`

NCM 109: Care of Mother and Child at-risk or with Problems

(Acute and Chronic)

RLE MODULE 1M

FEEDING HELPLESS PATIENTS

SECTION D-Group 1:
Almaden, Anton Miguel R.
Amiana, Trisha Mae C.
Basalo, Jannine D.
Baura, Hannah M.
Biscocho, Ma. Aloysia Victoria L.
Cawagas, Michael John Q.
Con-ui, Sofia Chantelle S.
Dahili, Kyle Kenjie B.
Deang, Angelie Camille C.
Dela Rama, Wilchris Kenneth D.
Deloso, Aizel Joy G.
Deresas, Kiara Margareth C.

Facilitator: Mrs. Patricia Marie Megio-Chiu

Date Submitted: January 23, 2023
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TABLE OF CONTENTS

Page

Learning Outcomes for Feeding Helpless Patients

CLO#1: Define key terms in feeding helpless patients. 4
CLO#2: Discuss the following:

CLO#2.1: Different factors affecting dietary patterns 10

CLO#2.2: Types of diet 11
CLO#2.3: Different types of feeding as to its definition, 20
indication, and contraindication

CLO#2.4: Clients who need assistance in feeding 25

CLO#3: Explain the following:

CLO#3.1: Importance of feeding helpless patients 28

CLO#3.2: Scientific principles applied in feeding helpless 28
patients.

CLO#4: State the important nursing responsibilities to be observed 30

before, during, and after feeding helpless patients.

CLO#5: Demonstrate beginning skills in feeding helpless patients. 31

References 33
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FEEDING HELPLESS PATIENTS

LEARNING OUTCOMES:
After 4.5 hours of various classroom and laboratory activities, the Level II
students will be able to:

CLO#1: Define the following terms:

1.1. Diet 1.8. Anorexia
1.2. Calorie 1.9. Peristalsis
1.3. Nutrient 1.10. Gavage
1.4. Nutrition 1.11. Aspiration
1.5. Feeding 1.12. Dietician
1.6. Appetite 1.13. Nutritionist
1.7. Nausea 1.14. Helpless Patient

CLO#2: Discuss the following:

2.1. Different factors affecting dietary patterns

2.2. Types of diet

2.2.1. Regular diet 2.2.8. Low sodium diet
2.2.2. Light diet 2.2.9. Low/high calorie diet
2.2.3. Soft diet 2.2.10. Diabetic diet
2.2.4. Bland diet 2.2.11. Dash diet
2.2.5. Low/high residue diet 2.2.12. Clear liquid diet
2.2.6. Low/high purine diet 2.2.13. General liquid diet
2.2.7. Low fat diet

2.3. Different types of feeding as to its definition, indication and contraindication

2.3.1. Enteral feeding
2.3.1.1. Orogastric tube feeding
2.3.1.2. Nasogastric tube feeding
2.3.1.3. Gastrostomy tube feeding
2.3.1.4. Jejunostomy tube feeding
2.3.2. Total parenteral nutrition
2.3.3. Brecht feeding
2.3.4. Clock face technique

2.4. Clients who need assistance in feeding

CLO#3: Explain the following:

3.1. Importance of feeding helpless patients
3.2. Scientific principles applied in feeding helpless patients

CLO#4: State the important nursing responsibilities to be observed before, during, and after
feeding helpless patients.
 3

CLO#5: Demonstrate beginning skills in feeding helpless patients.

 4
CLO#1: Define the following terms:
1.1. Diet
- The total amount of food consumed by individuals, and consists of various
constituents that can be influenced by a variety of factors such as environmental
conditions and food availability, religious beliefs, socioeconomic status, and so
on.

https://www.cookinglight.com/eating-smart/how-to-eat-a-balanced-diet

1.2. Calorie
- A unit of energy. It is the amount of energy released when the body breaks
down (digests and absorbs) food, which is then used to perform daily activities in
life.

https://www.leancuisine.com.au/calories/

1.3. Nutrient
- Substances obtained from food and used in the body to provide energy and
structural materials, as well as act as regulating agents to promote growth,
 5
maintenance, and repair. Nutrients may also lower the risk of certain diseases.
Our bodies require six essential nutrients: carbohydrates, fats, proteins, vitamins,
minerals, and water.

https://www.istockphoto.com/photo/salad-with-grilled-chicken-breast-avocado-pomegranate-seeds-and-tomato-on-white-gm1226733438-361532782?p
hrase=nutrients

