© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Nutritional Needs and Diet Modifications Unit 26

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Spell and define terms. Define normal nutrition. List the essential nutrients. Name the food groups and list the foods included in each group. Identify the basic facility diets and describe each. 2

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives State the purposes of the following diets: –Clear liquid –Full liquid –Soft –Mechanically altered 3

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives State the purpose of calorie counts and food intake studies. Define dysphagia and explain the risks of this condition. Describe general care for the patient with dysphagia and swallowing problems. 4

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives State the purposes of therapeutic diets. List types of alternative nutrition. Describe the nursing assistant actions when patients are unable to drink fluids independently. 5

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Introduction Nutrition –Entire process by which the body takes in food for growth and repair and uses it to maintain health 6

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Normal Nutrition Food is normally taken into the body through the mouth –The beginning of the digestive tract Digestion –Breaking down foods into substances used by body cells for nourishment –Essential nutrients 7

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Essential Nutrients To be well nourished, we must eat foods that: –Supply heat and energy –Regulate body functions –Build and repair body tissue 8

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Essential Nutrients Six essential nutrients: –Proteins –Carbohydrates –Fats –Minerals –Vitamins –Water 9

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Food Groups Grain Fruits Vegetables Dairy Protein foods 10

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. MyPlate 11

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. MyPlate MyPlate follows the federal government’s 2010 Dietary Guidelines for Americans. For additional information, refer to 12

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Water Water is an essential nutrient that is necessary to life A person can live only a few days without water 13

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Water Water is necessary for all cellular functions in the body An adequate intake of fluids is required to replace fluids lost through urine, stool, sweat, and evaporation through skin 14

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Water The normal adult intake of fluids –Should be two to three quarts a day 15

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Water Offering liquids to patients frequently is important because: –Some patients cannot drink liquids without your help –Elderly patients have a decreased sense of thirst –Adequate fluid intake is necessary to prevent urinary problems and constipation 16

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Basic Facility Diets Food served to patients in the health care facility is prepared by the dietary department –It includes the essential nutrients 17

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Basic Facility Diets The way in which it is prepared and its consistency –Will depend on each individual patient’s condition and needs Sometimes very strict dietary control is needed 18

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Regular Diet The regular-select or house diet is a normal or regular (unrestricted) diet –Based on the Food Guide Pyramid and MyPlate 19

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Clear Liquid Diet Temporary diet because it is an inadequate diet Made up primarily of water and carbohydrates for energy It may be used postoperatively –Or when the patient has a condition such as nausea and vomiting 20

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Full Liquid Diet Does supply nourishment –May be used for longer periods of time than the clear liquid diet 21

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Soft Diet Usually follows the full liquid diet Although this diet nourishes the body, between-meal feedings are sometimes given to increase the calorie count 22

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Special Diets Planned to meet specific patient needs Patients may need special diets because of religious preferences or health needs 23

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Religious Restrictions Religious practice requires changes in diet for some patients 24

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Therapeutic Diets Standard diets can be changed to conform to special dietary requirements For example –An order might be written for a low-sodium mechanical soft diet when a patient has ill- fitting dentures and heart disease 25

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Diabetic Diet Diet is an integral part of the therapy of the patient with diabetes mellitus The diet is nutritionally adequate Sometimes a proper diet is all that is needed to control the disease 26

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Consistent Carbohydrates Consistent carbohydrate diet –Served to persons with diabetes –Maintains a consistent carbohydrate content each day –Calories are not counted –Also focuses on maintaining fat levels 27

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Consistent Carbohydrates Patient receives about 50% of total calories from carbohydrates, 20% from protein, and 30% from fat Food supply is not unlimited The person is served three meals a day 28

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sodium-Restricted For persons with chronic renal failure and cardiovascular disease Table salt is a major source of sodium in the diet One of the most difficult diets to follow 29

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Low-Fat/Low-Cholesterol Diet Prescribed for patients who suffer from: –Vascular disease –Heart disease –Liver disease –Gallbladder disease –Those who have difficulty with fat metabolism 30

