Medical Nutrition Therapy Summary Sheet Sp 12

8/17/2019 Medical Nutrition Therapy Summary Sheet Sp 12

1/23

Medical Nutrition Therapy I & IIDisease Summary Worksheet

Directions: Complete the following table for each disease state covered in MNT I & II (47 & 47!"# The first one is done for $o%#

Disease NutritionProblems

Hallmark labvalues (iapplicable!

Possible NutritionDia"nosticTerminolo"y #sedin Documentation(& Number!

MNT and Diet$rder

%ommonly #sedMedications

PotentialNutritionelated Side'ects o Meds

GERD Dyspha

gia Heartbu

rn General

discomfortduring and

after eating

Inadequate

energy intake (NI-!"#

Inadequateoral food $

be%erage intake(NI- &!#

'alloingdifficulty (N)-!#

*N+,

'mallfrequent meals

fluids beteenmeals!

.%oidsmoking/ a%oid

foods thatdecrease 0E'

pressure (coffeeEt1H#

peppermint etc!# 2oss! ).2.

free diet

a%oidingindi%idualirritants

.%oid tightclothing ele%atehead of bed etc!

2ossible diet orders, 'mall

.ntacids (.lka-

'elt3er *aalo4 *ylantaRolaids#

5oaming agents 6co%er stomach ith foam

(Ga%iscon#

H& 7lockers 6 ↓ acid

production ()imetidine5amotidine Ni3atidineRanitidine#

2roton 2ump

Inhibitors (1mepra3ole0ansopra3ole

2antopra3ole# 2rokinetics 6

strengthen sphincter and

↑ gastric emptying

(7ethanechol*etoclopramide#

Diarrhea

or constipation


2/23

frequent meals 0o fat

*N+ IDysphagia 8eight

loss Nutritio

naldeficiencies

Dysphagia(difficultysalloing#

Heartbu

rn or reflu4 Dyspeps

ia(indigestion#

Nausea $%omiting

.spiration2neumoni

*alnutri

tion

Dehydration

Na $79N

.lbumin $ pre-albumin

Inadequateenergy intake (NI-"#

Inadequateoral food $

be%erage intake(NI-&!#

'alloingdifficulty (N)-!#

In%oluntary

eight loss (N)-:!

DysphagiaDiet ,Dysphagia2urreed

DysphagiaDiet &,Dysphagia*echanically.ltered

Dysphagia

Diet :,Dysphagia.d%anced

n$a n$a

HiatalHernia $GERD

7ackground Info,Hiatal Hernia

is the protrusion of

the stomach

.lbumin$pre-albumin

Na$79N for

dehydratio

Inadequateoral food$

be%erage intake

(NI-&!# 'alloing

Difficulty (N)-

'mallfrequent mealsfluid beteen

meals! .%oid

smoking and

.ntacids (.lka-'elt3er *aalo4 *ylantaRolaids#

H& 7lockers 6acid production

()imetidine 5amotidine

Diarrheaor constipation

Nausea


3/23

into the chestca%itythrough the

esophagealhiatus of thediaphragm!

Esophagitis reflu4

Dysphagia

Heartburn

Generaldiscomfort

during andafter eating

n !# foods that loer0E' pressure(coffee alcohol#

2ossible).2. free and

other irritants Raise head

of bed Eat sloly

rela4 che foodthoroughly

.%oid tightclothing thatincreases

abdominal pressure!

Diet 1rder, 'mall

frequent mealsor GERD diet

Ni3atidine Ranitidine# 2roton 2ump

Inhibitors (1mepra3ole

0ansopra3ole2antopra3ole# 2rokinetics 6

strengthen sphincter andgastric emptying(7ethanechol*etoclopramide#

.cute$)hronic Gastritis

2ernicious anemia

Gastric2ain

.nore4i

a

H ;H

*)<

.ltered GIfunction (N) !"#

Impaired Nutrient

9tili3ation (N)

&!#

If N$


4/23


5/23

formsdecreasingabsorpti%e

capacity andnarroing ofthe lumen!

)hronic bloodydiarrheaabdominal

pain fe%erdehydrationall can causet loss!

min$2re-albumin

Na$7

9N fordehydration

Electr olytes

oral food $ be%erage intake(NI- &!#

5ood andnutrition-related

knoledge deficit(N7-!#

.ltered GIfunction (N)-!"#

In%oluntaryeight loss (N)-:!



