FOUNDATIONS 2

Nutrition and Meal Prep

 Does Intake Change?
Growth spurt
Puberty:
at1 year, Finger
High
foods, High Fat
Nutrient for
Diet
Increase
School age, Growth Rate
( “I don’t
Nutrients
like!)
Cereal packed into
Rituals
(iron small
fortified) portions
4-6 mths,
1 new Supplements
food at a like “Ensure”
time, not
picky
(yet)
Energy Needs
Decrease (weight
Rapid Growth:
gain possible) in
Breast milk/
middle age
Formula
 *Geriatric Intake!
Decreased
Saliva
Tooth Loss
Production

Sensory Losses
(Lower taste
bud sensitivity)
– More Salt & Stomach acid
Sugar Decreases –
Fried or Fatty
Food Hard to
Digest

Motility
(peristalsis)
Decreases
Foods Needed
to Help avoid
Constipation
Improving Food intake of Elderly
• Room where client eats should be
free of unpleasant sights & odours
like
bedpans, old food, dressings

• Make sure client is comfortable with

eating: ie: pain free, dentures fit,
toileted
 Observe Client for:

• Any difficulties; • How much food &

Pain with chewing, fluids Client takes at
Nausea, Vomiting, each meal
Cramping after
meals, problems • In what situation
using Utensils, may this be
Swallowing or difficult?
Aspiration
 Factors Influencing Food Choices
Afford? Where
Meal Times,
Client Shops,
Spices, Foods
Poor quality, No
Avoided on
Fruits, Veggies,
Specific Days
Meat $

Fresh Food,
Specialty
Foods,
Supplements
High
Cost, Eat What
Specialty we Like!
Stores, Restrictions
Fear due to
Disease
 3 Parts to a Food Label
1. Ingredient list:
• Read to find out amount of fat, calories,
sugar, anything that could produce
allergy

• If on low salt diet, stay away from

processed meats, some canned
vegetables
2. Nutritional Facts
 Health Canada’s Recommended
Daily Intake
• Carbs – 60% of daily calories • Caffeine – 400mg
– 1 gram of Carbs supplies body with < for kids and Pregnant
4 calories or Lactating Women*
• Protein – 10% of daily calories
– 1 gram of Protein supplies body
with 4 calories
• Fats – 30% of daily calories
– 1 gram of fats supplies body with 9
calories!
– 10% from Saturated Fats
 Food, Nutrients & Health
• Alcohol intake – increases the risk of liver, esophageal
(squamous cell carcinoma), mouth, pharynx & larynx,
colorectal, and breast (post menopausal) cancer.
• Fats – replace saturated fat with carbohydrate, replace
trans fat with unsaturated fat
• Fibre – improves blood lipid levels
• Soy Protein – lowers LDL cholesterol
• Meats – processed meats increase risk of colorectal
cancer
• Sugars – sugar sweetened drinks increase risk of
weight gain, overweight and obesity.
Health Canada (2019).
 New Evidence
• Increase in polyunsaturated fat can improve blood
lipid levels
• Replacing saturated fats with unsaturated fats can
improve blood lipid levels in children
• Decreased saturated fat intake in children can lower
blood pressure and lower risk of obesity
• Diets high in nuts can lower LDL cholesterol
• Intake of sugar beverages i.e. fruit juice can increase
dental decay in children, & weight gain
• High glycemic index (glycemic load) can increase risk
of type 2 diabetes. Health Canada (2019).
 No longer ‘convincing’ evidence
• The evidence no longer supports that dietary
fibre, including fibre found in fruits and
vegetables as well as whole grains can
decrease the risk of colorectal cancer.
• The evidence no longer supports that red
meat can increase the risk of colorectal
cancer. Health Canada (2019).
 3. Nutritional Claims
Must meet governm’ • A healthy diet low
Requirements! Governm’
regulated!
in sat fat and
transfat mAy
Tell consumers what reduce the risk of
nutrients are in the heart disease.
product and it’s
nutritional benefits!

