Medical Nutrition Therapy I & II

Disease Summary Worksheet

Directions: Complete the following table for each disease state covered in MNT I & II (470 & 471). The first one is done for
you.
Disease

GERD

Nutrition
Problems

Dyspha

gia

Heartbu

rn

General
discomfort
during and
after eating

Hallmark lab
values (if
applicable)

Possible Nutrition
Diagnostic
Terminology Used
in Documentation
(& Number)

Inadequate
energy intake (NI1.4)

Inadequate
oral food /
beverage intake
(NI- 2.1)

Swallowing
difficulty (NC-1.1)

MNT and Diet

Order

Commonly Used
Medications

MNT:

Small
frequent meals,
fluids between
meals.

Avoid
smoking; avoid
foods that
decrease LES
pressure (coffee,
EtOH),
peppermint, etc.)

Poss. CAPA
free diet,
avoiding
individual
irritants

Avoid tight
clothing, elevate
head of bed, etc.
Possible diet orders:

Small

Antacids (AlkaSeltzer, Maalox, Mylanta,

Rolaids)
Foaming agents
cover stomach with foam
(Gaviscon)
H2 Blockers acid
production (Cimetidine,
Famotidine, Nizatidine,
Ranitidine)
Proton Pump
Inhibitors (Omeprazole,
Lansoprazole,
Pantoprazole)
Prokinetics
strengthen sphincter and
gastric emptying
(Bethanechol,
Metoclopramide)

Potential
Nutrition
Related Side
Effects of Meds

Diarrhea
or constipation


MNT I
Dysphagia

Weight

loss

Hiatal
Hernia /
GERD

Na /
BUN

Albu
min / prealbumin

Nutritio
nal
deficiencies
Dyspha
gia
(difficulty
swallowing)
Heartbu
rn or reflux
Dyspeps
ia
(indigestion)
Nausea /
vomiting
Aspirati
on
Pneumoni
Malnutri
tion
Dehydra
tion
Backgro
Albu
und Info:
min/preHiatal Hernia
albumin
is the

Na/B
protrusion of
UN for
the stomach
dehydratio

frequent meals
Low fat

Inadequate
energy intake (NI4)

Inadequate
oral food /
beverage intake
(NI-2.1)

Swallowing
difficulty (NC-1.1)

Involuntary
weight loss (NC3.2)

Dysphagia
Diet 1:
Dysphagia
Purreed

Dysphagia
Diet 2:
Dysphagia
Mechanically
Altered

Dysphagia
Diet 3:
Dysphagia
Advanced

Inadequate
oral food/
beverage intake
(NI-2.1)

Swallowing
Difficulty (NC-

Small
frequent meals,
fluid between
meals.

Avoid
smoking and

n/a

Antacids (AlkaSeltzer, Maalox, Mylanta,

Rolaids)

H2 Blockers
acid production
(Cimetidine, Famotidine,

n/a

Diarrhea
or constipation

Nausea

into the chest

cavity
through the
esophageal
hiatus of the
diaphragm.
Esophag
itis reflux
Dyspha
gia
Heartbu
rn
General
discomfort
during and
after eating

1.1)

Acute/Chron
Pernicio
ic Gastritis
us anemia

Gastric
Pain

Anorexi
a
PUD

Erosion
of the top
layer of
mucosa
(gastric,
duodenal,
esophageal)

H&

MCV

Na /
BUN

Albu
min/Prealbumin

H.
pylori

Altered GI
function (NC 1.4)
Impaired
Nutrient
Utilization (NC
2.1)
Altered GI
function (NC-1.4.)
Impaired
nutrient utilization
(NC-2.1.)
Food and
nutrition related

foods that lower

LES pressure
(coffee, alcohol)
Possible
CAPA free and
other irritants
Raise head
of bed
Eat slowly,
relax, chew food
thoroughly
Avoid tight
clothing that
increases
abdominal
pressure.
Diet Order:
Small
frequent meals
or GERD diet
If N/V; NPO
for a day or 2,
advance to
liquids then GI
soft diet

Nizatidine, Ranitidine)
Proton Pump
Inhibitors (Omeprazole,
Lansoprazole,
Pantoprazole)

Prokinetics
strengthen sphincter and
gastric emptying
(Bethanechol,
Metoclopramide)

Minimize

pain/irritation,

promote healing.

Eliminate
foods that are
irritating to the
individual

Antibiotics
Pepcid / H2 blockers

Diarrhea
Secondary
infection

Antibiotics
Antacids
Anti-ulcer agents

Nausea,
vomiting,
diarrhea,
constipation

Dumping
Syndrome

Crohns /
UC

Can
cause severe
abdominal
pain, nausea,
vomiting,
diarrhea
H.
pylori is #1
cause
Bloating
Abdomi
nal pain
Diarrhea
Crampin
g
Hyperm
otility
Dizzines
s, Weakness,
Tachycardia
Gas
Hypogly
cemia
( shakiness,
sweating,
confusion,
weakness)

knowledge deficit
(NB-1.1.)

