nutrition- chapter 18 Flashcards
1
Q
mouth
A
dental problems
- tooth decay
- ill-fitting dentures
- mechanical soft diet can be helpful
surgical procedures
- nutrients can be supplies with high protein, high calorie milkshakes
2
Q
problems of the mouth
A
oral tissue inflammation
- gingivitis
- stomatitis
- glossitis
- cheilosis
- mouth ulcers
salivary gland problems
- infections (ex. mumps)
- mucous cysts and obstructed salivary ducts
- excess salivation vs dry mouth
- xerostomia (chronic dry mouth)
3
Q
dysphagia
A
- difficulty swallowing
- common with Alzheimer’s, Parkinson’s stroke
- head and neck cancer, tooth loss, xerostomia, and muscular weakness of larynx
- symptoms: unexplained drop in food intake or repeated episodes of pneumonia
- usually diagnosed by a speech-language pathologist
4
Q
swallowing disorder warning signs
A
- reluctance to eat certain consistencies or any food at all
- very slow chewing or eating
- fatigue from eating
- frequent throat clearing
- complaints of food “sticking” in throat
- holding pockets of food in cheeks
- painful swallowing
- regurgitation, coughing, choking during attempted eating
5
Q
central tube problems
A
- muscle spasms, uncoordinated contractions
- stricture or narrowing of the tube
- ingestion of caustic chemicals or a tumor
- esophagitis (inflammation)
- treatment: widening of the tube
- diet: liquid to soft
6
Q
lower esophageal sphincter problems
A
- changes in smooth muscle
- nerve, muscle, and hormone control of peristalsis
- achalasia (“cardiospasm”)
- post-op nutrition therapy
7
Q
gastroesophageal reflux disease (GERD)
A
- caused by constant regurgitation of acidic gastric contents into lower esophagus
- pregnancy, pernicious vomiting, or extended use of nasogastric tubes are factors
- risk for GERD symptoms and erosive esophagitis increases with obesity and waist circumference
- constant irritation and inflammation (esophagitis)
- long-term complications include stenosis, Barrett’s esophagus and esophageal ulcer
8
Q
hiatal hernia
A
- portion of upper stomach protrudes through opening in the diaphragm (hiatus)
- especially common in obese adults
9
Q
peptic ulcer disease
A
- eroded mucosal lesion in the central portion of the GI tract, though it usually occurs in the duodenal bulb (first portion of duodenum)
- Two most common causes:
- Helicobacter pylori (H. pylori)
infection - Long-term use of NSAIDs irritates the gastric mucosa and decreases the mucosal integrity
- Helicobacter pylori (H. pylori)
10
Q
peptic ulcer disease
A
symptoms:
- increased gastric muscle tone
- painful contractions when stomach empty
- diagnosis via radiographs and gastroscopy
medical management:
- antibiotics, antacids, HCl secretion controllers (H2- blockers or proton pump inhibitors), mucosal protectors
- rest, sleep, coping and relaxation skills, avoid aggravating factors
- eliminate habits that contribute to ulcer development (smoking, alcohol use) and avoid irritating drugs (NSAIDs)
- well balanced healthy diet promotes tissue healing and maintenance
avoiding acid stimulation:
- food quantity – eat small quantities, avoid eating immediately prior to bedtime
- irritants – common irritants include hot chili peppers, black pepper, chili powder, caffeine, chocolate, and alcohol
- smoking – complete cessation is preferred
11
Q
malabsorption symptoms
A
- defect in absorption of essential nutrients, leading to chronic nutrient deficiencies
- can include any of 3 digestive processes
- digestion of macronutrients
- terminal digestion at the brush border mucosa
- absorption
- most common symptoms are chronic diarrhea and steatorrhea
- cystic fibrosis and inflammatory bowel disease specifically trigger malabsorption
12
Q
cystic fibrosis
A
- most common fatal genetic disease in North America for white people
- multisymptom disorder
- inhibits normal movement of chloride and sodium ions in the body tissue fluids. these ions become trapped in cells, causing thick mucus to form and clog ducts/passageways
- Lungs—damages airways, difficult breathing, infections
- Pancreas—lack of normal pancreatic enzyme secretion
- Malabsorption—food is left undigested and unabsorbed
- Liver and gallbladder—clogged bile ducts lead to degeneration
- Inflammatory complications—arthritis, vasculitis
13
Q
nutrition management of cystic fibrosis
A
- nutrition therapy is critical
- patients who are able to maintain an age-appropriate BMI percentile have better overall health outcomes
