Nursing Pharmacology

The seven rights of medication administrationRIGHT DRUGRIGHT CLIENTRIGHT DOSERIGHT TIMERIGHT ROUTERIGHT REASONRIGHT DOCUMENTATION

General Principles in Drug AdministrationWhoever prepares the medication, administers and charts itConsult a drug reference manual or pharmacist for information on unfamiliar drugsFor elderly clients: use devices like calendars, daily pill dispensersFor pediatric clients, use syringeObtain assistance of parents to hold child in position Assess client’s allergy Check drug’s expiry dateRead labels three times before administrationWash hands before and after administrationDo not let the tip of the tube/dropper touch the client Document administration on medication record and client’s response to medication.For eye medication:Position: supine or sitting position with forehead tilted back slightlyMedication is administered into the conjunctival sacFor ointments, apply from inner to outer canthus ending it with a twisting motionLet the client close his eyes For liquid medications, press firmly nasolacrimal duct for at least 30 seconds If medication temporarily affects vision, instruct client not to move until vision is clearerLift side rails and place call light within reachFor ear (otic) instillation : Wash ear if excess wax in notedPosition: Side-lying, sitting, or semi-Fowler’s positionFor adults: pull auricle of ear up and backFor children: down and back (<3 years)Instruct client to remain in position for 3-5 minutesFor nasal instillationCleanse naresPosition: Sitting with head tilted slightly backwards, or supine with head tilted back in hyperextended positionHold dropper ¼ to ½ inch above naresInstruct client to take one short deep breath after each instillation and to remain position for 3-5 minutes.For oral medication:Do not crush or chew enteric coated tablets.Many oral medications require administration with milk or foodSchedule first doses of new medications on different hours from other medicationsFor Pediatric PatientsIf drugs are being mixed with food or liquid, use only small amountMedicine can also be given through nipples or droppersToddlers: allow to choose on method of delivery- spoon, dropper, syringe, and allow to helpPosition: Semi-Fowler’s or sittingInstruct client to place tablets/ capsules at the back of the throat and to follow with enough liquid Administer liquid medications after pillsRemain with the client until all the medications are taken. Check the client’s mouth Check client 30-60 minutes later for effects of medication.

For buccal and sublingual medicationPlace under the tongue (sublinggual) and between cheek and gum (buccal)If client’s mucous membranes are dry, offer a sip of water

DRUGS 1.Local anesthetics:

-blocks nerve conduction-metabolized by hepatic enzymes-produces temporary loss of sensation and motion

in a limited area of the body.E.g: Procaine (novocain),Benzocaine

(americaine),mepivacaine (carbocaine)Nursing implications:

a. force fluidsb. keep side rail-upLIDOCAINE TOXICITYSLURRED SPEECHALTERED CNSMUSCLE TWITCHINGSEIZURES 2. Non narcotic analgesics and antipyreticsAspirin

-analgesia-antipyretic-anti-inflammatory-anti-platelet

Acetaminophen/Tylenol-Analgesic,antipyretic-Antidote: acetylcysteine (mucomyst)-monitor liver/kidney function and CBC.

SALICYLATE POISONINGTINNITUS LETHARGY/EXCITABILITY,HYPERVENTILATION HYPERTHERMIA METABOLIC ACIDOSISNONNARCOTIC ANALGESICS AND ANTIPYRETICSNursing ImplicationsMonitor CBC, PT, kidney and liver function studiesAdditive effects if with use with anticoagulantsDrink plenty of fluidsTake with food or fluids.Never given with children/adolescents with flu/ chicken poxDon’t crush enteric-coated tablets.Avoid intake of alcohol stop therapy one week before surgery 3. Narcotic analgesics Codeinehydromorphone (dilaudid), meperidine (demerol), methadone,oxycodone HCL-induces sedation, analgesia and euphoria.-relief of moderate to severe pain in MI.- relief of dyspnea in Pulmonary edema or Left ventricular failure.Nursing Implications:

