Chapter 32: Diet Therapy and Special Diet

SLIDE 1 — INTRODUCTION TO MED-SURG 1

DAY 3
DIET THERAPY AND SPECIAL DIET**

🔑 What this slide means:

• Today’s topic = Diet Therapy & Special Diets

• This is part of medical treatment, not just comfort food

• Food choices are ordered like medications

✅ Simple example:

• A diabetic patient does NOT just eat regular food

• A kidney patient cannot eat high potassium foods

✅ Memory Tip:
👉 Food = Treatment

✅ SLIDE 2 — Chapter 32: Diet Therapy and Special Diets

🔑 What this slide tells you:

• All this content comes from Rosdahl Chapter 32

• This chapter covers:

  • Special diets

  • Feeding assistance

  • Tube feedings

  • IV nutrition

  • Food & medication interactions

✅ Exam Tip:
If the question says “According to Chapter 32” → it’s talking about diet therapy

✅ SLIDE 3 — Introduction

🔑 Key Points (IN SIMPLE WORDS):

• ✅ Nutrition is a vital part of therapy

• ✅ Some illnesses require special diets

• ✅ Sick patients may need help meeting nutrition needs

• ✅ Mealtime is the best time for diet teaching

✅ Examples:

• Diabetic → carb-controlled diet

• Stroke → thickened liquids

• Surgery → high-protein diet

• Elderly → may need help feeding

✅ NCLEX Tip:
Patient education about food = nursing responsibility

✅ SLIDE 4 — Helping the Client Meet Nutritional Needs

🔑 Key Points:

• Eating should be pleasant

• Sick or stressed people may:

  • Want childhood comfort foods

  • Eat less

• Nurses help with nutrition in:

  • Hospitals

  • Nursing homes

  • Home care

✅ Examples:

• A sick adult only wants soup → normal

• A home health client cannot cook → nurse ensures food access

✅ Test Tip:
Comfort improves appetite → appetite improves healing

✅ SLIDE 5 — Serving Food #1

🔑 What the Nurse MUST Do:

• ✅ Match diet order + ID band

• ✅ Serve self-feeding patients first

• ✅ Keep portions small

• ✅ Hot food hot, cold food cold

• ✅ Fill cups ¾ full

• ✅ Food must match special diet

• ✅ Remove broken utensils

• ✅ Be pleasant

✅ Examples:

• Diabetic tray → NO regular soda

• Dysphagia patient → NO solid food

• Weak patient → serve last so food stays hot

✅ NCLEX Favorite Rule:
👉 Always verify DIET + ID first

✅ SLIDE 6 — Serving Food #2

🔑 Eating Environment:

• Hospital → follow facility system

• Nursing home → dining room

• Home care → relaxed setting

🔑 Preparing the Client:

• Sit them up

• Wash hands

• Clear clutter

🔑 During the Meal:

• Food should look appetizing

• Encourage self-feeding

• Document intake

✅ Examples:

• Bed patient → raise head of bed before eating

• Confused patient → gentle reminders to eat

• Weak patient → encourage independence before helping

✅ NCLEX Rule:
👉 Promote independence FIRST, assist only if needed

SLIDE 7 — Serving Food #3

Providing Between-Meal Supplements and Snacks

🔑 Key Points:

• Given to clients with:

  • High nutritional needs

  • Poor appetite

• May be ordered by the healthcare provider

• Must be served on time

• Encourage the client to:

  • Drink/eat the supplement

  • Choose preferred flavors

• Proper documentation is required

✅ Examples:

• Burn patient → high-protein shake between meals

• Elderly patient who barely eats → Ensure at 2 PM

• Cancer patient with weight loss → nutritional supplement ordered

✅ NCLEX Tip:
If it’s ordered, it must be given + documented.

✅ SLIDE 8 — Serving Food #4

Encouraging Fluid Intake

🔑 Key Points:

• Some clients have an order to:

  • Encourage fluids

  • Or force fluids

• When entering the room → always offer small fluids

• Fluids include:

  • Water, ice cream, ice pops

  • Gelatin (Jell-O)

  • Thin cereal, coffee, soda

• Fluids help:

  • ✅ Prevent complications

  • ✅ Maintain bladder & bowel routine

• Teach clients to:

  • Drink before they feel thirsty

  • Choose fluids they like

✅ Examples:

• Dehydrated patient → offer water every time you enter

• Constipated patient → increase fluid intake

• Patient who hates water → offer gelatin or ice pops

✅ NCLEX Tip:
If they feel thirsty, they’re already dehydrated.

