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1414Nutrition
Intervention and Diet–Drug
Interactions
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© Cengage Learning 2017
Implementing Nutrition Care
• Care planning– Nutrition interventions (Table 14-1)
• Food and/or nutrient delivery• Nutrition education• Nutrition counseling• Coordination of nutrition care
– Many interventions include diet orders
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Implementing Nutrition Care (cont’d.)
• Care planning– Nutrition care within the nursing process (see
Table 14-2)• Assessment• Nursing diagnosis• Planning: outcome identification• Planning: development of nursing strategies• Implementation• Evaluation
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Implementing Nutrition Care (cont’d.)
• Approaches to nutrition care– Long-term dietary intervention
• Plan must consider: current food practices, lifestyle, and degree of motivation
• 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
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Implementing Nutrition Care (cont’d.)
• Approaches to nutrition care– Nutrition education
• Allows patients to learn about the dietary factors affecting their particular medical condition
• Considerations: person’s age, literacy level, and cultural background; learning style; etc.
– Follow-up care• Monitor relevant outcome measures• Adjust care plan as necessary
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Dietary Modifications
• Energy intakes in hospital patients– Resting metabolic rate (RMR) is typically
calculated by clinicians– RMR is adjusted for “stress factors”
• Activity level factor may be applied– Box 14-2 walks through these calculations
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Dietary Modifications (cont’d.)
• Energy intakes in hospital patients– Indirect calorimetry
• Procedure that estimates energy expenditure by measuring oxygen consumption and carbon dioxide production
• Provides more accurate RMR value
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Dietary Modifications (cont’d.)
• Modified (therapeutic) diets (Table 14-4)– Contain foods altered in texture, consistency,
or nutrient/food content (include or omit specific foods)
– Reasons for modified diet• Relieve chewing or swallowing difficulties• Correct malnutrition• Relieve disease symptoms• Reduce the risk of developing complications
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Dietary Modifications:Modified Diets (cont’d.)
• Mechanically altered diets (Table 14-5)– Beneficial for individuals who have difficulty
chewing or swallowing• Dysphagia: impaired swallowing
– Why are dysphagia diets highly individualized?
– Forms: pureed, ground/minced, soft
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Dietary Modifications:Modified Diets (cont’d.)
• Blenderized liquid diet– Foods available from all four food groups
• Clear liquid diet– Foods that are liquid at body temperature– Leaves minimal residue in the colon
• Fat-restricted diet– Why is it important to avoid being too
restrictive?
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Menu—Clear Liquid Diet
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Dietary Modifications:Modified Diets (cont’d.)
• Low-fiber diet– Acute intestinal disorders, before/after surgery– Why is long-term fiber restriction
discouraged?• Low-sodium diet
– Prevent or correct fluid retention– Typically 2000 or 3000 milligrams daily
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Dietary Modifications:Modified Diets (cont’d.)
• High-kcalorie, high-protein diet (Table 14-6)– Increases kcalorie and protein intakes in
patients with high requirements or who are eating poorly
– High-fat foods, commercial supplements
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Dietary Modifications (cont’d.)
• Variations in the diet order– Physician is responsible for prescribing an
appropriate diet• Often relies on the dietitian or nurse to recommend
changes in the diet order when warranted– Diet progression
• Diet changes as patient’s food tolerance improves– NPO: What is the NPO (non per os) order?
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Dietary Modifications (cont’d.)
• Variations in the diet order– Alternative feeding routes
• Tube feedings: liquid formulas delivered directly into the stomach or intestine
• Parenteral nutrition: provision of nutrient solutions intravenously
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Foodservice
• Diet manual– Specifies the foods or preparation methods to
include or exclude in modified diets– Provides sample menus
• Food selection– Selective menus
• Provide choices in some or all menu categories• What are the benefits of selective menus?
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Foodservice (cont’d.)
• Food selection– Room-service, cook-to-order system– Extended food delivery hours
• Food safety– What is a Hazard Analysis and Critical Control
Points (HACCP) program?
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Foodservice (cont’d.)
