DIETARY MODIFICATION AND DIETARY THERAPY  -  allowance for ice chips, ice cream, sherbet, ice drop,
 -  allowance for ice chips, ice cream, sherbet, ice drop, popsicles
A. General Diets
Standard Hospital Diets
Liquid Diets
1. Clear Liquid Diet - consists of liquids without residue or fibers
 - used to relieve thirst and maintain water balance
 - diet used for 24-48 hours following acute vomiting, diarrhea or surgery
- allowance of tea, coffee, fat-free broth, ginger ale, fruit juices in sachet,    - also called general, house, full hospital diet, diet as tolerated
gelatin, fruit ices, hard candy and water
2. Full Liquid Diet - nutritionally adequate diet consisting of fluids and foods that liquefy at
body temperature
 - diet used for acute infections and fever of short duration and for patients who are ill to
chew
- milk, cream soups, cereal, soft custard, strained meat in broth, strained citrus fruits,
tomato juice, vegetable puree, eggnog, yogurt
3. Cold Liquid (Yin diet) - diet for patient undergone tonsillectomy and adenoidectomy
4. Soft Diet - nutritionally adequate diet differs from the normal diet in having reduce the
fiber content, soft consistency and bland flavor
- used immediately between the full fluid diet and regular diet following surgery, acute
infections, fever, and GI disturbances
- patient with no teeth or ill-fitting dentures;
- those who cannot tolerate highly seasoned, fried or raw foods
- the normal diet is modified in the following ways:
- meat and poultry are minced and ground
 - vegetables are cooked – little longer than usual
 - soft raw fruits may be used
 - soft rolls, bread or biscuits are used instead of crisp rolls, crust breads and toast
 - all desserts on a normal diet may be used
5. Mechanical Soft Diet - dental soft or mechanically altered diet
 - foods should be well cooked, easy to chew, chopped ground or minced
- foods are best served moist or with gravy and sauce
6. Regular Diet - most frequently ordered among the house diets
7. Light Diet - a transition between the soft and regular diets
 - for elders who cannot tolerate rich and heavy foods
8. Vegetarian Diet - usually low in saturated fatty acid, cholesterol, and high fiber
 - with disadvantage is inadequate or low level of Vit B12, Iodine, Calcium, Zinc, Vit. B2 and
Vit. D.
a. Vegan diet - total vegetarian, or strict vegetarian diet or plant in origin
b. Lacto-vegetarian - milk and milk products + items of plant origin
c. Ovo-vegetarian – eggs and eggs products + items of plant origin
d. Lacto-ovo-vegetarian – eggs + milk + plant origin Hyperthyroidism - High Calorie, High CHON
 e. Semi-vegetarian – lacto-ovo- vegetarian foods + fish + chicken + plant Liver Cirrhosis - Low CHON
 f. Pesco-vegetarian – fish and fish products + items of plant origin Nephrotic syndrome - Low Na, High CHON, High Calorie
Overweight and Obese - Low calorie
9. Restricted Diet - a diet limited in a specified amount or type of nutrient Pernicious Anemia - High CHON, Vitamin B
 - cholesterol restricted diet, salt restricted diet Tosilitis - Clear liquid diet   
Ulcerative Colitis - High CHON, High Calories, Low residue                                                             
10. Controlled Diet - implies careful adjustment of levels of nutrients from day to day as         
needed; controlled CHON, K, Na.
Bland - eliminate irritating foods to allow the stomach lining to heal (ulcer patients)
B. DIETARY MODIFICATION WITH CONSISTENCY High Fiber - provide bulk in the stool and bring water into the colon for patients with
Therapeutic Diet for specific disease condition constipation or diverticulosis

Acute Glumerulonephritis - Low Na, Low CHON Low residue - reduce fiber for patients with Crohn’s disease, colon or rectal surgery,
esophagitis, diarrhea.
Acute Renal Failure – Oliguric Phase - Low Na, Low CHON, High CHO                                 
High Calorie - growing periods, under nutrition, Chronic Obstructive Pulmonary Diseases
Addison’s Disease - High Na, Low K and Cystic fibrosis
Attention deficit hyperactivity disorder - Finger foods Low Protein - Liver and renal failure
Bipolar Disorder - Finger foods High Protein - Hypercatabolic disorder, Protein Energy Malnutrition
Cerebrovascular Accident -  Osterized Feeding with Low Na, Low cholesterol, High fiber Low Purine - reduce the amount of purine. It is used with patients who have gout or uric
Cholecystitis - Low fat, High CHO, High CHON acid kidney stones

