Nursing Assistant

1
Nursing Assistant

• Nutrition

2
Bodys need for food fluids

• Provide energy for daily living bodily
  functions
• Promote growth repair of tissue
• Provide necessary substances for regulation of
  bodily fluids

3
Nutrition

• Science of foods their relationship to health
• Essential to good health
• Composed of sufficient nutrients to meet the
  bodys requirements

4
Common Nutrients

• Carbohydrates
• Grains
• Pastas
• Breads
• Cereals
• Fruits
• Vegetables

5
Proteins

• Eggs
• Milk
• Meat
• Fish
• Nuts
• Poultry

6
Fats

• Oils
• Cream
• Cheese
• Meat fats
• Butter

7
Vitamins

• Vegetables
• Fruits
• Milk

8
Minerals

• Eggs
• Dried fruit
• Potatoes
• Fish
• Milk

9
Dietary fiber

• Raw fruits
• Raw vegetables
• Whole grains

10
Fluids

• Water
• Juices
• Other beverages

11
Food Pyramid

• www.mypyramid.gov
• Serving sizes based on age, gender, activity
  level

12
Vegan

• Vegetarian AND no animal by products
• Check www.mypyramid.gov for specifics

13
Special nutrient needs of elderly

• Age related changes
• Fewer calories needed, decreased activity
• Digestive disturbances add vitamins minerals
• Meds may interfere with digestion nutrient use
• Poor oral hygiene, ill-fitting dentures
• Ability to taste decreased
• Many common diseases interfere with eating or
  the ability to use nutrients
• Social isolation interference with appetite
• Food allergies know status check for
  additives (peanuts, shellfish, wheat)

14
Therapeutic diets

• Low sodium
• Diabetic
• Low fat
• Liquid
• Full liquid
• Clear liquid
• Thickened liquids
• Nectar thick
• Honey thick

15
Special consistency diets

• Mechanical soft
• Pureed
• Soft

16
Responsibilities of nursing assistant

• Check that residents receive diets ordered, check
  arm bands with tray
• Report any diet related problems preferences,
  difficulties, N V, anorexia
• Assist drs nurses to evaluate fluid balance,
  accurate I O
• Calculate food intake according to facility, if
  eats all, eats 100
• Offer alternate menu with refusal
• If alternate refused, report to licensed nurse

17
Technique for feeding

• Provide comfortable enjoyable atmosphere
• Sit at eye level
• Maintain a positive attitude when feeding
• Provide assistance if needed
• Serve residents in room if unable to join others
  in dining area (best choice is dining area)
• Alternate liquid solid food

18
Steps

• Wash hands
• Check diet card for name, diet order, special
  instructions, allergies
• Make sure food matches info on card
• Remove tray from food cart, see that all items
  are there
• Knock pause before entering room
• Introduce self
• Check armband
• Explain procedure

19
Steps cont.

• Lower side rail
• Place tray on overbed table
• If in dining room, remove food items place on
  table remove tray
• Place a towel or clothing protector
• Remove plate cover
• Seat yourself at eye level
• Arrange food, butter bread, season food

20
Steps cont

• Describe or show food before giving it to
  resident
• Use adaptive devices as indicated
• Use straws thickeners as indicated
• Offer small portions of solids ( no more than ½
  spoonful)
• Alternate solids liquids
• Ask what they would like
• Put food on unaffected side of mouth
• Monitor for pocketing swallowing difficulties
• Remove tray when resident is finished

21
Prevention of choking

• High risk residents
• CVA
• Neurological disease
• Trauma to head, neck, or throat
• Dementia
• Close supervision when eating
• Follow individual feeding plan
• Cut food into small pieces, offer in small
  amounts, wait until each portion is chewed
  swallowed before more is given

22
Choking cont.

• Notify licensed nurse if dysphagia
• Long time before swallowing
• Swallows several times with each bite
• Frequent throat clearing
• Difficulty handling foods/fluids in mouth
• Wet gurgling voice
• Pocketing food
• Unintentional weight loss
• Feeling by resident that food is sticking

23
Choking cont

• Proceed at residents pace dont rush
• Portion should be chewed swallowed before more
  is given
• Sit down while feeding helpless resident
• Use adaptive equipment as indicated

24
Recognition of signs of choking

• Universal sign
• Inability to speak, cough, breathe
• Cyanosis
• Loss of consciousness
• HEIMLICH MANEUVER

25
DIETARY MODIFICATIONS

• Affiliated with religions and/or cultures
• Ask if there are any preferences
• Ask family of residents who cannot communicate

26
Alternate ways to offer nutrition

• Tube feedings
• Ordered by doctor when resident unable to eat
• Started by a licensed nurse
• Your responsibility
• Monitor for tubing kinking or pressure
• Monitor level of feeding
• KEEP HOB AT 20 30 DEGREES AT ALL TIMES
• DO NOT LOWER HOB EVEN WHEN REPOSITIONING
• Never turn off pump notify nurse of alarm
• Notify nurse if signs of aspiration

27
Intravenous infusion

• Ordered by physician
• Started by licensed nurse
• Your responsibility
• Monitor IV for kinks, twisting, pressure, or
  obstruction
• Report
• Alarms
• C/o pain or burning at site
• Swelling or redness at site
• Fever
• SOB
• Bleeding of fluid leakage at IV site
• Disconnected IV tubing
• Empty IV container