Transcript Chapter 26 - Tiffany-Hyde

Nutritional Needs
and Diet Modifications
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 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.
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 Describe
purposes of the following
diets:
• Clear liquid
• Full liquid
• Soft
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•
•
State the purpose of calorie counts and
food intake studies.
Define dysphagia and explain risks of
this condition.
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 Describe
general care for the patient
with dysphagia and swallowing
problems.
 State purposes of therapeutic diets.
 List types of alternative nutrition.
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 Describe
the nursing assistant actions
when patients are unable to drink
fluids independently.
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 Nutrition
• Entire process by which the body takes in food
for growth and repair and uses it to maintain
health
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 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
• These substances are called…essential
nutrients
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 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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 Six
essential nutrients:
• Proteins
• Carbohydrates
• Fats
• Minerals
• Vitamins
• Water
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•
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
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 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
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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 The
normal adult intake of fluids
• Should be two to three quarts a day
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 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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 Dysphagia
is when a patient has difficulty
swallowing
 Dysphagia may be a result of:
• Stroke
• Cancer of head, neck, esophagus
• Neurological diseases
• Dementia
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 Signs
and symptoms of dysphagia:
• Taking a long time to swallow
• Frequent clearing or coughing of throat
• Swallowing three of four times with each bite
• Lack of a gag reflex or weak cough
• Difficulty controlling liquids or secretions in
mouth
 Inform
nurse if you see any of these
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 Food
served to patients in the health care
facility is prepared by the dietary
department
• It includes the essential nutrients
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 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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 Types
of common Facility Diets:
• Regular (also called general or house)
• Full liquid
• Clear liquid
• Soft
 Specialized
diets:
• 1800, 1500 or 1200 ADA diets
• NAS diet (no added salt)
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 The
regular-select or house diet is a
normal or regular (unrestricted) diet
• Includes all food groups
• Offers great variety
• Excludes only very rich foods, fried foods, or
heavily seasoned foods which might be difficult
for inactive people to digest
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 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
• Consists of liquids that do not irritate, cause
gas, or encourage bowel movements
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Examples of Clear Liquids are:
Tea
Coffee no cream
Soup broths
Jello
7-Up, Sprite, GingerAle
Apple juice
Popsicles
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 Does
supply nourishment
• May be used for longer periods of time than
the clear liquid diets
 Used
for patients:
• With acute infections
• Have difficulty chewing
• Have digestive tract conditions
 Examples:
 Sherbert
 Soups
 Milk and ice cream
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 Usually
follows the full liquid diet
 Although this diet nourishes the body,
between-meal feedings are sometimes
given to increase the calorie count.
 Mildly flavored, lightly seasoned foods
• Examples:
 Oatmeal, cheese, pudding, sponge cake, cooked
vegetables, pasta
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 Planned
to meet specific patient needs
 Patients may need special diets because
of religious preferences or health needs
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 Religious
practice requires changes in
diet for some patients.
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 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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 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
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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 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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 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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 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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 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
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 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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 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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 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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 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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 Planned
and regularly given, or
unplanned upon patient request
 Given to patients to prevent or eliminate
hunger between meals
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 The
physician or dietitian may order
special food intake studies for a
patient with special nutritional needs
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 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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 The
dietitian uses this information
• To plan a diet to meet the patient’s special
medical needs
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 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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 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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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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 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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•
Some patients have sensory problems
affecting their appetites, such as
problems with food:
• Temperature
• Smell
• Taste
• Hearing and vision
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•
Some patients have sensory problems
affecting their appetites, such as
problems with food:
• Touch
• Texture
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 Presentation
and attractiveness of food
are especially important for patients
• Whose smell, taste, and texture sensations are
impaired
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 Patients
who have difficulty swallowing
• May require one-to-one assistance
• Prompting
• Or supervision at meals
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 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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 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 (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 are administered by
tube
Many different types of tubes may be
used for these feedings
• Nurse or physician inserts the feeding tube
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•
•
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
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