Chapter 21
Kidney Disease
Key Concepts
• Kidney disease interferes with the normal
capacity of nephrons to filter waste products of
body metabolism.
• Short-term kidney disease requires basic
nutrition support for healing rather than dietary
restriction.
• 3.8 million Americans have some form of kidney
disease.
• 42,000 persons die from such diseases each
year.
Kidney Disease, cont’d
Dual Role of the Kidneys
• Kidneys make urine, through which they
excrete most of the waste products of
metabolism.
• Kidneys control the concentrations of most
constituents of body fluids, especially
blood.
Basic Structure and Function
• Structures
– Basic unit is the nephron
• Glomerulus
• Tubules
• Function
– Excretory and regulatory
– Endocrine
Basic Structure
Renal Nephrons
• Basic functional unit of the kidney
• Major nephron functions
–
–
–
–
Filtration of materials in blood
Reabsorption of needed substances
Secretion of hydrogen ions to maintain acid-base balance
Excretion of waste materials
• Additional functions
– Renin secretion (for body water balance)
– Erythropoietin secretion (for red cell production)
– Vitamin D activation
Nephron Structures
• Glomerulus
– Cluster of branching capillaries
– Cup-shaped membrane at the head of each nephron forms the
Bowman’s capsule
– Filters waste products from blood
– Glomerular filtration rate: Preferred method of monitoring kidney
function
• Tubules
–
–
–
–
Proximal tubule
Loop of Henle
Distal tubule
Collecting tubule
Tubules
Causes of Kidney Disease
•
•
•
•
•
Infection and obstruction
Damage from other diseases
Toxins
Genetic defect
Risk factors
Causes of Kidney Disease,
cont’d
Risk Factors and Causes of
Kidney Disease
• Sociodemographic factors
– Older age
– Racial or ethnic minority status
– Exposure to certain chemical and
environmental conditions
– Low income or education
Risk Factors and Causes of
Kidney Disease, cont’d
• Clinical factors
– Poor glycemic control in diabetes
– Hypertension
– Autoimmune disease
– Systemic infections
– Urinary tract infections
– Urinary stones
Risk Factors and Causes of
Kidney Disease, cont’d
• Clinical factors
–
–
–
–
–
–
–
Lower urinary tract obstruction
Neoplasia
Family history of chronic kidney disease
Recovery from acute kidney failure
Reduction in kidney mass
Exposure to certain nephrotoxic drugs
Low birth weight
– Copyright National Kidney Foundation.
Medical Nutrition Therapy
• Based on the nature of the disease
process and individual responses
– Length of disease
• Long term: More specific nutrient modifications
– Degree of impaired renal function
• Extensive: Extensive nutrition therapy required
– Individual clinical symptoms
Acute Glomerulonephritis or
Nephritic Syndrome
• Clinical symptoms: Hematuria,
proteinurea, edema, mild hypertension,
depressed appetite, possible oliguria or
anuria
Medical Nutrition Therapy
• Acute glomerulonephritis
– Uncomplicated disease: Antibiotics and bed
rest
– Advanced disease:
•
•
•
•
Possible restriction of protein, sodium
Liberal intake of carbohydrates
Potassium intake may be monitored
Fluid intake may be restricted
Nephrotic Syndrome
• Clinical symptoms: Massive edema,
ascites, proteinurea, distended abdomen,
reduced plasma protein level, body tissue
wasting
Medical Nutrition Therapy
• Nephrotic syndrome
– Protein intake to meet nutrition/growth needs
(without excess)
– Carbohydrate
– Lipids
– Sodium (~3 g/day)
– Potassium
– Water
– Other minerals and vitamins
Key Concepts
• The progressive degeneration of chronic
renal failure requires dialysis treatment
and modification according to individual
disease status.
Key Concepts, cont’d
• Current therapy for renal stones depends
more on basic nutrition and health support
for medical treatment than on major food
and nutrient restrictions.
