Eating and DrinkingEating and Drinking

SHARON HARVEYSHARON HARVEY

20/04/0420/04/04

Eating and DrinkingEating and Drinking

AIMAIM

Raise awareness of Raise awareness of the factors that may the factors that may enhance or impede enhance or impede nutritional intake of nutritional intake of clients.clients.

Eating and DrinkingEating and Drinking

ObjectivesObjectives recall some factors influencing normal nutritional recall some factors influencing normal nutritional

needsneeds recall some factors contributing to inadequate recall some factors contributing to inadequate

nutritional intakenutritional intake understand why nutritional assessment is conductedunderstand why nutritional assessment is conducted understand what contribution nursing can make in understand what contribution nursing can make in

meeting the client’s nutritional requirementsmeeting the client’s nutritional requirements understand what contribution other MTD members understand what contribution other MTD members

can make in meeting the clients nutritional needscan make in meeting the clients nutritional needs

Assessing Nutritional NeedsAssessing Nutritional Needs

Assessment is integral to holistic patient careAssessment is integral to holistic patient care

Malnourishment in institutional care is a big Malnourishment in institutional care is a big problem, up to 40% of patients may be problem, up to 40% of patients may be malnoursihed at any given time malnoursihed at any given time

There are numerous barriers to provide There are numerous barriers to provide adequate nutrition (physical, environmental adequate nutrition (physical, environmental and psychological)and psychological)

One of the roles of the nurse is also to One of the roles of the nurse is also to promote a healthy dietpromote a healthy diet

What are nutrients?What are nutrients?

ProteinsProteins

FatsFats

CarbohydratesCarbohydrates

VitaminsVitamins

MineralsMinerals

WaterWater

FibreFibre

Factors influencing Nutritional NeedsFactors influencing Nutritional Needs

AgeAge

GenderGender

Height and BuildHeight and Build

Physical activityPhysical activity

PregnancyPregnancy

LactationLactation

Factors contributingFactors contributing to inadequate nutritionto inadequate nutrition

Loss of appetiteLoss of appetite

Stress Stress

Lack of knowledge and Lack of knowledge and skillsskills

ConfusionConfusion

ParanoiaParanoia

Nausea and vomitingNausea and vomiting

Nil by MouthNil by Mouth

Physical factorsPhysical factors

DependencyDependency

Lack of financeLack of finance

Increase requirements for nutritionIncrease requirements for nutrition

PHYSIOLOGICAL STRESSPHYSIOLOGICAL STRESS

PERI AND POST OPERATIVELYPERI AND POST OPERATIVELY

Assessing the Client’s Nutritional NeedsAssessing the Client’s Nutritional Needs

MeasuringMeasuring

Body Mass IndexBody Mass Index

Growth ChartsGrowth Charts

ObservingObserving

Observation skills during AssessmentObservation skills during Assessment

Do clothes & dentures fitDo clothes & dentures fit

Sunken eyes in socket - dehydrationSunken eyes in socket - dehydration

Halitosis – poor dental health, dehydrationHalitosis – poor dental health, dehydration

Level of mobilityLevel of mobility

Drooling – poor swallow reflexDrooling – poor swallow reflex

behaviourbehaviour

Observe food intake. Observe food intake.

Observation skills during AssessmentObservation skills during Assessment

Questioning the Questioning the patient /relativepatient /relative current weight, current weight,

previous pattern of previous pattern of weight gain/ lossweight gain/ loss

Special dietsSpecial diets diabeticdiabetic Normal eating Normal eating

patternpattern

Nutritional Assessment ToolsNutritional Assessment Tools

Screening by these tools should be undertaken Screening by these tools should be undertaken duringduring:: admissionadmission regular intervals in acute or long term settingsregular intervals in acute or long term settings

Nutritional tools have the following:Nutritional tools have the following: BMI changesBMI changes evidence of dietary consumptionevidence of dietary consumption mobility and capabilitymobility and capability physical symptomsphysical symptoms psychological statepsychological state

Nutritional Assessment ToolsNutritional Assessment Tools

Goals of nutritional assessmentGoals of nutritional assessment::

identify clients at risk of protein-identify clients at risk of protein-energy malnutrition, or specific energy malnutrition, or specific nutrient deficienciesnutrient deficiencies

identify clients at risk of identify clients at risk of developing malnutrition related developing malnutrition related complicationscomplications

monitor efficacy of nutritional monitor efficacy of nutritional therapytherapy

Nursing InterventionNursing Intervention

If the patient has been identified to be at nutritional risk, If the patient has been identified to be at nutritional risk,

a referral may be made to a dieticiana referral may be made to a dietician..Position the patient in an upright position. Encourage Position the patient in an upright position. Encourage patients to sit out of bed during meal times.patients to sit out of bed during meal times.

