HCA 106- FINAL quiz

Changing Clothing, incontinence briefs and hospital Gowns:

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* Provide for privacy 
* Encourage the client to do as much as possible 
* Let the client to do as much as possible 
* Let the client choose what to wear 
* Remove clothing from unaffected side first (“RUF” REMOVE FROM UNAFFECTED SIDE FIRST)
* Put clothing on affected side first 
* Support clients arms or leg when removing or putting on a garment

Chest Tubes:

Air, blood, or fluid can collect in the pleural space (sac or cavity), when the chest has been penetrated because of injury or surgery.

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* Pneumothorax 
* Air in the pleural space
* Hemothorax
* Blood in the pleural space
* Pleural effusion 
* The escape and collection of fluid in the pleural space

Liquid oxygen system:

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* Portable unity is filled from a stationary container called a reservoir 
* Portable unit can be worn over the shoulder

Promoting Oxygenation:

To get enough oxygen, air must reach the alveoli, where O2 and CO2 are exchanged.

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* Disease and injury can prevent air from reaching the alveoli.
* Pain and immobility interfere with deep breathing and coughing.
* Narcotics can interfere with deep breathing and coughing.

Report abnormal pulses to the nurse at once:

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* **Tachycardia** is a heart rate of more than 100 beats per minute.
* **Bradycardia** is a heart rate of less than 60 beats per minute.

Measuring weight and height

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* Weight and height are measured on admission to the agency, and as directed.
* Balance beam scales, chair scales, lift scales, wheelchair weigh scales, and digital scales are used

Clients with swallowing difficulties

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* Help the client sit upright, leaning slightly forward.
* Ask the client to lower the chin when swallowing.
* Offer plenty of liquids.
* Give time to chew and swallow.
* Client to remain sitting for at least 30 minutes after meal.

Factors That Affect Eating and Nutrition:

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* Finances: people with limited income may buy cheaper (less nutritious) foods, so their diets may lack proteins, vitamins, and minerals 
* Appetite: loss of appetite can occur from illness, medication, anxiety, pain, depression, and unpleasant sights, thoughts, and smells 
* Illness 
* Aging

Bowel elimination:

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* Basic physical needs
* Follow standard practices

Normal Bowel Movements:

* Time and frequency of bowel movements varies 
* Most people go everyday or 2 to 3 days
* Stools are normally: brown, soft, formed, moist, and shaped like the rectum 
* Stools have a normal odour caused by bacterial action in the intestines 
* Observations:- carefully observe stools before disposing of them 

\- ask the nurse to observe abnormal stools

Observations:

* **Observe and report the following to the nurse. If you are allowed to chart:- Colour** 


* Amount 
* Consistency 
* Odour 
* Shape and size 
* Frequency and defecation 

Complaints of pain or discomfort

Factors Affecting Bowel Movement:

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* **Privacy** 
* Personal habits 
* Diet 
* Fluids 
* Activity 
* Medications 
* Aging 
* Disability 

Common Challenges Affecting Bowel Movement:

__Constipation:__ passage of a hard, dry stool with less frequency than normal 

* Occurs when feces move slowly through the bowel 
* Stool is hard, dry, and difficult to pass 
* client may complain of abdominal discomfort 
* Prevented by: 

Dietary changes, fluids, and activity 

Drugs and enemas 

__Fecal Impaction:__ prolonged retention and build-up of feces in the rectum 

* Fecal impaction results if constipation is not relieved 
* A digital exam is done to check for an impaction by a physician or a nurse 
* Fecal mass is removed with a gloved finger (digital removal of an impaction)
* Check for and removing impaction is never done by a support worker

__Diarrhea:__ frequent passage of liquid stools

* Feces move through the intestines rapidly 
* Diet and drugs are ordered to reduce peristalsis 
* You need to:Assist with elimination needs promptly 

Dispose of stools promptly 

Give good skin care 

* Fluid lost through diarrhea is replaced (otherwise, dehydration occurs)
* Follow standard practices when you come in contact with stools 

