Laoag City, Ilocos Norte

NUTRITION and DIET THERAPY

(NCM 105)
AY 2021-2022
ELSIE MARIE GENEVIEVE C. AGODON
KRISTEL GAIL A. VALENCIA
Professor

NUTRITION and DIET THERAPY

(NCM 105B)
AY 2022-2023-1
MYRA MICHELLE GUZMAN, RN
KRISTEL GAIL A. VALENCIA, RN
Instructor

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MODULE 2 (PART I)
Nutrition Care Process
(ADIME)

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In this part we will learn about

Nutrition Care Process

ACTIVITY 1 MAKE A 24 – HOUR RECALL

In order to get a more complete picture of your health and need to more about your eating
habit, answer the following questions.

1. What time did you go to bed the night before last? __________________________
Was this the usual time? _______________________________________________

2. What time did you get up yesterday? _____________________________________

What did you have and how much? _____________________________________

3. When was the first time you had anything to eat or drink?____________________
What did you have and how much? ______________________________________

4. When did you eat again? _______________________________________________

Where? _____________________________________________________________
What and how much? _________________________________________________
5. When did you eat next? ________________________________________________
What did you eat and how much? ________________________________________

6. Did you eat or drink anything else? _______________________________________

a. Anything from 1st to 2nd meal? ________________________________________
b. Anything from 2nd to 3rd meal? ________________________________________
c. Anything from 3rd meal to bed time? ___________________________________

7. Was this day’s food intake different from usual? ____________________________

If so why? ___________________________________________________________

8. Is weekend eating different? ____________________________________________

If so, why? __________________________________________________________

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Watch and intenalize this video.

https://www.youtube.com/watch?v=4IMhVISEcxA

1. In not more than 100 words, what do you think is the importance of Nutrition Care Process
in patient with nutritional problems?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

_____________________________________________________________________
_____________________________________________________________________

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

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is being met by the food the individual eats. The evaluation of the nutritional status involves
examination of the individual’s physical condition, growth and development, behavior, blood
and tissue levels of nutrients, and the quality and quantity of the nutrient intake.

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1. Nutritional History - It involves the role of nutrition in normal and abnormal

individuals, the impact of nutrition on health and disease, and the interactions between
diet, host, and environment.

a. Dietary intake date- refers to the daily eating patterns of an individual, including
specific foods and calories consumed and relative quantities.

b. Food diary - a detailed daily record of the food and drink one consumes over a
certain period of time, typically kept as a means of tracking calorie consumption
or identifying habitual eating patterns.

c. 24 – hour recall - is a structured interview intended to capture detailed

information about all foods and beverages (and possibly, [glossary term:] dietary
supplements) consumed by the respondent in the past 24 hours, most commonly,
from midnight to midnight the previous day.

2. Physical assessment
a. Anthropometric Measurement
Height and weight

• BMI ( body mass index ) -an index used to indicate whether a person is
over- or underweight. It is obtained by dividing a person's weight in
kilograms by the square of their height in metres. Normal values are
18.524.9. Values of 25-29.9 are considered overweight. Values of 30 or
higher are considered obese.

• Mid-Upper Arm Circumference (MUAC)- is the circumference of the

left upper arm, measured at the mid-point between the tip of the shoulder
and the tip of the elbow (olecranon process and the acromium).

• Fat- fold or skin fold thickness - An anthropometric measurement used to

evaluate nutritional status by estimating the amount of subcutaneous fat.
Calibrated calipers are used to measure the thickness of a fold of skin at
defined body sites that include upper arm or triceps, subscapular region,
and upper abdomen.

• Body composition – is a method of describing what the body is made of.

It includes fat, protein, minerals and body water. It also describes weight
more accurately than BMI.

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B. Nutrition diagnosis and Plan of care :

• The nutrition diagnostic statement describes alterations in the
patient/client/group’s nutritional status.
• A diagnostic label (qualifier) is an adjective that describes/qualifies the human
response such as:
• Altered, impaired, ineffective, increased/decreased, risk of, acute or chronic.

