Anorexia Nervosa

-Refusal to maintain body weight at or above normal weight

-Body weight < 85% of expected

-Intense fear of gaining weight/getting fat

-Disturbed perception of body shape/weight

-Amenorrhea

1. Restrictive: no binging/purging (70%)

2. bing/purge (30%)

Recurrent episodes of bing eating characterized by

1. eating an amount of food much larger than others would

2. sense of lack of control over eating

3. recurrent inappropriate compensatory behavior to prevent weight gain

4. Occurs at least TWICE A WEEK for 3 MONTHS

Types of Bulimia

1. Purging: induced vomiting or misuse of laxatives/diuretics/enemas

2.Nonpurging: inappropriate behavior such as fasting or excessive exercise

Recurrent episodes of binge eating

-eating a lot of food in a small amount of time

-3 or more of the following: eating really fast, eating until uncomfortable, eating a lot when not hungry, eating alone, feeling disgusted/angry about intake

-occurs at least twice a week for 6MONTHS

-no purging/compensatory behaviors

(2 or more "yes" answers)

1. make yourself SICK?

2. worry about loss of CONTROL?

3. lost more than ONE stone (14lbs.) in a 3 month period?

4. Believe you're FAT?

5. FOOD dominates your life?

(eating disorder not otherwise specified)

-don't meet strict diagnostic criteria

-often fear eating in public

-frequent dieting, obsession about weight loss, distorted body image

5-10 million females

1 million males (10% of diagnosed)

Personality traits of those likely to have Eating Disorders

-overachiever/perfectionist

-poor self-esteem

-OCD tendencies

-poor conflict resolution

-psychiatric comorbidity

1. "appearance sports" athletes

2. Type I diabetics (11%)

3. Vegetarians

4. Overachievers/perfectionists

1. intentional, sometimes necessary weight loss that doesn't stop

2. Comments from authority figures

3. Stressful events

-build trust; help them LET GO of food control issues

-be consistent, trustworthy

-find a solution to every excuse

-use "I" statements

-do NOT discuss wieght or eating habits

-DO discuss feelings

-do NOT compliment weight gain

Reason why people eat

-Hungry

-availability

-emotions

-religious

-entertainment/enjoyment

-status

-peer pressure

-tradition/culture

-excessive intake of starch, sodium, fat

-limited calcium

-commonly fry in lard

-lot of seasoning

-KOSHER

-meat from foreguarter of cloven hoofed quadrupeds that chew cud

-only fish with scales or fins

-animals killed according to rules (decrease blain, drain blood)

-meat and milk not used in same meal

-separate utensils to cook and prepare and eat meals

-admit what you don't know

-educate yourself ahead of time

-involve family in counseling

-avoid judgement

-ask open-ended questions

-be respectful

Alkaline Food

Acid Food

-meats

-cheese

-grains

-corn and lentils

-cranberries

-prunes/plums

-DECREASE urine pH

-milk and milk products

-veggies

-fruits

-INCREASE URINE pH

Primary use of Acid/Alkaline Diets

-INHIBIT URIC ACID CALCULI (KIDNEY STONES)

AND CYSTIC (GALLBLADDER) STONES

-decrease purine intake/ increase fluid intake

-soft, well-cooked foods (no frying, veggies are cooked)

-pureed

Foods allowed on Full liquid diets

-all clear liquid foods PLUS MILK and milkshakes

-cream soups

-eggnog

-custard/pudding/ice cream

-"jell-o" diet

-no milk

-soda, juices

-coffee & tea

-popsicles, hard candy, sherbet

-broth/buillon

"NIL PER OS"

(nothing by mouth)

health-care induced malnutrition

-person is worse off at time of discharge

-allows skeletal muscles and adipose tissue to use glucose for energy

-stimulate hepatic glucogensis

-inhibits gluconeogenesis

-enhances amino acid deposition in muscle

-juvenile onset

-5-10%

-autoimmune (beta cell destruction)

-diet and insulin control

-90-95%

-impaired beta cell function

-high in obese; especially those with high upper body fat

-decreased insulin production or sensitivity or resistance

-diet controlled

(3 or more of the following):

-waist measurement (40" or more in Males; 35" or more in Females)

-TGs: 150 mg or more

-HDL: males less than 40; females less than 50

-BP at least 135/80 or more

-blood suger 110mg/dl or more

-measures glucose molecules attached to hemoglobin

-good measure of control over time (2-3 months)

-normal= 4-6%

-try to keep diabetics at least under 7%

Results of Diabetes Complications and Control Trial

-found that tight blood glucose control (<7.2% A1Cs) dramatically decreases risk of complications

-show persistent decrease in risk of retinopathy and nephropathy

-decreases insulin requirements

-improves glucose tolerance

-improves glucose sensitivity

-helps control weight

-symptoms may cause hyperglycemia

-supply carbs (3 more grams) and continue insulin

-maintain fluid balance

-monitor blood glucose and urinary ketones

-through the intestines; use the GI tract

-oral supplements and tube feedings

-"outside" the intestines

-provided intravenously (bloodstream)

-can either be supplied PERIPHERALLY (PPN) or CENTRAL LINE (TPN)

delivering a 4-6 volume in about 20-30 minutes; 5-6 times/day

**commonly used for long term outpatient nutritional support**

Continuous Feedings

-around the clock

-generally through small intestine

tube feeding orders

product, strength, rate

osmotically active particles per kg of solvent

NORMAL= 285 mOsm or -50

Dumping syndrome

10-15 minutes after eating carbs: Cramping, bloating, nausea, vomiting, weakness, tachycardia

-hypoglycemia after and hour

single energy bearing nutrient

-pure CHO- polycose

-pure lipid= MCT oil

-pure protein= casec powder

BCAA's

Branch Chain Amino Acids

-leucine, isoleucine, valine

-for stressed and liver disease clients

1kcal/ml

(most are 60-80% water)

% dextrose in water = x

x grams/100 mL

D5W= 5 % Dextrose

BARLEY

RYE

OATS

WHEAT

(gluten-containing foods to be AVOIDED)

pouch-like herniations protruding from the muscular layer of the GI tract

**most frequent in the colon**

inflammation anywhere in the GI tract; usually in terminal ileum

-cobblestone appearance

*NOT TO BE MISTAKEN FOR ULCERATIVE COLITIS (which only occurs in the COLON and does NOT have cobblestone appearance)*

-CHO metabolism

-Lipid Metabolism

-Protein metabolism

-store vitamins

-form blood coagulation factors

-detoxification

-Fair

-female

-fat

-forty

-flatulence