Nutrition,feeding,and vital signs

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  1. Methods of Nutritional Assessment
    • Anthropometry
    • Biochemical test
    • Dietary history
    • Health history
    • Clinical signs
  2. Anthropometry
    Measurement system of the body size and make up
  3. Biochemical test
    • Test for plasma protein measurement
    • Nitrogen balance
    • Hgb levels
    • Electrolyte levels
  4. Dietary History
    • Eating habits
    • Preferences
    • Allergies
  5. Health History
    • Clt illness
    • Activity level to determine energy requirements
    • Health status
    • Age
    • Cultural background
    • Socioconomic status
    • Food preferences
    • Alcohol use
    • Herbal or other medications
    • Nutrition knowledge
  6. Clinical Signs
    • Key to nursing assessment.
    • Dry skin/edema
    • Obesity/anorexia
    • Fatigued
    • Irritability
    • Inattention
    • Weak
    • Inability to walk
  7. Body Mass Index (BMI)
    • Nutritional assessment tool to measure weight, corrected for height
    •    BMI = Client's Weight (kg)                                                                                                     Client's height (meters)2
  8. Maintaining a Healthy Weight
    • Caloric theory approach
    • Glycemic index approach
  9. Caloric Theory approach
    • Calories measure the amount of energy that is released as food is broken down(metabolized)
    •  Basal Metabolic rate (BMR) - energy requirement of a person at rest
    • Emergency Balance
    • - Maintaining the same weight =calorie used
    • -Gain weight = calories in > calories used
    • -Lose weight = calories in< calories used
  10. Glycemic Index Approach
    • Measures how quickly blood glucose level rise after eating a carbohydrate
    • Hyperglycemia - rapid increase of glucose in the blood
  11. Vegeterian Diet Vegan
    Eat only foods originating from plant source
  12. Vegeterian Diet Lacto-ovo-vegetarian
    In addition to plant source foods, will also eat dairy products and eggs.
  13. Vwgeterian Diet Pesco Vegeterian
    In addition to Vegan, Lacto-ovo, it includes fish.
  14. Clear Fluid/Transparent Fluids
    • Clear juices - apple juice, cranberry
    • Clear broth
    • Jello
    • Pop
    • Tea
    • Popsicles
  15. Full Fliuds
    • Liquids of foods that turn to liquid at bosy temperature.
    • Ex. Clear liquid plus
    • -Milk
    • -Cream
    • -Yogurt
    • -Pudding
    • -Custard
    • -Ice cream
    • -Pureed vegetables
    • -smooth peanut butter
    • -Refined cereal
  16. Soft food
    • Foods that are soft, wasy to chew and digest
    • Ex. - Full liquid plus
    • -soft cooked vegies
    • -Stew
    • -Ground beef
    • - Fish
    • -Spagetti
    • -Caned fruit
    • -Banana
  17. Vital signs are Measured to
    • Determine the clients Health status
    • Create a baseline reference
    • Monitor a condition
    • Identify issues
    • Evaluate the effectiveness of an intervention
  18. When should we take Vitals?
    • On admission
    • According to institutional policy/as ordered by physicians
    • Before and after:
    • -Surgical procedures
    • - invasive diagnostic procedures
    • - meds that affects VS
    • -interventions that might affect VS(ex. blood transfusion)
    • Any change in client condition - Ex. dizziness, or feeling funny
  19. Core body temperature
    • Temperature of deep tissues and organ
    • Ex. rectum, tympanic membrane, tempral artery, esophagus, pulmonary artery and uninary bladder.
  20. Surface temperature of skin
    • Fluctuates depending on blood flow to skin and heat lost to the external environment
    • Ex. skin, mouth, axillae
  21. Thermoregulation
    • The balance between heat lost and heat produced by the body
    • Anterior Hypothalamus controls - heat loss mechanism.
    • Posterior Hypothalamus controls - heat production
  22. What is the main source of heat production in the body?
    • Cellular metabolism - heat is a by-product of chemical reactions in all body cells
    • .Heat Porduce suring:
    • - Rest (BMR)
    • -Voluntary movement
    • -Involuntary movement
    • -Non-shevering thermogenesis(infant 0-2wk)
    • Physical activity increase metabolic rate
    • If metabolic rate increase, then heat is produce.
  23. Source of heat production: Basal Metabolic Rate (BMR)
    Heat produced by the body at absolute rest

