Chapter 32, Diet Therapy/special Diets

Front 1

Anorexia

Back 1

loss of appetite or refusal to eat

Front 2

Bland diet

Back 2

ulcers, esophagitis, gastroesophageal reflux disease, heartburn, gastritis, hiatal hernia. Limit foods that stimulate the production of gastric acid.

Front 3

Carbohydrate controlled diet

Back 3

May be based on the Diabetic Exchange Lists for Meal Planning or Carbohydrate Counting

Front 4

Dysphagia

Back 4

medical term for a swallowing disorder

Front 5

Edentulous

Back 5

Without teeth

Front 6

Fat controlled diet

Back 6

first step in treating clients with elevated blood lipids or fats, high cholesteral levels or triglyceride level or both

Front 7

hyperlipidemia

Back 7

elevated blood lipids or fats, high cholesterol levels or triglyceride level or both

Front 8

Infusion

Back 8

Given peripherally must be hypotonic or isotonic to prevent dehydration and electrolyte imbalance

Front 9

Ketogenic diet

Back 9

Low in carbohydrates and sometimes 80 to 90% fats.

Front 10

Liquid diet

Back 10

entirely liquids (after surgery, acute illness or irritation of the intestinal tract)

Front 11

low residue diet

Back 11

composed of foods that the body can absorb completely so that little residue is left for the formation of feces. Fiber-controlled diet.

Front 12

Modified diet

Back 12

physician and dietitian consider the disease process and the client's general condition to plan a special diet. Follow dietary orders carefully.

Front 13

Polydipsia

Back 13

Drinks excessive amounts of water

Front 14

Soft diet

Back 14

May vary.

Regular, digestive or mechanical, may be same as bland diet, or low-fiber diet.

Front 15

Stoma

Back 15

A short crosspiece (bolster) placed near the opening of the skin.

Front 16

Therapeutic diet

Back 16

may be prescribed as part of the treatment of more than one disease or condition. May be overweight and heart condition, diabetes and convalescing

Front 17

Tube feeding

Back 17

Providing liquid nourishment through a tube into the GI tract, also called enteral feedings.

Front 18

DAT

Back 18

diet as tolerated

Front 19

G tube

Back 19

gastrostomy tube directly into stomach through intestinal wall

Front 20

GERD

Back 20

gastroesophageal reflux disease

Front 21

IV

Back 21

intravenous therapy or parenteral therapy involves injecting into a vein any number of sterile solutions that the body needs, including drugs and electrolytes

Front 22

J tube

Back 22

jejuna tube inserted into the jejunum of the small intestine

Front 23

NG tube

Back 23

nasogastri tube, passed through the nose and into the stomach

Front 24

PEG

Back 24

percutaneous endoscopic gastrostomy placed through the skin.

Front 25

PPN

Back 25

peripheral parenteral nutrition contains lesser concentrations of the same ingredients found in central vein TPN, administered into a peripheral vein. Provides temporary nutritional support to promote protein synthesis and weight gain when oral intake is inadequate or contraindicated.

Front 26

TPN

Back 26

Total parenteral nutrition is a specifically formulated and calculated solution that is nutritionally complete to meet a specific individual's needs

Front 27

Describe 4 roles of the nurse in providing nutritional support to a client in an acute care hospital, a long term care facility, and a home care setting

Back 27

Check meal tray against the posted diet list before giving tray to client.

Present food in an attractive manner.

Refrain from negative comments or gestures pertaining to the food.

Encourage client to eat and to feed themselves so they do not feel helpless.

Remove tray covers just before placing the tray on the overbed table to allow diffusion of food odors that intensify while collecting under the cover.

Front 28

Identify the rationale for offering meal supplements, increasing fluids or decreasing fluids

Back 28

Supplements are often given to clients who have high nutritional needs or poor appetites. Supplemental nourishment must be served on time, not too early nor too late.

Documentation of the nourishment intake or refusal by the client is required, as is the client's intake of meals.

Front 29

Identify 4 reasons a client may need assistance with eating. State 2 nursing interventions for each type of circumstance.

Back 29

Clients who can feed themselves may need assistance in spreading butter on bread, cutting meat, opening milk cartons or pouring beverages.

Encourage the person to do as much as possible to develop self-confidence and a sense of progress.

Note any discomfort or digestive complaints the client expresses during feeding or afterward.

Very young, helpless or confused individuals require special attention. You may have to feed them to make sure they ingest enough nutrients.

Use your judgment about how much a client can do--sometimes the person can hold a piece of bread but cannot manage other foods.

When a client is blinded only temporarily, you may need to feed the client every meal. The visually impaired person needs to learn to locate the food on the plate.

Describe the location of foods as if they were on the face of a clock.

Consistent place settings promote independence.

Cut food into small pieces.

Some clients have difficulty swallowing. Diets range from thick liquids only

Front 30

Differentiate between the following types of diets: house diet, modified diet, and therapeutic diet

Back 30

House Diet: The house diet is the one most frequently ordered and is served to clients whose condition does not require a special diet.

Modified Diet: The physician and dietitian consider the disease process and the client's general condition.

Therapeutic Diet: may be prescribed as part of the treatment of more than one disease or condition. A client with a heart condition may also be overweight; a convalscent client may also have diabetes.

Regulating the amount of certain nutrients in disorders of metabolism (diabetes).

