Transcript Nutrient Delivery - Wilkes-Barre Area Career & Technical

Nutrient Delivery


Chapter 14
J Pistack MS/Ed
Screening



Joint Commission requires screening patients
within 24 hours of admission
Predetermined screening tool used
Rates potential nutritional risks
Potential Nutritional Risk






Changes in weight
Changes in appetite
Nausea
Vomiting
Dysphagia (difficulty swallowing)
Diseases such as diabetes, obesity,
hypertension, cancer
Assessment


Patients found to be at risk after screening
should have an assessment by a registered
dietician
Figure 14-1 p309 is an example assessment chart
Nutritional Assessment Information
•
•
•
•
•
•
•
•
•
Height, weight, body mass index, weight history
Lab values
Food intake
Potential food–drug interactions
Chewing and swallowing ability
Client’s self-feed ability
Bowel and bladder function
Evaluation for pressure ulcers
Food allergies and intolerances
More Assessment Information





Food preferences: cultural-religious beliefs
Body composition
Presence of burns, trauma, infection,
Physiological stressors
Learning barriers: hearing, mobility, language,
vision, speech, reading/writing skills, learning
disability
Monitoring

All patients should be monitored at appropriate
intervals
Items to Monitor






Initial nutritional screen and/or assessment
Present body weight and weight history
A record of recent food intake and/or tolerance
Any changes in medical condition
Diet orders from a physician or designee
Family support
Nutritional Counseling




All patients should be evaluated for nutritional
counseling
Promotes self-care
Responsibility for health and wellness
Pre-testing diets may be warranted
Special Diets


Seek to maintain patients nutritional status
Potential to alter the following:
 Nutrients
 Calories
 Consistency
 Fiber
 Fluid
Iatrogenic Malnutrition


Refers to health care provider “induced”
malnutrition
May be caused by:
 Diagnostic
tests
 Meal schedule
 Lack of appetite
 Drug therapy
Methods to Prevent Iatrogenic
Malnutrition








Record height/weight
Be a team player
Monitor client’s food intake
Have knowledge about good nutrition
Monitor NPO (Latin - nil per os)(nothing by mouth)
clients
Appreciate role of nutrition in total care
Recognize signs/symptoms of malnutrition
Monitor fluid intake and output (vomiting)
Nutrient Delivery Methods


Oral – by mouth
Enteral – direct supply of food into a functioning GI
system through a tube






NG – nasogastric
ND – nasoduodenal
NJ – nasojejunal
PEG - percutaneous endoscopic gastrostomy, the creation
of a new opening in the stomach for enteral tube feedings.
PEJ – used when stomach is removed
Parenteral - administered in a manner other than through
the digestive tract, as by intravenous or intramuscular
injection.
Enteral Tube Feeding Problems





Regurgitation
Aspiration
Contamination
Administration
Potential complications
Supplemental Feedings


Used when patients are unable to consume
enough kilocalories
In the form of solids (puddings) or liquids
(shakes)
Types of Supplemental Feedings




Modular supplements – limited number of
nutrients
Standard or “polymeric” formulas – contains all
the nutrients in a specified volume
Elemental and semi-elemental formulas –
nutrients are in their simplest easily
absorbable form
Disease-specific formulas – for people with
diabetes, kidney, or liver disorders….
Enteral Tube Feedings




Osmolality – basically compared to isotonic
food
Administration of medications to a tube-fed
client
Monitoring the tube-fed client
Home enteral nutrition
Types of Administration of Enteral
Feedings



Continuous feeding – recommended for
feedings going directly to the small intestine
Intermittent feeding
Bolus feeding
Parenteral Nutrition


Peripheral parenteral nutrition (PPN)
Total parenteral nutrition:
 Insertion
and care of the TPN line
 Monitoring
 Transition and combination feedings
 Home parental nutrition

Central parenteral nutrition – inserted into a
central vein. If a peripheral line is threaded into
the subclavian or jugular vein it is called a
PICC line