Understand - PowerPoint Presentation

Slide1

Understand

nurse aide skills needed to provide for residents’ nutrition and hydration needs.

Unit B Resident Care SkillsEssential Standard NA6.0 Understand nurse aide skills needed to provide for residents’ nutrition, hydration, and elimination needs. Indicator 6.01 Understand nurse aide skills needed to provide for residents’ nutrition and hydration needs.

6.01

Nursing Fundamentals 7243

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6.01Nursing Fundamentals 7243

6.01 IntroductionThis indicator introduces the nurse aide to the basic principles of nutrition. It

includes

ChooseMyPlate.gov,

therapeutic diets, adaptive devices, alternative methods of feeding, providing drinking water and nourishments, feeding a resident, and measuring/recording intake and output. Slide3

There

is

intentional repeat of some HSII course content in Nursing Fundamentals. Repeating course content distributes learning over time and increases long term memory. Academic and skill competence must be maintained at a very high level for direct

resident care.Be GREEN. Recycle knowledge and build on it!

Nursing

Fundamentals 724336.01Slide4

Food is broken down by the gastrointestinal system into small substances

called nutrients. Nursing Fundamentals 72434

Nutrients6.01Slide5

Nutrients are absorbed

into the body for use. Nursing Fundamentals 72435

6.01NutrientsSlide6

Nursing Fundamentals 72436

Nutrients6.01

Protein

CarbohydratesFats

Vitamins

Minerals

WaterSlide7

Builds and

repairs tissueNursing Fundamentals 72437Nutrient - Protein

6.01NUTRIENTSlide8

Supplies fuel for the body’s energy needs

Supplies fiber necessary for bowel eliminationNursing Fundamentals 72438Nutrient - Carbohydrates

6.01Slide9

Source of stored energy

Helps body use certain vitaminsConserves body heat Protects organs from injury

Holds kidneys placeNursing Fundamentals 72439Nutrients - Fat6.01Slide10

Necessary for carrying out and maintaining specific body

functionsNursing Fundamentals 724310Nutrients – Vitamins

6.01Slide11

Necessary

for carrying out and maintaining specific body functionsNursing Fundamentals 724311Nutrients –Minerals

6.01Slide12

Nursing Fundamentals 7243

12Nutrients - Water

6.01The most essential nutrient for lifeWithout it a person can only live a few daysAssist in digestion and absorption of foodHelps maintain normal body temperatureLargest component of blood plasmaSlide13

No one food contains ALL the NUTRIENTS needed for good health.

Nursing Fundamentals 724313Nutrients6.01

Soooooooooo . . .Eating a variety of foods is needed to sustain good health.Slide14

Nutrition guides typically divide foods into food groups

and recommend daily servings of each group for a healthy diet.Nursing Fundamentals 724314Nutrition Guides

6.01Slide15

A food group

is a collection of foods that share similar nutritional properties or biological classifications. Nursing Fundamentals 724315

Food Group6.01Slide16

Nursing Fundamentals 724316

Vegetable Group6.01Make half your plate fruits and

vegetables.Vary your vegetables.Slide17

Nursing Fundamentals 724317

Fruits Group6.01Make half your plate

fruits and vegetables.Slide18

Nursing Fundamentals 724318

Grains Group6.01Make

at least half your grains whole grains. Slide19

Nursing Fundamentals 724319

Protein Group6.01Make

lean choices.51+ years old, need 5 ½ ozs. daily for men and 5 ozs. for women. Slide20

Nursing Fundamentals 724320

Dairy Group6.01Switch to

fat-free or low-fat (1%) milk.Men and women over 51 years old need 3 cups of dairy group each day.Slide21

Nursing Fundamentals 724321

ChooseMyPlate.gov6.01Slide22

Two overarching concepts:Nursing Fundamentals 7243

22Dietary Guidelines for Americans6.01

Maintain calorie balance over time to achieve and sustain a healthy weight.Slide23

