MNT for Individuals

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rpeders
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196743
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MNT for Individuals
Updated:
2013-02-04 11:20:35
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dietetics review
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MNT
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  1. Ulcer
    • -Eroded mucosal lesion
    • -Treatment: antacids, antibiotics to eradicate H. pylori
    • -Drug Therapy: Cimetidine, Rantidine-H2 blocker; prevents binding of histamine to receptor: decreases acid secretion
    • -diet: as tolerated, well-balanced
    • -Omit: pepper, chili powder, coffee, alcohol
  2. Hiatal Hernia
    • -Protrusion of a portion of the stomach above the diaphragm into the chest
    • - small, bland feedings; avoid late night snacking, caffeine, chili powder, pepper
  3. Dumping Syndrome
    • -Follows a gastrectomy
    • - Cramps, rapid pulse, weakness, perspiration, dizziness (Flu-Symptoms)
    • -Undigested CHO enters jejunum--water is drawn in to reach osmotic balance. Decrease in vascular, peripheral fluid
    • -2 hours til CHO digests, increase BG, too much insulin
  4. Billroth 1 (gastroduodenostomy)
    Attached the remaining stomach to the duodenum
  5. Billroth II (gastrojejunostomy)
    attaches it to the jejunum, losing pancreactic secretions.
  6. Iron Deficieny Anemia
    • -Bleeding
    • -Impaired absorption due to loss of acid
  7. Pernicious Anemia
    -Lack of IF and bacterial overgrowth in loop of intestine interfere with absorption
  8. Test used to dianose pernicious anemia?
    Schilling Test
  9. Folate Deficiency Anemia
    • -Poor intake
    • -Needs B12 for transport inside the cell
    • -Low serum iron (cofactor in folate metabolism)
  10. How to treat Dumping Syndrome?
    • -Frequent, small, dry feedings.
    • -Fluids before or after meals (to slow passage)
    • -Restrict concentrated sweets
    • -Give 50-60% complex CHO, protein at each meal, moderate fat, b12 injections may be needed
    • -Lactose may be poorly tolerated.
  11. Gastroparesis
    • -Delayed gastric emptying: surgery, diabetes, viral infections, obstructions
    • -Mod-severe hyperglycemia
    • -Prokinetics increase stomach contractility
    • -Small, frequent meals; pureed, avoid high fiber, liquid fat tolerated
  12. What are Prokinetics?
    -type of drug which enhances gastrointestinal motility
  13. Tropical Sprue
    • -bacterial, viral, parasitic infection
    • -Chronic GI disease, intestinal lesions
    • -diarrhea, malnutrition, deficiencies of b12 & folate
    • -Decreased HCL and IF
    • -Hi Cal/Pro, oral b12 and folate supp.
  14. Celiac Disease
    • -Reaction to gliadin-affects jejunum & ileum (proximal intestine)
    • -Malabsorption (loss of fat soluble vits), macrocytic anemia, weight loss, diarrhea, IDA...
  15. Constipation
    • -Sometimes due to atonic colon (weakened muscle)
    • -High fluid, fiber diet and exercise
  16. Diverticula
    • Small mucosal sacs that protrude through the intestinal wall due to structural weakness
    • -Related to constipation and life-long colonic pressure
  17. Diverticulosis
    • The presence of diverticula
    • -High Fiber diet
  18. Diverticulitis
    • Inflammed diverticula from food and residue accumulation
    • -CL, low residue--gradually return to high fiber
  19. Dietary (insoluble) Fiber
    • -Nondigestible CHO's and lignin, binds water, increases fecal bulk
    • -Found in legumes, wheat bran, fruits, vegetables and whole grains
  20. Soluble Fibers
    • -Decrease serum cholesterol by binding bile acids converting more cholesterol into bile
    • -Delay gastric emptying, absorb water and form soft gel in SI
    • -fruits, vegs, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, banans
  21. Fiber Recommendations
    • Males=38g
    • Females=25g
  22. Gastritis
    • Inflammation of stomach; anorexia, nausea, vomiting, diarrhea
    • -Diet: CL, advance as tolerated
  23. Types of Inflammatory Bowel Disease (IBD)
    • Crohn's-Regional enteritis
    • Chronic Ulverative Colitis
  24. Crohn's Disease
    • -Affects terminal ileum; weight loss, anorexia
    • -B12 defiency leads to megaloblastic anemia
    • -Iron deficiency anemia due to blood loss, decreased absorption
  25. Ulcerative Colitis
    • -Ulcerative disease of the COLON, begins in rectum
    • -Chronic bloody diarrhea, weight loss, anorexia, electrolyte disturbance, neg nitrogen balance
  26. Treatment of IBD
    • -Maintain fluid & electrolyte balance, antidiarrhea agent (sulfasalazine)
    • -Crohn's flareup=bowel rest, PN or min residue
    • -UC flareup=elemental diet to min fecal volume
    • -Energy needs based on BMI, frequent feedings, high fat may improve energy balance
    • -In remission=high fiber
  27. Irritable Bowel Syndrome
    • -Chronic abdominal discomford, altered intestinal motility, bloating
    • -Goals: adequate nutrient intake, tailed to spec GI issues
    • -Avoid large meals, excess caffeine, alcgohol, sugars
    • -Work with client to alleviate stress
  28. Lactose Intolerance
    • -Lactase defiency
    • -Enzyme is used to split lactose into glucose and galactose..remaining intact, it exerts hyperosmolar pressure.
    • -Water is drawn to intestine (bloating), and bacteria ferments the lactose (CO2 gas)
  29. How to decect lactase deficiency?
    • -Detected by breath hydrogen test
    • -Hydrogen is produced by the colonic bacteria, absorbed into the bloog and exhaled 60-90 mins
  30. Acute Infant Diarrhea
    • Aggressive and Immediate rehydration
    • -WHO rec glucose electrolyte solution
  31. Chronic Infant and Child Diarrhea
    • -Consider ratio of fat and CHO cals
    • -Give 40% cals of fat, balanced with limited fluids
    • -Restrict or dilute apple/grape juice
  32. Adult Diarrhea
    • 1. Remove the cause, replace fluids and electrolytes
    • 2. Begin with low fiber foods, followed by proteins
    • 3. avoid lactose at first
    • 4. prebiotics/probiotics
  33. Steatorrhea
    • Consequence of malabsorption (>7 gin stool)
    • -Determine cause and treat
    • -High pro, complex CHO, fat soluble vits
    • -MCT oil (rapidly hydrolyzed in GI tract)
  34. Short Bowel Syndrome
    • Resection of small intestine
    • -Malabsorption, malnutrition, fluid and electrolyte imbalances
    • -Most digestion takes place in first 100cm of duodenum

    -jejunal resection: ileum can adapt and take over functions
  35. Ileal Resection
    • 1. Distal: absorption of b12, IF, bile salts
    • 2. normally absorbs most of the fluid
    • 3. If ileum cannot recycle bile salts:
    • -lipids are not emulsified
    • -malabsorption of fat combine with Ca, Zn, Mg, leading to "soaps"
  36. Loss of Colon
    water and electrolyte loss, loss of salvage absorption of CHO and other nutrients
  37. Nutrition care for SBS
    • -PN to restore and maintain nutrient status
    • -Enteral- start early to stimulate growth, increase over time; continuous drip
    • *May take weeks or months to transition to food*
    • -Jejunal: normal balance of CHO, pro, fat, avoid lactose, oxalates, noconswts

    -ileal-limit fat, use MCT oil (doesn't require bile salts & less intestinal surface area); supplement fat soluble vits & b12 injections

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