__Fecal Incontinence:__ (anal incontinence) is the inability to control the passage of feces and gas through the anus 

* Fecal incontinence affects the client emotionally 
* Can occur because of delayed requests for help to use bathrooms, commode or bedpan 
* A common problem support workers encounter is resistance to care, making washing and changing the client difficult 
* Follow clients care plan 

__Flatus:__

Common Challenges Affecting Bowel Movement: Part 2

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* __Flatus:__ Gas or air passed through the anus
* __Flatulence:__  excessive formation of gas or air in the stomach and intestines→ if flatus is not expelled, the intestine distended

Common causes in intestines:

*  Bacterial action in intestines 


* Constipation 
* Bowel and abdominal surgeries 
* Medications that decrease peristalsis 

Following help produce flatus:

* exercise 


* Walking 
* Moving in bed 
* The left side-lying position 
* Doctors may order enemas, rectal tubes, or drugs to relieve flatulence

Bowel Training:

Two goals: \n

* To gain control of bowel movements 


* To develop a regular pattern of elimination 


* Factors that promote elimination are part of the care plan and the bowel training program

Enemas:

* Introduction of fluid into the rectum and lower colon 


* Doctors order enemas for the following reasons:Removes feces 

Relieve constipation, fecal impaction, or flatulence 

To clean the bowel of feces, before certain surgeries and diagnostic procedures 

* Most enemas are commercial enemas: pre-packaged and ready to administer 
* Saline enema: must be prepared prior to administration

Delegation to perform an Enema:

*  Do your provincial or territorial laws and employers policies allow you to do this?Do you have the necessary education and training?
* Have you reviewed the procedure with a nurse?Is a nurse available to answer questions and supervise you?

Commercial Enemas:

* stimulate and distend the rectum and cause defecation


* Solution is usually administered at room temperature 
* To give enema, squeeze and roll up the plastic bottle from the bottom; **DO NOT RELEASE** pressure, as that would cause the solution to be drawn back into the bottle 
* Encourage client to hold the solution for 5 to 10 minutes before expelling

Rectal Tubes:

Flexible tube that is inserted into rectum to relieve flatulence and intestinal distension

* Usually inserted about 10 cm into adult rectum and left in place for 20 to 30 mins 
* Can be re-inserted every 2 to 3 hours 
* Procedure is performed by a nurse

Client with An Ostomy:

* Surgically created opening 

Opening is called a **stoma-** client wears a pouch over the stoma to collect stools and flatus

Colostomy:

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* Surgically created opening between the colon and abdominal wall 
* With a permanent colostomy, the diseased part of the colon is removed 
* A temporary colostomy gives the diseased or injured bowel time to heal (after healing, surgery is done to reconnect the bowel)
* Colostomy site depends on the site of disease or injury

Ileostomy:

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*  Surgically created opening between the ileum and the abdominal wall (stomy)
* Liquid stools drain constantly from an ileostomy 
* A portion or entire section of the colon is removed 
* Ileostomy pouch must fit well to avoid feces touching and irritating the skin 
* Good skin care- essential

Ostomy pouches:

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* The pouch has an adhesive backing that is applied to the skin 
* Sometimes pouches are secured to ostomy belts 
* Many pouches have a darin at the bottom that closes with a clip, clamp, or wire closure- drain is opened to empty the pouch 
* Pouch is changed every 3 to 7 dyas, and when it leaks 
* Do not flush pouches down the toilet

Stool Specimens:

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* Stools are checked and studied for blood, fat, microbes, worms and other abnormal contents 
* Stool specimen must not be contaminated with urine 
* Some test require warm stool

Testing Stools for Blood:

* __Stools may contain blood for many reasons:__- blood is seen if there is bleeding low in the bowel 


* Stools are black and tarry (melena) if there is bleeding in the stomach or upper gastro-intestinal tract 
* Sometimes bleeding occurs in very small amounts and cannot be seen (occult blood)- when using occult blood test kits, follow manufacturer instructions

Rectal Enema:

