Nutrition and Hydration
Nutrition questions reward knowing the diets, the swallowing precautions, and the observation skills. Know common therapeutic diets: regular, mechanical soft, pureed, clear and full liquid, low-sodium, low-fat, diabetic (consistent carbohydrate), renal, and high-fiber. Thickened liquids come in nectar and honey consistencies and are ordered after a swallow evaluation; never thin them or add water without an order, because thin liquids are the ones most often aspirated.
Dysphagia precautions: seat the resident upright, ideally at eye level with you, and keep them upright at least 30 minutes after the meal. Offer small bites, cue to swallow, check the cheek for pocketing, and stop if the resident coughs, gags, has a wet or gurgly voice, or breathes rapidly. Those signs may mean aspiration - report them. Do not feed a resident who is lying flat or too drowsy to swallow.
Monitoring matters. Track the percentage of food eaten, fluid intake, and output, and weigh as ordered on the same scale at the same time. Watch for dehydration - dry mouth, poor skin turgor, dark concentrated urine, confusion, dizziness - and for malnutrition - weight loss, poor wound healing, loose dentures, fatigue. Honor food preferences, cultural and religious practices, and the right to refuse. Offer fluids often; many residents are thirsty and cannot ask.
Trap: the answer that says feed quickly to save time, or add water to thickened liquids. Also wrong is giving a full liquid diet to a resident on aspiration precautions without an order.
Rule of thumb: upright, unhurried, small bites, and watch the mouth for pocketing.