DIET AND THE PATIENT

Instructor Ashenafi H.
MSc in Nutriton

DIET AND THE PATIENT

Instructor Ashenafi H.
MSc in Nutriton
 NUTRITION AND HEALTH
◾ Proper nutrition in hospitalized clients is necessary for

wound healing, recovery, reduction in morbidity, and

consequent reductions in length of stay and mortality
(death).

◾ The most common nutritional deficiency in hospitalized

clients is protein- energy malnutrition.

o This type of malnutrition reduce body cell mass and

impairs tissue and organ function
2
 NUTRITION AND HEALTH

• Nutrition plays a major role before, during and even

after treatment. Nourishing the body with the right
kinds of food will provide the required strength and
help you make you feel better.
• everyone’s nutritional patterns are affected with
disease and it’s treatment, due to this reason,
alterations in diet will be necessary.
 PLANNING A DIET

• Planning diets refers to determining what usual

nutrient intake should be.
• Regardless of whether one is planning diets for
individuals or groups, the goal is to have diets that
are:
 nutritionally adequate, or conversely,
 to ensure that the probability of nutrient
inadequacy or excess is acceptably low.
 FACTORS TO BE CONSIDERED IN PLANNING
THERAPEUTIC DIETS

• The underlying disease conditions which require a

change in the diet.
• The possible duration of the disease.
• The factors in the diet which must be altered to
overcome these conditions.
• The patient's tolerance for food by mouth.
• The normal diet may be modified to.
 DEFINITIONS

• Diet refers to the total amount of food consumed by

individuals; whereas nutrition is the process of
utilizing food for growth, metabolism and repair of
tissues.
• a person receiving or registered to receive medical
treatment.
 THERAPEUTIC DIETS

•A therapeutic diet is a meal plan that controls the intake of

certain foods or nutrients. It is part of the treatment of a
medical condition and are normally prescribed by a physician
and planned by a dietician. A therapeutic diet is usually a
modification of a regular diet. It is modified or tailored to fit the
nutrition needs of a particular person.

•Therapeutic diets are modified for

 nutrients,
 texture, and/or
 food allergies or food intolerances.
 COMMON REASONS THERAPEUTIC DIETS MAY BE
ORDERED:

 To maintain nutritional status

 To restore nutritional status

 To correct nutritional status

 To decrease calories for weight control

 To provide extra calories for weight gain

 To balance amounts of carbohydrates, fat and protein for

control of diabetes
 COMMON REASONS THERAPEUTIC DIETS MAY BE
ORDERED:

 To provide a greater amount of a nutrient such as protein

 To decrease the amount of a nutrient such as sodium

 To exclude foods due to allergies or food intolerance

 To provide texture modifications due to problems with

chewing and/or swallowing

 COMMON THERAPEUTIC DIETS INCLUDE:

1.Nutrient modifications
 No concentrated sweets diet

 Diabetic diets

 No added salt diet

 Low sodium diet

 Low fat diet and/or low cholesterol diet

 High fiber diet

 Renal diet
2. Texture modification
 Mechanical soft diet

 Puree diet

3.Food allergy or food intolerance modification

 Food allergy

 Food intolerance

4.Tube feedings
 Liquid tube feedings in place of meals

 Liquid tube feedings in addition to meals

5. Additional feedings – In addition to meal, extra
nutrition may be ordered as:
 Supplements – usually ordered as liquid nutritional

shakes once, twice or three times per day; given either

with meals or between meals
 Nourishments – ordered as a snack food or beverage

items to be given between meals mid-morning and/or

mid-afternoon
 HS snack – ordered as a snack food or beverage items to be

given at the hour of sleep

 FEEDING A PATIENT

Nurses need to refine their feeding skills to assist

patients in maintaining:
1. Nutritional status
2. Independence
3. Dignity
PHYSIOLOGICAL FACTORS THAT LIMIT FEEDING

• Altered activity level

• Decreased mobility
• Illness
• Physical impairments that limit self-feeding such as
hemiplegia, fractured arm, burns, cancer, surgery, or
generalized weakness.
• The presence of intravenous catheters or tubing’s,
dressings, and bandages
• Some elderly patients may require feeding assistance
because of the physical alterations associated with aging.
• Neurologically or orthopedically impaired patient who
may be unable to manipulate feeding utensils.
PSYCHOLOGICAL FACTORS THAT LIM
IT FEEDING
• Culture
• Religion
• Personal preference
• Mental cognition. When individuals are depressed,
lonely, apathetic, fearful, grieving, or feeling
hopeless, nutritional intake usually decreases.
• Being fed by another person may have psychological
implications. The increased need for feeding
assistance may lead to depression, because patients
feel they are a burden to either the staff or their
family.
 NURSING DIAGNOSIS

