Feeding a Patient Nurses need to refine their feeding skills to assist

patients in maintaining:

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Why follow a recommended diet plan?

What tools are used in planning and evaluating a diet for adequacy?

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MyPlate is divided into sections of approximately 30 percent grains, 30 percent vegetables, 20 percent fruits and 20 percent protein, accompanied by a smaller circle representing dairy, such as a glass of low-fat/nonfat milk or a yogurt cup.

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What are the consequences if a person has increased nutritional intake versus the person who has decreased nutritional intake?

Anorexia

Obesity

or

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What are examples of what the nurse can remove to not have any unpleasant sights?

How can a nurse remove any obnoxious odors?

How can the nurse ensure the over-bed table is clean?

How can the nurse provide good lighting?

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Remove any unpleasant sights – i.e. urinals, wound dressings, emesis basin, used alcohol wipes, old milk, prior meal

Remove any obnoxious odors – i.e. bedside commode, wound dressings, emesis, diapers, open meal cover away from the patient to avoid the odor of all the mixed foods.

Clean the over-bed table – i.e. wipe with a washcloth any sticky stuff

Provide good lighting – i.e. ask the patient if they want their window blinds open, lights on

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What is the highest priority when preparing a patient to eat?A.Apply any special devicesB.Assemble needed supplies to facilitate feeding.C.Assess swallow reflex D.Assist patient to urinate or defecate prior to the mealtimeE.Place in comfortable positionF.Provide oral hygiene- food will taste betterG.Provide with clothing protectorsH.Provide with dentures or eyeglasses

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List five strategies used to assist with eating:

1._______________________________

2._______________________________

3._______________________________

4._______________________________

5._______________________________10rev 4/2013

1. Assess tray for completeness, correct diet, order changes

2. Wash hands before serving & handling food.3. Sit in chair next to patient4. Allow patient to eat in order and speed of

choice, and the amount requested5. **Do NOT Hurry patient6. Cut food in bite size pieces7. Document

8. See page 1184 for additional strategies

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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, which may need to be upright

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These patients can feed self when given adequate information

Identify the food location on the plate as if it were a clock (meat at 12:00, potatoes at 3:00 asparagus at 9:00)

Place food in similar location for each meal

Open containers, cut up food, apply condiments, have it ready for the patient to eat.

12:00

3:009:00

6:00

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Which of the following actions is most important in maintaining safety when feeding a patient?

a. Checking the temperature of the food b. Providing clothing protectors c. Removing items from the overbed

table d. Removing obnoxious odors

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If patient is at risk for aspiration, check the swallowing and gag reflex firstfirst.

Check temperature—do not burn patient

Put in upright position

Do not feed patient who is asleep, unresponsive, choking, unable to swallow.

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What does aspiration mean?

A.Difficulty swallowingB.Misdirection of contents into the respiratory tract.

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1. Assess the patient for increased risk of aspiration – observe at mealtime for dysphagia.

2. Elevate head of bed

3. Add thickener to thin liquids to create consistency of honey. (Thin liquids such as water, sodas, juices, soups are difficult to control and lead to aspiration).

4. Provide smaller bites. Place ½ to 1 teaspoon of food on unaffected side of the mouth, allowing utensil to touch the mouth or tongue.

5. May need to place hand on throat to gently palpate swallowing event as it occurs. May need to swallow twice.

6. Feed slowly, allow patient to chew thoroughly and swallow the bite before taking another.

7. Allow to empty mouth after each spoonful.

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Which of the following would decrease the risk of aspiration during feeding? (select all that apply)

1. Sit the patient upright in a chair 2. Give liquids at the end of the meal 3. Place food in the strong side of the mouth. 4. Provide thin foods to make it easier to swallow. 5. Feed the patient slowly, allowing time to chew and swallow. 6. Encourage patient to lie down and rest for 30 minutes after a meal

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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 chokes, turn head to the side, sweep any food out of the mouth. If no food is present, may need to perform the Heimlich maneuver.

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The health care provider’s orders included:

1. NPO after midnight.

What does this mean?

What comfort measures can the nurse provide for the patient who is NPO?

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Clear liquidClear liquid◦Contains liquids that are without pulp or foods that liquefy at room or body temperature.

◦Most often used after surgery, or with patients with diarrhea or vomiting.

◦What are examples of foods allowed on this diet?

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Full liquidFull liquid◦Addition of calories, about 1500 and provides more nutrients than a clear liquid diet

◦What are examples of foods allowed on this diet?

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Soft DietSoft 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 fiber is without brans, strong vegetables, grains, raw fruit or vegetables

◦Mechanical soft – food is chopped, ground, or pureed-for those with difficulty with chewing / poor teeth Flaked fish, ground or finely diced meats Cottage cheese, rice, potatoes, pancakes Bananas, fruits, peanut butter Cooked vegetables

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Regular DietRegular Diet◦Contains approximately 2,500 calories

◦Consists of appropriate serving from a variety of food groups to meet nutritional needs.

◦Has no restrictions

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The nurse delivers the meal tray to the patient. The patient says that the HCP said his diet would be changed to a regular diet instead of a full liquid.

What will the nurse do?

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If the patient is on a clear liquid diet and the lunch tray is brought to the room with:◦Chicken broth◦Milk◦Tea◦Custard

◦What will the nurse do?

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Mrs. Brown has eaten 10% of food on tray. The nurse asks Mrs. Brown why she is not eating.

Mrs. Brown responds by saying, “I do not like this food.”

Mr. Brown offers to bring in food from home that his wife enjoys.

What is the nurses response? Should the nurse allow the family to bring in food from the outside? What is the criteria?

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