DNP 810 Identify a health issue that has been positively influenced by nutrition in your clinic

DNP 810 Identify a health issue that has been positively influenced by nutrition in your clinic

DNP 810 Identify a health issue that has been positively influenced by nutrition in your clinic

Nutrition has significantly impacted hypertension in patients at our healthcare facility. Patients diagnosed with hypertension in the clinic are referred to the clinical nutritionist who educates them about the DASH diet, which effectively lowers hypertension. The DASH diet encourages a high consumption of fruits, vegetables, and whole grains and moderate amounts of low-fat dairy products, lean meat, nuts, seeds, dry beans, fats, and oils. Patients are advised to have low consumption of red meat, salt, cholesterol and saturated fat, sweets, and sweetened drinks (Koehler & Drenowatz, 2019). The DASH diet has significantly reduced the number of patients with pre-hypertension who advance to stages 1 and 2 hypertension. Furthermore, it has helped maintain patients’ blood pressure below 140/90 and promoted weight loss, lowering the incidence of hypertension complications and comorbidities.

          Nutrition plays a major role in health and development. Good nutrition is associated with strong immunity and a low risk of malnutrition and non-communicable diseases (NCDs) (Shahid & Bishop, 2019). Malnutrition occurs in two forms, undernutrition (due to inadequate intake of nutrients) and overweight (excessive caloric intake). Individuals who observe healthy nutritional practices have a low risk of developing NCDs like hypertension, diabetes, heart disease, and some cancers.

          The DNP-nurse can utilize this information in practice by educating patients and their families about healthy dietary practices to promote good nutrition. The nurse can assess patients with malnutrition and offer nutritional counseling on the nutrients they should increase or reduce in their diet to attain healthy nutrition (Koehler & Drenowatz, 2019). Besides, the nurse can apply the information in managing patients with lifestyle diseases by educating them on dietary habits they need to adopt to promote weight loss and achieve optimal blood pressure and blood glucose levels.

References

Koehler, K., & Drenowatz, C. (2019). Integrated Role of Nutrition and Physical Activity for Lifelong Health. Nutrients, 11(7), 1437. https://doi.org/10.3390/nu11071437

Shahid, S. M., & Bishop, K. S. (2019). Comprehensive Approaches to Improving Nutrition: Future Prospects. Nutrients, 11(8), 1760. https://doi.org/10.3390/nu11081760

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Your post was insightful. Maintaining a DASH diet and increasing the intake of individual nutrients such as very low sodium and potassium and lifestyle modification such as weight loss significantly reduces blood pressure and the incidence of cardio-metabolic diseases. Besides hypertension, Song et al. (2021) note that the DASH diet can significantly reduce the risk of type 2 diabetes and metabolic syndrome. The researchers state that dietary factors are the main contributors to the incidences of these chronic diseases. The study further found that China has the highest diet-related CVD mortality globally. The study indicated that the high mortality is linked to high sodium intake and inadequate intake of whole grains and fruits.

Moreover, proper nutrition, specifically a diet rich in vitamin D, is pivotal in growth and muscle development. Vitamin D plays a monumental role in regulating the amount of calcium and phosphate in the body. The mentioned nutrients ensure that the bones, teeth, and muscles are healthy and strong. A diet deficient in vitamin D may lead to bone deformities such as rickets in children and osteomalacia in adults (Song et al., 2021). Due to the critical role of vitamin D in promoting health, the government advises individuals to take daily vitamin d supplements, especially during winter. Sources of vitamin d include omega-3 fatty acids, red meat, liver, and fortified foods such as breakfast cereals.

The DNP can utilize the information to develop policies to ensure mechanisms are in place to prevent diet-related diseases. According to the study by Evans, China has the highest diet-related deaths worldwide. Consequently, the information about the correlation between nutrition and diseases will help the nurse ensure that preventive measures are in place to curb the menace. Additionally, the information will enable the nurse to provide safe and evidence-based nursing. Koehler et al. (2019) note that properly trained nurses ensure that treatment costs are reduced threefold. DPN is knowledgeable and well equipped; thus he/she is to educate and guide patients and their families on how to utilize nutrition to manage and prevent some diseases (Koehler et al., 2019)

References

Song, Y., Lobene, A. J., Wang, Y., & Hill Gallant, K. M. (2021). The DASH Diet and Cardio-metabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries. Nutrients, 13(3), 984. https://doi.org/10.3390/nu13030984

Koehler, K., & Drenowatz, C. (2019). Integrated Role of Nutrition and Physical Activity for Lifelong Health. Nutrients, 11(7), 1437. https://doi.org/10.3390/nu11071437

The health issue mostly seen in adults and children is chronic kidney disease (CKD) impacted by protein-calorie malnutrition (PCM). Although they have different pathogenesis, protein-calorie (energy) malnutrition is caused by a deficiency of energy, protein, and micronutrients. Signs and symptoms of PCM include being underweight compared to the expected healthy weight or muscle wasting seen in certain disease conditions such as HIV/AIDS. Protein calorie malnutrition (PCM) is also common in older people as seen in aggressive weight loss programs or patients with CKD (Mathur, et al., 2022).

