LESSON 1 Flashcards
1
Q
A greek word means “to flow through”
A
Diabetes
2
Q
Latinword which means “honeyed”
A
Mellitus
3
Q
It is a chronic (long-lasting) health condition that affects how your body turns into energy.
A
Diabetes
4
Q
It is thought to be caused by an autoimmune reaction (the body itself by mistake) that stops your body from making insulin.
A
Type 1 Diabetes
5
Q
Usually diagnosed in children, teens, and young adults.
A
Type 1 Diabetes
6
Q
FACTS:
* Total: 34.2 million people have ______
(10.5% of the US population)
* Diagnosed: 26.9 million people, including
26.8 million adults
* Undiagnosed: 7.3 million people (21.4%
are undiagnosed)
A. DIABETES
B. PREDIABETES
A
A. DIABETES
7
Q
FACTS:
* Total: 88 million people aged 18 years or
older have _______(34.5% if the
adults US population)
* 65 years or older: 24.2 million people aged
65 years or older have _________
A. DIABETES
B. PREDIABETES
A
B. PREDIABETES
8
Q
- Develops in pregnant women who have
never had diabetes. - The baby could be at higher risk for health
problems - Usually goes away after your baby is born
but increases your risk for type 2 diabetes
later in life
A
GESTATIONAL DIABETES
9
Q
- Blood sugar levels are higher than
normal, but not high enough yet to be
diagnosed as type 2 diabetes - Risk for type 2 diabetes, heart disease and
stroke.
A
PREDIABETES
10
Q
SYMPTOMS OF DIABETES
A
B
W
V
A
A
S
N
F
S
A
ALWAYS THIRSTY
BLURRY VISION
WOUNDS THAT WON’T HEAL
VAGINAL INFECTIONS
ALWAYS HUNGRY
ALWAYS TIRED
SEXUAL PROBLEMS
NUMBNESS OR TINGLING IN HANDS OR FEET
FREQUENT URINATION
SYSTEMIC WEIGHT LOSS
11
Q
MEDICAL MANAGEMENT
1. Maintaining blood sugar level within the
desired normal level.
(Anti-diabetic drugs or oral hypoglycemic
agent (OHA); insulin)
2. Maintaining healthy blood lipid level
concentration.
3. Controlling blood pressure
4. Managing weight
5. Measures that can help to prevent or delay
previous diabetes complications.
A. DIABETES
B. MYOCARDIA INFARCTION
C. PEPTIC ULCER DISEASE
D. CHRONIC KIDNEY DISEASE
A
A. DIABETES
12
Q
What is the normal value for fasting glucose test
A
Less than 100
13
Q
What is the value of Prediabetes for fasting glucose test?
A
100-125
14
Q
What is the value of Diabetes for fasting glucose test?
A
126 or higher
15
Q
Give 3 NURSING MANAGEMENT for Diabetes
A
NURSING MANAGEMENT
* Review factors in glucose instability; and
educate the client about diet, exercise,
healthy lifestyle, and hyper or hypoglycemia
events.
o If the patient is admitted in the hospital,
nurses are assigned to conduct the
Random (anytime) glucose test through
pricking the patient early in the morning
and during the evening or depends on
the doctor’s prescription
o Nurses are responsible in providing the
medicines of the diabetic patients
o Nurses are also responsible for the diet of
the patient. Note if the patient finished
his food or not because it will affect the
patient’s blood glucose
o Nurses should monitor also other foods
the patient eat.
* Monitor VS; I&O and weight
o Nurses should monitor the vital
signs. Monitor the intake and output
especially the water consumed and urine
excretion of the patient. Monitor the
weight
* Discuss how client’s anti-diabetic medications
work
* Check injection sites periodically for client
administering insulin
o Check if the injection site already had
hematoma. If it happens, apply first aid.
* Educate about home glucose monitoring
o Nurses are responsible to educate
patients on how to use glucometer and
how to tally results
o Glucometer is not available before that is
why educating older people with
glucometer is necessary.
16
Q
Give 3 NURSING MANAGEMENT for Diabetes
A
NURSING MANAGEMENT
* Review factors in glucose instability; and
educate the client about diet, exercise,
healthy lifestyle, and hyper or hypoglycemia
events.
o If the patient is admitted in the hospital,
nurses are assigned to conduct the
Random (anytime) glucose test through
pricking the patient early in the morning
and during the evening or depends on
the doctor’s prescription
o Nurses are responsible in providing the
medicines of the diabetic patients
o Nurses are also responsible for the diet of
the patient. Note if the patient finished
his food or not because it will affect the
patient’s blood glucose
o Nurses should monitor also other foods
the patient eat.
* Monitor VS; I&O and weight
o Nurses should monitor the vital
signs. Monitor the intake and output
especially the water consumed and urine
excretion of the patient. Monitor the
weight
* Discuss how client’s anti-diabetic medications
work
* Check injection sites periodically for client
administering insulin
o Check if the injection site already had
hematoma. If it happens, apply first aid.
* Educate about home glucose monitoring
o Nurses are responsible to educate
patients on how to use glucometer and
how to tally results
o Glucometer is not available before that is
why educating older people with
glucometer is necessary.
