THERAPEUTIC

NUTRITION

KHIEN S. SASI, RN, MAN

OBJECTIVES:
At the end of the chapter, the
students should be able to:

1. Point out the purposes of

therapeutic nutrition

2. Recognize the role of nurses in

nutritional care.
Objectives of Nutritional Care in Disease:

1. Supply optimim nutrition.

2. Heal tissue, cure the disease.

3. Support recovery from disease.

4. Improve the function of the involved tissue or organ
system.
5. Reduced work of the affected organ ti promote healing
 Factors in Planning a Modified Diet:

1. Disease state, its nature, duration, intensity.

2. Food form or nutrient modification required by
the disease.
3. Patient’s individual food tolerances and food
habits.
4. Nutritional adequacy of modified diet.
5. Patient’s physical ability and home situation.
Illness and Nutrition
 The illness has many effects on the body’s ability to
use nutrients based upon the specific requirements.
 Lack of appetite, vomiting and pain often prevent
the intake of sufficient amount of food.
 In severe diarrhea the absorption of all nutrients is
poor, so that loss of weight, dehydration and signs of
malnutrition may happen.
 A fever increases the rate of metabolism, hence
increasing the need for calories, protein and vitamin.
 In metabolic diseases, nutrients are not fully utilized,
for example, the untreated diabetic patient cannot
make adequate use of carbohydrates.
 Illness and Food Acceptance
 A sick person faces added problems related to
meals. Diet is related to both comfort and the
treatment of the patient but sometimes it is
necessary to take therapeutic measures that may
distress rather than giving comfort. The nurse
plays an essential role to bridge the gap.
 An illness may reduce a person’s interest in food
because of gastric distention or discomfort.
 Inactivity and intake of some drugs also reduced
the desire for food.
 Illness and Food Acceptance
 If the patient’s diet is modified, the patient may
be getting less or more food than he/she
normally eats. The change in flavor or texture
of some diets may not be appealing to
him/her. He / She may be unwilling to accept
any changes. The patent worries about how
he/she will get the new food or food from
his/her home. He/ she may be bothered about
the inconvenience of sticking to a diet that is
different from his/ her family or friends.
 Illness and Food Acceptance

 The modified diet may make the patient

feel deprived or punished.

 During the time of his/her illness, the

patient often becomes more self-centered,

irritable or even angry. He/she may

complain incessantly about his/her food in

order to get more attention.

 Responsibilities of the Nursing
Department
 The nurse is usually the first person who sees the
patient’s feeding problems. He/she has direct
communication with patient and therefore, must
have knowledge of the principles of the diet as
well as the food allowed and restricted. The nurse
should immediately forward the diet prescription
to the dietary department.
 The nursing aide makes sure that the patient is
ready to consume the food served on his/her
tray. The nursing aide records the leftovers, if
there are any.
Nursing Responsibilities
The Role of Nurses in Nutritional Care:
 Observing, Listening and Reporting are three
important functions performed by the nurse in
the nutritional care. How well the patient eats
his/her food, the kind and amounts of food
refused and the patient’s attitude towards
his/her food are readily determined.
 For example, ill-fitting dentures results in the
inability to chew. If an elderly patient has a
sore mouth, pain is felt when acid acid juices
are taken .
The Role of Nurses in Nutritional Care:
 By listening, the nurse shows his/her general interest
in understanding the patient. This help the patient
express his/her feelings and perhaps “to blow off
steam”.
 Acting upon the information is essential to the best
care of the patient. It may be the nurse’s role to
directly act on it. More often, it involves reporting to
the nursing supervisor, dietitians or physicians
depending on the circumstances.
 The nurse has the opportunity for some informal
teaching. Patient may often ask questions about their
diet.
Diet Therapy
An appropriate diet is essential in the total care
plan developed for every patient. It usually
supplements medical and surgical care, sometimes
it is the specific treatment for the disease. Diet
therapy accomplishes one or more of these aims:
1. Maintain normal nutrition

2. Corrects nutritional deficiency

3. Changes the body weight

4. Adjust the body’s ability to use one or more nutrients

5. Permits maximum rest to the body or an organ.

Sample Diet Therapy Form
Patient: Ward and Bed No.;
Dietary Prescription: Physician:
Date Time food & Beverage Intake Amount Recorded by:

Remarks:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_____________________________________________
Standard Hospital Diets
Liquid Diets
1. Clear Liiquid Diet
 This is an allowance of tea, coffee or coffee

substitute, and fat-free broth. Ginger ale, fruit

juices, gelatin, fruit icesand water gruels are
sometimes given.
 Small amounts of fluid are offered every hour

or two to the patient. The diet is used for 24-

48 hours following acute vomiting, diarrhea
or surgery.
Liquid Diets
Standard Hospital Diets
2. Full Liquid Diet
 This is a nutritionally adequate diet
consisting of liquids and foods that liquefy at
body temperature. It is used for acute
infections and fever for short duration and for
patients who are too ill to chew. It may be
ordered as the first progressive from the clear
liquid diet following surgery or in the
treatment of acute gastro-intestinal (GI)
upsets.
Full Liquid Diet
Soft diet

 A nutritionally adequate diet differs from the normal

diet in terms of having reduced fiber content, soft

consistency and bland flavour. It is used

immediately between the full fluid diet and the

regular diet following surgery in acute infections and

fevers and in GI disturbances.

Soft Diet
The normal diet is modified in the following
ways:
1. Meat and poultry are minced or ground. Fish is
sufficiently tender without further treatment.
2. Vegetables, diced or chopped, are cooked.
They may be cooked a little longer than usual
to be sure they are soft.
3. Soft raw fruits may be used.
4. Soft rolls, breads or biscuits are used instead of
crisp rolls, crust breads and toast.
5. All desserts on a normal diet maybe used
including pies with tender crusts, cakes and
puddings.
Sample Menu for Soft Diet:
Breakfast:
 Fried hotdog and egg, Rice, Milk and sugar,ripe papaya

AM snack:
 Pineapple juice, chicken pie

Lunch:
 Fish sinigang, rice, banana

PM snack:
 Chicken arrozcaldo, kalamansi juice

Dinner:
 Almondigas with patola, rice, ripe mango

Bedtime:
 Milk
TEST MEALS
1. Fecal Fat Determination Test
 It measures fat globules in the stools to detect
fat absorption as in cases like cystic fibrosis. It
consist of 100 gram fat ingested daily for 3 days
prior to fecal collection.
 Food items included as follows:
 2 cups whole milk 8 oz lean meat
 1 egg 10 exchanges of fat
TEST MEALS
2. Meat-free Test
 It is used to determine GIT bleeding. A 3-day

diet excludes ingestion of meat, poultry and

fish.
3. Calcium Test
 It is used to determine urinary calcium

excretion to diagnose hypercalcuiria. The diet

requires 1000 mg calcium intake-400 mg from
food sources and 600 mg from oral
supplements.
TEST MEALS

4. Serotonin Test

 It is used to detect calcinoid tumors of the

intestinal tract. Food rice in serotonin is

excluded in the diet.

 Normal Diet and Its Modification
 The normal diet (sometimes called regular,
general or house diet) is the most frequently
used of all diets. A normal diet like a modified
diet, is of great importance in a therapeutic
sense.
 With satisfactory food intake, the body tissues
are continously maintained and there is
opportunity for repair from the effects of an
illness. However, the patient’s failure to eat
normal diet could lead to loss of body tissues
and a prolonged convalescence.
The Normal diet may be modified for:

1. Consistency and texture

2. Flavor
3. Energy value
4. Nutrient level such as fats, proteins,
carbohydrates, sodium and others
5. Food categories such as types of fats or
elimination diet for allergies
Good Tray Service

The essential of a good tray service are as follows:

1. A tray of sufficient size for uncrowded arrangement of dishes.

2. A clean, unwrinkled tray cover and napkin of linen or good

quality paper.

3. An attractive pattern of spotless chinaware withourt chips or

cracks, clean glassware and shining silverware.

4. An orderly arrangement of all items on the tray so that

everything can easily be within arms reach of the patient.
Good Tray Service

5. Portions of food suitable for the patient’s appetite.

6. Food attractively arranged with appropriate garnishes.
7. Meals served on time.
8. Hot food served on warm plates and kept warm with
food cover; cold foods served on chilled dishes.
9. Trays promptly served to the patient so that food is at
its best.
Good Tray Service
Thank you and Have a Good
Day!