Nutritional requirements and feeding issues

Transcription

1 Learning Guide Nutritional requirements and feeding issues Describe a person s nutritional requirements and feeding issues in a health or wellbeing setting Level 3 3 credits Name: Workplace: Issue 2.1

2 Copyright 2017 Careerforce All rights reserved. Careerforce (Community Support Services ITO Ltd) is the owner of the copyright of this publication. Other than as permitted by the Copyright Act 1994, no part of this publication may be reproduced, copied or transmitted in any other form or by any means, without prior written permission of Careerforce, PO Box , Christchurch, 8144, New Zealand.

3 Contents Introduction... 1 What is nutrition?... 2 Dietary requirements... 3 Personal plan... 3 The food pyramid... 5 Servings of food... 6 Fluid... 6 Life stage... 7 Infant (0-2 years)... 7 Child (2-18 years)... 7 Adolescents (13-18)... 8 Adult (19-64 years)... 8 Older person (65+ years)... 8 Health and impairment status... 9 Nutritional requirements related to health... 9 Diets and culture Nutritional requirements related to culture Food preparation Liquid diets Assistance with eating Eating and feeding issues Dysphagia, choking and aspirant pneumonia Techniques for managing eating and feeding Behavioural issues Using adaptive cutlery Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb 2017

4 Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb 2017

5 Introduction Nutrition is about making sure the body has the appropriate food for sustaining good health, wellbeing and growth. You ll learn about nutrition requirements and eating and feeding issues. How to use your learning guide This guide supports your learning and prepares you for the unit standard assessment. The activities should be used as a general guide for learning. This guide relates to the following unit standard: Describe a person s nutritional requirements and feeding issues in a health or wellbeing setting (level 3, 3 credits). This guide is yours to keep. Make it your own by writing notes that help you remember things, or where you need to find more information. Follow the tips in the notes column. You may use highlight pens to show important information and ideas, and think about how this information applies to your work. You might find it helpful to talk to colleagues or your supervisor. Finish this learning guide before you start on the assessment. What you will learn This topic will help you to: describe nutritional requirements. understand how age, health and disability status impact on nutrition requirements. recognise eating issues and apply techniques for safe feeding, if required. What you will need To complete this topic, you will need: this learning guide. your trainee assessment for this topic. forms from your workplace, such as: personal plans. the people you support. you! More info If you have a trainer, they should give you all the forms that you need for this topic. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

6 What is nutrition? Nutrition is about making sure the body has enough carbohydrates, proteins, vitamins and minerals to sustain good health, wellbeing and growth. Nutrition is important because it: provides energy. keeps the cells in the body alive and repairs body tissues. helps to prevent disease. helps people recover from illness more quickly. sustains life. A person s nutritional needs will change during different stages in their life. You may be involved in ensuring that the people you support receive good nutrition. Feeding issues are any difficulty, discomfort, reaction, or clinical condition associated with a person eating and drinking, including if assistance is required for the person to feed themselves. Feeding assistance is the physical support that may be required to make sure the person gets the nutrition they need. It may involve physically feeding a person, using feeding tubes, and/or special meal preparation such as thickening or pureeing food. It is important that any special dietary requirements a person may have are followed. A good diet will help to ensure a person gets their nutritional needs met. Healthy food Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

7 Dietary requirements For health and wellbeing, each person needs to have their nutritional requirements met. Nutritional needs are met through diet the food choices that people make. The type of food that a person should eat and how that food is prepared make up that person s dietary requirements. The people you support will all have specific dietary requirements. These dietary requirements will be based on: the life stage they are at. whether they have any health issues or medical conditions. the person s culture, ethnicity and/or religion. Special dietary requirements include: diabetic. low fat. low sodium. high protein. high calorie. lactose free. for weight reduction. gluten free. vegetarian/vegan. excluding particular foods or additives. boosted with nutritional supplements. to meet religious or other beliefs. adapted to a particular culture. soft or modified food textures. liquids only. There is a huge variation in the types of food that people prefer to eat, and personal food choice has to be considered in every diet regardless of any requirements that need to be met. The Ministry of Health have six Food and Nutrition Guidelines and related health education resources. They are helpful references. They can be found at and nutrition Personal plan People who need support with eating and drinking to meet their nutritional requirements will generally have a number of health professionals working together (a multi-disciplinary team) to ensure that they receive the care that best meets their needs. Ensure the person you are working with has input into the development of their personal plan. From time to time, check with the person to ensure they are feeling comfortable. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

