In-Service Training

BASICS OF THERAPEUTIC DIETS

LESSON PLAN

OBJECTIVE

As a result of this session, the foodservice worker will:

• Understand the importance of following a therapeutic diet order
• Understand basic definitions of common therapeutic diets
• Understand the importance of the diet manual

LESSON OUTLINE

Step 1: Pre-Test: Test of 10 Questions (5 minutes)

Step 2: Lecture and Discussion (10 minutes)

- Introduction: What is a therapeutic diet?
- Who may order a therapeutic diet?
- Why are therapeutic diets necessary?
- What are common types of therapeutic diets?
- What are definitions of commonly used therapeutic diets?
- Why use a diet manual?

Step 3: Handouts: “Abbreviations Used on Modified Diet Sheets” (5 minutes)

Step 4: Post-Test: Test of 10 Questions (5 minutes)

Pre-Test: Basics of Therapeutic Diets

Name: _____________________

TRUE OR FALSE

1. Only a Physician, Physician’s Assistant or Nurse Practitioner TRUE FALSE

can order a therapeutic diet:

2. A “No Concentrated Sweets” (NCS) diet includes regular foods TRUE FALSE
without the addition of sugar:

3. A diet manual should only be used by trained nursing staff: TRUE FALSE

4. A therapeutic diet is a meal plan that controls the intake of TRUE FALSE
certain foods or nutrients as part of the treatment for a medical condition:

5. A regular diet has no restrictions: TRUE FALSE

MULTIPLE CHOICE

6. A physician may order a therapeutic diet to:

A. Decrease calories for weight control C. Restore nutritional status
B. Correct nutritional status D. All of the above

7. A “No Added Salt” (NAS) Diet:

A. Is a regular diet with no salt packets on C. Is nutritionally adequate
tray
B. Provides regularly seasoned food D. All of the above

8. A therapeutic diet may be ordered to:

A. Maintain nutritional status C. Correct nutritional status
B. Restore nutritional status D. All of the above

9. LS means:
A. Less sugar C. Low sodium
B. Low sugar D. None of the above

10. A book that describes the food restricted or allowed on a diet is called a:
A. Medical Manual C. Diet Log
B. Diet Manual D. None of the above
LECTURE AND DISCUSSION: BASICS OF A THERAPEUTIC DIET

Introduction: What is a therapeutic diet?

• A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. A
therapeutic diet is sometimes called a “special diet”. It is part of the treatment of a medical
condition. A therapeutic diet is usually a modification of a Regular diet. It is modified or
tailored to fit the nutrition needs of a particular patient or resident. Therapeutic diets are
modified for (1) nutrients, (2) texture and/or (3) food allergies or food intolerances.

Who may order a Therapeutic diet?

A therapeutic diet order is made by a physician. In some cases, a physician’s assistant or a
nurse practitioner is allowed to order a therapeutic diet under a physician’s guidance. Dieti-
tians, nurses and speech therapists often make recommendations to physicians about therapeutic
diets for residents and patients. Once the therapeutic diet is ordered, it is filled by the foodser-
vice department. Filling a diet order in the foodservice department is similar to a nurse filling a
medication order. It must be done with the same importance.

Why are therapeutic diets necessary?

Common reasons therapeutic diets may be ordered include:
• To maintain nutritional status
• To restore nutritional status
• To correct nutritional status
• To decrease calories for weight control
• To provide extra calories for weight gain
• To balance amounts of carbohydrates, fat and protein for control of diabetes
• To provide a greater amount of a nutrient such as protein
• To decrease the amount of a nutrient such as sodium
• To exclude foods due to allergies or food intolerance
• To provide texture modifications due to problems with chewing and/or swallowing
What are common types of therapeutic diets?

