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CHAPTER SEVENTEEN ASSISTING WITH NUTRITION AND FLUIDS.

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Presentation on theme: "CHAPTER SEVENTEEN ASSISTING WITH NUTRITION AND FLUIDS."— Presentation transcript:

1 CHAPTER SEVENTEEN ASSISTING WITH NUTRITION AND FLUIDS

2 BASIC NUTRITION NUTRIENT - A SUBSTANCE THAT IS INGESTED, DIGESTED, ABSORBED, AND USED BY THE BODY. GROUPED INTO FATS, CARBOHYDRATES, PROTEINS VITAMINS, MINERALS, AND WATER CALORIE – THE AMOUNT OF ENERGY PRODUCED FROM THE BURNING OF FOOD BY THE BODY. 1 GRAM OF FAT SUPPLIES THE BODY WITH 9 CALORIES 1 GRAM OF PROTEIN PROVIDES 4 CALORIES 1 GRAM OF CARBOHYDRATE PROVIDES 4 CALORIES

3 FATS CARBOHYDRATES PROTEIN PRODUCE HEAT AND ENERGY
FOUND IN VEGETABLE FATS, OILS, BUTTER, MEATS, MILK PRODUCTS, AND POULTRY CARBOHYDRATES PRODUCE HEAT AND ENERGY SUPPLY ROUGHAGE IN THE DIET FOUND IN FRUITS, VEGETABLES, BREAD, CEREALS, PASTA PRODUCTS, AND MILK PROTEIN BUILD AND REPAIR BODY TISSUES REGULATE BODY FUNCTIONS AND SUPPLY ENERGY FOUND IN MEAT, POULTRY, FISH, AND CHEESE

4 MINERALS CALCIUM USED FOR BUILDING BONES AND TEETH, BLOOD CLOTTING, MUSCLE CONTRACTIONS, AND NERVE FUNCTIONS SODIUM HELPS WITH NERVE AND MUSCLE FUNCTION AND HELPS THE BODY MAINTAIN FLUID BALANCE POTASSIUM NECESSARY FOR HEALTHY NERVES, MUSCLES, AND HEART FUNCTION IRON NECESSARY FOR HEMOGLOBIN

5 VITAMINS VITAMIN A NEEDED FOR VISION, HEALTHY HAIR, SKIN, AND MUCUS MEMBRANES. HELPS FIGHT INFECTION. B-COMPLEX VITAMINS USED FOR DIGESTION, MUSCLE TONE, GROWTH, NERVE FUNCTION AND METABOLISM. VITAMIN C NECESSARY FOR TISSUE FORMATION, MINERAL ABSORPTION, HEALTHY SKIN AND MUCOUS MEMBRANES, AND RESISTANCE TO INFECTION.

6 VITAMINS VITAMIN D NEEDED BY THE BODY TO BUILD HEALTHY BONES AND TEETH
VITAMIN E USED FOR THE FORMATION OF RED BLOOD CELLS AND FOR HEALTHY MUSCLE FUNCTION VITAMIN K NECESSARY FOR BLOOD CLOTTING

7 STEPS TO A HEALTHIER YOU
MY PYRAMID FOOD GUIDE STEPS TO A HEALTHIER YOU

8 INTERPRETING THE FOOD GUIDE
TELLS YOU THE KIND AND AMOUNTS OF FOOD TO EAT DAILY GRADUAL IMPROVEMENT - TAKE SMALL STEPS EACH DAY THE PERSON SHOWS PHYSICAL ACTIVITY BY CLIMBING THE STEPS VARIETY - THE SIX COLOR BANDS STAND FOR THE 5 FOOD GROUPS PLUS OILS MODERATION - MEANS TO AVOID EXTREMES TAKE THE RIGHT AMOUNT FROM EACH FOOD GROUP BAND - THE WIDTH OF THE BAND SUGGESTS HOW MUCH FOOD TO CHOOSE FROM EACH GROUP

