A.

NUTRITION THERAPY FOR CARDIOVASCULAR DISEASES

ATHEROSCLEROSIS
- Atherosclerosis is caused by the accumulation of fatty materials including a high
proportion of cholesterol as well as other substances.
- Those who are most susceptible to this condition and to other heart diseases are the
following:
1. Male between ages 45 and 64 years
2. Overweight persons
3. Diabetics
4. Persons with high blood pressure
5. Persons consuming a diet high in saturated fat
6. Persons with high cholesterol levels
7. Persons whose family has a history of heart and blood vessel diseases
8. Sedentary individuals
9. Heavy smokers
Signs and symptoms:
⮚ Chest pain or pressure (angina)
⮚ Sudden arm or leg weakness or numbness
⮚ Slurred speech or difficulty speaking
⮚ Brief loss of vision in one eye
⮚ Drooping facial muscles
⮚ Pain when walking
⮚ High blood pressure
⮚ Kidney failure

Diet Therapy:
1. Low-fat diet, low in saturated fat and cholesterol
2. Increase in monounsaturated fatty acids
3. Increase in polyunsaturated fats, the omega-6 and omega-3 fatty acids at least 2 servings
per week
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 1200 - 1600 for women and 2000 - 2500 for men.
8. A healthy diet rich in nutrient-dense foods may help reduce your risk of developing
clogged arteries.
Treatment
- Drugs and diet

Sample Menu:
BREAKFAST
1 cup cooked oatmeal, sprinkled with 1 tablespoon chopped walnuts and 1
teaspoon cinnamon
1 banana
1 cup skim milk
 LUNCH
1 cup low-fat (1 percent or lower), plain yogurt with 1 teaspoon ground flaxseed
1/2 cup peach halves, canned in juice
5 Melba toast crackers
1 cup raw broccoli and cauliflower
2 tablespoons low-fat cream cheese, plain or vegetable flavor (as a spread for
crackers or vegetable dip)
Sparkling water
DINNER
4 ounces salmon
1/2 cup green beans with 1 tablespoon toasted almonds
2 cups mixed salad greens
2 tablespoons low-fat salad dressing
1 tablespoon sunflower seeds
1 cup skim milk
1 small orange
SNACK
1 cup skim milk
9 animal crackers
NURSING CARE PLAN
Assessment Diagnosis Planning Intervention Rationale
⮚ Restlessness Decreased cardiac After two days
⮚ Increased blood pressure output R/T of nursing ⮚ Monitor and ⮚ For baseline data
⮚ Cold clammy skin increased vascular interventions the record vital signs
⮚ Decreased peripheral resistance patient will ⮚ Encourage ⮚ To improve
pulses participate in patient to venous return
activities to verbalize
decrease in the concerns
heart's workload ⮚ Encourage ⮚ To reduce stress
patient to change
position every
two hours
⮚ Reinforced low ⮚ To divert
salt and low fat attention and help
diet patient lessen
experienced pain
and anxiety
Evaluation
⮚ Client had a satisfactory pain relief as evidenced by absence of urinary symptoms and decrease in
pain score

CONGESTIVE HEART FAILURE (CHF)

- Congestive heart failure (CHF) or cardiac failure is circulatory congestion resulting in the
heart’s inability to maintain adequate blood supply to meet the oxygen demands.

Signs and symptoms

 ⮚ Shortness of breath with activity or when lying down.
⮚ Fatigue and weakness.
⮚ Swelling in the legs, ankles and feet.
⮚ Rapid or irregular heartbeat.
⮚ Reduced ability to exercise.
⮚ Persistent cough or wheezing with white or pink blood-tinged mucus.
⮚ Swelling of the belly area (abdomen)

Diet Therapy:
1. Sodium-restricted diet is used for the prevention, control, and elimination of edema.
a. Mild restriction (2-3 g Na)
b. Moderate restriction (1,000 mg Na)
c. Strict restriction (500 mg Na)
d. Severe restriction (250 mg Na)
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.
5. Micronutrients (including coenzyme Q10, zinc, copper, selenium and iron) are required to
efficiently convert macronutrients to ATP.

Treatment:
- Medicines are the main treatment for heart failure, but for some people surgery may help.
Operations that can help with heart failure include: heart valve surgery.

