Download NUTRITION FOR THE HOSPITALIZED PATIENT

Elena Kuchler BSN, RD, MHA.
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The Joint Commission on Hospital
Accreditation has guidelines in place to
provide appropriate care to all patients
admitted into a hospitalized setting.
The Dietitian assesses all patients within the
first 24-48 hours of admission and must
recommend a course of action if a patient is
NPO greater than 72 hours upon admit.
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Different patient population require different
modes of nutrition. Most patients will be Rx’d a
regular diet that consist of three meals daily.
The American Dietetic Association includes the
‘Dietary Guidelines for Americans’ that dictate
the necessary requirements for health promotion
and disease prevention.
These include: Low fat, low sugar, high fiber, low
salt, alcohol in moderation, exercise daily, and no
smoking.
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This Diet RX will not meet a patients
nutritional requirements.
It is designed to last no longer than three
days as it does not provide enough calories to
meet patient’s nutritional requirements for
healing.
USES: To rest bowel and GI tract or to
progress slowly from surgery.
Components: Clear juices, broth and water
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Although diet Rx may provide more calories,
it is also not recommended for long term use
as it is not sufficient in fiber.
USES: To progress the gut after long periods
of rest and to provide more calories as it
includes Milk, and cream soups.
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Be mindful of lactose intolerant patients. 
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Lactose free high protein drinks are available.
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These Diet Rx are designed to help patients
recovering from CVA’s, (cerebral vascular
accidents or strokes) as they may have
dysphagia (difficulty swallowing).
These diets may have the same amount of
food: blended, pureed, or mechanically
modified for ease of chewing and swallowing.
This diet will meet the patient’s nutritional
requirements.
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Diabetic Diet Rx: The Dietitian uses the patients
ideal body weight to determine the ideal calorie
level for the patient.
1800 ADA is a typical diabetic diet that consist of
1800 calories and includes between meal and
bedtime snacks to help keep blood sugars stable.
Carbohydrates are counted to ensure blood
sugars stay within normal limits. Patients on
these diets typically have blood glucose levels
checked ac and hs (before meals and bedtime)
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Patients with elevated BUN and Creatine will require a
restriction in the nutrients that may cause kidneys to work
harder.
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This Diet is designed to reduce the workload of the kidney.
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Typically this diet is low in Protein, potassium, sodium,
and fluid.
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Protein metabolizes to amino acids which is further broken
down to urea and nitrogen. If the Kidneys are unable to
rid the blood of the toxic waste, than blood levels will
elevate and a modification of nutrients will be
implemented to prevent damage to the kidneys.
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USE IT OR LOSE IT’ This is the guideline and the
standard of care message. If a patient has a
functioning gut (bowel sounds are present), it is
always recommended to use the Gastrointestinal
system if warranted.
Tube Feedings Enteral Nutrition is another term
used for tube feeding. If a patient is unable to
swallow due to a brain injury etc, the Dietitian
recommends a feeding by Nasal gastric (NG) or if
anticipated long term/ PEG tube (percutaneous
endogastric)
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Tube feeding: If anticipated short term use
nasal gastric feeding as it is easily inserted
and removed. Long term Feeding, PEG, a
surgical procedure placing a tube in the gut
to directly add liquid nutrition into the
stomach. Patients are usually unable to
swallow: Stroke, dysphagia, or any patient at
risk for aspiration pneumonia would be a
candidate for this type of feeding.
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GASTRIC RESIDUALS: any substance not digested
after two hours of feeding.
Place syringe into PEG site and pull back until
gastric contents no longer fill syringe, if amount
is less than 60ml (this number changes per
facility policy and procedure manual) may
continue to feed patient.
If gastric residuals are too high, TF may be
decreased, not discontinued, until tolerance is
achieved.
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INDICATED WHEN A PATIENT DOES NOT HAVE A
FUNCTIONING GUT.
Used by administering nutrients that have already
been “broken down” to Glucose, Amino Acids,
and Lipids (or respectively known as CHO, PRO
and FAT).
These nutrients, Glucose, Amino Acids and
Lipids, are infused at a determined rate through
a Central Line to provide patients’ with nutrition
who do not have a functioning GI tract.
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Depending on the Diagnosis and prognosis of the patient,
the family, doctors, patient, and dietitian determine what
type of feeding is required.
If a patient will be unable to swallow for a short period of
time a nasal gastric feeding will be recommended as the
risk of infection for not using the gut, or keeping Patient
NPO is increased during the acute phase of illness.
Patients’ requiring long term feeding due to lack of ability
to swallow may have surgical placement of a feeding tube.
Only when a patient has no gut function, is TPN
recommended as it has been shown to cause
hyperglycemia, insulin resistance, and Pancreatic/liver
problems.
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Nursing requires a lot of skill especially Assessment Skills!
When you recognize a patient with untreated HTN or DM, it
is recommended to refer these patients to a dietitian.
Lifestyle and diet changes are the FIRSTLINE approach to
care of these patients prior to Rx treatment.
Last note of consideration…Nutrition is the first step to
well being. Overweight leads to obesity which leads to
HTN, Hyperlipidemia, DM, Renal failure and Cancer. All, if
not most of all disease today is related to nutrition.
Preventing illness with adequate nutrition is considered
the standard now instead of treatment approach.