Na /
BUN
K
MG
Hgb,
Hct,
Ferritin,
Fe,
B12/folat
Albu
min,
Prealbumi
n

As

Outpu
disease
t: Blood in
progresses
stool
fibrous tissue
Albu

Inadequate
oral food/beverage
intake (NI-2.1)
Inappropriate
intake of
carbohydrate
(simple or lactose)
(NI-5.8.3)
Altered GI
function (NC-1.4)
Impaired
nutrient utilization
(NC-2.1)
Involuntary
weight loss (NC3.2)
Food- and
nutrition-related
knowledge deficit
(NB-1.1)
Inadequate
energy intake (NI1.4)
Inadequate

CAPA free
diet (caffeine,
alcohol, peppers,
& aspirin)

Adequate
protein and kcals
for healing

Avoid
smoking
Anti-dumping diet
Acarbose- delays the
Abdomina

Simple
absorption of
l pain,
carbohydrates
disaccharides and
diarrhea,
controlled
complex carbs.
flatulence

High protein
Octreotide-may cause
Nausea,

Moderate fat
fat and fat soluble vitamin
vomiting,

Fluid
malabsorption and delay
abdominal
between meals
gallbladder emptying.
pain, bloating,

Small,
Alters insulin, growth
diarrhea,
frequent meals
hormone, thyroid
flatulence
hormone, and glucagon

Constipati
levels.
on with Fe and

Ca, Vit.D, Fe, B12

Ca
supplementatio
n.

MNT:

NPO if
fistula or
obstruction is

Corticosteroids
effective at inducing
remission

Anti inflammatory

Steroids
can cause
protein
catabolism,

forms
min/Predecreasing
albumin
absorptive

Na/B
capacity, and
UN for
narrowing of
dehydratio
the lumen.
n

Chronic
Electr
bloody
olytes
diarrhea,
abdominal
pain, fever,
dehydration
all can cause
wt loss.

oral food /
beverage intake
(NI- 2.1)
Food and
nutrition-related
knowledge deficit
(NB-1.1)
Altered GI
function (NC-1.4)
Involuntary
weight loss (NC3.2)
Food and
nutrition-related
knowledge deficit
(NB-1.1)
Impaired
nutrient utilization
(NC-2.1)

Short Bowel
Resectio
Imbal
Evident
Syndrome
n of the small
ance of
protein-energy
intestine
electrolyte
malnutrition (NIresulting in
s such as
5.2)
malabsorptio
K, Na, Cl,
Inadequate
n
Phos,
energy intake (NIglucose,
5.1)
osmolality,
Involuntary

present
Bowel
rest with TPN
in severe
cases/fistula/
obstruction
Small
frequent meals
Low residue
to decrease
diarrhea
No lactose if
intolerant
Low fat w/
MCT oil and if
fat
malabsorption is
present
Increased
energy needs if
experiencing wt
loss
MVI, Fe,
Zn, Vit C, folate,
B12, fat sol
vitamins
> 40-50%
resected p.o.
intake ASAP &
B12 supplement
> 50%
resected, TPN-> EN ASAP to
stimulate

agents like omega 3s

Anti diarrheal
Antibiotics
Immuno suppressants

Proton pump
inhibitors, H2 antagonists
for gastric
hypersecreation

Growth Hormone to
enhance cell proliferation

Octereotide to reduce
growth hormone and help

gluconeogenes
is, muscle
wasting,
negative N
balance, mood
changes, wt
gain, fluid ret,
increased BP
and BG.

Nausea,
Vomiting,
Constipation

Foul
smelling stools

Feeling
the need to
defecate

hematocrit
weight loss (NC, ca
3.2)

Fluid
Impaired
imbalance
nutrient utilization
s
(NC-2.1)

Check
Inadequate
for
vitamin/mineral
steatorrhea
intake (NI-54.1 &
55.1)

Excessive fat
intake (NI-51.2)
Diverticulosi
Alternat
-itis:
s/itis
ing
low
constipation/
albumin
diarrhea
and high

Abdomi
WBC
nal pain
count

Bloating
w/ rectal pain

N/V

Fever

Colostomy/il

Water

Electr

Food and
nutrition-related
knowledge deficit
(NB-1.1)

Limited
adherence to
nutrition-related
recommendations
(NB-1.6)

Altered GI
function (NC-1.4)

Inadequate
fiber intake (NI53.5)

Altered GI

adaptation
with diarrhea
ADAT to

LoMotil or other
small frequent
motility control drugs to
meals, low
help treat diarrhea.
residue, lactose
free

low fat, low

oxalate, MCT oil
(if steatorrhea)
low residue,
lactose free

Osis:

-itis: Antibiotics
o High fiber

-osis: Probiotic and

prebiotic supplements
o Gradually
increase to 35
g/day
o Ample fluids
o Avoid foods w/
seeds
o Avoid nuts and
seeds in general
o
Itis:
o NPO w/
complete bowel
rest until
symptoms
subside
o ADAT to low
residue diet

NPO post

MVI is recommended

Diarrhea
Bloating
Gas

eostomy

and
electrolyte
malabsorptio
n

Low
absorbency
of Vit B12

watery
stools

olytes
B12
levels

Other
vitamins

Na/B
UN

Albu
min/prealbumin

Function (NC-1.4)
Impaired
nutrient utilization
(NC-2.1)

Liver
Disease

Hepatic
steatosis
(fatty liver
caused by
alcohol or
long term
TPN)

Hepatiti
s (nausea)

Cirrhosi
s (portal

ALT
and AST
Albu
min/Pre
albumin
Biliru
bin
Prothr
ombin
time
Possib

Increased
nutrient needs (NI5.1)

Excessive
alcohol intake (NI4.3)

Inadequate
oral food and
beverage intake
(NI-2.1)

Inadequate

surgery ADAT
to clear liquids.
Low fiber
for 8 weeks
Bland foods
to prevent
obstruction
Avoid
stringy foods,
foods with tough
skins
Cut up and
chew food well
Encourage
adequate fluids
Avoid foods
that produce gas,
and aggravate
diarrhea
Small
frequent meals
Encourage
fluids
Adequate
kcal and protein
Use BEE
x1.2 without
ascites
Ascites,
infection, or
malnutrition use
30-35 kcal/kg
dry weight
Protein in

to avoid deficiencies

Diuretics with ascites

Lactulose (used to
treat constipation in liver
disease)

Antivirals (hepatitis)

Antibiotics
(infection)

Watch
potassium
levels as some
diuretics are
K+ sparing and
some are K+
depleting

Diarrhea

Nausea

Vomiting

Gallbladder

hypertension,
esophageal
varicies)
Ascites
(can result in
early satiety)
Hepatic
encephalopat
hy
A/N/V/
D
SOB

ly elevated
protein intake (NIALP,
52.1)
MCV,

Excessive
blood
fluid intake (NIglucose
3.1)

Undesirable
food choices (NB1.7)

Bile no

Dark
longer
color
carried to the
urine,
duodenum
feces no
Urine is
longer
a dark color
colored
Feces is
by bile
grayish
pigment
Disturba
hence
nce in
becomes
digestion and
grayish
fat
malabsorptio
n
Can lead to
pancreatitis,
liver damage
or jaundice

Altered GI
function NC-1.4

Food and
nutrition related
knowledge
deficit. (NB 1.1)

Excessive fat
intake (NI-51.2)

cirrhosis .8-1.0
g/kg
Protein for
repletion 1.2-1.3
g/kg
Protein for
sepsis 1.5 g/kg
Sodium and
fluid restriction
in ascites
No alcohol
If
steatorrhea,
MCT oil

Low-fat

Water-soluble
diet with a
vitamins A,D,E and K
modest protein
Antibiotic
content,

Ursodexychoiic

small
acid (ursodiol)
frequent meals,
Moctanin
due to poor
absorption of
fat

watersoluble forms
of vitamins
A,D,E and K
may be
necessary

Increased
fiber intake and
avoid foods

Constipati

on

Diarrhea

that cause
diarrhea
Pancreatitis

Malabso
Amyl
rption
ase and

N/V,
Lipase
pain

Blood

Steatorr
glucose
hea

Trigly
cerides

Chole
sterol

HCT/
HG

WBC

Food and

NPO w/IV
Nutrition-related
hydration and
knowledge deficit
NG suction at
(NB-1.1)
first
Involuntary

Enteral
weight loss (NCfeeding in
3.2)
jejunum is
Excessive
recommended in
alcohol intake (NIacute
4.3)
pancreatitis if
Hypermetabol
patient cant
ism (NI-1.1)
tolerate food
Inadequate
from nausea and
oral food/beverage
vomiting, then
intake (N1-2.1)
clear liquid diet
Impaired
advancing as
nutrient utilization
tolerated
(NC-2.1)

Chronic
pancreatitis- low
fat, small
frequent meals,
pancreatic
enzymes to
increase
absorption and
digestion

MCT oils,
B12, and water
soluble form of
fat soluble
vitamins

Antacids, H2receptor antagonists, or

proton pump inhibitors to
reduce gastric secretion

Antiulcer agents

PERT

Insulin

Antacid
side effects:
diarrhea,
constipation,
flatulence

Anti ulcer
side effects:
diarrhea,
nausea,
vomiting,
itching,
dizziness

PERT
iron and folate
absorption
Insulin:
hypoglycemia

Diabetes
(Type I&II)

