NUTRITION AND DIET THERAPY
• Nutrition Therapy – treatment based on
nutrition.
o Checking person’s nutrition status and
giving right food or nutrients to treat
conditions such as those cause by
diabetes, heart disease, and cancer.
• Medical nutrition therapy – nutrition therapy
may help patients recover more quickly and
spend less time in the hospital.
OBJECTIVES OF NUTRITIONAL CARE IN DISEASE
• Supply optimum nutrition
• Heal tissue, cure disease
• Support recovery from the disease
• Improve the function of the involved tissue or
organ system
• Reduce work of the affected organ to promote
healing
FACTORS IN PLANNING MODIFIED DIET
• Disease state, its nature, duration, intensity
• Food form or nutrient modification required by
the disease
• Patient’s individual food tolerances and food
habits
• Nutritional adequacy of modified diet
• Patient’s physical ability and home situation.
ILLNESS AND NUTRITION
• Illness has many effects on body’s ability to use
nutrients based upon specific requirement
o Lack of appetite, vomiting, and pain –
prevent intake of sufficient amount of
food
o Fever – increase the rate of metabolism
o Metabolic disease (diabetes) – nutrients
are not fully utilized
ILLNESS AND FOOD ACCEPTANCE
• Comfort vs treatment of the patient
• Distress the patient rather provide immediate
comfort
• Nurse plays an essential role of this gap
• An illness may reduce a person’s interest in food
o Gastric distention
o Inactivity and intake of several drugs
o Different food pattern and missing the
family
o Worries of mounting bills
o Changes in flavor, texture, etc
o Feeling deprived and punishes (pt.
become more self-centered, irritable, or
even angry)
RESPONSIBILITIES OF THE NURSING DEPARTMENT
• Channel/bridge:
o Nurse immediately forwards the diet
prescription to the diet department
• N.A. – monitoring
THE ROLE OF NURSES IN NUTRITIONAL CARE
• Observing, listening, and reporting – 3 important
functions
o Observing – checking you patient’s
condition
o Listening – understanding your patient
o Reporting – acting on the information
gathered
o Informal teaching – health education
DIET THERAPY
• Appropriate diet is essential in the total care plan
developed for every patient
• Aims:
o Maintain normal nutrition
o Correct nutritional deficiency
o Change body weight
o Adjusts the body’s ability to use one or
more nutrients
o Permits maximum rest to the body or an
organ
STANDARD HOSPITAL DIETS: LIQUID DIETS
CLEAR LIQUID DIET
• Allowance pf tea, coffee, or coffee substitute,
and fat-free broth
• Ginger ale, fruit juices, gelatin, fruit ices, and
water gruels can also be given
• Small amounts of fluid are offered every hour or
two
• Used 24-48 hours ff. acute vomiting, diarrhea, or
surgery
• Purpose: relieve thirst and maintain water
balance
FULL LIQUID DIET
• Liquids and foods that liquefy at body
temperature
 • For acute infection, fever of short duration, and o Desserts: pies w/ tender crust, cakes, and
pt. to ill to chew puddings
• Progressive from clear fluid ff surgery
• Tx to GI upset STANDARD HOSPITAL DIET: TEST MEAL
• Offered in six feedings or more (gradual giving)
o Commonly followed full-liquid diet TEST MEALS
regimens • Fecal Fat Determination Test
▪ Breakfast o Measures fat globules in the stool to
• Vegetable juice detect fat absorption as in cases of cystic
• One bowl gelatin fibrosis
• One glass pulp-less fruit o Changes in stool consistency and odor
juice can indicate that your body isn’t
• One cup coffee or tea absorbing as much fat as it should
• Water • Purposes of fecal fat testing
• Supplement with honey o Fecal fat testing may be performed if
▪ Lunch your doctor suspected that your digestive
• Glass pulp-less fruit juice system isn’t functioning correctly. In a
normal person, the absorption of fat is
• Vegetable juice
based on variety of factors:
• One bowl gelatin
▪ Bile production in the gallbladder
• Broth
or liver, if your gallbladder was
• Cream soup
removed
• Beverage
▪ Production of digestive enzymes
• Water
in the pancreases
• Ice cream ▪ Normal functioning of the
▪ Supper intestines
• Glass pulp-less fruit juice o If any of these organs are not working
• Vegetable juice properly, your body might not be able to
• One bowl gelatin absorb as much fat as you need to
• Broth remain healthy and nourished.
