1. Nutrition and Dietetic Services Basic Concepts and Procedures Blue text book Chapter 8 & 32

2. Basic Concepts & Procedures Positioning a patient for eating Completing a menu requisition Calculating daily caloric intake Determining body mass index (BMI)

3. Positioning a Patient for Eating Pts who are sick, weak, or injured may need assistance eating Needing assistance may be frustrating for some pts HCW should be patient & handle their frustration without a negative reaction Correct positioning is important to prevent choking & aspiration Coughing is the normal reflex to dislodge food blocking the airway Aspiration=when food or liquid advances beyond the larynx and enters the lungs Aspiration can lead to pneumonia

4. Positioning a Patient for Eating Steps for correct positioning to help protect pt’s airway: When possible, have pts sit in dining chair or wheelchair for meals Position pt as upright as possible (pt’s hips, knees, & ankles flexed at 90 degrees); this helps maintain support & balance Don’t allow pt’s head to fall backward during swallowing; when this happens it opens the airway & choking & aspiration can occur

5. Positioning a Patient for Eating Keep head upright with chin pointing slightly downward toward the chest If pt must eat in bed, support the head in upright position with a pillow After the meal, keep pt in upright position or HOB increased 30- 45 degrees to help avoid choking or aspirating food that may be regurgitated

6. Completing a Menu Requisition Many health care facilities have pts fill out a menu requisition for their meal trays Know your facility’s policy so you can educate your pt on how to order their meals The dietitian has notified the food preparation area of the therapeutic diet each pt is on so they are only allowed to order food that fits their diet

7. Calculating Daily Caloric Intake Calorie=unit that measures the energy the body obtains from nutrients Daily caloric intake depends on: age, gender, body size, proportion of muscle to fat, genetic makeup, level of activity To calculate your daily caloric intake, you must calculate your BMR BMR=basal metabolic rate BMR=rate at which your body uses energy just for maintaining its own tissue, without doing any voluntary work (brushing teeth, walking, homework)

8. Calculating Daily Caloric Intake see page 307-308 in blue text book For males: BMR=66.5 + (13.8 X W in kg) + (5.0 X H in cm) – (6.8 X age in yrs) For females: BMR=655.1 + (9.6 X W in kg) + (1.9 X H in cm) – (4.7 X age in yrs)

9. Calculating Daily Caloric Intake see page 307-308 in blue text book To account for daily activity, select an activity level that matches your lifestyle. Then multiply your BMR by that activity level factor to predict the total amount of calories that your body requires on a daily basis.

10. Determining BMI BMI=body mass index A measurement of the relationship between wt and ht An index for measuring obesity The higher person’s BMI, the greater risk of chronic disease

11. Determining BMI

13. BMI <20=Underweight BMI 20-25=Normal BMI 25-30=Overweight BMI 30-40=Obese BMI >40=Severely obese If Sam’s BMI was 28, what category does he fall in?