WESTERN MINDANAO STATE UNIVERSITY

COLLEGE OF HOME ECONOMICS

DEPARTMENT OF NUTRITION AND DIETETICS

NORMAL RD., BALIWASAN, ZAMBOANGA CITY

S.Y. 2022-2023

CASE STUDY

ROUTINE HOSPITAL DIET:

CLEAR LIQUID DIET FOR UNCOMPLICATED ACUTE DIVERTICULITIS

PATIENT

PRESENTED TO:

ASST. PROF. JAYASHREE CHUA ANAMA

PRESENTED BY:

ABDURAHMAN, HANNAH FAE H.

DALION, JON CLARENCE C.

DELOS SANTOS, ERICA F.

JORDAN, JESSIEL U.

BSND III

NOVEMBER, 28, 2022

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 VISION

The University of choice for higher learning with strong research orientation that
produces professionals who are socially responsive to and responsible for human
development, ecological sustainability and peace and security within and beyond the
region.

MISSION

The Western Mindanao State University, set in a culturally diverse environment, shall
pursue a vibrant socio-economic agenda that includes:

 A relevant instruction paradigm in the education and training of competent and

responsive human resource for societal and industry needs;

 A home for intellectual formation that generates knowledge for people

empowerment, social transformation and sustainable development; and,

 A hub where science, technology and innovation flourish, enrich by the

wisdom of the Arts and Letters, and Philosophy.

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 TABLE OF CONTENTS
Page no.

CHAPTER I. INTRODUCTION 4
Nature of the Disease 5
Physiology of the organ 6-7
Pathophysiology of the Organ 8
Sign and Symptoms of the disease 9
Possible complications of the disease 10-11
Definition of Terms 12-13

CHAPTER II. Patient’s Profile 14

CHAPTER III. Social History 15

CHAPTER IV. Medical History 16

CHAPTER V. Diet History 17-18

CHAPTER VI.
Diagnosis Or Impression of Present Admission 19

CHAPTER VII.
MEDICAL & NUTRITIONAL INTERVENTION 20
A. Medical Management with Rationale 20-21
B. Diet Prescription 22
C. Dietary Management with Rationale 22-23
D. Computations 24
E. Food Plan & Meal Distribution 25
F. Sample Menu 26

CHAPTER VIII. Progress And Prognosis 27-31

CHAPTER XI. Dietary Instructions 32-35
CHAPTER X. Conclusions and Recommendations 36-37
BIBLIOGRAPHY 38

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 CHAPTER I

INTRODUCTION

Diverticulosis is a clinical condition in which the gastrointestinal tract develops

several sac-like protrusions (diverticula). Although either the small or big intestines' walls can
have weak spots where diverticula can form, the large intestine is where they most frequently
do (most commonly the sigmoid colon).

The majority of individuals with diverticulosis are asymptomatic. Diverticular disease occurs
when there is symptomatic diverticulosis (e.g., diverticular bleeding); diverticulitis (e.g.,
acute or chronic inflammation that may or may not is complicated by abscess formation,
fistula formation, bowel obstruction, or perforation); or associated segmental colitis (e.g.,
inflammation in segments of the mucosal segments of the colon in between diverticula)

Diverticulitis occurs in approximately 4% to 15% of patients with diverticula, and the

incidence increases with age. On average, patients admitted for diverticulitis are about 63
years old. The overall incidence of diverticulitis continues to rise, with a 26% jump from
1998 to 2005, and the largest increases were seen in patients between the ages of 18 to 44
years old. Under the age of 50, diverticulosis is more common in males, whereas between the
ages of 50 to 70, the disease is seen slightly more often in females. Over the age of 70, there
is a significantly greater incidence of diverticulosis in females.

The risk of diverticulitis and bleeding is significantly higher in patients with obesity or larger
waist circumference. Smokers have been noted to have an increased incidence of diverticular
abscess formation or perforation. Medications associated with an increased risk of
diverticular bleeding or diverticulitis include nonsteroidal anti-inflammatory drugs, opiates,
and steroids.

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NATURE OF THE DISEASE

Diverticula are usually seen on colonoscopy. Recent studies have shown that the detection
rate of colonoscopy for left-sided diverticular disease is lower than barium enema. Follow-up
barium enema for diverticular disease of the left colon is a potential area to study and
improve clinical practice.

Diverticula are small, bulging pouches that can form in the lining of your digestive system.
They are found most often in the lower part of the large intestine (colon). Diverticula are
common, especially after age 40, and seldom cause problems.

Diverticular disease is classified based on whether it is uncomplicated diverticulosis or it has

been complicated by diverticulitis. A summary is given below;

 Type 0: Asymptomatic diverticulosis

 Type I: Acute uncomplicated diverticulitis
 Type II: Acute complicated diverticulitis
 Type III: Chronic diverticular disease

Complicated diverticular disease is further classified using the Hinchey classification system,
which is largely based on CT findings.

