Flashcards in Assessing nutrition status and nutritional intake Deck (55):
Comprehensive health care is best provided by
a team of health professionals and support staff
actions to promote healing and health
A personalized health care plan, evaluation, and follow-up care guide
Valid health care is centered on
the patient and his/her individual needs
Nutrition support is
-Vital to successful treatment of disease
-Often is the primary therapy
Registered dietitian provides
comprehensive nutrition care
Nurses also ________ nutrition needs
The Therapeutic Process consist of
-Health care setting
-Health care team
Health care team consist of
Physician and support staff
Role of the nurse and clinical dietitian
-Dietitian develops, manages, evaluates nutrition therapy
-Nurse develops, supports, carries out plan of care
-Coordinator and advocate: nurse works as advocate for patient nutrition
-Interpreter: explanations help reduce anxiety
-Teacher and counselor: reinforces dietitian’s work with patient
Of all health care providers, nurses are the ones who spend the most time in direct contact with patients/families
The Care Process and Drug Interactions
-A personalized health care plan, evaluation, and follow-up care guide actions to promote healing and health.
-Drug-nutrient interactions can create significant medical complications
-Who, do you think, is the member of the health care team best placed to flag these issues, as well as provide education to the patients/families?
Nurses and dietitians provide
essential support and personalized care
A real partnership with patients and caretakers is essential to valid care.
Nutrition care must be person centered and constantly updated with the patient’s status.
Where is nutrition care provided
Despite all the methods, tools and technologies; therapeutic use of self is the most healing tool a person will ever use. The human encounter is where health care workers bring themselves and their skills.
What is the Nutrition Care Process
A systematic problem-solving method that dieticians use to critically think and make decisions to address nutrition-related problems and provide safe and effective quality nutrition care.
Phases of nutrition Care Process
ystematic problem-solving method with four steps
-Nutrition monitoring and evaluation
-Family and medical history questionnaires
-Current status and goals
-Patient and family are primary sources
* evaluation needs to be ongoing *
Food and Nutrition-Related History
-RD is responsible for evaluating patient’s diet
-Guides for gathering a nutrition history
-It is common for hospitalized patients to have eaten less in days prior to hospitalization. It is therefore important to ask questions about *usual* intakes, etc
-Underreporting energy intake is common
-Physical activity logs
-Energy output/physical activity also tends to be over reported in a portion of the population
Nutrition Assessment ?
Collection of data such as: patient’s nutritional status; food and alcohol habits; prescribed and over the counter medications taken on a regular basis as well as street drugs; living situation; the patient’s needs, desires and goals.
Nutrition assessment: the ABCD approach.
A for anthropometry
B for biochemical tests
C for clinical observation
D for dietary evaluation
Anthropometric Measurements include ?
Weight and height used to calculate body mass index (BMI)
-Weigh patients at consistent times (in am)
-Weigh patients without shoes in light indoor clothing.
-Ask about recent weight loss or gain (refer if recent weight loss is >5% within the last month)
-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.
-Other methods of getting height for immobilized patients/young children/people with amputations
Body frame measurement?
height in cm /wrist circumference
will provide estimate body frame size
For an accurate measurement of wrist circumference, the patient’s arm should be flexed at the elbow with palm facing up and hand relaxed. Measure at the joint distal to the styloid process (bony wrist protrusion)
Body composition ~ while important is not often used in hospitals ~
ways to measure?
-Skinfold thickness measurement with calipers
-Bioelectrical impedance analysis*
-Hydrostatic weighing is done underwater. Not used anymore
-Dual energy x-ray absorptiometry*
-BOD POD body composition tracking system
-Waist circumference: fat stored in waist raises risks
-Hemoglobin, hematocrit, serum albumin
-Help detect protein and iron deficiencies
evaluates liver function
Blood urea nitrogen, serum electrolytes ?
evaluates renal function
Urinary urea nitrogen excretion?
estimates nitrogen balance
Creatinine height index
evaluates protein tissue breakdown
Complete blood count
evaluate for anemia
evaluate for high or low blood sugar levels
Total lymphocyte count
evaluates immune system function
Skeletal system integrity
-several tests for bone integrity
Full body bone scan if osteoporosis is suspected and/or for older patients
Barium swallow or enema if the patient presents with GI problems or if peptic ulcer is suspected
Clinical Observations for assessing nutritional status
Posture, muscles, cognitive and general vitality
-Hair texture, lustre
-Skin in general; more specifically on face, neck, lips and eyes
Resting Metabolic Rate (direct and indirect measurement methods discussed in chapter 6 of text) to determine total energy needs
*Important to note that laboratory values may be affected by hydration status, the presence of chronic diseases, changes in organ function, and certain medications (p. 339)*
Nutrition-Focused Physical Findings
Nutrition-focused physical findings: see Table 17.2
-religion, culture, beliefs, etc
-Psychological and emotional problems
-Evaluate the data collected
~ What are some of the reasons that a geriatric patient might suffer from depression and weight loss ~
Nutrition Diagnosis order
Problem: data is analyzed and
diagnostic category assigned
Etiology: cause or contributing risk factors identified
Signs and symptoms: changes in patient’s health status that indicate nutrition problem
Identification and labeling an actual occurrence, risk of, or potential for developing a nutrition problem that dieticians are responsible for treating independently.
