unit 26

Unit 26

Nutritional Needs

and Diet Modifications

Objectives

• 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.

Objectives

• Describe purposes of the following diets:– Clear liquid– Full liquid– Soft

Objectives

• State the purpose of calorie counts and food intake studies.

• Define dysphagia and explain risks of this condition.

Objectives

• Describe general care for the patient with dysphagia and swallowing problems.

• State purposes of therapeutic diets.• List types of alternative nutrition.

Objectives

• Describe the nursing assistant actions when patients are unable to drink fluids independently.

Introduction

• Nutrition– Entire process by which the body takes in

food for growth and repair and uses it to maintain health

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

Essential Nutrients

• To be well nourished, we must eat foods that:– Supply heat and energy– Regulate body functions– Build and repair body tissue

Essential Nutrients

• Six essential nutrients:– Proteins– Carbohydrates– Fats– Minerals– Vitamins– Water

The Food Guide Pyramid

• 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

• 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

• For most people:– Discretionary calorie allowance is between

100 and 300 calories daily

• Water is an essential nutrient that is necessary to life

• A person can live only a few days without 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

• The normal adult intake of fluids – Should be two to three quarts a day

• 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

Basic Facility Diets

• Food served to patients in the health care facility is prepared by the dietary department– It includes the essential nutrients

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

Regular Diet

• The regular-select or house diet is a normal or regular (unrestricted) diet – Based on the Food Guide Pyramid

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

Full Liquid Diet

• Does supply nourishment– May be used for longer periods of time

than the clear liquid diet

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.

Special Diets

• Planned to meet specific patient needs• Patients may need special diets

because of religious preferences or health needs

Religious Restrictions

• Religious practice requires changes in diet for some patients.

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

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

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

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

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

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

• 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

Pureed Diet

• Blenderized until it is the consistency of pudding or baby food

• Given to patients who have dysphagia– At risk of aspiration

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

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

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

Snacks

• Planned and regularly given, or unplanned upon patient request

• Given to patients to prevent or eliminate hunger between meals

Calorie Counts and Food Intake Studies

• The physician or dietitian may order special food intake studies for a patient with special nutritional needs

• 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

• The dietitian uses this information– To plan a diet to meet the patient’s special

medical needs

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

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

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

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

Sensory Problems

• Some patients have sensory problems affecting their appetites, such as problems with food:– Temperature– Smell– Taste– Hearing and vision

Sensory Problems

• Some patients have sensory problems affecting their appetites, such as problems with food:– Touch– Texture

Sensory Problems

• Presentation and attractiveness of food are especially important for patients– Whose smell, taste, and texture sensations

are impaired

Mealtime Assistance for Patients Who Have Swallowing Problems

• Patients who have difficulty swallowing– May require one-to-one assistance– Prompting– Or supervision at meals

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

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

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

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

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

unit 26

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food guide pyramid copyright

extra food

food groups

food guide pyramidfor

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food intake studies

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