.0 to 4.0, while intestinal fluid is usually above 6.0. Observe the aspirate’s appearance (e.g., bile-stained for intestinal fluid).
- Dispose of gloves and supplies and perform hand hygiene.
If fluid cannot be aspirated and there are no other risk factors, assume the tube placement is correct.
Intravenous fat emulsions: Fat-based nutrients delivered through an IV to provide essential fatty acids and energy in patients who cannot take food orally or enterally.
Ketones: Byproducts of fat breakdown used as an alternative energy source when glucose is in short supply, such as in diabetes or during fasting.
Kilocalories (kcal): A unit of energy used to measure the energy content of food and beverages.Lipids: Fats and oils, which are important for energy storage, cell structure, and hormone production.
Macrominerals: Minerals required by the body in larger amounts, such as calcium, magnesium, and potassium.
Nutrition Care: Methods for avoiding complications
Evidence-Based Practice for Feeding Tube Placement
Accuracy in Determining Placement: Complications of enteral feeding include pulmonary aspiration and accidental lung placement. Traditional methods, such as glucose detection and auscultation, have proven unreliable for detecting aspiration or confirming tube placement. X-ray film examination is the most accurate method, but non-radiological methods like aspirating fluid, measuring its pH, and observing its appearance are also effective. Gastric pH is typically between 1.0–4.0, while intestinal pH is usually 6.0 or higher.
Application to Nursing Practice:
X-ray confirmation of feeding tube placement is required in most acute care settings immediately after insertion.
Regular checks should be performed every 4 to 6 hours, using pH testing and observing aspirate appearance.
Do not use auscultation to confirm tube placement or the glucose detection method for aspiration.
Monitor gastric residual volumes in patients at risk for aspiration.
Enteral Feeding Tube Complications
Pulmonary Aspiration: Verify tube placement, keep the patient elevated during feeding, and reposition the tube if displaced.
Gastrointestinal Issues
Diarrhea: Manage by adjusting feeding rates or switching to isotonic formulas.
Constipation: Consult a dietitian for fiber-rich formulas.
Tube occlusion: Irrigate the tube before and after medication administration.
Electrolyte Imbalance
Monitor serum electrolytes, provide appropriate hydration, and adjust formulas in cases of fluid overload or refeeding syndrome.
Nutrition Care: Parenteral Nutrition
Parenteral nutrition (PN) is a specialized intravenous nutrition support system used when enteral feeding is not possible.
PN is a method of providing nutrition intravenously when a patient cannot digest or absorb food through the gastrointestinal (GI) tract. It includes amino acids, dextrose, electrolytes, vitamins, and trace elements. TPN (Total Parenteral Nutrition) is a more complex formula administered through a central venous catheter (CVC), while a simpler peripheral PN solution is used for short-term needs. Administering fat emulsions separately is critical to avoid complications like fat embolism. Meticulous monitoring of PN therapy is essential to prevent metabolic complications such as hyperglycemia, hypoglycemia, electrolyte imbalances, and fluid imbalances. Preventing infections, catheter-related issues, and metabolic disturbances requires consistent management and proper infusion techniques.
Metabolic Complications of PN
Issues like electrolyte imbalance, hypercapnia, hypoglycemia, hyperglycemia, and others can arise. Appropriate interventions (e.g., insulin for hyperglycemia, electrolyte adjustments) are critical in managing these complications. Air embolus and catheter occlusion are other risks that need to be carefully managed.
Transitioning from PN to Enteral Nutrition (EN) or Oral Feeding
The goal is always to transition from PN to oral or enteral feeding as soon as the patient’s condition allows, to avoid complications like villus atrophy and generalized cell shrinkage due to the GI tract being unused.
Restorative and Continuing Care
Patients discharged with dietary prescriptions need education to maintain their nutritional requirements. Medical Nutrition Therapy (MNT) helps treat illnesses and conditions through specific nutritional interventions. MNT is essential for managing gastrointestinal diseases, diabetes, cardiovascular diseases, and cancer treatment side effects.
