EATING AND DRINKING

Kelompok 1
1. Riska fitria
2. Gusti ratna sari
3. Intan sufina
 Introduction
Good nutritional status is essential to an individual’s health and
wellbeing. Many clients have an increased need for nutrients because of the
extra demands being placed on the body by illness. Poor nutritional status
has been associated with delayed recovery and an increase in mortality,
which also increase the cost of providing health care. In addition, adequate
nutrition not only promotes growth and repair of tissues but also aids
recovery from surgery, disease and trauma.
 Factors that may affect eating and drinking

.physical arising from alteration in the structure, function or

processes of the gastro-intestinal tract and associated systems,
for example ulcerative colitis, diabetes mellitus, facial
disfigurement
• psychological such as depression, anxiety and anorexia
• sociocultural, for example vegetarians, vegan or religious
persuasion
• environmental including unpleasant smells, inaccessibility of
shops
• politico-economic, for example lack of finances.
Assessing an individual’s nutritional status
Nurses are in an ideal position to assess a client’s nutritional status, and thus
identify if they are at risk from malnutritisi.
It should include taking a nutritional history, including consideration of the
factors identified below that can interfere with nutritional status, along with
physical measurements (see Figure 5.1).
status and susceptibility to malnutrition. If a tool is not being used, the client
on admission should at least be asked the following questions:
1 Have you been eating more or less than usual?
2 Have you unintentionally lost or gained weight?
3 How tall are you?
4 What is your normal weight?
 Specific points to consider when assessing individuals’ nutritional and hydration status
include:

1. Physical
a. What is the condition of the mouth, teeth and gums? Poor oral hygiene, a sore mouth
or ill-fitting dentures can cause difficulty when eating.
b. Does the client have halitosis? This may indicate poor oral hygiene or dehydration.
2. • Psychological
a. Is the client depressed or bereaved, thereby affecting appetite and motivation to
prepare food?
b. Is the client turning to food as a source of comfort, resulting in overeating during
periods of loneliness, insecurity or depression?
3. Sociocultural
a. Are there any cultural factors (that is, the collection of attitudes, taboos and beliefs)
influencing the individual’s diet and eating habits? For example, some people may feel
that without a daily hot meal their diet is incomplete.
b. Any other food ideologies that might influence the individual’s motivation to alter
their food habits?.
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4. Environmental

a. Does the client have adequate food preparation and cooking

equipment (or access to it)?
b. Is their appetite likely to be affected by the hospital
environment, for example unpleasant/unfamiliar smells and sounds.

5. Politico-economic
a. Does the client rely on starchy ‘filler’ foods such as white bread,
biscuits, cakes, sweets and fatty foods?
b. Is their vitamin and mineral status compromised as a result?
 Calculating body mass index

To calculate the BMI the following formula is

used:

BMI calculation = weight(kg)

height(m)
Signs and symptoms of dehydration
• The first symptom of dehydration is generally thirst. • A dry and coated tongue is a strong
indicator of dehydration. A client may find talking difficult due to the tongue sticking to the
roof of the mouth
. • The client may have increased skin turgor and the skin can be dry and scaly in appearance.
• The eyes may appear shrunken into their sockets. • An infant’s fontanels may be sunken.
• The urine may be dark in colour and low in amount as the body tries to conserve water.
• A client’s blood pressure is affected because the vascular compartment is the first to be affected
by dehydration.
• A client’s heartrate will begin to rise in an attempt to maintain blood pressure.
• Conditions that can cause dehydration need to be identified and considered. Everyday causes of
dehydration include:
not drinking enough
Alcohol
smoking
caffeine
sunstroke
central heating
infection and pyrexia
diarrhoea and vomiting illness (e.g. diabetes mellitus).
Assisting clients in selecting appropriate meals/fluids

be able to assist clients in the selection of an appropriate diet it is important that

