Friday, March 28, 2008
The Deadliest Cancer
Ovarian cancer is one of the deadliest cancer because it often goes undetected for years. Compared to other female reproductive organ disease, ovarian cancer claims more women lives for more than 16,000 annually. The reason why it is so deadly is that most of the victims of this disease present signs at stage three or four (terminal stage of the disease). Ovarian cancer often has no symptoms until it is advanced making it difficult to diagnose and treat effectively. Symptoms can include abdominal pain or bloating, increasing abdominal girth, loss of appetite, vaginal bleeding, constipation, frequent urination or shortness of breath, Pain or swelling in the abdomen, pain in the pelvis, and gastrointestinal problems, such as gas, bloating, or constipation.
Signs and Symptoms
Possible signs of ovarian cancer include pain or swelling in the abdomen. Early ovarian cancer may not cause any symptoms. When symptoms do appear, ovarian cancer is often advanced. If the symptoms get worse or do not go away on their own, a doctor should be consulted so that any problem can be diagnosed and treated as early as possible. When found in its early stages, ovarian epithelial cancer can often be cured. Women with any stage of ovarian cancer should think about taking part in a clinical trial. Once it is diagnosed aggressive treatment is necessary.
Treatment
Treatment should include removal of the tumors or affected tissue, surgery, intravenous chemotherapy, cancer drugs, anti-cancer medicines, and other therapies. But still the best treatment is to increase the awareness of the disease to fight against it. Screening programs should be conducted to target presence of ovarian cancer.
Analysis
Ovarian cancer can sometimes be associated with known risk factors for the disease. Many risk factors are modifiable though not all can be avoided. Avoiding risk factors when possible and increasing protective factors may help prevent ovarian cancer. Genetic Factors: Women who have inherited certain altered genes have a much higher risk of developing ovarian cancer. These mutations may be found in BRCA1 , BRCA2 , or hereditary nonpolyposis colon cancer (HNPCC) genes. Age: The risk of developing ovarian cancer increases as a woman gets older. Obesity: Having excess body fat as measured by body mass index, including during the teen years, increases the risk of ovarian cancer. Diet and nutrition during the teen years may play a role in prevention. Oral Contraceptives: Studies show that the use of oral contraceptives reduces the risk of developing ovarian cancer. The longer you use oral contraceptives, the lower your risk might be. The decrease in risk may last up to 25 years after the use of oral contraceptives has ended. This lower risk is seen both in women who have given birth and in women who have not. Oral contraceptives may also protect against ovarian cancer in women who are at higher risk because they have inherited an altered version of BRCA1 and BRCA2 genes. Harms from taking oral contraceptives include a higher risk of blood clots that can block blood vessels, especially in smokers and a slightly higher short-term risk of breast cancer that decreases over time when use is stopped.
Brief Essay of Important Theme
Ovarian epithelial cancer is a disease in which malignant (cancer) cells form in the tissue covering the ovary. The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones (chemicals that control the way certain cells or organs function). Ovarian epithelial cancer is one type of cancer that affects the ovary.
Women who have a family history of ovarian cancer are at an increased risk of developing ovarian cancer. Anything that increases your risk of getting a disease is called a risk factor. Women who have one first-degree relative (mother, daughter, or sister) with ovarian cancer are at an increased risk of developing ovarian cancer. This risk is higher in women who have one first-degree relative and one second-degree relative (grandmother or aunt) with ovarian cancer. This risk is even higher in women who have two or more first-degree relatives with ovarian cancer.
Reference:
Medical-Surgical Nursing Vol.2, by Lipincott, 3rd edition, pp. 1324.
http://www.cancer.gov/cancertopics/pdq/prevention/ovarian/Patient/page2
www.fccc.edu/pdq/English/Patients/OvarianEpithelialCancer.html
Wednesday, March 26, 2008
Resources for Mind , Body and Spirit
In healthjourneys.com, you can have good resources for your mind, body, and spirit. The site provides articles on weekly events, such as groundbreaking research which identifies genetic predisposition to PTSD; inspiring stories about three women with fertility struggle; and a lot more. Most frequently asked topics on insomnia, depression, pain, cancer, weight loss, fertility, heart health, and stress are useful guidelines in order to find solutions to such problems. The site offers outstanding practitioners such as Andrew Well, Jon Kabat-Zinn, Roxanne Daleo, Cyndi Lee, Emmett Miller, Susan Winter Ward, Carol Dickman, and Steven Mark Kohn and depression therapy as well as meditation cds. Recently, the website tackles issues on depression which provides that depression isn’t just sadness; it’s a lack of physical, emotional and psychic energies. There’s some cognitive distortion with depression too – people most of the time had wrong impression on themselves as having fewer choices, and being more narrowly restricted than they really are. Depression is very common, and it’s even estimated that over 50% of the patients suffer depression.
Saturday, March 15, 2008
How can you prevent Choking?
According to University of Oklahoma police department;
Adults:
-Cut food into small pieces.
-Chew food slowly and thoroughly, especially if wearing dentures.
-Avoid laughing and talking during chewing and swallowing.
-Avoid excessive intake of alcohol before and during meals.
Infants and Children:
-Keep marbles, beads, thumbtacks, and other small objects out of their reach and prevent them from walking, running, or playing with food or toys in their mouths.
Choking Prevention In Young Children
Young children can choke on virtually any object. Tragically, children have died from choking on things such as small balls, tiny toys, balloons and plants. For this reason, it is important to be aware of how to prevent choking:
· Hot dogs, nuts, peanuts, peanut butter, popcorn, carrots and grapes should not be given to children less than 4 years of age. In older children hot dogs should be sliced lengthwise first.
· Children should eat or drink only when sitting upright, and not while lying down. Also children should not be forced to feed, especially when they are sleepy.
· Children should never be allowed to eat or drink while playing or running around.
· Young children should always be supervised by an adult during meals or snacks, and even playtime.
· Toys your child plays with should be labeled appropriate for his or her age, and keep older children's toys away from any young child.
· If you have had visitors for a party or a dinner, remember to always immediately remove all foods, beverages or other objects potentially dangerous to a young child.
· It is important that your child's play and sleep areas are free of small objects.
· Latex balloons are pretty and often tempting to give as a gift or use as a decoration; But they pose a great choking hazard. Young children should not be given nor be in contact with balloons at all.
· Jewelry can easily be swallowed or inhaled. For this reason children should not wear any earrings, rings nor any other jewelry items before the age of 5.
· Keep coins and other small objects such as buttons, toothpicks, paper clips. plants etc(and any other household or office item that can be a potential choking threat) away from young children at all times.
· When visiting a friend’s or neighbor’s house or on vacation, make sure your child is not exposed to any choking hazards.
· It is a good idea to learn to give first aid to a choking child just in case...but prevention in the first place is best.
Choking Prevention
In addition to food, there are household items that can become choking hazards. You can help ensure a safe environment by keeping these items away from infants and young children:
· Latex balloons
· Coins
· Marbles
· Toys with small parts
· Toys that can be compressed to fit entirely into a child's mouth
· Small balls
· Pen or marker caps
· Small button-type batteries
· Medicine syringes
Choking can be prevented. Before your child begins to crawl, get down on his level and look for dangerous items. If you have older children, pay extra attention to their toys and be sure your younger child can't get into them. In addition to thoroughly childproofing your home, keep this list of choking prevention tips in mind:
· Learn cardiopulmonary resuscitation (CPR) (basic life support).
· Be aware that balloons pose a choking risk to children of any age.
· Keep the following foods from children until 4 years of age:
o Hot dogs
o Nuts and seeds
o Chunks of meat or cheese
o Whole grapes
o Hard, gooey, or sticky candy
o Popcorn
o Chunks of peanut butter
o Raw vegetables
o Raisins
o Chewing gum
· Insist that children eat at the table, or at least while sitting down. They should never run, walk, play or lie down with food in their mouths.
