Nutrition

Nutrition is vital for health, and this is particularly true for frail individuals with health problems. An elderly person with brittle bones needs to take in calcium and vitamin D to avoid fractures. Vitamin A is important for sight. B vitamins are necessary for a variety of needs, including replacing worn out blood cells and keeping good skin tone. Vitamin C deficiency can lead to bleeding gums and bone fractures. Protein is needed for repair of tissues. Iron is needed to avoid anemia. Carbohydrates are needed for energy and certain kinds of healthful fats are essential.

Residents can become malnourished for a variety of reasons. The reasons can be mechanical, psychosocial, or cultural.

Mechanical: Many residents have lost their teeth and ill-fitting dentures or dentures that do not stay in place well can make chewing a chore that does not seem worth it. If you notice your resident taking out his or her dentures, or if they make clicking noises while the person is eating, it is possible that a dental consultation is needed, and this should be reported to the nurse at the end of shift.

Various kinds of menus are prepared in nursing homes, and the diet should be right for the resident. If the resident has difficulty chewing and has a regular diet, changing to soft or pureed food can help, so report to your supervisor any problems the resident appears to have in chewing.

Residents with poor coordination can have trouble dealing with utensils. Large soft plastic handles can be put onto the handles of knives, forks, and spoons to make them easier to work with.

Poor eyesight can also cause difficulties in eating, so when you bring a tray, help your resident with eyeglasses if he or she has any. If the resident is blind, name each food and describe where you are putting each dish.

Psychosocial: Depression is a concern in nursing homes, because residents can feel isolated and feel the loss of health, family, and productivity. If the resident does not seem to have any interest in anything, including food, try to find something that will cheer him or her up, such as some time out on the patio, occupational therapy or visiting with others in the day room. Visits from families can be helpful, so encourage families to make frequent visits.

Residents who were used to eating with families can feel isolated eating in their rooms, so having them use the dining hall can be helpful if your facility has one. If not, try taking residents to the day room for meals so that they will have company.

Cultural: Certain religions have rules about what foods and combination’s of foods people are allowed to eat. If your resident is not eating what he or she is given, ask if some other diet would be more in keeping with his or her beliefs.

Some people have strong views on eating only vegetarian foods. This is part of certain religions and it is a moral conviction for some individuals. If you find that this is the case for your resident, report it to the nurse so that a vegan or vegetarian diet can be ordered.

People who are used to eating certain foods at home or in settings that include their own ethnic groups can find other kinds of foods unappetizing. If you see tray going back to the kitchen untouched, ask the resident why he or she did not eat, and you might get an answer you can do something about. Tell your supervisor if the resident is used to eating certain foods, and the kitchen might be able to make that accommodation.

QNA’s

Q.  True or False:  All patients in a healthcare setting have the same nutritional needs?

FALSE:  Patients in healthcare settings will have varying nutritional needs.  Their needs can depend on their age, illness and injury and the condition they are in while receiving healthcare services.

Explanation:  Menus cannot be the same for all patients.  There are some individuals who cannot eat certain foods based on their health condition or food allergies.  Some patients will need to have high calories meals to put weight back on after a serious health conditions.  There are other patients who will need their calories to be reduced.  Some individuals will need to have limited sugar and or fat intake.  These are just a few examples of the ways in which the nutrition of patients can vary greatly.

Q.  How can you help your patients to improve their eating if they are having difficulty biting and chewing as a result of problems with their teeth, oral health or dentures?

A.  You can assist patients with their meals if they have trouble eating as a result of problems with their teeth or dentures.  Cut up food for patients to make it easier for them to eat.  You can put some foods in a food processor so that it has a consistency that is easier for individuals to swallow.

Explanation:  There are some other considerations when working with patients who are struggling to eat their foods based on their teeth or dentures.  Talk to your supervisor to determine if some adjustments to the meals your patient receives can be made.  You can also determine if a dental professional can be consulted if you think that better fitting dentures or work on poor teeth could help your patient to have improved eating.

Q.  What are some common reasons why some patients need their intake of food and beverages, recorded?

A.  There are many reasons as to why it might be necessary to record a person’s intake of food and liquids.  One reason is to evaluate whether or not they are having proper output of urine or bowel movements when compared to their intake.  If a patient has not been eating well or has lost weight, recording their intake, will help staff evaluate if they are eating well enough.  There are patients who need their intake recorded to make certain they are taking in the proper level of nutrients for their particular health conditions.

Explanation:  A person’s intake of food and liquids can be a good indicator of how a person is progressing with their recovery.  It can also be used to determine if additional health concerns are present or if current health conditions are not improving.  The input of food and liquids is often compared to other statistics about a patient.  Additionally, records of input can help the medical staff to determine if IV fluids or nutrients and/or other forums of medical intervention for nutrition are needed.

This CNA Online Study Guide is a collaborative effort. This chapter along with others in this guide are constantly being updated and improved upon.