Ask how your patients want materials (recorded, large print [18-point type], via e-mail, etc.). Also, figure out a system that works for the patient to mark medications. For example, have the pharmacist put three rubber bands on a bottle of pills that should be taken three times a day.

Always read aloud what you write in the medical record.

Have all staff give their names and titles when entering the examination room, even if they have name tags.

Speak directly to the patient rather than asking the sighted person in the room, “Does he...?”

If the patient has a guide dog, ask before petting or greeting the animal.

Tell the patient what procedure you are about to do, and let him or her feel the equipment first if possible. Have the patient perform dressing changes, etc., that he or she will need to do at home, so you can coach.

Say “goodbye” before leaving the room so the patient is not left talking to himself or herself.

If you forget any of these tips and the interaction goes poorly, apologize and try again. It won't be the first time someone has been awkward about the patient's visual impairment, and it won't be the last. We appreciate being allowed to tell you how we prefer things.

Altered ability to chew related to loss of teeth, ill-fitting dentures, and gingivitis

Loss of senses of smell and taste

Decreased peristalsis in the esophagus

Gastroesophageal reflux

Decreased gastric secretions

Slowed intestinal peristalsis

Lowered glucose tolerance

Reduction in appetite and thirst sensation

Nutritional deficiencies related to alcohol intake

Loss of appetite associated with depression and loneliness

Physical handicaps

Low income

Malnutrition

Increased risk for drug-nutrient interactions

According to BMI guidelines, a person with a BMI below 18.5 is underweight, a person with a BMI of 18.5-24.9 is a healthy weight, and a person with a BMI of 25-29.9 is overweight, a person with a BMI of 30-39.9 is obese, and a person with a BMI of 40 or higher indicates extreme obesity.

BMI may not be accurate for certain groups of people, such as athletes, people with muscular build, people with edema or dehydration, and older people and others who have lost muscle mass.

Ethnic differences exist in the relationship between BMI and health risks.

Overweight and obesity are defined differently for children and teens than for adults.

Children are still growing and boys and girls mature at different rates.

BMIs for children and teens compare their heights and weights against growth charts that take age and sex assigned at birth into account. This is called the BMI-for-age percentile.

Less than 5th percentile=underwieght

5th percentile to less than 85th percentile=helath weight

85th percentile to less than 95th percentile- overweight

95th percentile or greater=obese

A significant intentional or unintentional change in the patient's weight can also indicate poor nutritional status and health problems.

This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home.

A growing number of patients are turning to vegetarianism as a diet-based therapy to manage symptoms and promote wellness.

Although a vegetarian diet is included in the National Center for Complementary and Alternative Medicine’s biologically based practice domain, little is known about relationships among vegetarian diet-based therapies and the management of symptoms and/or promoting wellness.

Vegetarian diets are totally devoid of red or white meat. However, there are numerous non–meat diet variations. For example, some vegetarian diets are restricted to plant products (plant based) only, whereas others include eggs and dairy products.

Increased food intake may lead to overweight and obesity.

Obesity presents a serious health problem physically, socially, and emotionally.

More than two-thirds of adults in the U.S. are considered to be overweight or have obesity.

An imbalance between calories consumed and calories expended, resulting from an excess caloric intake and decrease in energy expenditure, leads to the gradual accumulation of weight. An increase in physical inactivity due to lifestyle is also a cause of weight gain.

People whore are overweight or obese may be subject to weight bias and stigma and this could lead to feelings of rejection, shame or guilt, depression, isolation, and perceiving oneself as a failure.

Obesity is resistant to treatment, and requires modification of behavior and lifestyle.

Food intake may decrease for various reasons. Patients with a BMI of less than 18.5 are considered underweight.

Anorexia, or lack of appetite, may be related to systematic or local diseases; numerous psychosocial causes, such as fear, anxiety, depression, or pain; and impaired ability to smell and taste-- or it may occur secondary to drug therapy or medical treatments.

Others who may have a limited food intake include those who have limited food intake include those who have difficulty chewing and swallowing, those with GI problems, those who undergo certain procedures, and those with some chronic illnesses, and those with inadequate food budgets.

