Biomedical subjects
Publications and source records attributed to L K Gray.
This article describes the evolution of a practicum for baccalaureate nursing students in a Department of Veterans Affairs home care program. The model includes direct patient care, support to caregivers, and assessment and referral to community resources. Students also assess communities and conduct teaching projects to targeted populations.
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As most diet therapy texts provide little information about psychiatric illnesses and their treatment, this article is intended as a brief introduction for dietitians. Several psychiatric illnesses, including schizophrenia, mood disorders, eating disorders, and substance abuse, may adversely affect food intake and nutritional status. The drugs used to treat those disorders similarly have effects on appetite and gastrointestinal function and interact with food and nutrients. Antipsychotics, antidepressants, and monoamine oxidase inhibitors (MAOIs) cause dry mouth, constipation, and weight gain. Lithium may cause nausea, vomiting, diarrhea, polydipsia, and weight gain. MAOIs have well-known interactions with foods containing tyramine. Lithium interacts with dietary sodium and caffeine; decreasing dietary intakes of those substances may produce lithium toxicity. Despite claims to the contrary, major psychiatric illnesses cannot be cured by nutritional therapies alone. Dietitians can, however, play an important role as part of a multidisciplinary team in the treatment of patients with psychiatric illness. Such a role includes nutrition assessment and monitoring, nutrition interventions, patient and staff education, and some forms of psychotherapy, including supportive and behavioral therapies for patients with eating disorders.
As many as 50 per cent of hospitalized patients are estimated, in some surveys, to suffer from protein-calorie malnutrition. Anthropometry provides at least one quick and easy way to assess a patient's protein and calorie reserves. The measurements most commonly obtained are height, weight, triceps skinfold thickness, and upper arm circumference. An alternate method is suggested that compares these measurements with percentiles rather than, as in the current method, with percentages of the standard.
To assess the validity of standards for weight, arm circumference, triceps skinfold, and arm muscle circumference commonly used to assess the nutritional status of hospitalized patients, these standards were applied to data for the normal U.S. population. Moderate depletion was defined as a value between 60 and 90 percent of the standard; severe depletion was defined as a value below 60 percent of the standard. The standards themselves were found to differ substantially from the population averages, and this method of classifying an individual does not take into account the fact that there is more variation in the population for some measures than for others. As a result, the proportion of individuals classified as depleted varied greatly between measures and also between sexes and ages. Over half of all young women would be classified as moderately depleted based on the arm muscle circumference. Over half of young men would be classified as depleted based on the tricep skinfold, and half of these would be classified as severely depleted. It is recommended that the use of these standards and this method of interpretation be abandoned and replaced by the use of tables of percentiles for the U.S. population.