UNIT 4: Nutrition

Minimum Number of Hours: Theory 11, Clinical 6

Statement of Purpose

The purpose of this unit is to examine the dietary requirements of the client, respecting budgetary, environmental, and personal resources. This module includes the food pyramid and common therapeutic diets as planned and prepared in the home setting. Recognition of personal preferences, cultural and religious dietary practices are discussed.

Performance Standards (Objectives)

Upon completion of the eleven (11) theory hours, six (6) clinical hours and assignments the learner will be able to do the following:

  1. Define the terminology.
  2. Recognize the key principles of nutrition.
  3. Identify potential nutritional problems for home health clients.
  4. Demonstrate basic understanding of therapeutic diets.
  5. Discuss key principles of safe food handling and storage.
  6. Discuss adaptations necessary for feeding the home care client.
  7. Describe the importance of fluid balance and monitoring intake and output.
  8. Identify community resources for meeting nutritional needs.

 

Terminology

anorexia
carbohydrate
cholesterol
daily values
dehydration
dysphagia
edema
enteral feeding
fat
fiber
food-borne illness
hyperglycemia		 hypoglycemia
intake and output
parenteral feeding
polydipsia
polyuria
protein
protein deficiency malnutrition
recommended dietary allowances
saturated fat
sodium
USDA food guide pyramid

 

Learner Activities/Assignments

  1. “Wheel of Fortune ” game (p. 83) or Jeopardy game (p. 84)
  2. Putting the food label to work (www.cfsan.fda.gov/~dms/foodlab.html) (p. 88)
  3. Explore MyPyramid.gov (www.mypyramid.gov) (p. 89)
  4. Practice with modified consistency diets (p. 94)
  5. Develop a menu using a therapeutic diet (p.106)
  6. Feeding Assignment (p.113)
  7. Accessing nutritional resources in the community (p.114)

Teaching Strategies

  1. Classroom lecture and discussion
  2. Handouts:
    • Basic food categories (p. 85-86)
    • Food labeling (p. 87)
    • Potential nutritional problems for home health client (p. 90-91)
    • Food Guide Pyramid Printouts (access from www.mypyramid.gov)
      • Instructor to make printouts based on class participants’ age/sex/activity level if computer access is a problem for the class.
    • Ethnic and Regional Food Patterns (p. 92-93)
    • Theraputic diets (p. 95-96)
    • Patient Education Diet Handouts (p. 97-105)
      • Low Sodium Diet
      • Low Fat/Low Cholesterol Diet
      • Diabetes Diet Basics
      • Renal Diet
    • Basic for Handling Food Safely (p. 107-108)
    • Cold Food Storage Chart (p.109-112)
  3. Audiovisual aids: Food Pyramid (www.mypyramid.gov)
  4. Guest speaker (optional), dietician, speech therapist, representative of the commiuity meal program

References

Balduzzi, S., & Spatz, A. (2005). Homemaker home health aide (6th ed.). Clifton Park, NY: Thomson Delmar Learning.

Food Safety and Inspection Service. (2006). Fact Sheets Safe Food Handling. http://www.fsis.usda.gov/Fact_Sheets/Basics_for_Handling_Food_Safely/index.asp. Washington DC: United States Department of Agriculture.

Fuzy, J. & Leahy, W. (2005). The home health aide handbook (2nd ed.). Albuquerque, NM: Hartman Publishing Inc.

Mahan, L., and Escott-Stump, S. (2004). Krause’s food, nutrition and diet therapy (11th ed.). Philadelphia, PA: W.B. Saunders Company.

McWilliams, M. (2005). Food Fundamentals (8th ed.). Redondo Beach, CA: Plycon Press.

Polaski, A., and Warner, J.P. (1994). Fundamentals for nursing assistant.Philadelphia: W.B. Saunders. Robinson, C.H., Lawler, M.R., Chenoweth, W.L., and Garwick, A.E. (1996). Normal and therapeutic nutrition (Rev. ed.). New York: MacMillan.

Sorrentino, S. A. (2004). Assisting with patient care (2nd ed.). St. Louis, MO: Mosby. Whitney, E.N., & Rolfe, S.R. (2005). Understanding nutrition (10th ed.). Belmont, CA: Thomson/Wadsworth.

Zucker, E. & Ebrite, L.J. (2006). Being a home maker/home health aide (5th ed.). Englewood Cliffs, NJ: Prentice-Hall.

 

 

CONTENT OUTLINE

 SUGGESTED
LEARNING
ACTIVITIES

1. Define the terminology

Evaluation

Written Test

anorexia
carbohydrate
cholesterol
daily values
dehydration
dysphagia
edema
enteral feeding
fat
fiber
food-borne illness
hyperglycemia

hypoglycemia
intake and output
parenteral feeding
polydipsia
polyuria
protein
protein deficiency malnutrition
recommended dietary allowances
saturated fat
sodium
USDA food guide pyramid

Learner Activity #1

“Wheel of Fortune” game (p. 83) and/or “Jeopardy” game (p. 84)

2. Recognize the key principles of nutrition.
  1. Recommended Dietary Allowances (RDA)
    1. Daily consumption levels of energy and certain nutrients judged by the Food and Nutrition Board to meet the known nutrient needs of practically all healthy people.
    2. RDA’s are set for: energy, protein, certain vitamins, and minerals
  2. Daily Values
    1. Nutrient percentages listed on the food label are based on a standard 2,000-calorie diet allowing comparison of nutrients between products. Consumers can determine if the product is high/low in given nutrients when deciding to purchase an item.
    2. In general, 5% or less DV is considered low and 20% or higher is considered high.
  3. Basic food categories
    1. Carbohydrates
    2. Fiber
    3. Fat
    4. Protine
  4. Protine deficiency
    1. Commonly thought of as a problem in developing countries
    2. Common among the poor, elderly and homeless
    3. Can be a problem among:
      • People who are hospitalized for long periods of time
      • People who are addicted to drugs and/or alcohol
      • People with eating disorders such as anorexia nervosa
  5. New USDA Food Guid Pyramid (www.mypyramid.gov)
    1. More individualized approach than in  the past
    2. Calculates nutrient needs based on age, sex, and activity level
    3. Recommends more whole grains, fruits and vegetables
    4. Encourages physical activity and water intake
  6. Components of the food labels
    1. (www.cfan.fda.gov/~dms/foodlab.html)
    2. Review calories, serving size, daily values or certain nutrients, and ingredient list
    3. Determine better food choices using the food label
  7. Food Claims on Food Labels
    • Low calorie: 40 calories or less per serving
    • Reduced calorie: at least 25% lower calories than the reference food
    • Calorie free: fewer than 5 calories per serving
    • Fat free: less than 0.5 g of fat per serving
    • Low fat: 3 g or less of fat per serving
    • Trans fat free: less than 0.5 g of trans fat per serving
    • High fiber: 5 g or more per serving
    • Low sodium: 140 mg or less sodium per serving
    • Good source: 10-19% of the Daily Values per serving
    • Health: low in fat, saturated fat, cholesterol, sodium and containing at least 10% of the daily value for vitamin A, C, iron, calcium, protein, or fiber.

