NUTRITION

Prepared By: Angelica Anne J.

Lopez
OBESITY
 OBESITY
BASIC CAUSE: energy imbalance that
results when the number of calories
eaten doesn’t equal the number of
calories used for energy
INFLUENCES:

– Family History
– Environment
– Psychological Factors
– Illness
– Sociocultural Influences
 Benefits of Weight Loss
• Reduced risk of diabetes and
cardiovascular diseases
• Reduced risk of developing
hypertension
• Lower triglyceride levels
• Higher HDL cholesterol levels
• Lower HDL and total cholesterol
levels
• Lower blood glucose levels
 THREE COMPONENTS OF
WEIGHT LOSS THERAPY
• Diet Therapy
• Increased physical activity
• Behavioral Therapy
 Pharmacotherapy
• If the 3 components fail
• Sibutramine
– Appetite suppressant
• Orlistat (Xenical)
– Inhibits pancreatic lipase
 Gastric Restriction
• Vertical Banded Gastroplasty;
Stomach Stapling
• Inserting a vertical row of staples
across the patient’s stomach
• Instruct patient to eat small meals,
eating slowly and chewing food
thoroughly
 Gastric Bypass
• Roux-en-Y gastric bypass
• Combined gastric restriction with a
bypass of the duodenum, and 1st
portion of jejunum
ANOREXIA NERVOSA AND
BULIMIA NERVOSA
 Anorexia Nervosa
• Characterized by self imposed fasting
or dieting with severe weight loss
or maintenance of weight that’s
15% below the recommended
weight
 Signs and Symptoms
• Wasted • Constipation
appearance • Amenorrhea
• Thinning hair or • Reduced muscle
alopecia mass and joint
• Dry skin or brittle swelling
nails
• Decreased heart
rate
 Long Term Effects of
Anorexia
• Irregular heart rhythms
• Depression
• Malnutrition
• Anxiety
• Personality disorders
• Substance abuse problems
 GOAL
• Reestablishing normal eating
behaviors
• Restoring nutritional status
• Maintaining reasonable weight
 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 patient’s food
preferences
• Include nutritionally dense foods to meet
caloric need
• Include high fiber or low sodium foods to
control constipation
• Include multivitamins and mineral
supplements
• Avoid caffeine
 BULIMIA NERVOSA
• Disorder characterized by episodes
of recurrent binge-purge cycles
• Normal or above normal body weight
and has weight fluctuations
 Signs and Symptoms
• Puffy cheeks due to enlarged salivary
glands
• Damaged tooth enamel due to
excessive vomiting
Long Term Effects of Bulimia
• Electrolyte imbalances
• Loss of potassium
• Increased risk for cardiac arrest
• Esophageal inflammation
 Tips for Teaching Plan
(BULIMIA)
• Sit down during each meal to
increase awareness of eating and
satiety
• Eat meals slowly (20 minutes)without
distraction
• Use appropriate size utensils
• Refrain from skipping meals
GASTROESOPHAGEAL
REFLUX DISEASE
 GERD
• Gastroesophageal Reflux Disease
• Excessive reflux of gastric and
duodenal contents
• S/Sx: - Pyrosis
– Dyspepsia
– Regurgitation
– Dysphagia
– Esophagitis

 GERD
• Management:
– Low Fat Diet
– Avoid caffeine, tobacco, beer, milk etc
– Avoid eating and drinking 2H before
bedtime
– Maintain normal wt
– Elevate upper body
– H2 Receptor Antagonist
– Nissen Fundoplication

Nissen Fundoplication
CELIAC DISEASE
 Celiac Disease
• Digestive disease that damages the
small intestines and interferes with
absorption of nutrients
• CANNOT TOLERATE GLUTEN
 Signs and Symptoms
• Recurring • Bone pain
abdominal • Behavioral changes
bloating and pain
• Fatigue
• Chronic diarrhea
• Tooth discoloration
• Weight loss
• Pale, foul smelling
stools
• Unexplained
anemia
• Flatulence
•
 Treatment
• Gluten free diet
• Avoid BROW diet
• Lifetime treatment
LACTOSE INTOLERANCE
 Lactose Intolerance
• Inability to digest significant amounts
of lactose, the predominant sugar
in milk
• Signs and Symptoms
– Bloating
– Flatulence
– Cramps
– Diarrhea
– Nausea
 Treatment
• Lactase enzymes are available over
the counter
• Chewable lactase enzymes
• Many nondairy products are high in
calcium
DIABETES MELLITUS
 Diabetes Mellitus
• Sweet passing through or
siphoning from the body
• Characterized by elevated levels
of glucose in the blood
• Cause: Unknown
– Insulin secretion defects
– Problems in insulin action

 Diabetes Mellitus

•Classifications:
–Type 1
–Type 2
–Gestational DM

 DM
• Type 1 – Presence of
– Juvenile islet cells
– IDDM antibodies
– Ketosis prone – Little or no
– Etiology: endogenou
• Genetic s insulin
• Immunolog
ic
– Prone to
• Environme DKA
ntal – Insulin is
factors
always a

 DM
• Type 2 – No islet cells
– Adult onset antibodies
– Stable diabetes
– Decrease
– NIDDM
endogenou
– Ketosis resistant
diabetes s insulin
– Etiology: – Obese
• Obesity
• Heredity
– Prone to
• Environmenta HHNC
l
– OHA


 DM
• Manifestations: • Neuropathy
– Increased blood • Macrovascular
osmolarity Complications
– CAD
– Glycosuria
– CVD
– Polyuria – PVD
– Polydipsia • Microvascular
– Increase blood Complications
viscosity – Diabetic
– Polyphagia nephropathy
– Diabetic retinopathy


