Mealtime Management

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Effective Nutrition for patients with disabilities or special needs

Welcome! Patients with disabilities are known to have difficulties with maintaining proper nutrition by themselves, given their preexisting conditions.

It is important that we address this need by teaching you how to better care for them, especially by addressing their nutritional needs.

Lesson Objectives In this lesson, we will discuss: The basics of nutrition, The nutritional risks encountered by patients with disabilities, What makes nutrition effective for these patients, The role of mealtime management in effective nutrition, and Your responsibilities as a healthcare professional in ensuring the patients' proper health.

What is nutrition? In a nutshell, nutrition is about a person's food intake and the body's way of using this food as fuel.

Nutrition's Process Nutrition is a complex system with three parts: eating and drinking, digestion, and nutrient absorption.

Undernutrition or Overnutrition

Reliance on Maintenance Medications

Neurological Problems

Digestive Disorders Examples of these are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

Reflux and gastro-esophageal reflux disease (GORD)

Mealtime Management addresses these nutritional problems by addressing the patients' nutritional deficits and helping them with their physiological problems.

Nutritional Assessments The following is a checklist of assessments that can be done to gauge the nutritional health of a disabled patient. Body Measurements This will determine if a patient is underweight or overweight. 2. ## General Practitioner (GP) Assessment This step is crucial in pinpointing the causes of the patient's malnutrition. 3. ## Blood Biochemistry This test can help pinpoint potential nutritional disorders. 4. ## Medication Assessment This test can help identify the sources of weight gain for overweight patients. DEXA Scans Dual-energy X-ray absorptiometry scan or DEXA scan measures the patient's bone mineral density. 6. ## Endoscopy This procedure assesses the patient's gastrointestinal tract. 7. ## Dietary Assessment This is done by a Dietitian to gauge which nutritional defecits should be addressed in a patient. 8. ## Swallowing Assessment This is done by a speech pathologist. 9. ## Positioning, Support, & Eating Technique Assessment This is done by a physiotherapist, occupational therapist, and speech pathologist to know how to best support the patient when eating and drinking. 10. ## Assessment of Physical Activity This is done by a Physiotherapist. They can coordinate with a Dietitian if adjustments must be done to the patient's diet. 11. ## Dental Assessment This is done by a Dentist to pinpoint diagnoses such as sore gums or gingivitis.

Which of the following are the key targets of effective nutrition? You may select multiple answers.

What should you look out for in your patient? Ensure that their weight is regularly monitored and documented. 2. Be available to assist them when they're dehydrated. 3. Help them in elimination management. 4. Assess if they need to be referred to a specialist, e.g. dietitian, dentist, speech pathologist, etc. 5. Guarantee that they are being assisted in eating and drinking properly. 6. Follow through the dietitian's nutrition plans for them.

Which of the following should you look out for in a disabled patient? You may select multiple answers.

Managing Dysphagia Helping patients with swallowing difficulties

Welcome back! Let's talk about the most pressing concern when caring for disabled patients-- swallowing difficulties.

The NSW ombudsman considers dysphagia to be one of the major causes of preventable deaths when caring for disabled patients.

This is especially common in adults with multiple disabilities, with this prevalence amounting to 75%, according to Therapeutic Guidelines Ltd., Melbourne. Are you up for the task?

Lesson Objectives In this lesson, we will discuss: What is dysphagia and its symptoms, The health risks associated with dysphagia, and How any healthcare staff can support patients with swallowing problems.

The patient's position & posture

The patient's neuromuscular control of their mouth and throat

The patient's teeth or dentures

The patient's alertness while eating

The patient's breathing

The patient's medical conditions that may cause gagging or coughing

The patient's age

What are the symptoms of Dysphagia? When a patient seems to have difficulty in chewing or swallowing 2. When a patient coughs, chokes, or tries to clear their throat during or after swallowing 3. When a patient takes long to finish a meal (approximately 30 minutes or more) 4. When a patient has breathing difficulties while eating and/or drinking 5. When a patient avoids certain food that is difficult to swallow 6. When a patient regurgitates undigested food 7. When a patient drools and has a hoarse voice 8. When a patient has difficulty controlling food and liquid in their mouth 9. When a patient experiences frequent heartburn 10. When a patient has frequent respiratory infections

Which of the following are symptoms of dysphagia? You can select multiple answers.

Standard #1 Access to Appropriate Support Patients must have access to appropriate support systems that cater to their needs.

Standard #2 Safe environment for Support Patients must be treated in a safe environment where their needs can be addressed.

Standard #3 Risk Management Patients must have their health risks identified and managed.

Standard #4 Quality Management Patients must have access to a quality management system that will support the improvement of their health.

