STANDARD HOSPITAL DIETS

a. Clear Liquid Diet. This diet is indicated for the postoperative patient's first feeding when it is necessary
to fully ascertain return of gastrointestinal function. It may also be used during periods of acute illness, in
cases of food intolerance, and to reduce colon fecal matter for diagnostic procedures.

(1) The diet is limited to fat-free broth or bouillon, flavored gelatin, water, fruit drinks without pulp, fruit ice,
Popsicles®, tea, coffee or coffee substitutes, and sugar. No cream or creamers are used. Carbonated
beverages may be included when ordered by the physician; however, they are often contraindicated.

If the patient is to be on clear liquids for an extended period of time, the portion sizes should be increased
or an accepted enteral formula may be provided.

b. Full Liquid Diet. This diet is used when a patient is unable to chew or swallow solid food because of
extensive oral surgery, facial injuries, esophageal strictures, and carcinomas of the mouth and
esophagus. It may be used to transition between a clear liquid and a regular diet for the post-surgical
patient.

(1) The diet consists of foods, which are liquid at room or body temperature, and will easily flow through a
straw. Included in the full liquid diet are all juices, strained soups, thinned, cooked cereals, custards, ice
cream, sherbet, and milk. A high protein beverage is given at breakfast and between meals.
Commercially prepared liquid supplements may also be used.

(2) The standard menu mat (DA Form 2902-12-R) provides approximately 2777 calories. This diet is
slightly below the RDA in iron for females, and in niacin for men.

c. Advanced Full Liquid Diet. This diet may be prescribed to meet the nutritive requirements of a patient
who must receive a full liquid diet for an extended period of time or who has undergone oral surgery and
must have foods, which can pass through a straw.

(1) The foods permitted are the same as those allowed on the full liquid diet. The advanced full liquid diet
is made more nutritious by the addition of blended, thinned, and strained meat, potatoes, and vegetables.
High-protein beverages are served with meals and between meals.

d. Tonsillectomy and Adenoidectomy Cold Liquid Diet. This diet is used following a tonsillectomy and
adenoidectomy (T&A). It is also used when only fluids or soothing foods in liquid form are tolerated.

(1) The T&A cold liquid diet provides only cold liquids, which are free of irritants or acid properties. Foods
allowed are flavored gelatins, ice cream, sherbet, and milk. A high protein beverage is served between
meals.

e. Soft Diet. The soft diet is prescribed for patients unable to tolerate a regular diet. It is part of the
progressive stages of diet therapy after surgery or during recovery from an acute illness.

(1) The diet consists of solid foods that are prepared without added black pepper, chili powder, or chili
pepper. It does not contain whole grain cereals or salads with raw, fresh fruits and vegetables. Serving
sizes are small to provide a gradual increase in the amount of food from the liquid diet.

all desserts that are soft and cheeses soft bread and cereals  soft raw fruits  Pasta  cooked
vegetables  fish  liver  lamb  stewed or creamed beef,  ground  very tender minced

f. Dental Soft Diet. This diet is prescribed for patients who are recovering from extensive oral surgery,
have severe gingivitis, have had multiple extractions, have chewing difficulties because of tooth loss or
other oral condition, or for the very elderly, toothless patient.
(1) The diet is composed of seasoned ground meats, vegetables, and other foods, which are easily
chewed. The individuality of the patient must not be overlooked when a dental soft diet is prescribed.
Many patients resent being served ground meat.

g. Regular Diet. Regular diets are planned to meet the nutritional needs of adolescents, adults, and
geriatric phases of the life span.

(1) The regular diet includes the basic food groups and a variety of foods. The basic food groups include
meat, milk, vegetables, fruits, bread and cereal, fats, and sweets.

The Food Guide Pyramid is an outline of what we should eat each day (see figure 5-1). It shows six food
groups, but emphasizes foods from the five food groups shown in the lower sections of the Pyramid. You
need food from each group for good health. Each of the food groups provides some of the nutrients you
need. Food from one group cannot replace those of another group.

 Figure 5-1. Food Guide Pyramid.

h. Diabetic Diet. The diabetic diet is indicated in the treatment of the metabolic disorder diabetes
mellitus. This disease results from an inadequate production or utilization of insulin. The object of treating
the diabetic patient by diet, with or without insulin or oral drugs, is to prevent hyperglycemia,
hypoglycemia, glycosuria, and ketosis.