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Calorie-Restricted Diet As long as activity remains constant A person must take in approximately 500 calories a day less than usual to lose one pound 31

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Mechanically Altered Diets Any diet may be mechanically altered This means that the consistency and texture of foods are modified –Making foods easier to chew and swallow 32

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Mechanically Altered Diets Usually chopped to the texture of hamburger –Making it easier to swallow –Soft items, such as bread, are not modified 33

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Mechanically Altered Diets Usually served to patients with dental or chewing problems, and those with missing teeth 34

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Pureed Diet Blenderized until it is the consistency of pudding or baby food Given to patients who have dysphagia –At risk of aspiration 35

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Pureed Diet The pureed food should not be watery If it is the proper consistency, a plastic spoon will stand upright without falling Make the meal as visually appealing as possible –Avoid referring to the pureed food items as baby food 36

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Supplements and Nourishments Many patients receive a nutritional supplement or between-meal nourishments Supplements are ordered by the physician and have a definite therapeutic value 37

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Nourishments are substantial food items given to patients to increase nutrient intake –Often planned and ordered by the facility dietitian –Sandwiches or pudding –Nutritious liquids, such as milkshakes 38 Supplements and Nourishments

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Snacks Planned and regularly given, or unplanned upon patient request Given to patients to prevent or eliminate hunger between meals 39

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Calorie Counts and Food Intake Studies The physician or dietitian may order special food intake studies for a patient with special nutritional needs 40

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The patient’s food intake is carefully recorded for a period of time, usually three days The food intake is analyzed for nutritional adequacy and number of calories consumed 41 Calorie Counts and Food Intake Studies

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The dietitian uses this information –To plan a diet to meet the patient’s special medical needs 42 Calorie Counts and Food Intake Studies

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Fluid Balance Balance between liquid intake and liquid output –We take in approximately 2½ quarts of fluid daily –Typical output equals about 2½ quarts daily 43

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Recording Intake and Output An accurate recording of intake and output (I&O), or fluid taken in and given off by the body –Basic to the care of many patients Some patients have an order to force (encourage) fluids –Others have a fluid restriction 44

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Recording Intake and Output A fluid restriction requires a physician order You will find information regarding whether to push or restrict fluids on the care plan 45

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Changing Water It is important to provide fresh water for patients –Water is essential to life In all cases, you should know whether a patient is allowed ice or tap water and if water is to be especially encouraged 46

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sensory Problems Some patients have sensory problems affecting their appetites, such as problems with: –Food temperature –Food texture 47

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sensory Problems Some patients have sensory problems affecting their appetites, such as problems with food: –Smell –Taste –Hearing and vision –Touch 48

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sensory Problems Presentation and attractiveness of food are especially important for patients –Whose smell, taste, and texture sensations are impaired 49

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Mealtime Assistance for Patients Who Have Swallowing Problems Patients who have difficulty swallowing –May require one-to-one assistance –Prompting –Or supervision at meals 50

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Choking Requires quick, decisive action Tilting the head back may open the airway 51

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Choking Signs of a complete blockage include inability to speak, high-pitched sounds on inhalation, and grasping the throat in the universal distress signal Abdominal thrusts (Heimlich maneuver) 52

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Foodborne Illness Hot foods must be served hot Cold foods must be served cold –If the food is off-temperature, pathogens may multiply, causing foodborne illness Follow all temperature and infection control precautions when passing trays 53

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Documenting Meal Intake Accurate documentation of each patient’s meal intake is very important Keep diet clipboards and lists covered to protect patient privacy 54

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Total Parenteral Nutrition Total parenteral nutrition (TPN) –A technique in which high-density nutrients are introduced into a large vein –Such as the subclavian or the superior vena cava 55

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Enteral Feedings Enteral feedings are administered by tube Many different types of tubes may be used for these feedings –Nurse or physician inserts the feeding tube 56

© 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Enteral Feedings Specially prepared solutions contain all the nutrients required by the body Keep the patient’s head elevated when the feeding is infusing, and for an hour after meals 57