BHT-016 Block-3

BHT-016
Basic Home Health

Indira Gandhi
National Open University
Assistance
School of Health Sciences
Block
3
NUTRITIONAL, DIETARY AND
ELIMINATION NEEDS
UNIT 9
Introduction to Diet 5
UNIT 10
Special Dietary Practices 24
UNIT 11
Giving Medicines 34
UNIT 12
Meeting Elimination Needs 48
CURRICULUM DESIGN COMMITTEE
Dr. Pradeep Kumar Dr. Sneh Lata Manocha Dr. Biplab Jamatia
Professor Former Associate Professor Asst. Prof. (Sr. Scale)
Dr. M.K. Medical College Ahilya Bai College of Nursing SOHS, IGNOU
Ahmadabad, Gujrat New Delhi
Mrs. Madhavi Verma Prof. T.K Jena

Principal, College of Nursing Project Director Dr. Neerja Sood
ILBS New Delhi Skill Training Cell, SOHS, Asst. Prof. (Sr. Scale)
IGNOU SOHS IGNOU
Dr. Neelam Makheeja
Assistant Professor Mrs. Laxmi
Ahilya Bai College of Dr. Reeta Devi Asst. Prof. (Sr. Scale)
Nursing, New Delhi Asst. Prof. (Sr. Scale) & SOHS, IGNOU
Course Coordinator, SOHS,
Dr. Rubi Bansal IGNOU
HOD Preventive Health,
Yashoda Super Speciality
Hospital, Kaushambi,
Ghaziabad
BLOCK PREPARATION TEAM

Unit 9 & 10
Dr. Reeta Devi Unit 11 Unit 12
Asst. Prof. (Sr. Scale) & Mrs. Laxmi Dr. Sobha Gusain
Course Coordinator, SOHS, Asst. Prof. (Sr. Scale) Faculty Ahilya Bai College
IGNOU SOHS, IGNOU of Nursing, New Delhi
EDITORIAL TEAM
Dr. Reeta Devi Dr. A. K. Sood Dr. Anu Gauba
Asst. Prof. (Sr. Scale) & Senior Consultant, Consultant
Course Coordinator, SOHS, Skill Training Cell, SOHS, IGNOU Skill Training Cell, SOHS,
IGNOU IGNOU, Maidan Garhi,
Dr. D. C. Jain New Delhi
Senior Consultant,
Skill Training Cell, SOHS, IGNOU
CO-ORDINATION Course Coordinator

Prof. T. K. Jena Dr. A. K. Sood Dr. Biplab Jamatia
Project Director Senior Consultant, Assistant Professor (Sr. Scale)
Skill Training Cell, SOHS, Skill Training Cell, SOHS, IGNOU
IGNOU SOHS, IGNOU Maidan Garhi, New Delhi
Dr. D. C. Jain
Senior Consultant,
Skill Training Cell, SOHS, IGNOU
MATERIAL PRODUCTION
Sh. Ajit Kumar
Section Officer (Publication)
School of Health Sciences, IGNOU
The curriculum has been adapted from the “Short term Training Curriculum Handbook for
Home Health Assistance” prepared by MoHFW, 2017, whose Standards are based on the
National Skills Qualifications Framework (NSQF), Ministry of Skill Development and
Entrepreneurship (MSDE)
July, 2019
© Indira Gandhi National Open University, 2019
ISBN : 978-93-89200-88-1
All rights reserved. No part of this work may be reproduced in any form, by
mimeograph or any other means, without permission in writing from the Indira
Gandhi National Open University.
Further information on the Indira Gandhi National Open University courses may
be obtained from the University’s office at Maidan Garhi, New Delhi-110 068 or
the website of IGNOU www.ignou.ac.in
Printed and Published on behalf of the Indira Gandhi National Open University,
New Delhi, by Director, School of Health Sciences, IGNOU.
We acknowledge the reference of material and figures from CHBHC Programme,
Units 9, 10, 11 of SOHS, IGNOU.
LaserTypeset by : Rajshree Computers, V-166A, Bhagwati Vihar, (Near Sector 2,
Dwarka), Uttam Nagar, New Delhi-110059
BLOCK 3 INTRODUCTION
The Block 3: Nutritional and Elimination Needs, has four units (Unit 9 to
Unit-12).
The Unit 9 describes the concept of basic nutrients, sources and their
functions in human body. The Unit 10, covers special dietary practices,
types of diets used in illness. It will also tell you about patient care
before and after feeding. The Unit 11 is on giving medicine and insulin
injection. The Unit 12 will tell you about changing diapers, urinary catheter
care and giving enema.
Nutritional, Dietary and
Elimination Needs
4
UNIT 9 INTRODUCTION TO DIET
Structure
9.0 Introduction
9.1 Objectives
9.2 Basic Nutrients
9.3 Sources and Functions of Basic Nutrients
9.4 Balanced Diet
9.4.1 Steps of Healthy Eating/Living
9.4.2 Food Pyramid
9.5 Food Safety

9.5.1 Food Safety Measures at Home
9.6 General Precautions While Feeding

9.6.1 Myths Related to Diet in Diabetes
9.6.2 Health Education to Bring a Change in the way a Diabetic Client Eat
9.7 Concept of Glycaemic Index (GI)

9.7.1 Food Items Release Sugar Rapidly (very fast) in the Blood
9.7.2 Food Items Release Sugar with Moderate Pace in the Blood
9.7.3 Food Items Release Sugar Slowly in the Blood
9.8 Let Us Sum Up

9.9 Key Words
9.10 Answers to Check Your Progress
9.0 INTRODUCTION
Diet plays major role to maintain tissues and body function. Diet helps in
speedy recovery of the patients; it means that patient recover faster after
an illness with good diet. At the same time well balanced diet provide
resistance to fight against infection. As a home based care providers, you
would be concerned not only giving care and meeting physical needs of
the patients but also his nutritional needs, although you would be giving
food to your patients, provided by the family, but if you have basic
knowledge about nutrition in health and disease, then you can suggest
some changes in the food for the patient, motivate and encourage your
patient to have well balanced diet with those changes which suits during
illness. Hence, this unit explores interesting facts about the role of food in
health and disease. You will be learning about basic nutrients, their
sources, and functions in brief. You will also learn the types of diets,
dietary modification, and diet in disease conditions and food safety
measure.
5
Elimination Needs 9.1 OBJECTIVES
After going through this unit you should be able to:
 describe the concept of basic nutrients;
 name various nutrients;
 describe sources and functions of various nutrients;
 explain the types of diets used in illness;
 describe how to give advice on diet during various illnesses;
 describe contamination in food and food safety measures;
 explain myths related to diet in diabetes;
 impart health education to bring a change in the way a diabetic client
eat; and
 discuss the concept of Glycaemic Index (GI).
9.2 BASIC NUTRIENTS

The food refers to anything which keeps us healthy to work energetically.
Just think, can we survive without food? If yes, for how long? Answer is
no? We can not survive without food even if we are living healthy life.
What about those, who are sick and chronically ill? Every body needs
food to keep on surviving and sustaining life. Let us now learn about the
food which contains substances called nutrients.
A) Basic Nutrients
The substances present in the food, which are required to perform major
functions in our body, are known as nutrients. These nutrients are: (Fig. –
9.1)
i) Carbohydrates
ii) Proteins
iii) Fats
iv) Vitamins
v) Minerals
vi) Water
Fats Proteins
Carbohydrate
Nutrients
Vitamins Water
Minerals
6 Fig. 9.1: Basic Nutrients

Introduction to Diet
9.3 SOURCES AND FUNCTION OF BASIC
NUTRIENTS
Let us learn about sources and function of these nutrients along with diseases
caused due to deficiency of nutrients in the (Table - 9.1) given below:-
Table 9.1: Sources and Function of basic nutrients
Nutrients Sources with examples Functions Deficiency Disease
Carbohydrates 1. Cereals: Rice, wheat, Supply Energy Protein energy

maize, bajra, ragi, jowar. mal-nutrition
2. Root vegetables: (kwashiorkor):
Potato, sweet potato, Swelling of feet,
colocasia (Kachalu) etc. hands, to
3. Sugar and jaggery: generalized
gurh oedema.
Proteins 1. Milk and milk Body building Protein energy

products: Milk, curd, Build new tissues mal-nutrition
paneer, cheese, khoya and repair worn (marasmus)-Gross
2. Pulses : Dals out tissues wasting of
3. Flesh food : Fish, Egg, muscles, loss of
Meat weight.
4. Nuts and oil seeds:
Ground nut, almonds,
cashew nut
Fats 1. Fats and oils: Ghee, Supply Energy Malnutrition High

vanaspati, butter, intake leads to
vegetable oils, obesity.
(mustard, soyabean,
ground nut etc.)
Vitamin A Mango, apricot, orange, Prevent night Night

papaya (yellow colour blindness blindness
fruits and Yellow colour
vegetables)
Vitamin B Whole (Sabut) cereals, Protect the body 1. Cracking at

Whole (Sabut) pulses. from infection corners of the
lips
2. Feeling of pins
and needles,
sensation of
the legs
Vitamins C Green leafy vegetables Helps in healing of Scurvy, which can

e.g. spinach (palak), wound. lead to bleeding
amaranth, fenugreek in the gums
(methi), mustard (sarson)
and drumstick leaves
Fruit such as- Guava,
amla, Orange, Sweet lime,
Mausami Grapes etc.
Vitamins D Exposure to sunlight Bone growth Rickets –

provides Vitamin D, deformity of
which helps in bones/ Children
absorption of calcium in
the body
7
Nutritional, Dietary and C) Minerals
Elimination Needs
In order to make the diet well balanced, we need to know minerals and
their major functions as shown in Table 9.2
Table 9.2: Minerals and their Functions
Minerals Functions
Calcium Development of bones & teeth Contraction &
relaxation of heart muscles. Facilitation of nerve
impulses Clotting of blood
Phosphorous Development of bones & teeth Contraction &
relaxation of heart muscles. Facilitation of nerve
impulses
Iron Iron is required for the formation of hemoglobin.
Transport of oxygen through the action of
haemoglobin. To maintain immunity.
Iodine Iodine is required for the formation of hormone
thyroxin
Sodium Chloride Sodium Chloride – is also known as common salt
for regulation of fluid balance
Potassium for regulation of acid – basic balanceTransmission of
nerve impulse
Proteins build new tissues and repair worn out tissues e.g. all
are working hard all the day and get tired by evening we need
rest in the night so we sleep 6-8 hours in By next morning we
are again ready for work, once again feel fresh hence, the
proteins in the diet helps in building of worn out tissues.
Check Your Progress 1
1) List the minerals and their major functions.
2) Fill in the blanks:-
1) Rich sources of carbohydrates are ————————————
2) Fats are required to ———————————————
3) Rich sources of proteins are ——————————————
4) Name the fruits rich in vitamin C————————————
5) Name the sources of vitamin A —————————————
D) Energy value of nutrients
1 gm of carbohydrate – Provide 4 k.calories
1 gm of protein – Provide 4 k.calories
8 1 gm of fat – Provide 9 k.calories

Food provides us with energy. Energy is measured in kilocalories. One Introduction to Diet
kilocalorie is the amount of heat required to raise the temperature of one
kilogram of water by one degree centigrade. In the section 9.7 you will
read diet plan in different calories which are prescribed to the patients
depending upon their calorie requirements.
Vitamins
Major function - Protect the body from infection and helps in the
regulation of body processes.
9.4 BALANCED DIET

Let us read the balanced diet in details as given below:
Meaning and definition
Balanced diet is defined as one, which contains variety of foods in such

quantities and proportions that the need for carbohydrates, fats, proteins,
minerals, vitamins and water are adequately met. Hence, balance diet
 Consists of different types of food items such as a meal should

consists of chapatti, rice, dal, vegetable, curd, salad & water as per
the requirement of the body needs.
 Meet the minimum need for nutrients for the individual
With the help of Fig. 9.2 it will be easy for you to understand the
concept of well balanced diet.
As shown in the figure nutrients supply to the body is equal to nutrient

needed by the body is called balanced diet.
Nutrient supply Nutrient Need
Balance
Fig. 9.2 : Balance Diet Scale
9.4.1 Steps of Healthy Eating/Living

