Diet Education for Food Service Employees

Dietetic Services

Objectives
To

know and understand

Who receives a special diet? What are the diet guidelines for each diet? Why is tray accuracy important? Why is proper customer service important?

Clear Liquid Diet

Who: Patients who are pre or post-surgery or need to rest their digestive system Why: Gives patients calories with minimal amount of work for digestion

Milk based fluids are not allowed Serve only pulp free juices Additional foods may be added if physician ordered

Clear Liquid Diet

Diet Guidelines:

Consists of clear fluids Other beverages may be foods that are liquid at room temperature (e.g. Jell-O or popsicles)

Clear Liquid Foods

Apple

Juice Cranberry Juice Grape Juice Jell-O Broth Popsicles Coffee or Tea

Diabetic Clear Liquid Diet

Who: Patients who have diabetes and need a clear liquid diet Why: A regular clear liquid diet is used to provide enough calories and CHOs to avoid low blood sugars

Give patient sugar substitutes instead of regular sugar packets

Full Liquid Diet

Who: Patients advancing from clear liquids to solid foods Why: Provides more calories and protein than clear liquids Prepares digestive system for solid foods

Margarine is allowed Avoid foods that contain fruit, coconut, seeds or nuts Avoid solid foods unless special ordered by physician

Full Liquid Diet

Diet

Guidelines:

Given to patients who cannot tolerate solid foods Consists of foods and liquids that become (or remain) liquid at room temperature

Full Liquid Foods

Juices Health shakes Pudding Yogurt (no fruit) Strained soups Milk Grits Cream of Wheat Hard candy

Pureed Diet

Who: Patients who are unable to chew or swallow Can be used after certain surgeries (e.g. Wired Jaw, Gastric ByPass, etc) Why: To make chewing and swallowing easier To prevent choking For easier digestion

Blended food must be consistently smooth Garnishes must be pureed too!

Pureed Diet
Diet

Guidelines:

Foods have been changed in texture to be soft, moist, and easy to swallow Add gravies and sauces to garnish the food and to help moisten the food.

Pureed Diet
Most

foods can be pureed

Meat, eggs, vegetables, fruits, grits, beans Breads Cakes Cookies Nuts Most raw fruits and vegetables

Exceptions:

Mechanical Soft Diet

Who: For patients with chewing problems Why: All foods must be soft for easy
chewing and swallowing

AVOID Crunchy or hard-to-chew foods such as:

Raw fruits and vegetables (salads) Nuts Seeds Dried fruits

Mechanical Soft Diet

Diet

Guidelines:

Foods that are soft

Meats are chopped or ground Add gravy and/ or sauces to moisten foods Waffles, pancakes, and other bread products are served with syrup Canned fruits Serve cooked vegetables (no lettuce) Garnishes must comply with guidelines

Modified Dysphagia Diet

Who: Patients who have difficulty swallowing Why: Foods and liquids not thickened properly can cause choking

Use pre-thickened beverages when ordered Ground meats are served unless otherwise ordered Garnishes must meet diet guidelines No rice or corn allowed

Modified Dysphagia Diet

Diet

Guidelines

Foods are ground, pureed or naturally soft Liquids can be thickened:

Pudding consistency (thickest) *Honey consistency Nectar consistency

* If consistency level is not ordered, then default to Honey Consistency

Post-Gastric ByPass Diet

Who: Obese patients who have Gastric ByPass (GBP) surgery

Why: The patients stomach is reduced to the size of an egg, so they need:

Smaller Portions Nutrient Dense Food - PROTEIN!

