09.04 Nutrition (Diet) in Disease

Overview

Understand how disease can affect nutrition in the human body

Nursing Points

General

1. Diseases that have a very significant impact on nutrition
   1. Cardiac Disorders
   2. Diabetes Mellitus
   3. Gastrointestinal Disorders
   4. Renal Disorders

Assessment

Cardiac Disorders

1. Nutrition-Disease Relationship
   1. Heart is a pump
   2. Vessels deliver blood to the body
   3. Diet can affect the elasticity of the blood vessels, weaken the heart or cause blockages that contribute to heart disease, failure or blood pressure issues
2. Hypertension:
   1. HTN leads to increase risk of stroke, MI, and CHD
   2. Diet: Dietary Approach to Stop Hypertension (DASH Diet)
      1. Low in salt <2400 mg/day
      2. High in
         1. Calcium,  Magnesium and potassium
         2. Protein
         3. Fiber
            1.  Increase fruits, vegetables, and whole grains
3. Heart Failure
   1. Diet: Salt restriction Na < 2000 mg/day
   2. Possible fluid restriction <1500 mL/day
4. Myocardial Infarction & Coronary Heart Disease
   1. Diet
      1. Low fat/low chol diet
      2. Emphasis on limiting saturated and trans fats, and increasing monounsaturated fats
      3. Increased fiber
      4. Increase omega 3 fatty acids
      5. Decrease Sodium intake
5. Lifestyle changes:
   1. Smoking cessation
   2. Limit alcohol intake
   3. Maintain healthy weight
   4. Increase physical activity
   5. Keep blood pressure and blood cholesterol within normal limits
   6. Limit caffeine which increases heart rate,

Diabetes Mellitus

1. Nutrition/Disease Relationship
   1. Insulin is required for cellular metabolism
      1. Allows cell to use sugars in the blood for energy
   2. Diabetes a lack of insulin or production of ineffective insulin
      1. Causes increases in blood sugar
      2. Won’t allow body to use sugar for energy
   3. Diet Modifications
      1. Limit carbohydrates
   4. Lifestyle Changes
      1. Increase exercise
      2. Smoking cessation
      3. Maintain healthy body weight
   5. Blood sugar management
   6. Insulin and Diet
      1. Insulin has peak duration and onset

Gastrointestinal Disorders

1. Nutrition/Disease Relationship
   1. GI tract is responsible for absorption and digestion of food & nutrients
   2. Disruption in this process impedes nutritional intake
2. Disorders
   1. Oral,  Esophageal, & Gastric
      1. Dysphagia
         1. Inability or difficulty in swallowing
         2. Alterations in food consistency or possibly nutrition support

1. High Fowlers
2. Extra chewing
3. Oral care

1. 1. 1. Increase gastric emptying –

1. Used for conditions like GERD or gastroparesis
   1. These conditions intake a slow emptying of the stomach contents
   2. Elevate Head of Bed
2. Interventions
   1. Increase mobility
   2. Small frequent meals
   3. Decrease fiber and fat
   4. Drink plenty of fluid during meals
   5. Avoid caffeine, smoking, amd alcohol

1. 1. 1. Delay gastric emptying –  
         1. Used for conditions like dumping syndrome
         2. Interventions
            1. Lay down after meals
            2. Small frequent meals
            3. Avoid liquid during meals and an hour before and after
            4. limit high sugar meals
            5. Fat and protein with each meal
      2. Avoid stomach irritation – Gastritis PUD (peptic ulcer disease)
         1. Avoid frequent meals and snacking
            1. These habits stimulate gastric secretions
         2. Avoid
            1. NSAIDS
            2. Aspirin
            3. Caffeine
            4. Cigarettes
            5. Alcohol
            6. Spicy foods
      3. Intestinal Diseases
         1. Irritable Bowel Disease (IBD)
            1. Crohn’s
            2. Ulcerative colitis
               1. Low fiber, low residue, high protein, high calorie diet
               2. Avoid nicotine and foods that can aggravate diarrhea
         2. Diverticulitis/Diverticulosis
            1. Diverticulitis
               1. Clear liquid diet then advanced to a low fiber diet.
            2. Diverticulosis
               1. A high fiber diet for prevention of diverticulitis
         3. Ileostomies/Colostomies
            1. Focuses on symptom management
               1. Focus on fluids and electrolytes
               2. Provide interventions as needed to add bulk to stool, minimizing gas production, etc.  
               3. Avoid foods like broccoli or cabbage
      4. Liver/Pancreas, Gallbladder
         1. Liver Disease
            1. Synthesizes proteins
            2. Acts a filter
               1. Provide adequate protein to prevent muscle breakdown
               2. Avoid caffeine nicotine or alcohol
               3. Possible vitamin mineral replacement may be necessary
               4. Encourage calorie intake
         2. Pancreatitis
            1. Inflammation of the pancreas
               1. Diet orders should include nothing by mouth
               2. Nasogastric tubes placed to prevent or reduce aspiration risk  
         3. Cholecystitis
            1. Aim for a Low fat diet
      5. Other
         1. Nausea/Vomiting
            1. Avoid strong odors
            2. Provide bland low fat diet
            3. Elevate head of bed
         2. Constipation
            1. Provide plenty of fluids and fiber
         3. Diarrhea
            1. Replace electrolytes
            2. Provide fluids
            3. Improve fiber intake
         4. Anorexia
            1. Encourage high calorie foods
            2. Evaluate for causes of lack of appetite

Renal Disease

1. Nutrition/Disease Relationship
   1. Kidney is a filter
      1. Filters out and removes toxins
      2. Responsible for sodium and water balance
      3. Produces urine
2. Disorders
   1. Acute Kidney Injury (AKI)
      1. Similar diet to CKD, based of severity
   2. Chronic Kidney Disease (CKD)
      1. Limit protein, salt
      2. For more severe limit fluid, protassium, and phosphorus.
   3. End Stage Renal Disease (ESRD)
      1. Not on dialysis:
         1. Limit protein
         2. Salt
         3. Fluid
         4. Potassium
         5. Phosphorus
      2. Dialysis
      3. Provide high protein diet
      4. Monitor fluid intake
      5. Monitor for potassium and phosphorus – limit as needed
   4. Nephrotic syndrome
      1. Provide adequate protein
      2. Limit salt &  fluid

Nursing Concepts

1. Nutrition
2. Patient Education
3. Fluid & Electrolyte Balance