Nutritional Needs
Content
Nutritional needs
Children and Adolescents
Parents are responsible for setting an example of good nutritional habits for their children. Parental eating habits and attitudes toward food are readily passed on to their children. Parents who have little understanding of what constitutes a well-balanced diet or who cannot or will not learn good nutritional habits influence their children to follow the same poor dietary practices. The nurse is in a good position to help parents understand the changing food requirements of their children from infancy through adolescence. Infants and children differ from adults in several ways. In the first months of life, the infant’s gastrointestinal (GI) tract and kidneys are not functionally mature and therefore are limited in the kinds and quantities of nutrients that should be given. The metabolic rate of infants is higher and they have smaller nutritional reserve as compared with adults. = Adolescence is a particularly vulnerable time for the development of nutritional deficiencies because this is a time of rapid growth and bodily changes. It is a period during which there is extreme concern with body appearance and social acceptability. Teenage girls are often attracted to fad diets as a means of weight control. Unfortunately, fad diets are often nutritionally unsound. Unless good nutritional habits are encouraged and supervised by peers and parents during this developmental period, poor nutritional patterns may become established as away of life. A state of chronic inadequate nitrition may result
Socioeconomic status
Because individuals and families from the lower socioeconomic class spend a greater percentage of their limited income on food, there is a tendency to seek out cheaper foods as the cost of food increses. These foods may not provide adequate or balanced nutrition. In contrast, some lower-income persons may prefer to select foods that are more expensive, but only marginally nutritious,
because of their prestige value. The nurse and the registered dietician can assist the poor in making food choices that meet nutritional requirements while staying within their limited resources. Table 38-6 lists low-cost protein supplements.
Older Adults
The unique nutritional requirements of an older adult are often overlooked. It is more common to find an undernourished older person than an obese one. As a person grows older there are decreases in lean body mass (the metabolically active tissue), basal metaboic rate, and phycical activity. Combined, these factors decrease the caloric needs for energy. The older person frequently reduces the consuption of needed protein, vitamins, and minerals and may take “empty calories,” such as candy and pastries. The reasons given for succh alteration are varied. Table 38-7 outlines factors affecting nutritional intake in older adults. As a group, older adults may be less well informed about what constitutes a well-balanced diet. The older adult may be induced to purchase more costly “health foods” at specialty stores under mistaken assumptions, such as that these foods offer more nutrients than foods bought at the lokal marker, or that the food supply is nutritionally inadequete. When these factors are added to already existing medical problem, it is easy to see why poor dietary practices develop. In addition, poor dentition, ill-fitting dentures, anorexia, multiple losses affecting the social setting of meals, low income, and medical conditions involving the GI tract contribute to the type and amount of foods that is eaten. The nurse, working with the registered dietician, must be aware of common medical and psychosocial factors in the older adult and should in corpoate interventions for overcoming these problems in the plan of care.
Patients with physical illnesses
Regardless of the cause of the illness, the sick person has increased nutritional needs. Pathologic conditions are frequently aggravated by undernutrition, and an existing deficiency state is likely to become more severe during illness.
