Nutrition Honorlock Exam 2

Diabetes - Carbohydrate Counting

-15g of CHO = 1 choice -Individualized plan tells the client how many carbohydrate choices to consume at each meal and snack -Need to be able to read a nutrition facts label and estimate serving size correctly -Consistency in timing and amount of carbohydrates is key - variety in carbohydrate foods is advised

Malabsorption Disorders: Celiac Disease

-A chronic, genetic, autoimmune disorder characterized by chronic inflammation of the proximal small intestine mucosa -Caused by intolerance to gluten (protein) found in wheat, barley, and rye -Malabsorption of carbohydrates, protein, fat, vitamins, and minerals may occur +Resulting in diarrhea, flatulence, weight loss, and vitamin and mineral deficiencies

Type 1 Diabetes

-Absence of insulin -Exogenous insulin required

Dietary fiber recommendation

-Adequate intake is approx. 14g/1000 calories consumed -Around 25g/day for women Around 38g/day for men -High fiber intake is above these recommendations

Disorders of the Accessory GI Organs - Liver Disease

-After absorption, almost all nutrients are transported to the liver -Liver damage/inflammation can have profound and devastating effects on the metabolism of almost all nutrients +And affect appetite (anorexia) -Liver failure can occur from chronic liver disease or secondary to critical illnesses -Prevent: alcohol abuse, infection, medications -Dietary therapy different for each condition/cause

Diabetes - Meal Planning

-Carbohydrate counting +Most used, best blood glucose control -The plate method +Good for those who need a simplified approach -Food lists +Choose interchangeable foods from lists, less flexible

GERD (Gastroesophageal reflux disease)

-Caused by an abnormal reflux of gastric contents into the esophagus -LES (lower esophageal sphincter) relaxes when it shouldn't -Increased intra-abdominal pressure -Decreased esophageal motility

Conditions of the Large Intestine: Diverticular Disease

-Caused by increased pressure within the intestinal lumen -Usually asymptomatic -Occurs when diverticula become inflamed

Dumping Syndrome - Nutrition Therapy

-Caution with clear liquid diet after surgery: avoid simple sugars +Choose broth or water -Eat small, frequent meals -Eat protein and fat at each meal -Consume liquids 1hr before or after eating instead of with meals** -Lie down after eating (can help slow down the movement of food through the GI system)

Altered Bowel Elimination - Diarrhea

-Characterized by increased frequency of bowel movements and/or water content of stools -Potential for dehydration, electrolyte imbalances, pH changes -Chronic diarrhea can lead to malnutrition

IBD

-Characterized by periods of exacerbation and remission -Similar symptoms and treatment for Crohn & UC -Nutrition therapy depends on active state or remission state

Disorders of the Accessory GI Organs - Gallbladder Disease

-Cholelithiasis -Cholecystitis -May need surgical removal -Nutrition therapy: low fat may help (before/without surgery and after surgery), increase soluble fiber -Gallbladder disease is very common

Dumping Syndrome

-Common complication of gastrectomy and gastric bypass -Simple sugars can make it worse, candy, sugar sweetened foods and drinks -Group of symptoms caused by rapid emptying of stomach contents into the intestine

Altered Bowel Elimination

-Constipation -Diarrhea

Malabsorption Disorders: Lactose Malabsorption

-Decreased action of lactase -Lactose digestion is impaired -Undigested lactose increases the osmolality of the intestinal contents -Most common malabsorption disorder

Gastroparesis

-Delayed gastric emptying -Can cause nausea, vomiting, bloating, early satiety, pain -Can cause very serious metabolic problems -Most commonly associated with Diabetes

Peptic Ulcer Disease - Reduce Symptoms

-Diet -Certain foods can worsen symptoms, keep track of foods that cause a problem and avoid them +Common culprits: black pepper, caffeine, coffee (decaf and regular), tea, mint, chocolate, and tomatoes -Alcohol & smoking contribute to ulcers

Altered Bowel Elimination - Constipation

-Difficult or infrequent passage of stools that are hard and dry

Esophageal Dysphagia

-Difficulty passing food down the esophagus -Motility disorder -Mechanical obstruction +Structures, cancer

Aneroxia

-Diminished appetite -Common symptom of many physical conditions -Side effect of certain drugs -Emotional issues -Goals of nutrition therapy: Stimulate appetite and encourage adequate intake

