Nursing & Nutritional Needs of Patients

LISA B. FLATT, RN, MSN, CHPN

Nursing &

Nutritional Needs of Patients

Terminology

Gastrointestinal system – GI systemAlimentary canal – ‘tube’ that food/fluid

follow from the mouth to the anusPeristalsis – muscles of the alimentary canal

move in waves and push the food/fluid through

Follow the Path of the Alimentary Canal!

MouthEsophagusStomachSmall Intestine

Duodenum Jejunum Ileum

Large Intestine Ascending colon Transverse colon Descending colon

Sigmoid ColonRectumAnus

Anatomy & PhysiologyThe Gastrointestinal (GI) System

Mouth – dentition breaks down food into small enough pieces that enzyme-containing saliva begins breaking down the food (& fluids)

EsophagusStomach – secretes gastric acids to further

breakdown the foodSmall intestine – most of digestion happens

here, the villi and microvilli line the mucosal surface, from which enzymes, acids and proteins are secreted and nutrients are absorbed

And then there’s more…….

Large intestine – water is absorbed and digestive wastes are converted into feces

Sigmoid (pelvic) colon – waste/feces travels through to reach rectum

Rectum – contains vertical folds (each contain an artery and vein), these folds help hold feces in the rectum

Anus – internal sphincter muscles are stimulated by the autonomic nervous system and external sphincter muscles are stimulated by the somatic nervous system

The Basic Four Food Groups

Eat Healthier!

Grains Group – ½ of grains should be whole grains

Fruits – Focus on fruitsVegetables – Vary your veggiesDairy – Calcium richProtein - Go lean with your proteinGo Red!

Servings per dayServings per day Sample dietSample diet

Fruit &Vegetables 5-10

Meat 2-3Dairy 2-4Grains 5-12

Daily Requirements

What do we eat to be healthy?

Proteins - CarbohydratesFatsVitamins

Grains

Whole grains: Brown Rice: Buckwheat: Millet: Oatmeal: Popcorn:Bulgur (cracked wheat): Whole-wheat cereal flakes: Meuslix: Rolled oats: Quinoa: Wheat Pasta

Refined grains: corn tortillas: grits: pasta: pita: noodles: corn flakes

Examples of refined grains you have eaten today/this week?

Examples of whole grains you have eaten today/this week?

Fruits

Apples, Apricots, Bananas, Berries, Cherries, Grapes, Melons, Fruit cocktail, pears, mangoes, pineapple, peaches, plums, raisins, tangerines

100% Fruit juices

Can you think of some fruits you might want someone with low potassium to eat?

What are some fruits that are high in roughage? What does GO RED have to do with Fruits?

Vegetables

Dark green: spinach: kale: Mustard/turnip/collard greens

Red & orange vegetables: acorn/butternut squash: carrots: pumpkin:sweet potatoes: tomatoesbutternut squash

Beans and peas: lentils: kindey beans: soy beansStarchy vegetables: corn: black-eyed peas (not dry)Other Vegetables: beets: cucumbers: egg plant:

turnips

People who are low in iron might eat which vegetables?

Dairy

Milk: Cheese: Ice Cream: Yogurt: soy milk (Calcium fortified)

What are some dairy desserts?

Why would you want to restrict dairy products with a patient who is in kidney failure?

Protein

Meats - lean Seafood/ Fish/ ShellfishOrgan MeatsPoultry EggsGame MeatsSoy products – bean curdsBeansNuts

Oils & Fats

Oils are fats (they are liquid at room temperature). They may come from plants and fish. They provide essential nutrients.

What are some examples of oils found in plants?What are some nuts that may contain oil?Oils found in plants do not contain cholesterol.Most oils are low in saturated fats. They are high in

monounsaturated and/or polyunsaturated fats.Solid fats (solid at room temperature) for example

butter and shortening. These can be made through hydrogenation.

Others are: lard, milk fat, chicken fat, meat/beef fat

Solid FatsSolid Fats Added SugarsAdded Sugars

Fats that are solid at room temperature

Processed sugars added to beverages and syrups

Empty Calories

Exercise

What types of physical activity do you engage in?

Give some examples that are ‘low impact’Give some examples of ‘aerobic’ exercisesWhat are some things we can do in our daily

activities that are exercise?How many times a week and how much

exercise is recommended? Does it ever vary?

Vitamin = what do I do?Vitamin = what do I do?Where can I find it?Where can I find it?

A = growth & development, tooth & bone development, epithelial tissue functions

B =C =D=E=K=

Egg yolks, butterfat from milk

Name that Vitamin!

THAT’S RIGHT!THE SUN!

It’s light is absorbed through the skin and converted to which

vitamin?

What rises in the east?

Sets in the west?

Has solar flares?

Creates energy?

Gives us light?

Is eclipsed by the moon, on rare occasions?

The ancients thought this heavenly body revolved around the earth?

Minerals

Fiber & Fluid

Influencing Factors

PreferencesSocio-economic factorsCulture and EthnicitySpiritual BeliefsPhysical ActivityWork HabitsCooking HabitsHealth HabitsPsychological FactorsPeer pressureMental Status

Nutrition through the Ages

InfantPre-school-agedSchool agedAdolescentsYoung AdultsMiddle-aged adultsElderly

Nutritional Disturbances

Pg 21

Nursing Promotions

Nursing Interventions

Special Diets

Laboratory Data

Complete Blood Count (CBC) Hemoglobin (Hgb) Hematocrit (Hct)

Total Iron Binding Capacity (TIBC)Blood Urea Nitrogen (BUN)CreatinineLymphocytes

Applying the Nursing Process

Case Scenarios

Creating Care Plans

References