8 Needs may change as a person becomes more or less independent. Instructions, including updates after reviews, will be recorded in the person s personal plan. Nutrition, diet and eating and feeding The personal plan will give you valuable information such as: the physical help the person may need. the best times of the day for the person to eat. the supervision that is needed while the person is eating. any problems the person may have and the strategies that are used to address them. For example, the person leaving their mouth open allowing food to drop out, or turning their head away when fed. detailed instructions from a health professional involved in the person s care, such as a speech language therapist or dietitian on how to assist the person. risk analysis, and what you should do if the risk becomes a concern. Support may be needed on a temporary basis, for example during an illness or when a person is recuperating from surgery, or on a permanent basis, for example for a person who has tetraplegia or multiple sclerosis. Always communicate with the person you are working with. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

9 The food pyramid Fats, oils and sweets group Milk, yoghurt and cheese group Vegetable group Meat, poultry, fish, dry beans, eggs and nuts group Fruit group Bread, cereal, rice and pasta group The pyramid is broken up into sections that decrease in size. The top section (fats, oils and sweets), is the smallest part and represents the foods that should be consumed in the smallest quantities. As you move down the pyramid, the area gets wider and larger, representing the food groups that should be consumed the most. Fats and oils should make up the smallest part of a person s diet but should not be eliminated completely because they are essential to the body functioning properly. Milk and milk products, meats and other protein sources should be consumed daily, but in small amounts. Fruits, vegetables, breads, cereals, pasta and grains should be the largest part of a person s diet. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

10 Servings of food Serving sizes, or how much of each food should be eaten, will vary according to an individual s age and dietary requirements. For a standard adult to maintain a balanced diet and get all the essential nutrients that their bodies need, they should eat the following servings of the food groups each day: two servings of protein food, for example, lean meat, fish, eggs or pulses (lentils and beans). at least five servings of carbohydrate foods (potatoes, rice and bread). at least five servings of fruit and vegetables. two servings of dairy foods (low fat is best). Accurate measuring tools such as scales and cups are not always readily available so being able to estimate a serving size visually is useful. Here are some examples: a tennis ball = 1 serve of pasta. a fist = 1 serve of cereals, fruit or vegetables. palm of hand = 1 serve of meat or fish. 1 slice of bread = 1 serve. 1 cup of milk = 1 serve. Fluid In addition to the food that we eat, a person must get enough fluid for good nutrition. Our bodies are made up of two thirds water. We need to drink enough to remain hydrated so our body can continue to function properly. Fluid requirements will vary according to a person s size and weight, the amount of exercise they are doing and their body s metabolic rate. A rule of thumb is that a person needs 8 glasses of fluid a day. Although water is the best fluid to drink, tea and coffee are now considered part of our daily fluid intake; as are fruit juices, milk etc. Some medical conditions, such as congestive heart failure, may require that a person s fluid intake is restricted. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

11 Life stage What stage in life a person is at will have an impact on their nutritional requirements. The stages of human development and growth include birth, infancy, adolescence, adulthood and then into senescence (old age) and dying. The stages of human lifespan are: infant 0 23 months child/adolescent 2 18 years adult years older person 65+ years Infant (0-2 years) Child (2-18 years) Infants need a lot of protein and iron and other nutrients to support the rapid growth of their bodies and brain. They initially receive this nutrition from breast milk or formula. Solids are slowly introduced at around 6 months of age, until the infant is fully weaned at 18 months to 2 years. At this stage of the lifespan, a child needs a balanced diet with fruit and vegetables, breads and cereals, lean meats and some dairy products (milk and milk products such as yoghurt and cheese). They should not eat too much fat or sugar. They need regular meals, and will often eat 4 5 times a day. Their bodies and brains aren t growing quite so fast, but they are becoming more physically active as they learn to walk, run and engage in play. This is a time when they start developing likes and dislikes of certain foods and fluids. Recommended serves that preschoolers should eat are: fruit 2. vegetables at least 2. breads and cereals 4. meat, fish, eggs, nuts and seeds at least 1. milk and milk products at least 2 3. For school-age children, the amount of vegetables, breads and cereals and meat increase by 1 serve. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

