Proper nutrition is important for all of us. Home Health Aides/Personal Care Aides have very important roles to fill with regard to helping their patients obtain proper nutrition. This module will explore the basics of nutrition. We will discuss all the important types of food that should be in a patient’s diet. We will also talk about the type of food that should be avoided. We will learn how to use the USDA’s nutrition guidelines by learning how to plan meals using ChooseMyPlate guidelines. We will talk about food preparation and safe food handling. We will also explore what different types of diets mean and what foods should and should not be included in those special diets. Show
Unit A: The Basics of NutritionAll living things require nutrients in order to survive and to grow and develop normally. Nutrients are components (parts) of food that provide nourishment in order for us to survive. Nutrients provide our bodies with energy, help build and maintain body tissues, organs, bones, and teeth, and help regulate body functions such as metabolism and blood pressure (Lehman, 2014). Nutrients include protein, carbohydrates, fats, vitamins and minerals. The Care Plan will direct a HHA/PCA as to what the patient’s dietary requirements and restrictions are. Home Health Aides/Personal Care Aides should always be sure to follow these as they are in place to best promote good health for the patient. If they are ever in doubt about whether a patient can have a certain food, they should seek guidance from their supervisor. ProteinProteins are the essential (necessary) building blocks that our body needs in order to properly function. We need protein in order to build and repair body tissues, such as muscles, organs, and skin. Sources of protein include poultry, meat, fish, eggs, milk, cheese, nuts and nut butters, peas, dried beans, and soy products. Our bodies can also use protein as an energy source or convert it to fat (Lehman, 2014). The amount of protein that a person needs depends on their body size, age, activity level, and their general well-being (U.S. Department of Agriculture, 2015a). People who are sick, undernourished, and healing generally require higher amounts of protein in order to help the body’s tissues heal. Sources of Protein:
CarbohydratesCarbohydrates are the essential nutrients our body needs in order to provide us with energy. Carbohydrates are the major way our body gets energy in order to effectively function. Carbohydrates provide our body with sugar, starch, and fiber. Starches include grains, potatoes, beans, and peas. Sugars include fruits, vegetables, and sweeteners. Foods that have fiber in them include whole grain foods such as cereals and breads, fruits, and, vegetables. Fiber is important as it helps aid in digestion, helps to lower cholesterol, and helps us to feel fuller longer. Fiber is also necessary to aid with bowel elimination (Leahy, Fuze & Grafe, 2013). There are two basic types of carbohydrates: complex and simple. Complex carbohydrates are found in grain products such as bread, cereal, pasta, rice, and vegetables. Simple carbohydrates are foods found in sugars, sweets, syrups, and jellies. Complex carbohydrates have more nutritional value than simple carbohydrates. The body uses sugars and starches for energy. Extra carbohydrates or carbohydrates that we take in but do not need at the time, are converted to fat, which are then stored (Lehman, 2014). A diet in excess of carbohydrates can lead to obesity (being over the ideal weight for a person’s body size). Sources of Carbohydrates:
FatsFats are essential nutrients in our diets. Even though we tend to think of fats as bad for us, we do need a certain amount of fat in our diets. Fat helps to protect our organs, is necessary for all the membranes in most the cells in our body, for brain and nerve function, is used to insulate the body and help us prevent heat loss, and is a carrier for other nutrients ((Leahy, Fuze & Grafe, 2013; Lehman, 2014). Extra fat can also be used as energy for the body, or it can be stored. While we need a certain amount of fat in our diet, caution must be taken to not eat too much fat. A diet high in fat can lead to serious complications such as high cholesterol, myocardial infarction (heart attack), coronary artery disease, and cerebrovascular accidents (strokes). Sources of fat include oils, butter, margarine, salad dressings, and animal fats found in meat, fish, and milk. Some fats are healthier options than others. For example, choosing to eat a handful of nuts is a healthier option than choosing to eat a handful of potato chips. There are three main types of fats: monounsaturated fats, polyunsaturated fats and saturated fats (Leahy, Fuze & Grafe, 2013). Monounsaturated fats include vegetable fats such as olive oil and canola oil. Polyunsaturated fats include corn, soy, safflower, and sunflower oils, and omega-3-fatty acids. Saturated fats include butter, bacon, lard, coconut oil, and peanut oil. Saturated fats are less healthy options than monounsaturated and polyunsaturated fats. They should be consumed in limited quantities. Sources of Fat:
Match the nutrient with its function
VitaminsVitamins are essential to help our body use other nutrients we take in, and they also help to promote tissue growth. There are several kinds of vitamins, all of which have a specific purpose and which we need every day. With the exception of Vitamin D and Vitamin K, our body needs to obtain vitamins through our diets. We make a certain amount of Vitamins D and K within our bodies. While most people who eat a well-balanced diet do not need to take vitamin supplements, other people may need a daily supplement in order to meet their nutritional needs. The patient’s physician will discuss the specific vitamin supplements the patient needs, if any. If the patient has a question about a vitamin, Home Health Aides/Personal Care Aides should inform their supervisor about the patient’s question. Vitamin A is necessary to help keep the skin in good condition and also supports eye health. Vitamin A can be found in dark green, yellow, and orange vegetables. Vitamin B is needed to help the nervous and digestive systems function properly. It also is important for protein, carbohydrate, and