Nutrition and Hydration: Safe Eating and Drinking
What you are monitoring
Food and fluid are treatment. You are responsible for serving the correct tray, positioning the resident, feeding safely, recording intake and output, and reporting changes. Diets you must recognize include regular, mechanical soft, pureed, clear and full liquid, low sodium, consistent carbohydrate or diabetic, low fat, renal, and NPO.
Concepts to know cold
Dysphagia precautions: sit the resident upright, chin tucked, small bites, slow pace, empty mouth before the next bite, thickened liquids if ordered, and no straws unless approved. Aspiration signs include coughing, choking, wet voice, pocketing food, and sudden change in breathing. I and O includes ice chips, gelatin, soup, and IV fluids. Dehydration shows as dry mouth, dark urine, confusion, and poor skin turgor. Weights are taken on the same scale at the same time.
Traps
- Mixing pureed foods together. Flavor and appearance matter and mixing can reduce intake.
- Rushing a slow eater or leaving food in front of a resident who cannot feed themselves.
- Forgetting oral care for an NPO resident.
- Charting a percentage of a meal you did not actually observe.
- Ignoring cultural, religious, or preference-based food needs, such as pork or shellfish restrictions.
Rule of thumb
"Small bites, slow pace, empty mouth." Stay with a resident who has dysphagia, keep them upright for about 30 minutes after eating, and stop feeding at the first sign of choking.