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Page 1: Understand  nurse  aide skills needed to provide for residents ’  nutrition and  hydration needs.

Understand nurse aide skills needed to provide for residents’ nutrition and hydration needs.

Unit B Resident Care SkillsEssential Standard NA6.0 Understand nurse aide skills needed to provide for residents’ nutrition, hydration, and elimination needs. Indicator 6.01 Understand nurse aide skills needed to provide for residents’ nutrition and hydration needs.

6.01 Nursing Fundamentals 7243 1

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26.01 Nursing Fundamentals 7243

6.01 Introduction

This indicator introduces the nurse aide to the basic principles of nutrition. It includes ChooseMyPlate.gov, therapeutic diets, adaptive devices, alternative methods of feeding, providing drinking water and nourishments, feeding a resident, and measuring/recording intake and output.

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There is intentional

repeat of some HSII course content in Nursing

Fundamentals.

Repeating course content distributes learning over time and increases long term memory.

Academic and skill competence must be maintained at a very high level for direct resident care.

Be GREEN. Recycle knowledge and build on it!

Nursing Fundamentals 7243 36.01

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Food is broken down by the gastrointestinal system into small substances called nutrients.

Nursing Fundamentals 7243 4

Nutrients

6.01

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Nutrients are absorbed into the body for use.

Nursing Fundamentals 7243 56.01

Nutrients

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Nursing Fundamentals 7243 6

Nutrients

6.01

Protein

Carbohydrates

Fats

Vitamins

Minerals

Water

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Builds and repairs tissue

Nursing Fundamentals 7243 7

Nutrient - Protein

6.01

N U T R I E N T

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• Supplies fuel for the body’s energy needs

• Supplies fiber necessary for bowel elimination

Nursing Fundamentals 7243 8

Nutrient - Carbohydrates

6.01

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• Source of stored energy

• Helps body use certain vitamins

• Conserves body heat

• Protects organs from injury

• Holds kidneys place

Nursing Fundamentals 7243 9

Nutrients - Fat

6.01

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• Necessary for carrying out and maintaining specific body functions

Nursing Fundamentals 7243 10

Nutrients – Vitamins

6.01

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• Necessary for carrying out and maintaining specific body functions

Nursing Fundamentals 7243 11

Nutrients –Minerals

6.01

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Nutrients - Water

6.01

• The most essential nutrient for life

• Without it a person can only live a few days

• Assist in digestion and absorption of food

• Helps maintain normal body temperature

• Largest component of blood plasma

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No one food contains ALL the NUTRIENTS needed for good health.

Nursing Fundamentals 7243 13

Nutrients

6.01

Soooooooooo . . .Eating a variety of foods is needed to sustain good health.

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Nutrition guides typically divide foods into food groups and recommend daily servings of each group for a healthy diet.

Nursing Fundamentals 7243 14

Nutrition Guides

6.01

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A food group is a collection of foods that share similar nutritional properties or biological classifications.

Nursing Fundamentals 7243 15

Food Group

6.01

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Nursing Fundamentals 7243 16

Vegetable Group

6.01

Make half your plate fruits and vegetables.

Vary your vegetables.

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Nursing Fundamentals 7243 17

Fruits Group

6.01

Make half your plate fruits and vegetables.

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Nursing Fundamentals 7243 18

Grains Group

6.01

Make at least half your grains whole grains.

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Nursing Fundamentals 7243 19

Protein Group

6.01

Make lean choices.

51+ years old, need 5 ½ ozs. daily for men and 5 ozs. for women.

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Nursing Fundamentals 7243 20

Dairy Group

6.01

Switch to fat-free or low-fat (1%) milk.

Men and women over 51 years old need 3 cups of dairy group each day.

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Nursing Fundamentals 7243 21

ChooseMyPlate.gov

6.01

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Two overarching concepts:

Nursing Fundamentals 7243 22

Dietary Guidelines for Americans

6.01

Maintain calorie balance over time to achieve and sustain a healthy weight.

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A calorie is a unit of

energy.

