Ch. 15: Nutrition and Hydration

intake and output I&O

64-96 oz of fluid each day intake not healthy, dehydration. NA's must document intake/output measured in mL oz -> mL 1 oz = 30 mL oz * 30 mL oz = goes up by 30 mL cup goes up by fraction of 2 1/4 = 2 oz = 60 mL 1/2 = 4 oz = 120 mL 1 cup = 8 = 240 mL

Force fluids

FF, res. encouraged to drink as much as possible

Thickened liquids

Having thickening powder added to them, controls/improves of fluid in the mouth and throat. doctor prescribes after has been evaluated by speech lang. pathologist must be used with all liquids. cannot offer water, or other beverages bc need to be thickened.

Measure intake

KHIIEP Using graduate measure fluid res. served & note on paper When res. is done eating - measure leftover fluids & note on paper Initial - final = intake * 30 mL Document amount of fluid consumed. record time and what fluid taken obersve/report wash hands

Measure out put

KHIIEP gloves pour bedpan/urinal into graduate place graduate on flat surface, note amount and write on paper dump urine in toilet rinse bedpan/in toilet store away bedpan/equipment remove gloves wash hands, record output doc time, and amount of urine. R/D

Serving fresh water

KHIIEP gloves scoop ice into water pitcher, add fresh water take pictcher to res pour glass of water for res. leave ptcher and glass at bedside leave straw if desires/check if res. can lift it call light remove gloves wash hands

Minerals

Maintain body functions. provide energy and regulate body processes.

Nutritional probs of elderly or ill

Metabolism slows down. loss of vision weakened senses of smell and taste less saliva production affects chewing and swallowing dentures, tooth loss, and poor dental health digestion takes long and less efficient certain meds that affects constipation, affecting food intake

Water

Most essential nutrient for life. 1/2 - 2/3 of body's weight is water. 64 oz or 8 glasses of water each day. without it, can live only a few days. assists in digestion and absorption of food. waste/elimination.

Inserting feeding tubes

NA's not allowed to insert, do the feeding and clean the tubes. they obtain the supplies/equipment and hand them to the nurses. they also help to position residents into sitting position. Clean equipment. Observe/report/document

guidelines Tube feedings

NPO - nothing by mouth make sure not coiled/kinked or underneath resident if tube comes out - report fast feedings at room temp and liquid form 30 degrees in semi-sitting position keep upright for 30 minutes give careful skincare report if redness or drainage around opening.

Protein

Needed for tissue growth and repair. supply energy for body. whole grains contain some protein

Are all nutritional needs the same?

No, people have different nutritional needs depending on their age, gender, and activity levels.

PEG

Percutaneous endoscopic gastrostomy. tube insert in stomach thru abdominal wall

Restrict fluids

RF, allowed to drink but limit daily amounts to a level by doctor.

Low-sodium diet

Res. with HBP, heart disease, kidney disease, fluid retention. NO SALT. aka low NA, NAS (no added salt).

Vitamins

Substances that needed by the body to function. body cannot produce vitamins. must eat food.

Carbohydrates

Supply body with energy and extra protein, help body use fat efficiently. provide fiber. complex and simple carbs. Complex carbs are healthier than simple carbs

ChooseMyPlate

Vegetables/fruits: Dark green,red, and orange vegetables - best nutritional content Grains: foods rich in fiber reduces risk of heart disease, reduce constipation. Protein: eat plant based protein - best nut/seeds - important fatty acids - reduce risk of cardiovascular disease Almonds/sunflower - good sources of vitamin E. Dairy: fat free 1%. fat free or low fat milk or yogurt is healtheir than cheese Milk provides nutrients important for health and mainenance of the body. Calcium, potassium and vitamin D and protein Soy products - alternative to milk

Promoting appetites

assist with grooming and hygiene before dining oral care before eating offer trip to bathroom before eating encourage dentures, eyeglasses, and hearing aids check enironment- temp shud be comfy honor food likes and dislikes

Feeding

at 45 degrees - bc may have pneumonia and aspiration.

