8 Nutrition and Hydration

Define the following terms:

Nutrition how the body uses food to maintain health. Nutrient something found in food that provides energy, promotes growth and health, and helps regulate metabolism.

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1. Identify the six basic nutrients and explain MyPyramid REMEMBER: Bodies rely on proper nutrition to function well. A well-balanced diet will help residents maintain muscles and skin tissues and prevent pressure sores.

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Transparency 8-1: Six Basic Nutrients 1. Protein 2. Carbohydrates 3. Fats 4. Vitamins 5. Minerals 6. Water

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1. Identify the six basic nutrients and explain MyPyramid Remember this information about the six basic nutrients: Protein Essential for tissue growth and repair Provides a supply of energy Includes fish, seafood, poultry, meat, eggs, milk, cheese, nuts, peas, dried beans/legumes

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1. Identify the six basic nutrients and explain MyPyramid Six basic nutrients (contd.): Carbohydrates Provide fuel for energy Provide fiber Complex carbohydrates include bread, cereal, potatoes, rice, pasta, vegetables, and fruits Simple carbohydrates include sugars, sweets, syrups, and jellies

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1. Identify the six basic nutrients and explain MyPyramid Six basic nutrients (contd.): Fats Help the body store energy Provide insulation Protect the organs Fats include butter, margarine, salad dressings, oils, and fats in meat

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1. Identify the six basic nutrients and explain MyPyramid Six basic nutrients (contd.): Vitamins Vitamins are essential to body functions. Fat-soluble vitamins are A, D, E, and K. Water-soluble vitamins are B and C.

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1. Identify the six basic nutrients and explain MyPyramid Six basic nutrients (contd.): Minerals Maintain body functions Minerals include zinc, iron, sodium, potassium, calcium, magnesium, and phosphorus.

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1. Identify the six basic nutrients and explain MyPyramid Six basic nutrients (contd.): Water We need about eight glasses, or 64 ounces, per day. Water is the most essential nutrient for life. Water aids in digestion, absorption of food, elimination of wastes, and maintaining normal body temperature.

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Transparency 8-2: MyPyramid

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1. Identify the six basic nutrients and explain MyPyramid Here are some examples of the six food groups: Grains Found in cereal, bread, rice, and pasta Two subgroups of grains: whole grains and refined grains At least half of all grains consumed should be whole grains such as whole wheat breads, bran cereals, brown rice, and whole wheat pastas.

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1. Identify the six basic nutrients and explain MyPyramid Examples of the six food groups (contd.): Vegetables Provide fiber and vitamins Subgroups are dark green vegetables, orange vegetables dry beans and peas, starchy vegetables and other vegetables. Examples include spinach, carrots, peas, corn and potatoes.

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1. Identify the six basic nutrients and explain MyPyramid Examples of the six food groups (contd.): Fruits Provide complex carbohydrates, vitamins and fiber Examples include oranges, grapefruit, strawberries, mango, papayas, and cantaloupe.

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1. Identify the six basic nutrients and explain MyPyramid Examples of the six food groups (contd.): Milk Provides nutrients necessary for bones and teeth Provides protein, vitamins, and minerals Examples include cheese, yogurt, milk, buttermilk, cottage cheese, and evaporated milk.

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1. Identify the six basic nutrients and explain MyPyramid Examples of the six food groups (contd.): Meat and beans Provide protein, vitamins, and minerals Examples include fish, chicken, turkey, lean meats, and dry beans.

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1. Identify the six basic nutrients and explain MyPyramid Examples of the six food groups (contd.): Oils Fats and oils are needed in small amounts. Foods like nuts, olives, some fish, and avocados are naturally high in oils. Most of the fats consumed should be polyunsaturated (PUFA) or monounsaturated (MUFA) fats.

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1. Identify the six basic nutrients and explain MyPyramid Remember these points about elderly residents and MyPyramid: Elderly residents may need a modified MyPyramid that emphasizes nutrient-dense foods, fiber, and water. Calories may be reduced, but need for vitamins and minerals does not decrease. Dietary supplements may be appropriate.

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2. Describe factors that influence food preferences Remember these points about food preferences: Know and follow residents food preferences. Ask questions. Pay attention when residents express preferences, verbally or non-verbally.

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2. Describe factors that influence food preferences REMEMBER: Residents have a legal right to make choices about their food and to refuse food, and NAs must honor residents beliefs and preferences.

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Define the following terms:

Therapeutic diet a diet for people who have certain illnesses; also called special or modified diet. Diet cards cards that list the residents name and information about special diets, allergies, likes and dislikes, and other instructions. Puree to chop, blend, or grind food into a thick paste of baby food consistency.

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3. Explain special diets The following are common special diets: Low-Sodium Diet Fluid-Restricted Diet Low-Protein Diet Low-Fat/Low-Cholesterol Diet Modified Calorie Diet for Weight Management Dietary Management of Diabetes Liquid Diet Soft Diet Pureed Diet

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Define the following terms:

Force fluids a medical order for a person to drink more fluids. Restrict fluids a medical order for a person to limit fluids. Dehydration a condition that results from inadequate fluid in the body.

