2. Feeding a Patient  Nurses need to refine their feeding skills to assist patients in maintaining: Nutritional Status Independence Dignity 2rev 4/2013

3.  Why follow a recommended diet plan?  What tools are used in planning and evaluating a diet for adequacy? 3rev 4/2013

4.  MyPlate is divided into sections of approximately 30 percent grains, 30 percent vegetables, 20 percent fruits and 20 percent protein, accompanied by a smaller circle representing dairy, such as a glass of low-fat/nonfat milk or a yogurt cup.grains vegetablesfruitsproteindairy milkyogurt 4rev 4/2013

5.  What are the consequences if a person has increased nutritional intake versus the person who has decreased nutritional intake? Increased nutritional intake Decreased nutritional intake Anorexia Obesity or 5rev 4/2013

6.  What are examples of what the nurse can remove to not have any unpleasant sights?  How can a nurse remove any obnoxious odors?  How can the nurse ensure the over- bed table is clean?  How can the nurse provide good lighting? 6rev 4/2013

7.  Remove any unpleasant sights – i.e. urinals, wound dressings, emesis basin, used alcohol wipes, old milk, prior meal  Remove any obnoxious odors – i.e. bedside commode, wound dressings, emesis, diapers, open meal cover away from the patient to avoid the odor of all the mixed foods.  Clean the over-bed table – i.e. wipe with a washcloth any sticky stuff  Provide good lighting – i.e. ask the patient if they want their window blinds open, lights on 7rev 4/2013

8. What is the highest priority when preparing a patient to eat? A. Apply any special devices B. Assemble needed supplies to facilitate feeding. C. Assess swallow reflex D. Assist patient to urinate or defecate prior to the mealtime E. Place in comfortable position F. Provide oral hygiene- food will taste better G. Provide with clothing protectors H. Provide with dentures or eyeglasses 8rev 4/2013

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10. List five strategies used to assist with eating: 1. _______________________________ 2. _______________________________ 3. _______________________________ 4. _______________________________ 5. _______________________________ 10rev 4/2013

11. 1. Assess tray for completeness, correct diet, order changes 2. Wash hands before serving & handling food. 3. Sit in chair next to patient 4. Allow patient to eat in order and speed of choice, and the amount requested 5. **Do NOT Hurry patient 6. Cut food in bite size pieces 7. Document 8. See page 1184 for additional strategies 11rev 4/2013

12.  Feed patient, putting one type of food on utensil at a time  Provide fluids as requested  Use time to develop rapport with patient  At end of meal ◦ Wash hands ◦ Provide mouth care ◦ Assist to comfortable position, which may need to be upright  Document 12rev 4/2013

13. These patients can feed self when given adequate information  Identify the food location on the plate as if it were a clock (meat at 12:00, potatoes at 3:00 asparagus at 9:00)  Place food in similar location for each meal  Open containers, cut up food, apply condiments, have it ready for the patient to eat. 12:00 3:009:00 6:00 13rev 4/2013

14.  Which of the following actions is most important in maintaining safety when feeding a patient? a. Checking the temperature of the food b. Providing clothing protectors c. Removing items from the overbed table d. Removing obnoxious odors 14rev 4/2013

15. first  If patient is at risk for aspiration, check the swallowing and gag reflex first.  Check temperature—do not burn patient  Put in upright position  Do not feed patient who is asleep, unresponsive, choking, unable to swallow. 15rev 4/2013

16. What does aspiration mean? A. Difficulty swallowing B. Misdirection of contents into the respiratory tract. 16rev 4/2013

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18. 1. Assess the patient for increased risk of aspiration – observe at mealtime for dysphagia. 2. Elevate head of bed 3. Add thickener to thin liquids to create consistency of honey. (Thin liquids such as water, sodas, juices, soups are difficult to control and lead to aspiration). 4. Provide smaller bites. Place ½ to 1 teaspoon of food on unaffected side of the mouth, allowing utensil to touch the mouth or tongue. 5. May need to place hand on throat to gently palpate swallowing event as it occurs. May need to swallow twice. 6. Feed slowly, allow patient to chew thoroughly and swallow the bite before taking another. 7. Allow to empty mouth after each spoonful. 18rev 4/2013

19.  Which of the following would decrease the risk of aspiration during feeding? (select all that apply) 1. Sit the patient upright in a chair 2. Give liquids at the end of the meal 3. Place food in the strong side of the mouth. 4. Provide thin foods to make it easier to swallow. 5. Feed the patient slowly, allowing time to chew and swallow. 6. Encourage patient to lie down and rest for 30 minutes after a meal 19rev 4/2013

20.  If a patient questions anything on tray, check the doctor’s order for possible changes that the dietary department did not know about.  If the patient chokes, turn head to the side, sweep any food out of the mouth. If no food is present, may need to perform the Heimlich maneuver. 20rev 4/2013

22.  The health care provider’s orders included: 1. NPO after midnight. What does this mean?  What comfort measures can the nurse provide for the patient who is NPO? 22rev 4/2013

23.  Clear liquid ◦ Contains liquids that are without pulp or foods that liquefy at room or body temperature. ◦ Most often used after surgery, or with patients with diarrhea or vomiting. ◦ What are examples of foods allowed on this diet? 23rev 4/2013

24.  Full liquid ◦ Addition of calories, about 1500 and provides more nutrients than a clear liquid diet ◦ What are examples of foods allowed on this diet? 24rev 4/2013

25.  Soft Diet ◦ Used as a transition to the regular diet or for those who have difficulty eating ◦ Designed to be chewed and provide minimal fiber. Low fiber is without brans, strong vegetables, grains, raw fruit or vegetables ◦ Mechanical soft – food is chopped, ground, or pureed-for those with difficulty with chewing / poor teeth  Flaked fish, ground or finely diced meats  Cottage cheese, rice, potatoes, pancakes  Bananas, fruits, peanut butter  Cooked vegetables 25rev 4/2013

26.  Regular Diet ◦ Contains approximately 2,500 calories ◦ Consists of appropriate serving from a variety of food groups to meet nutritional needs. ◦ Has no restrictions 26rev 4/2013

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30.  The nurse delivers the meal tray to the patient. The patient says that the HCP said his diet would be changed to a regular diet instead of a full liquid.  What will the nurse do? 30rev 4/2013

31.  If the patient is on a clear liquid diet and the lunch tray is brought to the room with: ◦ Chicken broth ◦ Milk ◦ Tea ◦ Custard ◦ What will the nurse do? 31rev 4/2013

32.  Mrs. Brown has eaten 10% of food on tray. The nurse asks Mrs. Brown why she is not eating.  Mrs. Brown responds by saying, “I do not like this food.”  Mr. Brown offers to bring in food from home that his wife enjoys.  What is the nurses response? Should the nurse allow the family to bring in food from the outside? What is the criteria? 32rev 4/2013