DIET THERAPY

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 Medical Nutrition Therapy
Refers to the use of specific nutrition services to
treat an illness, injury or condition.
Two Phases:
1. Nutrition assessment
2. Nutrition therapy
Nutrition Therapy – refers to intervention used in
the treatment of a disorder or illness & includes
diet therapy, nutrition counseling, &/or the use
of specialized nutrition therapies such as:
ü Supplementation with nutritional or medical
foods.
ü Nutritional support through enteral or
parenteral methods.
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 All Hospital Diets are Modification of the
Normal Diets:
Aims:
1. To maintain good nutritional status
2. To correct deficiencies that may have occurred
3. To provide rest to the whole body or to certain
organs that may be affected by the disease
4. To adjust the food intake to the body’s ability to
metabolize the nutrients
5. To bring about changes on body weight
whenever necessary.

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 Responsibility of the Nurse in Relation to
Patient Diet:
1. Observes patient’s feeding problem
– Inability to chew.
– Physical handicap to feed himself
– Complaints about the food
2. Must be well-informed about the principles of
the diet food items allowed & prohibited.
3. Responsible to refer to the dietitian any question
of the patient regarding his food.
4. Forward immediately physician’s diet
prescription on the dietary department.
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5. Patient is for discharge with special diet, nurse
must notify the dietitian for the discharge diet or
take home diet.
6. Take note any left-over in the food tray, if food
recording is needed.

How to Compute Meal Appetite

Appetite Considered As:
0 – 5% very poor
10 – 30% poor
35 – 65% fair
70 – 85% good
90 – 100% excellent
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Routine Hospital Diets

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 Routine Hospital Diets

♥ Referred as “house” diet

♥ These are:
♥ Regular diet
♥ Soft diet
♥ Liquid diet
♥ Basis for special or therapeutic diets.
♥ To ensure adequacy of all hospital diets, use
of a food plan & meal pattern is
recommended.
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THERAPEUTIC DIETS

• Regular Diet
• Soft Diet
• Liquid Diet
• Bland Diet
• High fiber diet

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Regular Diet
ü Most frequently ordered among
house diets.

üOr general, house or full

hospital diets

ü is a balanced diet usually used for

the ambulatory patient. At times, it
has a slightly reduced calorie
content.
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 Regular Diet
ü Normal diet planned t o pro v i d e t h e
recommended daily allowances for the
essential nutrients & to meet caloric
needs of bedridden or any ambulatory
patient whose general condition does not
require general modifications or dietary
restrictions.
ü Patients failure to eat a normal diet could
lead to loss of body tissues & a prolonged
convalescence.

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üThis diet is a basic, adequate, general diet
of approximately 1600 to 2200 kcal;
üIt usually contains 60-80g of protein, 80-
100g of fat, and 180-300g of carbohydrate.
üHighly spiced foods, rich fatty foods and
gas formers should be avoided.
üAlthough there is no restriction, a regular
diet can be: low in fat, saturated fat,
cholesterol, sugar & salt.
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Normal diet may be modified for:
1. Consistency & texture
2. Flavor
3. Energy value
4. Nutrients level such as fat, protein,
carbohydrates, sodium & others.
5. Food categories such as types of fats or
elimination diet for allergies.

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 Soft Diet
üFoods must require little
chewing and can be easy to
digest. It is used immediately
between the full fluid & the
regular diet following surgery, or
for patients with infection,
digestive disorder, or chewing
problems.

üFollows the pattern of the

regular diet with modification in
consistency, texture & flavor
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Soft Diet
üDesign for patients who
are psychologically &
physically unable to
tolerate a general diet.

üFood allowed are low in

fiber diet & connective
tissues.

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üIt is not appropriate for patients
whose dentition is poor; these
patients require a mechanical
altered diet.
üSoft diet is most useful when the
selection of food is guided by
the patient’s tolerance.
üAverage composition of the soft
diet is 1800 to 2000 Kcal.

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Liquid Diets

Types:
1. Full liquid diet
2. Clear liquid diets

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Liquid Diets
Full liquid diets – contains all foods
that are liquid at room temperature
or could be liquefied at body
temperature
- It can melt in the mouth or
stomach
• Milk beverages, plain sherbets, ice
cream, plain pudding, soft custard
plain gelatin
• Strained fruit juices, coffee or tea
with cream & sugar
• Bland creamed soups, malt &
chocolate Page 17
v Full liquid diets provide a more
complete nutritional regimen
than the clear liquid diet, & can
be made nutritionally adequate
by proper planning.

v Average full liquid diet

contains 1000 to 1500Kcal,
with 45-50g of protein, 50-65g
fat, & 150-170g of
carbohydrates.

