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Unit 26Nutritional Needs and Diet ModificationsCopyright 2008 Delmar Learning. All rights reserved.Copyright 2008 Delmar Learning. All rights reserved.1ObjectivesSpell 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.Copyright 2008 Delmar Learning. All rights reserved.2ObjectivesDescribe purposes of the following diets:Clear liquidFull liquidSoftCopyright 2008 Delmar Learning. All rights reserved.3ObjectivesState the purpose of calorie counts and food intake studies.Define dysphagia and explain risks of this condition.Copyright 2008 Delmar Learning. All rights reserved.4ObjectivesDescribe general care for the patient with dysphagia and swallowing problems.State purposes of therapeutic diets.List types of alternative nutrition.Copyright 2008 Delmar Learning. All rights reserved.5ObjectivesDescribe the nursing assistant actions when patients are unable to drink fluids independently.Copyright 2008 Delmar Learning. All rights reserved.6IntroductionNutritionEntire process by which the body takes in food for growth and repair and uses it to maintain healthCopyright 2008 Delmar Learning. All rights reserved.7Normal NutritionFood is normally taken into the body through the mouthThe beginning of the digestive tractDigestionBreaking down foods into substances used by body cells for nourishmentThese substances are calledessential nutrientsCopyright 2008 Delmar Learning. All rights reserved.8Essential NutrientsTo be well nourished, we must eat foods that:Supply heat and energyRegulate body functionsBuild and repair body tissueCopyright 2008 Delmar Learning. All rights reserved.9Essential NutrientsSix essential nutrients:ProteinsCarbohydratesFatsMineralsVitaminsWaterCopyright 2008 Delmar Learning. All rights reserved.10The Food Guide PyramidUSDA Food Guide PyramidDesigned to be individualized to each person to maintain a healthy weightRefer to Figure 261 to review the six food groups and the familiar USDA Food Guide PyramidCopyright 2008 Delmar Learning. All rights reserved.11The Food Guide Pyramid

Copyright 2008 Delmar Learning. All rights reserved.12WaterWater is an essential nutrient that is necessary to lifeA person can live only a few days without waterCopyright 2008 Delmar Learning. All rights reserved.13WaterWater is necessary for all cellular functions in the bodyAn adequate intake of fluids is required to replace fluids lost through urine, stool, sweat, and evaporation through skin Copyright 2008 Delmar Learning. All rights reserved.14WaterThe normal adult intake of fluids Should be two to three quarts a day Copyright 2008 Delmar Learning. All rights reserved.15WaterOffering liquids to patients frequently is important because:Some patients cannot drink liquids without your helpElderly patients have a decreased sense of thirstAdequate fluid intake is necessary to prevent urinary problems and constipationCopyright 2008 Delmar Learning. All rights reserved.16DysphagiaDysphagia is when a patient has difficulty swallowingDysphagia may be a result of:StrokeCancer of head, neck, esophagusNeurological diseasesDementia Copyright 2008 Delmar Learning. All rights reserved.DysphagiaSigns and symptoms of dysphagia:Taking a long time to swallowFrequent clearing or coughing of throatSwallowing three of four times with each biteLack of a gag reflex or weak coughDifficulty controlling liquids or secretions in mouthInform nurse if you see any of theseCopyright 2008 Delmar Learning. All rights reserved.Basic Facility DietsFood served to patients in the health care facility is prepared by the dietary departmentIt includes the essential nutrientsCopyright 2008 Delmar Learning. All rights reserved.19Basic Facility DietsThe way in which it is prepared and its consistencyWill depend on each individual patients condition and needsSometimes very strict dietary control is needed

Copyright 2008 Delmar Learning. All rights reserved.20Basic Facility DietsTypes of common Facility Diets:Regular (also called general or house)Full liquidClear liquidSoftSpecialized diets:1800, 1500 or 1200 ADA dietsNAS diet (no added salt)Copyright 2008 Delmar Learning. All rights reserved.Regular DietThe regular-select or house diet is a normal or regular (unrestricted) diet Includes all food groupsOffers great varietyExcludes only very rich foods, fried foods, or heavily seasoned foods which might be difficult for inactive people to digestCopyright 2008 Delmar Learning. All rights reserved.22Clear Liquid DietTemporary diet because it is an inadequate dietMade up primarily of water and carbohydrates for energyIt may be used postoperativelyOr when the patient has a condition such as nausea and vomitingConsists of liquids that do not irritate, cause gas, or encourage bowel movementsCopyright 2008 Delmar Learning. All rights reserved.23Clear Liquid DietExamples of Clear Liquids are:TeaCoffee no creamSoup brothsJello7-Up, Sprite, GingerAleApple juicePopsiclesCopyright 2008 Delmar Learning. All rights reserved.Full Liquid DietDoes supply nourishmentMay be used for longer periods of time than the clear liquid dietsUsed for patients:With acute infectionsHave difficulty chewingHave digestive tract conditionsExamples:SherbertSoupsMilk and ice cream

