Food and Nutrition

Cooks Diet Training

presented by:
Amanda VanHaren
Alexis Weisser
Annie Clarkin
 Agenda

• Overview of therapeutic diets

– Heart Healthy
– Consistent Carbohydrate Diet (CCD)
– Renal Diet
– NDD #1, #2, #3
• Dice size & proper cooking
• Portion Sizes
• Allergens
• Q&A
What is your role in Room Service?

 Read tickets
 Fill orders according to diet
 Send orders down the line
 Re-stock stations during and after shifts
 Clean as you go!
Diet Orders

Diet orders are legal orders

that must be followed
 Regular
No nutrient restrictions
Work to keep within these guidelines:
Breakfast
1 Hot Entrée
Up to 4 Additional Items
(This Includes: Breakfast Sides, Cereals, Bakery and Fruits)
2 Beverages*
Up to 5 of any condiment type
Lunch and Dinner
1 Hot Entrée or Entrée Salad
Up to 4 Additional Items
(This Includes: Lunch/Dinner Sides, Soups, Side Salads and Desserts)
2 Beverages
Up to 5 of any condiment type
Why do we have to stay within these
guidelines for Regular Diets?
To Serve Neat, Appealing Trays
Therapeutic Diet Review
 Heart Healthy Diet

Definition

“Limits the amount of sodium and saturated fat a patient can

have, making certain items unavailable to the patient”
 Heart Healthy Diet
Foods allowed on this diet
• Fresh, frozen or canned fish or shellfish
• Skinless chicken, turkey or lean ground
beef
• Fat free or 1% milk
• Fat free or low fat yogurt
• Reduced fat and reduced sodium soups
• Whole grain breads, flour tortillas,
multi-grain cereals, pastas, rice
• unsalted crackers or graham crackers
• Fresh, frozen, canned or dried fruit
• Fruit flavored gelatin
• Herb seasoning packet
• Low fat, low sodium gravy
Foods to be avoided on this diet
• Fried/breaded fish/shrimp, fried
chicken, poultry skin or hot dogs
• Sausage, bacon, bologna or salami (deli
meat in general is high in sodium)
• Whole milk or regular cheeses
• Regular ice cream, whipping cream or
non-dairy creamers
• Soups that contain whole milk, cream,
and salt
• Vegetables fried or prepared with cream
or cheese
• Salted popcorn, pretzels, chips,
croissants, biscuits
• Pies, donuts, cookies or cream pies,
pastries
• Regular salad dressing or mayonnaise
• Regular gravies and sauces
• Butter or stick margarine
Heart Healthy Diet
 Consistent Carbohydrate

Why is Carb Counting Important?

Too many carbohydrates can cause hyperglycemia (high
blood glucose/sugars.) High blood sugar can slow
wound healing, cause infection, decrease vision,
damage nerves and/or cause kidney damage or failure.
 Consistent Carbohydrate

What foods contain carbohydrates?

• Fruit/fruit juice
• Starchy vegetables: potatoes (French fries), corn,
peas, beans/lentils
• Starches: breads, grains, cereals (hot and cold),
crackers, rice
• Milk: yogurt, soymilk, cow’s milk, rice milk
• Sweets, desserts
 Consistent Carbohydrate

What foods do not contain carbohydrates?

Meats/Proteins fish, chicken, pork, beef, eggs, tuna, sausage, lunch meats, cheese

Fats margarine, oils, nuts/seeds, avocado, butter/peanut butter, cream,

cream cheese, sour cream, mayonnaise, gravy (2 tablespoons)

Non-starchy Asparagus, beans (green, wax, Italian), broccoli, carrots, celery,

Vegetables cucumber, greens (ice berg lettuce, spinach), onions, squash
(summer, zucchini), tomatoes, artichoke, peppers, radishes,
rutabaga, sauerkraut, cauliflower, spinach, cucumber, eggplant,
mushrooms
Consistent Carbohydrate
 Renal Diet

Things to keep in mind:

• Not allowed to have salt packets on their tray
• Stay away from processed foods
• Foods typically high in sodium:
– Cheese
– Breads
– Processed meats
(bacon, breakfast sausage, hot dogs)
 Double Portions

For burn and cancer patients only!

