Transcript Patient Nutrition Hospital Diets.Finalx

Patient Nutrition
Basic Hospital Diets
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Heather Rawls RN MS
Pt Nutrition: Role in Wellness &
Illness
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Nutritional risk
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Potential to become malnourished
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Primary: inadequate intake of nutrients
Secondary: caused by disease or iatrogenic effects
Hospital setting
 Experience of being a patient
 Lack of privacy
 Emotional aspects of food
 Bed rest
 Impaired skin integrity
 Decreased muscle tone, bone calcium, plasma volume, and
gastric secretions
 Glucose intolerance
 Shifts in body fluids and electrolytes
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Nutrition Intervention:
Nutrition Care Process
Nutrition Care Process: American Dietetic Association
 Consists of nutrition assessment, diagnosis,
intervention, monitoring and evaluation
 Nutrition screening
 Required by JCAHO within 48 hours of admission
 Identifies patients with malnutrition or nutritional
risk
 Personnel involved
 Referral if necessary
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Nutrition Intervention
Nutrition Care Process
Nutrition Care Process: American Dietetic Association
 Consists of nutrition assessment, diagnosis,
intervention, monitoring and evaluation
 Nutrition screening
 Required by JCAHO within 48 hours of admission
 Identifies patients with malnutrition or nutritional
risk
 Personnel involved
 Referral if necessary
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Nutrition Intervention
Nutritional Assessment
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Nutritional assessment
 Comprehensive nutritional assessment:
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ABCD approach
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Anthropometric (measurement of body composition)
biochemical (measurements of serum protein, micronutrients, and
metabolic parameters)
clinical (assessment of altered nutritional requirements and social or
psychological issues that may preclude adequate intake)
dietary assessment (measurement of dietary intake)
Conducted to determine appropriate nutrition therapy
based on identified needs of patient
Basic Hospital Diets: general
diet/regular diet
Designed to attain or maintain optimal nutritional
status
 Dietary modification
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Quantitative: modification in numbers of meals served,
calories, specific nutrients
Qualitative: modification in texture, consistency, nutrients
What does dietary modification really mean?
Diet as tolerated
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Allows for postoperative diet progression based on
patient’s tolerance
Some clinicians call this a transition or progressive
diet
Basic Hospital Diets: Clear liquid diets
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Foods that are clear and liquid at room or body temperature
Inadequate in energy and almost all nutrients except water
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Caution in regard to caffeine
Should not be used for more than 24 hours
Relationship to hospital malnutrition
Made of up foods that are clear liquids or become clear
liquids at room temperature.
Only foods you can see through are allowed.
Foods Allowed
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Black coffee – no creamer or milk!
Tea – sugar & lemon okay
Clear fat-free broth
Bouillon
Carbonated clear drinks
Clear fruit juices
Gelatin
Fruit ices – no pulp (Lemon ice pops)
Popsicles
Basic Hospital Diets: Full liquid
diets
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Foods that are liquid at room temperature
Often used if patients have difficulty chewing or swallowing
solid foods
Can supply adequate energy and nutrients
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Potential problem with lactose intolerance
Concern with high saturated fat and cholesterol
Foods Allowed
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Everything on a clear liquid diet and extra
Water
Fruit juices, including nectars and juices with pulp
Butter, margarine, oil, cream, custard, and pudding
Plain ice cream, frozen yogurt, and sherbet.
Fruit ices and popsicles
Sugar, honey, and syrups
Soup broth (bouillon, consommé, and strained
cream soups -- but NO solids)
Sodas, such as ginger ale and Sprite
Gelatin (Jell-O)
Boost, Ensure, Resource, and other liquid
supplements/ formulas
Tea or coffee with cream or milk and sugar or honey
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Liquid foods does NOT include mashed foods
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Basic Hospital Diets: Mechanically
altered diets (this can vary)
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Diet generally varies based on type of dysphagia
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pts with chewing or swallowing difficulty
Chopped, ground, mashed, puréed
small amounts of liquids (e.g., broth, milk, gravies) can be
added to reach the appropriate consistency needed
liquid added to pureed foods should complement the food
and not conceal the food's original flavor
Butter, margarine, gravies, sugar, or honey may be added to
foods to increase kcal density
Food consistency altered only to the degree needed
Allowed
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Ground meats, softly cooked vegetables
Important to Consider
Mechanical Soft
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As mentioned previously, exact composition and consistency of a
mechanically altered diet will vary depending on the patient's
needs. These diets can be modified for additional needs such as
low sodium, kcal control, or low fat.
Care should be taken in evaluating the patient's needs for
consistency.
Food consistency should be altered only to the degree it is
needed.
Ex. If a patient needs only meats pureed, then only the meats
should be pureed. If a patient needs only the foods or meats
ground, then they shouldn't be pureed. Sometimes, foods just
need to be chopped coarsely or finely.
Tricks of the Trade
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Care should be taken to add only enough liquid to
achieve desired consistency yet allow nutritional quality
of the food to be retained.
Ex., a cake-decorating tool (icing bag and tips) can be
used to make pureed peas look like regular peas.
Molds are also used to shape foods. For example, a pork
chop can be pureed and then put into a pork chop–
shaped mold and reheated in a microwave oven
How much do solid liquids measure out?
Classifications
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Liquidized/thin - puree
Homogenous consistency which
does not hold its shape after serving.
Thick puree/soft and smooth Thickened, homogenous consistency
which holds its shape after serving,
and does not separate into liquid and
solid components during swallow,
i.e. cohesive.
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Soft/Finely minced Soft diet of
cohesive, consistent textures
requiring some chewing.
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Minced/normal - Normal foods of
varied textures which require
chewing, avoiding particulate foods
which pose a choking hazard.
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Bite size—can be broken up
with a fork, moderate amount
of Liquid—thickened
chewing required, pieces no
larger than 1·5cm.
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Easy chew—easily broken up
with fork, thickened and
holds moist, bolus forming,
pieces no larger than 0·5cm.
Basic Hospital Diets:
Soft diets
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Whole foods, low in fiber and lightly seasoned
Transition diet from liquid diets to regular or
general diets
traditionally been used for patients with mild GI
problems
Food supplements or between-meals snacks may
be used if needed to add kcal
Soft diets can contain “hard to chew” foods such
as white toast
This diet is not appropriate for patients requiring
mechanical soft diets
NCLEX Questions
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When caring for an elderly client who has
difficulty chewing, the nurse identifies which
diet is most appropriate?
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b.
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d.
Low residue diet
Full liquid diet
High-protein diet
Mechanical soft diet
NCLEX Questions
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A postoperative client has been placed on a
clear liquid diet. The nurse should provide the
client with which items(s) that are allowed to
be consumed on this diet? Select all that
applies.
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Broth
Coffee black
Gelatin
Pudding
Vegetable juice with pulp
Pureed vegetables
NCLEX Questions
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A client who is recovering from surgery has
been advanced to a full liquid diet. The client
is looking forward to the diet change
because he has been “bored” with the clear
liquid diet. The nurse should offer which full
liquid item to the client?
Tea
Gelatin
Custard
Ice pop
NCLEX Questions
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What should the nurse include as a primary
focus in the teaching plan for a client placed
on transition diet?
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b.
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The diet will be used on a long term basis.
The focus of the diet is on meal planning and diet
selection technique.
The client should understand the types of food
items that are restricted on the this diet.
This diet plan will be a temporary dietary
measure.