University of Cebu-Banilad Campus

College of Nursing

S.Y 2019 -2020

Banilad, Cebu City

NCM 105 LEC: NUTRITON AND DIET

THERAPY PROJECT ON
THERAPEUTIC DIETS

SUBMITTED BY:

VINZ ALYSSA MAE T. ONO

BSN II-A

SUBMITTED TO:

MAHLOU S. VILLAFLOR, MAN, RN

CLINICAL INSTRUCTOR
 NUTRITION THERAPHY FOR OBESITY AND WEIGHT CONTROL
Obesity is a condition in which the natural energy reserve is increased and considered as hazards to
health. They are prone to heart disease, gallbladder diseases, diabetes, or other chronic disease. The
degree of obesity is often judged by comparing what one weighs with the height-weight table. If one
weighs 10%-19% more than the average for hi/her height and body frame, he or she is overweight; if she
weighs 20% or more, he/she is, therefore, considered obese. Losing weight simply means balancing food
calorie intake with the body’s need for calories. 1 lb of fat is equal to about 3,500 calories. If one has 500
calories less everyday, he or she will lose about 1 lb/week. The state of being overweight and obese is a
condition in which the body stores of fat are enlarged. Underweight or undernutrition results when intake
does not meet the energy requirement. Usually, an underweight person weighs 10%-20% below the
desirable weight.

Prevention of Obesity

 There should be a change in the eating patterns of families so that the recommended calorie
intake for members is followed.
 Children should be encouraged to get more exercise and should be assigned to perform some
chores requiring daily physical activity.
 Pre-school children should not be bribed or rewarded with food. They should have a variety of
activities so that they their mind off the excessive pleasure of acting.

Planning for Weight Loss

1. Planning for weight loss should be directed by a physician.

2. It should set a reasonable goal.
3. It must keep a weekly weight chart.
4. It must include an exercise regimen.

LOW-CALORIE DIET

Women usually lose weight satisfactorily on diets restricted to 1,000-1,500 calories whereas men lose
weight satisfactorily on diets furnishing 1,200-1,800 calories. Bed patients, such as those with heart
disease, are often placed on diets restricted to 800-1,000 calories and sometimes less.

The daily food allowances for the 1,000-1,200 and 1,500 calorie diets are somewhat higher in protein than
normal. It provides most people with a feeling of satisfaction. It also helps correct the greater losses of
muscle tissues that occur during reducing. Usually, the food allowances are divided into 3 approximately
equal meals. Meals with a low-calorie diet should be attractive and palatable. Herbs and spices may be
used to give variety to vegetable and/or meat preparation. Meat, fish, and poultry should be lean and
prepared by boiling, broiling, roasting, and stewing. Fresh fruits or canned unsweetened fruits are used.
Low-calorie diets should not include alcoholic beverages, sweetened fruits, pastries, pies, potato chips,
pretzels, puddings, and others.
 NUTRITION THERAPHY FOR DIABETES MELLITUS
It is a metabolic disease that affects the endocrine system of the body and the use of carbohydrates and
fats. Specifically, there is not enough insulin available for the body’s needs. In some patients, the islets of
Langerhans of the pancreas are unable to produce enough insulin. In other patients, the pancreas requires
some stimulation to manufacture enough insulin, and, in some, the insulin that is produced cannot be
used, for some reason, by the tissues.

Two types of Juvenile diabetes Adult-type diabetes

diabetes:
Occurs at any age from birth through
adolescence. It is severe, requires
insulin for treatment, and is difficult
to manage.
Occurs primarily among obese
people who become diabetic in
middle age. The disease is usually
mild, stable, and well-regulated by
diet alone or by diet and oral
compounds.