Dietary guidelines are the recommended amount of each form of nutrient we should be consuming each day

They are science-based strategies compiled by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture.

A new edition is published q 5 years

People are encouraged to choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support adequate nutrition, and reduce the risk of chronic disease.

Throughout the life cycle, nutrient needs change in growth, development, activity, and age-related changes in metabolism and body composition.

Periods of intense growth and development, such as during infancy, adolescence, pregnancy, and lactation, can cause an increase in nutrient needs.

Infants: Nutritional needs per unit of body weight are greater during infancy and childhood than at other developmental stages. The period from birth- to age 1 is the most rapid period of growth.

Toddlers and Preschoolers: There is continued growth and development during this stage, but the growth rate slows.

Mobility, autonomy, and coordination increase, as do muscle mass and bone density,

Toddlers and preschoolers can feed themselves verbalize food likes and dislikes, and occasionally use food to manipulate their parents.

Children in this age group often experience an inadequate intake of fruits and vegetables and excessive intake of sweetened fruit drinks.

School-age children: The 6-12-year-old children have and uneven individualized and sometimes erratic slow progressive physical growth. Permanent teeth erupt, the digestive system matures, socialization and independence increase, and at this stage, the body accumulates reserves in prep for the upcoming adolescent growth spurt.

The focus is on health promotion. Increasing energy requirements need to be balanced with food of higher nutritional value.

The appetite improves but still may be irregular

Adolescents: ages 11-20, this is a period of rapid physical, emotional, social, and sexual maturation.

It is marked by intense psychosocial growth, family/caregiver conflict, and social and peer pressure.

Children in this age group tend to consume inadequate amounts of fruits vegetables, whole grains, and dairy products.

Nutrient needs especially calories, protein, calcium, and iron increase to support growth.

Health consciousness in teenagers could lead to an eating disorder.

Adults: With adulthood, growth ceases. This age is also marked by a decline in the BMR with each decade.

Adults may become more aware of the preventative role of exercise, or pressures of work and family may lead to a decline in physical activity and exercise.

Pregnant and Lactating Persons: During pregnancy, the fetus, maternal tissues, and placenta grow dramatically. Weight gain occurs, and GI changes as a result of the pregnancy may result in nausea, vomiting, heartburn, or constipation.

Nutrient needs during pregnancy increase to support growth and maintain maternal homeostasis, particularly during the second and third trimesters.

Older Adults: Because the BMR decreases and physical activity and loss of lean body mass, energy expenditure decreases.

Because of the changes related to aging, the caloric needs of the body decrease.

The need for nutrients however increases especially protein, calcium, b12, and vitamin D.

The alteration in nutrient requirements that results from illness and trauma varies with the intensity and duration of the stress.

For instance, fevers increase the need for calories and water.

Trauma such as major surgery, burns, and crush injuries, is followed by hormonal changes that profoundly affect the body's nutrients.

To preserve or replenish body nutrient stores and to promote healing and recovery, nutrient requirements increase dramatically in the adaptive phase after stress.

Chronic disorders can also alter nutrient requirements.

Mental health problems, such as depression and confusion, can cause pt to forget to eat or lack motivation to eat, leading to malnutrition.

Alcohol Use Disorder: It is a pattern of alcohol use that includes any alcohol that puts your helath or safety at risk or causes other alcohol-related problems and includes binge drinking ( a drinking pattern where a minimum of 4-5 drinks are consumed within 2 hours)

Alcohol can alter the body's use of nutrients and thereby its nutrient requirements, by numerous mechanisms

The toxic effect of alcohol on the intestinal mucosa interferes with normal nutrient absorption; thus, requirements increase as the efficiency of absorption decreases.

The need for B vitamins increases because they are used to metabolize alcohol.

Alcohol can also influence nutrient metabolism by impairing nutrient storage, increasing nutrient catabolism, and increasing nutrient excretion.

