Poor food choices and poor diet directly relate to four of the top 10 leading causes of death in the US including heart disease, cancer, stroke, and diabetes. The document discusses nutrition and hydration issues that residents may experience such as unintended weight loss, malnutrition, and dehydration which can contribute to poor health outcomes. It also covers the structure and function of the digestive system and how aging can impact it. Guidelines are provided for promoting nutrition, preparing residents for meals, assisting residents who can and cannot feed themselves independently, and ensuring safe eating.

1. Nutrition and
Fluids
Unit 10
Measuring intake and output
Feeding a Person

2. Nutrition and Hydration Issues
 Healthy food choices are important forHealthy food choices are important for
every cell in the body throughout life.every cell in the body throughout life.
 Poor food choices and poor diet directlyPoor food choices and poor diet directly
relate to at least four of the 10 leadingrelate to at least four of the 10 leading
causes for death in the US:causes for death in the US:
 Heart diseaseHeart disease
 CancerCancer Poor diet is implicatedPoor diet is implicated
inin
 StrokeStroke other disease conditionsother disease conditions
 DiabetesDiabetes

3. Nutrition and Hydration Issues
continued…
 The resident may experience nutrition-The resident may experience nutrition-
related situations such as unintendedrelated situations such as unintended
weight loss, malnutrition, andweight loss, malnutrition, and
dehydrationdehydration
 These situations contribute to poorThese situations contribute to poor
wound healing, lowered resistance towound healing, lowered resistance to
infections and other health problems asinfections and other health problems as
well as diminished quality of life.well as diminished quality of life.

4. Structure and Function of the
Digestive System
 Mouth, teeth and tongue (oral cavity)Mouth, teeth and tongue (oral cavity)
 Food is chewed and mixed with salivaFood is chewed and mixed with saliva
 Chewing/swallowing function may beChewing/swallowing function may be
affected by changes in dentition andaffected by changes in dentition and
muscle control.muscle control.
 Worn or missing teeth, poorly fitted denturesWorn or missing teeth, poorly fitted dentures
 A stroke or other neurological condition mayA stroke or other neurological condition may
result in loss of muscle control over part of theresult in loss of muscle control over part of the
mouth and throat.mouth and throat.

5. Structure and Function-Mouth
 Gag reflex may be diminished byGag reflex may be diminished by
disease.disease.
 Decrease in saliva production andDecrease in saliva production and
thicker saliva may affect the residentsthicker saliva may affect the residents
ability to swallow food.ability to swallow food.
 Taste buds on the tongue decrease inTaste buds on the tongue decrease in
number and sensitivity.number and sensitivity.
 The sense of smell also may diminish.The sense of smell also may diminish.

6. Structure and Function-Mouth
 Thirst sensation declines with age.Thirst sensation declines with age.
 Individuals may not recognize that theyIndividuals may not recognize that they
are thirsty, that the body needs moreare thirsty, that the body needs more
liquid.liquid.

7. Function-Esophagus
 Esophagus-carries food from the throatEsophagus-carries food from the throat
to the stomach.to the stomach.

8. Function-Stomach
 Functions-Functions-
 Mixes food with gastric juice to beginMixes food with gastric juice to begin
chemical breakdown.chemical breakdown.
 Empties food material gradually intoEmpties food material gradually into
intestine.intestine.
Changes due to agingChanges due to aging
Decreased stomach motility may result inDecreased stomach motility may result in
feeling of indigestion and flatulence.feeling of indigestion and flatulence.
Irritation/inflammation of the stomachIrritation/inflammation of the stomach
lining is more likely..lining is more likely..

9. Function-Small Intestine
 Contents mixed and moved by peristalsis, aContents mixed and moved by peristalsis, a
rhythmic, wavelike contraction of therhythmic, wavelike contraction of the
digestive system’s muscle walls.digestive system’s muscle walls.
 Most of digestion and absorption of usableMost of digestion and absorption of usable
material or nutrients occurs in the smallmaterial or nutrients occurs in the small
intestine.intestine.
 Changes due to agingChanges due to aging
 Decreased digestion of some materials becauseDecreased digestion of some materials because
of decrease in digestive enzymes.of decrease in digestive enzymes.
 Decreased absorption of some nutrients.Decreased absorption of some nutrients.