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1. Gather needed equipment 
2. Wash hands 
3. Explain procedure to client 
4.  Check the right rights 
5.  Position client on left side, if possible, with right knee flexed/bent over top of left leg 
6.  Remove plastic cap from enema and lubricate if necessary 
7.  Gently separate buttocks 
8. Have client take slow, deep breaths through mouth 
9.  Insert tip of enema into rectum, about two inches (4-5 cm). Tilt tip of enema slightly towards abdomen 
10. Squeeze enema until all solution had entered rectum and gently remove bottle 
11. Ask client to tighten buttocks to hold solution inside bowel for 5-7 minutes, if able 
12. Remove gloves and wash hands 
13.  Document procedure, including results

Rectal Suppository:

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1. Gather needed equipment 
2. Wash hands 
3. Explain procedure to client 
4. Check the nine rights 
5. Lubricate suppository 
6. Position client on left side, if possible, with right knee flexed/bent over top of left leg 
7.  Gently separate buttocks 
8.  Have client take slow, deep breaths through mouth 
9. Insert suppository into rectum, about three inches (6-8cm) 
10.  Wipe perineal area 
11. Remove gloves and wash hands 
12. Ask client to remain on side for fifteen to twenty minutes 
13. Document procedure, including results

Urinary Elimination:

* Eliminating waste is a physical need 
* Urinary System:- removes waste products from the blood 


* Maintains the body's water balance

When assisting with elimination: follow the rules of medical asepsis and Standard Practices 

* Follow infection control precautions

Normal Urination:

* Urinary Output: the amount of urine a person excretes 
* Healthy adult produces about 1 500 mL of urine a day:

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__Many factors affect urine production:__

* Age 
* Disease 
* The amount and kinds of fluid ingested 
* Dietary salt 
* Medication 
* Other substances- coffee, tea, alcohol

Urination, micturition and voiding:

* All 3 terms mean the process of emptying urine from bladder 


* __Frequency of urination is affected by:__

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The amount of fluid intake, habits, and available toilet facilities 

Activity, work, and illness

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* People usually void after getting up, before meals, and at bedtime 
* Urinary incontinence is not a normal part of aging

**Observations:** Normal Urine

* Is pale yellow, straw-coloured, amber-coloured 
* Has clear with no particles 
* Has a faint odour 

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1. Observe urine for colour, clarity, odour, amount, and particles 
2. Report client complaints of urgency, burning on urination, or painful or difficult urination

Bedpans:

 Used by clients who cannot be out of bed 

* Clients with female genitalia use bedpans for both voiding and bowel movements 
* Clients with male genitalia use them only for bowel movements

Fracture Pans (slipper pans) used for:

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* By clients with casts 
* In traction 
* Limited back motion 
* Fragile bones or painful joints 
* After hip fracture 
* (follow medical asepsis and standard practices when handling bedpans and their contents)

Urinals:

* Clients with male genitalia use urinals to void:

__To use urinal:__

\- the client stands 

* Some sit on the side of the bed or lie in bed 
* Some clients need support when standing 
* You may have to place and hold urinal for some clients

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__Remind clients:__

\- to signal after using the urinal 

* Cap urinal if there is one 
* Not to place urinals on overbed tables or on bedside stands 


* Empty urinals promptly, rinse, and clean to prevent odour 

Commodes:

Clients who are unable to walk to the bathroom often use commodes: \n

* Commode:

\- allows a normal position for elimination 

\- provides support and helps prevent falls

Come commodes are wheeled into bathrooms and place over toilets

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* The container is removed if the commode is used with the toilet.
* Wheels are locked after the commode is positioned over the toilet.
* A client should never be tied or restrained to a commode.
* The client should sit on the commode no longer than 20 to 30 minutes.

