Internship Report Amna Ramzan

Final Year Internship Report 1
Final Year Internship Report

Name: Amna Ramzan
Course: B.Sc. Hons. Home Sciences
Major: (Food and Nutrition)
Shaukat Khanum Memorial Cancer

Hospital & Research Centre
Department of Clinical and Nutrition
Shaukat Khanum Memorial Cancer Hospital & Research Centre

Table of Contents:
1. Acknowledgement ……………………….……………. 3
2. Weekly Schedule of Internship Program ……..……….. 4
3. Literature Review about Cancer ……………..……..….. 6
4. Diet Plans for different Diseases ………..…………….. 11
5. Renal and Liver Diseases ………….……………...…... 21
6. Surgery ………………………………...……………… 28
7. Intestinal cancers and stoma………..…………………. 30
8. Enteral feeding and pediatric assessment……………… 33
9. SGA rating form and OPD…………………..………… 39
10. References ……………………………………….. 39

1. ACKNOWLEGDEMENT
All praise to Almighty who has given me an opportunity pertaining an
internship program as a part of B.Sc. Hons. Home Sciences (Food and
Nutrition). It is one kind of research work. We know very well that research in
any field of knowledge enriches the stock of knowledge. There may be two
types of research viz. theoretical research and applied research.
First I would like to express my profound gratitude to my honorable Miss.
Rashida Javed (Head of clinical and nutrition department SKMCH&RC). She
helped me a lot by proper guidance, effective comments and with a good
support. She had always paved me the right way to conduct my internship
program. She has passed a lot of time in this respect. She was cordial to solve
my problem.
At last I am grateful to my respected teachers and the head of the department
Dr. Naheed Abbas.
Regards
Amna Ramzan
B.Sc. Hons. Home Sciences
(Food and Nutrition)
University of Agricultural Faisalabad

2. Weekly Schedule of Internship Program
WEEK 1.
• What is cancer, its treatment?
• Cancer cachexia and nutrition requirements.
• Nutrition assessment (tools/parameters)
• Exchange list (count caloric intake, food groups and diet consistencies.
WEEK 2.
• Diabetes mellitus
• Cardiac diseases, hypertension.
• Obesity
• Eating disorders (anorexia nervosa, bulimia nervosa)
• GI tract & celiac disease
WEEK 3
• Renal diseases (pre dialysis, dialysis, post dialysis)
• Renal calculi & uric acid
• Liver diseases (jaundice, hepatitis, cirrhosis)
WEEK 4
• Surgery (dietary modifications for buckle surgery, esophagectomy)
• Intestinal cancers and stoma formation
• Assignment
WEEK 5
• Enteral feeding (types, indication, supplement reconstitution)
• PEG/NG (problems and solutions)
• Pediatric assessment (ideal height &weight for age)

3. LITERATURE REVIEW ABOUT CANCER

CANCER
What is cancer?
Malignant growths or tumors that result from abnormal and uncontrolled cell
division. The development of the cancer is called carcinogenesis.
How cancer develops?
Inheritance:
Cancer arises from mutation in the genes. Vulnerability to cancer is sometimes
inherited. Phagocytes produce oxidants that cause DNA damage.
Environmental factors:
• Aflatoxins: (Regularly found in improper stored foods as chili pepper, corn,
cotton seed, Millet, peanut, rice, sorghum, sun flower seeds, wheat’s)
• Alcohol
• Asbestos: (a fire resistant mineral used in tiles, cement, textiles)
• Tobacco
Major types of cancer:
• Lymphoma: is a group of blood cell tumors that develop from lymphatic cells.
• Carcinoma: Carcinoma is a type of cancer that develops from epithelial cells.
Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or
outer surfaces of the body, and that generally arises from cells originating in the
endodermal or ectodermal germ layer during embryogenesis
• Leukemia: is a group of cancers that usually begin in the bone marrow and
result in high numbers of abnormal white blood cells. These white blood cells are
not fully developed and are called blasts or leukemia cells.
• Sarcoma: A sarcoma (from the Greek σάρξ sarx meaning "flesh") is a cancer that
arises from transformed cells of mesenchymal origin. Thus, malignant tumors
made definition, considered sarcomas. This is in contrast to a malignant tumor
originating from epithelial cells, which are termed carcinoma. Human sarcomas are
quite rare.

