1. Nutritional Needs and Diet Modifications
Unit 26
Nutritional Needs
and Diet Modifications

2. Introduction Nutrition
Entire process by which the body takes in food for growth and repair and uses it to maintain health

3. 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

4. Essential Nutrients To be well nourished, we must eat foods that:
Supply heat and energy
Regulate body functions
Build and repair body tissue

5. Essential Nutrients Six essential nutrients: Proteins Carbohydrates
Fats
Minerals
Vitamins
Water

6. The Food Guide Pyramid USDA Food Guide Pyramid
Designed to be individualized to each person to maintain a healthy weight

7. The Food Guide Pyramid In addition:
Each person may use a small number of discretionary calories
These are extra calories used to consume solid fats, added sugars, alcohol, or extra food from any group

8. The Food Guide Pyramid For most people:
Discretionary calorie allowance is between 100 and 300 calories daily

9. The Food Guide Pyramid

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

11. 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

12. Water The normal adult intake of fluids
Should be two to three quarts a day

13. 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

14. Basic Facility Diets
Food served to patients in the health care facility is prepared by the dietary department
It includes the essential nutrients

15. 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

16. Regular Diet
The regular-select or house diet is a normal or regular (unrestricted) diet
Based on the Food Guide Pyramid

17. 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

18. Full Liquid Diet Does supply nourishment
May be used for longer periods of time than the clear liquid diet

19. 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.

20. Special Diets Planned to meet specific patient needs
Patients may need special diets because of religious preferences or health needs

21. Religious Restrictions
Religious practice requires changes in diet for some patients.

22. Therapeutic Diets
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

23. 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

24. Sodium-Restricted Diet
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

25. 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

26. 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

27. 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

28. Mechanically Altered Diets
Usually chopped to the texture of hamburger
Making it easier to swallow
Soft items, such as bread, are not modified

29. Mechanically Altered Diets
Usually served to patients with dental or chewing problems, and those with missing teeth

30. Pureed Diet
Blenderized until it is the consistency of pudding or baby food
Given to patients who have dysphagia
At risk of aspiration

31. 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

32. 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

33. Supplements and Nourishments
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

34. Snacks Planned and regularly given, or unplanned upon patient request
Given to patients to prevent or eliminate hunger between meals

35. Calorie Counts and Food Intake Studies
The physician or dietitian may order special food intake studies for a patient with special nutritional needs

36. Calorie Counts and Food Intake Studies
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

37. Calorie Counts and Food Intake Studies
The dietitian uses this information
To plan a diet to meet the patient’s special medical needs

38. Fluid Balance 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

39. 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
While others have a fluid restriction

40. 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

41. 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

42. Sensory Problems
Some patients have sensory problems affecting their appetites, such as problems with food:
Temperature
Smell
Taste
Hearing and vision

43. Sensory Problems
Some patients have sensory problems affecting their appetites, such as problems with food:
Touch
Texture

44. Sensory Problems
Presentation and attractiveness of food are especially important for patients
Whose smell, taste, and texture sensations are impaired

45. Mealtime Assistance for Patients Who Have Swallowing Problems
Patients who have difficulty swallowing
May require one-to-one assistance
Prompting
Or supervision at meals

46. 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

47. Documenting Meal Intake
Accurate documentation of each patient’s meal intake is very important
Keep diet clipboards and lists covered to protect the patients’ privacy

48. 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

49. 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

50. 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