Patients at high risk of malnutrition include those who have recently been discharged from hospital, those with chronic diseases, progressive neurological disease, acute illness, frailty, social issues, undergoing rehabilitation or end of life/palliative care (Holdoway et al, 2017). Community nurses are often the first-line of care for these patients and can play an important role in ensuring that they get the best nutritional care. This article discusses some of the areas for consideration when assessing malnutrition risk and outlines a number of new resources designed to assist nursing teams in identifying, monitoring and managing patients at risk of malnutrition.
There are a number of clinical conditions that result in dysphagia (difficulties swallowing food and drink). Sometimes dysphagia can resolve, however, for many it can be long term and also continue to deteriorate over time as the disease progresses. Successful management of dysphagia requires provision of differing levels of texture modification to an individual’s food and fluid consistency. It is important that this is assessed correctly so that the individual receives the appropriate consistency to swallow safely. If an inappropriate consistency is given, this can result in aspiration pneumonia, which can have fatal consequences. If individuals are given a consistency which has been over modified so that it is softer or thicker than required, their pleasure in food and drinks can be reduced unnecessarily, risking malnutrition and dehydration. This article introduces the differing consistencies which are recommended and the consequences that can result from incorrect consistencies being given. It also discusses suitable foods and fluids to meet both the requirements of the differing texture modifications and nutritional components of these consistencies.
Healthy eating is a topic covered widely in the media, and is particularly relevant to healthcare, with diet and nutrition vital to the management and prevention of many conditions. Wound healing is a complex process that relies on the coordination and internal regulation of activities such as the removal of devitalised tissue and growth of fresh blood vessels. This article examines the phases of wound healing and discusses how nutrients can affect and enhance this process. Understanding the role of nutrients in wound care enables nurses to offer advice to patients whose wounds are not progressing in the expected manner. Nutrition should form part of holistic wound assessment, with any malnourished patient being referred to a dietician. It is a misconception that only underweight individuals can be malnourished and the use of a robust assessment tool will assist nurses in deciding which patients require onward referral. There appears to be a significant link between poor nutrition and delayed wound healing, with a higher risk of complications such as infection identified in malnourished patients
One in ten older people in the UK are suffering from, or at risk of malnutrition. This relatively unknown, yet significant issue, costs the NHS £19.6 billion per year (Elia, 2015). Often overshadowed by obesity as a public health issue, malnutrition impacts a person’s wellbeing; leading to further problems, such as an increase in hospital admissions, increased dependency and increased risk to life.
This article explores the natural ageing process and the impact it can have on the nutritional status of elderly patients. In the article, the author considers the body’s ageing process and the changes patients can struggle with as a result. Recognition, identification and treatment of malnutrition with this patient group is an essential part of care within the NHS, which, if done appropriately, can improve patient quality of life - in particular, functional status. An appreciation of the physiological changes which are happening as part of the ageing process allows healthcare professionals to offer tailored advice and provide reassurance to patients.
Dysphagia is a swallowing condition that mainly affects older adults and which can be a short- or long-term issue. Dysphagia can have an enormous impact on patients and their carers and for community nurses, early identification is key to managing the condition successfully. Similarly, by familiarising themselves with the signs and symptoms of the condition, nurses can ensure prompt referral to a speech and language therapist who can formulate an individualised plan of care. Managing dysphagia requires a multidisciplinary approach, with the aim of helping patients to maintain an adequate and safe oral intake.
Nutritional intake can have an effect on many areas of a patient’s health, while malnutrition specifically has a recognised role in pressure ulcer development. In this article, the author looks at whether there is any high quality evidence to recommend specific nutritional measures when trying to prevent pressure ulcers, as well as looking at overall recommendations for malnourished patients. Nutritional screening remains essential to help identify those patients most at risk of malnutrition and allows community nurses to prepare nutritional care plans and begin to correct any nutritional deficiencies. The author recommends that community nurses perform nutritional screening at any patient contact, be that in hospital, nursing home or in the patient’s
own home. Recording the outcome of screening at regular intervals also helps to identify trends in a patient’s nutritional state and means that any reduction will be picked up quickly.
Wound care and nutrition are two interlinked areas that will have a serious impact on the caseload of any community nurse. Healthy eating and regular physical activity help to prevent chronic illnesses, which in turn have an effect on the development of wounds and ulcers. In particular, malnutrition can impair wound healing and so it is essential that at-risk patients are identified in the early stages using an evidence-based nutritional screening tool. If a wound has developed, adequate nutritional management plays a key role in the healing process. If necessary, patients should be referred to a registered dietitian for a detailed nutritional assessment and treatment plan. This article looks at the link between nutrition and wound care, as well as highlighting preventative measures that can be encouraged in all patients at risk of developing a wound.
This article examines the role of malnutrition in chronic obstructive pulmonary disease (COPD). Until recently, weight loss was considered an inevitable consequence of COPD, however, modern research has demonstrated that weight gain is in fact achievable and can result in functional improvements. It is important that community nurses are aware of the importance of nutrition in COPD, both in screening for malnutrition and developing appropriate treatment plans, including the use of oral nutritional supplements alongside dietary advice and counselling. The current NHS policy of moving care 'closer to home' is resulting in more complex COPD patients being managed in the community and with this comes the challenge of managing reduced weight and low oral intake. It is, therefore, essential that community nurses develop the necessary skills and resources to deal with this growing group of patients.