Acute Kidney Failure
• Prerenal
• Intrinsic
• Postrenal obstruction
Acute Renal Failure
• Clinical symptoms: Oliguria, proteinurea,
hematuria, loss of appetite,
nausea/vomiting, fatigue, edema, itchy
skin
• Short-term dialysis may be needed
• May progress to chronic renal failure
Medical Nutrition Therapy
• Acute kidney failure
– Goal is to improve or maintain nutritional status
– Parenteral nutrition therapy may be required
– Recommendations for protein intake have been
debated
– Individualized therapy based on renal function
(indicated by glomerular filtration rate)
Medical Nutrition Therapy
Chronic Kidney Failure
• Caused by progressive breakdown of renal
tissue, which impairs all renal functions
• Develops slowly
• No cure (other than kidney transplant)
• Clinical symptoms: Polyuria/oliguria/anuria,
electrolyte imbalances, nitrogen retention,
anemia, hypertension, azotemia, weakness,
shortness of breath, fatigue, thirst, appetite
loss, bleeding, muscular twitching
Mosby items and derived items © 2006 by Mosby, Inc.
Slide 26
Medical Nutrition Therapy
Objectives
•
•
•
•
•
•
•
•
Reduce protein breakdown
Avoid dehydration or excess hydration
Correct acidosis
Correct electrolyte imbalances
Control fluid and electrolyte losses
Maintain optimal nutritional status
Maintain appetite and morale
Control complications of hypertension, bone pain,
nervous system involvement
• Slow rate of renal failure
Medical Nutrition Therapy
Principles
• Provide enough protein therapy to maintain tissue
integrity while avoiding excess
• Provide amino acid supplements for protein
supplementation
• Reserve protein for tissue synthesis by ensuring
adequate carbohydrates and fats
• Maintain adequate urine volume with water
• (Possibly) restrict sodium, phosphate, calcium
• Supplement diet with multivitamin
Stages of Chronic Kidney
Disease
End-Stage Kidney Disease
• Occurs when patient’s glomerular filtration
rate decreases to 15 ml/min
• Irreversible damage to most nephrons
• Dialysis or transplant are only options
Hemodialysis
• Uses an artificial kidney machine to remove toxic
substances from blood, restore nutrients and
metabolites
• Two to three treatments per week typically
required
• Patient’s blood makes several “round trips”
through machine
• Dialysis solution (dialysate) removes excess
waste material
Hemodialysis, cont’d
Hemodialysis, cont’d
Hemodialysis Patient
• Medical nutrition therapy
– Maintain protein and energy balance
– Prevent dehydration or fluid overload
– Maintain normal serum potassium and sodium
levels
– Maintain acceptable phosphate and calcium
levels
Hemodialysis Patient, cont’d
• Other dietary concerns
– Avoid protein energy malnutrition by careful
calculation of protein allowance
– Maintain body mass index of 25 to 28 kg/m2
– Fluid intake: 1000 ml/day, plus amount equal to urine
output
– Sodium: 2000 mg/day
– Potassium: 2000-3000 mg/day
– Supplement of water-soluble vitamins (e.g., B
complex, C)
Peritoneal Dialysis
• Performed at home
• Patient introduces dialysate solution directly
into peritoneal cavity four to five times per day
• Surgical insertion of permanent catheter is
required
• Disposable bag containing dialysate solution is
attached to catheter
• Diet is more liberal than with hemodialysis
Peritoneal Dialysis, cont’d
Peritoneal Dialysis, cont’d
Peritoneal Dialysis, cont’d
• Medical nutrition therapy
– Increase protein intake to 1.2 to 1.5 g/kg body
weight
– Increase potassium with a wide variety of
fruits and vegetables
– Encourage liberal fluid intake of 1500 to 2000
ml/day
– Avoid sweets and fats
– Maintain lean body weight
Comorbid Conditions
• Osteodystrophy
– Bone disease resulting from defective bone formation
– Found in about 40% of patients with decreased
kidney function and 100% of patients with kidney
failure
• Neuropathy
– Central and peripheral neurologic disorders
– Found in up to 65% of patients at the initiation of
dialysis
Kidney Stones
• Basic cause is unknown
• Factors relating to urine or urinary tract
environment contribute to formation
• Present in 5% of U.S. women and 12% of U.S.
