1. Mosby items and derived items © 2006 by Mosby, Inc. Slide 1 Chapter 17 Nutritional Care

2. Mosby items and derived items © 2006 by Mosby, Inc. Slide 2 Chapter 17 Lesson 17.1

3. Mosby items and derived items © 2006 by Mosby, Inc. Slide 3 Key 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.

4. Mosby items and derived items © 2006 by Mosby, Inc. Slide 4 Setting 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.

5. Mosby items and derived items © 2006 by Mosby, Inc. Slide 5 Phases of the Care Process Collecting information Identifying problems Planning care Implementing care Evaluating and recording results

6. Mosby items and derived items © 2006 by Mosby, Inc. Slide 6 Collection 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…)

7. Mosby items and derived items © 2006 by Mosby, Inc. Slide 7 Collection (…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…)

8. Mosby items and derived items © 2006 by Mosby, Inc. Slide 8 Collection (…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…)

9. Mosby items and derived items © 2006 by Mosby, Inc. Slide 9 Collection (…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.

10. Mosby items and derived items © 2006 by Mosby, Inc. Slide 10 Analysis Nutritional problems Drug interactions  Includes over-the-counter drugs, prescribed drugs, alcohol, “street drugs”  Drug-food interactions (Cont'd…)

11. Mosby items and derived items © 2006 by Mosby, Inc. Slide 11 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.

12. Mosby items and derived items © 2006 by Mosby, Inc. Slide 12 Chapter 17 Lesson 17.2

13. Mosby items and derived items © 2006 by Mosby, Inc. Slide 13 Key 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.

14. Mosby items and derived items © 2006 by Mosby, Inc. Slide 14 Basic Principles of Diet 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

15. Mosby items and derived items © 2006 by Mosby, Inc. Slide 15 Mode 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

16. Mosby items and derived items © 2006 by Mosby, Inc. Slide 16 Evaluation of Nutritional 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

17. Mosby items and derived items © 2006 by Mosby, Inc. Slide 17 Role of Clinical Dietitian and 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