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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