Chapter 14 Nutrition Intervention and Diert-Drug Interactions

1414
Nutrition
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

Chapter 14 Nutrition Intervention and Diert-Drug Interactions

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