Nutrition and Diet Therapy – Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 15

LESSON TITLE: Illness and Nutrition Care Materials:

Pen and notebook
LEARNING OUTCOMES:

At the end of the lesson, you can:

1. Describe the interrelationships between illness and
malnutrition; Reference:
2. Explain how health professionals identify and treat patients DeBruyne, L.K., Pinna, K., & Whitney E., (2016).
at risk for nutrition problems; Nutrition and diet therapy: Principles and practice
3. Discuss the different types of dietary modifications (9th ed.). USA: Cengage Learning.
available to patients with medical problems and how each
of these is used during patient care; and
4. Discuss the different formats in documenting nutrition
care.

LESSON PREVIEW/REVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the
space provided. You may use the back page of this sheet, if necessary. Have fun!

Instruction: List and describe the common nutrition related concerns during late adulthood.
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MAIN LESSON
You will study and read their book, if available, about this lesson.

A. Nutrition in Health Care

Malnutrition is frequently reported in patients hospitalized with acute illness, and acutely ill individuals without nutrition
problems on admission often exhibit a subsequent decline in nutrition status. Depending on the patient population,
estimates of malnutrition in hospital patients range from 15 to 60 percent. Poor nutrition status weakens immune function
and compromises a person’s healing ability, influencing both the course of disease and the body’s response to treatment.
Thus, preventing and correcting nutrition problems may improve the outcome of medical treatments and help to prevent
complications. In addition, patients are often concerned about the impact their diet has on their medical condition.

Effects of Illness on Nutrition Status

Illnesses and their treatments may lead to malnutrition by reducing food intake, interfering with digestion and absorption,
or altering nutrient metabolism and excretion. For example, the nausea caused by some illnesses or treatments can
diminish appetite and reduce food intake; similarly, inflammation in the mouth or esophagus can cause discomfort when
an individual consumes food. Some medications may cause anorexia (loss of appetite) or gastrointestinal (GI) discomfort
or interfere with nutrient function and metabolism. Prolonged bed rest often results in pressure sores, which increase
metabolic stress and raise protein and energy needs.

The dietary changes required during an acute illness are usually temporary and can be tailored to accommodate an
individual’s preferences and lifestyle. However, chronic illnesses (those lasting 3 months or longer) may require long-term

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modifications. For example, diabetes treatment requires lifelong changes in diet and lifestyle that some people may find
difficult to adhere to. The challenge for health professionals is to help their patients understand the potential benefits of
nutrition treatments and accept the dietary adjustments that can improve their health.

Ways in Which Illness Can Affect Nutrition Status

B. Responsibility for Nutrition Care

Physicians. Physicians are responsible for meeting all of a patient’s medical needs, including nutrition. They prescribe
diet orders (also called nutrition prescriptions) and other instructions related to nutrition care, including referrals for
nutrition assessment and dietary counseling. Physicians rely on nurses, registered dietitians, and other health
professionals to alert them to nutrition problems, suggest strategies for handling nutrition care, and provide nutrition
services.

Registered Dietitians. A registered dietitian is a food and nutrition expert who is qualified to provide medical nutrition
therapy. Registered dietitians conduct nutrition and dietary assessments; diagnose nutrition problems; develop,
implement, and evaluate nutrition care plans (described later); plan and approve menus; and provide dietary counseling
and nutrition education services. Registered dietitians may also manage food and cafeteria services in health care
institutions.

Registered Dietetic Technicians. Registered dietetic technicians often work in partnership with registered dietitians and
assist in the implementation and monitoring of nutrition services. Depending on their background and experience, they
may screen patients for nutrition problems, develop menus and recipes, ensure appropriate meal delivery, monitor
patients’ food choices and intakes, and provide patient education and counseling. Dietetic technicians sometimes
supervise foodservice operations and may have roles in purchasing, inventory, quality control, sanitation, or safety.