fat metabolism. Metabolism is the process by which the body converts (changes) what we eat and drink into usable energy. Foods high in vitamin B are those found in animal products such as meat, milk and milk products, green leafy vegetables, and fortified grain products. When foods are fortified, they have nutrients added to them in order to make them more nutritious. For example, many grain or bread products are fortified, or enriched with extra minerals and vitamins for extra nutrition. Vitamin C helps to strengthen blood vessel walls and aids in the healing of wounds and bones. It also helps the body to absorb iron. Foods rich in vitamin C include fruits such as oranges, strawberries, grapefruit, and vegetables like broccoli, Brussel sprouts, and green cabbage. Vitamin D is needed for our body to build strong bones and teeth. Sources of vitamin D include milk, butter, salmon, sardines, tuna, liver, fish liver oils, and fortified orange juice. We also synthesize (make) our own vitamin D when we get sunlight on our skin. Vitamin E is an antioxidant, which is a substance used to remove potentially damaging agents called free radicals. This helps to promote a good immune system. Sources of vitamin E are wheat germ, fish, fruits, vegetables, cereals, and nuts. MineralsOur bodies also require a number of minerals in order to best function. Minerals are compounds that our body needs in order to perform a variety of functions. There are a number of essential minerals that our bodies need. For example, we need calcium, which is a mineral, in order to help keep our bones and teeth strong. There are a number of minerals that we need to take in through eating a well-balanced diet. Calcium, potassium, chloride, sodium, phosphorus, and magnesium are known as major minerals (Lehman, 2014). Iron, fluoride, zinc, copper, selenium, chromium, and iodine are known as minor minerals (Lehman, 2014). Whether a mineral is major or minor has to do with the amount we need in our diets. We need a greater amount of calcium within our diet as compared to zinc, for example. Calcium: is a mineral that is needed for bone and teeth strength, blood clotting, proper muscle contraction, and a healthy heart. Milk and milk products such as cheese, ice cream, yogurt, leafy green vegetables, and canned fish, such as sardines (which have soft bones) are good sources of calcium. Potassium: helps the heart to function properly, helps muscles to contract, and is necessary for good nerve conduction. Foods high in potassium include tomatoes, potatoes, squash, dried apricots, yogurt, and bananas. Iron: iron combines with protein to make hemoglobin, which is a part of our red blood cells that carries oxygen. Good sources of iron include red meat, chicken, pork, dark green leafy vegetables such as spinach, iron fortified cereals and grain products, and dried fruits such as raisins. Iodine: is needed for proper functioning of the thyroid gland. The thyroid is important for our body’s metabolism. Sources of iodine in the diet can include cod, shrimp, canned tuna, iodized table salt and even milk and yogurt. Sodium: helps our body to maintain normal fluid balance. Foods high in sodium include most processed food, many canned food such as meats and soups, olives, pickles, packaged mixes, and canned foods such as vegetables. While we need sodium in our diet, we should limit the amount of sodium we take in. WaterWater is essential to all life, including human life. Without it, we cannot survive. We could only live for a few days without water. We need water for digestion, elimination, and control of our body temperature. The majority of our body is made up of water. We need about 8 glasses, or 64 ounces, of water each day to stay adequately hydrated. Liquids such as coffee, tea, juices, milk, and soda also provide us with fluid we need. However, it is healthier to select drinks such as water, milk, or juice rather than soda. It is important to remember to keep a patient hydrated. Some patients may not be able to or may forget to ask for a drink of water. It is a good idea for Home Health Aides/Personal Care Aides to offer a drink of water at least once every two hours. When turning and positioning a bedridden patient, offer them a glass of water at that time. Nutrients Work TogetherIt is important to have a well-balanced diet. While each of the individual nutrients discussed above are important, it is important that a person take in a combination of all of them to make a well-balanced diet. Together they work to keep the body working at its optimum (best) level. Self-Check Activity m8-2
Select the nutrient category to which the food in the list belongs.
A well–balanced diet means a diet in which all the nutrients our body needs for proper functioning and energy are taken in. A well-balanced diet contains a variety of foods from all the food groups, as well as all the necessary vitamins and minerals we need. It also means taking in an adequate supply of water for adequate health. A well-balanced diet can be planned by selecting healthy foods from each of the food groups. USDA‘s ChooseMyPlate Dietary GuidelinesThe United States Department of Agriculture (USDA) developed healthy eating guidelines for Americans to follow to help them make healthy food choices. According to the USDA, The ChooseMyPlate icon (symbol) serves as a reminder for people to help them build a healthy plate at meal times. The emphasis is on the five food groups that are necessary for good health: vegetables, fruits, grains, proteins, and low-fat dairy foods. ChooseMyPlate.gov is a scientifically based and up-to-date resource which can provide Home Health Aides/Personal Care Aides with useful information for planning meals and educating their patients about healthy food choices and physical activity. All recommended daily servings and food group sources discussed in this module are according to the guidelines set forth by the USDA and can be downloaded from www.choosemyplate.gov.
When selecting foods included in the milk group, low fat and fat-free choices should be made to promote good health. In general, 1 cup of milk, soy milk, yogurt, and 1 ½ ounces of cheese are considered a serving size (U.S. Department of Agriculture, 2015a).
Milk Sources:
Recommended daily servings of milk products:
Source: U.S. Department of Agriculture (2015a) Protein Foods GroupChooseMyPlate.gov suggests selecting a variety of foods high in protein with 8 ounces of seafood per week. In general 1 ounce (oz.) of meat, ¼ cup of beans, 1 tablespoon of peanut butter, or ½ ounce of nuts or seeds are considered a serving of protein (U.S. Department of Agriculture, 2015a). You can view sources of protein by visiting choosemyplate.gov at http://www.choosemyplate.gov/foodgallery–protein–foods
Protein sources:
Recommended daily servings of protein:
Source: U.S. Department of Agriculture (2015a) Fruit GroupMost fruits are low in fat and all fruits have no cholesterol (U.S. Department of Agriculture, 2015a). Fruits are considered an important part of our diets and have many protective health benefits. Eating a diet high in fruits has been shown to reduce the risk of heart disease, some types of cancer, obesity, and type 2 diabetes (U.S. Department of Agriculture, 2015a). In general, 1 cup of fruit or fruit juices or ½ cup of dried fruit is considered a serving size from the fruit group (U.S. Department of Agriculture, 2015a).
Fruit Sources:
Recommended daily servings of fruit:
Source: U.S. Department of Agriculture, 2015a Vegetable GroupMost vegetables are low in fat and all vegetables have no cholesterol (U.S. Department of Agriculture, 2015a). Vegetables are considered an important part of our diets and have many protective health benefits. Eating a diet high in vegetables has been shown to reduce the risk of heart disease, some types of cancer, obesity, and type 2 diabetes (U.S. Department of Agriculture, 2015a). In general, 1 cup of raw or cooked vegetables or 2 cups of leafy greens counts as one serving of vegetables (U.S. Department of Agriculture, 2015a).
Vegetable Sources:
Recommended daily servings of vegetables:
Source: U.S. Department of Agriculture, 2015a). Grain GroupFoods made from wheat, rice, cornmeal, rye, barley or other grains are considered grain products. Grain products are important sources of energy for our bodies. In general, 1 slice of bread, 1 cup cold cereal, ½ cup cooked cereal, rice, or pasta are considered to be a serving size of grain (U.S. Department of Agriculture, 2015a). Diets high in whole grain foods have been shown to reduce the risk of heart disease, stroke, type 2 diabetes, colorectal cancer, inflammatory diseases, helps to maintain a healthy blood pressure (American Heart Association, 2014b) reduce constipation, and help maintain a healthy weight. Select choices from the grain group from those that are high in fiber and made with whole grains for the most health benefit. You should strive to make at least half of your grains whole grains (U.S. Department of Agriculture, 2015a). You can view sources of grains by visiting choosemyplate.gov at http://www.choosemyplate.gov/grains
Grain Sources:
Recommended daily servings of grains:
Source: U.S. Department of Agriculture (2015a) OilsOils are NOT a food group, although they provide essential nutrients we need for our body (U.S. Department of Agriculture, 2015a). Oils include items such as butter, oils, margarine, mayonnaise, salad dressings. These food items should be used sparingly. Foods such as fish, nuts, and avocados are good choices of fats. Many foods we eat, especially those that are processed, often are high in fat. This should be considered when planning meals. In general, 1 ounce of nuts, 1 tablespoon margarine, mayonnaise, or oils, and 2 tablespoons of salad dressings count for one serving of oils (U.S. Department of Agriculture, 2015a). You can view sources of oils by visiting choosemyplate.gov at http://www.choosemyplate.gov/oils Recommended daily servings of oils:
Source: U.S. Department of Agriculture (2015a) Using ChooseMyPlate in Meal PlanningCreating a basic menu plan involves selecting a food from each food group. To help create well-balanced meals, it is helpful to follow the ChooseMyPlate food guidelines. ChooseMyPlate.gov suggests the following key points:
Dietary GuidelinesIn addition to taking in well-balanced foods and creating healthy meal plans, it is important for Home Health Aides/Personal Care Aides to keep the following in mind when planning and preparing meals to serve their patients:
Other ConsiderationsHome Health Aides/Personal Care Aides should involve their patients in meal planning. Use the communication skills learned throughout this course to educate patients about healthy food choices. When planning meals, they must take into consideration their patient’s food preferences, cultural and or religious background, eating habits, ability to chew and digest food, convenience of preparation, and calorie and special nutrient needs. Food preferences are determined by our family, culture, religious beliefs, foods we may choose not to eat, such as animal products for vegetarians, and the area we grew up or in which we live. There may be regional or ethnic differences in food preferences. Talk to the patient about their food preferences and beliefs. Watch the types of foods they eat. Make suggestions and ask for feedback. Ask them to share the foods they most enjoy. Always also assess for any allergies to foods, as these would be items to avoid purchasing or preparing in the patient’s home.
