Good nutrition is important for healing, stress tolerance, and metabolism. The elderly have different nutritional needs than younger people due to slower metabolism and changes in digestion. Factors like illness, dentition, taste changes, and depression can contribute to nutritional deficits. Facilities must provide nutritious and culturally appropriate meals while accommodating special diets and assisting residents who have difficulties eating or swallowing to prevent aspiration. Intake and output must be carefully monitored and recorded to prevent dehydration or fluid overload.

1. Nutrition and Hydration
Chapter 15

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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