Nutrition and Hydration
Concepts to understand
Older adults are at risk for malnutrition and dehydration due to reduced thirst, altered taste, dental problems, dysphagia, and medications. Know the signs of dehydration: dry mucous membranes, poor skin turgor, concentrated urine, confusion, and low urine output. Encourage fluids throughout the day unless restricted by order. Know dysphagia precautions: sit upright, chin tuck, small bites, thickened liquids as ordered, and never feed a resident who is lying flat or has an altered level of consciousness.
Diet and monitoring
Know common diets: regular, mechanical soft, pureed, low-sodium, diabetic, renal, and thickened liquids. Monitor intake and output, weigh residents as ordered, and report significant weight loss. Encourage independence at meals and provide adaptive equipment. Watch for aspiration signs: coughing, choking, wet voice, or fever after meals.
Traps
Questions often bait with "restrict fluids to prevent incontinence" - this is wrong without an order and can cause harm. Another trap is feeding a resident who is drowsy or has a swallowing problem. Also watch for answers that ignore a resident's cultural or religious food preferences or that force a resident to eat.
Worked example
A resident coughs after swallowing and has a wet-sounding voice. The correct action is to stop feeding, keep the resident upright, and report to the nurse; the wrong action is to give more fluids to clear the throat. Rule of thumb: coughing or a wet voice during meals means stop and report.