CHAPTER 27 Diet Therapy and Assisted Feeding Copyright © 2014, 2009 by Saunders, an imprint of...

CHAPTER 27

Diet Therapy and Assisted Feeding

Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

GOALS OF DIET THERAPY

T

reat and manage disease

P

revent complications and restore health• Specific diet for each patient is prescribed on the

physician’s order sheet• Patients can have nutritional goals met after a

thorough diet assessment• Some patients may need assistance with feeding

Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.Slide 2

PATIENTS NEEDING FEEDING ASSISTANCE

P

atients with paralysis of the arms

P

atients with visual impairment

P

atients with intravenous lines in their hands

S

everely impaired or weak patients

C

onfused patients• Feeding may be delegated to a nursing assistant or family member


FIGURE 27-1: ASSISTING WITH FEEDING


POSTOPERATIVE PATIENT

S

hould be well-nourished preoperatively to facilitate postoperative

healing and recovery

P

reoperative patients are usually NPO 6 to 8 hours before the procedure

P

ostoperative patients progress from a clear liquid to full liquid diet

M

ay progress to a soft diet before attempting a general or regular diet


C

lear liquids• Grape, apple, cranberry

juices• Strained fruit juices• Vegetable broth• Carbonated water• Clear, fruit-flavored

drinks• Tea, coffee• Gelatin and ices• Clear candies• Popsicles• Clear broth

FOODS ALLOWED ON A LIQUID DIET


F

ull liquids• Milk and milk beverages• Yogurt, eggnog, pudding• Custard and ice cream• Puréed meat, vegetables

in cream soups• Vegetable juices• Sweetened plain gelatin• Cooked refined cereals• Strained or blended

gruel• All other beverages• Cream

POSTOPERATIVE PATIENT

L

iquid diet is usually started when bowel sounds return

P

resence or absence of bowel sounds is determined by auscultation

G

oal is to have low-residue, easily digested foods

A

liquid diet decreases risk of abdominal discomfort, nausea, and

vomiting

P

atient may progress to soft diet before advancing to regular


ANOREXIA NERVOSA

M

ental disorder characterized by refusal to maintain a

normal weight and fear of becoming obese• Patient may refuse to eat despite being extremely

underweight• If not corrected, may be fatal• Treatment is:

• Nutritional intervention• Counseling


BULIMIA

E

ating disorder characterized by episodic binge eating

followed by behaviors to prevent weight gain; e.g.,

purging, fasting, using laxatives• Patients aware of their behavior and often feel

ashamed• Treatment is:

• Nutritional counseling• Psychological counseling


OBESITY

E

xcessive accumulation of fat, not just being

overweight according to height and weight scales• Incidence in United States is increasing • 65% of Americans are overweight• Approximately 30% are obese

• Mildly obese: 20% to 30% above ideal body weight• Morbidly obese: At least 100 lb above ideal body weight


OBESITY (CONT’D)

C

ontributing factors• Genetics, environment, poor eating habits, lack of

knowledge about good nutrition, body physiology, age, and gender

G

oal of diet therapy is to improve health and quality of life• Must expend more energy than is consumed through

intake of calories


PREGNANCY

N

utritional status before and during pregnancy can

influence health status of mother and fetus

W

eight gain should be 2 to 4 lb for the first trimester and 1

lb/week during the second and third trimesters• Recommended—no caloric increase in the first trimester,

then 300 calories/day for the second and third trimesters


SUBSTANCE ABUSE

A

buse of alcohol and other drugs

I

nterferes with food intake by decreasing appetite and

decreasing financial resources for food

M

ay lead to impaired absorption of nutrients• Thiamine deficiency is seen in alcohol abuse


SUBSTANCE ABUSE (CONT’D)

P

atients with a history of substance abuse should have

dietary counseling

T

reatment• Fluid and electrolyte supplements• Vitamin and mineral supplements (particularly thiamine)• High-calorie, high-carbohydrate diet• Dietary fat restriction if liver function impaired


