SUPPLEMENTAL MATERIAL CHAPTER 12 QUESTION
1. Where should the CDM, CFPP document a client’s willingness to comply with the written diet order?
2. A 59-year-old man with congestive heart failure, type 2 diabetes, and right-foot amputation resides at a health care facility. His usual weight range is 330-350 lbs. and he wants weigh 170 lbs. His diet order is an 1800 calorie, 2 gm sodium, 1200 mL fluid per day. The client visits the vending machine daily for sweet treats and is requesting double portions at all three meals. The CDM, CFPP tells the foodservice employees they must provide the extra food because it is the client’s right to have it. Is this an acceptable action? Explain.
ANSWER
In a progress note in the electronic medical record and in the care plan.
The CDM, CFPP and staff must provide the diet as prescribed. In this scenario, simply providing the client’s requests is not following the diet order and it is not within the CDM, CFPP’s Scope of Practice to change the diet order. A best practice would be to refer to the RDN/NDTR, or the IDT for further assessment and recommendation. The client’s care plan team, which includes the client, will be tasked with arriving at the best plan of care. The client’s behavior and ultimate plan determined must be documented in the client’s health record with a brief note and also in the client’s care plan.
CHAPTER 13 QUESTION
1. Experts advise to not give whole grapes to a toddler or preschooler for their snack. Explain.
ANSWER
The reasons are two-fold. First, small children have an underdeveloped ability to chew and swallow food. Secondly, the size of a grape is about the same size as a small child’s upper airway. With inadequate chewing, the slippery texture of a grape could easily cause it to slip into the airway and cause choking.
2. Modify the following snack to increase the nutrient density:
• Saltines with peanut butter • A glass of soda
3. Should an overweight child or adolescent be on a calorie- restricted diet? Explain.
Replace saltine crackers with whole grain crackers to increase fiber
Replace soda with milk to increase protein, vitamins, and minerals
Children and adolescents have high nutrient demands to support a growing body. Sometimes, the child may be overfed, but undernourished. A caloric restriction further deprives the child or adolescent of much-needed nutrients. A better strategy would be for the child or adolescent to work with an RDN to optimize meal and snack choices.
4. Is it possible to have an allergy to gluten? Explain why.
There are gluten-related disorders, but an allergy to gluten is a misnomer. People can experience adverse reactions, or intolerances to wheat. These reactions can be to skin, the digestive system, mood, and joints. This intolerance is called non-celiac gluten sensitivity and is not the same as celiac disease. Celiac disease is an immune system response to eating gluten and can result in damage of the intestinal lining, weight loss, and peripheral nerve
damage.There is no cure at this time for celiac disease. People with true celiac disease cannot eat any amount of gluten.
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Nutrition Fundamentals and Medical Nutrition Therapy
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