Characteristics of Diet
Energy Overweight diabetics are initially placed on low-calorie diets because
weight loss results in better tolerance to carbohydrate. Individuals of
normal weight are given sufficient calories to maintain their weight.
In bed : 11-12 cal/lb
Sedentary : 13-14 cal/lb
Moderately active : 15-16 cal/lb
Protein About 1 ½ g per kg body weight (1/2-2/3 g per lb) is usually allowed. The
higher level is more typical for patients who show a performance for
protein-rich foods.
Carbohydrate and Fat After subtracting the calories provided by protein, the remainder of the
calories for the day is usually divided about equally between
carbohydrate and fat. The number of grams of fat is ordinarily about the
same as the number of grams of protein; the amount of carbohydrate is
roughly twice the number of grams of protein.
The following are the steps in planning the measured diet:

1. Include basic foods to ensure adequate levels of minerals and vitamins: 2 cups milk (3 or more
for children)
5 oz meat, 2 servings vegetables, 2 servings fruit, bread and cereals
2. List the carbohydrate, protein, and fat values for milk, vegetables, and fruit.
3. Subtract the carbohydrate values of these foods from the carbohydrate level prescribed. Divide
the difference by 15 to determine the number of bread exchanges.
4. Subtract the total protein values of milk and meat from the total fat described. Divide the
difference by 7 to determine the number of meat exchanges.
5. Subtract the total fat values for milk and meat from the total fat prescribed. Divide the difference
by 5 to determine the number of fat exchanges.
 NUTRITION THERAPHY FOR DISEASES OF THE
GASTROINTESTINAL TRACT
Peptic ulcer - Is an ulceration The dietary treatment requires the
in the preparation of a bland diet (a nutritionally
protective adequate diet that includes food that has
inside layer of bland flavor and soft consistency, and
the lower mechanically and chemically non-
esophagus, stimulating). Particular emphasis is placed
stomach, or on:
duodenum. 1. Nutritive adequacy
2. Ability of the diet to dilute,
neutralize, or reduce the secretion
of acid by the stomach; and
3. Ability of the diet to avoid
mechanical, chemical, or thermal
irritation.
-
Diverticular - Diverticulitis  A well-balanced diet with variety of
diseases results from the foods and adequate protein is
(diverticulos swelling of recommended
is and small pouches  Acute episodes may require liquids
diverticulitis in the colon
and low-residue foods, excluding
) wall and lining.
roughage. However, some clinicians
Inflammation
develops the are increasingly favoring increased
minute bacteria fiber in the diet rather than less,
and other with more use of bran, whole
irritants are grains, and cellulose foods as a
ensnared means of reducing muscle
causing spasms contractions of the colon and
and pain in the facilitating normal muscle tone.
lower left side  A swelling abates, a high-fiber diet
of the is recommended to lessen straining.
abdomen.
Malabsorpti - a condition in General characteristics of the diet:
on syndrome which the 1. A high-protein diet (100 g or more) is usually
(celiac mucosa of the necessary. Mineral and vitamin supplements are often
sprue) small intestine prescribed.
is damaged by 2. Cereals and breads containing wheat, rye, or oats must
gluten which be omitted. Thickened soups, cooked salad dressings,
results in the cold cuts, breaded meats , meat loaf, and mixes of all
malabsorption
kinds must be avoided. Labels must be read carefully.
of nutrients.
3. Corn and rice cereals can be substituted. Breads
Non-tropical - a diarrheal especially prepared with rice, corn, potato starch, or
sprue condition in wheat can be used to thicken soups, gravies, and
which puddings.
excessive fat is 4. A low-fat fiber diet may be better tolerated during the
excreted in the
 stool initial stages.
(streatorrhea).
Nitrogen,
minerals, and
vitamins are
also excreted in
considerable
amounts so that
the individual
becomes
severely
malnourished.
- Intolerance for
gluten

- an Rest, nutritional 1. High Protein – used with food

Ulcerative inflammatory therapy, sources to supply 120 to 150 grams
colitis bowel disease sulfonamides of protein per day.
of the large 2. High Calories –2,500-3,000
intestine calories a day are needed to spare
limited to the proteins needed for healing and to
rectum and the
restore nutrient deficits from daily
colon which
loss in stools and consequent
causes profuse
and bloody weight loss.
diarrhea. It is 3. Increased Vitamins and Minerals –
characterized Supplements of vitamins and
by severe minerals as well as food sources
diarrhea, rectal are tolerated (grains, fruits,
bleeding, vegetables, protein foods).
cramping, 4. Low-residue Diet – Fairly low in
abdominal residue in acute stages is tolerated,
pain, anorexia, with gradual increases-avoiding
and weight only heavy roughage to prevent
loss. irritation.

