Chapter 24 nutritional care and
support
Support nutritional intake
🩺 Importance of Assessment
Accurate assessment is essential to meet patient’s nutritional needs.
Cannot plan effective interventions without knowing:
Allergies
Dietary restrictions
Personal, cultural, or religious food preferences
Physical ability to eat independently
🍽️ Initial Assessment Should Include:
Identify:
Food allergies (e.g., peanut allergy, lactose intolerance).
Special diets (e.g., diabetic, low-sodium, vegetarian).
Cultural/religious dietary restrictions (e.g., kosher, halal, vegetarian).
Personal food preferences.
Assess Physical Abilities:
Can the patient feed themselves?
Does the patient need:
Help cutting food?
Help opening containers?
Full feeding assistance (e.g., patients who are blind, weak, or post-surgery)?
💊 Medication-Related Assessment
Review current medications taken at home.
Many medications can cause:
Nausea
Loss of appetite
Altered taste
👩⚕️ Simple Nursing Interventions
Help select foods that the patient can tolerate.
Adjust meal/snack times to minimize nausea.
Support small, frequent meals if appetite is poor.
🍽️ Why Mealtime Matters
, Nutrition and hydration are critical for healing.
Meal trays should not be treated as a routine task.
It’s not acceptable to just drop off trays and leave without patient support.
👩⚕️ Nurse’s Responsibilities Before and During Meals
Prepare the patient for mealtime:
Ensure the patient is awake and alert.
Assist with hand hygiene if needed.
Position the patient properly (usually sitting up).
Remove obstacles (e.g., bedside clutter, medical equipment blocking the tray).
Assess and assist as needed:
Help open containers.
Cut up food if needed.
Feed the patient if they are unable to eat independently.
Monitor food intake:
Stay alert for eating difficulties.
Encourage and support adequate fluid and food intake during the meal.
🚨 Why This Is Critical
Inadequate intake can delay healing and worsen health.
Nurses play a vital role in ensuring patients meet their nutritional needs during
hospitalization.
Odors and the Mealtime Environment
🌸 Importance of a Pleasant, Odor-Free Environment
Odors can reduce appetite and trigger nausea in hospitalized patients.
Providing a pleasant, clean, clutter-free environment supports better food intake and
healing.
🚫 Odors to Eliminate Before Mealtime
Body odors (personal hygiene)
Fecal or urine odors
Infectious or bloody drainage odors
Halitosis (bad breath)
Food odors (from your hands or clothing)
🛑 Avoid Personal Fragrances
No perfumes, aftershaves, or fragranced lotions.
No strong-smelling hair products.
Avoid heavily scented fabric softeners or laundry detergents.
Even typically "pleasant" odors may cause nausea, headaches, or allergic reactions in ill
patients.
,Preparing the Environment for Mealtime
🛏️ Before Meal Trays Arrive
Prepare the patient’s room ahead of mealtime.
Ensure the overbed table is clean, clear, and ready for the meal tray.
🚫 Remove Offensive Items from the Table
Emesis basins (especially if containing sputum)
Urinals (empty or full)
Rolls of toilet tissue
Hairbrushes
Soiled tissues or washcloths
Any contaminated or dirty items
🧼 Final Cleaning Steps
Wipe the overbed table with a damp cloth or disinfectant if needed.
Make sure the table is sanitary, just like preparing a clean dining table at home.
Toileting Before Mealtime
🚽 Importance of Toileting Before Meals
Always ask if the patient needs to use the bathroom before meals.
Assist the patient to the bathroom or with a bedpan if needed.
🍽️ Why Toileting Matters for Nutrition
A full bladder or bowel can decrease appetite.
Discomfort may prevent the patient from eating adequately.
If a patient interrupts the meal for toileting:
They are less likely to return to finish eating.
Meal intake decreases, affecting recovery.
Patient Comfort Before Mealtime
🛌 Why Comfort Matters
Pain, nausea, and discomfort can greatly reduce appetite.
A comfortable patient is more likely to eat adequately.
🧣 Comfort Measures Before Meals
Keep patient warm:
Ensure they are wearing socks or slippers.
, Provide a robe or a second gown worn backward (like a robe).
Place a blanket across the lap if needed.
Assist with personal aids:
Dentures: Obtain, clean if necessary, and help insert them.
Glasses: Obtain, clean, and assist the patient in putting them on.
Patient Positioning Before Mealtime
🪑 Best Position for Eating
Assist the patient to sit upright:
In a chair if possible.
On the side of the bed if needed.
If unable to transfer, position in bed:
Good body alignment is essential.
Elevate head of the bed between 60° and 90°, depending on:
Patient condition
Patient comfort and preference
🍽️ Overbed Table Setup
Place the overbed table across the patient's lap.
Ensure the table is directly in front of the patient.
Adjust the table height so that it is comfortable for eating.
Patient Cleanliness Before Mealtime
🧼 Importance of Cleanliness
Reduces the risk of bacterial contamination while eating.
Helps promote dignity and comfort before meals.
👐 Steps for Patient Hand and Face Cleaning
Provide two warm wet washcloths:
One with soap for washing.
One without soap for rinsing.
OR use a rinse-free bath wipe if preferred.
Assist the patient if they are unable to perform hygiene independently.
✋ Nurse Hygiene
Wash your hands thoroughly before:
Delivering the meal tray.