· Cut food for infants and young children into pieces no larger than one-half inch and teach them to chew their food well.
· Supervise mealtime for infants and young children.
· Be aware of older children's actions. Many choking incidents occur when older brothers or sisters give dangerous foods, toys or small objects to a younger child.
· Avoid toys with small parts and keep other small household items out of reach of infants and young children.
· Follow the age recommendations on toy packages. Age guidelines reflect the safety of a toy based on any possible choking hazard as well as the child's physical and mental abilities at various ages.
· Check under furniture and between cushions for small items that children could find and put in their mouths.
· Do not let infants and young children play with coins
Choking prevention! Choking -- what are the risks?
What types of food can cause choking?
Dangerous foods can be grouped in four categories:
Crisp, crunchy foods
These include peanuts and other nuts, raw carrots and celery, popcorn kernels, sunflower seeds, fruits with pits, dried peas and beans. These foods can cause a severe coughing fit and end up in the bronchi (breathing tubes for the lungs), causing wheezing and eventually pneumonia.
Don’t introduce these foods to children until they are at least three years old and can chew and swallow crusty bread and raw apple and pear without coughing. Never give unpopped popcorn kernels to a toddler.
Round and rubbery foods
These include hot dogs, whole grapes and gel candies (such as “Fruit Poppers”), which are the most deadly foods. They can become stuck between the vocal cords and completely block breathing.
Cut hot dogs and grapes lengthwise and into small pieces until children are at least four years old and can chew and swallow steak without coughing. Avoid gel candies, which are banned but still available in certain stores in Canada.
Gum and hard candies
These can be inhaled and get stuck between the vocal cords.
Don’t give children gum or hard candies until they are at least five years of age and can understand the danger.
Fish bones (and other small bones)
Small and fine bones can become stuck higher in the throat and cause severe pain.
Carefully pick out bones before serving fish and poultry.
How can I keep my child safe at mealtimes?
Children are less likely to choke if they chew food thoroughly before swallowing. Teach children to sit quietly during meals and always supervise them while they eat. These activities will put your child at high risk for a choking episode:
· Talking, laughing or walking, running, jumping with food in the mouth
· Unsupervised snacking
· Incomplete chewing
· Tipping chairs backwards
Which non-food items cause choking?
It’s not only foods that pose a choking hazard. Common non-food risks include:
Small hard objects
Examples of these include plastic toy parts, metal hardware and fishing tackle. They can cause coughing fits and end up in the bronchi.
Teach children not to put non-food objects in their mouths and not to hold them between their lips or teeth. Keep these objects out of reach of young children.
Coins
These are the most common foreign bodies. Coins can become stuck in the esophagus (swallowing tube) and can cause pain and often drooling and retching.
Teach children to keep coins out of their mouths. Never store coins in open bowls or containers that are within reach of toddlers.
Disc batteries
Like coins, disc batteries are tempting to young children. However, they are much more dangerous because they cause severe internal burns and even death.
Keep toys and electronics with removable disc batteries away from young children. Store unused or discarded batteries where children cannot find them.
Balloons
Deflated balloons can become stuck between the vocal cords and completely stop a child’s breathing. Keep deflated balloons away from all young children.
Dishwasher powder and caustic liquids
Most household cleaners and hair straightners or relaxers can cause severe burns of the swallowing and breathing passages. Not all are marked with warning labels. Keep all caustic substances out of reach of children.
How can I prevent choking?
Remember choking deaths in children are mainly caused by foods and small objects such as gel candies, hot dogs, grapes, balloons, disc batteries and handfuls of nuts. Follow these simple steps to prevent choking:
· Keep a careful eye on the child during meals and snacks
· Introduce new food textures slowly and carefully
· Check for small items of any type that a child may choke on
· Choose toys that are labeled appropriate for the age of your child
· Teach older siblings NOT to give small items or toys to younger children
· Know how to give first aid to a choking child
If you suspect that a child has choked on an object, please explain that to medical personnel as soon as possible. Bring an example of the foreign body if possible. A Heimlich maneuver is necessary only if someone is unable to speak clearly and is turning blue.
The Bill #HR 2773 - Food Choking Prevention Act of 2003
Childhood Choking Prevention Tips:
1. Keep the following items away from infants and young children: Latex balloons, Coins, Marbles, Toys with small parts, Toys that can be compressed to fit entirely into a child's mouth, Small balls, Pen or marker caps, Small button-type batteries, Medicine syringes.
2. Before a child begins to crawl, get down on his level and look for dangerous items. If you have older children, pay extra attention to their toys and be sure your younger child can't get into them.
3. Be aware that balloons pose a choking risk to children of any age.
4. Keep the following foods from children until 4 years of age: Hot dogs, Nuts and seeds, Chunks of meat or cheese, Whole grapes, (Hard, gooey, or sticky) candy, Popcorn, Chunks of peanut butter, Raw vegetables, Raisins, Chewing gum.
5. Insist that children eat at the table, or at least while sitting down. They should never run, walk, play or lie down with food in their mouths.
Food preparation safety tips
Here are some suggestions to modify potentially hazardous foods to reduce the risk of choking and make them safer for children:
· Remove the skin from hotdogs, sausages, and frankfurters; cut them lengthwise, then cut them into small pieces or thin strips.
· Chop, grind, or dice meats.
· Chop nuts and grind seeds finely.
· Dice or grate raw vegetables.
· Steam, then slice or dice vegetables.
· Remove the pit, then dice fruits like cherries, apricots, and peaches.
· Spread peanut butter thinly over crackers or wheat bread.
· Blend peanut butter with applesauce or jam before serving.
· Serve bow-tie pretzels instead of pretzel sticks or potato chips.
· Remove the bones from fish or serve fish pieces that have been boned.
· Include plenty of liquids such as water, milk, or juice at meal and snack times and encourage children to sip in between mouthfuls
Prevention of Choking
1. Avoid small hard pieces of food (as listed above)
2.Cook food and cut it into small pieces
3. Don't let your infant run around with food in the mouth: encourage them to sit at the table while eating.
4. Model the kind of behavior you want for your child. I.e. sit at the table until you have finished eating (if you can!) and avoid putting pins etc in your own mouth.
5. Have a crawl around on the floor with your baby and check out potential choking hazards. Get rid of these!
6. Store batteries and beads etc where your child cannot get them
7. Tell your older children about the sorts of things that can cause choking for their young sibling.
Adults:
-Cut food into small pieces.
-Chew food slowly and thoroughly, especially if wearing dentures.
-Avoid laughing and talking during chewing and swallowing.
-Avoid excessive intake of alcohol before and during meals.
Infants and Children:
-Keep marbles, beads, thumbtacks, and other small objects out of their reach and prevent them from walking, running, or playing with food or toys in their mouths.
Choking Prevention In Young Children
Young children can choke on virtually any object. Tragically, children have died from choking on things such as small balls, tiny toys, balloons and plants. For this reason, it is important to be aware of how to prevent choking:
· Hot dogs, nuts, peanuts, peanut butter, popcorn, carrots and grapes should not be given to children less than 4 years of age. In older children hot dogs should be sliced lengthwise first.
· Children should eat or drink only when sitting upright, and not while lying down. Also children should not be forced to feed, especially when they are sleepy.
· Children should never be allowed to eat or drink while playing or running around.
· Young children should always be supervised by an adult during meals or snacks, and even playtime.
· Toys your child plays with should be labeled appropriate for his or her age, and keep older children's toys away from any young child.
· If you have had visitors for a party or a dinner, remember to always immediately remove all foods, beverages or other objects potentially dangerous to a young child.
· It is important that your child's play and sleep areas are free of small objects.
· Latex balloons are pretty and often tempting to give as a gift or use as a decoration; But they pose a great choking hazard. Young children should not be given nor be in contact with balloons at all.
