Nutritional Support for Adults and Children

A Handbook for Hospital Practice

Tim Bowling

• Publisher: CRC Press
• Year: 2019
• Print ISBN: 9781138454859
• eBook ISBN: 9781315345642
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

'This book effectively bridges the gap between dietitian, doctor, nurse and pharmacist and there is much in it to educate even the more experienced practitioner. I recommend the book highly and feel confident that well-thumbed and battered copies will soon be found on wards everywhere.' Alastair Forbes, Chairman of the British Association of Parenteral and Enteral Nutrition 'This book will help non-specialists to make appropriate choices regarding nutritional care for their patients. It should prove to be a valuable resource for all professions, in many areas of practice.' Lynne Colagiovanni, Chairman, National Nurses Nutrition Group 'This is a much needed comprehensive clinical nutrition guide for busy healthcare professionals. It covers all aspects of nutritional care in a logical and systematic way and will aid clinicians in making reasoned judgments on the nutritional care that their patients require.' Vera Todorovic, The Parenteral and Enteral Nutrition Group of the British Dietetic Association 'This handbook will be an invaluable resource, as it provides a concise, practical guide covering all aspects of clinical nutrition, both for adults and paediatric patients.' Rebecca White and Vicky Bradnam, British Pharmaceutical Nutrition Group

PART 1

Introduction to undernutrition

CHAPTER 1

Introduction

Malnutrition is a problem endemic in all countries, and encompasses both under-and overnutrition. This book concerns itself exclusively with undernutrition.

At least 20–30% of patients in European hospitals are undernourished, or at risk of becoming so as a result of their illness. Undernutrition increases complications and costs of care, and is therefore a very significant pressure on healthcare delivery.

To minimise the impact of undernutrition in hospitalised patients, effective and appropriate management must be achieved. Traditionally, certainly in the UK, nutrition has been poorly taught to nurses and at both undergraduate and post-graduate levels to doctors. As a result there is a great deal of ignorance and poor practice at all levels of seniority. Better education in this field is beginning to bear fruit, but there is still a long way to go.

With regards to the practice of nutritional support, multidisciplinary nutrition teams are an ideal means of delivering and leading best practice. However, despite a growing recognition of their benefits to patient care, both in the literature and also by national organisations, less than 50% of UK hospitals and even fewer in many European countries have them. Even where they do exist they are often poorly resourced and can usually only help with a relatively small proportion of patients, who will invariably be at the ‘high tech’ end of the spectrum, e.g. those on intravenous (IV) feeding. Dietitians are another key group, but their numbers are also limited and they cannot see everyone who needs nutritional input. Therefore, the majority of patients rely on ward-based doctors and nurses in all disciplines to look out for, identify and manage undernutrition, and to refer on to more experienced professionals, i.e. dietitians and nutrition teams, those that require particular help.

The abilities and experience of ward-based staff in recognising and managing nutrition-related illness are very poor. This book is therefore aimed specifically at clinicians (from medical student to consultant) and ward nurses (from student to ward sister). We make no apology for pitching it at a very basic level, because it is core knowledge that is lacking and, without this, best practice is not going to be achievable. For the interested reader, there are specific references in the further reading list at the end of each section, and some more generic nutrition references at the end of this chapter.

The book is broadly split into two parts, one dealing with adult-based practice and the other with paediatrics. The same topics are covered. Overall, the intention is to present a brief and succinct but up-to-date guide which will both inform and enable the target readership to improve and optimise their knowledge and practice of nutritional support in the hospital setting.

We have attempted to base any practice recommendations on the highest level of authority that is available. Sometimes this is consensus within and between national organisations. Often, though, such consensus does not exist, for example with peri-operative nutritional support, and then recommendations can only be on the basis of expert opinion. More explicit details for particular situations can be found in the references at the end of each section.

Throughout the book there are examples of practical management of procedures and various clinical situations. In many hospitals there may be local protocols/guidelines. Where these exist they should be referred to.

Further reading

• Lennard-Jones JE (ed) (1992) A Positive Approach to Nutrition as Treatment. Report of a working party. King’s Fund, London.

• Mann J and Truswell AS (eds) (2002) Essentials of Human Nutrition. Oxford University Press, Oxford.

• Payne-James JJ, Grimble GK and Silk DBA (eds) (2001) Artificial Nutritional Support in Clinical Practice. Greenwich Medical Media, London.

• Royal College of Physicians (2002) Nutrition and Patients: a doctor’s responsibility. Report of a working party of the Royal College of Physicians. Royal College of Physicians, London.

• Stratton RJ, Green CJ and Elia M (2003) Disease-related Malnutrition: an evidence-based approach to treatment. CABI Publishing, Wallingford.

• Todorovic V and Micklewright A (eds) (2000) Pocket Guide to Clinical Nutrition. British Dietetic Association, London.

BAPEN, Maidenhead, publications

• Allison SP (ed) (1999) Hospital Food as Treatment.

• BAPEN working party (2003) Drug Administration via Enteral Feeding Tubes.

• Lennard-Jones JE (ed) (1998) Ethical and Legal Aspects of Clinical Hydration and Nutritional Support.

• McAtear C (ed) (1999) Current Perspectives on Enteral Nutrition in Adults.

• Milla PJ (ed) (2000) Current Perspectives on Paediatric Parenteral Nutrition.

• Pennington CJ (ed) (1996) Current Perspectives on Parenteral Nutrition in Adults.

• Silk DBA (ed) (1994) Organisation of Nutritional Support in Hospitals.

• Sizer T (ed) (1996) Standards and Guidelines for Nutritiona...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Forewords
• Preface
• List of contributors
• Acknowledgements
• Part 1 Introduction to undernutrition
• Part 2 Adults
• Part 3 Children
• Part 4 Ethics of nutritional support
• Index