9 GRAINS THE ORANGE BAND IS FOR GRAINS
A PERSON NEEDS AT LEAST OUNCES OF WHOLE GRAINS EVERY DAY GRAINS HAVE THE FOLLOWING HEALTH BENEFITS: REDUCE THE RISK OF CORONARY ARTERY DISEASE HELPS PREVENT CONSTIPATION HELPS WITH WEIGHT MANAGEMENT CONTAINS THE FOLLOWING NUTRIENTS FIBER - B VITAMINS - MINERALS (IRON, MAGNESIUM, AND SELENIUM)

10 VEGETABLE GROUP THE GREEN BAND IS FOR VEGETABLES
SHOULD EAT AT LEAST CUPS OF VEGETABLES DAILY SHOULD SELECT VEGETABLES OF DIFFERENT COLORS PROVIDES MANY DIFFERENT NUTRIENTS HAVE THE FOLLOWING HEALTH BENEFITS: REDUCE THE RISK OF STROKE, CORONARY ARTERY DISEASE, DIABETES, KIDNEY STONES LOWER CALORIE INTAKE & PROVIDE FIBER

11 FRUIT GROUP THE RED BAND IS FOR FRUITS
1-2 CUPS OF FRUIT IS NEEDED DAILY FRUITS HAVE THESE BENEFITS: REDUCE THE RISK FOR STROKES, CORONARY ARTERY DISEASE, DIABETES, KIDNEY STONES MAY HELP LOWER CALORIE INTAKE CONTAINS MANY NUTRIENTS

12 MILK THE BLUE BAND IS FOR MILK AND MILK PRODUCTS
2 - 4 CUPS ARE NEEDED DAILY PROVIDES PROTEINS, FAT, CALCIUM AND VITAMIN D MILK HAS THESE BENEFITS: HELPS BUILD AND MAINTAIN BONE MASS

13 MEAT AND BEANS THE PURPLE BAND IS FOR MEATS AND BEANS
INCLUDES ALL FOODS MADE FROM MEAT, POULTRY, FISH, DRY BEANS, EGGS, NUTS, AND SEEDS CHOOSE LOW FAT MEAT AND POULTRY LIMIT SERVING TO OUNCES A DAY PROVIDES PROTEINS, VITAMINS, IRON

14 OILS THE YELLOW BAND IS FOR OILS
ENOUGH OIL IS USUALLY CONSUMED DAILY WITH NO ADDED SERVINGS. INTAKE SHOULD BE NO HIGHER THAN 3 TEASPOONS SHOULD BE USED AS LITTLE AS POSSIBLE. HAVE LITTLE NUTRITIONAL VALUE BUT ARE HIGH IN CALORIES.

15 GUIDELINES FOR A BALANCED DIET
EAT A VARIETY OF FOODS MAINTAIN A HEALTHY BODY WEIGHT SELECT FOODS LOW IN FAT, SATURATED FAT, AND CHOLESTEROL SELECT PLENTY OF FRUIT, VEGETABLE, AND GRAIN PRODUCTS USE SUGAR IN MODERATION USE SALT IN MODERATION DRINK ALCHOLIC BEVERAGES IN MODERATION, IF AT ALL

16 FACTORS THAT AFFECT NUTRITION
AGE – ELDERLY PERSON MAY HAVE A DECREASED APPETITE OR DIFFICULTY CHEWING OR SWALLOWING. CULTURE – PEOPLE FROM DIFFERENT CULTURES MAY HAVE DIFFERENT FOOD PREFERENCE. ( CHINESE – RICE, MEXICAN – HOT,SPICY ) RELIGION – MANY RELIGIONS HAVE RULES REGARDING COOKING, SERVING, AND EATING CERTAIN FOODS. FINANCES – SOME PEOPLE DO NOT HAVE THE MONEY TO BUY FOODS NEEDED FOR GOOD NUTRITION. HEALTH – ILLNESS MAY AFFECT A PERSON’S APPETITE OR CHOICE OF FOOD PERSONAL CHOICE – A PERSON MAY NOT LIKE CERTAIN FOODS

