Learn — Therapeutic diets & nutrition support

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Diabetic diet — carbohydrate counting, exchanges and meal timing

Medical nutrition therapy for diabetes is an individualised eating plan that matches the amount, type and timing of carbohydrate to the patient's insulin or tablets, activity and weight so that glucose stays in range without hypoglycaemia, while also correcting the blood pressure and lipids that decide the vascular outcome. There is no single diabetic diet and no need for special diabetic foods: the plan is built from ordinary Indian meals through carbohydrate counting or the exchange lists, and its rules — regular meals, no skipped meals on insulin, a fixed snack when the drug demands one — are what the nurse teaches at every visit.

Energy is set for the target weight — roughly 25 kcal per kilogram of ideal weight for a sedentary adult, 30 for moderate activity — and the macronutrients as carbohydrate 50 to 60 per cent from whole grains, millets, pulses and vegetables, protein 15 to 20 per cent (about 1 g/kg), and fat 20 to 30 per cent with saturated fat under 10 per cent; dietary fibre of 25 to 40 g a day slows glucose absorption.
Carbohydrate counting uses the 15-gram exchange: one small chapati, one-third cup of cooked rice, one slice of bread, one small fruit, 200 mL of milk, or half a cup of cooked dal each count as roughly one carbohydrate exchange; a patient on basal-bolus insulin doses the meal at, for example, 1 unit per 10 to 15 g of carbohydrate, while a patient on fixed insulin or a sulfonylurea keeps the same number of exchanges at each meal every day.
Glycaemic index ranks a carbohydrate food by how fast it raises glucose against glucose itself: low is 55 or below (most pulses, whole grains, oats, most fruits, curd), medium 56 to 69, high 70 or above (white rice, maida, potato, sugar, sweetened drinks); glycaemic load adds the portion size, and the practical rule is to prefer low-index foods, keep portions of the high-index ones small, and eat them with protein, fat or fibre.
Meal timing follows the drug: regular meal times and never a skipped meal on insulin or a sulfonylurea; a bedtime snack when intermediate-acting insulin is taken at night, to cover the early-morning peak; rapid-acting analogues 0 to 15 minutes before eating and regular insulin 30 minutes before, so a delayed meal after an injection is a hypoglycaemia in waiting.
Free sugars and sugar-sweetened drinks are cut out, but non-nutritive sweeteners are acceptable in moderation and jaggery, honey and brown sugar are sugar — the sugar-free biscuits and diabetic foods sold in shops are unnecessary, often high in fat, and not free of carbohydrate; fruit is eaten whole and counted, not juiced.
Sick-day rules: never stop insulin during illness; keep taking carbohydrate as soft foods or sweet fluids if meals cannot be eaten; check glucose every four hours and urine or blood ketones if it stays high; and seek help for vomiting that prevents fluids, because dehydration and ketoacidosis begin there.
Hypoglycaemia teaching goes with every diet plan: recognise sweating, tremor, hunger and confusion, treat with 15 g of fast carbohydrate (three to four glucose tablets, 150 mL of juice or three teaspoons of sugar in water), recheck after 15 minutes and repeat if still below 70 mg/dL, then eat the next meal; carry sugar always, and eat before unplanned exercise.
Alcohol is taken, if at all, with food and within limits because it blocks gluconeogenesis and causes delayed hypoglycaemia that looks like drunkenness; salt is kept under 5 g a day for the blood pressure; and a diabetic on a renal or cardiac restriction follows both plans, with the dietitian resolving the conflicts.

Renal diet — restrictions in CKD and on dialysis

The renal diet is the set of restrictions and allowances that keep a patient with chronic kidney disease out of the complications the failing kidney can no longer prevent — uraemia, hyperkalaemia, hyperphosphataemia, fluid overload and hypertension — while supplying enough energy to stop the body eating its own muscle. It changes at the point of dialysis: before it, protein is restricted to slow the disease and limit urea; on haemodialysis or peritoneal dialysis, protein is raised to replace what the treatment removes, and potassium, phosphorus, sodium and fluid stay restricted because the machine clears them only three times a week.

