👩‍⚕️Foundations of Nursing Practice Unit 10 – Nutrition and Fluid Balance

Key Nutritional Concepts

• Nutrition plays a vital role in maintaining health, preventing disease, and promoting recovery from illness or injury
• Nutrients are essential substances obtained from food and used by the body for growth, maintenance, and repair
• Malnutrition occurs when there is an imbalance between nutrient intake and the body's requirements, leading to deficiencies or excesses
• Nutritional status is influenced by various factors (age, gender, health status, medications, and cultural or religious practices)
• Adequate hydration is crucial for maintaining fluid balance, regulating body temperature, and supporting cellular functions
• The body's energy requirements are determined by basal metabolic rate, physical activity level, and specific physiological states (pregnancy or illness)
• Nutritional assessment involves gathering data on dietary intake, anthropometric measurements, biochemical markers, and clinical signs and symptoms

Macronutrients and Micronutrients

• Macronutrients are nutrients required in large amounts and include carbohydrates, proteins, and fats
  • Carbohydrates are the primary energy source for the body and are found in foods (grains, fruits, and vegetables)
  • Proteins are essential for tissue growth, repair, and maintenance and are composed of amino acids
  • Fats provide energy, support cell membrane structure, and aid in the absorption of fat-soluble vitamins
• Micronutrients are nutrients required in smaller amounts and include vitamins and minerals
  • Vitamins are organic compounds that play crucial roles in various metabolic processes and are classified as water-soluble (B vitamins and vitamin C) or fat-soluble (vitamins A, D, E, and K)
  • Minerals are inorganic elements that serve various functions (bone formation, enzyme activation, and fluid balance) and include calcium, iron, and zinc
• Fiber is a type of carbohydrate that promotes digestive health, regulates blood sugar, and aids in weight management
• Essential nutrients are those that cannot be synthesized by the body and must be obtained through the diet (essential amino acids and fatty acids)

Fluid Balance and Electrolytes

• Fluid balance refers to the maintenance of optimal levels of water and electrolytes in the body's compartments (intracellular and extracellular spaces)
• Electrolytes are minerals that carry an electrical charge and play crucial roles in maintaining fluid balance, nerve conduction, and muscle function
• The main electrolytes in the body include sodium, potassium, calcium, magnesium, chloride, and phosphate
• Fluid intake is regulated by thirst, while output is controlled by the kidneys, skin, lungs, and gastrointestinal tract
• Dehydration occurs when fluid losses exceed intake, leading to decreased intravascular volume and impaired cellular functions
• Overhydration can result from excessive fluid intake or impaired excretion, causing fluid accumulation in the tissues (edema)
• Electrolyte imbalances can arise from various factors (inadequate intake, excessive losses, or underlying medical conditions) and may lead to neurological, cardiovascular, or muscular complications

Nutritional Assessment Techniques

• Nutritional assessment is a systematic process of collecting and interpreting data to determine an individual's nutritional status and identify potential risks or deficiencies
• Dietary assessment methods include 24-hour recall, food frequency questionnaires, and food diaries, which provide information on the types, amounts, and frequency of foods consumed
• Anthropometric measurements involve assessing body composition and include height, weight, body mass index (BMI), and skinfold thickness
• Biochemical markers are laboratory tests that evaluate nutrient levels, organ function, and metabolic status (serum albumin, hemoglobin, and vitamin D levels)
• Clinical assessment involves examining physical signs and symptoms of nutrient deficiencies or excesses (skin changes, hair loss, and edema)
• Nutritional screening tools (Malnutrition Universal Screening Tool or Mini Nutritional Assessment) are used to identify individuals at risk of malnutrition and guide further assessment and intervention
• Nutritional assessment findings are used to develop individualized care plans, set goals, and monitor progress over time

Common Nutritional Disorders

• Obesity is a chronic condition characterized by excessive body fat accumulation, increasing the risk of various health problems (cardiovascular disease, diabetes, and certain cancers)
  • Causes of obesity include a combination of genetic, environmental, and behavioral factors (sedentary lifestyle and high-calorie diets)
  • Management of obesity involves a multidisciplinary approach, including dietary modifications, increased physical activity, behavioral therapy, and in some cases, pharmacological or surgical interventions
• Undernutrition results from inadequate nutrient intake or absorption, leading to weight loss, muscle wasting, and impaired immune function
  • Causes of undernutrition include poverty, food insecurity, eating disorders, and chronic illnesses (cancer or inflammatory bowel disease)
  • Treatment of undernutrition focuses on providing adequate nutrients through diet, oral supplements, or enteral or parenteral nutrition support
• Micronutrient deficiencies can occur due to inadequate intake, malabsorption, or increased requirements and may lead to specific clinical manifestations (iron-deficiency anemia or vitamin D deficiency)
• Eating disorders (anorexia nervosa and bulimia nervosa) are characterized by abnormal eating behaviors and distorted body image, leading to significant physical and psychological complications
• Nutritional disorders in specific populations (elderly, pregnant women, or individuals with chronic diseases) require specialized assessment and management approaches

