Download CLED41372_2010 LTC Dining, nutrition, hydration

July-Dec.: Dining, Nutrition, Hydration
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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.
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
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.
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Lean tissue and muscle mass decrease.
There is less bone mass. Body fat increases.
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Stomach acid may decrease and the stomach
might not empty as fast.
The intestine may absorb less nutrition from
the food it gets.
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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.
Other physical changes that occur after age 50
include:
 Teeth and gums
 Appetite and thirst
 Medications
 Disease
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
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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.
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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.
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
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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.
Malnutrition can be caused by not eating
enough foods
Malnutrition can also be caused by not
adequately digesting and absorbing nutrients
from food.
Malnutrition can also be caused by not
adequately digesting and absorbing nutrients
from food.
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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.
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.
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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.
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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.
You need to be aware of special considerations
or information when you are feeding your
residents. Some of these include:
 Dentures
 Adaptive Equipment
 Dysphagia
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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.
Dysphagia means difficulty swallowing.
Providing nutrition for a patient with dysphagia
requires the following considerations:
1. Resident must be upright (90 Degrees is ideal),
2. Liquids may need to be thickened in accordance
with a doctor’s order
3. Special diets may be ordered, such as no added
salt or sugar
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Patients choke easily, so be careful not to
feed too much or too fast.
You may need adaptive equipment for some
residents.
Examples of adaptive equipment include:
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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.
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.
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.
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.
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.
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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.
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20. Serve, report, and record food and fluid
intake as directed by the nurse.
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21. Remove the 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.
1.
Check the tray ticket to verify correct food,
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 proper position
with head up – (to prevent choking).
5.
Prepare the tray in accordance with the care
plan.
6.
Assist the resident with clothing protector or
napkin.
7.
Explain to the resident the foods and fluids on the
tray.
8.
Open cartons/condiment packs for the resident if
they are unable to.
9.
Season foods according to the resident’s
preferences in accordance with prescribed diet.
10.
Cut food into bite-size pieces, per resident choice.
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.
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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.
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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
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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
Survey Issues That You Need To Know:
1. 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
2. If there is a problem related to the meal, a feeding
assistant program may be scrutinized
3. Failure to feed a resident that needs to be fed could be
cited as neglect
4. Timing of meals is important because there must be at
least 4 hours between breakfast, then lunch, and then
dinner
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It is everyone’s job to keep the resident safe
This can only happen if each caregiver
Does the Right Thing