Nutrition and Hydration
Diets and swallowing
Know the common diets: regular, mechanical soft, pureed, clear and full liquid, consistent carbohydrate, low sodium, low fat, renal, and thickened liquids for dysphagia. Never add water or thin a thickened liquid, and never give food from home without nurse approval. Sit the resident upright (usually 45–90 degrees), feed small bites, allow time to chew and swallow, and check the mouth for pocketed food. Cue swallowing, offer fluids between bites, and stop if the resident coughs, gurgles, or has a wet voice. Keep residents upright for about 30 minutes after eating. Signs of aspiration include coughing during meals, choking, a wet voice, and later fever or pneumonia.
Fluids and intake/output
Offer fluids often; place them within reach and honor preferences. Dehydration signs include dry mouth, dark concentrated urine, confusion, weakness, and poor skin turgor. Measure and record all intake (oral fluids, soup, ice, tube feedings) and output (urine, vomit, liquid stool, drainage) in milliliters, and report a resident who drinks very little or urinates very little. Fluid-restricted residents get only the allowed amount. Weigh residents at the same time, on the same scale, with similar clothing.
Tube feedings
Elevate the head of the bed 30–45 degrees, verify placement and residual per policy, flush as directed, give oral care, and stop and report if the resident vomits, coughs, or has distention.
Traps
Look for "feed fast before it gets cold," "thin the thickened liquid," "feed a drowsy resident," or "let them lie down right after eating."
Rule of thumb: sit them up, slow down, and watch the swallow.