PINES CITY COLLEGES

NURSING DEPARTMENT

Course Syllabus
Basic Nutrition

Content

I. INTRODUCTION
A. Definition of Terms
1. nutrition
2. food
3. food qualities
4. nutrient
5. enzyme
6. hormones
7. nutritional status

B. History of Nutrition and Laws Related to Nutrition

C. Nutrition Programs in the Philippines

II.

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A. Role of Nutrients in the Maintenance of Normal Health
1. Food and its Functions
2. Digestion and absorption
3. Energy and Metabolism

B. Different Food Nutrients

1. water
2. protein
3. carbohydrates
4. fats
5. vitamins
6. minerals

III. ASSESSING NUTRITIONAL NEEDS

A. Physiological Importance of Food
1. Required Nutrition Across the Lifespan
a. Pregnancy and lactation
b. Infancy
c. Toddler
d. Pre-school age
e. School age
f. Adolescence
g. Adulthood

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 h. Aging and aged
2. Malnutrition and Forms of Malnutrition
a. Marasmus
b. Kwashiorkor
c. Iron deficiency anemia
d. Iodine deficiency
e. Vitamin A deficiency
f. Protein energy malnutrition

B. Eating Disorders
1. Anorexia Nervosa
2. Bulimia Nervosa

IV. NUTRITION CONDITIONS

1. diabetes mellitus
2. CVD ( atherosclerosis, congestive heart failure[CHF], HPN )
3. renal disorder
a. UTI
b. Acute renal failure
c. Chronic renal failure
d. Renal calculi
4. gastrointestinal disorder
a. nausea and vomiting

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 b. constipation
c. diarrhea
d. acute gastritis
e. peptic ulcer
5. surgery
a. pre-operative diet
b. post-operative diet
6. burns
7. cancer, AIDS, and other special problems

V. ROUTINE HOSPITAL DIETS

1. clear liquid diet
2. full liquid diet
3. bland diet
4. soft diet
5. low residue / low fiber diet
6. high fiber diet
7. fat controlled diet
8. high calorie diet
9. sodium restricted diet
10. protein restricted diet
11. low protein diet

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 12. low calcium diet
13. low purine diet
14. high iron diet
15. diet foe diverticular disease
16. fluid restriction diet
17. carbohydrate controlled diet

VI. MEAL PLANNING AND FOOD PREPARATION

VII. APPLIED NUTRITION COOKING DEMONSTRATION

TEXTBOOK AND REFERENCES

Claudio, Virginia and Dirige, Ofelia, 2002, Basic Nutrition for Filipinos, 5th ed., Manila Philippines: Merriam and
Webster Bookstore

Dudek, Susan, G., 1993. Nutrition Handbook for Nursing Practice, 2nd ed., Philadelphia:J.B. Lippincott Company

Eshleman, Marian, 1991, Nutrition and Diet Therapy, 2nd ed., Philadelphia: J.B. Lippincott Company

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I. INTRODUCTION
A. Definition of Terms
1. Nutrition
- Study of food in relation to health
- FNC = science of food, the nutrients and other substances, their action, interaction and balance in relation to health
and disease.

2. Food
- Sustains life, second to oxygen
- Any substance, organic or inorganic, when ingested or eaten, nourishes the body by building and repairing tissues,
supplying heat and regulating bodily process.
- What is not seen by naked eyes is the nutrient of food.

3. Food Quality
- essential identifying nature of nourishment for people which they need for energy and growth

4. Qualities of Food
a. Safety
- Prepared under sanitary conditions, aesthetically and scientifically.
- Free from toxic agents
b. nourishing/ nutritious
c. palatability
- color, aroma flavor, texture

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 d. satiety value
- should be sufficient or enough for consumer
e. offers variety and planned within the socio-economic context
- within budget and suitable to the lifestyle of the person.

5. Nutrients
- Chemical components needed by the body found chiefly in food.
Biosynthesis: a process wherein the body manufacture nutrients.

6. Essential Nutrients
- Important/ essential to human being.
a. Water
b. Protein
c. Mineral
d. Carbohydrates
e. Fats
f. Vitamins

7. Classification of Nutrients
a. Function

a.1. Body Building

-They form tissue or are structural components of the body.
- Water: most abundant in the body (2/3 of the body weight)
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- Protein: 20%
- Minerals: 4%
- Carbohydrates: 1% (about 1/3 by)
- Fats

a.2. Regulating
- Maintain normal physiologic process
- maintain homeostasis of body fluids and expedite metabolic
- includes all the 6 groups of nutrients.

a.3 Furnish energy

- Fuel nutrient
- Carbohydrates, fat and protein
* H2O, minerals and vitamins
* Non-caloric nutrients thus, do not yield energy.

b. Chemical nature
- Either organic/inorganic:
Organic: carbon-containing compounds and the exemption of carbonate and cyanide.
Inorganic: minerals and water

c. Essentiability
- all are physiologically essential to the body.

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 d. Concentration
- macro / micronutrients
d.1 Macronutrients: present in relatively large amounts in the body.
- H2O, CHO, CHON, Fat
- Major minerals – above .005 7-of body weight.
d.2 Micronutrients: all vitamins and trace minerals (measured in milligrams)

8. Enzymes
- organic catalysts that are protein in nature and are produced by living cells.

9. Hormones
- Organic substance produced by special cells of the body which are circulated in blood to specific
organs/tissues.
- Regulate vital processes which are highly specific.
- Produced by endocrine and ductless glands.
- Insulin, thyroxin, adrenaline, progesterone

10. Metabolism
- Ongoing chemical process within the body that converts digested nutrients into energy for the functioning of the
body cells

B. History of Nutrition and Laws Related to Nutrition ( to be given as assignment )

C. Nutrition Programs in the Philippines ( to be given as assignment )

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Goal: To improve nutritional status of the Filipinos.
Targets:
1. Reduce prevalence of protein energy. Malnutrition (PEM) – Pre- school and school children – 20%
2. Reduce prevalence of chronic energy deficiency (CED) – adults – 20%
3. Reduce prevalence of iron deficiency anemia – 20% IDA
4. Reduce prevalence of low deficient serum retinal level – 6 months to 6 years old children.
5. Reduce iodine deficiency indicated by median urinary iodine excretion (UIE) level-school children
6. Reduce prevalence of overweight-pre-school, school children, adult male and female – 20%.

Agenda:

N Nationwide Salt Iodization

U Unified efforts for micronutrient food supplementation and food fortification
T Targeted assistance to ensure household food and nutrition security
R Reinforced capacities in policy and plan formulation, advocacy, surveillance, research and its utilization.
I Integration of nutrition considerations in development policies and programs.
T Tri-media approach for effective nutrition information and education campaign.
I Intensive alliance among stakeholders towards increased investment in nutrition.
O Organization programs in poorest areas.
N Non-wage benefits packages in labor and industry.

B Breast milk
R Reduced allergy
E Establish bonding
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 A Antibodies
S Safe and sterile
T Temperature is constant
F Fresh
E Economical
E Easy to give
D Digestible
I Infection free
N Nutritious
G Gastroentiritis is reduced

II.
A. Role of Nutrients in the Maintenance of Normal Growth

1. Food and its function

Food includes articles used as drink or food and the articles used for the component of such. Milk, fish, egg, fruit
and vegetable are tangible food. Nutrients are not seen by the naked eye. Milk is a food comprise of water,
carbohydrate, fat, protein, mineral and vitamins.
Water is a beverage which is considered food as well as nutrient. Kalamansi juice is food that contains water,
carbohydrate and mineral and vitamins.
Denotes that food can be simple or complex in its chemistry and contains nutritional and or non nutritional and or nor
nutritional components (Food coloring, spices and preservatives)
Functions of food:
Nourishes the body by building and repairing tissues.
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 Supplying heat and energy
Regulating bodily processes
Sustains life second to oxygen

2. Digestion and absorption

Review Anatomy of Digestive Tract
a. Digestion
Digestion is accomplished mechanically by chewing and swallowing in the mouth.
The storage, mixing and controlled emptying occurs in the stomach and intestines.
Digestion chemically happens by the actions of enzymes resulting the eventual splitting up of food stuff into simple
components.
Enzymes are protein in nature, substances that initiated and accelerate chemical reactions without undergoing change.

Digestion in the mouth

With the entrance of food in the mouth, digestion started by means of mastication.
When masticated food mass (called bolus) is swallowed, it passes downward to the esophagus by means of
muscular contraction.
Digestion in the stomach
Stomach receives the food and acts a reservoir for a short time. Food reduced to semi fluid (called chime)
The acidity of the stomach (caused by HCL) stops the digestive action ptyalin in the food mass.
Thick slimy mucus called mucin is secreted from the stomach wall to protect the cells from being digested by the
enzymes.

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 All foods are liquefied and mixed with the HCL acid. The acid medium is also responsible for the reduced
activity of harmful bacterial that may have been taken in with the food. It also provides favorable
medium for absorption of Calcium and other minerals.
The food leaves the stomach in the form of chime.
Stomach is normally emptied in 1-4 hours with carbohydrate leaving the stomach rapidly followed by fats.
Digestion in the Large Intestine
The large intestine does not take part in the digestion of food. Any bulky and unused parts of the diet are passed
on to it.
In the colon, water is reabsorbed causing the formation of a fairly solid mass.
When the rectum is reached, the mass is evacuated in the form of feces. This consists of undigested food fibers,
bacteria, cell cast off from the intestines and some mucus and some salts.

b. Absorption
When the products of digestion pass through the lining of digestive tract into the blood stream and lymph, it is
termed as absorption.
The absorption of digested food takes place largely in the small intestine through villi. The villi are fingerlike
projections lined in the intestinal wall which increase the surface area for absorption.
The absorption in the small intestine may be accomplished by a number of processes depending on the nature of
the nutrient and the prevailing pressure gradient.
Passive diffusion and osmosis – small molecules passed through the capillary membranes and diffuse easily into
capillaries of the villi depending on the pressure.
Facilitative absorption or carrier-mediated diffusion – molecules which are large enough to traverse the
membrane pores are helped by the specialized transport systems which carried the large molecule through
the barrier.
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 Energy dependent active transport – the nutrient molecules must pass through the intestinal membrane to supply
the materials needed by the body even against a pressure gradient and this mechanism requires extra work
and energy.
Engulfing (pinocytosis) – when very large molecules are involved, the intestinal villi act like amoeba or
leukocytes by ingesting foreign particles into the interior of the cell. This method is used for fat
metabolism.