10. Function-Large Intestine
 Re-absorption of waterRe-absorption of water
 Stores material that the body cannotStores material that the body cannot
use until it is expelled from the rectumuse until it is expelled from the rectum
through the anus.through the anus.
 Changes due to agingChanges due to aging
 Decreased peristalsis(decreased motility)Decreased peristalsis(decreased motility)
leads to constipation and flatulence.leads to constipation and flatulence.

11. Additional factors affecting
nutritional/hydration status
 Decreased activity lessens caloricDecreased activity lessens caloric
need, and also decreases appetiteneed, and also decreases appetite
 Diminished hand and arm strength orDiminished hand and arm strength or
control from neurological conditionscontrol from neurological conditions
 Medications may affect: *how foodMedications may affect: *how food
tastes, *the resident’s appetite, as welltastes, *the resident’s appetite, as well
as *absorption and utilization of foodas *absorption and utilization of food
nutrients.nutrients.
 Resident may tire easily due to chronicResident may tire easily due to chronic
disease.disease.

12. Additional Factors affecting
nutritional/hydration status
 Depression may reduce interest in foodDepression may reduce interest in food
and eating.and eating.
 Dementia may lessen interest in foodDementia may lessen interest in food
and decrease attention span to remainand decrease attention span to remain
seated for meal.seated for meal.
 Lack of consideration by staff forLack of consideration by staff for
resident’s food and eating preferences.resident’s food and eating preferences.
 Individuals have developed preferencesIndividuals have developed preferences
and habits over a lifetime.and habits over a lifetime.

13. CNA’s role related to resident
nutrition and fluids
 Respect resident rights, including respectingRespect resident rights, including respecting
and accommodating resident’s individualand accommodating resident’s individual
preferences and habits.preferences and habits.
 Religious beliefs and cultural practicesReligious beliefs and cultural practices
may influence preferences.may influence preferences.
 Residents family may be able to supplyResidents family may be able to supply
helpful information about preferences andhelpful information about preferences and
habits.habits.
 Report information about residentsReport information about residents
preferences so that it can become part ofpreferences so that it can become part of
care plan.care plan.

14. CNA’s role related to resident
nutrition and fluids
 Incorporate restorative measures asIncorporate restorative measures as
part of assisting the resident withpart of assisting the resident with
nutrition and fluids.nutrition and fluids.
 Goal is for resident to be as independentGoal is for resident to be as independent
as possible.as possible.
 Assist the resident only with what he/sheAssist the resident only with what he/she
cannot do for himself/herself.cannot do for himself/herself.

15. CNA’s role related to resident
nutrition and fluids
 Work as a team member with other staff toWork as a team member with other staff to
provide resident nutritionprovide resident nutrition..
 Facility’s food service director plans meals toFacility’s food service director plans meals to
meet resident’s nutritional needs.meet resident’s nutritional needs.
 Facility’s philosophy of care influences foodFacility’s philosophy of care influences food
preparation and presentation.preparation and presentation.
 Meals may be prepared in a central kitchen andMeals may be prepared in a central kitchen and
delivered to the unit on trays or food may bedelivered to the unit on trays or food may be
prepared in the resident’s household and servedprepared in the resident’s household and served
family-style on traditional dishes.family-style on traditional dishes.
 Meals may be served on a regular schedule orMeals may be served on a regular schedule or
prepared on the unit when the resident requests.prepared on the unit when the resident requests.

16. CNA’s role related to resident
nutrition and fluids
 The nutrition assistant has limitedThe nutrition assistant has limited
responsibilities in assisting the residentresponsibilities in assisting the resident
with eating.with eating.
 Nurse assigns appropriate residents forNurse assigns appropriate residents for
the nutrition assistant (individuals with nothe nutrition assistant (individuals with no
complicated feeding problems), givescomplicated feeding problems), gives
pertinent information about the residentpertinent information about the resident
and explains how to assist the resident.and explains how to assist the resident.
 Nutrition assistant can provide only theNutrition assistant can provide only the
direct care of assisting the resident to eat.direct care of assisting the resident to eat.

17. CNA’s role related to resident
nutrition and fluids
 In addition, the nutrition assistant may push theIn addition, the nutrition assistant may push the
resident’s w/c, but cannot perform other tasks that areresident’s w/c, but cannot perform other tasks that are
considered direct care, such as dressing, grooming,considered direct care, such as dressing, grooming,
bathing, transferring, positioning or assisting thebathing, transferring, positioning or assisting the
resident to walk.resident to walk.
 Nutrition assistant may perform tasks related toNutrition assistant may perform tasks related to
housekeeping and dietary services , if properlyhousekeeping and dietary services , if properly
trained.trained.
 Nutrition assistant reports observations and problemsNutrition assistant reports observations and problems
to nurse.to nurse.
 CNA reports and records observations and problemsCNA reports and records observations and problems
to nurse.to nurse.

