MNT for Individuals III

• Inflammation of joints
• Reg, well balance diet
• best rest, aspirin
• normocytic anemia may present, inflammation of arthritis prevents reuse of iron

• No spec diet
• supplement iron, folate, ca, fiber, b12
• may show symptoms of celiac

• osetoclasts reabsorb and remove bone,
• oteoblasts reform bone

• (1) Postmenopausal within 15-20 yrs (2) age associated
• causes: malnutrition, lack of exercise, decline in estrogen
• treat: HRT (hormone replacement therapy), weight bearing exercise, vit D, Ca

• Adult Rickets
• Vit D defiency
• give vit d and calcium

• Seizures, altered consciousness
• Anticonvulsants interfere with Ca abs
• -take folate with drugs, vit d, ca, thiamin
• Ketogenic diet: high fat (80-90%), low CHO

• brain damage, inadequate control over voluntary muscles
• Spastic: high fluid, high fiber diet
• non-spastic: uncontrollable wiggling causes low weight
• high cal/hi pro/ finger foods

• Stroke
• decreased ability to abs ca, loss of nitrogen

• Spinal cord injury
• energy needs are 10% below predicted, at least 1.5 L of fluid
• Pressure ulcers: 30-40 cal/kg
• 1.2-1.5 g/kg pro
• supplement vit c, get vit a from intake

• ADHD
• Feingold diet: no salicylates, artificial colors or flavors (efficacy not proven)
• sugar does not cause hyperactivity

• Avoid distractions (no TV), regular consistent mealtimes, encourage self feeding, offer one course at a time
• lower sat fats, avoid dehydration
• may need verbal cues to chew and swallow

Decrease in total RBC mass bc less RBC's or smaller cells with less Hg

small, pale cells, due to iron deficiency--associated with chronic infections, renal disease

• FEW large cells, filled with Hg
• due to deficiency of folate or B12--Schilling test for pernicious

• Cow's milk protein is the single most common allergen for infants
• introduce eggs at 24 months, nuts and fish at 36

abnormal response, GI distress but NO antibody production

*Antibodies are produce when antigen enters*

• Excessive fluid loss, IV dextrose and water
• BMR increases 7% for each degree rise in F, normal: 98.6

• Immediate shock period-catabolism, BMR rises 50-100%
• replace fluids and electrolytes
• Increase cals 1.5-3 g pro
• Vit C & zinc for wound healing
• Water sol vits, 2x DRI
• vit K if on antibiotics

Hypovolemia, shock, tissue hypoxia

• follows fluid resuscitation and return of oxygen transport
• flight or fight (ephinephrine, norepinephrine)
• aldosterone
• ADH-renal water resbs
• hyperglycemia
• fluid and sodium retention
• 1.5-2 g pro

• causes protein-calorie malnutrition, malabsorption, fluid and elec imbalances
• 1. add flavorings and seasoning
• 2. meat aversions
• 3. thrush from oral infections: avoid spicy, acidic

*throat or neck cancer: PEG for feeding*

• loss of taste, xerostomia (dry mouth), esophagitis
• mucositis: avoid fresh, raw foods

• Chemical reagents which have toxic effects
• 1. nausea
• 2. stomatitis: cracks in skins at mouth corners (riboflavin deficiency)
• 2. methotrexate: anti-folate drug

• Protein/calorie starvation
• severe wasting, anthropometrics, no edema
• serum albumin normal

• Protein/Calorie malnutrition
• brought on by treatment, hospitals, medications

• distorted body image, preoccupation with food and weight gain
• 1. Correct elec imbalance
• 2. Plan meal times
• Realistic and Flexible 

damage to teeth, throat, esophagus

hunger stimulating hormone

High in those with Prader Willi

• bacterial enzymes ferment CHO on plaque
• Foods that can cause: ched cheese, nuts, meat
• Sugar alcohols DO NOT
• do not give children toothpaste until they can spit it out (2-3 yrs) bc of fluoride

*infants should not sleep with a bottle

• Associated with riboflavin def
• avoid very hot/cold foods, spices, sour/tart

• Treat by decreasing gastric acidity, reflux
• Diet: small, low fat, bland, low fiber

