NURS 3018: Diet Therapy

CONCEPTS OF DIET THERAPY

Objectives

▪ At the end of this presentation students

should be able to:
▪ Describe the purpose of nutrition therapy
▪ Describe methods of dietary modifications
for clients in primary and secondary care
settings
▪ Relate the role of the nurse in nutritional
care
Diet/Nutrition Therapy
▪ Nutrition care that encompasses the
assessment and treatment of any disease,
condition, or illness- Medical nutrition
therapy
▪ Includes
 Modified diet
 Nutrition education
 Specialized nutrition support with oral nutrition
supplements
 Tube feedings
 Intravenous nutrition
 Purpose of Nutrition Therapy
The purpose of nutrition therapy is to :-
▪ Ensure adequate energy and nutrient intake- to
prevent under and over nutrition
(malnutrition)
▪ Prevent insufficient intake of some
micronutrients such as iron and folate
▪ Prevent physiological consequences of
malnutrition- LBW babies, NCDs and mortality
▪ Improve adherence of recommendations such
as RDA, UL, EAR etc.
Dietary modifications in nutrition therapy
Types of diets regularly used in Nutrition therapy include:
▪ Regular
▪ Liquid
▪ Soft
▪ Diabetic
▪ Low Calorie
▪ High Calorie
▪ Low Cholesterol
▪ Fat-restricted
▪ Sodium-restricted
▪ Protein
 Bland
 Low-residue
Assignment

▪ List two diets that are modified based on texture

▪ List two diets that are modified based on energy
▪ Identify one diet that is modified based on
micronutrient content
▪ List two foods that are restricted in a blenderized
diet
▪ Differentiate between clear fluid and soft diets
▪ Identify two deficiencies that may arise if a client
consumes a clear liquid diet for a protracted time
▪ List two conditions that may require mechanically
soft diet
Diet Use Foods Allowed Foods not Nutritional
allowed adequacy and
advice
Regular General diet for All None Adequate if
people who do consumed as
not require ordered
texture or
nutrient
modification
Clear Hydration, bowel See through items Opaque Inadequate in all
Liquids prep for some liquid at room Liquids, solid nutrients, low in
procedures, temperature- foods energy. Consider
transition to juices, drinks, nutrition
solids from NPO broth, popsicle, supplement;
gelatin monitor length,
refer 5 or more
days
Full Liquids Chewing or Foods liquid or Solid foods, Nutri. adequate
swallowing pourable at room liquid at room when supplements
difficulties temperature- all temp. foods consumed. If
clear items & with added dysphagia consult
dairy, custards, solids e.g. ice doc for eval. High
supplements cream with fat/ low fibre long
nuts use
Diet Use Foods Allowed Foods not Nutritional
allowed adequacy and
advice
Mechanical Chewing or Liquids, minced, soft, Whole nuts, seeds, Nutri adequate if all
or Dental swallowing chopped, ground meat with casings, food groups are
Soft difficulties foods; protein w/o tough meats, hard consumed; may be
bones, grizzle. Cooked crusted bread, low in fibre-
beans and eggs. raw vege and consult
Desserts, Grains- fruits/vege- nutritionist- re safe
cooked/soft; fruits edible skin textures and doc re
and vege- cooked, soft gag reflex
Pureed Advanced Blenderized or Whole nuts, seeds, Nutri adequate if all
chewing or pureed foods. Any hard bread/rolls, food groups are
swallowing food allowed that can dried fruit, consumed; avoid
difficulties be pureed to a fruits/vege- over-modification.
custard-like edible skin, any Essential foods is
consistency w/o food that cannot presented in
solids remaining. Can be pureed to a attractive manner
add liquid to get smooth to stimulate
desired consistency consistency appetite- molds,
garnishes.

Tucker & Dauffenbach, 2011; Cichero, et al., (2017).