1. Home Health Aides/Personal Care Aides should ask their patient what their food preferences are and plan meals according to foods they enjoy and religious and cultural preferences. True or False? ______________ Cost of FoodIt is also important to consider the cost of food and the family’s ability to afford various types of food. If Home Health Aides/Personal Care Aides have a concern that the family is not getting enough to eat, they should speak to a supervisor. Various community resources are available to help families who cannot afford enough food. Use coupons when shopping for food and look for sales. Assist patients to plan meals weekly. Use items that are on hand or that wi ll spoil sooner first. Make a shopping list and stick to it. Purchase items such as dried beans and canned fishes to help provide less expensive sources of protein. When possible, buy in bulk. Purchase produce when it is in season as it will be freshest and cheaper. Unit C: Food Preparation and ServingWhen selecting foods to plan a menu and foods to offer a patient, Home Health Aides/Personal Care Aides should use the basics of good nutrition and follow the ChooseMyPlate guidelines found at www.choosemyplate.org
Multiple Choice 1. Which method of food preparation is the least healthy? a). Broiling b). Steaming c). Frying d). Roasting 2. Skin can be removed from meat and poultry to reduce fat. True or False? ________ Patient InvolvementIt is very important for Home Health Aides/Personal Care Aides to involve their patient in the planning and preparing of meals. Not only is the patient more likely to eat foods if they choose them, but it also helps to promote independence and self-determination. Working with a patient to plan meals and prepare foods can also help to strengthen the relationship. Share tasks of food preparation, keeping in mind any physical or cognitive limitations a patient may have. Home Health Aides/Personal Care Aides should not allow their patient to perform unsafe tasks if they are unable to do so. For example, young children should not be allowed to use sharp knives and dangerous equipment. A person with dementia who may forget what they are doing should be closely supervised while using knives or the stove. If adaptive equipment is available, teach and encourage the patient to use it. If they can assist to provide their own care, this will help promote self-esteem and independence. Getting involved in meal planning and preparation can also provide mental and physical stimulation, as well as relaxation and distraction. It can be a time where patients are encouraged to be creative and draw upon their strengths and talents, especially if they enjoy cooking. Many people enjoy food, either cooking or eating it. Home Health Aides/Personal Care Aides can make this time fun and relaxing by going through cookbooks and magazines with attractive pictures to help stimulate interests in food. Make a list of items that are on hand and Home Health Aides/Personal Care Aides can even make planning a meal with on-hand ingredients a fun game. Available Cooking EquipmentWhile preparing food in a patient’s home, Home Health Aides/Personal Care Aides may only have access to the available equipment they have on hand. There may not be a lot of equipment to choose from. They may need to get creative in order to adequately meet their patient’s nutritional needs. Discuss ideas with a supervisor about how to best do this. Serve Quality Food
Serving MealsMealtime is an excellent time to spend with a patient and their family. Home Health Aides/Personal Care Aides can use it as a time to talk, to learn more about their patient and to allow their patient time to socialize with them and others. Make sure to always plan for extra time during meals so the patient does not feel rushed. Sit next to or across from them whenever possible. Avoid doing other tasks while the patient is eating. Instead, use this time to socialize with them, unless they do not prefer it. If the patient has a swallowing problem, remember not to ask them questions while they are trying to chew or swallow, as this could lead to choking. Plan conversation for the time in between bites. If the patient requires assistance to eat, sit next to them. This will allow Home Health Aides/Personal Care Aides to be close enough so they do not have to overextend their back while feeding the patients. Be patient as they chew and do not rush them by trying to give them another bite of food while they are still chewing the first. Food Appearance, Texture, and Portion SizeSelect nutritious foods that are contrasting colors and textures. This adds to visual and chewing appeal. Try to vary the colors of the foods being served. Avoid serving foods that are all one color. Even for people who must have a mechanical diet, which is a diet that is altered in texture, such as food that is pureed or finely chopped, different colored foods can be selected. For example, select a green, soft vegetable (spinach), a red, crunchy fruit (an apple), and colorful, chewy wild rice to go along with a piece of chicken and a glass of milk. This lends visual and chewing appeal as the patient can see different colors and feel different textures as they chew. Home Health Aides/Personal Care Aides should be observant about changes in their patient’s appetite, and report any significant decreases of appetite to their supervisor. A poor appetite should be investigated. Some possible explanations of a poor appetite are:
1. Which of the following are possible causes of a poor appetite? Select all that apply. a). Poorly fitting dentures b). Depression c). Confusion or dementia d). Broken or loose teeth e). Medication side effects f). Not liking the food you prepared Unit D: Food Shopping, Storage, Handling, & Food SafetyFood can be expensive. Families on a tight budget may have trouble purchasing food. If Home Health Aides/Personal Care Aides ever observe that a patient does not appear to have enough food in the house, they should discuss this concern with their supervisor. Here are some tips for Home Health Aides/Personal Care Aides to keep in mind to help cut food costs:
Self-Check Activity m8-6
