The CARE CERTIFICATE
Fluids and
Nutrition
What you need to know
Standard
THE CARE CERTIFICATE WORKBOOK
What we eat is vital to our health
and wellbeing and how we look,
Fluids and feel and function. It is important that
nutrition and people have a diet that is safe to
food safety eat and has all the nutrients they
need. Food safety is essential when
preparing and handling food.
Not all substances and objects that can cause harm or illness can be seen. This means
that people can become ill from eating food that tastes normal and looks safe. Whether
you occasionally make someone a snack such as a sandwich, or are regularly involved in
preparing meals, you should always make sure that the food is safe to eat.
Contaminated
If something becomes contaminated it means it will become dirty, infected, unclean
or
polluted. This includes ‘going off’ by being too old to consume.
Food must be prepared and stored in ways that prevent it becoming contaminated with
things that can cause harm or illness. Food hazards could be:
Physical – such as objects that can be harmful, for example bones or bits of
packaging. These could be in food when bought or introduced when preparing food.
Check for these as far as is possible.
Chemical – such as pesticides, weedkillers or cleaning chemicals that could be
harmful if eaten, for example pesticides attached to fresh fruit and vegetables or
cleaning products sprayed onto prepared foods. Ensure all fruit and vegetables are
washed before preparation and avoid spraying cleaning products close to food.
Allergenic – such as those that may cause reactions if an individual is allergic to the
food, for example nuts, shellfish, milk or gluten. These may cause an itchy skin rash,
breathing problems and/or stomach cramps with vomiting or diarrhoea. In the worst
case the person may go into an anaphylactic shock. Always ensure foods that
contain allergens are kept and prepared separately from foods that do not.
Bacterial – such as pathogenic micro-organisms in food, for example raw foods
that need to be cooked to remove the pathogens, or those found in the human gut,
nose and mouth that can be transferred to food during the storage, handling and
preparation process. Effective food safety principles should be followed to remove
these risks.
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Anaphylactic shock
A severe and potentially life-threatening reaction to an allergy. Symptoms may
include swollen hands, feet or eyelids, trouble with breathing and/or collapse and
unconsciousness.
Pathogenic micro-organisms
These are harmful germs that can be found in food and which can enter the body
and grow or multiply causing infection and illness.
Legislation came into force on 13 December 2014 that sets out how food businesses deal
with allergen information. This legislation applies to all organisations that provide food,
including care and healthcare providers covering pre-packed and non-pre- packed foods.
Providers are required legally required to provide a warning if foods contain any of the 14
allergenic substances that are covered by the legislation. Information on the changes can
be found here:
www.food.gov.uk/science/allergy-intolerance/label/labelling-changes
Vulnerable
Individuals may be more vulnerable to being
affected by contamination than is usual if a
smaller number of bacteria can cause them
illness, or if the symptoms they experience
may be more severe. These could be due to
a variety of reasons.
Some groups of people are more vulnerable to food-related illnesses because of a
weakened immune system. These groups can include:
babies, toddlers, children and teenagers: as immunity develops throughout our
lives, the older we get the more immune we become to germs
pregnant and breastfeeding women: childbearing and breastfeeding uses up a lot
of the body’s iron and zinc which are important for immunity
older people: their immune system becomes less effective in recognising
contaminated food
people living on a low income: they find it difficult to afford a healthy and
balanced diet
people in prison: particularly through exposure in confined spaces to infectious
diseases like tuberculosis and hepatitis C
people in hospital: illness weakens the immune system, and some medication may
also affect the immune system.
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It is essential that precautions are taken to ensure that food is
safe to eat. There are some basic principles you need to keep in
mind to protect all individuals when handling, storing or preparing
food, these include:
remove jewellery before preparing food
wash your hands thoroughly before touching food
wash equipment in hot water between uses
ensure food is cooked thoroughly
store food in sealed containers and keep cooled
food stored in a fridge should be labelled, dated and kept
at 5ºC
store raw meat below cooked food
prepare raw and cooked foods separately
equipment should be washed in hot soapy water or a
dishwasher if available.
The Care Quality Commission requires that where food is
provided to individuals that it is handled, stored, prepared and
delivered in a way that meets the requirements of the Food
Safety Act 1990. If your role includes preparing or handling food,
you must have the knowledge and skills to do so safely. Your
manager will identify any training that you require.
The importance of good nutrition and
hydration in maintaining health and
wellbeing
The food and drink that we have must provide the nutrients that
our bodies need to work properly. To stay healthy we need a diet
that includes the correct balance of the following:
Carbohydrates Vitamins
These provide most of the energy that we need. That These support many different
includes energy for the basic actions that keep us functions, including blood clotting,
alive (called the Basal Metabolic Rate) - for example, maintaining an effective immune
keeping the heart beating, enabling breathing, system, and allowing the body to
keeping blood circulating and for the production of absorb energy from foods. Fruit
hormones and enzymes and new tissues. Examples and vegetables are good sources
are bread, potatoes, rice or pasta. of vitamins.