· Jewelry can easily be swallowed or inhaled. For this reason children should not wear any earrings, rings nor any other jewelry items before the age of 5.
· Keep coins and other small objects such as buttons, toothpicks, paper clips. plants etc(and any other household or office item that can be a potential choking threat) away from young children at all times.
· When visiting a friend’s or neighbor’s house or on vacation, make sure your child is not exposed to any choking hazards.
· It is a good idea to learn to give first aid to a choking child just in case...but prevention in the first place is best.
Choking Prevention
In addition to food, there are household items that can become choking hazards. You can help ensure a safe environment by keeping these items away from infants and young children:
· Latex balloons
· Coins
· Marbles
· Toys with small parts
· Toys that can be compressed to fit entirely into a child's mouth
· Small balls
· Pen or marker caps
· Small button-type batteries
· Medicine syringes
Choking can be prevented. Before your child begins to crawl, get down on his level and look for dangerous items. If you have older children, pay extra attention to their toys and be sure your younger child can't get into them. In addition to thoroughly childproofing your home, keep this list of choking prevention tips in mind:
· Learn cardiopulmonary resuscitation (CPR) (basic life support).
· Be aware that balloons pose a choking risk to children of any age.
· Keep the following foods from children until 4 years of age:
o Hot dogs
o Nuts and seeds
o Chunks of meat or cheese
o Whole grapes
o Hard, gooey, or sticky candy
o Popcorn
o Chunks of peanut butter
o Raw vegetables
o Raisins
o Chewing gum
· Insist that children eat at the table, or at least while sitting down. They should never run, walk, play or lie down with food in their mouths.
· Cut food for infants and young children into pieces no larger than one-half inch and teach them to chew their food well.
· Supervise mealtime for infants and young children.
· Be aware of older children's actions. Many choking incidents occur when older brothers or sisters give dangerous foods, toys or small objects to a younger child.
· Avoid toys with small parts and keep other small household items out of reach of infants and young children.
· Follow the age recommendations on toy packages. Age guidelines reflect the safety of a toy based on any possible choking hazard as well as the child's physical and mental abilities at various ages.
· Check under furniture and between cushions for small items that children could find and put in their mouths.
· Do not let infants and young children play with coins
Choking prevention! Choking -- what are the risks?
What types of food can cause choking?
Dangerous foods can be grouped in four categories:
Crisp, crunchy foods
These include peanuts and other nuts, raw carrots and celery, popcorn kernels, sunflower seeds, fruits with pits, dried peas and beans. These foods can cause a severe coughing fit and end up in the bronchi (breathing tubes for the lungs), causing wheezing and eventually pneumonia.
Don’t introduce these foods to children until they are at least three years old and can chew and swallow crusty bread and raw apple and pear without coughing. Never give unpopped popcorn kernels to a toddler.
Round and rubbery foods
These include hot dogs, whole grapes and gel candies (such as “Fruit Poppers”), which are the most deadly foods. They can become stuck between the vocal cords and completely block breathing.
Cut hot dogs and grapes lengthwise and into small pieces until children are at least four years old and can chew and swallow steak without coughing. Avoid gel candies, which are banned but still available in certain stores in Canada.
Gum and hard candies
These can be inhaled and get stuck between the vocal cords.
Don’t give children gum or hard candies until they are at least five years of age and can understand the danger.
Fish bones (and other small bones)
Small and fine bones can become stuck higher in the throat and cause severe pain.
Carefully pick out bones before serving fish and poultry.
How can I keep my child safe at mealtimes?
Children are less likely to choke if they chew food thoroughly before swallowing. Teach children to sit quietly during meals and always supervise them while they eat. These activities will put your child at high risk for a choking episode:
· Talking, laughing or walking, running, jumping with food in the mouth
· Unsupervised snacking
· Incomplete chewing
· Tipping chairs backwards
Which non-food items cause choking?
It’s not only foods that pose a choking hazard. Common non-food risks include:
Small hard objects
Examples of these include plastic toy parts, metal hardware and fishing tackle. They can cause coughing fits and end up in the bronchi.
Teach children not to put non-food objects in their mouths and not to hold them between their lips or teeth. Keep these objects out of reach of young children.
Coins
These are the most common foreign bodies. Coins can become stuck in the esophagus (swallowing tube) and can cause pain and often drooling and retching.
Teach children to keep coins out of their mouths. Never store coins in open bowls or containers that are within reach of toddlers.
Disc batteries
Like coins, disc batteries are tempting to young children. However, they are much more dangerous because they cause severe internal burns and even death.
Keep toys and electronics with removable disc batteries away from young children. Store unused or discarded batteries where children cannot find them.
Balloons
Deflated balloons can become stuck between the vocal cords and completely stop a child’s breathing. Keep deflated balloons away from all young children.
Dishwasher powder and caustic liquids
Most household cleaners and hair straightners or relaxers can cause severe burns of the swallowing and breathing passages. Not all are marked with warning labels. Keep all caustic substances out of reach of children.
How can I prevent choking?
Remember choking deaths in children are mainly caused by foods and small objects such as gel candies, hot dogs, grapes, balloons, disc batteries and handfuls of nuts. Follow these simple steps to prevent choking:
· Keep a careful eye on the child during meals and snacks
· Introduce new food textures slowly and carefully
· Check for small items of any type that a child may choke on
· Choose toys that are labeled appropriate for the age of your child
· Teach older siblings NOT to give small items or toys to younger children
· Know how to give first aid to a choking child
If you suspect that a child has choked on an object, please explain that to medical personnel as soon as possible. Bring an example of the foreign body if possible. A Heimlich maneuver is necessary only if someone is unable to speak clearly and is turning blue.
The Bill #HR 2773 - Food Choking Prevention Act of 2003
Childhood Choking Prevention Tips:
1. Keep the following items away from infants and young children: Latex balloons, Coins, Marbles, Toys with small parts, Toys that can be compressed to fit entirely into a child's mouth, Small balls, Pen or marker caps, Small button-type batteries, Medicine syringes.
2. Before a child begins to crawl, get down on his level and look for dangerous items. If you have older children, pay extra attention to their toys and be sure your younger child can't get into them.
3. Be aware that balloons pose a choking risk to children of any age.
4. Keep the following foods from children until 4 years of age: Hot dogs, Nuts and seeds, Chunks of meat or cheese, Whole grapes, (Hard, gooey, or sticky) candy, Popcorn, Chunks of peanut butter, Raw vegetables, Raisins, Chewing gum.
5. Insist that children eat at the table, or at least while sitting down. They should never run, walk, play or lie down with food in their mouths.
Food preparation safety tips
Here are some suggestions to modify potentially hazardous foods to reduce the risk of choking and make them safer for children:
· Remove the skin from hotdogs, sausages, and frankfurters; cut them lengthwise, then cut them into small pieces or thin strips.
· Chop, grind, or dice meats.
· Chop nuts and grind seeds finely.
· Dice or grate raw vegetables.
· Steam, then slice or dice vegetables.
· Remove the pit, then dice fruits like cherries, apricots, and peaches.
· Spread peanut butter thinly over crackers or wheat bread.
· Blend peanut butter with applesauce or jam before serving.
· Serve bow-tie pretzels instead of pretzel sticks or potato chips.
· Remove the bones from fish or serve fish pieces that have been boned.
· Include plenty of liquids such as water, milk, or juice at meal and snack times and encourage children to sip in between mouthfuls
Prevention of Choking
1. Avoid small hard pieces of food (as listed above)
2.Cook food and cut it into small pieces
3. Don't let your infant run around with food in the mouth: encourage them to sit at the table while eating.
4. Model the kind of behavior you want for your child. I.e. sit at the table until you have finished eating (if you can!) and avoid putting pins etc in your own mouth.
