Unit 6

Nutrition and Hydration

Nurse Aide I Course

Nutrition and Hydration

Introduction
This unit introduces the nurse aide to
the basic principles of nutrition and
emphasizes the functions of the major
nutrients required for health.

Nutrition and Hydration

Introduction
(continued)

This unit covers the Food Guide

Pyramid, the use of therapeutic diets,
adaptive devices, alternative methods
of feeding, providing water and
nourishments, the procedure for
feeding a resident, and the effects of
good nutrition and poor nutrition.
3

Nutrition and Hydration

Introduction
(continued)

Knowledge of nutrition will enable the

nurse aide to recognize the important
relationship between food and good
health.

6.0 Identify the general principles of

basic nutrition.
6.1 Identify factors that influence
dietary practices.

Good Nutrition
Promotes physical and
mental health
Provides increased
resistance to illness
Produces added energy
and vitality
7

Good Nutrition
(continued)

Aids in healing process

Assists one to feel and sleep better

Functions of Food
Provides energy
Growth and repair
of tissue
Maintenance and
regulation of body
processes
9

Factors Influencing Dietary

Practices
Personal preference
Appetite
Finance
Illness
Culture

10

6.1.1 Review cultural variations in diet.

11

Culture and Dietary Practices

The diets of Chinese,
Japanese, Koreans and
people from Far East
include rice and tea
The diets of Spanishspeaking people include
spicy dishes containing
rice, beans and corn
12

Culture and Dietary Practices

(continued)

The Italian diet includes

spaghetti, lasagna, and
other pastas
Scandinavians have a lot
of fish in their diets

13

Culture and Dietary Practices

(continued)

Americans eat a lot of

meat, fast foods, and
processed foods
Use of sauce and
spices are culturally
related
14

Culture and Food Preparation

Baking

Frying

Roasting

Smoking

Fresh/raw
15

6.1.2 List seven examples of foods

avoided by some religious
denominations.

16

Religion and Dietary Practices

Days of fasting when all or
certain foods are avoided.
Christian Science - avoid
coffee/tea and alcohol
Roman Catholic - avoid
food one hour before
communion, observe
special fast days
17

Religion and Dietary Practices

(continued)

Muslim/Moslem - avoid
alcohol, pork products
7th Day Adventist avoid coffee/tea,
alcohol, pork and some
meats, caffeine
18

Religion and Dietary Practices

(continued)

Baptists some avoid

coffee, tea and alcohol
Greek Orthodox - fast
days, but usually
forgiven when ill

19

Religion and Dietary Practices

(continued)

Conservative Jewish faith

Prohibits shellfish, nonkosher meats such as
pork
Requires special
utensils for food
preparation
20

Religion and Dietary Practices

(continued)

Conservative Jewish faith

Forbids cooking on
Sabbath
Forbids eating of
leavened bread during
Passover
21

Religion and Dietary Practices

(continued)

Conservative Jewish faith

Forbids serving milk
and milk products with
meat
Strict rules regarding
sequence in which milk
products and meat may
be consumed
22

6.1.3 Review the major classification of

nutrients and their function in the
body.

23

Nutrients
Nutrients are essential
Four classifications of nutrients
1. Fats - provide energy, help body
use certain vitamins, conserve
body heat and protect organs from
injury
2. Proteins build and repair tissue
24

Nutrients
(continued)

Four classifications of nutrients

(continued)

3. Carbohydrates - provide energy and

fiber that help in bowel elimination
4. Vitamins and minerals - ingested
through food and are necessary for
carrying out and maintaining
specific body functions
25

Nutrients
(continued)

Fats, proteins and carbohydrates

measured in calories

26

Nutrients
(continued)

Water - solvent for nutrients and

metabolic waste products
Found in all body tissue
Essential for digestion of food
Makes up most of blood plasma
6 to 8 glasses necessary per day
Has no caloric value
27

6.1.4 Describe six factors that influence

caloric needs.

