Nutrition And Diet Therapy - ADIME Process - Nutrition Intervention PDF

NUTRITION AND DIET THERAPY ADIME PROCESS – NUTRITION INTERVENTION BACHELOR OF SCIENCE IN NURSING / LEVEL 2 FIRST SEMESTER / 2023-2024 ADIME PROCESS – NUTRITION INTERVENTION...

NUTRITION AND DIET THERAPY ADIME PROCESS – NUTRITION INTERVENTION BACHELOR OF SCIENCE IN NURSING / LEVEL 2 FIRST SEMESTER / 2023-2024 ADIME PROCESS – NUTRITION INTERVENTION caregiving resources at the maternal, household and NUTRITION INTERVENTION community levels; and access to health services and a safe Purposeful planned actions intended to positively change and hygienic environment—and incorporate specific nutrition related behavior, environmental condition, or nutrition goals and actions aspect of health status. Purpose: resolve or improve the nutrition diagnosis or SPECIFIC NUTRITION INTERVENTIONS nutrition problem by provision of advice, education, or Support for exclusive breastfeeding up to 6 months of age delivery of the food component of a specific diet or meal and continued breastfeeding, together with appropriate and plan tailored to the patient/client’s needs nutritious food, up to 2 years of age. Fortification of foods – process whereby nutrients are Determining a nutrition intervention: added to food to maintain or improve the quality of the diet Nutrition diagnosis and its etiology drives’ the selection of a of a group, community, or population. nutrition intervention Micronutrient supplementation – provision of Nutrition intervention strategies are selected to change pharmaceutically prepared vitamins & minerals for nutritional intake, nutrition-related knowledge or behavior, treatment or prevention of specific micronutrient deficiency. environmental conditions, or access to supportive care and Treatment of severe malnutrition – Ready-to-use services. therapeutic food (RUTF) is used to treat over 4 million Nutrition intervention goals provide the basis for monitoring children with severe acute malnutrition annually. progress and measuring outcomes. NUTRITION – SENSITIVE APPROACHES Terminology for nutrition intervention is organized in 4 1. Agriculture and food security – Making nutritious food more domains (categories): accessible to everyone, and supporting small farms as a source of income for women and families Food and/or Nutrient Delivery o Nutrition-sensitive agriculture is a food-based Individualized approach for food/nutrient provision. approach to agricultural development that puts Food Administration: nutritionally rich foods, dietary diversity, and food o Oral Nutrition fortification at the heart of overcoming malnutrition o Enteral Nutrition and micronutrient deficiencies. o Short Term Enteral Access o The need for investments to boost agricultural o Long Term Enteral Access production, keep prices low, and increase incomes o Parenteral Nutrition is needed; targeted agricultural programs can Nutrient Education complement these investments by supporting A formal process to instruct or train a patient/client in a skill livelihoods, enhancing access to diverse diets in or to impart knowledge to help patients/clients voluntarily poor populations, and fostering women's manage or modify food, nutrition and physical activity choices empowerment. and behavior to maintain or improve health. 2. Social safety nets - currently provide cash or food transfers Nutrition Counseling to poor people and victims of shocks (eg, natural disasters, A supportive process, characterized by a collaborative Pantawid Pamilyang Pilipino Program 4P’s. Social counselor patient relationship, to establish food, nutrition and Amelioration Program (SAP). physical activity priorities, goals, and individualized action 3. Early child development - Combined early child plans that acknowledge and foster responsibility for self-care development and nutrition interventions show promising to treat an existing condition and promote health. additive or synergistic effects on child development—and in Coordination of Nutrition Care some cases nutrition—and could lead to substantial gains Consultation with, referral to, or coordination of nutrition care in cost, efficiency, and effectiveness, but these programs with other health care providers, institutions, or agencies have yet to be tested at scale. (NGO’s and INGO’s) that can assist in treating or managing 4. Classroom education on nutrition - Ways to enhance nutrition related problems program nutrition-sensitivity include: improve targeting; use conditions to stimulate participation; strengthen nutrition goals and actions; and optimize women's nutrition, time, NUTRITION – SENSITIVE INTERVENTIONS physical and mental health, and empowerment. Interventions or programs that address the immediate 5. Clean Water and Sanitation: Improving access to reduce determinants of fetal and child nutrition and development— infection and disease. adequate food and nutrient intake, feeding, caregiving and 6. Healthcare: Improving access to services to ensure that parenting practices, and low burden of infectious diseases. women and children stay healthy draw on complementary sectors such as agriculture, health, 7. Women’s Empowerment: At the core of all efforts, women social protection, early child development, education, and are empowered to be leaders in Nutrition-Sensitive water and sanitation to affect the underlying determinants Approaches. of nutrition, including poverty; food insecurity; scarcity of access to adequate care resources; and to health address the underlying determinants of fetal and child nutrition and development—food security; adequate LOURDES BSN-2E 1  ADIME PROCESS – NURSING INTERVENTION NUTRITION DIAGNOSIS #1: INTAKE FOOD AND NUTRITION DELIVERY Alteration in Nutrition: inadequate intake of the mineral Food safety is an important concept in food delivery. iodine r/t lack or insufficient supply of iodine in the diet as It is essential to provide clients with necessary education evidenced by enlargement of the neck & tightness in the regarding safe food handling and food-medication throat & breathlessness. interactions. Food safety includes preventing aspiration of food, reducing 1. Food and/or Nutrient Delivery the risk of foodborne illness, assessing for food allergies, Add iodized salt to cooking or as table salt and understanding food-medication interactions. Add seaweed, seafood to diet like fish, shellfish & others in cooking meals, show examples of iodine rich foods in a food FOOD SAFETY chart and how much of it she should take daily. Proper food storage guidelines o Fresh meat:1 to 2 days at 40O F (4O C) or colder 2. Nutrition Education o Fish: 1 to 2 days at 40O F (4O C) or colder Explain to client about nutritional deficiencies in her diet and o Dairy products: store in the refrigerator for 5 days how these can be provided with right choices of food which for milk, and 3-4 weeks for cheese are readily available in the market. o Eggs: store in the refrigerator for 3 weeks in shell, and 1 week for hard-boiled. 3. Nutrition Counseling as needed. o Fruits and vegetables: keep for 3-5 days. Citrus fruits and apples – 1 week or longer. 