1. Which are ways a HHA/PCA can help reduce food costs for a patient? Select all that apply. a). Buy salad from the salad bar b). Check expiration dates of food c). Purchase bulk items even if they are not needed or there is no storage space d). Find protein substitutes for fresh meats e). Use coupons and buy sale items It is important to properly store food. Food that is improperly stored can lead to illness and is also a waste of money as it will have to be thrown out. You can read more about refrigeration and food safety at the United States Department of Agriculture website: http://www.fsis.usda.gov/wps/portal/fsis/topics/food–safety–education/get–answers/food–safety–fact–sheets/safe–food–handling/refrigeration–and–food–safety/ct_index Here are some things for Home Health Aides/Personal Care Aides to keep in mind, based on recommendations from the United States Department of Agriculture (2015b):
Source: United States Department of Agriculture (2015b)
Source: United States Department of Agriculture (2015b)
True or False 1. It is okay to store food under the kitchen sink as long as it is in its original package. True or False? _________ Multiple Choice: 2. At what temperature should refrigerated foods be kept at? a). 55 degrees or above b). 0 degrees c). 40 degrees or below d). 45 degrees 3. At what temperature should frozen foods be kept at? a). 55 degrees or above b). 0 degrees c). 40 degrees or below d). 45 degrees Safe Food HandlingWhen handling food, it is important to keep safety at the forefront of food preparation. You can read more about safe food handling guidelines developed by the United States Department of Agriculture at: http://www.fsis.usda.gov/wps/wcm/connect/18cece94-747b-44ca-874f-32d69fff1f7d/Basics_for_Safe_Food_Handling.pdf?MOD=AJPERES#page=2 Home Health Aides/Personal Care Aides should follow these guidelines for safe food handling:
Source: United States Department of Agriculture (2013a) Self-Check Activity m8-8
True or False 1. You should wash your hands, cutting boards, and work surfaces immediately after handling raw meat, poultry, and fish. True or False? _________ 2. Separate cutting boards should be used for raw meats and fresh vegetables. True or False? _________ 3. Never eat or serve raw eggs or eggs that have cracks in them. True or False? _________ Many people use a microwave to cook or reheat food. It is important for the Home Health Aide/Personal Care Aide to follow safety precautions when using a microwave for food preparation. The United States Department of Agriculture has specific guidelines for safe use of a microwave for food preparation. You can read more about the following guidelines based on the USDA (2013b) recommendations for safe microwave use at: http://www.fsis.usda.gov/wps/portal/fsis/topics/food–safety–education/get–answers/food–safety–fact–sheets/appliances–and–thermometers/cooking–safely–in–the–microwave/cooking–safely–in–the–microwave–oven
Safe Cooking TemperaturesThe USDA has guidelines about safe food cooking temperatures. To avoid food-borne illnesses, these should be followed. Home Health Aides/Personal Care Aides should always check food for doneness with a thermometer. Just because food appears to be cooked from the way it looks on the outside does not mean it is cooked in the center. Insert a thermometer into the thickest part of the meat or the center of the food. Do not allow the thermometer to touch bone, fat, or gristle (United States Department of Agriculture, 2011).
Source: United States Department of Agriculture, 2011
True or False 1. If a food is brown on the outside, it is done. True or False? ___________ Multiple Choice 2. At which temperature should poultry be cooked to? a). 165 degrees b). 145 degrees c). 160 degrees d). 155 degrees 3. At which temperature should ground beef be cooked to? a). 165 degrees b). 145 degrees c). 160 degrees d). 155 degrees 4. At which temperature should leftovers be reheated to? a). 165 degrees b). 145 degrees c). 160 degrees d). 155 degrees 5. At which temperature should steaks, chops, and roasts be cooked to? a). 165 degrees b). 145 degrees c). 160 degrees d). 155 degrees Food Money ProceduresIf Home Health Aides/Personal Care Aides will be purchasing food for their patient and their family, they must always follow their agency’s procedures about handling money. They should save all receipts and turn them in to the appropriate place, and account for all money that was spent as soon as possible after shopping. Use checks instead of cash whenever possible. Always keep to the food budget and the grocery list. They should never purchase items for themselves or borrow money from their patient to buy something for themselves while shopping for the patient. They also cannot do their own shopping while doing a patient’s grocery shopping. Not only is this stealing company time, but they risk mixing up items, receipts, and money. This could lead to trouble. Unit E: Modified DietsSome patients may require a modified diet due to health conditions, diseases, or problems with chewing, swallowing, or choking. Sometimes, certain medications may even interact with certain foods, and a patient may need to have more or less of a certain food while on that medication. Modified diets are changes made in a particular nutrient or the texture of the food. Diets may be ordered by a physician. A Registered Dietician will often be involved in planning the patient’s diet in these cases. The patient may need to have more or less of a certain nutrient. For example, they may have an order to eat foods low in potassium if they have kidney disease or low in sodium if they have heart failure. Or, they may have an order that says they should eat a diet high in protein. Home Health Aides/Personal Care Aides should always follow the diet as specified in the Care Plan. It is in place for the health and safety of their patient. When in doubt, they should seek guidance from a supervisor. The Meaning Of “High” And “Low” Diet Orders:
Decreasing the Intake Of Certain FoodsLow Calorie and Low FatLow calorie foods are foods that are low in calories. Foods may be labeled as reduced calorie, low calorie, or light. Generally, these foods have fewer calories than other products of the same type. Low fat foods are foods that are low in fat. Foods may be labeled as nonfat, reduced fat, fat free, or light (Leahy, Fuzy & Grafe, 2013). Keep in mind that baked goods that are labeled low fat tend to have extra things like sugar in them to make them taste better without the fat (Leahy, Fuzy & Grafe, 2013). Always read the label. Patients should not reduce caloric intake without speaking to their doctor. It can be very difficult to follow a low calorie and low fat diet, especially long-term. Low Sodium/SaltLow sodium foods are foods that are low in sodium or salt. They may be labeled as low sodium, low salt, sodium free, very low sodium, or no salt added (Leahy, Fuzy & Grafe, 2013). Read food labels to check for the amount of sodium listed. For patients who are on low sodium diets, this is a special concern. Foods that contain a lot of sodium tend to be prepared foods, frozen dinners, canned soups and meats, and prepared boxed foods such as macaroni and cheese and pastas that are ready to eat with sauce. For patients who require a low sodium diet, Home Health Aides/Personal Care Aides should not add salt while preparing foods. Offer herbs, spices, and lemon or lime zest to improve the flavor of foods for these patients. It can take some getting used to not eating a high amount of sodium in the diet. Sugar Free/No Sugar AddedSugar free or no sugar added foods are those that do not have sugar in them or that do not add sugar to the ingredients. Patients who are diabetic may be on a sugar free diet and need to watch the amount of sugar they consume. Sugar free products tend to have artificial sweeteners such as saccharin or aspartame. Always read the nutrition label to check for the amount of sugar in a food. Sugar is added and hidden in many food products. Increasing the Intake of Certain FoodsHigh Protein/High CalorieFor patients who require a high protein or high calorie diet, an extra amount of protein and/or calories would be added to their diet. Patients on these types of diets may need extra calories or protein to help promote healing or weight gain if they are malnourished. It is best to provide snacks throughout the day or smaller meals in order to increase the amount of calories or protein in the diet, rather than to serve larger meals with a larger amount of food. The University of Pittsburgh Medical Center (UPMC) has suggestions for increasing protein into the diet. These can be found at: http://www.upmc.com/patients–visitors/education/nutrition/Pages/tips–for–increasing–protein–in–your–diet.aspx Here are some suggestions based on UPMC (2015) that Home Health Aides/Personal Care Aides can follow to increase calorie or protein intake for their patients:
Types of Modified DietsThe type of diet the patient has been prescribed can be found in the Care Plan. There are numerous reasons why a patient may be on a modified diet. Below are some of the more common types of modified diets and food suggestions that Home Health Aides/Personal Care Aides may encounter. Low Sodium/Low Salt DietsPatients who have conditions such as heart disease, heart failure, high blood pressure, coronary artery disease, and kidney disease may require a diet low in sodium/salt. This is because excess sodium causes the body to retain (hold in) more water. This excess water causes the heart to pump harder. For people who have heart or kidney problems, this makes their organs have to work harder than they are able. Excess sodium in their diets can cause a progression (worsening) of their disease. The excess fluids can also lead to edema (swelling) in their bodies. The Care Plan will specify how much sodium the patient should have in their diet. Here are some tips for Home Health Aides/Personal Care Aides to help people who have to be on low sodium diets:
1. Which of the following foods should a person on a low sodium diet avoid? Select all that apply. a). Fresh fruit b). Frozen dinners c). Boxed dinners d). Vegetables e). Canned soups f). Herbs and spices Fluid-Restricted DietsPatients who have heart and kidney disease may also need to watch their fluid intake. Just as in high sodium diets, excess water can make their heart and kidneys have to work harder. For patients with these types of problems, excess fluids can lead to a worsening of their disease. The excess fluids can also lead to edema (swelling) in their bodies. Here are some tips for Home Health Aides/Personal Care Aides to help people who are on restricted fluids:
High Potassium DietPatients who are taking medications such as diuretics may need to be on a high potassium diet (Leahy, Fuze & Grafe, 2013). Diuretics are medications that help the body to reduce fluid volume. Many people take diuretics to help lower blood pressure, or if they have heart disease. They help the heart to work less hard, as diuretics help remove water from the body. Too much water in the body makes the heart work harder, which weakens the heart and may cause or worsen heart failure. Some diuretics also remove potassium from the body. Other patients may have low potassium levels from other reasons such as excessive diarrhea, sweating, or vomiting and may need to eat diets higher in potassium to replace potassium that is lost. As we have discussed, potassium is necessary for a healthy body and heart. Low levels of potassium can cause an irregular heart rate, weakness, fatigue, muscle cramps, and constipation (Mayo Clinic, 2014). A list of foods high in potassium can be found at the National Kidney Foundation at: https://www.kidney.org/atoz/content/potassium According to the National Kidney Foundation (2015), here are some foods which are high in potassium:
Low Potassium DietsSome patients need to avoid taking in extra potassium in their diets. This may be due to kidney disease or from taking certain diuretics. While many diuretics deplete (get rid of) potassium, some diuretics help the body hold onto potassium. For these patients, they may be asked to not consume extra potassium. Just as not enough potassium can lead to problems, too much potassium can also lead to problems, such as irregular heart rhythms. If potassium levels are too high in the body, the patient may feel weakness, numbness, or tingling, and too high levels of potassium can cause an irregular heart rate or heart attack (National Kidney Foundation, 2015). Diets low in potassium may be prescribed for these patients. Instead of encouraging the foods found on the high potassium list, Home Health Aides/Personal Care Aides should teach patients to avoid these foods. Also be cautious to avoid using salt substitutes, which are high in potassium. A list of foods low in potassium can be found at the National Kidney Foundation at: https://www.kidney.org/atoz/content/potassium
