Cebu Doctors’ UniversityMandaue City, CebuCollege of Nursing

A.Y. 2010 -2011

“FEEDING HELPLESS PATIENTS”

SUBMITTED BY:

Paradela, Pius AugustusPunay, Lisa Marie

Querequincia, KimberlyRalloma, Maria Francheska

Sandigan, Nico DianeSiao, Angeli

Soco, Marc Lawrence

BSN – 2C

After 4 hours of varied teaching-learning experience, the Level II students will be able to:

1. define the following terms:1.1 diet 1.9 peristalsis1.2 calorie 1.10 gavage1.3 nutrient 1.11 aspiration1.4 nutrition 1.12 regurgitation1.5 feeding 1.13dietitian1.6 appetite 1.14nutritionist1.7 nausea 1.15helpless patient1.8 anorexia

2. discuss the following:2.1 different factors affecting dietary patterns2.2 types of diet 2.2.1 regular diet 2.2.8 low sodium diet 2.2.2 light diet 2.2.9 low/high calorie diet 2.2.3 soft diet 2.2.10 diabetic diet 2.2.4 bland diet 2.2.11 pureed diet 2.2.5 low/high residue diet 2.2.12 dash diet 2.2.6 low/high purine diet 2.2.13 clear liquid diet 2.2.7 low fat diet 2.2.14 general liquid diet2.3 different methods in feeding 2.3.1 enteral feeding

2.3.1.1 orogastric tube feeding 2.3.1.2 nasogastric tube feeding 2.3.1.3 gastrotomy tube feeding 2.3.1.4 jejunostomy tube feeding

2.3.2 total parenteral nutrition 2.3.3 brecht feeding 2.3.4 clock face technique2.4 clients who need assistance in feeding

3. explain the following3.1 importance of feeding helpless patients3.2 scientific principles applied in feeding helpless patients

4. state the important nursing responsibilities to observe in feeding helpless patients before, during & after the procedure

5. demonstrate beginning skills in demonstrating helpless patients

DEFINITION OF TERMS:

1. Diet - food and drink considered with regard to their nutritional

qualities, composition, and effects on health- nutrients prescribed, regulated, or restricted as to kind

and amount for therapeutic or other purposes2. Calorie

- amount of heat needed to raise the temperature of 1kg of water

- used to denote the heat expenditure of an organism and the fuel or energy value of food

3. Nutrient- A chemical substance that provides nourishment and

affects the nutritive and metabolic processes of the body

4. Nutrition- The sum of the processes involved in the taking in of

nutrients and their assimilation and use for proper body functioning and maintenance in health

- Study of food and drinks as related to the growth and maintenance of living organisms

5. Feeding- An act or process of providing nutritional intake for

patient who is unable to feed himself6. Appetite

- A natural or instinctive desire, such as for food7. Nausea

- An unpleasant wave-like sensation in the back of the throat, epigastrium, or throughout the abdomen that may or may not lead to vomiting

8. Anorexia- Lack or loss of appetite, resulting in the inability to eat

9. Peristalsis- The coordinated, rhythmic serial contraction of smooth

muscle that forces food through the digestive tract10. Gavage

- Introduction of nutritive material into the stomach by means of a tube

11. Aspiration

- Entry of gastric secretions, oropharyngeal secretions, exogenous food or fluids into tracheobronchial passages caused by dysfunction or absence of normal protective mechanisms

12. Regurgitation- The backward flow from the normal direction, as the

return of swallowed food into the mouth13. Dietitian

- An expert in food and nutrition who supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits

14. Nutritionist- A specialist who study and advise on human diet

15. Helpless patient- A client who is unable to help himself perform the

various activities of daily living.

