Nutrition is a basic human need that changes throughout the life-cycle and along the wellness-illness continuum. Food provides nutrition for the body and mind. Eating is not only necessary in life, but it may also be a source of pleasure, pass time, a social event, a political strategy, a religious symbol, a cultural emblem, or an integral component of medical treatment. Because nutrition is vital for life and health, and poor nutrition can seriously decrease one’s leva, of wellness, therefore it is a vital component of nursing.
Nutrition is the science of food and nutrients and of t, the process by which an organism takes them in and uses them for producing energy to grow, maintain function, and renew itself. Nutritional status is the condition of the body resulting from the use of essential nutrients available to it. A client, nutritional status may be good. fair, or poor depending on the intake of dietary essentials, on the relative need for them, and on the body’s ability to use them. A good nutritional status is essential for normal growth, development, and functions of the organs, or normal reproduction, growth, and maintenance for optimal activity and working efficiency, for resistance to infection, and for the repair of injury or damage.
Factors Affecting Nutritional Status
A person's dietary pattern is usually slow to change because food habits are deeply rooted in the past. Food choices have always been influenced by non-nutritional factors including religious taboos, ethnicity, gender roles, and social status.
1.Physiologic and Physical Factors
Developmental considerations: Throughout the life cycle, the nutrient needs keep changing in relation to growth, development, activity, and age-related change in metabolism and body composition. Periods of intense growth such as infancy, adolescence, pregnancy, and lactation cause increased nutrient needs. Nutritional needs usually stabilize during adulthood although older people may need more or less of some nutrients. Age influences not only nutrient requirements but also food intake.
2. Sociocultural and Psychosocial Factors
Dietary choices or restrictions are also influenced by culture, religion, and personal feelings and meanings associated with food.
People eat for many reasons. In addition, to satisfy hunger and provide nutrition, food may signify a celebration, a social gathering, reward, or a punishment. We can offer food to express love and approval or withhold it to express disapproval. Some people use various foods to indicate caring or to give comfort and reassurance during times of stress or unhappiness. Mealtime may evoke memories of family discussions, laughter, and enjoyable times.
Emotional states such as boredom, anger, depression, or loneliness, stress can influence the quality and quantity of the food eaten. Emotions can lead to under-eating or overeating. Emotions can also influence poor eating habits. Overeating can be a compensatory mechanism to cope with stress. Bulimia nervosa means psychogenic insatiable overeating.
3.Religion
Dietary restrictions associated with religion might affect a client’s nutritional requirements.
4. Economics
The adequacy of a person’s food budget affects dietary choices and patterns. The increasing cost of food coupled with limited purchasing power may result in a decrease in the nutritional quality of the diet.
5 Culture
Culture influences what is eaten, how it is prepared, and what combinations of food are permitted! The variations in food choices within a culture also depend on the income levels and availability of food.
6.Lifestyle Factors
Lifestyle factors are closely related to food habits. Food habits refer to what people eat and the way they eat. Food habits are developed from total life experiences and are resistant to change. Food habits are more closely linked to association with others and the attitude towards food and its nutritive value.
Factors Affecting Nutritional Intake
A combination of factors can affect an individual's food intake These factors can also result in a decrease or increase in food Intake.
Decreased Food intake
There are various reasons for a decreased food intake:
1.Anorexia, which may be related to systemic or local diseases.
2. Psychosocial causes such as fear, anxiety, depression, pain.
3.Impaired ability to smell and taste.
4. Can develop secondary effects to drug therapy or medical treatment.
5. Clients who have difficulty in chewing and swallowing.
6.Clients with chronic gastrointestinal problems.
7.Clients who have undergone certain surgical procedures.
8. Clients on the inadequate food budget.
9.Belief systems of clients.
10.Not is able to afford due to poverty.
11.Beauty consciousness.
This may lead to obesity. Obesity presents a series of health problems, physically, socially, and emotionally.
Obesity
1. Increases the risk for numerous medical problems.
2. Increases the risk associated with surgery.
3. Increases the risk for complications during pregnancy, labor, and delivery.
4, Increases mortality and morbidity.
General Assessment of Nutritional Status
The components of nutritional assessment include health history (including diet history), evaluation of food intake, physical examination, and diagnostic tests.
In order to carry out this assessment, a registered dietitian is contacted, The various methods used to take dietary history are as follows:
1. 24-Hour recall method.
2. Food frequency questionnaire.
3. Food diary: It is a written record of food intake maintained for a specified period of time usually 3 to 7 days.
4. Household food consumption.
Evaluation of food intake is done for adequacy. Three methods are used:
1. Food group method.
2. Nutrient composition method.
3. Calorie count.
A physical examination will help to detect physical signs of nutritional deficiencies. Anthropometric measurements are used to determine body dimensions. In children, this is used to assess growth rate, in adults they can give an indirect measurement of body protein and fat stores.
1. Height and weight measurement.
2. Body mass index (BMI) (Quetelet’s index)
BMI = Weight in kilograms/square of height in meters.
Normal BMI = 18.5-24.5
3. Body composition
-Triceps skinfold measurement
-Mid-arm muscle circumference
-Mid-arm circumference
Diagnostic Tests
The most common laboratory indices of nutritional status are:
-Serum parvalbumin
-Albumin
-Transferrin
-Lymphocyte count
-Haemoglobin
- Haematocrit
-Urine specific gravity
- 24-Hour urine tests
Nursing Diagnoses (NANDA)
1.Imbalanced nutrition: The nutrition less than the bod requirements related to-
-malabsorption.
-an inability to ingest or digest food.
-increased body requirements.
2.Imbalanced nutrition: The nutrition more than the body requirements related to-
-decreased thyroid function leading to a decrease in metabolism.
