its about fundamentals of nursing

1. Sanita Libin

2. Diet in sickness
Diet is an important as medicine in
the treatment of diseases. A modification in the diet or in
the nutrients can cure certain diseases. For example, a
client suffering from peptic ulcer needs a bland diet for
his recovery; a salt free diet can reduce the blood
pressure in a client with hypertension.
For everyone, eating food is an enjoyment. When the
person is ill, the food intake becomes a problem. The
nurse’s responsibility in the care of the sick in regard to
nutrition can be analyzed into four major areas:

3. 1. Assisting clients to obtain needed nourishment
either through feeding or assisting with eating, e.g.,
tube feeding feeds a helpless client to eat his food
etc.
2. Motivating client to eat.
3. Assisting clients to obtain needed nourishments
by proper planning of the diet.
4. Assisting clients with special problems about
therapeutic diets, e.g., helping a client to accept a
salt free diet

4. Principle Involved in the Diet Therapy
1. The diet must be planned in relation to changes
in metabolism occurring as a result of disease.
2. The diet must be planned according to the food
habits of the client based on culture,
religion, socioeconomic status, personal references
(likes and dislikes), physiological and psychological
conditions, hunger, appetite and satiety.
3. As far as possible, changes in the diet should be
brought gradually and adequate explanations are
given with the changes made, if any.

5. 4. In short and acute illness, the food should not be
forced because his appetite is very poor but he may
soon recover the normal appetite. But in prolonged
illness it is essential to provide adequate amount of
food to prevent wasting of tissues.
5. Whatever the diet prescribed, there should be
variety of foods for selection.
6. Small and frequent feeds are preferred to the usual
three meals.
7. Hot foods should be served hot and cold foods
should be served cold.

6. Modification in Therapeutic Diet
Carbohydrates are well
tolerated and are necessary to maintain the stores of
liver glycogen. It is particularly important in clients
with high fevers, liver diseases, hyperthyroidism etc. In
the absence of carbohydrate, the body fat may be used
for energy which may result in the formation of ketone
bodies and they accumulate in the blood – a condition
known as ketosis. Adequate amount of carbohydrate
intake can prevent ketosis. Carbohydrate is given in
easily digested forms such as glucose, sugars, gruels
etc.

7. The fat is often not tolerated in illness especially if
nausea and vomiting is present. Adequate amount of
carbohydrate can replace the requirement of the
body for fat.
In illness, especially when there is infection, the
protein metabolism is usually greatly increased
because of the increased destruction of protein. If an
adequate amount of protein is not given, the body
will use up the tissue proteins and the client will
lose weight. In illness, unless there are kidney and
liver damages, the protein intake should be high.

8. The requirements of minerals should be maintained in
illness especially that of calcium and iron. Sodium and
potassium may sometimes need to be restricted
especially when there is hypertension, oedema, ascites
etc.
Vitamins must always be adequate. Fat soluble vitamins,
vitamin A and vitamin D need to be added if the client is
on fat restricted diet. In pathological condition of the
gastrointestinal tract and in antibiotic therapy, vitamin
B complex should be supplied. The demand for vitamin
C is greatly increased in fevers and is especially
necessary for the healing of wounds after surgery.

9. Types of diets
 Full diet
It is a regular , well balanced and normal diet . It is
vegetarian or non vegetarian. It is served for the client
who do not need any modification.
 Soft Diet
It is full diet but consisting of food substances that
are easy to chew and digest. Some clients, particularly the
aged and convalescing clients cannot take food which
require chewing or the food that is difficult to digest. A
soft diet is enjoyed by these clients. A soft diet may
include double boiled rice, conjee, soft-cooked pulses and
dals, streamed fish, poached eggs, custards, ground or
chopped meat, sliced bread, sieved cooked vegetables,
cooked or ripe bananas etc.

10. Bland Diet
A bland diet is one in which the foods are easily
digestible, free from substances which might cause irritation
of the gastrointestinal tract, and generally of low roughage
content, used mainly for clients with gastrointestinal
conditions. The following point should be kept in mind when
supplying a bland diet.
1. The diet must be free from all mechanical and chemical
irritant. Mechanical irritant are mainly edible skins, seeds and
fibres composed of cellulose (roughage) in fruits and
vegetables. Food which contain a lot of cellulose should be
rubbed through sieve or strainer after cooking. Chemical
irritants are mainly the condiments and seasonings used in
cookery.

11. The hot seasonings particularly chilies, pepper, ginger and
spices should be avoided when preparing a bland diet.
2. For a bland diet, food should not be fried, either in deep
or shallow fat. Baking, boiling, steaming and grilling are
used.
3. Strong sugar solutions should be avoided.
4. Avoid fatty foods, since it takes a long time to digest.
5. Milk should be given in plan

12. Liquid Diet
Liquid diets must be used for clients who are unable to
take or tolerate solid food. It consists of clear fluids (non-
residual diet) and full fluid diet (residual fluid diet).
Clear Fluid Diet
Clear fluids are used when there is a marked intolerance
to foods and roughage. These include clear tea, weak
black coffee, clear soups, whey water, strained fruit juices,
soda water and other aerated beverages. Such fluids have
particularly no food value, but can help to maintain the
fluid balance of the body. Calories can be added by the use
of sugar or glucose. Clear fluid diet should be used only
for a short time since the clients may develop deficiency
symptoms.