Urinary Incontinence:

Loss of bladder control (temporary or permanent)

__basic types of incontinence:__ \n

* Stress incontinence (dribbling)
* Urge incontinence 
* Overflow incontinence 
* Functional incontinence 
* Reflex incontinence 
* Mixed incontinence
* If incontinence is a new problem for client- tell nurse

Challenges Related to Incontinence:

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* Incontinence is embarrassing 
* The client is uncomfortable 
* Skin irritation, infection, and pressure ulcers are risks
* Falling is a risk because the client may rush to the washroom 
* Clients pride, dignity, and self-esteem are affected 
* Good skin care and dry garments and linens are essential (for of neglect if failure to perform all of these)

Challenges related to Incontinence:

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* Challenges Related to Incontinence:
* Promoting normal urinary elimination prevents incontinence in some clients.
* Others need bladder training.
* Sometimes catheters are needed.
* Incontinence products help keep the client dry.
* Caring for clients with incontinence can be stressful.
* If you find yourself becoming short-tempered and impatient, talk to the nurse at once.
* The client has the right to be free from abuse, mistreatment, and neglect.

Urinary Catheter:

tube inserted through the urethra into the bladder that drains urine 

* A *straight catheter* drains the bladder and then is removed.


* An *indwelling catheter* (*retention* or *Foley catheter*) is left in the bladder.
* A balloon near the tip is inflated with sterile water after the catheter is inserted. It prevents the catheter from slipping out of the bladder

A **suprapubic catheter** is surgically inserted through the abdomen above the pubic bone.

* Tubing connects the catheter to the drainage bag.

**Catheterization** is the process of inserting a catheter.

Catheters:

Before, during, and after surgery to keep bladder empty

* For clients who are too weak or disabled to use the bedpan, urinal, commode, or toilet
* To protect wounds and pressure ulcers from contact with urine
* To allow hourly urinary output measurements
* As a last resort for incontinence
* Catheters do not treat the cause of incontinence.
* For certain diagnostic purposes


* For clients with in-dwelling catheters, the risk of infection is high.

Drainage Systems:

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* Closed drainage system is used for indwelling catheters 
* Nothing can enter the system from the catheter to the drainage bag 
* Drainage bag must not touch the floor 
* Drainage bag is always kept lower than the clients bladder 
* Some clients wear leg bags when they are out of bed.
* Never hang a drainage bag on the bed rail because when the bed rail is raised, the bag will be higher than the bladder.
* Position or cover the drainage bag to reduce the visibility of the bag.
* Some clients wear leg bags when not in bed.

Leg Bags:

 Leg bags are changed to drainage bags when the client is in bed.

__*Drainage bags are emptied and urine is measured:*__ \n

* At the end of every shift 
* When changing from a leg bag to a drainage bag 
* When changing from a drainage bag to a leg bag 
* When the bag is becoming full

Measuring Urine Drainage:

Empty drainage bag according to your **employer’s policy** 

* Always follow Standard Practices 
* Never use the measurement marked on the drainage bag—it is inaccurate and unreliable. 
* Use a see-through graduated cup or measuring cup.

\- For accuracy, read the measurement as close to eye level as possible.

\- Make a note of the amount, colour, odour, and abnormal particles.

\- Dispose of urine down the toilet.

Accidental Disconnection:

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* If the drainage system is disconnected accidentally, tell the nurse at once.
* Do not touch the ends of the catheter or tubing.
* Practise hand hygiene and put on gloves.
* Wipe the end of the tube with an antiseptic wipe.
* Wipe the end of the catheter with another antiseptic wipe.
* Do not put the ends down.
* Do not touch the ends after you clean them.
* Connect the tubing to the catheter.
* Discard the wipes into a biohazard bag.
* Remove the gloves and practice hand hygiene.

Condom Catheter:

(urinary sheaths, external catheters) often used for clients with a penis who are incontinent 

* Soft sheath that slides over the penis 
* **Apply condom catheter:**

\- Follow manufacturers instructions 

\- thoroughly wash the penis with soap and water 

\- dry the penis before applying the catheter

Condom catheters are self-adhering or applied with elastic tape:

Never use adhesive tape to secure catheters

Report and record:

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* Reddened or open areas on the penis
* Swelling of the penis 
* Colour, clarity and odour or the urine 
* Particles in the urine

Bladder Training:

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* Bladder training helps some clients with urinary incontinence.
* Some clients need bladder training after an in-dwelling catheter is removed.
* Control of urination is the goal of bladder training.
* You assist with bladder training as directed by the nurse and the care plan.
* Provide privacy and a normal position.
* Do not rush the client.

