Sea te Cardio Vascular dAisaase Chapter Diet Therapy in Diseases of the Circulatory System — Diet in Acute and Chronic Cardiac disease —Diet in Hypertension Aiteroscerois and Coronary Heart disease case affects people of all ages, butt is most frequent in ge and is most often caused by atherosclerosis, we heart may affect: ‘or outer covering of the ardium or membranes lining the heart or ye myocardium or the heart m the blood vessel within the heart or those leaving, may be diseased. fied according to the type of eof diet therapy is, orsemi-solid Diet Therapy in Diseases of the Circulatory System 251 Thera In Dennen ona CHRONIC CARDIAC DISEASE In chronic cardiac disease the condition may be either compensated or decompensated. When compensated the heart is able to maintain adequate circulation to all parts ofthe bady when decompensated, the heart is unabl adequate circulation to the tissues. 4. To provide a diet acceptable to the patient. When planning the calorie requirement for this patient it must be remembered that overwei indesirable. A gradual wei reduction is recommended for the obese patient in order the Work of the heart, A slight degree of underw. recommended for those who are not obese. A pi reduced protein has a stimul increases the demands n dynamic action Sodium is gradually res ted. The degree of restriction lepends t. Fluids are not usually restricted amount of sodium is carefully controlled in order to eliminate oedema. When planning the consistency and amount of food for this, semi-solid bland foods should be given according to the ability of the patient to chew/Constipation and straining may be avoided by a wise choice of fruits and vegetal sf that cause gas formation should be avoided Tndivi lerance for these foods will vary. In Compensated Heart Disease Dietary modification may nat have to be made. This depends toa ‘great extent, however, on the degree of injury fo the heart. Gradual252 Nursing Manual of Nutrlion and Therapeutic Diot s overweight. Mill. order to control and_ quantities a Guring this period. The foods are pureed to eliminate chewing, which an additional effort for the patient. He may also have to be diet given in small frequent feedings may be introduced as the proves) A diet of ‘consistency is allowed only when the patient is able to feed and can chew without excessive strain, The general nentioned above may be followed. ‘Sodium Restricted Diet ‘The foods in a full normal diet contain approxi sodiuim chloride before any further addition is reparation. A liberal intake of food to which ‘will increase the sodium intake. (The words ‘salt’ and ‘sodium’ may be used interchangeably). ‘of sodium in the body has been found to be the most factor causing oedema, iny degrees of sodiut restriction depending on the he condition of the patient formerly these diets were Low salt diet with no salt added at the table or (i) ‘no salt added in cooking. lable for the sodium content of foods in India group them the » (Approximately 2000-4000 mg of sodium) which is usually ordered for the patient with a moderate Amount of heart injury. A limited amount of salt (1-2. gm) may be used in cooking, butno salt is added alter cooking. Foods to 9e omitted are listed below: Souiuon Diet: (Approximately 600-1200 mg of sodium) which ‘prescribed for cardiac patients who have oedem: inated bothin cooking and on the table. The list of food to dis strictly followed. It may be prescribed to give 0.5 Diet Therapy in Diseases of the Circulatory System: 253 to 1 gm of sodium chloride to the patient, and this i carefully onThis fo0ds for he day. alas Lo : (Approximately 500 mg of sod which is prescribed for patients with congestive car severe oedema, ascites or. ertension No salt is added either § 5 2 g = IS than two cups per day. If this is not available whole skimmed milk ot half the amount of whole milk may be used, eiAilstoffoods tobe avalded n sodium restricted diets i given low: {General instructions for Low Sodium Diets] The following foods are high in sodium and should be avoided: 1, Salt 2. Baking powder 3. Bicarbonate of soda 4. Canned foods 5. Cheese 6. Bacon, ham, sausages iG 8 9. 10. 1 salad dressings and sauces 11, Soft drinks containing sodium benzoate 12, Soup cubes 13. Proprietary drinks—Bournvita and Chocolate drinks. ‘Most patients find it very difficult to adjust to taking food without salt. The necessity of the restriction should be made to make the food carefully explained, and every attempt should be made to make the food palatable. The careful use of tomato juice, lime juice, agar, mint, cloves, cinnamon, cardamom, pe] patient should include xo ichasin i of fish, meal of drinking water Should also be included in this. Salt substitutes may be used with the approval of the doctor.254 Nursing Manual of Nutrition and Therapeutic Diet HYPERTENSION Hypertension develops when, for some reason, there is reatstance to the normal circulation of blood. This may be temporary, da the result of exercise, emotion, pregnancy, or menopause; it may “manent, associated with atherosclerosis, cardiac failure or chronic kidney disease. High blood pressure (Hypeitension) is a common disorder nong the middle and old age groups. This condition ion’. The predisposing causes are (i) Hereditary (i) Obt ) Stress and strain of modern life pressure of over 50 mmHg and diastolic pressure of over 95 mmblg is considered high blood pressure. Treatment The principles of treatment are as follows: 5 as prescribed. by the physician and (i) Low sodium—low fat—low calorie diet Kempner's Diet Kempner (1948) has recommended a rigid rice-ruit—sugar diet for hypertension. It provides about 2000 kcal, 5 gm fat, 20 gr proteins, 150 mg sodium and 200 mg chloride. All fruits and fruit juices are permitted. The fluid intake is limited to meet the daily Needs, Vitamin supplements ace given to meet the daily needs of different vitamins. The pattern of diet and daily menu for an adult suffering from high blood pressure are given Tables below. |: Low sodium dots ‘s high blood pressure (gnfoaputay) Sodio Sod (200-300 mg) {600-400 ms) v Nv. Nv 7 adit suilerng fom Diet Therapy in Diseases of the Circulatory System 255 Table 15.2: Daily menu for high blood pressure Vegetarian = Weak teat cup Fruits—1 serving Weak tea—1 cup Weak tea—I cup Mil-morning juice lass Fruit juico—1 glass (Cooked rice or chappati—1 serving Meat or fish curry-halfeup in 2 Curds—1 cup ‘ooked vegetables and potato— (Cooked vegetables and potato Pee Pe Kea vegetables and potato— Fruits serving Fruits serving ‘Skio milk puding-—1 cup ‘Skim milk pudding —1 cup Evening Biscuits 2 Biscuits—2 Fruit uice—t glass Frit uice— glass Dimer Similar to Lunch, Note: 1. Salt should not be added in cooking, z amin tablet providing the dail viding the daly requirementsofallessential ld be included along withthe diet 3, Strong coffe is not permitted, ATHEROSCLEROSIS AND CORONARY HEART DISEASES. Amajority of coronary heart diseases are due to corona and atherosclerosis, are used to denote conditions in vsch deposited in the intima of the blood vessels. Inarleriosclerosis, the defect isin the media of ‘The important contributory causes for the development of is are: (i) high calorie intake, (ii) high saturated fat }) increased level of cholesterol in heart strain. _ Atherosclerosis is a condition concerned primarily with the intimal layer of the artery and is characterized by thickening and256 Nursing Manual of Nutrition and Therapeutic Diet pi Meraial of Nimrblon ai Taree eS of the arterial wall. Deposits consisting mainly of erol esters and triglycerides are also found. may result in the following Coronary occlusion and (iii) Drugs as prescribed by the physician and (i) Di acids, The pattern of diet and the daily menu for an adult suffering from coronary heart diseases are given in the table at the end of the sease as related to the circulating system is being widely is fairly. well established that certain ion of blood lipids leading to atherosclerosis which in turn leads to coronary disease. Blood cholesterol values can-be easily estimated in the laboratory i its concentration is used as a basis for observing the progress fade when using various diets. “The amount and nature of fat in the diet have been found to have the following effects. i. People taking low fat diets generally have lower cholesterol taking high fat diets. { reduction the blood cholesterol is atleast mporarily iil, The level of cholesterol in the blood i containing a high proportion of pol fare taken instead of the more saturated fats. ‘Because of the amount of research being done at present, any modification ofthe diet intencied to reduce the atherosclerosis must be considered a temporary measure as further ev' made. ‘A Jow fat (20-30 gm), law calorie (1200 to 1500) diet is advised with an increase: ty acids. Fats containing essential fatty acids. Since these diets 1 Jength of time the recommended allowances for protein minerals, and vitamins must be met. A list of foods which are allowed and those which must be avoided is given below. This low fat diet is especially low in saturated fats. Diet Therapy in Diseases of the Circulatory System 257 —___Det Therapy in Diseases of tho Cirulatory Systom 267 ___Foas to bewvoided except ppea-nut butter Allexcepton reducing 8 where potatoes and double beans ea, unsweetened 12 carbonated drinks 13. Misellaneoes Sugar, honey, syrup, pickles, fred chips relishes groundnut oil and gingelly oi used to make pies, muffins, etc. Qlive oil and coconut oil are restricted becuse ofthe high content of Saturated fats. he above restrictions in diet should be carefully expl a ‘plained to the patientso that he understands the need for this and can modify his eating habits accordingly.CHeeashines Diet Therapy in Diseases of the Kidneys and Urinary Tract Diet Therapy in Diseases of the Kidneys and Urinary Tract « Nephritis # Acute and Chronic Renal Fai * Acute Anuria + Renal and Vesical Caleali y management of the following disease is considered Nephi cute and chronic renal failure and (ii) Renal and vesical cale NEPHRITIS| classified neph ‘Type Nephitis, is into two classes: (i) Type I Nephritis and Type I Nephritis (Diffuse Nephri Inflammatory bright in