shaukat khanum memorial cancer hospital & … report amna...final year internship report 3...

Final Year Internship Report 1

Shaukat Khanum Memorial Cancer Hospital & Research Centre

Final Year Internship Report

Name: Amna Ramzan

Course: B.Sc. Hons. Home Sciences

Major: (Food and Nutrition)

Shaukat Khanum Memorial Cancer Hospital & Research Centre Department of Clinical and Nutrition



Table of Contents:

1. Acknowledgement ……………………….……………. 3 2. Weekly Schedule of Internship Program ……..……….. 4 3. Literature Review about Cancer ……………..……..….. 6 4. Diet Plans for different Diseases ………..…………….. 11 5. Renal and Liver Diseases ………….……………...…... 21 6. Surgery ………………………………...……………… 28 7. Intestinal cancers and stoma………..…………………. 30 8. Enteral feeding and pediatric assessment……………… 33 9. SGA rating form and OPD…………………..………… 39 10. References ……………………………………….. 39



1. ACKNOWLEGDEMENT All praise to Almighty who has given me an opportunity pertaining an internship program as a part of B.Sc. Hons. Home Sciences (Food and Nutrition). It is one kind of research work. We know very well that research in any field of knowledge enriches the stock of knowledge. There may be two types of research viz. theoretical research and applied research.

First I would like to express my profound gratitude to my honorable Miss. Rashida Javed (Head of clinical and nutrition department SKMCH&RC). She helped me a lot by proper guidance, effective comments and with a good support. She had always paved me the right way to conduct my internship program. She has passed a lot of time in this respect. She was cordial to solve my problem.

At last I am grateful to my respected teachers and the head of the department Dr. Naheed Abbas.

Regards

Amna Ramzan

B.Sc. Hons. Home Sciences

(Food and Nutrition)

University of Agricultural Faisalabad



2. Weekly Schedule of Internship Program

WEEK 1.

• What is cancer, its treatment?

• Cancer cachexia and nutrition requirements.

• Nutrition assessment (tools/parameters)

• Exchange list (count caloric intake, food groups and diet consistencies.

WEEK 2.

• Diabetes mellitus

• Cardiac diseases, hypertension.

• Obesity

• Eating disorders (anorexia nervosa, bulimia nervosa)

• GI tract & celiac disease

WEEK 3

• Renal diseases (pre dialysis, dialysis, post dialysis)

• Renal calculi & uric acid

• Liver diseases (jaundice, hepatitis, cirrhosis)

WEEK 4

• Surgery (dietary modifications for buckle surgery, esophagectomy)

• Intestinal cancers and stoma formation

• Assignment

WEEK 5

• Enteral feeding (types, indication, supplement reconstitution)

• PEG/NG (problems and solutions)

• Pediatric assessment (ideal height &weight for age)



3. LITERATURE REVIEW ABOUT CANCER

CANCER What is cancer?

Malignant growths or tumors that result from abnormal and uncontrolled cell division. The development of the cancer is called carcinogenesis.

How cancer develops?

Inheritance:

Cancer arises from mutation in the genes. Vulnerability to cancer is sometimes inherited. Phagocytes produce oxidants that cause DNA damage.

Environmental factors: • Aflatoxins: (Regularly found in improper stored foods as chili pepper, corn, cotton seed, Millet, peanut, rice, sorghum, sun flower seeds, wheat’s)

• Alcohol

• Asbestos: (a fire resistant mineral used in tiles, cement, textiles)

• Tobacco

Major types of cancer:

• Lymphoma: is a group of blood cell tumors that develop from lymphatic cells.

• Carcinoma: Carcinoma is a type of cancer that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or ectodermal germ layer during embryogenesis

• Leukemia: is a group of cancers that usually begin in the bone marrow and result in high numbers of abnormal white blood cells. These white blood cells are not fully developed and are called blasts or leukemia cells.

• Sarcoma: A sarcoma (from the Greek σάρξ sarx meaning "flesh") is a cancer that arises from transformed cells of mesenchymal origin. Thus, malignant tumors made definition, considered sarcomas. This is in contrast to a malignant tumor originating from epithelial cells, which are termed carcinoma. Human sarcomas are quite rare.



• Myeloma: Multiple myeloma is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies.

Cancer Consequences Cancer consequences depend upon the location of the tumor severity and treatment effects. Anorexia, lethargy, weight loss, night sweats and fever.