FACTORS AFFECTING DIETARY PATTERNS:

1. Physiological factors2. Psychological factors

- Some people over eat when stressed, depressed, or lonely but others eat only a little under the same circumstances

3. Lifestyle- Certain lifestyles are linked to food related behavior

4. Health status- Illnesses and disorders may prevent a person from

obtaining adequate nourishment5. Medication

- Effects may vary considerably. They may alter appetite, or disturb taste perception

6. Peer groups7. Personal influence and uniqueness

- People may develop likes and dislikes based on associations with a typical food

8. Religion

- An individual’s belief may affect his nutritional intake9. Advertising

- Food producers may persuade the people to change from the product they currently use to the brand of the product of the producer

10.Alcoholic beverages- The calories contained in alcoholic drinks include both

those of the alcohol itself and of the juices or other beverages added to the drink

11.Age- Nutritional requirements vary throughout the life cycle

of a person12.Beiefs about the health effects of food

- Many people acquire their beliefs about food from the media

13.Ethnicity and culture14.Socio-economic status

- People with limited income may not be able to afford some nutritional food needed in their diet

15.Therapy

TYPES OF DIET:

2.2.1 Regular diet

- a full, well-balanced diet containing all of the essential nutrients needed for optimal growth, tissue repair, and normal functioning of the organs.

Indication For Use

For ambulatory or patients whose conditions do not necessitate a modified diet.

Food Selection Guide

All foods are allowed2.2.2 Light diet

- Light diet should be given in convalescence following the fluid and soft diets, and in those cases not needing special dietary consideration.

Indication For Use

Resting or inactive person

often prescribed for gastrointestinal illness or before or after certain types of surgery involving the mouth or gastrointestinal tract.

Food Selection Guide:

 Fruits: fruit juices or cooked fruitsCereal   foods : well-cooked cereals, strained if necessary;

rice and macaroni; thin dry toast.

Vegetables: fresh spinach; celery; strained peas; potatoes, baked, boiled, or mashed.

Fats: butter, thin creamMeats: not more than one small serving a day of broiled

chop or steak; meatbroths

Milk: plain, in eggnog, in cream soups, in simple desserts.Simple desserts: custards, junket, ice cream, gelatin

desserts, cooked fruits or cereal puddings.

2.2.3 Soft diet

- follows the regular diet pattern but modified in consistency.

- foods allowed are those which are easy to digest, such as fruits and vegetables with low cellulose content, and met with little or no tough connective tissue like elastin.

Indication for Use

- Post-operative cases when patient cannot tolerate a full diet

- Fevers and mild infections- Gastro-intestinal disturbances- Convalescence- Transition diet from liquids to a regular diet- Condition in which ease of chewing, swallowing and

digestion are desired- extreme weakness, chemotherapy and radiation therapy

Food Selection Guide:

Vegetables:

Allowed: Well-cookedAvoided: Raw

Fruits:

Allowed: Ripe mango, avocado, atis, banana, papaya, kaimito, chico, and grapes without skin and seeds, orange sections without membrane; CANNED OR COOKED: pared apples, cherries, peeled apricots, peaches, pears, plums, guavas without skin and seeds; strained juices. AS TOLERATED: canned pineapple, figs, lychees, berries; stewed dried fruits

Avoided: All raw except those on ALLOWED list.

Meat or substitute:

Allowed: BOILED, BAKED OR BROILED: tender, ground or minced beef, liver, tongue, lean pork, brain, chicken; CANNED: corned beef, Vienna sausage, meat loaf; eggs cooked any way except fried; baked or boiled vegemeat, tokwa, or tofu; legumes without skin; mild processed, cream and cottage cheese.

Avoided: Meats with excessive fat and connective tissues; fried and highly spiced canned or cured meats, fish or poultry; sharp or spicy cheese and cheese spreads.

Fats:

Allowed: Butter, margarine, mayonnaise, cream, smooth peanut butter.

Avoided: All others including nuts and fried or greasy foods.

Sugar:

Allowed: IN MODERATION: plain candies, jellies, jams and marmalade made from allowed fruits, syrups.

Avoided: Excessive amounts.

2.2.4 Bland Diet

The Bland diet regimen is a progression of diets made up of foods which do not unduly increase gastric acid production and are non-irritating to the gastro-intestinal tract. The diets range from the very restricted Bland I to the rather liberal Bland V.

Bland Diets I to III are essentially low fiber diets and are deficient in some vitamins and iron.

Bland IV, sometimes called Soft Bland, is patterned after the Soft Diet with additional restrictions on coffee, tea, alcohol and certain spices and condiments. When well planned, the diet may be adequate but prophylactic supplementation with vitamins and iron desirable.