 Stage 1: Phlegmon (1a) or diverticulitis with pericolic or mesenteric abscess (1b)

 Stage 2: Diverticulitis with walled-off pelvic abscess
 Stage 3: Diverticulitis with generalized purulent peritonitis
 Stage 4: Diverticulitis with generalized fecal peritonitis

PHYSIOLOGY OF THE ORGAN

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 Figure 1. Small and Large Intestine Physiology

Small and Large Intestines has its different function when it comes to digesting. When food
leaves your stomach, it enters the small intestine, also called the small bowel. The small
bowel connects to the large bowel, also called the large intestine or colon. The intestines are
responsible for breaking food down, absorbing its nutrients and solidifying the waste.

Transverse Colon

A section of the large intestine that runs across the abdomen. It is where the body absorbs
water and salts from material that it cannot digest. Later, this becomes feces. A number of
conditions can affect the colon, including Irritable Bowel Syndrome (IBS), polyps,
diverticulosis, and cancer.

Ascending Colon

It is located in the digestive tract between the end of the small intestine and the second part of
the colon, the transverse colon. It is also sometimes called the right colon.

Descending Colon

is a section of the large intestine. It is the left part of the colon that passes downward. It is
responsible for storing the remains of digested food before they pass through the rest of the

6
colon and rectum for elimination. The large intestine plays a role in the absorption of
nutrients.

Cecum

A pouch that forms the first part of the large intestine. It connects the small intestine to the
colon, which is part of the large intestine. Enlarge. The cecum connects the small intestine to
the colon.

Appendix

is a small, thin pouch about 5 to 10cm (2 to 4 inches) long. It's connected to the large
intestine, where poo forms. Nobody knows exactly what the appendix does, but removing it is
not harmful.

Small intestine

It helps to further digest food coming from the stomach. It absorbs nutrients (vitamins,
minerals, carbohydrates, fats, proteins) and water from food so they can be used by the body.
The small intestine is part of the digestive system.

Sigmoid Colon

The S-shaped section of the colon that connects to the rectum.

Rectum

is the last several inches of the large intestine. It starts at the end of the final segment of your
colon and ends when it reaches the short, narrow passage leading to the anus.

Anal Canal

is a tube at the end of your rectum that measures 1 1/2 inches in length (about 4 centimeters).
Muscles (anal sphincters) that surround the anal canal relax to allow waste to leave your
body.

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PATHOPHYSIOLOGY OF THE ORGAN

Diverticula occur in weaker portions of the colonic wall where the vasa recta infiltrate the
circular muscular layer. The vast majority of colonic diverticula are typically “false”
diverticula, which are mucosa and submucosa herniating through a defect or weakness in the
muscularis layer, covered externally only by serosa. True diverticula are much more
uncommon (e.g., Meckel’s diverticulum) and involve outpouching of all layers of the
intestinal wall (e.g., mucosa, muscularis, and serosa).

A major predisposing factor for the formation of colonic diverticula is abnormal colonic
motility (e.g., intestinal spasms or dyskinesis), resulting in exaggerated segmental muscle
contractions, elevated intraluminal pressures, and separation of the colonic lumen into
chambers. As the sigmoid colon is the colon segment with the smallest diameter, it is also the
segment with the highest intraluminal pressures. Connective tissue disorders such as Marfan
syndrome, Ehlers-Danlos syndrome, or autosomal dominant polycystic kidney disease may
also predispose an individual to colonic diverticula formation as these diseases often involve
structural changes (e.g., weakness) in the intestinal wall.

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SIGNS AND SYMPTOMS OF THE DISEASE

Diverticulosis is thought to occur due to peristalsis abnormalities (e.g., intestinal

spasms), intestinal dyskinesia, or high segmental intraluminal pressures. Although the exact
cause is unknown, some environmental and lifestyle risk factors have been linked to this
condition. Several studies have suggested that a diet low in fiber and high in red meat may be
associated with an increased risk of diverticulosis, although a diet high in fiber will not
reduce the symptoms of an uncomplicated diverticular disease. In patients with symptomatic
complicated diverticular disease (e.g., inflammation or bleeding), there may be a benefit from
a diet high in fiber by decreasing overall inflammation and favorably changing the intestinal
microbiota.

The risk of diverticulitis and bleeding is significantly higher in patients with obesity or larger
waist circumference. Smokers have been noted to have an increased incidence of diverticular
abscess formation or perforation. Medications associated with an increased risk of
diverticular bleeding or diverticulitis include nonsteroidal anti-inflammatory drugs, opiates,
and steroids.

The signs and symptoms of diverticulitis include:

 Pain, which may be constant and persist for several days. The lower left side of
the abdomen is the usual site of the pain. Sometimes, however, the right side of
the abdomen is more painful, especially in people of Asian descent.

 Nausea and vomiting.

 Fever.

 Abdominal tenderness.

 Constipation or, less commonly, diarrhea.

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POSSIBLE COMPLICATION OF THE DISEASE

Usually, diverticulosis is asymptomatic or results in rectal bleeding. In the absence of colitis

or diverticulitis, the symptomatic uncomplicated diverticular illness manifests as persistent
abdominal pain attributable to diverticula. Inflammation of the diverticular mucosa without
involvement of the diverticular orifices is known as segmental colitis. Diverticulitis is
characterized as a diverticulum's inflammation. It may be acute or chronic, simple or difficult.
An abscess, fistula, bowel blockage, or free perforation might aggravate diverticulitis. A
fistula between the colon and nearby viscera may develop as a result of diverticula
inflammation. Colovaginal fistulas and colovesical fistulas are the two types of fistulas that
most frequently affect the bladder and vagina, respectively. Pneumaturia, fecaluria, or dysuria
are the presenting symptoms of a colon fistula.

Perforation

Diverticulitis causes tiny tears, called perforations, in the bowel walls. These weaken the
colon walls and, if they grow larger, can spill bowel contents into the abdominal cavity. This
can lead to infection and inflammation in the abdomen, called peritonitis.

Peritonitis is a medical emergency that requires immediate surgery to clear the abdominal
cavity. Part of the damaged colon may need to be removed. If peritonitis isn’t treated, it can
be fatal.

In addition, about 1 to 2 percent of larger perforations can lead to abscesses and fistulas.

Abscess and Phlegmon

An abscess forms when a pocket in the bowel becomes infected and fills with pus. A
phlegmon is the infected and inflamed area near the abscess. Both form along the wall of the
colon as a result of diverticulitis.

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Abscess symptoms include sore abdomen, fever, nausea, and vomiting. Up to 30 percent of
people who develop acute diverticulitis (one or more temporary attacks marked by infection
or inflammation) may also develop an abscess. A small abscess might be able to be treated
successfully with antibiotics. If it’s large or doesn’t respond to treatment, doctors will need to
surgically drain the pus and may even need to remove some of the damaged bowel tissue.

Bowel Obstruction

A bowel obstruction is a blockage in the colon. You can have a partial block or complete block of the
large intestine. It’s caused when scarring or inflammation makes the colon too narrow for stool to
pass. This narrowing process is called stricture formation.

A complete block requires emergency surgery to clear the path, while a partial block can be
surgically corrected at a later date.

Symptoms include severe constipation, bloating, vomiting, and abdominal pain.

Rectal Bleeding

Rectal bleeding caused by diverticulitis is not incredibly common, happening in about 17

percent of those with chronic diverticulitis, which is an ongoing form of the disease that never
clears up entirely. When it happens, it can be severe. Diverticular pouches can damage the
blood vessels in the colon wall, resulting in bleeding.

There are no symptoms of bleeding other than seeing red- or maroon-colored blood in the
bowel movements.

Sometimes bleeding stops on its own, if it’s mild. In severe cases, a hospital stays, blood
transfusion, and surgery may be required.

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DEFINITION OF TERMS:

Barium Enema – is a test that helps to highlight the large bowel so it can be clearly seen on

an X-ray.

Colonoscopy - is an exam used to look for changes — such as swollen, irritated tissues,

polyps or cancer — in the large intestine (colon) and rectum.

Dyskinesis - is an alteration or deviation in the normal resting or active position of the

scapula during shoulder movement.

Dietary Fiber - also known as roughage or bulk, includes the parts of plant foods your body

can't digest or absorb.

Non – inflammatory – green leafy vegetables, such as spinach, kale, and collards. nuts like

almonds and walnuts. fatty fish like salmon, mackerel, tuna, and sardines. fruits such as

strawberries, blueberries, cherries, and oranges.

Non – steroidal – are medicines that are widely used to relieve pain, reduce inflammation,

and bring down a high temperature.

Opiates – are substances that act on opioid receptors to produce morphine-like effects.

Medically they are primarily used for pain relief, including anesthesia. Other medical uses

include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid

overdose, and suppressing cough.

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Perforation – is a hole that develops through the wall of a body organ. This problem may

occur in the esophagus, stomach, small intestine, large intestine, rectum, or gallbladder.

Protrusions – protrusion of an organ through an abnormal opening; commonly called a

rupture.

Steroids - also called corticosteroids, are anti-inflammatory medicines used to treat a range of

conditions.

Stricture Formation – is a distinctive feature of Crohn's disease (CD) and a frequent

indication for surgical intervention. The etiology of stricture formation in CD is unclear but

both excess collagen deposition and smooth muscle cell accumulation may contribute.