Cancer Cachexia: A wasting syndrome associated with cancer that is characterized by Anorexia, waisting, weight loss, fatigue.

Weight loss: Weight loss is an evident at the time of cancer. Poor appetite, abnormal metabolism, and diversion of nutrients to support tumor growth result in lower supply of energy and nutrients when demands are high.

Metabolic changes: Cancer increase the rate of protein turn over, reduced muscle protein synthesis, gluconeogenesis occur staring the protein needs, increase lipid in serum and insulin resistant.

Anorexia and reduced food intake:

Anorexia is major contributor in wasting.

• Chronic nausea

• Early satiety

• Fatigue (Lack of energy leads to cachexia)

Medical Treatment Effects Chemotherapy:

Chemotherapy reduce the tumor prolification or shrink it before surgery

Short term side effects:

• Hair loss (alopecia)

• Finger nail and toenail weakness

• Pain

• Mouth and throat sores (mucositis, stomatitis)



• Fatigue

• Constipation

• Diarrhea

• Temporary loss of menstrual periods (amenorrhea)

• Menopausal symptoms (such as hot flashes)

• Infection

• Weight gain

• Sleep disorders (insomnia)

• Anemia

• Leukopenia/neutropenia

Long term side effects:

• Early menopause

• Fatigue

• Mental fatigue

• Long term health risks

Radiation therapy:

Radiation therapy uses high-energy radiation to shrink tumors and kill cancer cells. X-rays, gamma rays, and charged particles are types of radiation used for cancer treatment.

Side Effects:

• May damage healthy cells

• Skin problems (dryness, itching, blistering or peeling)

• Nausea & vomiting

• Changes in menstruation, vaginal itching, burning

• Rectal bleeding



Bone Marrow Transplant:

It is high quality chemotherapy which may be the radio therapy of the whole body. In it the whole bone marrow is destroyed and new bone marrow is transplant.

Side Effects:

• Low platelets and low red blood cells

• Pain

• Respiratory distress

• Organ damage

Side effects:

Acute metabolic distress caused by surgery raises the protein and energy needs, surgery also contribute to fatigue, pain and anorexia. Blood loss leads to mal nutrition due to loss of nutrients.

Cancer Cachexia:

Cancer cachexia is the multifactorial syndrome defined by an ongoing loss of skeleton muscle mass that can nutritional support and leads to functional impairment.

A clinical syndrome characterized by

• Anorexia

• Early satiety

• Weight loss

• Muscle wasting

• Anemia

• Edema

• Severe body weight, fat and muscle loss

• Increases protein catabolism

Diagnosis:

Involuntary weight loss >5% over last six months



Phases of cancer cachexia:

Pre cachexia Cachexia Refractory cachexia

Normal cachexia

Weight loss < 5% weight loss >5 low performance score

Metabolic/ often reduced food immune compromised

Endocrine change intake/systematic <3 months expected survival

Inflammation.

Neutropenia:

Neutropenia is the lower level of neutrophils. Neutrophils fight infection by destroying harmful bacteria and fungi or yeast that invade the body. Neutrophils formed in the bone marrow. Some level of neutropenia occurs in about half of the people with cancer who are receiving chemotherapy. That causes the infections due to the lower level of neutrophils.

Signs and symptoms of neutropenia:

• Neutropenia itself may not cause any symptoms. Patient usually find out through test.

• Patients of neutropenia, even a minor infection develop serious infections

• Fever >100.5 degree F

• Chills & sweating

• Sore throat, sours in mouth

• Abdominal pain

• Pain and burning during urination



• Diarrhea or soreness of breaths

• Any redness, swelling or pain

• Unusual vaginal discharge

Causes:

• Cancer treatment can cause a low level of neutrophils

• Some types of chemotherapy

• Cancers that effects the bone marrow e.g. leukemia, lymphoma and Myeloma

• Radiation therapy to the bones in the pelvic, legs, chest or abdomen

• People older than 70 years have more chances of neutropenia.

4. Diet Plans for Different Diseases

DIET Avoided:

• All fresh fruits vegetables

• Raw or rare cooked foods Tae or coffee

• Fresh yogurt

• Mutton

• Salads

ALLOWED:

• All things which are in hygienic conditions.

• Fruits which can use with its covering e.g; apple, banana, orange etc

• All processed or packed foods

• Meat which is completely cooked.

• Vegetables which are cooked completely.



