Topic 5 Therapeutic Diet PDF

1  RNB11903 BIOCHEMISTRY AND NUTRITION THERAPEUTIC DIET  LEARNING OUTCOMES At the end of the session, students should be able to: define therapeutic diet; state the purposes of therapeutic diet; identify the types of therapeutic diet; explain the var...

1  RNB11903 BIOCHEMISTRY AND NUTRITION THERAPEUTIC DIET  LEARNING OUTCOMES At the end of the session, students should be able to: define therapeutic diet; state the purposes of therapeutic diet; identify the types of therapeutic diet; explain the various types of therapeutic diet and its indication; state the role of nurses in implementing therapeutic diet. 3  INTRODUCTION Nutritional problems require dietary modification. Modified diet should promote effective nutrition within the patient/client’s lifestyle, this requires health education on avoidance on certain foods or adding food items to the diet, taking into consideration his/her: ‒ sociocultural context ‒ economic restraints ‒ religious belief ‒ food preference 4 THERAPEUTIC DIET 5  THERAPEUTIC DIET THERAPEUTIC Healing of disease Related to treatment of disease or disorders DIET The sum of food consumed by a person THERAPEUTIC DIET Modifications of normal diet prescribed by doctor to improve specific health conditions of client/patient. Therapeutic diet is one in which the amount of food, the kind of food or the frequency of eating is prescribed. 6  THERAPEUTIC DIET Modifications of normal diet used to improve specific health conditions experiencing by client/patient, such as diabetes mellitus, eating disorders, chronic renal diseases, cardiovascular diseases, obesity, etc. It is used to supplement the medical or surgical treatment. Normally prescribed by doctor and planned by dietician/nutritionist. In prescribing therapeutic diet, it may ‒ change nutrients, caloric content and/or texture ‒ remove or add certain content of food ‒ increase or decrease the energy values ‒ increase or decrease bulk in diet, e.g. high or low fiber diet 7  THERAPEUTIC DIET May seem strange and even unpleasant to the patient. Some therapeutic diet are temporary, e.g. for 1 meal or 1 week; others may be a lifetime therapeutic diet, e.g. diabetic diet. Every hospital have their unique dietary protocols. Clientswho do not have special needs/nutritional requirements, consume regular diet/balanced diet. Understandthe purpose and indication of therapeutic diet, helps nurses to provide simple and clear explanations to patient. 8  PURPOSES OF THERAPEUTIC DIET To maintain or improve nutritional status. To improve specific health conditions. To maintain, decrease or increase body weight. To rest or assist body organs to maintain normal functions. To eliminate particular food contents that individual may be allergic. To aid digestion, metabolism and excretion of certain nutrients/substances. To modify the intervals of feeding 9  TYPES OF THERAPEUTIC DIET Regular diet Bland diet Liquid diet Protein modified diet Soft diet Low fat/cholesterol diet High fiber diet Low salt diet Diabetic diet Ketogenic diet 10  TYPES OF THERAPEUTIC DIET There are many more therapeutic diets: ‒ Calorie modified diet, e.g. 1200 kcal, 1500 kcal, 1800 kcal, 2100kcal ‒ Low potassium diet ‒ Low phosphate diet ‒ Low purine diet ‒ Low residue diet ‒ Vanillylmandelic acid (VMA) diet ‒ Tonsillectomy diet ‒ Lactose free diet ‒ Gluten free diet ‒ Glucose-6 Phosphate Dehydrogenase (G6PD) Deficiency diet 11  REGULAR DIET Balanced diet usually used for ambulatory patients. At times is has a slightly reduced caloric content. Foodssuch as rich desserts, cream sauces, salad dressings and fried foods may be decreased or omitted. Indication: ‒ Client who is recovering ‒ Client who has good appetite and no contraindications 12  LIQUID DIET Nutritionally inadequate and should only be used for short periods of time. Indications: ‒ Post surgerypatient ‒ Patient with acute infections or digestive problems ‒ Patient with fluids lost due to vomiting or diarrhea ‒ Prior to undergoing some X-rays procedures of the digestive tract 13  LIQUID DIET 2 types i. Clear liquid diet ‒ Prescribed primarily for surgical patient ‒ Water, clear fruit juice, fat-free broths, plain gelatin, popsicles, ginger drink, tea, coffee ii. Full liquid diet ‒ Mainly for postoperative patients ‒ Everything on clear liquid diet plus strained soups and cereals, fruit and vegetable juices, smooth-textured dairy products, yogurt, hot cocoa, custard, ice cream, pudding and egg flip 14  SOFT DIET Similar to regular diet but foods must require little chewing and easy to digest. Avoid meat and shellfish with tough connective tissue, coarse cereals, spicy foods, rich desserts, fried foods, raw fruits and veggies, nuts, and coconuts. Indication: ‒ Clients having difficulty in chewing/swallowing ‒ Clients with fever, stomach upset, lack appetite ‒ Postoperative client Example: ‒ Porridge ‒ Steamed fish ‒ Mashed potato ‒ Puree 15 SOFT DIET 16  BLAND DIET Consists of easily digested foods that do not irritate the digestive tract, low in dietary fiber and not spicy. Eliminate chemical and