Nursing Pharmacology The seven rights of medication administration RIGHT DRUG RIGHT CLIENT RIGHT DOSE RIGHT TIME

RIGHT ROUTE RIGHT REASON RIGHT DOCUMENTATION General Principles in Drug Administration Whoever prepares the medication, administers and charts it Consult a drug reference manual or pharmacist for information on unfamiliar drugs For elderly clients: use devices like calendars, daily pill dispensers For pediatric clients, use syringe Obtain assistance of parents to hold child in position Assess clients allergy Check drugs expiry date Read labels three times before administration Wash hands before and after administration Do not let the tip of the tube/dropper touch the client Document administration on medication record and clients response to medication. For eye medication: Position: supine or sitting position with forehead tilted back slightly Medication is administered into the conjunctival sac For ointments, apply from inner to outer canthus ending it with a twisting motion Let the client close his eyes For liquid medications, press firmly nasolacrimal duct for at least 30 seconds If medication temporarily affects vision, instruct client not to move until vision is clearer Lift side rails and place call light within reach For ear (otic) instillation: Wash ear if excess wax in noted Position: Side-lying, sitting, or semi-Fowlers position For adults: pull auricle of ear up and back For children: down and back (<3 years) Instruct client to remain in position for 3-5 minutes For nasal instillation Cleanse nares Position: Sitting with head tilted slightly backwards, or supine with head tilted back in hyperextended position Hold dropper to inch above nares Instruct client to take one short deep breath after each instillation and to remain position for 3-5 minutes. For oral medication: Do not crush or chew enteric coated tablets. Many oral medications require administration with milk or food Schedule first doses of new medications on different hours from other medications For Pediatric Patients If drugs are being mixed with food or liquid, use only small amount Medicine can also be given through nipples or droppers Toddlers: allow to choose on method of delivery- spoon, dropper, syringe, and allow to help Position: Semi-Fowlers or sitting Instruct client to place tablets/ capsules at the back of the throat and to follow with enough liquid Administer liquid medications after pills Remain with the client until all the medications are taken. Check the clients mouth Check client 30-60 minutes later for effects of medication.

For buccal and sublingual medication Place under the tongue (sublinggual) and between cheek and gum (buccal) If clients mucous membranes are dry, offer a sip of water DRUGS 1.Local anesthetics: -blocks nerve conduction -metabolized by hepatic enzymes -produces temporary loss of sensation and motion in a limited area of the body. E.g: Procaine (novocain),Benzocaine (americaine),mepivacaine (carbocaine) Nursing implications: a. force fluids b. keep side rail-up LIDOCAINE TOXICITY SLURRED SPEECH ALTERED CNS MUSCLE TWITCHING SEIZURES 2. Non narcotic analgesics and antipyretics Aspirin -analgesia -antipyretic -anti-inflammatory -anti-platelet Acetaminophen/Tylenol -Analgesic,antipyretic -Antidote: acetylcysteine (mucomyst) -monitor liver/kidney function and CBC. SALICYLATE POISONING TINNITUS LETHARGY/EXCITABILITY, HYPERVENTILATION HYPERTHERMIA METABOLIC ACIDOSIS NONNARCOTIC ANALGESICS AND ANTIPYRETICS Nursing Implications Monitor CBC, PT, kidney and liver function studies Additive effects if with use with anticoagulants Drink plenty of fluids Take with food or fluids. Never given with children/adolescents with flu/ chicken pox Dont crush enteric-coated tablets. Avoid intake of alcohol stop therapy one week before surgery 3. Narcotic analgesics Codeine hydromorphone (dilaudid), meperidine (demerol), methadone, oxycodone HCL -induces sedation, analgesia and euphoria. -relief of moderate to severe pain in MI. - relief of dyspnea in Pulmonary edema or Left ventricular failure. Nursing Implications: -assess pain before giving -monitor RR -change position slowly -check urinary retention -nalaxone (narcan) available 4.Sedative and Hypnotics Eg. Phenobarbital-luminal Diazepam-Valium Hinders movement of impulses from thalamus of the brain cortex. Creates depression in the CNS Nursing Implications: Deep IM IV adm. monitor insertion sites for extravasation