Lactose - caused by a Nutritional 1. Lactose-restricted Diet – Milk,

intolerance deficiency of Management milk products, lactose, whey, and
lactase, the casein are avoided.
enzyme which 2. Cottage cheese, aged cheddar
hydrolyzes cheese, and fermented milk
lactose, the products like yogurt can be given
sugar in milk.
depending on the tolerance of the
individual.

- refers to a Nutritional 1. Nil per os(NPO) or “nothing by

Diarrhea frequent loose Management mouth” for 12 hours with IV fluids
or liquid bowel and electrolytes.
movement that
 prevents 2. Oral fluids as condition improves.
complete 3. Liberal fluids to prevent
digestion and dehydration.
absorption. 4. Broths and electrolyte solutions to
Types of Diarrhea: replace Na and K losses.
 Acute – 5. Pectin to help control diarrhea
Diarrhea of less 6. Oral rehydration to be
than 2 weeks administered (¾ tsp salt, 1 tsp
caused by viral, baking soda, 1 cup orange juice, 4
bacterial, or tbsp sugar, and 1 liter water)
protozoan
infections;
medication side
effects; or
altered dietary
intake.
 Chronic –
Diarrhea of
more than 2
weeks resulting
from disorders
like
malabsorption
or PEM or
medical
treatments.

Constipation - condition in Nutritional 1. High-fiber Diet – 20-35 g/day

which a person management, 2. Liberal Fluid Intake – Prunes and
experiences regular exercise prune juice contain laxatives and
hard feces that may be helpful.
are difficult to 3. In acute attacks of spastic
egest. Its constipation, a low-fiber diet can
symptoms are
be given.
lack of
appetite,
lethargy, bad
breath,
distended
stomach, and
caked tongue.
Types
1. Atonic
Constipation
2. Spastic
Constipation
3. Obstructive
Constipation
Intestinal - may be referred Nutritional 1. Exclude food that produces gas.
gas to as increased management 2. Small, frequent meals, and chewing food
occurrence of thoroughly are advised.
passage of gas
or cramping
pain associated
with the build-
up of gas in the
GIT, gas
swallowed, or
gas exchanged
in the GIT and
blood or
produced
during
digestion.
Hemorrhoid - are enlarged Nutritional 1. High-fiber Diet – 25 to 35 g/day to
s veins which Management relieve constipation
occur in the 2. Liberal Fluids – 8 to 10 glasses of
lower part of water per day
the rectum at 3. Highly-seasoned foods and relishes
anal opening. are to be avoided.
External
4. Low-fiber diet is recommended
hemorrhoids
during flare-ups.
crop up when
the rectum
meets the skin
while internal
hemorrhoids
form
completely
within the
rectum. The
causes are
constipation,
prolonged use
of cathartics,
childbearing,
and enemas.
Gastroesoph - take place 1 to Reducing intra- 1. Avoid foods high in fat.
ageal reflux 4 hours after a abdominal 2. Avoid large meals.
disease, meal when a pressure and 3. Limit foods that relax the lower
hiatal hernia, decrease in gastric acid esophageal sphincter.
and sphincter production 4. Increase the intake of foods that do
esophagitis pressure not affect the lower esophageal
or heart burn happens. This
sphincter pressure.
is often caused
5. Maintain the ideal body weight.
by increased
levels of
progesterone
brought about
 by pregnancy;
oral
contraceptives;
smoking; and
certain foods
like chocolates,
soft drinks,
citrus fruits and
juices, and
caffeinated
drinks.
Short bowel - Is a Nutritional 1. Parenteral nutrition support to be
syndrome malabsorption management indicated if enteral nutrition
disorder caused exacerbates symptoms
by resection of 2. Dietary fat restriction
portions of the 3. Frequent monitoring of fluids and
small intestine electrolyte balance
due to an
illness or injury

