Diet Therapy العلاج بالتغذيه

احضرت هذة المحاضرة لكم وللجميع من جانب الافادة ونؤكد بأنها ليست المحاضرة الرسمية الاساسية للكلية ولكنها من جانب المعرفة على الرغم انه لايوجد اختلاف كبير .


5-1. INTRODUCTION

Food is essential to life. To sustain life, the nutrients in food must perform three functions within the body: build tissue, regulate metabolic processes, and provide a source of energy. A proper diet is essential to good health. A well-nourished person is more likely to be well developed, mentally and physically alert, and better able to resist infectious diseases than one who is not well nourished. Proper diet creates a healthier person and extends the years of normal bodily functions. Diet therapy is the application of nutritional science to promote human health and treat disease.

5-2. FACTORS WHICH INFLUENCE EATING PATTERNS

We all eat certain foods for reasons other than good nutrition and health. Our eating patterns develop as part of our cultural and social traditions and are influenced by our life style and life situation. It is important for the nurse to understand factors, which influence food choice and eating patterns.

a. Social Aspects. Most people prefer to eat with someone, and the patient is probably used to eating meals with his family. In the hospital he is served his food on a tray and left alone. Poor nutrition may be the result.

b. Emotional Aspects. The patient may feel guilty for not eating all the food served, or may overeat just because the food is there. The patient may overeat because he or she feels sad, lonely, or depressed or may refuse to eat for the same reasons. Certain foods may be considered "for babies." Some foods may be used as rewards."

c. Food Fads and Fallacies. These are scientifically unsubstantiated, misleading notions or beliefs about certain foods that may persist for a time in a given community or society. Many people follow fad diets or the practice of eating only certain foods. Food fads fall into four basic groups: Food cures, harmful foods, food combinations that restore health or reduce weight, and natural foods that meet body needs and prevent disease.

d. Financial Considerations. The patient's financial status has a great bearing on eating patterns. Most people in the United States can afford a diet, which includes a variety of foods and a sufficient number of calories. However, many Americans consume an excessive amount of fat and sodium. Excess fat consumption has been shown to be related to the development of heart disease. Excess sodium consumption may be a problem for some patients with hypertension. Many Americans with lower incomes consume a great percentage of their calories in the form of fat, since fat is the least expensive nutrient (when compared to carbohydrate and protein) and provides for greater satiety (feeling of "fullness" after eating) than both carbohydrate and protein."

e. Physical Condition. The patient may not feel well enough or strong enough to eat. Encourage the patient to eat without forcing him to do so. Encourage him to feed himself, so that he will not feel helpless.

f. Cultural Heritage. Food preferences are closely tied to culture and religion. Understanding these preferences will enable you to assist the patient in reaching and maintaining good nutritional health.

(1) African-Americans. Food habits may be based on West Indian, African, or regional American influences. The majority of African-Americans are lactose intolerant and avoid milk but can tolerate cheese, yogurt, and ice cream. African-Americans who have been in the US for many generations have similar eating patterns to other Americans. Their diets are rich in fat, salt, sugar, and starches. Those who have recently immigrated to the US eat the staple rice and bean combination, yams, and tropical fruits.

(2) Hispanic-Americans. The Hispanic population is thought to be 60 percent Mexican, 18 percent Central and South American, 15 percent Puerto Rican, and 7 percent Cuban. They are a varied group having different food habits.

(a) Mexican-Americans eat tortillas, rice and beans with most meals. Meats are heavily spiced, and often chopped or ground. Adults use limited amounts of milk and milk products, but enjoy sweet baked desserts, sweetened beverages such as hot chocolate and carbonated drinks.

(b) Puerto Ricans tend to adopt American food habits. Traditional meals include white rice cooked with lard and served with beans. Some practice the "hot-cold" theory in the treatment of illness with food.

(c) Cuban-Americans use rice and beans extensively and meat is served if income is sufficient. Children drink milk but adults use milk only in coffee.

(3) Chinese-Americans. A common dietary principle is "Fan-tsai." Fan is the grain and tsai are the vegetables or other items served at the meal. Chinese-Americans obtain 80 percent of their calories from grains and 20 percent from vegetables, fruits, animal protein, and fats. Most adults dislike milk and cheese. Lactose intolerance is common.

(4) Japanese-American. Most Japanese-American's eating habits are Westernized. Traditional meals are light and little animal fat is used. The major starch used is rice. Meals contain fish, soup, fresh or pickled vegetables, and tea.