Malnutrition is not an uncommon conssequence of illness, surgery, injury, or hospitaliztion. Anorexia, nausea, vomiting, diarrhea, abdominal distentian, and abdominal cramping may accompany diseases of the GI system. Any combination of these symptoms interferes with normal food consumption and metabolism. Additionally, a patient may restrict the dietary intake to a few foods or fluids that may not be nutritionally sound out of fear of aggravating the already disturbed GI function. Malabsorption syndrome is defined as the impaired absrption of nutrients from the GI tract. It may result from descreased amounts of necessary enzimes or a reduced bowel surface area and can quickly lead to a deficiency state. Many pharmacologic agents may result in undersirable GI side affects, as well as alter normal digestive and absortive proceses. For example, antibiotics change the normal flora of the intestines, decreasing the body’s ability to synthesize biotin. Fever accompanies many illnesses, injusies, and afections, with a concomitant increase in the body’s basal metabolic rate (BMR). Each degree of temperature increase on the Fahrenheit scale raises the BMR by 7%. Without an increase in the amount of calories ingested in the diet, body protein stores will be used to supply calories, and protein depletion can become a problem. The hospitalized patient, especially the older adult, is at risk of becoming malnourished. Prolonged illness, major surgery , sepsis, draining wounds, burns, hemorrhage, fractures, and imobilization can all contribute to malnutrition. The nurse must assume responsibility , along with the physician and the dietician, for meeting the patient’s nutritional needs. The nurse must also be knowledgeable of the requirements of a patiens who is not overtly ill but who is undergoing diagnostic studies. This patient may be nutritionally fit on entering the hospital but can develop nutritional problems because of the dietary restrictions imposed by multiple diagnostic studies. The role of nutrition in the development of dieases has long been studied. Studies of the association of personal dietary habits with the development of selected cancers and cardiovascular disease have been widely published in recent years. There now appear to be links between some types of cancers and dietary intakes; for example, high ingestion of fatty foods is linked with
breast and endometrial cancer, and a low fiber intake may be linked with colon cancer (see chapter 40). Further research in this area is needed for a better understanding of diet and the development of disease, especially cancer.
Drug category/drug Anticoagulants
Food/nutrient Dietary vitamin k (e.g., green leafly vegetables, green tea, dairy product/meat) Folic acid
Drug-food effect or cautions Decrease or loss of anticoagulant effect
Antiseizure agents -phenytoin (Dilantin) Antidepressants -trazodone (desyrel) -tricylic antidepressant
Long-term drug use may increase folic acid requirement Food slows drug absorption Riboflavin requirements may increase with amitriptyline (elavil)or imipramine (tofranil) Drug should not be taken with high fat diet Food increases drug absorption Foods may inconsistenly alter bloavailability of methimzoale Drug may increase folic acid requirements; long-term therapy may require vitamin D suplements for
Food Riboflavin
Antidiabetic agents -glyburide (micronase, diabeta) -troglitazone (rezulin)
High fat diet
Food
Antithyroid agents -methimazole (tapazole)
Food
Barbiturates -phenobarbital -mephobarbitol
Folic acid
(mebaral)
osteomalacia
Children and Adolescents
Parents are responsible for setting an example of good nutritional habits for their children. Parental eating habits and attitudes toward food are readily passed on to their children. Parents who have little understanding of what constitutes a well-balanced diet or who cannot or will not learn good nutritional habits influence their children to follow the same poor dietary practices. The nurse is in a good position to help parents understand the changing food requirements of their children from infancy through adolescence. Infants and children differ from adults in several ways. In the first months of life, the infant’s gastrointestinal (GI) tract and kidneys are not functionally mature and therefore are limited in the kinds and quantities of nutrients that should be given. The metabolic rate of infants is higher and they have smaller nutritional reserve as compared with adults. = Adolescence is a particularly vulnerable time for the development of nutritional deficiencies because this is a time of rapid growth and bodily changes. It is a period during which there is extreme concern with body appearance and social acceptability. Teenage girls are often attracted to fad diets as a means of weight control. Unfortunately, fad diets are often nutritionally unsound. Unless good nutritional habits are encouraged and supervised by peers and parents during this developmental period, poor nutritional patterns may become established as away of life. A state of chronic inadequate nitrition may result
Socioeconomic status
Because individuals and families from the lower socioeconomic class spend a greater percentage of their limited income on food, there is a tendency to seek out cheaper foods as the cost of food increses. These foods may not provide adequate or balanced nutrition. In contrast, some lower-income persons may prefer to select foods that are more expensive, but only marginally nutritious,
because of their prestige value. The nurse and the registered dietician can assist the poor in making food choices that meet nutritional requirements while staying within their limited resources. Table 38-6 lists low-cost protein supplements.