1.4. Nutrition
- Nutrition is the process of utilizing food for tissue growth, metabolism, and repair,
which includes ingestion, digestion, absorption, transport, incorporation into
cells, and excretion.

https://www.istockphoto.com/photo/healthy-food-diagram-gm1213016352-352349887?phrase=nutrition

1.5. Feeding
- To give food or supply with nourishment.
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https://www.istockphoto.com/photo/care-gm120672187-16132451?phrase=feeding%20a%20patient

1.6. Appetite
- the psychological desire for foods or beverages. It differs from hunger, which is
the body's biological response to a lack of food. A person can have an appetite
even if their body is not showing signs of hunger, and vice versa. A variety of
factors influence appetite, including sensory responses to food's sights, sounds,
smells, and tastes.

https://www.istockphoto.com/photo/bored-little-girl-doesnt-want-to-eat-cornflakes-with-milk-for-breakfast-gm1184544172-333481764?phrase=no%20
appetite

1.7. Nausea
- An uneasiness of the stomach that often accompanies the urge to vomit, but
doesn't always lead to vomiting.

https://www.istockphoto.com/photo/pregnant-young-woman-sitting-on-bed-and-feeling-sick-gm678716712-124354945?phrase=nausea

1.8. Anorexia
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- An eating disorder characterized by abnormally low body weight, an intense fear
of gaining weight, and a distorted perception of weight.

1.9. Peristalsis
- The involuntary constriction and relaxation of the muscles of the intestine or
another canal, creating wave-like movements that push the contents of the canal
forward.

1.10. Regurgitation
- Regurgitation occurs when food, liquid, or stomach acids come back up from the
stomach and into the mouth.
 8

https://www.buoyhealth.com/learn/regurgitation#definition

1.11. Gavage
- The administration of food or drugs by force, especially to an animal, typically
through a tube leading down the throat to the stomach.

1.12. Aspiration
- The action or process of drawing breath or the action of drawing fluid by suction
from a vessel or cavity. It is when food or liquid goes into your airway
instead of your esophagus.
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1.13. Dietician
- A health professional who has special training in diet and nutrition and are
qualified to diagnose eating disorders and design diets to treat specific medical
conditions

1.14. Nutritionist
- A person without any professional training who advises others on matters of food
and nutrition and their impacts on health dealing with general nutritional aims
and behaviors.
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1.15. Helpless Patient

- A patient lacking in or deprived of strength or power.
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CLO#2: Discuss the following:
2.1. Different factors affecting dietary patterns
Self-aware and maintaining dietary patterns, one must look at the aspects that affect
food choices in order to completely comprehend why we eat the foods that we eat.

1. Age
➔ Throughout life, nutrient needs are altered by changes in activity, metabolism,
and body composition.

2. Medication
➔ Numerous drugs may affect how people eat and how well they absorb nutrients,
which may result in increased morbidity and mortality as well as the beginning of
nutritional problems in the elderly.

3. Lifestyle
➔ People work at different jobs and times which affects their eating behavior. They
might want to adapt to their eating habits or make changes in their routine
schedules if food intake is affected. In return, managing a balanced diet helps
shield the body from some diseases, especially non-communicable ailments like
obesity, diabetes, cardiovascular disease, some forms of cancer, and skeletal
problems. A balanced body weight can also be achieved through a healthy diet.

4. Alcohol Abuse
➔ Alcohol may replace food in a person’s diet, and it can depress the appetite. With
such, excessive drinking has negative effects on the immune system, such as
lowering the white blood cell count, it might cause nutritional deficiencies.

5. Socio-economic Status
➔ A social group's member/s depend on one another, share a shared culture, and
have an influence on each other's attitudes and behaviors. Membership in
specific peer, workplace, or community groups has an impact on a person's
eating habits. Therefore, with higher socioeconomic status, the more options of
purchase they get from their eating choices, the higher the consumption of fruits
and vegetable intake.

6. Personal Influence
➔ Every person has distinctive foods which we like and dislike. These preferences
emerge gradually and are shaped by individual experiences such as being
encouraged to eat, being exposed to a cuisine, following family traditions and
rituals, being exposed to advertising, and having personal values.
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7. Religious Influence
➔ There are a few too many religious prohibitions, ranging from moderate to quite
rigid. This will impact a follower's dietary preferences and actions.

8. Advertisement
➔ Food products attempt to persuade consumers to switch from the product they
are now using to the user's brand.

9. Cultural Influence
➔ A cultural group establishes standards for permissible meals, food pairings,
eating habits, and eating behaviors. Following these rules gives the individual a
sense of identity and belonging.