12 Adolescents (13-18) Adolescents will go through growth spurts when they need to eat more, but they need to eat healthy food. They should ensure that they are eating the 5+ serves of fruit and vegetables a day, as well as getting plenty of protein from a variety of sources. Both girls and boys may feel pressure from peers to be thin, and to limit what they eat. A healthy body image is vital to children of this age. Poor dietary habits at this age are likely to be transferred through to adolescence and adulthood and can lead to obesity, diabetes, stroke and heart disease in later life. Adult (19-64 years) As our bodies slow down and our lifestyles change, we need to change our eating habits to compensate. Most adults need to eat plenty of fruit and vegetables, plenty of breads and cereals including rice, pasta and other grain products, some milk and milk products, protein from lean meats and a small amount of fat, salt and sugar. Lack of nutrition can be an issue for some people in late adulthood. Their diet may have insufficient vitamins or minerals, or eating habits of previous years may catch up with them, for example, osteoporosis from a lack of calcium. Having enough energy to get through the day and perform all the daily tasks as well as extra activities is important. Eating well, getting calories from food rich in vitamins, minerals and other nutrients is essential. This will help fight off illness and disease as well as providing energy and maintaining a good health status. Older person (65+ years) As we age, it may get harder to get the daily calories that we need. Older adults still need to eat plenty of fruit and vegetables, breads and cereals. They need at least two servings of milk and milk products and at least one serving a day of lean meat, chicken, fish or eggs. Older adults may find that they lose the ability to taste or smell food, and therefore don t want to eat as much as they need to. It may become physically harder to stand and move, and to complete tasks such as cooking. If a person is alone, they may not want to eat, or can t be bothered making the effort. Dehydration is common with this age range. Many elderly people think if they do not drink they will not have to get up to go to the toilet through the night. You can find more on the nutritional needs of people at different life stages. Use the following link and its related publications, resources and links to help you at Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

13 Health and impairment status A person s health and impairment status will influence both their nutritional needs and their dietary requirements. For example: A person with cancer may require additional nutritional support through supplements. A person with limited mobility who only performs a small amount of physical activity may require fewer calories than someone who is more active. A person who is recovering after an accident may require more protein in their diet to help their body do the necessary repair work to bones and muscles. A person with congestive heart failure may have to reduce the amount of salt in their diet. Nutritional requirements related to health Diabetic diets People develop diabetes when their body cannot make (or properly use) insulin a hormone that is released in response to the level of glucose (sugar) in the blood. If not enough insulin is being produced, the level of glucose in the blood will rise and be harmful to health. There are two types of diabetes. Type 1 diabetes requires the person to inject insulin, usually two times a day, to control the level of glucose in the blood. Instructions for a person with type 1 diabetes may include: making sure that the person eats within a certain period of time after injecting insulin. what to do if their blood sugar level gets too low and they become hypoglycaemic. Hypoglycaemia When people become hypoglycaemic they may get shaky and confused, pale and sweaty or show personality changes. This can often be mistaken for being drunk. When a person becomes hypoglycaemic, it is important to raise blood glucose levels rapidly, and eating jelly beans is a popular method. This is a quick fix however, and needs to be followed by eating more complex carbohydrates. A cheese sandwich is ideal. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

