Lecture 2c 13 Jan 2014

Nutritional care in the health care facility including alternate feeding methods 

Health care facility-prevent onset of ill health via meeting age- specific nutrient requirements -this includes addressing:

-nutritional deficiencies -the immune response to specific foods

-presenting food in a way that the patient can eat (food form) and wants (patient must like the food to consume it)

-food must be patient-specific and time-specific

Health care facility

Address nutritional needs of pathology (pathologies) and limitations placed on patient by pathology(pathologies) or culture

-treat patient as an individual-not only as human

-ensure patient gets correct nutrition in time and person-sensitive fashion -watch food trays and that patient is

not dumping food or watch for pulled nasogastric tubes and IVs

Health care facility

Assess situation and then implement nutrition (including nutritional education) and then evaluate the outcome

Health care facility

-standard diet (to meet needs of healthy individual) or modified to meet medical needs (meet nutritional needs and address medical situation of patient)

-diet manuals-foods allowed and not allowed on a particular diet-an institutional form of standard operating procedure

Health care facilityProgressive diets

-clear liquid diet at room temperature(containingfluids and electrolytes) leaving littleintestinal residue (easily absorbed)

-then progress to full liquid diet (clear and opaque liquids and some semiliquid foods used if patient unable to chew or swallow regular foods (full liquid may contain lactose-problem?) -note that clear and full liquid diets are limited in nutrient composition so use only these diets for a short time

-then progress to solid foods

Health care facilityProgressive diets

-then progress to solid foods

-solid food diet is sometimes started via soft (eg bananas), low fibre or low residue diets (low fibre and low residue minimises fecal volume and hence risk of indigestion and intestinal obstruction when gut motility is slow or when intestinal tract is narrow due to intestinal inflammation or scarring)

Health care facility

-food interactions-

- with medications that are approved by Health Canada

- with dietary supplements (concept of complementary therapy) that are regulated by Health Canada -Health Canada rules are changing to regulate supplements just like regular drugs

-tables 19-2, 19-3, 19-4, 19-5 – 9th edition of Rolfes et al.

Tyramine toxicity – hypertensive crisis frequently with headache

- may also cause intercranial haemorrhage, cardiac failure and pulmonary oedema

Health care facility continued

Alternate feeding methods

Enteral-using gi tract -nasogastric feeding (e.g. coma patient) Parenteral-going around gi tract

-intravenous-patient gastrointestinal tract can not be used for digestion and/or

absorption due to e.g. severe malnutrition