Older Adults
The unique nutritional requirements of an older adult are often overlooked. It is more common to find an undernourished older person than an obese one. As a person grows older there are decreases in lean body mass (the metabolically active tissue), basal metaboic rate, and phycical activity. Combined, these factors decrease the caloric needs for energy. The older person frequently reduces the consuption of needed protein, vitamins, and minerals and may take “empty calories,” such as candy and pastries. The reasons given for succh alteration are varied. Table 38-7 outlines factors affecting nutritional intake in older adults. As a group, older adults may be less well informed about what constitutes a well-balanced diet. The older adult may be induced to purchase more costly “health foods” at specialty stores under mistaken assumptions, such as that these foods offer more nutrients than foods bought at the lokal marker, or that the food supply is nutritionally inadequete. When these factors are added to already existing medical problem, it is easy to see why poor dietary practices develop. In addition, poor dentition, ill-fitting dentures, anorexia, multiple losses affecting the social setting of meals, low income, and medical conditions involving the GI tract contribute to the type and amount of foods that is eaten. The nurse, working with the registered dietician, must be aware of common medical and psychosocial factors in the older adult and should in corpoate interventions for overcoming these problems in the plan of care.
Patients with physical illnesses
Regardless of the cause of the illness, the sick person has increased nutritional needs. Pathologic conditions are frequently aggravated by undernutrition, and an existing deficiency state is likely to become more severe during illness.
Malnutrition is not an uncommon conssequence of illness, surgery, injury, or hospitaliztion. Anorexia, nausea, vomiting, diarrhea, abdominal distentian, and abdominal cramping may accompany diseases of the GI system. Any combination of these symptoms interferes with normal food consumption and metabolism. Additionally, a patient may restrict the dietary intake to a few foods or fluids that may not be nutritionally sound out of fear of aggravating the already disturbed GI function. Malabsorption syndrome is defined as the impaired absrption of nutrients from the GI tract. It may result from descreased amounts of necessary enzimes or a reduced bowel surface area and can quickly lead to a deficiency state. Many pharmacologic agents may result in undersirable GI side affects, as well as alter normal digestive and absortive proceses. For example, antibiotics change the normal flora of the intestines, decreasing the body’s ability to synthesize biotin. Fever accompanies many illnesses, injusies, and afections, with a concomitant increase in the body’s basal metabolic rate (BMR). Each degree of temperature increase on the Fahrenheit scale raises the BMR by 7%. Without an increase in the amount of calories ingested in the diet, body protein stores will be used to supply calories, and protein depletion can become a problem. The hospitalized patient, especially the older adult, is at risk of becoming malnourished. Prolonged illness, major surgery , sepsis, draining wounds, burns, hemorrhage, fractures, and imobilization can all contribute to malnutrition. The nurse must assume responsibility , along with the physician and the dietician, for meeting the patient’s nutritional needs. The nurse must also be knowledgeable of the requirements of a patiens who is not overtly ill but who is undergoing diagnostic studies. This patient may be nutritionally fit on entering the hospital but can develop nutritional problems because of the dietary restrictions imposed by multiple diagnostic studies. The role of nutrition in the development of dieases has long been studied. Studies of the association of personal dietary habits with the development of selected cancers and cardiovascular disease have been widely published in recent years. There now appear to be links between some types of cancers and dietary intakes; for example, high ingestion of fatty foods is linked with
breast and endometrial cancer, and a low fiber intake may be linked with colon cancer (see chapter 40). Further research in this area is needed for a better understanding of diet and the development of disease, especially cancer.
Drug category/drug Anticoagulants
Food/nutrient Dietary vitamin k (e.g., green leafly vegetables, green tea, dairy product/meat) Folic acid
Drug-food effect or cautions Decrease or loss of anticoagulant effect
Antiseizure agents -phenytoin (Dilantin) Antidepressants -trazodone (desyrel) -tricylic antidepressant
Long-term drug use may increase folic acid requirement Food slows drug absorption Riboflavin requirements may increase with amitriptyline (elavil)or imipramine (tofranil) Drug should not be taken with high fat diet Food increases drug absorption Foods may inconsistenly alter bloavailability of methimzoale Drug may increase folic acid requirements; long-term therapy may require vitamin D suplements for
Food Riboflavin
Antidiabetic agents -glyburide (micronase, diabeta) -troglitazone (rezulin)
High fat diet
Food
Antithyroid agents -methimazole (tapazole)
Food
Barbiturates -phenobarbital -mephobarbitol
Folic acid
(mebaral)
osteomalacia