National Dysphagia Diet
NDD
Dysphagia Diets and Thickened Liquids

NDD#1 - Pureed Honey Thick

NDD#2 - Ground Nectar Thick

NDD#3 – Chopped/Diced Spoon (Pudding) Thick

Dysphagia Diets and Thickened Liquids

http://youtu.be/huZ6ymeKFd4
 If a patient is on an NDD diet, a liquid consistency
must be entered in order to send liquids.
Side Note:
If you see a diet order missing a fluid consistency,
please contact a supervisor
Example:
 NDD#1 - Pureed

Pureed foods on level 1 should have a pudding like

texture. The foods are smooth, and free of lumps, the
same texture throughout and do not stick to the mouth
or teeth. The patient cannot have any foods that need
to be chewed.
 NDD#1 - Pureed
Foods Included

• Smooth cream of wheat, cream of • Gravies, margarine, butter, sauces or

rice broths
• Mashed potatoes, squash • Pureed meats or casseroles with gravy
• Very ripe mashed bananas or broth to moisten
• Tomato sauce without seeds • Pureed legumes
• Yogurt without fruit, custard or • Strained soups
pudding • Honey, sugar, syrup, jelly
• Pureed fruits and vegetables • Magic Cup nutritional supplement
without seeds or skins
Foods To Avoid

• Melted cheese
• Peanut butter
• Scrambled eggs
• Mixed dishes like casseroles, lasagna, ravioli, macaroni and cheese
• Nuts, Raw fruits and vegetables
• Oatmeal
• Bars, cookies, cakes, pies and fruited yogurt
NDD#1 - Pureed
 NDD#1 - Pureed

Proper cooking involves waiting for pasta to solidify for 1.5 minutes before plating, warming
up the puree for 3 min with plastic covering on so that it doesn’t burn, should still have a
shape when it’s on the plate
 NDD#2 – Mechanically Altered

Definition
The mechanical altered diet includes foods that are moist and tender, and
easy to chew. These foods need to be very moist so they stick together to
form a ball in the mouth. This prevents the foods from pocketing
between their cheeks and gums.

Special instructions
All foods should be served with a sauce or gravy to make sure it is moist
enough to stick together. Meats should be ground or chopped and no
larger than one quarter inch pieces. All foods from the Level 1 Dysphagia
diet are acceptable on this diet as well.
NDD#2 – Mechanically Altered
NDD#3 – Advanced

Definition
This diet consists of food with
nearly normal textures. It
excludes foods that are very hard,
dry, sticky or crunchy. Foods in
this diet still need to be moist,
tender and easy to chew. All
foods should be in “bite-size”
pieces.
NDD#3 – Advanced
 Thickened Liquids

Nectar Thick Honey Thick Spoon (Pudding) Thick

 Craniofacial Diet
(NDD#1/Full Liquids)

Definition
• This diet consists of a combination of dysphagia level #1 and full liquids.
Textures must be smooth, non-fibrous.

• This diet is used for patients who have undergone a facial surgery, typically
to correct a clef pallet.
 Ketogenic Diet
Definition
• A high fat, adequate protein, low carbohydrate diet used to prevent
epilepsy in adolescents
• Protein must be PLAIN with no seasoning

Special Instructions
• There is no specific diet order in HealthTouch
• Nurses may ask for large #’s of butter pats, heavy whipping cream or oil
Portion Sizes
Soups

• 6 oz. = teal spoodle

• Or 3 oz black spoodle X 2
• Leave space!
Hot Cereal

• 6 oz. = teal spoodle

• Or 3 oz black spoodle X 2
• Leave space!
Desserts - yogurt, cottage cheese, pudding,
jello, fruit cup, & mousse

• 4 oz. = #8 gray scoop

 Activity –
compare your hand with the person next to you!

Will you have

the same
portion?
Omelets
• 6 oz. total
• 4 oz. of egg = 4 oz. green or gray
spoodle
• 2 oz. of extras (diced ham,
veggies, sausage, etc.)
• #30 black scoop (1 oz.) or
tongs
• 2 oz. of cheese
• #30 black scoop (1 oz.) or
tongs
Hash browns

• 4 oz. =
• computer mouse
• deck of cards
• picture in the palm of your
hand
Why does the portion size matter?
Pass around the computer mouse
 What should it look like???

Full order Half order

Why does portion size matter?