Diabetic Diet

calories and carbs planned out nicely in meal plan. protein and fats also planned. all correct/amount of foods for each day may count carbs food portions. to maintain glucose levels near normal must eat all that is served avoid foods high in sugar --> probs with insulin balance ex. soft drinks, jellies, jams, fruits canned in heavy syrup, breakfast cereals, and ketchup Meal tray -> artifical sweetner, low calorie. NCS - no concentrated sweets LCS - low concenrated sweets

Pureed Diet

chop, blend or grind into thick paste of baby food consistency. thick enough to hold its form in mouth. does not require person to chew food. trouble chewing/swallowing more textured foods.

Vegetarian diet

different types of vegetarians lacto-ovo - no meat, but allows eggs and diary lacto - diary products (no eggs and meat) ovo - allows eggs vegan - no nothing. and no nothing coming from animals. no eggs, no fish, no meats

dyspahgia

difficulty swallowing. stroke, cva, nerve/muscle damage, multiple sclerosis, parkinsons disease, alzheimers disease. signs: food or fluid coming up nose rapid breathing while eating watery of eyes dribbling saliva gurgling during or after meals or losing voice eating slowly spitting out pieces having food residue inside mouth or cheecks after /during meals

High Potassium diets (K+)

diuretics - medications reduce fluid volume or BP meds. - leads to decrease in potassium. there are other reasons bananas, grapefruits, oranges, orange juice, prune juice, prunes, dried apricots, figs, raisins, dates, tomatos....potatoes....

Dehydration

does not have enuff fluid. very important to prevent offer ice chips with water if cud swallow report less than 6-8 ozes. needs help drinking trouble swallowing frequent vomit, diarrhea, or fever easily confused or tired dry mouth cracked lips sunken eyes dark urine strong-smelling urine

Maintaining fluid balance

drink at least 64 oz of water or fluids a day. w/o fluid...urine become concentrated, more concentration -> higher risk for infection sense of thirst lessens as older.

If intake more than output

fluid build up in body tissues - fluid retention cause medical probs/discomfort

Gluten free diet

free of gluten. which is a protein found in wheat, rye, and barley. for: celiac disease - disorder that damages the intestines if gluten is consumed gluten intolerance - doesn't damage intestines but had bad side effects: abdominal pain, gas, and diarrhea restrict wheat flour, tortillas, crackers, some sauces and dressings, beer, hot dogs, candy, broths, and meds

Bland diet

gastric or duodenal ulcers - no acids intestinal disorders/ crohn's disease, bowel syndrome - avoid drinks. alochol, caffiene drinks, citrus, spicy, black pepper. 3 meals or more per day. if drink alcohol - drink with food

Fats

help body store energy. add flavor to food. absorption of certain vitamins. monosaturated and polysaturated fats are healthier kinds of fats. Saturated fats are not healthy.

Low-fat/low cholesterol diet

high cholesterol in blood --> heart attacks and heart disease. gall bladder disease - interfere with fat digestion and liver disease no dairy products. fish, white meat of turkey and chicken and vegetable fats, cottage cheese, skim milk food diet: eat lean cuts of meat, beef and pork 3X a week limit egg yolks to 3 or 4 per week. avoid organ meats - shellfish, fatty meats, cream butter, lard, meat drippings, coconut, deserts, and soups w/ whole milk avoid fried foods and sweets

how to serve meal trays

identify residents before serving meal tray. before delvering check if correct resident and food, and beaverages serve all residents sitting together at one table. set food and drink on table from tray cut food into small - bite sized portions cut it before bringing up to them open milk or juice cartons apply butter on bread and veggies open any packets, seasons food as preferred

percentage of eaten

if 70% or lower, report to nurse

Aspiration

inhaling food fluid, or foreign material into lungs cause pneumonia or death

Low Protein diet

kidney disease restricted bc breaks down into compounds that may lead to further kidney damage encourage veggies, starches, breads and pasta

Thickened food

makes it easier to swallow bc improves ability to control fluid in the mouth and throat.