Protein before dialysis (stages 3 to 5): about 0.6 to 0.8 g per kilogram per day, mostly of high biological value (egg white, milk, fish, chicken, soya), with enough energy — 30 to 35 kcal/kg — so the protein is not burnt as fuel; on haemodialysis it rises to 1.0 to 1.2 g/kg and on peritoneal dialysis to 1.2 to 1.3 g/kg because protein leaks into the dialysate.
Potassium is limited to about 2 to 3 g a day once the serum level rises or the urine output falls: the foods to limit are coconut water, bananas, oranges and other citrus, tomatoes, potatoes, dried fruit, chocolate, nuts and fruit juices, and every salt substitute, which is potassium chloride; leaching — peel, cut small, soak and boil in plenty of water and discard it — removes much of the potassium from vegetables.
Phosphorus is held to about 800 to 1000 mg a day because retained phosphate drives the bone and vascular disease of kidney failure: limit milk and cheese, nuts, whole grains, pulses in excess, organ meats and above all colas and processed foods with phosphate additives; phosphate binders such as calcium carbonate or sevelamer are swallowed with meals, not between them.
Sodium is kept to about 2 g a day (5 g of salt), which means no pickles, papad, chutneys, namkeen, processed meats, bread and biscuits in quantity, and no added salt at the table; fluid on dialysis is the previous day's urine output plus 500 to 750 mL, aiming for an interdialytic weight gain of no more than 2 to 2.5 kg, with thirst managed by ice chips, sour sweets and salt restriction rather than by drinking.
Vitamins and minerals: water-soluble vitamins are lost in dialysis and are replaced with a renal multivitamin taken after the session, vitamin C is capped at about 100 mg a day because it forms oxalate, vitamin A is avoided because it accumulates, and calcium and active vitamin D are given to prescription against the serum calcium and phosphate; anaemia is treated with iron and erythropoietin, not with diet alone.
Energy and protein malnutrition, not excess, is the commonest nutritional problem of dialysis: appetite is poor, restrictions are many and the treatment itself is catabolic, so the dietitian's target is to reach the protein prescription first and then fit the restrictions around it, with oral supplements formulated for renal patients (low electrolyte, energy dense) when meals fall short.
The diabetic on dialysis follows both plans, with the conflicts resolved in favour of the kidney where they clash — fruit and dairy are limited for potassium and phosphate even though they are otherwise good choices — and the patient with a transplant returns towards a normal diet with the sodium, weight and food-safety cautions of immunosuppression.

Cardiac diet — DASH, salt restriction and fats

The cardiac diet is the eating pattern prescribed for hypertension, coronary artery disease, heart failure and dyslipidaemia, built on three restrictions — sodium, saturated and trans fat, and excess energy — and one positive prescription, the DASH pattern rich in fruit, vegetables, whole grains, pulses and low-fat dairy that lowers blood pressure as much as a single drug. In heart failure a fluid limit and a daily weight are added, and in every cardiac patient the diet is where most of the modifiable risk lives.

DASH (Dietary Approaches to Stop Hypertension) means 4 to 5 servings each of fruit and vegetables a day, 6 to 8 of whole grains, 2 to 3 of low-fat dairy, 4 to 5 servings a week of nuts, seeds and pulses, lean fish and poultry in small portions, and sweets rarely; with sodium under 2.3 g a day it lowers systolic pressure by about 8 to 14 mmHg, and under 1.5 g a day by more — the largest effect of any lifestyle measure apart from weight loss.
Sodium: the WHO limit for everyone is under 5 g of salt (2 g of sodium) a day and in heart failure about 2 g of sodium; most sodium in Indian food is not the table salt but pickles, papad, chutneys, namkeen and processed snacks, bread and biscuits, cheese, sauces, instant noodles, baking soda and monosodium glutamate — so reading the label for milligrams per serving matters more than hiding the salt cellar.
Heart failure adds a fluid limit of about 1.5 to 2 litres a day when there is congestion or hyponatraemia, a daily morning weight on the same scale, and the rule to report a gain of 2 kg in two days or 2 to 3 kg in a week; small frequent meals reduce the breathlessness of a full stomach, and potassium-rich foods are encouraged or restricted according to the diuretic and the serum potassium.
Fats for the lipids: saturated fat under 7 to 10 per cent of energy (ghee, butter, coconut and palm oil, red meat, full-cream milk), trans fat as close to zero as possible (vanaspati, bakery products, repeatedly fried oil), dietary cholesterol under about 200 to 300 mg (egg yolks in moderation, organ meats and shellfish limited), and the replacement made with unsaturated oils — mustard, groundnut, rice bran, olive, sunflower in rotation — nuts, and fatty fish twice a week for omega-3.
Fibre and plant foods do the lowering: 10 to 25 g a day of soluble fibre from oats, barley, pulses, fruit and psyllium lowers LDL cholesterol, plant sterols in fortified foods add a little more, and whole grains and vegetables replace the refined cereals and sugar that raise triglycerides; alcohol is limited because it raises pressure and triglycerides.
Drug-diet interactions the cardiac nurse watches: potassium salt substitutes with ACE inhibitors, ARBs or spironolactone cause hyperkalaemia; grapefruit raises the level of some statins and calcium-channel blockers; the patient on warfarin keeps a constant, not a zero, intake of green leafy vegetables; and liquorice raises blood pressure.
After a myocardial infarction the ward diet is small, soft, frequent, low-sodium meals with no caffeine excess and enough fibre to prevent straining at stool; the discharge diet is DASH with the fat and energy limits, weight reduction of 5 to 10 per cent where needed, and 150 minutes a week of moderate activity once cleared.

