Learning Outcomes
By the end of this section, you should be able to:
- 19.2.1 Prioritize hypotheses of nutritional habits that optimize musculoskeletal and integumentary wellness.
- 19.2.2 Generate solutions to optimize musculoskeletal and integumentary wellness utilizing nutritional habits.
Planning Nutritional Goals
The nurse is responsible for educating the client on nutritional strategies to impact musculoskeletal and integumentary wellness. Based on the client’s history and current medical diagnosis, the nurse will prioritize hypotheses of nutritional habits (or assess expected client responses of nutritional habits) to optimize the well-being of the client. In doing so, the nurse will plan nutritional goals for the client and focus on assisting the client to meet the goals.
Nutrition is an important lifestyle factor related to many long-term diseases. The musculoskeletal and integumentary systems are no exception. Long-term consumption of low nutrient foods may contribute to musculoskeletal pain and may also lead to obesity, homeostasis, inflammation, and sensitization of the central nervous system. Therefore, it is essential that proper nutrition be a priority in planning for better health that is related to the musculoskeletal and integumentary systems.
Calcium and vitamin D are essential to good bone health, and it is important that clients follow the recommended daily allowances. Because more foods are being fortified with calcium and vitamin D, clients may not realize they are consuming these micronutrients at unsafe levels. For example, a buildup of calcium can increase the risk for kidney stones, cardiac issues, and prostate cancer.
For people over age 50, at least 1200 mg of calcium per day is recommended. Excess vitamin D can cause kidney damage and dangerous serum calcium levels. Recommended vitamin D levels for adults to age 70 years is 600 IU and above 70 years, 800 IU (Mayo Clinic, 2021). See Table 19.7 for calcium and vitamin D food sources.
| Food Sources of Calcium | Food Sources of Vitamin D |
|---|---|
| Milk | Egg yolk |
| Yogurt | Mushrooms |
| Fortified orange juice | Oily fish (swordfish, herring) |
| Cheese | Fortified milk |
| Sardines | Fortified orange juice |
| Ice cream | Fortified cereals |
| Tofu | |
| Soy | |
| Bread | |
| Pudding | |
| Broccoli |
Other vitamins and minerals essential to include in planning nutritional goals for the musculoskeletal system are phosphorus, magnesium, vitamin K, vitamin C, and vitamin A. Phosphorus is a major mineral found in bone and needed for bone health. It can be consumed through such foods as dairy products and meat, as well as shellfish, beans, sunflower seeds, lentils, sardines, and cheese. Magnesium improves overall bone strength and is found in spinach, bananas, nuts and seeds, avocado, and chickpeas. Vitamin K is essential to bone formation, and it channels calcium into the bones. Foods containing vitamin K include leafy green vegetables, kiwi, and pumpkin. Vitamin C is necessary in the synthesis of collagen, which is the main protein in bone. Vegetables, citrus fruits, and tomatoes are high in vitamin C. Vitamin A is important for bone growth and can be found in liver, eggs, leafy green vegetables, and carrots (Campbell, 2021).
Planning nutritional goals for integumentary health is very important as related to wound healing, inflammation, and dermatologic disease processes. The primary focus is on protein because this is the important nutrient needed for tissue repair. An important nutritional goal during wound healing is to stay well hydrated. Hydration helps skin maintain its integrity; the loss of skin elasticity caused by dehydration makes the skin more susceptible to infections, thus impeding the healing process (Campbell 2023). In setting nutritional goals that include protein, these food items may be suggested:
- Salads (tuna, salmon, egg, and grilled chicken salad)
- Nuts
- Milk
- Cottage cheese
- Tuna and salmon
- Peanut butter
- Greek yogurt
- Whole grains
- Protein shakes (if food cannot be tolerated)
Identifying Challenges to Nutritional Goals
One big challenge to any nutritional plan is making sure the client can understand and follow the plan. Does the client have financial means to purchase and prepare specific foods? Often, fast foods and non-nutritious foods are more convenient and much less expensive. Is the client able to read nutrition labels? Is there a challenge to finding necessary food items in the area in which the client lives? Does the client have transportation or internet services for ordering food? If the client is unable to follow the plan for any of the reasons listed, the nurse should provide information on assistance programs or make a referral to another agency to assist the client in these matters. Motivation is also often a challenge for any nutritional goal. The client must understand how they will benefit from the diet plan. The nurse should clearly identify potential complications the client ignores nutritional goals.
Maintaining a diet rich in vitamin D is challenging even if a client has the means and the motivation to follow the diet. Our bodies naturally make vitamin D in our skin when it is exposed to sunlight. However, because of the importance of protecting our skin by using sunscreen, we are blocking our skin’s ability to make vitamin D. Therefore, vitamin D needs to come in the form of nutrition or added supplements for most people.
Consuming a diet with nutrient rich calories is often a challenge for the client during wound or tissue healing. The client is often more immobile during such times, and the client may worry about gaining weight. The nurse can be a vital resource for the client by educating them on the difference between consuming empty calories and nutrient-rich calories. The client must understand the importance of nutrition and the positive impact that nutrient-rich calories play in the tissue and wound healing process.