certified nurse assistant module 11 nutrition section 1 define key terminology a review the terms listed in the terminology section b spell the listed terms accurately c pronounce the terms correctly and d use the terms in their proper context section 2 the body's need for food and fluids the body depends upon foods and fluids to provide energy for daily living and bodily functions to promote growth and repair of tissue and provide necessary substances for regulation of bodily functions also to meet a basic physiological need for survival nutrition is the science of food and its relationship to health a balanced diet is essential to good health composed of sufficient nutrients to meet the body's daily requirements sufficient amount of fluids approximately 1500 milliliters per day minimum for an adult section 3 common nutrients and their food sources nutrients in their food sources and functions carbohydrates grains pastas breads cereals fruits and vegetables they're the main source of energy and provide dietary fiber proteins eggs milk meat fish nuts poultry cheese and beans peanut butter and soy products essential for tissue growth and repair made up of amino acids fats oils milk cream cheese meats fats butter and mayonnaise they provide energy carry vitamins conserve body heat and protect internal organs vitamins are found in almost all foods especially vegetables and fruits they do not contain calories they are essential for building and repairing body tissues and assisting in regulation of body functions minerals found in almost all foods they do not contain calories and are essential for regulation of body function building and repairing of body tissue dietary fiber raw fruits and vegetables whole grain breads and cereals provides bulk to assist in maintaining normal bowel elimination fluids water juices and other beverages may or may not provide calories and nutrients water is essential for normal body functioning all chemical reactions in the body take place in water section 4 the my plate food guidance system my plate food guidance system a the grain group whole grain bread cereal crackers rice and pasta a minimum of five to six ounces per day for women and six to eight ounces per day for men b the vegetable group eat more dark green and orange vegetables dry beans and peas a minimum of two to two and a half cups per day for women and two and a half to three cups a day for men c fruit group fresh frozen canned or dried fruits limit fruit juices minimum one and a half to two cups a day for women two cups a day for men dairy group milk yogurt and cheese choose low fat or non-fat minimum 3 cups a day for men and women e protein meat poultry fish dry beans eggs and nuts a minimum of five to five and a half ounces per day for women five and a half to six and a half ounces per day for men f oil group make most oil choices from fish nuts and vegetable oil limit solid fats such as butter lard and shortening five to six teaspoons a day for women and six to seven teaspoons a day for men section 5 the vegan basic for food groups the vegetarian diet excludes meat including game and slaughter by-products fish shellfish and other sea animals and poultry variations may include or exclude milk fish eggs and honey the vegan diet excludes all animal products including milk fish eggs and honey the vegan basic four food groups are whole grains five or more servings each day vegetables three or more servings each day fruits three or more servings each day and legumes two to three servings each day section six nutritional and fluid needs of the elderly age-related changes affecting nutritional needs of the elderly fewer calories may be needed if the patient or resident is less active additional vitamins and minerals may be required due to digestive disturbances medications may interfere with fluid balance digestion and nutrient use poor oral hygiene or loss of teeth and ill-fitting dentures may lead to poor nutrition the ability to taste foods may be diminished many common diseases interfere with eating and or the ability to use nutrients social isolation may interfere with appetite and the body's utilization of nutrients a patient or resident may need nutritional supplements such as insure or boost one to three times a day to meet daily nutrient requirements specific food allergies know the patient or resident's allergies check every tray served check for new allergies check for food additive allergies such as peanuts shellfish and wheat check for lactose intolerance factors affecting patients or residents food choices likes and dislikes facility food service menus and options medical restrictions culture and religious beliefs section 7 therapeutic diets commonly ordered for patients or residents and the responsibilities of the nurse assistant therapeutic or special diets most commonly ordered low sodium diabetic low fat low cholesterol liquid clear liquid full liquid or thickened liquids such as nectar thick or honey thick and bland special consistency diets mechanical soft prepared to require very little chewing pureed food that has been processed in a blender for easier swallowing and digestion requires little or no chewing soft liquid or semi-solid foods that are easily digested responsibilities of the nurse assistant make sure all patients or residents receive their ordered diet check armbands against names on trays at each meal report any problems related to the diet such as food or liquid preferences difficulty chewing or swallowing nausea or vomiting anorexia or food intolerances open containers on tray as needed assist nurses dietitians and physicians in evaluating fluid balance through accurate monitoring and documentation of intake and output calculate and record food intake according to facility guidelines determine reason log any tray or food refusal offer alternatives as allowed if alternative is refused report refusal to licensed nurse do not offer extra food or condiments without checking with the licensed nurse serve hot foods hot and cold foods cold do not mix pureed foods always check trays to monitor percentage of diet eaten always have patient or resident in an upright position when eating unless otherwise ordered section 8 proper techniques for feeding patients or residents proper techniques for feeding patients or residents provide a comfortable and enjoyable atmosphere sit at eye level maintain a positive attitude when assisting with feeding encourage to participate as able holding bread picking up juice cup moving fork to mouth after food is put on it allow them to set the pace as much as possible and do not rush provide assistance as needed using adaptive equipment as indicated serve them in their rooms if unable to join them in the dining area serve in dining room if at all possible alternate liquids and solid foods check swallowing before they eat or is fed feed by placing food on unaffected side if applicable prevention of choking identify patients or residents who are at high risk for dysphagia and choking such as those with a cerebral vascular accident neurological disease trauma to head neck or throat and dementia supervise closely when eating follow their individual feeding plans cut food into small pieces offer in small amounts wait until each portion is chewed and swallowed before more is given notify the licensed nurse if signs of dysphagia is observed such as long intervals before swallowing swallowing several times with each bite frequent throat clearing difficulty handling foods and fluids and mouth wet gurgling voice pocketing food excessive drooling and the patient a resident feels that food is sticking in the mouth or throat proceed at the patient or resident's pace and do not rush keep them in an upright position during and 30 minutes after eating sit at eye level while feeding thicken liquids if they have difficulty swallowing assist them in using appropriate adaptive equipment recognize signs of choking universal sign of choking is hands to the throat inability to speak cough or breathe cyanosis especially of lip skin or nails and loss of consciousness objective 9 cultural and religious influences on dietary practices dietary practices affiliated with religions and or cultures ask all patients or residents if they have any food preferences ask family of non-communicative patient or resident about food preferences if allowed encourage family to bring in ethnic and cultural foods avoid making assumptions regarding food likes and dislikes section 10 alternative ways to administer nutrition tube feedings ordered by the doctor when a patient or resident is unable to eat started by a licensed nurse the nurse assistant's responsibility includes the monitoring of pressure or kinking of the tubing monitoring the level of feeding and reporting when low keep the head of bed elevated at least 20 to 30 degrees at all times do not lower bed even when repositioning the patient or resident never turn off pump notify licensed nurse of alarm notify licensed nurse of signs or symptoms of aspiration intravenous infusion ordered by the physician started and monitored by a licensed nurse according to the facility policy the nurse assistant's responsibility includes making sure that there are no kinks twisting pressure or obstruction of ib tubing report the following alarm ringing on the iv complaints of pain or burning at the iv site swelling and redness at the iv site fever difficulty breathing bleeding or leakage of fluids at the iv site disconnected iv tubing or report any empty iv fluid containers the nurse assistant should never adjust or turn off the iv monitoring equipment also make sure the patient or resident and family do not handle adjust or stop the infusion please proceed to assessment questions