Suggested Menu Plan for Clear Liquid Diet
| Breakfast |
| ½ c. fruit juice 6 oz broth 4 oz gelatin 8 oz tea or coffee |
| Lunch |
| ½ c. fruit juice 6 oz broth 4 oz gelatin 8 oz tea or coffee |
| Supper |
| ½ c. fruit juice 6 oz broth 4 oz gelatin 8 oz tea or coffee |
| Snack Ideas |
| ½ c. fruit juice 4 oz gelatin Popsicle Clear liquid nutritional supplement |
FULL LIQUID DIET
Use
The Full Liquid Diet has traditionally been prescribed for the postoperative patient between the clear liquid and postsurgical soft diet, however a literature search reveals there are no data supporting the use of a Full Liquid Diet as part of a postoperative diet progression. For patients with chewing or swallowing difficulties, dysphagia or mechanically altered diets are recommended.
Adequacy
Depending on the amount and choice of food eaten, this diet will tend to be low in vitamins, minerals, and fiber. It is recommended for temporary use only. A daily multivitamin and mineral supplement or commercial nutritional supplement is recommended if the diet continues for more than 5 to 7 days.
Diet Principles
1. The Full Liquid Diet includes foods that are liquid at body temperature and tolerated by the patient.
2. Because the diet typically includes many milk-containing foods, it may need modification for patients who do not tolerate lactose. Acidophilus milk, lactose-free milk, soymilk, or plain yogurt may be tolerated, and lactose-free medical nutritional supplement beverages can be useful.
3. Low-fat or fat-free dairy products should be considered for patients’ not tolerating fat. (4). Modifications in carbohydrate levels may also be necessary for people with diabetes mellitus or hypoglycemia. Patients with diabetes should receive approximately 200 grams of carbohydrate dispensed equally throughout the day. (1)
Table 4.3 Full Liquid
| Food for the Day | |
| Vegetables 1 cup or more (including potatoes) | Potato, strained in cream soups; other mild-flavored vegetables, such as asparagus, carrots, green beans, peas, or spinach, strained and combined with clear broth, cream soup, plain or flavored gelatin; vegetable juices |
| Fruits 1 cup or more | Citrus and other fruit juices; pureed fruit without seeds |
| Grains 1 or more servings | Refined or strained cooked cereals that have been thinned with hot milk or hot half-and-half |
| Dairy Products 2-3 servings | As a beverage and in cooking; milk in milk drinks, such as eggnog, milk shake, or malted milk; in strained cream soups; yogurt without fruit pieces or seeds, melted cheese |
| Note: Do not serve raw egg. Use blended baked custard, soft custard with added milk, or a commercial mixture that is pasteurized. | |
| Protein Foods 2–7 ounce-equivalents | Eggs in eggnog, soft custard; pureed meat added to broth or cream soup |
| Added Sugars | Sugar, honey, sugar substitutes, syrup |
| Fluids | Coffee, tea, carbonated beverages, flavored waters, sports drinks |
| Other | Broth or strained cream soup combined with allowed strained vegetables; soft or baked custard, flavored and unflavored gelatin, plain ice cream, pudding, sherbet, popsicles, fruit ices, flavorings and mild spices in moderation; nutritional supplement beverages |
Table 4.4 Full Liquid
Suggested Menu Plan for Full Liquid Diet
| Breakfast |
| ½ c. fruit juice 6 oz thinned, cooked cereal with cream, sugar 8 oz milk or milk beverage |
| Lunch |
| 6 oz soup* ½ c. pureed fruit ½ c. pureed vegetable ½ c. fruit or vegetable juice ½ c. strawberry ice cream 8 oz milk or milk beverage |
| Supper |
| 6 oz soup* ½ c. pureed fruit ½ c. pureed vegetable ½ c. fruit or vegetable juice ½ c. pudding or custard 8 oz milk or milk beverage |
| Snack Ideas |
| ½ c. fruit juice ½ c. pureed fruit 6 oz yogurt 8 oz milk or milk beverage Nutritional supplement |
*Soups may be fortified with dry milk, pureed meat and vegetables, and a fat serving. Note: canned soups are higher in sodium.
REFERENCES
1. American Diabetes Association. Clinical Practice Recommendations. Diabetes Care. 2008;31(Supplement 1):S61–S78.
2. Correla MITD, Fonseca PC, Cruz GAM. 2009. Perioperative nutritional management of patients undergoing laparotomy. Nutr Hosp. July-Aug; 24(4):xx.
3. Jeffery KM, Harkins B, Cresci GA, et al. The clear liquid diet is no longer a necessity in the routine postoperative management of surgical patients. Am Surg. 1996 Mar; 2(3):167–70.
ENTERAL NUTRITION
Use
Enteral nutrition (tube feeding) may be prescribed for patients who are physically or psychologically unable to take food by mouth in amounts that will meet nutrient requirements. Enteral nutrition can either supplement a patient’s inadequate oral intake or it can provide the sole source of nutrition. Enteral nutrition must be closely monitored by a Registered Dietitian.
Adequacy
Most enteral feedings will be nutritionally adequate when given in recommended amounts, but it is important to evaluate each patient individually.
Diet Principles
1. Selection. Choice of an enteral feeding product depends on the medical and nutritional needs of the patient as determined by the physician and dietitian. The patient’s condition and nutritional status and requirements must be identified and then compared to formulas available. Choose the enteral formula which most closely meets the patient’s requirements.
2. Administration. Access to the stomach or small intestine is gained via a small diameter, flexible feeding tube. The tube may be placed (a) through the nose into the stomach or bowel for short-term use or (b) directly through the skin into the stomach or bowel for long-term use. Formula is delivered through the tube by gravity flow (bolus) or by use of an enteral feeding pump. The rate and volume of formula given depend on individual factors, such as nutritional status, body size, tolerance, and type of formula. The feeding is usually initiated at a slow rate and then advanced as tolerated to the goal rate. Formula does not require dilution. Even though formulas are typically more than 80% water, this is not sufficient to meet fluid requirements. Water flushes are necessary to meet hydration needs as well as to avoid clogged feeding tubes. Flushes must be given before and after feedings and each medication, and when the feeding is interrupted for any reason.
3. Complications. There are four major areas of complications associated with enteral nutrition: mechanical (tube obstruction, suspected inaccurate pump administration, tube displacement), metabolic (hyperglycemia, electrolyte imbalance, dehydration), gastrointestinal (diarrhea, nausea and vomiting, cramping, constipation), and respiratory (labored breathing, aspiration). Causes and contributing factors to these complications are many and varied. Careful observation and assessment are required to treat them. Some very basic preventative strategies are: elevate head of bed to 30 to 45 degrees and maintain strict sanitary practices when storing, handling, and administering feedings. Frequent monitoring of hydration status, lab work, weight status, and physical signs is important to identify complications early.
4. Information about specific enteral feeding formulas can be obtained from company representatives.
