Nutrition in Health Care
and
The Role of Clinical Dietitian
Relationship between nutrition & illness is complex.Medical
problems can alter nutrient needs & result in malnutrition:
 Reduction in food intake( nausea, depression,
chemotherapy, and radiation )
 Interference with digestion & absorption (vomiting,
diarrhea, chemotherapy, radiation, and some mediations
 Alteration of nutrient metabolism & excretion
 Increase metabolic rate & energy needs ( fever- stress)
Poor nutrition can affect:
1.Course of disease
2. Body’s response to treatment
•
Poor nutrition can delay wound-healing, contribute to
anemia, depress immune system, and increase
susceptibility to infections. When malnutrition occurs as a
result of hospitalization, it is called Iatrogenic malnutrition.
So the Purpose of Clinical Nutrition(Medical Nutrition
Therapy) is to achieve or maintain good nutritional status.
Patient Care Team
• Physician
• Clinical Dietitian
• Nurse
• Pharmacist
• Occupational Therapist
• Social Worker
The Physician prescribes diet orders & other aspects of nutrition
care.
Clinical dietician identify nutritional problems, suggest
strategies, provide nutritional services.
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Improving Client’s Food Intake
 Loss of appetite is common among patients in
hospitals or other medical care facilities
-Result of medical condition, treatment, emotional
distress.
-Can be affected by medications & other treatments that
alter taste perceptions.
Improving the Client’s Nutrition
• Make formal nutritional assessments on regular basis.
• All members of health care team should be alert to signs of
malnutrition every day.
• Listen to client’s concerns about diets served.
• Watch reaction to food served.
• Include dietitian in plan of care.
The role of clinical dietitian in improving patients
nutrition status
– Loss of appetite is common among patients in
hospitals or other medical care facilities as a result of
medical condition, treatment, emotional distress or
Can be affected by medications & other treatments
that alter taste perceptions.
1- Improving Client’s Nutrition status
•
Make formal nutritional assessments on regular basis.
• All members of health care team should be alert to signs of
malnutrition every day.
• Listen to client’s concerns about diets served.
• Watch reaction to food served.
• Include dietitian in plan of care.
2- Helping patients to eat at hospital
• motivate patient to eat.
• Help patient select foods he likes & mark menus
appropriately according to his health condition
• Suggest foods that require little effort to eat
• Check patient’s tray to confirm correct diet & food
selections
• Take a positive attitude toward hospital foods
• At home, family menu should serve as basis for client’s
meal whenever possible.
• Family meals are easily adapted for the client by:
1. omitting or adding certain foods or
2. varying the method of preparation.
3-Serving the Meal
• Make tray and food arrangement as attractive as possible
with a colorful garnish which must fit into the client’s diet
plan
• Serve water and another beverage (unless it is prohibited
by the physician)
• Serve food at proper temperature
When the client is on complete bed rest, special preparations
are required before the meal is served:
• Ensure client is in comfortable position with tray and
utensils placed conveniently
• Offer bedpan and hygiene care before and after meal
• Remove any unpleasant sights
• Open containers and try to anticipate client’s needs (If the
client needs help, the napkin should be opened and placed,
the bread spread, the meat cut, and the straw offered
• Give sufficient time to eat.
•
If the meal is interrupted, the tray should be reheated and
served again as soon as the interruption has resolved.
• Document intake per facility policy.The kinds and amounts
of food refused, the time, type of diet, and client’s appetite
should be recorded on the client’s chart after each meal.
4-Feeding the Client Who Requires Assistance
Encourage clients to feed themselves However, offer help when
needed If the client is unable to feed herself or himself:
• Sit near side of bed
• Small amounts of food should be placed toward back of
mouth with slight pressure on tongue with spoon or fork
• Do not feed client with syringe
• If one-sided paralysis, food and drinking straw should be
placed on non-paralyzed side of mouth
• If client begins to choke, help sit up straight. Do not give
food or water while the client is choking
A-Feeding the Blind Client
• Arrange food as if plate were face of clock
• Use consistent pattern so client knows where each item
will be each time
• Client usually feels better when helping themselves.
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B- Feeding the physically impaired Client
• Eating and drinking require a considerable number
of individual coordinated motions.
• Adaptive feeding equipment can help patients with
feeding disabilities gain independence.
• Provide utensils that have modified handles, or are
smaller or larger as necessary.
• Encourage the use of hands for feeding if utensils
are difficult to maneuver.
• Provide plates with food guards to prevent spilling.
• Supply clothing protection
Modified Diets
During many illness a person can meet energy and
nutrients needs by :
1. Standards/ regular diet
2. Modified diet
Standard or regular diet
Diet that includes all foods and meets the nutrient needs
of healthy people.
