Module 26. Assisting with Complex Modified Diets

Transcription

1 Home Health Aide Training Module 26. Assisting with Complex Modified Diets Goals The goals of this module are to: Introduce participants to complex modified diets and their role in assisting clients with them. Provide participants with the opportunity to practice menu planning for clients with complex modified diets. Identify participants own attitudes and feelings about assisting clients with complex modified diets. Time 4 hours Activities Teaching Methods Time 1. Introduction to Complex Modified Diets 2. Complex Modified Diets for Clients with Diabetes 3. How to Approach Assisting with Complex Modified Diets Interactive presentation, smallgroup work, and small-group reporting Interactive presentation, smallgroup work, and small-group reporting Role play, large-group discussion, and interactive presentation 1 hour 2 hours and 20 minutes 40 minutes Trainer s Manual Page 26.1

2 Supplies Flip chart, markers, and tape Paper and pencils Samples of nutrition guidelines, cookbooks, carbohydrate counting guides, and exchange lists from the American Diabetes Association Learner s Book 1. What Are Complex Modified Diets? 2. Your Role in Assisting with Preparing a Complex Modified Diet 3. What Can Mr. Vela Eat? 4. Assisting with Nutritional Supplements 5. Basic Information about Diabetes 6. Why Blood Sugar Is Important: Emergency Response Tips 7. Measuring Blood Sugar 8. Tools for Meal Planning for Clients with Diabetes 9. Diet Sheet for Inna Bronski 10. Basic Exchange Chart 11. Shopping and Cooking Tips for Clients with Diabetes 12. Learning from Maria 13. What to Observe, Record, and Report Worksheets Worksheet 1. What Can Mr. Vela Eat? Worksheet 2. Creating a Menu for Mrs. Bronski Handouts Handout 1. Key Terms Handout 2. Summary of Key Information Advance Preparation Review all training instructions and learner s materials for this module. Note that icons are used to remind the trainer of the following: Trainer s Manual Page 26.2

3 When you are presenting or covering Key Content in the discussion. (Key Content is also addressed in the Learner s Book and the handouts, but we use the key icon only when it is covered elsewhere in the learning process.) When it is important to ask a particular question to get participants input. When it is time to refer to the Learner s Book. When it is time to distribute a worksheet. When it is time to distribute and discuss a handout. Copy all worksheets and handouts for participants. Gather all necessary supplies and equipment. Please note that the Key Content is meant to be background information for the trainer. DO NOT READ OUT LOUD TO PARTICIPANTS. Activity 1. Introduction to Complex Modified Diets Prepare the following flip chart pages: Learning Agenda (Step 1) Review of Diet, Meal Planning, and Meal Preparation (Step 3) Activity 2. Complex Modified Diets for Clients with Diabetes Make sure you have copies of The Exchange Lists for Meal Planning from the American Diabetes Association or another exchange list tool. These are not distributed as handouts, but are made available as references for the small-group work. Ideally, you should have enough copies so that each small group can have one. Possible sources include: Choose Your Foods: Exchange List for Diabetes (see Trainer s Manual Page 26.3

4 Choose Your Foods: A Guide to Planning Meals for Diabetes (see 25pk.aspx) Activity 3. How to Approach Assisting with Complex Modified Diets Make a copy of the scripted role play (Teaching Tools, Activity 3 Scripted Role Play: Complex Modified Diet) and share it with your cotrainer or teaching assistant ahead of time. As the lead trainer, you will play the role of Maria, the home health aide; your assistant will be the client, Mrs. Bronski. It helps to highlight each person s parts on separate copies of the script. Trainer s Manual Page 26.4

5 Activity 1. Introduction to Complex Modified Diets 1 hour Learning Outcomes By the end of this activity, participants will be able to: Describe three types of complex modified diets. Describe the home health aide s role in the preparation of complex modified diets. Describe the meal planning process when multiple dietary restrictions must be met. Describe how to measure and mix prescribed supplements. Key Content Participants already know about their role in assisting with planning and preparing meals. Participants also already know about their role in assisting clients with simple modified diets. Participants will assist with many of the same tasks when working with clients who are prescribed complex modified diets. There are several kinds of complex modified diets. The three examples that are introduced in this module are: o A diet that combines two or more simple modified diets (for example, a lowsalt, high-protein diet) o A diet that includes supplements that are measured and then added to food o A diet that adjusts the level or balance of protein, fat, and carbohydrate (for example, a diet for diabetics) There are many tasks related to complex modified diets that the home health aide may assist with. There are other tasks that the home health aide may not assist with. There are also tasks that the home health aide may assist with only under special circumstances. Trainer s Manual Page 26.5

6 When a client is prescribed more than one simple modified diet, the home health aide can assist the client in selecting appropriate foods. The home health aide can also help prepare meals that will help the client meet his or her dietary goals. The home health aide may assist a client with mixing prescribed medical supplements into their foods and beverages. This is because supplements are not considered medications. The home health aide may not assist a client with mixing medications into their foods and beverages. Activity Steps Interactive Presentation 5 minutes 1. Introduce the activity. Post the prepared flip chart page with the Learning Agenda and review. Ask if there are any questions. Flip Chart LEARNING AGENDA: ASSISTING WITH COMPLEX MODIFIED DIETS Learn what complex modified diets are and what your role is in assisting with them. Describe how to plan a meal for clients with more than one dietary restriction. Describe how to measure and mix prescribed supplements. Explore how you feel about assisting with complex modified diets. Describe what to observe, record, and report. Trainer s Manual Page 26.6

