2.4 Nutrition, Hydration & Elimination

Feeding and Aspiration Precautions

Quick Answer: To prevent aspiration (food or fluid entering the airway), seat the resident fully upright at 90 degrees, offer small bites, alternate solids and liquids, and keep the resident upright for about 30 minutes after the meal.

Aspiration can cause choking and aspiration pneumonia, so safe feeding is both a daily duty and a tested skill. When assisting a resident to eat:

• Verify the right resident gets the right diet by checking the tray against the diet card and the ID
• Sit at eye level, facing the resident, and never feed someone who is lying down or reclined
• Offer small amounts, allow time to chew and swallow, and check that the mouth is empty before the next bite
• Alternate solid and liquid, and offer fluids to help wash food down
• Encourage residents to feed themselves as much as possible to support independence, using adaptive utensils if available
• Make the meal pleasant: remove unpleasant sights, provide dentures and glasses, and do not rush

Report poor intake, refusals, and any difficulty so the care team can adjust the diet or texture.

Dysphagia and Special Diets

Dysphagia is difficulty swallowing and greatly raises aspiration risk. The CNA must recognize warning signs during meals and stop feeding and report them at once:

• Coughing or choking while eating or drinking
• Pocketing food (holding it in the cheeks) or food spilling from the mouth
• A wet, gurgly voice after swallowing, drooling, or watery eyes
• Slow eating, refusing food, or repeated throat clearing

The care plan may order a chin-tuck position (chin toward the chest while swallowing) and thickened liquids (nectar, honey, or pudding consistency) that are easier to control than thin liquids. The CNA must follow the exact texture ordered and never give thin liquids to a resident on thickened-liquid orders. Common therapeutic diets include mechanical soft, pureed, low-sodium (for heart or kidney conditions), diabetic/carbohydrate-controlled, and NPO (nothing by mouth). Serving the wrong diet is a serious error, so always check the diet card.

Intake and Output (I&O)

Intake and output (I&O) tracks all fluids a resident takes in and puts out, which helps the care team monitor hydration and kidney function. Measurements are recorded in milliliters (mL).

Intake includes water, juice, milk, coffee, soup, gelatin, ice cream, and ice chips; count ice chips as about half their measured volume. Output includes urine, vomit (emesis), liquid stool, and wound or tube drainage. To measure, pour output into a graduate (calibrated measuring container) set on a flat surface and read at eye level, then record promptly. Wear gloves, empty and rinse the container, and never estimate from memory at the end of the shift, since accurate totals guide fluid and medication decisions.

Catheter Care

An indwelling urinary catheter drains urine continuously into a closed collection bag. To prevent a catheter-associated urinary tract infection (CAUTI) and protect the resident, follow these rules:

• Keep the drainage bag below the level of the bladder at all times so urine flows down and cannot back up toward the bladder
• Never let the bag touch the floor, and hang it on the bed frame, not the movable side rail (a rail lifts the bag above the bladder)
• Keep the tubing free of kinks and coiled on the bed so urine drains freely
• Provide daily perineal care and clean the catheter where it enters the body, wiping away from the body along the tube
• Secure the tubing to the leg to prevent pulling, and keep the system closed (do not disconnect it routinely)
• Report cloudy, bloody, or foul-smelling urine, leaking around the catheter, no urine output, or any complaint of pain or burning

Empty the bag at the end of the shift or when ordered, measure the output, and record it as part of I&O.

Bowel, Bladder, and Incontinence Care

The CNA supports normal elimination and assists with bowel and bladder programs:

• Offer the bedpan, urinal, or toileting on a regular schedule and answer call lights promptly
• Provide privacy and enough time; never rush or shame the resident
• Encourage fluids and fiber (as the diet allows) and activity to support regular bowel movements
• Observe and report constipation, diarrhea, blood in the stool, hard or unusual stool, or no bowel movement for several days

A bladder or bowel training program uses a set toileting schedule to help the resident regain control. Incontinence is the loss of bladder or bowel control; prompt, gentle care protects skin and dignity: change wet or soiled briefs and linens right away, clean the skin and pat dry, and apply a barrier cream if ordered.

For fluid balance, encourage fluids throughout the day unless the resident is on a fluid restriction. Report signs of dehydration (dark concentrated urine, dry mouth and skin, low intake, confusion, dizziness) and signs of fluid overload (sudden weight gain, swelling, shortness of breath) to the nurse.