Common health problems

Medical surgical nursing

Zahraa Hassan Ramzy

 1-Dyspnea
Nursing Diagnosis: Ineffective Breathing Pattern
Definition: subjective experience of breathing discomfort that consists of qualitatively
distinct sensations that vary in intensity. (Difficulty in breathing at any position).
Related Factors (according to disease):
Cardiovascular
• Increased pulmonary venous pressure.
• Mitral stenosis and left ventricular failure.
• Ischemia.
• Decreased cardiac output.
Respiratory
• Upper air way obstruction.
• Decrease lung expansion.
• Chest wall diseases as deformity.
Grades of dyspnea:
– Grade 1:- occur when the patient does more than his daily living activity,
provided that this extra amount of effort didn't produce Dyspnea before.
– Grade 2:- occur when the patient does his usual activity.
– Grade 3:- occur on an effort which is less than the patient's usual daily
activity.
– Grade 4:- Dyspnea at rest or at minimal effort.
As evidenced by:
- Changes in respiratory rate or pattern from baseline.
- Changes in pulse (rate, rhythm).
- Cyanosis
- Nasal flaring
- Respiratory depth changes
- Use of accessory muscles
- Hyperpnea- Tachypnea.
Assessment:
- Assess degree of dyspnea
- Assess respiratory rate, depth, effort, rhythm and breath sounds
- Assess skin color, temperature, capillary refill
- Note muscles used for breathing (e.g., sternocleido-mastoid, abdominal,
diaphragmatic). The accessory muscles of inspiration are not usually involved in
quiet breathing. These include the scalenes (attach to the first two ribs) and the
sternocleidomastoid (elevates the sternum).
- Note retractions or flaring of nostrils. These signify an increase in work of
breathing.

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 - Assess position patient assumes for normal or easy breathing.
- Monitor for changes in orientation, increased restlessness, anxiety, and air
hunger. Restlessness is an early sign of hypoxia.
- Assess presence of sputum for quantity, color, consistency.
- Assess for pain. Postoperative pain can result in shallow breathing.
Patient’s goal:
The patient will: Demonstrate an effective respiratory rate, depth, and pattern A.E.B.:
 Color pink/ absence of cyanosis.
 Absence of diminished breath sounds.
Nursing Intervention
 Position patient with proper body alignment for optimal breathing pattern (fowler
or high fowler or sitting). If not contraindicated, these allow for good lung
excursion and chest expansion.
 Ensure that oxygen delivery system is applied to the patient.
 Remove any tight clothes.
 Open doors and windows.
 Encourage deep breathing exercises between attack by:
 Using demonstration (emphasizing slow inhalation, holding end inspiration
for a few seconds, and passive exhalation)
 Using incentive spirometer (place close for convenient patient use)
 Maintain a clear airway by encouraging patient to clear own secretions with
effective coughing. If secretions cannot be cleared, suction as needed to clear
secretions.
 Provide reassurance and allay anxiety by staying with patient during acute
episodes of respiratory distress
 Provide relaxation training as appropriate (e.g., biofeedback, imagery,
progressive muscle relaxation).
 Use pain management ( analgesic) as appropriate.

2-Cough

Definition:-

Cough is an explosive expiration that provides a mean of clearing the

traceobronchial tree of secretions and foreign bodies. Cough is produced by
inflammatory, mechanical, chemical, and thermal stimulation of cough receptors.

Nursing Diagnosis:

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Ineffective airway clearance related to increase mucous production and ineffective
cough characterized by wheezing, and Dyspnea.

Patient goal:

Patient secretions will be mobilized and airway will be free of secretions as evidenced
by clear lung sound, clear air entry.

Intervention:-

• Assess airway for patency.