7 Small-Group Work 10 minutes 2. Introduce review session. Remind participants that they already know basic information about their role in meal planning, preparing shopping lists, purchasing food, and meal preparation. Explain that you will start this module by reviewing what they already know. 3. Form small groups and give instructions. Divide participants into small groups of three to five people; then post the flip chart page with the review question. Distribute 5 index cards to each group. After you read the question out loud, let the groups know that they will now have five minutes to answer this question together. Ask them to write their answers down on the index cards you have given them (one answer on each index card). Explain that after five minutes, you will call on one of the groups to come to the front of the room and tape one of their index cards to the flip chart. Explain that each group will get a chance to tape one of their answers to the flip chart, and that you will continue to go around to each group until all of their answers have been listed. Flip Chart REVIEW OF DIET, MEAL PLANNING, AND MEAL PREPARATION What should you keep in mind when you are planning and preparing a meal for a client? Teaching Tip If the small groups do not add any of the following information to the list, you can add it yourself: Plan meals with a variety of foods from the five food groups. Take the client s personal and cultural preferences into account when planning the meal. Be aware that the meals you plan should cost no more than the client can afford. Trainer s Manual Page 26.7

8 Choose nutritious foods that are in season. Avoid frying food. Instead, try steaming, baking, and broiling. Serve food attractively. Store food properly for safety and to retain nutrients. 4. Review simple modified diets. Remind participants that they have also already learned about simple modified diets. Ask participants: What is an example of a simple modified diet? Teaching Tip Be sure that participants list the following types of simple modified diet: soft, bland, high calorie, low calorie, low salt (sodium restricted), and low fat. Interactive Presentation 10 minutes 5. Refer to Learner s Book. Refer to 1. What Are Complex Modified Diets? and 2. Your Role in Assisting with Preparing a Complex Modified Diet in the Learner s Book. Explain to participants that they may be assigned to assist with only part of the food planning or preparation, and that they should study the client s care plan to know how they are expected to assist. Answer any questions. Small-Group Work 10 minutes 6. Discuss food choice when more than one simple modified diet is prescribed. Explain that participants are now going to learn about how to assist with the different kinds of complex modified diets that they learned about on 1. What Are Complex Modified Diets? Remind participants that one kind of complex modified diet is a diet that is comprised of two or more simple modified diets. Explain that this type of diet can be confusing for the client because some foods that are permitted on one simple modified diet may be restricted on another. For example, a client may be prescribed a diet that is both high protein and low fat. The client might choose a food because it is high in protein (like bacon), but this food may not be permitted, because it is not low in fat. Explain that one way that the home health aide can assist clients is by working with them to select foods that are appropriate for their diet. Trainer s Manual Page 26.8

9 7. Set up small-group work. Refer to 3. What Can Mr. Vela Eat? and distribute Worksheet 1. What Can Mr. Vela Eat? Explain that participants will now practice selecting foods that would be appropriate for a client who is on more than one simple modified diet. Divide participants into small groups. Explain that section 3 describes a client who has been prescribed a low-fat and a low-salt (sodiumrestricted) diet. They will have ten minutes to think about what foods this client can and cannot eat and to complete the worksheet. Ask if there are any questions. Small-Group Reporting 10 minutes 8. Facilitate small-group reporting. After ten minutes, facilitate reporting out from the small groups. Read the first question and ask one group to volunteer to share their answer. Discuss as needed. Continue by asking other groups to share their answers to each remaining question. Interactive Presentation 15 minutes 9. Discuss nutritional supplements. Explain that nutritional supplements are sometimes prescribed to clients to increase protein or vitamin and mineral intake, or to promote weight gain. These nutritional supplements may be in liquid form, or they may come as powders that need to be mixed with liquids. Explain that, as home health aides, they are permitted to mix nutritional supplements into foods or drinks when these are prescribed. Teaching Tip Be sure that participants understand that they are not allowed to add medications to their clients foods or beverages. Nutritional supplements are not considered medications. 10. Refer to 4. Assisting with Nutritional Supplements in the Learner s Book. Explain that some clients who take prescribed nutritional supplements may have a poor appetite, so it is important for the home health aide to be patient and understanding. Ask if participants have any questions. Trainer s Manual Page 26.9

10 Activity 2. Complex Modified Diets for Clients with Diabetes 2 hours and 20 minutes Learning Outcomes By the end of this activity, participants will be able to: Describe the symptoms of low and high blood sugar in clients with diabetes. Describe the steps the home health aide can take to assist clients when their blood sugar is either too high or too low. Describe how to assist the client to use a glucometer to measure their blood sugar. Describe how to plan and prepare meals using an exchange list. Describe what to observe, record, and report when assisting with the preparation of complex modified diets. Key Content Diabetes is a group of diseases that result in the body being unable to produce and/or use glucose. Symptoms of diabetes include: Feeling weak Feeling tired all the time Feeling hungry or thirsty all the time Weight loss Frequent urination Diabetes that is not properly treated can lead to serious health consequences, including: Skin problems Poor circulation (which may lead to amputation) Poor eyesight or blindness Trainer s Manual Page 26.10