28

Factors That Influence Caloric Need

Age
Sex
Size and activity level
Climate
State of health
Amount of sleep
obtained
29

6.1.5 Cite nine age-related

changes/factors that affect the
residents nutritional status.

30

Age Related Changes/Factors

Affecting Nutrition
Need for fewer calories
Vitamin and mineral
requirements change
Drugs that affect how nutrients
are absorbed and used
Teeth/dentures affect ability to
chew food
31

Age Related Changes/Factors

Affecting Nutrition
(continued)

Diminished sense of taste and

smell
Assistance required with eating
Decreased saliva and gastric juices
production
Discomfort caused by constipation
Decreased appetite and thirst
32

6.1.6 Recognize the signs of good

nutrition.

33

Signs Of Good Nutrition

Healthy, shiny looking hair
Clean skin and bright eyes
A well-developed, healthy
body
An alert facial expression
An even, pleasant
disposition
34

Signs Of Good Nutrition

(continued)

Restful sleep patterns

Healthy appetite
Regular elimination
habits
Appropriate body
weight
35

6.1.7 Identify seven results of poor

nutrition.

36

Results of Poor Nutrition

Hair and eyes
appear dull
Irregular bowel
habits
Weight changes
Osteoporosis and
other diseases
37

Results of Poor Nutrition

(continued)

Lack of interest mental slowdown

Skin color and
appearance poor

38

Results of Poor Nutrition

(continued)

Anemia leading to:

tired feeling
shortness of breath
increased pulse
problems with
digestion

pale skin
poor sleep
patterns
headaches

39

40

6.2

Discuss the six basic food groups

from the Food Guide Pyramid
that contribute to balanced
nutrition.

41

Dietary Guide For Americans

Guidelines are the foundation of the
Food Guide Pyramid and include nine
key recommendations.
Key recommendation #1: Consume
nutrient-dense foods and beverages
within calories needed for age, sex
and activity level.
42

Dietary Guide For Americans

Key recommendation #2: To maintain
health body weight, balance calories
consumed with calories expended.
Key recommendation #3: Engage
regularly in a variety of physical
activities and reduce sedentary
activities.
43

Dietary Guide For Americans

Key recommendation #4: Encourage
the following:
Choose variety of fruits and
vegetables daily.
Half of daily grains should come from
whole grains.
Consume 3 cups fat-free or low fat
milk or equivalent milk products daily.
44

Dietary Guide For Americans

Key recommendation #5: Consume
foods and beverages that are low in
saturated fats, trans fats and cholesterol.
Key recommendation #6: For
carbohydrates: Choose fiber-rich foods,
vegetables and grains often. Reduce
intake of sugar- and starch-containing
foods.
45

Dietary Guide For Americans

Key recommendation #7: Consume
less than a teaspoon of salt per day.
Key recommendation #8: Consume
alcoholic beverages in moderation if
alcohol intake is permitted.
Key recommendation #9: Prepare
foods in a safe manner to avoid
microbial foodborne illness.
46

Six Basic Food Groups From the

Food Pyramid Guide

GRAINS

Vegetables

Fruits

Milk

Meat
&
Beans

47

Food Pyramid Guide

Grain Group
(breads, cereal, rice, pasta)
Provides
carbohydrates
minerals
fiber

48

Food Pyramid Guide

Grain Group
(breads, cereal, rice, pasta)
(continued)

1 ounce equivalent is about

1 slice of bread, about 1
cup of breakfast cereal or
cup cooked rice, cereal
or pasta.

