1. Nutrient Delivery  Chapter 14  J Pistack MS/Ed

2. Screening  Joint Commission requires screening patients within 24 hours of admission  Predetermined screening tool used  Rates potential nutritional risks

3. Potential Nutritional Risk  Changes in weight  Changes in appetite  Nausea  Vomiting  Dysphagia (difficulty swallowing)  Diseases such as diabetes, obesity, hypertension, cancer

4. Assessment  Patients found to be at risk after screening should have an assessment by a registered dietician  Figure 14-1 p309 is an example assessment chart

5. Nutritional Assessment Information Height, weight, body mass index, weight history Lab values Food intake Potential food–drug interactions Chewing and swallowing ability Client’s self-feed ability Bowel and bladder function Evaluation for pressure ulcers Food allergies and intolerances

6. More Assessment Information  Food preferences: cultural-religious beliefs  Body composition  Presence of burns, trauma, infection,  Physiological stressors  Learning barriers: hearing, mobility, language, vision, speech, reading/writing skills, learning disability

7. Monitoring  All patients should be monitored at appropriate intervals

8. Items to Monitor  Initial nutritional screen and/or assessment  Present body weight and weight history  A record of recent food intake and/or tolerance  Any changes in medical condition  Diet orders from a physician or designee  Family support

9. Nutritional Counseling  All patients should be evaluated for nutritional counseling  Promotes self-care  Responsibility for health and wellness  Pre-testing diets may be warranted

10. Special Diets  Seek to maintain patients nutritional status  Potential to alter the following:  Nutrients  Calories  Consistency  Fiber  Fluid

11. Iatrogenic Malnutrition  Refers to health care provider “induced” malnutrition  May be caused by:  Diagnostic tests  Meal schedule  Lack of appetite  Drug therapy

12. Methods to Prevent Iatrogenic Malnutrition  Record height/weight  Be a team player  Monitor client’s food intake  Have knowledge about good nutrition  Monitor NPO ( Latin - nil per os)(nothing by mouth) clients  Appreciate role of nutrition in total care  Recognize signs/symptoms of malnutrition  Monitor fluid intake and output (vomiting)

13. Nutrient Delivery Methods  Oral – by mouth  Enteral – direct supply of food into a functioning GI system through a tube  NG – nasogastric  ND – nasoduodenal  NJ – nasojejunal  PEG - percutaneous endoscopic gastrostomy, the creation of a new opening in the stomach for enteral tube feedings.  PEJ – used when stomach is removed  Parenteral - administered in a manner other than through the digestive tract, as by intravenous or intramuscular injection.

14. Enteral Tube Feeding Problems  Regurgitation  Aspiration  Contamination  Administration  Potential complications

15. Supplemental Feedings  Used when patients are unable to consume enough kilocalories  In the form of solids (puddings) or liquids (shakes)

16. Types of Supplemental Feedings  Modular supplements – limited number of nutrients  Standard or “polymeric” formulas – contains all the nutrients in a specified volume  Elemental and semi-elemental formulas – nutrients are in their simplest easily absorbable form  Disease-specific formulas – for people with diabetes, kidney, or liver disorders….

17. Enteral Tube Feedings  Osmolality – basically compared to isotonic food  Administration of medications to a tube-fed client  Monitoring the tube-fed client  Home enteral nutrition

18. Types of Administration of Enteral Feedings  Continuous feeding – recommended for feedings going directly to the small intestine  Intermittent feeding  Bolus feeding

19. Parenteral Nutrition  Peripheral parenteral nutrition (PPN)  Total parenteral nutrition:  Insertion and care of the TPN line  Monitoring  Transition and combination feedings  Home parental nutrition  Central parenteral nutrition – inserted into a central vein. If a peripheral line is threaded into the subclavian or jugular vein it is called a PICC line