Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Large Intestine • Working knowledge of physiological changes during disease processes & the effects of these on nutrition care. Large Intestine • Calculate & interpret nutrient composition of foods appropriate for diets used in MNT. • Calculate & define diets for common conditions. Large Intestine • Parts of the colon – haustra - sacculations in wall of colon, due to the circular muscle fibers & tenia coli Large Intestine • Parts of the colon – tenia coli - three thickened bands of soft tissue 1/4” wide & 1/6 shorter than the colon, longitudinal fibers that go from appendix to rectum • Diagram of colon next Colon Constipation • Infrequent and difficult passage of stool • Fewer than 3 stools/week while eating high residue diet • What is the normal time it takes food to pass from the mouth to the anus? Constipation Etiology • Not defecating when the urge happens • Failure to establish a regular time to defecate • Lack of fiber in the diet Constipation Etiology • Insufficient fluid intake • Loss of muscle tone in intestinal tract • Side effects of medications • Lack of exercise • Pregnancy Constipation Nutr Care • Fluids • Fiber Laxatives • Gradual reduction of laxatives - can become dependent Laxatives - Stimulants • Senna (natural) • Bisacodyl – stimulates nerve endings to increase peristalsis • Dulcolax - active ingredient is bisacodyl Laxatives - Bulking Agents • What do you think are the bulking agents? Laxatives - Stool Softeners • Colace – active agent is docusafe sodium – surface active agent Laxatives - Prunes • Dihydroxyphenyl isatin – stimulates intestinal motility Irritable Bowel Syndrome • Cause unknown • Exaggerated gastrocolic reflex • Abnormal colonic sensitivity to stretching • Anxiety & stress IBS • Contributing causes – excessive use laxatives – excessive use caffeine – antibiotic therapy – irregular sleep, rest, fluid intake, bowel movements IBS • Abnormal stooling pattern associated with symptoms of intestinal dysfunction that persists • May be some inflammation • Slide of what colon looks like in irritable bowel syndrome next Colon in irritable bowel syndrome IBS Symptoms • • • • • Diarrhea & constipation Excessive flatulence Sensation of incomplete evacuation Rectal pain Mucus in stools IBS Monitoring • • • • • Body weight H&H Alb Na, K, Cl Ca, Mg IBS Nutritional Care • Get over fear of eating • Gain or maintain wt • Acute phase – elemental food products – advance DAT IBS Nutritional Care • Chronic phase – high fiber diet – avoid gas forming foods – DAT – exclusion of caffeine & chocolate IBS Nutritional Care • Why the high fiber diet? Diverticular Disease • Diverticulosis – collection of herniations of the colonic wall Diverticular Disease • Diverticulitis – accumulation of fecal matter in the diverticular pockets with infection & inflammation Diverticular Disease • Outpouchings results from segmentation due to high intracolonic pressures • Low fiber diet • Colon muscle weakens • Common elderly • Next figure of diverticula Diverticula Symptoms • Diverticulitis – pain – bleeding – low Hgb & Alb levels Symptoms • Diverticulosis – can be asymptomatic – pain – constipation with diarrhea Diverticular Monitoring • • • • • Body wt & change H&H Alb Transferrin, TIBC Stool number & frequency Diverticular Monitoring • Blood pressure • WBC (may increase) Nutritional Care • Get over fear of eating • Maintain or increase body wt • Diet lessen pain Nutritional Care • Diverticulitis – bowel rest to prevent perforation – low fiber & residue – No nuts, seeds, fibrous veg – DAT Nutritional Care • Diverticulosis – increase stool caliber & vol – lessen intraluminal pressure – high fluid & fiber Patient Education • Fiber in foods • Drink fluid • Avoid constipation Ileostomy & Colostomy • • • • Ulcerative colitis Crohn’s disease Colon cancer Intestinal trauma Ileostomy • Surgical formation of an opening of the ileum onto the surface of the abdomen Colostomy • Surgical formation of an artificial anus on the abdominal wall by incising the colon & bringing to the surface Ileostomy & Colostomy • Consistency of material in colon next • Next slides of openings and where in the intestinal tract Colon material consistency Ileostomy Colostomy • What would be the consistency of the material for each of these procedures? Nutritional Care • Avoid foods that cause odor – corn – dried beans – onions – cabbage – highly spiced foods Nutritional Care • Avoid foods that cause odor – fish – antibiotics – some vitamin & mineral supplements Nutritional Care • • • • • Avoid foods that produce flatulence Avoid very fibrous veg Chew food well More fluid More salt • Crohn’s Disease Case study #40 - 3, 4, 5 • Diverticulosis Case study #17 - 2, 3, 4, 5, 6, 7, 8, 10, 11, 12 • Select menu high in fiber from reg menu • Write SOAP note Digestion-AbsorptionMetabolism