A calorie is a unit of

energy. Nursing Fundamentals 724323

Calories6.01Slide24

Nursing Fundamentals 724324

Calories6.01

Taken from: How Stuff WorksSlide25

Two overarching concepts:Nursing Fundamentals 7243

25Dietary Guidelines for Americans6.01

Focus on consuming nutrient-dense foods and beverages.Slide26

Foods that have high nutritional content

as well as “energy”Nursing Fundamentals 724326Nutrient Dense

6.01Slide27

Calories contained in food that provide

“fuel” but few or no nutrients. Nursing Fundamentals 724327 Empty Calories

6.01Slide28

Factors That Influence Caloric Need

AgeSexSize and activity levelClimateState of healthAmount of sleep obtained

Nursing Fundamentals 7243286.01Slide29

6.01

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29Effects of Good NutritionPromotes physical and mental healthProvides increased resistance to illnessProduces added energy and

vitalityAids in the healing processAssists one to

feel and sleep betterSlide30

Healthy, shiny looking hairClean skin and bright eyes

A well-developed, healthy bodyAn alert facial expressionAn even, pleasant dispositionNursing Fundamentals 7243

30Signs of Good Nutrition6.01Slide31

Restful sleep patternsHealthy appetite

Regular elimination habitsAppropriate body weightNursing Fundamentals 724331

Signs of Good Nutrition6.01Slide32

Hair and eyes appear dullIrregular bowel habits

Weight changesOsteoporosis and other diseases

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Signs of Poor Nutrition

6.01Slide33

Results of Poor Nutrition(continued)

Lack of interest - mental slowdownSkin color and appearance poor

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Signs of Poor Nutrition

6.01Slide34

Results of Poor Nutrition(continued)

Anemia leading to:tired feelingshortness of breathincreased pulseproblems with digestionpale skinpoor sleep patternsheadaches

Nursing Fundamentals 724334Signs of Poor Nutrition6.01Slide35

Basic Nutrition

Have we got it?Let’s check and seeStick diagnostics

Student Name AStudent Name BNursing Fundamentals 7243

356.01Slide36

6.01

Nursing Fundamentals 724336Influences on nutrition and dietary habits

1) Aging2) CultureSlide37

Metabolism slows

muscles weaken body moves slow activity is reduced reduced activity decreases appetite. Nursing Fundamentals 724337

Nutritional Challenges of Geriatrics6.01Slide38

Loss of vision affects the way food looks, which can decrease appetite.

Nursing Fundamentals 724338Nutritional Challenges of Geriatrics6.01Slide39

The aging process and some medications weaken the sense of smell and taste

which can decrease appetite. Nursing Fundamentals 724339Nutritional Challenges of Geriatrics

6.01Slide40

Less saliva production affects chewing and swallowing.

Nursing Fundamentals 724340Nutritional Challenges of Geriatrics6.01Slide41

Dentures and poor dental health make chewing difficult.

Nursing Fundamentals 724341Nutritional Challenges of Geriatrics6.01Slide42

Digestion takes longer and it is less efficient.

Nursing Fundamentals 724342Nutritional Challenges of Geriatrics6.01Slide43

Constipation interferes with appetite.

Nursing Fundamentals 724343Nutritional Challenges of Geriatrics6.01

XSlide44

6.01

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44Factors Influencing Dietary PracticesPersonal preferenceAppetiteFinance

IllnessCultureSlide45

The diets of Chinese

, Japanese, Koreans and people from Far East include rice and tea The diets of Spanish-speaking people include spicy dishes containing rice, beans and corn

Nursing Fundamentals 7243

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Culture and Dietary Practices

6.01Slide46

Culture and Dietary Practices(continued)

The Italian diet includes spaghetti, lasagna, and other pastasScandinavians have a lot of fish in their diets

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Culture and Dietary Practices

6.01Slide47

Culture and Dietary Practices(continued)

Americans eat a lot of meat, fast foods, and processed foodsUse of sauce and spices are culturally related

Nursing Fundamentals 7243

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Culture and Dietary Practices

6.01Slide48

Days of

fasting when all or certain foods are avoidedChristian Science - avoid coffee/tea and alcoholRoman Catholic - avoid food one hour before communion, observe special fast days

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6.01Slide49

Muslim/Moslem - avoid alcohol, pork products

7th Day Adventist - avoid coffee/tea, alcohol, pork and some meats, caffeine

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6.01Slide50

Baptists – some avoid coffee, tea and alcohol

Greek Orthodox - fast days, but usually “forgiven” when ill

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6.01Slide51

Conservative Jewish faithProhibits shellfish, non-kosher meats such as pork

Requires special utensils for food preparation

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6.01Slide52

Conservative Jewish faithForbids cooking on Sabbath

Forbids eating of leavened bread during Passover

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6.01Slide53

Conservative Jewish faithForbids serving milk and milk products with meat

Strict rules regarding sequence in which milk products and meat may be consumedNursing Fundamentals 724353

