Download Unit 6

Unit 6
NS335 Special Populations
Review for Unit 6 Project
Cancer, HIV, and AIDS
Leslie Young MS, RD, LDN
Unit 6 Project/Paper
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Address the following questions in a 2-3 page essay (60 pts) in APA format. Include an
additional title page and reference page (20 pts). Include an additional one-page
Nutrition Care Plan using the Nutrition Care Process (20 pts) for this patient.
You can format the essay portion (2-3 pages) with 5 paragraphs with strong topic
sentences. Please avoid cutting and pasting these questions as the sub-titles within
the paper. I would really like it to flow like a formal paper.
Page 1: Title page (APA format)
Page 2,3,4 Essay portion that answers the questions.
Page 5 Nutrition Care Process (chart note in A, D, I, M order)(see doc sharing
document)
Page 6 Reference page (APA format)
ADIM note
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Nutritional Care Plan for ________________
Nutrition Assessment
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Medical hx:
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Nutritional Hx:
Nutritional Diagnosis
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(nutritional problem) related to (cause) as evidenced by (signs and symptoms).
You have to choose a Nutr DX from the list: and structure it in a sentence PES.
Nutritional Intervention
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(What you will do or provide)
Monitoring & Evaluation
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(What you will check on)
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(How long until you will follow up)
Nutritional Diagnosis
Writing the note
• A: assessment part
• D: Nutr Dx (from list) related to medical dx as evidenced by
Symtoms etc. (PES statement is within the D section of the
note-problem,etiology, symptoms)
Example: Excessive carbohydrate intake related to Type 2 DM
as evidenced by dietary non-compliance/elevated blood
sugars
I: Intervention: what are the plans for the patient?
M: Monitoring: how will you assess the progress of the patient?
Paper info
• Remember title page, nutrition note, reference
page do not count towards the page min.
• Please include references- APA style. Use
quotes and paraphrases
• Stay in a formal tone, avoid use of personal
pronouns- “I” etc…better to say….It is advised
that the patient etc…
• Please review the 2 announcements I posted
last week…very helpful !
Cancer
• When cells divide and reproduce abnormally and
have the potential to spread throughout the
body, crowding out normal cells and tissues
• One third of the cancer deaths in the United
States each year can be attributed to nutrition
and other lifestyle factors.
Cancer – Causes
Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.
Medicine and Nutrition Management
Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.
Nutrition Implications of Cancer Therapy Radiation Therapy
Head/Neck/Esophagus
-anorexia
-impaired taste acuity
-reduced food intake
-tooth decay and gum disease
-difficulty swallowing
-decreased salivary secretions
and taste sensations
-sensitivity to texture and
temperature of food
-inflamed oral mucosa
Abdomen
-loss of intestinal villi and
absorbing surfaces
-vascular changes
-inflammation
-obstructions
-strictures, fistulas
-anorexia and nausea
-malabsorption
-diarrhea
Table 21-1 (Stanfield, 2008)
Nutrition Implications of Cancer Therapy Chemotherapy
• Interference with production of white blood cells
and red blood cells
• Nausea, vomiting, stomatitis, anorexia, ulcers,
and diarrhea; response of the GI system similar
to those that occur in radiation therapy
• Body fluid and electrolyte disturbances
• Hair Follicle Loss
Table 21-1 (Stanfield, 2008)
Nutrition Implications of Cancer Therapy Surgery
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Effects are site dependent
Impaired food ingestion
Malabsorption
Potential dumping syndrome
Possible low blood glucose following gastric resection
Insulin deficiency from resection of pancreas (DM)
Fluid and electrolyte imbalances
Head and neck surgery or resection poses special feeding
problems; different feeding methods (enteral and parenteral)
and feeding intervals, and modifications in oral food
preparation
Table 21-1 (Stanfield, 2008)
Commonly Used Complementary
and Alternative Therapies
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Macrobiotic diet
Vegetarian diet
Gerson therapy
Kelley/Gonzales regimen
Juice therapies
Black cohosh
Echinacea
Flaxseed
Ginger
Iscador
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Shark cartilage
DHEA
Enzymes
Oxymedicine
Coenzyme Q10
Milk thistle
PC-SPECS
Saw palmetto
Soy and soy foods
Teas
Prevention of Cancer Factors
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Energy balance and exercise
Fat
Protein
Fiber
Fruits and vegetables
Chemoprevention
Alcohol
Coffee and tea
Artificial sweeteners
Nitrates, nitrites, and nitrosamines
Method of food preparation
Fruits and Vegetables
• Appear to have a protective effect against
cancer
• Thought to be due to the phytoestrogen and
phytochemical content of the plant-based diet
Fats
• Research, although controversial, has shown
evidence that high-fat diets are linked to an
increased risk of cancer of the breast, colon,
lung, and prostate
American Cancer Society’s
Dietary Recommendations for Cancer Prevention
1. Eat a variety of healthful foods, with an emphasis on
plant sources.
2. Adopt a physically active lifestyle.
3. Achieve and maintain a healthy body weight
throughout life.
4. Limit consumption of alcoholic beverages.
Any Questions
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Human Immunodeficiency Virus
(HIV)
• HIV is a virus that targets the body’s immune
system and inhibits a person’s body from
producing adequate immune defenses.
• This virus can develop into AIDS
over time.
Acquired Immunodeficiency
Syndrome (AIDS)
• AIDS is the final stage of HIV.
