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Miss : Shurouq qadose
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Food habits are a product of many evolving
variables, such as physical factors (eg,
geographic location, food technology, and
income), physiologic factors (eg, health, hunger,
and stage of development), and psychosocial
factors (eg, culture, religion, tradition,
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education, politics, social status, food ideology
[the meaning of food for an individual].
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1- Developmental Considerations
Throughout the life cycle, nutrient needs change
in relation to growth, development, activity, and
age-related changes in metabolism and body
composition. Periods of intense growth and
development, such as during infancy,
adolescence, pregnancy, and lactation, cause an
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increase in nutrient needs. Nutrient needs
stabilize during adulthood, although older
people may need more or less of some nutrients.
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A - Infants
The period from birth to 1 year of age is the most
rapid period of growth. Birth weight doubles in 4 to
6 months and triples by 1 year of age. Length
increases 50% in the first year. The iron stores
present at birth start to become depleted between 3
and 4 months of age. The immune system matures
between 4 and 6 months of age. Breastfeeding is
recommended as the major source of nutrition for
the first 6 to 12 months of life. If the infant is not
breastfed, the infant should receive one of the
commercially prepared infant formulas that contain
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iron. Solid foods are not introduced until 6 months
of age because solid foods given too early may
trigger allergic reactions. By 1 year of age, the
infant typically is eating table food.
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B- Toddlers and Preschoolers
Nutritionally, toddlers and preschoolers can feed
themselves, verbalize food likes and dislikes, and
occasionally use food to manipulate their parents.
Appetite dramatically decreases and becomes
erratic. Inappropriate use of food ( i.e., to punish,
reward, bribe, or convey love) may lead to
inappropriate food attitudes.
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C- School-Aged Children
Nutritional implications for the school-aged child
focus on health promotion. Increasing energy
requirements need to be balanced with foods of high
nutritional value. The appetite improves but still
may be irregular.
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E- Adolescents
Adolescence is a period of rapid physical, emotional,
social, and sexual maturation. The growth spurt begins
at different ages among individuals. Girls begin
menstruation and experience fat deposition, whereas
males experience an increase in muscle mass, lean body
tissue, and bones. Nutrient needs, especially for calories,
protein, calcium, and iron, increase to support growth.
Weight consciousness becomes compulsive in 1 of 100
teenaged girls and results in anorexia nervosa, an
eating disorder characterized by extreme weight loss,
muscle wasting, arrested sexual development, refusal to
eat, and bizarre eating habits.
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Bulimia, another eating disorder characterized by
gorging followed by purging with self-induced
vomiting, diuretics, and laxatives, also becomes
more common in this age group. If a teenage
pregnancy occurs, both mother and child are at
increased nutritional risk due to competition for the
nutrients between the adolescent mother’s body and
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that of the infant.
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F- Adults
Nutritional needs level off in adulthood, and fewer
calories are required because of the decrease in
BMR. If adjustments in caloric intake are not made,
weight gain results.
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G- Pregnant and Lactating Women
Nutrient needs during pregnancy increase to
support growth and maintain maternal
homeostasis, particularly during the second and
third trimesters. Key nutrient needs include
protein, calories, iron, folic acid, calcium, and
iodine. Caloric needs are higher for lactation
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than pregnancy, and the nutritional quality of
breast milk is maintained at the expense of
maternal
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H- Older Adults
Because of the decreases in BMR and physical activity and
loss of lean body mass, energy expenditure decreases.
Loss of teeth and periodontal disease may make chewing
more difficult. A decrease in peristalsis can result in
constipation. Loss of taste between sweet and salty begins
between 55 and 59 years of age, but discrimination
between bitter and sour remains intact. The sensation of
thirst also decreases. Elderly people are also prone to
dehydration, and lack of interest in eating is common.
Nutrient intake, digestion, absorption, metabolism, or
excretion may be altered because of the physiologic
changes common to this age.
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2- Sex
Men differ from women in their nutrient
requirements due to differences in body composition
and reproductive function. Muscle is more
metabolically active than adipose tissue (women
have proportionately more adipose tissue). Women
of childbearing age have higher iron requirements
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related to menstruation.