Handout: Basic Food Categories (p. 85-86)
Handout: Food labeling (p. 87)

Learner Activity #2

Putting the food label to work (p. 88)

Learner Activity #3

Explore MyPyramid.gov (p. 89)

Compare recommendations for the typical HH client to recommendations for the student.

www.mypyramid.gov
SUGGESTED
LEARNING
ACTIVITIES

3. Identify potential nutritional problems for home health clients.

Learner Activity #4

Practice with modified consistency diets (p. 89)
  1. Lack of budgetary, environmental and personal resources
  2. Personal preferences, cultural or religious dietary practice
  3. Anorexia, diminished appetite
  4. Difficulty eating/swallowing/altered texure diets
  5. Tube feedings
  6. Medications
  7. Fluid intake
  8. Appropriate use of supplements

Handout: Potential nutritional problems for home health client (p. 90-91)
Handout: Ethnic and Regional Food Patterns (p. 92-93)

 

 Guest Speaker: Speech Therapist (optional)

4. Demonstrate a basic understanding of therapeutic diets.

Learner Activity #5

Develop a menu using a therapeutic diet (p. 106)
  1. Discuss the basic principles of common therapeutic diets
    1. Cardiac
    2. Low sodium
    3. Diabetic
    4. Renal
  2. Cardiac Diet
    1. Low fat (aim for <20-30% calories)
      • Limit saturated fats (meats and dairy)
      • Choose healthier fats (canola oil, light spreads, avocado, nuts)
    2. Low salt (aim for  <2000 mg/day or as MD orders)
      • Avoid adding salt to foods
      • Limit most processed foods (instant/boxed/frozen meals)
    3. Low cholesterol (only found in foods of animal origin)
      • Limit animal fats in the diet
      • Choose legumes, soy, nuts, seeds, and whole grains
    4. High Fiber
      • Include fruits and vegetables (5-9 servings daily)
      • Choose whole grains (at least 3-5 servings daily)
      • Includ beans and legumes daily
    5. Limit alcohol
    6. Avoid smoking
    7. Exercise regularly, with physician approval
    8. Reduce body weight, if necessary
  3. Low Sodium Diet
    1. Cook with as little salt as possible
    2. Avoid highly salted, processed foods (e.g., salty snacks, salad dressings, soy sauce, ketchup, pickles, frozen foods, canned soup, cheese)
    3. Avoid smoked, processed or cured meats and fish (e.g., ham, bacon, corned beef, cold cuts, sausage, anchovies, tuna, sardines)
    4. Use salt substitutes with caution (watch out for sodium on the food label)
    5. Limit alcohol
    6. Reduce body weight, if necessary
    7. Exercise regularly, with physician approval
    8. Limit total fat, saturated fat, and cholesterol in the diet
  4. Diabetic Diet
    1. Goal is to maintain as near-normal blood glucose levels as possible through balancing food choices, medications and exercise
    2. Avoid diabetic ketoacidosis (DKA) (elevated blood glucose)
      • Symptoms include polyuria, polydipsia, hyperventilation, dehydration, ketones, fatigue
      • Acute illnesses can lead to DKA
      • Managed with insulin, fluid and electrolyte replacement, and medical treatment
    3. Avoid hypoglycemia (low blood glucose)
      • Symptoms include headaches, confusion, poor coordination, blurred vision, and seizures.
      • Treatment begins with carbohydrate (15 g) and glucose testing
    4. Adequate carbohydrate, protein, and fat should be included to maintain a healthful body weight
    5. Meals and snacks should be spaced to maintain blood glucose levels
    6. Excessive sweets, simple carbohydrates and juices should be avoided
  5. Renal Diet
    1. Protein, potassium, sodium, fluid and phosphorus limited as directed by MD
  6. Plan a menu for a client on a therapeutic diet.

Handout: Therapeutic diet (see p. 95-96)
Handout: Patient Education Diet Handouts (p. 97-105)

  • Low Sodium Diet
  • Low Fat/Low Cholesterol Diet
  • Diabetes Diet Basics
  • Renal Diet

 

 

5. Discuss key principles of safe food handling and storage.
  1. Principles of safe food handling:
    1. Personal hygiene of the food handler
      • Wash hands thoroughly with soap and water before handling food.
      • Use clean utensils for tast testing.
      • Avoid preparing food when sick.
    2. Kitchen sanitation
      • Clean surfaces and dishes with hot water and detergent
      • Cutting boards – Plastic is preferable to wood for cleaning
      • Prepare raw foods separately from meats to be cooked
      • Thoroughly wash and scrub fresh fruits and vegetables before serving.
    3. Storage condtions and practices
      • Food temperatures maintained below 40° or above 140°
      • Avoid storing protein-containing foods at room temperature over 2 hours
      • Keep meats in the lowest part of the refrigerator to avoid contamination
      • Keep storage areas clean to avoid contamination of new foods
      • Store foods properly as soon as possible after purchase
      • Buy only quantities you will use before spoilage can occur
  2. The “danger zone” for food storage
    1. The temperature at which most microorganisms grow rapidly is 40-140°
    2. Pork must be cooked to an internal temperature of 170°
  3. Common food-born illnesses
    1. Salmonellosis
      • Transmitted by contaminated food or infected individuals
      • Onset: 12-36 hrs.
      • Duration: 2-7 days.
      • Symptoms: Severe headache, vomiting, diarrhea, abdominal cramps and fever. Infants and elderly most susceptible. Death in severe cases.
    2. Perfringens poisoning
      • Transmitted by contaminated food. Withstands most cooking temperatures and will grow in meats and gravies without proper refrigeration.
      • Onset: 8-20 hrs
      • Duration: 24 hrs
      • Symptoms: Diarrhea without vomiting, diarrhea inflammation of stomach and intestines.
    3. Streptococcal infections
      • Transmitted by consuming raw milk. Killed by adequate heating, 165°
      • Onset: varies
      • Duration: several days
      • Symptoms: sore throat.
    4. Staphylococcal poisoning – most common cause of food poisoning.
      • Transmitted by food handlers carrying the bacteria.
      • Onset: 3-8 hrs
      • Duration: 1-2 days
      • Symptoms: Vomiting, diarrhea, prostration, abdominal cramps
    5. Botulism
      • Transmitted by contaiminated foods stored in absence of oxygen. Produced in low-acid foods held in refrigerator 2 weeks or longer. Spores are heat resistant – destroyed by high tempuratures of pressure canner.
      • Onset: 12-36 hrs
      • Duration: 3-6 days
      • Symptoms: double vision, inability to swallow, speech difficulty, progressive resiratory paralysis. Fatality rate about 65%
    6. Parasites
      • Trichinosis is the most common parasitic disease in the U.S.
      • Present in meat, especially pork.
      • Must be cooked to an internal temperature of 170° to kill parasites.
      • Symptoms: diarrhea, nausea and vomiting.
      • Long term symptoms include recurrent fever and muscular pains.
  4. Storage times for meat and poultry
    1. Review handout
    2. Fresh meats 1-5 days
    3. Fresh poultry 1-2 days
    4. Frozen meats 4-6 months average
    5. Fresh processed products, i.e. milk, 3-7 days.
    6. Fresh eggs 3-5 weeks
  5. Product dating
    1. Product dating is NOT required by law and is an indicator or quality, not necessarily safety.
    2. Sell-by dates are often used on highly perishable products like milk, meat, and bread
    3. Best if used by dates are used on bakes/packaged/canned goods. The food is safe to eat, but may have altered taste or texture.
    4. Expiration dates/use by/use before dates are indicators for best quality. Used on refrigerated items such as eggs, yogurt, etc.
    5. Properly stored foods can be used beyond the product dates
    6. Mishandled foods with off-odor/flavor or appearance should be discarded regardless of the product date.

