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Unit 26

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Unit 26

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  1. 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 ofaspiration

  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 supplementor 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