reference booklet for nutritionists - copy (1)

8/10/2019 Reference Booklet for Nutritionists - Copy (1)

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1 46

ADULT NUTRITION ASSESSMENT FORM

Patient's Name ____________________________________ Ward/clinic _______________________

IP/OP No _______________ Sex ____ Age ____ DOA _____________ DOD _____________

Referred from _______________________________________________________________________

Principal medical diagnosis ___________________________________________________________

Nutrition implication ________________________________________________________________

________________________________________________________________________________

Medical History ____________________________________________________________________

________________________________________________________________________________

Anthropometric assessment

Height (m)_____ Weight (kg) _____ BMI (kg/m2) ______ IBW _______ MUAC (cm)_____________

Waist circumference (cm) _________ Hip circumference _______ W/H ratio _______________

Remarks (classify nutrition based on BMI and MUAC) ______________________________________

___________________________________________________________________________________

Biochemistry (Based on principal diagnosis) _____________________________________________

________________________________________________________________________________

Clinical ____________________________________________________________________________

______________________________________________________________________________________

Diet History ________________________________________________________________________

________________________________________________________________________________

Nutrition diagnosis

________________________________________________________________________________

Prescription

_____________________________________________________________________________________________

___________________________________________________________________

Remarks/Comments

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_______________________________________________________________

Nutritionist/dietician/doctor______________________ Signature ______________ Date ___________


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2

Nutrition care starts from the care

Process:

THE STEPS IN NUTRITION CARE PROCESS

Patient identification

Nutritional assessment

- This involves the following:

Anthropometrical data

Biochemical data

Clinical examination

Nutritional/dietary history

Psychosocial information

Planning nutritional care

Implementation of nutritional care Evaluation nutritional care

Client History consists of four areas: Medication and supplement

history, social history, medical/health history,

and personal history.

Medication and supplement history includes, for instance, prescrip-

tion and over the counter drugs,

herbal and dietary supplements, and illegal drugs.

Social history may include such items as socioeconomic status, so -

cial and medical support, cultural and

religious beliefs, housing situation, and social isolation/connection.

Medical/health history includes chief nutrition complaint, present/

past illness, disease or complication

risk, family medical history, mental/emotional health, and cognitive

abilities.

Personal history consists of factors including age, occupation, role infamily, and education level.

PAEDIATRIC NUTRITION ASSESSMENT FORM

Patient's Name ____________________________________

Diagnosis ________________________________________

IP/OP No _______________ Date ____________________________________________Age ___________________________________ Sex ____________________________Family History

Child birth order ______________________ Parent's marital status ___________________Age of siblings (if any) _____, _____, _____, ______, _____, _____, _____, _____Mother's age __________ Occupation ___________________________________________Father's age __________ Occupation ____ _______________________________________Residence _________________________________________________________________Other psychosocial information____________________________________________________________________________________________________________________________________________________________________________________________________Nutrition history

Breast feeding history __________________________________________________________Age of introduction to other foods other than breast milk ______________________________Usual and current dietary intake __________________________________________________Socio economic/education status _________________________________________________Medical History_______________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________Anthropometric assessment

Birth Wt (kg)_____ Admission weight (kg) _____ Height/Length (cm) ______Head circumference (mm) _________ Wt/Age (Z-score) _______ W/H ratio _______________Discharge weight _________________________________________________________________________________________________________________________Clinical_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Diet History_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Nutrition diagnosis_____________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________

Prescription_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Remarks/Comments

______________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________Nutritionist/dietician/doctor______________________ Signature ______________ Date ___________


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44

ENTERAL AND PARENTERAL NUTRITIONS.

Pentasure Ensure Frebini juniour F100

Pedia gold Pentasure critipep Obesigo F75

Amminogard Pentasure hp Osteoproforte MUM TO

BE

Pentasure hepat-

ic

Pentausre renal Supportan Nursoy

Isomil Life gain Immunomax Nan

Provide extra Lifegain juniour Kabiven Forceval

Fresubin energy

drink

Fresubin protein

energy drink

Diaben B immune

Prosobee Prenan TNA SPECIAL

UJI

SPECIAL MILK SPECIAL SOUP COW AND

GATE

DEXTROSE

GENERAL GUIDELINES FOR DIET ORDERING PROCESS

Food Service System of a hospital starts atfood productionservice - consumption feed back/resultspolicySpecific diet prescriptions should be indicated on the treatment/diet chartAll diet orders should be given in writing on the diet sheetSpecific diets should be accommodated with a meal patternThe diet sheet is completed by the nurses and the nutritionist

Common acceptable diet ordering termsNormal/regular diet

High calorie, high protein dietDiabetic diet

Sodium restricted diet(low salt)Low cholesterol dietBlenderised diet(toto diet)Light diet/soft dietRenal: low protein(preferably HBV protein) and potassium restricted dietHigh fibre dietLow residue dietHigh protein high energy diet( special uji, soup, milk)Lactose free mixtureParenteral nutrition

Enteral nutritionParenteral nutrition, enteral nutrition and dietary consultation to be indicatedin the treatment sheet

Late requests should not be honored . nurses and the hospital nutritionist to

follow therapeutic diet request up with the cateress for kitchen delivery.


