Nursing Perspective on Feeding Evaluation and...
Transcript of Nursing Perspective on Feeding Evaluation and...
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Nursing Perspective on
Feeding Evaluation and
Treatment
Cyndi Chapman, APRN,MSN,MHCL
August 2017
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Nursing Perspective on Feeding Evaluation and
Treatment
• OBJECTIVES:
• Participant will understand the nursing assessment regarding feeding issues
• Participant will be able to verbalize the nurse’s role in the interdisciplinary
team for feeding plans
• Participant will learn different tools from a nursing perspective for feeding
evaluation.
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Nursing Perspective on Feeding Evaluation and
Treatment
• Different stages of newborn/pediatrics
• Prematurity
• Newborn
• Specific diagnosis
• Developmental disabilities
• Infant
• Toddlers
• Adolescents
• Pre teen
• Teenager
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Nursing Perspective on Feeding Evaluation and
Treatment
• Prematurity
• Assessment
• Gestational age
• Specific diagnosis
• Breast feeding strengthening
• Feeding readiness
• Feeding cues
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Nursing Perspective on Feeding Evaluation and
Treatment
• Feeding Cues
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Nursing Perspective on Feeding Evaluation and
Treatment
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Nursing Perspective on Feeding Evaluation and
Treatment
• Categories
• Structural Abnormalities-anatomic abnormalities of the structures associated with eating and feeding. Examples: defects associate with Pierre-Robin syndrome, retrognathic jaw, cleft palate, posterior tongue placement, macroglossia, tracheotomy, esophageal strictures or stenosis.
• Neurological conditions- feeding problems associated with central nervous systems insult or musculoskeletal disorders. Example, CP, muscular dystrophies, cranial nerve dysfunctions, mental retardation/develo0pmental disabilities, brain stem injury, pervasive developmental disorders
• Behavioral Issues-feeding difficulties resulting from psychosocial difficulties (poor environmental stimulation, dysfunctional feeder-child interaction), negative feeding behaviors shaped and maintained by internal and/or external reinforcement (selective food refusal, rumination) and/or emotionally based difficulties (phobias, conditioned emotional reactions, depression).
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Nursing Perspective on Feeding Evaluation and
Treatment
• Categories, cont.
• Cardiorespiratory Problems-feeding difficulties associated with diseases and
symptoms which compromise the cardiovascular and respiratory systems,
complicating the coordination of sucking, swallowing and breathing during feeding.
Ex tachypnea associated with bronchopulmonary dysplasia
• Metabolic dysfunctions-feeding difficulties associate with metabolic diseases and
syndromes which interfere with the development and/or maintenance of normal
feeding patterns. Ex hereditary fructose intolerance, dumping syndrome.
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Nursing Perspective on Feeding Evaluation and
Treatment
• Complex pediatric feeding problems
• Normal development
• Pediatric difficulties either medical or developmental
• 25-35%of normal developing have issues
• 33-80% of development delay
• 50-70% of premature infants born before 36 weeks require significan feeding support
• Biobehavioral conditions
• Need to assess biological aspects
• Need to assess behavioral aspects
• Nonorganic vs organic origins
• Non-disruptive social and environmental emotional antecedents and consequences for feeding
• Organic-structural, neuromuscular,or other physiologic reasons
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Nursing Perspective on Feeding Evaluation and
Treatment
• Feeding observations are best done in natural environments*
• Assessments should include:
• Manifestation of problem Thorough medical/developmental history
• Data on growth and weight Emotional climate during meals
• Family Stressors Motor skills, posture and tone
• Antenatal and perinatal history Feeding routines and environments
• Oral motor skills and swallowing Sensory processing
• Feeding routines/environments Child behavior prior to and during meals
• Self-regulation/level of alertness Strategies previously used
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Nursing Perspective on Feeding Evaluation and
