Report by Fu, Yan & Opolinto, John Michael R.

NUTRITION Nursing Interventions

Offer nutritionally-dense foods. Since many seniors arent eating as much as they should, the food they do eat must be as nutritious
as possible. Encourage whole, unprocessed foods that are high in calories and nutrients for their size. Some examples include: healthy
fats (nut butters, nuts, seeds and olive oil), whole grains (brown rice, whole wheat bread, oats and whole grain cereals), fresh fruits and
vegetables (canned and frozen are also good choices), and protein-rich beans, legumes and meat and dairy products. This will help
ensure that they are getting all the vitamins and minerals needed to maintain proper health.

Enhance aromas and flavors. Appealing foods may help stimulate appetite, especially in someone whose senses of taste and smell
aren't what they used to be. Seniors can intensify flavors with herbs, marinades, dressings and sauces. Switching between a variety of
foods during one meal can also keep the meal interesting. Try combining textures, such as yogurt with granola, to make foods seem
more appetizing.

Make eating a social event. Many seniors who live alone or suffer from depression may stop cooking meals, lose their appetites, and
depend on convenience foods. If you are worried that your parent or grandparent isnt eating properly, make meals a family occasion.
Bring a hot meal over to her home or invite her to your house on a regular basis. She may become more interested in food when other
people are around.

Encourage healthy snacking. Many seniors dont like to eat large meals or don't feel hungry enough to eat three full meals a day. One
solution is to encourage or plan for several mini-meals throughout the day. If this is the case, make sure each mini-meal is nutritionally-
dense with plenty of fruits, vegetables and whole grains. Whole grains and fortified cereals are a good source of folate, zinc, calcium,
Vitamin E and Vitamin B12, which are often lacking in a seniors diet. Cut back on prepared meats, which are high in sodium and
saturated fat.

Take care of dental problems. Maintaining proper oral health can enhance nutrition and appetite. Make sure dentures fit properly and
problems like cavities and jaw pain are being properly managed. Insurance plans, including Medicare, cover certain dental procedures.

door transportation, and - to - delivered meals, adult daycare, nutrition education, door - Home Consider government assistance.
people over the age of 60 who need help. financial assistance programs are available to

If lack of transportation is an issue, take your loved on to the grocery yourself. You can also hire a helper or Take them to the store.
groceries for him, either from local grocers that make home neighbor to do this if you aren't available. Another option is to order his
om the deliveries (for an additional fee) or from an online grocery website. Many seniors might not be savvy enough to order food fr
t groceries will be delivered right to their doorsteps. internet, but you could schedule a regular order for them so tha

If poor memory is interfering with good nutrition, schedule meals at the same time each day and give visual and Give reminders.
verbal reminders about when it's time to eat.

hand in case of an emergency. Elderly people who live alone should keep some canned - eep extra food on K Maintain food storage.
perishable foods in the cupboard in case weather or health problems make it difficult to go shopping. - and non

ing to take vitamin supplements to make up for nutritional shortfalls, be careful about While its tempt Use supplements carefully.
, for toxicity. The elderly do not process Vitamin A as quickly as younger people do, making them susceptible to Vitamin A toxicity
teract with medications, so make sure you or your loved ones discuss the idea of supplements example. Certain vitamins can also in
with their health care provider.
Report by Fu, Yan & Opolinto, John Michael R.
A. Collaboration
1. Refer to dietitian if patient is at risk for or has under-nutrition.
2. Consult with pharmacist to review patient's medications for possible drugnutrient interactions.
3. Consult with a multidisciplinary team specializing in nutrition.
4. Consult with social worker, occupational therapist, and speech therapist as appropriate.

B. Alleviate Dry Mouth
1. Avoid caffeine; alcohol; tobacco; and dry, bulky, spicy, salty, or highly acidic foods.
2. If patient does not have dementia or swallowing difficulties, offer sugarless hard candy or chewing gum to stimulate
saliva.
3. Keep lips moist with petroleum jelly.
4. Encourage frequent sips of water.

C. Maintain adequate nutritional intake: Daily requirements for healthy older adults include 30 kcal per kg of body
weight and 0.8 to 1g/kg of protein per day, with no more than 30% of calories from fat. Caloric, carbohydrate, protein,
and fat requirements may differ depending on degree of malnutrition and physiological stress.

D. Improve oral intake
1. Assess each patient's ability to eat within 24 hours of admission.
2. Mealtime rounds to determine how much food is consumed and whether assistance is needed.
3. Limit staff breaks to before or after patient mealtimes to ensure adequate staff are available to help with meals.
4. Encourage family members to visit at mealtimes.
5. Ask family to bring favorite foods from home when appropriate.
6. Ask about and honor patient food preferences.
7. Suggest small frequent meals with adequate nutrients to help patients regain or maintain weight.
8. Provide nutritious snacks.
9. Help patient with mouth care and placement of dentures before food is served.

E. Provide conducive environment for meals
1. Remove bedpans, urinals, and emesis basin from room before mealtime.
2. Administer analgesics and antiemetics on a schedule that will diminish the likelihood of pain or nausea during
mealtimes.
3. Serve meals to patients in a chair if they can get out of bed and remain seated.
4. Create a more relaxed atmosphere by sitting at the patients eye level and making eye contact during feeding.
5. Order a late food tray or keep food warm if patients are not in their room during mealtime.
6. Do not interrupt patients for round and nonurgent procedures during mealtimes.





Report by Fu, Yan & Opolinto, John Michael R.

F. Specialized nutritional support. (Ref 20)
1. Start specialized nutritional support when a patient cannot, should not, or will not eat adequately and if the benefits
of nutrition outweigh the associated risks.
2. Prior to initiation of specialized nutritional support, review the patient's advanced directives regarding the use of
artificial nutrition and hydration.

G. Provide oral supplements
1. Supplements should not replace meals but rather be provided between meals but not within the hour preceding a
meal and at bedtime. (Ref 19, 21)2. Ensure that oral supplement is at appropriate temperature. (Ref 19)
3. Ensure that oral supplement packaging is able to be opened by the patients. (Ref 19)
4. Monitor the intake of the prescribed supplement. (Ref 19)
5. Promote a sip style of supplement consumption. (Ref 19)
6. Include supplements as part of the medication protocol. (Ref 19)

H. N.P.O. orders
1. Schedule older adults for test or procedures early in the day to decrease the length of time they are not allowed to
eat and drink.
2. If testing late in the day is inevitable, ask physician whether the patient can have an early breakfast.