Nutrition

Carolyn  Best is a Nutrition Nurse Specialist at Royal Hampshire County Hospital, Winchester, UK.

• Contributors. Preface.Introduction.1 National and European Initiatives to Improve Standards of Nutritional Care (Carolyn Best).Introduction.National and European initiatives 1990–2007.2 Malnutrition (Harriet Gordon and Helen Hitchings).Introduction.What is malnutrition?Signs and consequences of malnutrition.Specific vitamin and mineral deficiencies.Management of malnutrition.Nutrition support.Recognising and managing malnutrition in obese patients.3 Nutrition Screening and Assessment (Helen Hitchings).Introduction.Nutrition screening.Nutrition assessment. Screening tools.Documentation.When to refer to a dietitian.4 The Nursing Role in Maintaining Patients’ Oral Nutritional Intake (Carolyn Best).Introduction.Identifying the problems.Registered nurse responsibilities in patient nutrition.The responsibilities of the healthcare assistant.Roles and responsibilities of other individuals involved in patient nutrition.The patient in hospital.Recommendations to improve patient intake.Safety considerations when assisting a patient to eat.Helping the dysphagic patient to eat.Effects of dementia on oral nutritional intake.Red trays.Protected mealtimes.Recording food intake.Use of specialised equipment.Educating healthcare workers to assist patients with their meals.5 Enteral Nutrition (Carolyn Best, Helen Hitchings, Joanna Boult and Harriet Gordon).Introduction.Oral nutrition support.Options for enteral tube feeding: short-term feeding.Options for enteral tube feeding: long-term feeding.Enteral tube feeds.Drug administration through an enteral feeding tube.Flushing enteral feeding tubes.6 Parenteral Nutrition (Carolyn Best, Helen Hitchings, Joanna Boult and  Harriet Gordon). Introduction.Indications of parenteral nutrition.Clinical assessment of the patient requiring parenteral nutrition.Routes for intravenous accessTypes of central venous catheter.Non-central access options.Multi-lumen vs single-lumen catheters.Confirming central venous catheter tip position.Using a previously used central venous catheter.Aftercare of line and insertion site.Dressing changes.Observations.Flushing following insertion.Estimating nutritional requirements.Biochemical and haematological assessment.Preparations available.Nutritional content of parenteral nutrition.Allergies to components of parenteral nutrition.Drug therapy that may affect nutrition support.Care of parenteral nutrition before administration.Mode of delivery: continuous or cyclical administration.Administration of medication through a central venous catheter.Should an in-line filter be used?Maintaining catheter patency.Patient monitoring.Complications associated with the administration of parenteral nutrition.Discontinuing parenteral nutrition.Removal of a central venous catheter.The role of non-medical prescribing in parenteral nutrition.7 Re-feeding Syndrome (Helen Hitchings and Harriet Gordon).Introduction.The process of starvation.Incidence of re-feeding syndrome.Impact on the patient.Summary of electrolyte disturbances.Reducing the risk of re-feeding syndrome.Ward checklist for re-feeding syndrome.8 Ethics and Commitment to Feed (Carolyn Best).Introduction.Benefits vs burden.Informed consent.Decision-making in the competent patient.Decision-making in the non-competent patient.Best interests.Advanced directives.Power of attorney.Percutaneous endoscopic gastrostomy feeding in advanced dementia.Persistent vegetative state.Withdrawing nutrition support.9 The Role of a Hospital Nutrition Support Team (Carolyn Best, Helen Hitchings, Joanna Boult and Harriet Gordon).Introduction.Roles within the team.Individual roles within the core team.Getting started: developing the Nutrition Support Team.Agreeing the referral process.Developing skills within the Nutrition Support Team.Maintaining momentum.Agreeing standards for practice.Proving the worth of the Nutrition Support Team.The role of the Nutrition Steering Committee.10 Transfer of Care from Hospital to Community(Carolyn Best and Helen Hitchings). Introduction.Planning discharge.Education.Training required.Equipment required for discharge.The review process.Potential problems.Further reading.Support group details.11 Case Studies (Harriet Gordon, Carolyn Best, Helen Hitchings and Joanna Boult).Introduction.Enteral nutrition.Combined enteral/parenteral nutrition.Parenteral nutrition.References.Glossary and Abbreviations.Index.