5. Have a crawl around on the floor with your baby and check out potential choking hazards. Get rid of these!
6. Store batteries and beads etc where your child cannot get them
7. Tell your older children about the sorts of things that can cause choking for their young sibling.
Diabetes Mellitus Foot, Wagner II
Diabetes mellitus is a group of metabolic disorders characterized by elevated levels of blood glucose (hyperglycemia) resulting from defects in insulin production and secretion, decreased cellular response to insulin, or both. This leads to hyperglycemia, which may lead to acute metabolic complications, such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Longterm hyperglycemia may contribute to chronic microvascular complications (kidney and eye disease) and neuropahtic complications. Diabetes is also associated with an increased occurrence of macrovascular disease, icluding coronay artery disease, (myocardial infarction), cerebrovascular disease (stroke) and peripheral vascular disease.
Types of Diabetes
Type 1 (Formerly Insulin-Dependent Diabetes Mellitus)
About 5%-10% of diabetic patients have type 1 diabetes. Beta cells of the pancreas that normally produce insulin are destroyed by an autoimmune process. Insulin injections are needed to control the blood glucose levels.
Type 1 diabetes has a sudden onset, usually before the age of 30 years.
Type 2 (Formerly Non-Insulin Dependent Diabetes Mellitus)
About 90% to 95% of diabetics have type 2 diabetes. It results from a decrease sensitivity to insulin (insulin resistance) or from a decreased amount of insulin production.
Type 2 diabetes is first treated with diet and exercise, then oral hypoglycemic agents as needed.
Type 2 diabetes occurs most frequently in patients older than 30 years of age and in obese patients.
Gestational Diabetes Mellitus
Gestational diabetes is characterized by any degree of glucose intolerance with onset during pregnancy (2nd or 3rd trimester).
It occurs in women 25 years of age or older, women younger than 25 years of age who are obese, women with a family history of diabetes in first-degree relatives, member of certain ethnical racial groups (eg, Hispanic Americans, Native Americans, or Pacific Islander). It increases their risk for hypertensive disorders of pregnancy.
Clinical Manifestations
Polyuria, polydipsia, and polyphagia
Fatigue and weakness, sudden vision changes, tingling or numbness in hands or
feet, dry skin, sores that heal slowly and recurrent infections.
Onset of type 1 diabetes may be associated with nausea, vomiting, or stomach pains.
Type 2 diabetes results from a slow (over years, progressive glucose intolerance and results in longterm complications if diabetes goes undetected fro many years (eg, eye disease, peripheral neuropathy, peripheral vascular disease). Complications may have developed before the actual diagnosis is made.
Signs and symptoms of DKA include abdominal pain, nausea, vomiting, hyperventilation, and a fruity breath odor. Untreated DKA may result in altered level of consciousness, coma, and death.
Assessment and Diagnostic Methods
High blood glucose levels: fasting plasma glucose levels 126 mg/dl or more, or random plasma glucose levels more than 200 mg/dl on more than one occasion.
Evaluation for complications.
Prevention
For obese patients (especially those with type 2 diabetes): weight loss is the key to treatment and major preventive factor for the development of diabetes.
Complications of Diabetes
Complications associated with both types of diabetes are classified as acute or chronic. Acute complications occur from short-term imbalances in blood glucose and include:
Hypoglycemia
DKA (Diabetic Ketoacidosis)
HHNS (Hyperglycemic Hyperosmolar Nonketotic Syndrome)
Chronic complications generally occur 10 to 15 years after the onset of diabetes mellitus. They include:
Macrovascular (large vessel) disease: affects coronary, peripheral vascular and cerebral vascular circulations.
Microvascular (small vessel) disease: affects the eyes (retinopathy) and kidneys (nephropathy); control blood glucose levels to delay or avoid onset of both microvascular and macrovascular complications.
Neuropathic disease: affects sensory motor and autonomic nerves and contributes to such problems as impotence or foot ulcers.
Gerontologic Considerations
Because the incidence of elevated blood glucose levels increases with advancing age, elderly adults should be advised that physical activity that is consistent and realistic is beneficial to those with diabetes. Advantages of exercise include a decrease in hyperglycemia, a general sense of well-being, metabolism of ingested calories, and weight reduction. Consider physical impairment from other chronic diseases when planning an exercise regimen for elderly diabetic patients.
Medical Management
The main goal of treatment is to normalize insulin activity and blood glucose levels to reduce the development of vascular and neuropathic complications. The therapeutic goal within each type of diabetes is to achieve normal blood glucose levels without hypoglycemia and without seriously disrupting patient’s usual activities. There are five components of management for diabetes: nutrition, exercise, monitoring, pharmacologic therapy and education.
Primary treatment of type 1 diabetes is insulin.
Primary treatment of type 2 diabetes is weight loss.
Exercise is important in enhancing the effectiveness of insulin.
Use oral hypoglycemic agents if diet and exercise are not successful in controlling blood glucose levels. Insulin injections may be used in acute situations.
Because treatment varies throughout course because of changes in lifestyle and physical and emotional status as well as advances in therapy, continuously assess and modify treatment plan as well as daily adjustments in therapy.
Education is needed for both patient and family.
Nutritional Management
Meal plan should be based on patient’s usual eating habits and lifestyle and should provide all essential food constituents (eg, vitamins and minerals).
Goals are to achieve and maintain ideal weight, meet energy needs, prevent wide daily fluctuations in blood glucose levels (keep as close to normal as is safe and practical), and decrease blood lipid levels, if elevated.
For patients who require insulin to help control blood glucose levels, consistency is required in maintaining calories and carbohydrates consumed at different meals.
Consult dietician for diabetes management planning to gradually increase or add fiber in meal plan (grains, vegetables).
Caloric Requirements
Determine basic caloric requirements, taking into consideration age, gender, body weight, and height and factoring in degree of activity.
Long-term weight reduction can be achieved by reducing basic caloric intake by 500 to 1,000 calories from calculated basic caloric requirements.
Teaching Patients About Self Care
Teach patient about proper foot care since diabetic patients are prone to development of wounds due to diminished sensation on the extremities.
Instruct patient not to submit self to pedicure or manicure because it can cause wound or abrasions that may heal solely and could predispose the client to development of infection.
Inform patient not to use any sharp objects in cleaning the nails on foot.
Instruct significant others to assess for temperature of hot items to be utilized by the patient to prevent burns or skin abrasions.
Nutrition
Initial education addresses the importance of consistency in eating habits, the relationship of food and insulin, and provision of individualized meal plan.
Teach patient to read food labels and adjusting meal for exercise, illness and special occasions.
Teach patients to read labels of “health” foods because they often contain sugar products (ie, brown sugar, honey, and corn syrup and may contain saturated vegetable fats, hydrogenated vegetable fats, or animal fats that may be contraindicated with elevated blood lipids.
Exercise
* Exercise is very important because of its effects on lowering blood glucose levels and reducing cardiovascular risk factors. Exercise is useful in losing weight, easing stress, and maintaining a feeling of well-being.
* Encourage patient to eat a 15-g carbohydrate snack (fruit exchange) or a snack of complex carbohydrates with protein before moderate exercise to prevent hypoglycemia.
* Warn patient about postexercise hypoglycemia, which occurs many hours after exercise.
* Discuss testing blood glucose before, during and after exercise and eating carbohydrate snacks to maintain blood glucose.
* Encourage regular exercise rather than sporadic exercise.
* Advise all patients with diabetes to discuss an exercise program with the physician.
Self-monitoring and Drug administration
* Teach patient self-monitoring of blood glucose levels. Instruct patient to keep a record of blood glucose test results.
* Teach patient on the administration of insulin and taking oral hypoglycemic agents.
Source: Johnson, J.Y., Handbook for Brunner and Suddharth’s Textbook of Medical-Surgical Nursing 10th edition.
Types of Diabetes
Type 1 (Formerly Insulin-Dependent Diabetes Mellitus)
About 5%-10% of diabetic patients have type 1 diabetes. Beta cells of the pancreas that normally produce insulin are destroyed by an autoimmune process. Insulin injections are needed to control the blood glucose levels.
