Patient asking for more food and being denied

[Trixyp]

Im a student, and i was assisting another patient with feeding(Pt B). The patient sitting on the other side of me (Pt A) was scraping his plate with his fingers and trying to get the last bit of food. He was watching me feed pt B, and commenting on how good the food was, and how good that food im feeding to pt B looks. My fellow classmate asked him if he enjoyed his food and if he was full. He said the food was great, but no he's definitely not full! He showed her the plate with his shakey hands and asked he he could maybe have a little more. This is a nursing home, so this man is almost 90. It was so sad seeing him still hungry, so she set off to see if he could have more food. After determining that he was on a regular pureed diet with no calorie restrictions, she asked the CNA if it was ok to get him another serving. She told her no, because they were low on pureed food. So she asked another CNA, and she said no as well. So then she asked the charge nurse, and he said "no, he always asks though so dont worry about it". Then she came in and tried to tell the man his nurse said no more food. Then the CNA comes in with another plate, grabs his other plate and drops the new one in front of him, tosses his spoon on the table and says "Your always asking for more food!" and a rude and annoyed tone, then leaves. He is pretty old, and didnt realize what she had just done, so he just said "oh wow thankyou so much! This looks delicious im so hungry! yum!" as she was walking out the door. He then ate everything off that plate too. The portion they expected to satisfy this tall 6'5 170 pound mobile man was the same amount of food given to the 5'0, 70 pound wheelchair bound woman sitting next to him. Please tell me this is not the way things are supposed to be run in a facility. Is this justified in any way? In any circumstance? It was so sad that I wanted to cry. This man is the sweetest politest man and after she did that my classmates and i sat there with a shocked look on our faces for a good couple minutes.

[NurseHopefulInOH]

If he has no calorie or diet restriction (except puree as you have stated) I see no reason why they would not allow him to have more food. To play "devils advocate" however, there might be more that you do not know about as to why they would not let him eat as much as he wants and the nurse didnt have time to explain?? First thing I would do is talk to your instructor and let them handle it. You/Your instructor could get in touch with the dietician for the facility and see if his diet can be re-evaluated. I would also let the social worker know this is going on. Facilities are big on making sure everyone maintains a healthy weight and receives enough cals for their body. Resident losing weight can be a huge ding for state evals. I have a few residents who receive a "double portion" at meals and are not overweight at all! They put on their meal ticket to send a double portion at all meals. As a floor nurse its really easy to not see the big picture because we are sooo busy and wrapped up in completing all the tasks and can barely have time just to get everyones medications to them on time. Its easy to just brush things off because "they always do that" or "it's always been that way". Sometimes it takes a student or new grad to point out the obvious that we have grown callous to. Not saying this def whats going on here but its something I've noticed in my work environment and have been guilty of.

[AZMOMO2]

If this is your patient or if you can take him as your patient you may be able to do some work here, to advocate for this man.

ADPIE right?

Start with the chart!

Look at the History:

- Look at the weights from admission until present or at the very least the last 6 months. See any weight loss trends?

o If not you know that the amount of food given to this person is actually better than you think based on one interaction at a meal time.

o Maybe that lady in the w/c next to him is getting a higher calorie diet because SHE has weight loss issues. Purred diets can be misleading on quantity sometimes.

o Maybe he wouldn't eat his other meals that day?

- Does a medication side effect cause increased hunger?

- Does is medical DX cause increased hunger?

- Does he have an order for nourishments throughout the day?

o Is he getting any?

o Are they offered?

o Are they still sitting in his room, at the desk, or in the nourishment kitchen undelivered?

- Sometimes hydration needs can also be the cause of that hunger too.

o Are they on a fluid restriction?

o Look at the fluids that this person has on their tray. What do they have on the tray for liquids? Are they offered milk, water and juice or coffee with every meal?

o Do they drink them?

o Are they offered additional fluids throughout the day?

See how you have to look at the whole picture? Just like the above nurse said, just because they told you "he always does that" does not mean that they haven’t addressed the issues. They just may not have time to tell you WHY and the CNA may not understand the clinical etiology of the disease process this gentleman may have.

However, if you do see a weight loss trend, or note nourishments are not being given, or he is thirsty, then BINGO. You have your AEB right?

Think like a Nurse what is the NANDA for this patient? What signs do you see r/t to this DX? What interventions can you do? What measurable outcomes do you want to have?

Note: Should the CNA have acted with such attitude? Nope and they sure as heck would have heard it from me!

[TopazLover, BSN, RN]

I like both answers. As a student you see things from a perspective that is fresh and new. You and your classmate are to be commended for follow up.

There are many possibilities for the person's request for food. In addition to what has been suggested before you might think about the fact that you and your classmate were seen as giving time and interaction with another by this person. Who would not want to be included in these interactions? Getting more food may have been the primary focus. It may have also been a secondary bonus to getting more attention.

Another possibility is dementia. If that sentence is one that "sticks" to the person . he may be able to say that and little else. Sometimes with dementia we see the same sentence used for everything. It could be need for fluids, food, or even toileting.

Dealing with people with communications deficits can be challenging. It is similar to working with children or animals. No disrespect intended. Just the opposite. It requires great assessment skills and a detective's brain some times to figure out what is really going on.

Use your voice with your instructor. Ask for feedback from that instructor as to how to approach staff in a way that they can feel good about helping you, and the resident, rather than showing anger that something was being checked. There are really good communications tools that help when you are interacting with staff such as you describe.

Best wishes. Please don't lose your caring nature.