The Importance of Proper Nutrition and the Six Basic Nutrients 
  Proper nutrition is very important. Nutrition is how the body uses food to maintain health. Bodies need a well-balance diet containing essential nutrients and plenty of fluids. This helps the body grow new cells, maintain normal body function, and have energy for activities. Proper nutrition in childhood and early adulthood helps ensure good health later in life. For the ill or elderly, a well-balanced diet helps maintain muscle and skin tissues and prevents pressure ulcers. A healthy diet promotes the healing of wounds. It also helps us cope with physical and emotional stress. A nutrient is sometimes found in food that provides energy, promotes growth and health, and helps regulate metabolism. Metabolism is the process by which nutrients are broken down to be used for energy and other needs.

The body needs the following six nutrients for growth and development: 
* WATER - water is the most essential nutrient for life. Because one-half to two-thirds of our body weight is water, we need about 64 ounces, or eight glasses of water or other fluids a day. Without water, a person can only live a few days. Water assists in digestion and absorption of food. It helps with elimination of waste. Through perspiration, water also helps maintain normal body temperature. Maintaining enough fluid in our bodies is necessary for good health. The fluid we drink- water, juice, soda, coffee, tea, and milk- provide most of the water our bodies use. Some foods are also sources of water, including soup, lettuce, apples, and peaches.

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* CARBOHYDRATES - carbohydrates supply the body with energy and extra protein and help the body use fat efficiently, they also provide FIBER, which is necessary for bowel elimination. Carbohydrates can be divided into two basic types : Complex carbohydrates are found in bread, cereal, potatoes, rice, pasta, vegetables, and fruits. Simple carbohydrates are found in foods such as sugars, sweets, syrups, and jellies.

* PROTEINS - proteins are a part of every body cell. They are essential for tissue growth and repair. Proteins also provide energy for the body. Excess proteins are excreted by the kidneys or stored as body fat. Sources of protein include seafood, poultry, meat, eggs, milk, cheese, nuts, nut butters, peas, dried beans, or legumes, and soy products. Whole grain cereals, pastas, rice, and breads contain some proteins, too.

* FATS - fat helps the body store energy. Body fat also provides the body with insulation. It protects body organs. In addition, fats add flavor to food and are important for absorption of certain vitamins. Examples of fats are butter, margarine, salad dressings, oils, and animal fats found in meats, dairy products, fowl, and fish.

* VITAMINS - vitamins are substances that are needed by the body to function. The body can not produce most vitamins, they can be obtained by eating certain foods. Vitamins A, D, E, and K are fat-soluble vitamins. This means they are carried and stored in body fat. Vitamins B and C are water-soluble vitamins that are broken down by water in the body and used by the body, but can not be stored. They are eliminated in urine and feces.

* MINERALS - minerals maintain body functions. They provide energy and regulate body processes. Zink, iron calcium, and magnesium are examples of minerals. Minerals are found in many foods.
Most foods contain several nutrients, but no one food contains all necessary nutrients. That is why it is important to eat a daily diet that is well-balanced. There is not one single dietary plan that is right for everyone.   People have different nutritional needs depending upon their age, gender, and activity level. 

* Recommended portions of VEGETABLES and FRUIT : Make half your plate fruits and vegetables. Vegetables include all fresh, frozen, canned, and dried vegetables, and vegetable juices. A variety of fruits and vegetables of every color and group should be included:
  • dark green vegetables
  • red and orange vegetables
  • dry beans and peas
  • starchy vegetables
  • Fruits include all fresh, frozen, canned, and dried fruits, and 100% fruit juices. Most choices should be whole, cut up, or pureed fruit, rather than juice, for additional dietary fiber provided. 
*GRAINS - make half your grains whole grains. Grains include all foods made from wheat, rice, oats, cornmeal, or barley, such as bread, pasta, oatmeal, breakfast cereals, tortillas, and grits. Grains can be divided into two groups: whole grains and refined grains.

* PROTEIN - eating a variety of protein foods every week is important. Meat, poultry, seafood, and eggs are animal sources of proteins. Beans, peas, soy products, nuts, and seeds are plant sources of proteins.

* DAIRY - all milk products and foods made from milk that retain their calcium content, such as yogurt and cheese, are part of the dairy category. These nutrients include potassium, calcium, vitamin D, and protein.