11 Increased risk of infection Increased risk of heart attack, stroke, or kidney disease Coma Diabetes has no cure, but it can often be managed through diet modification and weight management. People with diabetes may also take insulin to keep their blood sugar from getting too high or too low. The home health aide should assist the client in managing blood sugar levels by supporting the client in following their diet. The diet will be described in detail in the care plan. Often, a sample menu for the week will be included. The client may also vary what they eat by using a menu planning guide. This helps people with diabetes to stick to the recommended daily food allowance for each food group. An exchange list explains how foods within a food group can be exchanged for one another. This makes it easier for the client to vary their menu while still staying within their total daily allowance for each food group. The home health aide may also assist the client by reminding the client to take prescribed medications (such as insulin) and/or reminding the client to use a glucometer as directed. The home health aide should also know the symptoms of high blood sugar and low blood sugar and know what steps to take when these symptoms are present. Activity Steps Teaching Tip You should have a 10-minute break at some point in this activity. A logical time would be after the first interactive presentation and before the start of small-group work. However, you can be flexible and have the break whenever it seems to be needed. Trainer s Manual Page 26.11

12 Interactive Presentation 35 minutes 1. Review what participants already know about diabetes. Ask participants: Do you know anyone who has diabetes? What are their symptoms? How do they treat their diabetes? 2. Refer to the Learner s Book. Refer to 5. Basic Information about Diabetes in the Learner s Book and review with participants. Connect the information that is on the handout with what the participants shared in the last step. Emphasize that diet is a very important part of controlling diabetes, because it can prevent the client s blood sugar levels from getting too high or too low. Next, refer to 6. Why Blood Sugar Is Important Emergency Response Tips and 7. Measuring Blood Sugar in the Learner s Book. Ask if they have any questions. Teaching Tip When reviewing section 7, remind participants that they learned about proper disposal of sharps in the Infection Control module. The lancet with the glucometer is considered a sharp. Participants should be aware that the procedure for safe disposal of the sharps container varies depending on where the client lives. The home health aide can ask the client or family about the procedure that should be followed. If the client or family is not certain, the home health aide can ask the building s superintendent or call the nurse or supervisor. 3. Introduce the diabetic diet and meal planning. Explain that there is no such thing as the diabetic diet, because clients who have diabetes will each have a diet that is specifically prescribed for their individual needs. Their diet will prescribe how many calories they should eat per day, as well as which foods to eat and when to eat them. Explain that there are different approaches to planning meals for people with diabetes, and that each of these approaches works for some clients. Refer to 8. Tools for Meal Planning for Clients with Diabetes in the Learner s Book and review with participants. Then explain that an individual client s meal planning will be based on assessment data and food and nutrition history information. Refer to 9. Diet Sheet for Inna Bronski in the Learner s Book and review it with participants. Trainer s Manual Page 26.12

13 Explain how the total exchanges for the day are broken down into three meals and a snack. Explain that figuring out exchanges can be confusing, so the client will usually have a complete and detailed diet for a week. The home health aide simply needs to follow that diet. Later on, if the client gets tired of the food on the diet, the aide can work with the client to figure out different foods from the exchange list. 4. Introduce Basic Exchange Chart. Refer to 10. Basic Exchange Chart in the Learner s Book. Explain that section 10 tells them the amount of some of the most common foods in each food group that equals one exchange. Explain that the client can exchange other foods in the same food group, as long as they are worth the same number of exchanges. Emphasize that many starches swell when they are cooked (like pasta), so it is important to know that the exchange measurements should be taken after the starch is cooked. Ask if there are any questions. Small-Group Work and Small-Group Reporting 1 hour and 30 minutes 5. Form small groups and introduce exchange lists. Divide the participants into small groups of two or three people. Give each small group a copy of an exchange list for meal planning (see Advance Preparation). Review so that participants are familiar with how to use the exchange list. 6. Give instructions for small-group work. Distribute Worksheet 2. Creating a Menu for Mrs. Bronski. Read the first two paragraphs on the worksheet. Then explain that their task is to review the foods in the sample menu (column A) and then work together with their small group to plan alternative meals for Mrs. Bronski. These meals should have the same number of exchanges in each food group, but different food choices. Point out that not all of the foods in the sample menu are worth one exchange. Explain that the groups will have 10 minutes to complete each alternative meal. Then they will share their menu with the rest of the group. Ask if there are any questions. Trainer s Manual Page 26.13

14 7. Demonstrate meal planning with the snack. Explain that you will show how to do this assignment by working with them on alternatives to the snack menu. Ask participants to refer to their exchange lists to find foods that have the same number of exchanges as are listed in the snack section of Mrs. Bronski s diet plan. Discuss participants choices for snack alternatives and correct as needed. 8. Ask groups to start with alternatives to breakfast. Note that participants will have 10 minutes in their groups to identify alternative breakfast foods that will have the same number of exchanges as the breakfast on Mrs. Bronski s diet plan. 9. Debrief for the alternative breakfast menu. After ten minutes, ask the small groups to share their breakfast menus with the whole group. If any of the groups make errors, take the time to discuss them and correct them. 10. Ask groups to continue with alternatives to lunch. Next, explain that participants will have another ten minutes to work with their small group to develop an alternative lunch menu for Mrs. Bronski. Ask if there are any questions, then ask participants to begin. 11. Debrief for the alternative lunch menu. After ten minutes, ask the small groups to share their lunch menus with the whole group. If any of the groups make errors, take the time to discuss them and correct them. 12. Ask groups to continue with alternatives to dinner. Next, explain that participants will have a final ten minutes to work with their small group to develop an alternative dinner menu for Mrs. Bronski. Ask if there are any questions, then have participants begin. 13. Debrief for the alternative dinner menu. After ten minutes, ask the small groups to share their dinner menus with the whole group. If any of the groups make errors, take the time to discuss them and correct them. Teaching Tip If you do not have time for the small groups to develop alternative menus for all three meals, you can assign one meal to each small group. Try to have at least two groups working on each meal, so that you can show how different food selections can have the same number of exchanges. Trainer s Manual Page 26.14

