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ELECTROLYTE
1 Sodium
2 Potassium
3 Phosphate
4 Calcium
5 Bicarbonate
6 Magnesium
7 Chloride
ROLE OF ELECTROLYTE
Proper hydration
Having electrolyte in right concentration is important in maintaining fluid balance among the
compartment
OSMOTIC PRESSURE
When water move from more dilute solution to more concentrated solution called osmosis
Regulate pH of fluid
Regulate body pH
Enumerate the RAS SYSTEM and its role in body homeostasis
The renin – angiotensin system (RAS), or renin -angiotensin- aldosterone system (RAAS), is a
hormone system that regulate blood pressure and fluid and electrolyte balance, as well as
systemic vascular resistance. This increase the volume of extracellular fluid in the body, which
also increases blood pressure
RENIN HARMONE
Explanation
•With awareness that 80 -100% of patients in hospitals rely completely on food provided by the
catering service for their nutritional support it is important to remember, many of the problems
that arise in the provision of nutritionally balanced food are potentially preventable with good
planning.
•Planning a menu effectively requires the collection of a wide range of information and input
from numerous groups within a hospital.
A planning group is responsible for implementing local protocol for provision of food and
fluid for patients. Core membership needs to include a senior member of catering staff, a
senior nurse, doctor, a senior dietitian and allied health professionals and patient
representative.
Method of production
Method of distribution
include: 4, 7, 32
Method of production
Method of distribution
/ \
Food Serving
Preparation. Method
/ | \
Method.
•Foods and/or drinks high in fat and/or sugar (and foods high in salt)
•Fluids
• Ward supplies
• Standard recipe
Consistent quality - a dish prepared with exactly the same ingredients using the
same method should produce the same end product each time
Consistent nutritional value - a nutrient profile of each dish can be established
Consistent budgetary control - clearer planning for budgets and costing of menus
Safe provision of therapeutic diets - coding for therapeutic diets are always reliable
Recipe analysis
• portion size
Essential criteria
Portion sizes must be set in order that they can deliver the required nutrition (as specified in this
document) to the relevant patient population in a size that can be eaten.
At a local level, ingredient and therefore nutrient content, of individual recipes will vary from
hospital to hospital. Therefore, the appropriate portion sizes for individual meal items must:
Have their nutrient content and size in relation to serving and food wastage audited
annually.
Write a detailed note on alternative feeding routes
1. Enteral nutrition
Enteral administration is food or drug administration via the human gastrointestinal tract. This
contrasts with parenteral nutrition or drug administration, which occurs from routes outside the
GI tract, such as intravenous routes. Enteral administration involves the esophagus, stomach, and
small and large intestines.
physical disabilities.
who is critically ill or an older person who can’t maintain their nutritional
2. Parental Nutrition
• Parenteral nutrition (PN) is intravenous administration of nutrition, which may include protein,
carbohydrate, fat, minerals and electrolytes, vitamins and other trace elements for patients who
cannot eat or absorb enough food through tube feeding formula or by mouth to maintain good
nutrition status.
• Parenteral nutrition is slowly pumped into the blood stream through a drip. As it can be very
irritant
to blood vessels
• In some cases, enteral feeding may not be an option. If you’re at risk for
malnutrition and don’t have a functional GI system, you may need an
option called parenteral feeding.
• Parenteral feeding refers to giving nutrition through a person’s veins.
You’ll have a type of venous access device, such as a port or a
peripherally inserted central catheter (PICC or PIC line), inserted so you
can receive liquid nutrition.
• If this is your supplementary nutrition, it’s called peripheral parenteral
nutrition (PPN). When you’re getting all of your nutritional requirements
through an IV, it’s often called total parenteral nutrition (TPN).
• Parenteral feeding can be a life-saving option in many circumstances.
However, it’s preferable to use enteral nutrition if at all possible. Enteral
nutrition most closely mimics regular eating and can help with immune
system function.
Who shouldn’t have Enteral Feeding?
• The main reason a person wouldn’t be able to have enteral feeds is if them
stomach or intestines aren’t working properly.
• Someone with a bowel obstruction, decreased blood flow to their intestines
(ischemic bowel), or severe intestinal disease such as Crohn’s disease
would likely not benefit from enteral feedings.