14 It is important to remember that sugar in the form of jelly beans or even honey can only be given to a person who is conscious enough to swallow safely. Some people will lose consciousness when hypoglycaemic and will need urgent medical attention. Type 2 diabetes is usually caused by being overweight. The person may be on a weight reduction diet as well as oral medication to help control blood glucose levels. Diabetic dietary requirements are similar to general healthy diet guidelines, such as to: eat regular, small meals. limit sweet food. limit carbohydrates. eat less fat. limit alcohol. eat plenty of fruit and vegetable and whole grain foods. Low fat diets A low fat diet may be recommended for reasons such as weight control or to reduce high cholesterol levels. In a low fat diet, the saturated fat makes up only 7 10% of energy requirements. It is important not to cut out fat completely as our bodies need fat to maintain certain functions. Nutritional requirements may include instructions to: choose lean red meat and trim fat off meat. use lower fat milk. limit intake of fried foods. use vegetable oils instead of saturated fats, for example, margarine instead of butter. control portion sizes. limit intake of chocolate, nuts, seeds and cheese. avoid processed foods. eat lots of fruit and vegetables, wholegrain bread, cereals and pasta. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

15 Low sodium diets People who have heart failure or salt sensitive blood pressure may need to reduce the amount of sodium (salt) in their diet. Instructions for low sodium diets may include: do not add salt when cooking or eating food. use lots of unprocessed, fresh foods. read food labels to check sodium levels. use salt free or low salt foods such as cereals and bread. use alternative seasonings such as pepper, lemon juice or vinegar; and herbs and spices such as garlic, parsley and chilli. High protein diets A high protein diet is when at least 30% of the daily energy requirements are derived from protein sources. A high protein diet is likely to be required by people who are malnourished, wanting to put on weight or to build up more muscle, or who are doing a lot of exercise and training. Nutritional requirements for high protein diets may include: small, frequent meals including plenty of meat, fish, and dairy products. include eggs and nuts. milk or juice based drinks. nutritional supplements, for example, Complan and Fortisip. High calorie diets A high calorie diet may be recommended when people need to gain weight, when they are exercising a lot (sports training, competing etc), or when they are recovering from severe illness. A high calorie diet involves eating food with high calorie values. It is very important that a high calorie diet provides calories from nutritious sources. Nutritional requirements for high calorie diets may include: eat frequent meals. choose favourite foods. take supplements in the form of drinks. eat calorie dense foods such as nuts, seeds and peanut butter. keep snacks readily available. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

16 Lactose free diets Lactose is a simple sugar found in milk and milk products. Our small intestine contains an enzyme called lactase which splits the lactose into two sugars which the body can absorb and use. If our body does not produce lactase, the lactose goes straight through into the colon, where it can cause irritation, gas, abdominal cramps and bloating. A lactose free diet is a diet where all lactose is eliminated. People with Crohn s disease or coeliac disease, for example, may need to eliminate lactose from their diets. This means that they should not eat any animal, milk or milk by-products. Requirements for lactose free diets may include: no food or drink that contains animal milk. products like yoghurt or ice cream must be made from non-animal milk such as rice, soya bean or almond. supplements may be needed to provide calcium, riboflavin and vitamin D. Weight reduction diets People trying to lose weight need to have a diet that covers all the major food groups, but provides less calories than they use during the day. Instructions for weight reduction diets will be very similar to those for a low fat diet. Following instructions about the portion sizes a person should eat at each meal is particularly important in a weight reduction diet. Gluten free diets Gluten is a plant protein found in grains, mainly wheat. A person with coeliac disease will need a gluten free diet. There are also growing numbers of people who are gluten intolerant. Nutritional requirements for gluten free diets may include: avoid food made with flour and/or grains derived from wheat, rye and barley. eat bread, baked products and cereals made from wheat alternatives such as rice. read labels carefully products such as soy sauce, tomato sauce and ice cream may contain gluten. buy products from specialist bakeries and supermarkets. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

17 Exclusion diets People can be intolerant to a specific type of food or additive within food and will develop symptoms shortly after eating it. If the reaction is severe it is considered an allergy rather than intolerance. The most severe type of allergic reaction is called anaphylaxis which affects breathing and can be life threatening. Food allergies frequently start in childhood but can begin at any age. The most common things people can be allergic to are eggs, peanuts or shellfish. Instructions for exclusion diets may include: be aware of what foods or additives a person reacts to. check labels carefully for warnings such as may contain traces of nuts. The signs and symptoms that a person may be having a reaction to something that has been eaten include: itchiness of the skin, eyes, mouth or throat. rash or hives (itchy lumps). stomach cramps and/or diarrhoea. shortness of breath and/or wheezing. swelling, especially of the eyelids, face, lips and tongue. difficulty swallowing. If a person you are supporting has a known food allergy, it should be clearly indicated in their personal plan. Your organisation will have policies and procedures to follow if someone has an adverse reaction to food, and guidelines about what to do if medical assistance is required. In general, the faster a reaction occurs, the more severe it is likely to be. If a person has any difficulty breathing, call for urgent medical assistance. Nutritional supplements Nutritional supplements will need to be taken by people whose daily intake of essential nutrients is less than it should be. A doctor or dietitian will have been consulted, and the required supplements will have been included in the person s plan. Supplements may need to be taken for a short period of time, for example, when recovering from illness or for an extended period of time, for example, an iron supplement for a vegan. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

