Chapter 10

Diet and Nutrition

• Section 1 Introduction
• Section 2 Hospital Diets
• Section 3 Nutrition Assessment
• Section 4 Diet nursing
• Section 5 Special diet nursing
Section 1 Introduction
• Body Requirement for Nutrients

Energy-yielding
carbohydrate
nutrients
fats
protein
organic
vitamins
minerals
water

The human body and foods are

made of the same materials,
arranged in different ways.
 How Diet Relates to Health and disease?

Balanced diet
Rational nutrition

Support growth,maintenance,and repair of the body

Improve immunity
Prevent and treat diseases
 Conversel
y
malnutrition
deficiencies
imbalances
excesses
a poor diet chronic disease
heart disease
diabetes
some kinds of cancer
adult bone loss,etc.
Food Guide Pyramid:
A Guide to Daily Food Choices

fats,25g

milk,100g;Beans,50g

meat,50 ～ 100g; fish,50g

eggs,25 ～ 50g

vegetable,400 ～
500g
fruit,100 ～ 200g
grains,300 ～ 500g
 Section 2 Hospital Diets

• Basic Diets
• Therapeutic Diets
• Test Diets
 Basic Diets

Basic diets are the foundation of the other diets.

• General diet
• Soft diet
• Semi-liquid diet
• Liquid diet
 General diet
• Clients with normal digestive and absorptive
function, with normal temperature, and those
during the process of recovery or without diet
limit.
• Reference--Balanced nutrition, easily digested,
not stimulating, 3 meals a day with total
energy of 2200-2600kcal/d, and protein of 70-
90g/d.
 Soft diet
• Clients having difficulty in chewing, or
gastrointestinal function disorders, elders,
infants and those during postoperative
recovery.
• Reference--Balanced nutrition, easily chewed,
not stimulating, soft food such as noodle,
steamed bread, vegetables, well-cooked mince
meat, 3-4 meals a day with total energy of
2200-2400kcal/d and protein of 60-80g/d.
 Semi-liquid diet

• Clients with fever, oral diseases or

gastrointestinal disorders or having difficulty in
chewing and swallowing, or those during
postoperative period.
• Reference--Not stimulating, easily chewed and
swallowed, semi-liquid food such as rice
porridge, noodle, bean-curd and dumpling, small
frequent meals with fixed quantity of each staple
food, 5 meals recommended a day with total
energy of 1500-2000kcal/ d and protein of 50-
70g/d.
 Liquid diet
• Clients with hyperthermia, oral diseases, acute
inflammation, having difficulty in swallowing,
acute gastrointestinal disturbances, or those in
critical conditions, during postoperative period.
• Reference--Easily swallowed and digested liquid
food such as milk, bean milk, fruit juice, only
for temporary use because of insufficient
energy, 6-7 meals a day 200-250ml each time
with total energy of 836-1195kcal/ d and protein
of 40~50g/ d.
 Therapeutic Diets

• Therapeutic diets are based on the basic

diets and used as treatment by adjusting
total energy and certain nutrients.
 Therapeutic Diets
High energy diet
High protein diet
Low protein diet
Low salt diet
Salt free and low sodium diet
Low fat diet
Low cholesterol diet
Low residue or residue free diet
High food fiber diet
 High energy diet

• Clients with diseases of high consumption of

energy; such as tuberculosis, large area burns,
liver diseases, and hyperthyroidism.
• Reference--In addition to basic diet, 2 more
meals are added a day such as milk, bean milk,
egg, cake, chocolate, with total energy of
3000kcal/d.
 High protein diet

• Clients with long-term consumptive diseases,

malnutrition, anemia, burns, malignancy,
nephritic syndrome, hypoprotein, and those
before or after operation, in pregnancy, and
lactation.
• Reference--In addition to basic diet ,high-protein
food such as meat, fish, egg, beans are added
with total amount of protein 1.5-2g/ (kg ． d), <
120g/d and total energy of 2500-3000kcal/ d.
 Low protein diet

• Clients who need limited protein intake, such

as acute nephritis, uremia, and hepatic coma.
• Reference--Limited protein intake with total
amount of protein < 40g/d for adult.
(20-30g/ d according to conditions)
 Low salt diet

• Clients with hypertension, congestive heart

failure, ascites, aura eclampsia, chronic
nephritis.
• Reference--Restricted salt in cooking and diet,
with total amount of salt < 2g/ d for adult except
for natural sodium in food. Pickled food is
forbidden.
 Salt free and low sodium diet

