Chapter 26,27,28,29_CN_Lung, Cardiovascular, Renal, and Metabolic Disorders and Diseases

Acute respiratory failure

Condition that happens suddenly in which the exchange of O2 and/or CO2 between the alveoli and the pulmonary capillaries is inadequate.

Chronic obstructive pulmonary disease (COPD)

a group of lung diseases in which the bronchial airflow is chronically or recurrently obstructed, making it hard to breathe - dyspnea - as its major symptom

Forced Expiratory Volume (FEV)

used to measure and classify copd into

gold 1,,2,3,4

Emphysema

A serious disease that destroys lung tissue and causes breathing difficulties, characterized by abrnomal enlargement of air spaces

Bronchitis

Inflammation of the bronchi

Asthma

A condition in which a person's airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe; an immunological response to an allergen

Hypercapnea

High amounts of CO2 in the blood

Hypoxemia

Low levels of O2 in the blood

Cyanosis

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.

20-25 kcal/kg/day

Calorie recommendation for patients with COPD

SFF(air swallowing)

Frequency of feeding for patients with COPD

45-50% High fat(low RQ=0.7)

30-35% low carb(high RQ=1)

15% protein(RQ=0.8)

sodium restricted diet

avoid gas forming foods

avoid choking hazard foods(stringy/tough/crunchy)

Diet order for patients with COPD

Diabetes Mellitus

A group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

Insulin

Hormone that lowers blood sugar levels

Beta cells

Cells in the Islets of Langerhans that secrete insulin

Hyperglycemia

Excess of sugar in the blood

type 1 diabetes mellitus

Diabetes caused by a total lack of insulin production; usually develops in childhood, and patients require insulin replacement therapy to control the disorder

- autoimmune

type 2 diabetes mellitus

Diabetes in which the body produces insulin, but not enough, or there is insulin resistance. The patient usually is not dependent on insulin for survival. Largely the result of sedentary lifestyle and excess body weight

Gestational diabetes

a form of diabetes mellitus that occurs during some pregnancies

impaired glucose tolerance (IGT)

A disorder in which blood glucose levels become elevated, and is the intermediate between normoglycemia and diabetes

180 mg/dL

Renal threshold for glucose

Somogyi phenomenon

A rebound phenomenon that occurs in clients with type 1 diabetes mellitus. Normal or elevated blood glucose levels are present at bedtime; hypoglycemia occurs at about 2 to 3 am. Counterregulatory hormones, produced to prevent further hypoglycemia, result in hyperglycemia (evident in the prebreakfast blood glucose level).

Polydipsia

excessive thirst

Polyuria

excessive urination

Polyphagia

excessive hunger

Ketosis

an abnormal accumulation of ketone bodies that is frequently associated with acidosis

Glycosuria

Excretion of sugar in urine

Ketonuria

Excretion of ketone bodies in the urine

>=200 mg/dL

RBS(random blood sugar) result indicative of DM

>126 mg/dL

FBS result indicative of DM

140-199 mg/dL

2hr OGTT/RBS result indicative of IGT

2hr OGTT/RBS result indicative of normal

>=200 mg/dL

2hr OGTT result indicative of

Oral Glucose Tolerance Test (OGTT)

Timed glucose challenge to examine efficiency of the body in metabolism of glucose

fasting blood sugar (FBS)

measurement of blood sugar level after fasting (not eating) for 12 hours

HbA1c

test to assess how well blood sugars have been controlled over the past 90-120 days.

HbA1c result for non-diabetics

5.7-6.4%

HbA1c result forpre-diabetics

>=6.5%

HbA1c for diabetes

Macroangiopathies

Damage to large blood vessels

Microangiopathies

Damage to the small blood vessels

Diabetic nephropathy

Damage to glomerular capillaries due to high blood sugar of diabetes mellitus

Diabetic retinopathy

Damage to the retina as a complication of uncontrolled diabetes

Diabetic Neuropathies

Cell damage from increased glucose levels leads to nerve degeneration & delayed conduction

Sensory deficits & symptoms (more than mator involvement)

Diabetic ketoacidosis

Acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy

- pH

Non-ketotic hyperosmolar coma

A syndrome of marked diabetic stupor, hyperglycemia, and hyperosmolarity in the absence due to dehydration of the brain cells caused by hyperosmolarity of blood due to excess sugar.

Gangrene

Death of tissue caused by loss of blood supply followed by bacterial invasion

Insulin shock

The result of too much insulin which causes a dangerous drop in blood glucose.

Sulphonylurea drugs

DM drugs contraindicated to pregenant DM patients due to risk of neonatal hypoglycemia and congenital anomalies

sulfonylureas

- ends in amide

diab drug

- stimulate insulin secretion

biguanides

- metformin

diab drug

- reduce glucose prod

- lessen insulin resistance

Short acting insulin

insulin that

starts 1hr or less

peaks 2-3hr

duration 3-6 hr

Intermediate acting insulin

insulin that

starts 2-4hr

peaks 4-12hr

duration 12-18 hr

long acting insulin

insulin that

starts 2hr

peaks no peak

duration 24 hr

1/3, 1/3, 1/3 or

2/5, 1/5, 2/5

CHO distribution for short-acting insulin

1/7, 2/7, 1/7, 2/7, 1/7

CHO distribution for intermediate-acting insulin

1/5, 2/5, 2/5;

1/3, 1/3, 1/3 both with 20-40 g h.s.

