Nutrition and Fluid Balance Chapter 14

Weight loss in elderly Malnutrition, unhealthy weight loss, and dehydration are serious problems among the elderly. Depression, less sensitivity to taste, decreased gastrointestinal function, low physical activity, and slowing of metabolism contribute to weight loss in elderly. Food should look attractive, be warm, soft, be one of their favorite, and have pleasant taste in order to improve appetite in elderly.

Nutritionist Sometimes older people have their preference for food and stick to certain foods, like ice cream. We should try to accommodate their choice without compromising nutritional value of food. It is a challenging task, that’s why most of facilities have a specialist – nutritionist for at least part time.

Nutritionist Monitors weight loss on patients and recommends supplemental nutrition to patients with unstable weight. Analyzes how much food patients eat and what their preferences and makes recommendations for their menu. Nutritionist specialty requires Bachelor or Master Degree in Nutrition.

Food monitoring Patients with weight loss require food monitoring. Nursing Assistant responsibility is to record how much and what food patients ate every meal. Then this data goes to the nutritionist. Monitoring is done in percentage for solid food and ml for fluids Bread – 50% Turkey – 20 % Vegetables – 80% Starch (mash potatoes) – 100% Desert 50% Milk 240 ml Milk shake 120 ml Juice 100 ml

I=O Intake and output = I&O Intake – the amount of liquids patient consumed in a given time (shift or 24 hours) Intake and output should be equal in a given time Output – the amount of liquids patient lost in a given time (urine, vomiting, diarrhea) I=O From the previous slide – what should be counted toward Intake?

Fluid balance Fluid balance occurs when person consumes and eliminates equal amount of fluid Count of intake and output can be ordered by physician for monitoring certain conditions as CHF – congestive heart failure, and ARF – acute renal failure

Urine output less than 240 ml in 8 hours (one shift) Dangerous signs Urine output less than 240 ml in 8 hours (one shift) This is a sign of acute renal failure! Report immediately to the nurse and chart!

Signs of fluid misbalance Dehydration is a condition when there is not enough fluid in the body: Signs: dry mouth and throat, thirst, dark urine, low blood pressure. Causes of dehydration: Difficulty swallowing, not drinking enough fluids during meals, nursing assistant not offering fluids to resident every time they see resident Fluid overload – too much fluid in the body, Happens to patients with CHF, CRF, liver cirrhosis, etc Signs: weight gain more then 1 pound a day, swelling of ankles, feet, hands, increased abdominal grid, dyspnea (difficulty breathing), SOB – fast, shallow breathing This patients require close monitoring of their I&O and weight, to gave accurate data to MD to adjust treatment

Fluid restriction Can be prescribed by MD to relieve fluid overload in patient Know the amount of fluids allowed to the patient during a day. It can be as little as 500ml, up to 2000ml per doctor’s order Monitor I&O closely, count intake during the day not to exceed the daily allowed amount Diuretics (medications increasing urinary output) can be prescribed by MD to the remove excess of fluid from the body Urinary output in these patients is much higher then intake, sometimes 1000 – 3000 ml a day

Liquids count 1 oz = 30 ml

Liquids count Average size cup: 8 oz = 240 ml

Liquids count Small cup 4 oz = 120 ml

Liquids count Big cup, or coffee mug 12 oz = 360 ml

Activity Get a medicine 30 ml cup, spoon, and a mug from our kitchen Using spoon define how many spoons of water fit into the 30 ml cup. Define what a volume of the spoon is. Using 30 ml cup define how much ml is in your chosen mug Keep your medicine cup, mug filled with water, and a spoon for the next activity.

Exercise – I&Os of a patient Patient’s intake for the day: Breakfast – average size mug of coffee Lunch – 120 ml of milk, 1 cup of milk Dinner – 120 ml of juice, 12 oz of tea Output: 1200 ml of urine through the day Questions: Are I&Os of this patient balanced?

Dehydration Remember that most residents in the nursing home unable to drink without help or even realize that they are thirsty. You can notice their dry mouth and lips and low blood pressure. That would be a sign of dehydration. Most of residents unfortunately have liquids only during their meals, so even in case they refuse most of their food, try to gently encourage them to finish their liquids.

Dehydration Some facilities have Hydration Cards in the hall. Offer fluids to residents often.

