Pendekatan dan management makanan pada orang tua
Kata siapa sulit makan hanya pada anak kecil,ternyata kesulitan akan asupan makanan dapat juga terjadi pada oang tua,terutama orang tua yang telah lanjut atau memiliki suatu penyakit,untuk management nya dapat kita lakukan :
Assessment with Elder and Care Givers
Rituals used before meals (e.g., hand washing and toilet use), dressing for dinner.
Blessings of food or grace, if appropriate.
Religious rites or prohibitions observed in preparation of food or before meal begins, e.g., Moslem, Jewish, Seventh Day Adventist. Consult with Pastoral counselor, if available.
Cultural or special cues of family history, especially rituals surrounding meals.
Preferences as to end-of-life decisions regarding withdrawal or administration of food and fluid in the face of incapacity, or request of designated health-proxy. Ethicist or social worker may facilitate process.
Penyebab dari kesulitan makanan :
Weight and height - on admission to determine Body Mass Index (weight in kg/height in m2); thereafter weight taken at least every 7 days if a diagnosis of alteration in nutritional status exists. Weight loss/gain strategy devised by Registered Dietician with input from provider, if appropriate.
Skin - lesions, turgor, dryness, hair loss.
Neurological - Cranial nerves V, VII, IX, X, XI, XII (involved in swallowing).
Sensory limitations - vision, smell, taste, hearing.
Oral cavity - cleanliness, dentition including caries at root and surface, fit of denture or other oral appliances, lesions, condition of gums and tongue. Refer to Dentist for evaluation and treatment.
Neck - capacity to swallow. Refer to Speech Language Pathologist for thorough assessment.
Respiratory - restrictive disease limiting ability to eat or tolerate larger quantities of food, oxygen desaturation during meals, exercise intolerance. Refer to Respiratory Therapist, if appropriate.
Cardiac - presence of heart failure -- Stages III or IV, or poorly controlled angina, indicating intolerance of any activity.
Gastrointestinal – Gastroesophageal reflux disease (GERD), hiatal hernia, hypo or hyperactive bowel (constipation or diarrhea), abdominal pain or tenderness, diverticular disease.
Strength and coordination- neuro and musculoskeletal exam (i.e., sitting posture, use of upper extremities including range of motion, tremors, fine motor movements). Refer to Occupational and Physical Therapist for assessment, as appropriate.
Psychological - affective disorders, especially depression.
Pain - general and localized especially in jaw, mouth, throat, gastrointestinal.
Endocrine - Fasting blood sugar, microalbuminuria and thyroid-stimulating hormone in weight loss, for undiagnosed/poorly controlled diabetes and thyroid disease.
Medications - sedation, abnormal movements, dehydration. Pharmacologist to determine polypharmacy
Lingkungan dan yang diharapkan dalam melakukan pemberian nutrisi :
Dining or patient room: personal trappings versus institutional; no treatments or other activities occurring during meals; no distractions.
Tableware: use of standard dinnerware, e.g., china, glasses, cup and saucer, flatware, tablecloth, napkin versus disposable tableware and "bibs".
Furniture: elders seated in armed chair, table appropriate height versus eating in wheelchair or in bed.
Noise level: environmental noise from music, care givers, television is minimal; personal conversation between patient and care giver is encouraged.
Light: adequate and nonglare-producing versus dark, shadowy, or glaring.
Odor: familiar smells of food prepared versus all food prepared away from elder or medicinal smells and waste.
Adaptive equipment: available, appropriate, and clean; caregivers and/or elder is knowledgeable in use. Occupational therapist assists in evaluation.
Social atmosphere: meal sharing versus accomplishment of task.
Position of caregiver relative to elder: eye contact, seating so faces are in same plane (en face).
Pacing and choice: caregiver allows elder to choose food and determine tempo of meal; relies on elder's preference whenever known, voiced, or expressed through gestures and/or sounds.
Cueing: caregiver cues elder whenever possible with words or gestures.
Self-feeding: encouragement to self-feed with multiple methods versus assisted-feeding to minimize time.
Kata-kata yang terkait dengan gangguan intake nutrisi :
Aphasia: cannot verbally express preferences.
Apraxia: cannot manipulate utensils and food prior to eating, cannot manipulate food within mouth/swallow.
Agnosia: cannot recognize utensils, food.