men
• Major stones are formed from one of three
substances:
– Calcium
– Struvite
– Uric acid
Kidney Stones, cont’d
Risk Factors
Calcium Stones
• 70% to 80% of kidney stones are composed of
calcium oxalate
• Almost half result from genetic predisposition
• Other causes
– Excess calcium in blood (hypercalcemia) or urine
(hypercalciuria)
– Excess oxalate in urine (hyperoxaluria)
– Low levels of citrate in urine (hypocitraturia)
– Infection
Examples of Food Sources of
Oxalates
• Fruits: Berries, Concord grapes, currants, figs, fruit
cocktail, plums, rhubarb, tangerines
• Vegetables: Baked/green/wax beans, beet/collard
greens, beets, celery, Swiss chard, chives, eggplant,
endive, kale, okra, green peppers, spinach, sweet
potatoes, tomatoes
• Nuts: Almonds, cashews, peanuts/peanut butter
• Beverages: Cocoa, draft beer, tea
• Other: Grits, tofu, wheat germ
Struvite Stones
• Composed of magnesium ammonium
phosphate
• Mainly caused by urinary tract infections
rather than specific nutrient
• No diet therapy is involved
• Usually removed surgically
Other Stones
• Cystine stones
– Caused by genetic metabolic defect
– Occur rarely
• Xanthine stones
– Associated with treatment for gout and family
history of gout
– Occur rarely
Kidney Stones: Symptoms and
Treatment
• Clinical symptoms: Severe pain, other urinary
symptoms, general weakness, fever
• Several considerations for treatment
–
–
–
–
–
Fluid intake to prevent accumulation of materials
Dietary control of stone constituents
Achievement of desired pH of urine with medication
Use of binding agents to prevent absorption of stone elements
Drug therapy in combination with diet therapy
Nutrition Therapy:
Calcium Stones
• Low-calcium diet (~400 mg/day) recommended for those
with supersaturation of calcium in the urine and who are
not at risk for bone loss
• If stone is calcium phosphate, sources of phosphorus
(e.g., meats, legumes, nuts) are controlled
• Fluid intake increased
• Sodium intake decreased
• Fiber foods high in phytates increased
Nutrition Therapy:
Uric Acid Stones
• Low-purine diet sometimes recommended
• Avoid:
–
–
–
–
–
Organ meats
Alcohol
Anchovies, sardines
Yeast
Legumes, mushrooms, spinach, asparagus,
cauliflower
– Poultry
Medical Nutrition Therapy:
Cystine Stones
• Low-methionine diet (essentially a lowprotein diet) sometimes recommended
• In children, a regular diet to support
growth is recommended
• Medical drug therapy is used to control
infection or produce more alkaline urine
General Dietary Principles:
Kidney Stones
Summary
• The nephrons are the functional units of the kidneys.
Through these unique structures the kidney maintains
life-sustaining blood levels of materials required for life
and health.
• The nephrons accomplish their tremendous task by
constantly “laundering” the blood many times each day,
returning necessary elements to the blood and
eliminating the remainder in concentrated urine.
Summary, cont’d
• Various diseases that interfere with the vital
function of nephrons can cause kidney disease.
• At its end stage, chronic kidney disease is
treated by dialysis or kidney transplantation.
• Dialysis patients require close monitoring for
protein, water, and electrolyte balance.
Summary, cont’d
• Kidney diseases have predisposing factors (e.g.,
recurrent urinary tract infections may lead to renal
calculi, and progressive glomerulonephritis may lead to
chronic nephrotic syndrome and kidney failure).