• Auscultate lungs and note any change in breathing sound as wheezing, crackles,
or absent of breathing sound.
• Assess respiratory rate, quality, rhythm and depth.
• Note the presence of sputum and assess amount, color, odor and consistency.
• Assist the patient to perform coughing and breathing exercise to improve
productivity of cough.
• Instruct the patient to optimal position (sitting position) to controlled cough and
mobilized secretions.
• Use humidity as humidified oxygen to loosen secretions.
• Encourage oral intake of fluid about 3 liters per day to reduce viscosity of
secretions.
• Administer of medications (antibiotic, mucolytic, bronchodilator) as ordered.
• Perform chest physiotherapy as percussion to loosen and mobilize secretions in
smaller airway that can't be removed by coughing or suctioning.
• Maintain period of rest to promote energy because fatigue is contributing factor
of ineffective cough.
• If secretions can't be clear, anticipate the need for artificial airway (intubation)
and during suction avoid use of sterile saline has adverse effect on oxygen
saturation.

3-Pain
Nursing Diagnosis: Alteration in Comfort: Pain (severity, site)
Definition: Unpleasant sensory and emotional experience arising from actual or
potential tissue damage.
Related Factors:
………………..
As evidenced by:

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Pt. reports or demonstrates discomfort.
Autonomic response to acute pain:
 increased BP, P, R
 diaphoresis
 dilated pupils
 guarding
 facial mask of pain
 crying/moaning
 abdominal heaviness
Assessment:
- Assess characteristics of pain: location, severity on a scale of 1-10, type,
frequency, precipitating factors, and relief factors.
- Observe or monitor signs and symptoms associated with pain, such as BP, heart
rate, temperature, color and moisture of skin, restlessness, and ability to focus.
- Eliminate factors that precipitate pain: as …..
Patient’s goal:
The patient will: Experience relief of pain A.E.B. verbal reports of relief of pain.
: State that pain is decreased or relieved.
Nursing Intervention
- Respond immediately to complaint of pain
- Repositioning in comfortable position.
- Eliminate additional stressors or sources of discomfort whenever possible.
- Explore non-pharmacological methods for reducing pain/promoting comfort:
 Back massage
 Slow rhythmic breathing
 Imagination
- Diversion activities such as music, TV, etc
- Provide rest periods to facilitate comfort, sleep, and relaxation.
- Whenever possible, reassure patient that pain is time-limited and that there is
more than one approach to easing pain.
- Cold applications: Cold reduces pain, inflammation, and muscle spasticity by
decreasing the release of pain-inducing chemicals and slowing the conduction of
pain impulses. Cold applications should last about 20 to 30 min/hr.
- Heat applications: Heat reduces pain through improved blood flow to the area
and through reduction of pain reflexes. Heat applications should last no more
than 20 min/hr. Special attention needs to be given to preventing burns with this
intervention.

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 - Massage of the painful area: Massage interrupts pain transmission, increases
endorphin levels, and decreases tissue edema. This intervention may
require another person to provide the massage.
- Teach patient to request analgesics before pain becomes severe.
- Offer analgesics (according to physician order).
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4-Constipation
Nursing Diagnosis: Relative or absolute constipation

Definition: Decrease in normal frequency of defecation accompanied by difficult or

incomplete passage of stool and/or passage of excessively hard, dry stool.

Related Factors:

1. Inadequate fluid intake

2. Malnutrition
3. Low-fiber diet
4. Inactivity, immobility
5. Drug side effects
6. Lack of privacy
7. Irregular evacuation pattern
8. Dehydration
9. Pain (upon defecation)
10.Fear of pain
11.Laxative abuse
12.Neurogenic disorders

As evidenced by:
- Passage of hard formed stool and/or defecation occurs fewer than three times per
week.
- Decreased bowel sounds (hypoactive bowel sound).
- Reported feeling of rectal fullness or pressure around rectum.
- Straining and pain on defecation.
- Palpable impaction.

Patient’s goal:

The patient will: pass soft formed stool at a frequency perceived as "normal" by the patient.

Assessment:

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 - Assess usual pattern of elimination; compare with present pattern. Include size,
frequency, color, and quality.
- Assess type and duration of constipation.
- Assess abdomen for distention,
- Assess bowel sounds.
- Assess bowel elimination.
- Evaluate laxative use, type, and frequency.
- Evaluate usual dietary habits, eating habits, eating schedule, and liquid intake.
- Assess activity level.
- Evaluate current medication usage that may contribute to constipation Drugs that can
cause constipation include the following: narcotics, antacids with calcium or
aluminum base, antidepressants, anticholinergics, antihypertensives, iron and
calcium supplements.
- Assess privacy for elimination (e.g., use of bedpan, access to bathroom facilities with
privacy during work hours)
- Evaluate fear of pain. Hemorrhoids, anal fissures, or other anorectal disorders that
are painful can cause ignoring the urge to defecate, which over time results in a
dilated rectum that no longer responds to the presence of stool.

