Nutrition and Hydration
Following the order
Serve only the diet and liquids ordered for that resident: regular, no concentrated sweets, low sodium, renal, pureed, mechanically soft, or thickened liquids at a specified consistency. Never give water or ice chips to a resident on thickened liquids or a fluid restriction without checking; never add salt or sugar to food. Honor food preferences, cultural and religious needs, and the resident's right to refuse a meal.
Aspiration precautions
Signs of swallowing trouble include coughing or choking with eating, a wet or gurgling voice, drooling, food pocketing, and repeated pneumonia. Seat the resident upright, ideally at 90 degrees, before any food or fluid, and keep them upright for 30 minutes afterward. Offer small bites, alternate solids with liquids as ordered, encourage a chin tuck, and check the mouth for pocketed food. Keep the resident on a tube feeding at the head of the bed elevated at least 30 degrees per policy.
Encouraging intake
Offer fluids frequently, not just at meals, and record the percentage of food eaten and actual fluid amounts. Dehydration shows as dark strong-smelling urine, dry mouth, poor skin turgor, confusion, and dizziness; constipation and urinary tract infections often follow poor intake. Report poor appetite, weight loss, or a resident who suddenly refuses food.
Traps
A question may show a resident with dysphagia being handed a straw or a thin-liquid drink. Straws speed liquid flow and increase aspiration risk for many residents; follow the swallowing plan. Another trap is forcing food into a resident who is coughing.
Rule of thumb
Upright, unhurried, small bites, mouth checked, and every change reported.