-assess pain before giving-monitor RR-change position slowly-check urinary retention-nalaxone (narcan) available

4.Sedative and HypnoticsEg. Phenobarbital-luminal

Diazepam-ValiumHinders movement of impulses from thalamus of the brain cortex.Creates depression in the CNSNursing Implications:Deep IMIV adm. monitor insertion sites for extravasationTablet can be crushed and mixed with food/fluidsTeratogenic5. AnticonvulsantsBarbiturates (phenobarbital)-for gen. and absence seizuresBenzodiazepines (valium)-drug of choice for status epilepticusHydantoins (dilantin)-prevents dissemination of electrical discharges in motor cortex area of the brain

Succinimides (zarontin)/valporic acid (delpakene)-absence seizuresAcetazolamine (diamox)/ Tegretol-diuretics,absence,tonic-clonic or myoclonic seizures.Nursing Implications

-7-10 days therapeutic level-turn urine pink, red or red-brown.-not given IM-gingival hyperplasia-caution use in pregnancy

ENDOCRINE DRUGS1. ANTIDIABETIC AGENTSInsulinAdverse Effects:AllergyHypoglycemiaLipodystrophyNursing Implications:Do not inject cold insulin.Discard discolored solutions or those with precipitates. Do not shake vial.Draw up clear insulin first.Rotate injection sitesMonitor blood glucose levels regularly.Inform patients regarding signs of hypoglycemia and appropriate treatment.If ill continue taking insulin and drink freely nancaloric liquids.Inform regarding avoidance of smoking. Oral Hypoglycemic agentsa. Sulfonylureaspromotes inc. insulin secretion from pancreatic beta cells First-Generation Agents:Tolbutamide, Acetohexamide, Tolazamide, ChlorpropamideSecond-Generation AgentsGlypizide, Glyburideb. Biguanides reduces hepatic production of glucose by inhibiting glycogenolysisdecrease the intestinal absorption of glucose and improving lipid profileAgentsPhenformin , Metformin , Buformin c. Alpha-glucosidase inhibitors Inhibits alpha-glucosidase enzymes in the small intestine and alpha amylase in the pancreas Decrease rate of complex carbohydrate metabolism resulting to a reduced rate postprandially.AgentsAcarbose (precose), Miglitol (glyset)Nursing implications:Tablets should not be crushedMonitor for signs of hypoglycemiaUse other forms of contraception aside from OCPsAlcohol can trigger a hypoglycemic effect.Cover body is sunshine. Use of sunscreen.Sulfonylureas are best taken before mealsMonitor for drug to drug interactions.CORTICOSTEROIDSCortisol, hydrocortisone, prednisone, prednisolone, methylprednisone, triamcinolone, dexamethasoneMineralocorticoid (fludrocortisone)Uses:Replacement therapy for adrenocortical insufficiencyAnti-inflammatory agentAdverse effects:1. Altered protein metabolismMuscle wastingOsteoporosisEasy bruisability2. Altered fat metabolismMoon faciesBuffalo humpTruncal obesityhyperlipidemia

3. Altered carbohydrate metabolismHyperglycemiaAltered immune responseSodium and water retentionHypertension7. Hypokalemia, metabolic alkalosis8. Emotional instability9. Excessive androgen activity10. Gastric irritationNursing Implications:Review patient’s medical history prior to giving the drugAdminister in light-resistant containersObserve for mental changes.Monitor for BP, weight, I and O, glucose, electrolytes.Take with food or milk.Take drug before 9 AM.Never abruptly stop taking the drugTeach patient ways to prevent infection.Restrict sodium, alcohol and caffeine intake.Increase intake of foods high in potassium.Rinse mouth after using inhaled steroidsTeach patient to avoid strenuous activities and falls ANTITHYROID DRUGSPropylthiouracil (PTU) and methimazole Mechanism of actionBlocks thyroid hormone synthesisAdverse effects:Skin rashUrticariaAgranulocytosisHepatitisMyalgiaHeadcaheHypoprothrombinemiahypothyroidismNursing considerationsGive the drug with meals to reduce GI effectsWatch for signs of hypothyroidism WOF: AgranulocytosisInstruct patient to report for skin eruptions The drug should be stopped if severe rash develops or cervical lymph nodes become enlargedAdvise patient to avoid foods high in iodine or potassiumWarn the patient against the use of the over-the-counter medicationStore the drug in a light-resistant containerMonitor for weight and PR regularly.SSKI/Lugol’s solutionPotassium or sodium iodide (potassium iodide SSKI), strong iodine solution (Lugol’s solution) Treatment for thyrotoxic crisis