• Same as those of low salt diet, in addition

to severe edema clients.
• Reference--No salt in cooking except for
natural sodium in food, with no more
than 0.5g/d, High-sodium food and
medicine is forbidden.
 Low fat diet

• Clients with hepatic, cystic, and pancreatic

diseases, hypercholesterolemia,
arteriosclerosis, coronary heart disease and
obesity.
• Reference--Restricted oil and forbidden fat,
and fried food. with total fat amount <50g/ d.
 Low cholesterol diet

• Clients with arteriosclerosis, hypertension,

coronary heart disease, high serum cholesterol
levels.
• Reference--High-cholesterol food such as
animal’s brain, viscera, yolk are restricted
with total cholesterol amount<300mg/ d.
 Low residue or residue free diet

• Clients with diarrhea, enteritis, typhoid,

dysentery, and those after gastrointestinal
operation, Gastroesophageal varication,
rectum and anus operation.
• Reference--High fiber food is forbidden or
restricted. Hard food with smashed bones
is forbidden.
 High food fiber diet

• Clients with constipation, obesity,

diabetes, and hyperlipidemia.
• Reference--High fiber food are
recommended.
 Test Diets(diagnostic diets )

Test diets are used to help diagnosis and insure

accurate testing by adjusting the contents of diets in
special time.

Occult test diet

Cholecystography test diet
Creatinine test diet
131
I thyroid uptake test diet,etc.
 Occult blood test diet

• The three-day test diet is used for preparation

of occult blood test to assist the diagnosis of
gastrointestinal bleeding.
• The client who is going to have the test is
forbidden during this period any food that can
lead to a false positive result, such as meat,
poultry, medicine and food rich in iron, and
green vegetables. The test sample will be taken
on the forth day.
 Cholecystography test diet
• The test is used in diagnosing gallbladder disease,
bile duct disease and hepatic bile duct disease.
• Before the test day, the client should have high fat
diet for lunch and fat free, low protein, high
carbohydrates diet for supper, followed by contrast
after which food and water are absolutely
forbidden until the morning of the test day.
• The client should not have breakfast on the test
day. After the first X-ray examination, the client
can have a high fat meal (fat 25-50g) if the gall
bladder develops well. In 30 minutes the client can
have the second X-ray examination.
 Creatinine test diet

• The three-day test is used. to check the kidney

filtration function. During this period, meat,
poultry, fish, tea, and coffee are absolutely
forbidden, and protein intake is also limited to
the total amount of protein<40g/d. The test
sample will be taken on the third day.
 131
I thyroid uptake test diet

• The two-week test is used to check the function

of thyroid. During this period, food rich in
iodine, such as kelp, jellyfish, shrimp, iodized
salt as well as iodine for skin disinfection are
absolutely forbidden.
Section 3 Nutrition Assessment

• Affecting factors
• Diets status
• Physical status
• Laboratory Test
Affecting factors

Physical factors

psychological factors

Sociocultural factors
 Physical factors

Age
Physiological factors Physical activity
Special life cycle status

Disease and drug

Pathological factors
food allergies
 Sociocultural factors

• Economic Situation
• Lifestyle
• Personal Preference
• Environment
• Knowledge About Nutrition
 Diets status

 Meals time
• eating patterns  Category and amount
of Food intake
• Changes in appetite

• Influencing factors
(impaired chewing or swallowing)
 Physical status

• Physical Examination
• Anthropometric Measurements
 Physical Examination

Area of Examination Signs of Malnutrition

General appearance and vitality Apathetic, look tired, easily fatigued
Skin Dry, flaky or scaly; pale or pigmented;
lack of subcutaneous fat
Nails Brittle, pale, ridged or spoon-shaped
Hair Dry, dull, sparse, loss of color, brittle
Eyes Pale or red conjunctiva, dryness, soft cornea, dull
cornea
Lips Swollen, red cracks at side of mouth
Tongue Swollen, beefy red or magenta colored; smooth
appearance; decrease or increase in size
Gums Spongy, swollen, inflamed; bleed easily

Muscles Underdeveloped, wasted, soft

 
Clinical Signs of Malnutrition
Anthropometric Measurements

• Height and weight

• skin fold thickness
• arm circumference ， AC
 Height and weight

The standard of IBW

• IBW (kg) = [height(cm) –100] ×0.9
• IBW (kg) = height(cm) –105
Calculating percent of weight loss or gain
• %weight loss ＝ IBW － CBW / IBW×100%
• %weight gain ＝ CBW － IBW/ IBW×100%

normal :± 10 %
 Body Mass Index(BMI)

BMI = weight(kg) / height(m2)

