BAY AREA COLLEGE OF NURSING

Module 11: Nutrition

I. Terminology A. B. C. D. E. ADA (American Diabetes Association) Allergies Amino Acids Bland Diet Carbohydrates F. Cellulose or fiber G. Clear Liquid Diet H. Clothes Protector (i.e. towel, bib) I. Dehydration J. Diaphoresis K. Digestion L. Diuresis M. Edema N. Emesis O. Enternal Feeding P. Essential Nutrients Q. Exchange List R. Expectorate S. Fats T. Fluids U. Force Fluids V. Full Liquid Diet W. Gastrotomy Tube X. Gavage Y. Hyperalimentation Z. Intake and Output (I&O) AA. Intravenous Infusion BB. Low Fat Diet CC. Low Sodium Diet DD. Mechanical Soft Diet EE.Minerals FF. Nasogastric Tube GG. Nutrients HH. Nutrition II. Proteins JJ. Pureed Diet KK.Soft Diet LL. Therapeutic Diets MM. Thickened Liquids NN. TPN Total OO. Parental Nutrition PP. Vitamins

II. The bodys need for food and fluids A. The body depends upon foods and fluids to function properly. Foods and fluids: a) Provide energy for daily living and bodily functions. b) Promote growth and repair of tissue. c) Provide the necessary substances for regulation of bodily functions. B. Nutrition is the science of foods and their relationship to health. A balanced diet is: a) Essential to good health. b) Composed of sufficient nutrients to meet the bodys requirements. III. A. Common nutrients and their food sources Nutrients - essential components of a balanced diet and their food source 1. Carbohydrates grains, pastas, breads, cereals, fruits, vegetables 2. Proteins eggs, milk, meat, fish, nuts, poultry 3. Fats oils, cream, cheese, meat fats, butter 4. Vitamins vegetables, fruits 5. Minerals eggs, dried fruit, potatoes, fish, milk 6. Dietary fiber raw fruits and vegetables, whole grains 7. Fluids water, juices, other beverages

IV. Food Pyramid A. The food pyramid replaces the Basic Four Food Groups 1. Bread, cereal, rice and pasta group (6-11 servings/day) 2. Vegetable group (3-6 servings/day) 3. Fruit group (2-4 servings/day) 4. Milk, yogurt, cheese group (2-3 servings/day) 5. Meat, poultry, fish, dry beans, eggs and nut group (2-3 servings/day) 6. Fats, oils and sweets group (use sparingly) see Food Guide Pyramid V. Vegan basic four food groups

A. Vegan = vegetarian and no animal by products (e.g. eggs, etc)

B. The vegan basic four food groups: 1. Whole grains (5 or more servings/day) 2. Vegetables (3 or more servings/day) 3. Fruits (3 or more servings/day) 4. Legumes (2-3 servings/day) VI. Special nutritional needs of the elderly. A. Age-related changes affecting nutritional needs of the elderly: 1. Fewer calories may be needed if resident is less active. 2. Additional vitamins and minerals may be required due to digestive disturbances.

3. Medications may interfere with digestion and nutrient use. 4. Poor oral hygiene or ill-fitting dentures may lead to poor nutrition. 5. Ability to taste food may be diminished.

6. Many common diseases interfere with eating and/or the ability to use nutrients. 7. Social isolation may interfere with appetite and bodys utilization of nutrients. B. Specific food allergies

VII.

Diet therapy for residents

A. Therapeutic diet or special diets most commonly ordered: 1. Low sodium 2. Diabetic 3. Low Fat 4. Liquid a. Full Liquid b. Clear Liquid c. Thickened Liquids B. Special consistency: 1. Mechanical soft 2. Pureed 3. Soft C. Responsibilities of the CNA: 1. See that residents receive the diets ordered, check arm bands against names on trays. 2. Report any problems related to diet, such as food preferences, liquid preferences 3. Assist the doctors and nurses in evaluating a residents fluid balance. 4. Calculate and record residents food intake according to facility guidelines. 5. Upon refusal, offer alternative menu. 6. If alternate refused, report refusal to charge nurse. D. Proper techniques for feeding residents: 1. Provide a comfortable and enjoyable atmosphere. 2. Provide feeding assistance. 3. Serving residents in their rooms. 4. Serving residents in dining room. 5. Alternate liquid/solid food.

E. Refer to manual skill procedures Preparing the Resident for

Mealtime, Feeding the Helpless Resident and Assisting the Resident Who Can Feed Self (pp. 11.9 11.2) F. Prevention of choking: 1. Close supervision when eating. 2. Follow residents individual feeding plan.

3. Cut food into small pieces, offer in small amounts, wait until each portion is chewed and swallowed before more is given. 4. Observe swallowing process for difference. 5. Proceed at the residents pace do not rush the resident. 6. Sit down while feeding the helpless resident. 7. Thicken liquids as ordered.

G. Recognition of signs of choking: 1. Inability to speak, cough or breathe. 2. Cyanotic (blue color) 3. May lose consciousness.

H. Review Heimlich maneuver in Module 12 Emergency Procedures

manual skills (pp. 12.10 12.11) I. Dietary modifications generally affected by religious and/or cultural preferences: 1. Dietary modifications affiliated with religions and/or cultures. 2. Ask all residents if they have any food preferences. 3. Ask family of non-communicative residents about food preferences.

VIII. Alternative ways to meet the need for food and fluids A. Alternative ways to administer nutrition: 1. Tube feedings: a) Ordered by the doctor when patient is unable to eat or refuse to eat by mouth. b) Started by an RN or LVN c) CNAs responsibility is to watch the level of the tube feeding. d) Monitor for pressure on or kinking of tubing. e) Keep head of bed elevated at least 20o 30o at all times. f) Never turn off pump notify charge nurse of alarm 2. Intravenous infusion a) Ordered by the doctor when the resident is unable to take enough fluids by mouth. b) Started by an RN or LVN according to facility policy. B. CNAs responsibility is to report: 1. alarm ringing on I.V. or feeding pump 2. complaints of pain or burning at the I.V. site 3. swelling or redness at the I.V. site 4. fever 5. difficulty breathing 6. bleeding or leakage of fluid at the I.V. site 7. disconnected I.V. tubing 8. empty I.V. fluid container