2017 1st Quarter In-Service Training

2017 1st Quarter In-Service Training

Food and Nutrition Meal Planning and Preparation, including Special Diets (3 Hours) Planning Meals Using Dietary Guidelines Tailor the Guidelines to the specific patient/client Choosing appropriate Dietary Guidelines: Physicians/Dietitians guidelines, prescribed specifically for the patient - Ask if your elder patient should be on a special diet or avoid certain foods. - Note any food allergies, food/drug interactions and all other Do Not Serve foods Common allergy-producing foods include eggs, milk products, peanuts, wheat products

Some foods reduce effectiveness of certain drugs Patient may complain that certain foods cause gastric discomfort Determine Patients Food Preferences Avoid serving foods the person dislikes Meal Planning Tips From Appropriate Dietary Guidelines & Patients Preferences: Prepare meal planning form, one plan sheet/day As you plan, remember that good nutrition can come from simple foods, simply prepared. Attach recipes (if any) for that day to the form. You may want to make copies of frequently used recipes; attaching a copy is easier than moving the recipe from form to form. Plan for one to two weeks. Look on the time required to do this planning as in investment in

future time-saving & stress reduction. Shopping Prepare grocery list from meal plan form and recipes Become familiar with the specific grocery store you use ( & food safety practices). Prepare grocery shopping list in the order of the aisles as you will shop them. Meal Plans File meal plans for use & rotating re-use (plan once, use over & over). File plans in loose-leaf notebook. Use a sheet protector to display the plan-of-the-day & to hold any recipes for the day. Mount

meal plans on refrigerator door with magnets. Meal Times Patient may prefer (or may be prescribed) to have several smaller meals, rather than the traditional three squares. Breakfast, lunch & dinner, plus mid-morning, mid-afternoon, bedtime snacks. Smaller, more frequent meals help keep blood sugar levels more constant Mealtimes & snack times can become daily events to be anticipated Adjusting Foods Served to Dietary Guidelines Whatever Dietary Guidelines are used to plan and serve the patient,

adjustments are often required for optimum nutrition. Reducing sodium (salt): Remove salt shaker from dining area Use salt substitutes, lemon juice, herbs (as permitted) Reducing sugar: There are at least 18 different names for sugar that may appear on labeling: brown sugar, corn sweetener, corn syrup, dextrose, fructose, fruit juice concentrate, glucose, high fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, raw sugar, sucrose, syrup, table sugar. If any of these ingredients appear first or second on label or if there are several in the list the sugar content is deemed high. Calories & Other: Use both product labels and a reliable calorie counter to record calories on meal plans.

Be aware of serving sizes. Be aware that some patients may need more calories, not fewer. Other ingredients as prescribed. Reorganizing the Kitchen For Safety & Convenience Assess the kitchen for physical hazards Tripping/falling hazards: Slippery or cracked flooring Loose tiles Throw rugs Extension cords Clutter Electrical/fire hazards: Frayed electrical cords Overloaded plugs Natural gas leaks After assessing, make any needed corrections and repairs.

Fire Extinguisher: Should be charged and operational Stress: If there is smoke or fire GET OUT! (Plan and practice exit strategies). Smoke Alarm/Carbon Monoxide Alarm: Batteries working (change them at least when changing clocks to/from Daylight Savings Time) Again stress GET OUT! Hazardous Materials in the Kitchen: The kitchen does contain hazardous materials! To keep the kitchen a safe place, ask, What is the worst that could happen if this product were used inappropriately? Then develop strategies to avoid this possible outcome. Read labels on all non-food products especially cleaning

products. Store all hazardous products in a separate cabinet away from foods. Provide a lock for this cabinet if necessary for safety. Assess the Abilities of Patient(s)/Client(s) Every care receiver is unique, with individual strengths and weaknesses. Caregivers need to assess the functional abilities of care receivers to identify the best possible care consult professionals, as needed. Assess physical abilities and limitations: How much can s/he safely lift?

How far can s/he comfortably reach? How much bending can s/he tolerate? Cognitive/memory abilities. Can s/he understand, remember and follow safety precautions? Sharing the Kitchen with the Patient/Client Patient/Client independence is a prime goal for caregivers Since patient/client and caregiver may share the kitchen space, duties, equipment and food, reduce conflicts by making all changes tactfully and with the care receivers participation. Make adaptations for mobility equipment such as wheelchairs & walkers. Use this collaboration as an opportunity to chunk the junk. Declutter cabinets, shelves, drawers, pantries. Since this may be a major job, take it one shelf or drawer at a time encourage patient/client to give away unneeded items to family or friends,

give to a charity, or to have a garage sale. Arranging the Kitchen Place items within easy reach of the patient/client. The caregiver adapts to the kitchen as laid out for the patient/client. When the patient/client no longer comes into the kitchen as a participant, it can then be arranged for the convenience of the caregiver. Arrange equipment and food packages by type. Face all food packages with labels forward for easy identification. Label cabinets, shelves, and drawers, using address labels and bold markers A place for everything and everything in its place equals a stress reducer for the caregiver(s), especially if there are two or more caregivers. Grocery Shopping for Nutrition, Economy & Safety