Type 1 diabetes has a sudden onset, usually before the age of 30 years.
Type 2 (Formerly Non-Insulin Dependent Diabetes Mellitus)
About 90% to 95% of diabetics have type 2 diabetes. It results from a decrease sensitivity to insulin (insulin resistance) or from a decreased amount of insulin production.
Type 2 diabetes is first treated with diet and exercise, then oral hypoglycemic agents as needed.
Type 2 diabetes occurs most frequently in patients older than 30 years of age and in obese patients.
Gestational Diabetes Mellitus
Gestational diabetes is characterized by any degree of glucose intolerance with onset during pregnancy (2nd or 3rd trimester).
It occurs in women 25 years of age or older, women younger than 25 years of age who are obese, women with a family history of diabetes in first-degree relatives, member of certain ethnical racial groups (eg, Hispanic Americans, Native Americans, or Pacific Islander). It increases their risk for hypertensive disorders of pregnancy.
Clinical Manifestations
Polyuria, polydipsia, and polyphagia
Fatigue and weakness, sudden vision changes, tingling or numbness in hands or
feet, dry skin, sores that heal slowly and recurrent infections.
Onset of type 1 diabetes may be associated with nausea, vomiting, or stomach pains.
Type 2 diabetes results from a slow (over years, progressive glucose intolerance and results in longterm complications if diabetes goes undetected fro many years (eg, eye disease, peripheral neuropathy, peripheral vascular disease). Complications may have developed before the actual diagnosis is made.
Signs and symptoms of DKA include abdominal pain, nausea, vomiting, hyperventilation, and a fruity breath odor. Untreated DKA may result in altered level of consciousness, coma, and death.
Assessment and Diagnostic Methods
High blood glucose levels: fasting plasma glucose levels 126 mg/dl or more, or random plasma glucose levels more than 200 mg/dl on more than one occasion.
Evaluation for complications.
Prevention
For obese patients (especially those with type 2 diabetes): weight loss is the key to treatment and major preventive factor for the development of diabetes.
Complications of Diabetes
Complications associated with both types of diabetes are classified as acute or chronic. Acute complications occur from short-term imbalances in blood glucose and include:
Hypoglycemia
DKA (Diabetic Ketoacidosis)
HHNS (Hyperglycemic Hyperosmolar Nonketotic Syndrome)
Chronic complications generally occur 10 to 15 years after the onset of diabetes mellitus. They include:
Macrovascular (large vessel) disease: affects coronary, peripheral vascular and cerebral vascular circulations.
Microvascular (small vessel) disease: affects the eyes (retinopathy) and kidneys (nephropathy); control blood glucose levels to delay or avoid onset of both microvascular and macrovascular complications.
Neuropathic disease: affects sensory motor and autonomic nerves and contributes to such problems as impotence or foot ulcers.
Gerontologic Considerations
Because the incidence of elevated blood glucose levels increases with advancing age, elderly adults should be advised that physical activity that is consistent and realistic is beneficial to those with diabetes. Advantages of exercise include a decrease in hyperglycemia, a general sense of well-being, metabolism of ingested calories, and weight reduction. Consider physical impairment from other chronic diseases when planning an exercise regimen for elderly diabetic patients.
Medical Management
The main goal of treatment is to normalize insulin activity and blood glucose levels to reduce the development of vascular and neuropathic complications. The therapeutic goal within each type of diabetes is to achieve normal blood glucose levels without hypoglycemia and without seriously disrupting patient’s usual activities. There are five components of management for diabetes: nutrition, exercise, monitoring, pharmacologic therapy and education.
Primary treatment of type 1 diabetes is insulin.
Primary treatment of type 2 diabetes is weight loss.
Exercise is important in enhancing the effectiveness of insulin.
Use oral hypoglycemic agents if diet and exercise are not successful in controlling blood glucose levels. Insulin injections may be used in acute situations.
Because treatment varies throughout course because of changes in lifestyle and physical and emotional status as well as advances in therapy, continuously assess and modify treatment plan as well as daily adjustments in therapy.
Education is needed for both patient and family.
Nutritional Management
Meal plan should be based on patient’s usual eating habits and lifestyle and should provide all essential food constituents (eg, vitamins and minerals).
Goals are to achieve and maintain ideal weight, meet energy needs, prevent wide daily fluctuations in blood glucose levels (keep as close to normal as is safe and practical), and decrease blood lipid levels, if elevated.
For patients who require insulin to help control blood glucose levels, consistency is required in maintaining calories and carbohydrates consumed at different meals.
Consult dietician for diabetes management planning to gradually increase or add fiber in meal plan (grains, vegetables).
Caloric Requirements
Determine basic caloric requirements, taking into consideration age, gender, body weight, and height and factoring in degree of activity.
Long-term weight reduction can be achieved by reducing basic caloric intake by 500 to 1,000 calories from calculated basic caloric requirements.
Teaching Patients About Self Care
Teach patient about proper foot care since diabetic patients are prone to development of wounds due to diminished sensation on the extremities.
Instruct patient not to submit self to pedicure or manicure because it can cause wound or abrasions that may heal solely and could predispose the client to development of infection.
Inform patient not to use any sharp objects in cleaning the nails on foot.
Instruct significant others to assess for temperature of hot items to be utilized by the patient to prevent burns or skin abrasions.
Nutrition
Initial education addresses the importance of consistency in eating habits, the relationship of food and insulin, and provision of individualized meal plan.
Teach patient to read food labels and adjusting meal for exercise, illness and special occasions.
Teach patients to read labels of “health” foods because they often contain sugar products (ie, brown sugar, honey, and corn syrup and may contain saturated vegetable fats, hydrogenated vegetable fats, or animal fats that may be contraindicated with elevated blood lipids.
Exercise
* Exercise is very important because of its effects on lowering blood glucose levels and reducing cardiovascular risk factors. Exercise is useful in losing weight, easing stress, and maintaining a feeling of well-being.
* Encourage patient to eat a 15-g carbohydrate snack (fruit exchange) or a snack of complex carbohydrates with protein before moderate exercise to prevent hypoglycemia.
* Warn patient about postexercise hypoglycemia, which occurs many hours after exercise.
* Discuss testing blood glucose before, during and after exercise and eating carbohydrate snacks to maintain blood glucose.
* Encourage regular exercise rather than sporadic exercise.
* Advise all patients with diabetes to discuss an exercise program with the physician.
Self-monitoring and Drug administration
* Teach patient self-monitoring of blood glucose levels. Instruct patient to keep a record of blood glucose test results.
* Teach patient on the administration of insulin and taking oral hypoglycemic agents.
Source: Johnson, J.Y., Handbook for Brunner and Suddharth’s Textbook of Medical-Surgical Nursing 10th edition.
Saturday, March 8, 2008
Rheumatic Heart Disease
· Almost one out of every 2.7 deaths results from cardiovascular disease.
Rheumatic heart disease/rheumatic fever kills 3,554 Americans each year. Almost one out of every 2.7 deaths results from cardiovascular disease. Since 1900, cardiovascular disease has been the leading cause of death in every year but one - 1918. More than 2,600 Americans die of cardiovascular disease each day, an average of one death every 33 seconds. Cardiovascular disease is the cause of more deaths than the next seven causes of death combined. It is a myth that heart disease is a man's disease. In fact, cardiovascular diseases are the number one killer of women (and men). These diseases currently claim the lives of nearly a half a million females every year. In 1999, approximately one-third (33 percent) of cardiovascular disease deaths occurred prematurely (before age 75, the approximate average life expectancy in that year). The cost of cardiovascular diseases and stroke in 2002 is estimated at $329.2 billion. Stroke killed 167,366 people in 1999 - on average, someone in the US suffers a stroke every 53 seconds; someone dies every 3 minutes from stroke. Stroke is a leading cause of serious, long-term disability that accounts for more than half of all patients hospitalized for a neurological disease. Stroke deaths have been increasing in recent days.
