1. 2010 LTC Continuing Education
July-Dec.: Dining, Nutrition, Hydration

2. Introduction:
People who are sick or elderly have different food requirements than young, healthy people. They are also more likely to suffer harm from not eating the right foods.
After age 50 there are chemical and physical changes in the body that affects nutritional needs.

3. Physical Changes After Age 50
After age 50 there are chemical and physical changes in the body that affect nutritional needs.
These changes include:
Metabolic Rate
Lean Tissue
Stomach Acid
Swallowing and Taste

4. Metabolic Rate
Metabolic Rate: The metabolic rate or metabolism slows down. The metabolic rate is the speed at which the body uses energy. Older bodies’ burn less fuel for daily operations. This means seniors need fewer calories for normal everyday activities. This also applies to anyone who is not very active or is confined to bed.

5. Lean Tissue
Lean tissue and muscle mass decrease. There is less bone mass. Body fat increases.

6. Stomach Acid
Stomach acid may decrease and the stomach might not empty as fast.
The intestine may absorb less nutrition from the food it gets.

7. Swallowing & Taste
Some people have trouble swallowing, especially those who have had strokes.
There is a loss of taste and smell. This causes people to be less interested in food.

8. More Physical Changes After Age 50
Other physical changes that occur after age 50 include:
Teeth and gums
Appetite and thirst
Medications
Disease

9. Teeth and gums
Tooth and gum problems increase, sometimes making it difficult to chew.
Dentures may not fit well.
Natural teeth may be decayed or missing
Gums may be tender or sore

10. Appetite and Thirst
Appetite and thirst decrease. Many elderly or ill people eat and drink less than they should. This leads to fatigue, sadness, infections, skin breakdown, and lack of energy.
Sometimes people are too tired or weak to eat an entire meal.

11. Medications
Medications can affect appetite or thirst. Sometimes medicines upset the stomach or cause intestinal problems like diarrhea or constipation.
Some foods and drinks can affect some types of medications.

12. Diseases Many diseases affect the way the body uses food or water.
Someone with an illness usually needs more food and water because the body needs energy to heal.
People with some conditions, however, must carefully control the amount and type of calories they take in. Diabetes is one example

13. Malnutrition
Bodies will break down if they do not get the type and amount of fuel they need.
Malnutrition means “badly nourished,” another way of saying that the person isn’t getting enough of the right nutrients the body needs to stay healthy.

14. Causes of Malnutrition
Malnutrition can be caused by not eating enough foods Malnutrition can also be caused by not adequately digesting and absorbing nutrients from food.

15. Dehydration Dehydration is a serious, sometimes fatal condition.
It means there are not enough body fluids and important blood salts in the body for it to carry on normal functions at the best level.
This happens by loss of fluids, not drinking enough water, or a combination of both.

16. Water
Water is essential in all the vital functions of the body. It is part of temperature regulation; building new cells; lubricating joints; and keeping the kidneys, brain, heart, and other organs working.

17. Thirst
Thirst is the warning signal that we should drink. However, just drinking when we are thirsty is not enough. Many people stay mildly dehydrated much of the time.

18. Dining, Nutrition, and Hydration
Dining, Nutrition, and Hydration are the process of providing nutrition by placing food into a resident’s mouth. It is important because nutrition is needed for survival.

19. Special Considerations
You need to be aware of special considerations or information when you are feeding your residents. Some of these include:
Dentures
Adaptive Equipment
Dysphagia

20. Special considerations: dentures
Keep in mind that confused residents with dentures sometimes remove the dentures and put them in a napkin or place them on the food tray. Check the tray before putting it back on the dietary cart.
Dentures may not fit well, so chewing is difficult. If you see this occur with a resident, report it to the nurse. The nurse may order a soft or pureed diet to make chewing easier.

21. Special considerations: Dysphagia
Dysphagia means difficulty swallowing.
Providing nutrition for a patient with dysphagia requires the following considerations:
Resident must be upright (90 Degrees is ideal),
Liquids may need to be thickened in accordance with a doctor’s order
Special diets may be ordered, such as no added salt or sugar
Patients choke easily, so be careful not to feed too much or too fast.

