HLTEN504A - INCP

Nutritional assessment &

Assist with Meals

Nutritional assessment

General appearance – noting:-• Skin colour, • Texture, • Bruising; • Hair; • Eyes; • Nails; • PostureWeight – • Ask about recent changes in

weight; • BMI; • Waist/hip ratio;• Distribution of fat deposits

Nutritional assessment (cont)

Daily intake – • Special diets or preferred foods; • Appetite; • Likes, dislikes, • Allergies;Alterations in consumption• Nausea, vomiting; • Indigestion; • Swallowing, chewing;

Nutritional assessment (cont)

Activity levels

Cognitive function – self directed, dependent

Alcohol consumption

Medications – sedatives, analgesics

Elimination patterns

Diseases related to nutrition

• Obesity• Atherosclerotic vascular

disease• Large bowel cancer• Alcohol - Cirrhosis of the

liver, heart failure, brain damage, nerve damage, vitamin deficiencies, pancreas damage

• Vitamin deficiencies • Dental caries

Causes of altered nutrition

Physical

• GI disorders, • Mobility • Dexterity • Food sensitivities, • Nausea/vomiting

Psychological

1. Depression

2. Self-concept

3. Body imageCognitive

1. Confusion

2. Dementia

AnorexiaLoss of appetite in the presence of a physiological need for food.

It is a common symptom of gastrointestinal and endocrine disorders e.g. • Appendicitis • Gastritis • Hepatitis • Crohn’s disease, • Ketoacidosis • Hyperthyroidism

Causes of anorexia

Anxiety

Chronic pain

Increased blood temperature

Alterations in taste or smell

Alcoholism

Drugs

Cancer

Radiation therapy

Nursing interventions for anorexia

Offer small meals frequentlyProvide food liked by the patientSuitable environmentHigh caloric snacksKeep fat content of food to a minimum

Nausea and vomiting

Categorising nausea and vomiting

Pathological – due to disease process e.g. obstruction

Iatrogenic – relating to treatment e.g. chemotherapy

Psychological – relating to emotional response

Vomiting centres

Complications of vomiting

Malnutrition

Dehydration

Electrolyte imbalance

Dehiscence of wound

Aspiration

Nursing interventions for vomiting

Positioning and emesis bowlPrivacyDentures removedPlace hand on forehead to provide support and comfort, splint abdomen if requiredRemove vomitus a.s.a.p.Remove soiled linedWash face, hands and give oral hygieneAssist patient into position of comfortReport and record

Observation of vomitus

Quantity

Presence of blood

Odour

Consistency

Colour

HLTEN504A - INCP

Assisting clients with meals

Feeding across the life span

Newborns• Milk

Toddler• Variety of foods• Full fat (usually)

Child• Variety • Lowe fat• Reduced sugar

Adolescent• Variety• Low fat• Reduced sugar

Adult1. Variety

2. Low fat

3. Low salt

4. Low sugar

Aged 1. Variety

2. Low fat

3. Low salt

4. Low sugar

5. Increased protein (if kidney function permits)

Assisting the client with oral nutrition• Determine the type of diet that the person can

tolerate• Assess the person's ability to swallow• Determine the person's ability to self-feed• Assess the person's appetite, tolerance to food, likes

and dislikes• Assess whether the person has food allergies

EMAP Healthcare

Prepare the room for mealtime

• Remove any unpleasant odours and sights• Clear over bed table• Set up chair for client and for nurse

EMAP Healthcare

Prepare patient for meals

Assess need to urinate or defaecate

Person to wash hands

Assist with mouth care - dentures in, mouth moist

Ensure person has glasses or contacts in place

Assist the person into a comfortable sitting position

Ensure that person has serviette and special devices to facilitate feeding if required

Assisting with meals

Let patient see and smell the mealCheck the temperature of food and drinksCheck for sharp bones or pipsConsider individual preferences e.g use of condiments, one food at a time or meat and vegetables together

EMAP

Assisting with meals (cont)

Sit down to feed patient

Don't rush or present too much with each mouthful, use a gentle action

Feed person in a manner that facilitates chewing and swallowing• Elderly person: feed small amounts at a time,

assessing chewing, swallowing and fatigue• Neurological person: feed small amounts at a time

and assess for ability to chew, manipulate tongue to form a bolus and swallow. Give small amounts of fluids and assess swallowing

Assisting with meals (cont)

Provide fluids as requested.

Do not allow person to drink all liquids at beginning of meal

Encourage independence

Attend to oral hygiene and comfort needs

Have patient sitting up for at least 30 minutes following meal

Evaluation and documentationDuring meal note person's ability to swallow

Assess person's tolerance to diet

Assess person's fluid and food intake

Assess person's ability to self-feed

Weight as directed in care plan

Documentation e.g. food chart, progress notes, etc

Reporting

Therapeutic diets

These diets are prescribed to • Rectify a nutritional deficiency• Decrease specific nutrients• Provide modification in the texture or consistency of

food• May be temporary or permanent

Renal failureProteins are limited to minimise excessive amounts of uraemia – complete proteins are bestCarbohydrates are increased to ensure

– Adequate caloric intake– Provide a protein sparing effect

Fluid intake is replacement of insensible loss (500ml) plus the equivalent of last 24-hours urinary outputMonitor potassium intake to prevent hyperkalaemiaLimit sodium to prevent the further retention of fluid and raising blood pressure

Diabetic Satisfy hunger

Provide enough energy and nutritional requirements for effective body function

Maintain desirable body weight

Maintain blood glucose within normal range

Prevent long-term complications

Three meals and three snacks per day

Low GI food

Cardiac Limit sodium to prevent raising blood pressureLow fat (especially saturated), low cholesterol to prevent further damage to the blood vessels and increase in body weightFat in the diet to be monosaturated and/or omega-3 fatty acidsFluid intake may be restricted to prevent further retention of fluid and the resulting stress on the heart

Modification of texture or consistency

Clear fluids• Broth, bouillon, coffee, tea, carbonated beverages,

clear fruit juices, gelatine, ice blocksFull liquid• Plus smooth textured dairy products, custards, refined

cooked cereals, vegetable juice, pureed vegetables, all fruit juices

Pureed• Plus scrambled eggs, purred meats, vegetables, fruits,

mashed potatoes and gravySoft• Plus tenderised meat, poultry, fish, soft casseroles,

lettuce, tomatoes, soft fruit, cake, biscuits without nuts or coconut