Unit 6-nutrition And Hydration

Unit 6

Nutrition and Hydration Nurse Aide I Course

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Nutrition and Hydration Introduction This unit introduces the nurse aide to the basic principles of nutrition and emphasizes the functions of the major nutrients required for health.

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Nutrition and Hydration Introduction (continued)

This unit covers the Food Guide Pyramid, the use of therapeutic diets, adaptive devices, alternative methods of feeding, providing water and nourishments, the procedure for feeding a resident, and the effects of good nutrition and poor nutrition. DHSR Approved Curriculum-Unit 6

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Nutrition and Hydration Introduction (continued)

Knowledge of nutrition will enable the nurse aide to recognize the important relationship between food and good health.

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6.0 Identify the general principles of basic nutrition. 6.1 Identify factors that influence dietary practices.

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Good Nutrition • Promotes physical and mental health • Provides increased resistance to illness • Produces added energy and vitality DHSR Approved Curriculum-Unit 6

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Good Nutrition (continued)

• Aids in healing process • Assists one to feel and sleep better

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Functions of Food • Provides energy • Growth and repair of tissue • Maintenance and regulation of body processes DHSR Approved Curriculum-Unit 6

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Factors Influencing Dietary Practices • Personal preference • Appetite • Finance • Illness • Culture

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6.1.1 Review cultural variations in diet.

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Culture and Dietary Practices • The diets of Chinese, Japanese, Koreans and people from Far East include rice and tea • The diets of Spanishspeaking people include spicy dishes containing rice, beans and corn DHSR Approved Curriculum-Unit 6

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Culture and Dietary Practices (continued)

• The Italian diet includes spaghetti, lasagna, and other pastas • Scandinavians have a lot of fish in their diets

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Culture and Dietary Practices (continued)

• Americans eat a lot of meat, fast foods, and processed foods • Use of sauce and spices are culturally related DHSR Approved Curriculum-Unit 6

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Culture and Food Preparation Baking

Frying

Roasting

Smoking

Fresh/raw DHSR Approved Curriculum-Unit 6

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6.1.2 List seven examples of foods avoided by some religious denominations.

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Religion and Dietary Practices • Days of fasting when all or certain foods are avoided. • Christian Science - avoid coffee/tea and alcohol • Roman Catholic - avoid food one hour before communion, observe special fast days DHSR Approved Curriculum-Unit 6

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Religion and Dietary Practices (continued)

• Muslim/Moslem - avoid alcohol, pork products • 7th Day Adventist avoid coffee/tea, alcohol, pork and some meats, caffeine DHSR Approved Curriculum-Unit 6

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Religion and Dietary Practices (continued)

• Baptists – some avoid coffee, tea and alcohol • Greek Orthodox - fast days, but usually “forgiven” when ill

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Religion and Dietary Practices (continued)

• Conservative Jewish faith – Prohibits shellfish, nonkosher meats such as pork – Requires special utensils for food preparation DHSR Approved Curriculum-Unit 6

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Religion and Dietary Practices (continued)

• Conservative Jewish faith – Forbids cooking on Sabbath – Forbids eating of leavened bread during Passover DHSR Approved Curriculum-Unit 6

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Religion and Dietary Practices (continued)

• Conservative Jewish faith – Forbids serving milk and milk products with meat – Strict rules regarding sequence in which milk products and meat may be consumed DHSR Approved Curriculum-Unit 6

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6.1.3 Review the major classification of nutrients and their function in the body.

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Nutrients • Nutrients are essential • Four classifications of nutrients 1. Fats - provide energy, help body use certain vitamins, conserve body heat and protect organs from injury 2. Proteins – build and repair tissue DHSR Approved Curriculum-Unit 6

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Nutrients (continued)

• Four classifications of nutrients (continued)

1. Carbohydrates - provide energy and fiber that help in bowel elimination 2. Vitamins and minerals - ingested through food and are necessary for carrying out and maintaining specific body functions DHSR Approved Curriculum-Unit 6

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Nutrients (continued)

• Fats, proteins and carbohydrates measured in calories

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Nutrients (continued)

• Water - solvent for nutrients and metabolic waste products – Found in all body tissue – Essential for digestion of food – Makes up most of blood plasma – 6 to 8 glasses necessary per day – Has no caloric value DHSR Approved Curriculum-Unit 6

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6.1.4 Describe six factors that influence caloric needs.