17
Q
What is the DIETARY MANAGEMENT for DIABETES?
A
DIET:
* HIGH FIBER DIET
o Normal diet with fiber increased
o Give more whole grains, fruits, and
vegetables
- LOW FAT DIET
o Severely restricted fats allowed 10-15% of
TER
o All foods rich in fats are not allowed or
restricted
o Foods cooked by a method not requiring
the addition of fats - Especially if the patient has a high
cholesterol level in the blood, high
triglycerides, high LDL, and low HDL.
Patient is advised for a severely restricted
diet. Instead of giving 20-35% of TER for
fats, they are only allowed for 10-15% of
fats TER per day.
18
Q
T or F.
Encourage rich desserts to to a diabetic patient.
A
FALSE
19
Q
Give a food selection for diabetes
A
Give skimmed milk, lean meat, cereals, fruits,
and vegetables. Avoid fatty meats, rich
desserts, and fried foods.
o Avoid rich desserts because it can be
made with trans-fat or simple sugar or
added sugar or processed sugar or
refined sugar.
20
Q
DIETARY MANAGEMENT OF DIABETES (T OR F)
The carbohydrates intake depends on the
metabolic needs, type of diabetes or degree of
glucose tolerance and individual preferences.
A
TRUE
The amount of carbohydrate ingested
has the most significant influence on
blood glucose levels after meals, the
more grams of carbohydrates
consumed, the greater the glycemic
response.
21
Q
DIETARY MANAGEMENT OF DIABETES (T OR F)
Carbohydrates intake must
not be consistent at
meals and snacks to help reduce fluctuations
in blood glucose levels between meals
A
FALSE
Carbohydrates intake must be consistent at
meals and snacks to help reduce fluctuations
in blood glucose levels between meals
22
Q
DIETARY MANAGEMENT FOR DIABETES
A
- The carbohydrates intake depends on the
metabolic needs, type of diabetes or degree of
glucose tolerance and individual preferences.
* The amount of carbohydrate ingested
has the most significant influence on
blood glucose levels after meals, the
more grams of carbohydrates
consumed, the greater the glycemic
response. - Carbohydrates intake must be consistent at
meals and snacks to help reduce fluctuations
in blood glucose levels between meals - Give carbohydrates foods that are low in GI
effects such as high in fiber foods like fresh
fruits, legumes, and whole grains. These foods
have a moderate effect on blood glucose. - Minimize foods and beverages with added
sugar and excessive use of fructose as a sugar
alternative. Because these are high in
glycemic index and has an adverse effect on
blood lipid levels. - Sugar alcohols are not recommended.
Because although sugar alcohols such as
sorbitol and mannitol have lower glycemic
effects than glucose, fructose or sucrose, but
their use has no significant long-term
improvement on glycemic control - Artificial sweeteners such as aspartame,
saccharin, and sucralose contain no digestible
carbohydrates and can be safely used in
place of sugar - Alcohol is w/ a daily limit of one drink for
women and two drinks for men. Alcohol can
cause hypoglycemia by interfering with
glucose production in the liver. Excessive
alcohol can worsen hyperglycemia and it can
also raise triglyceride levels - Should limit saturated fat intake to less than
7% of total kcal from fats. Should minimize
consumption of trans-fats and cholesterol to
less than 200mg/day. Because people with
diabetes are at high risk of developing
cardiovascular disease. Saturated fats
contribute to increased insulin resistance. - Give moderate protein of 10 to 15 % of resting
metabolic rate (RMR), give lean meat, fish,
and poultry to avoid muscle wasting. High
CHON intake is detrimental to kidney
function.
23
Q
Myo means _______
A
MUSCLE
24
Q
Cardia pertains to ______
A
HEART
25
tissue death d/t lack of blood
suppl
INFARCTION
25
More commonly known as a heart
attack
MYOCARDIA INFARCTION
26
* Most common form of coronary heart
disease (CHD)
* Has multiple genetic and acquired risk
factors
MYOCARDIA INFARCTION
27
What are the diagnostics for MYOCARDIA INFARCTION?
o 12-lead ECG
o Echocardiogram
o Biochemical markers, like
o CKMB, troponin T and troponin I
Cardiac catheterization
28
Plaque buildup in arteries-atherosclerosis-plaque ruptures- thrombus formation in a coronary artery- cardiac ischemia- ?
MYOCARDIAL INFARCTION
29
SIGNS AND SYMPTOMS OF MI
A
P
S
C
H
D&L
N&V
R
* Angina (paninikip ng dibdib)
* Pain or discomfort in other areas (left
shoulder and arm, back, neck, jaw,
stomach)
* Difficulty of breathing (and/or shortness of
breath)
* Cold sweat (kahit malamig ang panahon
pinag pawisan sa malamig)
* Heartburn (may have feeling of fullness or
indigestion)
* Dizziness and lightheadedness
* Nausea and vomiting
* Rapid or irregular heartbeat
30
STATISTICS OF MI (T or F)
According to the WHO, the coronary
heart disease-related deaths in the
Philippines in 2018 reached 120,800 or
19.83% of total deaths
TRUE
30
STATISTICS OF MI (T or F)
In the United States, about 805, 000 have
a heart attack each year. Of these cases,
o 605,00 are a first attack
o 1 in 5 heart attacks is silent
TRUE
31
What are the 3 Medical Management for MI?
