Chapter 24 Nutrition and Fluids Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Dietary Practices  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  Culture, finances, and personal choice affect dietary practices. Slide 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

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. Slide 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 The Dietary Guidelines for Americans, 2010 is for persons 2 years of age and older.  The Dietary Guidelines help people: Attain and maintain a healthy weight. Attain and maintain a healthy weight. Reduce the risk of chronic disease. Reduce the risk of chronic disease. Promote overall health. Promote overall health.  The Guidelines focus on: Consuming fewer calories Consuming fewer calories Making informed food choices Making informed food choices Being physically active Being physically active Slide 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Basic Nutrition (cont’d)

 The MyPtate symbol encourages healthy eating from 5 food groups.  MyPlate, issued by the United States Department of Agriculture (USDA), helps you make wise food choices by:   Balancing calories   Increasing certain foods   Reducing certain foods   The USDA recommends that adults do at least one of the following:   2 hours and 30 minutes each week of moderate physical activity   1 hour and 15 minutes each week of vigorous physical activity Slide 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Basic Nutrition (cont’d)

 Nutrients  Protein is the most important nutrient. It is needed for tissue growth and repair. It is needed for tissue growth and repair.  Carbohydrates provide energy and fiber for bowel elimination.  Fats provide energy. They provide and help the body use certain vitamins. They provide and help the body use certain vitamins.  Vitamins are needed for certain body functions.  Minerals are used for many body processes.  Water is needed for all body processes. Slide 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Basic Nutrition (cont’d)

 Food labels  Food labels are used to make informed food choices for a healthy diet.  Food labels contain information about: Serving size and the number of servings in each package Serving size and the number of servings in each package Calories and calories from fat Calories and calories from fat Nutrients Nutrients  How a serving fits into the daily diet is called the Daily Value (DV). The DV is a percent based on 2000 calories daily. The DV is a percent based on 2000 calories daily. Slide 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Basic Nutrition (cont’d)

MEETING NUTRITIONAL NEEDS  A team approach is needed to meet a person’s nutritional needs.  The nutritional care plan involves the person’s:  Likes and dislikes  Lifelong habits Slide 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Special Diets  Doctors may order special diets:  For a nutritional deficiency or a disease  For weight control (gain or loss)  To eliminate or decrease certain substances in the diet  The health team considers the need for dietary changes, personal choices, religion, culture, and eating problems.  Regular diet, general diet, and house diet mean no dietary limits or restrictions. Slide 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Special Diets (cont’d)  The sodium-controlled diet  Sodium causes the body to retain water. The heart has to work harder. The extra workload can cause serious problems or death. The heart has to work harder. The extra workload can cause serious problems or death.  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 Omitting high-sodium foods Not adding salt to food at the table Not adding salt to food at the table Limiting the amount of salt used in cooking Limiting the amount of salt used in cooking Diet planning Diet planning Slide 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Diabetes meal plan  A meal plan for health eating is developed. Consistency is key. Consistency is key.  The meal plan involves: The person’s food preferences The person’s food preferences Calories needed Calories needed Eating meals and snacks at regular times Eating meals and snacks at regular times  You need to: Serve meals and snacks on time. Serve meals and snacks on time. Always check what was eaten. Always check what was eaten. Report what the person did and did not eat. Report what the person did and did not eat. Report changes in the person’s eating habits. Report changes in the person’s eating habits. Slide 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Special Diets (cont’d)

 The dysphagia diet  Dysphagia means difficulty swallowing. Food thickness is changed to meet the person’s needs. Food thickness is changed to meet the person’s needs.  Doctor, speech-language pathologist, occupational therapist, dietitian, and nurse choose food thickness.  When feeding the person with dysphagia, you must: Know the signs and symptoms of dysphagia. Know the signs and symptoms of dysphagia. Feed the person according to the care plan. Feed the person according to the care plan. Follow aspiration precautions and the care plan. Follow aspiration precautions and the care plan. Report changes in how the person eats. Report changes in how the person eats. Observe for signs and symptoms of aspiration: choking, coughing, or difficulty breathing during or after meals, and abnormal breathing or respiratory sounds. Observe for signs and symptoms of aspiration: choking, coughing, or difficulty breathing during or after meals, and abnormal breathing or respiratory sounds.  Report these observations at once. Slide 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Special Diets (cont’d)

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. This is called edema.  If fluid output exceeds intake, dehydration occurs. Slide 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Fluid Balance (cont’d)  Normal fluid requirements  An adult needs 1500 mL (milliliters) of water daily to survive.  About 2000 to 2500 mL are needed for normal fluid balance.  The water requirement increases with: Hot weather Hot weather Exercise Exercise Fever and illness Fever and illness Excess fluid losses Excess fluid losses Slide 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Common special fluid orders are:  Encourage fluids: the person drinks an increased amount of fluids.  Restrict fluids: fluids are limited to a certain amount.  Nothing by mouth (NPO): the person cannot eat or drink anything.  Thickened liquids: all fluids are thickened, including water. Slide 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Fluid Balance (cont’d)