• Myeloma: Multiple myeloma is a cancer of plasma cells, a type of white blood

cell normally responsible for producing antibodies.
Cancer Consequences
Cancer consequences depend upon the location of the tumor severity and treatment
effects. Anorexia, lethargy, weight loss, night sweats and fever.
Cancer Cachexia: A wasting syndrome associated with cancer that is
characterized by Anorexia, waisting, weight loss, fatigue.
Weight loss: Weight loss is an evident at the time of cancer. Poor appetite,
abnormal metabolism, and diversion of nutrients to support tumor growth result in
lower supply of energy and nutrients when demands are high.
Metabolic changes: Cancer increase the rate of protein turn over, reduced muscle
protein synthesis, gluconeogenesis occur staring the protein needs, increase lipid in
serum and insulin resistant.
Anorexia and reduced food intake:
Anorexia is major contributor in wasting.
• Chronic nausea
• Early satiety
• Fatigue (Lack of energy leads to cachexia)
Medical Treatment Effects

Chemotherapy:
Chemotherapy reduce the tumor prolification or shrink it before surgery
Short term side effects:
• Hair loss (alopecia)
• Finger nail and toenail weakness
• Pain
• Mouth and throat sores (mucositis, stomatitis)

• Fatigue
• Constipation
• Diarrhea
• Temporary loss of menstrual periods (amenorrhea)
• Menopausal symptoms (such as hot flashes)
• Infection
• Weight gain
• Sleep disorders (insomnia)
• Anemia
• Leukopenia/neutropenia
Long term side effects:
• Early menopause
• Fatigue
• Mental fatigue
• Long term health risks
Radiation therapy:
Radiation therapy uses high-energy radiation to shrink tumors and kill cancer cells.
X-rays, gamma rays, and charged particles are types of radiation used for cancer
treatment.
Side Effects:
• May damage healthy cells
• Skin problems (dryness, itching, blistering or peeling)
• Nausea & vomiting
• Changes in menstruation, vaginal itching, burning
• Rectal bleeding

Bone Marrow Transplant:

It is high quality chemotherapy which may be the radio therapy of the whole body.
In it the whole bone marrow is destroyed and new bone marrow is transplant.
Side Effects:
• Low platelets and low red blood cells
• Pain
• Respiratory distress
• Organ damage
Side effects:
Acute metabolic distress caused by surgery raises the protein and energy needs,
surgery also contribute to fatigue, pain and anorexia. Blood loss leads to mal
nutrition due to loss of nutrients.
Cancer Cachexia:
Cancer cachexia is the multifactorial syndrome defined by an ongoing loss of
skeleton muscle mass that can nutritional support and leads to functional
impairment.
A clinical syndrome characterized by
• Anorexia
• Early satiety
• Weight loss
• Muscle wasting
• Anemia
• Edema
• Severe body weight, fat and muscle loss
• Increases protein catabolism
Diagnosis:
Involuntary weight loss >5% over last six months

Phases of cancer cachexia:
Pre cachexia Cachexia Refractory

cachexia
Normal
cachexia
Weight loss < 5% weight loss >5 low performance
score
Metabolic/ often reduced food immune compromised
Endocrine change intake/systematic <3 months expected
survival
Inflammation.
Neutropenia:
Neutropenia is the lower level of neutrophils. Neutrophils fight infection by
destroying harmful bacteria and fungi or yeast that invade the body. Neutrophils
formed in the bone marrow. Some level of neutropenia occurs in about half of the
people with cancer who are receiving chemotherapy. That causes the infections
due to the lower level of neutrophils.
Signs and symptoms of neutropenia:
• Neutropenia itself may not cause any symptoms. Patient usually find out through
test.
• Patients of neutropenia, even a minor infection develop serious infections
• Fever >100.5 degree F
• Chills & sweating
• Sore throat, sours in mouth
• Abdominal pain
• Pain and burning during urination