10. Sex
➔ Men and women have varied nutritional needs due to differences in body
composition and reproductive processes. Men need more calories and proteins
since they have more muscular mass.

11. Psychological Influence

➔ Overindulgence in very appetizing foods is associated with depression, anxiety,
frustration, wrath, and other negative emotions. Some people find it easier to
grab a piece of sweet, salty, or high-fat food that offers momentary relief rather
than dealing with the underlying reason for unpleasant sensations, which can be
difficult and time-consuming.

2.2. Types of diet

Type of Diet Description Indication Sample Food

Regular diet Any meal can be a part ● Patients who ● Vegetables
of a regular diet, and are in good (dark green,
the patient is allowed to health. red, and orange
consume any food they ● Patients vegetables)
choose. Dietary without any ● Fruits (banana,
limitations are also not impairments apple, mango,
considered. However, and health canned fruit in
the diet should have all problems that 100% juice,
the qualities of a may require frozen fruit,
healthy diet, including them to and dried fruit)
being balanced, having consume a ● Bread/Grains
enough nutrients, being particular diet. (whole grains,
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reasonable with all including whole
foods, and being under wheat bread,
calorie control. wheat pasta,
brown rice, and
The regular diet whole grain
consists of a variety of cereals such as
meals from the oatmeal)
fundamental food ● Meat, Poultry,
groups: Meat, milk, and Fish:
vegetables, fruits, seafood (fish
bread and cereal, fats, and shellfish),
and sweets. lean meat, and
poultry without
Purpose: A regular skin (turkey
diet provides a and chicken);
well-balanced diet and pork leg,
ensures that individuals shoulder, or
who do not require tenderloin, and
dietary changes get beef round,
enough nutrition. sirloin,
tenderloin, and
extra lean
ground beef.
● Other protein
foods (eggs
and egg
substitutes,
beans, peas,
soy products,
nuts, and
seeds)
● Low-fat dairy
products (skim,
pro1% milk or
low-fat yogurt,
cheese, and
cottage cheese)

Light diet These are foods that ● Patients who ● Cereals

have a soft texture and are recovering (Cooked cereals
are easy to chew. For from abdominal such as farina,
patients who do not or cream of
need a soft diet but are gastrointestinal wheat,
unable to start a full surgery. oatmeal;
diet, this technique can ● Patients who refined cereals
be used as an had renal such as
alternative. transplant or cornflakes, rice
cardiothoracic cereals, puffed
The diet differs from surgery. wheat or rice)
the standard menu in ● Patients with ● Starchy (White
how it eliminates foods gastroenteritis, sweet potato,
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high in indigestible diverticulitis, or macaroni,
fiber, the less digestible inflammatory noodles,
connective tissue of bowel flares. spaghetti, grits,
meats, extremely ● Gastrointestinal white rice,
coarse breads and investigation green English
cereals, and food that is and bowel peas)
heavily seasoned. obstruction. ● Meat, Poultry,
● Esophageal and Fish
Purpose: A light diet stent insertion (Tender beef,
will assist in the bowel's ● Mothers who veal, lamb, lean
recovery following had cesarean pork, mild ham,
surgery or illness, and delivery. fish, liver or
help gradually retrain poultry)
itself to process meals. ● Beverages
(Coffee, tea,
decaffeinated
coffee, cocoa
and carbonated
beverages)
● Fats (Butter,
margarine,
cream, cream
substitute,
mayonnaise,
shortening,
vegetable oil,
whipped
topping, gravy,
mild salad
dressing, crisp
bacon)

Soft diet This diet consists of ● Patients who ● Fruits /

physically soft and have dysphagia Vegetables
easily digestible foods. (difficulty (Fruit and
Soft foods are swallowing). vegetable
recommended for ● Patients who juices,
individuals who cannot find it difficult well-cooked or
tolerate regularly to chew or canned fruits
textured or highly swallow food and vegetables,
seasoned foods. due to dental any dried fruit,
or oral issues. baked, boiled,
They could be mashed, ● Patients who mashed,
diced, or boiled until are recovering creamed
they are tender. from head, potatoes)
neck, or mouth ● Bread/Grains
Purpose: A soft diet surgery. (Rice, noodles,
helps in the ● Patients spaghetti,
management of transitioning macaroni, dry
swallowing difficulties, from liquids to or cooked
also referred to as a regular diet refined cereals,
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dysphagia, and may after a chronic such as farina,
also be needed for illness. cream of
patients who are too ● Narrowing of wheat,
weak or whose the esophagus. oatmeal, grits,
dentition is too poor to ● Indigestion. whole wheat
handle all foods on a cereals)
general diet. ● Meat (Tender,
Broiled,
roasted, baked
or stewed)
● Milk/Dairy (Milk
and milk drinks,
milkshakes,
cream cheese,
cottage cheese,
mild cheeses)
● Beverages
(Fruit and
vegetable
juices,
caffeine-free
carbonated
drinks, coffee,
and tea)

