15 Nutrition and Hydration 1 Describe the importance

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients 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.

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients Define the following terms: complex carbohydrates that are broken down by the body into simple sugars for energy; found in foods such as bread, cereal, potatoes, rice, pasta, and vegetables. simple carbohydrates that are found in foods such as sugars, sweets, syrups, and jellies and have little nutritional value.

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients REMEMBER: The human body relies on proper nutrition to function well. A well -balanced diet will help residents maintain muscles and skin tissues and will help prevent pressure ulcers.

15 Nutrition and Hydration Transparency 15 -1: Six Basic Nutrients • Water • Carbohydrates • Proteins • Fats • Vitamins • Minerals

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about water: • Most essential nutrient for life • We need 64 ounces per day. • Water aids in digestion, absorption of food, elimination of wastes, and maintaining normal body temperature.

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about carbohydrates: • Provide energy and extra protein • Provide fiber • Complex carbohydrates include bread, cereal, potatoes, rice, pasta, vegetables, and fruits. • Simple carbohydrates include sugars, sweets, syrups, and jellies.

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about protein: • Essential for tissue growth and repair • Provides a supply of energy • Protein sources include seafood, poultry, meat, eggs, milk, cheese, nuts, nut butters, peas, dried beans or legumes, and soy products.

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about fats: • Help the body store energy • Provide insulation • Protect the organs • Sources include butter, margarine, salad dressings, oils, and animal fats found in meat, dairy products, fowl, and fish • Monounsaturated and polyunsaturated vegetable fats are healthier fats.

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about vitamins: • Vitamins are essential to body functions. • Fat-soluble vitamins are A, D, E, and K. • Water-soluble vitamins are B and C.

15 Nutrition and Hydration 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about minerals: • Minerals form and maintain body functions. • Include zinc, iron, sodium, potassium, calcium, magnesium, and phosphorus

15 Nutrition and Hydration Handout 15 -1: Vitamins and Minerals VITAMIN SOURCE FUNCTION Vitamin A dark green and yellow vegetables, such as broccoli and turnips assists with skin and eye development; keeps the skin healthy; helps the eyes adjust to dim light; helps the linings of the respiratory and digestive tracts resist infection Vitamin C fruits such as oranges, strawberries, grapefruit, cantaloupe; and vegetables such as broccoli, cabbage, brussels sprouts, and green peppers assists with healing wounds and building bones and teeth; holds cells together; strengthens the walls of blood vessels; and helps the body absorb iron Vitamin B 2 or riboflavin milk, milk products, lean meat, green leafy vegetables, eggs, breads, and cereals helps cells use oxygen, which allows them to release energy from food; important for protein and carbohydrate metabolism; needed for growth, healthy eyes, skin, and mucous membranes

15 Nutrition and Hydration Handout 15 -1: Vitamins and Minerals (cont’d) VITAMIN SOURCE FUNCTION Vitamin B 3 or niacin lean meat, poultry, fish, peanuts and peanut butter, whole grain breads and cereals, peas, beans, and eggs important for protein, carbohydrate, and fat metabolism; important for appetite; important for the functioning of the skin, tongue, nervous system, and digestive system; helps cells use oxygen for energy Vitamin D milk, butter, liver, and fish liver oils; also obtained by exposing the body to direct sunlight, which interacts with the cholesterol in the skin responsible for the body’s absorption of the minerals calcium and phosphorus and contributes to the formation of healthy bones; especially important to growing children and women who are pregnant or breastfeeding Vitamin E cereals, nuts, vegetable oils, wheat germ, vegetables, fish, and fruits antioxidant that protects the body from damage from free radicals; helps boost the immune system; assists in formation of red blood cells Thiamin lean pork, dried beans, peas, whole grain and enriched breads and cereals, and certain types of nuts helps the body obtain energy from foods

15 Nutrition and Hydration Handout 15 -1: Vitamins and Minerals (cont’d) Mineral SOURCE FUNCTION Iron egg yolks, green leafy vegetables, breads, cereals, and organ meats necessary for red blood cells to carry oxygen; helps in the formation of enzymes Sodium almost all foods and table salt important for maintaining fluid balance (helps the body retain water) Calcium milk and milk products such as cheese, ice cream, and yogurt; green leafy vegetables such as collards, kale, mustard, dandelion, and turnip greens; and canned fish with soft bones, such as salmon important for the formation of teeth and bones, the clotting of blood, muscle contraction, and heart and nerve function Potassium fruits and vegetables, cereals, coffee, and meats essential for nerve and heart function and muscle contraction Phosphoru s milk, milk products, meat, fish, poultry, nuts, and eggs needed for the formation of bones and teeth and for nerve and heart function; important for the body’s utilization of proteins, fats, and carbohydrates

15 Nutrition and Hydration Transparency 15 -2: My. Plate

15 Nutrition and Hydration 2. Describe the USDA’s My. Plate The USDA provides the following instruction about fruits and vegetables: • Half a person’s plate should consist of fruits and vegetables. • Dark green, red, and orange vegetables have the best nutritional content. • Vegetables are low in fat and calories and have no cholesterol. • Vegetables provide fiber and vitamins. • Fruits are low in fat, sodium, and calories and have no cholesterol. • Fruits provide vitamins and fiber.

