Importance of Proper Nutrition and Basic Nutrients

1. 1. Describe the importance of proper nutrition and list the six basic nutrients • Define the following terms: • 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.

2. 1. Describe the importance of proper nutrition and list the six basic nutrients Define the following terms: complex carbohydrates carbohydrates that are broken down by the body into simple sugars for energy; found in foods such as bread, cereal, potatoes, rice, pasta, and vegetables. simple carbohydrates carbohydrates that are found in foods such as sugars, sweets, syrups, and jellies and have little nutritional value.

3. 1. Describe the importance of proper nutrition and list the six basic nutrients • REMEMBER: • The human body relies on proper nutrition to function well. A well-balanced diet will help residents maintain muscles and skin tissues and will help prevent pressure ulcers.

4. Transparency 15-1: Six Basic Nutrients • Water • Carbohydrates • Proteins • Fats • Vitamins • Minerals

5. 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about water: Most essential nutrient for life We need 64 ounces per day. Water aids in digestion, absorption of food, elimination of wastes, and maintaining normal body temperature.

6. 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about carbohydrates: Provide energy and extra protein Provide fiber Complex carbohydrates include bread, cereal, potatoes, rice, pasta, vegetables, and fruits. Simple carbohydrates include sugars, sweets, syrups, and jellies.

7. 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about protein: Essential for tissue growth and repair Provides a supply of energy Protein sources include seafood, poultry, meat, eggs, milk, cheese, nuts, nut butters, peas, dried beans or legumes, and soy products.

8. 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about fats: Help the body store energy Provide insulation Protect the organs Sources include butter, margarine, salad dressings, oils, and animal fats found in meat, dairy products, fowl, and fish Monounsaturated and polyunsaturated vegetable fats are healthier fats.

9. 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about vitamins: Vitamins are essential to body functions. Fat-soluble vitamins are A, D, E, and K. Water-soluble vitamins are B and C.

10. 1. Describe the importance of proper nutrition and list the six basic nutrients NAs should know these facts about minerals: Minerals form and maintain body functions. Include zinc, iron, sodium, potassium, calcium, magnesium, and phosphorus

11. Handout 15-1: Vitamins and Minerals

12. Handout 15-1: Vitamins and Minerals (cont’d)

13. Handout 15-1: Vitamins and Minerals (cont’d)

14. Transparency 15-2: MyPlate

15. 2. Describe the USDA’s MyPlate The USDA provides the following instruction about fruits and vegetables: Half a person’s plate should consist of fruits and vegetables. Dark green, red, and orange vegetables have the best nutritional content. Vegetables are low in fat and calories and have no cholesterol. Vegetables provide fiber and vitamins. Fruits are low in fat, sodium, and calories and have no cholesterol. Fruits provide vitamins and fiber.

16. 2. Describe the USDA’s MyPlate The USDA provides the following instruction about grains: At least half of all grains consumed should be whole grains. Whole grains contain the bran and germ, as well as the endosperm. Refined grains retain only the endosperm. Grains are found in cereal, bread, rice, and pasta.

17. 2. Describe the USDA’s MyPlate The USDA provides the following instruction about proteins: Meat, poultry, seafood, and eggs are animal sources of proteins. Beans, peas, soy products, nuts, and seeds are plant sources of proteins. •Eat seafood twice a week in place of meat or poultry. Choose lean meat and poultry. Include eggs and egg whites on a regular basis. Eat plant-based protein foods more often. Some nuts and seeds (flax, walnuts) are excellent sources of essential fatty acids.

18. 2. Describe the USDA’s MyPlate The USDA provides the following instruction about dairy: Provides protein, vitamins, and minerals Includes all of the foods made from milk that retain their calcium content, such as yogurt and cheese Most dairy group choices should be fat-free or low-fat (1%). Choose fat-free or low-fat milk or yogurt more often than cheese. Soy products enriched with calcium are an alternative to dairy foods.

19. 2. Describe the USDA’s MyPlate NAs should remember these tips about making healthy food choices: Balance calories. Enjoy your food, but eat less. Avoid oversized portions. Eat these foods more often: vegetables, fruits, whole grains, and fat-free or 1% milk and low-fat dairy products.

20. 2. Describe the USDA’s MyPlate Tips about making healthy food choices (cont’d): Eat these foods less often: foods high in solid fats, added sugars, and salt. These foods include fatty meats, like bacon and hot dogs, cheese, fried foods, ice cream, and cookies. Compare amounts of sodium in foods. Select canned foods that are labeled sodium-free, very low sodium, low-sodium, or reduced sodium. Drink water instead of sugary drinks.