Nausea & Vomiting - More Interventions

-Eat slowly (or don't eat if short-term) -Oral hygiene with mouthwash and ice chips -Limit liquids with meals -Promote fluid intake between meals -Serve foods at room temperature or chilled -Avoid high-fat and spicy foods if they contribute to nausea +Ex: Cheeseburger, fried foods, whole fat dairy, tacos, pizza, or pepperoni -If can, sit up for 1hr after meals to promote movement of the food and fluid through the GI system by gravity -Ginger tea or foods with ginger might help

Dysphagia S/S

-Eating slowly -Chocking, coughing, throat clearing while eating or after -Frequent heartburn -Drooling -Being hoarse -Unintended weight loss *Risk to nutritional status and risk of aspiration

FODMAP

-Fermentable -Oligosaccharides (fructans & galacto-oligosaccharides) -Disaccharides (lactose) -Monosaccharides (excess fructose) -And -Polyols (sorbitol, mannitol, maltitol, xylitol)

Peptic Ulcer Disease

-Gastric ulcers (stomach) -Duodenal ulcers -Most commonly caused by H. Pylori

Ileostomies and Colostomies - Nutrition Therapy

-Goals of nutrition therapy are to minimize symptoms and replenish losses - Eat meals regularly to establish & maintain regularity in the fecal material and what is excreted -Chew food thoroughly -Avoid foods that cause symptoms -Eat protein with each meal and snack -Use salt liberally -Adequate fluids very important at least 80oz/day

Diabetes: Nutrition Therapy

-Highly individualized -Heart-healthy is important: Diabetes leads to atherosclerotic CVD, the most common cause of death in those with diabetes -General recommendations are the same as for the general population: limit/eat less, saturated fat, trans fat, sodium, added sugars -Eat more fiber -Likely will involve recommending weight loss if overweight or obese +Improves BG control +Reduces cardiovascular risk +Hypocaloric eating pattern, physical activity, lifestyle behavior change, ongoing support/counseling

Foods that contain lactose

-Ice cream -Cheese -Butter -Cottage cheese -Milk -Yogurt -Sour cream

Dysphagia

-Impairment of the process of swallowing -Swallowing could be impaired during: oral phase, pharyngeal phase, esophageal phase

Diarrhea - Nutrition Therapy

-In addition to determining the cause and treating it, the priority is to replace fluids +water or oral rehydration solution (ORS) best +Avoid alcohol, caffeine, lactose, high fiber +Sugary things like apple juice, sprite, coke can make it worse -Electrolytes may need to be administered if the diarrhea was severe and/or prolonged -Mild diarrhea lasting: Usually requires no nutrition intervention other than encouraging a liberal fluid intake to replace losses

Constipation - Nutrition Therapy

-Increase fiber intake (gradually) +Especially w/o a correlating water intake, insoluble fibers such as whole grains, bran, skins of fruits and vegetables -Increase water intake -Increase physical activity

Dumping Syndrome - Complications

-Increased risk of maldigestion, malabsorption, and decreased oral intake -Excretion of calories and nutrients produces weight loss and increases risk of malnutrition

Disorders of the Accessory GI Organs - Pancreatitis

-Inflammation of the pancreas -People with pancreatitis may also develop hyperglycemia related to insufficient insulin secretion -Severe, acute pancreatitis - enteral nutrition with specialized formula to start (EN typically delivered into the jejunum) -Chronic pancreatitis - oral diet with supplementation of pancreatic enzymes

Type 2 Diabetes

-Insulin resistance & relative insulin deficiency, occurs more slowly -Most cases (some people may need insulin at some point)

Conditions of the large intestine

-Irritable bowel syndrome (IBS) -Diverticular disease

Malabsorption Disorders

-Lactose malabsorption -Inflammatory bowel disease (IBD) +Crohns and Ulcerative Colitis -Celiac Disease -Short Bowel Syndrome

IBD - During Remission

-Liberalize diet -May need to limit these if not tolerated +Lactose, dairy, spices, herbs, fried foods, gas-producing foods, high fiber, meat, alcohol, broccoli and cabbage -Mediterranean-Style Eating Pattern is usually a good choice