Vasa Recto - numerous small vessels that arise from the terminal branches of arteries

supplying the intestine, encircle the intestine, and divide into more branches between its

layers.

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 CHAPTER II

PATIENT’S PROFILE

A. Patient’s data:

Name: Mr. Macario S. Fernandez

Gender: Male
Age: 48 years old
Birthday: March 12, 1974
Address: Surabay, R.T. Lim, Zamboanga Sibugay
Civil Status: Married
Religion: Roman Catholic
Nationality: Filipino
Dialect: Cebuano/Bisaya
Occupation: Carpenter

Patient Status:

Height: 163 cm / 5’4”

Weight: 73 kg

Date of Admission: June 16, 2019 / 9:32 A.M.

Chief Complaint: Mild Constipation, LLQ Pain, Lumpy Tarry Stools

Admission Diagnosis: Abdominal Pain to fever etiology to be determined,

Diverticular Infection.

Admitting Physician: Dr. Jufferio C. Tan, MD

Attending Physician: Dr. Lorenzo J. Alante, MD

Diet Prescription: Clear Liquid Diet (No Dark Foods: Red or Purple) to low-residue
diet. No spicy and high fiber foods when therapy is ongoing.

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 CHAPTER III

SOCIAL HISTORY

Mr. Macario is a 48 year-old residing at Surabay, R.T. Lim, Zamboanga Sibugay. He

is a married man and a father of 4 children. One of his relatives works in an abbotoir,

thus leads access for them having meats to be eaten thrice a week. He works as a

carpenter since 2008. Since Mr. Macario was so dedicated to his job, it makes him

more busy the whole week. During weekends, he went to another barangay for extra

carpentry service that adds for his daily income. Drinking alcohol after work will

always be present together with his work companion as he believes that it can

always do ease the tiredness that he had. He does not engage in exercise as he

believes that it’s just a waste of time.

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 CHAPTER 4

MEDICAL HISTORY

Mr. Macario S. Fernandez weighs 73 kg and stands 5 feet and 4 inches tall with a
nutritional status classification of Overweight (27.65 kg/m 2). The patient has no
previous hospitalization.

In 2016, Mr. Macario last visited the hospital for check-up due to severe headache
and overfatigue. It later reveals. That Mr. Macario has blood pressure of 190/100
which stands the value of being hypertensive. It shows no symptoms of fever and the
results below provides a slightly elevated blood urea nitrogen, creatinine and
electrolyte value except for potassium (K+). He was given a drug to be taken twice a
day particulary amlodipine every after meal but sometimes forgotten to take due to
busy time.

TEST RESULT NORMAL VALUES

BUN 21 mg/dl 5-20 mg/dl

Creatinine 1.5 mg/dl 0.6-1.2mg/dl

(Serum Electrolyte Value) 136 mEq/L 135-145 mEq/L

Na+

K+ 3.3 mEq/L 3.6-5.0 mEq/L

Cl 112 mEq/L 101-111 mEq/L

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 Table 1. BUN, Creatinine and Serum Electrolyte values level result in 2016

CHAPTER 5

DIET HISTORY

Mr. Macario hates to serve vegetables unto their table since he always complains
about it’s effect unto his digestive tract by giving him stomach upset when he was still
young up until he reach 40’s. Coffee will always be present in the morning and even
as he go home from work. Upon observing the patient’s food recall, the portion is
higher than the expected amounts consumed in line with Mr. Macario’s daily intake
value. He consumes fruits in very limited amounts. Sometimes, he access the foods
preferred according to kinds that is available at work especially sesame bread balls
(binangkal), slice bread. Meat products available in certain food stores near his
workplace.

FOOD HISTORY

(24 HOUR TYPICAL FOOD INTAKE)

Breakfas HH. Lunch HH Supper HH. Snacks HH.

t Meas. Meas. Meas. Meas.
Plain 2 cups Plain Rice 2 cups A.M
Slice 4 pcs Rice SNACK 2 pcs
Bread
Siopao
pork
filling

Fried 2 pcs 2 pc
Plain Rice 1 cup Bihon 1 ½ cup Galunggon Binangkal medium
Guisado g Bread & size
Coffee ( 1 binangkal
cup)
P.M.
Coffee 1 cup Snack

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 Balut 1 pc

Corned 1 cup
Beef w/
egg
Table 2. FOOD RECALL OF PATIENT

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 CHAPTER VI

Diagnosis Impression on Present Admission

Chief complaint:

Mild Constipation

Left Lower Quadrant Pain

Lumpy Tarry Stools

Admission Diagnosis:

Abdominal pain to fever to be determined, diverticular infection.

Final Diagnosis: Acute Uncomplicated Diverticulitis

Admitting Physician:

Dr. Jufferio C. Tan, MD

Attending Physician:

Dr. Lorenzo J. Alante, MD

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 CHAPTER VII

Medical and Nutritional Intervention

A. Medical Management
Medical management refers to the planning and coordination of health care services
appropriate to achieve the goal of medical rehabilitation. This chapter includes the
type drug appropriate for the patient’s condition. This do requires the evaluation of
medical condition, developing and implementing a plan of care, coordinating medical
resources, communicates health care needs to the individual, monitors an individuals’s
progress and promotes cost-effective care. Drug dosage was indicated, according to
patient’s appropriate category. The drug stated below is intended for both in and
outpatient. The drug was prescribed to patient as an oral therapy for acute
uncomplicated diverticulitis.

MEDICINES DRUG INDICATION RATIONALE

DOSAGE

Metronidazole ADULT 500 -used to treat Used to treat infections caused by certain
(flagyl) 500mg mg taken by abdominal, vaginal bacteria. . To provide adequate coverage of
mouth every and intestinal gram-negative rods and anaerobic bacteria,
6 hours ( 7- infections. patients with acute diverticulitis treated as
10 days) Metronidazole outpatients should receive metronidazole
works by killing combined with a quinolone or with
bacteria and trimethoprim-sulfamethoxazole (bactrim,
parasites . septra) or amoxicillin-clavulanate
(augmentin)

Amoxicillin- ADULT – -used to treat mild – Amoxicillin and clavulanate combination is

clavulanate 375 moderate- to severe used to treat bacterial infections in many
(augmentin) mg( three infections different parts of the body. Amoxicillin and
500 mg every times a day) clavulanate combination is an antibiotic that

20
eight (8) hours. tid . belongs to the group of medicines known as
Best taken at penicillins and beta-lactamase inhibitors.
the start of
meals for
better
absorption
and reduce
GI
discomfort.

-Seticimia, intra- This helps to avoid the spread of infection

Clindamycin ADULT: abdominal and is appropriate to be given to patient who
(Cleocin) 150-450 mg infections, lower are in a clear liquid diet. This will be taken
orally every respiratory especially when the patient is staying at
6-8 hrs; infections, their home receiving care and assistance to
gynecological somebody that stays at home too.
infections, bone and
joint infections, skin
to skin structure
infections.
Used to treat Since high fiber foods is temporarily be
Bisacodyl constipation, helps restricted, taking laxatives will help aid the
Dulcolax to clean out constipation.
(Laxative) intestine before
bowel examination
or surgery and it
helps stool to come
out.
Table 3. Medical Management Table Indicated Type of Drug and Dosage to Patient
with Acute Uncomplicated Diverticulitis

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B. Diet Prescription

From clear liquid diet to low residue diet/ low fiber diet –

-To patients with diverticulitis, diet prescription includes the progression of the diet
from clear liquid- low residue diet- regular diet that is low in fiber. The addition of
low fiber after clear liquid does not imply to worsen the condition of the patient but to
limit the ability of forming semi-solid texture of stool, since the patient takes
antibiotic, modifying it’s diet is necessary in order to avoid further infection when
stools are subjected to pass in the linings of colon (esp. when formation of diverticula
is already present).

C. Dietary Management with Rationale

Clear Liquid- Low Residue Diet/ Low Fiber Diet- High Fiber diet

DIET RATIONALE
A clear liquid diet is prescribed for short periods for specific medical
CLEAR purposes. It helps gastrointestinal tract heal from severe bouts of
LIQUID disease, such as diverticulitis, and it helps clear it out before certain
tests and procedures, such as colonoscopy. It should be consume a day
before or 24 hrs before the colonoscopy- solid foods are restricted.

LOW After a clear liquid diet, a low-residue diet is highly prescribed after
RESIDUE days subjected to a clear-liquid diet. This is being done in order to
DIET achieve minimum nutrient requirements to achieve good nutrition
while healing the part of the organ affected.

LOW FIBER A low fiber may reduce GI discomfort during flares of diverticulitis by
DIET reducing frequency of stools. While with diverticulitis: follow a low
fiber diet usually 10-15 grams of fiber per day. Low fiber can also be

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 used especially one-1 day before the day of starting clear liquid, in
order to lessen the frequency of bowels and for effective bowel
cleanse.

HIGH FIBER If patient can already tolerate foods rich in fiber, and his healed, this is
DIET a great chance to help the patient consume vegetable and fruits which
can allow his digestive system cleansed after months of undergoing a
previous diagnostic procedure.