Chronic Renal Failure - Low CHON, Low Na, Low K Low Cholesterol - reduce the intake of cholesterol in order to lower blood cholesterol levels
in client heart diseases
Congestive Heart Failure  -  Low Na, Low Cholesterol                                        
Gluten free - eliminates gluten, a protein found in wheat products. These are used for
Cushing Disease - High K, Low Na patients with malabsorption syndromes such as celiac disease
Decubitus Ulcer - High CHON, High Vitamin C Lactose free - reduce or eliminate foods with lactose, for patients who cannot metabolize it
Dengue Fever - Diet as tolerated except dark-colored food Low sodium - patients with kidney, cardiovascular disease or hypertension to control the
Diabetes Melitus - Well-balanced diet retention of sodium and water and thus lower blood pressure

Diverticulitis - Low fiber

Dumping Syndrome - High fat, High protein
Hepatic Encephalopathy - Low CHON, High calorie Sodium Restriction Salt allowed
Hirschsprung’s disease - High calorie, Low residue, High CHON       
Mild (3000 mg) >1/2 teaspoon per day
Hyperparathyroidism - Low Calcium
 DASH diet - (Dietary Approaches to Stop Hypertension). A recommendation that those
¼ teaspoon per day
Moderate (2000 mg) with high blood pressure consume large quantities of fruits, vegetables, whole-grains and
1 serving of processed foods low fat dairy foods as part of their diet, and avoid sugar sweetened foods, red meat and
fats.
No salt Elemental diet - A medical, liquid-only diet, in which liquid nutrients are consumed for ease
Strict (1000 mg) No processed foods of ingestion.

Limit bread and milk Ketogenic diet - A high-fat, low-carb diet, in which dietary and body fat is converted into
energy. It is used as a medical treatment for epilepsy.
Sodium free Paleo diet - foods include meat, fish, eggs, seeds, nuts, fruits and veggies, along with
Very Strict (500 mg) healthy fats and oils. Avoid processed foods, grains and sugar.
Restrict natural foods high in sodium

NUTRITIONAL EDUCATION AND COUNSELING

C. DIETARY MODIFICATION WITH COMPOSITION
Nutrition Education and Counseling
BRAT diet
Nutrition education is a set of learning experiences designed to assist in healthy eating
– banana, rice, apple, toast – indicated patients with diarrhea choices and other nutrition-related behavior.  Nutrition education is delivered through
multiple venues and involves activities at the individual, community, and policy levels.
Butterball diet
Nutrition counseling aims to help clients understand important information about their
- spare protein but high in CHO indicated with liver disorders
health and focuses on practical actions to address nutrition needs, as well as the benefits of
Giordano diet behavior change. Nutrition counselors may be nurses or other facility- based providers or
community health workers.
– spare protein, indicated for patients with CRF
Giordano-Giovannetti diet Behavioral Change

