BACHELOR OF SCIENCE IN NURSING:

NUTRITION AND DIET THERAPY

COURSE MODULE COURSE UNIT WEEK
2 9 10

Nutrition Education and Counseling

Read course and unit objectives

Read study guide prior to class attendance
Read required learning resources; refer to unit
terminologies for jargons
Proactively participate in classroom discussions
Participate in weekly discussion board (Canvas)
Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive
1. Describe the need for and the factors to consider in planning for a therapeutic diet.
2. Differentiate the types of dietary modification.
A. General Diets
B. Diets modified in consistency
C. Diets modified in composition
D. Liquid Diets
E. Soft Diets
F. Test Meals
 2.1. Good Tray Service
3. Determine the appropriate therapeutic diet specific to a patient’s health condition.
A. Obesity and Weight Control
B. Diabetes Mellitus
C. Diseases of the Gastrointestinal Tract
D. Diseases of the Lliver, Gallbladder, and Pancreas
E. Cardiovascular Diseases
F.Diseases of the Kidneys
G. Cancers
H. Immune Deficiency Syndrome

4. Deduce the role of the nurse in nutritional care.

5. Discuss the patient’s (individual and/or the family) need for nutrition education.
6. Describe the nutrition education process.
7.Utilize selected behavioral theories as guide in the teaching-learning process.
A. Health Belief Model
B. Self- Efficacy Theory
C. Stages of Change Model
D. Theory of Reasoned Action and Theory of Planned Behavior
E. Therapeutic Alliance Model
8. Determine the patient’s (individual and family) need for nutritional counseling.
10. Refer patients (individual and/or the family) to the appropriate agency for their needs related to
nutrition as needed.

Affective
1.Express the necessity of the nurse to conscientiously monitor patients’ progress.
2. Demonstrate diligence in preparing and presenting nutrition education and
nutritional counseling.
3. Display warmth to patients during the nurse-patient interaction.
4.Utilize the therapeutictechniques in communication during the nurse-patient interaction.
5. Follow standards in documenting and reporting nutrition care process/nutritional
Counseling implemented.

Psychomotor
1. Draft a teaching plan for the nutritional education of a given patient, using the following:
A. Goal
B. Objectives
C. Content
D. Methodology
E. Resources needed
F. Indicators
 2. Plan a Counseling Session for a patient with specific nutritional need.

I.Modified Diets
Illness affects numerous bodily processes, including how one nutrients are being processed;
A sick person’s usual interest in food may change and the disease process may put limitations
to his/her food choices and thus, food acceptance. Patients are affected by the dynamics of
Illness and food acceptance - thus the need to modify the diet. Nutrients are required to
control illness and sustain life. The nurse will play specific roles in the patient’s and/or the
family’s nutritional care.
Diet Therapy may be a specific treatment of a disease or a supplement of other modes of
treatment that a patient may go through. Included in its purposes are maintenance of normal
nutrition; correction of nutritional deficiency, changes in body weight and adjusting the body’s
ability to use one or more nutrients.
Normal Diet (also known as regular, general or house diet) is the foundation on which
therapeutic diet modifications are based. Regardless of the type of diet prescribed, the
purpose of the diet is to supply needed nutrients to the body in a form it can handle.
Modification of this diet include:
a. consistency and texture
b. flavor
c. energy value
d. nutrient level
e. food category
Standard hospital diets are:
A. Liquid diets
a. Clear Liquid Diet : indicated for patients experiencing acute vomiting, diarrhea or
surgery; the diet is used for 24-48 hours; it allows tea, coffee or coffee substitute
and fat-free broth.
b. Full Liquid Diet: used for acute infections and fever of short duration; patients who’
 are too ill to chew. It consists of liquids and foods that liquefy at body temperature,
generally offered in 6 feedings or more.