Diet in liver disease — cirrhosis, encephalopathy and ascites

Nutrition in liver disease has been rewritten in the last decade: the cirrhotic patient is malnourished and sarcopenic far more often than overfed, so the diet is now high in energy and protein, taken as frequent small meals with a late-evening snack, with sodium restricted only for ascites and protein never restricted for encephalopathy. The old low-protein hepatic diet has been abandoned because it starves the muscle that clears ammonia and worsens the very encephalopathy it was meant to prevent.

Cirrhosis: 35 to 40 kcal per kilogram per day and 1.2 to 1.5 g of protein per kilogram per day (dry weight, not the weight with ascites), because 50 to 90 per cent of cirrhotics are malnourished and muscle loss predicts death; protein is never restricted, even in hepatic encephalopathy, and vegetable and dairy proteins are preferred when animal protein is poorly tolerated.
Meal pattern matters as much as content: four to six small meals and a late-evening snack of about 50 g of carbohydrate (a glass of milk with bread, a bowl of dalia) shorten the overnight fast, because the cirrhotic liver has no glycogen and starts breaking down muscle within hours; breakfast is never skipped.
Ascites is treated with sodium restriction to about 2 g a day (5 g of salt) plus diuretics — spironolactone first, then furosemide — and fluid is restricted only when the serum sodium falls below about 125 mmol/L; weighing daily and measuring the abdominal girth show whether the diet and the diuretics are working.
Hepatic encephalopathy is treated by removing the precipitant — bleeding, infection, constipation, dehydration, sedatives, electrolyte disturbance — and with lactulose to two or three soft stools a day and rifaximin, while the protein intake continues; branched-chain amino acid supplements help the patient who truly cannot tolerate whole protein, and the nurse's job is to keep the bowels moving and the meals coming.
Micronutrients: thiamine before glucose in every alcoholic patient, a multivitamin, zinc for taste and encephalopathy, and the fat-soluble vitamins A, D, E and K in cholestatic disease; vitamin A in large doses and herbal remedies are avoided because both can damage the liver further, and raw shellfish is banned because Vibrio vulnificus kills cirrhotics.
Acute viral hepatitis needs no special diet: a normal, palatable diet with enough carbohydrate and small frequent meals during the anorexic phase, glucose drinks if food is refused, and no fat restriction beyond what nausea dictates; alcohol is stopped and hepatotoxic drugs, including paracetamol above the safe dose, are avoided.
Fatty liver disease is treated by 7 to 10 per cent weight loss through an energy deficit and exercise, no sugar-sweetened or fructose-rich drinks, less refined cereal, and a Mediterranean-style pattern; coffee is protective and alcohol is stopped, and the same diet treats the diabetes and dyslipidaemia that travel with it.

Enteral feed formulas and regimens — types, complications and prevention

Enteral nutrition is feeding through the gut when the patient cannot eat enough by mouth but the intestine works — by nasogastric or nasojejunal tube for a few weeks, by gastrostomy or jejunostomy for longer — and it is preferred over the parenteral route because it keeps the gut mucosa and its immune barrier alive, costs less and infects less. This note carries the dietetics of the feed itself: which formula for which patient, how the regimen is started and advanced, and the complications the nurse prevents; the placement and care of the tube, the parenteral line and the refeeding criteria are on the surgical nutrition note.

