The document discusses nutrition, including the importance of food and nutrients for human health and well-being. It describes the components of nutrition, such as carbohydrates, proteins, fats, vitamins, minerals and water, and how nutritional needs can be affected by factors like appetite, medical conditions, and socioeconomic status. The assessment and management of nutritional status is also covered, including diagnostic tests, special diets, enteral nutrition support, and strategies to improve nutritional intake.
Diet does not substitute drugs but it is considered a complementary therapy.
The goals of dietary advice are:
To prevent or manage some medical conditions
To maintain or improve health through the use of appropriate and healthy food choices
To achieve and maintain optimal metabolic and physiological outcome
Age:
During the growth period, the BMR is high, therefore during infancy the energy need per Kg of body weight is highest than during adulthood.
The period at which the basal metabolism reaches its highest level is between the ages of 1-2 years.
A gradual decline occurs between the age of 2-5 years, with a more rapid decline until adult age.
Sex:
The BMR is higher in adolescent boys and adult males as compared to adolescent girls and adult females though it is not due to direct influence of sex differences, but are due to the differences in body composition.
Males have a greater amount of muscles and glandular tissues which is metabolically more active whereas, females have greater adipose tissues which is metabolically less active, Hence energy requirement of males is higher than of females.
Diet does not substitute drugs but it is considered a complementary therapy.
The goals of dietary advice are:
To prevent or manage some medical conditions
To maintain or improve health through the use of appropriate and healthy food choices
To achieve and maintain optimal metabolic and physiological outcome
Age:
During the growth period, the BMR is high, therefore during infancy the energy need per Kg of body weight is highest than during adulthood.
The period at which the basal metabolism reaches its highest level is between the ages of 1-2 years.
A gradual decline occurs between the age of 2-5 years, with a more rapid decline until adult age.
Sex:
The BMR is higher in adolescent boys and adult males as compared to adolescent girls and adult females though it is not due to direct influence of sex differences, but are due to the differences in body composition.
Males have a greater amount of muscles and glandular tissues which is metabolically more active whereas, females have greater adipose tissues which is metabolically less active, Hence energy requirement of males is higher than of females.
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
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Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
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ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
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Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
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Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. NUTRITION
Nutrition is the science of food and
nutrients and it includes the process of
utilizing it by the humans
3. IMPORTANCE
– Food is one of the fundamental needs of all
living organisms
– Food is important for human beings through
out wellness-illness continuum
– Diet therapy is a major treatment for disease
control (Eg: HTN , DM)
4. NUTRITIONAL STATUS
Is the state of body resulting from the use
of nutrients available in the body
• Food is composed of nutrients necessary for
the body process and functions
– Carbohydrates Macronutrients
– Proteins
– Fats
– Vitamins and minerals
– Water Micronutrients
7. Factors affecting nutritional needs
• Anorexia :loss of appetite
• Psychosocial problems:
(Fear ,Anxiety, Depression and Pain)
• Problems in the sense of smell and taste
• Secondary effects of drug therapy or treatment
• Patient with difficulty in swallowing and chewing
• Chronic GI problems
• Post-operative patients
• Patient from low socioeconomic status
• Certain beliefs of patients
8. Factors affecting nutritional intake
• Decreased food intake
– Anorexia
– Psychosocial factors
– Impaired ability to smell and taste
– Can develop secondary effect to drug therapy or
medical treatments
– Swallowing difficulty
– GI problems
– Surgery
– Poverty
– Consciousness
21. Signs of poor nutrition
• Hair : thin, coarse, lacking luster, breaks easily.
• Skin : excessive bruising, bleeding, pressure
sores, poor wound healing.
• Muscles : wasting, lack of growth
• Skeletal : poor posture, painful joints, bowed
legs, increase in bone fracture
• Mental: confusion, motor weakness
22. Diagnosing
• Imbalanced Nutrition: More Than
Body Requirements
• Imbalanced Nutrition: Less Than
Body Requirements
• Readiness for Enhanced Nutrition
• Risk for Imbalanced Nutrition: More
Than Body Requirements
23. Diagnosing
• Diagnostic label used as etiology
– Activity Intolerance
– Constipation
– Low Self-Esteem
– Risk for Infection
24. Planning
• Maintain or restore optimal
nutritional status
• Promote healthy nutritional practices
• Prevent complications associated
with malnutrition
• Decrease weight or regain specified
weight
25. Planning
• Planning for home care
– Provide aid with eating, purchasing
food, and preparing meals
– Instruct about nutrition therapy
– Assess client and family's abilities for
self-care, financial resources, and need
for referrals
26. Implementing
• Hospitalized client
– Provided in collaboration with the
primary care provider and the dietitian
– Reinforce information presented by
dietitian
– Create an atmosphere that encourages
eating
– Provide and assist with eating as
needed
continued on next slide
27. Implementing
• Hospitalized client
– Monitor the client's appetite and food
intake
– Administer enteral and parenteral
feedings
– Consult with primary care provider and
dietitian about nutritional problems
28. Implementing
• Assisting with special diets
– Altered diets used to treat disease,
increase/decrease weight, restore
nutritional deficit, allow organ to
rest/heal
– Diets modified in texture, kilocalories,
specific nutrients, seasonings,
consistency
continued on next slide
29. Implementing
• special diets
– Clear liquid diet
• Fluid and carbohydrates
• No adequate protein, fat, vitamins,
minerals, calories
– Full liquid diet
• Liquids or foods that turn liquid at body
temperature
• Clients with GI disturbances
continued on next slide
30. Implementing
• special diets
– Soft diet
• Low residue (low-fiber)
– Diet as tolerated
• Advance the diet if the patient is responding
as expected
continued on next slide
31. Implementing
• Assisting with special diets
– Modification for disease
• Altered metabolism
• Diabetic diet is a lifetime diet.
– Dysphagia
• Older clients, clients with cancer
• Nurses may be first to detect.
• Levels of liquid foods are thin, nectar-like,
honey-like, and spoon-thick liquids
32. Implementing
• Stimulating the appetite
– Decrease in food intake often
accompanied by decrease in fluid
intake.
– Short-term decrease not a problem, but
over time it leads to nutritional
problems.
– Determine reason for lack of appetite,
then deal with problem
33. Implementing
• Assisting clients with meals
• Be sensitive to client's feelings of
embarrassment
• Help client to feed self
• Ask order in which client would like to eat
• Use normal utensils whenever possible
• Special community nutritional services
• Meals on Wheels
34. Implementing
• Enteral nutrition
– Enteral
• Through the GI system
– Enteral access devices
• Nasogastric tube
• Nasoenteric (nasointestinal) tube
• Gastrostomy and jejunostomy devices
continued on next slide