• Diarrhea or soreness of breaths

• Any redness, swelling or pain
• Unusual vaginal discharge
Causes:
• Cancer treatment can cause a low level of neutrophils
• Some types of chemotherapy
• Cancers that effects the bone marrow e.g. leukemia, lymphoma and Myeloma
• Radiation therapy to the bones in the pelvic, legs, chest or abdomen
• People older than 70 years have more chances of neutropenia.
4. Diet Plans for Different Diseases
DIET
Avoided:
• All fresh fruits vegetables
• Raw or rare cooked foods Tae or coffee
• Fresh yogurt
• Mutton
• Salads
ALLOWED:
• All things which are in hygienic conditions.
• Fruits which can use with its covering e.g; apple, banana, orange etc
• All processed or packed foods
• Meat which is completely cooked.
• Vegetables which are cooked completely.

Glycemic Index:
Glycemic index was designed to help the people with diabetes, control their blood
sugar level. It helps to drop extra weight. Glycemic index focusing on carbs like
white bread, cookies & white potatoes make the sugar level rise quickly.
High GI foods: (70 or higher)
• White rice
• White bread
• White baked potatoes
• Crackers
• Sugar sweetened beverages.
• Preteels (fatty biscuits)
Medium GI foods:
• Banana
• Grapes
• Spaghetti
• Ice cream
• Raisins
• Corn
Low GI foods:
• Oatmeal
• Kidney beans
• Carrot
• Peas
• Peanuts
• Skim milk
• Most fruits except (water melon)

FOOD GI Serving (g) Glycemic GI Type

load
BREAD
White wheat 71 30 9 High
flour bread
Whole wheat 73 30 9 High
bread
100% whole 51 30 7 Low
grain bread
Beverages
Coca Cola 63 250ml 16 Medium
Fanta 68 250ml 23 Medium
Orange Juice 50 250ml 12 Low
Breakfast
cereals
Bran 55 30 12 Low
Corn flakes 77 30 20 High
White rice 89 150 43 High
Brown rice 50 150 16 Low
Dairy
products
Ice cream 57 50 6 Medium
Milk full fat 41 250ml 5 Low
Milk skim 32 250ml 4 Low
Fruits
Apple 39 120 6 Low
Banana ripe 62 120 16 Medium
Dates dried 42 60 18 Low
Grape fruit 25 120 3 Low
Orange 40 120 4 Low
Peach 42 120 5 Low
Pear, canned 42 120 5 Low
pear juice
Raisins 64 60 28 Medium
Water melon 72 120 4 High
Grapes 59 120 3 Medium
Beans & Nuts
Baked beans 40 150 6 Low
Black beans 30 150 7 Low

Chick peas 10 150 3 Low

Kidney beans 29 150 7 Low
Soy beans 27 150 3 Low
cashews 7 50 3 Low
peanuts 7 50 0 Low
Pasta Noodles
Macroni 47 180 23 Low
Macroni and 64 180 32 Medium
cheese
Spaghetti 46 180 22 Low
white boiled
Spaghetti 42 180 17 Low
whole meal
boiled
Snack foods
Corn chips 42 50 11 Low
Microwave 55 20 6 Medium
popcorn
Vegetables
Green peas 51 80 4 Low
Carrot 35 80 2 Low
Baked crusset 82 150 21 High
potato
Sweet potato 70 150 22 High
Yam 54 150 20 Low
Miscellaneous
Chicken 46 100 7 Low
nuggets
Pizza(plain , 80 100 22 High
baked dough)
Pizza hut 36 100 9 Low
(super
supreme)

Diabetes
• Add fruits and vegetables in diet.
• Avoid bakery products & sweet beverages.
• Walk daily for at least 20min.
• Use fat free dairy products.
• Use lean meat & meat products.
• Insulin should be used according to the doctor’s recommendation.
• Diabetes should check out before every meal.
• Limit the oily foods
• Artificial sweeteners are not so healthy.
Serving Carbs Protien Fats Calories
Breakfast
Yogurt 2/3cup 15g 8g 0-3g 100
chapati 1(6inches) 15g 8g 0-3g 80
Egg 1 0g 7g 4-7g 75
Brunch
Tea 1cup 15g 8g 0-3g 100
Biscuit 3 small 15g 5g 10g 90
Lunch
Baryani
Rice 1/3cup 15g 3g 0-1g 80
chicken 2oz 0g 14g 3-6g 90
Yogurt 2/3cup 15g 8g 0-3g 100
Snack
Grape fruits&
strawberries
juice
Grape fruit 1 3og 0g 0g 60

