Chapter 32
Diet Therapy and Special Diets
Nutrition
Nutrition is a vital component of therapy for many disorders.
Some disorders necessitate a special diet, either during acute illness or throughout life.
People who are ill may need help fulfilling their nutritional requirements.
Mealtime is an excellent time to introduce or to reinforce diet teaching.
Providing Nutritional Support to a Client
Present food in an attractive and appetizing manner.
Check the tray for the correct diet and check the client’s identification to ensure that the food is going to
the right client.
Monitor and teach good dietary habits.
Make observations related to consumption of food and the client’s ability to prepare and eat food.
Provide educational support about nutritional needs.
Note clients who can have nothing by mouth (NPO).
Meal Supplements
Between-meal and bedtime supplements are often given to clients who have high nutritional needs or
poor appetites.
It may be ordered by physicians or initiated by dietitians.
It must be served on time. If given too early, the client may still feel full from the previous meal. If given
too late, it may ruin the client’s appetite for the next meal.
Document nourishment intake or refusal by the client.
Fluid Intake
Fluid is required to maintain homeostasis; too much plain water can lead to electrolyte imbalance.
Fluids include all foods and beverages that are in fluid form at room temperature.
Force fluid
Promote increased fluid intake
Fluid restriction
Polydipsia or end-stage renal disease
Monitor client for intake and output (I&O).
Assistance With Eating
Very young, helpless, or confused individuals
Visually impaired or temporarily blinded following surgery
Individuals who have trouble chewing
Clients with dysphagia or swallowing disorder
Document
Poor appetite, food refusal, swallowing difficulty, or complains of nausea
Fluid intake, caloric intake, or the amount of tube feeding taken
House Diets
House diet
Normal diet in acute or extended care facilities
Regular diet, general diet, or full diet
Served to clients who do not require a special diet
Select diet or client’s select diet
Diet as tolerated (DAT)
Depends on client’s appetite and ability to eat and to tolerate food
Modified Diets
Modified diet
Important part of therapy for many diseases.
The physician and dietitian consider the disease process and the client’s general condition.
Therapeutic diet
Prescribed as part of the treatment of more than one disease or condition
Question
Is the following statement true or false?
A diabetic client is more likely to comply with diet restrictions if it is referred to as “controlledcarbohydrate” diet rather than “diabetic diet.”
Answer
True
Clients are more likely to comply with diet restrictions if they are not constantly reminded of their
disease by having the diet classified according to a disease name.
Referring to a diabetic diet as a “controlled-carbohydrate” diet de-emphasizes diabetes and focuses
attention on nutritional habits the client should develop.
Modified Diets
The following classifications indicate how diets are modified in treatment:
Consistency and texture (liquid, soft, mechanical, high-fiber, low-fiber)
Energy value (high- or low-calorie)
Nutrients (controlled carbohydrate, high- or low-fat or protein, sodium, calcium, phosphorus or
potassium controlled)
Amount (e.g., six small feedings)
Specific allergens (e.g., eggs, dairy, nuts)
Consistency Modifications
Liquid diets
Clear liquid diet
Short-term, requires minimal digestion, leaves minimum residue, provides some electrolytes and
carbohydrates
Full liquid diet
Suitable for long-term use, used to approximate the nutritional value of a diet, may be inadequate in
folic acid, iron, vitamin B6, fiber
Consistency Modifications (cont’d)
Soft diet
Digestive soft diet
Nutritionally adequate diet; low in fiber, connective tissue, and fat; gas-forming foods are eliminated
and mild seasonings are used
Mechanical soft diet or dental soft diet
Nutritionally adequate; meats, fruits, and vegetables may be chopped, ground, or pureed
Consistency Modifications (cont’d)
High-fiber diet
Increased amount of insoluble fiber that helps increase stool bulk and stimulates peristalsis
Increased amount of soluble fiber that helps lower the serum cholesterol level and improves glucose
tolerance in diabetes
Potential problems are cramping, diarrhea, and gas.
Consistency Modifications (cont’d)
Low-fiber or low-residue diet
Foods that the body can absorb completely so that little residue is left for the formation of feces
May be inadequate in iron, calcium, and some vitamins and minerals because of limited food choices
and overprocessing of fruits and vegetables
Bland diet
Limit foods that stimulate the production of gastric acid
Energy Value Modifications
High-calorie diet
Used in cases of weight loss, hyperthyroidism, undernutrition, general malnutrition, severe burns
Clients with a depressed appetite may need smaller and more frequent meals.
