• Part of wellness, healing, and recovery
• Provides energy-activity
• Maintains body temperature
• Provides raw materials for growth, replacment, and repair

• Pleasure
  • tied to emotions
• Social gatherings
• Political statement
• Religious symbol
• Cultural emblem
• Medical treatment-therapeutic

• Primary- Not enough intake
  • anorexia (not the disorder)
  • Alcoholism
  • Poor habits ($, knowledge, ability to cook or shop)
  • Hospitalization (tests, pain, nausea)
• Secondary- Increased needs
  • Burns, infections, wounds, fever, stress, elevated thyroid
    • also increase oxygen needs
  • Improper utilization of foods, ingestion, digestion, or malabsorption
    • cystic fibrosis, IBS, gluten and lactose intolerance

Another nutritional problem is excessive amounts. There are two types, what are they?

• Primary
  • eats too much
• Secondary
  • Error in metabolism
  • Unable to use nutrients
    • PKU0 can't have alanine/can't process

• Anticoagulants & Vit K- antagonist (avoid leafy greens)
• Tetracycline & minerals- antagonist (minerals bind to AB)
• Antacids & nearly everything- blocks absorption
• Diuretics & Potassium- depletes K
• MAOI & aged foods and wine- can be deadly
• Antiparkinson meds & Vit B6- antagonist
• Antitubercular meds & Vit B6- B6 reduces side effects

What are micronutrients? What are the micronutrients?

What are therapeutic diets used for? Is a therapeutic diet as important as medications?

• the disease process
• social and religious considerations
• patients likes and dislikes
• allergies
• client's condition (can they chew, swallow, ...)
• purpose of diet and consequences of not following diet

• allowed and prohibited foods
• reasons why food labels are important
  • educate them on how to read the labels
• include significant others/family
  • who cooks/shops
• refer to dietician or diet manual

• Increase or decrease body weight  by manipulating kcals
• Reduce or prevent edema by limiting fluids/salt (CHF)
• Aid in digestion by avoiding foods that irritate the GI
• Eliminating a food that the body is unable to tolerate (lactose intolerance)

• clarify misinformation
• individualize the diet
• help them understand the relation between their disease and diet

Take into consideration the dietary restrictions of their religion.
Hindu- lacto-ovo vegetarians and no stimulants
Islam- No pork, slaughter laws, fasting
Jewish- No pork, fish w/o scales, slaughter laws, some fasting, meal preparation
Mormon- no stimulants
Catholic- no meat on Friday & Lent, some fasting, no food or drink except water before Holy communion
Seventh-Day Adventist- lacto-ovo vegetarians, no stimulants
Vegans- complicated diet (nothing with a face)

1. Clear liquid
2. Full liquid
3. Soft
4. Altered consistency (mechanical soft)
5. High residue/high fiber
6. Regular diet

Explain a clear liquid diet.

What are some concerns with clients on a clear liquid diet and how long is a clear liquid diet "effective"?

• monitor client for tolerance and oral intake
• there is no nutritional value (no vitamins or proteins)
• only adequate for 3 days max

• clear consomme, bouillon, broth
• tea, coffee
• clear fruit juices: cranberry, apple, grape, NO OJ
• Jell-o
• carbonated beverages
• popsicles
• Honey, sugar, gumdrops, lemon for tea

• it can become monotonous
• can be nutritionally inadequate
• diabetics must be sugar-free
• monitor for tolerance of feeding

• any clear liquids
• soups (creamed or strained)
• milks, creams
• sherbert, plain ice cream
• custard, pudding, eggnog (yum)
• all cooked cereals
• vegetables and strained fruit juice

• Fried
• highly seasoned
• flatus causing foods
• no bran or unrefined grains
• no seeds, nuts, fresh fruit, and coconut
• no spiced lunch meat

• macaroni
• soft chicken, turkey, fish fillet
• mashed potatoes
• Jell-o, custard pie, angel food cake
• applesauce, ice cream, pudding

• mechanical soft diet
• pureed diet
• ground diet

• fruits and vegetables
• fruit juices
• whole grain cereals, breads

As you are assessing your client you find that he has hot dry skin, is c/o frequent urination, thirst, and hunger. What might be the cause of his symptoms?

As you enter the room you notice that your client "appears" to be drunk. Well, there isn't any alcohol allowed in the hospital. What could be the cause of their "drunken" behavior?

