Transcript of Nutrient Delivery Chapter 14 J Pistack MS/Ed.
- Slide 1
- Nutrient Delivery Chapter 14 J Pistack MS/Ed
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- Screening Joint Commission requires screening patients within
24 hours of admission Predetermined screening tool used Rates
potential nutritional risks
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- Potential Nutritional Risk Changes in weight Changes in
appetite Nausea Vomiting Dysphagia (difficulty swallowing) Diseases
such as diabetes, obesity, hypertension, cancer
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- Assessment Patients found to be at risk after screening should
have an assessment by a registered dietician Figure 14-1 p309 is an
example assessment chart
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- Nutritional Assessment Information Height, weight, body mass
index, weight history Lab values Food intake Potential fooddrug
interactions Chewing and swallowing ability Clients self-feed
ability Bowel and bladder function Evaluation for pressure ulcers
Food allergies and intolerances
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- More Assessment Information Food preferences:
cultural-religious beliefs Body composition Presence of burns,
trauma, infection, Physiological stressors Learning barriers:
hearing, mobility, language, vision, speech, reading/writing
skills, learning disability
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- Monitoring All patients should be monitored at appropriate
intervals
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- Items to Monitor Initial nutritional screen and/or assessment
Present body weight and weight history A record of recent food
intake and/or tolerance Any changes in medical condition Diet
orders from a physician or designee Family support
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- Nutritional Counseling All patients should be evaluated for
nutritional counseling Promotes self-care Responsibility for health
and wellness Pre-testing diets may be warranted
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- Special Diets Seek to maintain patients nutritional status
Potential to alter the following: Nutrients Calories Consistency
Fiber Fluid
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- Iatrogenic Malnutrition Refers to health care provider induced
malnutrition May be caused by: Diagnostic tests Meal schedule Lack
of appetite Drug therapy
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- Methods to Prevent Iatrogenic Malnutrition Record height/weight
Be a team player Monitor clients food intake Have knowledge about
good nutrition Monitor NPO ( Latin - nil per os)(nothing by mouth)
clients Appreciate role of nutrition in total care Recognize
signs/symptoms of malnutrition Monitor fluid intake and output
(vomiting)
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- Nutrient Delivery Methods Oral by mouth Enteral direct supply
of food into a functioning GI system through a tube NG nasogastric
ND nasoduodenal NJ nasojejunal PEG - percutaneous endoscopic
gastrostomy, the creation of a new opening in the stomach for
enteral tube feedings. PEJ used when stomach is removed Parenteral
- administered in a manner other than through the digestive tract,
as by intravenous or intramuscular injection.
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- Enteral Tube Feeding Problems Regurgitation Aspiration
Contamination Administration Potential complications
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- Supplemental Feedings Used when patients are unable to consume
enough kilocalories In the form of solids (puddings) or liquids
(shakes)
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- Types of Supplemental Feedings Modular supplements limited
number of nutrients Standard or polymeric formulas contains all the
nutrients in a specified volume Elemental and semi-elemental
formulas nutrients are in their simplest easily absorbable form
Disease-specific formulas for people with diabetes, kidney, or
liver disorders.
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- Enteral Tube Feedings Osmolality basically compared to isotonic
food Administration of medications to a tube-fed client Monitoring
the tube-fed client Home enteral nutrition
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- Types of Administration of Enteral Feedings Continuous feeding
recommended for feedings going directly to the small intestine
Intermittent feeding Bolus feeding
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- Parenteral Nutrition Peripheral parenteral nutrition (PPN)
Total parenteral nutrition: Insertion and care of the TPN line
Monitoring Transition and combination feedings Home parental
nutrition Central parenteral nutrition inserted into a central
vein. If a peripheral line is threaded into the subclavian or
jugular vein it is called a PICC line