Common therapeutic diets include:

Nutrient Modifications
No Concentrated Sweets Diet
Diabetic Diets
No Added Salt Diet
Low Sodium Diet
Low Fat Diet and/or Low Cholesterol Diet
High Fiber Diet
Renal Diet

Texture Modification
Mechanical Soft Diet
Puree Diet

Food Allergy or Food Intolerance Modification

Food Allergy
Food Intolerance

Tube Feedings
Liquid Tube Feedings in place of Meals
Liquid Tube Feedings in addition of Meals

Additional Feedings
In addition to meal, extra nutrition may be ordered as:
Supplements– usually ordered as liquid nutritional shakes once, twice or three times per day;
given either with meals or between meals.
Nourishments– ordered as a snack food or beverage items to be given between meals mid-
morning and/or mid-afternoon.
HS Snack– ordered as a snack food or beverage items to be given at the hour of sleep.
What are definitions of commonly used therapeutic diets?
The following defines a regular diet and lists brief explanations of common therapeutic diets.

Regular Diet
• Has no restrictions.
• Is nutritionally adequate in calories, protein, carbohydrates, fats, vitamins and minerals.
• Is for patients or residents with no special dietary needs.

No Concentrated Sweets Diets (NCS)

• Is considered a liberalized diet for diabetics when their weight and blood sugar levels are
under control.
• It includes regular foods without the addition of sugar.
• Calories are not counted as in ADA calorie controlled diets.

Diabetic or Calorie Controlled Diets (ADA)

• These diets control calories, carbohydrates, protein and fat intake in balanced amounts to
meet nutritional needs, control blood sugar levels and control weight.
• Portion control is used at meal times as outlined in the ADA “Exchange List for Meal Plan-
ning”.
• Most commonly used calorie levels are: 1200, 1500, 1800 and 2000.

No Added Salt Diet (NAS)

• Is a regular diet with no salt packet on the tray.
• Food is seasoned as regular food.

Low Sodium Diet (LS)

• May also be called a 2 gram Sodium Diet.
• Limits salt and salty foods such as bacon, sausage, cured meats, canned soups, salty season-
ings, pickled foods, salted crackers, etc.
• Is used for residents or patients who may be “holding water” (edema) or who have high
blood pressure, heart disease, liver disease or first stages of kidney disease.

Low Fat/Low Cholesterol Diet

• Is used for patients or residents to reduce fat levels and/or treat medical conditions that in-
terfere with how the body uses fat such as diseases of the liver, gallbladder or pancreas.
• Limits fat to 50 grams or no more than 30% calories derived from fat.
• Is low in total fat and saturated fats and contains approximately 250-300 mg cholesterol.

High Fiber Diet

• Is prescribed for patients in the prevention or treatment of a number of gastrointestinal, car-
diovascular and metabolic diseases.
• Increase fiber should come from a variety of sources including fruits, legumes, vegetables,
whole breads and cereals.
What are definitions of commonly used therapeutic diets? Con’t.
Renal Diet
• Is for renal/kidney patients.
• The diet plan is individualized for each patient depending on if the patient is on dialysis.
• The diet restricts sodium, potassium, fluid and protein specified levels.
• Lab work is followed closely.

Mechanically Altered or Soft Diet

• Is used when there are problems with chewing and swallowing.
• Changes the consistency of the regular diet to a softer texture.
• Includes chopped or ground meats as well as chopped or ground raw fruits and vegetables.
• Is for residents or patients with poor dental conditions, missing teeth, no teeth or a condition
known as dysphasia.

Pureed Diet
• Changes the regular diet to a soft pudding-like consistency.
• Is for patients or residents with chewing or swallowing difficulties or with the condition of
dysphasia.

Food Allergy Modification

• Food allergies are due to an abnormal immune response to an otherwise harmless food.
• Food implicated with allergies are strictly eliminated from the diet.
• Appropriate substitutions are made to ensure the meal is adequate.
• Them most common food allergens are milk, egg, soy, wheat, peanuts, tree nuts, fish and
shellfish.