B. Soft diets
These diet is often used immediately between full fluid diet and the regular diet
following surgery, acute infections and fevers, and in GI disturbances. It has
reduced fiber content, bland flavor and soft consistency.

Modifications are done by having the meat and poultry being minced or ground;
Vegetables are diced, chopped or cooked longer than usual; the use of soft raw
fruits and the use of soft rolls, breads or biscuits.

C. Test Meals : used for specific diagnostic tests such as

a. Fecal Fat Determination – to measure fat globules to detect fat absorption.
b. Meat-free Test – to determine GIT bleeding .
c. Calcium Test – to determine urinary calcium excretion.
d. Serotonin Test – to detect calcinoid tumors of the intestinal tract.

I.2.Good Tray Service

Tray service is a style of service that makes use of a tray and does not make use of the
usual dining table; dishes and utensils are arranged in a tray and brought to the patient in
his/her room.Essentials of good tray service are as follows:
1. Sufficient size of the tray for un crowded arrangement.
2. Clean, unwrinkled tray cover and napkin or good quality paper.
3. Attractive pattern of spotless chinaware without chips or cracks; clean
glassware and shining silverware.
4. An orderly arrangement of all items on the tray.
5. Food portions are suitable for the patient’s appetite.
6. Foods are attractively arranged with the appropriate garnishing.
7. Meals are served on time; Hot foods served warm and cold foods served
chilled.
8. Trays are served promptly to the patient.
II. Therapeutic Diets
A.Nutrition Therapy for Obesity and Weight Control

Obesity is said to be a state of adiposity in which body fat is above the ideal weight.
Assessment will show a body mass index of 30 – 39.9.Whereas, being overweight is
having a body mass index of 25 – 29.9 or greater. Often this results from an imbalance of
the complex system of neural, hormonal and chemical mechanisms that keeps the
balance between energy intake and energy expenditure. There are reasons why an
individual may have an excessive intake of calorie; but obesity can be prevented and the
intention to lose weight is planned. A Low calorie Diet and exercise may help in weight
control.

B.Nutrition Therapy for Diabetes Mellitus

Diabetes Mellitus is a condition that results from the lack of insulin produced by the
Body. This metabolic problem affects the use of carbohydrates and fats by the body.
Hyperglycemia or hypoglycemia often occur. These signs along with the excess in
weight can be prevented by controlling the amount of food and their distribution in
meals in a day to day basis.

Patients may initially be placed on a low calorie diet; those with normal weight are given
sufficient calories to maintain their weight. Protein of about 11/2 per kg body weight
may be allowed ; the same may be given to the amount of fat allowed. The amount of
carbohydrate is roughly twice the number of protein. Menu Plan follows the
recommended Food Exchange List.

C.Nutrition Therapy for Diseases of the Gastrointestinal Tract

Dietary modifications in disorders of the intestinal tract are designed to alleviate

symptoms , correct nutrient deficiencies, and where possible, address the primary
cause of the difficulty. The nature of the modification will depend on the medical
condition that the patient has.

Bland diet may be prescribed to manage Peptic ulcer. This diet must meet nutritive
adequacy, bland flavor and soft consistency, and mechanically and chemically
non-stimulating. Long term use is not recommended as this may lead to the patient
becoming malnourished.

Management of Diverticular diseases may include the increase of fiber in the diet, with
Bran, whole grains and cellulose foods to reduce muscle contractions and facilitate
normal muscle tone. Celiac sprue and Non-tropical sprue will show intolerance for gluten;
thus food sources containing gluten are removed from the diet. A high-protein diet is
usually necessary, along with supplements of minerals and vitamins.
 A diagnosis of Ulcerative colitis – where there is an inflammation of the colon and the
rectum - implies a diet with high calorie, high protein, high vitamins and mineral. In its
acute stages, the patient is placed on a Low-residue diet , avoiding heavy roughage to
prevent irritation. Lactose intolerance is a condition brought about by a deficiency in
the enzyme lactase; the lactose (sugar in milk) then, cannot be hydrolyzed. A lactose-
restricted diet is prescribed. Milk, milk-products, foods containing whey and casein are
avoided.

