Nursing Assistant

Nutrition

Body’s need for food & fluids

Provide energy for daily living & bodily functions

Promote growth & repair of tissue Provide necessary substances for

regulation of bodily fluids

Nutrition

Science of foods & their relationship to health– Essential to good health– Composed of sufficient nutrients to meet

the body’s requirements

Common Nutrients

Carbohydrates– Grains– Pastas– Breads– Cereals– Fruits – Vegetables

Proteins

Eggs Milk Meat Fish Nuts Poultry

Fats

Oils Cream Cheese Meat fats Butter

Vitamins

Vegetables Fruits Milk

Minerals

Eggs Dried fruit Potatoes Fish Milk

Dietary fiber

Raw fruits Raw vegetables Whole grains

Fluids

Water Juices Other beverages

Food Pyramid

www.mypyramid.gov Serving sizes based on age, gender, &

activity level

Vegan

Vegetarian AND no animal by products Check www.mypyramid.gov for

specifics

Special nutrient needs of elderly

Age related changes– Fewer calories needed, decreased activity– Digestive disturbances = add vitamins & minerals– Meds may interfere with digestion & nutrient use– Poor oral hygiene, ill-fitting dentures– Ability to taste decreased– Many common diseases interfere with eating & or the

ability to use nutrients– Social isolation = interference with appetite

Food allergies – know status & check for additives (peanuts, shellfish, wheat)

Therapeutic diets

Low sodium Diabetic Low fat Liquid

– Full liquid– Clear liquid– Thickened liquids– Nectar thick– Honey thick

Special consistency diets

Mechanical soft Pureed Soft

Responsibilities of nursing assistant Check that residents receive diets ordered,

check arm bands with tray Report any diet related problems –

preferences, difficulties, N & V, anorexia Assist drs & nurses to evaluate fluid balance,

accurate I & O Calculate food intake according to facility, if

eats all, eats 100% Offer alternate menu with refusal If alternate refused, report to licensed nurse

Technique for feeding

Provide comfortable & enjoyable atmosphere– Sit at eye level– Maintain a positive attitude when feeding

Provide assistance if needed Serve residents in room if unable to join

others in dining area (best choice is dining area)

Alternate liquid & solid food

Steps

Wash hands Check diet card for name, diet order, special

instructions, & allergies Make sure food matches info on card Remove tray from food cart, see that all items are

there Knock & pause before entering room Introduce self Check armband Explain procedure

Steps cont.

Lower side rail Place tray on overbed table If in dining room, remove food items & place

on table – remove tray Place a towel or clothing protector Remove plate cover Seat yourself at eye level Arrange food, butter bread, season food

Steps cont Describe or show food before giving it to resident Use adaptive devices as indicated Use straws & thickeners as indicated Offer small portions of solids ( no more than ½

spoonful) Alternate solids & liquids Ask what they would like Put food on unaffected side of mouth Monitor for pocketing & swallowing difficulties Remove tray when resident is finished

Prevention of choking

High risk residents– CVA– Neurological disease– Trauma to head, neck, or throat– Dementia

Close supervision when eating Follow individual feeding plan Cut food into small pieces, offer in small

amounts, wait until each portion is chewed & swallowed before more is given

Choking cont.

Notify licensed nurse if dysphagia– Long time before swallowing– Swallows several times with each bite– Frequent throat clearing– Difficulty handling foods/fluids in mouth– Wet gurgling voice– Pocketing food– Unintentional weight loss– Feeling by resident that food is sticking

Choking cont

Proceed at resident’s pace – don’t rush Portion should be chewed & swallowed

before more is given Sit down while feeding helpless resident Use adaptive equipment as indicated

Recognition of signs of choking

Universal sign Inability to speak, cough, breathe Cyanosis Loss of consciousness HEIMLICH MANEUVER

DIETARY MODIFICATIONS

Affiliated with religions and/or cultures Ask if there are any preferences Ask family of residents who cannot

communicate

Alternate ways to offer nutrition

Tube feedings– Ordered by doctor when resident unable to eat– Started by a licensed nurse– Your responsibility

• Monitor for tubing kinking or pressure• Monitor level of feeding• KEEP HOB AT 20 – 30 DEGREES AT ALL TIMES• DO NOT LOWER HOB EVEN WHEN REPOSITIONING• Never turn off pump – notify nurse of alarm• Notify nurse if signs of aspiration

Intravenous infusion Ordered by physician Started by licensed nurse Your responsibility

– Monitor IV for kinks, twisting, pressure, or obstruction– Report

• Alarms• C/o pain or burning at site• Swelling or redness at site• Fever• SOB• Bleeding of fluid leakage at IV site• Disconnected IV tubing• Empty IV container