Impairednutrient utili3ation

(N)-&!#

present A7oel

restB ith +2N

in se%erecases$fistula$obstruction

'mallfrequent meals

0o residueto decreasediarrhea

No lactose if intolerant

0o fat $

*)+ oil and iffat

malabsorption is present

Increasedenergy needs if

e4periencing tloss

*


6/23

hematocrit ca

5luid

imbalances )heck

forsteatorrhea

eight loss (N)-:!

Impaired

nutrient utili3ation(N)-&!# Inadequate

%itamin$mineralintake (NI-?"! ;??!#

E4cessi%e fatintake (NI-?!

adaptation .D.+ to

small frequent

meals loresidue lactosefree

lo fat loo4alate *)+ oil(if steatorrhea#lo residuelactose free

ith diarrhea 0o*otil or other

motility control drugs to

help treat diarrhea!

Di%erticulosis$itis

.lternating

constipation$diarrhea

.bdominal pain

7loating$ rectal pain

N$< 5e%er

-itis,lo

albuminand high87)count



0imitedadherence tonutrition-relatedrecommendations

(N7-!# .ltered GI

function (N)-!"# Inadequate

fiber intake (NI-

?:!?#

1sis,o High fiber

o Graduallyincrease to :?

g$dayo .mple fluids

o .%oid foods $

seedso .%oid nuts and

seeds in generalo

Itis,

o N21 $

complete boelrest untilsymptoms

subsideo .D.+ to lo

residue diet

-itis, .ntibiotics -osis, 2robiotic and

prebiotic supplements

Diarrhea 7loating

Gas

)olostomy$il 8ater Electr .ltered GI N21 post *


7/23

eostomy andelectrolytemalabsorptio

n 0oabsorbencyof sparing and

some are >depleting

Diarrhea Nausea


8/23

hypertensionesophageal%aricies#

.scites(can result in

early satiety# Hepatic

encephalopathy

.$N$


9/23

that cause

diarrhea2ancreatitis *alabso

rption N$


10/23

Diabetes(+ype I;II#

>etoacidosis

Hypergl

ycemia Hypoglycemia

5asting plasmaglucose

1ralglucose

tolerancetest

'elf-monitoring of bloodglucose('*7G#

Hg.c

Inconsistentcarbohydrateintake (NI-?:!"#

Inappropriateintake of types of

carbohydrates (NI-?:!:#

E4cessi%ecarbohydrateintake (NI-?:!

Inadequatefiber intake (NI-?:!?#

Inappropriate

intake of food fats(NI-?!:#


(N)-&!# 5ood and

nutrition relatedknoledge deficit

(N7-!# Not ready for

diet$lifestyle

change (N7-!:# 'elf-monitoring deficit(N7-!"#

2hysicalinacti%ity (N7-&!#

*N+,)onsistentcarbohydrate

increased fibercardiac smallfrequent meals

Diet 1rder,o )on

sistent )H1intake

Education,2atients may

requireeducation for

counting )H12R1 5.+ and

glucoseregulation as

ell as insulintherapy

+ype , types of insulin Rapid-acting insulin

analogs, can be used in

pump thearpt 'hort-acting, can bemi4ed ith long actinginsulin!

Intermediate-acting,gi%en in & daily doses

E4tended long-actinganalog, cannot be mi4ed

2remi4ed

.ntihyperglycemicDrug, gi%en at meal time

to increase efficacy ofinsulin

+ype &, .lpha-glucosidase

inhibitors, delaysintestinal absorption of

glucose .mylin analogs,

delays gastric emptyingsuppresses appetite

7iguanides

(*etformin#, decreaseshepatic glucose production increasesinsulin uptake in muscled

.lpha-glucosidaseinhibitors,

diarrhea lessefficacyfrequentdosing!

.mylinanalogs, GIcomplaintsmust be usedin syringeseprate frominsulin

7iguanides (*etformin#,

diarrheanausea

bloatinganore4ia

*N+ II


11/23

)12D Hydration, 5luidretention (cor

pulmonale#can mask07* loss

Decrintake &C'17

2otassium deficient&C to

2)1& 21& H)+

Na& 79N .lbu

min 2realn

umin 87)

R7) 0ym

ph *g&

2hosphorous


12/23

malnutrition poor grotheight loss

2oordig$abs offats

*alabsof )a >*g and fat-sol %itamins

)onstipation

Nauseaand loss of

appetite Risk of

osteopenia ;osteoporosis

'toolsthat are pale

or claycolored foul

smellingha%e mucus

or that float

especiallyfor the fat-soluble

%itamins 0ossof bile and

bile salts .lbu

min 2re-albumin

'odium

2otassium

H ;H

7G$Hb.)

*agnesium

87) +ransf

errin

nutrient needs (NI-?!#

Impaired

nutrient utili3ation(N)-&!# Inadequate

oral food$be%erageintake (NI-&!#

5ood andnutrition relatedknoledge (N7-!#



(N)-&!# In%oluntary

eight loss (N)-:!

decrease fatintake ifsteatorrhea and

add *)+ oil High saltintake required

*onitor%itaminsespecially%itamins . DE and >

Diet 1rder High kcals

; protein .dditional

supplementa-tion ith 5.s

and minerals 1ral doses

of 2ancrease(2ER+# ith

e%ery feeding

Ipratropium# *ucolytics 6 increase

sputum %olume$decrease

sputum thickness(2ulmo3yme *ucomyst# .nti-inflammati%es 6

decrease inflammation inthe lungs (.3macort.erobid 5lo%ent#

.ntibiotics ()ipro'eptra 7actrim#

#

2ancreatic En3ymes(2ancrelipase#

)onstipation

Diarrhea

Di33iness Increasedheart rate

.llergicreactions

H+N

Headaches

+ired

all the time

7lurred

%ision If

untreated can

7lood pressure

E4cessi%emineral intake of

sodium

Inadequatemineral intake ofcalcium

potassium andmagnesium (NI-??!#

D.'H diet,Dietary

.pproaches to

'topHypertension

o .ss

essfruit$%egetable

Diuretics, either potassium

sparing$depleting and it

depletes fluids(furosemidehydrochlorothia3ide#

7eta-7lockers, sloheart rate and reduce theforce of contraction

Diarrhea )onstipati

on

Nausea Heartburn Edema


13/23

lead to,o >

idney

diseaseo )

H5

o %

entricular

hypertrophyo r

etinopathyo c

erebro%ascular disease

o myocardialinfraction

o a

neurysms

Inadequatefiber intake (NI-?:!?#

5ood andnutrition related-knoledge deficit(N7-!#

2hysicalinacti%ity (N7-&!#

intake (@-ser%ings aday#

o

.ssess sodiumintake (addedsalt processedfoods#

o .ss

ess lo fat

dairy intakeo .ss

ess lean protein

sources .%oid

smoking No more

than& alcoholdrinks$day formen and alcoholdrink$day foromen

?FFmg$day

of sodium or less 2otassium

"!Jg$day

2hysicalacti%ity

(metoprolol atenololacebutolol#

.ce inhibitors,

Inhibits renin-angiotensinsystem in kidneys thisdecreases%asoconstriction andfluid$sodium retention(captopril bena3eprilenalapril lisinoprilramipril#

.lpha--receptor blockers, %asodilation(alfu3osin tera3osin

tamsulosin pra3osin# )alcium channel

blockers, inhibitsmo%ement of )a into

muscle cells of heart andarteries and decreases

force of heart pumping(nisoldipine nifedipine

nicardipine bepridildiltia3em %erapamil#

0oss ofappetite

Hyperkale

mia$hypokalemia

)H5 '17 'odium

and fluid

.lbumin

2realb

E4cessi%esodium intake (NI-"!#

*N+, )onsider

underlying risk

5irst, .)E inhibitors'econd,

*ayincrease serum

potassium


14/23

retention Decreas

ed appetite

5eelingof fullness )onstip

ation *alabso

rption )ardiac

cache4ia

umin )R2 'odiu

m$79N

E4cessi%efluid intake (NI-:!