Sample Menu:
BREAKFAST
1 cup plain, low-fat yogurt, topped with 3/4 cup blueberries
3/4 cup calcium-fortified orange juice
LUNCH
1 whole-wheat pita stuffed with 1 cup shredded romaine lettuce
1/2 cup sliced tomatoes
1/4 cup sliced cucumbers
2 tablespoons crumbled feta cheese
1 tablespoon reduced-fat ranch dressing
1 kiwi
1 cup skim milk
DINNER
Chicken stir-fry (3 ounces) with eggplant (1 cup) and basil
1 cup brown rice with 1 tablespoon chopped dried apricots
1 cup steamed broccoli
4 ounces red wine or concord grape juice
SNACK
2 tablespoons mixed, unsalted nuts 1 cup fat-free frozen yogurt

NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale
SUBJECTIVE: Short Term Goal: ⮚ Position patient ⮚ To reduce
⮚ The client has a history Risk for ⮚ After 1 day of in semi- preload and
of hospitalization due to Decreased nursing Fowler’s to ventricular
progressive dyspnea, Cardiac Output interventions the high-Fowler’s filling.
triggered by less than as related to client will be able ⮚ Monitor and ⮚ To monitor
ordinary activities, alteration in to demonstrates note the client's cardiac output
lower-extremity edema preload as adequate cardiac input and output and perfusion
and abdominal evidenced by output as of the kidneys
enlargement. presence of evidenced by : ⮚ Auscultate heart through urine
ascites,pedal normal blood sounds and note output.
OBJECTIVE : edema and pressure, normal rate, rhythm, ⮚ To monitor
⮚ The client is oriented but ECGresult urinary output presence ofS3, onset of a
breathes heavily. revealed ⮚ After 1 day of S4; and lung gallop rhythm,
⮚ The client has presence cardiomegaly. nursing sounds. tachycardia,
of ascites, pedal edema, interventions the and fine
and paresthesia on hands client will be able crackles in lung
and feet. to report bases can
⮚ ECG results revealed decreased of ⮚ Note chest pain. indicate heart
cardiomegaly and dyspnea and Identify failure
development of dysrhythmia as location, ⮚ Chest pain is
pulmonary edema. evidenced by: radiation, generally
⮚ Echocardiogram, ECG, normal heart rate severity, suggestive of
paracentesis, blood normal heart quality, an inadequate
workups diagnosed rhythm duration blood supply to
progressive heart failure. Long Term Goal: the heart,
⮚ After 2-3 days of ⮚ Limit fluids and which can
nursing sodium as compromise
interventions the ordered. cardiac output.
client will be able ⮚ Fluid
to demonstrates restriction
an increase in decreases
activity tolerance extracellular
as evidenced by: fluid volume
1. decreased and reduces
occurrence of demands on the
fatigue heart.
2. decreased
occurrence of
dyspnea
during and
after
activities
Evaluation
Short Term Evaluation:
⮚ After 1 day of nursing interventions the goal to demonstrates adequate cardiac output was:
_√_ met
⮚ After 1 day of nursing interventions the goal to report decreased of dyspnea and dysrhythmia was:
_√_ met
Long Term Evaluation:
● After 2-3 days of nursing interventions the goal to demonstrates an increase in activity tolerance was:
_√_ met
HYPERTENSION
- Hypertension is also known as high blood pressure. It is common among males rather than
females, 55 years and below.

Signs and Symptoms:

⮚ Blurry or double vision.
⮚ Lightheadedness/Fainting.
⮚ Fatigue.
⮚ Headache.
⮚ Heart palpitations.
⮚ Nosebleeds.
⮚ Shortness of breath.
⮚ Nausea and/or vomiting.

Diet Therapy:
1. A mild restriction of sodium and occasionally a 1000 mg Na diet may be ordered.
2. Weight reduction may facilitate the lowering of blood pressure.
3. Low-fat diet with emphasis on unsaturated oils is recommended.