Bland diet A bland diet is a diet ● Patients with ● Milk, Dairy

consisting of foods that diarrhea. Products, and
are generally soft, low ● Patients who Milk
in dietary fiber, cooked are nauseated. Alternatives
rather than raw, and not ● Patients who ● Vegetables
spicy. It also includes have loss of ● Fruits and
food that has a bland appetite or Juices
flavor. It is an eating changes in ● Bread and
plan that emphasizes
taste. Grains
foods that are easy to
● Ulcers ● Meats and
digest.
● Heartburn Other Proteins
Purpose: Bland diets ● Gastroesophag ● Fats and Oils
are generally helpful for eal reflux ● Beverages
people with digestion disease (GERD) (Caffeine-free
problems. beverages)

Low Residue Diet It limits high-fiber ● Recovering ● fruit without

foods, like whole-grain from recent peels or seeds
bread and cereals, bowel surgery ● certain canned
nuts, seeds, raw or (e.g., ileostomy, or well-cooked
dried fruits, and colostomy, fruit (e.g.,
vegetables. resection), peeled apples,
● preparing for a seedless peeled
Purpose: The goal of colonoscopy grapes,
Low Residue Diet (LRD) ● Experiencing banana,
is to have fewer, heightened cantaloupe,
 16
smaller bowel symptoms of etc.)
movements each day. abdominal pain ● some soft,
That will ease ● Cramping cooked
symptoms like diarrhea, ● Diarrhea vegetables
bloating, gas, and ● active digestive (e.g., beets,
stomach cramping. flare-ups beans, carrots,
cucumber,
eggplant,
mushrooms,
etc.)

High Residue Diet A diet that contains ● Constipation ● whole-wheat

considerable amounts ● diverticular breads
of substances such as disease during ● whole-wheat
fiber or cellulose, which non-acute pasta
the human body is phase ● Barley
unable to metabolize ● Colic and ● Bran
and absorb. irritable colon ● brown rice
● Popcorn
Purpose: This diet is ● Oats
particularly useful in ● Quinoa
treating constipation ● Bulgur
and may be beneficial ● Rye
also in preventing ● Millet
certain diseases of the ● buckwheat
gastrointestinal tract.

Low Purine Diet Purines are chemicals ● People with ● low-fat dairy
that are naturally found hyperuricemia. products
in certain foods and ● Patients ● whole grains
drinks. When your body managing gout ● vegetables
breaks down these or kidney ● non-soy
chemicals, uric acid is stones. legumes
the byproduct. A ● fruits and fruit
low-purine diet reduces juices
the foods and drinks ● eggs
with the highest purine ● water
content to reduce uric ● coffee
acid. ● Tea

Purpose: low purine

diet helps minimize the
number of purines in
the body and reduce
the amount of uric acid
in the blood.

High Purine Diet A High Purine Diet ● Patients with ● Alcoholic

involves consumption of hypouricemia beverages (all
foods that are high in ● Patients who types)
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purine. are not ● Some fish,
suffering from seafood and
Purpose: High Purine kidney stones shellfish
Diet maximizes the or gout. (anchovies,
amount of uric acid in ● Patients sardines,
the blood. experiencing herring,
oxidative stress mussels,
● Patients with codfish,
endothelial scallops, trout
dysfunction and haddock)
● Some meats,
such as bacon,
turkey, veal,
venison and
organ meats
like liver

Low-fat diet A low-fat diet refers to Patients with: ● Fruits (Apples,

a decrease in dietary ● Gallbladder Oranges,
fat consumption, disease Melons, Berries,
● Gastroparesis etc.)
limiting fat intake to
● Diarrhea ● Vegetables
30% or less of the (Leafy greens,
individual’s daily calorie Potatoes,
intake. Squash, etc.)
● Low-fat Dairy
Purpose: A low-fat diet (Low-fat
primarily serves three yogurt, cheese,
sour cream,
benefits, including
skim milk)
weight loss, weight ● Grains,
maintenance, and Legumes, and
improved heart (or Pulses (Whole
overall health) grains, beans,
conditions. lentils, peas)
● Lean Protein
(Skinless
poultry, white
fish [halibut &
cod], flank
steak, filet
mignon, pork
tenderloin, egg
whites)
● Low-fat Sweets
(Sherbet,
Sorbet,
Licorice)