For patients on bed rest in a supine position, log roll and For patients on bed rest in a supine position, log roll and place pillows behind back, to prevent choking food.place pillows behind back, to prevent choking food.

Ensure choice of food, with appropriate size of meal for Ensure choice of food, with appropriate size of meal for the patient;s needs.the patient;s needs.

Place food within reach of patient, and ensure they are Place food within reach of patient, and ensure they are aware that food is in front of them.aware that food is in front of them.

Nursing InterventionNursing Intervention

For the visually impaired patient, use the clock methodFor the visually impaired patient, use the clock method..Provide appropriate cutlery, lipped plates, non-slip mats. An Provide appropriate cutlery, lipped plates, non-slip mats. An

O.T may help provide you with necessary equipmentO.T may help provide you with necessary equipment..Eating with the patient may prompt them to eat. Eating with the patient may prompt them to eat.

For the paranoid patient, eating some of his food may dispel For the paranoid patient, eating some of his food may dispel

fear that the food is poisonedfear that the food is poisoned..Encourage patients to eat their own snacks, if appropriate.Encourage patients to eat their own snacks, if appropriate.

Ensure food is of the correct consistency, patients who have Ensure food is of the correct consistency, patients who have swallowing difficulties will require thickened fluids .swallowing difficulties will require thickened fluids .

You may need to assist with feeding, cutting food and provide You may need to assist with feeding, cutting food and provide

encouragement to the patientencouragement to the patient..

Serving of MealsServing of Meals

The serving of meals in health care settings is controlled by Food Hygiene The serving of meals in health care settings is controlled by Food Hygiene Regulations.Regulations.

In the NHS food is either cooked by a catering department or delivered In the NHS food is either cooked by a catering department or delivered from another hospital as cook chilled delivery.from another hospital as cook chilled delivery.

Practice may vary between wards and settings, but personnel from Practice may vary between wards and settings, but personnel from catering may serve food under the guidance of nursing staff or nursing catering may serve food under the guidance of nursing staff or nursing staff themselves may serve food.staff themselves may serve food.

All food has to be cooked and stored at the correct temperature, in order All food has to be cooked and stored at the correct temperature, in order to reduce the risk of food poisoning.to reduce the risk of food poisoning.

Personal hygiene is very important when serving meals.Personal hygiene is very important when serving meals. Washing of handsWashing of hands wearing of a disposable apron not used for other nursing care of the wearing of a disposable apron not used for other nursing care of the

patient patient

Serving of MealsServing of Meals

Personal hygiene is very important when serving meals.Personal hygiene is very important when serving meals. washing of handswashing of hands wearing of a disposable apron (different colour coded) wearing of a disposable apron (different colour coded)

not used for other nursing care not used for other nursing care wearing serving gloveswearing serving gloves washing hands after serving of mealswashing hands after serving of meals washing hands before and after going to the toiletwashing hands before and after going to the toilet

Food will be tested by a temperature probe before it is Food will be tested by a temperature probe before it is served to ensure that it has been cooked properly before served to ensure that it has been cooked properly before

being served to the patientbeing served to the patient. .

Common cause of Food PoisoningCommon cause of Food Poisoning

Food prepared too far in advanceFood prepared too far in advance

Food stored at room temperature or not refrigeratedFood stored at room temperature or not refrigerated

Cooling food too slowly prior to refrigerationCooling food too slowly prior to refrigeration

Not re-heating food to high enough temperature to Not re-heating food to high enough temperature to destroy food poisoning bacteriadestroy food poisoning bacteria

Undercooking meat and meat productsUndercooking meat and meat products

Not thawing frozen meat and poultry for sufficient timeNot thawing frozen meat and poultry for sufficient time..Cross contamination from raw cooked foodCross contamination from raw cooked food

Storing hot food below 63CStoring hot food below 63C

Infected food handlers.Infected food handlers.