Handout: Basic for Handling Food Safety (p. 107-108)

 
SUGGESTED
LEARNING
ACTIVITIES

6. Discuss adaptations necessary for feeding the home care client.

Learner Activity #6

Feeding Assignment (p. 113)

Utalizes proper feeding technique to meet the needs of the client
  1. Positioning to facilitate swallowing
    1. Best in location associated with eating
    2. Furniture/equipment
      • boxes and pillows to prop
  2. Promoting self-care
    1. plates with rims
    2. cups with large handle
    3. utensils with built up handles
  3. Socialization

 

7. Describe the importance of fluid balance and monitoring intake and output.

Evaluation

Written Test
Review Household Measurements NATAP or DHS Module 7
Review Key Principles of Fluid Balance, Refer to NATAP or DHS Module 11

  1. Importance of Fluids
    1. Types – oral, IV, NG
    2. Fluid Balance
  2. Intake and Output
    1. Calculations
    2. Documentation
  3. Alternate Feeding Methods (not performed by an HHA)
    1. Parental (TPN, hyperalimentation)
    2. Enteral – tube feeding
    3. HHA responsibilities

 

8. Identify community resources for meeting nutritional needs.

Learner Activity #7

Find information about how to access nutritional recourses in the community (p. 114)
  1. Community Resources
    1. Senior Centers
    2. Home Delivered Meals
    3. Food Stamps
    4. Food Banks
    5. Community and church-based meal programs

Activity

Guest speaker from community (optional)

Evaluation

Written Test

 

Unit 4: Nutrition

Learner Activity: Wheel of Fortune (Good for vocabulary)

  1. Empty blocks representing the letters of a word or phrase which has been predetermined by the instructor are drawn on a board.
  2. The class is divided into two to four teams. Only one person may respond to the question for the team, but the team may discuss the options for the answer during 15 seconds allowed for a response to the question.
  3. Each team attempts to gain points and solve the identity of the word or phrase by guessing letters which make up the word or phrase. Correct answers result in the team receiving points for each of the letters in the puzzle. Incorrect guesses passes the opportunity to guess to another team. Specified letters (4-6) may be “bought ” using points earned from previous correct guesses.

 

 

Unit 4: Nutrition

Learner Activity: Jeopardy Game

  1. A minimum of 25 questions need to be developed. They may be in groups of 5 that are related to a particular topic.
  2. Questions should be single word fill-in, true/false, or multiple choice.
  3. Questions are written on slips of paper that are folded and arranged in categories according to the difficulty for game points on the game board.
  4. The class needs to be divided into two to four teams. Only one person may respond to the question for the team, but the team may discuss the options for the answer during the 15 seconds allowed for a response to the question.
  5. A correct answer allows the team to gain the specified points and select a subsequent question. An incorrect answer allows another team to answer, win the points for the question, and select the subsequent question.

GAME BOARD

Topic 1

Topic 2

Topic 3

Topic 4

Topic 5

100

100

100

100

100

200

200

200

200

200

300

300

300

300

300

400

400

400

400

400

500

500

500

500

500

 

 

UNIT 4: Nutrition

Handout: Basic Food Categories

What are the different Categories?

  • Carbohydrate
  • Fiber
  • Fat
  • Protein

___________________________

Carbohydrates:

  • Compounds composed of single or multiple sugars.
  • Complex carbohydrates are long chains of sugars.
  • Glucose from carbohydrates is the preferred fuel for the body.
  • In general should comprise 55-60% of the diet.

Fiber:

  • Composed of long chains of sugars that humans cannot digest.
  • Classified as soluble and insoluble based on how they dissolve in water.
  • Benefits of fiber: promotes fullness, prevents constipation, prevents diverticulosis, reduces the risk for colon cancer, heart and artery disease, improves glucose control and may help lower blood cholesterol.

Fat:

  • Triglyceride is one of the main classes of dietary lipids.
  • Essential fatty acids are fats the body needs but cannot make. Omega-6 fatty acids are essential. They are found in vegetable oils, seeds, nuts, and whole grains. Omega-3 fatty acids are also essential and are found primarily in fatty fish and to a lesser degree in flax seed and canola oil.
  • Saturated fatty acids/Monounsaturated fatty acids/Polyunsaturated fatty acids differ in the number and point of saturation. This affects the hardness of the fat at room temperature and has differing affects on blood lipids and heart disease risk.
  • Trans fats are produced through hydrogenation. Trans fats elevate bad LDL cholesterol and lower beneficial HDL. This may lead to even greater heart disease risk than saturated fats.
  • In general fat should be limited to 20-30% of the diet.

Protein:

  • Distinctive because they contain nitrogen and are made up of amino acids. There are nine essential amino acids that must be supplied by the diet.
  • Supports numerous bodily functions:
    • Protein supports growth and maintenance in the bodybuilding new tissue and replacing worn-out cells.
    • Enzymes, hormones, and other chemicals are formed from proteins.
    • Proteins build antibodies to defend against foreign proteins.
    • They are critical for maintaining fluid and electrolyte balance.
    • Acid-base balance, blood ph, is maintained by protein’s buffering capacity.
    •  Proteins transport substances such as lipids, minerals and oxygen in the body.
    • Emergency energy to fuel body functions can also be produced from proteins.
  • Protein quality is determined by its amino acids, digestibility and how well it supports growth.
  • Complete proteins are found in meat, dairy, eggs, and soy products. Incomplete proteins are found in grains, legumes, nuts and seeds. When eaten in combination the proteins are complementary and meet amino acid needs.
  • In general, most people need approximately 0.8 g protein per kg body weight. 15-20% of the diet should be high-quality protein.

