2. Week 5
LEARNING OUTCOMES:
1.Formulate an individualized plan of care for a client
related to nutritional conditions and diet therapy, needs and
problems based on priorities.
2.Implement safe and quality nursing interventions, based
on assessment findings in managing nutritional and diet
therapy needs problems and issues.
3. LEARNING OUTCOMES:
3. Provide health education on nutrition and diet therapy
appropriate to healthy, at risk and sick client’s needs.
4. Provide appropriate evidence- based nursing care using a
participatory approach based on guidelines, principles, theories,
research in clinical practice, client preferences and client and
staff safety, customer care standards in nutrition and diet
therapy.
4. LEARNING OUTCOMES:
5. Adhere to establish norms of conduct based on the Philippine
Nursing Law, Patient Bill of Rights and other legal, regulatory,
and institutional requirements relevant to safe nursing practice.
6. Protect the rights of clients with problems in nutritional
status and diet therapy based on "Patient's Bill of Rights and
Obligations.”
5. LEARNING OUTCOMES:
7. Adhere to ethico-legal considerations when providing safe,
quality and professional nursing care.
8. Apply ethical reasoning and decision - making process to
address situations of ethical distress and moral dilemma.
9. Employ self-directed learning strategies aiming for
continuous professional development and competence.
7. DIET AND DIET THERAPY
• WHAT IS DIET?
- Diet is defined as the types and amount of food eaten
daily by an individual.
8. DIET THERAPY
• Modifications of normal diet to meet the nutritional needs
of a person based on a specific health conditions, such as
diabetes, hypertension, kidney disease, cancer,
gastrointestinal disorders, or malnutrition.
• Normally prescribed by doctor and planned by dietician.
• May change nutrients, caloric content and/or texture.
9. TYPES OF DIETS
A. General Diets
B. Diets Modified in Consistency
C. Diets Modified in Composition
D. Allergy-Restricted Diet
10. TYPES OF GENERAL DIETS
1. Regular/full diet
2. High fiber diet
3. Vegetarian diet
4. Therapeutic diet
11. REGULAR/FULL DIET
• No dietary restrictions
• Characteristics of a healthy diet:
✔ Balanced meal
✔ Adequate in nutrients
✔ Moderate in all
✔ foods/ food groups,
✔ Variety of foods,
✔ Calorie-controlled
12. HIGH FIBER DIET
• Diet high in non-digestible part of
plants, which is fiber.
• Fiber is found in fruits, vegetables,
whole grains, and
• legumes. Insoluble fiber increases
stool bulk,
• decrease transit time of food in the
bowel, and
• decreases constipation and the risk
of colon cancer.
• Here's a look at how much dietary
fiber is found in some common
foods
Fruits Serving size Total fiber
(grams)
Pear 1 medium 5.5
Apple with skin 1 medium 4.5
Banana 1 medium 3.0
Orange 1 medium 3.0
13. Other High-fiber Rich foods
Vegetables Serving size Total fiber
(grams)
Broccoli, boiled 1 Cup chopped 5.0
Potato, with
skin, baked
1 medium 4.0
Sweet corn,
Boiled
1 cup 3.5
Cauliflower, raw 1 Cup chopped 2.0
Carrot, raw 1 medium 1.5
Grains Serving size Total fiber
(grams)
Spaghetti,
whole-wheat,
cooked
1 Cup 6.0
Oatmeal,
instant, cooked
1 Cup 5.0
Popcorn, air-
popped
3 cups 3.5
Brown rice,
cooked
1 cup 3.5
Bread, whole-
wheat
1 sliced 2.0
14. VEGETARIAN DIET
• does not include any
meat, poultry, or seafood.
• It is a meal plan made up
of foods that come mostly
from plants.
• These include:
• Vegetables
• Fruits
• Whole grains
• Legumes
• Seeds
• Nuts
15. The different types of vegetarian diets
• Vegan: Includes only plant-based foods. No animal proteins or animal
by-products such as eggs, milk, or honey.
• Lacto-vegetarian: Includes plant foods plus some or all dairy
products.
• Lacto-ovo vegetarian: Includes plant foods, dairy products, and eggs.