Low-calorie diet
Promotes weight loss in those with, or at risk for, complications related to obesity
Nutrient Modifications
Carbohydrate-controlled diets
Diabetic diet
Eat foods in their natural form to increase fiber intake.
Lactose-restricted diet
People with lactose intolerance lack sufficient amounts of the enzyme lactase, which is needed to digest
the sugar (lactose) in dairy products.
Nutrient Modifications (cont’d)
Fat-controlled diets
First step in treating individuals with hyperlipidemia
Low-fat diet
Prescribed for clients with malabsorption syndromes, pancreatic, and gallbladder diseases
High-fat diet
Prescribed for children with seizure disorders. This ketogenic diet is extremely low in carbohydrates and
is sometimes as high as 80% to 90% fat.
High-protein diet
Encompasses a range of protein intakes depending on the severity of depletion and causative factors
Protein-restricted diet
The amount of protein is based on the client’s weight or may be ordered as a total amount per day.
Nonprotein calorie intake should be high.
Gluten-restricted diet
Prescribed for clients with celiac disease
Nutrient Modifications (cont’d)
Diets with controlled minerals and electrolytes
Sodium-controlled diets
Depends on the client’s disease and the amount of edema present
Mild sodium restriction
Moderate sodium restriction
Strict and severe sodium restriction
Nutrient Modifications (cont’d)
Diets with controlled minerals and electrolytes
Calcium- or phosphorus-modified diets
High calcium intake is indicated for both the prevention and treatment of osteoporosis.
Low phosphorus diet may be indicated for the person with kidney failure.
Potassium-modified diet
For clients who are taking diuretics
Question
Is the following statement true or false?
The progression of a client’s diet should always start with a clear liquid diet, then full liquid diet,
followed by a soft diet, and finally, a regular diet.
Answer
True
The progression of diets should be: clear liquid, full liquid, soft, and regular.
A client’s diet should progress as soon as possible to ensure an adequate nutritional intake and to
increase the client’s sense of well-being.
Diets Modified for Allergens
An allergic reaction is caused by an autoimmune response to specific proteins called allergens in certain
foods.
Depending on the number of allergens and how widespread they are in the diet, vitamin and mineral
supplements may be necessary to ensure a nutritionally adequate intake.
Tube Feedings
A tube feeding or enteral feeding
Provides liquid nourishment through a tube into the gastrointestinal (GI) tract
Liquid formulas
Routine formulas
Specialized formulas
Ready-mixed formulas
Powdered formulas
Tube Feedings (cont’d)
Placement sites
Nasogastric tube (NG tube)
Passed through the nose and into the stomach
Gastrostomy tube (G tube)
Placed directly into the stomach through the abdominal wall
A jejunal tube (J tube)
Inserted into the jejunum of the small intestine
Question
Is the following statement true or false?
The bed should be put flat when the client is receiving a tube feeding.
Answer
False
The head of the bed must be elevated about 30 degrees whenever a client is receiving a tube feeding.
If the bed is put flat, even for a short period of time, such as for changing bed linens, the client has a
chance of aspirating stomach contents. Serious complications, such as aspiration pneumonia, may lead
to client morbidity or mortality.
Types of Tubes
Nasogastric: Through the nose into the stomach
Percutaneous: Percutaneous endoscopic gastrostomy (PEG) placed through the skin
Endoscopic: Placed with an instrument called an endoscope
Gastrostomy: Inserted into the stomach
Button feeding device: A small silicone device used in place of a gastrostomy tube
Nursing Considerations
The nurse is responsible for washing or replacing the feeding bag, as per hospital policy, and
documenting care.
The client may need an extra water (“free water”) allowance.
Document findings and alert the physician if untoward signs develop: Dry mouth, poor skin turgor
(tone), complaints of thirst, illness, fever or physical complaints.
Question
Is the following statement true or false?
The nurse should inform the team leader or physician if a client is NPO for more than 3 days.
Answer
True
The prolonged use of nothing by mouth (NPO) is a serious problem. A client may be NPO for tests, after
surgery, or because of vomiting. A client who has been NPO for 3 or more days and is not receiving
nutritional support is at serious nutritional risk.
Intravenous Therapy
Intravenous (IV) therapy or parenteral therapy
Involves injecting into a vein sterile solutions, drugs, and electrolytes that the body needs
Total parenteral nutrition (TPN)
Infused directly into the blood circulation and bypasses the digestive tract
Peripheral parenteral nutrition (PPN)
Contains lesser concentrations of TPN, administered into a peripheral vein
End of Presentation