Lesson 8: Patient Care (2) Flashcards
Assisting with Nutrition and Fluid
Digestion
The process of eating through both mechanical and chemical actions into another form the body can use
Gastrointestinal system (GI)
Made up of the mouth, pharynx, esophagus, stomach, small and large intestine, rectum, and anus
Mouth
Food begins here, and is then chewed, pushed forward by the tongue, and broken down by saliva
Pharynx
During swallowing, the food moves through the throat which is attached to the esophagus
Esophagus
A muscular tube that connects the pharynx to the stomach
- Top: sphincter and swallowing mechanism
- Allows food to pass towards the stomach
Stomach
Acids breaks down the food even further
- Food next moves to the small intestine
Small intestine
A long tube that continues the digestive process and begins the absorption process
- Top: duodenum
- Digestive juices and enzymes finish breaking down food into usable energy
- Juices come from the pancreas, gallbladder, and liver
Large intestine (colon)
The body absorbs water from the remaining undigested food matter and passes waste from the body
- Parts of the colon: cecum, rectum, anal canal, and anus
Cecum
Pouch-like expansion of the large intestine
- Beginning of colon
- Chyme moves from the small intestine to the cecum
Rectum
At the end of the colon
- Stores the fecal material, which passes through the anal canal and to the anus
Anus
A sphincter that allows a person to control when to defecate
- Contains strong muscles
Functions of the GI system
Ingestion, mastication, deglutition, digestion, absorption, and elimination
Ingestion
The taking of food into the mouth to be chewed and moistened so that it can be swallowed easily
Mastication
Chewing
- Uses the movement of the teeth and tongue to break down the mouthful of food into an easily swallowed bolus
Deglutition
Swallowing food using the tongue, pharynx, and esophagus
- Food moves from the mouth through the opening of the esophagus, and down the esophagus into the stomach
Digestion
Breaking down of foods into the separate nutrients: proteins, fats, carbohydrates, vitamins, minerals, and water
Absoprtion
In order to use the nutrients in food, they are absorbed into the bloodstream, where they can be carried to all areas of the body
- Small intestine is an important site for nutrient absoprtion
Elimination
Any remaining substance that is not absorbed is eliminated from the GI system
What are the six classes of nutrients?
Carbohydrates, fats, proteins, vitamins, minerals, and water
Carbohydrates
Body’s first and primary source of fuel
- Found in grains, cereals, pastas, rice, fruits, and certain vegetables
- Eventually broken down into glucose
Glucose
A simple sugar that is absorbed into the blood and used immediately as fuel or stored in the muscles and liver as glycogen to be mobilized later when the blood runs out of this between meals
Fats (lipids)
An important source of energy
- Categories: saturated fats, monounsaturated fats, polyunsaturated fats
- Move through the body through lipoproteins
Saturated fats
tend to increase one’s risk for heart disease
Unsaturated fats
Correlated with lower risk of heart disease
Lipoproteins
Simple proteins that combine with a lipid component
- HDLs, LDLs, and VLDLs
High-density lipoproteins (HDLs)
Associated with lowered risk for heart disease
Low-density lipoproteins and Very-low-density lipoproteins (LDLs and VLDLs)
Are associated with a high risk of heart disease
- Cholesterol level
Aging and nutrition
As a person ages, several conditions impact good nutrition.
- May lose teeth, which is necessary for the mastication of foods
- Sense of taste and smell become diminished
- A slowing of the nervous system causes the peristalsis of the esophagus, stomach, and intestines to slow down
- Metabolism slows, causing an increase in weight
- Activity also tends to decrease, resulting in the burning of fewer calories
- Elderly individuals also lose the capacity or the desire to shop and cook food
- This tends to lower the foo quality and quantity they consume
- Medications also impact appetite, lowering food consumption, and can interfere with the digestion and absorption of some foods
- Isolation and reduced income can also be significant factors in poor nutrition
Alcohol is ____.
a non-nutrient
Meal time
- Make the meal time a pleasant time in the day that the person can look forward to
- Make the atmosphere conducive to stimulating the appetite
- Serve the meal in a room free form unpleasant odors
- Make the person comfortable in terms of temperature and noise
- When possible, allow individuals to decide the foods they wish to eat and the times they wish to eat
- Serve food that the individual likes
Menu planning (8)
- Variety
- Food variety refers to selecting many different kinds of foods so that all nutrients will be ingested.
