1. BY
Nelson Munthali Dip/RN

2.  Definition of nutrition.
 Identify the physiological value of nutrients.
Describe how diet guidelines and menu
planning promotes nutrition and health.
 Explain how culture influences food
preferences and eating habits.
 Explain the impact of age related changes on
nutritional status.

3.  Describe the process of assessing a clients
nutritional status.
 Explain how food for a sick patient can be
prepared.
 Describe the expected outcomes of nursing
interventions that promote optimum
nutritional status.

4.  Identify common nursing interventions for
clients experience nutritional deficits
 Describe the role of nutritional support teams
in managing the care of clients with
nutritional deficits.
 What are the indications for different feeding
methods

5.  Nutrition is the process by which the body
metabolizes and utilizes nutrients.
 Nutrients are classified as energy nutrients,
organic nutrients and inorganic nutrients.
 Energy nutrients release energy for
maintenance of homeostasis. These are
carbohydrates, proteins and fats.
 Organic nutrients build and maintain body
tissues and regulate body processes.

6.  Examples are carbohydrates, proteins, fats
and vitamins.
 Inorganic nutrients provide a medium for
chemical reactions, transport materials,
maintain body temperature, promote bone
formation and conduct nerve impulses. These
are water minerals.
- Carbohydrates are converted into glucose
before they reach the cells.

7. - Proteins are converted into aminoacids.
- Fats are converted into fatty acids.
TERMS TO KNOW
-Digestion. - metabolism -
hyperthyroidism
-mastication. -absorption -
hypothyroidism
-deglutition. -peristalsis
-anabolism. - catabolism

8. Understanding the role of basic nutrients
provides the foundation for selecting foods
that promote good health.
There are six categories of nutrients: water
vitamins, minerals, carbohydrates, proteins
and lipids(fats).

10.  Water
The most abundant nutrient in the body 70% in
adults, 77% in infants weight. Major
components of body fluids, secretions and
excretions. Body water decreases as body fat
increases and with aging.
 Vitamins
These are organic compounds that regulate
cellular metabolism, assisting the biochemical
processes

11. that release energy from the digested food,
water soluble and fat soluble.
 Minerals
Serve as catalysts in biochemical reactions.
Classified as macro and micro minerals.
Macro have quantities of 100mg or greater
eg calcium, phosphorus, and magnesium.
While micro nutrients have trace elements
with quantities less than 100mg eg fluoride,
iodine, iron, zinc which play an essential role
in metabolism.

12. Carbohydrates
These are organic compounds composed of
carbon, hydrogen and oxygen. They play a
significant role in providing cells with energy
and supporting the normal functioning of the
body.
Carbohydrates are classified according to the
number of saccharides(sugar units).

13. 1. Monosacharides (simple sugar) includes
glucose, galactose and fructose.
2. Disaccharides(double sugar) includes
sucrose, lactose and maltose.
3. Polysaccharides(complex sugars) includes
glycogen, cellulose and starch.
Glucose supplies the major source of energy
needed for cellular activity such as nerve

14. In order to make a nursing diagnosis, the nurse
must interpret the subjective and objective
data and draw a conclusion.
 Imbalance nutrition
-less than body requirements.
-more than body requirements or risk for more
than body requirements.

15. Impulse transmission, muscle contractions etc.
glucose is also needed for the synthesis of
fatty acids and amino acids .
Glucose metabolism is dependent on the
availability of insulin.
NOTE: hyperglycemia is blood sugar level of
>110mg/dl
hypoglycemia sugar level of <80mg/dl

16. Proteins
These are organic compounds that contain
carbon, hydrogen and nitrogen atoms. They
are important for every bodily function
beginning wit the genetic control of protein
synthesis, cell function and cell reproduction.
The end product is amino acid 20 in number
and categorized as essential and nonessential
amino acids.

17. - Essential amino acids must be ingested in the
diet because they cannot be synthesized by
the body.
- Nonessential amino acids can be synthesized
(manufactured) in the cells.
- Transport of amino acids into the cells is
enhanced by potassium and magnesium
electrolytes.

18. Lipids
These are organic compounds insoluble in
water but soluble in organic solvents such
ether and alcohol. They are classified as
saturated and unsaturated fatty acids.