15 Nutrition and Hydration 2. Describe the USDA’s My. Plate The USDA provides the following instruction about grains: • At least half of all grains consumed should be whole grains. • Whole grains contain the bran and germ, as well as the endosperm. Refined grains retain only the endosperm. • Grains are found in cereal, bread, rice, and pasta.

15 Nutrition and Hydration 2. Describe the USDA’s My. Plate The USDA provides the following instruction about proteins: • Meat, poultry, seafood, and eggs are animal sources of proteins. Beans, peas, soy products, nuts, and seeds are plant sources of proteins. • • Eat seafood twice a week in place of meat or poultry. • Choose lean meat and poultry. Include eggs and egg whites on a regular basis. • Eat plant-based protein foods more often. • Some nuts and seeds (flax, walnuts) are excellent sources of essential fatty acids.

15 Nutrition and Hydration 2. Describe the USDA’s My. Plate The USDA provides the following instruction about dairy: • Provides protein, vitamins, and minerals • Includes all of the foods made from milk that retain their calcium content, such as yogurt and cheese • Most dairy group choices should be fat-free or low-fat (1%). • Choose fat-free or low-fat milk or yogurt more often than cheese. • Soy products enriched with calcium are an alternative to dairy foods.

15 Nutrition and Hydration 2. Describe the USDA’s My. Plate NAs should remember these tips about making healthy food choices: • Balance calories. • Enjoy your food, but eat less. • Avoid oversized portions. • Eat these foods more often: vegetables, fruits, whole grains, and fat-free or 1% milk and low-fat dairy products.

15 Nutrition and Hydration 2. Describe the USDA’s My. Plate Tips about making healthy food choices (cont’d): • Eat these foods less often: foods high in solid fats, added sugars, and salt. These foods include fatty meats, like bacon and hot dogs, cheese, fried foods, ice cream, and cookies. • Compare amounts of sodium in foods. Select canned foods that are labeled sodium-free, very low sodium, low-sodium, or reduced sodium. • Drink water instead of sugary drinks.

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill These changes of aging can affect nutrition: • Slower metabolism and body movement • Loss of vision • Weakened sense of smell and taste • Less saliva • Dentures, tooth loss, or poor dental health • Less efficient digestion • Use of certain medications

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill Unintended weight loss is a serious problem for the elderly. NAs should remember these guidelines for preventing unintended weight loss: • Report observations and warning signs to the nurse. • Food should look, taste, and smell good. • Encourage residents to eat; talk positively about food. • Honor food likes/dislikes. • Offer different kinds of foods and beverages. • Help residents who have trouble self-feeding.

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill Guidelines for preventing unintended weight loss (cont’d): • Season foods to residents’ preferences. • Allow plenty of time to finish eating. • Tell nurse if residents have trouble with utensils. • Record meal/snack intake. • Give oral care before and after meals. • Position residents upright for feeding. • If resident has low appetite or seems sad, ask about it.

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill NAs should observe and report the following: • Resident needs help eating/drinking • Resident eats less than 70% of food • Resident has mouth pain • Resident’s dentures do not fit • Resident has difficulty chewing or swallowing • Resident coughs or chokes while eating • Resident is sad, has crying spells, or withdraws • Resident is confused, wanders, or paces

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill These conditions can make it difficult for residents to eat or swallow: • Stroke/CVA • Nerve and muscle damage • Multiple sclerosis • Parkinson’s disease • Alzheimer’s disease

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill Define the following terms: total parenteral nutrition (TPN) the intravenous infusion of nutrients administered directly into the bloodstream, bypassing the digestive system. nasogastric tube a feeding tube that is inserted into the nose and goes to the stomach. percutaneous endoscopic gastrostomy (PEG) tube a feeding tube placed through the abdominal wall into the stomach. gastrostomy a surgically-created opening into the stomach in order to insert a tube.

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill NAs do not perform tube feedings, but they may assist with feedings and observe carefully for problems and changes in a resident receiving tube feedings. They should remember these guidelines: • Wash hands before assisting with tube feedings. • Make sure tubing is not coiled or kinked. • Be aware of NPO orders. • Report if tube comes out.

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill Guidelines for tube feedings (cont’d): • Doctor prescribes feedings. They will be in liquid form and served at room temperature. • Head of the bed should always remain elevated at 30 degrees, but during feedings the head of the bed should be elevated 45 degrees. Resident should stay upright after eating as long as ordered (at least 30 minutes). • Give careful skin care.

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill It is important to observe and report the following when a resident is receiving tube feedings: • Redness/drainage around opening • Skin sores or bruises • Cyanotic skin • Resident complaints of pain or nausea • Choking or coughing • Vomiting

15 Nutrition and Hydration 3. Identify nutritional problems of the elderly or ill Observe and report for tube feedings (cont’d): • Diarrhea • Swollen abdomen • Fever • Tube falling out • Problems with equipment • Sound of feeding pump alarm • Change of resident’s inclined position

15 Nutrition and Hydration 4. Describe factors that influence food preferences NAs need to do the following to accommodate residents’ food preferences: • Know and follow food preferences. • Ask questions. • Pay attention.

