1. Nutrition and Fluids Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. Dietary Practices  The person’s diet affects physical and mental well-being.  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  Culture, finances, and personal choice affect dietary practices. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 2

3. Basic Nutrition  Nutrition is the processes involved in the ingestion, digestion, absorption, and use of foods and fluids by the body.  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 © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 3

4. Basic Nutrition (cont’d)  The Dietary Guidelines for Americans, 2010 is for persons 2 years of age and older.  The Dietary Guidelines help people:  Attain and maintain a healthy weight.  Reduce the risk of chronic disease.  Promote overall health.  The Guidelines focus on:  Consuming fewer calories  Making informed food choices  Being physically active Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 4

5. Basic Nutrition (cont’d)  The MyPtate symbol encourages healthy eating from 5 food groups.  MyPlate, issued by the United States Department of Agriculture (USDA), helps you make wise food choices by:  Balancing calories  Increasing certain foods  Reducing certain foods  The USDA recommends that adults do at least one of the following:  2 hours and 30 minutes each week of moderate physical activity  1 hour and 15 minutes each week of vigorous physical activity Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 5

6. Basic Nutrition (cont’d)  Nutrients  Protein is the most important nutrient.  It is needed for tissue growth and repair.  Carbohydrates provide energy and fiber for bowel elimination.  Fats provide energy.  They provide and help the body use certain vitamins.  Vitamins are needed for certain body functions.  Minerals are used for many body processes.  Water is needed for all body processes. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 6

7. Basic Nutrition (cont’d)  Food labels  Food labels are used to make informed food choices for a healthy diet.  Food labels contain information about:  Serving size and the number of servings in each package  Calories and calories from fat  Nutrients  How a serving fits into the daily diet is called the Daily Value (DV).  The DV is a percent based on 2000 calories daily. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 7

8. MEETING NUTRITIONAL NEEDS  A team approach is needed to meet a person’s nutritional needs.  The nutritional care plan involves the person’s:  Likes and dislikes  Lifelong habits Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 8

9. Special Diets  Doctors may order special diets:  For a nutritional deficiency or a disease  For weight control (gain or loss)  To eliminate or decrease certain substances in the diet  The health team considers the need for dietary changes, personal choices, religion, culture, and eating problems.  Regular diet, general diet, and house diet mean no dietary limits or restrictions. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 9

10. Special Diets (cont’d)  The sodium-controlled diet  Sodium causes the body to retain water.  The heart has to work harder. The extra workload can cause serious problems or death.  Sodium control decreases the amount of sodium in the body.  The doctor orders the amount of sodium allowed.  Sodium-controlled diets involve:  Omitting high-sodium foods  Not adding salt to food at the table  Limiting the amount of salt used in cooking  Diet planning Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 10

11. Special Diets (cont’d)  Diabetes meal plan  A meal plan for health eating is developed.  Consistency is key.  The meal plan involves:  The person’s food preferences  Calories needed  Eating meals and snacks at regular times  You need to:  Serve meals and snacks on time.  Always check what was eaten.  Report what the person did and did not eat.  Report changes in the person’s eating habits. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 11

12. Special Diets (cont’d)  The dysphagia diet  Dysphagia means difficulty swallowing.  Food thickness is changed to meet the person’s needs.  Doctor, speech-language pathologist, occupational therapist, dietitian, and nurse choose food thickness.  When feeding the person with dysphagia, you must:  Know the signs and symptoms of dysphagia.  Feed the person according to the care plan.  Follow aspiration precautions and the care plan.  Report changes in how the person eats.  Observe for signs and symptoms of aspiration: choking, coughing, or difficulty breathing during or after meals, and abnormal breathing or respiratory sounds.  Report these observations at once. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 12

13. Fluid Balance  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. This is called edema.  If fluid output exceeds intake, dehydration occurs. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 13

