1. DIET THERAPY Flashcards by ROHANEE HAFSA KAPUSAN

An allowance of food and drink consumed regularly
by an individual.

DIET

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T or F. Skipping meals is not a diet.

TRUE

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The branch of dietetics that is concerned with the
study of the use of food for therapeutic purposes.

DIET THERAPY/DIETOTHERAPY

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The study of the modification of the normal diet to
meet the physiological requirements of the sick
individua

DIET THERAPY/DIETOTHERAPY

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The study of the use of food as a factor in aiding
recovery from illness.

DIET THERAPY/DIETOTHERAPY

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A diet modified or adapted from the normal diet to
suit specific disease conditions.

THERAPEUTIC DIET

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Modifying a regular diet to become therapeutic diet.

THERAPEUTIC DIET

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Designed to treat or cure disease.

THERAPEUTIC DIET

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Refer to the regular, soft, liquid diets commonly
used in the hospital, differ from one another in
consistency and composition to suit individual
needs and dietary requirements.

ROUTINE HOSPITAL DIETS

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Refers to the physical characteristics of the food

CONSISTENCY

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Soft, solid, high fiber, low fiber.

CONSISTENCY

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Nutrient content of the food.

COMPOSITION

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Low protein, high protein.

COMPOSITION

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If you are undernourished, restore it using the diet as one of the factor for the recovery for illness.

A. TO MAINTAIN OR RESTORE GOOD NUTRITIONAL STATUS

B. TO CORRECT NUTRITIONAL DEFICIENCIES WHICH MAY HAVE OCCURRED

C. TO AFFORD REST TOO A PARTICULAR ORGAN OR TO THE WHOLE BODY WHICH MAY BE AFFECTED

D. TO ADJUST THE DIET TO THE ABILITY OF THE
BODY TO METABOLIZE THE NUTRIENTS

E. TO BRING ABOUT THE CHANGES IN THE BODY WEIGHT, WHENEVER NECESSARY

A. TO MAINTAIN OR RESTORE GOOD NUTRITIONAL
STATUS

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Specific deficiency like anemia, especially if it is iron deficiency anemia (IDA), then the diet should be modified into high iron or supplementation of iron.

A. TO MAINTAIN OR RESTORE GOOD NUTRITIONAL STATUS

B. TO CORRECT NUTRITIONAL DEFICIENCIES WHICH MAY HAVE OCCURRED

C. TO AFFORD REST TOO A PARTICULAR ORGAN OR TO THE WHOLE BODY WHICH MAY BE AFFECTED

D. TO ADJUST THE DIET TO THE ABILITY OF THE
BODY TO METABOLIZE THE NUTRIENTS

E. TO BRING ABOUT THE CHANGES IN THE BODY WEIGHT, WHENEVER NECESSARY

B. TO CORRECT NUTRITIONAL DEFICIENCIES WHICH MAY HAVE OCCURRED

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Combination of consistency and composition.

A. TO MAINTAIN OR RESTORE GOOD NUTRITIONAL STATUS

B. TO CORRECT NUTRITIONAL DEFICIENCIES WHICH MAY HAVE OCCURRED

C. TO AFFORD REST TOO A PARTICULAR ORGAN OR TO THE WHOLE BODY WHICH MAY BE AFFECTED

D. TO ADJUST THE DIET TO THE ABILITY OF THE
BODY TO METABOLIZE THE NUTRIENTS

E. TO BRING ABOUT THE CHANGES IN THE BODY WEIGHT, WHENEVER NECESSARY

C. TO AFFORD REST TOO A PARTICULAR ORGAN OR TO THE WHOLE BODY WHICH MAY BE AFFECTED

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Inflammation of the pancreas

CHRONIC PANCREATITIS

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Abnormal amount of fats in stool

KETORHEA

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Indication that fats are not properly digested and metabolized

KETORHEA

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Maldigestion of fats because of the absence of ___________.

lipase enzyme

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What diet will you give to the patient who has chronic pancreatitis?

Low fat diet

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Especially if there is maldigestion and malabsorption disease

A. TO MAINTAIN OR RESTORE GOOD NUTRITIONAL STATUS

B. TO CORRECT NUTRITIONAL DEFICIENCIES WHICH MAY HAVE OCCURRED

C. TO AFFORD REST TOO A PARTICULAR ORGAN OR TO THE WHOLE BODY WHICH MAY BE AFFECTED

D. TO ADJUST THE DIET TO THE ABILITY OF THE
BODY TO METABOLIZE THE NUTRIENTS

E. TO BRING ABOUT THE CHANGES IN THE BODY WEIGHT, WHENEVER NECESSARY

D. TO ADJUST THE DIET TO THE ABILITY OF THE
BODY TO METABOLIZE THE NUTRIENTS

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We have to know the etiology of the disease so we
could address the particular metabolic disorder especially celiac disease and PKU

A. TO MAINTAIN OR RESTORE GOOD NUTRITIONAL STATUS

B. TO CORRECT NUTRITIONAL DEFICIENCIES WHICH MAY HAVE OCCURRED

C. TO AFFORD REST TOO A PARTICULAR ORGAN OR TO THE WHOLE BODY WHICH MAY BE AFFECTED

D. TO ADJUST THE DIET TO THE ABILITY OF THE
BODY TO METABOLIZE THE NUTRIENTS

E. TO BRING ABOUT THE CHANGES IN THE BODY WEIGHT, WHENEVER NECESSARY

D. TO ADJUST THE DIET TO THE ABILITY OF THE
BODY TO METABOLIZE THE NUTRIENTS

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The usual diet prescribed for this is low calorie diet
(obese), high calorie diet (severely malnourished).

A. TO MAINTAIN OR RESTORE GOOD NUTRITIONAL STATUS

B. TO CORRECT NUTRITIONAL DEFICIENCIES WHICH MAY HAVE OCCURRED

C. TO AFFORD REST TOO A PARTICULAR ORGAN OR TO THE WHOLE BODY WHICH MAY BE AFFECTED

D. TO ADJUST THE DIET TO THE ABILITY OF THE
BODY TO METABOLIZE THE NUTRIENTS

E. TO BRING ABOUT THE CHANGES IN THE BODY WEIGHT, WHENEVER NECESSARY

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Guide on how to modify the diet

BASES OF MODIFICATION

What are the normal requirements?

RENI/Dietary Prescription ❖ Guide to Good Nutrition/Food Guide -10 kumainments - Food pyramid - Three basic food groups and proper nutrition ❖ Food Pyramid/Pinggang Pinoy

Medical history

PREVIOUS NUTRITIONAL STATUS OF THE INDIVIDUAL

Etiology, causes, and characteristics of the disease

PATHO-PHYSIOLOGY OF THE DISEASE

T OR F. Sometimes, the cause and characteristics might also be the cure in the therapeutic diet to be prescribe

TRUE

- Inflammation of the glomeruli - The kidney isn't functioning well especially in the filtering of ammonia from protein - Should not be given high protein diet - Give low protein diet or zero protein for emergency purposes

CHRONIC KIDNEY DISEASE

Up to how many days the patient should be given ex: low fat diet or low protein diet

ANTICIPATED DURATION OF THE DISEASE AND INJURY

What are the BASES OF MODIFICATION?

1. NORMAL REQUIREMENT 2. PREVIOUS NUTRITIONAL STATUS OF THE INDIVIDUAL 3. PATHO-PHYSIOLOGY OF THE DISEASE 4. ANTICIPATED DURATION OF THE DISEASE AND INJURY 5. DIETARY FACTORS TO BE ALTERED 6. AMOUNT AND CHARACTER OF THE NUTRIENTS WHICH IS BEING LOST FROM THE BODY 7. PATIENTS TOLERANCE FOR FOOD 8. SOCIO-ECONOMIC AND OTHER CONSIDERATIONS SUCH AS RELIGION BELIEFS, CUSTOMS, ETC.

What are the PRINCIPLES OF DIETARY MANAGEMENT?

LIBERALIZATION INDIVIDUALIZATION SIMPLIFICATION

❖ As tolerated ❖ As much as possible, we will practice as tolerated to the patient to hasten the recovery from the illness ❖ As long as still within prescribed diet and restrictions ❖ Hindi masyadong restrictive and selective ang diet if within the recovery period

LIBERALIZATION

❖Individualized preparation of the diet for a specific patient with a specific nutrient needed ❖ There some diseases that requires individualized diet ❖ Lots of restriction and selection of foods ❖ Ex: Chronic kidney disease, PKU, metabolic disorders

INDIVIDUALIZATION

❖ Time wise and effort wise ❖ Easy to prepare ❖ Don't have to look the ingredients everywhere ❖ Affordability and availability

SIMPLIFICATION

An allowance of food and drink consist of food that are liquid and leave no residue

CLEAR LIQUID DIET

Inadequate of nutrient contents and calorie (Usually inadequate) Should not be used for more than 2 days

CLEAR LIQUID DIET

➔ Fat free broths ➔ Strained juice ➔ Black coffee ➔ Salabat ➔ Plain gelatin ➔ Plain sugar or hard candies

CLEAR LIQUID DIET These are examples of food selection for clear liquid diet but it doesn't mean that these foods are applicable and can be given to all kinds of disease prescribed with clear liquid diet ➢ Ex: Diabetes (no plain sugar or hard candies) ➢ Ex: Bypass operation on the heart (no black coffee)

INDICATIONS: Pre and post operative conditions.

CLEAR LIQUID DIET

- Intermediary between clear liquid and soft diet ➔ Consist of liquid or strained semi-fluid foods or foods that liquefy at room temperature ➔ Free from cellulose and irritating spices and condiments ➔ Can be planned to be nutritionally adequate

FULL LIQUID DIET *After two days, the patient cannot immediately have soft diet, instead, give full but still liquid in consistency

➔ Pureed strained meat and fish ➔ Oatmeal ➔ Strained lugao

FULL LIQUID DIET

➔ Post operative condition ➔ Acute infection ➢ Most affected organ is the tonsils ➔ Face lifting

FULL LIQUID DIET

➔ Cold fluids given to prevent bleeding of the operated area ➔ Cooked soft foods and bland which have been allowed to cool may also be given

COLD AND LIQUID DIET (T (Tonsillectomy) AND A (Adenectomy) Diet)

➔ Plain ice cream ➔ Cold milk ➔ Iced tea ➔ Coffee ➔ Soft drinks

COLD AND LIQUID DIET (T (Tonsillectomy) AND A (Adenectomy) Diet)

● INDICATIONS ➔ Tonsillectomy ➔ Adenectomy ➔ Dental extraction ➔ Other minor throat

COLD AND LIQUID DIET (T (Tonsillectomy) AND A (Adenectomy) Diet)

➔ Made up of food which form the least amount of fecal matter ➔ Inadequate in vitamins and minerals ➔ This diet is given several days before the operation and only liquids 24 hours before surgery to decrease intestinal residue ➢ Especially if the operations is within the intestine ➔ After surgery, the diet progresses as follows a clear to full liquids, soft low residue, and regular as tolerated ➔ Avoid foods that are gaseous or that may cause stomach obstruction. ➔ Encourage fluid intake of at least 2L/day. If the patient is dehydrated or has low urine output, encourage an additional 1-2L/day.

MINIMUM/LOW RESIDUE DIET *Vegetables and fruits are a high residue diet and are usually high in vitamins and minerals. In a low residue diet, fruits and vegetables or high fiber foods are avoided.

➔ Plain, strained lean tender ➔ Well cooked fruits ➔ Vegetables ➔ Beef ➔ Chicken (no skin) ➔ AVOID milk & milk products

MINIMUM/LOW RESIDUE DIET

INDICATIONS ➔ Diarrhea ➔ Pre and post operation ➔ Colostomy ➢ Operation in the colon and large intestine ➔ Ileostomy ➢ Operation in the ileum or the last part of the small intestine

MINIMUM/LOW RESIDUE DIET

Chemically (free of spices, condiments, and other high flavored foods), mechanically (free from coarse textures and the size should be reduced to small pieces; ex: instead of whole fish, give flake. instead of giving small back sizes of meat, give ground beef or pork) and thermally non-irritating (should not be so hot and so cold)

BLAND DIET

FOOD SELECTION ➔ Mild in flavor ➔ No coarse fibers and tough connective tissues ➔ Non stimulating and any food tolerated by the patient ➔ AVOID black pepper, chili powder, strong coffee, and alcohol

BLAND DIET

INDICATIONS ➔ Gastritis ➔ Ulcers

BLAND DIET

➔ Extracted from bland diet because one of the description of the bland diet is mechanically non-irritating ➔ Food given requires little chewing ➔ Spices and flavorings are allowed. The only limitation is the portion and texture of the food.

MECHANICAL SOFT DIET

● FOOD SELECTION ➔ Full diet but reduced into small portions by grinding, chopping, and mincing, etc.

MECHANICAL SOFT DIET

● INDICATIONS ➔ Poor dentures ➔ Lack of teeth

MECHANICAL SOFT DIET

● DESCRIPTION ➔ Contains minimum indigestible CHO and tough connective tissues

LOW FIBER DIET

● FOOD SELECTION ➔ AVOID tough and connective tissues in meat, seeds, skin of fruits and vegetables, whole grain cereals and coarse bread ➔ Whole foods especially whole grains are avoided

LOW FIBER DIET

● INDICATIONS ➔ Spastic constipation ➢ Fiber can increase bulk in the stools ➢ Spastic constipation produce large stools and dry stools that are not easy to excrete ➔ Diverticulitis ➔ GI disturbances

LOW FIBER DIET

● DESCRIPTION ➔ Normal diet with fiber increased ➔ Prescribed with high consumption of water

HIGH FIBER DIET

● FOOD SELECTION ➔ Include food avoided in low fiber diet

HIGH FIBER DIET

● INDICATIONS ➔ Atonic constipation ➢ Lazy bowel ➢ Lazy bowel has no muscle tone so it needs to be pushed

HIGH FIBER DIET

● DESCRIPTION ➔ Plan to provide for an increase in calorie intake above physiologic needs to allow an increase in body weight

HIGH CALORIE DIET

● FOOD SELECTION ➔ Food in normal diet ➔ AVOID excessive amount of fried food which may interfere with appetite

HIGH CALORIE DIET

● INDICATIONS ➔ Underweight

HIGH CALORIE DIET

● DESCRIPTION ➔ Plan to provide an intake below calorie needs and designed to allow for loss in weight

LOW CALORIE DIET

● FOOD SELECTION ➔ AVOID high fat food ➔ AVOID CHO

LOW CALORIE DIET

● INDICATIONS ➔ Overweight ➔ Obesity

LOW CALORIE DIET

● DESCRIPTION ➔ CHO is increased by 50% above normal TER ➢ Normal TER is 1000 and we have to give 500 which is 50% of 1000

HIGH CARBOHYDRATES

● FOOD SELECTION ➔ Rice ➔ Cereals ➔ Root Crops ➔ Dried beans ➔ Legumes

HIGH CARBOHYDRATES

● INDICATIONS ➔ Renal liver disturbances ➢ Low diet from protein and fats, so the main source for the body is only carbohydrates ➔ Preparation for surgery ➢ Diet should be increased in carbohydrates to have many glycogen stores so that during muscle wasting, body weight wouldn't be affected

HIGH CARBOHYDRATES

● DESCRIPTION ➔ CHO is reduced by 50% but CHON and FATS are increased ➔ Decreased in carbohydrates but not as extensive compared to ketogenic diet

LOW CARBOHYDRATES

● FOOD SELECTION ➔ Foods high in CHON

LOW CARBOHYDRATES

● INDICATIONS ➔ Obesity ➔ Celiac disease ➔ Epilepsy

LOW CARBOHYDRATES

● DESCRIPTION ➔ CHON increased by 50 - 100% above normal TER ➔ One of the function of protein is to mend worn out tissue together with Vitamin C

HIGH PROTEIN

● FOOD SELECTION ➔ Milk ➔ Eggs ➔ Cheese ➔ Meat ➔ Poultry ➔ Fish

HIGH PROTEIN

● INDICATIONS ➔ Pregnant ➔ Lactating ➔ PEM ➔ Surgery ➔ Burns ➔ Fever ➔ Disease of the liver ➢ Especially not the progressive type ➢ 1st stage

HIGH PROTEIN

● DESCRIPTION ➔ Restricted to 50% below of the normal CHON requirement

LOW PROTEIN

● FOOD SELECTION ➔ Give legumes, nuts, cereals, and vegetables in limited amounts ➔ AVOID K and Na

LOW PROTEIN

● INDICATIONS ➔ Hepatic Coma ➔ Acute glomerulonephritis ➢ The protein cannot pass through the liver for detoxification, and the kidneys cannot filter well because the glomerular filtration rate is gradually malfunctioning because of the inflammation of glomeruli ➢ To afford rest to the liver by not giving a lot of protein

LOW PROTEIN

● DESCRIPTION ➔ Used only as an emergency measures, give high in CHO and FATS to avoid tissue breakdown

CHON FREE/ZERO CHON

● FOOD SELECTION ➔ Fruit juices if K is not restricted

CHON FREE/ZERO CHON

● INDICATIONS ➔ Hepatic Coma ➔ Acute Anuria

CHON FREE/ZERO CHON

● DESCRIPTION ➔ Severely restricted fats allowed 10-15% of TER ➔ All foods rich in fats not allowed or restricted ➔ Foods cooked by method not requiring addition of fats

LOW FAT DIET

● FOOD SELECTION ➔ Skim milk ➔ Lean Meat ➔ Cereals ➔ Fruits and vegetables ➔ Sugar ➔ AVOID fatty meats, rich desserts, and fried foods.

LOW FAT DIET

● INDICATIONS ➔ Steatorrhea ➢ Fats in the feces ➢ More than 7%-10% of fats ➔ Acute attack of pancreatitis ➔ Cholecystitis

LOW FAT DIET

● DESCRIPTION ➔ Dietary cholesterol reduced to less than 300 mg per day

LOW CHOLESTEROL

● FOOD SELECTION ➔ Egg yolk limited to 2-3 per week ➔ Egg white as desired ➔ Lean meat only or fish ➔ Skim milk ➔ Fruits ➔ Vegetables

LOW CHOLESTEROL

● INDICATIONS ➔ Atherosclerosis ➢ Deposition of fats in the wall of the arteries ➔ Hypercholesterolemia ➢ Large amount of cholesterol in the blood ➔ Coronary artery disease

LOW CHOLESTEROL

➢ Deposition of fats in the wall of the arteries

Atherosclerosis

➢ Large amount of cholesterol in the blood

Hypercholesterolemia

● DESCRIPTION ➔ Sodium content is limited to specific level which may range from mild to severe restriction ➢ Mild is 2000 mg per day ➢ Severe restriction is 1500 mg per day to 1000 mg per day ➔ Provides an adequate diet with a prescribed level of sodium according to individual needs

Na RESTRICTED DIET

➔ AVOID canned, cured process food which uses salt and sodium containing flavoring agents and preservatives ➔ Salt, patis, and toyo are omitted from the table or on the patient’s tray ➔ Give foods that contains natural sodium

Na RESTRICTED DIET

● INDICATIONS ➔ Hypertension ➔ Congestive heart failure (CHF) ➔ Pregnancy induced hypertension (PIH)

Na RESTRICTED DIET

● DESCRIPTION ➔ K content of the diet is reduced to about 1.0-1.6 mg/day ➢ Half of the normal requirement

K RESTRICTED DIET

● FOOD SELECTION ➔ Give cereals, breads, sugar fats, protein foods, fruits and vegetables within the prescribed amounts ➔ Restrict amount of milk, cream, eggs, meat, fish, and poultry ➢ Contain higher amount of potassium

K RESTRICTED DIET

● INDICATIONS ➔ Renal failure ➢ Potassium will be accumulated in the blood that may result to hyperkalemia that affects the heartbeat and leads to heart attack ➔ Hyperkalemia ➔ Addison’s disease ➔ Anuria ➔ Oliguria

K RESTRICTED DIET

● DESCRIPTION ➔ Reduced to approximately 150 to 350 mg/day in adults and in children respectively ➔ Normal is 1000 to 2000 mg/day

Ca RESTRICTED DIET

● FOOD SELECTION ➔ Restrict amount of milk, cheese, eggs, nuts, meat, fish, and other high calcium foods

Ca RESTRICTED DIET

● INDICATIONS ➔ Calcium stones ➔ Hypercalcemia ➔ Pancreatitis

Ca RESTRICTED DIET

❖ DESCRIPTION ● A house diet, general diet, or regular diet ● Designed for patient who require no special dietary modifications or restrictions

FULL DIET

❖ FOOD SELECTION ● Give liberal diet

FULL DIET

❖ INDICATIONS ● Patient who do not need dietary modification

FULL DIET