strawberries 1cup 15g 0g 0g 60
Dinner

chapati 1 (6inches) 15g 16g 0g 160

Potato(gravy) 1/3cup 3g 3g 0-1g 80
Carrot 1/2cup 2g 2g 0 25
Post dinner
Milk(skim) 1cup 15g 8g 0-3g 100
Almonds 10 0g 0g 5g 45
Total 170g 93g 21g 1235
DIET PLAN
Calories split up:
Carbs: 55% Protein: 30% Fats: 15%
HYPERTENTION & CARDIOVASCULAR DISEASES
• Avoid bakery products.
• Do not sprinkle salt on fruits.
• Use less fast foods and cold drinks.
• Celery should not use frequently in a week.
• Purified water should be used because fresh water also contains salt.
• Processed foods should be avoided like bread, biscuits, cake.
DIET PLAN
Serving Carbs Protein Fats Calories
Breakfast
Chapati 1(6inches) 15g 3g 0-3g 80
Omelate 1 0g 7g 4-7g 75
Milk 1cup 15g 8g 0-3g 100
(skim)
Brunch
Grape 1 15g 0g 0g 60
fruit
Lunch
Chicken
plao
Rice 1cup 15g 3g 1g 160
Chicken 2oz 0g 7g 0-3g 80

Yogurt 1cup 15g 8g 0-3g 100

Salad 1cup 5g 5g 2g 25
Snack
Tea 1cup 15g 3g 0-3g 80
Nuggets 3 15g 3g 0-3g 80
Dinner
chapati 1(6inches) 15g 3g 0-3g 80
Mix 1cup 5g 2g 0g 25
vegetables
Yogurt 1cup 15g 8g 0-3g 100
Post
dinner
Milk 1cup 15g 8g 0-3g 100
Total 170g 75g 20g 1145
Calories split up:

Carbs: 59% Protein: 26% Fats: 15%
EATING DISORDERS:
Eating disorders describe illness that are characterized by irregular eating habits
and severe distress or concern about body weight & shape.
Types:
• Bulimia nervosa
• Anorexia nervosa
BULIMIA NERVOSA:
Behaviors that compensate by the overeating such as forced vomiting, excessive
exercise or extreme use of laxatives & diuretics result in thickened skin.
Signs and symptoms:
• Swollen salivary glands , sores in mouth and throat.
• Dehydration
• Sores on hands from using them to induce vomiting
• Electrolyte imbalance

• Dry skin
• Fatigue
• Irregular and absent menstrual cycle in females
ANOREXIA NERVOSA:
An eating disorder which effects brain and nerves, hair , heart and other parts of
the body
Causes:
• Develop later as a result of mal nutrition.
• Fear of gaining weight
Treatment:
• Brush regularly to prevent the further decay of teeth
• Avoid acidic foods.
Nutritional support:
• Protein drinks (powdered protein)
• Milk
• Eggs
• Meat
• Sauces or gravies
• Oil
• Before treatment the parenteral nutrition or enteral nutrition should be provided.
GI TRAC DISEASES
The digestive tract is a twisting tube about 30 feet long. It starts at the mouth and
ends at the anus. In between are the esophagus, stomach and bowels (intestines).
The liver and pancreas aid digestion by producing bile and pancreatic juices which
travel to the intestines. The gallbladder stores bile until the body needs it for
digestion.

The digestive system breaks down food and fluids into much smaller nutrients. In
this complex process, blood carries the nutrients throughout the body to nourish
cells and provide energy. The GI tract is divided into two main sections: the upper
GI tract and the lower GI tract.
• Upper GI tract — mouth, pharynx, esophagus and stomach. The stomach leads to
the small intestine.
• Lower GI tract — intestines (bowel) and the anus. The bowel is made up of two
sections:
• Small intestine — the duodenum, jejunum and ileum
• Large intestine — the cecum (where the appendix is attached), colon and rectum
CELIAC DISEASE:
When people with celiac disease eat gluten (a protein found in the wheat, rye,
barley), their body mounts an immune system that attacks the small intestine.
These attacks lead to damage on villi. When villi get damage, nutrients cannot be
absorbed properly in to the body.
Treatment:
• Strictly follow the gluten free diet.
Untreated celiac disease leads to many problems such as
• Iron deficiency anemia
• Early onset of osteoporosis
• Infertility, miscarriage
• Lactose intolerance
• Pancreatic insufficiency
• Intestinal lymphoma
Crohn’s Disease:
Foods to avoid:
• Nuts
• Fruits with skin

