Feeding a Patient

1. Feeding a Patient

2. Introduction Feeding a Patient • Nurses need to refine their feeding skills to assist patients in maintaining:

3. Physiological Factors that limit feeding • Altered activity level • Decreased mobility • Illness • Physical impairments that limit self-feeding such as hemiplegia, fractured arm, burns, cancer, surgery, or generalized weakness. • The presence of intravenous catheters or tubing’s, dressings, and bandages • Some elderly patients may require feeding assistance because of the physical alterations associated with aging. • Neurologically or orthopedically impaired patient who may be unable to manipulate feeding utensils.

4. Psychological Factors that Limit Feeding • Culture • Religion • Personal preference • Mental cognition. When individuals are depressed, lonely, apathetic, fearful, grieving, or feeling hopeless, nutritional intake usually decreases. • Being fed by another person may have psychological implications. The increased need for feeding assistance may lead to depression, because patients feel they are a burden to either the staff or their family.

5. NURSING DIAGNOSIS • Some common nursing diagnosis that relate to the individual with a nutritional intake problem include: • Altered nutrition: less than body requirements RT: • Self-care deficit: feeding RT:

6. GOALS • The patient will: 1. 2. 3.

7. Setting the Stage • Remove any unpleasant sights • Remove any obnoxious odors • Clear the over-bed table • Provide good lighting • Set up chair for the nurse

8. Preparing the Patient for Eating • Assist patient to urinate or defecate prior to the mealtime • Provide oral hygiene • Provide with dentures or eyeglasses • Place in comfortable position • Apply any special devices • Provide with clothing protectors • Assemble needed supplies to facilitate feeding.

9. Assisting the Patient to Feed Self • Wash hands before handling food and serving trays • Identify the diet tray for particular patient • Assess tray for completeness and correct diet • Prepare tray to meet patient’s needs • Check temperature of food • Place tray at height and position so it is easy for the patient to access.

10. Assisting to Feed a Patient • Wash hands before handling food and serving tray • Identify the diet tray for the patient • Assess tray for completeness, correct diet, order changes • Sit in chair next to patient • Allow patient to eat in order and speed of choice, and the amount requested **Do NOT Hurry patient • Cut food in bite size pieces

11. Feeding a Patient • Feed patient, putting one type of food on utensil at a time • Provide fluids as requested • Use time to develop rapport with patient • At end of meal • Wash hands • Provide mouth care • Assist to comfortable position • Document

12. Safety Precautions • If patient is at risk for aspiration, check the gag reflex first. • Check temperature—do not burn patient • Do not feed patient who is asleep, unresponsive, choking, unable to swallow, unable to elevate head 450, or whose head is tilted backwards or downwards. • Feed patients with swallowing difficulties semi-solid foods that will not choke the patient.

13. Safety Precautions • If a patient questions anything on tray, check the doctor’s order for possible changes that the dietary department did not know about. • If the patient should get choked, turn to the side, sweep any food out of the mouth. If no food is present, may need to perform the Heimlich maneuver.

14. Critical Thinking • You deliver a tray to your patient and he says that the doctor said he could have a regular diet today instead of a full liquid. • What would you do?

15. TYPES OF DIETS • Clear liquid • Contains liquids that are thin and without pulp or foods that liquefy at room temperature. • Most often used after surgery, or with patients with diarrhea of vomiting • Examples: • Apple juice, ginger ale. Gelatin • Decaffeinated coffee, tea, broth • Fruit ices, or Popsicles • Temporary diet

16. TYPES OF DIETS • Full liquid • Addition of calories, about 1500 and provides more nutrients than a clear liquid diet • Examples: • Milkshakes, all juices • Blenderized foods • Custards and puddings • Eggnog • Creamed soups

17. Critical Thinking • If the patient is on a clear liquid diet and the lunch tray is brought to the room with: • Chicken broth, milk, tea, and custard • What would the nurse do?

18. TYPES OF DIETS • Soft Diet • Used as a transition to the regular diet or for those who have difficulty eating • Designed to be chewed and provide minimal fiber. • Low in fiber and devoid of brans, grains, strong vegetables, raw fruit or vegetables • Mechanical soft – food is chopped, ground, or pureed-for those with difficulty with chewing / poor teeth

19. TYPES OF DIETS • Regular Diet • Contains approximately 2,500 calories • Consists of appropriate serving from a variety of food groups to meet nutritional needs. • Has no restrictions

20. TYPES OF DIETS Special Diets • Diabetic diet • Contains specified calorie intake and certain foods that are allowed to meet that intake goal • Cardiac diet • Low in saturated fat, cholesterol, and salt • Low Salt diet • Used for patients with hypertension

21. TYPES OF DIETS SSpecial Diets • Kidney diet • Used for patients with kidney disease. • Protein restriction with restrictions of fluid, sodium, potassium, phosphorus • Liver Diet • Used for patients with liver disorder • Low in protein, high in CHO, vitamins • Sodium, fluid may be restricted • Gastrointestinal Diet • Avoid foods that increase stomach acid • May have increase or decrease in fiber

22. Critical Thinking • The nurse notes that Mrs. Brown has eaten about 10% of food on tray. The nurse is concerned about her nutritional status and asks Mrs. Brown why she is not eating. • Mrs. Brown responds by saying that it is not the type of food that she eats. Mr. Brown offers to bring in food from home that she likes. • What is the nurses response? Do you allow the family to bring in food from the outside? What is the criteria?