nhhc chapter 14 ppt

Nutrition for Health and Health Care, 5th Edition

DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition Intervention

and Food-Drug

Interactions

Chapter 14



Implementing Nutrition Care

• Nutrition interventions (Table 14-1)

– Food and/or nutrient delivery

– Nutrition education

– Nutrition counseling

– Coordination of nutrition care



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




• 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




• 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



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



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




• 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




• 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?




• 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?




• 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




• Modified diets (Table 14-6)

– High-kcalorie, high-protein diet

• Increase kcalorie and protein intakes: patients with

high requirements or eating poorly




• 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?




• Variations in the diet order

– Alternative feeding routes

• Tube feedings: directly into the stomach or

intestine

• Parenteral nutrition: nutrient solutions supplied

intravenously



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?



Foodservice (cont’d.)

• Food selection

– Other amenities

• Room-service, cook-to-order system: expanded

choices

• Extended food delivery hours




• 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




• 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



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



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




• 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




• 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




• 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.




• 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




• 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




• 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




• 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




• 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

nhhc chapter 14 ppt

Education