3 types of thicken liquids

nectar thick - thicker than water. thick juice such as tomato juice. can drink from cups honey thick - has the thickness of honey. pour very slowly. use a spoon to consume pudding thick - semi solid, much like pudding. spoon shud stand up straight. eat with spoon

NPO

nothing by mouth, no food or drink. -

H residue (high fiber)

opposite of low residue diet. helps with constipation, and bowel disorders

Special diets

prescribed by doctors. AKA therapeutic, modified, or special diets. NA's never modify diet. go as according to the special diet plan.

modified calorie diet

reduce weight, gain weight for malnutriton, surgery, illness, or fever.

Diet cards

res. name, info about special diets, allergies, likes, and dislikes and other dietary instructions. diet card included in meal served to residents not eating in dining hall

Low residue (low fiber) diet

restrict low whole grains, diary, and coffee. bowel disturbances, vegetables and raw fruits, seeds

Unintended weightloss

serious medical condition skin breakdown -> pressure ulcers REPORT HIV, COP, cancer, diabetes greater risk Prevention: food looks tasty/good encourage res. to eat. talk about food. Honor likes/dislikes offer different kinds of food and beverages help feed season to liking report if struggle to use utensils record meal/snack intake oral care before and after meals if sad, ask about it Report res. needs help eating/drinking res. eats less than 70% of meals mouth pain dentures don't fit res. coughs chokes wanders/paces/confused

Soft diet and mechanical soft diet

soft texture and consists of soft or chopped foods that are easier to chew and swallow. restrict fried foods, high fiber foods, and spicy foods to help with digestion mechanical soft blended food. - does not limit spices, fat, and fiber. only texture is changed. ppl recovering from surgery

Eating/Swallowing hard caused by

stoke/CVA - facial weakness and paralysis nerve and muscle damage multiple sclerosis parkinsons disease alzheimer's disease

Gastrostomy

surgically created opening into stomach in order to insert tube

Fluid restricted diet

the amount of fluid consumed = fluids that leaves the body --> fluid balance when fluid intake is greater than fluid output = body tissues swollen with excess fluid. Prone: kidney disease and heart disease. NA need to measure and document exact amounts of fluid intake and report excesses to nurse additional fluids: ice cream, puddings, gelatin, etc.... if complain of thirst or request fluids - let nurse know. RF

TPN

total parenteral nutrition. soln administered directly into blood stream. when digestive doesn't work

Preventing aspiration

upright position do not try feeding in reclining position offer small pieces of food or small spoonfuls of pureed food feed residents slowly place food in unaffected, stronger, side of mouth keep upright for 30 minutes after meal

what counts as out put?

urine, feces, diarrhea, vomitting, persppiration, moisture in air that person exhales, and wound drainage

Assist with special needs

use assitive devices. maintain independence when eating verbal cues - short/clear "pick up spoon, open mouth" visually impaired -> use face of imaginary clock place food in unaffected side, stronger side, of mouth place in field of vision put food near res. if shakiness/parkinson disease neck brace put on for neck control. if bites on spoon, ask to open mouth if pockets food in check, ask him to chew and swallow. touch side of cheek, ask to use his tongue to get food and with your finger gently push food toward teeth gently use spoon to press down on tongue - to lead him to swallow

liquid diet

usually orderd for short time due to med. condition. before or after surgery. when need to keep intestinal tract free of food. clear or full.

Assisting with resident eating

verify have right resident check diet card, ask res. to state name. check diet on tray sit eye level put res. in upright position 90 degree offer some food to cool down cut up food and pour liquids, season as needed identify foods and fluids that are in front of res. - pured food by their actual name of the food. ask which one wud like to eat do not mix foods unless requested alternate between food and water if wants a different food, inform dietician so alternative may be offered

Fluid overload

when body cannot handle the amount of fluid consumed heart or kidney disease signs: edema - swelling caused by excess fluid in body tissues dec urine output shortness of breath inc heart tight, smooth, shiny skin

Nasogastric tube

when hard to swallow is fed thru tube. tube inserted to the nose and goes to the stomach