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D. Computations
DBW: NPC:
= 112 lbs + (4) ( 4lbs) = 58 kg x 1.1
= 112 lbs + 16 = 63.8 or 65g
= 128 lbs ÷ 2.2 = 65g x 4
= 58kg = 260 kcal

= 1,700 kcal - 260 kcal

= 1,440 kcal

BMI: DISTRIBUTION:
= 64 inch x 2.54 cm
= 162.56 cm ÷ 100 cm CHO= 1,440 x .70 = 1,008 ÷ 4
= 1.6256 cm x 1.6256 cm = 252 or 250g
= 2.64m2
FAT= 1,440 x .30 = 432 ÷ 9
= 73 kg ÷ 2.64m2 = 48 or 50g
= 27.65 kg/m2 = OVERWEIGHT

TER: DX:
= 58 kg DBW x 40 kcal/kg DBW
= 2,320 kcal x 0.05 (age deduction) Kcals= 1,700 kcals
= 2,320 kcal - 116 CHO= 250g
= 2,204 kcal or 2,200 kcal – 500 CHON= 65g
= 1700 FATS= 50g

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FOOD PLAN

Food Group # of HM C P F Kcal B AM L PM S BS

Ex
Vegetable 4 ½ cup 12 4 - 64 2 2
Fruit 3 V 30 - - 120 1 1 1
Milk Low 1 V 12 8 5 125 1
Fat
A 2 V 46 - - 184 1 1
B 5 V 115 10 - 500 2 2 1
Rice C 1 V 23 4 - 108 1
LF 2 V 16 2 82 2
Meat MF 3 V 24 18 258 2 1
HF V
Fat 5 1 tsp - - 25 225 1 2 2
Sugar 3 1 tsp 15 - - 60 2 1
253g 66g 50g 1,726
TOTAL kcal

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SAMPLE MENU

MEAL MENU HOUSEHOLD MEASURE

BREAKFAST Slice of Banana Ripe 1/2
Scrabbled egg w/ sardines
- sardines in tomato sauce (strained) 2 pcs
- pc medium egg 1
Boiled Rice 1 cup
Fat for frying 1 tsp
A.M, SNACK
Kutsinta 2 pcs
Low Fat Yoghurt/ Yakult 1/2 cup

LUNCH
Chicken Pastel
Chicken Breast 2 slice
Mixed Vegetables 1/4 cup
Boiled Rice 1 cup
Ripe papaya 1 slice
Fat for sauteing 2 tsp
P.M. SNACK
Champorado
Protein-Reduced Rice 1/3 cup
Cocoa Tablet 2 pcs
Sugar for champorado 1 tsp

SUPPER
Chicken Vegetable Soup w/ patis
-Chicken Thigh 1 pc
-Chayote (chopped) 1/2 cup
- Boiled rice 1/2 cup
-Watermelon 1 slice

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 -Fat for sauteing 2 tsp
BT SNACK Loaf Bread 2 pcs
Fruit Jam/Jelly 2 tsp

27
 CHAPTER VIII

PROGRESS AND PROGNOSIS

A colonoscopy result in June 20,2019 9:30 A.M. and procedure images attached to a
document to see the evidence of Mr. Macario’s colonic wall condition.

28
29
30
STOOL EXAMINATION DIVERTICULITIS

DATE: 06/ 21/ 19

TEST RESULT
PHYSICAL EXAMINATION OF STOOL
Colour Black and Tarry
Consistency Loose
Blood Present
Mucus Present
CHEMICAL TEST
Occult Blood Present
MICROSCOPIC EXAMINATION
White Blood Cells Present
Red Blood Cells Absent
Epethelial Cells Absent
Bacteria Present

VITAL SIGNS

DATE & B/P R.R P.R TEMP.°C O² SAT

TIME mmHg BPM BPM
06/16/19 125/70 18 117 39.8 95
Initial
9:40 A.M. 120/70 17 100 39.8 95
1:00 P.M. 100/80 20 95 39.1 98
5:40 P.M. 100/60 22 90 38.0 98

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DATE & B/P R.R P.R TEMP.°C O² SAT
TIME mmHg BPM BPM
06/17/19
6 A.M. 110/60 15 87 37.9 97
10 A.M. 110/60 16 90 38.5 96
2 P.M. 120/80 15 89 37.7 98
6 P.M. 100/70 16 91 36.5 97
10 P.M. 110/80 15 88 36.6 98
2 A.M. 110/80 16 87 36.6 98

DATE & B/P R.R P.R TEMP.°C O² SAT

TIME mmHg BPM BPM
06/18/19
6 A.M. 120/80 15 80 36.6 97
10 A.M. 120/60 16 91 36.6 98
2 P.M. 110/70 15 91 36.7 96
6 P.M. 120/80 16 90 36.6 96
10 P.M. 130/90 16 88 36.5 97
2 A.M. 150/90 16 87 36.6 97

DATE & B/P R.R P.R TEMP.°C O² SAT

TIME mmHg BPM BPM
06/20/19
6 A.M. 100/80 16 90 36.5 98
2 P.M. 100/70 15 89 36.6 97
6 P.M. 100/80 16 89 36.7 96
10 P.M. 100/60 16 90 36.6 96
2 A.M. 100/60 16 91 36.6 97