NUTRITION THERAPHY FOR DISEASES OF THE LIVER,

GALLBLADDER, AND PANCREAS
LIVER

Hepatitis - An inflammation Rest, optimum 1. Protein

of the liver nutritional therapy 2. Energy
Types of hepatitis: 3. Minerals andVitamins
 Hepatitis A 4. Moderate Fat
 Hepatitis B
 Hepatitis C
 Hepatitis D
 Hepatitis E
Cirrhosis - A chronic Rest, supportive 1. In severe cirrhosis of the
degenerative care, nutritional liver, a serious
disease in which therapy complication of ascites
the build-up of (fluid in abdomen), diets
fibrous connective restricted to 250 mg Na
tissue replaces the may be prescribed in an
liver cells effort to control the edema.
following fatty 2. Patients with cirrhosis of
degeneration of the liver are often depleted
long standing. of protein. A protein intake
of 100 g at a sodium level
of 250 mg is possible when
low-sodium milk in the 500
mg sodium, 1,800-calorie
diet plan is used
3. It is no longer believed
 necessary to restrict the
amounts of fats in patients
with cirrhosis of the liver
4. Alcohol is strictly forbidden
to avoid continued irritation
and malnutrition
Hepatic - Happens where Nutritional therapy High calories about 1,500-2,000
coma there is too much calories to prevent tissue catabolism
ammonia in blood and the liberation of additional
circulation nitrogen.

GALLBLADDER

Cholecystitis - Refers to the Nutritional therapy, 1. Low-fat diet may be

inflammation of the reduced discomfort used to avoid stimulus
gallbladder which to the gallbladder
might result from which constricts to
either the formation excrete bile with
of gallstones subsequent pain. Rich
blocking the cystic pastries, chocolates,
duct or infection of nuts, and fatty, fried,
the gallbladder. and gas-forming foods
are avoided
2. Plain and simple foods
are recommended
3. Spices and high-
residue foods must be
avoided as they may
cause distention and
increase peristalsis

PANCREAS

Pancreatitis - Inflammation of Depends on the 1. Acute attacks – NPO for 48

the pancreas due severity of hours to avoid organ
to a decreased pancreatitis itself stimulation
production of the 2. Low-fat, low-elemental
digestive formulas when enteral
enzymes. feeding is appropriate
- This condition 3. In chronic cases, a low to
may result from moderate fat, high CHO, and
biliary tract moderate protein diet
disease and 4. Fluids and electrolytes given
surgery, alcohol intravenously
abuse, and 5. Six feedings daily to
gallbladder facilitate adequate
disease. nutritional intake
Two types:
 Acute
  Chronic
Cystic - A hereditary Improvement of 1. Calories enough to supply
fibrosis disease in which nutritional status demands for growth
the levels of 2. High-protein diet to
sodium and compensate for fecal losses
chloride in tears 3. Liberal fat intake since fat is
and saliva, an important source of
electrolytes in calories
sweat, and 4. Vitamins and Minerals
viscous secretions 5. Liberal fluid intake
in the small
intestine,
pancreas, bile
ducts, and bronchi
become high

