Lecture 2 Flashcards
Nutritional Care
Overarching term to describe the form of nutrition, nutrient
delivery and the system of education that is required for meal
service or to treat any nutrition-related condition in both
preventive nutrition and clinical nutrition.
Nutrition Therapy
Nutrition therapy describes how nutrients are provided to treat
any nutritional-related condition. Nutrition or nutrients can be
provided orally (regular diet, therapeutic diet, e.g. fortified food,
oral nutritional supplements), via enteral tube-feeding or as
parenteral nutrition to prevent or treat malnutrition in an
individualized way.
Components of the Nutritional Care Plan
Energy, nutrient (protein), fluid requirements
• Measurable (short/long-term) nutritional goals
• Instructions for implementing the specified form of nutrition
therapy
– Part of charting / documentation
• Most appropriate route of administration and method of nutrition
access
• Anticipated duration of therapy
• Discharge planning, education
Evidence informed practice contains what 4 concepts
Research Evidence
Patient Preferences & Values
Resources Available
Clinical Expertise
• Canadian Malnutrition Task Force (CMTF)
Cohort of 1015 medical/surgical patients
– 45% of patients admitted to Canadian hospitals are malnourished at
time of admission
• Malnutrition is associated with:
Prolonged hospital length of stay (LOS), increased mortality,
increased hospital costs, increased risk of infection, delayed wound
healing, increased morbidities
• Factors associated with nutritional decline (medical patients):
Lower admission BMI, cancer, >2 diagnoses, new in-hospital infection
– Reduced food intake
– Dissatisfaction with food quality
– Illness related-factors affecting food intake
Barriers to Food Intake in Acute Care Hospitals
Physiological (Illness Related) Poor appetite (anorexia) • Early satiety • Taste changes • Nausea / vomiting • Difficulty chewing / swallowing • Pain • Fatigue
Food Quality / Satisfaction Taste • Appearance • Smell • Portion sizes • Temperature
Organizational Interrupted by staff • Missed meals due to tests • NPO for procedures • Disturbed by activities, noises etc • Didn’t receive help when needed • Didn’t receive food ordered • Unsuitable meal times
Physical (Ability to Eat) Difficulty reaching, cutting up, and/or unwrapping food • Difficulty feeding self • Uncomfortable position to eat • Not enough time to eat all food • Need meal assistance
Nutrition Therapies: Routes of Feeding
Oral Diets (PO=per os = by mouth)
Enteral Nutrition (EN) (Enteric– relating to or occurring in the intestines) can lead to tube feeding or Oral Nutrition Supplements (ONS)
Parenteral Nutrition (PN) Nutrition via intravenous route (IV)
Oral Feeding – Types of (Hospital) Diets
House/Regular diet
– Standardized energy and macronutrient content
• i.e. 1500 kcal, 60 g protein per day
• Therapeutic diets
– Manipulation/modification of single/multiple nutrients
– Multiple different types, i.e.
• Diabetic (patterns, snacks, lower CHO etc.)
• Cardiac (low Na, lower fat etc.)
• Renal (low K, low Phos etc.)
What is the issue with clear liquid diets
they are intended to supply fluid and energy in a form that required minimal digestion and stimulation of the GI tract
they contain clear fluids or foods tha are liquid body temperature , clear fruit juices, bouillon, gelatin, candy,
they are nutritionally adequate
-ALMOST ALL SUGAR
Therapeutic Diets
Texture & Fluid Modifications
Texture Modifications • Soft • Diced • Minced • Pureed
Fluid Modifications • Thickened fluids (dysphagia management) – Nectar-thick • Easily pourable; comparable to thicker cream soups – Honey-thick • Slightly thicker, less pourable and drizzle from a cup/bowl – Pudding-thick • Hold their own shape; not pourable
• How can we assess dietary intake in hospitalized patients?
Gold standard: weighed food records.
• Practical?
– Patient history (prior to admission)
• On ONS or any special diets PTA?
– In hospital
• “Calorie counts”
• Recall (patient, family, nursing staff)
Oral Feeding Strategies to Increase Oral Intake
• Increase frequency of food delivery
– Snacks
• Food fortification – Increase nutrient density • Protein • Calories • Micronutrients
• Oral Nutrition Supplements (ONS)
– Used for patients who fail to cover their nutritional needs by hospital food or
fortification
Oral Nutrition Supplements (ONS)
Medical nutrition supplements
– Commercially prepared beverages/foods that supplement calories
and/or macronutrients
– Complete or non-complete (Carnation Breakfast Essentials)
• Modulars
– Adds single nutrients, i.e.
• Protein (Beneprotein)
• Fibre (Benefibre)
