Chapter 4

Dietary Management
for Infections and
Fevers

Definitions:
Infection – is the invasion and development of pathogenic microorganisms or parasites resulting in
abnormal processes within.

Fever – is an elevation of body temperature above normal. Fever is usually a symptom of infections. A
person with fever is easily recognized by his flustered face and elevated body temperature. He usually
complains weakness, headache, poor appetite, discomfort, restlessness, drowsiness and thirst.

Metabolic effects of Fever

The metabolic effects of fever are proportional to the elevation of the body temperature and the
length of time the temperature remains elevated.

Classification of infections
 According to Krause and Mahan, infections are classified as ACUTE, CHRONIC and
RECURRENT.

1. ACUTE infections are usually of short duaration, with sudden onset and rapid progression. This
is seen in colds, influenza, tonsillitis, pneumonia, measles, chicken pox, and typhoid fever.

2. CHRONIC infections last for weeks, months and years. In short, it last for a long period of time.

3. RECURRENT infections occur at periodic intervals.

Principles of Diet Therapy

The dietary principles are summarized as follows:

CALORIES, PROTEIN, CARBOHYDRATE, FATS, WATER, MINERALS, VITAMINS

Tuberculosis
Cause:
Mycobacterium tuberculosis 

Characterized by:
• Fever, Loss of weight, Fatigue, Cough, Night sweats, Weakness

Dietary Management
• Protein Intake, Moderately high (75 – 120 gms), Caloric intake is adjusted, Minerals, particularly
Calcium, Vitamin supplementation -> Ascorbic Acid , Vitamin K and B complex

Treatment
• Isoniazid , Proper diet , Fresh air and exercise , Chemotherapy , Good hygiene 

Foods Allowed
• lot of fresh fruits like ‘’oranges’’ , Apples, Melons, Pears, Grapes, Pineapples 

Foods Avoided
• Alcohol, fried foods, canned foods, Coffee, Sugar and sweeteners, White bread , Tea 

Measles
Spread :
• Droplet infection , Direct contact 

Characterized by:
• Rashes, Colds, Pneumonia

Pathognomonic Sign: Koplik spots

Dietary Management

• LIQUID soft diet in INCREASING amounts, ( Tube feeding) Adequate intake of nutrients and
electrolytes

Food Allowed
• Apple, apricot, broccoli, brown rice, cabbage, Melon, Carrot, Mango, Oats, Orange, Pumpkin,
Sunflower seed, Sweet potato, Squash, watermelon 

Foods Avoided
• Greasy foods, Fatty foods , Caffeinated, Sweet drinks like – coffee and soft drinks 
Poliomyelitis
• Is an acute viral infection resulting in inflammation and destruction of the grey matter of the anterior
horns of the spinal cord 
Paralysis and Atrophy and muscle concerned follow

Kinds of POLIOMYELITIS
• Spinal poliomyelitis – paralysis of skeletal muscles
• Bulbar poliomyelitis – affects the brain nerve cells

Four Stages:
• Pre – paralytic, Paralytic, Regressive, terminal 
Incubation period
10 to 14 the following symptoms appear 

Signs and symptoms

• Tremors, Intense sweating, Apathy, Headache à Nape of the Neck, Pulmonary, GI disturbances

Landry’s paralysis
• Starts 
Lower joints -> Trunk -> Respiratory Muscles -> DEATH

Dietary Management
• High Protein, High Caloric diet, Vitamins and Minerals
Consistency of diet
• Liquid – Soft diet – Regular Food(if tolerated) 

Bulbar Poliomyelitis
• More feeding problem compare to SPINAL 
( because swallowing is difficult and may even FAIL, causing CHOKING or ASPIRATION)
PARENTERAL feeding is used.. 

Foods allowed
• Meat , Poultry products, Orange, Yogurt, Green leafy vegetables 

Foods Avoided
• Uncooked foods 

RheUmatic FeVer
Characterized by:
• High fever, Swelling of Joints, Inflammation of HEART, MUSCLE & VALVES, Permanent damage
to the HEART

Dietary Management
Acute Infection
• Full liquid diet
Caloric intake
• Maintain desirable body weight 

Cortisone = Prescribe or Carditis = Present

• Sodium intake is 
-> RESTRICTED to avoid sodium 
RETENTION and edema FORMATION 
Foods Allowed
• Meat, Soup, Donuts, Bread, Tomato sauce, Vanilla 
Foods Avoided
• Spicy foods  : include chili and pepper
• Acidic foods  : orange , citrus fruits

Chronic Obstructive Pulmonary Disease ( COPD )

Dietary Management
• Soft , high Caloric diet, Easy to masticate , Concentrated in calories and proteins, Low carbohydrate,
High fat diet, High in Calories, Adequate vitamin and mineral supplements , Protein is moderately high 

Foods Allowed
• Bacon fried, Cereals , Soup , Meat , Poultry product, Fish , Potatoes , Breakfast cereals

Foods Avoided
• Beans, Cabbage, Onions, Cauliflower, Broccoli, Canned vegetables and soup, Fast food

CHoLeRa
Cholera, also known as EI TOR is a self-limiting acute dehydrating disease of the intestines of the
intestines particularly the small gut caused by Vibrio cholerae. The powerful exotoxin produced causes
hypersecretion of water and sodium in the lumen of the gut leading to intense diarrhea.