Glycemic Index:

Glycemic index was designed to help the people with diabetes, control their blood sugar level. It helps to drop extra weight. Glycemic index focusing on carbs like white bread, cookies & white potatoes make the sugar level rise quickly.

High GI foods: (70 or higher)

• White rice

• White bread

• White baked potatoes

• Crackers

• Sugar sweetened beverages.

• Preteels (fatty biscuits)

Medium GI foods:

• Banana

• Grapes

• Spaghetti

• Ice cream

• Raisins

• Corn

Low GI foods:

• Oatmeal

• Kidney beans

• Carrot

• Peas

• Peanuts

• Skim milk

• Most fruits except (water melon)



FOOD GI Serving (g) Glycemic load

GI Type

BREAD White wheat flour bread

71 30 9 High

Whole wheat bread

73 30 9 High

100% whole grain bread

51 30 7 Low

Beverages Coca Cola 63 250ml 16 Medium Fanta 68 250ml 23 Medium Orange Juice 50 250ml 12 Low Breakfast cereals

Bran 55 30 12 Low Corn flakes 77 30 20 High White rice 89 150 43 High Brown rice 50 150 16 Low Dairy products

Ice cream 57 50 6 Medium Milk full fat 41 250ml 5 Low Milk skim 32 250ml 4 Low Fruits Apple 39 120 6 Low Banana ripe 62 120 16 Medium Dates dried 42 60 18 Low Grape fruit 25 120 3 Low Orange 40 120 4 Low Peach 42 120 5 Low Pear, canned pear juice

42 120 5 Low

Raisins 64 60 28 Medium Water melon 72 120 4 High Grapes 59 120 3 Medium Beans & Nuts Baked beans 40 150 6 Low Black beans 30 150 7 Low



Chick peas 10 150 3 Low Kidney beans 29 150 7 Low Soy beans 27 150 3 Low cashews 7 50 3 Low peanuts 7 50 0 Low Pasta Noodles Macroni 47 180 23 Low Macroni and cheese

64 180 32 Medium

Spaghetti white boiled

46 180 22 Low

Spaghetti whole meal boiled

42 180 17 Low

Snack foods Corn chips 42 50 11 Low Microwave popcorn

55 20 6 Medium

Vegetables Green peas 51 80 4 Low Carrot 35 80 2 Low Baked crusset potato

82 150 21 High

Sweet potato 70 150 22 High Yam 54 150 20 Low Miscellaneous Chicken nuggets

46 100 7 Low

Pizza(plain , baked dough)

80 100 22 High

Pizza hut (super supreme)

36 100 9 Low



Diabetes • Add fruits and vegetables in diet.

• Avoid bakery products & sweet beverages.

• Walk daily for at least 20min.

• Use fat free dairy products.

• Use lean meat & meat products.

• Insulin should be used according to the doctor’s recommendation.

• Diabetes should check out before every meal.

• Limit the oily foods

• Artificial sweeteners are not so healthy.

Serving Carbs Protien Fats Calories Breakfast Yogurt 2/3cup 15g 8g 0-3g 100 chapati 1(6inches) 15g 8g 0-3g 80 Egg 1 0g 7g 4-7g 75 Brunch Tea 1cup 15g 8g 0-3g 100 Biscuit 3 small 15g 5g 10g 90 Lunch Baryani Rice 1/3cup 15g 3g 0-1g 80 chicken 2oz 0g 14g 3-6g 90 Yogurt 2/3cup 15g 8g 0-3g 100 Snack Grape fruits& strawberries juice

Grape fruit 1 3og 0g 0g 60 strawberries 1cup 15g 0g 0g 60 Dinner



chapati 1 (6inches) 15g 16g 0g 160 Potato(gravy) 1/3cup 3g 3g 0-1g 80 Carrot 1/2cup 2g 2g 0 25 Post dinner Milk(skim) 1cup 15g 8g 0-3g 100 Almonds 10 0g 0g 5g 45 Total 170g 93g 21g 1235

DIET PLAN

Calories split up:

Carbs: 55% Protein: 30% Fats: 15%

HYPERTENTION & CARDIOVASCULAR DISEASES

• Avoid bakery products. • Do not sprinkle salt on fruits. • Use less fast foods and cold drinks. • Celery should not use frequently in a week. • Purified water should be used because fresh water also contains salt. • Processed foods should be avoided like bread, biscuits, cake.

