Nutrition and Hydration: Safe Eating and Drinking
What you must understand
Know the diet orders you will see: regular, mechanical soft, pureed, clear and full liquid, NPO, and modifications such as low-sodium, low-fat, consistent-carbohydrate (diabetic), renal, high-fiber, and thickened liquids (nectar, honey, or spoon-thick). Thickened liquids are a safety order, not a preference - do not thin them.
A resident with dysphagia is at risk for aspiration. Warning signs include coughing or choking with eating, a wet or gurgly voice, pocketing food in the cheek, drooling, and a fever that appears after meals.
Feeding technique
Seat the resident upright, ideally at 90 degrees. Sit at eye level facing them. Offer small bites, allow full chewing and swallowing before the next bite, offer fluids as ordered between bites, and check the mouth for pocketing. Keep them upright for about 30 minutes after the meal. Never rush, never force, and never feed a resident who is lying flat or not fully alert.
Intake and output: record all fluids taken by mouth plus IV and tube feedings; output includes urine, emesis, and liquid stool. Convert ounces to milliliters (1 oz = 30 mL; 1 cup = 240 mL).
Dehydration signs: thirst, dry mucous membranes, dark concentrated urine, poor skin turgor, and new confusion in an older adult.
Traps
Assuming NPO allows ice chips or sips of water - it does not unless specifically ordered. Assisting the wrong resident's tray without verifying the name and diet card. Forcing food to improve intake. Ignoring a resident's food allergies or religious restrictions.
Rule of thumb
Upright, slow, and small. If something goes down the wrong way, stop feeding, let the resident cough, and report to the nurse.