- a low-protein, low-fat, high- carbohydrates diet with controlled potassium and sodium
intake, used in chronic renal insufficiency and liver failure
Kosher diet
– meat and milk cannot be served simultaneously diet for Orthodox Jews
Tyramine rich diet
– use to prevent hypertensive crisis  for patients who are taking in MAOI anti-depressant
  No to ABC – avocado, banana, canned, processed, smoked, aging and fermented foods
South Beach Diet - diet developed by the Miami-based cardiologist Arthur Agatston, M.D.,
who says that the key to losing weight quickly and getting healthy isn’t cutting all
carbohydrates and fats from your diet, but choosing the right carbs and the right fats.
Monothropic Diet - A diet that involves eating only one food item, or one type of food, for a
period of time to achieve a desired weight reduction.
- Behavior Theories used in Nutrition Education and Counseling. Programs and Services
available in Governmental Organization’s or Non-Governmental Organization’s
Nutrition education:
 Is any combination of educational strategies, accompanied by environmental supports,
designed to facilitate voluntary adoption of food choices and other food- and
nutrition-related behaviors conducive to health and well-being.
 Nutrition education is delivered through multiple venues and involves activities at the
individual, community, and policy levels.
I. Theories
A. Health Belief Model (HBM)
- Explains and predicts health behaviors based on patient’s beliefs about the health problem
and the health behavior
- Relies on the assumptions that patients are willing to participate and that they believe that (Columns)
health is highly valued (Becker, 1990)
Objectives:
Components:
Content/Time:
a. Individual perceptions
Method:
b. b. Modifying factors
Resources:
c. c. Likelihood of Action
Indicators:
Self-Efficacy Theory (Bandura, A. 1997)
Theory of Reasoned Action and Theory of Planned Behavior
- based on a person’s expectations relative to a specific course of action.
- a person's behavior is determined by their intention to perform the behavior and that this
- It deals with the belief that one is competent and capable of accomplishing a specific intention is, in turn, a function of their attitude toward the behavior and subjective norms
behavior – a precursor to expected outcomes. (Fishbein & Ajzen, 1975).
- 4 Principal sources of info cognitively appraised and processed: - It focuses on the construction of a system of observation of two groups of variables, which
are: attitudes defined as a positive or negative feeling in relation to the achievement of an
a. Performance accomplishment
objective; subjective norms, which are the very representations of the individuals’
b. Vicarious experiences perception in relation to the ability of reaching those goals with the product.
c. Verbal persuasion
d. Emotional arousal Therapeutic Alliance Model (Barofsky, 1978)
- Addresses the shift of power from the provider to a learning partnership in which
collaboration and negotiation with the consumer are key.
Stages of Change Model (Prochaska & DiClemente, 1996)
- A therapeutic alliance is formed between the caregiver and the care receiver in which the
6 Stages:
participants are viewed as having equal power. The client is viewed as active and
1. Precontemplation responsible, with an outcome expectation of self care.
2. Contemplation - Concordance – emphasis on the consultative process ( Hobden,2006).
3. Preparation
4.Action The Teaching-Learning Process
5. Maintenance 1. Assessment of Learning needs, readiness to learn, and learning styles
6. Termination 2. Mutually setting the goals/objectives.
3. Teaching-learning sessions
Teaching Plan Format 4. Determination of behaviour changes (outcomes) in knowledge, attitudes and skills.
Patient name: Age/Gender:
Topic: EVIDENCED BASED GUIDELINES (EBG) IN NURSING PRACTICE
Goal:
- Major Recommendation
-Background Information

- Reference List

Evidence based practice (EBP)

 is the conscientious use of current best evidence in making decisions about patient

care (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). GRADE ranking Recommendation
 is a conscientious, problem-solving approach to clinical practice that incorporates the
best evidence from well-designed studies, patient values and preferences, and a
 High Confident that the effect in the study reflects the
clinician's expertise in making decisions about a patient's care.

actual effect.

 Moderate Quite confident that the effect in the study is

close to the true effect, but it is also

possible it is substantially different.

The Iowa Model of Evidence-Based Practice

It is a five-step process:
 Beginning with the identification of the nursing problem and readings about the
situation/problem identified.
 Reconciling with the priorities of the Organization.
 A core group or a team is identified;
 Implementation of the project
Statement of Evidence  Evaluate the project/study implemented.

I a Evidence obtained from meta-analysis of RCTs
I b Evidence obtained from at least 1 RCT
II a Evidence obtained from at least 1 well-designed controlled study without
randomization
II b Evidence obtained from at least 1 other type of well-designed quasi- experimental
study
A thorough review of literatures available is done and critiquing and synthesis follows. The
following need to be looked into:
a. Consistency of the findings across the studies.
b. Types and the quality of the studies.
c. Relevance of the findings to clinical practice.
d. Adequacy of the studies using a population similar to that of the organization , where the

,
III Evidence obtained from well-designed non-experimental descriptive studies such
as comparative studies, correlation studies, and case reports
findings may be applied.
e. Feasibility of the findings in practice.
f. Risk-benefit ratio.