Dietary Modification: Requirements and Restrictions

A client may have a special diet due to a disease, condition, medication, or food allergy. A special diet can limit or increase the intake of certain foods or how foods must be prepared.

It is important for you to understand how and why nutrition therapy is needed and what foods should be added or avoided in food preparation. A client should have a doctor’s prescription before you make changes to their normal diet. If you do not have the specific information you need, alert the case manager or your supervisor depending on the care setting where you work.

Balancing Choice with Safety

In some cases, a client may choose not to follow a prescribed special diet or make food choices that are not as healthy as others. Choosing which foods to eat is the client’s right. If the client is making unhealthy food choices or not following their prescribed diet, Follow the steps outlined in Balancing a Client’s Right of Choice and Safety in Module 4 on page 64.

explain your concerns to the client;
offer safe alternatives;
report your concerns to the appropriate person in your care setting; and
document your concerns and what you did.

Food Allergies

Some people have allergies to food that can cause sudden, life-threatening reactions. Even a small amount of the food can make a person who has a food allergy sick.
Foods that cause the most allergies include milk, soy, eggs, wheat, peanuts, nuts, fish, and shellfish. Foods to avoid should be listed on the client’s service plan. A client with a food allergy must avoid any source of that food.
A client’s safety can depend on safe preparation steps in the kitchen (e.g. paying close attention to the ingredient list on food labels). Make sure to talk with the client about any food allergies they have. Symptoms of an allergic reaction to a food can include the following.

A tingling or itching sensation
Hives (raised welts on the skin)
Swelling of the mouth or throat, eyelids, face, lips, and tongue
Abdominal pain
Diarrhea
Nausea
Vomiting
Difficulty breathing
Light-headedness
Loss of consciousness

It is a medical emergency if a person develops even one whole-body reaction such as hives. As in any other emergency, call 911 and follow the emergency and reporting procedures where you work.

Dysphagia

Dysphagia is a common condition that makes swallowing more difficult. Dysphagia is more likely for people who have had a stroke, certain diseases (Parkinson’s, multiple sclerosis, certain cancers), dementia, some individuals with developmental disabilities, and people who are on certain medications. Warning signs of dysphagia include:

taking a long time to begin a swallow or needing to swallow 3-4 times for each bite of food;
having pain while swallowing;
being unable to swallow;
fullness or tightness in the throat or chest or a sensation of food sticking there;
difficulty controlling liquids in the mouth or drooling out of the front or side of the mouth;
being hoarse;
bringing food back up; regurgitation
having frequent heartburn;
having food or stomach acid back up into the throat;
unexpected weight loss;
coughing or gagging before, during or after a swallow;
having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing; or
pocketing food in the mouth (storing food in the cheek), spitting food out, or refusing to eat.

Report any of these signs to the appropriate person in your care setting if the client has not already been diagnosed with dysphagia.

Caring for a Client with Dysphagia

Clients who have dysphagia need support to make sure they get adequate nutrition and hydration as well as to protect against food or fluid getting into the airway and lungs.

Clients with dysphagia will have a prescribed special diet. Depending on the severity of the condition, the consistency of foods and liquid must be changed to make it easier and safer for the client to eat or drink (e.g. making foods soft and easy to swallow or thickened or thinned to prevent choking).

You may also be asked to work directly with the client’s healthcare provider to understand how to prepare food correctly. This depends on the care setting where you work. Diet modifications should be noted in the client’s service plan. Check with your supervisor if you have any questions.

See Clients who Have Difficulty with Eating in the Resource Directory on page 347 for more information.