Nutrition and Oral Hydration

It is important to know the principles of nutrition, such as the basic food groups, their functions, and which foods fall within those groups. These include:

• Carbohydrates: Are converted to glucose, which the body uses for energy. Sources of carbohydrates include grain products (bread, pasta, and rice), fruits, milk, and products with high sugar content.
• Proteins: Are used to build and repair body tissue, such as muscles, and also for many essential body processes, such as nutrient transport and muscle contraction. Sources of protein include meat, poultry, fish, eggs, nuts, beans, peas, and lentils.
• Fats: Are used to insulate the body, provide energy, and store certain vitamins such as A, D, E, and K, which are soluble in fats and insoluble in water. Sources of fat include whole milk and milk products, oils, nuts, and certain meats.

Be familiar with general dietary guidelines, key nutritional concepts across a client’s life span, and types of diets appropriate for specific conditions, for example, which foods would be appropriate for a client with heart disease (foods with low fat and low cholesterol) or inappropriate (foods with high fat and high cholesterol). You should also be able to apply your knowledge of mathematics to nutrition (e.g., body mass index [BMI] calculations).

You can use the following to assess a client’s ability to eat:

Documented history

•  
  • From patient
  • Nutritional screening initiatives (NSIs)

• Anthropomorphic measures
  • Height, weight, and body size
  • BMI
  • Basal metabolic rate (BMR)
  • Distribution of body fat (obesity)
• Lab/diagnostic measures
  • Albumin levels
  • Total lymphocyte count (TLC)
  • Hemoglobin levels
• Ability to chew and swallow

Assess clients for specific food/medication interactions, and consider client choices regarding nutritional requirements and dietary restrictions. Also monitor client hydration status. For example, be familiar with the signs and symptoms of both edema (excess fluid) and dehydration.

For clients unable to eat on their own, nutrition can be provided through continuous or intermittent tube feedings. This includes nasogastric, enterostomy (surgical), or percutaneous tubes. You should know how to maintain the tube insertion site, monitor it for infection and proper function, as well as ensure that the proper volume of formula is getting through. You should also recognize mechanical or metabolic problems and intervene, as needed. These include:

• Formula selection
• Formula adjustment
• Skin irritation
• Clogging
• Aspiration

Monitor the client’s underlying condition to ensure the right dietary/feeding choices are made. Factors you must monitor include weight, protein measures, TLC, blood urea nitrogen (BUN), and creatinine levels, making adjustments as needed.