Chicken Thighs Baked with Lemon, Sage, Rosemary & Thyme
Final Lesson PlanTitle: Sodium Restriction for Renal Dialysis PatientsMethods Used: Interview, Contrived Situations, Lesson in a Box, and SortingTarget Audience: Hemodialysis Patients & FamilyClass Size: 10Terminal Objectives:Family members will make a commitment to support their loved one in reducing sodium intake. Patients will identify ways to reduce sodium intake and will appreciate the variety of foods available within a reduced sodium diet. Terminal Concept:Hemodialysis renal failure patients must follow a strict reduced sodium diet. Excessive sodium is responsible for increased thirst, increased fluid gain, and hypertension. There are numerous salt substitutes as well as alternative food preparations. Herbs and other seasonings are excellent alternatives. Domain: Affective/ Cognitive Taxonomic Level:Responding & Valuing/ApplicationReferences:Nutrition Care Manual: Chronic Kidney Disease: Dialysis Stage 5, Kraus pg. 822, National Kidney Foundation Preparation: Collect sodium substitutes and alternatives and place in box – First items listed place in the box firstPaper for sorting activity (view assessment)TarragonSageThymeRosemaryMarjoramGingerDillCurryCardamomCarawayBay LeafBasilAllspiceSalt ShakerTableclothObtain/load slide showGather various nutrition labels Print handoutsInvite MD, PA, or RNPrepare food samples- rosemary lemon thyme chicken samples (view recipe)Pre-assessment :Patients on dialysis Time (if in class): NAIntroduction :Qs & experiences from last lesson on restricting fluid.Share feelings how hemodialysis is going.Today we are going to talk about Sodium!Time: 5-7 min.Supporting Objectives Content Outline TimeLearning ExperiencesFamily members and clients will understand the effect eating sodium has on their health.Patients and family members will be able to value the feelings of each other and explain how the other might feel in given situations. Patients and family members will be able to list ways to reduce sodium intake.Patients will be able to read a nutrition label and determine how much sodium/serving. They will also be able to apply this knowledge to their current diet. Patients will be able to list foods to limit. Patients will be able to list alternatives in cooking in order to lower salt intake. Salt intake during dialysis leads to increased thirst, water retention and hypertension.Hypertension leads to further damage of the kidneys and the blood vessels leading to the kidneys. This can seriously impair the chance for a dialysis patient to receive a kidney transplant. Renal failure with its accompanying complications and maintenance is difficult physically as well as emotionally. As was emphasized by the Dr. (or RN or PA) individuals with kidney disease must change their diet drastically which puts pressure on them as well as their family. It can be a very emotional and frustrating time for all involved. It is much easier to make and maintain changes with the support of loved ones. The native American Cherokee tribe coined the phrase, “Don't judge a man until you have walked a mile in his shoes”. In order to succeed in this, you must learn to understand each other. Hints to keep your sodium intake down Cook with herbs and spices instead of salt. Read food labels and choose foods low in sodium.Avoid salt substitutes. They are high in potassium. When eating out, ask for meat or fish without salt. Ask for gravy or sauce on the side.Limit use of canned, processed and frozen foods.Simple rule of thumb: If salt is listed in the first five ingredients, the item is probably too high in sodium to use.All food labels now have milligrams (mg) of sodium listed. Follow these steps when reading the sodium information on the label:Know how much sodium you are allowed each day. Remember that there are 1000 milligrams (mg) in 1 gram. For example, if your diet prescription is 2 grams of sodium, your limit is 2000 milligrams per day. Consider the sodium value or other food to be eaten during the day.Look at the package label. Check the serving size. Check the number of servings you will be eating at one sitting. Nutrition information is given per serving. How does this compare to your total daily allowance? Try to stay below 300mg/servingCompare labels of similar products. Select the lowest sodium level for the same serving size.I have some good and bad news about the dialysis diet. The bad news is there are quite a few foods you should be aware of that are high in salt. These foods should be limited. Foods to limit:SaltLemon pepperBouillon cubesFlavor enhancersSaucesSalty snacksCured meatsProcessed foodsThe good news, there is a way to spice up the foods you can eat making them a much healthier and tastier option. Allspice: Use with beef, fish, beets, cabbage, carrots, peas, fruit.Basil: Use with beef, pork, most vegetables.Bay Leaf: Use with beef, pork, most vegetables.Caraway: Use with beef, pork, green beans, cauliflower, cabbage, beets, asparagus, and in dips and marinades.Cardamom:Use with fruit and in baked goods.Curry:Use with beef, chicken, pork, fish, green beans, carrots and in marinades.Dill:Use with beef, chicken, green beans, cabbage, carrots, peas and in dips.Ginger:Use with beef, chicken, pork, green beans, cauliflower and eggplant.Marjoram: Use with beef, chicken, pork, green beans, cauliflower and eggplant.Rosemary: Use with chicken, pork, cauliflower, peas and in marinades.Thyme: Use with beef, chicken, pork, fish, green beans, beets and carrots.Sage: Use with chicken, pork, eggplant and in dressing.Tarragon: Use with fish, chicken, asparagus, beets, cabbage, cauliflower and in marinades.Tips for cooking with herbs and spices Purchase spices and herbs in small amounts. Use no more than ? teaspoon of dried spice (? of fresh) per pound of