DIET PLAN

Serving Carbs Protein Fats Calories Breakfast Chapati 1(6inches) 15g 3g 0-3g 80 Omelate 1 0g 7g 4-7g 75 Milk (skim)

1cup 15g 8g 0-3g 100

Brunch Grape fruit

1 15g 0g 0g 60

Lunch Chicken plao

Rice 1cup 15g 3g 1g 160 Chicken 2oz 0g 7g 0-3g 80



Yogurt 1cup 15g 8g 0-3g 100 Salad 1cup 5g 5g 2g 25 Snack Tea 1cup 15g 3g 0-3g 80 Nuggets 3 15g 3g 0-3g 80 Dinner chapati 1(6inches) 15g 3g 0-3g 80 Mix vegetables

1cup 5g 2g 0g 25

Yogurt 1cup 15g 8g 0-3g 100 Post dinner

Milk 1cup 15g 8g 0-3g 100 Total 170g 75g 20g 1145

Calories split up:

Carbs: 59% Protein: 26% Fats: 15%

EATING DISORDERS:

Eating disorders describe illness that are characterized by irregular eating habits and severe distress or concern about body weight & shape.

Types:

• Bulimia nervosa

• Anorexia nervosa

BULIMIA NERVOSA:

Behaviors that compensate by the overeating such as forced vomiting, excessive exercise or extreme use of laxatives & diuretics result in thickened skin.

Signs and symptoms:

• Swollen salivary glands , sores in mouth and throat.

• Dehydration

• Sores on hands from using them to induce vomiting

• Electrolyte imbalance



• Dry skin

• Fatigue

• Irregular and absent menstrual cycle in females

ANOREXIA NERVOSA:

An eating disorder which effects brain and nerves, hair , heart and other parts of the body

Causes:

• Develop later as a result of mal nutrition.

• Fear of gaining weight

Treatment:

• Brush regularly to prevent the further decay of teeth

• Avoid acidic foods.

Nutritional support:

• Protein drinks (powdered protein)

• Milk

• Eggs

• Meat

• Sauces or gravies

• Oil

• Before treatment the parenteral nutrition or enteral nutrition should be provided.

GI TRAC DISEASES

The digestive tract is a twisting tube about 30 feet long. It starts at the mouth and ends at the anus. In between are the esophagus, stomach and bowels (intestines). The liver and pancreas aid digestion by producing bile and pancreatic juices which travel to the intestines. The gallbladder stores bile until the body needs it for digestion.



The digestive system breaks down food and fluids into much smaller nutrients. In this complex process, blood carries the nutrients throughout the body to nourish cells and provide energy. The GI tract is divided into two main sections: the upper GI tract and the lower GI tract.

• Upper GI tract — mouth, pharynx, esophagus and stomach. The stomach leads to the small intestine.

• Lower GI tract — intestines (bowel) and the anus. The bowel is made up of two sections:

• Small intestine — the duodenum, jejunum and ileum

• Large intestine — the cecum (where the appendix is attached), colon and rectum

CELIAC DISEASE:

When people with celiac disease eat gluten (a protein found in the wheat, rye, barley), their body mounts an immune system that attacks the small intestine. These attacks lead to damage on villi. When villi get damage, nutrients cannot be absorbed properly in to the body.

Treatment:

• Strictly follow the gluten free diet.

Untreated celiac disease leads to many problems such as

• Iron deficiency anemia

• Early onset of osteoporosis

• Infertility, miscarriage

• Lactose intolerance

• Pancreatic insufficiency

• Intestinal lymphoma

Crohn’s Disease:

Foods to avoid:

• Nuts

• Fruits with skin



• Popcorns

• Fried foods

• Cured meat

• Seeds like strawberries

• Tomatoes

• Coffee, carbonated beverages

• Chocolate

• Alcohol

• Diary

• Butter, mayonnaise

• Food high in fiber

• Spicy foods

Recommended Foods:

• Soft foods

• Cooked or canned fruits

• Fish chicken

• Choose harder and aged cheese

DIET PLAN

Serving Carbs Protein Fats Calories Breakfast Sandwich

Potato 1 (small) 15g 3g 0-1g 80 Chicken(lean) 1 0z 0g 0-3g 7g 45 Bread slice 2 15g 3g 0-1g 80 Strawberries juice

