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FLUIDS!AND!
NUTRITION!
AWARENESS!
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INTRODUCTION:!
The!aim!of!this!module!is!to!provide!the!service!provider/carer!with!a!knowledge!and!understanding!on!the!
importance!of!good!hydration!and!nutrition!to!maintain!physical!and!mental!health!and!well=!being.!
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LEARNING!OUTCOMES:!
By!the!end!of!this!module!the!learner!should!be!able!to;!
•! Explain!the!importance!of!good!hydration!and!nutrition!in!maintaining!optimum!health!and!wellbeing!in!
service!users!
•! Recognise!the!signs!and!symptoms!of!poor!hydration!and!nutrition!
• Explain!how!to!promote!adequate!hydration!and!nutrition!of!individuals!in!care!settings!
•! Identify!how!individuals!can!be!supported!and!encouraged!to!access!fluids,!food!and!nutrition!in!
accordance!with!their!preferences,!requirements!and/or!plan!of!care!
•! Identify!the!effects!of!culture!and!religion!on!an!individual’s!dietary!requirements!and!preferences!
•! Describe!the!importance!of!food!safety,!including!hygiene,!in!the!preparation!and!handling!of!food!in!
care!settings!
•! Be!aware!of!whom!to!raise!concerns!with!where!substandard!care!is!provided!in!relation!to!hydration!
and!nutrition.!!!
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WHAT!IS!NUTRITION?!
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Apart!from!breastmilk,!no!single!food!contains!all!the!essential!nutrients!the!body!needs!to!be!healthy!and!!
function!efficiently.!But!to!sustain!life,!water!and!food!are!essential.!We!need!energy!to!live!and!this!is!
!provided!by!the!macronutrients!of!carbohydrate,!protein!and!fat!in!our!diets.!But!the!balance!between!
these!nutrients!must!be!right!for!us!to!remain!healthy.!Getting!the!right!amounts!of!vitamins,!minerals,!!
dietary!fibre!and!water!is!also!important!for!health.!
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Health!and!social!carers!whose!role!involves!supporting!individuals!with!their!routine!fluid!and!nutritional!
needs,!are!responsible!for!ensuring!that!good!fluids!and!nutrition!are!made!available!to!the!individuals!!
receiving!care.!Staff!are!also!responsible!for!ensuring!that!the!individuals!can!and!do!consume!it,!whether!
independently!or!with!assistance!via!feeding!aid.!There!is!no!benefit!or!nutritional!value!of!uneaten!food.!
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Definitions:!
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Nutrition:! the!science!of!food!and!how!the!body!works!
Diet:! the!intake!of!foods!and!fluids!whether!via!nasogastric!tube,!gastrostomy!tube,!peripherally,!
orally!etc.!
Food:! any!sources/substances!that!provides!us!with!energy,!nutrients,!fibre!and!water.!
Energy:! a!source!of!fuel!that!is!needed!for!the!body!to!function!such!as!movement,!maintain!body!!!!!!!!!!!!!!!
temperature!and!the!breathing!
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Nutrients:! components!of!food!which!have!functions!in!growth,!maintenance,!repair!and!protection!
against!ill!health!
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HYDRATION:!
This!is!the!body's!way!of!trying!to!increase!water!intake!and!decrease!water!loss.!Dehydration!can!be!mild,!
moderate!or!severe,!depending!on!how!much!of!your!body!weight!is!lost!through!fluids.!Two!early!signs!of!
dehydration!are!thirst!and!dark!coloured!urine.!Water!is!vital!to!the!function!of!every!organ!of!the!body,!
including,!the!heart,!liver,!brain!and!kidney.!Adequate!hydration!helps!maintain!a!good!blood!flow!to!the!
tissues.!Dehydration,!if!not!treated,!can!quickly!become!a!medical!emergency.!Everyone!can!become!
dehydrated.!While!water!is!one!of!the!essential!nutrients!for!everyone,!children!and!older!people!have!
additional!needs!for!hydration.!
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When!our!bodies!don't!have!enough!water,!we!are!said!to!be!dehydrated.!!
