CHAPTER SEVENTEEN

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CHAPTER SEVENTEEN ASSISTING WITH NUTRITION AND
FLUIDS
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BASIC NUTRITION

• NUTRIENT - A SUBSTANCE THAT IS INGESTED,
  DIGESTED, ABSORBED, AND USED BY THE BODY.
• GROUPED INTO FATS, CARBOHYDRATES, PROTEINS
• VITAMINS, MINERALS, AND WATER
• CALORIE THE AMOUNT OF ENERGY PRODUCED FROM THE
  BURNING OF FOOD BY THE BODY.
• 1 GRAM OF FAT SUPPLIES THE BODY WITH 9 CALORIES
• 1 GRAM OF PROTEIN PROVIDES 4 CALORIES
• 1 GRAM OF CARBOHYDRATE PROVIDES 4 CALORIES

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FATS
PRODUCE HEAT AND ENERGY FOUND IN VEGETABLE FATS,
OILS, BUTTER, MEATS, MILK PRODUCTS, AND POULTRY
CARBOHYDRATES
PRODUCE HEAT AND ENERGY SUPPLY ROUGHAGE IN THE
DIET FOUND IN FRUITS, VEGETABLES, BREAD, CEREALS,
PASTA PRODUCTS, AND MILK
PROTEIN
BUILD AND REPAIR BODY TISSUES REGULATE BODY
FUNCTIONS AND SUPPLY ENERGY FOUND IN MEAT,
POULTRY, FISH, AND CHEESE
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MINERALS

• CALCIUM
• USED FOR BUILDING BONES AND TEETH, BLOOD
  CLOTTING, MUSCLE CONTRACTIONS, AND NERVE
  FUNCTIONS
• SODIUM
• HELPS WITH NERVE AND MUSCLE FUNCTION AND HELPS
  THE BODY MAINTAIN FLUID BALANCE
• POTASSIUM
• NECESSARY FOR HEALTHY NERVES, MUSCLES, AND HEART
  FUNCTION
• IRON
• NECESSARY FOR HEMOGLOBIN

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VITAMINS

• VITAMIN A
• NEEDED FOR VISION, HEALTHY HAIR, SKIN, AND MUCUS
  MEMBRANES. HELPS FIGHT INFECTION.
• B-COMPLEX VITAMINS
• USED FOR DIGESTION, MUSCLE TONE, GROWTH, NERVE
  FUNCTION AND METABOLISM.
• VITAMIN C
• NECESSARY FOR TISSUE FORMATION, MINERAL
  ABSORPTION, HEALTHY SKIN AND MUCOUS MEMBRANES,
  AND RESISTANCE TO INFECTION.

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VITAMINS

• VITAMIN D
• NEEDED BY THE BODY TO BUILD HEALTHY BONES AND
  TEETH
• VITAMIN E
• USED FOR THE FORMATION OF RED BLOOD CELLS AND
  FOR HEALTHY MUSCLE FUNCTION
• VITAMIN K
• NECESSARY FOR BLOOD CLOTTING

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MY PYRAMID FOOD GUIDE
STEPS TO A HEALTHIER YOU
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INTERPRETING THE FOOD GUIDE

• TELLS YOU THE KIND AND AMOUNTS OF FOOD TO EAT
  DAILY
• GRADUAL IMPROVEMENT - TAKE SMALL STEPS EACH DAY
• THE PERSON SHOWS PHYSICAL ACTIVITY BY CLIMBING
  THE STEPS
• VARIETY - THE SIX COLOR BANDS STAND FOR THE 5
  FOOD GROUPS PLUS OILS
• MODERATION - MEANS TO AVOID EXTREMES
• TAKE THE RIGHT AMOUNT FROM EACH FOOD GROUP BAND
  - THE WIDTH OF THE BAND SUGGESTS HOW MUCH FOOD TO
  CHOOSE FROM EACH GROUP

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GRAINS

• THE ORANGE BAND IS FOR GRAINS
• A PERSON NEEDS AT LEAST 3 - 6 OUNCES OF WHOLE
  GRAINS EVERY DAY
• GRAINS HAVE THE FOLLOWING HEALTH BENEFITS
• REDUCE THE RISK OF CORONARY ARTERY DISEASE
• HELPS PREVENT CONSTIPATION
• HELPS WITH WEIGHT MANAGEMENT
• CONTAINS THE FOLLOWING NUTRIENTS
• FIBER - B VITAMINS - MINERALS (IRON, MAGNESIUM,
  AND SELENIUM)

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VEGETABLE GROUP

• THE GREEN BAND IS FOR VEGETABLES
• SHOULD EAT AT LEAST 1 - 2 CUPS OF VEGETABLES
  DAILY
• SHOULD SELECT VEGETABLES OF DIFFERENT COLORS
• PROVIDES MANY DIFFERENT NUTRIENTS
• HAVE THE FOLLOWING HEALTH BENEFITS
• REDUCE THE RISK OF STROKE, CORONARY ARTERY
  DISEASE, DIABETES, KIDNEY STONES
• LOWER CALORIE INTAKE PROVIDE FIBER

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FRUIT GROUP

• THE RED BAND IS FOR FRUITS
• 1-2 CUPS OF FRUIT IS NEEDED DAILY
• FRUITS HAVE THESE BENEFITS
• REDUCE THE RISK FOR STROKES, CORONARY ARTERY
  DISEASE, DIABETES, KIDNEY STONES
• MAY HELP LOWER CALORIE INTAKE
• CONTAINS MANY NUTRIENTS

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MILK

• THE BLUE BAND IS FOR MILK AND MILK PRODUCTS
• 2 - 4 CUPS ARE NEEDED DAILY
• PROVIDES PROTEINS, FAT, CALCIUM AND VITAMIN D
• MILK HAS THESE BENEFITS
• HELPS BUILD AND MAINTAIN BONE MASS

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MEAT AND BEANS

• THE PURPLE BAND IS FOR MEATS AND BEANS
• INCLUDES ALL FOODS MADE FROM MEAT, POULTRY,
  FISH, DRY BEANS, EGGS, NUTS, AND SEEDS
• CHOOSE LOW FAT MEAT AND POULTRY
• LIMIT SERVING TO 2 - 4 OUNCES A DAY
• PROVIDES PROTEINS, VITAMINS, IRON

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OILS

• THE YELLOW BAND IS FOR OILS
• ENOUGH OIL IS USUALLY CONSUMED DAILY WITH NO
  ADDED SERVINGS. INTAKE SHOULD BE NO HIGHER THAN
  3 TEASPOONS
• SHOULD BE USED AS LITTLE AS POSSIBLE.
• HAVE LITTLE NUTRITIONAL VALUE BUT ARE HIGH IN
  CALORIES.

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GUIDELINES FOR A BALANCED DIET

• EAT A VARIETY OF FOODS
• MAINTAIN A HEALTHY BODY WEIGHT
• SELECT FOODS LOW IN FAT, SATURATED FAT, AND
  CHOLESTEROL
• SELECT PLENTY OF FRUIT, VEGETABLE, AND GRAIN
  PRODUCTS
• USE SUGAR IN MODERATION
• USE SALT IN MODERATION
• DRINK ALCHOLIC BEVERAGES IN MODERATION, IF AT ALL

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FACTORS THAT AFFECT NUTRITION

• AGE ELDERLY PERSON MAY HAVE A DECREASED
  APPETITE OR DIFFICULTY CHEWING OR SWALLOWING.
• CULTURE PEOPLE FROM DIFFERENT CULTURES MAY
  HAVE DIFFERENT FOOD PREFERENCE. ( CHINESE RICE,
  MEXICAN HOT,SPICY )
• RELIGION MANY RELIGIONS HAVE RULES REGARDING
  COOKING, SERVING, AND EATING CERTAIN FOODS.
• FINANCES SOME PEOPLE DO NOT HAVE THE MONEY TO
  BUY FOODS NEEDED FOR GOOD NUTRITION.
• HEALTH ILLNESS MAY AFFECT A PERSONS APPETITE
  OR CHOICE OF FOOD
• PERSONAL CHOICE A PERSON MAY NOT LIKE CERTAIN
  FOODS