Treatment
- Lifestyle modifications, nutritional therapy

Sample Menu:
BREAKFAST
1 slice whole-wheat bread, toasted
1 large egg, cooked in 1/4 tsp. olive oil or coat pan
2 Tbsp. salsa
Top toast with egg and salsa.
1 medium banana
A.M. SNACK
3/4 cup blueberries
LUNCH
2 cups mixed greens
3/4 cup veggies of your choice (try cucumbers and tomatoes)
1/3 cup white beans, rinsed
1/2 avocado, diced
Combine ingredients and top salad with 1 Tbsp. red-wine vinegar, 2 tsp. olive oil
and freshly ground pepper.
P.M. SNACK
1 medium orange
DINNER
1/2 cup cooked lentils seasoned with a pinch each of kosher salt and pepper

NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale
 Subjective:
⮚ Excessive Imbalanced Client ⮚ Assess the ⮚ Assessment aids
eating/hunger nutrition, more than demonstrates a nutritional in diagnosis and
⮚ Increase in weight body requirements change in the pattern of client planning
⮚ Sedentary lifestyle related to excessive eating pattern and interventions
⮚ Eating junk and fast food intake in maintains an ideal ⮚ Monitor the ⮚ To identify the
foods relation to the body weight by weigh, BMI, and
nutritional status
⮚ Non-vegetarian diet metabolic needs following regular vital signs daily
of the client
⮚ Lack of exercise and sedentary exercise program ⮚ Advice the client
⮚ Lack of control over lifestyle causing to take healthy ⮚ To reduce the
eating habits thick obesity leading to foods like fruits, blood pressure
sputum compression and vegetables, green and decrease the
pressure in the leaves and risk
Objective: blood vessels increase fiber in
⮚ Weight gain diet
⮚ BMI - overweight ⮚ Advice the client ⮚ To decrease
⮚ Triceps skin fold to take foods obesity
increased containing
⮚ Obesity vitamin D and
⮚ Disorganized eating omega-3 fatty
pattern acids like fish
⮚ Increased abdominal oils ⮚ To decrease
girth ⮚ Advice the client blood pressure
⮚ Blood pressure to limit sodium
increased intake to 2-4 gm
⮚ Total cholesterol levels per day and avoid
increased foods packaged
⮚ Triglycerides increased and processed
⮚ VLDL and LDL foods
increased
⮚ HDL increased
Evaluation
⮚ Client maintained a normal nutritional pattern as evidenced by gradual decrease in weight and control of blood
pressure and modifying lifestyle habits

MYOCARDIAL INFARCTION (MI)

- Myocardial infarction (MI) or heart attack, results from atherosclerosis of the coronary
arteries. This happens when one or more areas of the heart muscle don't get enough
oxygen.
Signs and Symptoms:
⮚ Chest pain or discomfort
⮚ Shortness of breath
⮚ Pain or discomfort in the jaw, neck, back, arm, or shoulder
⮚ Feeling nauseous, light-headed, or unusually tired.

Diet Therapy:
1. Liquid diet on the initial stages and as the condition improves, progresses to foods of
regular consistency
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

Treatment
- Reduced workload of the heart

Sample Menu:
BREAKFAST
1 cup bran cereal
1 cup skim milk
1/4 cup blueberries
A.M. SNACK
1 medium apple
LUNCH
1 serving Spinach & Strawberry Meal-Prep Salad
P.M. SNACK
1 medium orange
DINNER
1 serving Charred Shrimp & Pesto Buddha Bowls

NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale
Subjective:
⮚ Chest pain Acute chest pain Client is relieved ⮚ Monitor the vital ⮚ To identify the
⮚ Pain radiating to related to myocardial from pain signs, ECG, baseline data and
neck and left arm ischemia secondary oxygen saturation cause of pain
⮚ Chest tightness to coronary and pain score
⮚ Palpitation obstruction caused by regularly ⮚ To push the
⮚ Diaphoresis atherosclerotic plaque ⮚ Provide high diaphragm down
(excessive formation fowler's position
and create
sweating) with cardiac table
enough space in
⮚ Shortness of to support the
breath client the thoracic
cavity for
Objective: breathing
⮚ Painful score ⮚ Assess the ⮚ To evaluate the
increased precipitating cause of pain and
⮚ Presence of factors, quality, take measures to
visible heaves on intensity, and relieve pain and
the chest wall severity of pain prevent further
⮚ Apical pulse myocardial
increased ischemia
⮚ Cardiac enzymes ⮚ Administer inj. ⮚ To relieve chest
elevated Morphine as
pain
⮚ ECG shows ST prescribed
segment ⮚ Administer
elevation oxygen therapy ⮚ To aid in
⮚ Cardiac murmurs as needed respiration and
 present prevent shortness
⮚ Echo shows of breath
systolic
dysfunction
Evaluation
⮚ Clients' pain was relieved as evidenced by decrease in pain score and verbalizing comfort.