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Factors That Influence Caloric Need • • • • • •

Age Sex Size and activity level Climate State of health Amount of sleep obtained DHSR Approved Curriculum-Unit 6

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6.1.5 Cite nine age-related changes/factors that affect the resident’s nutritional status.

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Age Related Changes/Factors Affecting Nutrition • Need for fewer calories • Vitamin and mineral requirements change • Drugs that affect how nutrients are absorbed and used • Teeth/dentures affect ability to chew food DHSR Approved Curriculum-Unit 6

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Age Related Changes/Factors Affecting Nutrition (continued)

• Diminished sense of taste and smell • Assistance required with eating • Decreased saliva and gastric juices production • Discomfort caused by constipation • Decreased appetite and thirst DHSR Approved Curriculum-Unit 6

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6.1.6 Recognize the signs of good nutrition.

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Signs Of Good Nutrition • Healthy, shiny looking hair • Clean skin and bright eyes • A well-developed, healthy body • An alert facial expression • An even, pleasant disposition DHSR Approved Curriculum-Unit 6

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Signs Of Good Nutrition (continued)

• Restful sleep patterns • Healthy appetite • Regular elimination habits • Appropriate body weight DHSR Approved Curriculum-Unit 6

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6.1.7 Identify seven results of poor nutrition.

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Results of Poor Nutrition • Hair and eyes appear dull • Irregular bowel habits • Weight changes • Osteoporosis and other diseases DHSR Approved Curriculum-Unit 6

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Results of Poor Nutrition (continued)

• Lack of interest mental slowdown • Skin color and appearance poor

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Results of Poor Nutrition (continued)

• Anemia leading to: – tired feeling – shortness of breath – increased pulse – problems with digestion

– pale skin – poor sleep patterns – headaches

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6.2

Discuss the six basic food groups from the Food Guide Pyramid that contribute to balanced nutrition.

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Dietary Guide For Americans • Guidelines are the foundation of the Food Guide Pyramid and include nine key recommendations. • Key recommendation #1: Consume nutrient-dense foods and beverages within calories needed for age, sex and activity level. DHSR Approved Curriculum-Unit 6

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Dietary Guide For Americans • Key recommendation #2: To maintain health body weight, balance calories consumed with calories expended. • Key recommendation #3: Engage regularly in a variety of physical activities and reduce sedentary activities. DHSR Approved Curriculum-Unit 6

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Dietary Guide For Americans • Key recommendation #4: Encourage the following: – Choose variety of fruits and vegetables daily. – Half of daily grains should come from whole grains. – Consume 3 cups fat-free or low fat milk or equivalent milk products daily. DHSR Approved Curriculum-Unit 6

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Dietary Guide For Americans • Key recommendation #5: Consume foods and beverages that are low in saturated fats, trans fats and cholesterol. • Key recommendation #6: For carbohydrates: Choose fiber-rich foods, vegetables and grains often. Reduce intake of sugar- and starch-containing foods. DHSR Approved Curriculum-Unit 6

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Dietary Guide For Americans • Key recommendation #7: Consume less than a teaspoon of salt per day. • Key recommendation #8: Consume alcoholic beverages in moderation if alcohol intake is permitted. • Key recommendation #9: Prepare foods in a safe manner to avoid microbial foodborne illness. DHSR Approved Curriculum-Unit 6

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Six Basic Food Groups From the Food Pyramid Guide

GRAINS

Vegetables

Fruits

Milk

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Meat & Beans

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Food Pyramid Guide Grain Group (breads, cereal, rice, pasta) • Provides – carbohydrates – minerals – fiber

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Food Pyramid Guide Grain Group (breads, cereal, rice, pasta) (continued)

• 1 ounce equivalent is about 1 slice of bread, about 1 cup of breakfast cereal or ½ cup cooked rice, cereal or pasta. DHSR Approved Curriculum-Unit 6

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Food Pyramid Guide Grain Group (breads, cereal, rice, pasta) (continued)

• Daily: – 6 ounce equivalents for males over 60 – 5 ounce equivalents for females over 60 DHSR Approved Curriculum-Unit 6

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Food Guide Pyramid Vegetable Group • Provides: – vitamins – minerals – fiber (roughage) • Easier to chew if cooked, chopped or diced DHSR Approved Curriculum-Unit 6