1cup 15g 0g 0g 60

Brunch Chicken



vegetable pasta Pasta 1cup 15g 3g 0-1g 100 chicken 10z 0g 7g 0-3g 45 vegetables 1/3cup 5g 2g 0-1g 25 Lunch Chinese rice Rice 1 cup 15g 3g 0-1g 100 vegetables 1/3 cup 5g 2g 0g 25 chicken 1 oz 0g 7g 0-3g 45 snack Steam chicken

2 oz 0g 14g 0-3g 90

Apple juice 1 cup 15g 0g 0g 60 Dinner Grill fish 5 0z 0g 28g 0-3 g 180 Cheese sandwiches

cheese 1/3 cup 0g 7g 8g 100 Bread slice 2 15g 3g 0-1g 80 Total 150g 84g 30g 1200

Calories split up:

Carbs:50% Protein:28% Fats: 22%

RENAL DIASESES

NUTRITIONAL REQUIREMENT

Acute Renal failure

Chronic Renal failure

Hemodialysis Peritoneal Dialysis

Calories (kcal/kg/d)

25-35 35<60yrs 30-35>60yrs

35<60yrs 30-35>60yrs

35<60yrs 30-60yrs include calories from dialysis

Protein (gm/kg/d)

1-1.5 0.6-0.75 50%HBV

1.2 50% HBV

1.2-1.3 50% HBV

Fat 0.8-1.5 Patients are higher risk of CVD emphasis on



(g/kgBW/d) PUFA,MUFA,250-300mg cholesterol/day Carbohydrates (g/kgBW/d)

3.0-5.0 Maximum (7)

- - -

Sodium (mg/d)

1000-3000 2000 2000 2000

Potassium (mg/d)

Generally not restricted unless serum potassium is elevated or urine output less than 1L/day

Correlated to laboratory values

2000-3000 (8-17mg/kg)

2000-3000 (8-17mg/kg)

Calcium (mg/d)

1200-1600 1200 <2000 from diet and medications

<2000 from diet and medications

Phosphorus (mg/d)

800-1200 Correlated to laboratory values

800-1000 800-1000

RENAL CALCULI: Kidney stones or renal calculi are solid masses made of crystals. Kidney stones usually originate in our kidney. The urinary tract includes the kidneys, ureter, bladder and urethra.

Types:

• Calcium stones

• Uric acid stone

• Struvite

• Cysteine



Calcium stones:

Calcium stones are most common. They can be made up of calcium oxalate, phosphate or maleate. Use lower oxalic foods.

High oxalate foods

• Potato

• Chips

• Peanuts

• Nuts

• Chocolate

• Beets

• Spinach

• Oranges

• Dark green vegetables

Purine high foods:

• Meat

• Sea foods

Uric acid stones:

This type of kidney stone are more common in men the women. They can occur in people with gout or those who going through chemotherapy.

This type develop when urine is too acidic.

• Avoid the high purine diet.

STRUVITE:

These stones are found in the women with urinary tract infections. These are caused by kidney infections.



CYSTINE:

These occur both men and women who have genetic disorder cystinuria.

(Disorder due to the defect of transport of amino acids including cysteine). In this type cysteine that leaks from kidney to the urine.

Symptoms:

• Blood in urine

• Vomiting

• Nausea

• Discoloration or foul smelling.

• Chills

• Fever

• Frequent and small amount of urination.

Foods that trigger the kidney stones:

• Excessive caffeine

• Red meat

• Oxalate rich foods

• Non fermented soy

• Carbonated drinks

• Excessive drinking ( alcohol)

• Table salt

5. LIVER DISEASES • Hepatitis

• Jaundice

• Cirrhosis

Hepatitis:

Hepatitis is the condition of liver in which inflammation occur.



Types:

Hepatitis A: is present in the faces of infected person and is most often transmitted through consumption of water or food.

Symptoms:

• Fatigue

• Fever

• Dark urine

• Light color stool

• Fever

• Jaundice

Hepatitis B: Needs rest; diet required high protein and carbs.

Hepatitis C: vitamin B12 supplement can be given to the patients

How to prevent hepatitis?

• Wash your hands with soap after going to toilet

• Only use those foods which just have been cooked.

• Only drink boiled water

• Only eat fruits that you can peel.

• Eat raw vegetables after washing.

• Don’t share needles, brushes, and machine equipment’s

Foods to avoid:

• Alcohol

• Junk foods

• Hydrogenated oils

• Processed food

• Artificial sweeteners

• High fat



JAUNDICE:

Jaundice occur when hemoglobin break down and produce bilirubin. It results in yellowness of eyes, skin and mouth.