Food Intolerance Modification

• The most common food intolerance is an intolerance to lactose (milk sugar) because of a
decreased amount of an enzyme in the body.
• Other common types of food intolerance include adverse reactions to certain products added
to food to enhance taste, color or protect against bacterial growth.
• Common symptoms involving food intolerances are vomiting, diarrhea, abdominal pain and
headaches.

Tube Feedings
• Tube feedings are used for patients who cannot take adequate food or fluids by mouth.
• All or part of the patient’s nutritional needs are met through tube feedings.
• Some patients may receive food by mouth if they can swallow safely and are working to be
weaned off the tube feedings.
Why use a diet manual?
The diet manual is a book that describes foods allowed and restricted on a therapeutic diet. It
includes the reason and use of diets, sample menus and non-routine diet orders such as a high
potassium diet. Physicians, dietitians, nurses and therapists also use the diet manual as a re-
source when evaluating the need for a therapeutic diet. The foodservice department uses the
diet manual to design modified menus for its residents or patients.

All facilities are required to have a diet manual. A diet manual should be reviewed and updated
every five years. A copy of the diet manual should be kept in the dietary department and also at
each nursing station.
Abbreviations Used on Modified Diet Sheets

Therapeutic
DT Diet
NCS No Concentrated Sweets
NAS No Added Salt
LS Low Sodium
LF Low Fat
UNS Unsweetened
PUR Pureed
SLR Slurry
CHP Chopped
EP Edible Portion

Utensils
Scp Scoop
S Spoodle
L Ladle

Potions
Tsp Teaspoon
Oz Ounce
Sl Slice
Ea Each
T Tablespoon
C Cup
Post-Test: Basics of Therapeutic Diets

Name: _____________________

TRUE OR FALSE

1. Only a Physician, Physician’s Assistant or Nurse Practitioner TRUE FALSE

can order a therapeutic diet:

2. A “No Concentrated Sweets” (NCS) diet includes regular foods TRUE FALSE
without the addition of sugar:

3. A diet manual should only be used by trained nursing staff: TRUE FALSE

4. A therapeutic diet is a meal plan that controls the intake of TRUE FALSE
certain foods or nutrients as part of the treatment for a medical condition:

5. A regular diet has no restrictions: TRUE FALSE

MULTIPLE CHOICE

6. A physician may order a therapeutic diet to:

A. Decrease calories for weight control C. Restore nutritional status
B. Correct nutritional status D. All of the above

7. A “No Added Salt” (NAS) Diet:

A. Is a regular diet with no salt packets on C. Is nutritionally adequate
tray
B. Provides regularly seasoned food D. All of the above

8. A therapeutic diet may be ordered to:

A. Maintain nutritional status C. Correct nutritional status
B. Restore nutritional status D. All of the above

9. LS means:
A. Less sugar C. Low sodium
B. Low sugar D. None of the above

10. A book that describes the food restricted or allowed on a diet is called a:
A. Medical Manual C. Diet Log
B. Diet Manual D. None of the above
Answers to Pre– and Post– Test Questions: Basics of Therapeutic Diets

1. T
2. T
3. F
4. T
5. T
6. D
7. D
8. D
9. C
10.B
In-Service Attendance Form

Facility: ________________________________________________________

Instructor (s): ____________________________________________________

TOPIC: Basics of Therapeutic Diets

Step 1: Pre-Test: Test of 10 Questions (5 minutes)

Step 2: Lecture and Discussion (10 minutes)

- Introduction: What is a therapeutic diet?
- Who may order a therapeutic diet?
- Why are therapeutic diets necessary?
- What are common types of therapeutic diets?
- What are definitions of commonly used therapeutic diets?
- Why use a diet manual?

Step 3: Handouts: “Abbreviations Used on Modified Diet Sheets” (5 minutes)

Step 4: Post-Test: Test of 10 Questions (5 minutes)

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