·At least 71 million people in this country suffer from some form of heart disease.
·One person in four suffers from some form of cardiovascular disease, including:
high blood pressure - 65,000,000
coronary heart disease - 13,000,000
angina pectoris - 6,400,000
myocardial infarction (heart attack) - 7,500,000
stroke - 5,400,000
congenital cardiovascular defects - 1,000,000
congestive heart failure - 5,000,000
·Rheumatic heart disease / rheumatic fever kills 3,554 Americans each year.
myLot User Profile
Rheumatic heart disease/rheumatic fever kills 3,554 Americans each year. Almost one out of every 2.7 deaths results from cardiovascular disease. Since 1900, cardiovascular disease has been the leading cause of death in every year but one - 1918. More than 2,600 Americans die of cardiovascular disease each day, an average of one death every 33 seconds. Cardiovascular disease is the cause of more deaths than the next seven causes of death combined. It is a myth that heart disease is a man's disease. In fact, cardiovascular diseases are the number one killer of women (and men). These diseases currently claim the lives of nearly a half a million females every year. In 1999, approximately one-third (33 percent) of cardiovascular disease deaths occurred prematurely (before age 75, the approximate average life expectancy in that year). The cost of cardiovascular diseases and stroke in 2002 is estimated at $329.2 billion. Stroke killed 167,366 people in 1999 - on average, someone in the US suffers a stroke every 53 seconds; someone dies every 3 minutes from stroke. Stroke is a leading cause of serious, long-term disability that accounts for more than half of all patients hospitalized for a neurological disease. Stroke deaths have been increasing in recent days.
·At least 71 million people in this country suffer from some form of heart disease.
·One person in four suffers from some form of cardiovascular disease, including:
high blood pressure - 65,000,000
coronary heart disease - 13,000,000
angina pectoris - 6,400,000
myocardial infarction (heart attack) - 7,500,000
stroke - 5,400,000
congenital cardiovascular defects - 1,000,000
congestive heart failure - 5,000,000
·Rheumatic heart disease / rheumatic fever kills 3,554 Americans each year.
myLot User Profile
Wednesday, March 5, 2008
Essential Vitamins and Minerals in Foods
Vitamin A promotes vision in dim light, mucous membranes, bones, teeth and skin. Carrots, pumpkin, sweet potatoes, spinach, butternut squash, cantaloupe, mangoes, apricots, broccoli, watermelon, tuna.
Vitamins B
Thiamin keeps carbohydrate metabolism and nervous system in good condition. Pasta, peanuts, legumes, watermelon, oranges, brown rice, oatmeal, eggs.
Riboflavin takes care of the skin, and fat / protein / carbohydrate metabolism. Milk, avocadoes, tangerines, prunes, asparagus, broccoli, mushrooms, salmon, turkey.
Niacin promotes effective use of oxygen by our cells, fat / protein / carbohydrate metabolism, and the nervous system. Peanut butter, legumes, soybeans, whole-grain cereals, broccoli, asparagus, baked potatoes, fish.
Vitamin B6 is for protein metabolism. Soybeans, avocadoes, lima beans, bananas, cauliflower, green peppers, potatoes, spinach, raisins, fish.
Folate is the same as folic acid, which is good for red blood cell tissue growth and repair. Legumes, mushrooms, oranges, asparagus, broccoli, spinach, bananas, strawberries, cantaloupe, tuna.
Vitamin B12 promotes new tissue growth, red blood cells, the nervous system and the skin. Eggs, salmon, swordfish, tuna, clams, crab, mussels, oysters.
Biotin metabolizes fat, protein and carbohydrates. Peanut butter, oatmeal, nuts, cauliflower, legumes, eggs.
Pantothenic Acid aids in the metabolism of fat, protein and carbohydrates. Whole-grain cereals, mushrooms, avocadoes, broccoli, peanuts, cashews, lentils, soybeans, eggs, fish.
Vitamin C builds collagen, healthy gums, teeth and blood vessels. Oranges, grapefruit, bell peppers, strawberries, tomatoes, spinach, cabbage, melons, broccoli, kiwi, raspberries, blueberries.
Vitamin D is good for calcium absorption, bones and teeth. Sunlight, cereals, eggs, milk, butter, tuna and salmon.
Vitamin E protects cells from damage. Nut and vegetable oils, mangoes, blackberries, apples, broccoli, peanuts, spinach.
Vitamin K prevents blood clotting. Spinach, broccoli, brussels sprouts, cabbage, parsley, carrots, avocadoes, tomatoes, eggs, dairy.
Calcium builds strong bones and teeth, muscles and nerves, and prevents blood from clotting. Broccoli, green beans, almonds, turnip greens, orange juice, milk, cheese, yogurt, salmon and sardines with bones.
Chloride aids in digestion. It works with sodium to maintain fluid balance. Salt.
Chromium assists in metabolism of carbohydrates. Whole grains, broccoli, grape juice, orange juice, black pepper.
Copper is good for the blood cells and connective tissues. Nuts, cherries, cocoa, mushrooms, gelatin, legumes, oysters, shellfish, fish, eggs.
Flouride protects the tooth enamel. Tea, fish.
Iodine promotes thyroid function. Spinach, iodized salt, lobster, shrimp, oysters, milk.
Iron brings oxygen in blood and is good for metabolizing energy. Asparagus, spinach, pumpkin seeds, soybeans, tofu, clams.
Magnesium protects the bones, nerve and muscle function. Molasses, nuts, spinach, pumpkin seeds, baked potatoes, broccoli, bananas, seafood, dairy.
Manganese is good for the bones, connective tissues and fat / carbohydrate metabolism. Nuts, legumes, tea, dried fruits, spinach, green leafy vegetables.
Molybdenum helps in nitrogen metabolism. Legumes, whole-grain cereals, dairy.
Phosphorus metabolizes energy. It works with Calcium for healthy bones and teeth. Cereals, fish, eggs, dairy.
Potassium keeps acids balanced. It also works with Sodium to maintain fluid balance. Baked potatoes, avocadoes, dried fruit, yogurt, cantaloupe, spinach, bananas, mushrooms, tomatoes.
Selenium works with Vitamin E to protect cells and body tissue. Whole grain cereals, mushrooms, Brazil nuts, dairy, fish and shellfish.
Sodium keeps the fluid balanced and the nervous system in good condition. Salt, soy sauce, seasonings.
Zinc aids in wound healing, growth, appetite and sperm production. Lima beans, legumes, nuts, oysters, seafood, dairy
Vitamins B
Thiamin keeps carbohydrate metabolism and nervous system in good condition. Pasta, peanuts, legumes, watermelon, oranges, brown rice, oatmeal, eggs.
Riboflavin takes care of the skin, and fat / protein / carbohydrate metabolism. Milk, avocadoes, tangerines, prunes, asparagus, broccoli, mushrooms, salmon, turkey.
Niacin promotes effective use of oxygen by our cells, fat / protein / carbohydrate metabolism, and the nervous system. Peanut butter, legumes, soybeans, whole-grain cereals, broccoli, asparagus, baked potatoes, fish.
Vitamin B6 is for protein metabolism. Soybeans, avocadoes, lima beans, bananas, cauliflower, green peppers, potatoes, spinach, raisins, fish.
Folate is the same as folic acid, which is good for red blood cell tissue growth and repair. Legumes, mushrooms, oranges, asparagus, broccoli, spinach, bananas, strawberries, cantaloupe, tuna.
Vitamin B12 promotes new tissue growth, red blood cells, the nervous system and the skin. Eggs, salmon, swordfish, tuna, clams, crab, mussels, oysters.
Biotin metabolizes fat, protein and carbohydrates. Peanut butter, oatmeal, nuts, cauliflower, legumes, eggs.