It mostly occurs in newly born babies.

Types:

Hepatocellular: that occurs as a result of liver disease or injury.

Hemolytic: that occurs as a result of hemoglobin breakdown.

Obstructive Jaundice: that occurs as a result of obstruction in bile duct.

Causes:

• Acute inflammation of liver

• Inflammation of bile duct

• Hemolytic anemia

Symptoms:

• Yellow tinge to eyes

• Pruitis (ichiness)

• Fatigue

• Abdominal pain

• Weight loss

• Vomiting

• Fever

• Paler than usual

• Dark urine

Treatment:

• Drink plenty of water

• Adequate rest

• Avoid digestive disturbance



• Moderate exercise.

CIRRHOSIS:

Cirrhosis is a late stage of scaring of liver caused by many forms of liver diseases.

Fluid retention: cirrhosis gets a buildup of fluid in edema. For this purpose use less sodium in diet to prevent fluid retention.

Symptoms:

• Nausea

• Vomiting

• Severe weight loss

• Shortage of zinc

• Weakness

Life style remedy:

• Don’t drink alcohol.

• Eat low sodium diet.

• Eat plenty of fruits and vegetables.

• Use lean meat.

• Use protein as legumes, poultry and fish

• Wash hands before eating

• Get vaccinated for hepatitis A, Influenza and pneumonia

• Avoid drugs like aspirin and ibuprofen.

HEPATIC ENCEPHALOPATHY

Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction.

Causes:

• Pneumonia

• Dehydration



• Low Oxygen

• Use of medications to suppress immune system

• Eating too much protein

• Electrolyte imbalance

Symptoms:

• Difficulty in thinking

• Personality changes

• Poor concentration

• Problems in hand writing or loss of other small hand movements.

• Confusion

• Forgetfulness

• Poor judgment

• Confusion

• Anxiety

• Severe personality changes

• Shaky hands

• Slow movements

6. SURGERY Types:

• Buccle surgery

• Esophageal surgery

• Gastractomy



BUCCLE SURGERY

DIET FOOD Generally well

tolerated Avoid

Beverages • Carbonated • Ice drinks

Milk products all None Meat and meat alternatives

• Tender, minced, moist Fish, poultry

• Use gravy sauces

• Soft cooked eggs

• Dry, rough or stringy

• Nuts seeds • Crunchy peanut

butter • Stringy cooked

cheese like mozzarella cheese

Grain products • Hot cereals • Well soaked • Pasta • rice

• fresh doughy • popcorn • any grain

containing nuts seeds or dry fruits

Fruit • canned or cooked fruits

• fresh fruits without skin

• Dried fruits • Coconut • Apple ,

pineapple and orange

vegetables • Well cooked or canned vegetables

• Use vegetable soup

• Raw vegetables • Stringy cooked • Vegetables such

as spinach

Fats and oils All None



ESOPHAGEAL SURGERY

DIET

Recommended Avoid Water with lemon orange slices Salty, sugary and fast foods Low fat yogurt Cold cuts of processed meat Broccoli Grape fruit juice Kale Potatoes, yams Banana More than 500mg of calcium ,

2000IU of vitamin D and 500mg supplements of vitamin C per day

Raw red and yellow pepper Black tea, wheat , bran GASTRACTOMY-DIET

• Avoid high fiber diet.

ANTI DUMPING DIET

GROUPS CHOOSE AVOID

MILK Products As tolerated butter milk Canned soup Yogurt

Cocoa powder Milk shakes

vegetables All none Fruits Fresh fruits Dried foods

Frozen fruits

Bread and grains Cracker pasta plain bread

Sugar coated cereals Doughnuts Sweet rolls

Meat and meat products

Eggs are foods none

Fats and oils Butter margarine Salad dressings

none

beverages Sugar free Water

Regular soft drinks



7. INTESTINAL CANCER OR STOMA Intestinal cancer:

Tumor in the small intestine may block the flow of food and effect digestion.

