Nutrition Diagnosis

Question 1

Difference between medical and nutrition Dx

Answer 1

medical diagnosis is a disease or pathology that can be treated or prevented. It does not change as long as the condition is present.

Nutritional diagnosis changes as the patients response changes.

Question 2

Diagnosis: NC 1.4

Answer 2

Altered GI function

looks at problems inside the GI tract including exocrine functions of the liver and pancreas, with changes in digestion, absorption, and/or elimination

Question 3

Diagnosis: NC 2.1

Answer 3

Impaired nutrition utilization

Refers to problems with the metabolism of nutrients once they have entered the circulatory system

Question 4

Discharge plan…

Answer 4

begins on day 1

Question 5

Ulcer

Answer 5

Likely cause: helicobacter pylori

Diet: as tolerated, avoiding cayenne and black pepper, large amounts of chili powder, avoid excess caffeine and alcohol

Question 6

Dumping syndrome

Answer 6

Following a gastrectomy (Billroth I/II)

Deficiency: B12 (anemia), folate
Treate with frequent small, dry feedings, fluids before or after meals, restrict hypertonic concentrated sweets (simple sugars), moderate fat, B12 injections, lactose may be poorly tolerated

Question 7

Tropical sprue

Answer 7

Deficiencies of B12 and folate due to decr. HCL and IF

Question 8

Non-tropical sprue (Celiac)

Answer 8

Need gliadin-free gluten-restricted diet: NO wheat, rye, oats (if harvested and milled with wheat), barley, buckwheat may be contaminated, no bran, graham, malt, bulgur, cousous, durum, orzo, thickening agents

OK corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax, amaranth, millett, teff, quinoa

Question 9

Diverticular disease

Answer 9

Oat bran and soluble fibers decr. serum cholesterol by binding bile acids converting more chol into bile

Soluble fiber: pectins, gums, f/v, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, bananas

Question 10

Inflammatory Bowel Disease

Answer 10

B12 deficiency leads to megaloblastic anemia

UC symptoms: chronic bloody diarrhea, wt loss, anorexia, electrolyte (NA, K) disturbance, dehydration, anemia, fever, neg nitro balance

Question 11

Lactose Intolerance

Answer 11

lactase deficiency

lactose tolerance test: if intolerant of lactose, blood glucose will rise <25 mg/dl above fasting (flat curve). If tolerant the rise would be above 25 mg/dl (normal curve)

diet: no animal milk or milk products (some tolerate aged cheese or yogurt)

Question 12

Short Bowel Syndrome

Answer 12

Illial resection: distal affects B12, IF, bile salts

Ileal: limit fat, use MCT, supplement fat sol vitamins, CA, MG, Zn

Question 13

Liver Disorders

Answer 13

All enzymes are elevated in liver disease

Alkaline Phosphatase (ALP)
Lactic acid dehydrogenase (LDH)
Aspartate amino transferase (AST, SGOT)
alanine aminotransferase (ALT, SGPT)

Question 14

Acute viral hepatitis

Answer 14

Anorexia

rec. small, frequent meals (4-6) because of anorexia

Question 15

Cirrhosis

Answer 15

Ascites occurs when blood cannot leave the liver

Connective tissue overgrowth blocks blood flow out of the liver (ascites) AND into liver from the portal vein (portal hypertension and esophageal varices)

Diet:
adequate to high protein 0.8-1.2g/kg, in stress at least 1.5
High cal, 25-35 cal/kg dry weight or BEE + 20%
mod to low fat (25-40%), MCT if needed, FAT is perferred fuel in cirrhosis, include omega-3
Low fiber if varices are present
with hyponatremia, fluid restriction

Question 16

Alcoholic liver disease

Answer 16

thiamin deficiency- Wernicke-Korsakoff syndrome

Question 17

Hepatic Failure

Answer 17

Altered neurotransmitter theory: low BCAA (used by muscles for energy); high AAA (aromatic amino acids) because damaged liver is unable to clear them

adding BCAA adds cals and prot; may not reduce symptoms, used when standard therapy does not work and when pt doe snot tolerate standard protein

Question 18

Gallbladder disease

Answer 18

cholecystectomy- surgical removal of gallbladder; bile now secreted from liver directly into intestine

Limit fat intake for several months to allow liver to compensate
slowly increase fiber to help normalize bowel movements

Question 19

CVD Management

Answer 19

salt restriction (1500-2300 mg sodium/day 
DASH diet: whole grains, fruits, veg, low fat dairy, poultry, fish, mod sodium, limit alcohol, decr sweets, calcium to meet DRI (not supplements)

Question 20

NECP Therapeutic Lifestyle Change

Answer 20

National Cholesterol Eduction Program

TLC
up to 35% cal from total fat, <7% sat fat, 5-10% PUFA, up to 20% MUFA, <200 mg cholesterol
25-30 grams fiber (half soluble)
stanols nd sterols to inhibit chol absorption
maintain DBW, prevent wt gain
incr. physical activity to 30 mni of mod intenstidy most days