Nurses. Nurses interact closely with patients and thus are in an ideal position to identify people who would benefit from
nutrition services. Nurses often screen patients for nutrition problems and may participate in nutrition and dietary
assessments. Nurses also provide direct nutrition care, such as encouraging patients to eat, finding practical solutions to
food-related problems, recording a patient’s food intake, and answering questions about special diets. As members of
nutrition support teams, nurses are responsible for administering tube and intravenous feedings. In facilities that do not
employ registered dietitians, nurses often assume responsibility for much of the nutrition care. Other Health Care
Professionals

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Other health practitioners who may assist with nutrition care include pharmacists, physical therapists, occupational
therapists, speech therapists, nursing assistants, home health care aides, and social workers. These individuals can be
instrumental in alerting dietitians or nurses to nutrition problems or may share relevant information about a patient’s health
status or personal needs

C. Implementing Nutrition Care

Once the health care professional has collected assessment information, the next steps of the nutrition care process can
be carried out. A nutrition care plan often includes both dietary adjustments and nutrition education. Note that some
aspects of nutrition care fall within the scope of dietetics practice, whereas others require the assistance of other health
professionals.

Dietary Modifications. During illness, many patients can meet energy and nutrient needs by following a regular diet.
Other patients may require a modified diet, which is altered by changing food consistency or texture, nutrient content, or
the foods included in the diet.

Modified diets should be adjusted to satisfy individual preferences and tolerances and may need to be altered as a
patient’s condition changes.

Diet Progression. A change in diet as a patient’s food tolerance improves is called diet progression. For example, the diet
order may read, “progress diet from clear liquids to a regular diet as tolerated.” In practice, this means that the patient
would be given clear beverages initially, and then gradually be provided with other beverages or solid foods that are
unlikely to cause discomfort. As another example, the diet may progress from small, frequent feedings to larger meals as
tolerance improves. Symptoms such as nausea, vomiting, diarrhea, and gastrointestinal pain suggest intolerance

Diet Manual. When designing menus for modified diets, the dietary and foodservice personnel refer to a diet manual,
which details the exact foods or preparation methods to include in or exclude from a modified diet. The diet manual may
also outline the rationale and indications for use of the diets and include sample menus. The manual may be compiled by
the dietetics staff or adopted from another health care facility or a dietetics organization.

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Alternative Feeding Routes. In most cases, patients can meet their nutrient needs by consuming regular foods. If their
nutrient needs are high or their appetites poor, oral supplements can be added to their diets to improve their intakes.
Sometimes, however, a person’s medical condition makes it difficult to meet nutrient needs orally.

Two options remain: tube feedings or parenteral nutrition:

⎯ Tube feedings. Nutritionally complete formulas can be delivered through a tube placed directly into the stomach
or intestine. Tube feedings are preferred to parenteral nutrition if the GI tract is functioning normally.
⎯ Parenteral nutrition. A person’s medical condition sometimes prohibits the use of the GI tract to deliver nutrients.
If the person is malnourished and the GI tract cannot be used for a significant period of time, parenteral nutrition,
in which nutrients are supplied intravenously, can meet nutritional needs.

Nothing by Mouth (NPO). An order to not give a patient anything at all—food, beverages, or medications—is indicated by
NPO, an abbreviation for non per os, meaning “nothing by mouth.” For example, an order may read “NPO for 24 hours” or
“NPO until after X-ray.” The NPO order is commonly used during certain acute illnesses or diagnostic tests involving the
GI tract.

D. Approaches to Nutrition Care

Long-Term Dietary Intervention. When long-term changes are necessary, a care plan must take into account a person’s
current food practices, lifestyle, and degree of motivation. Behavior change is a process that occurs in stages; therefore,
more than one consultation is usually necessary. The following approaches may be helpful in implementing long-term
dietary changes:
⎯ Determine the individual’s readiness for change. Some people have little desire to change their food practices,
and even those who are willing may not be fully prepared to take the necessary steps. The health practitioner
needs to consider a patient’s readiness to adopt new dietary behaviors before attempting to implement an
ambitious care plan.
⎯ Emphasize what to eat, rather than what not to eat. Emphasizing foods to include in the diet, rather than those
to restrict, can make dietary changes more appealing. For example, encouraging additional fruits and vegetables
is a more attractive message than telling the patient to restrict butter, cream sauces, and ice cream.
⎯ Suggest only one or two changes at a time. People are more likely to adopt a nutrition care plan that does not
deviate too much from their usual diet. If they succeed in adopting one or two changes, they are more likely to
stick to the plan and be open to additional suggestions. Stricter plans may yield quicker results but are useful only
for highly motivated people.

