Diet Nursing1031

Diet Nursing
Lecturer: Xiao-wen ZHU
School of Nursing, Jinan University
Fundamentals of Nursing
objectives
Understand: people's needs for nutrition
Familiar with: 1. The variety of the hospital

diet and the range of diet and application of
all kinds of diets
2. Nutritional assessment
objectives
Master: 1. Diet nursing of clients
2. The purpose, assessment, planning,

implementation and evaluation of nasogastric
gavage feeding
3. The concept, implementation and notes

to elemental diet
1 Overview
Overview
People's needs for nutrition
Calory: The necessary energy all creatures

maintain life, growth and to engage in all kinds of
activities. It is transformed by the chemical
potential within the food.
Nutrients: Ingredients in food that can be digested,
absorbed and utilized by the human body, and has
certain physiological functions.
Six main categories: Protein, fat, carbohydrate,

minerals and microelement, vitamin, water
Recommended dietary energy
Chinese Dietary Reference Intakes
Adult male: 10.0~17.5MJ/d
Adult female: 9.2~14.2MJ/d
A reasonable diet requires a proper proportion of

the three major substances
Percent of total energy: protein: 10~14%
fat: 20~25%
carbohydrate:60~70%
Nutrients
Adults have about
Protein 3 percent protein
Body function updates daily
To form and repair human cellular tissue
Consist of enzymes and hormones
Consist of antibodies
Maintain plasma colloid osmotic pressure
Give energy supply

“Meat” as
“firewood” !!
Food source
Meat, aquatic products, beans, eggs, dairy products
Intakes
Adult male: 90g/d female: 80g/d
Children, adolescents, pregnant women and
lactating women need more
Usually 10-20%
Fat/lipid body weight
Body function
Supply and storage of heat
Compose of body tissue
Supply essential fatty acids
Promote the adsorption of fat-soluble Vitamin
Maintain body temperature and protect the viscera
Improve the sensory properties of food, increase

the sense of feeling full
Food source
Cooking oil, animal products, nuts
Intakes
Adult: ordinary 50g/d

Carbohydrate
Body function
Glycolipid,
Supply energy glycoprotein, and
proteoglycan form
The main constituent of nerve and cell

Glucuronic acid
combines with
Protect liver and detoxify toxins in our
bodies
Antiketogenesis
Food source
Cereal, root vegetables, such as grains, potato
kind
Sugar, such as sucrose, barley-sugar
Intakes
60-70% of total energy
Mineral & microelement
Iron
Calcium
Phosphorus
Iodine
Zinc
Vitamin
Water-soluble vitamins
Fat-soluble vitamins
Vit. B1
Vit. A (nyctalopia) Vit. B2

Vit. PP
Vit. D (osteomalacia)
Vit. B6
Vit. E Vit. B12
Vit. C (scurvy)
Vit. K
叶酸
Water
Body function: Form the human body
Transport of metabolism and nutrients
Regulate body temperature
Dissolve nutrients and metabolites
Maintain digestion and absorption
Food source and intakes

Food source: drinking water, drink
staple and vegetables
Intakes: the average adult 2~3L/d
a reasonable daily dietary
Diversity foods, appropriate hunger and satiety,
suitable amount of fatty oil, even collocation of
fibre thickness, limited salt, less sweet, restraint
dietary
Balance Diet Pagoda for Chinese Residents
Oil ≤25g/d
Fish, poultry,
legumens and milk
meat, or eggs
dairy 100g/d
125-200g/d
soy foods 50g/d
Fruit
vegetables
100-200g/d
400-500g/d
whole grains Rice, bread,

300-500g/d cereal and
flour food
2 Assessment of
nutritional status
Assessment of
nutritional status
Investigation of dietary nutrition
 Eating behaviors
 Appetite and
Physical examination weight changes
 Factors that
affect eating
Anthropometric measures
 Health and
disease history
Laboratory testing
Fundamentals of Nursing JINAN

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Assessment of
nutritional status
 Skin, muscles
Physical examination  Hair, fingernails
 Eyes

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Assessment of
nutritional status
Physical examination
 Height, weight
Anthropometric measures  Skinfold thickness
 Girth

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Assessment of
nutritional status
Standard weight=
Anthropometric measures [height(cm)-100]0.9(0.85)
Body mass index=

Laboratory testing weight(kg)/height(m2)

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Assessment of
nutritional status
 Serum protein
 Urea nitrogen
 Creatinine…

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3 General diet nursing
General diet nursing
1. Prior to mealtime
Environment preparation
How to provide a tidy, quiet, comfortable and

clean environment for clients?

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1. Prior to mealtime
Environment preparation
Client preparation
Nurse preparation

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2. At mealtime
Check the type of diet
Supervise and assist in the distribution of food
For special clients, assisting with meals

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2. At mealtime
 Assist clients who cannot help themselves to be

eaten

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2. At mealtime
The liquid can be sucked through a straw

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2. At mealtime
For a blind client, identify the placement of food

as you would describe the time on a clock
Green vegetable
Green
Soup vegetable
Rice

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2. At mealtime
Inspect and observe clients’ eating situation

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2. At mealtime
Inspect and observe clients’ eating situation
To deal with the special problems in the feeding
process

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2. At mealtime
nausea and vomiting
 Tell the clients to stop eating and encourage them to

breathe deeply or slowly.
 Assist the vomer to tilt his head to one side, remove
the vomit, and observe the nature and quantity of the
vomit.