 Intake and output (I&O) records  The doctor or nurse may order (I&O) measurements.  I&O records are kept: To evaluate fluid balance and kidney function To evaluate fluid balance and kidney function To help in planning medical treatment To help in planning medical treatment When the person has special fluid orders When the person has special fluid orders  The following fluids are measured and recorded: All fluids taken by mouth All fluids taken by mouth Foods that melt at room temperature Foods that melt at room temperature IV fluids and tube feedings IV fluids and tube feedings  Output includes urine, vomitus, diarrhea, and wound drainage. Slide 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Fluid Balance (cont’d)

 Measuring intake and output Intake and output are measured in milliliters (mL). Intake and output are measured in milliliters (mL). A measuring container for fluid is called a graduate. A measuring container for fluid is called a graduate. The measuring device is held at eye level to read the amount. The measuring device is held at eye level to read the amount. An I&O record is kept at the bedside. An I&O record is kept at the bedside. Amounts are totaled at the end of the shift. Amounts are totaled at the end of the shift. The purpose of measuring I&O and how to help are explained to the person. The purpose of measuring I&O and how to help are explained to the person. The urinal, commode, bedpan, or specimen pan is used for voiding. The urinal, commode, bedpan, or specimen pan is used for voiding. Slide 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Fluid Balance (cont’d)

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 Slide 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Meeting Food and Fluid Needs (cont’d)  Preparing for meals  To promote comfort when preparing patients and residents for meals: Assist with elimination needs. Assist with elimination needs. Provide oral hygiene. Provide oral hygiene.  Make sure needed dentures are in place. Make sure eyeglasses and hearing aids are in place (if worn). Make sure eyeglasses and hearing aids are in place (if worn). Make sure incontinent persons are clean and dry. Make sure incontinent persons are clean and dry. Position the person in a comfortable position. Position the person in a comfortable position. Assist the person with hand washing. Assist the person with hand washing. Slide 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Serving meals  You serve meals after preparing patients and residents for meals.  Some agencies have “room service” meal programs.  Serve meals in the assigned order.  If food is not served within 15 minutes, re-check food temperatures. Slide 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Meeting Food and Fluid Needs (cont’d)

 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.  Let the person do as much as possible.  Always tell the visually impaired person what is on the tray.  When feeding visually impaired persons, describe what you are offering. For persons who feed themselves, describe foods and fluids and their places on the tray. For persons who feed themselves, describe foods and fluids and their places on the tray. Use the numbers on a clock for the location of foods. Use the numbers on a clock for the location of foods. Slide 21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Meeting Food and Fluid Needs (cont’d)

 Allow time and privacy for prayer.  Engage the person in pleasant conversation.  Allow time for chewing and swallowing.  Sit facing the person. You can see how well the person is eating. You can see how well the person is eating. You can also see if the person has problems swallowing. You can also see if the person has problems swallowing. Slide 22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Meeting Food and Fluid Needs (cont’d)

 Between-meal nourishments  Snacks are served upon arrival on the nursing unit.  Follow the same considerations and procedures as for serving meals and feeding persons.  Calorie counts  On a flow sheet, note what the person ate and how much.  A nurse or dietitian converts the portions into calories.  Providing drinking water  Patients and residents need fresh drinking water each shift and whenever the pitcher is empty.  Follow the agency’s procedure for providing fresh drinking water. Slide 23 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Meeting Food and Fluid Needs (cont’d)

Foodborne Illnesses  A foodborne illness (food poisoning) is caused by pathogens in food and fluids.  Report signs and symptoms to the nurse at once.  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  F and 140  F. This range is called the danger zone by the USDA. This range is called the danger zone by the USDA. Slide 24 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Foodborne Illnesses (cont’d)  To keep food safe, the USDA recommends these 4 safety tips.  Clean. Wash hands, utensils, and counter tops often. Wash hands, utensils, and counter tops often.  Separate. Avoid cross-contamination. Avoid cross-contamination.  Cook. Cook food to a safe internal temperature. Cook food to a safe internal temperature. Re-heat cooked food to 165  F. Re-heat cooked food to 165  F.  Chill. Refrigerate or freeze food within 2 hours. Refrigerate or freeze food within 2 hours. If the air is 90  F or above, chill food within 1 hour. If the air is 90  F or above, chill food within 1 hour. Slide 25 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.