Mechanism of action: Inhibits the release and synthesis of thyroid hormonesDecreases the vascularity of the thyroid glandDecreases thyroidal uptake of radioactive iodine following radiation emergencies or administration of radioactive isotopes of iodineAdverse Effects:Unpleasant taseHypersalivationAcneRashesangioedemaBurning sensationTHYROID HORMONESLevothyroxineLiothyronineThyroglobulin (Proloid)Adverse Effects:Signs of hyperthyroidismNursing Implications:Different brands of levothyroxine may not be bioequivalent

Warn the patient (especially the elderly) to tell the doctor if with signs of hyperthyroidismInstruct the patient to take thyroid hormones at the same time each day to maintain constant hormone levels.Nursing Implications:Medications taken in the morningMonitor apical pulse and blood pressure. If pulse is >100 bpm, withhold the drugStore in air-tight and light-resistant containersMonitor prothrombin time; a patient taking these hormones usually requires less anticoagulantOXYTOCINUses:Promotion of uterine contractionsControl of bleedingRelease of milk from breastOxtocin-related drugs:MethergineErgonovineAdverse Effects:TachycardiaWater intoxicationUterine ruptureNausea and vomitingCardiovascular collapseAnaphylaxisHypertension (oxytocin-related drugs)Nursing Implications:Use infusion pump for administration. Never give IMMonitor BP, heart rate and I and O.Regularly monitor for uterine contractions and FHR.Discontinue if:With note of tetanic uterine contractions.Signs of fetal distressUrinary flow is less than 30 ml/hourSigns of abruptio placenta and uterine ruptureFor ergonovine/methergine- C/I for patients with vascular, renal and hepatic problemsOphthalmic DrugsA. Mydriatics and Cycloplegics

-Atropine, Cyclogyl-causes mydriasis (dilatation) and cyloplegia, w/c

paralyzes the lens and eye muscles.Nursing Implications:

-sunglasses-artificial tears-elderly caution to atropine-IOP

B. MioticsAcetylcholine (miochol)Carbachol (isopto carbachol)Pilocarpine

-causes miosis (contraction) of pupils and ciliary muscles

-decreases IOPCardiovascular DrugsCardiac GlycosidesDigoxin (Lanoxin)-increases force of myocardial contraction (+ inotropic effect- improves blood supply to vital organs and kidneys, providing a diuretic effect.-decreases rate of contraction (- chronotropic effect)-CHF,Atrial fibrillation, atrial flutter,paroxysmal atrial tachycardia.Cardiovascular DrugsNursing Implications:

-avoid high Na, increase K-Antidote: digoxin immune Fab (digi-bind)

Hold if apical pulse:-infants: below 90 beats-children/adolescence: below 70-adults: below 60 or above 120.

Monitor serum digoxin levels: 0-5 to 2.0ng/ml.Anti anginal Drugs Nitrites & Nitroglycerin

-dilates the peripheral vascular smooth muscles of small vessels.-decreases cardiac pre load and after load.- decreased myocardial oxygen needs-dilates large coronary arteries,which helps decrease anginal pain & hypoxia of the myocardiumAnticoagulantsHeparin

-blocks conversion of prothrombin to thrombin and fibrinogen to fibrinWarfarin (coumarin)

-blocks prothrombin synthesis-takes 2-5 days –effect

Thrombolytic DrugsStreptokinaseActivase, urokinase

-when use in treatment of MI, start therapy within 6 hours of attack.

