NCMA215 BSN 2ND YEAR SUMMER FINAL 2022 PDF

Bachelor of Science in Nursing 2YC NCMA215: BSN 2ND YEAR SUMMER FINAL 2022 - diet for patient undergone tonsillectomy and Coverage for Final: Modules 9-17...

Bachelor of Science in Nursing 2YC NCMA215: BSN 2ND YEAR SUMMER FINAL 2022 - diet for patient undergone tonsillectomy and Coverage for Final: Modules 9-17 adenoidectomy Dietary Modification and Therapy - allowance for ice chips, ice cream, sherbet, ice drop, Nutrition Education and Counseling popsicles Evidence-Based Guidelines in Nutrition Practice - Ex. if the patient undergoes the tonsillectomy pwede Legal Mandates Related to Nutrition and Diet Therapy sakanila yung cold diet or ice cube and ice cream BUT Ethico-moral Principles Related to Cultural and Spiritual vanilla only kase kapag may color hindi pwede it will Preferences affect the color of feces Life-long Learning Activities 4) Soft Diet Nutrition Counseling and Dietary Instruction - nutritionally adequate diet differs from the normal diet in Nutripreneurship having reduce the fiber content, soft consistency and bland flavor DIETARY MODIFICATION AND DIETARY THERAPY - used immediately between the full fluid diet and regular Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador diet following surgery, acute infections, fever, and GI Therapeutic diet disturbances - a meal plan that controls the intake of certain foods or - patient with no teeth or ill-fitting dentures; nutrients. It is part of the treatment of a medical condition and - those who cannot tolerate highly seasoned, fried or raw are normally prescribed by a physician and planned by a foods dietician. - the normal diet is modified in the following ways: - A therapeutic diet is usually a modification of a regular diet. meat and poultry are minced and ground Therapeutic diets are formulated by doctors and dietitians. vegetables are cooked – little longer than usual - Purposes of Therapeutic Diet: Decrease calories for weight soft raw fruits may be used control soft rolls, bread or biscuits are used instead of crisp rolls, crust breads and toast General Diets all desserts on a normal diet may be used Standard Hospital Diets (Liquid Diets) 5) Mechanical Soft Diet 1) Clear Liquid Diet - dental soft or mechanically altered diet - consists of liquids without residue or fibers - foods should be well cooked, easy to chew, chopped - used to relieve thirst and maintain water balance ground or minced - diet used for 24-48 hours following acute vomiting, - foods are best served moist or with gravy and sauce diarrhea or surgery 6) Regular Diet - allowance of tea, coffee, fat-free broth, ginger ale, fruit - most frequently ordered among the house diets juices in the sachet, gelatin, fruit ices, hard candy and - also called general, house, full hospital diet, diet as water tolerated - Malinaw or malabnaw - Ex. if may admission before carry out the order of the - Milk and juices are not allowed physician tawag ka muna sa dietitian to check 2) Full Liquid Diet 7) Light Diet - nutritionally adequate diet consisting of fluids and foods - a transition between the soft and regular diets that liquefy at body temperature - for elders who cannot tolerate rich and heavy foods - diet used for acute infections and fever of short duration 8) Vegetarian Diet and for patients who are ill to chew - usually low in saturated fatty acid, cholesterol, and high - milk, cream soups, cereal, soft custard, strained meat in fiber broth, strained citrus fruits, tomato juice, vegetable puree, - with disadvantage is inadequate or low level of Vit B12, eggnog, yogurt Iodine, Calcium, Zinc, Vit. B2 and Vit. D. - Thicker than liquid diet Vegan diet - total vegetarian, or strict vegetarian diet - Naoperahan na like appendectomy or plant in origin - Peritoneal lavage – hinugasan ang mga intestine dahil Lacto-vegetarian - milk and milk products + items of nagkaroon ng peritonitis (chemical irritation). plant origin - Patient is NPO for 24 to 72 hrs. Ovo-vegetarian – eggs and eggs products + items of - Sa umaga clear liquid muna after operation then sa hapon plant origin general na, pero need to check the tolerance of the patient, Lacto-ovo-vegetarian – eggs + milk + plant origin no vomiting then the patient can have soft diet. Semi-vegetarian – lacto-ovo- vegetarian foods + fish - Matabang wala nasyadong asin + chicken + plant - for rotation of diet after operation, NPO – clear liquid diet Pesco-vegetarian – fish and fish products + items of – check tolerance – full liquid diet – check for the bowel plant origin movements – kailangan ma utot yung patient – soft diet 9) Restricted Diet 3) Cold Liquid (Yin diet) - a diet limited in a specified amount or type of nutrient J.A.K.E 1 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 - cholesterol restricted diet, salt restricted diet - Hypertonic – attracts water goes to GIT lead to shock like - Congestive heart failure symptoms, my fullness, may vertigo, may cold clammy - Patient who has liver problem skin 10) Controlled Diet - Kakain naka upo pero after need to lie down para hindi - implies careful adjustment of levels of nutrients from day agad pumunta sa intestine ang pagkain to day as needed, controlled CHON, K, Na. - Dried food item - Hindi muna iinom agad after kumain or habang kumakain Dietary Modification with Consistency Hepatic Encephalopathy - Low CHON, High calorie - The modified consistency diet includes all the foods you are - liver cirrhosis, inflammation of Liver allowed to eat in your regular diet based on your tolerance, - Ammonia level is so high lead to intoxication This diet may also meet all your nutrition needs if you make - Ammonia must converted by urea in the liver but the liver healthy food choices. Cut starches into small pieces, mash or did not able to convert it will lead to high level of puree. Cook fruits: cook or steam vegetable Ammonia lead to hepatic encephalopathy. - Modified Consistency Diet Hirschsprung’s disease - High calorie, Low residue, High Pureed diet CHON Mechanical soft diet - Low residue – limit the dietary fiber - Modified Regular Diet - Vegetables Liquid diet Hyperthyroidism – High calorie, High CHON Thickened liquids Hyperparathyroidism – Low calcium Therapeutic Diet for specific disease condition Liver Cirrhosis – Low CHON Acute Glumerulonephritis - Low Na, Low CHON (unable to Nephrotic Syndrome – Low Na, High CHON, High Calorie filtering, unable to circulate, metabolism will be affected. Urea - High urea and creatine of patient monitor na ang sodium level is increasing) and prepare for Low Na diet. Acute Renal Failure – Oliguric Phase - Low Na, Low CHON Overweight and Obese - Low calorie (urea and creatinine), High CHO (for energy) (unable to Pernicious Anemia - High CHON, Vitamin B excrete urine) – may excess fluid Tosilitis - Clear liquid diet Addison’s Disease - High Na, Low K (hypofunction of Ulcerative Colitis - High CHON, High Calories, Low adrenal cortex = hyponatremia, hypernatremia) residue Attention deficit hyperactivity disorder - Finger foods Bland - eliminate irritating foods to allow the stomach lining Bipolar Disorder - Finger foods to heal (ulcer patients) Cerebrovascular Accident (stroke) - Osterized Feeding with High Fiber - provide bulk in the stool and bring water into the Low Na, Low cholesterol, High fiber colon for patients with constipation or diverticulosis - prevent aspiration lang Low residue - reduce fiber for patients with Crohn’s disease, Cholecystitis - Low fat, High CHO, High CHON colon or rectal surgery, esophagitis, diarrhea. - gallbladder disease High Calorie - growing periods, under nutrition, Chronic - High CHO and CHON for energy Obstructive Pulmonary Diseases and Cystic fibrosis Chronic Renal Failure - Low CHON, Low Na, Low K Low Protein - Liver and renal failure - irreversible High Protein - Hypercatabolic disorder, Protein Energy - Electrolytes imbalance is fatal for