Nutrition Education. Nutrition education allows patients to learn about the dietary factors that affect their particular
medical condition. Ideally, this knowledge can motivate them to change their diet and lifestyle in order to improve their
health status. A nutrition education program should be tailored to a person’s age, level of literacy, and cultural
background. Learning style must also be considered: some people learn best by discussion supplemented with written
materials, whereas others prefer a demonstration with visual examples, such as food models and measuring devices.
Information can be provided in one-on-one sessions or group discussions. The meeting should include an assessment of
the person’s understanding of the material and commitment to making changes. Follow-up sessions can reveal whether
the person has successfully adopted a dietary plan.

E. Documenting Nutrition Care

ADIME Format
The ADIME format closely reflects the steps of the nutrition care process. The letters represent the different steps:
Assessment, Diagnosis, Intervention, and Monitoring and Evaluation. Using this format, the nutrition care plan is recorded
as follows:
⎯ Assessment. The assessment section summarizes relevant assessment results, such as the medical problem,
historical information, height, weight, BMI, laboratory test results, and relevant symptoms.
⎯ Diagnosis. The diagnosis section lists and prioritizes the nutrition diagnoses.
⎯ Intervention. The intervention section describes treatment goals and expected outcomes, specific interventions, and
the patient’s responses to nutrition care.
⎯ Monitoring and Evaluation. The monitoring and evaluation section records the patient’s progress, changes in the
patient’s condition, and adjustments in the care plan

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SOAP Format.
The SOAP format is the oldest method used for documenting nutrition care and is still in popular use. The letters represent
the types of information included in each section: Subjective, Objective, Assessment, and the Plan for care.
⎯ Subjective information is obtained in an interview with the patient or caregiver and includes the chief medical
problem and relevant symptoms.
⎯ Objective information includes nutrition screening or assessment data, such as the results of anthropometric
and laboratory tests and the physical examination.
⎯ Assessment section contains a brief evaluation of the subjective and objective data and provides concise
diagnoses of the nutrition problems.
⎯ Planning includes recommendations that can help solve the problem, including the nutrition prescription, plan for
nutrition education and counseling, and referrals to other professionals or agencies.

Improving Food Intake

People in hospitals and other medical facilities often lose their appetites as a result of their medical condition, treatment, or
emotional distress. Moreover, some medications and other treatments can dramatically alter taste perceptions. Patients
may receive meals at specified times, whether they are hungry or not, and often must eat in bed without companionship.
Under these types of conditions, eating can become more of a chore than a pleasurable experience. Meals may also be
unwelcoming if the person is in pain or has been sedated.

To improve food intakes, health professionals should ensure that the patient’s room remains calm and quiet during
mealtime. Excessive activity, like room maintenance or ward rounds, can distract patients and reduce appetite. If the
patient’s appetite or sense of taste is affected by illness, the patient can be asked to identify foods that are the most
enjoyable

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CHECK FOR UNDERSTANDING
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. Mr. Segobre experiences loss of appetite, difficulty swallowing, and mouth pain as a consequence of illness. Mr.
Segobre is at risk of malnutrition due to:
a. altered metabolism.
b. reduced food intake.
c. altered excretion of nutrients.
d. altered digestion and absorption.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. Of the following data collected during a nutrition screening, which item does not place the person at risk for
malnutrition?
a. Having a health problem that is frequently associated with PEM
b. Using prescription medications that affect nutrient needs
c. Residing with a spouse in a middle-income neighborhood
d. Significantly reducing food intake over the past five or more days
ANSWER: ________
RATIO:___________________________________________________________________________________________
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3. A nurse notices a food on a patient’s tray and is not sure if the food is allowed on the patient’s diet. An appropriate
action for the nurse to take would be to check the:
a. diet manual.
b. diet order.
c. nutrition care plan.
d. medical record.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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4. A successful nutrition intervention would include a long list of:

a. dietary changes that the patient should consider making.
b. foods that the patient should avoid.
c. appetizing meals and foods that the patient can include in the diet.
d. reasons why the patient should make dietary changes.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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5. The most important factor(s) that affect(s) how nutrition education is presented is (are):
a. the person’s nutrient needs and nutrition status.
b. the person’s abilities and motivation.
c. the person’s medical history.
d. the entries in the medical record
ANSWER: ________
RATIO:___________________________________________________________________________________________
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RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.

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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: MINUTE PAPER

This strategy provides feedback on whether or not you understand the lesson. Use the space provided in this activity
sheet to answer the following questions. Make sure to not miss a tiny detail!

How would you illustrate the relationship of illness to nutrition?

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