17 RESIDENT'S RIGHTS RELATED
TO NUTRITION BE SERVED FOOD ACCORDING TO ETHNIC, CULTURAL, OR RELIGIOUS BELIEFS. BE SERVED FOOD ACCORDING TO PERSONAL PREFERENCE. BE SERVED ATTRACTIVE,, TASTY FOOD AT CORRECT TEMPERATURES. PARTICIPATE IN TRADITIONAL HOLIDAY MEALS. FOOD SHOULD BE PREPARED TO MEET THE INDIVIDUAL’S NEEDS. EACH PERSON SHOULD RECEIVE 3 MEALS A DAY. SPECIAL EQUIPMENT SHOULD BE SUPPLIED IF NEEDED.

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19 SPECIAL DIETS REGULAR DIET DESCRIPTION
INCLUDES THE GREATEST VARIETY OF FOODS COMMON PURPOSE TO MAINTAIN OR ATTAIN OPTIMAL NUTRITION STATUS IN PATIENTS WHO DO NOT REQUIRE A SPECIAL DIET.

20 EXAMPLES OF FOODS ALLOWED
CLEAR LIQUID DIET DESCRIPTION CONSISTS OF FOOD THAT ARE LIQUID AT ROOM TEMPERATURE THAT ARE CLEAR ENOUGH TO SEE THROUGH. USED ONLY FOR A SHORT TIME BECAUSE IT DOES NOT PROVIDE ENOUGH NUTRIENTS FOR GOOD NUTRITION. COMMON PURPOSE ORDERED FOR PATIENTS WHO HAVE HAD SURGERY, ACUTELY ILL PATIENTS, PATIENTS WITH FLUID LOSS CAUSED BY VOMITING OR DIARRHEA. EXAMPLES OF FOODS ALLOWED WATER BROTH COFFEE CLEAR JUICES JELL-O TEA POPSCICLES SODA POP

21 EXAMPLES OF FOODS ALLOWED
FULL LIQUID DIET DESCRIPTION INCLUDES ALL LIQUIDS INCLUDED IN THE CLEAR LIQUID DIET, PLUS ALL OTHER LIQUIDS ( FOOD THAT IS LIQUID AT ROOM TEMPERATURE) COMMON PURPOSE ORDERED FOR PATIENTS WHO HAVE HAD SURGERY, PATIENTS WITH STOMACH ALIMENTS, PERSONS UNABLE TO CHEW, SWALLOW, OR DIGEST SOLID FOODS OR AS A TRANSITION BETWEEN A CLEAR LIQUID DIET AND A SOFT DIET. EXAMPLES OF FOODS ALLOWED STRAINED SOUPS ICE CREAM CUSTARD ALL JUICES COOKED CEREAL IF IT IS SOUPY THIN

22 EXAMPLES OF FOODS ALLOWED
SOFT DIET DESCRIPTION FOODS SOFT IN CONSISTENCY MILDLY FLAVORED COMMON PURPOSE USED FOR PATIENTS WHO ARE UNABLE TO CHEW OR SWALLOW HARD OR COARSE FOODS. EXAMPLES OF FOODS ALLOWED SOUPS FISH CHICKEN TOAST COOKED FRUIT AND VEGETABLES EGGS ICE CREAM

23 MECHANICAL SOFT DIET PUREED DIET DESCRIPTION
SAME FOOD INCLUDED IN A SOFT DIET EXCEPT FOOD IS GROUND . COMMON PURPOSE FOR PATIENTS WITH DIFFICULTY CHEWING OR SWALLOWING SOFT FOOD. PUREED DIET DESCRIPTION ALL FOUND IS STRAINED OR BLENDERIZED. COMMON PURPOSE FOR PATIENTS WHO CANNOT CHEW OR HAVE DIFFICULTY SWALLOWING.

