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Thursday, May 1, 2008

Feeding Adult Patients

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Feeding Adult Patients Slide Transcript
Slide 1: Feeding Adult Patients M.J. Bailey

Slide 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

Slide 3: Factors Influencing Dietary Patterns 1. 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 M.J. Bailey

Slide 4: Factors Influencing Dietary Patterns 1. 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

Slide 5: Factors Influencing Dietary Patterns 1. 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

Slide 6: Factors Influencing Dietary Patterns 1. 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

Slide 7: Factors Influencing Dietary Patterns 1. 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

Slide 8: Factors Influencing Dietary Patterns 1. 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

Slide 9: Factors Influencing Dietary Patterns 1. 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 14: Types of Diets Sodium Restricted – Low levels of sodium = NO SALT – CHF, Renal failure, cirrhosis, hypertension Low Cholesterol – Cholesterol intake 300mg/day – Fat intake 30–35% – Eliminate/reduce fatty foods M.J. Bailey

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

Slide 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

Slide 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

Slide 18: Suspect Dysphagia when client Coughs/ gags during eating Exhibits multiple attempts @ swallowing c/o food getting stuck in throat Poor lip & tongue control M.J. Bailey

Slide 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

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

Slide 21: Procedure for Feeding Relaxed pace Small bites/spoonfuls Rocking motion of utensil on tongue Maintain sitting 15-30 min. pc. M.J. Bailey

Slide 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

Slide 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

Slide 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

Slide 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

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

Slide 27: Tube feeding schedule Continuous – Over 24 hrs Cyclic – Prescribed period ( ie:16hrs) Bolus – Prescribed volume over 30-60 min. 4-6 X/day. – Physician orders frequency, amount, & type of feeding M.J. Bailey

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

Slide 29: Do’s and don’ts re tube feeding Do not hurry/force feeding – Abdominal distention & discomfort Clean not sterile technique Formula @ room temp. – Warm= bacterial growth – Cold= gastric cramping & discomfort, liquid is not warmed by the mouth and esophagus M.J. Bailey

Slide 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

Slide 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

Slide 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

Slide 33: Position for tube feeding  Fowlers before and after – Prevents aspiration  Regulate the flow of the feeding 6mls/min  Gravity/ feeding pump  Flush tube well post feeding  Clamp tube post flushing  Intake/output Avoid introducing air into tubing M.J. Bailey

Slide 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 2100-2900mls M.J. Bailey

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

Slide 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

Slide 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

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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

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

Slide 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

Slide 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

Slide 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

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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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

Slide 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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