1. Copyright © 2008 Delmar Learning. All rights reserved. Nutritional Needs and Diet Modifications

2. Copyright © 2008 Delmar Learning. All rights reserved.  Spell and define terms.  Define normal nutrition.  List the essential nutrients.  Name food groups and list foods included in each group.  State liquids/foods allowed on basic facility diets.

3. Copyright © 2008 Delmar Learning. All rights reserved.  Describe purposes of the following diets: Clear liquid Full liquid Soft

4. Copyright © 2008 Delmar Learning. All rights reserved. State the purpose of calorie counts and food intake studies. Define dysphagia and explain risks of this condition.

5. Copyright © 2008 Delmar Learning. All rights reserved.  Describe general care for the patient with dysphagia and swallowing problems.  State purposes of therapeutic diets.  List types of alternative nutrition.

6. Copyright © 2008 Delmar Learning. All rights reserved.  Describe the nursing assistant actions when patients are unable to drink fluids independently.

7. Copyright © 2008 Delmar Learning. All rights reserved.  Nutrition Entire process by which the body takes in food for growth and repair and uses it to maintain health

8. Copyright © 2008 Delmar Learning. All rights reserved.  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 These substances are called…essential nutrients

9. Copyright © 2008 Delmar Learning. All rights reserved.  To be well nourished, we must eat foods that: Supply heat and energy Regulate body functions Build and repair body tissue

10. Copyright © 2008 Delmar Learning. All rights reserved.  Six essential nutrients: Proteins Carbohydrates Fats Minerals Vitamins Water

11. Copyright © 2008 Delmar Learning. All rights reserved. USDA Food Guide Pyramid Designed to be individualized to each person to maintain a healthy weight  Refer to Figure 26–1 to review the six food groups and the familiar USDA Food Guide Pyramid

12. Copyright © 2008 Delmar Learning. All rights reserved.

13.  Water is an essential nutrient that is necessary to life  A person can live only a few days without water

14. Copyright © 2008 Delmar Learning. All rights reserved.  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

15. Copyright © 2008 Delmar Learning. All rights reserved.  The normal adult intake of fluids Should be two to three quarts a day

16. Copyright © 2008 Delmar Learning. All rights reserved.  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

17. Copyright © 2008 Delmar Learning. All rights reserved.  Dysphagia is when a patient has difficulty swallowing  Dysphagia may be a result of: Stroke Cancer of head, neck, esophagus Neurological diseases Dementia

18. Copyright © 2008 Delmar Learning. All rights reserved.  Signs and symptoms of dysphagia: Taking a long time to swallow Frequent clearing or coughing of throat Swallowing three of four times with each bite Lack of a gag reflex or weak cough Difficulty controlling liquids or secretions in mouth  Inform nurse if you see any of these

19. Copyright © 2008 Delmar Learning. All rights reserved.  Food served to patients in the health care facility is prepared by the dietary department It includes the essential nutrients

20. Copyright © 2008 Delmar Learning. All rights reserved.  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

21. Copyright © 2008 Delmar Learning. All rights reserved.  Types of common Facility Diets: Regular (also called general or house) Full liquid Clear liquid Soft  Specialized diets: 1800, 1500 or 1200 ADA diets NAS diet (no added salt)

22. Copyright © 2008 Delmar Learning. All rights reserved.  The regular-select or house diet is a normal or regular (unrestricted) diet Includes all food groups Offers great variety Excludes only very rich foods, fried foods, or heavily seasoned foods which might be difficult for inactive people to digest

23. Copyright © 2008 Delmar Learning. All rights reserved.  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 Consists of liquids that do not irritate, cause gas, or encourage bowel movements

24. Copyright © 2008 Delmar Learning. All rights reserved. Examples of Clear Liquids are: Tea Coffee no cream Soup broths Jello 7-Up, Sprite, GingerAle Apple juice Popsicles

25. Copyright © 2008 Delmar Learning. All rights reserved.  Does supply nourishment May be used for longer periods of time than the clear liquid diets  Used for patients: With acute infections Have difficulty chewing Have digestive tract conditions  Examples:  Sherbert  Soups  Milk and ice cream

26. Copyright © 2008 Delmar Learning. All rights reserved.  Usually follows the full liquid diet  Although this diet nourishes the body, between-meal feedings are sometimes given to increase the calorie count.  Mildly flavored, lightly seasoned foods Examples:  Oatmeal, cheese, pudding, sponge cake, cooked vegetables, pasta

27. Copyright © 2008 Delmar Learning. All rights reserved.  Planned to meet specific patient needs  Patients may need special diets because of religious preferences or health needs

28. Copyright © 2008 Delmar Learning. All rights reserved.  Religious practice requires changes in diet for some patients.