24 BLAND DIET DESCRIPTION
FOODS MILD IN FLAVOR, OMIT SPICY FOOD, CAFFEINE, AND ALCOHOL. COMMON PURPOSE ORDERED IF THE ORGANS OF THE DIGESTIVE SYSTEM ( INTESTINES, STOMACH, OR ESOPHAGUS ) ARE IRRITATED.

25 SODIUM-CONTROLLED DIET
USED FOR PERSONS WITH HEART, LIVER, AND KIDNEY DISEASES SODIUM CAUSES THE BODY TO RETAIN WATER SODIUM RESTRICTED TO 2 GM.DAILY DIABETIC DIET THE DOCTOR DECIDES HOW MANY CALORIES ARE ALLOWED THE DIETICIAN DEVELOPS A BALANCED PLAN DIVIDING THE CALORIES INTO MEALS AND SNACKS *** MEALS MUST BE SERVED ON TIME *** *** PERSON MUST EAT EVERYTHING ON TRAY *** *** IF FOOD NOT EATEN - TELL THE NURSE ***

26 DYSPHAGIA DIET DYSPHAGIA - DIFFICULTY SWALLOWING
ASPIRATION - BREATHING FOOD, FLUIDS, OR AN OBJECT INTO THE LUNGS SOME PEOPLE HAVE DIFFICULTY SWALLOWING LIQUIDS LIQUIDS MUST BE “THICKENED” THICKENED LIQUID - CONSISTENCY OF BABY FOOD MEDIUM THICK - CONSISTENCY OF NECTAR (LIKE TOMATO JUICE) EXTRA THICK - CONSISTENCY OF HONEY YOGURT LIKE CONSISTENCY - THICK, HOLDS ITS SHAPE

27 SIGNS AND SYMPTOMS OF DYSPHAGIA
THE PERSON COMPLAINS THAT FOOD WILL NOT GO DOWN OR FOOD IS STUCK THE PERSON FREQUENTLY COUGHS OR CHOKES BEFORE, DURING OR AFTER SWALLOWING THE PERSON REGURGITATES FOOD AFTER EATING THE PERSON SPITS OUT FOOD SUDDENLY AND FORCEFULLY FOOD COMES UP THROUGH THE PERSON’S NOSE AFTER SWALLOWING, THE PERSON MAKES GARGLING SOUNDS WHILE TALKING OR BREATHING THE PERSON HAS A RUNNY NOSE, SNEEZES, OR HAS EXCESSIVE DROOLING OF SALIVA

28 ASPIRATION PRECAUTIONS
POSITION THE PERSON IN FOWLER’S POSITION SUPPORT THEUPPER BACK, SHOULDERS, AND NECK WITH A PILLOW OBSERVE FOR SIGNS AND SYMPTOMS OF ASPIRATION DURING MEALS AND SNACKS CHECK THE PERSON’S MOUTH AFTER MEALS TO ASSURE THERE IS NO POCKETING OF FOODS MAINTAIN THE PERSON IN A SITTING POSITION FOR 1 HOUR AFTER MEALS

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30 RESIDENTS ARE ENCOURAGED TO GO TO THE DINING ROOM FOR MEALS IF POSSIBLE.
THIS PROVIDES OPPORTUNITIES FOR SOCIALIZATION. PROVIDE ORAL CARE, WASH THE FACE AND HANDS, AND ASSIST WITH TOLIETING BEFORE MEALS. MAKE SURE THE PERSON IS NEAT AND WELL-GROOMED

31 SERVING MEAL TRAYS MATCH THE NAME ON THE TRAY WITH THE PERSON’S ID BRACELET. NOTE IF THERE ARE ANY FOOD ALLERGIES IDENTIFIED AND IF THE DIET IS CORRECT. SERVE TRAYS PROMPTLY TO ASSURE FOOD IS SERVED AT THE CORRECT TEMPERATURE

32 IF THE PERSON IS IN BED RAISE THEM TO A HIGH FOWLER’S POSITION.
PLACE THE TRAY ON THE OVERBED TABLE AND REMOVE THE FOOD COVERS. ASSIST AS NEEDED BY OPENING PACKAGES OF SALT, MILK,ETC., CUT UP MEAT, BUTTER BREAD, OPEN COFFEE AND ADD SUGAR OR CREAM.