• AIDS is a disease that prevents the body’s
ability to fight off infection
and illness.
Risk Factors for Contracting HIV
HIV
can be transmitted through four different
types of fluids that can enter the bloodstream
1. Blood
2. Semen
3. Vaginal fluids
4. Breast milk (mother)
Fluids
such as saliva, sweat, tears, and urine do not
transmit the virus, but HIV antibodies may be
present in these fluids.
People at risk for HIV
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Heterosexuals with more than one sex partner
Hemophiliacs—inability to clot blood
These people have many blood transfusions.
Homosexual or bisexual males
Intravenous drug users
Infants with HIV-positive mothers
Acquired Immunodeficiency
Syndrome (AIDS)
• Diagnosed when a person has HIV infection and
CD4 cell count below 200 or less than 14%
• Dementia, wasting syndrome, malignancies such
as Kaposi’s sarcoma, or one of more than 26
opportunistic infections
Symptoms of HIV/AIDS
• Early: fever
Weight loss
Diarrhea
Flulike
• Later: opportunistic infections
Malignancies
Nutrition Therapy HIV / AIDS
patients
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Delay the progression of infections and improve patient’s immune
system
Prevent the wasting effects of HIV infection: severe involuntary
malnutrition and weight loss
Prevent opportunistic diseases
Recognize infections early and provide rapid treatment for an
incompetent immune system, which includes infections and cancer
When nutrient needs of HIV/AIDS patients cannot be met by a
normal diet, nutrition intervention such as a high protein, high calorie
diet, and a multivitamin/mineral supplement may be necessary.
Low-fat lactose-free oral supplement may be better tolerated than
high fat supplements.
HIV Assessment
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Baseline status at diagnosis
Follow and reassess as complications develop
Consider mental status
Misinformation
Knowledge of food sanitation and
good nutrition
General Goals of Nutrition
Intervention in HIV Disease
• Preserve optimal somatic and visceral protein status
• Prevent nutrient deficiencies or excesses known to
compromise immune function
• Minimize nutrition-related complications that
interfere with either intake or absorption of nutrients
• Support optimal therapeutic drug levels
• Enhance the quality of life
Factors that Influence Food Intake
for this population:
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Income
Psychosocial factors
Dependency issues
Psychological factors
Ethnic and cultural considerations
Management of Symptoms in
HIV/AIDS
• Nausea and vomiting
• Loss of appetite
• Sore mouth and throat
• Diarrhea
• Poor absorption of nutrients
• Abdominal cramping
• Weight loss
Eating Tips for Common Symptoms
• Lack of appetite
—Eat favorite foods often.
—Eat snacks or a small meal every 2 to 3 hours.
—Go for a short walk or exercise to boost appetite.
• Nausea and vomiting
—In the morning eat crackers, dry toast, or dry cereal.
—Avoid greasy, fried, or very sweet foods such as french fries,
pastries, and ice cream.
—Sip on flat sodas, weak ginger tea, or mint tea.
Eating Tips for Common
Symptoms—continued
• Sore mouth and throat
—Try soft smooth foods, like mashed potatoes, applesauce,
baby foods, and cream soups.
—Avoid foods that sting or irritate the mouth, like orange or
tomato juice, hot sauces, and salty foods.
—Eat cold foods, such as Popsicles or ice cream.
• Diarrhea
—Eat foods like bananas, applesauce, rice, and gummy candy.
—Cut back on fatty foods.
—Cut down on fiber in the diet.
Suggested Diets for HIV/AIDS Patients
• Diets rich in fruits and vegetables that includes iron,
vitamin E, and riboflavin may delay the development of
full-blown AIDS.
• There have been many alternative therapies that
include nutrition-based options such as megadoses of
nutrients, Dr. Berger’s Immune Power Diet, and
macrobiotic diet.
• Most of these diets are low in fat and calcium and high
in fiber. They have not been proven effective.
Role of a Dietitian
• Guiding the patient with emotional support, proper
nutrition, and incorporating exercise into the daily
routine are some of the challenges dietitians face.
• Monitor body composition and hormone levels to
improve body composition.
• Monitor blood lipid, sugar levels, diet, and medications
to prevent hyperlipidemias and elevated blood sugars.
Wasting Syndrome
• Wasting syndrome is defined as the unexplained weight
loss of more than 10%, and is accompanied by fever or
diarrhea for 30 days.
• It is considered a condition that is an indicator for AIDS.
• It is a multifactorial condition that can be associated
with variety of infectious, neoplastic, metabolic, and
nutritional abnormalities.
Food Safety Suggestions
• Wash hands with hot soapy water before touching or
eating foods.
• Cook meat, poultry, fish, and eggs until they are well
done.
• Wash fresh fruits and vegetables thoroughly.
• Drink filtered water.
• Wash dishes and cutting boards in hot soapy water.
• Use leftovers in refrigerator within 2 days.
Nutrition-Related Complementary
and Alternative Therapies
Herbs/botanicals
—Astragalus
—Cat’s claw
—Echinacea
—Garlic
—St. John’s wort
Yeast-free
of vitamins and minerals
Antiviral AL-721
and homemade
formulas
Dr.
—Ginseng
Homeostatic
Megadoses
Berger’s Immune Power Diet and
maximum immunity diet
Medical
macrobiotic diet
diet
marijuana
Any Questions
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