Medication Use: Many drugs have the potential to influence nutrient requirements, Nutrient absorption may be altered by drugs that 1.) change the pH of the GI tract 2.) increase GI motility, 3.) damage the intestinal mucosa, or 4.) bind with nutrients, rendering them unavailable to the body

Nutrient metabolism can be altered by drugs that 1.) act as nutrient antagonists 2.) alter the enzyme systems that metabolize nutrients, or 3.) alter nutrient degradation.

Some drugs alter renal reabsorption of nutrients and therefore, may increase or decrease nutrient excretion.

Megdoses of Nutrient Supplements: Because some nutrients compete against each other for absorption, an excess of one nutrient can lead to a deficiency (or increase the requirement) of another, especially if one is absorbed preferentially.

Dietary supplements can have a drug-like effect and may interact with food and medications.

Dietary choices or restrictions also are influenced by social determinants of health, cultures, religion, and personal feelings and meanings associated with food.

Healthcare providers need an understanding of a patient's cultural values, beliefs, and practices to provide culturally acceptable care.

Acquire basic information about health beliefs and practices of various cultural groups in your health care setting. This provides a basis for assessing patients’ beliefs and practices. 

Recognize, however, that within all cultures and ethnic groups, there are members who do not hold all the values of the group.

Ask specifically about the use of folk or home remedies prescribed by nontraditional healers. Determine the patient’s language preferences for spoken and written communication. 

Utilize printed or audiovisual information that is in the language spoken by your patients. 

Promote healthy food choices by identifying healthy traditional food practices and encouraging their use. Encourage cultural sensitivity in health care workers in your particular setting. 

Recognize that diversity exists within cultural groups. For example, the Hispanic population includes Mexicans, Cubans, Puerto Ricans, and other Latino groups. Emphasize threads or messages in health teaching that are common to all cultures (e.g., concern about family, faith, home). 

Help culturally diverse patients to value and understand the importance of communicating concerns and asking questions about prescribed dietary practices.

A 24-hour dietary recall (24HR) is a structured interview intended to capture detailed information about all foods and beverages (and possibly, [glossary term:]dietary supplements) consumed by the respondent in the past 24 hours, most commonly, from midnight to midnight the previous day.

A key feature of the 24HR is that, when appropriate, the respondent is asked for more detailed information than first reported. For example, a respondent reporting chicken for dinner or a sandwich for lunch would be asked about the preparation method and type of bread.

This open-ended response structure is designed to prompt respondents to provide a comprehensive and detailed report of all foods and beverages consumed.

They are either not synthesized in the body or are made in insufficient amounts.

Must be provided in the diet through supplements, and they supply energy and build tissue (such as carbs, fats, and proteins)... these are referred to as macronutrients.

Micronutrients are vitamins and minerals and are required in smaller amounts to regulate and control body processes.

Food intake may decrease for various reasons. Patients with a BMI of less than 18.5 are considered underweight.

Anorexia, or lack of appetite, may be related to systematic or local diseases; numerous psychosocial causes, such as fear, anxiety, depression, or pain; and impaired ability to smell and taste-- or it may occur secondary to drug therapy or medical treatments.

Others who may have a limited food intake include those who have limited food intake include those who have difficulty chewing and swallowing, those with GI problems, those who undergo certain procedures, and those with some chronic illnesses, and those with inadequate food budgets.

Anthropometric measurements are noninvasive quantitative measurements of the body. According to the Centers for Disease Control and Prevention (CDC), anthropometry provides a valuable assessment of nutritional status in children and adults. Typically they are used in the pediatric population to evaluate the general health status, nutritional adequacy, and the growth and developmental pattern of the child. Growth measurements and normal growth patterns are the gold standards by which clinicians assess the health and well-being of a child. In adults, body measurements can help to assess health and dietary status and future disease risk. These measurements can also be used to determine body composition in adults to help determine underlying nutritional status and diagnose obesity.

Nutritional risk screening tools are very helpful in the daily routine to detect potential or manifest malnutrition in a timely manner. Such tools should be easy to use, quick, economical, standardized, and validated. Screening tools should be both sensitive and specific, and if possible, predictors of the success of the nutritional therapy. Nutritional screening should be part of a defined clinical protocol that results in a plan of action if the screening result is positive.

