ROUTINE NUTRITION

THERAPY
ENRIQUEZ R. CAYABAN, RN, LPT, MAN
 PARENTERAL NUTRITION
• Is intravenous administration of nutrition
• Is a mean of providing protein, carbohydrate, fats,
vitamins and minerals to those who are unable to
assimilate nutrients provided via gastrointestinal tract.

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 Indications for Parenteral Nutrition
• A non-functioning GI tract (e.g. severe malabsorption,
short bowel syndrome, intractable vomiting or diarrhea.
• Bowel rest (e.g. Pancreatitis, GI fistula)
• Severe Malnutrition or Catabolism when the patient is
unable to eat for 5 more days.
• Indicated when anticipated return to enteral nutrition is
less that 7-10 days in adult, 3-5 days in infants/ child

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 Contraindications of PN
• Treatment anticipated for less that 5 days in patients
without severe malnutrition
• Functioning GI tract
• Inability to obtain venous access
• A prognosis that does not warrant aggressive nutrition
support

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 PARENTERAL NUTRITION
Nutriflex (mixed ready for use Kabiven Peripheral (is available in a
1000ml) three chamber system)

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 Kabiven Composition
2400ml 1920ml 1440ml
Glucose (Glucose 11%) 1475 ml 1180 ml 885 ml
Amino Acids & Electrolytes (Vamin 18 500 ml 400 ml 300 ml
Novum)
Fat Emulsifier (Intralipid 20%) 425 ml 340 ml 255 ml

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 CLEAR LIQUID DIET
• This diet consist of clear fluid and juices that provide little
residue and are easily absorbed.

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 Characteristics of the Diet
• This diet is used when one is severely restrict undigested
materials in the GI tract because of temporary decreased
function.
• Inadequate in all nutrition thus, prolonged use is not
encouraged. It should not be used more than 3 days
without supplementation.
• Aims to provide fluids without stimulating extensive
digestive processes and to relieve thirst and provide oral
feedings that will promote gradual return to a normal
intake of food.

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 Indications for Use
• For preoperative or postoperative patients
• For patients with inflammatory condition of the GI tract
• In acute stage of many illnesses especially those with fever
• In condition when it is necessary to minimize fecal material
(residue free).

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 Food Allowed
• The diet is composed of clear liquids. Small servings may
be offered every 2 to hours and in mealtime. Certain
preoperative patients may be limited to tea and fat-free
broth for one or more meals.
FOOD EXAMPLES
Fruits Strained fruit juices
Soup Fat- free clear broth and bouillon
Sugar or Sweets Flavor or unflavoured gelatin, popsicles, fuit ices (made
without milk, sugar, honey, syrup, hard candy
Fluids Coffee, tea, carbonated beverages, fruit beverage
drinks

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 FULL LIQUID DIET
• This diet includes fluids and semisolid foods that are liquid
at body temperature.

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 Characteristics of the diet
• This diet is used as intermediate step in post-operative dietary
regimens or other situation in which the gastrointestinal
function is moderately reduced.
• Aims to provide oral feedings that will promote return to a
normal intake of food.
• Needs a multivitamins/mineral supplement if prescribed to be
used for more than 2-3 weeks
• If used over several weeks, low-fat dairy products should be
included in patients with high cholesterol levels. Modifications
in carbohydrates levels may also be necessary for people with
diabetes mellitus or hypoglycaemia.

