Chapter 17 Nutritional Care
-
Upload
alexandra-roberson -
Category
Documents
-
view
69 -
download
3
description
Transcript of Chapter 17 Nutritional Care
![Page 1: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/1.jpg)
Nutritional support is fundamental in the successful treatment of disease
Nutritional support is often the primary therapy
This chapter focuses on:◦ the comprehensive care of the patient’s
nutritional needs as provided by the RD and◦ the nursing role in the care process in identifying
nutritional needs within the nursing diagnosis
1
![Page 2: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/2.jpg)
Define the therapeutic process Describe the collection & analysis of nutritional information
Describe the planning & implementation of nutritional care
Identify the evaluation of nutritional care
2
![Page 3: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/3.jpg)
Key concepts◦Valid health care is centered on the
patient and his or her individual needs◦Comprehensive health care is best
provided by a team of various health professionals and support staff persons
◦A personalized health care plan, evaluation, and follow-up care guides actions to promote healing and health
3
![Page 4: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/4.jpg)
Nurses and dietitians provide essential support and personalized care.◦Patients need personal advocates in a
maze of complex medical technology that can be confusing
Registered Dietitian (RD) carries major responsibility “medical nutrition therapy” – i.e. for determining individual nutritional therapy needs and plan of care
4
![Page 5: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/5.jpg)
Nurses are in the closest continuous contact with patients and their families. Real partnership with patients and caretakers essential to valid care.◦ Coordinate the patient’s special services and
treatments◦ Consult and make referrals as needed◦ Interprets and explains the plan of care to the
patient◦ Teacher and counselor
Nutritional care must be person-centered.◦ Needs must constantly be updated with the
patient’s status
5
![Page 6: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/6.jpg)
Collecting information
Identifying problems
Planning care Implementing care Evaluating and
recording results
6
![Page 7: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/7.jpg)
Nutrition Assessment
7
![Page 8: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/8.jpg)
ABCD approach: ◦Anthropometry◦Biochemical tests◦Clinical observation◦Dietary evaluation
Anthropometric Measurements – are the physical measurements of the human body used for health assessment
8
![Page 9: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/9.jpg)
Three types of measurements are common:◦ Weight – preferably
before breakfast, without shoes, in light indoor clothing
◦ Height – stand as straight as possible without shoes or cap
◦ Body composition – to determine fat vs muscle
9
![Page 10: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/10.jpg)
Biochemical Tests: Include:
◦Plasma Proteins (serum albumin, prealbumin, hemoglobin) Help detect protein and iron deficiencies
◦Liver enzymes◦BUN, Serum electrolytes◦Cr◦CBC◦Fasting glucose
10
![Page 11: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/11.jpg)
Protein metabolism Basic 24-hour urine tests measures byproducts of
protein metabolism – Cr, Urea Nitrogen Elevated levels may indicated excess breakdown of body
tissue
◦ Immune system integrity Determines lymphocyte count
◦ Skeletal system integrity Status of bone integrity and possible osteoporosis
◦ Gastrointestinal function: lab and x-ray Evaluate for peptic ulcer disease and malfunctions along
GI tract
11
![Page 12: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/12.jpg)
Clinical Observations:◦Clinical signs of
nutritional status◦Physical
examination◦Inspection of skin
for edema, turgor, nail integrity, abdominal exam, BS, and lungs.
12
![Page 13: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/13.jpg)
Dietary Evaluation: Specific food
history obtained using three-day food record.◦Nutritional
Supplements◦Food allergies,
intolerances◦Activity level
13
![Page 14: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/14.jpg)
“Identification and labeling an actual occurrence, risk of, or potential for developing a nutrition problem that dietetics professionals are responsible for treating independently”
Nutrition diagnosis will change as the patient’s nutrition needs change.
14
![Page 15: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/15.jpg)
Example:◦ Excessive caloric intake related to frequent
consumption of large portions of high-fat meals as evidenced by (AEB) average daily intake of calories exceeding recommended amount by 500 kcals and 12 pound weight gain during the past 18 months.