6.01Slide54

6.01

Nursing Fundamentals 724354Therapeutic, Modified, or Special DietsSlide55

Help body organs to maintain and/or regain normal function

Treat metabolic disorders by regulating amount of food

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Therapeutic, Modified or Special Diets

6.01Slide56

Add or eliminate calories to cause a change in body weight

Assist with digestion of food by taking foods out of diet that irritate digestive systemRestrict salt (sodium) intake to prevent or decrease edema

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Therapeutic, Modified or Special Diets

6.01Slide57

Clear liquidFull liquid

BlandLow residueControlled carbohydrate (Diabetic)Low fat/low cholesterol

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6.01

Types of Therapeutic

, Modified or Special DietsSlide58

High fiber Low calorie

High calorieSodium restrictedHigh proteinMechanical soft, chopped, pureed

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6.01

Types of Therapeutic, Modified or Special DietsSlide59

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6.01Diet CardsList:the resident’s name

Information about special dietsFood allergiesLikes and dislikesSlide60

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6.01Low-Sodium DietsResidents with high blood pressure, heart disease, kidney disease, or retention may be placed on a low-sodium diet.

Salt packets will not be on the food tray.Common abbreviations: “NAS” (no added salt) and Low Na (low sodium)Slide61

Nursing Fundamentals 724361

6.01Low-Protein DietsResidents with severe kidney disease may be on a low protein diet.

Proteins breakdown into substances that can harm the kidneys.Extent of protein restriction will vary depending on the stage of kidney disease.Slide62

Nursing Fundamentals 724362

6.01Fluid-Restricted DietsResidents with severe heart or kidney disease may need fluid restriction.

Measure and document exact amounts of fluid intake. Report excesses to the nurse. Do not offer additional fluids or foods that contain fluids. Notify the nurse if the resident complains of thirst. Common abbreviation is “RF” (restrict fluids)Slide63

Nursing Fundamentals 724363

6.01Low-Fat/Low-Cholesterol DietsResidents with high levels of cholesterol, gall bladder disease, diseases that interfere with fat digestion, and liver disease may be placed on these diets.

Diets permit skim milk, low fat cottage cheese, fish, white meat of turkey and chicken, veal, and vegetable fats. Use of monounsaturated fats such as olive oil, canola, and peanut oils are encouraged.Do not offer additional fluids or foods that contain fluids. Notify the nurse if the resident complains of thirst. Common abbreviation is “Low-Fat/Low-Chol”Slide64

Nursing Fundamentals 724364

6.01Modified Calorie DietsResidents may need to reduce calories to lose weight or increase calories to gain weight.

Do not offer residents on a low-cal diet extra food. Check with the nurse. Common abbreviation is “Low-Cal/High-Cal”Slide65

Nursing Fundamentals 724365

6.01Dietary Management of DiabetesCalories and carbohydrates are carefully controlled.

Fats and proteins are regulated.Amounts of food are determined by energy needs. Diabetics must eat all the food served on the tray.Do not offer other foods without the nurse’s approval. Slide66

Nursing Fundamentals 724366

6.01Dietary Management of DiabetesMeal tray may contain artificial sweeteners

Common abbreviations for diabetic diets are “NCS” no concentrated sweets and the amount of calories allowed followed by “ADA” (American Diabetic Association)Slide67

Nursing Fundamentals 724367

6.01Diets Modified in ConsistencyLiquid Diet

Soft Diet and Mechanical Soft DietPureed DietSlide68

Nursing Fundamentals 724368

6.01Liquid DietsOrdered short term for medical condition or before or after a test or surgery.

Liquid food is anything that is in the liquid state at room temperature. Slide69

Nursing Fundamentals 724369

6.01Liquid Diets“Clear Liquids”Clear juices

BrothGelatinPopsicles“Full Liquids”Clear liquids plus:Cream soupsMilkIce creamSlide70

Nursing Fundamentals 724370

6.01Soft and Mechanical Soft DietsMakes food easier to chew and swallow

SOFT DIETSHigh fiber foods, fried foods, spicy foods, raw vegetables and fruits and some meats will be restricted. Food is chopped or blended. MECHANICAL SOFT DIETS Food choices are not limited. Only the texture of the food is changed.Slide71

Nursing Fundamentals 724371

6.01Pureed DietsThis diet does not require that a resident chew his/her food.