 

 

Unit 4: Nutrition

Handout: New Food Labeling

Starting in May 1994, labels of all processed foods and most raw foods will tell consumers not only what their foods contain but also how they relate to a healthy diet. See chart below for terms being used and what their definitions are.

FREE – A serving contains no or a physiologically inconsequential amount: < 5 calories; < 5 mg sodium; < 0.5 g fat; < 0.5 g saturated fat; < 2 mg cholesterol; or < 0.5 g sugar.

LOW – A serving (and 50 g of food if the serving is small) contains no more than 40 calories; 140 mg sodium; 3 g fat; 1 g saturated fat; and 15% of calories from saturate fat or 20 mg cholesterol; not defined for sugar, for “very low sodium”, no more than 35 mg sodium.

LEAN – A serving of food (and 100 g) of meat, poultry, seafood and game meats contains < 10 g fat; < 4 g saturated fat; and < 95 mg cholesterol.

EXTRA LEAN – A serving of food (and 100 g) of meat, poultry, seafood, and game meats contains < 5 g fat; < 2 g saturated fat; and < 95 mg cholesterol.

HIGH – A serving contains 20% or more of the Daily Value (DV) for a particular nutrient.

GOOD SOURCE – A serving that contains 10-19% of the DV for a nutrient.

REDUCED – A nutritionally altered product contains 25% less of a nutrient or 25% fewer calories than a reference food; cannot be used if the reference food already meets the requirement for a “low” claim.

LESS – A food contains 25% less of a nutrient or 25% fewer calories than a reference food.

LIGHT – (1) An altered product contains one-third fewer calories or 50% of the fat in a reference food; if 50% or more of the calories comes from fat, the reduction must be 50% of the fat; or (2) The sodium content of a low calorie, low-fat food had been reduced by 50% (the claim “light in sodium” may be used); or (3) The term describes properties as texture and color, as long as the label explains the intent (e.g. “light brown sugar”, “light and fluffy”).

MORE – A serving contains at least 10% of the DV of a nutrient more than a reference food. Also applies to fortified, enriched and added claims for altered foods.

%FAT FREE – A product must be low-fat or fat free, and the percentage must accurately reflect the amount of fat in 100 g of food. Thus, 2.5 g of fat in 50 g of food results in 95% fat- free claim.

HEALTHY – A food is low in fat and saturated fat, and a serving contains no more than 480 mg sodium and no more than 60 mg cholesterol.

FRESH – (1) A food is raw, has never been frozen or heated, and contains no preservatives (irradiation at low levels is allowed); or (2) The term accurately describes the product (e.g. “fresh milk” or “freshly baked bread”).

FRESH FROZEN – The food has been quickly frozen while still fresh; blanching is allowed before freezing to prevent nutrient breakdown.

* Source: Food and Drug Administration

 

 

 

Unit 4: Nutrition

Learner Activity: Putting the food label to work

(www.cfsan.fda.gov/~dms/foodlab.html)

  1. Pass around a grocery bag full of different types of food labels (good labels to use are regular Campbell’s soup labels, Healthy Choice Campbell’s soup, packaged breads and crackers, instant cereals, juice and juice cocktails, Rice a Roni, and other typical foods clients might choose).
  2. Review the basic components of the label, i.e. calories, serving size, daily value, and the ingredient list.
  3. Compare similar items and discuss how to make informed choices about which foods are healthier based on the food label.
  4. Note any food claims on the package and review what specific nutritional information the claim is conveying, i.e. how much fat is allowed in an item claiming to be “lowfat,” etc.

Unit 4: Nutrition

Learner Activity: Explore MyPyramid.gov

(www.mypyramid.gov)

  1. Briefly state that there has been an evolution of methods for guiding consumers on choosing foods to meet nutritional needs, i.e. the basic four and the previous food guide pyramid. Each was flawed and didn’t provide clear direction for individuals to make sound nutritional choices. This new pyramid is the government’s new attempt to make it easier for individuals to make good choices for their own nutritional needs.
  2. Have the class participants pair up or divide in any reasonable way and access the food guide pyramid online at the above website.
  3. Ask the class to first put in their own data and find out what their own nutritional needs are. Ask them to share anything that surprised them.
  4. Second have the class input data for a typical Home Health client, (elderly, less physically active, etc.).
  5. Finally have the class discuss the different nutritional needs of their clients. Discuss the importance of fluid intake, whole grains and physical activity for clients. Brainstorm how they can be sensitive to their different needs when talking about diet and nutrition with the clients and their family. Remind them that what one person’s needs may be quite different from another.

Note: if computer access is a problem, the instructor should bring in examples of the food guide’s recommendations for people of different age, sex, and activity levels for the class to use in the discussion.

UNIT 4: Nutrition

Handout: Potential nutritional problems for home health clients

Lack of budgetary, environmental and personal resources

  • Low income individuals often buy foods of low nutritional quality
  • Few fresh fruits and vegetables
  • Healthy foods perceived as more expensive
  • May lack food storage/preparation facilities, i.e. refrigerator/freezer space, cooking appliances
  • Limited mobility – difficulty getting food/preparing food

Personal preferences, cultural or religious dietary practices

  • Familiar foods may be comforting
  • May be resistant to dietary changes (i.e. therapeutic diets)
  • Cultural and religious dietary practices should be supported
  • Family may be helpful in meeting cultural/religious dietary needs

Anorexia, diminished appetite

  • Depression/loneliness
  • Lack of desire to eat/motivation
  • Poor memory – can’t remember to eat regularly

Difficulty eating/swallowing/altered texture diets

  • Tooth loss
  • Poor fitting dentures
  • CVA – speech therapist may need to assess swallowing capabilities
  • Dysphagia – may be related to a variety of conditions, but should be assessed to determine food texture needs.

Tube Feedings

  • Patients either cannot ingest, digest, or absorb food through normal feedings (CVA, surgery to GI tract, difficulty eating food, etc.)
  • Enteral feedings (through the gut) are preferred
  • Patenteral feedings (through the veins) are sometimes necessary
  • May be fed by continuous drip or bolus
  • Monitoring for tolerance to feeding is critical
    • Check residuals
    • Monitor stool frequency and consistency o Signs of edema/ dehydration
    • Fluid intake/ output o Weight changes

Medications

  • Drugs can alter food intake o
    • Change the appetite
    • Interfere with taste or smell
    • Induce nausea or vomiting
    • Cause dry mouth, oral and/or GI tract ulcers
  • Food and drugs can mutually affect absorption
    • Change the acidity of the digestive tract (antacids)
    • Alter the motility of the digestive tract (laxatives reduce nutrient absorption) o Damage the mucosal cells (chemotherapy)
    • Bind nutrients (calcium and iron bind with antibiotics)

Fluid Intake

  • Reduce thirst signal
  • Fear of bladder control/ not wanting to go to the restroom
  • Total body water is reduced with aging – more susceptible to dehydration
  • Dehydration can lead to increased urinary tract infections, pneumonia, pressure ulcers, confusion and disorientation
  • Estimated fluid needs are 1 oz/ kg actual body weight, usually 6-8 glasses per day.