affects mostly children and young adults. treptococc: of the kidney. The fected by a specific inflammatory process. The renal glomerular fate volume are reluced. The urine contains blood, albumin and casts, water, electrolytes, urea Erotier wane products are retained in the blood and tissues. ‘The blood urea and NPN rise and plasma protein concentration falls, Glomerulo nep! Diet Therapy in Diseases of the Kidneys and Urinary Tract 305 ee Rs th Kidney and Urinary Tract 305 Type Il Nephritis (Chronic Parenchymatous Nephritis). This conditi groups, a majority of the cases being adults. There is Kidney or urinary tract infection. The first indication is tis (Le,, increased ith adequate blood flow) account for the albumin- blood flow is deficient the urine volume is reduced. tains large quantities of albumin. Blood shows marked increases in chlorides. Cholesterol and moderate increases in urea and NPN. ‘Type | Nephritis As mentioned earlier, the urine volume is very low in Type T Nephritis and the levels of urea andl NPN in blood are markedly increased. The requirements for different dietary essentials are discussed below: Calories The calorie intake should be about 10 per cent less than that of a sedentary person as the subject will be in bed at rest. An intake of 1 for adult males and 1500 kcal for adult females may be adequ Proteins The intake of proteins should be reduced ta the minimum ie, about 30 keep the body in N equilibri ixcess of prc will give rise to increase in blood urea levels.) Fats Fat consumption can be maintained at normal levels i.e., 50 to Zip par aby Carbohydrates Since carbohydrates are the main source of energy, the bulk of the calorie requirements should be supplied in the form of carbo- hydrates; 3808 Nursing Manual of Nutrition and Therapeutic Diet Vitamins Witamin intake should be adequaie) Qne multivitamin tablet providing the daily requirements of Vitamins may be included. Minerals and Sodium Chloride ‘The minerals provided by the diet will be adequate to meet the needs of the body. Intake of sodium should be restricted. Addition of salt is not permitted, Figs Apart from the water excreted in urine, about 100 mais lost daily through respiration, in sensible perspiration, sweat and defaecation. ‘The fluid intake should be 1000 ml plus the volume of water lostin jo urine which may vary from 400 to 600:ml per day. Water contained 1%) in the diets should be taken into account for estimating the extra le al \ water required, i Diet | The diet should be Jow in proteins and sodium and rich in carbohydrates, Fluid intake should be restricted. The pattern of fiet and daily menu for an adult suffering from Type I Nephritis in Tables 18.1 and 18.2. “Table 161: Dat or an adult sulting fom Type | Nephrits {Proton 25 to 80 gm; Carbohydrate 250-260 g; Fat 60-65 gm and calves 1050-1750 Keal Salree diet) Fanta ‘ghepuili 250 400 200 150 50 50 “0 80 no retention of urea and other nitrogenous waste al volume of urine excreted may be normal oF — Diet Therapy in Diseases ofthe Kidneys and. Urinary Tract 307 Table 18.2: Dal menu for an adut suring fom Type | Mephitis Tea or coffee os Mga Loup Breakat Bread or chappati ‘mango or 1 orange) Loup glass ‘Cooked rice or bread or ch 1 serving Cooked! vegetabis (wi 1 aeving ‘Cooked potato and carrots serving B 4 teaspoons. Leap 2bananas, Teup Tea orca Fruits Ik ° Tapple ort mango Dinner : Siar to Lanch ee Not: Adon of sodiam hordes not pete othe foods dng oval snaking slightly reduced. The nutritional requirements in Type TI Nephvit are discussed below: eee Calories ‘The calorie intake should be adequate (2000 kcal) per adult males and 1700 kcal for adi les) to prevent breakdown of tissue proteins. aoe Proteins he daily toss of albumins in urine may be about 10 to 20 gm Clepencting onthe severity of albuminuria) Hence the protein intake should be adequate for making up loss of serum albusnin. For the effective replacement of serum albumin, the dietary proteins shoul be of high nutritive value, eg. proteins of milk, eggs, meat, and fish. The protein intake should be about 100-120 gm per day308 Nursing Manual of Nutrition and Therapeutic Diet Fats ‘The fat intake should be about 60 to 70 gmnfhalf the fat being in the form of vegetable oils rich in essential fatty acids, fg sesame oils and safflower seed oil, as this will help to lower the cholesterol Jevel in the blood.) Carbohydrates \-Carbohydrates will supply a major part of the calorie requirements. Vitarnins \¢ intake of vitamins should be adequate) This can be achieved by the intake of one multivitamin tablet providing the daily requirements of all vitamins. Sodium Chloride and Other Minerals Addition of sodium chloride to the diet is not permitted as it will aggravate oedema, The diet will provide adequate amount of all and daily menu for adulls suffering from Type IL Nephritis are given in Tables 18.3 and 18.4 ACUTE AND CHRONIC RENAL FAILURE Acute Renal Failure In acute renal failure, accumulation of urea and other waste products takes place in blood and tissues. A reduction in the endogenous waste products (urea anid other compounds):and in the breakdown of issue proteins can be achieved by giving glucose Diet Therapy in Diseases of the Kidneys and Urinary Tract 309 Tab 16.3 Dit or an aut sie ie Ju suing to Typ I Nephi esp {Protein 100-120 gm; Fat 60-70 g; Carbohydrate i se ; j ns 22080 gm, Caan ‘kcal—~Salt free) 2 e pol Non be at 200 x Milk, cow's: a Mea and fish ¥s io ter = 0 (peanut, cashewnut, etc) 190, 00 ib odin se vepatable ln) ‘” Shae 0 © mi 200 Green leafy vegetables : Roos and es 5 ° Other vogetblen % 3 Ca vant ot scott Note Sodium diene Sommon “Tea or coffee or milk—1 cup Braalfast Butte? teaspoons Jam—2 teaspoons Choose? sheen Tea, cofee or milk—1 cup Fruits—2 bananas or 1 apple or range or mage A cup uils—1 serving Cooked sic or cap Toervng Cooked dal cup Nate? fespoone Cook eet seri Canis—teap 2 Frute—1 banana or1 apple or Torangeor mango Hi or ili serving, Brad or hppa or iit servi Batler2tempoong Jam—2 teaspoons Boiled egg? Ten cofee Cooked sc or chapat or ro Cooked dal—1 eup Cooked meat-1 serving Cooked vegetablos—t serving Curds—1 cup Feuits— banana ot 1 apple or Torange or 1 mango310 Nursing Manual of Nutrition and Therapeutic Diet and emulsified fat in one litre of water equivalent to the water lost from the body in insensible perspiration, sweat and respiration, 100 gm refined ‘of water with dai ener of vi “through nasogastric tube>Some phy of glucose in one litre of water as Bull’s regimen may diarthoea in some cases(As soon as the flow of urine the patient may be given more fluids in the form of mill etd) Chronic Renal Failure Chronie Ret pyelonephritis. In this condition, the glomer heavily damaged. an adit suffering from elon rer Proteins 15:20 gm; Fat 40-50 samy Carbohydrates ACUTE ANURIA 1's when there is kidney failure and little orno urine is, inall water products being re anges which occur are uratemia, water and sodium. Diot Therapy in Diseases of the Kidneys and Urinary Tract 311 an Tenney Ty Oiboanes of the Kidneys aed Udnany Tract 611 ‘able 18.6: Daly menu for chonie renal allure Fruit juice with glucose— glass Breakfast 1d—2 slices ter—2 teaspoons :—2 teaspoons With glucose—1 glass Lich ice orbread—1 serving Butter or ghee—2 teaspoons Potato and Carrot cursy—1 serving Curds—t cup i th ghucose—1 glass \ slucoso—t glass nud not be added during orafier cooking, One mulGviamin the daily requirements should be taken. imbalance, and high potassium level (hyperkalemia). Ian artfic | kidney is availa nd very expensive, Control of the disease by dict is usually icated. When modifying the diet it must be noted that the patient is He will have anorexia, nausea, vomiting and a very poor appetite. Diet therapy should aim at: 1, Reducing uratemia (2. Avoiding sodium and water retention | _ 3. Reducing potassium level in the blood. ' bohydrates given in amounts of 100 to 200 gm per day are ly effective in reducing tissue catabolism. Fat should be added nerease the daily intake of calories. Protein is generally avoided when uratemia and anuria are present, When diuresis occurs protein is gradu: progressing from 20 to 60 per day dep the patient. The fluid intake must be carefully regulated: Measurement of intake should include the fluid content of foods taken as well as theba given. Adiily intake of500-700 mlis usually given f fluid may be increased with improvement of the ion of the patient. Potassium is avoided as much as possible. Adequate calorie | intake is given by addition of carbohydrates and fats, This helps to prevent catabolism and arising level of potassium in the blood.312 Nursing Manual of Nutrition and Therapeutic Diet hat is free from protein, sodium and potassium does not permit a wide choice of foods. These are limited to white sugar, ‘glucose, salt-free butter, comflour, sago and arrowroot and flavour- ings. Sugar candy helps to increase the calories when the patient is able toeatit. A mixture of butter, sugar, starch, and water, as chosen from the daily allowances, can be cooked in the form of a thick soup and flavouring added, Allnecessary calories can be provided by giving this mixture by mouth in 5 or 6 feedings giving per day. is necessary to use tube feedings for the provision of calories, and emulsion of sugar and butter may be used. ‘All of the above dietary restrictions are extremely severe and may icult for the very ill patients to eat and to accept. He ‘must be given encouragement and be assured of the necessity of type of diet, URINARY INFECTIONS is mainly by medicines and with the other treatment ii value but alc prescribed, the following points should not be less than 2500 ml perday. 