18. Guidelines that promote
nutrition and safe eating
 Prepare residentPrepare resident
 Residents eat better when dining with others, whenResidents eat better when dining with others, when
social interaction with other residents and staff issocial interaction with other residents and staff is
possible. Most residents will eat in a dining room.possible. Most residents will eat in a dining room.
 Verbally prepare the resident for mealtime. (“ItsVerbally prepare the resident for mealtime. (“Its
almost time for breakfast.”)almost time for breakfast.”)
 Dress and groom resident appropriately for socialDress and groom resident appropriately for social
contact.contact.
 Assistive devices such as hearing aids, glasses andAssistive devices such as hearing aids, glasses and
dentures should be in place and functioning.dentures should be in place and functioning.

19. Guidelines that promote
nutrition and safe eating
 Toileting needs and comfort needs shouldToileting needs and comfort needs should
be checked.be checked.
 Assist resident to wash handsAssist resident to wash hands
 Residents eat better (and more safely)Residents eat better (and more safely)
when seated in an upright position.when seated in an upright position.
 Head should be positioned slightly forward,Head should be positioned slightly forward,
tilted forward and downward.tilted forward and downward.
 Body should be in alignment.Body should be in alignment.
 If resident must remain in bed, elevate theIf resident must remain in bed, elevate the
head of bed to the highest position, supportinghead of bed to the highest position, supporting
the resident’s body and head in an uprightthe resident’s body and head in an upright
position.position.

20. Guidelines that promote
nutrition and safe eating
 Use gloves if CNA will touch significantUse gloves if CNA will touch significant
mouth secretions while feeding.mouth secretions while feeding.

21. Assist resident at mealtime
 Provide for positive atmosphere andProvide for positive atmosphere and
social interaction.social interaction.
 Position resident to have eye contact withPosition resident to have eye contact with
others during mealtime.others during mealtime.
 Talk with residents during mealtime. (StaffTalk with residents during mealtime. (Staff
conversations that do not include residentsconversations that do not include residents
convey disrespect)convey disrespect)

22. While serving food
 Assure that resident receives theAssure that resident receives the
correct food. Some resident havecorrect food. Some resident have
special diets.special diets.
 Ask resident if she/he needs assistanceAsk resident if she/he needs assistance
in preparing food for eating.in preparing food for eating.
 Example: CNA may add seasonings toExample: CNA may add seasonings to
food, open packages of crackers, cut meatfood, open packages of crackers, cut meat
or add sugar to coffee.or add sugar to coffee.
 Assist resident with visual impairment toAssist resident with visual impairment to
locate food and utensilslocate food and utensils

23. While serving food
 Supplemental food or snacks may beSupplemental food or snacks may be
given to resident between meals.given to resident between meals.
 Do not touch any of the food with yourDo not touch any of the food with your
fingers.fingers.
 Do not blow on the food to cool it.Do not blow on the food to cool it.
 Open the straw wrapper carefully beingOpen the straw wrapper carefully being
sure not to touch either end of thesure not to touch either end of the
straw.straw.

24. Promote independent eating
 Use adaptive equipment such as plateUse adaptive equipment such as plate
guard or adapted spoon to aid theguard or adapted spoon to aid the
resident in independent eating. Aresident in independent eating. A
capped spout cup may be used by acapped spout cup may be used by a
resident who cannot control a straw orresident who cannot control a straw or
open cup.open cup.
 Presenting food in form that is easilyPresenting food in form that is easily
managed will help independent eatingmanaged will help independent eating
(for example finger food)(for example finger food)

25. Promote independent eating
 Offer feeding assistance, starting withOffer feeding assistance, starting with
the least assistance and adding thethe least assistance and adding the
next level as needed.next level as needed.
 Social interaction (talking with resident onSocial interaction (talking with resident on
way to dining room)way to dining room)
 Nonverbal cueing (placing food in front ofNonverbal cueing (placing food in front of
resident)resident)
 Verbal cueing (How about some meatloaf)Verbal cueing (How about some meatloaf)
 Physical guidance (hand over handPhysical guidance (hand over hand
techniques guiding residents hand to holdtechniques guiding residents hand to hold
utensils)utensils)

26. Promote independent eating
 Full assistanceFull assistance
 Continue to offer feeding assistance untilContinue to offer feeding assistance until
resident ends the meal, verbally orresident ends the meal, verbally or
nonverbally.nonverbally.

