Eight Intake and output sheet by liaoqinmei

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Nutrition and Fluid Balance
1. Define important words in this chapter
apathy:
   a lack of interest.

aspiration:
   the inhalation of food or fluid into the lungs; may cause
   pneumonia or death.

dehydration:
   condition that occurs when a person does not have enough
   fluid in the body.

diet cards:
   cards that list residents’ names and information about
   special diets, allergies, likes and dislikes, and any other
   dietary instructions.
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Nutrition and Fluid Balance
1. Define important words in this chapter (con’t)
diuretics:
   medications that reduce fluid volume in the body.

dysphagia:
   difficulty with swallowing.

edema:
   swelling in body tissues caused by excess fluid.

fasting:
   a period of time during which food is given up voluntarily.
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Nutrition and Fluid Balance
1. Define important words in this chapter (con’t)
fluid balance:
    taking in and eliminating equal amounts of fluid.

fluid overload:
    a condition in which the body cannot eliminate the fluid
    consumed.

force fluid:
    medical order for a person to drink more fluids.

glucose:
   natural sugar.
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Nutrition and Fluid Balance
1. Define important words in this chapter (con’t)
graduate:
   a measuring container.

input:
   the fluid a person consumes; also called intake.

intake:
   the fluid a person consumes; also called input.

malnutrition:
  poor nutrition due to insufficient food intake or an improper
  diet.
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Nutrition and Fluid Balance
1. Define important words in this chapter (con’t)
metabolism:
  the process of utilizing all nutrients that enter the body to
  provide energy, growth, and maintenance.

nutrient:
   substance in food that enables the body to use energy for
   metabolism.

nutrition:
   the taking in and using of food by the body to maintain
   health.

output:
   fluid that is eliminated each day through urine, feces, and
   vomitus, as well as perspiration; also includes suction
   material and wound drainage.
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Nutrition and Fluid Balance
1. Define important words in this chapter (con’t)
puree:
   to chop, blend, or grind food into a thick paste of baby food
   consistency.

restrict fluids:
   a medical order that limits the amount of fluids a person
   takes in.

special diet:
   a diet for people who have certain illnesses or conditions;
   also called therapeutic or modified diet.

vegans:
   vegetarians who do not eat any animal products, including
   milk, cheese, other dairy items, or eggs; vegans may also
   not use or wear any animal products, including, wool, silk,
   and leather.
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Nutrition and Fluid Balance
1. Define important words in this chapter (con’t)
vegetarians:
   people who do not eat meat, fish, or poultry for religious,
   moral, or health reasons; they may or may not eat eggs
   and dairy products.
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Nutrition and Fluid Balance
2. Describe common nutritional problems of the
elderly and the chronically ill


Problems of the elderly and the chronically ill:

•   Malnutrition
•   Unhealthy weight loss
•   Dehydration
•   Dysphagia
•   Less saliva
•   Aspiration
•   The inability to see well
•   Problems with teeth and dentures, etc.
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Nutrition and Fluid Balance
3. Describe cultural factors that influence food
preferences


• Fasting is a practice during with food is voluntarily
  given up for a period of time.
• Vegetarians do not eat meat, fish, or poultry.
• Vegans are vegetarians who do not eat any animal
  products, including milk, cheese, other dairy items, or
  eggs.
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Nutrition and Fluid Balance
4. Identify six basic nutrients


•   Water
•   Fats
•   Carbohydrates
•   Proteins
•   Vitamins
•   Minerals
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Nutrition and Fluid Balance
5. Explain the USDA’s MyPyramid

•   Grains
•   Vegetables
•   Fruits
•   Milk
•   Meat and Beans
•   Oils
•   Physical Activity
14 Nutrition and Fluid Balance

Transparency 14-1: MyPyramid
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Nutrition and Fluid Balance
6. Explain the role of the dietary department

• Dietary cards list the resident’s name and
  information about special diets, allergies, likes and
  dislikes, as well as any other dietary instructions.
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Nutrition and Fluid Balance
7. Explain the importance of following diet orders
and identify special diets

Special diets are often ordered for residents who have
certain illnesses or conditions.
• Liquid Diets
• Soft Diet or Mechanical Soft Diet
• Pureed Diet
• Bland Diet
• High-Residue or High-Fiber Diet
• Low-Residue or Low-Fiber Diet
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Nutrition and Fluid Balance
7. Explain the importance of following diet orders
and identify special diets (con’t)

Special diets are often ordered for residents who have
certain illnesses or conditions (con’t).
• Modified Calorie Diets
• Low-Sodium Diet
• High-Protein Diet
• Low-Protein Diet
• Low-Fat/Low-Cholesterol Diet
• High-Potassium Diet
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Nutrition and Fluid Balance
7. Explain the importance of following diet orders
and identify special diets (con’t)

Special diets are often ordered for residents who have
certain illnesses or conditions (con’t).
• Fluid-Restricted Diet
• Diabetic Diet
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Nutrition and Fluid Balance
8. Explain thickened liquids and identify three basic
thickening consistencies