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INTERPRETATION OF DIET ORDERS

In the absence of specifications, diet orders are interpreted as follows:

Imprecise diet orders interpretation

Low salt diet 2gms Na (no salt)Diabetic diet 1800 kcalLow protein 0.6g/kg or 40g prot if weight is unknown

Low fat diet 50gLow calorie diet 1500kcal

High protein 1.2 to 1.5g/kg bwt (9for adults)2.5-3.0 g/kg bwt (for children)

High calorie diet 45 kcal/kg bwt (adults)

150-200 kcal/kg bwt(children)

Normal diet regular diet

Menu development stages

Factors to consider in diet formulation/planning

Specic needs of the individual

Locally available foodsPersonal and cultural preferences

Beliefs and lifestyle

Wishes and willingness to change

Food accessibility

Food diversity

Food variety.

Principles governing diet formulation/ planning

Nutritional adequacy providing adequate amounts of all the essential

nutrients, energy and ber.

Caloric control Managing the amount of energy consumed without over-

or under-eating.

Nutrient density Choosing foods that give a good variety of nutrients for

a small number of calories

Variety and Balance Selecting foods from each of the food groups in pro-

portion to each other thus preventing nutritional risks.

Individuality Using the information from the assessment to meet individ-

ual needs.

Flexibility Allowing clients to choose foods within a practical and creative

seing.

Moderation-eating the right quantities of dierent foods


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5 42

CONDITIONS AFFECTING OR INVOLVING THE GI TRACT, LIVER AND ENDOCRONE P ANCRE-

ASES

DISORDERS POSSIBLE DIET MODIFICATION

Blind loop syndrome Fat restricted, fluid and electrolyte replacement

Broken jaw Mechanical soft and liquid diet

Celiac disease Gluten restricted

Cirrhosis Protein restricted, sodium restricted, fluid in moderate amounts

Constipation High fibre diet, increased fluids and fruits encouraged

Cystic fibrosis High calorie, high protein

Gastric emptying Liquids, low fibre, tube feeding, total parenteral nutrition

Dental caries Mechanical soft

Diarrhoea Liquid, low fibre, lactose free, regular, fluids and electrolyte re-placement

Difficulty in swallow-ing

Mechanically soft, tube feeding, TPN

Diverticulosis High fibre

Diverticulitis Low fibre

Dry mouth Mechanically soft

Dumping syndrome CHO restricted, no concentrated sugars, frequent small feeding,fluids and electrolyte

Gastritis Low fibre, bland diet

Hepatic coma Protein restricted, sodium restricted, fluid restricted

Hepatitis Regular, high calorie, high protein

Hiatal hernia Frequent small feedings, fat restricted, bland, calorie restricted

HIGH RISK CONDITIONS

Listed below are high risk conditions that require Medical Nutritional Ther

apy by a Registered Dietitian:

High risk cardiovascular indicators.

Protein depletion serum albumin 3.0 or below.

New long bone fracture.

Unstable GI conditions.

Renal failure.

Cancer.

Consistent meal refusal or inadequate intake of meals (50% or less).

Decubitus ulcer.

Chronic underweight (10% or below).

Chronically poor oral intake of food and/or liquid resulting in nutritiondeciencies or dehydration.

Unplanned weight loss:

1 week 2% or greater b). 1 month 5% or greater c).3 months 7.5% or greater

d).6-12 month 10% or greater, e). a steady gain or loss that doesnt fall into

the above %s.

Obesity (20% or more above acceptable weight range) with one or more e

xisting medical conditions impacting nutritional status.

Dysphagia with documented aspiration, which impacts nutritional status.

Type I diabetes or poorly controlled Type II diabetes.

Increased metabolic needs i.e. burn, trauma, surgery, fever, infection.

Uncontrolled hypoglycemia.Food/medication interactions having an active impact on nutritional status.

Dehydration.


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641

Indigestion(dyspepsia)

Low fibre, bland, frequent small feeding

Inflammatory boweldisease

Low fibre, fat restricted, high calorie, high protein, fluid andelectrolyte replacement, lactose restricted, tube feeding, TPN

Irritable bowelsyndrome

High fibre, fat restricted

Lactose intolerance Lactose restricted

Mal absorption Fat restricted, high calorie, high protein, fluid and electrolytereplacement

Missing teeth Mechanical soft

Nausea Low fibre, bland, frequent small feedings, no liquids withmeals

Oral surgery Mechanically soft

Pancreatitis

Fat restricted, regular, frequent small feedings, tube feeding,TPN

Peptic ulcer Bland

Periodontal disease Mechanical sooft

Plastic surgery ofhead and neck

Mechanical soft, tube feeding, TPN

Reflux esophagitis Frequent small feedings, fat restricted, bland, calories re-stricted

Short bowel syn-drome

Fat restricted, high calorie, high protein, fluid and electrolytereplacement

Ulcer of mouth or

gums

Mechanically soft, avoid spicy foods and foods with seeds

Vomiting Fluids and electrolyte replacement

CONDITIONS AFFECTING THE ENDOCRINE PANCREASE

Diabetes mellitus Carbohydrate controlled, calorie controlled, low fat, sodiumcontrolled, high fibre diet