Nutritional Support for Specific Diseases
For conditions like diabetes, cardiovascular disease, cancer, HIV/AIDS, and gastrointestinal diseases, specific diets and nutritional therapies are employed. Diabetes management emphasizes carbohydrate control, while cardiovascular disease management focuses on fat and cholesterol intake. Cancer treatment often involves enhancing nutrient intake, while HIV/AIDS care focuses on addressing malnutrition and improving intake.
Evaluation and Patient Outcomes
Monitoring patient outcomes is essential for adjusting nutrition therapy. Nurses need to evaluate weight, serum albumin levels, and dietary intake regularly to track progress. Multidisciplinary collaboration is vital to ensure the plan of care is appropriate, individualized, and flexible according to the patient’s needs and preferences.
Additional Key Points to Ensure Safety:
Balanced Diets: A balanced diet is essential for maintaining the body’s normal physiological function. Diets should include carbohydrates, fats, proteins, vitamins, and minerals to promote health.
Nutritional Assessment: A complete nutritional assessment, including a physical review of the patient’s overall health, is vital for determining the patient’s needs and any potential deficiencies or dietary adjustments required.
Enteral Feedings (EN): Enteral nutrition is essential for patients who cannot eat or drink, but who are able to absorb nutrients through their gastrointestinal tract. This method preserves intestinal function and boosts immunity.
Total Parenteral Nutrition (TPN): TPN is used for patients who are unable to digest food.
Nutritional Therapy in Disease Management (MNT): Medical nutrition therapy (MNT) is an important treatment strategy for patients with both acute and chronic diseases. It involves tailoring the diet to support recovery and improve outcomes.
Aspiration Prevention: One of the nurse’s most critical responsibilities when administering enteral feedings is to take every possible precaution to prevent aspiration, which can lead to severe complications such as pneumonia or respiratory distress.
Special Diets: Special diets are tailored to address the patient’s specific health needs and may include alterations in food composition, texture, or digestibility. Adhering to these special diets ensures that the patient receives the correct nutrition and avoids complications.
Nutrient density: The amount of essential nutrients in a food relative to its calorie content, with more nutrient-dense foods providing more vitamins, minerals, and other nutrients per calorie.
Nutrients: Substances required by the body for energy, growth, and maintenance, including carbohydrates, proteins, fats, vitamins, and minerals.
Parenteral nutrition (PN): The intravenous delivery of nutrients when a person is unable to eat or absorb food through the digestive tract.
Peristalsis: The wave-like muscle contractions that move food through the digestive tract.
Polyunsaturated fatty acids: Healthy fats found in foods like fish, nuts, and seeds, which help lower cholesterol and support heart health.
Resting energy expenditure (REE): The amount of energy the body uses at rest to maintain basic physiological functions.
Saccharides: Sugars, which are the simplest form of carbohydrates, including monosaccharides like glucose and disaccharides like sucrose.
Saturated fatty acids: Fats typically found in animal products and some plant oils, which can contribute to higher cholesterol levels and cardiovascular disease risk when consumed in excess.
Simple carbohydrates: Carbohydrates that are quickly broken down by the body, found in foods like table sugar and fruits, providing quick energy.
Trace elements: Minerals needed by the body in small amounts, such as iron, zinc, and copper, that support vital functions.
Triglycerides: A type of fat found in the blood and stored in fat cells, used for energy by the body.
Unsaturated fatty acids: Healthy fats found in plant-based oils and fish, which can reduce the risk of heart disease when consumed in place of saturated fats.
Vegetarianism: A dietary practice that excludes meat and sometimes other animal products, focusing on plant-based foods.
Vitamins: Organic compounds that are essential for various body functions, such as immune support and energy production.
Water-soluble vitamins: Vitamins that dissolve in water and are not stored in the body, including vitamin C and the B vitamins. These need to be replenished regularly.