Transcript Slide 2

CHAPTER 27
Diet Therapy and Assisted Feeding
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 2
Learning Objectives
Theory
1) Identify the nurse’s role related to diet therapy and special diet.
2) Compare and contrast a full liquid with a clear liquid diet.
3) Explain the different dietary modification levels: puréed,
mechanically altered, advanced, and regular.
4) Describe health issues related to nutrition.
5) List disease processes that may benefit from diet therapy.
Clinical Practice
1) Use therapeutic communication with a patient who needs a
special diet.
2) Develop a teaching plan for nutritional therapy.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Learning Objectives
Theory
8) Discuss the procedure for tube feeding.
9) Identify medical rationale and nursing care for a patient
receiving peripheral parenteral nutrition (PPN) and total
parenteral nutrition (TPN).
10) Understand the possible complications associated with modified
diets, tube feedings, PPN, and TPN.
Clinical Practice
4) Demonstrate feeding a patient through a nasogastric tube or
percutaneous endoscopic gastrostomy (PEG) tube.
5) Know your facility’s policies, procedures, and protocols for
nutrition-related problems and complications with tube feedings.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 4
Goals of Diet Therapy
• Treat and manage disease
• Prevent 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 5
Patients Needing Feeding Assistance
• Patients with paralysis of the arms
• Patients with visual impairment
• Patients with intravenous lines in their hands
• Severely impaired or weak patients
• Confused patients
• Feeding may be delegated to a nursing assistant or family member
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 6
Postoperative Patient
• Should be well-nourished preoperatively to facilitate
postoperative healing and recovery
• Preoperative patients are usually NPO 6 to 8 hours before
the procedure
• Postoperative patients progress from a clear liquid to full
liquid diet
• May progress to a soft diet before attempting a general or
regular diet
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 7
Foods Allowed on a Liquid Diet
• Clear liquids
• Grape, apple, cranberry
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juices
Strained fruit juices
Vegetable broth
Carbonated water
Clear, fruit-flavored drinks
Tea, coffee
Gelatin and ices
Clear candies
Popsicles
Clear broth
• Full liquids
• Milk and milk beverages
• Yogurt, eggnog, pudding
• Custard and ice cream
• Puréed meat, vegetables in
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cream soups
Vegetable juices
Sweetened plain gelatin
Cooked refined cereals
Strained or blended gruel
All other beverages
Cream
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 8
Postoperative Patient
• Liquid diet is usually started when bowel sounds
return
• Presence or absence of bowel sounds is
determined by auscultation
• Goal is to have low-residue, easily digested foods
• A liquid diet decreases risk of abdominal
discomfort, nausea, and vomiting
• Patient may progress to soft diet before advancing
to regular
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 9
Anorexia Nervosa
• Mental 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
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 10
Bulimia
• Eating 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
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 11
Obesity
• Excessive 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
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 12
Obesity (cont’d)
• Contributing factors
• Genetics, environment, poor eating habits, lack of knowledge about
good nutrition, body physiology, age, and gender
• Goal of diet therapy is to improve health and quality of life
• Must expend more energy than is consumed through intake of
calories
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 13
Pregnancy
• Nutritional status before and during pregnancy can
influence health status of mother and fetus
• Weight 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
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 14
Substance Abuse
• Abuse of alcohol and other drugs
• Interferes with food intake by decreasing appetite and
decreasing financial resources for food
• May lead to impaired absorption of nutrients
• Thiamine deficiency is seen in alcohol abuse
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 15
Substance Abuse (cont’d)
• Patients with a history of substance abuse should have
dietary counseling
• Treatment
• Fluid and electrolyte supplements
• Vitamin and mineral supplements (particularly thiamine)
• High-calorie, high-carbohydrate diet
• Dietary fat restriction if liver function impaired
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 16
Cardiovascular Disease
• Includes diseases of the blood vessels, hypertension,
myocardial infarction, and congestive heart failure
• Focused on reduction of fat and sodium intake to
decrease atherosclerosis
• Cholesterol, three types:
• High-density lipoprotein
• Low-density lipoprotein
• Very-low-density lipoprotein
• Sodium: 1 teaspoon salt contains 2300 mg sodium
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 17
Diabetes Mellitus
• Disturbance of the metabolism of carbohydrates and the
use of glucose by the body
• Two main types
• Type 1: insulin dependent (juvenile onset)
• Type 2: non–insulin dependent (adult onset)
• Higher risk in African Americans and Hispanics
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Slide 18
Diabetes Mellitus (cont’d)
• Diet therapy to control carbohydrate intake to maintain
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serum glucose at 75 to 115 mg/dL
Patients should avoid large amounts of carbohydrates in
one meal
Meals should contain 45% to 60% carbohydrates, 20% to
25% protein, and 20% to 25% fat
Calories restricted if patient is overweight
Carbohydrates should be complex
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 19
Diabetes Mellitus (cont’d)
• Diabetic patients are at higher risk for:
• Cardiovascular disease
• Hypertension
• Kidney disease
• Blindness
• Stroke
• Dietary counseling is essential
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 20
HIV/AIDS
• HIV/AIDS patients often have:
• Severe diarrhea
• Profound weight loss
• Muscle wasting
• Therapy is aimed at:
• Replacement of fluids and electrolytes
• Weight gain
• Replacement of lost muscle mass
• Maintaining the immune system
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 21
Learning Objectives
Theory
6) Verbalize the rationale for assisted feedings and tube
feedings.
7) List the steps for the procedure to insert, irrigate, and
remove a nasogastric tube.
Clinical Practice
3) Demonstrate insertion, irrigation, and removal of a
nasogastric tube.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 22
Nasogastric and Enteral Tubes
• Usually a temporary measure to provide nutritional
support
• Check tube placement prior to feeding or administering
medications
• Irrigate to ensure it is patent
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Slide 23
Nasogastric and Enteral Tubes (cont’d)
• Reasons 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
• Insertion and care (Review Skill 27-2)
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 24
Figure 27-2: Nasogastric tube
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Slide 25
Figure 27-2: Duodenal tube
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Slide 26
Figure 27-2: Gastrostomy tube
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Slide 27
Figure 27-2: Jejunostomy tube
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Slide 28
Percutaneous Endoscopic Gastrostomy Tubes
• Generally used when a patient requires long-term
nutritional support
• Tube placement should be checked every shift and before
feeding or administering medication
• Before feeding or administering medications, amount of
residual fluid in the stomach should be assessed
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 29
Types of Feeding Tubes
• Plastic nasogastric tubes: can be used for lavage, tube
feeding, and administering medications
• Small-bore silicone feeding tubes: usually used only for
tube feeding
• Percutaneous endoscopic gastrostomy (PEG) tube and
jejunostomy tube: used for tube feeding and administering
medication
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 30
Figure 27-3: Nasogastric and enteral feeding
tubes
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Slide 31
Feeding Pumps
• Continuous feeding effective for patients who cannot
tolerate large amounts of fluids at one time
• Intermittent feeding beneficial for patients who are able to
feed themselves or when beginning to reintroduce oral
feeding
• Amount of tube feeding is prescribed by the physician;
ranges from 8 to 12 oz per feeding
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 32
Total Parenteral Nutrition
• A method of delivering total nutrition through a catheter
placed in a large central vein
• High concentrations of carbohydrates main source of
energy
• Started slowly to allow the body to adjust to the high level
of glucose concentration and the hyperosmolality
• Used for patients on long-term therapy for:
• Burns, intestinal obstruction, inflammatory bowel disease, AIDS,
cancer (chemotherapy)
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.