Chapter 17 Nutrition Care Nutrition care is important in overall health and disease management. It must be provided in a comprehensive manner.

Chapter 17 Lesson 17.1 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Key Concepts Comprehensive health care is best provided by a team of health professionals and support staff. A personalized health care plan, evaluation, and follow-up care guide actions to promote healing and health. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Setting and Focus of Care Health care setting Person-centered care Health care team Physician and support staff Role of the nurse Role of the dietitian How do the roles of the nurse and dietitian differ? Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Setting and Focus of Care, cont’d Nursing role Coordinator and advocate Interpreter Teacher or counselor What is meant by “interpreter”? Explain that the nurse often is the communicator between the physician and the family. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Setting and Focus of Care, cont’d Figure information: The nutrition care process model. From Lacey K, Pritchett E: Nutrition care process and model: ADA adopts road map to quality care and outcomes management, J Am Diet Assoc 103(8):1061, 2003. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Setting and Focus of Care, cont’d Nurses and dietitians provide essential support and personalized care. Registered dietitians (RDs) carry major responsibilities. A real partnership with patients and caretakers is essential to valid care. Nutrition care must be person centered. The dietitian plans, implements, and evaluates care. What is meant by “person-centered care”? Why is it important to involve the patient in nutrition care? Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process Nutrition assessment Nutrition diagnosis Nutrition intervention Nutrition monitoring and evaluation What methods are used to collect nutrition information? Be sure to discuss the nurse’s role in each phase of the care process. The plan of care must be congruent with the patient’s wishes and must be effective. Evaluation should be ongoing. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment Anthropometric data Biochemical tests Diet evaluations Clinical observations Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment, cont’d Anthropometrics Age Gender Weight Height Body frame Body composition Why are these data important? Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment, cont’d Anthropometric measurements Weight Weigh patients at consistent times. Weigh patients without shoes in light indoor clothing. Ask about recent weight loss or gain. Height Use fixed measuring stick on wall or moveable measuring rod on platform clinic scale. Have patient stand as straight as possible with no shoes or cap. Weight and height are used to calculate body mass index. Accurate measurements are important in determining patient needs. Nurses must be vigilant in obtaining accurate weights. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment, cont’d Anthropometric measurements, cont’d Body composition Skinfold thickness measurement with calipers Hydrostatic weighing Bioelectrical impedance analysis Dual energy x-ray absorptiometry BOD POD body composition tracking system Body composition is important but often not used in hospitals. Laboratory tests can identify many chronic nutrition problems. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Measuring height in an infant Figure information: From Mahan LK, Escott-Stump S: Krause’s food & nutrition therapy, ed 12, Philadelphia, 2008, Saunders. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment, cont’d Biochemical tests Plasma protein Protein metabolism Immune system integrity Skeletal system integrity Gastrointestinal function What do protein tests indicate? Why is gastrointestinal function part of the nutrition assessment? Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment, cont’d Biochemical tests, cont’d Plasma protein Hemoglobin, hematocrit, serum albumin Help detect protein and iron deficiencies Protein metabolism Basic 24-hour urine tests Elevated levels may indicated excess breakdown of body tissue Immune system integrity Determine lymphocyte count These tests can be quite effective in identifying chronic problems. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment, cont’d Biochemical tests, cont’d Skeletal system integrity Status of bone integrity and possible osteoporosis Gastrointestinal function Radiographs used to detect peptic ulcer disease Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment, cont’d Dietary evaluation History Usual intake, current intake, restrictions, modifications (use 24-hour recall and food diaries) Support system Nutrition supplements, vitamin or mineral supplements Food allergies, intolerances Activity level (average energy expended per day) What are the pros and cons of using a 24-hour recall? Explain that a sick patient often does not eat normally the day or two before entering the hospital, so it often is a good idea to ask what normal intake was before the sickness. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition assessment, cont’d Observations Clinical signs of nutrition status Physical examination Why is diet history important? What information can be gained from it? Three-day calorie counts are frequently used in long-term care settings to evaluate nutrition status and identify problem areas. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition diagnosis Problem Etiology Signs and symptoms In terms of drug-food interactions, certain foods may affect absorption, distribution, metabolism, or elimination of drugs. What effects on nutrition do drug interactions have? Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Chapter 17 Lesson 17.2 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Key Concepts Valid health care is centered on the patient and his or her individual needs. A personalized health care plan, evaluation, and follow-up care guide actions to promote healing and health. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process Nutrition intervention Disease modification Personal adaptation Mode of feeding Routine house diet Oral feeding Assisted oral feeding Enteral feeding Parenteral feeding What is the difference between enteral and parenteral feeding? When are these modes of feedings indicated? Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Phases of the Care Process, cont’d Nutrition monitoring and evaluation Nutrition goals Changes Ability to follow diet More information or resources needed Name some reasons why a person may not have the ability to follow a diet. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Drug Interactions Over-the-counter self-medications Prescribed drugs Alcohol “Street drugs” Some patients are hesitant to tell health professionals about street drug use. Name some over-the-counter self-medications that can interact with other drugs. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Drug-Food Interactions Alcohol Analgesics and nonsteroidal antiinflammatory drugs Antiulcer agents (histamine blockers) Antibiotics Anticoagulant Antineoplastic drugs Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Drug-Food Interactions, cont’d Antiemetics Anticonvulsants Antidepressants: Monoamine oxidase inhibitors Antihistamines Antihypertensives Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Drug-Food Interactions, cont’d Antihyperlipemics (HMG-CoA reductase inhibitors) or statins Antiparkinson drugs Antituberculosis drugs Bronchodilators Corticosteroids Hypoglycemic agents Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Drug-Nutrient Interactions Primarily occur when medications are taken in combination with over-the-counter vitamin and mineral supplements Examples Corticosteroids and vitamin C Antibiotics and gut flora Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Drug-Herb Interactions Least well defined Common examples St. John’s wort and antidepressants Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Summary The basis for effective nutrition care begins with the patient’s nutrition needs and must involve the patient and family. Such person-centered care requires initial assessment and planning by the dietitian and continuous close teamwork among all team members providing primary care. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Summary, cont’d Careful assessment of factors influencing nutrition status requires a broad foundation of pertinent information (e.g., physiologic, psychosocial, medical, and personal). Nutrition therapy is based on the personal and physical needs of the patient. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.

Summary, cont’d Drug interactions with nutrients, foods, or other medications can present complications with patient care. Careful questioning to determine all prescription and over-the-counter supplements and medications taken will help guide education needs for the patient. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.