15 Nutrition and Hydration 4. Describe factors that influence food preferences Think about this question: What regional, cultural, or religious food preferences are significant in your life?

15 Nutrition and Hydration 4. Describe factors that influence food preferences REMEMBER: Residents have a legal right to make choices about their food and to refuse food. NAs must honor residents’ beliefs and preferences. Communicating with residents is the best way to understand their preferences and the reasons behind them.

15 Nutrition and Hydration 5. Explain the role of the dietary department Define the following term: diet cards that list the resident’s name and information about special diets, allergies, likes and dislikes, and other dietary instructions.

15 Nutrition and Hydration 5. Explain the role of the dietary department The dietary department has the following responsibilities: • Meet residents’ different nutritional needs • Take into account likes and dislikes • Make sure residents can manage the food they are eating and that it looks appealing • Strictly follow infection prevention measures

15 Nutrition and Hydration 6. Explain special diets Define the following terms: special, modified, or therapeutic diets for people who have certain illnesses. fluid balance taking in and eliminating equal amounts of fluid. diuretics medications that reduce fluid volume in the body. puree to chop, blend, or grind food into a thick paste of baby food consistency.

15 Nutrition and Hydration 6. Explain special diets Some residents may require special diets, such as the following: • Low-sodium diet • Fluid-restricted diet • High-potassium diet • Low-protein diet • Low-fat/low-cholesterol diet • Modified calorie diet • Bland diet • Diabetic diet

15 Nutrition and Hydration 6. Explain special diets Examples of special diets (cont’d): • Low-residue (low-fiber) diet • High-residue (high-fiber) diet • Gluten-free diet • Vegetarian diet • Liquid diet • Soft diet and mechanical soft diet • Pureed diet

15 Nutrition and Hydration 6. Explain special diets Some residents’ care plans may include instructions to use nutritional supplements. NAs should know the following points about these supplements: • Given on the advice of a doctor or dietitian • Usually given to encourage weight gain or increase the resident’s intake of protein, vitamins, or minerals • May come in powdered or liquid form • Care plan will include instructions on preparation • If a resident does not want to drink the supplement, the NA should not insist that he do so, but should report this to the nurse.

15 Nutrition and Hydration 6. Explain special diets REMEMBER: Residents may receive daily menus for their meals, and NAs may need to help residents complete them. If an NA is asked to assist, she should make sure the menu offered matches the correct resident.

15 Nutrition and Hydration 6. Explain special diets Think about these questions: Have you ever been on a special diet of any kind? What was your experience like?

15 Nutrition and Hydration Handout 15 -2: Sample Exchange List for Diabetic Diets Following the meal plan for how many servings of each type of food to eat, the person chooses specific foods and determines serving sizes using the exchange lists. Exchange List Sample Items • Starch list: 1 slice of bread, ½ bagel, ½ cup cereal, ½ cup pasta, ½ cup rice, 1 baked potato, 3 cups popcorn, 15 -20 fat-free potato chips • Milk list: 1 cup milk (skim, 1%, 2%, or whole, depending on other dietary guidelines), ¾ cup yogurt • Fruit list: ½ cup unsweetened applesauce, 1 small banana, ½ cup orange juice, 2 tablespoons raisins, 1 small orange, ½ cup canned pears • Vegetable list: ½ cup cooked vegetables or vegetable juice, 1 cup raw vegetables (not included are corn, potatoes, and peas, which are on the starch exchange list instead) • Meat list: 1 ounce meat, fish, poultry, or cheese, 1 egg, or ½ cup dried beans • Fat list: 1 teaspoon margarine or butter, 2 teaspoons peanut butter, 2 tablespoons sour cream, 1 teaspoon mayonnaise, 10 peanuts

15 Nutrition and Hydration 7. Explain thickened liquids and identify three basic thickened consistencies NAs should know these facts 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 regular liquids, including water, to residents who must have thickened liquids.

15 Nutrition and Hydration 7. Explain thickened liquids and identify three basic thickened consistencies The three basic thickened consistencies are as follows: • Nectar thick • Honey thick • Pudding thick

15 Nutrition and Hydration 8. Describe how to make dining enjoyable for residents REMEMBER: Meals are not only a time for getting nourishment. They are also a time for socialization. An NA’s role is vital to residents being able to obtain proper nutrition.

15 Nutrition and Hydration 8. Describe how to make dining enjoyable for residents NAs should remember these guidelines for promoting appetites: • Assist with grooming/hygiene tasks before dining as needed. • Give oral care before eating if requested. • Offer a trip to the bathroom before eating. • Assist with handwashing. • Encourage use of dentures, eyeglasses, and hearing aids. • Check the environment. Address odors. Make sure room is a comfortable temperature. Turn off TVs. Do not shout or bang plates or cups.

15 Nutrition and Hydration 8. Describe how to make dining enjoyable for residents Guidelines for promoting appetites (cont’d): • Seat residents next to friends. • Properly position residents for eating, which is normally in the upright position. • Serve food promptly at correct temperature. • Plates should look appetizing. • Provide proper eating tools, including adaptive utensils if needed. • Be cheerful, positive, and helpful. • Honor requests regarding food.

