10.2 Feeding Assistance, Hydration, and Intake/Output Recording

Feeding Assistance, Hydration, and Intake/Output Recording

Feeding and hydration is one of the 21 mandated INACE performance skills, and measuring and recording intake and output is another. These skills are fundamental to ensuring residents receive adequate nutrition and hydration for health and healing.

Feeding Assistance Procedure (INACE Skill)

Before the Meal:

1. Wash hands and identify the resident
2. Assist with toileting and hand hygiene before the meal
3. Position the resident in Fowler's position (sitting upright at 90 degrees)
4. Check the diet card against the tray — verify the correct resident, diet type, and allergies
5. Remove tray covers and describe the food to the resident
6. Check food temperature — should be appropriate for each item
7. Cut food into bite-sized pieces if needed
8. Offer condiments (if permitted by diet order)

During the Meal:

1. Sit at the resident's level — do not stand over them
2. Offer food in the order the resident prefers (ask them)
3. Use a spoon (not a fork) for safer feeding
4. Fill the spoon only 1/3 full to prevent choking
5. Feed at the resident's pace — never rush
6. Alternate between food and beverages
7. Wipe the resident's mouth as needed with a napkin
8. Allow time for chewing and swallowing before the next bite
9. Encourage self-feeding whenever possible (adaptive utensils if needed)
10. Engage in pleasant conversation (but not while the resident is chewing/swallowing)

After the Meal:

1. Record the percentage of the meal eaten (0%, 25%, 50%, 75%, 100%)
2. Record fluid intake in milliliters (mL) or cubic centimeters (cc)
3. Remove the tray
4. Provide mouth care
5. Keep the resident upright for at least 30 minutes after eating (aspiration prevention)
6. Report poor intake or refusal to eat to the nurse

Hydration

Adequate hydration is critical for elderly residents, who are at increased risk for dehydration:

Encouraging Hydration:

• Offer fluids every time you enter the room
• Place water within reach at all times
• Offer a variety of beverages (juice, milk, coffee, tea, water) per diet order
• Serve beverages at the resident's preferred temperature
• Use straws, cups with lids, or adaptive cups as needed
• Track fluid intake on the I&O sheet

Measuring and Recording Intake and Output (INACE Skill)

Intake (I) — Everything that enters the body:

Output (O) — Everything that leaves the body:

Common Measurement Conversions:

Weight Measurement (INACE Skill)

Measuring and recording weight and height is another mandated INACE skill:

• Weigh at the same time each day (usually before breakfast)
• Use the same scale each time for consistency
• The resident should wear similar clothing each time
• Remove shoes before weighing
• Report weight changes of 5 lbs in a week or 10 lbs in a month to the nurse
• Weight loss may indicate: inadequate nutrition, illness, depression, swallowing problems
• Weight gain may indicate: fluid retention, medication effects, dietary changes