10.1 Nutrition Basics and Therapeutic Diets
Key Takeaways
- Therapeutic diets are ordered by the physician — never change a diet without an order
- Dysphagia (swallowing difficulty) creates aspiration risk — watch for coughing, choking, and wet voice during meals
- Position dysphagia residents upright (Fowler's, 90 degrees) during and 30 minutes after meals
- Never give thin liquids to a resident ordered for thickened liquids — aspiration risk
- NPO means nothing by mouth — do not give any food or drink
- Report changes in appetite, difficulty eating, weight loss, and signs of dehydration to the nurse
Nutrition Basics and Therapeutic Diets
Proper nutrition is essential for healing, immune function, and overall health, particularly in elderly residents. As a CNA, you play a vital role in ensuring residents receive adequate nutrition by assisting with meals, monitoring food intake, and reporting changes in appetite or eating patterns. Feeding and hydration are among the 21 mandated INACE performance skills.
Essential Nutrients
| Nutrient | Function | Food Sources |
|---|---|---|
| Carbohydrates | Primary energy source | Bread, rice, pasta, fruits, vegetables |
| Proteins | Build and repair tissue; immune function | Meat, fish, eggs, dairy, beans, nuts |
| Fats | Energy storage, insulation, cell membranes | Oils, butter, nuts, avocado, fatty fish |
| Vitamins | Regulate body processes | Fruits, vegetables, dairy, fortified foods |
| Minerals | Bone health, fluid balance, nerve function | Dairy (calcium), meat (iron), bananas (potassium) |
| Water | Hydration, temperature regulation, waste removal | Water, juice, soup, fruits |
| Fiber | Digestive health, bowel regularity | Whole grains, fruits, vegetables, bran |
Common Therapeutic Diets in Long-Term Care
| Diet | Purpose | Restrictions | CNA Role |
|---|---|---|---|
| Regular | No restrictions | None | Serve as ordered |
| Diabetic/Carb-Controlled | Blood sugar management | Controlled carbohydrates and sugars | Monitor for uneaten food; report |
| Low Sodium | Heart failure, hypertension | Limited salt and high-sodium foods | Do not add salt; check tray accuracy |
| Low Fat/Low Cholesterol | Heart disease, gallbladder | Limited fried foods, fatty meats | Ensure correct tray delivered |
| Renal | Kidney disease | Limited protein, potassium, sodium, fluids | Monitor fluid intake carefully |
| Pureed | Swallowing difficulty (dysphagia) | All foods pureed to smooth consistency | Check for proper consistency |
| Mechanical Soft | Chewing difficulty | Soft, chopped, or ground foods | Ensure food is properly prepared |
| Thickened Liquids | Swallowing difficulty | Liquids thickened to nectar/honey/pudding consistency | Thicken ALL liquids per order |
| Clear Liquid | Pre/post-surgery, acute illness | Broth, gelatin, juice, tea | Temporary; encourage intake |
| Full Liquid | Transition from clear to soft | Milk, soup, ice cream, pudding | Monitor tolerance |
| Calorie Count | Monitoring nutritional intake | None — just tracking | Record EVERY item consumed |
| NPO (Nothing by Mouth) | Pre-surgery, swallowing evaluation | NO food or drink | Do NOT give anything by mouth |
Dysphagia (Swallowing Difficulty)
Dysphagia is one of the most critical nutritional concerns in long-term care because it creates an aspiration risk (food or liquid entering the airway):
Signs of Dysphagia — Report Immediately:
- Coughing or choking during or after meals
- Wet or gurgling voice during or after eating
- Food falling out of the mouth
- Excessive drooling
- Refusing to eat or drink
- Frequent throat clearing during meals
- Weight loss or dehydration
- Recurrent pneumonia (aspiration pneumonia)
Aspiration Prevention for Dysphagia Residents:
- Follow the diet order exactly (pureed, mechanical soft, thickened liquids)
- Position the resident in Fowler's position (upright, 90 degrees) during and for 30 minutes after meals
- Feed slowly — small bites and sips
- Ensure the resident has swallowed before offering the next bite
- Check the mouth for food pocketing (especially with stroke residents)
- Follow speech therapist (SLP) recommendations in the care plan
IMPORTANT: Never Thicken Liquids Without an Order
Thickened liquids must be ordered by a physician based on SLP evaluation. The thickener consistency levels are:
| Level | Consistency | Comparable To |
|---|---|---|
| Thin | Regular liquids | Water |
| Slightly Thick (Level 1) | Thicker than water | — |
| Mildly Thick (Level 2) | Flows off a spoon | Nectar |
| Moderately Thick (Level 3) | Can be eaten with spoon, drips slowly | Honey |
| Extremely Thick (Level 4) | Holds shape on spoon | Pudding |
A resident on a pureed diet asks you for a glass of regular (thin) water. What should you do?
Which of the following is a sign of dysphagia that should be reported to the nurse?