1. Pharmacologic Therapy
2. Cardiac Catheterization
3. Coronary Angioplasty
32
What are under Pharmacologic Therapy?
I
I
A
F
T
A
* IV nitroglycerin
* IV morphine
* ACE inhibitors
* Fibrinolytics
* Thrombolytics
* Antihyperlipidemic
33
What are under the Coronary Angioplasty?
B
C
A
L
* Balloon angioplasty
* Coronary artery stent
* Atherectomy
* Laser angioplasty
34
NURSING MANAGEMENT FOR MI
1. Assess for history of illnesses
2. Monitor vital signs, especially blood pressure
and pulse rate
3. Administer medications, as ordered
4. Priority during an attack: pain management
5. Monitor pain: quantify the type,
characteristics, and intensity
6. Intravenous and oxygen therapy, as ordered
(especially if person is suffering from SOB)
7. Obtain diagnostics
8. Assess for shortness of breath, dyspnea, or
crackles
9. Weigh the patient
- this is done especially if myocardial
infarction happen because of life style,
over weightiness or obesity
10. Provide opportunities for adequate rest
11. Initiate cardiac rehabilitation
- cardiac rehabilitations are dietary
management, medical management,
weight management, smoking and
alcohol cessation, stress management
35
DIETARY MANAGEMENT FOR MI
Recommended diets:
* Low salt, low fat/low cholesterol and
high fiber
o doctors usually given is low
sodium or restricted diet and low
cholesterol diet
36
T OR F
Diagnosed with MI should Cut down salt (common table salt) intake
in your diet to avoid hypertension. Intake
should not exceed more than 2 to 2.5
grams a day
TRUE
37
MANAGEMENT FOR MI
1. Cut down salt (common table salt) intake
in your diet to avoid hypertension. Intake
should not exceed more than 2 to 2.5
grams a day
2. Avoid food rich in cholesterol: ground nut
oil, butter, whole milk, eggs, lard (fats
derived from pig meat), tallow (fats
derived from goat or sheep mutton), oily
fish, meats and red meats, and all
nonvegetarian food contain cholesterol in
varied amount
3. Avoid non-vegetarian food especially red
meat
4. Increase intake of foods that contain
PUFA’s (polyunsaturated fatty acids):
flax/linseed oil is the richest source of
PUFA’s. Other oils that contain its
consumption should be limited. The
intake of oils should not exceed 20 grams
a day.
5. Sesame oil and almond oil hinders the
absorption of LDL (low-density
lipoproteins), so it is advisable to use,
replace other cooking oils by sesame oil
6. Increase your intake of water
7. Take high fiber diet-whole grains, bran,
oat, green leafy vegetables etc.
8. Cut down the intake of sugar and other
sweeteners
9. Avoid fat-rich portions of flesh foods.
Instead have lean meat
10. Avoid fat-rich desserts and fried snacks
like cakes, pastries, pudding etc.
11. Instead of frying food boil, steam, grill or
roast food
12. Avoid coffee and caffeinated drinks
13. Consume food rich in magnesium; - nuts
and sea food, green leafy vegetables, sea
plants like sea grapes, whole grains peas,
legumes and oil seeds
14. Increase intake of vitamin C, it maintains
the elasticity and integrity of the artery
walls. Eat citrus fruits, green leafy
vegetables. Eat vegetables – cabbage,
broccoli, tubers, potatoes, and sweet
potatoes
15. Avoid eating junk food – pizza, burgers
etc.
16. Reduce calcium intake (reduce but do not
completely avoid calcium as it is needed
for maintenance of our body): give milk
and sea food, nuts, green leafy
vegetables, whole grains, peas, legumes,
and oil seeds
* Calcium deposits are part of
artery-clogging plaque.
* They also contribute to stiffening
of the arteries and interfere with
the action of heart valves
38
DIETARY PLAN FOR MYOCARDIAL INFARCTION
What are the Best heart-friendly foods to eat?
* lots of fruits and vegetables
* skinless poultry
* fish
* plant-based oils such as olive oil
* lean meats
* nuts, beans, and legumes
* whole grains
* low-fat dairy products
39
What is the total energy requirement for MI?
1, 450 kilocalories
40
__________ is an excavated (hollowed-out area) that forms in the mucosa of the
stomach, in the pyiorus (the opening
between the stomach and duodenum), in
the duodenum or in the esophagus.
Peptic ulcer
41
T or F.
Erosion of a circumscribed area of mucosa is the cause of MI.
TRUE
This erosion may
extend as deeply as the muscle layers or
through the muscle to the peritoneum
(thin membrane that lines the inside of
the wall of the abdomen), may be
referred to as a gastric, duodenal, or
esophageal ulcer, depending on its
location. (Brunner & Suddarth, 2018).