- No single food will meet all nutrient needs – foods need to be selected from grains, meats, fruits, vegetables, fats, and dairy products
- If one of these groups is not appropriate for the individual, take care to select substitutes that will provide the same nutrients - Texture
- When appropriate, it is important to combine crispy foods with smooth, soft foods
- Select a variety of textures in a meal, unless a physician has prescribed a soft diet. - Flavors
- Make sure that the strong flavors in a meal do not compete with each other
- When planning a meal, keep very strong-flavored foods as the spotlight of the entire meal and make milder-tasting foods the background to that flavor
- Season the foods according to the individual’s preferences
- Always consider dietary restrictions prescribed by the physician. - Temperature
- For food safety reasons, it is important to cook foods to the correct temperature. Some undercooked foods can be extremely dangerous, especially to people with compromised immune systems
- Consider the individual’s preferences - Taste
- Consider the individual’s taste preferences when preparing food
- Ask the resident if he prefers spicy foods, specific spices, or certain types of food and then prepare accordingly, as long as choices are in accordance with any dietary restrictions from the physician
- Get feedback about meals and try to improve your ability to meet taste preferences - Size and Shape
- Consider the size and shape of the foods and try to prepare them in accordance with the individual’s preferences and customs
- Some individuals may have difficulty cutting meat or vegetables and prefer them cut into smaller pieces
- Even something as simple as cutting a sandwich into triangles or squares may encourage better eating - Color
- Meals should be appetizing and appealing in terms of color
- Not only does color add variety and visual appeal to a meal, it is important to select fruits and vegetables that are different in colors
- Each different color reflects a high concentration of different types of vitamins and minerals - Cost
- Most people have somewhat limited funds, especially considering the high costs of healthcare in general
- Discuss with the family or resident the amount of money available to spend on meals and create a budget accordingly, if this is a part of the meal-planning task.
- Avoid wasting food
Food habits
When planning meals, consider the eating habits of the individual.
- Plan for 3 meals a day plus snacks
- Consider the resident’s cultural and religious beliefs when planning meals
- When a restricted or specific diet is prescribed, try to adapt it to the desired food choices
Grocery shopping
In some home health situations, caregivers are asked to do the grocery shopping.
- Prepare a shopping list that will accommodate the meals for an established time period.
- Discuss the size of the purchase, the budget, the likes and dislikes, the meals that will be prepared by the family, the favorite stores, and the method of payment
- Ensure that the family members and resident know that you are leaving the home
- After returning, be sure to save all receipts
- When preparing a meal, you can make it from scratch, starting with the individual ingredients, or purchase convenience foods, which are foods with some or all of the preparation already done.
Tips for grocery shopping (9)
- Buy fruits and vegetables in season.
- Consider the quality required.
- Use poultry when it is cheaper than red meat
- Consider cuts of meat that may cost more per pound but give more servings per person
- Learn to prepare less-tender cuts of meat for casseroles and crock pot meals
- Save eggs or egg substitutes instead of meat.
- Substitute dried beans and peas for higher-cost meals.
- Use fillers such as bread crumbs or pasta to make a meat dish serve more people
- Look for specials and sales in meat and produce.
Storing food
Once groceries are purchased, they must be stored appropriately so that they do not spoil.
- Meats
- All meats should be refrigerated
- Ground meat and variety meats spoil more quickly than other kinds, so they must be used soon after they are purchased
- Raw meats and poultry should be maintained at 40F or below
- This reduces the growth of pathogenic bacteria that might be present on the surface of the meat
- Whne meat is already cooked and ready to store as leftovers, it is important to cool it quickly before putting it back into the refrigerator
- Meats should not be kept at a warm temperature for longer than 1 hour (40F - 140F) - Fruits and vegetables
- Most fruits and vegetables should be kept in the refrigerator in plastic bag or tightly covered containers, or in the crisper drawer of the refrigerator
- Some fruits such as apples, apricots, avocados, cantaloupe, guavas, kiwi, mangos, honeydew melons, papayas, peaches, pears, plums, prunes, quinces, and tomatoes produce high quantities of ethylene
- Ethylene causes some foods to soften and become bitter and accelerates their ripening; therefore do not store ethylene-producing foods near other foods
- Unrefrigerated fruits will ripen more quickly than if they are refrigerated - Bread
- Bread should be placed in the fridge because the moisture is pulled out of it and the bread becomes stale faster
- Buying artisanal bread in a paper bag is stored in the paper to preserve the bread’s crispness
- Bread can be frozen and kept for a long time if wrapped tightly so that all air is eliminated
- Slice the bread before freezing; label and date frozen items - Milk
- Milk requires refrigeration and is generally fresh for several days
- Keep the containers closed to prevent the milk from picking up odors from other foods
- Store milk on the cooler shelves rather than in the door and avoid exposing it to light
- Instant nonfat dry milk can be used in many same ways as whole milk and can be stored for much longer periods without refrigeration - Canned foods
- Canned foods should be stored in a cool, dry place - Frozen foods
- Keep frozen foods at a temperature of 0C or 32F.
