Nutrition for the Well Patient Jennifer Oelke MSN, RN Learning Objectives Identify Identify factors affecting nutrition. Review Review dietary guidelines for a well patient. Integrate Integrate culture and health conditions in assessing nutritional status across the lifespan. Explore Explore the components of a healthy diet for a well patient. Identify Identify how foods are introduced in the pediatric patient. Explain Explain the importance and the components of a Nutritional Screening. Identify Identify types of special diets (clear liquid, full liquid, soft, general) Modify Modify patient’s diet based on alterations in health. Six Classes of Nutrients Supply Energy • Carbohydrates • Proteins • Fats (Lipids) • Micronutrients Regulate Body Processes • Vitamins • Minerals • Water Sources of Vitamins Dietary Guidelines for a Well Patient Eat a variety of foods Balance food with physical activity Eat plenty of grains, vegetables, & fruits Eat a diet low in fat & cholesterol Use sugars in moderation Use salt & sodium in moderation If alcohol, do so in moderation Eat the Rainbow Basal Metabolism Rate (BMR) • Factors that increase BMR Growth Infections Fever Emotional tension Extreme environmental temperatures • Hormones • • • • • • Factors that decrease BMR • Aging • Prolonged fasting • Sleep Body Mass Index (BMI) • Underweight • BMI below 18.5 • Healthy weight • BMI 18.5-24.9 • Overweight • BMI 25-29.9 • Obesity • BMI 30-39.9 • Extreme obesity • BMI over 40 Anthropometric Measurements Are used to determine body dimensions In children they are used to assess growth rate In adults they give indirect measurements of body protein and fat stores Factors Affecting Nutrition • • • • • • • Physiologic & Physical Biological sex Growth/Development Age State of health Alcohol abuse Medications Pregnancy • • • • • • • Physical, Sociocultural, & Psychosocial Economic Religion Meaning of food Culture Knowledge Literacy level Language barriers Altered Nutrition Malnutrition– lack of necessary or appropriate food sources: Undernutrition– intake of insufficient nutrients (anorexia/bulimia) Overnutrition– calorie intake in excess Nutritional Screening Assessment Purpose is to identify those who have altered nutrition or at risk for it. Should be completed in a timely manner Factors to assess • Usual dietary intake • Food allergies/intolerances • Food preparation/storage • Type of dietary practices • Eating disorders • Lab values • Physical assessment Nursing Diagnoses • Imbalanced nutrition: less than body requirements • Imbalanced nutrition: more than body requirements • Impaired swallowing • Feeding: self-care deficit • Risk for unstable blood glucose level • Risk for electrolyte imbalance • Risk for overweight • Readiness for enhanced fluid balance • Readiness for enhanced nutrition • Deficient/Excess fluid volume • Obesity • Insufficient breast milk • Risk for imbalanced nutrition • Ineffective infant feeding pattern Special Diets Clear liquid Full liquid Mechanical Soft/Pureed Consistent Carbohydrate Cardiac Renal General High/Low Residue/Fiber MyPlate Great resource for current food guidelines and recommendations Nurse’s Role Provide Provide education about how weight can impact health Base Instruct Base nutrient intake on physical activity, age, & gender Instruct clients to seek medical advice before considering any major changes in diet Nutritional Support/Alternate Feeding Routes Nasogastric tube (NG) • Short term use Percutaneous endoscopic gastrostomy (PEG) • Long term use Total Parenteral Nutrition (TPN) • Administered via intravenous route into a dedicated line Nutrition Across the Lifespan Cultural Considerations Food choices represent their personal beliefs and customs Culture influences what is eaten, what is considered edible, how it is prepared, and what is permitted Herbals used for treatment may interfere/counteract with meds Customize diet to meet the person’s cultural demands Promote healthy food choices by identifying healthy traditional food practices and encourage their use Infant 0-12 Months Neonate weight loss – no more then 10% Most rapid growth period Birth weight doubles in 4-6 months and triples by 1 year Nutritional needs greater than any other time Solid foods introduced when developmentally ready Being fed when hungry helps develop trust Breast Fed Infants Advantages Breast feeding recommend for first 612 months Breast milk is best related to digestion and absorption May have acquired some preferences in utero or with breast milk • Immunoglobins • Fewer allergies • Fat increases at the end of a feeding (so baby doesn’t get full too soon) Even partial breastfeeding is helpful & offers health benefits Formula Fed Infants The nurse should make sure the parents know: Formula should have iron in it • Dilution • Water quality • Storage • Bottles • Avoid air • Do not force to drink all • Do not add food or medicines • Do not prop • Do not give in bed • Do not heat in microwave Introducing Solids Recommendation- start when birthweight has doubled (usually 4-6 months) Introduce one-at-a-time Start with a taste or two Assess for 2-3 days (allows for identification of food allergies) Should be non-sweetened, non-salted, don’t