B. NUTRITION THERAPY FOR DISEASES OF THE KIDNEYS

ACUTE GLOMERULONEPHRITIS
- Acute glomerulonephritis may be a deferred hypersensitivity reaction initiated by
infectious agents related with tonsillitis or scarlet fever
Signs and Symptoms:
⮚ Pink or cola-colored urine from red blood cells in your urine (hematuria)
⮚ Foamy or bubbly urine due to excess protein in the urine (proteinuria)
⮚ High blood pressure (hypertension)
⮚ Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen.
⮚ Urinating less than usual.
⮚ Nausea and vomiting.

Treatment:
Nutritional therapy

Diet Therapy:
1. Usually a short-term condition so overall nutrition is of greater concern with adequate
rather than restricted protein
2. No sodium restriction unless edema is seen
3. High-calorie diet chiefly from carbohydrates and fat to spare tissues from being used as
an energy source
Sample Menu:
BREAKFAST
Cottage cheese pancakes with fresh strawberries
Whipped topping or syrup
Scrambled egg or egg whites
Coffee or tea
Sweetener or creamer
LUNCH
Lemon curry chicken salad
Naan (Indian flatbread) or pita bread
Cranberry juice
DINNER
Cilantro-lime cod
Lettuce, cucumber and carrot salad
Basic salad dressing
Steamed Rice
Luscious Lime Dessert
Lemon-lime soda
NURSING CARE PLAN
Assessment Diagnosis Objective Intervention Rationale
Subjective: Excess Fluid Volume Short term goal: ⮚ Obtain complete ⮚ To have baseline
““I felt mutated with related to decreased Clients will have an physical data on the
this enlarged arms renal function increased urine assessment. progress of fluid
and feet since if secondary output of 70 - 80 ml elimination
suffered from this to glomerulonephritis, for the next 6 hours. through physical
illness,” as verbalized as evidenced by facial appearance
by the patient. and leg edema, Long term goal:
⮚ To have a
Objective: azotemia, proteinuria, Client will have a
measurable
⮚ +3 edema on both weight gain, and sustained minimum ⮚ Monitor daily
foot blood pressure level urine output of 20 ml weight account on the
⮚ +2 edema on both of 140/90 per hour and manifest fluid elimination
hands lesser edema (+) 1. ⮚ To know the
⮚ (+) periorbital progressing
edema ⮚ Monitor fluid condition via
⮚ (+) proteinuria intake and output glomerular
⮚ 30 ml urine output every 4 hours filtration.
for the last 8 hours ⮚ To know the
progression of
Vital Signs: ⮚ Monitor BP and hypertension and
BP: 140/90 PR every 4 hours basis for further
PR: 120 bpm
nursing
intervention or
referral.
Evaluation:
⮚ Client had a total urine output of 72 ml 4 hours after the implementation of the nursing interventions.
⮚ Client had edema of (+) 1 the second day of nursing intervention. Patient also had an average of 24 ml of urine
output for the last 10 hours.with regular dialysis therapy.

NEPHROTIC SYNDROME
- Nephrotic syndrome describes a composite of symptoms that can occur as a result of
injury to the capillary walls of the glomerulus.

Signs and Symptoms:

⮚ Severe swelling (edema), particularly around your eyes and in your ankles and feet.
⮚ Foamy urine, a result of excess protein in your urine.
⮚ Weight gain due to fluid retention.
⮚ Fatigue.
⮚ Loss of appetite.