1. Fluid intake should not be less than 2500 ml per day 2. Diet should be light and bland, but well balanced 3. Condiments and spices should be omitted because of their tating effect on the renal tract. RENAL AND VESICAL CALCULI Renal calculi consists of mucopolysaccharides, urates, cal oxalate, calcium phosphate and calcium carbonate. Urate and oxalate stones are the most common, Cystine stones are very rare. Aetiology Several factors contribute to the formation of ‘occupation (iii) infection of the urinary tract (iv) dietary habits- habitual intakes of foods rich in oxalates, calcium, phosphates and purines and (v) hereditary. the urine volume in low and the urine is highly concentrated with urates, oxalates, and calcium salts. Diet Therapy in Diseases of the Kidneys and Urinary Tract $13 Occupation Individuals who have to work inthe direct sun and who perspire a lot may, generally pass concentrated urine. Infection of the Urinary Tract Frequent infection of urinary tract may be one of the contributory causes, Puscells and epithelial cells may form a focus around which the stone may be formed. Dietary Habits Person consuming habitually foods rich in oxalates. Calcium, purines and phosphates, e.g, whole cereal flours (rich in phosphates), leafy vegetables (rich in calcium and oxalates) and meat (rich in purines and phosphates) may predispose the ivicual to the formation of renal calculi. Excessive consumption of tea may be an important causative factor. Hereditary Defective metabolism of uric acid and oxalates may be of hereditary Diet for the Prevention of Renal Calculi Data regarding the calcium and phosphorous contents of foods in Table 1A and oxalic acid content of foods in Table 2A in the appendix, Data regarding the purine content of foods are given in table and a list of foods rich in the above constituents is given in table at the end of this topic for reference. Adiet intended for the prevention of renal calculi should be low in ox The intakes of calcium and phosphates should also be reduced to a moderate level. Foods rich in oxalates and purines should be completely avoided. The subject should consume large amounts of fluids so as to increase the urine output to 2 to 25 litres per day. The pattern of diet and daily menu for an adult suffering from renal calc’ given in tables at the end of this topic. ace mibob. GouT— + Gout is considered a hereditary disease resulting from defective uric acid metabolism, Serum uric acid levels are raised and urates.314 Nursing Manual of Nutiton and Therapeutic Diot 314 Nursing Manual of NusiNon and Theiapeune TS “Table 18.7: Foods rich in calcium, phosphates, oxalates and purines Parnes Diet Therapy in Diseases of the Kidneys and Urinary Tract 318 “Table 18.9: Dally manu Calum Phosphates Oxalate Vegeta Loni agai Wholecrs—Lesfy wep, Meni Tees tel a poe: = Caffe ormitwatnogar—lcxp Cait or mkt oar cop Meal, fish, eggs Rhubarb White bread— slices SSS icc SIS AE SS en Butter—2 teaspoons “Table 18.8: Det for tha prevention of renal calcul in adults (gmlcapulday) Jam—2 teaspoons Jam—2 teaspoons Vegetarian —_Now-egeturis Chasse cate ae . 100 200 60 50 200 Tablet providing the daily requiem be consumed. are deposited inthe cartilage and ints, There are recurrent attacks of p: swelling of the joints. (Gout dug to, abnorm Jc acid metabolism is called out (Gout resulting from excess uric acid production due ‘nuclei occurring in other diseases inaemig, haemolytic anaemias and solyey themia is called secondary gout, Uric Acid Metabolism in Normal Subjects ‘The body derives uric acid from two sources: () Endogenous Source Exogenous Source. Endogenous Uric Acid es derived from the breakdown of nucleoproteins or By sis are converted into wric acid. Oia purine-free diet about 300 to 600 mg uri derived from the endogenous sources is excreted in the urine of a normal adult. Pruits—1 orange ofee—I cup Mi Fruit juice—1 glass Cooked rice, or bread or chappati ‘Cooked rice or bread or chappati (som rofated wheat lous) (oom refined wheat A serving Meat soup Cooked vegetables Cooked vegetables Fruits nits Butter milk—t glass Butter milk —1 glass Eeering Biscuits —2 juice glass Exogenous Uric Acid {The exogenous source of uric acid is the diet which high purine imal and nucleic acid contents such as meat, fish and all tissues) About 200 to 800 mg of uric acicl may be derived from soureé depending on the intake of flesh foods(The quantity of acid excreted in urine of normal adults is about 1 gm/day) Jevel of serum uric acid in normal subjects is about 5 to 6 mg/ 100 ml po ad a Uric Acid Metabolism in Gout ‘The level of serum uric acid generally high in patients suffering from gout (6 to 10 mg/100 ml). The possible mechanism for the high serum levels of uric acid in gout are: i) Increased production and (ii) Diminished excretion816 Nursing Manual of Nutrition and Therapeutic Diet Increased Protiuction There isevidence that in gout there is increased synthesis of purines in the body, leading to increased production of uric acid. Diminished Excretion ‘There is evidence that uric acid excretion by the kidney is diminished in gout. This abnormality in the kidneys appears to be hereditary. Diets for Subjects Suffering from Gout gout should have a low purine content. Foods rich in ‘and nucleoproteins,e.g., meat, fish and other animal issues should be avoided. The purine content of food is given in Table 18.10. ‘The role of different constituents in the diet on uric acid ‘metabolism is briefly discussed below: Calories Obese persons are more prone to develop gout. The body weight should be maintained at normal level, as inflammed and cannot bear more wei supplying more calories tends to precipitate an attack, The cal intake should be restricted to that required for sedentary persons. Proteins and Purines ‘The protein, intake should be between 50 to 60 gm for an adul ‘The proteins should be derived from cereals, milk and eggs. Meaty fish and other animal tissues should be avoided as they are rich in purines and nucleic acids. Consumption of excess of proteins, ma lead to excessive synthesis of purines in the body, Fats Fat consumption should be restricted as high fat intake tends to decrease uric acid excretion in urine, a Diet Therapy in Diseases of the Kidneys and Urinary Tract 317 Carbohydrates © During an attack of gout, the main source of calories should be from carbohydrates, ids should be advised as it helps to the volume of urine excreted. Beverages Tea, coffee and cocoa contain methyl purines. They are not converted into uric acid in the body. Hence, 2 to 3 cups of tea or coffee or cocoa per day may be consumed. Alcohol In some individuals, ingestion of alcohol precipitates an attack on gout. Diets for subjects suffering from gout are given in Table 18.11 Dietary Management During Acute Attack ‘The subject should be treated by a qualified physician, The dietary management during the treatment is briefly described below. Duting the first two or three days of an acute attack to gout, the patient has very little appetite, diet consisting of porridge, mil Juices and soups. Bread, cooked cereals and boiled egg one may bbe consumed according to the preference of the patient. The patient should drink as much fluid as possible in order to fac “uric aciel, Consumption of alkaline mixtures containing, arbonate oF Sodium citrate will help in the excretion of alkaline urine in which urje acid is more readily soluble and hence is less likely to form calculi, Table 18.10: Foodstuls classtied according to ther cantent of purines Cont318 Nursing Manual of Nutrition and Therapeutic Diet Diet Therapy in Diseases of the Kidneys and Urinary Tract 319 Diet Therapy in Diseases of the Kidneys and Urinary Tract 319 con Fish oss Weal Wil and mile products One helping of meat oF fish Wie bie Chicken or otherbirds Eggs Fruts—1 serving ‘White fish Milk pudding —I serving, Milk pudding—1 serving Cereals Te Vegetables Biscuits—2 Biscuits—2 Hering Fruits Tea cup Tee] cup Sweet Breads (pancrens or thymus) Sager i Dinner ® Cooks rice or bread or chappati Cooked ie or bread or chappati 1 serving rr 3 Vegetable soup serving ‘Vegetable soup—1 cup elem Nene Cooked vegetabls—1 serving Cooked vagotables serving i Curds—1 ey “Tablo 18.11: Dist for adult suffering rom chronic gout (girvcaputiday) Be ip ing serving Mill pudding —1 svi ‘Males: Females 2 ei png = v ww. vow “000 300 —~—«80 0 20 30 30 100100 100. 100 100100 100 10 100100 10100 soo Ce 3 s a a 20 = 20 a 20 See 2) 0 0 0 a0 50 50 Boo "Nove Foods vich in purines and nucleic acids such as mea, fish and other animals ould be avoided, 8.12: Dally menu for subjacts suffering from chronic gout Breakfist Com fakes or porridge with milk Comm flakes or porsidge with mill serving <1 serving cl Boiled oF poached egg—! Tread—2 slice Fruits serving Coffee or tea—t1 cup Coffee or tea—1 cup) Lami Cooke rice—A serving Cooked rico serving Cooke! mashed dal and vegetable Cooked mashed dal and vegetable soup—1 cup soup—I cup Cooked! vegetables—1 serving Cooked mashed dal and vegetable ContdEasy cha) A Diet Therapy in Diseases of the Gastrointestinal Tract ‘The functional disorders of the gastrointestinal tract are; + Excessive or defective secretion and motility ‘Vomiting Diarrhoea lence Malabsorption Excessive or Defective Secretion and Mot ‘These conditions may be due to disturbed mental condi be purely functional normay. mn of saliva and gastric juice is often associated and a sp: —family or abnormal ty—movement + Malabsorption—poor absorption * Spastic—having excessive contractions in long spasms. Defective secretion and hypochlorhydria or decreased sect and small intestine and a dilated, lazy colon, which also leads to constipation. In both conditions therefore, constipation is liable to occur, butonan unerapasy Diels 1260 Nursing Manual of Nutrition and Therapeutic Diet 5 ot an excess of residue left in the col mn In avoiding roughage, most of which comes from fruits tables, care must be taken to see that there isno deficiency ‘advisable for the patient to drink plenty of fluid ‘and molility, food should be attractive timulate secretion of the digestive is better that food be taken rather xd to drink plenty of fluids between leave a larger tasty, and finely choppe ices. To promote digest tient be encourage 1. All whole grain cereals, and thelr products like millet, jowas, com flakes, brown bread, wheat bran, puffed wheat, unpolished dry peas, etc. ‘All whole grains and legumes andl vegetables 2 5, Hidible skins and seeds of fresh fn 4, Greeitleaty vegetables 5, Raw 6. "vegetables salads and dried fruits Foods having a Méderate Fibre Contents 1. Fruits with no skin and seed 2. Tender root and stem vegetables 3. Pureed vegetables Foods having Little or No Fibre 1es and