Define the following terms:

1. Nutrition how the body uses food to maintain health. Nutrient something found in food that provides energy, promotes growth and health, and helps regulate metabolism. Define the following terms:

2. 1. Identify the six basic nutrients and explain MyPyramid • REMEMBER: • Bodies rely on proper nutrition to function well. • A well-balanced diet will help residents maintain muscles and skin tissues and prevent pressure sores.

3. Transparency 8-1: Six Basic Nutrients 1. Protein 2. Carbohydrates 3. Fats 4. Vitamins 5. Minerals 6. Water

4. Remember this information about the six basic nutrients: Protein Essential for tissue growth and repair Provides a supply of energy Includes fish, seafood, poultry, meat, eggs, milk, cheese, nuts, peas, dried beans/legumes 1. Identify the six basic nutrients and explain MyPyramid

5. 1. Identify the six basic nutrients and explain MyPyramid • Six basic nutrients (cont’d.): • Carbohydrates • Provide fuel for energy • Provide fiber • Complex carbohydrates include bread, cereal, potatoes, rice, pasta, vegetables, and fruits • Simple carbohydrates include sugars, sweets, syrups, and jellies

6. 1. Identify the six basic nutrients and explain MyPyramid • Six basic nutrients (cont’d.): • Fats • Help the body store energy • Provide insulation • Protect the organs • Fats include butter, margarine, salad dressings, oils, and fats in meat

7. 1. Identify the six basic nutrients and explain MyPyramid • Six basic nutrients (cont’d.): • Vitamins • Vitamins are essential to body functions. • Fat-soluble vitamins are A, D, E, and K. • Water-soluble vitamins are B and C.

8. 1. Identify the six basic nutrients and explain MyPyramid • Six basic nutrients (cont’d.): • Minerals • Maintain body functions • Minerals include zinc, iron, sodium, potassium, calcium, magnesium, and phosphorus.

9. 1. Identify the six basic nutrients and explain MyPyramid • Six basic nutrients (cont’d.): • Water • We need about eight glasses, or 64 ounces, per day. • Water is the most essential nutrient for life. • Water aids in digestion, absorption of food, elimination of wastes, and maintaining normal body temperature.

10. Transparency 8-2: MyPyramid

11. 1. Identify the six basic nutrients and explain MyPyramid • Here are some examples of the six food groups: • Grains • Found in cereal, bread, rice, and pasta • Two subgroups of grains: whole grains and refined grains • At least half of all grains consumed should be whole grains such as whole wheat breads, bran cereals, brown rice, and whole wheat pastas.

12. 1. Identify the six basic nutrients and explain MyPyramid • Examples of the six food groups (cont’d.): • Vegetables • Provide fiber and vitamins • Subgroups are dark green vegetables, orange vegetables dry beans and peas, starchy vegetables and other vegetables. • Examples include spinach, carrots, peas, corn and potatoes.

13. 1. Identify the six basic nutrients and explain MyPyramid • Examples of the six food groups (cont’d.): • Fruits • Provide complex carbohydrates, vitamins and fiber • Examples include oranges, grapefruit, strawberries, mango, papayas, and cantaloupe.

14. 1. Identify the six basic nutrients and explain MyPyramid • Examples of the six food groups (cont’d.): • Milk • Provides nutrients necessary for bones and teeth • Provides protein, vitamins, and minerals • Examples include cheese, yogurt, milk, buttermilk, cottage cheese, and evaporated milk.

15. 1. Identify the six basic nutrients and explain MyPyramid • Examples of the six food groups (cont’d.): • Meat and beans • • Provide protein, vitamins, and minerals • • Examples include fish, chicken, turkey, lean meats, and dry beans.

16. 1. Identify the six basic nutrients and explain MyPyramid • Examples of the six food groups (cont’d.): • Oils • Fats and oils are needed in small amounts. • Foods like nuts, olives, some fish, and avocados are naturally high in oils. • Most of the fats consumed should be polyunsaturated (PUFA) or monounsaturated (MUFA) fats.

17. 1. Identify the six basic nutrients and explain MyPyramid • Remember these points about elderly residents and MyPyramid: • Elderly residents may need a modified MyPyramid that emphasizes nutrient-dense foods, fiber, and water. • Calories may be reduced, but need for vitamins and minerals does not decrease. • Dietary supplements may be appropriate.

18. 2. Describe factors that influence food preferences • Remember these points about food preferences: • Know and follow residents’ food preferences. • Ask questions. • Pay attention when residents express preferences, verbally or non-verbally.