(1) The diabetic food exchange lists are the basis for a meal planning system that was designed by a
committee of the American Diabetes Association and The American Dietetic Association. The system
lists: meat exchange, bread exchange, fruit and juice exchange, vegetable exchange, milk exchange and
fat exchange. The number of exchanges allowed is based upon the doctor's order and the dietitian's
calculations. Each diabetic diet should be individualized to meet the needs of the patient. The foods in
each exchange contain the same amount of calories, carbohydrate, protein, and fat per portion size.
Patients select from the exchange based upon their preference.
(2) The adequacy and possible deficiencies depend on the calories. A diet of less than 1200 calories for
women and less than 1500 calories for men would have a great chance of being deficient in some
nutrients.

(3) The goals of the diabetic diet are:

(a) To improve the overall health of the patient by attaining and maintaining optimum nutrition.

(b) To attain and maintain an ideal body weight.

(c) To provide for the pregnant woman and her fetus: normal physical growth in the child, adequate
nutrition for lactation needs if she chooses to breast-feed her infant.

(d) To maintain plasma glucose as near the normal physiologic range as possible.

(e) To prevent or delay the development and progression of cardiovascular, renal, retinal, neurologic, and
other complications associated with diabetes.

(f) To modify the diet as necessary for complications of diabetes and for associated diseases.

i. Liberal Bland Diet. This diet is indicated for any medical condition requiring treatment for the reduction
of gastric secretion, such as gastric or duodenal ulcers, gastritis, esophagitis, or hiatal hernia.

(1) The diet consists of any variety of regular foods and beverages, which are prepared or consumed
without black pepper, chili powder, or chili pepper. Chocolate, coffee, tea, caffeine-containing products,
and decaffeinated coffee are not included in the diet. The diet should be as liberal as possible and
individualized to meet the needs of the patient. Foods, which cause the patient discomfort, should be
avoided. Small, frequent feedings may be prescribed to lower the acidity of the gastric content and for the
physical comfort of the patient.

j. Low Fat Diet. Fat restricted diets may be indicated in diseases of the liver, gallbladder, or pancreas in
which disturbances of the digestion and absorption of fat may occur (pancreatitis, post-gastrointestinal
surgery, cholelithiasis, and cystic fibrosis).

(1) The diet contains approximately 40 grams of fat from the six ounces of lean meat, fish, or poultry, one
egg and three teaspoons of butter, margarine, or other allowed fats. Only lean, well-trimmed meats and
skim milk are used. All foods are prepared without fat.

k. Sodium Restricted Diet. The purpose of the sodium-restricted diet is to promote loss of body fluids for
patients who are unable to excrete the element normally because of a pathological condition. The diet is
indicated for the prevention, control, and elimination of edema in congestive heart failure; cirrhosis of the
liver with ascites; renal disease complicated by either edema or hypertension; when administration of
adrenocorticotrophic hormone (ACTH) or steroids are prescribed, and for certain endocrine disorders
such as Cushing's disease and hypothyroidism.

(1) The sodium-restricted diets provide a specific sodium level or a range of sodium. The diet order must
indicate the specific sodium level or range desired either in milligrams (mg) or mill equivalent (mEq).
Terms such as "salt free" and "low sodium" are not sufficient.

(a) All foods on the 500 mg and 1000 mg sodium diets are prepared without the addition of salt, and foods
high in sodium are omitted. The 500 mg sodium diet uses both sodium restricted bread and margarine.
The 1000 mg sodium diet uses sodium restricted margarine and regular bread. The 2000 mg sodium diet
uses regular bread and margarine, and regular cereal and desserts prepared with sodium.
L. Low Protein Diet- is a diet in which people reduce their intake of protein.

