Therapeutic diets are modified meal plans prescribed by healthcare professionals to improve specific health conditions, adjusting nutrients, caloric content, or texture to meet the patient's needs. Common types include gluten-free, clear liquid, diabetic, and renal diets, each tailored to address various health concerns and ensure adequate nutrition. Factors such as disease duration, patient preferences, and economic status are considered when planning these diets to encourage adherence and optimal health outcomes.

1. Therapeutic Diets

2. Therapeutic Diets
 Modifications of normal diet used to
improve specific health conditions
 Normally prescribed by doctor and
planned by dietician
 May change nutrients, caloric content
and/or texture
 May seem strange and even unpleasant
to the patient

3. Therapeutic Diet
 Patient’s appetite may be affected by
anorexia or loss of appetite, weakness,
illness, loneliness, self-pity and other
factors
 Use patience and tact to convince
patient to eat food
 Understand purpose of diet and provide
simple explanations to patient

4. Definition
 A therapeutic diet is a meal plan that controls the
intake of certain foods or nutrients. It is usually a
modification of a regular diet which is normally
prescribed by a physician and planned by a
dietician.

5. Examples of common therapeutic
diets
 Gluten-free diet
 Clear Liquid diet
 Full Liquid diet
 Diabetic (Calorie
controlled) diet
 No concentrated
sweet diet
 Low fat diet
 Sodium restricted(no
added salts) diet
 Renal diet
 High fiber diet

6. Objectives of therapeutic diet
 To maintain a good nutritional status.
 To correct nutrient deficiencies which
may have occurred due to the disease.
 To afford rest to the whole body or to
the specific organ affected by the
disease.

7. Objectives continue….
 To adjust the food intake to the body’s
ability to metabolize the nutrients during
the disease.
 To bring about changes in the body weight
whenever necessary.
 To educate the patient regarding the need
for adherence to prescribed diet.

8. Principles of therapeutic diet
 Diet should be based on a normal diet.
 It should fulfill the necessary food
requirement in the simplest way.
 It should be planned according to the
patient’s likes and dislikes, religion and
constraints.

9. Principles continue….
 Complete knowledge of the disease should
be gathered so that required changes in the
diet should be done.
 Possible duration of the disease should be
considered (acute & chronic).

10. Indications of therapeutic diet
 To maintain, restore & correct nutritional
status.
 To decrease calories for weight control.
 To provide extra calories for weight gain.
 To balance amounts of carbohydrates, fat and
protein for control of diabetes.
 To provide a greater amount of a nutrient
such as protein.

11. Continue…
 To decrease the amount of a nutrient such
as sodium.
 To exclude foods due to allergies or food
intolerance.
 To provide texture modifications due to
problems with chewing &/or swallowing.

12. Factors to consider in planning
therapeutic diets
 The underlying diseased condition which requires
a change in the diet.
 The possible duration of the disease.
 The factors in the diet which must be altered to
overcome these conditions.
 The patients tolerance for food by mouth.
 Also the patient’s economic status, his food
preferences, his occupation and time of meals
should be considered.

13. Modifications of therapeutic diets
Quantitative
Modification
Qualitative
Modification
Restriction of nutrients
Ex. sodium in hypertension
Change in consistency
Ex. clear liquid diet
Excess of nutrients
Ex. tuberculosis, where
increased protein & energy
are required
Rearrangements of meals
Increasing frequency of meals or
omission of foods
Ex. energy which demands
complete exclusion of the foods the
person is allergic to.

14. Modification based on consistency
 These diets are used in the treatment of
gastro intestinal tract.
 These diets can range from a very low
residue diet to a very high fiber diet.
 Routine hospital diets are as follows.

15. Clear liquid diet:-
 In this diet, small amounts of fluids (usually 30-
60ml) are served at frequent intervals(2hrs) to
replace fluid and electrolytes and also t relieve
thirst.
 Composed mainly of water, carbohydrates and
some electrolytes.
 Provide only 400-500kcal,5gms protein, negligible
fat & 100-120gms carbohydrates.
 Ex. juices without pulp, broth and jell-O.

