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Facts and Figures: 1.5 million people per year have heart attacks and over 1/3 die. It’s the leading cause of death in Americans. New drugs can stop a heart attack by dissolving coronary clots, but must be administered in the early stages of a heart attack New techniques using lasers or special drills can open clogged coronary arteries Adherence to a low fat, low cholesterol diet plan can reverse at least some buildup of atherosclerotic plaque If a person lowered their blood cholesterol from 250 to 200 mg./dl, they reduce their risk of a heart attack by 40%

Symptoms of Heart Disease: Center of Chest Pain, also whole chest or neck, jaws, and shoulders, even down the arms Mild Aches or Pressure, severe crushing or squeezing sensation Burning or Bloated Feeling Continuous or intermittent cold sweats, nausea, vomiting, weakness, anxiety or shortness of breath Symptom of Heart Defects: Abnormal heart rhythms Swollen ankles or feet Extreme/Easy fatigue Dizziness upon exertion/exercise Shortness of breath Chest Pain Bluish skin and nails

How is an acute heart attack diagnosed and treated? Description of pain and other sensations is given 1 or more electrograms evaluate the rhythm and function of the heart muscle Blood tests detect enzymes released by the heart damaged from an attack

Consistency of foods served: Do not mix textures as Vegetable Soup or Lasagna where you have a solid and liquid. The patient will chew the solid and the liquid will drool from the patient’s mouth. Use viscosity foods as broth, gelatin, nectars and mashed banana. Never exclude milk from the diet plan. Juices that can cut mucus are: pineapple, grapefruit, cranberry and papaya. The Dysphagia patient has 4 tastes: Sour, Sweet, Bitter, and Salty Always have the patient in an upright position to feed, this allows the food to go down better and causes less problems. Eat with the weakest side turned-cramps weak side esophagus and use the strong side to swallow. Can also use a vaporizer in the room with warm air. Temperature of the foods should be hot at 135 degrees F or higher and cold foods should be 41 degrees F or lower. The patient or resident with dysphagia can’t feel the temperatures in-between warm or Luke-warm. Patient should sit in the upright position for 15 to 20 minutes after eating or drinking food or beverages. Make sure and clean the mouth after eating with a swab to ensure the food is not aspirated later.

Oral Preparatory Stage – The food is chewed (masticated), mixed with saliva, and formed into a cohesive food ball (bolus). Oral Stage – The food (bolus) is moved back through the mouth with a front-to-back squeezing action, performed primarily by the tongue. Pharyngeal Stage – This stage begins with the pharyngeal swallowing response. The food enters the upper throat area (above the voice box), and the soft palate elevates. The epiglottis closes off the trachea as the tongue moves backwards and the pharyngeal wall moves forward. These actions help force the food downward to the esophagus. Esophageal Stage – The food bolus enters the esophagus (the tube that transports the food directly to the stomach). The bolus is moved to the stomach by a squeezing action of the throat.

Prevalence of Dysphagia: 10% of general hospital populations are affected 30% of all stroke patients are affected 3 out of 4 recovering from brain injury at a Rehabilitation Center are affected 1/3 to 1/2 of all patients in Long Term Care/Nursing Homes are affected Warning Signs of Dysphagia: Coughing, choking before, after or during the swallowing process. Weight decrease/Refusal to eat and drink. Excessive drooling, pocketing of food, eating very slowly Taking 1 to 2 hours to complete a meal, complains food is caught. Chest pain with swallowing. Reflux of food through the nose. Slurred Speech. Possible Causes of Dysphagia: Stroke Head Trauma Spinal Cord Injury Cancer Alzheimer’s Disease Parkinson’s Disease Neuromuscular Disorder as MS (Multiple Sclerosis) Face or Neck Surgery Patients with dysphagia have a high risk of: Air Obstruction Dehydration, constipation, UTI (Urinary Tract Infection) Malnutrition – due to the decreased food

