Nursing Skills in Nutrition, Hydration and Elimination

Sheila Cunningham,Tina Moore

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351065689
• Edition: 1
• Topic: Medicina
• Subtopic: Tecniche infermieristiche

The body needs a constant supply of nutrients and water in order to survive, with water being required for the transportation of nutrients to cells and also for the transportation of waste out of the body.

This practical pocket guide focuses on what you need to know to support your patients' health and comfort. It looks at:

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• The anatomy and physiology of the gastrointestinal system

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• The anatomy and physiology of the renal system

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• Elimination and associated skills

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• Catheterisation

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• Nutrition

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• Hydration

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• Fluid balance

This competency-based text covers relevant key concepts, anatomy and physiology, lifespan matters, assessment and nursing skills. To support your learning, it also includes learning outcomes, concept map summaries, activities, questions and scenarios with sample answers, and critical reflection thinking points.

Quick and easy to reference, this short, clinically focused guide is ideal for use on placements or for revision. It is suitable for pre-registration nurses, students on the nursing associate programme and newly qualified nurses.

CHAPTER 1

Nutrition

Tina Moore

Overview

The importance of maintaining a healthy dietary intake and exercise has been advocated within nursing and now society for many years. Careful monitoring and promotion of adequate nutritional input are an essential part of the nurse’s role to promote recovery and prevent additional problems for the patient.

Link to Future Nurse Proficiencies (Nursing and Midwifery Council [NMC] 2018)

Platform 4 Providing and evaluating care: specifically 4.6

Skills annexe B, part 1: Procedures for assessing people’s needs for person-centred care. Specifically 2.6: accurately measure weight and height, calculate body mass index and recognise healthy ranges and clinically significant low/high readings.

Skills annexe B, part 2: Procedures for the planning, provision and management of person-centred nursing care. Specifically 5.1: observe, assess and optimise nutrition and hydration status and determine the need for intervention and support. 5.7: manage artificial nutrition and hydration using oral, enteral and parenteral routes. 5.9: manage fluid and nutritional infusion pumps and devices.

Expected knowledge

• An overview of basic food groups

• Factors affecting the individual’s ability to eat a healthy diet

Introduction

As with the recording of fluid balance (next chapter), nutrition within some sectors of nursing, does not receive the amount of attention that it should and would benefit from improvements. Nutrition is essential for the functional maintenance and survival of cells. During periods of ill health, an individual’s daily requirements can double. Another ‘at-risk’ group is the ageing population. The problem here is that the older person’s nutritional requirements have not been so well defined. In addition, both lean body mass and basal metabolic rate decline with age, resulting in their energy requirement (per kilogram of body weight) also being reduced, and making this group particularly vulnerable to malnutrition. Malnutrition is the state in which there is a deficiency in energy, protein and other essential nutrients, causing adverse effects on body tissue, function and composition. Signs and symptoms of malnutrition include: weight loss that is unplanned; increased susceptibility to infections; delayed wound healing; irritability; osteoporosis; muscle loss/ weakness.

Disorders that have been linked to poor nutritional intake can include: cancer, diabetes, cardiovascular and cerebrovascular disease, and osteoporosis.

Content

Nutritional – body mass index assessment	Enteral feeding	Percutaneous endoscopic gastrostomy (PEG) feeding
Total parenteral nutrition (TPN)

Learning outcomes

• Demonstrate knowledge and understanding how to identify the importance of a balanced healthy nutritional intake

• Assess a patient’s nutritional status

• Recognise the signs and symptoms of factors contributing to a deteriorating nutritional state

• Differentiate the different types of nutritional support available

Key background

Conducting a comprehensive nutritional assessment and ensuring that the patient’s nutritional needs are met is very much part of the nurse’s role. Nurses should work in collaboration with a nutritionist. Adequate nutrition is vital for physical and psychological wellbeing, even to the extent that the patient’s quality of life can be improved.

At the time of writing the daily reference intakes for adults are: energy: 8,400 kJ/2,000 kcal; total fat: <70 g; saturates: <20 g; carbohydrate: at least 260 g; total sugars: 90 g; protein: 50 g; salt: <6 g. This is elaborated on in the ‘Eat Well Guide’ which is an interactive web resource that explains, in great detail, the type of food and food combinations that can be taken to maintain a healthy diet. The ‘Eat Well Guide’ can be found AT www.nhs.uk/live-well/eat-well/the-eatwell-guide.

Children have different nutritional needs. Between the ages of two and five, children should gradually move to eating the same foods as the rest of the family in the proportions shown in the ‘Eat Well Guide’. Therefore this guide does not apply to under two year olds. It has long been recognised that primarily breast milk (for at least six months) is the most valuable feed to promote the growth, development and overall health of babies, because breast milk contains the nutrients that babies require, in addition to antibodies to help boost their immunity and protect them from various common childhood infections. The World Health Organization (WHO 2017) recommends that infants should receive complementary foods with continued breastfeeding up to two years of age or beyond.

To help eat healthily many food packages are now colour coded. The red, amber and green colour coding on the front of food packs helps to quickly assess whether a food is high (red), medium (amber) or low (green) in fat, saturated fat, sugars or salt.

There are a number of routes and devices that can support meeting the needs of individuals during their period of ill health.

FIGURE 1.1 Nutritional – body mass index assessment

FIGURE 1.2 Enteral feeding

FIGURE 1.3 Percutaneous endoscopic gastrostomy (PEG) feeding

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