Protocolo de avaliação e assistência nutricional a pacientes em uso de terapia nutricional enteral domiciliar

Abstract

Introduction: due to the demographic transition, there has been an increase in the elderly population, together with chronic non-communicable diseases (NCDs) that can lead to physical, physiological and psychological disabilities. However, it is very common for these patients to be followed up at their homes to need Home Enteral Nutritional Therapy (DNED), which is nutritional assistance related to the administration of nutrients through enteral nutrition at home. Objectives: to assess the effects of the use of enteral formulas on the nutritional status of patients hospitalized at home, identify the main clinical outcomes, establish and correctly implement a nutritional assistance protocol, in addition to developing guidance strategies to help caregivers during the adaptation period. Methods: this is a prospective cohort study of the quali-quantitative type approved by the Ethics Committee for Research in Human Beings under protocol number 3.820.760. The research was carried out with the population of patients aged 20 years or over, of both sexes, using TNED via probe, from January 2020 to March 2021. Patients who ate orally were excluded, parenteral and who used enteral nutrition for a period of less than 30 days. A diagnosis of nutritional status was performed using various nutritional assessment instruments, in addition to analyzing nutritional therapy, presence of pressure injuries (LPP), gastrointestinal complications and clinical outcomes at three times: beginning of the assessment, with three months and six months of follow-up. Statistical analysis of data was performed using the IBM Statistical Package for Social Sciences (SPSS) software, with a significance level of 5%. Results: most patients had malnutrition in all diagnoses, however, with improved nutritional status throughout the research, showing a significant association in the diagnoses of body mass index (BMI), Subjective Global Assessment (SGA) and Mini Nutritional Assessment (MAN) between the period evaluated (p=0.01), 59.3% of the patients received a high-protein diet at the end of the study and LPP was absent in 70.4% of the subjects. The most prevalent complication was constipation in 35.9% of patients, 10.9% of those evaluated died and there were 4.7% readmissions. Developed products: six products were developed: 1) clinical protocol to support the practice of nutritionists in the context of TNED in AD, 2) practical manual on TNED, 3) video with guidance to caregivers, 4) integrative review article portraying the theme in question and 5) original article on the topic in question and 6) extended abstract published in online congress proceedings. Conclusion: there was an improvement in nutritional status, with a small percentage of deaths and readmissions during the follow-up period and few reported complications, thus concluding that TNED can contribute to improving the nutritional status of individuals. In addition, the products developed can help in the diagnosis of nutritional status, lead to an improvement in the care provided throughout the period of home care and guide caregivers to better monitor their patients.