14. Fluid Balance (cont’d)  Normal fluid requirements  An adult needs 1500 mL (milliliters) of water daily to survive.  About 2000 to 2500 mL are needed for normal fluid balance.  The water requirement increases with:  Hot weather  Exercise  Fever and illness  Excess fluid losses Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 14

15. Fluid Balance (cont’d)  Common special fluid orders are:  Encourage fluids: the person drinks an increased amount of fluids.  Restrict fluids: fluids are limited to a certain amount.  Nothing by mouth (NPO): the person cannot eat or drink anything.  Thickened liquids: all fluids are thickened, including water. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 15

16. Fluid Balance (cont’d)  Intake and output (I&O) records  The doctor or nurse may order (I&O) measurements.  I&O records are kept:  To evaluate fluid balance and kidney function  To help in planning medical treatment  When the person has special fluid orders  The following fluids are measured and recorded:  All fluids taken by mouth  Foods that melt at room temperature  IV fluids and tube feedings  Output includes urine, vomitus, diarrhea, and wound drainage. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 16

17. Fluid Balance (cont’d)  Measuring intake and output  Intake and output are measured in milliliters (mL).  A measuring container for fluid is called a graduate.  The measuring device is held at eye level to read the amount.  An I&O record is kept at the bedside.  Amounts are totaled at the end of the shift.  The purpose of measuring I&O and how to help are explained to the person.  The urinal, commode, bedpan, or specimen pan is used for voiding. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 17

18. Meeting Food and Fluid Needs  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 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 18

19. Meeting Food and Fluid Needs (cont’d)  Preparing for meals  To promote comfort when preparing patients and residents for meals:  Assist with elimination needs.  Provide oral hygiene.  Make sure needed dentures are in place.  Make sure eyeglasses and hearing aids are in place (if worn).  Make sure incontinent persons are clean and dry.  Position the person in a comfortable position.  Assist the person with hand washing. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 19

20. Meeting Food and Fluid Needs (cont’d)  Serving meals  You serve meals after preparing patients and residents for meals.  Some agencies have “room service” meal programs.  Serve meals in the assigned order.  If food is not served within 15 minutes, re-check food temperatures. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 20

21. Meeting Food and Fluid Needs (cont’d)  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.  Let the person do as much as possible.  Always tell the visually impaired person what is on the tray.  When feeding visually impaired persons, describe what you are offering.  For persons who feed themselves, describe foods and fluids and their places on the tray.  Use the numbers on a clock for the location of foods. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 21

22. Meeting Food and Fluid Needs (cont’d)  Allow time and privacy for prayer.  Engage the person in pleasant conversation.  Allow time for chewing and swallowing.  Sit facing the person.  You can see how well the person is eating.  You can also see if the person has problems swallowing. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 22

23. Meeting Food and Fluid Needs (cont’d)  Between-meal nourishments  Snacks are served upon arrival on the nursing unit.  Follow the same considerations and procedures as for serving meals and feeding persons.  Calorie counts  On a flow sheet, note what the person ate and how much.  A nurse or dietitian converts the portions into calories.  Providing drinking water  Patients and residents need fresh drinking water each shift and whenever the pitcher is empty.  Follow the agency’s procedure for providing fresh drinking water. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 23

24. Foodborne Illnesses  A foodborne illness (food poisoning) is caused by pathogens in food and fluids.  Report signs and symptoms to the nurse at once.  Food is not sterile.  Pathogens are present when food is purchased.  Foods can become contaminated from other foods.  Food handlers with poor hygiene can contaminate the food.  Pathogens grow rapidly between 40 F and 140 F.  This range is called the danger zone by the USDA. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 24

25. Foodborne Illnesses (cont’d)  To keep food safe, the USDA recommends these 4 safety tips.  Clean.  Wash hands, utensils, and counter tops often.  Separate.  Avoid cross-contamination.  Cook.  Cook food to a safe internal temperature.  Re-heat cooked food to 165 F.  Chill.  Refrigerate or freeze food within 2 hours.  If the air is 90 F or above, chill food within 1 hour. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slid e 25