Tablet can be crushed and mixed with food/fluids Teratogenic 5. Anticonvulsants Barbiturates (phenobarbital) -for gen. and absence seizures Benzodiazepines (valium) -drug of choice for status epilepticus Hydantoins (dilantin) -prevents dissemination of electrical discharges in motor cortex area of the brain Succinimides (zarontin)/valporic acid (delpakene) -absence seizures Acetazolamine (diamox)/ Tegretol -diuretics,absence,tonic-clonic or myoclonic seizures. Nursing Implications -7-10 days therapeutic level -turn urine pink, red or red-brown. -not given IM -gingival hyperplasia -caution use in pregnancy ENDOCRINE DRUGS 1. ANTIDIABETIC AGENTS Insulin Adverse Effects: Allergy Hypoglycemia Lipodystrophy Nursing Implications: Do not inject cold insulin. Discard discolored solutions or those with precipitates. Do not shake vial. Draw up clear insulin first. Rotate injection sites Monitor blood glucose levels regularly. Inform patients regarding signs of hypoglycemia and appropriate treatment. If ill continue taking insulin and drink freely nancaloric liquids. Inform regarding avoidance of smoking. Oral Hypoglycemic agents a. Sulfonylureas promotes inc. insulin secretion from pancreatic beta cells First-Generation Agents: Tolbutamide, Acetohexamide, Tolazamide, Chlorpropamide Second-Generation Agents Glypizide, Glyburide b. Biguanides reduces hepatic production of glucose by inhibiting glycogenolysis decrease the intestinal absorption of glucose and improving lipid profile Agents Phenformin , Metformin , Buformin c. Alpha-glucosidase inhibitors Inhibits alpha-glucosidase enzymes in the small intestine and alpha amylase in the pancreas Decrease rate of complex carbohydrate metabolism resulting to a reduced rate postprandially. Agents Acarbose (precose), Miglitol (glyset) Nursing implications: Tablets should not be crushed Monitor for signs of hypoglycemia Use other forms of contraception aside from OCPs Alcohol can trigger a hypoglycemic effect. Cover body is sunshine. Use of sunscreen. Sulfonylureas are best taken before meals Monitor for drug to drug interactions. CORTICOSTEROIDS

Cortisol, hydrocortisone, prednisone, prednisolone, methylprednisone, triamcinolone, dexamethasone Mineralocorticoid (fludrocortisone) Uses: Replacement therapy for adrenocortical insufficiency Anti-inflammatory agent Adverse effects: 1. Altered protein metabolism Muscle wasting Osteoporosis Easy bruisability 2. Altered fat metabolism Moon facies Buffalo hump Truncal obesity hyperlipidemia 3. Altered carbohydrate metabolism Hyperglycemia Altered immune response Sodium and water retention Hypertension 7. Hypokalemia, metabolic alkalosis 8. Emotional instability 9. Excessive androgen activity 10. Gastric irritation Nursing Implications: Review patients medical history prior to giving the drug Administer in light-resistant containers Observe for mental changes. Monitor for BP, weight, I and O, glucose, electrolytes. Take with food or milk. Take drug before 9 AM. Never abruptly stop taking the drug Teach patient ways to prevent infection. Restrict sodium, alcohol and caffeine intake. Increase intake of foods high in potassium. Rinse mouth after using inhaled steroids Teach patient to avoid strenuous activities and falls ANTITHYROID DRUGS Propylthiouracil (PTU) and methimazole Mechanism of action Blocks thyroid hormone synthesis Adverse effects: Skin rash Urticaria Agranulocytosis Hepatitis Myalgia Headcahe Hypoprothrombinemia hypothyroidism Nursing considerations Give the drug with meals to reduce GI effects Watch for signs of hypothyroidism WOF: Agranulocytosis Instruct patient to report for skin eruptions The drug should be stopped if severe rash develops or cervical lymph nodes become enlarged Advise patient to avoid foods high in iodine or potassium Warn the patient against the use of the over-the-counter medication Store the drug in a light-resistant container Monitor for weight and PR regularly. SSKI/Lugols solution Potassium or sodium iodide (potassium iodide SSKI), strong iodine solution (Lugols solution) Treatment for thyrotoxic crisis Mechanism of action:

Inhibits the release and synthesis of thyroid hormones Decreases the vascularity of the thyroid gland Decreases thyroidal uptake of radioactive iodine following radiation emergencies or administration of radioactive isotopes of iodine Adverse Effects: Unpleasant tase Hypersalivation Acne Rashes angioedema Burning sensation THYROID HORMONES Levothyroxine Liothyronine Thyroglobulin (Proloid) Adverse Effects: Signs of hyperthyroidism Nursing Implications: Different brands of levothyroxine may not be bioequivalent Warn the patient (especially the elderly) to tell the doctor if with signs of hyperthyroidism Instruct the patient to take thyroid hormones at the same time each day to maintain constant hormone levels. Nursing Implications: Medications taken in the morning Monitor apical pulse and blood pressure. If pulse is >100 bpm, withhold the drug Store in air-tight and light-resistant containers Monitor prothrombin time; a patient taking these hormones usually requires less anticoagulant OXYTOCIN Uses: Promotion of uterine contractions Control of bleeding Release of milk from breast Oxtocin-related drugs: Methergine Ergonovine Adverse Effects: Tachycardia Water intoxication Uterine rupture Nausea and vomiting Cardiovascular collapse Anaphylaxis Hypertension (oxytocin-related drugs) Nursing Implications: Use infusion pump for administration. Never give IM Monitor BP, heart rate and I and O. Regularly monitor for uterine contractions and FHR. Discontinue if: With note of tetanic uterine contractions. Signs of fetal distress Urinary flow is less than 30 ml/hour Signs of abruptio placenta and uterine rupture For ergonovine/methergine- C/I for patients with vascular, renal and hepatic problems Ophthalmic Drugs A. Mydriatics and Cycloplegics -Atropine, Cyclogyl -causes mydriasis (dilatation) and cyloplegia, w/c paralyzes the lens and eye muscles. Nursing Implications: -sunglasses -artificial tears -elderly caution to atropine-IOP B. Miotics Acetylcholine (miochol)

Carbachol (isopto carbachol) Pilocarpine -causes miosis (contraction) of pupils and ciliary muscles -decreases IOP Cardiovascular Drugs Cardiac Glycosides Digoxin (Lanoxin) -increases force of myocardial contraction (+ inotropic effect - improves blood supply to vital organs and kidneys, providing a diuretic effect. -decreases rate of contraction (- chronotropic effect) -CHF,Atrial fibrillation, atrial flutter,paroxysmal atrial tachycardia. Cardiovascular Drugs Nursing Implications: -avoid high Na, increase K -Antidote: digoxin immune Fab (digi-bind) Hold if apical pulse: -infants: below 90 beats -children/adolescence: below 70 -adults: below 60 or above 120. Monitor serum digoxin levels: 0-5 to 2.0ng/ml. Anti anginal Drugs Nitrites & Nitroglycerin -dilates the peripheral vascular smooth muscles of small vessels. -decreases cardiac pre load and after load.- decreased myocardial oxygen needs -dilates large coronary arteries,which helps decrease anginal pain & hypoxia of the myocardium Anticoagulants Heparin -blocks conversion of prothrombin to thrombin and fibrinogen to fibrin Warfarin (coumarin) -blocks prothrombin synthesis -takes 2-5 days effect Thrombolytic Drugs Streptokinase Activase, urokinase -when use in treatment of MI, start therapy within 6 hours of attack. - corticosteriods -given to decrease allergic reaction -Reconstitute it with normal saline or 5% dextrose solution -Avoid IM route -Antidote: Aminocaproic acid Antihypertensives ACE INHIBITORS - CAPOTEN/CAPTOPRIL, VASOTEC/ENALAPRIL, LOTENSIN/BENZAPRIL BETA BLOCKERS- INDERAL/PROPANOLOL, TENORMIN/ATENOLOL CALCIUM ANTAGONIST- CALAN ISOPTIN/VERAPAMIL, CARDIZEM/DIALTIZEM, PROCARDIA/ NIFEDIPINE Nursing Implications -avoid alcohol & hot showers -low Na diet -change position gradually -monitor CBC,E+,urinalysis Diuretics Thiazides: hydrochlorothiazide (Hydrodiuril) Chlorathiazide (Diuril) - Blocks Na reabsorption in the distal convoluted tubule,which prevents H20 reabsorption -increases urine output -decrease blood volume -K excretion