Low sodium diet A low sodium diet Patients with: ● Fresh and
involves purposeful ● Hypertension frozen
 18
cutoff of salty food, ● Acute and vegetables
limiting daily sodium chronic (Greens,
intake to 2,000 congestive Broccoli,
heart failure Cauliflower)
milligrams.
● Chronic hepatic ● Fresh, frozen,
failure with or dried fruits
Purpose: As sodium is ascites (Apple, banana,
an electrolyte that berries, pears)
influences fluid balance ● Grains and
within the body, beans (Dried
regulating sodium beans, brown
rice, quinoa)
intake stabilizes blood
● Starchy
volume and blood vegetables
pressure. (Potatoes,
butternut
squash)
● Fresh or frozen
meat and
poultry (Beef,
pork, chicken,
turkey)
● Fresh or frozen
fish (Tuna, sea
bass)
● Eggs (Whole or
egg white)
● Healthy fats
(Plant-based
oils)
● Low-sodium
soups
● Dairy products
(Milk, yogurt)
● Bread and
baked goods
(low-sodium
tortillas,
unsalted
crackers)
● Unsalted nuts
and seeds
(Almonds,
pumpkin seeds)
● Low-sodium
snacks
(Unsalted
popcorns and
pretzels)
● Low-sodium
condiments
 19
(Mayonnaise,
vinegar)
● Low-sodium
condiments(Her
bs, spices)

Low-calorie diet A low-calorie diet Patients: ● Fruits

involves intensive ● Categorized as ● Vegetables
planning of one’s meals moderately to ● Lean proteins
extremely ● Low or no fat
wherein the individual’s
obese or having dairy products
consumed food a BMI over 40 ● Whole grains
provides 800 to 1,500 ● With diabetes ● Herbs and
calories only (or an ● With high blood spices
average of 1,200 pressure
calories) - a range
significantly lower than
the recommended daily
calorie intake.

Purpose: Undergoing
a low-calorie diet often
leads to weight loss.

High-calorie diet Contrasting its Patients with: ● Cheese, cream

counterpart (low-calorie ● Increased cheese
diet), a high-calorie diet calorie needs ● Whole milk,
for surgery or heavy cream,
entails consumption of
health whipped cream
meals to produce conditions ● Sour cream
4000-5000 calories a (wounds, ● Butter,
day. cancer, AIDS, margarine, oil
malnutrition) ● Ice cream
Purpose: A ● Hypermetabolic ● Cake, cookies,
high-calorie diet allows conditions chocolate
(hyperthyroidis ● Gravy
the individual to gain
m) ● Salad dressing,
weight and further ● Cystic fibrosis mayo
nourishment. ● Significant (and ● Avocado
dangerous) ● Jam, jelly,
weight loss syrup
● Older age ● Honey, sugar
(elderly) ● Dried fruit

Diabetic diet generally refers to ● People with ● Fiber rich foods

having a regular meals diabetes (vegetables,
schedule and fruits,
Legumes,
consuming the
whole grains)
healthiest foods in ● Good fats
 20
moderation. A diabetes (Avocados,
diet is a balanced, nuts, Canola)
healthy diet that is ● Fish such as
salmon,
generally the best
mackerel, tuna
choice for everyone and sardines
since it is naturally high
in nutrients and low in
fat and calories.

Purpose: helps you

manage your weight,
blood sugar (glucose)
levels, and risk factors
for heart disease such
high blood pressure
and blood fat levels.
This improves how well
you use the insulin your
body makes or receives
from a medicine.

Dash diet DASH stands for ● Hypertensive ● foods that are

Dietary Approaches to patients rich in
Stop Hypertension. potassium (
Bananas,dried
Studies show that the
fruits,milk),
DASH diet can lower calcium
blood pressure in as (cheese,
little as two weeks. yogurt,canned
sardines,salmo
Purpose:The DASH n) and
diet is a healthy-eating magnesium
(Whole grains
plan designed to help
and dark-green,
treat or prevent high leafy
blood pressure vegetables)
(hypertension). ● Low in
saturated fat
● Low in sodium

Clear liquid diet limits the options you ● digestive ● Plain water,
have to simple gelatin, problems such ● Soup broth
broth, and water. These as vomiting or ● Gelatin
diarrhea ● Tea
are easily digested and
● Diverticulitis to ● Cranberry juice
leave no leftover food decrease stool ● Popsicles
in your digestive tract. in the colon
 21
● Prior to
Purpose: A clear liquid procedures to
diet is routinely used minimize
gastric
before examinations or
stimulation and
procedures that contents
demand an empty ● Post-operatively
stomach or clear to minimize
intestines. Additionally, gastric
if you experience stimulation and
certain digestive nausea
problems, such as
nausea, vomiting, or
diarrhea, it might be
prescribed for a short
while.

