MEALTIMENATCEP Day Twenty-Three

OBJECTIVES Describe measures to promote a positive

atmosphere at mealtime. Identify devices & techniques that may be

used to help the resident maintain independence.

Demonstrate how to feed a resident. Describe and identify dysphagia and actions

address. Identify nurse aide actions to eliminate

choking risks. Identify choking and demonstrate choking

management techniques.

PROMOTE A POSITIVE MEALTIME ATMOSPHERE Physically comfortable; position, empty

bladder, dry clothing. Surroundings should be pleasant and

comfortable. Social aspects should be considered –

converse with resident, not co-workers! Be positive about mealtime and the

experience!

PROMOTING MEALTIME INDEPENDENCE Food is in a manageable form: cut,

buttered, containers opened. Visually impaired: Use numbers of clock

to describe location of food. Devices: plate guard or adapted spoon.

PROPER FEEDING TECHNIQUES Wash hands = both yours and your resident’s Prayer, if requested Sit facing resident Check diet card and items on tray for match Prevent choking: sitting, head of bed elevated Open containers, cut, butter and/or season as preferred Serve food in order of resident preference Offer fluids between bites; alternate Offer to wipe face and hands throughout meal Spoons preferred utensil = 1/3 full Resident should help with finger foods Maintain flavors – don’t combine foods Identify foods as you feed resident “Here is some mashed potatoes” Feed hot foods cautiously Allow adequate time to chew thoroughly Observe, report and record food and fluid intake Notify nurse if they refuse to eat.

DYSPHAGIA & NURSE AIDE ACTIONS Difficult or painful swallowing Risk for choking Feed slowly, allowing time to chew and

swallow. Remind to swallow. Offer fluids frequently. Check for pocketed food or liquid in the

cheeks. Place food on strong side of mouth.

ASPIRATION Fowler’s position. Support upper back, shoulders and neck

with a pillow. Observe for signs and symptoms of

aspiration when eating or drinking. Check the resident’s mouth for pocketing

after eating. Maintain resident in semi-fowler’s position

for one hour after eating. 

NUTRITION & FLUID NEEDSNATCEP Day Twenty-Three

OBJECTIVES Discuss factors that affect nutritional status. Identify modified diets. Describe nurse aide responsibilities for

therapeutic diets. Describe the dietary department’s role in

providing nutrition to the resident. Identify the importance of hydration. Describe methods to encourage fluid intake. Name nurse aide responsibilities for tube-fed

residents. Describe IV therapy and the related nurse

aide’s responsibilities.

FACTORS THAT AFFECT THE NUTRITIONAL STATUS OF THE ELDERLY

Tooth loss, poorly fitting dentures, and a sore mouth.

Loss of muscle control over part of the mouth and throat as the result of a stroke.

Diminished hand and arm muscle strength or control from paralysis or tremor.

Diminished sense of smell, taste and vision. Decreased activity resulting in decreased

requirement for calories. Serving foods the resident may not like. Mood and behavior problems. Pain and/or discomfort.

MODIFIED DIETS Low sodium & salt restricted: Heart or

kidney disease, fluid retention Diabetic diet: Diabetics Mechanical soft: Dysphagia due to stroke,

paralysis, multiple sclerosis Pureed: Dysphagia due to stroke,

paralysis, multiple sclerosis

MODIFIED DIETS Nurse Aide Responsibilities

Do not interchange food from one resident’s tray to another

Report resident’s request for diet substitutions to the nurse

MODIFIED DIETS Dietary Department Service Staff Responsibilities

Plan mealsDiet balanced with adequate nutrientsFood prepared and presented in way resident

can manageFood presented in way that is visually

appealingInfection control maintainedTray cards provided

Identify type of diet Identifies resident likes & dislikes Identifies food allergies

HYDRATION Prevent constipation and urinary

incontinence. Dilutes wastes and flushes out urinary

system. Maintain skin turgor. Prevent confusion.

METHODS TO ENCOURAGE FLUID INTAKE Offer water each time you feed a resident Know resident drink preferences Some residents prefer no ice Snacks of juice and fluids may be distributed

between meals Offer small amounts of drinks frequently

TUBE FEEDINGS Enternal Nutrition

Giving nutrients into the digestive tract through a feeding tube

Person may be unable to ingest, chew or swallow

Person may be unable to pass food from the mouth into the esophagus or into the stomach or small intestines

Common causes Cancer or trauma to the face, mouth, head or

neck Coma Dementia Dysphagia (difficulty swallowing)

TUBE FEEDINGS

TUBE FEEDINGS Oral hygiene. Nose and nostril cleaned every 4 hours. Head of bed elevated 30-45 degrees at all

times. Oral care for unconscious residents (side-lying

position). Care and cleaning of insertion site –wear

gloves, soap & water, rinse. Observe for signs and symptoms of infection. Notify nurse if taped tube is loose. Tubes: no pulling, pinching, kinks, twisting. Connections tight and no leaks.

IV THERAPY Report immediately redness,

swelling, pain or tenderness. Tubing: catching, kinking,

twisting, pulling. DO NOT TOUCH any clamps

or controls on the IV or pump. Assist the resident with personal

care and activities with IV in place.