* ADDITIONAL TIPS for making healthy choices:
  • Balance calories
  • Enjoy your food but eat less
  • Avoid over size portions
  • Compare sodium in foods
  • Drink water instead of sugary drinks
Ways To Assist Clients in Maintaining Fluid Balance

 Most clients should be encouraged to drink at least 64 ounces of water or other fluids a day. It helps prevent constipation and urinary incontinence. The sense of thirst can diminish as people age. Remind your elderly clients to drink plenty of fluids often and offer them in smaller amounts rather than in one large glass.

Some clients may have a doctor's order to force fluids or restrict fluids because of medical conditions.
  • Force fluids(FF)  means to encourage the client to drink as much fluid as possible.
  • Restrict fluids(RF) means that the client is allowed to drink but must limit the daily intake to a level set by the doctor. Follow your clients care plan. The abbreviation
  • NPO stands for nothing by mouth. This means that a client is not allowed to have anything to eat or drink.
  • Dehydration occurs when a person does not have enough fluids in the body. Dehydration is a serious condition and a major problem among the elderly. 
Observing and reporting: Dehydration
 Report  any of the following immediately:
  • client drinks less than six eight-ounce glasses of liquid a day
  • client drinks little or no fluids at meals
  • client needs help drinking from a cup or glass
  • client has trouble swallowing liquids
  • client experiences frequent vomiting, diarrhea, or fever
  • client is easily confused or tired
  • dry mouth
  • cracked lips
  • sunken eyes
  • dark urine
  • strong-smelling urine
  • weight loss
  • complaints of abdominal pain


Guidelines: Preventing Dehydration
  • report observations and warning signs to your supervisor immediately
  • encourage clients to drink every time you see them
  • offer fresh water or other fluids often. offer drinks the client likes or enjoys. Honor personal preferences.
  • record fluid intake and output
  • ice chips, frozen flavored ice sticks, and gelatin are also forms of liquids. Offer them often. Do not offer ice chips or sticks if a client has a swallowing problem. 
  • if appropriate, offer sips of liquids between bites of food during meals and snacks.
  • make sure a picture and cup are near enough and light enough for a client to lift. 
  • Offer assistance if a client cannot drink without help. Use adaptive cups as needed.

Observing and Reporting: Fluid Overload
Report any of the following to your supervisor:
  • swelling/ edema of extremities ( ankles, feet, fingers, and hands) EDEMA is swelling caused by excess fluid in body tissues
  • weight gain (daily weight gain of one to two pounds)
  • decreased urine output
  • shortness of breath
  • skin that appears tight, smooth, and shiny
  • fluid balance is taking in and eliminating equal amounts of fluid

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Water Gain/Loss

Water Gain/Loss
Nutritional Problems of the Elderly or ill
  Aging and illness can lead to emotional and physical problems that affect the intake of food for example:

 - People who are lonely or who suffer from illness that affects their ability to chew and swallow may have little interest in food.
- Weaker hands and arms due to paralysis and tremors make it hard to eat.


Unintended weight loss is a serious problem for the elderly. Weight loss can mean the client has a serious medical condition. It can lead to skin breakdown, which leads to pressure ulcers. It is very important to report any weight loss, no matter how small. 

Observing and Reporting: Report the following to the Nursing Supervisor
  • client needs help eating or drinking (new)
  • client eats less than 70% of meals served
  • client has mouth pain
  • client has dentures that do not fit properly
  • client has difficulty chewing or swallowing
  • client coughs or chokes while eating
  • client is sad, has a crying spell, or withdraws from others
  • client is confused, wanders, or paces

Guidelines: Preventing Unintended Weight Loss 
  • food should look, taste, and smell good, particularly since the person may have a poor sense of taste or smell.
  • encourage clients to eat
  • Join your client at meal time, eating your own food while they eat theirs
  • honor clients foods likes and dislikes
  • offer many different kinds of foods and beverages
  • help clients who have trouble feeding themselves
  • season food to client's preferences
  • allow enough time for the client to finish eating
  • record the meal/snack intake
  • provide oral care before and after meals
  • position client sitting upright for eating
  • if a client has had a loss of appetite and/or seems sad, ask about it

Food Appearance, Texture, and Portion Size
- Keep the portions smaller so it doesn't overwhelm the client - have seconds available if they want.
- Take special care to make the plate look appetizing and attractive
- Serve food with a variety of colors and textures to increase the appeal
Awareness of Regional, Cultural, and Religious Food preferences
  Culture, ethnicity, income, education, religion, and geography affect ideas about nutrition. Food preferences may be formed by what a person ate as a child, by what taste good, or by personal beliefs about what should be eaten. For instance, some people choose not to eat any animals or animal byproducts, such as steak, chicken, butter, or eggs. These people are called vegetarians or vegans. The region or culture you grew up in often influence your food preference. Ethnic groups often share common foods. These may be eaten at certain times of the year or all the time. Religious beliefs influence diet, too. When planning meals and cooking for your clients, know their food preferences. Pay attention to what is eaten when you serve meals.
SPECIAL DIETS