- corticosteriods -given to decrease allergic reaction-Reconstitute it with normal saline or 5% dextrose

solution-Avoid IM route-Antidote: Aminocaproic acid

AntihypertensivesACE INHIBITORS - CAPOTEN/CAPTOPRIL,

VASOTEC/ENALAPRIL, LOTENSIN/BENZAPRILBETA – BLOCKERS- INDERAL/PROPANOLOL,

TENORMIN/ATENOLOLCALCIUM ANTAGONIST- CALAN ISOPTIN/VERAPAMIL, CARDIZEM/DIALTIZEM, PROCARDIA/ NIFEDIPINENursing Implications

-avoid alcohol & hot showers-low Na diet-change position gradually-monitor CBC,E+,urinalysis

DiureticsThiazides: hydrochlorothiazide (Hydrodiuril)Chlorathiazide (Diuril)

- Blocks Na reabsorption in the distal convoluted tubule,which prevents H20 reabsorption

-increases urine output-decrease blood volume-K excretion-use in HPN, edema with CHF

Nursing Implication:-take early am & after meals-agranulocytosis-take high K diet-change position gradually-daily weights

Loop Diuretics Furosemide ( lasix )

-Acts by inhibiting reabsorption of Na and CL at the proximal portion of the ascending loop of Henle,increasing H2O excretion.

-use in HPN, Pulmonary edema, cirrhosis, renal diseaseNursing Implications

-take with meals-monitor for hearing loss-use with 5 % dextrose in water, NaCL & LR-incorporated lasix should be use in 24 hours-take dose in am-diet high in K-stay out of sun, use sunscreen

K-sparing diureticssspironolactone ( aldactone )

-blocks aldosterone receptors in the kidney tubules,thus causing excretion of water & sodium & K retentionNursing Implications:

- may last 2-3 days after drug is stopped

-avoid high K diet

Osmotic Diuretics (mannitol)-acts by increasing osmotic pressure of the

glomerular filtrate inside the renal tubules-this causes less reabsorption of F & E+ by tubules

& increase loss of Fluid,CL & Na.Nursing Implications:

-warm solution to dissolve crystal-used IV filters-I&O q 30 minutes-Signs of E-

Respiratory DrugsA. Antiasthmatic DrugsTheophylline,Aminophylline

-relaxes bronchial smooth muscles cells-increases renal blood flow, producing diuretic

effects and acts as CNS stimulant.Respiratory DrugsNursing Implications

-theophylline level: 10-20 mcg/ml-with milk or meals:GI upset present-not present give 1-2 hours before meals with water-avoid excessive caffeine

B. Cromolyn sodium-acts on lung mucosa to prevent histamine release

C. Mucolytics-reduces the viscosity of mucus in the bronchial tree

GIT DrugsA.Histamine (H2) antagonistsCimetidine (Tagamet)

-Decreases stomach acidity by impending the action of histamine

-Competes with Histamine for occupancy of H2 receptors site on the parietal cells in the stomach

-Suppresses the release of gastric acid

Nursing Implications:-antacids decreases absorption-4-6 weeks treatment ,ulcer disease.-toxic effect: confusion

B. Antidiarrheals agentsAbsorbent

-Pepto-bismol-kaopectate

Opiate-Imodium-Lomotil-Paregoric

Nursing Implications:

-not taken with CNS depressants-

C. Laxatives-use to promote movement of feces

Ex. Dulcolax, Lactulose, Metamucil Nursing Implications:-not given with nausea, vomiting, abd’l pain, s/s

appendicitis or intestinal obstruction

D. Ipecac Syrup-irritates the GIT to induce vomiting / delaying the

absorption time of toxic substances

Nursing Implications:-emesis should occur w/in 20-30 min-repeat dose -less than 10 yrs old,one dose only-not given: corrosive,petroleum based or cyanide