Treatment;
- Nutritional therapy

Diet Therapy:
1. Diet high in protein, 100 - 150 g daily
 2. High calorie intake to spare proteins for tissue synthesis and to provide energy
3. Sodium restriction (500 mg)

Sample Menu:
BREAKFAST
½ cup orange juice
½ cup dry cereal
1 slice toast
1 tbsp jelly
1 cup low fat milk
MORNING SNACK
Banana
Cereal fruit bar
LUNCH
3 oz beef patty
1 oz hamburger bun
Sliced tomato and lettuce
1 cup lowfat milk
AFTERNOON SNACK
Oatmeal cookies (2)
Lemonade
DINNER
3 oz homemade chicken strips, baked and breaded
½ cup homemade oven-baked french fries
½ cup green beans
1 dinner roll
1 cup apple juice
½ frozen yogurt

NURSING CARE PLAN

Assessment Diagnosis Objective Intervention Rationale
Subjective: ⮚ Record accurate ⮚ Accurate intake
“Namamanas ang Excess fluid volume After 8 hours of intake and output and output is
kanang binti ng anak related to nursing interventions of the patient necessary for
ko” (My son has a compromised the patients will determining renal
massive edema on his regulatory display stable weight, function and fluid
lower right leg) as mechanism changes vital signs within replacement
verbalized by the in hydrostatic or patient’s normal
needs and
mother. oncotic vascular range, and nearly
reducing risk of
Objective: pressure and absence of edema.
⮚ Weight gain increased activations fluid overload.
⮚ Changes in vital of the renin ⮚ Monitor urine ⮚ Measures the
signs aldosterone system specific gravity kidney’s ability
⮚ V/S taken as to concentrate
follows: urine.
⮚ Assess skin, face, ⮚ Edema occurs
T: 37.3 dependent areas primarily in
P: 85 of edema. dependent tissues
 R: 21 of the body
Evaluation:
⮚ Client had a blanched fluid volume status as evidenced by maintenance of acceptable body weight with regular
dialysis therapy.
ACUTE RENAL FAILURE (ARF)
- Acute renal failure (ARF) is a sudden decline of kidney function or abrupt loss of kidney
function.

Three phases of ARF:

1. Oliguric phase - this phase lasts from 24 hours to 3 weeks
2. Diuretic phase - this phase lasts from 2 - 3 weeks
3. Recovery phase - this phase lasts from 3 - 12 months

Signs and symptoms:

⮚ Decreased urine output, although occasionally urine output remains normal.
⮚ Fluid retention, causing swelling in your legs, ankles or feet.
⮚ Shortness of breath.
⮚ Fatigue.
⮚ Confusion.
⮚ Nausea.
⮚ Weakness.
⮚ Irregular heartbeat.
Sample Menu:
BREAKFAST
Omelet
English muffin or toasted bread
Jam or jelly, margarine or butter
Fresh grapes
Coffee or tea
LUNCH
Blackened shrimp pineapple salad
Low-sodium crackers or crisp bread
Lemon cookies
Lemon-lime soda
DINNER
Stuffed green peppers
Dinner rolls
Stuffed strawberries
Sparkling water

NURSING CARE PLAN

Assessment Diagnosis Objective Intervention Rationale
Subjective: Excess fluid Client maintains a ⮚ Monitor the fluid ⮚ To assess balance
⮚ Edema volume related to balance in fluid volume status of between the fluid
⮚ Shortness of breath inability of the volume with fluid the client with intake and output
⮚ Weight gain kidneys to excrete and sodium 1/0 chart. and plan further
⮚ Irritability fluid secondary to restriction and
⮚ Increased stress and renal ischemia and maintains an interventions
tension necrosis acceptable body ⮚ Monitor the ⮚ To identify the
Objective: weight weight of the fluid volume
⮚ Vital signs monitoring client daily status
shows bounding pulse ⮚ To control edema
and hypertension ⮚ Advise salt and and hypertension
⮚ Increased weight protein restricted
⮚ Intake output chart diet
⮚ To indicate the
shows decreased urine
excess fluid
output ⮚ Monitor for signs
⮚ Urinalysis shows volume status
of pulmonary
presence of casts edema like
⮚ RBC’s, WBC’s in urine shortness of
and decreased specific breath, tachypnea
gravity and serum and frothy
osmolality sputum
⮚ 24 hour urine shows ⮚ To remove
decreased creatinine ⮚ Administer excess fluid
clearance and increased diuretic therapy
sodium volume of the
as prescribed
⮚ Sr. electrolytes body
deranged
⮚ Sr. BUN elevated
⮚ Sr. creatinine elevated
Evaluation:
⮚ Client had a blanched fluid volume status as evidenced by maintenance of acceptable body weight with regular
dialysis therapy.

CHRONIC RENAL FAILURE (CRF)

- Chronic Renal Failure (CSF) is the decline of kidney function.