• Semi- or partial vegetarian: Includes plant foods and may include
chicken or fish, dairy products, and eggs. It does not include red meat.
• Pescatarian: Includes plant foods and seafoods.
16. THERAPEUTIC DIETS
• a meal plan/ planned diet
• Modification of normal diet
• Prescribed by a doctor and planned by a dietician;
• Part of the treatment of a medical condition;
• Used to supplement the medical or surgical treatment.
17. DIETS MODIFIED IN CONSISTENCY
• What does Consistency mean?
• Foods that have been altered physically like the following:
20. LIQUID DIETS
• Nutritionally inadequate and should only be used for short periods
of time.
Uses:
⮚After surgery or a heart attack
⮚Pts with acute infections or digestive problems
⮚To replace fluids lost by vomiting or diarrhea
⮚Before some X-rays of digestive tract
21. MECHANICAL/SOFT DIET
•Similar to regular diet but foods must require little
chewing and be easy to digest.
•Avoid meat and shellfish with tough connective tissue,
coarse cereals, spicy foods, rich desserts, fried foods,
•Raw fruits and veggies, nuts and coconuts.
22. PUREED DIET
• Changes the regular diet by pureeing it to a smooth liquid consistency.
• Indicated for those with wired jaws extremely poor dentition in which
chewing is inadequate.
• Often thinned down so it can pass through a straw.
• For people with chewing or swallowing difficulties or with the
condition of dysphasia.
• Foods should be pureed separately.
• Avoid nuts, seeds, raw vegetables, and raw fruits.
• Nutritionally adequate when offering all food groups.
23. C. Diets Modified in Composition
a. Carbohydrate-Control Diet (Diabetic Diet)
b. Low salt, Low Fat Diet (Cardiac/heart Healthy Diet)
c. Renal ( kidney-friendly) Diet: Low sodium, protein, potassium
and phosphorus.
d. Low- Fiber ( Low-Residue) Diet.
e. Gluten- Free Diet.
f. Lactose-Free Diet.
g. Vegetarian Vegan Diet.
I. High calorie/ High Protein
24. DIABETIC DIET
•Diet contains exchange lists.
•Foods are grouped according to type, nutrients,
and calories.
•Pts are allowed a certain number of items from
each exchange list according to individual needs.
26. SODIUM RESTRICTED DIET
(Low Sodium or Low Salt Diet)
•Used for pts with cardiovascular diseases such as
hypertension or congestive heart disease, kidney
disease, and edema
•Avoid or limit addition of salt to any food,
smoked meats or fish, processed foods, pickles,
olives, and processed cheeses.
27. LOW FAT DIET
• Used for pts with gallbladder and liver disease,
obesity, and certain heart diseases;
⮚ AVOID cream, whole milk, cheese, fats, fatty
meats, rich
⮚desserts, chocolate, fried foods, salad dressings,
nuts, and coconut .
28. RENAL DIET
•This diet is for renal/kidney people.
•The diet plan is individualized depending on if the
person is on dialysis.
•The diet restricts sodium, potassium, fluid, and
protein specified levels.
•Lab work is followed closely
29. LOW FIBER/LOW RESIDUE DIET
•Used for pts with digestive and rectal diseases
such as colitis or
diarrhea.
•Eliminates or limits foods high in bulk or fiber
such as raw fruits and veggies, whole grains and
cereals, nuts, seeds, beans and peas, coconut,
and fried foods.
30. GLUTEN-FREE DIET
• What is gluten?
A compound of 2 proteins (glutenin & gliadin) found in wheat, barley, rye, &
triticale.
• Who should follow a gluten-free diet?
❖ Individuals with celiac disease need to avoid gluten.
❖ Evidence suggests that individuals with certain illnesses may benefit from a
gluten-free diet:
❖ Non-celiac gluten-sensitivity
❖ Irritable bowel syndrome
❖ Gluten ataxia
❖ HIV-associated enteropathy
32. HIGH-CALORIE DIET
•Used for pts who are underweight, or who have
anorexia nervosa, hyperthyroidism, or cancer
•Extra proteins and carbs are included; Avoid high-bulk
foods such as green salads, watermelon and fibrous
fruits
•Avoid high-fat foods such as fried foods, rich pastries,
and cheesecake because they digest slowly and spoil
appetite.