13. Full Fluid Diet
Full fluid diet is given when the total nutrition of the
client has to be maintained by fluids for a considerable
time. This is necessary when a client is unable to
swallow solid food or if the client is fed by tube feeding.
Milk is forms the basis of the diet. To this can be added
egg in the form of eggflips, thin custard etc., to supply
calcium, protein, vitamin A, and iron. Calories can be
made up from carbohydrate in the form of starch in thin
cereal preparation or by adding sugar or glucose.
Adequate amounts of vitamins can be supplied in the
form of medical concentrates. Salt should be added
unless it is restricted.

14. Special Diets
Many pathological conditions bring about changes in the
body process which necessitate addition or omission of
certain nutrients in the diet as part of the treatment. Some
of the special diets served in the hospitals are:
High caloric or low caloric diet
High protein or low protein diet
Fat free diet
Low salt or salt free diet
Sippy’s diet, Bull’s diet

15. General instruction for nurse in food services
 The diet should be planned according to his need ,
metabolic changes , food habit and socio economic
status
 See that the patient get prescribed food at the proper
time
 She should report the quantity of the food which left
in the tray, the food that is vomited if any, any signs
of allergy develops after taking food
 Create a pleasant environment for the patient

16. Cont……
 The patient should be undisturbed by the treatment ,
dressing , visitors , doctors rounds, loud cries of
another patient during their meal time.
 Dressing and painful treatment finished at lest one
hour before meal is served.
 Offer bedpan or urinals about half an hour before
serving meals.
 Avoid strong emotions which may interfere with
digestion by inhibiting the flow of saliva , gastric and
intestinal juices.

17. Cont….
 Meal should be served in clear and covered
container.
 provision should be made to wash hands and the
face of the patient before and after the meal.
 Remember that a sick person has a poor appetite.
Never force to take food.
 The food should be cut into small pieces and is
served one piece at a time, one food after another
 See the patient’s appear neat(well groomed)

18. Cont….
 Place the patient in a comfortable position in bed or
out of bed, unless contra-indicated a fowler’s
position is given with a over bed table.
 The patient should be see the food or , they should be
told what food is served in front of them.
 Physical and mental fatigue should be avoided
 If the nurse sit near the patient and engage in
conversation make the meal a pleasure experience
for the patient.
 Never make hurry to the patient

19. Cont….
 The patient should be encouraged to take variety of
food.
 Fluid requirement should be met to prevent
dehydration.
 The nurse should teach the patient and family
members about well balanced diet and food hygiene.

20. Nurses responsibility in feeding a helpless client orally
Preliminary assessment
 Check the physician order for any special precaution, if
any regarding diet, movement of the client, positioning of
the client etc.
 Plan the diet according to the need of the patient, his
likes and dislikes, socio economic status and the
availability of the food.
 Ensure that the ordered diet is prepared properly and
safely.
 Check the general condition of the client and ability for
self care

21. Cont…
 Find out the food habit of the client, his likes and
dislikes, his appetite, his ability to take foods , food
allergy if any.
 Check the client’s ability to follow directions
 Check the article available in client’s unit

22. Preparation of articles
Article Purpose
A tray containing
*Mackintosh and towel
*Full plate ,quarter plate, cup
saucer , jug etc
*Feeding cup or drinking tube
*spoon, fork , knife
*A glass of water
*Napkin
*Feeding cup with water and
kidney tray
*To protect the bed &garments
* To serve food
* To give fluid to the client
* To feed the client
* To offer at the end of a meal
*To wipe the face in between
* To wash the mouth before
and after meal

23. Preparation of the client
 Create a pleasant environment.
 Avoid visitors.
 Offer bedpan and urinal half an hour before meal.
 Position of the patient properly.
 Help the patient to wash his face and hands.
 Protect the garments and bed linen with the
mackintosh and towel.

24. Procedure
 Wash hands.
 Sit by the bedside ,usually at the
right side of the client , facing his
head so that the nurse can see each
other . The position should be
convenient for the nurse to help the
client when needed.
 Feed the client slowly, in small
amounts , waiting for him to chew
and swallow one mouthful before
giving the next . Place the spoon
accurately into the client’s mouth .
The dry food may be given to the
client’s hands to hold and eat.
 To prevent cross infection.
 The nurse can engage in
conversation with the client and
give the impression of not being in
a hurry. She can make the meal a
pleasure experience for the client.
 Feeding the client in small quantity,
help him to chew the food well.
Adequate chewing help in digestion
If the spoon is placed too far back in
the mouth, it may create a gag
reflex and the patient may vomit.

25. Cont…….
 Give the food in the order in
which they would normally by the
client , if he could.
 Talk pleasantly to the client as he
is taking food. Avoid asking
questions.
 When the blind clients are fed ,
they should be told what food they
are being given.
 Encourage the client to take all
kind of food served to him. Do not
force for the food , which he
dislikes.
 After completing food offer a
glass of water.
 To give the satisfaction to the
client.
 Pleasant talking creates a pleasant
atmosphere conducive to
stimulate appetite.
 Every client has the right to know
what food he takes.
 Forcing for the food may cause
vomiting.
 Water will wash away the food
which is lodged in the mouth and
in between the teeths .

26. After care of the client and articles
 Help the client to wash his face , mouth and hands .
 Dry the face and hands.
 Make the client comfortable by adjusting the position of the
client in bed.
 Take all articles and the food tray to the utility room , discard
the waste . Clean the article in the cold water first and then
with warm soapy water. Clean and dry them . Replace them
in their proper places.
 Wash hands
 Record in the nurse’s record

27. Cardiac table

28. Feeding cup