21. 3. Identify nutritional problems of the elderly or ill These changes of aging can affect nutrition: Slower metabolism and body movement Loss of vision Weakened sense of smell and taste Less saliva Dentures, tooth loss, or poor dental health Less efficient digestion Use of certain medications

22. 3. Identify nutritional problems of the elderly or ill Unintended weight loss is a serious problem for the elderly. NAs should remember these guidelines for preventing unintended weight loss: Report observations and warning signs to the nurse. Food should look, taste, and smell good. Encourage residents to eat; talk positively about food. Honor food likes/dislikes. Offer different kinds of foods and beverages. Help residents who have trouble self-feeding.

23. 3. Identify nutritional problems of the elderly or ill Guidelines for preventing unintended weight loss (cont’d): Season foods to residents’ preferences. Allow plenty of time to finish eating. Tell nurse if residents have trouble with utensils. Record meal/snack intake. Give oral care before and after meals. Position residents upright for feeding. If resident has low appetite or seems sad, ask about it.

24. 3. Identify nutritional problems of the elderly or ill NAs should observe and report the following: Resident needs help eating/drinking Resident eats less than 70% of food Resident has mouth pain Resident’s dentures do not fit Resident has difficulty chewing or swallowing Resident coughs or chokes while eating Resident is sad, has crying spells, or withdraws Resident is confused, wanders, or paces

25. 3. Identify nutritional problems of the elderly or ill These conditions can make it difficult for residents to eat or swallow: Stroke/CVA Nerve and muscle damage Multiple sclerosis Parkinson’s disease Alzheimer’s disease

26. 3. Identify nutritional problems of the elderly or ill Define the following terms: total parenteral nutrition (TPN) the intravenous infusion of nutrients administered directly into the bloodstream, bypassing the digestive system. nasogastric tube a feeding tube that is inserted into the nose and goes to the stomach. percutaneous endoscopic gastrostomy (PEG) tube a feeding tube placed through the abdominal wall into the stomach. gastrostomy a surgically-created opening into the stomach in order to insert a tube.

27. 3. Identify nutritional problems of the elderly or ill NAs do not perform tube feedings, but they may assist with feedings and observe carefully for problems and changes in a resident receiving tube feedings. They should remember these guidelines: Wash hands before assisting with tube feedings. Make sure tubing is not coiled or kinked. Be aware of NPO orders. Report if tube comes out.

28. 3. Identify nutritional problems of the elderly or ill Guidelines for tube feedings (cont’d): Doctor prescribes feedings. They will be in liquid form and served at room temperature. Head of the bed should always remain elevated at 30 degrees, but during feedings the head of the bed should be elevated 45 degrees. Resident should stay upright after eating as long as ordered (at least 30 minutes). Give careful skin care.

29. 3. Identify nutritional problems of the elderly or ill It is important to observe and report the following when a resident is receiving tube feedings: Redness/drainage around opening Skin sores or bruises Cyanotic skin Resident complaints of pain or nausea Choking or coughing Vomiting

30. 3. Identify nutritional problems of the elderly or ill Observe and report for tube feedings (cont’d): Diarrhea Swollen abdomen Fever Tube falling out Problems with equipment Sound of feeding pump alarm Change of resident’s inclined position

31. 4. Describe factors that influence food preferences NAs need to do the following to accommodate residents’ food preferences: Know and follow food preferences. Ask questions. Pay attention.

32. 4. Describe factors that influence food preferences Think about this question: What regional, cultural, or religious food preferences are significant in your life?

33. 4. Describe factors that influence food preferences REMEMBER: Residents have a legal right to make choices about their food and to refuse food. NAs must honor residents’ beliefs and preferences. Communicating with residents is the best way to understand their preferences and the reasons behind them.

34. 5. Explain the role of the dietary department Define the following term: diet cards cards that list the resident’s name and information about special diets, allergies, likes and dislikes, and other dietary instructions.

35. 5. Explain the role of the dietary department The dietary department has the following responsibilities: Meet residents’ different nutritional needs Take into account likes and dislikes Make sure residents can manage the food they are eating and that it looks appealing Strictly follow infection prevention measures

36. 6. Explain special diets Define the following terms: special, modified, or therapeutic diets diets for people who have certain illnesses. fluid balance taking in and eliminating equal amounts of fluid. diuretics medications that reduce fluid volume in the body. puree to chop, blend, or grind food into a thick paste of baby food consistency.