Indication: people with kidney or liver disease

Food sources: Peanut butter Cheese  Yogurt  Milk  poultry, eggs  Meat, fish  Food Sources: Low
Protein Diet

M. Low Cholesterol Diet- diet is designed to reduce fat and cholesterol blood levels

Indication: •people with hyperlipidemia •atherosclerosis •gallbladder stone •other cardiovascular

diseases

Food sources: Safflower Sunflower  vegetable juices  Pretzels  Unsalted crackers  Oat cereals 
squirrel  wild duck  rabbit  Chicken and turkey with skin removed

PREPARING THE PATIENT FOR MEALS

a. As a nurse, your duties may include serving the diet trays at mealtime. For many patients, mealtime is
the high point of the day. The patients are more apt to have a better appetite, eat more, and enjoy their
food more if you prepare them for their meals before the trays arrive.

(1) Provide for elimination by offering the bedpan or urinal or assisting the patient to the bathroom.

(2) Assist the patient to wash hands and face as needed.

(3) Create an attractive and pleasant environment for eating. Remove distracting articles such as an
emesis basin or a urinal, and use a deodorizer to remove unpleasant odors in the room. See that the
room is well lighted and at a comfortable temperature.

(4) Position the patient for the meal. If allowed, elevate the head of the bed or assist the patient to sit up in
a chair.

(5) Clear the overbed table to make room for the diet tray.

b. Avoid treatments such as enemas, dressings, and injections immediately before and after meals.

Helping patients meet their nutritional needs is a challenging task for a nurse. Ordering the tray and
delivering it to the patient's bedside is not enough. You must see that he eats the food needed to meet his
body requirements. Provide the patient with assistance to complete selective menus that meet his food
preferences as much as possible. See to his comfort at mealtime. Without proper nutrition, the healing
process slows down and the patient's condition does not improve as quickly as it should.
Different methods of cooking - A
Objectives

By the end of the lesson, the students should be able to:

 Describe the main differences between dry and moist heat cooking methods
 List the different cooking methods under dry and moist heat cooking methods
 Compile the list of foods that can be cooked using the dry and moist heat cooking
methods

 Introduction
In cooking, there are some basic methods of cooking that are used. These commonly used basic
cooking methods are divided into two general groups. The groups are: Dry heat cookery methods
and Moist heat cookery methods. The methods of cooking are divided into these two groups
because of the way food is cooked and the type of heat that is used. Let us have a look at the Dry
Heat cookery methods.

 Dry heat Cookery Methods

In dry heat cooking methods, the food being cooked does not use water to cook the food. The food
is left dry and heat is applied to cook the food. Such methods of cooking are: baking, steaming,
grilling, and roasting. When heat is applied to the food, the food cooks in its own juice or the water
added to the food during its preparation evaporates during the heating process and this cooks the
food. Heat is applied directly to the food by way of convection thus making the food to get cooked.
The action or movement of air around the food, cooks it. Let us now have a look at each of these
cooking methods

 Baking

In baking method of cooking, the food is cooked using convection heating. The food is put into an
enclosed area where heat is then applied and the movement of heat within the confined space, acts
on the food that make it get cooked.

 Steaming
To steam food, water is added to a pot and then a stand is placed inside the pot. The water level
should be under the stand and not above it. There is no contact between the food and the water that
is added to the pot. Food is then placed on the stand and heat is applied. The hot steam rising from
the boiling water acts on the food and the food gets cooked. It is the hot steam that cooks the food,
as there is no contact between the food and the water inside the pot. This method of cooking for
vegetables is very good as the food does not lose its flavour and much of the nutrients are not lost
during the cooking.

 Grilling
There are two methods of grilling that are used these days. One type of grilling is the one that is
commonly used by the people in the village. This is when food is cooked over hot charcoal on an
open fire. The food is placed on top of the burning charcoal. Sometimes people improvise by using
wire mesh and place it over the open fire to grill fish or vegetables. The other method is using grills
that are inbuilt in stoves. In this method, the griller, which has a tray, is heated up and the food is
placed on the grill tray to cook. The heat can be gas-generated or electric-generated depending on
the type of stove used. The food is again left to cook on the grill with the doors of the grill open.
People who can afford to buy a stove would use the grilling part to grill their food. What happens in
this type of cooking is the heat seals the outside part of the food and the juice inside the food cooks
it. The flavour of the food is not lost and much of the nutrients are not lost either. Food is frequently
turned over to prevent it from burning and to ensure that equal heating and cooking time is applied to
both sides of the food. By doing this, the food is cooked evenly and thoroughly.