tomato juice, white bread, toasted or as 2m flour, in small quantities plain eggs, cream, sugar, jaggery, honey, syrup, boiled ‘malted milk, yeast and meat extracts. Mut HIGH FIBRE DIET Fibres presentin nate vegetables and whole lly occurring foods especially in fresh fruits, Jn cereals. High fibre diets retard the Diet Therapy in Diseases of the Gastrointestinal Tract 261 absorption of cholesterol and so help to lower blood cholesterol levels, help to control diabetes more effectively and also prevent constipation by increasing bowel movements, = Roughage (fibre) is also known to combat many typically lem, western diseases such as@iverticular disease, appendicitis, bowel cancer and obesity? igh fibre (residue) diets for adults (calories 2400 eal; protein 60-70 gm. Fag a lr Non preg Whole cereals 350, 350 5 o © 50 50 sco 0 = 0 — Fr 100 100 210 200 100 100 Olt and fats 30 P Sugar and jggery so sa CONSTIPATION Constipation is characterised by frequent and incomplete evacua- tion of the stools. There are several causes for constipation. Inclinical ppractice, the term constipation is used to denote three types due to (i) Colonic stasis (ji) Rectal stasis (dyschezia) and (iii) Intestinal obstruction. Colonic Stasis Weakness of the musculature of the intestinal ation) (ii) Spasm of the colon (spastic Hard consistency of the stools due to lack of foughage and inadequate consumption of water. Rectal Stasis This may be due to (i) regular habits with regard to time of passing stools, (ii) Depressed reflex ‘Weakness of the voluntary muscles of defaecation.262. Nursing Manual of Nutrition and Therapeutic Diet Intestinal Obstruction ‘This may be due to malignancy or stricture of the colon. Treatment The principles of treatment of constipation are as follows: Correction of Faulty Habits ‘The bowels should be moved at fixed hours of the day. Ifthe diet does not contain adequate roughage, the subject must be asked to take foods rich in roughage, ie. whole cereals, whole legumes and “He mustbe encouraged to drink enough water, rly in the early morning, Physical Exercise ‘The patient must be advised to take exercise for the development of the abdominal muscles. Removal of Other Causes ninated. Anal fissures, if worry and anxiety should be st be treated by a surgeon. ‘The diets should contain foods tich in fibre viz., (i) whole cere whole legumes, and mature vegetables rich in fibre and (ji) fru hnin fibre and /or pectin, e.g., guava, apple, banana, The subjects ‘ould drink adequate amounts of water: The daily menu and of dict are given in Tables 16.1 and 16.2. VOMITING be due to many causes and occurs in many 1e gastric mucous membrane by some toxin in food, chemical poison or drug administered as an emetic. ‘obe due to ketosis, an abnormal production of acetone the same. Since vomiting results in loss of fluid from. important that this should be restored. rherapy in Diseases of the Gastrointestinal Tract 263 Commence feeding by giving water or clear fluids, iiss sear ate Ras lara soft solid preparations, pushing carbohydrat 7 rate as sugar and well cooked cereals and dry toast, but eliminating all fat from the diet. Diarrhoea Diarrhoea is a condition in which loose or watery stools are passed. ions Wien eter non nin aceenceonied Wy the bee ofblood and mnucus, the condition iscalled dysentery Infection of the colon by bacteria and amoeba is the cause of dysentery. Diarrhoea may be functional or organic. Functional diarrhoea results from neuromuscular overactivity consequent or emotional states, Diarrhoea follows irritation or inflammation of the mucous, ‘membranes of the bowel by physical, chemical or bacterial agents. ie—Drug given for the purpose of causing vomiting as after swal fring from constipation (grvcaputiday) Acute Diarrhoea ‘The treatment involves the followin; 1g steps: (i) Rest in bed ‘Therapy with suitable drugs as prescribed by a physician and, )) Correction of water and electrolytes losses. These may have to be administered parenterally in severe cases.264 Nursing Manual of Nutrition and Therapeutic Diet Table 16.2: Daly menu for en adult Vegetarian ‘Nonaegetarian Noni ing from constipation water—1 cup water— cup coffee —1 cup feo—1 cup Breast Whole wheat bread or chappati ‘We whet nd capa ing bane mepoons Boiled eg3—1 ‘Guava oF banana or apple—1 Coffee or tea—I eup Lunch ‘Whole wheat chappati or millet roti Cooked dal—1 serving vegetables serving for the first 2 days orally water conlaininig sodium chloride (0.5%), glucose (5%) and orange juice. Patients should be given 150-200 ml of the fluid every hour from 6 am to 10.00 pm from the 3rd day onwards, 2 hourly feeds (200- lowing should be given: (i) Barley water mixed lth added glucose (5%) Orange juice with glu mnce in 4 hours, When w patient improves, Tees eot pederng acid {uced along with dilute milk and fruit juice for a week, till ‘0 consume a bland diet similar to that essential to give the Diet Therapy in Diseases of the Gastrointestinal Tract 265, Chronic Diarrhoea Diet. (200-300 ml) should be given once in 2 hours and fruit juice urs for 2 days) When the is improved, bread, introduced in the diet When the patient is discharged, he/she should be advised to avoid condiments and spices, and foods (whole cereals and millets, mature vegetables, etc.) as these will ‘cause irritation to the mucous membranes of the gastrointestinal tract and diarrhoea may recur. Flatulence [Flatulence is usually caused by the swallowing of air, resulting in by road he suaing fi seul formentation in which case the carbohydrate content of the diet should be decreased but this is usually not necessary unless an organism is found in the stools. Some people suffer from \ce after taking one ormore specific foods, but there are great individual: variationsloods ‘most likely to cause trouble are onions, sarlic, cabbage, cauliflower and preparations of dried peas ani sand beans)Patients may therefore be advised to note the effect of eating these foods and then avoid them if found to cause trouble. Malabsorption Syndrome The term ‘malabsorption syndrome’ is used for conditions in which a number of constituents in the: not digested and absorbed. fropical sprue (ii) Celiac diseases of children and jopathic steatorthoea. Aetiology Malabsorption syndrome can occur as a result of the following disorders to the intestinal tract: (i) Injury tothe mucosa of the small,266 Nursing Manual of Nutrition and Therapeutic Diet Diseases intestines as a result of allergic reaction to some foods ( the small Consequeni absorbed. The signs and symptoms include diarrhoea (Steatorthoea) I distension, loss of weight, anaemia (both macrocytic ‘hypoproteinaemia and deficiencies of several Is. One or more of the following features— dermatitis, paraesthesia and pain in the loins Absorption of Nutrients Tn malabsor is poor. ion syndrom malabsorption syndrome may be as high as 10 to 30 gm daily. Proteins Excretion of excessive amounts of undigested proteins (over 3 gm N per day) azotorritaan. The digestion and absorption of protein are diminished in malabsorption syndrome. Carbohydrates nce to starch and disaccharides has been reported in ren during recent years, These have been on of the enzymes concerned in the digestion serice of one of the enzymes due to an in-born error particularly affected. Consequei of folicacid and vitamin B, are prevalent: from malabsorption syndrome. Diet Therapy in Diseases of the Gastrointestinal Tract 267 Minerals The absorption of all minerals—particularly calcium ancl bs. calcium and iron—is adversely affected in malabsorption syndrome. Anaemia due to iron deficiency occurs frequenttly’in th ts, A compari and differences tween the different syndromes is given in Table below: Broad aiforontation of coiac disease, ‘and topical sera “leptie Tp spe steatorrhoea rene Detective digestion TROPICAL SPRUE ‘Tropical sprue affects all age groups. The disease st diarthoea. Patients passing 3-20 watery stools per day. The other symptoms include nausea, anorexia, vomiting and a feeling of fullness in the abdomen. The course of the disease is characterised night blindness, hyperpigmentation, muscle cramps, swelling of depending parts and anaemia. The gastric contents show hypoacidity. The absorption ofall nutrients is poor: If the condition is not treated, the patient becomes very weak and bedridden, Diet ‘The pattern of the diet and the daily menu are given in Tables 16.3 and 16.4.268 Nursing Manual of Nutrition and Therapeutic Diet 208: Nursing Manual of Nuinfon| and Therap Tet ‘Table 16.3: Diet for adult suferng from tropical sprue (gleaputi Vegetarian Now begelarian als products 300 ~~*«OD 1d cereals product mm 100 = 50 50 its Chease frais (banana, papaya, mango or apple) oo ae egetables » 2 50 50 {rmilkand akira milk ‘of equalamor ly menu for pationtseulforing from tropial sprue Diet Therapy in Diseases of the Gastrointestinal Tract 269 Treatment The treatment cons weat and rye ten sse foods is the causative factor. The contain foods rich in indigestible carbohydrates lets and mature vegetables) and spices and the diets, the patient should receive one condiments. In ac ‘multivitamin tabl rarenterally) should be administered for the treatment of anacmias. Model diets and menus are given in (Tables 16.5 to 16,7), Table 16.5; Diets’ (luton free) for adults and erin (4 to 6 years) suffering from celiac disease (gleaputiday) Table 16.4: Vegetarian ‘Weak tea or coeoa—t cup tea or cocoa—1 cup, Breast ‘Corn flakes with mill and sugar —1 serving Boiled egg—1 Fruits—T serving ‘Weak tea or cocoa—l cup Wesker coer ep Mid nor i Linc Cooked eet serving Cooked cet serving able soup Matsoupe ap CGn—op Men cay serving Prato seving adding serving th sugar—1 cup Mili with sugar—1 cup iscits—3 sugar—1 cup. Dimer dar to Lunch Tablet should be taken daily on meot the needs of all ‘condiments should be completely avoided. Celiac disease is caused by sensitivi sent in wheat gluten is responsible f lammatory reaction in the mucosa of produces a ‘profes secretion of mucus which especialy of fat. disease usually occur in children. The child loses app becomes weak due to under nutrition. Readers Rice orcom split legume) Mya ee 1000 1000600600 Meat and liver 8 0 0 Eggs - - » » Cheese 