Therapeutic Diets and Interventions

• Therapeutic diets are modified meal plans designed to meet specific nutritional requirements, manage symptoms, or support the treatment of various medical conditions
• Clear liquid diet consists of transparent, easily digestible fluids (broth, gelatin, and clear juices) and is often used in the perioperative period or during acute gastrointestinal illnesses
• Full liquid diet includes both clear and opaque liquids (milk, strained soups, and puddings) and provides more calories and nutrients than a clear liquid diet
• Soft diet contains foods that are easy to chew and swallow and is often prescribed for individuals with dysphagia or recovering from oral or gastrointestinal surgery
• Diabetic diet aims to control blood sugar levels by emphasizing consistent carbohydrate intake, portion control, and the inclusion of fiber-rich foods
• Low-sodium diet restricts the intake of salt and high-sodium foods to manage hypertension, heart failure, or kidney disease
• Renal diet is modified to control the intake of protein, potassium, phosphorus, and fluid in individuals with chronic kidney disease
• Enteral nutrition involves the delivery of nutrients directly into the gastrointestinal tract via a feeding tube and is used when oral intake is insufficient or contraindicated
• Parenteral nutrition involves the intravenous administration of nutrients and is reserved for individuals with non-functional gastrointestinal tracts or severe malnutrition

Nursing Care for Nutrition and Hydration

• Nurses play a crucial role in assessing, planning, implementing, and evaluating nutritional care for patients across various healthcare settings
• Nutritional screening and assessment are performed upon admission and at regular intervals to identify patients at risk of malnutrition or dehydration
• Nursing interventions aim to promote optimal nutrition and hydration, prevent complications, and support recovery from illness or injury
• Encouraging oral intake involves creating a pleasant dining environment, offering food choices, and assisting with feeding as needed
• Monitoring fluid balance requires accurate measurement and documentation of intake and output, as well as assessing for signs of dehydration or fluid overload
• Administering enteral or parenteral nutrition involves maintaining the integrity of feeding tubes, preventing complications (aspiration or infection), and monitoring for tolerance and response to therapy
• Patient and family education focuses on promoting healthy eating habits, managing specific dietary restrictions, and recognizing signs and symptoms of nutritional problems
• Collaborating with interdisciplinary team members (registered dietitians, speech therapists, and physicians) ensures comprehensive and coordinated nutritional care

Clinical Applications and Case Studies

• Case study 1: A 75-year-old man with a history of stroke and dysphagia is admitted to the hospital with aspiration pneumonia. The nursing care plan focuses on maintaining adequate nutrition through a soft diet, thickened liquids, and close monitoring of swallowing function.
• Case study 2: A 28-year-old woman with anorexia nervosa is admitted to an inpatient eating disorder program. The nursing interventions include regular weight monitoring, supervising meals, providing emotional support, and collaborating with the mental health team to address underlying psychological issues.
• Case study 3: A 50-year-old man with type 2 diabetes and obesity is referred to a outpatient nutrition clinic. The nursing role involves conducting a nutritional assessment, providing education on carbohydrate counting and portion control, and setting realistic goals for weight loss and blood sugar management.
• Case study 4: A premature infant in the neonatal intensive care unit requires parenteral nutrition due to necrotizing enterocolitis. The nursing care focuses on maintaining the integrity of the central venous catheter, monitoring for signs of infection or metabolic imbalances, and gradually transitioning to enteral feeds as tolerated.
• Case study 5: An elderly woman with dementia is admitted to a long-term care facility with signs of dehydration and malnutrition. The nursing interventions include encouraging fluid intake, providing assistance with meals, monitoring skin integrity, and collaborating with the dietary team to develop an individualized nutrition plan.
• Case study 6: A middle-aged man with chronic kidney disease is advised to follow a renal diet. The nursing role involves educating the patient on food choices low in potassium, phosphorus, and sodium, monitoring laboratory values, and assessing for signs of fluid retention or electrolyte imbalances.