Food is chopped, blended, or ground into a thick paste of baby food consistency.Slide72

6.01

Nursing Fundamentals 7243

72Nurse Aide Responsibilities in Serving Therapeutic DietsServe the RIGHT resident the RIGHT tray containing the RIGHT therapeutic diet at the RIGHT

temperature in the RIGHT environment with the RIGHT attitude.Slide73

Therapeutic diets

Have we got it?Let’s check and seeStick diagnostics

Student Name AStudent Name BNursing Fundamentals 724373

6.01Slide74

6.01

Nursing Fundamentals 724374Devices and alternate methods used to take in nutrientsSlide75

Food GuardsDivided Plates

Built-up handled utensilsEasy grip mugs/glassesResidents have to be taught how to use these devices.

Nursing Fundamentals 7243

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6.01

Adaptive DevicesSlide76

Fluids administered through vein. IVs help hydrate but have little

nutritional valueResponsibility of licensed nurse

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6.01

Parenteral Fluids

(Intravenous Infusion - IV)Slide77

Observations to report

Near-empty bottle/bagChange in drip ratePain at needle site, and/or redness and/or swelling, if observableLoose, non-intact, or damp dressing

6.01Nursing Fundamentals 724377Slide78

Liquid formula administered into the stomach through

a tube by licensed

nurse Nose to stomach - nasogastric tubeDirectly into stomach – gastrostomy tube - “PEG tube” (Percutaneous Endoscopic G

astrostomy) Mitts may be ordered to prevent resident from dislodging tubeNursing Fundamentals 724378

6.01

Enteral FeedingSlide79

Nursing Fundamentals 724379

6.01Enteral Feeding

PEG tubeSlide80

Residents unable to take nutrients by mouth can consent to enteral feeding.

DepressedComatoseSwallowing problem (stroke, Alzheimer’s or other medical conditions)Disorders of digestive tract

Nursing Fundamentals 7243

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6.01

Enteral FeedingSlide81

6.01

Nursing Fundamentals 7243

81Nurse Aide Responsibilities in Alternative NutritionEnsure that there is no tension on tubing, no kinks, no coils, and tube not underneath resident.Keep resident’s nose clean and free of mucusKeep tube secure

Perform frequent oral care with nasogastric or PEG tubeSlide82

Immediately report:Redness or drainage around the opening

Skin sores or bruisesCyanotic skinResident complaints of chest pain or nauseaChokingTube falls outFeeding pump alarm soundsResident’s inclined position changes

6.01Nursing Fundamentals 724382Slide83

alternate ways to get nutrients

Have we got it?Let’s check and see

Stick diagnosticsStudent Name A

Student Name BNursing Fundamentals 7243836.01Slide84

6.01

Nursing Fundamentals 724384Fluid Balance(Hydration) Slide85

Nursing Fundamentals 7243

856.01Fluid NeedsUnder normal conditions:

64 ounces dailyEight 8-ounce glasses of water/fluids a daySlide86

Nursing

Fundamentals 724386Consume 2-1/2 to 3-1/2 quarts dailyeatingdrinking

Eliminate 2-1/2 to 3-1/2 quarts dailyurineperspiration water vapor through respirationsstool6.01Fluid (Hydration) BalanceSlide87

Nursing Fundamentals 7243

876.01Fluid ImbalancesEdema –

too much fluid in the bodyDehydration – too little fluid in the bodySlide88

Nursing Fundamentals 724388

Fluid intake exceeds fluid output - fluid retentionCaused by:Kidney or failure

Heart failureExcessive salt intake6.01EdemaSlide89

Nursing Fundamentals 724389

Signs of Edema:Weight gain Swelling of feet, ankles, hands, fingers, faceDecreased urine output

Shortness of breathCollection of fluid in abdomen (ascites)6.01EdemaSlide90

6.01

Nursing Fundamentals 7243

90Residents’ weights must be accurate! Fluid retention can be detected by weight gain.Slide91

6.02

Nursing Fundamentals 724391 SKILL

Weighing a residentTraining Lab AssignmentEngage in the Skill Distributed Practice for:Slide92

