Beruflich Dokumente
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CHAPTER 22
ROLE IN WELLNESS
Physical health dimension
Challenge to halt or minimize malnutrition often associated with
symptoms or treatments
Intellectual health dimension
To maintain optimal nutrient intake while dealing with serious
illness requires intellectual capability to comprehend aspects of
treatment and rehabilitation
Emotional health dimension
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ROLE IN WELLNESS,
CONTD
Social health dimension
Prejudice against (and fear of) clients with HIV/AIDS and
cancer affects potential for individuals to continue social and
work relations as in past
Spirituality health dimension
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CANCER
Cancer
Characteristics of cancer cells
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CANCER, CONTD
Carcinogenesis
Process resulting in abnormal cell production
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Initiation
Results in mutation of deoxyribonucleic acid (DNA)
Exact causes not clear for all malignancies
Physical and chemical agents or exposure to
microorganisms may cause mutation
CANCER, CONTD
Slide 6
Promotion
Replication of mutated cell promoted
Abnormal cell growth results
Factors in some malignancies include:
Estrogen
Testosterone
Nitrates
Cigarette smoke
Alcohol
Progression
Abnormal cells outside original location of cell
CANCER, CONTD
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CANCER, CONTD
Nutrition factors considered important environmental and
lifestyle factors in etiology and prevention of cancer
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CANCER, CONTD
National Cancer Institute guidelines
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CANCER, CONTD
Eat a low-fat diet
Maintain or reach a healthy weight
Be physically active
Protect skin from sunlight
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CANCER, CONTD
Nutrition and the diagnosis of cancer
Cancer cachexia
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CANCER, CONTD
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CANCER, CONTD
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CANCER, CONTD
Benefits of nutritional adequacy
Maintenance of nutritional status
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CANCER, CONTD
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CANCER, CONTD
Nutritional effects of cancer treatments
Surgery
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CANCER, CONTD
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CANCER, CONTD
Chemotherapy
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CANCER, CONTD
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CANCER, CONTD
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CANCER, CONTD
Radiation therapy
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CANCER, CONTD
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CANCER, CONTD
Bone marrow transplantation
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CANCER, CONTD
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CANCER, CONTD
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Hematologic malignancies
Patient receives bone marrow from genetically matched
donor (allogeneic) or in some cases from twin
(syngeneic)
Ability to maintain adequate oral intake difficult because of
nausea, vomiting, and mucositis
CANCER, CONTD
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CANCER, CONTD
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CANCER, CONTD
Graft versus host disease (GVHD)
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CANCER, CONTD
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May result in multiple organ damage, but skin, GI tract, and liver of
particular concern
Nutritional management complicated
May require intense therapy for as long as 1 to 2 years
posttransplant
CANCER, CONTD
Nutrition therapy
Cancer patients at high risk for malnutrition
Recognizing clinical signs and treating symptoms early helps
prevent protein-kcal malnutrition
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CANCER, CONTD
Prognosis considered to appropriately adjust aggressiveness
of nutritional intervention
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Supportive
Adjunctive
Definitive
CANCER, CONTD
Anorexia caused by cancer or its treatment
Etiology generally multifactorial
Changes in taste and smell
Decreased transit time and subsequent early satiety
Opportunistic infections
Therapy and other medication side effects
Pain
Emotional and psychologic effects
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CANCER, CONTD
Treatment options
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CANCER, CONTD
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CANCER, CONTD
Nausea and vomiting
Nausea and vomiting may result from:
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CANCER, CONTD
Treatment options
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CANCER, CONTD
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CANCER, CONTD
Taste abnormalities
Taste alteration causes
Changes or destruction of oral mucosa
Presence of tumor by-products systemically
Changes in quantity or quality of saliva
Inadequate mouth care
Drug-related taste changes
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CANCER, CONTD
Treatment options
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CANCER, CONTD
Principles of nutrition therapy
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CANCER, CONTD
Expected outcomes for nutrition therapy
Weight and lean body mass maintained within established
goal range
Consumption of adequate energy and protein or
appropriate nutritional support
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CANCER, CONTD
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AIDS
Acquired immunodeficiency syndrome (AIDS)
Retrovirus human immunodeficiency virus (HIV) causes
acquired immunodeficiency syndrome (AIDS)
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AIDS, CONTD
Target cells for HIV include:
T4 or CD4 lymphocytes
B-lymphocytes
Monocytes
Macrophages
Other cells of immune system
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AIDS, CONTD
Initial infection with HIV may include symptoms such as fever and
malaise
Antibodies produced against virus detectable within 2 to 4 months
after exposure
Replication of infected cell results in a steady depletion of CD4
cell count
