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THERAPEUTIC DIETS A. Clear Liquid Diet 1. Indications: a. A clear liquid diet serves a primary function of providing fluids and electrolytes to prevent dehydration. b. The diet is used as an initial feeding after complete bowel rest. c. The diet is used initially to feed a malnourished person who has not had any oral intake for some time. d. The diet is used also for bowel preparation for surgery or tests. e. The diet is a postoperative diet. f. A clear liquid diet is used in cases of diarrhea. 2. Nursing considerations: a. Clear liquid is deficient in energy and most nutrients. b. The body digests and absorbs clear liquid easily. c. Clear liquid contributes to little or no residue in the gastrointestinal tract. d. Clear liquid can be unappetizing. e. Client should not stay on a clear liquid diet for more than a day or two. f. Clear liquid consists of foods that are relatively transparent to light and are clear and liquid at room and body temperature. g. It includes water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, popsicles, and regular or decaffeinated coffee or tea. It also includes apple juice. h. The nurse should limit the amount of caffeine consumed by the client because caffeine can cause an upset stomach and sleeplessness. i. The client may have salt and sugar. j. Dairy products are not allowed. B. Full Liquid Diet 1. Indication: a. A full liquid diet may be used as a second diet after clear liquids following surgery or for a client who is unable to chew or swallow. 2. Nursing considerations: a. A full liquid diet is nutritionally deficient in energy and most nutrients. b. The diet includes clear and opaque liquid foods and those that liquefy at body temperature. c. It includes all clear liquids and items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard soups that are strained, and strained vegetable juices. C. Soft Diet 1. Indications: a. A soft diet is used for clients with dental problems, clients with poor-fitting dentures, and clients who have difficulty chewing or swallowing. b. The diet is used for clients who have ulcerations of the mouth or gums, oral surgery, a broken jaw, plastic surgery of the head or neck, dysphasia, or for the client who had a stroke. c. The diet is therapeutic for clients with impaired digestion or absorption as a result of conditions such as ulcerative colitis and Crohnss disease. 2. Nursing considerations: a. Client with mouth sores should be served foods at cooler temperatures. b. Clients with difficulty chewing and swallowing because of a reduced flow of saliva can increase salivary flow by sucking on sour candy. c. Encourage the client to eat a variety of foods. d. Provide plenty of fluids with meals to ease chewing and swallowing of foods. e. Sucking fluids through a straw may be easier than drinking them from a cup or glass. f. All foods and seasonings are permitted; however, liquid, chopped, or pureed foods or regular foods with a soft consistency are best tolerated. g. Avoid foods that contain nuts or seeds, which easily can become trapped in the mouth and cause discomfort. h. Avoid raw fruits and vegetables, fried foods, and whole grains. D. Bland Diet 1. Indication: a. A bland diet may be prescribed for the client with gastritis, ulcers, reflux esophagitis, or other gastrointestinal disorders, congestive heart failure, or myocardial infarction. 2. Nursing considerations:

5 jcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/a 5 fgjcg/afgjcg/afgjcg/afgjcg/afg a. Bland foods are less likely to form gas than regular diets. b. Eliminate foods that stimulate gastric acid secretions. c. Eliminate foods that are irritating to the gastric mucosa. d. Foods to be avoided include alcohol; caffeine and caffeine-containing beverages such as cola, cocoa, coffee, and tea; fried foods; pepper and spicy foods. E. Low-residue/Low-fiber Diet 1. Indications: a. The diet supplies foods that are least likely to form an obstruction when the intestinal tract is narrowed by inflammation or scarring or when gastrointestinal motility is slowed. b. The diet is used for inflammatory bowel disease, partial obstructions of the intestinal tract, enteritis, diarrhea, or other gastrointestinal disorders. 2. Nursing considerations: a. Foods high in carbohydrates are usually low in residue and include white bread, cereals, and pasta. b. Foods to be avoided are raw fruits (except bananas), vegetables, seeds, plant fiber, and whole grains. c. Dairy products are limited to two servings a day. F. High-residue/High-fiber Diet 1. Indications: a. The diet is used for clients who have constipation. b. The diet is used for irritable bowel syndrome when the primary symptom is alternating constipation and diarrhea and for asymptomatic diverticular disease. c. The diet helps regulate blood glucose in clients with diabetes mellitus. d. The diet helps control blood cholesterol in clients with heart disease. 2. Nursing considerations: a. The diet provides 20-25 g of dietary fiber daily. b. The diet adds volume and weight to the stool and speeds the movement of undigested materials through the intestine. c. The diet consists of fruits and vegetables and whole grain products. G. Fat-controlled Diet 1. Indications: a. The fat-controlled diet is indicated for atherosclerosis, diabetes mellitus, hyperlipidemia, hypertension, myocardial infarction, nephritic syndrome, and renal failure. b. The diet reduces the risk of heart disease. 2. Nursing considerations: a. Limit the total amount of fats and amounts of polyunsaturated, monounsaturated, and saturated fats and cholesterol. b. Avoid the following sources of fats: Cholesterol - Animal products - Egg yolks - Liver and organ meat Monounsaturated fats - Duck and goose - Eggs - Olive and peanut oils Polyunsaturated fats - Corn oil - Sunflower oil Saturated fats - Beef - Butter - Hard yellow cheeses - Luncheon meats H. High-calorie Diet 1. Indication: a. Person with severe stress, burns, cancer, human immunodeficiency virus infections, acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, respiratory failure, or any other type of debilitating disease require a high calorie diet. 2. Nursing considerations:

5 jcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/a 5 fgjcg/afgjcg/afgjcg/afgjcg/afg a. The high-calorie diet also should be high in protein because the purpose of the diet is to build or maintain lean body mass. b. Add fats to foods whenever possible. c. Add nuts and dried fruits such as raisins to desserts or cereals if the client can tolerate these foods. d. Add sugar to food, and provide high-calorie desserts. e. Encourage snacks between meals, such as milkshakes and instant breakfasts. I. Sodium-restriction Diet 1. Indications a. Person with hypertension, congestive heart failure, kidney diseases, cardiac diseases, and cirrhosis of the liver require a sodium-restriction diet. 2. Nursing considerations: a. This type of diet includes 2000 to 4000 mg of sodium daily (mild restriction), 1000 mg of sodium daily (moderate restriction), or 500 mg of sodium daily (strict but seldom prescribed). b. Cereals are allowed on a sodium restricted diet which include dried or instant cereals, puffed wheat, puffed rice, and shredded wheat. c. Sources of Sodium-free Spices and Flavorings includes: Almond extract Cinnamon Curry powder Garlic powder or garlic Ginger Lemon extract Maple extract Mustard powder J. Protein-restriction Diet 1. Indication: a. Person with acute renal failure, chronic renal disease, cirrhosis of the liver, and hepatic coma require a protein-restriction diet. 2. Nursing considerations: a. Provide enough protein to maintain nutritional status but not an amount that will allow the buildup of waste products from protein metabolism (40 to 60 g of protein daily). b. The smaller the amount of protein allowed, the more important it becomes that all protein included in the diet be of high quality. c. An adequate total energy intake from foods is critical for clients on proteinrestricted diets (protein will be used for energy, rather than for protein synthesis). d. Special low-protein products, such as pastas, bread, cookies, wafers, and gelatin made with wheat starch, can improve energy intake and add variety to the diet. e. Carbohydrates in powdered or liquid forms also can provide additional energy. f. Vegetables and fruits contain some protein, and for very low-protein diets, these foods must be calculated into diet. g. Foods are limited from the milk, meat, bread, and starch exchange. K. High-protein Diet 1. Indication: a. High-protein diets are for tissue building, burns, liver disease, and older clients. 2. Nursing considerations: a. High-protein diets correct protein loss or assist with tissue repair. b. Increase foods such as meat, fish, and dairy products. c. The client may need protein supplements. L. Low-calcium Diet 1. Indication: a. A low-calcium diet may be prescribed to prevent renal calculi in the client at risk for forming calculi composed of calcium. 2. Nursing consideration: a. Decrease the total intake of calcium to prevent further stone formation; avoid whole grains, milk and dairy products, and green, leafy vegetables. M. High-calcium Diet 1. Indication: a. Calcium is needed during bone growth and in adulthood to prevent osteoporosis. 2. Nursing considerations: a. Primary dietary sources of calcium are dairy products. Normal value - 8.6 to 10 mg/dL