• Improving food intake– Keep patient’s room calm/quiet during meals– Engage patient in identifying most enjoyable
foods– Place occasional “surprise” on the tray, e.g.,
decoration– Box 14-3 provides additional tips
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Diet-Drug Interactions
• Categories of interactions– Drugs altering food intake by reducing or
increasing appetite– Drugs altering the absorption, metabolism, or
excretion of nutrients; or nutrients altering the absorption, metabolism, and excretion of drugs
– Interactions between dietary components and drugs that cause drug toxicity
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Diet-Drug Interactions (cont’d.)
• Examples listed in Table 14-7• Drug effects on food intake
– Make food intake difficult or unpleasant– Persistent drug effects may require other
medications• Antinauseants and antiemetics
– Stimulate appetite and cause unintentional weight gain
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Diet-Drug Interactions (cont’d.)
• Drug effects on nutrient absorption– Widespread nutrient malabsorption
• Upset GI function or damage intestinal mucosa• Antineoplastic and antiretroviral drugs
– Drug-nutrient binding: prevents absorption• Bile acid binders, tetracycline, ciprofloxacin, etc.
– Altered stomach acidity• Reduced acidity impairs absorption of vitamin B12,
folate, and iron
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Diet-Drug Interactions (cont’d.)
• Drug effects on nutrient absorption– Direct inhibition: interference with nutrient
transport into mucosal cells• Proloprim, Daraprim, colchicine, etc.
• Dietary effects on drug absorption– Stomach-emptying rate
• Empty stomach ► drug reaches small intestine more quickly
• Slow emptying may enhance drug absorption
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Diet-Drug Interactions (cont’d.)
• Dietary effects on drug absorption– Stomach acidity
• Some drugs absorbed better in acidic environment; some in alkaline conditions
– Interactions between drugs and dietary components
• Dietary substances bind to drugs and inhibit absorption
• Fiber interferes with absorption of tricyclic antidepressants
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Diet-Drug Interactions (cont’d.)
• Drug effects on nutrient metabolism– Drugs and nutrients share similar enzyme
systems in the small intestine and liver• Some drugs enhance or inhibit the activities of
enzymes needed for nutrient metabolism– Anticonvulsants (phenobarbital, phenytoin)– Methotrexate and folate– Isoniazid and vitamin B6
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Folate and Methotrexate
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Diet-Drug Interactions (cont’d.)
• Dietary effects on drug metabolism– Some food components alter the activities of
enzymes that metabolize drugs – Some counteract drug effects in other ways– Effects of grapefruit juice– Vitamin K interaction with warfarin
(Coumadin)
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Diet-Drug Interactions (cont’d.)
• Drug effects on nutrient excretion– Increased urine production
• May reduce nutrient reabsorption in the kidneys• Diuretics
– Sodium and water retention with increased potassium excretion
• Corticosteroids
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Diet-Drug Interactions (cont’d.)
• Dietary effects on drug excretion– Inadequate excretion of medications
• Toxicity– Excessive losses
• Reduce drug availability for therapeutic effect– Consistent sodium intake needed when taking
lithium– Urine acidity affects excretion of quinidine
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Diet-Drug Interactions (cont’d.)
• Drug-nutrient interactions and toxicity– Interactions may:
• Cause toxicity• Intensify a drug’s side effects
– Tyramine (food component) + monoamine oxidase (MAO) inhibitors can be fatal
• Box 14-4 offers diet-drug interaction prevention strategies
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Nutrition in Practice: Complementary and Alternative Therapies
• Nearly 40% of U.S. adults use CAM• Alternative medical systems
– Naturopathic medicine, homeopathic medicine, traditional Chinese medicine (TCM)
• Mind-body interventions– Biofeedback training, meditation
• Biologically based therapies– Herbal products, other supplements
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Nutrition in Practice: Complementary and Alternative Therapies (cont’d.)
• Manipulative interventions– Chiropractic, massage therapy
• “Energy” therapies– Biofield therapies; bioelectrical or
bioelectromagnetic therapies• Safety and effectiveness of CAM
– Potential dangers• Patient counseling
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