-use in HPN, edema with CHF Nursing Implication: -take early am & after meals -agranulocytosis -take high K diet -change position gradually -daily weights Loop Diuretics Furosemide ( lasix ) -Acts by inhibiting reabsorption of Na and CL at the proximal portion of the ascending loop of Henle,increasing H2O excretion. -use in HPN, Pulmonary edema, cirrhosis, renal disease Nursing Implications -take with meals -monitor for hearing loss -use with 5 % dextrose in water, NaCL & LR -incorporated lasix should be use in 24 hours -take dose in am -diet high in K -stay out of sun, use sunscreen K-sparing diureticss spironolactone ( aldactone ) -blocks aldosterone receptors in the kidney tubules,thus causing excretion of water & sodium & K retention Nursing Implications: - may last 2-3 days after drug is stopped -avoid high K diet Osmotic Diuretics (mannitol) -acts by increasing osmotic pressure of the glomerular filtrate inside the renal tubules -this causes less reabsorption of F & E+ by tubules & increase loss of Fluid,CL & Na. Nursing Implications: -warm solution to dissolve crystal -used IV filters -I&O q 30 minutes -Signs of ERespiratory Drugs A. Antiasthmatic Drugs Theophylline,Aminophylline -relaxes bronchial smooth muscles cells -increases renal blood flow, producing diuretic effects and acts as CNS stimulant. Respiratory Drugs Nursing Implications -theophylline level: 10-20 mcg/ml -with milk or meals:GI upset present -not present give 1-2 hours before meals with water -avoid excessive caffeine B. Cromolyn sodium -acts on lung mucosa to prevent histamine release C. Mucolytics -reduces the viscosity of mucus in the bronchial tree GIT Drugs A.Histamine (H2) antagonists Cimetidine (Tagamet) -Decreases stomach acidity by impending the action of histamine -Competes with Histamine for occupancy of H2 receptors site on the parietal cells in the stomach -Suppresses the release of gastric acid

