chapter 17 nutritional care
DESCRIPTION
Chapter 17 Nutritional Care. Nutritional support is fundamental in the successful treatment of disease Nutritional support is often the primary therapy This chapter focuses on: the comprehensive care of the patient’s nutritional needs as provided by the RD and - PowerPoint PPT PresentationTRANSCRIPT
Nutritional support is fundamental in the successful treatment of disease
Nutritional support is often the primary therapy
This chapter focuses on:◦ the comprehensive care of the patient’s
nutritional needs as provided by the RD and◦ the nursing role in the care process in identifying
nutritional needs within the nursing diagnosis
1
Define the therapeutic process Describe the collection & analysis of nutritional information
Describe the planning & implementation of nutritional care
Identify the evaluation of nutritional care
2
Key concepts◦Valid health care is centered on the
patient and his or her individual needs◦Comprehensive health care is best
provided by a team of various health professionals and support staff persons
◦A personalized health care plan, evaluation, and follow-up care guides actions to promote healing and health
3
Nurses and dietitians provide essential support and personalized care.◦Patients need personal advocates in a
maze of complex medical technology that can be confusing
Registered Dietitian (RD) carries major responsibility “medical nutrition therapy” – i.e. for determining individual nutritional therapy needs and plan of care
4
Nurses are in the closest continuous contact with patients and their families. Real partnership with patients and caretakers essential to valid care.◦ Coordinate the patient’s special services and
treatments◦ Consult and make referrals as needed◦ Interprets and explains the plan of care to the
patient◦ Teacher and counselor
Nutritional care must be person-centered.◦ Needs must constantly be updated with the
patient’s status
5
Collecting information
Identifying problems
Planning care Implementing care Evaluating and
recording results
6
Nutrition Assessment
7
ABCD approach: ◦Anthropometry◦Biochemical tests◦Clinical observation◦Dietary evaluation
Anthropometric Measurements – are the physical measurements of the human body used for health assessment
8
Three types of measurements are common:◦ Weight – preferably
before breakfast, without shoes, in light indoor clothing
◦ Height – stand as straight as possible without shoes or cap
◦ Body composition – to determine fat vs muscle
9
Biochemical Tests: Include:
◦Plasma Proteins (serum albumin, prealbumin, hemoglobin) Help detect protein and iron deficiencies
◦Liver enzymes◦BUN, Serum electrolytes◦Cr◦CBC◦Fasting glucose
10
Protein metabolism Basic 24-hour urine tests measures byproducts of
protein metabolism – Cr, Urea Nitrogen Elevated levels may indicated excess breakdown of body
tissue
◦ Immune system integrity Determines lymphocyte count
◦ Skeletal system integrity Status of bone integrity and possible osteoporosis
◦ Gastrointestinal function: lab and x-ray Evaluate for peptic ulcer disease and malfunctions along
GI tract
11
Clinical Observations:◦Clinical signs of
nutritional status◦Physical
examination◦Inspection of skin
for edema, turgor, nail integrity, abdominal exam, BS, and lungs.
12
Dietary Evaluation: Specific food
history obtained using three-day food record.◦Nutritional
Supplements◦Food allergies,
intolerances◦Activity level
13
“Identification and labeling an actual occurrence, risk of, or potential for developing a nutrition problem that dietetics professionals are responsible for treating independently”
Nutrition diagnosis will change as the patient’s nutrition needs change.
14
Example:◦ Excessive caloric intake related to frequent
consumption of large portions of high-fat meals as evidenced by (AEB) average daily intake of calories exceeding recommended amount by 500 kcals and 12 pound weight gain during the past 18 months.
15
The “nutritional problem” is identified in the nutrition diagnostic statement◦ May include nutritional deficiencies or
underlying disease requiring a special modified diet
Etiology: Identify cause or contributing factors. ◦ Correctly identifying the cause is the only way to
design an intervention plan adequately
16
Nutrition care and teaching include an appropriate food plan with examples of food choices, food buying, and food preparation
Everyday emotions have a significant influence on food intake and choices
Influence of economic needs
17
Diet therapy based on patient’s normal nutritional requirements◦ Any therapeutic diet is only a modification of
normal nutritional needs◦ Only modified as an individual’s specific condition
requires
18
Disease modifications – Nutritional components of the normal diet may be modified in 3 ways:◦ Energy – total kcals may be increased or
decreased
◦ Nutrients – modified in amount or form
◦ Texture
19
Personal adaptation – Successful nutritional therapy can occur only when the diet is personalized.
Accomplished by planning with the patient or family
Four areas:◦Personal needs◦Disease ◦Nutrition therapy◦Food plan
20
Routine “house” diets: ◦ A schedule based on
a cycle menu◦ Basic modifications
in texture ranging from clear liquid full liquid soft food regular diet
21
Clear liquid◦ Clear broth, bouillon,
Sprite, fruit juice, gelatin, popsicles
Full liquid◦ Milk, yogurt, ice
cream, pudding
22
Routine House Diets cont.
Soft◦ Pasta, soft bread,
potatoes, cooked and soft fruits
Regular◦ Any foods
23
Oral feeding – preferred for as long as possible
Assisted oral feeding – nurse may have to help feed or cut up meat, butter bread, etc.◦make use of plate guards, special utensils,
etc. to promote independence Enteral feeding
◦Small tube placed through patient’s nasal cavity; runs down back of throat into either stomach or small intestine; may also use a “g-tube” for more permanent placement
24
Parenteral nutrition – for those who cannot tolerate food or formula through the GI tract◦ Peripheral vein
feeding (short term)◦ Central vein feeding
(long term)◦ Intralipids
25
Evaluated in terms of nutritional diagnosis and treatment objectives
Continues through period of care, stops at the point of discharge
General considerations◦ Nutritional goals – effect of the dietor feeding method on the illness or the patient’s situation?
26
◦ Required changes – is it necessary to change the type of food or feeding equipment, environment for meals, counseling procedures, or types of learning activities for nutrition education?
◦ Ability to follow diet – Does any hindrance or disability prevent the patient from following the treatment plan?
◦ Resources - Do the patient and family understand all the self-care instructions provided? Connection with community resources available?
27
Gathering information about all drug use is essential to the care process◦Includes over-the-counter drugs, prescribed
drugs, alcohol, “street drugs” Drug-food interactions
Increasing or decreasing the effect of a drug and adversely affect health
28
Drug-nutrient interactions Reactions occur when prescription drugs
are taken in combination with over-the-counter vitamin and mineral supplements.
Drug-herb interactions Is the least defined of drug interactions Some herbs have clinically documented
medicinal properties May affect key enzymes involved in
metabolism
29
30
Examples: Ginkgo biloba- Aspirin, warfarin (Coumadin),
ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine)
St. John's wort-Antidepressants Ephedra-Caffeine, decongestants,
stimulants Ginseng-Warfarin Kava-Sedatives, sleeping pills,
antipsychotics, alcohol
31
32