ORAL NUTRITION SUPPORT
Oral nutrition support is
usually the cheapest, safest and most physiological method of providing
additional nutrition. At its simplest, the importance of eating to prevent
problems and to aid recovery should be explained to patients with encouragement
to eat all meals provided. Staff should also try to ensure that meals are not
missed through investigations or procedures unless absolutely necessary.
Needing to be nil by mouth for a gastroscopy is acceptable, but missing lunch
because the patient was off the ward for a chest X-ray is not.
If spontaneous intake is
felt to be inadequate, encouragement and help should be offered and records of
daily food, nutritious drinks and other fluid intake should be commenced. If
the problem then persists, dietetic advice should be sought. Some patients may
benefit from special menus, snacks and increased choice, and dietitians are in
an ideal position to explore these possibilities. Changing food consistency may
also lead to improved intake in some patients with swallowing difficulties.
Soft diets may help in
oesophageal structuring whereas thickened liquids may help patients with
neurological dysphagia. Great care must be taken, however, to ensure that
dysphagic patients who are allowed to continue with oral intake do not
aspirate. Assessment by a speech and language therapist (SALT), with or without
radiological assessment of swallowing, may be required.
Food fortification, using
either high-energy foodstuffs (e.g. butter or cream) or commercially available
energy and/or protein supplements, is commonly recommended to try to improve
nutritional intake. We believe, however, that the use of this type of
nutritional supplementation should be viewed with caution. Malnourished
individuals are usually depleted in micronutrients, electrolytes and minerals as well as energy and protein, and food fortification may fail to address
all of their needs.
This could also put them
at risk of a re-feeding problem through shortage of a critical nutrient (see
Chapter 9). We therefore recommend that oral supplementation beyond that
provided from normal food should be with commercially produced, nutritionally
complete protein, energy and micronutrient preparations, e.g. sip-feed drinks.
Even then, some caution is needed. Although such commercial ‘complete’
supplements do contain sufficient quantities of vitamins and minerals to meet
daily requirements, they only do so if patients are consuming enough of the
supplement to meet their entire energy and protein needs. This is often not the
case and patients are only using the supplement as additional intake above that
from food. They may, therefore, still need additional multivitamin and trace
element supplementation to ensure balanced and truly complete nutrient intake.
It is important that any
oral nutritional supplements including, for example, sip-feed drinks and
micronutrients, are prescribed on drug charts. This will not only ensure that
they are actually given by nursing staff but also indicate clearly to both
patients and staff that nutritional care is an integral part of medical
treatment.
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