Copyright © 2008 Delmar Learning. All rights reserved. Unit 26 Nutritional Needs and Diet...
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Transcript of Copyright © 2008 Delmar Learning. All rights reserved. Unit 26 Nutritional Needs and Diet...
Copyright © 2008 Delmar Learning. All rights reserved.
Unit 26
Nutritional Needs
and Diet Modifications
Copyright © 2008 Delmar Learning. All rights reserved.
Introduction
• Nutrition– Entire process by which the body takes in
food for growth and repair and uses it to maintain health
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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
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Essential Nutrients
• To be well nourished, we must eat foods that:– Supply heat and energy– Regulate body functions– Build and repair body tissue
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Essential Nutrients
• Six essential nutrients:– Proteins– Carbohydrates– Fats– Minerals– Vitamins– Water
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The Food Guide Pyramid• USDA Food Guide Pyramid
– Designed to be individualized to each person to maintain a healthy weight
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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
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The Food Guide Pyramid
• For most people:– Discretionary calorie allowance is between
100 and 300 calories daily
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Water
• Water is an essential nutrient that is necessary to life
• A person can live only a few days without water
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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
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Water
• The normal adult intake of fluids – Should be two to three quarts a day
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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
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Basic Facility Diets
• Food served to patients in the health care facility is prepared by the dietary department– It includes the essential nutrients
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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
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Regular Diet
• The regular-select or house diet is a normal or regular (unrestricted) diet – Based on the Food Guide Pyramid
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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
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Full Liquid Diet
• Does supply nourishment– May be used for longer periods of time
than the clear liquid diet
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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.
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Special Diets
• Planned to meet specific patient needs• Patients may need special diets
because of religious preferences or health needs
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Religious Restrictions
• Religious practice requires changes in diet for some patients.
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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
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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
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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
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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
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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
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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
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Mechanically Altered Diets
• Usually chopped to the texture of hamburger– Making it easier to swallow– Soft items, such as bread, are not modified
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Mechanically Altered Diets
• Usually served to patients with dental or chewing problems, and those with missing teeth
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Pureed Diet
• Blenderized until it is the consistency of pudding or baby food
• Given to patients who have dysphagia– At risk of aspiration
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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
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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
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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
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Snacks
• Planned and regularly given, or unplanned upon patient request
• Given to patients to prevent or eliminate hunger between meals
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Calorie Counts and Food Intake Studies
• The physician or dietitian may order special food intake studies for a patient with special nutritional needs
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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
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Calorie Counts and Food Intake Studies
• The dietitian uses this information– To plan a diet to meet the patient’s special
medical needs
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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
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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
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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
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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
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Sensory Problems
• Some patients have sensory problems affecting their appetites, such as problems with food:– Temperature– Smell– Taste– Hearing and vision
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Sensory Problems
• Some patients have sensory problems affecting their appetites, such as problems with food:– Touch– Texture
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Sensory Problems
• Presentation and attractiveness of food are especially important for patients– Whose smell, taste, and texture sensations
are impaired
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Mealtime Assistance for Patients Who Have Swallowing Problems
• Patients who have difficulty swallowing– May require one-to-one assistance– Prompting– Or supervision at meals
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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
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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
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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
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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