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

3.  Altered activity level  Decreased mobility  Illness  Physical impairments that limit self-feeding such as hemiplegia, fractured arm, burns, cancer, surgery, or generalized weakness.  The presence of intravenous catheters or tubing’s, dressings, and bandages  Some elderly patients may require feeding assistance because of the physical alterations associated with aging.  Neurologically or orthopedically impaired patient who may be unable to manipulate feeding utensils.

4.  Culture  Religion  Personal preference  Mental cognition. When individuals are depressed, lonely, apathetic, fearful, grieving, or feeling hopeless, nutritional intake usually decreases.  Being fed by another person may have psychological implications. The increased need for feeding assistance may lead to depression, because patients feel they are a burden to either the staff or their family.

5.  Some common nursing diagnosis that relate to the individual with a nutritional intake problem include: ◦ Altered nutrition: less than body requirements RT: ◦ Self-care deficit: feeding RT:

6.  The patient will: 1. 2. 3.

7.  Remove any unpleasant sights  Remove any obnoxious odors  Clear the over-bed table  Provide good lighting  Set up chair for the nurse

8.  Assist patient to urinate or defecate prior to the mealtime  Provide oral hygiene  Provide with dentures or eyeglasses  Place in comfortable position  Apply any special devices  Provide with clothing protectors  Assemble needed supplies to facilitate feeding.

9.  Wash hands before handling food and serving trays  Identify the diet tray for particular patient  Assess tray for completeness and correct diet  Prepare tray to meet patient’s needs  Check temperature of food  Place tray at height and position so it is easy for the patient to access.

10.  Wash hands before handling food and serving tray  Identify the diet tray for the patient  Assess tray for completeness, correct diet, order changes  Sit in chair next to patient  Allow patient to eat in order and speed of choice, and the amount requested **Do NOT Hurry patient  Cut food in bite size pieces

11.  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  Document

12. first  If patient is at risk for aspiration, check the gag reflex first.  Check temperature—do not burn patient  Do not feed patient who is asleep, unresponsive, choking, unable to swallow, unable to elevate head 45 0, or whose head is tilted backwards or downwards.  Feed patients with swallowing difficulties semi-solid foods that will not choke the patient.

13.  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 should get choked, turn to the side, sweep any food out of the mouth. If no food is present, may need to perform the Heimlich maneuver.

14.  You deliver a tray to your patient and he says that the doctor said he could have a regular diet today instead of a full liquid.  What would you do?

15.  Clear liquid ◦ Contains liquids that are thin and without pulp or foods that liquefy at room temperature. ◦ Most often used after surgery, or with patients with diarrhea of vomiting ◦ Examples:  Apple juice, ginger ale. Gelatin  Decaffeinated coffee, tea, broth  Fruit ices, or Popsicles ◦ Temporary diet

16.  Full liquid ◦ Addition of calories, about 1500 and provides more nutrients than a clear liquid diet ◦ Examples:  Milkshakes, all juices  Blenderized foods  Custards and puddings  Eggnog  Creamed soups

17.  If the patient is on a clear liquid diet and the lunch tray is brought to the room with: ◦ Chicken broth, milk, tea, and custard ◦ What would the nurse do?

18.  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 in fiber and devoid of brans, grains, strong vegetables, raw fruit or vegetables ◦ Mechanical soft – food is chopped, ground, or pureed-for those with difficulty with chewing / poor teeth

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

20.  Diabetic diet ◦ Contains specified calorie intake and certain foods that are allowed to meet that intake goal  Cardiac diet ◦ Low in saturated fat, cholesterol, and salt  Low Salt diet ◦ Used for patients with hypertension

21.  Kidney diet ◦ Used for patients with kidney disease. ◦ Protein restriction with restrictions of fluid, sodium, potassium, phosphorus  Liver Diet ◦ Used for patients with liver disorder ◦ Low in protein, high in CHO, vitamins ◦ Sodium, fluid may be restricted  Gastrointestinal Diet ◦ Avoid foods that increase stomach acid ◦ May have increase or decrease in fiber

22.  The nurse notes that Mrs. Brown has eaten about 10% of food on tray. The nurse is concerned about her nutritional status and asks Mrs. Brown why she is not eating.  Mrs. Brown responds by saying that it is not the type of food that she eats. Mr. Brown offers to bring in food from home that she likes.  What is the nurses response? Do you allow the family to bring in food from the outside? What is the criteria?