Often misleading!
 FOOD SAFETY
Preventing Food Spoilage:
At room temp, bacteria in food can double
every 20 minutes
Freezing foods or storing them at cold temp
will not kill the bacteria, but will prevent them
from multiplying
*Refrigerate or freeze perishable foods and
leftovers with 2 hours of purchase or
consumption
Make sure fridge is at 4°C (40°F)
Don’t pack fridge too tight
Also marinate foods in fridge!
 Food borne illness
• Illness caused by improperly cooked or stored food
• Older adults, young children, pregnant women and
people with weakened immune systems are more
susceptible to severe bouts of food borne illness
• Food borne illness occurs when a person eats
food contaminated with microscopic, disease-
causing organisms, such as bacteria, viruses,
parasites.
• High Risk Foods:
• Dairy products , eggs, poultry
• Small goods such as salami and hams
• Seafood
• Prepared salads such as coleslaw, pasta salads and
rice salads
• Prepared fruit salads, raw sprouts
 FOOD SAFETY
Common signs and symptoms: Can start hrs – days
afterward and last for up to 5 days

• Stomach cramps, nausea, vomiting, diarrhea,

headache and fever, or any combination of these

• Can cause serious illness and even death

 FOOD SAFETY
Bacteria grow quickly in the right conditions

• Food poisoning bacteria can multiply very quickly,

particularly in certain conditions.

• 1 Factor that affects bacterial growth

is “Temperature”
 Cross Contamination
• Occurs when pathogens are passed from one
source to another

• ie: Fluids from raw, contaminated chicken

could drip on to vegetables in fridge
 Cross Contamination
• Use 2 cutting boards, one for raw meat etc
and one for washed fresh produce.

• Always wash hands, cutting boards, dishes,

knives and utensils with soap and warm water
after they come in contact with raw meat,
poultry.

• Always place cooked food on a clean plate.

 Cooking…
• Eggs should be cooked thoroughly to proper
temperature
• Microwave oven; make sure there are no cold spots
in food where bacteria can survive
• Reheat solid foods quickly to internal temp of at
least 74°C (165°C)
• Reheat and stir soups, stews, sauces and gravies to
a rolling boil

IF IN DOUBT THROW IT OUT!!

 What is food allergy?
• Food allergy - occurs when your body’s
immune system perceives a food as a foreign
invader and attempts to repel it.

• Food Intolerance – causes discomfort but no

immune system involvement. May be a lack of
a particular protein to metabolize food.
 Symptoms of Allergic Reaction
• Vomiting, diarrhea, nausea, swelling of eyes, lips.

• Some people can experience respiratory symptoms

such as coughing, difficulty swallowing, wheezing,
tightness in the chest, difficulty breathing, a runny
or stuffy nose.

• Food allergy can show on the skin with eczema or

hives. Other people develop all these symptoms at
once – anaphylaxis.
 What is Anaphylaxis?
• Potentially fatal form of allergy. Anaphylaxis can
intensify so rapidly from initial symptoms to
potentially fatal shock (10 – 15 minutes) that
there is often little time to seek medical help.

• Other people initially experience the milder

symptoms and then an hour to four hours later
plunge rapidly into the severe life-threatening
stage of anaphylaxis
 Anaphylaxis
• Anaphylaxis may begin mildly with itching around
the mouth or eyes, widespread hives, cough and a
vague feeling of anxiety or discomfort.

• In rapid succession, there is a feeling of chest

constriction, dizziness, wheezing, weakness,
difficulty breathing, confusion and a terrible
sensation of impending disaster.

• The victim’s blood pressure falls steeply, then

unconsciousness; coma and death can follow.
 What foods cause Anaphylaxis?
• While any food can
cause anaphylaxis, over
90% of reactions are
caused by a few foods:
peanuts (65%), nuts
(including seeds),
shellfish, fish, and
sulfites.

• Eggs and milk cause

anaphylaxis primarily in
children.
 What if a person has a reaction?
• Their first step is to obtain
medical help.