18 Diets and culture Nutritional requirements related to culture Some people require special diets to meet their nutritional needs because of their personal or religious beliefs or their culture. Vegetarian and vegan A vegetarian diet is one where no meat is consumed, but animal products such as eggs, milk and honey are eaten. Some vegetarians will eat fish. A vegan diet is one where no animal products are eaten. For diets such as vegetarian and vegan, careful planning is necessary to ensure that all nutritional needs are met. Supplements may be needed. Māori Anything tapu (forbidden, sacred or set apart by cultural custom) must not come into contact with any vessel or place where food is kept or prepared. Pacific Island Seafood is the primary dietary protein staple of the Pacific Island people. Fish is usually eaten raw, grilled or poached. Tubers such as taro, sweet potatoes and yams are also commonly eaten and coconuts and coconut milk are common cooking ingredients. Muslim Halal meat is meat that has been killed according to Muslim practices. Non-halal meat will not be eaten by practising Muslims. The Koran forbids Muslims to eat pork, bacon or products derived from pigs. Hindu Most Hindus are vegetarians, but will eat milk and milk products, and eggs. There is variation in regions and traditions, and some Hindus will eat meat. Cows are sacred to the Hindu religion, so a Hindu will not eat beef. Jewish Kosher food is food that conforms to the Jewish religion. Non-kosher foods include those that are a mix of milk and animal products, those prepared with cooking utensils or machinery that has been used for non-kosher food, certain types of fat and non-cloven hoofed animals (pigs, rabbits etc). For seafood to be kosher, it must have fins and scales, so lobster and shellfish are not kosher. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

19 Food preparation The health and impairment status of some people may mean that they will need their food prepared in a particular way. Thickened fluids and texture modified foods (mashed/pureed) are needed for people who have feeding and swallowing difficulties (dysphagia). These foods may also be given to a person who is recovering from stomach or bowel surgery or from an illness such as gastroenteritis (vomiting and diarrhoea). The NZ Speech Therapy Association (NZSTA) and Dietitians NZ endorse the following standards for fluids and foods: mildly thick fluid will run freely off the spoon, while leaving a coating on the spoon. moderately thick fluid will drip off the spoon in thick dollops. extremely thick fluid sits on the spoon and does not flow off it at all. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

20 Food textures are classified as: soft, which is naturally soft or cooked and cut to alter its texture. minced and moist is food that is soft, easily mashed with a fork and any lumps are smooth and rounded. smooth pureed food is smooth, moist and lump free although it may have a grainy quality. A speech and language therapist may have been consulted about a person with dysphagia, and instructions may be given on: the level of fluid and texture modified diet required. how to support that person with feeding. body positioning when feeding. Liquid diets A liquid diet is a partial or complete meal replacement. It is usually for people who are about to undergo surgery and need to lose weight quickly, or for people who cannot chew, swallow or digest solid foods. A liquid diet usually includes clear fluids, milk drinks, milk products such as ice cream, and creamy soup. Protein shakes are available to add calories and protein. Coffee, tea and sports drinks can be part of a liquid diet, as are nutritional supplements in liquid form. Yoghurt can be added to smoothies and milkshakes. Food can be put through a blender and then thinned with water or milk and strained. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

21 Write Think of a person you are currently supporting and answer the following questions. What is their life stage? How does their health or impairment status affect their nutritional requirements? What are their dietary requirements? What are any cultural or religious needs that have an impact on their diet? How is the person s food prepared? Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