Standard #5 Information Management All patient information must be up-to-date, well-documented, and confidential. These information must also be accessible to the patient's relevant healthcare providers.

Standard #6 Incident Management Patients must be protected by our incident management system to ensure that any incidents will be managed properly.

Standard #7 Human Resource Management Patients must be cared for by competent and experienced healthcare workers.

Which of the following is a part of NDIS' Practice Standards? You may select multiple answers.

What are the ways you can support these patients? Familiarize yourself with the symptoms and risks associated with dysphagia. 2. Be on the lookout for patients who may have swallowing difficulties and have them assessed immediately. 3. Support patients with their mealtime management plan. 4. Ensure the patient's safety while eating and drinking. 5. Monitor and review the patient's mealtime management plan regularly. 6. If the patient needs medications, monitor if the medication affects their swallowing problem.

Mealtime Management Assisting patients with dysphagia

Welcome back! This lesson will focus specifically on how you can ensure the safety of patients with swallowing problems while eating and drinking.

Lesson Objectives In this lesson, we will discuss: Safe eating and drinking strategies for patients with swallowing problems and Some strategies to increase and ensure the hydration of these patients.

Eating on a Chair To ensure the patient's safety while swallowing, they must be: sitting upright in a chair both their feet should be on the ground face must be facing forward with the chin slightly forward

Eating on a Wheelchair If the patient cannot sit in a chair, they can sit in a wheelchair. The back of the chair should be upright Knees should be at a 90° angle to the hips Their feet should be on the footplates Their head, trunk, and limbs must be properly supported

Alternative Solutions If the patient cannot sit in a chair or a wheelchair due to severe physical disability, a physiotherapist or occupational therapist will give them a specific seating plan.

Remember! After eating, the patient must sit upright for at least 30 minutes to minimize the risk of aspirating or triggering their reflux.

Supportive Techniques for the Support Staff Feed the patient in small mouthfuls. 2. Give the patient time to chew and swallow the food before continuing. 3. Sit in front of the patient while feeding them. 4. Support the patient's jaw to ensure the mouth's closure. 5. Give the patient a dry spoon every after 3-4 mouthfuls of food to help them swallow. 6. Most importantly, do not rush the patient!

The place should be calm and relaxed, without any distraction or pressure for the patient to hurry to eat.

Keep the noise level at a minimum.

Take note of the room temperature.

Do not put the patient in an unfamiliar place with unfamiliar people.

Hydration Ensuring the patient's hydration

What can you do to increase the patient's hydration? Familiarize yourself with the importance of hydration. 2. Remind the patient of their drinking schedule. 3. Offer small drinks to the patients regularly. 4. If the patient does not like the drink, find a replacement drink. 5. Fruits and vegetables are good sources of fluid, although be mindful of its texture and consistency when making smoothies out of them. 6. If the patient needs to take medication, encourage them to take ample amounts of liquid. 7. Always monitor the patient's fluid balance chart, especially in cases of diarrhea and vomiting.

Which of the following are necessary for ensuring that a patient is hydrated? You can select multiple answers.

Enteral Nutrition Helping patients who cannot be fed orally

Welcome back! In this lesson, we will focus on how we could best care for patients who cannot be fed orally.

Lesson Objectives In this lesson, we will discuss: The type of patients who need enteral nutrition, The types of enteral nutrition, The problems that lead to tube feeding, The methods in delivering enteral nutrition, and Some practical considerations when deciding about enteral feeding.

Let's talk about Enteral Nutrition

Enteral nutrition or tube feeding is a way to give disabled patients their key nutrients through a tube that will go directly to their stomach or small intestines.

Nasogastric Tube Feeding This procedure is done by inserting a nasogastric (NG) tube through the nose, throat, and down to the stomach. This is usually the resort for patients with short-term illnesses.

Gastrostomy This is usually done through a percutaneous endoscopic procedure with a PEG tube. The PEG tube goes through the abdomen then straight down the stomach.

Jejunostomy This is done through a percutaneous endoscopic jejunostomy, with a J tube. The tube is placed through the abdomen that goes straight down to the small intestines.

Practical Considerations When tube feeding Formula feed requirement and fluid intake must be consulted with a Dietitian. 2. You must also make sure that the patient is positioned and postured correctly during feeding and 30 minutes after feeding. 3. Patients undergoing tube feeding are at the risk of diarrhea, so make sure to look out for the following: Is the patient intolerant to the formula? Is the patient taking other medications like antibiotics? What is the temperature of the formula when it was delivered? Was the formula at room temperature for 4 hours? Was the formula delivered too quickly? Do you practice good hygiene with yourself and the patient's equipment? Lastly, tube feeding may be stressful for the patient's family. Be sure to offer their family support and assurance as well.