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The Role of Fats and CVD
- Saturated and trans fats increase VLDs and LDLs
- Total Cholesterol < 200 mg/dL
- HDL > 40 mg/dL
- LDL < 100 mg/dL
- Triglycerides < 150 mg/dL
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How to Improve Blood Lipid Levels
- Decrease dietary sat fats
- Increase omega-3 fatty acids
- Consume folate everyday
- Increase intake of whole grains, fruits, veggies
- Maintain blood glucose
- Eat smaller more frequent meals
- No more than 2 alcoholic drinks/day - red wine
- Stop smoking
- Get active
- Maintain healthy weight
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TLC Diet
- Sat Fat: < 7% of energy
- Monounsat: plant oils, nuts - substitute for sat fats up to 20% energy
- Polyunsat: sub for sat fats up to 10% energy - veg oils, semiliquid margarines
- Carbs: 60% energy
- Fiber: 5-10 g/day
- Protein: sub plant for animal
- Other: 2-3 g plant sterol
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Nutrition Therapy
- Measure LDL at 6-week interval
- If nutrition unsuccessful, try more, then add meds after 3 months
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MI Diet
- Goal: reduce workload
- Diet
- - liquid (24 hrs)
- - smaller, more frequent
- - restrict caffeine
- - moderate temp
- - Na, cholest, fat, calories individual
- - omega-3 fatty acids
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CHF Diet
- Goal: lessen workload
- Restrict Sodium
- Fluid restriction if hyponatremic (1-2 L/day)
- Give 20-30% above basal needs
- Nutritional supplements, enteral nutrition, or PPN
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ARF, RDS Diet
- Goal: inhibit tissue destruction
- Provide extra nutrients for hypermetabolic conditions
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COPD Diet
- Goal: preserve muscle strength and immune system
- Maximize oral intake
- 25-45 cal/kg
- Limit salt
- Increase fiber
- Increase fluids
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Renal Diets
- Ordered for chronic renal failure, not acute
- Changes with stages of CKD and dialysis
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Acute Renal Failure (ARF)
- Abrupt loss of renal function
- Prerenal, intrarenal, or postrenal
- GFR - 90-110
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ARF Nutritional Problems
- Retention of Na, H2O, Nitrogen
- Potassium retention leads to cardiac problems
- Anemia --> fatigue
- Proteinuria - loss of immunoglobulins and vit D proteins
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ARF Nutritional Therapy
- Protein: 40 g/day
- Na: 2-3 g/day
- K - 25-40 mEq/day restrictions
- TPN may be required
- Fluid intake: output + 500-700 ml/day
- I&O
- Daily weights
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Chronic Renal Failure (CRF)
- Irreversible loss of kidney function
- Stage 5: GFR < 15
- Stage 5 is on dialysis
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Decreasing GFR
- Abnormal urine production
- Poor water excretion
- Electrolyte imbalance
- Metabolic abnormalities
- Dilute urine reduced
- BUN increase
- Urine output decreases
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CRF Nutritional Problems
- Proteinuria
- Na excretion changes, early risk for hyponatremia
- Late Na retention - hypotension, edema
- Late K excretion, hyperkalemia
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Renal Diet
- Low:
- - P, K, protein, Na
- Exception: dialysis patients need more protein
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Potassium Foods
- Prunes
- Oranges
- Bananas
- Dried fruits
- Potatoes
- Tomatoes
- Brussel sprouts
- Spinach
- Beets
- CKD 4-5: restricted
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Phosphorus Foods
- Milk
- Cheese
- Yogurt
- Dried beans, peas
- Nuts
- PB
- Bran
- Whole-wheat bread
- CKD 3-5: restricted 800-1000 mg/day, binders may be needed
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Na Foods
- Processed meats
- Canned soups
- Salty snacks
- Deli meats
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Ca Foods
- Dairy
- CKD 1-4: 1200-1500 mg/day, may need vit D3
- CKD 5: < 2 g/day, activated vit D
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Renal Nutrition Therapy
- Foods with essential amino acids
- Vitamin supplements
- P restriction avoids osteodystrophy
- Protein restriction
- Sufficient calories, high carbs
- Replace Na and K loss
- Monitor labs, weight, BP
- Monitor fluids (FVE)
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Hemodialysis
- Treatments 3-4 hrs, 3x/week
- Protein increased
- Fat restricted
- P restricted
- Na, K, fluid based on weight
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Peritoneal Dialysis
- Usually performed at home
- Treatment 20-30 mins over 8-10 hrs
- 4-5x/week
- Vitamin supplments, folic acid, Ca
- Protein increased - loose 20-30 g/day
- P restricted
- HTN, edema, CHF between treatments due to Na and fluid
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Cachexia
- Wasting syndrome - 10% loss in 1 month
- Indicative of cancer/HIV prognosis
- Abnormalities in metabolism
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Malnutrition
- Risk for dehydration
- Protein malnutrition most common with cancer
- Vitamin/Mineral deficiencies
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Diarrhea
- No lactose
- Binding foods - bananas, oatmeal, crackers
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Dehydration
Fluid replacement
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Vitamin and Minerals
Multivitamin with meals
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Opportunistic Infection
- Client on antibiotics
- Yogurt
- Probiotics
- Thrush - cold beverages
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Household Poverty
Outreach programs
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Goals for Cancer/HIV
- Preserve lean body mass
- Gut function
- Prevent malnutrition
- Minimize symptoms of malabsorption
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