• Coffee/tea Decreased absorption of fats can be a
• Supplement with sign of many different illness, including:
honey/nectar ▪ Celiac disease – this digestive
disorder damages the intestinal
STANDARD HOSPITAL DIET: SOFT DIETS lining. It’s caused by an
intolerance to gluten
SOFT DIETS ▪ Crohn’s disease – this
• Differs from the normal diet in terms of having: autoimmune inflammatory bowl
reduced fiber content, soft consistency, and disease affects the entire
bland flavor. digestive tract
• Used immediately after full liquid diet ▪ Cystic fibrosis – the genetic
• Modified from normal diet in the ff ways: disease results in thick mucus
o Meat and poultry are minced and secretions in the lungs and
ground. Tender fish w/o digestive tract
o Vegetables, diced, or chopped are ▪ Pancreatitis – this condition is an
cooked (may be cooked a little longer to inflammation of the pancreases.
make sure it’s soft) ▪ Cancer – tumors in the pancreas
o Soft raw fruits or biliary ducts can affect your
o Soft roll, breads, biscuits body’s absorption of fat.
OTHER TEST MEALS o Age of family members
• Meat-free test o Storage and preparation facilities
o Used to determine GIT bleeding. A 3-day o Cooking skills
diet excludes ingestion of meat, poultry, Dietary standard → Recommended Dietary Allowance →
and fish. recommended Energy and Nutrient Intakes
• Calcium test • Giving emphasize that standards should be in
o Used to determine urinary calcium nutrients and not on food or diets.
excretion to diagnose hypercalciuria. The • Recommended Energy and Nutrient Intakes – are
diet required 1000 mg calcium intake. levels of intake and nutrients which, on the basis
400 mg from food source and 600 mg of current scientific knowledge are considered
oral supplements. adequate for the maintenance of health and well-
• Serotonin Test being of nearly persons of the population.
o Used to detect carcinoid tumors of the • Essentials of an Adequate Diet
intestinal tract. Food rice in serotonin is o proteins, carbohydrates, fats, vitamins,
excluded in the diet. minerals, cellulose, and water should be
NORMAL DIET MODIFICATION provided in sufficient quantity through
• Modification is needed in a therapeutic sense the daily meals to meet the needs of the
• Normal diet may be modified for body
o Consistency and texture o Meat group
o Flavor ▪ Provide generous amount of
o Energy value high-quality protein
o Nutrient level ▪ Iron, thiamine, riboflavin, niacin,
o Food categories phosphorus, and zinc are
• AIM: keep as many characteristics of the normal supplied
diet as possible ▪ Liver, kidney, saltwater fish
GOOD TRAY SERVICE should be included in the animal
• Sufficient size tray, uncrowded arrangements of protein allowance
dishes ▪ Plant-source/nonmeat
• Clean, unwrinkled tray cover and napkin of linen alternatives can also be provided.
or good quality paper o Bread and cereal group
• Attractive pattern of spotless chinaware w/o ▪ Furnished thiamine, protein, iron,
chips or cracks, clean glassware and shining niacin, carbohydrate, and
silverware cellulose at a relatively low cost.
• Orderly arrangement of all items o Vegetable-fruit group
• Portions of food suitable for pt’s appetite ▪ Important supplier of fiber,
• Food attractively arranged minerals, and vitamins
particularly vitamin A and C
• Meals served on time
• Assessment of nutritional status
• Hot food served and kept warm, cold foods
o Nutritional assessment (nutriture)
served on chilled dishes
▪ Degree to which the individual’s
• Trays promptly served to the patient
physiological need for nutrients
is being me by the food the
person eats.