pt. Malnutrition - Low = in order to decrease the product or urea and Low Purine - reduce the amount of purine. It is used with creatinine patients who have gout or uric acid kidney stones. Congestive Heart Failure - Low Na, Low Cholesterol Low Cholesterol - reduce the intake of cholesterol in order to Cushing Disease - High K, Low Na lower blood cholesterol levels in client heart diseases - Opposite of Addison’s Disease Sodium Restriction Salt allowed Decubitus Ulcer - High CHON, High Vitamin C Mild (3000 mg) >1/2 teaspoon per day - Redness, Puputok, bubuka na then makikita na yung mga ¼ teaspoon per day organ na pwedeng lumabas Moderate (2000 mg) 1 serving of processed foods Dengue Fever - Diet as tolerated except dark-colored food (it No salt will darker the stool it will alter the laboratories) Strict (1000 mg) No processed foods Diabetes Mellitus - Well-balanced diet Limit bread and milk - High fiber diet – decrease the absorption of glucose in the Sodium free intestine Very Strict (500 mg) Restrict natural foods high in sodium Diverticulitis - Low fiber - inflammation of the diverticulum Dietary Modification with Composition - parang loslos sa intestine Low Calorie Diet Dumping Syndrome - High fat, High protein Calorie restriction, or caloric restriction (CR) - partial gastrectomy - Dietary regimen that restricts calorie intake, where the - High in glucose baseline for the restriction varies - People who are interested in going on a low-calorie diet (VLCD) should first consult a physician. J.A.K.E 2 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 - A very low calorie diet is any diet plan that allows 800 - Foods high in digestible carbohydrates (e.g., bread, pasta) are calories or less in a day; and the diet is overseen by a limited or replaced with foods containing a higher percentage physician. of proteins and fats(e.g., meat, poultry, fish, shellfish, eggs, - The length of such a diet is relatively short, usually cheese, nuts, seeds, peanuts, and soy products) and other foods between 3 and 6 months. Any longer and serious health low in carbohydrates (e.g., most salad vegetables) although complications may arise. other vegetables and fruits(especially berries) are often Low-calorie diets and very low-calorie diets allowed. - A VLCD is differen from what a person might casually - The amount allowed of these foods varies with different low- call a “low calorie diet," which would commonly consist carbohydrate diets. of 1500 to 1800 calories per day. - Such diets are sometimes ketogenic (i.e. they restrict High Calorie Diet carbohydrate intake sufficiently to cause ketosis) for example, - One furnishing more calories than needed to maintain eight, the induction phase of the Atkins diet. often more than 3500-4000 calories per day. - Some sources, though, consider less restrictive bariants to - A diet containing more than 4,000 calories per day below-carbohydrate as well. - Some medical conditions require a high-calorie diet to help - Apart from obesity, low-carbohydrate diets are often used as maintain or promote weight gain. treatments for some other conditions, most notably diabetes - People with liver disease are at risk of malnutrition due to poor and epilepsy, but also for chronic fatigue syndrome (see intake and altered nutrient metabolism. ketosis) and polycystic ovarian syndrome. - To meet their needs, most people with liver disease should A low Sodium Diet increase the number of calories they eat each day. - A diet that includes no more than 1,500 to 2,400 mgs of - People with Huntington’s disease have higher calorie needs sodium per day. (One teaspoon of salt has about 2,300mg because of their constant fidgeting which increases their sodium.) metabolic rate. - People who follow a vigorous or moderate exercise schedule - Cancer patients tend to have higher clorie needs because of a are usually advised to limit their sodium intake to 3,000mg per poor appetite related to treatment. day and those with moderate to severe heart failure are usually - Eating more calorie-dense foods, such as whole milk, cheese advised to limit their sodium intake to 2,000mg per day. and nuts, can help you increase your calorie intake when you Low Potassium Diet have a poor appetite. - Potassium is a mineral that assists in maintaining normal blood - Severe Burns, Underweight, Competitive Athletics pressure and proper contraction of the heart. High-Protein Diet - The nervous system, digestive system, muscles, and heart are - a diet that contains large amounts of protein, consisting largely kept healthy. It is found in whole grains, vegetables, milk of meats, fish, milk, legumes, and nuts. fruits, peas and dried beans. - It may be indicated in protein depletion that results from any - Need of a low potassium diet – If an individual has kidney cause, as a preoperative preparation, or for patients with severe problems, excess potassium can accumulate up to dangerous burns and sepsis. levels in the blood. This causes irregular heartbeats, confusion - It may be contraindicated in liver failure or when kidney or a heart attack. In this case, a low potassium diet is function is so impaired that added protein could result in recommended. If the diet contains less than 2000 mg of azotemia and acidosis. potassium per day, then it is called as a "low potassium diet". Low-Protein Diet - Low potassium foods – serving of the following can be - Any diet in which the protein intake is reduce. Anyone considered to be low potassium food. 1 serving implies ½ cup. diagnosed with kidney or liver disease may be prescribed a More than 1 serving of the following can make it high low-protein diet. potassium food. - In any case, a diet which is especially low in protein should - General foods Bread (bread products): cake – angel, yellow; only be undertaken under medical direction. coffee (maximum 8 ounces); cookies (without nuts or - Reduced amount of protein: Some of each type of protein chocolate); noodles; pasta; pies (without chocolate or high should still be consumed each day from the two main sources: potassium foods); rise; tea (maximum 16 ounces) 1) Animal products (fish, poultry, eggs, meat, dairy Low Purine diet products) – considered high quality or complete protein. - A low-purine diet is an eating plan that limits foods that 2) vegetable products (breads, cereals, rice, pasta, dried contain purine. Purines are a natural substance found in some beans) – considered low quality or incomplete protein. foods. Low Fat Diet - When your body digest purine, a waste product called uric - According to the USDA, a low-fat diet–as the name implies–is acid is produced. a diet that consists of little fat, especially saturated fat and - A build-up of uric acid crystals in the joints can cause a type cholesterol, which is thought to lead to increased blood of arthritis known as gout. cholesterol levels and heart attack. - Purines are found in many healthy foods. The purpose of a - It is important to know that dietary fat is needed for good low-purine diet is not to completely avoid purines. health, as fats supply energy and fatty acids, in addition to - Instead, the goal are to limit and monitor how much purine is supplying fat-soluble vitamins like A, D, E, and K in the food you eat, and to learn how your body responds when Low Carbohydrates you eat different foods that contain purine. - Dietary programs that restrict carbohydrate consumption usually for weight control or for the treatment of obesity. J.A.K.E 3 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 BRAT diet – banana, rice, apple, toast – indicated patients Self-Efficacy Theory (Bandura, A. 1997) with diarrhea - based on a person’s expectations relative to a specific course Butterball diet – spare protein but high in CHO indicated of action. It deals with the belief that one is competent and with liver disorders capable of accomplishing a specific behavior – a