- pancreatic enzyme replacement products
- nutritional supplements to maintain weight
14
Q
inflammatory bowel disease (IBD)
A
- general term to describe chronic inflammation of GI tract
- persistent activation of mucosal immune system against normal gut flora
- disrupts protective epithelial barrier, destroying the function of segments of GI tract
- 2 common forms are idiopathic
- Crohn’s disease
- ulcerative colitis
15
Q
Crohn’s disease
A
- most common locations are ileum and colon
- risk factors: family history, jewish ancestry, smoking
- may cause deficiencies of vitamins A and D, iron, zinc, and protein-energy malnutrition
common symptoms:
- abdominal pain
- fever
- fatigue
- anorexia
- weight loss
- painful/urgent defecation
- diarrhea
16
Q
ulcerative colitis
A
- involvement limited to colon, but similar manifestations to Crohn’s disease
- progressive, beginning at anus
- resulting malnutrition hinders healing, but not associated with as many deficiencies as Crohn’s
- however, as pain increases, food intake decreases, or inflammation extends beyond the colon, the same deficiencies as are seen with Crohn’s disease may occur
common symptoms:
- urgent diarrhea with blood and mucus
- abdominal pain
- weight loss
- fever
- rectal pain
- iron-deficiency anemia
17
Q
nutrition therapy of IBD
A
- use enteral or parenteral nutrition feedings if necessary
- progress to low-fat, high-protein, high-kilocalorie, small, frequent meals when returning to a normal diet as tolerated
- the diet should be low in fiber only during acute attacks or with strictures. otherwise, fiber should be increased gradually
- vitamin and mineral supplementation should include vitamin D, zinc, calcium, magnesium, folate, vitamin B12, and iron
- during periods of remission: meet energy and protein needs that are specific for weight, and replenish nutrient stores
- avoid foods that are high in oxalates for patients with Crohn’s disease
- increase antioxidant intake, and consider supplementation with omega-3 fatty acids and glutamine
- consider the use of probiotics and prebiotics
18
Q
diarrhea
A
- symptom of another underlying condition
- intolerance to specific foods or nutrients
- acute food poisoning
- parasites, bacteria, and viral infections
- chronic diarrhea (more than 2 weeks) can be life threatening
- 4th or 5th leading cause of death globally
- IV fluid and electrolytes replacement or rehydration solutions may be used
19
Q
large intestine diseases
A
- diverticulosis: formation of many small pouches (diverticula) along mucosal lining in the colon
- caused by progressive increase in pressure
within the bowel resulting from a low-fiber diet
- caused by progressive increase in pressure
- diverticulitis: caused by pockets becoming inflamed and infected
- underlying age-related pathogenesis may develop in response to chronic low-grade inflammation, microbiome shifts, visceral hypersensitivity, and abnormal gut motility
20
Q
irritable bowel syndrome (IBS)
A
- most commonly diagnosed GI disorder
- functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit
- common recurrent pain in lower abdomen
- small-volume bowel dysfunction (constipation and/or diarrhea)
- excess gas formation
- multicomponent disorder
- genetic predisposition, altered GI tract sensation and motility, infection, inflammation, increased intestinal permeability, dietary intolerances, dysbiosis, and psychosocial stressors
21
Q
nutrition care for IBS
A
- regular diet containing optimal amounts of energy and nutrients
- eliminate food allergens and intolerances
- omit foods that increase gas and flatulence
- consider use of prebiotics/probiotics
- consider use of food diaries
22
Q
constipation
A
- “normal” intestinal elimination not clearly defined and varies greatly
- common short term problem
- dietary and lifestyle management should be primary focus for treatment
causes:
- nervous system tension and worry
- neurologic or neuromuscular problems
- changes in routines
- side effect of medications
- frequent laxative use
- low-fiber diets
- lack of exercise
23
Q
food allergy
A
- body’s immune system reacts to a protein as if it were a threatening foreign object and launches powerful attack
- anaphylactic shock = most severe reaction
24
Q
food intolerance
A
- not life-threatening
- nonimmunologic
- adverse reactions to foods or food constituents
