This document provides guidance for nurse aides on promoting positive mealtimes and nutrition for residents. It outlines objectives like describing measures to promote independence at meals and identifying actions to address dysphagia and choking risks. The document discusses promoting comfort and social engagement during meals, using adapted utensils and cutting food to support independence. It also outlines proper feeding techniques, signs of dysphagia, and actions for aspiration prevention. Modified diets and the roles of nursing staff and dietary services are reviewed. The importance of hydration and encouraging fluid intake is stressed. Tube feeding and IV therapy are described along with related nurse aide responsibilities.

1. MEALTIME
NATCEP Day Twenty-Three

2. OBJECTIVES
Describe measures to promote a positive
atmosphere at mealtime.
 Identify devices & techniques that may be used to
help the resident maintain independence.
 Demonstrate how to feed a resident.
 Describe and identify dysphagia and actions
address.
 Identify nurse aide actions to eliminate choking
risks.
 Identify choking and demonstrate choking
management techniques.
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3. PROMOTE A POSITIVE MEALTIME
ATMOSPHERE
Physically comfortable; position, empty
bladder, dry clothing.
 Surroundings should be pleasant and comfortable.
 Social aspects should be considered – converse
with resident, not co-workers!
 Be positive about mealtime and the experience!
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4. PROMOTING MEALTIME
INDEPENDENCE
Food is in a manageable form:
cut, buttered, containers opened.
 Visually impaired: Use numbers of clock to
describe location of food.
 Devices: plate guard or adapted spoon.
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5. PROPER FEEDING TECHNIQUES
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Wash hands = both yours and your resident’s
Prayer, if requested
Sit facing resident
Check diet card and items on tray for match
Prevent choking: sitting, head of bed elevated
Open containers, cut, butter and/or season as preferred
Serve food in order of resident preference
Offer fluids between bites; alternate
Offer to wipe face and hands throughout meal
Spoons preferred utensil = 1/3 full
Resident should help with finger foods
Maintain flavors – don’t combine foods
Identify foods as you feed resident “Here is some mashed potatoes”
Feed hot foods cautiously
Allow adequate time to chew thoroughly
Observe, report and record food and fluid intake
Notify nurse if they refuse to eat.

6. DYSPHAGIA & NURSE AIDE
ACTIONS
Difficult or painful swallowing
 Risk for choking
 Feed slowly, allowing time to chew and swallow.
 Remind to swallow.
 Offer fluids frequently.
 Check for pocketed food or liquid in the cheeks.
 Place food on strong side of mouth.
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7. ASPIRATION
Fowler’s position.
 Support upper back, shoulders and neck with a
pillow.
 Observe for signs and symptoms of aspiration
when eating or drinking.
 Check the resident’s mouth for pocketing after
eating.
 Maintain resident in semi-fowler’s position for one
hour after eating.
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8. NUTRITION & FLUID
NEEDS
NATCEP Day Twenty-Three

9. OBJECTIVES
Discuss factors that affect nutritional status.
 Identify modified diets.
 Describe nurse aide responsibilities for therapeutic
diets.
 Describe the dietary department’s role in providing
nutrition to the resident.
 Identify the importance of hydration.
 Describe methods to encourage fluid intake.
 Name nurse aide responsibilities for tube-fed
residents.
 Describe IV therapy and the related nurse aide’s
responsibilities.
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10. FACTORS THAT AFFECT THE NUTRITIONAL STATUS
OF THE ELDERLY
Tooth loss, poorly fitting dentures, and a sore
mouth.
 Loss of muscle control over part of the mouth and
throat as the result of a stroke.
 Diminished hand and arm muscle strength or
control from paralysis or tremor.
 Diminished sense of smell, taste and vision.
 Decreased activity resulting in decreased
requirement for calories.
 Serving foods the resident may not like.
 Mood and behavior problems.
 Pain and/or discomfort.
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11. MODIFIED DIETS
Low sodium & salt restricted: Heart or kidney
disease, fluid retention
 Diabetic diet: Diabetics
 Mechanical soft: Dysphagia due to
stroke, paralysis, multiple sclerosis
 Pureed: Dysphagia due to
stroke, paralysis, multiple sclerosis
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12. MODIFIED DIETS
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Nurse Aide Responsibilities
 Do not interchange food from one resident’s tray to
another
 Report resident’s request for diet substitutions to
the nurse

13. MODIFIED DIETS
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Dietary Department Service Staff Responsibilities
 Plan meals
 Diet balanced with adequate nutrients
 Food prepared and presented in way resident can
manage
 Food presented in way that is visually appealing
 Infection control maintained
 Tray cards provided
Identify type of diet
 Identifies resident likes & dislikes
 Identifies food allergies
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14. HYDRATION
Prevent constipation and urinary incontinence.
 Dilutes wastes and flushes out urinary system.
 Maintain skin turgor.
 Prevent confusion.
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15. METHODS TO ENCOURAGE FLUID
INTAKE
Offer water each time you feed a resident
 Know resident drink preferences
 Some residents prefer no ice
 Snacks of juice and fluids may be distributed
between meals
 Offer small amounts of drinks frequently
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16. TUBE FEEDINGS
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Enternal Nutrition
Giving nutrients into the digestive tract through a
feeding tube
 Person may be unable to ingest, chew or swallow
 Person may be unable to pass food from the mouth
into the esophagus or into the stomach or small
intestines
 Common causes
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Cancer or trauma to the face, mouth, head or neck
 Coma
 Dementia
 Dysphagia (difficulty swallowing)
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17. TUBE FEEDINGS

18. TUBE FEEDINGS
Oral hygiene.
 Nose and nostril cleaned every 4 hours.
 Head of bed elevated 30-45 degrees at all times.
 Oral care for unconscious residents (side-lying
position).
 Care and cleaning of insertion site –wear
gloves, soap & water, rinse.
 Observe for signs and symptoms of infection.
 Notify nurse if taped tube is loose.
 Tubes: no pulling, pinching, kinks, twisting.
 Connections tight and no leaks.
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19. IV THERAPY
Report immediately redness,
swelling, pain or tenderness.
 Tubing: catching, kinking,
twisting, pulling.
 DO NOT TOUCH any clamps
or controls on the IV or pump.
 Assist the resident with personal
care and activities with IV in
place.
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