-excessive intake in relation to metabolic needs.
- dysfunctional eating pattern.
3.Risk for imbalanced nutrition: The nutrition more than body requirement related to inappropriate use of supplements.
4.Impaired swallowing related to-
- neuromuscular impairment.
- mechanical obstruction.
- fatigue.
-limited awareness.
-reddened irritated oropharyngeal cavity.
Characteristics of Well-Nourished Person
1 Normal weight and height for age, body build, and developmental stage.
2. Adequate appetite.
3. Active, alert, and able to maintain adequate span.
4 . Firm healthy skin and mucus membrane.
5. Erect posture with straight arms and legs.
6. Well-developed muscle without excess body fat.
7. Normal schedule of tooth eruption and healthy teeth and gums.
8. Normal urinary and bowel elimination patterns.
9.Normal sleep patterns.
10.Normal hemoglobin, hematocrit, and serum protein levels.
11. Absence of diet-related abnormalities.
Diet in Sickness
Diet is as important as medicine in the treatment of diseases. Modification in the diet or in the nutrients can cure certain decreases. For example, a client suffering from a peptic ulcer needs a bland diet for his recovery; a salt-free diet can reduce blood pressure in a client with hypertension.
For everyone, eating food is an enjoyment. When the person is ill the food intake becomes a problem. The nurse’s responsibility in the care of the sick in regard to nutrition can be analyzed into four major areas:
1.Assisting clients to obtain needed nourishment either through feeding or assisting with eating, e.g., tube feeding, feeding a helpless client to eat his food, etc.
2.Motivating client to eat.
3. Assisting clients to obtain needed nourishment by proper planning of the diet.
4. Assisting clients with special problems about therapeutic diets, e.g., helping a client to accept a salt-free diet.
principles Involved in the Diet Therapy
1. The diet must be planned in relation to changes in metabolism occurring as a result of the disease.
2. The diet must be planned according to the food habits of the client based on culture, religion, socioeconomic status, personal preferences (likes and dislikes), physiological and psychological conditions, hunger, appetite, and satiety.
3 As far as possible, changes in the diet should be brought gradually and adequate explanations are given with the changes made if any.
4.In short and acute illness, the food should not be forced because his appetite is very poor but he may soon recover the normal appetite. But in prolonged illness, it is essential to provide an adequate amount of food to prevent wasting all tissues.
5. Whatever the diet prescribed, there should be a variety of foods for selection.
6. Small and frequent feeds are preferred to the usual three meals.
7. Hot foods should be served hot and cold foods should be served cold.
Modification of Nutrients in Therapeutic Diet
Carbohydrates are well tolerated and are necessary to maintain the stores of liver glycogen. It is particularly important in Clients with high fevers, liver diseases, hyperthyroidism, etc. In the absence of carbohydrates, the body fat may be used fat, maybe energy which may result in the formation of ketone bodies and they accumulate in the blood a condition known as ketosis. An adequate amount of carbohydrate intake can prevent ketosis. Carbohydrates are given in easily digested forms such as glucose, sugars, gruels, etc.
The fat is often not tolerated in illness especially if nausea and vomiting are present. An adequate amount of carbohydrates can replace the requirement of the body for fat.
In illness, especially when there is an infection, the protein metabolism is usually greatly increased because of the increased destruction of protein. If an adequate amount of protein is not given, the body will use up the tissue proteins and the client will lose weight. In illness, unless there are kidney and liver damages, the protein intake should be high.
The requirements of minerals should be maintained in illness especially that of calcium and iron. Sodium and potassium may sometimes need to be restricted especially when there is hypertension, edema, ascites, etc.
Vitamins must always be adequate. Fat-soluble vitamins, vitamin A and vitamin D need to be added if the client is on a fat-restricted diet. In the pathological conditions of the gastrointestinal tract and in antibiotic therapy, vitamin B complex should be supplied. The demand for vitamin C is greatly increased in fevers and is especially necessary for the healing of wounds after surgery.
Fluids are very important to prevent dehydration, especially when the fluid is lost from the body in excess amount in the form of sweat, urine, blood, and other body fluids. Clients with high fevers, vomiting, diarrhea, and bleeding are prone to dehydration unless extra fluid cannot be given by mouth, they must be given intravenously. Fluid with added proteins is necessary for a client who is fed on liquid diets for along time.
Total daily fluid intake averages from 2 to 3 L for an average adult in normal conditions. It is the nurse's responsibility to maintain the fluid balance by maintaining the Intake and output chart carefully. The amount of fluid intake would be sufficient in the case of adults if there is 1000 to 1500 ml of urine produced in a day. Infants require a higher amount of fluid compared to the adult requirements. They need 150 ml of fluid per kg of body weight.
factors Affecting Appetite
The appetite is increased by:
1. Sight and smell of food (attractive serving).
2. Food preference (likes and dislikes of the individual).
3. Physical and mental relaxation (freedom from hurry, worry, pain, stress, and fatigue).
4.Regularity in eating (spacing of meals).
5.Pleasant environment (attractive and cheerful atmosphere).
6. Exercise.
The appetite is decreased by:
1. Physical and mental fatigue.
2, Hurry, worry and fear.
3. Unpleasant environment and experiences.
4. Lack of exercise.
5. Irregular meals.
6. Long spacing of meal timings.
Types of Diets Served in the Hospital
Full Diet
It is a regular, well-balanced, and normal diet. It is either vegetarian or non-vegetarian. It is served for clients who do not need any modification.
Soft Diet
It is a full diet but consisting of food substances that are easy to chew and digest. Some clients, particularly the aged and convalescing client cannot take food that required chewing or food that is difficult to digest.
