5-11. STANDARD HOSPITAL DIETS

The types of standard diets used by the Department of the Army are found in TM 8-500, Nutritional Support Handbook.

a. Clear Liquid Diet. This diet is indicated for the postoperative patient's first feeding when it is necessary to fully ascertain return of gastrointestinal function. It may also be used during periods of acute illness, in cases of food intolerance, and to reduce colon fecal matter for diagnostic procedures.

(1) The diet is limited to fat-free broth or bouillon, flavored gelatin, water, fruit drinks without pulp, fruit ice, Popsicles®, tea, coffee or coffee substitutes, and sugar. No cream or creamers are used. Carbonated beverages may be included when ordered by the physician; however, they are often contraindicated.

(2) The standard menu mat (DA Form 2902-15R) provides approximately 1146 calories. This diet is below the recommended dietary allowances (RDA) for all nutrients tabulated except for Vitamin C (ascorbic acid). If the patient is to be on clear liquids for an extended period of time, the portion sizes should be increased or an accepted enteral formula may be provided.

b. Full Liquid Diet. This diet is used when a patient is unable to chew or swallow solid food because of extensive oral surgery, facial injuries, esophageal strictures, and carcinomas of the mouth and esophagus. It may be used to transition between a clear liquid and a regular diet for the post-surgical patient.

(1) The diet consists of foods, which are liquid at room or body temperature, and will easily flow through a straw. Included in the full liquid diet are all juices, strained soups, thinned, cooked cereals, custards, ice cream, sherbet, and milk. A high protein beverage is given at breakfast and between meals. Commercially prepared liquid supplements may also be used.

(2) The standard menu mat (DA Form 2902-12-R) provides approximately 2777 calories. This diet is slightly below the RDA in iron for females, and in niacin for men.

c. Advanced Full Liquid Diet. This diet may be prescribed to meet the nutritive requirements of a patient who must receive a full liquid diet for an extended period of time or who has undergone oral surgery and must have foods, which can pass through a straw.

(1) The foods permitted are the same as those allowed on the full liquid diet. The advanced full liquid diet is made more nutritious by the addition of blended, thinned, and strained meat, potatoes, and vegetables. High-protein beverages are served with meals and between meals.

(2) The standard menu mat provides approximately 4028 calories. The advanced full liquid diet meets the RDA for all nutrients tabulated.

d. Tonsillectomy and Adenoidectomy Cold Liquid Diet. This diet is used following a tonsillectomy and adenoidectomy (T&A). It is also used when only fluids or soothing foods in liquid form are tolerated.

(1) The T&A cold liquid diet provides only cold liquids, which are free of irritants or acid properties. Foods allowed are flavored gelatins, ice cream, sherbet, and milk. A high protein beverage is served between meals.

(2) The standard menu mat is DA Form 2902-14-R. The T&A cold liquid diet does not meet the RDA for niacin and Vitamin A for adult males or children ages 4 to 10, and is below the RDA for thiamine for children ages 1 to 4. It does not meet the RDA for iron for any age group.

e. Soft Diet. The soft diet is prescribed for patients unable to tolerate a regular diet. It is part of the progressive stages of diet therapy after surgery or during recovery from an acute illness.

(1) The diet consists of solid foods that are prepared without added black pepper, chili powder, or chili pepper. It does not contain whole grain cereals or salads with raw, fresh fruits and vegetables. Serving sizes are small to provide a gradual increase in the amount of food from the liquid diet.

(2) The standard menu mat (DA Form 2902-4-R) provides approximately 2236 calories. This diet does not meet the RDA in iron for females or thiamine for males, nor niacin for either males or females.

f. Dental Soft Diet. This diet is prescribed for patients who are recovering from extensive oral surgery, have severe gingivitis, have had multiple extractions, have chewing difficulties because of tooth loss or other oral condition, or for the very elderly, toothless patient.

(1) The diet is composed of seasoned ground meats, vegetables, and other foods, which are easily chewed. The individuality of the patient must not be overlooked when a dental soft diet is prescribed. Many patients resent being served ground meat.

(2) Standard menu mats available are DA Form 2902-6-R (dental soft diet) and DA Form 2906-13-R (dental soft, 2000 mg sodium diet). The dental soft diet does not meet the RDA in thiamin for males, nor iron for females.

g. Regular Diet. Regular diets are planned to meet the nutritional needs of adolescents, adults, and geriatric phases of the life span.

(1) The regular diet includes the basic food groups and a variety of foods. The basic food groups include meat, milk, vegetables, fruits, bread and cereal, fats, and sweets.

(2) The standard menu mat, DA Form 2901-R (Regular Diet) provides approximately 3375 calories. The selective menu is developed by each individual hospital according to patient needs, food availability, and cost. The regular diet is designed to provide exceptionally generous amounts of all recognized nutrients and meets or exceeds the RDA for all nutrients tabulated.

(3) The Food Guide Pyramid is an outline of what we should eat each day (see figure 5-1). It shows six food groups, but emphasizes foods from the five food groups shown in the lower sections of the Pyramid. You need food from each group for good health. Each of the food groups provides some of the nutrients you need. Food from one group cannot replace those of another group.

 Figure 5-1. Food Guide Pyramid.

h. Diabetic Diet. The diabetic diet is indicated in the treatment of the metabolic disorder diabetes mellitus. This disease results from an inadequate production or utilization of insulin. The object of treating the diabetic patient by diet, with or without insulin or oral drugs, is to prevent hyperglycemia, hypoglycemia, glycosuria, and ketosis.

