Nutrition and Hydration
Nutrition questions test two things: matching a diet or texture to a resident's swallowing ability, and remembering that mealtime is a social, dignified activity.
Core concepts
- Nutrients: carbohydrates, protein, fat, vitamins, minerals, and water. Water is the one a resident can least afford to miss.
- Diets: regular, consistent-carbohydrate, low-sodium, low-fat, renal, high-fiber, clear or full liquid, pureed, and mechanical soft. The diet order comes from the physician or dietitian - you never change it yourself.
- Dysphagia: sit the resident upright at 90 degrees, chin tucked, small bites, one texture at a time, allow a full swallow, and keep them upright about 30 minutes after the meal. Straws are usually avoided unless ordered, and thickened liquids require an order.
- Aspiration signs: coughing, choking, a wet or gurgling voice, pocketing food, drooling, watering eyes, and fever after meals.
- Intake and output: record accurately in milliliters and percentage eaten. Report poor intake, weight loss, dry mouth, dark urine, or new swelling.
- Independence: encourage self-feeding with adaptive equipment and honor cultural and religious food preferences.
Traps
"Feed the resident quickly so the food doesn't get cold" is wrong, and so is "lie the resident back after eating to rest." Never force food, and never mix the whole tray together to save time.
Rule of thumb
Upright at 90 degrees, chin tucked, small bites, slow pace, and stay upright for 30 minutes afterward.
Worked example
A resident who had a stroke coughs with every sip of thin liquid. Correct action: stop, keep them upright, allow time, and report to the nurse - do not merely slow down and continue.