Nutritional Intake & Alterations

Nutritional Intake & Alterations

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Factors Affecting Nutrition

Increased Food Intake

Decreased Food Intake

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How to Promote Eating

Provide a comfortable environment, especially in an institutionalized setting.

Serving Food

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Documenting Intake

75-100%

50-74%

• 3/4 - ALL of items on tray eaten.
• All of 5 or more food groups consumed.

• 1/2 to 3/4 of items on tray eaten.
• All of 2 or more food groups consumed.

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25-49%

Bites only

• 1/4-1/2 of items on tray eaten.
• All of 1 or more food group consumed.

• No basic food groups eaten.

How do you stimulate appetite?

Assistance with Eating

Used in client's who cannot feed themselves

Maintain dignity of those being fed

Provide comfort measures

Assisting Clients with Dementia

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Assisting the Visually Impaired

Assisting Clients with a Sore Mouth

Assisting Clients with Dysphagia

Alterations in Digestion

Pyrosis

Nausea/Vomiting

Flatus

Constipation

Diarrhea

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Pyrosis - "heartburn"

• Esophagus not lined like the stomach = pain!
• Nursing interventions:
• Small meals, HOB up after meals

• What foods/drinks should be avoided?
• What meds should you avoid?
• Avoid tight clothes…why?
• Avoid eating on the run!
• Don’t overeat!

Provide Comfort

• Sit client up in high-fowler's
• Use a spoon or straw for liquids (don't attempt to pour liquids into someones mouth!)
• Give small bits
• Wipe chin/face PRN

Diarrhea

• Frequent, loose, watery stools w/ increased GI peristalsis
• Threatens fluid volume & nutrient absorption
• What can this be related to?
• Nursing Interventions:
• Treat the cause
• Low fiber- what kinds of foods?
• Antidiarrheal medication - like what?

Maintain Dignity

• Do not rush!
• Provide napkin or towel...NOT a bib
• Sit at eye level
• Provide comfort measure before & during feeding
• Allow client to do as much as possible

Dementia

• Continuity is important
• Reduce/eliminate distractions
• Remove clutter
• Provide fluid in a glass
• Guide hand to mouth
• Provide finger foods for the wanderer
• Provide nutrient packed food

Decreased Food Intake

• BMI < 18.5 = underweight
• May be due to:
• _____________________________
• _____________________________
• _____________________________
• _____________________________
• _____________________________
• _____________________________

Flatus - intestinal gas

• Undigested carbs
• Very painful for the post-op client
• Nursing Interventions:
• Increase fiber slowly
• Note any allergies
• Prevent constipation in the first place
• Ambulate
• Eat slow, chew thoroughly
• NO straws or gum
• Avoid carbonated drinks

Increased Food Intake

• BMI of > 30 = obese
• May be due to:
• _____________________________
• _____________________________
• _____________________________
• _____________________________

Is this client ready to eat?

Assisting Clients with Visual Impairments

• Explain location of food on plate, use the clock method (picture on main page)
• Tell them what food they are being served
• Determine whether feeding assistance is needed

Nausea/Vomiting

• Peristalsis moves food UP instead of down
• Dehydration becomes a concern
• Nursing Interventions:
• AIRWAY PROTECTION
• Check for annoying sights, smell
• Avoid abrupt movements
• Limit food intake
• Cool wash cloths to neck, forehead
• Rinse mouth after emesis - antiemetics

• BRAT diet

Assissting Clients with a Sore Mouth

• What foods should you avoid?
• What kind of foods should you offer?
• When should you perform oral care?
• Should you use mouthwash?

Constipation

• Stools hard and difficult to pass
• Can lead to very serious problems!
• Prevention:
• Fluid, fiber
• Ambulation
• Relax, follow routine
• Avoid laxative -- why?
• DO NOT put off the urge - #1 cause of constipation