42
STATISTICS (PEPTIC ULCER)
* Peptic ulcer disease affects
approximately 4.5 million Americans
annually, and it requires inpatient
hospitalization for an estimated 30 out of every 100 patients (Brunner & Suddarth,
2018).
* According to the latest WHO data
published in 2018, Peptic Ulcer Disease
Deaths in the Philippines reached 6,283 or
1.03% of total deaths. The age adjusted
Death Rate is 9.69 per 100,000 of
population ranks Philippines #18 in the
world.
43
SIGNS AND SYMPTOMS OF PEPTIC ULCER
D
N
P
S
E
C
B
* Dull, gnawing pain or a burning sensation
in the mid-epigastrium or the back
* Nausea
* Pyrosis vomiting (rare in uncomplicated;
usually symptom of complicated)
* Sour eructation (burping)
* Epigastric tenderness or abdominal
distention
* Constipation or diarrhea
* Bleeding (severe) (thru hematemesis or
melena)
44
SIGNS AND SYMPTOMS OF PERFORATION
S
V
C
E
* Sudden, severe upper abdominal pain
(persisting and increasing in intensity);
pain may be referred to the shoulders,
especially the right shoulder, because or
irritation of the phrenic nerve in the
diaphragm
* Vomiting
* Collapse (fainting)
* Extremely tender and rigid (board like)
abdomen Hypotension and tachycardia,
indicating shock.
45
NURSING MANAGEMENT FOR PEPTIC ULCER
* Advise to adhere to and complete the
medication regimen to ensure complete
healing of the ulcer
* Meals should be eaten at regularly paced
intervals in a relaxed setting
* Learning relaxation techniques to help
manage stress and pain
* Advise to adhere dietary restrictions and
cessation of cigarette smoking
* Immediate correction of blood loss may
be required to prevent hemorrhagic
shock (for severe bleeding.
* Monitor vital signs
46
DIETARY MANAGEMENT FOR PEPTIC ULCER DISEASE
C
D
V
F
1.) CHEMICALLY BLAND
2.) DIET HIGH FIBER DIET (PREVENTIVE STAGE)
3.) VITAMIN A RICH FOODS
4.) FLAVONOID-RICH FOODS
47
It consists of foods which are chemically
non-irritating and are least likely to
irritate the gastrointestinal tract.
CHEMICALLY BLAND DIET
* Allow foods that are mild in flavor, nonstimulating or any food tolerated by the
patient.
* Avoid black pepper, chili powder,
chocolate, strong coffee and alcohol.
* These will increase acid secretion or
irritate the GI lining.
48
oats, psyllium husk, legumes, flax seeds,
barley, nuts, and certain vegetables and
fruits such as oranges, apples and carrots
HIGH FIBER DIET (PREVENTIVE STAGE)
* Foods that are high in soluble fiber include
oats, psyllium husk, legumes, flax seeds,
barley, nuts, and certain vegetables and
fruits such as oranges, apples and carrots
* Both insoluble and soluble fibers
demonstrate a stronger association of
decreasing risk for developing ulcers.
* Fibers can lower the amount of acid in
your stomach while easing bloating and
pain.
49
liver,
carrots, broccoli, sweet potatoes, kale,
and spinach. Generally, natural foods
that are deep yellow/orange
VITAMIN A RICH FOODS
* Good sources of vitamin A include liver,
carrots, broccoli, sweet potatoes, kale,
and spinach. Generally, natural foods
that are deep yellow/orange are rich in
vitamin A.
* Vitamin A increases the production of
mucous in the GIT. Vitamin A have a
protective effect against the development
of ulcer disease.
50
____________ increases the production of mucous in the GIT
VITAMIN A
Vitamin A increases the production of
mucous in the GIT. Vitamin A have a
protective effect against the development
of ulcer disease.
51
garlic,
onions, and colorful fruits and vegetables
such as cranberries, strawberries,
blueberries, broccoli, carrots, and snap
peas.
FLAVONOID-RICH FOODS
* Flavonoid-rich foods include garlic,
onions, and colorful fruits and vegetables
such as cranberries, strawberries,
blueberries, broccoli, carrots, and snap
peas.
* To inhibit the growth of H-pylori
52
To inhibit the growth of H-pylori
FLAVONOID-RICH FOODS
* Flavonoid-rich foods include garlic,
onions, and colorful fruits and vegetables
such as cranberries, strawberries,
blueberries, broccoli, carrots, and snap
peas.
* To inhibit the growth of H-pylori
53
What are the SPECIFIC MANAGEMENT for Peptic Ulcer?
CRANBERRY JUICE COCKTAIL
COFFEE AND ALCOHOL (AVOIDED)
54
TRUE OR FALSE
Drinking just two 250mL cups of
cranberry juice cocktail per day might
reduce the risk of H-pylori overgrowth in
the stomach.
TRUE
55
____________ helps by either not allowing the
bacteria to attach itself or by disengaging
it from the body once it is attached and
prevent inflammation.
CRANBERRY
56
CRANBERRY JUICE COCKTAIL
* Drinking just two 250mL cups of
cranberry juice cocktail per day might
reduce the risk of H-pylori overgrowth in
the stomach.
* Concerns about antibiotic resistance
make this finding especially significant
because cranberry tannins appear to
block the bacteria without destroying
them.
* When antibiotics are used to eradicate
infection, the bacteria mutate and
become resistant to treatment
* Cranberry helps by either not allowing the
bacteria to attach itself or by disengaging
it from the body once it is attached and
prevent inflammation.
57
Both caffeinated and decaffeinated coffee
does not increase acid production and
exacerbate symptoms in individuals with
ulcer disease.
FALSE
COFFEE AND ALCOHOL (AVOIDED)
* Both caffeinated and decaffeinated coffee
can increase acid production and
exacerbate symptoms in individuals with
ulcer disease.
* Alcoholic beverages can erode the
protective mucosal lining along the
gastrointestinal tract and lead to further
inflammation and bleeding.
* To minimize symptoms, individuals with
ulcer disease should avoid or limit coffee
and alcohol.
58
COFFEE AND ALCOHOL (AVOIDED)
* Both caffeinated and decaffeinated coffee
can increase acid production and
exacerbate symptoms in individuals with
ulcer disease.
* Alcoholic beverages can erode the
protective mucosal lining along the
gastrointestinal tract and lead to further
inflammation and bleeding.
* To minimize symptoms, individuals with
ulcer disease should avoid or limit coffee
and alcohol.
59
READING: Assess your individual tolerance
* It is important to find out what works for
you. If you notice that your symptoms get
worse after eating certain foods, then
limit or avoid them so you can feel your
best, making sure that you don’t
eliminate an entire food group.
* Small meals may be better tolerated than
large ones. Patients should avoid food
consumption for at least two hours before Bedtime to properly digest the food and
avoid gastric secretion.
60
_______________________ is a condition in which the kidneys are
damaged and cannot filter blood as well as
they should.
CHRONIC KIDNEY DISEASE
* is a condition in which the kidneys are
damaged and cannot filter blood as well as
they should. Because of this, excess fluid and
waste from blood remain in the body and may
cause other health problems, such as heart
disease and stroke.
61
RISK FACTORS OF CHRONIC KIDNEY DISEASE
D
H
H
HKD
BAAHNAA
B6
RISK FACTORS
o Diabetes
o High blood pressure (hypertension)
o Heart disease
o Having a family member with kidney
disease
o Being African-American, Hispanic, Native
American or Asian
o Being over 60 years old
62
SIGNS AND SYMPTOMS OF CHRONIC KIDNEY DISEASE
IM
N
N
S
T
T
T
SIGNS AND SYMPTOMS
o Itching
o Muscle cramps
o Nausea and vomiting
o Not feeling hungry
o Swelling in your feet and ankles
o Too much urine (pee) or not enough
urine
o Trouble catching your breath
o Trouble sleeping
63
GFR stands for?
GLOMERULAR FILTRATION RATE
64
__________ that checks how well your kidney
are filtering your blood, called GFR.
BLOOD TEST
65
___________ is a protein that can pass into the
urine when the kidneys are damaged.
ALBUMIN
66
A ______ for albumin.
URINE TEST
Dipstick test for albumin
67
This test measures and compares the
amount of albumin with the amount of
creatinine in your urine sample. HCP use
your UACR to estimate how much
albumin would pass into your uterine over
24 hours.
URINE ABLBUMIN-TO-CREATININE RATIO
(UACR)
68
A urine albumin result of:
o 30 mg/g or less is normal
o More than 30 mg/g may be a sign of
kidney disease
69
READ: MANAGEMENT FOR CHRONIC KIDNEY DISEASE
MANAGEMENT
1. Control blood pressure within normal
limits
2. Meet blood glucose goal if diabetic
maintain 80-120 mg/dL
3. Take medicines as prescribed depends of
the cause for example HTN: then antihypertensive medication if diabetic
the insulin or oral hypoglycemic agent
4. Work with a dietitian to develop a meal
plan
5. Make physical activity part of routine.
Exercise daily
6. Aim for a healthy weight
7. Get enough sleep
8. Stop smoking
9. Find healthy ways to cope with stress
and depression
MANAGEMENT
1. Control blood pressure within normal
limits
2. Meet blood glucose goal if diabetic
maintain 80-120 mg/dL
3. Take medicines as prescribed depends of
the cause for example HTN: then antihypertensive medication if diabetic
the insulin or oral hypoglycemic agent
4. Work with a dietitian to develop a meal
plan
5. Make physical activity part of routine.
Exercise daily
6. Aim for a healthy weight
7. Get enough sleep
8. Stop smoking
9. Find healthy ways to cope with stress
and depression
70
DIETARY MANAGEMENT OF CKD
DIET PREDIALYSIS
1. HICAL DIET
2. LOW CHON DIET
3. SATURATED FAT, CHOLESTEROL - FREE DIETS
4. Na RESTRICTED
5. PHOSPHORUS, AND POTASSIUM
RESTRICTIONS
6. CALCIUM AND VITAMIN D
SUPPLEMENTATIONS
71
DIET PREDIALYSIS
WHAT IS THE RATIONALE FOR:
1. HICAL DIET
MANAGEMENT:
- Give hard candies, honey, jam
- PUFA salad dressing and soft
mayonnaise
Rationale:
- For weight maintenance
- Prevent wasting
- Prevent malnutrition
- To increase energy content of food
72
DIET PREDIALYSIS
WHAT IS THE RATIONALE FOR:
2. LOW CHON DIET
MANAGEMENT:
- Give between 0.6 to 0.75g per KDBW
- 50% of CHON TER should be coming from
high quality such as eggs, milk products,
fish and soybeans. Egg yolk limited to 2-3
per week, egg white as desired.