• Kidney stones may be formed from a variety of
substances. For some patient, a change in dietary intake
of the identified substance (e.g. fluid, sodium, oxalate,
purine) may decrease stone formation.
Chapter 22
Surgery and Nutrition Support
Key Concepts
• Surgical treatment requires nutrition
support for tissue healing and rapid
recovery.
• To ensure optimal nutrition for surgery
patients, diet management may involve
enteral and parenteral nutrition support.
Nutrition Needs of General
Surgery Patients
• Nutrition needs are greatly increased in
patients undergoing surgery
• Deficiencies easily develop
• Pay careful attention to:
– Nutritional status before surgery
– Individual nutrition needs after surgery
Poor Nutritional Status
• Associated with:
– Impaired wound healing, immune system
– Increased risk of postoperative infection
– Reduced quality of life
– Impaired function of gastrointestinal tract,
cardiovascular system, respiratory system
– Increased hospital stay, cost, mortality rate
Preoperative Nutrition Care:
Nutrient Reserves
• Nutrient reserves can be built up before elective
surgery to fortify a patient
• Protein deficiencies are common
• Sufficient kilocalories are required
– Extra carbohydrates maintain glycogen stores
• Vitamin and mineral deficiencies should be
corrected
• Water balance should be assessed
Immediate Preoperative Period
• Patients are typically directed not to take
anything orally for at least 8 hours before
surgery.
• Before gastrointestinal surgery, a
nonresidue diet may be prescribed.
• Nonresidue elemental formulas provide
complete diet in liquid form.
Nonresidue Diet
• Includes only foods free of fiber, seeds,
and skins
• Prohibited foods include fruits, vegetables,
cheese, milk, potatoes, unrefined rice,
fats, pepper
• Vitamin and mineral supplements required
for prolonged nonresidue diet
Postsurgical Nonresidue Diet
• Nonresidue diet plus:
– Processed cheese, mild cream cheeses
– Potatoes
– Bread without bran
– All desserts except those containing fruit and
nuts
– Condiments as desired
Postoperative Nutrition Care:
Nutrient Needs for Healing
• Postoperative nutrient losses are great but food
intake is diminished.
• Protein losses occur during surgery from tissue
breakdown and blood loss.
• Catabolism usually occurs after surgery (tissue
breakdown and loss exceed tissue buildup).
• Negative nitrogen balance may occur.
Need for Increased Protein
•
•
•
•
•
•
Building tissue for wound healing
Controlling shock
Controlling edema
Healing bone
Resisting infection
Transporting lipids
Problems Resulting from
Protein Deficiency
•
•
•
•
•
•
•
•
Poor healing of wounds and fractures
Rupture of suture lines (dehiscence)
Depressed heart and lung function
Anemia, liver damage
Failure of gastrointestinal stomas to function
Reduced resistance to infection
Extensive weight loss
Increased mortality risk
Other Postoperative Concerns
• Ensure sufficient fluids to prevent dehydration
• Provide sufficient nonprotein kilocalories for
energy to spare protein for tissue building
• Ensure adequate vitamins
• Ensure adequate potassium, phosphorus, iron,
zinc
• Avoid electrolyte imbalances
Energy
• Mifflin–St. Jeor equations:
– Male:
BMR = 10 × Weight + 6.25 × Height – 5 × Age + 5
– Female:
BMR = 10 × Weight + 6.25 × Height – 5 × Age – 161
• Energy needs for burn patients directly depend
on percent of body surface area (BSA) burned
and are calculated as follows:
Energy needs = 20 kcal/kg + (40  % of BSA burned)
Initial Intravenous Fluid and
Electrolytes
• Oral feeding is encouraged soon after
surgery.
• Routine postoperative intravenous fluids
supply hydration and electrolytes, not
kilocalories and nutrients.