29. Copyright © 2008 Delmar Learning. All rights reserved.  Standard diets can be changed to conform to special dietary requirements  For example An order might be written for a low-sodium soft diet when a patient has ill-fitting dentures and heart disease

30. Copyright © 2008 Delmar Learning. All rights reserved.  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

31. Copyright © 2008 Delmar Learning. All rights reserved.  Sodium-restricted diets may be ordered for patients with chronic renal failure and cardiovascular disease  These diets are some of the most difficult diets to follow

32. Copyright © 2008 Delmar Learning. All rights reserved.  As long as activity remains constant  A person must take in approximately 500 calories a day less than usual to lose one pound

33. Copyright © 2008 Delmar Learning. All rights reserved.  Prescribed for patients who suffer from: Vascular disease Heart disease Liver disease Gallbladder disease Those who have difficulty with fat metabolism

34. Copyright © 2008 Delmar Learning. All rights reserved.  Any diet may be mechanically altered  This means that the consistency and texture of foods are modified Making foods easier to chew and swallow

35. Copyright © 2008 Delmar Learning. All rights reserved.  Usually chopped to the texture of hamburger Making it easier to swallow Soft items, such as bread, are not modified  Usually served to patients with dental or chewing problems, and those with missing teeth

36. Copyright © 2008 Delmar Learning. All rights reserved.  Blenderized until it is the consistency of pudding or baby food  Given to patients who have dysphagia At risk of aspiration

37. Copyright © 2008 Delmar Learning. All rights reserved.  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

38. Copyright © 2008 Delmar Learning. All rights reserved.  Many patients receive a nutritional supplement or between-meal nourishments  Supplements are ordered by the physician and have a definite therapeutic value

39. Copyright © 2008 Delmar Learning. All rights reserved.  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

40. Copyright © 2008 Delmar Learning. All rights reserved.  Planned and regularly given, or unplanned upon patient request  Given to patients to prevent or eliminate hunger between meals

41. Copyright © 2008 Delmar Learning. All rights reserved.  The physician or dietitian may order special food intake studies for a patient with special nutritional needs

42. Copyright © 2008 Delmar Learning. All rights reserved.  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

43. Copyright © 2008 Delmar Learning. All rights reserved.  The dietitian uses this information To plan a diet to meet the patient’s special medical needs

44. Copyright © 2008 Delmar Learning. All rights reserved.  Balance between liquid intake and liquid output We take in approximately 2 ½ quarts of fluid daily Typical output equals about 2 ½ quarts daily

45. Copyright © 2008 Delmar Learning. All rights reserved.  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 While others have a fluid restriction

46. Copyright © 2008 Delmar Learning. All rights reserved.  A fluid restriction requires a physician order  You will find information regarding whether to push or restrict fluids on the care plan

47. Copyright © 2008 Delmar Learning. All rights reserved.  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

48. Copyright © 2008 Delmar Learning. All rights reserved. Some patients have sensory problems affecting their appetites, such as problems with food: Temperature Smell Taste Hearing and vision

49. Copyright © 2008 Delmar Learning. All rights reserved. Some patients have sensory problems affecting their appetites, such as problems with food: Touch Texture

50. Copyright © 2008 Delmar Learning. All rights reserved.  Presentation and attractiveness of food are especially important for patients Whose smell, taste, and texture sensations are impaired

51. Copyright © 2008 Delmar Learning. All rights reserved.  Patients who have difficulty swallowing May require one-to-one assistance Prompting Or supervision at meals

52. Copyright © 2008 Delmar Learning. All rights reserved.  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. Copyright © 2008 Delmar Learning. All rights reserved.  Accurate documentation of each patient’s meal intake is very important  Keep diet clipboards and lists covered to protect the patients’ privacy

54. Copyright © 2008 Delmar Learning. All rights reserved.  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. Copyright © 2008 Delmar Learning. All rights reserved. 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. Copyright © 2008 Delmar Learning. All rights reserved. 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