Nursing Fundamentals 7243 23

Calories

6.01

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Nursing Fundamentals 7243 24

Calories

6.01

Taken from: How Stuff Works

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Two overarching concepts:

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Dietary Guidelines for Americans

6.01

Focus on consuming nutrient-dense foods and beverages.

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Foods that have high nutritional content as well as “energy”

Nursing Fundamentals 7243 26

Nutrient Dense

6.01

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Calories contained in food that provide “fuel” but few or no nutrients.

Nursing Fundamentals 7243 27

Empty Calories

6.01

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Factors That Influence Caloric Need

• Age• Sex• Size and activity level• Climate• State of health• Amount of sleep

obtained

Nursing Fundamentals 7243 286.01

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6.01 Nursing Fundamentals 7243 29

Effects of Good Nutrition Promotes physical and mental health Provides increased resistance to

illness Produces added energy and vitality Aids in the healing process Assists one to feel and sleep

better

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• 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

6.01

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• Restful sleep patterns

• Healthy appetite• Regular elimination

habits• Appropriate body

weightNursing Fundamentals 7243 31

Signs of Good Nutrition

6.01

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• Hair and eyes appear dull

• Irregular bowel habits

• Weight changes• Osteoporosis and

other diseases Nursing Fundamentals 7243 32

Signs of Poor Nutrition

6.01

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Results of Poor Nutrition(continued)

• Lack of interest - mental slowdown

• Skin color and appearance poor

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Signs of Poor Nutrition

6.01

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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

Nursing Fundamentals 7243 34

Signs of Poor Nutrition

6.01

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Basic NutritionHave we got it?

Let’s check and see

Stick diagnostics

Student Name A

Student Name B

Nursing Fundamentals 7243 356.01

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6.01 Nursing Fundamentals 7243 36

Influences on nutrition and dietary

habits1) Aging2) Culture

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• Metabolism slows muscles weaken body moves slow activity is reduced reduced activity decreases appetite.

Nursing Fundamentals 7243 37

Nutritional Challenges of Geriatrics

6.01

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• Loss of vision affects the way food looks, which can decrease appetite.

Nursing Fundamentals 7243 38

Nutritional Challenges of Geriatrics

6.01

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• The aging process and some medications weaken the sense of smell and taste which can decrease appetite.

Nursing Fundamentals 7243 39

Nutritional Challenges of Geriatrics

6.01

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• Less saliva production affects chewing and swallowing.

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Nutritional Challenges of Geriatrics

6.01

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• Dentures and poor dental health make chewing difficult.

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Nutritional Challenges of Geriatrics

6.01

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• Digestion takes longer and it is less efficient.

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Nutritional Challenges of Geriatrics

6.01

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• Constipation interferes with appetite.

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Nutritional Challenges of Geriatrics

6.01

X

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Factors Influencing Dietary Practices

•Personal preference•Appetite•Finance• Illness•Culture

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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

6.01

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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

Nursing Fundamentals 7243 46

Culture and Dietary Practices

6.01

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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

Nursing Fundamentals 7243 47

Culture and Dietary Practices

6.01

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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

Nursing Fundamentals 7243 486.01

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Muslim/Moslem - avoid alcohol, pork products

7th Day Adventist - avoid coffee/tea, alcohol, pork and some meats, caffeine

Nursing Fundamentals 7243 496.01

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Baptists – some avoid coffee, tea and alcohol

Greek Orthodox - fast days, but usually “forgiven” when ill

Nursing Fundamentals 7243 506.01

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Conservative Jewish faith–Prohibits shellfish, non-

kosher meats such as pork

–Requires special utensils for food preparation

Nursing Fundamentals 7243 516.01

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Conservative Jewish faith–Forbids cooking on Sabbath–Forbids eating of leavened

bread during Passover

Nursing Fundamentals 7243 526.01

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Conservative Jewish faith–Forbids serving milk and

milk products with meat–Strict rules regarding

sequence in which milk products and meat may be consumed

Nursing Fundamentals 7243 536.01

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6.01 Nursing Fundamentals 7243 54

Therapeutic, Modified, or Special

Diets

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• Help body organs to maintain and/or regain normal function