33. HIGH PROTEIN DIET
•Used for children and adolescents who need
additional growth, pregnant or lactating women,
before and/or after surgery, pts suffering from
burns, fevers, or infections.
•Regular diet with added protein rich foods such
as meats, fish, milk, cheese, and egg.
34. D. ALLERGY-RESTRICTED DIET
• Food allergies are due to an abnormal immune response to an
otherwise harmless food.
• Foods implicated with allergies are strictly eliminated from the diet.
• Appropriate substitutions are made to ensure the meal is adequate.
• The most common food allergens are milk, egg, soy, wheat, peanuts,
tree nuts, fish, and shellfish.
• A gluten free diet would include the elimination of
• wheat, rye, and barley. Replaced with potato, corn, and rice products.
36. Behavior Theories used in Nutrition
Education and Counselling
•Behavior change theories & models used in nutrition
education & counseling are validated within the field
of dietetics.
•It offers systematic explanations for nutrition-related
behavior change.
•They are integral to the nutrition care process, guiding
nutrition assessment, intervention & the outcome
evaluation.
37. NUTRITION COUNSELING
•Integral part of health care system.
•It provides primary, secondary and tertiary
prevention.
•Offers nutrition education and medical therapy w/c
reduces the risk & the impact of diseases & illnesses.
•Impacts positively management of or prevention of
many diseases and illnesses.
38. NUTRITION EDUCATION
Education & counseling should focus on:
•Appropriate & adequate food intake
•Food behaviors
•Symptoms that may affect appropriate food intake
•Benefits & risk of supplemental nutrients
•Strategies for symptom management
•Reduce effects of disease
•Reduce medication intolerance
39. NUTRITION COUNSELING THEORY
•are validated within the field of dietetics.
•These are frameworks for helping the practitioners
understand the external & internal issues & as well as
the dynamics that lead to behavioral changes.
•The use of these frameworks provides a rationale for
the selection of specific counseling strategies to
achieve a counseling objective.
40. DIFFERENT NUTRITION COUNSELING THEORY
•1. Trans theoretical Model/Stages
•2. Social Learning Theory
•3. Cognitive Behavioral Theory
41. TRANS THEORETICAL MODEL/STAGES
• James O. Prochaska
• Describes behavior change as a series of stages & provides a rationale
for matching counseling strategies to different stages of change.
• Focuses on the decision-making of the individual & is a model of
intentional change.
• This model operates on the assumption that people do not change
behaviors quickly & decisively.
• The trans theoretical model transits that individual move through the
6 stages of change.
42. 6 STAGES (PCPAM)
1. Precontemplation – in this stage, people are often unaware that their
behavior is problematic or produces negative consequences. The
strategies should raise the awareness about negative behavior.
2. Contemplation – the people are intending to start a healthy behavior &
a foreseeable future so that people recognize that their behavior may be
problematic & a more thoughtful & practical consideration or the pros
and cons of changing the behavior takes place with a co-emphasis placed
on both. Even with this recognition, people may still feel ambivalent
toward changing their behavior.
3. Preparation/determination – in this stage, people are ready to act.
People start to take small steps toward the behavior change & they
believe that changing their behavior can lead to a healthier life.
43. 4. Action
-The person is actively making changes to their behavior and environment.
Example: A person has stopped smoking and is using nicotine patches.
5. Maintenance
-The new behavior has been sustained for a while; the focus is on
preventing relapse.
Example: Someone who has been exercising regularly for 6 months and is working
to keep it going.
6. Termination
-The individual has no temptation to return to the old behavior and is
confident in maintaining the change permanently.
Note: Some models consider this stage optional or idealistic; many people
remain in maintenance long term.
44. COGNITIVE BEHAVIORAL THEORY
Albert Skinner, Aaron Beck, Albert Ellis
• It is based on the idea that how we think (cognition), feel (emotion), how
we act (behavior) all interact together. Specifically, our thoughts determine
our feelings & our behavior. Therefore, negative & unrealistic thoughts can
cause us distress & result in problems.
