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CHSC 3P93 Lecture 2- nutrition care.docx

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Health Sciences
Paul Leblanc

Lecture 2 -- Nutrition Care Through Assessment, Intervention, and Support State of health is a continuum that can change = healthy  acute illness  chronic disease  terminal illness Nutrition intervention -- reduce complications of illness Nutritional status • comparing the amounts and types of nutrients that a person consumes to nutrient requirements at various stages • plus factors that influence nutrient intake and nutrients required • Factors are listed in Table 2.2. • Nutrient imbalance = health consequences. • Inadequate intake of kcal and nutrients contributes to a compromised immune system and poor wound healing. Nutrition in Health Care • Medical condition requires assessment of nutrient needs -- condition may alter nutrient needs & treatment of disease • Illness (symptoms/treatments) can alter nutritional status, decreasing food consumption o interfering with digestion and absorption o changing metabolism and excretion Health Care Professionals and Nutrition • Physician -- prescribe diet orders • Nurses -- interact closely with the patient & administer nutritional support • Pharmacist -- formulate and package • Registered dietitians -- assess, diagnose, and treat nutrition problems • Plans called critical or clinical pathways • Table 1.2 Nutrition Care • to ensure balance between nutrient intake and nutrient requirements • Nutrient requirements – DRI tables as a “starting point” but disease and patient specific • Nutrient intake – multifactorial Nutrition Care: The Model • Central Core -- Relationship between client and dietetics professional • Outer rings -- Environmental factors impacting clients ability to receive and benefit from nutrition care • Supported by other systems -- Screening and referral systems & Outcomes management systems • Figure 2.3 Nutrition Care Process (NCP) • problem-solving method developed by the ADA that professionals use make decisions nutrition related problems • developed in 2002 by ADA, implemented in Canada (DC) in 2006 • 4 steps -- ADIM o nutrition assessment o nutrition diagnosis — identification/labeling of a nutrition problem that practitioners are responsible for treating o nutrition intervention -- activities and materials used to address a (nutrition-related) problem o nutrition monitoring and evaluation Nutrition Assessment • Collect information to evaluate nutritional status and needs • Differing causes of malnutrition require an understanding of the interaction with factors affecting nutritional status prior to intervention • Table 2.2 • Consists of gathering data o Subjective – from interviews, observation o Objective -- information from medical record • Table 3.1 • Table 3.2 Nutrition Assessment • Medical history – conditions/treatments may have nutritional implications • Diet history -- obtaining dietary intake information • Food selection variables o Biological (e.g. allergies, oral health, GI health) o Lifestyle (e.g. physical activity, meal patterns, attitude) o Food and nutrient o Environmental (e.g. economics, ethnic or cultural background) o System (e.g. food supply, educational, health care) • 24 hour recall o recall all food and beverage consumed over the past 24 hours o pros -- not dependent on literacy or education level of respondent o cons -- reliant on memory, food items may be omitted, over or underestimation of food • Food frequency questionnaire -- survey of food and beverages (retrospective) o pros -- long-term food intake, low cost o cons -- reliant on memory, misses short-term food intake changes, common foods only • Food Record -- diet consumed over a specified period of time o pros -- not dependent on memory, improved food intake data, useful for controlling intake o cons -- process influences intake, time-consuming, underreporting, requires literacy • Direct observation -- written account of food and beverages over a specified period of time o possible only in controlled environment (long-term care facilities, large scale intervention studies) o pros -- not dependent on memory, improved data, does not interfere with food intake o cons -- labour intensive, limited applicability • Consists of gathering data from • anthropometrics and body composition • biochemical data • potential drug-nutrient interaction • estimates of energy and protein requirements Nutrition Assessment – Anthropometrics and body composition • Height and weight o infants and children -- apply to growth curves, poor growth an indicator of malnutrition o adults -- BMI = weight in kg/(height in m)2 • Circumference o infants and children -- head circumference o adults -- waist and limbs = evaluate body fat and muscle mass • Skin fold thickness • Bioelectrical impedance analysis (BIA) • Underwater weighing • Near infrared interactance • Dual energy x-ray absorptiometry (DEXA) • BodPod Nutrition Assessment – Biochemical data • internal attributes -- nutritional markers, organ function • Based on – blood, urine, feces, tissue samples Assessment Significance • Creatinine (urine) -- muscle protein status • Serum protein (e.g. albumin) -- protein status • Total lymphocyte count -- Immunocompetence • RBC count or hemoglobin conc. -- Hematological health • Serum electrolytes -- Mineral status and hydration • Glycosylated hemoglobin -- Blood glucose control Nutrition Assessment – Drug-nutrient interaction • Must survey medications -- Prescription drugs & Over-the-counter drugs, Dietary supplements • Potential interactions -- nutrients alter drugs • Drugs alter food intake -- alter appetite, taste or smell, nausea or vomiting, oral function (dry mouth, sores, inflammation) • Drugs alter nutrient absorption -- change acidity of GI tract (e.g. antacids), damage mucosal cells, bind to nutrients • Drugs and nutrient interact and alter metabolism -- structural analogue, similar enzyme systems • Drugs alter nutrient excretion -- reabsorption in the kidney (e.g. diuretics), cause diarrhea or vomiting • Toxicity from nutrient and drug combination -- increase side effects of the drug (caffeine), increase drug action (grapefruit components may block metabolism of drugs) Nutrition Assessment – Energy and protein requirements • protein imbalance leads to wasting (insufficient) • Energy needs measured o TEE = BEE (or BMR) + PA + TEF o measure REE (or RMR) (~10% higher than BEE) o uses indirect calorimetry • Energy needs predicted o healthy population --EER equation (DRI tables) o clinical population (sex, weight, and age specific) o Harris-Benedict (HB) -- Mifflin-St. Jeor -- WHO/FAO basal energy estimation • Table 3.12 • Table 3.13 • Protein needs o measured by urine urea excretion and dietary protein intake (nitrogen balance) o estimated using RDA  0.8 g/kg/day for healthy adults
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