Inadegquateoral$food be%erageintake (NI-&!#

5ood-medicationinteractions (N)-&!:#

Inability to preparefood$meals (N7-&!"#

9ndesirablefood choices (N7-

!J# 0imited

adherence tonutrition-related

recommendation( N7!#

factors (H+NhyperlipidemiaD*# D.'H

'17 'odiumrestriction (&g$d#

5luidrestriction (&0$d#

.lcohol-moderation

)affeinea%oidance

)onsiderDrug-nutrient

interactions,Decreased

potassium*agnesium

thiamin andcalcium

7eta-blockers .ngiotensin receptor

blocker (.R7#

2rogression to classes III andI


15/23


16/23

!@F infemales

inacti%ity (N7-&!# Eat a %ariety

of differentfoods

.lloyourself

permissionto satisfycra%ingsithenKoyablefoods

*indful

sa%oring *indful

emotionaleating

2ost7ariatric'urgery

8eight loss

GERD 2rotein and

fatmalabsorptio

n Dumping

syndrome

.lbumin$pre-albumin

Na$79N for

dehydration

Electr

olytes

Inadequateoral food$be%erageintake (NI-&!#

Inadequate protein intake

Inadequatefluid intake (NI-

:!#

Inadequate%itamin intake specify (NI-?"!#


Impairednutrient utili3ation(N)- &!#

*N+,

'tage one(for &-" days

post op#, )learliquids

hydration 'tage to

(for &-: eeks

post op#, 5ullliquidshydration and

protein 'tage three

(" days postop#,*echanically

Routine supplementation,

*ulti%itamin,-&daily

)alcium )itrate ;


17/23

0imitedadherence tonutrition-relatedrecommendations(N7-!#

altered softfoods

'tage four,Healthy

balanced solidfood diet

.ll stages,"-F o3 fluid

per day0ong term *N+,

0iquids beteen meals

1ptimi3emeals ithnutrient densefoods

.%oidgreasy food

.nore4ia Ner%osa

Di33iness

)onfusion Edema

*uscleasting

1steopo

rosis 'toolretention

)ache4ia

0o blood pressure

1rthosta

0o87)

0oglucose

Highcholesterol

High

carotene Hyponatermia

incdeficiency

Hyper kalemia

Disorderedeating pattern

(N7-!?#

Normaleating (eating

based on physical signals#

tnormali3ation,

+5 may be

needed 2re%entrefeeding

syndrome 'mall

frequentfeedings

0o fiberlo satiety

.ntidepressants,2ro3ac oloft 2a4il

(raises le%el of serotonin# ypre4a (lessens

an4iety and obsessionalthinking#

*ay loer 7& folate

andhomocysteine

le%els Nausea


18/23

sis Dry skin )ardiac

arrhythmias 0anugo

foods, O kcalsfrom liquid andfiber Fg

*inimumgastroparesis

7ulimia Ner%osa

)onstipation (ifla4ati%eabuse#

Esophagitis

Gastroesophagealreflu4


19/23

)ancer Nauseaand anore4ia

)ache4ia

.lteredtaste

Dysphagia

Drymouth

'ore orirritatedmouth

Diarrhea

immuno-suppression

8eightgain and

eight loss .nemia

'odium$79N

'erum protein

)R2transferrin

H)+$HG7

Electr olyteimbalance(> Na )l)a 2hos#


Increasedenergy and proteinneeds (NI-?!#


Inadequateoral food$be%erageintake (NI-&!#

Inade%ateenerg$ inta'e (NI!#4"

)ood

medicationinteraction (NC*#+"

,wallowingdiffic%lt$ (NC!#!"

Chewingdiffic%lt$ (NC!#+"

-oor n%trition%alit$ of life (N.*#/"

Invol%ntar$weight loss (NC

+#*"

*N+, Energy

needs, &-:?g$kg

2roteinneeds, F!@-&!?g$kg

*ulti%itamin supplements

.ntio4idants ,mall

fre%ent meals 0ario%s

dietar$ad1%stments to

manages$mptomsrelated totreatment s%chas 23N303D

2ossible Diet 1rder, Neutropenic

diet

Chemotherape%ticagents are classified intothe following categories:

2l'$lating 2gents

2ntimetabolites -%rine p$rimidine

antagonists 2nthrac$clines -latin%m antit%mor

compo%nds 2ntibiotics Nitros%reas Mitototic inhibitors Microt%b%le targeting

agents Topoisomerase

inbhibitors C$to'ines .iologic response

modifiers Monoclonal

antibodies Imm%notherap$ 5ormones 6n$mes

.onemarrows%ppression

Na%sea

0ommitting

C$stitis ,tomatitis 2lopecia Diarrhea 5epatoto8i

cit$ Cardiac

to8icit$ 5$percale

mia

Increased3decreasedappetite

9a%ndice ,odi%m

and fl%idretention

5$potension

2lteredgl%cosemetabolism

HI


20/23

astingsyndrome

min 2re-

albumin +ransf

errin 5luid$

Electrolytes (Na79N >etc!#

1n *eds,

0ipid panel

Glucose

Insulin

Hg.c

.'+$.0+

79N$)r

Increasednutrient need (NI-?!#


9ndereight Impaired

nutrient utili3ation(N)-&!#

5oodmedicationinteraction (N)-&!:#

.ltered GIfunction

.lterednutrition-related

lab %alues 5ood-

medicationinteraction

Impairedability to prepare

foods$meals Intake of

unsafe foods

or glucoseintolerant-carbohydratecontrol highfiber lo fatdiet supplementfish oil

)orrectmicronutrientdeficiencies-common onesare 7 %itamins.ED seleniumand 3inc

'upportadherence to

medications Help

managemedication side

effects Neutropenic

diet$food safety

order for them to ork .nore4ia 0ipodystro

phy syndrome 1steoporo

sis$ osteopenia

)hronic>idney

5atiguemalaiseeakness

Decreased mentalacti%ity

G5Rless thanFm0$min$!J:m& for : ormore

Inadequateoral$food be%erageintake (NI-&!#

Impaired Nutrient9tili3ation (NI-

Renal Diet 5luid

Restriction to?FF-&FFFm0$day

'odium

.)E inhibitors- block angiotensincon%erting en3ymerela4es arteries(0isinopril#

.ngiotensin II

Increasese4cretion ofsodiumchloride andcalcium andretention of


21/23

Nocturia *ild

.nemia 6

.nemia(normochromicnormocytic#

9remia Nausea

%omitingdiarrhea GI

bleedingulcershiccupsanore4iastomatitis ;

altered taste 2E*

Edema

months 79N $

)reatinine H ;

H .lbu

min )a&

; Na 2hosp

horus 2otass

ium

&!# E4cessi%e

5luid Intake (NI-:!#

E4cessi%e*ineral Intake(2otassium# NI-(??!#

E4cessi%e2rotein Intake (NI-?&!

.lterednutrition-relatedlab %alues (N)-&!

5ood-nutrition

related knoledgedeficit (N7-!#

0imited-adherence to

nutrition-relatedrecommendation

(N7-!# 9ndesirable

food choices (N7-!J#

Restriction to&g$day

2otassiumRestriction to&FFFmg$day

2hosphorusRestriction to&FFmg$day

)ardiac 2ossible

proteinrestriction (F!@gm protein$day#

)alciumRestriction to nomore than

&FFFmg$day


22/23

Hyperk

alemia

Hyperp

hosphotemia

Edema

*etabolic .cidosis

fluid

Electrol

yte

imbalance .nemia

9remia

2E*

H+N

GI

bleeding

.lteredtaste

Higherrisk for

cardiac>idney+ransplant,

2roteincatabolism

hyperlipidemia sodium

retentioneight gain

ide

Glucose

79N )reati

nine

+G Hb.

)

Hg7$

Hct

)alcium

0ipid panel

2otassium

2hosp

horus

(N7-!"# Increased

nutrient needs (NI-?!#

Inadequate protein intake (NI-?&!#

E4cessi%emineral intake of

phosphate (NI-??!

:g$day 5luid

restrictionFFFml$day urinary output

2otassiumrestriction&FFFmg$day 6some 2D ptsneed to increase

potassium 2rotein, !&-

!?g$day/ proteinneeds slightlyhigher for 2D

Energy,

needs depend ontype of dialysis

(HD2D# 2hosphate

restrictionP&FFmg$day

0oering phos has priority

o%er increasing protein

>idney+ransplant,

High protein, !:-!?g$kg or &g$kgat first g$kglater

.dequate


23/23

glucoseintoleranceinhibition of)a$

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Medical Nutrition Therapy Summary Sheet Sp 12

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