50 sss Freshy fits (banana, mango, papaya or apple) 200 200 Fru 200 200 50 40 4030 "Wheat, rye and their products should be completely avoided. * Amixture of equal amounts of fll ft, cow's milk and reconstituted skim mail, IDIOPATHIC STEATORRHOEA This disease is characterised by i amounts of fat: The changes in the those seen in celine disease, The steatorthoea in many of the cases is aggravated by consuming wheat gluten. Treatment ‘The principles of treatment are as follows: (i) Rest inbed (ii) Therapy to control loose motions as prescribed by the physician (Gli) Administration of one multivitamin tablet and izon salts oral and folic acid and vitamin By, parenterally to correct vitamin deficiencies and anaemia (iv) The diet should nat contain: (a) Wheat and wheat products (b) Foods rich in fibre (whole cereals, millets:270 Nursing Manual of Nutrition and Therapeutic Diet 270 Nursing Manual of Nutriion and Therapele st ____— iy menu for adult suffering from celiac disease Light coffe or teat cup Brsatfo maakand sugtt Com takes with milk and sugar 1 serving Light coffee or tea cup nam Trait uice—1 glass Boiled vegetables serving Curds—2 cups “Table 16.7; Dally menu for chileren (4 t 6 years) z Now-egetaran Mic with sogae—t cup Diet Therapy in Diseases of the Gastrointestinal Tract 274 = Trempy ih Diseases of the Gastraintestinal Tract 271 and mature vegetables) and (c) Spices and condiments, It should have a low fat contents, The diet for idiopathic steatorrhoea will be the same as that recommended for celiac diseases, Diet in Some Intestinal Disorders Ulcerative Colitis (Non-specific) Ulcerative colitis is characterised by inflammation and ulceration of colon leading to passage of loose stools, with mucus and blood No specific organisms have been appetite. Recent studies have shown that the disease recurs patients when cow's milk was reintroduced in the di that intestinal allergy caused by some foods like milk may be responsible for the disease in some cases. Treatment ‘The principles of treatment Rest in bed, flanmation and ulceration ) Treatment for anaemia with iron salts (orally), folic acid and vitamin By» (parenterally). Diet to that used in the treatment of diarrhoea. It in foods rich in fibre; (whole cereals, whole legumes and mature vegetables) spices and condiments. It should have a low fat content Since milkeis some patentee ‘in ome patients, is better to avoid milk during treatment and use soyabean milk tead of cow's GASTRIC AND DUODENAL ULCERS formed in the stomach or duodenum usually as a result ion of excess hydrochloric acid on the mucous membrane. Other causes which may contribute to the development of an ulcer are infrequent meals, inadequate chewing, of food, ‘excessive alcohol or smoking on an empty stomach, fear and other emotional disturbances which may cause hypersecretion and hypermotility of the stomach and at the same time a reduction of the blood supply to the stomach. seci272 Nursing Manual of Nutrition and Therapeutic Diet ‘Symptoms ‘The commonest symptoms of ulcer is pain after food—about hour after food if the in the stomach and 2% hours after food if the uleer is in the duode the pain is relieved by taking more food. Vomiting is frequent and the vomitus and may contain blood. A chronic, bleeding ulcer, in time, leads Modification of the Diet lent of various kinds has been recommended, originall ‘with bleeding ulcers were given only to suck. Moder jent is based on the principles laid down by Lenhartz, py (1915), and meulengracht (1935). mmended by Lenhartz began by feeding patients mounts of milk, or milk and egg mixture gradually ine daily amounts. “The diet recommended by Sippy was very similar to the above butmore cream was used. One hundred ml of milkand cream were given on an hourly basis, Antacids were given between each ‘and 15 ml of olive oil were given twice or three day. Only milk was used for two clay in Sippy’s original diet. Soft ‘cooked eggs with toast and cereal were then added during the first reek, Quantities were increased and more pattern foods added dluring the second week; a normal pattern was established during, the thied week with three small meals and feedings at intervals between meals. Numerous modifications of Sippy’s diet have been ed, “The dict recommended by Meulengracht was based on thebelief that patients with haemorshage had a much lower mortality a they were given a full pureed from the beginning, This means that all foods, including meats and vegetables, were given in a pureed ot finely minced form. This provided adequate nourishment for the generally accepted aims in the dietary manage- tients with gastric or duodenal ulcers are: Diet Therapy in Diseases of the Gastrointestinal Tract 273 In an effort to give adequate nutrition that the bse clone, pron mineral and MEY seein of the patient with a peptic ulcer are similar to those of a normal healthy person. ron ascorbic acid and essential amino acids shoul be given in liberal amounts. Therefore, a selection of food which only slightly limited is recommended. - smount of food should be taken at each feedin is done in enero provide adequate est Re ; n of the gastric acid is necessary. In order to accomplish this 14 to 2 hourly intervals between feedings are recommend, Protein foods such a milk, eggs and et have high cbse epacy andre sed for in The production of gastric acid can also be inhibited by the use of nts are very hot orcold. pellel Goat hails avec Ie eugene ee On the basis of the principles mentioned above, a bland diet in four stages forms the basis of present day treatment of the patient with peptic ulcer. The first three stages are usually used when the patient is in bed. The last stage is adaptable to a normal pattern of life and can be followed, even alter discharge. There are gradual increases in kind and amount of good given. This is allows the patient to begun at the most appropriate stage according to his condition. The particularstage of which the patient’ ay begin aes by the doctor. Progress depends on the toleration of the274 Nursing Manual of Nutation and Therapeutic Diet 1: Milk and sugarin quantities as ordered by the doctor, to en at specified intervals. For example, 180 mil of specified be given energy two hours. Milk with cream. available. Minerals and vitamins must be given as supplements. Stage H in: Milk and sugar, in quantities as ordered by the doctor, may be given every four hours. Inaddition to this, small quantities of food chosen from the list below may given, These may be given in any combination between the milk feeding’s minerals and Well-cooked rice—sugar toast—salt Sweet curds—vanilla ice-cream Bis Sample Menu 6.00am = — 150ml mi 800am = — _ Straine ugar 10.00am = — — Milk—~150 ml Noon — Iwice boiled rice, sweet curds — Milk 150ml — | Custard — — Milk—150 ml — Toast—I slice with butter; egg—1 soft cooked — — Milk—200 ml nl Plan: Continue with five times per day as ordered by the doctor. ‘addition to this, give small servings of the following foods at Diet Therapy in Diseases of the Gastrointestinal Tract 275 — Strained cooked apple — Ripe plantain — Pureed vegetables — Mashed dal Saraple Menus 6.00 am — Milk—150 ml 8.00 am — Tali or Bread slice-1 eggs—I (half boiled or poached) Milk—150 ml 10.00 am Noon — Twice boiled rice 4 cup Minced me Soft pureed carrot or beetroot curds—4 cup 3.00 pm — Milk—150 ml and plain biscuits 5.00 pm, — Strained fruit juices 8.00 pm — Twice boiled rice % cup pureed vegetable curds—I cup, milk, custard Late = Milk—200 mi ‘Meal Plan During this stage the patient is given a fairly normal diet, bland in nature and consisting of three main meals (reduced with in between snacks. be minced or baked). Cereals Well-cooked ris nufted rice, mal greens without skins and seeds in pureed form.278 Nursing Manual of Nutrition and Therapeutic Diet _Nursing Manual of Nutntion and TherepENt Fauits Free of skin, seeds and fibre; ripe banana, plantain, mango lp, papaya, melon, apple jewed fri ‘Soups Creamed and made with vegetable puree. als Well-cooked and masked. arch puddings, milk and egg desserts, cake, Desserts C plain payasam, plain biscuits gelatine clesser' Fats Cream, butter, margarine, ghee, cooking oil, vanaspathyt ‘Sugars Sugat, clear fruit, jam (or jelly) honey, jaBBery- Beverage Weak tea: is: salt, tumeric, onion, coconut, ground. ied foods pastries and nuts Js of all vegetables and fruits ve made out of whole grain cereals like brown bread Whole pulses Concentrated sweets and syrup ‘as chillies, pepper, SiNBED BF 1 3, Prepa 4, 5 ., mustards, cloves Dist Therapy in Diseases of the Gasirointastinal Tract 277 fish or meat soft vegetable curds 9.00 pms Milk—200 mi (Milk: may be taken as necessary betw' fish may be taken for lunch for dinner the patient) Postoperative Diet following surgery for peptic ulce of ulcers, The purposes of such as a dis the stomach and to continue the control of ac before. Tn the immediate postoperative period the patient may be fed only intravenously until normal intestinal function is restored. Thereafter feedings should be small, bland, easily digested and -very similar to treatment ‘oid distension of and irritation as given at frequent intervals. PEPTIC ULCER Chronic ulcer formed in the region of the gastrointestinal tract where the gastricjuice comes in direct contact with the mucous membrane js knownas peptic ulcer. Such ulcers usually occurin the duodenum ‘duodenal ulcer) and in the stomach (gastric ulcer). Duodenal ulcer_ ity while gastric ulcer is not. Peptic Ulcer The dict is the most important factor in the treatment of pep! ulcer, Three main types of diets have been used in the treatment of ulcer. of Det “T Sippy’s diet fegg, meat and fish (Minced and strained) given once in hours Sippy’s diet consisting of milk and olive oil was used widely. Since itis monotonous and not adequate to meet the calorie needs,and Therapeutic Dist 278 Nursing Manual of Nu has been replaced by a bland ing large quantities of Nutritional Requirements Calories ie intake should be adequate according to age, sex and nlake should be about 50 per cent hig! ied allowances. Atleast 50 percent of the dietary proteins Fats mat Levels (50-80 gm) int depending on the calorie requirements. About 50 per cent of the f k ininys by vegetable fa rovidled by-milk and the rem: : een ‘fatty acids, eg., sesame oil, sunflower seed oil, “content. Vitamins as coffee and tea stimulate gastric secretion. Weak Ik or cocoa, Ovaltine, Boumnvita, ete., are Diet Therapy in Diseases of the Gastrointestinal Tract 279 Diet Therapy.in Diseases ofthe Gastrointostinal Tract 278 Alcohol Alcoholic drinks should be completely avoided as they’stimulate gastric secretion. 