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Unit 6 NS335 Special Populations Review for Unit 6 Project Cancer, HIV, and AIDS Leslie Young MS, RD, LDN Unit 6 Project/Paper • • • • • • • 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 • • • • • • • • • • • • Nutritional Care Plan for ________________ Nutrition Assessment · Medical hx: · Nutritional Hx: Nutritional Diagnosis · (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 · (What you will do or provide) Monitoring & Evaluation · (What you will check on) · (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 • • • • • • • • 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 • • • • • • • • • • Macrobiotic diet Vegetarian diet Gerson therapy Kelley/Gonzales regimen Juice therapies Black cohosh Echinacea Flaxseed Ginger Iscador • • • • • • • • • • Shark cartilage DHEA Enzymes Oxymedicine Coenzyme Q10 Milk thistle PC-SPECS Saw palmetto Soy and soy foods Teas Prevention of Cancer Factors • • • • • • • • • • • 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 ????? 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 • • • • • • 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 1) 2) 3) 4) 5) 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 • • • • • 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: • • • • • 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 ?????