• Popcorns
• Fried foods
• Cured meat
• Seeds like strawberries
• Tomatoes
• Coffee, carbonated beverages
• Chocolate
• Alcohol
• Diary
• Butter, mayonnaise
• Food high in fiber
• Spicy foods
Recommended Foods:
• Soft foods
• Cooked or canned fruits
• Fish chicken
• Choose harder and aged cheese
DIET PLAN
Serving Carbs Protein Fats Calories
Breakfast
Sandwich
Potato 1 (small) 15g 3g 0-1g 80

Chicken(lean) 1 0z 0g 0-3g 7g 45
Bread slice 2 15g 3g 0-1g 80
Strawberries 1cup 15g 0g 0g 60
juice
Brunch
Chicken

vegetable
pasta
Pasta 1cup 15g 3g 0-1g 100
chicken 10z 0g 7g 0-3g 45
vegetables 1/3cup 5g 2g 0-1g 25
Lunch
Chinese rice
Rice 1 cup 15g 3g 0-1g 100
vegetables 1/3 cup 5g 2g 0g 25
chicken 1 oz 0g 7g 0-3g 45
snack
Steam 2 oz 0g 14g 0-3g 90
chicken
Apple juice 1 cup 15g 0g 0g 60
Dinner
Grill fish 5 0z 0g 28g 0-3 g 180
Cheese
sandwiches
cheese 1/3 cup 0g 7g 8g 100
Bread slice 2 15g 3g 0-1g 80
Total 150g 84g 30g 1200
Calories split up:

Carbs:50% Protein:28% Fats: 22%
RENAL DIASESES
NUTRITIONAL REQUIREMENT
Acute Chronic Hemodialysis Peritoneal
Renal Renal Dialysis
failure failure
Calories 25-35 35<60yrs 35<60yrs 35<60yrs 30-
(kcal/kg/d) 30- 30-35>60yrs 60yrs include
35>60yrs calories from
dialysis
Protein 1-1.5 0.6-0.75 1.2 1.2-1.3
(gm/kg/d) 50%HBV 50% HBV 50% HBV
Fat 0.8-1.5 Patients are higher risk of CVD emphasis on

(g/kgBW/d) PUFA,MUFA,250-300mg cholesterol/day

Carbohydrates 3.0-5.0 - - -
(g/kgBW/d) Maximum
(7)
Sodium 1000-3000 2000 2000 2000
(mg/d)
Potassium Generally Correlated 2000-3000 2000-3000
(mg/d) not to (8-17mg/kg) (8-17mg/kg)
restricted laboratory
unless values
serum
potassium
is elevated
or urine
output less
than 1L/day
Calcium 1200-1600 1200 <2000 from <2000 from
(mg/d) diet and diet and
medications medications
Phosphorus 800-1200 Correlated 800-1000 800-1000
(mg/d) to
laboratory
values
RENAL CALCULI:
Kidney stones or renal calculi are solid masses made of crystals. Kidney stones
usually originate in our kidney. The urinary tract includes the kidneys, ureter,
bladder and urethra.
Types:
• Calcium stones
• Uric acid stone
• Struvite
• Cysteine

Calcium stones:
Calcium stones are most common. They can be made up of calcium oxalate,
phosphate or maleate. Use lower oxalic foods.
High oxalate foods
• Potato
• Chips
• Peanuts
• Nuts
• Chocolate
• Beets
• Spinach
• Oranges
• Dark green vegetables
Purine high foods:
• Meat
• Sea foods
Uric acid stones:
This type of kidney stone are more common in men the women. They can occur in
people with gout or those who going through chemotherapy.
This type develop when urine is too acidic.
• Avoid the high purine diet.
STRUVITE:
These stones are found in the women with urinary tract infections. These are
caused by kidney infections.