B. Various Nutrients of Food

1. Water
Next to oxygen, water is essential to stay alive. If about 20% of body water is lost, death results. Water
accounts for about 60-65% of body weight for normal adult.
Functions of Water
a. Universal solvent, it carries simple sugar, amino acid, lipoproteins, vitamins and minerals for transportation to the
different tissues for proper functioning and nourishment.
b. Used to excrete waste products from lungs, skin and kidneys.
c. Serves as transport medium for many biological reactions especially in digestion and absorption and circulation.
Participates in maintaining electrolyte balance.
d. Vital component of every cell, organ and tissue in the body.
e. Water acts as lubricant of the joints and the viscera in the abdominal cavity thus can protect a sensitive tissue.
Moisten the eyes, nose and mouth. Hydrates skin.
f. Regulator of the body temperature through its ability to conduct heat.
g. Acts as a shock absorber inside the spinal cord and amniotic sac surrounding the fetus.

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2. Protein
Contains several millions of protein molecules, building blocks of protein are amino acids. Protein is needed for
building and repairing cells and specialized role in metabolism.
Classification of Amino Acid
a. Essential – cannot be synthesized by the body from materials readily available at a speed to keep up normal growth
rate. Referred to as dietary essentials.
b. Semi-essential (semi indispensable) amino acid reduces the need for particular essential amino acid (EAA).
Amino acid that can maintain life processes for an adult but not enough for normal growth in children.
c. Non-essential amino acid (NEAA) – “dispensable amino acid” – not a dietary essential. It can be essential by the
body as long as the materials for synthesis are adequate.

3. Carbohydrates
Originally called “Saccharides” sugar
Organic compound abundant in plants and wide spread in nature.
Classification:
a. Monosaccharides – simplest form of sugar
 Glucose – dextrose or grape sugar
- Most important sugar in human metabolism. Known as “Physiologic sugar.” It is also the circulating
carbohydrate.
 Fructose – sweetest of all sugar and found preformed in honey, ripe fruits and some vegetables.
 Galactose – not found in nature but is hydrolyzed from fructose or “milk sugar.” Glucose is converted
to galactose to form sugar or lactose in breast milk.
 Sugar alcohols – have sweetening power as glucose.
a. Mannitol – poorly absorbed in the intestines and used a food ingredient and as drying agent.
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 b. Sorbitol – absorbed slowly than other monosaccharide and it has been used to delay the onset of
hunger.
 Pentoses – found in meat and sea foods in bound form. Important component of nucleic acid and some
co-enzymes.

b. Dissacharides – “oligosaccharides” two sugar unit base

 Sucrose – “ cane sugar to beet sugar” since it is commercially prepared from sugar cane and sugar beets.
Also abundant in molasses, maple syrup, sorghum. Also known as table sugar.
 Maltose – “malt sugar” because it is derived from the digestion of starch with the aid of the enzyme,
diastase found in sprouting grains. It is usually combined with dextrin for infant milk formula.
 Lactose – “milk sugar” found in milk and milk products. Least sweet among sugars only 1/16 as sweet
as sucrose or table sugar.

c. Polysaccharides – not water soluble sugar

 Starch- most abundant and cheap form of carbohydrate. Storage formation in plants, grains.
 Dextrin – intermediate product digestion or formed from partial hydrolysis of starch. The action of dry
heat o starch (as in toasting bread or browning of cake crust in the oven) produce dextrin.
 Glycogen - “animal starch” because its storage form of carbohydrate in the body, chiefly in the liver
and muscles.
a. Muscle glycogen – used directly to supply energy for the surrounding tissues as during exercise
and work.
b. Liver glycogen – changed into glucose and circulate as such by the blood to other parts of the
body.

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4. Fats
Called lipids are actually family of compounds that include both fats and oils. The body’s fat mass has virtually
unlimited storage capacity and fat supplies 2/3 of body’s ongoing energy need. During a prolonged period
of food deprivation fat stores may make even greater contribution to energy needs.
- Helps maintain the health of the skin and hair.
- Protects organs from temperature extremes and mechanical shock.
- Provides a continuous fuel supply, helping to keep the body’s lean tissue form being depleted.
- Carrier of fat soluble vitamins A, D, E, K.

5. Minerals
Found in unrefined food mostly combination with each other and other organic constituents.
Traces can be found in water.
In the body minerals compromise about 4-6% of total body weight. The rest of the body weight consists of water
63%, protein 18%, fat 13%, carbohydrate 1%.
Functions
 Structural – refers to the presence of the mineral in significant amounts to be part of the cells or body fluids
of as an important component of a molecule.
- Calcium, phosphorus and magnesium in the bones and teeth, iron in rbc, iodine in thyroxine,
chlorine in gastric secretion.
 Regulatory – these includes physiological processes for normal functioning of tissues.
- Maintenance of acid base balance
a. Acid forming- chlorine, sulfur and phosphorus
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 b. Base – calcium, sodium, potassium and magnesium.
 Catalysts for metabolic reactions – potassium, calcium, magnesium and phosphorus hasten the anabolism
of glucose to form glycogen.
 Regulator of muscle contractility-minerals maintain normal contraction and relaxation of muscles including
magnesium, potassium, sodium, calcium
 Transmitter of nerve impulses – during stimulation of a nerve fiber, Na and K exchange with each other
across the cell membrane to facilitate the transmission of a nerve impulse.

Classification
 Macrominerals – calcium (Ca), Phosphorus (P), Potassium (K), Sulfur (S), Sodium (Na), Chlorine (CI),
Magnesium (Mg).
 Microminerals – Iron (Fe), zinc (Zn), selenium (Se), Manganese (Mn), Copper (Cu), Iodine (I), Flourine (F)

6. Vitamins
- Organic compounds that are required in small amounts for normal growth, reproduction and maintenance of
health.
- Vitamins are co- enzymes. It helps to initiate a wide variety of body responses including energy production use
of minerals and growth of healthy tissue. Vitamins do not provide energy.

Characteristis
a. Organic compounds – all vitamins have carbon, hydrogen and oxygen in their chemistry component.
b. Potent minute quantities – very small concentrations of vitamins needed to maintain life and normal growth.
Measurements range from micrograms. (mcg or ug)
c. Dietary essentials – vitamins are ingested from diet.
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Fat Soluble Vitamins
 Vitamin A (Retinol)
- Maintains the integrity of epithelial tissues, especially mucus linings. It is needed for normal night vision.
- For normal bone and skeletal growth. Excessive use causes complete disintegration of bone matrix.
- For nervous and reproductive system need vit. A for stability of cell membrane. Excessive amounts of retinol
make the membrane abnormally susceptible to rupture as observe in hypervitaminosis A.
Sources - Animal sources, liver, eggyolk, milk, cream, butter, cheese. Fishes, “dilis”, clams, tahong and shell
fish. Fish liver oil are richest natural source.

 Vitamin D
- Promote normal bone and teeth development because it facilitates absorption of calcium and phosphorus.
- Lack of vit D results in reduced intestinal absorption of Calcium and phosphorus
Sources - fortified margarine, butter, milk and cheese, liver, other organ meat, sardines, salmon and egg yolk.

 Vitamin E
- Prevention of hemolysis of rbc( separation of Hgb from rbc)
- Anti oxidant in both animal and plant tissues.
Sources – wheat, corn, cottonseed, soybean, mayonnaise, salad dressing, margarine, nuts and legumes.

 Vitamin K
- Maintenance of prothrombin level in blood plasma.
Sources – liver, dark green leafy vegetables, wheat, bran, vegetable oils, soybean oil and wheat germ, tomatoes,
legumes, egg yolk
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Water Soluble Vitamin
 Ascorbic Acid
- Prevents scurvy
- Needed in formation and maintenance of intracellular cementing substance
- Helps in healing wounds and bone fractures.
- Prevention of megaloblastic anemia and pinpoint hemorrhages.
- Building body resistance against infection.
- Iron utilization is improved by vit. C
- Involves in brain metabolism.
- Anti oxidant vitamin protects normal cells from damage of free radicals and other substances by oxidation.
- Helps prevent cataract.
Sources - guava, papaya, oranges, dayap, kalamansi, melons, and berries. Eaten raw leafy greens, peppers and
tomatoes.

 Thiamin – Vit. B1
- Helps maintain good appetite, good muscle tone especially GIT.
- For normal function of the nerves
Sources – lean pork, pork liver, shellfish, egg yolk, whole grains, legumes and nuts.

 Riboflavin
- Maintain healthy skin, tongue and mouth, normal vision
- proper growth and development
Sources - cheese, milk, eggs, liver, organ, meat, lean meat, legumes, green leafy vegetables
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 Niacin
- Important in energy metabolism.
Sources – liver and organ meat, lean meat, fish and poultry, milk and cheese, egg and legumes

 Pyridoxine – Vit. B6
- Aids in acid metabolism
Sources - liver and organ meat, eggs, pork, fish, poultry, legumes, whole grains, bran, cereals.

 Pantothenic acid
- Essential for carbohydrate, protein and fat metabolism
- Maintenance of normal growth, healthy skin, and integrity of the CNS
Sources - liver, meat, organ, cheese and legumes.

 Cobalamin
- Helps in synthesis of heme – Fe containing CHON of Hg.
- Essential of the normal forming of nerves, bone marrow, and GIT. Promotes normal G in P.
- Prevents permicine anemia – incurable blood disorders, s/s – anorexia, vomiting, diarrhea, achlorhydria,
abdominal pain.

 Folic acid and PGA (Pteroylglutamis Acid)

- Macrocytic anemia is pregnancy

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III. ASSESSING NUTRITIONAL NEEDS
A. Physiologic Importance of Food
Nutrition provides information about how much of each nutrient is needed and under what
circumstances, and about the types and quantities of food that provide the necessary nutrients. Foods that should not be eaten
and the reasons for this are also identified. The functions of nutrients; how they interact; what happens when there is a lack,
excess or an imbalance of nutrients; and the processes by which the body digest, absorbs, uses and excretes the end-products
of food eaten are included in the science of nutrition.