27. Assist resident if he/she is
unable to feed self
 CNA should sit at or below theCNA should sit at or below the
resident’s eye level to promoteresident’s eye level to promote
interaction.interaction.
 Encourage resident to chew thoroughlyEncourage resident to chew thoroughly
and appreciate the flavors of foods.and appreciate the flavors of foods.
 Convey patience.Convey patience.
 Give time to talk between bites of food.Give time to talk between bites of food.

28. Assist resident if he/she is
unable to feed self
 Maintain separate flavors of foods. Do not stirMaintain separate flavors of foods. Do not stir
all foods together.all foods together.
 Identify food as it is fed to resident .”This isIdentify food as it is fed to resident .”This is
mashed potatoes. Now I’ll give you meatloaf”mashed potatoes. Now I’ll give you meatloaf”
 Alternate liquids and solids as the residentAlternate liquids and solids as the resident
prefers.prefers.
 Use fork with care. Load food on tip of spoon orUse fork with care. Load food on tip of spoon or
fork, presenting an amount that the residentfork, presenting an amount that the resident
can easily chew and swallow.can easily chew and swallow.

29. Assist resident if he/she is
unable to feed self
 Use napkin to frequently remove food particles fromUse napkin to frequently remove food particles from
face and clothing.face and clothing.
 Observe resident carefully for effective managementObserve resident carefully for effective management
of food and swallowing. Report observations to nurseof food and swallowing. Report observations to nurse..
 If resident shows signs of pain while chewing or swallowing,If resident shows signs of pain while chewing or swallowing,
report to nurse.report to nurse.
 If resident has facial or mouth weakness, observe forIf resident has facial or mouth weakness, observe for
retention of food debris inside affected cheek.retention of food debris inside affected cheek.
 If resident begins coughing, stop assisting to eat or drinkIf resident begins coughing, stop assisting to eat or drink
until resident recovers.until resident recovers.
 If resident vomits, provide for comfort and requestIf resident vomits, provide for comfort and request
assistance to clean area promptly.assistance to clean area promptly.

30. Assisting residents who have
dysphagia
 DIFFICULTY SWALLOWINGDIFFICULTY SWALLOWING
 Special care is needed to preventSpecial care is needed to prevent
aspiration (food and liquid is inhaledaspiration (food and liquid is inhaled
into the lungs)into the lungs)
 Speech therapist may develop specificSpeech therapist may develop specific
plan for assisting resident.plan for assisting resident.
 Assist resident to upright position withAssist resident to upright position with
head flexed slightly forward.head flexed slightly forward.
 Offer small amounts, giving resident timeOffer small amounts, giving resident time
to swallow. Provide encouragement.to swallow. Provide encouragement.

31. Food thickeners
 Thickeners may be used to assist theThickeners may be used to assist the
resident who has difficulty swallowing.resident who has difficulty swallowing.
 Thickener changes consistency but notThickener changes consistency but not
flavor of food.flavor of food.
 Follow care plan for use. FollowFollow care plan for use. Follow
manufacturers directions to prepare.manufacturers directions to prepare.
Common consistency levels are nectar,Common consistency levels are nectar,
honey and pudding thick.honey and pudding thick.

32. Guidelines that promote fluid
intake and good hydration
 An adequate amount of water andAn adequate amount of water and
other liquids is necessary for properother liquids is necessary for proper
body functioning.body functioning.
 Approximately 48-64 ounces(1500-Approximately 48-64 ounces(1500-
2000ml) of liquid is needed daily.2000ml) of liquid is needed daily.
 The body obtains liquid from within fruitsThe body obtains liquid from within fruits
and vegetables as well as from what isand vegetables as well as from what is
typically viewed as liquid.typically viewed as liquid.
 Dehydration results from inadequate fluidDehydration results from inadequate fluid
intake or excessive fluid loss.intake or excessive fluid loss.

