1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 22 Nutrition and Fluids

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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 for infection Increase the risk of acute and chronic diseases Increase the risk of acute and chronic diseases Cause chronic illnesses to become worse Cause chronic illnesses to become worse Cause healing problems Cause healing problems Affect physical and mental function, increasing the risk for accidents and injuries Affect physical and mental function, increasing the risk for accidents and injuries  Eating and drinking provide pleasure.

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Many factors affect dietary practices. Culture Culture Finances Finances Personal choice Personal choice  Dietary practices also include selecting, preparing, and serving food.

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  BASIC NUTRITION  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. Nutrients are grouped into fats, proteins, carbohydrates, vitamins, minerals, and water.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The Dietary Guidelines for Americans 2005 are for persons 2 years of age and older. They describe a healthy diet as one that: They describe a healthy diet as one that:  Is high in fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products  Includes lean meats, poultry, fish, beans, eggs, and nuts  Is low in fats, cholesterol, salt (sodium), and added sugar The Guidelines also include recommendations for older persons. The Guidelines also include recommendations for older persons.  MyPyramid is based on the Dietary Guidelines for Americans 2005.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  MyPyramid includes “Steps to a Healthier You.” The kind and amounts of food to eat daily The kind and amounts of food to eat daily Gradual improvement Gradual improvement Physical activity Physical activity Variety Variety Moderation Moderation The right amount from each food group band The right amount from each food group band  Food group bands Grains Grains Vegetables Vegetables Fruits Fruits Milk Milk Meat and beans Meat and beans Oils Oils

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Nutrients No food or food group has every essential nutrient. No food or food group has every essential nutrient. Protein is the most important nutrient. Protein is the most important nutrient. Carbohydrates provide energy and fiber for bowel elimination. Carbohydrates provide energy and fiber for bowel elimination. Fats provide energy, add flavor to food, and help the body use certain vitamins. Fats provide energy, add flavor to food, and help the body use certain vitamins. Vitamins are needed for certain body functions. Vitamins are needed for certain body functions.  They do not provide calories.  The body stores vitamins A, D, E, and K.  Vitamin C and the B complex vitamins are not stored.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Minerals are used for many body processes. Minerals are used for many body processes.  Bone and tooth formation  Nerve and muscle function  Fluid balance  Other body processes Water is needed for all body processes. Water is needed for all body processes.  Food labels are used to make informed food choices for a healthy diet.

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  FACTORS AFFECTING EATING AND NUTRITION  Meeting a person’s nutritional needs requires a team approach.  Culture influences dietary practices, food choices, and food preparation.  Selecting, preparing, and eating food often involve religious practices.  Finances affect the foods people buy.  Appetite relates to the desire for food.

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Personal choice  Body reactions  Illness  Age With aging, changes occur in the gastrointestinal system. With aging, changes occur in the gastrointestinal system.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  OBRA DIETARY REQUIREMENTS  Each person’s nutritional and dietary needs are met.  The person’s diet is well-balanced.  Food is appetizing.  Hot food is served hot and cold food is served cold.  Food is served promptly.  Food is prepared to meet each person’s needs.

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Other foods (of similar nutritional value) are offered to residents who refuse the food served.  Each person receives at least 3 meals a day. A bedtime snack is offered. A bedtime snack is offered.  The center provides needed adaptive equipment and utensils.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  SPECIAL DIETS  Doctors may order special diets: For nutritional deficiency or a disease For nutritional deficiency or a disease For weight control For weight control To eliminate or decrease certain substances in the diet To eliminate or decrease certain substances in the diet  Regular diet, general diet, and house diet mean no dietary limits or restrictions.

15. Slide 15 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The sodium-controlled diet If there is too much sodium, the body retains more water. If there is too much sodium, the body retains more water. Sodium control decreases the amount of sodium in the body. Sodium control decreases the amount of sodium in the body. The doctor orders the amount of sodium allowed. The doctor orders the amount of sodium allowed. Sodium-controlled diets involve: Sodium-controlled diets involve:  Omitting high-sodium foods  Not adding salt to food at the table  Limiting the amount of salt used in cooking  Diet planning

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Diabetes meal planning is for people with diabetes. Diabetes is usually treated with insulin or other drugs, diet, and exercise. Diabetes is usually treated with insulin or other drugs, diet, and exercise. The dietitian and person develop a meal plan that involves: The dietitian and person develop a meal plan that involves:  The person’s food preferences  Calories needed  Eating meals and snacks at regular times You need to: You need to:  Serve the person’s meals and snacks on time  Always check the tray to see what was eaten  Tell the nurse what the person did and did not eat

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The dysphagia diet Food thickness is changed to meet the person’s needs. Food thickness is changed to meet the person’s needs. The doctor, speech-language pathologist, occupational therapist, dietitian, and nurse choose the right food thickness. The doctor, speech-language pathologist, occupational therapist, dietitian, and nurse choose the right food thickness. When feeding a person with dysphagia, you must: When feeding a person with dysphagia, you must:  Know the signs and symptoms of dysphagia  Feed the person according to the care plan and swallow guide  Follow aspiration precautions  Report changes in how the person eats  Report the following at once: –Choking, coughing, difficulty breathing during or after meals –Abnormal breathing or respiratory sounds

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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 (edema). If fluid intake exceeds fluid output, body tissues swell with water (edema). If fluid output exceeds intake, dehydration occurs. If fluid output exceeds intake, dehydration occurs.