• Treat metabolic disorders by regulating amount of food

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Therapeutic, Modified or Special Diets

6.01

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• 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 (sodium) intake to prevent or decrease edema

Nursing Fundamentals 7243 56

Therapeutic, Modified or Special Diets

6.01

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• Clear liquid• Full liquid• Bland• Low residue• Controlled carbohydrate

(Diabetic)• Low fat/low cholesterol

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Types of Therapeutic, Modified or Special Diets

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

6.01

Types of Therapeutic, Modified or Special Diets

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Diet CardsList:• the resident’s name• Information about

special diets• Food allergies• Likes and dislikes

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Nursing Fundamentals 7243 606.01

Low-Sodium Diets

Residents with high blood pressure, heart disease, kidney disease, or retention may be placed on a low-sodium diet.

Salt packets will not be on the food tray.

Common abbreviations: “NAS” (no added salt) and Low Na (low sodium)

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Nursing Fundamentals 7243 616.01

Low-Protein Diets

Residents with severe kidney disease may be on a low protein diet.

Proteins breakdown into substances that can harm the kidneys.

Extent of protein restriction will vary depending on the stage of kidney disease.

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Nursing Fundamentals 7243 626.01

Fluid-Restricted Diets

Residents with severe heart or kidney disease may need fluid restriction.

Measure and document exact amounts of fluid intake. Report excesses to the nurse.

Do not offer additional fluids or foods that contain fluids. Notify the nurse if the resident complains of thirst.

Common abbreviation is “RF” (restrict fluids)

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Nursing Fundamentals 7243 636.01

Low-Fat/Low-Cholesterol Diets

• Residents with high levels of cholesterol, gall bladder disease, diseases that interfere with fat digestion, and liver disease may be placed on these diets.

• Diets permit skim milk, low fat cottage cheese, fish, white meat of turkey and chicken, veal, and vegetable fats. Use of monounsaturated fats such as olive oil, canola, and peanut oils are encouraged.

• Do not offer additional fluids or foods that contain fluids. Notify the nurse if the resident complains of thirst.

• Common abbreviation is “Low-Fat/Low-Chol”

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Modified Calorie Diets

• Residents may need to reduce calories to lose weight or increase calories to gain weight.

• Do not offer residents on a low-cal diet extra food. Check with the nurse.

• Common abbreviation is “Low-Cal/High-Cal”

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Dietary Management of Diabetes

• Calories and carbohydrates are carefully controlled.

• Fats and proteins are regulated.• Amounts of food are determined by energy

needs. • Diabetics must eat all the food served on the

tray.• Do not offer other foods without the nurse’s

approval.

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Nursing Fundamentals 7243 666.01

Dietary Management of Diabetes

• Meal tray may contain artificial sweeteners

• Common abbreviations for diabetic diets are “NCS” no concentrated sweets and the amount of calories allowed followed by “ADA” (American Diabetic Association)

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Nursing Fundamentals 7243 676.01

Diets Modified in Consistency

• Liquid Diet• Soft Diet and Mechanical

Soft Diet• Pureed Diet

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Liquid Diets

Ordered short term for medical condition or before or after a test or surgery.

Liquid food is anything that is in the liquid state at room temperature.

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Liquid Diets

“Clear Liquids”• Clear juices• Broth• Gelatin• Popsicles

“Full Liquids”Clear liquids plus:• Cream soups• Milk• Ice cream

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Nursing Fundamentals 7243 706.01

Soft and Mechanical Soft Diets

Makes food easier to chew and swallow

SOFT DIETSHigh fiber foods, fried foods, spicy foods, raw vegetables and fruits and some meats will be

restricted. Food is chopped or blended.

MECHANICAL SOFT DIETSFood choices are not limited. Only the

texture of the food is changed.

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Pureed Diets

This diet does not require that a resident chew his/her food.

Food is chopped, blended, or ground into a thick paste of baby food consistency.

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Nurse Aide Responsibilities in Serving Therapeutic Diets

• Serve the RIGHT resident the RIGHT tray containing the RIGHT therapeutic diet at the RIGHT temperature in the RIGHT environment with the RIGHT attitude.

