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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.
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.
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.
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.
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 doesnot 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.
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.
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.
(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.
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.
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.
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.
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.

A vegetarian diet focuses on plants for food. These include fruits, vegetables, dried
beans and peas, grains, seeds and nuts. There is no single type of vegetarian diet.
Instead, vegetarian eating patterns usually fall into the following groups:
The vegan diet, which excludes all meat and animal products
The lacto vegetarian diet, which includes plant foods plus dairy products
The lacto-ovo vegetarian diet, which includes both dairy products and eggs

Low-Residue Diet
This diet is designed to reduce the frequency and volume of fecal output while
prolonging intestinal transit time. Indigestable carbohydrate intake is reduced by
limiting ingestion of fruits and vegetables to limited amounts of well-cooked or
canned vegetables and canned, cooked, or very ripe fruits, and by replacing whole-
grain breads and cereals with refined products. Legumes, seeds and nuts are
omitted.
Guidelines:
Buy breads and cereals made from refined wheat and rice. Avoid whole-grain
products with added bran.
Remove skin from vegetables and fruits before cooking.
Avoid any food made with seeds, nuts, and raw or dried fruits.
Limit milk and milk products to 2 cups daily.
Sample Menu:
Breakfast:
cranberry juice (1/2 C)
puffed rice cereal (3/4 C)
canned peaches (1/2 C)
white toast (2 slices)
margarine (2 tsp)
jelly (1 tbsp)
2% milk (1/2 C)
Lunch:
lean beef patty (3 oz)
hamburger bun without seeds
mustard (1 tbsp)
ketcup (1 tbsp)
canned fruit cocktail (1/2 C)
vanilla wafer cookies (2)
2% milk (1 C)
Dinner:
strained tomato juice (1/2 C)
breaded baked chicken (3 oz)
white rice (1/2 C)
cooked carrots (1/2 C)
white dinner roll
margarine (2 tsp)
sherbert (1/2 C)
2% milk (1 C)
Afternoon Snack:
applesauce (1/2 C)
saltine crackers (2 squares)
Evening Snack:
fruit ice (1/2 C)
FOODS RECOMMENDED:
Breads/Grains:
Refined breads, toast, rolls, biscuits, muffins, crackers, pancakes, and waffles.
Enriched white or light rye bread or rolls.
Saltines, Melba toast
Refined ready-to-eat cereals such as puffed rice and puffed wheat
Cooked refined wheat, corn, or rice cereal
Strained oatmeal, grits and farina
Refined cold cereals made from rice, corn or oats (Rice Krispies, Cornflakes,
Cheerios)
White rice, refined pasta, macaroni, noodles
Vegetables:
Most tender cooked and canned vegetables without seeds such as carrots,
asparagus tips, beets, green or waxed beans, pumpkin, spinach, squash (acorn)
without seeds, potato (no skin), pureed or cooked strained lima beans, and peas (no
skin)
Fruits:
Most canned or cooked fruits, fruit cocktail, avocado, canned applesauce, apricots,
peaches, pears (all without skin and seeds), pureed plums and ripe bananas
Strained fruit juice
Milk/Dairy:
Milk, mild cheese, cottage cheese
Yogurt (no berries)
*limit milk/milk products to 2 cups per day
Meat:
Ground or well-cooked, tender beef, lamb, ham, veal, pork, fish, shellfish, and organ
meats
Eggs
Smooth peanut butter
Fat/Snacks:
Margarine, butter, vegetable oils, mayo, cream substitutes, crisp bacon, plain
gravies, and salad dressings
Broth, strained cream soups (no corn) made with allowed ingredients
Misc:
Salt, soy sauce, ketchup
Mild spices in moderation, white sauce
Sugar, honey, jelly, syrup
Lemon juice, vinegar, vanilla and other flavoring extracts
Decaffeinated coffee, herb tea, caffeine-free carbonated beverages and fruit drink
FOODS TO AVOID:
Breads/Grains:
Any bread product made with whole-grain flour or graham flour, bran, seeds, nuts,
coconut, or raw or dried fruit, cornbread, and graham crackers
Any whole-grain, bran, or granola ceral, oatmeal and cereal with seeds, nuts,
coconut or dried fruit
Bran, barley, brown and wild rice
Vegetables:
Raw vegetables and vegetables with seeds, sauerkraut, winter squash, and peas
Fruits:
Raw or dried fruit, all berries
Prune juice
Milk/Dairy:
Yogurt containing fruit skins or seeds
Strongly flavored cheeses
Meat:
Tough fibrous meats with gristle, shellfish with tough connective tissue
Meats prepared with whole-grain ingredients, seeds, or nuts
Dry beans, legumes, peas and lentils
Chunky peanut butter
Raw clams and oysters
Fats/Snacks:
Any made with whole-grain flour, bran, seeds, nuts, coconut, or dried fruit
Nuts, seeds, and popcorn
Pepper, chili pepper and other hot sauces
Chocolate, raisins, seeds, seed spices, pickles, olives, nuts, mustards, spicy
mustards and ketchups, relish, horseradish, vinegar
Highly spiced salad dressings
Jam or marmalade with nuts and seeds
Misc:
Beverages containing caffeine which is a stomach irritant.