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AIDS, CONTD
Diagnosis of AIDS includes:
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AIDS, CONTD
Progression from HIV to AIDS varies for each individual
May not be evident for several years
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AIDS, CONTD
HIV bloodborne and sexually transmitted infection
Contaminated blood
Semen
Vaginal secretions
Breast milk
Crosses placenta from mother to baby
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AIDS, CONTD
Highly active antiretroviral therapy (HAART)
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Combinations of:
Fusion inhibitors
Integrase inhibitors
Nucleoside/nucleotide reverse transcriptase inhibitors
Nonnucleoside reverse transcriptase inhibitors
Protease inhibitors
AIDS, CONTD
Goal of treatment regimens
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AIDS, CONTD
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AIDS, CONTD
Malnutrition in HIV/AIDS
Documented in all stages of HIV infection
Malnutrition in HIV/AIDS multifactorial
Most nutritional problems coincide with:
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AIDS, CONTD
AIDS-related wasting syndrome
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AIDS, CONTD
Malnutrition in HIV/AIDS multifactorial
Contributors include:
Altered nutrient intake
Weight loss and body composition changes
Physical impairment
Endocrine disorders
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AIDS, CONTD
Metabolic changes
Malabsorption
Presence of opportunistic infections
Psychosocial issues
Economic conditions
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AIDS, CONTD
Altered nutrient intake
Anorexia frequent symptom may be caused by:
HIV infection
Presence of opportunistic infections
Fatigue
Fever
Medication side effects
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AIDS, CONTD
Slide 57
Physical impairment
Mucositis, esophagitis, pain, nausea, and vomiting
Depression, loneliness, fear, anxiety, or other psychosocial
issues
Economic availability of adequate food supplies
AIDS, CONTD
Weight loss and body composition changes
Changes may occur as a result of:
Decreased nutrient intake from physical impairment
Symptoms that impair appetite
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AIDS, CONTD
Acute weight loss
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AIDS, CONTD
Changes commonly seen in wasting syndrome
Often coincide with increases in viral load
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AIDS, CONTD
Medications to treat weight loss
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AIDS, CONTD
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AIDS, CONTD
Physical impairment
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AIDS, CONTD
Endocrine and metabolic disorders
Hypogonadism identified with HIV/AIDS
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AIDS, CONTD
Fat redistribution syndrome (lipodystrophy)
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AIDS, CONTD
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AIDS, CONTD
Malabsorption
Malabsorption result of:
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AIDS, CONTD
Treatment of malabsorption
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AIDS, CONTD
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AIDS, CONTD
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AIDS, CONTD
Cycle of malnutrition and wasting
Complex causes
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AIDS, CONTD
Nutrition assessment in cancer and HIV/AIDS
Initial step evaluate anthropometric data
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AIDS, CONTD
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AIDS, CONTD
Biochemical indices
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AIDS, CONTD
Dietary assessment
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AIDS, CONTD
Slide 76
Careful attention
Gastrointestinal function
Presence of steatorrhea and diarrhea
Other physical symptoms that might interfere with
adequate oral intake
AIDS, CONTD
Nutrition therapy
Overall goals of nutrition management
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AIDS, CONTD
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AIDS, CONTD
Objectives of nutrition care
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AIDS, CONTD
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AIDS, CONTD
MifflinSt. Jeor Equation
Females: 10 W + 6.25 H 5 A 161
Males: 10 W + 6.25 H 5 A + 5
W = Weight (in kg)
H = Height (in cm)
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AIDS, CONTD
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Protein requirements
1 to 1.5 g protein/kg of actual body weight based on
patients current nutritional status
Vitamin and mineral status needs to be monitored closely
because deficiencies may evolve
Suppressed oral intake
Increased requirements for certain micronutrients
AIDS, CONTD
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AIDS, CONTD
Antiretroviral therapy
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AIDS, CONTD
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AIDS, CONTD
Slide 86
Saquinavir (Invirase)
Take within 2 hours of meal of high-fat foods or large
snack containing carbohydrate, protein, or fat
Ritonavir (Norvir)
Taking with food may decrease abdominal cramping
and diarrhea common when this drug initially
prescribed
Symptoms usually disappear within 8 weeks
AIDS, CONTD
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Indinavir (Crixivan)
Taken on empty stomach
Meal can be eaten 1 hour after drug or 2 hours
before drug
For some, may be necessary to eat small snack with
drug, but fat should be avoided
AIDS, CONTD
Prevention of foodborne illness
Crucial component of nutrition therapy and education for
HIV/AIDS
As CD4 counts fall, higher risk for infections from foods
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AIDS, CONTD
Low microbial diet prescribed with recommendations to avoid:
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AIDS, CONTD
Physical activity
Regular aerobic exercise and resistance training assist with:
Lipid abnormalities
Fat redistribution syndrome
Other body composition changes
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AIDS, CONTD
Benefits of physical activity
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AIDS, CONTD
Multidisciplinary approach
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