nutrition diseases
TRANSCRIPT
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NUTRITION
Prepared By: Angelica Anne J.
Lopez
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OBESITY
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OBESITY
BASIC CAUSE: energy imbalance thatresults when the number of calorieseaten doesnt equal the number of
calories used for energyINFLUENCES:
Family History
Environment Psychological Factors
Illness
Sociocultural Influences
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Benefits of Weight Loss
Reduced risk of diabetes andcardiovascular diseases
Reduced risk of developinghypertension
Lower triglyceride levels
Higher HDL cholesterol levels
Lower HDL and total cholesterollevels
Lower blood glucose levels
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THREE COMPONENTS OFWEIGHT LOSS THERAPY
Diet Therapy
Increased physical activity
Behavioral Therapy
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Gastric Restriction
Vertical Banded Gastroplasty;Stomach Stapling
Inserting a vertical row of staplesacross the patients stomach
Instruct patient to eat small meals,eating slowly and chewing food
thoroughly
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Gastric Bypass
Roux-en-Y gastric bypass
Combined gastric restriction with abypass of the duodenum, and 1st portion of jejunum
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ANOREXIA NERVOSA ANDBULIMIA NERVOSA
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Anorexia Nervosa
Characterized by self imposed fastingor dieting with severe weight lossor maintenance of weight thats
15% below the recommendedweight
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Signs and Symptoms
Wastedappearance
Thinning hair or
alopecia Dry skin or brittle
nails
Decreased heartrate
Constipation
Amenorrhea
Reduced muscle
mass and jointswelling
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Long Term Effects ofAnorexia
Irregular heart rhythms
Depression
Malnutrition Anxiety
Personality disorders
Substance abuse problems
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GOAL
Reestablishing normal eatingbehaviors
Restoring nutritional status
Maintaining reasonable weight
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Tips for Eating Plan(ANOREXIA)
Be reasonable, about 1500 calories per day
Include small, frequent meals and snacks
Gradually increase calories
Limit gas producing and high fat foods Include meals based on the patients foodpreferences
Include nutritionally dense foods to meetcaloric need
Include high fiber or low sodium foods tocontrol constipation
Include multivitamins and mineralsupplements
Avoid caffeine
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BULIMIA NERVOSA
Disorder characterized by episodesof recurrent binge-purge cycles
Normal or above normal body weightand has weight fluctuations
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Signs and Symptoms
Puffy cheeks due to enlarged salivaryglands
Damaged tooth enamel due toexcessive vomiting
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Long Term Effects of Bulimia
Electrolyte imbalances
Loss of potassium
Increased risk for cardiac arrest Esophageal inflammation
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Tips for Teaching Plan(BULIMIA)
Sit down during each meal toincrease awareness of eating andsatiety
Eat meals slowly (20 minutes)withoutdistraction
Use appropriate size utensils
Refrain from skipping meals
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GASTROESOPHAGEALREFLUX DISEASE
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GERD
Gastroesophageal Reflux Disease
Excessive reflux of gastric andduodenal contents
S/Sx: - Pyrosis Dyspepsia
Regurgitation
Dysphagia
Esophagitis
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GERD
Management:
Low Fat Diet
Avoid caffeine, tobacco, beer, milk etc
Avoid eating and drinking 2H beforebedtime
Maintain normal wt
Elevate upper body H2 Receptor Antagonist
Nissen Fundoplication
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Nissen Fundoplication
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CELIAC DISEASE
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Celiac Disease
Digestive disease that damages thesmall intestines and interferes withabsorption of nutrients
CANNOT TOLERATE GLUTEN
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Signs and Symptoms
Recurringabdominalbloating and pain
Chronic diarrhea Weight loss
Pale, foul smellingstools
Unexplainedanemia
Flatulence
Bone pain
Behavioral changes
Fatigue
Tooth discoloration
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Treatment
Gluten free diet
Avoid BROW diet
Lifetime treatment
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LACTOSE INTOLERANCE
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Lactose Intolerance
Inability to digest significant amountsof lactose, the predominant sugarin milk
Signs and Symptoms Bloating
Flatulence
Cramps Diarrhea
Nausea
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Treatment
Lactase enzymes are available overthe counter
Chewable lactase enzymes
Many nondairy products are high incalcium
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DIABETES MELLITUS
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Diabetes Mellitus
Sweet passing through orsiphoning from the body
Characterized by elevated levelsof glucose in the blood
Cause: Unknown
Insulin secretion defectsProblems in insulin action
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Diabetes Mellitus
Classifications:
Type 1Type 2
Gestational DM
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DM
Type 1
Juvenile
IDDM
Ketosis prone
Etiology:
Genetic
Immunologic
Environmentalfactors
Presence ofislet cellsantibodies
Little or noendogenous insulin
Prone toDKA
Insulin is
always a
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DM
Type 2 Adult onset
Stable diabetes
NIDDM
Ketosis resistantdiabetes
Etiology: Obesity
Heredity Environmenta
l
No islet cellsantibodies
Decrease
endogenous insulin
Obese
Prone toHHNC
OHA
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DM
Manifestations:
Increased bloodosmolarity
