DFS Approved Curriculum-Unit 61 Unit 6 Nutrition and Hydration Nurse Aide I Course.

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DFS Approved Curriculum- Unit 6 1 Unit 6 Nutrition and Hydration Nurse Aide I Course

Transcript of DFS Approved Curriculum-Unit 61 Unit 6 Nutrition and Hydration Nurse Aide I Course.

Page 1: DFS Approved Curriculum-Unit 61 Unit 6 Nutrition and Hydration Nurse Aide I Course.

DFS Approved Curriculum-Unit 6 1

Unit 6

Nutrition and HydrationNurse Aide I Course

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Nutrition and HydrationIntroduction

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 HydrationIntroduction

(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.

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Nutrition and HydrationIntroduction

(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

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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

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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 Spanish-speaking people include spicy dishes containing rice, beans and corn

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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

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Culture and Food Preparation

Frying Baking

Smoking Roasting

Fresh/raw

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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

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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

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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, non-

kosher meats such as pork

–Requires special utensils for food preparation

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Religion and Dietary Practices(continued)

• Conservative Jewish faith–Forbids cooking on

Sabbath–Forbids eating of

leavened bread during Passover

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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

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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

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Nutrients

(continued) • Four classifications of nutrients

(continued)3. Carbohydrates - provide energy

and fiber that help in bowel elimination

4. Vitamins and minerals - ingested through food and are necessary for carrying out and maintaining specific body functions

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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

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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

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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

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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

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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

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Signs Of Good Nutrition(continued)

• Restful sleep patterns• Healthy appetite• Regular elimination

habits• Appropriate body

weight

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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

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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.

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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.

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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.

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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. 

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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.

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Six Basic Food Groups From the Food Pyramid Guide

GRAINS Vegetables Fruits MilkMeat &Beans

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Food Pyramid GuideGrain Group

(breads, cereal, rice, pasta)

• Provides–carbohydrates–minerals–fiber

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Food Pyramid GuideGrain 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.

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Food Pyramid GuideGrain Group

(breads, cereal, rice, pasta)(continued)

• Daily:–6 ounce equivalents

for males over 60–5 ounce equivalents

for females over 60 

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Food Guide Pyramid Vegetable Group

• Provides:–vitamins–minerals–fiber (roughage)

• Easier to chew if cooked, chopped or diced

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Food Guide PyramidVegetable Group

(continued)

• Chose from all five vegetable subgroups:–dark green–orange– legumes–starchy–other vegetables

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Food Guide PyramidVegetable Group

(continued)

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

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Food Pyramid GuideFruit Group

• Provides–vitamins–minerals–fiber

• Chose fresh, frozen, canned or dried fruits

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Food Pyramid GuideFruit Group

(continued)

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

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Food Pyramid GuideMilk, Yogurt and Other Milk Products

• Provides–proteins–vitamins (A)–minerals (calcium)–carbohydrates–Fat

• Choose low-fat or fat-free milk and milk products

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Food Pyramid GuideMilk, Yogurt, Cheese Group

(continued)

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

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Food Pyramid GuideMeat, 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

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Food Pyramid GuideMeat, 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 GuideOil 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

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Food Pyramid GuideOil 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.

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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.

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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

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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

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Types of Therapeutic Diets(continued)

• High fiber • Low calorie• High calorie• Sodium restricted• High protein• Mechanical soft, chopped, pureed

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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.

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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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

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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 non-effected side

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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

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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

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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.)

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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

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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

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6.11 Demonstrate the procedure for providing fresh drinking water.

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