CYSTINE:
These occur both men and women who have genetic disorder cystinuria.
(Disorder due to the defect of transport of amino acids including cysteine). In this
type cysteine that leaks from kidney to the urine.
Symptoms:
• Blood in urine
• Vomiting
• Nausea
• Discoloration or foul smelling.
• Chills
• Fever
• Frequent and small amount of urination.
Foods that trigger the kidney stones:
• Excessive caffeine
• Red meat
• Oxalate rich foods
• Non fermented soy
• Carbonated drinks
• Excessive drinking ( alcohol)
• Table salt
5. LIVER DISEASES
• Hepatitis
• Jaundice
• Cirrhosis
Hepatitis:
Hepatitis is the condition of liver in which inflammation occur.

Types:
Hepatitis A: is present in the faces of infected person and is most often transmitted
through consumption of water or food.
Symptoms:
• Fatigue
• Fever
• Dark urine
• Light color stool
• Fever
• Jaundice
Hepatitis B: Needs rest; diet required high protein and carbs.
Hepatitis C: vitamin B12 supplement can be given to the patients
How to prevent hepatitis?
• Wash your hands with soap after going to toilet
• Only use those foods which just have been cooked.
• Only drink boiled water
• Only eat fruits that you can peel.
• Eat raw vegetables after washing.
• Don’t share needles, brushes, and machine equipment’s
Foods to avoid:
• Alcohol
• Junk foods
• Hydrogenated oils
• Processed food
• Artificial sweeteners
• High fat

JAUNDICE:
Jaundice occur when hemoglobin break down and produce bilirubin. It results in
yellowness of eyes, skin and mouth.
It mostly occurs in newly born babies.
Types:
Hepatocellular: that occurs as a result of liver disease or injury.
Hemolytic: that occurs as a result of hemoglobin breakdown.
Obstructive Jaundice: that occurs as a result of obstruction in bile duct.
Causes:
• Acute inflammation of liver
• Inflammation of bile duct
• Hemolytic anemia
Symptoms:
• Yellow tinge to eyes
• Pruitis (ichiness)
• Fatigue
• Abdominal pain
• Weight loss
• Vomiting
• Fever
• Paler than usual
• Dark urine
Treatment:
• Drink plenty of water
• Adequate rest
• Avoid digestive disturbance

• Moderate exercise.
CIRRHOSIS:
Cirrhosis is a late stage of scaring of liver caused by many forms of liver diseases.
Fluid retention: cirrhosis gets a buildup of fluid in edema. For this purpose use less
sodium in diet to prevent fluid retention.
Symptoms:
• Nausea
• Vomiting
• Severe weight loss
• Shortage of zinc
• Weakness
Life style remedy:
• Don’t drink alcohol.
• Eat low sodium diet.
• Eat plenty of fruits and vegetables.
• Use lean meat.
• Use protein as legumes, poultry and fish
• Wash hands before eating
• Get vaccinated for hepatitis A, Influenza and pneumonia
• Avoid drugs like aspirin and ibuprofen.
HEPATIC ENCEPHALOPATHY
Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities
in patients with liver dysfunction.
Causes:
• Pneumonia
• Dehydration

• Low Oxygen
• Use of medications to suppress immune system
• Eating too much protein
• Electrolyte imbalance
Symptoms:
• Difficulty in thinking
• Personality changes
• Poor concentration
• Problems in hand writing or loss of other small hand movements.
• Confusion
• Forgetfulness
• Poor judgment
• Confusion
• Anxiety
• Severe personality changes
• Shaky hands
• Slow movements
6. SURGERY
Types:
• Buccle surgery
• Esophageal surgery
• Gastractomy