Symptoms:

• Abdominal pain

• Unexplained weight loss

• Weakness and fatigue

• Bloody stool

• A noticeable lump in abdomen

Causes:

• Tobacco

• Eating high fat

• Chemical exposure

• Colon cancer

• Celiac disease

• Crohn’s disease

DIET

• High protein diet

• Small and frequent meals

• Plenty of fluids

• Chewable foods

STOMA

A stoma is an opening on front of the abdomen. This is made using surgery. It diverts feces urine in to a pouch. It sits on the surface of skin

Types:

• Colostomy (coming from colon)



• Ileostomy (coming from the ileum)

• Urostomy (Coming from kidneys)

Guidelines and Suggestions Foods that Are Poorly or Incompletely Digested and that May Block a Narrowed Stoma

Cabbage Lettuce

Celery Mushrooms

Coconut Nuts

Corn Olives

Cucumbers Peas

Dried fruits Pickles

Green peppers Pineapple

Things that Cause Excess Swallowed Air and Then Gas

Jittery or stressed personality and excessive saliva swallowing Poorly fitting dentures, smoking pipes or cigarettes, chewing gum or tobacco

can cause increased salivation and swallowing Eating fast and swallowing large chunks of food or large amounts of beverages Using straws or drinking from a bottle or can Inactivity and lying down after eating

Foods that Tend to Form Gas

Legumes Most beans, especially dried beans and peas, baked beans, soy beans, lima beans

Vegetables Cabbage, radishes, onions, broccoli, Brussels sprouts, cauliflower, cucumbers, sauerkraut, kohlrabi, rutabaga, turnips, asparagus, onions

Fruits Prunes, apples, raisins, bananas, excessive amounts of fruit

Cereals, breads

Excessive wheat products, including breads and cereals. Check labels for specific grains.



Milk, milk products Excessive milk, ice cream, cheese

Fatty foods Excessive pan-fried or deep-fried foods, fatty meats; rich cream sauces and gravies; pastries

Liquids Carbonated beverages

Odor-Reducing Foods and Medications

Buttermilk Yogurt

Cranberry juice Charcoal tablets (check with physician )

Parsley Odor-Producing Foods

Asparagus Garlic

Eggs Onions

Fish Foods that Tend to Thicken Stool

Applesauce Pasta

Bananas Creamy peanut butter

Breads Starchy foods, such as potatoes

Cheeses Foods that Tend to Cause Diarrhea

Apple juice Prune juice

Grape juice Highly seasoned foods, especially hot peppers



8. PARENTERAL ENTERAL FEEDING Enteral nutrition generally refers to any method of feeding that uses the gastrointestinal (GI) tract to deliver part or all of a person's caloric requirements. It can include a normal oral diet, the use of liquid supplements or delivery of part or all of the daily requirements by use of a tube.

When Would a Patient Really Require Enteral Nutrition?

When a patient has difficulty eating for whatever reason, and if the GI tract is working, then using this natural means for feeding would be preferable to feeding by intravenous means. Using the GI tract is closer to normal and can help the immune system. An example might be a patient who has had a stroke and now has difficulty swallowing (called dysphagia). The swallowing may normalize over time or in some instances may not return to normal which could put the patient at risk for inadvertently swallowing any solids and liquids consumed into the lungs which could cause a severe pneumonia. During the short term, a patient like this might be fed with a tube entering the nose. For longer use, a tube entering the stomach from outside the abdomen (a gastrostomy) might be appropriate.

COMPLICATIONS:

• Food entering the lungs,

• Constipation, diarrhea,

• Improper absorption of nutrients,

• Nausea,

• Vomiting,

• Dehydration,

• Electrolyte abnormalities,

• High blood sugar,

• Vitamin

• Mineral deficiencies,

• Decreased liver proteins.



Feeding tubes inserted through the nose:

• Irritation of the nose or throat,

• Acute sinus infections,

• Ulceration

PREVENTION:

• The most common complications associated with catheter placement include infection, clogging (occlusion), and breakage.

• Port sterilization before access,

• Close monitoring of catheter site appearance for redness or inflammation.

• When a catheter is cracked, leaking, or broken, the catheter must be repaired or replaced as soon as possible.

• A catheter is clamped between the exit site and the break to prevent entrance of air or leakage of blood.

• Thrombosis (blood clot) of a blood vessel around an intravenous catheter is another potential complication with intravenous therapy as well as intravenous nutrition.

(Formulas)

• Polymeric: complain, Horlicks, insulin, isocal, pediasure, ensureplus

• Disease specific: Glucena, Nova source, Renal, resource diabetes,

Elemental, captanen

• Modular formula: Bene, protein, MCT oil



PEDIATRICS ASSESSMENT

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