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 Indications for Use
• For postoperative patients following clear liquid diet
• For the acutely ill patient
• Patients who cannot chew or swallow pureed foods
• It may also be prescribed to supplement a tube feeding

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 Food Allowed
• The diet is composed of foods included in the clear liquid plus food
that are liquid at body temperature and tolerated by patient.
FOOD EXAMPLES
Meats Pureed meat soap, liver spread, potted meat, soft cooked egg
Milk Whole milk, evaporated milk, low-fat milk, milk drinks, milk shake,
malted milk, plain yogurt
Rice or substitute Pureed strained lugao, cooked cereal
Vegetables All juices, pureed vegetables such as chayote, carrots, green papaya
Fruits Citrus and other fruit juices
Soup Broth or strained cream soup, bouillon
Sugar/ Sweets Sugar, honey, syrup, plain and unflavoured gelatin, pudding, soft
custards, plain ice cream, popsicles, sherbet
Fluids Coffee, tea, carbonated beverages, cereal beverages, fruit drinks
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 ENTERAL FEEDING
• Provision of liquid formula diets by mouth or by tube into
the GI tract to provide nutritional support for persons
unable or unwilling to ingest or tolerate conventional
foods.

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 Characteristics
of the Diet
Several enteral
feedings will be
nutritionally
adequate when
given in
recommended
amounts

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 Indications for Use
• Patients who are physically or psychologically unable to
take food by mouth in amounts that will meet
individualized optimum nutrition
• Patients who are able to consume some, but not enough
food to support their nutritional needs
• Patient’s with full or partial GI function
• If oral dietary intake remains compromised or is
contraindicated for more than 5-7 days artificial nutritional
support in the form of enteral tube feeding may be
necessary
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 Examples of such situations are:
• Hyper metabolism- major surgery, sepsis, trauma, burns, organ
transplantation, HIV/ AIDS
• Neurological Disease- Stroke, motor neuron disease, multiple
sclerosis, head injury, demyelinating disease
• GI Disease- Esophageal obstruction, inflammatory bowel
syndrome, pancreatic insufficiency (eg. Cystic fibrosis)
gastrectomy
• Cancer- Chemotherapy or Radiotherapy, surgery
• Psychiatric Disease- Anorexia nervosa, severe depression
• Organ System Failure- Respiratory failure, Renal failure,
Cardiac failure, hepatic failure
• Learning Disability- Cerebral palsy, Rett Syndrome

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 Contraindications
• GI tract is not functioning or cannot accessed
• Patients whose nutritional needs cannot be met with oral
diets or enteral tube feeding
• Contraindications to enteral feeding are usually relative or
temporary rather than absolute. Potential
contraindications include:
Terminal Illness Short bowel Obstruction GI bleeding
Vomiting and diarrhea Fistulas GI ischemia Ileus
GI Inflammation Pancreatitis

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 Methods of Administration
Method of Feeding Description Indications Risk
1. Continuous • Pump Assisted Critically ill • Less risk of GI residuals and
• Small bowel feedings patient aspiration
2. Intermittent • Pump Assisted Non-critically • High risk of aspiration,
• Home tube feeding ill patient nausea, vomiting, abdominal
• Requires formula with more pain, distention, and diarrhea
calories and protein
• Feeding over short period of time
3. Bolus Intermittent • Via syringe or bulb Non-critically • High risk of aspiration,
• Home tube feeding ill patient nausea, vomiting, abdominal
• Feeding over short period (usually pain, distention, and diarrhea
15 mins) • Potential GI intolerance to
goal infusion rate
4. Cyclic Intermittent • Pump Assisted Non-critically Potential GI intolerance to goal
• Home tube feeding ill patient infusion rate
• Beneficial for transitioning tube
feeding to oral diet
• Requires formula with more
calories and protein density
• Requires high infusion rate over
short period 8-16 hrs/ period
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 SOFT DIET
• This diet consists of foods that are tender but not ground or
pureed. Whole meat, cooked vegetables and fruits are
allowed

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 Characteristics of the Diet
• Transition diet between liquid diet and full diet
• Aims to provide oral feedings that will promote return to a
normal intake of food

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 Indications for Use
• Post-surgical patients ready to have some whole foods but
are not yet ready for the regular diet.
• The diet may be sued for the debilitated patient to
facilitate ease in eating

