Nutrition therapy and pathophysiology

1080 Pages·2011·215.249 MB·English

by  Nahikian-Nelms, Marcia

Brief Table of Contents
PART 1 APPENDIXES
The Role of Nutrition Therapy Appendix A—Answers to End-of-Chapter Questions
in Health Care Appendix B—Answers to Application of the Nutrition Care
Process Questions
1 Role of the Dietitian in the Health Care System 2
Appendix C1—Nutrition Assessment and Monitoring and
PART 2 Evaluation Terminology
The Nutrition Care Process Appendix C2—Nutrition Diagnosis Terminology
Appendix C3—Nutrition Intervention Terminology
2 The Nutrition Care Process 14
Appendix D—Subjective Global Assessment Form
3 Nutrition Assessment: Foundation of the Nutrition
Care Process 34 Appendix E1—Growth Charts
4 Nutrition Intervention 66 Appendix E2 —Triceps Skinfold Thickness, Arm Muscle
Area (AMA), and Mid-Upper Arm Fat Area (AFA):
5 Enteral and Parenteral Nutrition Support 80
Procedures, Computations, Interpretations, and
6 Documentation of the Nutrition Care Process 106
Percentiles
PART 3 Appendix E3—Nomogram for Calculations of Arm Muscle
Introduction to Pathophysiology Circumference and Area
Appendix F—Routine Laboratory Tests With Nutritional
7 Fluid and Electrolyte Balance 119
Implications
8 Acid-Base Balance 137
Appendix G—Normal Values for Physical Examination
9 Cellular and Physiological Response to Injury: The
Appendix H—Nutritional Defi ciencies Revealed by Physical
Role of the Immune System 149
Examination
10 Nutritional Genomics 183
Appendix I—Evidenced-Based Analysis Process
11 Pharmacology 208
Appendix J—Enteral Formulas
PART 4 Appendix K—Parenteral Formulas
Nutrition Therapy Appendix L1—Choose Your Foods: Exchange Lists for
Diabetes
12 Energy Balance and Body Weight 238
Appendix L2—Exchange Calculation Form
13 Diseases of the Cardiovascular System 283
Appendix L3—Renal Medical Nutrition Therapy Calculation
14 Diseases of the Upper Gastrointestinal Tract 340
Form
15 Diseases of the Lower Gastrointestinal Tract 376
Appendix M1—Saturated Fat, Total Fat, Cholesterol,
16 Diseases of the Liver, Gallbladder, and Exocrine and Omega-3 Content of Meat, Fish, and Poultry
Pancreas 437 (3 oz. Portions)
17 Diseases of the Endocrine System 471 Appendix M2—Heme and Nonheme Iron Content of
18 Diseases of the Renal System 520 Selected Foods
19 Diseases of Hematological System 562 Appendix M3—Dietary and Supplemental Calcium Guide
20 Diseases and Disorders of the Neurological Appendix M4—Resistant Starch Guide
System 609 Appendix N—Common Medical Abbreviations
21 Diseases of the Respiratory System 648 Appendix O—Conversion Factors: Milliequivalents/
22 Metabolic Stress and the Critically Ill 682 Milligrams of Electrolytes
23 Neoplastic Disease 702
24 HIV and AIDS 735
25 Diseases of the Musculoskeletal System 771
26 Metabolic Disorders 805
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Aids to Calculation
Conversion Factors Percentages
A conversion factor is a fraction in which the numerator (top) A percentage is a comparison between a number of items (per-
and the denominator (bottom)express the samequantity in dif- hapsthenumberof kcaloriesinyourdailyenergyintake)and
ferent units. For example, 2.2 pounds (lb) and 1 kilogram (kg) a standard number (perhaps the number of kcalories used for
are equivalent; they express the same weight. The conversion Daily Values on food labels). To find a percentage, first divide
factors used to change pounds to kilograms and vice versa are: by the standard number and then multiply by 100 to state the
answer as a percentage(((percentmeans “per 100”).
1 kg 2.2 lb
and .