19. Think about this question: What are your regional, cultural, or religious food preferences? 2. Describe factors that influence food preferences

20. REMEMBER: Residents have a legal right to make choices about their food and to refuse food, and NAs must honor residents’ beliefs and preferences. 2. Describe factors that influence food preferences

21. Define the following terms: • Therapeutic diet • a diet for people who have certain illnesses; also called special or modified diet. • Diet cards • cards that list the resident’s name and information about special diets, allergies, likes and dislikes, and other instructions. • Puree • to chop, blend, or grind food into a thick paste of baby food consistency.

22. 3. Explain special diets The following are common special diets: Low-Sodium Diet Fluid-Restricted Diet Low-Protein Diet Low-Fat/Low-Cholesterol Diet Modified Calorie Diet for Weight Management Dietary Management of Diabetes Liquid Diet Soft Diet Pureed Diet

23. 3. Explain special diets • Think about this question: • Do you now or have you ever followed a special diet?

24. Define the following terms: • Force fluids • a medical order for a person to drink more fluids. • Restrict fluids • a medical order for a person to limit fluids. • Dehydration • a condition that results from inadequate fluid in the body.

25. Describe how to assist residents in maintaining fluid balance • Fluid intake is important for several reasons: • Helps prevent constipation and incontinence • Dilutes wastes and flushes out urininary system • May help prevent confusion

26. Watch for these signs and symptoms of dehydration: • Drinking less than six 8 oz glasses of liquid per day • Drinking little or no fluids at meals • Needing help drinking from cup • Having trouble swallowing liquids • Having frequent vomiting, diarrhea, or fever Describe how to assist residents in maintaining fluid balance

27. Describe how to assist residents in maintaining fluid balance • Signs and symptoms of dehydration (cont’d.): • Being easily confused or tired • Resident has any of the following: • Dry mouth • Cracked lips • Sunken eyes • Dark urine • Strong-smelling urine • Weight loss • Complaints of abdominal pain

28. Describe how to assist residents in maintaining fluid balance • Remember these guidelines for preventing dehydration: • Report warning signs immediately. • Encourage residents to drink every time you see them. • Offer fresh water and fluids often. • Record fluid I&O. • Offer other forms of liquids if permitted (e.g. ice chips, frozen flavored ice sticks, gelatin). • Offer sips of liquids between bites of food. • Make sure pitcher and cup are close by and are light enough for resident to lift. • Offer assistance.

29. Describe how to assist residents in maintaining fluid balance • REMEMBER: • Approach residents positively with, “Would you like water or juice?” rather than, “Do you want anything to drink?” • Make an effort to find out what residents’ favorite beverages are and offer at least three times a day, in addition to meals. • Prevention of dehydration is ongoing – you must constantly help residents to stay hydrated.

30. Serving fresh water Equipment: water pitcher, ice scoop, glass, straw, gloves Wash hands. Provides for infection control. Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification. Put on gloves. Promotes infection control.

31. Serving fresh water (cont’d.) • Scoop ice into water pitcher. Add fresh water. • Use and store ice scoop properly. Do not allow ice to touch hand and fall back into container. Place scoop in proper receptacle after each use. Avoids contamination of ice. • Take pitcher to resident. • Pour glass of water for resident. Leave pitcher and glass at the bedside. Encourages resident to maintain hydration.

32. Serving fresh water (cont’d.) • Make sure that pitcher and glass are light enough for resident to lift. Leave a straw if the resident desires. Demonstrates understanding of resident’s abilities and/or limitations. Prevents dehydration. • Before leaving resident, place call light within resident’s reach. Allows resident to communicate with staff as necessary. • Remove and discard gloves. • Wash your hands. Provides for infection control.

33. Define the following terms: • Fluid overload • a condition that occurs when the body is unable to handle the amount of fluid consumed. • Edema • swelling caused by excess fluid in body tissues.

34. Describe how to assist residents in maintaining fluid balance • Watch for these signs and symptoms of fluid overload: • Swelling of extremities • Weight gain • Decreased urine • Shortness of breath • Increased heart rate • Tight, smooth, or shiny skin

35. 5. List ways to identify and prevent unintended weight loss • REMEMBER: • Unintended weight loss is a serious problem for the elderly and NAs must report any weight loss, no matter how small.