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Clear liquid diet – a diet
consists of liquid without
residue or fiber.
- Intended to supply fluid
& energy in a form that
require minimal digestion.

Primary Purpose:
1. Relieve thirst
2. H e l p m a i n t a i n w a t e r
balance

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 – Plain tea, black coffee
– Fat free broth
– Ginger-ale
– Plain gelatin
– Glucose solution
Are added to supply
additional calories:
– Fruit drinks
– Popsicles
– Fruit ice
– Clear fruit juices
vClear liquid diets should not
be used for more than two
days.
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v All liquids must be given
in small, frequent
feedings considering
patient’s condition &
capacity for food.

v Feeding is done every

2-3hrs & each feeding
should not exceed
300ml of liquids,
between 6am to 10pm.
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Indications for Use
Full liquid diets prescribe to:
1. Patient who cannot tolerate
solid foods due to:
a. Fever
b. Infections
c. Lesion in the mouth
d. Gastrointestinal disturbances
e. Nausea
f. Vomiting

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2. Use for post operatively as a
transition between clear liquid
& solid foods.

3. Useful for the acutely ill patient

or those with esophageal
disorders.

4. Those who are unable to chew

& swallow foods following the
surgery of the face, neck area
or dental surgery.

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Clear liquids: often used just
immediately before & after
surgery.
Aims:
1. To relieve thirst
2. P r o v i d e s o m e f l u i d f o r
preventing dehydration
3. To minimize stimulation of the
gastrointestinal tract & to
serve as the initial feeding
following surgery of the face,
neck area, or dental surgery.
v It is nutritionally inadequate &
must not be used without
supplementation for a
prolonged period of time.

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Bland Diet
• Is a nutritionally adequate diet
that includes food that has
bland flavor & soft consistency,
& mechanically & are
chemically non-stimulating.

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 Bland Diet Food to Eat
• White Flour Breads -Low sugar cereal
• White Flour Pastas -Potatoes
• Oatmeal -Tofu
• Soy milk -Soy yogurt
• Peanut butter -Almond butter
• Fish like cod, trout, herring -Milk
• Buttermilk -Yogurt
• Cheese -Puddings and custard
• Eggs -Soup
• Plain toast, crackers -Ripe bananas
• Cooked vegetables like bland carrots, squash and peas
• All canned fruits (except pineapples)
• Lean cuts of chicken, turkey and pork that are either baked
or grilled
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 Bland Diet Foods to Avoid
• Vegetables like cabbage, broccoli, cucumber,
green peppers, corn, cauliflower, etc. that makes
one gassy
• Fresh berries -Fresh fruits
• Dried fruits -Whipped cream
• Strong cheese like Roquefort
• High fat ice cream -Pickles
-Fried foods -Alcohol
• Coffee
• Whole grain breads, pasta and crackers
• Foods with high sugar or honey content
• Highly seasoned cured or smoked meats and fish
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High Fiber Diet
• Helps the digestive system work
properly, promotes regularity,
prevent or treats constipation &
may even decrease the risk of
colon & rectal cancer.
• Helps decrease blood cholesterol,
improve glucose control in
diabetes & control weight.

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Variations of the Routine Hospital Diet
A. Light diet – a diet consists of foods that
are easily digested & are readily emptied
in the stomach.
Indication:
ü Special elder ones who cannot tolerate
rich & heavy foods.
• Given in 3 small meals with between
meal feedings.
• Fatty foods, rich pastries, concentrated
desserts, fibrous fruits & vegetables are
restricted or given as tolerated.
• Light diet are given in replace for soft diet.

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B. Mechanical soft diet – or
dental soft diet.
- Used for patient with difficulty
in chewing due to poor dental
condition, lack of teeth, or
presence of sores & lesions
in the mouth following head &
neck injury.

- Those who are debilitated &

too ill to eat the regular diet.
- Food should be well-cooked,
easy to chew if necessary,
chopped, ground or minced.

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Foods & best served moist or
with gravy & sauce.

