hiv part 2

same

the nutrition assessment for PLWHA is the _________ as any person with metabolic stress.

medical/social history, food-/nutrition-related history, anthropometrics, NFPE, biochemical data, medical tests, procedures

what are all the parts of the nutrition assessment?

• Educate clients and their caregivers on the role of nutrition and diet in both restoration and maintenance of health 

• Conduct initial and periodic assessment of client's nutritional status and challenges to maintain status 

• Provide support for maintenance and recovery of immune function through MNT strategies 

• Assist in developing nutrition-related strategies to manage nutrition-related side effects of disease and medications 

• Support medical treatment of HIV by promoting adherence to treatment and compliance to visit 

• Provide education for clients and caregivers on the potential impact of drug-nutrient interactions on nutritional status with ART 

• Maintain familiarity with community and other programs available to clients for referral 

• Remain knowledgeable of issues pertaining to privacy and confidentiality when providing nutritional care 

• Update knowledge and evaluate research on both nutrient-based and non-nutrient treatments to improve nutritional status 

what are the roles of the RD in HIV care?

well-nourished

a _______ person with HIV who has a controlled viral load is more likely to withstand the effects of HIV infection and delay disease progression.

ART

the use of _____ has dramatically shifted nutrition risk factors and comorbidities.

undernutrition, over nutrition, obesity, chronic diseases (HTN, DM, osteoporosis, cognitive impairment), and food insecurity

what are the nutrition-related problems seen in PWLHA?

complete baseline nutrition assessment consisting of NFPE, changes int eight, actual intake, biochemical, dietary assessment, side effects of ART

what are the basics of the NCP in PLWHA?

muscle wasting and weight loss

what are you looking for on baseline NFPE?

lipids for risk of hyperlipidemia, insulin sensitivity, HbA1c, iron through ferritin, hemoglobin and transferrin, B12, folate, BP, hormones

what are the labs to look at in HIV?

food insecurity, intolerances, allergies, cultural preferences, GI symptoms, supplement use

what are the components of the dietary assessment?

chronic diarrhea, anemia, metabolic alterations

what are some of the potential side effects of ART?

nutrition

_______ and nutrition status can affect absorption, utilization, elimination, and tolerance of ART and other medications.

9-15%

PLWHA are hypermetabolic, with an REE _________ higher in men with HIV than normal.

increased

_____ kcal are needed for restoration and maintenance.

1.0-1.4 g/kg BW

what are the protein needs for maintenance?

1.5-2.0 g/kg BW

what are the protein needs to increase muscle mass?

iron, b12, folic acid, selenium, calcium, vitamin d

what are the micronutrients of concern?

above

supplementation _____ RDA should only be initiated when clinical deficiencies have been confirmed.

simulate appetite, modulate hormone, and manage symptoms

what is the goal of treating wasting and lipodystrophy?

MNT, supplements, medical

wasting and lipodystrophy are treated using a combination of ______, ______, and _____ therapy.

increased protein and kcal, weight-bearing exercise, GH, anabolic steroids, insulin-sensitive agents, micronutrient supplementation, reduce alcohol intake, avoid Lactobacillus bacteremia probiotic supplementation

what are the recommendations for wasting and lipodystrophy?

lipodystrophy

abnormal metabolism and deposition of fat

lipoatrophy

loss of subcutaneous fat

lipohypertrophy

loss of truncal fat

not

probiotic supplementation has _____ been tested.

compromised

higher alcohol intake is associated with ________ gut integrity.

weight-bearing exercise, vitamin d and calcium supplementation, bisphosphates to inhibit bone reabsorption, cessation of smoking, alcohol, and caffeine

what are some interventions for osteoporosis?

ART, inflammation, lifestyle

CVD is associated with ___, HIV-related _____, and _____- factors.

CVD

hypothyroidism can increase the risk of _____.

monitor lipids, monitor thyroid levels, high fiber, low in simple carbs, lipid-lowering medications, exercise

what are the nutrition interventions for CVD?

more research is needed; low sodium, high potassium, F/V

what are the recommendations for HTN in HIV?

weight loss to improve insulin sensitivity, medications, carb counting, high fiber, low glycemic index, reduce added sugar

what are the recommendations for DM in HIV?

greater

weight loss improves insulin sensitive in adipose tissue, liver, and muscle in women with HIV; experience ____ losses of fat free mass.

not

DM medications are effective, but may _____ be as effective in persons with HIV compared to non-HIV.

echinacea, garlic, st. johns wart, kava

what are the complementary/alternative meds commonly associated with adverse effects in PLWHA?

vitamin c megadoses, gingko biloba, cat’s claw, ginseng, licorice, milk thistle

what are the complementary/alternative meds that have been reported to have negative effects?

high energy and protein needs to support growth and development; 50-200% DRI, 150-200% RDA for protein; growth failure and loss of lean body mass are common

what is the intervention for Peds?

children should dno’t be breastfed, formula with clean water is recommended, no mixed feedings

what are the breastfeeding recommendations for HIV?

intake, medication compliance, supplement use, weight changes, biochemical data, NFPE

what should be monitored/evaluated?