Concepts of Diet Therapy NURS 2018: Diet Therapy Concepts of Diet Therapy

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 care

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 nutrition

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.

Dietary modifications in nutrition therapy Regular Liquid Soft Diabetic Low Calorie High Calorie Low Cholesterol Fat-restricted Sodium-restricted Protein Bland Low-residue

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 use

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, soft Whole nuts, seeds, meat with casings, tough meats, hard crusted bread, raw vege and fruits/vege- edible skin Nutri adequate if all food groups are consumed; may be low in fibre- consult nutritionist- re safe textures and doc re gag reflex Pureed Advanced chewing or swallowing difficulties Blenderized 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 consistency Whole nuts, seeds, hard bread/rolls, dried fruit, fruits/vege- edible skin, any food that cannot be pureed to a smooth consistency Nutri adequate if all food groups are consumed; avoid over-modification. Essential foods is presented in attractive manner to stimulate appetite- molds, garnishes. Tucker & Dauffenbach, 2011

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 nurse

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 advocate

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 done

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.

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 diet

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 department

References Duggan, M., & Golden, B. (2007). Deficiency diseases. In C. Geissler & H. Powers (Eds.), Human Nutrition (11th 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.