15 Nutrition and Hydration 9. Explain how to serve meal trays and assist with eating NAs need to remember these points about serving meal trays and assisting with eating: • Food must be served at proper temperature. NAs will need to work quickly. • Wash hands first. • Identify residents before serving meals. • Check trays or plates closely before delivering them. • Serve all residents at one table before serving another table.

15 Nutrition and Hydration 9. Explain how to serve meal trays and assist with eating Serving meal trays and assisting with eating (cont’d): • Prepare the food, only doing what resident cannot do: • Remove food and drink, if on tray, and set on table. • Cut food into small portions if necessary. Try to cut food before bringing it to the table. • Open milk or juice cartons. Put in straw if resident uses one, taking care to touch only the paper wrapper. • Butter roll, bread, and vegetables as resident prefers. • Open condiment packets. Offer to season all food as resident prefers, including pureed food.

15 Nutrition and Hydration 9. Explain how to serve meal trays and assist with eating NAs should remember these tips for 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 benefit from cues—verbal and physical. • Some residents will need to be fed. Be sensitive and give privacy. • Encourage residents to do what they can. • Positive attitudes and conversation can increase food and drink intake and vice versa. • Say positive things about the food. • Do not judge food preferences.

15 Nutrition and Hydration 9. Explain how to serve meal trays and assist with eating Guidelines for assisting with eating include the following: • Verify that it is the right resident. • Sit at resident’s eye level. • Allow time for prayer if resident wishes. • Do not treat the resident like a child. Be supportive and encouraging. • 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.

15 Nutrition and Hydration 9. Explain how to serve meal trays and assist with eating Guidelines for assisting with eating (cont’d): • Ask resident what he wants to eat first. Allow resident to make the choice. • Do not mix foods unless resident prefers it. • Do not rush the meal. • Make mealtime social and friendly. Converse if the resident wishes to do so. • Give resident full attention. • Alternate food and drink, cold and hot foods, and bland sweet foods. • Honor requests for different food.

15 Nutrition and Hydration 9. Explain how to serve meal trays and assist with eating REMEMBER: An NA must not insist that a resident use a clothing protector. If the resident chooses to use a clothing protector, it is important that the NA not refer to it as a “bib. ”

Feeding a resident Equipment: meal, eating utensils, clothing protector, washcloths or wipes 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door.

Feeding a resident 5. Pick up diet card and ask resident to state her name. Verify that resident has received the right tray. 6. Raise the head of the bed. Make sure resident is in an upright sitting position (at a 90 -degree angle). 7. Adjust bed height to where you will be to able to sit at resident’s eye level. Lock bed wheels. 8. Place meal tray where it can be easily seen by the resident, such as on the overbed table.

Feeding a resident 9. Help resident clean her hands with hand wipes if resident cannot do it herself. 10. Help resident put on clothing protector if desired. 1. Sit facing resident at the resident’s eye level. Sit on the stronger side if the resident has onesided weakness. 12. Tell the resident what foods are on plate. Ask resident what she would like to eat first.

Feeding a resident 13. Check the temperature of the food. Using utensils, offer the food in bite-sized pieces. Tell the resident the content of each bite of food offered. Alternate types of food offered, allowing for resident’s preferences. Do not feed all of one type before offering another type. Make sure resident’s mouth is empty before next bite or sip. Report any swallowing problems to the nurse immediately.

Feeding a resident 14. Offer drinks of beverage throughout the meal. If you are holding the cup, touch it to the resident’s lips before you tip it. Give small frequent sips. 1. Talk with resident during meal. It makes mealtime more enjoyable. Do not rush the resident. 16. Use washcloths or wipes to wipe food from resident’s mouth and hands as needed during the meal. Wipe again at the end of the meal.

Feeding a resident 17. When the resident is finished eating, remove clothing protector if used. Dispose of protector in proper container. 18. Remove the food tray. Check for eyeglasses, dentures, or any personal items before removing tray. Place tray in proper area. 19. Make resident comfortable. Make sure the bed is free from crumbs. 20. Return bed to lowest position. Remove privacy measures.

Feeding a resident 21. Place call light within resident’s reach. 22. Wash your hands. 23. Report any changes in resident to the nurse. 24. Document procedure using facility guidelines.

15 Nutrition and Hydration 10. Describe how to assist residents with special needs Residents with certain conditions or diseases may need special assistance when eating. Those conditions include the following: • Stroke • Parkinson’s disease • Alzheimer’s disease or other dementias • Head trauma • Blindness • Confusion

15 Nutrition and Hydration 10. Describe how to assist residents with special needs The following dining techniques are helpful when assisting residents with special needs: • Use assistive devices as ordered. • 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. • For visually-impaired residents, use an 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. • If resident has blind spots, place food in field of vision.

