1. Standard 12 – I CAN… perform a nutritional therapeutic diet analysis

2. Diets TABLE OF CONTENTS Lessons 1. Basic Facility Diets Go
2. Therapeutic Diets Go
3. Other Dietary Considerations Go
TABLE OF CONTENTS

4. Lesson 1 – Basic Facility Diets
Regular
Soft
Liquid
Basic Facility Diets
The food served to patients in a health care facility is prepared by the dietary department. Usually each facility has many types of diets. Which diet is served depends on the patient's needs. Some common facility diets include:   
Regular   
Soft   
Liquid

5. Lesson 1 – Basic Facility Diets
Regular diet
Based on the food groups
No restrictions
Regular Diet
A regular diet is based on the food groups and has no restrictions. It may also be called a general diet or house diet. A regular diet is well-balanced and includes a great variety of foods. In many facilities, patients may choose foods from a menu.

6. Lesson 1 – Basic Facility Diets
Soft diet
Easily digested foods
Soft Diet
A soft diet includes only foods that are easy to digest. A soft diet may be used before and after surgery. It may also be used for patients who have problems with their digestive tract. And it may be prescribed for patients with chewing or swallowing problems.
Foods permitted on a soft diet include: soups, mild cheeses, crackers, toast, fruit juices, cooked or canned fruit, tea, coffee, milk, cream, butter, cooked cereals, cooked vegetables, boiled or stewed white meat of poultry, plain cakes, gelatin, custard, pudding, and plain ice cream.
Foods to be avoided on a soft diet include: coarse cereals, spices, beans and other gas-forming foods, high-fiber foods, fried foods, corn, raw fruits and vegetables, and rich pastries or desserts

7. Lesson 1 – Basic Facility Diets
Liquid diet
Foods that are liquid at room temperature or that melt at body temperature
Clear liquid diet
Full liquid diet
Liquid Diets
Liquid diets include food considered to be liquids. A liquid is defined as any food that is liquid at room temperature or melts at body temperature. The two types of liquid diets are clear liquid and full liquid diets

8. Lesson 1 – Basic Facility Diets
Clear liquid diet
Liquids that are transparent when held up to light
Clear-Liquid Diet
A clear liquid diet includes only liquids that are transparent when held up to light. These kinds of liquids leave little residue and do not cause irritation to the digestive tract. A clear liquid diet may be used to aid digestion before and after surgery. It may also be given in preparation for medical tests.
Foods permitted on a clear liquid diet include: water, fruit juices that can be seen through, plain coffee and tea, fat-free broths, soft drinks, gelatin, fruit ice, popsicles, and clear hard candy.

9. Lesson 1 – Basic Facility Diets
Full liquid diet
All liquids
Full Liquid Diet
A full liquid diet includes all liquids. A full liquid diet may be used before and after surgery. It may also be prescribed for patients with chewing or swallowing problems.
Foods permitted on a full liquid diet include: foods on the clear liquid diet, milk, all vegetable and fruit juices, yogurt, cooked cereals, strained soups, pudding, plain ice cream, sherbet, butter, margarine, cream, honey, and syrup.

10. Lesson 1 – Progression of Diet
Ice chips and sips of water
Clear liquid diet
Full liquid diet
Soft diet
Regular diet
Progression of Diets
After surgery or an upset stomach, a patient usually must follow a certain progression of diets. The typical order is:   
Ice chips and sips of water   
Clear liquid diet   
Full liquid diet   
Soft diet   
Regular diet
Each diet serves as a transition to the next one, easing restrictions along the way. The ultimate goal is for the patient eventually to return to the regular diet, if possible

11. Lesson 2 – Therapeutic Diets
Modification of normal diet for health reasons
Diabetic
Sodium-restricted
Calorie-restricted
Low-fat and low- cholesterol
High-calorie
High-protein
Bland
Mechanically altered
Therapeutic Diets
A therapeutic diet is a modification of a normal diet for health reasons. It is planned and prepared according to the patient's special needs. Therapeutic diets may treat and prevent health problems, aid digestion, or change body weight. They are usually ordered by a physician or dietician.
Some therapeutic diets are:   Diabetic diet   Sodium-restricted diet   Calorie-restricted diet   Low-fat and low-cholesterol diet   High-calorie diet   High-protein diet   Bland diet   Mechanically altered diet

12. Lesson 2 – Therapeutic Diets
Diabetic diet
Keep blood sugar level within normal limits
Eat complex carbohydrates
Eat at regular times
Diabetic Diet
The goal of a diabetic diet is to keep the patient's blood sugar level within normal limits. Diet is an important part of therapy for patients who have diabetes. Sometimes diet alone can be used to control the disease. However, oral medications and insulin injections often are also required.
Patients are encouraged to choose complex carbohydrates over concentrated sweets, such as soda, candy, and desserts. The body digests complex carbohydrates more slowly, and they cause less of a swing in blood sugar levels. Sometimes a specific calorie level is also prescribed, such as a 1,200 or 1,500 calories each day.
These patients should also eat meals and snacks at the same time every day. Eating at regular times is another way to prevent swings in blood sugar levels. It is critical for assistants to serve the meals and snacks on time.