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Describe how to assist residents in maintaining fluid balance Fluid intake is important for several reasons: Helps prevent constipation and incontinence Dilutes wastes and flushes out urininary system May help prevent confusion

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Describe how to assist residents in maintaining fluid balance Watch for these signs and symptoms of dehydration: Drinking less than six 8 oz glasses of liquid per day Drinking little or no fluids at meals Needing help drinking from cup Having trouble swallowing liquids Having frequent vomiting, diarrhea, or fever

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Describe how to assist residents in maintaining fluid balance Signs and symptoms of dehydration (contd.): Being easily confused or tired Resident has any of the following: Dry mouth Cracked lips Sunken eyes Dark urine Strong-smelling urine Weight loss Complaints of abdominal pain

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Describe how to assist residents in maintaining fluid balance Remember these guidelines for preventing dehydration: Report warning signs immediately. Encourage residents to drink every time you see them. Offer fresh water and fluids often. Record fluid I&O. Offer other forms of liquids if permitted (e.g. ice chips, frozen flavored ice sticks, gelatin). Offer sips of liquids between bites of food. Make sure pitcher and cup are close by and are light enough for resident to lift. Offer assistance.

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Define the following terms:

Fluid overload a condition that occurs when the body is unable to handle the amount of fluid consumed. Edema swelling caused by excess fluid in body tissues.

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Describe how to assist residents in maintaining fluid balance Watch for these signs and symptoms of fluid overload: Swelling of extremities Weight gain Decreased urine Shortness of breath Increased heart rate Tight, smooth, or shiny skin

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5. List ways to identify and prevent unintended weight loss Watch for these signs and symptoms of unintended weight loss: Needing help eating or drinking Eating less than 70% of meals/snacks Having mouth pain Having dentures that do not fit properly Having difficulty chewing or swallowing Coughing or choking while eating Being sad or withdrawing from others Being confused, wandering, or pacing

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5. List ways to identify and prevent unintended weight loss Remember these guidelines for preventing unintended weight loss: Report observations warning signs to the nurse immediately. Encourage residents to eat; talk positively about food. Honor food likes and dislikes. Offer different kinds of foods and beverages. Help residents who have trouble feeding themselves. Food should look, taste, and smell good. Resident may have poor sense of taste and smell.

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6. Identify ways to promote appetites at mealtime REMEMBER: Residents often view mealtime as the highlight of their days. Meals are not only a time for getting nourishment but a time for socialization as well. NAs play an important role in assisting residents to get proper nutrition.

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6. Identify ways to promote appetites at mealtime Remember these guidelines for promoting appetites: Check the environment. Address odors. Make sure room is a comfortable temperature. Turn off TVs. Do not shout or bang plates or cups. Assist with grooming/hygiene tasks before dining, as needed. Assist with handwashing. Give oral care before eating. Offer a trip to the bathroom before eating. Encourage use of dentures, glasses, and hearing aids.

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7. Demonstrate how to assist with eating Remember these points about assisting residents with eating: Residents will need different levels of help. Some residents will only need help with setting up but can feed themselves. Some residents will need to be fed. Be sensitive and give privacy. Encourage residents to do what they can.

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7. Demonstrate how to assist with eating Review the guidelines for assisting a resident with eating: Do not treat the resident like a child. Be supportive and encouraging. Sit at residents eye level. Allow time for prayer if resident wishes. Verify that it is the right resident. Do not touch food to test its temperature. Use a hand over the dish instead. Cut foods and pour liquids as needed. Identify foods and fluids that are in front of resident. Call pureed food by the correct name.

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7. Demonstrate how to assist with eating REMEMBER: Do not insist on using a clothing protector if a resident does not wish to use one. Use the term clothing protector rather than bib.

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7. Demonstrate how to assist with eating REMEMBER: It is important to know how much food a resident is eating. Tracking methods vary from facility to facility. Know your facilitys method.

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8. Identify signs and symptoms of swallowing problems Watch for these signs and symptoms of dysphagia: Coughing during or after meals Choking during meals Dribbling saliva, food, or fluid from the mouth Food residue inside the mouth or cheeks during and after meals Gurgling sound in voice during or after meals or loss of voice Slow eating

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8. Identify signs and symptoms of swallowing problems Remember these points about thickened liquids: Thickening improves the ability to control fluid in the mouth and throat. A doctor orders the necessary thickness after evaluation by a speech therapist. Some beverages arrive already thickened. NAs cannot offer residents who must have thickened liquids regular liquids, including water.

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8. Identify signs and symptoms of swallowing problems There are three different thickening consistencies for liquids: Nectar thick Honey thick Pudding thick

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Transparency 8-3: Preventing Aspiration Position in a straight, upright position. Offer small pieces of food or small spoons of pureed food. Feed resident slowly. Place food in the non-paralyzed side of the mouth. Make sure mouth is empty before next bite of food or sip of drink. Have residents stay in upright position for 30 minutes after eating or drinking.

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Define the following terms:

Total parenteral nutrition (hyperalimentation) the intravenous infusion of nutrients administered directly into the bloodstream, bypassing the digestive tract. Nasogastric tube a feeding tube that is inserted into the nose and goes into the stomach. Percutaneous endoscopic gastrostomy (PEG) tube a tube placed through the skin directly into the stomach to assist with eating. Gastrostomy surgical opening into the stomach.

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8. Identify signs and symptoms of swallowing problems Observe and report the following regarding tube feedings: Redness/drainage around opening Skin sores or bruises Cyanotic skin Resident complaints of pain or nausea Choking Tube falls out Problems with equipment Feeding pump alarm sounds

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9. Describe how to assist residents with special needs Remember these guidelines for assisting residents with special needs: Use physical cues like placing your hand over his. Use short, clear verbal cues (e.g. Pick up your spoon and Put some carrots on your spoon). Wait until one task is finished before giving the next cue. Use assistive devices as ordered. For visually impaired residents, use imaginary clock face to explain position of food on plate. For residents who have had CVA, place food in unaffected or stronger side of mouth. Make sure food is swallowed.