After meals are planned, grocery shopping is the next step in providing good nutritional care. Nutrition: Choose fresh fruits & vegetables as often as possible. Less-than-perfect-appearance does not necessarily mean less nutrition and those items may often be purchased for lower cost. Supplement fresh produce with canned and/or frozen. Read Food Labels: Size of serving (NOTE: serving size noted on labels may differ from serving size noted in dietary Guidelines; use Dietary Guidelines information). Nutrients contained (for a quick comparison, use the % of RDA information). Sell-by date (to avoid buying outdated or almost outdated foods). Avoid buying empty calories (junk food). Even if the care receiver needs extra calories, those provided should

Grocery Shopping For Economy Most households have food budgets

Careful planning & shopping can help stretch the food dollars available. Shop from the list. Use the food dollars for the foods actually needed. Avoid shopping when hungry; hungry shoppers are prey to impulse buying. Avoid Total shock at the check out stand, use a calculator to track total cost od items in the basket while shopping. Shop during less crowded times for a more pleasant experience. Shop for one or two weeks worth of groceries in a single trip, Fewer trips to the store = fewer opportunities to over-buy. Use Coupons Wisely. Only use for nutritious foods on your meal plan Be alert for combinations of store specials + coupons for extra savings. Choose to cook more from scratch foods. Initial time spent may be longer, but savings can be great. Use shelf labels to compare price-per-unit for best buys. Quality of lower priced items is often comparable to higher priced ones.

Grocery Shopping For Safety Being aware of safety concerns while grocery shopping, especially when patient/client are shopping with them, can help caregivers provide better care. Physical Safety; help patient/client avoid: Wet floors, mops and buckets. Produce and other merchandise on floor. Wrinkled floor mats. Unstable displays and stacked merchandise. On-floor advertising decals (which may be perceived as 3-dimentional and cause falls). Carts with protruding merchandise. Thoughtless shoppers & running children. NEVER, EVER, LEAVE PATIENT/CLIENT ALONE IN THE CAR!

Food Safety Shop in an order that will keep food at safe temperatures. Packaged and canned goods Produce Frozen foods Dairy and eggs Meats, poultry, fish To avoid long waits at check-out, avoid shopping when store is crowded. Take food directly home after shopping and put it away immediately to keep it safe to eat. Safe Food Handling Practices Many patient/client have weakened immune systems & are vulnerable to

food-borne illnesses Prevention of food-borne illnesses. Avoid infections by following safe food handling practices: Put away all refrigerated and frozen foods as soon as possible: meats, poultry, fish, dairy products. Use a thermometer to check temperature inside refrigerator. Temperature from 40 degrees F to 140 degrees F are in the DANGER ZONE for bacterial growth. Refrigerate all leftovers promptly, a two-hour limit is often suggested, but shorter times are safer times. Effective Infection Control Hand Washing Wash hands frequently in warm, soapy water for at least 20 seconds each time. Singing Happy Birthday (silently if you wish!) is suggested as a good timer for hand washing. Prevention of food-borne illnesses. Avoid infections by following safe

food handling practices: Put away all refrigerated and frozen foods as soon as possible: meats, poultry, fish, dairy products. Use a thermometer to check temperature inside refrigerator. Temperature from 40 degrees F to 140 degrees F are in the DANGER ZONE for bacterial growth. Refrigerate all leftovers promptly, a two-hour limit is often suggested, but shorter times are safer times. Effective Infection Control Hand Washing Wash hands frequently in warm, soapy water for at least 20 seconds each time. Singing Happy Birthday (silently if you wish!) is suggested as a good timer for hand washing. Frequently disinfect countertops, cutting boards and all other surfaces that come into contact with food. Wash surfaces and allow to air dry. Use a solution of 1 ounce of bleach to 1 gallon of water, Hypochlorite

Solution. US Department of Health & Human Service, Centers for Disease Control & Prevention guidelines Preparing Food Avoid cross-contaminating other foods when preparing meats, poultry, fish and eggs. Example: Do not use cutting board for chopping vegetables after it has been used for cutting meat disinfect thoroughly first. To spread the word about the importance of measuring food temperature, the USDA has created a campaign centered around Thermy Safe Food Handling. Damp towels, sponges and dish cloths are breeding ground for bacteria. Use paper towels or freshly disinfected-and-dried towels each

time. Cook eggs, meats and other dishes to safe temperatures. Use meat thermometer and chart showing safe temperatures for doneness of various foods. Observe freshness dates on food packaging. REMEMBER: WHEN IN DOUBT, THROW IT OUT! Sickness can be caused by food that still looks, smells and tastes OK and even a tiny taste can cause illness. Once a food has become contaminated with bacteria, it may not be possible to make it safe to eat by any means. Easy Meal Preparation After all the preliminary work is done (planning meals from appropriate