CHO distribution for long-acting insulin

20-30 g

Fiber recommendations for DM patients

Highly individualized diet

Diet prescribed to DM patients

Consistent carbohydrate diet

Diet which intends to keep intake of carbs at a constant level to avoid rapid increases or decreases in blood sugar levels.

- total carbs per day matter more

Make-up diet

Diet made from fruit/fruit juices foe insulin-requiring diabetics designed to make-up for missed meals to allay hypoglycemia

Limit to 30 g

Carbohydrate limit (g) during breakfast for GDM patients due to insulin resistance from hormonal action

1. Carb(normal=50-70%)

2. Protein(normal to high or 0.8kg if with dkd)

3. fat(25-30%)

4. Heart healthy

5. 20-30g fiber

6. soidum(

MNT for Diabetes

Metabolic Syndrome (Syndrome X)

Insulin Resistance Syndrome; A collection of risk factors that increase an individual's chance of developing cardiovascular disease and diabetes mellitus

Alternative sweeteners

Substances that are added to sweeten foods while providing few or no kilocalories and do not cause caries

low GI

56-69

medium GI

>=70

high GI

45-75 g

CHO allocation for meals for CC diet

15-30 g

CHO allocation for snacks for CC diet

reactive hypoglycemia

Decrease in blood sugar due to hypersecretion/dosing of insulin

Polyphagia, polyuria, polydipsia

3 P's of diabetes

Fasting hypoglycemia

Decrease in blood sugar due to insulin overdose, alcohol, tumor, heparic disease, or chronic renal insufficiency

Hyperthyroidism/Grave's disease

Abnormally high secretion of thyroid hormones

- weight loss

- high bmr(+50%)

- big thyroid and eyes

1. High kcal diet

2. vit and min supp

3. low iodine

Diet order for patients with hyperthyroidism

Hypothyroidism

condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity

- due to lack of iodine

- decreased BMR(30-40%)

- weight gain

- puffy face and hands

Low calorie diet

Iodine(to meet deficiency)

MNT for hypothyroidism

Hyperparathyroidism

Hypersecretion of parathyroid hormone; may result in hypercalcemia and Recklinghausen(cell growth neural tissues) disease

- osteoporosis

- kidney stones

Acid ash diet

Diet which acidifies urine, and prevents Ca-stone formation -- presribed to patients with hyperparathyroidism

1. high fluid

2. Acid Ash diet

3. Na IV

4. phosphate(to prevent calcium release to blood)

MNT for hyperparathyroidism

parathormone (PTH)

Hormone secreted by the parathyroid glands; increases blood calcium

Phosphate binders

drugs that bind with phosphorus in food so the phosphorus is not absorbed in the intestines

Hypoparathyroidism

hyposecretion of parathyroid hormone; may result in hypocalcemia and tetany

-chvostek's - face spasm

-trousseau's - hand spasm

- cramps

-spasms

High calcium, high vitamin D

Dietary managment of hypoparathyroidism to normalize calcium levels

Addison's disease

A condition that occurs when the adrenal glands do not produce enough cortisol or aldosterone -

weight loss,

hyponatremia,

hyperkalemia,

hypoglycemia, and

hypotension occur

Aldosterone

A mineralcortocoid produced by the adrenal cortex that promotes sodium and water reabsorption by the kidneys and potassium excretion in urine.

1. high na

2. low potassium

3. high kcal if underweight

4. adequate fluids

MNT for addison's disease

High sodium, low potassium

Mineral recommendations for patients with Addison's disease

High kcal

Calorie recommendation for underweight patients with Addison's disease

Cushing's disease

Hypersecretion of the adrenal cortex causing

weight gain,

hypernatremia,

hypokalemia,

hyperglycemia,

hypertension

1. low na

2. high k

3. low kcal if obese

4. fluid restriction

MNT for cushings

Low Na, High K

Mineral recommendations foe patients with Cushing's disease

Low kcal

Calorie recommendation doe obese patients with Cushing's disease

Wilson's disease

Inherited disorder characterized by defective metabolism and excretion of Copper, caused by mutation of gene for coper transporting adenosine triphosphatase

- jaundice

- kayser fleischer rings(dark ring around iris)

Copper-restricted diet

(oysters, shellfish, organ meats, whole grains, nuts, legumes, potatoes, mushrooms)

Diet order for patient's with Wilson's disease

Hemochromatosis

Hereditary disorder with an excessive buildup of iron deposits as hemosiderin in the body

Iron-restricted diet

(meat, organs, eggs, legumes, green leafies)

Diet order for patients with hemochromatosis

Inborn Errors of Metabolism (IEM)

A group of congenital conditions that cause either accumulation of toxins or disorders of energy metabolism in the neonate due to defective enzymes. These conditions are characterized by an infant's failure to thrive and by vague signs such as poor feeding.

1. restrict substrate

2. supply amount of product or cofactor

3. combination of all these

General goals of MNT for IEM

Newborn screening

Tests used to screen newborn infants for a range of genetic and non-genetic disorders

- 24 hrs from birth