health carer professionals understand the key components of a nutritious diet and
are aware of factors affecting nutritional demands in the healthy individual. In
addition, health promotion is a statutory requirement of the registered nurse so
knowledge of what constitutes a healthy diet and fluid intake for the client is
crucial. An in-depth discussion of what the constituents of a healthy balanced diet
are is beyond the scope of this chapter and will require further reading, but an
outline of the required nutrients and their role within the body is given in.
In addition to knowing about the various nutrients it is important to know what
foods make up a balanced diet. This can be summarized by the percentages given
below and is illustrated in Figure 5.3.
• Starchy foods: 33%
• Fruit and vegetables: 33%
• Milk and dairy products: 14%
• Meat and alternatives (e.g. tofu, pulses): 12%
• Oils, fats, fatty foods, sugars, sugary foods (and alcohol, if taken): 8%
Factors that influence a healthy individual’s nutritional needs

• Age: Children have higher metabolic rates than adults, and so require more energy and
also need to eat the correct amount and type of food to support growth. In adulthood, as
age increases, energy requirements decrease due to the lower metabolic rate of older
people compared with younger adults.
• Sex: Men require more energy, hence calories, because they have a higher metabolic rate
than women due to their relatively greater muscle mass. • Amount of physical activity:
As energy is used as fuel, the higher the level of activity the more energy is used up and
more calories are required.
• Height and build: The bigger the size of the body, the larger the amount of nutrients
required to maintain cells.
• Pregnancy: The rapid growth of the foetus, during the second and third trimesters of
pregnancy, changes nutritional needs although the exact changes vary from woman to
woman.
• Lactation: Women who are breast-feeding require more energy and therefore increased
calorific intake (up to 500 calories a day) as well as increased vitamin A, C and D and
calcium intake.
Selection of appropriate fluids
As well as the client’s food intake the health care professional needs to
ensure that sufficient fluid is consumed on a daily basis. The normal
requirement for an adult is three litres of fluid every 24 hours. Our role is
to ensure that clients drink a sufficient amount of fluids to prevent
dehydration. Encouraging patients to drink (or ‘push fluids’ as it is often
known) is usually left to junior or inexperienced staff. It is therefore
essential to have sound knowledge of the client’s needs and to work very
closely with them in order to encourage them to drink. They should be
checked frequently, that is, at least every two hours, ensuring that they are
offered the most acceptable beverages or alternatives (for example ice
lollies) and that what the client has consumed is accurately documented.
An important point to remember is that some patients may have restrictions
placed on the amount of fluid they are allowed to drink each day. For
example, some clients with renal failure can be restricted to as little as 600
ml per day.
Lanjutan

Monitoring nutritional status

To ensure that individual nutritional and hydration needs are

sufficiently met some clients may need close and accurate
monitoring. Nutritional assessment, as with other assessments,
should not be a one-off process but continuous, especially those
clients who are at risk of malnutrition. Simple indicators such as
regular weighing and BMI calculations may be sufficient as long
as the equipment used is accurate and of course available. It must
be remembered, however, that short-term losses and gains will
only reflect body fluid changes.
 Monitoring fluid intake

As discussed, even minor changes in the body’s fluid balance at

cellular level can have serious consequences for the client’s health.
The health professional’s role is critical in ensuring that fluid
balance is monitored and recorded if the client is identified as:
• being at risk of dehydration
• having excessive fluid losses (e.g. diarrhoea)
• being fasted
• vomiting
• having fluid restriction
• being given any form of artificial nutrition or hydration
• or having some other condition which requires the fluid intake to
be carefully maintained. Therefore the total intake and output of
fluids should be recorded on a fluid balance chart
Fluid balance charts

Each hospital or care facility will have its own form of fluid
balance chart but they will all follow a similar format, requiring
the nurse to record all types of fluid input and output, including:
• oral fluids
• enteral feed
• intravenous fluids
• blood and plasma
• urine
• vomit
• wound drainage
• nasogastric aspirate
• diarrhoea.
Assisting with eating and drinking
Terimakasih