Chapter 14 Nutrition Intervention and Diert-Drug Interactions

1414Nutrition

Intervention and Diet–Drug

Interactions

Copyright © 2017 Cengage Learning. All Rights Reserved.

© Cengage Learning 2017

Implementing Nutrition Care

• Care planning– Nutrition interventions (Table 14-1)

• Food and/or nutrient delivery• Nutrition education• Nutrition counseling• Coordination of nutrition care

– Many interventions include diet orders



Implementing Nutrition Care (cont’d.)

• Care planning– Nutrition care within the nursing process (see

Table 14-2)• Assessment• Nursing diagnosis• Planning: outcome identification• Planning: development of nursing strategies• Implementation• Evaluation




• Approaches to nutrition care– Long-term dietary intervention

• Plan must consider: current food practices, lifestyle, and degree of motivation

• Determine the individual’s readiness for change• Emphasize what to eat, rather than what not to eat• Suggest only one or two changes at a time




• Approaches to nutrition care– Nutrition education

• Allows patients to learn about the dietary factors affecting their particular medical condition

• Considerations: person’s age, literacy level, and cultural background; learning style; etc.

– Follow-up care• Monitor relevant outcome measures• Adjust care plan as necessary



Dietary Modifications

• Energy intakes in hospital patients– Resting metabolic rate (RMR) is typically

calculated by clinicians– RMR is adjusted for “stress factors”

• Activity level factor may be applied– Box 14-2 walks through these calculations




Dietary Modifications (cont’d.)

• Energy intakes in hospital patients– Indirect calorimetry

• Procedure that estimates energy expenditure by measuring oxygen consumption and carbon dioxide production

• Provides more accurate RMR value




• Modified (therapeutic) diets (Table 14-4)– Contain foods altered in texture, consistency,

or nutrient/food content (include or omit specific foods)

– Reasons for modified diet• Relieve chewing or swallowing difficulties• Correct malnutrition• Relieve disease symptoms• Reduce the risk of developing complications



Dietary Modifications:Modified Diets (cont’d.)

• Mechanically altered diets (Table 14-5)– Beneficial for individuals who have difficulty

chewing or swallowing• Dysphagia: impaired swallowing

– Why are dysphagia diets highly individualized?

– Forms: pureed, ground/minced, soft




• Blenderized liquid diet– Foods available from all four food groups

• Clear liquid diet– Foods that are liquid at body temperature– Leaves minimal residue in the colon

• Fat-restricted diet– Why is it important to avoid being too

restrictive?



Menu—Clear Liquid Diet




• Low-fiber diet– Acute intestinal disorders, before/after surgery– Why is long-term fiber restriction

discouraged?• Low-sodium diet

– Prevent or correct fluid retention– Typically 2000 or 3000 milligrams daily




• High-kcalorie, high-protein diet (Table 14-6)– Increases kcalorie and protein intakes in

patients with high requirements or who are eating poorly

– High-fat foods, commercial supplements




• Variations in the diet order– Physician is responsible for prescribing an

appropriate diet• Often relies on the dietitian or nurse to recommend

changes in the diet order when warranted– Diet progression

• Diet changes as patient’s food tolerance improves– NPO: What is the NPO (non per os) order?




• Variations in the diet order– Alternative feeding routes

• Tube feedings: liquid formulas delivered directly into the stomach or intestine

• Parenteral nutrition: provision of nutrient solutions intravenously



Foodservice

• Diet manual– Specifies the foods or preparation methods to

include or exclude in modified diets– Provides sample menus

• Food selection– Selective menus

• Provide choices in some or all menu categories• What are the benefits of selective menus?



Foodservice (cont’d.)

• Food selection– Room-service, cook-to-order system– Extended food delivery hours

• Food safety– What is a Hazard Analysis and Critical Control

Points (HACCP) program?



Foodservice (cont’d.)

• Improving food intake– Keep patient’s room calm/quiet during meals– Engage patient in identifying most enjoyable

foods– Place occasional “surprise” on the tray, e.g.,

decoration– Box 14-3 provides additional tips



Diet-Drug Interactions

• Categories of interactions– Drugs altering food intake by reducing or

increasing appetite– Drugs altering the absorption, metabolism, or

excretion of nutrients; or nutrients altering the absorption, metabolism, and excretion of drugs

– Interactions between dietary components and drugs that cause drug toxicity



Diet-Drug Interactions (cont’d.)

• Examples listed in Table 14-7• Drug effects on food intake

– Make food intake difficult or unpleasant– Persistent drug effects may require other

medications• Antinauseants and antiemetics

– Stimulate appetite and cause unintentional weight gain




• Drug effects on nutrient absorption– Widespread nutrient malabsorption

• Upset GI function or damage intestinal mucosa• Antineoplastic and antiretroviral drugs

– Drug-nutrient binding: prevents absorption• Bile acid binders, tetracycline, ciprofloxacin, etc.

– Altered stomach acidity• Reduced acidity impairs absorption of vitamin B12,

folate, and iron




• Drug effects on nutrient absorption– Direct inhibition: interference with nutrient

transport into mucosal cells• Proloprim, Daraprim, colchicine, etc.

• Dietary effects on drug absorption– Stomach-emptying rate

• Empty stomach ► drug reaches small intestine more quickly

• Slow emptying may enhance drug absorption




• Dietary effects on drug absorption– Stomach acidity

• Some drugs absorbed better in acidic environment; some in alkaline conditions

– Interactions between drugs and dietary components

• Dietary substances bind to drugs and inhibit absorption

• Fiber interferes with absorption of tricyclic antidepressants




• Drug effects on nutrient metabolism– Drugs and nutrients share similar enzyme

systems in the small intestine and liver• Some drugs enhance or inhibit the activities of

enzymes needed for nutrient metabolism– Anticonvulsants (phenobarbital, phenytoin)– Methotrexate and folate– Isoniazid and vitamin B6



Folate and Methotrexate




• Dietary effects on drug metabolism– Some food components alter the activities of

enzymes that metabolize drugs – Some counteract drug effects in other ways– Effects of grapefruit juice– Vitamin K interaction with warfarin

(Coumadin)






• Drug effects on nutrient excretion– Increased urine production

• May reduce nutrient reabsorption in the kidneys• Diuretics

– Sodium and water retention with increased potassium excretion

• Corticosteroids




• Dietary effects on drug excretion– Inadequate excretion of medications

• Toxicity– Excessive losses

• Reduce drug availability for therapeutic effect– Consistent sodium intake needed when taking

lithium– Urine acidity affects excretion of quinidine




• Drug-nutrient interactions and toxicity– Interactions may:

• Cause toxicity• Intensify a drug’s side effects

– Tyramine (food component) + monoamine oxidase (MAO) inhibitors can be fatal

• Box 14-4 offers diet-drug interaction prevention strategies




Nutrition in Practice: Complementary and Alternative Therapies

• Nearly 40% of U.S. adults use CAM• Alternative medical systems

– Naturopathic medicine, homeopathic medicine, traditional Chinese medicine (TCM)

• Mind-body interventions– Biofeedback training, meditation

• Biologically based therapies– Herbal products, other supplements



Nutrition in Practice: Complementary and Alternative Therapies (cont’d.)

• Manipulative interventions– Chiropractic, massage therapy

• “Energy” therapies– Biofield therapies; bioelectrical or

bioelectromagnetic therapies• Safety and effectiveness of CAM

– Potential dangers• Patient counseling


Education

Chapter 14 Nutrition Intervention and Diert-Drug Interactions