✅ SLIDE 9 — Serving Food #5

Encouraging Fluid Intake (cont.)

🔑 Daily Hydration Tips:

• Keep a water bottle nearby

• Drink water:

  • Before meals

  • With meals

• Use water instead of carbonated drinks

• Pack bottled water for the day

• Drink enough low-fat milk

• Try:

  • Sparkling water + lemon/lime

• Eat enough fruits & vegetables

• Drink extra fluids with exercise

✅ Examples:

• Patient drinks only soda → nurse teaches switch to water

• Forgetful patient → keep bottle at bedside

• Active patient → increase fluids before & after activity

✅ NCLEX Tip:
Fruits & vegetables count toward fluid intake.

Serving Food #6

Restricting Fluid

🔑 Key Points:

• Some clients have a fluid restriction order

  • Example order: Restrict fluids to 1,500 mL/day

• It may be easier if:

  • ½ of fluids during the day

  • ½ in the evening

• Fluid restriction includes ALL foods that are liquid at room temperature, such as:

  • Water

  • Jell-O

  • Ice cream

  • Popsicles

  • Soup broth

✅ Examples:

• Heart failure patient → fluid restriction to prevent fluid overload & pulmonary edema

• Kidney failure patient → fluid restriction to prevent swelling & electrolyte problems

• A popsicle DOES count as fluid intake

✅ NCLEX Tip:
👉 If it melts, it counts as fluid.

✅ SLIDE 11 — Serving Food #7

Teaching

🔑 What the Nurse Must Teach:

• Reinforce diet teaching using:

  • Verbal instructions

  • Written instructions

• Consider:

  • Religious beliefs

  • Cultural food practices

• Report adverse reactions to the diet

• Use teach-back:

  • Client should repeat the diet instructions to confirm understanding

✅ Examples:

• Diabetic patient repeats:
  “No regular soda, count my carbs” ✅

• Muslim patient avoids pork → nurse works with dietary services

• Patient becomes nauseated after a new diet → nurse reports it

✅ NCLEX Tip:
👉 The BEST proof of understanding = teach-back

✅ SLIDE 12 — The Client Who Needs Assistance with Eating #1

🔑 Key Points:

• Always encourage independence first

• The nurse may:

  • Feed the client

  • Allow a family member to assist

• When feeding:

  • Warn about very hot foods

  • Watch for:

    • Nausea

    • Pain

    • Trouble swallowing

• Allow the client to do as much as they can themselves

✅ Examples:

• Stroke patient holds spoon but can’t scoop → nurse assists with guiding, not full feeding

• Weak postop patient → nurse feeds slowly & safely

• Patient says food feels “stuck” → STOP feeding & assess for dysphagia

✅ NCLEX Tip:
👉 Safety + independence always come before speed

The Client Who Needs Assistance with Eating #2

🔑 TWO Special Populations:

1. The Visually Impaired Person

• Most can eat independently

• For temporary or severe blindness:

  • Describe food location using clock method
    (“Your chicken is at 12 o’clock.”)

  • Warn about hot foods

  • Cut food into small manageable pieces

  • Ask, don’t assume they need full feeding

⭐ Example:

• “Your mashed potatoes are at 3 o’clock and your meatloaf is at 9 o’clock.”

2. The Person with a Swallowing Disorder (Dysphagia)

• Work with speech therapist for correct consistency:

  • Thick liquids

  • Puree

  • Mechanical soft

• Work with dietitian to ensure nutrition is adequate

• Safety first:

  • Elevate head of bed

  • Feed slowly

  • Encourage patient to swallow after each bite

⭐ Example:

• Stroke patient pockets food in cheek → switch to pureed diet + thick liquids.

🔥 NCLEX Tip:

If the patient starts coughing or choking → STOP feeding immediately.

