module J

output= amount of fluids eliminated each day, includes urine, vomit, diarrhea, sound drainage, and gastric suction material

aspiration= accidental breathing in of food, fluid, vomit, or other objects into the lungs

edema= fluid intake > fluid output, excessive water collected in tissues

dysphagia= difficulty swallowing

dehydration= serious situation when a person does not take in enough fluid for the body causing a decrease in the amount of water in tissues

thickened liquids= used to help prevent residents from choking due to swallowing difficulties

how should a resident with an NG or G-tube be positioned when receiving feedings? per facility policy

who is responsible for planning and assessing nutritional needs for residents? dietician

OBRA Dietary Requirements for Residents in Nursing Homes: appetizing, smells and looks good; served at the correct temperature; other foods are offered if resident refuses; varied in color and texture

good nutrition helps avoid or manage these following diseases: type 2 diabetes (develops later in life) ; obesity; and certain cancers

sodium-controlled diets are usually ordered for residents with: heart disease, kidney disease, and liver disease

food that us allowed on a clear liquid diet are: apple juice, jell-o, and tea NO dairy- milky things

serving sizes of food compared to objects of similar size: 1 serving of meat: deck of cards; 1 serving of rice: womans fist; 1 serving of butter: postage stamp

signs and symptoms of dysphagia (difficulty swallowing): frequently clears throat. avoids certain textures, vomits or chokes while eating, eyes watering, pockets food in cheek, hoarseness after eating, coughing, and drooling

resident should be in a 90-degree position when feeding if they have dysphagia

nutritional facts label= simple took from FDA found on all packaged foods and beverages for single servings and serves as a guide for making choices that can affect health

serving size= shows the number of servings in a package or container of food or beverage

serving amount= shows the amount that is equal to one serving of a food or beverage

protein= a nutrient that is needed for tissue growth and repair

calorie= energy value of food or beverage

carbohydrate= a nutrient that supplies energy and helps the body use fats

spit, gas, and regular solid stool does not count as output

calcium= a mineral that keep bones and teeth strong

fats= a nutrient that is a good source of energy and gives flavor to food

fluid balance= when fluids taken in equal the fluids eliminated; lose water through urine, feces, vomit, sweat, breathing out, drainage from wounds, and suctioning of liquids from stomach

force fluids= medical order for person to drink more fluids

intake- amount of fluids taken in each day

iron= a mineral that helps blood carry oxygen to all parts of the body

malnutrition= refers to deficiencies, excesses, or imbalances in a persons intake of energy and/or nutrients

minerals= a nutrient that helps the body function normally

NPO= nothing by mouth

nutrients= substance found in food and fluids that are used by body for growth and maintenance of health

nutrition= when the body takes in and uses foods and fluids to maintain health

output= amount of fluid eliminated each day

special diet (therapeutic diet or modified diet)= a specific diet ordered for a person because of an illness, condition, or preparation for a procedure

vitamins= a nutrient that helps the body function normally; body gets majority of vitamins from certain foods; 13 essential vitamins; ex’s vitamin A + C

what does nutrition promote? physical and mental health; increase resistance to illness; produce energy and vitality; aids in healing

what diseases does the right nutrition help to avoid or manage? cancers, type 2 diabetes, heart disease, high blood pressure, obesity, and osteoporosis

what are the characteristics of a healthy diet? well-developed, heathy body, and appropriate weight; alert facial expression; healthy, shiny hair; clear skin and bright eyes; healthy appetite; regular elimination habits; and restful sleep patterns

characteristics of malnutrition: changes in weight; poor skin color and appearance; dull looking hair, eyes, and skin; irregular elimination habits; poor sleep patterns; abnormal conditions, such as osteoporosis or anemia; tired

Age-related changes affecting nutrition: need for fewer calories; vitamin and mineral requirements change; drugs may affect how nutrients are absorbed and used; saliva and gastric juices decrease as well as appetite and thirst and taste and smell; constipation

the types of nutrients: water, fats, carbohydrates, proteins, vitamins, and minerals

water: the most essential nutrient that is needed for every cell in the body and is the main part of the blood; it helps move oxygen and nutrients into cells and removes waste products out of cells; helps with digestion and absorption of food; helps maintain temperature by perspiration (sweating)

Fats: a good source of energy; give flavor to food; absorbs certain vitamins; certain fats may increase cholesterol levels and lead to heart disease

carbohydrates: supplies energy and helps body use fats; certain carbohydrates add fiber to diet that help with elimination

protein: needed by every cell to help grow new tissue and help with tissue repair

minerals: helps the body function normally; calcium keeps bones and teeth strong; iron helps blood carry oxygen to all parts on the body