Ketoaci
Fastin
dosis
g plasma

Hypergl
glucose
ycemia

Oral

Hypogly
glucose
cemia
tolerance
test

Selfmonitorin
g of blood
glucose
(SMBG)

HgA1
c

MNT II

Inconsistent

MNT:
carbohydrate
Consistent
intake (NI-53.4)
carbohydrate,
Inappropriate
increased fiber,
intake of types of
cardiac, small
carbohydrates (NIfrequent meals
53.3)

Diet Order:
Excessive
o
Con
carbohydrate
sistent CHO
intake (NI-53.2)
intake
Inadequate

Education:
fiber intake (NIPatients may
53.5)
require
Inappropriate
education for
intake of food fats
counting CHO,
(NI-51.3)
PRO, FAT and
Impaired
glucose
nutrient utilization
regulation as
(NC-2.1)
well as insulin
Food and
therapy
nutrition related
knowledge deficit
(NB-1.1)
Not ready for
diet/lifestyle
change (NB-1.3)
Selfmonitoring deficit
(NB-1.4)
Physical
inactivity (NB-2.1)

Type 1: types of insulin

Rapid-acting insulin
analogs: can be used in
pump thearpt,

Short-acting: can be
mixed with long acting
insulin.

Intermediate-acting:
given in 2 daily doses

Extended long-acting
analog: cannot be mixed

Premixed

Antihyperglycemic
Drug: given at meal time
to increase efficacy of
insulin
Type 2:

Alpha-glucosidase
inhibitors: delays
intestinal absorption of
glucose

Amylin analogs:
delays gastric emptying,
suppresses appetite

Biguanides
(Metformin): decreases
hepatic glucose
production, increases
insulin uptake in muscled

Alphaglucosidase
inhibitors:
diarrhea, less
efficacy
frequent
dosing.

Amylin
analogs: GI
complaints,
must be used
in syringe
seprate from
insulin

Biguanide
s (Metformin):
diarrhea,
nausea,
bloating,
anorexia,

COPD

Hydrati
on: Fluid
retention (cor
pulmonale)
can mask
LBM loss

Decr
intake 2
SOB

Potassiu
m deficient
2 to

PCO2
PO2
HCT
Na2+
BUN
Albu

min

Prealn
umin
WBC
RBC

%Lym
ph
Mg2+
Phosp
horous

Vitam
in D
Vitam
in K

Cystic
Fibrosis

Difficult
Vitam
y breathing
in

Diarrhea
deficiency
, steatorrhea,
is common,

Inadequate
oral food and
beverage intake
(NI-2.1)
Excessive
fluid intake (NI3.2)
Increased
nutrient needs:
protein, (NI-5.1)
Inadequate
Vitamin intake:
Vitamin D,
Vitamin K (NI54.1)
Inadequate
Mineral intake:
Magnesium, Phos,
Calcium (NI55.1)
Involuntary
weight loss (NC3.2)
Food and
nutrient-related
knowledge deficit
(NB-1.1)
Inability to
manage care (NB2.3)
Increased
energy needs (NI1.1)
Increased

Low
carbohydrate
(low RQ)

Sodium
Restriction

Fluid
restriction

Add snacks

Coumadin (warfarin)
Bronchodilators
Diuretics
Corticosteroids
Expectorants

MNT

A diet high
in kcals and
protein

Bronchodilators
help open constricted
airways (Albuterol,
Theophylline,

Consistent
Vitamin K
Potential
hypo/hyperkal
emia
(depending on
if diuretic is K
deleting or
sparing)
Electrolyte
imbalance
Sore
mouth/throat
Weight
gain
Fluid
retention
Hyperglyc
emia
Mood
change
Osteoporo
sis

Nausea
Vomiting
Bloating
Cramping

HTN

malnutrition,
especially
poor growth,
for the fatweight loss
soluble
Poor
vitamins
dig/abs of

Loss
fats
of bile and
Malabs
bile salts
of Ca, K,

Albu
Mg, and fatmin, Presol vitamins
albumin
Constip
Sodiu
ation
m
Nausea
Potass
and loss of
ium
appetite

H&
Risk of
H
osteopenia &
BG/
osteoporosis
HbA1C
Stools

Magn
that are pale
esium
or clay

WBC
colored, foul
Transf
smelling,
errin
have mucus,
or that float
Blood
Headac
pressure
hes

Tired
all the time

Blurred
vision

If
untreated can

nutrient needs (NI5.1)

Impaired
nutrient utilization
(NC-2.1)
Inadequate
oral food/beverage
intake (NI-2.1)
Food and
nutrition related
knowledge (NB1.1)
Altered GI
function (NC-1.4)
Impaired
nutrient utilization
(NC-2.1)
Involuntary
weight loss (NC3.2)

