Nutrition (eBook)

Carolyn Best is a Nutrition Nurse Specialist at Royal Hampshire County Hospital, Winchester, UK.

Nutrition: A Handbook for Nurses 1
Contents 7
Contributors 13
Preface 15
Introduction 17
Chapter 1: National and European Initiatives to Improve Standards of Nutritional Care 19
Introduction 19
National and European initiatives 1990–2007 20
Conclusion 37
References 37
Chapter 2: Malnutrition 41
Introduction 41
What is malnutrition? 41
Signs and consequences of malnutrition 44
Specific vitamin and mineral deficiencies 48
Management of malnutrition 53
Nutrition support 54
Recognising and managing malnutrition in obese patients 56
Conclusion 57
References 57
Chapter 3: Nutrition Screening and Assessment 59
Introduction 59
Nutrition screening 59
Nutrition assessment 62
Screening tools 69
Documentation 71
When to refer to a dietitian 71
Conclusion 72
References 72
Further reading 73
Chapter 4: The Nursing Role in Maintaining Patients’ Oral Nutritional Intake 75
Introduction 75
Identifying the problems 76
Registered nurse responsibilities in patient nutrition 77
The responsibilities of the healthcare assistant 82
Roles and responsibilities of other individuals involved in patient nutrition 82
The patient in hospital 85
Recommendations to improve patient intake 86
Safety considerations when assisting a patient to eat 88
Helping the dysphagic patient to eat 89
Effects of dementia on oral nutritional intake 90
Red trays 92
Protected mealtimes 92
Recording food intake 94
Use of specialised equipment 95
Educating healthcare workers to assist patients with their meals 96
References 97
Chapter 5: Enteral Nutrition 99
Introduction 99
Oral nutrition support 100
Options for enteral tube feeding: short-term feeding 104
Options for enteral tube feeding: long-term feeding 116
Enteral tube feeds 133
Drug administration through an enteral feeding tube 138
Flushing enteral feeding tubes 142
Conclusion 143
References 144
Chapter 6: Parenteral Nutrition 147
Introduction 147
Indications of parenteral nutrition 149
Clinical assessment of the patient requiring parenteral nutrition 150
Routes for intravenous access 152
Types of central venous catheter 153
Non-central access options 156
Multi-lumen vs single-lumen catheters 157
Confirming central venous catheter tip position 157
Using a previously used central venous catheter 157
Aftercare of line and insertion site 158
Dressing changes 159
Observations 161
Flushing following insertion 162
Estimating nutritional requirements 162
Biochemical and haematological assessment 163
Preparations available 164
Nutritional content of parenteral nutrition 164
Allergies to components of parenteral nutrition 166
Drug therapy that may affect nutrition support 166
Care of parenteral nutrition before administration 167
Mode of delivery: continuous or cyclical administration 169
Administration of medication through a central venous catheter 169
Should an in-line filter be used? 169
Maintaining catheter patency 170
Patient monitoring 170
Complications associated with the administration of parenteral nutrition 173
Discontinuing parenteral nutrition 178
Removal of a central venous catheter 179
The role of non-medical prescribing in parenteral nutrition 179
Conclusion 180
References 180
Further reading 183
Chapter 7: Re-Feeding Syndrome 185
Introduction 185
The process of starvation 186
Incidence of re-feeding syndrome 187
Impact on the patient 188
Summary of electrolyte disturbances 195
Reducing the risk of re-feeding syndrome 195
Ward checklist for re-feeding syndrome 197
Conclusion 198
References 198
Chapter 8: Ethics and Commitment to Feed 201
Introduction 201
Benefits vs burden 203
Informed consent 203
Decision-making in the competent patient 204
Decision-making in the non-competent patient 205
Best interests 206
Advanced directives 207
Power of attorney 208
Percutaneous endoscopic gastrostomy feeding in advanced dementia 208
Persistent vegetative state 210
Withdrawing nutrition support 210
Conclusion 211
References 212
Further reading 213
Chapter 9: The Role of a Hospital Nutrition Support Team 215
Introduction 215
Roles within the team 217
Individual roles within the core team 217
Getting started: developing the Nutrition Support Team 226
Agreeing the referral process 227
Developing skills within the Nutrition Support Team 228
Maintaining momentum 228
Agreeing standards for practice 229
Proving the worth of the Nutrition Support Team 231
The role of the Nutrition Steering Committee 233
Conclusion 234
References 234
Chapter 10: Transfer of Care from Hospital to Community 237
Introduction 237
Planning discharge 237
Education 238
Training required 239
Equipment required for discharge 240
The review process 240
Potential problems 244
Conclusion 247
References 247
Further reading 248
Support group details 248
Chapter 11: Case Studies 249
Introduction 249
Enteral nutrition 249
Combined enteral/parenteral nutrition 261
Parenteral nutrition 264
References 271
Glossary and Abbreviations 273
Index 283