The basic of food is carbohydrates in daily diet. These are taken in lunch
as well as in dinner such as chapatti, rice, bread, dalia, upma etc. These
foods provide energy, vitamins and hence minerals, whole wheat flour
(atta) should be preferred to refined flour (Maida), under milled rice is
better than polished rice as they/ both contain fibres.
Vegetables and Fruits, These are rich in antioxidant, which protect us from
several diseases like cancer, heart disease. so include plenty of vegetables
and fruits in the diet, including some in the raw form as salad like carrots,
raddish, cabbage etc. may be finely chopped or grated if person with
dental problem or elderly find it difficult to chew.
9
Nutritional, Dietary and Pulse, nuts milk and milk products, fish and chicken are good sources of
Elimination Needs
proteins are body building food and hence useful to the body. Hence one
should include at least one item from this group in every meal. Such as
curd milk and its products like cheese, curd, paneer etc. contain calcium
which help us to keep the bones strong.
Eggs and red meat should be taken in limited amounts, as one grows
older. They are rich in fat cholesterol Oil, ghee, butter provide energy,
Excessive consumption of these fats in old age is harmful to health. Avoid
eating too much of fried foods as one grows older, and may lead to
disease like high blood pressure, heart disorders and cancer in later life.
Salt is considered to be an essential constituent of diet. However, the

taste for salt is an acquired one. Too much salt is harmful for the body.
Its use should be restricted in old age as it can lead to high blood
pressure.
Sugar and Jaggery also provide energy; however, their use in the diet
should be restricted.
You can advise the patient and family members regarding these steps of
healthy living not only for the patient but also for family members to
promote their health and well being.
Precautions other than diet are as follows:
1. Exercise for a healthy heart: - Walking briskly for half an hour a day
at least 3-4 times per week.
2. Cope up with stress. It is not work but worry that kills.
3. Practice Yoga for better health.
4. Stop smoking-Think and stop today
Let us now learn about the food pyramid in which we will discussed what
should be eaten in more amount and food item which are to be eaten in
plenty and item to be eaten in little amount and fats and oils in very less
amount.
9.4.2 Food Pyramid

Food pyramid includes all the food groups – so that all five groups of
nutrients (carbohydrates, protein, fats, vitamins, and minerals are present in
your meal)
The foods at the bottom of the pyramid are to be eaten in plenty, to

provide bulk of basic requirements of calories, while those at the top are
to be eaten in small amounts. Reduce the relative amount as you move to
the top of the pyramid (Fig. 9.3A) .
The figure given below (Fig. 9.3B) is a simple diagrammatic representation

of what a nutritious and healthy diet should constitute.
10
Fig. 9.3A: Food Pyramid
Too much salt or sugar

Drink at least 6- 8
can be harmful, so use
glasses of water each
them in less amount.
day …it’s good for you
Eat for a healthy

heart. Don’t eat
your heart
Fig. 9.3 B : Healthy Living Tips
9.5 FOOD SAFETY

As a home assistance for health needs you must know about the
contaminants in the food and also what measures should be taken to keep
the food safe. As there are so many sources of infection, food can also
get contaminated and become source of infection. Let us earn the meaning
of contamination of food.
1) Food contamination – Harmful substances or micro organisms
present in the food which are capable of causing infection in human
beings is called contaminated food.
2) Causes of food contamination are:-
 Food infection can be transmitted by insects such as housefly
which causes diarrhea (loose motion), Typhoid fever.
11
Nutritional, Dietary and  Eating raw vegetables grown on soil contaminated with sewage
Elimination Needs
allow the entry of parasites such as round worm; tape worm
enters into the human system.
9.5.1 Food Safety Measures at Home

The followings are measures to promote food safety at home:-
 Any person handling food must be healthy and free from infection.
 Personal hygiene of food handlers must be maintained. It includes
hand washing with soap and water, daily bath, neat and tidy hair
style etc.
 Food storage is also to be maintained. Food stored is not only
important before preparation and before being served but also after
cooking, even during the process of serving the food. Freeze is best
option for raw vegetable and also to store left out cooked food.
Always cover the food with lid so that flies do not sit on it.
 In case of fruits and vegetables – it must be washed, scrubbed and
soaked in water
 Washing of vegetables and fruits before cutting or eating.
 Never eat cut vegetable/ fruit from out side vendor.
9.6 GENERAL PRECAUTIONS WHILE FEEDING

Let us read about general precautions to be followed while feeding the
patients or in some situations even normal food to the healthy individual
with some deformity for which he is not able to have food himself/herself,
You while communicating with the patient of family members might come
across myths related to dietary habits so we will discuss here, and
solution for resolving these false beliefs.
Points to remember while feeding the patients are given below:
 You should ensure to keep the preference of food by the patient in mind.
 Wash hand of the patient as well as your hand hygiene is very
important to prevent spread of infection.
 It is hygienic to use spoon instead of hands or knife and fork
depending upon the type of food made available to the patient.
 The food should not be too hot or too cold. Check the temperature
by touching from side of the serving dish.
 Ask the patient to pass urine or empty bladder before taking food.
 Encourage patient eating diet as prescribed by doctor/dietician for
early recovery.
 Ensure that the food served as per menu card of the same patient.
You need to verify with the Nursing officer before serving the diet
received from the kitchen. Diet is served as per the written order
only.
12
 In case of any doubt you need to ask the nursing officer first then Introduction to Diet
only give it to the patient.
 Feeding a patient on bed is essential for those who are not able to
get up from the bed. You will be learning in the practical session
how to meet nutritional needs of the patients.
 Ensure oral hygiene is well maintained, patient is groomed properly
and dressed in clean clothes before feeding.
 A soft diet is easy to chew and easily digestible food.
 Patient should be explained about the timings of meal serving in the
hospital for breakfast, lunch and dinner.
 Ensure correct method of feeding along with type of diet prescribed

by the physician and you would assist the nursing officer while giving
feed.
9.6.1 Myths Related to Diet in Diabetes

There are various myths which you may come across in the home hence,
you have to acquaint yourself, so that you can make them understand in
resolving the problem.
Let us understand with the help of example
There are myths in the mind of people related to diet, in diabetes, one of
the diseases in which diet plays very important role for control of blood
sugar levels.
Table 9.3 shows myths or false ideas which commonly come in our minds
related to diet in diabetes. There are several myths; some of these are
given below:
Table 9.3: False ideas (myths) related to diet in diabetes

Myths Solution to myths
Too many rules are There is some adjustment rather than too
there to follow the many rules. You need to choose the foods as
‘Diabetes Diet’ per the activities you carry out and the
medicines taken by you for blood sugar control.
‘Carbohydrates’
Carbohydrates constitute the largest portion in
(food containing
our diet as main sources of energy. Overall
starch e.g. wheat,
carbohydrates are good for diabetes. The one
rice, maize, jowar
having high glycaemic index (GI) are bad-
etc.) are ‘Bad’ for
Count how much carbohydrate you eat in a
diabetes
day. It contains essential nutrients, vitamins,
minerals, and fibres. Rich sources are: whole
grain chapati, rice, jowar, barley, maize. Wheat
and rice both raise blood sugar levels to similar
extent, hence, it hardly matters whether one
takes wheat or rice, as long as total amount is
restricted. Carbohydrates should account for 13
Elimination Needs 55% to 65% of the total calories you eat every
day as shown in figure 9.4 Please refer in
details about GI in Section 9.7 of this unit.
Proteins are Carbohydrates affect blood sugar levels very
better choice for fast. Hence, there is a tendency among diabetics
diabetes than to take more protein. Too much protein can
carbohydrates. be harmful in diabetes. The foods such as
meat, mutton having proteins as well as
saturated (bad) fat increases risk of heart
disease. Protein should account for 15% to 20%
of the total calories you eat every day as
shown in figure 9.4
Fig. 9.4: Percentage of major nutrients contributing to total Calories in a meal
9.6.2 Health Education to Bring a Change in the Way

a Diabetic Client Eat
You would provide advices to the patient and their family members as
explained below:
1) Bring a change gradually
It is very easy to say that to act according to rules. Although there
are certain food items which should be reduced as soon as possible
such as sweets, fruit juices either canned or freshly prepared, very
sweet fruit like chikoo, fried things like samosa, bread pakora, gulab
jamun, jalebi, etc.
However, you shouldn’t try to do everything at once. You should
learn to adjust and adopt various changes slowly. You should have
three major meals i.e. breakfast, lunch and dinner daily. Missing meals
14
and starving for a long time may be dangerous. In diabetes, take Introduction to Diet
small portion at each meal time and frequently (4-6 times) in a day.
2) Set realistic, short and achievable goals
Let us take an example: you set a goal to reduce weight. If your
target is to reduce 5-10 kg weight in a month or so, it may not be
a realistic goal. But if you set to reduce 400-500 gms/month, then it
may be a realistic goal, and you can achieve it. This will make you
feel happy.
3) Reward yourself
When you achieve your short-term goal, reward yourself by doing
something like going for a movie, shopping, or picnic with family
etc.
4) Measure the amount of food
It is important to eat the food in right size. If you eat a larger
portion, count it as more than one serving. We will cook half cup of
rice, after cooking it will be full (Double amount). The amount you
eat may be 1 cup. This would count as two servings from the starch
group of food. Let us read the equivalence of one serving size based
on food groups as follows.
The fruit serving sizes are:- 1/2 banana or 1 small apple or orange, or
pear.
The vegetable serving sizes are:-1 cup of raw leafy vegetables or 1/2
cup of other vegetables; cooked, raw (chopped) or 1/2 cup of vegetable
juice.
There are some foods which weigh less while uncooked and become
more after you cook it such as rice, pulses.
9.7 CONCEPT OF GLYCAEMIC INDEX (GI)

It is very important in context of Diabetes Mellitus to understand the
Glycaemic Index as given below:
Glycaemic Index (GI) is used to measure the glycaemic response of
food, in other words it means how quickly a food item gets converted
into sugar and enters the blood stream in comparison to an equivalent
amount of glucose (sugar). Knowing about GI is useful in planning
diets for diabetes.
The GI value for glucose is taken as 100
The closer the GI of different foods to glucose or 100; the more unsafe
it is for diabetics to eat that food item. Values of GI are given below:
 High GI value is 70 or more.
 Medium GI value is 56- 69
 Low GI value is less than 55.
15
Nutritional, Dietary and 9.7.1 Food Items Release Sugar Rapidly (very fast) in
Elimination Needs
the Blood
Food items having high Glycaemic index of more than 70 releases sugar
very fast in the blood. Avoid these items such as:
 Mashed potato (boiled) - French fries
 Glucose- sugar , sweets, cakes, pastries, gur, dates, sweetened
juices, honey
 White rice (polished)- puffed wheat, saboodana, arrowroot
 Maida items - white bread
 Flakes-corn flakes, rice-flakes
 Fruits - water melon, chickoo and sitaphal
9.7.2 Food Items Release Sugar at a Moderate Pace

in the Blood
There are food items having medium Glycemic index of 56-69 which
release sugar in moderate pace in the blood. Take these items in
moderation (neither too much nor too less) such as:
 Un-peeled boiled potato (with skin)
 Muesli (puffed rice), basmati rice, parboiled rice, whole bread.
 Digestive biscuits, pizza, ice cream, coca cola/pepsi
 Fruits and nuts: raisins, pine apple
9.7.3 Food Items Release Sugar Slowly in the Blood

There are food items having low Glycemic index below 55 which release
sugar slowly in the blood. These can be eaten daily, such as
 Nuts: walnut, almond, groundnut
 Vegetables : cabbage, cauliflower, tomato, green leafy vegetables
(methi, sarson, palak etc.), isabgol, peanuts
 Pulses: rajma, beans, black gram (kala chana), kabuli chana
,besan,
 Whole grains : brown rice, dalia, brown bread, oats, bajra, pasta,
millets macaroni , noodles
 Milk & Skimmed milk products : curd (low fat), milk chocolate
etc.
 Fruits: banana, mango (slightly unripe & smaller), orange, grape,
apple, peach, apricot, cherries, kiwi, strawberry, pears etc.
 Boiled egg white
16
Remember to advise a diabetic client:
Once in a while when you eat a high GI food, combine it
with a large portion of low GI food to balance your blood
sugar. Obese persons should be more careful.
Let us read and get familiar with some of the sample menus according to
calorie variations so that you can plan your meal for the whole day. Meal
plan of diabetics for different food groups are given below in Tables 9.4,
9.5, 9.6, 9.7).
Tabel 9.4: Meal plan of diabetics for different food groups

TOTALCALORIEVALUE CABOHYDRATES PROTEINS FATS
OF DIET (gm) (gm) (gm)
1200 150 60 40
1500 180 70 55
1700 210 80 60
(Source: Raghuram TC, Pasricha S, Sharma RD. Diet and Diabetes.