(5) Indian-Americans. Eating patterns vary, depending upon the religion, and the province and climate from which the Indian-American came. If from northern India, wheat is the primary grain used and meat dishes are popular. If from southern India, rice is the primary grain used, the food is highly spiced, and the person will usually be a vegetarian because of Hindu beliefs. Sweets are very sweet and eaten often. Most Indian-American's eat only two meals daily. Only the right hand is used for eating. Women eat only after men and children have eaten, even if they are ill. Traditional fads and fallacies result in a high rate of stillbirths, low birth weight infants, and a high maternal death rates.

(6) Native-Americans. Because about 200 different tribes of Native Americans exist in the United States, each with its own language, folkways, religion, mores, and patterns of interpersonal relationships, caution needs to be taken in generalizing about Native American culture and food preferences. Various tribal groups differ in their traditional values and beliefs. Each tribe assigns symbolic meanings to foods or other substances. At least one-third of the Native American population is poverty-stricken. Associated with this income level are poor living conditions and malnutrition.

5-3. RELIGION

Cultural and religious practices are often intertwined. Many people refrain from eating certain foods, or eat specific foods in certain combinations, because of their religious beliefs. There are some major religious customs related to diet that, as a nurse, you must be aware of.

a. Hindu. Most Hindus are lacto-ovo vegetarians. They do not use stimulants such as alcohol or coffee.

b. Moslem (Islam). Meat and poultry must be slaughtered according to strict rules. Moslems do not eat pork or pork products. They do not drink alcoholic beverages. They do drink tea. Moslems fast for one month each year, avoiding food from dawn until after dark.

c. Jewish (Orthodox). Orthodox Jews do not eat pork, shellfish, or scavenger fish. They do eat beef, veal, lamb, mutton, goat, venison, chicken, turkey, goose, and pheasant. Meat must be slaughtered by a ritual method. Meat and milk may not be served at the same meal. Meat and dairy foods must be prepared in separate containers and with separate utensils. Certain days of fasting are observed, but a rabbi may excuse an elderly or ill patient.

d. Mormon. Mormons do not drink alcohol, coffee, tea, or caffeine containing carbonated beverages. They do not use extremely hot or cold foods (no ice in beverages).

e. Roman Catholic. Catholics may voluntarily abstain from eating meat on Fridays and during Lent. They do not eat or drink (except water) before taking Holy Communion. They fast on Good Friday and Ash Wednesday, but a priest may excuse the elderly or an ill patient.

f. Seventh Day Adventists. Seventh Day Adventists do not drink alcohol, coffee, or tea. They are usually lacto-ovo vegetarians.


5-4. THE VEGETARIAN

a. Because of the dangers of too much animal protein resulting in health problems or for ecological reasons, many people have chosen to be vegetarians. They do not eat any type of meat. Some vegetarian diets are stricter than others.

(1) Lacto vegetarians eat plant foods and dairy products. They do not eat eggs.

(2) Ovo vegetarians eat plant foods and eggs. They do not eat dairy products.

(3) Lacto-ovo vegetarians eat plant foods, dairy products, and eggs.

(4) Fruitarians consume a diet that consists chiefly of fruits, nuts, olive oil, and honey. They do not eat any animal products.

(5) Vegans eat only plant foods.

b. The greatest concern in the vegetarian diet is attaining adequate amounts of complete protein. This is easy in the lacto-ovo vegetarian diet, but difficult for the vegan. The most efficient protein available is that found in dairy products, eggs, and fish. Among the sources of protein that can be used most efficiently by the body, meat actually ranks third. The second best supply of efficient protein is legumes, soybeans, nuts, and brown rice.

c. Complete proteins are needed to sustain life and to promote growth. Incomplete protein sources can be combined to become a complete protein.

(1) Grain may be combined with brewer's yeast, with milk and cheese, with nuts and milk or legumes. Examples are cereal and milk, a peanut butter sandwich and milk or yogurt, a cheese sandwich; rice cooked in milk, and baked beans with nut bread.

(2) Grain with dried beans or wheat germ and nuts, grain with egg, and grain with cheese. Examples are a poached egg on toast, macaroni and cheese, and a tortilla with cheese.

(3) Beans, legumes (peas, lentils), rice or soybeans (tofu) with milk, nuts, or eggs.

d. Vegans should eat at least two of the following at the same meal in order to provide all essential amino acids:

(1) Grains or nuts and seeds.

(2) Dried beans or tofu.

(3) Wheat germ.

e. Whole-wheat grains and cereals are preferred in vegetarian diets. Other foods must be added to the protein sources to supply vitamins and minerals. Vegetarian diets are often deficient in calcium, iron, zinc, vitamin D, iodine, and riboflavin. Vitamin B12 is probably missing entirely. Supplements of these substances often need to be taken.


