Nutritional Support and Malnutrition

Recovery from Malnutrition and Nutritional Assessment

• Recovery Time:
  • May take months to recover from malnutrition.
• Assessment Factors:
  • Evaluate patient's ability to comply with diet:
  • Past eating habits
  • Religious/ethnic food preferences
  • Age and income level
  • Current health status
  • Necessary follow-up to monitor progress.
• Community Resources:
  • Consider services like Meals on Wheels for support.
• Monitoring:
  • Keep a food diary for better tracking of nutritional intake.
  • Patient should weigh themselves 1-2 times a week and record weights.

Malnutrition Evaluation

• Expected Outcomes for Patients:
  • Achieve and maintain optimal body weight through balanced nutrition.
  • Ensure no adverse health outcomes related to malnutrition.
  • Maintain optimal physical functioning.

Gerontologic Considerations

• Vulnerability in Older Adults:
  • More prone to malnutrition due to factors like:
  • Poor wound healing
  • Pressure ulcers and increased risk of infections
  • Decreased muscle strength
  • Increased postoperative complications
  • Higher morbidity and mortality rates
• Social Factors:
  • Social isolation can lead to a decreased desire to cook.
  • Functional limitations and lack of transportation to access food.
  • Mental health issues such as depression and dysphagia w/ stroke onset.
• Oral Health Issues:
  • Conditions like xerostomia (dry mouth) often caused by medications.
• Sarcopenia:
  • Loss of body mass from aging decreases strength and function.

Nutritional Recommendations for Older Patients

• Dietary Suggestions:
  • Consume moderate amounts of protein-rich foods per meal.
  • Increase vitamin D intake.
  • Incorporate snacks and nutrition supplements.
  • Use protein shakes to administer medications if preferred.

Specialized Nutrition Support

• Types of Specialized Nutrition Support:
  • Oral Supplements:
  • Used alongside meals and fluid intake.
  • Example products include milkshakes and puddings.
  • Enteral Nutrition (EN):
  • Involves tube feeding with a liquefied balanced formula delivered into the GI tract.
  • Indicated when the GI tract is functional but oral intake isn't possible (e.g., trauma, burns).
  • Generally safer and more cost-effective than parenteral nutrition (PN).
• Forms of Enteral Feeding:
  • Intermittent feeding: Favored for better satiety, also known as Bolus Feeding.
  • Types of Tubes:
  • Orogastric, nasogastric, nasointestinal tubes.
  • Tubes made of polyurethane or silicone; designed to minimize mucosal damage.

Enteral Feeding Safety Measures

• Concerns:
  • Watch for risks like aspiration and tube dislodgment.
• Patient Positioning:
  • Keep head of bed elevated at least 30 degrees; 45 degrees is ideal.
• Tube Placement Verification:
  • Must confirm tube placement before feeding, using methods like abdominal X-ray (KUB).
  • Other checks include marking external tube length and testing with pH checks.

Skin Care and Tube Maintenance

• Site Care:
  • Assess tube insertion sites routinely for issues like redness and irritation.
• Tube Patency Maintenance:
  • Routine flushing with sterile water is recommended to maintain patency and prevent clogging.
• Safety from Misconnections:
  • Avoid tube misconnection to prevent potentially fatal complications.

Parenteral Nutrition (PN)

• Indications for PN:
  • Used when oral and enteral routes are not viable, delivering nutrients directly into the bloodstream.
• Types of PN:
  • Total Parenteral Nutrition (TPN): Customized for patients with high caloric needs.
  • Peripheral Parenteral Nutrition: Short-term use for less severe needs.
• Nursing Management:
  • Monitor for complications related to insertion and nutrition, including refeeding syndrome.
• Blood Sugar Monitoring:
  • Necessary throughout the administration of PN to prevent complications.

Learning Objectives

1. Identify essential components of a well-balanced diet and their health impacts.
2. Understand common factors, symptoms, and management strategies for malnutrition.
3. Describe the nutritional assessment process.
4. Know indications, complications, and management principles related to enteral and parenteral nutrition.
5. Understand dietary modifications suitable for specific health conditions like hypertension.