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RESIDENT'S RIGHTS RELATED TO NUTRITION

• BE SERVED FOOD ACCORDING TO ETHNIC, CULTURAL, OR
  RELIGIOUS BELIEFS.
• BE SERVED FOOD ACCORDING TO PERSONAL PREFERENCE.
• BE SERVED ATTRACTIVE,, TASTY FOOD AT CORRECT
  TEMPERATURES.
• PARTICIPATE IN TRADITIONAL HOLIDAY MEALS.
• FOOD SHOULD BE PREPARED TO MEET THE INDIVIDUALS
  NEEDS.
• EACH PERSON SHOULD RECEIVE 3 MEALS A DAY.
• SPECIAL EQUIPMENT SHOULD BE SUPPLIED IF NEEDED.

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SPECIAL DIETS
REGULAR DIET

• DESCRIPTION
• INCLUDES THE GREATEST VARIETY OF FOODS
• COMMON PURPOSE
• TO MAINTAIN OR ATTAIN OPTIMAL NUTRITION STATUS
  IN PATIENTS WHO DO NOT REQUIRE A SPECIAL DIET.

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CLEAR LIQUID DIET

• DESCRIPTION
• CONSISTS OF FOOD THAT ARE LIQUID AT ROOM
  TEMPERATURE THAT ARE CLEAR ENOUGH TO SEE THROUGH.
• USED ONLY FOR A SHORT TIME BECAUSE IT DOES NOT
  PROVIDE ENOUGH NUTRIENTS FOR GOOD NUTRITION.
• COMMON PURPOSE
• ORDERED FOR PATIENTS WHO HAVE HAD SURGERY,
  ACUTELY ILL PATIENTS, PATIENTS WITH FLUID LOSS
  CAUSED BY VOMITING OR DIARRHEA.
• EXAMPLES OF FOODS ALLOWED
• WATER BROTH COFFEE CLEAR JUICES JELL-O
  TEA POPSCICLES SODA POP

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FULL LIQUID DIET

• DESCRIPTION
• INCLUDES ALL LIQUIDS INCLUDED IN THE CLEAR
  LIQUID DIET, PLUS ALL OTHER LIQUIDS ( FOOD THAT
  IS LIQUID AT ROOM TEMPERATURE)
• COMMON PURPOSE
• ORDERED FOR PATIENTS WHO HAVE HAD SURGERY,
  PATIENTS WITH STOMACH ALIMENTS, PERSONS UNABLE TO
  CHEW, SWALLOW, OR DIGEST SOLID FOODS OR AS A
  TRANSITION BETWEEN A CLEAR LIQUID DIET AND A SOFT
  DIET.
• EXAMPLES OF FOODS ALLOWED
• STRAINED SOUPS ICE CREAM CUSTARD ALL
  JUICES
• COOKED CEREAL IF IT IS SOUPY THIN

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SOFT DIET

• DESCRIPTION
• FOODS SOFT IN CONSISTENCY
• MILDLY FLAVORED
• COMMON PURPOSE
• USED FOR PATIENTS WHO ARE UNABLE TO CHEW OR
  SWALLOW HARD OR COARSE FOODS.
• EXAMPLES OF FOODS ALLOWED
• SOUPS FISH CHICKEN TOAST COOKED FRUIT
  AND VEGETABLES EGGS ICE CREAM

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MECHANICAL SOFT DIET

• DESCRIPTION
• SAME FOOD INCLUDED IN A SOFT DIET EXCEPT FOOD IS
  GROUND .
• COMMON PURPOSE
• FOR PATIENTS WITH DIFFICULTY CHEWING OR
  SWALLOWING SOFT FOOD.

PUREED DIET

• DESCRIPTION
• ALL FOUND IS STRAINED OR BLENDERIZED.
• COMMON PURPOSE
• FOR PATIENTS WHO CANNOT CHEW OR HAVE DIFFICULTY
  SWALLOWING.

