Transcript userfiles/133/my files/chapter_019 unit 3 assisting with adls?id

Chapter 19
Nutrition and Fluids
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Nutrition
The person’s diet affects physical and mental
well-being.
 A poor diet and poor eating habits:
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Increase the risk for infection
 Increase the risk of acute and chronic diseases
 Cause chronic illnesses to become worse
 Cause healing problems
 Affect physical and mental function, increasing the
risk for accidents and injuries
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Eating and drinking provide pleasure.
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Dietary Factors
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Many factors affect dietary practices.
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Culture
Finances
Personal choice
Dietary practices also include selecting,
preparing, and serving food.
The Centers for Medicare and Medicaid
Services (CMS) requires that the health team
assess the resident’s nutritional status.
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Basic Nutrition
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Nutrition is the processes involved in the
ingestion, digestion, absorption, and use of
foods and fluids by the body.
Good nutrition is needed for growth, healing,
and body functions.
A well-balanced diet and correct calorie
intake are needed.
Foods and fluids contain nutrients.
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Nutrients are grouped into fats, proteins,
carbohydrates, vitamins, minerals, and water.
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Dietary Guidelines
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The Dietary Guidelines for Americans 2010 are
for persons 2 years of age and older.
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They describe a healthy diet as one that:
• Is high in fruits, vegetables, whole grains, and fat-free or
low-fat milk and milk products
• Includes lean meats, poultry, fish, beans, eggs, and nuts
• Is low in fats, cholesterol, salt (sodium), and added sugar
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The Guidelines also include recommendations for
persons at risk for chronic disease.
 The Guidelines promote overall health.
 They focus on consuming fewer calories, making
informed food choices, and being physically active.
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MyPlate
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MyPlate includes “Steps to a Healthier You.”
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The kind and amounts of food to eat daily
Gradual improvement
Physical activity
Variety
Moderation
The right amount from each food group band
Food groups
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Grains
Vegetables
Fruits
Dairy
Proteins
Oils
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Essential Nutrients
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Nutrients
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No food or food group has every essential nutrient.
Essential nutrients are those the body must ingest for
health.
Protein is the most important nutrient (besides water).
Carbohydrates provide energy and fiber for bowel
elimination.
Fats provide energy, add flavor to food, and help the
body use certain vitamins.
Vitamins are needed for certain body functions.
• Vitamins do not provide calories.
• The body stores vitamins A, D, E, and K.
• Vitamin C and the B complex vitamins are not stored.
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Nutrition
● Minerals are used for many body processes.
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Bone and tooth formation
Nerve and muscle function
Fluid balance
Other body processes
● Water is needed for all body processes.
 Food labels are used to make informed food choices
for a healthy diet.
 Food labels contain information about:
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Serving size and number of servings/package
Calories and calories from fat
Nutrients
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Factors Affecting Eating and Nutrition
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Meeting a person’s nutritional needs requires
a team approach.
Culture influences dietary practices, food
choices, and food preparation.
Selecting, preparing, and eating food often
involve religious practices.
Finances affect the foods people buy.
Appetite relates to the desire for food.
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Factors Affecting Eating
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Personal choice
Body reactions
Illness
Chewing and swallowing
Disability
Age
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With aging, changes occur in the gastro-intestinal
(GI) system.
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OBRA and CMS
Dietary Requirements
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Each person’s nutritional and dietary needs
are met.
The person’s diet is well-balanced.
Food is appetizing.
Hot food is served hot and cold food is served
cold.
Food is served promptly.
Food is prepared to meet each person’s
needs.
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Meeting Nutritional Needs
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Other foods (of similar nutritional value) are
offered to residents who refuse the food
served.
Each person receives at least three meals a
day.
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A bedtime snack is offered.
The center provides needed adaptive
equipment and utensils.
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Special Diets
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Doctors may order special diets:
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For nutritional deficiency or a disease
For weight control
To eliminate or decrease certain substances in the
diet
Regular diet, general diet, and house diet
mean no dietary limits or restrictions.
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Sodium
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The sodium-controlled diet
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If there is too much sodium, the body retains more
water.
Sodium control decreases the amount of sodium
in the body.
The doctor orders the amount of sodium allowed.
Sodium-controlled diets involve:
• Omitting high-sodium foods
• Not adding salt to food at the table
• Limiting the amount of salt used in cooking
• Diet planning
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Diabetic Nutrition
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Diabetes meal planning is for people with diabetes.
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Diabetes is usually treated with insulin or other drugs, diet,
and exercise.
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The dietitian and person develop a meal plan that involves:
• The person’s food preferences
• Calories needed
• Eating meals and snacks at regular times
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You need to:
• Serve the person’s meals and snacks on time.
• Always check the tray to see what was eaten.
• Tell the nurse what the person did and did not eat.
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Dysphagia
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The dysphagia diet
Food thickness is changed to meet the person’s needs.
 The doctor, speech-language pathologist, occupational
therapist, dietitian, and nurse choose the right food thickness.
 When feeding a person with dysphagia, you must:
• Know the signs and symptoms of dysphagia.
• Feed the person according to the care plan and swallow guide.
• Follow aspiration precautions.
• Report changes in how the person eats.