15 Nutrition and Hydration 10. Describe how to assist residents with special needs Dining techniques for residents with special needs (cont’d): • If resident has tremors, use physical cues and place food and drinks close to resident. • Place residents with poor balance in dining room chair with armrests. If resident leans, ask her to keep elbows on the table. • If resident has poor neck control, a neck brace may be used to stabilize his or head. • If resident bites utensils, ask him to open his mouth. Wait until jaw relaxes to remove utensil.

15 Nutrition and Hydration 10. Describe how to assist residents with special needs Dining techniques for residents with special needs (cont’d): • If resident pockets food in cheeks, remind him to chew and swallow. Touch cheek. Ask him to use his tongue to get the food. • If resident holds food in mouth, ask her to chew and swallow. Gently press down on tongue when removing spoon from the mouth to help trigger swallowing. Make sure resident has swallowed before offering more food.

15 Nutrition and Hydration 11. Define dysphagia and identify signs and symptoms of swallowing problems Define the following terms: dysphagia difficulty swallowing. aspiration the inhalation of food, drink, or foreign material into the lungs.

15 Nutrition and Hydration 11. Define dysphagia and identify signs and symptoms of swallowing problems The following conditions may cause dysphagia: • Stroke • Cancer • Multiple sclerosis • Parkinson’s disease • Alzheimer’s disease

15 Nutrition and Hydration 11. Define dysphagia and identify signs and symptoms of swallowing problems NAs should report these signs and symptoms of swallowing problems to the nurse: • Coughing during or after meals • Choking during meals • Dribbling saliva, food, or fluid from the mouth • Having food residue inside the mouth or cheeks during and after meals • Gurgling during or after meals or losing voice • Eating slowly • Avoiding eating • Spitting out pieces of food

15 Nutrition and Hydration 11. Define dysphagia and identify signs and symptoms of swallowing problems Signs and symptoms of swallowing problems (cont’d): • Swallowing several times per mouthful • Clearing the throat frequently during and after meals • Watering eyes when eating or drinking • Food or fluid coming up into the nose • Making a visible effort to swallow • Breathing rapidly while eating or drinking • Difficulty chewing food • Difficulty swallowing medications

15 Nutrition and Hydration Transparency 15 -3: Preventing Aspiration • Position in a straight, upright position for eating or drinking. • Offer small pieces of food or small spoonfuls of pureed food. • Feed resident slowly. • Place food in the unaffected/stronger side of the mouth. • Make sure mouth is empty before offering next bite of food or sip of drink. • Keep residents in the upright position for at least 30 minutes after eating and drinking.

15 Nutrition and Hydration 12. Explain intake and output (I&O) Define the following terms: intake (input) the fluid a person consumes; also called input. output all fluid that is eliminated from the body; includes fluid in urine, feces, vomitus, perspiration, moisture that is exhaled in the air, and wound drainage.

15 Nutrition and Hydration Transparency 15 -4: Conversion Table One milliliter (m. L) is a unit of measure equal to one cubic centimeter (cc). 1 ounce (oz) = 30 milliliters (m. L) or 30 cubic centimeters (cc) 2 oz = 60 m. L 3 oz = 90 m. L 4 oz = 120 m. L 5 oz = 150 m. L 6 oz = 180 m. L 7 oz = 210 m. L 8 oz = 240 m. L 1/4 cup = 2 oz = 60 m. L 1/2 cup = 4 oz = 120 m. L 1 cup = 8 oz = 240 m. L

15 Nutrition and Hydration Handout 15 -3: Basic Math Nursing assistants need math skills when doing certain tasks, such as calculating intake and output. A basic math review is listed below: Addition 2, 905 53, 138 +174 +3, 008 3, 079 56, 146 32, 542 549, 233 -8, 710 -26, 903 23, 832 522, 330 Subtraction

15 Nutrition and Hydration Handout 15 -3: Basic Math (cont’d) Multiplication Division 4, 962 79 x 13 x 41 14, 886 79 +49, 620 +3160 64, 506 3, 239 34 22 748 39 14 546 -660 -420 88 126 -88 -126 0 0

15 Nutrition and Hydration Handout 15 -3: Basic Math (cont’d) Converting Decimals, Fractions, and Percentages Decimals, fractions, and percentages are different ways of showing the same value. For example, a half can be written in the following ways: As a decimal: As a fraction: As a percentage: 0. 5 1/2 50% Here are common values shown in decimal, fraction, and percentage forms: Decimal Fraction Percentage 0. 01 1/100 1% 0. 1 1/10 10% 0. 2 1/5 20% 0. 25 ¼ 25% 0. 333 1/3% 0. 5 ½ 50% 0. 75 ¾ 75% 1 1/1 100%

15 Nutrition and Hydration Handout 15 -3: Basic Math (cont’d) Follow these rules for converting decimals, fractions, and percentages: To convert from decimal to a percentage, you will multiply by 100 and add a percent sign (%). 0. 25 x 100 = 25% To convert from a percentage to decimal, you will divide by 100 and delete the percent sign (%). 80% ÷ 100 = 0. 8 To convert a fraction to a decimal, you will divide the top number by the bottom number. 2/3= 2 ÷ 3 = 0. 67

15 Nutrition and Hydration Handout 15 -3: Basic Math (cont’d) To convert a decimal to a fraction, write the decimal over the number 1. Step 1 0. 5 1 Then multiply top and bottom by 10 for every number after the decimal point (10 for 1 number, 100 for 2 numbers, and so on. ) Step 2 0. 5 X 10 1 x 10 = 5 10 The resulting fraction is 5/10 (or 1/2 if you simplify the fraction).

