Applied Nutrition and Diet Therapy

confirmed protein-energy malnutrition.

ROLE OF NURSES - “Nutritional care process” – ABCD
● Screening in-patient to determine the level of risk.
1. Anthropometric
● Liaison between the dietitian and physician as well with
- Height and Weight
other members of the health care team. - BMI (Body Mass Index) - index of weight related
● Nutrition resource when dietitians are not available. to height.
● Basic nutrition counseling in hospitalized clients low to mid
risk.

ROLE OF DIETITIAN
● Obtaining history and usual diet prior admission.
● Nutrition history
● Calculate protein and protein requirements based on data.
● Nutrition interventions 2. Biochemical Data
● Determine nutritional diagnosis - Marker from fluids/wastes of the body.
- Laboratory tests from the patient.
Nursing Process - Urinalysis and blood tests (albumin and
1. Assessment prealbumin)
a. Malnutrition
● Deficiencies, excess or imbalances in intake of 3. Clinical Data
energy and/or nutrients. a. Kwashiorkor - protein deficiency
● 95 children per day die of malnutrition (WHO). b. Marasmus - carbohydrate deficiency
● 1000 Filipino children are not able to reach the
age of 5.
● 1/3rd Filipino children are stunted

Causes:
- Lack of safe drinking water and access to safe drinking
water
- Poor sanitation
- Dangerous practices

2 Kinds of Malnutrition:
1. Undernutrition
a. Wasting –– height is appropriate but have low 4. Dietary Data
weight. ● Are you on a diet?
b. Stunted –– height is small for age. ● Do you avoid any particular foods?
c. Underweight –– low weight for age ● Do you watch what you do in any way?
● How many meals and snacks do you eat in a
2. Overnutrition 24-hr period?
a. Diet related ● Do you have food allergies?
b. Overweight or obese ● Do you drink vitamin, mineral, herbal or other
supplements?
B. Nutritional Screening ● What concerns do you have about what or how
- Quick look at a few variables to judge a client’s risk for you eat?
nutritional items. ● For acutely ill, how has illness affected your
● Significant weight loss choice or tolerance of food?
● Diagnosis ● Who prepares the meals?
● Change in appetite ● Do you have enough food to eat?
● Difficulty eating ● How much alcohol do you consume daily?
● Bowel habits
● Use of enteral or parenteral nutrition Client Teaching
● Height - Compared with “well” clients, patients in a clinical setting
● Diet may be more receptive to nutritional advice, especially if
● Nausea/Vomiting they feel better by doing so or are fearful of a relapse or
● Weight complications.
● Albumin, Hematocrit
Ways to Promote Adequate Intake
C. Comprehensive Nutritional Analysis ● Encourage a big breakfast if appetite deteriorates
- In-depth analysis of nutritional status. throughout the day
- Focus: moderate-high risk with suspected or ● Advocate D/C of IV therapy (if feasible)
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● Replace meals withheld for diagnostic test
● Out of bed when eating (possible)
● Encourage good oral hygiene
● Solicit info on food preferences (cultural or religious)
● Display a positive attitude

Ways to Facilitate Client and Family Teaching

● Listen to concern and ideas
● Family involvement (if appropriate)
● Reinforce importance of nutrition
● Help in selecting appropriate foods
● Counsel the client about drug-nutrient interaction
● Keep message simple, emphasize things “to do”, not “not
to do”
A. VITAMINS ARE CHEMICALLY DEFINED
● Written handouts
- Adult Female needs
● Avoid if not tolerated
● 46g protein
● 1.1 mg thiamin
5. Monitoring and Evaluation ● 2.4 micrograms
Nursing Responsibilities: B. VITAMINS ARE SUSCEPTIBLE TO DESTRUCTION
● Check intake and output - Individual vitamins differ in their vulnerability to heat, light,
● Document appetite oxidation, acid, and alkalis
● Order supplements if intake is low or needs are high C. VITAMIN MAY EXIST IN MORE THAN ONE FORM
● Nutritional consults - Vitamin A exists as retinol (important for reproduction), retinal
● Assess tolerance (needed for vision), and retinoic acid (acts as a hormone to
● Assess weight and BMI regulate growth).
● Monitor progression of restrictive diets - Some vitamins have provitamins (precursors of vitamins), an
● Monitor comprehension of information and motivation to inactive form found in food that the body converts to the active
change form. Beta-carotene is a provitamin of vitamin A.
D. VITAMIN ARE ESSENTIAL
Classification of Nutrients - Vitamins are essential in diet because the body cannot provide
1. Macronutrients them.
- The body can make vitamin A, vitamin D, and niacin if the
a. The plant-based nutrients which are essential in
appropriate precursors are available.
large quantities as our body cannot produce by - Microorganisms in the gastrointestinal (GI) tract synthesize
itself. vitamin K and vitamin B12 but not in amounts sufficient to meet
b. These macro-nutrients provide energy and the body’s needs.
support the different metabolic system, growth,
Rich sources of antioxidants
and development of the body.
c. Macronutrients include fats, proteins, Beverages coffee, green and black tea, red wine
carbohydrates, vitamins and minerals.
2. Micronutrients Fruits bilberries, black currants, wild strawberries,
blackberries, goji berries, cranberries, dried apples,
a. The plant-based nutrients which are required in
dried plums, dried apricots, prunes
very small quantities and are mainly responsible
for repairing damaged cells and tissues, Vegetables kale, red and green chili
prevention of infectious diseases by fighting
Spices and herbs cloves, peppermint, allspice, cinnamon, oregano,
against the disease-causing pathogens including thyme, sage, rosemary
bacteria, virus, fungi, etc.
b. Micro-nutrients include calcium, iron, vitamins, other dark chocolate, walnuts and pecans with pellicle
iron, minerals and vitamin C.