16. Indications for clear fluid diet
 Pre-operative patients ex.: preparation for bowel
surgery.
 Prior to colonoscopic examination.
 Post-operative patients.
 Acute illness & infections as in acute gastro
intestinal(GI) disturbances such as acute
gastroenteritis.
 As the first step in oral alimentation of a
nutritionally debilitated person.
 Temporary food intolerance.
 To relieve thirst.
 To reduce colonic fecal matter.

17. Full fluid diet:-
 A full fluid diet includes all foods which are liquid
or can be liquefied at room and body
temperature.
 It is free from cellulose and irritating condiments
and spices includes creamy fluids.
 Ex. ice cream, pudding, thinned hot cereal,
custard, strained cream soups and juices with
pulp.
 Nutritional composition:1200kcal and 35g
protein.

18. Indications for full fluid diet
 Used post operatively by patients progressing from
clear liquids to solid foods.
 Acute gastritis and infections.
 Following oral surgery or plastic surgery of face or
neck area.
 In presence of chewing and swallowing dysfunction
for acutely ill patients.
 Patients with oesophageal or stomach disorder
who cannot tolerate solid foods owing to
anatomical irregularity.

19. Soft Diet
 A soft diet is used as a transitional diet between
full fluid and normal diet.
 It is nutritionally adequate.
 It is soft in consistency, easy to chew, made up of
simple, easily digested foods, containing limited
fiber and connecting tissues and does not contain
rich or highly flavored foods.
 Nutritional composition: 1800kcal and 50g
protein.
 The energy, protein and other nutrients are
adjustable according to the individuals need ,
based on activity, height, weight, sex, age and
disease condition.

20. Indications for soft diet
 Patients progressing from full fluid diet to general
diet.
 Post operative patients unable to tolerate general
diet.
 Patients with mild gastro-intestinal problems.
 Weak patients or patients with inadequate
dentition to handle all foods in a general diet.
 Diarrhea convalescence.
 Between acute illness and convalescence.
 Acute infections.

21. Mechanical soft diet
 Many people require a soft diet simply because
they have no teeth and such a diet is known a
mechanical or a dental soft diet.
 It is not desirable to restrict the patient to the
food selection.
 Following modifications to the normal diet are:
 Vegetables may be chopped or diced before
cooking.
 Hard raw fruits and vegetables are to be avoided
; tough skins and seeds to be removed.

22. Continue…
 Nuts and dried fruits may be used in chopped or
powdered forms.
 Meat to be finely minced or ground.
 Soft breads and chapattis can be given.

23. Indications for mechanical soft diet
 In cases of limited chewing or swallowing.
 Patients who have undergone head and neck
surgery.
 Dental problems.
 Anatomical oesophageal strictures.

24. Normal diet
 A normal diet is defined as one which consists of
any and all foods eaten by a person in health.
 All the nutrients are supplied in normal amounts
in normal diet.

25. Cold semi liquid diets
 This diet is given following tonsillectomy or
throat surgery until a soft or general diet may be
swallowed without difficulty.
 It contains more of cold beverages and luke
warm preparations.

26. Blenderized liquid diet
This is adopted in conditions of
 Inadequate oral control.
 Oral surgery with dysphagia.
 Wired jaws(blenderized foods can be consumed
through small openings)
 Patients with reduced pharyngeal peristalsis.
 Routine food is made into liquid pulp and can be
prepared using a kitchen blender.

27. Modification in nutrients
 Modification or change in the nutrient
composition of the diet to increase the
availability of nutrients to suit the body
requirements/limitations of a person.