Role of Nutrition on Growth and Development

a. Food Maintains Life
- Certain nutrients in food are required by the cells for growth, repair, rebuilding, and regulation of function.
- Retarded growth and delayed sexual developments results from deficiencies of certain nutrients.
- The combination of severe malnutrition and infection may result in permanent growth retardation and increased
susceptibility to disease.

b. Skeletal Growth and sexual Development

- The growth pattern of a child is useful means for judging nutritional well being.
- When a child is poorly nourished, the growth rate diminishes partly because of a delay in bone development.
- the quality of the bone (amount of calcium and phosphorus it contains) and its capability for growth are influenced
by nutrition.
- Sexual maturity appears later in populations that are malnourished than in developed countries and occurs at an
earlier age in each succeeding generation.

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c. Mental Development
 5 months before birth and 10 months after birth
- Period wherein most rapid growth of the brain occur.

 At the end of the first year of life

- The brain is the first organ to attain full development.
- Poorly nourished babies have fewer and smaller brain cells.
- Other factors that affect mental development
> Heredity
> Presence of disease
> Emotional state
> Home development
- Severe deficiencies of specific nutrients can cause adverse structural changes and impaired functioning of the
central nervous system.
- Symptoms such as anxiety; irritability; depression, mental, confusion, and physical and mental apathy (loss of
interest) are associated with certain deficiency diseases and may influence learning ability. E.g. Iron deficiency
anemia among school children may interfere with motivation and the ability to concentrate for extended periods of
time.
- Iron deficiency may cause a reduction in iron-containing enzymes in brain tissue which is turn cause alterations in
brain function.
- Poorly nourished persons who tire easily, have little energy, and are unable to concentrate will have difficulty
achieving their intellectual potential.

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1. Required Nutrition Across the Lifespan

a. Pregnancy and Lactation

 The nutritional status exerts its greatest influence during pre-natal life and infancy (weight increase 2x at 6 months;
3x at 12 months; and 4x at 18 months.)
 Within 2-3 months all the major body systems are formed (heart, lungs, brain 1st trim)
 Task of the body during pregnancy: changes in the respiratory and circulatory systems (increase blood volume leads
to the accumulation of fluid and increase in plasma = dilutional anemia dec. RBC); hormonal secretions
(progesterone maintains pregnancy and prepares breast for lactation)
 Prepare for lactation, provide for growth and development
 A gain of about 24 lbs, or 10.9 kgs (22-28 lbs or 10-12.7 kgs.) for an average normal woman
 Requirements for all nutrients increases.
 The caloric increases about 300kcal/day during pregnancy. Meat, fish, poultry, milk, eggs and cheese are high
biologic value and should be used liberally.
 Each additional cup of milk (ANMUM 2x) add 8g of CHON to the diet, milk also provides Ca and P which are
needed for the development of the fetal bony structure and teeths as well as for mother. Fortified milk also supplies
400IU of vit.D/ quart.
 Lean meat, prune juice, dried peas and beans, green leafy vegetables and whole grain cereals are good sources of Fe.
Including Vit.C rich foods with meals increases the absorption o nonheme Fe.
 The recommendation for folacin increases substantially for brain development of the fetus.
 Moderate use of salt is recommended since the tissues of both mother and fetus requires salt. Iodized salt should be
used because of the increased need of iodine in pregnancy.

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 The need of water is also increased; the diet should include 6-8 cups of fluid; which can be obtained from a variety of
beverages. Several glasses of water should be drunk each day.

NUTRITION IN LACTATION
 (+) 15g in 6 months and (+) 12g in months for the CHON requirement
 Vitamins and minerals – increases Vit. B6, Se, I, Vit. D
 Increase water and fluid intake – 87% of BM is water.
 Breast milk – unique in concentration of macro and minerals, enzymes, hormones, induces, modulators of immune
systems and anti-inflammatory
 Colostrums – first breast milk

FACTORS AFFECTING MILK COMPOSITION

 Stage of lactation- preterm milk – high in nitrogen
 Colostrum – 2 days high in CHON, low in fats and CHO, 3-6 – low CHON, high in CHO and fats
 Maternal diet – all women – enough with high quality BM; CHO; Ca; P, Mg and CHON concentration is not affected
- Concentrated FA, Vit. B6. Vit. D, I, Se – depends on maternal reserves

BREASTFEEDING
 Best for babies – all essential nutrients are present
 Natural – no flavoring and preservatives
 Presence of anti-infections
 Sterile, proper temperature
 Better for jaw 7 teeth development
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 Maternal and child bonding

MOTHER
 Mobilize fats
 Early stage (immediate post-partum); promotes uterine contraction (oxytocin and prolactin secretion)- prevents
hemorrhage and thromboembolism
 Readily available
 Childbirth and BF is a protection against CA – overuse (Ca of the cervix); underused (Ca of the ovary)
 Contraception: LACTATIONAL AMMENORHEAL MENSTRUATION – 0-6 months

GUIDELINES IN FORMULA FEEDING

 Avoid putting the child to be with bottle –destroy teeth, otitis media
 Hold baby as if mother is breast feeding – bonding
 Do the right mixing of formula and water as indicated in the commercial formula

WEANING – breastfeeding is gradually reduced with infant formula or foods appropriate to infants 4-6 months.

INTRODUCTION OF SOLID FOODS

 Infant cereal (4th) – veg and fruits (5th) – strained meats/ egg yolk (6th-7th)
 Introduction to table foods – 9th months coarsely textured foods.

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 GUIDELINES IN INTRODUCING SOLID AND TABLE FOODS
1. Introduce new foods one at a time at least 4-5 days of interval for child to adjust to new food and to determine food
allergies.
2. Introduce plain/ simple foods.
3. Increase fluid intake once solid foods are introduced.

b. Infancy
 ENERGY REQUIREMENT: 12 kcal / kg – 0-11 months (3x higher than adult req’t = 40 kcal in adult) – inc growth
and development; 100 kcal/kg in year old
 BREASTMILK AND FORMULA MILK; 67 kcal/ 100 ml
 FLUID REQUIRMENT: 150 ml/ kg in 24 hours
- If extra water is excreted – increase fluid intake (fever, vomiting, diarrhea)
- if (+) solid foods – increase fluid intake
 CHON REQUIREMENT: 2.2 g/ kg = 0-6 months; 1 8g/kg in 6 months and above, e.g. baby is 3 kg
120 kcal/ 1 kg = x /3kg = 360>360 kcal/x ml x 67 kcal/100 ml = 537 ml/day
 FAT REQUIREMENT: not specific = 48% BM and 46% FM
 CHO REQUIREMENT:
- BREASTFEEDING: lactose = 2-3 hours or 8-10 feeding
 PHYSIOLOGY OF BF: sucking reflex > release of PROLACTIN > signals mammary gland to be filled with
milk> Release of OXYTOCIN> contraction of breast and release of milk a.k.a LET DOWN
REFLEX 0-6 months supplement bottle for 1st 4 months is discouraged BM is already enough.

CONTENTS OF BREAST MILK

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 1. Lactose – well tolerated by the baby = efficiently digested and used by the GIT of the baby.
2. Essential fatty acids – linole, llinoleic, arachidonic and DNA (decoxahexaenoic acid)
helps the utilization of fats especially cholesterol; DHA is abundant in the brain and retina of the
eye, breastfed children are smarter with shaper cognitive abilities and sharper vision.

3. CHON – alpha lactalbummi – concentration is low – efficiency used by the baby – if high concentration will
increase kidneys workload.
4. VITAMINS – all vitamins are present except for Vit. D so expose the baby to enough sunlight proper Vit. D
usage.
5. MINERALS
6. CALCIUM – for bone and teeth formation.
7. LOW IRON and ZINC – HIGH BIOAVAILABILITY = maximum utilization/ absorption of minerals.

IMMUNOLOGICAL PROTECTIONS
COLOSTRUM – serum with antibodies and WBC’s (1st line of defense)
LACTOFERRIN – prevents bacteria to get Fe from the blood, iron binding CHON and antibiotic
LACTADITERIN – antiviral in the GIT

FORMULA MILK
1. Commercial – cow’s milk modified to BM; soy or cow based
2. Home prepared formula – evap milk H2) + sugar > high CHON concentration, skim milk – low calories, goats
milk – low folate (brain development)
3. Specialized formula – formula given to children with extraordinary problems
a. errors in metabolism – lactose intolerance> starch + sucrose
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 b. premature babies, low birth weight

FOLATE DEFICIENCY DURING PREGNANCY – NEURAL TUBE DEFECTS

1. Spina bifida – failure of some parts of the spinal column to close > CSF > Meningitis
2. anencephaly – small / no brain formation

c. Toddler (1-3 years old)

2 years old – low growth rate, birth weight quadruples and length doubles; 1 pint of milk/ 12 ounces of meat provides
the recommended daily allowance of a toddler for CHON, Ca, P and Mg.
E requirements: 1 year old – 1000 kcal/ day; 3 year old – 1,300 kcal/ day
Vitamins and minerals – increase with age especially Fe
Eating habits:
- They can learn to feed themselves between 1-2 y/o
- Changes in appetite is normal
- Nutritious between meals snacks are encouraged.
- Avoid bribing by rewarding them with sweets – decreases appetite.

d. Pre-schooler (3-6 y/o)

Prone to food rituals
Plan for diet: 3x regular meals + 2-3 snacks each day
Rule and principles: at 2 y/o they are fond of imitation, b/t 2-3 y/o there is the presence of rebellion
3 y/o stage of emotional development

GUIDELINES
29
 1. Set good examples of eating right food – avoid showing them your dislike on food.
2. Associate food with love and understanding – provide accurate information
3. Not all children have the same responses toward food – think of what / how much they’ll like it.
4. A child is keen on taste, flavor, texture and temperature – prepare nice, attractive, colorful food.
5. Satisfy his curiosity by giving him an opportunity to handle ingredients and acquainting him with pictures and names
of food – interest.
6. What a child thinks about himself and his world shows his sentiments on food.

FEEDING PROBLEMS OF PRE-SCHOOLERS

1. Eating too little – same food served everyday, emotional problem; NI; serve variety of food and prevent
argumentation in the table.
2. Eating too much – heredity (vocarious); clean plate principle> inc. weight/ obese, indigestion.
3. Dawdling – lingering with food > to get attention from authoritative figures (parents) or indicates loss of appetite due
to infections present > let child be checked.
4. Gagging – feels like vomiting especially with coarse foods> neglect to introduce food at the right time.
5. Allergy – observe for 4-5 days to give way for allergies to come out.

e. School Age
Slow growth rate, height is increased by 2-2.5 per year, weight by 4.5 lbs between 6-8 y/o
Eating habits; children who eat chips or cookies between meals have low appetite during meals, once the child is in
school, parents have no control over them.