•Utilizes a directive, action-oriented approach & that teaches a person to
explore, identify, & analyze dysfunctional patterns of thinking & acting.
•How we act (behavior), think (cognition), & how we feel (emotion) all
interact. Both cognitive & behavior change strategies are used to effect
change.
45. SOCIAL LEARNING THEORY
Albert Bandura
•People learn by observing other’s social interactions,
experiences, and outside media influences. Provides structure
for understanding, predicting, and changing behavior.
46. Evidenced-Based Guidelines in
Nursing Practice
•Evidence-based guidelines are systematically
developed recommendations that help nurses
and other healthcare professionals make
decisions about appropriate care for specific
clinical conditions.
47. Major Recommendations for Nutrition Education and
Counseling in Nursing Practice
1. Assessment and Screening
• Conduct initial nutrition screening using validated tools like MUST or MNA.
Identify individuals at risk of malnutrition, obesity, or other diet-related illnesses.
2.Patient-Centered Nutrition Counseling
Use Motivational Interviewing (MI) to guide patient-led behavior change.
Personalize dietary goals considering medical needs, culture, and socioeconomic
background.
Set goals using the SMART framework.
3.Use of Visual Aids and Tools
Support learning with tools like MyPlate, nutrition labels, and portion guides.
Offer culturally sensitive materials and suggest tracking apps to promote self-
monitoring.
48. 4.Interprofessional Collaboration
Refer patients with complex nutritional needs to a Registered Dietitian (RD).
Work with pharmacists, physicians, and social workers for holistic care.
5.Disease-Specific Nutrition Guidance
Diabetes: Focus on carbohydrate management and balanced meals.
Hypertension: Recommend the DASH diet.
Heart disease: Encourage low saturated fat and omega-3 intake.
Obesity: Emphasize calorie reduction and sustainable weight loss.
Malnutrition: Advise energy-dense, high-protein foods and supplements.
6.Monitoring and Follow-Up
Reassess nutritional status periodically (e.g., weekly for inpatients).
Monitor goal progression and adjust plans as needed.
Ensure detailed documentation of education, interventions, and patient
response.
49. Background Information– Nutrition Education and
Counseling in Nursing
Nutrition is vital for preventing and managing diseases.
Nurses play a key role in teaching healthy eating, planning meals, and
guiding lifestyle changes.
They work with dietitians and use evidence-based approaches that
combine research, experience, and patient preferences.
By using tools like goal setting and motivational interviewing, nurses
help patients improve their health, reduce hospital visits, and live
better lives.
50. • References (APA Format)
• 1. Academy of Nutrition and Dietetics. (2022). Nutrition care manual.
https://www.eatrightpro.org
• 2. National Institute for Health and Care Excellence (NICE). (2021).
Nutrition support for adults: Oral nutrition support, enteral tube feeding and
parenteral nutrition. https://www.nice.org.uk/guidance/cg32
• 3. Centers for Disease Control and Prevention (CDC). (2023). Healthy
eating for a healthy weight. https://www.cdc.gov/healthyweight/healthy_eating/
• 4. U.S. Department of Agriculture. (2020). Dietary guidelines for
Americans, 2020–2025. https://www.dietaryguidelines.gov
• 5. World Health Organization. (2020). Nutrition advice for adults
during the COVID-19 outbreak. https://www.who.int
• 6. Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes
of self-change of smoking: Toward an integrative model of change. Journal of
Consulting and Clinical Psychology, 51(3), 390–395.
51. LEGAL MANDATES RELATED TO NUTRITION AND
DIET THERAPY
• Current Nutritional Status of Philippines
• Undernutrition Indicators (as of 2023–2024)
•Stunting (Chronic Undernutrition): Approximately 26.7% of children under five are stunted, indicating
long-term nutritional deficiencies. Notably, the Bangsamoro Autonomous Region in Muslim Mindanao
(BARMM) reports the highest regional rate at 45.2%. 
•Wasting (Acute Undernutrition): About 5.4% of children under five suffer from wasting, reflecting
recent and severe weight loss.
•Micronutrient Deficiencies:
•Anemia: Affects 23% of pregnant women, increasing risks of low birth weight and preterm delivery.