Excessive
mineral intake of
sodium

Inadequate
mineral intake of
calcium,
potassium, and
magnesium (NI55.1)

decrease fat
intake if
steatorrhea and
add MCT oil

High salt
intake required

Monitor
vitamins,
especially
vitamins A, D,
E, and K

Diet Order

High kcals
& protein

Additional
supplementation with FAs
and minerals

Oral doses
of Pancrease
(PERT) with
every feeding

DASH diet:
Dietary
Approaches to
Stop
Hypertension
o
Ass
ess
fruit/vegetable

Ipratropium)
Mucolytics increase
sputum volume/decrease
sputum thickness
(Pulmozyme, Mucomyst)
Anti-inflammatives
decrease inflammation in
the lungs (Azmacort,
Aerobid, Flovent)
Antibiotics (Cipro,
Septra, Bactrim)
Vitamins (A, D, E, K)
Pancreatic Enzymes
(Pancrelipase)

Diuretics: either
potassium
sparing/depleting and it
depletes fluids
(furosemide,
hydrochlorothiazide)

Beta-Blockers: slow
heart rate and reduce the
force of contraction

Constipati

on

Diarrhea
Dizziness
Increased
heart rate

Allergic
reactions

Diarrhea
Constipati

on

Nausea
Heartburn
Edema
Vomit
Dryness of
mouth

lead to:

Inadequate
fiber intake (NI53.5)

Food and
nutrition relatedknowledge deficit
(NB-1.1)

Physical
inactivity (NB-2.1)

idney
disease
C

o
HF

o
entricular
hypertrophy

o
etinopathy
o
o
o

CHF

c
erebrovascul
ar disease
m
yocardial
infraction
a
neurysms

SOB
Sodium
and fluid

intake (8-11
servings a
day)
o
Ass
ess sodium
intake (added
salt, processed
foods)
o
Ass
ess low fat
dairy intake
o
Ass
ess lean
protein
sources

Avoid
smoking

No more
than2 alcohol
drinks/day for
men and 1
alcohol
drink/day for
women

1500mg/day
of sodium or less

Potassium
4.7g/day

Physical
activity

Excessive
MNT:
sodium intake (NI-
Consider
4.1)
underlying risk

Albu

min

Prealb

(metoprolol, atenolol,
acebutolol)

Ace inhibitors:
Inhibits renin-angiotensin
system in kidneys, this
decreases
vasoconstriction and
fluid/sodium retention
(captopril, benazepril,
enalapril, lisinopril,
ramipril)

Alpha-1-receptor
blockers: vasodilation
(alfuzosin, terazosin,
tamsulosin, prazosin)

Calcium channel
blockers: inhibits
movement of Ca into
muscle cells of heart and
arteries, and decreases
force of heart pumping
(nisoldipine, nifedipine,
nicardipine, bepridil,
diltiazem, verapamil)

Loss of
appetite

Hyperkale
mia/hypokale
mia

First:

ACE inhibitors
Second:

May
increase serum
potassium

retention
umin
Decreas
CRP
ed appetite

Sodiu
Feeling
m/BUN
of fullness
Constip
ation
Malabso
rption
Cardiac
cachexia

Hyperlipidemia

n/a

LDL ,
HDL,
VLDL,
and total

Cholestero
l

Trigly
cerides

Excessive
fluid intake (NI3.2)
Inadegquate
oral/food beverage
intake (NI-2.1)
Foodmedication
interactions (NC2.3)
Inability to
prepare
food/meals (NB2.4)
Undesirable
food choices (NB1.7)
Limited
adherence to
nutrition-related
recommendation(
NB1.6)
Excessive
CHO intake (NI53.2)
Excessive fat
intake (NI-51.2)
Inappropriate
intake of food fats,
saturated (NI-53.5)
Inadequate
fiber intake (NI53.5)
any NB

factors (HTN,
hyperlipidemia,
DM), DASH,
SOB
Sodium
restriction (2g/d)
Fluid
restriction (2L/d)
Alcoholmoderation
Caffeine
avoidance
Consider
Drug-nutrient
interactions:
Decreased
potassium,
Magnesium,
thiamin and
calcium

sat. fat,
trans fat and
cholesterol,
moderate
physical activity,
add plant sterols,
soluble fiber,

soy Intake

Alcohol

Diet order:
Cardiac

Beta-blockers
Angiotensin receptor
blocker (ARB)
Progression to classes III and
IV:

Diuretics

Digitalis

Aldosterone and
antagonists

Vasocilators

levels
Hyperglyc
emia

Statins (Lipitor,
Mevacor)

Bile acid sequestrants

(Questran)

