4.4 Nutrition, Hydration & Elimination
Key Takeaways
- Position a resident upright at 90° (high-Fowler's) for eating and keep them upright 30 minutes after to prevent aspiration
- A standard adult fluid goal is about 1,500-2,000 mL/day; intake and output (I&O) is measured and recorded in milliliters (1 ounce = 30 mL)
- Early dehydration signs include dark concentrated urine, dry mouth and skin, and confusion — report them promptly
- Keep a urinary drainage bag below the level of the bladder at all times and never let it touch the floor, to prevent infection
- Collect a clean-catch (midstream) urine specimen after perineal cleansing, and never touch the inside of the specimen container
Adequate nutrition, hydration, and normal elimination are essential to healing and comfort. New Jersey CNAs assist daily with these needs and observe for problems such as aspiration, dehydration, and infection.
Feeding and Aspiration Precautions
Aspiration is food or fluid entering the airway instead of the stomach; it can cause choking or pneumonia. To prevent it:
- Position the resident upright at 90° (high-Fowler's) before feeding.
- Offer small bites and allow time to chew and swallow; alternate solids and liquids.
- Check that the mouth is empty before the next bite.
- Use thickened liquids if ordered for swallowing problems (dysphagia).
- Keep the resident upright for at least 30 minutes after the meal.
- Minimize distractions and do not rush; let residents feed themselves when able.
Report coughing, choking, a wet 'gurgly' voice, or pocketing food in the cheek.
Therapeutic Diets
The nurse or dietitian orders special diets; the CNA serves the correct tray and reports intake.
| Diet | Purpose |
|---|---|
| Regular | No restrictions |
| Low-sodium | Heart failure, hypertension |
| Diabetic / consistent carbohydrate | Controls blood sugar |
| Mechanical soft / pureed | Chewing or swallowing difficulty |
| Clear liquid | Bowel rest, before/after procedures |
| NPO | Nothing by mouth |
Always verify the name on the tray matches the resident.
Fluid Balance and I&O
A typical adult needs about 1,500-2,000 mL of fluid per day. Intake and output (I&O) tracks all fluids in (drinks, soups, IV) versus out (urine, emesis, drainage), recorded in milliliters (mL). A useful conversion: 1 ounce = 30 mL.
Dehydration
Report early signs of dehydration: dark, concentrated, strong-smelling urine; dry mouth and lips; dry skin that 'tents'; sunken eyes; weight loss; and new confusion. Encourage fluids unless the resident is on a fluid restriction.
Catheter Care
An indwelling urinary catheter drains urine continuously. CNA responsibilities:
- Keep the drainage bag below the level of the bladder so urine does not flow back.
- Never let the bag touch the floor; secure tubing without kinks.
- Give perineal/catheter care daily and after bowel movements, cleaning from the meatus outward along the tube.
- Empty the bag at the end of the shift and record output; report cloudy, bloody, or foul urine and any leaking.
Bowel and Bladder Training
Bladder/bowel training helps a resident regain control on a schedule. Offer the toilet at regular times (for example, every 2 hours and after meals), provide privacy, encourage fluids and fiber, and respond promptly to requests. Praise success and never scold accidents — incontinence is never punished or ignored.
Ostomy Basics
An ostomy is a surgical opening (stoma) for stool or urine into a pouch on the abdomen. The CNA empties the pouch, observes the stoma (it should look pink/red and moist), keeps the skin around it clean and dry, and reports a pale, dark, or bleeding stoma or skin breakdown. Provide privacy and a matter-of-fact, non-judgmental approach.
Specimen Collection
Label containers before collection and follow medical asepsis:
- Clean-catch (midstream) urine: clean the perineal area first, have the resident start to void, then catch urine mid-stream. Never touch the inside of the container or lid.
- Stool specimen: the resident must not urinate into the sample; use a clean container.
- Wear gloves, transport promptly, and record collection on the chart.
A New Jersey CNA finishes feeding a resident who has dysphagia and was eating in high-Fowler's position. The resident says, 'I'm tired, please lay me flat now.' What is the BEST response?
While making rounds in a New Jersey nursing facility, a CNA notices a resident's indwelling catheter drainage bag has been hung on the side rail and is resting on the floor. What should the CNA do FIRST?