Bland V, sometimes called Full Bland, is the Full or Regular Diet with the same restrictions as Bland IV.

Indications For Use- Gastric and duodenal ulcers

- Peptic Ulcer Disease (PUD)- Gastroesophageal disease (GERD)- Gastritis- Esophageal varices- Post-esophageal, gastric, duodenal and pancreatic surgery

Food Selection Guide

Bland I Bland II Bland III Foods to avoid (unless tolerated)

Vegetables

White potatoes w/o skin – boiled, baked, or mashed

Strained low-fiber vegetables like carrots, chayote, squash.

Well-cooked carrots, squash, chayote, upo, green papaya, peas, young patola, cooked tomato and eggplant w/o skin and seeds.

All vegetables not under ALLOWED list.

Fruits

None Ripe banana; strained mango, papaya; canned peaches, pears; dilute orange and other fruit juices.

All fruits included in bland II; avocado, ripe mango, chico, tiesa, melon tagalong; scraped cantaloupe; seeded atis, seeded and peeled grapes;

Raw except those in ALLOWED 1’st; canned and freshfgis and pineapple.

baked apple w/o skin; all canned fruits except figs and pineapple.

Meat, Fish and Poultry

NoneBoiled, steamed or baked chicken; Pureed lean meat; Steamed or boiled tender fish (w/o scales or tough skin).

Tender, baked, broiled creamed, stewed; beef, chicken, fish, shrimps, turkey.

Fatty meats; tough meats with gristle; salted, smoked, cured and spiced as sausage, bologna, salami; gravy.

Fats

Butter and Margarine

Butter and Margarine

Butter, cream, margarine vegetable oils, cooking fat, smooth peanut butter.

Nuts

Sweets

Sugar in moderation

Sugar, jelly, syrup, plain hard candies; panocha, matamis na bao.

Sugar, jelly, syrup, plain hard candies; panacha, matamis na bao.

Candy containing nuts, glazed fuit, jam, marmalade, chewing gum.

2.2.5 High/Low Residue Diet

High Residue Diet

This diet is very restricted in the allowance of fruits and vegetables so that it is very low in fiber content. Adequate in energy value and protein, but should be supplemented with vitamins and minerals when used for prolonged periods.

Indications For Use

- atonic constipation- spastic colon (irritable bowel syndrome)- diverticulosis

Food Plan and Selection Guide

Same as for bland III, but with the following modifications:

Vegetables - Allow only strained juices and boiled or baked potato without skin.Fruits - Allow strained juices only.Milk - Skimmed milk only, and if tolerated.

Meat group - Beans not allowed.Beverages - Coffee, tea, cola beverages are allowed.

Low Residue Diet

A low residue diet is a diet designed to reduce the frequency and volume of stools while prolonging intestinal transit time

Provide a food and drinks that are easily digested and almost completely absorbed to produce only a moderate amount of stool.

Indications For Use

- acute diarrhea with abdominal cramping- Ulcerative colitis- Partial intestinal obstruction, rectal bleeding and stenosis

of esophageal or intestinal lumen.- Acute phases of inflammatory condition of the bowel such

as ulceratives colitis, Crohn’s disease, diverticulitis, radiation enteritis (due to radiation therapy).

- Intermediate diet after intestinal or rectal surgery as a person progresses from a liquid to a regular diet

- Esophageal varies, ileostomies, colostomies or narrowed intestinal lumen.

Food Selection Guide

White bread, refined pasta and cereals, and white riceLimited servings of canned or well-cooked vegetables that

do not include skins

Moderate fresh fruits without peels or seeds, certain canned or well-cooked fruitsTender, ground, and well cooked meat, fish, eggs, and poultryMilk and yogurt (usually limited to 2 cups per day), mild cheese, ricotta, cottage cheeseButter, mayonnaise, vegetable oils, margarine, plain gravies and dressingsPulp free, strained, or clear juices

2.2.6 Low/High Purine Diet

The purine content of the diet outlined below is about 120 to 150 mg., whereas the regular diet may contain as much as 600 to 1000 mg. per day. Foods moderately high in purines such as meat, fish, poultry and beans are allowed in limited amounts on this diet, while those very high in purines such as glandular organs, anchovies and glandular organs are avoided.