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 Food Allowed
• The diet is composed of foods that are easily digested. Mildly flavoured foods are
emphasized.
FOOD GROUP EXAMPLES
Vegetable Cooked mild- flavoured vegetables, asparagus tips, young tender beans, carrots,
mushroom, squash, tomato juice, chayote, green papaya, peas, spinach
Fruit Citrus fruits without membranes and all fruits juices; cooked or canned low fiber fruits
such as banana
Milk Whole milk, evaporated milk, low-fat milk, milk drinks, milk shake, malted milk, plain
yogurt
Rice/ Substitutes Rice gruel, bakery products made from white, refined wheat, refined cereals
Meat/ Subtiturtes Any tender meat, fish or fowl, all without tough connective tissues, eggs; cottage
cheese, mildly flavoured cheese; yogurt, cheesy-style peanut butter
Soup/Fluids Broth, cream soup, strained vegetable soup, coffee, tea, carbonated beverages,
cereal beverages
Sugar/ Sweets Suagr, honey, syrup, plain and unflavoured gelatin, soft custard, pudding, plain ice
cream, popsicles, sherbet, chocolate, cakes and cookies without nuts
Oils/ Fats Fortified margarine or butter, mayonnaise, gravy, cream, vegetable oil
Miscellaneous Salt, pepper, vinegar, soy sauce, catsup, mild spices, chopped or ground leaf herbs
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 REGULAR OR FULL DIET
• It is also called general, normal or full diet, formerly named
as DAT (diet as tolerated)
• Designed for the adult patient does not need any dietary
modification. The usual food and drink regularly
consumed.

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 Characteristics of the Diet
• The diet is aimed at supplying appropriate amounts of calorie,
protein and other nutrients
• May be used in educating the patient in the principle of
nutrition by example and basis in providing food the patient is
willing and able to eat
• The diet calls for careful planning of menu, wise selection and
proper preparation of foods as well as attractive service so
that it will appeal to patients with relatively poor appetites
• The quantity of food selected from each food group should
vary depending on the energy needs and preferences of the
patient.
• Serves as a basis for the modification of therapeutic diets in the
hospital

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 Indications for Use & Food Allowed
INDICATIONS FOOD ALLOWED
• For ambulatory patients whose • All foods are allowed with
conditions do not require any adequate supply of proper
dietary modification for nutrients and enough calories
therapeutic purposes to meet a person’s need of
energy

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 RESIDUE- RESTICTED DIETS (Low Residue)
• Diet similar to a low fiber diet, but typically includes
restrictions on foods that increase bowel activity, such as
milk and milk products and prune juice

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 Characteristics of the Diet
• The diet consists of foods that are low in fiber and foods
that are believed to increase fecal residue despite low
content of fiber such as milk. Note that residue is not the
same as fiber and this term refers t the end result of
digestive, secretory, absorptive and fermentative
processes.
• A low residue diet typically contains less than 10-15 grams
of fiber per day

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 Indication for Use
• Usually used as transition to a regular diet from soft or full
diet

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 Food Allowed
• Diet is somewhat liberal than the minimal residue diet because it allows low-
fibered vegetables ad fruits
FOOD GROUP ALLOWED AVOIDED
Vegetable Cooked/ canned, strained vegetables Vegetables with seeds,
without coarse fibers such as carrots, legumes, broccoli, cauliflower,
peas, squash, shayote, young string cabbage (cruciferous family)
beans, tomato juice, potatoes no skin,
beets, cucumber, green beans, celery,
eggplant, lettuce, red/green peppers,
mushrooms
Fruit Stained fruit juices, cooked apples, apple Fresh fruit, prune juice, dried
juice, apple sauce, canned fruits (eg. fruits, fruit with seeds and
Peaches, pears, lychees, mandarin, fruit cooked fruits, raisins and
cocktail), small banana berries
Milk Lactose-free milk in allowed amount only In excess of 2 cups
Rice/ Bread Refined breads & cereals, white crackers, Corn, whole wheat grain/
macaroni, spaghetti & noodles, strained whole bread/ cereals/rich
oatmeal. Potatoes- no skin pastries, rolled oats
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 Food Allowed
• Diet is somewhat liberal than the minimal residue diet because it allows low-
fibered vegetables ad fruits