NUTRITION THERAPHY FOR CARDIOVASCULAR DISEASES

Atherosclerosi - Hardening of - Drugs 1. Low-fat diet, low in saturated fat

s the arteries and diet and cholesterol
- Thickening of 2. Increase in monosaturated fatty
the inside acids to lower plasma total
walls of the cholesterol and LDL cholesterol
blood vessels levels
- Most common 3. Increase in polyunsaturated fats,
cause of heart the omega-6 (corn oil, soybean
attacks oil, safflower oil, and sunflower
oil) and omega-3 fatty acids
(fatty fish like salmon, tuna,
mackerel, sardines, trout, and
herring) at least 2 servings per
week to decrease plasma
cholesterol levels
4. A total of 300 mg cholesterol
intake per day
5. Increase in complex
carbohydrate intake and
restriction of simple sugars
6. Dietary fiber – 25-30 g/day
7. Restriction of calories to 1,200-
1,600 for women and 2,000-
2,500 for men
Congestive - Or cardiac 1. Sodium-restricted diet is used
heart failure failure is primarily for the prevention,
(CHF) circulatory control, and elimination of
congestion edema.
resulting in the a. Mild restriction (2-3 g Na)
 heart’s  No added table salt (light use in
inability to cooking)
maintain  No salted foods
adequate blood  All other foods as desired
supply to meet b. Moderate restriction (1,000
the oxygen mg Na)
demands  Same as above plus elimination of
salt in cooking and canned
vegetables
 Basic foods as desired,
unprocessed with salt
c. Strict restriction (500 mg
Na)
 Same as that of moderate
restriction plus increased control
of food with higher amounts of
natural sodium (smaller amounts
of eggs, meat, milk limited to 2
cups) and vegetables such as leafy
greens, beets, carrots, and celery
d. Severe restriction (250 mg
Na)
 All the previous restrictions, plus
tighter control of natural food
sources
 Meat limited to 2-3 oz daily
 2-3 eggs per week
2. Calorie control is applied to
reduce the work of the heart.
3. Texture control is applied in
acute stages to aid in digestion.
4. Caffeine should be limited
Hypertension - Also known as Lifestyle 1. A mild restriction of sodium and
high blood modifications, occasionally a 1,000 mg Na diet
pressure. nutritional may be ordered.
- Common therapy 2. Weight reduction may facilitate
among males the lowering of blood pressure
rather than 3. Low-fat diet with emphasis on
females, 55 unsaturated oils is recommended
years and Sources of Sodium:
below 1. Salt is 40% sodium. It is the
principal source of sodium in the
diet. Six grams of salt would
provide 2,400 mg Na. Salt is
used in:
 Food processing (bacon, ham,
dried fish, etc.)
 Baking and cooking
 The table
2. Milk
 3. Meat, fish, poultry
4. Shellfish
5. Eggs
6. Beets and spinach
Myocardial - Heart attack Reduced 1. Liquid diet on the initial stages
infarction (MI) - Results from workload of the and as the condition improves,
atherosclerosis heart progresses to foods of regular
of the coronary consistency
arteries 2. Small, frequent meals
3. Restriction on caffeine-
containing beverages to avoid
myocardial stimulation
4. Sodium, cholesterol, fat, and
calorie restriction
5. Consumption of omega-3 fatty
acid-rich foods to reduce blood
clots

NUTRITION THERAPHY FOR DISEASES OF THE KIDNEYS

Acute - May be deferred Treatment: Nutritional therapy
glomerulonephritis hypersensitivity Diet therapy:
reaction initiated agents 1. Usually a short-term condition so
related with tonsillitis overall nutrition is of greater concern
or scarlet fever or is a with adequate rather than restricted
consequence when an protein.
antigen-antibody 2. No sodium restriction unless edema
complex reaction in is seen.
which some of the 3. High-calorie diet chiefly from
complexes become carbohydrates and fat to spare tissues
ensnared in the from being used as an energy source
glomeruli leads to
swelling.
Nephrotic - Describes a composite Treatment: Nutritional therapy
syndrome of symptoms that can Diet Therapy:
occur as a result of 1. Diet high in protein, 100-150 g daily
injury to the capillary 2. 2. High calorie intake to spare
walls of the glomerulus. proteins for tissue synthesis and to
provide energy.
3. Sodium restriction (500mg)
Acute renal failure - Is a sudden decline of Treatment: Diuretics, nutritional therapy
(ARF) kidney function or Diet Therapy:
abrupt loss of kidney 1. Protein low to moderate according to
function. tolerance:30-50 g
- Three Phases of ARF: 2. Carbohydrates relatively high for
Oliguric Phase, Diuretic energy: 300-400 g
Phase, Recovery Phase 3. Fat relatively: 70-90 g
Chronic renal - Is the decline of kidney 4. Calories adequate for maintenance to
failure (CRF) function. prevent tissue breakdown: 2,000-