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One!of!the!first!signs!of!dehydration!is!feeling!thirsty.!If!you!think!you!may!not!be!getting!enough!fluids,!
check!if!you!have!any!of!these!other!common!signs!of!dehydration:!
• dark!coloured!urine!and!not!passing!much!urine!when!you!go!to!the!toilet!
• headaches!
• lack!of!energy!
• feeling!lightheaded!
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We!need!to!drink!about!1.2!litres!of!fluid!every!day!to!stop!us!getting!dehydrated.!This!is!in!addition!to!the!
fluid!we!get!from!the!food!we!eat.!All!non=alcoholic!drinks!count,!but!water,!milk!and!fruit!juices!are!the!
healthiest.!
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WHY!WE!EAT?!
All!individuals!have!different!needs!in!regards!to!nutrition!requirements!and!to!maintain!healthy!living.!!
Nutrition!is!essential!for!health!and!wellbeing,!in!general!for:!
•! Growth!and!development!
•! Prevention!of!ill!health!
•! Recovery!from!ill!health!
•! Good!mental!health!
•! Good!quality!of!life!
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Types!of!Nutrients:!
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Vitamins:!! Helps&to&heal&wounds&and&prevent&infections!
Minerals:!! Helps&cells&to&work&and&balance&body&fluid!
Fats:!!Provides&insulation!
Water/Liquids:!Dissolves&soluble&chemicals&enabling&digestion,&absorption,&metabolism&and&excretion!
Protein:!Growth&and&repair!
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Fibre:! !Helps&reduce&cholesterol!
Carbohydrates:!A&source&of&energy&
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Two!of!the!key!groups!at!risk!of!undernutrition!are!young!people!and!older!people.!Young!people!are!in!a!
period!of!very!rapid!growth,!which!demands!additional!nutritional!support.!Older!people!are!not!always!
able!or!motivated!to!cook!for!themselves.!Some!conditions!that!affect!older!people,!such!as!a!stroke,!
Parkinson’s!or!dementia!(for!example,!Alzheimer’s!disease),!can!seriously!affect!their!ability!to!feed!
themselves!and!to!swallow.!In!general,!when!people!are!unwell!they!may!lose!their!appetite.!
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Providing!patients!with!optimal!nutritional!care!is!an!integral!part!of!their!treatment!and!duty!of!care,!and!
provision!of!appropriate!food!and!fluids!to!meet!their!needs!is!essential!to!maximise!individual!health!
outcomes.!
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Over!the!last!decade,!there!has!been!increasing!concern!over!the!high!incidence!of!malnutrition,!in!
particular!under!nutrition!that!exists!in!the!hospital!population!and!a!growing!interest!in!improving!the!
overall!nutritional!care!experience!for!the!patient!together!with!delivery!of!appropriate!nutritional!care!to!
improve!clinical!outcomes.!Malnutrition!has!the!potential!to!affect!the!healthcare!sector!population!and!
can!adversely!affect!clinical!outcomes!for!patients.!These!have!been!areas!of!priority!with!certain!
Regulatory!bodies!such!as;!
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•!NICE!Guidance!on!Nutrition!Support!in!adults:!oral!nutrition!support,!enteral!tube!feeding!and!parenteral!
nutrition!(2006)!
•!NICE!Quality!standard!24:!Quality!standard!for!nutrition!support!in!adults!(2012)!
•!Care!Quality!Commission!(CQC):!Outcome!5!Nutrition!
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NUTRITIONAL!SUPPORT!IN!HEALTHCARE!SETTINGS:!
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Delivering!excellent!nutritional!care!to!patients!that!are!being!cared!for!is!a!complex!process!and!relies!on!
good!co=ordination.!Standards!of!care!need!to!be!set,!acted!upon,!audited!and!monitored!and!all!staff!
within!the!Organisation!have!some!responsibility!to!ensure!that!this!happens.!Nutritional!support!
therefore!needs!to!be!delivered!via!catering,!ward!nurses!and!the!patient’s!medical!team,!supported!by!
specialist!advice!and!an!authoritative,!specialist=derived!management!structure!which!fosters!excellence!
and!responsiveness!to!external!drivers.!For!those!in!the!community,!this!would!be!supported!by!the!
community!dietician/nutritionist!and!allocated!community!nurse!who!will!liaise!with!the!catering!delivery!
service.!