49

Food Pyramid Guide

Grain Group
(breads, cereal, rice, pasta)
(continued)

Daily:
6 ounce equivalents
for males over 60
5 ounce equivalents
for females over 60
50

Food Guide Pyramid

Vegetable Group
Provides:
vitamins
minerals
fiber (roughage)
Easier to chew if cooked,
chopped or diced
51

Food Guide Pyramid

Vegetable Group
(continued)

Chose from all five vegetable

subgroups:
dark green
orange
legumes
starchy
other vegetables
52

Food Guide Pyramid

Vegetable Group
(continued)

Daily:
2 cups for males over 60
2 cups for females over 60

53

Food Pyramid Guide

Fruit Group
Provides
vitamins
minerals
fiber

Chose fresh, frozen, canned or

dried fruits
54

Food Pyramid Guide

Fruit Group
(continued)

Daily:
2 cups daily for males over 60
1 cups daily for females over 60

55

Food Pyramid Guide

Milk, Yogurt and Other Milk Products
Provides
proteins
vitamins (A)
minerals (calcium)
carbohydrates
Fat
Choose low-fat or fat-free milk and
milk products
56

Food Pyramid Guide

Milk, Yogurt, Cheese Group
(continued)

Daily:
3 cups for males over 60
3 cups for females over 60

57

Food Pyramid Guide

Meat, Poultry, Fish and Beans Group
Provides
protein
fats
vitamins
Minerals
1 ounce of meat, poultry or fish is
about cup cooked beans, 1 egg, 1
tablespoon of peanut butter or
ounce nuts or seeds
58

Food Pyramid Guide

Meat, Poultry, Fish and Beans Group
(continued)

Daily:
5 ounce equivalents daily for
males over 60
5 ounce equivalents daily for
females over 60

59

Food Pyramid Guide

Oil Group = fats that are liquid at
room temperature
Provides essential

fatty acids
High in calories
Use sparingly

Keep total fat intake

between 20% to 35%
of calories
60

Food Pyramid Guide

Oil Group = fats that are liquid at
room temperature
Most fats consumed should be
polyunsaturated and
monounsaturated.
Make most fat sources from fish,
nuts and vegetable oils.
Limit solid fats like butter, stick
margarine, shortening and lard.
61

62

6.3

Define a therapeutic diet and

recognize the need for alterations
in a regular diet.
6.3.1 List five purposes of a therapeutic
diet.
63

Purposes of Therapeutic Diets

Add or eliminate calories to
cause a change in body
weight
Assist with digestion of food by
taking foods out of diet that
irritate digestive system
Restrict salt intake to prevent
or decrease edema
64

Purposes of Therapeutic Diets

(continued)

Help body organs to maintain and/or

regain normal function
Treat metabolic disorders by
regulating amount of food

65

6.3.2 Discuss the types of therapeutic

diets that the physician might
order for a resident.

66

Types of Therapeutic Diets

Clear liquid
Full liquid
Bland
Low residue
Controlled carbohydrate
(Diabetic)
Low fat/low cholesterol
67

Types of Therapeutic Diets

(continued)

High fiber
Low calorie
High calorie
Sodium restricted
High protein
Mechanical soft, chopped, pureed
68

Types of Therapeutic Diets

(continued)

Residents may have

difficulty accepting
special diets.

69

70

6.4

Recognize adaptive devices used

to assist residents with eating.

71

Adaptive Devices

Food Guards
Divided Plates
Built-up handled utensils
Easy grip mugs/glasses

Residents have to be
taught how to use these
devices.
72

73

6.5

Discuss alternate methods of

feeding.

74

Parenteral Fluids
(Intravenous Infusion)
Fluids administered
through vein. Little
nutritional value
Responsibility of
licensed nurse

75

Parenteral Fluids
(Intravenous Infusion)
(continued)

Observations to report
Near-empty bottle/bag
Change in drip rate
Pain at needle site, and/or redness
and/or swelling, if observable
Loose, non-intact, or damp
dressing
76

Enteral Feeding
Residents unable to take nutrients by
mouth
Depressed
Comatose
Swallowing problem (stroke,
Alzheimers or other medical
conditions)
Disorders of digestive tract
77

Enteral Feeding
(continued)