- lactose intolerance most common
- avoid offending food
25
Q
common food allergies
A
- eggs
- milk
- peanuts
- tree nuts
- wheat
- shellfish
- soy
signs and symptoms: hives, nausea, diarrhea, abdominal pain, and respiratory symptoms such as wheezing
26
Q
food allergy diagnostics
A
- food elimination diet
- skin-prick test
- allergen-specific serum IgE immunoassays
- oral food challenge
26
Q
food allergy diagnostics
A
- food elimination diet
- skin-prick test
- allergen-specific serum IgE immunoassays
- oral food challenge
27
Q
current recommendations for prevention of food allergies
A
- pregnant women: eat a well-balanced healthy diet and not avoid any specific allergens
- exclusively breastfeed infants for a minimum of 4 months. mother should not avoid eating food allergens during lactation
- introduce solid foods to infants between 4 and 6 months. include allergenic foods after the initial period of weaning
- include probiotics and prebiotics in the diet
28
Q
celiac disease
A
autoimmune response to the proteins in certain grains:
- gluten in wheat
- hordein in barley
- secalin in rye
- oats not problematic for celiac disease but can be cross-contaminated
symptoms: diarrhea, steatorrhea, unintended weight loss, progressive malnutrition
29
Q
celiac disease
A
- avoid all gluten
- avoid wheat, rye, and barley
- corn, potato, rice, and others used as substitutes
- careful label reading because many products use gluten-containing grains as thickeners or fillers
- monitor for vitamin/ mineral deficiencies
30
Q
GI accessory organs
A
produce digestive agents that help with digestion and absorption of food
- liver
- gallbladder
- pancreas
31
Q
fatty liver disease
A
- if from alcohol abuse: alcoholic liver disease (ALD)
- otherwise called nonalcoholic fatty liver disease (NAFLD)
- steatosis: fat accumulation in the liver
- excess fatty acids in circulation stored in the liver
- treatment: balanced diet, alcohol avoidance and weight loss (if indicated), possible antioxidant supplementation, tight blood glucose level control
- enteral nutrition therapy recommended for malnourished patients with alcoholic steatohepatitis (ASH)
32
Q
hepatitis
A
- inflammatory condition of the liver caused by virus, bacteria, parasite, or toxins (chloroform, alcohol, drugs)
- most common causes are viral infections (Hep A&B) and alcohol abuse
treatment:
- avoid hepatotoxic substances (alcohol, drugs, toxins)
- balanced diet of adequate energy
- 4 to 6 small meals daily
- protein intake of 1.0-1.2 g/kg body weight per day
- limit sodium to 2000 mg/day
33
Q
cirrhosis
A
- a chronic state of liver disease in which the liver is damaged beyond repair with scar tissue and fatty infiltration
- nearly ½ of all cases are a result of hepatitis C and alcoholism
- medications limited. nutrition therapy used
results in:
- portal hypertension
- hepatic encephalopathy
- esophageal varices
- ascites
34
Q
hepatic encephalopathy
A
- as cirrhosis continues, blood can no longer circulate normally through liver
- ammonia and nitrogen cannot reach the liver to be eliminated, which produces ammonia intoxication and coma
- treatment focuses on removing sources of excess ammonia
35
Q
management of cirrhosis
A
- avoid hepatotoxic substances
4 to 6 small meals daily - 20% increase above basal energy needs
- carbohydrates ~ 50% of total energy intake
- protein – 0.8-1.2 g/kg/day
- fat limited to 30% kcals if steatorrhea present
- may need enteral/parenteral nutrition support
- may need vitamin/mineral supplementation
- sodium limited to 2000 mg/ d
- fluids may be restricted
36
Q
gallbladder disease
A
- cholecystitis = gallbladder inflammation
- usually results from low-grade chronic infection or obstruction
- cholelithiasis = gallstone formation
- cholesterol may separates out and crystallize to form gallstones
- diet therapy centers on controlling fat intake and eating small, frequent meals
- treatments: cholecystectomy, litholysis, nutrition therapy
37
Q
pancreatic disease
A
- inflammation of the pancreas inhibits its release of digestive enzymes
- can be acute or chronic
- acute treatment: NPO with hydration
- chronic treatment: adequate energy and nutrients, especially protein; lower in fat; avoid alcohol and smoking
- supplemental pancreatic enzymes with each meal
causes:
- excessive alcohol consumption is most common
- pancreatic duct can be blocked by gallstones
- heredity, CF, autoimmune disorders
