Diet Therapy NURS 2018 Objectives At the end of this presentation students will be able to Describe the nutritional intake of persons who are institutionalized Explain the basis for determining the therapeutic nutritional requirements of individuals ID: 551273
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Slide1
Principles of nutrition therapy & the role of the nurse
Diet Therapy: NURS 2018Slide2
Objectives
At the end of this presentation students will be able to:
Describe the nutritional intake of persons who are institutionalized
Explain 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 Slide3
Factors affecting nutritional requirement and intake
Individual differences exist which impact nutritional requirements they include:
Age
Gender
General condition
Health disorder
Nutritional status
Soci
-economic backgroundSlide4
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 excessesSlide5
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 expenditureSlide6
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 femalesSlide7
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 higherSlide8
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 brainSlide9
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,
HypothyroidismSlide10
Hospitalized people
Nutrition 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. Slide11
Hospitalized people
Malnutrition 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.Slide12
Hospitalized people
Hospital
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. Slide13
Hospitalized people
Nutrition 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. Slide14
Hospitalized people
Malnutrition 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.Slide15
Hospitalized people
The 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.Slide16
Hospitalized people
Hospital
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. Slide17
Hospitalized people
Nutrition 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. Slide18
Hospitalized people
Malnutrition 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.Slide19
Hospitalized people
The 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.Slide20
Hospitalized people
Hospital
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. Slide21
Hospitalized people
Nutrition 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. Slide22
Hospitalized people
Malnutrition 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.Slide23
Hospitalized people
The 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.Slide24
Psychological Impact of Illness
Being 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 Slide25
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 eatSlide26
Nutritional Needs of the hospitalized patient
The 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 Slide27
Nutritional Needs of the hospitalized patient
Basis of determining needs
Predictive 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 + 496
Tucker &
Dauffenbach
, 2011Slide28
Nutritional Needs of the hospitalized patient
Basis for determining needs
EER
by gender
Formulae
Females
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
1
Light active
1.16
Active
1.31
Very active
1.56Slide29
Disadvantages of estimating energy requirements
Estimating 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)Slide30
Nutritional Needs of the hospitalized patient
Basis for determining needs
Based 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
N
Thus
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)Slide31
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 intakeSlide32
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 diseaseSlide33Slide34
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 groupsSlide35
References
Duggan, M., & Golden, B. (2007). Deficiency diseases. In C.
Geissler
& H. Powers (Eds.),
Human Nutrition
(11
th
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.