National Institute of Nutrition, Hyderabad, 2003)
Table 9.5: Sample of Diet Charts with different Calorie Values
1200 calories Diabetic Diet
This diet provides Gm % Calories
Protein 50 16
Fats 29 21
Carbohydrates 190 63
Food Stuff Vegetarian (g) Non-Vegetarian (g)
Cereals (Grains) 150 185
Pulses 60 15
Green leafy vegetables 200 200
Other vegetables 200 200
Fruits 100 100
Milk 300 100
Oil 10 15
Flesh foods — 50
17
Nutritional, Dietary and Table 9.6: Sample Menu (1200 Calories)
Elimination Needs
Schedule Cooked Food Non-Vegetarian
Vegetarian
Early MorningBed Tea/ coffee 1 cup 1 cup
Breakfast
Toast(Bread)/Dalia 1 piece or ½ cup Two
Milk 1 cup —-
Tea/Coffee (without sugar) — 1 cup
Mid MorningOrange/Nimbu pani One/1 glass One
Lunch
Rice/Chapati 1Katori /2 1Katori /2 chapati 40 g

chapati 40 g
Sambar/Dal/Paneer(25gm) 1 Katori 1 Katori
Vegetable (boiled) 1 Katori 1 Katori
Salad– (without Chakunder) One each One each
Buttermilk/ Curd (Dahi) 1 Katori or ½ Katori/ ¾ Katori

3/4Katori
Evening
Tea (without sugar) One cup One cup
Upma/Roasted Chana ½ Katori ½ Katori
Dinner
Chapati + Rice 2+1/2 cup 1+1/2 cup
Lentil Dal ¾ Katori —-
Beans curry 1Katori 1Katori
Egg curry/Meat/Fish/Chicken — 1Katori
Buttermilk/ Curd (Dahi) 1Katori/ 100g —
Salad – (without Chakunder) 100 g 100g
Note :- Here, one katori is equal to 100g

Table 9.6A: 1500 Calories Diabetic Diet
This diet provides G % Calories
Protein 60 15.5
Fats 37 21.5
Carbohydrates 244 63.0
18
Pulses 60 20
Fruits 100 100
Milk 300 150
Oil 15 20
Flesh foods — 70
Table 9.6B: Sasmple Menu (1500 Calories)
Vegetarian
(without sugar)
Breakfast
Toast Two Two
Egg (half boiled) —- One
Milk 1 Cup —-
Tea/Coffee(without sugar) — 1 Cup
Mid Morning Orange/apple/ One One
Papaya/sweet lime (100g)
Lunch
Rice/Chapati 2Katori/ 1 chapati, 2Katori/ 1chapati, 20 g
20 g
Sambar/Dal 1 Katori 1Katori
Vegetable (boiled) 1 Katori 1 Katori
Salad-100 gm. (without One each One each
Chakunder)
Dahi ½ Katori ¼ Katori
Evening
Tea (without sugar) One Cup One Cup
Upma/Roasted Chana 3/4 Katori ¾ Katori
Dinner
Chapati (20 gm each) 3 4
Green gram dal 1 Katori —-
Cauliflower curry 1Katori 1Katori
Fish/Chicken curry — 2 pieces
Roasted Papad One One
Salad – 100g (without Chakunder) 1Katori 1 Katori
Note :- Here, 1 katori is equal to 100g

19
Nutritional, Dietary and Table 9.7A: 2000 calories Diabetic Diet
Elimination Needs
This diet provides g % Calories
Protein 64 13
Fats 48 22
Carbohydrates 328 65

Pulses 70 25
Fruits 200 200
Milk 400 200
Oil 20 30
Flesh foods — 30
Table 9.7B: Sample Menu (2000 Calories)
Vegetarian
(without sugar)
Breakfast
Toast Three Four
Milk 1 Cup —-
Egg ( half boiled) — One
Tea/Coffee — 1 Cup
Mid Morning- Orange/apple/ One One

papaya/sweet lime (100g)
Lunch
Rice/Chapati 2Katori/ 1 2Katori/ 1 chapati 20 g

chapati 20 g
Sambar/Dal 1 Katori 1Katori
Vegetable (boiled) ½ Katori ½ Katori
Salad—100g (without Chakunder) 1Katori 1Katori
Buttermilk/ Curd (Dahi) 1 Katori/ 3/4Katori ½ Katori / ¾ Katori
Evening
Tea (without sugar) One Cup One Cup

20
Vegetable sandwich Two Two Introduction to Diet
Dinner
Chapati Two Three
Rice ½ Katori ½ Katori
Moth Dal 1K —-
Beans curry 1K 1K
Chicken roasted — 1 piece
Buttermilk/ Curd (Dahi) 1K/100g —
Salad – (without Chakunder) 100 g 100g

1) List the energy value of major nutrients.
................................................................................................................
................................................................................................................
2) Define balance diet
................................................................................................................
................................................................................................................
3) State the measures to promote food safety.
................................................................................................................
................................................................................................................
4. Discuss the values of Glycemic Index.
................................................................................................................
................................................................................................................
9.8 LET US SUM UP

This unit dealt with the following aspects:-
 Basics of nutrition and balanced diet
 Sources and functions of nutrients , balanced diet
 Food safety measures at home and step of healthy eating
Adequate diet is the key to good health. Every one wishes to remain
youthful even in old age. Hence one should be sensible in choosing the
right food from childhood onwards. Good life style can, not only delay
ageing and increase the life span but also adds to the quality of life. We
have discussed the myths related to diet in diabetes, and how to bring
about a change in behavior slowly, concept of calories and samples of
different clories diet, at the end of the unit we have highlighted the very
important aspect that is glycemic index with examples.
21
Elimination Needs 9.9 KEY WORDS
Food Contamination : Harmful substances or micro organisms
present in the food capable of causing
infection
Therapeutic diets : Modification or changes in normal diet
e.g. increase or decrease in consistency
and energy content, putting more or less
amount of one more nutrients, increases or
decreases in fiber content diet without
spices, etc.
Obesity : Excessive weight in skin folds, around
abdomen, etc. these conditions results
because of exercise intake of calories and
lac of physical activity.
Anemia : Pallor of mucous membrane, caused by
lack of iron due to deficiency of food
such as green leaf by vegetables, sprouted
pulses, meat and meat products
Food Hygiene : All measures necessary for ensuring the
safety of food at all stages from
protection till consumption.
A Bland diet : Diet free from spices and condiments.
Food Hygiene : Measures which are necessary for food
safety
9.10 ANSWER TO CHECK YOUR PROGRESS

Answer to Check Your Progress 1
1) Function of minerals are as given below:-
Minerals Functions
Calcium Development of bones & teeth Contraction
& relaxation of heart muscles. Facilitation of
nerve impulses Clotting of blood
Phosphors Development of bones & teeth Contraction
& relaxation of heart muscles. Facilitation of
nerve impulses
Iron Iron is required for the formation of
hemoglobin. Transport of oxygen through the
action of haemoglobin. To maintain immunity.
Iodine Iodine is required for the formation of
hormone thyroxin
Sodium Chloride Sodium Chloride – is also known as
common salt for regulation of fluid balance
Potassium for regulation of acid – basic balance
22
2) 1. Rice, wheat, Maize Introduction to Diet
2. Supply energy
3. Milk & milk products
4. Guava, amla, citrus fruits
5. Mango, orange, papaya
1) Energy value of nutrients
1 gm of carbohydrate – Provide 4 kcalories
1 gm of protein – Provide 4 kcalories
1 gm of fat – Provide 9 kcalories
Balanced Diet
2) Definition
Balanced diet is defined as one, which contains variety of foods in

such quantities and proportions that the need for carbohydrates, fats,
proteins, minerals, vitamins and water are adequately met. Hence,
balance diet.
3) Measures to promote food safety
 Any person handling food must be healthy and free from

infection.
 Personal hygiene of food handlers must be maintained. It include

hand washing with soap and water, daily bath, neat and tidy hair
style etc.
 Food storage is also to be maintained. Food stored is not only

important before preparation and before being served but also
after cooking, even during the process of serving the food.
Freeze is best option for raw vegetable and also to store left
out cooked food. Always cover the food with lid so that flies
do not sit on it.
 In case of fruits and vegetables – it must be washed, scrubbed

and soaked in water
 Washing of vegetables and fruits before cutting or eating.
 Never eat cut vegetable/ fruit from out side vendor.
4) Values of Glycemic Index are given below:
 High GI value is 70 or more.
 Medium GI value is 56- 69
 Low GI value is less than 55 23

Elimination Needs UNIT 10 SPECIAL DIETARY
PRACTICES
Structure
10.0 Objectives
10.1 Introduction
10.2 Dietary Modification in Disease Conditions
10.2.1 Types of Diets
10.2.2 Diet in Disease Condition
10.3 General Precautions while Feeding
10.3.1 Assisting in Feeding using Various Methods
10.4 Observation and Reporting of Unusual Findings
10.5 Let Us Sum Up
10.6 Key Words
10.7 Answer to Check Your Progress
10.0 OBJECTIVES
After going through this unit you should be able to:
 explain the types of diets used in illness;
 explain general precautions while assisting in feeding using various
methods of feeding;
 observe and report any unusual findings during feeding; and
 give health education on diet during various illnesses.
10.1 INTRODUCTION
Diet plays major role to maintain tissues and body function. Diet helps in
speedy recovery of the patients, it means that patient recover faster after
an illness with good diet. At the same time well balanced diet provide
resistance to fight against infection. As a home based care providers, you
would be concerned not only giving care and meeting physical needs of
the patients but also his nutritional needs, although you would be giving
food to your patients, provided by the family, but if you have basic
knowledge about nutrition in health and disease, then you can suggest
some changes in the food for the patient, motivate and encourage your
patient to have well balanced diet with those changes which suits during
illness. Hence, this unit explores interesting facts about the role of food in
health and disease. You will be learning about basic nutrients, their
sources, and functions in brief. You will also learn the types of diets,
dietary modification, and diet in disease conditions and food safety
measure.
10.2 DIETARY MODIFICATIONS IN DISEASE

CONDITIONS
In our previous section, you have come to know about three food groups,
their sources and functions. You must remember that change in diet is
24 required in case of several diseases and the modified diet is also part of
treatment for the patient to help him/her in early recovery from the illness. Special Dietary Practices
Hence, even if patient like/ dislike the taste of modified diet but he has to
follow necessary restrictions. As a Home Based Care Provider, you need
to make patient understand the importance of modified diet and ensure
that patient accept it and agree to take it. So, we will be discussing types
of modified diets. Look at the figure 10.1
10.2.1 Types of Diets
This sub unit will describe different types of diets (Fig. 10.1)
Normal Diet
Semi Solid Diet Modifications in diet Soft Diet
Clear fluid
Fig 10.1: Types of Diets
 Clear fluid – Clear food are given when intake of nutrients are
restricted to replace the fluid and electrolytes, and which supply very
little nutrients. e.g. Rice water, dal water, clear chicken soup etc.
 Semi solid diet – Semi Solid diet include all solid prepared in such
a manner that it become soft and mash them in the water in which it
was boiled. It does not require to strain the solids of the contents
eg. Rice mixed with water, dal mixed with water, mixed vegetable
water, saboodana, dalia, should be over cocked and shall be mashed.
 Soft diet – Soft diet is just like normal diet modified to help people
who have dental problems e.g. elderly persons. No food is restricted.
Soft diet is prepared by removing the skin and seeds, cutting or
chopping into fine pieces and cooking well e.g. mix vegetable khichri,
mixed vegetable dalia, sweet dalia, kheer etc.,
 Normal diet- Balance diet is a normal diet. It includes variety of
foods and ensure all nutrients are supplied. Such as all three food
groups are provided i.e. Group 1: Energy giving food, Group 2:
Body-building foods and Group 3: Protective or regulatory foods.
A list of dishes out of which food planned to be served in a meal or for
one day is called a Menu and list is called menu card. Please refer
details in Unit 9.
10.2.2 Diet in Disease Conditions
1. Eating the wrong type of foods can lead to several problems like
obesity, hypertension and heart disease, diabetes mellitus are common
diet related diseases of advancing age, hence, simple diet restriction
help to control these disorders. For example, obesity, leads to arthritis
(Joint problem), heart disease, diabetes mellitus etc. hence, maintaining
normal range of weight will keep one healthy and active.
25
Nutritional, Dietary and 2. Many patients require dietary modification as well as prescription from
Elimination Needs
the physician in addition to the medicines. It is the responsibility of
the dietician to plan diet for the patient and also explain to these
dietary modifications to them.
Table 10.1A given below tells about disease/condition/problem its meaning
and which modified diet should be given in different situation , but you
should also remember that provided diet by doctor is given priority. Diet
is planned keeping disease condition, age/sex, activity level, dietary habit,
socio economic, cultural characteristics in mind.
Let us read some of the disease conditions which require modifications in
diet which are commonly given to the patients in the hospital, and you
should get familiar with the terms in relation to the feeding requirements of
the patients so that you are well prepared to look after the patients
without facing problem.
Table 10.1: Disease conditions which require modifications in diet
Disease/Condition/ Meaning Modification in diet
Problem
Obesity Increase of excess of Decrease intake of (take in less

body fats leading to amount) rice, chapati, bread,
increase in body weight. excess of sugar, chocolates,
sweets, jam, jellies, pastry, ice
cream, ghee, butter, oils, patties,
fried snack- (prantha, pakoda,
samosa, patties etc.)
Increase intake of Fibre rich
fruits and vegetables, orange,
mango, cheekoo, carrot, radish
etc.
Diabetes Mellitus Increase of sugar in Decrease intake of (take in less
blood (Obesity is a amount) food items as mentioned
strong risk factor) in obesity. Eat plenty of fresh
Blood Glucose green leafy vegetables, salad,
LevelsNormal : 80-120 sprouts – moong dal, kala
mg%Impaired glucose chanaRestrict banana, mango,
tolerance-120-180 cheekoo, sweet potato etc.Food
mg%Diabetes mellitus: with high glycemic index such
More than 180 mg% as boiled & mashed potato, corn
flakes, water melon, riped banana
etc.
Hypertension High blood pressures Decrease intake of (take in