33. Guidelines that promote fluid
intake and good hydration
 Techniques to promote adequate fluid intake.Techniques to promote adequate fluid intake.
 Fluids easily available to resident.Fluids easily available to resident.
 Water pitcher is kept in resident’s living space, at bedsideWater pitcher is kept in resident’s living space, at bedside
or otherwise within reach.or otherwise within reach.
 Glass or cup, filled with liquid is placed within resident’sGlass or cup, filled with liquid is placed within resident’s
reach at dining table.reach at dining table.
Fluids offered to residents at regular intervals. The elderlyFluids offered to residents at regular intervals. The elderly
typically have decreased thirst sensation, and are lesstypically have decreased thirst sensation, and are less
aware of need to increase fluid intake.aware of need to increase fluid intake.
Offer liquids that the resident prefers.Offer liquids that the resident prefers.
Snacks of juice or other fluids may be distributed betweenSnacks of juice or other fluids may be distributed between
meals.meals.

34. Guidelines that promote fluid
intake and good hydration
 Resident may be cued to remind of thirstResident may be cued to remind of thirst
”Does your mouth feel dry? Here is”Does your mouth feel dry? Here is
something to drink.”something to drink.”
 Cue or offer fluids with every residentCue or offer fluids with every resident
contact, whenever care is given.contact, whenever care is given.
Regular toileting opportunities provided forRegular toileting opportunities provided for
resident who limit fluid intake becauseresident who limit fluid intake because
he/she fears incontinence.he/she fears incontinence.

35. Fluid Restriction
 The physician may order severelyThe physician may order severely
restricted fluid intake as a way ofrestricted fluid intake as a way of
managing certain medical conditions.managing certain medical conditions.
The nurse will determine how toThe nurse will determine how to
allocate the restricted total over a 24-allocate the restricted total over a 24-
hour period. The CNA must monitor allhour period. The CNA must monitor all
fluid intake, both at meals and betweenfluid intake, both at meals and between
meals to help the resident stay with inmeals to help the resident stay with in
the 24-hour total.the 24-hour total.

36. Recording food intake
 Identifying and recording the amount of foodIdentifying and recording the amount of food
intake is an important part of assisting theintake is an important part of assisting the
resident to meet goals for good nutrition.resident to meet goals for good nutrition.
 Following a meal or snack, the proportion ofFollowing a meal or snack, the proportion of
food eaten is usually recorded as a fraction orfood eaten is usually recorded as a fraction or
percentage.percentage.
 Example : the resident ate 50% or ½ of snack.Example : the resident ate 50% or ½ of snack.
Follow facility policy for reporting food intake to nurse.Follow facility policy for reporting food intake to nurse.
Example : eating less than 75% of meal is reportedExample : eating less than 75% of meal is reported
to nurse.to nurse.

37. Weighing
 Why weight is measured and recordedWhy weight is measured and recorded
 To monitor nutrition status-find out if resident’sTo monitor nutrition status-find out if resident’s
caloric intake is adequate for his/her energy needs.caloric intake is adequate for his/her energy needs.
 To monitor fluid balance-body may retain fluid asTo monitor fluid balance-body may retain fluid as
part of a medical condition. Diuretic medication maypart of a medical condition. Diuretic medication may
be used to help the body eliminate excess fluid.be used to help the body eliminate excess fluid.
Edema may be another sign of fluid retention.Edema may be another sign of fluid retention.

38. Weighing continued…
 How to measure weight accuratelyHow to measure weight accurately
 Weigh resident at same time of day(oftenWeigh resident at same time of day(often
before eating morning meal) and in samebefore eating morning meal) and in same
type of clothing.type of clothing.
 Use the same scale each time. Check toUse the same scale each time. Check to
see that the scale balances beforesee that the scale balances before
weighing resident.weighing resident.
 Compare weight to previous weight.Compare weight to previous weight.
Report changes according to facility policy.Report changes according to facility policy.