 Roasting

With roasting, direct heat is applied to the food. The heat seals the outside part of the food and the
juice inside the food cooks the food. Roasting is mainly used when cooking fleshy food like fish,
meat or chicken. When heat is applied to the outer covering of the food, it seals it up thereby
trapping all the juices inside the food. The action of direct heating, heats up the juices inside the
food, which then cooks the food. Again there is very little nutrient lost and the flavour is not spoilt.
Food is frequently rotated over the spit so that there is even heating applied to all parts of the food.
This is so that heat is applied evenly to the food to make it get cooked properly.
Moist Heat Cookery Methods In moist heat cookery methods, liquid is used as a medium to cook
the food. Such medium could be water, coconut cream or oil. These liquids are added to the food
before heat is applied to it or sometimes heat is applied to the liquid before the food is added into the
cooking utensils to be cooked. The moist heat cookery methods include: boiling, stewing, shallow
frying, deep frying, barbequing and basting. All these moist heat cooking methods use liquid to cook
the food in.

 Boiling
This is the most common method of cooking and is also the simplest. With this method of cooking,
enough water is added to food and it is then cooked over the fire. The action of the heated water
makes the food to get cooked. The liquid is usually thrown away after the food is cooked. In the case
of cooking rice, all the water is absorbed by the rice grains to make it get cooked. During the heating
process, the nutrients can get lost or destroyed and the flavour can be reduced with this method of
cooking. If you over cooked cabbage, all the nutrients can get lost.
• Poaching
is cooking food in water at 100 degrees Celcius. Heat is transferred mainly by
conduction. Poaching is a rapid method of cooking over slow heat with no loss of
nutrients, however, it may be unattractive if not well garnished. • Poaching is typically
reserved for cooking very delicate items like eggs and fish. But other proteins like
chicken are often prepared via poaching, and some vegetables can be poached too.
Among the advantages of poaching as a cooking technique are the fact that poached
items will turn out moist and tender, which is certainly desirable in the case of fish where
it is easy for fish to dry out when prepared using other cooking methods. And because
poaching involves keeping the cooking liquid at a constant temperature — a fairly low
one, at that — it makes it less likely that items will be overcooked. At least, it would take
a lot longer to overcook something.

 Stewing
In the process of cooking using the stewing method, food is cooked using a lot of liquid. Different
kinds of vegetables are chopped, diced or cubed and added to the pot. Sometimes pieces of
selected meat, fish or chicken is also chopped and added to the stew. The liquid is slightly thickened
and stewed food is served in that manner. This method is also used when preparing fruits that are
going to be served as desserts. With this cooking method, every food is cooked together at the same
time in one pot. The flavour, colours, shapes and textures of the different vegetables that are used,
makes stewing a handy method of cooking. The only disadvantage is that some of the vegetables
might be overcooked and thus the nutrient content becomes much less. It is therefore important that
the vegetables that take the longest to cook to be put into the pot first and the ones that need least
cooking to be put in last. In this way much of the nutrient contents of the food does not get lost.

 Frying
When food is fried using oil or solid fat it is important that you observe some rules in handling oil or
fat. Simple rules to follow when frying: 1.Make sure there is enough oil or fat put in the frying pan or
a deep frying pan. 2.The food to be cooked must not have water dripping from it. This is because
when water comes into contact with hot oil or fat, you will have the oil sizzling and spitting out of the
pan, which could burn your skin if you are not careful. 3.Put the food into the hot oil carefully. Try not
to make a big splash as the oil could burn your skin. 4.The oil of fat should be heated to the right
temperature before putting food into the pan to be fried. If the food is put in when the oil or fat is not
heated to the right temperature, the food will soak up the oil and you will have food that is all oily or
greasy. If the oil or fat is over heated, you will end up with food that is burnt. Sometimes the food
especially doughnuts will turn brown on the outside but the dough inside is uncooked. To cook food
using the frying method, there are two ways of doing it. There is the shallow frying and the deep
frying methods.