Signs and Symptoms:

⮚ Weight loss and poor appetite.
⮚ Swollen ankles, feet or hands – as a result of water retention (oedema)
⮚ Shortness of breath.
⮚ Tiredness.
⮚ Blood in your pee (urine)
⮚ An increased need to pee – particularly at night.
⮚ Difficulty sleeping (insomnia)
⮚ Itchy skin.

Treatment:
- Diuretics, nutritional therapy

Diet Therapy:
1. Protein low to moderate according to tolerance: 30 - 50 g
2. Carbohydrates relatively high for every: 300 - 400 g
3. Fat relatively moderate 70 - 90 g
 4. Calories adequate for maintenance to prevent tissue breakdown: 2000 - 2500 g daily
5. Sodium control according to serum levels and excretion capacities varying from 1300 -
1900 mg
6. Potassium control according to excretion about 800 - 1000 mL; careful intake-output
records vital

Sample Menu:
BREAKFAST
Egg in a Hole
Homemade Pan Sausage
Toasted bread
Jam or jelly, margarine or butter
Pineapple juice
LUNCH
Tuna veggie salad
Sliced bread or pita bread
Lemon cookies
Home-brewed iced tea with lemon and sweetener
DINNER
Slow rotisserie-style chicken
Red wine vinaigrette asparagus
Pasta tossed in olive oil and garlic
Chilled or frozen grapes
Decaffeinated coffee or herb tea

NURSING CARE PLAN

Assessment Diagnosis Objective Intervention Rationale
Subjective: Acute pain Short Term: ⮚ Establish rapport ⮚ To get the
None After 6 - 8 hours of cooperation of
nursing interventions, ⮚ Accept patient’s the patient.
Objective: the patient will description of ⮚ Pain is a
⮚ Facial grimaces demonstrate use of pain subjective
⮚ Guarding relaxation skills to experience and
behaviors relieve pain.
cannot be felt by
⮚ Costovertebral
⮚ Monitor and others.
pain/flank pain
⮚ Limited ROM record vital signs ⮚ To obtain
⮚ Body weakness Long Term: baseline data
⮚ Facial mask After 2 - 3 days of
⮚ Narrowed focus nursing interventions,
⮚ Sleep the patient will report
⮚ Disturbance relief/control of pain.
⮚ Diaphoresis
⮚ RR and BP
changes
Evaluation:
⮚ Client had satisfactory pain relief as evidenced by absence of urinary symptoms and decrease in pain score.
RENAL CALCULI (UROLITHIASIS)
- Is the formation of renal or urinary calculi in the urine that precipitate as stones in the
urinary passages

Signs and Symptoms:

⮚ Severe pain on either side of your lower back.
⮚ More vague pain or stomach ache that doesn't go away.
⮚ Blood in the urine.
⮚ Nausea or vomiting.
⮚ Fever and chills.
⮚ Urine that smells bad or looks cloudy.