Minerals Fibre Protein
These include calcium, which This promotes a healthy This is important for the
helps to build strong bones bowel and helps to body’s cells and tissues
and teeth, and iron, which remove waste products to be repaired and
helps the blood to carry from the body. Fruit, replaced. You will find
oxygen around the body. Milk vegetables, wholemeal protein in milk products
products are good providers bread, nuts and seeds but also in meat, fish or
of calcium and liver and are high in fibre. beans.
shellfish are full of iron.
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A diet that does not include the right balance of everything we need can lead to ill-health.
A healthy, balanced diet will give an individual the nutrients their body needs to function
properly.
The ‘eatwell plate’ has been developed by Public Health England in association with the
Welsh and Scottish Governments and the Food Standards Agency in Northern Ireland. It is
the model used widely in the UK to illustrate a healthy diet and is suitable for most groups
of people. It shows the five main food groups and the proportions of each food group
recommended as part of a daily healthy diet.
See http://www.nhs.uk/Livewell/Goodfood/Pages/eatwell-plate.aspx
The food groups include:
fruit and vegetables
bread, rice, potatoes, pasta and other starchy foods
meat, fish, eggs, beans and other non-dairy sources of protein
milk and dairy foods
foods and drinks high in fat and/or sugar.
Fluid is essential for life. Without enough fluid the body cannot carry out basic processes
that enable it to function correctly, such as:
digesting food and enabling nutrients to be absorbed
enabling blood to circulate around the body
removing waste products via urine and faeces
keeping cells and tissues moist, helping to avoid infection
controlling body temperature by perspiration
maintaining brain function.
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It is recommended that individuals should have about 1∙5–2 litres of fluid each day or 6–8
cups or glasses. Most ordinary drinks (for example, fruit juices, milk, tea and coffee in
moderation and low sugar drinks) count as fluid but lots of alcohol can lead to dehydration.
The best fluid to rehydrate the body is water. Some medical conditions, such as certain
types of heart condition or kidney disease will require individuals to drink less.
There are times when an individual must not eat or drink anything for a set period of time,
for example before an operation. This is known as “nil-by-mouth” and will be clearly shown
in their care plan. This must be followed for their own safety. An individual’s exact fluid
requirements will be in their care plan and should be referred to when providing care and
support.
Signs and symptoms of poor nutrition and hydration
Around a third of people admitted to hospital or care in the UK are malnourished or at risk
of becoming so. Signs and symptoms that a person is not having the correct balance of
nutrients include:
Malnourished Signs and
The term malnourished means that an individual’s diet
does not contain the right balance of nutrients it needs to
symptoms
These give us the first clues
function properly. This could include under-nutrition, when
that an individual may be
a person does not get enough nutrients or over-nutrition,
experiencing malnutrition.
when a person has more nutrients than they need.
muscle weakness
feeling tired all the time
increased infections
more falls
constipation
lack of energy
gaining or losing weight
changes in behaviour
depression
poor wound healing.
Early signs and symptoms of dehydration include:
feelings of thirst as the body tries to increase fluid levels
dark coloured urine as it tries to reduce fluid loss
headaches, tiredness and confusion, as the flow of blood to the brain decreases.
(These signs might also indicate an undiagnosed health problem, for example type 2
diabetes.)
Ongoing dehydration can contribute to:
constipation
urinary tract infections, which are prevalent in some groups in care
kidney stones and infections
poor wound healing.
If dehydration remains untreated, it can have serious consequences. Blood circulation can
be affected or kidneys can fail.
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Promoting adequate nutrition and hydration
When people receive any type of care or support (particularly long term care) an
assessment should be made about their nutrition and hydration. This should include food
allergies, likes and dislikes and the support they need to eat and drink. Information should
also include things like whether they have their own teeth and, if not, can they eat normally
or do they need soft food?
It is important to work in person-centred ways and to provide food which is suitable and
that meets each individual’s needs. If they have arthritis in the hands they may need help
with cutting up food or opening packs like yogurts. Do they have beliefs or preferences
that affect the foods that they eat? Are there any foods they should not have because of
medication? For example, some people on certain medications for depression should not
have cheese. Some individuals choose not to eat certain foods, for example, if they are
vegetarians or vegans, so it is important that you know what this means. For example,
those who are vegans do not eat dairy foods as well as not eating meat.
It is also important to know if there any foods a person should not have because of health
conditions. For example:
people with raised blood cholesterol levels may be advised not to have too much
saturated fat such as butter, fried items and pastry
people with diabetes may be encouraged to avoid too much sugar found in sweets,
chocolate, sugared breakfast cereals, cakes and puddings and encouraged to eat
fewer of these or smaller portions.
those who have high blood pressure may be advised to limit salt
anyone who is obese should be encouraged to limit sugary and fatty foods.