A gastrostomy tube, often called a G tube, is a surgically placed device used to give direct access to your child's stomach for supplemental feeding, hydration or medicine.

G tubes are used for a variety of medical conditions, but the most common use is for feedings to enhance your child’s nutrition. When a child is unable to eat enough food by mouth, a G tube helps deliver enough calories and nutrients to support their growth.

Feeding intolerance is highly prevalent and is associated with worse outcomes, especially in critically ill patients. It is thus imperative to standardize assessment of GI function and a bedside examination of the abdomen

They are either not synthesized in the body or are made in insufficient amounts.

Must be provided in the diet through supplements, and they supply energy and build tissue (such as carbs, fats, and proteins)... these are referred to as macronutrients.

Micronutrients are vitamins and minerals and are required in smaller amounts to regulate and control body processes.

Nonessential nutrients don't have to be supplied through dietary sources because they either are not required for body functioning or are synthesized in the body in adequate amounts.

Some nutrients can be converted to others in the body. For example, the body converts excess carbohydrates and proteins into fat and stores them as triglycerides.

3 supply nutrients: (carbohydrates, proteins, lipids)

3 are needed to regulate body processes (vitamins, minerals, and water)

Energy in the diet is measured in kilocalories.

only carbs, proteins, and fat provide energy.

Vitamins and minerals needed for metabolism energy don't provide calories

Energy in the body is used to carry out any kind of activity whether that be voluntary or involuntary

Commonly known as sugars, starches, are organic compounds composed of carbon, hydrogen, and oxygen

They are relatively easy to store, making them the most abundant and least expensive source of calories in the diet worldwide

The number of molecules within the structure determines the classification of carbohydrates. They are classified as simple (monosaccharide and disaccharide) or complex (polysaccharide) sugars.

Carbohydrates are more easily digested than fats and proteins. All carbs are converted to glucose for transport through the blood or the use of energy.

Glucose is transported from the GI tract, through the portal vein, to the liver. The liver stores glucose and regulates its entry into the blood. Hormones insulin and glucagon are responsible for keeping glucose levels fairly constant.

Through a series of steps, cells oxidize (burn) glucose to provide energy, carbon dioxide, and water.

Unlike protein and fat, glucose is burned efficiently and completely and does not leave a toxic product for the kidneys to excrete.

When the supply of glucose exceeds what is needed for energy and for maintaining serum levels, it is stored.

When glycogen stores are adequate, the body converts excess glucose to fat and stores it as triglycerides in adipose tissue.

4 calories per gram. It is recommended that carbs provides 45%-65% of total calories for adults

A vital component of every living cell.

More than 1000 different proteins are made by combining various amounts and proportions of the 22 basic building blocks known as amino acids.

Protein is required for the formation of all body structures, including genes, enzymes, muscle, bone matrix, skin, and blood

Complete proteins contain sufficient amounts and proportions of all the essential amino acids to support growth, whereas incomplete proteins are deficient in one or more essential amino acids.

In general, animal proteins are complete, and plant proteins are incomplete. Except for soy and quinoa

The major function of protein is to maintain body tissues that break down from normal wear and tear and to support the growth of new tissue

Protein intake should contribute to 10%-35% of total caloric intake

Fats in the diet are insoluble in water, and therefore, insoluble in blood.

Like carbohydrates, they are composed of carbon, hydrogen, and oxygen.

95% of lipids in the diet are in the form of triglycerides, the predominant form of fat in food and the major storage form of eating in the body.

Compound lipids and derived lipids constitute the remainder of the fats ingested.

Food fats contain mixtures of saturated and unsaturated fatty acids. The difference in the degree of saturation depends on the amount of H in fat molecules.

Unsaturated- remains liquid at room temp

Cholesterol is a fat-like substance found only in animal products. It is not an essential nutrient; the body makes sufficient amounts. It is an important component of cell membranes and is especially abundant in the brain and nerve cells.

High cholesterol levels are associated with increased risk for atherosclerosis.