Nursing Intervention:

- Encourage a regular time for elimination.

- Provide adequate fluid intake 1500:2000 cc/ day unless contraindicated.
- Encourage patient to consume high fiber diet to promote digestion vegetables and
fruits.
- Encourage physical activity and regular exercise as tolerated.
- Encourage isometric abdominal and gluteal muscle exercises.
- Promote patient privacy.
- Initiate bowel program to promote defecation.
- Avoid dehydration by avoiding dehydrating liquids such as soda, coffee, tea
- Encourage patient to have regular meal time.
- Encourage patient to use bathroom at a regular time.
- For hospitalized patients, the following should be done:
 Orient patient to location of bathroom and encourage use, unless contraindicated.
 Offer a warmed bedpan to bedridden patients; assist patient to assume a high-
Fowler’s position with knees flexed.
 Allow patient time to relax.
 For bed ridden patients provide position as close as normal as possible.
- Administer laxative or enema as ordered.

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 5- Diarrhea

Nursing Diagnosis: Diarrhea

Definition: frequent passage of loose, watery, unformed stool.
Related Factors:
- Stress/anxiety
- Medication use
- Bowel disorders: inflammation
- Malabsorption
- Enteric infections
- Disagreeable dietary intake
- Tube feedings
- Radiation
- Chemotherapy
- Lactose intolerance
As evidenced by:
- Passage of loose liquid stool and/or:
- Increased frequency of bowel movement.
- Urgency
- Cramping/abdominal pain
- Hyperactive bowel sounds
- Increase of fluidity or volume of stools
Patient’s goal:
- Patient will pass soft, formed stool as usual pattern.
Assessment:
- Record duration diarrhea (color, odor, amount, consistency and frequency of
stool).
- Assess for abdominal pain, cramping, frequency, urgency, loose or liquid stools,
and hyperactive bowel sensations.
- Identify factors that contribute to diarrhea.
- Identify change in eating schedule
- Assess adequacy or privacy for elimination.
- Assess presence of current stressors
- Assess hydration status, as in the following:
o Input and output: Diarrhea can lead to profound dehydration and
electrolyte imbalance.
o Skin turgor.

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 - Assess condition of perianal skin.
Nursing Intervention
- Monitor and record frequency and characteristics of stools to monitor treatment
effectiveness.
- Identify stressors and help the patient solve problems to provide more realistic
approach to care.
- Monitor perianal skin for irritation and ulceration; treat according to established
protocol to promote comfort, skin integrity, and freedom from infection.
- Provide skin care.
- Instruct patient to record diarrheal episodes and report them to staff to promote
comfort and maintain effective patient–staff communication.
- Provide diet:
o Rich in fluid as allowed.
o Decreased in fibers.
o Avoidance of stimulants (e.g., caffeine, carbonated beverages)
Stimulants may increase GI motility and worsen diarrhea.
o Avoid spicy, fatty foods.
o Broil, bake, or boil foods; avoid frying food.
o Avoid foods that are disagreeable.
- Assist with or administer perianal care after each bowel movement
- Administer antidiarrheal drugs as ordered.

6- Fever

Definition: Abnormal elevation of body temperature above normal level (36.6-37.2 c)

Nursing diagnosis: Altered body temperature
Related to for example: infection, disease process, drug reaction
As evidenced by elevation of body temperature above normal, increase respiratory
tachycardia rate, body feeling warm when touched
Goal: the patient will return to normal body temperature36.6-37.7 c
Nursing care of patient with fever:
1- Apply measures to reduce body temperature as:
-Bed rest
-Sponging the body with alcohol and tape water
-Tape water compresses

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 -Forced extra fluid up to 2500-3000cc/day
2- Accurate measuring of vital signs at frequent intervals (every 1 to 2 hours) and they
should be reported and recorded appropriately.
3- If fever is accompanied by chills, patient should be covered by several light
blankets.
4- Frequent oral hygiene, to prevent dryness of lips. Cracked lips may be avoided by
the use of petroleum jell or cold cream applications.
5- Hygienic care, body cleanliness, light clean dry clothes, and light bed covers.
6- Implement safety precautions to protect the patient if restless or delirious or if
convulsions occur.
7- Give the patient a high caloric intake to meet increased metabolic state.
8- Administer antipyretic as doctor order.