Hypoglycemia Carbohydrate controlled, limited simple sugars, frequentsmall feedinds

Adults

Energy Needs: Daily calorie requirements = [24kcal x kg usual body weight] + [40

kcal x TBSA {% burn}]

Where: TBSA stands for the total % burn

Protein Needs: Daily protein requirement = [1g x body weight] + [3g x TBSA]

Children

Daily calorie requirement

= [60kcal x kg usual body weight] + [35kcal x TBSA]

Daily protein requirement

= [3g x Kg. Usual Body weight] + [1g x TBSA]

The energy and protein needs of both adult and children burn patients is determined using the

Curreri formula (1979)

PREPARATION OF F75

Whole milk 300mlsSugar 25g

Vegetable 50mlsCmv/1scoop or KCL 40MLSClean water 1000MLS

NB CONSTITUTING/DILUTIONS

1 SCOOP F75 IN 20MLS WATER1SCOOP F100 IN 18MLS WATER1SCOOP RESOMAL IN 140 MLS WATERTO DILUTE F100 PUT 35MLS WATER TOALREADY PREPARED F100 (100MLS)PREPARATION OF F100

Whole milk 900mlsSugar 50gVegetable oil 25gmsCmv 1scoop or kcl 40mlsClean safe water 1000 mlsHOW TO MORDIFY F75 TO M AKE F100

1 litre f75

2 tsp level sugar2 tsp level cooking oil2oomls milk whole

SPECIAL UJI 2LITRES:

Uji 0.5litSugar 100gCorn oil 50mlsMilk 250mlsEggs 2eggs

SPECIAL SOUP IN 500MLS TO 500KCAL

AND 50G PROTEIN

Beef stalk 10kgsCarrots 2.5 kgsTomatoes 1.5kgsPotatoes 1.5kgCooking oil 125g

SPECIAL MILK FOR 1 LITRE:

Whole milk 1000mlsSugar 50gCorn oil 40mls

TOTO DIET:

PotatoesGreen grams/beansRice (not a must)Milk

CATCH UP GROWTH

DIET I

Fresh milk 900 mls

Sugar 70g

Oil 55 gWater 1000mls

DIET 2:

Refined flour 120 gRoasted groundnuts 80gSugar 40gOil 50g


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CONDITIONS AFFECTING THE BLOOD AND BLOOD VESSELS, HEART AND LUNGS

Atherosclerosis

Fat restricted, low cholesterol, calorie restricted, sodium restrict-ed, high fibre

Congestive heartfailure

Sodium restricted, calorie restricted, low fiber, bland, frequentsmall feedings, fluid restricted, caffeine restricted

Coronary heartdisease

Fat restricted, low cholesterol, sodium restricted, high fibre

Hypertension Sodium restricted, calorie restricted, high potassium, fat restrict-ed

Myocardial infarction Sodium restricted, calorie restricted, bland, morderate tempera-ture foods, caffeine restricted, fat restricted

Pulmonary disease High calorie, high protein

CONDITIONS AFFECTING THE KIDNEY

Acute renal disease Protein restricted, high calorie, fluid controlled, potassium con-trolled, sodium controlled, fat restricted, carbohydrate controlled.

Chronic renal dis-ease

Protein restricted, low sodium, fluid restricted, potassium re-stricted, phosphorus restricted and fat restricted

Kidney stones Increased fluid intake, calcium controlled, oxalate restricted,purine restricted, methionine-restricted

Nephritic syndrome High calorie, protein restricted, sodium restricted

CONDITIONS AFFECTING MANY ORGAN SYSTEMS

AIDS High calorie, high protein, fat controlled, fluids and electrolytereplacement, caffeine restricted, mechanical soft and TPN (where

indicated)

Burns High calorie, high protein, increased fluid intake

Cancer High calorie, high protein

Food sensitivities andallergies

Elimination of offending substance

Galactosemia Galactose restricted

BMI = weight in kilograms wt(kg)

height in meters2 ht(m)2

BMI Categories*

Underweight=


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839

Obesity, overweight Calorie restricted and fat restricted and high fibre

Stroke

Mechanically soft, regular, tube feeding, fat restricted, lowsodium, high pottasium

Surgery Regular, high calorie, high protein, increased fluids

Under weight High calorie, high protein,

CLINICAL SIGNS/SYMPTOMS FOR POSSIBLE NUTRIENT DEFICIEN-

CIESBody part/system Signs/ symptoms Possible deficiency

Hair Lackluster, thinness, sparse-ness, dryness, dyspigmenta-

tion, easy pluckability, tex-

ture change

Proteins, protein energy,zinc, copper biotin.