Collecting Urine Specimens:

Specimens (samples) are collected and tested to prevent, detect, and treat disease.

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* The doctor orders what specimen to collect and the test needed.
* Most specimens are tested in the laboratory.
* All specimens sent to the laboratory require requisition slips.
* Some tests are done at the bedside.

Random Urine Specimen:

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* Collected for a routine urinalysis 
* Collected any time during a 24-hour period 
* No special measures are needed

Midstream Specimen:

(clean-voided specimen or clean-catch specimen)

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* The perineal area is cleaned before collecting the specimen
* To collect the specimen:
* The client starts to void into a receptacle
* The client stops the stream of urine
* A sterile specimen container is positioned
* The client voids into the container until the specimen is obtained

24-Hour Urine Specimen

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* All urine voided during a 24-hour period is collected.
* Urine is chilled on ice or refrigerated during this time.
* A preservative is added to the collection container for some tests.
* The client voids first to begin the test with an empty bladder.
* Discard this voiding
* Save all voidings for the next 24 hours.

Testing for pH:

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* Urine pH measures whether urine is acidic or alkaline 
* A routine urine specimen is needed

Testing for glucose and ketones:

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* The client with diabetes may have: 
* Sugar (glucose) in the urine (glucosuria)
* Acetone (ketone bodies, ketones) in the urine (breakdown of fat)
* Urine is tested for glucose and ketones.
* The doctor uses the test to make drug and diet decisions.
* Usually done before each meal (ac) and at bedtime (hs).

Testing for Blood:

Injury and disease can cause hematuria (blood in the urine)

* Sometimes blood is seen in the urine 
* May be unseen 
* Routine urine specimen is needed

Reagent Strips:

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* Do not touch the test area on the strip.
* Dip the strip into the client’s urine.
* Compare the strip with the colour chart on the bottle.
* For accuracy, a watch or clock is required.

A stone (calculus) can develop in the kidney, ureter, or bladder

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* Stones (calculi) vary in size.
* Stones causing severe pain and urinary system damage may require surgical removal.
* Some stones are passed through urine.
* All of the client’s urine is strained.
* Passed stones are sent to the laboratory.

Ureterostomy:

* A urinary diversion is an artificial opening between the ureter and the abdomen. 

\- Used when the bladder has been surgically removed to treat cancer and bladder injuries.

* The artificial opening is called a *stoma.*

\- Stomas do not have nerve endings—not painful.

Ileal Conduit:

An ileal conduit is an artificial bladder created out of a section of the ileum.

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* Urine drains from the ureters into the newly created artificial bladder and then through the stoma. 

Ostomy Appliance

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* A pouch that covers the stoma 
* The appliance is replaced anytime it leaks, because urine can cause skin irritation, skin breakdown, and infection. 
* Provide good skin care.
* Be sensitive to the client's feelings of embarrassment.
* Immediately after surgery, the client will receive care from the nurse, but you will care for clients with long-standing ureterostomies.
* Client assists with care as much as possible.

Compassionate Care:

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* Elimination is a very personal and private act.
* Be sensitive to the client's feelings.
* Let your supervisor know if your client refuses care.
* Your responsibility is to promote the client’s dignity, independence, preferences, privacy, and safety (DIPPS).

Catheter Care: Standard Procedures

Goal: promote free flow of urine and reduce the risk of infection

**General Guidelines:** 

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*  Always use Standard Precautions 
*  Perineal care & catheter care to be done twice a day  
* Drain urine drainage bag at least every 8 hrs or no more than 2/3 full  
* Drain all liquid from urine drainage bag into toilet  
* Keep the urine drainage bag below the bladder to prevent backflow of urine into the bladder. Doing this it will decreases risk of bladder or kidney infections  
* Drain tube of urine drainage bag should not touch the drainage container, toilet or floor when emptying urine bags  
* Urine drainage bags/tubing are changed according to care plan or facility policy or when catheter is changed or drainage bag/tubing become smelly, leak or look dirty

Catheter Care- Observe and Report if:

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* Catheter has been removed or has fallen out by accident  
* Little or no urine in drainage bag for 4 or more hours 
*  No or little urine in drainage bag and the client states their bladder feels full 
* Client complains of pain in stomach, pelvic, legs or back  
* Urine has changed colour, is cloudy, looks bloody or has large blood clots  Insertion site is red, swollen or tender or pus is visible at insertion sit  Urine leaking around catheter tube 
*  Foul smelling urine  
* Client shows signs of fever or is feeling unwell 
*  Client has nausea or vomiting

Changing from one Urine Drainage Bag to Another:

1\. Check Care Plan or ADL

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 2. Explain procedure to client 

3\. Gather equipment: 

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a. New or cleaned urine drainage bag/tubing 

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b. clean gloves c. 2 alcohol swabs 

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d. clean towel 

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4\. Drain urine drainage bag/tubing currently in use – ensure urine is emptied into toilet (measure and record if needed) 

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5\. Prepare cleaned urine drainage bag/tubing: 

a. Remove plastic protective cap from tip of cleaned urine drainage bag/tubing 

b. Clean tip of cleaned urine drainage bag/tubing with alcohol swab 

c. Let dry for 1 minute 

d. Hold in hand while drying, making sure tip does not touch any surface 

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6\. Wipe connection between catheter and current attached urine drainage bag/ tubing with alcohol swab. Let dry for 1 minute 

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7\. Pinch or clamp the catheter to ensure urine does not drain on client or bedding 

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8\. Disconnect the catheter from tubing and put protective cap on to the used catheter bag tubing (to be cleaned later) 

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9\. Insert tip of cleaned tubing firmly into end of catheter until snug. Do not insert too far as it can be difficult to remove 

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10\. Be sure there are no kinks in the tubing and the urine drainage bag is lower than the bladder and off the floor 

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11\. Attach tubing and urinary drainage bag to leg or bed (whatever is appropriate) 

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12\. Clean the disconnected urine drainage bag/tubing according to agency/facility procedure 

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13\. Remove gloves and wash hands 

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14\. Document 

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15\. If you have any concerns, report to nurse/ Supervisor immediately

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**Cleaning Urinary Drainage Bags:** \n

1\. From Step 12 of Changing from One Urine Drainage Bag to Another

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 2. Gather supplies: clean container, tap water, white vinegar, funnel or syringe, soap (dish or bar) and clean gloves 

3\. Wash hands and apply clean gloves

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 4. Close drain tube of emptied urine drainage bag and tubing 

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5\. Using a syringe or funnel fill the bag up to ½ or 2/3 full of cold water; swish water around for 10-15 seconds. Drain water into toilet 

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6\. Close drain tube. Instill a drop of dish soap and fill urine drainage bag with water until ½ to 2/3 full. Swish liquid around for 10-15 seconds. Drain soapy water into toilet 

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7\. Rinse tubing and urine drainage bag with cold water until water is no longer soapy. 

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8\. Drain water into toilet 

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9\. Close the drain tube and add white vinegar and water solution using syringe or funnel. Note: Vinegar: Water Solution is made of 1 part white vinegar and 3 parts water, or a ratio in agency policy 

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10\. Attempt to remove all air bubbles from the urine drainage bag. Lie bag flat and carefully move bubbles toward drain tube opening. Open drain tube to release air 

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11\. Lie urine drainage bag flat for 30 minutes or longer. 

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12\. Clean remaining equipment and let air dry. Remove gloves and wash hands. 

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13\. After 30 minutes return to equipment. 

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14\. Wash hand and apply clean gloves 

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15\. Empty vinegar and water solution into the toilet. Hang bag and tubing to air dry with drain tube pointing downward 

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16\. Place a clean cap on the tip of the catheter bag tubing. Avoid touching tip of catheter bag tubing 

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17\. Document 

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18\. If you have any concerns, report to nurse/Supervisor immediately

Steps to Clean Tubing Caps:

1\. Wash hands and put on clean gloves 

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2\. Collect soiled tubing caps

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 3. Wash caps in warm soapy water 

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4\. Rinse caps well with warm running tap water and let air dry on clean paper towel 

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5\. Store caps in a clean container such as a Ziploc bag or other covered container. Clean with an alcohol swab before reusing.

