Common Diseases in Nutrition

* Incomplete Diets
Malnutrition - alcoholics, using drugs
- Deficit, excess, or imbalance of essential
nutrients * Drug-nutrient interactions
- durgs who have bitter taste
Undernutrition
- nutritional reserves are depleted Pathophysiology
Overnutrition
- ingestion of more food than is required for
body needs. e.g Obesity
Clinical Manifestation
* Dry and scaly skin
* Brittle nails
Etiology * Rashes
* hairloss
Starvation-related malnutrition * Crusting and ulceratiob of the tongue
- nutritrinal needs are not met * Decreased muscle mass
- chronic starvation without inflammation * Weakness
- small intake and there are no other * Mental Changes
pathophysiology involved e.g inflammation * Delayed wound healing
- pure chronic starvation
- primary protein calorie malnutririon
Ex. Anorexia nervosa Laboratory Studies
* Serum Albumin
Chronic disease-related malnutrition or - half life of 22 days
Secondary PCM * Prealbumin
- with sustained mild to moderate - half life of 2 days
inflammation * CRP
- deitary intake does not meet tissue needs - best indicator for malnutrition and
- has pathophysiology involved inflammation
Ex. Organ failure, pancreatic cancer, - positive acute phase reactants
rheumatoid arthritis and sarcopenic obeisty
* Eleveted CRP, low prealbumin and low
Acute disease-related or injury-related serum albumin, it indicates inflammation
malnutrition into the body
- related to acute disease or injury states
with marked inflammatory response * Serum electrolyte
- inflmmation is present - elevated K levels because of impaired
- Ex. Those who have major infection, sodium K pump
burns, trauma, closed head injury, SIRS,
MODS. * RBC, hemoglobin
* Anemia -
* Liver enzymes
Contributing factors - elevated with malnutrition
* Socioeconomic Factors Kwashiorkor
- food insecurity (lack of food due to - has edema, it begins in lower legs and feet
financial prob) starting to have moon face.
- there is hair changes
* Physical Illnesses - apathetic and lethargic
- involves prolong illnesses, major surgery,
sepsis, straining wounds, burns, Marasmus
hemorrhage, fractures and immobilization - emaciated
- malabsorption syndrome due to certain - alert and irritable
drugs like antibiotic

Nursing Assessment
* History taking
* Physical Examination
* Anthropometric measurement
- height and weight
- can identify the BMI of the patient
- BMI
Waist circumference
- hip to waist ratio
- arm demi span
- allow us to see any chromosomal
problems
- Skin fold thickness
- indicators for subcutaneous fat stores
- midarm muscle circumference
- indicator for protein stores
Nursing Diagnosis
* Impaired Nutritional Status
* Impaired Nutritional intake
* Fluid imbalance
Plan
* Achieve an appropriate weight
* Consume specified number of calories per
day on individualized diet
* To ahve no adverse consequences related
to malnutrition
Specialized Nutritional Support
* Oral feeding
* Enteral Feeding
- orogastric, nasogastric and nasointestinal
tubes
- gastrotomy and jejustomy tubes
* parenteral nutrition
Nursing Management in enteral
feeding
* check tube placement before feeding and
before each medication administration
* assess bowel sounds before feeding
* flush NG pr gastrostomy tube as needed
* evaluate nutrtional status of patient
receiving enteral feedings
* ensuring patient safety
Nursing Management for
parenteral nutrition
* follow proper aseptic technique
* solutions are good for 24 and must be
refrigerated until 30 mins before use
* ensure patient safety
Eating Disorders
* Anorexia Nervosa
* Bulimia Nervosa
* Binge-eating disorder
* Bigorexia or Muscle dysmorphia
* Female athlete triad
Anorexia Nervosa
• Characterized by restricting energy intake,
difficulties in maintaining an appropriate
weight, an intense fear of gaining weight or
being fat, and distorted body image
• Clinical manifestation: unwillingness to
maintain a healthy weight, refusal to eat,
continuous dieting, detailed food rituals,
avoiding social situations
Diagnostics and Laboratory
- x-ray
- CBC
- BUN, creatine
- electrolytes
Treatment
- Nutritional support
- Psychiatric care
Bulimia Nervosa
• Binge eating with inappropriate
compensatory behaviors to avoid weight
gain (vomiting, laxative misuse,
overexercise)
- intentional vomit
• CM: macerated knuckles, swollen salivary
glands, broken blood vessels in the eyes
(due to severe vomiting) dental problems
• Laboratories:
*serum potassium - hypokalemic
* ABG - metabolic alkalosis
* serum amylase - increase serum amylase
due to frequent vomiting
• Treatment: psychological counselling,
nutritional counselling
* FLUOXETINE - drug that approved by
the FDA
 OBESITY * Ghrelin from the stomach, it inhibits the
leptin,
- plays a role of compulsive eating
Epidemiology
• Hispanics (47%) and blacks (46.8%) have
the highest rates of obesity Nursing Management
• Among women, blacks have the highest * BMI
prevalence (17%) BMI Weight Status
• Among men, Hispanics (43.1%) have the Below 18.5 Underweight
highest prevalence 18.5 - 24.9 Normal weight
• Asian American have the lowest 25.0 - 29.9 Overweight
prevalence 30.0 - 34.9 Obesity class I
35.0 - 39.9 Obesity class II
Pathophysiology Above 40 Obesity class III
* Hyperplasia
- there is increase numbers of adipocytes * Waist Circumference
(more storage of fats) - one of the criteria for metabolic syndrome

* Hypertrophy
- the cells become bigger
* Primary Obesity
- excess calorie intake over expenditure
* Secondary Obesity
- result form various congenital anomalies,
chromosomal anomalies, metabolic
problems, CNS lesion and disorders, drugs
Men:
- more than 40 inches of waist
circumference, it is prone to have
myocardiovascular diseases
Women:
- more then 35 inches of waist
circumference, it is prone to have
myocardiovascular diseases.
* Hip ratio
- ideal ratio is less than 0.8

Etiology * android (apple)

* Genetic Link - men
- hereditary - fat is more stored in abdominal area
* FTO (fat mass and obesity-associated - visible in upper body like neck, arms and
gene) shoulders
* Environemental factors - greater risk for obesity complication
* Psychological Factors
* gynoid (pear)
Hypothalamus - women
- main control of our appetite - fat is more on the upper thigh

* Ghrelin, Peptide YY and leptin are most Nursing Diagnosis

important
* Peptide YY are the appetite stimulant.
- if it’s produce the person tends to over eat
leading to obesity and satiety is altered
* Leptin from adepocytes, which suppreses
the appetiteand increases fat metabolism
- if the abnormal there is no suppresion of
appetite and no fat metabolism.
* Obesity
* Activity intolerance due to weight
* Impaired physical mobility
* Disturbed body image
*must modify eating patterns
*regular physical activities
* achieve weight loss
*minimize health problems related to
obesity
 Nursing Implementation
* Management of co-morbidities NURSING CONSIDERATION
* Lifestyle interventions • Common side effects: nausea,
- weight loss program constipation, headache, dizziness, insomnia,
- support groups dry mouth
behavior modification • Suicidal thoughts and behaviors and
- over eating (self monitoring, neuropsychiatric reactions can occur
counseling, stimulus control) • Can increase BP and heart rate. Should not
be used in patients with uncontrolled
hypertension
• Can cause seizures. Must not be used in
patients who have seizure disorder
Nutritional therapy
- work with nutritionist DRUG
- better to reduce weight slower * Liraglutide (saxenda)
- decrease slowly the caloric intake in all
basic groups MECHANISM OF ACTION
* Glucagon-like peptide (GLP-1) agonist
Exercise * Induces satiety
- diabetic drug
Drug therapy - given through IV or IM
-sympathomimetic amine - it suppresses the
diet NURSING CONSIDERATION
* amphetamine • Used to treat type 2 diabetes
* nonamphetamines • Injected
Ex. Phentermine, diethylpropin, • Side effects: thyroid tumors, pancreatitis
phendimetrazine
DRUG
Surgical therapy * Lorcaserin (Belviq)

Bariatric surgery MECHANISM OF ACTION

- surgery in the stomach and intestine
to help the patient loss weight.
- those who are having BMI of 40 or more
or 35 or more with other significant co-
morbidities (hypertension, diabetes)
Gastrectomy
- supplement Vit. B12 after surgery
DRUG
* Bupropion/naltrexone (Contrave)
MECHANISM OF ACTION
Bupropion
- antidepresant
- increases the dopamine activity in the
brain whic leads to reduction in the appetite
and increase energy expenditure by
increasing the activity of the POMC
(proopiomelanocortin)
Naltrexone
- opiod antagonist
- increases the POMC activity
* Selective serotonin (5-HT) agonist
* Supresses appetite and creates a sense of
satiety
NURSING CONSIDERATION
• Side effects: headache, dizziness, fatigue,
nausea, dry mouth, constipation
DRUG
* Orlistat (xenical, alli [low-dose form
available over the counter])
MECHANISM OF ACTION
* blocks fat breakdown and absorption in
intestine
* Inhibits the action of intestinal lipases,
resulting in undigested fat excreted.
NURSiNG CONSIDERATION
• Associated with stool leakage, flatulence,
diarrhea, abdominal bloating, especially if a
high-fat diet is consumed
• Severe liver injury may occur
• May need fat-soluble vitamin supplements
DRUG
* Phentermine/topiramate ER (qsmyia)

MECHANISM OF ACTION
* Phentermine
- symathomimetic
* Topiramate
- decreases appetite

NURSiNG CONSIDERATION
• Common side effects: dizziness, insomnia,
dry mouth
• Do not use in patients with glaucoma or
hyperthyroidism
• Must avoid pregnancy
• Can increase heart rate. Should not be used
in patients with uncontrolled hypertension
or heart disease

Nursing Responsibilities for

patients undergoing surgery.

• Perform baseline assessment

• Assess baseline laboratory values and
diagnostic test result
• Teach patient and caregiver about
procedure and postoperative care
• Have available proper sized hospital
gowns, beds, BP cuffs and transfer
equipment