Chapter 14
Healthful Eating
GOALS
- Explain how culture, religion, economics, and family shape food attitudes.
- Describe major nutrients and the five food groups.
- Identify common therapeutic diets and when they’re used.
- Make mealtime pleasant and measure intake accurately.
After practicing the skills, you will be able to assist with eating (setup, feeding, and recording intake).
Key Terms
appetite
Desire to eat and drink.
calorie
Unit of energy in food.
cholesterol
Fatty substance in body and animal foods.
diabetes
Disease affecting insulin and blood glucose control.
malnutrition
Inadequate calories/nutrients.
nutrient
Substance the body needs to grow and stay healthy.
saturated fat
Fat common in meats, dairy, certain oils.
therapeutic diet
Diet ordered to treat a condition.
turgor
Skin’s rebound after gentle pinch; reflects hydration.
dehydrated
Insufficient body water.
obesity
Excess body fat.
Scenario — Mr. Rivera is practicing self-feeding with his left hand after a stroke. You set up adaptive utensils, encourage him, then assist as needed. Mealtime becomes both therapy and social time.
Attitudes About Food
Personal preferences reflect culture, religion, budget, and family traditions. Ask the person directly to learn what they like.
Basics of Nutrition
Diet means everything a person eats and drinks. Major nutrients include:
- Carbohydrates — primary energy; fiber adds bulk for elimination.
- Protein — builds/repairs tissue; helps fluid balance and immunity.
- Fat — concentrated energy; helps absorb vitamins.
- Minerals & Vitamins — regulate many body functions.
- Water — temperature control, circulation, excretion.
Calories measure energy; excess is stored as fat.
Reading Food Labels (Example)
| Per Serving | Amount |
|---|---|
| Calories | 130 |
| Protein | 12 g |
| Carbohydrate | 12 g |
| Fat | 3 g |
| Sodium | 870 mg |
| Potassium | 400 mg |
Use % Daily Value and ingredient lists to compare products and meet special-diet needs.
Major Nutrients — What, Why, Where
| Nutrient | What It Does | Where It’s Found |
|---|---|---|
| Carbohydrate | Easy energy; fiber aids elimination | Grains; starchy vegetables; fruits; sugars |
| Protein | Builds tissue; fluid balance; immunity | Dairy; meat/poultry/fish/eggs; beans; nuts; grains |
| Fat | Concentrated energy; vitamin absorption | Nuts; seeds; oils; dairy; meats; avocado; olives |
| Minerals | Build bones/teeth; regulate functions | Present across food groups |
| Vitamins | Enable use of other nutrients | Present across food groups |
| Water | Solvent; temp control; circulation & excretion | Vegetables, fruits, liquids |
The Five Food Groups (USDA pattern)
- Grains — ~6 oz/day for many adults; choose whole grains.
- Vegetables — ~2½ cups/day; vary colors and types.
- Fruits — ~2 cups/day; prefer whole fruits and 100% juices.
- Protein foods — ~5½ oz/day; lean meats, poultry, fish, or plant proteins.
- Dairy — ~3 cups/day; choose low‑fat/nonfat options.
Limit added fats/oils (≈5–6 tsp/day), sweets, and alcohol.
Common Therapeutic Diets
Texture-Modified
- Soft / Mechanical — easier to chew; often ground meats/soft vegetables.
- Pureed — pudding-like consistency for severe chewing/swallowing problems.
Liquid Diets
- Clear liquids — broth, gelatin, clear juices; short-term only.
- Full liquids — adds milk/strained soups; short-term.
Composition-Controlled
- NAS / Sodium-Controlled — avoid high-sodium foods.
- Calorie-Restricted — e.g., 1200–2000 kcal; includes NCS (no concentrated sweets).
- High-Protein — for healing (burns, pressure ulcers).
- Diabetic — balanced carbohydrates, protein, fats.
- Low-Fat — for cardiac/gallbladder/liver disease.
- Thickened Liquids — as ordered for dysphagia.
- Supplements — e.g., Ensure™, Glucerna™ per order.
Making Mealtime Enjoyable
- Bright, cheerful setting; good lighting and airflow.
- Neat, clean, odor-free room for in-room dining.
- Allow time for toileting and handwashing.
- Seat upright (~90° at hips); ensure safe positioning.
- Serve hot foods hot and cold foods cold.
- Honor prescribed diets; check allergies and dislikes.
- Offer substitutions and report poor intake.
Helping People Eat
Promote independence: open cartons, cut meats, steady a weak elbow. Name foods, check temperatures, and feed slowly with time to chew and swallow.
Helping a Person Who is Blind
Identify foods by “clock face,” cut items, open containers, and check occasionally for missed food.
If Swallowing Is Difficult (Dysphagia)
- Stay with the person; reduce distractions and encourage focus.
- Place food toward the back and on the unaffected side.
- Encourage chin-down posture and slow, thorough chewing.
- Elevate head during eating and for 30+ minutes after.
Adaptive Feeding Devices (Examples)
| Problem | Device | How It Helps |
|---|---|---|
| Getting food onto utensil | Plate guard / Scoop dish | Prevents food from falling off while scooping |
| Plate sliding | Suction base / Damp cloth | Keeps plate stable |
| Weak grasp | Built-up handles / Universal cuff | Makes utensils easier to hold |
| Tremor/weakness | Swivel utensil | Keeps utensil level to reduce spills |
| One-handed cutting | Rocker knife | Rocking motion allows one-handed cutting |
| Spilling drinks | Modified cup / Straw holder | Controls flow and reduces spills |
| Limited reach | Extension utensil | Longer handle increases reach |
Gastrostomy Tube Care (Overview)
- Only nurses give tube feedings or oral food if ordered.
- Elevate HOB ≥ 45° during feeding and for 30+ minutes after.
- Keep site clean/dry; report redness, pain, nausea, or drainage.
- Position to avoid lying on the tube; prevent dislodgement.
Mealtime in Isolation
Wear PPE as required; provide companionship; dispose of leftovers safely; double-bag reusables per policy.
Monitoring Intake
Record food acceptance and fluid intake (I&O). Offer substitutes if intake is inadequate; sum totals each shift.
Dehydration — Signs & Support
Watch For
Confusion, drowsiness; dry skin/lips/poor turgor; low or dark urine; constipation; fever.
Encourage
Preferred fluids at preferred temps; fluids with meals and between; fresh water pitchers; easy cups/straws; “force fluids” as ordered.
End of Chapter 14 — Healthful Eating