(More than 130 mmHg less amount):
systolic) (More than 90
mmHg diastolic) gradually Fats: ghee, butter, fried food,
increases over a period samosa, pakora.
of time. Obesity is an Restrict: use of salt either very
important risk factor. low or salt free diet or without
salt.Alcohol: restrict or
completely stop taking.
Fever Fever is a symptom of Increase intake of: energy

any infection in body in giving and body building food.
which temperature rises Plenty of liquids- Glucon C,
to above 1010F ORS, Lassi, Lemon water etc.
26
Kidney failure Fail to form urine, does Special Dietary Practices
Increase the amount of
not excrete wastes from proteins: Milk and milk
the body. Fails to products, egg white,
maintain fluids and pulsesIntake of fluid should be
electrolyte balance. equal to output. Salt restriction.
Kidney stone Solid particles get Restrict meat & meat products,
collected in the kidneys pulses, dried beans, spinach,
leading to severe pain. (palak), tomato, beetroot, fig,
almond.
Indigestion (Not able to digest food) Plenty of liquids:Glucon C, ORS,
Heart Burn (Acidity)Gas Lassi, Lemon water etc.Semisolid:
formation, feeling dalia, khichri with curd,
ofvomiting sensation or saboodana etc.
vomits
Gastritis (Infection in stomach) Clear fluid after 24-48 hours of

Lack of appetite, restriction of food. Then semi
(Acidity) Heart burn solid, followed by solid diet
based on tolerance by patient
choice
Constipation Difficult passage of hard Plenty of liquids: Coconut water,

stools light tea, butter milk (lassi), rice
water.Semi Solids: khichri, dalia,
riped mashed banana, bread
mashed with milk. Plenty of
fibers: Salad of raw vegetables:
whole dals and wheat floor
without straining with their skin.
Kidney stone Solid particles get Restrict meat & meat products,
collected in the kidneys pulses, dried beans, spinach,
leading to severe pain. (palak), tomato, beetroot, fig,
almond.
Indigestion (Not able to digest food) Plenty of liquids:Glucon C,

Heart Burn (Acidity)Gas ORS, Lassi, Lemon water
formation, feeling etc.Semisolid: dalia, khichri with
ofvomiting sensation or curd, saboodana etc.
vomits
Gastritis (Infection in stomach) Clear fluid after 24-48 hours of

Lack of appetite, restriction of food. Then semi
(Acidity) Heart burn solid, followed by solid diet based
on tolerance by patient choice
Constipation Difficult passage of hard Plenty of liquids: Coconut water,

stools light tea, butter milk (lassi), rice
water.Semi Solids: khichri, dalia,
riped mashed banana, bread
mashed with milk. Plenty of
fibers: Salad of raw vegetables:
whole dals and wheat floor
without straining with their skin.
Diarrhea (Piles) Loose frequent Plenty of liquids: Glucose

passage of grey, greasy, water, electrolyte solution, home
foul smelling stools made liquids, rice water, dal
(More than 3 times) water etc.
Hemorrhoids Bleeding at the time of Bland diet: (without spices boiled
passing Stool food)fiber restricted diet
27
Elimination Needs Cirrhosis of liver JaundiceDamage/ death High carbohydrates,
of liver cells High protein
Moderate fat
Vitamin B complex
Cholecystitis Inflamed gallbladder Low fat diet,

Bland diet
Fat restricted diet depending
upon condition of the patient
Pancreatitis Inflamed pancreas High calorie/carbohydrates Low
fat diet at small frequent
intervals. Restrict - Alcohol
strictly
Diarrhea (Piles) Loose frequent Plenty of liquids: Glucose water,
passage of grey, greasy, electrolyte solution, home made
foul smelling stools liquids, rice water, dal water etc.
(More than 3 times)
Hemorrhoids Bleeding at the time of Bland diet: (without spices

passing Stool boiled food)fiber restricted diet
Cirrhosis of liver JaundiceDamage/ death High carbohydrates,

of liver cells
High protein
Moderate fat
Vitamin B complex
Cholecystitis Inflamed gallbladder Low fat diet,

Bland diet
Fat restricted diet depending
upon condition of the patient
Pancreatitis Inflamed pancreas High calorie/carbohydrates Low

fat diet at small frequent
intervals. Restrict - Alcohol
strictly
10.3 GENERAL PRECAUTIONS WHILE

FEEDING
Let us read about general precautions to be followed while feeding the
patients or in some situations even normal food to the healthy individual
with some deformity for which he is not able to have food himself/herself,
depending upon the condition and situation.
Keep the following point in mind while feeding the patients
 Food is the most important requirement of human being to maintain
and restore health. You are going to help an individual in feeding
along with other health team members at home set up. You would
assist in serving the food and making your patient eat in comfortable
position.
 Some patients might eat themselves while other need assistance during
feeding. So You have to find out different needs of the patients, for
example, a helpless patient will not be able to eat him/herself, it
28 means you have to be with them throughout the finishing of food by
the patient. Special Dietary Practices
 Also it is important to keep the preference of food by the patient in

mind.
 It is hygienic to use spoon instead of hands or knife and fork
depending upon the type of food made available to the patient.
 The food should not be too hot or too cold. Check the temperature
by touching from side of the serving dish.
 Encourage patient eating diet as prescribed by doctor/dietician for
early recovery.
 Ensure that the food served as per menu card of the same patient.
You need to verify with the Nursing officer before serving the diet
received from the kitchen. Diet is served as per the written order
only.
 In case of any doubt you need to ask the nursing officer first then
only give it to the patient.
You will be visiting Kitchen to observe variety of menu cards displayed
which have different calorie calculations and also prepared with
measurements of nutrients, hence, be extra careful while serving food as
per prescription of each patient as per individual needs.
Feeding a patient on bed is essential for those who are not able to get
up from the bed. You will be learning in the practical session how to
meet nutritional needs of the patients.
Let us now read certain general precautions while feeding the patient
 Food plays the most important role in early recovery from the
disease.
 Ensure oral hygiene is well maintained, patient is groomed properly
and dressed in clean clothes before feeding.
 Patient should be explained about the timings of meal serving in the
hospital for breakfast, lunch and dinner.
 Ensure correct method of feeding along with type of diet prescribed
by the physician and you would assist the nursing officer while giving
feed.
 Ask the patient to pass urine or empty bladder before taking food.
10.3.1 Assisting in Feeding using Various Methods

 This will depend upon the order written by the doctor and also
condition of the patient. If the patient is conscious, independent usually
pre-operative patients, patient with fractures of lower legs, of in
recovery phase can take food themselves. Only you can serve the
food at their bed side.
 In case of partially dependent patients such as one eye operated, arm
fracture, etc. provide them food at their bedside and remain with the
patient for further assistance.
29
Nutritional, Dietary and  Assist the patient to wash hands before and after the food is taken
Elimination Needs
by the patient.
 Check the diet and ensure it is the one that is ordered. Serve the
diet so that it looks attractive to look.
 Feed the patient slowly and in small amounts, encourage chewing and
swallowing.
 Give water in between if he/she wants.
 Those who do not have teeth are mostly served liquid diet or
semisolid diet, So provide such as soup/ fruit juice/dalia/khichdi/idli etc
in container suitable for this food.
 If patient has difficulty drinking, use a bendable straw if permitted.
 Depending upon the condition of the patient, some might be
recommended to give feed through Ryle’s Tube: It means giving feed
to a patient through a tube inserted into the stomach through nose or
mouth. The purpose is to feed the patient who cannot take oral feed
such as patient in unconscious state, after major surgery on mouth,
throat and foodpipe (esophagus).
10.4 OBSERVATION AND REPORTING OF

UNUSUAL FINDINGS
After reading the methods of feeding and points to be kept in mind, let
us now the other important aspect is to observe the unusual findings if
any during the patient eating, so that you can report which would help in
improving the health of the patient. These are as follows:
1. The food served to the patient as per his/her liking or not.
2. Patient finished the food served in total or left in between.
3. In case of Unconscious patient- you found him/her uncomfortable/
uneasy/difficulty in breathing/ Coughing- stop giving feed immediately
and report to nursing officer.
4. Food might enter in wind pipe (Respiratory passage) instead of going
in food pipe- stop giving feed immediately and report to nursing
officer. This is Aspiration of food into respiration, need to be
handled within no time, otherwise consequences can be dangerous.
5. There can be other common finding-Regurgitation- food taken by
the patient returns back to food pipe rather than going ahead in the
stomach. Patient might feel in discomfort, and can compliant of
burning pain (Acidity). These findings should be reported to the health
team head i.e. Doctor concerned so that necessary measures can be
taken on time for the benefit of the patient.
6. It is also important to note the timings when the patient complaints of
any abnormal happening during taking food whether before or after
the meal such as breakfast, lunch or dinner timings.
7. You can ask for the indigestion, overeating or under eating by the
patient for which necessary action by the doctor needs to be carried
out. Your duty is to report only and carry out the order as per
30 instruction of the Nursing officer/Doctor.
Special Dietary Practices
10.5 LET US SUM UP
This unit dealt with the basics of nutrition and balanced diet followed by
types of dietary modification.
As per the condition of the patient diet to be served, hence, it is
important for you to know diet required to be given in diseases condition
/ problem. When caring for dietary need you have to keep certain point
in mind and we have discussed general precautions while meeting feeding
needs also. Adequate diet is the key to good health. Every one wishes to
remain youthful even in old age. Hence one should be sensible in choosing
the right food from childhood onwards. Good life style can, not only delay
ageing and increase the life span but also adds to the quality of life,
which were covered in the previous unit also. Some time unusual can
happen inspite of taking all precautions, hence, you must be aware of
these abnormal symptoms usually in case of semi conscious or unconscious
patients which has been given in one of the section.
1) Explain the types of diets for the patients
................................................................................................................
................................................................................................................
................................................................................................................
2) List the name of diseases which requires diet modification.
................................................................................................................
................................................................................................................
................................................................................................................
3) List general precautions while feeding the patient
................................................................................................................
................................................................................................................
................................................................................................................
4) Discuss the unusual findings during feeding
................................................................................................................
................................................................................................................
................................................................................................................
10.6 KEY WORDS

Therapeutic diets : Modification or changes in normal diet e.g.
increase or decrease in consistency and
energy content, putting more or less amount of
one more nutrients, increases or decreases in
fiber content diet without spices, etc.
Obesity : Excessive weight in skin folds, around
abdomen, etc. these conditions results because
of exercise intake of calories and lac of
physical activity. 31
Nutritional, Dietary and Anemia : Pallor of mucous membrane, caused by lack of
Elimination Needs
iron due to deficiency of food such as green
leaf by vegetables, sprouted pulses, meat and
meat products
Food Hygiene : All measures necessary for ensuring the safety
of food at all stages from protection till
consumption.
A Bland diet : Diet free from spices and condiments.
Food Hygiene : Measures which are necessary for food safety