2.2 lb 1 kg Example 3 Suppose your energy intake for the day is 1500
kcalories (kcal): What percentage of the Daily VVValue (DV) for
Because a conversion factor equals 1, measurements can be
energy does your intake represent? (Use the Daily Value of
multipliedbythefactortochangetheunitof measurewithout
2000 kcalories as the standard.)
changingthevalueof themeasurement.Tochangeoneunitof
measurementto anotherr, use the factor with the unit you are (cid:129) Divide your kcalorie intake by the Daily VVValue:
seeking in the numerator (top) of the fraction. 1500 kcal (your intake)(cid:4)2000 kcal (DV)(cid:3)0.75.
Example1 Convert the weight of 130 pounds to kilograms. (cid:129) Multiply your answer by 100 to state it as a percentage:
(cid:129) Choosetheconversionfactorinwhichthekilogramsare 0.75(cid:2)100(cid:3)75% of the Daily VVValue.
on top and multiply by 130 pounds:
Example4 Sometimesthepercentageismorethan100.Sup-
1 kg (cid:2)(cid:2) 113300 llbb (cid:3) 130 kg (cid:3) 59 kg. poseyourdailyintakeof vitaminCis120milligrams(mg)and
2.2 lb 2.2 yourRDA(male)is90milligrams.Whatpercentageof theRDA
for vitamin C is your intake?
Example2 Considera 4-ounce(oz)hamburgerthatcontains
7grams(g)of saturatedfat.Howmanygramsof saturatedfat 120 mg (your intake)(cid:4)90 mg (RDA)(cid:3)1.33.
are contained in a 3-ounce hamburger? 1.33(cid:2)100(cid:3)133% of the RDA.
(cid:129) Because you are seeking grams of saturated fat, the con-
Example5 Sometimes the comparison is between a part of a
version factor is:
whole (for example, your kcalories from protein) and the total
7 g saturated fat amount(yourtotalkcalories).Inthiscase,thetotalisthenum-
.
4 oz hamburger ber you divide by. If you consume 60 grams (g) protein, 80
grams fat, and 310 grams carbohydrate, what percentages of
(cid:129) Multiply 3 ounces of hamburger by the conversionfactor: your total kcalories for the day come from protein, fat, and
7 g saturated fat 3 (cid:2)7 21 carbohydrate?
3 oz hamburger(cid:2) (cid:3) (cid:3) (cid:3)
4 oz hamburger 4 4 (cid:129) Multiply the number of grams by thenumber of kcalories
from 1 gram of eachenergy nutrient (conversion factors):
5 g saturated fat (rounded off).
4 kcal
60 g protein (cid:2) (cid:3)240 kcal.
1 g protein
9 kcal
80 g fat (cid:2) (cid:3) 720 kcal.
1 g fat
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4 kcal WWWeights and Measures
310 g carbohydrate(cid:2) (cid:3)1240 kcal.
1 g carbohydrate
LENGTH
(cid:129) Find the total kcalories: 1 meter (m)(cid:3)39 in.
1 centimeter (cm)(cid:3)0.4 in.
240(cid:5)720(cid:5)1240(cid:3)2200 kcal. 1 inch (in)(cid:3)2.5 cm.
1 foot (ft)(cid:3)30 cm.
(cid:129) Find the percentage of total kcalories from each energy
nutrient (see Example 3): TEMPERAAATURE
Protein: 240(cid:4)2200(cid:3)0.109(cid:2)100(cid:3)10.9(cid:3) Steam 100°C 212°F Steam
11% of kcal. Body temperature 37°C 98.6°F Body temperature
Fat: 720(cid:4)2200(cid:3)0.327(cid:2)100(cid:3)32.7(cid:3)
Ice 0°C 32°F Ice
33% of kcal.
Carbohydrate: 1240 (cid:4) 2200 (cid:3) 0.563 (cid:2) 100 (cid:3) 56.3 (cid:3) Celsius* Fahrenheit
56% of kcal.
TTTotal: 11%(cid:5)33%(cid:5)56%(cid:3)100% of kcal.
(cid:129) TTTo find degrees Fahrenheit (°F) when you know degrees
Celsius (°C), multiply by 9/5 and then add 32.
In this case, the percentages total 100 percent, but sometimes
they total 99 or 101 because of rounding—a reasonable (cid:129) TTTo find degrees Celsius (°C) when you know degrees
estimate. Fahrenheit (°F), subtract 32 and then multiply by 5/9.