Disorders of the accessory GI organs

-Liver, gallbladder and pancreas

GERD - Recommendations to decrease symptoms

-Lose weight if overweight -Exercise -Avoid meals within 3hrs of lying down, avoid nighttime snacking, elevate the head of bed during sleep -Avoid foods that trigger symptoms (chocolate, citrus, orange, lemon, tomato, alcohol, carbonated beverages, high fat, fried foods, cheeseburger w/ French fries) -Medications, surgery: Many people on medications, not everyone needs surgery

Nausea & Vomiting

-May be related to +Decrease in gastric acid, enzymes, GI motility +Bacterial & viral infection, increased intracranial pressure, equilibrium imbalance +Liver, pancreatic, & gallbladder disorders (accessory organs) +Obstruction +Drugs

Diabetes Mellitus

-Metabolic disorder with hyperglycemia and abnormal insulin metabolism (insulin is either absent or ineffective) -Prevalence increasing, costs are high -Nearly every organ and tissue in the body can be affected -More common in adults but starting to see it more in adolescent/children

10 foods highest in lactose

-Milk -Soft serve ice-cream smoothie -Dulce de leche -Hot cocoa -Macaroni and cheese -Low-fat Greek yogurt -Pancakes (hot cakes) -Milk chocolate (kit-kat bar) -Cottage Cheese -Mashed potatoes (with milk)

Conditions of the Large Intestine - Irritable Bowel Syndrome

-Most frequently diagnosed digestive disorder in the US -Many factors involved in its etiology/cause -Symptoms include lower abdominal pain, constipation, diarrhea, alternating periods of constipation and diarrhea, bloating, and mucus in the stools -Can significantly impair quality of life

Oropharyngeal dysphagia

-Mouth into esophagus -Cause usually neurological or muscular disorder +Stroke (CVA), myasthenia gravis, Parkinson's disease, multiple sclerosis, upper esophageal sphincter disorder, muscular dystrophy, radiation injury, head and neck tumors

IBD - Inflammatory state

-Much variation patient-to-patient -Try to keep restrictions to minimum to support adequate nutrition -Low fiber to slow intestinal transit time -Increase protein to 1.2 to 1.5 g/kg/day -May need supplementation of micronutrients as prescribed

Nausea & Vomiting - Interventions

-No food -When can take oral food, start with clear liquids -Small meals are easily digested carbohydrates +Ex: Dry plain toast, saltines, plain bread, pretzels, bananas, and plain oatmeal -Avoid high fat if contributes to nausea

Nutrition for Patients with GI Disorders

-Nutrition therapy is used in the treatment of many digestive system disorders +Some diet therapy is only supportive +Some diet therapy is cornerstone of treatment (for example diabetes)

Malabsorption Disorders - causes

-Occurs secondary to nutrient maldigestion or from alterations to the absorptive surface of the intestinal mucosa -Malabsorption that stems from an altered mucosa is more generalized, resulting in multiple nutrient deficiencies and weight loss -Symptoms vary with the underlying disorder

Malabsorption Disorders - Short Bowel Syndrome (SBS)

-Occurs when the small intestine/bowel is surgically shortened to the extent that the remaining bowel is unable to absorb adequate levels of nutrients to meet the individual's needs -Nutrition complications depend on the amount and location of resected and remaining bowel +Most patients take PN initially after surgery and slowly progress to oral diet +Oral: 6-8 small meals per day +Low fat

Celiac Disease - Nutrition Therapy

-Only scientifically proven treatment is to implement a lifelong gluten-free diet -Gluten free diet requires a major lifestyle change and is expensive -Many people are sensitive to even the slightest, tiny bit of gluten, such as coming from the equipment that processes food -Gluten may be in foods and drinks you did not suspect

Peptic Ulcer - Symptoms

-Pain -Bloating -Early satiety -Nausea -Impaired intake -GI bleeding (can be life-threatening)

Ileostomies & Colostomies

-Performed after part or all the small intestine, colon, anus, or rectum is removed -Ileostomy is stoma created in small intestine -Colostomy is stoma created in large intestine -Potential nutritional problems is high -The smaller the length of remaining bowel, the greater the potential for nutritional problems

Prediabetes

-Precedes diagnosis diabetes -Identification of and intervention at this stage is key -Prevent the development of diabetes