Nursing Implications: -antacids decreases absorption -4-6 weeks treatment ,ulcer disease. -toxic effect: confusion B. Antidiarrheals agents Absorbent -Pepto-bismol -kaopectate Opiate -Imodium -Lomotil -Paregoric Nursing Implications: -not taken with CNS depressants C. Laxatives -use to promote movement of feces Ex. Dulcolax, Lactulose, Metamucil Nursing Implications: -not given with nausea, vomiting, abdl pain, s/s appendicitis or intestinal obstruction D. Ipecac Syrup -irritates the GIT to induce vomiting / delaying the absorption time of toxic substances Nursing Implications: -emesis should occur w/in 20-30 min -repeat dose -less than 10 yrs old,one dose only -not given: corrosive,petroleum based or cyanide E. Anti gout Allopurinol (Zyloprim) - prevents production of uric acid Nursing Implications: -force fluid:2-3 liters -take after meals -monitor Liver function test/CBC Colchicine (Novocolchine) -drug of choice for acute gouty attacks -decreases the inflammatory response to deposits of monosodium urate crystals Nursing Implications: -acute attack: given 1-2 hrs until pain ceases Antimicrobials A. Aminoglycosides: Gentamicin (Garamycin) -bactericidal Nursing Implications: -caution with decreased renal function, reduced hearing, dehydration,neuromuscular disorders -adequate hydration B.Penicillin G Potassium (Pentids) -Bactericidal Nursing Implication: -check allergic reactions -Skin test -give oral tablet empty stomach, with full glass of water -monitor CBC, BUN, Creatinine C. Cephalosporins: -Bactericidal Nursing Implications: -IM: rotate sites -Assess for hx.of penicillin allergy: cross allergy between cephalosporin & penicillin

-reduce dose with renal/liver problems. -Thrombophlebitis: long IV administration. Report diarrhea,rash,hives,dyspnea, bleeding D. Erythromycin: -Bacteriostatic Nursing Implications: -do not crush enteric coated tablet -take in empty stomach ,full glass of water -do not give w/ antacids -GI s/s are dose related E. Tetracyclines -Bactericidal Nursing Implications: -avoid with pregnant women Nursing mothers, Children under 8 y/o as drug binds to calcium in teeth & new bone growth -lead to tooth discoloration of permanent teeth & retarded bone growth. -Avoid taking w/ dairy products, antacids, vitamins, minerals. -take 1 hr before meals,2 hrs after meals. -report diarrhea episodes F. Urinary-Anti-infectives Nitrofurantoin (Macrodantin) -Bacteriostatic Nursing Implications: -monitor pulmonary ,neurologic status -give w/ milk or meals -avoid crushing tablet: tooth staining -dilute suspension -rinse mouth -nausea/vomiting common effect G.Vancomycin HCL (Vancocin) -Exhibit bactericidal & Bacteriostatic effect. Nursing Implications: -monitor renal/auditory function test -adm.IV slow 60 minutes: prevent phlebitis, extravasation, red-neck syndrome ( fever, hives, rash & redness of the face) H. ciprofloxacin (Cipro) -Bactericidal Nursing Implications: -adm. with large glass of water -do not give with antacids -give 2 hours after meals I. Antitubercular Drugs Isoniazid (INH) -Bacteriostatic, If high concentration becomes Bactericidal Nursing Implications: -assess neuromuscular function -give B6 pyridoxine -empty stomach-single daily dose -with meals & divide daily dose into 3 equal parts: GI upset. Ethambutol (Myambutol -report any s/s blurring of vision (unable to see red or green) -Caution with renal impairment .Rifampin (Rifadin, Rimactane) -expect orange tinged body fluids -report anorexia,nausea/vomiting, jaundice, malaise,dark urine Computations Preparing Solutions 1. Liquid to Drug Solutions