Some common nursing diagnosis that relate to the

individual with a nutritional intake problem include:
Altered nutrition: less than body requirements :
 Self-care deficit: feeding related:
 SETTING THE STAGE

• Remove any unpleasant sights

• Remove any obnoxious odors
• Clear the over-bed table
• Provide good lighting
• Set up chair for the nurse
PREPARING THE PATIENT FOR EATIN
G
• Assist patient to urinate or defecate prior to the
mealtime
• Provide oral hygiene
• Provide with dentures or eyeglasses
• Place in comfortable position
• Apply any special devices
• Provide with clothing protectors
• Assemble needed supplies to facilitate feeding.
ASSISTING THE PATIENT TO FEED
SELF
• Wash hands before handling food and serving trays
• Identify the diet tray for particular patient
• Assess tray for completeness and correct diet
• Prepare tray to meet patient’s needs
• Check temperature of food
• Place tray at height and position so it is easy for the
patient to access.
ASSISTING TO FEED A PATIENT
• Wash hands before handling food and serving tray
• Identify the diet tray for the patient
• Assess tray for completeness, correct diet, order
changes
• Sit in chair next to patient
• Allow patient to eat in order and speed of choice, and
the amount requested
**Do NOT Hurry patient
• Cut food in bite size pieces
 FEEDING A PATIENT
• Feed patient, putting one type of food on utensil at a time
• Provide fluids as requested
• Use time to develop rapport with patient
• At end of meal
Wash hands
 Provide mouth care
Assist to comfortable position

• Document
 TYPES OF DIETS
• Clear liquid
 Contains liquids that are thin and without pulp or
foods that liquefy at room temperature.
 Most often used after surgery, or with patients with
diarrhea of vomiting
 Examples:
 Apple juice, ginger ale. Gelatin
 Decaffeinated coffee, tea, broth
 Fruit ices, or Popsicles
 Temporary diet
 TYPES OF DIETS
• Full liquid
 Addition of calories, about 1500 and provides
more nutrients than a clear liquid diet
 Examples:
Milkshakes, all juices
Blenderized foods
Custards and puddings
Creamed soups
 TYPES OF DIETS
• Soft Diet
 Used as a transition to the regular diet or for
those who have difficulty eating
 Designed to be chewed and provide minimal
fiber.
 Low in fiber and devoid of brans, grains, strong
vegetables, raw fruit or vegetables
• Mechanical soft – food is chopped, ground, or pureed-for
those with difficulty with chewing / poor teeth
 TYPES OF DIETS

• Regular Diet
 Contains approximately 2,500 calories
 Consists of appropriate serving from a
variety of food groups to meet nutritional
needs.
 Has no restrictions
 TYPES OF DIETS SPECIAL DIETS
• Diabetic diet
 Contains specified calorie intake and
certain foods that are allowed to meet that
intake goal
• Cardiac diet
 Low in saturated fat, cholesterol, and salt
 Low Salt diet
 Used for patients with hypertension
TYPES OF DIETS SPECIAL DIETS
• Kidney diet
 Used for patients with kidney disease.
 Protein restriction with restrictions of fluid,
sodium, potassium, phosphorus
• Liver Diet
 Used for patients with liver disorder
 Low in protein, high in CHO, vitamins
 Sodium, fluid may be restricted
• Gastrointestinal Diet
Avoid foods that increase stomach acid
May have increase or decrease in fiber
 SAFETY PRECAUTIONS
• If patient is at risk for aspiration, check the gag reflex
first.
• Check temperature—do not burn patient
• Do not feed patient who is asleep, unresponsive,
choking, unable to swallow, unable to elevate head 450,
or whose head is tilted backwards or downwards.
• Feed patients with swallowing difficulties semi-solid
foods that will not choke the patient.
 SAFETY PRECAUTIONS

• If a patient questions anything on tray, check the

doctor’s order for possible changes that the dietary
department did not know about.
• If the patient should get choked, turn to the side,
sweep any food out of the mouth. If no food is present,
may need to perform the Heimlich maneuver