1 Lincoln Memorial University Caylor School of Nursing Nursing 115 Fall 2008 UNIT III LESSON PLAN Nutrition DATES TIMES See Class Schedule OBJECTIVES Upon completion of the unit the student will demonstrate mastery of the following objectives in the clinical campus laboratory in individual and group conferences and on written materials the ability to 1 2 3 4 5 6 7 8 9 10 11 12 13 Define and use the key terms as listed in the assigned readings Give examples of essential nutrients and explain why each is necessary List the end products of carbohydrate protein and lipid metabolism Outline the foundations of an adequate diet utilizing the food pyramid Explain physiologic sociocultural and psychological factors that influence nutritional habits status throughout the lifespan Give examples of the nutritional variables throughout the life span Utilize therapeutic techniques of communication in assessing nutritional needs Utilize the RAM nursing process to identify nutritional problems and develop a care plan Explain the importance of diet counseling and teaching Give examples of food modification in therapeutic diets Describe the process of initiating and maintaining continuous and intermittent enteral feedings Explain the principles and purpose of total parenteral nutrition and peripheral parenteral nutrition Give examples of medications supplements and additional agents utilized in nutrition TOPICAL OUTLINE I 8 08 Review of Nutrition A Principles of Nutrition 1 Energy balance 2 Metabolic requirements 3 Body weight standards 4 Caloric requirements B Nutrients 1 Macronutrients a Carbohydrates b Fats c Protein 2 Micronutrients a Vitamins i water soluble vitamins 2 C 1 2 3 4 II III 8 08 ii fat soluble vitamins b Minerals Foundations of an Adequate Diet Dietary Recommendations and Guidelines Recommended Dietary Allowance My Pyramid Food Guide Food Labeling Factors Affecting Nutritional Status A Physiologic Factors 1 Developmental Considerations 2 Health status medications B Sociocultural and Psychological Factors 1 Religion 2 Economic 3 Culture C Compromised Processes of Nutrition 1 Decreased Food Intake 2 Increased Food Intake Utilizing the RAM Nursing Process of Clients with Nutritional Status A Risk Factors B Assessment a Nutritional History b Physical Psychosocial C Nursing Diagnosis a Imbalanced Nutrition Less Than Body Requirements b Imbalanced Nutrition More Than Body Requirements c Risk for Imbalanced Nutrition More Than Body Requirements D Planning E Nursing Interventions a Education b Stimulating Appetite c Assisting with Eating d Special Diets e Enteral Nutrition i Short Term Nutritional Support 1 Nasogastric Tube 2 Nasointestinal Tube ii Long Term Nutritional Support 1 Percutaneous Endoscopic Gastrostomy 2 Gastrostomy Tube f Parenteral Nutrition i Total Parental Nutrition TPN ii Peripheral Parenteral Nutrition PPN g Medications See medication list F Evaluation Outcome 3 REQUIRED READINGS Karch A 2008 2008 Lippincott s nursing drug guide Philadelphia Lippincott Williams Wilkins TBA Taylor C Lillis C Lemone P Lynn P 2008 Fundamentals of nursing The art and science of nursing care 6th ed Philadelphia Lippincott Williams Wilkins chap 42 Taylor C Lillis C LeMone P Lynn P 2008 Study guide to accompany fundamentals of nursing The art and science of nursing care 6th ed Philadelphia Lippincott Williams Wilkins Readings to coincide with above chapter CLINICAL SKILLS 1 Obtain a diet history 2 Perform a nutritional assessment of assigned patient s 3 Provide preparation teaching follow up care appropriate for adults with ineffective responses to nutrition 4 Assess for psychosocial stimuli and or behaviors that could affect nutrition 5 Provide care for an adult receiving TPN 6 Provide care for an adult receiving PPN 7 Provide care for an adult receiving enteral nutrition 8 Plan teach a patient and family re the patient s prescribed diet incorporating the specific dietary restrictions HANDOUTS 1 Case study 2 Medications herbs supplements and nutritional agents 8 08 4 CASE STUDY N V AND DIARRHEA A 70 year old is admitted with N V and diarrhea r t to food poisoning The physician orders D5 1 2 NS to infuse at 125 mL hr 1 Include some important information that should be assessed during the patient history and physical assessment 2 Include 2 nursing diagnoses for this patient 3 Include 4 nursing interventions for this patient 4 The N V continues and the patient is unable to eat or drink The physician orders TPN to be started at 80 mL hr 1 Include the reason for TPN 2 Include nursing implications for a patient with TPN 8 08 5 MEDICATIONS HERBS SUPPLEMENTS AND NUTRITIONAL AGENTS Antiemetics Chlorpromazine Thorazine Hydroxyzine Vistaril Metochlopramide Reglan Promethazine Phenergan Anorectics Weight loss drugs or appetite suppressants Phenylethyamine Trimspa Phentermine Fastin Sibutramine Meridia Appetite Stimulants Cyproheptadine Periactin Dronabinol Marinol Eldertonic Magestrol Megace Mirtazapine Remeron Oxandrolone Oxandrin Steroids Dexamethasone Decadron Prednisone Deltasone Weight loss medication Orlistat Xenical Vitamins and Minerals Multivitamins and supplements Calcium Folate Folic Acid Magnesium Thiamine Vitamins A D E K Vitamin C Vitamin B6 and B12 Zinc Additional nutritional agents elements Anti Cholesterol medications Example Simvastatin Zocor Fat emulsion for parenteral nutrition Fiber Natural herbs 8 08