meat.Add dried spices to food about 15 minutes before the end of the cooking period.Add fresh spices to food at least one hour before the end of the cooking period. Allows the flavor to seep bine herbs with oil or butter, set for 30 minutes to bring out their flavor, then brush on foods while they cook.10 min10 min5 min10 min3 min7 min Interview with Renal Doctor (or nurse or PA).Q: Could you explain the importance of salt for these patients?Q: What are some of the immediate benefits for reducing salt intake?Q: What are the long term benefits?Q: On a scale of 1-10, 10 being life or death, how important is it for these patients to limit salt intake?Q: Do you have any other parting advice for our clients? Well thank you Dr., do any of you have questions for the Dr. before he leaves?Transition into Contrived Situation – Divide into groups-Pair patients with patients-Pair patent’s family members together-Distribute the following situations:Going out to eat to your favorite restaurantFamily reunion mealNeighborhood barbequeWork socialDiscuss the following questions with each other. If you are on dialysis, respond to the questions as if you were a member of your family that is experiencing the situation with you. If you are a family member of a dialysis patient, respond to the questions as if you were on dialysis and you were experiencing the situation with your family. How do you feel? How would you respond? How would you try and keep to your diet? Or how would you try to help your loved one keep to the diet? How would you like to receive support from your family? Let’s come back together and discuss….Allow individuals to share their thoughts of the experience. Hopefully, we can better understand how we are feeling, and we must all understand the importance of family support. You need each other. Make a commitment to always support your loved ones and remember what it might be like to be in their shoes. Those on dialysis must remember how frustrating it must be to family members to accommodate you. Family members must remember the difficulty in following such restrictions. Show slideHand out sample nutrition labels. Have individuals identify how much sodium there is per serving. Ask for a volunteer and ask how many servings of a typical food (pick one of the labels) they usually eat. Ex. How many crackers do you usually eat? How many cups of mac-n-cheese, how many cups of cereal….etc. Have the volunteer calculate the mg of salt contained in the number of servings they typically eat. Show slide and pass out “sodium containing food” handoutLesson in a box. Pull out tablecloth and salt shaker.Pull out each seasoning and explain what it is used for. Pass around herbs so people can smell them.Show slide for general cooking tips. Hand out “herb use” handout with recipe of sample. AssessmentTape the “Sodium” papers on the table and have patients sort the food. Once food is sorted, have patients suggest seasonings for the low-sodium foods. Time: 5-7 minClosure It may seem like you have no control over what is happening with your health, but we are here to let you know that you do have control. You are in control. That control comes in watching what you eat, consistently taking your medication at the right time, and working with your Doctor to create success for you.Chicken Thighs Baked with Lemon, Sage, Rosemary & Thyme INCLUDEPICTURE "" \* MERGEFORMATINET ????RATE ITread reviews?[10]Serves six.Make the menu:A Casual Dinner from Northeast Spainby?Bill Devin?from Fine Cooking?Issue 46In addition to the lemon and fresh herbs, the chicken thighs are flavored with an emulsified mash of garlic, salt, and olive oil, called allioli. I like to garnish each plate of chicken with a spoonful of? HYPERLINK "" romesco sauce.more about:chicken thighs??sage?rosemary??thyme?sea salt??lemons??garlic?kosher salt?black peppercorns2 large cloves garlicCoarse salt or sea salt3 to 4 Tbs. extra-virgin olive oil12 chicken thighs, trimmed of fat, rinsed, and patted dry2 large lemons, each cut into six 1/4-inch rounds1 bunch fresh rosemary, snipped into twelve 2-inch pieces1 bunch fresh thyme, snipped into twelve 2-inch pieces12 sage leavesFreshly ground black pepperUsing a mortar and pestle, mash the garlic with a large pinch of salt to create a coarse paste (or use a small mixing bowl and the back of a spoon, or mince the garlic very finely on a cutting board). Add the oil very slowly in drops while pounding and grinding the paste, continuing until the allioli is thick, creamy, and emulsified. Put the chicken in a bowl. Rub the allioli all over, including under the skin. Cover and refrigerate at least 2 hours or overnight.A pestle is perfect for pounding garlic, salt, and olive oil to a creamy paste. Photo: Sarah Jay.Heat the oven to 425°F and set an oven rack in the middle of the oven. Arrange the lemon slices in one layer in a large shallow roasting pan or baking dish (9x13x2 inches is good). Top each slice with a piece of rosemary and thyme and a sage leaf. Set the chicken thighs, skin side up, on top; sprinkle them generously with salt and pepper. Bake until the skin is golden and the juices are clear, 45 minutes to 1 hour.Sometimes the lemons and chicken produce a lot of juices, in which case you can make a delicious pan sauce. Transfer the chicken (keeping the herbs and lemon slices underneath) to a plate and cover loosely with foil. Tilt the pan to pool the juices in one corner. Spoon off the fat that rises to the top. Set the pan over medium heat (if the pan isn't flameproof, pour the juices into a small skillet) and scrape up any stuck-on juices. Let the juices boil and reduce so they thicken to a saucy consistency. Drizzle the sauce around, not on, the chicken to maintain the crisp skin. ................
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