Mealtimes
Name 2 things you should do BEFORE a meal to prepare patients.
Toileting
Make sure the tray table is clear
Make sure all medications needed for the meal have been given
Make sure the tray table is close/ accessible
Make sure they are sitting upright
When should a patient be weighed?
On admission and every week during acute admission.
Monthly during rehab admission.
Name 3 things that increase a patient's risk of pressure wounds
Poor oral intake, especially of protein
Inadequate skin care
Inadequate screening of skin integrity
Lack of repositioning
Limited mobility
Age
Incontinence
Name 3 things that will decrease the risk of a patient having a fall in hospital.
Encourage patient to call for assistance if needed
Constipation can increase the risk of delirium.
True or False?
True. Nursing staff should check for last BO if pt develops delirium/ check for abdo distension etc
What does the BLUE TRAY slip on a patient's meal tray mean?
This patient needs assistance with meal set up/ opening packages.
When should an MST be conducted?
Within 24 hours of admission to ward and weekly
More often if clinical status changes.
Patients do not need more calories with pressure injuries - just more protein.
True/ False
False - patients can need up to 20% more calories for pressure wounds, especially if there is exudate
So monitor their weight!
And encourage oral intake, especially protein foods.
Name 3 MORE things that will decrease the risk of falls.
Encourage patient to call for assistance if needed
Delirium will not impact a patient's nutritional status.
True or False?
False.
Delirium can greatly impact a patient's oral intake Poor oral intake can in turn make delirium worse.
These patients are least likely to tolerate NG feeds.
What does the RED TRAY slip on a patient's meal tray mean?
This patient is a HIGH RISK of aspiration. This patient needs to be fed or fully supervised by nursing staff. This meal should not be given to the patient until nursing staff are free to feed.
Name 3 things that increase the risk of malnutrition in hospital
Poor appetite
Delirium/ dementia
High energy needs
Lack of assistance at mealtimes
Extended length of time left NBM e.g. post surgery
Poor oral hygiene
Poor dentition
What is Arginaid?
Drink containing Arginine - amino acid important in protein accumulation at wound sites
No calories.
Validated for Stage 3/ 4 pressure wounds.
Patients who are eating poorly are more likely to have a fall in hospital. True/ False
True. Eating poorly is a known risk factor.
If a patient is delirious, you should encourage sleep at any time.
True or False?
False. It is better to keep patients orientated to day and night, keeping sleep for nighttime if possible.
Name 2 things you can do DURING a meal to improve patient nutrition.
Avoid unnecessary interruptions/ redirect back to their meal.
Assist with feeding.
Encourage them!
Give them time to finish their meal
3 days as a rough guide. Dietitians auto review patients NBM/ CF after 3 days. But nursing should also be raising this with medical teams at this time.
How much do protein needs increase by with pressure wounds? 10%, 20% or 50%?
Up to 50% more protein, depending on size and stage of pressure wound/ amount of exudate etc
There is no reason to refer a patient with a #NOF to the dietitian. True/ False
False - all patients with #NOF should be referred to the dietitian, for a full nutritional Ax and education as required.
How can a dietitian help with delirium?
They can't, but they can add supplements so that oral intake can be maximised.
What does the FEAST acronym stand for?
Feeding assistance
Encourage oral intake
Avoid interruptions unless urgent
Set up before meals
Time to finish meals
Give 3 reasons why malnutrition in hospital matters.
Impairs wound healing
Higher risk of infections and other complications
Muscle wasting
Increased frailty
Prolonged hospital stays
Increased hospital costs
Increased mortality
What will the dietitian do for patients with Stage 3/4/ unstageable PI/ suspected deep tissue injury?
Full nutritional assessment
HP diet
Supplements if not eating enough
Arginaid if eating enough
Multivitamins
Check Vit D, iron and zinc
Monitor wound healing (via nursing)
Name 3 nutrients that the body requires in greater amounts for #NOFs.
Protein (up to 20% more)
Calcium
Vitamin D
Name 3 things that increase the risk of delirium
Sleep deprivation
Cessation of regular EtOH
Organ failure
Poor nutrition
Constipation
Poor eye sight or hearing
Undertreated pain
and others.....