Nutrition and Hydration
Food is care
Eating and drinking are social, cultural, and personal. Know the diet order (regular, low-sodium, diabetic, renal, thickened liquids, mechanical soft), the allergies, and the food preferences. Honor religious and cultural food practices and pass the information to the dietitian. Never give food brought from home without checking with the nurse, and never ignore an NPO order.
Safe feeding
Position the resident upright - ideally 90 degrees - before food or fluids, and keep them upright for about 30 minutes afterward. Sit at eye level, offer small bites, alternate food and fluids, and let them set the pace. After a stroke, place food on the unaffected side of the mouth. Watch for dysphagia warning signs: coughing or choking, a wet or gurgly voice, pocketing food in the cheek, drooling, or food coming back through the nose. If any occur, stop feeding, keep the resident upright, and report.
Hydration and intake
Offer fluids often; older adults may not feel thirst, and some limit fluids to avoid incontinence. Signs of dehydration include dry mouth, dark concentrated urine, poor skin turgor, confusion, and dizziness. Record intake and output accurately - estimate the percentage of food eaten and measure fluids in milliliters. Report a resident who suddenly refuses food, has trouble swallowing, or is losing weight.
Traps
- Feeding a resident who is lying flat or leaning back.
- Rushing, or offering the next bite before the last is swallowed.
- Thickening liquids or mixing foods without an order.
- Guessing at intake percentages instead of measuring.
Rule of thumb
Upright, unhurried, small bites - and stop feeding at the first sign of coughing or a wet voice.