Nutrition Diseases

8/14/2019 Nutrition Diseases

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NUTRITION

Prepared By: Angelica Anne J.

Lopez


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OBESITY


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OBESITY

BASIC CAUSE: energy imbalance thatresults when the number of calorieseaten doesnt equal the number of

calories used for energyINFLUENCES:

Family History

Environment Psychological Factors

Illness

Sociocultural Influences


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Benefits of Weight Loss

Reduced risk of diabetes andcardiovascular diseases

Reduced risk of developinghypertension

Lower triglyceride levels

Higher HDL cholesterol levels

Lower HDL and total cholesterollevels

Lower blood glucose levels


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THREE COMPONENTS OFWEIGHT LOSS THERAPY

Diet Therapy

Increased physical activity

Behavioral Therapy


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Gastric Restriction

Vertical Banded Gastroplasty;Stomach Stapling

Inserting a vertical row of staplesacross the patients stomach

Instruct patient to eat small meals,eating slowly and chewing food

thoroughly


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Gastric Bypass

Roux-en-Y gastric bypass

Combined gastric restriction with abypass of the duodenum, and 1st portion of jejunum


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ANOREXIA NERVOSA ANDBULIMIA NERVOSA


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Anorexia Nervosa

Characterized by self imposed fastingor dieting with severe weight lossor maintenance of weight thats

15% below the recommendedweight


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Signs and Symptoms

Wastedappearance

Thinning hair or

alopecia Dry skin or brittle

nails

Decreased heartrate

Constipation

Amenorrhea

Reduced muscle

mass and jointswelling


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Long Term Effects ofAnorexia

Irregular heart rhythms

Depression

Malnutrition Anxiety

Personality disorders

Substance abuse problems


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GOAL

Reestablishing normal eatingbehaviors

Restoring nutritional status

Maintaining reasonable weight


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Tips for Eating Plan(ANOREXIA)

Be reasonable, about 1500 calories per day

Include small, frequent meals and snacks

Gradually increase calories

Limit gas producing and high fat foods Include meals based on the patients foodpreferences

Include nutritionally dense foods to meetcaloric need

Include high fiber or low sodium foods tocontrol constipation

Include multivitamins and mineralsupplements

Avoid caffeine


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BULIMIA NERVOSA

Disorder characterized by episodesof recurrent binge-purge cycles

Normal or above normal body weightand has weight fluctuations


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Signs and Symptoms

Puffy cheeks due to enlarged salivaryglands

Damaged tooth enamel due toexcessive vomiting


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Long Term Effects of Bulimia

Electrolyte imbalances

Loss of potassium

Increased risk for cardiac arrest Esophageal inflammation


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Tips for Teaching Plan(BULIMIA)

Sit down during each meal toincrease awareness of eating andsatiety

Eat meals slowly (20 minutes)withoutdistraction

Use appropriate size utensils

Refrain from skipping meals


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GASTROESOPHAGEALREFLUX DISEASE


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GERD

Gastroesophageal Reflux Disease

Excessive reflux of gastric andduodenal contents

S/Sx: - Pyrosis Dyspepsia

Regurgitation

Dysphagia

Esophagitis


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GERD

Management:

Low Fat Diet

Avoid caffeine, tobacco, beer, milk etc

Avoid eating and drinking 2H beforebedtime

Maintain normal wt

Elevate upper body H2 Receptor Antagonist

Nissen Fundoplication


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Nissen Fundoplication


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CELIAC DISEASE


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Celiac Disease

Digestive disease that damages thesmall intestines and interferes withabsorption of nutrients

CANNOT TOLERATE GLUTEN


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Signs and Symptoms

Recurringabdominalbloating and pain

Chronic diarrhea Weight loss

Pale, foul smellingstools

Unexplainedanemia

Flatulence

Bone pain

Behavioral changes

Fatigue

Tooth discoloration


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Treatment

Gluten free diet

Avoid BROW diet

Lifetime treatment


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LACTOSE INTOLERANCE


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Lactose Intolerance

Inability to digest significant amountsof lactose, the predominant sugarin milk

Signs and Symptoms Bloating

Flatulence

Cramps Diarrhea

Nausea


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Treatment

Lactase enzymes are available overthe counter

Chewable lactase enzymes

Many nondairy products are high incalcium


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DIABETES MELLITUS


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Diabetes Mellitus

Sweet passing through orsiphoning from the body

Characterized by elevated levelsof glucose in the blood

Cause: Unknown

Insulin secretion defectsProblems in insulin action


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Diabetes Mellitus

Classifications:

Type 1Type 2

Gestational DM


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DM

Type 1

Juvenile

IDDM

Ketosis prone

Etiology:

Genetic

Immunologic

Environmentalfactors

Presence ofislet cellsantibodies

Little or noendogenous insulin

Prone toDKA

Insulin is

always a


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DM

Type 2 Adult onset

Stable diabetes

NIDDM

Ketosis resistantdiabetes

Etiology: Obesity

Heredity Environmenta

l

No islet cellsantibodies

Decrease

endogenous insulin

Obese

Prone toHHNC

OHA


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DM

Manifestations:

Increased bloodosmolarity

Glycosuria Polyuria

Polydipsia

Increase blood

viscosity Polyphagia

Neuropathy

MacrovascularComplications

CAD

CVD

PVD

MicrovascularComplications

Diabeticnephropathy

Diabetic retinopathy


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PancreasDiabetes Mellitus

Diagnostic Tests

FBS

Secondary Post PrandialBlood Sugar

OGTT/ GTT

Glycosylated HgB


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Management

5 components

Nutritional management Exercise

Monitoring

Pharmacologic therapy Education


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PancreasDiabetes Mellitus - Nutrition