Niacin supplements

Fibric Acid

Myopathy,
liver enzymes,

GI
distress,
constipation,
absorption of
drugs

Flushing,
hyperglycemia,
gout, upper GI
distress,
hepatotoxicity


Overwt/
Obesity

n/a

BMI

Overw
eight 25.029.9

Obesit
y I 30.034.9

Obesit
y II 3539.9

Obesit
y III >40.0
Waist
circumferen
ce

Femal
es >35 in

Males
>40 in

Waist
-to-Hip
Ratio

Diseas
e risk
increases
if >.95 in
males and

diagnosis (NB1.1-1.7),
Physical
inactivity (NB-2.1)
Diet
Approach
Overweight/
obesity (NC3.3)
Involuntary
weight gain
(NC-3.4)
Excessive fat
intake (NI51.2)
Excessive
energy intake
(NI-1.5)
Undesirable
food choices
(NB-1.7)
Non-Diet
Approach
Food and
nutrition
related
knowledge
deficit (NB1.1)
Disordered
eating pattern
(NB-1.5)
Physical

Diet Approach
Alli (GI lipase
Energy
inhibitor- reduces 1/3
amount of fat absorbed
deficit of
from foods)
approx. 500
Phentermine
1000
(methanphetaminekcals/day,
appetite suppressant)
resulting in

Phendimetrazine
weight loss
(Bontril- appetite
of about
suppressant)
2lbs/ week
MyPyramid
Volumetrics
Aim for 510% weight
loss
Non-Diet
Approach
Get in touch
with hunger/
fullness cues
Take the
focus off of
losing
weight and
focus
instead on
normalizing
eating

Dysphagia
, gallstones,
myopathy

Diarrhea/
Steatorrhea

Rebound
weight gain

>.80 in
females

inactivity (NB-2.1)

Post
Bariatric
Surgery

Weight loss
Albu
GERD
min/pre Protein and
albumin
fat

Na/B
malabsorptio
UN for
n
dehydratio
Dumping
n
syndrome

Electr
olytes

Inadequate
oral food/beverage
intake (NI-2.1)
Inadequate
protein intake
Inadequate
fluid intake (NI3.1)
Inadequate
vitamin intake
specify (NI-54.1)
Altered GI
function (NC-1.4)
Impaired
nutrient utilization
(NC- 2.1)

Eat a variety
of different
foods
Allow
yourself
permission
to satisfy
cravings
with
enjoyable
foods
Mindful
savoring
Mindful
emotional
eating

MNT:

Stage one
(for 2-4 days
post op): Clear
liquids,
hydration

Stage two
(for 2-3 weeks
post op): Full
liquids,
hydration and
protein

Stage three
(~14 days post
op):
Mechanically

Routine supplementation:

Multivitamin:1-2
daily

Calcium Citrate &

Vitamin D: 1,200-2,00
mg/d & 400-800 IU

Folate: 400mcg/day
in multivitamin

Elemental Iron: 1827mg/day, 40-65mg/day

in menstruating females

Vitamin B12: 350500ug/d orally/

sublingually Or
1000ug/month
intramuscularly

Anorexia
Nervosa

Dizzines
s,
Confusion

Edema

Muscle
wasting

Osteopo
rosis

Stool
retention

Cachexi
a

Low
blood
pressure

Orthosta

Low
WBC,
Low
glucose,
High
cholesterol
High
carotene
Hypo
natermia
Zinc
deficiency
Hyper
kalemia

Limited
adherence to
nutrition-related
recommendations
(NB-1.6)

Disordered
eating pattern
(NB-1.5)

altered soft
foods

Stage four:
Healthy,
balanced solid
food diet

All stages:
46-60 oz fluid
per day
Long term MNT:

Liquids
between meals

Optimize
meals with
nutrient dense
foods

Avoid
greasy food

Normal
eating (eating
based on
physical signals)

wt
normalization:
TF may be
needed

Prevent
refeeding
syndrome

Small,
frequent
feedings

Low fiber,
low satiety

Antidepressants:
Prozac, Zoloft, Paxil
(raises level of serotonin)

Zyprexa (lessens
anxiety and obsessional
thinking)

May lower
B12, folate,
and
homocysteine
levels
Nausea
Vomiting
Constipati
on
Weight
gain
(antidepressant
s)

sis

foods: kcals
from liquid and
fiber ~10g

Minimum
gastroparesis

Dry skin
Cardiac
arrhythmias

Lanugo

Bulimia
Nervosa

Constip
ation (if
laxative
abuse)
Esophag
itis
Gastroes
ophageal
reflux
Vomitin
g
Dehydra
tion
Potentia
l renal
damage
Dental
damage (if
induced
vomiting)

Lipid
Disordered
Profile (H)
eating pattern

Hyper
(NB-1.5)
carotenem
ia

Zinc
(L)

Potass
ium (L)

