NHHC chapter 14 ppt
- 1. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Nutrition Intervention and Food-Drug Interactions Chapter 14
- 2. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Implementing Nutrition Care • Nutrition interventions (Table 14-1) – Food and/or nutrient delivery – Nutrition education – Nutrition counseling – Coordination of nutrition care
- 3. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Implementing Nutrition Care (cont’d.) • Incorporating nutrition care into the nursing care plan (Table 14-2) – Nursing process • Assessment • Nursing diagnosis • Outcome identification • Planning • Implementation • Evaluation
- 4. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Implementing Nutrition Care (cont’d.) • Approaches to nutrition care – Long-term nutrition intervention • Plan must consider: current food practices, lifestyle, and degree of motivation – Implementing long-term dietary changes • Determine the individual’s readiness for change • Emphasize what to eat, rather than what not to eat • Suggest only one or two changes at a time
- 5. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Implementing Nutrition Care (cont’d.) • Approaches to nutrition care – Nutrition education • Allows patients to learn about the dietary factors: specific to their particular medical condition • Considerations: person’s age, literacy level, and cultural background; learning style; etc. • Follow-up care: relevant outcome measures – Case Study – Implementing Nutrition Care
- 6. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications • Energy intakes in hospital patients – Resting metabolic rate (RMR): typically calculated by clinicians – RMR: adjusted for “stress factors” • Activity level factor may be applied
- 7. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 8. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications (cont’d.) • Energy intakes in hospital patients – “How To” Estimate Appropriate Energy Intakes for Hospital Patients – Indirect calorimetry • Procedure that estimates energy expenditure by measuring oxygen consumption and carbon dioxide production during a period of rest
- 9. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications (cont’d.) • Modified (therapeutic) diets – Contain foods altered in texture, consistency, or nutrient content: include or omit specific foods – Reasons for modified diet • Correct malnutrition • Relieve disease symptoms • Reduce the risk of developing complications
- 10. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications (cont’d.) • Modified diets (Table 14-4) – Mechanically altered diets (Table 14-5) • Beneficial for individuals who have difficulty chewing or swallowing • Why are dysphagia diets highly individualized?
- 11. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications (cont’d.) • Modified diets – Blenderized liquid diet • Foods available from all four food groups – Clear liquid diet • Clear fluids and foods: liquid at body temperature • Leaves minimal residue in the colon – Fat-restricted diet • Why is it important to avoid being too restrictive?
- 12. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 13. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 14. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications (cont’d.) • Modified diets – Low-fiber diet • Why is long-term fiber restriction discouraged? – Low-sodium diet • Prevent or correct fluid retention • Typically 2000 or 3000 milligrams daily
- 15. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications (cont’d.) • Modified diets (Table 14-6) – High-kcalorie, high-protein diet • Increase kcalorie and protein intakes: patients with high requirements or eating poorly
- 16. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications (cont’d.) • Variations in the diet order – Physician: responsible for prescribing an appropriate diet • Often relies on the dietitian or nurse to recommend changes in the diet order when warranted – Diet progression • Diet changes as patient’s food tolerance improves – What is the NPO (non per os) order?
- 17. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Dietary Modifications (cont’d.) • Variations in the diet order – Alternative feeding routes • Tube feedings: directly into the stomach or intestine • Parenteral nutrition: nutrient solutions supplied intravenously
- 18. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Foodservice • Diet manual – Specifies the foods or preparation methods to include or exclude in modified diets – Provides sample menus • Food selection – Selective menus • Provide choices in some or all menu categories • What are the benefits of selective menus?
- 19. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Foodservice (cont’d.) • Food selection – Other amenities • Room-service, cook-to-order system: expanded choices • Extended food delivery hours
- 20. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Foodservice (cont’d.) • Hazard Analysis and Critical Control Points (HACCP) program – Addresses food handling, cooking, and storage procedures; cleaning and disinfecting of utensils, surfaces, and equipment; and staff sanitation issues
- 21. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Foodservice (cont’d.) • Improving food intake – Patient’s room: calm and quiet during meals – Engage patient in identifying most enjoyable foods – Place occasional “surprise” on the tray, e.g., decoration – “How To” Help Hospital Patients Improve Their Food Intakes
- 22. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions • Categories – Drugs altering food intake reducing or increasing appetite – Drugs altering the absorption, metabolism, or excretion of nutrients; or nutrients altering the absorption, metabolism, and excretion of drugs – Interactions between dietary components and drugs causing drug toxicity
- 23. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Examples of diet-drug interactions (Table 14-7) • Drug effects on food intake – Making food intake difficult or unpleasant – Persistent complications: may require other medications • Antinauseants and antiemetics – Stimulating appetite: unintentional weight gain
- 24. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Drug effects on nutrient absorption – Widespread nutrient malabsorption • Upset gastrointestinal function or damage the intestinal mucosa • Antineoplastic and antiretroviral drugs – Drug-nutrient binding: prevent absorption • Bile acid binders, tetracycline, ciprofloxacin, etc. – Drugs for reducing stomach acidity • Impair absorption of vitamin B12, folate, and iron
- 25. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Drug effects on nutrient absorption – Interference with nutrient transport into mucosal cells • Proloprim, Daraprim, colchicine, etc. • Dietary effects on drug absorption – Stomach-emptying rate • Empty stomach ► drug reaches small intestine more quickly
- 26. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Dietary effects on drug absorption – Stomach acidity • Some drugs absorbed better in acidic environment; some in alkaline conditions – Interactions with dietary components • Dietary substances: bind to drugs and inhibit absorption • Phytates bind to digoxin; fiber interferes with absorption of tricyclic antidepressants; etc.
- 27. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Drug effects on nutrient metabolism – Drugs and nutrients: share similar enzyme systems in the small intestine and liver • Some drugs: enhance or inhibit the activities of enzymes needed for nutrient metabolism
- 28. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 29. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Dietary effects on drug metabolism – Some food components • Alter the activities of enzymes that metabolize drugs or may counteract drug effects in other ways – Effects of grapefruit juice – Vitamin K interaction with Coumadin
- 30. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 31. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 32. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Drug effects on nutrient excretion – Increased urine production: may reduce nutrient reabsorption in the kidneys • Diuretics – Sodium and water retention with increased potassium excretion • Corticosteroids
- 33. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Dietary effects on drug excretion – Inadequate excretion of medications • Toxicity – Excessive losses • Reduce drug availability for therapeutic effect – Consistent sodium intake • Needed when taking lithium – Urine acidity: excretion of quinidine
- 34. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Diet-Drug Interactions (cont’d.) • Drug-nutrient interactions and toxicity – Interactions between food components and drugs • Causing toxicity • Intensifying a drug’s side effects – Tyramine (food component) and monoamine oxidase (MAO) inhibitors: can be fatal • “How To” Prevent Diet-Drug Interactions
- 35. Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014