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Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Chapter 23
Nutritional Care of Clients
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Objectives
• Describe how illness and surgery can affect nutrition of clients
• Identify and describe three or more nutrition-related health problems common among elderly clients needing long-term care
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Objectives
• Demonstrate correct procedures for feeding bed-bound clients
• Explain importance of adapting family’s meal to suit clients’ nutritional requirements
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nutritional Care
• Fever, nausea, fear, depression, chemotherapy, and radiation can destroy client’s appetite
• Vomiting, diarrhea, chemotherapy, radiation, and some medications can reduce or prevent absorption of nutrients
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
PEM
• When food intake does not meet body needs, body uses own stores of energy
• When glycogen and fat stores exhausted, body must break down own tissues to provide protein for energy
• Can be problem among hospitalized clients
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
PEM
• Can delay wound-healing, contribute to anemia, depress immune system, and increase susceptibility to infections
• Symptoms:– Weight loss and dry, pale skin
• Iatrogenic malnutrition– Malnourishment as result of hospitalization
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Improving the Client’s Nutrition
• Make formal nutritional assessments on regular basis
• All members of health care team should be alert to signs of malnutrition every day
• Listen to client’s concerns
• Watch reaction to food served
• Include dietitian in plan of care
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Feeding the Client
• At home, family menu should serve as basis for client’s meal whenever possible
• Omit or add certain foods as necessary
• Vary method of preparation if needed
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Serving the Meal
• Make tray and food arrangement as attractive as possible
• Serve water and another beverage
• Serve food at proper temperature
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Serving the Meal
• Ensure client is in comfortable position with tray and utensils placed conveniently
• Offer bedpan and hygiene care before and after meal
• Remove any unpleasant sights
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Serving the Meal
• Open containers and try to anticipate client’s needs
• Give sufficient time to eat– Reheat food as needed
• Document intake per facility policy
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Feeding the Client Who Requires Assistance
• Sit near side of bed
• Small amounts of food should be placed toward back of mouth with slight pressure on tongue with spoon or fork
• Do not feed client with syringe
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Feeding the Client Who Requires Assistance
• If paralyzed, food and straw should be placed on non-paralyzed side of mouth
• If client begins to choke, help sit up straight
• Client diagnosed with dysphagia requires specialized diet– Should not use straw
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Feeding the Blind Client
• Arrange food as if plate were face of clock
• Use consistent pattern so client knows where each item will be each time
• Client usually feels better when helping self
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Physical Problems of the Institutionalized Elderly
• Majority of people age 85 or more have at least one chronic disease– Conditions affect attitudes, physical activities, and
appetites• Thus, nutritional status
• PEM– Major problem
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Physical Problems of the Institutionalized Elderly
• Anemia can develop and contribute to fatigue, confusion, and depression
• Provide sufficient animal protein and vitamin C in diet
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Physical Problems of the Institutionalized Elderly
• Pressure ulcers can develop in bedridden clients– Must be prevented
– Healing requires treatment of ulcer, relief of pressure, and high-calorie diet with sufficient protein, vitamin C, and zinc supplements
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Physical Problems of the Institutionalized Elderly
• Constipation can be caused by inadequate fiber, fluid, or exercise– Other causes:
• Medication, reduced peristalsis, or former abuse of laxatives
– Treatment:• Increasing fiber, fluid, and exercise
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Physical Problems of the Institutionalized Elderly
• Diarrhea can be caused by lack of muscle tone in colon– May be helpful to increase fiber in diet and combine with
supplemental vitamins and minerals
• Sense of smell declines with age
• Appetite diminishes
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Physical Problems of the Institutionalized Elderly
• Disease or medications can cause xerostomia– Dry mouth
• May be helpful to drink water, eat frequent, small meals, and chew sugar-free gums or candies
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Physical Problems of the Institutionalized Elderly
• Dysphagia can result from stroke, closed head trauma, head or neck cancer, surgery, or Alzheimer’s and other diseases– Many clients must have thickened liquids
– Clients should always be in upright position when eating
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Conclusion
• Illness and surgery can have devastating effects on client’s nutritional status
• PEM can be significant problem in hospitals
• Offer bed-bound clients bedpan and assistance with hygiene care before and after meals
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Conclusion
• Encourage clients to feed themselves– However, offer help and anticipate needs
• Client who is blind can eat more easily if food arranged in set pattern on plate
• Provide pleasant conversation and atmosphere
(continues)