1. { Patient Nutrition Basic Hospital Diets Heather Rawls RN MS

2. 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

3. 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

4. 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

5. 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

6. 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?

7.  Allows for postoperative diet progression based on patient’s tolerance  Some clinicians call this a transition or progressive diet Diet as tolerated

8. 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. Made of up foods that are clear liquids or become clear liquids at room temperature. Only foods you can see through are allowed. Only foods you can see through are allowed.

9. Black coffee – no creamer or milk! Black coffee – no creamer or milk! Tea – sugar & lemon okay Tea – sugar & lemon okay Clear fat-free broth Clear fat-free broth Bouillon Bouillon Carbonated clear drinks Carbonated clear drinks Clear fruit juices Clear fruit juices Gelatin Gelatin Fruit ices – no pulp (Lemon ice pops) Fruit ices – no pulp (Lemon ice pops) Popsicles Popsicles Foods Allowed

10. 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

11.  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 Foods Allowed

12. 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

13.  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. Important to Consider Mechanical Soft

14.  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? Tricks of the Trade

15. 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 1·5cm.  Easy chew—easily broken up with fork, thickened and holds moist, bolus forming, pieces no larger than 0·5cm.

16.  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 Basic Hospital Diets: Soft diets

17.  When caring for an elderly client who has difficulty chewing, the nurse identifies which diet is most appropriate? a. Low residue diet b. Full liquid diet c. High-protein diet d. Mechanical soft diet NCLEX Questions

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

19.  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? a. Tea b. Gelatin c. Custard d. Ice pop NCLEX Questions

20.  What should the nurse include as a primary focus in the teaching plan for a client placed on transition diet? a. The diet will be used on a long term basis. b. The focus of the diet is on meal planning and diet selection technique. c. The client should understand the types of food items that are restricted on the this diet. d. This diet plan will be a temporary dietary measure. NCLEX Questions