10.2 Feeding Assistance, Hydration, and Intake/Output Recording

Feeding Assistance — A Mandated INACE Skill

Feeding a dependent resident is one of the hands-on skills you may be asked to demonstrate on the Illinois Nurse Aide Competency Evaluation. The evaluator scores safety, dignity, and pacing — not speed. Feeding means the resident cannot do it alone; assisting means you set up, cue, and supervise while they do as much as possible. Always promote self-feeding with adaptive equipment (plate guard, built-up-handle spoon, nosey cup) before taking over, because eating independently preserves dignity and appetite.

Before the Meal

1. Wash hands, identify the resident, and offer toileting and hand hygiene.
2. Position upright in Fowler’s (90 degrees); for an alert resident, sitting in a chair at the table is ideal.
3. Match the diet card to the ID band — right resident, right diet, allergies checked.
4. Remove tray covers, name each food, and check temperatures (hot foods warm, not scalding).
5. Cut food into bite-size pieces and open packages before you begin, not mid-meal.

During the Meal

1. Sit down at the resident’s eye level — never stand over them or hurry.
2. Ask the order they prefer; offer choices to maintain control and appetite.
3. Use a spoon (safer than a fork) filled about one-third full to prevent overloading the mouth.
4. Feed at the resident’s pace; confirm each bite is swallowed before the next.
5. Alternate solids and beverages so food washes down; wipe the mouth gently as needed.
6. Talk pleasantly between bites, never while the resident is chewing or swallowing.

After the Meal

1. Record the percentage eaten (0/25/50/75/100%) and the fluid intake in mL.
2. Provide mouth care to clear pocketed food.
3. Keep the resident upright for at least 30 minutes to prevent reflux and aspiration.
4. Report refusal, choking, or intake under 50% to the nurse.

Hydration and Dehydration

Most adults need roughly 1,500–2,000 mL of fluid per day (about six to eight 8-oz cups) unless they have a fluid restriction. Elderly residents are high-risk because thirst sensation fades with age, mobility limits self-service, and some avoid drinking to reduce incontinence trips. Untreated dehydration causes confusion, falls, urinary tract infections, constipation, and pressure injuries — so steady fluids are a quiet but powerful intervention.

Encouraging Fluids

• Offer a drink every time you enter the room, not just at meals.
• Keep water within reach and at the resident’s preferred temperature.
• Offer variety the diet allows — juice, milk, decaf, flavored water, gelatin.
• Use a covered cup, straw, or nosey cup for those with weak grip or limited neck extension.
• For a thickened-liquid resident, all of these must be thickened to the ordered IDDSI level.

Two opposite cautions: Some residents have a fluid restriction (often renal or heart-failure) — do not “encourage fluids” on them; follow the daily limit and spread it across shifts. And never offer fluids to an NPO resident, even when they ask. When you are unsure which applies, check the care plan before offering anything.

Measuring and Recording Intake and Output (I&O) — INACE Skill

Accurate intake and output (I&O) recording is its own mandated skill. Intake is everything that enters the body by mouth (and IV/tube, recorded by the nurse); output is everything that leaves — urine, emesis, liquid stool, drainage. You record I&O in milliliters (mL), which equal cubic centimeters (cc). Anything liquid at room or body temperature counts as fluid intake, so gelatin, ice cream, popsicles, and broth are all recorded as fluids.

Conversions You Must Know Cold

Worked example: A resident drinks an 8-oz juice (8 × 30 = 240 mL), a 6-oz coffee (6 × 30 = 180 mL), and eats a 4-oz gelatin cup (120 mL). Total intake = 540 mL. Output example: if she voids 350 mL and vomits about 100 mL, output = 450 mL. Always record promptly while the numbers are fresh — estimating from memory at end-of-shift is a common documentation error.

Weighing Residents and Spotting Nutrition Problems — INACE Skill

Measuring and recording weight (and height) is also a tested INACE skill, and weight is the single best long-term indicator of nutrition and fluid status. The order is usually a standing, chair, or bed scale depending on the resident’s mobility — use the type listed in the care plan and stay with the resident on a standing scale to prevent falls.

Rules for an Accurate Weight

• Weigh at the same time of day (usually before breakfast, after voiding).
• Use the same scale every time and zero/balance it first.
• Have the resident wear similar clothing and remove shoes.
• Record immediately and compare to the previous weight.

Reportable Thresholds and What They Mean

Worked scenario: A resident weighs 7 lb less than last week. Because that exceeds the 5 lb-per-week threshold, you report it to the nurse immediately rather than “waiting to confirm tomorrow” — the dietitian may need to add supplements or order a swallow evaluation. A rapid gain with new ankle swelling is just as urgent, because it usually signals fluid retention from heart or kidney failure, not extra food.