precursor to Giordano diet – spare protein, indicated for patients with expected outcomes. CRF - 4 Principal sources of info cognitively appraised and Giordano-Giovannetti diet – a low-protein, low-fat, high- processed: carbohydrates diet with controlled potassium and sodium a) Performance accomplishment intake, used in chronic renal insufficiency and liver failure b) Vicarious experiences Kosher diet – meat and milk cannot be served simultaneously c) Verbal persuasion diet for Orthodox Jews d) Emotional arousal Tyramine rich diet – use to prevent hypertensive crisis for - kung ano sinabi ng Nurse expect ng patient to na may outcome patients who are taking in MAOI anti-depressant. No to ABC kaya susundin nya – avocado, banana, canned, processed, smoked, aging and Stages of Change Model (Prochaska & DiClemente, 1996) fermented foods Six Stages: South Beach Diet – diet developed by the Miami-based Precontemplation cardiologist Arthur Agatston, M.D., who says that the key to - para ka lang nagdu duty sa mental health, may takot at losing weight quickly and getting healthy isn’t cutting all ayaw mo kausapin ang pt. Merong pt. na normal, meron carbohydrates and fats from your diet, but choosing the right ayaw kase ngayon ka palang nakita. carbs and the right fats. Contemplation Monothropic Diet - A diet that involves eating only one food - Established rapport. Include significant others item, or one type of food, for a period of time to achieve a Preparation desired weight reduction. Action DASH diet - (Dietary Approaches to Stop Hypertension). A Maintenance recommendation that those with high blood pressure consume Termination large quantities of fruits, vegetables, whole-grains and low fat Teaching Plan Format dairy foods, Lean meats, nuts seeds and legumes, healthy vegetable based oil as part of their diet, and avoid sugar sweetened foods, red meat and fats. Elemental diet - A medical, liquid-only diet, in which liquid nutrients are consumed for ease of ingestion. Ketogenic diet - A high-fat, low-carb diet, in which dietary and body fat is converted into energy. It is used as a medical treatment for epilepsy. Paleo diet - foods include meat, fish, eggs, seeds, nuts, fruits and veggies, along with healthy fats and oils. Avoid processed foods, grains and sugar. - modern fats diet during paleolitic era Theory of Reasoned Action and Theory of Planned Behavior NUTRITIONAL EDUCATION AND COUNSELING (Fishbein and Azjen, 1975) Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador - A person’s behavior is determined by their intention perform Nutrition Education the behavior and that this intention is, in turn, a function of - any combination of educational strategies, accompanied by their attitude toward the behavior and subjective norms environmental supports, designed to facilitate voluntary - It focuses on the construction of a system of observation of adoption of food choices and other food- and nutrition-related two groups of variables, which are: behaviors conducive to health and well-being - attitudes defined as a positive or negative feeling in relation to - delivered through multiple venues and involves activities at the achievement of an objective; the individual, community, and policy levels. - subjective norms, which are the very representations of the individuals’ perception in relation to the ability of reaching Theories those goals with the product. Health Belief Model (HBM) Therapeutic Alliance Model (Barofsky, 1978) - Explains and predicts health behaviors based on patient’s - Addresses the shift of power from the provider to a learning beliefs about the health problem and the health behavior. partnership in which collaboration and negotiaton with the - Relies on the assumptions that patients are willing to consumer are key. participate and that they believe that health is highly valued - A therapeutic alliance is formed between the caregiver and the (Becker, 1990) care receiver in which the participants are viewed as having - Components: equal power. The client is viewed as active and responsible, a) Individual perceptions with an outcome expectation of self-care. b) Modifying factors - Concordance – emphasis on the consultative process c) Likelihood of Action (Hobden,2006). J.A.K.E 4 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 The Teaching-Learning Process Standard Hospital Diets 1) Assessment of Learning needs, readiness to learn, and learning Liquid diets styles Clear Liquid Diet 2) Mutually setting the goals/objectives. - indicated for patients experiencing acute vomiting, 3) Teaching-learning sessions diarrhea or surgery; the diet is used for 24-48 hours; it 4) Determination of behavior changes (outcomes) in knowledge, allows tea, coffee or coffee substitute and fat-free broth. attitudes and skills. - New surgery - after operation, the peristalsis of the intestine is not totally activated (possible na magkaroon Modified Diets ng abdominal distention ang patient kapag binigyan na - For every patient in the hospital, they have different types of agad ng pagkain) diet. The diet of the patient may be different from one another Full Liquid Diet according to their problems and conditions. - Used for acute infections and fever of short duration; - Modified diet is designed according to the needs of the patient. patients who’ are too ill to chew. There are some illness na nagrerequire na walang lasa yung - It consists of liquids and foods that liquefy at body food nila, while the others naman ay water or liquid yung temperature, generally offered in 6 feedings or more. kailangang iintake na dapat ay i-maintain. - Yung fluid ay may laman kaso mas dominant or mas - If there are improvements, the type of diet of the patient can be marami pa din yung fluid don sa pagkain. change until their diet will becomes normal. Soft diets - Modified diet is for those who is sick including yung mga - often used immediately between full fluid diet and the regular nagrereduce ng weight. diet following surgery, acute infections and fevers, and in GI Diet Therapy disturbances. - May be a specific treatment of a disease or a supplement of - It has reduced fiber content, bland flavor and soft consistency. other modes of treatment that a patient may go through. - Modifications are done by having the meat and poultry being - Included in its purposes are maintenance of normal nutrition; minced or ground correction of nutritional deficiency, changes in body weight - Vegetables are diced, chopped or cooked longer than usual and adjusting the body’s ability to use one or more nutrients. - the use of soft raw fruits and the use of soft rolls, breads or - While the patient is improving, at the same time they are biscuits. taking the appropriate diet that can help to further improve - Example: bread, cookies, ground meat, vegetable, fruits their health condition. (maliliit yung butil or hiwa, niluto ng matagal kaysa don sa normal na pagluluto para lumambot ng husto) Normal Diet (also known as regular, general or house diet) Test Meals - the foundation on which therapeutic diet modifications are - used for specific diagnostic tests such as based. Regardless of the type of diet prescribed, the purpose of a) Fecal Fat Determination the diet is to supply needed nutrients to the body in a form it - to measure fat globules to detect fat absorption. can handle. - if the fat is not digested, it will not be absorbed - Pinaka maganda para sa hospitalized patient. Pag sinabi ng - Fat cannot be digested without bile so if there is no doctor na DAT(Diet Accelerated) na yung patient, it means bile, the fat will not be digested even though there is pwede siyang kumain ng kahit na ano basta yung kaya at a lipase (enzymes for digestion-watersoluble enzyme) matotolerate (yung magagamit lang talaga mismo ng katawan) because they cannot be mixed together niya lang. - Water and oil will not be mixed together unless it is - Modification of this diet include: acted upon by the bile produced by the liver, the bile a) consistency and texture – ito ba ay well done, rare un mga will emulsify the fat and then the lipase will come meat and then that's the time that the fat will be digested b) flavor – natural or artificial into absorbable form c) energy value – in the case of Aspartame which is an b) Meat-free Test artificial sweetener, it is not healthy for our body because - to determine GIT bleeding. it doesn’t contain energy value. Usually the sweetness it - If we eat meat, our food can be dark in color and it contains is only an imitation of sugar. can mask the bleeding. If the sugar is being absorbed by our body, it will - Upper GIT bleeding: Dark feces; Lower GIT undergo metabolism and will produce energy. bleeding: feces are mixed with fresh blood Aspartame has a stimulant that enables the brain to - Mas better kung yung bleeding is nasa lower GIT work but it does not provide a supply of energy so kasi madedetect agad yung fresh blood but kung ito the patient will become exhausted which is very ay nasa upper GIT, di pwedeng kumain ng meat harmful for the brain. nagkakaroon ng discoloration sa feces at hindi Glucose – fuel of brain madedetect kung may bleeding ba sa feces. d) nutrient level – amount of calories that the food contains. c) Calcium Test e) food category – junk or nutritious foods - to determine urinary calcium excretion. - Usually gumagamit ng calcium tablet or pinapainom ng gatas d) Serotonin Test - to detect calcinoid tumors of the intestinal tract. J.A.K.E 5 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 Good Tray Service Nutrition Therapy for Diabetes Mellitus - a style of service that makes use of a tray and does not make Diabetes Mellitus use of the usual dining table; dishes and utensils are arranged - a condition that results from the lack of insulin produced by in a tray and brought to the patient in his/her room. the body. This metabolic problem affects the use of - Essentials of good tray service are as follows: carbohydrates and fats by the body. 1) Sufficient size of the tray for uncrowded arrangement. Hyperglycemia or hypoglycemia 2) Clean, unwrinkled tray cover and napkin or good quality - often occur. paper. - These signs along with the excess in weight can be prevented 3) Attractive pattern of spotless chinaware without chips or by controlling the amount of food and their distribution in cracks; clean glassware and shining silverware. meals in a day-to-day basis. 4) An orderly arrangement of all items on the tray. - Patients may initially be placed on a low-calorie diet those 5) Food portions are suitable for the patient’s appetite. with normal weight are given sufficient calories to maintain 6) Foods are attractively arranged with the appropriate their weight. garnishing. - Protein of about 11/2 per kg body weight may be allowed; the 7) Meals are served on time; Hot foods served warm and same may be given to the amount of fat allowed. cold foods served chilled. - The amount of carbohydrate is roughly twice the number of 8) Trays are served promptly to the patient. proteins. - In good tray service, we follow different criteria, but - Menu Plan follows the recommended Food Exchange List. sometimes it is okay not to follow it. For example, criteria no. 3 in which chinaware is so expensive, it is not realistic for Nutrition Therapy for Diseases of the Gastrointestinal Tract government hospitals. - Dietary modifications in disorders of the intestinal tract are - All we need to do is to make the food appetizing, palatable and designed to alleviate symptoms, correct nutrient deficiencies, most importantly it should be based on the patient’s need. and where possible, address the primary cause of the difficulty. - The nature of the modification will depend on the medical Therapeutic Diets condition that the patient has. Nutrition Therapy for Obesity and Weight Control - Bland diet may be prescribed to manage Peptic ulcer. This diet - Obesity is said to be a state of adiposity in which body fat is must meet nutritive adequacy, bland flavor and soft above the ideal weight. Assessment will show a body mass consistency, and mechanically and chemically non-stimulating. index of 30 – 39.9. Whereas, being overweight is having a - Long term use is not recommended as this may lead to the body mass index of 25 – 29.9 or greater. patient becoming malnourished. - this results from: Diverticular diseases An imbalance of the complex system of neural - There is a lump in the inner lining of the colon. May mga Hormonal and chemical mechanisms that keeps the nakalawit na bilog bilog and kapag nainfect don na balance between energy intake and energy expenditure. nagkakaroon ng problema. - There are reasons why an individual may have an excessive - Management may include: intake of calorie; but obesity can be prevented and the Increase of fiber in the diet intention to lose weight is planned With Bran - A Low-calorie Diet and exercise may help in weight control. Whole grains 1 gram of Carbohydrates: 4 calories Cellulose foods to reduce muscle contractions and 1 gram of protein: 4 calories facilitate normal muscle tone 1 gram of fat: 9 calories - Fiber- nagwawalis ng bituka so kapag may fiber matatanggal lahat ng waste residue. - Need low calorie lang yung mga overweight at obese patient Celiac sprue and Non-tropical sprue para mapilitan silang gamitin yung mga energy na naka store - Will show intolerance for gluten sa kanilang mga katawan. o Diet: - Management may include: Protein of about 11/2 (equivalent to 5.5 grams of protein) Food sources containing gluten are removed from the diet per kg body weight may be allowed A high-protein diet is usually necessary Same amount may be given to the fat Along with supplements of minerals and vitamins. The amount of carbohydrate is roughly twice the number Ulcerative colitis of protein. (11 grams of carbohydrates) - where there is an inflammation of the colon and the rectum - Menu Plan follows the recommended Food Exchange List. implies a diet with high calorie, high protein, high vitamins - Yung insulin na ibinibigay ay nakabase don sa diet ng patient. and mineral. Kailangan maging consistent siya sa diet para di pabago bago - Management may include: yung amount ng insulin na ibibigay sa patient kasi hindi Implies a diet with high calorie maganda kapag paiba iba. high protein (repair) - Kung ano yung recommended diet dapat ayon lang lagi yung high vitamins and mineral (fight infection) i-consume para maging regular yung amount ng insulin na - In these acute stages, the patient is placed on a Low-residue ibibigay sa patient. diet, avoiding heavy roughage to prevent irritation. Lactose intolerance - a condition brought about by a deficiency in the enzyme lactase; the lactose (sugar in milk) then, cannot be hydrolyzed. J.A.K.E 6 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 - Management may include - Fat should be taken in moderation. The foods added to the diet A lactose restricted diet is prescribed. are sufficient to meet the daily requirements for minerals and Milk vitamins. Milk-products - Hepatitis causes: taking medication without eating food, Foods containing whey and casein are avoided. drinking alcohol beverages, too much intake of fats, viral Diarrhea infections - Patients suffering from diarrhea may initially be placed on Cirrhosis NPO for 12 hours with. - Protein is often depleted in patients with cirrhosis. Often a 100 - IVT support; as the condition improves. g protein is given, with sodium restriction to 250 mg a day; - Management may include: and a 1,800 calorie diet is recommended. Oral fluids may be given liberally to prevent Dehydration. - Fat restriction is not necessary. Broths and rehydration solutions are given to replace the - Patients with hepatic coma are prescribed with a high calorie electrolytes lost. diet. (kapag