E. SOME VITAMINS ARE USED AS FOOD ADDITIVES

- vitamin C is added to frozen fish to help prevent rancidity and to
luncheon meats to stabilize the red color.
- Vitamin E helps retard rancidity in vegetable oils, and
beta-carotene adds color to margarine.

CLASSIFICATION OF VITAMINS
 Applied Nutrition and Diet Therapy

Table 5.1 Group Characteristics of Fat-Soluble and Water-Soluble Vitamins

FAT-SOLUBLE

WATER-SOLUBLE

TIPS FOR BOOSTING FRUITS AND VEGETABLES INTAKE

1. Most taken vitamins: B6, B12, C, A, and E.
2. Eat at least five servings of fruits and vegetables every day. More
is even better.
a. Five servings of fruits and vegetables per day may
provide more than 200 mg of vitamin C, far more than
the RDA of 75 mg for adult women and 90 mg for adult
men.
3. Concentrate on variety and color.
a. Aim for at least one green, one orange, one red, one
citrus, and one legume serving every day.
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4. Make an effort to preserve the vitamin content of vegetables:
store them in the refrigerator (except for onions, tomatoes, winter
squash, and potatoes), prepare them with minimal peeling, and
cook for as short a time as possible in as little water as necessary.
5. Start at least one meal each day with a fresh salad.
6. Eat raw vegetables or fresh fruits for snacks.
7. Add vegetables to other foods, such as zucchini to spaghetti sauce,
grated carrots to meat loaf, and spinach to lasagna.
8. Double the normal portion size of vegetables.
9. Buy a new fruit or vegetable when you go grocery shopping.
10. Eat occasional meatless entrees such as pasta primavera,
vegetable stir fry, or black beans and rice.

TO WHOM DO RECOMMEND SUPPLEMENTS

1. Dieters who consume fewer than 1200 calories.
2. Vegans, esp. B12 because it is found naturally only in animal
products.
3. Finicky eaters
4. A large proportion of adults age 51 years and older
5. Alcoholics
6. People who are food insecure
7. People with chronic illness or chronic use of a medication

MINERALS

SUMMARY OF MAJOR ELECTROLYTES

 Applied Nutrition and Diet Therapy
COMMON COMPLAINTS ASSOCIATED WITH PREGNANCY
1. Nausea & Vomiting
a. Small frequent meals
b. Drink liquids between rather than with meals
Avoid greasy and fried foods
c. Reduce coffee intake
d. Prepare in open space to reduce cooking odors
e. Dry toast or crackers upon awakening
f. Bring handy foods while traveling or working
2. Constipation
a. High fiber such as whole-grain cereals, fresh
fruit, raw vegetables
b. Increase OFI (at least 8 oz glasses of liquid)
c. Warm or hot water with lemon or prune juice
upon waking up
d. Regular exercise
3. Heartburn
a. Small frequent meals
b. Avoiding foods high in fat
c. Drinking fluids between meals, avoid coffee
Limiting spicy foods
d. Avoid lying for 1-2 hrs after eating
e. Wear loose-fitting clothes around the abdomen
NUTRITION FOR LACTATION
Benefits of Breastfeeding
For the mother:
1. Promotes optimal maternal–infant bonding
2. Stimulates uterine contractions
3. Is readily available and requires no mixing or dilution
4. Is less expensive than purchasing bottles, nipples,
sterilizing equipment, and formula
For the Infant
1. Increases bonding with mother
2. Optimal “natural” nutrition that contains no artificial
colorings, flavorings, preservatives, or additives
3. Safe and fresh
4. Reduces risk of acute otitis media, nonspecific
gastroenteritis, severe lower respiratory tract infections,
and asthma
5. Enhances immune system
6. Protects against allergies and intolerance
7. Promotes better tooth and jaw development
8. Associated with higher IQ and school performance through
adolescence
9. Reduces the risk of chronic diseases
10. Reduces risk for infant morbidity and mortality
Hospital Practices that Promote Breastfeeding
1. Offer the infant the breast within 1 hour of birth.
2. Hospital procedures should allow for immediate
maternal–infant contact after delivery.
3. Infant rooming-in. Inform all pregnant women about the
benefits and management of breastfeeding.
Contraindications to Breastfeeding
1. Galactosemia in the infant
2. Illegal drug use in the mother
3. Active tuberculosis
4. HIV/AIDS
5. Use of certain drugs, such as radioactive isotopes,
antimetabolites, cancer chemotherapy agents, lithium,
ergotamine
 Applied Nutrition and Diet Therapy
NUTRITION FOR INFANTS & CHILDREN 7. Consume milk, milk products and other calcium-rich foods
Infancy (Birth to 1 year) such as small fish and dark green leafy vegetables
● Birth weight doubles by 4-6 months, triples by the first everyday.
birthday. 8. Use iodized salt but avoid excessive intake of salty foods.
● Length increases by approx 10 inches during the 1st year. 9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition, exercise
Breast milk regularly, do not smoke, and avoid drinking alcoholic
● support optimal growth and development in the newborn beverages.