The normal range: 18.5~22.9
overweight :23~27.9
obesity: ≥28

WHO
 The BMI values have two major
drawbacks:
they fail to indicate

 how much of the weight is fat;

 where that fat is located.
 deep within the
central abdominal
area of the body

The fat lying deep within the body’s abdominal

cavity may pose an especially high risk to health.
 skin fold thickness

lean middling fat

male ＜ 10mm 10~40 mm ＞ 40mm
female ＜ 20mm 20~50 mm ＞ 50mm

the triceps skinfold

About half of the fat

in the body lies
directly beneath the
skin.
 Laboratory Test

• Serum Proteins
• Urinary Tests
• Total Lymphocyte Count
 Section 4 Diet nursing

 Diet administer
• Arrange the client's diet according to the diet
orders.

 Meals care
 Meals care

Pre- Meals care

During Meals care
Post- Meals care
 Pre- Meals care

Diet education

♣ Environment
Preparation ♣ client

Stimulating the Appetite

 Stimulating the Appetite

• Relieving illness symptoms that depress appetite

prior to mealtime.
• Providing familiar food that the client likes.
• Avoiding unpleasant or uncomfortable treatments
immediately before or after a meal.
• Providing a tidy, clean environment.
• Encouraging or providing oral hygiene for clients
before mealtime
• Reducing psychological stress.
 During Meals care
 Check the type of diet. Do not give an incorrect diet for
clients.
 Assist clients who cannot help themselves to remove
the food.
 For a blind client, identify the placement of food as
you would describe the time on a clock.

soup (12 )

vegetables(9) vegetables (3 )

rice (6 )
 Post- Meals care

 replace the food covers and give the client care.

 note how much and what the client has eaten
and the amount of fluid taken. If the client's
intake and output of fluid is being recorded,
nurse should record.
 Pay attention to the fasting client especially on
shift.
 Section 5 Special diet nursing

♣ Enteral Nutrition (EN)

*Tube feeding
*Elemental diets
♣ Parenteral Nutrition (PN)
 tube feeding

nasogastric gavage – is a medical approach to

maintain clients’ nutrition and ensure treatment by
inserting a tube to gastrointestinal duct via nasal
cavity, through which fluid food, water, and
medicine are infused.
 Elemental diets
• Elemental diet is a purified food
whose chemical composition is definite
and it contains all the required
nutrients of human body.

♣ severe burn and trauma

♣ digestive tract fistula
♣ the nutritional support of pre-operation and
post-operation
♣ non-infectious diarrhea
♣ malabsorption and malnutrition, etc.
 Purpose

Elemental diet could achieve the

Therapeutic and adjunctive therapy
effect for the severely ill patients.
 Administration

fractional
infusion

intermittent
continuous
infusion
infusion
 Complications

• Mechanical complications
• Infectious complications
• Gastrointestinal tract complications
• Metabolic complications
 Notes to nursing

• It should be initially offered in a small amount and

can be increased gradually at a low and slow pace
when patients are tolerated well then stabilize the
prescription, dosage and transfusion rate.
• Follow sterile procedure and prevent contamination.
• Prepared feedings should be stored in refrigerator
below 4°C and should be used up in less than 24h.
• The infusion temperature is 41°C ～ 42°C, and take
it orally in 37°C.
• Irrigate the tube with warm water before and after
infusion, which prevent tube from obstruction.
Continue

♣ Clients need some necessary lab tests such as blood

glucose, urine glucose, blood urea nitrogen,
electrolyte. Observe clients' urine and stool, record
client's weight, and monitor 24h intake and output.
♣ Observe the client's response during feeding. When
clients have some symptoms such as nausea, vomit,
abdominal distention, and diarrhea, nurses should
find the reason, adjust infusion rate and temperature,
and stop infusion for severe clients.
♣ The feedings is stopped gradually to prevent
hypoglycemia.
 Parenteral Nutrition (PN)

 PN also referred to as total parenteral nutrition (TPN). PN

is provided when the gastrointestinal tract is nonfunctional.
 PN is administered intravenously through a central venous
catheter into the superior vena cava.
 Clients who accept PN therapy include those with severe
malnutrition, severe burns, bowel disease disorder, acute
renal failure, hepatic failure, cancer or major surgeries
where nothing may be taken by mouth for more than 5
days.
Nursing care for the client's
receiving PN is based on three
major nursing goals:

• preventing infection;
• maintaining the PN system;
• preventing complications such as
metabolic, electrolyte or fluid balance.
• Observation and nursing during infusion
• Monitoring
• Prevention of complications and nursing
of client with complications
• Complications related to catheterization

• Infection
• Metabolic complications