Methods of Feeding
• Enteral: Nourishment through regular
gastrointestinal route, either by regular
oral feedings or by tube feedings
• Parenteral: Nourishment through small
peripheral veins or large central vein
Oral Feeding
• Allows more needed nutrients to be added
• Stimulates normal action of the
gastrointestinal tract
• Can usually resume once regular bowel
sounds return
• Progresses from clear to full liquids, then
to a soft or regular diet
Enteral Feeding
• Used when oral feeding cannot be
tolerated
• Nasogastric tube is most common route
• Nasoduodenal or nasojejunal tube more
appropriate for patients at risk for
aspiration, reflux, or continuous vomiting
Enteral Feeding, cont’d
Alternate Routes for Enteral
Tube Feeding
• Esophagostomy
• Percutaneous endoscopic gastrostomy
• Percutaneous endoscopic jejunostomy
Tube-Feeding Formula
• Generally prescribed by the physician
• Important to regulate amount and rate of
administration
• Diarrhea is most common complication
• Wide variety of commercial formulas
available
Enteral Nutrition Monitoring
• Monitoring the patient receiving enteral
nutrition
– Weight (at least three times per week)
– Signs and symptoms of edema (daily)
– Signs and symptoms of dehydration (daily)
– Fluid intake and output (daily)
– Adequacy of enteral intake (at least twice per
week)
Enteral Nutrition Monitoring,
cont’d
• Abdominal distention and discomfort
• Gastric residuals (every 4 hours) if appropriate
• Serum electrolytes, blood urea nitrogen,
creatinine (two to three times per week)
• Serum glucose, calcium, magnesium,
phosphorus (weekly or as ordered)
• Stool output and consistency (daily)
Sample Calculation*
•
How much formula (in milliliters) does the following patient need at each
feeding?
–
37-year-old woman, 5 feet, 7 inches tall
–
Under considerable catabolic stress, with an injury factor of 1.8
–
Formula: 1.5 kcal/ml
–
Schedule: 6 bolus feedings per day
1.
IBW: 100 lb + (7 in  5 lb) = 135 lb/2.2 = 61.4 kg
2.
RMR: (10  61.4 kg) + (6.25  170.2 cm) - (5  37) - 161 = 1332 kcal/day
1332 kcal/day  1.8 = 2398 kcal/day
3.
4.
Formula: 2398 kcal/day  1.5 kcal/ml = 1599 ml/day
Feeding schedule: 1599 ml/day  6 feedings/day = 266.5 ml/feeding
*These equations require the weight in kilograms, the height in centimeters, and the age in years.
Parenteral Feeding Routes
• Peripheral parenteral nutrition uses lessconcentrated solutions through small peripheral
veins when feeding is necessary for a brief
period (10 days)
• Total parenteral nutrition used when energy and
nutrient requirement is large or to supply full
nutrition support for long periods through large
central vein
Catheter Placement for
Parenteral Nutrition
Catheter Placement for
Parenteral Nutrition, cont’d
Catheter Placement for
Parenteral Nutrition, cont’d
Catheter Placement for
Parenteral Nutrition, cont’d
Administration of Parenteral
Nutrition
• Careful administration of total parenteral
nutrition formulas is essential. Specific protocols
vary somewhat but usually include the following
points:
–
–
–
–
–
–
–
Start slowly
Schedule carefully
Monitor closely
Increase volume gradually
Make changes cautiously
Maintain a constant rate
Discontinue slowly
Nutrition after GI Surgery
Key Concepts
• Nutrition problems related to
gastrointestinal surgery require diet
modifications because of the surgery’s
effect on normal food passage.
• Gastrointestinal surgery requires special
nutrition attention
• Nutrition therapy varies depending on the
surgery site
Mouth, Throat, and Neck
Surgery
• This surgery requires modification in the mode
of eating.
• Patients cannot chew or swallow normally.
• Oral liquid feedings ensure adequate nutrition.
• Mechanical soft diet may be optimal.
• Tube feedings are required for radical neck or
facial surgery.
Gastric Surgery
• Because the stomach is the first major
food reservoir in the gastrointestinal tract,
stomach surgery poses special problems
in maintaining adequate nutrition.