- D i e t s h o u l d b e
individualized to allow for
each patient’s chewing
tolerance.

- All beverages are allowed,

except for patient with
lesion in the mouth.

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C. Cold diet – or T & A diet
(tonsillectomy &
adenectomy)

- Consist of cold smoot h

liquids

- Diet is designed to
minimize the pain in the
oral cavity & avoid bleeding
in the affected area.

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Dietary Management: (main
objective)
1. Is to rest the organ
involved & avoid irritation
at the site of resection.
2. Promotes rapid wound
healing & replaces
nutrient losses.

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Post operative diet management:
1st day: start with ice chips or sips of cold water,
then cold milk & non irritating fruit juices.
2 n d day: cold liquids, gelatin, ice creams &
popsicles are added.
3 rd day & 4 th day: strained warm cream soups,
fruits, & vegetables purees, strained warm
cereals, milk, cheese, butter, rice porridge
(lugaw), mashed potato.
5th day: soft to light diet
vNormal diet should be resume after a week or as
early as on the 6th day.
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D. Enteral Tube feeding – this
type of diet requires a
consistency that can pass
through a polyvinyl tube.

- It is a method of introducing
food through a tube to
person with a functional
gastrointestinal tract either as
a supplemental nourishment
or as the only source of
nutrient intake.

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Enteral Feeding
- Pertains to the delivery of food &
nutrients either orally or by the
tube directly into the GIT.
- It is used on patients with a
functioning GIT but unable to
ingest required nutrients orally or
for patients with impaired
digesting capacity or unable to
absorb nutrients.

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• ENTERAL FEEDINGS
• An alternative feeding method to
ensure adequate nutrition through
GI system methods
• aka Total Enteral Nutrition (TEN)
• provided when the client is
unable to ingest foods or the
upper GIT is impaired and the
transport of food to the small
intestine is interrupted
– NASOGASTRIC OR
NASOENTERIC TUBES
– GASTROSTOMY
– JEJUNOSTOMY Page 37
Indications for Use of Tube Feeding
a. Inability to ingest food normally:
1. Stupor, unconsciousness, coma
2. Cerebrovascular accidents
3. Inflammation in central nervous
system
4. Cerebral neoplasm
5. Fracture of mandible
7. Oropharyngeal neoplasm, Head &
neck surgery
8. Dysphagia
9. Radiation to head or neck
10. Chemotherapy
11. Multiple sclerosis
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 b. Physiologic deterrents to food intake:
1. Nausea or vomiting in pregnancy, drug
reactions, radiation or chemotherapy
c. Impairment of digestion &/or absorption:
1. Pancreatic insufficiency; carcinoma
2. Chronic pancreatitis
3. Bile salt insufficiency
4. Bile acid-induced diarrhea; blind loop
syndrome
5. Short bowel syndrome
6. Gluten enteropathy
7. Crohn’s disease
8. Disaccharidase deficiency
9. Radiation damage
10. Abetalipoproteinemia
11. Obstruction of lymph flow
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d. Protein-calorie malnutrition:
1. Hypermetabolic state – burns,
trauma, dumping syndrome.

e. Obstruction of gastrointestinal
tract
(if access is below obstruction)
1. Esophageal stricture or
neoplasm
2. Spasm of pylorus
3. Neoplasm, foreign body or other
4. Obstruction of stomach or
intestine

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f. Psychiatric illness:
1. Anorexia nervosa
2. Depression
g. Diversion of flow: (fistula)
1. Surgery
2. Fever
h. Intestinal surgery:
1. Preparation for hemorrhoidectomy
2. Preparation for intestinal surgery
i. Transition from total parenteral
nutrition to conventional foods.
j. Renal failure
k. Hepatic failure
l. Inborn errors of metabolism
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Characteristics of Tube Feeding
and Preparations
v May be prepared from liquid foods using
calculated formulas, from commercial
preparations, or from regular or natural
foods liquefied in a homogenizer or
blender, & thus called “blenderized
feeding”.
v Satisfactory tube feeding must be
nutritionally adequate.
v Inexpensive, easily prepared, & stored.
v It should be well tolerated by the patient
with no reaction in the gastrointestinal tract
to cause flatulence, diarrhea, vomiting.