15 Interactive Presentation 15 minutes 14. Refer to Learner s Book. Explain that, in addition to knowing how to use exchange lists, there are certain things that participants should keep in mind when they are shopping and cooking for clients who have diabetes. Refer to 11. Shopping and Cooking Tips for Clients with Diabetes in the Learner s Book. Review with participants. Answer any questions. 15. Discuss how to respond to a client s sugar cravings. Explain that some clients with diabetes may want to eat sweet foods that are dangerous for them, because these foods can make their blood sugar level too high. Ask participants to imagine that they have a diabetic client who has asked them to buy candy at the grocery store. Ask participants: How would you respond to this client? After hearing participants responses, make sure to emphasize that it is helpful to point out the possible harmful effects of eating candy. Also, emphasize that it is important to let the client know that you care about them and about their health. 16. Wrap up the activity. Ask participants if they have any questions about diabetes or about how to assist a diabetic client with their diet. Trainer s Manual Page 26.15

16 Activity 3. How to Approach Assisting with Complex Modified Diets 40 minutes Learning Outcomes By the end of this activity, participants will be able to: Describe the home health aide s role in meeting specific dietary goals, according to the client s personal and ethnic preferences. Identify their attitudes and feelings about assisting with the preparation of complex modified diets. Key Content Clients may have a range of feelings about their complex modified diets. They may feel confused about what they can and cannot eat, or they may miss eating foods that they used to enjoy. The home health aide can assist the client in following their complex modified diet by: Helping the client to understand their diet Making meals appetizing and pleasant Acknowledging feelings Being positive The home health aide should be aware that clients have personal and ethnic preferences about the foods they eat. The home health aide should strive to learn as much as possible about their client s preferences, and to prepare foods that will both be appetizing to the client and help the client meet his or her dietary goals. Trainer s Manual Page 26.16

17 Activity Steps Role Play 10 minutes 1. Introduce and conduct the role play. Explain that clients may have a range of feelings about having a complex modified diet. Some complex modified diets are complicated, and some clients may feel confused about what they should and should not eat. Clients may also feel frustrated that they cannot eat foods that they used to enjoy. Explain that participants are now going to see a role play. In the role play, they will meet a home health aide named Maria and her client, Mrs. Inna Bronski. Mrs. Bronski is 70 years old; she lives alone and has type 2 diabetes, hypertension, and high cholesterol levels. As a result of these conditions, she needs to be on a complex modified diet. Ask participants to pay attention to how Mrs. Bronski is feeling about her complex modified diet. Also, ask them to pay attention to how Maria offers Mrs. Bronski emotional support and how she assists Mrs. Bronski in following her diet. Teaching Tip See Teaching Tools, Activity 3 Scripted Role Play: Complex Modified Diets and follow the script. Do not distribute script to participants at this time. You can perform the role play yourself with another trainer, or you can ask participants to volunteer to play one or both of the characters. Large-Group Discussion 15 minutes 2. Debrief the role play. After the role play is performed, ask the participants: How was Mrs. Bronski feeling about her complex modified diet in the role play? How did Maria offer Mrs. Bronski emotional support? What else did Maria do to support Mrs. Bronski in following her diet? Trainer s Manual Page 26.17

18 3. Refer to 12. Learning from Maria in the Learner s Book. Be sure to point out that part of making meals appetizing for a client is learning as much as you can about what the client likes to eat. This means learning which foods they prefer, how they like these foods prepared, and how they like their food seasoned. Remind participants that their clients may have different cultural backgrounds, and their food preferences may be very different from their own. 4. Discuss what to observe, record, and report. Emphasize that diet prescriptions are part of the care plan, just like medications. It is important for the home health aide to know what to observe, record, and report when the client is having problems related to their complex modified diet. Refer to 13. What to Observe, Record, and Report in the Learner s Book. Review with participants and answer any questions. 5. Ask participants to share their own feelings. Ask participants: How are you feeling right now about your role in assisting with the preparation of complex modified diets? Allow participants to share their responses, and validate the feelings that participants share by explaining that there is no wrong way to feel. Reassure participants who are feeling nervous or overwhelmed that their feelings will likely become more manageable as they become more familiar with complex modified diets. Encourage participants to review Learner s Book outside of class and to approach you with any questions as necessary. Interactive Presentation 15 minutes 6. Summarize key information. Distribute Handout 1. Key Terms and Handout 2. Summary of Key Information. Review with participants and answer any questions. Trainer s Manual Page 26.18