Indications are a working gut plus an intake that cannot meet need for more than a few days — dysphagia after stroke or head injury, ventilated or unconscious patients, burns and major trauma, severe anorexia in cancer or sepsis; contraindications are obstruction, ileus, high-output fistula, uncontrolled shock and active gastrointestinal bleeding, when the parenteral route is used instead.
Standard polymeric formulas (1 kcal/mL, intact protein, isotonic) suit most patients; energy-dense formulas (1.5 to 2 kcal/mL) suit fluid restriction; high-protein and fibre-containing versions treat catabolism and bowel habit; elemental and semi-elemental (peptide-based, medium-chain triglyceride) formulas are for malabsorption, pancreatitis and short bowel; disease-specific formulas exist for renal (low electrolyte, concentrated), hepatic (branched-chain amino acids), diabetic (low glycaemic, high monounsaturated fat) and immune-modulating (arginine, glutamine, omega-3) use.
Blenderised kitchen feeds — rice, dal, milk, egg, oil put through a mixer — are cheap and familiar but carry the risks of bacterial contamination, blocked tubes from thick particles, and unknown or unbalanced nutrient content; when they are used, the feed is freshly prepared, strained, given within two hours and the equipment scalded.
Regimens: bolus feeding by syringe or gravity gives 200 to 400 mL over 15 to 30 minutes four to six times a day into the stomach only, mimicking meals; intermittent feeding runs each feed over 30 to 60 minutes; continuous feeding by pump runs 20 to 30 mL an hour and is increased by 10 to 20 mL every 4 to 8 hours to the goal, and is the rule for jejunal feeding and the critically ill; cyclic feeding runs overnight to free the day for oral intake.
Targets and advancement: about 25 to 30 kcal/kg/day and 1.2 to 2 g/kg/day of protein in the critically ill, reached within 48 to 72 hours by stepwise increases, with the head of the bed at 30 to 45 degrees throughout and for an hour after a bolus, tube position confirmed before every feed, and 30 mL of water flushed before and after each feed and each drug.
Diarrhoea, the commonest complication, is usually not the formula: look first at sorbitol-containing liquid medicines, antibiotics and Clostridioides difficile, a hyperosmolar or too-fast feed, hypoalbuminaemia and a contaminated feed (open systems hang for no more than 4 to 8 hours, closed systems 24 to 48); slow the rate, change to a fibre-containing or isotonic feed, and send a stool sample before stopping the feed.
Other complications and their prevention: aspiration (head up, check placement, hold for vomiting or distension, gastric residuals per policy), tube blockage (flush warm water before and after everything, use liquid drugs and crush tablets separately, never mix drugs into the feed), hyperglycaemia (monitor, insulin), dehydration and hypernatraemia with concentrated feeds (free-water flushes), constipation (fibre, water), and drug interactions — phenytoin is held apart from feeds by two hours, and the vitamin K in feeds blunts warfarin.
Refeeding syndrome threatens the patient who has eaten little for more than five days: start at a low rate, give thiamine before feeding begins in the at-risk, and check phosphate, potassium and magnesium daily for the first week, because the fall in phosphate as insulin drives it into cells causes the weakness, arrhythmia and confusion of day two to four.

Obesity and weight management — Asian Indian BMI thresholds, diet and activity

Obesity is an excess of body fat that harms health, measured in practice by the body mass index (weight in kilograms divided by height in metres squared) and the waist circumference, and defined for Asian Indians at lower numbers than the WHO's because Indians carry more fat, and more of it around the abdomen, at any given BMI — the thin-fat phenotype behind the country's diabetes and heart disease. Weight management is a lifelong programme of a modest energy deficit, better food choices, activity and behaviour change, with drugs and surgery reserved for defined thresholds.

