Routine Therapeutic Diets Flashcards
Describe nutrition or dietary rx?
1) written by RND
2) designates type, amount, and frequency of nutrition based on the individual’s disease process and management goals
3) specify caloric level and other restrictions
4) limit or increase various dietary components
The dietary rx may limit
CHO
CHON
Fat
Vitamins and Minerals
Fiber
Alcohol
Water
Bioactive substances
Therapeutic diet is also called
Modified diet
Therapeutic diet is based on a
General, adequate diet
Purposes of a therapeutic diet
1) to provide the individual requirements based on digestive and absorptive capacity
2) to provide alleviation/arrest of a disease process
3) to address psychosocial factors affecting dietary intake
Therapeutic diets should vary as little as possible from the person’s normal diet
Personal eating patterns
Religious practices
Environmental factors
Food preferences
Socioeconomic conditions
7 forms of therapeutic diets
1) Change in consistency
2) Inc/Dec of energy
3) Increase or decrease of a type of food or nutrient
4) Elimination of specific food
5) Adjustments in level, ratio, or balance of macros
6) Rearrangement of the number and frequency of meals
7) Change in route of delivery of nutrients
Principles of Diet Planning (7)
- provide enough calories to maintain DBW
- provide enough protein to cover N losses
- provide enough nutrients to prevent deficiency
- be a modification of the usual normal diet
- be psychologically, culturally, and socioeconomically acceptable
- afford rest to the organ involved
- be adjusted to the body’s ability to digest, absorb, transport, metabolize, and excrete nutrients
Regular diet - also called
General diet, house diet, Diet as tolerated (DAT)
Describe the regular diet.
The usual food and drink regularly consumed.
For ambulatory patients whose conditions do not require any dietary modification for therapeutic purposes.
Regular diet
Goal of the regular diet
To supply appropriate amounts of calories, protein, and other nutrients.
Basis for the modification of therapeutic diets in hospitals.
Regular diet
Hospital diets require (3)
Careful menu planning
Wise and proper food selection
Attractive food presentation
Quantity of selected food in regular diets is based on…
Dietary rx and patient preferences
Regular diets contain approximately:
1600 - 2200 kcal
180 - 300 g CHO
60 - 80 g CHON
80 - 100 g FAT
Foods allowed for regular diet
All
What are the texture-modified diets?
Finger-food modification diet
Mechanical soft diet
Soft diet
Neutropenic diet
Designed to prompt self-feeding and independence of impaired patients
May involve the use of adaptive equipment
Finger-food modification diet
People with Alzheimer’s, dementia, cognitive problems, and neuromuscular disorders
People who are combative, resistant, have difficulty in manipulating utensils
Finger food modification diet
Goals of FFM diet
1) to decrease frustration
2) to enhance self esteem and dignity
3) to increase morale and motivation
4) to improve appetite
A regular diet with restriction for foods that stimulate gastric acids secretion and motility.
Full bland diet
A full bland diet must be served in _____ but _______ _______ to reduce gastric acid secretion and motility.
Small but frequent meals
Hyperacidity
Gastric ulcer
Duodenal ulcer
Full bland diet
Foods avoided in a full bland diet
Spices, onions, garlic
Caffeine-containing and alcoholic beverages
Transition diet between liquid and full diet
Soft diet
Consists of tender but not ground or pureed, easily digested and mildly flavored
Allows whole meat, cooked vegetables and fruits
Soft diet
Goal of soft diet
To provide oral feedings that will promote a return to normal food intake.
Postoperative patients
Debilitated patient who has eating difficulties
Soft diet
Dental soft or geriatric soft diet
Mechanically soft diet
Require minimal chewing
Chopped, pureed, sieved
Mechanical soft diet
Indications of mechanical soft diet
For those with ill-fitted dentures
Post-oral, head, and neck surgery
Elderly patients
With chewing difficulty
Similar to soft diet but restricts hot spices, caffeine-containing, and alcoholic beverages
Soft bland diet
Also given in small frequent feedings
Soft bland diet
Those with peptic ulcer disease who cannot tolerate a full bland diet
Soft bland diet
Low-bacteria or low-microbial diet
Neutropenic diet
Handled, prepared, and served under strict sanitary conditions to minimize microbial count especially pathogens
Neutropenic diet
Characteristics of the neutropenic diet
Restricts/limits fresh fruits and vegetables
Adequate cooking and covering
Served immediately
Keeping hot foods hot, cold foods cold
Observe recommended temperatures
Avoid cross contamination
Thaw fish, meat, poultry in the refrigerator
Indications for neutropenic diet
Patients who undergo:
- Chemotherapy
- Organ transplant
- HIV/AIDS
Contains greater amounts of total energy and vitamins and minerals
High-calorie diet
High-calorie diet:
Total energy should cause a _______ _________ _________
Vitamins and minerals must be _________ ________
Positive energy balance
Above recommendations
High-calorie diet should have an additional:
500-1000 kcal day to TER
Indications of high-calorie diet
Underweight
Malabsorption
Debilitating disease post operatively
Fever and infection
Hyperthyroidism
Burns
Growth periods
Pregnancy and Lactation
How do we conduct a high-calorie diet?
Start gradually beginning with small portion sizes
3 small meals with 3 between-meal snacks
OR decrease in frequency but increase in intake
A regular diet but with CHON increased by 50-100% of the recommendation.
High-protein diet
Proportion of HBV proteins in high-protein diet
1/3 to 1/2
Characteristics of high-protein diet
Addition of CHON-rich foods without increasing portion sizes
5-6 small meals or regular meals w/ snacks
Commercially prepared dietary supplements in between meals or added to liquids 1 hr before a meal
Indications for high-protein diet
Growth period
Pregnancy
Lactation
Malnutrition
Surgery
Burns
Fractures
Fever and Infection
Pernicious anemia
Nephrotic syndrome
Hepatitis
Cirrhosis w/o impending hepatic coma
A diet where dietary sources of sodium is restricted
Sodium-restricted diet
Dietary sources of sodium
Table salt
Foods to which salt/sodium compounds have been added
Foods that inherently contain sodium
Chemically softened water containing sodium salts
90-150 mEq
Stage 1 hypertension, mild edema
40-89 mEq
Stage 2 hypertension, cirrhosis with ascites
20-90 mEq
Congestive heart failure
20 mEq
Cirrhosis with massive ascites
Used for the prevention and control of edema and hypertension
No added salt diet
No salt is added during preparation and consumption
Limited use and consumption of foods that have liberal amounts of natural sodium
No added salt diet
No salt is added during preparation and consumption
Limited use and consumption of foods that have liberal amounts of natural sodium
No added salt diet
No added salt diet should contain ______ mg of sodium
3000-4000
Other term for high-fiber diet
High-roughage diet
A normal diet with additional 2-3 servings of foods rich in fiber
High fiber diet
High fiber should contain _____ g/day of fiber
25-30 g/day
Goal of high fiber diet
To increase fiber intake rather than to attain a precise level of intake.
Curative and preventive for the development of heart diseases, GIT cancer
High fiber diet
High fiber diet is rich in
vitamins A, C, E, Se, ZN
Indications for high fiber diet
Soluble
- coronary heart disease
- DM
- dyslipidemia
- gastric ulcer
Insoluble
- atonic constipation
- hemorrhoids
- colonic and rectal polyps/cancer
- diverticulosis
- IBS
Contains <10-15 g/day of dietary fiber
Low fiber diet
Goal of low fiber diet
To eliminate foods known to increase the fecal volume that might distend and aggravate the inflamed tissue
Limitations of low fiber diet
Does not provide the min. requirements for some nutrients due to maldigestion, malabsorption, drug-nutrient interaction, anorexia
May require supplementation of vitamins and/or minerals
Not intended for long term use
Plant-based
Consists of a variety of legumes, whole grains, nuts, veg, fruits, and in some, eggs and dairy products
May require modification to meet nutritional needs
Vegetarian diet
Exclusion of all animal products
Vegan/total vegetarian
With cheese, milk, and other dairy products
Lacto-vegetarian
With cheese, milk, other dairy products, and eggs
Lacto-ovo
Exclusion of all animal products except fish
Pesco-vegetarian
Exclusion of only red meats
Semi-vegetarian
Follows the typical progression of diet post-operatively
Heart surgery diet
Follows the pattern of a low-fat and/or weight loss diets
Heart surgery
Controlled in sodium to prevent congestive heart failure
Heart surgery
_______ and _________ depend on the type of heart surgery and patient response
Degree and duration
Progressive I (Acute Phase)
Clear liquid diet
Given 24-48 hrs only
1000 kcal/day
1-1.2 L/day
Progressive II (Sub-acute phase)
Full liquid diet
24-72 hrs only
1500 kcal
1.5-1.8 L/day
Progressive III (Convalescent Phase)
Mechanical soft diet
1500-1800 kcal
Progressive IV (Rehabilitative Phase)
Soft diet
1600-1800 kcal/day
Limit fat to 10-15% of total calories
Low fat
Low fat diet: Limitation of _____ ______ and ______ _______
Visible fats, added fats
Low fat diet includes:
Complex carbohydrates, MCTs
Indications of a low-fat diet
Hyperchylomicronemia
Type 1 hyperlipoproteinemia
Fat malabsorption syndromes
A special high-fat and low-CHO diet that helps to control seizures or reduced recurrence of prolonged seizures
Ketogenic diet
The ratio of fat to CHO + CHON
Ketogenic diet ratio
These have anti-convulsant effects
Ketones
Ketogenic diet requires supplementation of:
Vitamin D
Calcium
Folate
Iron
Requires _ days to achieve ketogenic ratio of ___:_
4 days
3-4:1
usual fat to CHO + CHON ratio
1:3
Ketogenic diet contains
75-100 kcal/kg BW
1-2 g CHON/kg BW
Ketogenic diet ratio for most children
4:1
Ketogenic diet ratio for infants, adolescents, and children with higher CHO or CHON requirements
3:1
Indications for ketogenic diet
Status epilepticus
Infantile spasms
Focal seizures
Tuberculosis sclerosis complex
Dravet syndrome
Rett syndrome
Doose syndrome
GLUT-1 deficiency
≠fiber
end result of digestive, secretory, absorptive, and fermentative processes
Residue
Transition from soft diet to regular diet
Similar to low-fiber but restricts foods that increase intestinal activity
Low-residue diet
Also consist of low-fiber foods that have a low capacity to increase fecal residue/volume
Low-residue
Limits/eliminates food that leave a high amount of residue in the colon
Minimal residue
Goals of minimal residue diet
1) to decrease intestinal muscular activity
2) to decrease frequency of bowel movements
3) to minimize fecal volume and water
Long term use of minimal residue diet may cause deficiency in:
vit. C, Ca, folate
Indications of minimal residue diet
Crohn’s disease
Ulcerative colitis
Diverticulitis
Intestinal obstruction
Post-hemorrhoidectomy
Diarrhea
Consists of clear liquids and juices that provide little residue and are easily absorbed
Clear liquid diet
True or false: clear liquid diet is adequate in all nutrients
False
True or false: clear liquid diets may not be used for more than 3 days without supplementation
True
Goals of clear liquid diet
1) to provide fluids without stimulating extensive digestive processes
2) to relieve thirst
3) to provide oral feedings that will promote gradual return to normal food intake
Indications of a clear liquid diet
Preoperative/post operative patients
With inflammatory conditions of the GIT
acute stages of illness
Conditions that require minimal residue
Consists of semi-solid foods and fluids that are liquid at body temperature
Full liquid diet
Transition diet in post-operative dietary regimens/conditions with moderately reduced GIT function
Full liquid diet
Goal of full liquid diet
To provide oral feedings that will promote the return to normal food intake
Indications of full liquid diet
Post-operative following clear liquid diet
Acute-ill
Patients who cannot swallow/chew pureed diets
Supplement to tube feeding
Indications of low-fiber diet
Spastic constipation
Small bowel obstruction
PUD
Ulcerative colitis
Radiation enteritis
Intestinal strictures
Gastroparesis
Acute diverticulitis
Pre-/postoperative for abdomen procedures
Inflammatory bowel syndrome
Chronic diarrhea
B-hydroxybutyrate levels should be:
More than 3 mmol/L
Restricts food that increase intestinal activity
Low-residue diet
True or False: 1-2 cups of milk in low-residue diet is okay.
True.
Simple sugars are avoided
Minimum residue diet
May require modification of CHO and fat content to address the needs of people with dyslipidemia, diabetes, and hypoglycemia
Full liquid diet