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PATIENT!SCREENING:!
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In=patients!or!those!in!the!community!under!the!care!of!Primary!Health!Care!and!Social!Trusts!are!required!
to!undergo!Nutrition!assessment!as!part!of!their!risk!assessment!to!identify!any!potential!risk!of!nutritional!
deficits!etc.!and!to!ensure!appropriate!intervention!is!implemented!to!prevent!deterioration!in!their!
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current!health!status.!Nutritional!assessment!is!a!more!detailed,!more!specific,!and!in=depth!evaluation!of!
a!patient’s!nutritional!state!carried!out!by!the!Dietitian/Nutritionist.!The!assessment!process!allows!more!
individualised!dietary!care!plans!to!be!developed.!
An!individual!who!continually!refuses!to!eat!or!drink!/!refuse!to!open!their!mouth!is!at!high!risk!of!
dehydration!and!malnutrition.!The!appropriateness!of!artificial!support!(e.g.!nasogastric!or!PEG!feeding)!
including!the!ethical!issues!involved!should!be!discussed!by!the!multidisciplinary!team!as!part!of!the!
patient’s!clinical!review.!
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TYPICAL!STANDARDS!RELATING!TO!NUTRITION!(this!will!vary!from!Trust!to!Trust/local!Governments):!
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The!Care!Quality!Commissions!(CQC):!Meeting!nutritional!needs!(MNN)!advises!the!following;!!
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Clinical!Priorities:!!
• Screening!for!malnutrition!and!the!risk!of!malnutrition!should!be!carried!out!by!healthcare!
professionals!with!appropriate!skills!and!training!
• Screening!should!be!repeated!weekly!for!inpatients!and!when!there!is!clinical!concern!for!
outpatients.!People!in!care!homes!should!be!screened!on!admission!and!when!there!is!clinical!
concern!!
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 • Nutrition!support!should!be!considered!in!people!who!are!malnourished,!as!defined!by!any!of!the!
following:!
−! a!body!mass!index!(BMI)!of!less!than!18.5!kg/m2!
−! unintentional!weight!loss!greater!than!10%!within!the!last!3–6!months!
−! a!BMI!of!less!than!20!kg/m2!and!unintentional!weight!loss!greater!than!5%!within!the!last!3–6!
months!
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Nutrition!support!should!be!considered!in!people!at!risk!of!malnutrition,!defined!as!those!who!have:!
−! eaten!little!or!nothing!for!more!than!5!days!and/or!are!likely!to!eat!little!or!nothing!for!5!days!or!
longer!
−! a!poor!absorptive!capacity!and/or!high!nutrient!losses!and/or!increased!nutritional!needs!from!
causes!such!as!catabolism!
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• All!healthcare/social!care!professionals!who!are!directly!involved!in!patient!care!should!receive!
education!and!training,!relevant!to!their!post,!on!the!importance!of!providing!adequate!nutrition!
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People!identified!as!'at!risk'!or!needing!support!are!being!monitored.!!
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Look!for:!
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•! Signs/alerts!showing!that!they!require!assistance/are!at!risk.!
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•! Food!intake!charts!being!monitored,!completed!and!reviewed!by!staff!during/following!mealtimes.!
•! Fluid!intake!charts!being!monitored,!completed!and!reviewed!by!staff!during/following!mealtimes.!
•! Staff!supporting!and!communicating!with!people!in!a!sensitive!manner!that!meets!their!needs!and!
requirements.!
•! Weight!being!recorded!weekly.!
•! Repeated!screening!
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FOOD!PREPARATION:!
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Food!Safety!and!Handling!Food:!
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• Patients/service!users!should!be!able!enabled/allowed!to!prepare!food!for!themselves!(promoting!
independence)!
• Ensure!hands!are!washed!before!and!after!the!preparation!of!food!and!when!dealing!with!raw!meat.!
• Staff!having!access!to!all!equipment!needed!for!the!safe!preparation!of!food!(boards,!knives,!gloves,!
etc.)!