Determine the strength of the solution, the strength of the drug on hand and the quantity of the solution required Formula Dose = Amount of Solution Strength on hand Example You have a 100% solution of hydrogen peroxide on hand. You need a liter of 50% solution. 50 X 1000 ml = 500ml 100 Solid Dose of Oral Administration Physician orders patient to have 1.0 g of ampicillin. The ampicillin bottle states that each tablet in the bottle contains 0.5 g. 2 Methods dosage desired = 1.0 g = 2 dosage on hand 0.5 g Exercise The physician order 1000 mg of ampicillin. On hand: 0.25 grams per tablet. X= Liquid Dose of Oral Administration 30 ml = 1 oz Physician orders 60 ml of a liquid medication. How many ounces will be given? Physician orders 45 ml. How many ounces will be given? Liquid Dose of Oral Administration Order: 500 mg;Dose at hand: 250mg/5 ml. How many ml will be given? Formula: D/H x Q 500/250 x 5 ml= 10 ml Order: 250 mg; dose at hand: 125 mg/ml Order: 500 mg; dose at hand: 125 mg/ml Calculation of Flow Rates Drops/ min Formula: vol in ml x gtts (ugtts)/ml = drops/min time in minutes Infuse 1000 ml Lactated Ringers (LR) solution over 10 hour to a 40 year old male. 1000ml x 15 gtts/min = 25 gtts/min 10 hrs x 60 min/hr Infuse 1 liter of 0.9 NACl over 8 hours using 10 gtt factor. Infuse 500ml of .45 NaCl over 12 hours to a 3-year-old child. Milliliters per Hour (ml/hr) Formula: Volume in ml Total # of hours= ml/hr Infuse 1000 ml Lactated Ringers (LR) solution over 10 hour. 1000 ml 10 hour = 100 ml/hr Drugs ordered in Units per Hour or Milligrams per Hour Doctors order: mix 10,000 U heparin in 1000 ml D5W; infuse 80 units per hour 1000 ml : 10,000 units :x ml : 80 U/hr 10,000 units x =80,000 ml-U/hr 10,000 U 10,000 U x= 8 ml/hr milliliters per hour Mix 10,000 U heparin in 1000 ml D5 W; infuse at 15 ml/hr. How many units of heparin are being delivered per hour? 1000 ml : 10,000 U : : 15 ml : x U 1000 ml X = 150,000 U-ml 1000 ml 1000 ml x= 150 U Calculation of Flow Rates Milliliters per Hour (ml/hr) Formula: Volume in ml Total # of hours= ml/hr

Infuse 1000 ml Lactated Ringers (LR) solution over 10 hour. 1000 ml 10 hour = 100 ml/hr NUTRITION Food Pyramid Bread, cereal, rice, pasta- 6-11 Fruit- 2-4 Vegetable- 3-5 servings Milk- 2-3 servings Meat, poultry, fish, dry beans, eggs, nuts- 2-3 servings Fats- use sparingly K Caloric Values Carbohydrates 4 Protein 4 Lipids (Fats) 9 Vitamin B1, (Thiamine) Vitamin B2, (Riboflavin) Vitamin B3, also Vitamin P (Niacin) Vitamin B5, (Pantothenic acid) Vitamin B6, (Pyridoxine) Vitamin B7, also Vitamin H (Biotin) Vitamin B9, (Folic acid) Vitamin B12, (Cyanocobalamin) Thiamine (B1) A coenzyme Need increases as metabolism increases Sources: lean pork, whole grains, legumes, seeds, nuts Deficiency: Beri-beri Wernicke-Korsakoff syndrome Riboflavin (B2) Coenzyme Sources: enriched grain, broccoli, asparagus, dark leafy vegs, milk, meat, fish, poultry Deficiency: Ariboflavinosis Niacin (B3) Active vitamin percursor Sources: meat, poultry. Fish, legumes. Milk, coffee ands tea Def: Pellagra ( diarrhea, dermatitis, dementia Pyridoxine (B6) deficiency causes blood, skin, and nerve changes. This vitamin is unique in that both deficiency and excess can cause peripheral neuropathy Biotin (B7) Assist in transfer of carbohydrate from one a compound to another Deficiency: dry scaly rash, hair loss, loss of appetite, depression, glossitis Sources: liver, kidney, peanut, egg yolk Folic Acid (B9) Coenzyme Sources: green leafy vegs, fruits, juice, legumes deficiency: in pregnant women, can lead to neural tube defects Cyanobalamin B12 Coenzyme Sources: meat, chicken, fish, pork, eggs, dairy products Deficiency: Pernicious anemia Vitamin C Anti oxidant; collagen formation Enhances absorption of iron RDA 90-125mg/day Deficiency: scurvy Vitamin A Maintains skin and mucous membranes throughout the body Vision, immune system, bone growth Sources: Whole milk, butter, liver, egg yolks, fatty fish Carotenoids: deep green, yellow, orange fruits