sumobra sa protein intake yung patient, Foods rich in pectin. mamanasin sya) Constipation Cholecystitis - A problem that is commonly experienced. - May be managed with a low-fat diet, to avoid stimulating the gallbladder. Spices and high-residue foods are avoided as - It may have a variety of causes but the management often these can cause distention and increase in peristalsis. includes high –fiber diet and liberal fluid intake. - Selection of food items must be carefully done as these may - Intestinal gas is controlled by excluding gas-producing foods; either be restricted or limited. the patient is advised to take small frequent meals and to chew food thoroughly. Hemorrhoids are managed with intake of - Excluded from food preparation such as the use of butter, high –fiber diet, liberal fluids and avoidance of highly- margarine and sauces as vegetable dressing; instead, lemon juice vinegar or low-calorie, fat-free dressings are used. seasoned foods and relishes. Gastroesophageal reflux disease - Patients with pancreatitis are placed on low-fat, low-elemental - hiatal hernia and esophagitis is a condition that takes place 1 to formulas when enteral feeding is appropriate. During acute 4 hours after a meal when a decrease in sphincter pressure attacks, the patient may be placed on NPO for 48 hours. In chronic cases, the diet is high calorie, moderate protein and happens. low to moderate fat. On the other hand, patients with cystic - Maintaining the ideal body weight is recommended; fibrosis are given high-protein diet to compensate for fecal - Dietary management includes avoiding foods high in fat and losses, with liberal fat intake. Calories are often according to eating of large meals. Protein and carbohydrate foods with the need for growth. low-fat content are preferred as these do not affect the lower esophageal sphincter pressure. Nutrition Therapy for Cardiovascular Diseases - These are the conditions that can be found on upper GIT: - Atherosclerosis is caused by the accumulation of fatty GAR – Pyloric sphinter materials including a high proportion of cholesterol and other Cardiac sphinter- entrance substances in the blood vessel, causing it to narrow. Dietary Pyloric Sphinter- exit management is low-fat, low in saturated fat and cholesterol Kapag masyadong tight yung pyloric sphinter and tunaw (300 mg/day). na yung food, isusuka ng patient yung gastric content - Increase in monounsaturated fatty acid, polyunsaturated fats, since hindi nga makadaan yung pagkain don sa pyloric omega-6 and omega-3 fatty acids – with at least 2 servings per sphinter week are recommended to decrease plasma cholesterol levels. - 2nd Condition: Hernia- the esophageal sphinter is too loose, so Simple sugars are restricted. the food in the stomach will return to the esophagus (hiatal - Complex carbohydrates and dietary fiber are increased to 25- hernia) 30 g/day and restriction of carbohydrates are also done. - Third condition: There is an inflammation on esophagus so - Congestive heart failure is managed by restricting sodium in there is difficulty in swallowing the diet. Depending on the severity of the condition, sodium restriction may range from mild (2-3 g) to severe (250 mg) Nutrition Therapy Diseases of the Lliver, Gallbladder, and restriction. Low-fat diet with emphasis on unsaturated oils is Pancreas recommended. Hepatitis - Diet for patients with Myocardial infarction (MI) are designed - the inflammation of the liver. to help reduce the work load of the heart. Small frequent meals - Diet Therapy includes: are done; Liquid diet is used on the initial stages gradually Protein coming from animal sources as these are progressing as the condition of the patient improves. considered to have a superior quality. - Among the food items restricted are caffeine-containing Additional serving of foods rich in protein is beverages, sodium, cholesterol, fat and calorie. Consumption recommended – like an additional milk, an extra egg, as of omga-3 fatty acid-rich foods may be done to reduce blood well as meat, fish and cheese. clots. - Caloric intake must also be adjusted to meet the body’s energy needs. - Patients with fever may have 2,500 to 4,000 calories per day. J.A.K.E 7 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 Nutrition Therapy for Diseases of the Kidneys and achieve optimal health. It aims to increase the competence - Acute glomerulonephritis is a condition consequent to an and confidence of clients for self management; increasing the antigen-antibody complex in which some of the complexes responsibility and independence of clients for self-care. A become ensnared in the glomeruli leading it to swell. partnership approach can provide clients with opportunities to - Emphasis of nutritional care is the overall nutritional needs of explore and expand their self-care abilities as they transition the patient rather than the restriction in protein; restriction in from being passive to active participants of their care. sodium is done only when edema is present. - Behavioral Models that the nurse may use as guide include the - High Calorie from carbohydrates is recommended. following: - Malnutrition may result from Nephrotic syndrome, as lesions Health Belief Model in the nephrons can effect massive albuminuria and protein - it explains and predicts health behaviors based on the patient’s losses. beliefs about the health problem and the health behavior. - Recommended is a diet high calorie, and high protein, low - Its subcomponents include the individual’s perceptions, sodium. modifying factors and the likelihood of action. - Acute renal failure patients are given high calorie, low to Self-efficacy theory moderate protein and moderate fat diet. Adequate caloric - this theory is based on a person’s expectations relative to a intake prevents tissue break down; Potassium and sodium are specific course of action. It deals with the belief that one is controlled according to the patient’s capacity to excrete them. competent and capable of accomplishing a specific behavior. - Water intake is also restricted to a liter a day and is carefully - The behavior-specific predictions of this theory can be used monitored. for understanding the likelihood of individuals participating in - Renal calculi requires a large intake of fluids to dilute the existing or a planned educational program. urine and prevent concentration of stones. Stages of Change Model - The type of stone present influence the nature of the diet. - This theory is useful in staging the client’s intentions and Calcium oxalate stones – low calcium, low phosphate or behaviors for change as well as to determine the strategies that oxalate –according to the Calcium compound, acid ash. will enable completion of a specific stage. Calcium-rich foods are eliminated; alkaline foods are - The six stages that the authors used begins with controlled; potassium-rich foods are increased. 1) Precontemplation Uric acid stones – low purine; limited protein with 2) Contemplation emphasis of milk, fruits and decreased intake of bread 3) Preparation products. 4) Action Cystine stones – High fluid intake, controlled intake of 5) Maintenance meat, milk, egg and cheese. 