1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 23 Nutritional Care of Clients

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Objectives Describe how illness and surgery can affect nutrition of clients Identify and describe three or more nutrition- related health problems common among elderly clients needing long-term care (continues)

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Objectives Demonstrate correct procedures for feeding bed-bound clients Explain importance of adapting family’s meal to suit clients’ nutritional requirements

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nutritional Care Fever, nausea, fear, depression, chemotherapy, and radiation can destroy client’s appetite Vomiting, diarrhea, chemotherapy, radiation, and some medications can reduce or prevent absorption of nutrients

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. PEM When food intake does not meet body needs, body uses own stores of energy When glycogen and fat stores exhausted, body must break down own tissues to provide protein for energy Can be problem among hospitalized clients (continues)

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. PEM Can delay wound-healing, contribute to anemia, depress immune system, and increase susceptibility to infections Symptoms: –Weight loss and dry, pale skin Iatrogenic malnutrition –Malnourishment as result of hospitalization

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Improving the Client’s Nutrition Make formal nutritional assessments on regular basis All members of health care team should be alert to signs of malnutrition every day Listen to client’s concerns Watch reaction to food served Include dietitian in plan of care

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Feeding the Client At home, family menu should serve as basis for client’s meal whenever possible Omit or add certain foods as necessary Vary method of preparation if needed

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Serving the Meal Make tray and food arrangement as attractive as possible Serve water and another beverage Serve food at proper temperature (continues)

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Serving the Meal Ensure client is in comfortable position with tray and utensils placed conveniently Offer bedpan and hygiene care before and after meal Remove any unpleasant sights (continues)

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Serving the Meal Open containers and try to anticipate client’s needs Give sufficient time to eat –Reheat food as needed Document intake per facility policy

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Feeding the Client Who Requires Assistance Sit near side of bed Small amounts of food should be placed toward back of mouth with slight pressure on tongue with spoon or fork Do not feed client with syringe (continues)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Feeding the Client Who Requires Assistance If paralyzed, food and straw should be placed on non-paralyzed side of mouth If client begins to choke, help sit up straight Client diagnosed with dysphagia requires specialized diet –Should not use straw

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Feeding the Blind Client Arrange food as if plate were face of clock Use consistent pattern so client knows where each item will be each time Client usually feels better when helping self

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Problems of the Institutionalized Elderly Majority of people age 85 or more have at least one chronic disease –Conditions affect attitudes, physical activities, and appetites Thus, nutritional status PEM –Major problem (continues)

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Problems of the Institutionalized Elderly Anemia can develop and contribute to fatigue, confusion, and depression Provide sufficient animal protein and vitamin C in diet (continues)

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Problems of the Institutionalized Elderly Pressure ulcers can develop in bedridden clients –Must be prevented –Healing requires treatment of ulcer, relief of pressure, and high-calorie diet with sufficient protein, vitamin C, and zinc supplements (continues)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Problems of the Institutionalized Elderly Constipation can be caused by inadequate fiber, fluid, or exercise –Other causes: Medication, reduced peristalsis, or former abuse of laxatives –Treatment: Increasing fiber, fluid, and exercise (continues)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Problems of the Institutionalized Elderly Diarrhea can be caused by lack of muscle tone in colon –May be helpful to increase fiber in diet and combine with supplemental vitamins and minerals Sense of smell declines with age Appetite diminishes (continues)

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Problems of the Institutionalized Elderly Disease or medications can cause xerostomia –Dry mouth May be helpful to drink water, eat frequent, small meals, and chew sugar-free gums or candies (continues)

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physical Problems of the Institutionalized Elderly Dysphagia can result from stroke, closed head trauma, head or neck cancer, surgery, or Alzheimer’s and other diseases –Many clients must have thickened liquids –Clients should always be in upright position when eating

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Conclusion Illness and surgery can have devastating effects on client’s nutritional status PEM can be significant problem in hospitals Offer bed-bound clients bedpan and assistance with hygiene care before and after meals (continues)

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Conclusion Encourage clients to feed themselves –However, offer help and anticipate needs Client who is blind can eat more easily if food arranged in set pattern on plate Provide pleasant conversation and atmosphere (continues)

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Conclusion Record type of diet, time of meal, client’s appetite, and type and amount of food eaten Nutrition-related health problems in elderly can sometimes be relieved with proper treatment