Consume 3

Antidepressants:
meals per day
Prozac, Zoloft, Paxil
with one to three
(raises level of serotonin)
snacks per day
in a structured
manner
Eventually
expand diet to
include
forbidden
foods
Weight
Normalization
Have a
client binge on
one food all wk
and it will get
them to stop.
Low fiber /
low satiety foods
(~1/2 kcals from
liquid) will
minimize
gastropariesis
and feeling
overly full

May lower
B12, folate,
and
homocysteine
levels
Nausea
Vomiting
Constipati
on
Weight
gain
(antidepressant
s)

Cancer

Nausea
and anorexia
Cachexi
a
Altered
taste
Dyspha
gia
Dry
mouth
Sore or
irritated
mouth
Diarrhea
immuno
-suppression
Weight
gain and
weight loss
Anemia

Sodiu
m/BUN
Serum
protein
CRP
transferrin
HCT/
HGB
Electr
olyte
imbalance
(K, Na, Cl,
Ca, Phos)

Involuntary
weight loss (NC3.2)

Increased
energy and protein
needs (NI-5.1)

Altered GI
function (NC-1.4)

Inadequate
oral food/beverage
intake (NI-2.1)

Inadequate

HIV/AIDS

Opportu
nistic
infections

Immuno
compromised

HIV/AI
DS-related

CD4
cells (T
helper
lymphocyt
es)

CRP

Albu

energy intake (NI1.4)

Foodmedication
interaction (NC2.3)
Swallowing
difficulty (NC-1.1)
Chewing
difficulty (NC-1.3)
Poor nutrition
quality of life (NB2.5)
Involuntary
weight loss (NC3.2)

Inadequate
energy intake (NI1.4)

Inadequate
oral food /
beverage intake
(NI- 2.1)

MNT:
Energy
needs: 21-35
g/kg

Protein
needs: 0.8-2.5
g/kg

Multivitami
n supplements

Antioxidants

Small

frequent meals
Various
dietary
adjustments to
manage
symptoms
related to
treatment such
as A/N/V/D

Possible Diet Order:

Neutropenic
diet

MNT:

If
malnourishedhigh kcal, high
protein

If
hyperlipidemia,

Chemotherapeutic
agents are classified into
the following categories:
Alkylating Agents
Anti-metabolites
Purine pyrimidine
antagonists
Anthracyclines,
Platinum antitumor
compounds
Antibiotics
Nitrosureas
Mitototic inhibitors
Microtubule targeting
agents
Topoisomerase
inbhibitors
Cytokines
Biologic response
modifiers
Monoclonal
antibodies
Immunotherapy
Hormones
Enzymes

ARTs-antiretroviral
Therapy

Use of at least three

ARTs out of the twenty
seven possible

Needs to be a 95%
adherence to ARTs in

Bone
marrow
suppression
Nausea
Vommittin
g
Cystitis
Stomatitis
Alopecia
Diarrhea
Hepatotoxi
city
Cardiac
toxicity
Hypercale
mia
Increased/
decreased
appetite
Jaundice
Sodium
and fluid
retention
Hypotensi
on
Altered
glucose
metabolism

Nausea,
Headache,
Fatigue,
Fever
Night
sweats

Diarrhea

wasting
syndrome

Chronic
Kidney

Fatigue,
malaise,
weakness

Decreas
ed mental
activity

min

Increased
Prenutrient need (NIalbumin,
5.1)

Transf
Involuntary
errin
weight loss (NC
Fluid/
3.2)
Electrolyte
Underweight
s (Na,

Impaired
BUN, K,
nutrient utilization
etc.)
(NC-2.1)

Food
On Meds:
medication

Lipid
interaction (NCpanel
2.3)

Gluco
Altered GI
se
function

Insuli
Altered
n
nutrition-related

HgA1
lab values
c

Food
AST/
medication
ALT
interaction

BUN/
Impaired
Cr
ability to prepare
foods/meals

Intake of
unsafe foods

GFR
less than
60mL/min
/1.73m2
for 3 or
more

Inadequate
oral/food beverage
intake (NI-2.1)

Impaired
Nutrient
Utilization (NI

or glucose
intolerantcarbohydrate
control, high
fiber, low fat
diet, supplement
fish oil
Correct
micronutrient
deficienciescommon ones
are B vitamins,
A,E,D selenium,
and zinc
Support
adherence to
medications
Help
manage
medication side
effects
Neutropenic
diet/food safety

Renal Diet
Fluid
Restriction to
15002000mL/day

Sodium

order for them to work

ACE inhibitorsblock angiotensin

converting enzyme,
relaxes arteries
(Lisinopril)

