2.3 Nutrition, Hydration, Feeding & Elimination

Serving Meals and Feeding Safely

Before delivering a tray, verify the resident's identity using two identifiers (for example, name and date of birth) and check the tray against the diet card. Serving the wrong diet can be dangerous — thin liquids to a resident with dysphagia, or unrestricted carbohydrates to a resident with diabetes, can cause a medical emergency. When feeding a dependent resident, sit at the resident's eye level to promote dignity and a natural chin-down swallow, offer small bites, alternate solids and liquids, and allow time between bites. Do not rush, and never blend all foods together unless the diet orders it.

Aspiration precautions are critical for residents with dysphagia (difficulty swallowing): keep the head of the bed elevated to at least 45 degrees — ideally as upright as tolerated — during meals, and keep the resident upright for 30 minutes after eating to prevent reflux. Provide prescribed thickened liquids, keep suction available, and watch for coughing, gurgling, a wet voice, or pocketing food in the cheek. If a resident suddenly clutches the throat and cannot speak or breathe, begin abdominal thrusts (the Heimlich maneuver) immediately and call for help.

Hydration and Intake and Output (I&O)

Older adults dehydrate easily; watch for a dry mouth, dark urine, confusion, and low intake, and encourage preferred fluids throughout the shift. For the intake and output (I&O) record, count as fluid all beverages plus any food that is liquid at room temperature — gelatin (Jell-O), ice cream, popsicles, and broth all count — and measure everything in milliliters (mL) using a graduate or the facility's known container volumes. Record output (urine, emesis, liquid stool, drainage) as well. Document meal intake as a percentage of the tray consumed; "50%" means about half of all food offered was eaten. Report low intake — commonly below 75%, and urgently when a resident eats under 25% and appears lethargic, which can signal illness, depression, or developing malnutrition.

Elimination: Toileting, Bedpan, and Urinal

Offer toileting on a regular schedule, respect privacy (close the door and curtain), and keep the call light within reach. Warm a metal bedpan under running water so it does not startle or chill the resident, elevate the head of the bed about 30-45 degrees if allowed, and never leave a frail resident sitting on a bedpan for a long time. Use a fracture pan (the flat, wedge-shaped pan) for residents who cannot lift the hips, such as after a hip fracture, and a urinal for males. Perform peri care front to back afterward. Report abnormal urine — dark amber, cloudy, strong-smelling, or bloody urine can indicate a urinary tract infection (UTI) or dehydration — and report changes in stool color, consistency, or frequency.

Catheters, Bowel and Bladder, and Incontinence

For a resident with an indwelling Foley catheter, keep the drainage bag below the level of the bladder and off the floor, and keep the tubing free of kinks. When emptying, wear gloves, drain into a graduate, and do not let the drain spout touch the container — contact introduces bacteria and causes a catheter-associated UTI (CAUTI). If there is no urine output, check the tubing for kinks and confirm the bag is positioned correctly, then report to the nurse; the SRNA never irrigates or inserts a catheter, which is outside scope.

Support bowel and bladder retraining by offering the toilet on schedule and encouraging fluids and fiber as allowed. Constipation — no bowel movement for 3 to 4 days plus abdominal discomfort — must be reported; enemas, suppositories, and laxatives require a nurse's order. For incontinence care, check and change the resident at least every 2 hours and after each episode, clean gently front to back with warm water, and pat (never rub) the skin dry. Report any redness or breakdown, which may be incontinence-associated dermatitis (IAD) — a precursor to pressure injury; applying a specific barrier cream requires a nurse's order in Kentucky facilities.

Common Feeding and Elimination Traps

A frequent exam scenario: a resident on thickened liquids asks for plain water. You cannot simply grant it — thin liquids can be aspirated — but you also do not force the diet on the resident. Explain kindly, offer thickened water as an alternative, and report the request to the nurse so the care team can reassess the order. Resident preference does not override a medical safety order until the care plan is changed. Another trap tests scope of practice: the SRNA observes, documents, and reports constipation, a blocked catheter, or pain, but enemas, catheter irrigation, and medications belong to the nurse. Finally, remember that daily fluid needs for most adults run roughly 1,500-2,000 mL, and that quietly encouraging sips of a preferred drink each time you enter the room helps prevent the dehydration that so often triggers confusion, UTIs, and avoidable hospital transfers among Kentucky long-term care residents.