Example of a nutrition diagnosis
Excessive caloric intake (problem) related to frequent consumption of large portions of high-fat meals (etiology) as evidenced by average daily intake of calories exceeding recommended amount of 500 kcal and 6 kg weight gain during the past 18 months (signs). What are some questions related to symptoms to include here? Using what type of communication style?
Suitable and realistic interventions or actions will carry out the personalized nutritional plan.
Consider psychological and emotional state of the patient that can weigh heavily on the overall outcome (eg- An elderly patient who does not eat; do you try to find the cause and work on it, or do you re-enforce by teaching?).
It is crucial to consider the patient’s personal goals and needs by including him/her to establish priorities for short and long-term care.
follows assessment and diagnosis
Written care plan addresses personal and medical needs
Food and/or nutrient delivery
Personalized: needs, disease, therapy affect food plan
Modes of feeding: total energy of diet, nutrient modification, texture
Oral feedings and *assisted oral feedings*
Enteral feedings when patient cannot consume food orally (NG, GT, Peg)
What is difference between enteral and parenteral feedings?
enteral: food passes through intestines
parenteral: food goes directly into venous system
nutrition intervention guidelines to think about regarding the pt
Mode of feeding
Routine house/hospital diet: The basic modification is in the texture (to clear fluids, no milk, to full liquid and soft food to a full regular diet) or further modified to low-sodium; low-fat; high-protein
Assisted oral feeding*
Parenteral feeding (TPN versus PPN)
Nutrition components of the normal diet may be modified in the following 3 ways
Nutrients: may be modified in amount and form
Energy: kcal value of the diet may increase or decrease
Texture: liquid or low-residue diet are examples
Example: A therapeutic diet will be altered in its nutrient content, its energy value, or its texture.*Is modified accordingly, as individual’s specific condition requires*
Nutrition Education and Counselling
Nutrition education and counseling
-Patients with education are more likely to be “compliant” with care plan
-Long-term lifestyle modifications ~ what part of NCP, in Orem’s model, addresses this? ~
Coordination of nutrition care
Dieticians, nurses, prescribing -----physicians, pharmacists
-Family, friends, care providers
Nutrition Monitoring and Evaluation
Measures progress toward patient goals:
-Ability to follow diet ~ think of and name some reasons why a person may not have the ability to follow a diet ~
-More information or resources needed
Nutrition Monitoring and Evaluation 3 components
* Nutrition monitoring and evaluation give feedback on the nutrition diagnosis and the intervention plan *
Personal adaptation: Four areas must be explored with the patient and family
Personal needs of the patient and family
The disease: how is the patient’s body and metabolic functions affected by the disease
Nutrition therapy: how and why must the diet be changed to meet needs created by the patient’s condition?
Food plan: how do these necessary nutritional modifications affect daily food choices? How can these needs be met?
-Grapefruit juice ~ grapefruit juice has come under particular scrutiny because of its ability to dramatically alter the bioavailability of certain drugs to a dangerous level
-Warfarin and certain foods
-Medications that alter taste or smell sensations
-Medications that stimulate appetite
-Certain illness’ & disease processes ~ can you think of any?
-Usually medications taken with OTC supplements
-Patients rarely report supplements to physicians
-Must gather information about all drug use, including OTC, prescription, alcohol, and street drugs
Health care providers must make a point of asking patients what other medications they are taking, including vitamin and mineral supplements
The interaction between some food and drugs can affect
Absorption of the drug
Distribution of the drug
Elimination of the drug
Warfarin is one of the most highly interactive medication with certain foods like broccoli, spinach, cauliflower, brussel sprouts
All medications specify to either avoid or reduce alcohol consumption to 1-2 drinks/day for men and 1 drink/day for women
drug/nutrient interactions primarily occur when
medications are taken in combination with over-the-counter vitamin and mineral supplements
Certain Antibiotics have decreased absorption when eating dairy products with them (eg- Ciprofloxacin and Penicillin)
Vitamin B6 reduces the effectiveness of Levodopa, anti-
See Tabe 17.3 for further details
*Polypharmacy is another consideration ~ especially with elderly population ~
Herb that has been researched the most is St. John’s Wort for its interaction with drugs. The conclusions are:
-Does not interact the same way on all medications
-Could decrease the activity of key enzymes involved in the metabolism of some drugs
-Other drugs studied have found the herb to increase their enzymatic activity
Other common herbs involved in drug interactions include papaya extract, ginkgo biloba, evening primrose, valerian, kelp, ginseng and ginger ~ likely this list is by no means complete ~ see pp 348-349 ~
*the use of herbs should be evaluated on an individual basis*
Abnormal reactions of the immune system to a number of substances in the environment. Could be life-treating.