Factors Influencing Food Preferences

Personal Preferences

• People develop likes and dislikes based on associations with foods and are sometimes carried through adulthood
• Preferences in tastes, smells, flavors, temperatures, colors, shapes, and sizes of food influence person's food choices
• Textures also play a great role in food preferences

Religious Practices

• Muslims are prohibited from eating pork
• Hindus do not eat beef

Lifestyle

• People who stay at home prepare foods from scratch
• People in a hurry might eat more ready-made meals

Economics

• Socioeconomic status affects what, how much, and how often a person eats
• Socioeconomic status also affects food preparation and storage facilities

Medications and Therapy

• Some medications may change appetite, disturb taste perception, or interfere with nutrient absorption or excretion
• Some nutrients can decrease drug absorption; others enhance absorption
• Older adults are at increased risk for drug-food interactions due to the number of medications they take, decrease in renal or hepatic functions, and age-related changes
• Chemotherapy may adversely affect eating patterns and nutrition

Health

• Client's health status, such as missing teeth, ill-fitting dentures, and dysphagia, can prevent person from getting adequate nourishment
• Disease processes and surgery of GI tract can affect digestion, absorption, metabolism, and excretion; create nausea, vomiting, diarrhea
• Gallstones can affect lipid digestion

Alcohol Consumption

• Alcohol has a large number of calories, can lead to weight gain
• Excessive alcohol use contributes to nutritional deficiencies, can depress appetite, and has a toxic effect on intestinal mucosa leading to a decrease in absorption of nutrients

Modified Therapeutic Diets

• Bland Diet: used to promote the healing of the gastric mucosa by eliminating food sources that are chemically and mechanically irritating
• Soft Diet: any food that can be easily chewed and digested can be included in the diet; low-residue (low-fiber)
• Pureed Diet: a pureed diet provides food that has been mashed, minced, or ground; modification of the soft diet
• Blenderized Liquid Diet: contains food and liquid that are blenderized to liquid form; used for individuals who cannot chew, swallow, or tolerate solid food
• Clear Liquid Diet: limited to water, tea, coffee, clear broths, carbonated beverages, strained and clear juices; provides fluid and carbohydrate but does not supply adequate protein, fat, vitamins, minerals, or calories

Nutrition

• Normal nutrition is based on recommended daily dietary allowances designed for the maintenance of health
• Therapeutic modification of nutritional needs may be based on a patient's disease condition associated with an excess or deficiency of a particular nutrient

Route of Feeding

• Oral
• Enteral These tubes are inserted through the nose, abdomen, or chest into the stomach, small intestine, or duodenum, allowing for nutritional support and medication administration to individuals who are unable to consume food orally.
• Parenteral (IV, PPN, TPN)

Enteral Feeding for Nutritional Support

• Enteral nutrition may be prescribed for patients who are unable or unwilling to eat or those who need a supplement to ingested food
• Enteral nutrition is provided when the patient cannot ingest foods or the upper GI tract is impaired and the transport of food to the small intestine is interrupted

Nutrition: Essential Body Nutrients

• Carbohydrates: provide energy; sources include potatoes, bread, corn, rice, oats
• Fats: provide long-term energy, insulation, and protection; sources include cheese, butter, avocado, egg yolk
• Proteins: build new tissues, antibodies, enzymes, hormones, and other compounds; sources include egg, fish, meat

Nursing Intervention to Improve Appetite

• Assessment: get medical history, current medications, nutritional status
• Provide information on nutrient: assist/educate patient/family members about healthy food choice and good nutrition
• Reduce psychological stress: eating with accompaniment/talk about something that can enhance mood or enhance appetite
• Hygiene: take a bath, wash hands, brush teeth to remove unpleasant odors/taste
• Environment: comfortable environment, should be clean, eating at appropriate space/place, free from odors and noise
• Food: should be warm/cold, good aroma, looks delicious/variety of foods, looks presentable
• Physical comfort of patient: assist with feeding as needed

Serving a Food Tray

• Preparation: check patient's record for healthcare provider's diet order, obtain dietary consult from dietician if necessary, elicit food preferences of the patient
• Check all diet trays before serving to ensure the diet provided is the one ordered
• Ensure that hot food is hot and cold food is cold
• Keep food trays attractive
• Assist patient to empty bladder and perform hand hygiene
• Remove unpleasant objects
• Ensure patient is allowed to eat/not (Nil By Mouth: NBM)

Documentation

• After the patient has completed the meal, observe how much and what the patient ate

Providing Consistent Carbohydrate Diets

• Balanced treatment for diabetes
• Diets include foods that are carefully selected to provide consistent carbohydrate levels

Providing Nutrient-Enhanced Diets

• Increased potassium diet
• High-iron diet
• High-calcium diet

Providing Progressive Diets

• Dietary fiber: insoluble fiber and soluble fiber
• Low-fiber diet for intestinal diseases
• High-fiber diet to treat constipation and diverticulosis

Postoperative Diet Progression

• Nil by Mouth (NBM) or Nothing by Mouth (NPO)
• Clear liquid diet: 1,000 - 1,500 mL/day of liquid foods (water, tea, clear juices)
• Full liquid diet: milk products, creamed soups, etc.