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2. At mealtime
Coughing and choking
 Pat the client on the back when he/she coughing.
 Remove the food in the choker's mouth in time and
encourage him to cough it out. Or place the client
lateral position with head dropped 45 degree lower,
flap the back of his chest to help it out.

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method
impact
c abdominal
Diaphragmati
2. At mealtime
 Give first aid to the client

who was suffocated.

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3. After the client has completed the meal
Give the client care such as washing hands, and

oral hygiene
Note how much and what the client has eaten

and the amount of fluid taken

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3. After the client has completed the meal
If the client is not eating, notify the responsible

nurse so that the diet can be changed or other
nursing measures can be taken
Nurses should pay attention to the fasting client

especially on shift

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4 Special diet nursing
Special diet nursing
Situation: Mr. Yang, 40 years old, the third day after
the traumatic brain injury, coma, vital signs are
stable, normal borborygmus. What kind of
nutritional support should be adopted?
Tube feeding

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Tube feeding
The nutrition is infused into gastrointestinal

duct through a tube (including nasogastric tube,
gastrointestinal tube or mouthpiece tube)

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Tube feeding Elemental diet
Is a purified formula whose chemical

composition is definite and it contains all the
required nutrients of human body
 To provide the energy and the nutrients

to the human body directly without
digest and absorb by the intestinal tract
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 The ingredients are clear and can be

adjusted according to the disease

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 Containing little or no residues and

cellulose
 Many of them are dry powder, easily to
be transported and saved

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Watch a nasogastric gavage video
What should be done before and after

nasogastric gavage?
What are the speed, temperature, quantity and

number of times of the formula be infused into
the nasogastric gavage?

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Nasogastric gavage

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Nasogastric gavage
Determine that the tube is in the client’s

stomach, inject some warm water into the gastric
tube; fold the end of the tube, using pin to
secure the tube to bed sheet, pillow or client’s
collar

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Nasogastric gavage
Feed the formula slowly as the physician’s order,

avoid the formula too cool or too hot
(38oC~42oC), the amount of tube feeding does not
exceed 200ml once. Interval is not less than 2h

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A drip-based elemental diets though gastric
jejunostomy
Prepare the solution the appropriate

concentration based on conditions
The infusion temperature is 41oC~42oC, the

speed of dropping start with 40~60ml/h and
gradually increase, and not faster than 150ml/h
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A drip-based elemental diets though gastric
jejunostomy
Nurses should irrigate the tube with warm water

before and after infusion
Follow sterile procedure

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Situation: Mr. Yang, 40 years old, the sixth day
after the traumatic brain injury, extract a large
amount of coffee sample from the stomach. He is
thought of stress ulcers and gastrointestinal
hemorrhage. What kind of nutritional support
should be adopted?
Parenteral nutrition

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Parenteral nutrition
Is administered intravenously through a central
venous catheter into the superior vena cava.

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Clients who accept PN therapy

 Severe malnutrition
 Bowel disease disorder
 Cancer
 Acute hepatic failure, renal failure
 Where nothing may be taken by mouth for
more than 5 days
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TPN solutions
 Preventing infection
 A mixture of dextrose in water, amino
acids and special additives such as
vitamins, minerals and trace elements
 To use it right after it is ready, use up
within 24 hours

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Infusion ways
 Often infused through central vein

 Or use peripherally inserted central
catheter (PICC)

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homework
Based on the related literatures, review the
nursing of parenteral nutrition, including the
prevention and treatment of complications.

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Thank
You!

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Diet Nursing

Lecturer: Xiao-wen ZHU

School of Nursing, Jinan University

Familiar with: 1. The variety of the hospital

2. The purpose, assessment, planning,

3. The concept, implementation and notes

Calory: The necessary energy all creatures

Six main categories: Protein, fat, carbohydrate,

A reasonable diet requires a proper proportion of

Consist of enzymes and hormones

Maintain plasma colloid osmotic pressure

Give energy supply

Fat/lipid body weight

Compose of body tissue

Supply essential fatty acids

Promote the adsorption of fat-soluble Vitamin

Maintain body temperature and protect the viscera

Improve the sensory properties of food, increase

Cooking oil, animal products, nuts

Adult: ordinary 50g/d

The main constituent of nerve and cell

Vit. A (nyctalopia) Vit. B2

Food source and intakes

whole grains Rice, bread,

Fundamentals of Nursing JINAN

Fundamentals of Nursing JINAN

Fundamentals of Nursing JINAN

Body mass index=

Fundamentals of Nursing JINAN

Fundamentals of Nursing JINAN

How to provide a tidy, quiet, comfortable and

Fundamentals of Nursing JINAN

Fundamentals of Nursing JINAN

Check the type of diet

Supervise and assist in the distribution of food

For special clients, assisting with meals

Fundamentals of Nursing JINAN

For special clients, assisting with meals

 Assist clients who cannot help themselves to be

Fundamentals of Nursing JINAN

For special clients, assisting with meals

The liquid can be sucked through a straw

Fundamentals of Nursing JINAN

For special clients, assisting with meals

For a blind client, identify the placement of food

Fundamentals of Nursing JINAN

Check the type of diet

Supervise and assist in the distribution of food

For special clients, assisting with meals

Inspect and observe clients’ eating situation

Fundamentals of Nursing JINAN

 Tell the clients to stop eating and encourage them to

Fundamentals of Nursing JINAN

Fundamentals of Nursing JINAN

 Give first aid to the client

Fundamentals of Nursing JINAN

Give the client care such as washing hands, and

Note how much and what the client has eaten

Fundamentals of Nursing JINAN