 Pancreas
Diabetes Mellitus
• Diagnostic Tests
–FBS
–Secondary Post Prandial
Blood Sugar
–OGTT/ GTT
–Glycosylated HgB
 Pancreas
Diabetes Mellitus
• Management
–5 components
• Nutritional management
• Exercise
• Monitoring
• Pharmacologic therapy
• Education
 Pancreas
Diabetes Mellitus - Nutrition

• Low caloric diet

• High fiber diet
• Complex carbohydrates
• Use of classification system
– Food pyramid
– Exchange lists
 Pancreas
Diabetes Mellitus - Nutrition
Exchanges Sample Sample Sample
2 starch Lunch
2 slices1 of Lunch 2
Hamburger Lunch
1 cup 3
bread bun cooked
pasta
3 meat 2 oz sliced 3 oz lean 3 oz boiled
turkey and beef patty shrimp
1 oz lowfat
cheese
1 vegetable lettuce, Green salad½ cup plum
tomato, tomatoes
onion
 Pancreas
Diabetes Mellitus - Nutrition
exchange Sample lunch 1 Sample lunch 2 Sample lunch 3

1 fat 1 tsp 1 tbsp salad 1 tsp olive oil

mayonnaise dressing

1 fruit 1 medium 11/4 cup 1 ¼ cup fresh

apple water melon strawberries

“Free” Unsweetened Diet soda Iced water

items iced tea 1 tbsp with lemon
(optional) Mustard, pickle, catsup, Garlic, basil
hot pepper
pickle,
onions
 Pancreas
Diabetes Mellitus
• Management
–5 components
• Nutritional management
• Exercise
• Monitoring
• Pharmacologic therapy
• Education
 Pancreas
Diabetes Mellitus – Pharmacologic
Therapy
• OHA
– Diabenase
– Orinase
– Tolinase
– Glucophage
– Glucobay
– Diamicron
– Micronase
– Daonil
 Pancreas
Diabetes 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

 Mild Pancreas
Assessment of Hypoglycemia
Moderate Severe
40-60 mg/dl 20-40 mg/dl Disoriented
Sweating Diabetes Mellitus
Inability to concentrate behavior
Tremor Difficulty
Headache
Tachycardia arousing from
Lightheadedness sleep
Nervousness Confusion Loss of
Hunger Memory lapses consciousness
Numbness of lips and tongue Seizures
Slurred speech
Impaired coordination
Emotional changes
Irrational or combative
behavior
Double vision
Drowsiness
 Pancreas
Diabetes Mellitus - Nutrition

Simple Carbohydrates to
Treat Hypoglycemia

Three or four commercially prepared

glucose tablets
4 to 6 ounces of fruit juice or
regular soda
6 to 10 hard candy
2 to 3 teaspoons of sugar or honey
 Pancreas
Diabetes Mellitus
• Nursing Responsibilities
– Route: SC
– Administer at room temperature
– Rotate site
– Store vial at room temperature
– Roll vials in the palms
– Monitor for Dawn’s Phenomenon and
Somogyi Effect
 Pancreas
Diabetes Mellitus
• Education • Do not go
barefoote
– Foot care d
• Inspect daily • Cut nails
• Wash with straight
warm water across
and mild • No lotion in
soap interdigita
• Pat dry l spaces
• Wear • Exercise
comfortable and
and well- massage
fitted shoes the
• Break in new extremitie
pair of s
 Pancreas
Diabetes Mellitus
• Acute complications of DM
– DKA
• Deficit in available insulin
resulting to metabolism of CHO,
CHO and fat
– HHNKS
• Insulin level is low to prevent
hyperglycemia but high enough
to prevent fat breakdown
 Pancreas
Diabetes Mellitus
Assessment OF DKA

B G : 3 0 0 to 8 0 0 W e a k , ra p id p u lse
m g /d l A n o rexia , N / V ,
Lo w H C O 3 a n d p H vo m itin g , a b d . Pa in
N a , K m a y b e  o r  A ce to n e b re a th
Po lyu ria K u ssm a u l
re sp ira tio n
Po lyd ip sia
M e n ta lsta tu s
B lu rre d visio n ch a n g e s
W e a kn e ss
H e a d a ch e
 Pancreas
Diabetes Mellitus
Assessment of HHNS

BG: 600 to 1200 mg/dl

Hypotension
DHN
Tachycardia
Mental Status Changes
Neurological Deficits
Seizures
HYPERTENSION
 Hypertension
• Systolic greater than 140 mm
Hg and a diastolic pressure
greater than 90 mmHg
• Based on 2 or more accurate
BP measurements
 Hypertension
• Systolic greater than 140 mm
Hg and a diastolic pressure
greater than 90 mmHg
• Based on 2 or more accurate
BP measurements
 Causes:
• Increased SNS activity
• Increased renal reabsorption
• Increased activity of RAAS
• Increased vasodilation

 Manifestations:
• Asymptomatic • Epistaxis
• Elevated BP • Dizziness
• Retinal • Tinnitus
hemorrhage • Unsteadiness
• Papilledema • Blurred Vision
• May develop to • Depression
angina or MI
• Nocturia
• LV hypertrophy
• Retinopathy
• Head ache
•
 Management:
• Primary
– Moderate intake of Na
– Low fat diet
– Maintain IBW
– Exercise
– Stop smoking
– Moderate consumption of alcohol
– Stress reduction
 Management:

• Secondary:
–Diuretics
–Adrenergic Inhibitors
–ACE inhibitors
–Calcium Antagonists
 Nursing Diagnoses
• Deficient knowledge regarding the
relation between the treatment
regimen and control of the
diagnostic process
• Non-compliance with therapeutic
regimen related to side effects of
prescribed therapy
 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
DASH diet
THANK YOU!