Tips to create positive eating environment Religious dietary Restrictions:

● Offer a variety of foods, not just the ones you like. 1. Christianity
● Fat and cholesterol should not be limited in the diets of ○ Minimal or no alcohol intake
very young children. ○ Hold day observances may restrict meat
i. Holy week - especially Good Friday)
● Never force a child to eat; if a healthy child is hungry, he or
she will eat. 2. Seventh-Day Adventist Church
● Do not use food to reward, punish, bribe, or convey love. ○ Pork and Shellfish
● Let toddlers explore and enjoy food, even if it means ○ Alcohol
eating with their fingers. ○ encourages vegetarian diet
● Space meals further apart and limit snacking so the child
will be hungry at mealtimes. 3. Judaism
○ Pork, rare meats, and predatory fowl (eagles,
● Keep mealtime relaxed, pleasant, and unhurried, allowing
hawks, etc.)
20 to 30 minutes per meal. ○ Shellfish (Eats only fish with scales)
● Eat with the child. ○ Blood (dinuguan, blood sausage, etc.) - blood
● Children may refuse to eat because: must be drained
○ too excited or distracted ○ Mixing of milk or dairy products with meat
○ seeking attention dishes in one meal must adhere to kosher food
○ expressing independence preparations
○ 24 hour fasting during Yom Kippur (Day of
○ too tired
atonement)
○ not hungry ○ No leavened bread eaten on passover (8 days)
○ No cooking during Sabbath (Saturday)
NUTRITION FOR TODDLERS AND ADOLESCENTS
● 1 to 2 years of age, the transition period between infancy 4. Islam
and childhood. ○ Pork
○ Alcohol
● The dramatic decrease in growth rate is reflected in a
○ Caffeine
disinterest in food, a “physiologic anorexia” due to lower ○ Practices
calorie needs per kilogram of body weight. ○ Ramadan (fasting from sunrise to sunset for a
● Two-year-olds should eat approximately 1000 calories per month)
day in three meals with one to two snacks. ○ Ritualized methods of animal slaughter (Halal)

NUTRITION FOR ADOLESCENTS 5. Church of Jesus of the Latter-Day Saints (Mormon)

○ Alcohol
● Approximately 15% to 20% of adult height and 50% of
○ Tobacco
adult weight are gained during adolescence. ○ Caffeine
● Fat distribution shifts and sexual maturation occurs.
● Girls: 10 and 11 years; peak at 12 years 6. Hinduism
● Boys: 12 years of age; peak at 14 years ○ All meats are prohibited

Nutrition Guidelines for Filipinos BASIC HOSPITAL DIETS

1. Eat a variety of foods everyday.
2. Breast-feed infants exclusively from birth to 4-6 months
and then, give appropriate foods while continuing
breastfeeding.
3. Maintain children's normal growth through proper diet
and monitor their growth regularly.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables, fruits and root crops.
6. Eat foods cooked in edible/cooking oil daily.
Applied Nutrition and Diet Therapy

Food Safety and Sanitation

1. Handwashing and personal hygiene
2. Food temperature should be maintained <4 degrees
Celsius or > 60 safe food handling and storage.
3. Hot foods should be served to patients as soon as possible.
4. Protein-rich food should be discarded after 2 hours at
room temperature.
5. To avoid contamination, ref should not mix drugs, staff
food and patient foods.
 Applied Nutrition and Diet Therapy
ENTERAL FEEDING 4. Diabetic diet
a. Select complex carbohydrates over simple sugars
b. Small, frequent feedings are preferred to avoid
hypoglycemia
c. Always bring simple sugars (ex. hard candy) in
case of hypoglycemic attack
d. Artificial sweeteners may be used
5. Regular diet
a. Normal diet of a sedentary person at 2,000
cal/day

Healthy Lifestyle
1. Sleep (7-8 hours daily)
2. Eat healthy
3. Maintain optimal body weight (18.6-22.9 BMI)
4. Regular exercise (30 minutes, > 5 days/week, moderate
intensity)
5. Avoid smoking
6. Moderate alcohol
7. Coping & Adaptation (stress management)
8. Physical health examination or check up

Special diets
1. Peptic ulcer disease
a. bland diet
b. eat small frequent meals
c. avoid gastric irritants, milk, NSAIDs, alcohol,
smoking
2. Celiac Disease
a. Avoid BROW foods
b. gluten free diet
3. Liver Cirrhosis
a. low sodium, protein diet
b. Restrict fluids