4 list of foods permitted dietary pattern and t t permitted in peptic ulcer; he daily menu are given in Tables 16. to 16.10. ibm peptic ulcer (aroapitiay) Vegetarians Now-végetaria Conditions which Cause Obstruction in esophagus or Stomach mach, including carcinoma, may requite surgery, and this sometimes necessitates the introduction of gastrostomy tube for feeding. If the ga: secretion and digestion are normal, there is no need for iquid form such a case a adequate for his needs and fully balanced Extra protein ‘may be needed if further extensive surgery is plained, Liquid Diets—Tube feeding Breakfast ‘Milk—400 ml (200 + 200) Rice flour conjee—25 gm Orange—1 ‘Sugar—100 gm for the day Raw egg—1" 280 Nursing Manual of Nutrition and Therapeutic Diet __Table 16.9: Daly menu for paptic ulcer patients taro ‘Mill-—2 cups (with 2 teaspoon sugar) 2 teaspoon sugar) Bred Butter—2 teaspoons Butter—2 teaspoons Boiled egg—one Milk—1 cup Wan sugar) 2.cups (with sugar) sd minced meat serving Boiled patata—twa Milk pudding 1 cup 2pm Frid foots ‘Alcohol and alcoholic drinks ‘Chewing betal leaves, arecanut and tobacco Diet Therapy in Diseases of the Gastrointestinal Tract 281 Det Therapy in Diseases ofthe Gastrointestinal Tract 281 Lunch Rice—25 gm Oil—2 teaspoons Orange—1 Milk—200 mi Tea Milk—200 ml Or blend with proteins plus Raw egg—1 Dinner Thin wheat conjeo—25 gm Oil-2 teaspoons Orange—1 Milk—400 ml Approximate calories—1900 without blend Protein—55 gm Jejunostomy Feeding Feeding directly into the jejunum is sometimes necessary temporarily, when further surgery is planned, or indefinitely, if the normal route for food is blocked as a result of surgery or cancer. This is however, more difficult than feeding by gastrostomy tube. The stomach normally receives foods for digestion, but this is already partly digested by the time itis passed onto the duodentim and jejunum, as it nce and diarrhoea. Thus the aim in jejunostomy feeding is to id the natural process. For this four conditions have been , Sugar concentration should not exceed'10 per cent ¢. Fat content should be low d. Food should be administered by drip method, and at body temperature, For the first two days, diluted skimmed milk and diluted orange juice, 120-150 ml may be given alternately every 1 or2 hours either bycontinuous drip or by drip for 40 minutesand rest for 20 minutes282 Nursing Manual of Nutrition and Therapeutic Diet it more than one level teaspoon sugar to 25 ml fhe concentration of milk feeds may then be inereased day by e feeding formula giving adequate nutrients is y ing the amount of blend, nes are tobe given by jejunostomy they should be mixed 120 mil of a milk feel and given at the same rate asa milkr Endlocrine & metabolic Diet fer ; we erat) Diet Therapy in Diseases of the Endocrine Glands and Metabolism * Diabetes Mellitus Hyperthyroidism and Excessive Leanness Hyper Insulinism The endocrine glands are orga of internal secretion whose ly into the blood. function of some fect the body in various ways. T ‘may produce a marked change in metabolism. a change in the diet to mect the different state ring it into a new balance. ns caused by changes in the endocrine glands which Iped considerably by changes in diet are: 3, Hyperthyroidism and excessive leanness Diabetes Mellitus characterised by hyperglycaemia, and glycosuria accompanied by polyuria, polydipsia, polyphagia, and if untreated for a long time by loss of weight. There may be many other complications which develop as a result of the disease, e.g., reduced resistance to infection, tuberculosis, neuritis and pruritus, gangrene, and changes in the eyes and kidneys. Diet Therapy in Diseases of the Endocrine Glands & Metabolism $21 RARER Of the Endocrine Glands & Metabolism 321 Predisposing Factors ‘The various predi osing factors are: (i) Hereditary, (ii) Age, and (v) Stress. eae A familial tendeney to diabetes has been found to exist. Genetic factors are involved when the disease clevelops before the age of 40 years. Ago The disease occurs at all ages but a greater per centage of the cases ‘occurs in persons over 45 years of age. Sex The disease affects both sexes. The incidence of the disease is somewhat greater in men than in women, Obesi ‘The incidence of diabetes is greater among obese persons thai in persons of normal weight. Stress Stresses of various types, e.g, frequent infections, worry, irregular meals, e(c, may also contribute to the development of the di Changes in metabolism in diabetes mellitus Indiabetes mel are affected. the metabolism of carbohydrate, fat and protein Carbohydrate Metabolism ‘ored in the liver and muscles as glycogen, utilised in the body because of ‘ose therefore, accumulates in the blood untilit reaches her than that at which the kidneys can prevent its excretion. The glucose then passes into the urine and glycosuria results, The quantity of glucose present in urine may vary from322 Nursing Manual of Nutrition and Therapeutic Diet 015 to 6 per centidependis on the severity of the disease, The volume of urine is increased (polyuria). The inability to use carbohydrate and its loss in the urine, means that the body loses its main source of energy. The metabolism of fat and protein is therefore, increased to try to provide the body with adequate energy. “Table 19:1: Percentage of calories supplied by carbohydrates, fats and proteins Calories % supple by ‘Type diabetes Carbohydrates Fats Protein Juvenile diabetics 0 0 2» ‘Adult obese diabetics 0 0 20 ‘Adult diabetics with normal body weight 40 40 20 “Table 19.2: Diets for labatio malo subjects of varying ages with normal body weight (amicaputay) “Adolescent Boys “Aull wales 13-15 years 16-18 years Sedentary. Moderate work Cloves (Kea!) 2375-2850 22802560 100 100 100 100 195130, 100s vVNV VN Vv NV Vv NV 100 100 150 150 100 100150150 joo 100 300 100 100 100 100100 1000 1000 1000 1000 1000 1000 10001000 = WD — Wm Groundnutor cashewnut m0 m7 0 0 7% 8 Meat ancl fish APS 5 te al Egg an le ea ae a, Vegetable oil (sesame saffwerseed oil = 3060 60 0 sO Tealy vegetables 150 180 150 150 150 150 150150 Guher vegetables 100 100 100 100 100 100, 100100 Fruits 50 50 60 508050 HYPERTHYROIDISM AND EXCESSIVE LEANNESS: ‘These two conditions may be due to very different causes but the dietary treatment isthe same, and therefore, they may beconsidered together. “Hyperthyroidism is due to over activity of the thyroid gland causing an increase of anything up to 100 per cent in the Basal ‘Metabolic Rate. With this enormous increase in energy expenditure, Diet Therapy in Diseases of tho Endocrine Glands & Metaboliam 92: 3 ese 222g \essegen a "ESE8S | \eae8 3 BSSsleasagse oeiser x3 ae >eeges i iaggs He ZSeeilansages 3 >S82eR1 lags 1 Br i ee BRS8 kesages slggee® us *RERSR I ages ala e i $g88/2888 laesages ae 3 PESR58 | lagas a &| 3E2 : sete § fois ath f | ag3,82 22 agtyie ate i | Hai824 Nursing Manual of Nutrition and Therapeutic Diet ‘abl 104 aly mons fr dato js Aawovie zm cy omen Tr ) rear coice (without supa) Breit 4 Com flakes with milk “Tea or coffee (without (Corn flakes with mull Cheese ‘Toast with butter Tea or coffee Mid-moring Tea or coffee (without sugar) ‘Tea or coffee (without sugar) Lunch chappati or bead Cooked tice or chappati or bread happat or bi Cooked dal i ble soup sppad laut orcashewmnut Roasted groundnut oreashewnut gout orca ‘apple or one slice =a Tea oe (without sugar) Diner Simila to Lunch r all the body resources, and may quickly reap tiesto fate even the body pote so hat the boy mn is usually treated surgic: ‘must have complete rest and a high for the increase in metabolism and to help store the wasted tissues. ce (Bacessive leanness may result from manu om, high calorie diet isagain nee emaciation with disease for thus ah esd . tis to givé a fully Balanced dit, wi eka iaral ies can ta casey tea ae wherever ‘and therefore, The protein should be easily diges milk Tooatiens (elk with added mul powder and ‘Sometimes egg) are especially useful."Glucose or lactose may be added. to all possible foods and drinks, and used in preference to sugar’, Diet Therapy in Diseases of the Endocrine Glands & Metabolism 325 a Meta of the Endocrine Glands & Metabolism 325 Fat Fat is also not properly metabolised in diabetes mellitus, The availability of carbohydrates determines how much fat is broken “down. Fatty acids are converted to ketone bodies in the liver but the oxidation of ketone bodies is: ‘completed in other tissues of the body When carbohydrates is not available ketone bodies are _Produived in the liver much more quickly than they-can be oxidised in the other-tissues and therefore, they accumulate in the blood, causing ketoacidosis) This may lead to dehydration and coma. Protein Metabolism Since carbohydrates are not utilised for the production of energy, there is increased breakdown of tiss eins creased oxidation of dietary proteins for use as energy. Hence, there is an increase in nitrogen excretion leading to negative nitrogen balance, <€_ Protein metabolism is also increased to try to make up for the loss of carbohydrate, but during metabolism, about 58 per cent of the protein is converted to carbohydrate which cannot be adequately used. When tissue prot this way fora long time, the body wastes, and weight is lost. ‘Wasting of muscles is a common symptoms in chronic diabetes Hence, diabeti more proteins (about 2 gm/kg body weight) than normal sul eae allowances Souler dingly higher (50% higher) for diabetic children and expectant and nursing mothers. Increased protein intake may help to increase insulin production, Clinical Types of Diabetes The classification of diabetes from the clinical point of view is as follows: () Juvenile Diabetes and (ii) Adult Diabetes Juvenile Diabetes This include all diabeties below