HLTEN504A - INCP Nutritional assessment & Assist with Meals

Nutritional assessment General appearance – noting:- Skin colour, Texture, Bruising; Hair; Eyes; Nails; Posture Weight – 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 image Cognitive 1.Confusion 2.Dementia

Anorexia Loss 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 frequently Provide food liked by the patient Suitable environment High caloric snacks Keep 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 bowl Privacy Dentures removed Place hand on forehead to provide support and comfort, splint abdomen if required Remove vomitus a.s.a.p. Remove soiled lined Wash face, hands and give oral hygiene Assist patient into position of comfort Report 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 Adult 1.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 meal Check the temperature of food and drinks Check for sharp bones or pips Consider 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 documentation During 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 failure Proteins are limited to minimise excessive amounts of uraemia – complete proteins are best Carbohydrates 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 output Monitor potassium intake to prevent hyperkalaemia Limit 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 pressure Low fat (especially saturated), low cholesterol to prevent further damage to the blood vessels and increase in body weight Fat in the diet to be monosaturated and/or omega-3 fatty acids Fluid 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 blocks Full 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 gravy Soft Plus tenderised meat, poultry, fish, soft casseroles, lettuce, tomatoes, soft fruit, cake, biscuits without nuts or coconut