Renal calculi - Is the formation of renal Treatment: Nutritional therapy
(Urolithiasis) or urinary calculi in the Diet Therapy:
urine that precipitate as
stones in the urinary
passages.
2,500 g daily
5. Sodium control according to serum
levels and excretion capacities
varying from 1,300-1,900 mg
6. Potassium control according to serum
levels and excretion capacities
varying from 1,300-1,900 mg
7. Water control according to excretion
about 800-1,000 mL; careful intake-
output records vital
1. Fluid Intake – large fluid intake to
dilute urine and help prevent
concentration of stone constituents.
2. Urinary pH – an attempt to control
the solubility factor by increased
acidity or alkalinity, depending on
the composition of the stones formed
3. Stone Composition – reduction of
material composing the stone
Diet According to Type of Stone
a. Calcium oxalate stones – low
calcium, low phosphate or oxalate
according to calcium compound, acid
ash; calcium foods, mainly
dairynproducts, are eliminated; acid
ash foods such as meat, eggs, and
grains are emphasized; alkaline foods
such as milk, vegetables, and fruits
are controlled. Oxalate is found in
beets, chocolates, strawberries, tea,
wheat bran, and rhubarb. Potassium-
rich foods and water are increased.
b. Uric acid stones – low purine (uric
acid is a metabolic product of purine
in the body), controlling purine,
foods such as meat, especially organ
meats, meat extractives, and to a
lesser extent, plant sources such as
whole grains and legumes; alkaline
ash since the stone composition is
acid. Protein is limited to 58-67 g/day
with emphasis on milk, fruits, and
decreased intake of bread products.
c. Cystine stones – rare genetic type;
diet is low, since methionine is the
essential amino acid from which the
non-essential amino acid cystine is
formed, controlling such protein
foods as meat, milk, egg, and cheese;
 alkaline ash since the stone is an acid
composition. High fluid intake is
recommended.

NUTRITION THERAPHY FOR CANCERS

Cancer is a group of many dissimilar diseases categorized by unfettered replication of cells. It is
generally seen as an atypical growth of cells resulting in a mass that invade and destroys normal tissues.
Any substance that is an agent directly involved in the promotion of cancer or in the facilitation of its
propagation called carcinogens.

A carcinogen is the formation of a tumor from initiation, promotion, and progression processes.

KINDS OF TUMOR

Benign tumor - confined to an area where it is originated.

- does not spread to other body parts and not a cancer.
- It would not come back
Malignant tumor -may multiply slowly or rapidly.
- can invade and injure tissues and organs near it and even enter the
bloodstream.

TYPES OF CANCER

Carcinoma - A malignant cancer that arises from the cells of the skin, glandular organs,
and inner linings of internal organs.
Sarcoma - Develops in the muscles, cartilages, connective tissues, and bones.
Glioma - Originates in the CNS and supporting connective tissues in the brain.
Lymphoma - Cancerous growth in the lymph nodes and other tissues of the lymphatic
system.

Nutritional Management

Oral Nutrition - High-calorie, high-protein beverages may be offered.

- In case of lactase deficiency, Lactaid may be given.
Tube Feedings - Complete products (meal replacements that require digestion and
absorption)
- Chemically-defined products (minimal or no digestion; for pancreatic
cancer patients).
- Modular products (used in combination with other tube feeding products to
enhance calorie or protein intake).
- Specialty products (vary in terms of specific amino acid, carbohydrate, and
fat content; for patients with hepatic or renal failure.
Total Parenteral - Used when the digestive tract is not functioning.
Nutrition - Nutrients administered intravenously
 NUTRITION THERAPHY FOR ACQUIRED IMMUNE DEFICIENCY
SYNDROME (AIDS)
Acquired immune deficiency syndrome (AIDS) is caused by human immunodeficiency virus or HIV.
An infected person can transmit the virus through/from: sexual intercourse, blood transfusion, sharing
contaminated needles, mother to child during pregnancy, childbirth, or breastfeeding. Not in mere kissing,
coughing, sneezing, touching, and sharing of utensils.

Nutritional Management

Dietary Management - Energy( 35 to 45 kcal/kg BW)

Alternative Management
- Protein (2 to 2.5 g/kg BW)
- Fats (increase omega-3 sources and decrease
saturated fats in the diet.
- Vitamins and minerals (an increase to be
recommended in case of altered metabolism)
- Common in patients with chronic r terminal illness
- May range from vitamin and mineral
supplementations.