• Problems may develop immediately after
surgery or after regular diet resumes.
Immediate Postoperative Period
• Increased gastric fullness and distention may
result if gastric resection involved a vagotomy
(cutting of the vagus nerve)
• Weight loss is common
• Patient may be fed by jejunostomy
• Frequent small, simple oral feedings are
resumed according to patient’s tolerance
Dumping Syndrome
• Common complication of extensive gastric resection
in which readily soluble carbohydrates rapidly “dump”
into small intestine
• Symptoms include:
–
–
–
–
Cramping, full feeling
Rapid pulse
Wave of weakness, cold sweating, dizziness
Nausea, vomiting, diarrhea
• Occurs 30 to 60 minutes after meal
• Results in patient eating less food
Diet for Postoperative Gastric
Dumping Syndrome
• Five or six small meals daily
• Relatively high fat content, low simple
carbohydrate content, low-roughage foods, high
protein content
• No milk, sugar, alcohol, or sweet sodas; no very
hot or very cold foods
• Fluids avoided 1 hour before and after meals;
minimal fluids during meals
Gallbladder Surgery
• Cholecystectomy is the removal of the
gallbladder.
• Surgery is minimally invasive.
• Some moderation in dietary fat is usually
indicated after surgery.
• Depending on individual tolerance and
response, a relatively low-fat diet may be
needed over a period of time.
Gallbladder with Stone
Intestinal Surgery
• Intestinal resections are required in cases
involving tumors, lesions, or obstructions.
• When most of the small intestine is removed,
total parenteral nutrition is used with small
allowance of oral feeding.
• Stoma may be created for elimination of fecal
waste (ileostomy, colostomy).
Intestinal Surgery, cont’d
Intestinal Surgery, cont’d
Rectal Surgery
• Clear fluid or nonresidue diet may be
indicated after surgery to reduce painful
elimination and allow healing.
• Return to a regular diet is usually rapid.
Nutrition Needs for Burn
Patients
• Tremendous nutritional challenge
• Plan of care influenced by:
– Age
– Health condition
– Burn severity
• Plan constantly adjusted
• Critical attention paid to amino acid needs
Type and Extent of Burns
Stages of Nutrition Care of Burn
Patients
• Stage 1, part 1: Immediate shock period
– Immediate loss of water, electrolytes, protein
– Immediate intravenous fluid therapy with salt solution
administered
– Albumin solutions or plasma used after 12 hours to
restore blood volume
– Little attempt made to meet protein and energy
requirements
Stages of Nutrition Care of Burn
Patients, cont’d
• Stage 1, part 2: Recovery period
– Tissue fluids and electrolytes are gradually
reabsorbed after 48 to 72 hours.
– Diuresis indicates successful initial therapy.
– Constant attention to fluid intake and output
remains essential.
Stages of Nutrition Care of Burn
Patients, cont’d
• Stage 2, part 1: Secondary feeding period
– Adequate bowel function returns after 7days.
– Life depends on rigorous nutrition therapy.
– Protein and electrolytes lost through tissue
destruction must be replaced.
– Lean body mass and nitrogen are lost through tissue
catabolism.
– Increased metabolism occurs.
– Increased energy is needed.
Stages of Nutrition Care of Burn
Patients, cont’d
• Stage 2, part 2: Nutrition therapy
– High protein intake
– High energy intake
• Caloric needs based on total BSA burned
• Liberal portion of kilocalories from carbohydrates
• Avoid overfeeding
– High vitamin and mineral intake
Stages of Nutrition Care of Burn
Patients, cont’d
• Stage 2, part 3: Dietary management
– Enteral feeding
• Solid foods based on individual preferences
• Concentrated liquids with added protein or amino
acids
• Calculated tube feedings when required
– Parenteral feeding
• When enteral feeding is impossible or inadequate
Stages of Nutrition Care of Burn
Patients, cont’d
• Stage 3: Follow-up reconstruction
– Continued nutrition support to maintain tissue
strength for successful grafting or
reconstructive surgery
Summary
• The nutritional demands of surgery begin
before a patient reaches the operating
table. Before surgery, the task is to correct
any existing deficiencies and build
nutritional reserves to meet surgical
demands.