Please explain the following diseases with brief introduction, etiology, sign and symptoms
and medical nutrition therapy
OBESITY
Introduction
Overweight and obesity are increasing problems that lead to significant health and social
difficulties for people. Commonly defined by a measurement of Body Mass Index (BMI -
calculated by dividing body weight (kilograms) by height (meters) squared), the prevalence of
overweight (adult BMI of between 25 and 29.9) and obesity (BMI of 30 or over) is increasing.
For children, these BMI standards require adjustments for age and gender. Overweight and
obesity are global problems and the World Health Organization (WHO) predicts that by 2015
approximately 2.3 billion adults worldwide will be overweight and more than 700 million obese.
Etiology
More consumption of fatty meal Genetics, environment, hormonal, medication, lack of exercise
etc.
Obesity is generally caused by eating too much and moving too little. If you consume high
amounts of energy, particularly fat and sugars, but do not burn off the energy through exercise
and physical activity, much of the surplus energy will be stored by the body as fat.
eating processed or fast food high in fat. not eating fruit, vegetables and unrefined
carbohydrates, such as whole meal bread and brown rice. drinking too much alcohol – alcohol
contains a lot of calories, and heavy drinkers are often overweight.
Back and joints pain, feel very tired, sleep and breath
increased sweating.
snoring.
inability to cope with sudden physical activity.
feeling very tired every day.
back and joint pains.
low confidence and self-esteem.
feeling isolated.
MNT
• Thoughts and behaviors are major risk factors for specifically obesity and overall health status.
• Hence, the lifestyle modification (dietary, physical activity, and other behavioral measures) is
considered the first-line treatment in obese patient
• Changing thoughts and behaviors are feasible function of primary care physician, although not
easy at all time.
•The objective of this paper is to discuss the dietary management of obese patients using
illustrated case scenario approach.
• It's also for people with certain health conditions. During treatment, you will work with a
registered dietitian to make a nutrition plan just for you
DIABETES
Introduction
Glucose is the fuel that your body needs. In your diet, this comes from
foods such as fruit, milk, some vegetables, starchy foods and sugar. To
help control your blood glucose you will need to eat healthy foods and be
Type 1:
Usually developed in adulthood, this occurs when the pancreas does not
produce enough insulin and when the body does not effectively use the
Etiology
Type 1 diabetes occurs when your immune system, the body's system for fighting infection,
attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type
1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the
disease.
Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas is
unable to produce enough insulin. Exactly why this happens is unknown, although genetics and
environmental factors, such as being overweight and inactive, seem to be contributing factors
Fatigue
Increased thirst
Frequent urination
Extreme hunger
Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and
fat that happens when there's not enough available insulin)
Fatigue
Irritability
Blurred vision
Slow-healing sores
MNT
Whole bread and wheat Fruits Vegetables Salad Skim milk and yogurt etc.
Lean meat
The link between diabetes and diet has been well documented, as has the importance of diet in
conjunction with medical interventions for diabetes. Patients often look to their primary care
physicians for advice about general diabetes care, including diet, but survey studies have
revealed that doctors feel uncomfortable advising patients on the sensitive issues of weight loss
and diet.1 Research is increasingly demonstrating that medical nutrition therapy (MNT),
administered by a registered dietitian (RD) or nutrition professional, is a key component of
diabetes management and a complement to treatment of diabetes by physicians. Nutrition
Recommendations and Interventions for Diabetes” emphasizes the importance of MNT in
preventing diabetes, managing existing diabetes, and preventing and slowing the onset of
diabetes-related complications.3 The integration of MNT into diabetes care has the potential to
improve patients' diabetes management and to lessen the burden on physicians to provide
nutrition information.
Introduction
Chronic Obstructive Pulmonary Disease (COPD for short) occurs when permanent blockages
form within the pulmonary system (the term "pulmonary" refers to the lungs and respiratory
system) that interfere with the transfer of vital gasses. To be diagnosed with COPD means that
some portion of one's bronchi or alveoli have become permanently obstructed, reducing the
volume of air that can be handled by the lungs. As this process progresses, the overall efficiency
of the gas exchange process is reduced.
There are two underlying disorders that can cause COPD: Emphysema and chronic Bronchitis.
Etiology
Protein-uria, Low serum albumin, Edema, Elevated blood lipids, Blood coagulation
• Edema
• Sodium retention
• Risk of CVD
MNT
A low-sodium diet is also recommended with nephrotic syndrome. Too much sodium
through diet can cause further fluid retention and salt retention, resulting in uncomfortable
✓ Dietary supplements
✓ IV iron administration
KIDNEY DISEASES
Introduction
Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way
they should. The disease is called “chronic” because the damage to your kidneys happens
slowly over a long period of time. This damage can cause wastes to build up in your body. CKD
can also cause other health problems.