Modified diet :
Diet that is adjusted to meet medical needs and may be
adjusted in:
• Consistency.
• Level of energy or nutrients.
• Inclusion or elimination of certain foods.
1- Mechanically altered diets:
-Are usually prescribed for patients with difficulty
chewing or swallowing
• Patients with dysphagia
• Patients with limited chewing abilities or dental
problems
- The most restrictive diet may contain pureed foods.
- The less restrictive diet may include moist, soft textured
foods.
-Diets for people with chewing problems include foods
that are ground/minced and easy-to-chew.
2- Blenderized liquid diets:
-Are often prescribed after oral or facial surgeries and for
patients with chewing problems ( Jaw fraction).
-Include fluids and foods that have been blenderized to a
liquid form (often with added liquid).
• Cereals and breads; cooked vegetables; fresh or
cooked fruits without skins or seeds; cooked, tender
meats and fish; potatoes, rice, and pasta.
-Exclude foods that do not blend well:
o Nuts and seeds; dried fruits; hard cheeses; raw
vegetables and corn.
-Should be consumed immediately after preparation or
can be refrigerated for up to 48 hours, to prevent
bacterial growth.
3- Clear liquid diets:
o Require minimal digestion.
o Often are the first foods offered after acute
gastrointestinal (GI) disturbances or IV feeding.
o Are used prior to bowel surgeries and
colonoscopy (examination of the colon).
o Include clear fluids and foods that are: liquid at
room temperature leave little residue
(undigested material) in the intestine.
o Include: clear or pulp-free fruit juices, clear
broths, fruit-flavored or unflavored gelatin,
fruit ices made from clear juices.
o Although it provides fluid and electrolytes, its
nutrient and calorie content are extremely
limited.
o If used for greater than 1-2 days, should be
supplemented with commercially prepared lowresidue formulas that provide required
nutrients.
4-Full liquid diets:
o Not limited to clear liquids
o Transitional diet between liquids and solid foods
o May include milk, yogurt, cream soups and thin
cooked cereals
o Because the diet contain milk products , it may be
inappropriate for individuals with significant lactose
intolerance.
5- Fat-restricted diets:
o May be recommended for reducing symptoms of fat
malabsorption, heartburn.
o Restricts fat to low as little as 50 grams/day or very
low as limited to as little as 25 grams/day.
o Shouldn’t restrict fat more than necessary it is an
important source of calories.
o Include foods that have less than 1 gram of fat per
serving.
o Include nonfat milk products, most fruits, most
breads, fat free broths, vegetables prepared without
fat and nonfat candies and sweets.
o Permit lean meat and meat substitutes – restricted
to 4-6 oz. per day depending on the degree of
restriction.
o Sometimes limit lactose or dietary fiber in patients
who cannot tolerate
6- Fiber-restricted diets:
o Are recommended during acute phases of intestinal
disorders when the presence of fiber may increase
intestinal discomfort or cause diarrhea or blockages.
o Used before surgery to minimize fecal volume, and
after surgery during transition to a regular diet.
o Shouldn’t be used on a long-term basis – associated
with constipation, diverticulosis, etc.
o Often eliminate whole-grain breads and cereals,
nuts and seeds, raw and dried fruits, berries, dried
beans and peas, chunky peanut butter, winter
squash, and most raw vegetables.
7- Low-residue diets:
o Differs from low-fiber diet by further restricting
most fruits and milk products ; for greater
reductions in colonic residue.
8-Sodium-restricted diets:
o Are used to prevent or correct fluid retention and is
often recommended for the treatment of
hypertension, heart failure, kidney and liver
diseases.
o The degree of restriction depends on the degree of
illness
o Restrict sodium in most cases to 2000-3000 mg/day
& may be further restricted in hospital setting
o Are difficult to adhere to because most patients find
them unpalatable
o May require :
Omitting salt in cooking and at the table
Eliminating most prepared foods and condiments,
Limiting consumption of milk and milk products.
9- High-kcalorie, high-protein diets:
o Are used for patients who have unusually high
requirements or who are eating poorly.
o High-fat foods are added - diet may exceed 35% of
calories from fat.
o Consist of small, frequent meals and commercial
liquid supplements (Boost or Ensure).
The diet order Nothing by mouth (NPO) :
o An order to not give a patient anything at all
(food, beverages, or medications).
o NPO is an abbreviation for non per os Which
means nothing by mouth
o Maybe for 24 hours (NPO for 24 hours)
o until after X-ray( NPO until after X-ray)
o Commonly used during certain acute illnesses or
diagnostic tests involving the GI tract.