Some individuals might experience difficulties in eating or drinking without help. This may
be due to:
forgetting to eat (perhaps due to dementia)
side effects of medication which may affect appetite or cause sickness
poorly fitting false teeth
physical illness such as a stroke which may have affected the individuals muscles
around their mouth for chewing or hand for lifting drinks
depression which may cause poor appetite
a visual impairment which may affect the way a person sees their food to eat it
Equipment is available to support people in eating and drinking independently including:
technology such as clocks or reminder messages to tell someone when it is time to
eat or drink
cutlery with shaped and padded handles that can help with gripping
two-handled mugs to help people with poor grip, tremors or weak wrists
cups with lids to reduce the risk of spillage
one-way straws that help people to drink without the need to lift cups and glasses,
even if muscle weakness has reduced their ability to suck
non-slip mats which stop plates from moving around while people are cutting food
plates and bowls with high sides to prevent food falling off the edges or insulated
bowls which keep the food hot if the individual eats slowly.
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It is important that individuals are treated with dignity and respect. They should have
plenty of time to eat, not be rushed and be able to choose whether they would like to use
any equipment offered. If you have concerns that an individual is not eating or drinking
enough despite being encouraged and supported, you should discuss your concerns with
your manager who may seek advice from a specialist such as a dietician or a nutritionist.
They will ensure that additional support can be provided. This might include:
closer monitoring of nutrition and fluid intake
talking to the person to identify any barriers to eating and drinking
emphasising that good nutrition and hydration are important
discussing the problem with the person’s carer or family member
consulting with other workers such as doctors, therapists or dentists.
Compassion
All individual needs should be respected and a person should be treated in a
compassionate way to help maintain adequate nutrition and hydration.
Supporting individuals to have access to
fluids, food and nutrition in accordance
with their care plan
Providing for nutrition and hydration must be carried out
in a person-centred way. Efforts must be made to meet
each individual’s needs and choices. Their care plan is an
essential part of recording and delivering this.
Individuals should have access to fluid at all times,
unless it is restricted for medical reasons. They should be
encouraged to drink throughout the day and not wait until
they feel thirsty, as feelings of thirst are an early sign of
dehydration. To make sure that individuals are drinking
enough you need to offer drinks and encourage and support
them to drink as set out in their care plan. Drinks need to
be refreshed regularly and placed within easy reach for
those with restricted movement or mobility. If you are at all
concerned about an individual’s fluid intake, make sure you
report these concerns to either a senior member of staff, the
individual’s carer or their family.
Food provided should be in accordance with an individual’s care plan, and the care plan
must ensure that cultural preferences, needs related to health conditions, and allergen
advice is followed. Food safety principles need to be applied when storing, preparing
and handling food. If the care plan states that the person needs encouragement or help
and support with eating, this needs to be provided. Food needs to be served at the
right temperature and within easy reach. If an individual needs specific utensils to eat
independently, these need to be available too. As with concerns about fluid intake, any
worries about an individual’s food or nutrition should be shared with a senior member of
staff, the individual’s carer or their family.
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The CARE CERTIFICATE
Fluids and
Nutrition
What do you know now?
Standard
THE CARE CERTIFICATE WORKBOOK
Activity 8.1a
Part i) Food safety is
essential when storing,
handling and preparing
food. Fill in the table below
to list four of the basic List - this term means to identify the
principles of food safety, main points which can be written as
including hygiene. bullet points.
Basic principles of food safety
1.
2.
3.
4.
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Activity 8.1a
Part ii) Thinking about where
you work, describe why food
Describe - to describe means to create a
safety, including hygiene, is so
important when preparing and picture with words but not simply writing
handling food. a list of bullet points.
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Activity 8.1b
Part i)
Explain the importance of
good nutrition and hydration
in maintaining health and Explain - to explain something you will
wellbeing. Make sure you need to provide a clear account of your
include the the factors in the understanding, including details like why
grey boxes in your answer. and how.
Carbohydrates Balance Fibre
Eatwell Plate Vitamins Protein
Bodily functions Minerals
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Activity 8.1b
Part ii) Fill in the answers to the
two questions on fluid intake.
How many 150ml
What is the
glasses would an
recommended daily
individual have
amount of fluid an
to consume to
individual must
reach the minimum
consume to support
recommended
good hydration?
………………...litres amount? …………......glasses
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Activity 8.1c
Part i) Complete the
List - this term means to identify the
diagram below to list the
signs and symptoms of
main points which can be written as
malnutrition. bullet points.
Signs and
symptoms of
malnutrition
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Activity 8.1c
Part ii) Complete the
diagram below to list the List - this term means to identify the
signs and symptoms of main points which can be written as
dehydration. bullet points.
Signs and
symptoms of
dehydration
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Activity 8.1d
As a healthcare support worker or
adult social care worker, you are
required to promote good nutrition
and hydration, encouraging and
supporting individuals to have the
correct balance of food and fluids
according to their care plan.
For each of the examples below, Explain - to explain something you
explain how you would promote will need to provide a clear account
adequate nutrition and hydration of your understanding, including
for each individual. details like why and how.
How would you promote adequate nutrition and
Individual
hydration?
An individual who has had a
stroke and whose muscles
are weakened
An individual who has
dementia and forgets to eat
and drink
An individual who has
a visual impairment
and needs assistance to
maintain their independence
when preparing food, eating
and drinking
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