Nutrition, Hydration, and Elimination
Assist with eating and toileting safely, record intake and output accurately, and recognize what these observations reveal.
By the end of this lesson you can
- Assist with feeding safely, including aspiration precautions
- Record intake and output accurately
- Assist with toileting while preserving dignity
- Recognize and report changes in elimination
Lesson Notes
Read through the key concepts before you try the challenge.
Feeding is a clinical task
You assist a patient with lunch at Lakeside Regional.
A patient recovering from a stroke is fed quickly because the tray cart is waiting, while reclined at 30 degrees, with large spoonfuls and no pause between them. Food enters the airway. Aspiration pneumonia is one of the most common hospital-acquired complications, and this is how it starts.
Your task: Treat feeding assistance as the clinical task it is.
| Practice | Why |
|---|---|
| Sit the patient fully upright, at 90 degrees | Reclining lets food travel toward the airway |
| Keep them upright 30 minutes after eating | Reduces reflux and aspiration risk |
| Small bites, and allow time between | Rushing is the single biggest risk factor |
| Confirm each swallow before the next bite | Watch the throat; do not rely on them telling you |
| Follow prescribed diet and thickened liquids exactly | Consistency is prescribed for a clinical reason |
| Sit at eye level, do not stand over them | Standing rushes the pace and is undignified |
| Stop if coughing, wet voice, or distress | Report immediately — these are aspiration signs |
Intake and output records inform real clinical decisions about fluid balance, kidney function, and medication dosing. Record intake in millilitres, including all oral fluids, ice chips at roughly half their volume, and fluids taken with medications. Record output including urine, emesis, drainage, and liquid stool. Guessing makes the record actively misleading — an inaccurate I&O is worse than none, because it will be trusted.
| Observation | May indicate |
|---|---|
| No urine output in 6-8 hours | Retention, dehydration, or kidney problem |
| Dark, concentrated, or strong-smelling urine | Dehydration or infection |
| Blood in urine or stool | Always report |
| Burning or pain on urination | Infection |
| New incontinence in a previously continent patient | Infection, retention with overflow, or neurological change |
| No bowel movement for three days | Constipation, possible impaction |
| Black tarry stool | Upper gastrointestinal bleeding — report urgently |
| Sudden watery diarrhea | Possible infection; consider precautions |
A patient prescribed thickened liquids asks for a glass of water, saying they swallow fine. What should you do?
Challenge
Apply what you've learned in this lesson.
Feeding assistance requires supervised practice, particularly for patients with swallowing difficulty.
- Research dysphagia. List the signs of aspiration a PCT could observe during a meal.
- Research the standard thickened liquid consistencies and what each is prescribed for.
- For a patient who drinks 240 mL coffee, 120 mL juice, a 200 mL soup, and 100 mL of ice chips, calculate total intake and show your work.
- Write a list of eight elimination observations you would report, and say which are urgent.
Finished this lesson?
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