Basic Nutrition:

* Clients diet affects their physical and mental growth and functioning 
* Food and drink contribute to both social and emotional health 
* Poor diet and poor eating habits:

\- increase the risk of diseases 

\- Cause chronic illnesses to become worse 

\- Affect physical and mental functioning, which increases the risk for accidents and injuries 

Nutrition:

Refers to the processes involved in the ingestion, digestion, absorption and use of foods and fluids by the body.

* Good nutrition is needed for growth, healing and body functions 
* A well balanced diet and correct calorie intake are needed 
* **Foods and fluids contain nutrients:**Nutrients are grouped fats, proteins, carbohydrates, vitamins, minerals, and water

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* No food or food group contains every essential nutrient 

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\- Protein is needed for tissue growth and repair 

\- Carbohydrates provide energy and fibre for bowel elimination

Fats:

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* provide energy
* Add flavour to food and help the body use certain vitamins 
* Three types of fat:Saturated, trans, unsaturated

Vitamins

* are needed for normal body function and growth 


* Do not provide calories 
* Minerals are used for many body functions 

Water:

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* Most important nutrient necessary for life 
* Body needs water in order to maintain cell function, regulates body temperature, deliver nutrients, remove waste, and perform other body processes

Canada’s Dietary Guidelines:

Canada's food guide was developed by Health Canada to promote wise food choices: \n

* Being mindful of eating habits 
* Cooking more often 
* Enjoying your food 
* Eating meals with others 
* Being aware of food marketing 

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“Food skills should be considered within the social, cultural and historic context of Indigenous peoples.”

Healthy Eating is needed to:

* ensure essential nutrients 


* Promote health and overall sense of physical and mental well being 
* Reduce the risk of health issues related to nutritional deficiencies
* **Vegetables and fruits:** provide carbs, vitamin C and A, iron and magnesium 
* **Whole Grain Foods:** contain fibre, vitamins, and minerals 
* **Protein Foods:** contain protein, vitamins and minerals 

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\- Plant based proteins- better

Nutritional Challenges That Canadians Face:

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* Limited income 
* Geographic isolation 
* Inclement weather 
* Lack of availability of local foods 
* Lack of education about nutrition 
* Mental illness or addictions

Late Adulthood- Nutrition Throughout the Life Cycle:

Late Adulthood: \n

* Older persons have wide variations in health and nutritional status 
* Nutritional status is affected by emotional, social and physical factors: \n


1. Many require transportation to obtain groceries 
2. Income may not be adequate to buy more nutritious food 
3. Physical changes can affect nutrition 
4. Those living in long term care facilities may not life the food that is served 

* Older persons require lower calories, high protein foods, high- calcium and high-fibre foods  

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Factors That Affect Eating And Nutrition:

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* Personal choice
* Allergies 
* Food intolerances 
* Religion 
* Culture

Food Labels:

* Food labels are used to help people make informed food choices for a health diet or special diet- physician 
* Food labels have three components: \n

\- List of ingredients 

\- Nutrition facts (calories, nutrient information, daily value percentages)

\- Nutrition claims (low in fat, high in fibre)

Caffeine Intake:

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* Caffeine consumption of 400 mg per day is not associated with any adverse effects 
* Small or larger amounts of caffeine can cause insomnia, headaches, irritability, and nervousness 
* Pregnant or breastfeeding women should not exceed 300 mg/day 
* 1 cup of coffee has 135 of caffeine 
* Caffeine- colds, chocolates, energy drinks, over the counter medications

Meal planning and Preparation- consider:

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* Dietary requirements 
* Food preferences 
* Eating and swallowing challenges 
* Eating habits

Handling Clients Money:

Clients usually provide cash for grocery shopping- keep receipts- follow employers policies

(do not use a substitute ingredient if client is on a special diet or food allergy)

Foodborne Illness:

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* Food poisoning is caused by pathogens in food and fluids 
* Signs and symptoms depend on the pathogen
* Common signs include diarrhea, nausea, and vomiting 
*  Children and older persons and those with chronic illnesses and weakened immune systems are at greater risk

