Nutrition and Hydration
What you must know
Know the common diets: regular, NPO (nothing by mouth), clear liquid, full liquid, mechanical soft, puree, low-sodium, consistent-carbohydrate (diabetic), renal, and high-fiber. Serve the correct tray to the correct resident and check the name card - a wrong tray can be life-threatening to someone on a restricted diet or with allergies.
Dysphagia (difficulty swallowing) is a major hazard. Warning signs: coughing or choking while eating, a wet or gurgly voice, pocketing food in the cheek, drooling, and food or fluid coming back through the nose. Precautions: sit the resident upright at about 90 degrees, keep the head slightly forward (chin tuck) if taught, give small bites, alternate solids and liquids as instructed, check the mouth for pocketing, and keep the resident upright for at least 30 minutes after the meal. Use the prescribed thickened liquid consistency - never add thickener or thin liquids on your own, and never use a straw unless the care plan allows it.
Intake and output: record in milliliters. One ounce is 30 mL, so a standard 8-ounce cup is 240 mL, and one liter is 1000 mL. Record what the resident actually drinks, not what you poured.
Encourage fluids between meals and offer choices. Signs of dehydration include dark, concentrated urine, dry mouth, poor skin turgor, and new confusion - report them.
Traps
Feeding a resident lying flat; giving water to an NPO resident; rushing a slow eater; forcing food; ignoring a resident's stated dislike of a food.
Rule of thumb: the resident decides whether and how much to eat; you control positioning, safety, and reporting.
Worked example: A resident coughs with every sip of thin liquid and has a wet voice. Stop the meal, keep them upright, and report to the nurse so a swallowing evaluation can be requested.