•Vitamin A Deficiency: Impacts nearly 17% of children aged 6–59 months, with the highest prevalence
among those aged 12–24 months. 
•Undernourishment: Approximately 5.9% of the population experiences insufficient caloric intake.
52. Iron Deficiency
•Affects 26.4% of pregnant women and 56.6% of infants aged 6–12 months.
•Caused by poor iron intake, low absorption, and increased needs during
pregnancy and infancy.
Iodine Deficiency
•Although national iodine levels are adequate, about 10% in some regions (e.g.,
BARMM) still suffer from severe deficiency.
•Due to uneven enforcement of the ASIN Law and low public awareness.
Maternal Nutrition
•25% of pregnant women are underweight; 37% of pregnancies occur in
adolescents.
•Poor maternal nutrition increases risks of stunting and wasting in children.
Infant and Young Child Feeding (IYCF)
•Only 53% of infants under 6 months are exclusively breastfed.
•41% of children aged 6–23 months have minimal diet diversity.
•90% lack proper complementary feeding.
53. National nutrition program and framework
Philippines plan of action on nutrition 2023-2028
The PPAN 2023–2028 is the Philippines’ national strategy to
address malnutrition at all life stages.
Led by the National Nutrition Council (NNC), it aligns with the
Philippine Development Plan and the Sustainable
Development Goals.
54. First 1000 Days Program
•Focuses on the period from conception to a child’s second birthday—a
critical time for preventing malnutrition and promoting healthy
development.
Key Interventions:
•Prenatal care (minimum 4 visits)
•Iron-Folic Acid (IFA) supplementation (180 tablets for pregnant
women)
•Balanced protein-energy supplementation for undernourished
mothers
•Exclusive breastfeeding for the first 6 months
•Complementary feeding from 6 to 24 months
•Micronutrient supplementation (e.g., vitamin A, MNPs)
•Goal: Prevent stunting and promote optimal child growth.
55. Micronutrient Supplementation Program
•Targets common nutrient deficiencies through routine and
community-based programs.
•Components:
•Vitamin A: For children 6–59 months to support immunity and
prevent blindness
•Iron-Folic Acid: For pregnant women and adolescent girls to
prevent anemia
•Multiple Micronutrient Powder (MNP): For children 6–23
months to enhance dietary intake
• These interventions are delivered through health services and
outreach programs to ensure nationwide coverage and impact.
56. Philippine Food Fortification Program
-The Philippine Food Fortification Program is a strategic component of
the PPAN 2023–2028, aiming to address micronutrient deficiencies
prevalent among Filipinos.
This initiative is grounded in two key legislations:
•Republic Act No. 8976 (Food Fortification Act of 2000): Mandates the
fortification of staple foods to combat micronutrient deficiencies. 
•Republic Act No. 8172 (ASIN Law): Requires the iodization of salt to
prevent iodine deficiency disorders.
57. Iron-Fortified Rice
•Mandate: Under RA 8976, all milled rice, except brown and
glutinous rice, must be fortified with iron. 
•Objective: To reduce iron-deficiency anemia, especially among
women and children. 
•Implementation: Iron-fortified rice is distributed through
government programs like school feeding and social safety nets.
Iodized Salt
•Mandate: RA 8172 requires all salt for human consumption to be
iodized. 
•Objective: To eliminate iodine deficiency disorders, which can lead
to goiter and developmental issues.
•Implementation: The Department of Health (DOH) oversees
compliance, ensuring that iodized salt is available nationwide.
58. Fortified Wheat Flour
•Mandate: Wheat flour must be fortified with vitamin A and iron as per RA
8976. 
•Objective: To address deficiencies in vitamin A and iron, crucial for vision
and blood health.
•Implementation: Fortified flour is used in bread and other flour-based
products, with monitoring by the Food and Drug Administration (FDA).
Vitamin A-Fortified Cooking Oil
•Mandate: Cooking oil is required to be fortified with vitamin A under RA
8976. 
•Objective: To prevent vitamin A deficiency, which can cause vision
problems and increase infection risk.