Rationale:
- To slow the progression of renal disease
- Low CHON produces fewer nitrogenous
waste and will reduce the risk of uremia
- Reduce the risk associated with
hyperphosphatemia
- To ensure an adequate amount of EAA
73
DIET PREDIALYSIS
WHAT IS THE RATIONALE FOR:
3. SATURATED FAT, CHOLESTEROL - FREE DIETS
MANAGEMENT:
- Provide unsaturated fats such as nuts,
seeds PUFA salad dressing and
mayonnaise, avocados, soybeans
products
Rationale:
- To control elevated blood lipids
- Reduce heart disease risk
74
DIET PREDIALYSIS
4. Na RESTRICTED
MANAGEMENT:
- Restrict up to ________mg/day
- Avoid canned, cured, processed foods
which use salt to sodium-containing
flavoring agents and preservatives
- Salt, fish sauce and soy sauce are omitted
from the table or on the patient’s tray
2000
75
DASH
Dietary Approach to Stop Hypertension
76
_________ is rich in fruits, vegetables, lowfat dairy products, whole grains, fish, poultry, beans, seeds, and nuts.
DASH Diet
77
It is low in salt and sodium, added sugars
and sweets, fat, and red meats. Known for
treatment of hypertension, heart disease,
and kidney disease.
DASH: Dietary Approach to Stop Hypertension
78
T or F
Unrestricted if urine output is normal
TRUE
- If not normal 1000ml/day + urine output
- To regulate fluid and electrolyte balance
79
Large amounts of __________ are found in:
- Dairy products such as milk, cheese,
yogurt, ice cream, and pudding
- Nuts and peanut butter
- Dried beans and peas, such as kidney
beans, split peas, and lentils
- Beverages such as cocoa, beer, and dark
cola drinks
- Bran breads and bran cereals
- Processed, convenience, and fast foods,
including some meats that have additives
to make them tender
PHOSPHORUS
80
T OR F
* Eating high-phosphorus foods can raise
the level of phosphorus in the blood.
TRUE
81
* Kidneys may not be able to remove all
this extra and may lead to?
HYPERPHOSPHATEMIA
82
READINGS:
5. PHOSPHORUS, AND POTASSIUM
RESTRICTIONS
Phosphorus Restriction
Large amounts of phosphorus are found in:
- Dairy products such as milk, cheese,
yogurt, ice cream, and pudding
- Nuts and peanut butter
- Dried beans and peas, such as kidney
beans, split peas, and lentils
- Beverages such as cocoa, beer, and dark
cola drinks
- Bran breads and bran cereals
- Processed, convenience, and fast foods,
including some meats that have additives
to make them tender
* Eating high-phosphorus foods can raise
the level of phosphorus in the blood.
* Kidneys may not be able to remove all
this extra and may lead to
hyperphosphatemia.
* The blood calcium levels drop, and
calcium is pulled from the bones. Over
time, the bones will become weak and
break easily
* This may also cause calcium to build up in
the blood vessels, heart, joints, muscles,
and skin, where it does not belong
* This may cause serious problems such as:
- Damage to the heart and other organs
- Poor blood circulation
- Bone pain
- Skin ulcers
* To keep phosphorus at safe levels in the
blood is to limit phosphorus – rich foods
* Using recommended milk substitutes
without added phosphorus is one way to
lower the amount of phosphorus in the
diet
* The doctor will prescribe a type of
medicine called a phosphate binder.
These binders are taken with the meals
and snacks.
83
Potassium Restriction/low Potassium Diet:
A. 1500-2000mg/day
B. 500-1000mg/day
C. 1500-1750mg/day
A. 1500-2000mg/day
84
Large amount of _______ are found in:
- Certain fruits and vegetables (like
bananas, melons, oranges, potatoes,
tomatoes, dried fruits, nuts, avocados,
deep-colored and leafy green vegetables,
and some juices)
- Milk and yogurt
- Dried beans and peas
- Most salt substitutes
- Protein – rich foods, such as meat,
poultry, pork and fish
POTASSIUM
85
_________ levels can rise between hemodialysis sessions and affect the
heartbeat.
A. PHOSPHORUS
B. POTASSIUM
B.POTASSIUM
Eating too much potassium
can be dangerous to the heart and may
even cause death.
86
6. CALCIUM AND VITAMIN D SUPPLEMENTATIONS
Ca
A. 15mg/day
B. 10mg/day
C. 12mg/day
C.12mg/day
* The best way to prevent calcium loss from
the bones is to limit high-phosphorus
foods. The patient may also need to take
phosphate binders and avoid eating
calcium-fortified foods.