15
![Page 16: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/16.jpg)
The “nutritional problem” is identified in the nutrition diagnostic statement◦ May include nutritional deficiencies or
underlying disease requiring a special modified diet
Etiology: Identify cause or contributing factors. ◦ Correctly identifying the cause is the only way to
design an intervention plan adequately
16
![Page 17: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/17.jpg)
Nutrition care and teaching include an appropriate food plan with examples of food choices, food buying, and food preparation
Everyday emotions have a significant influence on food intake and choices
Influence of economic needs
17
![Page 18: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/18.jpg)
Diet therapy based on patient’s normal nutritional requirements◦ Any therapeutic diet is only a modification of
normal nutritional needs◦ Only modified as an individual’s specific condition
requires
18
![Page 19: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/19.jpg)
Disease modifications – Nutritional components of the normal diet may be modified in 3 ways:◦ Energy – total kcals may be increased or
decreased
◦ Nutrients – modified in amount or form
◦ Texture
19
![Page 20: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/20.jpg)
Personal adaptation – Successful nutritional therapy can occur only when the diet is personalized.
Accomplished by planning with the patient or family
Four areas:◦Personal needs◦Disease ◦Nutrition therapy◦Food plan
20
![Page 21: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/21.jpg)
Routine “house” diets: ◦ A schedule based on
a cycle menu◦ Basic modifications
in texture ranging from clear liquid full liquid soft food regular diet
21
![Page 22: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/22.jpg)
Clear liquid◦ Clear broth, bouillon,
Sprite, fruit juice, gelatin, popsicles
Full liquid◦ Milk, yogurt, ice
cream, pudding
22
![Page 23: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/23.jpg)
Routine House Diets cont.
Soft◦ Pasta, soft bread,
potatoes, cooked and soft fruits
Regular◦ Any foods
23
![Page 24: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/24.jpg)
Oral feeding – preferred for as long as possible
Assisted oral feeding – nurse may have to help feed or cut up meat, butter bread, etc.◦make use of plate guards, special utensils,
etc. to promote independence Enteral feeding
◦Small tube placed through patient’s nasal cavity; runs down back of throat into either stomach or small intestine; may also use a “g-tube” for more permanent placement
24
![Page 25: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/25.jpg)
Parenteral nutrition – for those who cannot tolerate food or formula through the GI tract◦ Peripheral vein
feeding (short term)◦ Central vein feeding
(long term)◦ Intralipids
25
![Page 26: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/26.jpg)
Evaluated in terms of nutritional diagnosis and treatment objectives
Continues through period of care, stops at the point of discharge
General considerations◦ Nutritional goals – effect of the dietor feeding method on the illness or the patient’s situation?
26
![Page 27: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/27.jpg)
◦ Required changes – is it necessary to change the type of food or feeding equipment, environment for meals, counseling procedures, or types of learning activities for nutrition education?
◦ Ability to follow diet – Does any hindrance or disability prevent the patient from following the treatment plan?
◦ Resources - Do the patient and family understand all the self-care instructions provided? Connection with community resources available?
27
![Page 28: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/28.jpg)
Gathering information about all drug use is essential to the care process◦Includes over-the-counter drugs, prescribed
drugs, alcohol, “street drugs” Drug-food interactions
Increasing or decreasing the effect of a drug and adversely affect health
28
![Page 29: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/29.jpg)
Drug-nutrient interactions Reactions occur when prescription drugs
are taken in combination with over-the-counter vitamin and mineral supplements.
Drug-herb interactions Is the least defined of drug interactions Some herbs have clinically documented
medicinal properties May affect key enzymes involved in
metabolism
29
![Page 30: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/30.jpg)
30
![Page 31: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/31.jpg)
Examples: Ginkgo biloba- Aspirin, warfarin (Coumadin),
ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine)
St. John's wort-Antidepressants Ephedra-Caffeine, decongestants,
stimulants Ginseng-Warfarin Kava-Sedatives, sleeping pills,
antipsychotics, alcohol
31
![Page 32: Chapter 17 Nutritional Care](https://reader031.fdocuments.net/reader031/viewer/2022032206/5681322e550346895d989310/html5/thumbnails/32.jpg)
32