28. Types of diet based on modification in
nutrients:-
High calorie diet
Low calorie diet
High protein diet
Low protein diet
Fat controlled diet
No added salt diet
Low sodium diet
No concentrated
sweets diet
Diabetic diet
High fiber diet
Renal diet

29. High calorie diet:-
 This is normal diet with an increase in the calorie
level to 3000 or more.
 This is modified in consistency and flavour,
according to specific needs.
 Avoid high-bulk foods ,Avoid high-fat foods such
as fried foods, rich pastries, and cheese cake
because they digest slowly and spoil appetite
 These diets are prescribed for
• Weight loss
• Fever
• Hyperthyroidism
• burns

30. Low calorie diet
 These diets control calories, carbohydrates,
proteins and fat intake in balanced amount to
meet the nutritional needs and control blood sugar
and weight.
 Avoid or limit high calories foods such as:
◦ Butter, cream, whole milk, cream soups or
gravies, sweet soft drinks, alcoholic beverages,
salad dressings, fatty meats, candy and rich
desserts.
 Energy value reduced to 1500,1200 or 1000
calories, protein levels 65 to 100gm.

31.  These diets are prescribed for reducing body
weight in:-
 Diabetes mellitus
 Cardiovascular diseases
 Hypertension
 Gout
 Gall bladder disease
 Preceding surgery

32. High Protein Diet
 Used to treat malnutrition or to increase muscle
mass.
 High protein diet of 100-125g per day may be
prescribed for a variety of conditions like
 Fever
 Hyperthyroidism
 Burns
 Regular diet with added protein rich foods such as
meats, fish, milk, cheese, and eggs.
After surgery
Diarrhea
Elderly
Alcoholism

33. Low protein diet
 A low-protein diet is a diet in which people
reduce their intake of proteins.
 Diet is prescribed to people with kidney or liver
disorders.

34. Fat controlled diet
 It is used to reduce fat levels and/or treat
medical conditions like
 Gall bladder & liver diseases
 Obesity
 Certain heart diseases
 Avoid cream, whole milk, cheese, fats, fatty
meats, rich desserts, chocolate, fried foods,
salad dressings, nuts, and coconut

35. No added salt(NAS)diet
 It is a regular diet with no salt packet .
 Food is seasoned as regular food.
Low sodium diet:-
 Used for pts with hypertension, heart disease,
liver disease, kidney disease, and edema.
 Avoid or limit addition of salt to any food,
smoked meats or fish, processed foods, pickles,
olives, and processed cheese,canned soups.

36. No Concentrated Sweets(NCS) Diet
 This is for diabetics when their weight and blood
sugar levels are under control
 It includes regular foods without the addition of
sugar.
 Calories are not counted.

37. Diabetic diet
 These diets control calories, carbohydrates,
protein and fat intake in balanced amounts to
meet
o nutritional needs
o Control blood sugar levels
o Control weight
 Avoid sugar-heavy foods such as candy, soft
drinks, desserts, cookies, syrup, honey,
condensed milk, sugared gum, jams, and jellies.

38. High fiber diet
 It is prescribed in the prevention and treatment
of gastrointestinal, cardiovascular and metabolic
diseases.
 Fiber rich foods like fruits, legumes, vegetables,
whole breads and cereals.

39. Renal diet
 It is for people having renal/kidney diseases.
 The diet plan is individualized depending on if
the person is on dialysis.
 The diet restricts sodium, potassium, fluid and
protein in specified levels.

40. FEEDING TECHNIQUES
 Feeding methods depend on the type of disease,
pts condition and their tolerance to food.
 The nutrients can be administered to the patients
by special techniques to prevent the nutrient
deficiencies.

41. Modes of Feeding
 Nasogastric
 Nasoduodenal
 Nasojejunal
Enteral Parenteral
Tube feeding Total parenteral nutrition
(TPN)
Partial parenteral nutrition

42. Enteral
 Enteral means within or by the way of the
gastrointestinal tract.
 The foods are administered via a tube and hence
enteral feeding is also called tube feeding.
Tube feeding
 Tube feeding is advised when the patient is
unable to eat but the digestive system is
functioning normally.