Amnesia: forgets having eaten, does not recognize need to eat .
Anorexia: lack of desire to eat, possible physiological basis (i.e., failure to thrive).
Assessment with Elder and Care Givers
Rituals used before meals (e.g., hand washing and toilet use), dressing for dinner.
Blessings of food or grace, if appropriate.
Religious rites or prohibitions observed in preparation of food or before meal begins, e.g., Moslem, Jewish, Seventh Day Adventist. Consult with Pastoral counselor, if available.
Cultural or special cues of family history, especially rituals surrounding meals.
Preferences as to end-of-life decisions regarding withdrawal or administration of food and fluid in the face of incapacity, or request of designated health-proxy. Ethicist or social worker may facilitate process.
Penyebab dari kesulitan makanan :
Weight and height - on admission to determine Body Mass Index (weight in kg/height in m2); thereafter weight taken at least every 7 days if a diagnosis of alteration in nutritional status exists. Weight loss/gain strategy devised by Registered Dietician with input from provider, if appropriate.
Skin - lesions, turgor, dryness, hair loss.
Neurological - Cranial nerves V, VII, IX, X, XI, XII (involved in swallowing).
Sensory limitations - vision, smell, taste, hearing.
Oral cavity - cleanliness, dentition including caries at root and surface, fit of denture or other oral appliances, lesions, condition of gums and tongue. Refer to Dentist for evaluation and treatment.
Neck - capacity to swallow. Refer to Speech Language Pathologist for thorough assessment.
Respiratory - restrictive disease limiting ability to eat or tolerate larger quantities of food, oxygen desaturation during meals, exercise intolerance. Refer to Respiratory Therapist, if appropriate.
Cardiac - presence of heart failure -- Stages III or IV, or poorly controlled angina, indicating intolerance of any activity.
Gastrointestinal – Gastroesophageal reflux disease (GERD), hiatal hernia, hypo or hyperactive bowel (constipation or diarrhea), abdominal pain or tenderness, diverticular disease.
Strength and coordination- neuro and musculoskeletal exam (i.e., sitting posture, use of upper extremities including range of motion, tremors, fine motor movements). Refer to Occupational and Physical Therapist for assessment, as appropriate.
Psychological - affective disorders, especially depression.
Pain - general and localized especially in jaw, mouth, throat, gastrointestinal.
Endocrine - Fasting blood sugar, microalbuminuria and thyroid-stimulating hormone in weight loss, for undiagnosed/poorly controlled diabetes and thyroid disease.
Medications - sedation, abnormal movements, dehydration. Pharmacologist to determine polypharmacy
Lingkungan dan yang diharapkan dalam melakukan pemberian nutrisi :
Dining or patient room: personal trappings versus institutional; no treatments or other activities occurring during meals; no distractions.
Tableware: use of standard dinnerware, e.g., china, glasses, cup and saucer, flatware, tablecloth, napkin versus disposable tableware and "bibs".
Furniture: elders seated in armed chair, table appropriate height versus eating in wheelchair or in bed.
Noise level: environmental noise from music, care givers, television is minimal; personal conversation between patient and care giver is encouraged.
Light: adequate and nonglare-producing versus dark, shadowy, or glaring.
Odor: familiar smells of food prepared versus all food prepared away from elder or medicinal smells and waste.
Adaptive equipment: available, appropriate, and clean; caregivers and/or elder is knowledgeable in use. Occupational therapist assists in evaluation.
Social atmosphere: meal sharing versus accomplishment of task.
Position of caregiver relative to elder: eye contact, seating so faces are in same plane (en face).
Pacing and choice: caregiver allows elder to choose food and determine tempo of meal; relies on elder's preference whenever known, voiced, or expressed through gestures and/or sounds.
Cueing: caregiver cues elder whenever possible with words or gestures.
Self-feeding: encouragement to self-feed with multiple methods versus assisted-feeding to minimize time.
Kata-kata yang terkait dengan gangguan intake nutrisi :
Aphasia: cannot verbally express preferences.
Apraxia: cannot manipulate utensils and food prior to eating, cannot manipulate food within mouth/swallow.
Agnosia: cannot recognize utensils, food.
Amnesia: forgets having eaten, does not recognize need to eat .
Anorexia: lack of desire to eat, possible physiological basis (i.e., failure to thrive).
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