MDT involved with Nutritional CareMDT involved with Nutritional Care

Identify other members of the MDT who are Identify other members of the MDT who are involved with nutritional care:involved with nutritional care:

Physicians can treat the underlying Physicians can treat the underlying medical causemedical cause

Pharmacists will advise physicians, Pharmacists will advise physicians, particularly involved with enteral and particularly involved with enteral and parenteral nutrition.parenteral nutrition.

Dentists can assist patients with Dentists can assist patients with denture or dental problems.denture or dental problems.

Health Visitors can provide general Health Visitors can provide general advice on healthy eating to families for advice on healthy eating to families for their young children.their young children.

Psychologists may help the person who Psychologists may help the person who has an eating disorder.has an eating disorder.

MDT involved with Nutritional CareMDT involved with Nutritional Care

Dieticians provide comprehensive assessmentDieticians provide comprehensive assessment..

Speech and Language Therapists, assist patients of all ages Speech and Language Therapists, assist patients of all ages and abilities with chewing and swallowing problems.and abilities with chewing and swallowing problems.

Physiotherapist, may help with motor problems; and help Physiotherapist, may help with motor problems; and help positioning.positioning.

Occupational Therapist help identify suitable feeding or position Occupational Therapist help identify suitable feeding or position aids to promote independence.aids to promote independence.

Social Workers can arrange home care packages.Social Workers can arrange home care packages.

Enhancing Patient’s Nutritional IntakeEnhancing Patient’s Nutritional Intake

A wide range of nutritional supplements are available:A wide range of nutritional supplements are available: some are added to person’s normal diet e.g powdered some are added to person’s normal diet e.g powdered

glucose polymers (Maxijul or Polycal)glucose polymers (Maxijul or Polycal) some are to be taken as drinks between meals (Fortisip).some are to be taken as drinks between meals (Fortisip).

A dietician can advise which of the above is appropriate A dietician can advise which of the above is appropriate after a comprehensive nutritional assessment.after a comprehensive nutritional assessment.

If a patient is unable to orally intake nutritional If a patient is unable to orally intake nutritional supplements and food, the following will occur:supplements and food, the following will occur: enteral feeds may be prescribedenteral feeds may be prescribed parenteral feeds may be prescribedparenteral feeds may be prescribed

Promoting Healthy EatingPromoting Healthy Eating

A number of factors make healthy eating difficult in an A number of factors make healthy eating difficult in an institutional setting:institutional setting:

limited access by carers to food, and food regulations will limit limited access by carers to food, and food regulations will limit meal times and storage of food in the clinical areas.meal times and storage of food in the clinical areas.

lack of staff may during mealtimes (staff may have their lack of staff may during mealtimes (staff may have their breaks, ward rounds may be going on, medication is being breaks, ward rounds may be going on, medication is being administered).administered).

Institutions may not cater for mainstream cultural differences.Institutions may not cater for mainstream cultural differences.

Nurses may have lack of information of the patient’s Nurses may have lack of information of the patient’s nutritional preferences, (lack of relatives, state of nutritional preferences, (lack of relatives, state of consciousness of the patient, orientation)consciousness of the patient, orientation)

Enteral FeedingEnteral Feeding

Used to supplement or Used to supplement or completely replace oral completely replace oral feeding.feeding. nasogastric tubenasogastric tube gastrostomygastrostomy

N/G tubes can be used for N/G tubes can be used for short term problemsshort term problems

Gastrostomy tubes are Gastrostomy tubes are used for long term used for long term problem or permanent problem or permanent problemsproblems

Parenteral FeedingParenteral Feeding

Can be used for patients who are unable to use their Can be used for patients who are unable to use their G.I. Tract.G.I. Tract.

It may be temporary or long term , after major It may be temporary or long term , after major surgery of the G.I. Tract.surgery of the G.I. Tract.

It involves administration of all substances needed It involves administration of all substances needed to meet nutritional needs directly into the patient’s to meet nutritional needs directly into the patient’s blood circulation.blood circulation.

ConclusionConclusion

““Nurses have an implicit responsibility for ensuring patients Nurses have an implicit responsibility for ensuring patients are fed” are fed”

““While registered nurses may of course delegate the task While registered nurses may of course delegate the task of feeding the patients, for example to unregistered of feeding the patients, for example to unregistered practitioners, the overall responsibility remains with the practitioners, the overall responsibility remains with the registered nurse”registered nurse” - Registrar’s Letter 11/97- Registrar’s Letter 11/97