Presentation on theme: "M.J. Bailey Feeding Adult Patients. M.J. Bailey Nutrition Nutrition is an important treatment in any illness. Type 2: non-insulin –dependent diabetes."— Presentation transcript:
M.J. Bailey Feeding Adult Patients
M.J. Bailey Nutrition Nutrition is an important treatment in any illness. Type 2: non-insulin –dependent diabetes. Mellitus (NDDM). Mild hypertension. Proper intake of food is essential for optimal health during illness & healing of wounds. The body needs nutrients at these times.
M.J. Bailey Factors Influencing Dietary Patterns 1. Health status A good appetite is a sign of health Anorexia is usually a sign of disease or side effect of drugs Nutritional support is an essential part of recovery from medical treatment
M.J. Bailey Factors Influencing Dietary Patterns 2. Culture and religion. Culture, ethnic, and religious patterns and restrictions re food must be considered. Special foods and diets given when appropriate. Older clients more apt to cling to ethnic food habits, esp. During illness.
M.J. Bailey Factors Influencing Dietary Patterns 3. Socioeconomic status. Food expenses fluctuate, spending depends on $$ available. Whether someone is around to prepare the food determines the amount of convenience foods used.
M.J. Bailey Factors Influencing Dietary Patterns 4. Personal preference Individual likes and dislikes provide the strongest influence on diet Foods associated with pleasant memories become favorite foods/ foods with unpleasant memories are avoided Luxury foods = status Individual preferences used to plan therapeutic diet
M.J. Bailey Factors Influencing Dietary Patterns 5. Psychological factors. Individual motivations to eat balanced meals and individual perceptions about diet. Food has strong symbolic value. Milk=helplessness. Meat=strength.
M.J. Bailey Factors Influencing Dietary Patterns 6. Alcohol and drugs Excess use contributes to nutritional deficiencies Excess alcohol affects GI organs Drugs that appetite intake of essential nutrients Drugs can deplete nutrient stores and absorption in the intestines
M.J. Bailey Factors Influencing Dietary Patterns 7. Misinformation and food fads Food myths can be the result of cultural background, popular interest in natural foods, peer pressure, or desire to control diet choices Fads may involve erroneous beliefs certain foods are esp. Healthy Yogurt better than milk Oysters sexual potency Dont be condescending when giving nutritional guidance
M.J. Bailey Factors Influencing Dietary Patterns Physical Problems –Teeth –Loss of neuromuscular control –Poor state of health Psychological Problems –High point of day –Very degrading
M.J. Bailey Types of Diets Regular- (full/house/DAT) –Allows client selection Clear Liquid- clear, bland ie: broth, gelatin, apple juice (little residue, easily absorbed) Full Liquid –foods that liquify at room or body temperature. Easily digested & absorbed. –Milk+ creamed, strained soups –Pre & post-op patients –Those who cant chew or tolerate solids
M.J. Bailey Types of Diets Pureed- easily swallowed foods, no chewing Mechanical or Dental Soft- foods dont need chewing, avoid tough meats & fruits with tough skins Chewing problems Lack of teeth Sore gums
M.J. Bailey Types of Diets Soft- low in fiber, easily digested easy to chew and simply cooked. No fatty, rich or fried foods (Low Fiber Diet) High Fiber- Sufficient amt. of indigestible carbohydrates to : –relieve constipation – GI motility – stool weight
M.J. Bailey Types of Diets Sodium Restricted –Low levels of sodium = NO SALT –CHF, Renal failure, cirrhosis, hypertension Low Cholesterol –Cholesterol intake 300mg/day –Fat intake 30–35% –Eliminate/reduce fatty foods
M.J. Bailey Types of Diets Diabetic –Exchange list of foods –Imp. For Type I and Type II
M.J. Bailey Adults usually eat independently but may need to be fed in the presence of physical or cognitive limitations. –Neurological –Neuromuscular –Orthopedic problems Loss of control & independence can lead to psychological problems and depression.
M.J. Bailey Terms re Feeding Dysphagia- difficulty swallowing –Most common cause of aspiration in adults during feeding Aspiration- the inhalation of foreign substance into the lungs –stroke
M.J. Bailey Suspect Dysphagia when client Coughs/ gags during eating Exhibits multiple swallowing c/o food getting stuck in throat Poor lip & tongue control
M.J. Bailey Feeding the patient with dysphagia Safety – choking/ aspiration Symptoms of dysphagia –Coughing, choking, drooling, spilling food ( pocketing) –Provide food that stimulates swallowing –Dont feed too quickly –Thickened foods easier to swallow
M.J. Bailey Procedure for Feeding Bedpan/washroom first Wash hands Prepare room mid-to-high fowlers Dentures Bib/napkin Prepare tray/food
M.J. Bailey Procedure for Feeding Relaxed pace Small bites/spoonfuls Rocking motion of utensil on tongue Maintain sitting min. pc.
