Nutrition Care Process

A. Assessment of Nutritional Status

⚫ Responsibilities and Role of Nurses in Nutritional Care

⚫ Observing
⚫ Nurse - usually the first person who sees the patient’s eating
problems
⚫ has direct communication with the patient
⚫ how well the patient’s eats his food
⚫ what kinds and amounts of food are refused
⚫ the patient’s attitude towards his food are readily determined
⚫ must have a knowledge in diet therapy (food allowed / restriction)
⚫ should immediately forward the diet prescription to the dietary
department
⚫ makes sure that the patient is ready to consume the food served on
the tray
⚫ Listening
⚫ Nurse - shows his/her general interest and
understanding of the patient
⚫ helps the patient express his/her feelings
⚫ learned from the patient some of his/her favorite
foods and dislikes
⚫ explains concerns on foods that cannot be eaten due
to ethnic, cultural background and religious beliefs
⚫ becomes aware of what concerns the patient may
have about the diet he will have at home
⚫ Reporting
⚫ Nurse – documents and chart all the problems related to food
intake
⚫
⚫ Nutritional History
⚫ a. Dietary Intake Data
⚫ - Dietary Computations: Desirable Body Weight
Basal Metabolic Rate
Total Energy Requirement
Food Exchange List
⚫ b. Nutrient Intake Analysis (NIA)
⚫ c. Food Diary
⚫ d. Food Frequency
⚫ e. 24 hour Recall
⚫ Physical Assessment
⚫ a. Anthropometric Measurements
⚫ b. Height and Weight
⚫ c. Body Mass Index
⚫ d. Body Composition
⚫ e. Mid-arm Circumference (MAC)
⚫ f. Fat-fold or Skin-fold Thickness
⚫ Other Sources of Data
⚫ Malnutrition Universal Screening Tool (MUST)
⚫ Subjective Global Assessment (SGA)
⚫ Mini Nutritional Assessment (MNA)
⚫ Geriatric Nutritional Risk Index (GNRI)
⚫ B. Nutrition Diagnosis and Plan of Care
⚫ Nutrition Problems and/or Needs
⚫ Planning the Diet with Cultural Competency
⚫ Resources needed in Planning and Implementing
Dietary Regimen
⚫ C. Nutrition Intervention
⚫ Food and Nutrient Delivery
⚫ Food Administration
⚫ Oral Nutrition
⚫ Short-term enteral access
⚫ Long-term enteral access
⚫ Enteral Nutrition
⚫ Tube Feeding
⚫ Provide enteral nutrition for clients who cannot swallow, with esophageal
obstruction, unconscious, and cannot consume oral feeding.
⚫ Rubber – ice; Plastic- warm (Levine-single; Salem sump-double lumen)
⚫ High fowler’s, if contraindicated place left side lying position with head
slightly elevated to prevent aspiration.
⚫ Measure the distance from the tip of the nose to earlobe through the bottom
of the xiphoid process (adult)
⚫ Measure the distance from the tip of the nose to earlobe through the
midway of xiphoid process and umbilicus (children)
⚫ Use water soluble jelly as lubricant
⚫ Offer sips of water and advance tube forward, head bent forward closes the
epiglottis and trachea
⚫ Inject 10 ml of air and auscultate for gurgling sound
in the epigastrium.
⚫ Aspirate for residual stomach content (ph 1-3 of
yellow to green)
⚫ Immerse tip of the NGT into water and observe for
bubbling.
⚫ X-ray confirms
⚫ Flush with 30-60 ml of water after feeding
⚫ If NGT is to removed, instruct client to exhale and
remove tube with smooth, continuous pull
⚫ NG TUBE
⚫ N- ever give without checking
⚫ G- ive warm(room temperature)
⚫ T- urn to left side during the feeding for the stomach to empty better
⚫ U- se gravity, never force feeding
⚫ B- e sure to aspirate
⚫ E- nd with water and chart
⚫ Types of Enteral Formulation
⚫ Ready to Use Formulations
⚫ Tube feedings – prepared from regular foods
⚪ Standard tube feeding - fiber free, high in cholesterol, fat and sugar
⚫ - milk based, sugar and soft cooked eggs
⚫ 2. Blenderized tube feeding - soft diet allowances which can be
⚫ blenderized easily
⚫ Complications:
⚫ Mechanical
⚫ nasopharyngeal irritations – ice chips
⚫ luminal obstruction – flush, replace tube
⚫ mucosal erosions – reposition tube, ice water lavage, remove
tube
⚫ tube displacement – replace tube
⚫ aspiration – discontinue tube feeding
⚫ Gastrointestinal
⚫ cramping/distention – change formula, reduce infusion rate
⚫ vomiting/diarrhea – dilute formula, reduce infusion rate
⚫ constipation – promote sufficient, fluids and fibers, encourage
patient activity
⚫ Metabolic
⚫ hypertonic dehydration – increase water
⚫ cardiac failure – reduce sodium content, fluid
restriction
⚫ renal failure – decrease phosphate, magnesium,
potassium, CHON restriction, amino acids solution
⚫ glucose intolerance – reduce infusion rate
⚫ hepatic encephalopathy – decrease amount of CHON
⚫ Parenteral Nutrition
⚫ Peripheral Parenteral Nutrition (PPN) – nutrients are given via small veins,
usually in the arms
⚫ Total Parenteral Nutrition (TPN) – also called Central Parenteral Nutrition
(CPN) or intravenous hyperalimentation (IVH); nutrients are given
centrally into the superior or inferior vena cava or the jugular vein
⚫ TPN solutions are nutritionally complete based on the patient’s weight and
caloric/nutritional needs
⚫ TPN is indicated in clients who need extensive nutritional support over an
extended period like CA and severe malnutrition
⚫ Mixture of dextrose, amino acids, multivitamins, electrolytes and trace of
minerals
⚫ The usual site is subclavian vein
⚫ During TPN catheter insertion, Trendelenburg position – to engorge the
vein and facilitate insertion of the vein and prevent air embolism
⚫ The primary purpose of TPN is to administer glucose
⚫ PIC – basilic / cephalic; PPC - subclavian
⚫ Administer TPN at room temperature
⚫ Cold temperature of solution may cause chills
⚫ Consume TPN formula for 24 hours to prevent contamination
⚫ The TPN solution is hypertonic (25-35% of dextrose)
⚫ Use infusion pump to maintain steady infusion this prevents abnormal
shifting of fluids from intracellular compartment to the extracellular
compartment (cells shrink)
⚫ If infusion is delayed do not catch up – notify physician for calculation
⚫ Monitor urine and glucose level. Glycosuria is expected.
⚫ The client may need small amount of insulin as prescribed by the physician
to prevent glucose intolerance
⚫ Prevent infection on the catheter site. Infection is the most common
complication of TPN.
⚫ If TPN administration is interrupted or discontinued, administer D10W to
prevent hypoglycemia
⚫ D. Monitoring Nutritional Status
⚫ Strategies to address Age-related changes affecting
Nutrition
⚫ Selected Therapeutic Diets
⚫ Recording and reporting of Nutritional Status
⚫ E. Evaluation of Plan of Care
⚫ Effectiveness of the plan of care
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