the age of 20 years. The disease is Primarily due to deficiency of insulin, The subjects are generally undernourished and emaciated. They require a high calorie-high rotein diet and insulin for maintaining the blood Sugar level within See326 Nursing Manual of Nutrition and Therapeutic Diet ‘Adult Diabetes Amajority of them are obese subjects; the treatment will a ducing dit, rich in protein anc carbohydestes slo ly to maintain the blood glucose within normal limits. These subjects require more insulin than juvenile diabetes. ‘Treatment of Diabetes Mellitus i) Moderate The principles of treatment areas follows: (i) Diet (i) epg fea eh pal aaah ts cg The treatment of diabetes depends upon the severity of the condition. Mild Diabetes Commonly occursin the middle or elderly obese persons, with only slight deficiency of insulin, and can often be controlled by restriction’ ofthe dit alone. In such cases, if the intake of food is the in may be sufficient t6 control the metabolism. ere is very little insulin secreted in the body. This is mmmonly among young people. It is impossible to betes by diet along, insulin given by infection Jycemic agents will be required. long disease which can be treated, but not cured. he patient in good health. The diet, ‘needs. Each individual patient must have a diet planned specifically for him. Mae ate anene hae een made forthe dietary teat inet of Diabetes Melis, Movin ofthe normal dt are ade on the following general principles: Fal ous as aud alee ao the patient to gain or lose weight as necessary until the desirable weight (or slightly below this level) has been reached. 2 The ied weigh sould dm be ketone iood sugar should be maintained at a normal 2: cee al ox oral iedicnus,Hypoglycoemia aust be usted according to the economic means of the patient and his normal food habits. Diet Therapy in Diseases of the Endocrine Glands & Metabolism 327 en SNNNN othe Endocrine Glands & Metabolism 327 Calories TI intake of calories is important for a diabetic patient. It is best to keep a diabetic on a well balanced diet providing the lowest umber of calories which will maintain his body weight at 8 per cent below his ideal body weight. The ideal body weight depends Pon age sex heightand body frame{Of the total calories required 20 to 25 per cent should be from Proteins, 40 per cent from carbohydrates and 40 per cent fromtfat) Pet Calorie Requirements The calorie requirements should be about 5 per ss than the Actual requirements for the patients height and ideal body weight {In the case of an obese person, the calorie requirements for weight (for his height) should be taken and’ per cent deducted from the ‘igure given in tables enclosed along with this chapter, In case of an underweight Diabet ‘ments for his ideal body weight (for his height) should be ai mined and 5 per cent deducted from his figure, The foll ‘examples will illustrate the procedure for calculating the calorie requirements, 1. Adult male (A)—Height 5'4”—Body weight 55 kgs—Age 50 years 2. Adult male (B)—Height 5’4”—Body weight 82 kgs—Age 50 years 3. Adult male (C)—Height 5'4”—Body weight 48 kgs—Age 50 years, The ideal body weight for a subject of 5'4” (small frame) 55 kg, The calorie requirements for a sedentary person of 55 kg is 2400 kcal. After deducting 5 per cent, the actual requirements of the diabetic subject ‘A’ will be 2280 kcal. In the case of subject “B’ and , the calorie requirements, will be the same as that of subject’ as they are of the same height and the ideal body for all the three should be 55 kg. Subject ’B’ who is obese to reduce his body weight to'55 kg and so the calorie intake bereduced further to 1600 keal calories. Since, subject ‘C’ to put on weight, he can be given daily 2400 to 2500 ke subject attains the ideal body weight.828 Nursing Manual of Nutrition and Therapeutic Diet The Proportion.of Protein, Fat and Carbohydrate in the Diet ‘The proportion of calories derived from carbohydrates, fats and proteins in the dis jepend on the type of diabetes as indicated. Carbohydrates ‘There is disturbance of carbohydrate metabolism in diabetes as hyperglycemia and glycosuria. ion of carbohydrate should not be advised as this fut the sugar tolerance. If adequate carbohydrates are given reduction in f ism and “Fonsequently tess Ketone bodies are ‘carbohydrate should ‘amount is Gecreased in an obese and Gas daily intake of carbohydrates shi per cen intake should not exceed 40 per cent of the as otherwise, Proteins Since diabetics, in general, are in negative nitrogen balance, they should receive about twice as much proteins as normal subjec (he proteins should provide 20 to 25 per cent of the calories in diet.) ‘One gram of protein per kg of body weightis adequate but more may be given and the amount of fats and carbohydrates proportionately reduced. ntake should be adjusted to provide about 40 per cent of calories in the form of fat: In the case of obese diabetics, it Diet Therapy in Diseases of the Eiidocrine Glands & Metabolism 32 may be desirable to limit the fat intake to provide about 20 per cent of the total calories, as the body fat will be mobilised and oxidised. ake of fats is usually used, but the poly- unsaturated fatty acid content may be adjusted so that 2/3 of the could be from the vegetable oils and % from animal fat. Vitamins It is desirable to include one multivitamin tablet in the diet to provide the daily requirements ofall es ilamins with special Distribution of the Diet ‘The amounts of food and the time at which they are given are very important. This is modified according to the need of the individual nts controlled by diet alone; the total calories are divided (0 three or four meals, In many patients the blood sugar is at a higher level in the morning; Therefore a smaller breakfast may have to be given. The spacing of the meals will also depend ‘Soluble (regular) insulin is largely limited to use during surgery or for patients who have infection or diabetic coma. Food should be given within half an hour after the dose of insulin has been given. Soluble insulin is quick acting, and the distribution of calories depends on the pattem of infections, e.g. equal, doses of soluble insulin given every six hours will require feeding containing equal amounts of calories (carbohydrate, protein and fat) every six hours. ‘The slow-acting insulins and oral hypoglycemia tablets are used more commonly. In these cases, a late evening drink of milk is essential in order to provide a slowly available form of carbo- hydrate. The calories are usually divided into 1/5,2/5 and 2/5 for Dreakfast, lunch and dinner after the calories from the bed time milk have been deducted from the total ‘tis a well established fact the diabetic patients who are regularly controlled by treatment with diet and medications have fewer complications than those who are not controlled in this way.380 Nursing Manual of Nutrition and Therapeutic Diet Food Exchange Lists ‘A moderately accurate method for prescribing the diet has been classifies and standardises the values of specific fakes planning of the diet more sample for patients «i toa low calories intake. food groups. The measurements are given in wherever possibly and in common household rasures such as cup of a size of fruit, As more of these common become popular and standard, these may be substituted ere are many exchangeable foods of about the same compo- ‘on within each group. However, foods from one group cannot be exchanged for foods from another group. These exchange groups help the provide a variety with in restrictions, sample calculati yw calorie diets are also given, listing the number of portions that can be used from each group for each meal. Education of Patients Every diabetic person should know how to manage his diet with monotomy, and to ny toweigh foods according to the doctors orders and show the patient how to measure si ‘with equipment which he has in his home. Patients will not realize the importance of amounts of -2 of foods unless the reason is carefully explained and emphasized. If he is able to give his own insulin ions, instructions regarding this and regarding the testing of .0 have to be given} He should be familiar with signs sroms of hypogiveaeniié attacks so that he can avoid ity and know what to do if he feels such an attack coming, Diabetic Children and Pregnant Women Diabetic children need considerable supervision as the diabetic condition is usually severe, but they will need normal protein and calorie requirements for growth of the body, and for varying activity Insulin requirements need frequent adjustments to keep pace with Diet Therapy in Diseases of the Endocrine Glands & Metabolism 331 the changing dietary intake with growth and development, and the varying energy output. Pregnant women also need to be careful, otherwise the large amounts of carbohydrate in the blood may cause the development ofan abnormally lange baby, making delivery difficult. Itis however, essential to provide adequate food for the maintenance of the mothers body and for the development of the foetus. HYPERINSULINISM In hyperinsulinism, the production of insulin in the is exceeds normal, and causes the storage of glucose as glycog: the expense of the blood sugar, which therefore tends to be low. is of litle value to give additional carbohydrate in the diet because it is quickly stored as glycogen and the patient becomes hypo- glycemic again. The retention of sugar in the body many also lead to obesity. The general plan of dietary treatment is as follows: a, Restrict the total calories to the individual's requirements, or a little less if he is obese. b. Restrict the carbohydrate and fat within the limit of the total calories value. ¢. Give a high protein a that the protein is conversion to carbohydi lod sugar level. For example Carbohydrate — 150 gm Protein — 130gm | Approximately Fat — 42gm | 1500calories with protein food every two hours so able throughout the day for slow for the maintenance of the normalDiet for Allergy pict for Fever ginfectious disaases , Food Allergy and Therapeutic Diet m roteins, through xr chemical compounds present in foods may also produce c reaction. : all parts of the body. The allergic jes, The skin and mucous ‘The signs and skin lesions such as urticaria, a, vomiting, diarthoea and colitis, ) Redness, swelling, burning in of the nasal mucous Skin Tests Water extracts of the suspected food is applied to the skin in the following ways: Food Allergy and Therapeutic Diet 237 —______ Feast arecpyiatia the In which two drops of the extract are dropped on on the back or arm of the patients. b. The patch test: In which the suspected food or its extract is puton a filter paper which is placed on the skin covered with cel and kept for 24 hours. Ifa red inflammation or Hive-like wheel appears at the site of the scratch or point of contact, the food ‘material may be suspected to contain the allergen, TREATMENT OF ALLERGY ‘The allergic manifestations are treated by drugs. Different types of diets are used in the treatment of allergy. (i) Synth ; (ii) Elimination dis ) Restricted diets. Desensi the subject to the allergic food may also be carried out. Drugs For the treatment of severe drugs such as cortisone or ant Synthetic Diet Patients who are allergic to common foods show improvement when they are fed on a synthetic diet. Such diets ate used in only severe cases. [The diets consists of emulsified fat and vitamin concentratés) As they have to be fed through nasogastric tube! should be put on diet consis Lfoods) Care should be taken to avoid the food /foods responsible for the allergic reaction, Elimination Diet Pie elimination diets suggeste w treatment of allergy. The drugs.