1)  Clear Fluid – Clear food are given when intake of nutrients are
restricted to replace the fluid and electrolytes, and which supply
very little nutrients. e.g. Rice water, dal water, clear chicken soup
etc.
 Semi Solid Diet – Semi Solid diet include all solid prepared in
such a manner that it become soft and mash them in the water
in which it was boiled. It does not require to strain the solids of
the contents eg. Rice mixed with water, dal mixed with water,
mixed vegetable water, saboodana, dalia, should be over cocked
and shall be mashed.
 Soft Diet – Soft diet is just like normal diet modified to help
people who have dental problems e.g. elderly persons. No food
is restricted. Soft diet is prepared by removing the skin and
seeds, cutting or chopping into fine pieces and cooking well e.g.
mix vegetable khichri, mixed vegetable dalia, sweet dalia, kheer
etc.,
 Normal Diet- Balance diet is a normal diet. It includes variety
of foods and ensure all nutrients are supplied. Such as all three
food groups are provided i.e. Group 1: Energy giving food,
Group 2: Body-building foods and Group 3: Protective or
regulatory foods.
2) Obesity, Diabetes Mellitus, Kidney failure, Fever, Diaorrhea (De-
hyderation)
3) General precautions while feeding the patient
 Food plays the most important role in early recovery from the
disease.
 Ensure oral hygiene is well maintained, patient is groomed
properly and dressed in clean clothes before feeding.
 Patient should be explained about the timings of meal serving in
the hospital for breakfast, lunch and dinner.
32  Ensure correct method of feeding along with type of diet
prescribed by the physician and you would assist the nursing Special Dietary Practices
officer while giving feed.
 Ask the patient to pass urine or empty bladder before taking
food.
4) 1. In case of Unconscious patient- you found him/her in
comfortable/uneasy/difficulty in breathing/ Coughing- stop giving
feed immediately and report to nursing officer.
2. Food might enter in wind pipe (Respiratory passage) instead of
going in food pipe- stop giving feed immediately and report to
nursing officer. This is Aspiration of food into respiration, need
to be handled within no time, otherwise consequences can be
dangerous.
3. There can be other common finding-Regurgitation- food taken
by the patient returns back to food pipe rather than going ahead
in the stomach. Patient might feel in discomfort, and can
compliant of burning pain (Acidity). These findings should be
reported to the health team head i.e. Doctor concerned so that
necessary measures can be taken on time for the benefit of the
patient.
4. It is also important to note the timings when the patient c/o any
abnormal happening during taking food whether before or after
the meal such as breakfast, lunch or dinner timings.
You can ask for the indigestion, overeating or under eating by the patient
for which necessary action by the doctor needs to be carried out. Your
duty is to report only and carry out the order as per instruction of the
Nursing officer/Doctor.
33
Elimination Needs UNIT 11 GIVING MEDICINES
Structure
11.0 Objective
11.1 Introduction
11.2 Types of Medicines
11.3 Routes of Giving Medicines
11.4 Oral Medication
11.4.1 Definition and Purposes
11.4.2 Contra Indications
11.4.3 Points to be Kept in Mind
11.4.4 Five Rights while Giving Medicines
11.5 Subcutaneous Injection

11.5.2 Types of Insulin Syringe
11.5.3 Sites for Giving Subcutaneous Injection
11.5.4 Points to be Kept in mind While Giving Subcutaneous injection
11.6 Instillation of Drops

11.6.2 Instillation of Eye Drops
11.6.3 Instillation of Ear Drops
11.6.4 Nasal Drops Instillation
11.7 Let Us Sum Up

11.8 Key Words
11.0 OBJECTIVES
After completing this unit, you will be able to:
 identify different types of medicines;
 explain different ways of giving medicines;
 explain the written order of the physicians;
 assist in giving medicines on written prescriptions; and
34  describe the home health assistants in giving medicines.

Giving Medicines
11.1 INTRODUCTION
In the previous unit you have learnt about, how to maintain personal hygiene
and comfort of the patients and also how to maintain safety devices ( appliances)
that keeps the patients safe at home and prevent any injuries. Giving medicine
is the most responsible activity to be carried out for the patient at home. Usually
after a patient is discharged from the hospital, there are drugs prescribed by
the doctor that has to be given at different point of time of the day with
instructions, for example some of the medicines are to be taken before/after
the meal, some as and when needed, some empty stomach, or with food, etc.
In this unit, you will be learning about the various types of medicines, the purposes
of giving medicines, common medicines, the routes of giving drugs and its given
precautions i.e. points to keep in mind while giving medicines. One must read
it carefully because it is one of the very very important responsibility of the
home care assistant to take care of the patient. One wrong act can put the
life of patient in danger.
11.2 TYPES OF MEDICINES

There are various types of medicines available needed as per the health problem
of the patient. Every drug has certain specific actions, strict instructions are to
be followed while giving the medicines. and these are to be given via various
set routes. As a home health assistant, you will be giving medicines to clients
within the home set up, most of the time there the client is prescribed with
variety of medicines, most commonly these are given orally e.g. some times
when the patient’s condition do not allow to take tablet or capsule then he/
she is prescribed with other form of medicines either in the form of injections
or liquids. Let us now learn about the common forms of medicines.
1. Capsule : Powder or gel forms of drugs encased in a hard or soft outer
casing that dissolves in the stomach or powered drugs or liquids within
a gelatin container. E.g.Cap.Cobadex-Z, Vitamine E, Amoxicillin 500mg.
2. Lotion : Drugs in liquid suspension intended for external use e.g. Lacto-
calamine lotion, Cureac lotion. Calapure Lotion-skin, body care lotion.
3. Pill : Drug in powder form mixed in a cohesive material. These are single
dose units made by mixing the powdered drug with a liquid such as syrup
and rolling the mixture into round or oval shape. It is replaced by tablets
and capsules. e.g. Oral Contraceptive Pill-Saheli, Mala D.
4. Solution : Liquid preparations containing one or more substance completely
dissolved in a solvent commonly water).Betadine , dettol, savlone.
5. Suppository: A drug or several drugs mixed in a firm base such as
glycerinated gelatin and shaped for insertion into the body cavities such
as rectum, vagina or urethra. The base melts easily and slowly at body
temperature and release the drug. e.g. we give glycerin suppository in rectum
to relieve constipation and helps in passing of stool.
6. Syrup : Drug dissolved in a solution containing water and sugar, often used
to cover up the unpleasant taste of druge and smooth the irritated membrane
of the throat e.g Dexorange, Cremaffin, Corex.
35
Nutritional, Dietary and 7. Tablet : Solid drug that is compressed or molded into a particular shape
Elimination Needs
and that may be swallowed whole. It is also available in chewable forms
or placed under the tongue, depending on its purpose. Some are readily
broken along a scored line, some are enteric – coated to prevent irritation
to gastric mucosa or to prevent irritation to gastric mucosa or to prevent
the effect of gastric secretions upon the drug. Tab Gelusil, Digene, Crocin
(Paracetamol).
These are the common forms of drugs which we have discussed above
and you can see that all these types of drugs are easily available at home
setting and are also easy to use.
11.3 ROUTES OF GIVING MEDICINES

By now, you know that medicines are available in different forms i.e. tablet,
syrup, solution etc. As the type of medicines varies the routes of giving them
also are different. For e.g. some medicines we take some medicines by mouth,
or some are just applied on skin like balm while some are given by injection
etc.
Let us now discuss the various routes in the administration of medications:
 Oral : In the Oral medication route the medicine are taken by mouth e.g.
pill, capsule or liquid form which the patient swallow with water. Oral
administration is the most common, convenient, least expensive and safe
for most of the patients
 Sub-lingual : In Sub-lingual route the drug is placed under the tongue for
slow absorption.
 Injection: In this route medications are given by injecting a drug directly
into a vein (intravenous), muscle (intramuscular) or into the fatty tissue
beneath the skin (subcutaneous). The speed of effect of this is faster than
oral administration and is used when more complete and faster absorption
is needed.
 Inhalation and Nebulisation: Drugs are given by this method to have
local or systemic effect by nebulizers or inhalers to carry the drug into
to lungs by breath.
 Inunctions: It is the application of the drug on the skin usually by friction
rubbing (topical) such as Iodex, mosquito repellent.
 Instillation: It is putting of drug in a liquid form in a body cavity, or body
orifices e.g. eyes, ears, rectum or vagina.
 Insertion: It is introducing a solid form of drug into the body orifices e.g.
suppository.
You must have got prescription from the physician during your lifetime for some
or the other illness, or some family member or friend etc. You must have observed
the doctor saying that drug to be taken twice/thrice in a day for at least for
one week/month. While explaining the written order there often are some
abbreviations which are used in writing medication order
36
As a home health assistance must understand these abbreviations so that you Giving Medicines
can also assist the patient in taking right drug at right time and correct dose.Some
common abbreviations include:
 P.O.: by mouth
 I/M: intramuscular injection
 S/C: subcutaneous injection
 I/V: intravenous injection
 PR: per rectum
 H.S.: at bedtime
 AC: before meals
 PC: after meals
 O.D.: Once in a day
 B.I.D.: twice in a day
 T.I.D.: three times in a day
 Q.I.D.: four times in a day
Some examples of medication orders using these abbreviations are:
Tab Ferium 100mg H.S. x 7 day this means take Tab Ferium 100mg at
bed time for 7 days
1) List down three types of drugs
...............................................................................................................
...............................................................................................................
...............................................................................................................
2) List various routes of giving medicines
...............................................................................................................
...............................................................................................................
...............................................................................................................
3) Write down full form of the following abbreviations.
I/M :
S/C :
I/V :
OD :
TID :
37
Elimination Needs 11.4 ORAL MEDICATION
After going through in brief about the various routes of drug administration,
let us now learn about these routes one by one.
11.4.1 Definition and Purpose
Oral medication means administration/giving of medicine through mouth for
prophylactic and therapeutic effects.
Purpose
· To promote health: to increase resistance to diseases and to meet the
deficiencies of the patients e.g. iron supplementation, vitamins, etc.
 To relieve pain: pain relief e.g. analgesics (Crocin)
 To provide treatment (e.g. antibiotics for infections)
11.4.2 Contra Indications
It means when medicine are not allowed to be given orally and in certain
conditions oral route is avoided:-
 Unconscious patients. Such as Coma
 Uncooperative patients – Aggressive, depressed patients.
 Patient with oral surgery /surgery of the stomach.
11.4.3 Points to be Kept in Mind
There are few points to be kept in mind while administering medicines
Let’us discuss some of the important points to be kept in mind while giving
medicines to the patient.
Before giving medicines check the following points:-
 The doctor’s written order for the medicine.
 The expiry date of the drug.
 Dose of the drug written on the prescription slip.
 While giving tablets or capsules do not touch them with bare hands,
 Once it is taken out of the container do not put back the medicine inside
the container again.
In case of giving syrup/ liquid medicine make sure the following:-
 Shake the liquid medicine before pouring it in container.
 Wipe the mouth of the bottle, close it tightly and replace it at the proper
place.
 Pour prescribed quantity of liquid medicine
 You can measure the quantity with plastic cap of medicine bottle, which
38 has marking in ml.
11.4.4 Five Rights while Giving Medicines Giving Medicines
During the administration of medicines keep five R’s in mind:-
 Right drug. Before opening the package that contains the drug always
ensure that you are giving right prescribed drug by checking with doctor’s
order.
 Right route. Check for the route of administration of how the drug is
to be given orally or injectable etc Remember you are only allowed to
give subcutaneous injection after enhancing your competency and proving
your proficiency under the supervision of academic counselor only.
 Right dose. Check the medicine strip for the strength of medicine. Such
as a tablet of 5 mg, 100 mg and 200 mg etc. You need to make sure
what dosage is to be given to your patient as written in the order.
 This requires simple division. For Example if the tablet Betaloc 25 mg bd

is prescribed to your client and medicine is available in 50 mg tablet then
you will have to make a tablet half and make sure it should be equal halves
which will be equal to 25 mg than give to client
 Right time: The medicines should be given at right time. For example
if the dose is to be given once in a day then you have to give the dose
in the morning hours at 10 a.m. after the breakfast.
As you are looking after a patient at home, you always need to give the right
drug to right patient so that there is no confusion.
After giving medication
 Observe for local effect that might emerge i.e. rashes/ patches, irritation
and itching
 Ensure the patient has swallowed the pill completely
 Monitor the condition of the patient by observing for signs of nausea or

vomiting
 If one observes any local side effect immediately report to family members
so that they can inform the doctor.
 Ask your patients to remain in an upright position after taking medicines,

do not lie down immediately.
11.5 SUBCUTANEOUS INJECTION

The most common routes of giving injections are intramuscular, intravenous and
subcutaneous. We will be teaching you about the subcutaneous route only.
Because subcutaneous route is self administered injection by diabetic patients
and easy to administer , as well as given frequently depending upon the condition
of the patient for lifelong. This will ensure that the patient does not depend
upon on somebody else for getting it in time, as it has to be given before
breakfast, before lunch, and before dinner depending upon the condition of the
39
Nutritional, Dietary and patient i.e.- three times in a day. We would discuss about this insulin injection
Elimination Needs
in detail. This is as given below:

When medicines are given by the route of the injections and are introduced
just below the skin in cutaneous tissues at 45 degree angle that is in subcutaneous
tissues. hence it is called subcutaneous injection. The main purpose is to get
a rapid effect of the drug.
11.5.2 Types of Syringe and Needle used for Insulin
 A syringe which holds 0.5 to 1 ml of injection Insulin is insulinis an syringes
which is divided in units Figure 11.1
Fig. 11.1: Insulin Syringe
Each ml of solution contains 100 units of insulin

The needles for giving insulin through subcutaneous route is available in small
size only.
 For subcutaneous injections size of needles used is 25 gauge
 Disposable syringes and needles are available in market which you can
use for patient and throw it after use.
11.5.3 Sites for Giving Subcutaneous Injection

The best site for giving a subcutaneous injection includes Figure 11.2
Upper Arm
Left & right
On the abdomen
Coastal
margin of
Front thigh
iliac Left
Right & left
and right
Fig. 11.2: Sites for giving subcutaneous injection

40
 Area with more blood vessels also known as vascular areas, around the Giving Medicines
outer aspect of the upper arm,
 The abdomen from below the costal margin of iliac crest and
 Anterior (Front) aspect of the thigh. all these areas are easily accessible:
Look at the dark pink areas on these pictures to find areas of the body
where insulin is injected. Inject insulin into:
 The abdomen, but at least 2 inches from the belly button. The abdomen
is the best place to inject insulin because abdomen area can absorb insulin
most consistently.
 The top outer area of the thighs. Insulin usually is absorbed more slowly
from this site, hence you exercise soon after injecting insulin into your legs.
 The upper outer area of the arms.
 The buttocks.
Change of the spot of the injection spot slightly each time you inject insulin.
Because using same spot every time can form bumps or pits in the skin. For
instance, use the right upper arm 5 times in different places, then use the left
upper arm in 5 places. Site of giving injection has to be rotated for safe injection
practices and safety of the patient to avoid further complications.
11.5.4 Points to be Kept in mind while Giving Subcutaneous
Injections
 The injection site chosen should be free of infection, skin lesions, scars
of bony prominence.
· Change the injection site regularly to prevent infection, no injection site
should be used for more than five or six to weeks.
 You should choose the needle length and the angle of insertion based on
the patient’s weight. More commonly a 25-gauge (5-8)” needle is inserted
at a 45 – degree angle. Refer to the Practical Block for the procedure
of giving injection.
 If the patient is obese then you can pinch the tissue and use a needle
long enough to insert through the fatty tissue at base of skin fold.
 For a very weak and thin patient, the best site for subcutaneous injection
is upper abdomen.
1) List the sites for giving subcutaneous injections.
.................................................................................................................
.................................................................................................................
2) Discuss the point to be kept in mind while giving subcutaneous
injections.
.................................................................................................................
.................................................................................................................
41
Elimination Needs 11.6 INSTILLATION OF DROPS
Let us read about the other routes for giving certain drugs as given below:

Instillation of drops is the putting of drugs in a body cavity or body orifices
(openings) e.g. eyes, ear, nose, rectum or vagina.
Purpose
To provide local and therapeutic effects of drug released at slow and steady
rates is the main purpose. In this unit we will be discussing the instillation of
drugs in eyes, ear and nose.
11.6.2 Instillation of Eye drops

This is putting of drug in liquid form in eyes( Figure 11.3)
Purpose
 To relieve pain and discomfort
 To treat infection
 For moistening the eye
Fig. 11.3: Instillation of eye drope

42
Points to be kept in mind:- Giving Medicines
 First clean the eye with boiled cooled cotton swabs as learnt in eye care
in skill 7 of practical manual -1
 For instilling the eye drop ask the client to lie in bed or sitting position
with head slightly hyperxtended and stand behind the patient
 Ask the client to look up
 Separate lower lid of the eye by pressing it against the cheek bone.
 Hold a filled medication drop approximately 1 to 2 cm above conjunctival
sac and drop a prescribed number of drops in to conjunctival sac of the
lower eyeball.
 Ask the Client to close eyes and move eyeball from side to side.
11.6.3 Instillation Ear Drops

Definition
Putting drops into the ear canal for a localized effect (Fig 11.4)
Purpose:-
 To soften ear wax so that it can be removed easily.
 To provide local therapy to reduce infection.
 To relieve pain
Fig. 11.4: Instillation of ear dropes
Point to be kept in mind:-

 Tell the client to lie upwards so that the ear can be treated upwards.
 Clean the ear with an bud.
43
Nutritional, Dietary and  Straighten the external auditory/ear canal by holding the pinna of the ear
Elimination Needs
up and back word
 Instill the prescribed drop holding the dropper one cm above the ear canal
 Instruct client to be in same position for five minutes.
11.6.4 Instillation of Nasal Drops

Definition
It is an instillation of medicated liquid drops into a nasal cavity (Figure 11.5)
Purpose
 To straighten/reduce swollen mucous membrane of nose.
 To loosen secretions and facilitates drain safe
 To treat since are infection of nasal cavity
Fig. 11.5: Installation of nadal drops
Points to be kept in mind:-

 Advice the clients to avoid use of nasal decongestants for longer period.
 Nasal opening should be clean and free from any discharges
 The patient should be placed in a proper position i.e. supine positions and
place a pillow under the shoulders
 Hold the dropper 1 cm above nares and instill the prescribed no. of drops
towards the medium of the ethmoid bone
 Instruct clients to be in same position for five minutes
 Caution him not to blow the nose for several minutes
 Discard the remaining medication from the dropper before putting back
44 the dropper in the bottle.
Check Your Progress 3 Giving Medicines
1. List the steps of procedure for instillation of eye drops.

.................................................................................................................
.................................................................................................................
.................................................................................................................
2. Discuss the points to be kept in mind while instilling eye drops
.................................................................................................................
.................................................................................................................
.................................................................................................................
3. What are points to be kept in mind while instilling ear drops?
.................................................................................................................
.................................................................................................................
.................................................................................................................
11.7 LET US SUM UP

In this unit we have discussed learnt about the administration of medicine by
different routes. As a home health care assistant this will be the major task
for which patient and family will be dependent on you. In the practical unit
you will be doing it as a practical skill. The knowledge of the theory unit will
help you to perform better while administering drugs and subcutaneous injection.
11.8 KEY WORD

Prophylactic : When the medicine is given to prevent certain disease or
condition.
Therapeutic : When medicine is given for the treatment of particular disease
or infection
Resistance : Power to fight against infection
Antibiotic : Medicine used for killing the bacterial infection
Analgesic : A substance to reduce pain
Supplement : A pill or special kind of food to improve health

1) Tablets, Capsule, Syrups
2) Oral administration
Sub – lingual or buccal
Nebulisation,
Instillation,
Parental 45
Nutritional, Dietary and Answer to Check Your Progress 2
Elimination Needs
1) The best site for giving a subcutaneous injection includes vascular areas
around the outer aspect of the upper arm, the abdomen from below the
costal margin of iliac crest and the anterior aspect of the thigh. These areas
are easily accessible.
2)  Points to be kept in mine. The injection site chosen should be free
of infection, skin lesions, scars of bony prominence.
 Change the injection site regularly to prevent infection.
 No injection site should be used for more than six to seven weeks.
 You should choose the needle length and the angle of insertion based
on the patient’s weight. More commonly a 25-gauge (5-8)” needle
is inserted at a 45 – degree angle. Refer Practical Block for the
procedure of giving injection.
 If the patient is obese then you can pinch the tissue and use a needle
long enough to insert through the fatty tissue at base of skin fold.
 For a very weaker and thin patient, the best site for subcutaneous
injection is upper abdomen.
1)  For instilling the eye drop ask the client to lie in a supine position
or sitting position with head slightly hyper extended and stand behind
the patient
 Separate lower lid of the eye by pressing it against the check bone.
 Hold a filled medication drop approximately 1 to 2 cm above
conjunctival sac and drop a prescribed no. of drops in to conjunctival
sac/center of the lower eye boll.
 Ask the Client to close eyes and move eyeballs from side to side.
2) Following are the point to be kept in mind while giving subcutaneous
injections.
 The injection site chosen should be free of infection, skin lesions, scars
of bony prominence and large underlying muscles and nerves.
 For the patient of diabetes should change the injection site regularly
to prevent infection or hypertrophy (thickening).
3) Following are points to be kept in mind while instilling ear drops:-
 Give side lying position to client with ear to be treated upward.
 Clean the ear with ear bud.
 Straighten the external auditory/ear canal by holding the pinna of the
ear up and back word
· Instill the prescribed drop holding the dropper one cm above the ear
canal.
46
Answer to Check Your Progress 4 Giving Medicines
1. The purposes of putting eye drops are:-

 For instilling the eye drop ask the client to lie in a supine position
or sitting position with head slightly hyper extended and stand behind
the patient
 Separate lower lid of the eye by pressing it against the check bone.
 Hold a filled medication drop approximately 1 to 2 cm above
conjunctival sac and drop a prescribed no. of drops in to conjunctival
sac/ center of the lower eye boll.
 Ask the Client to close eyes and move eye boll from side to side.
47
Elimination Needs UNIT 12 MEETING ELIMINATION
NEEDS
Structure
12.0 Objectives
12.1 Introduction
12.2 Common Terminologies Related to Elimination
12.3 Brief Anatomy and Physiology Related to Urinary and Bowel
Elimination
12.4 Factors Affecting Urinary and Bowel Elimination
12.5 Common Problems of Urinary Elimination and their Management
12.5.1 Retention of Urine
12.5.2 Incontinence of Urine
12.6 Common Problems of Bowel Elimination and their Management

12.6.1 Constipation
12.6.2 Fecal Impaction
12.6.3 Diarrhea
12.6.4 Flatulence
12.6.5 Bowel Incontinence
12.7 Role of Home Health Assistant in Meeting Elimination Needs of

a Bed-Ridden Patient
12.7.1 General Care of a Bed Ridden Patient
12.7.2 Providing a Suppository
12.7.3 Providing Urinal/Bedpan
12.7.4 Applying Adult Diaper/Briefs/Absorbent Pad to Incontinent Patient
12.8 Seeking Medical Help

12.9 Let Us Sum Up
12.10 Key Words
12.0 OBJECTIVES
After completing this unit, you should be able to:
 define common terminology related to elimination;
 explain related anatomy and physiology of urinary and bowel
elimination;
 delineate factors affecting urinary and bowel elimination;
 explain various urinary and bowel elimination problems and their
management; and
 delineate home health assistant’s role in meeting elimination needs of a
48 bed ridden patient.
Meeting Elimination Needs
12.1 INTRODUCTION
Elimination is the expulsion of the wastes from the body by way of lungs, skin,
rectum and urinary bladder. Normal elimination of urine and stool is necessary
to maintain the homeostasis of the body and well-being of the person. If the
elimination is inadequate or improper then there can be accumulation of toxins
and unwanted substances in the body which may disturb the normal functioning
of the body and various complications may develop. In this unit you are going
to learn about common problems of elimination and your role in meeting
elimination needs of patient.
12.2 COMMON TERMINOLOGIES RELATED