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BLAND DIET

• DESCRIPTION
• FOODS MILD IN FLAVOR, OMIT SPICY FOOD, CAFFEINE,
  AND ALCOHOL.
• COMMON PURPOSE
• ORDERED IF THE ORGANS OF THE DIGESTIVE SYSTEM (
  INTESTINES, STOMACH, OR ESOPHAGUS ) ARE IRRITATED.

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SODIUM-CONTROLLED DIET
USED FOR PERSONS WITH HEART, LIVER, AND KIDNEY
DISEASES SODIUM CAUSES THE BODY TO RETAIN
WATER SODIUM RESTRICTED TO 2 GM.DAILY
DIABETIC DIET
THE DOCTOR DECIDES HOW MANY CALORIES ARE
ALLOWED THE DIETICIAN DEVELOPS A BALANCED PLAN
DIVIDING THE CALORIES INTO MEALS AND SNACKS
MEALS MUST BE SERVED ON TIME PERSON MUST
EAT EVERYTHING ON TRAY IF FOOD NOT EATEN
- TELL THE NURSE
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DYSPHAGIA DIET

• DYSPHAGIA - DIFFICULTY SWALLOWING
• ASPIRATION - BREATHING FOOD, FLUIDS, OR AN OBJECT
  INTO THE LUNGS
• SOME PEOPLE HAVE DIFFICULTY SWALLOWING LIQUIDS
• LIQUIDS MUST BE THICKENED
• THICKENED LIQUID - CONSISTENCY OF BABY FOOD
• MEDIUM THICK - CONSISTENCY OF NECTAR (LIKE
  TOMATO JUICE)
• EXTRA THICK - CONSISTENCY OF HONEY
• YOGURT LIKE CONSISTENCY - THICK, HOLDS ITS SHAPE

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SIGNS AND SYMPTOMS OF DYSPHAGIA

• THE PERSON COMPLAINS THAT FOOD WILL NOT GO DOWN
  OR FOOD IS STUCK
• THE PERSON FREQUENTLY COUGHS OR CHOKES BEFORE,
  DURING OR AFTER SWALLOWING
• THE PERSON REGURGITATES FOOD AFTER EATING
• THE PERSON SPITS OUT FOOD SUDDENLY AND
  FORCEFULLY
• FOOD COMES UP THROUGH THE PERSONS NOSE
• AFTER SWALLOWING, THE PERSON MAKES GARGLING
  SOUNDS WHILE TALKING OR BREATHING
• THE PERSON HAS A RUNNY NOSE, SNEEZES, OR HAS
  EXCESSIVE DROOLING OF SALIVA

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ASPIRATION PRECAUTIONS

• POSITION THE PERSON IN FOWLERS POSITION
• SUPPORT THEUPPER BACK, SHOULDERS, AND NECK WITH
  A PILLOW
• OBSERVE FOR SIGNS AND SYMPTOMS OF ASPIRATION
  DURING MEALS AND SNACKS
• CHECK THE PERSONS MOUTH AFTER MEALS TO ASSURE
  THERE IS NO POCKETING OF FOODS
• MAINTAIN THE PERSON IN A SITTING POSITION FOR 1
  HOUR AFTER MEALS

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RESIDENTS ARE ENCOURAGED TO GO TO THE DINING ROOM
FOR MEALS IF POSSIBLE. THIS PROVIDES
OPPORTUNITIES FOR SOCIALIZATION. PROVIDE ORAL
CARE, WASH THE FACE AND HANDS, AND ASSIST WITH
TOLIETING BEFORE MEALS.
MAKE SURE THE PERSON IS NEAT AND WELL-GROOMED
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SERVING MEAL TRAYS

• MATCH THE NAME ON THE TRAY WITH THE PERSONS ID
  BRACELET.
• NOTE IF THERE ARE ANY FOOD ALLERGIES IDENTIFIED
  AND IF THE DIET IS CORRECT.
• SERVE TRAYS PROMPTLY TO ASSURE FOOD IS SERVED AT
  THE CORRECT TEMPERATURE