22. Special Considerations: Adaptive Equipment
You may need adaptive equipment for some residents.
Examples of adaptive equipment include:
plate guard
built-up spoon, fork or knife
rocker knife
Cut-out cup
2-handled cup
non-skid mat for under plate, or
sectioned plate.

23. Subject: Feeding a Dependent Resident
Policy: It is the policy of this facility to provide dining, nutrition and hydration assistance for all residents in accordance with
assessed needs,
the care plan, and
standards of practice.

24. Procedure for feeding a dependent patient
1. Check the tray ticket to verify correct food and drinks. 2. Deliver the tray to the resident. 3. Place the tray on a table in front of the resident. 4. Make sure the resident is in the proper position with head up (to prevent choking). 5. Prepare the tray in accordance with the care plan.

25. Procedure continued:
6. Assist the resident with a clothing protector or napkin. 7. Allow time for prayer if requested. 8. Sit facing the resident. 9. Explain to the resident the foods and fluids on the tray. 10. Open cartons/condiment packs for the resident if the resident is unable to do so.

26. Procedure continued:
11. Season foods according to the resident’s preferences and in accordance with the resident’s prescribed diet.
12. Cut food into bite-size pieces, per the resident’s choice.
13. Maintain separate flavors of foods.
14. Do not stir all foods together before feeding.

27. Procedure Continued
15. Identify the foods as you feed them to the resident; for example, “This is chicken, would you like some potatoes?”
16. Feed hot foods and liquids cautiously to prevent injuring the resident.
17. Allow adequate time for the resident to chew thoroughly.
18. Alternate liquids and solids as the resident prefers.
19. Watch carefully to see that the resident swallows.

28. Procedure concluded:
20. Serve, report, and record food and fluid intake as directed by the nurse.
21. Remove the tray.

29. Subject: Serving a Tray
Policy: It is the policy of this facility to provide feeding and meal assistance for all residents in accordance with
assessed needs,
the care plan, and
standards of practice.

30. Procedure for serving a tray:
Check the tray ticket to verify correct food, drinks.
Deliver the tray to the resident.
Place the tray on a table in front of the resident
Make sure the resident is in proper position with head up – (to prevent choking).
Prepare the tray in accordance with the care plan.

31. Serving a tray continued
Assist the resident with clothing protector or napkin.
Explain to the resident the foods and fluids on the tray.
Open cartons/condiment packs for the resident if they are unable to.
Season foods according to the resident’s preferences in accordance with prescribed diet.
Cut food into bite-size pieces, per resident choice.

32. Serving a tray continued
Ask the resident if he or she would like anything else and offer a substitute of similar nutritive value if the resident does not eat a particular food group. Remove tray with resident permission and check for resident requests. Record food and fluid intake and report any issues to the nurse.

33. Subject: Communication
C.N.A. to Nurse: Report to the nurse any changes in resident’s ability to eat, drink and any difficulty chewing or swallowing, or is a referral.
Nurse to Physician: Nurse should contact the doctor or dentist if the resident is having problems swallowing or is loosing weight related to refusal to eat.

34. Subject: Communication
Nurse to Psychiatrist: Report mood issues having an impact on the resident’s desire to eat.
Nurse to Therapy Department: The nurse should talk to the various departments in therapy to report opportunities for improvement. Some examples would be:
report swallowing issues to speech therapy
Report issues with feeding self or the need for adaptive devices to occupational therapy

35. Subject: Communication
Nurse to Dentist: Communicate findings such as:
Gums are red, puffy, swollen, or tender
Gums bleed during brushing or flossing
Teeth appear longer because the gums have receded
Gums that have separated, or pulled away creating a pocket
Changes in the way the teeth fit together when biting
Pus coming from between teeth and gums
Constant bad breath or a bad taste in the mouth

36. Subject: Communication
Survey Issues That You Need To Know:
Failure to follow a correct diet, especially when thickened liquids are required, may lead to a severe survey citation at actual or potential for harm
If there is a problem related to the meal, a feeding assistant program may be scrutinized
Failure to feed a resident that needs to be fed could be cited as neglect
Timing of meals is important because there must be at least 4 hours between breakfast, then lunch, and then dinner

37. Does the Right Thing Conclusion:
It is everyone’s job to keep the resident safe
This can only happen if each caregiver
Does the Right Thing