Patients suffering from diarrhea may initially be placed on NPO for 12 hours with
IVT support; as the condition improves, Oral fluids may be given liberally to prevent
Dehydration. Broths and rehydration solutions are given to replace the electrolytes
lost as well as foods rich in pectin.

Constipation is also a problem that is commonly experienced. It may have a variety of

Causes but the management often includes high –fiber diet and liberal fluid intake.
Intestinal gas is controlled by excluding gas-producing foods; the patient is advised to
take small frequent meals and to chew food thoroughly. Hemorrhoids are managed with
intake of high –fiber diet, liberal fluids and avoidance of highly-seasoned foods and
relishes.

Gastroesophageal reflux disease, hiatal hernia and esophagitis is a condition that

takes place 1 to 4 hours after a meal when a decrease in sphincter pressure happens.
Maintaining the ideal body weight is recommended; Dietary management includes
avoiding foods high in fat and eating of large meals. Protein and carbohydrate foods
with low-fat content are preferred as these do not affect the lower esophageal sphincter
pressure.

D. Nutrition Therapy Diseases of the Lliver, Gallbladder, and Pancreas

Hepatitis is the inflammation of the liver. Diet Therapy includes protein coming from
animal sources as these are considered to have a superior quality. Additional serving
of foods rich in protein is recommended – like an additional milk, an extra egg, as well
as meat, fish and cheese. Caloric intake must also be adjusted to meet the body’s
energy needs. Patients with fever may have 2,500 to 4,000 calories per day. Fat
should be taken in moderation. The foods added to the diet are sufficient to meet the
daily requirements for minerals and vitamins.

Protein is often depleted in patients with cirrhosis. Often a 100 g protein is given, with
Sodium restriction to 250 mg a day; and a 1,800 calorie diet is recommended. Fat
restriction is not necessary. Patients with hepatic coma are prescribed with a high
calorie diet.

Cholecystitis may be managed with a low-fat diet, to avoid stimulating the gallbladder.
Spices and high-residue foods are avoided as these can cause distention and
increase in peristalsis. Selection of food items must be carefully done as these may
 either be restricted or limited. There also items to be excluded from food preparation
such as the use of butter, margarine and sauces as vegetable dressing; instead,
lemon juice vinegar or low-calorie, fat-free dressings are used.

Patients with pancreatitis are placed on low-fat, low-elemental formulas when enteral
feeding is appropriate. During acute attacks, the patient may be placed on NPO for 48
hours. In chronic cases, the diet is high calorie, moderate protein and low to moderate
fat. On the other hand, patients with cystic fibrosis are given high-protein diet to
compensate for fecal losses, with liberal fat intake. Calories are often according to the
need for growth.

E. Nutrition Therapy for Cardiovascular Diseases

Atherosclerosis is caused by the accumulation of fatty materials including a high

proportion of cholesterol and other substances in the blood vessel, causing it to
narrow. Thus Dietary management is low-fat, low in saturated fat and cholesterol (300
mg/day). Increase in monounsaturated fatty acid, polyunsaturated fats, omega-6 and
omega-3 fatty acids – with at least 2 servings per week are recommended to decrease
plasma cholesterol levels. Simple sugars are restricted. Complex carbohydrates and
dietary fiber are increased to 25-30 g/day and restriction of carbohydrates are also
done.

Congestive heart failure is managed by restricting sodium in the diet. Depending on

the severity of the condition, sodium restriction may range from mild (2-3 g) to severe
(250 mg) restriction. Low-fat diet with emphasis on unsaturated oils is recommended.
Diet for patients with Myocardial infarction (MI) are designed to help reduce the work
load of the heart. Small frequent meals are done; Liquid diet is used on the initial
stages gradually progressing as the condition of the patient improves. Among the
food items restricted are caffeine-containing beverages, sodium, cholesterol, fat and
calorie. Consumption of omga-3 fatty acid-rich foods may be done to reduce blood
clots.