TO ELIMINATION
The Common Terminologies Related To Urinary Elimination are as follows:
 Micturition (urination, voiding) –it is the act of expelling urine from the
bladder.
 Dysuria – it is painful micturition.
 Enuresis – it is the involuntary passage of urine.
 Pyuria –it means pus in the urine.
 Anuria- urine output less than 100 ml of urine per day (e.g. in
kidney failure).
 Oliguria – urine output less than 400 ml per day (e.g. in kidney
disease)
 Hematuria –presence of blood in urine
 Polyuria – abnormally large production of urine (more than 2.5 to 3
litres per day).
 Albuminuria –presence of albumin in the urine (e.g. in kidney
damage).
 Glycosuria –presence of glucose(sugar) in urine (e.g. in diabetes
mellitus)
 Haemorrhoids (Piles) – dilated/distended veins of rectum causing difficult
defecation.
Terminology related to bowel elimination
 Defecation –it is the act of expelling fecal material from the rectum.
 Flatus – intestinal gas
 Colonic irrigation- it is the thorough flushing of the large intestine.
 Enema (Clysis) – it is the introduction of fluid into the rectum.
 Proctoclysis- it is a slow injection of a large quantity of fluid into the
rectum for absorption into the body.
49
Nutritional, Dietary and  Melaena- stools those are very dark /black because of presence of
Elimination Needs
blood.· 3
 Steatorrhoea- abnormal quantity of fat in stool or fatty stools (e.g.
mal-absorption disorder)
 Acholic - Clay colored stools (e.g. in gall bladder disease)
12.3 BRIEF ANATOMY AND PHYSIOLOGY

RELATED TO URINARY AND BOWEL
ELIMINATION
Let us to through anatomy and physiology of urinary system before
reading problem.
The urinary tract consists of two kidneys, two ureters, urinary bladder and
urethra (figure 12.1). The kidneys filter and excrete blood constituents that
are not needed and retain those that are required by the body. Nephron
is the basic structural and functional unit of kidneys. The nephrons remove
urea, creatinine and uric acid from the blood plasma and form urine. Once
urine is formed it is sent to urinary bladder through a pair of urethra.
The urinary bladder serves as temporary reservoir for urine. It is made up
of smooth muscles. The person feels a desire to void when the bladder
fills about 150-250 ml in an adult. The urethra conveys the urine from
bladder to the exterior of the body. The male urethra is about 5.5 to 6.5
inches long whereas female urethra is about 1.5 to 2.5 inches long. The
act of micturition is normally painless and under voluntary control. The
frequency of micturition depends upon the amount of urine produced.
Fig. 12.1: Urinary system
Brief anatomy and physiology of bowel elimination

The gastrointestinal tract, also known as alimentary tract or canal, extends from
the mouth to the anus (Figure 12.2). The term bowel is related to intestine. The
major organ involved with bowel elimination is the large intestine. The large intestine
is the lower or distal part of the gastrointestinal tract. Functions of the large intestine
include the absorption of water, the formation of feces, and the expulsion of feces
from the body. Bacteria that reside in the large
intestine act on food residue while it makes its way through the large
intestine. Bacterial action produces vitamin K and some of the B-complex
50
vitamins. The large intestine is further divided into cecum, ascending colon, Meeting Elimination Needs
transverse colon, descending colon, sigmoid colon and rectum.
Peristalsis (contraction of the muscles of the intestine) occur every 3-12 minutes,
moving waste products along the length of the intestine continuously.
The sigmoid colon contains feces (solid waste products) that are ready for
excretion. After excretion, feces are known as stool. The rectum is empty except
immediately before and during defecation. Feces and flatus are excreted from
the rectum through the anus. Normal defecation is usually painless
Fig. 12.2: Large intestine
12.4 FACTORS AFFECTING URINARY AND

BOWEL ELIMINATION
Various factors affect the amount and quality of urine produced by the
body and manner in which it is excreted. The are follows:
Developmental stages
Infants are born without voluntary control of micturition and with little ability
to concentrate urine. As a child grows, the bladder gradually enlarges, with an
increase in capacity. Older children and adults control urination voluntarily. In
elderly, normal physiological changes due to aging may influence urination. These
physiological changes include decreased bladder tone, neuromuscular problems,
degenerative joint problems and weakness may interfere with voluntary control
of urine and ability to reach to toilet in time.
Medications
Sometimes medications may interfere in bladder function by changing the
color of urine and amount of urine. For example, Lasix may increase urine
output, tranquilizers may reduce urge to void, vitamin B-complex may turn
urine green and anticoagulants may turn urine pink or red.
Effect of food and fluid intake
When the body is functioning well, the kidneys help the body maintain
balance of fluid intake and output. Intake and output should be almost
equal. When the body is dehydrated, decreased amount of urine is
51
Nutritional, Dietary and produced. Conversely with excess fluid intake, large amount of urine is
Elimination Needs
produced.
Caffeine containing beverages (such cola, coffee, tea) and alcohol increase
urine production. Food with high sodium content cause retention of urine
and so urine output is decreased. Certain food like onion may change the
odor of urine.
Stress and other psychological factors
Stress may cause decreased amount of urine whereas embarrassment and
anxiety in person may affect normal voiding of person. E.g. needing
assistance with a bedpan from a health worker of opposite sex may
induce anxiety.
Muscle tone
Decreased bladder muscle tone may result in poor urinary control. Bladder
muscle tone may be affected by childbearing, menopause, damage to muscles
from trauma and immobility.
Disease conditions
Diseases such as kidney stones, hypertension, diabetes mellitus and gout
may affect production of urine. Arthritis may interfere with normal mobility
and toilet habits. Psychiatric disorders may interfere in voluntary control of
urine. Fever may result in decreased urine output.
Factors Affecting Bowel Elimination
Interference with normal functioning of bowel may occur in health as well
as in illness due to various factors as given below:-
Development stages
Infants have no voluntary control over bowel elimination. As the child
grows, the voluntary control of bowel elimination is achieved. Constipation
is often a chronic problem for elderly. The physiological changes such as
less active lifestyle, decreased muscle tone may cause changes in bowel
habits.
Daily patterns
Changes in individual patterns of bowel elimination such as frequency,
timing, position and place may lead to constipation. For example, it may
be difficult for a bed ridden patient to defecate on a bedpan as it was
not his daily routine. Moreover presence of health worker of opposite sex
may also cause embarrassment.
Food and fluid intake
Type and amount of food and fluid intake may affect bowel elimination. A
high fiber diet may facilitate bowel elimination whereas processed foods
may cause constipation.
Muscle tone
Regular exercise may enhance muscle tone and gastrointestinal motility.
Prolonged bed rest may predispose a person to constipation.
52
Lifestyle
Lifestyle of a person also determines the elimination habits of a person Meeting Elimination Needs
which is also influenced by socio cultural variables. A person’s daily
schedule, occupation and leisure activity may contribute a habit defecating.
Stress
Stress and anxiety may have direct effect on gastrointestinal motility and
may slow down it. Persons with chronic worry, or who tend to hold on
problems and negative feelings may experience frequent constipation.
Disease conditions
Various disease conditions like tumors of intestine, diarrhea, infection,
malabsorption, spinal cord disease, food poisoning etc. may change usual
bowel habits.
Medications
Certain medications may alter the characteristics of stool. For example
laxatives may increase peristalsis whereas antidiarrheal medications may
decrease peristalsis. Aspirin products may cause bleeding which result in
pink stools.
Diagnostic studies, hospitalization, surgery and effect of anesthesia
may also alter the elimination pattern.
1. Define the following terms
Hematuria
Melena
Pyuria
Peristalsis
2. Fill in the blanks
Absorption of water takes place in intestine. serves as temporary
reservoir for urine.
The basic structural and functional unit of kidney is .
Caffeine mayurine output.
may increase peristalsis.
12.5 COMMON PROBLEMS OF URINARY

ELIMINATION AND THEIR MANAGEMENT
12.5.1 Retention of Urine
Definition – Retention of urine means that the urine is retained in the bladder.
Though the urine production continues but the accumulated urine is not released
from the bladder.
Causes of retention of urine
53
Nutritional, Dietary and The possible causes of retention of urine are given below:-
Elimination Needs
 Urethral obstruction – urethral obstruction can occur due to enlarged
prostrate, narrowing of urethra etc.
 Lack of muscle tone of bladder as in women after delivery
 Pressure on the bladder due to tumours
 Poor fluid intake
 Surgery and trauma may affect urination
 Change in living pattern like change of daily routine
 Use of medications such as analgesics, tranquilizers
Management of patient with urinary retention and role of home
Health Assistant
 Assist the patient to induce natural urination by providing natural
position for urination, providing privacy, relieving pain, and assisting
patient when he/she feels the need to urge.
 Apply local heat to the perineum and lower abdomen by pouring
warm water/applying hot water bottle. Patient can also be made to sit
in a tub of warm water (sitz bath) to induce micturition.
 Sound of running water or flushing the toilet may stimulate micturition.
 Provide enough time to patient for micturition as hurrying the patient
may cause tension in patient.
 Give adequate fluids to patient.
 If all the measures fail then patient may be advised urinary
catheterization by the treating physician.
12.5.2 Incontinence of Urine

Definition- Urinary continence is the involuntary leakage of urine.it is the
inability of the urinary sphincters to control the passage of the urine from
the bladder.
Causes of incontinence of urine
The possible causes of incontinence of urine are given below:-
 Sphincter damage
 Weak perineal mascles
 Tumours
 Urinary tract infection
 Neurological disorders like paralysis
 Unconsciousness
 Effects of narcotics, sedatives and alcoholism

54
Types of urinary incontinence Meeting Elimination Needs
 Transient incontinence- It appears suddenly and lasts for 6 months or

less. It may be caused by acute illness, infection, or intravenous fluid
administration.
 Stress incontinence- There is involuntary loss of urine due to increased

intra-abdominal pressure. This may occur during coughing, sneezing,
laughing, or other physical activity. Childbirth, obesity and or straining due
to constipation may cause leakage of urine.
 Urge incontinence – It is the involuntary loss of urine that occurs soon after
feeling urgent need to void. The patient may void before reaching to toilet
due to urgency.
 Reflex incontinence- It is emptying of bladder without sensation of

the need to void.it may occur in case of spinal cord injuries.
 Mixed incontinence - Urine loss with features of two or more types

of incontinence.
 Total incontinence –It is the continuous and unpredictable loss of urine,
resulting from surgery, trauma or physical malformation
Treatment of patient with urinary incontinence
 Pelvic floor exercises- Kegel exercises strengthen the muscles of pelvic

floor. The steps of kegel exercise are given below:-
i. Ask the patient to identify the pelvic floor muscles. For this the patient
should contract the muscles as if he/she wants to stop urination or
defecation.
ii. Once the muscles are identified, contract these muscles for 3-5
seconds and then relax for 3-5 seconds. Gradually increase the
time for contractions as practice increases. Do not contract
abdominal or hip muscles.
 Biofeedback – The measuring devices help the patient to become aware

of pelvic muscle contraction.
 Electric stimulation – Electrodes are placed in the vagina or rectum that

then stimulate nearby muscles to contract.
 Timed voiding or bladder training- The patient keeps a record when

voiding and leaking occurs so that she/he can plan to void. Then the intervals
between voiding are prolonged as patient gains control over voiding. Bladder
training involves biofeedback and muscle training.
 Pharmacological treatment – Medications are given according to type of

incontinence. Some medicines inhibit contraction of bladder muscles, tighten
the muscles of bladder and urethra so as to prevent leaking of urine whereas
other medicines (hormone estrogen) may relieve atrophy of muscles to
micturition.
 Mechanical treatment- Some patients may be given certain devices as

55
Nutritional, Dietary and pessaries, external barriers, urethral inserts to stop incontinence.
Elimination Needs
 Surgical intervention- Surgery is the last resort and depends on the cause
of incontinence.
Management of Patient with Urinary Incontinence and Role of Home
Health Assistant
These patients may be given a variety of treatment options depending on their
socioeconomic status, individual preferences, disease and disability status. The
home health assistant has a role in maintaining these treatment options and
preventing complications. The role of home health assistant is given below:
 Patients with urinary incontinence may need absorbent pad for keeping
their clothing dry. Many types of disposable and reusable products
are available such as perineal pads or liner, adult brief/protective
underwear etc. if not used properly these may cause skin breakdown
and patient may be at risk of urinary tract infection. Therefore these
products should be used as and when necessary.
 Patient should be provided with devices as walking cane, wheelchair,
Velcro on clothing etc. to facilitate toileting.
 Keep the perineal region clean and expose the skin to air to prevent
skin breakdown.
 Excess use of caffeine and insufficient fluid intake should be avoided.
 If the patient is given indwelling urinary catheter for continuous
drainage of urine then perineum of the patient should be cleaned daily
especially around urinary opening. Take precautions so that the
catheter does not come out or urine spills from any part of the
catheter tube or collection bag. Keeps the tube kink free maintaining
a downward flow of urine to urine collecting bag. Empty the urine
collecting bag at regular intervals and note the urine output.
 Do not use powder or lotion on/around perineum until prescribed by
the physician.
 If there are any signs of urinary infection like burning sensation at urinary
meatus, cloudy urine, and pain in lower abdomen, chills and fever then
inform the doctor.
 Maintain personal hygiene and educate patient about importance of
personal hygiene.
12.6 COMMON PROBLEMS OF BOWEL

