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Unit 6

Nutrition and Hydration


Nurse Aide I Course

DHSR Approved Curriculum-Unit 6 1


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.

DHSR Approved Curriculum-Unit 6 2


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 3
Nutrition and Hydration
Introduction
(continued)
Knowledge of nutrition will enable the
nurse aide to recognize the important
relationship between food and good
health.

DHSR Approved Curriculum-Unit 6 4


DHSR Approved Curriculum-Unit 6 5
6.0 Identify the general principles of
basic nutrition.
6.1 Identify factors that influence
dietary practices.

DHSR Approved Curriculum-Unit 6 6


Good Nutrition

• Promotes physical and


mental health
• Provides increased
resistance to illness
• Produces added energy
and vitality

DHSR Approved Curriculum-Unit 6 7


Good Nutrition
(continued)

• Aids in healing process


• Assists one to feel and sleep better

DHSR Approved Curriculum-Unit 6 8


Functions of Food

• Provides energy
• Growth and repair
of tissue
• Maintenance and
regulation of body
processes

DHSR Approved Curriculum-Unit 6 9


Factors Influencing Dietary Practices

• Personal preference
• Appetite
• Finance
• Illness
• Culture

DHSR Approved Curriculum-Unit 6 10


6.1.1 Review cultural variations in diet.

DHSR Approved Curriculum-Unit 6 11


Culture and Dietary Practices

• The diets of Chinese,


Japanese, Koreans and
people from Far East
include rice and tea
• The diets of Spanish-
speaking people include
spicy dishes containing
rice, beans and corn
DHSR Approved Curriculum-Unit 6 12
Culture and Dietary Practices
(continued)

• The Italian diet includes


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

DHSR Approved Curriculum-Unit 6 13


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 14


Culture and Food Preparation

Frying Baking

Smoking
Roasting

Fresh/raw
DHSR Approved Curriculum-Unit 6 15
6.1.2 List seven examples of foods
avoided by some religious
denominations.

DHSR Approved Curriculum-Unit 6 16


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 17
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 18


Religion and Dietary Practices
(continued)

• Baptists – some avoid


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

DHSR Approved Curriculum-Unit 6 19


Religion and Dietary Practices
(continued)
• Conservative Jewish faith
– Prohibits shellfish, non-
kosher meats such as
pork
– Requires special
utensils for food
preparation
DHSR Approved Curriculum-Unit 6 20
Religion and Dietary Practices
(continued)

• Conservative Jewish faith


– Forbids cooking on
Sabbath
– Forbids eating of
leavened bread during
Passover

DHSR Approved Curriculum-Unit 6 21


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 22
6.1.3 Review the major classification of
nutrients and their function in the
body.

DHSR Approved Curriculum-Unit 6 23


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 24


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 25
Nutrients
(continued)

• Fats, proteins and carbohydrates


measured in calories

DHSR Approved Curriculum-Unit 6 26


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 27
6.1.4 Describe six factors that influence
caloric needs.

DHSR Approved Curriculum-Unit 6 28


Factors That Influence Caloric Need
• Age
• Sex
• Size and activity level
• Climate
• State of health
• Amount of sleep
obtained
DHSR Approved Curriculum-Unit 6 29
6.1.5 Cite nine age-related
changes/factors that affect the
resident’s nutritional status.

DHSR Approved Curriculum-Unit 6 30


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 31
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 32
6.1.6 Recognize the signs of good
nutrition.

DHSR Approved Curriculum-Unit 6 33


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 34


Signs Of Good Nutrition
(continued)

• Restful sleep patterns


• Healthy appetite
• Regular elimination
habits
• Appropriate body
weight

DHSR Approved Curriculum-Unit 6 35


6.1.7 Identify seven results of poor
nutrition.

DHSR Approved Curriculum-Unit 6 36


Results of Poor Nutrition

• Hair and eyes


appear dull
• Irregular bowel
habits
• Weight changes
• Osteoporosis and
other diseases
DHSR Approved Curriculum-Unit 6 37
Results of Poor Nutrition
(continued)

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

DHSR Approved Curriculum-Unit 6 38


Results of Poor Nutrition
(continued)

• Anemia leading to:


– tired feeling – pale skin
– shortness of breath – poor sleep
– increased pulse patterns
– problems with – headaches
digestion

DHSR Approved Curriculum-Unit 6 39


DHSR Approved Curriculum-Unit 6 40
6.2 Discuss the six basic food groups
from the Food Guide Pyramid
that contribute to balanced
nutrition.

