Module 2 - Nutrition Management for Infection, Communicable and Febrile Conditions PDF

COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Nutrition and Dietetics Program Medical Nutrition Therapy 2 (Nutrition Therapy 1)...

COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Nutrition and Dietetics Program Medical Nutrition Therapy 2 (Nutrition Therapy 1) LECTURE Module 2 Nutrition Management for Infectious, Communicable and Febrile Conditions 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 2 Packet: Nutrition Management for Infection, Communicable and Febrile Conditions Welcome to Module 2 In this module we will study nutrition management for infectious and communicable diseases and febrile conditions. We will find out the microorganisms that cause infectious and communicable diseases, their mode of transmission and the signs and symptoms of the diseases that they cause. Also a discussion about the relationship between fever, infections, communicable diseases and their nutritional consequence. Apply the nutrition care process in the nutritional management of these conditions. Learning information will be referenced from the main text book Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA. and web links and videos you will be directed to. Module 2 Learning Objectives At the end of this module, the student is expected to be able to: 1. Distinguish between infectious, non-infectious, and communicable diseases 2. Provide example of different infectious agents, describe their mode of transmissions, and signs and symptoms of diseases that they cause. 3. Explain the difference between outbreak, epidemics, and pandemics and provide examples 4. Discuss the relationship between fever, infections, communicable diseases and nutritional consequence. 5. Apply the nutrition care process (NCP) in the management in febrile conditions and infectious diseases. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 2 Content: Description Time to Complete Lesson 1 Overview and definition of terms 10minutes Activity 1 Reading and assignment Lesson 2 Infectious agents 20 minutes Activity 2.1 Read life in the microbial world. Lesson 3 What is outbreak, epidemics and pandemics 10 minutes Activity 3 Read and launch Timeline Lesson 4 Nutritional consequence of infections, communicable disease and fever 20 minutes Activity 4 Readings Lesson 5 Nutrition care process in nutritional management of 40 minutes infectious/communicable diseases and febrile conditions Activity 5 Read: Dengue Fever 20 minutes Case study: HIV Module 2: Lesson 1.0 Overview and definition of terms The Philippines is not new to the incidence and prevalence of infectious and communicable diseases as it has its own history with it in the 1800 as described by Ken De Bevoise in his book 1 Agents of Apocalypse: Epidemic Diseases in the Colonial Philippines. He described that smallpox, malaria and cholera were among the infectious diseases that afflicted the Filipinos during the late 19th century. He espoused that the ”probability of contact between the infectious agents and a susceptible host…the state of the host defenses…” that Filpinos were susceptible to the disease due to poverty, malnutrition, and debilitation as a consequence of demographic, economic and political and military intervention were contributing factors to the incidence of infectious diseases. The factors of the current incidence of infectious diseases in the Philippines have not change from then to now. Increasing population, behavior, vulnerability, crowded living environment, poverty, social inequality, more populations with weakened immune system (e.g. cancer patients and survivors), older people, injection drug use (HIV, Hepatitis C), changing sexual norms (HIV and STD), changing ecosystems,, microbial adaptation and change, economic development, 2 and the breakdown of public health measures are similar factors observed in the incidence of infectious diseases all through those years. The same is true globally. The war against the agents of infectious diseases continues and will even be more challenging when neglect, poverty, famine, political corruption, racism, war let down our defenses against them. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 2: Lesson 1.1 Definition of terms Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals that can cause 4 disease when transmitted to humans. Infectious diseases that spread from person to person are said to be contagious or communicable and transmission is very easy like resulting from close casual contact. However, some infectious diseases are not contagious. Communicable diseases are infectious diseases that are contagious, which are spread from person to person or from animal to person by infectious bacteria or viral organism. The spread or transfer can happen through the air, through contact with contaminated surfaces, bodily contact with an infected person or through direct contact with blood, feces, or other bodily fluids of the infected person. Factors involve in the mode of transmission of communicable diseases Reference: Communicable Diseases Module: 1. Basic Concepts in the Transmission of Communicable Diseases Accessed 26 July 2020 https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=84&printable=1 ► Infectious agents: Microorganisms that cause a disease and to enable them to Do this infectious agents needs the following: 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Reservoir is the place where the infectious agents is present before infecting a new human being. The disease agent will die without this reservoir and hence could not be transmitted to other people. Humans and animals which serve as a reservoir for infectious agents are called infected host. The infectious agents transmitted from animal hosts to susceptible humans, are called zoonoses (e.g. rabies). While non-living things reservoir like water, food, and soil are called vehicles, Route of exit of an infectious agent from an infected host, (the way the infectious agent gets out of the infected host) will facilitate the transfer of this to another host. These routes are: Mouth and nose through coughing, sneezing, talking or spitting Body through feces (anus), blood, saliva Skin through breaks in the skin Mode of transmission Mode of transmission is a process by which the infectious agent gets out of the infected host to a new host for it to live, multiply and cause a disease. Identification of this process is important in the prevention and control measures of the spread of infectious disease. The mode of transmission is either direct or indirect. Activity 1.1 1. Reading: Communicable Diseases Module: 1. Basic Concepts in the Transmission of Communicable Diseases Accessed 26 July 2020 https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=84&printable=1 Direct transmission: Person to person by direct contact through The transfer of an infectious agent from touching, biting, kissing, sexual intercourse, direct an infected host to a new host without projection of droplets from nose or mouth through the need for an intermediates such as coughing, sneezing, talking or spitting and across food, water, air or an animal the placenta (transfer from infected mother to the fetus via the placenta) e.g HIV/AIDS: sexual intercourse, across the placenta Covid 19: couching, sneezing Indirect transmission Airborne transmission: infectious agent is The infectious agent is transmitted to a transmitted through dried secretion from the new host through an intermediate such respiratory tract, which can remain suspended in as air, water, food, soil,or animal. the air for some time. e.g. Tuberculosis 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Vehicle borne transmission: infectious agent contaminates these non-living substances (food, soil, water) and transmits this to a new host. e.g Salmonella typhi form contaminated food causing typhoid fever Vector borne transmission: the transmission of the infectious agent from an organism, usually an arthropod ( flies, mosquitoes, lice, ticks) to a new host. e.g Malaria, dengue fever Route of entry: Route of entry is the site through which an infectious agent enter the host to transmit the disease. Some individuals will develop the disease so they are known as a susceptible host. This susceptibility of the individual is increased by the presence of risk factors. like the environmental e.g. poor personal hygiene or unsanitary surroundings or due to the low immunity level of the individual. Immunity is the resistance of the individual to communicable diseases, because their white blood cells and antibodies are able to fight the infectious agents successfully. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM ► Natural history of a communicable disease: The natural history of a disease is also known as the course of the disease, its development and progression. Knowledge of this will assist in the different intervention at the various stages of the disease to prevent and control the worsening condition of the infected person. This stages includes: Stage of exposure: susceptible host come in close contact with the infected agents either. directly or indirectly e.g. shaking hands with someone with common colds Stage of infection: at this stage, the infectious agents has not entered the susceptible host yet to cause the disease. Clinical manifestations, which are the typical symptoms and signs of the illness may not be manifested as yet. Clinical manifestations be exhibited as symptoms which are the complaints the patient can tell about (headache, stomach pain, vomiting, dizziness) and signs (high temperature, fast pulse rate, high blood pressure) referred to as the features that of the disease which could only be detected by a trained health care professional Stage of infectious disease: this is the time when the clinical manifestation of The time interval between the onset of infection and the appearance of the first symptoms are known as the incubation period. Incubation period of the disease varies, for malaria it is 7 to 14 days. COVID 19 has a similar incubation period. Depending on the level of immunity, infected persons who develops the diseases is known as an active case and those who do not are known as carriers. Both active and carries can transmit the disease. In COVID 19, positive (active) and asymptomatic (carriers) can infect persons they come in contact with. The disease becomes acute when there is rapid onset and short duration. It becomes chronic when there is prolonged duration of the illness. For instance diarrhea that lasts for less than 14 days is acute onset while if it lasts more that 14 these days it has become chronic. Stage of outcome: at this stage the disease may result in recovery, disability or death of the patient; For example a person recovers from diarrhea, is paralyzed by poliomyelitis or died of pneumonia. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Communicable/contagious versus infectious diseases A cold is an example of a communicable disease a viral infection of the upper respiratory tract. COVID-19 is indeed a contagious disease. It is caused by a virus: Corona Virus and very easily spreads by direct and casual contact with a person, droplets, and infected surfaces. That’s why we are staying at home and social-distancing, avoiding crowded places and social gatherings, good hand washing the best to avoid transmission., Where as…… Malaria is an infectious disease caused by a parasite, but it is not contagious because you don’t get it just by being around or coming into contact with an infected person. It’s usually transmitted by a mosquito bite, which transfers the parasite from the mosquito into your blood. Food poisoning is an infectious disease. It’s not contagious because it is spread by eating contaminated food, not spread by person to person, nor by sitting across from someone who has food poisoning. https://www.dictionary.com/e/contagious-vs-infectious-the-difference-can-be-important Therefore when reporting or describing a disease as infectious it is also important that we call it out as contagious, that it is easily spread by being around people and public places as this will help influence and guide behaviors to help prevent ourselves and others from getting infected A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, and others. NCDs, also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioral factors. 4 Watch and take notes: Infectious Diseases - How do we control them? https://www.youtube.com/watch?v=2JWku3Kjpq0 By: Dr. Ranil Appuhamy 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Module 2: Lesson 2: Infectious Agents 2.1 Discovery of microorganisms: Anton van Leeuwenhoek and Robert Hooke, two Fellows of the Royal Society discovered the existence of microorganisms, using the simple microscope they fabricated between 5 1665-1683. Van Leeuwenhoek is largely credited with the discovery of microbes, while Hooke is credited as the first scientist to describe live processes under a microscope. Other microbiologist credited for the discovery and understanding of how microorganism cause diseases were: Spallanzani and Pasteur performed several experiments to demonstrate that microbial life does not arise spontaneously. Cohn laid the groundwork for discovering and cataloging microbes, while Koch 6 conclusively showed that microbes can cause diseases. History of Microbiology - Hooke, van Leeuwenhoek, and Cohn https://bio.libretexts.org/Bookshelves/Microbiology/Book%3A_Microbiology_(Boundless)/1%3A _Introduction_to_Microbiology Robert Hook Microscope > (circa 1670 The discovery of microorganisms by Robert Hooke and Antoni van Leeuwenhoek, fellows of 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM the royal society Accessed 15 August 2020 https://royalsocietypublishing.org/doi/pdf/10.1098/rsnr.2004.0055 2.2 What are disease agents? Disease agents are microorganisms that cause a disease whether this are infectious, communicable or noncommunicable. These microorganisms are the bacteria, viruses and parasites. The types and number of organisms are immense and greatly diversified. They vary remarkably in size, shape, and life cycle, particularly the parasites. The evolutionary nature of these microorganism had affected where they live, how they grow, and how they reproduce, even their mode of transmission. a. The parasites https://www.cdc.gov/parasites/about.html A parasite is an organism that lives on or in a host organism and gets its food from or at the expense of its host. There are three main classes of parasites that can cause disease in humans: protozoa, helminths, and ectoparasites. Protozoa are microscopic, one-celled organisms that can be free-living or parasitic in nature. They are able to multiply in humans, which contributes to their survival and also permits serious infections to develop from just a single organism. Entamoeba histolytica is a protozoan that causes amoebiasis, that cause intestinal distress and characterized by bloody diarrhea, intestinal lesions. Helminths are large, multicellular organisms that are generally visible to the naked eye in their adult stages. Like protozoa, helminths can be either free-living or parasitic in nature. Examples of human parasites ►Flatworms– flukes and cestodes tapeworms ►Thorny-headed worms the adult forms of these worms reside in the GI tract gast ►Roundworms– the adult forms of these worms can reside in the gastrointestinal tract, blood, lymphatic system or subcutaneous tissues. c. Ectoparasites are organisms that live on the skin of a host, from which they derive their sustenance, the blood meal from a human host. Examples are ticks, fleas, lice, and mites but mosquitoes is broadly included as parasite. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM The Bacteria The oldest of the organisms inhabiting the earth for the first two billion of its existence. Bacteria are microscopic, single-celled organisms that thrive in diverse environments. These organisms can live in soil, the ocean and inside the human gut. Bacteria can be spherical Streptococcus pyogenes causing sore throat, rod-shaped Salmonella typhi causing typhoid fever, or helical or spiral shape, Treponema pallidum causing syphilis. Bacteria can be beneficial as well as detrimental to human health. Commensal, or "Friendly" bacteria share space and resources within our bodies and tend to be helpful. Other bacteria can cause infections such as Streptococcus, Clostridium perfringens (C. perfringens), E. coli and S. aureus can cause a rare but severe soft tissue infection called necrotizing fasciitis (flesh eating bacteria. Scanning electron micrograph of Methicillin-resistant Staphylococcus aureus (MRSA) bacteria with a human white cell. (Image: © Science Source/Getty Images) https://www.livescience.com/ https://www.google.com/search?q=images+of+bacteria+with+names The Viruses Viruses are microscopic living microorganism which consists of an RNA or DNA genome enclosed in a protein shell that is not able to reproduce or thrive on its own, without a host. They are considered the most abundant biological entity on the planet. Common shapes of viruses Helical: The tobacco mosaic virus has a helix shape. Icosahedral, near-spherical viruses: Most animal viruses are like this. Envelope: Some viruses cover themselves with a modified section of cell membrane, creating a protective lipid envelope. These include the influenza virus and HIV. Facts about viruses Viruses are living organisms that cannot replicate without a host cell. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM They are considered the most abundant biological entity on the planet. Diseases caused by viruses include rabies, herpes, Ebola, Covid 19, influenza There is no cure for a virus, but vaccination can prevent them from spreading. Major epidemics and pandemics that have occurred worldwide and as early as 429-427 BC known as Plague of Athens (typhoid) to 2019 to present: the Covid 19 were caused by viruses. https://www.google.com/search?q=images+of+viruses Activity 2.1: Read Discovering the microbial world and Life in the microbial world http://infectiousdiseases.edc.org/content/module/1/reading/1?view=student Read: Agents of disease http://infectiousdiseases.edc.org/content/module/1/reading/2?view=student Yellow fever virus Coronavirus COVID 19 Hepatitis C virus Hepatitis B virus 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Lesson 4: Nutritional consequence of infections, communicable disease and fever https://www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759 4.1 What is a fever and what does it indicate? A fever is an elevation of body temperature of 37.50C -38.30C (100-1010 F), often due to an illness and a sign that something out of normal is happening in the body. In adults a the temperature of 39.40 C (1030 F) should be a cause of concern. For infants and toddlers, a a slightly elevated temperature may indicate a serious infection. Symptoms associated with fever are: Chills and shivering Headache Muscle aches Loss of appetite Irritability Dehydration General weakness What does fever or elevated temperature indicates: A viral infection A bacterial infection Heat exhaustion Certain inflammatory conditions such as rheumatoid arthritis — inflammation of the lining of your joints (synovium) A malignant tumor Some medications, such as antibiotics and drugs used to treat high blood pressure or seizures Some immunizations, such as the diphtheria, tetanus and acellular pertussis (DTaP) or pneumococcal vaccine Infection cause most fevers. It is an indication that the body is trying to fight off or kill the virus and bacteria that causes the infection. It also activates the immune system, another defense of the body to fight off the infection. Treatment for fever will vary depending on the cause of the fever. However nutrition plays an important role in this situation. Since most of the fever is due to an infectious disease, these authors Farhadi and Ovchinnikov reviewed the relationship between nutrition and infectious disease. They identified that this relationship can be group as follows: 7 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 1. Effect of nutrition on the development of human immune system development of the immune system begins from the embryonic stage, hence fetal malnutrition has an unfavourable effect on the immune system breastfeeding improves the baby’s immune system nutrition therefore is critical in providing high immunity of persons to environmental pathogens 2. Effect of nutrition on emerge of infection gastrointestinal infection e.g microbial diarrhea food poisoning- e.g. botulism systemic infectious disease e.g.typhoid 3. Relationship between malnutrition and infectious diseases e.g tuberculosis there is a synergetic relationship between malnutrition and infection a malnourished person cannot is at risk of infection because of poor immune system due to inadequate protein, vitamins and mineral intake similarly, a person with an infectious disease becomes malnourished because of poor dietary intake and other environmental factors, e.g. contaminated water weight loss is often a consequence of poor diet and effect of infection 4. Nutrition in patients with severe combined immunodeficiency e.g cancer, AIDS Person becomes more susceptible to infection Persons with severe immune deficiency should avoid eating raw foods, especially if white blood cells are below 1000 or less. 5. Relationship between overeating and infection overweight/obese person are more at risk for respiratory tract infection at risk of developing diabetes hence sensitive to infection 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Activity 4 : Reading: 1. The Relationship between nutrition and infectious diseases: A Review https://www.researchgate.net/publication/327469753 The relationship between nutrition and infectious disease A review 2. The Interaction between Nutrition and Infection academic.oup.com › cid › article-pdf 3. Nutrition and infection https://www.researchgate.net/publication/282505596_Nutrition_and_Infection Lesson 5: Nutritional management of infectious/communicable diseases and febrile Conditions In fever the rate of burning calories increases with the increase in temperature. The body needs more calories to function properly in fever than it requires when one does not have a fever. Diet in fever is crucial for the immune system to function properly. It must be dense in nutrition, especially proteins, vitamins and minerals. 1. Meet person’s nutrient needs caused by the hypermetabolic state, especially energy requirements. Each 10 F elevation causes a 7% increase in metabolic rate. 2. Replace nitrogen loss by increasing protein intake. 3.Replenish carbohydrates since liver stores only last for 18-24 hours. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 4. Normalize electrolyte status, replace losses from perspiration/sweating 5. Facilitate toxin elimination through increase urine output 6. Prevent dehydration but avoid water overload. 7. Treat anorexia, nausea, and vomiting by having small frequent feedings, preferably softer options if regular foods are not well tolerated. 8. Limit fatty and spicy foods as they tend to upset the stomach and the digestive tract. 9. Nutrient requirements for adults: 30-40kcal/kg/day 1.5-2g protein/kg/day Supplement with vitamin A and C and thiamine with longer duration fever as these nutrients may be depleted If fever is acute, patients may prefer liquids. Nutrition management for specific conditions 1. General infection Provide adequate nourishment to counteract hypermetabolic state. Support body’s host defense system Prevent or correct dehydration, hypoglycemia, complications, and anorexia Replace nutrient losses (potassium, nitrogen, magnesium, phosphorus, and sulfur). Discuss role of nutrition in maintaining skin and mucous membrane integrity and preventing bacterial invasion and subsequent infection. Give a high protein, high calorie, rich in vitamins and minerals and fluids. Needs increases up to 20% in mild infection, 20-40% in moderate infection, and 40-60% in septic conditions. 2. Influenza The common cold and influenza are the most common syndrome of infection in human beings. Influenza virus is transmitted by respiratory route, especially in cold, rainy seasons (in Philippines) with an incubation period of 1-4 days, with abrupt onset. Signs and symptoms include chills, fever for 3-5 days, malaise lasting for 2-3 weeks, muscular aching, substernal soreness, nasal stuffiness, sore throat, some nausea, non—productive cough, and headache. Reduce fever and relieve symptoms Prevent secondary infection like pneumonia. Promote bed rest, adequate hydration, and calorie intake Replace fluid and electrolyte losses by increasing fluids from salty broth, juices and other fluids (e.g Gatorade, soda, calamansi juice, taho) A high energy and protein intake should be encouraged with small frequent feedings as this is better tolerated than the three big meals. Adequate vitamins A and C, sodium, and potassium should be considered. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 3. Measles Measles is an acute viral respiratory illness. It is characterized by a prodrome of fever (as high as 105°F) and malaise, cough, nasal congestion. The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities. Patients are considered to be contagious from 4 days before to 4 days after the rash appears. Common complications include bacterial middle-ear infection and bronchopneumonia, diarrhea and laryngotracheobronchitis, malnutrition, mouth ulcers Measles rash The Philippines Ukraine, Israel, Thailand, Vietnam, England, France, Germany, and India, are countries where large outbreaks were reported People at high risk for severe illness and complications from measles include: Infants and children aged 20 years Pregnant women People with compromised immune systems, such as from leukemia and HIV infection Transmission and recovery Measles is one of the most contagious of all infectious diseases; up to 9 out of 10 susceptible persons with close contact to a measles patient will develop measles. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area. Infected people should be isolated for four days after they develop a rash; airborne precautions should be followed in healthcare settings Recovery following acute measles may be delayed for many weeks and even months, with failure to gain weight recurrent infections, and persistent pneumonia and diarrhoea Vaccination Measles can be prevented with a measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. The 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella and varicella. Single-antigen measles vaccine is not available. There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections. References: Measles Accessed 12 August 2020 https://www.cdc.gov/measles/hcp/index.html#:~:text=Measles https://www.who.int/ith/diseases/measles/en/ Diet, nutrition and care management There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections. Address malnutrition and feeding problems, related to mouth ulcers, dehydration and fever, especially in children Diet should be balanced providing all the nutrients from calories, proteins to vitamins and minerals coming from varied food sources. Adequate nutrition should also be provided to support the growth and development of the child. Pay attention to food allergens of the child as they may worsen the condition. Eliminate this from the diet of the child. Provide an adequate amount of fluids to correct dehydration and lowering of fever. Observe food safety, environmental and hand hygiene. Handwashing should be done frequently. Reference: Treating measles in children - World Health Organization Accessed 12 August 2020 www.who.int › programmes_systems › interventions 4. Dengue fever (Hemorrhagic fever) Activity 5: Read Dengue and severe dengue https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue Example: NCP steps for nutrition Inadequate fluid intake Assessment data Dehydration, persistent vomiting, rapid breathing, I & O records Nutrition diagnosis (PES) Inadequate fluid intake related to fever of 1030 F, and nausea/vomiting as evidenced by signs of dehydration and low I&O. Nutrition Intervention Encourage intake of fluids, at all meals and between meals as well. Keep water or beverages on hand within easy reach Nutrition monitoring and Improved I & O records., reduction of fever, reduced or no evaluation vomiting 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 5. Covid 19 According to the CDC, “ COVID-19 is a disease caused by a virus called SARS- CoV-2. Most people with COVID-19 have mild symptoms, but some people can become severely ill. Although most people with COVID-19 get better within weeks of illness, some people experience post-COVID conditions. Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience more than four weeks after first being infected with the virus that causes COVID-19. Older people and those who have certain underlying medical conditions are more likely to get severely ill from COVID-19. Vaccines against COVID-19 are safe and effective.” 28 WHO and CDC stated that Covid 19 virus spreads via respiratory droplets which is the infectious agent. However, it has been known now that asymptomatic people can act as a reservoir for the virus therefore infecting others. According to Dr. Nancy Messonnier, former National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention from 2016 to 2021 in her telebriefing on February 14, she said that “Based on what is now known about COVID-19, we believe this virus spreads mainly from person (reservoir) to person among close contacts (defined as about six feet) through respiratory droplets produced when an infected person coughs or sneezes.” 29 The rapid transmission of from person to person of the Covid 19 virus from asymptomatic people, who are acting as a reservoir, is due to the “shedding significant amount of virus in their oropharyngeal compartment” up to 48 hours before developing symptoms, which according to CDC Director Robert Redfield “helps explain how rapidly this virus continues to spread across the country, because we have asymptomatic transmitters and we have individuals who are transmitting 48 hours before they become symptomatic,” 29 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Read: Maintaining a healthy diet during the COVID 19 pandemic www.fao.org 6. AIDS (Acquired immune deficiency syndrome) AIDS is caused by the human immunodeficiency virus (HIV) and affects the body’s ability to fight off infection and disease, which ultimately leads to death. Antiretroviral therapy (ART) for HIV infected persons have enhanced their quality of life and increased their life expectancy. It slows down the replication of the virus but does not eliminate them. Global prevalence of HIV/AIDS Reference: https://www.who.int/hiv/data/2019_summary-global-hiv-epi.png?ua=1 “Global situation and trends:: Since the beginning of the epidemic, 76 million people have been infected with the HIV virus and about 33 million people have died of HIV/AIDS. Globally, 38.0 million [31.6–44.5 million] people were living with HIV at the end of 2019. An estimated 0.7% [0.6-0.9%] of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. The WHO African region remains most severely affected, with nearly 1 in every 25 adults (3.7%) living with HIV and accounting for more than two-thirds of the people living with HIV worldwide to access country profile (Philippines) for AIDS/HIV: https://cfs.hivci.org/country-factsheet.html 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Mode of transmission HIV is not easily transmitted except by exchange of bodily fluids during sexual contact, by receipt of infected blood through a blood transfusion, by sharing contaminated needles as with intravenous injections, or from an HIV infected mother to neonate. Breast feeding of HIV positive mothers can result in transmission to the infant, especially during mastitis. HIV infection involves multiple organs. It targets the immune system and impair the ability to mount adequate immune response Persons at risk include intravenous drug addicts, heterosexuals with multiple partners, homosexuals, bisexual males, hemophiliacs, and infants of HIV positive mothers. Signs and symptoms Malnutrition is usually common among HIV infected person, especially the Severe Acute Malnutrition (SAM). Nutrition directly impacts the immune-cell triggering and indirectly affecting DNA and protein synthesis in HIV progression. Hence the onset of malnutrition impairs the body’s response to HIV and treatment. Aids Wasting Syndrome is the involuntary loss of at least 10% of body weight and is an AIDS defining diagnosis and is an independent prognostic indicator of outcome and mortality. It is due to reduced oral intake with pain, fever, infection, diarrhea, malabsorption, swallowing difficulties, effects of medications, inflammation, viral overload, lipodystrophy, and vomiting.. Fatigue, anorexia and low grade fever would also be present. Pathophysiology and Care Management Algorithm for HIV Disease; Attachment A Reference: Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA (Main textbook) Medical Nutrition Therapy (MNT) Proper nutrition, in HIV infected persons with adequate and balanced nutrition intake is essential to maintain a healthy immune system and prolong life. Proper nutrition may help maintain lean body mass, reduce the severity of HIV related symptoms, improve quality of life and enhance adherence to the effectiveness of ART. MNT, therefore, is integral to the successful management of HIV and the Registered Nutritionist Dietitian is well placed to deliver this nutrition management. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Intervention: Medical nutrition Therapy Reference: Escott-Stump, S. 2015. Nutrition Diagnosis-Related Care 8th ed. Wolsters Kluwer, USA pp.856-857 Nutrition therapy for HIV/AIDS patients can reduce illness, shorten hospital stay, and can lessen cost. Patient-centered care is therefore very important as this will address medication interactions, co-infection, other diseases, wasting lipodystrophy and other issues 1. Objectives that could be considered Improve nutrition-related immunity to prevent opportunistic infections. Enhance response to therapy through continuous nutrition counseling, dietary alternations, and drug effectiveness monitoring. Follow guidelines according to levels of risk. Use 3-day food records rather than food frequencies (Academy of Nutrition and Dietetics, 2013). Maintain body weight at 95% to 100% of usual body weight levels. Increased resting energy expenditure occurs and lean body mass is especially affected. Offer early nutrition interventions (Academy of Nutrition and Dietetics, 2013). Reduce mealtime fatigue to encourage better intake. Avoid unnecessary distractions and stresses. Lower the temperature when febrile. Manage altered GI function including diarrhea, malabsorption, vomiting, and HIV-induced enteropathy..Comply with food and water safety guidelines. 2. Food and Nutrition Maintain diet as appropriate for patients’ condition. Use a high- energy/ high-protein diet. Weight gain or maintenance is possible with use of oral liquid supplements. From 2 to 2.5 protein per kilogram and 35 to 45 ml/kg are needed. Fever, pneumonia, and infection may elevate needs. Use indirect calorimetry when available, estimates are often incorrect. Keep the body well hydrated. Estimate 35 to b45 ml/kg unless it is a reason to restrict fluids. Small, frequent feedings (six to nine times daily) are usually better tolerated but may be difficult to achieve given complex medication regimens. Use nutrient dense-dense snacks, such as pudding, if tolerated. Add protein powders and glucose polymers, if desired. Use oral supplements when needed. Try non acidic juices for sore moth, ices made with tolerated juices, and sandwiches made with cold meat salads. With bouts of diarrhea, use small meals and avoid extremes in temperature, room temperature is often best. Avoid excesses of caffeine, alcohol, and fried high-fat foods use soft cooked chicken, turkey, fish, and lean beef. Replace electrolytes with foods such as broth soups or Gatorade for sodium, potassium, magnesium, and chloride. If lactose intolerant, avoid milk and a low-lactose diet. Children present unique nutritional needs further compounded by HIV-infections; see section 3. 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Example of RND Nutrition Assessment Form Reference: Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA (Main textbook) p. 766 Fig.37-3 Nutrition screen and referral criteria for adults with HIV and AIDS(From ADA MNT Evidenced Based Guides for Practice Copyright 2005. American Dietetic Association, now Academy of Nutrition and Dietetics, March 2006. I. Nutrition Screen and Referral Criteria for Adults with HIV/AIDS Today’s Date __________ Name __________________________________________ Phone ____________ Message ☐ Yes ☐ No ☐ Discreet Gender _____ Language __________ DOB ____ / ____ / ____ Age _____ File # ____________________________ Medicaid Waiver Client? ☐ Yes ☐ No Insurance ____________________ Case Managed By ______________ Referred By ___________________________ Date _______________________ Phone _______________________ Screen every six months and/or per status change. Automatically refer to a registered dietician for any of the following: (Check and circle all that apply) II. A. Medical Diagnosis and Nutrition Assessment 1. ☐ Newly diagnosed HIV infection 2. ☐ Newly diagnosed with AIDS 3. ☐ Any change in disease, diet or nutritional status 4. ☐ No nutrition assessment by a registered dietician or not seen by a registered dietician in six months B. Physical Changes and Weight Concerns 1. ☐ ≥3% unintentional weight loss from usual body weight in the last 6 months or since last visit (% wt. loss formula: usual body weight – current body wt/usual body wt x100) 2. ☐ Visible wasting, 〈88 cm or 35 inches (women) 6. ☐ Client or MD initiated weight management, or obesity: BMI >30 kg/m2 C. Oral/Gl Symptoms 1. ☐ Uses an appetite stimulant or suppressant 2. ☐ Loss of appetite, desire to eat or poor oral intake of food or fluid for >3days 3. ☐ Missing teeth, severe dental caries, difficulty chewing and/or swallowing 4. ☐ Mouth sores, thrush, or mouth, tooth or gum pain 5. ☐ Persistant diarrhea, constipation or change in stools (color, consistency, frequency, smell) 6. ☐ Persistant nausea or vomiting 7. ☐ Persistant gas, bloating or hurt burn 8. ☐ Changes in perception of taste or smell 9. ☐ Food allergies or food intolerance (fat, lactose, wheat, etc.) 10. ☐ Medication involving food or meal modification 11. ☐ Receives or needs evaluation for oral supplement or enteral or parental nutrition D. Metabolic Complications and Other Medical Conditions 2021-22 Module 2 Packet for Medical Nutrition Therapy 2 (Nutrition Therapy 1) Lecture. College of Health and Allied Medical Profession: Nutrition and Dietetics Program. University of San Agustin, Iloilo City Philippines.  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 1. ☐ Diabetes mellitus, impaired glucose tolerance, impaired fasting glucose, insulin resistance, or history of hypoglycemia or hyperglycemia 2. ☐ Hyperlipidemia: cholesterol>200 mg/dL, triglycerides ≥ 150 mg/dL, LDL> 100 g/dL, and/or HDL < 40 mg/dL (men),