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Lecture 2c 13 Jan 2014
Nutritional care in the health care facility
including alternate feeding methods
Health care facility
-prevent onset of ill health via meeting agespecific nutrient requirements -this includes
addressing:
-nutritional deficiencies -the immune response to
specific foods
-presenting food in a way that the patient can eat
(food form) and wants (patient must like the food to
consume it)
-food must be patient-specific and time-specific
Health care facility
Address nutritional needs of pathology
(pathologies) and limitations placed on patient
by pathology(pathologies) or culture
-treat patient as an individual-not only as human
-ensure patient gets correct nutrition in time
and person-sensitive fashion
-watch food trays and that patient is
not dumping food or watch for pulled
nasogastric tubes and IVs
Health care facility
Assess situation and then implement nutrition
(including nutritional education) and
then evaluate the outcome
Health care facility
-standard diet (to meet needs of healthy
individual) or modified to meet medical needs
(meet nutritional needs and address medical
situation of patient)
-diet manuals-foods allowed and not allowed
on a particular diet-an institutional form of
standard operating procedure
Health care facility
Progressive diets
-clear liquid diet at room temperature(containing
fluids and electrolytes) leaving little
intestinal residue (easily absorbed)
-then progress to full liquid diet (clear and opaque
liquids and some semiliquid foods used if patient
unable to chew or swallow regular foods (full liquid
may contain lactose-problem?) -note that clear and
full liquid diets are limited in nutrient composition
so use only these diets for a short time
Health care facility
Progressive diets
-then progress to solid foods
-solid food diet is sometimes started via soft (eg
bananas), low fibre or low residue diets (low fibre
and low residue minimises fecal volume and hence
risk of indigestion and intestinal obstruction when
gut motility is slow or when intestinal tract is
narrow due to intestinal inflammation or scarring)
Health care facility
-food interactions- with medications that are approved by
Health Canada
- with dietary supplements (concept of
complementary therapy) that are regulated by
Health Canada -Health Canada rules are changing
to regulate supplements just like regular drugs
-tables 19-2, 19-3, 19-4, 19-5 – 9th edition
of Rolfes et al.
Tyramine toxicity – hypertensive
crisis frequently with headache
- may also cause intercranial
haemorrhage, cardiac failure and
pulmonary oedema
Health care facility continued
Alternate feeding methods
Enteral-using gi tract
-nasogastric feeding (e.g. coma patient)
Parenteral-going around gi tract
-intravenous-patient gastrointestinal tract
can not be used for digestion and/or
absorption due to e.g. severe malnutrition