Etiology
Syndrome
MNT
low-sodium diet
lean meats (poultry, fish, shellfish), dried beans, peanut butter, soybeans, fresh or frozen fruit and
vegetables
Introduction
Cardiovascular disease is a general term which describing diseases of the heart and
blood vessels especially coronary heart disease (CHD) is most common form of CVD.
Heart attack and stroke (blood supply to brain tissue is blocked) may result in disablement
or death.
CVD is a global health issue which is responsible for nearly 40 percent of deaths in the
United States; many people assume that heart problems are men’s diseases while CVD
deaths in women have exceeded those of men for the past 20 years.
The term cardiovascular disease refers to any disorder of the heart and blood vessels, including
hypertension, coronary artery disease (CAD), cardiac dysrhythmias, cerebrovascular disease,
valvar heart disease, cardiomyopathies, peripheral vascular disease, and congenital cardiac
abnormalities. Each disorder has been characterized epidemiologically; incidence and
prevalence rates vary widely by country and culture.
Etiology
or aching across the chest, usually starts behind the breastbone. The pain often spreads
to the neck, jaw, arms, shoulders, throat, back, or even the teeth Other symptoms include
indigestion, heartburn, weakness, sweating, nausea, cramping,
MNT
NUTRITION IN INFECTION
Introduction
Nutrition and infectious diseases are related to each other in some aspects. First, nutrition affects
the development of human body immune system. Moreover, nutrition can influence emerge of
infectious diseases (e.g., gastrointestinal infections), food poisoning, intestinal diseases, and
systemic infectious diseases. In this review, the mentioned aspects of the relationship between
nutrition and infections are discussed. Furthermore, the relationship between malnutrition and
infectious diseases, nutrition in patients with severe combined immunodeficiency and
relationship between overeating and infection are reviewed. Overall, some factors can weaken
the body's ability to fight infection and cause malnutrition. The factors include anorexia,
traditional behaviors, reduction of intestinal absorption, metabolic damage, disorder metabolism
of lipids and carbohydrates, reduction of vitamins, iron, zinc, and copper.
. Etiology
MNT
Introduction
Metabolic stress is a physiological process that occurs during exercise in response to low energy
that leads to metabolite accumulation [lactate, phosphate inorganic (Pi) and ions of hydrogen
(H+)] in muscle cells
Etiology
MNT
Introduction
There are many diseases of the upper digestive tract; some of which include hiatal hernia,
gastritis, ulcers, gastro-esophageal reflux disease (GERD), Barrett's esophagus, and mouth,
esophageal, gastric and small intestinal cancers.
Etiology
Viruses, Bacteria, Parasites are most common sign and included medications, such as antibiotics
Other common causes include bacteria, such as salmonella, campylobacter, Escherichia coli
certain medical conditions (such as Celiac disease or Crohn's disease); food intolerance or
medicines. Gastric diseases refer to diseases affecting the stomach. Inflammation of
the stomach by infection from any cause is called gastritis, and when including other parts of
the gastrointestinal tract called gastroenteritis. ... Peptic ulcers are most commonly caused by a
bacterial Helicobacter pylori infection.
Bleeding
Heartburn.
Difficulty swallowing.
Stomach pain.
Nausea.
Vomiting.
Problems in the passage of food.
Any combination of these symptoms.
MNT
Low fat milk, well cooked meat and vegetables without adding fat, white flour, fruit juices
etcWhole milk, fried meat (fish, poultry), fatty meal, raw and fried vegetable, caffeinated
Introduction
The GI tract is involved in transforming food that eaten into energy to meet the human
They consist of esophagus (food tube), stomach (mixes food and forms chyme), small
intestine (duodenum, the jejunum and the ileum) and large intestine (cecum, colon,
The dietary factors associated with ailments of the gastrointestinal tract (G.I.) are Acidity,
inadequate fiber, fat, substances (gluten in wheat) and lactose. Also alcohol affects the
The lower gastrointestinal tract, commonly referred to as the large intestine, begins at the
cecum and also includes the appendix (humans only) colon, rectum, and anus. ... All three
species have abundant bacterial flora within the colon, which carry out a rumen-like function that
is more prominent in rodents ...