Signs and symptoms: 

• Include diarrhea characterized by profuse brown watery stools, becoming rice-water like and mucoid
with little solids and a fishy odor.
• Stool volume may exceed 1500 ml in severe cases. Vomiting occurs after the diarrhea has been
established, characteristically effortless and productive of rice-water like material.
• The skin is cold and the fingers and toes wrinkled. 
• There is severe muscle cramps and prostration directly related to fluid loss. Due to fluid-electrolyte
disturbances, the patient experiences profound dehydration, restlessness and extreme thirst; circulatory
collapse and anuria; all of which may result in shock, coma and even death.

Mode of transmission:

Food and water contaminated with vomitus and stools of patients and carriers. 

Diet therapy:

Give additional fluids, “am”, soup, cereals mashed vegetables. Coconut water is said to be rich in
potassium, one of the electrolytes found in choleric stools. 
Dietary modification involve the same principles outlined for acute fever plus a bland diet to facilitate
digestion and rapid absorption because of reduced GI motility. Dietary fats are restricted or given in
moderate levels because of vomiting and diarrhea. 

Food allowed: 

Example
• banana, Soya beans boiled, Roast potato and potato chips, Sardine, Fatty meats, Fried foods, Whole
grain breads , Whole grain cereals , Dried beans and peas , Vegetables from the cabbage family,
Chocolate , Nuts , Seeds , Carbonated beverages 

MuMpS
Mumps is an acute generalized viral infection usually diagnosed by the sudden onset of painful swelling
in one or both parotid glands. He mumps virus has a particular tropism for nervous and glandular
structure particularly the testes n the male.

Signs and symptoms:

Modest rise in temperature for one or two days while severe infections may be accompanied by headache,
photophobia, and abdominal discomfort; severe parotid pain usually aggravated by eating; inflammation
of the orifices of the parotid ducts.

Mode of transmission: 
Mumps is transmitted by salivary secretions and the disease is contagious.

Diet therapy:
The diet should be soft or liquid as tolerated. Sour foods or fruit juices are disliked because of the burning
or stinging sensation they elicit.

Food allowed:

• can eat soft protein such as tuna, soft bread but not toast or bagels, mashed potatoes or other mashed
vegetables, Ice cream

Food not allowed:

• not chicken breast or steak tuna , not toast or bagels bread, cannot eat cooked or raw vegetables,
Baked potatoes

DeNgUe
Dengue is an acute, infectious mosquito-borne fever that is temporarily incapacitating but never fatal. It is
endemic in the tropics. The carrier incriminated is the yellow fever mosquito, Aedes Aegypti.

Signs and symptoms: 

Symptoms are malaise and anorexia in adults (for up to 13 months), fevers and chills with severe frontal
headaches, ocular pain, myalgia with severe headache, nausea and vomiting, mild pharyngitis, and rashes.

Mode of transmission:

Mosquito bite ( Aedes Aegypti ) 

Diet Therapy:

Low fat, low fiber, non-irritating, non-carbonated. 

Foods allowed:

• Plain tender meats and fish, Cooked eggs, Corn flakes, Salt, Hard candies, honey

Foods not allowed:

• Tough and luncheon meats, Fried or raw eggs, Raw and dried fruits, also pears, prunes, peaches,
raisins, citrus fruits, berries, figs, dates, pineapple, Vinegar, spiced salad dressings,

MALARIA
Malaria is recurrent infection caused by parasitic protozoa of the genus Plasmodium, and transmitted by
mosquitoes of the genus Anopheles. The malaria parasite has two cycles: sexual and asexual. 

Signs and symptoms: 

Main symptoms of malaria are intermittent fever with profuse sweating, chills swelling of the liver and
spleen, debility, and hypochromic anemia. 

Diet therapy:
A high calorie diet ( as much as 50% over RDA ), high in protein, moderate in fat is recommended
vitamin-mineral supplementation and liberal fluid intake are necessary for the therapy.

Foods allowed:

• Potatoes prepared with added fat such as butter, margarine and whole milk. Croissants, buttermilk
biscuits, muffins, or quick breads (banana bread or zucchini bread)., Vegetables prepared with added fat
(margarine, butter, cream cheese, and cheese), Nuts, seeds, and peanut butter, Beans, peas, and lentils.

