1. Eating and Drinking SHARON HARVEY 20/04/04

2. Eating and Drinking AIM Raise awareness of the factors that may enhance or impede nutritional intake of clients. Raise awareness of the factors that may enhance or impede nutritional intake of clients.

3. Eating and Drinking Objectives recall some factors influencing normal nutritional needs recall some factors influencing normal nutritional needs recall some factors contributing to inadequate nutritional intake recall some factors contributing to inadequate nutritional intake understand why nutritional assessment is conducted understand why nutritional assessment is conducted understand what contribution nursing can make in meeting the client’s nutritional requirements understand what contribution nursing can make in meeting the client’s nutritional requirements understand what contribution other MTD members can make in meeting the clients nutritional needs understand what contribution other MTD members can make in meeting the clients nutritional needs

4. Assessing Nutritional Needs Assessment is integral to holistic patient care Malnourishment in institutional care is a big problem, up to 40% of patients may be malnoursihed at any given time There are numerous barriers to provide adequate nutrition (physical, environmental and psychological) One of the roles of the nurse is also to promote a healthy diet

5. What are nutrients? ProteinsFatsCarbohydratesVitaminsMineralsWaterFibre

6. Factors influencing Nutritional Needs AgeGender Height and Build Physical activity PregnancyLactation

7. Factors contributing to inadequate nutrition Loss of appetite Stress Lack of knowledge and skills ConfusionParanoia Nausea and vomiting Nil by Mouth Physical factors Dependency Lack of finance

8. Increase requirements for nutrition PHYSIOLOGICAL STRESS PERI AND POST OPERATIVELY

9. Assessing the Client’s Nutritional Needs Measuring Body Mass Index Growth Charts Observing

10. Observation skills during Assessment Do clothes & dentures fit Sunken eyes in socket - dehydration Halitosis – poor dental health, dehydration Level of mobility Drooling – poor swallow reflex behaviour Observe food intake.

11. Observation skills during Assessment Questioning the patient /relative current weight, previous pattern of weight gain/ loss current weight, previous pattern of weight gain/ loss Special diets Special diets diabetic diabetic Normal eating pattern Normal eating pattern

12. Nutritional Assessment Tools Screening by these tools should be undertaken during: admission admission regular intervals in acute or long term settings regular intervals in acute or long term settings Nutritional tools have the following: BMI changes BMI changes evidence of dietary consumption evidence of dietary consumption mobility and capability mobility and capability physical symptoms physical symptoms psychological state psychological state

13. Nutritional Assessment Tools Goals of nutritional assessment : identify clients at risk of protein- energy malnutrition, or specific nutrient deficiencies identify clients at risk of protein- energy malnutrition, or specific nutrient deficiencies identify clients at risk of developing malnutrition related complications identify clients at risk of developing malnutrition related complications monitor efficacy of nutritional therapy monitor efficacy of nutritional therapy

14. Nursing Intervention If the patient has been identified to be at nutritional risk, a referral may be made to a dietician. Position the patient in an upright position. Encourage patients to sit out of bed during meal times. For patients on bed rest in a supine position, log roll and place pillows behind back, to prevent choking food. Ensure choice of food, with appropriate size of meal for the patient;s needs. Place food within reach of patient, and ensure they are aware that food is in front of them.

15. Nursing Intervention For the visually impaired patient, use the clock method. Provide appropriate cutlery, lipped plates, non-slip mats. An O.T may help provide you with necessary equipment. Eating with the patient may prompt them to eat. For the paranoid patient, eating some of his food may dispel fear that the food is poisoned. Encourage patients to eat their own snacks, if appropriate. Ensure food is of the correct consistency, patients who have swallowing difficulties will require thickened fluids. You may need to assist with feeding, cutting food and provide encouragement to the patient.