Food is not sterile:

* Pathogens are present when food is purchased 
* Foods can become contaminated from other food (cross-contamination)
* Food handlers with poor hygiene can contaminated the food 

Pathogens thrive at room temperature, but many die at temperatures below 4º C and 60º C

Ensure you sue safe food-handling practices

1. **Food preparation:**- rinse raw meats, etc
2. **Cooking and reheating:**- cook foods to at least minimum safe temperature 
3. **Food storage:**- avoid cross contamination

Special Diets:

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* Clients for nutritional deficiency or a disease 
* Weight control 
* Eliminate or decrease certain substances in the diet

Three common special Diets:

* Sodium controlled diet 
* Diabetic diet meal planning 
* Gluten-free diet 

**Regular diet, general diet, house diet**- mean no dietary limits or restrictions for client

Sodium Controlled diet:

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* Sodium causes the body to retain water 
* Sodium control by diet decrease the amount of sodium in the body 
* Doctor orders the amount of sodium allowed 
* Omitting high sodium foods 
* Not adding salt to food at the table 
* Diet planning

Diabetic Diet:

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* Type1 diabetes- caused by lack of insulin 
* Type 2 diabetes- caused by insulin resistance
* Clients food preferences, calories needed, eating meals and snack at regular times

Gluten-Free Diet:

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* Gluten: protein that comes from wheat or related grains- barley, oats, rye, triticale, kamut, or spelt 
* 1% of Canadian Population cannot tolerate gluten 
* **Celiac Disease:** caused by a negative physical reaction to a gluten protein, causing physical reaction to a gluten protein, causing inflammation and destruction of the inner lining of the small intestine 

Clients appetite and ability to eat can be affected by:

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* Appetite 
* Ability to eat 
* Weakness and illness 
* Odours 
* Unpleasant equipment
* Uncomfortable position 
* Need for oral hygiene 
* Need to urinate and pain

Make Mealtimes enjoyable:

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* Assist with menu choices
* Make the setting attractive
* Serve hot meals immediately
* Serve moderate portions
* Make mealtimes social occasions

Assisting Clients with Eating:

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* Assist with oral hygiene, elimination, handwashing.
* Change clothing and provide clean linens for clients who are incontinent.
* Be sure dentures, eyeglasses, and hearing aids are in place.
* Help the client get to the dining room.
* Ensure the client is in a comfortable position for eating.
* Allow time and privacy for prayer.
* Engage the person in pleasant conversation. 
* Allow time for chewing and swallowing.
* Sit facing the person.
* Wipe the person’s hands, face, and mouth as needed during the meal.
* Offer plenty of fluids.
* Never force a client to eat.
* Report and record your actions and observations.

Between- meal nourishments:

Follow the same considerations and procedures as for serving meal trays and feeding clients 

* **Calorie Counts:**(flow sheet) - nurse or dietitian converts portions into calories 
* **Providing Drinking Water:**Clients and residents need fresh drinking water each shift and whenever the pitcher is empty 

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Follow your employers procedures for providing fresh water

Chewing difficulties:

* offer plenty of fluids 

\- Offer small mouthfuls 

\- Give the client time to chew 

* Weakness- low energy

Vision impairment:

*  identify location of foods and fluids on tray or table 


* Describe the foods you are offering to the client

Three common consistencies of thickened liquids:

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* Nectar-thickened and easily pourable
* Honey-thickened or slightly thicker
* Pudding-thickened

Fluid Balance:

__Needed for health:__The amount of fluid taken in (intake) and the amount of fluid lost (output) must be equal 

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* If fluid intake exceeds fluid output, body tissues swell with water (edema)
* If fluid output exceeds intake, dehydration occurs
* Adults need 1 500 mL of water daily to survive 
* About 2 000 to 2 500 mL of fluid per day are needed for normal fluid balance

Common Special fluid orders:

* **Encourage fluids:** client drinks an increased amount of fluids 

Restrict fluids

**Nothing by mouth (NPO):** clients cannot eat or drink anything