FOOD GROUP ALLOWED AVOIDED

Meat/ Substitutes Tender chicken without skin, ground beef, Tough meats/fish & meats with
baked, boiled or broiled, and roasted, connective tissue and highly
egg except fried spiced and fried meat; beans
and lentils
Fats/oils Butter/ margarine/ oil None
Sweets/sugar Sugar, clear gelatine desserts, angel food Candies with nuts or whole
cake, hard candy, honey, syrups, fruits, marmalade, jam
molasses, plain cream, plain popsicle, milk
chocolate
Beverages Coffee, tea, cocoa, carbonated Alcohol
beverages

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 RESIDUE- RESTICTED DIETS (Minimal Residue)

• This diet limits or eliminates the intake of foods that leave a

high amount of residue in the colon after digestion in
order to minimize fecal volume
• Some foods such as milk and the connective tissue of
meats that are low in crude fiber may also alter stool
volume and has to be restricted

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 Characteristics of the Diet
• Diet aims to reduce both stool bulk and stool water, in
order to diminish intestinal muscular activity, to decrease
the frequency of bowel movements and to minimize the
amount of stool produced
• Long term of this diet, with its reduced intake of fruits and
vegetables may not provide required amounts of Vitamin
C, Calcium and Folic Acid.

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 Indication for Use
• Often prescribed in the management of diarrhea and
diseases involving the bowel, particularly associated with
obstruction, distention, edema, and inflammatory bowel
disease
• Crohn’s disease
• Diverticulitis
• Intestinal blockage
• Post- hemorrhoidetomy
• Severe diarrhea
• Ulcerative Colitis
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 Food Allowed
FOOD GROUP ALLOWED AVOIDED
Vegetable Lettuce; vegetable juice without the pulp; Legumes, resistant starches,
the following cooked vegetables: yellow starchy vegetables,
squash (w/o seeds), green beans, vegetables with pulp or not
spinanch, pumpkin, eggplant, asparagus, cooked except lettuce;
beets, carrots pickles, horseradish, fresh or
dried vegetables such as dried
peas an lentils; cabbage
family, onions, chives, peppers
soluble fibers
Fruit Fruit juices w/o pulp canned fruit except Fructose, fruit juices with pulp,
bananas and pineapples; strained fruit canned pineapple, fresh fruit
juice except on the allowed list,
prunes, prune juice, dried fruit,
jam, marmalade; dried fruits
Milk In allowed amount only, lactose- free, or Milk
no milk at all
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 Food Allowed
FOOD GROUP ALLOWED AVOIDED
Rice/ Bread White bread and cereals made from Baked goods, whole-grain
refined flours, pasta, white rice; cream of bread, cereals, rice, pasta;
wheat, cream of rice, strained oatmeal bran cereal; oatmeal, pop
corn; rich pastries
Meat/ Subtitutes Lean meat only; no tough or fibrous Dried beans, meats with
meats; no poultry skin connective tissues
Fats/ Oils Butter, Margarine Chunky peanut butter, nuts,
seeds
Sweets/ Sugars Sugar, flavoured gelatine, popsicles, Simple sugars, fructose,
angel food cake, jelly, syrup, hard candy mannitol, xylitol, desserts
containing nuts, coconut
Beverages Clear broth, bouillon, black coffee, tea, Prune juice, caffeine, beer,
fruit-flavoured drinks wine, alcoholic beverages,
carbonated beverages

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 FIBER MODIFIED DIETS (High-Fiber)
• Also called high roughage diet
• A normal diet with an additional 2 or 3 servings of foods
rich in dietary fiber, such as whole grain bread and cereal
products, fruits and vegetables