16. Serving of Meals The serving of meals in health care settings is controlled by Food Hygiene Regulations. In the NHS food is either cooked by a catering department or delivered from another hospital as cook chilled delivery. Practice may vary between wards and settings, but personnel from catering may serve food under the guidance of nursing staff or nursing staff themselves may serve food. All food has to be cooked and stored at the correct temperature, in order to reduce the risk of food poisoning. Personal hygiene is very important when serving meals. Washing of hands Washing of hands wearing of a disposable apron not used for other nursing care of the patient wearing of a disposable apron not used for other nursing care of the patient

17. Serving of Meals Personal hygiene is very important when serving meals. washing of hands washing of hands wearing of a disposable apron (different colour coded) not used for other nursing care wearing of a disposable apron (different colour coded) not used for other nursing care wearing serving gloves wearing serving gloves washing hands after serving of meals washing hands after serving of meals washing hands before and after going to the toilet washing hands before and after going to the toilet Food will be tested by a temperature probe before it is served to ensure that it has been cooked properly before being served to the patient.

18. Common cause of Food Poisoning Food prepared too far in advance Food stored at room temperature or not refrigerated Cooling food too slowly prior to refrigeration Not re-heating food to high enough temperature to destroy food poisoning bacteria Undercooking meat and meat products Not thawing frozen meat and poultry for sufficient time. Cross contamination from raw cooked food Storing hot food below 63C Infected food handlers.

19. MDT involved with Nutritional Care Identify other members of the MDT who are involved with nutritional care: Physicians can treat the underlying medical cause Physicians can treat the underlying medical cause Pharmacists will advise physicians, particularly involved with enteral and parenteral nutrition. Pharmacists will advise physicians, particularly involved with enteral and parenteral nutrition. Dentists can assist patients with denture or dental problems. Dentists can assist patients with denture or dental problems. Health Visitors can provide general advice on healthy eating to families for their young children. Health Visitors can provide general advice on healthy eating to families for their young children. Psychologists may help the person who has an eating disorder. Psychologists may help the person who has an eating disorder.

20. MDT involved with Nutritional Care Dieticians provide comprehensive assessment. Speech and Language Therapists, assist patients of all ages and abilities with chewing and swallowing problems. Physiotherapist, may help with motor problems; and help positioning. Occupational Therapist help identify suitable feeding or position aids to promote independence. Social Workers can arrange home care packages.

21. Enhancing Patient’s Nutritional Intake A wide range of nutritional supplements are available: some are added to person’s normal diet e.g powdered glucose polymers (Maxijul or Polycal) some are added to person’s normal diet e.g powdered glucose polymers (Maxijul or Polycal) some are to be taken as drinks between meals (Fortisip). some are to be taken as drinks between meals (Fortisip). A dietician can advise which of the above is appropriate after a comprehensive nutritional assessment. If a patient is unable to orally intake nutritional supplements and food, the following will occur: enteral feeds may be prescribed enteral feeds may be prescribed parenteral feeds may be prescribed parenteral feeds may be prescribed

22. Promoting Healthy Eating A number of factors make healthy eating difficult in an institutional setting: limited access by carers to food, and food regulations will limit meal times and storage of food in the clinical areas. lack of staff may during mealtimes (staff may have their breaks, ward rounds may be going on, medication is being administered). Institutions may not cater for mainstream cultural differences. Nurses may have lack of information of the patient’s nutritional preferences, (lack of relatives, state of consciousness of the patient, orientation)

23. Enteral Feeding Used to supplement or completely replace oral feeding. nasogastric tube gastrostomy N/G tubes can be used for short term problems Gastrostomy tubes are used for long term problem or permanent problems

24. Parenteral Feeding Can be used for patients who are unable to use their G.I. Tract. It may be temporary or long term, after major surgery of the G.I. Tract. It involves administration of all substances needed to meet nutritional needs directly into the patient’s blood circulation.

25. Conclusion “Nurses have an implicit responsibility for ensuring patients are fed” “While registered nurses may of course delegate the task of feeding the patients, for example to unregistered practitioners, the overall responsibility remains with the registered nurse” - Registrar’s Letter 11/97