Treatment
• Quality and timing of oral motor skills
• •Strength
• •Coordination
• •Sensory function
• •Tone
• •Asymmetry
• •Cranial nerve function
• •Motor planning
• •Gag, cough, quality of voice, watery eyes/nose –may be indicators of aspiration
• 6/
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Nursing Perspective on Feeding Evaluation and
Treatment
• After Assessment
• Oral Motor Stimulation and Exercise
• Positioning
• Behavioral Strategies
• Medications
• Altered Diets
• Sensory Strategies
• Feeding Tubes
• Vital Stim
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Nursing Perspective on Feeding Evaluation and
Treatment
• Team discipline
• Pediatric Gastroenterology
• Nursing
• Nutrition
• Occupational Therapy
• Psychology
• Speech pathology
• Pediatricians
• Case Management
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Nursing Perspective on Feeding Evaluation and
Treatment
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Nursing Perspective on Feeding Evaluation and
Treatment
• Nursing as a part of the interdisciplinary team
• Assessing family situation
• Assessing current situation
• Assessing patient- age dependent
• Social situation
• Eating is learned, not instinctual
• •History of negative experiences
• •Gastrointestinal issues
• •Neurological problems
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Nursing Perspective on Feeding Evaluation and
Treatment
• •Congenital malformation
• •Allergies
• •Cardiac and/or respiratory problems
• •Abnormal muscle tone
• •Disordered child-caregiver relationships
• •KIDS DON’T EAT IF THEY DON’T FEEL WELL
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Nursing Perspective on Feeding Evaluation and
Treatment
• Feeding is a science
• Feeding is evidence based
• Studies are done based on everything we talk about
• Physiology plays a part
• Breast feeding
• Textures or something else
• It’s all about the baby/child
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Nursing Perspective on Feeding Evaluation and
Treatment
• Persistent problem with eating, feeding, and/or swallowing*
• •Chronic food refusal
• •Feeding tube dependence
• •Food selectivity
• •Poor oral intake
• •Swallowing disorder
• TPN
• Oral Aversion
• Hirschsprungs etc
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Nursing Perspective on Feeding Evaluation and
Treatment
• Positioning Infants
Key factors for positioning infants*(fair evidence)
•Positioning should be first intervention
•Overall ‘feeling of flexion”
•Head aligned with trunk, elevated
•Most feed optimally semi-upright, with side-tilt positioning
•May also position in front of you with head/neck supported to
facilitate eye contact
•Swaddling provides additional support
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Nursing Perspective on Feeding Evaluation and
Treatment
• Position older children
Key factors for positioning older children***(good evidence)
•Goal –Most function with the least support/restriction
•Stable pelvis in neutral position
•Supported feet!
•Neutral or slightly flexed head
•Arms forward and free to move
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Nursing Perspective on Feeding Evaluation and
Treatment
• Babbitt RL, Hoch TA, Coe DA, Cataldo MF, Kelly KJ, Stackhouse C, Perman JA. Behavioral assessment and treatment of pediatric feeding disorders. Developmental and Behavioral Pediatrics 1994;15(4):278-291.
• Troughton KE, Hill AE. Relation between objectively measured feeding competence and nutrition in children with cerebral palsy. Developmental Medicine and Child Neurology 2001;43(3):187-190.
• Sharp W G, Jaquess D L, Morton J F, Herzinger C V. Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review 2010.
• Burklow,KathleenA, Phelps, Anne N, Schultz, Janet R, McConnell, Keith, Rudolph, Colin. Classifying Complex Pediatric Feeding Disorders. Journal of Pediatric Gastroenterology& Nutrition 1998. Volume 27. Issue 2 pp143-147.
• Schwarz,Steven M, Corredor, Julissa, Fisher-Medina,Julie, Cohen, Jennifer and Rabinowitz, Simon. Diagnosis and Treatment of Feeding Disorders in Children with Developmental Disabilities. Pediatrics 2001: 108:671.
• Babbitt, Roberta L, Hoch, Theodore A., Coe, David A., Cataldo, Michael F., Kelly, Kevin J., Stackhouse, Claire, Perman, Jay A. Journal of Developmental and Behavioral Pediatrics. August 1994.
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Nursing Perspective on Feeding Evaluation and
Treatment
THANK YOU
Questions??