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3- State of Health
The alteration in nutrient requirements that results
from illness and trauma varies with the intensity and
duration of the stress. For instance, fevers increase
the need for calories and water.
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4- Alcohol Abuse
Alcohol can alter the body’s use of nutrients. The
toxic effect of alcohol on the intestinal mucosa
interferes with normal nutrient absorption; thus,
requirements increase as the efficiency of absorption
decreases.
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5- Medication
Many drugs have the potential to influence nutrient
requirements. Nutrient absorption may be altered by
drugs that (1) change the pH of the GI tract, (2)
increase GI motility, (3) damage the intestinal
mucosa, or (4) bind with nutrients, rendering them
unavailable to the body.
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6- Mega doses of Nutrient Supplements
Because some nutrients compete against each other
for absorption, an excess of one nutrient can lead to
a deficiency (or increase the requirement) of
another. For instance, a delicate balance exists
between zinc and copper. People who take
therapeutic levels of zinc run the risk of developing
a copper deficiency— which is otherwise rare—
unless they also increase their intake of copper.
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1- Religion
Dietary restrictions associated with religions might
affect a patient’s nutritional requirements.
2- Economics
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The adequacy of a person’s food budget affects
dietary choices and patterns.
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3- Meaning of Food
Food means different things to different people, with
food playing multiple roles in the lives of most
individuals. In addition to satisfying hunger and
providing nutrition, food may signify a celebration,
a social gathering, or a reward. Some people use
various foods to indicate caring or to give comfort
and reassurance during times of stress or
unhappiness.
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4- Culture
Nutritional diversity is common among cultural or
ethnic groups. The variety and selections are unique
to each group and represent their personal beliefs
and customs.
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1- Decreased Food Intake
Food intake may decrease for various reasons. Anorexia,
or the lack of appetite, may be related to systemic and
local diseases; numerous psychosocial causes, such as
fear, anxiety, depression, pain; and impaired ability to
smell and taste—or it may occur secondary to drug
therapy or medical treatments. Others who may have
limited food intake include those who have
difficulty chewing and swallowing, those who
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experience chronic GI problems or undergo certain
surgical procedures, and those on inadequate food
budgets
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2- Increased Food Intake
Increased food intake may lead to obesity. Obesity
presents a serious health problem physically,
socially, and emotionally. Obesity is defined as
body weight 20% or more above ideal weight or
having a BMI of 30 or more.
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Assessing
Nutritional status has a significant impact on both
health and disease. serve as nutritional role models
and are ideally situated to identify nutritional needs
and assess and monitor for nutritional risks.
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Anthropometric Data
Anthropometric measurements are used to determine
body dimensions. Height and weight, the most
common anthropometric measurements, are obtained
when the patient is admitted to the healthcare facility
and periodically thereafter or assessed in a home care
environment. Additional anthropometric
measurements include triceps skin-fold
measurements, a measure of subcutaneous fat stores;
midarm circumference, a measure of skeletal muscle
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mass; and midarm muscle circumference, a measure
of both skeletal muscle mass and fat stores
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Clinical Data
Although signs and symptoms of altered nutrition
may be observed during a physical assessment.
Biochemical Data
Laboratory tests, which measure blood and urine
levels of nutrients or biochemical functions that
depend on an adequate supply of nutrients, can
objectively detect nutritional problems in their early
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stages.
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Diagnosing
Assessment data may reveal actual or potential
nutritional problems.
Imbalanced Nutrition as the Problem
The following nursing diagnoses may be made when
imbalanced nutrition is the cause of the patient’s
disorder:
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Imbalanced Nutrition: Less Than Body Requirements
related to nothing by mouth (NPO), inadequate tube
feeding, prolonged use of a clear liquid diet,
numerous food intolerance or allergies, excessive
dieting, anorexia, chewing or swallowing
difficulties, nausea, vomiting.
Risk for Imbalanced Nutrition: More Than Body
Requirements related to inappropriate eating,
closely spaced pregnancies, metabolic and
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endocrine disorders, inappropriate use of
supplements
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Imbalanced Nutrition as the Etiology
Nutritional problems may affect other areas of human
functioning. In the following nursing diagnoses, the
nutritional problem is the cause of another problem.
Activity Intolerance related to inadequate caloric
intake, obesity, iron-deficiency anemia.
