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Optimizing Nutrition Therapy

Optimizing Nutrition Therapy. Prevalence of Malnutrition. Malnutrition occurs frequently in hospitalized patients. It is associated with:. Increased complications Prolonged length of stay Higher hospital costs Increased mortality. Nutritional Screening and Assessment.

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Optimizing Nutrition Therapy

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  1. Optimizing Nutrition Therapy

  2. Prevalence of Malnutrition Malnutrition occurs frequently in hospitalized patients. It is associated with: • Increased complications • Prolonged length of stay • Higher hospital costs • Increased mortality

  3. Nutritional Screening and Assessment • Screening identifies and classifies patients at risk for malnutrition • Assessment – evaluates nutritional status – biochemical parameters – anthropometric measurements – Subjective Global Assessment (SGA)

  4. Early Detection of Malnutrition Patients at risk: History of chronic diseases Psychiatric disorders Gastrointestinal diseases Chronic renal insufficiency Impaired immune function Cancer Diabetes Elderly Chronic renal failure COPD

  5. Normal Energy Metabolism and Nutritional Needs • Nutrients are necessary to sustain life • The utilization of nutrients depends on availability (fasting) and the inflammatory response (stress) • Energy requirements vary according to clinical condition • Caloric distribution varies according to metabolic status

  6. Metabolic Response to Starvation and Trauma: Nutritional Requirements • The metabolic response to starvation is an adaptive mechanism • Nutritional needs increase in trauma

  7. Nutritional Requirements • Energy – Harris-Benedict Equation x stress factor – “Rule of thumb”: 25 – 30 kcal/kg BW – Indirect calorimetry • Protein – Stable patients: 0.8 – 1.0 g/kg BW – Stressed patients: 1.2 – 2.0 g/kg BW

  8. Nutritional Requirements • Lipids – Stable patient: 25% – 30% of calories – Stressed patient: 20% – 35% of calories • Carbohydrates – Stable patient: 50% – 65% of calories • Diabetes mellitus, hyperglycemia, COPD, hypercapnia, may benefit from – carbohydrates (about 30% of calories) –  lipids (about 50% of calories)

  9. Nutritional Requirements • Vitamins and Minerals – Stable patient: 100% daily recommended intake – Stressed patient: 100% daily recommended intake, (COPD, cancer, antioxidants critical care) – Hepatic patient: BCAA,B Vitamins,  folate Na, Cu, Fe, Mn – Renal failure: Na, K, CI, PO4, Vitamin A – HIV/AIDS: antioxidants, Vitamins B6, B12

  10. Early Intervention as Part of Initial Care • Enteral Nutrition • Oral supplements • Tube feeding • Parenteral Nutrition • Total • Peripheral “If the gut works, use it!”

  11. Parenteral Nutrition • Supplies partial or total nutrition through venous access • Supplies practically all essential nutrients • Metabolic monitoring and changes in solution components are needed to maintain metabolic balance

  12. Benefits of Enteral Nutrition Therapy • Maintains GI tract structure and function • Enhances intestinal immune function • Reduces bacterial translocation • Decreases risk of sepsis • Fewer complications than with parenteral nutrition • Lower costs

  13. Improved Patient Outcomes • Improved wound healing • Decreased risk of complications – Nosocomial infection • Decreased length of stay • Decreased healthcare costs

  14. Barriers to Nutritional Intervention • Lack of physician awareness • Limited physician knowledge of nutrition therapy • Minimal support from administration

  15. Lack of Physician Awareness • Physicians consider this the responsibility of other professionals • Nutritional assessment not included by physician as part of the initial history and physical • Only considered important when severe malnutrition is evident • Nutritional evaluation could be included in patient history and physical exam with minimal effort

  16. Lack of Administrator’s Awareness Administrator’s lack the knowledge of the positive impact that nutrition therapy can have on patient care and in reducing hospital costs.

  17. Goals of the TNT Program • Improve patient care • Give physicians the knowledge to prevent and manage nutrition-related problems. Teach them how to do this early, safely and efficiently.

  18. TNT Program: Next Steps • Screening – Establish a nutritional screening and assessment program • Standards – Develop guidelines and standards of care for nutrition therapy • Intervention – Promote early nutrition therapy

  19. TNT Program: Next Steps • Education – Raise awareness and increase knowledge of healthcare team members on importance of nutrition therapy • Research – Collect data on the incidence of malnutrition and positive clinical outcomes of nutritional intervention

  20. CONGRATULATIONS! TNT was sponsored by Abbott Laboratories

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