Illness And Nutrition Care PDF

Illness and Nutrition Care Subtitle A. Nutrition in Health Care Malnutrition is frequently reported in patients hospitalized with acute illness, and acutely ill individuals without nutrition problems on admission often exhibit a subsequent decline in nutrition status Poor nutrition status...

Illness and Nutrition Care Subtitle A. Nutrition in Health Care Malnutrition is frequently reported in patients hospitalized with acute illness, and acutely ill individuals without nutrition problems on admission often exhibit a subsequent decline in nutrition status Poor nutrition status weakens immune function and compromises a person’s healing ability, influencing both the course of disease and the body’s response to treatment. Effects of Illness on Nutrition Status Illnesses and their treatments may lead to malnutrition by reducing food intake, interfering with digestion and absorption, or altering nutrient metabolism and excretion. The dietary changes required during an acute illness are usually temporary and can be tailored to accommodate an individual’s preferences and lifestyle. However, chronic illnesses (those lasting 3 months or longer) may require long-term modifications B. Responsibility for Nutrition Care Physicians. Physicians are responsible for meeting all of a patient’s medical needs, including nutrition. They prescribe diet orders (also called nutrition prescriptions) and other instructions related to nutrition care, including referrals for nutrition assessment and dietary counseling.  Registered Dietitians. A registered dietitian is a food and nutrition expert who is qualified to provide medical nutrition therapy. Registered dietitians conduct nutrition and dietary assessments; diagnose nutrition problems; develop, implement, and evaluate nutrition care plans (described later); plan and approve menus; and provide dietary counseling and nutrition education services. Registered dietitians may also manage food and cafeteria services in health care institutions.  Registered Dietetic Technicians Registered dietetic technicians often work in partnership with registered dietitians and assist in the implementation and monitoring of nutrition services. Other health practitioners who may assist with nutrition care include pharmacists, physical therapists, occupational therapists, speech therapists, nursing assistants, home health care aides, and social workers. These individuals can be instrumental in alerting dietitians or nurses to nutrition problems or may share relevant information about a patient’s health status or personal needs Nurses Nurses interact closely with patients and thus are in an ideal position to identify people who would benefit from nutrition services. Nurses often screen patients for nutrition problems and may participate in nutrition and dietary assessments.  Nurses also provide direct nutrition care, such as encouraging patients to eat, finding practical solutions to food-related problems, recording a patient’s food intake, and answering questions about special diets. As members of nutrition support teams, nurses are responsible for administering tube and intravenous feedings. In facilities that do not employ registered dietitians, nurses often assume responsibility for much of the nutrition care. C. Implementing Nutrition Care Once the health care professional has collected assessment information, the next steps of the nutrition care process can be carried out. A nutrition care plan often includes both dietary adjustments and nutrition education. Note that some aspects of nutrition care fall within the scope of dietetics practice, whereas others require the assistance of other health professionals.  Dietary Modifications. During illness, many patients can meet energy and nutrient needs by following a regular diet. Other patients may require a modified diet, which is altered by changing food consistency or texture, nutrient content, or the foods included in the diet. Diet Progression. A change in diet as a patient’s food tolerance improves is called diet progression. Diet Manual.When designing menus for modified diets, the dietary and foodservice personnel refer to a diet manual, which details the exact foods or preparation methods to include in or exclude from a modified diet. The diet manual may also outline the rationale and indications for use of the diets and include sample menus. The manual may be compiled by the dietetics staff or adopted from another health care facility or a dietetics organization. Alternative Feeding Routes In most cases, patients can meet their nutrient needs by consuming regular foods. If their nutrient needs are high or their appetites poor, oral supplements can be added to their diets to improve their intakes. Sometimes, however, a person’s medical condition makes it difficult to meet nutrient needs orally. 1.Tube Feeding Nutritionally complete formulas can be delivered through a tube placed directly into the stomach or intestine. Tube feedings are preferred to parenteral nutrition if the GI tract is functioning normally. 