33 FEEDING THE PATIENT A PERSON WHO IS VERY SICK, WEAK, OR CONFUSED MAY NEED TO BE FED. YOU MAY BE FEEDING PATIENTS WHO ARE IN BED, IN A CHAIR, IN THEIR ROOM, OR IN THE DINING ROOM. BE SURE THE PATIENT IS SITTING UP STRAIGHT TO AVOID CHOKING. ALWAYS USE A SPOON TO FEED PATIENTS

34 GUIDELINES FOR FEEDING A PATIENT
WASH YOUR HANDS BEFORE PASSING TRAYS OR FEEDING PATIENTS PROVIDE A CLOTHING PROTECTOR IF NEEDED SIT DOWN FACING THE PATIENT AND MAKE EYE CONTACT COMMUNICATE WITH THE PATIENT, EVEN IF THERE IS NO RESPONSE MAKE SURE THE LIQUIDS ARE NOT TOO HOT SOME RESIDENTS NEED THICKENER ADDED TO THEIR LIQUIDS ENCOURAGE THE PATIENT TO HELP AS MUCH AS POSSIBLE FILL THE SPOON ABOUT ONE-HALF FULL

35 ALTERNATE FOODS AND FLUIDS
ALLOW TIME FOR CHEWING AND SWALLOWING AND DO NOT RUSH FEED ON THE UNAFFECTED SIDE OF THE PATIENT’S MOUTH IF THE PATIENT IS PARALYZED ON ONE SIDE MAKE SURE THE PATIENT SWALLOWS AFTER EACH BITE GENTLY STROKE THE PATIENT’S THROAT IF NECESSARY AND REMIND HIM TO SWALLOW DO NOT EAT WHEN FEEDING THE PATIENTS DO NOT TAKE FOOD OFF OF THE PATIENT’S TRAY FOR YOUR OWN USE DO NOT MIX THE FOODS ALL TOGETHER ON THE PLATE

36 SPECIAL EQUIPMENT

37 VISION-IMPAIRED PATIENT
USE THE CLOCK METHOD TO HELP THE VISION-IMPAIRED PATIENT WITH EATING. THE LOCATION OF THE FOOD IS COMPARED TO THE FACE OF A CLOCK.

38 SUPPLEMENTAL NUTRITION
BETWEEN-MEAL NOURISHMENTS PROVIDED TO PATIENTS WHO NEED EXTRA NOURISHMENT. SERVE SNACKS PROMPTLY AND ENCOURAGE THEM TO EAT. LIQUID ORAL SUPPLEMENTS PROVIDE EXTRA CALORIES AND NUTRIENTS. ( ENSURE, SUSTACAL )

39 CALORIE COUNT CALORIE RECORDS ARE KEPT, RECORDING ALL FOODS THE PERSON EATS THE DIETICIAN CONVERTS THE FOOD EATEN INTO CALORIE COUNTS THE NURSE WILL TELL YOU WHICH PATIENTS ARE ON CALORIE COUNTS

40 ENTERAL NUTRITION NASOGASTRIC FEEDING -
INSERTED THROUGH THE NOSE INTO THE STOMACH USED FOR SHORT TERM THERAPY INSERTED BY THE NURSE AND PLACEMENT IS CHECKED BY X-RAY

