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護理之家吞嚥困難個案之營養照護案例分享

Nutrition Care of A Nursing Home Case With Swallowing Difficulty-A Case Report

摘要


臺灣邁入高齡社會,約36.8%受試者對於自己咀嚼能力不滿意,因此面臨老年營養與飲食的迫切性需求。本研究為一個個案報告,宜蘭地區某護理之家個案,因為非計畫性體重減輕轉介營養師。個案為81歲女性,因舌頭肌肉不協調而有嗆咳問題,導致進食量低於建議需要量。營養診斷:主要問題(problem, P)為經口攝取不足,主因(etiology, E)為咀嚼困難與吞嚥困難等生理因素造成食物接受度受限,病徵(sign/symptoms, S)為個案僅攝取500 kcal/day、蛋白質31 g/day,短缺熱量800 kcal/day,個案無法攝取足夠熱量。營養介入:以質地調整飲食為營養介入方式,使用均衡配方並配合國際吞嚥障礙食物標準行動委員會(International Dysphagia Diet Standardization Initiative, IDDSI)對於液體濃稠度的分級標準。結果以粉狀均衡配方27.5 g加入100.0 mL水並加入1.0 g增稠劑調製,使其濃稠度供給達到IDDSI第2級,藉此改善病人攝食狀況使其量需求達到100%需求量。另外,因考慮個案腎臟功能不良,以及年齡高達81歲,為顧及腎臟功能需限制蛋白質及營養改善,故此期間飲食蛋白質建議為參考國人膳食營養素參考攝取量(dietary reference intakes, DRIs)和美國腎臟基金會提出的(Kidney Disease Outcome Quality Initiative, KDOQI)指引建議給予熱量1300~1500 kcal/day,蛋白質攝取量0.8~1.0 g/kg/day。積極營養照護二個月後個案體重增加5.9 kg改善了非計畫性體重減輕的問題。此介入期間腎臟功能皆未再惡化,而攝取量及體重減輕有所改善。

並列摘要


Taiwan is an aging society in the world, 36.8% of the elderly were reported to be dissatisfied with their chewing and swallowing ability. Nutrition and diet supports are becoming important issues for the needs in elderly. We reported case at the nursing home case in Yilan. An 81-year-old woman had unintended weight loss and referred to dietitians. She had a coughing problem due to uncoordinated tongue muscles. This conditions further caused the patient having difficulty of meeting the recommended energy and sufficient food intakes. Nutritional diagnosis was insufficient oral intake (problem, P) due to physiological factors such as difficulty in chewing and difficulty in swallowing. Patients had limited food intakes (etiology, E), which was estimated at about 500 kcal/day and protein 31 g/ day, showing a shortage of 800 kcal/day compared to recommendation (sign/symptoms, S). Nutritional intervention was prescribed a texture-adjusted diet corresponding to level 2 of International Dysphagia Diet Standardization Initiative (IDDSI) for liquid consistency. The diet consisted a 27.5 g commercial formula with 1.0 g thickener was adjusted with 100.0 mL water to improve feeding condition. The patient had followed this modified diet for one month, and gained 5.9 kg weight during December 2017 to February 2018. Dietary energy and protein intake fed to patients were estimated to be up to reached 100% of the recommended levels, respectively. Modification of dietary texture for this case appeared to show improvement of intakes, and weight gain. In addition, this 81 years old case has chronic kidney dysfunction problem, so it is necessary to pay attention to the amount of dietary energy and protein to prevent the deterioration of renal function and maintain nutritional status. Dietary prescription was given based on the recommendation of Dietary Reference Intakes (DRIs) and that of Kidney Disease Outcome Quality Initiative (KDOQI), recommended dietary energy was at 1300-1500 kcal/day and dietary protein at 0.8-1.0 g/ kg/day. Following intervention for 2 months, 5.9 kg increases in weight was noted, and successfully prevented unintentional weight loss. During period of receiving nutrition intervention, no further deterioration of kidney function and unintentional weight loss was noted, optimal nutritional intake was also maintained.

被引用紀錄


陳靜瑤、王婷怡、張佩琪、李紫萍、王淑敏、吳昭燕、林淑麗、吳徐慧(2021)。提升高齡長者進食安全指導執行率護理雜誌68(4),72-80。https://doi.org/10.6224%2fJN.202108_68(4).09

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