How to get ready for a Disaster? Educate Practice Role Play Take inventory of food, water (potable and non-potable) and disposable dishes and plastic ware Prepare 3 Days of Menus (for all diets) Know what you are responsible for as well as what others are responsible for… Having a plan in writing and go over a minimum of 4 times a year Choosing 2 designated areas to meet at when disaster strikes Having food on hand for the 3 day or 7 day disaster plan Going over a disaster in-service with all staff and have them to sign making sure all have read and are familiar with the plans Having an emergency contact person or persons. Have their information out and easily accessible Knowing where to go/send people if you have to evacuate (know ALL emergency exits)

What Causes Heart Enlargement: Severe Coronary Artery Disease Infections Inflammatory Disorders Metabolic Disorders Drugs or other toxins Alcohol Abuse Connective Tissue Disorders Inherited Neuromuscular and neurologic disorders Cancer What can I do to Avoid Heart Enlargement? Have infections treated promptly Avoid alcohol, moderation only Treat High Blood Pressure Do not use Cocaine Do not Smoke Lose excess weight Get adequate Sleep Risk-Factors: Age Family History Males are more susceptible Males > 45 years of age Females > 55 years of age Premature menopause without estrogen replacement therapy High Blood Cholesterol Levels Leads to atherosclerosis : clogging of the arteries with fatty deposits High Blood Pressure Diabetes Obesity

Purchasing Foodstuffs and nonfood supplies will be purchased for the kitchen only from companies in compliance with local, state, and federal sanitation and safety laws and regulations. Damaged food items, such as dented or bulging cans, will not be accepted from vendors. All foodstuffs and supplies will be stored 6 inches off the floor and 18 inches from the ceiling according to established regulations. Foods will be stored in the kitchen area and vending area at proper temperature to prevent bacterial growth. Perishable food will not remain at room temperature longer than 30 minutes Perishable foods will be refrigerated or frozen. Expiration date will be written or stamped on the container. Leftover food will not be stored in the refrigerator more than 48 hours. Foods to be stored more than 48 hours will be frozen. The food will be labeled, dated and covered. Refrigerators and freezers will be checked daily to assure maintenance of required temperatures. Records will be maintained. Food items will not be stored on ice that is being stored for dispensing, i.e. ice machine. Ice will not be dispensed by hand. Ice scoop will be stored in an enclosed, dry container near the ice machine. Sneeze guards will be provided to protect unwrapped foods served in the cafeteria. Self-service openings in counter guards will be designed and arranged to protect food from manual contact by customers. Food and nonfood supplies will be clearly labeled and stored in separate areas according to regulations.

Preparation Separate areas for hot and cold food preparation will be maintained. One absorbent cutting board will be provided for raw fruits and vegetables. Boards that are nonabsorbent and capable of being cleaned and sanitized adequately may be used, providing the cleaning and sanitizing procedure is performed between usages for different food categories. (All meats are sliced on a meat slicer). Frozen foods will be thawed at refrigeration temperature or quick thawed as part of the cooking process. All raw, unprocessed fruits and vegetables will be thoroughly washed under running water before use. Prepared foods will be transported to other areas in covered containers or otherwise wrapped or packaged to insure protection from contamination. Individual portions of food will be served with appropriate utensils to avoid manual contact. All unpackaged foods will be served with appropriate utensils to avoid manual contact. The Director of Food Service will be responsible to insure that all food is prepared and served in a safe, sanitary manner which meets the local, state, federal and hospital guidelines.

Critical Control Points: FSD/FSS/CDM (or alternate) will accompany the health inspector. Scores of < 100 will be posted on the back with a plan of correction. FSD/FSS/CDM (or alternate) will report to administration a plan of correction, and follow through. Staff must practice safe hand washing; wear a clean uniform, closed toe, non-skid shoes, and a hairnet over all hair. All refrigerated foods will be labeled, dated, and covered. All foods will be discarded after 2 days. Stored at 41’F or lower.

Plant Operations All openings to the outside of the building will be rodent and insect proof and should be maintained by the plant operations department. All surfaces will be inspected and repaired by plant operations department when necessary Ice machines will be cleaned and descaled monthly. Plant operations will have a written preventative maintenance plan for the food services department and the facilities and equipment therein. Lighting, ventilations, and humidity will be controlled to prevent condensation and the growth of molds. Steam tables, refrigerators, and ovens will be checked to insure maintenance of appropriate temperature requirements.