RECOMMENDED DIETARY ALLOWANCES AND
▪ It is the state of balance in the
ADEQUATE DIET
individual between the nutrient
• Factors to considered in planning nutritious
intake and the nutrient
meals
expenditure or needed.
o Regional availability of foods
o Evaluation of the Nutritional Status
o Socio-economic conditions
involves
o Taste preferences
o Food habits
 ▪ Examination of the individual’s
physical condition
▪ Growth and development
▪ Behavior
▪ Blood and tissue levels of
nutrients
▪ Quality and quantity of nutrient
intake
o In a thorough nutritional status
assessment, all of the following aspects
are considered:
▪ Dietary history and intake
▪ Biochemical date
▪ Clinical examination
▪ Anthropometric data
▪ Psychosocial data
• Methods of Assessing Dietary Intake
o 24-hour recall
▪ The individual completes a
questionnaire or is interviewed
by a dietitian/nutritionist, or a
nurse experienced in dietary
interviewing and is asked to
recall everything that he/she ate
within the last 24 hours or
previous day
▪ “In order to get a more complete
picture of your family’s health, I
need to know more about you
eating habits. Would you please
tell me everything you ate or
drank all day yesterday? Let’s
begin with:”
o Food frequency questionnaire
▪ Questions, should be modified
based on the information from
the 24-hour recall
o Diet history
▪ More complete than either the
24-hour recall or food frequency
questionnaire, though it usually
includes both of these sources.
The dietary history contains
additional information about the
following
• Economic
• Physical activity
• Ethnic and cultural
background
• Home life and meal
patterns
• Appetite
• Allergies, intolerances,
and food avoidance
• Dental and oral health
• Gastrointestinal concerns
• Chronic diseases
• Medication
o Food diary or Record
▪ This method involves time,
understanding, and motivation
on the part of the patient or
client. The subject is asked to
write down everything he/she
eats drinks for a certain time.
Three days, particularly two
weekdays and one weekend day,
have been found to be a
representative time period of
most people.
o Observation of food intake
▪ The most accurate method of
dietary intake assessment but
also the most time-consuming,
expensive, and difficult. It
requires knowing the amount
and kind of food presented to
the person and the record of the
amount actually taken.
• Evaluation of the Food Intake Data
o Evaluation by food group method
▪ The simplest and fastest, yet
crudest way to evaluate food
intake data is to determine how
many servings from each of the
four group were consumed
during the recorded day. The
number of servings is suggested
in the basic four or seven food
plans.
o General rules of meal planning
▪ Use the whole day as unit rather
than the individual meal. Make
breakfast relatively simple and
standardized, the plan dinner.
Lastly plan lunch and snacks to
supplement the other two meals
 ▪ Use some food from each of the
food groups daily (regulating,
energy-giving, bodybuilding)
▪ Use some raw fruits or
vegetables at least once daily.
▪ Plan to have for each meal at
least one food with staying
power or high in satiety value,
one which contains roughage
(fibrous), and generally some hot
food or drink.
▪ Combine or alternate foods of
bland form with those of a more
pronounced flavor
▪ Combine and alternate foods soft
and crisp foods
▪ Have a variety of color, food, and
food arrangement
▪ When more foods are served at
one meal, decrease the size of
portions, and used fewer rich
foods.
• According to one
dictionary, rich as applied
to food means fatty, oily,
or sweet, or highly
seasoned.
o Some don’ts for Menu Planning
▪ Avoid using the kind of food
twice a day w/o varying the form
in which it is served except
staples like rice, bread, and milk.
▪ Do not use the same food twice
the same meal even in different
forms.
▪ Do not use the same food too
often from day to day
o Other considerations:
▪ Meal patterns. Meal or menu
patterns are helpful in planning,
but they must consider the
family’s habit and needs.
▪ Planning for the week. Best to
have weekly menu plan. In
hospitals, the practice of
dietitians is to prepare a so-called
“cycle menu”
NUTRITIONAL SURVEY
• Is a epidemiological investigation of the
nutritional status of the population by various
methods together with an evaluation of the
ecological factors of the community
SIGNIFICANCE OF NUTRITIONAL ASSESSMENT
• It is the first essential in nutritional planning
• It provides data and information for planning and
evaluation
• It helps define priorities and responsibilities of
public health system at the national, regional,
provincial, city, municipal, and barangay levels.