mechanical food irritants such as fried foods, alcohol and caffeine. Also avoid coarse foods, highly seasoned foods, pastries, raw fruits and veggies, carbonated beverages, nuts, tea, smoked and salted meats and fish. Indications: ‒ Patientwith peptic ulcers and other digestive diseases, such as heartburn ‒ Paint with excessive digestive enzyme 17 Let’s take a break 18  HIGH FIBER DIET Contains additional dietary fiber, e.g. fruits and vegetables. Indication: ‒ Client who suffers from constipation, hemorrhoids 19  LOW RESIDUE DIET Eliminatesor limits foods high in bulk or fiber such as raw fruits and vegetables, whole grains and cereals, nuts, seeds, beans and peas, coconut and limit dairy products to two servings a day (or as prescribed). Indication: ‒ Clientswith digestive or recta diseases, such as diverticulitis, ulcerative colitis, Crohn’s disease, diarrhea ‒ Preparation for client undergoing colon or rectum surgery 20  DIABETIC DIET Used for patient with diabetes mellitus (body does not produce enough insulin to metabolize carbohydrates). Diet contains exchange lists ‒ Foods are grouped according to type, nutrients, and calories ‒ Patient are allowed a certain number of items from each exchange list according to individual needs Avoid sugar-heavy foods such as candy, soft drinks, desserts, cookies, syrup, honey, condensed milk, sugared gum, jams, and jellies. New trend is to count only carbs, as blood sugar levels are most affected by carbohydrates. Patient may requires insulin based upon the amount of carbs eaten. 21 PROTEIN MODIFIED DIET HIGH PROTEIN DIET LOW PROTEIN DIET 22  HIGH PROTEIN DIET Regulardiet with added protein rich foods such as meats, fish, milk, cheese, and eggs. To improve client’s growth and nutritional status. Indication: ‒ Children/adolescents who are malnourished, requires additional growth ‒ Client with anemia ‒ Pregnant or lactating mother ‒ Pre and postoperative patients ‒ Patients suffering from burns injury, fever or infections 23  LOW PROTEIN DIET Regular diet with limited or decreased protein rich foods. Example of foods: vegetables, fruits, bread, cakes, pasta, corn and potatoes Foods toavoid are any animal byproduct such as meats, eggs, fish, milk, yogurt, cheese, peanut butter and nuts. Indication: ‒ Client with kidney or liver disease ‒ Client having certain allergic conditions 24  LOW FAT/CHOLESTEROL DIET Limit foods high in saturated fats such as red meat, fatty meat, liver, egg yolk, cream, cheese, shellfish, whole milk, rich desserts, chocolate, coconut and palm oil products. Restricts foods containing cholesterol. Indication: ‒ Patient with atherosclerosis and heart disease ‒ Obese patient ‒ patient with gallbladder and liver disease, such as acute hepatitis, cholelithiasis 25  LOW SALT/SODIUM DIET Avoid or limit addition of salt to any food, for example, smoked meats or fish, processed foods, pickles, and processed cheeses. Indication: ‒ Patient with cardiovascular diseases such as hypertension, congestive cardiac failure (CCF), heart failure ‒ Patient with kidney disease/failure ‒ Patient having pitting edema 26 KETOGENIC DIET 27  KETOGENIC DIET A keto or ketogenic diet is a very low-carb diet. The classic ketogenic diet is composed primarily of fat (70 – 90%), protein (8 – 25%) and minimal CHO (2 – 5%). It has many proven benefits for weight loss and health performance. 28  KETOGENIC DIET The “keto” in a ketogenic diet comes from the fact that it makes the body produce small fuel molecules called “ketones”. Thisis an alternative fuel for the body, used when there is inadequate of blood sugar (glucose) supply. Ketonesare produced in the liver form fat source, if very few carbs are eaten. They arethen used as fuel throughout the body, including the brain. The brain requires lots of energy every day, and can only run on glucose or ketones. 29 KETOGENIC DIET 30 KETOGENIC DIET 31 KETOGENIC DIET 32 KETOGENIC DIET 33  ROLES OF NURSES IN IMPLEMENTATING THERAPEUTIC DIET 1. Reinforce the importance of therapeutic diet. 2. Identify and communicate the needs for changes in the patient’s diet. 3. Identify and implement changes in method of feeding & time of feeding. 4. Reinforce the meal plan with the patient and the patient's family. 5. Empower the patient in meeting his/her diet therapy. 6. Encourage the patient to eat, provide adaptive equipment, and conducive atmosphere. 7. Make sure that all health care professionals are aware with respect to diet plan and implementation. 34  CONCLUSION Therapeutic diets to be prescribed when necessary. Menu design should aim for diet integration and modification taking into consideration the client’s: ‒ sociocultural context ‒ economic restraints ‒ religious belief ‒ food preference It is the responsibilities of nurses to ensure patient complies to the therapeutic diet as ordered. 35  Self-Directed Learning & Activity Search three research papers related to the association between food and diseases/cancers Readfurther on ketogenic diet and provide comments based on your reading How to read a food label/nutrition facts label 36 37