Nutrition, Feeding, Fluids & Intake/Output

Quick Answer: Feed in upright Fowler, offer small bites/sips, document intake, measure I&O per 24-hour cycle, and report choking, refusal, or dehydration signs immediately.

Nutrition and Hydration Role

CNAs do not prescribe diets but implement care plans: regular, mechanical soft, pureed, thickened liquids, sodium restriction, diabetes consistency. Encourage intake; report poor appetite.

Dehydration Signs

Encourage fluids unless fluid restriction ordered—then offer allowed amounts on schedule.

Safe Feeding Technique

1. Wash hands; identify resident; explain
2. Position High Fowler (60–90°) during and 30+ minutes after meals
3. Sit at eye level; use adaptive utensils if needed
4. Small bites; allow complete chewing/swallowing
5. Alternate solids and liquids if safe
6. Wipe mouth as needed; maintain dignity
7. Document percentage eaten and fluid intake
8. Oral care after meals per plan

Aspiration Prevention

Complete obstruction: resident cannot speak/cough—call for help; abdominal thrusts if trained and resident is conscious/adult per policy.

Signs of Swallowing Difficulty

Thickened Liquids

Nectar, honey, pudding consistencies per speech therapy order. Thin liquids may aspirate in dysphagia. Never thin liquids without nurse order.

Intake and Output (I&O)

24-hour period usually midnight to midnight. Record in mL or oz per facility.

Urinary Output Skill (Prometric)

• Use graduate container; measure at eye level
• Record amount and time
• Hand hygiene before/after
• Report oliguria (low output) or abnormal appearance

Normal urine: yellow, clear to slightly cloudy, mild odor.

Special Diets (Awareness)

NPO Status

NPO (nothing by mouth) means no food or fluids unless nurse clears. Residents NPO for procedures still need oral care for comfort unless contraindicated. Never offer tray to NPO resident without verifying order.

Worked Scenario

Resident coughs with every sip of thin water; dysphagia care plan orders honey-thick liquids. You find thin water at bedside.

Remove thin water; offer honey-thick per plan; report to nurse that wrong fluid was at bedside.

Exam Traps

• Feeding in flat supine position
• Ignoring 30-minute upright post-meal for aspiration risk
• Counting ice chips as full volume (usually half)
• Forcing food when resident refuses (report refusal)
• Offering regular tray to resident on pureed diet

NYSDOH Nutrition and Hydration Standards

Malnutrition and dehydration are common survey deficiencies in New York nursing homes. CNAs are the primary observers of intake at every meal.

Mealtime Documentation Standards

Adaptive Feeding Equipment

Diabetic Meal Consistency

Diabetic trays may specify consistent carbohydrate portions. Do not trade desserts between residents. Report if resident refuses entire meal—blood sugar management depends on intake patterns.

Fluid Encouragement Techniques

Offer fluids with every interaction: "Would you like ice water or juice?" Use preferred temperature. Popsicles and gelatin count toward intake on many units—document per policy.

I&O Shift Handoff

At shift change, report cumulative I&O for residents on restriction: "Mr. Chen has taken 600 mL of 1500 mL restriction with 400 mL urine output." Nurses use this to adjust IV or diuretic orders.

Enteral Tube Feeding Awareness

CNAs may position residents for tube feeding, report if feeding pump alarms, and document residual if delegated. Never adjust feeding rate or reconnect disconnected tubes without nurse direction—aspiration and infection risks are high.

Religious and Cultural Diet Needs

Kosher, halal, vegetarian, and texture-modified trays must match diet order and preference. Report wrong tray before resident eats. Fasting residents may need modified meal timing—follow care plan and notify nurse of refusal patterns.

Choking Response Hierarchy

Partial obstruction: encourage coughing, do not slap back while food in airway. Complete obstruction: call for help; perform abdominal thrusts only if trained and policy allows. Always report choking event even if resolved—aspiration pneumonia can follow silently.

NY Exam Review Takeaway

Master the NYSDOH/Prometric decision rules for this topic: stay in scope, protect dignity, use standard precautions, and report changes to the licensed nurse before finishing non-urgent tasks. Practice until safe steps are automatic on skills day and written traps feel predictable.