VOLUME
Ratios 1 liter (L)(cid:3)1000 mL, 0.26 gal, 1.06 qt, or 2.1 pt.
1 milliliter (mL)(cid:3)1/1000 L or 0.03 fluid oz.
Aratioisa comparisonof two(orthree)valuesinwhichoneof
1 gallon (gal)(cid:3)128 oz, 8 c, or 3.8 L.
the values is reduced to 1. A ratio compares identical units and
1 quart (qt)(cid:3)32 oz, 4 c, or 0.95 L.
so is expressed without units.
1 pint (pt)(cid:3)16 oz, 2 c, or 0.47 L.
1 cup (c)(cid:3)8 oz, 16 tbs, about 250 mL, or 0.25 L.
Example 6 Suppose your daily intakes of potassium and 1 ounce (oz)(cid:3)30 mL.
sodiumare3000milligrams(mg)and2500milligrams,respec- 1 tablespoon (tbs)(cid:3)3 tsp or 15 mL.
tively. What is the potassium-to-sodium ratio? 1 teaspoon (tsp)(cid:3)5 mL.
(cid:129) Divide the potassium milligramsby the sodium milligrams: WEIGHT
1 kilogram (kg)(cid:3)1000 g or 2.2 lb.
3000 mg potassium(cid:4)2500 mg sodium(cid:3)1.2. 1 gram (g)(cid:3)1/1000 kg, 1000 mg, or 0.035 oz.
Thepotassium-to-sodiumratiois1.2:1(readas“onepointtwo 1 milligram (mg)(cid:3)1/1000 g or 1000 µg.
to one” or simply “one point two”), which means there are 1.2 1 microgram (µg)(cid:3)1/1000 mg.
milligramsof potassiumforevery1 milligramof sodium.A ra- 1 pound (lb)(cid:3)16 oz, 454 g, or 0.45 kg.
tio greater than 1 means that the first value (in this case, potasss- 1 ounce (oz)(cid:3)about 28 g.
sium) is greater than the second (sodium). When the ratio is
less than 1, the second value is larger. ENERGY
1 kilojoule (kJ)(cid:3)0.24 kcal.
1 millijoule (mJ)(cid:3)240 kcal.
1 kcalorie (kcal)(cid:3)4.2 kJ.
1 g carbohydrate(cid:3)4 kcal(cid:3)17 kJ.
1 g fat(cid:3)9 kcal(cid:3)37 kJ.
1 g protein(cid:3)4 kcal(cid:3)17 kJ.
1 g alcohol(cid:3)7 kcal(cid:3)29 kJ.
*Also known ascentigrade.
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Nutrition Therapy
and Pathophysiology
Second Edition
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Nutrition Therapy
and Pathophysiology
Second Edition
Marcia Nahikian Nelms Jeremy T. Barnes
The Ohio State University Southeast Missouri State University
Kathryn Sucher Mildred Mattfeldt-Beman
San Jose State University Saint Louis University
Karen Lacey Roschelle A. Heuberger
University of Wisconsin, Green Bay Central Michigan University
Sara Long Roth Kathy Jones Irwin
Southern Illinois University Carbondale Mercy Health Systems
Diane Habash Ethan A. Bergman
The Ohio State University Central Washington University
R. Gerald Nelms Susan N. Hawk
University Center for the Advancement of Central Washington University
Teaching at Ohio State University
Deborah A. Cohen
Christina Lee Frazier University of New Mexico
Southeast Missouri State University
Cade Fields-Gardner
Melissa Hansen-Petrik The Cutting Edge
The University of Tennessee–Knoxville
Elaina Jurecki
Robert D. Lee BioMarin Pharmaceutical Inc.
Central Michigan University
Joyce Wong
Thomas J. Pujol Kaiser Permanente Medical Center,
Southeast Missouri State University Northern California
Joshua E. Tucker
Michigan State University
Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States
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Dedication
For our colleagues in
nutrition and dietetics
For our students: past,
present and future.
For Jerry, Taylor, and Emory
Marcia Nahikian-Nelms
For my supportive and loving husband
Peter, and my son Alexander
Kathryn Sucher
For my husband Jim; your
encouragement and support
mean the world to me
Karen Lacey
JKR . . . your love and friendship make
life a joyous experience
Sara Long Roth
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