1. Nutrition Care Alerts As a Nursing Assistant who provides much of residents’ daily “hands-on” care, you have a great opportunity to make a difference in the lives of those you care Report to the nurses your observations and warning signs Nutrition Care Alerts As a Nursing Assistant who provides much of residents’ daily “hands-on” care, you have a great opportunity to make a difference in the lives of those you care Report to the nurses your observations and warning signs Nutrition Care Alerts As a Nursing Assistant who provides much of residents’ daily “hands-on” care, you have a great opportunity to make a difference in the lives of those you care Report to the nurses your observations and warning signs Nutrition Care Alerts As a Nursing Assistant who provides much of residents’ daily “hands-on” care, you have a great opportunity to make a difference in the lives of those you care Report to the nurses your observations and warning signs Nutrition Care Alerts As a Nursing Assistant who provides much of residents’ daily “hands-on” care, you have a great opportunity to make a difference in the lives of those you care Report to the nurses your observations and warning signs Nutrition Care Alerts As a Nursing Assistant who provides much of residents’ daily “hands-on” care, you have a great opportunity to make a difference in the lives of those you care Report to the nurses your observations and warning signs

2. Adapted with permission of the Nutrition Screening Initiative, a project from the American Academy of Family Physicians, American Dietetic Association and National Council on the Aging, Inc., and founded in part by a scholarship of Ross Products Division, Abbott Laboratories Inc. These materials were developed to the National Policy and Resource Center on Nutrition and Aging of Florida International University through scholarships of the US Administration on Aging and US Health Care Financing Administration.. Adapted with permission of the Nutrition Screening Initiative, a project from the American Academy of Family Physicians, American Dietetic Association and National Council on the Aging, Inc., and founded in part by a scholarship of Ross Products Division, Abbott Laboratories Inc. These materials were developed to the National Policy and Resource Center on Nutrition and Aging of Florida International University through scholarships of the US Administration on Aging and US Health Care Financing Administration..

3. Unintended Weight Loss ! warning signs  Needs help to eat or drink  Eats less than half of meals or snacks served  Complains of mouth pain  Has dentures that don’t fit  Has a hard time chewing or swallowing  Has trouble using utensils  Is sad, has crying spells, or  withdraws from others  Is confused, wanders, or paces  Has diabetes, COPD, cancer, HIV, or other chronic disease Unintended Weight Loss ! warning signs  Needs help to eat or drink  Eats less than half of meals or snacks served  Complains of mouth pain  Has dentures that don’t fit  Has a hard time chewing or swallowing  Has trouble using utensils  Is sad, has crying spells, or  withdraws from others  Is confused, wanders, or paces  Has diabetes, COPD, cancer, HIV, or other chronic disease Unintended Weight Loss ! warning signs  Needs help to eat or drink  Eats less than half of meals or snacks served  Complains of mouth pain  Has dentures that don’t fit  Has a hard time chewing or swallowing  Has trouble using utensils  Is sad, has crying spells, or  withdraws from others  Is confused, wanders, or paces  Has diabetes, COPD, cancer, HIV, or other chronic disease Unintended Weight Loss ! warning signs  Needs help to eat or drink  Eats less than half of meals or snacks served  Complains of mouth pain  Has dentures that don’t fit  Has a hard time chewing or swallowing  Has trouble using utensils  Is sad, has crying spells, or  withdraws from others  Is confused, wanders, or paces  Has diabetes, COPD, cancer, HIV, or other chronic disease Unintended Weight Loss ! warning signs  Needs help to eat or drink  Eats less than half of meals or snacks served  Complains of mouth pain  Has dentures that don’t fit  Has a hard time chewing or swallowing  Has trouble using utensils  Is sad, has crying spells, or  withdraws from others  Is confused, wanders, or paces  Has diabetes, COPD, cancer, HIV, or other chronic disease Unintended Weight Loss ! warning signs  Needs help to eat or drink  Eats less than half of meals or snacks served  Complains of mouth pain  Has dentures that don’t fit  Has a hard time chewing or swallowing  Has trouble using utensils  Is sad, has crying spells, or  withdraws from others  Is confused, wanders, or paces  Has diabetes, COPD, cancer, HIV, or other chronic disease