RESPONSIBILITIES
a. Monitor food eaten by child at home.
30
 b. Promote good eating habits – do not skip meals, equal distribution
c. Enhance nutritional status – monitor growth rate, age, height, weight
d. Regular meals with pleasant and relaxed atmosphere

f. Adolescence
Period when there is growth spur
Female growth spurts starts from 10-11 years old while a male starts from 12-13 years old.
Females; increase fat deposits; 6”taller (but hereditary limits determination of height), 35 lbs. weight gain, increase Fe
intake.
Males: lean body mass, 8” taller, 45 lbs. weight gain, fe-myglobin present for muscle formation
Calcium should also increase, maximum bone growth

EATING HABITS
- Skipping meals, fast food, snacks with low nutritional value

RECOMMENDATIONS
- Parents continue to encourage good eating habits by having:
a. Regular meals
b. Nutritious snacks at hand
c. Set good example for children.

g. Nutrition for Adults and the Elderly

Adulthood – is the period of life when one has attained full growth and maturity. (21-50)
Senescence – the process of growing old
31
Gerontology – the scientific study of aging and its effects
Geriatrics – the branch of medicine that deals with the illnesses and medical care of senior citizens
Senile – often clinically associated with an old man with physical and mental weakness

PHYSICAL FEATURES
1. Gastrointestinal – decreased taste threshold, decreased motility, diminished secretions of the digestive enzymes,
increase in gastric pH, decreased number of absorbing cells.
2. Circulatory – decreased myocardial ability to use oxygen, loss of elasticity of vessels, decreased blood flow (renal,
GI, cerebral), increased pressure and systolic pressure.
3. Excretory – diminished amount of the nephrons, slow glomerular filtration rate, decreased BUN and waste excretion.

DISADVANTAGE: manual expression for some uncomfortable for inverted nipples, drug can contaminate BM

CONTRAINDICATIONS / CONSIDERATIONS
Error in metabolism (lactose intolerance)
Chronic illness
Mother under medication
Psychiatric disorders
CA with chemotherapy/ Radiation therapy
Mastitis
Pregnant and lactating at the same time
NOT CI for cracked nipples – saliva can heal

GUIDELINES IN FEEDING THE ELDERLY

32
 1. Mashed, pureed or chopped are given to those without teeth.
2. Soluble fiber fruits, vegetables and whole grain cereals will promote normal elimination.
3. A glass of milk, or flavored with malt, cocoa before going to bed can induce sleep (TRYPTOPHAN).
4. Those who cannot tolerate milk, excellent local food sources can provide the major minerals. (ex. Dilis, tinapa, small
shrimps, balut, malungay)
5. Avoid too much fatty foods
6. Coffee and tea before going to bed may prevent a good sleep
7. Small frequent feeding

2. Malnutrition
- Condition of the body resulting from lack or excess of one or more important nutrients.
- Also condition in which an individual cannot perform well at such things as physical work, physical
growth, pregnancy, lactation and resisting or recovering from illness.

FORMS OF MALNUTRITION
a. Protein-Energy Malnutrition (PEM)
- A condition resulting from the lack of intake of energy or protein or both, characterized by marked loss of
weight and failure to grow.
- Effects/Clinical Manifestations
* Stunted physical and mental development
* High risk to infection
* In extreme cases, death
* Lower academic performances
33
 * Lower levels of productivity

b. Iron Deficiency Anemia (IDA)

- A condition where there is not enough hemoglobin in the red blood cells due to lack of iron.
RBC – also known as erythrocytes
- Hemoglobin – reddish protein containing iron.
Characterized by feeding of fatigue, anxiety, and sleepiness and reduced work capacity.
- IDA increases the risk of infections and even dying especially among pregnant and lactating women as
well as infants.

c. Iodine Deficiency Disorder (IDD)

- A condition resulting from iodine deficiency or the failure of the thyroid gland to obtain a supply of iodine
sufficient to maintain normal structure and function.
- Characterized by the swelling of the neck or goiter (BOSYO). However, even before goiter becomes
visible, iodine levels in the body are reduced.
- The deficiency may be due to low intake of foods rich in iodine (e.g. sea foods and seaweeds) and may be
prevented through the regular use of iodized salt.

SERIOUS CONSEQUENCES OF IDD

- Increased miscarriages
- Stillbirths
- Spontaneous abortions
- Irreversible mental retardation
- Cretinism
34
 - Physical abnormalities such a deaf-mutism, squint (Pagkaduling)
- Increased mortality among children
- Iodine deficient adults have lower levels of productivity.

d. Vitamin A Deficiency (VAD)

- Results because of low intake of animal foods, and green leafy and yellow vegetables and yellow fruits,
which are rich sources of vitamin A.
- May also be due to poor absorption and utilization due to low intake of fats in the diet.
- It may result from severe infections.
- Common consequence is NIGHT BLINDNESS (matang manok). Frequent and severe infections may occur
which may result to death in extreme cases.
- The deficiency also results to poor growth.

Undernourished persons do not tolerate illness well.

- Shows delayed wound healing.
- Susceptible to infection and complications of illness
- Unable to withstand and handling medical treatments.

3. Measuring Nutritional Status

- Well nourished person have general energy appearance of vitality and well being.
- They are alert, have sufficient energy to perform physical activities, and recover rapidly from
periods of stress. However, it doe not mean that it is only due to lack of nutrition. It could also be caused by non-traditional
factors such as lack of rest or emotional stress.
a. Medical History
35
 - Before the physician examines the client, a medical history is taken.
- A carefully taken medical history provides much information that is useful in the nutritional
assessment. E.g. History of hypertension, alcoholism, surgery, or physical disability.
- During physical examination (examine skin, mouth, and eyes, etc.) the examiner looks for
physical signs and symptoms associated with malnutrition, a hormone imbalance, or chemotherapy.
- Vital signs such as pulse rate, respiration, temperature and blood pressure provided additional
physical data.

Anthropometric measurements
- Body measurements such as height, weight, skin fold thickness, and mid arm circumference that
reflect growth and development or an increase in body fat and muscle tissue.

Height and Weight

- height and weight tables are used to evaluate an individuals weight as it corresponds to his or her
weight.

Head Circumference
- An important measurement when assessing infants and young children. (May reflect the effect
of nutrition on brain growth).

Skinfold Thickness
- A measurement of a double layer skin and subcutaneous fat using a skinfold caliper.
- The amount of fat in the body is an important indicator of nutritional status.

36
Laboratory Data
Blood, urine, and stool tests reveal much about what foods have been eaten, the quantity of certain
nutrients in the body stores, and how the nutrients are being used. Laboratory

Serum Albumin levels

Measurement of the amount of this main protein in the blood is used to determine protein status.

Serum Transferring Levels

The amount of this iron-carrying protein in the blood increases above normal if iron stores is low; it
decreases when the body is lacking protein.

Total Lymphocyte Count

The count of white blood cells, which defend the body against infection, is a measure of the body’s
immune function, and may or may not reflect nutritional status. When protein intake is
inadequate, the lymphocyte count decreases.

Radiographic Studies
Radiographic of the bones, wrist of bones of children are particularly useful. These bones appear
earlier and develop earlier in well-nourished children.
Nutritional such as rickets and scarring can be detected by radiograph.
Existed for a long time.

Diet Hx and Food Intake Record

Diet recall, food diary, food frequency record, frequency of consumption of food.
37
SURGERY NUTRITION

 Before surgery, the patient must have an optimal nutritional status.

a) To enable them to withstand the stress of surgery.

b) To speed up the recovery time.
c) To shorten period of hospitalization.

 Diet Management

Before Surgery

1. Provide a high-calorie, high protein diet.

38
 2. Promote a liberal intake of nutrients important for wound healing, specially Vitamin C and Vitamin K.
3. NPO for at least 8

After Surgery

1. Give IV fluids and electrolytes.

2. NPO
3. Clear liquid, is flatus is
4. Ful liquid
5. Soft diet
6. Diet is tolerated, or depending on the case of the patient

BURNS

- Are classified according to the degree or extent of the damage. Burns over 20% of the body may be
fatal.

CLASSIFICATIONS

1. First-degree burn – burn destroys the epidermis. The affected area appears pink to red with slight edema and no
blisters, Pain is present. Relieved by cooling.

2. Second degree burn – burn that includes the epidermis with redness and blisters. Pain is felt.

39
3. Third degree burn – the epidermis, dermis and nerve are destroyed so there is no pain. The burned area may appear
red, white, black or brown.

 Causes

Thermal
Electrical
Chemical
Radioactive

 Treatment depends on the extent of the burn.

 Diet Management
a) When bowel sounds return, start as oral diet, (liquids) and observe for signs of intolerance then to diet as
tolerated.
b) High protein intake to facilitate wound healing and to replace the loss of lean body mass.
c) High calorie intake to meet increased energy requirement.
d) Adequate fluid intake.
e) Fruit juice high in potassium and Vitamin C.
f) Work with the client and family for food preferences.
g) Ask family to bring food from home.
h) Reschedule debridement and other medical or surgical procedures that may interfere.

40
CANCER

- it is a condition that is characterized by the uncontrolled growth and spread of abnormal cells
- unknown cause for the change in normal cell structure

 Predisposing Factors

1) Repeated or prolonged exposure to radiation or carcinogens

2) Cigarette smoking
3) Excessive exposure to sunlight
4) Alcohol
5) Ingestion of food with carcinogens
6) Genetic factors
7) Viral infection

 Diet Management

1) Avoid obesity
2) Cut fat intake to 30% of total calories
3) Eat food that are high in fiber
4) Eat food that are rich in Vitamins A and C
5) Include the cabbage family in your diet because they produce powerful enzymes in the liver that
breakdown cancer-promoting chemicals
6) Moderate intake of alcohol
41
 7) Decrease intake of salt-cured, smoked, nitric cured foods

DISORDERS OF THE LIVER

 The liver is involved in the metabolism of all nutrients. If the liver is damaged, it will cause a devastating effect on
the metabolism of almost all nutrients.