1. Which of the following foods should a person on a low potassium diet avoid? Select all that apply. a). Bananas b). Potatoes c). Steak d). Chicken and turkey e). Beans f). Tomatoes g). Peanut butter h). Milk i). Dried fruits Low Fat/Low CholesterolSome patients may need to limit their fat or cholesterol intake. People with heart disease, high cholesterol levels, gallbladder disease, liver disease, and some digestive problems may have to limit how much fat or cholesterol is in their diets. Here are some tips for Home Health Aides/Personal Care Aides to help a patient on a low fat/low cholesterol diet:
BlandPatients who have digestive problems such as Crohn’s disease or Irritable Bowel Syndrome, or ulcers in their digestive tract may be required to be on a bland diet. This means that foods that are irritating to the gastric mucosa (stomach lining) need to be eliminated. This is because certain foods make the stomach produce more acid. Increased acid can lead to irritation of the stomach or other parts of the digestive tract such as the small or large intestine. Foods high in acid content can also irritate the esophagus as they are being swallowed. Here are some foods to avoid for a bland diet:
Gluten-Free DietSome people may be required to be on a gluten–free diet. Gluten is a protein in wheat, rye, and barley, and helps to hold foods together (Celiac Disease Foundation, 2015c). Gluten can also be found in foods in which it may be unexpected that gluten would be so it is important that Home Health Aides/Personal Care Aides always read food labels when preparing food for patients on a gluten-free diet. People on a gluten-free diet may have digestive problems, such as celiac disease. Celiac disease is an autoimmune disorder in which ingestion of gluten leads to damage to the small intestine. Eating gluten leads to damage on the villi, which are finger-like projections lining the small intestine. These villi are important to help us absorb nutrients. When they are damaged, malabsorption (difficulty absorbing nutrients) can occur. This can lead to many health problems. According to the Celiac Disease Foundation (2015b) about 1 in 100 people around the world have Celiac disease with 2.5 million Americans undiagnosed with this potentially health-complicating disease. Some people have a gluten intolerance, which does not damage the villi but causes symptoms such as abdominal pain, gas, and diarrhea (Leahy, Fuze & Grafe, 2013). Other people may just prefer to be on a gluten-free diet. Here is a list of foods to avoid for people on a gluten–free diet:
It can be frustrating for a person who cannot have gluten to find foods they can have. As a Home Health Aide/Personal Care Aide you can assist your patient to make healthy food selections to help them be compliant with their diet. Many foods are naturally gluten-free such as fruit, vegetables, meat, poultry, dairy, beans, legumes, and nuts (Celiac Disease Foundation, 2015a). Here is a list of items according to the Celiac Disease Foundation that a person on a gluten–free diet can have:
There are many products now found on the market that make bread, cereals, and pasta without gluten in them. These items may be more expensive. It is important to always read the label. Many foods are made with wheat in them, which is often used as a thickener.
1. Which of the following foods should a person on a gluten-free diet avoid? Select all. a). Wheat cereals and breads b). Corn c). Potatoes d). Vegetable soup with barley e). Soy f). Rye bread Vegetarian DietSome people may be on a vegetarian diet for health, personal, or religious reasons. There are many different types of vegetarian diets, which indicate what types of foods are avoided. According to the American Heart Association (2014a) there are several types of vegetarian diets, including lacto-vegetarian, ovo-vegetarian, vegan, and semi-vegetarian. Lacto–vegetarian: excludes meat, fish, poultry, and eggs. This diet allows dairy products, along with fruits, vegetables, nuts, seeds, grains, legumes, lentils, and peas. Ovo–vegetarian: excludes meat, fish, poultry, and dairy, but allows eggs, along with fruits, vegetables, nuts, seeds, grains, legumes, lentils, and peas. Vegan: excludes all meat, fish, poultry, eggs, dairy products, and any food with these ingredients. Foods allowed include fruits, vegetables, nuts, seeds, grains, legumes, lentils, and peas. Semi–vegetarian: excludes red meat, but may allow poultry, fish, eggs, and dairy products, along with fruits, vegetables, nuts, seeds, grains, legumes, lentils, and peas. It is important to remember that people who eat vegetarian type diets need to consume enough nutrients in their diets for good health. While they do not get protein from meat, fish, and poultry, protein can be found in other food sources. Excellent alternatives to meat protein include soy proteins and protein from legumes, lentils, peas, and milk products. Liquid DietLiquid diets are those that patients may be on for a short period of time for a specific reason. Some people may need to be on a liquid diet prior to a medical procedure, test, or surgery. Others may be on a liquid diet in order to help heal their stomach or intestines from a medical condition. Foods on a liquid diet must be in their liquid state. There are two types of liquid diets: clear liquid and full liquid. A rule of thumb for clear liquid diets is that you should be able to see through them. They may be colored, such as popsicles and jello, but you can see through these foods. Clear liquid diet:
Full liquid diet:
1. A full liquid diet means the person can have all items on the clear liquid food list plus also items like cream of wheat, milk shakes, yogurt, and pudding. True or False? ________ 2. Which of these items would not be allowed on a clear liquid diet? a). Beef broth b). Jello c). Frozen yogurt d). Apple juice Soft DietSoft diets are used for people who may have poor dentition, (this refers to the strength, number of, and arrangement of teeth in the mouth) who are recovering from a gastrointestinal surgery, and people who have difficulty with chewing and swallowing. When a patient is on a soft diet, the HHA/PCA must be concerned with the consistency of the diet. Soft foods require almost no chewing. They are easy to chew and swallow. Raw fruits and vegetables, hard-to-chew meats, and dry foods that can easily be choked on such as crackers and dry toast should be avoided. Mechanically Altered DietsA mechanically altered diet is a diet in which the texture (consistency) of the food is changed to help the person chew or swallow. A mechanically altered diet is given to a person who has dysphagia. Dysphagia means difficulty chewing or swallowing. A dysphagia diet or mechanically altered diet makes it easier to chew and swallow food and reduces the risk of aspiration (Ohio State University Wexner Medical Center, 2013). Dysphagia can occur due to many reasons, including reflux which can eventually cause the esophagus to narrow, making food difficult to pass through, neurological disorders such as from a stroke, cerebral palsy, multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease (Jackson, 2015). For a comprehensive list of food suggestions on mechanically altered diet as well as recipes, visit http://gicare.com/diets/dysphagia–diet/ Mechanical soft dietA mechanical soft diet is a diet that consists of food that is made softer and easier to chew and swallow by changing the texture of the food. For example, by cooking chopped or diced carrots until soft, they can be mashed or pureed. Cooked foods can also be chopped, diced, or ground. This helps a person who has trouble chewing and swallowing to still take in the nutrients they need. Preparing mechanically altered diets:
Pureed dietA diet that is pureed consists of food that is cooked and then chopped, blended, or ground into a thick paste that is the consistency of baby food or mashed potatoes. No chewing is required for this type of diet. Mechanical soft diet food suggestions:
Foods to avoid:
1. Which of the following foods are safe to eat on a mechanical diet? Select all that apply. a). Meatloaf b). Applesauce c). Gum d). Popcorn e). Cream of wheat f). Yogurt g). Granola h). Tough meat i). Crackers j). Jello k). Egg salad l). Cottage cheese m). Dried fruit n). Salad o). Pudding Provide nutritious and attractive mechanically altered foodWhen food is mechanically altered (chopped, ground, or pureed) it may lose its appeal to the patient. It looks different than the food they are used to. It is important for Home Health Aides/Personal Care Aides to remember to maintain nutritious meal planning using ChooseMyPlate guidelines, and to try to present food in an appealing way. Important things to keep in mind when preparing mechanically altered diets:
True or False 1. It is very important, especially for a patient with a swallowing problem to be in an upright position during mealtime and to be kept upright for 30-60 minutes after eating to prevent choking. True or False? ______ 2. It is okay to put all the food items together in the blender instead of blending each separately when preparing a pureed diet for a patient, as this saves time. True or False? ________ Follow safe food preparation and storage guidelinesAlways use proper food safety and storage precautions. This applies to preparing any type of food, even foods that are mechanically altered. Keep the following important points in mind:
Post-test
American Heart Association. (2014a, March 19). Vegetarian diets. Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Vegetarian–Diets_UCM_306032_Article.jsp American Heart Association (2014b, April 14) The greatness of whole grains. Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/The–Greatness–of–Whole–Grains_UCM_455739_Article.jsp#.VnxsxdIrIy4 Celiac Disease Foundation. (2015a). What can I eat? Retrieved from http://celiac.org/live–gluten–free/glutenfreediet/food–options/ Celiac Disease Foundation. (2015b). What is celiac disease? Retrieved from http://celiac.org/celiac–disease/what–is–celiac–disease/ Celiac Disease Foundation. (2015c). What is gluten? Retrieved from http://celiac.org/live–gluten–free/glutenfreediet/what–is–gluten/ Jackson, F. W. (2015). Dysphagia diet: Five levels for difficulty in swallowing diet. Retrieved from http://gicare.com/diets/dysphagia–diet/ Leahy, W., Fuzy, J., & Grafe, J. (2013). Providing home care: A textbook for home health aides (4th ed.). Albuquerque, NM: Hartman. Lehman, S. (2014, June 9). Nutrients: What they are and why you need them. Retrieved from http://nutrition.about.com/od/nutrition101/a/nutrients.htm Mayo Clinic (2014, July 8). Low potassium (hypokalemia). Retrieved from http://www.mayoclinic.org/symptoms/low–potassium/basics/definition/sym-20050632 National Kidney Foundation. (2015). Potassium and your CKD Diet. Retrieved from https://www.kidney.org/atoz/content/potassium Ohio State University Wexner Medical Center. (2013, June 27). Dysphagia: Mechanically altered diet (Level 2). Retrieved from https://patienteducation.osumc.edu/documents/dys-2.pdf U.S. Department of Agriculture. (2011, May 25). Cooking meat? Check the new recommended temperatures. Retrieved from http://blogs.usda.gov/2011/05/25/cooking–meat–check–the–new–recommended–temperatures/ U.S. Department of Agriculture. (2013a, June 8). Easy lessons in safe food handling. Retrieved from http://www.fsis.usda.gov/wps/wcm/connect/18cece94-747b-44ca-874f-32d69fff1f7d/Basics_for_Safe_Food_Handling.pdf?MOD=AJPERES#page=2 U.S. Department of Agriculture. (2013b, August 8). Cooking safely in the microwave oven. Retrieved from http://www.fsis.usda.gov/wps/portal/fsis/topics/food–safety–education/get–answers/food–safety–fact–sheets/appliances–and–thermometers/cooking–safely–in–the–microwave/cooking–safely–in–the–microwave–oven U.S. Department of Agriculture. (2015a). ChooseMyPlate. Retrieved from http://www.choosemyplate.gov/ U.S. Department of Agriculture. (2015b, March 23). Refrigerator and food safety. Retrieved from http://www.fsis.usda.gov/wps/portal/fsis/topics/food–safety–education/get–answers/food–safety–fact–sheets/safe–food–handling/refrigeration–and–food–safety/ct_index University of Pittsburgh Medical Center. (2015). Tips for increasing protein in your diet. Retrieved from http://www.upmc.com/patients–visitors/education/nutrition/Pages/tips–for–increasing–protein–in–your–diet.aspx |