39. Long-term care facility diets
 Meeting nutritional needs happens whenMeeting nutritional needs happens when
nutritious foods are presented and the residentnutritious foods are presented and the resident
eats the foods. Providing appetizing food is oneeats the foods. Providing appetizing food is one
of the ways that a long-term care facility meetsof the ways that a long-term care facility meets
the goal of providing highest quality of life forthe goal of providing highest quality of life for
residents. The facility may choose to use whatresidents. The facility may choose to use what
is a “liberalized” diet menu plan rather thanis a “liberalized” diet menu plan rather than
traditional “therapeutic diets”traditional “therapeutic diets”

40. Regular Diet
 Includes all foods, used for mostIncludes all foods, used for most
residents.residents.
 Calories, fat and sodium areCalories, fat and sodium are
controlled(about 2000 calories, 30% ofcontrolled(about 2000 calories, 30% of
calories from fat, about 3000mg ofcalories from fat, about 3000mg of
sodium per day)sodium per day)

41. Mechanical Soft Diet
 For resident who has difficulty chewingFor resident who has difficulty chewing
or swallowing.or swallowing.
 Food is easy to chew and swallow,Food is easy to chew and swallow,
such as bread, cooked cereals, drysuch as bread, cooked cereals, dry
cereals, rice, pasta; all canned, cookedcereals, rice, pasta; all canned, cooked
or frozen fruits and vegetables; all freshor frozen fruits and vegetables; all fresh
fruits and vegetables that are easy tofruits and vegetables that are easy to
chew or finely chopped ; eggs, cheese,chew or finely chopped ; eggs, cheese,
peanut butter, tender meats and fish.peanut butter, tender meats and fish.

42. Pureed Diet
 For resident who has more difficultyFor resident who has more difficulty
chewing or swallowing.chewing or swallowing.
 Foods that are soft and/or smooth inFoods that are soft and/or smooth in
texture. Retaining food flavors andtexture. Retaining food flavors and
appealing appearance is an issue.appealing appearance is an issue.

43. Liquid Diet
 For resident in preparation for diagnostic testsFor resident in preparation for diagnostic tests
or following surgery or digestive system upset.or following surgery or digestive system upset.
Is not nutritionally adequate for long-term use.Is not nutritionally adequate for long-term use.
 Contains foods that are liquid at bodyContains foods that are liquid at body
temperature.temperature.
 Clear Liquid-liquids one can see throughClear Liquid-liquids one can see through
 Full Liquid- other liquids, including milk-basedFull Liquid- other liquids, including milk-based
liquidsliquids

44. Low Concentrated Sweets
Diet
 Also called limited concentrated sweets,Also called limited concentrated sweets,
consistent carbohydrate, or no concentratedconsistent carbohydrate, or no concentrated
sweets.sweets.
 For resident with diabetes. Food intake is balancedFor resident with diabetes. Food intake is balanced
with insulin need.with insulin need.
 Regular diet with limits on foods containing a highRegular diet with limits on foods containing a high
amount of simple sugar.amount of simple sugar.
 Resident is encouraged to eat all of meal or snackResident is encouraged to eat all of meal or snack
provided.provided.
 Notify nurse if resident is unable to eat or ifNotify nurse if resident is unable to eat or if
meal/snacks are delayed or omitted.meal/snacks are delayed or omitted.

45. No Added Salt Diet
 For resident with heart or kidneyFor resident with heart or kidney
disease, who has trouble with fluiddisease, who has trouble with fluid
retention.retention.
 No additional salt at the table.No additional salt at the table.
Seasonings or salt substitute may beSeasonings or salt substitute may be
used to enhance flavor.used to enhance flavor.

46. No Added Fat Diet
 For resident who has difficulty digestingFor resident who has difficulty digesting
fat or who has elevated cholesterol.fat or who has elevated cholesterol.
 Omits foods that are high inOmits foods that are high in
fat/cholesterol, such as regular gravies,fat/cholesterol, such as regular gravies,
bacon and butter/margarine.bacon and butter/margarine.
Alternatives are used, such as low fatAlternatives are used, such as low fat
salad dressings and skim milk.salad dressings and skim milk.

47. Calorie Controlled-Low
 For resident who needs to lose weightFor resident who needs to lose weight
or has low energy needs.or has low energy needs.
 Contains foods that are lower inContains foods that are lower in
calories, as the name explains. Maycalories, as the name explains. May
have smaller servings.have smaller servings.

48. Calorie Controlled-High
 For residents who needs to gain weightFor residents who needs to gain weight
or has high energy needs.or has high energy needs.
 Contains foods that are fortified withContains foods that are fortified with
high calorie ingredients such as dryhigh calorie ingredients such as dry
milk powder, sugar, cream and butter.milk powder, sugar, cream and butter.
Snacks between meals may includeSnacks between meals may include
canned liquid supplements or liquidcanned liquid supplements or liquid
“shakes” made onsite.“shakes” made onsite.