Pantothenic Acid aids in the metabolism of fat, protein and carbohydrates. Whole-grain cereals, mushrooms, avocadoes, broccoli, peanuts, cashews, lentils, soybeans, eggs, fish.
Vitamin C builds collagen, healthy gums, teeth and blood vessels. Oranges, grapefruit, bell peppers, strawberries, tomatoes, spinach, cabbage, melons, broccoli, kiwi, raspberries, blueberries.
Vitamin D is good for calcium absorption, bones and teeth. Sunlight, cereals, eggs, milk, butter, tuna and salmon.
Vitamin E protects cells from damage. Nut and vegetable oils, mangoes, blackberries, apples, broccoli, peanuts, spinach.
Vitamin K prevents blood clotting. Spinach, broccoli, brussels sprouts, cabbage, parsley, carrots, avocadoes, tomatoes, eggs, dairy.
Calcium builds strong bones and teeth, muscles and nerves, and prevents blood from clotting. Broccoli, green beans, almonds, turnip greens, orange juice, milk, cheese, yogurt, salmon and sardines with bones.
Chloride aids in digestion. It works with sodium to maintain fluid balance. Salt.
Chromium assists in metabolism of carbohydrates. Whole grains, broccoli, grape juice, orange juice, black pepper.
Copper is good for the blood cells and connective tissues. Nuts, cherries, cocoa, mushrooms, gelatin, legumes, oysters, shellfish, fish, eggs.
Flouride protects the tooth enamel. Tea, fish.
Iodine promotes thyroid function. Spinach, iodized salt, lobster, shrimp, oysters, milk.
Iron brings oxygen in blood and is good for metabolizing energy. Asparagus, spinach, pumpkin seeds, soybeans, tofu, clams.
Magnesium protects the bones, nerve and muscle function. Molasses, nuts, spinach, pumpkin seeds, baked potatoes, broccoli, bananas, seafood, dairy.
Manganese is good for the bones, connective tissues and fat / carbohydrate metabolism. Nuts, legumes, tea, dried fruits, spinach, green leafy vegetables.
Molybdenum helps in nitrogen metabolism. Legumes, whole-grain cereals, dairy.
Phosphorus metabolizes energy. It works with Calcium for healthy bones and teeth. Cereals, fish, eggs, dairy.
Potassium keeps acids balanced. It also works with Sodium to maintain fluid balance. Baked potatoes, avocadoes, dried fruit, yogurt, cantaloupe, spinach, bananas, mushrooms, tomatoes.
Selenium works with Vitamin E to protect cells and body tissue. Whole grain cereals, mushrooms, Brazil nuts, dairy, fish and shellfish.
Sodium keeps the fluid balanced and the nervous system in good condition. Salt, soy sauce, seasonings.
Zinc aids in wound healing, growth, appetite and sperm production. Lima beans, legumes, nuts, oysters, seafood, dairy
Malnutrition
Malnutrition is the condition that develops when the body does not get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function.
Undernutrition
Malnutrition occurs in people who are either undernourished or overnourished.
Undernutrition is a consequence of consuming too few essential nutrients or using or excreting them more rapidly than they can be replaced.
Infants, young children, and teenagers need additional nutrients. So do women who are pregnant or breastfeeding. Nutrient loss can be accelerated by diarrhea, excessive sweating, heavy bleeding (hemorrhage), or kidney failure. Nutrient intake can be restricted by age-related illnesses and conditions, excessive dieting, food allergies, severe injury, serious illness, a lengthy hospitalization, or substance abuse.
The leading cause of death in children in developing countries is protein-energy malnutrition. This type of malnutrition is the result of inadequate intake of calories from proteins, vitamins, and minerals. Children who are already undernourished can suffer from protein-energy malnutrition (PEM) when rapid growth, infection, or disease increases the need for protein and essential minerals. These essential minerals are known as micronutrients or trace elements.
Two types of protein-energy malnutrition have been described-kwashiorkor and marasmus. Kwashiorkor occurs with fair or adequate calorie intake but inadequate protein intake, while marasmus occurs when the diet is inadequate in both calories and protein.
About 1% of children in the United States suffer from chronic malnutrition, in comparison to 50% of children in southeast Asia. About two-thirds of all the malnourished children in the world are in Asia, with another one-fourth in Africa.
Overnutrition
In the United States, nutritional deficiencies have generally been replaced by dietary imbalances or excesses associated with many of the leading causes of death and disability. Overnutrition results from eating too much, eating too many of the wrong things, not exercising enough, or taking too many vitamins or other dietary replacements.
Risk of overnutrition is also increased by being more than 20% overweight, consuming a diet high in fat and salt, and taking high doses of:
· Nicotinic acid (niacin) to lower elevated cholesterol levels
· Vitamin B6 to relieve premenstrual syndrome
· Vitamin A to clear up skin problems
· Iron or other trace minerals not prescribed by a doctor.
Nutritional disorders can affect any system in the body and the senses of sight, taste, and smell. They may also produce anxiety, changes in mood, and other psychiatric symptoms. Malnutrition begins with changes in nutrient levels in blood and tissues. Alterations in enzyme levels, tissue abnormalities, and organ malfunction may be followed by illness and death.
Causes and symptoms
Causes
Poverty and lack of food are the primary reasons why malnutrition occurs in the United States. Ten percent of all members of low income households do not always have enough healthful food to eat. Protein-energy malnutrition occurs in 50% of surgical patients and in 48% of all other hospital patients.
Loss of appetite associated with the aging process. Malnutrition affects one in four elderly Americans, in part because they may lose interest in eating. In addition, such dementing illnesses as Alzheimer's disease may cause elderly persons to forget to eat.
There is an increased risk of malnutrition associated with chronic diseases, especially disease of the intestinal tract, kidneys, and liver. Patients with chronic diseases like cancer, AIDS, intestinal parasites, and other gastric disorders may lose weight rapidly and become susceptible to undernourishment because they cannot absorb valuable vitamins, calories, and iron.
People with drug or alcohol dependencies are also at increased risk of malnutrition. These people tend to maintain inadequate diets for long periods of time and their ability to absorb nutrients is impaired by the alcohol or drug's affect on body tissues, particularly the liver, pancreas, and brain.
Eating disorders. People with anorexia or bulimia may restrict their food intake to such extremes that they become malnourished.
Food allergies. Some people with food allergies may find it difficult to obtain food that they can digest. In addition, people with food allergies often need additional calorie intake to maintain their weight.
Failure to absorb nutrients in food following bariatric (weight loss) surgery. Bariatric surgery includes such techniques as stomach stapling (gastroplasty) and various intestinal bypass procedures to help people eat less and lose weight. Malnutrition is, however, a possible side effect of bariatric surgery.
Symptoms
Unintentionally losing 10 pounds or more may be a sign of malnutrition. People who are malnourished may be skinny or bloated. Their skin is pale, thick, dry, and bruises easily. Rashes and changes in pigmentation are common.
Hair is thin, tightly curled, and pulls out easily. Joints ache and bones are soft and tender. The gums bleed easily. The tongue may be swollen or shriveled and cracked. Visual disturbances include night blindness and increased sensitivity to light and glare.
Other symptoms of malnutrition include:
· anemia
· diarrhea
· disorientation
· night blindness
· irritability, anxiety, and attention deficits
· goiter (enlarged thyroid gland)
· loss of reflexes and lack of muscular coordination
· muscle twitches
· amenorrhea (cessation of menstrual periods)
· scaling and cracking of the lips and mouth.
Malnourished children may be short for their age, thin, listless, and have weakened immune systems.
Diagnosis
Overall appearance, behavior, body-fat distribution, and organ function can alert a family physician, internist, or nutrition specialist to the presence of malnutrition. Patients may be asked to record what they eat during a specific period. X rays can determine bone density and reveal gastrointestinal disturbances, and heart and lung damage.