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Therapeutic dietsHave we got it?

Let’s check and see

Stick diagnostics

Student Name A

Student Name B

Nursing Fundamentals 7243 736.01

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Devices and alternate methods used to take in

nutrients

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• Food Guards• Divided Plates• Built-up handled utensils• Easy grip mugs/glasses

Residents have to be taught how to use these devices.

Nursing Fundamentals 7243 756.01

Adaptive Devices

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• Fluids administered through vein. IVs help hydrate but have little nutritional value

• Responsibility of licensed nurse

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Parenteral Fluids (Intravenous Infusion - IV)

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• 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

6.01 Nursing Fundamentals 7243 77

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Liquid formula administered into the stomach through a tube by licensed nurse • Nose to stomach - nasogastric tube• Directly into stomach – gastrostomy tube -

“PEG tube” (Percutaneous Endoscopic Gastrostomy)

• Mitts may be ordered to prevent resident from dislodging tube

Nursing Fundamentals 7243 786.01

Enteral Feeding

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Enteral Feeding

PEG tube

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Residents unable to take nutrients by mouth can consent to enteral feeding.

• Depressed• Comatose• Swallowing problem (stroke,

Alzheimer’s or other medical conditions)

• Disorders of digestive tract

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Enteral Feeding

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Nurse Aide Responsibilities in Alternative Nutrition

• Ensure that there is no tension on tubing, no kinks, no coils, and tube not underneath resident.

• Keep resident’s nose clean and free of mucus

• Keep tube secure• Perform frequent oral care with

nasogastric or PEG tube

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Immediately report:• Redness or drainage around the opening• Skin sores or bruises• Cyanotic skin• Resident complaints of chest pain or nausea• Choking• Tube falls out• Feeding pump alarm sounds• Resident’s inclined position changes

6.01 Nursing Fundamentals 7243 82

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6.01 Nursing Fundamentals 7243 83

Fluid Balance(Hydration)

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Fluid Needs

Under normal conditions:

64 ounces daily

Eight 8-ounce glasses of water/fluids a day

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Nursing Fundamentals 7243 85

Consume 2-1/2 to 3-1/2 quarts daily

• eating• drinking

Eliminate 2-1/2 to 3-1/2 quarts daily

• urine• perspiration • water vapor

through respirations

• stool

6.01

Fluid (Hydration) Balance

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Fluid Imbalances

Edema – too much fluid in the body

Dehydration – too little fluid in the body

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Fluid intake exceeds fluid output - fluid retention

Caused by:• Kidney or failure • Heart failure• Excessive salt intake

6.01

Edema

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Signs of Edema:–Weight gain –Swelling of feet, ankles,

hands, fingers, face–Decreased urine output–Shortness of breath–Collection of fluid in

abdomen (ascites)6.01

Edema

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6.01 Nursing Fundamentals 7243 89

Residents’ weights must be accurate!

Fluid retention can be

detected by weight gain.

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Nursing Fundamentals 7243 90

Fluid output exceeds fluid intake • Common problem of long-term care

residents

6.01

Dehydration

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Nursing Fundamentals 7243 91

• Signs –thirst–decreased urine output–parched or cracked lips–dry, cracked skin–fever–weight loss–concentrated urine–tongue coated and thick

6.01

Dehydration

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• Causes of dehydration–poor fluid intake–diarrhea–bleeding –vomiting–excessive perspiration

6.01

Dehydration

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Special Fluid Orders

Force Fluids “FF” means to encourage the resident to drink more fluids.

Restrict Fluids “RF” means to limit the amount of fluids to the amount set by the physician.

