objectives at the completion of this unit you will be able to: 1) describe nursing interventions for...

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


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.


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


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.


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


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


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.


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


Nutritional Needs Assessment• Ability to chew and swallow• Food tolerances, allergies, and

preferences• Cultural and religious practices• Diet modifications related to medical

conditions


Kosher Diet

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


Decreased income is often a barrier, but nutritious food is available on a limited income.

EDUCATION


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


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


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


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


Foods High in Fiber

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

Dysphagia Risk for Aspiration

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

http://www.youtube.com/watch?v=_e4LciuRyCA

http://www.youtube.com/watch?v=_e4LciuRyCA

https://www.youtube.com/watch?v=x_sssJErd6U

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


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


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

Review and Practice Activities

Video Activity: “Feeding the Patient”Using Thick-it activityWork book questions: p. 204-205

(11,13,16,20,24,25,26,27)Review and practice skill 24-1 (p. 526-7) Role Playing:

Feeding a client with hemiplegia (CVA)

Feeding a blind patient

objectives at the completion of this unit you will be able to: 1) describe nursing interventions for...

Documents

meal prolonging

hurrying meal time

locations of items

priority food items

mealsassisting patients

nursing interventions

mealsprotect patients

mealswhen feeding