19. Slide 19 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Normal fluid requirements An adult needs 1500 ml of water daily to survive. An adult needs 1500 ml of water daily to survive. About 2000 to 2500 ml of fluid per day is needed for normal fluid balance. About 2000 to 2500 ml of fluid per day is needed for normal fluid balance. The older person is at risk for dehydration and edema. The older person is at risk for dehydration and edema.  Some persons have special fluid orders. Encourage fluids Encourage fluids Restrict fluids Restrict fluids Nothing by mouth (NPO) Nothing by mouth (NPO) Thickened liquids Thickened liquids

21. Slide 21 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Intake and output records: Are used to evaluate fluid balance and kidney function Are used to evaluate fluid balance and kidney function Help in evaluating and planning medical treatment Help in evaluating and planning medical treatment Are kept when the person has special fluid orders Are kept when the person has special fluid orders All fluids taken by mouth are measured and recorded. All fluids taken by mouth are measured and recorded. Foods that melt at room temperature are measured and recorded. Foods that melt at room temperature are measured and recorded. The nurse measures and records IV fluids and tube feedings. The nurse measures and records IV fluids and tube feedings. Output includes urine, vomitus, diarrhea, and wound drainage. Output includes urine, vomitus, diarrhea, and wound drainage. 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.

22. Slide 22 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  MEETING FOOD AND FLUID NEEDS  The following can affect appetite and ability to eat: Weakness, illness, and confusion Weakness, illness, and confusion Unpleasant odors, sights, and sounds Unpleasant odors, sights, and sounds An uncomfortable position An uncomfortable position The need for oral hygiene The need for oral hygiene The need to eliminate The need to eliminate Pain Pain

23. Slide 23 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Dining programs meet the needs of the following residents: Alert and oriented residents Alert and oriented residents Those who like to eat in their rooms Those who like to eat in their rooms Those who are confused and noisy at mealtime Those who are confused and noisy at mealtime Persons who are incontinent or have odor problems Persons who are incontinent or have odor problems Persons who are too weak or ill to leave their rooms Persons who are too weak or ill to leave their rooms

24. Slide 24 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The following dining programs are common in nursing centers: Social dining Social dining Family dining Family dining Assistive dining Assistive dining Low-stimulation dining Low-stimulation dining Restaurant-style menus Restaurant-style menus Open-dining Open-dining

28. Slide 28 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Preparing 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 needed dentures are in place. Make sure needed eyeglasses and hearing aids are in place. Make sure needed eyeglasses and hearing aids are in place. 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.

29. Slide 29 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Serving meal trays OBRA requires that food be at the desired temperature when the person receives it. OBRA requires that food be at the desired temperature when the person receives it. You serve meal trays after preparing residents for meals. You serve meal trays after preparing residents for meals. Serve trays in the order assigned by the health team. Serve trays in the order assigned by the health team. If food is not served within 15 minutes, recheck food temperatures. If food is not served within 15 minutes, recheck food temperatures. If food is not at the correct temperature, get a fresh tray. If food is not at the correct temperature, get a fresh tray. – Some centers allow reheating in microwave ovens. – Some centers allow reheating in microwave ovens.  When feeding the person: Serve food and fluids in the order the person prefers. Serve food and fluids in the order the person prefers. Offer fluids during the meal. Offer fluids during the meal. Use teaspoons to feed the person. Use teaspoons to feed the person.

30. Slide 30 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Persons who need to be fed may: Be humiliated and embarrassed Be humiliated and embarrassed Be depressed or resentful Be depressed or resentful Refuse to eat Refuse to eat  Let the person do as much as possible.  Always tell the visually impaired person what is on the tray. For persons who feed themselves: For persons who feed themselves:  Describe foods and fluids and their place on the tray.  Use the numbers on a clock for the location of food.  Allow time and privacy for prayer if the person wishes.

32. Slide 32 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Meals provide social contact with others. Engage the person in pleasant conversation. Engage the person in pleasant conversation. Sit facing the person. Sit facing the person.  Persons with dementia may: Become distracted during meals Become distracted during meals Not be able to sit long enough for a meal Not be able to sit long enough for a meal Forget how to use eating utensils Forget how to use eating utensils Resist your efforts to assist them with eating Resist your efforts to assist them with eating Throw or spit food Throw or spit food

33. Slide 33 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Between-meal nourishments Nourishments are served upon arrival on the nursing unit. Nourishments are served upon arrival on the nursing unit. Provide needed utensils, a straw, and a napkin. Provide needed utensils, a straw, and a napkin. Follow the same considerations and procedures for serving meal trays and feeding persons. Follow the same considerations and procedures for serving meal trays and feeding persons.  Providing drinking water Residents need fresh drinking water each shift and whenever the pitcher is empty. Residents need fresh drinking water each shift and whenever the pitcher is empty.  Calorie counts On a flow sheet, note what the person ate and how much. On a flow sheet, note what the person ate and how much. A nurse or dietitian converts the portions into calories. A nurse or dietitian converts the portions into calories.

34. Slide 34 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Nutrition and fluid balance are important for quality of life.  The right to personal choice is important in meeting food and fluid needs.  Persons with dementia may require special measures to meet their nutritional needs.  Sometimes families and friends bring food from home.  OBRA requires that food be served correctly.