ADLs #2 - Midterm Flashcards
Define nutrition.
Processes involved in the ingestion, digestion, absorption, and use of foods and fluids by the body.
What are factors greatly affected by what we eat?
- life expectancy
- personality
- behaviour
- energy level
- sense of well-being
Since early in childhood, food becomes associated with:
- celebration
- consolation
- reward
- punishment
- symbol of love
- part of social gatherings
Briefly describe the function of the digestive system.
- for the body to get energy from the food we eat, the food must first be changed into a form that can be absorbed into the bloodstream and carried to the cells
- where digestion occurs
- starts in the mouth and is completed in the intestines
- has a chemical and mechanical component
Digestion
Process of changing food into a useable form for the body that takes place in the digestive system.
Digestive system: Mouth
- food enters digestive system through mouth
- food is chewed and mixed with saliva
- the tongue and automatic muscle movements in the pharynx moves food out of the mouth and into the esophagus = swallowing
- larynx automatically closes off the passage to the lungs at the time that swallowing occurs
Digestive system: Esophagus
- connects to the stomach
- a muscular tube that helps move food particles into the stomach
- peristalsis moves nutrients down the esophagus into the stomach (involuntary muscle contractions)
Digestive system: Stomach
- a temporary storage place for food
- churns and mixes (mechanical action) at the same time that food is being broken down by acids (chemical action)
- lined with a mucous membranes which protects the stomach that contains glands that secrete gastric juices (contains strong acids)
- digestive juices mix with the food particles to form a semi-liquid substance called chyme
- can take 3-5 hours
Digestive system: Small intestine
- 6 metres long
- most important area of digestion
- most of the job of breaking food down into usable parts takes place here
- important chemical changes take place here
- proteins and fats are changed into forms that can be absorbed
- made up of the duodenum, jejunum and ileum
- has tiny projections called villi that line the small intestine and absorb the digested nutrients into capillaries
Digestive system: Duodenum
- where more digestive juices are added to the chyme
- the juices chemically break down the nutrients so that they can absorbed
Digestive system: Jejunum and ileum
-most of the absorption of nutrients takes place in these two places
Digestive system: Liver
- helps the small intestine with its activities
- metabolizes fats, proteins and carbohydrates
- detoxifies substances from blood
- stores fat-soluble vitamins
- produces bile, cholesterol and bilirubin
Digestive system: Gall bladder
- the digestive juices is bile (greenish liquid) produced by the liver and is then stored in the gall bladder
- bile aids in digestion of fat and absorption of fat-soluble vitamins
- gives stool its brownish colour
Digestive system: Pancreas
- secretes enzymes for digestion
- juices from pancreas and small intestine are added to chyme
Digestive system: Large intestine
- final phase of digestion
- what is left of the chyme after it has passed through the small intestine enters this area where water is absorbed
- any leftover material that cannot be used by the body is called feces and is expelled from the body through the anus
Define nutrients.
Substances that are ingested, digested, absorbed and used by the body.
Nutrients: Protein
- for growth and repair of tissues, blood clotting and fight against infection and disease
- can be complete (contains all the amino acids needed by the body) or incomplete proteins
- complete proteins found in eggs, meat, fish and milk
- incomplete proteins found in vegetables, legumes and grains (but can be combined to be receive complete proteins
- foods high in proteins are usually expensive and lack in diet of people with low income
Nutrients: Carbohydrates
- found in sugar, breads, cereals, fruits and vegetables
- seldom lacking in diet of people around the world
- supply energy for heat and activity, provide fibre for bowel elimination (fibre not digested so provides bulk that helps pass wastes from the body)
Nutrients: Fats
- provide energy but not as easily used by the body as carbohydrates so are saved for emergencies when carbohydrates are not available
- adipose tissue (body fat) that helps conserve body heat and forms a protective cushion around internal organs
- fat makes food taste good
- found in butter, margarine, oils, cheese, milk, eggs, chocolate, salad dressing, cream and ice cream
Nutrients: Vitamins
- essential for body functioning
- help to promote growth, increase resistance to disease, build strong teeth and bones
- vitamin A,D,E,K are fat-soluble and can be stored by the body
- vitamin B,C are water-soluble and must be ingested daily
Nutrients: Minerals
- help build body tissues (bones and teeth) and help with nerve function
- calcium, phosphorous, iron, iodine, sodium and potassium
Nutrients: Water
- 3/4 of body weight is water
- aids in digestion and elimination, controls body temperature, lubricates moving parts
- water enters body in beverages like milk, juice, soup and fruit
- water is not in sugar, pure fats, oils
- people can live a few weeks without food but only a few days without water
- drink at least 200 mL of water every day
Which are the best sources of energy and why?
