NURS 2018 Diet Therapy Objectives At the end of this presentation students should be able to Identify the purpose of dietnutrition therapy Describe methods of dietary modifications for clients in primary and secondary care settings ID: 285263
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Slide1
Concepts of Diet Therapy
NURS
2018:
Diet TherapySlide2
Objectives
At the end of this presentation students should be able to:
Identify the purpose of diet/nutrition therapy
Describe methods of dietary modifications for clients in primary and secondary care settings
Relate the role of the nurse in nutritional careSlide3
Diet/Nutrition Therapy
Nutrition care that encompasses the assessment and treatment of any disease, condition, or illness-
Medical nutrition therapy
Includes
Modified diet
Nutrition education
Specialized nutrition support with oral nutrition supplements
Tube feedings
Intravenous nutritionSlide4
Purpose of Nutrition Therapy
The purpose of nutrition therapy is to :-
Ensure adequate energy and nutrient intake- to prevent under and over nutrition (malnutrition)
Prevent insufficient intake of some micronutrients such as iron and
folate
Prevent physiological consequences of malnutrition- LBW babies, NCDs and mortality
Improve adherence of recommendations such as RDA, UL, EAR etc. Slide5
Dietary modifications in nutrition therapy
Regular
Liquid
Soft
Diabetic
Low Calorie
High Calorie
Low Cholesterol
Fat-restricted
Sodium-restricted
Protein
Bland
Low-residueSlide6
Diet
Use
Foods Allowed
Foods not allowed
Nutritional adequacy
and advice
Regular
General
diet for people who do not require texture or nutrient modification
All
None
Adequate if consumed as ordered
Clear Liquids
Hydration, bowel prep for some procedures, transition to solids from NPO
See through items liquid at room temperature-
juices, drinks, broth, popsicle, gelatin
Opaque Liquids,
solid foods
Inadequate
in all nutrients, low in energy. Consider nutrition supplement; monitor length, refer 5 or more days
Full Liquids
Chewing or swallowing difficulties
Foods liquid or pourable at room temperature- all clear items & dairy, custards, supplements
Solid foods, liquid at room temp. foods
with added solids e.g. ice cream with nuts
Nutri
.
adequate when supplements consumed. If
dysphagia
consult doc for
eval
. High fat/ low
fibre
long useSlide7
Diet
Use
Foods Allowed
Foods not allowed
Nutritional adequacy
and advice
Mechanical or Dental Soft
Chewing or swallowing difficulties
Liquids, minced, soft, chopped, ground
foods; protein w/o bones, grizzle. Cooked beans and eggs. Desserts, Grains- cooked/soft; fruits and
vege
- cooked, softWhole nuts, seeds, meat with casings, tough meats, hard crusted bread, raw vege and fruits/vege- edible skinNutri adequate if all food groups are consumed; may be low in fibre- consult nutritionist- re safe textures and doc re gag reflexPureedAdvanced chewing or swallowing difficultiesBlenderized or pureed foods. Any food allowed that can be pureed to a custard-like consistency w/o solids remaining. Can add liquid to get desired consistencyWhole nuts, seeds, hard bread/rolls, dried fruit, fruits/vege- edible skin, any food that cannot be pureed to a smooth consistencyNutri adequate if all food groups are consumed; avoid over-modification. Essential foods is presented in attractive manner to stimulate appetite- molds, garnishes.
Tucker &
Dauffenbach
, 2011Slide8
Food Modifications
Foods- particular those provide by the oral route may be modified based on
Energy needs
Nutrients- supplemental immunonutrition may be given to improve illness recovery such as included antibodies, antioxidants and additional minerals
Energy- may increase or decrease depending on type of illness and the metabolic demand
Preparation, flavouring, seasoning- low levels recommended in colitis, diarrhoea, CA of GI
These modifications affect the clients likelihood of acceptance
Based on presentation
Level of modification
Usual intake
Preparation style
Commentary form the nurseSlide9
Nurse’s responsibilities with nutritional care
The nurse has responsibility to assist in coordinating care and services.
The nurse usually collaborates with other members of the health care team in
nutritional assessment,
nutrition education,
delivery of dietary support- modified diets, tube feedings, IV nutrition.
The Physician is usually needed to assess gag, identify GI functionality, examine the presence of strictures,
dysphagia
& swallowing disorders- from these assessments the physician usually makes dietary prescriptions for regular diet, modified, enteral,
parenteral
, palliative
The nurse collaborates with the physician to implement dietary prescriptions as well as to re-examine the patient for nutritional imbalances and serves as an advocateSlide10
Nurse’s responsibilities with nutritional care
Dietician and dietary department- is responsible for:-
anthropometric assessment and clinical assessment.
They recommend the appropriate biochemical tests that are needed to determine deficiencies.
From these assessments, they usually makes dietary prescriptions for regular diet, modified, enteral,
parenteral
, palliative.
They usually provide more detail about the composition of the diet- total energy requirement, protein, and supplements that may be needed.
They also recommend preparation methods of foods.
They are also responsible for preparing data for nutrition education.
The nurse collaborates and ensures these actions are doneSlide11
Nurse’s responsibilities with nutritional care
The nurse also works with other health team
The nurse works with the phlebotomist, nutritionist, meal services department to ensure that the nutritional needs of the patients are met.
The nurse may also communicate with the family and the patient the changes that are important and necessary for health maintenance.
The nurse usually recommends follow up care and advocates for referral to HTN, Renal, DM, HIV/AIDS clinic and dietetics department. Slide12
Nurse’s responsibilities with nutritional care
The nurse also serves as Communicator
Explaining the treatment regime; advocating for more detailed explanation particularly of dietary prescriptions
Interpret rationale for diet
Assists in food selection, may advice on preparation style and techniques
Ensures that the ordering, delivery and administration of the prescribed dietSlide13
Nurse’s responsibilities with nutritional care
Nurse as Teacher/
Counsellor
Uses informal opportunities to teach- such as during medication administration, meal service and family visits
Plan instructions- useful in primary health care and health promotion and for new diagnoses
Counsels patient and family
Support, supplement and reinforce the information provided by the dietary departmentSlide14
References
Duggan, M., & Golden, B. (2007). Deficiency diseases. In C.
Geissler
& H. Powers (Eds.),
Human Nutrition
(11
th
Ed.) (pp 517-536). Edinburgh, UK: Elsevier Churchill Livingstone.
Smith, R. C. (2007). Nutritional support for hospitalized patients. In J. Mann & A. S.
Truswell
(Eds.),
Essentials of human nutrition (pp 33-52). New York, USA: Oxford University Press.Tucker, S. & Dauffenbach, V. (2011). Nutrition and diet therapy for nurses. Boston, USA: Pearson.