Nutrition in Health Care FNU- 422

Effects of Illness on Nutrition Status Relationship between nutrition & illness is complex FNU- 422

Medical problems can alter nutrient needs & result in malnutrition Reduction in food intake( nausea, depression, chemotherapy, and radiation ) Interference with digestion & absorption (vomiting, diarrhea, chemotherapy, radiation, and some mediations Alteration of nutrient metabolism & excretion Increase metabolic rate & energy needs ( fever- stress) FNU- 422

Poor nutrition can affect: Course of disease Body’s response to treatment Poor nutrition can delay wound-healing, contribute to anemia, depress immune system, and increase susceptibility to infections. FNU- 422

When malnutrition occurs as a result of hospitalization, it is called Iatrogenic malnutrition FNU- 422

so : the Purpose of Clinical Nutrition (Medical Nutrition Therapy) is to achieve or maintain good nutritional status. FNU- 422

What is Medical nutrition therapy? Medical nutrition therapy (MNT) is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a: certified clinical nutritionist [CCN], registered dietitian or Functional Doctor.

The diet is based upon the patient's medical and psychosocial history, physical examination, functional examination and dietary history. FNU- 422

The role of MNT when administered by a dietitian is to reduce the risk of developing complications in pre-existing conditions such as diabetes as well as ameliorate the effects any existing conditions such as high cholesterol. FNU- 422

Patient Care Team Physician Clinical Dietitian Nurse Pharmacist Occupational Therapist Social Worker FNU- 422

Responsibility for Nutrition Care Physician: prescribes diet orders & other aspects of nutrition care Clinical dietician identify nutritional problems, suggest strategies, provide nutritional services. FNU- 422

What happens during a visit to a clinical nutritionist? First, the clinical nutritionist will ask you questions about your medical history, family history, and personal lifestyle. The medical history might include questions about your diet, digestion, history of weight loss or gain, sleep and exercise patterns, and relaxation habits..

Some clinical nutritionists will ask you to bring a 3 day food diary and list of any herbs, supplements, or medicines that you take regularly. Laboratory tests might be used to find out if you are low in any nutrients and to test your organ function. This way, a nutritionist will get a full picture of your nutritional lifestyle FNU- 422

During the second part of the visit, the nutritionist will suggest ways that you can fill the gaps and reduce the nutritional "overloads" in your diet. For example, your nutritionist may suggest that you eat your meals at different times or cut down on the amount of carbohydrates that you eat. The nutritionist will also offer advice on specific nutritional supplements if necessary. The nutritionist will then schedule follow up visits to monitor your health.

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Dr.Lamiaa Ali FNU- 422

Improving Client’s Food Intake Loss of appetite is common among patients in hospitals or other medical care facilities Result of medical condition, treatment, emotional distress Can be affected by medications & other treatments that alter taste perceptions FNU- 422

Improving the Client’s Nutrition Make formal nutritional assessments on regular basis All members of health care team should be alert to signs of malnutrition every day Listen to client’s concerns about diets served Watch reaction to food served FNU- 422

these may indicate that : 1. The client may need information about nutritional needs 2. The client may need a supplement 3. The client may want other foods FNU- 422

Clinical dietitian have central role in helping patients to eat FNU- 422

Helping patients to eat At hospital , motivate patient to eat. Help patient select foods he likes & mark menus appropriately according to his health condition Suggest foods that require little effort to eat Check patient’s tray to confirm correct diet & food selections Take a positive attitude toward hospital foods FNU- 422

Feeding the Client At home, family menu should serve as basis for client’s meal whenever possible. Family meals are easily adapted for the client by: omitting or adding certain foods or varying the method of preparation. FNU- 422

Mashed potatoes with butter Buttered peas Salad with French dressing Suppose the client was to limit fat intake and the family menu was the following: Fried hamburgers Mashed potatoes with butter Buttered peas Salad with French dressing Ice cream with fresh strawberries Whole milk FNU- 422

Serving the Meal Make tray and food arrangement as attractive as possible with a colorful garnish which must fit into the client’s diet plan Serve water and another beverage (unless it is prohibited by the physician) Serve food at proper temperature FNU- 422

Offer bedpan and hygiene care before and after meal When the client is on complete bed rest, special preparations are required before the meal is served: Ensure client is in comfortable position with tray and utensils placed conveniently Offer bedpan and hygiene care before and after meal Remove any unpleasant sights FNU- 422

Give sufficient time to eat. continue Open containers and try to anticipate client’s needs (If the client needs help, the napkin should be opened and placed, the bread spread, the meat cut, and the straw offered Give sufficient time to eat. If the meal is interrupted, the tray should be reheated and served again as soon as the interruption has resolved. FNU- 422

The kinds and amounts of food refused, the time, type of diet, and client’s appetite should be recorded on the client’s chart after each meal. FNU- 422

Feeding the Client Who Requires Assistance Encourage clients to feed themselves However, offer help when needed FNU- 422

If the client is unable to feed herself or himself the person doing the feeding: Sit near side of bed Small amounts of food should be placed toward back of mouth with slight pressure on tongue with spoon or fork FNU- 422

If one-sided paralysis, food and drinking straw should be placed on non-paralyzed side of mouth If client begins to choke, help sit up straight. Do not give food or water while the client is choking FNU- 422

Feeding the Blind Client Arrange food as if plate were face of clock Use consistent pattern so client knows where each item will be each time Client usually feels better when helping themselves. FNU- 422

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Feeding the physically impaired Client Eating and drinking require a considerable number of individual coordinated motions. Adaptive feeding equipment can help patients with feeding disabilities gain independence. FNU- 422

• Provide plates with food guards to prevent spilling. Provide utensils that have modified handles, or are smaller or larger as necessary. • Encourage the use of hands for feeding if utensils are difficult to maneuver. • Provide plates with food guards to prevent spilling. • Supply clothing protection FNU- 422

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