Purine a compound that is mainly found in animal protein and is metabolized to uric acid in the body.

Indications For Use

Supplementary to medical management of patients with uric acid problems.

- Gout- Hyperuricemia- Uric acid stones

Food Selection Guide

Food Groups Allowed Avoided/Restricted

Vegetables All except those on Avoid list.

Asparagus, cauliflower, mushroom, spinach.

Fruits All None

Meat or substitute Beef, pork and chicken, up to 3 oz. per day; cheese and eggs

Anchovies, sardines, glandular organs; legumes and lentils; others in excess of allowance.

Beverages Coffee, tea, cocoa Alcoholic beverages

2.2.8 Low Sodium Diet

is a diet that includes no more than 1,500 to 2,400 mgs of sodium per day.

The human requirement for sodium in the diet is about 69 mg per day, which is typically less than one-tenth as much as many diets "seasoned to taste". For certain people with salt-sensitive blood pressure, this extra intake may cause a negative effect on health.

Individuals with the following medical conditions are advised to follow a low sodium diet: Congestive heart failure, Cirrhosis, Kidney disease, Ménière's disease, Hypertension, and Diabetes.

Unprocessed, fresh foods, such as fresh fruits, vegetables, lean meats, poultry, fish and unprocessed grains are low sodium.

2.2.9 Low Calorie diet

is any diet plan that allows 800 calories or less in a day; and the diet is overseen by a physician.

often prescribed for hypertension and edematous states. Individuals who usually go on such a diet are very

overweight or suffer from severe obesity. Children, adolescents, and pregnant women should not go on this diet.

Boiled potatoes, Celery, Broccoli, Mushroom, Tomatoes, Apricot, Melon, Lean ham, Beef, White eggs, Low fat cheese are examples of low calorie foods.

High Calorie diet

is a diet furnishing more calories than needed to maintain weight, often more than 3500–4000 calories per day.

For people with Huntington's Disease it is important to eat adequately to prevent weight loss.

Potatoes prepared with added fat such as butter, margarine and whole milk, Granola and other cereals with dried fruit, Vegetables prepared with added fat (margarine, butter, cream cheese, and cheese), Canned fruit in heavy syrup, Fried meats, Meats covered in cream sauces or gravy, Whole milk and milk products (yogurt, ice cream, cheese), Whipping cream or heavy cream, Creamed and meat soups.

2.2.10 Diabetic diet

is a diet prescribed in diabetes mellitus, usually limited in the amount of sugar or readily available carbohydrate.

The diet most often recommended is high in dietary fiber, especially soluble fiber, but low in fat (especially saturated fat).

2.2.11 Pureed diet

also known as Strained soft diet is when the meat is ground and vegetables and fruits are

pureed. Used for patients with difficulties in chewing and swallowing,

acute infections/some gastrointestinal disturbances and as a transitional step from the liquid to an unrestricted diet in post operative patients.

2.2.12 DASH diet

Dietary Approaches to Stop Hypertension is a diet promoted by the National Heart, Lung, and Blood

Institute to control hypertension. This eating plan is rich in fruits, vegetables, whole grains,

and low-fat dairy foods; includes meat, fish, poultry, nuts and beans; and is limited in sugar-sweetened foods and beverages, red meat, and added fats.

The diet reduced systolic blood pressure by 6 mm Hg and diastolic blood pressure by 3 mm Hg in patients with normal blood pressure. Those with hypertension dropped by 11 and 6, respectively.

2.2.13 Clear liquid diet

Is made up of clear liquid foods which leave no residue in the gastro-intestinal tract.

It is non-distending, non-irritating and non-stimulating to peristaltic action. It is very adequate nutritionally in all respects and it’s use should therefore be limited to 24 hours to 48 hours.

A clear liquid diet is important in some cases of diarrhea and vomiting

Clear snack drinks like HiC, Koolaid, and most juice boxes, Popsicles, Bullion or clear broth (skimmed of fat), Cranberry, grape and apple juices, Some types of soda pop; non-caffeinated, no artificial sweeteners, and most carbonation (fizz) should be gone (These must be diluted by one-half with ice or water first.)

2.2.14 General liquid diet

a liquid diet includes clear liquids or opaque fluids that are completely or partially fluid in consistency.