CARDIOVASCULAR DISEASE

I

ncludes diseases of the blood vessels, hypertension, myocardial

infarction, and congestive heart failure

F

ocused on reduction of fat and sodium intake to decrease atherosclerosis

C

holesterol, three types:• High-density lipoprotein• Low-density lipoprotein• Very-low-density lipoprotein

S

odium: 1 teaspoon salt contains 2300 mg sodium


DIABETES MELLITUS

D

isturbance of the metabolism of carbohydrates and the use of

glucose by the body

T

wo main types• Type 1: insulin dependent (juvenile onset) • Type 2: non–insulin dependent (adult onset)

H

igher risk in African Americans and Hispanics


DIABETES MELLITUS (CONT’D)

D

iet therapy to control carbohydrate intake to maintain serum glucose at 75 to 115

mg/dL

P

atients should avoid large amounts of carbohydrates in one meal

M

eals should contain 45% to 60% carbohydrates, 20% to 25% protein, and 20% to

25% fat

C

alories restricted if patient is overweight

C

arbohydrates should be complex


DIABETES MELLITUS (CONT’D)

D

iabetic patients are at higher risk for:• Cardiovascular disease• Hypertension• Kidney disease• Blindness• Stroke

D

ietary counseling is essential


HIV/AIDS

H

IV/AIDS patients often have:• Severe diarrhea• Profound weight loss• Muscle wasting

T

herapy is aimed at:• Replacement of fluids and electrolytes• Weight gain• Replacement of lost muscle mass• Maintaining the immune system


NASOGASTRIC AND ENTERAL TUBES

U

sually a temporary measure to provide nutritional support

C

heck tube placement prior to feeding or administering

medications

I

rrigate to ensure it is patent


NASOGASTRIC AND ENTERAL TUBES (CONT’D)

R

easons for use• Dysphagia following stroke• Inflammatory bowel disease• Decompression of the stomach before or after surgery• Obtaining gastric specimens for analysis• Gastric feeding or lavage • Administration of medications

I

nsertion and care (Review Skill 27-2)


FIGURE 27-2: NASOGASTRIC TUBE


FIGURE 27-2: DUODENAL TUBE


FIGURE 27-2: GASTROSTOMY TUBE


FIGURE 27-2: JEJUNOSTOMY TUBE


PERCUTANEOUS ENDOSCOPIC

GASTROSTOMY TUBES

G

enerally used when a patient requires long-term nutritional

support

T

ube placement should be checked every shift and before feeding

or administering medication

B

efore feeding or administering medications, amount of residual

fluid in the stomach should be assessed


TYPES OF FEEDING TUBES

P

lastic nasogastric tubes: can be used for lavage, tube feeding,

and administering medications

S

mall-bore silicone feeding tubes: usually used only for tube

feeding

P

ercutaneous endoscopic gastrostomy (PEG) tube and jejunostomy

tube: used for tube feeding and administering medication


FIGURE 27-3: NASOGASTRIC AND

ENTERAL FEEDING TUBES


FEEDING PUMPS

C

ontinuous feeding effective for patients who cannot tolerate large

amounts of fluids at one time

I

ntermittent feeding beneficial for patients who are able to feed

themselves or when beginning to reintroduce oral feeding

A

mount of tube feeding is prescribed by the physician; ranges from

8 to 12 oz per feeding


TOTAL PARENTERAL NUTRITION

A

method of delivering total nutrition through a catheter placed in a large

central vein

H

igh concentrations of carbohydrates main source of energy

S

tarted slowly to allow the body to adjust to the high level of glucose

concentration and the hyperosmolality

U

sed for patients on long-term therapy for: • Burns, intestinal obstruction, inflammatory bowel disease, AIDS, cancer

(chemotherapy)


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CHAPTER 27 Diet Therapy and Assisted Feeding Copyright © 2014, 2009 by Saunders, an imprint of...

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