7- Edema
Definition: Abnormal accumulation of fluid in extracellular space or interstitial space.
Assessment of edema:
Depending on its cause and mechanism, edema may be localized or have generalized
distribution.
Assessment of edema:
A. Types of Edema:
a. A-Non pitting peripheral edema:
 It is caused by gravity flow or by interruption of the venous return to the
heart as a result of constricting clothing or pressure on the vein of lower
extremities. And often disappear by elevation of body part.
b. B-Pitting Edema:
• Is describing as an indentation left in the skin after a thumb has applied gentle
pressure. It doesn't disappear by elevation of extremity. It caused by heart
failure.
B. Site
C. Degree:
 1+three is a barely detectable 2mm Slight pitting , disappears rapidly (mild)

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  2+there is a 4mm deep pit. 10-15 seconds to rebound. Indentation subsides
rapidly (moderate)
 3+there is a 6mm deep pitting to rebound lasts more than a minute (deep).
 4+ there is an 8mm deep pit (very deep): Lasts for 2-5 to rebound minutes, legs
looks swollen
Nursing diagnosis: fluid volume excess
Related factors:
 According to Pathophysiology of disease.
Evidenced by:
 Increased body weight
 Intake exceed output
 Jugular vein distention
 Abnormal breath sounds: crackles (pulmonary edema)
 Shortness of breath; orthopnea/dyspnea (ascites)
 BP changes
 Tachycardia
Patient goal: the patient will stated that edema is decrease and retain normal body
weight
Nursing intervention:
- Assess vital signs and breath sounds every 4 hours. (BP and HR)
- Monitor intake and output every 4 hours.
- Change patient position every 2 hours
- Weight patient daily with the same scale, same clothes and the same time of day
and measure circumference
- Elevate the edematous part
- Put patient in semi fowler position in case of ascites
- Restrict fluid intake
- Limit sodium intake
- Increase protein intake
- Inspect skin for redness with each turn and Provide skin care and avoid using
irritant soap or lotions
- Range of motion exercise of edematous part.
- Encourage walking as allowed.
- Give medications as physicians order such as diuretics (Lasix).

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 8- Insomnia

Nursing diagnosis: sleep pattern disturbance

Related to: hospitalization, Pain, change patients lifestyle, anxiety, Increase intake of
caffeine as tea and coffee, poor hygiene, effect of medications

Evidenced by: yawning, redness of eye, decrease concentration, wakening up too

early, daytime tiredness, fatigue, restlessness.

Goal: the patient will report optimal balance of sleep

Nursing intervention:

1- Provide calm, clean and comfortable environment

2- Encourage warm bath and back care before sleep
3- Limiting intake of caffeine and chocolate prior to sleep and encourage drinking
milk.
4- Arrange nursing care to provide uninterrupted sleep.
5- Avoid eating heavy meals before sleep
6- Encourage day time activities
7- Recommend engaging in a relaxing activity before resting (e.g., calm music,
warm bath, relaxation exercises, reading an enjoyable book)

9-Anorexia

Nursing diagnosis: Imbalanced nutrition less than body requirements.

