Nutritional Care in Acute and Chronic Illness

Abstract

Nutrition is essential for maintaining good health and preventing diseases, especially in patients suffering from acute or chronic diseases, infectious diseases, or critical illnesses because dietary intake involves both quantitative and qualitative changes and may disturb energy homeostasis (Richardson & Davidson, 2003). The metabolism of patients with critical illnesses is categorized as hypercatabolic, with significant loss of lean body tissue facilitated by the immune-neuroendocrine response of acute critical illness (Mechanick & Brett, 2005). Therefore, facing hunger during a period of physiological stress because of disease or treatment, results in an increased basal metabolic rate, accelerated protein breakdown, and increased energy and nutritional requirements in response to tissue damage, infection, and inflammation. This situation will develop rapidly into malnutrition or further exacerbate malnutrition because of inflammation and metabolic stress associated with diseases and injuries (Wortinger & Burns, 2015). The inflammatory response triggers the neurophysiology of patients and severely affects digestive behavior (Konsman & Dantzer, 2001), especially in terms of increasing demand for protein to provide amino acids for immunoglobulin and acute-phase protein production, both of which are fundamental to proper immune system functions. Under conditions of severe nutrient deficiency, the protein catabolism of the viscera and skeletal muscle for energy and protein generation will occur quickly in the acute phase. This catabolism has the potential to affect the cardiovascular, respiratory, immune, and all other body systems (Chan, 2015). Therefore, malnutrition during hospitalization may initiate immunosuppression and increase the risk of bacterial spread and sepsis, delayed wound healing, impaired organ function, prolonged hospitalization, and morbidity and mortality (Chan, 2015). As severe malnutrition is related to poor illness or treatment outcomes, which is associated with longer hospitalization and increased medical expenses, assessing patients' nutritional status and providing adequate nutritional care are critical. A nutritional assessment that includes body weight, physical condition and muscle condition, and calculation of resting energy requirements must be included as a standard part of the initial examination received by each patient. The results of this assessment should be considered together with the patient's illness status to formulate a nutritional care plan to provide the nutrition (energy, protein, essential fatty acids, and micronutrients) necessary to meet daily requirements, minimize metabolism, and break down proteins to support the immune system and wound healing (Chan, 2010). It is necessary to provide patients with full-spectrum nutrition and be aware that overeating may also cause metabolic and gastrointestinal complications, liver dysfunction, increased carbon dioxide production, and respiratory muscle weakness (Chan, 2010). Natural food should be provide the main source of nutrition as much as possible, and patients should be encouraged to eat a high-quality, complete diet. Although nutritionists may contribute to the assessment and design of nutritional plans for patients in clinical practice, their limited availability in hospitals disallows their providing the individualized attention required by each patient (Xu et al., 2017). Nurses have the most contact with patients and are most sensitive to their illness conditions. They are able to quickly assess the patient's nutritional needs according to changes in the situation, make referrals, and provide consultations on diet modifications. As the nutritional status of patients is involved in their treatment and physical recovery, nurses have always shouldered inter-professional responsibilities and played an essential role in the nutritional care of patients (Xu et al., 2017). For hospitalized patients and residents of long-term care institutions, nurses are able to pay attention to their nutritional related problems during the process of care, respond rapidly to nutrition-related treatment needs, and participate in the transdisciplinary professional team to prevent patient malnutrition.