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Feeding Adult Patients

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1 Feeding Adult Patients
M.J. Bailey

2 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

3 Factors Influencing Dietary Patterns
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 Anorexia refers to lack of appetite in this case. M.J. Bailey

4 Factors Influencing Dietary Patterns
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

5 Factors Influencing Dietary Patterns
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

6 Factors Influencing Dietary Patterns
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

7 Factors Influencing Dietary Patterns
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

8 Factors Influencing Dietary Patterns
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

9 Factors Influencing Dietary Patterns
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 Don’t be condescending when giving nutritional guidance M.J. Bailey

10 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

11 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 can’t chew or tolerate solids M.J. Bailey

12 Types of Diets Pureed- easily swallowed foods, no chewing
Mechanical or Dental Soft- foods don’t need chewing, avoid tough meats & fruits with tough skins Chewing problems Lack of teeth Sore gums M.J. Bailey

13 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

14 Types of Diets Sodium Restricted Low Cholesterol
Low levels of sodium = NO SALT CHF, Renal failure, cirrhosis, hypertension Low Cholesterol Cholesterol intake 300mg/day Fat intake –35% Eliminate/reduce fatty foods M.J. Bailey

15 Types of Diets Diabetic Exchange list of foods
Imp. For Type I and Type II M.J. Bailey

16 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

17 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

18 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

19 Feeding the patient with dysphagia
Safety – choking/ aspiration Symptoms of dysphagia Coughing, choking, drooling, spilling food ( pocketing) Provide food that stimulates swallowing Don’t feed too quickly Thickened foods easier to swallow M.J. Bailey

20 Procedure for Feeding Bedpan/washroom first Wash hands Prepare room
mid-to-high fowlers Dentures Bib/napkin Prepare tray/food M.J. Bailey

21 Procedure for Feeding Relaxed pace Small bites/spoonfuls
Rocking motion of utensil on tongue Maintain sitting min. pc. M.J. Bailey

22 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

23 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

24 Nasogastric tube Through nose into stomach (infants through the mouth, nostrils too small) Only with a physician’s order Ensure correct tube placement Purpose Nutrition for clients with impaired swallowing, unconscious, or inability to ingest food M.J. Bailey

25 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: Crohn’s Disease M.J. Bailey

26 Tube Feedings Additional water post: Feedings Medications
Prescribed times Liquid/ dissolved No enteric coated or time released capsules Do not mix meds with formula. Give meds. prior to formula M.J. Bailey

27 Tube feeding schedule Continuous Cyclic Bolus Over 24 hrs
Prescribed period ( ie:16hrs) Bolus Prescribed volume over min. 4-6 X/day. Physician orders frequency, amount, & type of feeding M.J. Bailey

28 Problems with tube feeding
Dry mouth Sore mouth Thirst Feeling deprived M.J. Bailey

29 Do’s and don’ts 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

30 Do’s and don’ts 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 30-60 ml water before and after feedings, meds, residual checks M.J. Bailey

31 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

32 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

33 Position for tube feeding
Fowlers before and after Prevents aspiration Regulate the flow of the feeding mls/min Gravity/ feeding pump Flush tube well post feeding Clamp tube post flushing Intake/output Avoid introducing air into tubing M.J. Bailey

34 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

35 Fluid Loss Fluids are lost Total daily loss = 2100 –2900mls Skin Lungs
Feces Urine output = majority Total daily loss = 2100 –2900mls M.J. Bailey

36 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

37 Regulation of Body Fluids
Those at risk for dehydration include: Infants Elderly Neurologically impaired Psychologically impaired Must be conscious and alert M.J. Bailey

38 Fluid Output Kidneys Lungs Skin GI tract M.J. Bailey

39 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

40 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

41 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

42 Intake and Output Measurement
Many illnesses cause changes in the body’s ability to maintain balance. Require accurate measure In & Out Institution policies Physician orders RN initiates Data for assessment Monitor patient’s condition M.J. Bailey

43 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

44 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

45 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

46 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

47 Output items Urine Diarrhea Profuse diaphoresis Vomit
Drainage from suction devices Wound drainage Bleeding M.J. Bailey

48 Measurement Wear gloves Urine output Mexican hat for females
Urinal for males Mls. or cc’s 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

49 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

50 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

51 Fluids and Electrolyte Balance
Solutes = substances dissolved in a solution Electrolytes: Na, K, Cl Minerals Glucose Urea Bilirubin M.J. Bailey

52 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

53 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

54 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

55 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

56 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

57 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

58 Fluids and Electrolyte Balance
Minerals Ingested Catalysts in nerve response, muscle contraction, regulating electrolyte balance Cells Basic units of all living tissue RBC’s, WBC’s Within body fluids M.J. Bailey

59 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

60 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

61 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

62 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

63 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

64 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 M.J. Bailey

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