WHO classification: BMI under 18.5 underweight, 18.5 to 24.9 normal, 25 to 29.9 overweight, 30 or more obese (class I 30 to 34.9, class II 35 to 39.9, class III 40 and above); the Asian Indian consensus lowers the bands to normal 18 to 22.9, overweight 23 to 24.9 and obese 25 or more, so an Indian with a BMI of 25 is already obese for treatment purposes.
Abdominal obesity is the better predictor of diabetes and heart disease: waist circumference of 90 cm or more in men and 80 cm or more in women (Asian Indian action points), or a waist-to-hip ratio above 0.9 in men and 0.85 in women; the metabolic syndrome for South Asians is this waist plus any two of triglycerides 150 mg/dL or more, HDL under 40 (men) or 50 (women), blood pressure 130/85 or more, and fasting glucose 100 mg/dL or more.
In children and adolescents BMI-for-age on the WHO reference is used — above +1 SD overweight and above +2 SD obese from 5 to 19 years — and the causes to exclude before blaming the diet are hypothyroidism, Cushing's syndrome, polycystic ovary syndrome and drugs such as steroids, antipsychotics, insulin and sulfonylureas.
The diet is an energy deficit of about 500 to 750 kcal a day below requirement, giving a loss of 0.5 to 1 kg a week and a realistic target of 5 to 10 per cent of body weight in six months, which is enough to improve glucose, pressure and lipids; typical plans are 1200 to 1500 kcal for women and 1500 to 1800 for men, and anything under 800 kcal a day is a very-low-calorie diet used only under medical supervision.
Food choices carry the plan: the plate method (half vegetables, a quarter cereal or millet, a quarter pulse, egg, fish or lean meat), 25 to 40 g of fibre, protein of about 1 to 1.2 g per kilogram of ideal weight to protect muscle, water instead of sugar-sweetened drinks, and cutting fried snacks, sweets, refined cereals and the ultra-processed foods that supply energy without satiety; crash diets lose muscle and water and are regained.
Activity is 150 to 300 minutes a week of moderate exercise such as brisk walking plus resistance exercise on two days, built up gradually, and behaviour change is what keeps the weight off — a food and activity diary, regular meals and no eating in front of screens, seven to eight hours of sleep, stimulus control, and a non-judgemental follow-up that measures waist and weight monthly.
Beyond lifestyle: drugs (orlistat, liraglutide, semaglutide) are considered at a BMI of 30 or more, or 27 with a comorbidity — lower for Asian Indians — and bariatric surgery at a BMI of 40 or more, or 35 with a comorbidity, with the Asian thresholds set 2.5 units lower; the complications being prevented are type 2 diabetes, hypertension, dyslipidaemia, fatty liver, sleep apnoea, osteoarthritis, infertility and several cancers.

Gluten-free, dumping-syndrome, high-fibre and low-residue diets

The gastrointestinal therapeutic diets each remove or add one thing the diseased gut cannot handle: gluten for coeliac disease, rapidly absorbed sugar and fluid-with-meals for dumping syndrome after gastric surgery, fibre added for constipation and diverticulosis or removed as a low-residue diet for an inflamed or narrowed bowel. They are asked as lists of allowed and forbidden foods, and the nurse's value is in translating those lists into Indian meals the patient will actually eat.

Coeliac disease is a lifelong immune reaction to gluten that flattens the small-bowel villi, so the diet is strict and permanent: no wheat, barley or rye in any form — atta, maida, suji, dalia, bread, biscuits, noodles, malt and beer — and oats only if certified free of contamination; safe staples are rice, maize, jowar, bajra, ragi, buckwheat, amaranth, quinoa, sago, potato, pulses, milk, eggs, meat and fish.
Hidden gluten is the reason a coeliac child fails to improve: sauces, soups, processed meats, some sweets and snacks, the shared tawa, toaster or frying oil, and flour dusted on a surface; a gluten-free label means under 20 parts per million, the family is taught to read every label, and the iron, folate, calcium and vitamin D deficiencies of the untreated disease are corrected while the bowel heals.
Dumping syndrome follows gastrectomy, vagotomy and bariatric surgery: early dumping within 30 minutes of a meal (fullness, cramps, diarrhoea, sweating, palpitations from the fluid shift into a hyperosmolar bowel) and late dumping one to three hours later (sweating, tremor, faintness from reactive hypoglycaemia); item for item, the diet is the opposite of a normal meal.
The dumping diet: six small dry meals a day, fluids 30 to 60 minutes before or after meals and never with them, little or no simple sugar, more protein and moderate fat, complex carbohydrates and soluble fibre such as pectin or guar to slow emptying, foods neither very hot nor very cold, and lying down or reclining for 20 to 30 minutes after eating; acarbose or octreotide are added only when the diet fails.
A high-fibre diet of 25 to 40 g a day treats constipation, diverticulosis without inflammation, irritable bowel with constipation, and helps diabetes and cholesterol: whole grains and millets, whole pulses, fruit and vegetables with their skins, and psyllium (isabgol), increased gradually with at least two litres of fluid so that bloating and cramps do not make the patient give up; soluble fibre (oats, pulses, fruit, psyllium) lowers glucose and cholesterol, insoluble fibre (wheat bran, vegetables) adds bulk.
A low-residue, low-fibre diet under about 10 to 15 g of fibre a day rests the bowel in acute diverticulitis, a flare of inflammatory bowel disease, partial obstruction, radiation enteritis, and before colonoscopy or bowel surgery: white rice and bread, refined cereals, well-cooked peeled vegetables, tender meat, eggs and strained juices, with no whole grains, nuts, seeds, raw vegetables, fruit skins or large amounts of milk; it is temporary, and fibre is added back as the bowel settles.
Two related diets: a lactose-free or lactose-reduced diet for lactose intolerance (curd and hard cheese are usually tolerated, milk in small amounts with food, lactase drops if needed), and the peptic ulcer diet, which is no longer bland — small regular meals, avoidance of the patient's own triggers, alcohol, smoking and NSAIDs, and no milk at bedtime, because milk stimulates acid as it buffers it.