6) Termination. - Among its current applications are in health promotion and the Nutrition Therapy for Cancers processes by which people decide to change. - Cancer is a group of many dissimilar diseases categorized by Theory of Reasoned Action and Theory of Planned Behavior unfettered replication of Cells. - the premise of this theory is that humans behave in a rational - The clinical status of the patient also warrants the appropriate way that is consistent with their beliefs; suggesting that a route of feeding. person’s behavior can be predicted by examining the - Oral nutrition is high calorie, high protein. Tube feedings may individual’s attitudes about the behavior as well as the range from complete products – meal replacements that individual’s beliefs about how others might respond to the require digestion and absorption; chemically-defined products behavior. – minimal or no digestion – or Specialty products – which - nurses as educators need to take beliefs, attitudinal factors and may vary in terms of amino acid, carbohydrate or fat content. subjective norms into consideration. - Total parenteral nutrition may also be done when the digestive Therapeutic Alliance Model tract is not functioning well. - Fundamental to this model is the shift toward self- determination and control over one’s own life. This model Nutrition Therapy for Human Immune Deficiency Syndrome views the client as active and responsible, with an outcome (HIV/AIDS) expectation of self-care. The therapeutic alliance is formed - HIV/AIDS is an infection that is transmitted via sexual contact, when the nurse and patient views each other as having equal transfusion of contaminated blood, sharing of contaminated power. needles and mother to child during pregnancy, childbirth or - The therapeutic is significant as it relates to the patient’s breast feeding. adherence to therapeutic interventions and achievement of set - Nutritional management for patients with HIV/AIDS include goals. Energy of 35 – 45 kcal/kg BW; Protein 2 – 2.5 g/kg BW ; Fats Counseling for change – increase in omega-3 sources and decrease in saturated fats in - When a person makes a lifestyle change, he or she is giving up the diet something; adapting new behaviors entails “costs” and - Vitamins and minerals - an increase to be recommended in “benefits”. In communities where individual health care case of altered metabolism. providers and mass media promote healthy habits, there may be more motivation for people to make changes. Nutrition Education and Counseling: Behavioral Change - By using motivational interviewing techniques, the counselor - Patient education is a process of assisting people to learn can help the patient move through the stages of change. The health-related behaviors that can be used in their everyday life goal is to increase the client’s intrinsic motivation so that he or J.A.K.E 8 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 she can express the rationale for the changes. Persuasion and GRADE ranking recommendation support are key elements in counseling. High – Confident that the effect in the study reflects the actual Community Resources effect. - Basic in communities are the availability of wellness centers Moderate – quite confident that the effect in the study is close where patients may be referred to for assistance. The Barangay to the true effect but it is also possible it is substantially Nutrition Scholar is tasked to do preliminary assessment, different. monitoring and ensuring availability of food supplements for Low – true effect may differ significantly from the estimate. children who may be suffering from Vit A Deficiency, Iron Very low – true effect is likely to be substantially different Deficiency Anemia, malnutrition or Iodine deficiency. from the estimated effect. - Available from the Web are various literatures and sites that may be used for specific nutritional needs and support groups, The Iowa Model of Evidence-Based Practice is a five-step such as Overeaters Anonymous, glutenfreediet.com and the process: like. 1) Identifying the nursing problem and conduct a search of the literature. EVIDENCED- BASED GUIDELINES IN NUTRITION - The nursing problem prioritized may be about meeting the Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador nutritional need of a well patient or a patient with an - Evidence based practice (EBP) is the conscientious use of identifie health deficit, such as over or undernutrition; current best evidence in making decisions about patient care. post surgery or problems pertaining to absorption. - a conscientious, problem solving approach to clinical practice - Cost-effectiveness may be also be a concern with the that incorporates the best evidence from well designed studies, family or the inadequacy of their skills for food patient values and preferences, and a clinician's expertise in preparation. making decisions about a patient's care 2) Determine whether the issue is a priority for the - Halimbawa, hospital. The practices of that hospital are where organization. it came from? They have researchers to know and modify the - Organizational priorities must also be known – should a studies in order to decide the patient care. research into the problem identified be needed. The - proven and tested beh conduct of studies will require resources. - Basis and guidelines - Collaboration will help guide the nurses to an appropriate direction or focus. 3) Form a team to develop, implement and evaluate the project. - The authors of the model suggests that the team include representatives from those who may have an interest on the project. Also, this avoids duplication of tasks as committees may already be in place. 4) Assemble the relevant literature. - Review of literatures relevant to the project is done. Abstracts, bibliographies, conference proceedings, theses and dissertations may be included. 5) Begin the process of critiquing the literature. - At this stage, literatures are synthesized. Members of the group may divide the workload and understand the scientific basis for implementing changes. The group need to decide if the materials gathered are enough to guide the practice. - The following need to be looked into: Statement of Evidence Consistency of the findings across the studies. Evidence obtained from meta-analysis of RCTs Types and the quality of the studies. Evidence obtained from at least 1 RCT Relevance of the findings to clinical practice. Evidence obtained from at least 1 well-designed controlled Adequacy of the studies using a population similar to study without randomization that of the organization, where the findings may be Evidence obtained from at least 1 well-designed quasi- applied. experimental study. Feasibility of the findings in practice. Evidence obtained from well-designed non experimental Risk-benefit ratio. descriptive studies, such as comparative studies , correlation studies, and case reports LEGAL MANDATES RELATED TO NUTRITION AND Evidence obtained from expert committee reports or opinions DIET THERAPY and/ or clinical experiences of respected authorities Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador Mandate - a judicial command or precept issued by a court or magistrates, directing the proper officer to enforce a judgment, sentence or decree. J.A.K.E 9 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 Executive Orders - acts of the President providing for rules of Act 8976 Act nutritional deficiency a general or permanent character in implementation or problems in the execution of constitutional or statutory powers shall be Philippines, a Food Fortification plan promulgated in executive orders. provides for the Presidential Decree - innovation made by President addition of nutrients to Ferdinand E. Marcos with the proclamation of Martial Law processed foods or Republic Act - a piece of legislation used to create policy in food products as per order to carry out the principles of the Constitution. the Recommended Food fortification - the addition of one or more essential Dietary Allowances nutrients to food, whether or not it is normally contained in the (RDA) food, for the purpose of preventing or correcting a Republic Act (RA) demonstrated deficiency of one or more nutrients in the 3720 of the Republic of population or specific population groups (Codex Alimentarius). the Philippines was Year amended with the Code Title Purpose passage of a new signed law ,RA 9711 - “The Creation of the Food and Drug National Nutrition Administration (FDA) Presidential Council (NCC) of the Food and Drug Nutrition Act of Republic Act of 2009” The FDA 1974 Decree No. Philippines as the 2008 Administration the Philippines Act 9711 Act of 2009 created the 491 highest policy-making Act Food and Drug and coordinating body Administration (FDA) on nutrition. in the Department of Provision of safe and Health (DOH) to be National Code of adequate nutrition for headed by a Director Marketing of infants; protection and General with the rank Breastmilk promotion of breast of Undersecretary of Executive Substitutes, feeding ; ensuring the Health. 