During recent research by Mathur, et al., 2022 in a large community cohort with CKD, studies have characterized the relationship between severe protein-calorie malnutrition and the appearance of metabolic syndrome (MS) in adulthood. With each rise in serum bicarbonate levels, the hazard ratios adjusted for age, sex, race, GFR rate, serum albumin, hemoglobin, diabetes, and cardiovascular comorbidities were noted as an outcome of protein-calorie malnutrition (Mathur, et al., 2022).

Experimental animal and human studies conducted by Mathur, et al., 2022 show that chronic kidney disease (CKD) is very high among geriatric patients with a risk of adverse effects such as metabolic acidosis associated with protein catabolism and bone loss. Research studies by Mathur, et al., 2022 sought to quantify the independent association of metabolic acidosis with adverse muscle, bone, and functional outcomes in patients with non-dialysis-dependent patients with stage 3–5 CKD who had low estimated glomerular filtration (GFR) and serum bicarbonate values. The presence and severity of metabolic acidosis were significant and independent risk factors for failure to thrive, protein-calorie malnutrition, and falls with a possible fracture (Mathur, et al., 2022).

The second type of protein-calorie malnutrition is edematous malnutrition known as Kwashiorkor and Marasmus. They are two clinical syndromes observed in severe acute malnutrition in young children primarily found in developing countries. Marasmus comprises of depletion of antioxidants, vitamins, and minerals. While Kwashiorkor is a severe and uncontrolled oxidative stress associated with the depletion of gut anaerobes and proliferation of aerotolerant gut pathogens (Pham, et al., 2021).

How does nutrition improve health?

Nutrition improves health positively because, urgent correction of plasma glutathione depletion, alongside supply of specific essential amino acids, particularly methionine and cysteine, early suppression of gut Proteobacteria including K. pneumoniae, and the use of probiotics to restore the human gut anaerobic and mature microbiota open new avenues to develop more targeted and effective treatments modalities. We can use this knowledge to healthily educate our patients and their family that increasing the intake of protein-containing foods, using milk-based formulas, antioxidants, vitamins, minerals, and daily multivitamins are the treatment of choice for replacement therapy (Mathur, et al., 2022).

How can the doctoral-prepared nurse apply this information in practice?

The doctoral-prepared nurse applies this information in practice by using Anthropometry methods to monitor blood pressure, weekly weight, and laboratory test levels such as plasma levels of glucose, triglyceride, and HDL. It was determined that the prevalence of non-communicable diseases such as protein-calorie malnutrition shows a direct and significant association between the burden of metabolic syndrome on body mass index, waist/height index, Dyslipidemia, CKD, and blood pressure. Identification of the specific pathogenic organisms and treatment with antibiotics could also save many children with kwashiorkor and marasmus (Pham, et al., 2021).

Reference

Mathur, V., Reaven, N. L., Funk, S. E., Whitlock, R., Ferguson, T. W., Collister, D., & Tangri, N. (2022). Association of metabolic acidosis with fractures, falls, protein-calorie malnutrition and failure to thrive in patients with chronic kidney disease. Clinical Kidney Journal. V15 (7), p1379-1386, 8p. Retrieved from DOI: 10.1093/ckj/sfac065

Pham, T. P., Alou, M. T., Golden, M. H., Million, M., & Raoult, D. (2021). Difference between kwashiorkor and marasmus: Comparative meta-analysis of pathogenic characteristics and implications for treatment. Microbial pathogenesis. V150, pp. 104702. DOI:

10.1016/j.micpath.2020.104702

Allow me to add that nutrition is critical in managing chronic kidney disease. The study elucidates that protein restrictions in patients with CKD in stages 3 to 5 (not dialysis) will go a long way in delaying kidney failure and improving the quality of life. Dietary protein restriction prevents and delays the symptoms of kidney failure and time of kidney replacement and averts the commencement of protein-energy wasting (Hanach et al., 2019) Further, a lower protein diet (LPD) offers numerous metabolic benefits. Apart from controlling phosphate balance and providing a higher dietary alkaline load, LPD controls other aspects of CKD such as proteinuria, inflammation, and dyslipidemia.

According to Cupisti et al. (2020), proper nutrition improves health. Sarcopenia is a degenerative condition characterized by progressive loss of muscle loss and strength. The condition is predisposed by insufficient protein intake and depletion of gut microbiota. According to the study by Hanach et al. (2019), protein supplementation significantly improves muscle anabolism, strength, and general health. Frequent use of daily products such as milk and cheese has been demonstrated to improve the condition. Dietary protein accelerates the anabolic process in the skeletal muscle. Moreover, dietary proteins insert amino acids that stimulate postprandial muscle protein synthesis. This phenomenon has led to the development of amino acid supplementation to ameliorate the decline effect associated with sarcopenia.

