1
lOMoAR cPSD| 11763056
Nutrition In Nursing
Page 1 of 45
, lOMoAR cPSD| 11763056
CH 14(15 ON NOTES)
Feeding Patients: Hospital Food and Enteral and Parenteral Nutrition
** Up to 40% of hospitalized patients are malnorished
● Hospital food may be refused because
● It is unfamiliar
● Tasteless (e.g., cooked without salt)
● Inappropriate in texture (e.g., pureed meat)
● Religiously or culturally unacceptable
● Served at times when the patient is unaccustomed to eating
● Meals may be withheld or missed.
● Inadequate liquid diets may not be advanced in a timely manner.
● Giving the right food to the patient is one thing; getting the patient to eat (most of it) is
another.
Oral Diet
● Easiest and most preferred method of providing nutrition
● Oral diets may be categorized as
● “Regular”
● Modified consistency
● Therapeutic
● Normal, regular, and house diets
○ Regular diets are used to achieve or maintain optimal nutritional status.
○ Regular diets are adjusted to meet age-specific needs throughout the life cycle.
○ Diet as tolerated (DAT)
○
● Modified consistency diets
○ Modified consistency diets include
○ Clear liquid
○ Mechanically altered diets
○ Clear liquid diets may be used.
○ To maintain hydration during gastrointestinal illness
○ In preparation for bowel surgery or procedures
○ When oral intake resumes after a prolonged period
○ Most patients can tolerate a regular diet for their second postoperative meal.
●
○ Mechanically altered diets contain foods that are chopped, ground, pureed, or
soft.
○ Diets prepared in a blender provide food in liquid form.
○ Dysphagia (Difficulty to swallow) diets are another variation of modified
consistency diets.
● Therapeutic diets
○ Therapeutic diets differ from a regular diet.
○ Used for the purpose of preventing or treating disease or illness
● Nutritional supplements
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, lOMoAR cPSD| 11763056
○ Some patients are unable or unwilling to eat enough food to meet their
requirements
Categories of supplements include
■ Clear liquid supplements
■ Milk-based drinks
■ Prepared liquid supplements
■ Specially prepared foods
○ Liquid Supplements are:
■ Easy to consume
■ Are generally well accepted
■ Tend to leave the stomach quickly
■ A good choice for between-meal snacks
■ Allow the patient to taste test several options available
■ Explain the rationale for adding supplements and closely monitor
acceptance
■ Given on a rotation schedule
○ Modular Products
■ Less frequently used option for maximizing a patient’s oral intake
■ Generally composed of a single nutrient
■ Disadvantages
● Ineffective quality control (calculation errors)
● Bacterial contamination
● Higher costs than standard formulas
Enteral Nutrition
● A way of providing nutrition for patients who are unable to consume an adequate oral
intake but have at least a partially functional GI tract that is accessible and safe to use
● Enteral nutrition (EN) may augment an oral diet or may be the sole source of nutrition.
Patients who:
- Have problems chewing and swallowing
- Have prolonged lack of appetite
- Have an obstruction, fistula, or altered motility in the upper gastrointestinal tract
- Are in a coma
- Have very high nutrient requirements
● Contraindicated when the gastrointestinal tract is nonfunctional
● Patients who receive enteral nutrition experience less septic morbidity and fewer
infections and complications than patients who receive parenteral nutrition.
● Significantly less costly than parenteral nutrition
● Has not been proven to reduce the length of the hospital stay and improve mortality
○ More high-quality trials are needed.
■ Factors that influence how and what is used to feed patients enterally
include
■ The patient’s calorie and protein requirements
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, lOMoAR cPSD| 11763056
■ Ability to digest nutrients
■ Feeding route
■ Characteristics of the formula
■ Equipment available
■ Method of delivery
● Feeding route
○ Depends on the patient’s medical status and the anticipated length of time the
tube feeding will be used
○ Transnasal tubes
○ Nasogastric (NG) tube is the most common.
○ Generally used for tube feedings of relatively short duration
○ Ostomy feedings are preferred for permanent or long-term feedings.
○ Percutaneous endoscopic gastrostomy (PEG) tubes are placed with the aid of an
endoscope
● Formula characteristics
○ Formulary of various enteral products available within major categories
○ Are designed to provide complete nutrition
● Protein
○ Enteral formulas are classified by the type of protein they contain.
○ Standard formulas
○ Made from whole proteins or protein isolates
○ Provide 34 to 43 g protein/L
- Variations
- High in protein
- High in calories
- Fiber enriched
- Disease-specific formulas designed for patients with diabetes, immune system
dysfunction, renal failure, or respiratory insufficiency
● Hydrolyzed protein formulas
○ Completely hydrolyzed formulas contain only free amino acids as their source of
protein.
○ Partially hydrolyzed formulas contain proteins that are broken down.
○ Intended for patients with impaired digestion or absorption
○ Disease-specific formulas are available for liver failure, HIV/AIDS, and immune
system support.
● Calorie and nutrient density
○ Calorie density of a product determines the volume of formula needed.
○ Routine formulas provide 1.0 to 1.2 cal/mL.
○ High-calorie formulas provide 1.5 to 2.0 cal/mL.
