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Nutrition Care for the Elderly. Proper Nutrition Is Important to the Health and Well Being of Nursing Home Residents. What is good nutrition?. Proper Nutrition is:. Enough intake of essential nutrients to maintain good health. Carbohydrates Fat Protein Water Vitamins Minerals.

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Presentation Transcript
slide3

Proper Nutrition is:

  • Enough intake of essential nutrients to maintain good health.
slide4

Carbohydrates

Fat

Protein

Water

Vitamins

Minerals

6 Main Nutrients

slide5

Nutrients are needed for:

Energy

Preventing disease

Maintaining a healthy body

nutrition care alerts program

Nutrition Care Alerts Program

!

Improving the Nutritional Health of Your Residents

slide9

Nutrition Care Alerts

!

  • Designed to help maintain nutritional health of residents
  • Designed to help facilities address four areas of resident care
four common nutrition related conditions
Four Common Nutrition Related Conditions
  • Unintended weight loss
  • Dehydration
  • Pressure ulcers
  • Complications of tube feeding
unintended weight loss

!

Unintended Weight Loss

Warning Signs

  • Needs help to eat or drink
  • Eats less than half of meals/snacks
  • Complains of mouth pain
  • Has dentures that don’t fit
  • Has a hard time chewing or swallowing
unintended weight loss1

!

Unintended Weight Loss

Warning Signs

  • Has trouble using utensils
  • Is sad, has crying spells, or withdraws from others
  • Is confused, wanders, or paces
  • Has diabetes, COPD, cancer, HIV, or other chronic disease.
unintended weight loss poor food intake

Action Steps

Unintended Weight Loss(Poor Food Intake)
  • Alert RD/physician to poor food intake
  • Provide high-calorie liquids for medication administration, if indicated
  • Order weekly weights
  • Assess ability of resident to feed self
unintended weight loss poor food intake1

Action Steps

Unintended Weight Loss(Poor Food Intake)
  • Recommend strategies to enhance self-feeding skill
  • Monitor feeding assistance provided for appropriateness
unintended weight loss oral health problems

Action Steps

Unintended Weight Loss(Oral Health Problems)
  • Examine oral cavity, evaluate swallowing ability
  • Alert physician/RD to poor oral health/dental or swallowing problems
  • Request dental consult, if indicated
  • Request speech/language pathologist consult, if indicated
unintended weight loss emotional or cognitive impairment

Action Steps

Unintended Weight Loss(Emotional or Cognitive Impairment)
  • Evaluate decline in mood/mental status
  • Alert physician to decline in mood/mental status
  • Report fever/infection to physician
unintended weight loss2

Action Steps

Unintended Weight Loss
  • RD/DTR

Develop strategies to increase food intake

  • Pharmacist

Assess impact of medications on appetite

  • Physician

Adjust diet, as indicated

dehydration

!

Dehydration

Warning Signs

  • Drinks less than 6 cups of liquid daily
  • Has dry mouth, cracked lips, sunken eyes, or urine is dark in color or has strong odor
  • Needs help to drink
  • Has trouble swallowing liquids
  • Has vomiting, diarrhea or fever
  • Is dizzy, easily confused, or tired
dehydration1

Action Steps

Dehydration
  • Review vital signs
  • Assess hydration status
  • Alert physician/RD to deterioration in hydration status
  • Assess resident’s ability to drink unassisted and recommend strategies to enhance ability to drink unassisted
  • Monitor affects of strategies to increase oral fluid intake
dehydration2

Action Steps

Dehydration
  • Suggest IV or oral hydration, if indicated
  • Monitor IV hydration; suggest changes in type, volume,or rate of administration, as indicated
  • Consider enteral tube feeding for rehydration
  • Evaluate for swallowing impairment, if indicated
  • Give medications with 6-8 ounces of liquid
dehydration3

Action Steps

Dehydration
  • RD/DTR

Recommend strategies to increase oral fluid intake

  • Pharmacist

Assess continued need for diuretics, if prescribed

  • Physician

Prescribe IV or PO hydration, if indicated

pressure ulcers

!

Pressure Ulcers

Warning Signs

  • Is subject to

- incontinence

- heavy perspiration

  • Needs help
  • moving arms,legs,or body
  • turning in bed

- changing position when sitting

pressure ulcers1

!

Pressure Ulcers

Warning Signs

  • Has lost weight
  • Eats less than half of meals and snacks served
  • Is dehydrated
  • Has discolored, torn, or swollen skin over bony areas
pressure ulcers2

Action Steps

Pressure Ulcers
  • Alert physician to tissue breakdown/wound development
  • Follow wound care protocol
  • Alert physician to resident decline in bowel and bladder function
  • Implement bowel/bladder training protocol, if indicated
  • Alert physician to resident inability to shift position adequately
pressure ulcers3

Action Steps

Pressure Ulcers
  • Restraints not recommended; if needed, check skin covered by restraints
  • Insert urinary catheter only as a last option
  • Follow “Unintended Weight Loss” and “Dehydration” interventions
pressure ulcers4

Action Steps

Pressure Ulcers
  • RD/DTR

Develop nutrition plan for wound care

  • Pharmacist

Assess impact of medication on resident ability to shift position/move body

  • Physician

Examine resident’s skin; order wound care, if indicated

residents who are tube fed

!

Residents Who Are Tube Fed

Warning Signs

  • Has nausea, vomiting or diarrhea
  • Has swollen stomach or stomach ache
  • Has constipation or cramping
residents who are tube fed1

!

Residents Who Are Tube Fed

Warning Signs

  • Has coughing, wheezing, wet breathing, or a feeling of something caught in the throat
  • At the site where the feeding tube enters the body there is
    • pain, redness, heat or swelling
    • crusty or oozing fluid
residents who are tube fed stomach abdominal complaints

Action Steps

Residents Who Are Tube Fed(Stomach/Abdominal Complaints)
  • Alert RD/physician to stomach/abdominal complaints
  • Assess complaints to rule out nonfeeding causes
  • Assess gastric residuals, recommend change in feeding tube end point, if indicated
residents who are tube fed stomach abdominal complaints1

Action Steps

Residents Who Are Tube Fed(Stomach/Abdominal Complaints)
  • Flush feeding tube as needed to maintain prescribed rate of flow
  • Follow protocol for tube feeding hang time
  • Use liquid medications, if possible
residents who are tube fed site complications

Action Steps

Residents Who Are Tube Fed(Site Complications)
  • Alert the physician to complaints regarding site of tube placement:

- nasal placement:

nose, ear, throat

- percutaneous placement: ostomy site

  • Follow protocol for addressing tube site complications
tube feeding

Action Steps

Tube Feeding
  • RD/DTR

assess complaints to rule out nonfeeding causes

  • Pharmacist

Rule out medication side effects/interactions as a source of complaints

  • Physician

Rule out infection or mechanical source of complaints

slide33

Based on the Nutrition Care Alerts

Adapted with permission by the Nutrition Screening Initiative, a project of the American Academy of Family Physicians, American Dietetic Association, and National Council on the Aging, Inc., and funded in part by a grant from Ross Products Division, Abbott Laboratories, Inc. These materials were developed by the National Policy and Resource Center on Nutrition and Aging at Florida International University through grants from the US Administration on Aging and US Health Care Financing Administration.