Low caloric diet

High fiber diet

Complex carbohydrates Use of classification system

Food pyramid

Exchange lists

Pancreas


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Exchanges SampleLunch 1

SampleLunch 2

SampleLunch 32 starch 2 slices of

bread

Hamburgerbun

1 cupcookedpasta

3 meat 2 oz slicedturkey and1 oz lowfatcheese

3 oz leanbeef patty

3 oz boiledshrimp

1 vegetable lettuce,tomato,onion

Green salad cup plumtomatoes

Pancreas


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exchange Sample lunch 1 Sample lunch 2 Sample lunch 3

1 fat 1 tspmayonnaise

1 tbsp saladdressing

1 tsp olive oil

1 fruit 1 mediumapple

11/4 cupwater melon

1 cup freshstrawberries

Freeitems(optional)

Unsweetenediced teaMustard, pickle,hot pepper

Diet soda1 tbspcatsup,pickle,

onions

Iced waterwith lemonGarlic, basil


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Management

5 components

Nutritional management Exercise

Monitoring

Pharmacologic therapy Education

Pancreas


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PancreasDiabetes Mellitus Pharmacologic

Therapy OHA

Diabenase

Orinase

Tolinase Glucophage

Glucobay

Diamicron

Micronase

Daonil

Pancreas


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PancreasDiabetes Mellitus Pharmacologic

Therapy

Insulin

Rapid Acting

Humulin R & Actrapid

Peak: 2-4 hours

Intermediate acting

NPH & Humulin N

Peak: 6 8 hours Long acting

PZI

Peak: 12 16 hours

P

Assessment of Hypoglycemia


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Assessment of Hypoglycemia

Mild- /40 60 mg dl

Sweating

TremorTachycardia

Nervousness

Hunger

Moderate- /20 40 mg dl

Inability to concentrate

Headache

Lightheadedness

Confusion

Memory lapses

Numbness of lips and tongueSlurred speech

Impaired coordination

Emotional changes

Irrational or combativebehavior

Double vision

Drowsiness

SevereDisoriented

behavior

Difficultyarousing fromsleep

Loss ofconsciousness

Seizures


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imple Carbohydrates toreat HypoglycemiaThree or four commercially prepared

glucose tablets

4 to 6 ounces of fruit juice orregular soda

6 to 10 hard candy

2 to 3 teaspoons of sugar or honey

P


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Nursing Responsibilities

Route: SC

Administer at room temperature

Rotate site

Store vial at room temperature

Roll vials in the palms

Monitor for Dawns Phenomenon andSomogyi Effect

P


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Education Foot care

Inspect daily

Wash withwarm waterand mildsoap

Pat dry

Wearcomfortableand well-fitted shoes

Break in newpair of

Do not gobarefooted

Cut nails

straightacross

No lotion ininterdigital spaces

Exerciseandmassagetheextremitie

s

P


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Acute complications of DM

DKA

Deficit in available insulinresulting to metabolism of CHO,CHO and fat

HHNKS

Insulin level is low to preventhyperglycemia but high enoughto prevent fat breakdown

Pancreas


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Assessment OF DKA

:B G 3 0 0 to 8 0 0

/m g d l

Lo w H C O 3 a n d p H

,N a K m a y b e o r Po ly u ria

Po ly d ip sia

B lu rre d v isio n

W eakness

H e a d a ch e

, W e a k ra p id p u lse

, / ,A n orexia N V

, .v o m itin g a b d Pa in

Acetone breath

K u s s m a u l

re sp ira tio n

M entalstatusc h a n g e s

P


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Assessment of HHNS

: /BG 600 to 1200 mg dl

Hypotension

DHN

Tachycardia

Mental Status Changes

Neurological Deficits

Seizures


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HYPERTENSION


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Hypertension

Systolic greater than 140 mmHg and a diastolic pressure

greater than 90 mmHg Based on 2 or more accurate

BP measurements


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Hypertension

Systolic greater than 140 mmHg and a diastolic pressure

greater than 90 mmHg Based on 2 or more accurate

BP measurements


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Causes:

Increased SNS activity

Increased renal reabsorption

Increased activity of RAAS Increased vasodilation


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Manifestations:

Asymptomatic

Elevated BP

Retinal

hemorrhage Papilledema

May develop toangina or MI

LV hypertrophy Head ache

Epistaxis

Dizziness

Tinnitus

Unsteadiness Blurred Vision

Depression

Nocturia

Retinopathy


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Management:

PrimaryModerate intake of Na

Low fat diet

Maintain IBW

Exercise

Stop smoking

Moderate consumption of alcohol

Stress reduction


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Management:

Secondary:

Diuretics

Adrenergic InhibitorsACE inhibitors

Calcium Antagonists


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Nursing Diagnoses

Deficient knowledge regarding therelation between the treatmentregimen and control of the

diagnostic process Non-compliance with therapeutic

regimen related to side effects of

prescribed therapy


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Nursing Interventions

Patient teaching

Preventing Non compliance

Teaching about medication

Side effects of diuretics

Change position gradually

Avoid very warm bath

Avoid tyramine rich food


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THANK YOU!

Documents

Nutrition Diseases