• Report the following at once:
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Choking, coughing, or difficulty breathing during or after meals
Abnormal breathing or respiratory sounds
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Fluid Balance
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Death can result from too much or too little
water.
Fluid balance is needed for health.
The amount of fluid taken in (intake) and the
amount of fluid lost (output) must be equal.
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If fluid intake exceeds fluid output, body tissues
swell with water (edema).
 If fluid output exceeds intake, dehydration occurs.
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Fluid Requirements and Orders
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Normal fluid requirements
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An adult needs 1500 mL of water daily to survive.
About 2000 to 2500 mL of fluid per day is needed
for normal fluid balance.
The older person is at risk for dehydration and
edema.
Some persons have special fluid orders.
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Encourage fluids
Restrict fluids
Nothing by mouth (NPO)
Thickened liquids
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Intake and Output
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Intake and output (I&O) records:
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Are used to evaluate fluid balance and kidney function
Help in evaluating and planning medical treatment
Are kept when the person has special fluid orders
All fluids taken by mouth are measured and recorded.
Foods that melt at room temperature are measured
and recorded.
The nurse measures and records IV fluids and tube
feedings.
Output includes urine, vomitus, diarrhea, and wound
drainage.
An I&O record is kept at the bedside.
Amounts are totaled at the end of the shift.
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Meeting Food and Fluid Needs
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The following can affect appetite and ability to
eat:
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Weakness, illness, and confusion
 Unpleasant odors, sights, and sounds
 An uncomfortable position
 The need for oral hygiene
 The need to eliminate
 Pain
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Dining Programs
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Dining programs meet the needs of the
following residents:
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Alert and oriented residents
 Those who like to eat in their rooms
 Those who are confused and noisy at mealtime
 Persons who are incontinent or have odor
problems
 Persons who are too weak or ill to leave their
rooms
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Types of Dining Programs
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The following dining programs are common in
nursing centers:
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Social dining
 Family dining
 Low-stimulation dining
 Restaurant-style menus
 Open-dining
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Preparing Residents for Meals
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Preparing for meals
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Assist with elimination needs.
 Provide oral hygiene.
 Make sure needed dentures are in place.
 Make sure needed eyeglasses and hearing aids
are in place.
 Make sure incontinent persons are clean and dry.
 Position the person in a comfortable position.
 Assist the person with hand washing.
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Serving Meals
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Serving meal trays
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OBRA requires that food be at the desired temperature when
the person receives it.
You serve meal trays after preparing residents for meals.
Serve trays in the order assigned by the health team.
If food is not served within 15 minutes, recheck food
temperatures.
If food is not at the correct temperature, get a fresh tray.
When feeding the person:
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Serve food and fluids in the order the person prefers.
Offer fluids during the meal.
Use teaspoons to feed the person.
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Feeding the Person
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Persons who need to be fed may:
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Let the person do as much as possible.
Always tell the visually impaired person what is on
the tray.
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Be angry, humiliated, and embarrassed
Be depressed or resentful
Refuse to eat
For persons who feed themselves:
• Describe foods and fluids and their place on the tray.
• Use the numbers on a clock for the location of food.
Allow time and privacy for prayer if the person
wishes.
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Feeding the Person (Cont’d)
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Meals provide social contact with others.
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Engage the person in pleasant conversation.
Sit facing the person.
Persons with dementia may:
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Become distracted during meals
 Not be able to sit long enough for a meal
 Forget how to use eating utensils
 Resist your efforts to assist them with eating
 Throw or spit food
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Between Meals
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Between-meal nourishments
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Providing drinking water
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Nourishments are served upon arrival on the nursing unit.
Provide needed utensils, a straw, and a napkin.
Follow the same considerations and procedures as for
serving meal trays and feeding persons.
Residents need fresh drinking water each shift and
whenever the pitcher is empty.
Calorie counts
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On a flow sheet, note what the person ate and how much.
A nurse or dietitian converts the portions into calories.
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Foodborne Illnesses
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A foodborne illness (food poisoning) is caused by
pathogens in food and fluids.
Report signs and symptoms of foodborne illnesses to
the nurse at once.
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Signs and symptoms depend on the pathogen.
Food is not sterile.
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Pathogens are present when food is purchased.
Foods can become contaminated from other foods.
Food handlers with poor hygiene can contaminate the food.
Pathogens grow rapidly between 40 and 140 F
(Fahrenheit). This range is called the “danger zone” by the
USDA.
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Keep Food Safe
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To keep food safe, the United States Department
of Agriculture (USDA) recommends four tips:
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Clean. Wash hands, utensils, and counter tops often.
 Separate. Avoid cross-contamination. Do not let raw
meat, poultry, or their juices touch other foods that will
not be cooked.
 Cook. Cook food to a safe internal temperature. Use a
food thermometer to check the internal temperature.
When re-heating cooked food, re-heat to 165 F.
 Chill. Refrigerate or freeze food within 2 hours. If the
air is 90 F or above, chill food within 1 hour.
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Quality of Life
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Nutrition and fluid balance are important for
quality of life.
The right to personal choice is important in
meeting food and fluid needs.
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Residents have the right to express their preferences.
Persons with dementia may require special
measures to meet their nutritional needs.
Sometimes families and friends bring food from
home.
OBRA requires that food be served correctly.
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