1. Proper Nutrition Is Important to the Health and Well Being of Nursing Home Residents.

3. Enough intake of essential nutrients to maintain good health.

8. Nutrition Care Alerts Program Improving the Nutritional Health of Your Residents !

9. Designed to help maintain nutritional health of residents Designed to help facilities address four areas of resident care !

10. Four Common Nutrition Related Conditions Unintended weight loss Dehydration Pressure ulcers Complications of tube feeding

11. Unintended Weight Loss Needs help to eat or drink Eats less than half of meals/snacks Complains of mouth pain Has dentures that don’t fit Has a hard time chewing or swallowing !

12. Unintended Weight Loss Has trouble using utensils Is sad, has crying spells, or withdraws from others Is confused, wanders, or paces Has diabetes, COPD, cancer, HIV, or other chronic disease. !

13. Unintended Weight Loss (Poor Food Intake) Alert RD/physician to poor food intake Provide high-calorie liquids for medication administration, if indicated Order weekly weights Assess ability of resident to feed self

14. Unintended Weight Loss (Poor Food Intake) Recommend strategies to enhance self-feeding skill Monitor feeding assistance provided for appropriateness

15. Unintended Weight Loss (Oral Health Problems) Examine oral cavity, evaluate swallowing ability Alert physician/RD to poor oral health/dental or swallowing problems Request dental consult, if indicated Request speech/language pathologist consult, if indicated

16. Unintended Weight Loss (Emotional or Cognitive Impairment) Evaluate decline in mood/mental status Alert physician to decline in mood/mental status Report fever/infection to physician

17. Unintended Weight Loss RD/DTR Develop strategies to increase food intake Pharmacist Assess impact of medications on appetite Physician Adjust diet, as indicated

18. Dehydration Drinks less than 6 cups of liquid daily Has dry mouth, cracked lips, sunken eyes, or urine is dark in color or has strong odor Needs help to drink Has trouble swallowing liquids Has vomiting, diarrhea or fever Is dizzy, easily confused, or tired !

19. Dehydration Review vital signs Assess hydration status Alert physician/RD to deterioration in hydration status Assess resident’s ability to drink unassisted and recommend strategies to enhance ability to drink unassisted Monitor affects of strategies to increase oral fluid intake

20. Dehydration Suggest IV or oral hydration, if indicated Monitor IV hydration; suggest changes in type, volume,or rate of administration, as indicated Consider enteral tube feeding for rehydration Evaluate for swallowing impairment, if indicated Give medications with 6-8 ounces of liquid

21. Dehydration RD/DTR Recommend strategies to increase oral fluid intake Pharmacist Assess continued need for diuretics, if prescribed Physician Prescribe IV or PO hydration, if indicated

22. Pressure Ulcers Is subject to -incontinence -heavy perspiration Needs help -moving arms,legs,or body -turning in bed -changing position when sitting !

23. Pressure Ulcers Has lost weight Eats less than half of meals and snacks served Is dehydrated Has discolored, torn, or swollen skin over bony areas !

24. Pressure Ulcers Alert physician to tissue breakdown/wound development Follow wound care protocol Alert physician to resident decline in bowel and bladder function Implement bowel/bladder training protocol, if indicated Alert physician to resident inability to shift position adequately

25. Pressure Ulcers Restraints not recommended; if needed, check skin covered by restraints Insert urinary catheter only as a last option Follow “Unintended Weight Loss” and “Dehydration” interventions

26. Pressure Ulcers RD/DTR Develop nutrition plan for wound care Pharmacist Assess impact of medication on resident ability to shift position/move body Physician Examine resident’s skin; order wound care, if indicated

27. Residents Who Are Tube Fed Has nausea, vomiting or diarrhea Has swollen stomach or stomach ache Has constipation or cramping !

28. Residents Who Are Tube Fed Has coughing, wheezing, wet breathing, or a feeling of something caught in the throat At the site where the feeding tube enters the body there is -pain, redness, heat or swelling -crusty or oozing fluid !

29. Residents Who Are Tube Fed (Stomach/Abdominal Complaints) Alert RD/physician to stomach/abdominal complaints Assess complaints to rule out nonfeeding causes Assess gastric residuals, recommend change in feeding tube end point, if indicated

30. Residents Who Are Tube Fed (Stomach/Abdominal Complaints) Flush feeding tube as needed to maintain prescribed rate of flow Follow protocol for tube feeding hang time Use liquid medications, if possible

31. Residents Who Are Tube Fed (Site Complications) Alert the physician to complaints regarding site of tube placement: - nasal placement: nose, ear, throat - percutaneous placement: ostomy site Follow protocol for addressing tube site complications

32. Tube Feeding RD/DTR assess complaints to rule out nonfeeding causes Pharmacist Rule out medication side effects/interactions as a source of complaints Physician Rule out infection or mechanical source of complaints

33. Based on the Nutrition Care Alerts Adapted with permission by the Nutrition Screening Initiative, a project of the American Academy of Family Physicians, American Dietetic Association, and National Council on the Aging, Inc., and funded in part by a grant from Ross Products Division, Abbott Laboratories, Inc. These materials were developed by the National Policy and Resource Center on Nutrition and Aging at Florida International University through grants from the US Administration on Aging and US Health Care Financing Administration.