* The doctor may advice to take a special
form of Vitamin D to help the calcium and
phosphorus levels in balance, and to
prevent bone disease.
* Do not take over-the-counter Vitamin D
or calcium supplements unless
recommended by the kidney doctor.
87
WHAT ARE THE DIET MANAGEMENT AFTER HEMODIALYSIS?
H
H
U
F
K
P
S
1. HICAL DIET
2. High CHON Diet
3. UNSATURATED FATS & CHOLESTEROL – FREE
DIETS
4. FLUID AND Na RESTRICTED DIETS
5. K restricted
6. P restriction
7. SUPPLEMENTATION OF Ca & VITAMIN D
88
T OR F
In case of diabetes and need to gain
weight, it may be best to increase the
calories from starches and vegetables
fats.
TRUE
89
- 1.2g/KDBW
- Give lean meat, fish, poultry, dairy
products and eggs all contain of high
biological value
HI CHON DIET
90
WHAT IS THE RATIONALE FOR GIVING HIGH CHON DIET AFTER HEMODIALYSIS?
Rationale:
- Dialysis removes nitrogenous waste and
amino acid losses are substantial,
amounting to 6-9g per treatment
91
WHAT IS THE TER OF UNSATURATED FATS & CHOLESTEROL – FREE
DIETS (AFTER HEMODIALYSIS)?
A. 15- 25% of TER from fats/day
B. 15- 20% of TER from fats/day
C. 10-15% of TER from fats/ day
B. 15- 20% of TER from fats/day
92
WHAT DIET?
- 300mg of cholesterol/day
- Give more on PUFA such as olive oil,
peanut oil, corn oil
- Limit butter, lard, shortening, red meat
UNSATURATED FATS & CHOLESTEROL – FREE
DIETS
93
WHAT IS THE RATIONALE FOR UNSATURATED FATS & CHOLESTEROL – FREE
DIETS?
Rationale:
- Low cholesterol levels in the blood help to
slow down the progression of chronic
kidney disease
- To maintain a healthy lipid profile
94
WHAT DIET?
- 1000ml plus urine output
- A rise in body weight and blood pressure
suggests that a person is retaining and
fluid, and most persons with kidney
disease tend to retain sodium and may
benefit from a mild restriction.
- Fluids are not restricted until urine output
decreases.
- Advise patients that foods such as
flavored gelatin, soups, fruit juices, frozen
fruit juice bars and milk contribute to fluid
intake.
- The patient must control the sodium and
fluid intake until the subsequent dialysis
treatment.
FLUID AND Na RESTRICTED DIETS
95
K restricted (AFTER HEMODIALYSIS)
A. 2000- 3000mg/day
B. 2550- 3000mg/day
C. 2250- 2750mg/day
A. 2000-3000mg/day
96
WHAT DIET?
- To prevent hyperkalemia and
hypertension
- The restriction is usually necessary for
persons treated with hemodialysis
K RESTRICTED
- Recommended intake depends on serum
k levels, renal functions, medications, and
the dialysis procedure used.
- All fresh fruits provide K, but some fruits
and vegetables contain large amounts
that some patients need to restrict
intakes
- Examples of high K choices include
avocado, banana, brussels sprout,
cantaloupe, dried fruit, dried beans, peas,
prune juice, spinach, tomatoes, and
winter squash.
- Other high K foods include milk, molasses,
and nuts
- Salt substitute that contains potassium
chloride should be avoided on a Krestricted di
97
WHAT DIET?
- 800 – 1000mg/day
- To prevent hyperphosphatemia
P RESTRICTION
98
WHAT DIET?
- Ca can be less or within ________ mg/day or
can be from diet or medications
- To prevent renal osteodystrophy
A. 2000mg/day & _______
B. 2500mg/day & _______
C. 3000mg/day & _______
A. 2000mg/day & SUPPLEMENTATION OF Ca & VITAMIN D
- Once dialysis treatments begin,
phosphorus restrictions and calcium and
vitamin D supplementation become the
standard treatment
- Serum Ca levels must be monitored to
guard against hypercalcemia, which can
develop in response to simultaneous
vitamin D and Ca supplementation
- High protein foods are also high in
phosphorus, so protein-restricted diets
curb P intakes as well
- After dialysis treatments begin and
protein intakes are liberalized, phosphate
binders become essential for phosphorus
control
- Because foods rich in calcium, such as
milk and milk products are usually high in
phosphorus and are therefore restricted,
patients must rely on Ca supplements to
meet their Ca needs.
99
______________ is a late stage of chronic liver
disease. Long term liver disease
gradually destroys liver tissue, leading to
scarring (fibrosis) in some regions and
small areas of regenerated healthy tissue
in others (DeBruyne, 2016)
CIRRHOSIS
100
!!! STATISTICS!!!