Achalasia: LES motility, causes dysphagia, start with pureed

• Hypertension, edema, proteinuria, rapid weight gain after 20th week
• do NOT sodium restrict
• could be from poor prenatal care, poor diet

severe pregnancy nausea, bed rest and freq cho feedings

1. diarrhea, malabsorption, nausea, vomiting, weight loss

• 1.3 x BEE
• if wasted 1.2-2 g pro
• preserve lean body mass

• Avoid Raw foods
• HIV Pos should not breastfeed
• Retrovir causes non-nutr macrocytic anemia
• do not use any drugs with

• High cal/pro with supplements for wgt gain
• vits/mins 1-2x DRI or RDA

• Persistent obstruction of pulmonary airflow
• emphysema & chronic bronchitis
• symptoms: weight loss, emaciation, anorexia
• maintain stable wgt, high cal/pro
• 1-1.5 g/kg pro 30-45% as fat

• Respiratory failure
• Lungs cannot exchange gas
• Severely underweight-goal to maintain stable weight, provide adequate but not excessive cals
• EPA abd GLA enteral formulas
• 1.5-2 g pro

• Normal GI function
• lecithin may be added
• 1-1.5 cals/cc
• intact protein, and isotonic (osmolality is close to that of blood)
• osmolite

• Used with malabsorption, comp GI funcion, 
• Predigested protein, glucose, fat, vit/min
• absorbed in proximal intestine, low to no residue
• dont need panc enzymes
• Vivonex, Peptamen

• Nepro-Renal
• Pulmocare, Respalor: high fat, low cho-pulmonary
• Hepatic Aid: liver
• Glucerna: Diabetes
• the more specialized the more $$$

• based on viscosity of feeding
• Large #16: blenderized whole foods
• Small #8: ready prepared formulas

• Bolus: for those with functional stomach
• Continuous drip: steady rate over 16-24 hours. For those who have compromised GI funcion
• Cyclic feeding: continuous drip at a increased rate throughout the night, for elderly or under-nourished.
• Intermittent drip: Pump or gravity-more mobile
• Nasduodenal or nasojejunal: if unable to tolerate gastric feedings
• Traspyloric: used in comatose pts

DO NOT USE BLUE DYE

• 1 cc/ calorie
• 1 cal/cc formulas are 80-86% water; 1.5 cal/cc are 76-78% water..
• throw out open containers after 24 hrs

• small surface veins--short term/no effect on nutritional status
• -post surgery when TF will start 5-7 days
• IV dextrose: 3.4 cals/g
• mL*%*3.4=calories
• 3-15% protein
• IVFE: 10%=1.1 cal; 20%=2.0 cals

• infusion of hypertonic solutoin to central venous catheter
• last option when pt cannot eat
• Use for NC 1.4 (altered GI) and CC 2.1 (impaired nutrient utilization)
•  
• Concern: bacteria translocation; GALT (gut associated lymphoid tissue) is compromised--immune system is compromised

• Ratio for anabolism is 1 g nitrogen: 150 cals
• 1-1.5 g/kg/day
• cystalline AA: 3-15%
• %=number of g of pro in 100mL of solution

example: a 3% solution has 3 g of AA's in 100ml

• 35-50 cals/kg; up to 70% dextrose
• a 10% solution provides 100mg CHO/Liter
• to avoid overfeeding and hyperglycemia, start at <20-25 cals/kg
• max rate of dextrose should not exceed 4 to 5 mg/kg/minute to prevent hyperglycemia

• Needed to prevent EFAD
• give 500 cc of 10% fat emulsion 1-2x/week
• symptoms of EFAD are petechiae (red spots)

• Total Nutrient Admiztures
• 3 in one: dextrose, AA's and lipids

• Introduce a min amount of FULL-STRENGTH enteral feeding at a low rate (30-40) to get GI tolerance
• decrease PN as you increase enteral rate by 25-30 every 8-24 hours
• when pt can tolerate 75% of needs, d/c the PN

• aggressive adimin of nutrition to malnourished
• starved cells take up nutrients, pot and phos shift to intracellular compartments
• results in hypokalemia, hypophosphatemia, hypomagnesemia

overfeeding PN and dextrose >5 mg/kg/min may lead to hyperglycemia

• mind-body meds
• acupuncture, oriental meds
• lifestyle, herbs, chiropractic
• bioelectric magnetics