Nutrition Other Health Professionals

- the study of food and its processes. - Assist with nutrition care
- study of essential nutrients and the process by Includes :
which nutrients are used by the body.
1. Pharmacist
 Ingestion 2. Physical Therapist
 Digestion 3. Occupational Therapist
 Metabolism 4. Speech Therapist
 Circulation 5. Social workers
 Elimination 6. Nursing assistants
7. Home health care aids
Nutrients
Dietary Modification and Dietary Therapy
-substance in food required by the body for energy,
growth, maintenance and repair Diet
Responsibility for Nutrition Care - the sum of food consumed by a person or
other organism
 Cooperative effort of multidisciplinary health
care team Dietary modification
 Physician - prescribes diet orders and other
aspects of nutrition care - Changes made during food preparation,
 Nurses, registered dietician, other health processing, and consumption to increase the
professionals, identity problems suggest bioavailability of micronutrients and reduce
strategies, provides nutritional services. micronutrient deficiencies.

Registered Dietician Diet therapy

- food and nutrition expert  concerned with recovery from illness and
prevention of disease
Role includes :  branch of dietetics concerned with the use of
food for therapeutic purposes
 Conducts nutrition and dietary assessment  it is part of the treatment of a medical
 Develop, implement and evaluate nutrition condition prescribed by a physician
care plans  usually a modification at a regular diet
 Plan and approve menus
 Provides nutrition education 1. Standard diet
 May manage food services in health care
institution - regular diet/general diet

Nurses - include all foods and meets the nutrient needs

of healthy people
- interacts closely with patients
2. Modified diet
- participates as member of nutrition support team - therapeutic diet
- altered by changing food consistency or
 Identify those who would require nutrition nutrient content or by including or
services eliminating specific foods.
 Screen for nutrition problems participates in
nutrition assessment Classification of modified Diet
 Provide direct nutrition care
* Consistency
 - clear liquid TPN Total Parenteral Nutrition
- full liquid  reliably meet complete nutrient requirement
- soft  provide nutrient dense solution for patients
- Mechanical soft diet with high nutrient needs or fluid restriction
- Light diet  preferred for long term IV feedings
- pureed  inserted directly into a large central vein or
- bland via peripheral vein
 Modified consistency
* Nutrient content/ composition - Mashed
- high fiber - Chopped
- low protein - Grounded
-not restricted - Pureed
- low fat Example: Blenderized, Clear liquid,
- low fiber mechanically altered

* Quantity  Modified Nutrient Content

- obesity Fiber - bulk and fiber has been used for all
- vomiting indigestible polysaccharides which remains
- diarrhea after digestion of food.
- diabetes
High Fiber Diet
* Special Method of Feeding - prevent / treat constipation
- obesity ( reduce volume of food )
1. Enteral ( tube feeding) - provision of
nutrition using GI Tract : Low Fiber Diet
- Oral feeding - acute infections in GI Tract
- Tube Feeding ( ngt ) - Ulcerative colitis, severe diarrhea

Enteral Nutrition - selected on basis of Examples:

medical condition, expected duration potential - Fat Restricted
complication of a particular routes: - Fiber Restricted
Main Route : - Sodium Restricted
 Trans nasal – Nasogastric, - High Calorie, High Protein
Nasoduodenal, Nasojejunal
 Gastrostomy Types of Therapeutic Diet
 Jejunostomy 1. Regular Diet

2. Parenteral ( intravenous fluid)  ambulatory patients

 do not have functioning GI Tract
 life saving option - critically ill
 Two main site :
- Central and Peripheral Vein
Peripheral Parenteral Nutrition
 can only provide limited amount of energy
and protein
 Peripheral Vein can be damaged by highly
concentrated solution
 Used most often for short term nutrition
support: 7-10 days
 Rotation of vein sites may be necessary
 Slightly reduced calorie content

