Nutrition and Supplements

Malnourishment Signs and Symptoms

  • Various signs and symptoms indicate malnourishment.

Nutritional History

  • Assessing nutritional status is crucial for diagnosing deficiencies.
  • A nutrition assessment is essential upon hospitalization, including:
    • Complete medical history
    • Dietary history
    • Physical exam
    • Measurements
    • Laboratory values

Enteral Nutrition

  • Definition: Nutrients delivered through the GI tract, not directly into the bloodstream (unlike parenteral nutrition).
  • Administration:
    • Orally
    • Nasogastrically
    • Nasojejunally
    • Nasoduodenally
  • Use:
    • When oral consumption is impossible.
    • Examples: head/neck surgery, esophageal obstruction, stroke (affecting chewing/swallowing), dementia.
  • Advantages over Parenteral Nutrition:
    • Stimulates GI tract function.
    • Lower infection risk.
    • Less expensive.
  • Contraindications:
    • Paralyzed ileum
    • Fistulas
  • Therapeutic Outcomes:
    1. Stabilize patient's weight.
    2. Ensure sufficient nutrient intake for growth and development.
    3. Improve laboratory results.

Methods of Tube Feeding

  • Intermittent/Bolus Feedings:
    • Administering a certain amount over 20-30 minutes, then stopping and repeating later.
  • Continuous Feedings:
    • Slow, continuous drip, especially when infusing into the jejunum.
    • Slows rate to avoid overwhelming the system.
  • Hyperglycemia:
    • Check blood sugar levels and monitor for hyperglycemia, especially after a period of not eating.
    • Insulin might be required if glucose levels spike.

Adverse Effects of Enteral Nutrition

  • Respiratory Issues:
    • Aspiration is the primary concern.
  • GI Tract Issues:
    • Diarrhea or constipation (especially when starting).
      • Action for Diarrhea: Stop feeding, then inform the provider.
    • Nausea, vomiting, and increased residual volume:
      • Could indicate bowel obstruction.
      • Action: Immediately discontinue feedings.
  • Allergic Reactions:
    • Hypersensitivity, rash, chills, fever, respiratory difficulty may indicate an allergy to the formula.
      • Action: Provide emergency care (airway management), discontinue feeding, and report to the provider.

General Response to Adverse Reactions

  • First Action: Stop the feeding.
  • Second Action: Inform the healthcare provider.

Medication Administration via Feeding Tube

  • Important Considerations:
    • Never crush enteric-coated, chewable, or extended-release tablets; use liquid forms instead.
    • Ensure the medication is appropriate for tube administration.

Dietary Supplements

  • Includes herbal supplements, vitamins, minerals, amino acids, and other chemicals.
  • Lack FDA oversight (no safety or effectiveness requirements).
  • Claims are often unproven.
  • No standardized manufacturing requirements.
  • Third-party organizations may test for potency, manufacturing quality, and contamination.

Healthcare Professional's Role

  • Ethical responsibility to recommend only proven safe and effective medications.
  • Nurses should not recommend dietary supplements due to the lack of safety and efficacy evidence.

Patient Assessment Regarding Supplements

  • Inquire about supplement use and reasons for taking them.
  • Check medication history for listed supplements.
  • Research potential drug interactions and adverse effects.
  • Cultural Beliefs:
    • Inform the healthcare team about culturally relevant supplements and their significance to the patient.