Face Paleness, moon face(swollen), greasy scalingaround nostrils

Riboflavin, niacin, pyridoxine,iron

Eyes pale white eyes and eyelidslining, redness and fissuring

of eyelid corners, dullness

and dryness, redness, lesionof conjunctivae

Iron, forlate, vitamin A, C, B2,B6 and B12

Mouth Angular redness, lesions orscars at the corners of the

mouth, swelling and rednessof lips and mouth

Riboflavin, niacin, pyridoxine,iron

Tongue Smoothness, slickness,redness, pain, swollen, ma-

genta colour

Niacin, pyridoxine, riboflavin,vit B12, Folate, iron

Gum Swelling, sponginess, bleed-ing

Vit C


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38

Skin Dryness, scaling, lightening ofskin colour often centrally on

the face, rough, goosefleshskin, small skin hemorrhages,hyper pigmented patches,superficial ulcers, oedema,

delayed wound healing

Vit A, C and K, Zinc,essentialfatty acids, protein, niacin

Nails Spoon shaped, pale brittle,ridged

iron

Glands Enlarged thyroid or parotid iron

Musculoskeletal

system

Bowlegs, knock knees, en-

larged joints, hemorrhages,muscle and fat wasting

Protein-energy, vit D and C,

calcium

Neurological system Mental confusion, irritability,psychomotor changes, motor

weakness, sensory loss

Thiamin, riboflavin and vit B12

Basis of estimation Calculation

Body weight

Adults

Young active :16 30 years

Average: 25 55 years

Older: 55 65 years

Elderly:> 65 years

Children

10kg

20kg21kg or more

Energy intake

Nitrogen plus energy intake

40ml/kg

32 ml/kg

30 ml/kg

25 ml/kg

100 ml/kg.

An additional 50ml per each kg> 10kg.

An additional 25ml per each kg

> 20kg

1 ml per Kcal.

100 ml/g nitrogen intake plus 1

ml per Kcal*

Methods of estimating daily uid allowance and tubefeeding

Browders chart for burns patients


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3611

Diet Indications Characteristics of the diet

Febrile conditions

Cancer

Wounds

Burns

Tissue injuries and

trauma

After surgery

Acute and chronic

fever e.g. TB, Malaria

and Typhoid.

Certain physiological

alteration -pregnan-

cy and lactation/

The diet must provide adequate

protein carbohydrates ratio of (2:1).

The diet should provide i.e.35-

40kcal/kg body weight/day 1.5-

2.0g/kg body weight/day

Consist more of high biological

value protein

HIGH PROTEIN-HIGH CALORIE DIET

Diet Indications Characteristics of the

diet

Unprocessed

foods and bever-ages

Low sodium

bread

Impaired liver func-

tions Cardiovascular dis-

eases

Severe cardiac failure

Acute and chronic

renal diseases

A diet low in pro-

cessed foods and bev-erages

Diet should be low in

canned foods, marga-

rine, cheeses, and salad

dressings.

LOW SODIUM DIET

Micro-

nutrient

Target

group

Dosage Frequency Timing and

schedule

Vitamin

A

Pregnant

Lactating

-

200,000IU

-

Single dose

-

At delivery

(should be giv-

en within 4

weeks of deliv-

ery)

folic

acid

Pregnant

Lactating

400

g/0.4mg

280 g

Daily

throughout

pregnancy

From rst

month of preg-

nancy or on 1st

contact

Iron Pregnant

Adolescentand adults

including

pregnant

women

with anae-

mia

60mg

120mg

Daily

throughout

pregnancy

(critical for

the rst 90

days of preg-nancy)

Daily

From rst

month of preg-

nancy or on 1st

contact

3 months


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3413

HIGH ENERGY DIET

Diet

Indication Characteristic ofthe diet

Energy dense

foods include

buer, sugar, hon-

ey and ghee

which are added

to the normal diet

to increase energy

content

Hyperthyroidism

Wasting

Typhoid

Malaria

HIV/AIDS

All cases of pro-longed degenerative

illnesses

Increased kilocalo-

rie energy 35-40kcal/

kg/day in adults

CALORIE RESTRICTED DIET

Diet Indication Characteristic of

the diet

Vegetables

Carbohy-

drates

Overweight and obe-

sity

Hypertension with

excess weight

Hyper lipidemia

Diabetes mellitus

with excessive weight

Gout

Gall bladder diseasespreceding surgery

The diet should

provide20-

25kcal/kg Body-

weight/day

Complex carbo-

hydrates

High in dietary

fiber

Proteins shouldbe within the

DRI

Total nutrient requirements for healthy pregnant and lactating women

State Trimester/ Period Energyrequire-

ments

Protein require-ments

Pregnancy First trimester 36-40kcal/

kg/day

0.8-1.0g/kg/d

+150kcal/day +0.7g/day

2nd trimester +300kcal/day +3.3g/day

Third trimester +300kcal/day 6g/day

Adolescent in

pregnancy

40-43 kcal/kg/d 1.5g/kg/day

add extra as

per the tri-

mester

Lactation First 6mths then

decrease gradual-

ly

+505kcal/

day

+17.5g/day for the

rst 6mths of

lactation

+13g/day for next

six months and

11g/day thereaf-

ter

*Underweightwomen

+675kcal/day +21g/day

Sedentary Moderate Active

Overweight 20 25 kcal/kg 25-30 kcal/kg 30-35 kcal/kg

Normal 25-30 kcal/kg 30-35 kcal/kg 35-40 kcal/kg

Underweight 30-35 kcal/kg 35-40 kcal/kg 40-45kcal/kg


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Complementary feedingFIBER RESTRICTED (LOW RESIDUE) DIET