✅ SLIDE 14 — The Client Who Needs Assistance with Eating #3

🔑 1. The Person Who Cannot Chew

• Reasons:

  • Poor dental health

  • Missing teeth

  • Ill-fitting dentures

• May need diet consistency modified

  • Mechanical soft

  • Puree

  • Soft foods

⭐ Example:

• Elderly patient with no dentures → needs mechanical soft diet (soft chicken, mashed potatoes, soft veggies).

🔑 2. Documenting and Reporting

Nurses must document if the client has:

• Poor appetite

• Refuses meals

• Difficulty chewing or swallowing

• Nausea or vomiting

• GI discomfort

• Exact percentage of meal eaten

• Fluid intake

• Tube feeding amount

⭐ Example:

• “Patient consumed 25% of meal; complained of nausea after 3 bites; notified RN.”

🔥 NCLEX Tip:

Inadequate intake → report to team leader & provider because it can delay healing.

House Diets

🔑 Also Called:

• Regular diet

• General diet

• Full diet

🔑 Who gets this diet?

• Clients in acute or extended care

• Whose condition does NOT require a special diet

🔑 What this allows:

• Wide variety of foods

• Client chooses meals from a menu

• Also called:

  • Select diet

  • Client-select diet

• May be ordered as:

  • Regular diet as tolerated (DAT)

✅ Examples:

• Young patient admitted for observation → regular diet

• Post-op patient tolerating food → DAT

✅ NCLEX Tip:
House/regular diet = NO dietary restrictions

✅ SLIDE 18 — Modified Diets #1

🔑 Big Idea:

Modified (therapeutic) diets are part of treatment for disease

🔑 Why diets are modified:

• To regulate nutrients in metabolic disorders

  • Example: Diabetes → carb control

• To increase or decrease weight

• To reduce edema by controlling sodium

  • Example: Heart failure → low sodium

• To aid digestion

  • Avoid foods that irritate the stomach

• To help overworked organs rest

  • Example: Kidney or liver disease

✅ Examples:

• CHF patient → low-sodium diet

• Diabetic patient → carbohydrate-controlled diet

• Gastritis patient → bland diet

• Underweight patient → high-calorie diet

✅ NCLEX Tip:
If the question mentions a disease, think:
👉 “What diet modification does this condition need?”

Modified Diets #2

🔑 Continuation of therapeutic diets

Why a therapeutic diet may be ordered:

• To eliminate a food the body cannot tolerate
  (Example: Lactose intolerance → lactose-restricted diet)

• To slow overactive intestinal motility
  (Example: Diarrhea → low-fiber or low-residue diet)

Classifications of modified diets:

1. Consistency & texture

2. Energy level (calories)

3. Nutrients

4. Amount of food

5. Specific allergens

⭐ Examples:

• Allergy to eggs → diet eliminates egg-containing foods

• Severe diarrhea → low-fiber diet

• Patient with celiac disease → gluten-restricted diet

✅ SLIDE 20 — Modified Diets #3

Consistency Modifications

Consistency = how the food feels / how easy it is to swallow

🔑 Types:

1. Liquid Diets

Clear Liquid Diet

• Water, broth, tea, gelatin

• Inadequate in calories, protein, nutrients

• Used short-term (≤3 days unless receiving IV/NG support)

Full Liquid Diet

• Includes all clear liquids PLUS milk, cream soups, pudding

• If used long-term → add supplements

2. Soft Diet

Types:

• Regular soft / Digestive soft

  • Low in fiber, fat, connective tissue

  • Easy to digest

• Mechanical soft

  • For oral problems, difficulty chewing

⭐ Examples:

• Pre-op or post-op → clear liquids → full liquids → soft → regular

• Patient with no teeth → mechanical soft

• GI irritation → digestive soft

🔥 NCLEX Tip:

Sequence of advancing diet:
👉 Clear → Full → Soft → Regular

Modified Diets #4

Consistency Modifications (continued)

1. High-Fiber Diet

• Increases insoluble and soluble fiber

• Helps with:

  • Constipation

  • IBS

  • Lowering cholesterol

• ⚠ Potential side effects:

  • Cramping

  • Gas

  • Diarrhea

2. Low-Fiber Diet

• Also called low-residue diet

• Used for:

  • Severe diarrhea

  • Colitis

  • Diverticulitis

  • Intestinal obstruction

  • Before/after GI surgery

• ⚠ May be low in:

  • Iron

  • Calcium

  • Vitamins/minerals

⭐ Examples:

• Diverticulitis flare → low-fiber diet

• Chronic constipation → high-fiber diet

• Pre-colonoscopy → low-residue diet

• — Modified Diets #5

  Consistency Modifications (cont.) — Bland Diet

  🔑 What a Bland Diet Is:

  • Ordered for GI problems

  • Goal: limit gastric acid production

  🔑 Conditions that need a Bland Diet:

  • Ulcers

  • Esophagitis

  • GERD / heartburn

  • Gastritis

  • Hiatal hernia

  🚫 Foods to AVOID:

  • Alcohol

  • Caffeine (even decaf coffee & tea)

  • Red & black pepper

  • Chili powder

  • Fried foods

  • High-fat foods

  • Peppermint & spearmint oils

  • Citrus fruits & juices

  • Tomato products

  ⚠ Milk-based diet is discouraged

  ---

  ✅ Examples:

  • GERD patient → bland diet

  • Ulcer patient → no coffee, no spicy food

  • Heartburn patient → avoid tomato sauce & citrus

  ✅ NCLEX Tip:
  Bland diet = NO spicy, acidic, fatty, caffeinated foods

  ---

  ✅ SLIDE 23 — Modified Diets #6

  Energy Value Modifications — High-Calorie Diet

  🔑 Used For:

  • Underweight individuals

  • Hyperthyroidism

  • Undernutrition

  • General malnutrition

  • Severe burns

  🔑 Diet Characteristics:

  • Over 3,000 calories/day

  • 130+ grams of protein

  • High in:

    • Protein

    • Carbohydrates

    • Fat

    • Vitamins & minerals

  • May need small, frequent meals

  • Always consider:

    • Food preferences

    • Eating habits

  ---

  ✅ Examples:

  • Burn patient → high-calorie, high-protein diet

  • Malnourished elderly patient → small frequent high-calorie meals

  • Hyperthyroid patient → needs extra calories due to ↑ metabolism

  ✅ NCLEX Tip:
  Burns + malnutrition = HIGH calorie & HIGH protein

  ---

  ✅ SLIDE 24 — Modified Diets #7

  Energy Value Modifications — Reduced-Calorie Diet

  🔑 Used For:

  • Weight loss

  • Obesity management

  🔑 What It Includes:

  • ✅ Healthy carbohydrates

  • ✅ Lean proteins

  • ✅ Healthy fats

  • ❌ NOT crash dieting

  • ❌ NOT starving

  ---

  ✅ Examples:

  • Patient with BMI of 38 → reduced-calorie diet

  • Pre-diabetic patient → weight loss diet to prevent diabetes

  ✅ NCLEX Tip:
  Safe weight loss = balanced calories, not starvation

— Modified Diets #8

Nutrient Modifications — Carbohydrate-Controlled Diets

🔑 Main Purpose:

• To control blood sugar and fat levels

• To delay complications of diabetes

🔑 Key Concepts:

• Also called a Diabetic diet

• Uses:

  • Plate model

  • Picture cues

  • Food groups

• Carbohydrate counting focuses on:

  • Cereals

  • Rice

  • Pasta

  • Dairy

  • Fruits

  • Vegetables

• Consistent-carbohydrate diet

• Clients do NOT need special foods

• Diet should be individualized to likes and dislikes

✅ Examples:

• Diabetic patient eats:

  • ½ plate veggies

  • ¼ protein

  • ¼ carbs

• Patient learns that:

  • Bread, milk, fruit all count as carbs

✅ NCLEX Tip:
Diabetic diet = CONSISTENT carbs, not “no carbs”

✅ SLIDE 26 — Modified Diets #9

Nutrient Modifications — Lactose-Restricted Diet

🔑 Why This Diet Is Needed:

• Lactose intolerance = not enough lactase enzyme

🔑 Key Points:

• Tolerance is different for each person

• Many people:

  • Can’t tolerate a full glass of milk

  • But CAN tolerate:

    • Yogurt

    • Aged cheeses

    • Lactose-free milk

    • Milk taken with food

• Severe cases must avoid:

  • Milk cooked into other foods (like bread)

✅ Examples:

• Patient gets cramps after milk → switched to lactose-free milk

• Patient tolerates yogurt but not ice cream → normal for lactose intolerance

✅ NCLEX Tip:
Lactose intolerance ≠ complete dairy elimination for everyone

✅ SLIDE 27 — Modified Diets #10

Nutrient Modifications — High- and Low-Fat Diets

✅ Fat-Controlled Diet

🔑 Used For:

• Hyperlipidemia

  • High cholesterol

  • High triglycerides

• To reduce risk of:

  • Coronary artery disease

🔑 What’s Modified:

• Total fat

• Saturated fat

• Sometimes total calories too

✅ Examples:

• Patient with cholesterol 280 → fat-controlled diet

• Patient with CAD → limits saturated fats

✅ NCLEX Tip:
High cholesterol = LOW saturated fat

Modified Diets #11

Nutrient Modifications (cont.) — Low-Fat & High-Fat Diets

1. LOW-FAT DIET

🔑 Used For:

• Malabsorption syndromes

• Pancreatitis

• Gallbladder disease

🔑 Guidelines:

• Total fat (both saturated & unsaturated) limited to 25–30% of total calories

2. HIGH-FAT DIET

🔑 Used For:

• Children with seizure disorders

• Usually a ketogenic diet

🔑 Characteristics:

• Extremely low carbohydrates

• 80–90% fat

⭐ Examples:

• Pancreatitis patient → low-fat diet to reduce pancreatic stimulation

• Gallbladder disease → avoid fried/high-fat foods

• Pediatric seizure patient → ketogenic diet to reduce seizure activity

🧠 NCLEX Tip:

Gallbladder + pancreatitis = low fat
Seizure child = keto high fat

✅ SLIDE 29 — Modified Diets #12

Nutrient Modifications — Protein-Controlled Diets

1. HIGH-PROTEIN DIET

🔑 Used For:

• Healing

• Burns

• Malnutrition

• Post-surgery

🔑 Protein sources:

• Eggs

• Meat

• Poultry

• Fish

• Cheese

• Milk

• Commercial protein drinks

2. PROTEIN-RESTRICTED DIET

🔑 Used For:

• Kidney disease

• Liver disease (depending on severity)

🔑 Guidelines:

• Protein amount depends on client’s weight

• Should be:

  • High quality

  • Spread evenly throughout the day

• May also require sodium and fluid restrictions

⭐ Examples:

• Nephrology patient with kidney failure → protein-restricted diet

• Burn victim → high-protein diet

• Post-op patient → increased protein for wound healing

🧠 NCLEX Tip:

Kidney disease = limit protein
Burns/surgery = increase protein

✅ SLIDE 30 — Modified Diets #13

Nutrient Modifications (cont.) — Gluten-Restricted Diet

🔑 Used For:

• Celiac disease

• Gluten sensitivity

🔑 Foods Containing Gluten:

• Wheat

• Rye

• Oats*

• Barley

🔑 Key Points:

• Permanent elimination of gluten is necessary for celiac disease

• Eliminating gluten reverses intestinal damage

• Must read labels carefully — gluten is often used as a stabilizer in processed foods

⭐ Examples:

• Celiac patient cannot eat:

  • Bread, pasta, crackers, cakes

• Celiac-safe foods include:

  • Rice, corn tortillas, quinoa, gluten-free oats

🧠 NCLEX Tip:

Celiac = NO wheat, rye, oats, barley → lifelong.

Modified Diets #14

Nutrient Modifications (cont.) — Diets with Controlled Minerals and Electrolytes

Sodium-Controlled Diet

🔑 Key Sodium Limits:

• Normal upper limit: < 2,300 mg/day

• Moderate restriction: 1,500 mg/day

• Strict/severe restriction: 500–250 mg/day

⚠ Important Teaching:

• Salt substitutes (e.g., potassium salt)
  → ONLY with provider approval

• Many “low-sodium” foods still contain hidden sodium

✅ Examples:

