The Importance of Nutrition

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The Importance of Nutrition

• Department of Nutrition and Dietetics
• Laura Haigh

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Aims of the presentation

• Help your understanding of
• Malnutrition and its consequences
• Factors that influence nutritional needs
• The role of the dietitian
• Ward level activities to improve nutritional
  intake
• Importance of monitoring nutritional parameters
  e.g. weight

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Malnutrition?

• What is malnutrition?
• Malnutrition imbalance between nutritional
  intake and nutritional requirements.
• Malnutrition in the UK costs in excess of 7.3
  billion
• Who is at risk of malnutrition?
• A malnourished patient can ? their length of stay
  in hospital by 50
• 75 of patients may ? weight during admission
• A large proportion of patients are at risk
• Auxiliary nurses play a very important role in
  the provision of nutritional care

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Why might patients become undernourished?

• Decreased food intake
• Increased nutritional/energy requirements
• Decreased nutrient absorption (diseases affecting
  the gastro-intestinal tract)

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What are the consequences of malnutrition?

• ? Illness
• ? Reduced food intake
• ? Reduced muscle strength
• ? Decreased mobility
• ? Impaired immunity
• ? Susceptibility to wound/chest infection
• ? Apathy
• ? Depression

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Identifying patients at nutritional risk

• Nutritional screening
• Identifies patients who are or at risk of
  becoming undernourished
• Action plan
• 1. identifies appropriate strategies of care
• 2. identifies responsibilities for care
• Not all patients identified as being at risk
  require being seen by a dietitian

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Role of the dietitian

• The dietitian is an expert in nutrition
• Assess more high risk patients
• Assess nutritional status (ABCD)
• Estimate nutritional requirements
• Give appropriate nutritional advice
• Request prescription products if appropriate
• Discuss care plans with multi disciplinary teams
  to ensure implementation

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Catering system

• Dietitians will inform nursing staff of specific
  dietary requirements
• Speech and Language Therapist will inform nursing
  staff on appropriate texture modified diet
• All meals are ordered by nursing staff
• Fortified foods and additional snacks can be
  arranged via the dietitian

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Benefits of Nutritional Support

• Patient Benefits
• ? Length of stay
• ? Rehab time
• ? Mortality
• ? Quality of life

• NHS Benefits
• Cost savings

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Your role in preventing undernutrition

• Think about your job how much time do you spend
  doing food related activities?
• Request Nursing Staff complete Nutritional
  Screening Tool
• Weighing patients
• Completing menu cards
• Food record charts
• Advising on appropriate food choices
• Food fortifying
• Meal Provision

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Why weigh?

• Weight is an essential component of assessing
  nutritional status
• Weight history highlights changes of significance
• Unexplained weight loss should be investigated

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How should weights should be obtained?

• Weekly weights (unless otherwise instructed)
• Obtain using the same scales preferably
• Ensure patient wearing similar clothing
• Weights should be recorded in the nursing or
  medical notes
• If weight has significantly changed
• Re-check the weight
• Inform the named nurse if concerned

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Completing menu cards

• Are menu choices appropriate?
• Clarify likes/dislikes
• Observe physical limitations which may impact
  intake
• Offer assistance if required
• Offer encouragement

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How to Complete Food Record Charts
Breakfast Mid-morning Lunch Mid-afternoon Evening meal Supper
Ideal way ½ bowl porridge Full cup of orange juice All Fortisip All tea biscuit All soup ½ portion of mince potatoes Glass of milk ¼ Fortisip Refused tea biscuit Refused main meal Ate full high protein custard ¾ glass of milk Cup of tea 1 slice of toast
Wrong way Some porridge Biscuit Soup Main meal Enlive Custard Tea Toast
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Methods of providing Nutritional Support

• Appropriate food choices/? no. of meals/snacks
• Fortify foods to ? their nutritional value
• Provide supplement drinks
• Enteral nutrition
• Parenteral nutrition

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Appropriate food choices

• British Nutrition Foundation (2007)

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Food Fortification

• Full fat or sugar products
• Add extra butter, cheese, full cream milk, cream
• Add sugar or preserves
• Food fortification with Procal, Build Up,
  Calogen, Fortisip or Fortijuice

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Nutritional Supplements

• Some can not meet their nutritional needs through
  oral diet alone
• Supplement drinks may be indicated
• Prescription products
• should only be given to patients as directed by
  medical or dietetic staff

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Nutritional Supplements

• Always check the best before date
• Offer between or after meals
• Offer chilled or at room temperature
• Ask about flavour preference
• Offer encouragement

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Nutrition Support cont..

• Some can not meet nutritional requirements
• ? enteral or parenteral feeding may be initiated
• Provision of these forms of nutrition are carried
  out by trained nursing staff

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Check List

• Request Nursing Staff complete Nutritional
  Screening Tool
• Weighing patients
• Appropriate meal provision
• 1. Completing menu cards
• 2. Supervising on appropriate food choices
• 3. Food fortifying
• 4. Assistance offered if required
• 5. Suitable position for food consumption
• 6. Appropriate cutlery
• Food record charts

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Thank you

• Any Questions?
• Any Questions?
• Any Questions?