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Bryn WilkinKNH 413Medical Nutrition Therapy Diet – Soft Diet 1. Purposea. Nutrition IndicatorsA soft diet is used for patients who cannot tolerate a regular diet, and can be used as a transition diet from full liquids to solid foods. Soft foods may be recommended for patients who are unable to swallow normal food items due to a stroke, oral surgery, metabolic stress, etc. A speech-language pathologist would accurately diagnose this diet. However, a dietitian may recommend a soft diet prescription if they notice difficulty chewing, swallowing, dental problems, weakness, stomach discomfort, head or neck trauma, or a patient is taking chemotherapy. b. Criteria to Assign the DietThere are several criterions that are used to assign a soft diet. The patient must show GI tolerance of a full liquid diet before transitioning to a soft diet. In addition, a speech pathologist should test the patient in order to ensure that they are capable of chewing and swallowing the foods in a soft diet. A dietitian should feel confident that the patient will be compliant with a soft diet before prescribing it. Finally, the patient’s GI tract should be tolerating a full liquid diet with no negative side effects such as the presence of steatorrhea, diarrhea, or vomiting. c. Rationale for DietThis diet is most often used as a transition diet. The soft diet should be used to increase a patient’s tolerance to solid foods. As a patient’s GI tract improves, a soft diet can be used to slowly introduce solid food and the required digestion to the body. This diet allows for some bowel rest as the patient begins to return to a regular diet. 2. Populationa. OverviewA soft diet is most often used as a transition diet for people who are recovering from surgery. Many times a soft diet will be used after an individual undergoes gastrointestinal surgery or resection. The soft diet is part of a progression that comes after a full liquid diet. Although there are many surgeries where a soft diet may be prescribed, the following example covers how a soft diet would incorporated into a patient’s recovery from a bowel resection, as the result of damage from Crohn’s disease or ulcerative colitis. b. Disease ProcessInflammatory bowel disease (IBD) is defined as an autoimmune, chronic inflammatory condition of the gastrointestinal tract. It can be used as a general term to describe one of two diseases: ulcerative colitis, and/or Crohn’s disease. The complete etiologies for both inflammatory bowel diseases are not known. However, it is clear that environmental factors play a part in causing an abnormal inflammatory response. These factors include smoking, infectious agents, intestinal flora, and physiological changes in the small intestine. There is also a strong connection between IBD and family history. These genetic associations have been connected within both the innate and acquired immune response. (Nelms, pg. 415-417)c. Biochemical and Nutrient NeedsDepending on what part of the bowel is removed, the patient will have different biochemical and nutrient needs. If the jejunum is resected, it is very likely that the ileum will be able to adapt to absorb nutrients typically absorbed in the jejunum. The distal ileum is the only site for absorption of bile salts, vitamin B12 and also absorbs a large volume of fluid. The ileocecal valve is crucial in maximizing nutrient absorption. It controls the rate of passage of ileal contents into the colon. The colon is also essential for reabsorbing electrolyte-rich fluid each day and helps to maintain a person’s hydration status. Proper healing will require adequate protein and energy needs. Therefore, it may be necessary to supplement a soft diet with continued enteral feedings. 3. General Guidelinesa. Nutrition RxDiet Order: “Soft Diet” Purpose: To decrease peristalsis and limit stimulation of the GI tract. Often used as a transitional diet after surgery.General Description & Priniciples: Includes easily digestible foods that are low fiber, mildly seasoned, and tender. Omit caffeine and alcohol. b. Adequacy of Nutrition RxA soft diet nutrition prescription would be written to cover 100% of the patient’s energy needs via soft foods. However, depending on GI tolerance of the new diet, it is possible that a soft diet alone will not supply the patient with adequate nutrition. Therefore, it may be necessary to continue enteral feeding supplementation to ensure that the patient is receiving enough calories, protein, and micronutrients. c. GoalsOnce the patient begins a soft diet, it would be important to monitor the patient’s weight maintenance/gain to UBW, the redevelopment of bacterial flora in the GI tract, and nutrient absorption in the remaining small intestine. The patient’s blood panels should be evaluated, including levels of macro and micronutrients. In addition, it would be important to see signs of diet tolerance from the patient. The patient should not be experiencing excessive diarrhea or vomiting. In addition, the patient should not feel GI discomfort in the stomach or intestines. It would be important to monitor for signs and symptoms of steatorrhea or dumping syndrome. The goal would be for the patient to experience a smooth transition to the soft diet, with adequate energy and few negative clinical symptoms. d. Does it Meet DRIYes, a soft diet will meet the recommended energy allowances as specified by the DRIs. However, if patient compliance is low, or a new GI tract does not tolerate the diet, enteral supplementation may be required for adequate nutrition. 