Generally your doctor might recommend you a liquid diet in case you are about to undergo certain medical tests, surgery or any other medical procedures that require your stomach or intestine to be devoid of solid food particles.

The other scenario in which you might be advised to follow a liquid diet is when you suffer from ailments of the digestive system and suffer from problems like diarrhea or vomiting. In addition to this if you have trouble swallowing or chewing, the doctor might recommend you a liquid diet until the proper chewing and swallowing functions are restored.

Juices, milk, ice cream, pudding, strained cream soups, fruit nectar with pulp, soft-cooked cereals like oatmeal or even wheat are examples of liquids under this diet.

DIFFERENT METHODS IN FEEDING:

A.ENTERAL FEEDING Is a very useful method of ensuring adequate intake

of nutrients in patients who, for a variety of reasons are unable to use the oral route, or are unable to take sufficient nutrients to maintain growth and development.

1. Naso-Gastric Tube Feeding= refers to the process of placing a soft plastic nasogastric (NG) tube through a patient’s nostrils, past the pharynx and down the esophagus into the patient’s stomach.

= is the most common route for enteral feeding.=Benefits include:

It is easy to establish It is minimally invasive

= risk/drawbacks associated with NG tube feeding include: The procedure for inserting the tube is traumatic for

the majority of children The tube is very noticeable Babies and young patients and uncooperative

children are likely to pull out the tube making regular re-insertion necessary

Aspiration= NG tube feeding is particularly useful in the short term.= however, in the term, gastrostomy feeding may be more suitable

= CONTRAINDICATIONS to passing a naso-gastric tube: Anatomical deformity Trauma Recent oral, nasal or esophageal surgery Severe gastro-esophageal reflux desease (GERD)

= INDICATIONS for enteral nutrition include the following: Prolonged anorexia Severe protein-energy under nutrition Coma or depressed sensorium Liver failure Inability to take oral feedings due to head or neck

trauma or neurologic disorders

2. Orogastric tube feeding= is a long, narrow tube inserted through the mouth, which descends down the throat directly into the stomach.

=INDICATIONS: Prolonged positive pressure ventilation Preferred route in newborns

o Keeps nose open for ventilation Gastric lavage

o  "to wash"o such devices are normally used on a person who

has ingested a poison or overdosed on a drug or consumed too much alcohol

ADVANTAGES It is easier to insert an oro-gastric feeding tube than a

naso-gastric tube and the tube is more easily tolerated during use, according to the UCL Institute of Child Health. It is also a less traumatic method of feeding for an infant or child.

DISADVANTAGES If the infant is taking some breast or bottle feeds, the

tube should be passed as required and removed between feeds.

3. Gastrostomy Tube Feeding= “G-tube” is a tube inserted through the abdomen that delivers nutrition directly to the stomach.

= INDICATIONS: Congenital (present from birth) abnormalities of the

mouth, esophagus, stomach or intestines Sucking and swallowing disorders, which are often

related to prematurity, brain injury, developmental delay, or certain neuromuscular conditions like sever cerebral palsy.

Child’s inability to gain weight and grow appropriately Advantage:

o used for long-term enteral nutrition

= the three methods for inserting a G-tube are:a. Percutaneous Endoscopic Gastrostomy (PEG)

- The most common technique, uses an endoscope (a thin, flexible tube with a tiny camera and light at the tip) inserted through the mouth and into the stomch to guide the doctor’s positioning of the G-tube

b. Laparoscopic Techniquie- Done by making several small incisions in the

abdomen and inserting telescope that helps surgeons see the stomach and surrounding organs

c. Open Surgical Procedure- A good approach for replacing a gastrostomy tube but

usually is severed for cases where the child’s anatomy wont allow for a PEG; if there is scar tissue from a previous surgery, procedure, or illness; or if the child requires another surgical procedure at the same time.

4. Jejunostomy Tube Feeding= the J-tube is surgically implanted in the upper section of the small intestine called the jejunum which is just below the stomach. The tube will be located lower and more towards the center of the abdomen, when comparing it to the location of a G-tube

= tube is placed for the patient who is unable to take in enough food or drink through the mouth to maintain body weight. Most people who receive a J-tube are those who have trouble digesting food or emptying their stomach, aspirate food into their lungs

= Feeding through a J-tube is always done using a feeding pump. A visiting nurse or home care company will help arrange for your feeding pump and instructions on how to use the pump at home.