2. Parenteral Nutrition A person’s medical condition sometimes prohibits the use of the GI tract to deliver nutrients. If the person is malnourished and the GI tract cannot be used for a significant period of time, parenteral nutrition, in which nutrients are supplied intravenously, can meet nutritional needs. Nothing by Mouth (NPO) An order to not give a patient anything at all— food, beverages, or medications—is indicated by NPO, an abbreviation for non per os, meaning “nothing by mouth.” For example, an order may read “NPO for 24 hours” or “NPO until after X-ray.” The NPO order is commonly used during certain acute illnesses or diagnostic tests involving the GI tract. D. Approaches to Nutrition Care Long-Term Dietary Intervention When long-term changes are necessary, a care plan must take into account a person’s current food practices, lifestyle, and degree of motivation. Behavior change is a process that occurs in stages; therefore, more than one consultation is usually necessary The following approaches may be helpful in implementing long-term dietary changes: Determine the individual’s readiness for change Emphasize what to eat, rather than what not to eat. Suggest only one or two changes at a time E. Documenting Nutrition Care ADIME Format SOAP Format The SOAP format is the oldest method used for documenting nutrition care and is still in popular use. The letters represent the types of information included in each section: Subjective, Objective, Assessment, and the Plan for care. Medications, Diet-Drug Interactions, and Herbal Supplements A. Medications in Disease Treatment Drugs must be proved to be safe and effective before they can be marketed in the United States. The Food and Drug Administration (FDA) is responsible for approving sales of new drugs and inspecting facilities where drugs are manufactured  By law, drugs are divided into two categories: 1. Prescription drugs are usually given to treat serious conditions and may cause severe side effects. For these reasons, they are sold by prescription only, which ensures that a physician has evaluated the patient’s medical condition and determined that the benefits of using the medication outweigh the risks of incurring side effects.  2. Over-the-counter (OTC) drugs are those that individuals can use safely and effectively without medical supervision. The FDA regulates labels on OTC drugs to make sure they provide accurate information about the drugs’ appropriate uses and dosages and potential adverse effects. Prescription drugs considered safe enough for self-medication are often given OTC status, sometimes in smaller doses than are available by prescription. B. Risks from Medications Drug-Drug Interactions when a person uses multiple drugs, one drug may alter the effects of another drug, and the risk of side effects increases Diet-Drug Interactions Substances in the diet may alter the effectiveness of drugs, and drugs may affect food intake or the digestion, absorption, metabolism, or excretion of nutrients. Later sections of this chapter describe these interactions in detail.  C. Patients at High Risk of Adverse Effects Advise the patient that drugs should not be taken unless absolutely necessary Request a complete list of prescription medications, OTC drugs, and dietary supplements that the patient is taking. Verify that the patient understands how to take medications properly. Alert the patient to potential drug-drug and diet-drug interactions. Encourage the patient to keep track of side effects.  D. Diet-Drug Interactions Drugs may alter food intake by reducing the appetite or by causing complications that make food consumption difficult or unpleasant. Other drugs may increase the appetite and cause weight gain. Drugs may alter the absorption, metabolism, or excretion of nutrients. Conversely, nutrients and other food components may alter the absorption, metabolism, and excretion of drugs. Some interactions between dietary components and drugs can cause drug toxicity. Drug Effects on Food Intake Some drugs can make food intake difficult or unpleasant: they may suppress the appetite, cause mouth dryness, alter the sense of taste, lead to inflammation or lesions in the mouth or gastrointestinal (GI) tract, or induce nausea or vomiting. Drug Effects on Nutrient Absorption The medications that are most often because nutrient malabsorption is those that either upset GI function or damage the intestinal mucosa. Antineoplastic drugs and antiretroviral drugs are especially detrimental, whereas nonsteroidal anti- inflammatory drugs (NSAIDs) and some antibiotics can have similar, though milder, effects. This section describes additional ways in which medications may alter nutrient absorption. Altered Stomach Acidity Medications that reduce stomach acidity can impair the absorption of vitamin B12, folate, and iron. Examples include antacids, which neutralize stomach acid by acting as weak bases, and antiulcer drugs (such as proton pump inhibitors and H2 blockers), which interfere with acid secretion. E. Dietary Effects on Drug Absorption Stomach-Emptying Rate Drugs reach the small intestine more quickly when the stomach is empty. Therefore, taking a medication with meals may delay its absorption, although the total amount absorbed may not be lower. As an example, aspirin works faster when taken on an empty stomach, although taking it with food is often encouraged to reduce stomach irritation.  Stomach Acidity Interactions Between Drugs and Dietary Components Drug Effects on Nutrient Metabolism Dietary Effects on Drug Metabolism Drug Effects on Nutrient Excretion. Dietary Effects on Drug Excretion F. Herbal Supplements Effectiveness and Safety of Herbal Products. Despite the popularity of herbal products in the United States, the benefits of their use are uncertain. Although many medicinal herbs contain naturally occurring compounds that exert physiological effects, few herbal products have been rigorously tested, many make unfounded claims, and some may contain contaminants or produce toxic effects.  Efficacy. Herbs have been used for centuries to treat medical conditions, and many have acquired reputations for being beneficial for individuals with specific diseases. Unfortunately, only a limited number of clinical studies support the traditional uses, and the results of studies that suggest little or no benefit are rarely publicized by the supplement industry  Safety Issues Consumers. often assume that because plants are “natural,” herbal products must be harmless. Many herbal remedies have toxic effects, however.18 The most common adverse effects of herbs include diarrhea, nausea, and vomiting. Herb-Drug Interactions. Like drugs, herbs may either intensify or interfere with the effects of other herbs and drugs or they may raise the risk of toxicity