1. Therapeutic Diets By: Sari Bornstein

2. Objectives  Describe the most used therapeutic diets and their restrictions  Demonstrate your understanding of therapeutic diets by accurately assembling and delivering the correct food items and their quantities in relation to diet order on a daily basis.

3. Therapeutic diets to discuss:  Renal/Kidney Care  Dysphagia Diets I, II, III  Dental Soft  Bariatric Stage 1  Low Microbial/Neutrop enic  Safety Trays  Fluid Restrictions  1:1 Assistance

4. ICE BREAKER ACTIVITY

5. Renal/Kidney Care  Restricted in potassium, phosphorus, sodium, (protein, fluid)  Minimizes work put on the kidneys  Poor choices: salty foods, dairy, fresh fruit and vegetables, acidic foods  Good choices: Processed, white items  Novasource® Renal supplement

6. Pureed: Dysphagia Level I  Difficulty chewing or swallowing food or liquids  Blended, whipped, mashed to pudding- like texture, no lumps  No garnish  May be accompanied with thickened liquids o Thickened liquids easier to swallow

7. Ground Meat/Diced Fruit and Vegetables: Dysphagia Level II  Difficulty swallowing or chewing due to poor dentition  Meat ground or diced < ¼ inch  Well moistened with gravies  Fruit/vegetables/starches chopped < ½ inch  Soft cooked vegetables, chopped  Soft/canned fruit only, chopped  No bread or rice  Garnish OK

8. Dice/Chop All Foods: Dysphagia Level III  Food broken down for poor dentition with slight swallowing difficulty  All food chopped to < ½ inch  Meats well-moistened, chopped  Vegetables soft cooked, chopped  Most items compliant if chopped  Salad: Shredded lettuce & chopped tomato OK  Soft bread OK, no rice  Sandwiches/burgers OK if cut into quarters  Deli meat OK  No sandwich fillings

9. Dental Soft  Restricts hard to chew, fibrous foods  Mouth pain, poor-fitting dentures  No raw vegetables and limited fresh fruit  No tough, fibrous meats  No hard, sticky or crunchy food  Patient preference = many exceptions

10. Bariatric Stage 1  Post bariatric surgery, clear liquids only  Sugar-free  Diet, clear liquids  caffeine-free  Decaf coffee or tea  No carbonated beverages

11. Low Microbial/Neutro penic Restricts bacterial exposure for immunocompromised patients Well-washed fresh fruit and vegetables OK No uncooked tofu or deli meats No garnish

12. Safety Tray  Harm to self or others  Restricts sharp objects, glass, saran wrap  Foil OK  No hot beverages or soup  No metal utensils, glass dishes, soda cans, saran wrap, hot plates or domes  Do not deliver to patient

13. 1:1 Assistance  Patients need assistance with eating  At risk for aspiration  Call RN before tray delivery  May deliver into room, but not within reach of the patient

14. Enteral Fluid Restriction  Prevents fluid retention  Heart or kidney failure  Dry, 1000, 1200, 1500, 1800, 2000 mL per day  Total includes fluid allowance from the floor  Includes: all beverages, jello, popsicles, ice cream, milk, soup/broth, ice, supplements  Example: 1 cup coffee = 6 oz. coffee  Small paper cup = 12 oz.  Be aware of hot fluid amounts dispensed

15. Looking at the ticket:  Diet order may not match food consistency  Example: Dice/Chop All Foods  Pear Halves  pears chopped to ½ inch  Squash and Carrot Medley  chopped to ½ inch  Grilled Cheese on White  cut into quarters  Angel food cake  chopped Angel food cake to ½ inch  EVERYTHING chopped   Assuming tray line staff & cooks look at diet   Always pay attention to service notes

16. Considerations & Conclusion:  There may be exceptions  Always follow service notes first  If it’s questionable, ask diet clerks  Expeditors double check tickets  Hosts dispense correct liquid portions  appropriateness of additional condiments  Diet manual

17. Empower yourself to…  One thing you can do to improve tray line accuracy  All food items present  All portions are correct  All consistencies are correct  Presentable  Delivered within 45 minutes  Dietary restriction knowledge  Cheat sheet  Diet manual

18. THANK YOU