Nursing Assistant

1. Nursing Assistant Nutrition

2. Body’s need for food & fluids • Provide energy for daily living & bodily functions • Promote growth & repair of tissue • Provide necessary substances for regulation of bodily fluids

3. Nutrition • Science of foods & their relationship to health • Essential to good health • Composed of sufficient nutrients to meet the body’s requirements

4. Common Nutrients • Carbohydrates • Grains • Pastas • Breads • Cereals • Fruits • Vegetables

5. Proteins • Eggs • Milk • Meat • Fish • Nuts • Poultry

6. Fats • Oils • Cream • Cheese • Meat fats • Butter

7. Vitamins • Vegetables • Fruits • Milk

8. Minerals • Eggs • Dried fruit • Potatoes • Fish • Milk

9. Dietary fiber • Raw fruits • Raw vegetables • Whole grains

10. Fluids • Water • Juices • Other beverages

11. Food Pyramid • www.mypyramid.gov • Serving sizes based on age, gender, & activity level

12. Vegan • Vegetarian AND no animal by products • Check www.mypyramid.gov for specifics

13. Special nutrient needs of elderly • Age related changes • Fewer calories needed, decreased activity • Digestive disturbances = add vitamins & minerals • Meds may interfere with digestion & nutrient use • Poor oral hygiene, ill-fitting dentures • Ability to taste decreased • Many common diseases interfere with eating & or the ability to use nutrients • Social isolation = interference with appetite • Food allergies – know status & check for additives (peanuts, shellfish, wheat)

14. Therapeutic diets • Low sodium • Diabetic • Low fat • Liquid • Full liquid • Clear liquid • Thickened liquids • Nectar thick • Honey thick

15. Special consistency diets • Mechanical soft • Pureed • Soft

16. Responsibilities of nursing assistant • Check that residents receive diets ordered, check arm bands with tray • Report any diet related problems – preferences, difficulties, N & V, anorexia • Assist drs & nurses to evaluate fluid balance, accurate I & O • Calculate food intake according to facility, if eats all, eats 100% • Offer alternate menu with refusal • If alternate refused, report to licensed nurse

17. Technique for feeding • Provide comfortable & enjoyable atmosphere • Sit at eye level • Maintain a positive attitude when feeding • Provide assistance if needed • Serve residents in room if unable to join others in dining area (best choice is dining area) • Alternate liquid & solid food

18. Steps • Wash hands • Check diet card for name, diet order, special instructions, & allergies • Make sure food matches info on card • Remove tray from food cart, see that all items are there • Knock & pause before entering room • Introduce self • Check armband • Explain procedure

19. Steps cont. • Lower side rail • Place tray on overbed table • If in dining room, remove food items & place on table – remove tray • Place a towel or clothing protector • Remove plate cover • Seat yourself at eye level • Arrange food, butter bread, season food

20. Steps cont • Describe or show food before giving it to resident • Use adaptive devices as indicated • Use straws & thickeners as indicated • Offer small portions of solids ( no more than ½ spoonful) • Alternate solids & liquids • Ask what they would like • Put food on unaffected side of mouth • Monitor for pocketing & swallowing difficulties • Remove tray when resident is finished

21. Prevention of choking • High risk residents • CVA • Neurological disease • Trauma to head, neck, or throat • Dementia • Close supervision when eating • Follow individual feeding plan • Cut food into small pieces, offer in small amounts, wait until each portion is chewed & swallowed before more is given

22. Choking cont. • Notify licensed nurse if dysphagia • Long time before swallowing • Swallows several times with each bite • Frequent throat clearing • Difficulty handling foods/fluids in mouth • Wet gurgling voice • Pocketing food • Unintentional weight loss • Feeling by resident that food is sticking

23. Choking cont • Proceed at resident’s pace – don’t rush • Portion should be chewed & swallowed before more is given • Sit down while feeding helpless resident • Use adaptive equipment as indicated

24. Recognition of signs of choking • Universal sign • Inability to speak, cough, breathe • Cyanosis • Loss of consciousness • HEIMLICH MANEUVER

25. DIETARY MODIFICATIONS • Affiliated with religions and/or cultures • Ask if there are any preferences • Ask family of residents who cannot communicate

26. Alternate ways to offer nutrition • Tube feedings • Ordered by doctor when resident unable to eat • Started by a licensed nurse • Your responsibility • Monitor for tubing kinking or pressure • Monitor level of feeding • KEEP HOB AT 20 – 30 DEGREES AT ALL TIMES • DO NOT LOWER HOB EVEN WHEN REPOSITIONING • Never turn off pump – notify nurse of alarm • Notify nurse if signs of aspiration

27. Intravenous infusion • Ordered by physician • Started by licensed nurse • Your responsibility • Monitor IV for kinks, twisting, pressure, or obstruction • Report • Alarms • C/o pain or burning at site • Swelling or redness at site • Fever • SOB • Bleeding of fluid leakage at IV site • Disconnected IV tubing • Empty IV container