BUCCLE SURGERY
DIET
FOOD Generally well Avoid
tolerated
Beverages • Carbonated
• Ice drinks
Milk products all None
Meat and meat • Tender, • Dry, rough or
alternatives minced, moist stringy
Fish, poultry • Nuts seeds
• Use gravy • Crunchy peanut
sauces butter
• Soft cooked • Stringy cooked
eggs cheese like
mozzarella
cheese
Grain products • Hot cereals • fresh doughy
• Well soaked • popcorn
• Pasta • any grain
• rice containing nuts
seeds or dry
fruits
Fruit • canned or • Dried fruits
cooked fruits • Coconut
• fresh fruits • Apple ,
without skin pineapple and
orange
vegetables • Well cooked or • Raw vegetables
canned • Stringy cooked
vegetables • Vegetables such
• Use vegetable as spinach
soup
Fats and oils All None

ESOPHAGEAL SURGERY
DIET
Recommended Avoid
Water with lemon orange slices Salty, sugary and fast foods
Low fat yogurt Cold cuts of processed meat
Broccoli Grape fruit juice
Kale Potatoes, yams
Banana More than 500mg of calcium ,
2000IU of vitamin D and 500mg
supplements of vitamin C per
day
Raw red and yellow pepper Black tea, wheat , bran
GASTRACTOMY-DIET
• Avoid high fiber diet.
ANTI DUMPING DIET
CHOOSE AVOID
GROUPS
MILK Products As tolerated Cocoa powder
butter milk Milk shakes
Canned soup
Yogurt
vegetables All none
Fruits Fresh fruits Dried foods
Frozen fruits
Bread and grains Cracker pasta Sugar coated

plain bread cereals
Doughnuts
Sweet rolls
Meat and meat Eggs are foods none
products
Fats and oils Butter none
margarine
Salad dressings
beverages Sugar free Regular soft
Water drinks

7. INTESTINAL CANCER OR STOMA

Intestinal cancer:
Tumor in the small intestine may block the flow of food and effect digestion.
Symptoms:
• Abdominal pain
• Unexplained weight loss
• Weakness and fatigue
• Bloody stool
• A noticeable lump in abdomen
Causes:
• Tobacco
• Eating high fat
• Chemical exposure
• Colon cancer
• Celiac disease
• Crohn’s disease
DIET
• High protein diet
• Small and frequent meals
• Plenty of fluids
• Chewable foods
STOMA
A stoma is an opening on front of the abdomen. This is made using surgery. It
diverts feces urine in to a pouch. It sits on the surface of skin
Types:
• Colostomy (coming from colon)

• Ileostomy (coming from the ileum)

• Urostomy (Coming from kidneys)
Guidelines and Suggestions Foods that Are Poorly or Incompletely

Digested and that May Block a Narrowed Stoma
Cabbage Lettuce
Celery Mushrooms
Coconut Nuts
Corn Olives
Cucumbers Peas
Dried fruits Pickles
Green peppers Pineapple
Things that Cause Excess Swallowed Air and Then Gas
Jittery or stressed personality and excessive saliva swallowing

Poorly fitting dentures, smoking pipes or cigarettes, chewing gum or tobacco
can cause increased salivation and swallowing
Eating fast and swallowing large chunks of food or large amounts of beverages
Using straws or drinking from a bottle or can
Inactivity and lying down after eating
Foods that Tend to Form Gas

Most beans, especially dried beans and peas, baked beans, soy
Legumes
beans, lima beans
Cabbage, radishes, onions, broccoli, Brussels sprouts,
Vegetables cauliflower, cucumbers, sauerkraut, kohlrabi, rutabaga,
turnips, asparagus, onions
Fruits Prunes, apples, raisins, bananas, excessive amounts of fruit
Cereals, Excessive wheat products, including breads and cereals.
breads Check labels for specific grains.

Milk, milk
Excessive milk, ice cream, cheese
products
Excessive pan-fried or deep-fried foods, fatty meats; rich
Fatty foods
cream sauces and gravies; pastries
Liquids Carbonated beverages
Odor-Reducing Foods and Medications
Buttermilk Yogurt
Cranberry
Charcoal tablets (check with physician )
juice
Parsley
Odor-Producing Foods
Asparagus Garlic
Eggs Onions
Fish
Foods that Tend to Thicken Stool
Applesauce Pasta
Bananas Creamy peanut butter
Breads Starchy foods, such as potatoes
Cheeses
Foods that Tend to Cause Diarrhea
Apple juice Prune juice
Grape juice Highly seasoned foods, especially hot peppers