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IF THE PERSON IS IN BED RAISE THEM TO A HIGH
FOWLERS POSITION. PLACE THE TRAY ON THE OVERBED
TABLE AND REMOVE THE FOOD COVERS. ASSIST AS
NEEDED BY OPENING PACKAGES OF SALT, MILK,ETC.,
CUT UP MEAT, BUTTER BREAD, OPEN COFFEE AND ADD
SUGAR OR CREAM.
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FEEDING THE PATIENT
A PERSON WHO IS VERY SICK, WEAK, OR CONFUSED MAY
NEED TO BE FED. YOU MAY BE FEEDING PATIENTS WHO
ARE IN BED, IN A CHAIR, IN THEIR ROOM, OR IN THE
DINING ROOM. BE SURE THE PATIENT IS SITTING UP
STRAIGHT TO AVOID CHOKING. ALWAYS USE A SPOON TO
FEED PATIENTS
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GUIDELINES FOR FEEDING A PATIENT

• WASH YOUR HANDS BEFORE PASSING TRAYS OR FEEDING
  PATIENTS
• PROVIDE A CLOTHING PROTECTOR IF NEEDED
• SIT DOWN FACING THE PATIENT AND MAKE EYE CONTACT
• COMMUNICATE WITH THE PATIENT, EVEN IF THERE IS
  NO RESPONSE
• MAKE SURE THE LIQUIDS ARE NOT TOO HOT
• SOME RESIDENTS NEED THICKENER ADDED TO THEIR
  LIQUIDS
• ENCOURAGE THE PATIENT TO HELP AS MUCH AS
  POSSIBLE
• FILL THE SPOON ABOUT ONE-HALF FULL

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• ALTERNATE FOODS AND FLUIDS
• ALLOW TIME FOR CHEWING AND SWALLOWING AND DO NOT
  RUSH
• FEED ON THE UNAFFECTED SIDE OF THE PATIENTS
  MOUTH IF THE PATIENT IS PARALYZED ON ONE SIDE
• MAKE SURE THE PATIENT SWALLOWS AFTER EACH BITE
• GENTLY STROKE THE PATIENTS THROAT IF NECESSARY
  AND REMIND HIM TO SWALLOW
• DO NOT EAT WHEN FEEDING THE PATIENTS
• DO NOT TAKE FOOD OFF OF THE PATIENTS TRAY FOR
  YOUR OWN USE
• DO NOT MIX THE FOODS ALL TOGETHER ON THE PLATE

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SPECIAL EQUIPMENT
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VISION-IMPAIRED PATIENT
USE THE CLOCK METHOD TO HELP THE VISION-IMPAIRED
PATIENT WITH EATING. THE LOCATION OF THE FOOD IS
COMPARED TO THE FACE OF A CLOCK.
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SUPPLEMENTAL NUTRITION

• BETWEEN-MEAL NOURISHMENTS
• PROVIDED TO PATIENTS WHO NEED EXTRA NOURISHMENT.
• SERVE SNACKS PROMPTLY AND ENCOURAGE THEM TO EAT.
• LIQUID ORAL SUPPLEMENTS
• PROVIDE EXTRA CALORIES AND NUTRIENTS.
• ( ENSURE, SUSTACAL )

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CALORIE COUNT
CALORIE RECORDS ARE KEPT, RECORDING ALL FOODS THE
PERSON EATS THE DIETICIAN CONVERTS THE FOOD
EATEN INTO CALORIE COUNTS THE NURSE WILL TELL YOU
WHICH PATIENTS ARE ON CALORIE COUNTS
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ENTERAL NUTRITION

• NASOGASTRIC FEEDING -
• INSERTED THROUGH THE NOSE INTO THE STOMACH
• USED FOR SHORT TERM THERAPY
• INSERTED BY THE NURSE AND PLACEMENT IS CHECKED
  BY X-RAY

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• GASTROSTOMY FEEDING
• PLACED DIRECTLY INTO THE STOMACH THROUGH A SMALL
  INCISION.
• THE TUBE MAY BE SUTURED IN PLACE.