(When the allergic reactions, are cured, he is placed on one of the diets given in the Tab! dd dictary history is not likely to cause allergic The di efouldbetonsud fr 23 aggre oe ea asa occurs soon alter constuming the di Ifthe patient does not develop any allergic reactions, then he can continue the diet. Otherwise, a238 Nursing Manual of Nutrition and Therapeutic Diet second in the table is used for 2-3 weeks (A period of 2-3 wks i essential to make sure whether any of the foods included in the diet caused allergic reactions in the subjecl) If the patient fe well to the second di try the remaining two diets the above manner. Ifthe p rates the foods included inl the four diets in the table all the foods listed in the four diets can be used. ‘Tabblo 13.1: Elimination diets (Rowe 1944) combinat soya, Lima bean and Comnarye muffing Ryebread Rye-Krisp the subject tolerates one of theel foods such as milk, wheat and meat should Food Allergy and Thorapeutio Dlat 289 cause allergic reaction in the patient can be found out and the same should be completely eliminated from the diet. Desensi The objective in desensitization is to develop tolerance to the allergen in the subject. For this purpose, the subject should be fed ona diet which he tolerates well. The offending food is administered in very small amounts. If he tolerates small amounts of the food, fo tolerate the given in increasing amounts gradually. In this way, ance to an allergic food can be cleveloped in the subject. If the subject does not tolerate even minute amounts of the food, may be difficult to develop resistance in the body to that particular food. Nutrtonal Problems in the Use of Restricted Diets {Han individual does not tolerate milk then milk substitutes based soybean should be induced in the diet\[If a patient does not consume larger amounts to milk and egg3 (The restricted diet should be supplemented with other protein-ri protec observed frequently among infants receiving, milk. Breast milk is hypoallergenic. A child born in a or both parents are allergic to some foods is likely the same foods. The foods allergic to eggs tomatoes, legumes, strawbarrigs, » fish, pork and corn, Wheat and corn may be ‘oats. Cow's milk should be replaced by fortified sich foods such as processed soyabean flour be used in place of eggs, and meat. The infantshould receive supplement of vitamins and essential minerals to meet the daily requirements of these nutrients.- hc Diets in Fever— Infectious Diseases and Constitutional Ailments ——————————————————————— FEVER a Faver is caused by infection ofthe body through microorganisms. ‘The elevation in body temperature is due to increase ie 5: r Pivjever may be classified broadly into two groups: @) Acute o Ids, influenza, chickenpox, selatively of short duration such as colds influenza, ch mean typhoid fever, etc. and (il) Chronic, such as tuberculos lasting for a long time. Metabolism in Fevers s are: () Incr sal ‘The important metabolic changes in fevers are: (i) Increased bas Fahrenheit rise in body ic rate (7%) for every degree—Fahrenheit ris Rana Increased catabolism of tissu f i spiration loss as a rased loss of water due to increased perspirat oF nah body Temperature, ¥) Increased loss of sedi nd potassium salts, (v) Loss of appetite, nausea an ig and (vi) Decreased liver glycogen stores. Treatment The ‘Treatment consist Drugs for controlling, Diet to meet i Diets in Fover—intectious Diseases and Gonst. Almonte 241 ere infectious Diseas0s and Const. Aments 241 Requirements {onal requirements will depend on the nature, severity ion of the fever and the duration of the convalescent Period. These are briefly discussed below: ‘The calorie requirements may be increas 50 percent ‘over thebasal metabolism depend nperature. It ‘may be difficult to meet the calorie needs during the peak of the fever but a high calorie diet instituted as soon as the fever th frequent feeding should be trolled, Proteins Since there is increased loss of tissue proteins during fever, the intak: of proteins should be about 50 percent in excess of the ‘etoments. fe protein should be of high nuevas i easily digestible such as milk and egg protein beverages are preferable to solid foods} Carbohydrates ‘Whe carbohyctrate should consists ofa mixture of glucose sucrose and starch) Glucose has the advantage over sucrose as itis lees Sweet and hence more of it can consumed, further to the body. Starch is present in cereals and cereal flours can be Cooked into pudding along with milk, eggs and sugar and given to the patients, Fats as butter, ghee and vegetable oils does not be as soon as the fever is controlled as these are twice as rich as carbohydrates in calories and hence help to reduce the bulk of the food Vitamins The vitamin requirements are increased due to increased calorie requirements and increased loss from the catabolism of tissues, The vitamin requirements can be met by the intake of one m mineral tablet containing all the essential vitamins and242° Nursing Manual of Nutrition and Therapeutic Diet Minerals {he calcium and phosphorous requitements will be met by taking. ‘one litre of milk daily! The mu during winter and more water during summer. Ease of Digestion ‘The foods given should be readily digestible. A fh Interval of Feeding small quantities (6 ounces) of fluid diet viz., milk with \cose should be given once in 3 hours. Fruit juice with glucose should also be given 2-3 times daily. When the fever comes down, bread with butier and milk pudding should be fed along with milk 4 times a day, ie., once in 4 hours, Fruit juices with glucose can be given in between two meals. ‘Model diets for acute fever and during convalescence are given in Tables 14.1 to 14.6. fo an adult suing trom fever (gmcaputiey) (uring peak of ever) (Celories 2700 Kcal; Proteins 95 gm Carbohydrates 600 gm) Quantiy 3000 1000 200 100 Diets in Fever—intectious Diseases and Const. Ailments 243 Table 14.2: Daly menu for an alt sulle 5.00 am fy wale, glucose an den 2eupe 8.00 an 7 ce wth sugar and glucose 1 ge 2eups “pls 2.00pm f with glucose and sugar 1 las 6.00 pm ley wate aces and denttmalose ape Milk with bac ith barley — Mi 2eups 00 Dextrimaltose 100 ‘ ‘Multivitamin mineral tablet One DIET TYPHOID FEVER Modern antibiotic therapy has greatly sh cl ly shortened the acute stage of fies Nevertheless, the patient should receive pene ion during fever and later during convalescence {Dur there sinoreased breakdown oftissue prot. ee store is rapidly depleted and water balances upset) The int store is rapi testinal tract becomes highly inflammed in typhoid fever and loose motions will be a frequent complication. [Because of the intestinal inflam. mation, too much protein should not be given af the peak of the fever. Allbulk foods should be completely avoided! els give244 Nursing Manual of Nutrition and Therapeutic Diet i244 ‘Nureing Marea of Nuxiion end: Tnempees Ot “Table'44: Dally menu for adults during ator part of fever ie Vegetarian ‘Now vegetarian Loup 2slices serving Leup serving 1 glass Bruit juie 1 glass 1 glass Biscuits 2 Milk 38 i - 50 Ment os * » Green ey vegoablen 2 = 100 100 20 20 % stable ot ” and vegetable » > in Table below will be suitable for patients suffering from typhoid fever at different stages of recovery. diet Therapy S i compensate for the increase in mete ic os fi be given su ring 40-50 cal rate, a high cal fe protein should be high, aiming at 100 gm per 4 ae digested and efficiently used protein food ‘The most Diets in Fover—infectious Diseases and Const. Ailments: 245 Diet in Fover— infectious Diseases and Const. Aiments 245 ‘Tablo 14.6: Daly menu for en aclult during convalescence Vegetarian Non-2egetarian with sugar—1 cup Bread—2 slices asa (on Uppuma—t plate Egg, boiled—one Butter—2 teaspoons Jam—2 teaspoons Mill cup Nuts—2 tablespoons (eo) of Uppuma—t plate Cheese—t slice Dutter—2 teaspoons Jom~2 rice or chappati—1 serving Vegetable curry serving, Dal Cooked rice or chappati—L serving Matton or fish curry—1 serving Vegetable curry—1 serving Dal soup—1 cup Mill pudding 1 serving Milk p ruits—1 serving -nilk and eggs, should be used liberally? iet should be free from roughage because of the intestinal inflammation. ‘The very high calorie diet may nat be tolerated well at first. Thus, it may be necessary to begin with 2,000 calories and increase gradually to 3,000 calories or more. A sample meal pattern for a high protein, high calorie, low fibre semi-solid diet is given below, High protein, high calorie, low fibre diet protein—B0 gm calories—2000 Typhoid diet 600.am 8.00 am Dreakfast 9 strained porridge with milk and sugae oka egg clfee or ir Mid-moming 10.00am — Eg flip Lunch = Wallcooked very sat ice or Porridge Curis Conta