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

2. Chapter 17
Lesson 17.1
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3. 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.

4. 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?
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5. 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.

6. 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.

7. 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.

8. 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.

9. Phases of the Care Process, cont’d
Nutrition assessment
Anthropometric data
Biochemical tests
Diet evaluations
Clinical observations
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10. 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?
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11. 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.
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12. 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.

13. 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.

14. 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?
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15. 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.
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16. 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
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17. 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.
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18. 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.
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19. 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.

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

21. 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.

22. 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?
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23. 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.
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24. 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.
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25. Drug-Food Interactions
Alcohol
Analgesics and nonsteroidal antiinflammatory drugs
Antiulcer agents (histamine blockers)
Antibiotics
Anticoagulant
Antineoplastic drugs
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26. Drug-Food Interactions, cont’d
Antiemetics
Anticonvulsants
Antidepressants: Monoamine oxidase inhibitors
Antihistamines
Antihypertensives
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27. Drug-Food Interactions, cont’d
Antihyperlipemics (HMG-CoA reductase inhibitors) or statins
Antiparkinson drugs
Antituberculosis drugs
Bronchodilators
Corticosteroids
Hypoglycemic agents
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28. 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
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29. Drug-Herb Interactions
Least well defined
Common examples
St. John’s wort and antidepressants
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30. 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.

31. 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.

32. 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.