Diet

Indication Characteristicsof the diet

Gastro-intestinal disorders colitis,

colostomy

Inflammatory bowel disease, diar-

rhea, hemorrhoids, etc

Acute phase of diverticulosis

Ulcerative colitis in initial stage

Partial intestinal obstruction

Pre and post-operative periods of

the large bowels

convalescents from surgery, traumaor other illnesses before returning

to the regular diet

post -perennial suturing

Low in com-

plex carbohy-

drates

Has refined

cereals and

grains

Legumes,

seeds and

whole nuts

should beomitted

HIGH FIBER DIET

Diet Indication Characteristics of the

diet

Gastro-intestinal disorders:

Diverticular disease: high

Cardiovascular disease(hypercholesterolemia):

Cancer prevention:

Diabetes mellitus:

Weight reduction:

High in complex

carbohydrates

Has less of refinedcereals

Age Texture

Frequency Amount of foodan

average child will

eat in

each meal

6-8

months

Start with thick

porridge, wellmashed

food and con-

tinue with

mashed family

foods

2-3 meals per day

plus frequentbreast feeds, De-

pending on the

childs appetite, 1-

2 snacks may

be offered

Start with 2-3 table-

spoonsper feed increasing

gradually to of a 250

ml

cup

9-11

month

s

Finely chopped

or

mashed foods

and

foods that baby

can

pick up

3-4 meals plus

breastfeeds.

Depending on the

childs

appetite, 1-2

snacks may be

offered

of a 250 ml cup or

bowl

12-23

month

s

Family foods,

chopped

or mashed if

necessary

Depending on the

childs

appetite, 1-2

snacks may be

offered

to one 250ml cup/

bowl


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3215

Summarized nutritional management of patients

Diagnosis Prescription Management/ nutritionalcare

Obesity Calories restriction.Boby fat is 3500kcal per

poundProtein: 0.8-1.5 gms/kg bwt( increases satiety and

should be kept at maximum)

Exercise goes hand in handwith dietary treatment

Avoid recipes containing fatFrying and other methodsusing much fat excluded, use

grilling, boiling, steaming,baking.

Achalasia (esophageal dys-

synergia)

Give Semi solid or liquid

foods as toleratedSmall frequent meals as

toleratedReduce protein and carbo-hydrate in the diet and

increase fat to reduce gas-tric secretion and a de-

crease in lower esophagealsphincter pressure.Avoid foods that can injure

the esophageal mucosa

Use low fibre diet if the

patient finds it easy to swal-low

Avoid extreme temperaturesin food

SOFT OR LIGHT DIET

Diet Indications Characteristics of

the diet

Fruit juices or cooked

fruits,

Well-cooked cereals,

strained if necessary;

Fresh spinach

Amaranth (Terere);

Pumpkin leaves;

Managu Strained peas;

Potatoes, baked, boiled, or

mashed.

Fats: buer, thin cream.

Milk: plain, in scrambled

egg, in cream soups, in sim-

ple desserts.

Eggs: soft-cooked, ome-

lees, custards. Simple des-

serts; custards, ice cream,

gelatine desserts,

Cooked fruits or cereal

puddings

Patients with

mild gastro intes-

tinal problems

Post operative

patients.

Non-surgical

patients whose

dentition is tooweak or whose

dentition is inad-

equate to handle

a general diet

For transition

from thick liquid

to a general diet

Moderately low

in cellulose andconnective tissues

Tender foods

Fluids and solid

foods may be

lightly seasoned

Food texture

ranges from

smooth andcreamy to moder-

ately crispy

Most raw fruits

and vegetables,

course breads and

cereals gas pro-

ducing foods and

tough meats are

eliminated

Fried and highly

seasoned foods,

strong smellingfoods should be

omitted


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1631

Esophagitis In acute phase the patient may want aliquid diet which is less abrasive to

esophagusSuch foods as orange juice , other cit-rus and tomato products

Foods that include chili powder and

black pepper may be irritating andshould be limited.

Avoid foods that are known to ca useheart burnSmall frequent meal to prevent disten-

tion and result in gastric acid secretionAvoid high fat meals

Avoid chocolate, alcohol, caffeine, smok-ing

Avoid lying down or bending immediatelyafter eatingAvoid eating within 2-3 hours of going to

bed.

Hiatal hernia Diet therapy for hiatal hernia includesthe omission of the same type of foods

as are excluded for esophagitis egcaffeine, chilli, blach pepper etc. noeating for 3 hours before reclining or

sleepingIndigestion A well balanced diet plus correct eating

habit are usually sufficientAvoid rapid eating, chew properly, do

not over eat.

Thick Liquid Diet (Blended or Semisolid Diet)

Diet Indications Characteristics of the diet

After oral surgery or plas-

tic surgery of the face or

neck area with chewing or

swallowing dysfunctions

For acutely ill patients and

those with oral, esophageal

or stomach disorders who

are unable to tolerate solid

foods due to stricture or ana-

tomical irregularities Those progressing from

full liquid to a general diet.