C. Nutrition Intervention and diet Therapy :

The purpose of nutrition intervention is to resolve or improve the nutrition
diagnosis or nutrition problem by provision of advice, education or delivery of
the food component of a specific diet or meal plan tailored to the
patient/client’s needs.
1. Food administration

a. Oral nutrition – are sterile liquids, semi-liquid, semi-solids or

powders which provides macro and micro nutrients. They are widely
used within the acute and community health settings for individuals
who are unable to meet their nutritional requirement through oral diet
alone.

b. Enteral nutrition – sometimes a person cannot eat any or enough food

because of an illness. Others may have a decreased appetite,
difficulties in swallowing, or some type of surgery that interferes with
eating. When this occurs, and one is unable to eat, nutrition must be
supplied in a different way. One method is “enteral nutrition” or: tube
feeding”.

c. Short-term enteral access – tubes are placed into the nares or

sometimes, orally, usually at the bedside. This provides a means to
meet the patient nutrient needs and can provide a chance to assess
tolerance of the tube feedings if more permanent long-term placement
is determined to be required.

d. Long-term enteral access – there are some situations where enteral

feeding is used as long-term solution, such as for people with
movement disorder or children with physical disabilities.

e. Parenteral nutrition – is intravenous administration of nutrition

which may include protein, carbohydrate, fat, minerals and electrolytes,
vitamins and other trace elements for patients who cannot eat or absorb

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enough food through tube feeding formula by mouth to maintain good

nutrition status.

2. General Diet

a. Diet modified in consistency – a modified consistency diet provides

food in a physically altered form, such as chopped, ground or pureed.
-The diet is based on the individual food tolerances. People with a
decreased ability to chew may benefit from this consistency diet.
-Conditions that warrant the use of this diet include : absence of teeth,
loose dentures, sore gums and head and neck injuries

b. Diet modified in composition :

1. Low calorie diet – a dietary regimen that restricts calorie intake 
A very low calorie diet is any diet plan that allows 800 calories or
less in a day; and the diet is overseen by a physician.
 The length of such diet is relatively short, usually between 3
– 6 months. Any longer and serious health complication
may arise.

2. High calorie diet – furnishing more calories that needed to

maintain weight often more than 3500 – 4000 calories per day.
 Some medical conditions require a high-calorie to help
maintain or promote weight gain.
 People with liver disease are at risk of malnutrition due to
poor intake and altered nutrient metabolism.

3. High protein diet – a diet that contains large amount of protein,

consisting largely of meats, fish, milk, legumes and nuts.
 It may be indicated in protein depletion that results from
any cause, as a preoperative preparation or for patients with
severe burns and sepsis

4. Low protein diet – any diet which the protein intake is reduced.
 Some of each type of protein should still be consumed each
day from the 2 main sources: animal products (fish,
poultry, eggs, meat, and dairy products) considered high
quality of complete protein. Vegetable products (breads,
cereals, rice, pasta, dried beans) considered low quality or
incomplete protein.

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5. Low fat diet – a diet that consist of little fat, especially saturated
fat and cholesterol, which is thought to lead to increased blood
cholesterol levels and heart attack

6. Low carbohydrate diet - restrict carbohydrate consumption

usually for weight control or for the treatment of obesity.
 Foods high in digestible carbohydrate ( bread, pasta ) are
limited to replace with foods containing a higher percentage
of proteins and fats ( meat, poultry, fish shellfish, eggs,
cheese, nuts, seeds, peanuts and soy products ) and other
foods low in carbohydrates ( most salad vegetables )
 It is often used as treatment for some other conditions, most
notably diabetes and epilepsy, but also for chronic fatigue
syndrome and polycystic ovarian syndrome

7. Low sodium diet – a diet that includes no more than 1500 to 2400
mgs of sodium per day ( 1 tsp of salt has 2300 mg sodium )
 People who follow a vigorous or moderate exercise
schedule are usually advised to limit their sodium intake to
3000 mg per day and those with moderate to severe heart
failure are usually advised to limit their sodium intake to
2000 mg per day.
 Human requirement for sodium in the diet is about 69 mg
per day which is typically less than one-tenth as much as
many diets “seasoned to taste”