2. Liquid Diet
 Nutritionally adequate and used for a short
period of time
 After surgery/ heart attack
 Pts with acute infections/ digestive problems
 Replace fluids ( vomiting/ diarrhea )
 Before some x-rays of digestive tract
 Types of Liquid Diet 6. Calorie Controlled Diet
a. Clear Liquid Diet a. Low Calorie Diet
- water  Overweight patients
- apple or grape juice
- fat free broths b. High Calorie Diet
- used to minimize digestion within the GI  Underweight
tract  Anorexia nervosa
- Fluid and energy are provided in a form to  Athletes
minimize digestion Hyperthyroidism - extra proteins and
calories
b. Full Liquid Diet  Avoid high bulk foods and high fat foods
- clear liquid diet + strained soups and
cereals, fruit and vegetable juices, yogurt, hot 7. High Protein Diet
cocoa, custard, ice cream, pudding, sherbet,
 Additional growth, pregnant and lactating
eggnog
woman
- intended to person who cannot
 Before and after surgery, patients suffering
swallow/chew solid foods
from burns, fever and infections
- Progressive Diet: transition from clear to
 Meat, fish, milk cheese and egg
soft/general diet
 Not for patients with liver and kidney disease
3. Soft Diet
8. Low Protein Diet
 Foods requiring little chewing and easy to
 No Cholesterol
digest
 Patients with CV disease
 Mush / porridge type
 Patients with kidney or liver disease
 Similar to regular diet but food must require
 Should be taken under medical direction
a little chewing and easy to digest
 Avoid meat and shellfish with tough 9. Fat restricted Diet
connective tissue, coarse cereals, spicy foods,
rich desserts, fried food, raw fruits, veggies,  Coronary Heart Disease patients
nuts and coconut  Patients with gallbladder and liver disease
 Progression from full liquid diet to general  Obesity
diet  Avoid cream, whole milk, cheese, fats, fatty
 May be used by a post-operative patient who meat, coconut, fried foods, chocolates
is too ill to tolerate general diet  Purpose: low fat/low cholesterol diet are
designed to reduce serum lipid for the
4. Low residue Diet treatment and prevention of CHD
 Study believes that lowering the levels of
 Patients with digestive / rectal disease such
cholesterol in the blood will prevent the
as diarrhea or colitis
formation of fatty plaques found in
 Low fiber diet
thickening of artery walls known as
 "Rest" the bowel
atherosclerosis
10. Sodium restricted
5. Diabetic Diet
 Patients with cardiovascular disease
 Diabetes Mellitus: Elevated blood glucose
- hypertension or high blood pressure.
concentrations and disordered insulin
Sustained at > 140/90 mmHg
management
- edema
 Polyuria
- Renal Disease
 Polydypsia
- Ascites
 Polyphagia
- avoid addition of salt to food
 Carbohydrate-Controlled Diet
  Used to reduce blood pressure in hypertension
and to promote the loss of excess fluids in
edema due to cardiovascular or renal disease
and in ascites due to hepatic disease
Diet for Hypertensive patient : DASH - Dietary
Approaches to Stop Hypertension - Fruits and
Vegetables
11. Bland Diet
 Eliminate irritants from diet
- junk foods, highly seasoned, carbonated,
salted meat and fish, pastries raw fruit and
vegetables
 Decrease irritation of intestinal Mucosa and
aid in physical comfort
 Designed to provide adequate nutrition during
treatment of inflammatory or ulcerative
condition of esophagus, stomach and
intestine.
Nutrition Care Process
- Systemic approach to medical nutrition
therapy with 4 distinct interrelated steps
Assessment
 Collection of information needed to evaluate
patients condition status and dietary needs
 Information gathered from variety of sources
Diagnosis
 Nutritional individual problem
 Includes specific problem, etiology, signs and
symptoms
 Diagnosis may change over a course of illness
Nutrition intervention
 Action designed to alternate nutritional
problem
 Includes goals and desirable outcomes
 Dietary changes
Nutrition monitoring and evaluation
 Determine the effectiveness of nutrition care
plan
 Goals and outcomes are compared with
assessment data and diagnosis
 Plan of care is modified based on evaluation
Religion and food choice
Roles of food in religion
1. To communicate with God
2. To demonstrate faith through following
religious sites concerning diets
3. To develop discipline through fasting
Religions around the world
Religion which requires particular food rules
 Islam
 Hinduism
 Judaism
 Buddhism (strict)
 Seventh - day adventist Church
 Rastafani Movement
ISLAM
 Prohibited animal flesh : pork
 The quran outlines the foods which can be
eaten (halal) and those forbidden (haram)
 Haram foods (forbidden) : pork, blood,
alcohol, and meat sacrificed to idols
 Beef, lamb, and chicken can only be eaten if
the animal has been slaughtered by the halal
method
BUDDHISM
 Prohibited animal flesh: All
 Buddhist believe that they should not be
responsible for the death of any other living
organism
 Many, but not all Buddhist following strict
vegetarian, if not vegan diet
 WESAK, a festival celebrating the birth,