1986 Order 51 Breastmilk proper use of An act expanding the Supplements and breastmilk substitutes promotion of Other Related and breastmilk Expanded Republic breastfeeding, Products”. supplements when 2009 Breastfeeding Act 10028 amending for the necessary, Promotion Act purpose republic act no. 7600 Provides protection to consumers against Strengthens food safety hazards to health and. regulatory system in Republic Consumer Act of 1992 Safety and deceptive, the country; provides Act 7394 the Philippines unfair and protection to unconscionable sales Republic consumers so they will acts and. Practices. 2013 Food Safety Act Act 10611 have access to local foods and food An act providing products that have incentives to all undergone thorough The Rooming-in government and private Republic and rigid inspection. 1992 and Breastfeeding health institutions with Act 7600 Act rooming-in and the standardization and breastfeeding practices regulation of nutrition and for other purposes and dietetics education; (b) the examination, Contribute to the registration and elimination of licensing of micronutrient nutritionist-dietitians; malnutrition in the (c) the standardization, country, particularly “Nutrition Republic supervision, control, iodine deficiency 2015 and Dietetics Act 10862 and regulation of the Act for Salt disorders, through the Law ” practice of nutrition Republic Iodization cost-effective 1995 and dietetics; (d) the Act 8172 Nationwide (ASIN preventive measure of development of Law) salt iodization; require professional all producer competence of manufacturers of food- nutritionist-dietitians grade salt to iodize the through continuing salt that they produce, profession manufacture, import, trade or distribute 2000 Republic Food Fortification To prevent and limit J.A.K.E 10 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 An act scaling up the Manufacturers and distributors shall not be permitted to national and local give, directly, or indirectly, samples and supplies of health and nutrition products within the scope of this Code or gifts of any sort “Kalusugan at programs through a to any member of the general public, including members Republic strengthened integrated of their families, to hospitals and other health institutions, 2018 Nutrisyon ng Act 11148 strategy for maternal, as well as to personnel within the health care system, save Mag-Nanay Act" neonatal, child health as otherwise provided in this Code. and nutrition in the first one thousand (1,000) There shall be no point-of-sale advertising, giving of days of life samples or any other promotion devices to induce sales directly to the consumers at the retail level, such as special displays, discount coupons, premiums, special Presidential Decree No. 491 (1974) sales, bonus and tie-in sales for the products within the Nutrition Act of the Philippines scope of this Code. This provision shall not restrict the - Under Section 4, the National Nutrition Council was created establishment of pricing policies and practices intended to as the country’s policy-making and coordinating body on provide products at lower prices on a long term basis. nutrition. Council was reorganized through Executive Order Manufacturers and distributors shall not distribute to No. 234 s. 1987 and Administrative order No. 88 s. 1988. It pregnant women or mothers of infants any gifts or articles was attached to the Department of Health (DOH) on or utensils which may promote the use of breastmilk November 30, 2005. The NCC was instructed to realign its substitutes or bottle feeding, nor shall any other groups, operations to focus on client-based activities and to address institutions or individuals distribute such gifts, utensils or hunger and malnutrition in the context of Millennium products to the general public and mothers. Development Goals (MDG). Marketing personnel shall be prohibited from advertising - Objectives of the National Nutrition Council (NCC): or promoting in any other manner the products covered by Formulate national food and nutrition policies and this Code, either directly or indirectly, to pregnant women strategies; or with mother of infants, except as otherwise provided by Coordinate the planning, monitoring and evaluation of the this Code. national nutrition program; Nothing herein contained shall prevent donations from Coordinate the release of funds, loans and grants from the manufacturers and distributors of products within the government and nongovernment organizations; and scope of this Code upon request by or with the approval Call on any department, bureau, office, agency and other of the Ministry of Health. instrumentalities of the government for assistance in the form of personnel, facilities and resources as the need Republic Act 7394 (1992) arises. “Consumer Act of the Philippines” - The month of July was designated as NUTRITION MONTH - This law is designed to prevent business that engage in fraud under Section 7 to create greater awareness among people on or specified unfair practices from gaining an advantage over the importance of nutrition. Activities thereto shall be competitors and provide additional protection for the weak and approved and coordinated by the Council. those unable to take care of themselves. - Objectives: Executive Order 51 (1986) Protection against hazards to health and safety; protection “National Code of Marketing of Breastmilk Substitutes, against deceptive, unfair and unconscionable sales acts Breastmilk Supplements and Other Related Products” and practices; - In consistent with Article 11 of the International Code of Provision of information and education to facilitate sound Marketing of Breast-milk Substitutes, the government adopted choice and the proper exercise of rights by the consumer; an appropriate legislation to give effect to the principles and Provisions of adequate rights and means of redress; and aim of the aforesaid International Code to ensure that safe and Involvement of consumer representatives in the formation adequate nutrition for infants is provided, to protect and of social and economic policies. promote breastfeeding and to inform the public about the - Consumer Rights: proper use of breastmilk substitutes and supplements and Right to basic needs related products through adequate, consistent and objective Right to safety information and appropriate regulation of the marketing and Right to information distribution of the said substitutes, supplements and related Right to choice products. Right to representation - Some of the important policies under Section 6: The General Right to redress Public and Mothers are the following: Right to consumer education No advertising, promotion or other marketing materials, whether written, audio or visual, for products, within the Right to a healthy environment scope of this Code shall be printed, published, distributed, - The following are some important policies under the Republic exhibited and broadcast unless such materials are duly Act 7394: authorized and approved by an inter-agency committee - Article 11. The department shall also direct the manufacturer, created herein pursuant to the applicable standards distributor or seller of such product to extend any or all of the provided for in this Code. following remedies to the injured person: J.A.K.E 11 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 to bring such product into