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GUIDELINES FOR CARE OF THE PATIENT WITH A FEEDING
TUBE

• OBSERVE THE PATIENT FREQUENTLY
• CALL THE NURSE IF THE FEEDING PUMP ALARM SOUNDS
• MAKE SURE THE TUBING IS NOT KINKED, TANGLED, OR
  UNDER THE PATIENTS BODY
• AVOID PULLING ON THE TUBE
• KEEP THE HEAD OF THE BED ELEVATED
• PROVIDE FREQUENT ORAL CARE
• CHECK THE INSERTION SITE FOR IRRITATION
• CHECK WITH THE NURSE BEFORE GIVING FOOD OR FLUIDS

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GUIDELINES FOR CARE OF THE PATIENT WITH AN I.V.

• KEEP THE FLUID BAG ABOVE THE LEVEL OF THE
  INSERTION SITE
• AVOID PULLING ON THE TUBING
• DO NOT TAKE A BLOOD PRESSURE IN AN ARM WITH AN
  I.V.
• DO NOT ADJUST THE FLOW RATE OF THE I.V.
• REPORT TO THE NURSE IF
• SWELLING, REDNESS, BLEEDING, OR LEAKING AT
  INSERTION SITE
• COMPLAINTS OF PAIN OR BURNING
• HOT OR COLD SKIN NEAR THE IV SITE
• LOW FLUID LEVEL IN THE IV BAG
• THE TUBING HAS BEEN DISCONNECTED

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HYPERALIMENTATION

• IV FEEDING THAT CONTAINS CONCENTRATED NUTRIENTS
• FLOWS INTO A MAJOR VEIN ON THE UPPER CHEST
• INSERTED BY THE DOCTOR
• MAY ALSO BE CALLED HYPER-AL, TPN, OR TOTAL
  PARENTERAL NUTRITION

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WATER

• WATER IS AN ESSENTIAL INGREDIENT OF A
  WELL-BALANCED DIET.
• WATER IS LOST THROUGH THE URINE AND FECES,
  THROUGH THE SKIN AS PERSPIRATION, AND THROUGH THE
  LUNGS WITH EXPIRATION.
• WATER ENTERS THE BODY THROUGH FOODS AND FLUIDS.

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FLUID BALANCE
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MAINTAINING FLUID BALANCE

• ADEQUATE HYDRATION FOR THE ADULT IS BETWEEN 2000
  CC TO 2500 CC DAILY.
• ANYTHING THAT INCREASES FLUID ELIMINATION OR
  DECREASES FLUID INTAKE CAN AFFECT FLUID BALANCE.
• EDEMA THE ACCUMULATION OF FLUID IN THE
  TISSUES.
• DEHYDRATION LACK OF ADEQUATE FLUID IN THE
  BODY.
• FORCE FLUIDS HAVING THE PERSON DRINK INCREASED
  AMOUNTS OF FLUID.
• RESTRICT FLUIDS RESTRICTING FLUIDS TO A
  CERTAIN AMOUNT.
• NPO NOTHING BY MOUTH.

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INTAKE

• INCLUDES ALL LIQUIDS INGESTED BY THE PERSON
  THROUGH THE MOUTH. ALSO FLUIDS GIVEN BY IV AND
  TUBE FEEDINGS.

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OUTPUT

• INCLUDES URINE, VOMITUS, DIARRHEA, AND WOUND
  DRAINAGE.

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TYPICAL I O

• DEHYDRATED
• RECEIVING INTRAVENOUS INFUSION
• HAVE HAD RECENT SURGERY
• HAVE A URINARY CATHETER
• ARE VOMITING
• HAVE CERTAIN DIAGNOSES SUCH AS CONGESTIVE HEART
  FAILURE OR RENAL DISEASE

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INTAKE AND OUTPUT SHEET
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A SPECI-PAN IS USED TO CATCH THE URINE OF A
PATIENT WHO IS ON IO THAT CAN BE UP TO THE
BATHROOM. INSTRUCT THE PATIENT TO NOT PUT TOLIET
PAPER IN WITH THE URINE TO BE MEASURED.
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ALL MEASUREMENTS MUST BE MADE IN CUBIC
CENTIMETERS (CC) INSTEAD OF OUNCES. 30CC. 1 OZ.
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