Limit fluid volume at one time Limit high fat foods

Post-Gastric ByPass Diet

Diet

Guidelines

Progressive Diet
Day 1: Clear Liquids (limited amount) Day 2: Full Liquids Day 3: Pureed Foods

No sugar! Sugar substitutes are allowed 6 Small meals per day No Garnishes allowed on trays

Bland Diet

Who: Patients with ulcers or stomach irritation (can cause heartburn after meals) Why: Eating these foods can cause further pain and discomfort

Black pepper packets Caffeine containing: Coffee / Tea / Soda Chocolate: Pudding / Cake/ Frosting / Ice Cream

Bland Diet
Diet

Guidelines:
Coffee Tea Sodas

Foods that are NOT ALLOWED:

Caffeine drinks

Chocolate Spicy foods Black pepper Alcohol Chili Powder

Low Fat Diet

Who: Patients with digestive disorders (e.g. pancreatitis) Why: Some patients cannot properly break down fats Too much fat in the diet can cause diarrhea, gas or other unpleasant side effects

High fat desserts/pastries (e.g. doughnuts, muffins, sweet rolls) Butter, margarine, cooking oils, salad dressing Whole milk Fried foods Some cheeses

Low Fat Diet

Diet Guidelines:

NO fried foods Use LOW FAT gravy ONLY Select FAT free dairy products Serve *FYH (For Your Health) vegetables AVOID Red Meat, fried and fatty meats NO margarine added to trays

*FYH foods are limited in fat, cholesterol, and sodium

Low Sodium (Na+) Diet

Who: Patients with high blood pressure, and heart, kidney, or liver disease Why: Large amounts of salt in the diet may cause the body to retain fluid, which makes the heart, kidneys, and liver work harder

Serve For Your Health (FYH) foods ONLY DO NOT add salt packets to trays Extra herb seasoning packets may be added

Low Sodium (Na+) Diet

Diet Guidelines:

AVOID processed foods like

Deli meats, canned soups, frozen meals

Limit canned and instant products like

Canned vegetables, and meats Instant grits, instant potatoes

Cardiac Fitness Diet

Who: For patients with heart problems

Why: Too much sodium causes the heart to work harder Too much fat can clog arteries and cause heart attacks or strokes

AVOID:

Fried foods Salad dressings Cooking oils Eggs High fat meat and dairy products Foods high in sodium such as cheeses and soups

Cardiac Fitness
Diet

Guidelines:
Eat chicken, fish, or fresh pork instead of red meat Use herbs instead of salt Limit margarine (only 1 pat of margarine at Breakfast) Select low fat dairy products (e.g. skim milk) Avoid high fat desserts

Foods that are low in sodium and fat

Carbohydrate Counting (CHO)

Who: Patients with diabetes or require weight control

Why: - Diabetes is a disease which affects blood sugar control - Carbohydrate (CHO) foods turn into sugar when eaten - Too little or too much CHO can result in coma or death

Carbohydrate (CHO) Counting diet

Diet Guidelines:

The amount of CHOs per day are restricted CHO foods include:
Breads & Cereals Dairy products Starchy vegetables (beans, corn, potatoes) Fruit and fruit juices Sweets

Portion sizes are very important and need to be accurate

CHO Counting Cont.

Portion size: Correct portions are essential!
Substitutions: If a patient asks to substitute a menu items, check with a dietitian first Free Foods: The patient can have unlimited amounts of: Coffee Diet Soda Diet Jell-O Broth Lettuce Sugar substitutes (Sweet n Low)

Renal Diet

Who: Patients with kidney disease Why: The kidneys can not get rid of excess potassium (K+), sodium (Na), and phosphorus

DO NOT serve foods high in potassium, sodium, or phosphorus Portions! Soaking (potatoes, French Fries)! Limit FLUIDS as ordered

Renal Diet

Diet Guidelines:

ALLOWED Foods Low in Sodium

Fresh and frozen foods

Low in Phosphorus

White bread, lettuce, green beans, corn

Low in potassium

Pears, pineapple, applesauce

HIGH Phosphorus
AVOID HIGH phosphorus foods:

Beverages:

Chocolate drinks, canned iced teas, dark colas Dairy Products: Limit to 1/2c serving: milk, ice cream, pudding, cream soup, yogurt; cheese, cottage cheese Protein: Liver, oysters, sardines Vegetables: Beans - (Baked, black, garbanzo, kidney, porkn beans, soy) chick peas, lentils, lima beans, split peas