E. Anti gout

Allopurinol (Zyloprim) - prevents production of uric acid Nursing Implications:

-force fluid:2-3 liters-take after meals-monitor Liver function test/CBC

Colchicine (Novocolchine)-drug of choice for acute gouty attacks-decreases the inflammatory response to deposits

of monosodium urate crystalsNursing Implications:

-acute attack: given 1-2 hrs until pain ceasesAntimicrobialsA. Aminoglycosides:Gentamicin (Garamycin)

-bactericidalNursing Implications:

-caution with decreased renal function, reduced hearing, dehydration,neuromuscular disorders

-adequate hydrationB.Penicillin G Potassium (Pentids)

-BactericidalNursing Implication:

-check allergic reactions-Skin test-give oral tablet empty stomach,

with full glass of water-monitor CBC, BUN, Creatinine

C. Cephalosporins:-BactericidalNursing Implications:-IM: rotate sites-Assess for hx.of penicillin allergy: cross allergy between cephalosporin & penicillin-reduce dose with renal/liver problems.-Thrombophlebitis: long IV administration.Report diarrhea,rash,hives,dyspnea, bleedingD. Erythromycin:

-BacteriostaticNursing Implications:

-do not crush enteric coated tablet-take in empty stomach ,full glass of water-do not give w/ antacids-GI s/s are dose related

E. Tetracyclines-Bactericidal

Nursing Implications:-avoid with pregnant womenNursing mothers, Children under 8 y/o as drug

binds to calcium in teeth & new bone growth-lead to tooth discoloration of permanent teeth &

retarded bone growth.-Avoid taking w/ dairy products, antacids, vitamins,

minerals.-take 1 hr before meals,2 hrs after meals.-report diarrhea episodes

F. Urinary-Anti-infectivesNitrofurantoin (Macrodantin)

-BacteriostaticNursing Implications:

-monitor pulmonary ,neurologic status -give w/ milk or meals-avoid crushing tablet: tooth staining-dilute suspension-rinse mouth-nausea/vomiting common effect

G.Vancomycin HCL (Vancocin)-Exhibit bactericidal & Bacteriostatic effect.

Nursing Implications:-monitor renal/auditory function test-adm.IV slow 60 minutes: prevent phlebitis,

extravasation, red-neck syndrome ( fever, hives, rash & redness of the face)

H. ciprofloxacin (Cipro)-Bactericidal

Nursing Implications:-adm. with large glass of water-do not give with antacids-give 2 hours after meals

I. Antitubercular Drugs Isoniazid (INH)

-Bacteriostatic, If high concentration becomes BactericidalNursing Implications:

-assess neuromuscular function-give B6 pyridoxine-empty stomach-single daily dose-with meals & divide daily dose into 3 equal parts:

GI upset. Ethambutol (Myambutol

-report any s/s blurring of vision(unable to see red or green)-Caution with renal impairment

.Rifampin (Rifadin, Rimactane)-expect orange tinged body fluids-report anorexia,nausea/vomiting, jaundice,

malaise,dark urineComputations Preparing Solutions1. Liquid to Drug Solutions Determine the strength of the solution, the strength of the drug on hand and the quantity of the solution required Formula Dose = Amount of Solution Strength on hand Example You have a 100% solution of hydrogen peroxide on hand. You need a liter of 50% solution.

50 X 1000 ml = 500ml100

Solid Dose of Oral AdministrationPhysician orders patient to have 1.0 g of ampicillin. The ampicillin bottle states that each tablet in the bottle contains 0.5 g.2 Methodsdosage desired = 1.0 g = 2 dosage on hand 0.5 gExercise