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Food Guide Pyramid Vegetable Group (continued)

• Chose from all five vegetable subgroups: – dark green – orange – legumes – starchy – other vegetables DHSR Approved Curriculum-Unit 6

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Food Guide Pyramid Vegetable Group (continued)

• Daily: – 2½ cups for males over 60 – 2 cups for females over 60

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Food Pyramid Guide Fruit Group • Provides – vitamins – minerals – fiber

• Chose fresh, frozen, canned or dried fruits DHSR Approved Curriculum-Unit 6

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Food Pyramid Guide Fruit Group (continued)

• Daily: – 2 cups daily for males over 60 – 1½ cups daily for females over 60

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Food Pyramid Guide Milk, Yogurt and Other Milk Products • Provides – proteins – vitamins (A) – minerals (calcium) – carbohydrates – Fat • Choose low-fat or fat-free milk and milk products DHSR Approved Curriculum-Unit 6

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Food Pyramid Guide Milk, Yogurt, Cheese Group (continued)

• Daily: – 3 cups for males over 60 – 3 cups for females over 60

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Food Pyramid Guide Meat, Poultry, Fish and Beans Group • Provides – protein – fats – vitamins – Minerals – 1 ounce of meat, poultry or fish is about ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut butter or ½ ounce nuts or seeds DHSR Approved Curriculum-Unit 6

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Food Pyramid Guide Meat, Poultry, Fish and Beans Group (continued)

• Daily: – 5½ ounce equivalents daily for males over 60 – 5 ounce equivalents daily for females over 60

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Food Pyramid Guide Oil Group = fats that are liquid at room temperature • Provides essential

fatty acids • High in calories • Use sparingly

• Keep total fat intake between 20% to 35% of calories DHSR Approved Curriculum-Unit 6

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Food Pyramid Guide Oil Group = fats that are liquid at room temperature • Most fats consumed should be polyunsaturated and monounsaturated. • Make most fat sources from fish, nuts and vegetable oils. • Limit solid fats like butter, stick margarine, shortening and lard. DHSR Approved Curriculum-Unit 6

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6.3

Define a therapeutic diet and recognize the need for alterations in a regular diet. 6.3.1 List five purposes of a therapeutic diet. DHSR Approved Curriculum-Unit 6

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Purposes of Therapeutic Diets • Add or eliminate calories to cause a change in body weight • Assist with digestion of food by taking foods out of diet that irritate digestive system • Restrict salt intake to prevent or decrease edema DHSR Approved Curriculum-Unit 6

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Purposes of Therapeutic Diets (continued)

• Help body organs to maintain and/or regain normal function • Treat metabolic disorders by regulating amount of food

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6.3.2 Discuss the types of therapeutic diets that the physician might order for a resident.

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Types of Therapeutic Diets • • • • •

Clear liquid Full liquid Bland Low residue Controlled carbohydrate (Diabetic) • Low fat/low cholesterol DHSR Approved Curriculum-Unit 6

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Types of Therapeutic Diets (continued)

• • • • • •

High fiber Low calorie High calorie Sodium restricted High protein Mechanical soft, chopped, pureed DHSR Approved Curriculum-Unit 6

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Types of Therapeutic Diets (continued)

Residents may have difficulty accepting special diets.

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6.4

Recognize adaptive devices used to assist residents with eating.

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Adaptive Devices • • • •

Food Guards Divided Plates Built-up handled utensils Easy grip mugs/glasses Residents have to be taught how to use these devices. DHSR Approved Curriculum-Unit 6

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6.5

Discuss alternate methods of feeding.

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Parenteral Fluids (Intravenous Infusion) • Fluids administered through vein. Little nutritional value • Responsibility of licensed nurse

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Parenteral Fluids (Intravenous Infusion) (continued)

• Observations to report – Near-empty bottle/bag – Change in drip rate – Pain at needle site, and/or redness and/or swelling, if observable – Loose, non-intact, or damp dressing DHSR Approved Curriculum-Unit 6

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Enteral Feeding Residents unable to take nutrients by mouth • Depressed • Comatose • Swallowing problem (stroke, Alzheimer’s or other medical conditions) • Disorders of digestive tract DHSR Approved Curriculum-Unit 6

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Enteral Feeding (continued)

