Chapter 14 Nutrition Intervention & Diet-Drug Interactions © 2007 Thomson - Wadsworth Implementing Nutrition Care • Care Planning Assessment of nutrition Diagnosis of nutritionrelated problems Identifying expected outcomes Implementing interventions © 2007 Thomson - Wadsworth Approaches to Nutrition Care • Long-term interventions • Nutrition education Determine readiness for change Emphasize what to eat, rather than what not to eat Suggest only 1-2 changes at a time Should be tailored to © 2007 Thomson - Wadsworth • Person’s age • Level of literacy • Cultural background Modified Diets • Altered consistency • Altered nutrient content Including or eliminating foods © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth The Diet Order • Physician prescribes • Consults with dietitian & nurse • Order must be precise • Diet manuals to identify foods • Diet progression as patient adapts to foods • NPO order Nothing by mouth © 2007 Thomson - Wadsworth Dietary Modifications • Mechanically altered Dysphagia • Blenderized liquid Oral, facial surgeries, chewing problems • Clear liquid First foods Little residue • Fiber-restricted Acute intestinal disorders Before surgery • Sodium-restricted Prevent or correct fluid retention Treatment of hypertension • High-kcalorie, highprotein • Fat-restricted Fat malabsorption problems High nutrient requirements Eating poorly © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Alternate Feeding Routes • Tube feedings Gastric or intestinal Need functioning GI tract Preferred over IV • Intravenous feedings Malnourished Non-functioning GI tract © 2007 Thomson - Wadsworth Improving Food Intake • Identify patient’s favorite foods • Arrange food & utensils attractively • Help patient wash up before the meal © 2007 Thomson - Wadsworth Diet-Drug Interactions • Medications can Reduce appetite Increase appetite & weight gain Alter absorption, metabolism, & excretion of nutrients Become toxic when they interact with food • Nutrients can Alter absorption, metabolism, & excretion of medications © 2007 Thomson - Wadsworth Drug Effects on Food Intake • Induce nausea & vomiting • Alter taste sensations • Suppress appetite • Dry the mouth • Cause inflammation & lesions in the mouth • Sedate the patient • Unintentional weight gain © 2007 Thomson - Wadsworth Drug Effects on Nutrient Absorption • Drug-nutrient binding Bile acid binders Some antibiotics • Altered stomach acidity Affects vitamin B12, folate, & iron • Direct inhibition Interferes with intestinal absorption or transport to mucosal cells © 2007 Thomson - Wadsworth Dietary Effects on Drug Absorption • Stomach emptying rate Meals delay absorption Empty stomach enhances absorption • Stomach acidity Some drugs need an acidic environment Others may need enteric coating • Interactions with food components Some foods can bind to drugs and decrease absorption Phytates Calcium and some antibiotics © 2007 Thomson - Wadsworth Drug Effects on Nutrient Metabolism • Drugs & nutrients Share similar enzyme systems in small intestine & liver Some drugs may enhance or inhibit the activities of these enzymes © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Dietary Effects on Drug Metabolism • Grapefruit juice Increases blood concentrations of some drugs • Vitamin K-rich foods Can weaken the effect of blood thinners • Herbs that enhance blood thinners St. John’s wort Ginkgo Garlic Ginseng Dong quai Danshen Others © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Drug Effects on Nutrient Excretion • Some medications may Alter mineral reabsorption in the kidneys Cause an increase or decrease in urinary losses • Problems with Multiple drugs with same effect Impaired kidney function Long-term use of medications © 2007 Thomson - Wadsworth Dietary Effects on Drug Excretion • Inadequate excretion of medications can cause toxicity • Excessive losses of medications can reduce the therapeutic effect • Urine acidity can affect drug excretion © 2007 Thomson - Wadsworth Diet-Drug Interactions & Toxicity • Example Tyramine in foods MAO inhibitors • Interactions can be fatal © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth