Chapter 23 Nutritional Care of Clients Copyright 2011

Objectives • Describe how illness and surgery can affect nutrition of clients • Identify

Objectives • Demonstrate correct procedures for feeding bed-bound clients • Explain importance of adapting

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

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

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

Improving the Client’s Nutrition • Make formal nutritional assessments on regular basis • All

Feeding the Client • At home, family menu should serve as basis for client’s

Serving the Meal • Make tray and food arrangement as attractive as possible •

Serving the Meal • Ensure client is in comfortable position with tray and utensils

Serving the Meal • Open containers and try to anticipate client’s needs • Give

Feeding the Client Who Requires Assistance • Sit near side of bed • Small

Feeding the Client Who Requires Assistance • If paralyzed, food and straw should be

Feeding the Blind Client • Arrange food as if plate were face of clock

Physical Problems of the Institutionalized Elderly • Majority of people age 85 or more

Physical Problems of the Institutionalized Elderly • Anemia can develop and contribute to fatigue,

Physical Problems of the Institutionalized Elderly • Pressure ulcers can develop in bedridden clients

Physical Problems of the Institutionalized Elderly • Constipation can be caused by inadequate fiber,

Physical Problems of the Institutionalized Elderly • Diarrhea can be caused by lack of

Physical Problems of the Institutionalized Elderly • Disease or medications can cause xerostomia –

Physical Problems of the Institutionalized Elderly • Dysphagia can result from stroke, closed head

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

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

Conclusion • Record type of diet, time of meal, client’s appetite, and type and

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Objectives • Describe how illness and surgery can affect nutrition of clients • Identify and describe three or more nutritionrelated health problems common among elderly clients needing long-term care Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

Objectives • Demonstrate correct procedures for feeding bed-bound clients • Explain importance of adapting family’s meal to suit clients’ nutritional requirements Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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

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 tissues to provide protein for energy • Can be problem among hospitalized clients Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

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

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

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

Serving the Meal • Make tray and food arrangement as attractive as possible • Serve water and another beverage • Serve food at proper temperature Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

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

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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

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

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

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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

Physical Problems of the Institutionalized Elderly • Anemia can develop and contribute to fatigue, confusion, and depression • Provide sufficient animal protein and vitamin C in diet Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

Physical Problems of the Institutionalized Elderly • 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

Physical Problems of the Institutionalized Elderly • 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

Physical Problems of the Institutionalized Elderly • 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

Physical Problems of the Institutionalized Elderly • 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

Physical Problems of the Institutionalized Elderly • 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. (continues)

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.