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DATE & B/P R.R P.R TEMP.°C O² SAT
TIME mmHg BPM BPM
06/24/19
6 A.M. 110/70 16 90 36.8 96
10 A.M. 110/80 16 90 36.7 97
2 P.M. 100/70 15 89 36.5 96
6 P.M. 110/80 15 89 36.5 98
10 P.M. 100/80 16 88 36.6 98
2 A.M. 110/80 16 88 36.6 98

DATE & B/P R.R P.R TEMP.°C O² SAT

TIME mmHg BPM BPM
06/27/19
6 A.M. 100/60 15 91 36.8 98
10 A.M. 100/80 15 91 36.6 96
2 P.M. 110/60 16 90 36.7 97
6 P.M. 110/80 16 89 36.6 97
10 P.M. 100/70 17 89 36.5 97
2 A.M. 110/80 17 89 36.6 98

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 CHAPTER IX

DIETARY INSTRUCTION

CLEAR LIQUID DIET

FOODS ALLOWED FOODS AVOIDED

 Clear of fat-free both  -Fruits and vegetables hard cooked and

soft cooked
 Water  Meat
 Coffee/Tea with no added  Grains
milk/cream  Cream soups
 Strained clear fruit juices w/o pulp  Noodle cup
such as apple juice / lemonade  Milk and Milk alternatives
 Clear sodas like ginger ale or  Creams
sprite
 Juice with nectars or with pulp such as
 Carbonated drinks like cola. orange

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  Sports drinks like Gatorade.  Spices are highly restricted
 No alcohol is allowed
 Popsicles or ice drops without solid  Avoid Milkshakes and smoothies
fruit  Any gelatin, popsicles, or ice drops with
fruit or toppings
 Hard candies like lemon drops or  Chocolate
lollipops  Ice cream
 Plain gelatin without fruit or whipped  Yogurt and sherbets
cream
If colonoscopy procedure follows on the next
day, avoid foods that is color blue, red and
purple to avoid wrong impression during
colonoscopy as it can be a blood-like color in a
intestine. This diet can only be used a day ( 24
hrs) before the colonoscopy.

LOW-RESIDUE/LOW FOODS ALLOWED FOODS AVOIDED

FIBER DIET

Bread, Cereals, Rice, and

Pasta
For milder cases of
diverticulitis, eat a low-fiber,
or GI soft, diet. A low-fiber
diet limits fiber intake to
between 8 and 12 grams of
fiber, depending on the
severity of the flare-up
2. Fruit
 
 Enriched white bread,
1. Bread, Cereals, Rice, and
rolls, biscuits, muffins, Pasta 
crackers   Bread products
made with whole-
 French toast,
grain flour, seeds,
pancakes, and
waffles 
nuts, fruit, 
 Refined cold cereals:  Cornbread and
puffed rice, puffed graham crackers 
wheat, corn flakes Brown rice, wild rice,

 White rice pasta and buckwheat -
whole grain cereals,
 Canned or cooked bran cereals,
fruits  granola-type
cereals, and cereals
 Strained fruit juice  with nuts, seeds,
 Ripe bananas  coconut, or dried

35
  Soft melon
3. Milk and Dairy Products
 Milk, yoghourt,
custard, and ice
cream  
 Cheese and cottage
cheese
4. Vegetables
 Well-cooked and
canned vegetables
without seeds  4. Vegetables
 Lettuce 
 Strained vegetable
juice 
 Potatoes without skin
5. Meats, Poultry, Fish, and
Eggs
 Ground,
well-cooked/tender
beef, lamb, ham, veal,
pork, fish, poultry, and
organ meats.
 eggs
6. Fats, Condiments, and
Beverages
 Butter, oils,
mayonnaise, sour
cream, salad
dressing, plain
gravies  6. Fats, Snacks,
 Sugar, clear jelly,
honey, and syrup
 Spices, cooked herbs,
bouillon, broth, and
soups made with
recommended foods  
 Coffee, tea, and
carbonated beverages
-plain cakes and
cookies  
 Gelatin, puddings,
custard, ice cream,
sherbet, popsicles
36
fruit 
2. Fruit
 Raw or dried fruit 
All berries 
 Prune juice
3. Milk and Dairy Products
 Yoghurt with nuts or
seeds
 Raw vegetables and
vegetables with
seeds
 Sauerkraut, winter
squash, and peas 
 Broccoli, brussels
sprouts, cabbage,
onions, cauliflower,
baked beans, corn
 Potatoes with skin.
5. Meats, Seeds, and Nuts
 Tough, fibrous
meats with gristle 
 Dry beans, peas,
and lentils 
 Peanut butter
Condiments, and Beverages
 Nuts, seeds,
coconut 
 Jam, marmalade,
and preserves 
Pickles, olives,
relish, and
horseradish 
All desserts
containing nuts,
seeds, dried fruit,
coconut or made
from whole grains or
bran 
 Candy made with
nuts or seeds 
  Popcorn