- complex carbohydrates (grains, cereal, fruit, vegetables) are the best because they take longer to digest
- simple carbohydrates (donuts, potato chips) are broken down very quickly and easily stored as fat by the body
- 1 gram of protein or carbohydrate produces 28 kJ
- 1 gram of fat supplies 63 kJ
If you eat 3 grams of carbohydrate, 4 grams of protein and 2 grams of fat, which will give you the most calories in kJ?
3 grams of carbohydrate = 328kJ = 84kJ
4 grams of protein = 428kJ = 112kJ
2 grams of fat = 2*63kJ = 126kJ
In Canada, which guide can help us make healthy food choices?
Eating Well with Canada’s Food Guide
- serves as a pattern for eating but not a rigid set of rules
- designed to give a balanced, healthy diet
- categorized into four basic food groups
Identify the four major food groups of the Canada’s Food Guide to Healthy Living.
1) Grain Products
2) Vegetables and Fruits
3) Milk and Alternatives
4) Meat and Alternatives
* Oils and Fats
Identify the number of servings from each major food group that are recommended daily for adults.
1) Grain Products: M=8, F=6-7
2) Vegetables and Fruits: M=8-10, F=7-8
3) Milk and Alternatives: M=2, F=2
4) Meat and Alternatives: M=3, F=2
* Oils and Fats: small amount (30-45mL of unsaturated fats each day)
Identify the food groups to which various foods belong.
1) Grain Products: bread, pasta, rice
2) Vegetables and Fruits: fresh, frozen, canned vegetables, leafy vegetables, fresh, frozen, canned fruits, juice
3) Milk and Alternatives: milk, soy, yogurt, kefir, cheese
4) Meat and Alternatives: fish, poultry, legumes, eggs, peanuts
* Oils and Fats: salad dressing, margarine, mayonnaise, olive oil, lard
What is the WRHA Food and Nutrition Services (CBORD)?
- take care of the dietary needs of Winnipeg acute care hospitals and a few personal care homes
- unique in Canada
- over 7800 customized meals are planned for, prepared, assembled and delivered daily from a centralized location
- 3 week cycle of menus provides a wide variety of foods
- each patient takes a questionnaire to best suit to their likes, dislikes, allergies
Describe factors which affect eating and nutrition.
1) age: infants don’t have much say in what they eat, physiological changes due to getting old changes the person’s desire and ability to consume, they need fewer calories, taste/smell/appetite is decreased
2) activity level: being sedentary makes you feel like eating less
3) environment: unpleasant sights, odours and noises can cause loss of appetite
4) stress/emotions: being uncomfortable, in pain, constipated, foul taste in mouth, digestive upset, upset, worried, afraid, angry, excited, lonely can make someone lose appetite
5) appearance of food: pleasant smell of food or that looks attractive can encourage appetite
6) likes and dislikes/personal opinions: everyone has preferences and must be considered when preparing meals, strong opinions could cause problems
7) misinformation/food fads: peer pressure and advertising can contribute to misinformation about food and nutrition which may lead to improper eating habits
8) Cultural and Religious Customs: Jewish eat kosher foods and Mosley’s do not eat pork, religious fasts (don’t eat food)
9) Socioeconomic Status: having a limited income could mean difficulty purchasing meats and milk due to being more expensive
10) Alcohol and Drugs: contribute to dietary deficiency because money needed for food goes toward alcohol and drugs, can interfere with the absorption of nutrients
11) allergies
Convert kilograms to pounds.
A) 100kg = ?
B) 80 kg =?
C) 51 kg =?
1 kilogram (kg) = 2.2 pounds (lb)
A) 220 lb
B) 176 lb
C) 112.2 lb
Measuring body weight is important why?
