Persistent Link:
http://hdl.handle.net/10150/298731
Title:
Responsible nutrition therapy in palliative care
Author:
Parrington, Diane J.
Issue Date:
2003
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
The purpose of this study was to begin to fill the void regarding nutriologic status in patients with Congestive Heart Failure (CHF) and or Chronic Obstructive Pulmonary Disease (COPD) receiving palliative care, and to bring the quality of palliative care to a more appropriate level as related to nutritional injury. Objectives: The objectives were: 1) to determine the prevalence of patients with a stage of nutritional injury at or above the clinical horizon; 2) to determine the response, specifically changes in biochemical parameters and physical manifestations of nutrient based lesions, after micronutrient intervention; 3) to determine if there is a relationship between micronutrient intervention and macronutrient intake; 4) to determine if there is a positive relationship between micronutrient intervention and stage of nutritional injury regardless of the percent of estimated non-protein calorie and protein needs consumed and 5) to ascertain what characteristics identify patients without resiliency / response to treatment. Design: The design was a prospective theory-based effectiveness trial exploring nutriologic status and response to micronutrient intervention utilizing a quasi-experimental design. Twenty-six Veterans with CHF / COPD admitted to the Nursing Home Care Unit for palliative care or designated as Advanced Disease were enrolled; nineteen completed the study. Subjects were recruited consecutively and comparisons were made between baseline and post-treatment values. Methods: A Minimum Data Set structured nine-step nutritional care process including evidence, diagnoses, etiologies, goals / predicted outcomes, interventions and actual outcomes was utilized. Results: All subjects presented at or above the clinical horizon of nutritional injury at baseline representing acquired nutritional loss; 84% had lesions suggestive of nutrient imbalance. Prevalence of pyridoxine, thiamin and zinc deficits were 63%, 11% and 21% respectively. Pyridoxine status following treatment improved significantly, p = .000. Fifty-three percent of subjects had improved outcomes indicating nutritional resiliency, and change within stage of injury. Factors observed in suboptimal nutritional resiliency included drug-nutrient interactions and acute infection. Conclusions: The nutritional cost from lack of responsible nutrition therapy is likely to be significant in veterans with CHF/COPD receiving palliative care. Drug-nutrient interactions and acute infections are most likely the offending factors interacting with the resiliency state.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Health Sciences, Nutrition.; Health Sciences, Public Health.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Graduate College; Nutritional Sciences
Degree Grantor:
University of Arizona
Advisor:
Kight, Mary Ann

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleResponsible nutrition therapy in palliative careen_US
dc.creatorParrington, Diane J.en_US
dc.contributor.authorParrington, Diane J.en_US
dc.date.issued2003en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractThe purpose of this study was to begin to fill the void regarding nutriologic status in patients with Congestive Heart Failure (CHF) and or Chronic Obstructive Pulmonary Disease (COPD) receiving palliative care, and to bring the quality of palliative care to a more appropriate level as related to nutritional injury. Objectives: The objectives were: 1) to determine the prevalence of patients with a stage of nutritional injury at or above the clinical horizon; 2) to determine the response, specifically changes in biochemical parameters and physical manifestations of nutrient based lesions, after micronutrient intervention; 3) to determine if there is a relationship between micronutrient intervention and macronutrient intake; 4) to determine if there is a positive relationship between micronutrient intervention and stage of nutritional injury regardless of the percent of estimated non-protein calorie and protein needs consumed and 5) to ascertain what characteristics identify patients without resiliency / response to treatment. Design: The design was a prospective theory-based effectiveness trial exploring nutriologic status and response to micronutrient intervention utilizing a quasi-experimental design. Twenty-six Veterans with CHF / COPD admitted to the Nursing Home Care Unit for palliative care or designated as Advanced Disease were enrolled; nineteen completed the study. Subjects were recruited consecutively and comparisons were made between baseline and post-treatment values. Methods: A Minimum Data Set structured nine-step nutritional care process including evidence, diagnoses, etiologies, goals / predicted outcomes, interventions and actual outcomes was utilized. Results: All subjects presented at or above the clinical horizon of nutritional injury at baseline representing acquired nutritional loss; 84% had lesions suggestive of nutrient imbalance. Prevalence of pyridoxine, thiamin and zinc deficits were 63%, 11% and 21% respectively. Pyridoxine status following treatment improved significantly, p = .000. Fifty-three percent of subjects had improved outcomes indicating nutritional resiliency, and change within stage of injury. Factors observed in suboptimal nutritional resiliency included drug-nutrient interactions and acute infection. Conclusions: The nutritional cost from lack of responsible nutrition therapy is likely to be significant in veterans with CHF/COPD receiving palliative care. Drug-nutrient interactions and acute infections are most likely the offending factors interacting with the resiliency state.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectHealth Sciences, Nutrition.en_US
dc.subjectHealth Sciences, Public Health.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineNutritional Sciencesen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorKight, Mary Annen_US
dc.identifier.proquest3090010en_US
dc.identifier.bibrecord.b44425764en_US
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