Transcript Nutrition Intervention

Chapter 14
Nutrition Intervention &
Diet-Drug Interactions
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Implementing Nutrition Care
• Care Planning
Assessment of nutrition
Diagnosis of nutritionrelated problems
Identifying expected
outcomes
Implementing interventions
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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
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• Person’s age
• Level of literacy
• Cultural
background
Modified Diets
• Altered consistency
• Altered nutrient
content
Including or
eliminating foods
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© 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
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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
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© 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
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Improving Food Intake
• Identify patient’s
favorite foods
• Arrange food &
utensils attractively
• Help patient wash up
before the meal
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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
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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
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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
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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
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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
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© 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
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© 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
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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
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Diet-Drug Interactions & Toxicity
• Example
Tyramine in foods
MAO inhibitors
• Interactions can be
fatal
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© 2007 Thomson - Wadsworth