Related to: hospitalization, anxiety and stress, separation from family, medications

Evidenced by: weakness and fatigue,

Goal: the patient will return to normal eating habits

Nursing intervention:

1- Provide small frequent high caloric meal

2- Avoid drinking fluids ½ hours before eating
3- Provide favorite food and encourage oral hygiene
4- Provide variety of different foods to stimulate appetite
5- Provide clean, odorless and well ventilated environment

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 6- Serve food in attractive manner
7- Encourage eating in groups as family, friends
8- Administer appetizers as doctor order

10-Nausea and vomiting

Nausea: feeling of sickness with a desire to vomit

Vomiting: forceful expulsion of gastric content through the mouth

Nursing diagnosis for vomiting: fluid volume deficit related to side effect of
medications, pathophysiology of disease, environmental factors, and stress….as
evidenced by lethargy, restlessness, patients complain….etc

Assessment of vomiting: Duration, assess causes e.g: medications, emotional stress,

unpleasant odors, and vomitus: odor, color, consistency (presence of foreign
substances, blood, and mucus), amount

Nursing intervention:

1- Put patient on sitting position to avoid aspiration of vomitus

2- Provide clean, odorless and well ventilated environment
3- Provide oral care to stimulate eating
4- Fluid replacement either orally or IV fluids
5- Monitor signs and symptoms of dehydration
6- Provide psychological support and reassurance e.g encourage patient to express
feelings
7- Provide small frequent meals in attractive presentation
8- Avoid fatty, fried, spicy, hot or have strong odor foods
9- Encourage fluid intake according intake and output chart
10- Give medications as doctor order (ant emetic drugs as primperan and Zofran.

11-Anxiety
Nursing Diagnosis: Anxiety
Definition: Vague uneasy feeling of discomfort or dread accompanied by an
autonomic response (the source often nonspecific or unknown to the individual).
Related Factors:

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 - Hospitalization
- Unfamiliar environment.
- Threat or perceived threat to physical and emotional integrity
- Changes in role function
- Intrusive diagnostic and surgical tests and procedures
- Changes in environment and routines
As evidenced by:
 [Physiological]
- Elevated BP, P, R
- Insomnia
- Restlessness
- Dry mouth
- Dilated pupils
- Frequent urination
- Diarrhea
 [Emotional] :Patient complains of apprehension, nervousness, tension
 [Cognitive]:Inability to concentrate
:Blocking of thoughts, hyper attentiveness
Patient’s goal:
- The patient will: Demonstrate a decrease in anxiety A.E.B:
 A reduction in presenting physiological, emotional, and/or cognitive
manifestations of anxiety.
 Verbalization of relief of anxiety (The patient will state that anxiety is decreased)
- The patient will demonstrate effective coping mechanisms for dealing with
anxiety.
Nursing Intervention
Assist patient to reduce present level of anxiety by:
 Provide reassurance and comfort.
 Provide calm relaxed environment.
 Don't make demands or request any decisions.
 Speak slowly and calmly.
 Orient patient to the environment and new experiences or people as needed. Give
clear, concise explanations regarding impending procedures.
 Give brief explanation about disease process and patient progress.
 Identify and reinforce coping strategies patient has used in the past.

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  Use simple language and brief statements when instructing patient about self-care
measures or about diagnostic and surgical procedures.
 Encourage patient to talk about anxious feelings and examine anxiety-provoking
situations if able to identify them.
 Assist patient in assessing the situation realistically and recognizing factors
leading to the anxious feelings. Avoid false reassurances.
 Discuss alternate strategies for handling anxiety.
o (Eg.: relaxation techniques and exercises,
o stress management classes,
o directed conversation (by nurse),
 Focus on present situation.
 Reinforce positive responses.
 Include family in patient care.
 Administer medication as doctor order.

12-High risk for infection: as ( IV line infection, UTI, wound infection, chest
infection……..)

Goal: the patient will free from signs and symptoms of infections as evidenced by
normal WBC and normal Body temperature.
Nursing intervention:
The nurse should:
 Monitor temperature q ___ hrs.
 Inspect and record signs of erythema, foul smelling drainage, from or around
wound, skin, invasive line, mouth/throat, or other site q ___ hrs.
 Asses for cloudiness of urine q ___ hrs.
 Report abnormal changes in WBC count and/or pathogenic growth on cultures.
 Utilize good hand washing technique.
 Avoid invasive procedures; i.e. rectal temperatures, bladder catheters, etc.
 Observe and report signs of infection such as redness, warmth, discharge, and
increased body temperature.
 Assess skin for color, moisture, texture, and turgor (elasticity).
 Carefully wash of dry skin, including skinfold area. Use hydration and
moisturization on all at-risk surfaces.
 Use proper hand washing techniques before and after giving care to client
 Follow Standard Precautions and wear gloves during any contact with blood
 Provide site care for all peripheral, central venous, and arterial lines
 Change intravenous insertion sites according to hospital policy

