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THERAPEUTIC DIETS

Health Disorder Dietary Modification Rationale or Comments


AIDS Based on specific See Diarrhea and COPD
symptoms.
Anemia, folate Recommend folic acid Lab reports "megaloblastic"
deficiency (folate) supplements. RBCs. Folate is essential for
Increase dietary intake of RBC production and
dark-green, leafy maturation. Maternal
vegetables. deficiency prior to conception
is associated with fetal neural
tube defects (spina bifida).
Anemia, iron Give iron supplements Lab reports "hypochromic"
deficiency (called milk and iron-rich diet that and "microcytic" RBCs.
anemia in child who includes liver, red meats, Milk and antacids impair
drinks excessive whole grains, dark-green absorption of iron
amounts of milk leafy vegetables, and supplements.
rather than eating cereals. Vit C facilitates absorption of
iron-rich foods) Ensure adequate intake iron.
of vitamin C.
Anemia, pernicious Administer B12. Lab reports "megaloblastic"
RBCs. Anemia is caused by
malabsorption of B12.
Anemia, sickle cell Increase fluids to at least Sickled cells tend to clump
1½ times usual together, causing vaso-
requirement for weight occlusion. Increased fluid
and age. intake results in hemodilution,
Folic acid (folate) may be which impedes the clumping
given. process.
Folic acid essential for normal
RBC formation.
Arthritis Maintain ideal body Excess weight causes stress on
weight by limiting fat and joints.
caloric intake.
Burns High kilocaloric and Calories and protein needed
protein intake. for healing.
Give vitamin and mineral Decreased level of
supplements. consciousness, poor appetite,
Enteral or parenteral or paralytic ileus may interfere
feedings if PO feedings with PO intake.
inadequate.
Calculi, renal Generous fluid intake. Calculi most often composed
Dietary calcium adequate of calcium, which is more
to maintain serum soluble in acidic urine.
calcium and prevent Dilute urine less likely to
excessive bone loss of support stone formation.

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calcium.
Cancer Varies according to site Progressive disease causes
and type of cancer. hypermetabolism, weight loss,
Generally, increase negative nitrogen balance, and
calories and protein with the use of fat and muscle
low to moderate fat. tissue for energy.
When chemotherapy
destroys taste buds,
slightly salty or sour
tastes are usually
accepted best.
Cardiovascular disease Prudent diet: Control These are recommendations of
calories in accordance the American Heart
with ideal body weight. Association for prevention and
Diet to consist of: treatment of CV disease. Fat
carbohydrate (mainly has 9 cal/g, whereas protein
complex) = 50% of daily and carbohydrates have 4
calories, protein = 20% of cal/g.
daily calories, and fat Excess salt may cause edems,
(mostly vegetable) = 30% which may result in elevated B
of daily calories.
Salt added lightly during
cooking, but not at table.
Avoid salty-tasting foods.
Celiac disease Exclude wheat, oats, rye, Foods on "excluded list" cause
barley, and buckwheat diarrhea and GI villi atrophy
products. Give potato, in persons with this inborn
corn, and rice products. disorder.
Cholecystitis or Low-fat or possibly a fat- Fat in duodenum stimulates
cholelithiasis free diet for a limited gallbladder contraction,
time. thereby causing pain.
Fat-free diet for more than 1
month may result in essential
fatty acid deficiency.
Cirrhosis Increase calories. Anorexia usually present.
Protein as tolerated Low sodium does not
(usually limited). eliminate edema but may slow
Moderate fat. its progression.
Low sodium. BCAAs are amino acids that do
MCT oil if fat poorly not require metabolism by
tolerated. liver.
BCAAs (branched-chain Monitor serum ammonia level
amino acids) may be used to assess dietary protein
to provide protein. tolerance.
Constipation Increase fluid and fiber Extra fluids and fiber increase