•Implementation: The FDA, in collaboration with the Philippine Coconut
Authority, ensures fortified cooking oil is produced and distributed.
59. ❑The DOH and FDA are responsible for monitoring compliance with
fortification standards.
Efforts include: 
•Quality Assurance: Regular testing of fortified products to ensure
nutrient levels meet standards.
•Public Awareness: Campaigns to educate consumers about the
benefits of fortified foods.
•Industry Collaboration: Working with manufacturers to facilitate
fortification processes and compliance.
60. DIETARY AND NUTRITION EDUCATION
• Pinggang Pinoy- is a culturally relevant food guide by FNRI-DOST that helps
Filipinos visualize balanced meals and proper portion sizes based on traditional
food groups. Its goal is to promote healthy eating habits suited to Filipino diets.
• Promotion of Healthy Eating in Schools and Communities - involves
nutrition education in school curricula, school gardens, healthy canteens, feeding
programs, and community activities like seminars and cooking demos to improve
nutrition knowledge and prevent malnutrition.
• Nutrition Month Campaign- is celebrated every July nationwide with
changing themes. It features public awareness, education drives,
contests, and community events to boost nutrition knowledge and
encourage healthy lifestyles.
61. School-Based Nutrition Programs
•Nutrition Education: Integration of nutrition lessons into the school
curriculum to teach students about healthy eating and lifestyle.
•School Feeding Programs: Providing nutritious meals or snacks to
undernourished children to improve their health and learning capacity.
•School Gardens: Hands-on activities where students grow fruits and
vegetables to learn about food sources and nutrition.
•Healthy Canteen Policies: Encouraging schools to offer healthy,
affordable food options and limit junk food availability.
•Health and Nutrition Monitoring: Regular screening of students for
growth, nutritional status, and health concerns.
62. Community-Based Nutrition Programs
•Nutrition Seminars and Workshops: Conducted for parents, caregivers, and
community members to increase awareness and knowledge of proper
nutrition.
•Supplementary Feeding Programs: Targeting undernourished children and
pregnant/lactating women to provide additional nutrient-rich foods.
•Breastfeeding Support Groups: Promoting exclusive breastfeeding and
proper infant feeding practices within communities.
•Micronutrient Supplementation Campaigns: Distributing vitamin A, iron-
folic acid, and other supplements to vulnerable groups.
•Community Gardens and Livelihood Projects: Encouraging the production
of nutritious foods locally and improving food security.
•Collaboration with Local Health Workers: Mobilizing barangay health
workers for nutrition education, monitoring, and follow-up.
63. MONITORING AND EVALUATION SYSTEM
• The National Nutrition Survey (NNS) by FNRI-DOST is conducted every 5
years to assess the nutrition and health status of Filipinos.
• It gathers data on anthropometry, dietary intake, micronutrient levels,
and food security to guide national policies and programs.
• Operation Timbang Plus (OPT Plus) is an annual barangay-level monitoring
activity led by Barangay Nutrition Scholars. It tracks the weight and height
of children under five to identify undernutrition and inform local nutrition
planning.
• Both systems support evidence-based decision-making and program
evaluation nationwide.
64. Legal Mandates in Nutrition and Food Safety (Philippines)
The Philippines has established several key laws to support nutrition and food safety:
PD 491 (Nutrition Act of 1974): Established the National Nutrition Council and made nutrition
a national priority.
RA 11148: Promotes health and nutrition during the First 1000 Days of life.
RA 8976 (Food Fortification Act): Requires fortification of staple foods with vitamins and
minerals.
RA 8172 (ASIN Law): Mandates iodized salt to prevent iodine deficiency.
RA 10611 (Food Safety Act): Ensures food safety from farm to table, enforced by FDA and DA.
EO 51 (Milk Code): Promotes exclusive breastfeeding and regulates breastmilk substitute
marketing.
FDA: Oversees safety and quality of food, drugs, and supplements.
•The National Nutrition Council (NNC) is the highest policy-making and coordinating body on
nutrition in the Philippines. It was created under Presidential Decree No. 491 (Nutrition Act
of the Philippines) in 1974.
•These mandates guide national policies to improve nutrition, prevent deficiencies, and
ensure food safety.