 Shallow Frying
In shallow frying, food is cooked in a frying pan with a little amount of oil or fat. The oil or fat is
heated to the correct amount and the food is put into the heated oil. The food is turned over a few
minutes or is stirred around a couple of times before it is cooked and dished out. If patties, potato
chips or coated foods are fried, it is best to put a piece of brown paper or paper napkin inside the
tray to soak up any oil from the food before serving it.
 Deep Frying
This is when a lot of oil or fat is used in cooking the food. The oil or fat is usually put into a deep pan
and is heated to boiling point. Food is then put into the hot boiling oil and is cooked in that way. Such
food as fish fingers, potato chips, meat balls, and dough nuts to name a few, are cooked using the
deep frying method.

 Barbequing

The method of cooking food by barbequing is usually associated with fund raising activities, parties
or picnics. It is most suitable to cooking meat cutlets, fish or chicken pieces. The food is usually
marinated with spices and tenderizers (for meat cuts) for sometime before it is cooked. With this
method of cooking, a sheet of metal with stands is heated up and oil is used to cook the food. A
sufficient amount of oil is heated up and food is added. The food is then turned over a couple of
times before it is dished out.

 Basting
This method of cooking is usually associated with roasting. The juice or liquid that comes out of the
meat being cooked is spooned over the roast frequently while it is being roasted. The outer part of
the meat is moistened frequently during the cooking process with the juice that is being spooned
over. Usually, the extra juice from the cooked meat is added to a mixture to make the meat sauce.
Basic Table Setting

For a basic table setting, here are two great tips to help you--or your kids--remember the order
of plates and utensils:

1. Picture the word "FORKS." The order, left to right, is: F for Fork, O for the Plate (the
shape!), K for Knives and S for Spoons. (Okay, you have to forget the R, but you get the
idea!)

2. Holding your hands in front of you, touch the tips of your thumbs to the tips of your
forefingers to make a lowercase 'b' with your left hand and a lowercase 'd' with your right
hand. This reminds you that "bread and butter" go to the left of the place setting and
"drinks" go on the right. Emily Post could have used that trick--she was often confused
about which bread and butter belonged to her--and sometimes she used her neighbor's!
In which case, when it was called to her attention, she would say to the dismayed lady or
gentleman, "Oh, I am always mixing them up. Here, please take mine!"

Some other things to know:

 Knife blades always face the plate

 The napkin goes to the left of the fork, or on the plate
 The bread and butter knife are optional

Formal Place Setting

The one rule for a formal table is for everything to be geometrically spaced: the centerpiece at
the exact center; the place settings at equal distances; and the utensils balanced. Beyond these
placements, you can vary flower arrangements and decorations as you like.

The placement of utensils is guided by the menu, the idea being that you use utensils in an
"outside in" order. For the illustrated place setting here, the order of the menu is:

 Appetizer: Shellfish
 First Course: Soup or fruit
 Fish Course
 Entree
 Salad
 

(a) Service Plate: This large plate, also called a charger, serves as an underplate for the plate
holding the first course, which will be brought to the table. When the first course is cleared, the
service plate remains until the plate holding the entree is served, at which point the two plates
are exchanged. The charger may serve as the underplate for several courses which precede
the entree.

(b) Butter Plate: The small butter plate is placed above the forks at the left of the place setting.

(c) Dinner Fork: The largest of the forks, also called the place fork, is placed on the left of the
plate. Other smaller forks for other courses are arranged to the left or right of the dinner fork,
according to when they will be used.

(d) Fish Fork: If there is a fish course, this small fork is placed to the left of the dinner fork
because it is the first fork used.

(e) Salad Fork: If the salad is served after the entree, the small salad fork is placed to the right
of the dinner fork, next to the plate. If the salad is to be served first, and fish second, then the
forks would be arranged (left to right): salad fork, fish fork, dinner fork.

(f) Dinner Knife: The large dinner knife is placed to the right of the dinner plate.

(g) Fish Knife: The specially shaped fish knife goes to the right of the dinner knife.

(h) Salad Knife (Note: there is no salad knife in the illustration): If used, according to the above
menu, it would be placed to the left of the dinner knife, next to the dinner plate. If the salad is to
be served first, and fish second, then the knives would be arranged (left to right): dinner knife,
fish knife, salad knife.