F. Nutrition Therapy for Diseases of the Kidneys

Acute glomerulonephritis is a condition consequent to an antigen-antibody complex

in which some of the complexes become ensnared in the glomeruli leading it to swell.
Emphasis of nutritional care is the overall nutritional needs of the patient rather than the
Restriction in protein; restriction in sodium is done only when edema is present. High
Calorie from carbohydrates is recommended.

Malnutrition may result from Nephrotic syndrome, as lesions in the nephrons can effect
massive albuminuria and protein losses. Thus, recommended is a diet high calorie, and
high protein, low sodium.
 In contrast, Acute renal failure patients are given high calorie, low to moderate protein
and moderate fat diet. Adequate caloric intake prevents tissue break down; Potassium
and sodium are controlled according to the patient’s capacity to excrete them. Water
intake is also restricted to a liter a day and is carefully monitored.

Renal calculi requires a large intake of fluids to dilute the urine and prevent
concentration of stones. The type of stone present influence the nature of the diet.
Such that:
a. Calcium oxalate stones – low calcium, low phosphate or oxalate –according to the
Calcium compound, acid ash. Calcium-rich foods are
Eliminated; alkaline foods are controlled; potassium-rich
Foods are increased.
b. Uric acid stones – low purine; limited protein with emphasis of milk, fruits and
Decreased intake of bread products.
c. Cystine stones – High fluid intake, controlled intake of meat, milk, egg and cheese.

G. Nutrition Therapy for Cancers

Cancer is a group of many dissimilar diseases categorized by unfettered replication of

Cells. The clinical status of the patient also warrants the appropriate route of feeding.
Oral nutrition is high calorie, high protein. Tube feedings may range from complete
products – meal replacements that require digestion and absorption; chemically-
defined products – minimal or no digestion – or Specialty products – which may vary
in terms of amino acid, carbohydrate or fat content. Total parenteral nutrition may also
be done when the digestive tract is not functioning well.

H. Nutrition Therapy for Human Immune Deficiency Syndrome (HIV/AIDS)

HIV/AIDS is an infection that is transmitted via sexual contact, transfusion of

contaminated blood, sharing of contaminated needles and mother to child during
pregnancy, childbirth or breast feeding. Nutritional management for patients with
HIV/AIDS include Energy of 35 – 45 kcal/kg BW; Protein 2 – 2.5 g/kg BW ; Fats –
increase in omega-3 sources and decrease in saturated fats in the diet; Vitamins and
minerals - an increase to be recommended in case of altered metabolism.

III. Nutrition Education and Counseling: Behavioral Change

Patient education is a process of assisting people to learn health-related behaviors that

can be used in their everyday life and achieve optimal health. It aims to increase the
competence and confidence of clients for self-management; increasing the
responsibility and independence of clients for self-care. A partnership approach can
provide clients with opportunities to explore and expand their self-care abilities as they
transition from being passive to active participants of their care.
 Behavioral Models that the nurse may use as guide include the following:
1. Health Belief Model : it explains and predicts health behaviors based on the
Patient’s beliefs about the health problem and the health behavior. Its
subcomponents include the individual’s perceptions, modifying factors and the
likelihood of action.
2. Self-efficacy theory : this theory is based on a person’s expectations relative to a
specific course of action. It deals with the belief that one is competent and capable
of accomplishing a specific behavior. The behavior-specific predictions of this theory
can be used for understanding the likelihood of individuals participating in existing
or a planned educational program.

3. Stages of Change Model: This theory is useful in staging the client’s intentions and
behaviors for change as well as to determine the strategies that will enable
completion of a specific stage. The six stages that the authors used begins with
1.)Precontemplation 2.)Contemplation 3.)Preparation 4.)Action 5.) Maintenance
6.)Termination. Among its current applications are in health promotion and the
processes by which people decide to change.