Appropriate uses of supplements

  • Always encourage food as the best source of nutrition
  • Overall energy needs are lower for the elderly
  • Protein needs should be met to support the immune system and avoid muscle wasting
  • Oral supplements are an option for those who simply cannot maintain adequate food intake. Check with the doctor/dietician for an appropriate supplement.

Unit 4: Nutrition

Handout: Ethnic Food Patterns

Ethnic Group

Bread and Cereal

Eggs, Meat, Fish, Poultry

Dairy Products

Fruits and Vegetables

Seasonings, Etc.

Chinese

Rice, wheat, millet, corn noodles

Little meat and no beef, fish including raw fish, eggs of hen, duck, pigeon

Water buffalo milk-occasionally, soybean milk, cheese

Soybeans, soybean sprouts, bamboo sprouts, soy curd cooked in lime water, radish leaves, legumes, vegetables, fruits

Sesame seeds, ginger, almonds, soy sauce

African American

 Hot breads, cookies, pastries, cakes, cereals, white rice, corn breads Chicken, salt pork, ham, bacon, sausage, salted salmon, salt herring, fish Milk and milk products, little cheese Kale, mustard, turnip greens, cabbage, hominy grits, dandelion greens Molasses

Jewish

 Noodles, crusty white seeded rolls, rye bread, pumpernickel bread, challah Koshered meat (from forequarters and organs from beef, lamb, veal), milk not eaten at the same meal (not a rule for all Jewish people), fish Milk and milk products, cheese Vegetables (sometimes cooked with meat), fruits Salt, garlic, dill, parsley

Italian

Crusty white bread, cornmeal and rice (Northern Italy), pasta (Southern Italy)

 Beef, veal, chicken, eggs, fish Milk in coffee, cheese (many different kinds) Broccoli, zucchini, other squash, eggplant, artichokes, string beans, tomatoes, peppers, asparagus, fresh fruit Olive oil, vinegar, salt, pepper, garlic
Puerto Rican Rice, beans, noodles, spaghetti, oatmeal, cornmeal Dry salted cod-fish, meat, salt pork, sausage, chicken, beef Coffee with hot milk Starchy root vegetables, green bananas, plantain, legumes, tomatoes, green pepper, onions, pineapple, papaya, citrus fruits Lard, herbs, oil, vinegar
Near Eastern Bulgar (wheat) Lamb, mutton, chicken, fish, eggs Fermented milk, sour cream, yogurt, cheese Nuts, grape leaves Sheep’s butter, oil
Greek Plain wheat bread Lamb, pork, poultry, eggs, organ meats Yogurt, cheeses, butter Onions, tomatoes, legumes, fresh fruits Olive oil, parsley, lemon, vinegar
Mexican Lime-treated corn, rice Little meat (ground beef or pork), poultry, fish Cheese, evaporated milk as a beverage for infants Pinto beans, tomatoes, potatoes, onion, lettuce Chili pepper, salt, garlic, herbs

Unit 4: Nutrition

Learner Activity: Practice with modified consistency diets

A speech therapist as a guest speaker for this section would be best to lead this section if possible.

  1. Have several types of juice and water available with cups and spoons for stirring. Add “thick-it” or whichever thickening agent is available to practice making fluids of various consistencies: honey-thick, nectar-thick, pudding-thick.
  2. Working in pairs, have class participants practice making fluid of various consistencies and try them. Have a discussion about what it would be like to be a Home Health client who had to drink thickened fluids; soft, chopped and/or pureed foods.

Unit 4: Nutrition

Handout: Therapeutic Diets

Diet

General Use

Foods Allowed

Foods to Avoid

Low-calorie

overweight

skim milk, fresh fruits, lean meat or fish, vegetables, 1-2 servings cereal per day

fried foods, rich gravies and sauces, jam, jellies, rich desserts
High-calorie underweight peanut butter, eggnog, jellies, ice cream, desserts, frequent snacks, milkshakes None
Bland Stomach or intestinal problems, ulcers milk, cream, buttermilk, cottage cheese, cream cheese, mild cheddar cheese, butter, eggs (not fried), beef, lamb, veal, chicken, fish, liver (only tender meats, roasted, boiled or broiled), refined cereals, macaroni, white rolls, crackers (unsalted), cream soups, white potatoes, peas, tender carrots, most fruit juices, canned fruits, peaches, pears, puddings, custards highly seasoned, fried foods, raw vegetables, and fruit, whole grains and cereals
Diabetic Diabetes canned fruits without sugar, fresh fruits, regular meat, vegetables, bread, sugarless gelatin, custards foods containing sugar, alcoholic beverages, gravy, sauces, chocolate, carbonated beverages
Low-sodium Fluid retention; heart problems, high blood pressure food cooked without salt, regular meat, vegetables, fruits, salt substitute smoked, cured, canned meats, cold cuts, cheese, potato chips, pickles, bouillon, prepared mustard, catsup, commercial salad dressing, soy sauce
Low-fat gallbladder; liver disease; heart disease; hypertension veal, poultry, fish, skim milk, buttermilk, yogurt, low-fat cottage cheese, fat-free soup broth, fresh fruits and vegetables, cereals, gelatin, angel cake, ices, carbonated beverages, coffee, tea, jam, jellies

fatty meats, bacon, butter, whole milk, cheese, kidney, liver, heart, fried foods, rich desserts, sauces
Clear-liquid Postoperative tea or black coffee with sugar, apple juice, plain gelatin (no fruit), fat-free broth solid foods
Full-liquid intestinal problems; chewing problems all foods in clear-liquid diet, strained juices, milk, cream, buttermilk, eggnog, strained cream soups, strained cereal, cocoa, carbonated beverages, ices, ice cream, gelatin, custard puddings, sherbets, milk shakes, bouillon, yogurt solid foods
Soft gastrointestinal conditions; chewing problems milk, cream, butter, mild cheeses (cottage, cream cheese), eggs (not fried) soup, broth, strained cream soups, tender cooked vegetables, fruit juices, cooked fruits, bananas, grapefruit and oranges peeled with all section skin removed, white bread, cereals, cooked cereals, spaghetti, noodles, macaroni, pasta, tea, coffee, carbonated beverages, sherbets, ices, sponge cake, tender chicken, fish, ground beef or lamb, only small amounts of salt and spices fibrous meat, coarse cereals, fried foods, raw fruits and vegetables, rich pastries