• Heart failure (CHF) patient → 1,500 mg sodium/day

• Severe edema/HTN patient → 500 mg sodium/day

• Patient using salt substitute without asking → STOP & notify provider

✅ NCLEX Tip:
CHF + HTN + edema = LOW SODIUM

✅ SLIDE 32 — Modified Diets #15

Nutrient Modifications (cont.) — Controlled Minerals

Calcium, Phosphorus & Potassium

✅ Calcium-Modified Diet

• High calcium → for osteoporosis

✅ Phosphorus-Modified Diet

• Low phosphorus → for kidney failure

✅ Potassium-Modified Diet

• High potassium → with diuretic use

• Low potassium → with end-stage renal disease

✅ Examples:

• Osteoporosis patient → increase calcium

• Dialysis patient → low phosphorus & low potassium

• Patient on Lasix (furosemide) → needs high potassium

✅ NCLEX Tip:
Lasix → LOSES potassium → replace potassium
Kidney failure → CAN’T excrete potassium → restrict potassium

✅ SLIDE 33 — Modified Diets #16

Diets Modified by Serving Size & Allergens

✅ Diets Modified by Serving Size

• Some clients need small, frequent meals

• Example:

  • Six meals/day instead of three

✅ Used For:

• Nausea

• Weakness

• Cancer patients

• Post-op patients

✅ Diets Modified for Allergens

• Allergens = proteins that cause autoimmune/allergic response

• Common allergens:

  • Milk

  • Eggs

  • Chocolate

  • Grains

  • Peanuts

  • Certain fruits

• Allergen foods must be ELIMINATED

• May need vitamin/mineral supplements if food groups are removed

✅ Examples:

• Peanut allergy → completely avoid peanuts

• Milk allergy → eliminate dairy + add calcium supplement

• Chemo patient → 6 small meals/day

✅ NCLEX Tip:
Allergy = TOTAL elimination, not “small amounts”

Nutritional Support #1

Tube Feedings (Enteral Feedings)

🔑 What Tube Feeding Means:

• Also called enteral nutrition

• Used when the patient:

  • Is unconscious

  • Cannot swallow

  • Has mouth, throat, esophagus, or stomach cancer

  • Has oral trauma or surgery

  • Has anorexia

• Also used when extra nutrition is needed:

  • Burns

  • Infection

  • Surgery

  • Fractures

✅ MOST IMPORTANT RULE:

👉 The patient MUST have a working GI tract

✅ Examples:

• Stroke patient who cannot swallow → NG tube feeding

• Burn patient → tube feeding for high protein & calories

• Jaw wired shut → tube feeding

✅ NCLEX Tip:
If the GI tract works → choose ENTERAL
If the GI tract does NOT work → choose IV nutrition (TPN)

Nutritional Support #2

Tube Feedings (cont.)

🔑 Types of Formulas

• Contain:

  • ✅ Protein

  • ✅ Fat

  • ✅ Carbohydrates

  • ✅ Vitamins

  • ✅ Minerals

• Special formulas exist for specific diseases (renal, diabetic, high-protein, etc.)

🔑 Placement Sites

• Through the nose into the stomach → NG tube

• Through the abdominal wall into the stomach or jejunum → PEG / jejunostomy

✅ Examples:

• Stroke patient → NG tube

• Long-term feeding needs → PEG tube

• Renal failure → renal-specific formula

✅ NCLEX Tip:
Short-term = NG tube
Long-term = PEG tube

✅ SLIDE 38 — Nutritional Support #3

Tube Feedings (cont.) — Tubes & Terminology

🔑 Key Vocabulary:

• Nasogastric (NG): nose → stomach

• Percutaneous: through the skin

• PEG: percutaneous endoscopic gastrostomy

• Endoscopic: placed with a camera/instrument

• Gastrostomy: tube into the stomach

• Button feeding device: small silicone device that replaces a long tube

✅ Examples:

• Child with long-term feeding needs → button device

• Adult post-stroke → NG tube

• Cancer patient with swallowing problem → PEG tube

✅ NCLEX Tip:
PEG = long-term feeding access

✅ SLIDE 39 — Nutritional Support #4

(Image Slide: Tube Feeding Equipment)

🔑 What This Slide Is Showing (Visually):

• Feeding bag

• Tubing

• Pump

• Syringe for flushing

• Tube connection to patient

🔑 What You Need to Know for Tests:

• Tube feeds can be:

  • Continuous (all day via pump)

  • Intermittent/bolus (given at set times)

• Tubes must be:

  • Flushed

  • Properly positioned

  • Monitored for complications

✅ Examples:

• ICU patient → continuous pump feeding

• Stable patient at home → bolus feedings with syringe

✅ NCLEX Safety Rule:
Feeding tube use = high aspiration risk if done incorrectly

Nutritional Support #5

Tube Feedings (cont.) — Nursing Considerations

🔑 Critical Nursing Responsibilities:

• Follow Nursing Procedure 32-2

• Clients may still eat by mouth if ordered

• Document:

  • Tolerance

  • Intake

  • Any complications

• Notify the provider if untoward signs develop

• Head of bed MUST be elevated ~30° during feeding

✅ Examples:

• Patient receiving tube feeding → bed at 30°

• Patient starts coughing during feeding → STOP feeding & notify RN/provider

• Patient allowed to sip water orally with tube feeding → must be provider-ordered

✅ NCLEX Priority Rule:
👉 HOB UP = Aspiration prevention

✅ SLIDE 41 — Nutritional Support #6

Intravenous Therapy — Parenteral Nutrition

🔑 What This Means:

• Parenteral nutrition = nutrition through the vein

• Used when the patient cannot use the GI tract

• Includes:

  • TPN (Total Parenteral Nutrition)

  • PPN (Peripheral Parenteral Nutrition)

✅ TPN (Total Parenteral Nutrition)

• Also called hyperalimentation

• A specially calculated solution

• Used when the GI tract is not working

• Contains:

  • Carbohydrates

  • Protein

• Requires a central venous catheter

✅ Examples:

• Patient with bowel obstruction → TPN

• Severe Crohn’s flare with no absorption → TPN

✅ NCLEX Tip:
If the GI tract does not work → TPN

✅ SLIDE 42 — Nutritional Support #7

Intravenous Therapy (cont.) — PPN

✅ PPN (Peripheral Parenteral Nutrition)

• Same ingredients as TPN but:

  • Lower concentration

  • Given through a peripheral vein

• Used for:

  • Temporary nutrition support

• Must be:

  • Hypotonic or isotonic

• Provides fewer calories than TPN

✅ Examples:

• Patient NPO for a few days post-surgery → PPN

• Mild GI rest → PPN

• Long-term non-functioning gut → NOT PPN → TPN instead

✅ NCLEX Tip:
Short-term + peripheral vein = PPN
Long-term + central line = TPN

Food and Medication Interactions

(Image slide in your deck)

🔑 What this slide is testing:

Some foods change how medications work — they can:

• Increase drug effects

• Decrease drug effects

• Cause dangerous side effects

✅ High-Yield Examples (NCLEX favorites):

• 🍊 Grapefruit + many meds

  • Affects: statins, some cardiac meds, psych meds

  • 👉 Can cause toxic drug levels

• Vitamin K foods + Warfarin

  • Spinach, kale, broccoli

  • 👉 Decreases the effect → ↑ risk of clots

• ☕ Caffeine + stimulants

  • Increases:

    • Heart rate

    • Anxiety

    • Blood pressure

• 🍺 Alcohol + sedatives/opioids

  • 👉 Risk for respiratory depression & death

• 🥛 Calcium/dairy + some antibiotics

  • Decreases absorption (esp. tetracyclines, fluoroquinolones)

✅ NCLEX Rule:
If a med level is “off” → think FOOD interaction

✅ SLIDE 44 — Question #3

❓ Question:

True or False?
The bed should be put flat when the client is receiving a tube feeding.

✅ SLIDE 45 — Answer to Question #3

✅ Correct Answer: FALSE

🔑 Rationale:

• The head of the bed must be elevated ~30°

• If the bed is flat:

  • Stomach contents can move upward

  • Patient can aspirate

• This can cause:

  • Aspiration pneumonia

  • Respiratory failure

  • Death

✅ Examples:

• Nurse lowers bed to change sheets during feeding → dangerous

• Patient receiving NG feeds → must stay at 30–45°

✅ NCLEX Priority:
👉 HOB UP during tube feeding — ALWAYS