Review slides as needed.

1. Nutrition and Hydration
Chapter 15

2. • Good nutrition
– Very important for:
• Healing wounds
• Stress
• Metabolism
– 6 nutrients are needed in diet
• Protein
• Carbohydrates
• Fats
• Vitamins
• Minerals
• water

3. Types of foods we should eat
• Vegetables
• Whole grains
• Fruits
• Milk
• Meat
• Beans
• Oils – fish oils

4. Activity and Nutrition
• Work together for better health.
• Older residents have different nutritional
needs
– Slower metabolism
– Don’t need as much food
– Constipation big problem

5. Many things contribute to nutritional
deficits in elderly
• Poor fitting dentures
• Depression
• COPD or other chronic illness
• Changes in digestive patterns
• Stroke---swallowing issues
• Decreased sense of taste “nothing tastes good”
• Problem:
unintended weight loss

6. Different feeding methods
• NG tube – through the nose
• PEG tube – through the stomach
• TPN – through an IV
• Your job…
– Report any problems with tubing
– Redness around dressing site
– Any alarms

7. Factors influencing Food
• Cultural preferences
• Education
• Religion
• Upbringing
• Personal beliefs about food

8. Choice
• Residents have right to make choices about
their food
• Menus
• Dietary department
– Must practice strict infection control
– Make sure meals are nutritionally sound
– Makes dietary card for each resident, indicating
name and type of diet

9. Special Diets
• Modified
– Low salt or sodium
– Low protein
– Low carbohydrate
– Pureed, thickened liquids (nectar, honey, pudding)
– Mechanical soft – chopped, easy to chew
– Bland
– Soft – cooked cereals,
– Clear, full liquid

10. Promoting appetites
• Make environment comfortable, as much as is
possible
• Take resident to BR before meal
• Give oral care, if desired
• Make sure dentures, glasses, hearing aids are in
or on
• Make sure resident is upright – 90 degree angle
• Give adaptive equipment (see pic on pg 262)

11. Assisting with feeding
• Name card
• Clothing protector
• Offer different foods to resident
• Offer drink throughout meal
• Give enough time to finish eating
• Wait until resident has swallowed, before
offering another bite.

12. Special needs
• Dysphagia – difficulty swallowing
• Watch for
– Coughing
– Choking
– Spitting out food
– Difficulty with chewing food

13. Prevention of aspiration
• What is aspiration?
Inhaling food into trachea or windpipe
People with dysphagia are at greatest risk
* Make sure resident is sitting straight up
* Offer small bites
* Do not rush eating time
* Place food in unaffected side of mouth
*Make sure they have swallowed before another bite
*Upright for 30 minutes after eating

14. Water
• ½ - 2/3 of our body weight is water
• Most essential nutrient
• Helps with digestion
• Helps with elimination
– Kidneys
– bowels

15. Intake and Output (I & O)
• Measuring what people are eating and
drinking - Intake
• Measuring urine, emesis, feces, wound
drainage - Output
• 1 ml = 1 cc – this is a “unit of measurement”
• Fluid-restricted diet – Fluids are strictly given,
meaning only a certain amount in a 24 hour
period…1000 ml, 2000 ml, etc

16. I & O (continued)
• Restricting fluids due to patient status
– Lab values abnormal, sodium too low
– Heart problems
– Kidney problems
• Usually a temporary measure until problem
resolves
• If resident tells you about thirst or requests
water, tell nurse. Do not give…

17. Output
• Measuring and recording urinary output…
– Certain procedure for measuring output of urine.
– This is one of your skills
• When performing this skill, don’t forget to
record.
• Emptying a drainage bag.
• See steps in Blue book, pg 32

18. Dehydration
• Serious medical condition
• Fluid balance
– Intake should equal output
– If not, then fluid overload or fluid deficit can occur
– This causes either edema or dehydation
• Monitoring intake and output involves..
– Measuring and recording actual fluid consumed and % of
meals eaten
– Measuring and recording excretion of
• Urine
• Emesis
• Feces (sometimes diarrhea)

19. Some common terms…
• Force fluids
– Means to encourage resident to drink
• Restrict fluids
– Means to limit daily amount according to MD
order
• NPO – nothing by mouth
• Fluid overload – too much fluid
• Edema – excess fluid in tissues