Download Dietary Guidelines for Americans 2005

Chapter 22
Nutrition and Fluids
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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The person’s diet affects physical and mental wellbeing.
A poor diet and poor eating habits:
• Increase the risk for infection
• Increase the risk of acute and chronic diseases
• Cause chronic illnesses to become worse
• Cause healing problems
• Affect physical and mental function, increasing the risk
for accidents and injuries
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Eating and drinking provide pleasure.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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Many factors affect dietary practices.
• Culture
• Finances
• Personal choice
 Dietary practices also include selecting, preparing,
and serving food.
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BASIC NUTRITION
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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.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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The Dietary Guidelines for Americans 2005 are for
persons 2 years of age and older.
• They describe a healthy diet as one that:
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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.
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MyPyramid is based on the Dietary Guidelines for
Americans 2005.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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 MyPyramid includes “Steps to a Healthier
• The kind and amounts of food to eat daily
• Gradual improvement
• Physical activity
• Variety
• Moderation
• The right amount from each food group band
You.”
 Food group bands
• Grains
• Vegetables
• Fruits
• Milk
• Meat and beans
• Oils
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 Nutrients
• No food or food group has every essential nutrient.
• Protein is the most important nutrient.
• Carbohydrates provide energy and fiber for bowel
elimination.
• Fats provide energy, add flavor to food, and help the
body use certain vitamins.
• Vitamins are needed for certain body functions.
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They do not provide calories.
The body stores vitamins A, D, E, and K.
Vitamin C and the B complex vitamins are not stored.
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• Minerals are used for many body processes.
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Bone and tooth formation
Nerve and muscle function
Fluid balance
Other body processes
• Water is needed for all body processes.
 Food labels are used to make informed food
choices for a healthy diet.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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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.
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Personal choice
 Body reactions
 Illness
 Age
• With aging, changes occur in the gastrointestinal system.
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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.
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Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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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.
 The center provides needed adaptive equipment
and utensils.
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SPECIAL DIETS
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Doctors may order special diets:
• For nutritional deficiency or a disease
• For weight control
• To eliminate or decrease certain substances in the diet
 Regular diet, general diet, and house diet mean no
dietary limits or restrictions.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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The sodium-controlled diet
• If there is too much sodium, the body retains more water.
• Sodium control decreases the amount of sodium in the
body.
• The doctor orders the amount of sodium allowed.
• Sodium-controlled diets involve:
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Omitting high-sodium foods
Not adding salt to food at the table
Limiting the amount of salt used in cooking
Diet planning
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Diabetes meal planning is for people with diabetes.
• Diabetes is usually treated with insulin or other drugs, diet,
and exercise.
• The dietitian and person develop a meal plan that
involves:
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The person’s food preferences
Calories needed
Eating meals and snacks at regular times
• You need to:
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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
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The dysphagia diet
• 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.
• When feeding a person with dysphagia, you must:
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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
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FLUID BALANCE
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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 output exceeds intake, dehydration occurs.
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Normal fluid requirements
• 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.
• The older person is at risk for dehydration and edema.
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Some persons have special fluid orders.
• Encourage fluids
• Restrict fluids
• Nothing by mouth (NPO)
• Thickened liquids
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Intake and output records:
• Are used to evaluate fluid balance and kidney function
• Help in evaluating and planning medical treatment
• Are kept when the person has special fluid orders
• All fluids taken by mouth are measured and recorded.
• Foods that melt at room temperature are measured and
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recorded.
The nurse measures and records IV fluids and tube
feedings.
Output includes urine, vomitus, diarrhea, and wound
drainage.
An I&O record is kept at the bedside.
Amounts are totaled at the end of the shift.
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MEETING FOOD AND FLUID NEEDS
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The following can affect appetite and ability to eat:
• Weakness, illness, and confusion
• Unpleasant odors, sights, and sounds
• An uncomfortable position
• The need for oral hygiene
• The need to eliminate
• Pain
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Dining programs meet the needs of the following
residents:
• Alert and oriented residents
• Those who like to eat in their rooms
• Those who are confused and noisy at mealtime
• Persons who are incontinent or have odor problems
• Persons who are too weak or ill to leave their rooms
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The following dining programs are common in
nursing centers:
• Social dining
• Family dining
• Assistive dining
• Low-stimulation dining
• Restaurant-style menus
• Open-dining
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Preparing for meals
• Assist with elimination needs.
• Provide oral hygiene.
• Make sure needed dentures are in place.
• Make sure needed eyeglasses and hearing aids are in
place.
• Make sure incontinent persons are clean and dry.
• Position the person in a comfortable position.
• Assist the person with hand washing.
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Serving meal trays
• OBRA requires that food be at the desired temperature when
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the person receives it.
You serve meal trays after preparing residents for meals.
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 at the correct temperature, get a fresh tray.
– Some centers allow reheating in microwave ovens.
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When feeding the person:
• Serve food and fluids in the order the person prefers.
• Offer fluids during the meal.
• Use teaspoons to feed the person.
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Persons who need to be fed may:
• Be humiliated and embarrassed
• Be depressed or resentful
• 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:
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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.
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Meals provide social contact with others.
• Engage the person in pleasant conversation.
• Sit facing the person.
 Persons with dementia may:
• Become distracted during meals
• Not be able to sit long enough for a meal
• Forget how to use eating utensils
• Resist your efforts to assist them with eating
• Throw or spit food
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Between-meal nourishments
• Nourishments are served upon arrival on the nursing
unit.
• Provide needed utensils, a straw, and a napkin.
• Follow the same considerations and procedures for
serving meal trays and feeding persons.
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Providing drinking water
• Residents need fresh drinking water each shift and
whenever the pitcher is empty.
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Calorie counts
• On a flow sheet, note what the person ate and how
much.
• A nurse or dietitian converts the portions into calories.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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QUALITY OF LIFE
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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.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
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