NUTRITION NOTES!!!!!!!!!!!!!!!!!!!!!!!!!!!! DIET THERAPHY!!!!!!!!!!!!!!!!!!!!!!!!!!

Types of Diets

Normal Hospital Diet

- Normal diet is the most commonly used diet in hospital

- It aims to meet the recommended dietary allowances of nutrients
- There are no restrictions involved in food planning, but the food plan is balance to avoid over- or
under nutrition.
- In the hospitals, there is choice of menu based on normal food acceptance patterns of the
patients.

A clear-liquid diet is given

- For a patient suffering from nausea, vomiting or loss of appetite (anorexia)

- During acute stage of diarrhea
- Post-operative first stage

Full Liquid Diet

- in full liquid diet, food included are -liquid and food which are liquid at body temp
- It can provide adequate nutrition, with the exception of iron
- As the nutrient-density is not high, six or more feeding are given.
- This increases the lactose content of the diet and therefore, it should not be given to persons
with low lactase activity.
- This diet has high calcium and fat content and is low in fiber.

Soft Diet

- Soft diet is used to after full-liquid diet and before moving on to a normal diet
- It is nutritionally adequate. Foods included are those, which are easy to mix with saliva, swallow
and digest.
- Exclude Foods, which contain harsh fiber, strong flavor`s and too much fat

Pureed Diets

- Pureed diets include foods, which are smooth

- These are good for patients who have difficulty in swallowing
- All foods (except those that are already soft or smooth) are blended or pureed in a mixer
- Liquids are added to get the consistency needed by the patient. To increase calories, fat and/ or
sugars are added

Soft Fiber- Restricted Diet

- Indigestible carbohydrates are excluded from this

 - Indigestible fibers include those which make up cell wall of plants (such as cellulose,
hemicellulose etc.)
- The amount of indigestible carbohydrates in the diet can be reduced by using.
- (A)Refined cereals and breads
- (B)Immature veggies
- (C)Fruits without skins and seeds and
- (D)Cooked vegetables and fruits

Some of the aspects that affect food acceptability include connective tissue, strong flavor and the
amount of stimulant present.

Connective Tissue :

The texture of meat, tender or less tender is mainly decided by the amount of connective tissue present.
The amount of connective tissue in meat depends on the age of the animal

Flavour

Strong flavoured vegetables such as onins, leeks, radishes, dried beans and cabbage family vegetables
(Brussel sprouts, cauliflower, broccoli, turnips) are normally omitted

Beverages

- Both tea and coffee are stimulating beverages.

Nutrient Content

- In the past, it was common practice to put more emphasis on “Food to avoid” and less on
“Foods to eat”

Tube Feeding

- If a patient whose gastrointestinal tract is working, cannot take sufficient food orally, tube
feeding is resorted to.

Tube feeding is given in the following conditions

- Babies who have low birth weight and cannot suck

- Those who are undernourished and cannot take or retain food taken orally
- Persistent anorexia patients, who need forced feeding
- After certain types of surgery
- Patients with severe malabsorption
- Patients who cannot absorb or digest food
- Semiconscious or unconscious patients or any other condition which prevent intake of sufficient
food.
Since the feed must be formulated to meet the nutritional needs of the patient, it is called formula feed.
It is important that the formula should be such that it is well tolerated. Many types of formulas can be
made or purchased to serve the needs of the patient. The food fed by tube may be :

- Natural liquid foods

- Raw or cooked foods blended to liquid form,
- Commercially made special formulated diets.

Composition

- The for of proteins in the formula can be intact proteins (Source of protein Milk and Egg) or
protein hydrolysates containing peptides and amino acids. When the patient has normal
enzymatic digesive function (absorption) intact proteins are included in the formula
- Carbohydrates is in the form of polymers of glucose, which are easily broken and absorbed.
- Fats used in the

Osomolality

- The number and size of particles per kg of water is called Osmomality.

- This is an important factor in deciding patient tolerance.

Types of formulas

1. Balance complete formulas – are made from ordinary foods or baby food by blending thse
2. A milk based formulas - is prepared from cow`s, toned or skim milk with addition of pasteurized
egg.
3. Lactose free formulas
4. Specialty formulas

- The mode of administration of formula is decided taking patients condition and the period for
which tube feed is to be given.
- When there is injury to the esophagus or for long term tube feeding, a gastrostomy tube may be
surgically inserted into the stomach.
- This route is not suitable for patients with unchecked vomiting or where gastric emptying is
disturbed.
- A jejunostomy tube may be used when the stomach must be bypassed
- The feeding can be continuous or intermittent. Intermittent feeding permits patient to move
about.
- Like all other diets, diluted formulas are fed in the beginning and gradually concentration is
increased to full strength.
- The rate of feeding is begun slowly and then increased gradually
- This decreases the possibility of diarrhea. The patients bed (head side) is raised while feeding, to
reduce chance of air block

Home Tube Feeding

- Long term tube feeding can be given at home, with guidance from the health care team
 - The care provider needs to be given instructions about how to maintain sanitation and hygiene
in handling feeds and the equipment used.

PARENTERAL NUTRITION

- In parenteral feeding, the nutrient preparations are given directly into a vein.
- When a patient is likely to be dehydrated and needs quick reversal of the condition, a 5%
dextrose solution in water (DSW) is usually given by a peripheral vein (also known as IV drip) to
provide fluids and some energy (calories).
- Electrolyte solutions can also be given by this mode.
- In some conditions the higher dextrose concentrations with amino acids and lipids are given.

Total Parenteral Nutrition (TPN)

- TPN is used only when it is not possible to use enteral route and the patient is hypermetabolic
or debilitated.
- Before giving TPN, a thorough nutritional and metabolic assessment of the patient is done
- The blood levels of various nutrients are monitored frequently during TPN and the solution
adjusted, if needed
- TPN is need to find another route to give it to PX

Composition of solutions

- Crystalline amino acids are used to meet protein needs, so that the composition can be
controlled to meet patients needs. Dextrose solutions (hypertonic) provide carbohydrates as
energy source and ensure amino acid sparing action.
- Emulsions of safflower or soy oil are given separately.

Home Care of Patients

- The family could be guided to take care of the patients nutrition at home.