 Food Modifications
▪ Foods- particular those provided by the oral route may be
modified based on
 Energy needs
 Nutrients- supplemental immunonutrition may be given to
improve illness recovery such as included antibodies, antioxidants
and additional minerals
 Energy- may increase or decrease depending on type of illness and
the metabolic demand
 Preparation, flavouring, seasoning- low levels recommended in
colitis, diarrhoea, CA of GI
▪ These modifications affect the clients likelihood of
acceptance; Based on
 Presentation
 Level of modification
 Usual intake
 Preparation style
 Commentary from the nurse
 Nurse’s responsibilities with nutritional care

▪ The nurse has responsibility to assist in

coordinating care and services.
▪ The nurse usually collaborates with other
members of the health care team in
 nutritional assessment,
 nutrition education,
 delivery of dietary support- modified diets, tube
feedings, IV nutrition.
 Nurse’s responsibilities with nutritional care

▪ The Physician is usually needed to :

 Assess gag,
 Identify GI functionality,
 Examine the presence of strictures, dysphagia &
swallowing disorders
▪ From these assessments the physician usually
 makes dietary prescriptions for regular diet, modified,
enteral, parenteral, palliative
▪ The nurse collaborates with the physician to
implement dietary prescriptions as well as to re-
examine the patient for nutritional imbalances and
serves as an advocate
 Nurse’s responsibilities with nutritional care
Dietician and dietary department- is
responsible for:-
▪ Anthropometric assessment and clinical
assessment.
▪ They recommend the appropriate biochemical
tests that are needed to determine deficiencies.
▪ From these assessments, they usually make
dietary prescriptions for :
 regular diet, modified, enteral, parenteral, palliative.
 Nurse’s responsibilities with nutritional care
Dietician &dietary department- is responsible
for:-
 Providing more detail about the composition of the diet-
total energy requirement, protein, and supplements that
may be needed
 Recommend preparation methods of foods
 Preparing data for nutrition education

▪ The nurse collaborates and ensures these actions

are done
 Nurse’s responsibilities with nutritional care
The nurse also works with other health team to
ensure that the nutritional needs of the patients
are met
 the phlebotomist, nutritionist, meal services
department
▪ The nurse may also communicate with the family
and the patient the changes that are important
and necessary for health maintenance.
▪ The nurse usually recommends follow up care
and advocates for referral to HTN, Renal, DM,
HIV/AIDS clinic and dietetics department.
Nurse’s responsibilities with nutritional care

The nurse also serves as Communicator

 Explaining the treatment regime; advocating for
more detailed explanation particularly of dietary
prescriptions
 Interpret rationale for diet
 Assists in food selection, may advice on
preparation style and techniques
 Ensures that the ordering, delivery and
administration of the prescribed diet
Nurse’s responsibilities with nutritional care

Nurse as Teacher/Counsellor
▪ Uses informal opportunities to teach- such as
during medication administration, meal service
and family visits
▪ Plan instructions- useful in primary health care
and health promotion and for new diagnoses
▪ Counsels patient and family
▪ Support, supplement and reinforce the
information provided by the dietary
department
 References
▪ Cichero, J. A., Lam, P., Steele, C. M., Hanson, B., Chen, J., Dantas, R. O., ... & Pillay, M. (2017).
Development of international terminology and definitions for texture-modified foods and
thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia, 32(2),
293-314.

▪ Duggan, M., & Golden, B. (2007). Deficiency diseases. In C. Geissler & H. Powers (Eds.),
Human Nutrition (11th Ed.) (pp 517-536). Edinburgh, UK: Elsevier Churchill Livingstone.
▪ Nix- McIntosh, S. (2017). Williams’ Basic Nutrition and Diet Therapy. ( 15th Ed.). Missouri:
Elsevier.

▪ Smith, R. C. (2007). Nutritional support for hospitalized patients. In J. Mann & A. S.

Truswell (Eds.), Essentials of human nutrition (pp 33-52). New York, USA: Oxford
University Press.

▪ Tucker, S. & Dauffenbach, V. (2011). Nutrition and diet therapy for nurses. Boston, USA:
Pearson.
▪ Wright-Myrie, D. (2018). Computations in nutrition: A guide for healthcare workers. (1st
Ed.). South Carolina: CreateSpace.
▪ Wright-Myrie, D. (2018). Nutrition for the Ordinary Man. South Carolina: CreateSpace.