High Potassium (K+)

AVOID: Foods HIGH in Potassium

Apricots Avocado Banana Cantaloupe Honeydew Kiwi Lima beans Milk Oranges and orange juice Potatoes (unless soaked overnight) Prunes Spinach Tomatoes Vegetable juice Winter squash

Fluid Restriction
Limit

the drinks as written on menu Remember that some foods count as fluids:

Jell-O ( c) Ice Cream ( c) 1 Popsicle

= 120 cc fluid = 120 cc fluid = 120 cc fluid

Gluten-Free Diet
What

is gluten?

Gluten is a general name for certain proteins in different types of grains Wheat, rye, and barley products contain gluten!

Gluten-Free Diet

Who: Patients with gluten-sensitive disorders (e.g. Celiac Disease) Why: Food containing Gluten may damage the small bowel, which can become life threatening

DO NOT serve items containing wheat, rye, or barley DO NOT let gluten foods touch gluten-free foods (even pots, pans or griddles)

Gluten-Free Diet
Diet

Guidelines DO NOT serve ANY items containing:

WHEAT RYE BARLEY

Most breads and pastas contain Gluten Fillers and thickeners contain Gluten (e.g. hotdogs, soups, desserts)

Gluten-Free Diet

Common Gluten containing foods to AVOID:

Barley Bread Flour Club Wheat Common Wheat Food Starch Gum Base Bran Blue Cheese Coloring Couscous Germ Hard Wheat

Kamut
Matzo Pasta Soy Sauce

Malt
Oats Rice Malt Teriyaki Sauce

Isolation Diet
Who:

Patients with infections that could pass to other people Why: Patients are placed in isolation rooms to prevent the spread of infections

You MUST wear gloves when entering these patient rooms, remove gloves when leaving AND wash and/or sanitize your hands

Isolation Diet

Diet Guidelines

Follow guidelines posted on the patients door Use regular China (except for Iodine treatment) Dietary may enter contact isolation rooms wearing gloves BEFORE leaving room: remove gloves, wash or sanitize hands
Patients with C-diff must wash AND sanitize hands BEFORE leaving the room Patients receiving Iodine (I 131) treatment
Use isolation trays for these patients ONLY Rooms are draped in plastic

Reverse Isolation (Neutropenic) Diet

Who: Patients unable to fight off infections (e.g. chemotherapy) Why: Serving uncooked fruits and vegetables can introduce bacteria into their body

- Avoid fresh fruits and vegetables that cannot be peeled! - Pepper packets are not allowed

Reverse Isolation (Neutropenic) Diet

Diet

Guidelines:

Avoid * Fresh fruits (grapes, blueberries, strawberries, etc) Avoid * Fresh vegetables (lettuce, cabbage, broccoli, peas, etc) Avoid pepper (unless cooked in food) No yogurt (or soft served dairy products) * That can not be peeled.

Toddler Diet

Who:

Toddlers (1-3 years old) Preschool (4-5 years old)

Why: Because Toddlers have small stomachs, frequent small feedings are provided Finger foods promote self feeding

Choking Risks: Nuts, hotdogs, popcorn, grapes, peanut butter, jelly, beans, and hard candy

Toddler Diet
Diet

Guidelines:

Finger foods (e.g. chicken fingers) Include a variety of colors, textures, and shapes Limit sweet foods and drinks Include milk at every meal 6 Small meals provided Avoid foods that may cause choking

YOUTH DIET

Who:

Children 6 18 years old

Why:

Providing adequate nutrition for growing children is important Honor food preference whenever possible!

A sick child is at greater nutrition risk.