4.Theory of Reasoned Action and Theory of Planned Behavior: the premise of this
theory is that humans behave in a rational way that is consistent with their beliefs;
suggesting that a person’s behavior can be predicted by examining the individual’s
attitudes about the behavior as well as the individual’s beliefs about how others
might respond to the behavior. In designing the educational program for patients,
nurses as educators need to take beliefs, attitudinal factors and subjective norms into
consideration.

5.Therapeutic Alliance Model: Fundamental to this model is the shift toward self-
determination and control over one’s own life. This model views the client as active and
responsible, with an outcome expectation of self-care. The therapeutic alliance is formed
when the nurse and patient views each other as having equal power. The therapeutic is
significant as it relates to the patient’s adherence to therapeutic interventions and
achievement of set goals.

Counseling for change: When a person makes a lifestyle change, he or she is giving
up something; adapting new behaviors entails “costs” and “benefits”. In communities
where individual health care providers and mass media promote healthy habits, there
may be more motivation for people to make changes. By using motivational interviewing
techniques, the counselor can help the patient move through the stages of change. The
goal is to increase the client’s intrinsic motivation so that he or she can express the
rationale for the changes. Persuasion and support are key elements in counseling.

Community Resources: Basic in communities are the availability of wellness centers

where patients may be referred to for assistance. The Barangay Nutrition Scholar is
tasked to do preliminary assessment , monitoring and ensuring availability of food
supplements for children who may be suffering from Vit A Deficiency, Iron Deficiency
Anemia, malnutrition or Iodine deficiency. Available from the Web are various literatures
 and sites that may be used for specific nutritional needs and support groups, such as
Overeaters Anonymous, glutenfreediet.com and thelike.

Modified Diet refers to changes in texture and composition being made from a regular diet
(normal diet) to meet a patient’s nutritional need.

Therapeutic Diets is a form of a diet prescribed , specifying the type, amount and frequency
of feeding based on the patient’s disease process and management goals. It specifies the
caloric level, restrictions or increase in various components of the diet such as the
carbohydrate, protein, fat, specific vitamins, minerals, fiber or water.

Pelletier, D., Porter,C. et al. Expanding the Frontiers of Nutrition Research: New Questions,
New Methods, and New Approaches.January 2013.Advances in Nutrition 4(1):92-114

Prepare a one-hour teaching plan or a counseling session as needed for these patients:

Patient 1: Pam Age: 40 y/o/Single Ht: 5 ft 4 in. Wt: 80kg (lowest weight she had was 55kg
about 3 years ago) BP: 160/90 claims to take some antihypertensive meds; none of
which she can remember. She has followed strict diets and has never exercised in her
previous weight-loss attempts. Her favorite foods include fried foods, fruits, kakanins
and soda – which helps digest her food faster. Her hectic schedule often mean eating
out or buying to go from a convenience store near where she lives.

Patient 2: Rene Age: 26y/o/Male Ht:5 ft 9 inches Wt: 70 Kg He claims to have problems
maintaining his weight; he cycles for an hour, three times a week and goes to the Gymn
twice a week. He works as a hair stylist and is on his feet most of the day. Busy days will
mean skipping lunch. On weekends, he works late and when he gets home, he would be
 too tired to prepare his dinner. To date, he is not aware of any medical problems present.

Caudal, Maria Lourdes C. (2019). Basic nutrition and diet therapy : textbook for nursing
students 2nd Edition. QC: C&E. F 613.2 C31 2019
Caudal, Maria Lourdes C. (2019). Basic nutrition and diet therapy : laboratory manual for
nursing students. QC: C&E. F 613.2078 C31 2019
Bastable, S. (2019) Nurse as Educator: principles of teaching and learning for nursing
practice. 5th Ed.