7.4 Nutrition, Hydration & Elimination

Feeding, Dysphagia, and Aspiration Precautions

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

Safe Feeding Rules

• Position the resident upright at about 90 degrees (high Fowler's or in a chair) before and during meals.
• Keep the resident upright for at least 30 minutes after the meal.
• Offer small bites, place food on the unaffected side of the mouth, and allow plenty of time; do not rush.
• Alternate solids and liquids and check that the mouth is empty before the next bite.
• Provide the exact ordered diet texture and any thickened liquids; never change a diet on your own.
• Encourage the resident to tuck the chin slightly when swallowing if that is in the plan (a chin-tuck protects the airway).
• Sit at eye level, encourage self-feeding, and keep mealtime unhurried and social.

Thickened Liquids and Texture-Modified Diets

For dysphagia, a speech therapist orders thicker liquids and softer foods so the bolus moves slowly and safely. Modern facilities use the IDDSI framework (levels 0-7); older charts use nectar, honey, and pudding thick. The CNA serves exactly what is ordered and never thins a drink to make it easier.

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
• A long time to chew, or refusing to eat

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

Hydration, Intake & Output, and Dehydration

Residents are at high risk for dehydration, which causes confusion, falls, urinary tract infections, constipation, 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). 1 ounce equals about 30 mL (a 240 mL cup is 8 ounces).

Measure urine with a graduate, record promptly, and report low intake, low urine output, or large losses. Note that gelatin, ice cream, popsicles, and sherbet count as fluids because they melt to liquid; a common exam trap is to call them solids.

Signs of Dehydration to Report

• Dark, strong-smelling, or scant urine
• Dry mouth, cracked lips, dry skin, and poor skin turgor (skin "tents" when pinched)
• Sunken eyes, sudden weight loss
• New or worsening confusion, dizziness, low blood pressure

Report these the same shift; dehydration is reversible when caught early.

Elimination: Catheter, Ostomy, 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 cannot flow back and cause infection.
• Keep tubing free of kinks; do not let the bag touch the floor; secure tubing to the leg.
• Provide daily perineal and catheter care, cleaning from the meatus outward along the tubing.
• Never disconnect, clamp, or irrigate the catheter; those are outside CNA scope.
• Empty the bag using clean technique, measure the output, and record it.
• Report cloudy, bloody, or foul urine, leaking, no output, or pain.

Ostomy Care

An ostomy is a surgical opening (the stoma) on the abdomen through which stool (colostomy/ileostomy) or urine (urostomy) leaves the body into a pouch. The CNA provides skin care and empties or changes the pouch per policy:

• A healthy stoma is pink to red and moist; report a stoma that is pale, gray, dusky, or bleeding heavily.
• Empty the pouch when it is about one-third to one-half full to prevent leaks and odor.
• Keep the skin around the stoma clean and dry; report redness, breakdown, or leaking seals.
• Provide privacy and manage odor without comment to protect dignity.

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 upright positioning, and unhurried time.
• Encourage adequate fluids and fiber per the plan to support regular bowel movements.
• Give prompt peri-care and skin checks after each incontinence episode.
• Praise success, never scold accidents, and report 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, a pink-red stoma, and a consistent, dignified toileting schedule.