19. EXPECTED OUTCOMES FOR A CLIENT WITH
IMBALANCED NUTRITION
 Client maintains intake and output balance.
 Client consumes the proper amounts of food
from the six food groups.
 Client complies wit diet therapy.
 Client tolerates tube feeding without
experiencing nausea, vomiting and diarrhea.

20.  Client remains infection free while receiving
parenteral nutrition.

21.  The goal of a nursing assessment is to
collect subjective and objective data
regarding the nutritional status of the patient
and determine what type of nutritional
support is needed.
 Nurses are in a unique position to recognize
malnutrition or alterations related to
inadequate intake, disorders of digestion,
absorption or overeating.

22.  The assessment has the following
components: nutritional history, physical
examination, diagnostic and laboratory data.
A. Nutritional history.
This is important in the development of a care
plan for a patient experiencing alterations in
nutrition and metabolism. Several methods
are used to collect subjective data; 24 hour
dietary recall, food frequency questionaire
,food record and diet history

23. B. Physical examination
A physical assessment requires decision
making, problem solving and organization.
The nurse should be aware of rapidly
proliferating tissues such as hair, skin , eyes
lips and tongue that usually show nutrients
deficiency sooner than other tissues . Intake
and output are critical measurements and
daily weight for some conditions.

24. C. Diagnostic and laboratory data.
This is objective data which can show
alterations in nutrition.

25. Nutritional problems often require dietary
modifications with consideration to patients
culture, socioeconomic, psychologic and
physiologic. Modified diets should promote
effective nutrition within clients lifestyle. This
requires teaching the avoidance of certain
foods or adding food items to the diet.

26.  NOTHING PER MOUTH
This is a diet modification as well as fluid
restriction. This intervention is prescribed
prior to surgery and certain diagnostic
procedures, or when a patients nutritional
problems have not been identified.
 CLEAR LIQUID DIET
Dairy products are not allowed on a clear liquid
diet. The patient is allowed to ingest only
liquids that keep the GIT empty(no residues),
such as water and apple juice.

27. LIQUID DIET
A full liquid diet consisting of various types of
liquids is prescribed mainly for post
operative patients because of calorie and
nutrient consideration. If a client tolerates a
liquid diet without nausea or vomiting and
has normal bowel sounds the diet is
progressed to as tolerated.

28.  SOFT DIET
A soft diet promotes the mechanical digestion
of foods. It is prescribed for clients
experiencing difficulties in chewing and
swallowing as well as post operative patients.
 LOW RESIDUE DIET
it has reduced fiber and cellulose. Prescribed
to decrease GI mucosa irritation in patients
with ulcerations. Foods to be avoided are raw
fruits except banana, vegetables, seeds, plant
fibers and whole grains

29.  HIGH FIBER DIET.
The opposite of low residue diet. It increases
the forward motion of the indigestible wastes
through the colon.
 BLAND DIET
It eliminates chemical and mechanical food
irritants such as fried foods, alcohol and
caffeine.
Other types of diets are sodium restricted diet
and fat controlled diet.

30. Proper nutrition in hospitalized clients is
necessary for wound healing, recovery,
reduction in morbidity and consequently
reduction in length of stay and mortality.
Because eating is a social activity, the nurse
should encourage a family member to be
present during meals.

31.  Clean patients mouth to expose the taste
buds which promotes food intake.
 Provide a clean and quiet environment to
avoid lose of appetite due to unattractive
environment.
 Provide small frequent meals. They do not
demand for a lot of work to finish and they
are attractive.
 Provide food that the patients likes if
possible.

32.  Present meals in attractive manner as this
promotes appetite

33.  There are two routes namely enteral(EN) route
and parenteral(PN) nutrition.
a) Enteral nutrition includes both the ingestion of
food orally and the delivery of nutrients
through a gastrointestinal tube.
b) Parenteral nutrition refers to nutrients
bypassing the small intestines and entering the
blood directly.
Enteral nutrition is preferred over parenteral
because of decreased bacterial traslocation and
reduced expense and is usually delivered
through a feeding tube.

34.  Gastrointestinal function.
 Expected duration of therapy.
 Aspiration risks.
 The potential for or the actual development
of organ dysfunction.
Enteral feeding maintains the structural and
functional integrity of the GIT. It enhances the
utilization of nutrients and provide a safe and
economical method of feeding

35. Enteral route is contraindicated in clients wit
the following.
 Diffused peritonitis.
 Intestinal obstruction that prohibits normal
bowel functioning.
 Projectile vomiting.
 Paralytic ileus.
 Severe diarrhea

36.  Naso enteral insertion is the simplest and
most commonly used method of tube
feeding.
 Used as a temporary measure for clients
expected to resume oral feeding.
 Nutrients are in liquid form so they can easily
pass through the tube, be digested and
absorbed.