Nursing Fundamentals 724392

Fluid output exceeds fluid intake Common problem of long-term care residents

6.01

DehydrationSlide93

Nursing Fundamentals 724393

Signs thirstdecreased urine outputparched or cracked lipsdry, cracked skin

feverweight lossconcentrated urinetongue coated and thick6.01DehydrationSlide94

Nursing Fundamentals 724394

Causes of dehydrationpoor fluid intakediarrheableeding vomitingexcessive perspiration

6.01

DehydrationSlide95

Nursing Fundamentals 7243

956.01Special Fluid OrdersForce Fluids “FF” means to encourage the resident to drink more fluids.

Restrict Fluids “RF” means to limit the amount of fluids to the amount set by the physician. NPO means nothing by mouthThickened liquids help prevent choking Slide96

Force

fluidsOffer fluids in small quantitiesOffer fluids (resident preference) without being asked on every contact with residentRemind resident of importance of fluids in bodily functions

Nursing Fundamentals 7243966.01Special Fluid OrdersSlide97

RESTRICTED FLUIDS

Remind resident of the restrictionMeasure and record exact amount of fluid intake Report excesses to the nurseDo not offer additional fluids or foods that contain fluidsTell nurse if resident complains of thirstAbbreviation is “RF”Nursing Fundamentals 7243

976.01Special Fluid Orders

RESTRICTEDSlide98

N P O

Nada per os or nothing by mouthResident is not allowed anything to eat or drink!NEVER OFFER FOOD OR DRINK OR WATER TO A RESIDENT WHO IS NPONPO residents will be getting IVs or tube feedingsNPO is ordered before surgery and some tests

Nursing Fundamentals 7243986.01Special Fluid OrdersSlide99

Nursing Fundamentals 724399

THICKENED LIQUIDSImproves the ability to control fluids in the mouth and throat. For residents with swallowing problems. If ordered, must be used with all liquids.Do not offer water, water pitcher, or other liquids to a resident who must have thickened liquids.Three basic consistencies are:Nectar thick; like a thick juice such as tomato

Honey thick; pours slowly like honeyPudding thick; must be consumed with spoon

6.01Special Fluid OrdersSlide100

6.01

Nursing Fundamentals 7243100RelatedSKILLSlide101

Fresh water should be provided periodically throughout dayEncourage to drink 6-8 glasses daily if

appropriateOffer fluids on every resident encounter unless ordered otherwise.

Nursing Fundamentals 7243

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6.01

Providing Fresh Drinking WaterSlide102

6.02

Nursing Fundamentals 7243102 SKILL

6.01AProvide fresh drinking waterTraining Lab AssignmentEngage in the Skill Acquisition Process for:Slide103

6.01

Nursing Fundamentals 7243103What is

pagophagia?Slide104

Nursing Fundamentals 7243104

Ice craving is a condition called pagophagia, or compulsive eating of ice. This is a form of pica, a condition in which people crave and eat non-food substances like ice, chalk, paper, laundry soap, starch, hair, dirt, clay, or paint.There are several reports linking the craving of ice to iron-deficiency anemia (low blood count as a result of an iron-deficiency). In fact, there’s even website called “

All About Chewing Ice,” which also has a support group for people with this condition.Residents often crave ice.

6.01PagophagiaSlide105

6.01

Nursing Fundamentals 7243

105When residents ask for ice….GET IT!Unless ordered otherwise.Slide106

Nursing Fundamentals 7243106

Fluids measured in milliliters (ml) which is metric measure30 ml = 1 ounceDO NOT MEASURE IN CCs

30

20

10

6.01

Measuring FluidsSlide107

Nursing Fundamentals 7243107

30 ml = 1 ounce

30

20

10

6.01

REMEMBER Slide108

Nursing Fundamentals 7243108

Physician orders intake and outputINTAKE includes:All liquid taken by mouthFood items that turn to liquid at room temperatureTube feedings into stomach through nose or abdomen

