Key Takeaways
- Nutritional assessment includes physical exam, lab values, dietary history, and functional status
- Therapeutic diets are prescribed based on specific disease conditions and patient needs
- Always verify tube placement before administering enteral feedings
- Elevate HOB 30-45 degrees during tube feeding to prevent aspiration
- Dehydration signs include poor skin turgor, dry mucous membranes, and concentrated urine
Nutrition and Hydration
Proper nutrition and hydration are fundamental to patient health and recovery. As an LPN/VN, you play a critical role in assessing nutritional status, implementing dietary interventions, and monitoring hydration levels. This content area accounts for a significant portion of the Basic Care and Comfort category on the NCLEX-PN.
Nutritional Assessment
A comprehensive nutritional assessment includes multiple components:
| Assessment Component | Key Indicators |
|---|---|
| Physical Examination | Weight, height, BMI, skin turgor, muscle wasting, edema |
| Laboratory Values | Albumin, prealbumin, hemoglobin, electrolytes |
| Dietary History | Food preferences, allergies, cultural practices, eating patterns |
| Functional Status | Ability to feed self, chewing/swallowing ability, dentition |
Body Mass Index (BMI) is a key screening tool:
- Underweight: < 18.5
- Normal: 18.5-24.9
- Overweight: 25-29.9
- Obese: ≥ 30
Therapeutic Diets
LPN/VNs must understand common therapeutic diets and their indications:
| Diet Type | Indications | Key Features |
|---|---|---|
| Clear Liquid | Pre-surgery, acute GI distress, bowel prep | Broth, gelatin, clear juices, tea |
| Full Liquid | Post-surgery transition, swallowing difficulty | All clear liquids plus milk, cream soups, pudding |
| Mechanical Soft | Chewing/swallowing problems, dental issues | Soft, moist foods; chopped or ground |
| Low Sodium | Hypertension, heart failure, kidney disease | < 2,000 mg sodium/day |
| Diabetic/Carbohydrate-Controlled | Diabetes mellitus | Consistent carbohydrate intake, low glycemic foods |
| Renal | Chronic kidney disease | Limited protein, sodium, potassium, phosphorus |
| Low Residue/Fiber | Crohn's disease, diverticulitis flare, bowel surgery | Limited fiber, minimal residue |
| High Protein | Wound healing, burns, malnutrition | Increased protein sources, supplements |
Enteral Nutrition
Enteral nutrition (tube feeding) is used when patients cannot meet nutritional needs orally but have a functioning GI tract.
Types of Feeding Tubes:
- Nasogastric (NG) - Short-term use (< 4 weeks), inserted through nose to stomach
- Nasoduodenal/Nasojejunal - For patients at aspiration risk, bypasses stomach
- Gastrostomy (PEG) - Long-term use, surgically placed through abdominal wall
- Jejunostomy (J-tube) - For patients with gastric issues, placed in small intestine
LPN/VN Responsibilities for Tube Feeding:
- Verify tube placement before each feeding (pH testing, X-ray confirmation)
- Check residual volume (hold feeding if > 200-500 mL per facility policy)
- Elevate head of bed 30-45 degrees during and 1 hour after feeding
- Flush tube with 30-60 mL water before/after feeding and medications
- Monitor for complications: aspiration, diarrhea, tube displacement
Hydration Assessment
Dehydration and fluid overload are common clinical concerns:
| Condition | Signs/Symptoms | Interventions |
|---|---|---|
| Dehydration | Dry mucous membranes, poor skin turgor, concentrated urine, tachycardia, hypotension | Increase fluid intake, IV fluids if severe, monitor I&O |
| Fluid Overload | Edema, weight gain, crackles in lungs, distended neck veins, dyspnea | Restrict fluids, elevate HOB, monitor I&O, diuretics as ordered |
Daily fluid requirements for adults: approximately 30 mL/kg body weight, or 2,000-2,500 mL/day under normal conditions.
Special Considerations
Dysphagia (Difficulty Swallowing):
- Use thickened liquids as ordered (nectar, honey, pudding consistency)
- Position upright during and after meals
- Allow adequate time for eating
- Supervise meals, watch for coughing or choking
- Consider speech therapy referral
Cultural and Religious Dietary Practices:
- Respect patient preferences (kosher, halal, vegetarian, vegan)
- Accommodate fasting requirements when medically safe
- Include family in meal planning when appropriate
A patient with chronic kidney disease is placed on a renal diet. Which foods should the LPN/VN advise the patient to limit?
Before administering a tube feeding, the LPN/VN should first:
Which assessment finding indicates dehydration?