38. EQUIPMENT
• Non sterile gloves .
• Cup of water and straw.
• Towel and tissue.
• Hypoallergic tape and rubber band.
• 20ml syringe with a small bole tube.
• Water soluble lubricant.
• Feeding tube.
• Administration tube.

39. 1. Review clients medical record, to confirm
prescription for inserting a nasogastric
tube, history of nasal or sinus insertion.
Identify the right client.
2. Gather equipment, wash hands. This
promotes efficiency and reduces transfer of
microorganisms.
3. Explain the procedure to the patient and
show the items to be used. This reduces
anxiety and increases clients cooperation.

40. 4. Place client in a fowlers position at least a 45
degrees angle or higher with a pillow behind
the client’s shoulders, provide privacy. Place a
comatose patient in semifowlers position.
This facilitates passage of the tube into the
esophagus and swallowing.

41. 5. Place towel over chest, put tissues in reach .
Don gloves . This prevents soiling of the
gown and beddings and protects the nurse
from contamination with body fluids
respectively.
6.Examine nostril and assess as client breaths
through each nostril to determine the most
patent nostril to facilitate insertion

42. 7. Measure length of tubing needed by using
tube as a tape measure:
-measure length from bridge of patients nose
to earlobe to xiphoid of sternum’
-if tube is to go below stomach(nasoduodenal
or nasojujenal) add an addition 15 to 20 cm.
-place a small piece of tape on tube to mark
length to appropriate length of tube needed
to reach stomach.

45. 8. Have a clients blow nose and encourage
swallowing of water if level of consciousness
and treatment plan permit. This clears nasal
passage without pushing microorganisms
into inner ear, facilitates passage of tube.
9. Lubricate first 4 inches of the tube with
water soluble lubricant to facilitate passage
into the nares.
10. Insert tube as follows:

46. - Gently pass tube into nostrils to back of
throat 9client may gag; aim tube towards
back of throat and down.
- When client feels tube in back of throat, use
flashlight or penlight to locate tip of tube.
- Instruct client to flex head towards chest.
This opens the esophagus and assists in tube
insertion. Minimal trauma to mucosa is
experienced.
- Instruct client to swallow, offer water and
advance tube as client swallows.

47. -this assists in pushing tube past oropharynx.
-if resistance is met, rotate tube slowly with
downward advancement towards clients
closest ear, do not force tube , tube may be
coiled or kinked or in the oropharynx or
trachea.
11.Withdraw tube immediately if changes
occurs in respiratory status, this indicates
placement of tube in the bronchus or lungs.

48. 12. Advance tube, giving clients sips of water
until taped mark is reached. This assists with
tube insertion.
13. Check placement of tube to ensure proper
placement in the stomach by aspirating and if
contents from the stomach appears it means
its in the right position.
Leave syringe attached to free end of tube to
prevent leakage of gastric contents.

49. 14. Secure with tape to prevent tube from
coming out or being dislodged.

51. 15. Instruct client about movements that can
dislodge the tube. This reduces anxiety and
teaches clients how to prevent tugging n tube
with head movement.
16gastric decompression:
-remove syringe from free end of tube and
connect tube to suction tubing, set machine
on type of suction and pressure as prescribed
by physician.

52. - Observe nature and amount of gastric tube
drainage.
- Assess client of nausea, vomiting and
abdominal distention. This indicates
effectiveness of interventions.
17. provide oral hygiene and cleanse nares
with a tissue to promote comfort.
18. Remove gloves, dispose of contaminated
materials in proper container and wash
hands.

53. - This reduces transmission of
microorganisms, protects other health
workers from coming into contact with
objects contaminated with body fluids
19. Position client for comfort.
20. Document :
- Reason for tube insertion.
- Type of tube inserted.
- Type of suctioning and pressure setting .
- The nature and amount of aspirate and
drainage.

54. - Clients tolerance to the procedure.
- The effectiveness of the interventions.

55. CRAVEN - FUNDAMENTALS OF NURSING.

56. YEBO