unit 26

Copyright © 2008 Delmar Learning. All rights reserved.

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

• Water is an essential nutrient that is necessary to life

• A person can live only a few days without water


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


Water

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


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


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

daily


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

Documents

delmar learning

food guide pyramid copyright

extra food

food groups

food guide pyramidfor

group copyright

food intake studies

skin copyright