4. Coordination of Nutrition Care o Pantry Items: store in a dry, dark place at room Referral to, or coordination of nutrition care with other temperature. health care providers, institutions, or agencies that can o Canned goods: store 1 year or longer at room assist in treating or managing nutrition-related problems. temperature. Proper food handling NUTRITION DIAGNOSIS #2: BEHAVIORAL – o Wash hands and food preparation surfaces ENVIRONMENTAL frequently Insufficient food intake including mineral iodine r/t o Separate foods to avoid cross contamination inadequate supply or access to food due to economic Proper preparation guidelines factors as evidenced by husband out of work for 6 months o Perform frequent hand hygiene & statement of not enough food to eat at home. o Cook food to the proper temperature – (ex: eggs at 160O F; roasts & stakes at 145O F) Coordination of Nutrition Care o Avoid cross-contamination when preparing food Referral to, or coordination of nutrition care with other o Understand the packaging labels such as sell-by health care providers, institutions, or agencies that can date, used-by date, and expiration date assist in treating or managing nutrition-related problems. Referral to DOH/DSWD programs like supplemental FOODBORNE ILLNESS feeding program, sustainable livelihood program for both Occur due to improper storage of food products and unsafe husband and wife when both are restored to normal handling. In order to decrease the incidence of foodborne functioning. illnesses, primary education should be conducted. Foodborne illnesses pose the greatest risk to children, older NUTRITION DIAGNOSIS #3: CLINICAL adults, and immunocompromised and pregnant clients. Difficulty in swallowing r/t enlargement of the thyroid gland COMMON FOODBORNE ILLNESSES or goiter as evidenced by enlargement of the neck and tightening of the throat when eating. o Salmonella o Occurs due oto The condition can be eating fatal. Common 1. Food and/or Nutrient Delivery undercooked or manifestations include Add iodized salt to cooking or as table salt raw meat, headache, fever, Add seaweed, seafood to diet like fish, shellfish & others n poultry, eggs, abdominal cramping, cooking meals, show examples of iodine rich foods like fish, fruit, and diarrhea, nausea, and eggs. dairy products. vomiting. o o Raw Escherichia coli oor Severe abdominal pain 2. Nutrition Education 0157: H7 undercooked Diarrhea Explain to the patient in terms she understands about the meat, especially thyroid gland compensating for the lack of iodine in her diet hamburger, can (To compensate, the thyroid gland works harder to try to cause this make more. This causes the cells to grow and multiply, foodborne eventually leading to enlargement in the neck or goiter) pathogen. Explain to client about nutritional deficiencies in her diet and o Shigella o Poor personal o Diarrhea how these can be provided with right choices of food which hygiene and are readily available in the market. improper food hygiene 3. Nutrition Counseling as needed. commonly cause Shigella. 4. Coordination of Nutrition Care Referral to, or coordination of nutrition care with other health care providers. If adding iodine to the diet is not enough, oral medications can help. LOURDES BSN-2E 2  ADIME PROCESS – NURSING INTERVENTION o Listeria o Soft cheese, raw Cause significant laxatives, some beta-blockers, ACE o Monocytogenes milk products, problems for inhibitors, some calcium channel undercooked newborns, pregnant blockers, monoamine oxidase (MAO) poultry, meat, clients, and inhibitors, and spironolactone. seafood, and immunocompromised o Tyramine a naturally occurring amine found in many vegetables can clients. foods that has hypertensive effects similar cause this Onset occurs with the to other amines (norepinephrine) illness. development of a metabolized by MAO, and clients taking o sudden fever, MAO inhibitors who consume foods high diarrhea, headache, in tyramine may suffer hypertensive back pains, and crisis abdominal o Herbal cause potential interactions with discomfort. Supplements prescribed medications It can lead to stillbirth It is important that any herbal medication or miscarriage in consumed by a client be discussed with pregnant clients. the provider. FOOD ALLERGIES FOOD ADMINISTRATION Nutritional assessments should include a complete profile of clients like identification of food allergies. The most food GOOD TRAY SERVICE allergies reported are the milk, peanuts, fish, egg, and wheat. Common reactions and manifestations may include The essential good tray service are as follows: nausea, vomiting, dyspnea, itching, dizziness, and 1. A tray of sufficient size for uncrowded arrangement of headache. Some reactions are severe and can cause dishes anaphylaxis. 2. A clean, unwrinkled tray cover and napkin of linen or good quality paper FOOD – MEDICATION INTERACTIONS 3. An attractive patter of spotless chinaware without chips or Food and medications can interact in the body in ways that cracks, clean glassware and shining silverware alter the intended action of medications. The composition 4. An orderly arrangement of all items on the tray so that and timing of food intake should be considered in relation everything can easily be within arm’s reach of the patient to medication use. 5. Portions of food suitable for the patient’s appetite 6. Food attractively arranged with appropriate garnishes Food can alter the absorption of the medication. It can 7. Meals serve on time decrease the rate and extent of absorption. 8. Hot food served on warm plates and kept warm with food o Reducing the rate of absorption alters the onset of cover; cold foods served on chilled dishes peak effects. 9. Tray promptly served to the patient so that food is at its best o Reducing the extent of absorption reduces the intended effect of medication. Some medication causes gastric irritation. It is important to ILLNESS AND NUTRITION take certain medication, some antibiotics, amoxicillin Illness has many effects on the body’s ability to use [Amoxil], and some antidepressants, bupropion [Wellbutrin] nutrients. with food to avoid gastric upset. Lack of appetite, vomiting, and pain prevents the intake of sufficient amount of food. Sample Food-Medication Interaction In severe diarrhea, the absorption of all nutrients is poor, weight loss, dehydration, signs of malnutrition happen o Grapefruit Interferes with the metabolism of many A fever increases the rate of metabolism, increasing need juice medications, resulting in an increased for calories, protein, and vitamins. serum level of medication. In metabolic disease, nutrients are not utilized fully eg. DM o (eg. statin drugs to lower if untreated results in inadequate carbohydrate use. cholesterol. Some drugs that treat high blood pressure like A wheelchair/bedbound client, losses increased amounts of nifedipine, Some antihistamines, nitrogen and calcium in the body. such as Allegra.) can affect proteins in the body known as ILLNESS AND FOOD ACCEPTANCE drug transporters, which help move a drug Illness reduces person’s interest in food r/t gastric into our cells for absorption → less of the discomfort or distention after meals. drug enters the blood and the drug may Intake of some drugs reduce desire for food. not work as well Client maybe away from home for the first time, and food in o Food high in increase the metabolism of the anti- hospital different from what he/she used to. protein, Parkinson’s medication levodopa (L-dopa, Client may worry about mounting hospital bills, work, or amino acids, Sinemet), which decreases the duration of when to return to normal health. and vitamin its therapeutic effects The modified diet may not be appealing, and may make B6 client feel deprived or punished o Consumption decrease the anticoagulant effects of During the time of illness may become self-centered, of foods high warfarin (Coumadin) irritable or angry in Vitamin K May complain about food in order to get more attention. o Licorice cause hyperkalemia (elevated serum potassium) Excess ingestion can be dangerous for clients taking digoxin (Lanoxin), stimulant LOURDES BSN-2E 3  ADIME PROCESS – NURSING INTERVENTION RESPONSIBILITIES OF THE NURSE IN NUTRITION 1. Is the first person to see the patient’s feeding problems. 