DIET AND CLIENTS WITH DISEASE AND DISORDERS

DIET AND WEIGHT CONTROL

RULE OF THUMB "Rule of Thumb"
 Method for determining desired weight.
 Males assume 106 pounds for the first 5 feet (60 inches) and add 6 pounds for each inch over 60.
 Females assume 100 pounds for the first 5 feet (60 inches) and add 5 pounds for each inch over 60.
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DEFINITIONS  Overweight: 10 to 20% above average

 Obesity: 20% above average
 Underweight: 10 to 15% below average

BMI BMI
 Body Mass Index
 Medical standard used to define obesity.
 Used to determine whether a person is at health risk from excess weight.
 Obtained by dividing weight in kilograms by height in meters squared.

FAT DISTRIBUTION Fat Distribution
 Fat in the abdominal cavity is associated with a greater risk for hypertension, diabetes, coronary heart
disease, type 2 diabetes, and certain types of cancer than fat in the thigh, buttocks, and hip area.
 Pear-shaped body has a lower risk for disease than does apple-shaped body.
 
OVERWEIGHT & Overweight and Obesity
OBESITY  Overweight is a serious health hazard.
 It increases susceptibility to diabetes mellitus and hypertension.
 No one cause for obesity.
 Energy imbalance is a significant cause.

Theories of Weight Loss

 Fat cell theory: obesity develops when the size of fat cells increase.
 Set point theory: everyone has a set point or natural weight at which the body is so comfortable that it
does not allow for deviation.

Healthy Weight
 Not everyone can match the "healthy weight target", which is a BMI of 19 to 25.
 A "healthy weight" may be the weight at which one is eating nutritiously, is exercising, has no health
problems, and is free from disease.

Dietary Treatment for Obesity

 Reduce one's food intake
 Weight-reduction (low-kcal) diet
 Base on the Food Guide Pyramid
 Use exchange lists to control kcal value
 Reduction of 3,500 kcal results in weight loss of one pound.
 No more than 1 to 2 pounds lost in a week.
 Do not reduce below 1,200 kcal per day.
 Diet should consist of 15 to 20% protein, 45 to 55% carbohydrate, 30% or less fat.
 Key is changing eating habits.

FOOD SELECTION Food Selection

 Substitution foods:
o Fat-free milk for evaporated milk
o Evaporated fat-free milk for evaporated milk
o Yogurt or low-fat sour cream for regular sour cream
 o Lemon juice and herbs for heavy salad dressings
o Fat-free salad dressings for regular salad dressings
o Fruit for rich appetizers or desserts
o Bouillon instead of cream soups
o Water-packed canned foods rather than those packed in oil or syrup

Low-kcal Foods
 Black coffee  Tomatoes
 Plain tea  Zucchini
 Cantaloupe  Cauliflower
 Strawberries  Broccoli
 Lettuce  Celery
 Bean sprouts  Cucumbers
 Cabbage  Spinach
 Mushrooms  Red/green peppers
 Asparagus

COOKING METHODS Cooking Methods

 Broiling, grilling, baking, roasting, poaching, boiling
 Trim fat from meat before cooking
 Skim fat from the tops of soups and meat dishes
o We remove It by means of spoon
 Avoid addition of extra butter or margarine

EXERCISE Exercise
 Excellent adjunct to any weight-loss program
 Lowers set point
 Dancing, jogging, bicycling, skiing, rowing, power walking
 Such exercise helps tone muscles, burns kcal, increases the BMR so food is burned faster, and is fun for
the participant.
Stop and Share:
 Your client would like to use behavior modification for weight loss.
 What recommendations could you give your client?
o Weigh regularly, but not daily.
o Don't wait too long between meals.
o Join a support group and go to meetings during and after the weight loss.
o Eat whole, fresh foods and avoid processed foods.
o Treat yourself with something besides food.
o Anticipate problems (banquets and holidays) and "undereat" slightly before and after.
o "Save" some kcal for snacks and treats.
o If something goes wrong, don't punish yourself by eating.
o If no weight loss for 1 week, realize it may be from exercising (production of lean muscle) or
water retention.
o If binging occurs, don't punish yourself.
o Go for a walk, movie, or museum. Call a friend.
o Adapt family meals to suit your needs.
o Don't make a production of your diet.
o Avoid the heavy-kcal items.
o Substitute something you like that is low in kcal.
o Take small portions.
o Eat vegetables and bread without butter or margarine.
o ---

CRASH DIET Crash Diet

 Intended to cause a very rapid rate of weight reduction.
 Results in an initial rapid weight loss.
 Weight loss caused by a loss of body water and lean muscle mass rather than body fat.
  Plateau period follows in which weight does not decrease.

YO-YO EFFECT Yo-Yo Effect

 Disillusionment occurs and may lead to "eating binge".
 This can result in regaining weight.
 Causes dieter to try another weight-loss diet, creating a yo-yo effect.

POPULAR REDUCING Popular Reducing Diets

DIETS  Severely limit the foods allowed, providing a danger of nutrient deficiencies over time.
 May provide too much cholesterol and fat.
 May contain an excess of protein which puts too great a demand on the kidneys and may be life
threatening if sufficient potassium is not provided for the heart.

SURGICAL TREATMENT Surgical Treatment of Obesity

FOR OBESITY  May be used when obesity becomes morbid (damaging to health)
 Two types
o Gastric bypass
o Stomach banding

Gastric Bypass
 Most of the stomach is stapled off, creating a pouch in the upper part.
 The pouch is attached directly to the jejunum.
 
Stomach Banding
 Stomach is also stapled but to a slightly lesser degree than in gastric bypass.
 Food moves to the duodenum, but the outlet from the upper stomach is somewhat
 restricted.

Surgery for Obesity

 Common complications include diarrhea, electrolyte and fluid imbalances, liver problems, kidney stones,
and bone disease.
 Pharmaceutical Treatment of Obesity
 Miracles are still in short supply.
 Amphetamines (pep pills) depress appetite.
 Effectiveness reduced within a short time.
 Causes nervousness and insomnia.
 Can become habit forming

OVER-THE COUNTER Over-the-Counter Diet Pills

DIET PILLS  Intended to reduce appetite, not thought to be effective.
 Contain caffeine, artificial sweeteners, and phenylpropanolamine, which can damage blood vessels and
should be avoided.

Diuretics and Laxatives

 Do not cause a reduction of body fat, only water.
 An excess can result in fluid and electrolyte imbalance.
 Laxatives can become habit-forming.
 
Sibutramine (Meridia)
 Suppresses appetite.
 Used in conjunction with a reduced calorie diet.
 Indicated for those with a BMI of at least 30.
 
Orlistat (Xenical)
 Blocks one-third of the fat in food from being digested.
 Reduced calorie diet with no more than 30% fat should be followed.

UNDERWEIGHT Underweight
 Treated by a high-kcal diet or high-kcal diet combined with psychological counseling.
 It can be as difficult for an underweight person to gain weight as it is for an overweight person to lose it.
 Diet should be based on the Food Guide Pyramid.
 3,500 kcal added to normal weekly intake to gain 1 pound per week.
 An extra 500 kcal taken in each day.
 Easily digested food is recommended.
 Avoid fried and bulky foods

DIET AND DIABETES MELLITUS

DIABETES MELLITUS Diabetes Mellitus
 Glucose is the primary source of energy for the body.
 Glucose is transported by the blood, and its entry into the cells is controlled by insulin.
 