Glycosuria Polyuria
Polydipsia
Increase blood
viscosity Polyphagia
Neuropathy
MacrovascularComplications
CAD
CVD
PVD
MicrovascularComplications
Diabeticnephropathy
Diabetic retinopathy
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PancreasDiabetes Mellitus
Diagnostic Tests
FBS
Secondary Post PrandialBlood Sugar
OGTT/ GTT
Glycosylated HgB
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PancreasDiabetes Mellitus
Management
5 components
Nutritional management Exercise
Monitoring
Pharmacologic therapy Education
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PancreasDiabetes Mellitus - Nutrition
Low caloric diet
High fiber diet
Complex carbohydrates Use of classification system
Food pyramid
Exchange lists
Pancreas
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PancreasDiabetes Mellitus - Nutrition
Exchanges SampleLunch 1
SampleLunch 2
SampleLunch 32 starch 2 slices of
bread
Hamburgerbun
1 cupcookedpasta
3 meat 2 oz slicedturkey and1 oz lowfatcheese
3 oz leanbeef patty
3 oz boiledshrimp
1 vegetable lettuce,tomato,onion
Green salad cup plumtomatoes
Pancreas
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PancreasDiabetes Mellitus - Nutrition
exchange Sample lunch 1 Sample lunch 2 Sample lunch 3
1 fat 1 tspmayonnaise
1 tbsp saladdressing
1 tsp olive oil
1 fruit 1 mediumapple
11/4 cupwater melon
1 cup freshstrawberries
Freeitems(optional)
Unsweetenediced teaMustard, pickle,hot pepper
Diet soda1 tbspcatsup,pickle,
onions
Iced waterwith lemonGarlic, basil
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PancreasDiabetes Mellitus
Management
5 components
Nutritional management Exercise
Monitoring
Pharmacologic therapy Education
Pancreas
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PancreasDiabetes Mellitus Pharmacologic
Therapy OHA
Diabenase
Orinase
Tolinase Glucophage
Glucobay
Diamicron
Micronase
Daonil
Pancreas
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PancreasDiabetes Mellitus Pharmacologic
Therapy
Insulin
Rapid Acting
Humulin R & Actrapid
Peak: 2-4 hours
Intermediate acting
NPH & Humulin N
Peak: 6 8 hours Long acting
PZI
Peak: 12 16 hours
P
Assessment of Hypoglycemia
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PancreasDiabetes Mellitus
Assessment of Hypoglycemia
Mild- /40 60 mg dl
Sweating
TremorTachycardia
Nervousness
Hunger
Moderate- /20 40 mg dl
Inability to concentrate
Headache
Lightheadedness
Confusion
Memory lapses
Numbness of lips and tongueSlurred speech
Impaired coordination
Emotional changes
Irrational or combativebehavior
Double vision
Drowsiness
SevereDisoriented
behavior
Difficultyarousing fromsleep
Loss ofconsciousness
Seizures
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PancreasDiabetes Mellitus - Nutrition
imple Carbohydrates toreat HypoglycemiaThree or four commercially prepared
glucose tablets
4 to 6 ounces of fruit juice orregular soda
6 to 10 hard candy
2 to 3 teaspoons of sugar or honey
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PancreasDiabetes Mellitus
Nursing Responsibilities
Route: SC
Administer at room temperature
Rotate site
Store vial at room temperature
Roll vials in the palms
Monitor for Dawns Phenomenon andSomogyi Effect
P
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PancreasDiabetes Mellitus
Education Foot care
Inspect daily
Wash withwarm waterand mildsoap
Pat dry
Wearcomfortableand well-fitted shoes
Break in newpair of
Do not gobarefooted
Cut nails
straightacross
No lotion ininterdigital spaces
Exerciseandmassagetheextremitie
s
P
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PancreasDiabetes Mellitus
Acute complications of DM
DKA
Deficit in available insulinresulting to metabolism of CHO,CHO and fat
HHNKS
Insulin level is low to preventhyperglycemia but high enoughto prevent fat breakdown
Pancreas
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PancreasDiabetes Mellitus
Assessment OF DKA
:B G 3 0 0 to 8 0 0
/m g d l
Lo w H C O 3 a n d p H
,N a K m a y b e o r Po ly u ria
Po ly d ip sia
B lu rre d v isio n
W eakness
H e a d a ch e
, W e a k ra p id p u lse
, / ,A n orexia N V
, .v o m itin g a b d Pa in
Acetone breath
K u s s m a u l
re sp ira tio n
M entalstatusc h a n g e s
P
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PancreasDiabetes Mellitus
Assessment of HHNS
: /BG 600 to 1200 mg dl
Hypotension
DHN
Tachycardia
Mental Status Changes
Neurological Deficits
Seizures
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HYPERTENSION
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Hypertension
Systolic greater than 140 mmHg and a diastolic pressure
greater than 90 mmHg Based on 2 or more accurate
BP measurements
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Hypertension
Systolic greater than 140 mmHg and a diastolic pressure
greater than 90 mmHg Based on 2 or more accurate
BP measurements
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Causes:
Increased SNS activity
Increased renal reabsorption
Increased activity of RAAS Increased vasodilation
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Manifestations:
Asymptomatic
Elevated BP
Retinal
hemorrhage Papilledema
May develop toangina or MI
LV hypertrophy Head ache
Epistaxis
Dizziness
Tinnitus
Unsteadiness Blurred Vision
Depression
Nocturia
Retinopathy
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Management:
PrimaryModerate intake of Na
Low fat diet
Maintain IBW
Exercise
Stop smoking
Moderate consumption of alcohol
Stress reduction
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Management:
Secondary:
Diuretics
Adrenergic InhibitorsACE inhibitors
Calcium Antagonists
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Nursing Diagnoses
Deficient knowledge regarding therelation between the treatmentregimen and control of the
diagnostic process Non-compliance with therapeutic
regimen related to side effects of
prescribed therapy
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Nursing Interventions
Patient teaching
Preventing Non compliance
Teaching about medication
Side effects of diuretics
Change position gradually
Avoid very warm bath
Avoid tyramine rich food
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THANK YOU!