Fluids given by intravenous infusion 6.01Measure/Record Intake & OutputSlide109

Nursing Fundamentals 7243109

OUTPUT includesUrineLiquid stoolEmesisDrainage

Suctioned secretionsExcessive perspiration

6.01

Measure/Record

Intake & OutputSlide110

6.01

Nursing Fundamentals 7243110RelatedSKILLSlide111

6.02

Nursing Fundamentals 7243111 SKILL

6.01BMeasure and record intake and outputTraining Lab AssignmentEngage in the Skill Acquisition Process for:Slide112

fluid balance, measuring I & 0, providing drinking water

Have we got it?Let’s check and seeStick diagnostics

Student Name AStudent Name BNursing Fundamentals 7243

1126.01Slide113

6.01

Nursing Fundamentals 7243113Preparing Residents for MealsSlide114

Make meals an enjoyable and sociable experience

Provide pleasant environmentClean areaOdor-free areaAdequate lightingFlowers/decorations and music add interest to dining areaNursing Fundamentals 7243114

6.01Preparing Residents for MealsSlide115

Because eating is a social activity

of daily living…Do not enclose the bedbound resident with privacy curtains when feeding them. Nursing Fundamentals 72431156.01

Preparing Residents for MealsSlide116

All residents clean and dressed for meals

Hair combedOral care providedEncourage to use bathroom or urinal/bedpanCleanse and dry incontinent residents

Nursing Fundamentals 7243

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6.01

Preparing Residents for MealsSlide117

Resident’s face and hands

washed before meal – rewash residents’ hands and mouth after mealsProvide for comfortRaise head of bedPosition in chairTransport to dining areaProvide clothing protector

if appropriate Nursing Fundamentals 72431176.01Preparing Residents for MealsSlide118

Clothing Protector:Offer but do not insist, residents’ have the right to refuse

Using the term “bib” decreases the residents dignity by treating them like childrenNursing Fundamentals 72431186.01Preparing Residents for MealsSlide119

Check to be certain resident receives right tray and has correct diet

Food should be attractively served and placed within reachCheck tray to see that everything needed is there

Nursing Fundamentals 7243

119

6.01

Preparing Residents for MealsSlide120

Assist resident as needed with:

cutting meatpouring liquidsbuttering breadopening containers

Nursing Fundamentals 7243

120

6.01

Preparing Residents for MealsSlide121

Orient blind residents

to food placement on the plate according to face of clockApproach residents from non-effected sideAlternate fluid and food

Nursing Fundamentals 72431216.01General Guidelines Assisting with MealsSlide122

Residents should be encouraged to do as much as possible for themselves

Provide time for resident to complete mealDisplay pleasant, patient attitude while assisting

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6.01

General Guidelines

Assisting with MealsSlide123

Remove tray when meal finished

Tell nurse is not eatingObserve and record amount eaten in %Record fluid intake if orderedAssist to position of comfort

Nursing Fundamentals 7243

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6.01

General Guidelines

Assisting with MealsSlide124

Call signal and supplies positioned within reachArea should be left clean and tidy

Hands washed before and after care of each residentNursing Fundamentals 72431246.01General Guidelines Assisting with MealsSlide125

6.01

Nursing Fundamentals 7243125RelatedSKILLSlide126

6.02

Nursing Fundamentals 7243126 SKILL

6.01CAssisting with dining/feeding resident who cannot feed selfTraining Lab AssignmentEngage in the Skill Acquisition Process for:Slide127

Ordered by physicianServe as directed by supervisor

Provide necessary eating utensils, straw and/or napkinNursing Fundamentals 72431276.01Supplementary NourishmentsSlide128

Usually served:Midmorning

Mid-afternoonBedtime

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128

6.01

Supplementary NourishmentsSlide129

Serve on schedule

so the next meal is not jeopardized by decreased resident appetite.Nursing Fundamentals 72431296.01Supplementary NourishmentsSlide130

MilkJuice

GelatinCustard, ice cream, sherbetCrackersNutritional supplementation products (e.g., Ensure, etc.)

Nursing Fundamentals 7243

130

6.01

Types of NourishmentsSlide131

6.01

Nursing Fundamentals 7243131RelatedSKILLSlide132

6.02

Nursing Fundamentals 7243132 SKILL

6.01Dserving supplementary nourishments.Training Lab AssignmentEngage in the Skill Acquisition Process for:Slide133

Serving meals and supplements

Have we got it?Let’s check and see

Stick diagnosticsStudent Name A

Student Name BNursing Fundamentals 72431336.01Slide134

Understand nurse aide skills needed to provide for residents’ nutrition and hydration needs.

134

 END 6.01

6.01

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