HLTEN504A - INCP
Nutritional assessment &
Assist with Meals
Nutritional assessment
General appearance – noting:-• Skin colour, • Texture, • Bruising; • Hair; • Eyes; • Nails; • PostureWeight – • 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 imageCognitive
1. Confusion
2. Dementia
AnorexiaLoss 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 frequentlyProvide food liked by the patientSuitable environmentHigh caloric snacksKeep 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 bowlPrivacyDentures removedPlace hand on forehead to provide support and comfort, splint abdomen if requiredRemove vomitus a.s.a.p.Remove soiled linedWash face, hands and give oral hygieneAssist patient into position of comfortReport 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
Adult1. 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 mealCheck the temperature of food and drinksCheck for sharp bones or pipsConsider 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 documentationDuring 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 failureProteins are limited to minimise excessive amounts of uraemia – complete proteins are bestCarbohydrates 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 outputMonitor potassium intake to prevent hyperkalaemiaLimit 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 pressureLow fat (especially saturated), low cholesterol to prevent further damage to the blood vessels and increase in body weightFat in the diet to be monosaturated and/or omega-3 fatty acidsFluid 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 blocksFull 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 gravySoft• Plus tenderised meat, poultry, fish, soft casseroles,
lettuce, tomatoes, soft fruit, cake, biscuits without nuts or coconut