The physician order 1000 mg of ampicillin. On hand: 0.25 grams per tablet.X=Liquid Dose of Oral Administration30 ml = 1 ozPhysician orders 60 ml of a liquid medication. How many ounces will be given?Physician orders 45 ml. How many ounces will be given?Liquid Dose of Oral AdministrationOrder: 500 mg;Dose at hand: 250mg/5 ml. How many ml will be given?Formula: D/H x Q500/250 x 5 ml= 10 mlOrder: 250 mg; dose at hand: 125 mg/mlOrder: 500 mg; dose at hand: 125 mg/mlCalculation of Flow RatesDrops/ minFormula: vol in ml x gtts (ugtts)/ml = drops/min time in minutes Infuse 1000 ml Lactated Ringer’s (LR) solution over 10 hour to a 40 year old male.1000ml x 15 gtts/min = 25 gtts/min 10 hrs x 60 min/hr Infuse 1 liter of 0.9 NACl over 8 hours using 10 gtt factor.Infuse 500ml of .45 NaCl over 12 hours to a 3-year-old child.Milliliters per Hour (ml/hr)

Formula: Volume in ml Total # of hours= ml/hrInfuse 1000 ml Lactated Ringer’s (LR) solution over 10 hour. 1000 ml ¸ 10 hour = 100 ml/hr

Drugs ordered in Units per Hour or Milligrams per HourDoctor’s order: mix 10,000 U heparin in 1000 ml D5W; infuse 80 units per hour1000 ml : 10,000 units :x ml : 80 U/hr 10,000 units x =80,000 ml-U/hr 10,000 U 10,000 Ux= 8 ml/hrmilliliters per hourMix 10,000 U heparin in 1000 ml D5 W; infuse at 15 ml/hr. How many units of heparin are being delivered per hour?1000 ml : 10,000 U : : 15 ml : x U 1000 ml X = 150,000 U-ml 1000 ml 1000 mlx= 150 UCalculation of Flow RatesMilliliters per Hour (ml/hr) Formula: Volume in ml Total # of hours= ml/hrInfuse 1000 ml Lactated Ringer’s (LR) solution over 10 hour. 1000 ml ¸ 10 hour = 100 ml/hrNUTRITIONFood PyramidBread, cereal, rice, pasta- 6-11Fruit- 2-4Vegetable- 3-5 servingsMilk- 2-3 servingsMeat, poultry, fish, dry beans, eggs,

nuts- 2-3 servingsFats- use sparingly K Caloric ValuesCarbohydrates 4Protein 4Lipids (Fats) 9Vitamin B1, (Thiamine) Vitamin B2, (Riboflavin) Vitamin B3, also Vitamin P (Niacin) Vitamin B5, (Pantothenic acid ) Vitamin B6, (Pyridoxine)Vitamin B7, also Vitamin H (Biotin) Vitamin B9, (Folic acid)Vitamin B12, (Cyanocobalamin) Thiamine (B1)A coenzymeNeed increases as metabolism increasesSources: lean pork, whole grains, legumes, seeds, nutsDeficiency: Beri-beri Wernicke-Korsakoff syndromeRiboflavin (B2)CoenzymeSources: enriched grain, broccoli, asparagus, dark leafy vegs, milk, meat, fish, poultryDeficiency: Ariboflavinosis Niacin (B3)Active vitamin percursorSources: meat, poultry. Fish, legumes. Milk, coffee ands teaDef: Pellagra ( diarrhea, dermatitis, dementiaPyridoxine (B6)deficiency causes blood, skin, and nerve changes. This vitamin is unique in that both deficiency and excess can cause peripheral neuropathy Biotin (B7)Assist in transfer of carbohydrate from one a compound to anotherDeficiency: dry scaly rash, hair loss, loss of appetite, depression, glossitis Sources: liver, kidney, peanut, egg yolkFolic Acid (B9)CoenzymeSources: green leafy vegs, fruits, juice, legumes

deficiency: in pregnant women, can lead to neural tube defectsCyanobalamin B12CoenzymeSources: meat, chicken, fish, pork,