The doctoral–prepared nurse functions in a critical role in not only discharging preventive care but also ensuring patients are adequately informed. Thus, knowledge about the correlation between nutrition, health, and disease will be handy for the DPN. The nurse will utilize the information to show that some conditions such as sarcopenia are prevented by ensuring that patients consume adequate nutrients. Moreover, the information will equip the nurse with the knowledge to enable him/her to guide his patients on how to leverage nutrients to manage myriad diseases and conditions (Hanach et al., 2019)

References

Cupisti, A., Gallieni, M., Avesani, C. M., D’Alessandro, C., Carrero, J. J., & Piccoli, G. B. (2020). Medical Nutritional Therapy for Patients with Chronic Kidney Disease not on Dialysis: The Low Protein Diet as a Medication. Journal of clinical medicine, 9(11), 3644. https://doi.org/10.3390/jcm9113644

Hanach, N. I., McCullough, F., & Avery, A. (2019). The Impact of Dairy Protein Intake on Muscle Mass, Muscle Strength, and Physical Performance in Middle-Aged to Older Adults with or without Existing Sarcopenia: A Systematic Review and Meta-Analysis. Advances in nutrition (Bethesda, Md.), 10(1), 59–69.

Malnutrition and PIs:

Malnutrition is a major health concern in community-dwelling older adults. Decreased intake of calories, protein, vitamins, and minerals is commonly seen in individuals with malnutrition, which is often associated with undernutrition. This results in unplanned and undesired weight loss, protein-calorie malnutrition, decreased BMI, reduced muscle mass, and dehydration, all of which are linked to Pressure Injury.

How does nutrition improve health?

Meeting the body’s nutrition requirements is essential to promote health and well-being. Although the point at which inadequate nutrient intake affects skin integrity has not been defined, insufficient nutrient intake and low body weight are both associated with impaired wound healing.  Nutrition plays an important role in the prevention and treatment of pressure injuries (PIs) among critical and hospitalized patients.

Question: How can the doctoral-prepared nurse apply this information in practice?

DNP prepared nurse can support with research and Evidence based practice implementation activities in the following:

• Using a validated nutrition screening tool to identify the nutrition status of individuals at risk of or with PIs.
• Referring individuals at risk of or with PIs to an RDN or other qualified professional for a nutrition assessment and collaborate with the interprofessional team and patient to determine a patient-centered nutrition plan.

References:

Munoz, Nancy DNC, MHA, RDN, FAND; Posthauer, Mary Ellen RDN, LD, FAND; Cereda, Emanuele MD, PhD; Schols, Jos M. G. A. MD, PhD; Haesler, Emily PhD, BN, P Grad Dip Adv Nurs The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations, Advances in Skin & Wound Care: March 2020 – Volume 33 – Issue 3 – p 123-136 doi: 10.1097/01.ASW.0000653144.90739.ad

Defining healthy foods and nutritional needs is typically very simple. Our patients need to stay away from sugars and fats. Make sure that they are not overdoing carbohydrates and processed foods. But sometimes, the food itself is a significant part of healing and maintaining a healthy life. In the Alaska Native population, traditional foods are essential to their recovery and health. The top traditional foods for this population are fish, moose, reindeer, berries, whales, and seals. Almost 75% of their diet is fish they have caught as a village or individually (Redwood et al., 2019). In hospitals, these foods can be hard to find as they are not the normal. But to the Alaska Native, it is a cultural necessity and something they need.

The Alaska Native Medical Center has a program to bring traditional foods and nutrition to the patients they serve. Daily there will be reindeer chili, smoked salmon, or another type of fish. Because of the illegality of selling big game such as moose or whales in Alaska, the hospital takes donations of these meats to prepare them for the patients. (Petersen, 2021) Having worked for this organization for a while, I have seen firsthand how catering to the cultural needs of nutrition makes such a difference. Patients are happier and feel how important their culture is and how it’s respected.

As a DNP-prepared nurse, it is my obligation to look at programs and processes such as this one that will enhance our patient’s healing. Understanding the population I serve and the needs of their culture is just as important as understanding the medical aspects of what we do. Bringing the two together is how I, as a nurse, can improve the lives of my patients.

References

Petersen, V. (2021, November 4). At one alaskan hospital, indigenous foods are part of the healing plan. https://www.nytimes.com/2021/11/04/dining/covid-indigenous-foods-alaska.html

Redwood, D. G., Day, G. M., Beans, J. A., Hiratsuka, V. Y., Nash, S. H., Howard, B. V., Umans, J. G., & Koller, K. R. (2019). Alaska native traditional food and harvesting activity patterns over 10 years of follow-up. Current Developments in Nutrition, 3(11). https://doi.org/10.1093/cdn/nzz114