principles of nutrition therapy & the role of the nurse
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Principles of nutrition therapy & the role of the nurse
Diet Therapy: NURS 2018
ObjectivesAt the end of this presentation students will be
able to: Describe the nutritional intake of persons who
are institutionalizedExplain the basis for determining the
therapeutic nutritional requirements of individuals
Use the concept of diet therapy in planning menus for patients
Identify ways of incorporating dietary management in nursing care plans
Describe the role of nurse in providing nutritional care to institutionalized individuals
Factors affecting nutritional requirement and intakeIndividual differences exist which
impact nutritional requirements they include:
AgeGenderGeneral conditionHealth disorderNutritional statusSoci-economic background
Factors affecting nutritional requirement and intake
Emotional and cultural factors are very important in determining food intake.
The cultural pattern of three meals will impact dietary choice.
Animal experiments have shown that habitual factors such as three meals per day have great influence on dietary pattern and choices
Dietary information may affect early choices which has implications for later life; in respect of NCDs and excesses
Factors affecting nutritional requirement and intake
Appetite may be adequate for selection of a nutritionally acceptable diet under certain circumstances
Selection of food on the basis of nutritional principles is more reliable and is recommended
There are normal variations in food intake in relation to
age, sex, environmental temperature, and caloric expenditure
Factors affecting nutritional requirement and intake
Age- higher caloric and micronutrient requirement needed to support :◦growth and development; ◦bone and muscle mass development
Sex- BMR is increased with higher muscle mass◦higher in adults compared with older
adults who have sarcopenia;◦ higher in males than females
Factors affecting nutritional requirement and intake
Reports have suggested that decrease in appetite occurs when environmental temperature has reached a point at which maintenance of body temperature is difficult
Caloric expenditure increases both the requirement for more calories and usually the appetite (thus intake)
Illness and disease- though this may decrease appetite in some instances- the actual micronutrient and caloric requirements may be higher
Factors affecting nutritional requirement and intake
Factors causing increased intake
Cystic fibrosis of the pancreas
Hyperthyroidism
Diabetes mellitus
Epinephrine-producing tumors of the adrenal medulla
Pts on ACTH, adrenal cortical steroids, androgens, estrogens, and isoniazide.
Tumors of the hypothalamic regions of the brain
Factors affecting nutritional requirement and intake
Factors causing reduced intake
Dietary deficiency of any essential nutrient
Acute and chronic febrile illnesses,
Debilitating illnesses such as rheumatoid arthritis and ulcerative colitis,
Hepatic and renal diseases,
Hypothyroidism
Hospitalized peopleNutrition care in hospitals is aimed at the
role that nutrition plays in any acute process occurring during hospitalization as well as long-term goals.
Nutrition services include food service and clinical nutrition
Medical nutrition therapy is the assessment and treatment of illness or disease that relates to nutritional care.
Hospitalized peopleMalnutrition risk increases in the hospitalized
client because of factors that decrease dietary intake, increase nutrient losses and lead to increased metabolic needs
The provision of specialized nutrition support in the form of enteral or parenteral nutrition should be done after careful consideration of the indicators, risks and benefits of treatment
Palliative nutrition care involves providing hydration and nutrition in accordance with client centered decisions particularly in end of life care.
Hospitalized peopleHospital patients usually spend most of their time
in bed.
Their needs for energy are therefore lower than those of active persons of the same sex, age and weight.
However, some may have increased nutritional requirements. These include ◦ patients who entered hospital undernourished; ◦ those who are pregnant or lactating or have recently
had a baby;◦ and those with diseases that require a special diet or
extra nutrients.
Hospitalized peopleNutrition care in hospitals is aimed at the
role that nutrition plays in any acute process occurring during hospitalization as well as long-term goals.
Nutrition services include food service and clinical nutrition
Medical nutrition therapy is the assessment and treatment of illness or disease that relates to nutritional care.