41 GASTROSTOMY FEEDING PLACED DIRECTLY INTO THE STOMACH THROUGH A SMALL INCISION. THE TUBE MAY BE SUTURED IN PLACE.

42 THE PATIENT WITH A FEEDING TUBE
GUIDELINES FOR CARE OF THE PATIENT WITH A FEEDING TUBE OBSERVE THE PATIENT FREQUENTLY CALL THE NURSE IF THE FEEDING PUMP ALARM SOUNDS MAKE SURE THE TUBING IS NOT KINKED, TANGLED, OR UNDER THE PATIENT’S BODY AVOID PULLING ON THE TUBE KEEP THE HEAD OF THE BED ELEVATED PROVIDE FREQUENT ORAL CARE CHECK THE INSERTION SITE FOR IRRITATION CHECK WITH THE NURSE BEFORE GIVING FOOD OR FLUIDS

43 GUIDELINES FOR CARE OF THE
PATIENT WITH AN I.V. KEEP THE FLUID BAG ABOVE THE LEVEL OF THE INSERTION SITE AVOID PULLING ON THE TUBING DO NOT TAKE A BLOOD PRESSURE IN AN ARM WITH AN I.V. DO NOT ADJUST THE FLOW RATE OF THE I.V. REPORT TO THE NURSE IF: SWELLING, REDNESS, BLEEDING, OR LEAKING AT INSERTION SITE COMPLAINTS OF PAIN OR BURNING HOT OR COLD SKIN NEAR THE IV SITE LOW FLUID LEVEL IN THE IV BAG THE TUBING HAS BEEN DISCONNECTED

44 HYPERALIMENTATION IV FEEDING THAT CONTAINS CONCENTRATED NUTRIENTS
FLOWS INTO A MAJOR VEIN ON THE UPPER CHEST INSERTED BY THE DOCTOR MAY ALSO BE CALLED HYPER-AL, TPN, OR TOTAL PARENTERAL NUTRITION

45 WATER WATER IS AN ESSENTIAL INGREDIENT OF A WELL-BALANCED DIET.
WATER IS LOST THROUGH THE URINE AND FECES, THROUGH THE SKIN AS PERSPIRATION, AND THROUGH THE LUNGS WITH EXPIRATION. WATER ENTERS THE BODY THROUGH FOODS AND FLUIDS.

46 FLUID BALANCE

47 MAINTAINING FLUID BALANCE
ADEQUATE HYDRATION FOR THE ADULT IS BETWEEN 2000 CC TO 2500 CC DAILY. ANYTHING THAT INCREASES FLUID ELIMINATION OR DECREASES FLUID INTAKE CAN AFFECT FLUID BALANCE. EDEMA – THE ACCUMULATION OF FLUID IN THE TISSUES. DEHYDRATION – LACK OF ADEQUATE FLUID IN THE BODY. FORCE FLUIDS – HAVING THE PERSON DRINK INCREASED AMOUNTS OF FLUID. RESTRICT FLUIDS – RESTRICTING FLUIDS TO A CERTAIN AMOUNT. NPO – NOTHING BY MOUTH.

48 INTAKE INCLUDES ALL LIQUIDS INGESTED BY THE PERSON THROUGH THE MOUTH. ALSO FLUIDS GIVEN BY IV AND TUBE FEEDINGS.

49 OUTPUT INCLUDES URINE, VOMITUS, DIARRHEA, AND WOUND DRAINAGE.

50 TYPICAL I &O DEHYDRATED RECEIVING INTRAVENOUS INFUSION
HAVE HAD RECENT SURGERY HAVE A URINARY CATHETER ARE VOMITING HAVE CERTAIN DIAGNOSES SUCH AS CONGESTIVE HEART FAILURE OR RENAL DISEASE

51 INTAKE AND OUTPUT SHEET

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53 A SPECI-PAN IS USED TO CATCH THE URINE OF A PATIENT WHO IS ON I&O THAT CAN BE UP TO THE BATHROOM.
INSTRUCT THE PATIENT TO NOT PUT TOLIET PAPER IN WITH THE URINE TO BE MEASURED.

54 ALL MEASUREMENTS MUST BE MADE IN CUBIC CENTIMETERS (CC) INSTEAD OF OUNCES.
30CC. = 1 OZ.

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