5 jcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/a 5 fgjcg/afgjcg/afgjcg/afgjcg/afg Common food sources - Cheese - Milk and soy-milk - Sardines - Spinach - Tofu - Yogurt b. Clients experiencing lactose intolerance need to incorporate sources of calcium other than dairy products into their dietary patterns regularly. N. Low-purine Diet 1. Indication: a. The diet is used to treat gout. 2. Nursing considerations: a. Purine is a precursor for uric acid that forms stones and crystals. b. The client needs to avoid consuming fish such as anchovies, herring, mackerel, sardines, and scallops. c. The client needs to avoid consuming glandular meats, gravies, meat extracts, and goose. O. High-iron Diet 1. Indication: a. The diet is used for clients with anemia. 2. Nursing considerations: a. The high-iron diet replaces iron deficit from inadequate intake or loss. b. The diet includes organ meats, meat, egg yolks, whole wheat products, leafy vegetables, dried fruit, and legumes. P. Diet for Diverticular Disease 1. Symptomatic Diverticulitis: The client avoids fiber because a high-fiber diet is irritating to the bowel. 2. Asymptomatic Diverticular Disease: The client consumes a high-fiber diet to prevent constipation. 3. The client should maintain a liberal fluid intake of 2500 to 3000 mL/day, unless contraindicated. 4. The client should avoid seeds and nuts because they become trapped in the diverticula and cause irritation. 5. The client should avoid gas-forming foods\ Gas-Forming Foods - Apple - Honey - Barley - Milk - Beans - Nuts - Broccoli - Onions - Cabbage - Radish - Celery - Soybeans - Cherries - Wheat - Coconut - Yeast - Eggplant Q. Fluid-restriction Diet 1. Indication: a. Acute renal failure-oliguric phase, chronic renal disease, cirrhosis of the liver, congestive heart failure and other cardiac disorders, and hepatic coma require fluid restriction. 2. Nursing consideration: a. Usually this diet restricts those foods that are composed largely of water, such as carbonated beverages, coffee, juices, milk, tea, water, frozen yogurt, gelatin, ice cream, popsicles, sherbet, soup, cream, and liquid medications. R. Carbohydrate-controlled Diet: 1. Indications: a. The diet helps maintain normal glucose levels in clients with disorders that cause blood glucose level to rise or fall abnormally. b. The diet is used for clients with diabetes mellitus, hypoglycemia, lactose intolerance, galactosemia, dumping syndrome, and obesity. 2. Nursing considerations:

5 jcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/a 5 fgjcg/afgjcg/afgjcg/afgjcg/afg a. The Exchange System for Meal Planning developed by the American Dietetic Association and the American Diabetes Association is a food guide used to control diabetes mellitus and manage weight. b. The Exchange System groups foods according to the amounts of the carbohydrates, fats, and proteins they contain. c. Major food groups include carbohydrate group, meat and meat substitute group, and fat group. S. Alkaline-ash Diet 1. Outcome: a. Increases the pH of the urine. b. Reduces the acidity of the urine. 2. Foods to include: a. Fruits, except cranberries, and prunes. b. Milk and most vegetables. c. Small amount of beef and salmon. 3. Indications: a. For uric acid stones and cystine stones. T. Acid-ash Diet: 1. Outcome: a. Decreases the pH of the urine. b. Makes the urine more acidic. 2. Foods to include: a. Bread, cereal, and whole grains. b. Cheese and eggs. c. Corn and legumes. d. Cranberries, prunes and tomatoes. e. Meat, fish, oysters and poultry. f. Pastries 3. Indications: a. For calcium oxalate stones, calcium phosphate stones, struvite stones, and urinary tract infection. Alkaline-Ash Diet Acid-Ash Diet Uric acid stones Calcium phosphate stones caused by excess dietary purine caused by supersaturation of urine or from gout with calcium and phosphate tend to form in acidic environment diet includes acid-ash foods because calcium stones have an diet include alkaline-ash foods and alkaline chemistry decreased intake of purine sources such as organ meats, decrease intake of foods high in gravies, red wines, and sardines calcium and phosphate to reduce Cystine stones urinary calcium content and to avoid excess vitamin D intake to caused by cystine crystal prevent stones from forming formation Calcium oxalate stones tend to form in acidic environment caused by supersaturation of urine diet include a low intake of with calcium and oxalate methionine, an essential amino diet includes acid-ash foods acid that forms cystine and avoid because calcium stones have meat, milk, cheese, and eggs alkaline chemistry increase fluid intake up to 3 L a avoid oxalate food sources like day, to help dilute the urine and tea, almonds, cashews, chocolate, prevent cystine crystal formation cocoa, beans, and spinach Struvite stones also called triple phosphate stones and are composed of magnesium and ammonium phosphate caused by urea splitting by bacteria tend to form in alkaline urine diet includes acid-ash foods limit high-phosphate foods such as dairy products, red and organ meats, and whole grains

5 jcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/afgjcg/a 5 fgjcg/afgjcg/afgjcg/afgjcg/afg VEGETARIAN DIETS

1. Types: a. Lacto-ovo Vegetarians Diet consists of plant foods with dairy products and eggs Person may consume fish and occasionally poultry b. Lacto-vegetarians Diet consists of plant foods and dairy products excluding eggs c. Vegans Persons follow a strict vegetarian diet and use no animal foods Food pattern consists entirely of plant foods 2. Nursing considerations: a. Ensure that the client eats a sufficient amount of varied foods to meet normal nutrient and energy needs. b. Protein intake can be increased by consumption of a variety of vegetable protein sources based in whole grains, legumes, seeds, nuts, and vegetables combined to provide all of the essential amino acids. c. Adequate energy intakes are important to ensure that dietary protein is used for protein synthesis.