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intake. peristalsis. (High-fiber intake
If enteral feedings are in can result in constipation if
use, try formula with fluid intake is inadequate.)
added fiber. If fiber- Corn syrup increases
containing formula is osmolarity of intestinal
ineffective, try one that is contents, thereby pulling
fiber free. water into gut and softening
Corn syrup may be added stool.
to infant formula.
COPD Increase fats. Fat has lower R/Q (respiratory
Decrease carbohydrates. quotient), uses less oxygen,
Adequate fluids. and releases less CO2than
carbohydrates or protein.
Fluids help liquefy pulmonary
secretions.
Crohn’s disease Inactive periods: Regular Lactose poorly tolerated
(regional enteritis) diet with lactose and fiber because of deficiency or
limited. absence of enzyme (lactase)
Exacerbations: Increase needed for its digestion.
calories and protein. Fiber is irritating to intestinal
Parenteral (IV) feedings mucosa. Increased calories
may be used. and protein needed because of
fecal losses and
malabsorption. Parenteral
feeding allows gut to rest and
heal.
Cystic fibrosis Increase calories and Genetic condition results in
protein. malabsorption of nutrients
Fats as tolerated because of lack of adequate
(decrease if stools are pancreatic enzymes and thick
fatty). intestinal secretions.
Encourage salty foods. Excessive electrolytes are lost
in sweat.
Decubitus (pressure Adequate kilocalories, These are critical components
ulcers) protein, vitamin C, iron, of the healing process.
and zinc.
Diabetes mellitus
Type 1 Balance available glucose Pancreas produces limited or
from food with available no insulin.
insulin. Children have unpredictable
Exchange system often activity spurts and high levels
used. of growth hormone, causing
Dietary fiber may reduce blood glucose levels to be
rate of GI glucose inconsistent even when a strict
absorption. diet is followed. It is
For children, limitation of psychologically important for
concentrated sweets may children to have diets similar
be only modification. to their peers.
Diet adjusted for
individual life style and
eating habits.
Type 2 Primarily weight Reducing one’s weight (if
reduction and control of overweight) decreases insulin
diet. requirement.
MODY (mature-onset Similar to Type 2 that
diabetes of the young) occurs in adults.
Diarrhea First, give diet of clear ORS contain fluids and
liquids (including ORS electrolytes. Elements of
[oral rehydration BRAT diet contain pectin and
solutions]). NPO if PO nonirritating carbohydrates.
intake causes increased
stooling. Advance to full
liquids if tolerated, then
to BRAT diet (bananas,
rice, applesauce, and tea
or toast).
Diverticulitis High fiber during High fiber helps to promote
remissions. peristalsis and may prevent
Bland diet during material from remaining in
exacerbations. diverticula but is not tolerated
Elemental formulas or during exacerbations.
parenteral feedings may Elemental formulas
be used. (predigested) or parenteral
feedings allow gut to rest.
Dumping syndrome Alternate liquids and dry Alternation of liquid and dry
foods. foods puts less food in
Avoid simple solution, thereby decreasing
carbohydrates such as osmolarity of gut contents.
fruit juices or sodas. Simple carbohydrates trigger
Dilute concentrated tube- rapid release of insulin,
feeding formulas. resulting in hypoglycemia after
the GI supply of glucose
diminishes.
Concentrated tube-feeding
formulas attract water to the
gut.
Edema Control sodium. Provide Edema may be caused by
adequate protein. excess sodium or decreased
albumin levels, or both.
Esophagitis Give small, frequent Large meals, obesity, or lying
meals. Promote weight down causes increased
loss if overweight. Avoid abdominal pressure resulting
caffeine, pepper, and any in esophageal reflux.
food not well tolerated. Foods avoided are those that
Chew food thoroughly. cause irritation.
Avoid lying down after Hiatal hernia often results in
meals. esophagitis.
Fracture Adequate protein, Adequate protein and vitamin
calcium, phosphorus, and C needed for collagen
vitamins A, C, and D. formation.
Dairy products are Adequate calcium and
excellent sources for the phosphorus needed for bone
above nutrients except for strength.
vitamin C. Vitamins A and D necessary
Citrus fruits provide for bone cell development,
vitamin C. protein synthesis, and
mineralization.
Gallbladder disease See Cholecystitis
Gastroesophageal Avoid chocolate, fatty Listed foods lower (loosen)
reflux disorder foods, peppermint and esophageal sphincter pressure,
(GERD) spearmint oils, caffeine, which results in reflux.
and alcohol. Protein increases (tightens)
Encourage protein-rich sphincter pressure.
foods.
Gout Encourage fluids. Extra fluid promotes uric acid
Limit fats. excretion and helps prevent
Decrease high-purine renal stone formation.
foods such as meats Fats prevent excretion of uric
(especially organ meats), acid.
fish, fowl, lentils, whole Purine breaks down to form
grains, asparagus, uric acid.
mushrooms, spinach,
cauliflower, and alcohol.
Hepatic Limit protein intake. On the limited-protein diet,
encephalopathy Essential amino acids essential amino acids receive
may be used (given IV). top priority because they
cannot be manufactured by
the body.
Ammonia improperly removed
from serum by liver causes
abnormal CNS symptoms. See
Cirrhosis
Hepatitis High calorie and protein. Anorexia is major problem.
Moderate fat. Moderation of fat promotes
Avoid alcohol. liver regeneration and healing.
Alcohol is detoxified by the
liver.
Hiatal hernia Same indications as
Esophagitis.
Hypertension Control calories to avoid Obesity increases risk of
excess weight. hypertension. Although the
Limit sodium. role of sodium in hypertension
Increase foods high in is debated, research shows
potassium (fruits and that limiting dietary sodium
vegetables) and calcium and increasing potassium and
(low-fat dairy products). calcium can lower blood
DASH diet pressure.
Irritable bowel Regular diet when Bland diet decreases GI
syndrome asymptomatic. Bland diet irritation.
during exacerbation.
Lactose intolerance Reduce lactose (milk Condition may be partial or
sugar) intake. complete and may be inherited
or due to stress or GI
irritation.
Nausea/vomiting Clear liquids. Clear liquids prevent
Offer ORS every 20–30 dehydration.
min. ORS replaces electrolytes lost
in emesis.
Nephrosis or Increase protein in diet Protein is lost in urine in this
nephrotic syndrome unless accompanied by disorder.
renal failure or elevated Salt restriction does not
BUN. remove edema but may limit
No salt added at table. its increase.
Obesity Decrease calories. One pound of adipose (fat)
Modify food habits. tissue is roughly equivalent to
3500 Kcal. An increase or
decrease of 500 Kcal a day
leads to 1 lb weight gain or loss
per week.
Osteoporosis Ensure adequate dietary Adequate dietary calcium and
calcium by consuming adequate exercise thought to
dairy products or by be preventive.
taking supplemental
calcium.
Encourage exercise as
tolerated.
Ostomy Progress from clear liquid Ostomies result in increased
to low-residue, high- nutrient losses (including
calorie diet. Maintain electrolyte) from GI tract.
until desirable weight Diet is individualized to avoid
attained. foods that cause patient to
Gradually add fiber have excess stooling or gas.
(individual tolerance Intrinsic factor not available
varies), avoiding gas- following ileal resection;
forming foods (based on therefore, B12cannot be
individual tolerance). absorbed through GI tract.
Ileal resections make
B12injections necessary.
Pancreatitis High protein, high Tolerance of fat is judged by
carbohydrate with fat fat in stools, abdominal
added to tolerance. distention, or abdominal
Eliminate gastric discomfort.
stimulants such as coffee, Gastric stimulants cause
tea, alcohol, and pepper. irritating pancreatic enzymes
Withhold oral feedings to be secreted.
during exacerbations.
Peptic ulcer Bland diet with small, Meat extracts stimulate
frequent feedings if ulcer stomach acid secretion.
is active. Obvious irritating foods
Avoid meat extract, avoided.
pepper, caffeine, and
alcohol.
Phenylketonuria Control phenylalanine An inborn error results in a
(an essential amino acid) lack of enzyme needed to
in diet. catabolize phenylalanine.
Breast-feeding is
contraindicated.

