AUTHOR : REJITHA RAJAN
Diet in Sickness – Principles, therapeutic diet, types of diet, Nurse’s responsibility, procedure and after care of patient.
Principle Involved in the Diet Therapy
1. The diet must be planned in relation to changes in metabolism occurring as a result of disease.
2. The diet must be planned according to the food habits of the client based on culture, religion, socioeconomic status, personal references (likes and dislikes), physiological and psychological conditions, hunger, appetite and satiety.
3. As far as possible, changes in the diet should be brought gradually and adequate explanations are given with the changes made, if any.
4. In short and acute illness, the food should not be forced because his appetite is very poor but he may soon recover the normal appetite. But in prolonged illness it is essential to provide adequate amount of food to prevent wasting of tissues.
5. Whatever the diet prescribed, there should be variety of foods for selection.
6. Small and frequent feeds are preferred to the usual three meals.
7. Hot foods should be served hot and cold foods should be served cold.
Carbohydrates are well tolerated and are necessary to maintain the stores of liver glycogen. It is particularly important in clients with high fevers, liver diseases, hyperthyroidism etc. In the absence of carbohydrate, the body fat may be used for energy which may result in the formation of ketone bodies and they accumulate in the blood – a condition known as ketosis. Adequate amount of carbohydrate intake can prevent ketosis. Carbohydrate is given in easily digested forms such as glucose, sugars, gruels etc.
The fat is often not tolerated in illness especially if nausea and vomiting is present. Adequate amount of carbohydrate can replace the requirement of the body for fat.
In illness, especially when there is infection, the protein metabolism is usually greatly increased because of the increased destruction of protein. If an adequate amount of protein is not given, the body will use up the tissue proteins and the client will lose weight. In illness, unless there are kidney and liver damages, the protein intake should be high.
The requirements of minerals should be maintained in illness especially that of calcium and iron. Sodium and potassium may sometimes need to be restricted especially when there is hypertension, oedema, ascites etc.
Vitamins must always be adequate. Fat soluble vitamins, vitamin A and vitamin D need to be added if the client is on fat restricted diet. In pathological condition of the gastrointestinal tract and in antibiotic therapy, vitamin B complex should be supplied. The demand for vitamin C is greatly increased in fevers and is especially necessary for the healing of wounds after surgery.
Fluids are very important to prevent dehydration, especially when the fluid is lost from the body in excess amount in the form of sweat, urine, stool, blood and other body fluids. Clients with high fevers, vomiting, diarrhea and bleeding are prone to dehydration unless extra fluids are forced in. If adequate fluids cannot be given by mouth, they must be given intravenously. Fluids with added proteins are necessary for clients who are fed on liquid diets for a long time.
Total daily fluid intake averages from 2 to 3 L for an average adult in normal conditions. It is the nurse’s responsibility to maintain the fluid balance by maintaining the intake and output chart carefully. The amount of fluid intake would be sufficient in case of adults, if there is 1000 to 1500 ml of urine produced in a day. Infants require a higher amount of fluid compared to adult requirement. They need 150 ml of fluid per kg of body weight.
Types of Diets Served in the Hospital
It is a regular, well-balanced and normal diet. It is either vegetarian or non-vegetarian. It is served for clients who do not need any modification.
It is full diet but consisting of food substances that are easy to chew and digest. Some clients, particularly the aged and convalescing clients cannot take food which require chewing or the food that is difficult to digest. A soft diet is enjoyed by these clients. A soft diet may include double boiled rice, conjee, soft-cooked pulses and dals, streamed fish, poached eggs, custards, ground or chopped meat, sliced bread, sieved cooked vegetables, cooked or ripe bananas etc.
A bland diet is one in which the foods are easily digestible, free from substances which might cause irritation of the gastrointestinal tract, and generally of low roughage content, used mainly for clients with gastrointestinal conditions. The following point should be kept in mind when supplying a bland diet.
1. The diet must be free from all mechanical and chemical irritant. Mechanical irritant are mainly edible skins, seeds and fibres composed of cellulose (roughage) in fruits and vegetables. Food which contain a lot of cellulose should be rubbed through sieve or strainer after cooking. Chemical irritants are mainly the condiments and seasonings used in cookery. The hot seasonings particularly chillies, pepper, ginger and spices should be avoided when preparing a bland diet.
2. For a bland diet, food should not be fried, either in deep or shallow fat. Baking, boiling, steaming and grilling are used.
3. Stimulating foods such as soups, meat extracts, strong tea and coffee, alcohol etc. are to be avoided.
4. Strong sugar solutions should be avoided.
5. Avoid fatty foods, since it takes a long time to digest.
6. Milk should be given in plenty.
Liquid diets must be used for clients who are unable to take or tolerate solid food. It consists of clear fluids (non-residual diet) and full fluid diet (residual fluid diet).
Clear Fluid Diet
Clear fluids are used when there is a marked intolerance to foods and roughage. These include clear tea, weak black coffee, clear soups, whey water, strained fruit juices, soda water and other aerated beverages. Such fluids have particularly no food value, but can help to maintain the fluid balance of the body. Calories can be added by the use of sugar or glucose. Clear fluid diet should be used only for a short time since the clients may develop deficiency symptoms.
Full Fluid Diet
Full fluid diet is given when the total nutrition of the client has to be maintained by fluids for a considerable time. This is necessary when a client is unable to swallow solid food or if the client is fed by tube feeding. Milk is forms the basis of the diet. To this can be added egg in the form of eggflips, thin custard etc., to supply calcium, protein, vitamin A, and iron. Calories can be made up from carbohydrate in the form of starch in thin cereal preparation or by adding sugar or glucose. Adequate amounts of vitamins can be supplied in the form of medical concentrates. Salt should be added unless it is restricted.
