chapter 19 nutrition and fluids all items and derived items © 2015, 2011 by mosby, inc., an imprint...

Chapter 19

Nutrition and Fluids

All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Nutrition

The person’s diet affects physical and mental well-being.

A poor diet and poor eating habits: 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 Eating and drinking provide pleasure.

2All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Dietary Factors

Many factors affect dietary practices. 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.


Basic Nutrition

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. Nutrients are grouped into fats, proteins,

carbohydrates, vitamins, minerals, and water.


Dietary Guidelines

The Dietary Guidelines for Americans 2010 are for persons 2 years of age and older. 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

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.


MyPlate

MyPlate includes “Steps to a Healthier You.” 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 Grains Vegetables Fruits Dairy Proteins Oils


Essential Nutrients

Nutrients 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.


Nutrition

● Minerals are used for many body processes. 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: Serving size and number of servings/package Calories and calories from fat Nutrients


Factors Affecting Eating and Nutrition

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.


Factors Affecting Eating

Personal choice Body reactions Illness Chewing and swallowing Disability Age

With aging, changes occur in the gastro-intestinal (GI) system.


OBRA and CMS Dietary Requirements

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.


Meeting Nutritional Needs

Other foods (of similar nutritional value) are offered to residents who refuse the food served.

Each person receives at least three meals a day. A bedtime snack is offered.

The center provides needed adaptive equipment and utensils.


Special Diets

Doctors may order special diets: 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.


Sodium

The sodium-controlled diet 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


Diabetic Nutrition

Diabetes meal planning is for people with diabetes. Diabetes is usually treated with insulin or other drugs, diet,

and exercise. The dietitian and person develop a meal plan that involves:

• The person’s food preferences

• Calories needed

• Eating meals and snacks at regular times

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.


Dysphagia

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: Choking, coughing, or difficulty breathing during or after meals Abnormal breathing or respiratory sounds


Fluid Balance

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. If fluid intake exceeds fluid output, body tissues

swell with water (edema). If fluid output exceeds intake, dehydration occurs.


Fluid Requirements and Orders

Normal fluid requirements 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.

Encourage fluids Restrict fluids Nothing by mouth (NPO) Thickened liquids


Intake and Output

Intake and output (I&O) records: 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.


Meeting Food and Fluid Needs

The following can affect appetite and ability to eat: Weakness, illness, and confusion Unpleasant odors, sights, and sounds An uncomfortable position The need for oral hygiene The need to eliminate Pain


Dining Programs

Dining programs meet the needs of the following residents: 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


Types of Dining Programs

The following dining programs are common in nursing centers: Social dining Family dining Low-stimulation dining Restaurant-style menus Open-dining


Preparing Residents for Meals

Preparing for meals 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.


Serving Meals

Serving meal trays 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: Serve food and fluids in the order the person prefers. Offer fluids during the meal. Use teaspoons to feed the person.


Persons who need to be fed may: Be angry, humiliated, and embarrassed Be depressed or resentful Refuse to eat

Let the person do as much as possible. Always tell the visually impaired person what is on

the tray. 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.

Feeding the Person


Feeding the Person (Cont’d)

Meals provide social contact with others. Engage the person in pleasant conversation. Sit facing the person.

Persons with dementia may: 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


Between Meals

Between-meal nourishments 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. Providing drinking water

Residents need fresh drinking water each shift and whenever the pitcher is empty.

Calorie counts On a flow sheet, note what the person ate and how much. A nurse or dietitian converts the portions into calories.


Foodborne Illnesses

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. Signs and symptoms depend on the pathogen.

Food is not sterile. 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.


Keep Food Safe

To keep food safe, the United States Department of Agriculture (USDA) recommends four tips: 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.


Quality of Life

Nutrition and fluid balance are important for quality of life.

The right to personal choice is important in meeting food and fluid needs. 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.


chapter 19 nutrition and fluids all items and derived items © 2015, 2011 by mosby, inc., an imprint...

Documents

derived items

imprint of elsevier

body stores vitamins

body processes

dietary guidelines

certain vitamins

certain body functions

dietary factors