PCA's can prepare a client's food who is on a "Simple Modified Diet."  A Simple Modified Diet is making 1 change in the diet, such as any ONE of the following: 

 
  • Low Sodium Diet:   Salt is the first food to be restricted in a low-sodium diet because it is high in sodium. Excess sodium causes the body to retain more water in tissues and in the circulatory system than is necessary. This causes the heart to pump harder. This is harmful for clients who have high blood pressure, coronary artery disease, or kidney disease. Read product labels to determine if they contain salt or sodium in any form. A common form of sodium is monosodium glutamate or sodium nitrate. You can make low-sodium meals more flavorful by adding lemon, dry mustard, pepper, paprika, orange rind, onion, and garlic to recipes. The flavor of meats can also be enhanced by the addition of fruits and jellies. Common abbreviations for this diet are (low Na) which means "low sodium", or( NAS), which stands for "no added salt".

  • Fluid-Restrictive Diet:  The amount of fluid consumed through food and fluids must equal the amount of fluid that leaves the body through perspiration, stool, urine, and expiration. This is fluid balance. When fluid intake is greater than fluid output, body tissues become swollen with excess fluid. For clients on fluid restrictions, you will need to measure and document exact amounts of fluid intake. Follow the care plan. A common abbrev. of this diet is (RF) which stands for "Restricted Fluids". 

  • High-Potassium Diet: Some client's are taking DIURETICS, which are medications that reduce fluid volume, or blood pressure medications. These clients may be excreting so much fluid that their bodies could be depleted of potassium. Foods high in potassium include bananas, grapefruit, oranges, orange juice, prune juice, prunes, dried apricots, figs, raisins, dates, cantaloupes, tomatoes, potatoes with skin, sweet potatoes, and yams, winter squash, legumes, avacodoes, and unsalted nuts. "K+" is the common abbrev. for this diet.

  • Low-Protein Diet: People with kidney disease may also be on low-protein diets. Protein is restricted because it breaks down into compounds that may lead to further kidney damage. The extent of the restrictions depends on the stage of the disease and whether the client is on dialysis. Vegetables and starches, such as breads and pastas, are encouraged.