Dysphasia and aspiration If patient has dysphasia (difficulty swallowing), thickening of liquids could be prescribed by speech therapist (specialist in swallowing) to ease swallowing Liquids are the hardest thing to swallow for patient with dysphasia. Choking, coughing, and watering eyes during meals are first signs of dysphasia. It is Nursing Assistant responsibility to report it to the nurse or speech therapist Thickening liquids will be ordered for dysphasia http://www.youtube.com/watch? v=wqMCzuIiPaM http://www.youtube.com/watch? v=1sFNMk87558&feature=rela ted

Nectar thick liquids Nectar thick liquids are thick as a pulp juice, such as mango or tomato juice

Honey thick liquids Honey-thickened liquids are defined as liquids that coat the spoon. They are pourable, but not runny. They thick as honey

Spoon thick liquids Stays in spoon when it turn upside down

NPO NPO means nothing by mouth Can be ordered prior to certain procedures and exams The note NPO will be placed on the door for staff not to give food to the patient Fasting – is a practice during which food is voluntarily given up for a period of time

Homework Chapter 14 Nutrition WB, test and 10 abbreviations #83-92 due on Friday Dec 9 $12 for BLS card Bring your stethoscope, if you have one, and a watch for tomorrow and for the rest of the week as we will need it for a disaster drill. Bring canned and dry food for the food drive – points per leadership paper.

Six basic nutrients 1. Water – the most essential nutrient for life, solvent for everything. People can’t survive without water for more than 7 days, vs 40 days without food 2. Fats - source of prolonged energy 3. Carbohydrates – fast source of energy, slows down with fiber 4. Proteins – help the body to grow new tissue, essential for immune system. 5. Vitamins – enable chemical reactions in the body 6.Minerals – essential for bones Ca – calcium, fluid balance - Na sodium, Cl chloride, neurons conductivity - K potassium, thyroid function – I iodine

USDA My Plate USDA – United States Department of Agriculture developed the icon My Plate for visualization of healthy eating habits for general public

My plate Is developed in 2011 to provide a general guidelines to people to avoid extremes in their diets. Principles: 1. Half of your daily menu should be vegetables and fruits 2. Eat more plant based proteins 3. Eat seafood twice per week 4. Consume fat free or low-fat milk (1%) 5. Follow your calorie recommended intake.

What is your calorie recommended intake? http://nutritiondata.self.com/tools/calories-burned Activity: open this site, find out your BMI Calorie recommended intake Protein intake How many calories are in an apple, a slice of pizza, a hamburger Recommended weight: Calculator.net http://www.calculator.net/ideal-weight- calculator.html?ctype=standard&cage=53&csex=f&ch eightfeet=5&cheightinch=4&cheightmeter=180&print it=0&x=57&y=8

Various Diets - NIH site http://www.nlm.nih.gov/me dlineplus/diets.html Clear liquid Full Liquid Bland, mechanical soft, pureed Cardiac Diabetic Renal Hepatic Gluten free High fiber Low fiber Vegetarian Vegan Vegan raw Mediterranean Calorie count Low carb Atkins South beach

How to read Nutrition Facts Label http://www.fda.gov/Food/ResourcesForYou/Consu mers/NFLPM/ucm274593.htm Activity: How much protein do I need? http://exercise.about.com/cs/nutrition/a/protein_2. htm http://www.cdc.gov/nutrition/everyone/basics/prot ein.html What are the types of protein? Write it in your notebook. http://www.cdc.gov/nutrition/everyone/basics/prot ein.html#Types of protein

Milk: to drink or not to drink? This is a question… http://www.youtube.com/watch?v=MkPnUL5xfYA 10 min

How drinking the diet soda can make you to gain weight? http://www.youtube.com/watch?v=hpoAtwVyzZI 9 min

Feeding the patient Serving meal trays: Serve patients table by table Check the meal card with the patient’s bracelet to avoid serving wrong food to the wrong patient Prepare food – open milk cartoons, butter cups, cut the meat in pieces Do only what resident can’t do for themselves – encourage independence

Each patient is unique in their eating habits Observe and the patient to find out the best approach to their feeding Follow the aspiration precautions: Be sure patient swallowed the previous bite before offering another one – observe “Adam Apple” moving

Feeding the blind patient Use the imaginary clock to explain the position of what is in front of them.

Test of content 1. Decode a diet order: A. Regular, Regular, Thin B. NAS, Regular, Nectar C. Regular, Mechanical soft, Honey D. Regular, Pureed, Spoon thick 1. Which 8 hours shift I&O you should report immediately? A. I: 1200 O: 1300 B. I: 1500 O: 2300 C. I: 1100 O:210

Test of content What is constipation? What is diarrhea? What is fluid restriction?