Patient Nutrition Basic Hospital Diets Heather Rawls RN

Patient Nutrition Basic Hospital Diets { Heather Rawls RN MS

Pt Nutrition: Role in Wellness & Illness Nutritional risk Potential to become malnourished 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

Nutrition Intervention: 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

Nutrition Intervention 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

Nutrition Intervention Nutritional Assessment Nutritional assessment Comprehensive nutritional assessment: ABCD approach 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 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 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 Foods that are clear and liquid at room or body temperature Inadequate in energy and almost all nutrients except water • • 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 • • • 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 Foods that are liquid at room temperature Often used if patients have difficulty chewing or swallowing solid foods Can supply adequate energy and nutrients Potential problem with lactose intolerance Concern with high saturated fat and cholesterol

Foods Allowed 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 Liquid foods does NOT include mashed foods

Basic Hospital Diets: Mechanically altered diets (this can vary) Diet generally varies based on type of dysphagia 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 Ground meats, softly cooked vegetables

Important to Consider Mechanical Soft 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 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 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. Soft/Finely minced Soft diet of cohesive, consistent textures requiring some chewing. Minced/normal - Normal foods of varied textures which require chewing, avoiding particulate foods which pose a choking hazard. Bite size—can be broken up with a fork, moderate amount of Liquid—thickened chewing required, pieces no larger than 1· 5 cm. Easy chew—easily broken up with fork, thickened and holds moist, bolus forming, pieces no larger than 0· 5 cm.

Basic Hospital Diets: Soft diets 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 When caring for an elderly client who has difficulty chewing, the nurse identifies which diet is most appropriate? a. b. c. d. Low residue diet Full liquid diet High-protein diet Mechanical soft diet

NCLEX Questions 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. a. b. c. d. e. f. Broth Coffee black Gelatin Pudding Vegetable juice with pulp Pureed vegetables

NCLEX Questions a. b. c. d. 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 What should the nurse include as a primary focus in the teaching plan for a client placed on transition diet? a. b. c. d. 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.