8. PARENTERAL ENTERAL FEEDING

Enteral nutrition generally refers to any method of feeding that uses the
gastrointestinal (GI) tract to deliver part or all of a person's caloric requirements. It
can include a normal oral diet, the use of liquid supplements or delivery of part or
all of the daily requirements by use of a tube.
When Would a Patient Really Require Enteral Nutrition?
When a patient has difficulty eating for whatever reason, and if the GI tract is
working, then using this natural means for feeding would be preferable to feeding
by intravenous means. Using the GI tract is closer to normal and can help the
immune system. An example might be a patient who has had a stroke and now has
difficulty swallowing (called dysphagia). The swallowing may normalize over time
or in some instances may not return to normal which could put the patient at risk
for inadvertently swallowing any solids and liquids consumed into the lungs which
could cause a severe pneumonia. During the short term, a patient like this might be
fed with a tube entering the nose. For longer use, a tube entering the stomach from
outside the abdomen (a gastrostomy) might be appropriate.
COMPLICATIONS:
• Food entering the lungs,
• Constipation, diarrhea,
• Improper absorption of nutrients,
• Nausea,
• Vomiting,
• Dehydration,
• Electrolyte abnormalities,
• High blood sugar,
• Vitamin
• Mineral deficiencies,
• Decreased liver proteins.

Feeding tubes inserted through the nose:

• Irritation of the nose or throat,
• Acute sinus infections,
• Ulceration
PREVENTION:
• The most common complications associated with catheter placement include
infection, clogging (occlusion), and breakage.
• Port sterilization before access,
• Close monitoring of catheter site appearance for redness or inflammation.
• When a catheter is cracked, leaking, or broken, the catheter must be repaired or
replaced as soon as possible.
• A catheter is clamped between the exit site and the break to prevent entrance of
air or leakage of blood.
• Thrombosis (blood clot) of a blood vessel around an intravenous catheter is
another potential complication with intravenous therapy as well as intravenous
nutrition.
(Formulas)
• Polymeric: complain, Horlicks, insulin, isocal, pediasure, ensureplus
• Disease specific: Glucena, Nova source, Renal, resource diabetes,
Elemental, captanen
• Modular formula: Bene, protein, MCT oil

PEDIATRICS ASSESSMENT


Internship Report Amna Ramzan

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Final Year Internship Report 1

Final Year Internship Report

Shaukat Khanum Memorial Cancer

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

2. Weekly Schedule of Internship Program

Shaukat Khanum Memorial Cancer Hospital & Research Centre

3. LITERATURE REVIEW ABOUT CANCER

Shaukat Khanum Memorial Cancer Hospital & Research Centre

• Myeloma: Multiple myeloma is a cancer of plasma cells, a type of white blood

Medical Treatment Effects

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Bone Marrow Transplant:

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Phases of cancer cachexia:

Pre cachexia Cachexia Refractory

Shaukat Khanum Memorial Cancer Hospital & Research Centre

• Diarrhea or soreness of breaths

4. Diet Plans for Different Diseases

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

FOOD GI Serving (g) Glycemic GI Type

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Chick peas 10 150 3 Low

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Grape fruit 1 3og 0g 0g 60

Shaukat Khanum Memorial Cancer Hospital & Research Centre

chapati 1 (6inches) 15g 16g 0g 160

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Yogurt 1cup 15g 8g 0-3g 100

Calories split up:

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Potato 1 (small) 15g 3g 0-1g 80

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Calories split up:

Shaukat Khanum Memorial Cancer Hospital & Research Centre

(g/kgBW/d) PUFA,MUFA,250-300mg cholesterol/day

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Bread and grains Cracker pasta Sugar coated

Shaukat Khanum Memorial Cancer Hospital & Research Centre

7. INTESTINAL CANCER OR STOMA

Shaukat Khanum Memorial Cancer Hospital & Research Centre

• Ileostomy (coming from the ileum)

Guidelines and Suggestions Foods that Are Poorly or Incompletely

Jittery or stressed personality and excessive saliva swallowing

Foods that Tend to Form Gas

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre

8. PARENTERAL ENTERAL FEEDING

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Feeding tubes inserted through the nose:

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Shaukat Khanum Memorial Cancer Hospital & Research Centre