DIPHTHERIA
-Is an acute infectious and communicable disease that affects the respiratory system, especially the local
production of the membrane and the myocardium or the central nervous system.
- The causative agent is Corynebacterium diptheraie.

DIET:
• Fluid or Soft diet

FOODS ALLOWED:
• Warm milk, Broth, Creamed soups, Fruit juice, Gelatin

FOODS NOT ALLOWED:

- Foods that can aggravate reflux.
• Ketchup and other tomato products, Citrus fruits, Chocolate, Mint, Spicy foods, Alcohol
- Glucose and amino acids are administered intravenously to increase calories.
- When the child is unable to swallow an account of pain or accumulation of membrane in the throat,
forced feeding with a nasal or stomach tube.

PERTUSSIS
- Sometimes called whooping cough.
- An acute serious infectious, communicable disease that affects the respiratory tract.
- The causative agent is Bordatella pertussis and B. Parapertussis
- The mode of transmission is by Droplet infection.

3 stages:

• Catarrhal or coryzal stage- highly communicable stage.

Symptoms:
Sore throat, Malaise, Anorexia, sneezing
• Paroxysmal stage
Symptoms: Coughing, Episodes of cyanosis for infants due to apnea, Vomiting
• Convalescent stage
Mild cough, Paroxysmal, Short lived

DIET:
• Low residue diet ( if oral feeding is tolerated)
• Advised to eat and drink slowly to avoid triggering paroxysms

FOODS ALLOWED:
• White bread, refined pasta and cereals, and white rice, Limited servings of canned or well-cooked
vegetables that do not include skins, Pulp free, strained, or clear juices, Tender, ground, and well
cooked meat, fish, eggs, and poultry

FOODS NOT ALLOWED:

• Popcorn, Nuts and Seeds, Dried beans, peas, and legumes, Tough meat, meat with gristle, Whole
grain breads and pastas, corn bread or muffins, products made with whole grain products, or bran,
Strong cheeses, yogurt containing fruit skins or seeds, Juices with pulp.

INFLUENZA
- Is an acute infectious disease of the respiratory tract characterized by fever, non-productive cough, and
myalgia.
- More common during cold season.
Common symptoms:
• Prostration, Malaise, Fatigue, Nasal obstruction, Sore throat
DIET: soft- regular diet

FOODS ALLOWED:
• Milk – for 2 or 3 days, Chicken broths with beaten eggs added, Tender breast of chicken

FOODS NOT ALLOWED

Whole-grain breads, cereals and pasta, Dried fruits, Raw fruit with skin or membranes, such as oranges
and grapefruit, Raw vegetables, Dried beans or peas, Luncheon meats, Seeds and nuts, and foods
containing them, Coconut, Popcorn

TYPHOID FEVER
- is a bacterial infection of the alimentary tract in humans. 
- Salmonella typhi is the causative agent
- It is ingested through contaminated food and water and thus it enters the alimentary tract of humans.

SYMPTOMS;
• Period of high fever, Severe prostration, Gastro intestinal disturbances, Delirium

DIET: Low fiber diet

FOODS ALLOWED:
• Rice, Potatoes, Eggs, Milk, soups, fruit juices 

FOODS NOT ALLOWED:

• overcooked and uncooked foods

FOOD SERVICE TO PATIENTS WITH COMMUNICABLE

DISEASES
 The food is served in disposable containers made of paper or plastic ware. Spoons, forks and
knives may also be of the disposable types.
 After the meal everything is thrown away in tightly covered garbage cans or plastic bags and
immediately burned.

Preventive Measures In The Dietary

Department
Presidential Decree No. 856
 Code on Sanitation of the Philippines.
 In local setting, Presidential decree No. 856 embodies the Code on Sanitation of the Philippines
enforced by the Department of health.

The following are the standards should be

follow in food preparation:
1. Place should be atleast 25 meters away from possible sources of contamination.
2. There should be no direct connection with toilet.
3. No animal should be kept in the premises.
4. The building should be constructed to conform with the requirements of the local health
authority.
5. It should be well maintained and should offer no entrance for rats and mice.
 6. The floors, walls and ceiling requirements should be so constructed as to facilitate cleaning and
maintaining sanitation.
7. Lighting should be free from glare : if glass is used it should be so distributed as to avoid the
shadow and permit effective inspection and cleaning.
8. Sufficient ventilation should be provided to maintain comfortable conditions.
9. Locker rooms with toilets and facilities for washing hand and availability of hot and cold rinsing
water, disposal garbage and vermin control are also specified in the code.

REVERSE ISOLATION
• Means protecting the patient from all possible contamination of infections .

REPORT
IN
NUTRITION
& DIET
THERAPY
SUBMITTED TO:

SUBMITTED BY:
MA. THERESA BINGARO
JONAH ANNE L. ALDEA
PAUL VINCENT DUAG
MA. THERESA BLANCO
SHARMEN ARAZA
BSN-2A