• After surgery, the task is to replace losses
and support recovery.
Summary, cont’d
• Postsurgical feedings are given in a variety of
ways.
• The oral route is always preferred. However,
inability to eat or damage to the intestinal tract
may require feeding through a tube or into veins.
• Special formulas are used for such alternate
means of nourishment and are designed to meet
specific individual needs.
Summary, cont’d
• For patients undergoing surgery on the
gastrointestinal tract, special diets are modified
according to the surgical procedure performed.
• For patients with massive burns, increased
nutrition support is necessary in successive
stages in response to the burn injury and to the
continuing tissue rebuilding requirements.
Chapter 23
Nutrition Support in Cancer and
AIDS
Key Concepts
• Environmental agents, genetic factors, and
weaknesses in the body’s immune system
can contribute to the development of
cancer.
• The strength of the body’s immune system
relates to its overall nutritional status.
Cancer
• Malignant tumor (neoplasm) can express
itself in multiple forms
• Tumors identified by primary site of origin
and state of growth
• Stages of tumor development depend on
growth rate, degree of functional selfcontrol, and amount of spread
Causes of Cancer Cell
Development
• Underlying cause is the functional loss of
cell control over normal cell reproduction
from:
–
–
–
–
–
–
Mutations
Chemical carcinogens
Radiation damage
Viruses
Epidemiologic factors
Stress and dietary factors
Epidemiology
The Body’s Defense System
• Two populations of lymphocytes in
immune system
– T cells
• Derived from thymus cells
• Activate phagocytes that attack antigens
– B cells
• Derived from bursal intestinal cells
• Produce antibodies that attack antigens
T- and B-Cell Development
Nutrition and Immunity
• Inadequate nutrition weakens the immune
system and causes atrophy of tissues in
gastrointestinal structures
• Antibodies are proteins
Nutrition and Healing
• Body tissue strength depends on ability to
build and rebuild, which requires optimal
nutrition intake
• Protein and key vitamins and minerals, as
well as nonprotein energy sources, must
be constantly supplied by the diet
Key Concepts
• Nutrition problems affect the nature of the
disease process and the medical
treatment methods in patients with cancer
or AIDS.
Surgery
• All surgery requires nutrition support for
the healing process.
• General condition of cancer patients often
is weakened by the disease process.
Radiation Therapy
• Involves high-energy radiographs targeted
on the cancer site
• Often kills surrounding healthy cells as
well as cancerous cells
• Nutrition problems driven by site and
intensity of radiation treatment
Chemotherapy
• Highly toxic drugs administered by the
bloodstream to kill cancer cells
• Use of monoamine oxidase inhibitors
(pretreatment antidepressant drugs)
requires tyramine-restricted diet
Systemic Effects of Cancer
• Several systemic effects cause continuing
weight loss
– Anorexia, loss of appetite
– Increased metabolism
– Negative nitrogen balance
Cachexia
• Extreme weight loss and weakness
caused by inability to ingest or use
nutrients
• Body feeds off its own tissue protein
• Experienced by half of all cancer patients
• Aggressive nutrition therapy is necessary
Objectives of Nutrition Therapy
• Prevention of catabolism
– Meet increased metabolic demands
• Relief of symptoms
Principles of Nutrition Care
• Nutrition assessment
– Determine and monitor nutritional status
– Body measurements, calculations of body
composition, laboratory tests, physical examination,
clinical observation, dietary analysis
• Personal care plan
– Daily plan for nutrition therapy incorporated into
nursing care plan
Nutrition Needs
•
•
•
•
Energy
Protein
Vitamins and minerals
Adequate fluid intake
Enteral: Oral Diet
• Oral diet with supplementation is optimal
when tolerated
• Food plan must include adjustments in
food texture and temperature, food
choices, and tolerances
Tips for Controlling Nausea and
Vomiting
•
•
•
•
•
•
•
•
Try smaller, more frequent meals.
