Nutrition Intervention
From diagnosis to prescription
Intervention has four standardized categories: food and/or nutrient delivery, nutrition education, nutrition counseling, and coordination of nutrition care. Selection flows from the PES etiology - if the cause is inadequate access, coordinate resources; if it is a knowledge deficit, educate.
The nutrition prescription specifies the intervention, amount, and time frame: energy and protein goals, diet texture or modification, route (oral, enteral, parenteral), supplements, and monitoring instructions. Goals should be SMART (specific, measurable, achievable, relevant, time-bound) and negotiated with the client.
Enteral vs parenteral: the guiding rule is "if the gut works, use it" - enteral nutrition maintains mucosal integrity, costs less, and carries fewer infectious complications. Contraindications to EN include ischemic bowel, mechanical obstruction, uncontrolled shock, high-output proximal fistula, and severe malabsorption; PN is reserved for these and for gut failure. Refeeding syndrome risk is high with BMI <16, >15% weight loss in 3–6 months, minimal intake for >10 days, or low baseline potassium, magnesium, or phosphate. Correct electrolytes (especially phosphate) and give thiamine before feeding, start at 10–20 kcal/kg, and advance slowly.
Traps: treating a "clear liquid diet" as nutritionally adequate or automatically appropriate after surgery; confusing a diet order with an individualized nutrition prescription; escalating to PN before optimizing EN.
Rule of thumb: start low, go slow, and give thiamine before or with the first feed in an at-risk patient.