2. Has direct communication with the patient, & therefore must be knowledgeable of the principles of the diet as well as the food allowed and restricted. 3. Immediately forwards the diet prescription to the dietary department. 4. Observes, listens to and reports any problems related to nutritional needs of the patient. 5. Observes how well the patient eat their meals, the kind of food refused, & the patients’ attitude towards food. 6. By listening the nurse shows general interest in understanding the patients’ nutritional needs. 7. Acting on information acquired regarding nutritional needs is essential, it may be necessary to relay this to the supervisor, dietitian and or physician in charge. DIET THERAPY An appropriate diet is essential in the total care plan developed for every patient. It usually supplements medical and surgical care; sometimes, it is the specific treatment for the disease. Diet therapy accomplishes one or more of these aims: 1. Maintains normal nutrition 2. Corrects nutritional deficiency 3. Changes body weight 4. Adjusts the body’s ability to use one or more nutrients 5. Permits maximum rest to the body or an organ. LOURDES BSN-2E 4  ADIME PROCESS – NURSING INTERVENTION ORAL NUTRITION TYPES OF STANDARD HOSPITAL DIET A. Liquid Diets 1. Clear Liquid Diet The allowance of tea, coffee or coffee substitute, Primary purpose of this diet is to relieve thirst used for 24-48 hours following and fat-free broth. and to help maintain water balance. acute vomiting, diarrhea, or Ginger ale, fruit juices, gelatin, fruit ices, and water Broth provides sodium surgery gruels Broth and juice contribute potassium Administration: Small amount of fluid is offered Carbonated beverages, sugar, and fruit juices every hour or two to the patient furnish a small amount of carbohydrate 2. Full Liquid Diet A nutritionally adequate diet consisting of liquids Increase the calorie intake, one pint of light used for acute infections and and foods that liquefy at body temperature. cream may be substituted for one pint of milk fever of short duration and for Food allowance per day: approx. 85 g of Protein patients who are too ill to chew & 1,950 of Calories Increase protein level at approx. 30g by May be ordered as the first Milk, light cream, strained meat, strained citrus including 3 oz non-fat dry milk each day progressive form the clear fluid juice, tomato juice, vegetable puree, stained diet following surgery or in the cereal, plain gelatin, sugar, butter, soft custard treatment of acute Strained meat may be added to broth or hot gastrointestinal (GI) upsets. tomato juice Only use pasteurized dried egg powder to avoid salmonella infection from raw eggs Administration: the diet is offered in 6 feedings or more. (Breakfast, AM Snack, Lunch, PM Snack, Dinner, Bed Time) 3. Blenderized Liquid Diet Modified with regard to calories, protein, fat, or Consists of liquids and foods that are pureed to (Pureed) other nutrients based on the dietary needs of the liquid form For clients who have chewing, client. or swallowing Add broth, milk, gravy, cream, soup, fruit juice to difficulties, oral or facial surgery foods instead of water provides additional nutritive and wired jaws value B. Soft Diet Soft Diets - “Bland, Low-fiber” A nutritionally adequate diet differs from the It serves as a transition from liquids to a regular diet normal diet in terms of having reduced fiber diet for individuals who are recovering from used immediately between the content, soft consistency, and bland flavor. surgery or a long illness. full fluid diet and the regular diet Normal diet is modified in following ways: o Meat following surgery, acute and poultry are minced or ground. Fish is usually Help to ease difficulty in chewing and/or infections and fevers, and in GI tender without further treatment swallowing due to dental problems or extreme disturbances Vegetables, diced or chopped, are cooked. weakness. Soft raw fruits Soft roll, breads, or biscuits are used instead of To relieve mild intestinal or stomach discomfort. crisp rolls, crust bread, and toast All desserts on a normal diet may be used including pies with tender crusts, cake, and puddings. Administration: the diet is offered in 6 feedings (Breakfast, AM Snack, Lunch, PM Snack, Dinner, Bed Time) C. Test Meals 1. Fecal Fat It consists of 100g fat ingested daily for 3 days It measures fat globules in the stools to detect Determination Test prior to fecal collection. fat absorption as in cases like cystic fibrosis. Food items included are as follows: 2 cups whole milk, 1 egg, 8 oz lean meat 10 exchanges of fat 2. Meat-Free Test A 3-day diet excludes ingestion of meat, poultry, Use to determine GIT bleeding and fish. 3. Calcium Test The diet requires 1,000 mg calcium intake – 400 Use to determine urinary calcium excretion to mg from food sources and 600 mg from oral diagnose hypercalciuria. supplements 4. Serotonin Food rice in serotonin is excluded in the diet Use to detect calcinoid tumors of the intestinal tract. LOURDES BSN-2E 5  ADIME PROCESS – NURSING INTERVENTION D. Regular Diet Normal Diet “regular diet” is the most frequently used of all A normal diet, like a modified diet, is of great diets. The normal diet may be modified for: importance in a therapeutic sense. consistency and texture With satisfactory food intake, the body tissues flavor are continuously maintained, and there is energy value opportunity for repair from the effects of illness. nutrient level such as fat, proteins, carbohydrates, The patient’s failure to eat normal diet could lead sodium, and others to loss of body tissues and a prolonged food categories such as types of fats or elimination convalescence of diet for allergies. ENTERAL NUTRITION Example: Enteral feeding pertains to the delivery of food and nutrients 1,800 kcal C – 60% P – 15% either orally or by tube directly into the gastrointestinal track F – 20% C – 270 P – 70 F – 50 (GIT). It is intended for patients with a functioning GIT but unable Follow the same procedure in the distribution of food items then to ingest the required nutrients orally (burns, trauma, translate to household measures. radiation therapy or chemotherapy, liver or renal dysfunction) or for patients with impaired digesting capacity How to compute total fluid volume: Volume = Cal Rx____ or unable to absorb nutrients. Cal Density It is also administered to those who are neuro-muscularly impaired and cannot chew or swallow food Example: Cal Rx = 1,800 kcal EN feeding or gavage feeding for an infant too weak for Cal Density = 1 cal / mL sucking, lacks a gag reflex & to conserve energy when attempting to feed but cyanotic Volume = 1,800 kcal = 1,800 mL or 7.5 cups Consists of blenderized foods or commercial formula 1 cal/mL administered by a tube into the stomach or small intestine Total Fluid Rx – Sub total = 1,800 – 200 TYPES OF ENTERAL NUTRITION = 1,600 mL 1. Ready-to-use Formulation Cups of thick lugaw a. Nutritionally complete formulation can be used 1600mL alone and provides the total needs in a specified = 6 – 7 cups 240 mL volume of formula. b. Modular formulation provides the different forms of individual nutrients to supplement existing Rice lugaw = 6 cups = 1,440 mL; 6 cups of thick lugaw = 4 formulas. ex rice c. Combined