19 Teaching Tools, Activity 3 Scripted Role Play: Complex Modified Diet Roles: Maria Nunez, a HHA Mrs.Inna Bronski, her client Case Scenario: Introduce the role players. Then read this scenario to participants. [Do NOT give the role play script to participants.] Mrs. Bronski is a 70-year-old woman who is living alone. She has type 2 diabetes, hypertension, and high cholesterol. As a result of these conditions, she is on a complex modified diet. Maria: Mrs. Bronski, it s time for me to make your lunch for you. Mrs. Bronski: I m not hungry. Maria: Well, because of your diabetes, it s important for you to eat lunch at the same time every day. That helps you keep your blood sugar level in the normal range. Besides, I saw a meal on your sample menu that I thought you might like. How about pasta with grilled chicken and broccoli? Mrs. Bronski: I want a chicken sandwich and potato chips. Maria: I can make you the sandwich if you d like. But if you have the sandwich, then we should skip the potato chips. Mrs. Bronski: Why can t I have the potato chips? I like potato chips! Trainer s Manual Page 26.19

20 Maria: It s because of your diabetes, Mrs. Bronski. The care plan says that you should have only one food from the Starch List for your lunch. And bread and potato chips are both from the starch list. Mrs. Bronski: That s not fair. Maria: I understand that it doesn t feel fair. But remember how sick you got the last time your blood sugar got too high? I don t want that to happen again. Mrs. Bronski: Fine. Then I ll have the sandwich. I want it with lettuce. And lots of mayonnaise! Maria: I will put the lettuce on for you. But because of your cholesterol, the care plan tells me that you shouldn t have mayonnaise. Mrs. Bronski: Is that because of my diabetes too? Maria: It s because you also have high cholesterol. Mrs. Bronski: I don t want to eat a sandwich without mayonnaise! Maria: Mrs. Bronski: Would you like to skip the sandwich then? I could make you a baked potato with chicken and broccoli. How does that sound? What s the point? I m not allowed to have salt or butter on the potato anyway. Trainer s Manual Page 26.20

21 Maria: Salt and butter aren t good for your hypertension, Mrs. Bronski. That s true. But we do have some margarine that doesn t have any salt in it. We could put that on your potato. How does that sound? Mrs. Bronski: I used to be able to eat whatever I wanted. Maria: It sounds like you miss that. Mrs. Bronski: Yes, I do. Maria: I understand that. I know it s hard not to be able to eat some of the foods that you really like. But I want to try to find ways for you to be able to enjoy your meals even if there are some foods you can t eat. Mrs. Bronski: I know you always try, Maria. You always make my plate look so nice! But what I like most is that you keep me company while I m eating. Maria: Do you enjoy that? Mrs. Bronski: I do. In fact, I look forward to mealtime because of it. Maria: I m glad to hear that! So I will be sure to plan my time so that I can always keep you company while you eat your lunch. Today, I can bring the clean laundry in so that I can sit and fold it while you are eating. How does that sound? Mrs. Bronski: Thank you, Maria. You are always so thoughtful. I feel a little better. Trainer s Manual Page 26.21

22 Learner s Book Module 26. Assisting with Complex Modified Diets Activity 1. Introduction to Complex Modified Diets 1. What Are Complex Modified Diets? 2. Your Role in Assisting with Preparing a Complex Modified Diet 3. What Can Mr. Vela Eat? (to be used with Worksheet 1) 4. Assisting with Nutritional Supplements Activity 2. Complex Modified Diets for Clients with Diabetes 5. Basic Information about Diabetes 6. Why Blood Sugar Is Important: Emergency Response Tips 7. Measuring Blood Sugar 8. Tools for Meal Planning for Clients with Diabetes 9. Diet Sheet for Inna Bronski 10. Basic Exchange Chart 11. Shopping and Cooking Tips for Clients with Diabetes Learner s Book Page 26.1

23 Activity 3. How to Approach Assisting with Complex Modified Diets 12. Learning from Maria 13. What to Observe, Record, and Report Learner s Book Page 26.2

24 1. What Are Complex Modified Diets? Some illnesses or diseases may be treated with changes (modifications) to the diet. Some of these diseases are: Type 1 and type 2 diabetes Heart disease Kidney and liver disease A complex modified diet usually has more than one kind of change in the diet. Here are some of the different types of complex modified diets: A diet that combines two or more simple modified diets Example: a low-salt and high-protein diet A diet that includes supplements that are measured and then added to the food A diet that adjusts the level (or balance) of protein, fat, and carbohydrates Examples: diet for diabetics, ketogenic diet, renal diet, cholesterollowering diet Learner s Book Page 26.3

25 2. Your Role in Assisting with Preparing a Complex Modified Diet You may assist a client with preparing complex modified diets by: Planning meals with the client or family member Preparing shopping lists that are appropriate for the diet Buying foods that are appropriate for the diet Setting up equipment, utensils, and supplies that you will need to prepare meals Preparing meals Measuring and adding nutritional supplements to foods or drinks Serving meals Cleaning cooking areas, equipment, and utensils Storing uneaten foods properly Observing, recording, and reporting changes or problems in the client s eating patterns, including when they eat out You may not assist a client by mixing medication into foods or drinks. Learner s Book Page 26.4

