objectives at the completion of this unit you will be able to: 1) describe nursing interventions for...
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OBJECTIVESAT THE COMPLETION OF THIS UNIT YOU WILL BE ABLE TO:1) DESCRIBE NURSING INTERVENTIONS FOR PATIENTS WITH SPECIAL DIETARY NEEDS (IMPAIRED SWALLOWING, SPECIAL DIETS, SELF-CARE DEFICITS, & NPO STATUS
Fundamentals of NursingFeeding & Meal Preparation
Instructor: R. Hanock
Nutrition & Meal Preparation
Objectives continued2) Identify and discuss nursing interventions that correct or prevent imbalanced nutrition
Reading AssignmentBurton fundamentals textbook:
pages: 497-501, 526-527 (skill 24-1)
Syllabus: Nutrition & Meal Preparation
I. Assisting patients with mealsII. Nutrition and health relationshipsIII.Diet consistency modification IV. Impaired swallowing
Nutrition & Meal Preparation: Assisting with Meals
Recommendation: one staff member for every three patients requiring feeding assistance; supervised by licensed personnel.
Allow up to 30 minutes to complete a meal; prolonging or hurrying meal time both have negative impacts on appetite.
Depending on client conditions, clients should eat in chair, preferably in a dining room. If client must remain in bed, put the HOB in the highest position tolerated
Nutrition & Meal Preparation: Assisting with Meals
Assist only when necessary; encourage independence
Attempt to make meal time a social event: encourage family members to be present.
Assess for rituals before meals: prayers, blessings of food
Provide music during mealtime while being sensitive to client preferences.
Nutrition & Meal Preparation: Assisting with Meals
Offer food choices and control over how foods are prepared; encourage friends and family to bring in favorite foods
Offer pain control at least 20 minutes before the meal
Avoid intake of large amounts of fluids full feeling
Provide a friendly, clean, and odor free environment
Nutrition & Meal Preparation: Assisting with Meals
Protect patient’s privacy and from embarrassment
(How would you feel about wearing a bib?) • Proper fitting dentures• Provide opportunity for hand washing,
toileting, and oral hygiene prior to meals.• Most often a patient can feed himself after
cartons are opened, meats are cut, & other preparations are made.
Nutrition & Meal Preparation: Assisting with Meals
When Feeding:Only feed those who can not feed
themselves; do not feed them because they are too slow.
Always provide adequate time to chew and swallow (aspiration precautions)
Ask which foods they would like nextHave casual conversations
Nutrition & Meal Preparation: Assisting with Meals
Assisting Patients with Dementia• Assess individual feeding abilities and
present situation• Minimize distractions• Remove secondary food items from site
(i.e.: desserts, concentrated sweets, sodas) until priority food items are consumed.
• Remove unnecessary utensils and items that should not be eaten
• Cue verbally and use pantomime
Nutrition & Meal Preparation: Assisting with Meals
Visually Impaired• Name the items on the tray; include
details• Identify the locations of items on the
plate based on the face of a clock. Other items on the tray are to the right, left, or above the plate
• Ask what they would like you to prepare and open.
Nutrition & Meal Preparation: Assisting with Meals
After The Meal• Wash hands, face, oral care; restroom• Record the amounts of fluid and foods
taken• Document feeding behaviors• Nutritional status assessments:
involve multidisciplinary approach and time interval comparisons
Nutrition & Meal Preparation: Assisting with Meals
Nutritional Needs Assessment• Ability to chew and swallow• Food tolerances, allergies, and
preferences• Cultural and religious practices• Diet modifications related to medical
conditions
Nutrition and Health Relationships
Nutritional Deficiencies • Poor, elderly, less educated are prone to
nutritional problems because they make poor food choices
• Disease, illness, and delays in achieving growth and development milestones
• Attention deficits, behavioral & psychiatric disorders
• School meal programs have been overhauled
Nutrition and Health Relationships
Decreased income is often a barrier, but nutritious food is available on a limited income.
EDUCATION
Nutrition and Health Relationships
Decreased nutritional intake physical problems such as poor wound healing and decreased ability to combat physical stress (illness)
Nursing interventions improved nutritional intake and appetite
Anxiety, pain, & fatigue anorexiaGastric distention and bloating is relived
by offering smaller and more frequent meals
Nutrition and Health Relationships
Gastroesophageal Reflux : Certain foods cause GI irritation and
reflux: fatty foods, chocolate, alcohol, fruit juices, acidy foods, smoking, & some medications
Keep HOB up 45 degrees or more for at least 90 minutes before laying down
Avoid eating and drinking for 90 minutes before bedtime
Avoid bending over
Nutrition and Health Relationships
Glucose Intolerance• Increased intake of sugars (sweets) initial
glucose level elevation hypoglycemia• Increased production of insulin• Avoid concentrated sweet and refined
sugars• Complex carbohydrates are better tolerated• Smaller and more frequent meals may be
better tolerated
Nutrition and Health Relationships
Decreased Intestinal Peristalsis• Prevent constipation and promote bowel
regularity and optimal function• Fiber: 5 servings of fruits and vegetables
is recommended• Prunes and apples are an effective
remedy• High fiber diet also prevents GI diseases
such as diverticulosis and diverticulitis
Diet Consistency Modification
Please complete the “Diet Consistency Modification Guided Reading Assignment”
Impaired Swallowing: Causes
Dysphagia: difficulty swallowing• Neurological disorders: CVA, cerebral palsy,
cranial nerve disorders, altered mental status
• Mechanical obstructions: inflammation, over-growth or oropharynx structures, tumors
Impaired Swallowing : Assessment
You note that your new client coughs and gags easily as a family member assists her while eating.
How do you intervene?
Impaired Swallowing: Assessment
Assessment of cough and gag reflexReflexes may be absent, weak, or
over-active report immediatelySwallowing evaluations, speech
therapyhttp://www.youtube.com/watch?v=_e4
LciuRyCABedside Swallow Screen - YouTube
Impaired Swallowing: Nursing Interventions
Aspiration precautions• Observe LOC, cough & gag reflex, &
swallowing ability• Position patient upright when eating
or drinking (ideally 90 degrees)• Suction set up at bed side• Feed in small amounts
Impaired Swallowing: Nursing Interventions
Aspiration precautions continued• Avoid thin liquids, use thickening
agents• Cut food into small pieces and modify
consistency as needed• Keep HOB elevated or patient upright
for one hour after eating or drinking
Impaired Swallowing: Nursing Interventions
Avoid the use of strawsAvoid thin liquids, use thickening
agentsForward flex the head while
swallowing (chin tuck)Place food toward the back of the
mouth and on the unaffected sideAssess for pocketing of foodRoutine body weights