22 Assistance with eating There are different reasons why people need assistance with eating and feeding. Reason A person s life stage Description For example, the effects of old age may create the need for dentures and/or soft foods. Cognitive impairment Physical impairment Illness, medications and pain Dental and oral problems Difficulty swallowing Dysphagia Conditions such as dementia or an intellectual impairment may mean a person needs assistance with eating and drinking eg finishing a meal, using a knife and fork or remembering to eat. Conditions such as cerebral palsy may mean a person needs assistance with cutting their food and bringing it to their mouth. These can all mean a person needs support and encouragement to eat because they may have a reduced appetite or find it difficult to keep food down (vomiting). Medications and pain can also cause nausea which reduces a person s desire to eat. These make it physically difficult for a person to eat and drink. These problems may include sores in the mouth, ill-fitting dentures, gum disease, tooth pain and dry mouth. These problems can result from a person s stage of life or from an accident, illness or the side effects of medication. Medical conditions such as Parkinson s disease or stroke can affect the throat muscles making it difficult to swallow. Dysphagia is when a person has difficulty swallowing or experiences pain while swallowing. It can leave some people completely unable to swallow liquids, foods or saliva. Dysphagia particularly affects people who have had a stroke, and people with multiple sclerosis (MS), Parkinson s disease and Alzheimer s disease. It can also affect people who have head, neck or spinal cord injuries, or internal burns from poisoning or radiotherapy. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

23 Your understanding of the reason why the person needs assistance with eating and feeding will determine how you approach the person. For example, you may need to: Take an active role in feeding the person. This will require you to: feed them in an appropriate way (not too fast, not too much food on the spoon, being patient). carefully observe them to make sure they are physically managing to eat the food (chewing and swallowing easily). check they are eating enough to meet their nutritional requirements. Take a more supportive role, for example: keep the person company, or share a cup of tea with them while they eat so they are more encouraged to eat. be encouraging but respectful if the person is feeling unwell or is reluctant to eat. make sure the food is appetising and tempting for the person. adding a simple garnish to a meal such as a slice of tomato and a sprig of parsley can also make the food more visually appealing. be creative and present some alternative food choices to tempt the person to eat. make the person feel relaxed. people who are tense when eating will find it harder to chew and swallow and eating will be more difficult. talk to the person about what they are experiencing or feeling and how you can help them. A part of your role may be making sure the food is suitable and appropriate. For example, people with dental problems or difficulties swallowing may need food that is soft, moist and not too hot. People who have a serious illness such as cancer may require small meals of food that are easy to eat, such as steamed fish and scrambled eggs. Adults with medical conditions that require smooth and/or pureed food may need to feel that they are still eating adult food and not baby food. It is your approach that can influence how they feel about the food they are eating. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

24 Eating and feeding issues There are a variety of eating and feeding situations that people may have that call for adaptations to how they eat and/or drink. These may include: dysphagia, choking and aspirant pneumonia. swallowing difficulty. behavioural issues. managing eating utensils (knife, fork and spoon). holding anything such as a cup. hand-eye coordination. remaining on task (cognitive, for example, thinking they have already eaten or have eaten but can t remember). Always consult the person s personal plan which will let you know the person s eating and feeding issues. Check in with the person as you work with them to make sure they are comfortable too. Dysphagia, choking and aspirant pneumonia Eating and drinking can put some people at a higher risk of choking and/or aspiration. Choking is when food gets caught in the oesophagus (gullet) and can t move down into the stomach. The trachea (windpipe) can become partially or completely blocked stopping the person being able to breathe. Aspiration is when food or fluids get into the lungs. This can cause aspiration pneumonia, which is a dangerous infection. For people who have dsyphagia (swallowing difficulties), it is essential that you know the warning signs that could indicate the need for urgent assistance. These are: flushed face. weak cough and attempts to clear throat of increased mucus. increased heart rate. coughing or gagging during or after a meal. choking and inability to speak. noisy breathing or a gurgling sound in throat. bluish colour of lips or fingernail beds. rapid breathing, shortness of breath or gasping for breath. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