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Implementing
Providing proper and adequate nourishment to the
patient is a team effort implemented in a variety of
settings.
- Teaching Nutritional Information
- Monitoring Nutritional Status
- Providing Nutrition in Special Situations
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Clear liquid diets contain only foods that are clear
liquids at room or body temperature—gelatin, clear
juices, carbonated beverages.
Full liquid diets contain milk, plain frozen desserts,
pasteurized eggs, cereal gruels, and milk and egg.
Soft diets are usually regular diets that have been
modified to eliminate foods that are hard to digest
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and to chew, including those that are high in fiber,
high in fat.
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Routes of nutrition support
The nutritional needs of patients are met through a
variety of delivery routes and with an array of
nutritional formulation components and
administration equipment.
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Enteral nutrition (EN)
Long-term nutrition:
Gastrostomy
 Jejunostomy
Short-term nutrition:
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Nasogastric feeding
 Nasoduodenal feeding
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Nasojejunal feeding
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Parenteral nutrition (PN)
Peripheral Parenteral Nutrition (PPN)
 Total Parenteral Nutrition (TPN)
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Enteral nutrition
An alternative feeding method to ensure adequate
nutrition includes Enteral (through the
gastrointestinal system) methods. Enteral nutrition
(EN), also referred to as total enteral nutrition
(TEN), is provided when the client is unable to
ingest foods or the upper gastrointestinal tract is
impaired and the transport of food to the small
intestine is interrupted.
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Enteral Access devices
Enteral access is achieved by means of nasogastric or
nasointestinal ( nasoenteric ) tubes, or gastrostomy
or jejunostomy tubes.
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Parenteral Nutrition
Parenteral Nutrition (PN) or total Parenteral
nutrition (TPN) or intravenous hyperalimentation
(IVH), is provided when the gastrointestinal tract is
nonfunctional because of an interruption in its
continuity or because its absorptive capacity is
impaired. PN is administered intravenously such as
through a central venous catheter into the superior
vena cava. (subclavian or internal jugular veins).
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Partial Parenteral nutrition or peripheral
parenteral nutrition (PPN) is prescribed for
patients who require nutrient supplementation
through a peripheral vein because they have an
inadequate intake of oral feedings.
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Parenteral feedings are solutions of dextrose, water,
fat, proteins, electrolytes, vitamins, and trace
elements, they provide all needed calories.
Medications such as insulin (because TPN contains
large concentrations of glucose) and heparin (to
prevent formation of a blood clot on the tip of the
catheter) may also be added to the solution.
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TPN solutions are hypertonic (highly concentrated in
comparison to the solute concentration of blood),
they are injected only into high – flow central veins,
where they are diluted by the client’s blood.
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Indication for TPN
Client with severe malnutrition
 Severe burns
 Client with bowel disease disorders (e.g., ulcerative
colitis or enteric fistula )
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Acute renal failure
 Hepatic failure
 Metastatic cancer
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Major surgeries where nothing may be taken by
mouth for more than 5 days.
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



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y. The nurse must always observe
surgical as aseptic technique when changing
solutions, tubing, dressings, and filters.
Infecti
on
Increased risk of fluid, electrolyte, and glucose
contro imbalances and require frequent evaluation and
l is of
utmos modification of the TPN mixture.
t
Insertion problems, such as pneumothorax, air
import
ance embolism, and thromboembolism.
during Phlebitis
TPN
therap
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SPECIAL CONSIDERATION
TPN
solutions are 10% to 50 % dextrose in water ,
plus a mixture of amino acids and special additives
such as vitamins (e.g., B complex, C, D,K ),
minerals (e.g., potassium, sodium, chloride, calcium
, phosphate, magnesium), and trace elements (e.g.,
cobalt, zinc, manganese).Additives are modified to
each client’s nutritional needs.
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TPN
solutions are high in glucose, infusions are
started gradually to prevent hyperglycemia, so
glucose are monitored during the infusion.
When
TPN is to be D/C, the TPN infusion rates are
decreased slowly to prevent hyperinsulinemia and
hypoglycemia. Weaning a client from TPN may take
up to 48 hours but can occur in 6 hours as long as
the client receives adequate carbohydrates either
orally or intravenously.
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