formulation meets the therapeutic Slice bread = 5 ex = 10 slices needs. Fluid = 200 + 1,440 = 1,640 2. Tube Feedings – This type of feeding may be prepared Water to be added from regular foods. = Rx – sum total fluid 3. Standard Tube Feedings – This type of feeding is fiber- = 1,800 – 1640 free and high in cholesterol, fat and sugar. It is a milk-based = 160 mL formulation with sugar and soft cooked eggs. Sample Daily Food Plan for Standard Tube Feedings Fruit 3 Exchanges Juices Only Milk 2 ex wholes 2 cups Evaporated Milk 2 ex skims ½ cup skim milk powder Eggs 3 mediums Strained, soft cooked Sugar 10 tbsp Sucrose, glucose, lactose or corn syrup 4. Blenderized Tube Feeding – It consists of soft diet allowances which can be blenderized easily. Plan for Blenderized Formula: LOURDES BSN-2E 6  ADIME PROCESS – NURSING INTERVENTION ENTERAL FEEDING ROUTES 1. Short-term Enteral Access o A patient’s medical status and the anticipated length or time that the tube feeding will be require to determine the type of tube used. o Short-term enteral access is the temporary nutrition support needed by the patient (defined as less than 3 to 4 weeks), and includes nasogastric (NG) and nasoenteric (NE) tubes. Feeding Route Characteristics Advantages Disadvantages Nasogastric Tube extends from nose into the Rapid placement requiring minimal Tube can be easily removed stomach equipment by patients Feedings can be immediately Tube can be in advertently following confirmation of tube inserted into trachea, placement and bowel sounds especially among patients with poor gag reflexes. Formula can be delivered or Anomalies in nose and neck continuous infusion (deviated septum, esophageal strictures) may prevent tube placement. Nasointestinal Tubes Tube extends from the nose to the Placed by doctor or nurse only with Not safe for those with trauma intestine. guidance of a fluoroscope or to the jaw, base of skull or endoscope neck, those who have large These tubes are used whenever there is esophageal varices a reason to bypass the stomach, such as with gastric surgery, trauma to the stomach, or paralysis of the stomach muscles Nasoduodenal or Nasoduodenal: Tube extends from nose Risk for aspiration may be reduced. Dislodgment of tube into the nasojejunal tubes through the pylorus into the duodenum; stomach by coughing or Tube maybe Feedings are better tolerated by vomiting is common (will advanced by peristalsis or patients with poor tolerance to increase risk of aspiration in videoflouroscopy gastric feedings (gastric retention or patients with altered gastric reflux) mobility. Nasojejunal: Tube extends from the nose through pylorus into the jejunum Nasojejunal feedings permit enteral Administration usually limited and is usually placed by feeding in patients with partial to continuous delivery of videoflouroscopy gastric outlet obstruction or formula (small intestine does duodenal fistula. not tolerate bolus feedings or Mostly for infants and children at risk for sudden rate changes well. aspiration and regurgitation. May require use of pump.) 2. Long-term Enteral Access o An access technique for long-term enteral nutrition (defined as over 4 to 6 weeks) includes esophagostomy, gastrostomy and jejunostomy. Feeding Route Characteristics Advantages Disadvantages Esophagostomy Surgical formation of opening into can be performed under local Route requires surgery and neck through which a feeding tube anesthesia formation of a stoma, which must is placed into esophagus and down be carefully maintained. into the stomach (sometimes used does not require opening the in patients with head and neck abdominal wall Skin surrounding stoma may cancer) become irritated. Feeding can begin immediately Wound may become infected. Gastrostomy or Gastrostomy: Tube is passed Takes advantage of the Excessive granulation of tissue Percutaneous through incision in abdominal wall stomach’s natural function of surrounding stoma may occur. Endoscopic into the stomach. adjusting osmolarity, mixing, Gastrotomy and serving as a reservoir; Accidental dislodgement of tube (PEG) PEG: Tube is percutaneously is common, and requires placed in the stomach under Ensures nutrients are allowed immediate replacement of tube to endoscopic guidance, secured by maximal opportunity for prevent closure of stoma. robber “bumpers” or inflated balloon absorption; catheter Gastric contents may leak around Closely simulates natural the tube with gastrotomy. delivery of nutrients into the stomach; Wound dehiscence may occur. LOURDES BSN-2E 7  ADIME PROCESS – NURSING INTERVENTION Eliminates nasal or This type of feeding usually esophageal irritation, cannot be started until up to 72 esophageal sphincter closed, hours after surgery. may reduce risk of aspiration; Tube is unobtrusive; PEG feeding can be started after approximately 24 hours. Jejunostomy or Types include needle catheter Permit feeding in patients with Surgical procedure is required. Percutaneous placement, direct tube placement, upper GI tract obstruction, Endoscopic and creation of jejuna stoma that is esophageal reflex, ulcerated Ambulatory patients may find Jejunostomy catheterized intermittently. or neoplastic disease of jejunal feeding restrictive (PEJ) stomach, impaired gastric because of the need for PEJ: weighted feeding tube passes emptying; reduces risk for continuous infusion of formula. endoscopically through as trostomy aspiration; early postoperative tube (from PEG insertion) into the feeding possible (jejunum duodenum; Peristaltic action rapidly resumes its function advances tube into the jejunum. within 12-24 hours) COMPLICATION OF ENTERAL FEEDING Type Route Nursing Intervention Nasopharyngeal irritation ice chips, topical anesthetic, and decongestant Luminal obstruction flush; replace tube Mucosal erosions reposition tube; ice water lavage; remove tube Mechanical Tube displacement replace tube Aspiration discontinue tube feeding Cramping / Distention change formula; reduce infusion rate Vomiting / Diarrhea dilute formula; reduce infusion rate; anti-diarrhea agents Gastrointestinal Constipation promote sufficient fluids and fibers; encourage patient activity Hypertonic dehydration increase free water Glucose intolerance reduce infusion rate; give restriction Cardiac failure reduce sodium content; fluid restriction Metabolic Renal failure decrease phosphate, magnesium, potassium, protein restriction, essential amino acid solution Hepatic encephalopathy decrease amount of protein PARENTERAL NUTRITION Parenteral feeding is designed for individuals who cannot accept or assimilate nutrients given enterally. Based upon the patient’s nutritional needs and anticipated duration of therapy, parenteral nutrition (PN) can be given as either total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN). PPN (Peripheral Parenteral Nutrition) TPN (Total Parenteral Nutrition) May be used when central venous access is not Commonly used in patients undergoing treatment for available, or for transition from TPN to enteral or oral cancer, bowel disorders, and those suffering from intake trauma or extensive burns, as these conditions are associated with high caloric requirements Peripheral Vein Route Parenteral Hyperalimentation (IVH) route 5% available in concentration of carbohydrates or Up to 70% available in concentration of carbohydrates dextrose solution or dextrose solution Nutritionally complete solution, but administered to Nutritionally complete solution peripheral vein, resulting in a limited nutritional value. Indicated for clients who require short-term nutritional