General liquid diet is only composed of ● are ● Strained

liquids, foods that are recommended creamy soups
typically liquid, and for people who ● Tea
can't chew, ● Juice
foods like ice cream
swallow, or ● Jell-O
that become liquid digest solid ● Milkshakes
when they reach room food. ● Pudding
temperature. ● Post surgery ● Popsicles
● patients who
Purpose: This diet is have difficulty
designed to be used by eating or
swallowing
patients who are unable
to chew or swallow
solid foods as a
transition from a clear
liquid to a soft or
general diet.

2.3. Different types of feeding as to its definition, indication and

contraindication
2.3.1. Enteral feeding

Enteral Feeding refers to the intake of food via the gastrointestinal tract
(GI Tract) which is composed of the mouth, esophagus, stomach, and intestines.
This may mean that the nutrition taken through the mouth or tube goes directly
to the stomach or small intestine. Most notable type of enteral feeding is called
tube feeding which is used if the patient cannot physically eat, cannot eat safely,
 22
or if the caloric requirement of a patient is beyond the ability to eat.

This can be applied for a short or long period of time for a variety of
reasons including:
1. Unable to consume adequate nutrients
2. Impaired swallowing
3. Facial or oesophageal structure abnormalities
4. Anorexia related to a chronic illness
5. Eating disorders
6. Increased nutritional requirements
7. Congenital anomalies
8. Primary disease management

2.3.1.1. Orogastric tube feeding

Orogastric Tube (OGT) is inserted through the mouth

which leads to the esophagus and ends in the
stomach.

Indications:
1. Gastric Content Retention
2. Intestinal Obstruction
3. Suspected Upper Gastrointestinal bleeding
4. Coma
5. Medication Administration
6. Gastric Dilation

Contraindications:
1. Esophageal stricture
2. Esophageal rupture
3. Recent Esophageal variceal banding
4. Damaged facial structures due to incidents
5. Recent surgery to ear, nose, throat, or jaw

2.3.1.2. Nasogastric tube feeding

 23
Nasogastric Tube (NGT) is inserted through the nose that passes through
the esophagus and ends in the stomach.

Indications:
1. Abnormal swallow may be considered in the following:
unconscious, cerebrovascular accident (CVA)
2. Unable to meet nutritional requirements orally
3. Increased requirements e.g. pressure sores
4. Anorexia e.g. oncology patients, depression
5. Neurological disorder e.g. motor neurone disease
6. Chronic malnutrition

Contraindications:
1. Gastrointestinal obstruction
2. Oesophageal /gastric fistulas
3. Persistent poor gastric emptying
4. Peritonitis
5. Intractable vomiting
6. Acute inflammatory bowel disease (requiring complete bowel rest)
7. Basal skull fracture

2.3.1.3. Gastrostomy tube feeding

G-Tube, also known as the PEG-tube, is inserted through an

abdominal puncture site into the stomach which is done
through a regional anesthesia.

Indications:
1. Dementia
2. Cystic Fibrosis
3. Peritoneal Dialysis

Contraindications:
1. Active coagulopathies and thrombocytopenia
2. Haemodynamic compromise
Sepsis or Perforated viscus
3. Bleeding disorders
4. Severe ascites, peritonitis, pharyngeal or esophageal obstruction
 24
5. Sepsis

2.3.1.4. Jejunostomy tube feeding

J-Tube, also known as the PEJ-tube, is inserted through an

abdominal puncture site into the Jejunum which is done through
regional anesthesia.

Indications:
1. Oro-pharyngeal and esophageal malignancy
2. Acute ischaemic or hemorrhagic stroke
3. Chronic progressive neuromuscular disease
4. Major surgery of upper digestive tract

Contraindications:
1. Severe ascites, peritonitis, pharyngeal or esophageal obstruction
2. Acute severe illness
3. Anorexia
4. Previous gastric surgery
5. Gastric outlet obstruction

2.3.2. Total parenteral nutrition

Total parenteral nutrition (TPN) is a type of feeding that provides
complete nutrition for patients who are unable to feed by way of the
gastrointestinal tract through IV administration of a highly concentrated
solution of nutrients as the only source of nutrition.