Hospitalized peopleMalnutrition risk increases in the hospitalized
client because of factors that decrease dietary intake, increase nutrient losses and lead to increased metabolic needs
The provision of specialized nutrition support in the form of enteral or parenteral nutrition should be done after careful consideration of the indicators, risks and benefits of treatment
Palliative nutrition care involves providing hydration and nutrition in accordance with client centered decisions particularly in end of life care.
Hospitalized peopleThe nurse is a vital member of the
interdisciplinary health care team providing nutrition support and care.
One of the key processes in clinical nutrition in nutritional assessment which includes anthropometric and clinical measures of assessment.
Hospitalized peopleHospital patients usually spend most of
their time in bed. Their needs for energy are therefore lower
than those of active persons of the same sex, age and weight.
However, some may have increased nutritional requirements. These include ◦patients who entered hospital undernourished; ◦ those who are pregnant or lactating or have
recently had a baby;◦and those with diseases that require a special
diet or extra nutrients.
Hospitalized peopleNutrition care in hospitals is aimed at the
role that nutrition plays in any acute process occurring during hospitalization as well as long-term goals.
Nutrition services include food service and clinical nutrition
Medical nutrition therapy is the assessment and treatment of illness or disease that relates to nutritional care.
Hospitalized peopleMalnutrition risk increases in the hospitalized
client because of factors that decrease dietary intake, increase nutrient losses and lead to increased metabolic needs
The provision of specialized nutrition support in the form of enteral or parenteral nutrition should be done after careful consideration of the indicators, risks and benefits of treatment
Palliative nutrition care involves providing hydration and nutrition in accordance with client centered decisions particularly in end of life care.
Hospitalized peopleThe nurse is a vital member of the
interdisciplinary health care team providing nutrition support and care.
One of the key processes in clinical nutrition in nutritional assessment which includes anthropometric and clinical measures of assessment.
Hospitalized peopleHospital patients usually spend most of
their time in bed. Their needs for energy are therefore lower
than those of active persons of the same sex, age and weight.
However, some may have increased nutritional requirements. These include ◦patients who entered hospital undernourished; ◦those who are pregnant or lactating or have
recently had a baby;◦and those with diseases that require a special
diet or extra nutrients.
Hospitalized peopleNutrition care in hospitals is aimed at
the role that nutrition plays in any acute process occurring during hospitalization as well as long-term goals.
Nutrition services include food service and clinical nutrition
Medical nutrition therapy is the assessment and treatment of illness or disease that relates to nutritional care.
Hospitalized peopleMalnutrition risk increases in the hospitalized
client because of factors that decrease dietary intake, increase nutrient losses and lead to increased metabolic needs
The provision of specialized nutrition support in the form of enteral or parenteral nutrition should be done after careful consideration of the indicators, risks and benefits of treatment
Palliative nutrition care involves providing hydration and nutrition in accordance with client centered decisions particularly in end of life care.
Hospitalized peopleThe nurse is a vital member of
the interdisciplinary health care team providing nutrition support and care.
One of the key processes in clinical nutrition is nutritional assessment which includes anthropometric and clinical measures of assessment.