Insulin
 Secreted by the beta cells of the islets of
 Langerhans in the pancreas gland.
 When there is inadequate production of insulin or the body is unable to use the insulin it produces,
glucose cannot enter the cells and it accumulates in the blood, creating hyperglycemia.

Symptoms
 Polyuria: excessive urination
 Polydipsia: excessive thirst
 Polyphagia: excessive appetite
 Loss of weight, weakness, fatigue
 
 Complications
 Ketones: substances to which fatty acids are broken down in the liver.
 Ketoacidosis: condition in which acids from ketones accumulate. May lead to diabetic coma which can
result in death if the client is not treated quickly with fluids and insulin.
 Atherosclerosis is a major cause of death in diabetics.
 Retinopathy is the leading cause of blindness in the United States.
 Kidney disease resulting in dialysis.
 Nerve damage (neuropathy) is not uncommon.
 Infections, especially of the urinary tract are frequent problems.

Etiology
 The cause of diabetes is unconfirmed although it is believed that it may be hereditary.
 Environmental factors may also play a role in the development of diabetes.
 Viruses or obesity may precipitate the disease.

CLASSIFICATION OF Classification
DIABETES MELLITUS  Type 1: insulin-dependent diabetes mellitus
 Type 2: non-insulin-dependent diabetes mellitus
 Gestational diabetes: diabetes in pregnancy

Type 1
 Formerly juvenile-onset diabetes mellitus.
 Occurs between the ages of 1 and 40. 10 to 20% of all diabetes cases.
 Secrete little, if any, insulin. Clients become insulin dependent requiring both insulin injections and a
carefully controlled diet.

Type 2
 Previously called adult-onset diabetes.
 Usually occurs after age 40, new evidence suggests screening at age 25.
 Obesity epidemic has increased prevalence among young adults.
 Treatment: diet, exercise, oral glucose- lowering medication (may or may not need insulin).
 Goals of medical nutrition therapy include maintaining healthy glucose, blood pressure and lipid levels;
weight reduction.

Gestational Diabetes
 Occurs between sixteenth and twenty- eighth week of pregnancy.
 Insulin required if not responsive to diet and exercise.
 Usually, gestational diabetes disappears after the infant is born.
 Diabetes can develop 5 to 10 years after the pregnancy.
 Treatment
o Goals:
 Control blood glucose levels
 Provide optimal nourishment for the client
 Prevent symptoms and thus delay complications
 Normal blood glucose levels are 70 to 110 mg/dl.

Treatment Regimes
 Diet alone
 Diet combined with glucose-lowering medication
 Diet combined with insulin
 Exercise combined to any of the above
 Regularly monitor blood glucose levels in addition to any of the above
 

NUTRITIONAL Nutritional Management

MANAGEMENT  Client's kcal needs will depend on age, activities, lean muscle mass, size and REE.
  Recommended:
o Carbohydrates 50 to 60% of the kcal
o 40 to 50% from complex carbohydrates
o 10 to 20% from simple sugars
 It is the total amount of carbohydrates eaten that affects blood sugar levels rather than the type.
 Fats should be limited to 30% of total kcal.
 Proteins provide from 15 to 20% of total kcal.

Carbohydrate Counting
 Newest method for teaching a diabetic client how to control blood sugar with food.
 The starch/breads, milk, and fruits have all been put under the heading of "carbohydrates."
 Exchange lists are utilized in carbohydrate counting as well as traditional meal planning.

Diets Based on Exchange Lists

 Most commonly used method of diet therapy is based on exchange lists.
 These lists were developed by the American Diabetes Association in conjunction with the American
Dietetic Association.
 Foods within each list contain approximately equal amounts of kcal, carbohydrates, protein, fats.
 One food on a particular list can be substituted for any other food on that particular list and still provide
the client with the prescribed types and amounts of nutrients and kcal.
 The amounts of nutrients and kcal on one list are not the same as those on any other list.
 The diet is given in terms of exchanges rather than as particular foods.

Fiber
 High fiber intake appears to reduce the amount of insulin needed because it lowers blood glucose.
 It also appears to lower the blood cholesterol and triglyceride levels.
 High fiber may mean 25-35g of dietary fiber a day.
 Increase water when increasing fiber

Alternative Sweeteners
 Saccharin has been shown to produce bladder cancer in rats when used in large quantities.
 Approved by FDA:
o Aspartame—made from amino acids; does not require insulin for metabolism.
o Sucralose—sweetener made from sugar molecule.
 

Dietetic Foods
 Use of diabetic foods is generally a waste of money and can be misleading to the client.
 Often the containers of foods will contain the same ingredients as containers of foods prepared for the
general public.
 These foods will contain carbohydrates, fats, and proteins that must be calculated in the total day's diet.
Read the label!

Alcohol
 Not recommended for diabetic clients.
 Limited use sometimes allowed if approved by physician.
 Some diabetic clients who use hypoglycemic agents cannot tolerate alcohol.
 Include in diet plan if used.

Exercise
 Type 2: exercise helps improve weight control, glucose levels, and the cardiovascular system.
 Type l: exercise can complicate glucose control. If done, should be on regular basis, and considered
carefully as meals are planned to avoid hypoglycemia.

INSULIN Insulin Therapy

 Clients with type 1 diabetes must have injections of insulin everyday to control blood glucose levels.
 Must be injected because it is a protein and would be digested if swallowed.
 Human insulin most common and preferred; made synthetically.
 Beef or pork insulin available.
  Not as commonly used because antibodies in them make them less pure than human.
 Insulin classified by action: very rapid-, rapid-, intermediate(half day)- and long-acting (whole day).
 Intermediate types work within 2 to 8 hours and are effective 24 to 28 hours.
 Shorter and longer-acting insulin may be given together and more than one injection a day may be
required.
 Insulin pumps are now available and can deliver short-acting continuous dose and pre-meal boluses

Insulin Reactions
 Insulin reaction, or hypoglycemic episode, can result from too much insulin.
 Symptoms include headache, blurred vision, tremors, confusion, poor coordination, eventual
unconsciousness.
 Brain damage, coma, or death may result.
 

Treatment for Insulin Reactions

 Conscious clients may be treated by giving them a glucose tablet, a sugar cube, or a beverage containing
sugar followed by a complex carbohydrate.
 Unconscious clients require intravenous treatment with dextrose and water.
 Diabetic clients should carry identification.

CONSIDERATIONS Considerations for Health Care Professional

 If diet is followed, medication is taken, and time is allowed for sufficient exercise and rest, one can live a
near-normal life.
 Emphasize importance of eating all of the prescribed food.
 Meals should be eaten at regular times, and clients should read labels.

DIET AND CLIENTS WITH CARDIOVASCULAR DISEASES

CARDIOVASCULAR Cardiovascular Disease
DISEASE  Acute: myocardial infarction (MI, heart attack)
 Chronic: develops over time, loss of heart function
o Develops over time
 Heart may or may not maintain circulation
 Heart may beat faster and enlarge to compeensate
 Congestive herat failure occurs when the heart cannot maintain blood circulations to all body tissue
 The heart muscle (myocardium), the valves, the lining (endocardium), the outer covering (pericardium), or
the blood vessels may be affected by heart disease.

ARTERIOSCLEROSIS & Arteriosclerosis and Atherosclerosis

ATHEROSCLEROSIS  Arteriosclerosis: arteries become thick and hard making the passage of blood difficult and sometimes
impossible.
 Atherosclerosis: affects inner lining of arteries where deposits of cholesterol, fats, and other substances
accumulate over time, thickening and weakening artery walls. Deposits are called plaque.
 Arteriosclerosis first before atherosclerosis
 NOTES

Atherosclerosis
 Plaque may cause a reduced blood flow beyond the obstruction; ischemia occurs.
 Ischemia may cause pain.
 Angina pectoris: Chest pain; may radiate down left arm.
 Coronary artery bypass graft (CABG): procedure to bypass circulation around a clogged artery.
 Cerebrovascular accident (CVA): blood flow to brain is blocked or blood vessel bursts (stroke).

Risk Factors
 Major:
o Hyperlipidemia (elevated total cholesterol; high LDL, low HDL)
 o Hypertension
o Smoking
 Contributory factors:
o Obesity
o Diabetes mellitus
o Male sex
o Heredity
o Personality type (ability to handle stress)
o Age (risk increase with age)
o Sedentary lifestyle

HYPERLIPIDEMIA Hyperlipidemia: Medical Nutritional Therapy

 your blood has too  Primary treatment for hyperlipidemia.
many lipids (or  Involves reducing the quantity and types of fats and often kcal in the diet.
fats), such as  American Heart Association guidelines:
cholesterol and o blood cholesterol 200 mg/dl or less is desirable
triglycerides. o 200 to 239 mg/dl is borderline high
o 240 mg/dl and greater is high
 American Heart Association recommendations for prevention:
o Adult diets contain less than 200 mg of cholesterol per day
o No more than 30% of kcal from fat; maximum of 7% from saturated fats, 8% from
polyunsaturated fats, 15% from monounsaturated fats

Stop and Share

 Your client has been given a very low fat diet to follow. The client expresses to you that it is almost
impossible to follow this diet.
 What recommendations would you suggest?
o A diet very low in fat will seem unusual and highly unpalatable.
o It takes 2 to 3 months to adjust to a low-fat diet
o Change should be made gradually if physician allows.
o Provide client with information about the fat content of foods and methods to prepare it.
o Encourage client to select whole, fresh foods and to prepare them without addition of fat.
o Lean meat should be selected and all visible fat removed.
o Use fat-free milk and fat-free skim cheeses.
o ---

Cholesterol-lowering Agents
 If appropriate blood lipid levels cannot be attained within 3 to 6 months by use of fat- restricted diet
alone, the physician can prescribe a cholesterol-lowering drug.
 Example: simvastatin (Zocor)
 Client teaching: Zocor interacts with grapefruit and its juice; total avoidance is necessary.

MYOCARDIAL Myocardial Infarction

INFARCTION  Caused by blockage of a coronary artery supplying blood to heart.
 Heart tissue beyond blockage dies.
 Causes: atherosclerosis, hypertension, abnormal blood clotting, infection such as that caused by
rheumatic fever (damages heart valves).
 After the attack, the client is in shock
 Fluid sift occurs, client may be thirsty
 IV fluids may be given
o Offer moistened cotton balls
 After several hours, client may begin to eat
 Liquid diet usually recommended first 24 hours
 Then, low-cholesterol and low-sodium diet is prescribed
 Foods should not be extremely hot or cold.
 Food that is easy to chew and digest prescribed.
 Percentage of energy nutrients will be based on particular needs of the client.
 Sodium limited to prevent fluid overload.
 Restriction on caffeine the first few days after an MI.
 
CONGESTIVE HEART Congestive Heart Failure
FAILURE  Injury to the heart muscle occurs from atherosclerosis, high BP, rheumatic fever.
 When damage is extreme and the heart cannot provide adequate circulation, the amount of oxygen taken
in is insufficient for body needs.
 Shortness of breath is common and chest pain can occur on exertion.
 Tissues retain fluid that would normally be carried off by the blood.
 Sodium builds up, and more fluid is retained, resulting in edema.
 Heart beats faster and enlarges to compensate.
 Death can occur in severe cases
 Body tissues do not receive sufficient amounts of nutrients.
 Edema may mask the problems of malnutrition and underweight.
 Fluid restriction may be ordered.
 Diuretics aid in the excretion of water and sodium, and a sodium-restricted diet typically prescribed.
 SIR NOTE
HYPERTENSION Hypertension
 Chronically high blood pressure.
 Essential, or primary hypertension: 90% of cases; cause is unknown.
 Secondary hypertension: 10% of cases; caused by another condition.
 Causes of secondary hypertension include kidney disease, problems of the adrenal glands, use of oral
contraceptives.
 ----
 Contributes to heart attack, stroke, heart failure, and kidney failure.
 "Silent disease" because sufferers can be asymptomatic.
 Frequency increases with age and is more prevalent among African Americans.
 Heredity and obesity are predisposing factors in hypertension.
 Smoking and stress also contribute to hypertension.
 Weight loss usually lowers blood pressure and, consequently, clients are often placed on weight-reduction
diets.
 Sodium and fluid collect in body tissue, causing edema, extra pressure is placed on the blood vessels.
 Sodium-restricted diet, often accompanied by diuretics, can be prescribed to alleviate this condition.
 Increasing fruits and vegetables to 6 to 10 servings per day helps to lower blood pressure.

o
TREATMENT Dietary Treatment
 Weight loss
 Sodium-restricted diet
 Diuretics
 When diuretics are prescribed together with a sodium-restricted diet, the client may lose potassium via
the urine and, thus, be advised to increase the amount of potassium-rich foods in the diet.

Sodium-Restricted Diets
 Regular diet in which the amount of sodium is limited.
 Used to alleviate edema and hypertension.
 Food and Nutrition Board recommends daily intake of sodium be limited to no more than 2,400 mg (2.4
g).
 Impossible to have a diet totally free of sodium.
 Meats, fish, poultry, dairy products, and eggs all contain substantial amounts of sodium naturally.
 Cereals, vegetables, fruits, and fats contain small amounts of sodium naturally.
 Water contains vary amounts of sodium
 Many products contain sodium; check labels.
 Some over-the-counter medicines contain sodium.
 Physician's permission should be obtained before using any medication
 or salt substitute.
 Adjustment to Sodium Restriction
o Most people are accustomed to salt in their food and transition to sodium-restricted diet may
be difficult.
o It will help the client if the reduction in sodium can be gradual.
o Most people are accustomed to salt in their food and transition to sodium-restricted diet may
 be difficult.
o It will help the client if the reduction in sodium can be gradual.
o Remind the client of the numerous herbs, spices, and flavorings allowed

CONSIDERATIONS Considerations for the Health Care Professional

 Most of the cardiac clients will be told they must reduce the fats, sodium, and sometimes, the amount of
kcal in their diets.
 Help the cardiac client want to learn how to help himself or herself via nutrition.

DIET AND CLIENT WITH RENAL DISORDERS

INTRODUCTION Kidneys
 Kidneys excrete wastes, maintain volume and composition of body fluids, and secrete certain hormones.
 They filter the blood, cleanse it of waste products, and recycle other, usable, substances so that the
necessary constituents of body fluids are constantly available.
 One million working parts called nephrons.
 Glomerulus is the filtering unit.
 The kidneys maintain both the composition and the volume of body fluids.
 They maintain fluid balance, acid-base balance and electrolyte balance.
 Waste materials sent via 2 tubes called ureters from the kidneys to the urinary bladder.
 1.5 liters of urine excreted per day.
 Waste materials include end products of protein metabolism (urea, uric acid, creatinine, ammonia, and
sulfates), excess water and nutrients, dead renal cells, and toxic substances
 Oliguria: urinary output less than 500 ml/day.
 Kidneys unable to adequately eliminate waste products—can result in renal failurc
 Kidneys indirectly stimulate the bone marrow to produce red blood cells.
 

TYPES OF RENAL Types of Renal Disorders

DISORDERS  Initially caused by infection, degenerative changes, diabetes mellitus, cardiovascular disorders, cysts, renal
stones, trauma.
 When severe, renal failure may result.

I. Acute Renal Failure

o Acute renal failure occurs suddenly and may last a few days to a few weeks.
o Caused by another medical problem such as a serious burn, a crushing injury, or cardiac arrest.
II. Chronic Renal Failure
o Develops slowly, number of functioning nephrons constantly diminishing.
o Uremia is a condition in which protein wastes that should normally have been excreted are
instead circulating in the blood.
o Symptoms include nausea, headache, coma, convulsions. Severe renal failure will result in death
unless dialysis used.
III. Nephritis
o Inflammatory diseases of the kidneys.
o Caused by infection, degenerative processes, or vascular disease.
o Glomerulonephritis is a nephritis affecting the capillaries in the glomeruli.
 
IV. Nephrosclerosis
o Hardening of renal arteries.
o Caused by arteriosclerosis and hypertension.
o Usually occurs in older people, sometimes develops in young diabetic clients.
 
V. Polycystic Kidney Disease
o Relatively rare, hereditary disease.
o I Cysts form and press on the kidneys.
o Kidneys enlarge and lose function.
o Although people with this condition have normal kidney function for many years, renal failure
may develop near the age of 50.
 
VI. Nephrolithiasis
 o Stones develop in the kidneys.
o Stones classified according to their composition—calcium oxalate, uric acid, cystine, calcium
phosphate, and magnesium ammonium phosphate (known as struvite).
o Associated with metabolic disturbances and immobilization of the client.

TREATMENT Dietary Treatment of Renal Disease

 Extremely complicated.
 Intended to reduce the amount of excretory work demanded of the kidneys while helping them maintain
fluid, acid-base, and electrolyte balance.
 Clients with chronic renal failure may have protein, sodium, potassium and phosphorus restricted.
 Sufficient calories necessary: 25 to 50 kcal per kilogram of body weight.
 Energy requirements should be fulfilled by carbohydrates and fat.
 Protein increases the amount of nitrogen waste the kidneys must handle.
 Diet may limit protein to 40 grams based on glomerular filtration rate and weight.
 Sodium may be limited if the client tends to retain it.
 Fluids are typically restricted for renal clients.
 Calcium supplements may be prescribed.
 Vitamin D may be added and phosphorus limited, to prevent osteomalacia.
 Potassium may be restricted in some clients because hyperkalemia tends to occur in end stage renal
disease (ESRD).
 Excess potassium can cause cardiac arrest.
 Renal clients often have an increased need for vitamins B, C, and D, and supplements are often given.
 Iron is commonly prescribed

Dialysis
 Done be either hemodialysis or peritoneal dialysis.
 Hemodialysis requires permanent access to the bloodstream through a fistula.
 Hemodialysis is done 3 times a week for 3- 5 hours at a time.
 Peritoneal dialysis makes use of the peritoneal cavity.
 Less efficient than hemodialysis.
 Treatments usually last about 10 to 12 hours a day, 3 times a week.
 Complications include peritonitis, hypotension, weight gain.
 
 Diet During Dialysis
o Dialysis clients may need additional protein.
o Amount must be carefully controlled.
o A client on hemodialysis requires I .0 to 1.2g of protein per kilogram of body weight to make up
for losses during dialysis.
o A client on peritoneal dialysis requires 1.2 to 1.5g protein per kilogram body weight.
o 75% of this protein should be high biological value (HBV) protein, found in eggs, meat, fish,
poultry, milk, and cheese.
o Potassium is usually restricted.
o A typical renal diet could be written as "80-3-3" which means 80g protein, 3g sodium, and 3g
potassium daily.
o Healthy people ingest from 2,000 to 6,000 mg of potassium per day.
o Daily intake allowed clients in renal failure is 3,000 to 4,000 mg.
o End stage renal disease clients intake allowed is 1,500 to 2,500 mg per day.

Diet After Kidney Transplant

 Need for extra protein or for the restriction of protein.
 Carbohydrates and sodium may be restricted.
 Additional calcium and phosphorus may be necessary if there was substantial bone loss before the
transplant.

Stop and Share

 A client with renal disease is on a potassium restriction of 3,000 mg.
 What recommendations would you give the client?
o Regulate intake by making careful choices.
 o Milk is normally restricted to 1/2 cup a day because it is high in potassium.
o Suggest use of potassium content charts to select low potassium foods.
 
Dietary Treatment of Renal Stones
 Treatment varies based on type of stone.
 Clients should drink lots of fluid.
 Eat a well-balanced diet.
 Once stones have been analyzed, specific diet modifications may be indicated.

KIDNEY STONES Calcium Oxalate Stones

 A diet low in calcium can reduce the risk of calcium oxalate renal stones. In fact, higher dietary calcium
intake may decrease the incidence of renal stones for most people.
 Reduce level of oxalate, which is found in beets, wheat bran, chocolate, tea, rhubarb, strawberries,
spinach.
 
Uric Acid Stones
 Purine-rich foods restricted.
 Purines are the end products of nucleoprotein metabolism.
 Found in meats, fish, poultry, organ meats, anchovies, sardines, meat extracts, broths.
 Usually associated with gout, GI diseases that cause diarrhea, and malignant disease.
 
Cystine Stones
 Cystine is an amino acid.
 Cystine stones may form when the cystine concentration in the urine becomes excessive because of a
hereditary metabolic disorder.
 Increase fluids and recommend an alkaline-ash diet.
 
 
Struvite Stones
 Composed of magnesium ammonium phosphate.
 Sometimes called infection stones because they develop following urinary tract infections caused by
certain microorganisms.
 Low phosphorus diet is often prescribed.

CONSIDERATION Considerations for the Health Care Professional

 Client with renal disease has a lifelong challenge.
 Develop a trusting relationship with the client
 Help motivate clients to learn how to manage their nutritional requirements and help the dietitian assist
them.

DIET AND CLIENT WITH GASTROINTESTINAL PROBLEMS

GASTROINTESTINAL Dyspepsia
DISEASES  Indigestion, discomfort in the digestive tract, can be physical or psychological in origin.
 "Heartburn", bloating, pain, regurgitation.
 Psychological stress treatment includes:
o Finding relief from underlying stress
o Allowing sufficient time to relax and enjoy meals learning to improve eating habits

Esophagitis
 Irritating effect of acidic gastric reflux on mucosa of esophagus.
 Heartburn, regurgitation, and dysphagia.
 Chronic, or reflux esophagitis is caused by recurrent gastroesophageal reflux (GER)
 Causes include hiatal hernia, reduced lower esophogeal sphincter pressure, abdominal pressure, or
recurrent vomiting.

Hiatal Hernia
 A part of the stomach protrudes through the diaphragm into the thoracic cavity.
 The hernia prevents the food from moving normally along the digestive tract.
  Food moves back into the esophagus, creating a burning sensation (heartburn), and sometimes food will
be regurgitated into the mouth.
 Nutrition Therapy for Hiatal Hernia
o Small, frequent meals; well-balanced diet.
o Avoid irritants such as carbonated beverages, citrus fruits and juices, tomato products, spicy
foods, coffee, pepper, and some herbs.
o Avoid foods that relax sphincter such as alcohol, garlic, onion, oil or peppermint and spearmint,
chocolate, cream sauces, gravies, margarine, butter, and oil.
o If client is obese, weight loss may be recommended.
o Avoid lying down 2 to 3 hours after eating.
o When lying down, sleep with head and upper torso elevated.
o Surgery may become necessary.

Peptic Ulcers
 Erosion of the mucous membrane.
 May occur in the stomach (gastric ulcer) or the duodenum (duodenal ulcer); cause unclear.
 Factors that predispose: genetics, high secretion of hydrochloric acid, stress, excessive use of aspirin or
ibuprofen, smoking, Helicobacter Pylori bacteria.
 Symptoms include gastric pain (burning relieved with food or antacids), hemorrhage (usually requires
surgery).
 Treatment: drugs such as antibiotics and cimetidine to kill bacteria and inhibit acid secretion respectively.
Antacids neutralizc excess acid.
 Rest and counseling.
 Dietary recommendation:
o Sufficient low-fat protein should be provided.
o No less than 0.8g of protein per kilogram of body weight recommended.
o Avoid caffeine containing beverages, alcohol, aspirin, smoking.
o Well balance of three meals a day

Diverticulosis/Diverticulitis
 Diverticulosis is an intestinal disorder characterized by little pockets in sides of the large intestine where
food gets trapped.
 Diverticulitis can result from bacteria breeding in these pockets.
 Cause is diet lacking sufficient fiber.
 Diet treatment includes clear liquid diet, then low-residue progressing to high fiber over several weeks.

DIETS Residue-controlled Diets

 Residue is the solid part of feces. Residue is made up of all the undigested and unabsorbed parts of food
(including fiber), connective tissue in animal foods, dead cells, and intestinal bacteria and their products.
Most of this residue is composed of fiber. Diets can be adjusted to increase or decrease fiber and residue.

The High-fiber Diet

 30g or more of dietary fiber is believed to help prevent diverticulosis, constipation, hemorrhoids, and
colon cancer.
 A high-fiber diet is often 25 to 35g.
 Coarse and whole grain breads and cereals, bran, all fruits, vegetables (especially raw), and legumes.

Low-residue Diet
 5 to 10g of fiber a day is intended to reduce the normal work of the intestines by restricting the amount of
dietary fiber and reducing food residue.
 Low-fiber or residue-restricted diets may be used in cases of severe diarrhea, diverticulitis, ulcerative
colitis, and intestinal blockage and in preparation for and immediately after intestinal surgery.

Stop and Share.

 A client with severe diarrhea has been placed on a low-residue diet.
 What kinds of foods would you recommend for the client?
o Milk, buttermilk (limit to 2 cups/day)
 o Cottage cheese and some mild cheeses
o Butter and margarine
o Eggs, except fried
o Tender chicken, fish, sweetbreads, ground
o beef, and ground lamb
o Soup broth

INFLAMMATORY Inflammatory Bowel Disease

BOWEL DISEASES  Inflammatory bowel disease (IBD) is a chronic condition causing inflammation in the GI tract.
 Two examples include ulcerative colitis and Crohn's disease.
 ----

 Crohn's Disease
 Chronic progressive disorder that can affect both the small and large intestines.
Symptoms of Inflammatory Bowel Disease
Bloody Diarrhea Anorexia
Cramps Malnutrition
Fatigue Weight Loss
Nausea

Treatment of Inflammatory Bowel Disease

 Anti-inflammatory drugs
 Medical nutrition therapy
 Low-residue diet
 100g of protein, additional kcal, vitamins, and minerals
 Severe cases may require total parenteral nutrition (TPN
Ileostomy or Colostomy
 Clients with inflammatory bowel disease may require a surgical opening, a stoma, from the body surface
to the intestine for the purpose of defecation.
 Ileostomy: from ileum to abdomen surface.
 Colostomy: from colon to abdomen surface.
 Clients with ileostomies have a greater than normal need for salt and water because of excess losses.
 A vitamin C supplement is recommended, and, in some cases, a B12 supplement may be needed.

CIRRHOSIS Cirrhosis
 Liver disease may be acute or chronic.
 Cirrhosis is a general term referring to all types of liver disease characterized by cell loss.
 Alcohol abuse is the most common cause of cirrhosis.
 Other causes include congenital defects, infections, or other toxic chemicals.
 Liver does regenerate, however, the replacement during cirrhosis does not match the loss.
 Complications include hypertension, anemia, hemorrhage in the esophagus.
 Dietary treatment of cirrhosis provides at
o I' least 25 to 35 kcal or more, and 0.8 to 1.0g of protein per kilogram of weight each day.
o Supplements of vitamins and minerals are usually needed.
o In advanced cirrhosis, 50 to 60% of the kcal should be from carbohydrates.
 Sometimes cirrhosis causes ascites.
 Sodium and fluids may be restricted.
 If there is bleeding in the esophagus, fiber can be restricted to prevent irritation of the tissue.
 Smaller feedings will be better accepted than larger ones.

HEPATITIS Hepatitis
 Inflammation of the liver.
 Caused by viruses or toxic agents such as drugs and alcohol.
 Hepatitis A virus (HAV) contracted through contaminated drinking water, food, and sewage via a fecal-oral
route.
 ---
 Symptoms may include nausea, headache, fever, fatigue, tender and enlarged liver, anorexia, and jaundice
(yellow cast of the
  skin and eyes). Weight loss can be pronounced.
 Treatment involves bed rest, plenty of fluids, diet therapy.

Diet Therapy for Hepatitis

 Diet should provide 35 to 40 kcal per kilogram of body weight.
 Most kcal should be provided by carbohydrates; moderate amounts of fat; and if the necrosis has not
been severe, up to 70 to 80grams of protein for cell regeneration.
 If the necrosis has been severe and the proteins cannot be properly metabolized, they must be limited to
prevent the accumulation of ammonia in the blood.
 Clients may prefer frequent, small meals rather than three large ones.
 

CHOLECYSTITIS AND Cholecystitis and Cholelithiasis

CHOLELITHIASIS  Being female, obesity, total parenteral nutrition (TPN), very-low-calorie diets for rapid weight loss, the use
of estrogen, and various diseases of the small intestine are frequently associated.
 Cholecystitis: Inflammation of gallbladder
 Cholelithiasis: Gallstones
 Inhibit the flow of bile and cause pain.
 Symptoms include pain, which can be severe, indigestion, and vomiting (particularly after the ingestion of
fatty foods).
 Treatment may include medication to dissolve the stones and diet therapy.
 Surgery may be indicated.
 Diet therapy includes abstinence during acute phase.
 Followed by clear liquid diet and, gradually, a regular but fat-restricted diet.
 Fats allowed range from 40 to 45 grams a day.
 

PANCREATITIS Pancreatitis
 ----
 Symptoms include abdominal pain, nausea and steatorrhea (abnormal amounts of fat in the feces).
 Malabsorption (particularly of fat-soluble vitamins) and weight loss.
 If islets of Langerhans are destroyed, diabetes mellitus may result.
 During acute pancreatitis, the client is nourished strictly parenterally.
 Later, when the client can tolerate oral feedings, a liquid diet consisting mainly of carbohydrates is given
because, of these 3 nutrients, carbohydrates have the least stimulatory effect on pancreatic secretions.
 As recovery progresses, small, frequent feedings of carbohydrates and protein with little fat or fiber are
given.
 Vitamin supplements may be given.
 Alcohol is forbidden in all cases

DIETS FOR CLIENTS WITH CANCER

CANCER  Cancer-always consider that cause of cancer is from unfortunate cell
 Cancer is the second leading cause of death in the United States.
 It is a disease characterized by abnormal cell growth and can occur in any organ.
 Cancerous tumors are malignant, affecting the structure and consequently the function of organs.
 The mortality rate for cancer client is high but cancer does not always….
 Oncology is the study of cancer.
 An Oncologist is a physician who specializes in cancer.

CAUSES OF CANCER Causes of Cancer

 Precise etiology of cancer unknown.
 Heredity, viruses, environmental carcinogens, and possibly emotional stress may contribute to its
development.
 Cancer is not inherited, but some families appear to have a genetic predisposition for it.
 Environmental carcinogens include radiation (x-rays, sun, nuclear wastes), certain chemicals (ingested in
food, water or touched by skin) and certain substances that are breathed in (tobacco smoke and
asbestos).
 Carcinogens cause cancer after repeated exposure.
 Viruses linked to cancer: Epstein Barr, hepatitis B, and herpes simplex Il.
 o Epstein Barr: nasopharyngeal cancer, T- cell lymphoma, Hodgkin's disease and gastric carcinoma
o Hepatitis B: liver cancer
o Herpes Simplex Il: cervical and uterine cancer

CLASSIFICATION Classifications of Cancer

 Majority of all cancers fall under these headings: carcinomas, sarcomas, lymphomas, and leukemias.
 Skin cancer is becoming more prevalent.
 There are three types of skin cancer: basal cell, squamous cell, and melanoma.

RELATIONSHIP TO FOOD Relationships of Food and Cancer

 Both good and bad relationships between food and cancer exist.
 Carcinogens include nitrates in cured and p: smoked foods such as bacon and ham.
 Regular ingestion associated with stomach and esophagus cancer.
 High-fat diets associated with uterine, breast, prostate, and colon cancers.
 Excessive caloric intake associated with gallbladder and endometrial cancer.
 Smoking and drinking alcohol associated with lung, mouth, pharynx, and esophagus cancer.
 Diets high in fiber help protect against colorectal cancer.
 Diets rich in vitamin C may protect against stomach and esophagus cancer.
 Diets high in vitamin A may protect against lung, bladder, and larynx cancer.
 Flavonoids, phenols, and indoles are phytochemicals. These are substances that occur naturally in plant
foods and are thought to be anticarcinogenic.
 Eat five or more servings of fruits and vegetables each day.
 An immune system that has been damaged—possibly through malnutrition—may be a contributing factor
in the development of cancer.
 Excessive protein and fat intake, however, may be a factor in the development of cancer of the colon.

EFFECTS The Effects of Cancer (not only during the disease but also during treatment)
 Unexplained weight loss, weakness, anorexia.
 Loss of muscle tissue and hypoalbuminemia.
 Sense of taste and of smell becomes abnormal.
 Satiated earlier than normal. (busog kahit konti lang yung kinain)
 Abnormal insulin production with hyperglycemia.
 Hypercalcemia, renal stones, impaired kidney function
 ….severe

TREATMENT Treatment of Cancer

 Surgical removal, radiation, chemotherapy, or a combination of these methods used to treat cancer.
o Even normal flora are destroyed
 Side effects of these treatments can affect nutrition.
 These include xerostomia (dry mouth) and dysphagia (difficulty in swallowing).
 Tooth decay and loss of teeth sometimes occurs.
 Radiation and chemotherapy may depress appetite.
 Anorexia (loss of appetite), nausea, vomiting, and diarrhea can lead to fluid and electrolyte imbalances.

NUTRITIONAL CARE Nutritional Care

 Kcal needs of the cancer client are greater than before the illness.
 Clients on high-protein and high-kcal diets tolerate the side effects of therapy and higher doses of drugs
better than those who cannot eat normally.
 Clients can form aversions to food making anorexia worse.
 To help with aversions:
o Hold chemotherapy 2 to 3 hours before and after meals
o Include favorite foods served attractively in familiar ways
 If chewing is a problem, use a soft diet.
 For diarrhea, use a low-residue diet.
 High-protein, high-kcal diets and plenty of fluids recommended for clients undergoing radiation or
chemotherapy.
 45 to 50 kcal per kg of body weight per day.
 Carbohydrates and fat will be needed to provide energy and spare protein for tissue building and the
immune system.
  1.0 to 1.2g of protein per kg of body weight a day.
 Malnourished clients may need from 1.3 to 2.0g of protein per kg of body weight a day.
 Vitamins and minerals are essential.
 During chemotherapy and radiation therapy the recommendation is to eliminate vitamin A and vitamin E
in supplemental form and in the diet. Intake of these vitamins may prevent cancer cells from self-
destructing and work against cancer therapy.
 Encourage food that will increase appetite.
 Foods brought from home
 Cold foods may be more appealing than hot foods
 Milk, cheese, eggs, and fish may be more appealing than meat (can taste bitter)
 Add sugar if food is not sweet tasting
 Salad dressings, gravies, sauces, and syrups appropriately served on foods can be helpful for dry mouth.
 Several small meals may be better tolerated than three large meals.
 Use drugs to control nausea and pain.
 Nutritional supplements may be needed

Stop and Share

 A client with cancer may feel that comments to encourage eating are depressing reminders of the cancer
and the situation.
 How can the health care professional be helpful to the client?
o At appropriate time, explain why it is important that the client eat.
o Encourage the client to eat foods the client enjoys.
o Recommend the client avoid eating at the time of day nausea is likely to occur.
o Refrain from food that gives off odors that contribute to nausea.

CONCLUSION Conclusion
 Improving the nutritional state is difficult because of the illness and anorexia.
 Parenteral or enteral nutrition may be necessary.
 Health care professional can help the client improve nutrition.
 

DIET AND SURGERY, ENTERAL, PARENTAL NUTRITION, BURNS, INFECTIONS AND AIDS
HOMEOSTASIS Homeostasis
 Homeostasis is a state of physical balance; a stable condition.
 Normally, the body operates in a state of homeostasis.
 When the body experiences the trauma of surgery, severe burns, or infections, this balance is upset.
o USESTRESS- healthy stress/beneficial stress
o DISTRESS- A distraction, negative type of stress hat causes trauma
 During its response to physical stress, the body signals the endocrine system, which activates a self-
protective, hypermetabolic response.
 Surgery, burns, and infections can create stress.
 Nutrition plays an important role in the lives of clients undergoing this stress.
 Stressors…
 

SURGICAL PATIENT Nutritional Care of Surgery Clients

 Surgery stresses the client.
 If the surgery is elective, nutritional status should be evaluated before surgery.
 Extra protein, carbohydrates, vitamins, and minerals may be needed.
o Elective surgery- scheduled, can still be evaluated by the ohysician the nutritional status of
patients
o Emergency surgery- biglaan
 Clients will usually be NPO (nothing by mouth) after midnight the night before surgery. This ensures that
the stomach contains no food, which could be regurgitated and then aspirated during surgery.
 In most cases, intravenous solutions are given first 24 hours after surgery.
o Solutions contain water, 5 to 10% dextrose, electrolytes, vitamins, and medications as needed
 (pain medication for pain, to facilitate comfort, round the clock).
 Maximum kcal supplied by solutions is 400 to 500 kcal per 24-hour period.
 Estimated daily kcal requirement for adults after surgery is 35 to 45 kcal per kilogram of body weight.
 A high-protein diet of 80 to 100g a day may be recommended.
 Extra vitamin and minerals are needed
 
STOP AND SHARE
 Your client weighs 192 pounds and has just had major surgery.
 How many ----
 
 First, calculate the client's weight in kilograms.
o 192 lbs + 2.2 kg/lb = 87.27 kg
 Next, multiply the client's weight in kg by the number ofkg/lb (35, then 45) to get range.
o 87kg x 35kcal/kg 3045
o 87kg x 45kcal/kg = 3915
 Client needs between 3,045-3,915 kcal/day
 
If not meet proceed to progressive diet but first make sure that peristalsis retursn to make sure that the GI is intact

Nutritional Care After Surgery

 When peristalsis returns, ice chips may be given and, if they are tolerated, a clear liquid diet can follow.
 Normally in postoperative cases, clients proceed from the clear-liquid diet to the regular diet.
 The average client will be able to take food within 1 to 4 days after surgery.
 Sometimes following gastric surgery, dumping syndrome occurs within 15 to 30 minutes after eating.
 Characterized by dizziness, weakness, cramps, vomiting, and diarrhea.
 
Dumping Syndrome
 Caused by food moving too quickly from the stomach into the small intestine.
 To prevent dumping syndrome, the diet should be high in protein and fat, and carbohydrates should be
restricted.
o Metabolism is bypassed and normal absorption
 Gradually reintroduce complex carbohydrates.
 Fluids should be limited to 4 ounces at meals.
 Divide total daily food intake and serve as several small meals in an attempt to avoid overloading the
stomach.
 Some clients do not tolerate milk well after gastric surgery.

TUBE FEEDING Tube Feeding

 Problem is oral feeding is not tolerated
 Enteral nutrition includes the forms of feeding that bring nutrients directly into the digestive tract.
 Tube feedings may be necessary in clients due to unconsciousness, surgery, stroke, severe malnutrition, or
extensive bums.
 Nasogastric tube (NG) inserted through the nose and into the stomach or small intestine.
 Used for periods of 6 weeks or less.
 Gastrostomy (opening into the stomach) or [jejunostomy (opening into the jejunum) may be done
surgically if feeding is needed for longer than 6 weeks.
 
 Numerous commercial formulas available for tube feeding.
 Polymeric formulas (1-2 kcal/ml) contain intact proteins, carbohydrates, and fats that require digestion.
Used for clients that can digest and absorb nutrients normally.
 Elemental, or hydrolyzed formulas (1.0 kcal/ml) contain the products of digestion of proteins,
carbohydrates, and fats, and are lactose-free. Used for clients who have limited ability to digest or absorb
nutrients.
 Modular formulas (3.8-4.0 kcal/ml) can be used as supplements to other formulas or for developing
customized formulas for certain clients. Not nutritionally complete by themselves.
 Methods of administration:
o Continuous: On-going over 16- to 24- hour period
o Intermittent: At night, with food eaten during the day
o Bolus: Given over a 15-minute period
 Problems Associated with Tube Feeding
 PLACEMENT- to prevent aspiration
 The osmolality of a liquid substance means the number of particles per kilogram of solution.
 When a formula with high osmolality reaches the intestine, the body may draw fluid from the blood to
dilute the formula.
o Take consideration that this needed to be diluted. Because if high viscous causes weakness and
diarrhea (malapot kasi)
 Aspiration can occur (some of the formula enters the lung), causing the client to develop pneumonia.
 Tube may become clogged, or client may pull the tube out.
 Placement of tube should be checked with an X-ray to decrease possibility of aspiration.
o Checking can be checking gurgling, acidity of gastric contents
 Keep head of bed elevated
 

PARENTERAL Parenteral Nutrition (intravenously)

NUTRITION  When there is problem in digestive tract
 The provision of nutrients intravenously.
 Used if the gastrointestinal tract is not functional or if normal feeding is not adequate for the client's
needs.
 Total parenteral nutrition (TPN) or hyperalimentation is when parenteral nutrition is used to provide total
nutrition.
 Peripheral vein used for nutrient solutions needed for two weeks or less.
 Central vein used for TPN needed for an extended period of time.
 High blood flow facilitates quick dilution of highly concentrated TPN reducing risk of phlebitis and
thrombosis.
o 2 weeks less per
o Extended period use TPN

COMPLICATIONS OF PARENTERAL NUTRITION

 Infection at site of catheter can cause infection of blood called sepsis.
 Bacterial or fungal infections can develop in the solution if unrefrigerated for over 24 hours.
 Abnormal electrolyte levels, phlebitis, or blood clots can occur.
 Loss of skin surface leads to enormous losses of fluids, electrolytes, and proteins in cases of serious burns.
 Fluids and electrolytes are replaced by intravenous therapy immediately to prevent shock.
 Glucose is not included in these fluids for the first 2 to 3 days after the burn, to reduce the risk of
hyperglycemia.
 Enormous increase in energy is needed for the healing process to occur.
 Protein needs can be as high as 1.5 to 3.0 or more grams per kilogram of weight, and fat intake, 15 to 20%
of nonprotein calories.
 A high-protein, high-kcal diet is used.
 

BURN PATIENT Nutrition Therapy for Burn Clients

 There is an increased need for vitamin C and zinc for healing.
 Vitamin B is needed for the metabolism of the extra nutrients.
 The badly burned client needs sufficient fluids to help kidneys hold the unusual load of wastes in solution
and to replace those lost.

FEVER AND INFECTIONS Nutritional Care of Fevers and Infections

 Protein intake should be increased because of infections (sepsis).
 Minerals are needed to help build and repair body tissue and to maintain acid- base, electrolyte, and fluid
balance.
 Extra kcal are needed for the increased metabolic rate.
 Fever is a hypermetabolic state in which each degree of fever on the Fahrenheit scale raises the basal
metabolic rate (BMR) 7%.
o When patient have fever there must have extra calories because without it it proceeds to
detoriation of…..
 If extra kcal are not provided during fever, the body first uses its supply of glycogen, then its stored fat,
and finally its own muscle tissue for energy.
  Extra vitamins are also necessary for the increased metabolic rate and to help fight the infection causing
the fever.
 Extra liquid is needed to replace that lost through perspiration and possibly vomiting and diarrhea, which
can accompany infection.

PATIENTS WITH AIDS Nutritional Care of the AIDS Client

 HIV invades the T cells, which are white blood cells that protect the body from infections.
 When the T cells cannot function normally, the body has no resistance to opportunistic infections.
 Opportunistic infections are caused by other microorganisms that are present but do not affect people
with healthy immune systems.
o But when immunocompromised…
 HIV infection ultimately leads to acquired immune deficiency syndrome (AIDS), which is incurable and
fatal.
 Persons diagnosed as being HIV-positive should have a baseline nutrition and diet assessment by a
registered dietitian.
 Unhealthful eating habits can be corrected at an early stage of the disease, and future nutritional needs
explained.
 AIDS clients experience serious protein- energy malnutrition (PEM) and thus, body wasting.
 This may be referred to as HIV wasting syndrome, which results in hypoalbuminemia and weight loss.
 When possible, medications should be given after meals to reduce the chance of nausea.
 Sores in the mouth or esophagus can make eating painful, and soft foods may be better tolerated than
others.
 Taste can be affected. Avoid spicy, highly acidic, extremely hot or cold foods.
 Additional sugar and flavoring may increase the acceptability of liquid supplements.
 Because of the nausea and diarrhea, sufficient fluids are essential.
 Tube feeding may be necessary if client has difficulty swallowing or simply cannot eat.

Causes of Nutrient Loss in AIDS

Anorexia Certain medications
Cancer Malabsorption caused by cancer or diarrhea
Diarrhea Protein energy malnutrition
Increased metabolism due to fever  

Causes of Anorexia in AIDS

Medications Causes nausea, vomiting
Oral Infections Diminish saliva, alter taste, cause mouth pain
Altered taste Changes or exaggerates flavors
Fever pain Depresses appetite
Depression Depresses appetite
Dysphagia Makes swallowing difficult
Dementia May cause clients to forget to eat

Stop and Share

 You are teaching a class about methods to improve the appetite of an AIDS client.
 Name some of the methods.
o Give medications after meals.
o Offer soft food.
o Avoid spicy, acidic, and extremely hot or cold foods.
o Serve frequent, small meals.
o Add sugar and flavorings to liquid supplements.
o Take advantage of the "good" days and offer any food the client tolerates.
o Talk with the client to help ease concerns about finances, family, and friends.

SPECIAL CONSIDERATIONS FOR CLIENTS

NUTRITIONAL CARE  Fever, nausea, fear, depression, chemotherapy, and radiation can destroy appetite.
 Vomiting, diarrhea, chemotherapy, radiation, and some medications can reduce or prevent absorption of
nutrients.
PROTEIN ENERGY  When the increased needs for energy and protein are not met by food intake, the body must use its stores
MALNUTRITION of glycogen and fat.
 Body breaks down its own tissues to provide protein for energy.
 Protein-energy malnutrition can be a problem among hospitalized clients.
 PEM can delay wound healing, contribute to anemia, depress the immune system and increase
susceptibility to infections.
 Symptoms of PEM include weight loss and dry, pale skin.
 Iatrogenic malnutrition is malnourishment as a result of hospitalization.

IMPROVING THE  Formal nutritional assessments should be made on a regular basis.

CLIENT'S NUTRITION  All members of the health care team should be alert to signs of malnutrition every day.
 Listen to client's concerns and watch reaction to food served.
 …
 
 .

FEEDING THE CLIENT  In the home, the family menu should serve as the basis of the client's meal whenever possible.
 Omit or add certain foods as necessary.
 Vary the method of preparation if needed
SERVING THE MEAL  When serving food at the bedside, tray should be lined with a pretty cloth or paper liner.
 Attractive dishes should be used.
 Food should be arranged attractively
 Utensils arranged conveniently
 Serve water, as well as another beverage. Serve food at proper temperature.
 Give client the opportunity to use the bedpan and to wash before the meal is served.
 Client should be in a comfortable position.
 Any unpleasant sights should be removed.
 Pleasant conversation during preparation can improve the client's mood.
 Tray should be placed so that it is easy for the client to feed self.
 If client needs help, prepare items by opening containers and anticipating needs.
 Client should be given sufficient time to eat.
 If meal is interrupted, warm food should be re-heated.
 Help client brush teeth after meal.
 Document intake for facility policy

FEEDING THE CLIENT  Sit near the side of the bed.

 Small amounts of food should be placed toward the back of the mouth with a slight pressure on the
tongue with the spoon or fork.
 Clients should not be fed with a syringe.
 Asepto syringe
 If paralyzed, food and straw should be placed on nonparalyzed side of the mouth.
 Allow client to help self as much as possible.
 If client begins to choke, help her or him sit up straight.
 Do not give food or water while the client is choking .
 Clients mouth should be wiped as needed
 A client diagnosed with dysphagia will require a specialized diet.
 Depending upon the swallowing abnormality, the client may need pureed foods with either thin or
thickened liquids.
 A dysphagic client should not use straws.
FEEDING THE BLIND  Arrange the food as if the plate were the face of a clock.
CLIENT  Use a pattern for preparing the meal, so the client knows where each item will be each time.
 People who are blind usually feel better when they can help themselves.
PHYSICAL PROBLEMS OF  Majority of people 85 and over have at least one chronic disease such as arthritis, osteoporosis, diabetes
THE INSTITUTIONALIZED mellitus, , cardiovascular disease, mental disorder.
ELDERLY  These conditions affect their attitudes, physical activities, appetites and, thus, nutritional status.
 PEM is a major problem for this population.
 Anemia can develop and contribute to fatigue, confusion and depression.
 Sufficient animal protein and vitamin C should be provided in the diet.
 Pressure ulcers (bedsores) can develop in bedridden clients.
 Healing of pressure ulcers requires treatment of the ulcer, relief of the pressure, a high-kcal diet with
sufficient protein, vitamin C and zinc supplements.
 Constipation can be caused by inadequate fiber, fluid, or exercise.
 Other causes include medication; reduced peristalsis; or former abuse of laxatives.
 Treatment includes increasing fluid, fiber, and exercise.
 Diarrhea can be caused by lack of muscle tone in the colon.
 An increase of fiber in the diet combined with supplemental vitamins and minerals may be helpful.
 The sense of smell declines with age and the appetite diminishes.
 Xerostomia (dry mouth) can be caused by disease or medications.
 Drinking water, eating frequent small meals, and chewing sugar-free gums or candies may be helpful.
 Dysphagia (difficulty swallowing) can result from a stroke, closed head trauma, head or neck cancer,
surgery, or
 Alzheimer's and other diseases.
 Many dysphagia clients must have thickened liquids.
 Dysphagia clients should always be in an upright position when eating.