4.3 Nutrition, Hydration, and Elimination

Feeding and Aspiration Precautions

Good nutrition and fluids let the body grow, heal, fight infection, and function. When assisting with meals, the single most important safety concern is aspiration — food or fluid entering the airway and lungs, which can cause pneumonia or choking.

Key aspiration precautions:

• Position the resident upright at a 90-degree angle (high-Fowler's or in a chair) before feeding.
• Keep the resident upright for at least 30 minutes after the meal.
• Offer small bites, alternate solids and liquids, and allow plenty of time.
• Make sure each bite is swallowed before the next is offered.
• Watch for coughing, throat-clearing, a wet/gurgly voice, or pocketing food in the cheek — stop and report these.
• Provide oral care before and after meals; sit at eye level and do not rush.

Promote independence with adaptive devices: built-up handles, weighted or swivel silverware, plate guards, and nosey or covered cups. Always check the care plan for the resident's ordered diet and assistance level.

Special Diets and Hydration

The physician orders a diet to match each resident's medical needs. The CNA must know what is served, not change it.

Thickened liquids (nectar-thick or honey-thick) are ordered for residents with swallowing disorders (dysphagia); the thicker texture moves more slowly and lowers aspiration risk. Never give thin liquids to a resident ordered thickened liquids.

Hydration prevents many problems. Encourage fluids and keep water within reach. Signs of dehydration include dry skin and lips, dark/concentrated urine, weight loss, confusion, and dizziness — report them. Items that melt at room temperature count as fluid: ice chips, ice cream, gelatin (Jell-O), popsicles, and broth.

Intake and Output (I&O)

Many residents are on I&O monitoring to track fluid balance. The CNA measures and records everything that goes in and out, in milliliters (mL), also called cc (1 mL = 1 cc).

• Conversion: ounces × 30 = mL. So 1 oz = 30 mL, 4 oz = 120 mL, 8 oz (1 cup) = 240 mL.
• Intake = all fluids: water, juice, milk, coffee, soup, ice chips (count as half their volume), and IV/tube feedings (recorded by the nurse).
• Output = urine, vomit (emesis), liquid stool, and wound drainage. Measure urine in a graduate (measuring container).
• Food intake is estimated by percentage (e.g., "ate 75% of breakfast"), to the nearest 25%.

Report intake that is much less than output, or vice versa, and any sudden change.

Elimination, Catheters, and Bowel/Bladder Care

Assist promptly when a resident needs the toilet, bedpan, or urinal — delays cause incontinence and embarrassment. Provide privacy and peri-care after each use.

• Indwelling catheter care: Keep the drainage bag below the level of the bladder so urine flows down and does not back up. Never let the bag touch the floor, keep tubing free of kinks, and secure it to the leg. Clean the catheter from the insertion site outward.
• Incontinence: Change and clean the resident promptly, apply barrier cream, and protect skin. Never scold a resident for incontinence.
• Constipation: No bowel movement for three days is reported. Encourage fluids, fiber, and activity. Report hard stools, diarrhea, blood, or unusual color.

Safe Toileting and What to Report

Dignity and safety go together during elimination care. Answer call lights for toileting quickly — an unmet urge leads to incontinence and falls when residents try to get up alone. Provide a bedpan for a resident who cannot get to the toilet (a fracture pan, the flatter type, for residents who cannot lift their hips), and a urinal for males. Warm a cold bedpan, raise the head of the bed slightly so the resident is not lying flat, and give privacy while staying nearby. After use, perform peri-care, wash the resident's hands, and observe the contents before emptying.

Elimination is a rich source of information the nurse needs. Report to the nurse:

• Urine: dark, cloudy, bloody, foul-smelling, or very small amounts; complaints of burning or urgency (signs of a urinary tract infection).
• Stool: black/tarry, bloody, clay-colored, hard pellets, or watery diarrhea.
• Patterns: no urine output in 8 hours, or no bowel movement for 3 days.

Never flush specimens the nurse has asked you to save. Hand hygiene before and after every elimination task, and wearing gloves, protects both the resident and the aide from infection. Treating residents calmly and matter-of-factly during these tasks preserves their dignity at a vulnerable moment. A regular toileting schedule — offering the bathroom every two hours — often prevents incontinence entirely and keeps skin dry and intact, which is far better than cleaning up afterward.