Patients who are too weak

to tolerate a general diet.

Those whose dentition is

too poor to handle foods in a

general diet.

-Those for whom a light

diet has been indicated e.g.

post operative

Fluids and food blended to a

liquid form

Viscosity ranges from the

thickness of fruit juice to that of

cream soup

All liquids can be used to

blend foods. However, nutrient

dense liquids with similar or

little flavor are preferable. Use

of broth, gravy, vegetable juic-

es, cream soups, cheese andtomato sauces, milk and fruit

juices is recommended

Multivitamin and mineral sup-

plementation is recommended


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3017

Gastritis Acute To allow the stomach to rest and heal, food isusually withheld for 24-48 hrs

Since it can stimulate gastric acid secretion evenwater taken by mouth is restricted with exceptionof cracked ice , which may be held in the mouth to

relieve thirst

Fluids are given intravenouslyAfter the first period, low fibre , liquid foods are

added as toleratedMilk is usually a good food to start the diet, smallamounts of milk, uji(cereal) and soup are fed at

interval of 30-45 minStimulating broth and highly seasoned foods to be

avoidedAmount increased according to patients tolerance

until he is able to eat regular dietAvoid over eating, eating too fast, too much alco-hol, tobacco and highly seasoned foods.

Chronic Diet should be adequate in calories and nutrientsSoft in consistencyEat at regular intervals and chew the food well

Highly seasoned foods avoided

Excessive amount of liquids with meals tend tocause discomfort.Same principle for ulcer care, that is reduction ofgastric activity is followed

Frequent small meals interspersed with anti acid

therapy are the main treatment.

FULL LIQUID DIET

Diet Indications Characteristics of the

diet

Soft desserts

from milk

and eggs,

Pureed and

strained

soups, ice

creams, milk

or yoghurt,

etc.

For post operative

patients

For acutely ill

patients or those

with esophageal/

GIT disorders and

cannot tolerate

solid foods

Following surgery

of the face-neck

area or dental or

jaw wiring

Foods should be liq-

uid at room tempera-

ture

Free from condiments

and spices

Provides between

1500-2000kcal/day

Large percentage is

milk based foods; lac-tose intolerant indi-

viduals need special

consideration.

The diet may be inad-

equate in micronutri-

ents and ber


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1829

Gastric and duodenal

ulcer (peptic ulcer)Diet management consists of providing a nutritionally adequate

diet that includes frequently a bland fiber restricted diet isrecommended

The objective of the bland fibre restricted diet include:Decrease secretions of gastric juices, neutralize stomach

acidity, decrease gastric motility, avoid irritationthrough mechanical movements on the lesion.

Principles of bland diet:

Lower fibre and connective tissue

Little or no condiments or spices except salt in smallquantities

No highly acidic foods

Foods simply prepared.Diet for PUD:Dont go to sleep for atleast 2hrs after meals.

Avoid coffee and black teaDont eat chocolate, and dont drink irritating sodas

Avoid beer and wine , above all in an empty stomachAvoid foods with excessive acids like lemon, pine apples

and oranges

Avoid fatty foods

Possibly stop smoking and chewing miraaAvoid tomatoes, reduce beans, no problem with ugali, uji,

maize

Prefer white to red meat. Avoid fatty meatHoney can help the ulcer healTake plenty of water.

CLEAR LIQUID DIET

Diet Indication Characteristics of

the diet

E.g. Black tea, broth,

strained fruit/ vegeta-

ble juices etc.

Pre-and Post-

operation,

As a transition

from intravenous

feeding to a full

liquid diet,

When other liq-

uids and solid

foods are not tol-erated,

During bowel

preparation prior

to diagnostic vis-

ualization or sur-

gery

In the initial re-

covery phase after

abdominal sur-

gery

Composed of water

and carbohydrates.

Clear liquid at room

temperature

Leaves minimal

amount of residue in

the Gastrointestinal

(GI) tract.Provides approxi-

mately 400-500kcals, 5

-10g proteins, 100-

120g CHO and no fat.

Should be of low

concentration

Milk and milk

drinks are omied

Improve energy

level by addition of

sugar

Are nutritionally

inadequate in all nu-

trients


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2819

Cont..

Gastric and duodenal ulcer

(peptic ulcer)

Dietary managementThe patient with peptic ulcer disease should:

Eat three regular meals daily Eat small meals to avoid stomach distension Eat slowly

Use in moderation easily digested fats like fat of whole

milk, egg yolk, cream andbutter Avoid drinking excess coffee and alcohol

Cut down on or quit sm oking

Avoid using large amounts of aspirin, other NSAIDs orother

drugs known to

damage the stomach lining Avoid foods or drinks that cause discomfort Eat meals in a relaxed atmosphere as possible

Take antacids one and three hours after meals and be-fore bedtime

Bland diet Moderate in fibre and connective tissues Little or no condiments or spices except salt in small

amounts Avoid or eliminate highly acid foods Foods simply prepared

TB 300- 500 kcal (35 -40 kcalper ideal body weight) is rec-ommended1.2- 1.5 g of protein per kg body weightFat 25-30% or less of the total energyHigh protein high calorie diet

