reference booklet for nutritionists - copy (1)
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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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
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