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.
A pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can be present as intact skin or an open ulcer and may be painful (NHS Improvement, 2018a). The consequences of pressure ulcers are increased length of hospital stays for the patient, estimated at 4.31 days (National Institute for Health and Care Excellence [NICE], 2005), but also an increase in cost to the NHS, which is identified at around £14-21 billion annually (Nutritional Pressure Ulcer Advisory Panel et al, 2014). Poor nutrition has been recognised as one of the risk factors in the development of pressure ulcers. Improving nutritional intake of patients is thus paramount in reducing patient harm and unnecessary cost. This article looks at the role nutrition plays in the prevention and treatment of pressure ulcers, provides practical advice and signposts readers to the resources produced by the Nutrition and Pressure Ulcer Task and Finish Group.
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
A new, practical and informative guide to bolus feeding has been launched by Nutricia in response to requests from healthcare professionals, as this form of feeding is becoming more frequently used in clinical practice.
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.
Irritable bowel syndrome (IBS) is a chronic and debilitating condition effecting over 10% of the UK population with a higher preponderance among adult Caucasian females. It places a significant economic burden on the NHS with annual cost projections ranging from £45 to £200 million. Misdiagnosis is common and is reflected in the high prevalence of gastrointestinal-related surgery within this cohort, and it is essential to obtain a detailed case history to ensure correct treatment. National guidelines now recommend diet as the first line approach, with research repeatedly advocating the use of the low FODMAP diet, particularly for those with diarrhoea dominant or mixed IBS. However, specialist dietetic support is essential to ensure nutritional adequacy and prevent the use of unnecessary or highly restrictive diets. Where access to dietitians may be limited, dietetic departments are now able to recommend technology, such as dietitian-led webinars, mobile phone apps and YouTube videos to increase patient access to reliable information.
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.
Eating difficulties affect many older people and can be a short or long-term issue, while poor nutritional status can have a huge impact upon older people’s health, wellbeing and quality of life. Nurses, carers and relatives need to identify potential problems with older patients’ nutrition so that they can manage any issues successfully. Providing adequate nutrition for older people requires a multidisciplinary approach, with the aim of improving patients’ nutrition by assessing any barriers to successful eating. Often, being alert to very subtle issues and addressing them is the key to success in helping older people achieve a healthy diet. This article will highlight some of the issues that may affect older people and lead to under-nutrition. It also provides some simple preventative measures.
The number of patients in a community setting with percutaneous endoscopic gastrostomy (PEG) tubes is increasing year-on-year. PEGs provide a secure route of delivering artificial nutrition, hydration, and medication in patients who are unable to swallow safely, however, there are complications associated with their insertion and ongoing use. Common problems include infection, leakage, tube blockages, development of granulomas at the insertion site, and so-called ‘buried bumper syndrome’. Community nurses are ideally placed to identify these complications, and this article provides a quick reference guide to troubleshooting and managing these issues.
