Nursing Management: Nutritional Problems (Chapter 40)

 Good nutrition in the absence of any underlying disease process results from the
ingestion of a balanced diet.

 The MyPyramid (formerly the Food Guide Pyramid) consists of food groups that are
presented in proportions appropriate for a healthy diet, including grains, vegetables,
fruits, oils, milk, and meat and beans.

 The National Research Council recommends that at least half of the body’s energy needs
should come from carbohydrates, especially complex carbohydrates.

 The Dietary Guidelines for Americans 2005 from Healthy People 2010 recommends that
people reduce their fat intake to 20% to 35% of their total daily caloric intake.

 An average adult requires an estimated 20 to 35 calories per kilogram of body weight per
day, leaning toward the higher end if the person is critically ill or very active and the
lower end if the person is sedentary.

 The recommended daily protein intake is 0.8 to 1 g/kg of body weight.

 Vegetarians can have vitamin or protein deficiencies unless their diets are well planned.

 Culture, personal preferences, socioeconomic status, and religious preferences can

influence food choices.

 The nurse should include cultural and ethnic considerations when assessing the patient’s
diet history and implementing interventions that require dietary changes.

MALNUTRITION
 Malnutrition is common in hospitalized patients.

 With starvation, the body initially uses carbohydrates (glycogen) rather than fat and
protein to meet metabolic needs. Once carbohydrate stores are depleted, protein begins to
be converted to glucose for energy.

 Factors that contribute to malnutrition include socioeconomic status, cultural influences,

psychologic disorders, medical conditions, and medical treatments.

 Regardless of the cause of the illness, most sick persons have increased nutritional needs.

 Each degree of temperature increase on the Fahrenheit scale raises the basal metabolic
rate (BMR) by about 7%.
  Prolonged illness, major surgery, sepsis, draining wounds, burns, hemorrhage, fractures,
and immobilization can all contribute to malnutrition.

 On physical examination, the most obvious clinical signs of inadequate protein and
calorie intake are apparent in the skin, eyes, mouth, muscles, and the central nervous
system.

 The malnourished person is more susceptible to all types of infection.

 Across all settings of care delivery, the nurse must be aware of the nutritional status of
the patient.

 The protein and calorie intake required in the malnourished patient depends on the cause
of the malnutrition, the treatment being employed, and other stressors affecting the
patient.

 The older patient is at risk for nutritional problems due to the following factors:
o Changes in the oral cavity
o Changes in digestion and motility
o Changes in the endocrine system
o Changes in the musculoskeletal system
o Decreases in vision and hearing

 High-calorie oral supplements may be used in the patient whose nutritional intake is
deficient.

TUBE FEEDINGS
 Tube feeding (also known as enteral nutrition) may be ordered for the patient who has
a functioning GI tract but is unable to take any or enough oral nourishment.

 A gastrostomy tube may be used for a patient who requires tube feedings over an
extended time.

 The most accurate assessment for correct tube placement is by x-ray visualization.

PARENTERAL NUTRITION
 Parenteral nutrition (PN) is used to meet the patient’s nutritional needs and to allow
growth of new body tissue.

 All parenteral nutrition solutions should be prepared by a pharmacist or a trained

technician using strict aseptic techniques under a laminar flow hood.

 Complications of parenteral nutrition include infectious, metabolic, and mechanical

problems.