I. HEPATITIS is an inflammation of the liver.

 Probable Cause

1. Viral infection: Type A, Type B, Type non-A, Type non-B

2. Alcohol abuse
3. Drugs

 Early Symptoms

1. vomiting
2. headache
3. fever
4. weight loss

 Later Symptoms

42
 dark-colored urine
jaundice
liver tenderness
possible liver enlargement

 Diet Management

Moderate protein intake (80-100 g/day) for liver cell regeneration

* Emphasizing sources: milk and eggs
* If hepatic coma is impending, decrease protein to the maximum amount tolerated by the patient.
Increase in calories to spare protein liberal intake of carbohydrate (300 – 400 g)
* Moderate fat-restrict fat if steatorrhea develops.
Provide small frequent meals and encourage the client to eat all meals and snacks.
Limit sodium and fluid for patients with ascetics.
Eliminate alcohol
Avoid spices, pepper, caffeine and coarse foods as they will cause irritation to the esophageal areas
Monitor intake and output balances
Monitor weight

II. LIVER CIRRHOSIS

- is characterised by extensive loss of liver cells, fibrosis and fatty infiltration of the liver. Liver function
is impaired as liver cells are replaced by scar tissue.

43
 Causes

alcoholism
untreated hepatitis
chronic biliary obstruction
malnutrition

 Early Symptoms

fever
anorexia
weight loss
fatigue

 Later Symptoms
1. portal hypertension
2. dyspepsia
3. diarrhea or constipation
4. jaundice
5. esophageal varices
6. hemorrhoids
7. ascitis
8. bleeding tendencies
9. hepatic coma
44
  Diet Management – same as hepatitis

DISEASE OF THE GALL BLADDER

I. CHOLECYSTITIS

- is the inflammation of the gall bladder

 Causes

gall stone (cholelithiasis) obstructing the cystic duct

trauma
previous surgery

 Signs and Symptoms

1. abdominal pain
2. nausea and vomiting
3. jaundice
4. fever
5. fat intolerance
6. flatulence

45
  Diet Management – objective or role of the diet is to minimize gall bladder stimulation

1. Low fat diet (20 – 60 g/day of fat)

2. Promote weight loss if indicated
3. Avoid any food not tolerated

II. CHOLELITHIASIS

Is characterized by the presence of stones in the gall bladder.

 Case: Unknown
 Early Symptoms are the same with Cholecystitis

ACQUIRED IMMUNODEFICIENCY SYNROME (AIDS)

It is an infection of human T-cell lymphotropic retrovirus referred to as human immunodeficiency syndrome, which infects T-
cells. T-cells are white blood cells that protect the body from infection and other diseases. If the function of the T-cells is lost,
the body becomes susceptible to many diseases.

 Signs and Symptoms

1. fever
2. chills
3. diarrhea
46
 4. oral lesions
5. weight loss
6. poor nutritional status
7. anorexia

 Diet Management

* The objective of the diet management is to prevent further weight loss and maintain strength and level of
functioning.
* Provide high caloric and high protein adequate fluid based on individual requirements.

a. Decreased appetite
1. Encourage small frequent meals
2. Nutritionally dense liquid supplements
3. Administer drugs after meals

b. Pain while eating

1. Determine what the client can tolerate
2. Nutritionally complete liquid formula

c. Neurologic – depends on the care

1. normal
2. may need special utensils
3. an advance case may need to be fed or tube fed
47
 d. Gastrointestinal care
1. If cause can be treated, total parental nutrition to give the colon time to rest and heal.
2. If cause is unknown
2.a. a low lactose
2.b. low fat diet
2.c. low fiber
2.d. add fermented daily products
2.e. fluid intake

ROUTINE HOSPITAL DIETS

A. CLEAR LIQUID DIET

1. Indications:

48
 a. Serve a primary function of providing fluids and electrolytes to prevent dehydration.
b. Initial feeding after complete bowel rest.
c. Used to feed a malnourished person or a person that has not had any oral intake for some time.
d. Bowel preparation for surgery or tests.
e. Post surgical diet.
f. Diarrhea

2. Nutritional Considerations:

a. Is deficient in energy and most nutrients.

b. The body digests and absorbs clear liquids easily.
c. Contributes to little or no residue in the GIT.
d. Can be unappetizing and boring.
e. Patient should not stay on a clear liquid diet for more than 1 to 2 days.
f. Consists of foods that are relatively transparent to light, are in liquid form at body temperature, and may be
semisolid when cooled.
g. Foods include water, bouillon, clear broth, carbonated beverages, either regular or decaffeinated coffee, fruit
drinks, or strained fruit juices, gelatin, hard candy, honey, lemonade, popsicles and tea.
h. Patient may have salt or sugar.
i. Dairy products are not allowed.

B. FULL LIQUID DIET

1. Indications:
49
 May be used as a second diet after clear liquids following surgery, or for the patient is unable to chew or swallow.

2. Nursing Considerations:

a. Nutritionally deficient in energy and most nutrients.

b. Includes both clear and opaque liquid foods and those that liquefy at body temperature.
c. Foods include all clear liquids, butter, margarine, cream, cooked strained cereals, cream custard, soft cooked
or scrambled eggs, plain ice cream, breakfast drinks, milk, mashed potatoes, pudding, sherbet, strained
soups, strained vegetables and fruit juices.

C. SOFT DIET

1. Indications:

a. Used in patients with dental problems. Patients with poor-firming dentures and patients who have difficulty
chewing or swallowing.
b. Used for ulcerations of the mouth or gums, oral surgery, broekn jaw, plastic surgery of head or neck,
dysphagia, stroke, acquired immunodeficiency syndrome (AIDS).
c. Therapeutic for patients with impaired digestion and/or absorption due to conditions such as ulcerative
colitis and Crohn’s disease.

2. Nursing Considerations:

50
 a. Patients with mouth sores should be served foods at cooler temperature.
b. Patients who have difficulty chewing and swallowing due to a reduced flow of saliva can increase salivary
flow by sucking of sour candy or chewing gum.
c. Encourage the patient to eat a variety of foods, all foods and seasonings are permitted.
d. Provide plenty of fluids with meals to ease chewing and swallowing of foods.
e. Sucking fluids through a straw may be easier than drinking them from a cup or glass.
f. Liquid, chopped, pureed, or regular foods with a soft consistency are best tolerated.
g. Avoid foods that contain nuts or seeds because these can become easily trapped in the mouth and cause
discomfort.
h. Avoid raw fruits and vegetables, fried foods, and whole grains.

D. BLAND DIET

1. Indications:

Used for gastritis, ulcers, reflux esophagitis, congestive heart failure (CHF) and myocardial infarction (MI).
2. Nursing Considerations

a. Bland foods are less likely to form gas than regular diets.
b. Eliminate foods that stimulate gastric acid secretions.
c. Eliminate foods that are irritating to the gastric mucosa.
d. Foods to be avoided include alcohol, caffeine-containing beverages such as cola, cocoa, coffee, tea, fried
foods, pepper and spicy foods.

51
E. LOW RESIDUE / LOW FIBER DIET

1. Indications:

a. Supplies foods that are least likely to form an obstruction when the intestinal tract is narrowed by
inflammation or scarring, or when GI motility is slowed.
b. Used for inflammatory bowel disease, ileostomy, colostomy, partial obstructions of the intestinal tract,
enteritis, or diarrhea.

2. Nursing Indications:

a. Foods high in carbohydrates are usually low in residue and include white bread, cereals and pasta.
b. Foods to be avoided are raw fruits (except bananas), vegetables, seeds, plant fiber, and whole grains.
c. Dairy products are eliminated to two servings a day.

F. HIGH-FIBER DIET

1. Indications

a. Used in constipation.
b. Used in irritable bowel syndrome and when the primary symptom of irritable bowel syndrome is alternating
constipation and diarrhea.
c. Helps regulate blood glucose in patients with heart disease.

52
 2. Nursing Considerations

a. Provides 20 to 25 g of dietary fiber daily.

b. Adds volume and weight to the stool and speeds the movement of undigested materials through the intestine.
c. Consists of fruits and vegetables.

G. FAT-CONTROLLED DIET

1. Indications

a. Indicated for atherosclerosis, diabetes, hyperlipidemia, hypertension, MI, nephrotic syndrome, and renal
failure.
b. Reduces the risk of heart disease.

2. Nursing Considerations:

Limit the total amount of fats as well as amounts of polyunsaturated, monounsaturated, saturated fats and cholesterol.

H. HIGH-CALORIE DIET

1. Indications:

53
 Severe stress, burns, cancer, human immunodeficiency virus (HIV) and AIDS, chronic obstructive pulmonary disease
(COPD), respiratory failure.

2. Nursing Considerations:

a. High-calorie diets are also high-protein diets because the purpose of the diet is to build or maintain lean
body mass.
b. Add fats to foods whenever possible.
c. Add nuts and dried fruits such as raisins to desserts or cereals.
d. Add sugar to food and encourage high calorie desserts.
e. Encourage snacks between meals, such as milkshakes and instant breakfasts.

I. SODIUM-RESTRICTION DIET

1. Indications:

Hypertension, CHF, kidney diseases, cardiac diseases, and cirrhosis.

2. Nursing Considerations:

a. The amount of sodium allowed varies from 250 mg to about 4 g daily.

b. A No-Added-Salt Diet includes no salt at the table and lightly salting foods during cooking.
c. Foods allowed on a sodium-restricted diet include dried or instant cereals, puffed wheat, puffed rice, and
shredded wheat.
54
J. PROTEIN-RESTRICTED DIET

1. Indications:

Acute renal failure, chronic renal disease, cirrhosis and hepatic coma.

2. Nursing Considerations:

a. Provide enough protein to maintain nutritional status but not enough to allow the build-up of waste products
from protein metabolism (40 – 60 g of protein daily).

b. The lower the amount of protein allowed, the more important it becomes that all protein included in the diet
be of high quality.

c. An adequate total energy intake is critical for patients on protein-restricted diets because without adequate
energy, protein will be used for energy rather than in protein synthesis.

d. To boost energy intake, patients may use fats and concentrated sweets from margarine, creamed butter, hard
candy, jelly and sugar whenever possible.

e. Specially low-protein products such as pastas, breads, cookies, wafers, and gelatin made with wheat starch
can improve energy intake and add variety to the diet.

