Nutrition, Hydration, and Meal Preparation
What this domain covers
Know the six nutrient groups - protein, carbohydrates, fats, vitamins, minerals, and water - and check the diet order before every meal. Common orders include regular, low-sodium, diabetic, renal, mechanical soft, pureed, thickened liquids, and NPO (nothing by mouth). Never give food or fluid, including ice chips, to an NPO client without checking first.
Dysphagia (difficulty swallowing) raises aspiration risk. Sit the client upright at 90 degrees, offer small bites slowly, alternate bites with allowed fluids, check for food pocketed in the cheek, and keep the client upright for about 30 minutes after eating. Stop feeding and report coughing, choking, a wet or gurgling voice, or a change in breathing.
Hydration: most adults need roughly 1,500-2,000 mL of fluid daily unless restricted. Signs of dehydration include dark concentrated urine, dry mouth, thirst, confusion, and poor skin turgor - report them. Record intake and output when ordered.
Food safety: wash hands and surfaces, keep hot foods hot and cold foods cold, refrigerate perishables within two hours, date leftovers, and check temperatures. Honor cultural, religious, and personal food preferences, and encourage independence with adaptive equipment such as weighted utensils or plate guards.
Traps
Feeding a client who is lying down, rushing meals, giving thin liquids to a client on thickened liquids, leaving food at the bedside for hours, and ignoring a poor appetite.
Rule of thumb
Check the diet order, sit the client upright, go slowly - and report any coughing or choking right away.