(1) The diabetic food exchange lists are the basis for a meal planning system that was designed by a committee of the American Diabetes Association and The American Dietetic Association. The system lists: meat exchange, bread exchange, fruit and juice exchange, vegetable exchange, milk exchange and fat exchange. The number of exchanges allowed is based upon the doctor's order and the dietitian's calculations. Each diabetic diet should be individualized to meet the needs of the patient. The foods in each exchange contain the same amount of calories, carbohydrate, protein, and fat per portion size. Patients select from the exchange based upon their preference.

(2) The adequacy and possible deficiencies depend on the calories. A diet of less than 1200 calories for women and less than 1500 calories for men would have a great chance of being deficient in some nutrients.

(3) The goals of the diabetic diet are:

(a) To improve the overall health of the patient by attaining and maintaining optimum nutrition.

(b) To attain and maintain an ideal body weight.

(c) To provide for the pregnant woman and her fetus: normal physical growth in the child, adequate nutrition for lactation needs if she chooses to breast-feed her infant.

(d) To maintain plasma glucose as near the normal physiologic range as possible.

(e) To prevent or delay the development and progression of cardiovascular, renal, retinal, neurologic, and other complications associated with diabetes.

(f) To modify the diet as necessary for complications of diabetes and for associated diseases.

i. Liberal Bland Diet. This diet is indicated for any medical condition requiring treatment for the reduction of gastric secretion, such as gastric or duodenal ulcers, gastritis, esophagitis, or hiatal hernia.

(1) The diet consists of any variety of regular foods and beverages, which are prepared or consumed without black pepper, chili powder, or chili pepper. Chocolate, coffee, tea, caffeine-containing products, and decaffeinated coffee are not included in the diet. The diet should be as liberal as possible and individualized to meet the needs of the patient. Foods, which cause the patient discomfort, should be avoided. Small, frequent feedings may be prescribed to lower the acidity of the gastric content and for the physical comfort of the patient.

(2) The standard menu mat, DA Form 2902-1-R, provides 3213 calories. The liberal bland diet is slightly below the RDA for thiamine and niacin for men 19 to 22 years of age. It is also below the RDA in iron for women of all ages.

j. Low Fat Diet. Fat restricted diets may be indicated in diseases of the liver, gallbladder, or pancreas in which disturbances of the digestion and absorption of fat may occur (pancreatitis, post-gastrointestinal surgery, cholelithiasis, and cystic fibrosis).

(1) The diet contains approximately 40 grams of fat from the six ounces of lean meat, fish, or poultry, one egg and three teaspoons of butter, margarine, or other allowed fats. Only lean, well-trimmed meats and skim milk are used. All foods are prepared without fat.

(2) The standard menu mat, DA Form 2905-R, provides approximately 2168 calories. Caloric content of the diet can be increased by adding allowable breads, vegetables, fruits, or skim milk. The diet is below the RDA in iron for males between the ages of 11 and 22 and females 11 through 50 years of age.

k. Sodium Restricted Diet. The purpose of the sodium-restricted diet is to promote loss of body fluids for patients who are unable to excrete the element normally because of a pathological condition. The diet is indicated for the prevention, control, and elimination of edema in congestive heart failure; cirrhosis of the liver with ascites; renal disease complicated by either edema or hypertension; when administration of adrenocorticotrophic hormone (ACTH) or steroids are prescribed, and for certain endocrine disorders such as Cushing's disease and hypothyroidism.

(1) The sodium-restricted diets provide a specific sodium level or a range of sodium. The diet order must indicate the specific sodium level or range desired either in milligrams (mg) or mill equivalent (mEq). Terms such as "salt free" and "low sodium" are not sufficient.

(a) All foods on the 500 mg and 1000 mg sodium diets are prepared without the addition of salt, and foods high in sodium are omitted. The 500 mg sodium diet uses both sodium restricted bread and margarine. The 1000 mg sodium diet uses sodium restricted margarine and regular bread. The 2000 mg sodium diet uses regular bread and margarine, and regular cereal and desserts prepared with sodium.

(b) The standard menu mats, DA Form 2906-1-R (500 mg sodium diet), DA Form 2906-2-R (1000 mg sodium diet), and DA Form 2906-3-R (2000 mg sodium diet), provide between 2083 and 2554 calories.

(2) The diets are below the RDA in iron for males ages 11 to 22 and for females ages 11 to 50. Thiamine is inadequate for males at all levels. Calcium and niacin are also low for certain diets and ages.

5-12. PREPARING THE PATIENT FOR MEALS

a. As a nurse, your duties may include serving the diet trays at mealtime. For many patients, mealtime is the high point of the day. The patients are more apt to have a better appetite, eat more, and enjoy their food more if you prepare them for their meals before the trays arrive.

(1) Provide for elimination by offering the bedpan or urinal or assisting the patient to the bathroom.

(2) Assist the patient to wash hands and face as needed.

(3) Create an attractive and pleasant environment for eating. Remove distracting articles such as an emesis basin or a urinal, and use a deodorizer to remove unpleasant odors in the room. See that the room is well lighted and at a comfortable temperature.

(4) Position the patient for the meal. If allowed, elevate the head of the bed or assist the patient to sit up in a chair.

(5) Clear the overbed table to make room for the diet tray.

b. Avoid treatments such as enemas, dressings, and injections immediately before and after meals.

5-13. CLOSING

Helping patients meet their nutritional needs is a challenging task for a nurse. Ordering the tray and delivering it to the patient's bedside is not enough. You must see that he eats the food needed to meet his body requirements. Provide the patient with assistance to complete selective menus that meet his food preferences as much as possible. See to his comfort at mealtime. Without proper nutrition, the healing process slows down and the patient's condition does not improve as quickly as it should. You should always remember that the dietitians and hospital food service specialist (MOS 91M) of the hospital's Nutrition Care Division are available to you as experts in all aspects of patient nutrition care. Ask for their advice or intervention when you believe a patient's condition requires it.

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