Psychological Impact of IllnessBeing ill may have severe
psychological impact on health and result in several health care conditions suited to the NANDA list:
Emotional needs- caregiver role strain, sadness, anxiety, fear
Ability to cope:- impaired coping, anticipatory grieving, depression, social isolation
Institutional setting:- powerlessness
Illness:- Impact on food behaviour
Illness and institutionalization may impact negatively on dietary intake as they may impair:-◦Appetite- smells, appearance of food, texture
may differ from what was consumed at home◦Acceptance and Rejection of foods:- pain,
nausea, drowsiness, physical disabilities (temporary and permanent) may affect the willingness to accept or reject food
◦Failure to eat:- the same conditions affecting acceptance may also affect and result in failure to eat
Nutritional Needs of the hospitalized patientThe nutritional status of a patient at admission
has implications for the management and outcome of the condition. Some nutritional issues that have negative impact on outcome and management are:-◦ Undernutrition◦ Loss of lean body mass◦ Prolonged admission
These have negative impact◦ Co-morbidity◦ Opportunistic infections◦ Length of stay ◦ Mortality
Nutritional Needs of the hospitalized patient
Basis of determining needsPredictive Equation
Formulae
Harris-Benedict (males)
66.45 +13.75 * wt + 5 * ht - 6.75 * age
Harris-Benedict (females)
655.09 + 9.56 * wt + 1.84 * ht - 4.67 * age
Mifflin-St. Jeor (males)
9.99 * wt+6.25* ht - 4 .92 * age + 5
Mifflin-St. Jeor (females)
9.99 * wt + 6.25 * ht – 4.92 * age - 161
WHO (males) [18-30 years]
15.3 * wt + 679
WHO (females) [18-30 years]
14.7 * wt + 496Tucker & Dauffenbach, 2011
Nutritional Needs of the hospitalized patientBasis for determining needs
EER by gender FormulaeFemales 354- (691* age) + PA * (9.36 * wt +
726 * ht)Males 662- (9.53 * age) + PA * (15.91 * wt +
539 * ht)
Activity Activity Factor (PA)Sedentary 1Light active 1.16Active 1.31Very active 1.56
Disadvantages of estimating energy requirementsEstimating energy needs just
based on weight may be erroneous as the ratio of active lean body mass to total weight is not constant- thus a DEXA scan or a bioelectrical impedance may be useful.
(Duggan and Golden, 2007)
Nutritional Needs of the hospitalized patientBasis for determining needsBased on Nitrogen balance studies the normal
Nitrogen requirements range from 105mg N/kg/d to 132mg N/kg/d for nitrogen equilibrium- losses= intake
NB. 1g protein= 6.25mg NThus 0.105gN * 6.25= 0.65g Protein/kg/d &
0.132gN * 6.25= 0.83kg Protein/kg/d - which is two sd units of the mean of 0.65
Thus normal protein requirement for nitrogen balance is 0.65 to 0.83 g/kg/d
Protein requirements should be 10%- 15% of total energy intake/d
(Smith, 2007)
Nutritional Needs of the hospitalized patient
The tools that are important in determining the needs of hospitalized patients include
Nutritional assessment including – anthropometry, biochemical tests and clinical assessment
Medical diagnosis:- this is often a multiplier in energy determination
Dietary history which provides an analysis of usual intake
Prescribed nutritional therapy
There are several ways that the hospitalized patient may be supported nutritional. The method of dietary delivery is dependent on: ◦Anorexia due to illness- weakens due to
illness or surgery; cancer; eating disorders◦Swallowing disorders:- presence of gag
reflex; Cerebrovascular motor neuronal, esophageal stricture
◦Gastric stasis, gastroparesis- post op; ICU◦Inability to take sufficient orally- burns,
trauma, Inflammatory bowel disease
Nutrition as part of the Nursing Care Plan
Analysis of food- The nurse identifies, type, amount, preparation styles, likes and dislikes
Plan and implement diet instruction:- in collaboration with the dietician/nutritionist and based on patient needs the nurse prepares the patient for discharge and wellness maintenance and in primary settings
Identify follow-up care needs- HTN, Renal, DM, HIV/AIDS clinic along with dietary referral
Other assistance- Social Worker, Path programmes, advise regarding gyms, recovery groups
ReferencesDuggan, M., & Golden, B. (2007). Deficiency
diseases. In C. Geissler & H. Powers (Eds.), Human Nutrition (11th Ed.) (pp 517-536). Edinburgh, UK: Elsevier Churchill Livingstone.
Smith, R. C. (2007). Nutritional support for hospitalized patients. In J. Mann & A. S. Truswell (Eds.), Essentials of human nutrition (pp 33-52). New York, USA: Oxford University Press.
Tucker, S. & Dauffenbach, V. (2011). Nutrition and diet therapy for nurses. Boston, USA: Pearson.
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