37. 6. Explain special diets Some residents may require special diets, such as the following: Low-sodium diet Fluid-restricted diet High-potassium diet Low-protein diet Low-fat/low-cholesterol diet Modified calorie diet Bland diet Diabetic diet

38. 6. Explain special diets Examples of special diets (cont’d): Low-residue (low-fiber) diet High-residue (high-fiber) diet Gluten-free diet Vegetarian diet Liquid diet Soft diet and mechanical soft diet Pureed diet

39. 6. Explain special diets Some residents’ care plans may include instructions to use nutritional supplements. NAs should know the following points about these supplements: Given on the advice of a doctor or dietitian Usually given to encourage weight gain or increase the resident’s intake of protein, vitamins, or minerals May come in powdered or liquid form Care plan will include instructions on preparation If a resident does not want to drink the supplement, the NA should not insist that he do so, but should report this to the nurse.

40. 6. Explain special diets REMEMBER: Residents may receive daily menus for their meals, and NAs may need to help residents complete them. If an NA is asked to assist, she should make sure the menu offered matches the correct resident.

41. 6. Explain special diets Think about these questions: Have you ever been on a special diet of any kind? What was your experience like?

42. Handout 15-2: Sample Exchange List for Diabetic Diets Following the meal plan for how many servings of each type of food to eat, the person chooses specific foods and determines serving sizes using the exchange lists. Exchange List Sample Items Starch list: 1 slice of bread, ½ bagel, ½ cup cereal, ½ cup pasta, ½ cup rice, 1 baked potato, 3 cups popcorn, 15-20 fat-free potato chips Milk list: 1 cup milk (skim, 1%, 2%, or whole, depending on other dietary guidelines), ¾ cup yogurt Fruit list: ½ cup unsweetened applesauce, 1 small banana, ½ cup orange juice, 2 tablespoons raisins, 1 small orange, ½ cup canned pears Vegetable list: ½ cup cooked vegetables or vegetable juice, 1 cup raw vegetables (not included are corn, potatoes, and peas, which are on the starch exchange list instead) Meat list: 1 ounce meat, fish, poultry, or cheese, 1 egg, or ½ cup dried beans Fat list: 1 teaspoon margarine or butter, 2 teaspoons peanut butter, 2 tablespoons sour cream, 1 teaspoon mayonnaise, 10 peanuts

43. 7. Explain thickened liquids and identify three basic thickened consistencies NAs should know these facts about thickened liquids: Thickening improves the ability to control fluid in the mouth and throat. A doctor orders the necessary thickness after evaluation by a speech therapist. Some beverages arrive already thickened. NAs cannot offer regular liquids, including water, to residents who must have thickened liquids.

44. 7. Explain thickened liquids and identify three basic thickened consistencies The three basic thickened consistencies are as follows: Nectar thick Honey thick Pudding thick

45. 8. Describe how to make dining enjoyable for residents REMEMBER: Meals are not only a time for getting nourishment. They are also a time for socialization. An NA’s role is vital to residents being able to obtain proper nutrition.

46. 8. Describe how to make dining enjoyable for residents NAs should remember these guidelines for promoting appetites: Assist with grooming/hygiene tasks before dining as needed. Give oral care before eating if requested. Offer a trip to the bathroom before eating. Assist with handwashing. Encourage use of dentures, eyeglasses, and hearing aids. Check the environment. Address odors. Make sure room is a comfortable temperature. Turn off TVs. Do not shout or bang plates or cups.

47. 8. Describe how to make dining enjoyable for residents Guidelines for promoting appetites (cont’d): Seat residents next to friends. Properly position residents for eating, which is normally in the upright position. Serve food promptly at correct temperature. Plates should look appetizing. Provide proper eating tools, including adaptive utensils if needed. Be cheerful, positive, and helpful. Honor requests regarding food.

48. 9. Explain how to serve meal trays and assist with eating NAs need to remember these points about serving meal trays and assisting with eating: Food must be served at proper temperature. NAs will need to work quickly. Wash hands first. Identify residents before serving meals. Check trays or plates closely before delivering them. Serve all residents at one table before serving another table.

49. 9. Explain how to serve meal trays and assist with eating Serving meal trays and assisting with eating (cont’d): Prepare the food, only doing what resident cannot do: Remove food and drink, if on tray, and set on table. Cut food into small portions if necessary. Try to cut food before bringing it to the table. Open milk or juice cartons. Put in straw if resident uses one, taking care to touch only the paper wrapper. Butter roll, bread, and vegetables as resident prefers. Open condiment packets. Offer to season all food as resident prefers, including pureed food.

50. 9. Explain how to serve meal trays and assist with eating NAs should remember these tips for 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 benefit from cues—verbal and physical. Some residents will need to be fed. Be sensitive and give privacy. Encourage residents to do what they can. Positive attitudes and conversation can increase food and drink intake and vice versa. Say positive things about the food. Do not judge food preferences.