METHODS OF NUTRITIONAL ASSESSMENT
• Method that provides direct information
o clinical examination
o biochemical examination
o anthropometric measurement
o biophysical technique
• method that provides indirect information
o studies on food consumption
o studies on health conditions and vital
statistics
o studies on socio-economic conditions
o studies on cultural and anthropological
influences
• Factors considered in the selection of nutrition
survey method
o Unit to be surveyed
o Types of information required
o Degree of reliability and accuracy
acquired
o Human resources
o Time reference
o Funding or financial support
• Features of methods and reference standards
used
o Clinical assessment – deals with the
examination of changes that can be seen
or felt in superficial tissues such as skin,
hair, eyes
▪ Advantages
• More coverage in a short
time
• Inexpensive; no need for
sophisticated equipment
▪ Disadvantages
• Non-specificity of signs
• Overlapping of deficiency
state
• Bias of the observer
▪ Clinical signs – known to be value
in nutrition surveys and their
interpretations
 o Biochemical assessment – estimation of
time desaturation, enzymes activity, or
blood composition
▪ Test are confined to two fairly
easily obtained fluids: blood,
urine
▪ Results are generally compared
to standards – normal levels for
age and sex
▪ Advantages
• Objectivity, independent
of the emotional and
subjective factors that
usually affect the
investigators
• Can detect early
subclinical states of
nutritional deficiency
▪ Disadvantages
• Costly, usually requiring
expensive equipment
• Time-consuming
▪ Factors affecting accuracy of
results
• Standards of collection
• Methods of transport
and storage of samples
• Techniques employed
▪ Common biochemical
parameters/tests

• Anthropometric Measurements – the

measurement of variations of the physical
dimensions and gross composition of the human
body at different age levels and degrees of
nutrition
o Common anthropometric measurements
• Clinical assessment
o Protein-energy malnutrition
▪ Mild to moderate
▪ Severe
• Marasmus (fry form)
• Kwashiorkor (edematous
form)
• Marasmic kwashiorkor
o Xeropthalmia – affects the eyes,
gradually beginning with an impairment
of night vision. Initial stages may be
treated by the supplementation of the
daily diet with vitamin A. Severe cases
need large supplements and
simultaneous treatment of the eye
problem with antibiotics
▪ Impaired night vision
▪ Smokey conjunctive
▪ Dry eyes
▪ Cornea softening and ulcers
o Prevalence criteria for determining the
public health significance of
exophthalmia and vitamin A deficiency in
children aged 6 months to 6 years
o Anemia – sole reliance on breast milk for
children beyond 6 mos. Leads to anemia.
Since blood cells require both protein
and iron for their formation, treatment
should concentrate on supplementing
their nutrients in the diet
▪ Tiredness
▪ Paleness under the eyelid
▪ Breathlessness
▪ Heart palpitation
▪ Paleness under the nails
▪ Edema
o Goiter – enlargement of the thyroid
glands is due to its need for iodine.
Common in female
▪ Swelling of the neck
▪ Difficulty in breathing
▪ Difficult in swallowing
▪ Tight feeling in throat
o Vitamin B2 or Riboflavin Deficiency
▪ Magenta red tongue
▪ Sores at the angle of the mouth
and folds of the nose
▪ Itching and scaling of skin around
nose, mouth, scrotum, forehead,
ears, scalp
• Biochemical assessment deficiency probably up to 1 year
o Protein in adults and up to 4 months in
▪ Amino acid imbalanced test young children.
• Ratio of four dispensable ▪ Serum carotene level in not
amino acids and four indicative ingestion of carotene-
indispensable amino containing foods.
acids in serum by paper ▪
chromatography
• High (5-10) in
kwashiorkor and low
(less than2) in well-fed
children
▪ Hydroxyproline excretion in
random urine
• Low (0.5-1.5) in clinically
malnourished children;
normal 2.0 to 5.0
▪ Serum albumin
• Lowered in severe
protein depletion
• Guide in interpretation
(g/100ml)
o High – 4.25
o Acceptable –
3.52 – 4.24
o Low – 2.80 – 3.51
o Deficient – less
than 2.80
o Iron
▪ Hemoglobin determination
• Cyanmethemoglobin
method by
spectrophotometry
▪ Hematocrit
• Obtained from a finger
prick
• Values below which
anemia is said to exist

o Vitamin A
▪ Serum vitamin A and serum
carotene level by
spectrophotometry using micro
and macro methods
▪ Low serum vitamin A reflects
prolonged sever, dietary