Liquid formula administered

through tube by licensed
nurse/NAII
Nose to stomach nasogastric tube
Directly into stomach gastrostomy tube
78

Nurse Aide Responsibilities in

Alternative Nutrition
Ensure that there is no
tension or pulling on tube
Keep residents nose clean
and free of mucus
Check that tube is securely
taped to nose
Perform frequent oral care
with nasogastric tube
79

Nurse Aide Responsibilities in

Alternative Nutrition
(continued)

Fasten tube with pin to shoulder area

of clothing to prevent straining or
tension on tube
Report non-intact dressing around
tube site
80

Nurse Aide Responsibilities in

Alternative Nutrition
(continued)

Report any signs or symptoms

related to aspiration or GI problems
Mitts may be ordered to prevent
resident from dislodging tube

81

82

6.6

Identify the responsibilities of the

nurse aide in preparing residents
for meals.
6.6.1 Serve prepared food as
instructed.
83

Preparing Residents for Meals

Meals enjoyable, social experience
Provide pleasant environment
Clean area
Odor-free area
Adequate lighting
Flowers/decorations and music add
interest to dining area
84

Preparing Residents for Meals

(continued)

All residents clean and

dressed for meals
Hair combed
Oral care provided
Encourage to use bathroom
or urinal/bedpan
Cleanse and dry incontinent
residents
85

Preparing Residents for Meals

(continued)

Face and hands washed

Provide for comfort
Raise head of bed
Position in chair
Transport to dining
area
Provide clothing
protector if appropriate
86

Preparing Residents for Meals

(continued)

Check to be certain resident

receives right tray and has
correct diet
Food should be attractively
served and placed within reach
Check tray to see that
everything needed is there
87

Preparing Residents for Meals

(continued)

Assist resident as needed with:

cutting meat
pouring liquids
buttering bread
opening containers

88

Preparing Residents for Meals

(continued)

Blind residents made

aware of food placement
according to face of
clock
Stroke residents
approached from noneffected side
89

Preparing Residents for Meals

(continued)

Residents should be
encouraged to do as
much as possible for
themselves
Provide time for resident
to complete meal
Display pleasant, patient
attitude
90

Preparing Residents for Meals

(continued)

Remove tray when meal

finished
Report unconsumed food
to supervisor
Record fluid intake if
ordered
Assist to position of
comfort
91

Preparing Residents for Meals

(continued)

Call signal and supplies positioned

within reach
Area should be left clean and tidy
Hands washed before and after
care of each resident

92

93

6.7

Demonstrate the procedure for

assisting with dining/feeding
resident who cannot feed self.

94

95

6.8

Discuss the various types of

supplementary nourishments.

96

Types of Nourishments

Milk
Juice
Gelatin
Custard, ice cream, sherbet
Crackers
Nutritional supplementation
products (e.g., Ensure, etc.)
97

Supplementary Nourishments
Usually served:
Midmorning
Mid-afternoon
Bedtime

98

Supplementary Nourishments
(continued)

Ordered by physician
Serve as directed by
supervisor
Provide necessary
eating utensils, straw
and/or napkin
99

100

6.10 Demonstrate the procedure for

serving supplementary
nourishments.

101

102

6.11 Identify the special fluid orders

that the physician could write.

103

Providing Fresh Drinking Water

Fresh water should be
provided periodically
throughout day
Encourage to drink 6-8
glasses daily if
appropriate

104

Providing Fresh Drinking Water

(continued)

Note residents who have special

fluid orders
N.P.O.
Fluid restrictions:
Schedule 24-hour intake
Remind resident

105

Providing Fresh Drinking Water

(continued)

Note residents who have special fluid

orders
Force fluids
Offer fluids in small quantities
Offer fluids (resident preference)
without being asked
Remind resident of importance of
fluids in bodily functions
No ice
106

107

6.11 Demonstrate the procedure for

providing fresh drinking water.

108

109