- Label with a date
- The packaging and temperature of the freezer impact the length and time food can be safely frozen
- Recommended storage times:- fruits and vegetables: less than 8 - 12 months
- poultry: less than 6 - 9 months
- fish: less than 3 - 6 months
- ground meat: less than 3 - 4 months
- cured or processed meat: less than 1 - 2 months
- Do not refreeze thawed meat, poultry, or fish unless it has been cooked first
Guidelines for cooking (8)
- Use the oven to prepare more than one food at a time to save energy
- Do not preheat the oven longer than necessary
- Put the pot or pan on the burner of the correct size. (If the burner is too big for the pot or pan, it wastes energy.)
- Cover pots while food in them is cooking to save energy and decrease cooking time.
- Consider preparing one-dish meals
- Make enough food for more than one meal to save time
- With electric ranges, turn off the heat a few minutes before the food is ready to conserve energy.
- Use the correct appliance for the job.
Methods of cooking
- Bake or roast
- Boil
- Braise
- Broil
- Fry
- Poach
- Steam
- Stew
To bake/roast
Cooking food in an oven with dry heat.
- Roasting is similar to baking and also refers to cooking food in an oven with dry heat
- Roasting typically refers to vegetables, meats, fish, and poultry
To boil
To cook in a liquid hot enough for the bubbles to break on the surface
To braise
To cook meals and vegetables at a low temperature in a liquid
- The food is typically browned briefly in hot fat, a little liquid is added to just cover the food
- The pot is tightly covered and the food is cooked at a temperature just below boiling
- Good way to cook tough meats and vegetables because the long cooking breaks down their fibers
To broil
To cook with the food directly above or below the heat source
To fry
To cook quickly in fat over high heat.
- When only a small amount of fat is used, the process is called pan-frying/sauteing
- If enough fat is used to over the food, the process is called deep frying or deep fat frying
To poach
A method of cooking used to preserve the delicate texture of foods and to prevent toughening foods.
- The food is covered by water or some other liquid
- The liquid may be either boiling or lose to the boiling point, depending on the food
To steam
A method of cooking that exposes the food to the steam of boiling water.
- The food must be above the water but not touch it
- The cooking container is kept closed during the cooking to let the steam accumulate
- This method is good for preserving a higher proportion of the food’s original flavor and texture because the nutrients are not dissolved in the cooking liquid
- More time-consuming than other ways of cooking
To stew
The process of long-slow cooking of food in a liquid in a covered pot with seasoning
- A slow cooker is often used to stew for hours
- It is good for tenderizing tough cuts of meat
Observations concerning serving a meal
- How is the person’s appetite?
- Does he eat the foods that are prescribed in a restricted diet?
- Does she avoid specific foods?
- Is the person uncomfortable in any way when eating?
- Does she drink sufficient fluids?
- Does he prefer to eat several meals or one or two big meals?
- How does the person get meals when a caregiver is not on duty? Is this sufficient?
Therapeutic diets
These are diets that are restricted or adapted by a physician or dietician and planned according to the individual’s illness or disorder.
- Soft (mechanical) diet
- Liquid diet
- Bland diet
- Low-residue diet
- High-calorie diet
- Low-calorie diet
- Low-fat diet
- Low-cholesterol diet
- Diabetic diet
- High-protein diet
- Low-sodium diet
- Salt-free diet
Soft (mechanical) diet
This may be prescribed for patient who have difficulty chewing or swallowing.
- Include the same foods in a normal diet, but chopped or strained so that they require very little chewing and are easy to digest
- These are mechanically soft
- Avoid meat, shellfish with tough connective tissue, course cereals, spic foods, rich desserts, fried foods, raw fruits and vegetables, nuts and coconuts
- This is used after surgery for people with infections and for those with digestive disorders or chewing problems
Liquid diet
These are nutritionally inadequate and should only be used for short periods of time.