DHSR Approved Curriculum-Unit 6 41


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 42


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 43


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 44
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 45
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 46
Six Basic Food Groups From the
Food Pyramid Guide

Meat
GRAINS Vegetables Fruits Milk &
Beans

DHSR Approved Curriculum-Unit 6 47


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

• Provides
– carbohydrates
– minerals
– fiber

DHSR Approved Curriculum-Unit 6 48


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 49


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 50


Food Guide Pyramid
Vegetable Group

• Provides:
– vitamins
– minerals
– fiber (roughage)
• Easier to chew if cooked,
chopped or diced

DHSR Approved Curriculum-Unit 6 51


Food Guide Pyramid
Vegetable Group
(continued)
• Chose from all five vegetable
subgroups:
– dark green
– orange
– legumes
– starchy
– other vegetables
DHSR Approved Curriculum-Unit 6 52
Food Guide Pyramid
Vegetable Group
(continued)

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

DHSR Approved Curriculum-Unit 6 53


Food Pyramid Guide
Fruit Group

• Provides
– vitamins
– minerals
– fiber
• Chose fresh, frozen, canned or
dried fruits
DHSR Approved Curriculum-Unit 6 54
Food Pyramid Guide
Fruit Group
(continued)
• Daily:
– 2 cups daily for males over 60
– 1½ cups daily for females over 60

DHSR Approved Curriculum-Unit 6 55


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 56
Food Pyramid Guide
Milk, Yogurt, Cheese Group
(continued)
• Daily:
– 3 cups for males over 60
– 3 cups for females over 60

DHSR Approved Curriculum-Unit 6 57


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 58
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

DHSR Approved Curriculum-Unit 6 59


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 60
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 61
DHSR Approved Curriculum-Unit 6 62
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 63


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 64
Purposes of Therapeutic Diets
(continued)
• Help body organs to maintain and/or
regain normal function
• Treat metabolic disorders by
regulating amount of food

DHSR Approved Curriculum-Unit 6 65


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

DHSR Approved Curriculum-Unit 6 66


Types of Therapeutic Diets

• Clear liquid
• Full liquid
• Bland
• Low residue
• Controlled carbohydrate
(Diabetic)
• Low fat/low cholesterol

DHSR Approved Curriculum-Unit 6 67


Types of Therapeutic Diets
(continued)

• High fiber
• Low calorie
• High calorie
• Sodium restricted
• High protein
• Mechanical soft, chopped, pureed
DHSR Approved Curriculum-Unit 6 68
Types of Therapeutic Diets
(continued)

Residents may have


difficulty accepting
special diets.

DHSR Approved Curriculum-Unit 6 69


DHSR Approved Curriculum-Unit 6 70
6.4 Recognize adaptive devices used
to assist residents with eating.

DHSR Approved Curriculum-Unit 6 71


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 72
DHSR Approved Curriculum-Unit 6 73
6.5 Discuss alternate methods of
feeding.

DHSR Approved Curriculum-Unit 6 74


Parenteral Fluids
(Intravenous Infusion)

• Fluids administered
through vein. Little
nutritional value
• Responsibility of
licensed nurse

DHSR Approved Curriculum-Unit 6 75


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 76
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 77
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 78
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 79
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 80


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

DHSR Approved Curriculum-Unit 6 81


DHSR Approved Curriculum-Unit 6 82
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 83


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 84
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 85
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 86
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 87


Preparing Residents for Meals
(continued)
• Assist resident as needed with:
– cutting meat
– pouring liquids
– buttering bread
– opening containers

DHSR Approved Curriculum-Unit 6 88


Preparing Residents for Meals
(continued)

• Blind residents made


aware of food placement
according to face of
clock
• Stroke residents
approached from non-
effected side
DHSR Approved Curriculum-Unit 6 89
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 90
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 91


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

DHSR Approved Curriculum-Unit 6 92


DHSR Approved Curriculum-Unit 6 93
6.7 Demonstrate the procedure for
assisting with dining/feeding
resident who cannot feed self.

DHSR Approved Curriculum-Unit 6 94


DHSR Approved Curriculum-Unit 6 95
6.8 Discuss the various types of
supplementary nourishments.

DHSR Approved Curriculum-Unit 6 96


Types of Nourishments
• Milk
• Juice
• Gelatin
• Custard, ice cream, sherbet
• Crackers
• Nutritional supplementation
products (e.g., Ensure, etc.)
DHSR Approved Curriculum-Unit 6 97
Supplementary Nourishments

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

DHSR Approved Curriculum-Unit 6 98


Supplementary Nourishments
(continued)

• Ordered by physician
• Serve as directed by
supervisor
• Provide necessary
eating utensils, straw
and/or napkin

DHSR Approved Curriculum-Unit 6 99


DHSR Approved Curriculum-Unit 6 100
6.10 Demonstrate the procedure for
serving supplementary
nourishments.

DHSR Approved Curriculum-Unit 6 101


DHSR Approved Curriculum-Unit 6 102
6.11 Identify the special fluid orders
that the physician could write.

DHSR Approved Curriculum-Unit 6 103


Providing Fresh Drinking Water

• Fresh water should be


provided periodically
throughout day
• Encourage to drink 6-8
glasses daily if
appropriate

DHSR Approved Curriculum-Unit 6 104


Providing Fresh Drinking Water
(continued)

• Note residents who have special


fluid orders
– N.P.O.
– Fluid restrictions:
• Schedule 24-hour intake
• Remind resident

DHSR Approved Curriculum-Unit 6 105


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 6 106
DHSR Approved Curriculum-Unit 6 107
6.11 Demonstrate the procedure for
providing fresh drinking water.

DHSR Approved Curriculum-Unit 6 108


DHSR Approved Curriculum-Unit 6 109

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