enlightenment and death of Siddhartha
(believed to be buddha)
HINDUISM
 Prohibited animal flesh: all except lamb,
chicken and fish
 Strict Hindus are vegetarian
 Cow is held in high regard and a symbol of
abundance therefore they don't eat beef
 Some Hindus may also avoid certain food
such as domestic fowl, salted pork, milk,
ghee, onions, garlic, eggs, coconut.
JUDAISM
 Prohibited animal flesh: pork, non-kosher
beef, lamb and chicken
 TORAH outlined which foods are allowed for
Jews to eat
 KOSHER - permissible food
 TREFA - forbidden foods
 Kosher animals have a completely split beef
and chew cud, cow, goat
 Kosher fish must have fins and scales
 All plant foods are kosher, unless damaged or
rot by insects
CHRISTIANITY
 The general beliefs are that there is no
restriction on kinds of animal that can be
eaten
 Some Christians may choose to follow
vegetarian or vegan diet
 There are number of accession in the church
where special food may be eaten, these
includes :
- EASTER
- CHRISTIANS
RASTAFARIAN MOVEMENT
 Prohibited animal flesh: all
 Most are vegetarian or vegans
 ITAL - Foods approved which should be
natural or pure, without the addition of
artificial colors, flavoring or preservatives
 Avoid alcohol and some also avoid tea, coffee
and other caffeinated drinks because these
confuses the soul
SEVENTH DAY ADVENTIST
 Ovu-lacts, vegetarians - they do not consume
animal flesh of any kind but will consume
dairy and egg products.
 Avoid food and drinks that contains caffeine,
does not consume tea and coffee
 Avoids alcohol
NUTRITION IN PRACTICE - ETHICAL ISSUES
IN NUTRITION CARE
New technologies, including availability of
specialized nutrition support, results in difficult
ethical dilemmas
Decision to withhold/withdraw nutrition support
requires careful consideration of ethical principles
MEDICAL FUTILITY
 Medical futile treatments are those that are
highly unlikely to benefit a patient. Ethical
decision to forego or withdraw life sustaining
treatments are accompanied by an
assessment that such treatments would be
medically futile
WITHHOLDING AND WITHDRAWING
MEDICAL TREATMENTS
 Resuscitation
 Mechanical Ventilation Use
 Nutrition and Hydration
END-OF-LIFE ( EOL) CARE
 Active compassionate approach that treats,
comforts, and support persons who are living
with or dying from progressive or chronic
life threatening condition
ETHICAL ISSUES IN NUTRITION
ETHICAL PRINCIPLES
1. Autonomy
 Self-determination by choosing among
available treatment options
2. Beneficence
 Taking action for the patients benefits
3. Non- Maleficence
 Avoiding Harm
4. Justice
 Societal distributive
 Doing what is good for the society as a
whole
 Allocating resources wisely
5. Fidelity
 Truthfulness and faithfulness in delivering
healthcare
6. Advance Directive
 Living will or medical directive
-Include detailed instruction regarding life
sustaining procedure individual wants or
doesn’t want
  Durable power of attorney (or health care
proxy)
-Another person or health care agent is
appointed to act as decision maker in
event of patient incapacitation
-Agent is given comprehensive power to
supervise care, make decisions about
medical staff, facilibility and procedures.
Nutritional Genomics
 New field which includes the study of the
effects of diet on gene expression
 Research suggest that some dietary factors
may have effect (helpful of harmful) in
people with particular genetic variation
Genomics
- The study of genomes
Genome
- Full complement of genetic material in the
chromosomes of cell
Nutritional genomics research strives to:
1. Identify the gene which could cause disease
2. Explain the mechanism of how bioactive
foods could alter the outcome of the gene
3. Develop practical application for which
nutrient levels would help maintain health
along with a whole diet that could prevent or
relieve chronic disease
Genomic research is helpful in these areas
1. Fine tuning nutrient
2. Establishing indicators of nutrient status
3. Understanding how nutrient deficiencies alter
gene expression
Examples of gene interact with Diet
 PKU
 Galactosemia
What is PKU?
Phenylketonuria in its ‘classic’ form : is a rare,
inherited metabolic disease that results in mental
retardation and other neurological problems when
treatment is not started within the first few weeks of
life.
 Characterized by the inability to utilize the
essential amino acid phenylalanine
 Levels of blood phenylalanine : 1mg/dl
 In case of PKU, levels may range from 6-
80mg/dl but are usually greater than 30mg/dl
Enzymatic Activity
In case of PKU, the enzyme that breakdown
phenylalanine, phenylalanine hydroxylase is
completely or nearly completely deficient
This enzyme normally converts phenylalanine to
another amino acid, tyrosine, which is utilized by the
body
When this enzyme, phenylalanine hydroxylase is
deficient or absent, phenylalanine and its breakdown
chemicals from other enzyme routes, accumulate in
the blood and body tissues
Phenylalanine may build in the body and cause brain
damage. This may lead to serious growth and
learning problem such as mental retardation.
What causes phenylketonuria?
Caused by a defect in the gene that makes the enzyme
phenylalanine hydroxylase (PAH). A gene contains
the information needed to make a certain substance.
For a child to inherent PKU, both parents must have
the defective gene.
If the child gets only one defective gene, he may only
be a PKU carrier. A carrier is not usually affected in
any way.
Signs and symptoms of PKU
 May look normal and completely healthy for
the first few months of life.
 If left untreated, signs and symptoms may
appear between 3 to 6 months of age
 Child may begin to be less active and do
things later than other children. He may lose
interest or not pay attention to things around
him.
 Learning speech or behavior problems.
 More irritable, fussy or restless than normal.
 Musty color hair, slim, or urine
 Fair skin
 Short stature (height) or small head
 Skin may be dry or have rashes such as
eczema
  Vomiting or throwing up. Muscle stiffness or
seizures (convulsion)
How is PKU diagnosed?
Blood test
 A newborn screening test is usually done
during your first day of life. A sample of
Childs blood is taken and sent to lab.
How Is PKU treated?
Diet
 A special diet is needed to keep the amount of
phenylalanine in the body low.
 This diet is different from one child to
another. It started as early as the first few days
of life or a few weeks after birth.
 This diet may need to be followed for life
Medicine
 child may be given medicine to treat his
symptoms. Medicine may be given to treat his
rash, vomiting, to control his seizures or t
relax his muscles
Special formulas or product
 there are also called protein substitute that
have little or no phenylalanine. these formulas
have the right amino acids, calories, vitamins
and minerals.
GALACTOSEMIA
Lactose Intolerance
- inability to break down the milk sugar lactose
Galactosemia
- inability to metabolize the milk sugar
component galactose
Arginine Supplementation
- does not appear helpful in patient with
galactosemia
Causes:
Galactosemia is an inherited disorder. This means
that it passes down through families
If an infant with galactosemia is given with milk,
substance made from galactose build up in the infants
system. These substances damage the liver, brain,
kidney and eyes.
Symptoms:
 convulsion
 irritability
 lethargy
 poor feeding ( baby refuses to eat formula
containing milk)
 poor weight gain
 yellow skin and whites of the eye ( jaundice)
 vomiting
Treatment
People with condition must avoid all milk, milk-
containing products ( including dry milk ) and other
foods that contain galactose for life.
It is important to read product label and be an
informed consumer
Infants can be fed with :
 soy formula
 meat-based formula or nutramigen ( a
protein hydrolysate formula)
 another lactose-free formula
 calcium supplement are recommended.
Nutrition education, counselling and referrals
Counselling vs. Education Advice
 giving advice is directive
 educating is conveying information from an
expert to a group of people
 counselling is non-directive, non judgement,
dynamin, empathetic, interpersonal
communication to help someone use
information to make a choice or solve
problem.
Aim and purpose:
 provide the patient important insight into
food-related illness and education regarding
how various nutrients affect illnesses or
obesity
Diet Counselling
 diet counselling provides individualizing FDA
nutritional care for encouraging modification
of eating habits.  Food and Drug Administration of the
 It may also assist in prevention or treatment of Philippines
nutrition related illnesses such as:  Formerly called Bureau of Food and Drugs
 Caries and other oral disorders was created under the department of health
 Cardiovascular disease  to license, monitor, and regulate the flow of
 Cancer food, drugs, cosmetics, medical devices, and
 Obesity household hazardous waste in the Philippines.
 Diabetes  The FDA’s main goal is to ensure the health
and safety of food and drugs made available
in public.
Skills that Facilitate Counselling
 Using helpful non-verbal communication
 Showing interest
 Showing empathy
 Asking open -ended question
 Reflecting back what the client says.
 Avoid judgement
 Praising what client does correctly
 Giving relevant information at a time
 Using simple language
 Giving practical suggestion, not commands

Pinggang Pinoy
 easy to understand
 uses a familiar food plate model to convey
right food group proportion
 per meal basis to meet energy and nutrient
needs of filipino adult
Nurse entrepreneurs
 may build their businesses to develop and
distribute medical products or devices, offer
direct patient care or patient advocacy,
educate or train other professionals or
community members, or provide health care
related consultation and other function.
Nutrition Nurses
 clinical specialist with expertise in nutrition
support who focus on assessing the diets of
patents with various medical condition.