26 3. What Can Mr. Vela Eat? Mr. Vela has heart disease. His doctor has prescribed a diet that is low in calories and low in sodium (salt). Below, you will see a list of the foods that are included in each of these diets. You will also see the foods that Mr. Vela should avoid. Read these lists with your small group, and then answer the questions on Worksheet 1. Low-Fat Diet Include: All food groups of MyPlate, especially skim milk, lean meat, fish and poultry, low-fat cottage cheese, fruits, and vegetables. Avoid: Fried foods, cooking oil, cheese, butter, margarine, ice cream, salad dressings, eggs, gravies, bacon, lunch meat, and avocados. Sodium-Restricted (Low-Salt) Diet Include: All food groups of MyPlate, especially fresh fruits and vegetables, but limit cheese, milk, bakery bread. Avoid: Table and cooking salts, lunch meat, bacon, canned vegetables and soups, salted butter and margarine, commercially prepared frozen dinners. Learner s Book Page 26.5

27 4. Assisting with Nutritional Supplements You may assist a client by mixing prescribed nutritional supplements into their foods and beverages. When you assist with nutritional supplements, be sure to: Mix or shake supplements thoroughly Follow the instructions exactly Make sure the client eats or drinks them at the time that is shown on the care plan Encourage the client to swallow the whole amount Nutritional supplements are NOT the same as medications. Remember you may not assist a client by mixing medication into foods or drinks. Learner s Book Page 26.6

28 5. Basic Information about Diabetes Page 1 of 2 What is diabetes? Glucose is a sugar that travels in the bloodstream. It is normally absorbed into the body s cells and used for energy. The body needs a hormone called insulin (from the pancreas) to absorb glucose into the cells. Without insulin, sugars can build up in the blood. This can cause problems with circulation and can damage organs. Diabetes is a disease where the pancreas does not produce enough insulin. Too much glucose in the blood is called high blood sugar or hyperglycemia. High blood sugar is caused by having too little insulin, or eating too much. This can lead to diabetic ketoacidosis or diabetic coma. The client can pass out from high blood sugar and can possibly die. (See the signs and what to do in Section 6.) Too little glucose in the blood is called low blood sugar or hypoglycemia. Low blood sugar is caused by taking too much insulin or not getting enough food. This can lead to insulin shock (also called insulin reaction). The client can also pass out from low blood sugar and possibly die. (See the signs and what to do in Section 6.) What are the health risks of diabetes? Skin problems, such as sores and skin breakdown Poor circulation (can lead to amputation, especially of the feet and legs) Poor eyesight (can lead to blindness) Increased risk of getting common infections (like colds) Increased chance of having a heart attack, stroke, or kidney disease Diabetic coma Death Learner s Book Page 26.7

29 5. Basic Information about Diabetes Page 2 of 2 What is the treatment? Diabetes has no known cure, but the symptoms can be controlled. Type 1 Diabetes usually starts in childhood or early adulthood. People with Type I Diabetes need to keep blood glucose levels within the normal range. They do this by taking insulin and monitoring (measuring) sugar in the blood. It is also important to exercise regularly, eat healthy foods, and maintain a healthy weight. Type 2 Diabetes usually starts later in life. People with Type 2 Diabetes must also modify their diet. Often, this type of diabetes is related to obesity, so eating less and getting more exercise are important parts of treatment. These clients may also take medication. Learner s Book Page 26.8

30 6. Why Blood Sugar Is Important: Emergency Response Tips People with diabetes need to monitor their blood sugar. This is because it can be dangerous to have blood sugar levels that are too low or too high. Low Blood Sugar The signs of low blood sugar are: Hunger and weakness Feeling dizzy Sweating or shaking Cold, clammy skin Being nervous, irritable, or having mood changes Having blurred vision Passing out Insulin shock is an emergency! If the client shows signs of low blood sugar: Give the client a quick source of sugar. Good choices are a sugar packet, orange juice, or candy. If the client doesn t get better, call 911 and then call your supervisor. High Blood Sugar The signs of high blood sugar are: Hunger and weakness Heavy breathing Dry skin Breath that smells sweet or fruity Passing out Diabetic ketoacidosis is an emergency! If the client shows signs of high blood sugar: Assist with checking the blood glucose and call your supervisor. If the client does not respond, call 911 and then call your supervisor. Learner s Book Page 26.9

31 7. Measuring Blood Sugar Many people with diabetes use a glucometer to measure their blood sugar. This is a device that requires the client to prick their finger (with a lancet) to get a drop of blood. Then the blood is placed on a test strip. The test strip goes into the glucometer for the glucose reading. (The test strip package will have exact instructions for what to do.) You are permitted to assist your client in measuring their blood sugar levels with a glucometer by: Bringing the glucometer to your client Reminding your client to wash their hands before the glucose reading Handing the lancet to your client Inserting the test strip in the meter Reading and recording the blood sugar reading Handing your client a medical waste container (for sharps ) to throw away the lancet after it is used Reminding your client to wash their hands after the glucose reading Storing all supplies You should always wear gloves when assisting your client with this procedure. You are NOT permitted to assist your client with: Pricking the skin with the lancet Putting the used lancet in the sharps container Learner s Book Page 26.10

32 8. Tools for Meal Planning for Clients with Diabetes People with diabetes use four different tools to help them plan their meals: 1. Diabetes Nutrition Guidelines These provide general guidelines for how to plan meals. Some examples are: o The First Step in Diabetes Meal Planning ( o Healthy Food Choices from the American Dietetic Association ( 2. Sample Menus for People with Diabetes There are cookbooks for people with diabetes. The American Diabetes Association has published a number of them. 3. Carbohydrate Counting Guides These guides help people with diabetes know how to measure the amount of carbohydrates in the foods they eat. The American Diabetes Association has published several guides. 4. Exchange Lists In the exchange system, foods are grouped into basic types. Within each group, the list compares foods for the same amount of calories, carbohydrates and other nutrients. A client with diabetes can exchange one food on a list for another. Learner s Book Page 26.11

