Nutrition and Hydration Discussion Assignment Paper
Nutrition and Hydration Discussion Assignment Paper
Geriatric patients have many nutritional and hydration concerns that impact their health and ability to acquire sufficient nutrients. Advanced practice nurses evaluating these patients must be able to account for all barriers that prevent elders from obtaining adequate nutrition, including medical conditions, transportation, finances, physiologic changes, and functional abilities.Nutrition and Hydration Discussion Assignment Paper When evaluating patients, it is important to consider how they eat, what their diet consists of, and whether they have any special dietary needs that are not being met. Assessment tools, such as the Lawton Instrumental Activities of Daily Living (IADL) Scale, are an integral part of this evaluation process as they help providers identify potential obstacles for patients. In this Discussion, you assess a patient at your current practicum site and consider strategies for improving any nutrition or hydration issues.Nutrition and Hydration Discussion Assignment Paper
To prepare for Nutrition and Hydration Discussion:
Review this week’s media presentation, as well as Chapters 28 and 29 of the Flaherty and Resnick text.
Assess a patient using tools for inpatient and long-term patient care, such as the Lawton IADL Scale. Note: You should coordinate this opportunity with the Preceptor at your practicum site.Nutrition and Hydration Discussion Assignment Paper
Consider whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Reflect on whether the patient is able to go out and get food to eat, cook meals, safely use the stove, etc.
Consider the patient’s diet and whether they have any special dietary needs due to medical conditions, such as congestive heart failure, end-stage kidney disease, diabetes, oral health issues, etc. Reflect on whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet.Nutrition and Hydration Discussion Assignment Paper
Based on your patient assessment, think about strategies for improving any nutrition issues that might have presented (e.g., nutritional supplements, community resources such as Meals on Wheels, referral to a nutritionist or dietician, etc.).
Post on or before Day 3 a description of the patient assessment you performed using a tool for inpatient and long-term patient care, such as the Lawton IADL Scale.Nutrition and Hydration Discussion Assignment Paper Explain whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Then, describe the patient’s diet and whether he or she has any special dietary needs due to medical conditions. Address whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet. Finally, explain strategies for improving any nutrition issues that might present during the patient assessment.
Read a selection of your colleagues’ responses on Nutrition and Hydration Discussion.
Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the following ways:Nutrition and Hydration Discussion Assignment Paper
Suggest additional strategies for improving nutrition issues for your colleagues’ patients.
Offer and support an alternative perspective based on your own experience and additional literature search.
Validate an idea with your own experience and additional literature search.Nutrition and Hydration Discussion Assignment Paper
Providing food and fluids has great meaning to many people as they often relate the provision of food and fluids to comfort and nourishment, and to the giving and preserving of life. A person’s cultural background can have great impact on their values and beliefs regarding this topic and should never be underestimated.
Providing food and fluids for as long as someone wants them and can safely take them is important. It is when the person can no longer take them that the complexities of ethical decision making arise. This can be an emotive issue for nurses as well as for families.
Some family members insist on trying to continue to feed their loved one even when it is no longer safe to do so. They may consider not doing this as a failure to care.Nutrition and Hydration Discussion Assignment Paper They may also insist on parenteral fluids or a feeding tube once someone can no longer eat or drink. In these circumstances it is important to talk to them about comfort measures, such as regular mouth care, wetting the patient’s lips and using lip balms. If the family are so distressed at the thought of dehydration, a small amount of subcutaneous fluid may be an acceptable compromise.
Other health professionals are a good resource. For example, if unsure whether someone can still safely swallow food and fluids, referral to a speech therapist would be helpful.
Some patients themselves choose to specifically request not to receive artificial nutrition or hydration at the end of their life, such as in an advance directive.Nutrition and Hydration Discussion Assignment Paper Some may make this choice at the time, with or without the agreement of their relatives.
Artificial nutrition and hydration are seen by some as interventions in what should be a natural process. They may be easy to initiate but there can be difficulties when the time comes to consider their withdrawal. All discussions should take place early with families, ensuring they are aware of burdens and benefits of continuing this therapy.Nutrition and Hydration Discussion Assignment Paper
Nutrition and hydration are essential for health and quality of life.
