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The nutrition care process is a systematic approach used to ensure and provide adequate and high-quality nutrition care to a patient. To draw a nutrition care plan for Mr. Rambo, the five-step nutrition care process involving assessment, diagnosis, intervention, monitoring, and evaluation needs to be followed. The first step is an assessment to see if there is a nutrition problem in the patient. To do this, the patient’s history is important with emphasis on food and nutrition history. Some findings on a physical exam can also be useful in assessment. Anthropometric measurements, biochemical data, and medical tests would also help in the assessment. Diagnosis involves the identification of the problem aided by signs and symptoms in the patient. The cause of the problem and any contributing factors are also identified (Stump, 2010).
After identifying the problem, a nutrition care plan is then formulated. An intervention strategy, with specific set goals, is defined and a nutrition prescription is formulated. The strategy when put into work should be able to deal with the nutrition problem and alleviate signs and symptoms. In stages four and five, monitoring and evaluation are done. The amount of progress the patient has made is determined and checked against the set goals. The measurements done during assessment can be repeated to see if there is an improvement (Stump, 2010).
Anthropometric data is important in the assessment of nutritional status. Mr. Rambo’s anthropometric measurements including age, sex, height, weight, and percentage body fat are taken. His BMI is then calculated and this is used to detect nutritional problems like obesity and underweight status (Stump, 2010).
There are two options for providing nutritional support depending on the route of administration. It can be enteral, which can be either orally or by a feeding tube, or parenteral. Enteral nutrition provides luminal contents for the synthesis of trypsinogen which makes the symptoms of acute pancreatitis worse (Lugli, Carli, & Wykes, 2007). It has, however, had better outcomes and is known to be cost-effective. It is the best way to support the metabolism of the intestines. Parenterally administered nutrients can stimulate the regeneration of intestinal mucosa (Ioannidis, Lavrentieva, and Botsios, 2008).
In Mr. Rambo’s case, feeding should be started within 48 hours as opposed to late nutrition. Feeding should be enteral by way of a nasogastric tube or nasojejunal tube. This early enteral feeding will ensure a reduction in infections of the pancreas. Feeding by nasogastric tube is tolerated just like feeding by nasojejunal tube (Petrov, Pylypchuk, and Uchugina, 2009).
The formula to be used when doing tube feeding can be determined using blood glucose and triglyceride levels to avoid hyperglycemia and hypertriglyceridemia. An elemental diet would be appropriate to use, but other formulations like the standard enteral and immune-enhancing formulations can also be used. (Ioannidis, Lavrentieva and Botsios, 2008).
Enteral feeding is important in patients with severe acute pancreatitis as it leads to better control of sugar levels. It also presents a decreased risk of infectious complications and hence decreased mortality. However, enteral feeding is associated with increased secretion of pancreatic enzymes as a complication (McClave et al, 2006). To deal with this, jejunal placement of the tube is done since it does not induce pancreatic enzyme secretion. Jejunal delivery of food can induce the production of substances that will inhibit pancreatic enzyme production (Petrov, Correia, and Windsor, 2008).
Tube feeding can be discontinued due to various reasons. In some cases, the tube is not well tolerated and is, therefore, removed to avoid adverse effects. Feeding can lead to exacerbation of pain and hence stoppage of the feeds. The patient may repeatedly remove the feeding tube and necessitate its removal. However, even when the feeding tube is well tolerated, the patient will need to revert to oral feeding. The return to oral feeding will depend on the status of the patient regarding pancreatitis. The level of pancreatic enzymes should be in the normal range. Oral feeding can cause the return of pain which had already ceased and therefore care should be taken on when to do oral feeding (Petrov, Correia and Windsor, 2008).
To evaluate Mr. Rambo’s progress towards reaching his nutritional needs, the presenting symptoms are monitored. The symptoms will be expected to have been alleviated or at least decreased in severity if the intervention is effective. Nutrition-related history and physical findings such as appetite and physical appearance can give an impression of the impact of the nutritional intervention measures put in place. Laboratory data from medical tests done on Mr. Rambo can also show if there is an improvement. Anthropometric measurements can be done to show any improvements from previous outcomes (Stump, 2010).
References
Ioannidis, O., Lavrentieva, A. and Botsios, D., (2008), Nutrition support in acute pancreatitis. Journal of pancreas, 9, 4, 375-390.
Lugli, A., Carli, F., & Wykes, L., (2007). The importance of nutrition status assessment: The case of severe acute pancreatitis. Nutrition Reviews 65, 7, 329-334.
McClave, S., Chang, W., Dhaliwal, R., & Heyland, D., (2006). Nutrition support in acute pancreatitis: A systematic review of the literature. JPEN, Journal of Parenteral and Enteral Nutrition 30, 2, 143-56.
Petrov, M., Correia, M. and Windsor, J., (2008), nasogastric tube feeding in predicted Severe pancreatitis: A systemic review of the literature to determine safety and tolerance, Journal of the pancreas, 9, 4, 440-448.
Petrov, M., Pylypchuk, R., and Uchigina, A., (2009), Systemic review on the timing of artificial nutrition in acute pancreatitis. British journal of nutrition, 101, 6, 787-793.
Stump, S., (2010), Nutrition care process, Akron; OH: Becky & Associates.
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