Nutrition Intervention to Improve Appetite

• Assessment: get medical history, current medications, nutritional status
• Provide information on nutrient: assist/educate patient/family members about healthy food choices and good nutrition
• Reduce psychological stress: eating with company/talking about something to enhance mood or appetite
• Hygiene: take a bath, wash hands, brush teeth to remove unpleasant odors/taste
• Environment: comfortable environment, should be clean, eating in an appropriate space/place, free from odors and noise
• Food: should be warm/cold, good aroma, looks delicious/variety of foods, looks presentable
• Physical comfort of pt.: assist with feeding as needed

Serving a Food Tray

• Preparation
  • Check pt.'s record for healthcare provider's diet order
  • Obtain dietary consult from dietician, if necessary
  • Elicit food preferences of the pt.
  • Check all diet trays before serving to ensure the diet provided is the one ordered
• Ensure that hot food is hot and cold food is cold
• Keep food trays attractive
• Assist pt. to empty bladder and perform hand hygiene
• Remove unpleasant objects
• Ensure pt. is allowed to eat / not (Nil By Mouth: NBM)

Parenteral Nutrition

• Provides nutrients, multivitamin supplementation, and calories intravenously to pts. who cannot be fed orally or meet caloric requirements via the enteral route
• Can contribute to infectious complications (line sepsis), volume overload, and hyperglycemia
• Shown to decrease morbidity and mortality in critically ill and severely malnourished pts.

Modified Therapeutic Diets

• Alterations in the pt.'s diet needed to treat a disease process
• Diets modified in one or more of the following aspects: texture, kilocalories, specific nutrients, seasonings, or consistency

Enteral Feeding

• Preferred over parenteral (intravenous) nutrition because it is safer, less expensive, and associated with fewer complications
• Helps maintain GI function and speeds regeneration of the small intestine
• Preserves production of humoral antibodies, reduces gut bacterial overgrowth, and promotes gut motility and reduces risk of sepsis

Normal and Therapeutic Nutrition

• Normal nutrition based on recommended daily dietary allowances designed for maintenance of health
• Therapeutic modification of nutritional needs may be based on a pt.'s disease condition associated with an excess or deficiency of a particular nutrient

Enteral Feeding

• Enteral feeding is preferred over parenteral nutrition because it is safer, less expensive, and associated with fewer complications
• It helps to maintain GI function and speeds regeneration of the small intestine
• Enteral nutrition preserves production of humoral antibodies, reduces gut bacterial overgrowth, and promotes gut motility and reduces risk of sepsis
• Enteral formulas come in powder form to reconstitute or as ready-to-use liquids, containing protein, carbohydrates, fat, electrolytes, and vitamins and minerals depending on the patient's needs

Parenteral Nutrition

• Parenteral nutrition (PN) is intravenous administration of nutrition, including protein, carbohydrate, fat, minerals, and electrolytes, vitamins, and other trace elements
• PN is sometimes called Total Parenteral Nutrition (TPN) and provides nutrients, multivitamin supplementation, and calories intravenously to patients who cannot be fed orally or meet their caloric requirements via the enteral route
• PN is invasive and costly, and can contribute to infectious complications, volume overload, and hyperglycemia, but has been shown to decrease morbidity and mortality in critically ill and severely malnourished patients

Who Receives Parenteral Nutrition?

• People of all ages receive parenteral nutrition, including infants, children, and adults
• Parenteral nutrition bypasses the normal digestion in the gastrointestinal tract and is a sterile liquid chemical formula given directly into the bloodstream through an intravenous (IV) catheter

Modified Therapeutic Diets

• Modified therapeutic diets involve alterations in the patient's diet to treat a disease process, prepare for a special examination or surgery, increase or decrease weight, restore nutritional deficits, or allow an organ to rest and promote healing
• Diets are modified in one or more of the following aspects: texture, kilocalories, specific nutrients, seasonings, or consistency

Psychological Factors

• Anorexia and weight loss can indicate severe stress or depression
• In female adolescents, bulimia nervosa (binge eating and purging) and anorexia nervosa (distorted body self-perception, food restriction, inappropriate eating habits or rituals, obsession with having a thin figure, irrational fear of weight gain) may occur