eggs, dairy productsDeficiency: Pernicious anemiaVitamin CAnti oxidant; collagen formationEnhances absorption of ironRDA 90-125mg/dayDeficiency: scurvyVitamin AMaintains skin and mucous membranes throughout the bodyVision, immune system, bone growthSources: Whole milk, butter, liver, egg yolks, fatty fishCarotenoids: deep green, yellow, orange fruitsDeficiency: Xeropthalmia night blindness keratomalacia Toxicity: Hypervitaminosis A Vitamin DEnhance absorption of calcium Deficiency: Rickets Osteomalacia OsteoporosisToxicity: hypercalcemia Vitamin EAnti oxidant aphrodisiacSources: vegetable oil; margarineWhole grains, seeds, nuts, wheat germ, green leafy vegetableMay interfere with CoumadinPrimary deficiency: rareVitamin KCofactor in synthesis of blood clottingSources: bacteria in GITLiver production Sources: green, leafy vegetableLesser amt in cereals, dairy products, meats and fruits

CalciumNerve impulseMuscle contraction and relaxationBlood clotBlood pressure regulationSources:Milk and milk products except cream cheese and butterBroccoliSmall fish with bones+Tea and tannins reduce absorption of calcium+Deficiency: osteoporosisToxicity: urinary stoneironResponsible to distribute oxygen throughout our bodyFound in RBC, musclesSpleen and liverDeficiency: anemiaToxicity: hemosiderosiszincGrowth processes, taste, smell, healing process, immune system, carbohydrate metabolism by assisting insulin functionFound in: meat, fish, poultry, whole grains, legumes, eggs Deficiency: related to functionDwarfism, hypogonadism, hypogeusia, hyposmia poor wound healing, reduce immunity

toxicity: Vomiting, diarrhea, fever, exhaustion

iodinePart of thyroxine Increase in hypothyroidismDecrease in hyperthyroidismWaterFluid in which the substances can be use by the bodyProvides a means of transportation for nutrients to and from cells8 glasses of water/dayClear liquid dietIllness or surgery, acute inflammatory conditions of the GIT, for conditions requiring decreased fecal materialInadequate in nutritional essentialsliquid at room temperature; Use for 1 -2 days onlyClear fat free broths , strained juices, tea and coffee , salabat, plain gelatin , sugar plain, hard candiesFull liquid dietPost –op , acute infection, acute inflammatory conditions of the G.I.T. for patients too ill to eat solid or semi solid foods, impaired chewing and swallowing abilityLiquid at room temp. and free from cellulose and irritating spices and condiments. 6-8 small feedings recommendedStrained cream or soups, pureed strained meat and fish, strained fruit juices ,plain ice cream and custard, cornstarch pudding and milk and cocoaSoft DietPatients who are unable to chew, swallow or digest foods Modification in consistency and textureFoods low in cellulose content, low in fiber free from connective tissues and strong flavors, simple and easily digestedLow residue dietDysentery , diarrheas , pre-op and post –op when it is desired to reduce fecal residue, as in colostomy, ileostomy , and bowel resectionfoods which form least amount of fecal matter; may require supplementation Cereals strained soups, chicken Bland dietGastric and duodenal ulcers, gastritis , ulcerative colitisFoods are non irritatingMildly flavored foods without fiber, connective tissue avoid – alcohol , coffee black pepper and chili powderHigh fiber dietAtonic constipation, Atherosclerosis, diverticulosis, DMFull diet with emphasis on long fibered vegetables , raw fruits and vegetables, whole grain cereals and coarse breadsHigh caloricUnderweight, protein energy malnutrition, fevers and infections, hyperthyroidism, burns, growth pregnancy and lactation3 meals with in between feeding – gradual rather than drastic. Vitamins and minerals at or above RDA. Contains greater amount of total energyCereals, bread, butter , cream and other fats and sugar Low caloricObesity and those cases where excess weight is a complicating factor as DM, CVD, renal, HPN, gout, gall bladder and preceding surgeryContains reduced amount of energy to effect a negative energy balanceSufficient bulk , low in calories . Avoid high fat foods and high CHO foods

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