• #20 yellow scoop = 1 oz.

• strawberry topping for
angel food cake
 CCD & Insulin Dosing

• Control of blood sugars = insulin dependent

• High blood sugars or low blood sugars
– BOTH ARE VERY DANGEROUS
• Insulin dosing is amount of insulin given
before a meal or throughout the day
– CCD – carbs are spread throughout day
• Ex. 5 choices
• B = 5, L = 5, D = 5
• CANNOT exceed limit
Portion size is important!
 CCD & Insulin Dosing

• Brownies & Rice Krispie treats

– Use cutting board pattern
– If not cut properly & then put on the line - it will
get sent to patient
 Fluid Restriction
What on the line contributes to fluid intake?
– Soups/broths, jello, anything that is a liquid!
– Portion size is important
Allergens
 Gluten Free

Definition
• This means the patient is sensitive to a protein found in wheat, barley and
rye. Oats should be avoided as well due to cross-contamination.
 Gluten Free

What items do we offer that are gluten free?

• French Toast
• Sandwiches
• Pasta (Rice Noodles)
• Hot Breakfast Cereal (Cream of Rice)
• Blueberry Muffins
• Buns (Hamburgers & Chicken Sandwiches)
 Gluten Free

Special Instructions
• Call out the allergen to the other cooks.
• Change gloves when preparing a gluten free tray to prevent
cross contamination.
• Separate portioning utensils should be used for wheat
containing products and gluten free products.
• Cover item with dome or plastic lid to prevent cross
contamination.
 Gluten Free

Special Instructions
• Gluten free bread should not be toasted in a toaster that
toasts any other kind of bread. A separate toaster should be
used for only gluten free bread.
 Gluten Free

Special Instructions
• Do not throw GF bread into a
container of regular bread
• Sanitize counter before gluten
free sandwich making
 Milk Allergy

Definition
• This diet is ordered for people allergic to protein in milk

Can cause:
• Rashes, hives, itching, swelling
• Trouble breathing, wheezing, loss of consciousness
 Milk Allergy

What do we offer that does

not contain milk?

• Lactaid Milk
• Protein Bowls
• Tacos (without cheese)
• Plain Bagel
• Fried egg
• Egg whites Milk
• Dairy free French toast
• Vegetables
• Boost supplements
 Milk Allergy

Special Instructions
• Call out the allergen to the other cooks.
• Change gloves when preparing a tray with a milk allergy to
prevent contamination.
• Cover item with dome or plastic lid to prevent contamination
 Egg Allergy

Definition
• This diet is ordered for people allergic to protein in eggs

Can cause
• Skin rashes, hives, nasal congestion, vomiting
• Digestive problems
• anaphylaxis
 Egg Allergy

What do we offer that doesn’t contain egg products?

• Yogurt
• Cereal
• Cottage cheese
• Hashbrowns
• Meats and Fish
• Sandwiches
• Any beverages
• Apple crisp
• Rice Krispie treat
 Egg Allergy

Special Instructions
• Call out the allergen to the other
cooks
• Change gloves when preparing a
tray with allergens to prevent
cross contamination
• Separate portioning utensils
should be used for egg containing
products.
• Cover item with dome or plastic
lid to prevent contamination.
 Fish & Shellfish Allergies

Definition
• This diet is ordered for individuals allergic to the protein in certain types of
fish
• No shellfish on the line

Can Cause:
• anaphylaxis
• Hives, skin rash,
• vomiting./ diarrhea
• Asthma
• Stuffy or runny nose
 Fish & Shellfish Allergies

How do we make sure fish doesn’t contaminate

other foods?

• Call out the allergen to the other cooks.

• Change gloves when preparing a tray with
allergens to prevent cross contamination.
• Separate portioning utensils should be used for
handling fish.
• Cover item with dome or plastic lid to prevent
contamination.
 Allergy Scenario

A ticket for a default tray comes down the line- the order includes:
• cheese quesadilla
• salsa
• Corn
• 1% milk

But the Allergy listed on the ticket is “lactose intolerant”.

What do you do?

Patients trust us to take care of
them by providing appropriate
amounts of food and providing
food that has been handled safely

Keep up the good work!!

If you see something, please
say something! Everyone in the
hospital has a role in patient
safety and experience.
Questions?