  • Low-Fat/ Low-Cholesterol Diet: People who have high levels of cholesterol in their blood are at risk for heart attacks and heart disease. People with gallbladder disease, diseases that interfere with fat digestion, and liver disease are also placed on this diet. This diet permits skim milk, low-fat cottage cheese, fish, white meat of turkey and chicken, veal, and vegetables fats (especially monounsaturated fats such as olive oil, canola, and peanut oils). 
  •  Modified Calorie Diet   Some clients may need to reduce calories to lose weight or prevent additional weight gain. Other clients may need to gain weight and increase calories because of malnutrition, surgery, illness, or fever. Clients with certain conditions need more protein to promote growth and repair of tissues and regulation of body functions, common abbrev for this diet is 'high-cal" or "low-cal".
  • Bland diet: Gastric and duodenal ulcers can be irritated by foods that produce or increase levels of acid in the stomach, so these foods are eliminated. The bland diet is also used for people who have intestinal disorders, such as Crohn's disease or irritable bowel syndrome or (IBS).
  • Diabetic Diet: People with diabetes must be very careful about what they eat. Calories and carbohydrates are carefully regulated in the dietary management of clients who have diabetes. Protein and fats are also regulated. A dietitian and the client will make up a meal plan, taking into account the person's health status, activity level, and lifestyles.
  • Low-residue (low-fiber) Diet: This diet decreases the amount of fiber, whole grain, raw fruits and vegetables, seeds and other foods, such as dairy and coffee. The low residue diet is used for people with bowel disturbances.
  • High-residue:  (high-fiber) Diets: Increase the intake of fiber and whole grains, such as whole grain cereals, bread, and raw fruits and vegetables. This diet helps with problems such as constipation and bowel disorders. 
  • Gluten-free diet:This diet is free of gluten, which is protein found in rye, and barley. It is used for people with celiac disease, which is a disorder that can damage the intestines if gluten is consumed. Unlike celiac disease, gluten intolerance is a condition that does not cause damage to the intestines. It does, however, cause unpleasant symptoms such as abdominal pain, gas and diarrhea.  
  • Vegetarian diet: Health issues may cause a person to require a vegetarian diet. A person may also choose to eat a vegetarian diet for religious reason due to a dislike of meat, a compassion for animals, a belief in non-violence, or financial issues. 
  • Liquid Diet: A liquid diet is usually ordered for a short time due to a medical condition or before or after a test or surgery. It is ordered when a client needs to keep the intestinal tract free of food. 
  • Soft Diet: is soft texture and consists of soft or chopped foods that are easy to chew and swallow. 
  • Mechanical Diet: consists of chopped or blended foods that are easier to chew and swallow. Unlike the soft diet, the mechanical soft diet does not limit spices, fat, and fiber. Only the texture of foods is changed.
  • Puree diet: to puree a food means to chop, blend, or grind it into a thick paste of baby food consistency.A puree diet is often used for people who have trouble chewing and or swallowing more textured food.
Eating and Swallowing Problems That Could Affect Your Client:
  Clients may have conditions that make eating or swallowing difficult. Dysphagia means difficulty in swallowing. A Stroke can cause weakness on one side of the body and paralysis. Nerve and Muscle damage from head and neck cancer, multiple sclerosis, Parkinson's disease, or Alzheimer's disease can also contribute to Dysphagia.  
Home care aid's need to be able to recognize and report signs that the client has a swallowing problem. Signs and systems of swallowing problems include the following:
* coughing during or after meals.
* chocking during meals
* dribbling saliva, food, or fluid from the mouth
* having food residue inside the mouth or cheeks during and after meals
* gurgling during or after meals or losing voice
* eating slowly
* avoiding eating
* spitting out pieces of food
* swallowing several times per mouthful
* clearing the throat frequently during and after meals
* watering of eyes when eating or drinking
* food or fluid coming up into the nose
* making a visible effort to swallow
* breathing rapidly or with shorter breaths while eating or drinking
* difficulty chewing food
* difficulty swallowing medications
Swallowing problems put clients at high risks for chocking on food or drink. Inhaling food, fluid, or foreign material into the lungs is called Aspiration. Aspiration can cause pneumonia or death. Alert your supervisor immediately if you notice any signs of swallowing problems.
PREPARING A BASIC FOOD PLAN and SHOPPING GUIDELINES

When planning, take into account the client's dietary restrictions, food preferences, and the clients budget. By planning for each day, you will plan the right number of meals and buy the right amount of food, you may end up serving the meals in different order if the client has appointments or something comes up.

Fill in Breakfast, Lunch, Dinner and Snacks for each day. Plan to have leftovers that can be easily reheated on days you will not be in the home.

Plan plenty of nutritious snacks; clients may need as many as three snacks a day.

Remember to list beverages as well.

When your meal plan is complete, make your shopping list, remember to check the refrigerator, cabinet and pantry for ingredients you already have on hand.

Keep an updated shopping list available so family members, client's and you can write down things you run out of during the week.