AIDS 35-40

40-55

kcal/kgbwt/d

60-70% oftotal calo-

ries

1-1.4g/kgbwt(maintain)

1.5-2g/kgbwt

(reple-

tion)

Fat 30% of

total calo-ries

Inflammatory boweldisease

Crohns disease Diet to relieve symptoms and enhance nutri-tional status

Patient in acute phase may require TPN

When foods are reinforced, low residue dietliquid diets are given initially followed bymaximum residue or low fibre diet

Small frequent mealsNutrient supplementation is almost neces-sary due to the mal absorption

Ulcerative As in crohn;s disease elemental diet areconsidered when its acute

TPN used when there are fistulas, obstruc-

tion or abscess in order to rest the bowelLow residue diet, high in protein and energyis initiated

Irritating foods such as nuts seeds, legumes,whole grains are excluded

As patients progress, fibre supplementationshould be started and increased gradually toa high fibre diet

Lactose intolerance Omission of milk and milk containing foodsCheese contain little lactose most patient

tolerate i


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2027

Diverticulardisease

(diverticulosis)

During acute periods oral feeds may be limited to clear liquid with grad-ual progression to full liquid diets

Follow up diet therap[y is based on texture mordification using first theresidue free diet if necessary, then need on a low residue dietary re-gime.

As the inflammation subsides efforts should be directed towards in-

creasing fibre inorder to reduce strain during defecation. A high intakeof fluids is emphasized.

In the current thinking, high fibre diets can decrease the incidence ofdiverticular disease by producing soft, bulky stools that are easilypassed resulting in decreased pressure within the colon and shorten

transit time. However once diverticula develop a high fibre diet cannotmake them disappear. A low residue diet has to be used during an acute

phase of diverticulosis or when complications such as intestinal bleed-ing, perforation or abscess exists

A high fibre diet is recommended for long term prevention and treatmentof diverticulosis and prevention of diverticulitis.

Flatulence Eat slowly, chew with mouth closed and avoid gulping foodDiscourage drinking with a straw

Decrease amount of fat in diet

Some foods act as offending agents, if patient has intolerance to anyshould be avoided

Gas forming foods:

Beans, cabbage, cauliflower, green pepper, carrots, soya beans, turnips,celery, onions, cucumber, raw apples, avocados, water melon, bananas,

citrus fruits.

Hemorrhoids High fibre and plenty of fluidsFoods known to be irritating to be avoided

In acute phase the patient may require a low residue, low fibre diet

Gradual return to the high fibre diet should be the objective

High fibre and plenty of fluids

Foods known to be irritating to be avoided

In acute phase the patient may require a low residue, low fibre diet

Gradual return to the high fibre diet should be the objective

Conservativemgt of chron-

ic failures

35

40-50

25-30

kcal/kgbwt/d

0.6g/kgbwt/day

40g ptotein ifweight is notknown

60-75% HBV

protein

Burns 3000-5000(adults)

70-100(children)kcal/day

50% of calo-ries

3g/kg/bwt 30% of totalcalories fat

Cancer 40-45 cal/kgbwt

2000-2500

kcal/day(maintain)

50-60 kcal/kgbwt3000-4000

kcal/day

(repletion)

Maintenance

1.5-2.0g/kgbwt/day or

90-100kcal/day

repletion

2.0-3.0g/kgbwt

100-200g/

day

Fat 25-35%

Surgery 35-40cals/kgbwt/day

1-1.5 g/

kgbwt/day


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2225

Diarrhea Fluids, electrolyte and protein replacementHigh in protein (100-150g)

Low in fibreIf diarrhea is severe food must be with held for 24 hrs to 48 hrs or re-stricted to clear liquids followed by soft diet in frequent small amounts as

tolerated

Raw fruits and vegetables , whole grains and concentrated sweets may beavoided as tolerated as the patient convalesces

Severe diarrheaIV fluids are used to replace water and electrolytes.

If the need for iv fluids continues beyond 72 hours, amino acids and vita-mins may be added

If it prolongs TPN will be necessary.Resumption of oral feeding:

Day 1. Clear liquids with minimum of sugarDay 2. Progressively introduce a minimum residue diet, high protein andcalcium supplements are provided, gradually progress to soft solid diet.

Replace the potassium loss through intake of fruit juice rich in potassium

Irritablebowel syn-

drome

Acute: minimal fibre indicated as the patient improves, soft non irritatingfoods are used with a high intake of fluids. High fibre diet remains the

ultimate goalReduce fat in dietReduce quantities of foods at meals

Avoiding foods known to be triggerAvoid use of laxatives

Malab-

sorptionDiet should be high in calorie and proteinMordification of fat intake often indicatedIn some disorders elimination of some CHOs and protein often indicated

Soft and fibre restricted diet is useful to patients with persistent diarrhea

Gallbladder condi-tions:

1.Gallstone/cholelithiasis2.Cholecystitis

Avoid rich pastries, nuts, chocolate and fatty fried gasforming foods

Condiments and highly seasoned foods may cause disten-tion/ increased peristalisis irritating the gall bladerAcute:

All visible fat omitted

All liquid diet to 2-3 litres per day parenteral supplementa-tion may be required

The protein (30-40g) supplied by skimmed milk

Patient should adhere to low fat dietChronic:

Diet low in fat, peotein allowance kept at the low require-ment

50g fat, 275g CHO, 1870 kcal, if patient is over weight re-duce concentrated CHO

FOODS OMMITTED:

Fat from meat, skin of chicken, bacon, sausage, fatty fis,fish canned in oil

FOODS LIMMITED:

Gout Achieve desirable body weightPurine content of the daily diet is restricted

Organ meat high in purines to be avoided

Reduce fat and alcohol intake, fat restricted to 60g/day Increase consumption of fluids

High carbohydrate diet fluids are given to prevent exces-sive catabolism of adipose tissues

Acohol contraindicated

3litres of fluids(atleast), coffee and tea should be used in

morderationProtein intake restricted to 1gm/kg bwt

Omitted in acute stage:


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2423

Diabetes 30-35(normal)

40-45(underweight)

50-60%of total

caloricrequire-ments.

0.8-1.5g/kgbwt/

day or

20-30% oftotal calories

High fibre diet, caloriecontrolled, CHO con-

trolled, low fat diet,sodium restricted diet.

Hepatitis 300-400kcals

(adults)or

300-400g/day

1.5-20g/kg bwt or

25-35% In severe cases ac-companied by vomit-

ing, 5% - 10% dex-trose. Protein hydroly-sate or amino acids

(3.5% solution) are

added.

Fluid intake should be

high to correspondwith the increasedprotein intake

(3000mls/day)

Avoid alcohol, smallfrequent feeding

Restrict fat incase of

billiary obstruction

Cirrhosis 45-50kcal/kg/day

300-400gm/day

1-5gm/kg/dayor 70-

80gm/day

25% High calorie, CHOModerate protein andfat

High in vitamins espe-cially folic acid, vit K

and B complexes

Small frequent feeding

If hepatic coma oc-curs all protein omit-

ted

Pancreatitis Foods low in fatOr without addition of fat

Avoid fatty meal, avocado, oils, nuts, lards, creams

Consists of foods that will not stimulate/excite secreto-ry activity or bile(eg fat, alcohol)

Avoid highly seasoned foods, highly flavoured, fried/

fatty foods chocolate nuts.Acute attack:

All oral feeding with held and IV feeding are given inorder to rest the GI tract after 24-48 hrs the patientmay be given a clear liquid diet while tolerance is as-

sessed. However in the presence of pancreatic abscess,oral feeding must be withheld longer and TPN imple-

mented

Myocardial infarction The diet restriction include avoiding the heavy meals. Alow cholesterol, low sodium, low fat diet(rich in essen-

tial fatty acid) should be given in small quantities at allthe time tsp of salt /day

Adequate potassium

Not more than 1 Lit/day

Sodium chloride should not be used for cooking HepaticFailure

1500-2000kcalfrom CHO

and fat

Protein free toprotein low diet of20-30 gm with

improvement thediet continuously

advanced by 10gevery few days untilnormal diet is

achieved

20-30% of totalcalories

Decrease protein tominimize ammoniaproduction


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111

GUIDELINES

The Reference is based on the use of guiding manuals . Nutrion is a dynam-ic eld and the amount of facts needed somemes need to be referred so as

to be accurate and factual. The informaon here is not cast on stone and

there fore may be errac

The informaon here maybe highly summarized

It may have borrowed from other reference you may have by now

It should just remind you of a few things and is usable with other

manuals and is not an authority in its self

Learning is a connuous process, if you cant use other peoples

brains then yours is not t for use.

1. The Kenya National Technical Guidelines for Micronutrient Defi-

ciency Control (2008)

2. IOM and NRC

3. National food composition tables and the planning of satisfacto-

ry diets in Kenya (1993): WHO/FAO 2001

4. FAO/ WHO (1998)

5. WHO/UNICEF (2006), Infant and Young Child Feeding Counseling

Guide

6. WHO/FAO (2002)

7. Kenya National Manual for Clinical Nutrition and Dietetics

8.

Foods in the hospital9. Manual of clinical nutrition management

10. STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES

AGENCYDIET MANUAL

11. Nutrition Diagnosis: A Critical Step in the Nutrition Care Process

12. Pocket Resource for Nutrition Assessment

13. Browders chart for burnshttp://www.ncbi.nlm.nih.gov/pmc/articles/

PMC449823/

Appreciation for resourceful material from above materials

Resources


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II

Acknowledgement

I acknowledge the work that has been done by other nutritionists andother organizations.

I acknowledge that this work borrows from other pieces of work and

my duty was to make it highly summarized and pocket friendly for

ward rounds and consultation.

I acknowledge that my love for nutrition makes me issue this work

for free with cost to the pass word only if in electronic form or to the

hosting charges.


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Nutrition and Dietitian

Pocket Reference Book

BY

Millan Ochieng Otieno

reference booklet for nutritionists - copy (1)

Documents