4. Unintended Weight Loss actions steps  Report to the nurses your observations and warning signs  Encourage the resident to eat  Honor residents’ food preferences  Offer alternatives foods, beverages  Help residents who have trouble feeding  themselves  Don’t rush resident who is eating  Record meal and snack intake  Provide oral care before meals  Position resident for feeding as directed by nurse Unintended Weight Loss actions steps  Report to the nurses your observations and warning signs  Encourage the resident to eat  Honor residents’ food preferences  Offer alternatives foods, beverages  Help residents who have trouble feeding  themselves  Don’t rush resident who is eating  Record meal and snack intake  Provide oral care before meals  Position resident for feeding as directed Unintended Weight Loss actions steps  Report to the nurses your observations and warning signs  Encourage the resident to eat  Honor residents’ food preferences  Offer alternatives foods, beverages  Help residents who have trouble feeding  themselves  Don’t rush resident who is eating  Record meal and snack intake  Provide oral care before meals  Position resident for feeding as directed Unintended Weight Loss actions steps  Report to the nurses your observations and warning signs  Encourage the resident to eat  Honor residents’ food preferences  Offer alternatives foods, beverages  Help residents who have trouble feeding  themselves  Don’t rush resident who is eating  Record meal and snack intake  Provide oral care before meals  Position resident for feeding as directed. Unintended Weight Loss actions steps  Report to the nurses your observations and warning signs  Encourage the resident to eat  Honor residents’ food preferences  Offer alternatives foods, beverages  Help residents who have trouble feeding  themselves  Don’t rush resident who is eating  Record meal and snack intake  Provide oral care before meals  Position resident for feeding as directed Unintended Weight Loss actions steps  Report to the nurses your observations and warning signs  Encourage the resident to eat  Honor residents’ food preferences  Offer alternatives foods, beverages  Help residents who have trouble feeding  themselves  Don’t rush resident who is eating  Record meal and snack intake  Provide oral care before meals  Position resident for feeding as directed

5. Dehydration ! warning signs  Drinks less than 6 cups of liquid daily  Has dry mouth, cracked lips, sunken eyes or urine has strong odor or dark color  Needs help drinking from a cup or glass  Has trouble swallowing liquids  Has vomiting, diarrhea or fever  Is dizzy, easily confused or tired Dehydration ! warning signs  Drinks less than 6 cups of liquid daily  Has dry mouth, cracked lips, sunken eyes or urine has strong odor or dark color  Needs help drinking from a cup or glass  Has trouble swallowing liquids  Has vomiting, diarrhea or fever  Is dizzy, easily confused or tired Dehydration ! warning signs  Drinks less than 6 cups of liquid daily  Has dry mouth, cracked lips, sunken eyes or urine has strong odor or dark color  Needs help drinking from a cup or glass  Has trouble swallowing liquids  Has vomiting, diarrhea or fever  Is dizzy, easily confused or tired Dehydration ! warning signs  Drinks less than 6 cups of liquid daily  Has dry mouth, cracked lips, sunken eyes or urine has strong odor or dark color  Needs help drinking from a cup or glass  Has trouble swallowing liquids  Has vomiting, diarrhea or fever  Is dizzy, easily confused or tired Dehydration ! warning signs  Drinks less than 6 cups of liquid daily  Has dry mouth, cracked lips, sunken eyes or urine has strong odor or dark color  Needs help drinking from a cup or glass  Has trouble swallowing liquids  Has vomiting, diarrhea or fever  Is dizzy, easily confused or tired Dehydration ! warning signs  Drinks less than 6 cups of liquid daily  Has dry mouth, cracked lips, sunken eyes or urine has strong odor or dark color  Needs help drinking from a cup or glass  Has trouble swallowing liquids  Has vomiting, diarrhea or fever  Is dizzy, easily confused or tired