5-5. FACTORS WHICH ALTER A HOSPITALIZED PATIENT'S EATING PATTERNS

The meals served in a hospital cannot accommodate all social and cultural variations in food habits. However, meals can be individualized to assure that patients are provided with foods that are acceptable to them, but still within the restrictions of their diet. A meal, no matter how carefully planned, serves its purpose only if it is eaten. Many factors alter a patient's eating patterns during hospitalization.

a. The forced menu of available foods.

b. Isolation from family and significant others.

c. Restriction in activity.

d. A forced eating schedule.

5-6. FACTORS IN ILLNESS WHICH MAY ALTER FOOD INTAKE

Nutrition plays an important part in a patient's overall condition. A person who is ill may need help in meeting his basic needs for adequate nutrition. Certain factors in illness may alter food intake.

a. The disease processes. The patient's ability to ingest food is dependent upon the condition of his mouth and oral structures, and his ability to swallow. Impairment of any of these components will interfere with eating.

b. Drug therapy, which may alter the patient's appetite.

c. Anxiety about his illness.

d. Loneliness.

e. Diet restrictions. In many disease conditions, a special diet is an important part of therapy. In addition to educating the patient about the diet, you should help him to adapt to the diet and enjoy the food that he can have.

f. Changes in usual activity level. Exercise has been reported to increase, decrease, or have no effect on food intake. Although food intake is decreased immediately after exercise, habitual moderate exercise over a long period of time promotes increased food intake.

5-7. REASONS FOR HOSPITALIZED PATIENTS BEING AT RISK OF MALNUTRITION

a. The effect of the disease on metabolism. Most illnesses and diseases increase the need for nutrients. For example, one of the first symptoms of an infectious disease is loss of appetite and decreased tolerances for food. But, the infection and possible fever increase the metabolic rate and the actual nutrient requirements.

b. The disease may cause problems with absorption. An abnormality in either secretion or motility affects not only digestion but also optimal absorption. Motility is the movement of food through the digestive tract.

(1) Alterations in motility in the esophagus or stomach may result in symptoms of indigestion and vomiting. Increased motility of the gastric contents through the small and large intestines results in decreased absorption and diarrhea.

(2) Conditions that increase motility of the small intestine primarily affect absorption.

c. The anxiety and stress of being ill may reduce the patient's appetite.

d. The treatment may cause problems with intake, digestion, or absorption. The decreased desire to eat may be caused by impaired ability to taste food because of medication, bloating resulting from decreased peristalsis in the gastrointestinal tract following surgery, or nausea resulting from chemotherapy. Withholding food for various tests and procedures, or restricting the patient's intake may affect his appetite.

5.8. NURSING INTERVENTIONS WHICH HELP THE PATIENT MEET NUTRITIONAL NEEDS

Mealtime is an important event in the patient's long day and the patient's diet is an integral part of the total treatment plan. Certain nursing interventions may help the patient meet his or her nutritional needs.

a. Consider the patient's food preferences as much as possible. Encourage the patient to fill out the selective menu, so that preferred foods will be served.

b. Provide the patient with assistance in selecting the appropriate foods from the menu. The use of selective menus has improved food acceptance in most hospitals.

c. Order and deliver the patient's tray promptly when it has been delayed while he was undergoing tests or procedures.

d. Feed or assist the patient as necessary. Even patients, who can feed themselves, may need assistance in opening milk cartons, cutting meat, and spreading butter on bread.

e. Discuss the advantages of following the diet. Explain to the patient why he will feel better and heal faster. For some diseases or disorders, the patient may be required to follow a special diet during the period of illness or the remainder of his life.

(1) A high protein diet is essential to repair tissues in any condition, which involves healing, such as recovery from surgery or burns.

(2) A person with diabetes must adhere to a diet controlled in calories, carbohydrates, protein, and fat.

(3) A person with hypertension may require a diet restricted in sodium.

f. Inform the dietitian or food service specialist of any special needs the patient may have. A patient who has lost his teeth and has difficulty chewing will need modifications in the consistency of the food he eats.

g. Visit with the patient briefly when serving the food tray.

h. Encourage family members to visit during mealtime. If present, a family member may want to feed the patient who needs assistance. Be sure that this is relaxing and safe for the patient.

i. When conditions allow for it, encourage the ambulatory patient to go to the dining hall for meals or open curtains in a double room so that patients may eat together. If the patient must eat alone, turn on the television or radio.