55
 f. Carbohydrates in powdered or liquid forms can also provide additional energy.

g. Vegetables and fruits contain some protein and for very-low-protein diets, these foods must be calculated
into the diet.

h. Foods are limited from the milk, meat, break and starch exchanges.

K. HIGH-PROTEIN DIET

1. Indications:

Tissue building, burns, liver disease and maternity patient.

2. Nursing Considerations:

a. High-protein diets correct protein loss or assist with tissue repair.

b. Increase foods such as meat, fish, fowl, and dairy products.
c. Client may need protein supplements.

L. LOW CALCIUM DIET

56
 1. Indications:

To prevent renal calculi.

2. Nursing Considerations:

a. Decrease the total intake of calcium to prevent further stone formation.

b. Avoid whole grains, milk, dairy products and green leafy vegetables.

M. LOW-PURINE DIET

1. Indications:

Used to treat gout.

2. Nursing Considerations:

a. Purine is a precursor for uric acid that forms stone and crystals.
b. Include organ meats, meat, egg yolks, whole wheat products, leafy vegetables, dried fruit, and legumes.

O. DIET FOR DIVERTICULAR DISEASE

1. Foods with seeds need to be avoided as they get trapped in the diverticula and cause irritation.

57
 2. Foods to avoid include whole grain breads and cereals, fruits, vegetables, dried beans, peas, and nuts.

3. Gas-forming foods should be avoided in patients with irritable bowel syndrome.

P. FLUID RESTRICTIONS DIET

1. Indications:

Acute renal failure oliguric phase, chronic renal disease, cirrhosis, CHF, hepatic coma, MI.

2. Nursing Considerations:

a. usually this diet restricts those foods that are composed largely of water.
b. Restrict carbonated beverages, coffee, juices, milk, tea, water, frozen yogurt, gelatin, ice cream, ice milk,
popsicles, sherbet, soup, cream, and liquid medications.

Q. CARBOHYDRATE-CONTROLLED DIET

1. Indications:

a. Help maintain normal glucose levels in-patients with disorders that cause blood glucose levels to rise or fall
abnormally, such as diabetes or hypoglycemia.

58
 b. Used for diabetes mellitus, hypoglycemia, lactose intolerance, galactosemia, dumping syndrome, obesity and
overweight.

2. Nursing Considerations:

a. Adjust energy intake from foods to provide specific amounts and types of carbohydrates.

b. The exchange list system most frequently used to plan carbohydrate-controlled diets.

ENTERNAL NUTRITION

A. Description

1. Tube feedings that consists of blenderized food or prepared products that provide carbohydrates, fat, protein and
water.
2. Administered through nasogastric or gastrostomy tube.
3. Administered continuously or intermittently.
59
B. Indications:

1. When the gastrointestinal (GI) tract is functional but oral intake is not feasible.
2. Used for patients with swallowing problems, cancer, burns, major trauma, liver failure, or severe malnutrition.

C. Administering Enternal Feedings

1. Keep the head of the bed elevated to prevent aspiration.

2. Warm feeding to room temperature to prevent diarrhea and cramps.
3. Check placement of tube every 4 hours by aspirating gastric contents and measuring the pH (should be 4 or less).
4. Aspirate all stomach contents (residual), measure the amount, and return contents to the stomach to prevent
electrolytes imbalance.
5. Usually, if residual is less than 100 to 150 mL, feeding is administered, if greater than 150 mL, hold the feeding.
6. Check for bowel sounds, hold the feeding if bowel sounds are absent and report the findings.
7. Flush turbing with water following feeding to maintain fluid balance and patency of tube.
8. Use a feeding pump for continuous feedings.
9. Do not allow feeding to hang longer than 8 hours and change feeding bag every 24 hours to avoid contamination.

D. Prevention of Complications

1. Diarrhea

a. Use fiber-containing feedings.

60
 b. Administer feeding slowly and at room temperature.

2. Aspiration

a. Verify tube placement.

b. Do not administer feeding if residual is greater than 150 mL.
c. Keep the head of the bed elevated.
d. Is aspiration occurs, suction as needed, monitor temperature for aspiration pneumonia, monitor for dyspnea,
monitor RR and prepare the patient for a chest radiograph.

3. Clogged Tube

a. Flush the tube with 20 to 50 mL of water before and after feeding administration.
b. Flush with water every 4 hours for continuous feeding.

4. Vomiting

a. Administer feeding slowly, and for bolus feedings, make feeding last for 30 minutes.
b. Measure abdominal girth.
c. Do not allow feeding to run dry.
d. Do not allow air to enter the tubing.
e. Administer feeding at room temperature.
f. Elevate the head of the bed.
g. Administer antiemetics as prescribed.
61
 h. If patient vomits, place in side-lying position.

TOTAL PARENTERAL NUTRITION (TPN)

A. Description

1. Supplies necessary nutrients via veins.

2. Supplies carbohydrates in the form of dextrose, fats in a special emulsified form, proteins in the form of amino acids,
vitamins and minerals.
3. Prevents subcutaneous fat and muscle protein from being catabolized by the body for energy.

B. Indications

1. When the GI tract is severely dysfunctional or nonfunctional.

2. Patients who can take some oral nutrition, but not enough to meet the body’s needs.
3. Patients with multiple GI surgeries, GI trauma, severe intolerance to enteral feedings, intestinal obstructions, or when
the bowel needs to rest for healing.
4. Patients with AIDS, cancer, or malnutrition.

C. Intravenous Sites

1. Peripheral Parental Nutrition (PPN)

62
 a. Administered through a peripheral vein.
b. Used for short periods (5-7 days) and when the patient needs only small concentrations of carbohydrates,
fats and proteins.

2. Central Parenteral Nutrition (CPN)

a. Administered through the subclavian or internal jugular vein.

b. Used when feeding must last longer than 7 days.

D. Complications

Infection
Hyperglycemia
Fluid overload
Air embolism

E. Precautions

1. Assist with insertions of catheter, position the patient in trendelenburg position with a towel under the scapula.
2. Ask the patient to perform the valsalva maneuver insertion to prevent air emboli.
3. When the central line is inserted, placement is confirmed by chest x-ray.
4. TPN catheter is not use for blood draws or the administration of other medications or fluids.
5. TPN is always delivered via electronic infusion device.
63
 6. Solutions should be stored under refrigerator.
7. TPN solution is changed every 24 hours.

F. Nursing Interventions

1. Maintain aseptic technique.

2. Monitor vital signs.
3. Monitor weight, intake and output daily.
4. Monitor site for redness, swelling, tenderness or drainage.
5. Monitor urine for sugar and acetone four times per day.
6. Electrolytes, glucose and blood urea nitrogen (BUN) are monitored as prescribed.
7. Monitor rate hourly.
8. If sepsis is suspected, a blood culture will be drawn, and the tip of the catheter will be cultured for bacteria.
9. Monitor rate hourly.
10. If sepsis is suspected, a blood culture will be drawn and the tip of the catheter will be cultured for bacteria.
11. Monitor for signs of fluid overload such as bounding pulse, jugular vein distention, headache, increased blood
pressure, and lung crackles.
12. Keep tubing connections taped.
13. If the intravenous (IV) tubing disconnects, instruct the patient to perform the valsalva maneuver.
14. Monitor for the signs of an air embolous such as confusion, pallor, light-unresponsiveness.
15. Place the patient in the left side-lying position with the head lower than the feet if air embolism is suspected and
contact the physician.

G. Fat Emulsion
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 1. Assess for allergy to eggs, a contraindication for lipid infusion.
2. Administer slowly for the first 15 to 30 minutes and monitor the patient for adverse reactions such as dyspnea,
cyanosis and allergic responses.
3. Monitor for signs and symptoms of fat overload, which include fever, leukocytosis, hyperlipidemia, pruritic urticaria
and possibly.

MEAL PLANNING

Planning meals includes not only the listing of food to serve at any one meal, known as the menu, but also these
considerable factors.

FACTORS TO CONSIDER IN PLANNING MEALS

1. Nutritional adequacy or the provision of palatable foods that is rich in essential nutrients. Nutrition needs of an
individual is affected by age, sex, body built and activities engage in by the individual.

2. Aesthetic and Psychological aspects of food or the proper combination of flavor, texture and shapes as well as
variety in color, form and arrangement.

3. Suitable, Availability and Quality of food to be served – The flavor to be prepared must be in season and should be
possessing essential organic and non-organic substances considering the health condition and ages of the family
members.

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 4. The food budget – The food budget is influenced by the family income; knowledge of the family market shopper’s
shopping skills, family food likes and dislikes and their goals and values.

5. Differences in Food Habits – These includes the dietary habits of nationality groups, religion food pattern, cultural
and religious food pattern and the socioeconomic background.

6. The Time and Skill in Planning Meals – The length of meal preparation, the amount of experience and the time
available are to be considered.

7. Physiological Aspects – The meal to be prepared must be based on the health status of each member of the family,
like therapeutic diet.

8. Equipment available for food preparation – It must be clean and in variation.

PRINCIPLES IN PLANNING MEALS

CONVENTIONAL MEAL

a. Plan several days’ meals at one tome, utilizing simple meals that are easy to prepare and serve.
b. Include more of one-dish meals like “sinigang”, “nilaga”, “tinola”, sautéed vegetable with serving portion of
meat.
c. Plan dishes that do not entail too much preparation at one time. If possible, preparation is done the day
before dish is served.
d. Plan meals that have interesting variety in color, texture, and flavor.
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 e. Plan to serve foods that are not only in season but also enjoyed by the diner.
f. Consider palatable foods that are rich in essential nutrients. Consult the different food groups.
g. Make out a market list to avoid extra trips to the food stores.
h. Check and see if all ingredients are available and equipment are in good working condition.
i. Avoid dishes requiring last minute attention in one meal.
j. Utilized leftover or meats that require a short time to cook.
k. Serve simple dessert.

ECONOMIC MEAL

BETTER BUYING PRACTICES

a. Before purchasing, plan the menu for nutrient adequacy, variety and flexibility and make a shopping list.
b. Compare prices among market place, groceries, between fresh and canned goods, between one brand and
another, between cuts of meats, between cuts of meats, between whole and ready-made items.
c. Know how much money you have to spend.
d. Avoid impulse buying by not shopping when you are tired or in a hurry, by reading label, by knowing
specification of food products.
e. Choose foods that are available and in season.