ELIMINATION AND THEIR MANAGEMENT
Let us read the common elimination problems and management.
12.6.1 Constipation
Definition – Constipation is passage of hard and dry stools.
Causes of constipation
56
The possible causes of constipation are given below:- Meeting Elimination Needs
 Inadequate, irregular and restricted diet

 Insufficient intake of roughage and fluid
 Lack of exercise and prolonged rest
 Emotional upset like depression, anxiety
 Use of drugs like sedatives
 Excessive use of beverages such as coffee, tea
 Fecal impaction
 Diseases like hemorrhoids, cancer, thyroid disorder
Management of constipation and home health assistant’s role
 Advice the patient to take adequate roughage in the diet and adequate
intake of diet.
 Encourage patient to take adequate amount of fluid.
 Encourage the patient to establish a habit pattern.
 Provide a conducive and relaxing environment.
 Provide enough privacy.
 Encourage exercise and activity.
 If patient does not get any relief then patient may be prescribed laxatives,
suppositories or enema by the physician
12.6.2 Fecal impaction

Definition – Fecal impaction is the prolonged retention or an accumulation
of fecal material that forms the hardened mass in the rectum.
12.6.3 Diarrhea
Definition – It is the passage of excessively liquid and unformed stools
resulting loose stools.
Causes of diarrhea
The possible causes of diarrhea are given below:-
 Intestinal infection
 Nervous tension
 Medications
 Incomplete obstruction of bowel
Management of diarrhea and home health assistant’s role
 Patient should be given small frequent bland food. Avoid spicy,
excessive hot and cold food.
57
Nutritional, Dietary and  Provide bed pan whenever necessary.
Elimination Needs
 There can be skin excoriation due to diarrhea so keep patient clean
and dry.
 Replace the lost fluid by giving adequate amount of fluid and oral
rehydration solution (ORS) as prescribed.
 Patient may be prescribed certain medications to treat diarrhea.
12.6.4 Flatulence
Definition – Excessive formation of gases in the stomach or intestine is known
as flatulence.
Causes of flatulence
The possible causes of flatulence are given below:-
 Constipation
 Anxiety
 Intake of gas forming foods like beans, cabbage etc.
 Effect of anaesthesia
 Narcotic drugs
 Lack of activity
Management of flatulence and home health assistant’s role
 Advice patient to avoid gas forming foods.
 Advice patient not to lie down after meals.
 Encourage the patient to be active and exercise.
 Sometimes physician may prescribe rectal tube to pass to relieve
flatulence.
12.6.5 Bowel Incontinence
Definition – Bowel incontinence is the inability of the anal sphincter to
control the discharge of fecal and gaseous material.
Causes of bowel incontinence
The possible causes of bowel incontinence are given below:-
 Damage to nerves supplying bowel
 Diseases of bowel
Management of bowel incontinence and role of home health
assistant
 Offer the patient bed pan at regular interval. If there is a pattern of
incontinence then place the patient on a bed pan at that time.
 Keep the skin clean and dry. You can use disposable bed pads,
disposable briefs/diapers for patient if necessary as these materials
58
may also irritate the skin or cause pressure sore by retaining moisture Meeting Elimination Needs
against the skin.
 Change bed linen and clothing as necessary to prevent odor, skin
irritation and embarrassment.
12.7 ROLE OF HOME HEALTH ASSISTANT IN

MEETING ELIMINATION NEEDS OF A BED
RIDDEN PATIENT
Let us read the role of home health assistant in meating elimination needs.
12.7.1 General Care of A Bed-Ridden Client

 Examine the patient daily for redness, blisters, bluish discoloration of skin
and report it.
 Keep the patient clean and dry.
 Change the position every 2 hourly and examine the buttock and perineum
for wetness and soiling.
 Assist the patient in movement in and out of the bed.
 Prevent dryness of the skin and protect the damaged skin.
 Keep the patient well hydrated and well nourished.
 Avoid excess use of alcohol based solutions for back rub.
12.7.2 Providing A Suppository

Definition - Suppository is a solid substance which is conical or oval
shaped and melts at body temperature. There are various types of rectal
suppositories which may soften the stools, and help in elimination.
Procedure of inserting a suppository
 Explain procedure to the patient.
 Wash hands and wear gloves.
 Give side lying position to patient.
 Separate the buttocks and ask patient to relax by breathing through
mouth
 Using fingers insert the suppository well into the rectum so that it
does not come out.
12.7.3 Procedure of Providing A Urinal/Bedpan

Procedure of providing a urinal
 Explain the procedure to patient.
 Wash hands and wear disposable gloves.
 Provide urinal to patient in appropriate position, standing at bedside, sitting
59
Nutritional, Dietary and on bed or lying on one side of bed.
Elimination Needs
 If the patient is unable to do so then provide the urinal in bed in lying
bed.
 Fold the linen and provide privacy.
 Ask the patient to spread the legs and position the penis within the urinal.
Keep the bottom of urinal lower than the penis. If necessary assist the patient
to hold the urinal.
 Cover the patient with bed linen and ensure patient safety.
 Once the patient is relieved, remove the bedpan and cover it.
 Provide patient hand hygiene.
 Explain the procedure to patient.
 Make the patent comfortable.
 Wash hands and wear disposable gloves.
 Warm the bed pan by rinsing it with luke warm water.
 Apply a pad/or powder at the rim of bed pan.
 Close curtains and provide patient privacy.
 Place the patient in a supine position with head of the bed elevated unless
contraindicated.
 Fold the top linen at the side of the bed and spread a waterproof pad
under buttocks of the patient.
 Ask the patient to bend the knees and lift her/his buttocks . Then slip
the bedpan underneath the buttock so as the buttocks are resting on the
rounded rim of the bedpan.
 Raise the head of the bed to as near to the sitting position as tolerated
unless contraindicated and cover the patient with bed linen. Ensure safety
of the patient.
 Once the patient is done with, lower the head of the bed. Ask the patient
to bend the knees and lift the buttocks. Remove the bed pan in the same
manner as it was given. Assist the patient with perineal hygiene by cleaning
the perineum from front to back. Use one tissue for one stroke and use
more if required. Discard tissue in appropriate receptacle.
 Leave the patient clean and dry. Change the disposable pad if required.
 Offer the patient to wash his/her hands.
 If the specimen is required then collect it and empty and clean the bedpan.
 Perform hand hygiene.
60
12.7.4 Applying Adult Diaper/Briefs/Absorbent Pad To Meeting Elimination Needs
Incontinent Client
 Incontinent patients should be kept clean, dry and odor free. For this patient
may be provided with an absorbent pad below the buttocks extending from
lower back to mid-thigh. They may require adult diapers or briefs. Let us
discuss the procedure:-
 Turn the patient on one side.
 Slide the absorbent pad underneath the patient / slide diaper between the
legs of the patient. Then again turn the patient on another side to spread
the remaining part of absorbent pad on the free side.
 Now make the patient lie down in supine position (lying on back) and
fix the diaper.
 If patient can stand then patient can be helped to wear a disposable brief.
12.8 SEEKING MEDICAL HELP

As a home health assistant you are required to meet elimination needs of patient
in a best possible way. Still if you are not able to do so, it is better to seek
medical help for further interventions for patient’s benefits. The advance
procedures may not be done by you, but you may assist and care the patient
after the procedure under the guidance of competent medical help.
Write one word for the following
I. Involuntary leakage of urine
II. Passage of excessively liquid and unformed stools
III. Exercises to strengthen the muscles of pelvic floor
IV. Excessive formation of gases in the stomach or intestine
V. Inability of the anal sphincter to control the discharge of fecal and
gaseousmaterial _______________________
VI. Solid substance which is conical or oval shaped and melts at
bodytemperature ____________________
12.9 LET US SUM UP

You have learnt in this unit about meeting various elimination needs of the patient.
These include common urinary and bowel problems of patients, their management
and role of home health assistant. The general procedures which may be
performed by you are given in the unit so that you can practice them Few
video links are also given for you to see and understand the procedure.
61
Elimination Needs 12.10 KEY WORDS
Sphincter : A circular muscle that normally maintains constriction
of natural body passage such as urethral sphincter, anal
sphincter
Atrophy : To reduce in size and strength and become weak
Pessaries : Stiff ring inserted in the vagina
External barriers : A small foam pad placed over the urethral opening.
It seals against the body to urine from leaking.
Urethral insert : Small plug like device fitted into urethra
Laxatives : Food or medicine to help in relieving constipation
Enema : A procedure in which liquid is injected into the rectum,
to expel its contents
Pelvic floor : The area in lower abdomen, formed of muscles
which are attached to the pelvis to form a base.to
provide support to pelvic organs like intestine and
bladder.
12.11 ANSWERS TO CHECK YOUR PROGRESS

1) a) blood in urine
b) blood in stool
c) pus in urine
d) contractions of muscles of intestine
2) a) Large intestine
b) Urinary bladder
c) Nephron
d) Increase
e) Laxatives
i. Urinary incontinence
ii. Diarrhea
iii. Kegel exercise
iv. Flatulence
v. Bowel incontinence
vi. Suppository
62

BHT-016 Block-3

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

BHT-016 Block-3

Uploaded by

Copyright:

Available Formats

BHT-016

Basic Home Health

Mrs. Madhavi Verma Prof. T.K Jena

BLOCK PREPARATION TEAM

CO-ORDINATION Course Coordinator

9.5 Food Safety

9.6 General Precautions While Feeding

9.7 Concept of Glycaemic Index (GI)

9.8 Let Us Sum Up

9.2 BASIC NUTRIENTS

6 Fig. 9.1: Basic Nutrients

Carbohydrates 1. Cereals: Rice, wheat, Supply Energy Protein energy

Proteins 1. Milk and milk Body building Protein energy

Fats 1. Fats and oils: Ghee, Supply Energy Malnutrition High

Vitamin A Mango, apricot, orange, Prevent night Night

Vitamin B Whole (Sabut) cereals, Protect the body 1. Cracking at

Vitamins C Green leafy vegetables Helps in healing of Scurvy, which can

Vitamins D Exposure to sunlight Bone growth Rickets –

Check Your Progress 1

1) List the minerals and their major functions.

2) Fill in the blanks:-

1) Rich sources of carbohydrates are ————————————

2) Fats are required to ———————————————

3) Rich sources of proteins are ——————————————

4) Name the fruits rich in vitamin C————————————

5) Name the sources of vitamin A —————————————

D) Energy value of nutrients

1 gm of carbohydrate – Provide 4 k.calories

1 gm of protein – Provide 4 k.calories

8 1 gm of fat – Provide 9 k.calories

9.4 BALANCED DIET

Meaning and definition

Balanced diet is defined as one, which contains variety of foods in such

 Consists of different types of food items such as a meal should

 Meet the minimum need for nutrients for the individual

As shown in the figure nutrients supply to the body is equal to nutrient

Nutrient supply Nutrient Need

9.4.1 Steps of Healthy Eating/Living

Salt is considered to be an essential constituent of diet. However, the

Precautions other than diet are as follows:

2. Cope up with stress. It is not work but worry that kills.

3. Practice Yoga for better health.

4. Stop smoking-Think and stop today

9.4.2 Food Pyramid

The foods at the bottom of the pyramid are to be eaten in plenty, to

The figure given below (Fig. 9.3B) is a simple diagrammatic representation

Fig. 9.3A: Food Pyramid

Too much salt or sugar

Eat for a healthy

Fig. 9.3 B : Healthy Living Tips

9.5 FOOD SAFETY

9.5.1 Food Safety Measures at Home

9.6 GENERAL PRECAUTIONS WHILE FEEDING

 Ensure correct method of feeding along with type of diet prescribed

9.6.1 Myths Related to Diet in Diabetes

Let us understand with the help of example

Table 9.3: False ideas (myths) related to diet in diabetes

Fig. 9.4: Percentage of major nutrients contributing to total Calories in a meal

9.6.2 Health Education to Bring a Change in the Way

9.7 CONCEPT OF GLYCAEMIC INDEX (GI)

9.7.2 Food Items Release Sugar at a Moderate Pace

9.7.3 Food Items Release Sugar Slowly in the Blood

Tabel 9.4: Meal plan of diabetics for different food groups