M.J. Bailey Indications for Enteral Feeding Clients unable to eat –ie: comatose with functional GI system –Ventilated patients –Post-op oral, head or neck surgery Clients who will not eat –Older adults –Confused clients Unable to maintain adequate oral nutrition –Cancer, sepsis, infection, trauma, head injury
M.J. Bailey Intubation Placemnt of a tube into the stomach or intestine through the mouth, nasopharynx, (Nasogastric/Levine), or through an artificial opening made in the abdominal wall of the stomach (gastrostomy) or small intestine (jejunostomy) Nasogastric= short term Gastrostomy= long term, surgically inserted directly into the stomach(gastrostomy) or small intestine (jejunostomy)
M.J. Bailey Nasogastric tube Through nose into stomach (infants through the mouth, nostrils too small) Only with a physicians order Ensure correct tube placement Purpose –Nutrition for clients with impaired swallowing, unconscious, or inability to ingest food
M.J. Bailey Nasogastric tube Small bore tube for tube feeding Large bore tube for stomach decompression and irrigation Formulas for tube feedings commercially prepared, provide complete nutritional balance and some do not require any digestion Imp. If necessary to rest the bowel ie: Crohns Disease
M.J. Bailey Tube Feedings Additional water post: –Feedings –Medications –Prescribed times Medications –Liquid/ dissolved –No enteric coated or time released capsules –Do not mix meds with formula. Give meds. prior to formula
M.J. Bailey Tube feeding schedule Continuous –Over 24 hrs Cyclic –Prescribed period ( ie:16hrs) Bolus –Prescribed volume over min. 4-6 X/day. –Physician orders frequency, amount, & type of feeding
M.J. Bailey Dos and donts re tube feeding Do not hurry/force feeding –Abdominal distention & discomfort Clean not sterile technique room temp. –Warm= bacterial growth –Cold= gastric cramping & discomfort, liquid is not warmed by the mouth and esophagus
M.J. Bailey Dos and donts re tube feeding Formula can hang for 8hrs. ( check directions) Change tubing q24hrs. Or according to policy Check tube position q8hrs. And ac feeds/meds Clamp b/t feedings ml water before and after feedings, meds, residual checks
M.J. Bailey Procedure for checking tube placement X-ray- best and most accurate Air insertion and listen with stethoscope Aspirate gastric contents –Determines tube placement and checks for digestion of previous feeding ( should be less than 50mls ) Note -any gastric contents should be returned to the stomach so the chemical balance is not disturbed. –Check pH of aspirate with pH paper
M.J. Bailey Aspirate pH Stomach is acidic 1-4 Intestine is 7 or greater Pleural secretions 6 Wait at least 1 hr after feedings to check Feeding is not given if no bowel sounds are heard, abdomen is distended, too much residual, or tube dislodged
M.J. Bailey Position for tube feeding Fowlers before and after –Prevents aspiration Regulate the flow of the feeding 6mls/min Gravity/ feeding pump Flush tube well post feeding Clamp tube post flushing Intake/output Avoid introducing air into tubing
M.J. Bailey Fluid Intake and Output 3 main sources of fluids and electrolytes –Fluids ingested in liquids –Food that is eaten –H2O as a byproduct of oxidation of foods and body substances Total daily intake approximately mls
M.J. Bailey Fluid Loss Fluids are lost –Skin –Lungs –Feces –Urine output = majority Total daily loss = 2100 –2900mls
M.J. Bailey Regulation of Body Fluids Fluid Intake primarily regulated by: –Thirst mechanism in hypothalamus The thirst mechanism is affected by: – plasma osmolality – plasma volume –Dry mucus membranes –Other factors
M.J. Bailey Regulation of Body Fluids Those at risk for dehydration include: –Infants –Elderly –Neurologically impaired –Psychologically impaired Must be conscious and alert
M.J. Bailey Fluid Output Kidneys Lungs Skin GI tract
M.J. Bailey Kidneys Major regulators fluid balance – blood flow to kidneys urinary output –Amount of urine produced influenced by ADH & aldosterone (stimulated by changes in blood volume) –Urine output = 1.5L/day in adults or 60 mls/hr –Where Na goes H2O follows
M.J. Bailey Insensible Losses Immeasurable –Evaporation through the skin Affected by humidity –Lungs Respiratory rate and depth –Fever Loss through skin & lungs Infants lose more H2O from their skin than adults
M.J. Bailey Sensible Losses Measurable Fluid losses from –Urination –Defecation –Wounds –Vomiting Normally GI losses 100mls/day In cases of severe diarrhea, losses may exceed 5,000ml/day
M.J. Bailey Intake and Output Measurement Many illnesses cause changes in the bodys ability to maintain balance. Require accurate measure In & Out Institution policies Physician orders RN initiates Data for assessment Monitor patients condition
M.J. Bailey Indications for intake and output Special medications ( diuretics) Post-op patients I/V therapy Indwelling catheters Feeding tubes Low oral intake Intake =output in 48-72hr. period
M.J. Bailey Indications for intake and output Risk for Fluid Volume Deficit –Intake < output Risk for Fluid Volume Excess –Intake > output Urine output < 30 mls/hr x 2 consecutive hrs. indicates renal disease or dehydration
M.J. Bailey Daily Weights Deficient or Excess Same time each day Same scale Same clothing Fluid retention can be detected early b/c 5- 10lbs of fluid is retained before edema appears. 5 lbs fluid= approx. 2.5 L fluid volume
M.J. Bailey Intake Items include Items that are liquid at room temperature –H2O, milk, juice, beverages, ice cream, jello, liquid part of soup Tube feedings ( not pureed foods, considered solids) I/V fluids Irrigating fluids that are not returned
M.J. Bailey Measurement Wear gloves Urine output –Mexican hat for females –Urinal for males –Mls. or ccs –Infants, weigh diaper, subtract wt. of dry diaper from wt. of wet diaper. Count # of wet diapers. Be cautious of weight of stool.