Indication Contraindication

● Inadequate absorption caused ● Infants with a small bowel

 25

by short bowel syndrome length of less than 8 cm

● Prolonged bowel rest
● When enteral therapy is not an
option
● Other diseases or conditions
where oral or enteral feeding is
not an option
● Patients with critical
cardiovascular instability or
metabolic instabilities;
● When it is possible to feed via
the gastrointestinal tract
● Lack of a therapeutic goal

Advantages Disadvantages

● Fast and effective direct ● Liver dysfunction

administration ● Infection
● Allows the gastrointestinal system ● Adverse reactions to lipid
to heal emulsions

2.3.3. Brecht feeding

Brecht feeding is a type of feeding technique used to encourage full
oral feeding in patients with cleft lips or cleft palates.

Indication Contraindication

● Patient has a cleft lip or cleft ● Absence of cleft lip or cleft

 26
palate palate
● Impaired sucking ability ● Poor swallow reflex

Advantages Disadvantages

● Facilitates feeding when baby has ● Aspiration to the lungs

difficulty in swallowing ● Regurgitation to the nose
● Prevents discomfort from
increased amount of inhaled air

2.3.4. Clock face technique

Clock face technique is a technique in feeding where the healthcare
provider utilizes the positions of the numbers on a clock as a reference
point to guide a visually-impaired patient in locating their food on their
plate.

Indication Contraindication

● Patient is visually-impaired ● Patient with cognitive

dysfunction

Advantages

● Promotes independence in visually-impaired patients

2.4. Clients who need assistance in feeding

 27
Elderly

- Due to physical limitations or medical conditions that make it difficult for the
elderly to eat independently, they may require assistance during feeding.

Blind or poor vision person

- Clients with poor vision require feeding assistance because they are unable to
see what they are eating, which can be unsafe. Having someone assist them
with these tasks ensures that they can safely feed themselves and maintain a
healthy diet.

Unconscious patient

- Patients who are unconscious require assistance during feeding because they are
unable to feed themselves and may aspirate food or liquids if not properly
monitored.

Patients with spinal cord injury

 28
- Patients with spinal cord injuries may have difficulty with feeding themselves due
to paralysis and impaired motor control. Depending on the severity of the injury,
patients may have limited or no control over their arms, hands, or fingers,
making it difficult to use utensils.
 29
CLO#3: Explain the following:
3.1. Importance of feeding helpless patients
● Establish the nutritional needs of the patient
- A well-balanced diet provides all of the: energy you need to keep active
throughout the day.
● To promote patient’s health and recovery
- Ensuring the correct diet can help promote health and speed up your
recovery.
● To provide assistance, especially for patients who are unable to feed themselves
- It ensures continual proper nutrition even if the patient cannot feed
themselves
● Promotes regular eating habits of patients
- Maintain the regular eating habit of patient despite of them not able to
feed themselves
● Promotes nurse-client relationship
- As the nurse feeds the patient this in turn promotes a relationship
because of the interaction
● Corrects nutritional deficiencies
- Nutrients you need for growth and repair, helping you to stay strong and
healthy and help to prevent diet-related illness

3.2. Scientific principles applied in feeding helpless patients

● Microbiology
Before beginning to serve the customer, it is essential to effectively
decontaminate your hands to prevent cross-contamination. To reduce the risk of
infection and the transmission of microorganisms, wear gloves and the appropriate PPE.
The concept of handwashing is also the most important and fundamental practice for
preventing and controlling illnesses. Healthcare professionals with contaminated hands
are one of the causes of cross-infection, therefore, we must wash our hands thoroughly
especially when assessing a patient.

● Body Mechanics
Observing proper body mechanics can help avoid fatigue when assisting in
feeding helpless patients. The entire process requires carrying different supplies and
equipment while carrying out other procedures for how many times in a day. When not
observed, this puts the healthcare professionals at risk for back injuries or physical
strain. Such measures are used to not only protect the healthcare professional, but the
 30
patients as well. It gives healthcare professionals more energy to attend to the needs of
their patients.

● Anatomy and Physiology

It's critical that you understand the anatomy of the client's body portion in order
to locate the tube in the body. With that, it is also to ensure safety before, during, and
after the feeding by knowing the basic knowledge of their Anatomy and Physiology.

● Time and Energy

To prevent any delays, be sure to gather all the supplies required for feeding the
client. Remember that everything should be prepared before entering the client room.
This prevents the process from having any delays and perfect time management is
observed.