Treatment:
Nutritional therapy

Diet Therapy:
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 - potassium-rich foods and water are increased.
b. Uric acid stones - protein is limited to 58 - 67 g/day with emphasis on milk, fruits, and
decreased intake of bread products.
c. Cystine stones - high fluid intake is recommended.
Renal Surgery
a. Post-operative nutritional needs
1. Protein - increased protein caused by protein losses and catabolic period recovery
and tissue recovery and tissue healing; a period of negative nitrogen balance
initially
2. Calories - adequate amount to supply energy and spare proteins for tissue building
3. Water - adequate fluid therapy to avoid dehydration caused by large fluid losses
4. Minerals - replacement of deficiencies and assurance of continued adequacy
essential to maintain electrolyte balance.
5. Vitamins - Vitamin C especially needed for tissue synthesis and wound healing; B-
complex vitamins essential in energy production and tissue-building
b. Dietary Management
1. Initial IV therapy - for water and electrolytes, but oral intake needed as soon as
possible for adequate nutrition
2. Hyperalimentation - parenteral nutrition of high nutrient density to avoid thrombosis
in peripheral veins
3. Post-operative diet - liquid, soft, to full diet as soon as possible to supply nutritive
demands
Special Gastrointestinal Surgery
 a. Mouth, throat or neck surgery - oral liquid feeding tube feedings, either blenderized food
mixtures or special formula preparations
b. Gastric resection
1. Immediate postoperative period - gradual build-up of foods a few at a time until
until tolerance is established
2. “Later-dumping syndrome” may develop, rapid food passage draws water from
surrounding blood volume causing shock symptoms
3. Cholecystectomy - low fat following surgery which avoids pain from constriction at
wound site; general voidance of heavy fat intake on a continuing basis
4. Ileostomy and colostomy - initial period of reduced residue diet to be indicated, but
return to regular full diet as soon as possible for both nutritional and psychological
reasons
5. Rectal surgery - non-residue diet given immediately; then low-residue diet given as
needed with return to full diet as soon as possible
Burns
a. Immediate shock period - days 1 to 3
1. Initial fluid and electrolyte problems, massive flooding edema at burn site pulling
water from other parts of the body, as well as protein loss and electrolyte loss
(sodium); potassium drawn from cells to replace sodium loss with rising serum
levels of potassium
2. Immediate parenteral - protein through blood or plasma expander (dextran), sodium
and chloride replacement through lactated Ringer’s solution, water (dextrose
solution) to cover losses
b. Recovery period - dyas 3 to 5
1. As fluid and electrolytes are reabsorbed, pattern shifts and sudden diuresis follows.
2. Oral liquid solutions may not be tolerated
c. Secondary feeding period - days 6 to 15
1. Critical nutrition stage tissue regeneration, turning from initial catabolic period of
negative nitrogen balance to an active tissue rebuilding stage
2. Diet therapy - high protein (150 - 400 g) with protein supplements, high calorie
(3500 - 5000), high vitamins especially for wound healing and B-complex vitamins
for energy and protein metabolism; record keeping of intake vital to ensure meeting
the high-nutrient requirements
d. Follow-up reconstruction period - from second week on
1. Grafting and plastic surgery - continued optimum nutrition
2. Rehabilitation period - rebuilding the patient both physically and emotionally

Sample Menu:
BREAKFAST
½ cup low fat sugar free yogurt
2 slices toast
2 tsp low-sugar jelly
1 cup tea or coffee
LUNCH
12 unsalted saltine crackers
1 medium peach
 1 cup low sodium chicken noodle soup
1 cup sugar free lemonade
SNACK
3 cups unsalted popcorn
1 cup carrot sticks
1 cup water
DINNER
4 oz salmon
⅔ cup cooked rice
1 cup green beans
½ cup sugar free vanilla pudding
½ cup mixed berries
1 small dinner roll

NURSING CARE PLAN

Assessment Diagnosis Objective Intervention Rationale
Subjective: Acute flank Client ⮚ Perform a ⮚ To identify
⮚ Dysuria pain related to verbalizes relief comprehensive baseline data and
⮚ Urgency, frequency and the passage of from pain and urinary and pain plan further
intermittent urination stones through decrease in pain assessment and interventions
⮚ Painful micturition the obstructed score monitor pain
⮚ Costovertebral flank pain urinary tract score
⮚ Renal colic causing ⮚ Provide ⮚ To provide
⮚ Groin pain dysuria and comfortable comfort
⮚ Pain associated with nausea, oliguria supine position
vomiting with pillows
supported to the
Objective: flanks
⮚ To aid
⮚ Painful facial grimaces ⮚ Advice the client
spontaneous
⮚ Cool and moist skin to drink plenty of
⮚ Pain score - increased fluids passage of stones
⮚ Vital signs monitoring shows through the
tachycardia urinary tract
⮚ Urinalysis shows low pH and ⮚ Advice the client ⮚ To relieve pain
presence of casts in urine to take warm and burning
⮚ 24-hour urine specimen shows showers and micturition
the presence of calcium, clean the perineal
magnesium, and phosphorus area with warm
⮚ Mid-stream urine culture and water when there
sensitivity to identify the is irritation
presence of microorganisms ⮚ Provide
⮚ Intravenous pyelogram (IVP) diversional ⮚ To divert the
localizes the degree and site of therapy in the mind of the client
stone obstruction form of light from pain
⮚ USG KUB measures the music or
presence of radiolucent watching TV etc.
calculus and size of stones
⮚ CT scan abdomen reveals the
presence of non-opaque stones
Evaluation:
⮚ Client had a satisfactory pain relief as evidenced by absence of urinary symptoms and decrease in pain score.