HIGH FIBER-FOODS
FOODS ALLOWED
These are the allowed foods under high-
fiber diet and this includes first is fruits such
as Apple w/ skin, Banana, Mangoes, Guava,
Strawberries, raspberries and persimmons
-Wheat breads, brown rice, wild rice, peas,
lentils, sprout, oats, wheat crackers.
-For vegetables although most of them
contains fiber, the following type of
vegetable contain most of high amounts:
carrots, broccoli, artichokes, squash.
FOODS AVOIDED
The following foods are cannot be avoided
but rather has a low amount of dietary
fiber that can’t reach the required amount of
fiber needed.
-Refined breads
-Eggs, tofu, and creamy peanut butter
-White rice and pasta
-Baked goods such as cakes, pancakes,
waffles, biscuits.
-Canned vegetables, apple sauce,

37
 -Peanuts and beans, seeds and nuts watermelon, canned fruits.

CHAPTER X

CONCLUSIONS & RECOMMENDATION

CONCLUSION

It is highly recommended that the need of including fiber in our diet is

important to avoid serious complications later in life. A fiber is a simple type of carbohydrate
found naturally in plant-based foods that is not completely digested by humans. It has a major
role of protecting against colon cancer, high cholesterol, and reduces inflammation even to
gastrointestinal status. Everyone is capable of wanting something to achieve and that’s health.

38
Poor healthy lifestyle and engaging in poor food habits will lead to serious condition if is not
taken care immediately. Over the years, nutrition therapy has been proved to be an effective
approach to patient through the application of hospital special diets. It was believed to be a
way of helping people that suffers from severe cases of condition by considering that it is in
an individualized approach and allows the patient to benefit from the nutritional care that is
necessary to ensure satisfaction of the patient’s nutritional requirements. One that can be
considered as cause poor food choices that leads to an worsen the inflammation is the
development of diseases that can be portrayed as one that affects the lining of the intestine;
was commonly known as diverticular disease. This level of health problem will worsen if
certain health practices, such as proper discipline for food choices, are not followed. Certain
adjustments to food behavior may become difficult to manage as we age, but the effect of
consequences will always be present if ignored. We should embrace the wonders of being
healthy and choose our foods wisely while we’re young.

RECOMMENDATION:

We, a BS Nutrition and Dietetics students, it is recommended to follow a diet

progression that begins with a clear liquid and progresses to a low-fiber or low
residue diet. Once the prescribed medication has been completed, the patient could
be able to tolerate high fiber foods. For Mr. Macario’s case;a patient diagnosed with
diverticulitis, after the diagnostic procedure, he is not advisable yet to consume foods
that are too high in fiber since this will lead to rapid formation of more bulky stool. In

39
contrast, the presence of fiber in the diet will help to prevent the development of a
more serious condition of having diverticulitis in asymptomatic patients When on a
special hospital diet, it is best to avoid physical activity because it may burn more
calories that are completely insufficient due to the diet being consumed: It is
inadequate in nutrients because the only food subjected to comfort here is the pure
clear liquid diet prior to the diagnostic procedure. Nutrition counselling is needed in
order to help the patient improve his view towards healthy lifestyle.

When a patient has surgery or any medical procedure, his or her nutritional status
should be improved. It is strongly advised to consume fruits and vegetables once
they have been healed in order to provide adequate nutrition. Probiotics and fiber-
rich supplements will help to relieve constipation. Allowing the patient to engage in
physical activity for 30 to 40 minutes, such as jogging or walking, is recommended
since the patient is overweight, it is a must-task to do in order to reduce the risk of
certain complications such as the cardiovascular diseases. It is recommended to limit
the frequent consumption of red meats and if possible to consume for twice a month
only. A patient should avoid alcohol consumption, as this irritates the digestive tract.

BIBLIOGRAPHY

https://www.ncbi.nlm.nih.gov/books/NBK430771/

https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758

https://www.merriam-webster.com/medical/vasa%20recta#:~:text=vasa%20rec
%C2%B7%E2%80%8Bta%20%2D%CB%88rek,more%20branches%20between%20its%20layers

https://my.clevelandclinic.org/health/diseases/10352-diverticular-disease

https://www.aafp.org/pubs/afp/issues/2005/1001/p1229.html

40
https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/symptoms-causes/syc-
20351460

https://www.msdmanuals.com/professional/gastrointestinal-disorders/diverticular-disease/colonic-
diverticulosis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780269/

https://www.tampacolorectal.com/blog/foods-you-should-avoid-if-you-have-diverticulitis

https://www.iapac.org/fact-sheet/normal-laboratory-values/

https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-2037175

41