(i) Soup Spoon or Fruit Spoon: If soup or fruit is served as a first course, then the
accompanying spoon goes to the right of the knives.

(j) Oyster Fork: If shellfish are to be served, the oyster fork goes to the right of the
spoons. Note: It is the onlyfork ever placed on the right of the plate.

(k) Butter Knife: The small spreader is paced diagonally on top of the butter plate, handle on
the right and blade down.

(l) Glasses: These can number up to five and are placed so that the smaller ones are up front.
The water goblet (la) is placed directly above the knives. Just to the right are placed a red (lc) or
white (ld) wine glass. A sherry glass, or champagne flute, to accompany a first course or for an
opening toast, go to the right of the wine glasses (le).

(m) Napkin: The napkin is placed on top of the charger (if one is used) or in the space for the
plate. It can also go to the left of the forks, or under the forks if space is tight.

 In General: 
 Knife blades are always placed with the cutting edge toward the plate.
  No more than three of any implement are ever placed on the table, except when an
oyster fork is used in addition to three other forks. If more than three courses are served
before dessert, then the utensil for the fourth course is brought in with the food; likewise
the salad fork and knife may be brought in when the salad course is served.
 Dessert spoons and forks are brought in on the dessert plate just before dessert is
served.

Informal Place Setting

When an informal three-course dinner is served, the typical place setting includes these utensils
and dishes:

Our illustration shows how a table would be set for the following menu:

 Soup course
 Salad or first course
 Entree
 Dessert
 

(a) Dinner Plate: This is the "hub of the wheel" and is usually the first thing to be set on the
table. In our illustration, the dinner plate would be placed where the napkin is, with the napkin on
top of the plate.

(b) Two Forks: The forks are placed to the left of the plate. The dinner fork, the larger of the
two forks, is used for the main course; the smaller fork is used for a salad or an appetizer. The
forks are arranged according to when you need to use them, following an "outside-in" order. If
the small fork is needed for an appetizer or a salad served before the main course, then it is
placed on the left (outside) of the dinner fork; if the salad is served after the main course, then
the small fork is placed to the right (inside) of the dinner fork, next to the plate.

(c) Napkin: The napkin is folded or put in a napkin ring and placed either to the left of the forks
or on the center of the dinner plate. Sometimes, a folded napkin is placed under the forks.

(d) Dinner Knife: The dinner knife is set immediately to the right of the plate, cutting edge
facing inward. (If the main course is meat, a steak knife can take the place of the dinner knife.)
At an informal meal, the dinner knife may be used for all courses, but a dirty knife should never
be placed on the table, place mat or tablecloth.

(e) Spoons: Spoons go to the right of the knife. In our illustration, soup is being served first, so
the soup spoon goes to the far (outside) right of the dinner knife; the teaspoon or dessert spoon,
which will be used last, goes to the left (inside) of the soup spoon, next to the dinner knife.

(f) Glasses: Drinking glasses of any kind -- water, wine, juice, iced tea -- are placed at the top
right of the dinner plate, above the knives and spoons.

Other dishes and utensils are optional, depending on what is being served, but may include:

(g) Salad Plate: This is placed to the left of the forks. If salad is to be eaten with the meal, you
can forgo the salad plate and serve it directly on the dinner plate. However, if the entree
contains gravy or anything runny, it is better to serve the salad on a separate plate to keep
things neater.

(h) Bread Plate with Butter Knife: If used, the bread plate goes above the forks, with the
butter knife placed diagonally across the edge of the plate, handle on the right side and blade
facing down.

(i) Dessert Spoon and Fork: These can be placed either horizontally above the dinner plate
(the spoon on top with its handle facing to the right; the fork below with its handle facing left); or
beside the plate. If placed beside the plate, the fork goes on the left side, closest to the plate
(because it will be the last fork used) and the spoon goes on the right side of the plate, to the
right of the dinner knife and to the left of the soup spoon.

(j) Coffee Cup and Saucer: Our illustration shows a table setting that would be common in a
restaurant serving a large number of people at once, with coffee being served during the meal.
The coffee cup and saucer are placed above and to the right of the knife and spoons. At home,
most people serve coffee after the meal. In that case the cups and saucers are brought tot he
table and placed above and to the right of the knives and spoons.