Inflammatory Bowel Disease (IBD)

-Primarily refers to two chronic inflammatory GI disease +Crohn's disease (more likely to cause nutritional complication) +Ulcerative Colitis -Believed to be caused by an abnormal immune response to a complex interaction between environmental and genetic factors -Increases risk for malnutrition

Lactose Malabsorption - Nutrition Therapy

-Reduce lactose intake to the maximum amount tolerated by the patient -Ingesting lactose with other food can help, building tolerance is usually possible a little at a time -A lactose-free diet is difficult to maintain -Probiotics may help -Special milk with reduced lactose and lactase enzyme tablets are options -Some conditions benefit from a temporary lactose restriction (diarrhea)

Diverticular Disease - Nutrition Therapy

-Reduce risk by limiting intake of red meat and avoiding obesity +Choose poultry and fish instead -High fiber diet may help prevent diverticulitis +Good choices: fruits, vegetables, whole grains, legumes -Some need to avoid popcorn, nuts, seeds - can get stuck in the diverticula

Dysphagia - Promoting Intake

-Remember that dysphagia can be emotionally challenging -Alterations to viscosity and consistency can change the flavor as well +Convey understanding and support your patients -Utilize feeding techniques -Serving foods and drinks that adhere to the patient's prescribed dysphagia diet is a must

Irritable bowel syndrome - Nutrition Therapy

-Restriction of FODMAPs -Elimination diet can help identify trigger foods +Reintroducing FODMAPs individually -Probiotics may help with symptoms -Small, more frequent meals -Reduce fat intake -Avoid caffeine, chocolate, alcohol -Increase soluble fiber slowly

Constipation causes

-Risk: Inadequate fiber intake, sedentary lifestyle, and low food intake (less peristalsis due to less food intake) -Can occur secondary to some lifestyle, psychogenic and medical factors -Certain medications cause constipation (opioids, iron, and calcium)

Anorexia - Interventions

-Serve food attractively, season according to patient's taste -Schedule procedures and medications when they are least likely to interfere with meals, if possible -Medications as ordered for pain, nausea, and depression (all can contribute to/cause anorexia) -Provide small, frequent meals -Withhold beverages for 30mins before and after meals. (don't want it to take up space of nutritional food) -Offer liquid supplements between meals can help support dietary and nutritional intake -Limit fat intake if fat can be contributing to early satiety

Techniques to Facilitate Safe Swallowing

-Serve small, frequent meals to help maximize intake -Encourage clients to rest before mealtime. Postpone meals if the client is fatigued -Position the client in a 90 degree upright position -Give mouth care immediately before meals to enhance the sense of taste -Instruct the client to think of a specific food to stimulate salivation. A lemon slice, lemon hard candy or dill pickles may also help to trigger salivation (as may moderately flavored foods) -Reduce or eliminate distractions at mealtime -Encourage small bites and chewing Ensure patient remains sitting upright for 15 to 20 mins after eating

Nausea & Vomiting - Complications

-Short-term concern of nausea & vomiting is fluid & electrolyte balance -If prolonged, dehydration & weight loss are concerns

Lower GI tract

-Small intestine, large intestine, rectum, anus -Liver, gallbladder, pancreas: play a vital role in nutrient digestion and absorption -Most nutrient absorption occurs in the small intestine especially the jejunum -Large intestine absorbs water and electrolytes and primarily response for elimination of solid wastes

Gastroparesis - recommendations to decrease symtomps

-Small, frequent meals -Liquids may be tolerated better -Low fat -Avoid carbonated beverages -Chew well -Upright 1hr -Avoid alcohol and smoking

Dysphagia - Minimize aspiration risk

-Speech pathologist does a swallow evaluation and recommends appropriate changes to food texture, the consistency of liquids, and the method of feeding -Nutrition therapy +Modify texture of foods +Modify viscosity (thickness)/consistency of liquids - To enable the patient to eat & drink and minimize aspiration risk

Disorders that Affect Eating

Anorexia, nausea & vomiting

Disorders of the Esophagus

Dysphagia, GERD

Upper Gastrointestinal Tract

Mouth, esophagus, stomach

Disorders of the Stomach

Peptic ulcer disease, gastroparesis, dumping syndrome