13. Lesson 2 – Therapeutic Diets
Sodium-restricted diet
Limits salt
Sodium-Restricted Diet
A sodium-restricted diet limits salt in the diet. It may be used for patients who have kidney, liver, or heart diseases, including high blood pressure.
The following foods should be avoided on a sodium-restricted diet: salted crackers and snacks, pork and ham, luncheon meats, processed meats, pickles, canned foods, peanut butter, mayonnaise, and sauces such as soy, chili, tomato, steak, and barbecue.
In some cases, using salt for cooking or adding it to food at the table is not permitted.

14. Lesson 2 – Therapeutic Diets
Calorie-restricted diet
Limit calories consumed in a day
Control sizes of food portions
Calorie-Restricted Diet
A calorie-restricted diet limits the amount of calories consumed in a day. It may be used for patients who are inactive or overweight.
The following foods should be avoided on a calorie-restricted diet: fried food, high-fat meats, gravy, butter, cream, salad oils, rice, noodles, cakes, pastries, candy, and soda.
The sizes of food portions should also be controlled on a calorie-restricted diet.

15. Lesson 2 – Therapeutic Diets
Low-fat and low- cholesterol diet
Limit:
Fried food
High-fat meats
Cheese
Butter
Cream
Salad oils
Cakes and pastries
Low-Fat and Low-Cholesterol Diet
A low-fat, low-cholesterol diet limits the amount of fat and cholesterol in the diet. It may be used for patients who have liver or heart disease, or who have difficulty processing fat.
The following foods should be avoided on a low-fat, low-cholesterol diet: fried food, high-fat meats, cheese, butter, cream, salad oils, cakes, and pastries.

16. Lesson 2 – Therapeutic Diets
High-calorie diet
No restrictions
Increased sizes of food portions
Snacking encouraged
High-Calorie Diet
A high-calorie diet increases the amount of calories consumed in a day. It may be used for patients who are underweight or who have cancer or anorexia nervosa.
There are no restrictions on the food in this diet. The sizes of food portions are increased at regular meals. In addition, snacks are served between meals.

17. Lesson 2 – Therapeutic Diets
High-protein diet
Increase protein to promote tissue repair and healing
High-Protein Diet
A high-protein diet increases the amount of protein in the diet. Protein helps with tissue repair and promotes healing. This diet may be used for patients with high fever, infection, burns, or other wounds.
The following foods are included on a high-protein diet: meat, milk, eggs, cheese, fish, poultry, and green, leafy vegetables.

18. Lesson 2 – Therapeutic Diets
Bland diet
Foods mild in flavor
Soft foods
Bland Diet
A bland diet consists of foods that are mild in flavor and soft. It may be used for patients who have digestive problems.
The following foods should be avoided on a bland diet: whole-grain breads and cereals, raw fruits and vegetables, smoked and salted meats or fish, coarse foods, fried foods, spicy foods, carbonated beverages, coffee and tea, pastries, and candy.

19. Lesson 2 – Therapeutic Diets
Mechanically altered diet
Mechanical soft diet
Foods ground to consistency of hamburger
Pureed diet
Foods blended with a liquid until consistency of pudding
Mechanically Altered Diet
With a mechanically altered diet, the consistency and texture of the food is changed. It may be used for patients who have difficulty chewing or swallowing.
The mechanically altered diet may include foods offered on a regular or therapeutic diet.   
With a mechanical soft diet, meat and hard foods are ground to the consistency of hamburger. Soft items, such as bread or mashed potatoes, are not ground. This diet may be used for patients with no teeth or other severe dental issues.   
With a pureed diet, the food is blended with gravy or another liquid until it is like pudding. This diet may be used for patients who have difficulty with swallowing.

20. Lesson 3 – Other Dietary Considerations
Factors that affect diet
Age
Culture
Religion
Personal choice
Health conditions and illness
Factors that Affect Diet
Several factors can affect a person's diet and eating habits. These factors may include:   
Age   
Culture   
Religion   
Personal choice   
Health conditions and illness

21. Lesson 3 – Other Dietary Considerations
Digestive system aging
Taste buds decrease
Enzymes decrease
Gag reflex less effective
Movement of food slows
Flatulence and constipation more common
Nutrients absorbed slower
Aging Changes to the Digestive System
As people age, they experience physical changes in their bodies. Like other body systems, the digestive system changes with age.   
Taste buds decrease in both number and the ability to sense flavors.   
The flow of enzymes decreases, and saliva is thicker.   
The gag reflex is less effective, which increases the risk of choking.   
The muscles along the digestive tract have less tone and strength, and the movement of food through the system slows.   
Flatulence and constipation are more common.   
Nutrients are absorbed into the body at a slower rate.
As a result of such changes, some older persons may not be able to eat certain foods that they previously enjoyed.

22. Lesson 3 – Other Dietary Considerations
Cultural food practices
Food choices and preparation vary among ethnic groups
Cultural Food Practices
Culture influences food practices. Food choices and preparation vary among ethnic groups. For example, beef is a common source of protein in the United States. However, it is not eaten in India. And in Mexico, rice and beans are more common protein sources. Even within a particular country, special foods may be associated with certain regions. A patient's cultural food practices must be considered when planning a diet.

23. Lesson 3 – Other Dietary Considerations
Religious food practices
Rules for cooking, serving or eating selected foods
Religious Food Practices
Many religions have established certain rules for food practices. They may affect how a person cooks, serves, or eats selected foods. Some religious groups:   
Require specific periods of fasting for their followers.   
Forbid certain meats and fishes. For example, Islam and Judaism do not permit their followers to eat pork.   
Forbid the use of alcohol, coffee, or tea. Religions with such restrictions include Adventist, some Baptist, Mormon, and Islam.   
Require that food is prepared with approved methods. For example, the laws of Judaism do not allow meat and milk products to be cooked or eaten together or even served with the same utensils or dishes.
It is important for health care workers to respect each patient's religious practices.

24. Lesson 3 – Other Dietary Considerations
Personal choice of foods
Influenced by family practices and memories
Personal Choice of Foods
Some choices about food are personal. Many preferences are influenced by family practices. For example, people usually like foods that bring back pleasant memories. As a result, adults tend to like foods that were served to them in the home when they were children.
People usually dislike foods that have been associated with an unpleasant reaction. They tend to avoid foods that have caused them allergic reactions, nausea, indigestion, or headaches in the past.
A patient's individual preferences regarding food should also be respected.

25. Lesson 3 – Other Dietary Considerations
Health conditions and illness may impact how a person eats.
Health Conditions and Diet
Health conditions and illness may impact how a person eats. Pain, nausea, and medications may cause a loss of appetite. Confused patients may not recognize the signs of hunger. Loss of teeth affects the ability to chew food. Illness may also make a person unable to prepare and serve meals.

26. Lesson 3 – Other Dietary Considerations
Dysphagia diet
Patients with difficulty swallowing
Change thickness of foods
Dysphagia Diet
Patients with dysphagia have difficulty swallowing. With this condition, they may not be able to ingest enough food and fluids to meet their needs. As a result, these patients may be at risk for malnutrition and dehydration.
Food thickness is changed for these patients to make swallowing easier. A physician may order a mechanically-altered diet. Food thickeners may also be ordered for liquids. The assistant normally adds the thickener at the time of feeding. Care must be taken to add the correct type and amount of thickener.

27. Lesson 3 – Other Dietary Considerations
Nourishments
Snacks served between meals
Supplements
Liquids or foods to improve patient’s nutrition
Nourishments and Supplements
Nourishments are snacks served to patients between meals. Common snacks offered include: milk, juice, fruit, gelatin, custard, sherbet, and ice cream.
Supplements are liquids or foods ordered by a physician to improve a patient's nutrition. They are often given to increase weight. High-protein drinks may be used to help the healing process for a patient with wounds.
The assistant should serve nourishments and supplements in a timely manner. Patients should be encouraged to eat them and provided with assistance as needed. The assistant also picks up the used glasses and dishes after the patient has finished.

28. Exit Ticket 1. Define Dysphagia 2. List the three basic facility diets
3. Contrast mechanical vs. pureed diet
4. List the 5 factors that effect diet
5. Three factors of digestive system aging
6. 5 steps of a diet progression
7. I HAVE…