Copyright 2008 Delmar Learning. All rights reserved.25Soft DietUsually follows the full liquid dietAlthough this diet nourishes the body, between-meal feedings are sometimes given to increase the calorie count.Mildly flavored, lightly seasoned foodsExamples:Oatmeal, cheese, pudding, sponge cake, cooked vegetables, pastaCopyright 2008 Delmar Learning. All rights reserved.26Special DietsPlanned to meet specific patient needsPatients may need special diets because of religious preferences or health needsCopyright 2008 Delmar Learning. All rights reserved.27Religious RestrictionsReligious practice requires changes in diet for some patients.Copyright 2008 Delmar Learning. All rights reserved.28Therapeutic DietsStandard diets can be changed to conform to special dietary requirementsFor exampleAn order might be written for a low-sodium soft diet when a patient has ill-fitting dentures and heart diseaseCopyright 2008 Delmar Learning. All rights reserved.29The Diabetic Diet Diet is an integral part of the therapy of the patient with diabetes mellitusThe diet is nutritionally adequateSometimes a proper diet is all that is needed to control the diseaseCopyright 2008 Delmar Learning. All rights reserved.30Sodium-Restricted DietSodium-restricted diets may be ordered for patients with chronic renal failure and cardiovascular diseaseThese diets are some of the most difficult diets to followCopyright 2008 Delmar Learning. All rights reserved.31Calorie-Restricted DietAs long as activity remains constantA person must take in approximately 500 calories a day less than usual to lose one poundCopyright 2008 Delmar Learning. All rights reserved.32Low-Fat/Low-Cholesterol DietPrescribed for patients who suffer from:Vascular diseaseHeart diseaseLiver diseaseGallbladder diseaseThose who have difficulty with fat metabolismCopyright 2008 Delmar Learning. All rights reserved.33Mechanically Altered DietsAny diet may be mechanically alteredThis means that the consistency and texture of foods are modifiedMaking foods easier to chew and swallowCopyright 2008 Delmar Learning. All rights reserved.34Mechanically Altered DietsUsually chopped to the texture of hamburgerMaking it easier to swallowSoft items, such as bread, are not modifiedUsually served to patients with dental or chewing problems, and those with missing teeth

Copyright 2008 Delmar Learning. All rights reserved.35Pureed DietBlenderized until it is the consistency of pudding or baby foodGiven to patients who have dysphagiaAt risk of aspirationCopyright 2008 Delmar Learning. All rights reserved.36Pureed DietThe pureed food should not be wateryIf it is the proper consistency, a plastic spoon will stand upright without fallingMake the meal as visually appealing as possibleAvoid referring to the pureed food items as baby foodCopyright 2008 Delmar Learning. All rights reserved.37Supplements and NourishmentsMany patients receive a nutritional supplement or between-meal nourishmentsSupplements are ordered by the physician and have a definite therapeutic valueCopyright 2008 Delmar Learning. All rights reserved.38Supplements and NourishmentsNourishments are substantial food items given to patients to increase nutrient intakeOften planned and ordered by the facility dietitian Sandwiches or puddingNutritious liquids, such as milkshakesCopyright 2008 Delmar Learning. All rights reserved.39SnacksPlanned and regularly given, or unplanned upon patient requestGiven to patients to prevent or eliminate hunger between mealsCopyright 2008 Delmar Learning. All rights reserved.40Calorie Counts and Food Intake StudiesThe physician or dietitian may order special food intake studies for a patient with special nutritional needsCopyright 2008 Delmar Learning. All rights reserved.41Calorie Counts and Food Intake StudiesThe patients 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 consumedCopyright 2008 Delmar Learning. All rights reserved.42Calorie Counts and Food Intake StudiesThe dietitian uses this informationTo plan a diet to meet the patients special medical needsCopyright 2008 Delmar Learning. All rights reserved.43Fluid BalanceBalance between liquid intake and liquid output We take in approximately 2 quarts of fluid dailyTypical output equals about 2 quarts dailyCopyright 2008 Delmar Learning. All rights reserved.44Recording Intake and OutputAn accurate recording of intake and output (I&O), or fluid taken in and given off by the bodyBasic to the care of many patientsSome patients have an order to force (encourage) fluidsWhile others have a fluid restrictionCopyright 2008 Delmar Learning. All rights reserved.45Recording Intake and OutputA fluid restriction requires a physician order You will find information regarding whether to push or restrict fluids on the care planCopyright 2008 Delmar Learning. All rights reserved.46Changing WaterIt is important to provide fresh water for patientsWater 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 encouragedCopyright 2008 Delmar Learning. All rights reserved.47Sensory ProblemsSome patients have sensory problems affecting their appetites, such as problems with food:TemperatureSmellTasteHearing and visionCopyright 2008 Delmar Learning. All rights reserved.48Sensory ProblemsSome patients have sensory problems affecting their appetites, such as problems with food:TouchTextureCopyright 2008 Delmar Learning. All rights reserved.49Sensory ProblemsPresentation and attractiveness of food are especially important for patientsWhose smell, taste, and texture sensations are impairedCopyright 2008 Delmar Learning. All rights reserved.50Mealtime Assistance for Patients Who Have Swallowing Problems Patients who have difficulty swallowingMay require one-to-one assistancePromptingOr supervision at mealsCopyright 2008 Delmar Learning. All rights reserved.51Foodborne IllnessHot foods must be served hotCold foods must be served coldIf the food is off-temperature, pathogens may multiply, causing foodborne illnessFollow all temperature and infection control precautions when passing traysCopyright 2008 Delmar Learning. All rights reserved.52Documenting Meal IntakeAccurate documentation of each patients meal intake is very importantKeep diet clipboards and lists covered to protect the patients privacyCopyright 2008 Delmar Learning. All rights reserved.53Total Parenteral NutritionTotal parenteral nutrition (TPN)A technique in which high-density nutrients are introduced into a large veinSuch as the subclavian or the superior vena cavaCopyright 2008 Delmar Learning. All rights reserved.54Enteral FeedingsEnteral feedings are administered by tubeMany different types of tubes may be used for these feedingsNurse or physician inserts the feeding tubeCopyright 2008 Delmar Learning. All rights reserved.55Enteral FeedingsSpecially prepared solutions contain all the nutrients required by the bodyKeep the patients head elevated when the feeding is infusing, and for an hour after mealsCopyright 2008 Delmar Learning. All rights reserved.56