○ Nutrient density
○ Varies among formulas
○ Ranges from 1000 to 1500 mL/day
● Water Content
○ Varies with the caloric concentration
Downloaded by GEOFREY GEOFFREY ()
lOMoAR cPSD| 11763056
Nutrition In Nursing
Page 1 of 45
, lOMoAR cPSD| 11763056
CH 14(15 ON NOTES)
Feeding Patients: Hospital Food and Enteral and Parenteral Nutrition
** Up to 40% of hospitalized patients are malnorished
● Hospital food may be refused because
● It is unfamiliar
● Tasteless (e.g., cooked without salt)
● Inappropriate in texture (e.g., pureed meat)
● Religiously or culturally unacceptable
● Served at times when the patient is unaccustomed to eating
● Meals may be withheld or missed.
● Inadequate liquid diets may not be advanced in a timely manner.
● Giving the right food to the patient is one thing; getting the patient to eat (most of it) is
another.
Oral Diet
● Easiest and most preferred method of providing nutrition
● Oral diets may be categorized as
● “Regular”
● Modified consistency
● Therapeutic
● Normal, regular, and house diets
○ Regular diets are used to achieve or maintain optimal nutritional status.
○ Regular diets are adjusted to meet age-specific needs throughout the life cycle.
○ Diet as tolerated (DAT)
○
● Modified consistency diets
○ Modified consistency diets include
○ Clear liquid
○ Mechanically altered diets
○ Clear liquid diets may be used.
○ To maintain hydration during gastrointestinal illness
○ In preparation for bowel surgery or procedures
○ When oral intake resumes after a prolonged period
○ Most patients can tolerate a regular diet for their second postoperative meal.
●
○ Mechanically altered diets contain foods that are chopped, ground, pureed, or
soft.
○ Diets prepared in a blender provide food in liquid form.
○ Dysphagia (Difficulty to swallow) diets are another variation of modified
consistency diets.
● Therapeutic diets
○ Therapeutic diets differ from a regular diet.
○ Used for the purpose of preventing or treating disease or illness
● Nutritional supplements
Downloaded by GEOFREY GEOFFREY ()
, lOMoAR cPSD| 11763056
○ Some patients are unable or unwilling to eat enough food to meet their
requirements
Categories of supplements include
■ Clear liquid supplements
■ Milk-based drinks
■ Prepared liquid supplements
■ Specially prepared foods
○ Liquid Supplements are:
■ Easy to consume
■ Are generally well accepted
■ Tend to leave the stomach quickly
■ A good choice for between-meal snacks
■ Allow the patient to taste test several options available
■ Explain the rationale for adding supplements and closely monitor
acceptance
■ Given on a rotation schedule
○ Modular Products
■ Less frequently used option for maximizing a patient’s oral intake
■ Generally composed of a single nutrient
■ Disadvantages
● Ineffective quality control (calculation errors)
● Bacterial contamination
● Higher costs than standard formulas
Enteral Nutrition
● A way of providing nutrition for patients who are unable to consume an adequate oral
intake but have at least a partially functional GI tract that is accessible and safe to use
● Enteral nutrition (EN) may augment an oral diet or may be the sole source of nutrition.
Patients who:
- Have problems chewing and swallowing
- Have prolonged lack of appetite
- Have an obstruction, fistula, or altered motility in the upper gastrointestinal tract
- Are in a coma
- Have very high nutrient requirements
● Contraindicated when the gastrointestinal tract is nonfunctional
● Patients who receive enteral nutrition experience less septic morbidity and fewer
infections and complications than patients who receive parenteral nutrition.
● Significantly less costly than parenteral nutrition
● Has not been proven to reduce the length of the hospital stay and improve mortality
○ More high-quality trials are needed.
■ Factors that influence how and what is used to feed patients enterally
include
■ The patient’s calorie and protein requirements
Downloaded by GEOFREY GEOFFREY ()
, lOMoAR cPSD| 11763056
■ Ability to digest nutrients
■ Feeding route
■ Characteristics of the formula
■ Equipment available
■ Method of delivery
● Feeding route
○ Depends on the patient’s medical status and the anticipated length of time the
tube feeding will be used
○ Transnasal tubes
○ Nasogastric (NG) tube is the most common.
○ Generally used for tube feedings of relatively short duration
○ Ostomy feedings are preferred for permanent or long-term feedings.
○ Percutaneous endoscopic gastrostomy (PEG) tubes are placed with the aid of an
endoscope
● Formula characteristics
○ Formulary of various enteral products available within major categories
○ Are designed to provide complete nutrition
● Protein
○ Enteral formulas are classified by the type of protein they contain.
○ Standard formulas
○ Made from whole proteins or protein isolates
○ Provide 34 to 43 g protein/L
- Variations
- High in protein
- High in calories
- Fiber enriched
- Disease-specific formulas designed for patients with diabetes, immune system
dysfunction, renal failure, or respiratory insufficiency
● Hydrolyzed protein formulas
○ Completely hydrolyzed formulas contain only free amino acids as their source of
protein.
○ Partially hydrolyzed formulas contain proteins that are broken down.
○ Intended for patients with impaired digestion or absorption
○ Disease-specific formulas are available for liver failure, HIV/AIDS, and immune
system support.
● Calorie and nutrient density
○ Calorie density of a product determines the volume of formula needed.
○ Routine formulas provide 1.0 to 1.2 cal/mL.
○ High-calorie formulas provide 1.5 to 2.0 cal/mL.
○ Nutrient density
○ Varies among formulas
○ Ranges from 1000 to 1500 mL/day
● Water Content
○ Varies with the caloric concentration
Downloaded by GEOFREY GEOFFREY ()