Fat digestion occurs largely in the small intestine.

Bile excreted by the gall bladder emulsifies fat to increase the surface area so that pancreatic lipase can break down fat more effectively.

Fats are the most concentrated source of energy in the diet, providing 9 calories per gram.

Minerals are inorganic elements found in all body fluids and tissues in the form of salts or combined with organic compounds (iron in hemoglobin)

Some minerals function to provide the structure within the body, whereas others help to regulate body processes

Minerals, which are elements, are not broken down or rearranged in the body but rather are contained in the ash that remains after digestion.

excessive soaking and cooking in water can cause loss of minerals from food

Major minerals are present in the body in amounts greater than 5g and include calcium, phosphorus, sulfur, sodium, chloride, potassium, and magnesium

Trace elements of minerals present in the body in amounts less than 5; they are not less important than major minerals and include: iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, and iodide

As the major body constituent present in every body cell, water accounts for between 50%-60% of the adult's total weight.

About 2/3 of the body's water is contained within cells (intracellular fluid); the remainder is extracellular fluid.

Water is more vital to life than food bc it provides the fluid medium necessary for all chemical reactions, it participates in many reactions, and it is not stored in the body

Water acts as a solvent that s=dissolves many solutes, thereby aiding in digestion, absorption, circulation, and excretion.

Sources of water in the diet include not only beverages but also solid foods, which contain between 10%-98% water.

Water is also produced through the metabolism of carbs, protein, and fats

insertion of an NGT is typically a clean (not sterile), “blind” procedure, meaning the person performing the procedure can’t visualize where the tube is going in the client’s body as they are inserting it. Insertion involves passing the tube through the nose, along the nasal floor, through the pharynx and down the esophagus until the proximal tip of the tube rests in the client’s stomach

NG tubes are inserted and removed by nurses and other health care providers. Due to the invasive nature of the placement process, privately ask the client if they desire visitors to leave the room during placement or removal of the NG tube.

Nurses provide the daily care of NG tubes, as well as the administration of nutritional formulas, medications, and other substances through the tube.

There are two types of contraindications for any procedure or intervention and are referred to as absolute and relative. An absolute contraindication means the procedure or intervention may produce a life-threatening situation and should be avoided if possible.

A relative contraindication means caution should be used because the possibility of an adverse event is possible; therefore, benefits must outweigh the risks.

Relative contraindications include esophageal trauma, especially if caustic substances were ingested. Coagulation abnormalities or anticoagulation therapy may cause bleeding from the tissue trauma from tube placement. For clients with previous gastric bypass surgery, hiatal hernia repair, or abnormal GI anatomy (such as esophageal varices or strictures), NG tubes should be placed by a provider under endoscopy

In patients dependent on nasogastric or PEG tubes, drugs are often crushed into a powder and suspended in water to enable its passage through the tubes. Typically, when drugs are crushed, multiple tablets are crushed together and then mixed and put in one sachet.

Verify order Crush and dissolve medication in 20 mL water in an individual medication cup Hand hygiene Flush NG Tube with 30 mL of water Administer medications with 10 mL water flushes between each medication Flush with 30-60 mL water when complete Document administration

A nasogastric tube (NG tube) is a thin, flexible tube that is inserted through the nose and down the esophagus into the stomach. NG tubes are used to deliver food and medication to people who are unable to eat or drink by mouth, and to remove stomach contents to relieve pressure or remove poisons.

NG tubes are often used for short-term tube feeding and to deliver oral medications to hospitalized people. They can also be used to suction out stomach contents to relieve pressure or remove poisons. In some cases, NG tubes may also be used to deliver fluids to people who are dehydrated.

Delayed gastric emptying (DGE) is a major cause of undernutrition that can be overcome using nasointestinal (NI) feeding, but tube placement often fails.

They must understand the manner in which these devices work, their purpose, and ways to prevent complications. Although inserting an NG tube is a commonly performed procedure, it can cause significant risk to the client if performed improperly.

Nursing responsibilities associated with caring for a client with an enteral tube include the following: