Transcript Concepts of Diet Therapy

NURS 2018: Diet Therapy
CONCEPTS OF DIET THERAPY
Objectives
 At the end of this presentation students
should be able to:
 Identify the purpose of diet/nutrition
therapy
 Describe methods of dietary modifications
for clients in primary and secondary care
settings
 Relate the role of the nurse in nutritional
care
Diet/Nutrition Therapy
 Nutrition care that encompasses the
assessment and treatment of any disease,
condition, or illness- Medical nutrition
therapy
 Includes
 Modified diet
 Nutrition education
 Specialized nutrition support with oral nutrition
supplements
 Tube feedings
 Intravenous nutrition
Purpose of Nutrition Therapy
The purpose of nutrition therapy is to : Ensure adequate energy and nutrient intake- to
prevent under and over nutrition
(malnutrition)
 Prevent insufficient intake of some
micronutrients such as iron and folate
 Prevent physiological consequences of
malnutrition- LBW babies, NCDs and mortality
 Improve adherence of recommendations such
as RDA, UL, EAR etc.
Dietary modifications in nutrition therapy
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Regular
Liquid
Soft
Diabetic
Low Calorie
High Calorie
Low Cholesterol
Fat-restricted
Sodium-restricted
Protein
 Bland
 Low-residue
Diet
Use
Foods Allowed
Foods not
allowed
Nutritional
adequacy and
advice
Regular
General diet for
people who do
not require
texture or
nutrient
modification
All
None
Adequate if
consumed as
ordered
Clear
Liquids
Hydration, bowel
prep for some
procedures,
transition to
solids from NPO
See through items
liquid at room
temperaturejuices, drinks,
broth, popsicle,
gelatin
Opaque
Liquids, solid
foods
Inadequate in all
nutrients, low in
energy. Consider
nutrition
supplement;
monitor length,
refer 5 or more
days
Foods liquid or
pourable at room
temperature- all
clear items &
dairy, custards,
supplements
Solid foods,
liquid at room
temp. foods
with added
solids e.g. ice
cream with
nuts
Nutri. adequate
when supplements
consumed. If
dysphagia consult
doc for eval. High
fat/ low fibre long
use
Full Liquids Chewing or
swallowing
difficulties
Diet
Use
Foods Allowed
Foods not
allowed
Nutritional
adequacy and
advice
Mechanical Chewing or
or Dental
swallowing
Soft
difficulties
Liquids, minced, soft,
chopped, ground
foods; protein w/o
bones, grizzle. Cooked
beans and eggs.
Desserts, Grainscooked/soft; fruits
and vege- cooked, soft
Whole nuts, seeds,
meat with casings,
tough meats, hard
crusted bread,
raw vege and
fruits/vegeedible skin
Nutri adequate if all
food groups are
consumed; may be
low in fibreconsult
nutritionist- re safe
textures and doc re
gag reflex
Pureed
Blenderized or
pureed foods. Any
food allowed that can
be pureed to a
custard-like
consistency w/o
solids remaining. Can
add liquid to get
desired consistency
Whole nuts, seeds,
hard bread/rolls,
dried fruit,
fruits/vegeedible skin, any
food that cannot
be pureed to a
smooth
consistency
Nutri adequate if all
food groups are
consumed; avoid
over-modification.
Essential foods is
presented in
attractive manner
to stimulate
appetite- molds,
garnishes.
Advanced
chewing or
swallowing
difficulties
Tucker & Dauffenbach, 2011
Food Modifications
 Foods- particular those provide by the oral route may be
modified based on
 Energy needs
 Nutrients- supplemental immunonutrition may be given to
improve illness recovery such as included antibodies, antioxidants
and additional minerals
 Energy- may increase or decrease depending on type of illness and
the metabolic demand
 Preparation, flavouring, seasoning- low levels recommended in
colitis, diarrhoea, CA of GI
 These modifications affect the clients likelihood of
acceptance
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Based on presentation
Level of modification
Usual intake
Preparation style
Commentary form the nurse
Nurse’s responsibilities with nutritional care
 The nurse has responsibility to assist in coordinating care
and services.
 The nurse usually collaborates with other members of the
health care team in
 nutritional assessment,
 nutrition education,
 delivery of dietary support- modified diets, tube feedings, IV
nutrition.
 The Physician is usually needed to assess gag, identify GI
functionality, examine the presence of strictures, dysphagia &
swallowing disorders- from these assessments the physician
usually makes dietary prescriptions for regular diet, modified,
enteral, parenteral, palliative
 The nurse collaborates with the physician to implement
dietary prescriptions as well as to re-examine the patient for
nutritional imbalances and serves as an advocate
Nurse’s responsibilities with nutritional care
Dietician and dietary department- is responsible for: anthropometric assessment and clinical assessment.
 They recommend the appropriate biochemical tests that
are needed to determine deficiencies.
 From these assessments, they usually makes dietary
prescriptions for regular diet, modified, enteral,
parenteral, palliative.
 They usually provide more detail about the composition
of the diet- total energy requirement, protein, and
supplements that may be needed.
 They also recommend preparation methods of foods.
 They are also responsible for preparing data for
nutrition education.
 The nurse collaborates and ensures these actions are
done
Nurse’s responsibilities with nutritional care
The nurse also works with other health team
 The nurse works with the phlebotomist,
nutritionist, meal services department to
ensure that the nutritional needs of the
patients are met.
 The nurse may also communicate with the
family and the patient the changes that are
important and necessary for health
maintenance.
 The nurse usually recommends follow up care
and advocates for referral to HTN, Renal, DM,
HIV/AIDS clinic and dietetics department.
Nurse’s responsibilities with nutritional care
The nurse also serves as Communicator
 Explaining the treatment regime; advocating for
more detailed explanation particularly of dietary
prescriptions
 Interpret rationale for diet
 Assists in food selection, may advice on
preparation style and techniques
 Ensures that the ordering, delivery and
administration of the prescribed diet
Nurse’s responsibilities with nutritional care
Nurse as Teacher/Counsellor
 Uses informal opportunities to teach- such as
during medication administration, meal service
and family visits
 Plan instructions- useful in primary health care
and health promotion and for new diagnoses
 Counsels patient and family
 Support, supplement and reinforce the
information provided by the dietary
department
References
 Duggan, M., & Golden, B. (2007). Deficiency
diseases. In C. Geissler & H. Powers (Eds.), Human
Nutrition (11th Ed.) (pp 517-536). Edinburgh, UK:
Elsevier Churchill Livingstone.
 Smith, R. C. (2007). Nutritional support for
hospitalized patients. In J. Mann & A. S. Truswell
(Eds.), Essentials of human nutrition (pp 33-52).
New York, USA: Oxford University Press.
 Tucker, S. & Dauffenbach, V. (2011). Nutrition and
diet therapy for nurses. Boston, USA: Pearson.