• Ensure!that!foods!are!separated!in!accordance!with!individual!cultural!and!ethical!preferences!(for!
example,!halal!food!should!not!come!into!contact!with!non=halal!food,!food!prepared!for!vegan!diets!
should!not!come!into!contact!with!animal!products).!
• Ensure!equipment!available!for!those!who!need!it!(for!example,!adapted!crockery!or!cutlery!
• Temperature!of!food!being!checked.!
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 • Staff!who!are!preparing!the!food!being!aware!of!those!requiring!alerts.!
• Sample!the!prepared!food!yourself.!
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FOOD!DELIVERY:!
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Food!delivery,!handling!and!storage.!Look!for:!
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• Food!handling!policy!on!display.!
•!!Food!hygiene!policy!on!display.!
•!!Those!handling!food!washing!their!hands.!!
•!!Policies!and!procedures!being!followed!for!the!safe!handling,!storage!and!labelling!of!food!(including!
vegetarian!and!halal!food)!
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Food!should!be!presented!in!an!appealing!way.!Good!practice!includes:!
•! Serve!the!food!on!time!
•! Make!sure!that!warm!foods!are!warm!and!cold!foods!are!cold!
•! Food!should!neither!be!overcooked!nor!undercooked!
•! Texture!modified!food!should!be!served!separately!on!a!plate,!not!stirred!altogether!
•! Refresh!drinks!on!a!regular!basis!
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OFFERING!CHOICES:!
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People!are!offered!choice.!Look!for:!
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•! People!being!given!an!informed!choice,!i.e.!using!a!menu,!lists,!verbal!descriptions,!pictures,!
photographs.!
•!! Staff!being!able!to!respond!to!a!request!for!a!replacement!meal!that!is!appropriate!to!the!person’s!
individual!needs.!
•!! A!range!of!replacement!meals!being!offered!that!include!the!provision!of!culturally!sensitive!choices!
(for!example,!halal)!and!for!reasons!associated!with!special!physical!needs!(for!example,!dysphagia).!
Mealtimes!are!important!in!most!religions!or!cultures.!People!using!the!UK!health!and!social!care!
services!originate!from!different!regions,!countries,!ethnic!groups,!socio=economic!backgrounds,!
religions!and!cultures.!It!is!vitally!important!to!respect!and!respond!to!language!and!cultural!
differences.!A!lack!of!respect!for!people’s!diverse!needs!can!have!an!impact!on!their!appetite!and!
overall!wellbeing.!The!person!you!care!for!may!have!important!cultural!food!preferences,!such!as!
vegetarianism!or!veganism!
• People!not!waiting!too!long!for!a!meal!of!their!choice.!
•! People!preparing!food!for!themselves.!
•!! Relatives!providing!alternative!meals.!
•!! Staff!checking!whether!people!eat!their!food!and!recording!this!in!the!person’s!care!plan.!
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Addressing!the!Nutritional!Needs!of!Patients!Who!Lack!Mental!Capacity:!
If!a!patient!lacks!capacity!and!is!unable!to!make!safe!and!appropriate!food!and!fluid!choices!for!
themselves,!they!may!be!putting!themselves!at!nutritional!risk!and!compromising!their!health!outcomes.!
Appropriate!intervention!should!be!taken,!taking!into!consideration!the!requirements!of!the!Mental!
Capacity!Act!(2005).!!
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Reporting!of!Concerns:!
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Each!member!of!staff!plays!a!vital!part!in!helping!to!ensure!that!every!individual!receives!appropriate!
nourishment.!This!can!be!at!the!point!of!screening,!helping!the!individual!to!select!food,!delivering!and!
presenting!food!well,!assisting!individuals!who!need!it!with!drinking!or!eating,!or!recording!and!monitoring!
their!food!intake.!The!different!staff!groups!must!work!together!and!in!support!of!each!other.!The!
individual!is!part!of!this!team,!playing!as!important!a!role!as!each!health!or!social!care!worker!in!achieving!
the!goal!of!adequate!hydration!and!nutrition.!
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If!you!have!any!concerns!about!the!hydration!and!nutrition!of!the!individuals!in!your!care,!it!is!important!
that!you!report!it!to!a!relevant!person.!This!could!include!a!senior!member!of!staff,!a!carer!or!a!family!
member.!
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