- is one indicator of health and can help to provide insight into their nutritional status
- weight gain may indicate a diet higher in calories than needed by the body
- weight loss may indicate inadequate nutrition or disease process
- major changes must be reported to the nurse or supervisor
- can also be a cause of a variety of medical conditions
What are key points when taking a patient’s weight?
- measure accurately and report findings to nurse
- weigh the person on the same scale at approximately the same time of day with the same amount of clothing on
- usually weighed during their weekly bath time
List reasons for ordering a therapeutic diet.
- changing the consistency of the food, making it easier to chew and swallow and decrease the risk of choking
- changing the caloric intake (low-calorie diet)
- changing the amount of certain nutrients (high-protein diet, low sodium diet)
- changing the amount of seasonings (bland diet)
- omitting foods that the patient is allergic to
- altering the time and number of meals
Therapeutic diet: fluid diets
1) clear fluids
- temporary diet made up primarily of water and carbohydrates for energy
- used for patients with the flu, fever or diarrhea, recovering from anaesthesia or gastrointestinal surgery
- water, tea, coffee, fruit juice, fat-free clear broth
2) full fluids
- natural progression from a clear fluid diet
- for those with difficulty chewing, swallowing, digesting food, dental surgery, stomach or intestine upsets
- clear liquid diet plus custard, egg-nog, strained soups, strained fruit and vegetable, milk, milkshakes
Therapeutic diet: Light diets
- intermediate step between a full fluids diet and a regular diet
- consists of easily digested foods that are mildly seasoned, non-gas forming and relatively low in fibre
Therapeutic diet: Soft diets / Pureed diets
- a soft diet contains adequate nutrients and includes liquids and semi-solid foods that have a soft texture and are more easily chewed and digested
- food put into blender to achieve desired smooth consistency
- for those with no dentures or problems with chewing foods
- puréed vegetables, pudding, smoothies
Therapeutic diet: Low residue diets
- used for patients who have an irritation or disease of the bowel
- omits foods that are difficult to digest
- coffee, tea, fruit juices, ice cream
Therapeutic diet: High fibre diets
- opposite of low residue diet
- includes foods that are high in bulk and difficult to digest
- frequently used for individuals who suffer from constipation
- fruits and vegetables, whole wheat bread, whole grain cereals
Therapeutic diet: Sodium controlled diets
- increased sodium in the diet causes increased water retention
- ordered for patients with certain heart conditions and where circulation would be impaired by fluid retention
- sodium is in table salt, most people consume 1-2 teaspoons per day
- sodium restricted patients are advised not to cook with salt, but substitute with herbs, spices
- fruits, vegetables, unsalted butter
Therapeutic diet: Low fat/Low cholesterol diets
- low fat diet ordered for patients who have difficulty digesting fat such as those with gallbladder disease
- low cholesterol diet is used to help regulate the amount of cholesterol in the bloodstream
- restricted foods are dairy products, fired foods, fatty meats, olives
- cooking methods are steaming, baking, broiling, grilling
- skim milk, cottage cheese, jelly, fruit, rice, pasta, cereal
Therapeutic diet: Diabetic diet
- to balance carbohydrates, protein and fats intake to help the patient with diabetes to lead a normal and active life
- foods determined by nutritional and energy requirements
Describe preparation of a patient for mealtime.
- ensure that the patients is awake and alert
- offer the bedpan or assist the patient to the bathroom
- assist patient to wash hands and face
- provide oral hygiene
- ensure patient has clean, well-fitting dentures in place and eyeglasses on
- report complaints of pain to nurse so that analgesics can be given before the meal is served
- position the patient comfortably is sitting in a chair or wheelchair, check the height for the table, ensure the patient’s head and body should be in good alignment with feet firmly supported on the ground
- if eating in bed, patient should be sitting upright so elevate the bed as much as possible and support the head and place a pillow behind the shoulders, head should face forward with chin tilted down, over bed table should be placed in front of the patient
- place napkin or clothes protector as needed (do NOT refer as bib)
- clear away any unpleasant items
- ensure room is well lit and free from drafts
- keep the environment free of distractions
- seat patients together
Why should you check the patient’s ID bracelet against the dietary card on the tray?