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• ENTERAL FEEDINGS
• TYPES:
• Intermittent feedings- are the
administration of 300- 500 ml of enteral
formula several times per day

• Continuous feedings- generally

administered over a 24- hr period using an
infusion pump that guarantees a constant
flow rate

• Cyclic feedings- continuous feedings that

are administered in less than 24 hrs

• note: the bag and tubing shld be replaced

every 24 hours

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 Factors to Consider in choosing
Tube Feeding Preparations
a. Physical properties of formulas
b. Ingredient & nutrient content
c. Product availability
d. Cost & preparation time
e. Techniques of administration

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In Preparing Tube Feeding it is Advisable
to Observe the following
1. Use enough liquid for better blending & liquefying.
2. Plain pasteurized milk is not recommended because
the butterfat tends to clump the blender. Use
homogenized milk instead.
3. Avoid coarse, fibrous foods that tend to clog the
blender. Use low-fiber fruits & vegetables, strain after
blending.
4. Use baby foods in bottles for convenience.
5. Keep prepared blended foods refrigerated until use.
Discard formulas after 24 hours.
v Tube feeding should not be warmed before use.
v Chilled or cold formula can be fed without problems if
administered slowly.
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v Heating the mixture may result
in:
a. Destruction of water soluble
vitamins
b. Coagulations of proteins
c. Clogging of nasogastric tube
d. Coagulation of formula

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Intervals of Feeding & Administration:
ü Feeding regimen should be adjusted to
the patients condition, nutritive &
dietary prescription by the doctor.
ü Initiate tube feeding, use dilute mixture
at first about ½ the required
concentration.
- Start at 50ml of mixture at hourly
interval then gradually increased. Till
patient can tolerate 2000ml at 2-3 hrs
interval
- Do not exceed at 3000ml of feeding of
3 – 4 hrs interval.

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ü If pump are used, formula need not be diluted.
ü Continues drip method:
- Flow of the tube feeding should be very slow at first,
then increased gradually but kept in constant, steady
rate.
- Total volume should not exceed 100ml per hour.
To prevent bacterial contamination:
1. Use feeding containers that are closed to reduce the
risk of airborne organism.
2. Never add new formula to old ones.
3. Extension tubing administration set & bag should be
change daily.
4. Prepared formulas should be refrigerated if not used
immediately.
5. Feeding formulas should not be allowed to hang for
longer 8-10hrs.
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Enteral Feeding
Types of Enteral formulations:
1. Ready-to-use formulations
a. Nutritionally complete formulation
can be used alone & provides total
needs in a specified volume of
formula.

b. Modular formulation provides

different forms of individual nutrients
to supplement existing formulas

c. Combined formulation meets

therapeutic needs

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2. Tube feedings may be prepared from
regular foods.
3. Standard tube feeding is fiber-free &
high in cholesterol, fat & sugar. It is
milk based, sugar, & soft cooked eggs.
4. Blenderized tube feeding are soft diet
allowances which can be blenderized
easily.

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Complications :
1. Mechanical
a. Nasopharyngeal irritation (ice
chips, topical anesthetic &
decongestant)
b. Luminal obstruction (flush,
replace tube)
c. Mucosal erosions (reposition tube,
ice water lavage; remove tube).
d. Tube displacement (replace tube)
e. Aspiration (discontinue tube
feeding)
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2. Gastrointestinal
a. Cramping/distention (change formula; reduce infusion
rate).
b. Vomiting/diarrhea (dilute formula; reduce infusion rate;
antidiarrheal agents).
c. Constipation (promote sufficient fluids & fibers;
encourage patient activity).
3. Metabolic
a. Hypertonic dehydration (increased free water)
b. Glucose intolerance ( reduce infusion rate; give
insulin.)
c. Renal failure (decrease phosphate, magnesium,
potassium, protein restriction, essential amino acids
solution.)

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d. Cardiac failure (reduce sodium content; fluid
restriction.)
e. Hepatic encephalopathy (decrease amount of
protein).