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  Use careful technique when changing and emptying urinary catheter bags; avoid
cross-contamination. Sterile technique must be used when inserting urinary
catheters. Catheters must be cared for at least every shift.
 Visitors and health care workers with active infection are to avoid contact with
patient.
 Explore with patient potential etiological factors which potentiate infection and
include appropriate health teaching.
 Ensure client's appropriate hygienic care.
 Encourage high protein/high carbohydrate foods when indicated.
 Encourage fluid intake of 2,000 to 3,000 mL of water per day (unless
contraindicated).
 Provide well ventilated, clean and calm environment.
 Place the patient in protective isolation/protective environment if he or she is at
very high risk
 Administer antimicrobial agent as doctor order
 Instruct the patient to take the full course of antibiotics even if symptoms
improve or disappear

13-High risk for bleeding

Goal: the patient will be free from any signs and symptoms of bleeding A.E.B normal
bleeding and clotting time, normal PT, PTT and INR.

Nursing intervention:

1. Monitor for signs and symptoms of persistent bleeding (e.g. check all secretions
for frank or occult blood) to detect internal bleeding
2. Avoiding or minimizing intramuscular injections as possible.
3. Apply adequate direct pressure after injections (IM &IV).
4. Monitor coagulation studies as PT and PPT to determine bleeding risk
5. Protect patient from trauma that may cause bleeding to reduce tissue trauma and
subsequent bleeding into tissue.
6. Frequently monitor surgical site and dressings to detect any signs of bleeding.
7. Report abnormalities such as decreasing blood pressure; rapid pulse and resp.;
cool, clammy skin; pallor and bright red blood on dressings.
8. Instruct patient to brush teeth with a soft toothbrush to decrease gum bleeding
9. Use with caution in clients with GIT problem, cardiac, renal and/or liver disease,
alcoholism, diabetes, hypertension, hyperlipidemia, and in the elderly and
premenopausal women.
10. Avoid use sharp objects when dealing with patient.
11.Decrease invasive procedure for high risk patient.
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 12.Provide safe environment.
13.Take caution with patients who take anticoagulant therapy such as clexane,
hebarin or marivan.

Knowledge deficit related to:

Examples:
 Therapeutic diet
 Cardiac diet (Na restricted diet, Fat controlled diet) …. For cardiac disease.
 DASH diet (dietary approach to stop hypertension) …. For hypertension.
 Diabetic diet…. For diabetes mellitus
 Hepatic diet… For liver disease.
 Uremic diet… For renal disease.
 Exercise and physical activity
 Medication compliance
 Smoking cessation.
 Follow up
 Eye care ( for diabetic patients)
 Foot care ( for diabetic patients)
 Prevent hypo or hyperglycemia ( for diabetic patients)
 Oral hygiene
 Nitroglycerin (for cardiac patients).
 Prevention of complication (according to disease).

Therapeutic diet

Knowledge deficit about diabetic diet:

Goal: patient will list the items of diabetic diet

Nursing role:

1- Approximately 50%-60% of a person’s daily calories should come from

carbohydrate. The patient should intake complex carbohydrates as (bread, white
potato, rice and pasta) than simple carbohydrates as (jam, honey, cake, chocolate&
sweet) as it takes more time for absorption than simple so decrease high elevation
of blood sugar level.

2-Approximately <30 percent of a person’s daily calories should come from fat.
Unsaturated fats, such as olive oil, canola oil, nuts, seeds and fish (especially those

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high in omega-3 fatty acids, such as salmon, herring and sardines , Foods that are high
in saturated fat, such as beef, pork, lamb and high-fat dairy products (cream cheese,
whole milk) should be eaten in small amounts.

3-Foods that are high intrans fats such as fast foods, commercially baked goods,
crackers, cookies and some margarine should be avoided.