Etiology
Antibiotics and other medications may cause diarrhea. These medications generally
cause diarrhea either by increasing GI motility or by altering the normal flora of the colon.
disease disrupts normal digestion and absorptive capabilities, diarrhea will most often
These diagnoses can also result in malabsorption of lipids and other nutrients, which
Other diseases that do not originate in the gastrointestinal tract can also present with
symptoms of diarrhea. These may include, but are not limited to, AIDS enteropathy with
MNT
Food allowed: Buttermilk, skim and low-fat milk, Yogurt with live active cultures, Cheese,
Sherbet
Not allowed: whole milk, cream, Regular (whole milk) ice cream, Yogurt with berries, dried
fruit, or nuts
Food allowed: Tender, well-cooked meat, poultry, fish, eggs, or foods made without
added fat
Not allowed: Fried meat, poultry, or fish, Sausage, Hot dogs, Fatty meats, Nuts, Chunky
nut butters
Grains
Food allowed: White flour, Bread, bagels, rolls, crackers, and pasta made from white or
refined flour, Cold or hot cereals made from white or refined flour
Not allowed: Whole-wheat or whole-grain breads, rolls, crackers, or pasta, Brown or wild
rice, Barley, oats, and other whole grains, Cereals made from whole grain or bran, Breads
Increase exercise
DISEASE OF LIVER
Introduction
Liver is the largest organ in human body, they play a vital role, performing many complex
functions that is essential for human life. They serve as human body’s internal chemical
power plant. The quality of our life depends on health of the liver.
Liver manufactures proteins, carbohydrates, absorbs fat products and makes them
available as fuel. Liver and biliary system diseases are caused by infections (virus,
bacteria and parasites), alcohol intake, toxic chemicals, poor nutrition and metabolic
disorders.
Jaundice
Jaundice is a yellow discoloration of skin and tissues. In this condition the blood levels of
bile pigments are higher as compare to normal. This is a frequent sign of liver and biliary
tract diseases. The bilirubin is a byproduct of daily natural breakdown and destruction of
red blood cells in the body. Normally, liver metabolizes and excretes the bilirubin in the
form of bile. So, if there is a disruption in this normal metabolism and production of
The abnormal metabolism and/or excretion of bilirubin cause the jaundice. Alcohol abuse
and liver disease: Alcohol abuse is the most common cause of liver disease in North America.
Alcohol is directly toxic to liver cells and can cause liver inflammation, referred to as alcoholic
hepatitis. In chronic alcohol abuse, fat accumulation occurs in liver cells affecting their ability
to function.
that may include nausea, vomiting, abdominal pain and small spider like blood vessels
that visible in the skin (spider angiomas). Men may have enlarged breasts, shrunken
hypertension (High blood pressure in veins that bring blood to the liver, that can lead to
with jaundice included the yellow discoloration of skin, mucous membranes, and the
whites of the eyes, light-colored stools, dark-colored urine and itching of the skin.
Skin and eyes that appear yellowish (jaundice)
Abdominal pain and swelling.
Swelling in the legs and ankles.
Itchy skin.
Dark urine color.
Pale stool color.
Chronic fatigue.
Nausea or vomiting.
MNT
Eat a balanced diet: Select foods from all food groups: Grains, fruits, vegetables, meat and beans,
milk, and oil. Eat food with fiber: Fiber helps your liver work at an optimal level. Fruits,
vegetables, whole grain breads, rice and cereals can take care of your body's fiber needs.
DYSPHAGIA
Introduction
Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have
problems swallowing certain foods or liquids, while others can't swallow at all. Other signs
of dysphagia include: coughing or choking when eating or drinking. bringing food back up,
sometimes through the nose.
Etiology
In some cases, swallowing difficulties can be a symptom of cancer, but the most common causes
of dysphagia are the consequences of a stroke or a hiatus hernia
Pain, difficulty in swallowing, feeling like food stuck in their throat and chest part etc.
MNT
Level 4 (Chopped
Regular Diet)
Pureed breads (also called “pre-gelled” breads)
Smooth puddings, custards, yogurts, and pureed desserts.
Pureed fruits and well-mashed bananas.
Pureed meats.
Soufflés.
Well-moistened mashed potatoes.
Pureed soups.
Pureed vegetables without lumps, chunks, or seeds.