36 CHAPTER 14 QUESTION
1. The administrator informs the CDM, CFPP that the foodservice department is consistently going over the commercial nutritional supplement budget. Many of the residents are on nutritional supplements. What steps could be taken to reduce the use of supplements in the facility?
ANSWER
• Discuss with the RDN and MD if liberalizing the diets of residents on supplements is appropriate (if this has not been done up to this point). Liberalization may allow for more flavors, textures, and preferred foods.
• Real foods instead of oral commercial supplements should be considered first as snacks. Oral commercial supplements should only be offered after attempts at real foods fail. Real food is preferred by most people over oral commercial supplements.
• Consider simple menu planning techniques that can add calories, protein and other nutrients to foods (easily done in hot cereal, soups, shakes, mashed potatoes)
2. James is a 90 year-old client that was admitted one month ago. James is very thin and not eating well. The MD ordered an MNT product three times a day. The nurses report that James is not drinking the MNT product. James states that the drinks are “too sweet” and he would rather have whole milk. James is on a low-fat, low-cholesterol diet due to a history of high cholesterol. What should the CDM, CFPP recommend to the MD?
3. The CDM, CFPP notices while visiting a client who is on a tube feeding that they are laying flat in their bed and coughing. What should the CDM, CFPP do?
• Liberalize to regular diet • Give whole milk with meals
• Use real foods and comfort foods that James prefers to supplement his intake. See Figure 14.4 for Techniques for Increasing Calorie and Protein Intake in Real Food
SUPPLEMENTAL MATERIAL
It is standard practice for nursing to elevate the head of the bed to a 45 degree angle to help reduce the chance of aspiration pneumonia. The CDM, CFPP should notify the nurse of what they observed, then check back at a later time to follow-up and make sure the head of the bed is raised.
Nutrition Fundamentals and Medical Nutrition Therapy
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