USDA= U.S. Department of Agriculture (MyPlate)

what does the USDA say? they recommend balancing intake of healthy food choices and physical activity; designed to help people easily build a healthy plate during meal times; advocates making healthy meal choices

the diet card= prepared by dietary department based on doctor’s order; each resident’s meal has its own card; at a minimum, lists the residents room number, name, and type of diet and food allergies; NA must verify residents name

regular diet: it is ordered by the doctor, basic well-balanced diet, no limits or restrictions

advanced diet: food is gradually reintroduced to the resident; given post surgery or a specific medical condition; resident may start out NPO

NPO>ice chips>clear liquids>full liquids>mechanical soft>regular diet

special diets: therapeutic or modified diet; ordered by the doctor and planned by the dietician with input from the resident; may restrict or eliminate certain foods or fluids, based on illness, in preparation for procedures, or to meet nutritional needs

what are other forms of nutrition? Intravenous (IV) fluids, parenteral nutrition, feeding tube through gastrointestinal track, nasogastric tube, and a gastrostomy tube

alternative and supplemental nutrients: ordered by physician and to serve as between meals; given to a resident when needs extra protein, calories, and fluids

supplemental nutrition: protein supplements, pudding, ice cream, milkshakes

the NA needs to assist the resident and report amount resident ate or drank when the resident has alternative and supplemental nutrients

when a resident pockets food in cheeks: remind the resident to chew and swallow, touch cheek, and ask the resident to use their tongue to move the food

when a resident holds food in mouth: ask resident to check and swallow, make sure resident has swallowed before offering more food

what the NA must do to prevent aspiration: place resident in upright position at 90-degree angle for eating and drinking, and at least 30 mins afterwards; feed slowly; avoid distractions; offer small amounts of food and then offer a sip of water; feed on strong side of the mouth; make sure food is swallowed after each bite; provide mouth care after meals; repost signs of aspiration; provide thickening liquids if directed to

for visually-impaired residents: read the menu and use imaginary clock face to explain position of food on plate

for residents who had a stroke (CVA): place food on the unaffected/stronger side, make sure food is swallowed, place food in resident’s field of vision

the causes of dysphagia: illness, such as stroke, some medicines, problems with mouth and throat muscles, weakness, problems with teeth or dentures

signs and symptoms of dysphagia: eats slowly and frequently clears throat; avoids eating certain textured foods; when eating/drinking they vomit or choke and have watery eyes or spits out food pieces, also has to swallow several times when eating a single bite; complaints of heartburn, food getting stuck, and hoarseness after eating

measuring intake and output (I&O): fluid intake reflects nutritional status, measurement of fluid intake helps prevent or detect complication, medical treatment is planned and evaluated based on results, evaluates kidney function

special fluid orders: the doctor may order a specific amount and type of fluid a resident must drink a day to maintain fluid balance; it is identified on the resident’s diet card; encourage fluids- increase fluids; restrict fluids- limit fluids; nothing by mouth- no fluids or food; thickened liquids- all fluids are thickened

dehydration: may occur from vomiting, diarrhea, fever, or refusing to drink fluids; may occur with bleeding, dementia, fever, poor fluid intake, fluid restriction, excess sweating, vomiting, increase in urination, medicines

warning signs of potential for dehydration: drinks less than six 8-ounce glasses of fluids per day, drinks little or no fluids during meals, needs help drinking fluids, has trouble swallowing fluids, has fever, vomiting or diarrhea, confused, complaints of thirst, dry mouth, and decrease in urinary output

signs/symptoms of dehydration: severe thirst, dry mouth and mucous membrane, cracked lips, warm, dry, wrinkled skin, sunken eyes, flushed face, dark, strong smelling urine, constipation, weight loss, weakness, dizziness, confusion, headache, irritable, rapid, weak pulse, irregular heartbeat, low blood pressure

what’s on MyPlate? 2 cups fruits, 2 ½ cups vegetables, 6 ounces, grains, 5 ½ ounce protein, and 3 cups dairy

type of diets: clear liquid= can see through, non-irritating, non-gassy- post operative, acute illness, infection, nausea, prepare for GI procedures; full-liquids= all liquids; mechanical soft= semi-solids, easily digested; fiber restricted= leaves little residue and fiber in colon; high-fiber=increases residue and fiber in colon, stimulates movement of food; bland= non-irritating, low in roughage, moderate temperature, not spicy; calorie-restricted= promotes weight loss and lowers body fat; high-calorie= calories increased to 3000-4000 daily; high-iron= foods high in iron; low cholesterol= fat controlled, foods low in fat and prepared without adding fat; high-protein=promotes tissue healing; sodium-controlled=salt controlled; diabetic diet= dependent upon individual needs, calories and carbohydrates; gluten free= free of gluten, which is a protein found in wheat, rye, and barely; vegetarian diets (lacto-ovo)=excludes all meats, fish, and poultry, but allows eggs and dairy products; lacto-vegetarian= excludes all meats, fish, poultry, and eggs, but allows dairy products; vegan= excludes all meats, fish, poultry, eggs, and dairy products, along with all foods that are derived from animals