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What is the Nutrition Prescription?

Concise statement of plan to best meet patient/client’s nutrition needs (developed by the RD)


What is the Nutrition Prescription NOT?

the admit/current diet order (MD orders)


What is the PURPOSE of the Nutrition RX?

To communicate RD’s nutrition/ diet recommendations (based on complete assessment)


What is found within the Nutrition RX?

-Content should be related to the PES statement;
-EX: if problem= inadequate energy intake, then nutrition RX should address meeting energy needs;
-Enmount of desired weight gain/specific time period (ie:wk)


What should the RX include?

1. Energy level;
2. Amount of desired weight gain/specific time period (i.e.:wk);
3. May include specifications of:
-meals & snacks
-supplemental feedings;
-enteral feedings;
-Environmental changes to promote intake;
-% energy from specific macronutrients


Items from the IDNT that might be in the RX:

-Number, size, frequency of meals;
-Macronutrient rec’s (specify gm/day or %kcal);
-Micronutrient rec’s ;
-Bioactive substances;
-Texture/ consistency of solid or liquids;
-Liquid diet (ie: clear/ full);
-Food groups/ exchanges/ servings;
-Enteral/ parenteral feedings (specify formula/solution, rate, access, schedule)


What are the 4 categories of Intervention Strategies?

1. Food and/or Nutrient Delivery
2. Nutrition Education
3. Nutrition Counseling
4. Coordination of Nutrition Care
**Use IDNT terminology


What are some CLINICAL goals for Monitoring/Eval?

1. Weight gain/loss (specify amt/time frame);
2. Protein status: biochemical indicators, physical findings, body composition;
3. Biochemical Assessment(LDL C, serum glu,Hgb A1C);
4. Hydration status indicators: biochemical, physical findings, anthropometrics, cognitive function


What are some BEHAVIORAL goals for Monitoring/Eval?

1. Change in eating behavior (e.g. increasing fruit and vegetable intake);
2. Change in nutrition knowledge/ awareness ;
3. Change in environment/continuum of care?;
4. Provision of nutrient intake (ie: energy intake, enteral/parenteral feedings)


What is Enteral Nutrition?

-Feeding through the GI tract via a tube, catheter, or stoma that delivers nutrients distal (after) the oral cavity → Nutrient intake that is NOT consumed orally;
-“Enteral or Tube Feeding”;
-NO “volitional” intake


What are the indications for the need of Enteral Nutrition?

**FUNCTIONAL GI tract, but cannot adequately feed (orally) themselves;
Recommended for patients:
-Altered mental status;
-Swallowing dysfunction;
-Upper GI disorders → Bypass by insertion of tube past dysfunction


What Nutrition Diagnoses could indicate Enteral Nutrition?

-Increased energy expenditure;
-Involuntary weight loss;
-Inadequate oral food/beverage intake ;
-Inadequate fluid intake ;
-Increased nutrient needs;
-Biting/chewing difficulties;
-Impaired swallowing;
-Impaired nutrient utilization


What are the CONTRAINDICATIONS to Enteral Nutrition?

**DO NOT utilize enteral tube feeds;
Serious medical conditions of GI tract =
-Diffuse peritonitis (inflammation/infection of the peritoneal lining of abdominal cavity);
-GI bleeding;
-Obstruction or ileus that prevent passing of intestinal contents;
-Intractable vomiting or diarrhea not responsive to medical treatment


ADAVANTAGE of Enteral Nutrition

-Reduced hospital stay;
-Reduced surgical interventions;
-Reduce rate of infectious complications in critical care patients;
-Improved wound healing;
-Maintenance of GI function


When might Enteral be used along with Parenteral Nutrition?

-Even when pt. cannot meet all nutritional needs through EN, trophic or “trickle” may be prescribed with parenteral to minimize villous atrophy and prevent bacterial translocation → Keeps protective villi alive and maintains immunity ;
-“Use It or lose it”


DISADVANTAGES of Enteral Nutrition

-Potential difficulty of administration;
-Poor tolerance;
-Difficulty meeting nutritional requirements
→ Minimize disadvantages by careful patient selections through nutrition physical and standard protocols


What decisions need to be made about implementing Enteral Nutrition?

1. GI Access;
2. Formula;
3. Delivery schedule;
4. Duration


What is a Nasogastric tube feed?

Nose → stomach;
-Normal GI function;
-Stimulates normal digestion;
-Meds can be placed in tube;
-Bedside insertion;
-Can potentially cause aspiration, discomfort, nasal irritation and tube displacement


What is a Nasoduodenal tube feed?

Nose → duodenum (intestine);
-Normal SI function, but need to bypass stomach;
-Tube insertion bedside;
-Can lead to discomfort and tube displacement


What is a Nasojejunal tube feed?

Nose → ileum (intestine);
-Normal SI function, but need to bypass stomach;
-Tube insertion bedside;
-Can lead to discomfort and tube displacement


What is a Gastrostomy tube feed?

Directly into stomach (surgically through skin);
-Normal GI function but need to bypass upper GI;
-Long-term feeding access;
-Reduced risk of tube displacement;
-Allows bolus feedings;
-Surgical procedure accompanied with possible irritation or infection


What is a PEG (percutaneous endoscopic gastrostomy)?

Directly into stomach (laparoscopic through skin);
-Normal GI function but need to bypass upper GI;
-Long-term feeding access;
-Outpatient procedure w/o anesthesia;
-Less expensive and lower risk of displacement;
-Allows bolus feedings;
-Risk of irritation and infection


What is Jejunostomy tube feed?

Directly into jejunum (through skin);
-Normal GI function but need to bypass part of GI;
-Long-term feeding access;
-Surgical procedure with risk of irritation and infection;
-Small lumen of tube, so risk of clogging increased


What needs to be assessed to determine the appropriate formula for Enteral feeding?

-Medical diagnosis;
-Nutrition diagnosis;
-Skin breakdown;
-Weight (weight loss/gain);
-Tolerance of previous tube feedings;
-Risk of aspiration;
-PO or NPO;


What are the most common formulas used for Enteral Feedings?

1. Jevity
2. Jevity 1.2
3. Jevity 1.5


Other formulas

-Glucerna 1.0, 1.2, 1.5;


What the 3 different type of delivery schedules for Enteral Feeding?

** Enteral nutrition delivery is usually regulated by a small, programmable feeding pump;
1. Bolus;
2. Intermittent;
3. Continuous


What are Bolus Feedings?

-Rapid administration of formulas of 240-480 ml of formula several times a day;
-Calculate amount needed in number of cans per feeding and how many times per day
-Example: 2 cans three times/day and 1 can HS = Mimics 3 meals and a bedtime snack
*Note: 1 can = 240 ml


When might bolus feeding be appropriate?



What are Intermittent Feedings?

-Administered several times a day;
-Administered a little slower than bolus;
-Usually over 20-30 minutes;
-Uses a pump to administer formula;
-If a pump is not available then can use gravity drip