33 9. Diet Sheet for Inna Bronski Page 1 of calorie diet TOTAL DAILY FOOD ALLOWANCES: Meat Vegetable Starch/bread Fat Milk (whole or 2%) Fruit 6 exchanges 2 exchanges 6 exchanges 3 exchanges 2 exchanges 3 exchanges MEALTIME FOOD ALLOWANCES: Breakfast Food Amount Sample Meat 1 exchange 1 egg Starch/ 2 exchanges 2 slices of toast bread Fat 1 exchange 1 tsp. margarine Milk 1 exchange 1 cup milk Fruit 1 exchange 1 orange Lunch Food Amount Sample Meat 2 exchanges 2 ounces mozzarella cheese (for grilled cheese sandwich) Starch/ 2 exchanges 2 slices bread (for sandwich) bread Fat 1 exchange 1 tsp. margarine Vegetable 1 exchange ½ cup cooked green beans Milk ½ exchange ½ cup milk Fruit 1 exchange 1/3 cantaloupe Learner s Book Page 26.12

34 9. Diet Sheet for Inna Bronski Page 2 of 2 Dinner Food Amount Sample Meat 3 exchanges 3 oz. chicken breast Vegetable 1 exchange ½ cup cooked broccoli Starch/ 1 exchange 1 baked potato bread Fat 1 exchange 1 tsp. margarine Milk ½ exchange ½ cup milk Snack Food Amount Sample Starch/ 1 exchange 6 saltine crackers bread Fruit 1 exchange 15 grapes From the office of: John Roberts, M.D. Learner s Book Page 26.13

35 10. Basic Exchange Chart Here are some basic foods from each of the five food groups that are equal to one exchange. You can use this chart to offer a client with diabetes alternative foods within a food group. Any food that is listed as one exchange can be substituted for any other food in the same food group that is listed as one exchange. Food Group Milk Meat Vegetable Fruit Starch One Exchange 1 cup milk ½ cup evaporated milk 6 ounces yogurt 1 ounce chicken breast (no skin) 1 ounce canned tuna (in water) ¼ cup low-fat cottage cheese 2 egg whites ½ cup cooked green beans ½ cup cooked collard greens 1 cup raw carrots 1 cup raw spinach 1 small apple (4 ounces) 4 ounces applesauce (unsweetened) 15 small grapes ½ cup orange juice 1 slice of bread ½ cup of cereal ⅓ cup of rice ½ cup of starchy vegetable Learner s Book Page 26.14

36 11. Shopping and Cooking Tips for Clients with Diabetes Tips for Shopping People with diabetes may feel that they need to buy special foods that are labeled diabetic or sugar free. However, these foods are not necessarily healthier for your client. For example, sugar-free food products do not contain sucrose, but they may contain other kinds of sugar that your client should avoid. When you shop for your client, keep these tips in mind: Read the ingredients list or nutrition facts label carefully Buy fresh, unprocessed food Tips for Cooking Avoid added fats (like butter) Use leaner cuts of meat or trim fat off of meats Do not fry food. Instead, you can bake, roast, broil, grill, or simmer. Avoid using coating mixes or bread crumbs on foods. Learner s Book Page 26.15

37 12. Learning from Maria In the role play, you saw that Mrs. Bronski (the client) was confused about her diet. She also felt frustrated and discouraged because she is not allowed to eat the foods she likes. Here s advice from Maria (the home health aide) about how you can support your client in following a diet: Help your client understand the diet. I explain why some foods that Mrs. Bronski likes are not good for her health, and I tell her how important her health is to me. Sometimes, I also remind her about what might happen if she eats the foods that aren t good for her. Try to make meals appetizing and pleasant. I try to learn as much as I can about what Mrs. Bronski likes so that I can find ways of preparing foods that she will find appetizing. Sometimes, I feel tempted to give Mrs. Bronski foods she really likes even if they are foods that she should avoid. But then I remind myself that it is very important to stick to the diet in the care plan because her diet is an important part of her teatment. I also try to find ways to make mealtime pleasant for her. I make sure the food is presented nicely. Sometimes I find a flower in her garden and put it in a vase near where she eats. I try to make mealtime special. Acknowledge feelings, and be positive. When Mrs. Bronski is feeling discouraged, I let her know that I understand. Then I try to focus her attention to positive things, like the foods that she still CAN eat. Learner s Book Page 26.16

38 13. What to Observe, Record, and Report Diet prescriptions are part of the treatment plan, just like medications. It is important for the client to follow the directions for their diet. It is important to report: Any changes in the client s eating pattern Any eating problems encountered by the client If the client is not following their diet prescription Any sudden changes or problems Learner s Book Page 26.17