43. Tube feeding
 Full fluid diets administered through this route.
 Tube may be passed through the nose into the
stomach(nasogastric),duodenum
(nasoduodenal), or jejunum (nasojejunal).
 When there is an obstruction in the oesophagus,
enteral feeding is done by passing a tube surgically
through an incision in the abdominal wall into the
stomach (gastrostomy), duodenum
(duodenostomy) or jejunum (jejunostomy).

44. Nasogastric

45. Nasoduodenal

46. Nasojejunal

49. Indications for tube feeding
 Inability to swallow due to paralysis of muscles
of swallowing (diphtheria, poliomyelitis)
 Unwillingness to eat
 Persistent anorexia requiring forced feeding
 Semiconscious or unconscious patients
 Severe malabsorption requiring administration of
unpalatable formula
 Short bowel syndrome
 Babies of very low birth weight

50. A satisfactory tube feeding must be
 Nutritionally adequate
 Should be well tolerated by the patient
 Should be easily digestible with no
adverse reactions
 Easily prepared
 Inexpensive

51. Enteral Nutrition Delivery System
 The enteral Nutrition is utilised when the
patient cannot or will not take adequate oral
nutrients.
 Enteral route is preferred to parenteral
Nutrition as the later involves invasive
procedures which are more expensive, painful
and cause local or systemic infections and
sepsis.
 Following are the routes of access of nutrition.

52. 1.Pharyngostomy and
Oesophagostomy
 It performed in head and neck operations, trauma and
tumours of the head and neck.
 Nursing care for pharyngostomy and oesophagostomy are
1. Clan the stoma site with hydrogen peroxide and distilled
water.
2. Keep the area around the stoma dry and clean.
3. Use absolutely sterile met.
4. Check suspected sources for infections around the stoma
site.
5. Secure the feeding tube properly to avoid accidental
dislodgement.

54. Gastrostomy
 This procedure is frequently used in patients with mechanical
or functional obstructing lesions of head, neck or oesophagus
or in neurologically impaired patients.

55. Nursing care for gastrostomy:
 Apply sterile dressing to minimize swelling or
bleeding immediately after surgery.
 Observe stoma for redness, swelling, necrosis
and drainage.
 Check dressing 8 hourly for gastric leakage
which can cause rapid breakage.
 Assess the position of the tube and secure it
properly.

56. Jejunostomy
 Intra-jejunal feeding eliminates the problem of
gastric overload, reflux vomiting and
aspiration associated with gastric feeding.
Nursing care for jejunostomy:
 Immediately following placement of
jejunostomy tube attach it to the gravity
drainage.
 Irrigate the tube frequently to maintain
patiency.
 Continuous drip method with infusion pump is
preferred.

58. Enteral feeds
 The types of feeds that can be administered
through a tube include:
 Blenderized Food:
 This is prepared for patients who cannot chew
and swallow due to cancer of the oral cavity,
larynx or oesophagus.
 Ordinary food items which cannot be swallowed
are cooked well and blenderized to make them
liquid for feeding through a nasogastric tube.

59.  Polymeric Mixtures:
 This contain intact protein, fat and carbohydrate
of high molecular weight and are thus lower in
osmolarity and require normal digestive juices.
 Elemental Diets:
 These are commercially predigested mixtures of
amino acids, dextrins, sugars, electrolytes,
vitamins and minerals with small amounts of fat.
 They are free of lactose and can be easily
administered.
 These diets are used as alternatives to
intravenous feeding.

60. Methods of administration
 The three common methods of tube
feeding administration are :
1. Continuous Drip
2. Intermittent Drip
3. Bolus method

61. 1. Continuous Drip:
 This is the most common form of administration.
 The drip rate is adjusted in increments to
prevent cramping, nausea, diarrhoea or
distension.
 Feedings are started at 30 to 59 ml/hr every 8 or
12 hrs until the final rate is attained.

62. 2. Intermittent Drip:
 In this 4-6 feeds are given with regular periods
of interruption,e.g.4 hours on and 4 hours off.
3. Bolus method:
 In this method, large volumes are given in a
short time, e.g. 200 ml is administered in a
minimum time of ten minutes.