Use when caloric needs are very high, when the support with fewer calories per day. anticipated duration of therapy is greater than 7 days LOURDES BSN-2E 8  ADIME PROCESS – NURSING INTERVENTION The solution must be isotonic and contain no more The solution to be administered is hypertonic than 10% of dextrose and 5% amino acids. (composed of greater than 10% dextrose). VEIN ROUTES 1. Peripheral Vein Route – this route is intended for patients with mild to moderate nutritional deficiency. a. Short-term maintenance and not hypermetabolic – NPO for 2 weeks b. Supplemental energy and protein to an oral diet c. Weaning into enteral or parenteral hyperalimentation requiring additional energy and protein 2. Parenteral Hyperalimentation (IVH) – this is a long-term nutritional support of 2 weeks for patients who cannot be fed through the GIT. COMPLICATIONS Infection and sepsis are evidenced by a fever or elevated WBC count. Infection can result from contamination of the catheter during insertion, contaminated solution, or a long-term indwelling catheter. Metabolic complications include hyperglycemia, hypoglycemia, hyperkalemia, hypophosphatemia, hypocalcemia, hypoalbuminemia, dehydration, and fluid overload (as evidenced by weight gain greater than 1 kg/day and edema. Mechanical complication includes catheter misplacement, pneumothorax (evidenced by shortness of breath, diminished or absent breath sounds), subclavian artery puncture, catheter embolus, air embolus, thrombosis, obstruction, and bolus infusion. LOURDES BSN-2E 9 NUTRITION AND DIET THERAPY ADIME PROCESS – NUTRITION DIAGNOSIS AND PLAN CARE BACHELOR OF SCIENCE IN NURSING / LEVEL 2 FIRST SEMESTER / 2023-2024 ADIME PROCESS – NUTRITION DIAGNOSIS AND PLAN CARE NUTRITION DIAGNOSIS ▪ Beliefs-Attitudes Terminology for Nutrition Diagnosis is organized in three (3) ▪ Cultural categories: ▪ Knowledge 1. Intake – Too much or too little of a food or nutrient ▪ Physical Function compared to actual or estimated needs ▪ Physiologic o Defined as “actual problems related to intake of ▪ Social-Personal energy, nutrients, fluids, bioactive substances ▪ Treatment through oral diet or nutrition support (enteral or Signs and Symptoms parenteral nutrition) o Will measuring the signs and symptoms indicate if ▪ Classified as: Calorie energy balance the problem is resolved or improved? Are the ▪ Class: Oral or nutrition support intake signs and symptoms specific enough that the ▪ Class: Fluid intake balance RN/RDN can monitor and document resolution or ▪ Class: Bioactive substances balance improvement of the nutrition diagnosis? ▪ Class: Nutrient balance 2. Clinical - Nutrition problems that relate to medical or Example: Problem Nutrition (Swallowing Difficulty) physical conditions Nursing (Impaired swallowing) Etiology (related to post o Defined as “nutritional findings/problems identified stroke complications) Sign and Symptoms (as evidenced that relate to medical or physical conditions by results of swallowing tests and observation of choking ▪ Class: functional balance (change in during mealtimes) physical or mechanical functioning with nutritional consequences) Problem (Diagnostic Etiology Signs/Symptoms Label) (Cause/Contributing (Defining ▪ Class: biochemical balance: change in Factors) characteristics) capacity to metabolize nutrients as a Describes alterations Related factors that Evidence that problem result of in patients’ nutritional contribute to problem exists Linked to ▪ medications, surgery, or as indicated by status Impaired etiology by words “as altered lab values (nutrient utilization…) Identifies cause of the evidenced by” problem ▪ Class: weight balance: chronic weight or Altered (GI changed weight status when compared function…) Helps determine with usual or desired body weight. Inadequate/excessive whether (calorie intake…) nutrition intervention 3. Behavioral-Environmental – Knowledge, attitudes, will improve problem beliefs, physical environment, access to food, or food safety Inappropriate (intake o Defined as “nutritional findings/problems identified of types Linked to problem by that relate to knowledge, attitudes/beliefs, physical of carbohydrate) words Swallowing difficulty “related to” (RT) environment, or access to food and food safety ▪ Class: knowledge and beliefs Note: etiology may not ▪ Class: physical activity, balance and always be clear function ▪ Class: food safety and access Note: The Registered Dietitian or nutritionist has a list of o Pre-defined list of potential conditions PES OR PROBLEM, ETIOLOGY, o Pre-defined criteria (signs and symptoms) to SIGNS & SYMPTOMS which the current situation can be compared Problem o Is the Diagnostic Label. This statement has a NANDA NURSING DIAGNOSIS distinct format: Problem related to Etiology as DOMAIN 2. NUTRITION evidenced by Signs and Symptoms; can you Class 1. Ingestion resolve or improve the nutrition diagnosis? Imbalanced nutrition: less than body requirements (Nursing Etiology care Plan) o Determine if this is the “root cause” for the Readiness for enhanced nutrition problem. If addressing the etiology will not resolve Insufficient breast milk production the problem, can your intervention lessen the Ineffective breastfeeding (Nursing care Plan) signs and symptoms? Identifying the etiology Interrupted breastfeeding (Nursing care Plan) leads to selection of the nutrition intervention Readiness for enhanced breastfeeding aimed at resolving the underlying cause of the Ineffective adolescent eating dynamics nutrition problem. Ineffective child eating dynamics o If the intervention cannot be aimed at resolving the Ineffective infant feeding dynamics underlying cause, as is the case in Physiologic- Ineffective infant feeding pattern (Nursing care Plan) Metabolic etiologies, then the nutrition intervention Obesity is targeted at minimizing signs/symptoms of the Overweight nutrition problem. Etiologies are grouped by the Risk for overweight type of cause or contributing risk factor. LOURDES BSN-2E 1  ADIME PROCESS – NUTRITION DIAGNOSIS AND PLAN CARE Impaired swallowing (Nursing care Plan) 3. Nutritional Dx: Altered nutrition: less than body requirements r/t impaired metabolic processes as e/b Class 2. Digestion steatorrhea (fat in the stools) This class does not currently contain any diagnoses o Medical Dx: Cirrhosis of the Liver o Nursing Dx: Altered nutrition: less than body Class 3. Absorption requirements r/t inability to absorb nutrients This class does not currently contain any diagnoses insufficient to meet metabolic needs e/b loss of appetite & ascites Class 4. Metabolism 4. Nutritional Dx. Excessive energy intake r/t to lack of access Risk for unstable blood glucose level (Nursing care Plan) to healthy food choices (eats at restaurants 6x a week) as Neonatal hyperbilirubinemia e/b diet intake hx & BMI >35 Risk for neonatal hyperbilirubinemia o Medical Dx: Obesity Risk for impaired liver function o Nursing Dx: ▪ Altered nutrition: more than body Risk for metabolic imbalance syndrome requirements r/t excessive intake more than body needs as e/b weight 20% more Class 5. Hydration than ideal body weight & dysfunctional Risk for electrolyte imbalance eating. Risk for imbalanced fluid volume ▪ Body Image disturbance r/t excess Deficient fluid volume (Nursing care Plan) weight e/b weight of more than DBW. Risk for deficient fluid volume 5. Nutritional Dx: Inadequate mineral intake:iron r/t lack of Excess fluid volume (Nursing care Plan) mineral resources in the diet as e/b patient. Hx. as e/b hemoglobin of 120mg/dl osteoporosis 2. Nutritional Dx: Increased energy needs r/t multiple trauma American – (Western Diet) – varies with region food high as e/b results of indirect calorimetry in fat & cholesterol (meat eating) Risk for Obesity, CVD, o Medical Dx: Trauma and closed head injury Diabetes common o Nursing Dx: Risk for altered behavior r/t multiple trauma from VA e/b confusion & disorientation LOURDES BSN-2E 2  ADIME PROCESS – NUTRITION DIAGNOSIS AND PLAN CARE Hispanic – Traditional Diet high in CHO such as corn, recipes with other users, friends and family, too. Each beans, & squash Use fat in food preparation ** Risk for recipe has a nutrition breakdown based on the ingredients, obesity DM, High Cholesterol so patients can have a clear idea of what they're serving. Christian – Catholics-no meat on Ash Wed or Friday in 6. Food and Nutrition Information Center - This website Lent & fasting on some religious days provides food and nutrition resources for dietitians, health Mormons - no coffee, tea alcohol or tobacco professionals, educators, Government personnel, and Seventh Day Adventists – lacto-ovo- vegetarian (milk & consumers. eggs added) no coffee, tea, alcohol or strong seasonings, 7. Fruits & Veggies – More Matters - This health initiative no snacking inspires consumers to eat more fruits and vegetables by Islam – No pork or birds of prey. Fasting during religious showcasing the combination of great taste, nutrition, times variety, and various product forms. Judaism – Kosher meat or poultry 8. Sample 2-Week Menus USDA, Center for Nutrition Policy and Promotion - These sample 2-week menus can Note: Although identified by specific ethnic/religious group, be used by any person or family wanting to follow a healthy practices vary by area of origin and sect. Not all individuals diet at a modest price. The menus are designed to meet practice these practices or they have issues. nutrition needs on a budget. In Nutrition intervention planning and implementation are 9. Tasty and Low-Cost Recipes - USDA, Center for Nutrition important. Policy and Promotion -Visit these resources to discover delicious and budget-friendly recipes your family will love. 10. What's in Season? USDA, Food and Nutrition Service, RESOURCES NEEDED IN PLANNING AND Healthy Meals Resource System - Find out what fruits and IMPLEMENTING DIETARY REGIMEN vegetables are in season. Nurses have more daily contacts and interviews with 11. Serving Sizes and Portions - HHS, National Institutes of patients in health-care settings than do those in any other Health, National Heart, Lung, and Blood Institute. Read professional group and thus have a great potential for about the difference between servings and portions, and influencing their clients. Providing nutrition resources to find out how much portion sizes have grown over the past patients is a great way to support healthy habits. 20 years. International on line resources are available and some of 12. Grocery Budget Calculator Iowa State University these are: Extension and Outreach. This tool allows you to look at 1. EatRight.org - This website from the Academy of Nutrition what you’re spending now and how you can make small and Dietetics is a family's onestop shop for basic nutrition changes that add up to big savings info. Any basic questions about nutrition can be answered 13. Food and Nutrition Research Institute (FNRI) from the here, with sections for parents and children to make DOST Philippines has a complete set of dietary guidelines navigation easy. This website has a breakdown of the for Filipinos from different age groups. Posters and stickers MyPlate dietary guidelines, a nutrition question of the day, are posted at Community Health centers and are and an easy guide to understanding food labels. Tell your emphasized during the celebration of Nutrition Month in patients to keep this site bookmarked and refer to it July of each year. regularly, for easy answers to a broad range of questions. 2. The Mayo Clinic Food Substitution Guide - If your FOUR ASPECTS OF CHANGING EATING BEHAVIORS patients are trying to lead healthier lifestyles without THAT SHOULD BE CONSIDERED WHEN STRIVING sacrificing the foods they love, point them to this food substitution chart from the Mayo Clinic. Here, you can easily TO ACHIEVE COMPLIANCE: see which ingredients could be swapped out for lower-fat or People need evidence that the changes they make will be lower-sodium versions. Clicking at the In-Depth link at the effective. bottom of the chart leads to the entirety of the Mayo Clinic's Changes should allow for individual latitude in nutrition resources, too, so introducing this website to implementation. patients is a great first step into the world of nutrition. An accountability and reinforcement tool, such as a daily 3. NHLBI Portion Distortion - this interactive tool from the checklist of goal achievement, is needed to help implement National Heart, Lung and Blood Institute is as important for dietary discipline. adults as for children. These quizzes and informational Consumers need individual encouragement and slides from the NHLBI detail how portion sizes have reassurance. Where face-to-face contact is not possible, changed within the last 20 years. Altering portion size is one electronic follow-ups, reports, and feedback can help. of the simplest ways to make a dietary change since no alteration to ingredients is required. This resource also INNOVATIVE APPROACHES THAT WILL AFFECT provides visual representations of the amount of physical IMPLEMENTATION OF DIETARY GUIDELINES activity needed to burn off a meal's calories, based on portion size. It does a great job of showing exactly why Simplify and stratify nutritional guidelines – Prioritize needs mindful diet planning is so crucial. according to specific groups that may have distinct nutrition 4. Shopwell App - Good dietary habits start at the grocery needs, such as children, young adults, pregnant women, store. Based around each user's grocery list, the Shopwell and persons with diabetes App provides nutrition scores for the food families buy every Make dissemination of nutrition guidance information more day. It's easy to see if a grocery list falls short and needs a effective by building alliances and create collaborations couple changes. This app allows patients to make smarter among government agencies, the media, and industry. decisions when planning meals and makes swapping foods Nutrition messages to consumers must be filtered so that for more nutritious choices easy. There are even pre- they reflect how people think. programmed lists of foods for improving heart health or Integrate Physical Activity Guidelines with Dietary living with celiac disease, among other patient needs. Guidance, while emphasizing food patterns, physical 5. AllRecipes.com - This website (and the app!) make it easy activity should be stressed as a complement to the total diet to save recipes in one accessible-anywhere spot. Users approach. can search by ingredient, putting certain restrictions on their Create multiple communication tools to address multiple query to guarantee nutrition parameters. It's easy to share audiences for dietary guidance messages. LOURDES BSN-2E 3 NUTRITION AND DIET THERAPY ADIME PROCESS – NUTRITION MONITORING AND EVALUATION BACHELOR OF SCIENCE IN NURSING / LEVEL 2 FIRST SEMESTER / 2023-2024 ADIME PROCESS – NUTRITION MONITORING AND EVALUATION NUTRITION MONITORING AND EVALUATION Note: Monitoring and Evaluation determines whether the Determines whether the patient/client is meeting the patient is meeting the nutrition intervention goals or desired nutrition intervention outcomes outcomes. Nutrition reassessment is needed to identify Is the nutrition intervention strategy working to resolve the whether the nutrition related problem still exists and nutrition diagnosis, its etiology, and/or signs and evaluate the progress made toward resolving the problem. symptoms? Assess the patient/clients progress by the nutrition care AGE-RELATED CHANGES AFFECTING NUTRITION indicator against recognized, science-based standards 1. GASTROINTESTINAL CHANGES NUTRITION CARE INDICATORS number of changes that occur in the stomach which Markers that can be measured and evaluated to determine negatively affect digestion and reduce the absorption of effectiveness of nutrition care nutrients (ex: reduced stomach acid production or Factors that food and nutrition can impact directly such as secretion, which compromises digestion and reduces the food and nutrient intake; growth and body composition, food absorption of vitamin B-12 and iron, is relatively common in and nutrition related knowledge, attitudes, and behaviors; the elderly). and food access. B-12 deficiency is linked to cognitive impairment, whereas Laboratory values such as HgbA1c, hematocrit, serum not enough iron leads to anemia – symptoms of which are cholesterol severe fatigue and loss of appetite Functional capabilities such as physical activity stomach emptying is slower in older people, which tends to Perception of nutrition care and results of nutrition care, reduce the desire to eat more frequently such as nutrition quality of life movement of food in the intestines (peristalsis), is slower in the elderly and is a common cause of constipation and NUTRITION CARE EVALUATION bloating Measurement and evaluation of Nutrition Indicators: 1. Nutrition care criteria – what is it compared against 2. REDUCED METABOLISM 2. Nutrition prescription or goal – dietary As people age, they often lose muscle mass due to reduced intervention, behavior change activity levels, illnesses and hormonal changes. 3. Reference Standard – select what is appropriate for metabolic rates decline proportionately with the decline in goal muscle tissue The result of lower metabolism is weight gain in the form of Nutrition Monitoring: preplanned review and fat, which can increase the risk of type 2 diabetes and measurement of selected nutrition care indicators of cardiovascular diseases. patient/client’s status relevant to the defined needs, Less muscle mass also reduces the amount of water the nutrition diagnosis, nutrition intervention, and outcomes. body can hold, as approximately 72 percent of total body Nutrition Evaluation: the systematic comparison of water is held within muscle tissue. current findings with the previous status, nutrition intervention goals, effectiveness of overall nutrition care, or 3. PERCEPTUAL CHANGES a reference standard. Nutrition Care Outcomes: the results of nutrition care that Elderly people have a higher risk of malnutrition (not getting are directly related to the nutrition diagnosis and the goals enough calories, protein, vitamins and minerals). of the intervention plan. Malnutrition is strongly associated with reduced cognitive Purpose: The purpose of nutrition monitoring and capacity in the elderly (example, people with age-related evaluation is to determine and measure the amount of senility often forget about mealtimes, how to grocery shop progress made for the nutrition intervention and whether the and how to prepare food). In turn, deficiency of certain nutrition related goals/expected outcomes are being met. nutrients – particularly vitamins B-6, B-9 and B-12, are associated with further cognitive impairment. Terminology for nutrition monitoring and evaluation is Reduced sense of smell and taste as people age may also organized in 4 domains (categories) negatively affect eating habits due to food becoming less appealing. 4. LESS SALIVA AND DENTITION PROBLEMS reduced saliva production (xerostomia), is also common among the elderly Saliva contains a variety of enzymes that trigger the initial chemical breakdown of nutrients such as starch and fat. Loss of teeth and poorly fitting dentures are common in the elderly as well and tend to reduce the ability to chew food and mechanically break it down. LOURDES BSN-2E 1  ADIME PROCESS – NUTRITION MONITORING AND EVALUATION Teeth problems may also be a significant factor in food medically prescribed eating plan recommended as a mode choice, food preparation and eating patterns – such as of treatment for a chronic disease eating less chewy and crunchy foods. usually requires to eliminate or limit certain types of foods, eat more of certain types of foods, change the consistency STRATEGIES THAT ADDRESSES THE CHANGES of foods or alter eating pattern ADAPTING TO DIETARY CHANGES I. EAT HEALTHY MEALS Although all nutrients are important, two are critical during the older years: Protein and Antioxidants Protein o especially crucial because it helps to preserve valuable lean tissue (muscle and bone) o Higher lean tissue reduces frailty, falls, and fractures, all of which are associated with poorer quality of life and earlier death. Antioxidants o body’s defense team o Aim for five servings of vegetables and fruits a day — and choose a variety of colors! Different colors (red, purple, green, orange, etc.) often relate to different nutrient compounds, so the more colorful the “rainbow” you’re consuming, the more nutrients you’re getting. II. ACHIEVE OR MAINTAIN A HEALTHY WEIGHT According to research, there is a BMI “sweet spot” for the elderly. Seniors with a BMI between 25 and 32 have the lowest rates of mortality and recover better from illness and infection. III. QUIT SMOKING AND ELIMINATE ALCOHOL IN THE DIET IV. KEEP MOVING Exercise is one of the most impactful things we can do for our health. As we age, our metabolism declines and our bodies don’t use nutrients as well. V. GET THE RIGHT AMOUNT OF SLEEP As we age, it’s normal to need less sleep, and to sleep less consistently. As a result, older people may have trouble falling or staying asleep, and/or may wake early. VI. CONNECT WITH OTHERS When people are surveyed about the most meaningful aspects of their lives, they list good marriages, close family relationships, rich friendships, and lively work relationships. VII. ASK A PROFESSIONAL FOR HELP A professional nutritionist can help determine calorie needs and offer tips like how to include easy-to-digest meats, eggs and dairy into daily meal plans. VIII. MONITOR NUTRITIONAL STATUS, REGULARLY Monitor nutritional status, regularly so deficiencies can be addressed early, before they have a profound impact on health. THERAPEUTIC DIETS A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. part of the treatment of a medical condition and are normally prescribed by a physician and planned by a dietician, and usually a modification of a regular diet LOURDES BSN-2E 2  ADIME PROCESS – NUTRITION MONITORING AND EVALUATION Diet Description Low Calorie Diet typically between 1000 to 1500 calories and used to promote weight loss should be followed with guidance from a professional to ensure all nutritional needs are met not appropriate for everyone, especially athletes and breastfeeding women (Chrissy Carroll, RD, MPH) Take in fewer calories than you burn (via daily living and deliberate exercise), to lose weight. Diabetic Diet therapeutic diet for treatment of diabetes (a metabolic disease that affects the endocrine system of the body and the use of carbohydrates and fats) In diabetes, glucose cannot be used which raises the blood sugar level (hyperglycemia), some of glucose will be excreted in the urine (glycosuria), patient complains of frequent thirst (polydipsia), frequent urination (polyuria) and increase in appetite (polyphagia) Two types are: o Juvenile Diabetes – occurs at birth through adolescence o Adult-onset Diabetes – occurs primarily among obese people usually mild, stable and well-regulated with diet or with oral medication Principle behind the eating plan: people with diabetes have a difficult time managing the sugar their body produces from the food they eat due to an inability to make enough insulin (at the Islet of Langerhans of the pancreas) or properly use the insulin they do make Aims: control the amount of food eaten, especially foods that dramatically affect blood sugar, to help manage the disease, and promote a healthy weight because this improves blood sugar management The Food Exchange Lists - The Exchange System groups together foods that have roughly the same amounts of calories, carbohydrate, fat and protein into "Exchange" groups, so that one may be exchanged for another. DASH Diet The Dietary Approaches to Stop Hypertension, also known as the DASH diet, is a therapeutic diet used to treat high blood pressure. The diet encourages to eat foods that contain high amounts of potassium, magnesium, calcium and fiber to help lower blood pressure, and recommends to limit intake of sodium to 1,500 mg a day for high blood pressure considered an overall healthy diet and has also been shown to be helpful for those wishing to lose weight and prevent the onset of diabetes includes high amounts of fruits, vegetables and whole grains, along with lean sources of protein, low-fat dairy foods, nuts, seeds and legumes DIET THERAPY FOR DISEASES OF THE GASTROINTESTINAL TRACT Disease Description Recommended Diet Therapy Peptic Ulcer a condition in which painful sores or ulcers Bland Diet develop in the lining of the lower consist of foods with adequate nutritive value that are esophagus, stomach or the first part of the generally soft, low in dietary fiber, cooked rather than small intestine (duodenum) raw, and not spicy with the ability to dilute, neutralize, or reduce the secretion of acid by the stomach Diverticulosis and Diverticulosis occurs when small, bulging Liquid Diet in the acute phase and low residue foods, Diverticulitis pouches (diverticula) develop in your then a well-balanced high fiber diet with more use of digestive tract. When one or more of these bran, whole grains and cellulose foods pouches become inflamed or infected, the condition is called diverticulitis. Malabsorption inability to absorb nutrients, vitamins, and Gluten Free Diet Syndrome minerals from the intestinal tract (damaged Healthy fats are in foods like avocado, walnuts, coconut (Celiac Sprue) by gluten) into the bloodstream oil, ghee, and cold-pressed olive oil. Add eggs, and fish such as salmon, sardines and tuna to help increase the Causes may include: Diseases affecting healthy fats in the diet. the intestine itself, such as celiac disease. Avoid lactose-containing dairy products (milk, ice cream, and cheese). Absence or low levels of certain digestive enzymes Non-tropical a rare digestive disease in which the small Gluten Free Diet Sprue intestine's ability to absorb nutrients omit cereal grains containing wheat, rye, or oats from (gluten) is impaired (malabsorption) the diet, and substitute with rice and corn cereal Consequently, nutritional deficiencies and abnormalities in the mucous lining of the small intestine may be present. Excessive fat is excreted in the stool (steatorrhea) Ulcerative Colitis an inflammatory bowel disease (IBD) that High protein, high calorie, with increased vitamin causes long-lasting inflammation and supplement low residue – for healing of colitis and ulcers (sores) in the digestive tract restoration of nutrient deficits LOURDES BSN-2E 3  ADIME PROCESS – NUTRITION MONITORING AND EVALUATION affects the innermost lining of the large intestine (colon) and rectum which causes profuse and bloody diarrhea, cramping, abdominal pain anorexia and weight loss Gastroesophageal occurs when stomach acid frequently flows A diet rich in whole grains and fruits and vegetables can Reflux (GERD) back into the tube connecting the mouth help GERD symptoms. and stomach (esophagus) AVOID foods high in fat, large meals, and foods that This backwash (acid reflux) can irritate the relax the lower esophageal sphincter such as alcohol, lining of the esophagus. chocolates and high fat foods. Many people experience acid reflux from time to time. Hepatitis inflammation of the liver enriched protein, moderate fat, high energy diet from 2500 to 4000 calories with minerals and vitamin Viruses cause most cases of hepatitis. supplement The type of hepatitis is named for the virus that causes it (hepatitis A, hepatitis B or hepatitis C) Drug or alcohol use can also cause hepatitis. Hepatitis A viral liver disease that can cause mild to severe illness hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person. Almost everyone recovers fully from hepatitis A with a lifelong immunity. Hepatitis B vaccine-preventable liver infection caused by the hepatitis B virus (HBV) spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected can happen through sexual contact; sharing needles, syringes, or other drug injection equipment; or from mother to baby at birth Hepatitis C liver infection caused by the hepatitis C virus (HCV) spread through contact with blood from an infected person Today, most people become infected with the hepatitis C virus by sharing needles or other equipment used to prepare and inject drugs. Hepatitis D also known as the hepatitis delta virus, is an infection that causes the liver to become inflamed swelling can impair liver function and cause long term liver problems, including liver scarring and cancer caused by the hepatitis D virus (HDV) Cirrhosis of the severe scarring of the liver and poor liver Na restricted diet, high protein liver function seen at the terminal stages of compensate for the depletion chronic liver disease Alcohol is strictly forbidden LOURDES BSN-2E 4  ADIME PROCESS – NUTRITION MONITORING AND EVALUATION scarring is most often caused by long-term exposure to toxins such as alcohol or viral infections Patients are often depleted of protein and complications of ascites (accumulation of fluids in the peritoneal cavity). Cholecystitis inflammation of the gallbladder, and Low Fat Diet usually occurs when drainage from the gallbladder becomes blocked (often from a AVOID rich pastries, chocolates, nuts, fatty fried gas gallstone) forming foods, spices and high residue food It may be acute (come on suddenly) and cause severe pain in the upper abdomen, or chronic (multiple recurrent episodes) with swelling and irritation that occurs over time. Pancreatitis inflammation in the pancreas due to a during acute attacks NPO for 48 hours then low fat, low decreased production of the digestive elemental formulas when enteral feeding is appropriate enzymes Acute Renal sudden decline of kidney function or abrupt Low Protein, essential amino acid-controlled potassium, Failure loss of kidney function high carbohydrate diet (for energy) to sustain patients with uremia and alleviate symptoms Cancer group of dissimilar diseases categorized High calorie, high protein orally or via tube feedings and by unconstrained replication of cells or Total parenteral Nutrition Seen as an atypical growth of cells resulting in a mass that invades and