Nutrition and Fluid Intake
What to know
Nutrition questions test safety first. For a resident with swallowing difficulty (dysphagia), sit them fully upright, at about 90 degrees, before any food or fluid; keep them upright for 30 minutes afterward. Feed small bites, one texture at a time, at a slow pace, and check the mouth for pocketing on the weak side. Watch for coughing, choking, a wet or gurgly voice, or food leaking - all signs of aspiration.
Know the common diets: regular, mechanical soft, pureed, low-sodium, consistent carbohydrate (diabetic), renal, and thickened liquids. Follow the order exactly; never add salt or sugar, and never thin a thickened liquid.
Record intake and output in milliliters and record the percentage of a meal eaten. Offer fluids often; dehydration shows as dark urine, dry mouth, confusion, and poor skin turgor.
Respect choice and culture: food preferences, religious restrictions, and the right to refuse. Offer, do not force.
Traps
'Feed the resident lying down' - wrong. 'Put food in the weak side of the mouth' - wrong; use the unaffected side. 'Give a straw to a resident with dysphagia' - usually wrong. 'Rush the meal' - wrong. 'Withhold fluids so the resident will not need the toilet' - wrong and dangerous.
Rule of thumb
Upright, unhurried, one bite at a time, and never feed anyone flat in bed.
Worked example
A resident coughs with every sip of water. Stop feeding, keep them upright, check the mouth, and report to the nurse - the order may need evaluation for thickened liquids or a swallow study. Do not simply switch to a straw or continue.