Hospital Nutrition Management

by Michael_Koger

Malnutrition in hospitals can occur in a variety of ways, but careful management will reverse it.

Poor nutritional status in hospitalized patients may be present upon admission, or the client can develop it during the hospital course. It may happen in those who are not able to chew or swallow. Some patients will lose their appetite because of the illness. There are also interactions between certain medications to treat diseases, and these may create an imbalance in the body’s nutrients [3].

Many inpatients undergo procedures, whether major or minor surgery, or other diagnostic studies. In general, the staff will withhold food the night before in order to ensure a smooth examination or to prevent the patient from regurgitation or other gastrointestinal issues during surgery. Unless some food intake resumes shortly after the procedure, the patient becomes at risk for metabolic imbalance and malnutrition [3].

Medical Predisposition

Medical conditions such as intestinal obstruction, ileus, peritonitis, malabsorption, diarrhea, and intractable vomiting can quickly lead to an imbalance in the human body.  The same is true for high output enterocutaneous fistulae, intestinal ischemia, severe shock, and fulminant sepsis.  In these instances, it may be necessary to feed the patient via parenteral nutrition [1, 2].

It is also possible to deliver food and nutrients to a patient through nasogastric tube, gastrostomy feeding tube, or oral nutrition supplementation.  The method of choice will, of course, depend on the patient’s ability to receive artificial nutrition and his or her metabolic situation [2, 3].

Refeeding Syndrome

Despite the seriousness of nutritional imbalance, it is important that the staff not administer too much food for these clients.  The danger is that excessive replacement of nutrients can lead to severe fluid and electrolyte disturbances in the human body.  This may affect major organs systems and result in death.  The term for this is refeeding syndrome [1].

Refeeding syndrome may especially occur in patients with advanced age, cancer, alcohol dependence, diuretic therapy, chronic malnutrition or fasting, malabsorption, and postoperative status.  For these cases, in which the risk of refeeding is high, the recommendation is to replace vitamins during the first several days of artificial nutrition administration.  Moreover, since these metabolic problems can generate irregular rhythms of the heart, continuous cardiac monitoring is often advisable [1].

Conclusion

Attention to the nutritional status of every inpatient is essential.  Hospital staff must also keep abreast of malnutrition detection and management as it can become a life-threatening scenario.

References

  1. Kirkland, L., Kashiwagi, D., Brantley, S. et al.  (2012).  Nutrition in the hospitalized patient.  Journal of Hospital Medicine, 8, 52-58.
  2. Seron-Arbeloa, C., Zamora-Elson, M., Labarta-Monzon, L. and Mallor-Bonet, T.  (2013).  Enteral nutrition in critical care.  Journal of Clinical Medicine Research, 5, 1-11.
  3. Tappenden, K., Quatrara, B., Parkhurst, M. et al.  (2013).  Critical role of nutrition in improving quality of care:  an interdisciplinary call to action to address adult hospital malnutrition.  Journal of Parenteral and Enteral Nutrition, 37, 482-497.
  4. The photograph shows lower extremities of a patient with multiple vitamin deficiencies and skin changes as a result.  Reprinted with permission from Centers for Disease Control.

Disclaimer

The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 01/08/2014, Michael_Koger
 
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