Measuring and recording intake and output Equipment: I&O sheet, graduate (measuring container), pen and paper to record your findings Measure intake first. 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Measuring and recording intake and output 4. Provide for resident’s privacy with curtain, screen, or door. 5. Using the graduate, measure how much fluid a resident is served. Note the amount on paper. 6. When resident has finished a meal or snack, measure any leftover fluids. Note this amount on paper.

Measuring and recording intake and output 7. Subtract the leftover amount from the amount served. If you have measured in ounces, convert to milliliters (m. L) by multiplying by 30. 8. Document amount of fluid consumed (in m. L) in input column on I&O sheet. Record the time and what fluid was taken. Report anything unusual that was observed, such as the resident refusing to drink, drinking very little, feeling nauseated, etc.

Measuring and recording intake and output 9. Wash your hands. Measuring output is the other half of monitoring fluid balance. Equipment: I&O sheet, graduate, gloves, pen and paper 1. Wash your hands. 2. Put on gloves before handling bedpan/urinal. 3. Pour the contents of the bedpan or urinal into graduate. Do not spill or splash any of the urine.

Measuring and recording intake and output 1. Place graduate on flat surface. Measure the amount of urine at eye level. Keep the container level (Fig. 15 -29). Note the amount on paper, converting to m. L if necessary. 5. After measuring urine, empty graduate into toilet without splashing. 6. Rinse graduate and pour rinse water into toilet. 7. Rinse bedpan/urinal and pour rinse water into toilet. Flush the toilet.

Measuring and recording intake and output 8. Place graduate and bedpan in area for cleaning or clean and store according to policy. 9. Remove and discard gloves. 10. Wash hands before recording output.

Measuring and recording intake and output 11. Document the time and amount of urine in output column on sheet. For example: 1545 hours, 200 m. L urine. To measure vomitus, pour from basin into measuring container, then discard in the toilet. If resident vomits on the bed or floor, estimate the amount. Document emesis and amount on the I&O sheet. 12. Report any changes in resident to the nurse.

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance Define the following terms: force fluids (FF) a medical order to encourage a person to drink more fluids. restrict fluids (RF) a medical order to limit the amount of fluids a person drinks to the level set by the doctor. NPO (nothing by mouth) medical order to withhold all food and fluids taken orally. dehydration a serious condition resulting from inadequate fluid in the body.

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance Fluid intake in important for these reasons: • Helps prevent constipation and incontinence • Dilutes wastes and flushes out urinary system • May help prevent confusion

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance REMEMBER: NPO means nothing by mouth. An NA should never offer any food or drink to a resident with this order - not even water.

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance NAs should know the following guidelines for preventing dehydration: • Report warning signs immediately. • Encourage residents to drink every time you see them. • Offer fresh water and fluids often. • 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. • Record fluid I&O.

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance NAs should report these signs and symptoms of dehydration: • Drinking less than six 8 -ounce glasses of liquid per day • Drinking little or no fluids at meals • Needing help drinking from cup or glass • Having trouble swallowing liquids • Having frequent vomiting, diarrhea, or fever

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance Signs and symptoms of dehydration (cont’d): • 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

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance NAs can use these tips to encourage residents to maintain fluid balance: • Ask questions like, “Would you like water or juice? ” rather than, “Do you want anything to drink? ” • Make an effort to find out what residents’ favorite beverages are. • Offer favorite beverages at least three times each day, in addition to meals.

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance REMEMBER: Prevention of dehydration is an ongoing job for the care team.

Serving fresh water Equipment: water pitcher, ice scoop, glass, straw, gloves 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Put on gloves. 4. Scoop ice into water pitcher. Add fresh water. 5. Use and store ice scoop properly. Do not allow ice to touch your hand fall back into container. Place scoop in proper receptacle after each use. 6. Take pitcher to resident.

Serving fresh water 7. Pour glass of water for resident. Leave pitcher and glass at the bedside. 8. Make sure that pitcher and glass are light enough for resident to lift. Leave a straw if the resident desires. 9. Place call light within resident’s reach. 10. Remove and discard gloves. 11. Wash your hands.

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance Define the following terms: fluid overload a condition that occurs when the body cannot handle the amount of fluid consumed. edema swelling caused by excess fluid in body tissues.

15 Nutrition and Hydration 13. Identify ways to assist residents in maintaining fluid balance NAs should be familiar with the following signs and symptoms of fluid overload: • Swelling of extremities • Weight gain • Decreased urine • Shortness of breath • Increased heart rate • Tight, smooth, or shiny skin

15 Nutrition and Hydration Exam Multiple Choice. Choose the correct answer. 1. A well-balanced diet (A) Is very difficult to achieve (B) Does not provide any health benefit (C) Contains many servings of fats and sugars (D) Can help promote healing 2. Which of the following is one of the nutritional problems of the elderly? (A) Increased appetite makes it hard to stay slender. (B) Body movement slows, and reduced activity affects appetite. (C) Metabolism increases. (D) Nutritional problems are no different for the elderly than for anybody else.