• Once the incident is over,

the contents of the food
ingested before the incident
will be analyzed to ascertain
the presence of the
ingredient.
 Therapeutic Diets
*prescribed by doctor, implemented by
nutritionist, i.e. Low sodium for client with high
Blood Pressure i.e. Full Fluid diet – fluid or
dissolve at body temperature
•Plan to incorporate client’s likes and dislikes,
background, budget
•*Remember: Your meal planning
responsibilities will be specific to the “care plan”
of each client!
 When grocery shopping &
following a recipe:
• Remember;
– Ask dietician if you are making any substitutes
– Client Preferences (They will eat more of what they like)
– Leftovers? Will they eat them?
– Follow recipe fairly closely and remember all oven
temps are different
– Keep in mind 1. colour 2. texture 3. serving size 4. temp
5. supplements need to added?
– Sales? Does client have extra room for storage?
 Enteral (Tube) Feedings
• Is a common way of giving food and water when a
person is unable to eat or drink enough on his or her
own. When?
– Stroke, Surgery, Facial Trauma, Digestive Issues, Dysphasia
– Difficulty Swallowing

• Liquid food and water are put into a plastic bag and
sent through the tube into the stomach or small
intestine
– May be Continuous or Scheduled (Intermittent)
Where tube is placed
• Nasogastric

• Gastrostomy or PEG
(surgically inserted into
stomach)

• Jejunostomy (surgically
inserted into small
intestine)
Types of Administration
Via
Gravity

Via Pump
And Syringe method
 General PSW Role
• Type and formula ordered by MD,
Nutritionist not PSW
• Person is usually NPO – no oral intake
• Formula should be at room temperature
• Person should be placed in an upright
position and remain in Semi-Fowler position
for at least 1 hr after feeding
• Continuous feeds require feeding pumps
• 1 can at a time (Do not fill bag!)
• Observe skin integrity at point of insertion
PSW’s only utilize Observation
Skills with Nasal Gastric tubes!
If delegated a PSW
may “pause” a
kangaroo pump if
turning or positioning a
patient in specific
situations.

Why is our role so

limited with this type of
Enteral feed’s?
 Role in Community Care (Wow!)
• Delegated act! (We will discuss at length this semester)
• Usually family will be taught first – but this skill
must be delegated by registered staff
• PSW may be delegated to:
– Administer enteral feeds via Peg or Gastrostomy
tube utilizing the Pump, Gravity or Syringe method
– Flush tube with pre-ordered amount of H2O
– Prime tubing, attach &/or remove tubing from
client & turn pre-programmed pump on
– Change simple dressing around insertion site
– Trouble shoot blocked tubing
 Role in Long Term Care Facility
Minimal
• Observations skills of client before – during –
after enteral feeds
• PSW may be delegated to “pause” a pump if
client requires repositioning

Regardless of Where client is receiving Enteral

therapy All PSW’s are required to understand
the Complications that may occur with Feeds &
utilize comfort measures for clients!
 Complication’s may include:
Aspiration
Definition : The inspiration into the airway of
foreign material. Breathing fluid or object into
lungs.
Signs of Aspiration
 coughing
 respiratory distress
 Others?
 Other Complications to Observe
for During Enteral Feeds
 1. Diarrhea
 2. Constipation
 3. Regurgitation – (can cause aspiration)
 4. Nausea, vomiting
 5. Distended abdomen
 6. Heart burn, c/o gas
 7. Signs of infect’n @ tube insertion site
 Intravenous (IV) Therapy
• Fluids given through a needle or catheter
inserted into a vein.
• Once the catheter (cannula), which is
threaded over a needle is inserted through
the skin, the needle is removed.
– Only the soft, pliable cannula
remains under the skin
 Reasons for IV therapy
 Providing fluids that cannot be taken by
mouth
 Replacing electrolytes, vitamins or minerals
lost during illness or surgery
 Providing Sugar for energy or to control
Hypoglycemia for a Diabetic client
 Medication or Blood administration
 Hyperalimentation – ?
 Where will I find an IV cannula
inserted?

