Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 23 Nutritional Care of...

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 23

Nutritional Care of Clients


Objectives

• Describe how illness and surgery can affect nutrition of clients

• Identify and describe three or more nutrition-related health problems common among elderly clients needing long-term care

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Objectives

• Demonstrate correct procedures for feeding bed-bound clients

• Explain importance of adapting family’s meal to suit clients’ nutritional requirements


Nutritional Care

• Fever, nausea, fear, depression, chemotherapy, and radiation can destroy client’s appetite

• Vomiting, diarrhea, chemotherapy, radiation, and some medications can reduce or prevent absorption of nutrients


PEM

• When food intake does not meet body needs, body uses own stores of energy

• When glycogen and fat stores exhausted, body must break down own tissues to provide protein for energy

• Can be problem among hospitalized clients

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PEM

• Can delay wound-healing, contribute to anemia, depress immune system, and increase susceptibility to infections

• Symptoms:– Weight loss and dry, pale skin

• Iatrogenic malnutrition– Malnourishment as result of hospitalization


Improving the Client’s Nutrition

• Make formal nutritional assessments on regular basis

• All members of health care team should be alert to signs of malnutrition every day

• Listen to client’s concerns

• Watch reaction to food served

• Include dietitian in plan of care


Feeding the Client

• At home, family menu should serve as basis for client’s meal whenever possible

• Omit or add certain foods as necessary

• Vary method of preparation if needed


Serving the Meal

• Make tray and food arrangement as attractive as possible

• Serve water and another beverage

• Serve food at proper temperature

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Serving the Meal

• Ensure client is in comfortable position with tray and utensils placed conveniently

• Offer bedpan and hygiene care before and after meal

• Remove any unpleasant sights

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Serving the Meal

• Open containers and try to anticipate client’s needs

• Give sufficient time to eat– Reheat food as needed

• Document intake per facility policy


Feeding the Client Who Requires Assistance

• Sit near side of bed

• Small amounts of food should be placed toward back of mouth with slight pressure on tongue with spoon or fork

• Do not feed client with syringe

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Feeding the Client Who Requires Assistance

• If paralyzed, food and straw should be placed on non-paralyzed side of mouth

• If client begins to choke, help sit up straight

• Client diagnosed with dysphagia requires specialized diet– Should not use straw


Feeding the Blind Client

• Arrange food as if plate were face of clock

• Use consistent pattern so client knows where each item will be each time

• Client usually feels better when helping self


Physical Problems of the Institutionalized Elderly

• Majority of people age 85 or more have at least one chronic disease– Conditions affect attitudes, physical activities, and

appetites• Thus, nutritional status

• PEM– Major problem

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• Anemia can develop and contribute to fatigue, confusion, and depression

• Provide sufficient animal protein and vitamin C in diet

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• Pressure ulcers can develop in bedridden clients– Must be prevented

– Healing requires treatment of ulcer, relief of pressure, and high-calorie diet with sufficient protein, vitamin C, and zinc supplements

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• Constipation can be caused by inadequate fiber, fluid, or exercise– Other causes:

• Medication, reduced peristalsis, or former abuse of laxatives

– Treatment:• Increasing fiber, fluid, and exercise

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• Diarrhea can be caused by lack of muscle tone in colon– May be helpful to increase fiber in diet and combine with

supplemental vitamins and minerals

• Sense of smell declines with age

• Appetite diminishes

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• Disease or medications can cause xerostomia– Dry mouth

• May be helpful to drink water, eat frequent, small meals, and chew sugar-free gums or candies

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• Dysphagia can result from stroke, closed head trauma, head or neck cancer, surgery, or Alzheimer’s and other diseases– Many clients must have thickened liquids

– Clients should always be in upright position when eating


Conclusion

• Illness and surgery can have devastating effects on client’s nutritional status

• PEM can be significant problem in hospitals

• Offer bed-bound clients bedpan and assistance with hygiene care before and after meals

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Conclusion

• Encourage clients to feed themselves– However, offer help and anticipate needs

• Client who is blind can eat more easily if food arranged in set pattern on plate

• Provide pleasant conversation and atmosphere

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Conclusion

• Record type of diet, time of meal, client’s appetite, and type and amount of food eaten

• Nutrition-related health problems in elderly can sometimes be relieved with proper treatment

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 23 Nutritional Care of...

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