For older people, adequate food and drink can help them recover from illness and surgery, remain independent, reduce their length of stay in hospital and help avoid readmission to hospital.
Malnutrition is common in older people. To identify people over 65 at risk of malnutrition, they should be screened within 24 hours of admission and at regular intervals throughout their hospital stay.
This topic gives an overview of nutrition and hydration and recommends actions that we and our organizations can take, in addition to health service policy and procedures, to provide quality nutrition and hydration care to our older patients.Nutrition and Hydration Discussion Assignment Paper
Nutrition and hydration for exercise
Good nutrition and hydration are essential to help you perform at your best when exercising. For anyone who will be exercising for an extended period, it is important to plan what you eat and drink before, during and after exercise. This is especially important for anyone involved in sport where optimal nutrition and hydration can make a significant difference to your performance. For anyone participating in exercise at a more moderate level, a healthy diet that includes plenty of fruit, vegetables and water will usually suffice.Nutrition and Hydration Discussion Assignment Paper
Fuel for exercise
The body’s main sources of fuel during exercise are fat and carbohydrate, and the one you need to focus on is carbohydrate. This is because we all have ample stores of fat to undertake even the longest bouts of exercise (unless in a state of starvation). However, our carbohydrate stores (in the form of muscle glycogen) are more limited and can become significantly depleted during vigorous exercise in excess of 90 minutes or moderate exercise of a longer duration (several hours).Nutrition and Hydration Discussion Assignment Paper
Carbohydrate stores can also become depleted over the course of several exercise sessions, if not replenished through appropriate nutrition between times.Nutrition and Hydration Discussion Assignment Paper Depleted muscle glycogen will impair your capacity to exercise, limiting how fast you can run, cycle or swim. This is clearly evident in some people at the end of a marathon, in which their muscles have become depleted of glycogen and they struggle to maintain a speed faster than a slow jog.
Fluid for exercise
Maintaining your body in a fully hydrated state is essential for both your health and performance when exercising. If you are dehydrated you will have a reduced blood volume and less fluid available to form sweat. Dehydration will reduce your capacity to deliver oxygen to your muscles and your ability to prevent your body from overheating, both of which will adversely affect your exercise performance. So it’s important to be fully hydrated when you start exercising, and to maintain a regular intake of fluids while exercising to prevent dehydration.Nutrition and Hydration Discussion Assignment Paper
Food and fluid before exercise
In most circumstances, most of us will have enough stored fat and carbohydrate to fuel our next exercise session without needing to make special arrangements (as exemplified by those who walk or jog before breakfast). However, if you are undertaking a more prolonged or vigorous bout of exercise, you may wish to maximize your glycogen stores before you exercise, and you can do this by eating a meal between one and 4 hours beforehand.Nutrition and Hydration Discussion Assignment Paper This allows enough time for the meal to be digested. Ideally, you should eat a small amount of food that is low in fiber for easy digestion.
To increase your body’s fuel supply, the meal should be predominantly carbohydrate — approximately 2 to 5 grams of carbohydrate per kilogram of body weight. Meals based around rice, pasta, bread or potatoes are often advocated by sports dietitians, and you’ll need to try different ones to see what suits you best. The meal should also be low in fat and protein, to minimize any gastrointestinal discomfort.
For most sports and types of exercise, it is recommended that you drink 400-600 mL of fluid one to 2 hours before the activity, and another 200-400 mL 15 minutes before exercising. Water is usually a suitable choice of fluid to drink before exercising.Nutrition and Hydration Discussion Assignment Paper
Food and fluid during exercise
Fluid loss can impair performance and can affect your body’s ability to control its own temperature. If you are exercising for less than 60 minutes, you should drink approximately 200 mL of fluid every 15-20 minutes. Water is appropriate in this situation. In longer duration activities where there is a risk of glycogen depletion, such as more than 60 minutes of vigorous exercise, a sports drink containing glucose and electrolytes can be most effective. And for activities lasting several hours these sports drinks can be supplemented with energy bars.Nutrition and Hydration Discussion Assignment Paper
Post-exercise food and fluid
After exercise it is important to restore your body’s fuel and fluid stores to normal levels. For most people this is easily achieved by following a healthy diet that includes plenty of fruit and vegetables, and plenty of non-alcoholic, non-caffeinated fluids.