Shopping for clients:
* use coupons only for the items you have already planned to buy that week
* check store circulars for advertised specials and coupons
* buy fresh foods that are in season
* buy in quantity, but do not buy more than you can store
* shop from your list. do not be tempted by items that are not on your list
* buy a cheaper brand when appearance is not important
* read labels for ingredients that may be harmful to your client, such as excessive salt or sodium or sugar 
* consider the amount of waste in bones and fat when buying cheaper cuts of meat or pick lean meats and take the skin off chicken or turkey parts. The skin holds most of the fat.
When deciding what to buy, keep in mind these four factors;
* Nutritional value - does this food contain essential nutrients, vitamins, and minerals? Is it unprocessed, without added salt or sugar?
* Quality - Is this food fresh and in good condition? Example; canned food not dented, rusted or expanded. Items not passed the expiration date, looks good?
* Price - is this the most economical choice? If it cost more, is it worth it?
* Preference - will my client like this food and can I make this meal appealing?
Food Preparation
The following basic methods of food preparation will allow you to prepare a variety of healthy meals:
* Boiling - food is cooked in boiling water until tender or done. This is the best method for cooking pasta, noodles, rice, and hard-or-soft boiled eggs.
* Steaming - is a healthy way to prepare vegetables. A small amount of water is boiled in the bottom of a saucepan, and food is set over it on a rack. The pan is tightly covered to keep in the steam.
* Poaching - fish or eggs may be cooked by poaching in barely boiling water or other liquids. Eggs are cracked and shells are discarded before poaching. Fish may be poached in milk or broth, on top of the stove or in the oven in a baking dish.
* Roasting - used for meats and poultry or some vegetables, roasting is a simple way to cook. Dry heat roasting means food is roasted in an open pan in the oven. Meats and poultry are Basted, or Coated with juices or other liquids, during roasting.
* Braising - is a slow-cooking method that uses moist heat. Liquid such as broth, wine, or tomato-sauce is poured over and around meat or vegetables, and the pot is covered.
* Baking - is used for many foods, including breads, poultry, fish, and vegetables. Baking is done in moderate heat, 350 to 400 degrees.
* Broiling - used primarily for meats, broiling involves cooking food close to the source of heat at a high temperature for a short amount of time.The Broil setting on the oven can also be used to melt cheese or brown the top of a casserole. Leave the oven door ajar when broiling and never leave the kitchen; things can burn very fast.
* Sauteing or Stir Frying - these are quick cooking methods for vegetables and meats. Use a small amount of oil in a frying pan or wok over high heat.
* Microwaving - microwave ovens are safe to use for defrosting, reheating, and cooking. However, "cold spots" can occur in microwaved foods because of the irregular way the microwaves enter the oven and are absorbed by the food. If food does not cook evenly, bacteria may survive and cause food-borne illness. When defrosting food in the microwave, remove food from store wrap first. Place food in microwave safe bowl instead. Cover foods, stir them from the outside in to encourage safe, even heating. To ensure that the meat is properly cooked, use a meat thermometer to verify that the food has reached a safe temperature. 
* Frying - uses a lot of fat and is the least healthy way to cook
* Fresh, uncooked foods - many fruits and vegetables have the most nutrients when eaten fresh, as in salads. However, fresh fruits and vegetables may be difficult for some clients to chew or digest. Wash fruits and vegetables well to remove any chemicals or pesticides.
Do not consume raw eggs
Four Methods of Low-fat Food Preparation
* Cook Lean - Boiling, steaming, broiling, roasting, and braising are all methods of cooking that require little or no added fat. Broiling allows fats in meat to drip out before food is consumed. This lowers the fat content even more.
* Drain Fat - When using ground meat, brown it first. Then remove it with a slotted spoon and drain it on paper towels to remove excess fat. You can also drain it in a colander.
* Plan Lean - choosing foods with lower fat content to begin with will make low-fat cooking easier.Planning meals around grains will help cut the fat content. Low-fat meals based on grains include pasta dish's, rice and beans, baked or stuffed potatoes, and soups.
* Substitute or Cut down - leave out cheese or reduce the amount of cheese used on sandwiches or to top casseroles. Substitute plain nonfat yogurt for mayonnaise or sour cream. Nonfat cottage cheese can also be used.
Safe Food Storage
Buy cold food last & get it home fast!
After shopping, put away refrigerated foods first!
Maintain refrigerator temperature between 36 and 40 degrees f.
Maintain freezer at 0 degrees f.
Refrigerated items that easily spoil should be kept in the rear of the refrigerator and not on the door.
Do not refreeze items after they have been thawed. 
Use small containers that seal tightly
Foods cool more quickly when stored in smaller containers
Never leave food out for more than TWO HOURS
Tightly cover all foods
               When in doubt; throw it out! 
Check the expiration dates on foods, especially perishables.
CHECK THE REFRIGERATOR OFTEN FOR SPOILED FOOD.
Throw out foods that have become moldy (mold cannot be just scraped off)

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* 1. UNIT TEST
Your Name Here

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* 2. What should half of a persons plate be made up of?

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* 3. What does the abbreviation "NPO" stand for?

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* 4. It is important for a home care aid to report any weight loss, no matter how small.

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* 5. It is proper positioning to place a client for eating flat on their back ?

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* 6. Why is important to check serving size on a food label?

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* 7. List three signs and symptoms of swallowing problems.

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* 8. To promote appetites, make sure that food is attractively arranged on the plate?

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* 9. Why is more expensive meat sometimes a better deal?

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* 10. What is the longest period of time that it is safe to leave cooked food unrefrigerated?

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* 11. What needs to happen after a home care aid has used a cutting board to cut up fresh meat?

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* 12. When is it acceptable to refreeze an item?

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* 13. What does the phrase "when in doubt, throw it out" mean?

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* 14. What is a healthy way to prepare vegetables?

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* 15. What is a slow-cooking method that uses moist heat?

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* 16. What is the least healthy way to cook?

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* 17. Which of the following are methods for low-fat food preperations?

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* 18. Many fruits and vegetables have the most nutrients when eaten fresh, as in salads.

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* 19. Do not consume or serve raw eggs.

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