4. Education Materiala. Nutrition TherapyWhen an oral soft diet is first initiated, the patient should be given a low-residue, lactose-free with small, frequent meals—as tolerated. As the patient tolerates the mild diet, small amounts of fiber could be introduced. Foods that are considered to be “gas-producing,” such as spicy/fried foods or caffeinated beverages should be avoided. A multivitamin should be give throughout this time in order to ensure delivery of complete nutrition to the patient. In addition, probiotics should be incorporated into the diet in order to ensure that the patient’s new GI tract builds a new bacterial flora. The patient should be asked to maintain a food and exercise journal during their transition to the soft diet. In addition, the patient should note any episodes of vomiting, diarrhea, or steatorrhea. Compliance and tolerance of the diet should be evaluated during follow-up appointments. b. Ideas for ComplianceIncorporating some of the patient’s favorite foods into the diet can increase patient compliance. During an initial counseling session, the dietitian should try to modify the patient’s pre-surgery usual food intake to fall within the restrictions of a soft diet. In addition, the dietitian should involve a patient’s family in the counseling sessions. Involving family members and receiving their support for the new diet can greatly improve patient compliance – especially if the patient is an elderly client. Finally, the dietitian should inform the patient of the prognosis for their recovery. Inflammatory bowel disease can be managed by diet and exercise. A soft diet prescription is not a lifetime prescription. The client will be able to return to a regular diet if he or she is compliant with the current soft diet prescription. 5. Sample Menua. Foods RecommendedFood GroupRecommended Foods Grains Breads, biscuits, muffins, pancakes, waffles that have been well moistened with syrup, jelly, margarine, or butter. Well-moistened cooked or dry cereals. All pasta and noodles, rice, wild rice, and moist bread dressing.VegetablesTender-fried potatoes. All cooked tender vegetables. Shredded lettuce.FruitsAll canned and cooked fruits. Soft, peeled fresh fruits such as peaches, nectarines, kiwi, mangoes, cantaloupe, honeydew, watermelon (without seeds). Soft berries with small seeds such as strawberries.MilkMilk, cream, half and half, pudding, custard, ice cream, sherbet, malts, frozen yogurt, and cottage cheeseMeat and Other Protein Products Well-moistened, thin-sliced, tender, or ground meat, poultry, or fish with gravy or sauce. Eggs prepared in any way. Yogurt without nuts or coconut. Casseroles with small chunks of meat, ground or tender meats.b. Foods to AvoidFood GroupFoods Not Recommended GrainsDry bread, toast, and crackers that have not been moistened. Tough, crusty breads such as French bread or baguettes. Coarse or dry cereals such as shredded wheat or All Bran. Dry bread dressing. Dry cakes or cookies that are chewy or very dry.VegetablesAll raw vegetables expect shredded lettuce. Cooked corn. Tough crisp-fried potatoes, potato skins, or other fibrous, tough, or stringy cooked vegetables.FruitsDifficult to chew fresh fruits such as apples or pears. Stringy, high-pulp fruits such as papaya, pineapple, or mango. Fresh fruits with difficult to chew peels such as grapes. Uncooked dried fruits such as prunes and apricots. Fruit leather, fruit roll-ups, fruit snacks, dried fruits. MilkNone unless liquids are restricted.Meat and Other Protein FoodsAnything with nuts, seeds, dry fruits, coconut, pineapple. Tough, dry meats and poultry. Dry fish or fish with bones. Chunky peanut butter. Yogurt with nuts or coconut. Fats and OilsAll fats with coarse, difficult to chew, or chunky additives such as cream cheese spread with nuts or pineapple. c. Example of a meal planMealMenuBreakfast? cup (4 ounces) orange juice – no pulp? cup well-moistened dry cereal with ? cup of milk1 scrambled egg with cheese on a moist biscuit1 cup (8 ounces) milkLunch1 cup moist beef stew in small chunks with a variety of well-cooked vegetables1 slice moistened bread with butter or margarine? cup canned fruit salad? cup pudding with a moist cookie1 cup (8 ounces) milkDinner? cup potato soup made with milk1 slice moistened bread with butter or margarine3 ounces moist chicken on ? cup soft-cooked rice ? cup soft-cooked green beans1 slice apple pie with a moist crust, cheese wedge, and ice cream1 cup (8 ounces) milk 6. Websitesa. Organizations with WebsitesDigestive Healthcare of Georgia. (2013). Retrieved from: : Know more. Be sure. (2013). Retrieved from: , B. (2012). Nutrition Assessment. Retrieved from:uic.edu/depts/mcam/nutrition/ppt/nutrition_assessment.pptNutrition Care Manual. (2014). Soft Diet. Retrieved from: of Minnesota Medical Center: Fairview. (2014). Retrieved from: . Government Websites. Referencesa. Journal articles referencesNCBI Database. (2002). Short bowel syndrome: a nutritional and medical approach. Retrievedfrom: Database. (2009). Surgical therapy of recurrent Crohn’s disease. Retrieved from: ................
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