Overview
This lecture covers advanced nutrition concepts, focusing on tube feedings, medication and food interactions, special population dietary needs, food safety, and cultural/religious considerations.
Enteral Feeding Management
- Advance intermittent tube feedings by 50 mL per day if well-tolerated.
- Avoid bolus feedings delivered over 5–10 minutes; optimal is 20–30 minutes.
- Typical feeding amounts should be 150–250 mL per interval, not 250–500 mL.
Medications Affecting Nutrition
- Ampicillin may alter taste and reduce dietary intake.
- Furosemide decreases absorption of food/drugs if taken with meals.
- Acetaminophen affects the liver; monitor liver function with prolonged use.
- Morphine can cause constipation but does not alter taste.
Food Safety & Foodborne Illnesses
- E. coli is commonly contracted from undercooked ground beef or fecal contamination.
- Botulism risk comes from canned foods and sausages.
- Listeriosis risk is higher with soft cheeses, and shigellosis from milk products.
Nutrition & Special Populations
- Burns, severe trauma, infection, or fever increase risk for negative nitrogen balance.
- Extra carbohydrates are needed after burns to spare protein for tissue repair.
- When introducing solids to infants, start with non-wheat cereal, then vegetables, one new food per week.
- Fruits should be introduced after vegetables to avoid preference issues.
Pediatric and Geriatric Considerations
- Toddlers are typically picky eaters; offer nutrient-dense finger foods to meet needs.
- Infants double their birth weight by 4–5 months and triple by one year.
- Never give honey or corn syrup to infants due to botulism risk.
- Elderly often have a decreased sense of thirst; encourage regular fluid intake, not just when thirsty.
Allergies and Dietary History
- Ask specifically, "What happens when you eat peanuts?" to assess true allergic responses.
Adolescent & Adult Dietary Needs
- Use iodized table salt to meet increased iodine demands during adolescence.
- Grapefruit inhibits absorption of many drugs; avoid with certain medications.
- Jewish dietary laws prohibit combining meat with dairy (e.g., beef lasagna).
- Seventh-Day Adventists encourage vegetarianism and avoid shellfish.
Key Terms & Definitions
- Negative Nitrogen Balance — Condition where nitrogen loss exceeds intake, often from burns, trauma, or infection.
- Bolus Feeding — A specific amount of enteral nutrition given over a short period.
- Listeriosis — Foodborne illness linked to soft cheeses.
- Botulism — Deadly illness from toxins in improperly canned foods or honey (in infants).
- IG-E Mediated Response — Severe, systemic allergic reaction.
Action Items / Next Steps
- Review lecture part one for foundational nutrition concepts.
- Look up and understand foodborne illnesses and at-risk foods.
- Read textbook sections on special diets, pediatric and geriatric nutrition needs, and cultural dietary restrictions.