M.J. Bailey Measurement Patient participation –Instructions –Explanation –Equipment –Recording Bedside record- individual items Permanent record- totals for time frame designated by institutional policy. Kept on chart.
M.J. Bailey Fluids and Electrolyte Balance H2O – the indispensable nutrient 60% total adult body weight 70-80% total infant body weight Body Fluids –H2O and dissolved substances H2O major constituent of the body H2O = Solvent in which substances are dissolved or suspended
M.J. Bailey Fluids and Electrolyte Balance Solutes = substances dissolved in a solution –Electrolytes: Na, K, Cl –Minerals –Glucose –Urea –Bilirubin
M.J. Bailey Functions of the Fluid System Transportation of Nutrients to cells Removing wastes from cells Homeostasis- maintaining a stable physical & chemical environment in the body
M.J. Bailey Body Fluid Distribution 2 Basic Compartments –Intracellular- inside the cells, must be balanced with extracellular –Extracellular- outside the cells, further divided into Interstitial fluid in the spaces b/t cells Intravascular or plasma- liquid portion of blood, watery, colorless fluid portion in which blood cells are suspended Hint: Inter= between Intra= within/ inside
M.J. Bailey Fluids and Electrolyte Balance Many solutes in the intracellular fluid compartment are the same as those located in the extracellular fluid space. However the proportion of the substances is different ie: K > intracellular Body fluids & electrolytes shift from compartment to compartment to maintain Homeostasis
M.J. Bailey Fluids and Electrolyte Balance Homeostasis maintained by: –Diffusion- solutes from areas to concentrations across semipermeable membrane until = Remember in diffusion solutes move –Osmosis- passive movement of fluid from areas with more fluid and fewer solutes to areas with less fluid and more solutes across a membrane Remember in osmosis fluid moves –Active transport ATP( adenosine triphosphate) pushes against concentration gradient Solutes from concentration to concentration
M.J. Bailey Fluids and Electrolyte Balance –Filtration-removing particles from a solution by allowing the liquid portion to pass through a membrane ( ex. Nephron of the kidney) All body fluids contain similar substances although concentration may vary: –Electrolytes –Minerals –Cells
M.J. Bailey Fluids and Electrolyte Balance Electrolytes –Substances which dissolve in solution –Split into charged ions –Conduct an electrical current –+ charged = cations( Na+, K+, Ca+) – - charged = anions ( Cl-) –Vital for body functioning Neuromuscular Acid/base balance
M.J. Bailey Fluids and Electrolyte Balance Minerals –Ingested –Catalysts in nerve response, muscle contraction, regulating electrolyte balance Cells –Basic units of all living tissue –RBCs, WBCs –Within body fluids
M.J. Bailey Fluids and Electrolyte Balance Body fluids are not stagnant – fluids and electrolytes shift from compartment to compartment to facilitate body processes such as acid/ base balance. K+ most abundant intracellular cation Na+ most abundant in extraellular fluid Where Na+ goes H2O follows Na+ retained K+ excreted
M.J. Bailey Variables Affecting Fluid and Electrolyte Balance Age – Infants have more H2O Greater risk for loss Kidneys immature – not able to concentrate urine –Elderly Less body H2O Decreased renal function- not able to concentrate urine Body size –Fat does not contain H2O – body H2O in females b/c more fat deposits in breasts and hips, obese have body H2O
M.J. Bailey Fluids and Electrolyte Balance Environmental Temperature – – temperature sweating fluid loss = loss of Na+ and Cl- ions. Life style –Inadequate diet- body breaks down glycogen and fat stores. Next destroys protein stores Decrease in serum protein (hypoalbuminemia) Decrease osmotic pressure and fluid shifts from circulating blood to interstitial spaces. –Stress- fluid volume –Exercise- insensible H2O losses
M.J. Bailey Fluids and Electrolyte Balance Fluid Disturbances –Fluid Volume Deficit -H2O and electrolytes are lost. At Risk –Decreased oral intake –Vomiting –Diarrhea –Gastric suction The very young and very old quickly affected by these losses.
M.J. Bailey Fluids and Electrolyte Balance Fluid Volume Excess –H2O and Na+ are retained = Hypervolemia with unchanged levels of electrolytes –At Risk Renal failure CHF
M.J. Bailey Fluids and Electrolyte Balance Healthy bodies maintain a very precise fluid, electrolyte and acid-base balance. Factors that can disturb balance –Insufficient intake –GI and Kidney function disturbances –Excessive perspiration or evaporation –Volume losses