Setting up the meal tray.
support
Support nutritional intake
🩺 Importance of Assessment
Accurate assessment is essential to meet patient’s nutritional needs.
Cannot plan effective interventions without knowing:
Allergies
Dietary restrictions
Personal, cultural, or religious food preferences
Physical ability to eat independently
🍽️ Initial Assessment Should Include:
Identify:
Food allergies (e.g., peanut allergy, lactose intolerance).
Special diets (e.g., diabetic, low-sodium, vegetarian).
Cultural/religious dietary restrictions (e.g., kosher, halal, vegetarian).
Personal food preferences.
Assess Physical Abilities:
Can the patient feed themselves?
Does the patient need:
Help cutting food?
Help opening containers?
Full feeding assistance (e.g., patients who are blind, weak, or post-surgery)?
💊 Medication-Related Assessment
Review current medications taken at home.
Many medications can cause:
Nausea
Loss of appetite
Altered taste
👩⚕️ Simple Nursing Interventions
Help select foods that the patient can tolerate.
Adjust meal/snack times to minimize nausea.
Support small, frequent meals if appetite is poor.
🍽️ Why Mealtime Matters
, Nutrition and hydration are critical for healing.
Meal trays should not be treated as a routine task.
It’s not acceptable to just drop off trays and leave without patient support.
👩⚕️ Nurse’s Responsibilities Before and During Meals
Prepare the patient for mealtime:
Ensure the patient is awake and alert.
Assist with hand hygiene if needed.
Position the patient properly (usually sitting up).
Remove obstacles (e.g., bedside clutter, medical equipment blocking the tray).
Assess and assist as needed:
Help open containers.
Cut up food if needed.
Feed the patient if they are unable to eat independently.
Monitor food intake:
Stay alert for eating difficulties.
Encourage and support adequate fluid and food intake during the meal.
🚨 Why This Is Critical
Inadequate intake can delay healing and worsen health.
Nurses play a vital role in ensuring patients meet their nutritional needs during
hospitalization.
Odors and the Mealtime Environment
🌸 Importance of a Pleasant, Odor-Free Environment
Odors can reduce appetite and trigger nausea in hospitalized patients.
Providing a pleasant, clean, clutter-free environment supports better food intake and
healing.
🚫 Odors to Eliminate Before Mealtime
Body odors (personal hygiene)
Fecal or urine odors
Infectious or bloody drainage odors
Halitosis (bad breath)
Food odors (from your hands or clothing)
🛑 Avoid Personal Fragrances
No perfumes, aftershaves, or fragranced lotions.
No strong-smelling hair products.
Avoid heavily scented fabric softeners or laundry detergents.
Even typically "pleasant" odors may cause nausea, headaches, or allergic reactions in ill
patients.
,Preparing the Environment for Mealtime
🛏️ Before Meal Trays Arrive
Prepare the patient’s room ahead of mealtime.
Ensure the overbed table is clean, clear, and ready for the meal tray.
🚫 Remove Offensive Items from the Table
Emesis basins (especially if containing sputum)
Urinals (empty or full)
Rolls of toilet tissue
Hairbrushes
Soiled tissues or washcloths
Any contaminated or dirty items
🧼 Final Cleaning Steps
Wipe the overbed table with a damp cloth or disinfectant if needed.
Make sure the table is sanitary, just like preparing a clean dining table at home.
Toileting Before Mealtime
🚽 Importance of Toileting Before Meals
Always ask if the patient needs to use the bathroom before meals.
Assist the patient to the bathroom or with a bedpan if needed.
🍽️ Why Toileting Matters for Nutrition
A full bladder or bowel can decrease appetite.
Discomfort may prevent the patient from eating adequately.
If a patient interrupts the meal for toileting:
They are less likely to return to finish eating.
Meal intake decreases, affecting recovery.
Patient Comfort Before Mealtime
🛌 Why Comfort Matters
Pain, nausea, and discomfort can greatly reduce appetite.
A comfortable patient is more likely to eat adequately.
🧣 Comfort Measures Before Meals
Keep patient warm:
Ensure they are wearing socks or slippers.
, Provide a robe or a second gown worn backward (like a robe).
Place a blanket across the lap if needed.
Assist with personal aids:
Dentures: Obtain, clean if necessary, and help insert them.
Glasses: Obtain, clean, and assist the patient in putting them on.
Patient Positioning Before Mealtime
🪑 Best Position for Eating
Assist the patient to sit upright:
In a chair if possible.
On the side of the bed if needed.
If unable to transfer, position in bed:
Good body alignment is essential.
Elevate head of the bed between 60° and 90°, depending on:
Patient condition
Patient comfort and preference
🍽️ Overbed Table Setup
Place the overbed table across the patient's lap.
Ensure the table is directly in front of the patient.
Adjust the table height so that it is comfortable for eating.
Patient Cleanliness Before Mealtime
🧼 Importance of Cleanliness
Reduces the risk of bacterial contamination while eating.
Helps promote dignity and comfort before meals.
👐 Steps for Patient Hand and Face Cleaning
Provide two warm wet washcloths:
One with soap for washing.
One without soap for rinsing.
OR use a rinse-free bath wipe if preferred.
Assist the patient if they are unable to perform hygiene independently.
✋ Nurse Hygiene
Wash your hands thoroughly before:
Delivering the meal tray.
Setting up the meal tray.