Eat more when feeling better.
Eat drier foods with fluids in between.
Try cold foods, saltier foods.
Avoid fatty or overly sweet foods.
Do not recline immediately after eating.
Replace fluids and electrolytes.
Use foods with pleasant aromas.
Tips for Increasing Energy and
Protein Intake
•
•
•
•
•
Add high-calorie condiments, sauces, dressings
Add extra ingredients during food preparation
Drink commercial food supplements
Avoid low-calorie foods and beverages
Have a meal or snack every 1 to 2 hours
Enteral: Tube Feeding
• When gastrointestinal tract can be used
but patient is unable to eat
Parenteral Feeding
• When gastrointestinal tract cannot be used
• Peripheral vein feeding (for brief period)
• Central vein feeding (for extended period)
Prevention
• American Cancer Society
– Eat a variety of healthful foods
– Adopt a physically active lifestyle
– Maintain a healthful weight
– Limit alcohol consumption
• U.S. Food and Drug Administration
– Low-fat diets rich in grain products, fruits, and
vegetables may reduce the risk of some
cancers
Key Concepts
• Nutrition problems affect the nature of the
disease process and the medical
treatment methods in patients with cancer
or AIDS.
• The progressive effects of HIV, through its
three stages of white T-cell destruction,
have many nutrition implications and often
require aggressive medical nutrition
therapy.
Human Immunodeficiency Virus
• Virus causes immune system suppression
• Created a widespread epidemic
Stages of Disease Progression
• Stage 1: Clinical category A
– Flulike symptoms 4 to 8 weeks after initial
exposure
• Stage 2: Clinical category B
– Infectious illnesses invade the body
• Stage 3: Clinical category C
– Rapidly declining T-helper lymphocyte counts
Goals of Medical Management
• Delay progression of the infection and
improve the immune system
• Prevent opportunistic illnesses
• Recognize the infection early
Severe Malnutrition, Weight
Loss
• Decreased appetite, insufficient energy
intake in addition to elevated resting
energy expenditure
• Major weight loss, eventual cachexia
Causes of Body Wasting
• Inadequate food intake
• Malabsorption of nutrients
• Disordered metabolism
Nutrition Assessment
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•
•
•
•
Anthropometry
Biochemical tests
Clinical observations
Diet observations
Environmental, behavioral, and
psychological assessment
• Financial assessment
Principles of Nutrition
Counseling
•
•
•
•
Motivation for dietary changes
Rationale for nutrition support
Provider-patient agreement on plan
Development of manageable steps for
change
• Development of personal food
management skills
Summary
• The general term cancer is given to various
abnormal, malignant tumors in different tissue
sites.
• The cancer cell is derived from a normal cell that
loses control over its growth and reproduction.
• Cancer cell development occurs from mutation
of regulatory genes and is influenced by
environmental chemical carcinogens, radiation,
and viruses.
Summary, cont’d
• Cell integrity is mediated by the body’s immune
system, primarily through its two types of white
blood cells: T cells that kill invading agents that
cause disease and B cells that make specific
antibodies to attack these agents.
• Cancer therapy primarily consists of surgery,
radiation, and chemotherapy.
Summary, cont’d
• Likewise, nutrition care of patients with
AIDS must be built on knowledge and
compassion, with a sensitivity and concern
for individual patient needs.
• The current worldwide spread of HIV and
its fatal consequences have reached
epidemic proportions and are still growing.
Summary, cont’d
• Nutrition management centers on providing
individual nutrition support to counteract the
severe body wasting and malnutrition
characteristic of the disease.
• The process of nutrition care involves
comprehensive nutrition assessment and
evaluation of personal needs, planning care with
patient and caregivers, and meeting practical
food needs.