63. Parenteral Nutrition
 The delivery of nutrients directly through
the peripheral or central vein is termed as
parenteral nutrition.
 This can be of two types i.e. Total or
supplemental.

64. Total parenteral nutrition (TPN):
 The total nourishment of increased
Nutritional requirements through intravenous
feeding has been termed total parenteral
nutrition (TPN).
Partial parenteral nutrition:
 When parenteral nutrition provides 30-50%
of the total daily nutrients, it is termed
partial parenteral nutrition.

65. Conditions for which parenteral nutrition is
given:
 Gastrointestinal problems
 Acute renal failure
 Hepatic failure
 Congenital anomalies of the gastrointestinal
tract
 Burns

66. Parenteral feed solutions
 Glucose
 Emulsified fat
 Crystalline amino acids
 Vitamins
 Electrolytes- sodium, chlorine, phosphorus,
potassium, calcium and magnesium.
 Trace elements- zinc, copper, chromium,
manganese and iodine
 Water

67. Parenteral feeding
 For a hospitalized patient to be given nutrients
parenterally.
 This gives special attention to the provision of
energy nutrients by peripheral or central vein.

68. Total parenteral nutrition(TPN)
 It is most sophisticated method of nutritional
support.
 It involves feeding the patients with sterile
solution or glucose, amino acids and micro-
nutrients usually via an indwelling catheter
inserted into the large central vein(i.e. superior
vena cava).
 Administered either continuous infusion of
nutrient solution round the clock or in cyclic
pattern of infusion

71. Parenteral nutrition delivery
system
 Parenteral nutrition is a complex form of therapy
designed to provide daily nutritional
requirements by the intravenous route.
The success of the therapy depends on:
 Appropriate nutrient prescription
 Sterile management
 Catheterization technique
 Dressing management
 Continuous patient monitoring

72. Central venous access:
 Central venous access is required for infusion
of hypertonic solution.
The veins used are:
 Subclavian vein
 Internal jugular vein
 External jugular vein
 Peripheral vein
 Basilic vein
 Cephalic vein

73. Femoral veins:
 Careful concentration is given for vein selection.
 The patient’s clinical situation, anatomic factors,
experience and the skill of the physician
 Femoral and peripheral veins are not widely used
for prolonged venous access due to infection and
thrombosis.

74.  Subclavian is the preferred vein, specially the
right side as the pathway to superior vena cava
is more direct and the apex of the lung is lower
on the right side.

75. Complications of Parenteral
Nutrition Delivery System
1. Catheter Occlusion:
• Initial treatment for catheter occlusion is
aspiration of the clot with a syringe.
• Sterile technique is essential.
2. Sepsis
3. Air Embolism and Hemorrhage
 Air embolism is a potentially lethal complication
related to the use of central venous catheters.

76. Complications of Catheter Insertion
1. Pneumothorax:
 It is an abnormal collection of air in the pleural
space between the lung and the chest wall.
 Clinical manifestation depends on the size and
type of pneumothorax.
 Typical symptoms include pain, dyspnea and
hypoxia.

77. 2. Haemothorax:
 Arterial trauma by the inserting needle is the
usual cause of injury to the vein.
 Blood collects in the plural space.
 Chest tubes may be necessary to drain blood.

78. Assignment
Write in detail dietary management and
one day menu plan for following condition
and do group presentation
 Roll no. 1 to 5:Dietary management in
obesity.
 Roll no. 6 to 10: Dietary management for
diabetes mellitus.
 Roll no. 11 to 15: Dietary management
for cardiovascular diseases .
 Roll no. 16 to 21: Dietary management
for underweight.

79.  Roll no. 22 to 26: Dietary management
for renal diseases.
 Roll no. 27 to 31: Dietary management
for hepatic disorders.
 Roll no. 32 to 36: Dietary management
for constipation.
 Roll no. 37 to 41: Dietary management
for diarrhea.
 Roll no. 42 to 49: Dietary management
for pre-operative and post operative.