use other seasonings Considerations • Foods that commonly cause allergies if given in the 1st year of life are: • • • • • • Cow’s Milk Peanuts Citrus Strawberries Wheat Egg whites • Foods to Avoid in Infancy: • Honey • Egg Yolks & Meat (until 10 mos.) • Excessive amounts of fruit juice • Foods likely to cause choking • Peanuts • Popcorn • Small, hard foods (carrots, apples, etc.) • Grapes • Hot Dog slices Toddlers 1-3 Years Growth rate slows Never leave alone while eating Should be drinking from a cup Offer a variety of foods Require high energy intake Tend to have lowest daily Iron intake of any age group May use food to manipulate parents Promoting Self-Feeding Toddlers most often eat with their fingers Always cut food into bite size pieces Normal behavior – mouthing, handling, tasting, extruding food & resampling food is common Toddlers often “picky” about foods to try Parents should decide what foods to serve & toddler decides how much to eat Toddlers may not eat well every day Preventing Unhealthy Weight Greatest risk factor for obesity in children <5 yrs – parent with high BMI Another factor – juice intake (high sugar content & sweet taste) May fill on juice & decrease food intake Don’t use food as a reward – or a punishment! Don’t force to eat all that is provided Preschooler 3-6 Years Develops attitudes toward food Great time! Like to learn and try new things Important that they continue to learn & build upon healthy eating habits Developmental Task - Initiative: Assist with purchasing and preparation Has full set of teeth; able to chew & swallow Has learned to use utensils fairly well Regular meal times with nutritious snacks Teach Hand washing Clearing the table Nutritional Needs Tend to be low in all areas of the food pyramid except fats & sugars Supplements should enhance not replace good nutrition Iron deficiency common Promoting Healthy Eating May be “picky” eaters Parent must maintain a positive & patient attitude Child should still be offered diet high in nutrient-rich foods Meals should be structured Limit fruit juice Encourage physical activity Limit screen time School-Aged 6-12 Years Individualized; sometimes erratic growth pattern Permanent teeth erupt Body starts to accumulate reserves Promote healthy food choices as their independence increases Needed calories decrease; appetite increases Calorie needs vary based on age, gender, & activity level Promoting Healthy Eating Can start using MyPlate as a guide Need to limit intake of fat and processed sugars Preventing obesity at this age is important because the fat cells of childhood are carried into adulthood Children who eat with their families tend to have better nutrition – model eating patterns after families Adolescents Childhood nutrition problems often worsen during this time Tend to skip breakfast- may impact school performance May become obsessive about weight Often eat food rapidly Food choices may be influenced by peers High-risk time for developing an eating disorder Girls need to increase their iron intake Nutritional Needs • Nutritional needs increased for growth • Need variety, balance, & moderation • Need increased calories, zinc, calcium, protein & iron for growth • Vitamin C needs increase with stress • Least likely age group to get adequate fiber • Fast foods, Fad diets common • Low calcium intake • Obesity • Eating disorders Eating Disorders • Anorexia characterized by: • • • • • • Loss of appetite Extreme weight loss Muscle wasting Stoppage of sexual development Refusal to eat Bizarre eating habits • Bulimia characterized by: • Gorging followed by purging with self-induced vomiting • Diuretics • laxatives • Other unhealthy diet practices • Fasting • Diet pills • Laxative abuse Promoting Healthy Eating • Assess eating habits and diet preferences • Help plan a healthy diet • Educate on how diet can lead to diseases Adults GROWTH CEASES DECLINE IN BMR WITH EACH DECADE FEWER CALORIES REQUIRED WEIGHT GAIN IF ADJUSTMENTS ARE NOT MADE ENCOURAGE ACTIVITY Pregnancy & Lactating Women Nutrient needs increase Quality of breast milk produced depends on adequate supply of nutrients Key nutrient needs include: • Protein • Calories (higher for lactation than during pregnancy) • Iron • Folic acid • Calcium • Iodine Older Adults Chewing may become difficult Constipation becomes an issue Decrease in taste, smell, and vision Sensation of thirst decreases Social isolation, poor self-esteem, loss of independence may impact nutritional intake Finances may impact food choices Nursing Interventions for Stimulating Appetite Small frequent meals Ask about food preferences Encourage Educate Help set up food tray/help feed patient Ensure room is free of irritating odors Provide a comfortable position Provide oral hygiene “Let food be thy medicine and medicine be thy food.” Hippocrates References • Lutz, C., Mazur, E. & Litch, N. (2018) Nutrition and Diet Therapy (7th ed.). Philadelphia, F.A. Davis Company. • Ricci, S., Kyle, T., & Carman, S. (2017). Maternity and Pediatric Nursing (3rd ed.). Wolters Kluwer. • Taylor, C., Lynn, P., & Bartlett, J. L. (2019). Fundamentals of Nursing: The Art and Science of Person-Centered Care (9th ed). Wolters Kluwer.