The ID bracelet is checked to be sure that the patient is receiving the correct meal (particularly if there is an order for a special therapeutic diet).
What can the health care aide do to help prepare the food for eating?
- removing food covers
- opening milk and juice containers
- buttering bread
- cutting food into bite-size pieces
- adding seasonings as allowed (salt, pepper)
- positioning cutlery within reach
- identifying foods that are on the tray
Give examples of assistive devices available to enhance independence at mealtime.
- non-slip placemats
- cutlery with special handles
- combination utensils
- rocking knife
- unbreakable dishes and glasses
- suction cups on the bottom of dishes
- plate guards
- cups with wide handles which fit over the whole hand
- glasses with indented rims for people who cannot tip their head back to drink
What is a technique used by health care aides to help patients that can’t see their plate?
-use the clock method by using different “times” to describe where food is located on the plate
Identify steps for serving meal trays.
1) help the patient to a sitting position
2) place the tray on the overbed table or other table
3) remove lids, open milk cartons, cereal boxes, cut meat, butter bread
4) place napkin, clothes protector and utensils within client’s reach
5) measure and record intake
6) check for and remove any food in the client’s mouth, wear gloves
7) remove the tray
8) assist with hand washing, offer oral hygiene
9) clean any spills and change soiled linen
10) help client return to bed
Identify guidelines for feeding a dependent patient.
1) sit at eye level, preferably in front of the patient
2) focus your attention on the patient, be friendly and pleasant
3) tell patient that you are putting food in his mouth before each mouthful, follow the patient’s preferences regarding the order in which food items are eaten, avoid mixing foods together unless the patient requests it
4) use a teaspoon to offer only one-half to one teaspoonful of food at a time, place the tip of the teaspoon into the middle of the patient’s mouth
5) if patient is paralyzed on one side, place food in the unaffected side of the mouth
6) do not hurry, feed small amounts slowly, allow sufficient time for chewing
7) be sure that food is being swallowed by watching the adam’s apple, encourage extra swallows between mouthfuls to help prevent buildup of food in the throat
8) offer fluids with every few bites of food, always make sure the mouth is clear of food before giving fluids, give small sips or use a straw
9) allow for rest periods throughout the meal, watch for signs that the patient is tiring
10) encourage patient to assist as much as possible
11) wipe mouth with napkin during and at the end of the meal
12) remember that the patient has the right to refuse food
13) observe for signs of swallowing difficulties
14) be alert for signs of choking, be prepared to perform the Heimlich maneuver
15) report any changes or unusual occurrences
16) report to nurse if client does not complete meal or refuses to eat
17) report amount of diet taken in
18) perform mouth care after feeding in order to remove any food that may not have been swallowed
True or false? The dependent patient is at a greater risk for choking.
True
True or false? The gag reflex can be used to predict the presence or adequacy of swallow.
False
What special considerations must be taken with patients who have dysphasia?
- dysphasia=swallowing difficulties
- swallowing assessment done by a speech language pathologist
- feeding recommendations made and followed by staff
- some patients may have thickened fluids ordered due to commercial thickener to slow transit time and protect the airway
- thickened fluids referred to Nectar Consistency
Which patients generally require the recording of food and fluid intake?
- dehydrated patients
- receiving intravenous therapy
- have recently had surgery
- have specific condition that require accurate monitoring of their intake
Def: Caloric intake / calorie count
- requires that the type and amount of food the patient has eaten be observed so that an accurate number of calories can be determined
- be sure to only consider the food that the patient has actually eaten
Def: Fluid intake
- done to determine if patient is having a problem with fluid balance
- fluid balance=amount of fluid taken in is equal to amount of fluid put out
- fluid balance is necessary for optimal health
How much fluid is required by the average person?
1500-2500 mL of fluids a day
Def: restricting fluids
- patients who have excess fluids may experience weight gain, edema or congested breathing
- these patients are only allowed a very specific amount of fluids in a day and no more
Def: encouraging fluids
- patients who have a deficit of fluids will be dehydrated and may have a dry mouth and complain of being thirsty
- may be encouraged to drink as much fluid as possible