NPO means nothing by mouth

Thickened liquids help prevent choking

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Force fluids•Offer fluids in small quantities•Offer fluids (resident preference) without being asked on every contact with resident

•Remind resident of importance of fluids in bodily functions

Nursing Fundamentals 7243 946.01

Special Fluid Orders

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RESTRICTED FLUIDS• Remind resident of the restriction• Measure and record exact amount of

fluid intake • Report excesses to the nurse• Do not offer additional fluids or foods

that contain fluids• Tell nurse if resident complains of

thirst• Abbreviation is “RF”

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Special Fluid Orders

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N P O • Nada per os or nothing by mouth• Resident is not allowed anything to

eat or drink!• NEVER OFFER FOOD OR DRINK OR

WATER TO A RESIDENT WHO IS NPO• NPO residents will be getting IVs or

tube feedings• NPO is ordered before surgery and

some tests

Nursing Fundamentals 7243 966.01

Special Fluid Orders

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Nursing Fundamentals 7243 97

THICKENED LIQUIDS• Improves the ability to control fluids in the mouth

and throat. For residents with swallowing problems. • If ordered, must be used with all liquids.• Do not offer water, water pitcher, or other liquids to a

resident who must have thickened liquids.• Three basic consistencies are:

– Nectar thick; like a thick juice such as tomato – Honey thick; pours slowly like honey– Pudding thick; must be consumed with spoon

6.01

Special Fluid Orders

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• Fresh water should be provided periodically throughout day

• Encourage to drink 6-8 glasses daily if appropriate

• Offer fluids on every resident encounter unless ordered otherwise.

Nursing Fundamentals 7243 986.01

Providing Fresh Drinking Water

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What is pagophagia?

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• Ice craving is a condition called pagophagia, or compulsive eating of ice. This is a form of pica, a condition in which people crave and eat non-food substances like ice, chalk, paper, laundry soap, starch, hair, dirt, clay, or paint.

• There are several reports linking the craving of ice to iron-deficiency anemia (low blood count as a result of an iron-deficiency). In fact, there’s even website called “All About Chewing Ice,” which also has a support group for people with this condition.

• Residents often crave ice.

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Pagophagia

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When residents ask for ice….

GET IT!Unless ordered otherwise.

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• Fluids measured in milliliters (ml) which is metric measure

30 ml = 1 ounce

DO NOT MEASURE IN CCs

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Measuring Fluids

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30 ml = 1 ounce

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REMEMBER

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• Physician orders intake and outputINTAKE includes:

–All liquid taken by mouth–Food items that turn to liquid at room

temperature–Tube feedings into stomach through

nose or abdomen–Fluids given by intravenous infusion

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Measure/Record Intake & Output

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• OUTPUT includes–Urine–Liquid stool–Emesis–Drainage–Suctioned secretions–Excessive perspiration

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Measure/Record Intake & Output

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• Make meals an enjoyable and sociable 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

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• Because eating is a social activity of daily living…

• Do not enclose the bedbound resident with privacy curtains when feeding them.

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Preparing Residents for Meals

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• All residents clean and dressed for meals

• Hair combed• Oral care provided• Encourage to use

bathroom or urinal/bedpan• Cleanse and dry

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Preparing Residents for Meals

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• Resident’s face and hands washed before meal – rewash residents’ hands and mouth after meals

• 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

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Clothing Protector:• Offer but do not insist,

residents’ have the right to refuse

• Using the term “bib” decreases the residents dignity by treating them like children

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Preparing Residents for Meals

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• 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

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

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Preparing Residents for Meals

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• Orient blind residents to food placement on the plate according to face of clock

• Approach residents from non-effected side

• Alternate fluid and food

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General Guidelines Assisting with Meals

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• Residents should be encouraged to do as much as possible for themselves

• Provide time for resident to complete meal

• Display pleasant, patient attitude while assisting

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General Guidelines Assisting with Meals

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• Remove tray when meal finished

• Tell nurse is not eating• Observe and record amount

eaten in %• Record fluid intake if

ordered• Assist to position of comfort

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General Guidelines Assisting with Meals

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• 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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General Guidelines Assisting with Meals

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• Ordered by physician• Serve as directed by

supervisor• Provide necessary

eating utensils, straw and/or napkin

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Supplementary Nourishments

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

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Supplementary Nourishments

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Serve on schedule so the next meal is not jeopardized by decreased resident appetite.

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Supplementary Nourishments

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• Milk• Juice• Gelatin• Custard, ice cream, sherbet• Crackers• Nutritional supplementation

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Types of Nourishments

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