conformity with the emergency purposes upon issuance of a prescription. requirements of the applicable consumer product These prohibitions extend to the use of pacifiers, the standards or to repair the defect in order to conform with donation of samples of formula, and the promotion of the same; infant formulas in hospitals. Government and private to replace the product with a like or equivalent product hospitals will receive financial incentives for compliance. which complies with the applicable consumer product Noncompliance will place health personnel and standards which does not contain the defect; institutions in danger of losing their licenses and of being to refund the purchase price of the product less a found guilty of a wrongdoing. reasonable allowance for use; and to pay the consumer reasonable damages as may be determined by the Republic Act 8172 (1995) department. “Act for Salt Iodization Nationwide (ASIN Law) - Some Articles under Chapter II and III: - Include in its policy is to protect and promote the health of the Article 23. Adulterated Food people, to maintain an effective food regulatory system and to Article 24. Regulations of unprocessed food provide the entire population especially women and children Article 29. Adulterated drugs and device with proper nutrition. For this purpose, the State shall promote Article 32. Dangerous drugs the nutritional fortification of food and combat micronutrient malnutrition as a priority health program for the nation. Article 33. Banned or restricted drugs - SECTION 3. Purposes. The purposes of this Act are to: Article 35. Adulterated cosmetics Contribute to the elimination of the micronutrient Article 46. Prohibited Acts. Every product should label malnutrition in the country, particularly iodine deficiency their products if those are hazardous or dangerous, banned disorders, through cost-effective preventive measure of hazardous products but still delivered by products are salt iodization; strictly prohibited. Require all producers/manufacturers of food-grade salt to Article 77. Minimum labelling requirements for consumer iodize the salt that they produce, manufacture, import, products trade or distribute; Article 78. Philippine Products Standard Mark Require the Department of Health (DOH) to undertake Article 80. Special packaging of consumer products for the salt iodization program and for its Bureau of Food and the protection for children Drugs (BFAD) to set and enforce standards for food- Article 84. Additional labelling requirements for food grade iodized salt and to monitor compliance thereof by (such as expiration date, semi-cooked, fully processed the food-grade salt manufacturers; etc.) Require the local government units (LGU), through their Article 87. Additional labelling requirements for health officers and nutritionist/dietitians, or in their cosmetics absence through their sanitary inspectors, to check and Article 94. labelling requirements for cigarette monitor the quality of food-grade salt being sold in their market in order to ascertain that such salt is properly Republic Act 7600 (1992) iodized; “The Rooming-in and Breastfeeding Act” Require the Department of Trade and Industry (DTI) to - An act providing incentives to all government and private regulate and monitor trading of iodized salt; health institutions with rooming-in and breastfeeding practices Provide mechanisms and incentives for the salt industry and for other purposes. in the production, marketing and distributi0on of iodized - This law is in promotion of the State policy to encourage the salt; and practice of breastfeeding in the Philippines. It composes of 14 Ensure the sustainability of the salt iodization program. Sections divided into 4 chapters. Chapter 1 states the rules and regulations which contain Republic Act 8976 (2000) standard procedures to be followed for rooming-in and “Food Fortification Act” breastfeeding in all private and government health - The Philippine Food fortification Program, hereinafter referred institutions. Specific provisions are made for complicated to as the Program, shall cover all imported or locally processed births. The right of the mother to breastfeed and the right foods or food products for sale or distribution in the of the infant to receive breast milk is expressed, and Philippines; Provided, That, dietary supplements for which mothers may only exercise their right to bottle feed after established standards have already been prescribed by the being fully informed of the benefits of breastfeeding and DOH through the BFAD and which standards include by expressing their intention to formula feed in writing. specifications for nutrient composition or levels of fortification The regulations cover the establishment and operation of shall not be covered by this Act. human milk banks and the donation of human milk which - The program shall consist of (1) Voluntary Food Fortification is stated in Chapter 2 of the act. and (2) Mandatory Food Fortification. Provisions are stated in Chapter 3 of the act for the - Section 5. Voluntary Food Fortification. - Under the Sangkap continuing education and training of health personnel and Pinoy Seal Program (SPSP), the Department shall encourage the education and counseling of parents. the fortification of all processed foods or food products based Other provisions indicated in Chapter 4 states that the on rules and regulations which the DOH through the BFAD only milk formula to be stocked in the hospital is to be shall issue after the effectivity of this act. Manufacturers who kept in a closed cabinet out of sight and used for only opt to fortify their processed foods of food products but do not J.A.K.E 12 of 21  NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022 apply for Sangkap Pinoy Seal shall fortify their processed food - This Act has the following objectives: or food products based on acceptable standards on food To enhance and strengthen the administrative and fortification set by the DOH through the BFAD. technical capacity of the FDA in the regulation of - Section 6. Mandatory Food Fortification. - (a) the fortification establishments and products under its jurisdiction; fo staple foods based on standards sets by the DOH through To ensure the FDA’s monitoring and regulatory coverage the BFAD is hereby made mandatory for the following: over establishments and products under its jurisdiction; Rice - with Iron; and Wheat flour 0 with vitamins A and Iron; To provide coherence in the FDA’s regulatory system for Refined sugar - with vitamin A; establishments and products under its jurisdiction. Cooking oil - with vitamin A; and Other staple foods with nutrients as may later required by Republic Act 10028 (2009) The NCC. “Expanded Breastfeeding Promotion Act” - The National Nutrition Council (NCC) shall require other - An act expanding the promotion of breastfeeding, amending processed foods or food products to be fortified based on the for the purpose republic act no. 7600 Provisions: findings of nutrition surveys. Such requirement shall be Lactation stations in every private enterprises, promulgated through regulations to be issued by the government agencies, government-owned and controlled Department of Health (DOH) through the Bureau of Food and corporations Drugs (BFAD) and other concerned agencies. “Lactation periods” for breastfeeding employees, in - The fortification of processed foods or food products under addition to time-off for meals, to allow them time to this Section shall be undertaken by the manufacturers: express their breast milk. Provided, that in the case of imported processed foods or food Breast milk banks in health institutions to store products, the required fortification shall be done by the pasteurized breast milk donated by breastfeeding mothers. producers/manufacturers of such imported processed foods or Inclusion of breastfeeding in the