15 Nutrition and Hydration Exam 1. To help prevent aspiration, residents should be in the ____ position when eating. (A) Upright (B) Lying down (C) Prone (D) Lateral 2. A nursing assistant’s duties regarding tube feedings include (A) Inserting the tubes (B) Doing the feedings (C) Observing the feeding and reporting problems (D) Cleaning the tubes

15 Nutrition and Hydration Exam 1. Which of the following is the most essential nutrient for life? (A) Vegetables (B) Water (C) Grains (D) Protein 2. Which of the following is a good source of protein? (A) Corn oil (B) An orange (C) Fish (D) Grape jelly

15 Nutrition and Hydration Exam 1. Which of the following is an example of a plant-based protein? (A) Salmon (B) Tofu (C) Steak (D) Bacon 2. According to the USDA’s My. Plate icon, which food groups should make up at least half of a person’s plate? (A) Grains and proteins (B) Vegetables and fruits (C) Dairy and proteins (D) Grains and fruits

15 Nutrition and Hydration Exam 1. According to My. Plate, what percentage of milk fat should be in a person’s dairy choices? (A) 1% (B) 2% (C) 3% (D) 4% 2. What information is found on a diet card? (A) Infection prevention procedures (B) Food likes and dislikes (C) Care team members’ names (D) Advance directives

15 Nutrition and Hydration Exam 1. Which of the following is true about food preferences? (A) Residents are old enough that their preferences will not change. (B) It is not important to honor residents’ food preferences. (C) Education is never a factor in determining food preference. (D) Religion might influence food preference. 2. Which of the following is an effective way for an NA to help prevent dehydration? (A) The NA should encourage the resident to drink every time she sees him. (B) The NA should insist that the resident drink juice because it is healthy. (C) The NA should withhold fluids if a resident is incontinent. (D) The NA should administer a saline solution IV for a resident who is dehydrated.

15 Nutrition and Hydration Exam 1. ____ is taking in and eliminating equal amounts of fluid. (A) Dehydration (B) Input (C) Fluid balance (D) Restrict fluids 2. Eight ounces is equal to ______ cc. (A) 180 (B) 240 (C) 210 (D) 120

15 Nutrition and Hydration Exam 1. To convert ounces to milliliters, the NA should multiply by (A) 30 (B) 20 (C) 60 (D) 15 2. What does the abbreviation NPO mean? (A) Nothing pureed only (B) Not prepared on-site (C) Nothing by mouth (D) Note preferences only

15 Nutrition and Hydration Exam 1. Which of the following are signs of unintended weight loss that should be reported? (A) Eating lean cuts of meat (B) Eating dessert before dinner (C) Avoiding fried foods and sweets (D) Coughing or choking while eating 2. Which of the following statements about mealtime is true? (A) Social interaction is an important part of mealtime. (B) Mealtime is only about getting proper nourishment. (C) Mealtime is a good time for NAs to chat with colleagues since the residents are busy eating. (D) If an NA thinks a resident’s meal looks unappetizing, she should let the resident know.

15 Nutrition and Hydration Exam 1. At which angle should residents be positioned for eating? (A) 90 degrees (B) 120 degrees (C) 180 degrees (D) 98 degrees 2. When serving meal trays, the nursing assistant should (A) Not worry about identifying residents because the food will get cold (B) Serve favorite residents first (C) Serve female residents before male residents (D) Correctly identify a resident before serving the tray

15 Nutrition and Hydration Exam 1. If a resident refuses to wear a clothing protector, the nursing assistant should (A) Respect the resident’s refusal (B) Refuse to serve the resident until she puts it on (C) Insist that the resident wear it (D) Point out to the resident that she is making her work more difficult 2. Residents who need some assistance with eating may benefit from (A) The nursing assistant doing everything for the resident (B) The nursing assistant insisting that the resident manage eating alone so that he can learn to be independent (C) The nursing assistant using the hand-over-hand approach (D) The nursing assistant telling his family that they need to visit at mealtimes to help

15 Nutrition and Hydration Exam 1. How can an NA best help residents with eating? (A) The nursing assistant should choose which foods residents eat first. (B) The nursing assistant should review her documentation paperwork while residents are eating since residents will be busy. (C) The nursing assistant should identify the food and fluids in front of residents. (D) The nursing assistant should do everything for residents during mealtime so residents will not be anxious. 2. Which of the following is a symptom of dysphagia (difficulty swallowing)? (A) Eating everything on the tray at every meal (B) Sweating profusely during meals (C) Fever during meals (D) Watering eyes during meals

15 Nutrition and Hydration Exam 1. Which of the following is a reason why a resident might be placed on a special diet? (A) Because the NA thinks the resident is too heavy (B) Because the dietary department is testing out new recipes (C) Because the resident does not care for eggs (D) Because the resident has food allergies 2. What is the first food to be restricted in a low-sodium diet? (A) Milk (B) Salt (C) Poultry (D) Foods high in fat