Replacing fluid stores largely depends on how much fluid was lost during exercise. This can be calculated by comparing your pre- and post-exercise body weight. A simpler method is to check your urine. You need to drink sufficient fluid until you are passing clear, dilute urine.Nutrition and Hydration Discussion Assignment Paper
The amount of fluid that you’ll need to drink will depend upon how much you’ve sweated and the temperature of the environment. So on hot days after a vigorous bout of exercise, you may need to drink several lit res. In doing so, be wary of consuming it in the form of sugary drinks, as you may take in more calories than you’ve burned off during the exercise.Nutrition and Hydration Discussion Assignment Paper This may not be a problem if you are a highly trained sports person with a good body composition, but will be contrary to your goals if you are trying to lose weight.
To replenish your glycogen stores after exercising vigorously, you need to eat 1-1.5 grams of carbohydrate per kilogram of body weight within the first couple of hours after exercise. Ideally, this should be in the form of high GI foods, such as sports drinks, muffins or white bread. Over the 24 hours after exercise, a total of 7 to 10 grams of carbohydrate per kilogram of body weight should be ingested to maximize the glycogen stores again, thereby preparing you for your next bout of exercise.Nutrition and Hydration Discussion Assignment Paper
Signs and effects of malnutrition may include:
- unplanned or unexplained weight loss
- feeling tired, lacking energy
- an increased risk of illnesses or infections
- poor concentration
- difficulty keeping warm Nutrition and Hydration Discussion Assignment Paper
- low mood/depression
- having a BMI under 18.5
- reduced/weaker muscle and tissue mass
- risk of pressure ulcer development
- delayed wound healing
- decreased mobility and stamina
- increased respiratory difficulties
- poor libido (sex drive) and fertility problems
- increased chance in developing post-operative complications
Nutrition and hydration is frequently poorly managed but implementing some simple steps can significantly improve mortality and morbidity.
Medical evidence shows that good hydration can assist in the management of diabetes and help prevent many other medical conditions 1. Nutrition and Hydration Discussion Assignment Paper Similarly, meta-analyses suggest that provision of nutritional supplements to malnourished patients reduces complications such as infections and wound breakdown by 70% and mortality by 40% 2.
Resources in this section include tool kits for improving nutrition and hydration in both primary and secondary care, and guidance for organizations and commissioners to develop services to support best practice.
Support for professionals
Support for healthcare professionals, particularly in the community, to undertake nutritional screening and identify malnutrition and disease related malnutrition is provided in Managing adult malnutrition in the community.Nutrition and Hydration Discussion Assignment Paper It includes an evidence-based management pathway for using oral nutritional supplements and also guidance on the use of individualized multiple-disciplinary interventions.
Nutrition strategy
The British Association for Par enteral and Enteral Nutrition have developed a nutrition strategy for commissioners incorporating screening, care pathways, education and management structures. This is brought together in Malnutrition Matters: Meeting Quality Standards in Nutritional Care, a toolkit for commissioners and organizations. Nutrition and Hydration Discussion Assignment Paper It also includes tools for assessing and optimizing current service provision.
Identifying barriers
It is important to identify barriers to the provision of good nutritional care in order to improve services and reduce harm. These barriers are discussed a the paper in Proceedings of the Nutrition Society. The key finding is that the greatest barrier to good nutritional care is a lack of knowledge around nutrition and that a multi-component approach is likely to be the most successful to improve services.Nutrition and Hydration Discussion Assignment Paper
Adequate hydration
Adequate hydration is a vital component of good nutrition that may be over-looked. The Royal College of Nursing, have introduced a toolkit to emphasize the importance of hydration in good care. This provides evidence on harm associated with dehydration and includes practical ideas for incorporating provision of fluids within nursing care in hospitals and the community.Nutrition and Hydration Discussion Assignment Paper