• Nectar thick
• Honey thick
• Pudding thick
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Nutrition and Fluid Balance
9. List ways to identify and prevent unintended
weight loss

Warning signs for unintended weight loss include the
following:
• Resident needs help eating or drinking
• Resident eats less then 70% of meals/snacking
• Resident has mouth pain
• Resident has dentures that do not fit properly
• Resident has difficulty chewing or swallowing
• Resident coughs or chokes while eating, etc.
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Nutrition and Fluid Balance
10. Describe how to make dining enjoyable for
residents

To make mealtimes enjoyable and pleasant, follow these
guidelines:
• Follow a routine for dining.
• Residents may want to look their best.
• Help to give oral care before meals, if they request it.
• Help with toileting and bathing before mealtime.
• Honor requests to seat residents with friends, etc.
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Nutrition and Fluid Balance
11. Describe how to serve meal trays and assist
with eating

Guidelines for serving meal trays:
• Wash your hands.
• Check diet card for special diet orders.
• Serve all residents sitting at one table.
• Prepare the food before helping residents eat.
• Open juice or milk cartons, etc.
Feeding a resident who cannot feed self

Equipment: meal tray,
clothing protector, 1-2
washcloths
  1.   Identify yourself by
       name. Identify the
       resident. Greet the
       resident by name.
  2.   Wash your hands.
  3.   Explain procedure to
       resident. Speak clearly,
       slowly, and directly.
       Maintain face-to-face
       contact whenever
       possible.
Feeding a resident who cannot feed self

  4.   Provide for the resident’s
       privacy with a curtain,
       screen, or door.
  5.   Pick up diet card. Verify
       that resident has
       received the right tray.
  6.   Help resident to wash
       hands (and face if
       needed) if the resident
       cannot do it on her own.
  7.   Adjust bed height so you
       will be to able to sit at
       resident’s eye level. Lock
       bed wheels.
Feeding a resident who cannot feed self

  8.   Lower the side rail (if
       bed has one and if it is
       not already lowered) on
       side nearest you.
  9.   Raise the head of the
       bed. Make sure resident
       is in an upright sitting
       position (at a 90-degree
       angle).
  10. Help resident to put on
      clothing protector, if
      desired.
Feeding a resident who cannot feed self

  11. Sit facing resident. Sit at
      resident’s eye level (Fig.
      14-22). Sit on the
      stronger side if resident
      has one-sided weakness.
  12. Offer drink of beverage.
      Offer different types of
      food, allowing for
      resident’s preferences.
      Do not feed all of one              Fig. 14-22. The resident
      type before offering                should be sitting upright and
                                          you should be sitting at her
      another type.                       eye level.
Feeding a resident who cannot feed self

  13. Offer the food in bite-
      sized pieces (Fig. 14-
      23). Report any
      swallowing problems to
      the nurse immediately.
      If resident has one-sided
      weakness, direct food to
      the unaffected, or
      stronger, side.
  14. Make sure resident’s                Fig. 14-23. Offer the food in
      mouth is empty before               bite-sized pieces, and direct
                                          food to the resident’s
      next bite or sip.
                                          stronger, or unaffected, side.
  15. Offer beverage to
      resident throughout the
      meal.
Feeding a resident who cannot feed self

  16. Talk with the resident
      during the meal
      (Fig. 14-24).




                                          Fig. 14-24. Talking with the
                                          resident makes mealtime
                                          more enjoyable and may
                                          promote her appetite.
Feeding a resident who cannot feed self

  17. Use washcloths to wipe
      food from resident’s
      mouth and hands as
      needed during the meal.
      Wipe again at the end of
      the meal (Fig. 14-25).
  18. Remove clothing
      protector if used.
      Dispose of in proper
      container.                          Fig. 14-25. Wiping food from
                                          the mouth during the meal
  19. Remove food tray. Check             helps to maintain the
      for eyeglasses, dentures,           resident’s dignity.
      hearing aids, or any
      personal items before
      removing tray.
Feeding a resident who cannot feed self

  20. Make resident
      comfortable.
  21. Return bed to low
      position if raised. Ensure
      resident’s safety. Return
      side rails to ordered
      position. Remove privacy
      measures.
  22. Leave call light within
      resident’s reach.
  23. Wash your hands.
Feeding a resident who cannot feed self

  24. Be courteous and
      respectful at all times.
  25. Report any changes in
      the resident to the
      nurse. Document
      procedure using facility
      guidelines. Record intake
      of solid food and fluids
      properly.
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Nutrition and Fluid Balance
12. Describe how to assist residents with special
needs

Guidelines for dining techniques for residents with special
needs:
• Use assistive or adaptive devices for eating when
  necessary.
• To help maintain independence when eating, use
  physical and verbal cues.
• For residents who are visually-impaired, read menus
  to them, etc.
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Nutrition and Fluid Balance
13. Discuss dysphagia and list guidelines for
preventing aspiration

The following are signs and symptoms of dysphagia:
• Eating very slowly
• Avoidance of eating
• Spitting out pieces of food
• Difficulty chewing food
• Difficulty swallowing small bites of food or pills, etc.
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Nutrition and Fluid Balance
15. List ways to identify and prevent dehydration

• Dehydration is a serious condition that occurs
• Output is the fluid that is eliminated each day that
  cannot stay in the body. Output includes urine, feces,
  vomitus, perspiration and moisture in the air that a
  person exhales.
14 Nutrition and Fluid Balance

Transparency 14-2: Preventing Aspiration
●    Position in a straight, upright position at a
     90-degree angle.