- Used after surgery or a heart attack, with those who have acute infections or digestive problems, to replace the fluids lost by vomiting or diarrhea, nd before some X-ray exams of the digestive tract
There are two types: Clear liquid diet, full liquid diet
Clear liquid diet
Includes water, apple juice, grape juice, fat-free broths, plain gelatin, popsicles, ginger ale, tea, or coffee
Full liquid diet
Includes everything on clear liquid diet plus strained soups and cereals, fruit and vegetables juices, yogurt, hot cocoa, custard, ice cream, pudding, sherbet, and eggnog
Low-fat diet
This limits the amount of butter, cream, fats, and eggs and is used for patients who have problems digesting fats, such as with gallbladder, cardiovascular, or liver diseases or disorder.
- Includes veal, poultry, fish, skim milk, fresh fruits and vegetables
Bland diet
This consists of easily digested foods that do not irritate the digestive tract and is used for people with ulcers and other digestive diseases.
- It avoids coarse foods, fried foods, highly seasoned foods, pastries, raw fruits and vegetables, alcohol, carbonated beverages, nuts, coffee, tea, smoked and salted meats and fish
- Includes puddings, creamed dishes, milk, eggs, and plain potatoes
Low-residue diet
This is used for individuals with digestive and rectal diseases, such as colitis or diarrhea.
- Thsi type of diet eliminates or limits food high in bulk or fiber such as raw fruits and vegetables, whole grains and cereals, nuts, seeds, beans, peas, coconut, and fried foods
- The goal is to spare the lower digestive tract
High-calorie diet
This is used for those who are underweight, have anorexia nervosa, hyperthyroidism, or cancer or are otherwise malnourished.
- The diet includes foods high in protein, minerals, and vitamins, such as eggnog, ice cream, frequent snacks, peanut butter, and milk.
Low-calorie diet
This is used for people who are trying to lose weight.
- Include skim milk, fresh fruit, and vegetables, lean meat, fish, cereals, foods low in fats and complex carbohydrates, and low-fat desserts
- Avoid fried foods, sauces, gravies, and rich desserts
Low-cholesterol diet
This restricts food containing cholesterol, such as organ meats, egg yolks, beef, pork, lamb, cream, cheeses, shellfish, whole milk, and coconut and palm oil products
- Includes fruits, vegetables, cereals, grains, nuts, and vegetable oil
High-protein diet
Includes meat with high-protein foods, such as meat, fish, cheese, milk, and eggs
- Assists in the growth and repair of tissues wasted by disease and helps in wound healing
- Often used for children and adolescents who need additional growth, pregnant or lactating women, individuals suffering from burns or cancer, those with wounds or malnutrition, and before and after surgery
Diabetic diet
This is used for individuals with diabetes mellitus, which causes the body not to produce sufficient insulin for the metabolizing of carbohydrates
- This diet balances carbohydrates, protein, and fats by the individual’s needs
- The diet should match the food intake with the insulin and nutritional requirements and include fresh fruits and vegetables low in sugar
- Avoid high-sugar foods, alcohol, carbonated drinks, candy, soft drinks, desserts, cookies, syrup, honey, condensed milk, sugared gum, jams, and jellies
Low-sodium diet
This limits foods that contain sodium or salt.
- It is used for people whose circulation is impaired by fluid retention and those who have hypertension and certain heart or kidney conditions
- Include puffed wheat, rice, shredded wheat, fruits, and fruit juices
- Avoid canned vegetables, ham, luncheon meats, frankfurters, and most cheeses, processed foods, pickels, sauerkraut, and olives
- Should not add any salt to food, can add spices instead
Salt-free diet
One that eliminates salt entirely.
- Foods that do not have salt include more fresh and frozen vegetables
Nutrition with chemotherapy and radiation
Some individuals who receive chemotherapy and radiation therapy may significantly change their eating habits because of periods of nausea, vomiting, appetite loss, or constipation
- Decrease red meats and substitute other high-protein foods
- Use plastic utensils because some patients say they get a bitter taste from metal utensils
- Maintain adequate fluid intake of cool, clear liquids
- Encourage the patient to eat small meals more frequently, to chew food well, and to eat warm rather than hot foods
- Decrease the consumption of sweets and fried or fatty foods to decrease nausea and intake of empty calories
- Encourage the individual to stay in a seated position for a couple of hours after the meal
- Feed the person foods that do not produce gas. These may be different for each individual.