• Candy (not really, we crush glucose tabs)
• OJ
• Dextrose IV per doctor's order
• follow with carb/protein drink
• give them their snack and make sure they eat meals

• HTN
• edema
• renal disease
• liver disease
• CHF

• encourage fruits and vegetable
• increase use of other seasonings and spices that do not contain sodium
• be aware of foods that are hiding sodium

• soups
• snacks
• sauces (soy sauce, ketchup)
• sauerkraut
• smoked meats
• seasonings
• sweetners
• sodium processed meats (kosher meats)

• Strict: 500mg/d
• Moderate: 1000mg/d
• Mild: 2000mg/d
• NAS: no food restrictions BUT do not add salt at the table or the stove

• MSG
• bacon/sausage, ham, cold cuts, hot dogs, polish sausage
• canned soups, canned veggies, canned meats
• water softners
• processed or prepared foods
• baking powder/soda
• butter, cheeses, butter milk
• olives, pickles
• catsup, soy and worchester sauces

• Antacids
• Antibiotics
• Cough medicines
• Laxatives

• To prevent the depletion of body potassium reserves.
• Increase intake of fruits and vegetables, oranges, raisins, bananas,spinach, squash, carrots, meats,  poultry, fish, salt substitutes contain potassium

• Prevent the potentially fatal build up of potassium in those who cannot excrete it as in renal failure
• Avoid salt substitutes

Also, cook fresh vegetables in lots of water and then discard the water

• meals are delayed
• procedures
• surgery
• N/V
• labs
• diagnostic tests
• PAIN

• assess the cause and eliminate the reason
• small frequent meals, attractive, small servings
• pt choice of foods- may bring from home
• seasoning to taste
• liquid supplements
• exercise throughout the day
• oral hygiene before meals
• sitting position for meals
• pain medication

• Anorexia- lack or loss of appetite
  • cancer, chemo, post-op, viral illness, SOB
• Anorexia nervosa- aversion to food
  • psych disorder
  • do not want food
  • altered body image
  • don't encourage them

• provide oppurtunity to void
• wash hands, face, and provide chance for oral care before meals
• avoid unpleasant and painful treatments before or after meals
• avoid unpleasant tasting medications before and during meals
• If in pain, medicate 1/2 hour prior to meals
• remove unpleasant oders and litter
• cover unpleasant things (really just remove them)
• allow time and offer assistance
• assist to fill out menu
• room temperature- cooler temps stimulate appetite
• clients do not like to eat alone!

• SIT THEM UP!
• let them void
• glasses and dentures
• wash hands, face, oral hygiene
• CHECK TRAY AND DIET ORDER,check for utensils, condiments
• make sure client is not NPO
• check allergies and name band
• serve hot foods hot and cold foods cold
• fill bowls and glasses 3/4 full
• be pleasant
• check on client to make sure eating (if not find out why)
• document amount consumed (food and liquid) in mL's

• wash hands
• provide comfor measures
• napkin/towel
• arrange tray
• don't rush
• sit down and visit
• use a spoon and straw for liquids (shorten straw)
• give small bites
• alternate food with liquids (wipe chin, do not use utensil to scrap)
• ask client how they like to eat (what order)
• warn of hot or cold
• allow client to do as much as possible

• plate with guard
• wide handled spoons
• bowel with stable base
• cup with a cut out for the nose

• tell them where the food is located (describe the location using a clock)
• guide hand to reinforce
• tell them what food they are being served
• may need some assistance especially is they are new to it

• maintain continuity
  • same time and place and assistant
• reduce or eliminate distractions
• place plate close to patient
• remove unecessary clutter
• milk and other fluids in a glass
• guide hand to mouth
• reinforce positive
• finger foods for the wanderer
• nutrient packed foods (no empty calories)

Assisting a client with a sore mouth at meal times would include...

• avoid dry, acidic, spicy, and salty foods
• moisten foods
• offer moist, soft foods
• cold water, ice chips, ice cream, sherbert
• saliva subs
• good oral hygiene (no ETOH in mouthwash)

• have suction readily available
• assist to sitting position
• oral hygiene before feeding
• smi solids with some texture
• quarter size bites
• observe for swallowing
• tuck chin, remind to swallow 2-3 times
• check mouth for food/fluids still in cavity
• keep sitting, HOB up 30 degrees after meals for 30 minutes
• watch for coughing and choking
• always place food on unaffected side

• poor, loose fitting teeth
• CVA
• tracheostomy
• paralyzed vocal cords
• tumor in mouth, throat, or esophogus
• surgery to head,neck, or esophogeal areas

• drooling
• feeling that food is sticking in throat during or after meal
  • sensation of a "lump" in throat
• weight loss
• poor nutritional intake
• choking and coughing with eating
• frequent respiratory infections