●    Feed resident slowly.

●    Avoid distractions.

●    Offer small pieces of food or small spoons of
     pureed food.

●    Offer food and then a liquid.
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Transparency 14-2: Preventing Aspiration
●    Place food in the non-paralyzed side of the
     mouth.

●    Make sure mouth is empty before next bite of
     food or sip of drink.

●    Have residents stay in upright position for at
     least 30 minutes after eating and drinking.
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Transparency 14-2: Preventing Aspiration
●    Provide mouth care after eating.

●    Observe residents closely. Report signs of
     aspiration immediately.
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Nutrition and Fluid Balance
14. Describe intake and output (I&O)

• Intake or input is the fluid a person consumes.
• Output is the fluid that is eliminated each day that
  cannot stay in the body. Output includes urine, feces,
  vomitus, perspiration and moisture in the air that a
  person exhales.
14 Nutrition and Fluid Balance

Transparency 14-3: Conversion Table
One milliliter (mL) is a unit of measure equal to one cubic
centimeter (cc). Follow your facility’s policies on whether to
document using “mL” or “cc”.

1 oz. = 30 mL or 30 cc
2 oz. = 60 mL
3 oz. = 90 mL
4 oz. = 120 mL
5 oz. = 150 mL
6 oz. = 180 mL
7 oz. = 210 mL
8 oz. = 240 mL
¼ cup = 2 oz. = 60 mL
½ cup = 4 oz. = 120 mL
1 cup = 8 oz. = 240 mL
Measuring and recording intake and output

Equipment: I&O sheet,
graduate (measuring
container), pen and paper to
record your findings
  1.   Identify yourself by
       name. Identify the
       resident. Greet the
       resident by name.
  2.   Wash your hands.
  3.   Explain procedure to
       resident. Speak clearly,
       slowly, and directly.
       Maintain face-to-face
       contact whenever
       possible.
Measuring and recording intake and output

  4.   Provide for the resident’s
       privacy with a curtain,
       screen, or door.
  5.   A list of container sizes
       should be available to
       help with measuring. For
       example, a water cup
       equals 240 mL, a cereal
       bowl equals 150 mL, and
       a milk carton equals 240
       mL. If amounts are not
       available, use a graduate
       to measure how much
       fluid a resident is
       served.
Measuring and recording intake and output

       (con’t) Note the amount
       of fluid the resident is
       served on paper.
  6.   When the resident has
       finished a meal or snack,
       measure any leftover
       fluids. Note this amount
       on paper.
  7.   Subtract the leftover
       amount from the amount
       served. If you have
       measured in ounces,
       convert to milliliters
       (mL) by multiplying by
       30.
Measuring and recording intake and output

  8.   Record amount of fluid
       consumed (in mL) in
       input column on I&O
       sheet. Record the time
       and what fluid was
       consumed.
  9.   Wash your hands.
Measuring and recording intake and output

Measuring output is the other
half of monitoring fluid
balance.
Equipment: I&O sheet,
graduate, gloves, additional
PPE if required, pen and
paper to record your findings
  1.   Wash your hands.
  2.   Put on gloves before
       handling bedpan/urinal.
  3.   Pour the contents of the
       bedpan or urinal into
       measuring container. Do
       not spill or splash any of
       the urine.
Measuring and recording intake and output

  4.   Place container on flat
       surface. Measure
       amount of urine at eye
       level. Keep container
       level (Fig. 14-31).
  5.   After measuring urine,
       empty measuring
       container into toilet. Do
       not splash.
  6.   Rinse measuring
       container. Pour rinse
       water into toilet. Clean
       container using facility
       guidelines.


                                            Fig. 14-31. Keep container
                                            level while measuring
                                            output.
Measuring and recording intake and output

  7.   Rinse bedpan/urinal.
       Pour rinse water into
       toilet. Use approved
       disinfectant.
  8.   Return bedpan/urinal
       and measuring container
       to proper storage.
  9.   Remove and dispose of
       gloves.
  10. Wash hands before
      recording output.
Measuring and recording intake and output

  11. Record contents of
      container in output
      column on sheet. Report
      any changes to the
      nurse.
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Nutrition and Fluid Balance
15. List ways to identify and prevent dehydration


• Dehydration is a serious condition that occurs when
  a person does not have enough fluid in the body.
• Force fluids means to encourage the resident to
  drink more fluids.

								
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