Dietary Guidelines, shopping for groceries, being certain that the kitchen is safe) its finally time to prepare meals for the care receiver in ways that are easy on the caregiver Remember: good nutrition can come from simple food, simply prepared. Easy-on-the-Caregiver Techniques Plan ahead Use very simple recipes Cook once, serve several times Examples: Example 1 Example 2 COOK IN QUANTITY BAKED CHICKEN freeze in portions to serve over time: Served as: Entre Beans (or beans and rice) Sliced in sandwiches Stew

Chopped and served as Soup chicken salad Pasta and sauce Leftovers and bones simmered Roast beef with vegetables & rice Baked turkey to make soup Assemble meals and snacks for the entire day; put on trays & refrigerate (as needed). Use store-heat-and-serve containers. Assemble meals from what is available. It is not necessary to cook every meal! Be adventurous and creative in combinations of foods. Use prepared foods sometimes from a Deli or Restaurant.

When cooking for the rest of the family, prepare and set aside an extra serving for the care receiver. Delegate tasks to: The care receiver (tailor the tasks to his/her capacities and interests) Family Friends Making Meal Preparation Easier for the Caregiver: Play a CD of favorite music to make kitchen tasks more fun. If care receiver is present, choose some favorites of theirs, too. When friends ask what they can do ask them to bring a meal now and then! Consider using Meals on Wheels for temporary caregiver respite. Making Mealtime Pleasant For the Patient/Client Mealtimes are not just about food, they provide the opportunity for socialization, and mark the times of the day, they can be a meaningful, enjoyable activity to be anticipated with pleasure

for the patient/client. As needs change, mealtimes can become uncomfortable, frustrating and unpleasant. Caregivers can help avoid this by making thoughtful and appropriate changes. Food: Serve favorites often by adopting recipes to Dietary Guidelines. There may be a detectable difference, but often the care receiver will still enjoy the food. Provide choices to provide the care receiver with a sense of control. Adjust food consistency, texture and morsel size Chewing and Swallowing: Serving some pureed foods may help care receiver become accustomed to them in case they are limited to that form of food later.

Assemble meals that appeal to several senses Aroma and contrasting colors, even foods of different temperatures, make dining more pleasant. Serving Sizes: Avoid servings that seem too large to the patient/client, being presented with large servings can be discouraging to the patient/client. For many patient/client, having smaller, more frequent meals can provide needed nutrients more pleasantly for them. Place Settings: Use solid-color plates and bowls that provide visual contrast with the food. Patterned china can be frustrating for those with low vision: is it food or part of the decoration? Use easily grasped or adaptive utensils, cups and glasses suited to needs The size and shape of the handles of flatware may be hard to hold; adjust to needs. Physical Comfort

Adjust chair height, table height, chair-to-table relationship as needed. Having the table top at elbow height is usually comfortable. Provide cushions, pillows, footstool to avoid pain and reduced blood flow to the legs. Brighter light is often welcome. For most people, brighter is more cheerful; for those with reduced vision, it is essential. Social Comfort Include care receiver in family meals whenever possible. But also realize that if s/he feels uncomfortable because of changing needs at the table, s/he may prefer to dine alone, joining the family, perhaps for just a beverage. Adjust to his/her needs. Take care of spills with tact; have a towel nearby but out of sight. Provide shirt savers or dress savers at every meal if spills are frequent: Do not refer to this as bibs even though the care receiver may. Provide them in styles and colors that blend with the care receivers

clothes. If The Patient/Client Dines Alone Family photos on or near the dining table can provide a sense of comfort. If possible, see that the photos are large enough to be easily seen by the care receiver. A pleasant video or a favorite television show may provide some company. Providing a system easily used by the Care Receiver may be challenging. A window view with a bird or squirrel-feeder right outside can provide mealtime entertainment. Letting Go Realize that as the end of life nears, systems of the body begin to shut down. Coaxing a patient/client who is in this stage to eat and drink

only causes them greater discomfort. Follow the physicians guidelines, and when this time comes, find the strength to let go. Seek other meaningful ways to provide care and comfort for the patient/client and solace for yourself. Test material 1. In Food Preparation. Cutting board can be use for chopping vegetables even after it has been used for cutting meat. Agree or Disagree? 2. On Dietary Guidelines. Smaller, more frequent meals attributes spike blood sugar. Agree or Disagree? 3. Realize that as the end of life nears, the body begin to shut down. When this time comes, you must have the strength to let go, and seek other meaningful ways to provide care and comfort for the patient/client and solace for yourself. Agree or Disagree? 4. In Prevention of Food-Borne Illnesses, safe food handling practice considers food temperature to be at DANGER ZONE for bacterial growth at between _____ degree F to ____ degree F.

5. Wash hands frequently in warm, soapy water for at least ____ seconds each time. Test material Answers 1. 2. 3. 4. 5. Disagree Disagree Agree 40`F / 140`F 20 sec.

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