Many pathological conditions bring about changes in the body process which necessitate addition or omission of certain nutrients in the diet as part of the treatment. Some of the special diets served in the hospitals are:
High caloric or low caloric diet
High protein or low protein diet
Fat free diet
Low salt or salt free diet
Sippy’s diet, Bull’s diet
Nurse’s Responsibility in Feeding a Helpless Client Orally
1. Check the physician’s orders for any specific precautions if any, regarding the diet, movement of the client, positioning of the client etc.
2. Plan the diet according to the need of the client, his likes and dislikes, socioeconomic status and the availability of food etc.
3. Ensure that the ordered diet is prepared properly and safely.
4. Find out the food habits of the client, his likes and dislikes, his appetite, his ability to take foods, food allergies if any, etc.
5. Find out whether any treatment or procedure to be carried out immediately or whether they can be postponed for sometime.
6. Check the general condition of the client and the ability for self care.
7. Check the client’s ability to follow directions.
8. Check the articles available in the client’s unit.
A tray containing:
1. Mackintosh and towel
Purpose: to protect the bed and garments.
2. Full plate, quarter plate, cup saucer, jugs etc.
Purpose: to serve the food.
3. Feeding cup or drinking tubes.
Purpose: to give the fluid to the client.
4. Spoon, fork, knife etc
Purpose: to feed the client
5. A glass of water
Purpose: to offer at the end of a meal
Purpose: to wipe the face in between
7. Feeding cup with water and kidney tray
Purpose: to wash the mouth before and after the feed
Preparation of the Client and the Unit
1. Create a pleasant environment for the client. Room should be well-ventilated and free from all disturbances, such as noise, odour, and unpleasant sights.
2. Send the visitors away tactfully.
3. Offer bedpan or urinal at least half an hour before the expected time for the meals.
4. Remove them immediately after their use.
5. Help the client to dress and appear neat.
6. If the client’s general condition allows, help the client to sit out of the bed at the side table, or place the client in a Fowler’s position with an overbed table in front or give a propped up position with extra pillows to raise the head. If a Fowler’s position is not is allowed, place him in a left lateral position, so that he can feed himself. See that the client is comfortable in any one of the above positions.
7. Place a high stool, at the bedside, that brings the nurse on a level with the client.
8. Help the client to wash his face and hands.
9. Protect the garments and the bed linen with the mackintosh and towel. Place them over the chest under the chin.
The table where the food tray is placed should be cleared except for flowers which add to the pleasure of the meal. In every case the food should be served attractively and the containers placed conveniently for the client to see the food and to feed him if possible. If the food is brought in large pieces, it should be cut into small pieces. If there is delay in taking food, there should be arrangements to keep the hot food hot and cold food cold.
Steps of Procedure
1. Wash hands
Reason: to prevent cross infection
2. Sit by the bedside, usually at the right side of the client, facing his head, so that the nurse and the client can see each other. The position should be convenient for the nurse to help the client when needed.
Reason: the nurse can engage in conversation with the client and give the impression of not being in a hurry. She can make the meal a pleasure experience for the client.
3. Feed the client slowly, in small amounts, waiting for him to chew and swallow one mouthful before giving the next. Place the spoon accurately into the client’s mouth. The dry foods may be given to the client’s hands to hold and eat.
Reason: feeding the client in small quantity, helps him to chew the food well. Adequate chewing helps to digest. If the spoon is placed too far back in the mouth, it may create a gag reflex and the patient may vomit.
4. Give the foods in the order in which they would normally be eaten by the client, if he could.
Reason: to give the satisfaction to the client.
5. Talk pleasantly to the client as he is eating his food. Avoid asking questions.
Reason: pleasant talking creates a pleasant atmosphere conducive to stimulate appetite.
6. When the blind clients are fed, they should be told what food they are being given.
Reason: every client has the right to know what food he takes.
7. Encourage the client to take all types of foods served to him. Do not force for the food, which he dislikes.
Reason: forcing for the food may cause vomiting.
When the client has eaten the food in sufficient amount and to his satisfaction, then stop feeding and offer a glass of water. Water can be given by means of a feeding cup or by the drinking tubes.
Reason: water at the end of the feeding will wash away the food particles lodged in the mouth and in between the teeth.
After Care of the Client and Articles
1. Help the client to wash his mouth, face and hands.
2. Dry the face and hands.
3. Make the client comfortable by adjusting the position of the client in bed.
4. Tidy up the bed.
5. Take all articles and the food tray to the utility room. Discard the waste. Clean the articles in the cold water first and then with warm soapy water. Clean and dry them.
6. Replace them in their proper places. The articles used for a client with infectious diseases should be boiled before they are replaced.
7. Wash hands.
8. Record in the nurse’s record the following things:
Amount and the type of the food taken
General attitude towards the food
If vomiting has taken place, the amount vomited.
Diet is an important as medicine in the treatment of diseases. A modification in the diet or in the nutrients can cure certain diseases. For example, a client suffering from peptic ulcer needs a bland diet for his recovery; a salt free diet can reduce the blood pressure in a client with hypertension.
For everyone, eating food is an enjoyment. When the person is ill, the food intake becomes a problem. The nurse’s responsibility in the care of the sick in regard to nutrition can be analyzed into four major areas:
1. Assisting clients to obtain needed nourishment either through feeding or assisting with eating, e.g., tube feeding feeds a helpless client to eat his food etc.
2. Motivating client to eat.
3. Assisting clients to obtain needed nourishments by proper planning of the diet.
4. Assisting clients with special problems about therapeutic diets, e.g., helping a client to accept a salt free diet.