Diet Instruction: Full Liquid Diet

Transcription

1 Diet Instruction: Full Liquid Diet Liz DeJulius KNH 413 Description of patient and diagnosis Susan, a 21 year old woman, who was diagnosed with Irritable Bowel Syndrome (IBS) and Crohn s disease. After her initial diagnosis, she was treated with medications (anti-inflammatories, antibiotics, antidiarrheals, corticosteroids, and immune suppressing) that aimed to reduce symptoms of pain and diarrhea. Although she was compliant with her medication regimen, her body did not respond to the medications. She was admitted to the ED with severe abdominal pain, diarrhea, and a fever. A blockage in her intestine was detected, and it was decided that surgery was necessary to remove the blockage. Post-operation, she was put on parenteral nutrition to supply her body with nutrients but bypassing her intestinal tract while it healed. Her body responded well to the surgery, and she was eventually taken off parenteral nutrition. In order to ensure complete healing, Susan was temporarily prescribed to be put on a full liquid diet. Discussion of the disease A full liquid diet may be necessary for people prior to a medical test, procedure, or operation or those who have difficulty swallowing or chewing. Additionally, full liquid diets may be temporarily necessary for patients who have had surgery on their stomach or intestines to promote adequate healing and prevent infection. The diet includes only fluids and foods that are in the liquid form or turn into liquid at room temperature. Unlike a clear liquid diet that is not nutritionally adequate, full liquid diets have enough calories, protein, and nutrients to meet daily calorie and protein requirements. Because of this, they can be followed for a long time; vitamins and supplements may be recommended from a physician if the diet is followed for more than two to three weeks. The caloric goal on a full liquid diet is between 1,35 and 1,5 calories and 45 grams of protein per day. No solid foods may be consumed on this diet, including large pieces found in liquids such as chunks in soup or ice cream. Creamy soups and ice creams (at room temperature) can be consumed as long as they are strained. The following list describes foods that are classified as safe on a full liquid diet: o Fruit or vegetable juice (juices with pulp may be tested for tolerance), Jell-O, milkshakes, pudding, popsicles, tea, coffee, butter/margarine, oil, cream, custard, sherbet, frozen yogurt, sugar, honey, syrups, soup broth, soda (ginger ale or Sprite), and nutritional supplements such as Boost, Ensure, Resource, or Sustacal. Those who are lactose intolerant should be cautious of the liquids consumed. Additionally, surgery may cause lactose to be hard to digest in the stomach, causing the patient to avoid dairy products. Milk, lactose, milk solids, whey, curd, caseinates,

2 skim milk solids, and skim milk powder should be avoided. Soy or rice milk may be supplemented for these foods. Foods that may need to be checked for tolerance include: cooked, refined cereals (Cream of Wheat, cream of rice, oatmeal, grits, or farina), strained meats (in baby food), and potatoes pureed in soup. Physicians should be consulted before including these foods into a full liquid diet. Foods that may not be included in the diet are: cheese, fruit (fresh, frozen, or canned), meat, cereals not approved by a physician, vegetables (raw or cooked), frozen desserts/ice cream with solids in or on top (such as nuts, chocolate chips, cookie pieces). Liquid foods do not include mashed foods such as mashed potatoes or avocado. Consuming a variety of foods will ensure maximum nutrient consumption, which will aid in the healing products. Patients should aim to mix five to seven of the approved foods in each meal. Additionally, consuming enough calories is important for tissue healing. Strategies to increase calorie content in a full liquid diet include: adding nonfat dry milk to drinks, instant breakfast powder to milk, pudding, custards, and milkshakes, strained meats added to broths, butter or margarine added to hot ceral and soups, and sugar/syrup added to beverages. If necessary, nutritional supplements may be necessary to obtain adequate nutrients and calories. Medical Nutrition Therapy Susan is going to follow a full liquid diet for 2 weeks. I am going to discuss the all of the approved foods with her, foods to avoid, and relate this information back to her preferences. I have created a sample diet plan that she may follow as a reference (see handout). I will also have Susan log how each day goes on the diet and how her body is responding to certain foods. After one week, we can evaluate how the diet and her body are doing and progress from this point. Susan is going to aim for 1,4 calories per day and 45 grams of protein per day. The following calculations were used to determine her nutrient needs: CHO: 6% 14 x 6% = 84 kcal/4 kcal = 21 g CHO per day FAT: 27% 14 x 27% = 378 kcal/9 kcal = 42 g FAT per day PRO: 13% 14 x 13% = 182 kcal/4 kcal = 45 g PRO per day Susan s favorite foods: chocolate bars, chicken breast with gravy, apples, and carrots

3 Prognosis I will work the flavors of Susan s favorite foods into her full liquid diet by providing food sources with similar tastes. For example, instead of eating chocolate bars, she could try a chocolate milkshake or chocolate custard. Instead of chicken breasts with gravy, she could try cream of chicken soup that is strained. To provide the same taste of apples and carrots, she could drink apple juice or carrot juice. Susan is expected to have good response to the full liquid diet. As long as she notes which foods are tolerated and is compliant with the diet regimen, her body will be able to heal fully within the next two weeks. After an RD and physician assess her following the diet, she may proceed to her normal diet in relation to her Crohn s. A full liquid diet is adequate in nutrients, calories, and protein, thus Susan should heal fully (Nelms, p. 68).

4 References Nelms M, Sucher K, Lacey, K., Habash, D., Roth S. Nutrition Therapy and Pathophysiology. 2nd ed. Belmonte, CA: Thomson Brooks/Cole, 21.

5 Sample Menu for a Full Liquid Diet Meal Suggested Foods/Beverages Kcal PRO (g) FAT (g) CHO (g) Breakfast ½ cup orange juice ½ cup cream of Wheat 1 cup 2% milk Coffee Snack Chocolate milkshake (4 oz.) Lunch Cream of chicken soup, strained ½ cup strawberry Jell-O ½ cup carrot juice Dinner Strained meat Beef broth ½ cup apple juice 1 cup skim milk Grape juice popsicle Snack ½ cup vanilla pudding Ginger ale (12 oz.) Total

6 Food Group Foods Allowed Foods to Avoid Fruits Fruit juice *Beware tolerance of pulp Fruit ices and popsicles Fresh, frozen, canned Vegetables Vegetable juices Fresh, frozen, canned Potato pureed in soup *Check with Physician Dairy Cereals Meats Milk and milk drinks (shakes, eggnog, yogurt) *Beware of lactose tolerance Cream Custard Pudding Ice cream, melted Frozen yogurt, melted Cooked, refined cereals (Cream of Wheat, cream of rice, oatmeal, grits, farina) *Check with Physician Strained meats (in baby food) *Check with Physician No large pieces in/on top of ice cream No large pieces in/on top of frozen yogurt All others All others Cheese None Avoid all Miscellaneous Jell-O desserts Sherbet Butter/margarine Popsicles Honey, syrup Soup broth *Strain cream soups No solids within soups Beverages Soda (Ginger ale and Sprite) Avoid alcohol *Could cause dehydration Liquid supplements (Boost, Ensure, Resource, Sustacal) Tea or coffee

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