PROPER FOOD STORAGE

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 a. Food items should be stored properly to protect them from contamination and to preserve their flavor, food
value and appearance.
b. Plan your menu in such a way that fresh items are served on marketing days such as vegetables and fruits
and salads.
c. Keep meat, fish poultry, vegetable and some fruits in refrigerator, loosely covered. Plan to use them as soon
as possible or freeze them.
d. Store dried beans, cereals, and root crops in cool dry places where there is air circulation. Keep them away
from animals such as rodents, roaches and ants.

BENEFITS OF MEAL PLANNING

1. Composing menu and shopping list and drafting plans for preparing and serving meals save time and energy in
shopping. Cooking, and planning each meal. Keeping the plans from week to week because each old plan is evaluated
in the light of its merits and gives ideas of new plans.

2. Precise planning made it easier to control the expenditure of money because meals planned in the market on the spur
of the moment tends to be costly.

3. Planning for meals is to achieve the goal of good nutrition. Meals planned on the spur of the moment may or may not
provide for good nutrition.

4. Planned meals include a wider variety of food than meals hurriedly compose and prepared. It is proven to be the
needed stimuli for people with poor appetite and lack of interest in eating

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 5. Planning meals is to help from good planning habits. Experience in deciding what to serve, how much to spend, and
how much time and energy to invest in meals favors the development of good judgment in meal management.

FOOD PREPARATION

It has been proven by experiments that there can be considerable nutritive loss in food after processing and cooking.,
and too long holding after cooking.

FACTORS THAT AFFECT NUTRIENT RETENTION DURING FOOD PREPARATION

1. pH CHANGES

In general, most nutrients are stable at pH neutral medium except Ascorbic Acid (Vit. C), Folic Acid, (Vit. B9), and
Thiamin (Vit. B1). Folic acid can be stabilized by an alkaline medium, while for ascorbic acid and thiamin, alkalinity
even in slight degree is distinctly destructive.

2. OXIDATION

Pigments in food like tannin in fruits like mangoes and carotene in yellow vegetable like squash and carrots oxidize
upon exposure to air causing darkening and decrease in nutritive value

The formation of metmyoglobin or pigments in beef is accelerated at high humidity and lower air velocity attributes
to the stimulated bacterial growth under these condition.

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3. LIGHT

Among the amino acids, only trytophan is affected by light and the rest are relatively stable.

4. HEAT

Food is cooked to bring about desirable result namely:

 To kill microorganism and parasites.
 To destroy anti-digestive factors especially in beans, peas, cereals making this food utilizing by man.
 To inactive or destroy enzymes which is found in certain fishes that have anti-thiamine factors, or in fruits
and vegetables to halt the action of maturing enzymes.
 To prolong shelf life or to preserve the food.
 To soften tissue, bones and cellulose.
 To bring out color and flavor changes and develop a more palatable products.
 To have variety in food preparation which makes eating an art.

5. DRYING

New techniques of drying such as puff drying freeze during and foam-mat drying in insignificant nutrient losses
except in Vit. C.

6. COLD STORAGE AND FREEZING

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 Nutrient looses are insignificant during refrigeration and freezing as long as the food are properly processed, well
packed and correct temperature steadily maintained.

PRACTICAL GUIDES TO CONSERVE NUTRIENTS IN FOOD PREPARATION

After a general review of the affects of various factors and conditions on nutrients, the following hints on proper
selection, preparation and service of food should be useful to fundamentals of nutrient ion.

1. Select fresh fruits and vegetables at the right maturing and buy the peak of the seasons.
2. Buy products that needed refrigeration but do not store it long in the refrigerator.
3. Nutrients are found in the skin or just beneath the skin of the fruits like apple and banana and other foods like peanuts
and carrots.
4. Prepare fruits and vegetables at the time needed. Avoid long exposure to air or light.
5. Minimize soaking in water to prevent darkening of certain fruits and vegetable that decrease or diminish the nutrient
contents.
6. In preparing vegetables and fruits, keep skin intact. When cooking in water, they should be prepared with minimum
heat as to preserve the delicate flavors present in the form of volatile compounds.
7. Look for the shorter possible time. Avoid stirring and keep pan covered except for some greens and strong flavored
vegetables.
8. Use dripping of meats and fish. Dry heat method for meat is preferable. Boiling and baking result in less thiamine
loss compared to long stewing.
9. Avoid overheating fats and reusing cooking oil many times, twice enough.
10. The shorter the time between cooking and serving the more nutrients ingested.

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72
DISEASES, THEIR DEFINITIONS, CAUSES, SYMPTOMS, and NURSING DIET MANAGEMENT

ENDOCRINE DISEASE

DIABETES MELLITUS

* Diabetes Mellitus is a chronic disease characterized by elevated blood glucose

 Normal Physiology

After ingestion of food, blood glucose levels rise. This rise in glucose signals the b-cells in the Islets of the Langerhans of
the pancreas to secrete insulin. Insulin binds with insulin receptors in the blood stream and enables the cells to absorb
glucose. This makes blood glucose normal. The cells break down some of the glucose to energy. The rest are converted to
fat and stored in the cells.

 2 Types of Diabetes

1. Type I – Insulin dependent diabetes mellitus (IDDM) is characterized by lack of insulin secretion (without insulin, serum
glucose level increases, and all cells are unable to use glucose for energy. Glucose is then spilled into the urine.

 Exact Cause – Unknown

 Possible cause – Viral infection

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 Symptoms:

Polyuria Itchy skin

Polydipsia Poor wound healing
Polyphagia If left untreated will
Rapid weight loss Untreated ill lead to ketosis or ketonsidosis
Muscle wasting that may lead to death
Fatigue
Weakness
Irritability

 Goal of Diabetic treatment – to achieve metabolic control as near normal possible

- to prevent onset of complications.

 Diet management

 Objectives:

To maintain weight
To avoid hypoglycemia
To match calorie intake an expenditure with insulin therapy (budget)

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1. Meals and snacks must be consistent in number, timing, and composition daily to avoid hypoglycemia (patient is taking
insulin)
2. Need extra food to avoid hypoglycemia depending on the activity

Example: each hour of moderate exercise – 1 serving of fruit

Each hour of vigorous exercise – 2 serving of fruit or 2 servings of bread

3. Need to eat sources of protein and fat to slow down the digestion and absorption of carbohydrates
4. Must carry with him hard candy or sugar cubes at all times for unexpectedly delayed meal.
5. Food does not have to be prepared separately from the rest of the family. Just don’t add extra sugar and fat. Remove skin
from chicken.
6. Diabetic diet

2) Type II – insulin dependent

- it is characterized by normal or above-normal insulin level
- the delayed glucose – insulin response

 Contributing factor
- obesity

 Signs and symptoms

1. Drowsiness
2. Fatigue
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 3. Blurred vision
4. Tingling or numbness of the extremities

 Diet Management

* Goal – to attain normal blood glucose levels through weight reduction

1. Low calories diet until blood sugar is controlled

- maintain normal weight
- decrease weight, if obese

2. Low cholesterol to reduce risk of cardiac arrest.

3. Meal spacing – 4 to 5 hours apart to allow postprandial glucose levels return to normal.
4. Diabetic diet

Cardiovascular diseases

1. Atherosclerosis
2. Hypertension
3. Congestive heart failure

I. ATHEROSCLEROSIS – it is formation of plagues, mostly of fat, blood components, and connective tissue at the
arterial walls.

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 With the accumulation of fats in the arterial wall, plaques develop that narrow the artery that restricts the flow of blood.
These plaques may become so large that will totally occlude the artery.

Narrowed blood vessels will reduce blood flow thereby reducing the flow of oxygen to the tissues and organs. This will
result in damage to the tissues and organs.

 3 most common afflicted by atherosclerosis

a. legs
b. brain – cerebral hemorrhage
c. heart – coronary heart disease
- myocardial infarction
- may lead to death

 Causes

a. Familial hypercholesterolemia – caused by defective genes

b. Diet
c. Various diseases
d. Drugs

 Diet Management

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 a. Adjust calorie intake to attain or maintain “healthy” weight
b. High fiber – lowers cholesterol level
c. Reduce total fat, saturated fat and cholesterol
d. Increase intake of CHO
e. Moderate use of alcohol

II. HYPERTENSION

- It is sustained elevated blood pressure above 140/90 mmkg.

- It is a symptom, not a disease

 Causes
1.) 95% of HPN are from unknown causes and its classified as essential hypertension that can be controlled but not
cured.
 Predisposing factors of essential hypertension:
obesity
familial tendencies
2.) 5-10% cases of HPN are secondary to

a. stemosis of aorta
b. renal disease
c. endocrine imbalances
d. sodium retention during pregnancy
e. increased intracranial pressure
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 f. advanced collagen disease

 Diet Management

1) a) For weight loss – decrease weight

b) For overweight – reduce sodium intake between 2 to 4 g to promote a drop in blood pressure.
c) Acute care setting l- initial restricted sodium intake is 200 to 250 mg a day.
2) Adjust potassium intake; depending on dry therapy
3) Modify fat intake by:
a) increasing polyunsaturated fat
b) decreasing saturated fats
4) Discourage alcohol intake and limit caffeine containing beverages to 3 to 4 cups a day.
5) Monitor fluid and electrolyte balance of diuretics used

III. CONGESTIVE HEART FAILURE

- it is syndrome characterized by the inability of the heart to maintain adequate blood flow through the circulatory
system.
- Leads to decreased blood flow to the kidneys, excessive sodium and fluid retention, peripheral and pulmonary
edema, overworked and enlarged heart.
 Causes
1. All organic heart diseases like MI, HPN, OMP, etc.
2. Circulatory overload related to excessive IV fluids or renal failure.
3. Circulatory deficit such as hemorrhage and dehydration and pulmonary diseases
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 4. Any condition that increases metabolic demands like hyperthyroidism
5. Pregnancy
6. Obesity.

 Classification
1. Left sided heart failure
- caused by inefficient oxygenation of the blood related to lung congested.

 Symptoms
1. dyspnea
2. orthopnea
3. paroxysmal nocturnal dyspnea
4. pleural effusion
5. pulmonary edema

2. Right sided heart failure

- caused by inefficient oxygenation of the blood related to lung congested.

