DHSR 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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