Why would
this specific
Back of the Hand is the area be
Primary Site for Peripheral problematic
IV site as an IV
site?
 Forearm and crease of elbow
(antecubital fossa) may also be used as
Peripheral IV site

Any issues
you can
foresee
using this
site?
 Peripheral Site vs Central Site
• A nurse may insert a A nurse or MD inserts a
short catheter (cannula) long catheter (cannula)
into a peripheral vein into a central vein,
• Used for hydration, which is then threaded
Short term IV therapy. to Superior Vena Cava
Site usually changed or Right Atrium.
every 3-4 days.
Used for Long term IV
therapy, caustic
medications such as ?.
Catheter (Cannula)
threaded to the
entrance of the
heart
 Complications to Watch For
Phlebitis – Infiltration -
Infection of the Vein (interstitial) IV

Tissue
hot, red
and
tender
around Tissues swollen with fluid
IV site around IV site, cannula
dislodged from vein
Other Observations?
 Bleeding at IV site
 Paleness or cold temp of
skin at site
 Complaints of Pain at IV
site
Also Systemic Complications:
 Fever
 Itching
 Signs of Cardiac or
Respiratory Distress (SOB)
 Nausea or Confusion
Our Role
 Careful handling of IV
sites and tubing
 If pulled out – apply
pressure dressing with
sterile gauze
 Keep site dry and intact
during assistance with
ADL’s
 Pump’s should be
turned off by Registered
staff only
 Reminding client’s
about their IV!
 Our Role with IV Therapy
 PSW never responsible for the insertion or
maintenance of an IV site!
 Safe care and good Observation skills are our job
however 
 Careful handling of IV sites and tubing imperative.
 If Client Personal Hygiene is required keep IV site
dry.
 Pumps should be turned off (by Registered Staff)
when assisting client in shower.
 Intake and Output - review
Total amount water taken in from all sources
(Total Intake) is about _______ml/day for an
adult

• Daily intake for survival – 1500 ml for an adult

• Daily adult urine output – 1500 ml

 Intake substances
• How do we put fluids
into the body?

• IV fluids and IV meds

• Tube feeds
• All fluids taken by
mouth
• Others?
What circumstances
could increase our
intake? 51
 Output
• Urine
• Vomit
• Diarrhea
• Wound drainage
• Chest tube
• Sputum
• Bleeding
• What about
Sweat? Drool?
52
 Why do we measure?
• Evaluate fluid balance and kidney function
• Plan medical treatments
– Why would intake and output change the course of
a client’s medical treatment??

• Special diets may include increasing or

restricting fluid intake, or stopping intake
(NPO)
– When might these circumstances come into play?
53
 Normal Fluid Balance
• Must be a balance between total intake and
total output (the amount of fluid lost) for the
body to stay in homeostasis

54
 Edema
• Swelling caused by fluid collecting in
tissue ( intercellular space )

55
 Dehydration
Dehydration – decreased amount of fluid in the
tissues.
Occurs when there is an excessive loss of fluids
from tissues or low intake of fluids into body

• Causes?

56
 Fluid Restriction
• Limiting fluid intake, small amounts
• Ordered by physician
Why?

57
 Variations for age groups
• Infants & Children • Elderly
– More body water than
adults (75%)
– Dehydrate very quickly
– Fluid loss can lead to
death
– Need more fluids
– Medications, disease,
infections can affect body
fluids
– Decreased sense of thirst
– Decreased mobility – can’t
easily get a drink from the
fridge
– Dementia – don’t remember
when they had their last
drink of water
58
 Recording Intake and Output
• Required to know
– Amount of fluid each drink container holds
– Proper measurement of enteral feeds
– Proper skill utilization for measuring urine output
from bedpan, urinal, catheter or diaper
– Proper measurement of sputum, emesis (vomit)
– The impact of client’s IV fluids, chest tube output or
diarrhea
• Amounts totalled at the end of the shift
– Some clients can record their own intake and output

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