Hospital diets — clear liquid, full liquid, soft and regular; progression

Hospital diets are the standard diet orders a ward runs on — regular, soft, full liquid and clear liquid — each a modification of the normal diet in consistency, and the therapeutic diets that modify its nutrients (sodium, fat, protein, energy, potassium), its frequency or its route on top of that. Diet progression is the stepwise return from nil by mouth through clear and full liquids and soft food to a regular diet as the gut tolerates each stage, and the nurse who feeds the patient is the one who judges tolerance and reports when a stage is failing.

The clear liquid diet is transparent, leaves no residue and needs almost no digestion: water, clear strained soup or broth, tea or black coffee, clear fruit juices such as apple, coconut water, glucose water, oral rehydration solution, jelly and ice pops; it gives fluid, electrolytes and a little energy but is not nutritionally adequate and should not run for more than 24 to 48 hours without supplementation — its uses are before and after surgery, during bowel preparation and in acute gastrointestinal upset.
The full liquid diet adds everything liquid or that melts at body temperature — milk, milkshakes, lassi and buttermilk, cream soups, strained porridge or kanji, custard, ice cream, yoghurt, eggnog and nutritional supplements; it can be made adequate with supplements and is the step after clear liquids and the diet for dysphagia, wired jaws and oesophageal narrowing.
The soft diet is soft in texture, low in fibre, mildly seasoned and easily digested — khichdi, dalia, soft chapati, boiled and mashed vegetables, dal, curd, eggs, ripe banana and papaya — with no fried, spicy, raw or fibrous foods and no nuts; a mechanical soft diet is the regular diet chopped, minced or ground for the patient who cannot chew, and a puréed diet the same food blended.
The bland diet — no chilli, spices, pickles, strong tea or coffee, alcohol or fried food — is what hospitals still order for gastritis and peptic ulcer, though the evidence supports small regular meals and avoiding the patient's own triggers rather than blandness for its own sake; the regular or normal diet is a balanced diet with no restriction, adjusted for age, culture and religion (vegetarian, Jain, halal) and for allergies.
Dysphagia diets follow the International Dysphagia Diet Standardisation Initiative: fluids from level 0 thin to level 4 extremely thick, foods from level 3 liquidised through 4 puréed, 5 minced and moist, 6 soft and bite-sized to 7 regular, prescribed after a swallowing assessment; thickened fluids and the upright position are what stop the stroke patient aspirating.
Progression after surgery is nil by mouth, then clear liquids, full liquids, soft and regular as each step is tolerated — no nausea, vomiting or distension — and modern enhanced-recovery practice starts oral fluids and food within 24 hours of most operations without waiting for bowel sounds or flatus; before surgery the fasting rule is clear fluids up to 2 hours, a light meal or milk up to 6 hours and a fried or fatty meal up to 8 hours.
Feeding a patient is a nursing procedure: check the diet order against the tray label, the wrist band and the allergy record, sit the patient upright at 90 degrees with dentures in and mouth care done, assist without hurrying, watch for coughing or a wet voice, keep the patient upright for 30 minutes afterwards, record the intake on the chart, and report a meal of which less than half was eaten so the dietitian can act.

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