Nutrition, Hydration, and Fluid Intake
What you must know
Diets are ordered for a reason: regular, mechanical soft, pureed, clear or full liquid, low-sodium, low-fat, consistent-carbohydrate (diabetic), renal, and thickened liquids (nectar, honey, or spoon-thick). Check the resident's name and diet card before every tray, and honor food preferences and cultural or religious practices within the ordered diet.
Aspiration is the danger. Position the resident upright - ideally 90 degrees, at least 45 - before any food or fluid; offer small bites; let the resident set the pace; check for food pocketed in the cheek; and stop if there is coughing, choking, a wet or gurgly voice, or a delayed swallow. Report those signs; do not change the diet or thickness on your own.
Intake and output is measured in milliliters. Record all fluids taken by mouth, and count ice chips as roughly half their volume when calculating intake. Encourage fluids between meals and with medications, but never force them. Signs of dehydration include dark concentrated urine, dry mouth, poor skin turgor, and new confusion - report them.
NPO means nothing by mouth: no water, no ice chips, no sip just to take a pill. Check before offering anything.
Traps
- Never hide medications in food or drink unless specifically directed and permitted by policy.
- Do not rush a slow eater or leave a resident eating while lying flat.
- 'Just a sip' for an NPO resident is still a violation of the order.
Worked example
Mr. R takes a sip of water, coughs, and his voice sounds wet. Stop feeding, sit him fully upright, check his mouth for pocketed food, and report the episode to the nurse before the next meal.