6. Dehydration action steps  Report to the nurses your observations and warning signs  Encourage intake of 2 to 4 ounces of water or liquid every time you see the resident, unless otherwise directed  Record fluid intake  Offer ice chips frequently  Offer sips of liquid between bites of food at meals and snacks  Make sure resident can lift pitcher and cup  If resident cannot drink without help, offer appropriate assistance Dehydration action steps  Report to the nurses your observations and warning signs  Encourage intake of 2 to 4 ounces of water or liquid every time you see the resident, unless otherwise directed  Record fluid intake  Offer ice chips frequently  Offer sips of liquid between bites of food at meals and snacks  Make sure resident can lift pitcher and cup  If resident cannot drink without help, offer appropriate assistance Dehydration action steps  Report to the nurses your observations and warning signs  Encourage intake of 2 to 4 ounces of water or liquid every time you see the resident, unless otherwise directed  Record fluid intake  Offer ice chips frequently  Offer sips of liquid between bites of food at meals and snacks  Make sure resident can lift pitcher and cup  If resident cannot drink without help, offer appropriate assistance Dehydration action steps  Report to the nurses your observations and warning signs  Encourage intake of 2 to 4 ounces of water or liquid every time you see the resident, unless otherwise directed  Record fluid intake  Offer ice chips frequently  Offer sips of liquid between bites of food at meals and snacks  Make sure resident can lift pitcher and cup  If resident cannot drink without help, offer appropriate assistance Dehydration action steps  Report to the nurses your observations and warning signs  Encourage intake of 2 to 4 ounces of water or liquid every time you see the resident, unless otherwise directed  Record fluid intake  Offer ice chips frequently  Offer sips of liquid between bites of food at meals and snacks  Make sure resident can lift pitcher and cup  If resident cannot drink without help, offer appropriate assistance Dehydration action steps  Report to the nurses your observations and warning signs  Encourage intake of 2 to 4 ounces of water or liquid every time you see the resident, unless otherwise directed  Record fluid intake  Offer ice chips frequently  Offer sips of liquid between bites of food at meals and snacks  Make sure resident can lift pitcher and cup  If resident cannot drink without help, offer appropriate assistance

7. Pressure Ulcers ! warning signs  Risk of suffering pressure ulcer depends on: Incontinence heavy perspiration  Needs help: Moving arms, legs or body Turning in bed Changing position when sitting Has lost weight Eats less than half of meals or snacks served Is dehydrated Has discolored, torn, or swollen skin over a bony area Pressure Ulcers ! warning signs  Risk of suffering pressure ulcer depends on: Incontinence heavy perspiration  Needs help: Moving arms, legs or body Turning in bed Changing position when sitting Has lost weight Eats less than half of meals or snacks served Is dehydrated Has discolored, torn, or swollen skin over a bony area Pressure Ulcers ! warning signs  Risk of suffering pressure ulcer depends on: Incontinence heavy perspiration  Needs help: Moving arms, legs or body Turning in bed Changing position when sitting Has lost weight Eats less than half of meals or snacks served Is dehydrated Has discolored, torn, or swollen skin over a bony area Pressure Ulcers ! warning signs  Risk of suffering pressure ulcer depends on: Incontinence heavy perspiration  Needs help: Moving arms, legs or body Turning in bed Changing position when sitting Has lost weight Eats less than half of meals or snacks served Is dehydrated Has discolored, torn, or swollen skin over a bony area Pressure Ulcers ! warning signs  Risk of suffering pressure ulcer depends on: Incontinence heavy perspiration  Needs help: Moving arms, legs or body Turning in bed Changing position when sitting Has lost weight Eats less than half of meals or snacks served Is dehydrated Has discolored, torn, or swollen skin over a bony area Pressure Ulcers ! warning signs  Risk of suffering pressure ulcer depends on: Incontinence heavy perspiration  Needs help: Moving arms, legs or body Turning in bed Changing position when sitting Has lost weight Eats less than half of meals or snacks served Is dehydrated Has discolored, torn, or swollen skin over a bony area