Tips for assisting a patient with feeding
- Never rush the meal
- Use a straw for liquids if approved by the occupational or speech therapist
- If the person is confused, try feeding him one bowl of food at a time
- If three meal times do not work, try feeding several small meals in the day.
- If the individual cannot sit up, paces, leaves the table, or exhibits other disruptive behavior, try giving her finger food so she can feed herself as she walks about.
- Keep a pleasant conversation going during the meal to help distract uncooperative individuals.
- Feed foods separately rather than mixed together unless the person wants the food mixed.
- Always touch a glass, cup, or utensil to the individual’s lips when offering it.
- Record the intake and output of food and liquid if requested.
- Record any abnormal behavior or incident
dysphagia
This refers to a difficulty in chewing or swallowing because of damage to nerves or muscles
- May be caused by head and neck cancer, multiple sclerosis, Parkinson’s or Alzheimer’s disease
Signs and symptoms of dysphagia
Pocketing food in the mouth
Drooling
Choking on food
Frequently clearing the throat
Speaking in a wet, gargled voice
Feeding a patient with dysphagia
Preparation
1. Wash your hands
2. Wash the individual’s hands
3. Assemble the equipment on the over-bed table
4. If you are in a facility, ensure that the name on the card on the tray matches the person
5. Tell the individual you are going to help him or her eat a meal
6. Position the individual with a 90 degree flexion of hips and a 45 degree neck flexion. Put pillows behind the back and neck if needed to hold this position. If using a hospital bed, adjust the lower section to elevate the knees to prevent the patient from slipping down
7. Serve the foods right away so that the cold foods stay cold and hot foods stay warm.
8. Add a thickening product if being used and advised.
Assisting with feeding
1. Sit down with the president and stay with him while feeding. Never rush the person or be impatient. It takes longer for these individuals to eat.
2. Allow the person to feed himself as much as he can and allow him to choose what he wants to eat
3. Use a cut-out cup to make it easier to feed liquids. Remind the person to keep his head down, suck in a small amount of liquid, swallow it, then rest
4. Offer very cold foods or Italian ices between every 5 or 6 votes to make it easier to eat
5. Avoid offering dry foods, such as bred, waffles, or pancakes. If these foods are being served, add honey, syrup butter, or apple sauce to make them easier to swallow.
6. Encorage the individual to swallow two times after each bite
7. Be aware of any distress the patient is experiencing and offer verbal cues as needed.
Clean-Up
1. Check that the person’s mouth is empty after feeding and encourage her to remain sitting up for 30 minutes.
2. Assist with oral care after the meal and wash her hands and face
3. Document what and how much was eaten and any problems
4. Clean up all equipment and make the individual comfortable.
5. Wash your hands.
Procedure for feeding a patient with a physical challenge
Step 1: Preparation
Step 2: Assisting with feeding
Step 3: Assisting with feeding cont.
Step 4: Clean up
Feeding a patient with a physical challenge: Step 1
- Wash your hands
- Wash the individual’s hands
- Assemble the equipment on the over-bed table
- If you are in a facility, ensure that the name on the card on the tray matches the person
- Tell the individual you are going to help him or her eat a meal
- Position the individual with a 90 degree flexion of hips and a 45 degree neck flexion. Put pillows behind the back and neck if needed to hold this position. If using a hospital bed, adjust the lower section to elevate the knees to prevent the patient from slipping down
- Tuck a napkin under the individual’s chin
- Season the food the way the person likes it and in accordance with any prescribed diet
Feeding a patient with a physical challenge: Step 2
- Sit down with the president and stay with him while feeding. Never rush the person or be impatient. It takes longer for these individuals to eat.
- Allow the person to feed himself as much as he can and allow him to choose what he wants to eat
- In most cases, it is easiest to use a spoon. Fill it only half-way with food. Give the food from the tip of the spoon, not the side. Put the food in one side of the person’s mouth so he can chew it more easily. Serve the food on the side of the body that is most functional.
- If the person cannot see the food, tell what is in each spoonful and offer the foods in a logical order, such as soup, salad, main course, and dessert. Also alternate between food and liquid just as normally functioning people eat. Allow the individual to tell you what he wants to each as well.
Feeding a patient with a physical challenge: Step 3
Feeding a patient with a physical challenge: Step 4
