3.2 Nutrition and the Patient Flashcards
Assessing Dietary Intake
24 Hour Recall
- Easiest way to collect dietary data.
- Ask patient everything they ate in the last 24 hours
- Includes portion size, snack patterns, meal timing, location.
Assessing Dietary Intake
Food Diaries/Calorie Counts
- Patient record everything they had to eat. (Portion size) over set period of time. Documentation usually completed by nursing staff.
Assessing Dietary Intake
Food Frequency Record
- Gives general picture of average number of times a certain food group was eaten in a given period of time
- “In the last week how many times have you eaten fish”
- “In the last week how many times have you had alcohol”
Medical/Social Data
Medical, Social, Economic, Cultural, and Psychological require evaluation for impact on nutrition.
Medical
Current Illness, surgery, medications taken, food intolerance, allergies, ability to chew and swallow.
Social
Developmental Factors, Educational Background, Activity, Sleep, Cultural Influence.
Economic
Ability to pay for food
Anthropometric Data
- Measurements that determine size and proportion of body using height and weight to compare with others of the same age and gender
- Most common is (BMI)
- Take at same time of day (preferably morning)
- Others include triceps skin-fold measurement, subcutaneous fat stores, midarm circumference, measure of skeletal mass, midarm muscle circumference, measure of skeletal muscle mass and fat stores.
Clinical Data
- Dysphagia (difficulty swallowing) can result in poor dental health, cancer, neurological disease (stroke), Parkinson’s disease, dementia. May also increase risk of food going into lungs.
- Dental problems may cause patients to avoid difficult to chew food including meat, fibrous fruits, vegetables.
Biochemical data
- Evaluate adequate nutrition through laboratory tests on patient blood and urine.
- Poor nutrition found in blood through anemia, glucose, and cholesterol.
- Urine can measure protein, blood, and nitrites.
Monitoring nutritional status
- Malnourishment and dehydration likely to have health complications and slower healing.
- Nurses are heavily involved in diet progression
- Advancement in diet is based on absence of symptoms or advancement of GI functions (bowel sounds or moving gas).
- Medical orders created to begin patient on one diet and advance to another if needed.
- Nurses assess symptoms such as nausea, vomiting, abdominal pain, abdominal distension.
Example - Patient moves from clear liquid diet to regular diet.
Stimulating Diet
- Serve small frequent meals. (Avoid overwhelming)
- Encourage favorite foods if possible
- Provide encouragement (pleasant eating environment)
- Prepared foods should look attractive
- Schedule procedures and medications at times least likely to effect appetite
- Control pain, nausea, or depression with meds
- Offer alternatives if patient does not want to eat
- Provide good oral hygiene
- Remove clutter from eating area
- Keep area free of irritating odors
- Arrange food to be easily reachable
- Provide comfortable position
- Keep food warm if patient is not there during mealtime
- Do not interrupt patients during mealtime
Assisting with eating
- Involve patient as much as possible when feeding
- Patient preference on eating pace/order of eating
- Provide appropriate drinks
- Sit at eye level and make eye contact
- Engage patient in pleasant conversation
- Place napkin (not bib) over patients clothes
- Use straws or special eating utensils whenever possible
- ## Open containers, cut meat, apply condiments when patient wishes
Assisting Eating (Visually Impaired)
Explain placement of food on plates and food trays. (Relaying items like a clock is useful)
- Provide special plate guards
- Place food/dishes in similar locations each meal
- Use straws for beverage if not contradicted by dysphagia.
Safety with feeding
- Keep patient upright and sit in line of vision with patient
- Provide Encouragement
- Avoid hovering with extra spoonful as it causes patient to hurry.
- Allow 5-10 sec with each bite/sip
- Allow patient to drink between mouthfills
- Observe for food collecting on a side of a mouth (stroke)
- Patient must stay upright 15 minutes after eating.
Oral Suction
If patient aspirates their food suction is required
Pressure
Adult - 150mmHg
Child - 100-120mmHg
Infant - 80-100mmHg
- Put catheter along sides of mouth towards trachea (3-4 inches)
- Assess RR, Effort, oxygen saturation and breath sound after done suctioning.
Oral Nutrition
Regular - No restrictions
Modified Consistency - Start with clear liquids and advance to full liquids and soft foods as fast as possible until patient can eat regular diet. Clear liquid can also include jello and popsicles. (poured at room temperature)
Full Liquid - Milk, pudding, custard, frozen desserts, pasteurized eggs, Vegetable juices.
- High calorie high protein supplement recommended if full liquid diet used more than 3 days.
- Pureed and mechanical altered diets can be used long term on patients with dysphagia.
Therapeutic Diets
- Treat health conditions (low fat diet, low sodium diet, renal diet)