YOUTH DIET
Diet

Guidelines:

Comply with food preferences Milk is served at every meal Provide a variety of foods Snacks are provided as needed

AGE SPECIFIC COMPETENCIES

Growth

and development specific to each stage of life Important to appropriately care for patients Major areas: physical, cognitive, social, and emotional

Neonate (0 28 days)

Potentially hazardous articles out of reach Parent is primary care provider

Infant (29 days 12 months)

Fears unfamiliar situations and people Supervision and safety precautions Choking risk - Avoid popcorn, nuts, grapes, peanut butter, hot dog Avoid hot foods Foods and texture based on age/motor skills Parent is primary care provider

Pediatric (13 months-12 years)

Learning manners Asserts self Desires to be involved in care Involved in decision-making Avoid hot foods, use with caution as child grows older and more mature

Adolescent (13-18 years)

Privacy required Interested and confused in bodily changes Involved in decision-making

Adult (19-60 years)

Achievement oriented Increased responsibility/stress Balance of career, family, and social life Personal set of values Cope with change Involve in own plan of care

Geriatric ( 61+ years)

Altered texture due to tooth loss Decreased ability to self feed Decreased taste and smell Slower GI tract Early satiety Speak with family as well as the patient

Customer Service
Tray

Preparation

Wash hands Food Safety

Tray

Passing

Get trays to patients on time Identify yourself and patient Place tray within reach Ask Have you received the menu? Ask Is there anything else I can do?

Customer Service
NPO

(nothing by mouth)

Check with diet office and nursing station Look for NPO sign on door

Patient

not in room

Check with nursing station Know patients location Know how long before patient will return

Customer Service
Tray

Pick up

Ask How was your meal? Ask Is there anything else I can do for you? Be sure to say Thank you for your comments. Have a nice day!

SMILE!!!!

Diet Education Quiz

1. True/False - Popsicles count as a clear liquid. True Popsicles become liquid at room temperature so they are
considered a liquid and may be placed on a clear liquid tray.

2. True/False On a pureed diet tray, a lettuce leaf can be used as a garnish. False All garnishes used for the pureed diet must also be
pureed. Gravies and sauces are good garnishes to use because they add color and moisture to pureed food.

Diet Education Quiz

3. For a modified dysphagia diet, if no consistency is ordered, what is the default consistency?
Honey is the default consistency for all modified dysphagia diets.

4. True/False Extra herb seasoning packets (e.g. Mrs. Dash) may be added to low sodium diet trays. True Extra herb seasoning packets may be added, but
no salt packets should be added to low sodium diet trays.

Diet Education Quiz

5. Why are portion sizes so important for the carbohydrate counting diet?
Using the correct portion sizes is important because the purpose of the this diet is to make it easier for a patient to control his/her blood sugar. If serving sizes are too large, the patients blood sugar could go very high.

6. True/False Bananas and orange juice are high in potassium. True Both of these foods are high in potassium
and should not be served to a patient on a renal diet.

Diet Education Quiz

7.True/False Blue Cheese, some food colorings and soy sauce could all contain gluten and should not be served for a Gluten-free diet. True Gluten may be found in all three of these commonly used
foods or food ingredients

8. True/False Gloves must be changed between every patient visit. True Gloves should ONLY be worn in one room. Put on the
gloves when you enter the room, then remove the gloves and wash and/or sanitize your hands before you leave.

Diet Education Quiz

9. Name three foods that can cause a child to choke and should not be included on a toddler tray.
Nuts, hotdogs, popcorn, grapes, peanut butter, jelly beans, and hard candy are all foods that could cause a young child to choke.

10. Why is hand washing an important part of customer service?

Hand washing and sanitizing are both important parts of avoiding food borne illnesses and preventing the spread of infection. This simple task can make a big difference.

Acknowledgements:
Developed by:

Mary Basel, MNS, RD 2006 MUSC Dietetic Interns Denise Boutwell Jill DeJulio Anna Grusin Leanne Kaye Elissa Murphy Erika Murtaugh
Narrated by: Elissa Murphy, MUSC Dietetic Intern

Resource:
American Dietetic Association Manual of Clinical Dietetics, Sixth Edition