8. Low potassium diet – potassium is a mineral that assists in

maintaining normal blood pressure and proper contraction of the
heart. It is found in whole grain, vegetables, milk, fruits, peas and
dried beans.
 Need of a low potassium diet if an individual has kidney
problem, excess potassium can accumulate up to dangerous
levels in the blood. This causes irregular heartbeat,
confusion or a heart attack.
 If the diet contains less than 2000 mg of potassium per day
then it is called as a “low potassium diet”

9. Low purine diet – it is an eating plan that limits foods that contain
purine.

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 When the body digest purine, a waste product called uric

acid is produced.
 A build-up of uric acid crystals in the joints can cause a
type of arthritis known as gout.
 The purpose of low-purine diet is not to completely avoid
purines, instead the goals are to limit and monitor how
much purine is in the food an individual eat and to learn
how the body responds when eating different foods that
contain purine

D. Monitoring Nutritional status

1. Strategies to Address age-related changes affecting nutrition

• Aging is linked to muscle loss, thinner skin and reduced stomach acid.
• The ability to recognize hunger and thirst may also be reduced as we age.
• Older adults generally need fewer calories. However, their nutrient needs are
just as high as or higher than when they were younger. That is why eating
nutrient-rich, whole foods becomes extremely important.
• Eating a protein-rich diet could help fight sarcopenia, the age –related loss of
muscle and strength. Research show that a person get the most benefits if they
combine a protein-rich diet with resistance exercise
• Bowel- related issues, including constipation and diverticular disease, can
occur as we age. An individual can help protect herself by increasing fiber
intake
• Calcium and vitamin D are important nutrients for maintaining optimal bone
health. The body stands to benefit from getting more calcium and vitamin D as
we age.
• Aging increases the risk of vitamin B12 deficiency. Older adults can especially
benefit from taking a vitamin B12 supplement or consuming foods fortified
with vitamin B12.
• Potassium, magnesium, omega-3, fatty acids and iron are other nutrients a
person can benefit from as we age.
• Drinking an adequate amount of water is important as we age, as our body
become less able to recognize the signs of dehydration.
• It is common for elderly people to experience reduced appetite. If this issue is
not addressed, it can lead to weight loss, nutritional deficiencies and poor
health.

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2. Therapeutic diets – is a meal plan that controls the intake of a certain foods or
nutrients. It is a part of the treatment of a medical condition and are normally
prescribed by a physician and planned by a dietician.

a. Hospital regular diet – it aims to provide a variety of nutrients, including

protein, carbohydrates, vitamins and minerals to patient. It generally contains
moderate amounts of fat and sodium. Its purpose: is to nourish patients, help
them heal and get them used to eating regular food again.

b. High fiber diet – all fibers comes from plants, bushes, vines and trees.

3 types of fiber that are most important to the health of the body:

1. Insoluble fiber –does not dissolve in water, nor is it fermented by

the bacteria residing in the colon. It retains water thus help promote
a larger, bulkier and more regular bowel activity
 Sources : whole grain wheat, whole grains corn bran
including popcorn, unflavoured and unsweetened nuts and
seeds, potatoes, apples, bananas and avocados, green beans,
zucchini and cauliflower

2. Soluble fiber – are fermented or used by the colon bacteria as a

food source or nourishment. When these good bacteria grow and
thrive, many health benefits occur in both the colon and the body.
 Sources : legumes, oats, berries, plums, apples, banana,
broccoli, carrots

3. Prebiotic soluble fiber – the technical name for this fiber is inulin
or fructan

 Occurs in significant amounts in : asparagus, onions, garlic,

bananas,

c. Clear liquid diet – consist of clear liquid such as water, broth and plain gelatin
that are easily digested and leave no undigested residue in the intestinal tract.
• The doctor may prescribe a clear liquid diet before certain medical
procedure or have a certain digestive problem.
• It cannot provide adequate calories and nutrients It should not be
continued for more than a few days.

