SNH5419 Clinical Nutrition Summary Quiz

SNH5419 Clinical Nutrition Module Summary

• Course name: SNH5419 Clinical Nutrition
• Semester: 2024/25, Semester 1
• Instructor: Dr. Kent Yeung
• Email: [email protected]

SOAP Documentation

• SOAP: Subjective, Objective, Assessment, Plan
• Subjective (S): Information provided by the patient, family, or others, including diet history, physical activity, beliefs, attitudes, prior dietitian contact, and nutrition education; also includes patient complaints (e.g., nausea, vomiting, decreased appetite), and previous dietetic input/nutrition support
• Objective (O): Factual observations and findings, including diagnosis, current diet/nutrition support/special diet, height, weight, BMI, weight history, biochemical data, temperature, activity factor, physical activity, bowel movements, infection, medications related to intake/nutritional needs, and relevant social/nutrition-focused physical examination findings (e.g., SGA, PG-SGA)
• Assessment (A): Overall nutrition status/problem; energy, protein, fluids (including calculation); assessment of dietary intake; PESS statement (Problem/Etiology/Signs/Symptoms); assessment of nutrition knowledge, motivation, and stage of change.
• Plan (P): Nutritional interventions (hospital diet - energy, protein, fluids), discharge plan, education for patients/caregivers, items for monitoring, and review plans/timeframes

Stages of Change Theory

• Behavioral change is a process
• Individuals go through different stages before changing their behavior.
• Commonly identified stages: Enter, Pre-contemplation, Contemplation, Preparation, Action, Maintenance
• Stages are cyclical: Individuals can exit and re-enter at any stage.

L1 Nutritional Care Plan (SOAP Example)

• Patient: 34-year-old male, with a history of hypertension, type 2 diabetes mellitus (T2DM), and hyperlipidemia. (BMI 35.7, Obesity II)
• Subjective (S): Eats two meals daily, fried foods, burgers, ice cream, and beers frequently. No salt added to food. Activity: Plays golf monthly.
• Objective (O): The patient has a rapid increase in body weight.
• Assessment (A): Increased food intake with high sugar and fat content in takeaways. The patient could benefit from increased physical activity and a gradual weight loss.
• Plan (P): Education on balanced diet and appropriate fat/carbohydrate intake; counseling on dining out and takeaway guidelines. Follow-up with outpatient nutrition clinic within one month.

L2 Hypertension

• Hypertension: Persistently high arterial blood pressure.
• Primary/Essential Hypertension: In 90-95% of patients, it results from complex interactions of poor lifestyle choices, gene expression, and high sodium intake and low fruit and vegetable intake and physical inactivity.
• Secondary Hypertension: Caused by another disease, commonly endocrine disorders (e.g., thyroid problems, renal failure).
• Diagnostic Criteria: Systolic blood pressure (SBP) ≥ 140 mmHg OR diastolic blood pressure (DBP) ≥ 90 mmHg. Prehypertension: SBP between 120-139 mmHg or DBP between 80-89 mmHg.
• Management: Eat less salt, increase potassium intake, reduce excess weight, physical activity, reduce alcohol intake, stress management, and medications.
• DASH (Dietary Approaches to Stop Hypertension) diet: Promotes consuming fruits, vegetables, whole grains, and low-fat dairy foods, along with limited sugar-sweetened foods, red meat, and added fats. The DASH diet aims to increase the intake of magnesium and potassium via fruit and vegetable consumption, and increase calcium intake with low-fat dairy consumption. It will help reducing BP in hypertensive and normotensive people.

L3 Malnutrition

• Sources of Protein: Complete sources (animal-based) contain all essential amino acids; Incomplete sources (plant-based) lack at least one essential amino acid.
• Screening tools: Subjective Global Assessment (SGA), Patient-Generated Subjective Global Assessment (PG-SGA), Mini Nutritional Assessment (MNA), Malnutrition Universal Screen Tool (MUST).
• Top 10 common cancers in Hong Kong (incidence 2021)

L4 Oncology

• Top 10 cancers incidence and mortality data for both sexes for Hong Kong
• Includes sites like Lung, Colorectal, Breast, Prostate, etc. (data specific values provided on 2021 data).

L7 GI Disorder

• Gastroesophageal Reflux Disease (GERD): Esophageal protective mechanisms have decreased pressure in the lower esophageal sphincter which increases intra-abdominal pressure. Episodes of reflux overwhelm esophageal protective mechanisms.
• Symptoms: Reflux of gastric secretions, heartburn, substernal pain, belching, esophageal spasm
• High-risk groups: Pregnant women, overweight individuals, patients with COPD, and individuals taking certain medications such as muscle relaxants and NSAIDs; people who smoke.
• Management: Avoid large, high-fat meals, alcoholic beverages, coffee, excess spices (e.g., chili, peppermint), and excess citrus fruits. A low-fat, liquid diet, weight loss, gradual dietary changes, avoid lying down immediately after eating.

L8 Metabolic Disorder

• Genetic Metabolic Disorders: Different genetic metabolic disorders affecting amino acid (e.g., Phenylketonuria (PKU)), carbohydrate (e.g., Galactosemia), and fatty acid oxidation disorders are described. Associated enzymes and their respective disorders are outlined.
• Glucose-6-Phosphate dehydrogenase (G6PD) deficiency: G6PD is an enzyme protecting red blood cells; deficiency can lead to hemolytic crisis (RBC damage, jaundice, brain damage, etc.). Management can include avoiding specific foods like fava beans and certain Chinese herbal medicines, some antibiotics, and antipyretics
• Avoid contact with mothballs.

L9 Metabolic Stress

• Enteral Nutrition: Methods for feeding patients with non-functioning GI tract or insufficient feeding needs. Main types: nasogastric tube (NGT), orogastric tube (OGT), nasoenteric tube (nasojejunal/nasoduodenal tubes), oroenteric tube, gastrostomy tube (PEG, PRG, button tubes), jejunostomy tube (PEJ, PRJ tubes).
• Parenteral Nutrition: Provision of nutrients intravenously used for patients with non-functioning GI tracts or insufficient feeding needs. Details of the types of parenteral nutrition and how it is administered (via central vein or peripheral vein using a catheter).

L10 Functions of Liver, Gallbladder, and Pancreas

• Liver: Metabolism of carbohydrates, proteins, and fats; storage/activation of vitamins and minerals; conversion of ammonia to urea; metabolism of steroids; action as a filter and flood chamber.
• Gallbladder: Concentrates, stores, and excretes bile, which is produced by the liver.
• Pancreas:
  • Exocrine function: secretes enzymes for digesting proteins, fats, and carbohydrates;
  • Endocrine function: secretes hormones (insulin & glucagon) to regulate blood sugar levels; synthesizes somatostatin to inhibit insulin and glucagon secretion.
• Liver diseases: Hepatitis (Acute Viral Hepatitis, Chronic Hepatitis), Liver Cirrhosis, Fatty Liver, Alcoholic Fatty Liver Disease, and Non-alcoholic Fatty Liver Disease (NAFLD)
• Cirrhosis: Clinical symptoms (internal issues like portal hypertension, hepatic encephalopathy, esophageal varices, hepatorenal syndrome)

L11 Renal Disease

• Chronic Kidney Disease (CKD): Defined by damaged markers (e.g., albuminuria, haematuria), structural abnormalities, eGFR <60 ml/min/1.73m² on at least 2 occasions 90 days apart. Risk factors include diabetes, hypertension, chronic glomerulonephritis, infections, toxic agents, renal vascular or tubular diseases, genetic disorders (e.g., polycystic kidney disease), and systemic autoimmune diseases (e.g., lupus).
• CKD stages (1-5) based on eGFR.
• Nutritional management: Goals to achieve optimal nutritional status; prevent toxic metabolic product buildup (minimize uremic toxicity); delay progression of renal failure; postpone need for dialysis; and prevent complications.

L12 Food Allergy and Intolerance

• Types of hypersensitivity reactions (Type I to Type IV).

L13 Other Diseases

• Irritable Bowel Syndrome (IBS): Medications (laxatives, loperamide, antispasmodic agent, antidepressants), pain management, dietary modification (low FODMAP diet, probiotic), counseling (relaxation and stress reduction)
• Low FODMAP Diet: Diet instructions, carbohydrate restriction (fructose, oligo-, di-, monosaccharides, polyols), lactose restriction, etc
• Major Burns: Increase in energy requirement and protein catabolism; susceptible to infection
• Wallace Rule of Nines: Tool to estimate BSA involved in burn patients
• Other topics that were presented include Galactosemia, and its dietary management

L14 Other Special Mentions

• Disclaimer: This summary is extracted from the slides, and therefore might contain inaccuracies. It is essential to consult original sources for precise information.