NSE 111 - Factors that Affect Nutritional Intake and Status

Cognitive Factors

Meal Assistance Needs: Determine if a person requires meals to be provided, supervised, reminded, or cued.
Cognitive Decline: Age-related cognitive decline can impair ability to eat independently.
Behavioral Issues: Some patients may exhibit aggressive or non-cooperative behaviors impacting their nutritional intake.
Age-Related Disorders: Conditions such as dementia, Alzheimer's, and Parkinson's disease.

Physical Limitations

Dental Issues: Poor dentition refers to problems with teeth or dentures that affect eating.
Swallowing Difficulties: Individuals may have difficulty swallowing (dysphagia) which complicates meal consumption.
Loss of Appetite: This could stem from psychological factors or physical illnesses.
Bowel Habits: Irregularities in bowel habits can deter appetite.
Nausea & Vomiting: Medical conditions leading to nausea can lower intake.
Surgical/Medical Illnesses: Various illnesses impact nutritional status directly.
Socioeconomic Conditions: Financial constraints may limit food access and quality.

Meal Readiness: Check and ensure patients are ready to eat before serving meals.
Medical Factors Assessment: Be aware of medications and treatment effects on appetite.
Assistance Needs: Provide help for those with mobility or physical challenges.
Positive Dining Environment: Create a comforting and inviting atmosphere for meals.
Seating Position: Sit clients up at 90 degrees to ease eating.
Hygiene: Ensure patients’ hands are clean before eating.
Use of Aids: Encourage clients to wear glasses and dentures if required.
Accessibility of Food: Position food within easy reach, open packages, and cut food into manageable pieces.
Minimize Distractions: Reduce noise and unpleasant smells while ensuring good lighting.
Comfort Assessment: Evaluate the client for any discomfort or pain that may impede eating.
Tray Table Assessment: Clear the tray table for ease of access and comfort.

Visually Impaired Clients

Descriptive Assistance: Provide a clear verbal description of food appearance and layout using the clock method to indicate item positions.
Contrasting Tableware: Use plates and utensils with colors that contrast with the food to help clients identify items easily.

Hearing Impaired Clients

Clear Communication: Speak clearly, facing the client while using simple language and short sentences.
Environmental Controls: Minimize background noise and distractions to enhance communication clarity.
Eye Contact: Maintain eye contact to ensure the client has full attention before speaking.

Nutritional Maintenance: To maintain a stable nutritional status or improve deteriorating conditions.
Restoration of Nutritional Status: To recover lost nutrients or establish a balanced dietary intake.
Weight Control: Adjust caloric intake to support weight loss or gain as needed.
Macronutrient Balance: Modify the ratios of carbohydrates, fats, and proteins to meet specific health needs.
Texture Modifications: Alter food textures to accommodate chewing or swallowing difficulties.

Dysphagia

Definition: A condition characterized by difficulty swallowing.
Consequences: Can lead to malnutrition, dehydration, weight loss, aspiration pneumonia, airway obstruction.

Aspiration Pneumonia

Definition: Occurs when foreign objects or substances enter the trachea and lungs, potentially causing severe respiratory conditions.

Conditions such as stroke, dental problems, nervous system disorders, history of acid reflux, or esophageal blockages.

Symptomatic Indicators:
- Sensation of food sticking in the throat or coming back up.
- Pain or difficulty while swallowing.
- Shortness of breath or fatigue during meals.
- Wet-sounding voice post meals indicating throat issues.
- Chest discomfort or heartburn.
- Food pocketing in the mouth.

Eating Protocols: Do not eat in bed, use straws when appropriate, and ensure supervision during meals.
Swallowing Techniques: Employ specialized methods for safe swallowing and assess for food pocketing regularly.

Positioning: Ensure the client is seated upright during meals.
Availability of Suction Tools: Have suction apparatus available if required for emergencies.
Swallowing Practices: Encourage two swallows between mouthfuls, allowing sufficient time for swallowing without rushing.
Verbal Support: Provide consistent verbal encouragement during meals.
Placement of Food: Place food on the client’s strong side, slightly tilting the head to that side for easier access.
Post-Meal Protocol: Keep the client upright for 30 minutes post-meal to ensure safe digestion.

Table Setup: Ensure the bedside table is clutter-free and appropriately sized for comfortable eating.
Patient Preparations: Offer opportunities for toilet use and hand washing before meals.
Assistive Devices: Check for the use of dentures and any visual/hearing aids.
Accessibility: Make sure all necessary items are within the client's reach.
Order Accuracy: Confirm the meal corresponds with the patient’s order and dietary needs.

Importance of Oral Care: Good oral hygiene is crucial to minimizing medical problems and enhancing quality of life, especially in older adults with impairments.
Routine: Oral hygiene should be performed four times daily—before breakfast, after meals, and at bedtime.
Training for Caregivers: Staff/ caregivers should be educated on the significance of oral care.
Access to Supplies: Ensure patients have access to appropriate oral care products, especially for those with nasogastric tubes or those who are NPO (nothing by mouth).
Mouth-Breathing Impact: Patients who mouth- breathe may experience drier oral mucosa, necessitating more frequent oral care.