Angiotensin II

Anorexia
Lipodystro
phy syndrome

Osteoporo
sis/ osteopenia

Increases
excretion of
sodium
chloride and
calcium and
retention of

Nocturia
Mild
Anemia
Anemia
(normochrom
ic,
normocytic)
Uremia
Nausea,
vomiting,
diarrhea, GI
bleeding,
ulcers,
hiccups,
anorexia,
stomatitis, &
altered taste
PEM
Edema

months
BUN /
Creatinine
H&
H
Albu
min
Ca2+
& Na
Phosp
horus
Potass
ium

2.1)

ESRD

Excessive
Fluid Intake (NI3.1)
Excessive
Mineral Intake
(Potassium) NI(55.1)
Excessive
Protein Intake (NI52.2)
Altered
nutrition-related
lab values (NC2.2)
Food-nutrition
related knowledge
deficit (NB-1.1)
Limitedadherence to
nutrition-related
recommendation
(NB-1.6)
Undesirable
food choices (NB1.7)

Food and
Hypertr
Sodiu
nutrition related
iglyceridemi
m
knowledge deficit
a

Potas
(NB-1.1)

Hypoca
sium

Self
lcemia

Chlor

monitoring deficit

Restriction to
2g/day
Potassium
Restriction to
2000mg/day
Phosphorus
Restriction to
1200mg/day
Cardiac
Possible
protein
restriction (0.8
gm protein/day)
Calcium
Restriction to no
more than
2000mg/day
Vitamin C
Restriction to no
more than
100mg/day
Supplement
Active Vit D
Supplement
Iron
Supplement
Water soluble
vitamins
MNT:
Hemodialysi
s and peritoneal
dialysis:
Sodium
restriction 2-

receptor blockers
(Candesartan)
Diuretics- cause fluid
loss by urine (potassium
sparing/depleting) (Lasix)
Beta blockersdimishes effects of
epinephrine, slows heart
rate (Propranolol)
Calcium channel
blockers (Norvasc)
Vasodilators- relax
and open blood vessels
(Alazine)
Direct rennin
inhibitors-inhibits rennin
which causes sodium and
fluid to not be held onto
(Tekturna)
Erythropoietin
therapy-replaces red
blood cells (Eprex)
Iron replacement
therapy (Ferate)

Hemodialysis/Periton
eal Dialysis:

Phosphate-binding
pills

Calcium
supplementation

potassium,
causing
hypokalemia
and low serum
potassium
Increase
excretion of
sodium,
chloride,
potassium,
magnesium
and calcium.
Can
increase
glucose levels
May cause
diarrhea,
stomach
cramps,
nausea,
vomiting, and
decrease blood
glucose levels.
Altered
taste, appetite
loss,
constipation,
and edema
Phosphatebinding pills:
need to take
many at each
meal and can
cause GI upset,

Hyperk
alemia
Hyperp
hosphotemi
a
Edema,
Metabo
lic Acidosis
fluid
Electrol
yte
imbalance
Anemia
Uremia
PEM
HTN
GI
bleeding
Altered
taste
Higher
risk for
cardiac

Kidney
Transplant:

Protein
catabolism,
hyperlipidem
ia, sodium
retention,
weight gain,

(NB-1.4)
3g/day
Increased

Fluid
nutrient
needs
(NIrestriction
se
5.1)
1,000ml/day +

BUN

Inadequate
urinary output

Creati
protein intake (NI-
Potassium
nine
52.1)
restriction

TG

Excessive
2,000mg/day

HbA1
mineral intake of
some PD pts
C
phosphate (NIneed to increase

HgB/
55.2)
potassium
Hct

Protein: 1.21.5g/day; protein

Calci
needs slightly
um
higher for PD

Lipid

Energy:
panel
needs
depend on

Potas
type of dialysis
sium
(HD>PD)

Phosp

Phosphate
horus
restriction
<1,200mg/day

Lowering
phos has priority
over increasing
protein

Kidney
Transplant:

High
protein: 1.31.5g/kg or 2g/kg
at first, 1g/kg
later

Adequate

ide

Gluco

Vitamin D
supplementation

ACE inhibitors
Angiotensin
receptor blockers
Diuretics
Beta-blockers
Calcium channel
blockers
Vasodilators
Direct renin
inhibitors
Phosphate binders

Kidney Transplant:
Corticosteroids,
prednisone, cyclosporine

often
constipation

Altered
potassium
levels for some
diuretics

Corticoster
oids,
prednisone,
cyclosporine:
Protein
catabolism,
hyperlipidemia
, sodium
retention,
weight gain,
glucose
intolerance,
inhibition of
Ca/Vit D/Phos
metabolism,
hyperkalemia,
HTN

glucose
intolerance,
inhibition of
Ca/Vit
D/Phos
metabolism,
hyperkalemia
, HTN

energy: 3035kcal/kg

Moderate
sodium
restriction

Dietary
potassium
restriction

Adequate
calcium,
phosphorous and
vit D