Low-residue

postoperative; colitis; diverticulitis

milk, buttermilk, butter, mild cheeses, tender chicken, fish, ground beef, ground lamb, soup broths, fruit juices, breads and cereals, macaroni, noodles, custards, sherbet, vanilla ice cream, sponge cake, plain cookies, strained and cooked vegetables

fried foods, fresh fruits and vegetables, fibrous meats, nuts

High-Fiber

constipation

whole grain breads and cereals, raw and cooked vegetables, fruit juices, water, milk, protein-rich foods, bran or bran flakes

High-Potassium

potassium loss due to medication; kidney disease

fresh fruits and vegetables, especially bananas and raisins

canned tomato juice, raw clams, sardines, frozen lima beans, frozen peas, canned spinach, canned carrots

 

Chart from HOMEMAKER/HOME HEALTH AIDE 4th Edition, by Helen Huber and Audree Spatz; Revised by Suzann Balduzzi. Delmar Publishers, Inc., Albany, New York, Copyright 1994. Reproduced by permission.Note: This chart is a general guide to special diets. Always follow the dietitian’s prescribed diet 1 plan.

 

 

*** Key Information about your Special/Restricted Diet ***

Low Sodium Diet

A low sodium diet may help manage high blood pressure (hypertension).
It also may help with water retention.

Choose

Avoid

Breads, Cereals, Rice and Pasta

Breads, rolls, unsalted crackers Most ready-to-eat cereal and cooked cereal All rice and pasta

Salted rolls, crackers, muffins Quick breads, self-rising flour, biscuit/muffin mixes Instant hot cereal Commercially prepared rice, pasta or stuffing.

Vegetables

Fresh, frozen, low-sodium canned vegetables Low sodium vegetable juice

Regular canned vegetables Sauerkraut, pickled vegetables Frozen vegetables with sauce Potato and vegetable mixes
Fruit Fresh, frozen, canned fruit Fruit juice Fruits prepared with sodium, some desserts.
Milk, Yogurt, and Cheese Milk (limit 16 oz/day) Yogurt Low sodium cheese: ricotta, cream cheese & cottage cheese Malts, chocolate milk Regular and processed cheese, spreads, sauces Limit buttermilk to 1 cup/week
Meats, Poultry, Fish, Beans, and Nuts Fresh or frozen meat Eggs and egg substitute Low-sodium peanut butter Dried peas and beans Smoked, cured, salted, or canned meat (bacon, cold cuts, ham, frankfurters, sausage, sardines and anchovies) Breaded meats Salted nuts
Misc. Low sodium sauces, salad dressings, soups, snacks Low-sodium carbonated drinks Salad dressings and gravies made from instant mixes Salty snacks, seasoned meat, softened water

 

Tips for Limiting Sodium

  • Try herbs, spices, lemon juice, and other low sodium condiments to flavor foods
  • Ask your doctor or pharmacist about sodium in your medications.
  • When dining out, ask for your order to be prepared without salt.
  • Watch for seasoning made from salt, including: garlic salt, celery salt, onion salt, seasoned salt; monosodium glutamate; regular soy sauce, barbecue sauce, teriyaki sauce, steak sauce, Worcestershire sauce, flavored vinegar, canned gravy and mixes.

***Key Information about your Special/Restricted Diet***

Low Fat/ Low Cholesterol Diet

A low fat/ low cholesterol diet, along with exercise and medications, is useful in improving blood cholesterol levels. There are many types of cholesterol. The total cholesterol and low-density lipoprotein (“bad cholesterol”) should be kept as low as possible. The high-density lipoprotein (“good cholesterol”) is best to keep as high as possible.

The body needs cholesterol for several important functions. It makes blood cholesterol from the fat and cholesterol in the diet. Since the body makes all the cholesterol it needs, it is not necessary to eat cholesterol-containing foods. Cholesterol is only found in foods of animal origin, including meat, fish, shellfish, eggs and dairy products.

Breads, cereals, rice and pasta

Choose whole-grain or enriched breads, cereals, rice and pasta. Choose low-fat and fat-free crackers. Avoid breads prepared with eggs or cheese, granola, biscuits, muffins, pancakes and pastries.

Fruits and vegetables

All fresh, frozen, canned and dried fruits and vegetables are recommended. Avoid vegetables prepared with fat, cream sauce or cheese sauce.

Milk, Yogurt and Cheese

Choose skim, nonfat and fat-free milk, cheese and yogurt. Avoid 2% milk, whole milk, cream and regular cheese. Substitute evaporated skim milk for whole milk and cream.

Meats, poultry, fish, dry beans, eggs and nuts

Lean cuts of meat, skinless poultry and fish packed in water are recommended. Choose legumes cooked without fat. Avoid fatty cuts of meat, most luncheon meats and egg yolks.

 

 

Effects of Fats on Cholesterol

The type of fat you choose can also help improve cholesterol levels. In general, avoiding fats that come from animal sources is recommended. Healthier choices include olive oil, Canola oil, nuts, olives, fish and flaxseed.

(Use Sparingly)

Soybean oil

↓ Decreases total cholesterol

Type of Fat

Sources

Effect on Blood Lipids
Saturated
(Limit)		 All animal meats
Lard/Beef tallow
Coca butter
Dairy Products
Stick margarine/Butter

Shortening

Palm oil/Coconut oil

Hydrogenated oils

↑ Increases total cholesterol

↑ Increases LDL cholesterol

Polyunsaturated

(Us Sparingly)

Sunflower oil

Soybean oil
Sunflower oil
Sesame oil
Corn oil
Soft margarine

Liquid margarine

 ↓ Decreases total cholesterol

↓ Decreases LDL cholesterol

↓ Decreases HDL cholesterol

Monounsaturated

(Use Often)

Olive oil

Peanut oil

Canola oil

Olives

Nuts

Peanut butter

Avocados

 ↓ Decreases total cholesterol

↓ Decreases LDL cholesterol

Omega-3

 Fatty fish

Shellfish

Soybeans

Tofu

Flaxseed oil

 ↓ Decreases total cholesterol

↓ Decreases LDL cholesterol

↓ Decreases HDL cholesterol

 

***Key Information about your Special/Restricted Diet***

Diabetes Diet Basics

Good control of blood sugars is essential to feel well and reduce medical complications for people with diabetes. Taking medications as directed and limiting the amount of concentrated sugar in the diet is crucial for managing blood sugars effectively.

The key to diabetic meal planning is choosing healthy foods, eating the right amount of food for your body’s needs, and eating at the right times. Try to include a variety of foods at each meal.

