Teaching Your Patient How to Reduce Their Sodium Intake

How many of you have ever struggled with helping your patient to understand a reduced sodium diet? I’ll give you 5 ways to help your patients be more successful in their sodium reduction.

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Teaching Your Patient How to Reduce Their Sodium Intake

What do your patients typically say when you tell them they need to reduce their dietary sodium? I hear, "What is sodium anyways?” Guess what? - Its salt! And in my clinic, most patients have never heard this before. As a heart failure nurse, teaching about sodium is something I practice daily. I've put together 5 ways to help teach your patients how to reduce their sodium intake.

Put away the salt shaker

I know – it seems obvious right? But in fact, it isn't. Most patients have not been educated on nutrition and have never been on any dietary restrictions before. Teaching them that sodium = salt should be your first step. Did you know that a single teaspoon of salt contains approximately 2,300mg of sodium? Chances are, neither does your patient. Putting down the salt shaker could mean the difference in thousands of milligrams of sodium taken in per day. Another important consideration is to teach your patient that salt = salt. Don't get confused by other types of salt such as Pink Himalayan or Sea Salt. These still contain sodium and count toward the total daily limit.

Read the nutrition labels

Would you be surprised if I told you that most patients don't know how to read a nutrition facts label? This is an essential step in making sure your patient knows how to reduce their daily sodium intake. Start with the basics. What is a serving size? How many servings are in this container? Then move on to the good stuff – milligrams of sodium. A lot of my patients gravitate toward the daily percent – but what we really want is the milligrams (mg) per serving. The Heart Failure Society of America recommends that a heart failure patient should limit their sodium to between 2,000 – 3,000mg sodium per day. If your patient doesn't understand how to read a food label, this recommendation becomes difficult to visualize. Ensure you know what their restrictions are, and help them understand how to stay within that range.

Prepare your food at home

One of my favorite memories as a new nurse in CHF was an elderly patient telling me, "Honey, I'm not going to learn how to cook now!” Cooking at home is a struggle for many patients as they belong to all backgrounds and all walks of life, but it is essential for being successful with a low sodium diet. Teaching patients that they can still have proteins that they season and prepare along with fresh fruits and vegetables is a good place to start. I always say- the fresher the better! Providing patients with a visual of options to choose and options to avoid has been really helpful in my practice because patients usually start out by saying "what can I eat?” I also like to add that seasonings are NOT off limits, they just need to be sure the seasonings they buy don't contain sodium. Choosing seasonings like black pepper, garlic powder, onion powder, cumin or chili powder are all perfectly good alternatives to pre-made seasonings.

Limit intake of processed foods

As you can probably tell, I've created my own personal script after teaching low sodium for 5 years. My favorite line is, "if it comes in a box, a bag or a jar, you probably shouldn't eat it!” Explain to your patient that processed foods (food that is not fresh and comes in packaging) generally contain much more sodium than foods that are fresh. Educate them that nutrition labels live on these food items and that it's important to read them before purchasing. Also, inform your patient that labels are often tricky and can say things like "reduced sodium.” In reality, this could mean the difference of only a few milligrams versus several hundred.

Check restaurant menus before you go

Thankfully, most restaurants these days are sympathetic to the nutritional needs of their customers. It's now relatively easy for a patient to Google the nutritional facts for their favorite restaurants before they leave the house. This way, they can have a plan before they go, and are aware of what foods with easily work within their sodium restrictions. Often times in the clinic I will ask my patient, where do you go out to eat? If they give me an answer, I will look it up right there and show them the sodium amounts for that particular item. It can be quite shocking to discover the chicken nuggets from your favorite place are suddenly off-limits, but this is a really great way to help your patient visualize actual amounts of sodium in processed or prepared foods.

Every opportunity we have to teach a patient can help them to be more successful.

What techniques have you developed in your practice to teach patients about sodium restriction?

Resources

HFSA Module 2: How to Follow a Low Sodium Diet

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Meagan

About Meagan, BSN, RN

Meagan is a nurse who has worked with patients in Progressive Care, Telemetry, Congestive Heart Failure, and Wound care.

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Specializes in ER.

There's a lot of evidence that reducing salt doesn't have any impact on health.

https://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/

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Specializes in Community health.

My patients have such a hard time because our urban area (I work in an FQHC) is really a food desert. People who want to cook often have to take a long bus ride (our patients generally don’t have cars) and haul food home in their arms. Many of them do just that, but it’s a big commitment.

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Specializes in CHF.
16 minutes ago, CommunityRNBSN said:

My patients have such a hard time because our urban area (I work in an FQHC) is really a food desert. People who want to cook often have to take a long bus ride (our patients generally don’t have cars) and haul food home in their arms. Many of them do just that, but it’s a big commitment. 

Thank you so much for your response. In my area we also struggle with transportation and lack of grocery store choices. We have several patients that are limited to food that is given from food pantries. I will often times try to help them maximize on quantity of food by seeing if there are any lower sodium options that they can pair with those higher sodium foods.

Have you been able to reach them by showing them real time sodium content in fast food? This is always eye opening for my patients.

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Specializes in CHF.
34 minutes ago, Emergent said:

There's a lot of evidence that reducing salt doesn't have any impact on health.

https://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/

Thank you for your response. I can certainly appreciate the need to better study the effects of an increased or reduced sodium diet on patients patient as it pertains to patient outcomes. I also like to look at lower sodium diets as a more health conscious diet in general. It doesn't hurt to limit intake of processed "junk" foods for any patient population.

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Specializes in ER.

Your post actually seems to be targeting the chemical NaCl specifically. My point is that it's not particularly relevant in light of new research.

I agree, junk food is bad, filled with cheap carbohydrates, sugars and low quality fats, and meat from factory farms...

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Specializes in SICU, trauma, neuro.

I admittedly don’t know as much about nutrition as some nurses do... it just isn’t my professional focus.

But as a neuro/trauma ICU RN I routinely infuse 2%, 3%, 23% NaCl directly into the bloodstream of TBI pts. Usually the neurosurg team gives us a goal for the serum Na+ to be ELEVATED, often 145-155.

It doesn’t have any noticeable effect on BP.

How high can too many chips REALLY make your serum Na+? Am I missing something?

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Specializes in CHF.
7 hours ago, Here.I.Stand said:

I admittedly don’t know as much about nutrition as some nurses do... it just isn’t my professional focus. 

But as a neuro/trauma ICU RN I routinely infuse 2%, 3%, 23% NaCl directly into the bloodstream of TBI pts. Usually the neurosurg team gives us a goal for the serum Na+ to be ELEVATED, often 145-155.

It doesn’t have any noticeable effect on BP.

How high can too many chips REALLY make your serum Na+? Am I missing something?

I work in a CHF clinic, so the focus with low sodium diet is specific to fluid retention and symptom management. For us, it's about the overnight weight gain that can accompany those high sodium foods. A Liter of fluid weighs around 2 lb, so in a patient with CHF that could lead to worsening symptoms and possibly an admission for diuresis if it's left unmanaged.

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