Nutrition in clinical practice 1 (1)
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Course: Nutrition & Dietetics
Topic: Nutrition in clinical practice-identifying nutrition risks and feeding patients
Instructor: Dr. Vimala Edwin
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Learning outcome:
Understand malnutrition
Identify the criteria of malnutrition
Categories etiology based malnutrition definition
Understand nutrition screening protocol and tools
Understand nutrition assessment through nursing process
Discuss feeding hospitalized patients
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Introduction:
Nutrition knowledge and skills are important for evaluating nutrition status and providing appropriate care.
Covers the prevalence of malnutrition among hospitalized clients and how it is identified and treated.
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Malnutrition:
Refers to protein-calorie undernutrition
Focus of clinical nutrition is to prevent or treat malnutrition
Common and unrecognized problem among hospitalized clients
Contributes to morbidity, mortality, impaired function, decreased quality of life, increased hospital stay, and higher healthcare costs
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Criteria for Diagnosing malnutrition:
Inadequate calorie intake
Unintentional weight loss
Loss of muscle mass
Loss of subcutaneous fat
Localized or generalized fluid accumulation
Diminished functional status as measured by handgrip strength
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Etiology(Causes) based malnutrition definition:
Starvation related malnutrition
Chronic disease related malnutrition
Acute disease related or injury related
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Starvation related malnutrition:
Occurs when food is not available due to environmental or social circumstances
Inflammation is absent
Develops slowly
Caused by abuse, neglect, famine, poverty, or disordered eating
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Chronic disease related malnutrition:
May occur in clients with diseases such as congestive cardiac or chronic pulmonary disease
Mild to moderate degree of inflammation delays appetite, intake, or nutritional utilization
Acute disease related or injury related:
Malnutrition may occur in clients with critical illness, multi-trauma, or major infection due to marked inflammatory response
These clients may be adequately nourished upon admission but are high risk for malnutrition due to the nature of their illness
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Nutrition screening:
Used to identify clients at risk for malnutrition
Screening protocol specified by the joint commission
Must be conducted within 24 hours after admission to a hospital
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Screening tools:
Should be quick, simple, valid, and reliable
Criteria often include recent weight loss, recent food intake, current body mass index
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Malnutrition screening tool:
Questions about weight loss and decreased appetite
Scores assigned based on answers
Total score used to assess malnutrition risk
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Nutritional assessment:
Clients at risk for malnutrition referred to a dietitian for a comprehensive nutritional assessment
Identifies specific risks or confirms the existence of malnutrition
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Nutritional assessment (Screening):
Encompasses the nursing care process and its four steps:
Nutrition/nursing assessment
Nutrition/nursing diagnosis
Nutrition/nursing intervention
Nutrition monitoring and evaluation
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Nutrition/Nursing assessment:
Medical-psychosocial history
Medical conditions associated with malnutrition
Psychological factors affecting nutrition intake
Social factors affecting nutrition intake
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Social factors affecting nutrition intake:
Illiteracy
Limited knowledge of nutrition and food safety
Social isolation
Lack of caregiver or social support system
Limited use or knowledge of community resources
Use of tobacco or recreational drugs
Limited or low income
Advanced age
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Anthropometric Assessment:
Height, weight, and body mass index
Weight loss:
Unintentional weight loss is an indicator of malnutrition
Dietary intake:
Questions about meal frequency and food preferences
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Physical findings:
Loss of subcutaneous fat
Loss of muscle mass
Localized or generalized fluid retention
Dry skin
Diminished hand grip strength
Laboratory data:
Albumin as an indicator of disease severity and outcome
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Nursing Analysis:
Identifying the risk of malnutrition based on poor intake and weight loss
Client outcome/Goal:
To consume adequate calories, protein, and nutrients using foods they like and tolerate as appropriate
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Nursing interventions:
Ensuring dietitian prescribed interventions occur in a timely manner
Facilitating actions to treat clients at risk of malnutrition
Educating and reinforcing the importance of adequate nutrition
Communicating concerns and responding to questions
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Nutrition-related monitoring/Evaluation:
Observing food and supplement intake
Assessing tolerance of food
Monitoring weight and motivation to eat
Rescreening clients within established timeframe
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Feeding hospitalized patients:
Goal is to provide sufficient calories and nutrients
Oral diets are the easiest and most preferred method
Patients choose from a menu representing the ordered diet
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Oral diets categorized as:
Regular diet
Modified consistency
Therapeutic
Combination diets
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Regular Diets:
Used to maintain optimal nutritional status in patients without altered nutritional needs
No foods excluded, portion sizes not limited
Adjusted to meet age-specific needs
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Modified Consistency Diets:
Clear liquid diet for hydration during gastrointestinal illness
Gradual progression from clear liquid to regular diet postoperatively
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Mechanically altered diets:
Foods pureed, chopped/ground, or soft for clients with chewing or swallowing difficulties
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Therapeutic Diets:
Differ from regular diet in nutrient or food component amounts
Altered number or timing of meals
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Selected therapeutic diets:
Cardiac diet for prevention and treatment of cardiovascular disease
Consistent carbohydrates diet for diabetes
High fiber diet for constipation, diabetes, obesity
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Selected therapeutic diets: characteristics and indications
Renal diet
Slightly lower in protein
Emphasizes heart-healthy fats
Sodium, potassium, and phosphate levels adjusted
Indications: Chronic kidney disease
Sodium-restricted diet
Sodium limit may be set at 1500mg/day or 2000mg/day
Indications: Hypertension, Congestive cardiac failure, Chronic kidney disease, Liver disease
Gluten-free diet
Sources of gluten eliminated from the diet
Indications: Celiac disease
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Nutritional Supplements
Some patients are unable or unwilling to eat enough food to meet their requirements.
Nutritional supplements with or between meals can significantly boost protein and calorie intakes.
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Feeding method (Enteral route)
Patients who are unable to consume at least 50% of their protein and calories orally may require enteral nutrition support (NG-Nasogastric tube feeding).
Parenteral nutrition (Intravenous) is considered only if the oral and enteral routes are inadequate or unavailable.