Mosby items and derived items © 2006 by Mosby, Inc. Slide 1

Chapter 17Chapter 17Nutritional Care

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Chapter 17Chapter 17

Lesson 17.1Lesson 17.1

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Key ConceptsKey Concepts

• Valid health care is based on individual care.

• Comprehensive health care is best provided by a team of various health professionals and support staff persons.

• A personalized health care plan, based on individual needs and goals, guides actions to promote healing and health.

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Setting and Focus of CareSetting and Focus of Care

• Nurses and dietitians provide essential support and personalized care.

• Registered dietitian (RD) carries major responsibility

• Real partnership with patients and caretakers essential to valid care

• Nutritional care must be person-centered.

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Phases of the Care ProcessPhases of the Care Process

• Collecting information

• Identifying problems

• Planning care

• Implementing care

• Evaluating and recording results

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CollectionCollection

• 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.

(Cont'd…)

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CollectionCollection(…Cont’d)

• Anthropometric measurements Body composition• Skinfold thickness measurement with calipers• Hydrostatic weighing• Bioelectrical impedance analysis (BIA)• Dual energy x-ray absorptiometry (DEXA)• BOD POD body composition tracking system

• Medical tests Plasma protein• Hemoglobin, hematocrit, serum albumin• Helps detect protein and iron deficiencies

(Cont'd…)

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CollectionCollection(…Cont’d)

• Medical tests Protein metabolism• Basic 24-hour urine tests• 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• X-rays used to detect peptic ulcer disease

(Cont'd…)

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CollectionCollection(…Cont’d)

• Observations Careful observation of various body

parts may reveal signs of poor nutrition.

• Diet history Specific food history obtained using

three-day food record.

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AnalysisAnalysis

• Nutritional problems

• Drug interactions Includes over-the-counter drugs, prescribed

drugs, alcohol, “street drugs” Drug-food interactions

(Cont'd…)

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Analysis Analysis (…Cont’d)

• Drug interactions 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

• Personal needs and goals Personal, cultural, ethnic needs must be considered.

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Chapter 17Chapter 17

Lesson 17.2Lesson 17.2

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Key ConceptsKey Concepts

• Comprehensive health care is best provided by a team of various health professionals and support staff persons.

• A personalized health care plan, based on individual needs and goals, guides actions to promote healing and health.

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Basic Principles of Basic Principles of Diet TherapyDiet Therapy

• Diet therapy based on patient’s normal nutritional requirements

• Disease modifications Energy, nutrients, texture

• Personal adaptation Personal needs, disease, nutrition therapy, food plan

• Routine house diets Based on cycle menu usually followed in most

hospitals

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Mode of FeedingMode of Feeding

• Oral feeding

• Assisted oral feeding

• Enteral feeding Small tube placed through patient’s nasal

cavity; runs down back of throat into either stomach or small intestine

• Parenteral nutrition (IV feeding) Peripheral vein feeding Central vein feeding

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Evaluation of Evaluation of Nutritional CareNutritional Care

• Evaluated in terms of nutritional diagnosis and treatment objectives

• Continues through period of care, terminates at point of discharge Nutritional goals Accuracy of care plan actions Ability to follow diet

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Role of Clinical DietitianRole of Clinical Dietitianand Nurseand Nurse

• Dietitian Determines nutritional needs Plans and manages nutrition therapy Evaluates plan of care Records results

• The nurse should Resolve conflicts with medical treatment Explain various treatments and plans of care Teach and counsel patient on nutrition care