Eating and Drinking

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Eating and Drinking

• SHARON HARVEY
• 20/04/04

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Eating and Drinking

• AIM
• Raise awareness of the factors that may enhance
  or impede nutritional intake of clients.

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Eating and Drinking

• Objectives
• recall some factors influencing normal
  nutritional needs
• recall some factors contributing to inadequate
  nutritional intake
• understand why nutritional assessment is
  conducted
• understand what contribution nursing can make in
  meeting the clients nutritional requirements
• understand what contribution other MTD members
  can make in meeting the clients nutritional needs

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Assessing Nutritional Needs

• Assessment is integral to holistic patient care
• Malnourishment in institutional care is a big
  problem, up to 40 of patients may be
  malnoursihed at any given time
• There are numerous barriers to provide adequate
  nutrition (physical, environmental and
  psychological)
• One of the roles of the nurse is also to promote
  a healthy diet

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What are nutrients?

• Proteins
• Fats
• Carbohydrates
• Vitamins
• Minerals
• Water
• Fibre

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Factors influencing Nutritional Needs

• Age
• Gender
• Height and Build
• Physical activity
• Pregnancy
• Lactation

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Factors contributing to inadequate nutrition

• Loss of appetite
• Stress
• Lack of knowledge and skills
• Confusion
• Paranoia
• Nausea and vomiting
• Nil by Mouth
• Physical factors
• Dependency
• Lack of finance

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Increase requirements for nutrition

• PHYSIOLOGICAL STRESS
• PERI AND POST OPERATIVELY

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Assessing the Clients Nutritional Needs

• Measuring
• Body Mass Index
• Growth Charts
• Observing

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Observation skills during Assessment

• Do clothes dentures fit
• Sunken eyes in socket - dehydration
• Halitosis poor dental health, dehydration
• Level of mobility
• Drooling poor swallow reflex
• behaviour
• Observe food intake.

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Observation skills during Assessment

• Questioning the patient /relative
• current weight, previous pattern of weight gain/
  loss
• Special diets
• diabetic
• Normal eating pattern

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Nutritional Assessment Tools

• Screening by these tools should be undertaken
  during
• admission
• regular intervals in acute or long term settings
• Nutritional tools have the following
• BMI changes
• evidence of dietary consumption
• mobility and capability
• physical symptoms
• psychological state

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Nutritional Assessment Tools

• Goals of nutritional assessment
• identify clients at risk of protein-energy
  malnutrition, or specific nutrient deficiencies
• identify clients at risk of developing
  malnutrition related complications
• monitor efficacy of nutritional therapy

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Nursing Intervention

• If the patient has been identified to be at
  nutritional risk, a referral may be made to a
  dietician.
• Position the patient in an upright position.
  Encourage patients to sit out of bed during meal
  times.
• For patients on bed rest in a supine position,
  log roll and place pillows behind back, to
  prevent choking food.
• Ensure choice of food, with appropriate size of
  meal for the patients needs.
• Place food within reach of patient, and ensure
  they are aware that food is in front of them.

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Nursing Intervention

• For the visually impaired patient, use the clock
  method.
• Provide appropriate cutlery, lipped plates,
  non-slip mats. An O.T may help provide you with
  necessary equipment.
• Eating with the patient may prompt them to eat.
• For the paranoid patient, eating some of his food
  may dispel fear that the food is poisoned.
• Encourage patients to eat their own snacks, if
  appropriate.
• Ensure food is of the correct consistency,
  patients who have swallowing difficulties will
  require thickened fluids .
• You may need to assist with feeding, cutting food
  and provide encouragement to the patient.

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Serving of Meals

• The serving of meals in health care settings is
  controlled by Food Hygiene Regulations.
• In the NHS food is either cooked by a catering
  department or delivered from another hospital as
  cook chilled delivery.
• Practice may vary between wards and settings, but
  personnel from catering may serve food under the
  guidance of nursing staff or nursing staff
  themselves may serve food.
• All food has to be cooked and stored at the
  correct temperature, in order to reduce the risk
  of food poisoning.
• Personal hygiene is very important when serving
  meals.
• Washing of hands
• wearing of a disposable apron not used for other
  nursing care of the patient

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Serving of Meals

• Personal hygiene is very important when serving
  meals.
• washing of hands
• wearing of a disposable apron (different colour
  coded) not used for other nursing care
• wearing serving gloves
• washing hands after serving of meals
• washing hands before and after going to the
  toilet
• Food will be tested by a temperature probe before
  it is served to ensure that it has been cooked
  properly before being served to the patient.

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Common cause of Food Poisoning

• Food prepared too far in advance
• Food stored at room temperature or not
  refrigerated
• Cooling food too slowly prior to refrigeration
• Not re-heating food to high enough temperature to
  destroy food poisoning bacteria
• Undercooking meat and meat products
• Not thawing frozen meat and poultry for
  sufficient time.
• Cross contamination from raw cooked food
• Storing hot food below 63C
• Infected food handlers.

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MDT involved with Nutritional Care

• Identify other members of the MDT who are
  involved with nutritional care
• Physicians can treat the underlying medical cause
• Pharmacists will advise physicians, particularly
  involved with enteral and parenteral nutrition.
• Dentists can assist patients with denture or
  dental problems.
• Health Visitors can provide general advice on
  healthy eating to families for their young
  children.
• Psychologists may help the person who has an
  eating disorder.

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MDT involved with Nutritional Care

• Dieticians provide comprehensive assessment.
• Speech and Language Therapists, assist patients
  of all ages and abilities with chewing and
  swallowing problems.
• Physiotherapist, may help with motor problems
  and help positioning.
• Occupational Therapist help identify suitable
  feeding or position aids to promote independence.
• Social Workers can arrange home care packages.

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Enhancing Patients Nutritional Intake

• A wide range of nutritional supplements are
  available
• some are added to persons normal diet e.g
  powdered glucose polymers (Maxijul or Polycal)
• some are to be taken as drinks between meals
  (Fortisip).
• A dietician can advise which of the above is
  appropriate after a comprehensive nutritional
  assessment.
• If a patient is unable to orally intake
  nutritional supplements and food, the following
  will occur
• enteral feeds may be prescribed
• parenteral feeds may be prescribed

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Promoting Healthy Eating

• A number of factors make healthy eating difficult
  in an institutional setting
• limited access by carers to food, and food
  regulations will limit meal times and storage of
  food in the clinical areas.
• lack of staff may during mealtimes (staff may
  have their breaks, ward rounds may be going on,
  medication is being administered).
• Institutions may not cater for mainstream
  cultural differences.
• Nurses may have lack of information of the
  patients nutritional preferences, (lack of
  relatives, state of consciousness of the patient,
  orientation)

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Enteral Feeding

• Used to supplement or completely replace oral
  feeding.
• nasogastric tube
• gastrostomy
• N/G tubes can be used for short term problems
• Gastrostomy tubes are used for long term problem
  or permanent problems

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Parenteral Feeding

• Can be used for patients who are unable to use
  their G.I. Tract.
• It may be temporary or long term , after major
  surgery of the G.I. Tract.
• It involves administration of all substances
  needed to meet nutritional needs directly into
  the patients blood circulation.

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Conclusion

• Nurses have an implicit responsibility for
  ensuring patients are fed
• While registered nurses may of course delegate
  the task of feeding the patients, for example to
  unregistered practitioners, the overall
  responsibility remains with the registered nurse
  
  -
  Registrars Letter 11/97