7.4 Nutrition, Hydration & Elimination

Feeding and Aspiration Precautions

Aspiration is food, fluid, or saliva entering the airway instead of the stomach; it can cause choking and aspiration pneumonia. Safe feeding is high-yield on the Florida written test.

Safe Feeding Rules

• Position the resident upright at about 90 degrees (sitting up) before and during meals.
• Keep the resident upright for at least 30 minutes after the meal.
• Offer small bites and adequate time; do not rush.
• Alternate solids and liquids and check that the mouth is empty before the next bite.
• Provide any ordered thickened liquids and the prescribed diet texture; do not change a diet on your own.
• Sit at the resident's eye level, encourage self-feeding, and make mealtime unhurried and social.

Aspiration Warning Signs to Report

• Coughing or choking while eating or drinking
• A wet, gurgly, or hoarse voice during or after meals
• Pocketing food in the cheeks
• Drooling or food falling from the mouth
• Refusing to eat or pointing to the throat

Stop feeding, keep the resident upright, and report these signs immediately. If the resident is choking and cannot speak, breathe, or cough, begin emergency choking response and call for help.

Hydration and Intake & Output

Residents are at risk for dehydration, which can cause confusion, falls, urinary tract infections, and skin breakdown. Offer fluids frequently, keep water within reach (within the care plan), honor preferences, and report a resident who drinks poorly.

Intake and output (I&O) tracks fluid balance and is recorded in milliliters (mL).

Measure with a graduate, record promptly, and report low intake, low urine output, or large losses. Convert household measures using the facility's equivalents; 1 ounce equals about 30 mL.

Reporting Signs of Imbalance

Report dark or strong-smelling urine, very low urine output, dry mouth, sunken eyes, sudden weight change, or new confusion; these may indicate dehydration or fluid overload.

Elimination, Catheter Care, and Training

Catheter Care (CNA Scope)

An indwelling urinary catheter drains urine into a collection bag. The CNA's role is routine care, not insertion or removal:

• Keep the drainage bag below the level of the bladder at all times so urine does not flow back.
• Keep tubing free of kinks; do not let the bag touch the floor.
• Provide daily perineal and catheter care, cleaning from the meatus outward along the tubing.
• Never disconnect, clamp, or irrigate the catheter; that is outside CNA scope.
• Empty the bag using clean technique, measure output, and record it.
• Report cloudy, bloody, or foul urine, leaking, no urine output, or resident complaints of pain.

Bowel and Bladder Training

Training helps residents regain control and dignity and reduces incontinence-related skin breakdown.

• Follow a consistent toileting schedule based on the resident's normal pattern (for example, after meals).
• Answer call lights and toileting requests promptly; delays cause incontinence and falls.
• Provide privacy, normal positioning, and unhurried time.
• Encourage adequate fluids and dietary fiber per the care plan to support regular bowel movements.
• Provide prompt peri-care and skin checks after each incontinence episode.
• Praise success, never scold accidents, and report changes in bowel or bladder pattern, constipation, diarrhea, or no bowel movement for several days.

Exam Tip

Florida items reward: upright positioning for meals, immediate reporting of aspiration signs, drainage bag below the bladder, no catheter disconnection or irrigation, and a consistent, dignified toileting schedule.