1. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.1 Chapter 17 Nutrition Care

2. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.2 Lesson 17.1 Chapter 17

3. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.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.

4. 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

5. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.5 Setting and Focus of Care, cont’d Nursing role –Coordinator and advocate –Interpreter –Teacher or counselor

6. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.6 Setting and Focus of Care, cont’d

7. 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.

8. 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

9. 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

10. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.10 Phases of the Care Process, cont’d Nutrition assessment, cont’d –Anthropometrics Age Gender Weight Height Body frame Body composition

11. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.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.

12. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.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

13. 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

14. 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

15. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.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

16. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.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

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

18. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.18 Phases of the Care Process, cont’d Nutrition assessment, cont’d –Observations Clinical signs of nutrition status –Physical examination

19. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.19 Phases of the Care Process, cont’d Nutrition diagnosis –Problem –Etiology –Signs and symptoms

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

21. 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.

22. 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

23. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.23 Phases of the Care Process, cont’d Nutrition monitoring and evaluation –Nutrition goals –Changes –Ability to follow diet –More information or resources needed

24. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.24 Drug Interactions Over-the-counter self-medications Prescribed drugs Alcohol “Street drugs”

25. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.25 Drug-Food Interactions Alcohol Analgesics and nonsteroidal antiinflammatory drugs Antiulcer agents (histamine blockers) Antibiotics Anticoagulant Antineoplastic drugs

26. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.26 Drug-Food Interactions, cont’d Antiemetics Anticonvulsants Antidepressants: Monoamine oxidase inhibitors Antihistamines Antihypertensives

27. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.27 Drug-Food Interactions, cont’d Antihyperlipemics (HMG-CoA reductase inhibitors) or statins Antiparkinson drugs Antituberculosis drugs Bronchodilators Corticosteroids Hypoglycemic agents

28. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.28 Drug-Nutrient Interactions Primarily occur when medications are taken in combination with over- the-counter vitamin and mineral supplements Examples

29. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.29 Drug-Herb Interactions Least well defined Common examples

30. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.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.

31. 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.

32. 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.