Nutrition, Hydration, and Elimination
Eating safely is a nursing skill
The care plan tells you the diet: regular, mechanical soft, pureed, low sodium, consistent-carbohydrate (diabetic), renal, or thickened liquids (nectar, honey, or spoon thick). Never add thickening powder to the whole tray or thin liquids to make swallowing easier - follow the ordered consistency exactly.
Aspiration precautions: seat the resident upright at about 90 degrees before eating and keep them upright for about 30 minutes afterward. Offer small bites and small sips, alternate food and fluid, cue to swallow, check for pocketing in the cheek, and stop if the resident coughs, gurgles, or has a wet voice. Report those signs. Honor food preferences, cultural and religious needs, and the right to refuse. Encourage independence with setup and adapted utensils.
Record intake and output in milliliters, measuring what you actually observe rather than estimating. Watch for dehydration (dry mouth, dark concentrated urine, confusion, poor skin turgor) and for weight loss.
Elimination care includes toileting schedules and bladder or bowel retraining, prompt incontinence care, catheter care with the bag below bladder level, and collecting specimens per policy. Note the color, odor, clarity, and amount of urine and the character of stool; cloudy, foul-smelling urine or a sudden change in bowel pattern is reported. Constipation is common - fluids, fiber, and activity help.
Traps: forcing fluids, mixing thickener inconsistently, laying a resident down right after a meal, or charting an "estimate" as exact intake.
Rule of thumb: upright at 90 degrees during meals and for 30 minutes after.