39 Handout 1. Key Terms Page 1 of 3 Complex modified diet [1] A diet that has more than one kind of change from the regular diet. Modified diets are also called therapeutic diets or special diets. They are prescribed by a doctor, to help the client deal with a specific illness. Diabetes [5] Diabetes is a disease where the pancreas does not produce enough insulin. This results in the body not using glucose properly. Diabetes can lead to a wide range of serious health problems, or death. There are two types of diabetes. Neither can be cured, but both can be controlled with medication, diet, and exercise. Diabetic ketoacidosis [5] A complication of diabetes when the blood sugar gets too high. The client can pass out (diabetic coma) and possibly die. Exchange List [8-10] A list of foods that is used for meal planning. Foods are grouped into basic types. Within each group, the exchange list shows the amount of different foods that would give you the same number of calories and other nutrients. Glucometer [7] A device to measure blood sugar. The client pricks his/her own finger (with a lancet) to get a drop of blood. The blood is placed on a test strip. The test strip goes into the glucometer for the glucose reading. Glucose [5] Sugar that travels in the bloodstream. It is normally absorbed into the body s cells and used for energy. Handouts

40 Handout 1. Key Terms Page 2 of 3 High blood sugar [5 & 6] Too much glucose in the blood. (It is also called hyperglycemia.) High blood sugar is caused by having too little insulin, or eating too much. If it is not treated, it can lead to diabetic ketoacidosis. Hyperglycemia [5] Too much glucose in the blood. (It is also called high blood sugar or high blood glucose.) Severe hyperglycemia can lead to diabetic ketoacidosis. Hypoglycemia [5] Too little glucose in the blood. (It is also called low blood sugar or low blood glucose.) Severe hypoglycemia can lead to insulin shock. Insulin [5] A hormone made in the pancreas. The body needs insulin to absorb glucose into the cells. Problems with insulin lead to diabetes. Insulin shock [5] A complication of diabetes when the blood sugar gets too low. (It s also called insulin reaction.) The client can pass out and possibly die. Low blood sugar [5 & 6] Too little glucose in the blood. (It is also called hypoglycemia.) Low blood sugar is caused by taking too much insulin or getting too little food. If it is not treated, it can lead to insulin shock. Handouts

41 Handout 1. Key Terms Page 3 of 3 Nutrient Something found in food that gives energy or helps with growth and health. Nutritional supplements [4] Powders or liquids that are added to food or to drinks. This is done when a client s diet needs extra nutrients. Pancreas The organ that produces insulin. The pancreas is part of both the endocrine system and the digestive system. Handouts

42 Handout 2. Summary of Key Information Page 1 of 3 A complex modified diet is a special diet for clients with certain illnesses, such as diabetes and diseases that affect the heart, liver, or kidney. Complex modified diets: Have more than one change (for example, low-salt and high-protein) Include food supplements Change the level of protein, fat, or carbohydrates in a client s diet When you assist with the preparation of a complex modified diet, you may: Plan meals with the client or family member Prepare shopping lists that are appropriate for the diet Prepare meals Measure and add nutritional supplements to foods or drinks Observe, record, and report changes or problems in the client s eating patterns, including when they eat out With careful planning, you can prepare tasty and nutritious meals for a client with a complex modified diet. You should encourage your clients to be as independent as possible in their meal planning and preparation. Nutritional supplements are NOT the same as medications. You may add nutritional supplements to food or drinks. But you may not assist a client by mixing medication into foods or drinks. You will make specific observations and record and report certain information when assisting with complex modified diets. In general, this includes: Any changes in the client s eating pattern Any eating problems encountered by the client If the client is not following their diet prescription Any other sudden changes or problems Handouts

43 Handout 2. Summary of Key Information Page 2 of 3 Diabetes is a disorder in which foods are not used correctly in the body, due to problems with insulin. Diabetes can have serious complications that can lead to death. Diabetes is treated by medications (such as insulin), diet, and exercise to control weight. What are the health risks of diabetes? Skin problems, such as sores and skin breakdown Poor circulation in the feet and legs (can lead to amputation) Poor eyesight (can lead to blindness) Increased risk of getting common infections (like colds) Increased chance of having a heart attack, stroke, or kidney disease Diabetic coma Death Low Blood Sugar If a client with diabetes skips a meal or takes too much insulin without eating, their blood sugar level may drop. This is called low blood sugar, or hypoglycemia. It can lead to insulin shock (insulin reaction). The symptoms of low blood sugar are: Hunger and weakness Feeling dizzy Sweating or shaking Cold, clammy skin Being nervous, irritable, or having mood changes Having blurred vision Passing out (insulin shock) Emergency Response to Low Blood Sugar: Give the client a quick source of sugar. Good choices are a sugar packet, orange juice, or candy. If the client doesn t get better, call 911 and then call your supervisor. Handouts

44 Handout 2. Summary of Key Information Page 3 of 3 High Blood Sugar If a client forgets to take their insulin, or eats too much, or is sick with a cold, their blood sugar level may get too high. This is called high blood sugar, or hyperglycemia. It can lead to diabetic ketoacidosis or diabetic coma. The symptoms of high blood sugar are: Hunger and weakness Heavy breathing Dry skin Breath that smells sweet or fruity Passing out (diabetic coma) Emergency Response to High Blood Sugar: Assist with checking the blood glucose and call your supervisor. If the client does not respond, call 911 and then call your supervisor. You may be asked to assist your client to measure blood sugar with a glucometer. This involves pricking the client s finger to get a drop of blood. You are NOT permitted to prick the client s skin they must do that for themselves. It is very important for clients with diabetes to carefully monitor and control what they eat, especially when it comes to carbohydrates. There are books and pamphlets to make it easier to plan meals for clients with diabetes. These include nutrition guidelines, menus, carbohydrate counting, and exchange lists. You can plan nutritionally balanced meals for a client with diabetes using a meal plan and exchange lists. Handouts