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 Characteristics of the Diet
• Dietary fiber is indigestible because it cannot be broken
down by digestive enzymes. Some fiber are insoluble and
some are soluble.
• Insoluble fibers include cellulose, some hemicellulose and
lignins.
• Soluble fibers are gums, pectins, some hemicellulose and
mucilages.
• A high fiber diet is generally considered to contain about
25- 30 grams of dietary fiber per day. The goal is to
increase the intake of the fiber rather than to attain a
precise level of intake
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 Indication for Use
• To avoid or relieve haemorrhoids
• Treatment of irritable bowel syndrome and diverticulitis
• Important in treating diabetes, elevated cholesterol, colon
polyps and cancer of the colon
• A balanced diet containing different kinds of fiber can
help regulate the bowels, aid in the prevention of heart
disease and protect against a number of other health
problems by helping to protect against cancer of the
colon and rectum
• Food that contain fibers also tend to contain other
cancer-fighting nutrients such as the antioxidant vitamins
A, C, E and the mineral Selenium
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 Food Allowed
• In addition to the regular diet, this diet emphasizes foods
from the following food groups:
FOOD GROUP EXAMPLES
Vegetables Cabbage, kangkong, eggplant, onions, radishes, string
beans, carrots, cauliflower, cucumber, green peppers,
soybean sprout, spinanch, turnip, okra, tomatoes, asparagus,
broccoli, garbanzos
Fruits Fresh fruits (including the skin and pulp), dried or stewed fruits
(such as prunes, raisins), cherries, strawberries, pears, apples,
kiwi fruits, quava, banan, grapefruit, oranges, mango,
pineapple, watermelon
Rice or Substitute Whole grain foods (such as bran cereals) and breads (those
made with whole wheat grains), oatmeal, oat bran, whole
wheat pasta, brown rice
Others All beans and peas
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 FIBER MODIFIED DIETS (Low-Fiber)
• Diet containing less than 10- 15 grams of fiber per day and
eliminates foods known to increase the amount of stool

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 Characteristics of the Diet
• This diet contains a minimal amount of indigestible carbohydrates or
dietary fiber to avoid large fecal volume that might distend and
further aggravate inflamed tissue
• The fiber content of the diet may be reduced by removing seeds
and skins from fruits and vegetables, cutting off gristle and
connective tissue in meats, omitting leafy vegetables, fibrous and
dried fruits, nuts, seeds and legumes; using refined cereals and
breads
• This diet does not provide the minimal requirements for some
nutrients and is not intended for long-term use. It can be used as a
preoperative or postoperative diet for patients undergoing certain
abdominal procedures or during some attacks of acute diverticulitis
• Supplemental vitamins and minerals and trace elements may be
needed to replace stores or for maintenance because of
maldigestion, malabsorption, drug nutrient interactions, or because
the patient cannot eat a complete diet
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 Indication for Use
• Ulcerative colitis
• Spastic constipation
• Small bowel obstruction
• Radiation enteritis
• Peptic Ulcer Disease
• Narrowing of the intestine
• Inflammatory bowel syndrome
• GI surgeries
• Gastroparesis
• Chronic diarrhea
• Acute Diverticulitis
• Divertical Disease

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 Food Allowed
FOOD GROUP ALLOWED AVOIDED
Vegetable Strained vegetables, peeled Celery, squash, lettuce,
cucumber broccoli, Brussels sprouts, potato
skins
Fruits Strained juices, low fiber fruits, Oranges, suha, grapefruits,
peaches without skin berries, figs, prunes, raisins,
cherries, apples, grapes
Milk In allowed amount
Rice/ Bread White bread, rice Bran, popcorn, oatmeal
Meat/ Substitutes Eggs, meats Kidney beans, nuts
Fats/ Oils In allowed amounts Coconut meat
Sweets/ Sugar Simple sugars None

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