15 Nutrition and Hydration Exam 1. Which statement best describes a pureed diet? (A) This diet consists of food that is blended into a thick paste for easier swallowing. (B) This diet consists of clear juices, broth, gelatin, and popsicles. (C) This diet consists of lean cuts of meat and nonfat dairy products. (D) This diet restricts protein for people who have kidney disease. 2. A diet often used for people who need to keep the intestinal tract free of food is (A) Bland diet (B) Liquid diet (C) Low-fat diet (D) High-residue diet

15 Nutrition and Hydration Exam 1. A diet used for people with ulcers that avoids alcohol and spicy foods is called the (A) Bland diet (B) Liquid diet (C) Low-fat diet (D) High-residue diet 2. In order to lose weight, a resident may be placed on this diet: (A) Low-residue diet (B) Soft diet (C) Gluten-free diet (D) Modified calorie diet

15 Nutrition and Hydration Exam 1. A diet that consists of foods that are chopped to help people who have trouble chewing and swallowing is called a (A) Low-cholesterol diet (B) High-potassium diet (C) Low-residue diet (D) Soft diet 2. Which of the following is a common reason why a resident may be on a fluid -restricted diet? (A) The resident has heart disease. (B) The resident has urinary incontinence. (C) The resident has constipation. (D) The resident has pressure ulcers.

15 Nutrition and Hydration Exam 1. Which of the following foods is high in potassium? (A) Pasta (B) Ham (C) Avocado (D) Coconut 2. This type of diet limits intake of egg yolks and fried foods and is used for people who are at risk for heart attacks and heart disease. (A) Low-sodium diet (B) Low-protein diet (C) Low-residue diet (D) Low-cholesterol diet

15 Nutrition and Hydration Exam 1. This type of diet eliminates foods containing wheat flour and is used for people who have celiac disease. (A) Gluten-free diet (B) Low-cholesterol diet (C) Low-residue diet (D) Modified calorie diet 2. Which type of vegetarian diet eliminates poultry, meats, fish, and eggs, but allows dairy products? (A) Ovo-vegetarian diet (B) Lacto-ovo vegetarian diet (C) Lacto-vegetarian diet (D) Vegan diet

15 Nutrition and Hydration Exam 1. Which type of vegetarian diet eliminates all poultry, meats, fish, eggs, and dairy products, along with all foods that are derived from animals? (A) Lacto-ovo vegetarian diet (B) Lacto-vegetarian diet (C) Ovo-vegetarian diet (D) Vegan diet 2. Which of the following is one way that residents who have diabetes eat a healthy diet? (A) By counting carbohydrates (carb-counting) (B) By eating whatever they want but keeping track of it in a food diary (C) By adding more sugar into their diet (D) By eating large amounts of food and then exercising vigorously to burn calories

15 Nutrition and Hydration Exam 1. Residents who are on a low-residue diet must limit which of the following foods? (A) Foods that are spicy (B) Sugary foods (C) Foods that are high in fiber (D) Low-fat foods 2. This type of diet increases the intake of fiber and whole grains and is prescribed for residents who have constipation and bowel disorders. (A) High-residue diet (B) Liquid diet (C) Gluten-free diet (D) Low-cholesterol diet

15 Nutrition and Hydration Exam 1. This type of diet is ordered as either clear or full. (A) Low-residue diet (B) Pureed diet (C) Liquid diet (D) Bland diet 2. Which type of residents may have an order for thickened liquids? (A) Residents who have swallowing problems (B) Residents who refuse to drink water (C) Residents who do not eat meat (D) Residents who have certain religious beliefs

15 Nutrition and Hydration Exam 1. Why is it important for a nursing assistant to observe plates and meal trays when residents have finished eating? (A) It helps the NA decide what to feed residents first. (B) Residents who are trying to lose weight will want the NA to keep a record of how much they have eaten. (C) It helps the NA write a new diet order if the current one is not working. (D) It helps to identify a change in residents’ food preferences. 2. When assisting residents who have had a stroke, the nursing assistant should (A) Watch for signs of choking (B) Place food in the weaker side of the resident’s mouth (C) Offer another bite of food before the resident has swallowed the last bite (D) Encourage the resident to take large bites

15 Nutrition and Hydration CHAPTER 15 PRACTICE 1. Eight ounces is equal to ______ cc. (A) 180 (B) 240 (C) 210 (D) 120 2. What does the abbreviation NPO mean? (A) Nothing pureed only (B) Not prepared on-site (C) Nothing by mouth (D) Note preferences only 3. At which angle should residents be positioned for eating? (A) 90 degrees (B) 120 degrees (C) 180 degrees (D) 98 degrees 4. Which of the following is a symptom of dysphagia (difficulty swallowing)? (A) Eating everything on the tray at every meal (B) Sweating profusely during meals (C) Fever during meals (D) Watering eyes during meals

15 Nutrition and Hydration CHAPTER 15 PRACTICE ANSWERS 1. 2. 3. 4. BCAD- 240 NOTHING BY MOUTH 90 DEGREES WATERING EYES DURING MEALS