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Nursing Responsibilities

1. Document baseline weight &

obtain daily weight thereafter
2. Inspect insertion site for
signs/symptoms of potential
irritation & infection
3. Check for tube placement
prior to administration of any
feeding regimen or medication
administration
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Nursing Responsibilities

4. Check for residual on tube

feedings to prevent
complications & document
response to therapy
-residuals are often checked
every 4-12hours during
continuous feeds
-when feeding is not continuous,
residuals are checked before
starting the next feeding
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Nursing Responsibilities
5. If the residual amount is greater
than expected, the rate of
feeding will be decreased
and/or withheld in order to
prevent overload complications
resulting from inadequate
digestion
ü For continuous feeding-checked
q4hrs, if residual is >400ml, then
the feeding should be withheld &
the residual rechecked 1 hour to
determine if the client is now able
to tolerate feeding Page 69
Nursing Responsibilities

6 . Ch e c k p e r t in e n t la b s, d a i l y
weight, and I&O to monitor
response to clinical therapy

7. Communicate with other

healthcare team members in
order to meet individualized
client goals

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E. Parenteral Feeding
§ Is a means of providing the nutrients by routes
other than the mouth & digestive tracts.
§ Long-term nutritional support of 2 weeks for
patients who cannot be fed through the GIT.
§ Can be used in addition to enteral feedings or
used alone.
Routes:
1. Peripheral, Parenteral Nutrition (PPN) – given
via small vein. Net dextrose content is 10%.
2. Central, Parenteral Nutrition (CPN)/ Total
Parenteral Nutrition (TPN) or Intravenous
Hyperalimenation (IVH) – given centrally into
the superior or inferior vena cava or the jugular
vein. Net dextrose content is 25%. Page 71
Peripheral Vein Route:
- Given to patients with mild to
moderate nutrition deficiency.
a. Short term maintenance & not
hypermetabolic – NPO for 2 wks.
b. Supplemental energy & protein to an
oral diet
c. Weaning into enteral or parenteral
hyperalimentation requiring additional
energy & protein.

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Hyperalimentation – is a
feeding process in which a
catheter is inserted into the
superior or inferior vena cava.
- Is also called Total Parenteral
Nutrition = is a form of
intravenous feeding, nutrients
are introduced directly to the
bloodstream bypassing the
gastrointestinal tract entirely
- Primary goal: to maintain the
nutritional equilibrium &
conserve lean body mass.
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List of conditions which may need TPN for nutritional
support:
1. Disease of the small intestine at critical stage
2. Massive small bowel resection
3. Radiation enteritis
4. Severe diarrhea
5. Intractable vomiting
6. Bone marrow transplantation
7. Patients on high dose chemotherapy
8. Severe pancreatitis
9. Severe malnutrition
10. Hypercatabolic states as burns & cancer
11. Other major surgeries where enteral feeding will not
supply complete & balanced nutritional intake.

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 Vegetarian Diets
These diet is designed to utilized a combination of
vegetable protein providing a similar quantity &
quality of protein as animal protein.
Concern:
1. Religious reasons
2. Environmental considerations
3. humanitarian issues
4. Socio-economic
5. Political reasons

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Types:
1. Semi-vegetarian – fruits, grains, legumes, nuts &
seeds, vegetables, milk, & milk products, eggs,
chicken & fish are included in the diet. Excluded are all
other animal meats.
2. Vegan diet – or strict vegetarian diet, foods allowed
are strictly of plant origin devoid of animal product.
Fruits, vegetables, legumes & nuts, breads, cereals &
processed foods made from these items; ex. Peanut
butter, soy milk, cheese & ice cream, eggs, fish &
poultry, red meats.
3. Lacto-vegetarian – in this diet, milk & milk products
are allowed in addition to food items of plant origin.
4. Ovo-vegetarian – egg & egg products are allowed
besides items of plant origin.

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5. Lacto-ovo-vegetarian – eggs, milk & their
products are both allowed in addition to food
from plants.
6. Pesco-vegetarian – in this diet, fish & fish
products are added to the list of items of plant
origin, all animal meats are excluded.
v Vegetarian diets are usually low in saturated
fatty acids & cholesterol. It has high fiber
content & is generally more economical than
diets with meats, fish, poultry.
v Disadvantage: low level of Vit.B12, calcium,&
vit.D.
v Deficiency can be prevented by proper
supplementation. Page 84
Diet as Tolerated (DAT)
- Routinely, the diet regimen may range from full
liquid to regular diet, allowing preference at the
dietitian’s discretion.
- this type of order should be a temporary
measure, lasting no more one day until a more
specific diet is ordered, based on results of
diagnostic test & medical examination.
- Usually prescribed to patient who are newly
admitted & has a problem with digestion.

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