1. Dining assistant-proper nutrition and hydration

2. Nutrition is how the body uses food to maintain health. – Need a well balanced diet with essential nutrient and plenty of fluids – Helps grow new cells, maintain normal body function and provide energy for activities – For the ill or elderly: helps maintain muscle and skin tissues, prevent pressure sores and promote healing of wounds.

3. What affects the intake of food? Loneliness or depression- little interest in food Weaker hand and arm muscle strength due to paralysis or tremors –make it difficult to eat Poor ability to chew or swallow- may not want to eat or can’t eat well People slow down- affects appetite Loss of vision- decreases appetite, makes it difficult to feed self well

4. Weakened sense of smell or taste-affects appetite Medications side effects –affect appetite Decrease saliva production- affects chew and swallow ability Dentures, tooth loss – make chewing difficult Digestion takes longer- affects appetite

5. Feeling rushed- negatively affects intake Not being allowed to finish- affects intake A lack of socialization- can decrease intake Tiring out- can affect intake Sense of thirst diminishes with age- affects intake

6. Six basic nutrients Protein- for tissue growth and repair and for energy. Source: fish, poultry, meat, eggs, milk, cheese, nuts, peas, beans Carbohydrates- for energy, for fiber. Source: bread, cereal, potatoes, rice, pasta, vegetables, fruits, sugars, syrups, jellies. Fats- help store energy, help absorb vitamins. Source: butter, margarine, salad dressings, oils, animal fats.

7. Vitamins- essential to allow the body to function. Sources: foods of all types. Minerals- form and maintain body cell functions, provide energy and regulate processes. Sources: many foods Water- assists in the digestion and absorption of food, helps eliminate waste, maintains body temperature. Sources: water and many foods

8. Six food groups/ Food Guide pyramid Grains: bread, cereal, rice, pasta- 6-11 servings per day Fruits: 2-4 servings per day Vegetables: 3-5 servings per day Dairy products: 2-3 servings per day Meat, poultry, fish, beans and nuts; 2-3 servings per day Fats, oils, and sweets- be sparing

9. Dietary department Plans, considers needs of individuals, prepares and presents food. Prepares diet cards containing: name, allergies, food likes and dislikes, special diets, other instructions Follow infection control in preparation

10. Water- essential for life Most residents: should drink at least 8 glasses, or 64 ounces, of water or other fluids a day. Helps prevent constipation and urinary incontinence, also helps prevent confusion. Prevents dehydration

11. Preventing dehydration Report observations and warning signs to the nurse immediately Encourage residents to drink every time you see them Offer fresh water and other fluids often Be aware of what they like and offer substitutions that they enjoy. Report if they don’t like something.

12. Offer gelatin, ice chips or popsicles often. Give fluids without ice if they prefer it. Offer sips of liquids between bites of food Make sure a pitcher of water and cup are nearby and light enough to lift and use. Offer assistance for those who need it. Report if the resident drinks little or no fluids at meals.

13. What to report ? If a resident needs help drinking from a cup If a resident has trouble swallowing liquids If a resident is easily confused or tired If a resident has a dry mouth If a resident has cracked lips If a resident has sunken eyes.

14. Special fluid orders Force fluids- encourage the resident to drink more fluids. Restrict fluids- the person is allowed to drink but must limit the daily amount to a specific level set by the doctor. Do not give them any extra fluids, do not give them a water pitcher unless the nurse approves it.

15. Unintended weight loss Can lead to skin breakdown, pressure sores, poor wound healing… is a serious problem.

16. How can I help prevent unintended weight loss? Encourage residents to eat Talk about food in a positive tone and words Honor food likes and dislikes Help those who need it Allow enough time for them to finish Season foods according to their preference Ask about it if they seem sad or have not appetite.

17. What to report about food? If resident needs help eating/drinking If resident eats less than half of the food served If a resident has mouth pain If the dentures aren’t fitting properly If a resident has difficulty chewing or swallowing If a resident coughs, or chokes while eating

18. If a resident is sad, has crying spells, or withdrawn from others If a resident keeps clearing their throat If a resident is confused, wanders, or paces If the resident drools or has nasal discharge during meals

19. Special diets Therapeutic, modified or special diets- ordered by the doctor for specific reasons. Dietitian then plans the diet.

20. Examples of special diets Low- sodium diet- might be on the diet slip as: Low Na to restrict certain foods or NAS, which means no added salt (people with heart disease, kidney disease) Low-protein diet- (people with kidney disease) Low-fat/low-cholesterol diet- Low fat/low chol. (people with gallbladder disease, liver disease)

21. No Concentrated Sweets: NCS for diabetics of need for keeping blood sugar under control. Will use artificial sweeteners, etc. ADA diets- will show the number of calories followed by ADA (American Diabetic Association) Modified calorie diet for weight loss- Low-cal.

22. Full liquid diet- usually ordered for a short time, includes cream soups, milk, ice cream and clear liquids. Clear liquid diet- includes clear juices, broth, gelatin, popsicles Soft diet- soft in texture, easier to chew and swallow, consists of soft and chopped foods

23. Pureed diet- blended into a past of baby food consistency, good for those who have difficulty chewing or swallowing more textured foods. NPO- nothing by mouth Thickened liquids: – Nectar thick- thicker than water like a thick juice – Honey thick- pours slowly, like honey consistency – Pudding thick- semi-solid, like pudding, will need a spoon.

24. How to record meal intake It is important for the staff to observe what and how much the resident is eating. The method of recording this varies in each facility – Some use percentage method 0%, 25%, 50%, 75% or 100% – Some use letters to correspond R (refused), P (poor), very little food eaten; F (fair), half of the food eaten; G (good), most of the feed is eaten; A (all) entire meal is eaten.

25. – Some use percentage of specific foods like, protein, fats, carbohydrates, etc. Document carefully Report to the charge nurse if a resident eats 25% or less of his or her meal.

26. How to record fluid intake A healthy person needs to take in 64-96 ounces (oz) of fluid each day. If it is less, he or she an become dehydrated. To record intake, you need to know how much fluid is in the cup or glass or bowl (jello etc) You need to know how much of the fluid the resident consumed.

27. Fluids are usually measured in cubic centimeters (cc’s). Ounces (oz) are converted to cc. To convert, multiply by 30. (30 cc= 1 oz) 1 cubic centimeter equals 1 milliliter (1cc= 1ml) (cc’s measure space taken up, ml measure liquid volume) (30cc or 30 ml = 1 oz)