Geriatric nurses, can you help?

Long Term Care Columnist / Guide · Oct 30, 2005

I've never heard of that particular, but I've had to improvise many times while working with a patient's food preferences. In the LTC where I once worked, we mixed Promod powder with milkshakes, puddings, and yes, even soft ice cream. We also used Boost or Ensure as the base for milkshakes (lots of people don't care for these supplements when used alone, but when you whip up a shake with strawberry Boost, real ice cream and frozen strawberries, it becomes a treat!:)). Plus, I made sure that my nutritionally at-risk residents received a multivitamin and Vitamin C every day, and if they'd eat meats and vegetables at all, they got extra gravy and lean protein.

Of course, all of this only works when you can get the food INTO the resident........I've found that FTT and depression often go hand in hand, and a nightly dose of Remeron can not only help the depression but increase appetite. Some years back, there was a resident on my skilled wing who was 6'2" and weighed 115# when he came to us from the hospital; he was A&O, but he was depressed and fatigued from many months of illness, and he was ready to give up. We tried almost everything to get some nutrients in him except a PEG tube, and he wasn't willing to go that far; luckily, I'd done some reading in a nursing journal about Remeron, which was still fairly new at that time, and after getting an OK from the resident I asked his doctor to try him on a 15 mg. dose at HS. (It seems the smaller doses are more effective in stimulating appetite and less sedating.)

Within weeks, his outlook was brighter, and his weight was up by eight pounds. Within months, he'd gained 30# and even begun to ambulate again; eventually he left us for an assisted living facility where he still resides today, happy and active. I run into him in town every now and again, and he still remembers me from those long, dark days when everyone, including himself, thought that he would never leave the NH except feet first. And although much of it was his doctor's and his own doing, he even credits me with saving his life.

There are other meds that can also serve as appetite stimulants, such as Marinol and Megace, but you have to proceed very carefully with any of them.

Good luck to both you and your resident, and I hope you can find that ice cream soon!

UM Review RN, ASN, RN · Oct 30, 2005

Thanks, Marla. I'll see to it that we get a psych consult and possibly some kind of antidepressant therapy. Never really considered it, but you're right, depression is a cause of the problem.

I found that the Magic Cups are made by Hormel, but I haven't found their website to order it. I guess it'll take some more Googling.

Any other suggestions are certainly more than welcome. I'm always game to learn to help my patients get better.

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 30, 2005

We used prostat (usual dose was 30 ml's) http://www.cwimedical.com/prostat150.html Really good for those with skin breakdown or potential for it. Also we used resource for out non-diabetics http://www.cwimedical.com/resourcest.html and med-pass for our diabetics. Usual dose on those would be anywhere from 30-120mL, mostly ordered BID. http://www.cvs.com/CVSApp/cvs/gateway/detail?prodid=258201. Megace was also used a lot, with fairly good results.

javanurse2000, BSN, RN · Oct 31, 2005

How about "If you eat half your meal, I'll score you an extra ice cream"

I've shaken prostat powder (have to have an order) in a carton of chocolate milk and then serve it over shaved ice...I feel like a bartender a lot of times but the residents consume more of it that way than any other way I've tried.

Also with the FTT Dx. would the doctor consider marinol?

msnursekim · Oct 31, 2005

You might try buttermilk or sweet milk with cornbread and add promod to this mixture. I know alot of people don't like buttermilk, but our little southern residents love this as an alternate with milkshakes. they get tired of the sweet taste quickly. This really works to put the weight on! Good Luck!

UM Review RN, ASN, RN · Oct 31, 2005

Great suggestions, everyone!

I remember one LOL who would only eat alternating bites of her meal in between strawberry ice cream.

So a lot of it is figuring out which taste bud is still semi-functional on these folks.

Again, all suggestions are welcome. Share all that have worked for you.

JentheRN05, RN · Oct 31, 2005

I'm needing some nutritional resources for a patient who has a FTT (failure to thrive) dx. Doesn't want a Peg, but will eat certain foods with a very good appetite.
One is ice cream. I recall that there used to be some ice cream supplement called Magic Cup that I would like to get for him, but I can't find the website.
Can anyone help?

http://www.bussvc.wisc.edu/purch/contract/wp5202.html

magic cup

UM Review RN, ASN, RN · Oct 31, 2005

http://www.bussvc.wisc.edu/purch/contract/wp5202.html
magic cup

I'm a little confused. :confused: The website seems to be a UofW purchasing contract from a local vendor.

Not sure how I'm supposed to use the information. Could you explain, please?

Bird2 · Oct 31, 2005

How is the residents renal function? I would consult with a Dietician to make sure they can handle the extra protein. BTW - great suggestion on the Pscyh eval and Remeron. We have had good luck with Remeron with some residents and Megace with others.

txspadequeenRN, BSN, RN · Oct 31, 2005

You may have already thought of this but most of the time your dietary dept can order this type of stuff for you. Especially if you have a Doc's order for it!

I'm needing some nutritional resources for a patient who has a FTT (failure to thrive) dx. Doesn't want a Peg, but will eat certain foods with a very good appetite.
One is ice cream. I recall that there used to be some ice cream supplement called Magic Cup that I would like to get for him, but I can't find the website.
Can anyone help?

HONEYBEAR · Oct 31, 2005

Try this web site

www.med-diet.com hope this helps. :)