Liquid formula administered through tube by licensed nurse/NAII • Nose to stomach nasogastric tube • Directly into stomach gastrostomy tube DHSR Approved Curriculum-Unit 6

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Nurse Aide Responsibilities in Alternative Nutrition • Ensure that there is no tension or pulling on tube • Keep resident’s nose clean and free of mucus • Check that tube is securely taped to nose • Perform frequent oral care with nasogastric tube DHSR Approved Curriculum-Unit 6

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Nurse Aide Responsibilities in Alternative Nutrition (continued)

• Fasten tube with pin to shoulder area of clothing to prevent straining or tension on tube • Report non-intact dressing around tube site DHSR Approved Curriculum-Unit 6

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Nurse Aide Responsibilities in Alternative Nutrition (continued)

• Report any signs or symptoms related to aspiration or GI problems • Mitts may be ordered to prevent resident from dislodging tube

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6.6

Identify the responsibilities of the nurse aide in preparing residents for meals. 6.6.1 Serve prepared food as instructed. DHSR Approved Curriculum-Unit 6

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Preparing Residents for Meals • Meals enjoyable, social experience • Provide pleasant environment – Clean area – Odor-free area – Adequate lighting • Flowers/decorations and music add interest to dining area DHSR Approved Curriculum-Unit 6

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Preparing Residents for Meals (continued)

• All residents clean and dressed for meals • Hair combed • Oral care provided • Encourage to use bathroom or urinal/bedpan • Cleanse and dry incontinent residents DHSR Approved Curriculum-Unit 6

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Preparing Residents for Meals (continued)

• Face and hands washed • Provide for comfort – Raise head of bed – Position in chair – Transport to dining area • Provide clothing protector if appropriate DHSR Approved Curriculum-Unit 6

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Preparing Residents for Meals (continued)

• Check to be certain resident receives right tray and has correct diet • Food should be attractively served and placed within reach • Check tray to see that everything needed is there DHSR Approved Curriculum-Unit 6

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Preparing Residents for Meals (continued)

• Assist resident as needed with: – cutting meat – pouring liquids – buttering bread – opening containers

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Preparing Residents for Meals (continued)

• Blind residents made aware of food placement according to face of clock • Stroke residents approached from noneffected side DHSR Approved Curriculum-Unit 6

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Preparing Residents for Meals (continued)

• Residents should be encouraged to do as much as possible for themselves • Provide time for resident to complete meal • Display pleasant, patient attitude DHSR Approved Curriculum-Unit 6

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Preparing Residents for Meals (continued)

• Remove tray when meal finished • Report unconsumed food to supervisor • Record fluid intake if ordered • Assist to position of comfort DHSR Approved Curriculum-Unit 6

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Preparing Residents for Meals (continued)

• Call signal and supplies positioned within reach • Area should be left clean and tidy • Hands washed before and after care of each resident

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6.7

Demonstrate the procedure for assisting with dining/feeding resident who cannot feed self.

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6.8

Discuss the various types of supplementary nourishments.

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Types of Nourishments • • • • • •

Milk Juice Gelatin Custard, ice cream, sherbet Crackers Nutritional supplementation products (e.g., Ensure, etc.) DHSR Approved Curriculum-Unit 6

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Supplementary Nourishments • Usually served: – Midmorning – Mid-afternoon – Bedtime

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Supplementary Nourishments (continued)

• Ordered by physician • Serve as directed by supervisor • Provide necessary eating utensils, straw and/or napkin DHSR Approved Curriculum-Unit 6

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6.10 Demonstrate the procedure for serving supplementary nourishments.

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6.11 Identify the special fluid orders that the physician could write.

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Providing Fresh Drinking Water • Fresh water should be provided periodically throughout day • Encourage to drink 6-8 glasses daily if appropriate

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Providing Fresh Drinking Water (continued)

• Note residents who have special fluid orders – N.P.O. – Fluid restrictions: • Schedule 24-hour intake • Remind resident

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Providing Fresh Drinking Water (continued)

• Note residents who have special fluid orders – Force fluids • Offer fluids in small quantities • Offer fluids (resident preference) without being asked • Remind resident of importance of fluids in bodily functions – No ice DHSR Approved Curriculum-Unit 6

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6.11 Demonstrate the procedure for providing fresh drinking water.

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