CIRRHOSIS
In 2017, cirrhosis caused more than 1. 32
million deaths (440,000 in females and
883,000 in males) globally
101
SIGNS AND SYMPTOMS OF CIRRHOSIS
F
EB
L
N
S
W
I
Y (J)
F (A)
S
R
FW
FM
C (HE)
o Fatigue
o Easily bleeding or bruising
o Loss of appetite
o Nausea
o Swelling in your legs, feet, or ankles
(edema)
o Weight loos
o Itchy skin
o Yellow discoloration in the skin and
eyes (jaundice)
o Fluid accumulation in your abdomen
(ascites)
o Spiderlike blood vessels on your skin
o Redness in the palms of the hands
o For women, absent or loss of periods
not related to menopause
o For men loos of sex drive, breast
enlargement (gynecomastia) or
testicular atrophy
o Confusion, drowsiness, and slurred
speech (hepatic encephalopathy)
102
MEDICAL MANAGEMENT FOR CIRRHOSIS
A
D
I
L
S
F
P
o Appetite stimulants
o Diuretics
o Immunosuppressants
o Lactulose
o Sodium restriction
o Fluid restriction
o paracentesis
103
!!! NURSING MANAGEMENT FOR CIRRHOSIS!!!
Nursing management for the patient
with cirrhosis of the liver should focus on
promoting rest, improving nutritional
status, providing skin care, reducing risk
of injury, and monitoring and managing
complications.
104
DIETARY MANAGEMENT FOR CIRRHOSIS
H
H
L
S
N
N
S
1.HICAL DIET
2. HICHON DIET
4. LOW CHO
5. Saturated Fats and Cholesterol Restricted
diets
6. Na RESTRICTED & FLUID RESTRICTED
7. Na RESTRICTED & FLUID RESTRICTED
8. SUPPLEMENTATION OF VIT-B1
104
!!! NURSING ASSESSMENT FOR CIRRHOSIS!!!
B
F
M
Assessment of the patient with cirrhosis should
include assessing for:
- BLEEDING. Check the patient's skin, gums,
stools, and vomitus for bleeding.
- FLUID RETENTION. To assess for fluid
retention, weigh the patient and
measure abdominal girth at least once
daily.
- MENTATION. Assess the patient's level of
consciousness often and observe closely
for changes in behavior or personality.
105
DIETARY MANAGEMENT FOR CIRRHOSIS
DIET?
- TER based on RMR
- For infection and malnutrition
HICAL DIET
106
DIETARY MANAGEMENT FOR CIRRHOSIS
DIET?
- _______ grams KDBW day
- Give high biological protein from the
protein of high quality such as fish,
poultry, and soy
- To maintain N balance Synthesis of blood
clotting factor
- To normalize altered AA ratios in brain
tissues
- To improve mental state.
HICHON DIET
107
DIETARY MANAGEMENT FOR CIRRHOSIS
DIET?
- 50-60% of TER
- Give complex ____ consistent from day
by day and at each meal & Snack, to
prevent hyperglycemia
LOW CHO
108
DIETARY MANAGEMENT FOR CIRRHOSIS
DIET?
- Give only EFA, omega 3, MUFA, and
PUFA food sources
- For less appetite & malnutrition
- To increase energy supply
Saturated Fats and Cholesterol Restricted
diets
109
Na RESTRICTED & FLUID RESTRICTED
- _________mg of Na /day
- Increase 1g Na intake will increase 200ml
water retention.
A. 2000
B. 2500
C. 3000
A. 2000
Diuretic therapy
- If serum Na level (128mEq/L) restrict fluid
to 1.200 to 1,500ml \
- If serum Na level (125mEq/L) restrict fluid
to 1,000 to 1,200 ml
- To control ascites resulting from the
kidney's reabsorption of Na in the blood
which, results in Na and water retention
110
__________ also interferes with the absorption of thiamine in the gastrointestinal tract.
ALCOHOL
111
DIETARY MANAGEMENT FOR CIRRHOSIS
DIET?
- Alcohol also interferes with the
absorption of thiamine in the
gastrointestinal tract.
- Drinking large amounts of alcohol
suppresses the appetite
- For altered neurological and motor
functions because alcohol impairs
memory, judgment, and coordination
and disrupts sleep patterns.
- When used long-term, alcohol may
cause permanent brain damage
SUPPLEMENTATION OF VIT-B1
112
READ!!ng MANAGEMENT (CIRRHOSIS)
Suggestions on how to increase the energy intake
of the patient.
A.
1. If the restriction is necessary, make Sure the
patient fully understand how to modify the diet so
that food intake is not restricted unnecessarily.
2. Provide lists of acceptable foods & menus.
3. Explain how to modify their favorite foods to
become therapeutic for them.
B.
1. Suggest between meals snacks during the day
and a snack at bedtime.
2. An oral supplement such as Ensure can
substitute for a snack and requires to
preparation
3. Should consume snack within 2 hours before
meals, it may reduce appetite at mealtime
C.
1. If the patient has little appetite or is quickly
satiated or full, suggest foods that are higher in energy content, such as whole milk instead of
reduced-fat milk
D.
Recommended energy boosters
1. For water, give fruit juices or fruit nectars
2. For vegetables and potatoes, use PUFA salad
dressings
3. For sandwiches use PUFA mayonnaise
4. For casserole and meatloaf, add hard boiled
eggs
5. For crackers, use peanut butter old fashioned
6. For salads, cooked cereals, and bakery
products add chopped nuts or walnuts
