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Nutrition for Nurses

9.2 Plan Nutritional Strategies to Impact Hematological Wellness

Nutrition for Nurses9.2 Plan Nutritional Strategies to Impact Hematological Wellness

Learning Outcomes

By the end of this section, you should be able to:

  • 9.2.1 Prioritize hypotheses of nutritional habits that optimize hematological wellness.
  • 9.2.2 Generate solutions to optimize hematological wellness utilizing nutritional habits.

Identifying Challenges to Nutritional Goals

Once nutritional deficiencies impacting hematopoiesis have been discovered, the nurse should explore goals aimed at restoration of wellness. Barriers to a client’s success can include physiological and psychosocial factors. Assisting the client in determining which nutritional habits can be modified is challenging but essential at this stage of planning. The nurse should consider both the setting (hospital, clinic, client’s home) and the audience for discussion. Goals that consider cultural influences are more likely to guide the client toward a nutritional lifestyle with a lasting positive impact (Walker-Clarke et al., 2022).

Physiological Factors

Most physical attributes are non-modifiable; however, understanding the impact of physiological factors on nutrition is an important component of client education. Providing anticipatory guidance related to nutrient demands in various stages of life can influence goal setting through the management of expectations. Although clients cannot manipulate their family medical history and genetics, health promotion strategies can be applied using these factors as motivators.

Typically, males have higher energy demands than females, as well as an increased trajectory for height and weight compared. Nutritional needs increase during pregnancy because of physiological and hormonal changes and fetal demand. Folate deficiency is common during pregnancy and can lead to serious hematologic deficits in both the pregnant client and fetus (Grzymisławska et.al., 2020).

Neonates and infants have increased caloric and protein needs to support the rapid growth and development that occurs during this time, as well as to prevent anemia and bleeding disorders. Breastfed infants are dependent on the health and diet of the person feeding them. Research has discovered that genetic variations in both the parents and child can affect the production and consumption of milk (Golan, 2020). With this knowledge, nurses can intentionally explore breastfeeding habits and provide support and rationale if nutritional supplementation is indicated.

As humans age, growth hormone and erythropoietin deficiencies occur, which contribute to decreased production of red blood cells. Additionally, appetite and food intake decrease due to delayed gastric emptying and changes in taste. Papillae (taste buds) density decreases in older adults that results in taste and smell alterations. Poor dental health, ill-fitting dentures, and dry mouth further contribute to decreased food intake, leading to nutrient deficiencies. Although energy needs decrease with age, protein and micronutrients requirements increase (Kaur et al., 2019).

Disease comorbidities often result in increased caloric, protein, and micronutrient needs. Acute and long-term illnesses such as trauma, burns, cancer, lung disease, and immune dysfunction require even higher protein and micronutrient intake to restore homeostasis during the healing stage.

Psychosocial Factors

Psychological and social factors impact eating behaviors throughout the lifespan (Walker-Clarke et al., 2022). These are often considered modifiable contributors and are a major target for interventional strategies to restore hematologic wellness (Figure 9.3). Assisting clients in recognizing the presence of these factors is the first step—requiring empathy, emotional intelligence, and therapeutic communication. For example, although eating more beef or fresh spinach may help combat iron deficiency in the older adult, financial constraints may prevent this intervention; therefore, the nurse is challenged to create a more realistic economical and culturally sensitive option for the client.

The psychological factors influencing nutritional goals are divided into three subcategories: social influences, emotional influences, and psychological influences. Social influences include food insecurity, influence of living and eating arrangements, social supports, mealtime interactions, gender roles, and social expectations around food. Educational influences include health literacy, cognitive function, and decision making. Psychological influences include health-related attitudes, self-efficacy, mental health, personality, mood, and food indulgence.
Figure 9.3 Psychological and social factors influence nutritional goals. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Planning Nutritional Goals

Understanding clients’ needs requires knowledge regarding their food preferences and choices. Accessing nutrient-rich food lists for the client to review can facilitate a meal plan that is both desirable and feasible. Food preferences often cross physical, psychological, social, and environmental domains. Common themes to explore include:

  • Taste and food preferences of the client and their household
  • Health concerns
  • Convenience and time
  • Cultural and religious traditions
  • Social influences
  • Physical environment
  • Economics
  • Availability and variety

Planning nutritional goals starts with the nurse determining what is reasonable to tackle during the time available and in the current setting, considering both physiological and psychosocial influences. It is important to evaluate the client’s immediate external constraints such as finances, knowledge level, and current well-being. For example, has the client recently received medication with drowsiness as a side effect? Will the client be able to focus on the education to actively participate in goal planning?

Unfolding Case Study

Part B

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Grant is planning a discharge for Ms. Foster as she completes her blood transfusion. He recognizes that Ms. Foster may be experiencing fatigue or drowsiness from the medical interventions and anxiety and/or fear related to the need for a major modification to her diet. Further, he is aware that the emergency department environment can be distracting to learning. With these factors in mind, Grant determines that he will focus the discharge education on iron replacement therapy, follow-up with her PCP, and referral to a dietician.

He develops the following goal for Ms. Foster’s discharge education: Provide oral and written information on iron replacement therapy including dose, route, frequency, side effects, and administration considerations immediately before discharge. Grant will include a list of food sources rich in iron and inform Ms. Foster that taking her iron supplement with 4–6 oz of orange juice can improve iron absorption.

3.
Which of the following psychosocial factors should be considered first as the nurse prepares a list of iron-rich foods?
  1. Cultural and religious preferences
  2. Home-cooked or prepared meals
  3. Social influences
  4. Availability and variety
4.
Which of Ms. Foster’s risk factors for worsening anemia is modifiable?
  1. Hypertension
  2. Diabetes
  3. Decreased taste
  4. Decreased food intake

Encouraging Change

To prevent client frustration that can derail nutritional goals, the nurse should anticipate obstacles to the first steps of the plan. After creating a plan to restore hematologic wellness, asking open-ended questions regarding the plan’s steps can proactively help identify solutions to barriers (Hooker et al., 2018). Use of motivational interviewing, increasing knowledge, and assessing readiness for change are the first steps. Ultimately, the client needs to believe that the nutritional change will improve their life. For example, in the case of Ms. Foster, Grant learns that Ms. Foster’s grandson is getting married in 3 months, and she has been worried about her ability to walk the distance required at the wedding venue. Grant uses this information as an influence of motivation, encouraging her to add iron-rich foods to at least 2 meals daily, eat meals in the dining room with her friends as much as possible, and use a daily pill container or set a reminder to take her daily iron replacement. Convenient foods containing iron, such as canned or frozen spinach, iron-enriched bread and cereals, and canned white beans, are recommended staples to have on hand. He informs Ms. Foster that with these strategies, she should see a significant improvement in her anemia and energy level within 2–3 months, just in time to participate in the wedding festivities.

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