25 Techniques for managing eating and feeding Your role may be to support the person with techniques to ensure they can eat and drink safely in order to meet their nutritional requirements. The personal plan of a person who is at risk of choking or aspiration should include instructions about how to support the person so that the risk is limited. These instructions should include: the position of people when feeding. If they are lying down, they need to have the head of their bed elevated to 30 degrees, and have their head and neck supported. if they are sitting in bed, they need to have their torso and hips at 90 degrees. if they are sitting in a chair, they need to have their feet flat on the floor, with a 90 degree angle in their hips and knees. position of care staff during feeding. the proper food consistency such as pureed, thickened, thin liquids, etc. using adaptive feeding equipment. using techniques to help with lip closure, jaw stability and tongue position. You need to know what your organisation s policies and procedures are for reporting and documenting any difficulties you notice as you support the person with their eating and drinking. It is also important that you know how to give first aid if an emergency situation arises. Assisting with drinking Helping with drinking. Remember to communicate with the person to build comfort and trust between you and the person you are working with. Take the lead from the person you are assisting. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

26 Write Read through the general steps on safe swallowing in the table below. Tick the steps that you do in your workplace. Write any additional steps that you follow in the space provided at the bottom. Additional steps: Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

27 Behavioural issues A person may have a number of behaviour issues during eating and feeding. These can have a number of different causes such as illnesses like dementia or emotions such as anger and frustration. Examples of behavioural issues are: refusing to eat. not opening their mouth. holding food in the mouth. wandering away from the table. playing with their food. spitting food onto the floor. causing disturbances, for example, yelling, throwing food and/or objects, eating another person s food. The technique you use to address the behavioural issue will depend on the nature of the behavioural issue and the setting the person is in. Your organisation will also have policies and procedures that you may need to follow when assisting people with these issues. When working with people with behavioural issues, it is important that you are always: patient and understanding. respectful of the person s likes and dislikes. able to listen to their needs. Always seek advice from your supervisor if you need help. Here are some suggestions that may help to avoid or reduce behavioural issues: communicate with the person to build trust and to show you respect them (not treat them like a child) limit the number of distractions in the room, for example, by turning off the television. if possible, seat the person in a chair to help promote comfort and good posture. remove any utensils that are not needed for the meal. get the person to perform oral hygiene and hand washing. ensure dentures, glasses and/or hearing aids are in place. provide clothing protectors, for example, napkins. position the chair correctly to be the right height for the table. serve one or two foods at a time. if the person has difficulty managing utensils, provide finger foods. use verbal cues that are simple and easy to understand, for example, take a bite and pick up your fork. give the person plenty of time to eat. be patient. Do not criticise the person s eating habits. check the food temperature to ensure it is not too hot or too cold. Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

28 Using adaptive cutlery A person may also find eating difficult if they have to use normal cutlery. This is usually because the muscles in their fingers, hand or arm may be weak or partially paralysed. This makes it hard for them to grip the cutlery. The person s coordination may also have been affected in some way making it difficult for them to lift their hand from their plate to their mouth. Difficulties managing cutlery can be overcome by the use of adaptive cutlery and plates. These assistive devices can help a person to eat and drink independently. Utensils are items like knives, forks and spoons as well as tools that may be used in the preparation of food, for example, a potato peeler or an automatic jar and bottle opener. Cups may have sipper spouts and/or a large or double handle. They may be shaped to assist people who have difficulty breathing. Attachable handles can be used for both cups and glasses. Straws can be a longer length and flexible so that people don t need to bend their heads to drink. Plates and bowls can be weighted or have suction cups on the base to prevent spills. They can be insulated to maintain the required food temperature and shaped, for example with a high edge so that food does not spill off the edge. Modified utensils Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb

29 Write Think of a person you are currently supporting with their nutritional requirements and/or eating or feeding issues. Find the personal plan for this person. Answer the following questions. What are the nutritional requirements and dietary needs of this person? What assistance does this person need in order to eat and drink safely? What (if any) assistive device does this person use? Why do they use them? What are any risks associated with eating and drinking for this person? How do you manage these risks? Nutritional requirements and feeding issues (US 27460) Learning Guide Careerforce Issue 2.1 Feb