Increasing or decreasing body weight by adding or limiting calories and fat (underweight or overweight)

Reducing or preventing edema by controlling the level of sodium (cardiac conditions)

Aiding digestion by avoiding foods that irritate the gastrointestinal tract or interfere with stomach action (ulcer, diverticulitis)

Helping an overburdened orgain regain normal function (nephritis)

Eliminating a food that the body is unable to tolerate (allergies, phenyketonuri

Front 31

State 5 methods of modifying diets in terms of nutrients, consistency or energy value

Back 31

Consistency and texture (liquid, soft, mechanical, high-fiber, low-residue)

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)

Front 32

Differentiate between a clear liquid and a full liquid diet. State the rationale and the limitations for the use of each diet.

Back 32

The clear liquid diet is inadequate in calories, protein, and most other nutrients. It should not be used for more than 3 days, unless the client is receiving nutritional support (NG or IV feedings) or other nutritional supplements.

If a full liquid diet is to be used for a long time, nutritional supplements (e.g., Ensure, Glucerna) should be added. Be aware of any side effects of these supplements, such as diarrhea, constipation, gas and bloating.

Front 33

Differentiate between a digestive soft diet and a mechanical soft diet. State the rationale and the limitations for the use of these diets.

Back 33

The digestive soft diet is a nutritionally adequate diet that is low in fiber, connective tissue and fat. Gas-forming foods are eliminated and mild seasonings are used. This is a transition diet between clear liquid diet and house diet.

The mechanical soft diet is used for the person who is edentulous, has oral problems, or has had a cerebrovascular accident. May be chopped, ground or pureed, depending on the client's ability to chew and swallow.

Front 34

Differentiate between a high residue diet and a low-residue diet. State the rationale and the limitations for the use of these diets.

Back 34

A high fiber diet has an increased amount of both insoluble and soluble fiber. Insoluble fiber helps increase stool bulk and stimulates peristalsis. Soluble fiber helps lower the serum cholesterol level and improves glucose tolerance in diabetes. A high-fiber diet is often ordered as part of treatment for constipation and diverticulosis.

Potential problems with high-fiber are cramping, diarrhea, and gas, especially if fiber is added to a diet too quickly or in excessive amounts. Increased fluid intake is important.

A low-residue diet is composed of foods that the body can absorb completely, so that little residue is left for the formation of feces. Also called a fiber-controlled diet. Used for severe diarrhea, colitis, diverticulitis, other gastrointestinal disorders, intestinal obstruction, and before and after intestinal surgery. Diet may be inadequate in iron, calcium, and some vitamins and minerals because of limited food choices and overprocessing of fruits and vegetables.

Front 35

Differentiate among the following diets, fat-controlled, low cholesterol and limited saturated fats.

Back 35

Fat-controlled diet: is often the first step in treating individuals with elevated blood lipids or fats (hyperlipidemia). These clients may have a high cholesterol level, a high triglyceride level or both. (Heart attack, stroke, death)

Low cholesterol: The fat-controlled diet is altered in both the total amount of fat and the type of fat provided. Overweight individuals should also lose weight. Clients with hyperlipidemia may have calorie restrictions as well.

Limited saturated fats: Low-fat diets are used for clients with malabsorption syndromes because fat aggravates diarrhea and promotes nutrient losses. Total fat is limited to 25-50 g per day, depending on the severity of symptoms.

Front 36

Explain 2 uses of low and high protein diets

Back 36

Low protein diet: Kidney and liver disorders are treated with a controlled-protein diet. The amount of protein allowed may be based on the client's weight or may be ordered as a total amount per day. Non-protein calorie intake should be high. Most protein should be of high-quality and should be spread evenly over the day's meals. Other restrictions, such as sodium and fluid, may also be necessary.

High protein diet: Protein requirements increase whenever metabolism increases or when tissue needs to be replaced, such as following burns, major trauma, surgery, multiple fractures, hepatitus and sepsis. Malabsorption syndromes that waste protein, such as diseases of the gastrointestinal tract and the acute phases of inflammatory bowel disease and celiac disease, also elevate protein needs. Protein losing hemodialysis and peritoneal dialysis patients are treated with a high protein diet.

Front 37

Identify the components of a mild, moderate, and severe sodium restricted diet

Back 37

Mild sodium restricted diet: Limit the sodium content to less than 4,000 mg/d. A limited amount of salt is allowed in cooking, but no salt is added at the table. Used when a person suffers from mild hypertension and stable kidney or heart disease.

Moderate sodium restricted diet: 1,000-2,000 mg per day is used in cases of severe edema, hypertension, and heart disease. Salt is not used in cooking or on the table. Milk and milk products are limited to 2 cups daily, use of regular bread may be restricted.

Severe sodium restricted diet: 500 and 250 mg per day, respectively, are unpalatable and hard to follow. They are used only in severe conditions and for short periods. Limited quantities of meat, milk and regular bread.

Front 38

Demonstrate the procedure for the insertion of a nasogastric tube

Back 38

Demonstrate

Front 39

Differentiate between TPN and PPN.

Back 39

TPN: a specifically formulated and calculated solution that is nutritionally complete to meet a specific individual's needs. May be called hyperalimentation. Used when the gastrointestinal tract is functioning improperly, such as in stomach cancer, when a person has multiple trauma, severe infection, burns or multi-organ failure. TPN is infused directly into the blood circulation and bypasses the digestive tract.

PPN: Contains lesser concentrations of the same ingredients found in central vein TPN, administered into a peripheral vein. It is used to provide temporary nutritional support and to promote protein synthesis and weight gain when oral intake is inadequate or contraindicated. Infusions given peripherally must be hypotonic or isotonic to prevent dehydration and electrolyte imbalance. PPN provides fewer calories than TPN.