Renal dialysis Generous calories. See Renal Failure


Supplement of water-
soluble vitamins.
Limit fluids, protein,
potassium, sodium, and
phosphates.
Renal failure, acute Restrict protein until Urea (BUN) and creatinine are
BUN and serum the end products of protein
creatinine are normal. metabolism. If kidneys are
Restrict fluids during unable to remove urea, blood
oliguric phase. levels rise and affect CNS.
Replace electrolyte Serum potassium levels may
deficits. (Avoid giving fluctuate rapidly.
potassium during oliguric
phase.)

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Renal failure, chronic Restrict protein Urea and creatinine
proportionate to kidney accumulate in blood from
function. Prevent weight protein breakdown. Addition
loss by including of essential amino acids may
sufficient calories. Amino be indicated if protein
acids may be given. tolerance is less than 20 g/24
Restrict potassium and h. (Monitor BUN and
phosphate intake. creatinine.) Diseased kidneys
do not effectively remove
potassium, phosphates, urea,
or creatinine from the blood.
Surgery Adequate protein, Listed nutrients are needed for
calories, iron, and connective tissue (collagen)
vitamin C. formation.
Ulcerative colitis Low-lactose and low- Stressed mucosa results in
residue diet. (Avoid dairy impaired ability to produce
products and residue, no lactase, which leads to lactose
alcohol, no fried foods, no intolerance.
raw or cooked whole Residue (any material that
vegetables.) ends up as fecal mass) is
Regular diet during irritating.
remission.

Pinoy R.N. | Up-to-date nursing news and information | This file was downloaded from www.PinoyRN.co.nr

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