Nursing Tips: Nutrition

Vitamin C deficiency is known as scurvy, and it causes swollen/bleeding gums, tooth loss, and poor wound healing. 

Vitamin B9 (folic acid) is needed to prevent neural tube defects in a developing fetus.

With Cushing's Syndrome, restrict fluid and sodium but increase the patient's intake of protein, calcium, and vitamin D.

Carbohydrates and protein each provide 4 kcal of energy/gram. Lipids provide 9 kcal of energy/gram.

Ask your patient about any dietary considerations they may have in relation to their religion rather than assuming!

A nursing nutritional assessment includes a patient's height/weight/BMI, assessing for recent weight loss/gain assessing for difficulty swallowing or chewing, and identifying food allergies, diet restrictions, and religious/cultural dietary preferences.

Celiac disease is the inability to digest gluten. Patients with celiac disease CAN eat: dairy, rice, corn, potatoes, eggs, fruits and vegetables. Foods containing wheat, rye, and barley should be avoided.

A negative nitrogen balance indicates insufficient PROTEIN intake (due to illness, malnutrition, or aging).

It means the patient is using protein faster than it is being synthesized.

A key function of Vitamin D is that it helps with absorption of calcium.

Sunlight is a key source of Vitamin D! Other sources include: fortified milk, fatty fish, and eggs.

3,500 calories = 1 pound.

To lose 1 pound a week, patients need to decrease their daily caloric intake by 500 calories.

The DASH diet (for patients with hypertension) emphasizes low sodium, high potassium, and high calcium foods.

Do NOT administer any medications through a patient's parenteral nutrition (i.e. TPN) IV line! You need to use a separate line.

Fat-soluble vitamins are: Vitamin A, D, E, K.

Best practices for patients with DYSPHAGIA

Vitamin C increases the absorption of iron. If your patient is taking an iron supplement, be sure they eat foods rich in Vitamin C! Examples: citrus fruit or juices, tomatoes, green leafy vegetables, peppers.

Cholesterol intake should be limited to 200-300 grams/day to prevent heart disease.

Important conditions caused by B-complex vitamin deficiencies:
Deficiency of Thiamin (B1) = Beriberi
Deficiency of Riboflavin (B2) = Cheilosis, Glossitis
Deficiency of Folate (B9) = Neural tube defects (in utero)
Deficiency of Cobalamin (B12) = Pernicious anemia

There is an INVERSE relationship between Phosphorus and Calcium. If calcium is high, phosphorus is low. If calcium is low, phosphorus is high.

If your patient's next parenteral nutrition (i.e. TPN) line is unavailable, administer 10-20% dextrose in water until it arrives!

Nutrition recommendations to prevent DUMPING syndrome:

• Consume small frequent meals.
• Do not drink liquids with meals.
• Include protein and fat at each meal.
• Avoid dairy products and concentrated sugar.

Patients with Diverticulitis should avoid seeds and husks. Avoid: popcorn, tomatoes, berries.

Patients with cholecystitis should consume a LOW FAT diet.

Patients with Chronic Kidney Disease (CKD) should LIMIT intake of phosphorus, potassium, and sodium.

If your patient has hypoglycemia (blood glucose level under 70 mg/dL), provide a 10-20g carbohydrate. This could be a 4 oz juice or regular soda.

The MOST important side effect to know for BOTH hyperkalemia and hypokalemia is DYSRHYTHMIAS.

Chloride (Cl) expected range: 98 - 106 mEq/L HINT: I like my hot tub chlorinated, with a temperature between 98-106 degrees.

Somogyi phenomenon is MORNING hyperglycemia due to untreated OVERNIGHT hypoglycemia. To prevent Somogyi's phenomenon, provide a bedtime snack and insulin.

Stomatitis is inflammation of the mouth/lips. It is a common side effect of chemotherapy. If your patient has stomatitis, provide the following teaching:

• Do not use alcohol based mouthwash!
• Use a soft toothbrush.
• Avoid acidic, spicy, dry, or crunchy foods.
• Cut food is smaller bites.
• Use a straw.

Oral iron supplements can cause teeth staining!  Administer with a straw.

When evaluating a patient's nutritional status, be sure to check: albumin (normal range: 3.5-5) and prealbumin levels (normal range 15-36).