4-Approximately 15 to 20 percent of a person’s total calories should come from

protein. Protein also helps to maintain lean body mass during weight loss. Examples
of protein include fish, skinless chicken or turkey, nonfat or low fat dairy products
and legumes such as kidney beans, black beans, chick peas and lentils.

5-Sodium: Moderately restricted in salt intake is less than 2400 mg/dl.

6-Fiber intake should be approximately 25-35 grams daily. Fibers can be soluble or
insoluble:

Soluble fibers: As in legumes and some fruits as oranges and apples, and
vegetables as carrots. Soluble fibers prolong stomach emptying time so that sugar is
released and absorbed more slowly and it bind with fatty acids so it will lower total
cholesterol and LDL.
Insoluble Fiber: As in Whole-wheat products, Corn bran, vegetables as green
beans, cauliflowers. Insoluble fiber promotes regular bowel movement and prevents
constipation.
Patient must restrict these foods:

1. Sugar and artificial sweeteners, including honey.

2. Sweets and chocolates, including so-called sugar-free types.
3. Foods which contain significant proportions of things whose ingredients end in -ol
or -ose as these are sugars (the only exception is cellulose, which is a form of
dietary fiber).
4. "Diet" and "sugar-free" foods (except sugar-free jelly).
5. Starchy vegetables: potatoes and parsnips in particular; and go easy with beet,
carrots, peas, beans, et cetera and packets of mixed vegetables which might contain
them.
6. Milk (except in small quantities).
7. Sweetened fruit.
8. Cottage cheese (except in small amounts).
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9. Beware of commercially packaged foods such as TV dinners, "lean" or "light" in
particular, and fast foods, snack foods and "health foods".
10.Fruit juices, as these are much higher in crabs than fresh fruit.
Patient can eat these foods:

All meats – lamb, beef, pork, etc. Include the organ meats: liver, kidneys, heart, as
these contain the widest range of the vitamins and minerals that body needs (liver has
4 times as much Vitamin C as apples and pears, for example).

 All poultry: chicken, goose, duck, turkey, etc.

 Fish and seafood of all types.
 Eggs: 2-3 per week.
 All cheeses (except cottage cheese as this has a high carb content and very little
fat).
 Vegetables and fruits as allowed by carb content.
 Condiments: pepper, salt, mustard, herbs and spices
 Soy products.

Hepatic diet:

1. Large amounts of carbohydrate foods. Carbohydrates should be the major source

of calories in this diet.
2. Moderate intake of fat, as prescribed by the health care provider. The increased
carbohydrates and fat help preserve the protein in the body and prevent protein
breakdown.
3. About 1 gram of protein per kilogram of body weight. This does not include the
protein from starchy foods and vegetables. A person with a severely damaged
liver may need to eat less protein than this, and may even be limited to small
quantities of special nutritional supplements. Avoid limiting protein too much,
however, because it can lead to malnutrition.
4. Vitamin supplements, especially B-complex vitamins.
5. Reduce how much salt you consume (typically less than 1500 milligrams per
day) if you are retaining fluid.

low salt low fat diet (for cardiac diseases)

1. Eat no more than 3-4 egg yolks a week. It may be used alone or cooking and baking.
2. Moderate the use of shrimp & Limit organ meats.
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3. Use fish, skinless chicken & turkey and veal in most of the meat meals for the week.
4-Avoid deep- fat frying and use oil that is low in saturated fats when frying is done.
(Sunflower, safflower, corn, peanut, canola).
5-Restrict the use of fatty luncheon and variety meats as sausage& salami.

6-choose lean cuts of meat and removing the skin from pieces of chicken.
7-Instead of butter & cooking fats that are solid or completely hydrogenated,
emphasize liquid vegetable oil, as olive or sesame seed oil and soft or liquid
margarines.

8-Instated of whole milk & cheese made from whole milk & creams, use skim milk &
skim milk cheeses & low fat yogurt.

9-Use of plant food in place of animal foods.

For example, fill up on wholegrain breads and vegetable rather than meat.
10- Cooking methods that required little or no fat:-
Boil Broil, Bake, Sauté, steam, microwave.
11-Sodium restriction is often recommended because sodium instruction
improves the effectiveness of diuretic therapy and use of vinegar or lemon juice

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