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• Foods can be considered liquid if they are even partly liquid at room
temperature. A patient cannot eat solid food while on a clear liquid diet
• Purpose: it is often used before tests, procedures or surgeries that
require no food in the stomach or intestines.
• It may also be recommended as a short term diet for certain digestive
problems such as nausea, vomiting or diarrhea or after certain types of
surgery

Foods that are allowed in a clear liquid diet :

 Water ( plain, carbonated or flavoured)
 Fruit juices with pulp such as apple or white grapes
 Fruit flavored beverages such as lemonade
 Gelatin
 Tea or coffee without milk or cream
 Strained tomato or vegetable juice
 Clear fat-free broth
 Ice pops without milk, bits of fruit, seeds or nuts

d. Full liquid diet – is made up only of fluids and foods that are normally liquid
and foods that turn to liquid when they are at room temperature like ice cream.
It also includes :
 Strained creamy soups
 Tea, juice
 Jell-O, milkshakes
 Pudding, popsicles
• A patient cannot eat solid food while on a full liquid diet.
• For most patient on a full liquid diet, the goal is to get 1,350 to 1,500
calories and minerals for their energy
• This diet is safe for people with diabetes, but only when they are
allowed closely by their doctor.

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Patients may have these foods and drinks:

 Water
 Fruit juices including nectars and juices with pulp
 Butter, margarine, cream, custard, pudding
 Fruit ices and popsicles
 Soup broth (strained cream soups but NO solids)
 Sodas such as ginger ale and sprite
 Ensure, and other liquid supplements
 Tea or coffee with cream or milk and sugar or honey

e. Cold liquid diet – is also termed as TONSIL diet, is food preparation includes
serving cold or iced liquids
• This diet varies depending on the severity of the patient’s condition,
age and overall health status.
• Patients are instructed to refrain from eating solid foods for a day or
two only since this diet does not provide adequate nutrition.
• The aim of prescribing a cold liquid diet is to promote relief to fresh
mouth sores or following tonsillectomy.
Guidelines in preparing for a cold liquid diet :
 C – consult a nutritionist or a doctor before initiating this diet
 O - only soothing fluids are allowed in this diet
 L -let the client shift to mechanical soft diet first before
launching the diet
 D - duration of the diet should only be 2-3 days to avoid risking
patient’s condition.

Foods allowed :
 Fresh fruit juice – iced or cold
 Commercial fruit juices – iced or cold
 Blended fresh fruit – fresh or cold
 Fruit shake – iced or cold
 Dairy or non-dairy chilled yogurt
 Cold thin cereal as a rice substitute
 Any cold thin soup
 Plain ice cream
 Popsicles

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3. Dietary Computation
a. BMI – is a measurement of body fat based on height and weight.
BMI = weight (kg)

(Ht meters) 2
Example: male 5’6 and 90 kg conversion: 1 meter = 3.3 ft
1 meter = 39.6 inches
Solution: 5 ft x 1 m_
3.3 ft = 1.52 m

= 6 inches x 1 m
39.6 inches = 0.15 m
Add: 1.52 + 0.15 = 1.67

90 kg
= 1.67 (1.67) – multiply by the number itself

= 90
2.79

BMI = 32.25 obesity grade 1

Classification (BMI):
• underweight – less than 18.5
• normal - 18.6 - 24.9
• over weight - 25 - 29.9
• obesity grade 1- 30 - 34.9
• obesity grade 2 - 35 - 39.9
• extreme obesity - > 40
grade 3

b. desired body weight determination ( DBW )

DBW = (ht. cm – 100) – 10 %

Example: 5’3”
= 5 x 12 = 60 + 3 = (63 inches x 2.54)
= (160.02 – 100) = (60.02-6.002(10%) = 54 kg

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c. Total energy requirement (TER) = DBW x activity level

Example: 5’3” student = 54 x 35 = 1,890 cal.

Conversion:

Height weight
1 ft = 12 inches 1 kg = 2.2 lb
1 inch = 2.54 cm
100 cm = 1 meter

Activity Level:
Bed rest = 27.5 ( hospital patients)
Sedentary = 30 ( secretary, clerk, typist administrator, cashier, bank teller)
Light = 35 (teacher, nurse, student, lab. Tech, housewife with maid)
Moderate = 40 ( housewife w/o maid, vendor, mechanic, jeepney and car driver )
Heavy = 45 ( farmer, laborer, cargador, laborer, coal miner, fisherman,
Heavy equipment operator )

E. Effectiveness of the plan of care

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