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Nutrition Fundamentals and Medical Nutrition Therapy
Managing Selective Menus, Nourishments and Supplemental Feedings
Corresponds with LEARNING PLAN 15Copyright 2016 Association of Nutrition and Foodservice Professionals
15
Objectives
Review dietary requirements of client
Determine client’s knowledge and needs
Evaluate client’s food preferences
Suggest acceptable food substitutes based on client’s preferences
Verify substitutes in terms of availability and facility practices
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Objectives
Define the culture change in feeding practices in long-term care
Define the concept of “real food first”
Identify clients who need nourishments/supplemental feedings
Identify appropriate supplemental products
Monitor the delivery of nourishments and supplements
Audit the acceptance of nourishments and supplements
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Culture Change Focus
Client’s choice and self-determination
CMS F242
Person-centered
Client driven
Dietary requirements
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Culture Change - Language
See more language examples in Figure 15.1
Goal is to maintain dignity of client
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Say NotElder ElderlyDining table Feeder tableLiving center FacilityNapkin Bib
Brain Break
What is the suggested terminology for dietary service or foodservice?
» Dining Services
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Culture Change - Dining
Goal is a client driven dining experience
Begin with a client interview
Research options and resources to help guide process
Include all departments in the process
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Make good and timely communication with departments a priority
Develop policies that outline department responsibilities
Initiate training
Brain Break
What questions would the CDM need to ask/answer when considering changing to restaurant style dining?
» Examples:- What existing equipment might be needed- How will menu be communicated- Are there client safety concerns- How will items be labeled or designated for dietary restrictions
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Culture Change - Menu Options
Selective Menu» Honor therapeutic diets» Allow special requests per facility policy
Non-selective menus» Ensure extensive recording of likes and dislikes
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Culture Change - Service Options
Restaurant style service
Buffet style
Family style dining
Room service dining
24-hour dining
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Comfort Foods
Foods that are familiar
Associated with feelings of well-being
May help with unintended weight loss
Improve client’s appetite
Increase socialization
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Brain Break
What are some common comfort foods?
» Chicken soup» Potatoes – mashed, French fries» Fried chicken» Pizza» Burritos» Mac and Cheese» Breads, especially hot breads
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Comfort Foods
Two major nutrient components» Carbohydrate» Fats
Usually staples in the American diet
Regional differences
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Incorporating Comfort Foods
Start small
Incorporate client input
Incorporate into existing menu structure
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Brain Break
What are some simple ways to incorporate comfort foods into a menu?
» Examples:- Soups can be offered at the start of a meal- Add them to breakfast like a topping bar for pancakes or waffles- Use them as a side dish such as a side of mashed potatoes or
mac and cheese- Consider fresh baked bread or cookies so that the aromas
announce the food
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Nutrition Support
Provide foods and liquids to improve nutritional status» Simplest form is high-protein, high-calorie diet
Provide “real” food first
Liberalize the diet
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Nutrition Support - Enteral Nutrition
Feeding formulas by mouth or by tube that contain essential nutrients
Standard enteral formula provides one calorie per ml or about 240 calories per cup
Are specialized for different dietary conditions such as diabetes, renal failure or liver failure
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Brain Break
How many calories would you expect to be in a 6-ounce standard supplement?
» 180 calories assuming 30 ml to an ounce
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Nutrition Support - Enteral Nutrition
Advantages» Offer controlled and measured amounts of nutrients» Available with key dietary modifications» May be calorically dense (480 calories/cup)
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Nutrition Support - Enteral Nutrition
Disadvantages» Acceptance» Cost» How they are dispensed in the facility
- CDM should oversee that the supplements be offered in a timely manner and consumed
- Intake should be documented
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Nutrition SupportIncreasing Enteral Nutrition Acceptance
Combine commercial products with contention foods» Milkshake made from a supplement» Garnish supplements with chocolate or fruit
Stir supplement powders into beverages, soups or other foods
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Brain Break
Provide examples of how to combine conventional foods with supplements.
» Examples:- Add supplement powder to mashed potatoes or cream soups- Make cream gravies with supplements- Use supplements to make toppings for cakes- Add fresh fruit to supplement puddings
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Enteral Nutrition - Tube Feeding
When taking food or liquids by mouth is not possible or practical but the gastrointestinal tract is functioning
Location» NG – nasogastric» ND – nasoduodenal» NJ – nasojejunal
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Enteral Nutrition - Tube Feeding Complications Gastrointestinal disturbances
» Diarrhea
Metabolic complications» Electrolyte imbalance
Mechanical complications» Rate of administration
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
Nutrition Support - Parenteral
Administration of simple essential nutrients into a vein
Uses» When GI tract is no longer able to digest or absorb food» Maintain fluid and electrolyte balance before and after
surgery» When a client is not receiving enough nourishment by other
feeding methods
TPN – when a client’s total nutrient needs are received via parenteral nutrition
Nutrition Fundamentals and Medical Nutrition Therapy • Managing Selective Menus, Nourishments, etc. • Learning Plan 15