B.TOTAL PARENTERAL NUTRITION

- Also referred to as hyperalimentation

- Is the intravenous infusion of water, protein, carbohydrates, electrolytes, minerals and vitamins through a central vein.

Components of Parenteral Nutrition

Component Description

Protein Supplied as crystalline synthetic amino acids; contains essential and nonessential amino acids (4 calories/ gram of protein; 1 gram nitrogen/ 6grams protein)

Carbohydrate Supplied as dextrose at 3.4 calories/gram. Peripheral administration 0% to 10% dextrose; central administration up to 50%, although usual is 20% to 25%.

Electrolytes Added to formula: can include sodium, potassium, chloride, acetate, calcium, phosphorus, magnesium; administration according to need.

Minerals Added to formula; can include zinc, chromium, manganese, and copper; administered according to need.

Vitamins Recommended allowances of vitamins A, thiamin, riboflavin, B6, B12, C, D, E, folic acid,

niacin, biotin, and pantothenic acid.

Fat Contains primarily essential fatty acids; requires separate container due to stability problems.

TPN formulas provide all of the known essential nutrients in quantities that promote weight gain, wound healing, anabolism, and, in children, growth.

A thorough nutritional assessment is required to determine the appropriate TPN regimen.

Traditionally, the dextrose, amino acids, electrolytes, vitamins, and minerals are mixed together in one container and infused as the primary solution.

Indicated for the following clients: Those, who for prolonged periods, are unable to ingest

food because of trauma, a comatose state, or a disease process

Those who are unable to absorb food via the gastrointestinal tract, e.g., a client with paralytic ileus

Those who are malnourished or at risk for malnutrition and who will need the Parenteral nutrition for longer than 5 days

Those in whom the bowel or other organs need to rest, such as those with inflammatory bowel disease or pancreatitis.

The client receiving TPN is at risk for the same complications as are clients with a CVC: example,

Catheter misplacement Pneumothorax

- cause: incorrect placement of catheter- S/S: absence of breath sounds on affected side, chest or shoulder pain, sudden shortness of breath, tachycardia, cyanosis.

Air embolism- Causes: opened catheter system, disconnected IV tubings, Air on IV tubings- S/S: apprehension, chest pain, dyspnea, hypotension, rapid and weak pulse, respiratory distress, loud churning sound over pericardium.

Systemic infection or infection at the infusion site- causes: poor aseptic technique, catheter contamination, contamination of solution- S/S: chills, fever, elevated WBC, Erythema or discharges at insertion site.

Metabolic complications (possible)

Potential Complications: Hyperglycemia Hypoglycemia Acidosis Electrolyte deficiency or excesses such as: hyperkalemia,

hyponatremia, and hypocalcemia. Potential complications require meticulous

monitoring during therapy. The nurse must:

Monitor the client’s fluid balance and weight gain daily.

Blood glucose levels to assess for blood glucose imbalances.

Implement aseptic measures to prevent contamination of the parenteral nutrition solution and the infusion catheter.

Should handle solutions and infusion tubing carefully, especially when setting up or changing the tubing.

Major Complications associated with TPN

Problem/cues Signs & symptoms

Preventive Actions

Immediate Actions

Hyperglycemia:

May occur if hypertonic glucose infusion is too fast or if there is too little insulin in the solution

Presence of sugar in the urine (glucosuria); high blood sugar; excessive thirst (polydipsia); excessive urination (polyuria); excessive hunger (polyphagia)

Administer concentrated glucose solutions very slowly via infusion pump.

Monitor blood glucose levels.

If infusion rate slows, maintain prescribed drip rate; never increase the infusion rate.

Decrease infusion rate if too fast; notify physician, who may order the insulin be added to the infusion.

Hypoglycemi Blood glucose Use an infusion Adjust infusion

a:

May occur if infusion flow stops abruptly or if there is too much insulin in the solution

level below 60mg/dl; diaphoresis; tachycardia; anxiety; trembling; hunger; dizziness; personality change; unconsciousness

pump to administer the infusion, and maintain prescribed flow rate.