  24. Source of heat production: Voluntary movement
    Muscle activity during exercise increase BMR significantly and produce heat 50 times normal.
  25. Source of heat production: Involuntary Movement
    • Can produce 4-5 times heat production than normal, and therefore deplete a very fragile client's energy reserves
  26. Source of heat production: Non-shivering thermogenesis
    Infant less than 2 wks unable to shiver. Rely on vasoconstriction through an increase in norepinephrine
  27. Body loss heat when?
    • Body skin exposure to:
    • -Radiation
    • -Conduction
    • -Convection
    • -Evaporation
  28. Vasodilation
    • When body feels warm and want to release heat.
    • Dilates blood vessels and closer to the skin surface.
  29. Vasoconstriction
    • When body feels cold and want to keep warn temperature in the body
    • Contrict blood vessels and away tot he skin surface
  30. Alteration in temperature: Fever/pyrexia
    • An alterration in the hypothalamus "set point" for normal. The point is set above normal
    • 3 phase of fever:
    • -Phase1 - the chill phase
    • -Phase2 - fever phase
    • -Phase3 - Resolution phase
  31. Fever Phase 1 - The chill phase
    Pyrogen triggers the immune system to cause a rise in the body temp
  32. Fever Phase 2 - Fever phase
    Chill phase resolve as body reaches the new set point, and client feels warm and dry.
  33. Fever Phase 3 - Resolution
    • As pyrogens are removes or destroyed, the hypothalamus set point drops to normal, initiating heat lost "Fever breaks"
    • Ex. sweeting
  34. Other alteration in Temperature:
    • Hyperthermia
    • Heat exhaustion
    • Heat stroke
    • Hypothermia
    • Frosbite
  35. Other alteration in temperature: Hyperthermia
    Elevated(high) body temperature r/t body inable to promote heat lost or reduce heat production.
  36. Other alteration in temperature:Heat exhaustion
    Profuse diaphoresis leads to loss of water and electrolytes
  37. Other alteration in temperature: Heat stroke
    Prolonged exposure to sun or high temperature overwhelm body's heat/loss mechanisms. heat depresses hypothalamus function
  38. Other alteration in temperature: Hypothermia
    • Environmental condition overwhelm body mechanisms - core tem, drops below normal
    • Ex. falling to ice
  39. Other alteration in temperature:Frosbites
    • Exposure of body to subnormal temp(low temp).
    • Ice crystals formation inside cell can result in permament circulatory and tissue damage
    • Common areas: ear lobes, fingers, nose and toes.
  40. Measuring temperature
    • Oral
    • Axillary
    • Tympanic membrane
    • Rectal
  41. Measuring temp. at Oral
    • Most accessible
    • Comfortable
    • Reflects rapic changein core temp.
    • Disadvantage:
    • -Inaccurate if not held in the mouth correctly
    • -Not use after oral surgery
    • -Not to be used for infants, small children, confused clt, comatose clt.
    • -Reading affected by hot/cold food and drink
  42. Measuring temp. at Axillary
    • Safet and non-invasive
    • Can be used with new borns and uncooperative clt
    • Disadvantages:
    • - Usually 0.5 below oral
    • -Must expose torso to obtain reading
    • -During rapid temperature changes, axial slower to refect core changes.
    • -Not recomended to detect fever in infant and young children
  43. Measuring temp. at Rectal
    • Argued to be more reliable if oral not able to be obtained
    • Usually 0.5oC above oral
    • Disadvantages:
    • -Not to be used with diarrhea, rectal surgery, rectal disorder, or bleeding disorfer
    • -Special positioning required
    • -Risk of exposure to body fluids
  44. The Pulse
    • Normal adult rage = 60-100 beats/min.
    • Higher = tachycardia
    • Lower = bradycardia
  45. What is pulse?
    • Small bolus of blood flow that can be felt
    • Its a measurement of the rate that blood is being pumped through the body
  46. Cardiac Output
    Volume of blood pumped out by the heart during 1 minute
  47. Where we take pulses?
    • Temporal
    • Coratid
    • Apital
    • Brachial
    • Radial
    • Ulnar
    • femoral
    • Popliteal
    • Posterior tibial
    • Dorsalis pendis
    • Image Upload 1
  48. Respiratory
    • 1 Repiratory CYCLE = 1 inspiration + 1 expiration
    • Normal adult rate = 12-20 breaths per min.
    • Apnea - absence of breathing

  49. Two Mechanical process of ventilation
    • Inspiration
    • Expiration
  50. Inspiration
    • Contration of diaphram, lung area enlargement, vacuum suck air into the lung
    • Active process
  51. Expiration
    • Diaphram relaxes, elastic ling tissue return to original shape, air moves out
    • Passive process
  52. Assessment of Respirations
    • Ease/Effort - normally effortless
    • Dyspnea - difficult breathing
    • Orthopnea - need to sit up to breath

    • Breath Sounds - normally quite
    • Wheezes
    • Crackles
    • Rub
    • Cough
  53. Pulse oximetre (SpO2)
    LED probe that detects the amount of oxygen bound to the hemoglobin and calculates the pulse saturation (SpO2)
  54. Blood Pressure
    • The force exerted on the walls of an artery by the pulsing blood under pressure from the heart
    • Normal adult range = 120/80
    • Systolic = <140
    • Diastolic = <90
    • Hypertensive = systolic >140/diastolic >90
    • Hypotensive = systolic <90
  55. Physiology of blood pressure: Peripheral Vascular Resistance
    the resistance to blood flow is determined bu the tone of the muscle layer in the blood vessels and the blood vessel diameter
  56. Physiology of blood pressure:Blood Voscosity ( thickness)
    Thinkness of blood affects the ease with which blood flows through small vessels
  57. Physiology of blood pressure: Arterial Elasticity
    Arteries are normally elastic and easily distensible (stretch)
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Nutrition,feeding,and vital signs

Nutrition,feeding,and vital signs
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