Deficiency: Xeropthalmia night blindness keratomalacia Toxicity: Hypervitaminosis A Vitamin D Enhance absorption of calcium Deficiency: Rickets Osteomalacia Osteoporosis Toxicity: hypercalcemia Vitamin E Anti oxidant aphrodisiac Sources: vegetable oil; margarine Whole grains, seeds, nuts, wheat germ, green leafy vegetable May interfere with Coumadin Primary deficiency: rare Vitamin K Cofactor in synthesis of blood clotting Sources: bacteria in GIT Liver production Sources: green, leafy vegetable Lesser amt in cereals, dairy products, meats and fruits Calcium Nerve impulse Muscle contraction and relaxation Blood clot Blood pressure regulation Sources: Milk and milk products except cream cheese and butter Broccoli Small fish with bones +Tea and tannins reduce absorption of calcium+ Deficiency: osteoporosis Toxicity: urinary stone iron Responsible to distribute oxygen throughout our body Found in RBC, muscles Spleen and liver Deficiency: anemia Toxicity: hemosiderosis zinc Growth processes, taste, smell, healing process, immune system, carbohydrate metabolism by assisting insulin function Found in: meat, fish, poultry, whole grains, legumes, eggs Deficiency: related to function Dwarfism, hypogonadism, hypogeusia, hyposmia poor wound healing, reduce immunity toxicity: Vomiting, diarrhea, fever, exhaustion iodine Part of thyroxine Increase in hypothyroidism Decrease in hyperthyroidism Water Fluid in which the substances can be use by the body Provides a means of transportation for nutrients to and from cells 8 glasses of water/day Clear liquid diet Illness or surgery, acute inflammatory conditions of the GIT, for conditions requiring decreased fecal material

Inadequate in nutritional essentials liquid at room temperature; Use for 1 -2 days only Clear fat free broths , strained juices, tea and coffee , salabat, plain gelatin , sugar plain, hard candies Full liquid diet Post op , acute infection, acute inflammatory conditions of the G.I.T. for patients too ill to eat solid or semi solid foods, impaired chewing and swallowing ability Liquid at room temp. and free from cellulose and irritating spices and condiments. 6-8 small feedings recommended Strained cream or soups, pureed strained meat and fish, strained fruit juices ,plain ice cream and custard, cornstarch pudding and milk and cocoa Soft Diet Patients who are unable to chew, swallow or digest foods Modification in consistency and texture Foods low in cellulose content, low in fiber free from connective tissues and strong flavors, simple and easily digested Low residue diet Dysentery , diarrheas , pre-op and post op when it is desired to reduce fecal residue, as in colostomy, ileostomy , and bowel resection foods which form least amount of fecal matter; may require supplementation Cereals strained soups, chicken Bland diet Gastric and duodenal ulcers, gastritis , ulcerative colitis Foods are non irritating Mildly flavored foods without fiber, connective tissue avoid alcohol , coffee black pepper and chili powder High fiber diet Atonic constipation, Atherosclerosis, diverticulosis, DM Full diet with emphasis on long fibered vegetables , raw fruits and vegetables, whole grain cereals and coarse breads High caloric Underweight, protein energy malnutrition, fevers and infections, hyperthyroidism, burns, growth pregnancy and lactation 3 meals with in between feeding gradual rather than drastic. Vitamins and minerals at or above RDA. Contains greater amount of total energy Cereals, bread, butter , cream and other fats and sugar Low caloric Obesity and those cases where excess weight is a complicating factor as DM, CVD, renal, HPN, gout, gall bladder and preceding surgery Contains reduced amount of energy to effect a negative energy balance Sufficient bulk , low in calories . Avoid high fat foods and high CHO foods End**** Mbc5/08