Monitor blood glucose levels.

rate, or decrease insulin in infusion.

C.BRECHT FEEDING

- Also called as Brecht feeder, is a type of feeding used for cleft lip and cleft palate clients.

- Indicated for breast feeding because the bulk of the mother’s breast tends to form a seal against the incomplete upper lip.

- An eyedropper or an Asepto syringe with a short piece of rubber tubing on the tip. Support the baby in an upright position. The dropper or syringe is used carefully to drip formula

into the newborn’s mouth at a rate slow enough to allow the newborn to swallow.

D.CLOCK FACE TECHNIQUE

- Used by healthcare providers to feed patients especially for blind patients.

- Purpose: To assist patients with vision problems. Awareness that they can benefit from verbal clues. To learn special techniques to feed themselves

independently.- Indicated for: blind patients, geriatric patients

CLIENTS WHO NEED ASSISTANCE FEEDING

The Handicapped – these include the blind patients, paralyzed patients like those who remain in a back-lying position or those who cannot use their hands

The Elderly – those patients who are weakened and quickly fatigued, also those patients who are chronically or acutely ill that cannot support themselves

Children; infants; the mental-ill patients – those with sensory motor dysfunction

Unconscious/comatose patients or those patients who have under gone surgery - they need immediate assistance (via I.V. therapy)

IMPORTANCE OF FEEDING HELPLESS PATIENTS

Promotes regular eating habits of patients Meets client’s nutritional needs Promotes nurse-client relationship Promotes early recovery of patients through maintenance

of good nutritional deficiencies Corrects nutritional deficiencies It ensures continual proper nutrition even if the patient

cannot feed themselves Food is the source of our energy

Food contains essential nutrients, vitamins and minerals

SCIENTIFIC PRINCIPLES APPLIED IN FEEDING HELPLESS PATIENTS

Human Anatomy and Physiology – the digestive system breaks down food and provides nutrients that help provide our body with the energy we need

Chemistry – essential nutrients are proteins, carbohydrates, fat(lipids), water, vitamins, and minerals.

Carbohydrates are the major source of energy for the body.

Proteins serves as a source of energy, as substrates for tissue growth and maintenance, and for certain biological functions,

Lipids consist of fats and oils.

Vitamins are chemical compounds that are required for normal growth and metabolism .

Minerals play vital roles in several physiological functions, including critical involvement in nervous system functioning, in cellular reactions, in water balance in the body, and in structural systems, such as the skeletal system.

Water is helpful as a conduction system for transportation of vital nutrients and unnecessary waste, and as a mode of temperature regulation.

Microbiology – microorganisms are able to enter the body through our food and drink so the food must be properly

cooked before eating and utensils must be cleaned also beforehand

Psychology – the health care provider should present a clean and pleasant environment for the patient; the food should also look appetizing so that the patient will eat it

Physics – cleaning of the utensils requires the force of friction to remove dirt; when doing tube feeding physics is applied in terms of the height of the feeding

Time and Energ y – prepare all the materials needed before starting

Body Mechanics – observe proper body mechanics to avoid back strains

Pharmacology – patients are given various medication through the different feeding techniques

Sociology – the nurse should establish rapport with the patient in order to reduce anxiety and maintain cooperation

NURSING RESPONSIBILITIES IN FEEDING HELPLESS PATIENTS:

Before:- Do medical hand washing- Check the patient’s chart- Greet and inform the patient of what you are about to

do- Verify that the patient has been given the correct tray- Ensure that food is at desired temperature- Place a towel on patient’s chest- Protect clothing with towel/napkin- Remove unpleasant odor and sight from the

environment During:

- Arrange the tray conveniently- Always tell the patient what food is being fed or given- Don’t rush the patient- Be therapeutic in conversing with the patient- Provide fluids as requested- Wipe the patient’s mouth in one event of spillage

After:

- Check the patient’s garment for any spillage- Wipe one patient’s chin and mouth starting from the

least contaminated to the most contaminated- Ask the patient about his/her feedback about the

experience- Allow the patient to rest- Offer oral care and hand washing- Make the patient comfortable- Record important data- Do after care