8. Pressure Ulcers action steps Check and change linens as appropriate to keep resident dry Handle and move the resident with care to avoid skin tears and scrapes Reposition frequently and properly Use “Unintended Weight Loss Action Steps” to improve calorie and protein intake Record meal and snack intake Use “Dehydration Action Steps” to improve fluid intake Pressure Ulcers action steps Check and change linens as appropriate to keep resident dry Handle and move the resident with care to avoid skin tears and scrapes Reposition frequently and properly Use “Unintended Weight Loss Action Steps” to improve calorie and protein intake Record meal and snack intake Use “Dehydration Action Steps” to improve fluid intake Pressure Ulcers action steps Check and change linens as appropriate to keep resident dry Handle and move the resident with care to avoid skin tears and scrapes Reposition frequently and properly Use “Unintended Weight Loss Action Steps” to improve calorie and protein intake Record meal and snack intake Use “Dehydration Action Steps” to improve fluid intake Pressure Ulcers action steps Check and change linens as appropriate to keep resident dry Handle and move the resident with care to avoid skin tears and scrapes Reposition frequently and properly Use “Unintended Weight Loss Action Steps” to improve calorie and protein intake Record meal and snack intake Use “Dehydration Action Steps” to improve fluid intake Pressure Ulcers action steps Check and change linens as appropriate to keep resident dry Handle and move the resident with care to avoid skin tears and scrapes Reposition frequently and properly Use “Unintended Weight Loss Action Steps” to improve calorie and protein intake Record meal and snack intake Use “Dehydration Action Steps” to improve fluid intake Pressure Ulcers action steps Check and change linens as appropriate to keep resident dry Handle and move the resident with care to avoid skin tears and scrapes Reposition frequently and properly Use “Unintended Weight Loss Action Steps” to improve calorie and protein intake Record meal and snack intake Use “Dehydration Action Steps” to improve fluid intake

9. Residents who are tube fed ! warning signs Has nausea, vomiting, diarrhea, swollen stomach or stomach ache, constipation or cramping Has pain, redness, heat or swelling, crusty or oozing fluid where the feeding tube enters the body Has cough, wheezing, wet breathing or a feeling of something “caught” in the throat Residents who are tube fed ! warning signs Has nausea, vomiting, diarrhea, swollen stomach or stomach ache, constipation or cramping Has pain, redness, heat or swelling, crusty or oozing fluid where the feeding tube enters the body Has cough, wheezing, wet breathing or a feeling of something “caught” in the throat Residents who are tube fed ! warning signs Has nausea, vomiting, diarrhea, swollen stomach or stomach ache, constipation or cramping Has pain, redness, heat or swelling, crusty or oozing fluid where the feeding tube enters the body Has cough, wheezing, wet breathing or a feeling of something “caught” in the throat Residents who are tube fed ! warning signs Has nausea, vomiting, diarrhea, swollen stomach or stomach ache, constipation or cramping Has pain, redness, heat or swelling, crusty or oozing fluid where the feeding tube enters the body Has cough, wheezing, wet breathing or a feeling of something “caught” in the throat Residents who are tube fed ! warning signs Has nausea, vomiting, diarrhea, swollen stomach or stomach ache, constipation or cramping Has pain, redness, heat or swelling, crusty or oozing fluid where the feeding tube enters the body Has cough, wheezing, wet breathing or a feeling of something “caught” in the throat Residents who are tube fed ! warning signs Has nausea, vomiting, diarrhea, swollen stomach or stomach ache, constipation or cramping Has pain, redness, heat or swelling, crusty or oozing fluid where the feeding tube enters the body Has cough, wheezing, wet breathing or a feeling of something “caught” in the throat

10. Residents who are tube fed action steps  Report to the nurses your observations and warning signs  Maintain residents’ position with head elevated 30 grades or more, as tolerated, during feedings and for at least 30 minutes after feedings Residents who are tube fed action steps  Report to the nurses your observations and warning signs  Maintain residents’ position with head elevated 30 grades or more, as tolerated, during feedings and for at least 30 minutes after feedings Residents who are tube fed action steps  Report to the nurses your observations and warning signs  Maintain residents’ position with head elevated 30 grades or more, as tolerated, during feedings and for at least 30 minutes after feedings Residents who are tube fed action steps  Report to the nurses your observations and warning signs  Maintain residents’ position with head elevated 30 grades or more, as tolerated, during feedings and for at least 30 minutes after feedings Residents who are tube fed action steps  Report to the nurses your observations and warning signs  Maintain residents’ position with head elevated 30 grades or more, as tolerated, during feedings and for at least 30 minutes after feedings Residents who are tube fed action steps  Report to the nurses your observations and warning signs  Maintain residents’ position with head elevated 30 grades or more, as tolerated, during feedings and for at least 30 minutes after feedings