N210 Week 4 Lab Nutrition

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N210 Week 4 Lab Nutrition
2015-10-12 22:21:51
N210 Week Lab Nutrition
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  1. 1. Discuss the assessment of a patient’s normal nutritional status (1214-1218)
    • 1. Assessment
    • I. Nutritional screening
    • A. Looks for cues associated with nutrition problems
    • 1. Looks to see if person is malnourished or at risk for malnutrition
    • B. Usually referred to a dietician for comprehensive nutritional assessment
    • II. Assessing Dietary Intake
    • A. 24-Hour Recall Method
    • 1. Easiest way to collect dietary data is to obtain 24-hour recall of all food/drinks
    • 2. Recalls details r/t nutritional intake from the prior 24 hours
    • i. Portion sizes
    • ii. Meal and snack patterns
    • iii. Meal timing
    • iv. Location where food is eaten
    • B. Information may not be reliable
    • 1. Relies on memory and accurate interpretation of portion sizes
    • III. Food Diaries/Calorie Counts
    • A. Documents of actual intake for a specified period of time
    • B. Record everything that the patient has had to eat or drink
    • 1. Portion size over a set period of time
    • IV. Food Frequency Record
    • A. General picture of nutritional consumption
    • V. Diet History
    • A. Full diet history
    • B. Geared to provide information on past and present food intake and habits
    • VI. Medical and Socioeconomic Data
    • A. Medical Data
    • 1. Current illness as well as medical and surgical history
    • 2. Past and current drug history
    • 3. History of drug dependence or abuse
    • 4. Ability to chew and swallow, include condition of mouth, missing teeth, or dentures
    • 5. Appetite, food intolerance and allergies, and bowel habits
    • B. Social Data
    • 1. Age, gender, family hx, lifestyle
    • 2. Educational background
    • 3. Information about occupation, exercise, and sleep patterns
    • 4. Religious affiliation, cultural and ethnic background
    • 5. Use of alcohol and tobacco
    • C. Economic Data
    • 1. Source of income
    • 2. Food budget
    • VII. Anthropometric Data
    • A. Determine body dimensions
    • VIII. Body Mass Index and Waist Circumference
    • IX. Clinical Data
    • A. Determine if abnormal findings are caused by a nutritional deficiency
    • B. Assess for barriers to eating
    • 1. Dysphagia
    • i. Result of poor dental health, CA, neurologic disease
    • ii. Increased risk for aspiration
    • X. Biochemical Data
  2. 2. Discuss cultural influences r/t meeting nutritional needs (1212-1213)
    • 1. Culture influences what is eaten or considered edible, how it’s prepared, and what combo is permitted
    • 2. Mormons
    • I. Not use coffee, tea, or alcohol, and are encouraged to limit meat consumption
    • 3. Hindus
    • I. Do not eat beef because cows are considered sacred
    • 4. Kosher dietary laws
    • I. Require special food prep techniques and prohibit intake of pork and shellfish
    • 5. If patient of different culture is placed on specific diet:
    • I. Discuss food choice option is necessary to customize diet to meet person’s cultural demands
  3. 3. Describe how to feed a patient with special needs (1223)
    • 1. Dementia or other alterations in cognition
    • I. Reduce distractions
    • II. Food should be close to patient
    • III. Remove wrappers, prepare cereals, coffee and tea
    • IV. Pour into glass/cup (instead of leaving in cartons)
    • V. Encourage memory of foods
    • VI. Assist/promote self feeding
    • VII. Remain with client
    • 2. Dysphagia
    • I. Place client in sitting position
    • 3. Remain with client during meal
    • I. Commercial thickeners – you may have to add thickeners to liquids (water, milk, juice, etc.)
    • A. Items may come with thickener already added – check carton!
    • II. Semi-solid/solids are easier for client to swallow vs puree/liquids
    • III. Full liquid/mechanical soft for oral/facial surg-trauma
    • IV. Make sure patient swallowed food before second spoonful
    • V. If difficulty swallowing – ask patient to dry swallow
    • 4. Visually Impaired
    • I. Place tray, orient patient to food items/utensils
    • A. Use clock locations – 12, 3, 6, 9
    • II. Open/prepare food items, orient patient to condiments
  4. 4. Describe commonly ordered therapeutic diets (1224 Table 35-6)
    • 1. Consistent Carb Diet
    • I. Type 1 and 2 DM, gestational DM, impaired glucose tolerance
    • II. Total daily carbohydrate content is consistent
    • III. Emphasizes general nutritional balance
    • IV. Calories based on attaining and maintaining healthy weight
    • V. High-fiber and heart-healthy fats encouraged
    • 2. Fat-Restricted Diet
    • I. Chronic cholecystitis to decrease gallbladder stimulation
    • II. Cardiovascular disease – help prevent atherosclerosis
    • III. Low-fat diets are intended to lower the patient’s total intake of fat
    • 3. High-Fiber
    • I. Prevent or treat constipation
    • II. Emphasis on increased intake of foods high in fiber
    • 4. Low-Fiber
    • I. Before surgery
    • II. Fiber limited to < 10 g/day
    • 5. Sodium-Restricted
    • I. HTN
    • II. HF
    • III. Acute/Chronic renal/liver disease
    • IV. Sodium limit may be set at 500-3000 mg/day
    • 6. Renal Diet
    • I. Nephrotic syndrome
    • II. Chronic kidney disease
    • III. Diabetic kidney disease
    • IV. Reduce workload on kidneys to delay or prevent further damage
    • V. Control accumulation of uremic toxins
    • VI. Protein restriction 0.6-1 g/kg/day
    • VII. Sodium restriction 1,000-3000 mg/day
    • VIII. K+ and fluid restrictions dependent on patient situation
  5. 5. Demonstrate meal percentage and oral fluid intake measurement and record
  6. 6. List interventions to assist the patient who is on restricted fluids.
    • 1. Clear Liquid Diet
    • I. Composed only of clear fluids or foods that become fluid at body temperature
    • II. Requires minimal digestion and leaves minimal residue
    • III. Examples:
    • A. Clear Broth
    • B. Coffee
    • C. Tea
    • D. Clear fruit juices (apple, cranberry, grape)
    • E. Gelatin
    • F. Popsicles
    • G. Commercially prepared clear liquid supplements
    • 2. Pureed Diet
    • I. Blenderized liquid diet because diet is made up of liquids and foods blenderized to liquid form
    • II. All foods are allowed
    • 3. Mechanically Altered Diet
    • I. Regular diet with modifications for texture
    • II. Excludes most raw fruits and vegetables and foods with seeds, nuts, and dried fruits
    • III. Foods are chopped, ground, mashed, or soft