36. 5. List ways to identify and prevent unintended weight loss • Watch for these signs and symptoms of unintended weight loss: • Needing help eating or drinking • Eating less than 70% of meals/snacks • Having mouth pain • Having dentures that do not fit properly • Having difficulty chewing or swallowing • Coughing or choking while eating • Being sad or withdrawing from others • Being confused, wandering, or pacing

37. 5. List ways to identify and prevent unintended weight loss • Remember these guidelines for preventing unintended weight loss: • Report observations warning signs to the nurse immediately. • Encourage residents to eat; talk positively about food. • Honor food likes and dislikes. • Offer different kinds of foods and beverages. • Help residents who have trouble feeding themselves. • Food should look, taste, and smell good. Resident may have poor sense of taste and smell.

38. 5. List ways to identify and prevent unintended weight loss • Guidelines for preventing unintended weight loss (cont’d.): • Season food to residents’ preferences. • Allow plenty of time to finish eating. • Tell nurse if resident cannot use utensils. • Record meal/snack intake. • Give oral care before and after meals. • Position residents sitting upright for feeding. • Ask about loss of appetite or sadness if you observe them.

39. 6. Identify ways to promote appetites at mealtime • REMEMBER: • Residents often view mealtime as the highlight of their days. • Meals are not only a time for getting nourishment but a time for socialization as well. • NAs play an important role in assisting residents to get proper nutrition.

40. 6. Identify ways to promote appetites at mealtime • Remember these guidelines for promoting appetites: • Check the environment. Address odors. Make sure room is a comfortable temperature. Turn off TVs. Do not shout or bang plates or cups. • Assist with grooming/hygiene tasks before dining, as needed. • Assist with handwashing. • Give oral care before eating. • Offer a trip to the bathroom before eating. • Encourage use of dentures, glasses, and hearing aids.

41. Guidelines for promoting appetites (cont’d.): Properly position residents for eating, which is normally in the upright position. Seat residents next to friends. Serve food at correct temperature. Plates should look appetizing. Provide proper eating tools, including adaptive utensils if needed. Be cheerful, positive, and helpful. Give additional food when requested. 6. Identify ways to promote appetites at mealtime

42. Remember these points about assisting residents with eating: Residents will need different levels of help. Some residents will only need help with setting up but can feed themselves. Some residents will need to be fed. Be sensitive and give privacy. Encourage residents to do what they can. 7. Demonstrate how to assist with eating

43. Review the guidelines for assisting a resident with eating: Do not treat the resident like a child. Be supportive and encouraging. Sit at resident’s eye level. Allow time for prayer if resident wishes. Verify that it is the right resident. Do not touch food to test its temperature. Use a hand over the dish instead. Cut foods and pour liquids as needed. Identify foods and fluids that are in front of resident. Call pureed food by the correct name. 7. Demonstrate how to assist with eating

44. Guidelines for assisting a resident with eating(cont’d.): Ask resident what he wants to eat first. Allow resident to make the choice. Do not mix foods unless resident prefers it. Do not rush the meal. Make mealtime social and friendly. Converse if the resident wishes to do so. Give resident full attention. Alternate food and drink and cold and hot or bland and sweets. Honor requests for different food. 7. Demonstrate how to assist with eating

45. REMEMBER: Do not insist on using a clothing protector if a resident does not wish to use one. Use the term “clothing protector” rather than “bib.” 7. Demonstrate how to assist with eating

46. Feeding a resident who cannot feed self Equipment: meal tray, clothing protector, 2-3 washcloths or wipes Wash hands. Provides for infection control. Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

47. Feeding a resident who cannot feed self (cont’d.) • Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. • Pick up diet card. Ask resident to state his or her name. Verify that resident has received the right tray. Tray should only contain foods, fluids, and condiments permitted on the diet.

48. Feeding a resident who cannot feed self (cont’d.) • Raise the head of the bed. Make sure resident is in an upright sitting position (at a 90-degree angle). Promotes ease of swallowing. Prevents aspiration of food and beverage. • Adjust bed height to where you will be to able to sit at resident’s eye level. Lock bed wheels. • Place meal tray where it can be easily seen by the resident, such as on the overbed table.

49. Feeding a resident who cannot feed self (cont’d.) • Help resident to clean hands with hand wipes if resident cannot do it on her own. Promotes good hygiene and infection control. • Help resident to put on clothing protector, if desired. Protects resident’s clothing from food and beverage spills. • Sit facing resident at resident’s eye level. Sit on the stronger side if resident has one-sided weakness.

50. Feeding a resident who cannot feed self (cont’d.) (cont’d.) Promotes good communication. Lets resident know that he or she will not be rushed while eating. Tell the resident what foods are on the tray. Ask what resident would like to eat first. Resident has legal right to make decisions.