Nutrition Intervention and Food-Drug Interactions

1. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Nutrition Intervention
and Food-Drug
Interactions
Chapter 14

2. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Implementing Nutrition Care
• Nutrition interventions (Table 14-1)
– Food and/or nutrient delivery
– Nutrition education
– Nutrition counseling
– Coordination of nutrition care

3. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Implementing Nutrition Care (cont’d.)
• Incorporating nutrition care into the
nursing care plan (Table 14-2)
– Nursing process
• Assessment
• Nursing diagnosis
• Outcome identification
• Planning
• Implementation
• Evaluation

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DeBruyne ■ Pinna © Cengage Learning 2014
Implementing Nutrition Care (cont’d.)
• Approaches to nutrition care
– Long-term nutrition intervention
• Plan must consider: current food practices,
lifestyle, and degree of motivation
– Implementing long-term dietary changes
• 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

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DeBruyne ■ Pinna © Cengage Learning 2014
Implementing Nutrition Care (cont’d.)
• Approaches to nutrition care
– Nutrition education
• Allows patients to learn about the dietary factors:
specific to their particular medical condition
• Considerations: person’s age, literacy level, and
cultural background; learning style; etc.
• Follow-up care: relevant outcome measures
– Case Study – Implementing Nutrition Care

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DeBruyne ■ Pinna © Cengage Learning 2014
Dietary Modifications
• Energy intakes in hospital patients
– Resting metabolic rate (RMR): typically
calculated by clinicians
– RMR: adjusted for “stress factors”
• Activity level factor may be applied

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DeBruyne ■ Pinna © Cengage Learning 2014

8. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Dietary Modifications (cont’d.)
• Energy intakes in hospital patients
– “How To” Estimate Appropriate Energy
Intakes for Hospital Patients
– Indirect calorimetry
• Procedure that estimates energy expenditure by
measuring oxygen consumption and carbon
dioxide production during a period of rest

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DeBruyne ■ Pinna © Cengage Learning 2014
Dietary Modifications (cont’d.)
• Modified (therapeutic) diets
– Contain foods altered in texture, consistency,
or nutrient content: include or omit specific
foods
– Reasons for modified diet
• Correct malnutrition
• Relieve disease symptoms
• Reduce the risk of developing complications

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DeBruyne ■ Pinna © Cengage Learning 2014
Dietary Modifications (cont’d.)
• Modified diets (Table 14-4)
– Mechanically altered diets (Table 14-5)
• Beneficial for individuals who have difficulty
chewing or swallowing
• Why are dysphagia diets highly individualized?

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Dietary Modifications (cont’d.)
• Modified diets
– Blenderized liquid diet
• Foods available from all four food groups
– Clear liquid diet
• Clear fluids and foods: liquid at body temperature
• Leaves minimal residue in the colon
– Fat-restricted diet
• Why is it important to avoid being too restrictive?

12. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014

13. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014

14. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Dietary Modifications (cont’d.)
• Modified diets
– Low-fiber diet
• Why is long-term fiber restriction discouraged?
– Low-sodium diet
• Prevent or correct fluid retention
• Typically 2000 or 3000 milligrams daily

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Dietary Modifications (cont’d.)
• Modified diets (Table 14-6)
– High-kcalorie, high-protein diet
• Increase kcalorie and protein intakes: patients with
high requirements or eating poorly

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DeBruyne ■ Pinna © Cengage Learning 2014
Dietary Modifications (cont’d.)
• Variations in the diet order
– Physician: 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
– What is the NPO (non per os) order?

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Dietary Modifications (cont’d.)
• Variations in the diet order
– Alternative feeding routes
• Tube feedings: directly into the stomach or
intestine
• Parenteral nutrition: nutrient solutions supplied
intravenously

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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?

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Foodservice (cont’d.)
• Food selection
– Other amenities
• Room-service, cook-to-order system: expanded
choices
• Extended food delivery hours

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DeBruyne ■ Pinna © Cengage Learning 2014
Foodservice (cont’d.)
• Hazard Analysis and Critical Control
Points (HACCP) program
– Addresses food handling, cooking, and
storage procedures; cleaning and disinfecting
of utensils, surfaces, and equipment; and staff
sanitation issues

21. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Foodservice (cont’d.)
• Improving food intake
– Patient’s room: calm and quiet during meals
– Engage patient in identifying most enjoyable
foods
– Place occasional “surprise” on the tray, e.g.,
decoration
– “How To” Help Hospital Patients Improve
Their Food Intakes

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Diet-Drug Interactions
• Categories
– Drugs altering food intake 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 causing drug toxicity

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DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• Examples of diet-drug interactions (Table
14-7)
• Drug effects on food intake
– Making food intake difficult or unpleasant
– Persistent complications: may require other
medications
• Antinauseants and antiemetics
– Stimulating appetite: unintentional weight gain

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DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• Drug effects on nutrient absorption
– Widespread nutrient malabsorption
• Upset gastrointestinal function or damage the
intestinal mucosa
• Antineoplastic and antiretroviral drugs
– Drug-nutrient binding: prevent absorption
• Bile acid binders, tetracycline, ciprofloxacin, etc.
– Drugs for reducing stomach acidity
• Impair absorption of vitamin B12, folate, and iron

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DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• Drug effects on nutrient absorption
– 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

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DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• Dietary effects on drug absorption
– Stomach acidity
• Some drugs absorbed better in acidic environment;
some in alkaline conditions
– Interactions with dietary components
• Dietary substances: bind to drugs and inhibit
absorption
• Phytates bind to digoxin; fiber interferes with
absorption of tricyclic antidepressants; etc.

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DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• 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

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DeBruyne ■ Pinna © Cengage Learning 2014

29. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• Dietary effects on drug metabolism
– Some food components
• Alter the activities of enzymes that metabolize
drugs or may counteract drug effects in other ways
– Effects of grapefruit juice
– Vitamin K interaction with Coumadin

30. Nutrition for Health and Health Care, 5th Edition
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31. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014

32. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• 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

33. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• 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: excretion of quinidine

34. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014
Diet-Drug Interactions (cont’d.)
• Drug-nutrient interactions and toxicity
– Interactions between food components and
drugs
• Causing toxicity
• Intensifying a drug’s side effects
– Tyramine (food component) and monoamine
oxidase (MAO) inhibitors: can be fatal
• “How To” Prevent Diet-Drug Interactions

35. Nutrition for Health and Health Care, 5th Edition
DeBruyne ■ Pinna © Cengage Learning 2014