● Security and Safety

In assessing a helpless patient, healthcare professionals are required to carefully
inspect the materials and equipments used for the assessment. Following the different
safety measures, it prevents any harm to the patients in cases where any mishaps
might happen. If you are feeding and no one else is in the room, avoid leaving the
room because it could result in mistakes. To reduce the risk of falling, always raise the
side railings. Place the utensils in a convenient location for the customers to use.

● Psychology
In order to set the client's expectations and lessen anxiety, it's critical for the
nurse to explain the rationale behind each procedure and to orient the client and close
family members. In feeding, it is necessary for the patient to comprehend what will
happen to them before, during, and after the procedure. The patient's uneasiness
during feeding will be lessened by building rapport and projecting a kind, safe, and
welcoming aura.

● Sociology
It's crucial to develop a rapport with the client in order to gain their trust and
comfort.

● Physics
It is the connection between the food we eat and our interpretation of these
stimuli as a "texture" response. This entails breaking down and reassembling
food, chewing , mixing, lubrication and dilution (via the addition of saliva), and
swallowing a bolus. The foods that we consume (natural or processed), also vary
 31
considerably, in terms of structure, mechanical properties, such as particle size,
moisture content, fat content, viscosity, phase volume of air and the presence of
ice or fat crystals.
 32
CLO#4: State the important nursing responsibilities to be
observed before, during, and after feeding helpless patients.
Before
● Perform handwashing.
● Prepare the needed utensils and towel
● Ensure that the environment is convenient for the client.
● Place the towel over the chest to protect the client’s clothing
● Check that the correct tray is given to the client.
● Place the client in a comfortable position and assess their ability to eat.

During
● Cover patient below the chin with a face towel, be careful not to spill food. Wipe the
patient’s mouth and chin whenever necessary
● Feed the patient either by using spoon or fingers
● Ensure that the food is the right temperature
● Offer water as required
● Allow time for patient to properly swallow to avoid choking
● Set a comfortable pace for eating and for the patient to enjoy the food
● Food should not be too hot or too cold

After
● Observe the patient's appetite.
● List any foods that the patient disliked.
● Help with handwashing, denture cleaning, and general oral hygiene
● Help the patient get back into a comfortable position.
● After-care and appropriate equipment disposal
● Complete documentation
 33
CLO#5: Demonstrate beginning skills in feeding helpless patients.
Materials Needed for Feeding Helpless Patients:
- A tray lined with cloth or placemat
- Spoon, fork, knife
- Drinking glass /cup (straw for patients with difficulty drinking from a cup or glass)
- Plates with cover
- Cereal bowl with cover
- Table napkin

Procedure Guide: Feeding Helpless Patients

Procedure Rationale

1. Prepare the patient for the meal. Have To avoid cross-contamination, because our
patient change clothes and comb hair if hands in general carry germs we can't see,
necessary. Provide with facility for hand and these germs can be introduced into the
washing and drying. patient's food during their meal.

2. Make the environment conducive to eating.
Keep out of sight all unpleasant objects like
urinals and bedpans, close doors of comfort
rooms. Uncomfortable treatment like
injections, enemas, dressing must be done
outside eating time schedule.
The ambiance of your surroundings can play
a role in how much food you consume. A
dirty environment can influence you to eat
less a clean environment can make you eat
more.

3. Set silvers and covered chain wares with This promotes a much better and easy access
food in their proper places on the tray. of feeding for the patient and to avoid
untidiness and disorderly arrangement of the
utensils.

4. Place the tray where the patient can see This is for patient accessibility which can
and reach it. encourage independence and participation
during the meal. This is also why the tray is
usually placed on their stronger side.

5. Assist the patient into a comfortable. If To prevent the patient from choking while
permissible raise the head of the bed, so he eating.
can assume sitting or semi-sitting position.

6. Line the patient’s chest with a towel. To prevent soiling of patient’s gown and bed
linens. This procedure, in return, helps
maintain a clean environment essential for
healing and recovery.
 34
7. Remove food covers to start the meal. This is to show respect to the patient's
Inquire of patient’s wants to pray before culture or religion.
eating.

8. If the patient is capable of movement, Allowing the patient to feed himself promotes
even limited, allow him to feed himself and independence and allows himself to eat with
assist him with the food he finds difficulty in the help of the nurse if needed.
dealing with.

REMINDER: If the patient is blind but

capable of feeding himself, orient him to the
food placement on the tray using the “Clock
Face Technique”.

9. If the patient is unable to feed himself, the To enhance health outcomes by encouraging
nurse feeds the patient while teaching a healthy behavior and participation in
family member how it is done. caregiving during mealtimes.
 35
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