Choose More

  • Fresh vegetables and fruits
  • Frozen or canned vegetables and fruit without added sugar or sauce
  • Whole grain breads, cereals, pasta and crackers
  • Legumes, beans and peas
  • Lean meats, eggs and peanut butter
  • Lowfat milk and light yogurt
  • Unsweetened juice (Limit 4 oz/day)

Choose Less

  • Sweet sauce, syrup, honey, added sugar
  • Vegetables prepared with heavy sauces or syrup
  • Sweetened breads, doughnuts, pastries, cakes or muffins
  • Baked beans with brown sugar or syrup
  • Meat or poultry with barbecue sauce or other sugary sauce
  • Whole milk, regular yogurt, ice cream and butter
  • Sweetened juice drinks or teas

Tips for keeping your blood glucose at a healthy level

  • Eat about the same amount of food each day.
  • Eat meals and snacks at the same times each day. Do not skip meals/snacks.
  • Take your medicines at the same times each day.
  • Exercise at about the same times each day.
  • Achieve and maintain a sensible body weight.

***Key Information about your Special/Restricted Diet***

Renal Diet

Low sodium, low potassium, low phosphorus, fluid restricted diet

The kidneys are responsible for regulating the amounts of protein, sodium, potassium, phosphorus and fluids in the body. If your kidneys fail to function properly waste products and fluids can build up in the body and make you very sick.

The key to renal meal planning is restricting foods that are high in these nutrients while choosing foods to meet your specific nutrient needs.

Protein1

Tips for Living on a Renal Diet

Choose: Fresh meat, poultry, fish and shellfish; eggs/egg substitute. Limit cheese to 2 oz/wk. Limit milk or dairy products to 1 cup/day.

Avoid: salted, smoked, cured, canned meat; deli meat or frozen dinners; frozen or breaded fish; processed cheeses such as American or “’Velveeta.” Avoid dry beans, peas and lentils; nuts and nut butters; chocolate, cocoa, puddings or custard mixes.
  • Read labels of foods carefully.
  • Avoid any type of salt, including salt substitutes or “lite salt.”
  •  Watch for sodium or potassium compounds, including: baking powder substitute, potassium chloride, tartrate baking powders.
  • Eat plenty of unsalted bread and cereal products.
  • Choose quality protein foods and fresh fruits and vegetables that are lower in potassium and phosphorus.
  • Add extra calories to your diet if you find it difficult to eat. Add oil, unsalted salad dressing or unsalted gravy to foods. Try using cream for additional calories.
Sodium

Choose: Fresh, unprocessed foods. Try lemon juice, garlic, dry mustard, pepper, vinegar, extracts, and fresh herbs and spices to flavor foods.

Avoid: Processed/packaged foods, baking mixes, seasoning mixes, frozen dinners, salty foods and snacks; tomato juice, pickles, olives, catsup, soy sauce, and Worcestershire sauce. Watch out for hidden sources of salt, including: baking soda, baking powder, chili sauce, MSG, lite salt or substitutes containing sodium or potassium.
 Potassium

Vegetables

Choose: Green beans, beets, cabbage, green peas, cucumber, eggplant, pepper, onion, lettuce. Limit corn, asparagus, okra, cooked carrots, mixed vegetables, summer squash.

Avoid: Artichokes, avocado, broccoli, potatoes*, greens, raw carrots, pumpkin, spinach, tomatoes, winter squash, and brussel sprouts.

*Potatoes may be “dialyzed.” Peel, slice and soak potatoes in water 4 hours, boil 10 minutes, toss out the water and cook as desired.

Fruit

Choose: Applesauce, berries, canned and drained peaches, pears, mandarins; lemon, lime, peach or pear nectar. Limit apple, mango, pear, plum, cherries, tangerine, guava, strawberries, grape juice.

Avoid: Fresh apricots, avocado, banana, cantaloupe, honeydew and casaba melon, dates, oranges/juice, papaya, persimmon, prunes or prune juice, kiwi, fresh peach, watermelon, or dried fruit.

Other High Potassium Foods: All nuts and nut butters, all dried beans and peas, milk and milk products, chocolate, and molasses.

Phosphorus

Avoid: cola, nuts and seeds, dried beans and peas, chocolate, canned sardines and salmon, milk and milk products and organ meats, bran cereals and wheat germ.

Fluid
Your fluid intake per day will vary according to kidney function. Usually, 6 cups (48 oz or 1500 ml) of total fluid per day is the maximum allowed. Ask your doctor how much fluid is appropriate for you.

Unit 4: Nutrition

Learner Activity: Develop a Menu using a Therapeutic Diet

  1. Working in groups or pairs, depending on size of class, have participants choose one of the main therapeutic diets from class discussion.
  2. Have each group make simple, inexpensive menus for one day (3 meals) for a client based on the therapeutic recommendations keeping in mind the food guide pyramid recommendations for servings from each food group.
  3. Pass out the special/restricted therapeutic diet handouts to class participants. Tell them to keep them and have copies available to give clients since they are patient education materials. They can also use the recommendations from the handouts when designing their menus.

Unit 4: Nutrition

Handout: Basics for Handling Food Safely

Safe steps in food handling, cooking, and storage are essential to prevent foodborne illness. You can’t see, smell, or taste harmful bacteria that may cause illness. In every step of food preparation, follow the four Fight BAC!™ guidelines to keep food safe:

  • Clean — Wash hands and surfaces often.
  • Separate — Don’t cross-contaminate.
  • Cook — Cook to proper temperatures.
  • Chill — Refrigerate promptly.

Shopping

  • Purchase refrigerated or frozen items after selecting your non-perishables.
  • Never choose meat or poultry in packaging that is torn or leaking.
  • Do not buy food past “Sell-By,” “Use-By,” or other expiration dates.

Storage

  • Always refrigerate perishable food within 2 hours (1 hour when the temperature is above 90 °F).
  • Check the temperature of your refrigerator and freezer with an appliance thermometer. The refrigerator should be at 40 °F or below and the freezer at 0 °F or below.
  • Cook or freeze fresh poultry, fish, ground meats, and variety meats within 2 days; other beef, veal, lamb, or pork, within 3 to 5 days.
  • Perishable food such as meat and poultry should be wrapped securely to maintain quality and to prevent meat juices from getting onto other food.
  • To maintain quality when freezing meat and poultry in its original package, wrap the package again with foil or plastic wrap that is recommended for the freezer.
  • In general, high-acid canned food such as tomatoes, grapefruit, and pineapple can be stored on the shelf for 12 to 18 months. Low-acid canned food such as meat, poultry, fish, and most vegetables will keep 2 to 5 years — if the can remains in good condition and has been stored in a cool, clean, and dry place. Discard cans that are dented, leaking, bulging, or rusted.

Preparation

  • Always wash hands before and after handling food.
  • Don’t cross-contaminate. Keep raw meat, poultry, fish, and their juices away from other food. After cutting raw meats, wash hands, cutting board, knife, and counter tops with hot, soapy water.
  • Marinate meat and poultry in a covered dish in the refrigerator.
  • Sanitize cutting boards by using a solution of 1 teaspoon chlorine bleach in 1 quart of water.