 Symptoms
1. dependent edema of the feet and ankles
2. pitting edema
3. ascites
4. sudden weight gain related to fluid retention
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 5. upper abdominal pain related to liver congestion, anorexia and nausea.
6. Nocturia
7. Weakness

 Diet Management

Objective:
- To reduce sodium and fluid retention
- minimize cardiac overload

1. Limit sodium intake

2. Decrease calories for weight loss
3. Provide 5 to 6 meals a day of non-irritant and non-gas forming food limit gastric distention and pressure on the
heart.
4. Fluids are limited to 3 liters depending on the clients response to sodium restriction.
5. Caffeine-free drinks.

RENAL DISEASE

I. CHRONIC RENAL FAILURE

- It is a progressive loss of renal function related to irreversible nephron deterioration.

 3 PHASES OF CHRONIC RENAL FAILURE

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 1) Decreased renal function – there is a 50% reduction in the glomerular filtration rate. It is a symtomatic.
2) Renal insufficiency – the general filtration rate decreased by 70-75
 Signs and symptoms
1. Creatinine; blood urea nitrogen levels rise
2. Urine becomes more dilute
3. Mild anemia develops
4. Asymptomatic because the remaining nephrons become hypertrophic to maintain homeostatis
3) Renal failure 80-85% of renal function is lost. Increase in serum createnine
 Cause / Predisposing Factor
1. Chronic glomerulonephritis
2. Polycystic disease
3. Chronic pyelonephritis
4. Urinary tract obstruction
5. Infection
6. Poor circulation related to atherosclerosis heart failure
7. Drugs
8. Nephrotoxic agents
9. Dehydration
10. Others

 Diet Management
1. LOW PROTEIN, LOW PHOSPHORUS, HIGH CHO, HIGH FAT

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 2. Adjust and modify protein intake to promote nitrogen balance while maintaining BUN levels below 60-
90 mg/day
3. Approximately 2/3 of total protein; should be from high biologic source.
4. Provide adequate non protein calories is needed when protein is restricted to prevent the use of distance
protein for energy, prevent tissue catabolism.
5. Maintain and restore ideal weight.
6. Obese clients may require fewer calories
7. Limit sodium intake to 2.0-3.0
8. If sodium retention is present (sudden weight loss, hypertension, symptoms of heart failure), restrict
fluid urine output + 500 ml for insensible losses.
9. Moderately restrict potassium intake to prevent hyperkalemia to 1.5 to 2.8/day. Actual requirements are
based on urine and serum levels of potassium.

II. ACUTE RENAL FAILURE

a) decrease in renal blood flow

b) glomerular or tubular damage leading to sudden loss of renal function and oliguria

 Phases

1) Oliguria – low urine output of less than 400-600 in 24 hours which may deteriorate to anurea.
- high-output renal failure-large amounts of urine are extracted deposit loss of renal function and
nitrogenous wastes
2) Diuretic phase – the kidneys are unable to conserve water
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 - urine volume may double daily until a fixed amount is reached
- loss of fluid, sodium and potassium are extensive
- last for 14-21 days
3) Recovery phase – there is gradual improvement in kidney function over 3 to 12 months period.

 Pre – natal causes: decreased renal blood flow related to:

a) Shock
b) Trauma
c) Hemorrhage
d) Surgery
e) Burn
f) Hypertension
g) Serum dehydration
h) Heart failure

 Intra-renal causes: nephron damage due to:

a) Nephrotoxins
b) Autoimmune diseases
c) Infections
d) Acute glomerulonephritis

 Post-renal etiologies: obstructed urine outlow due from kidneys due to benign prostatic hypertrophy, bladder or
prostate cancer
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 a) Calculi
b) Trauma
c) Medications

 Diet Management

Objective: To lesson workload of the kidneys and restore optimal nutritional status
1) Adjust protein intake according to renal function. Initially, parental solutions of amino acid and glucose maybe given
if client is unable to eat. Protein allowance may begin at 0.8g/ body weight and increase as renal function improves.
2) Increase calorie intake to approximately 50 cal/kg to promote nitrogen balance and replenish losses. Adjust fluid
intake to avoid overhydration. Allow output + 500 ml/day.
3) Adjust sodium intake according to urine output, serum sodium level, symptoms of sodium imbalance, and concurrent
use of dialysis. Sodium intake may be restricted to 500-100 mg/day. During the oliguria phase sodium requirement
increase during diuretic the anuric phase liberalized during the diuretic phase. Provide small, frequent meals and
assistance with eating, as needed for clients receiving an oral diet and are weak or fatigued.

 Instruct the client and family of the principles and rationale of diet management
 Monitor
a) the compliance with the diet and follow diet counseling
b) effectiveness of the diet
c) the evaluation of the need for diet modification
d) observe changes in weight, the intake and output in over 24-48 hour periods.

III. UROLITHIASIS
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 - Formation of stones n the urinary system

 Causes
a. idiopathic
b. infections
c. urinary stasis
d. metabolic abnormalities
e. hormone imbalance
f. inadequate fluid intake leads to concentrated urine output
g. symptoms depend on the site of stones
1. nausea
2. vomiting
3. diarrhea
4. abdominal pain

 Bladder stones
1. chills
2. fever
3. dyssuria

 Renal Pelvic Stones

a. Renal colic
b. Severe pain that radiates down the urinary tract accompanied by sweating, pallor, nausea, vomiting and
possible abdominal pain and diarrhea
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 Stones in the Ureter
a. uretal colic
b. severe colicky pain
c. that radiates down the thigh to the genitalia
d. small frequent urination that contain blood

 Causes
1. Hyperparathyroidism
2. Immobility
3. Excessive use of alkali antacids
4. Renal disease
5. Excessive intake of proteins or Vitamin D
6. Infection
7. Genetic disorders of cystine metabolism
8. Iodophatic

 Diet Management

1) Calcium phosphate stones

- increase fluid intake to 3 to 41/daily
- avoid excessive protein intake
- increase intake of acid-forming food

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 2) Calcium oxate stones
- avoid foods high in oxate, ex. Eggplant, okra, parsley, peppers
- avoid Vitamin C supplements, they increase oxalate excretion

3) Magnesium ammonium phosphate stone

- increase intake of acid-forming foods

4) Cystine stones
- increase intake of base-forming foods
- diets low in methonine and protein

5) Uric acid stones

- increase intake of base-forming foods
- low purine diet

6) Urinary tract infection

- increase fluid intake

Foods lacking in Oxalate that should be avoided:

Beets Peppers-green Soy bean Wheat germ

Celery Draft beer Cocoa/ovaltine
Eggplant Sweet potatoes Tea Red grape
Dandelions Spinach Currents Rhubarb
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 Leeks Summer squash Lime peel Parsley
Okra Chocolates Black raspberry
Nuts peanut

GASTROINTESTINAL DISEASES

I. NAUSEA VOMITING

Nausea – it is the sensation of impending vomiting

Vomiting – the involuntary expectation of food from the stomach

 Causes
1. Decreases in gastric acid secretion
2. Decrease in digestive enzyme activity
3. Decrease in gastrointestinal motility
4. Gastric irritation
5. Acidosis
6. Bacterial and viral infection
7. Increased intracranial pressure disorder
8. Equilibrium imbalance
9. Liver, pancreatic and gall bladder disorders
10. Pyloric and intestinal obstruction
11. Drugs
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  Diet Management
a. Withhold food until nausea or vomiting subsides
b. Feedings given in progress as clients tolerance improves – from clear liquid is to fall liquid to diets as tolerated
c. Elevate head of bed
d. Encourage patient to eat slowly
e. Promote good hygiene
f. Limit liquids with meals because they will cause a feeling a full, bloated sensation.
g. Serve food at room temperature

II. CONSTIPATION
- It is a difficult or infrequent passage of stool that maybe hard or dry.

 Causative factors
1) lack of activity
2) chronic laxative use
3) inadequate intake of fluid and fiber
4) metabolic and endocrine disorders
5) bowel abnormalities

 Diet Management
1) high fiber intake
2) promote adequate fluid intake
3) encourage intake of prunes, prune juice (laxative effects)
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III. DIARRHEA
It is the frequent excretion of watery stool

 Causes
1. Emotional or physical stress
2. Gastro – intestinal disorders and mal-absorption syndromes
3. Metabolic and endocrine disorders
4. Surgical bowel intervention
5. Certain drug therapies
6. Medical treatment
7. Bacterial viral and parasitic infection
8. Food allergies
9. Use of tube feeding
10. Use of laxatives

 Diet Management
1. For acute diarrhea, encourage clear fluids
2. For chronic diarrhea, withhold food for 24 to 48 hours, give intravenous fluid and electrolytes to provide
hydration.
3. Progress oral intake of patient’s according to her/her tolerance, from clear liquids to full liquid to low residue
diet
4. Encourage food high in pectin
5. BRAT diet: Banana, Rice, Apple, Toast
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 6. Avoid milk and milk products
7. Avoid carbonated beverages

IV. GASTRITIS
- It is an inflammation of the gastric mucosa

1. Ingestion of corrosive or infections substance, such as aspirin.

2. Food poisoning
3. Acute alcoholism
4. Uremia

 Symptoms
- depends on source of irritation
- mild heartburn to severe vomiting, bleeding, hematemesis

 Diet Management

Objective of Diet Management of peptic ulcer and gastritis is to:

1. Decrease gastric acid secretion and eliminate gastric irritants

2. Bland diet with adequate calories, protein and Vitamin C, 4 to 6 small meals in a day.
3. Avoid spices, alcohol, caffeine and cigarette smoking
4. Avoid rigorous activity immediately before and after eating.
5. Eat in relaxed environment
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 6. Chew food thoroughly

V. PEPTIC ULCER/GASTRIC ULCER

- The erosion of the mucus lining of the stomach (gastric ulcer) or duoenum (duodenal ulcer)

 Cause: Excess secretion of or decreased mucosal resistance to hydrochloric acid; stress

 Predisposing factors

1. Physiologic psychological stress

2. Cigarette smoking
3. Genetic factors
4. Certain medicators, such as aspirin
5. Excessive coffee and caffeine intake

 Symptoms
1. dull, burning, or piercing pain when the stomach is empty
2. heartburn
3. nausea
4. vomiting
5. melena

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