Thawing

  • Refrigerator: The refrigerator allows slow, safe thawing. Make sure thawing meat and poultry juices do not drip onto other food.
  • Cold Water: For faster thawing, place food in a leak-proof plastic bag. Submerge in cold tap water. Change the water every 30 minutes. Cook immediately after thawing.
  • Microwave: Cook meat and poultry immediately after microwave thawing.

Cooking

  • Beef, veal, and lamb steaks, roasts, and chops may be cooked to 145 °F.
  • All cuts of pork, 160 °F.
  • Ground beef, veal and lamb to 160 °F.
  • All poultry should reach a safe minimum internal temperature of 165 °F.
  • Serving
  • Hot food should be held at 140 °F or warmer.
  • Cold food should be held at 40 °F or colder.
  • When serving food at a buffet, keep food hot with chafing dishes, slow cookers, and warming trays. Keep food cold by nesting dishes in bowls of ice or use small serving trays and replace them often.
  • Perishable food should not be left out more than 2 hours at room temperature (1 hour when the temperature is above 90 °F).

Leftovers

  • Discard any food left out at room temperature for more than 2 hours (1 hour if the temperature was above 90 °F).
  • Place food into shallow containers and immediately put in the refrigerator or freezer for rapid cooling.
  • Use cooked leftovers within 4 days.

Refreezing

Meat and poultry defrosted in the refrigerator may be refrozen before or after cooking. If thawed by other methods, cook before refreezing.

Food Safety and Inspection Service. (2006). Fact Sheets Safe Food Handling. http://www.fsis.usda.gov/Fact_Sheets/Basics_for_Handling_Food_Safely/index.asp. Washington DC: United States Department of Agriculture.

Cold Storage Chart

These short, but safe, time limits will help keep refrigerated food from spoiling or becoming dangerous to eat. Because freezing keeps food safe indefinitely, recommended storage times are for quality only.

 

 

Cold Storage Chart
Product Refregerator(40°F) Freezer (0°F)
Eggs
“Fresh, in shell” 3 to 5 weeks Do not freeze
Raw yolks & whites 2 to 4 days 1 year
Hard cooked 1 week Does not freeze well
“Liquid pasteurized eggs, egg substitutes”
Opened 3 days Does not freeze well
Unopened 10 days 1 year
“Mayonnaise, Commercial”
Refrigerate after opening 2 months Do not freeze
Frozen Dinners & Entrees
Keep Frozen until ready to heat — 3 to 4 months
Deli & Vacuum-Packed Products
“Store-prepared (or homemade) egg, chicken, ham,
tuna, & macaroni salads”		 3 to 5 days Does not freeze well
Hot dogs
Opened package 1 week 1 to 2 months
Unopened package 2 weeks 1 to 2 months
Luncheon Meats
Opened package 3 to 5 days 1 to 2 months
Unopened package 2 weeks 1 to 2 months
Bacon & Sausage
Bacon 7 days 1 month
“Sausage, raw, from chicken turkey, pork, beef” 1 to 2 days 1 to 2 months
“Smoked breakfast links, patties” 7 days 1 to 2 months
“Hard sausage, pepperoni, jerky sticks” 2 to 3 weeks 1 to 2 months
“Summer sausage labeled “Keep Refrigerated”
Opened 3 weeks 1 to 2 months
Unopened 3 months 1 to 2 months
Corned Beef
“Corned beef, in pouch with pickling juices” 5 to 7 days Drained, 1 month
“Ham, canned labeled “Keep Refrigerated”
Opened 3 to 5 days 1 to 2 months
Unopened 6 to 9 months Do not Freeze
“Ham, fully cooked”
“Vacuum sealed at plant, undated, unopened” 2 weeks 1 to 2 months
“Vacuum sealed at plant, dated, unopened” “Use-By” date on package” 1 to 2 months
Whole 7 days 1 to 2 months
Half 3 to 5 days 1 to 2 months
Slices 3 to 4 days 1 to 2 months
“Hamburger, Ground & Stew Meat”
Hamburger & stew meat 1 to 2 days 3 to 4 months
“Ground turkey, veal, pork, lamb, & mixtures of them” 1 to 2 days 3 to 4 months
“Fresh Beef, Veal, Lamb, Pork”
Steaks 3 to 5 days 6 to 12 months
Chops 3 to 5 days 4 to 6 months
Roasts 3 to 5 day 4 to 12 months
“Variety meats ‚tongue, liver, heart, kidneys, chitterlings” 1 to 2 days 3 to 4 months
“Pre-stuffed, uncooked pork chops, lamb chops,
or chicken breasts stuffed with dressing”		 1 day Does not Freeze well
Soups & Stews Vegetable or meat added 3 to 4 days 2 to 3 months
Fresh Poultry
“Chicken or turkey, whole” 1 to 2 days 1 year
“Chicken or turkey, pieces” 1 to 2 days 9 months
Giblets 1 to 2 days 3 to 4 months
Cooked Meat and Poultry Leftovers
Cooked meat & meat casseroles 3 to 4  days 2 to 3 months
Gravy & meat broth 1 to 2 days 2 to 3 months
Fried  chicken  3 to 4  days 4 months
Cooked poultry casseroles  3 to 4  days 4 to 6 months
“Poultry pieces, plain”  3 to 4  days 4 months
“Poultry pieces in broth, gravy” 1 to 2 days 6 months
“Chicken nuggets, patties” 1 to 2 days 1 to 3 months
Other Cooked Leftovers
“Pizza, cooked” 3 to 4 days 1 to 2 months
“Stuffing, cooked” 3 to 4 days 1 month

Food Safety and Inspection Service. (2006). Fact Sheets Safe Food Handling. http://www.fsis.usda.gov/Fact_Sheets/Basics_for_Handling_Food_Safely/index.asp Washington DC: United States Department of Agriculture.

UNIT 4: Nutrition

Learner Activity: Feeding Assignment

This role-playing exercise is designed to acquaint the student with the feelings experienced by a client who needs to be fed.

The student will choose a meal according to personal preference.

The student will play the role of an individual who is a quadriplegic and aphasic. Another student or a significant other will feed the student an entire meal including liquids.

At the end of the experience, the student will write a brief report about the experience or discuss it verbally.

Emphasis is on:

  1. Positive/negative reactions
  2. Feelings about the dependent role
  3. What they have learned that will be useful in future situations

Unit 4: Nutrition

Learner Activity: Accessing Nutritional Resources in the Community

  1. Working in pairs, have participants choose a community feeding resource to visit.
  2. Have each pair contact the community feeding program they chose and arrange a visit.
  3. Afterwards each pair should write a short description of the program, people it serves, and their impressions after visiting.


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