Blood and urine tests are used to measure the patient's levels of vitamins, minerals, and waste products. Nutritional status can also be determined by:
· Comparing a patient's weight to standardized charts
· Calculating body mass index (BMI) according to a formula that divides height into weight
· Measuring skinfold thickness or the circumference of the upper arm.
Treatment
Normalizing nutritional status starts with a nutritional assessment. This process enables a clinical nutritionist or registered dietician to confirm the presence of malnutrition, assess the effects of the disorder, and formulate diets that will restore adequate nutrition.
Patients who cannot or will not eat, or who are unable to absorb nutrients taken by mouth, may be fed intravenously (parenteral nutrition) or through a tube inserted into the gastrointestinal (GI) tract (enteral nutrition).
Tube feeding is often used to provide nutrients to patients who have suffered burns or who have inflammatory bowel disease. This procedure involves inserting a thin tube through the nose and carefully guiding it along the throat until it reaches the stomach or small intestine. If long-term tube feeding is necessary, the tube may be placed directly into the stomach or small intestine through an incision in the abdomen.
Tube feeding cannot always deliver adequate nutrients to patients who:
· Are severely malnourished
· Require surgery
· Are undergoing chemotherapy or radiation treatments
· Have been seriously burned
· Have persistent diarrhea or vomiting
· Whose gastrointestinal tract is paralyzed.
Intravenous feeding can supply some or all of the nutrients these patients need.
Prognosis
Up to 10% of a person's body weight can be lost without side effects, but if more than 40% is lost, the situation is almost always fatal. Death usually results from heart failure, electrolyte imbalance, or low body temperature. Patients with semiconsciousness, persistent diarrhea, jaundice, or low blood sodium levels have a poorer prognosis.
Some children with protein-energy malnutrition recover completely. Others have many health problems throughout life, including mental retardation and the inability to absorb nutrients through the intestinal tract. Prognosis for all patients with malnutrition seems to be dependent on the age of the patient, and the length and severity of the malnutrition, with young children and the elderly having the highest rate of long-term complications and death.
Prevention
Breastfeeding a baby for at least six months is considered the best way to prevent early-childhood malnutrition. The United States Department of Agriculture and Health and Human Service recommend that all Americans over the age of two:
· Consume plenty of fruits, grains, and vegetables
· Eat a variety of foods that are low in fats and cholesterols and contain only moderate amounts of salt, sugars, and sodium
· Engage in moderate physical activity for at least 30 minutes, at least several times a week
· Achieve or maintain their ideal weight
· Use alcohol sparingly or avoid it altogether.
Every patient admitted to a hospital should be screened for the presence of illnesses and conditions that could lead to protein-energy malnutrition. Patients with higher-than-average risk for malnutrition should be more closely assessed and reevaluated often during long-term hospitalization or nursing-home care.
Key Terms
Anemia
Not enough red blood cells in the blood.
Anorexia nervosa
Eating disorder marked by malnutrition and weight loss commonly occurring in young women.
Bariatric
Pertaining to the study, prevention, or treatment of overweight.
Calorie
A unit of heat measurement used in nutrition to measure the energy value of foods. A calorie is the amount of heat energy needed to raise the temperature of 1 kilogram of water 1°C.
Kwashiorkor
Severe malnutritution in children primarily caused by a protein-poor diet, characterized by growth retardation.
Marasmus
Severe malnutritution in children caused by a diet lacking in calories as well as protein.
Marasmus may also be caused by disease and parasitic infection.
Micronutrients
Essential dietary elements that are needed only in very small quantities. Micronutrients are also known as trace elements. They include copper, zinc, selenium, iodine, magnesium, iron, cobalt, and chromium.
Resources
Books
· Beers, Mark H., MD, and Robert Berkow, MD, editors. "Malnutrition." Section 1, Chapter 2. In The Merck Manual of Diagnosis and Therapy.Whitehouse Station, NJ: Merck Research Laboratories, 2004.
· Flancbaum, Louis, MD, with Erica Manfred and Deborah Biskin. The Doctor's Guide to Weight Loss Surgery. West Hurley, NY: Fredonia Communications, 2001.
Periodicals
· Alvarez-Leite, J. I. "Nutrient Deficiencies Secondary to Bariatric Surgery." Current Opinion in Clinical Nutrition and Metabolic Care 7 (September 2004): 569-575.
· Amella, E. J. "Feeding and Hydration Issues for Older Adults with Dementia." Nursing Clinics of North America 39 (September 2004): 607-623.
· Bryan, J., S. Osendorp, D. Hughes, et al. "Nutrients for Cognitive Development in School-Aged Children." Nutrition Reviews 62 (August 2004): 295-306.
· Grigsby, Donna G., MD. "Malnutrition." eMedicine December 18, 2003.
· Gums, J. G. "Magnesium in Cardiovascular and Other Disorders." American Journal of Health-System Pharmacy 61 (August 1, 2004): 1569-1576.
· Halsted, G. H. "Nutrition and Alcoholic Liver Disease." Seminars in Liver Disease 24 (August 2004): 289-304.
· Reid, C. L. "Nutritional Requirements of Surgical and Critically-Ill Patients: Do We Really Know What They Need?" Proceedings of the Nutrition Society 63 (August 2004): 467-472.
Organizations
· American College of Nutrition. 722 Robert E. Lee Drive, Wilmington, NC 20412-0927. (919) 452-1222.
· American Institute of Nutrition. 9650 Rockville Pike, Bethesda, MD 20814-3990. (301) 530-7050.
· Food and Nutrition Information Center. 10301 Baltimore Boulevard, Room 304, Beltsville, MD 20705-2351.
Other
· World Health Organization (WHO) Nutrition web site.
Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group The Essay Author is Mary K. Fyke.
Undernutrition
Malnutrition occurs in people who are either undernourished or overnourished.
Undernutrition is a consequence of consuming too few essential nutrients or using or excreting them more rapidly than they can be replaced.
Infants, young children, and teenagers need additional nutrients. So do women who are pregnant or breastfeeding. Nutrient loss can be accelerated by diarrhea, excessive sweating, heavy bleeding (hemorrhage), or kidney failure. Nutrient intake can be restricted by age-related illnesses and conditions, excessive dieting, food allergies, severe injury, serious illness, a lengthy hospitalization, or substance abuse.
The leading cause of death in children in developing countries is protein-energy malnutrition. This type of malnutrition is the result of inadequate intake of calories from proteins, vitamins, and minerals. Children who are already undernourished can suffer from protein-energy malnutrition (PEM) when rapid growth, infection, or disease increases the need for protein and essential minerals. These essential minerals are known as micronutrients or trace elements.
Two types of protein-energy malnutrition have been described-kwashiorkor and marasmus. Kwashiorkor occurs with fair or adequate calorie intake but inadequate protein intake, while marasmus occurs when the diet is inadequate in both calories and protein.
About 1% of children in the United States suffer from chronic malnutrition, in comparison to 50% of children in southeast Asia. About two-thirds of all the malnourished children in the world are in Asia, with another one-fourth in Africa.
Overnutrition
In the United States, nutritional deficiencies have generally been replaced by dietary imbalances or excesses associated with many of the leading causes of death and disability. Overnutrition results from eating too much, eating too many of the wrong things, not exercising enough, or taking too many vitamins or other dietary replacements.
Risk of overnutrition is also increased by being more than 20% overweight, consuming a diet high in fat and salt, and taking high doses of:
· Nicotinic acid (niacin) to lower elevated cholesterol levels
· Vitamin B6 to relieve premenstrual syndrome
· Vitamin A to clear up skin problems
· Iron or other trace minerals not prescribed by a doctor.
Nutritional disorders can affect any system in the body and the senses of sight, taste, and smell. They may also produce anxiety, changes in mood, and other psychiatric symptoms. Malnutrition begins with changes in nutrient levels in blood and tissues. Alterations in enzyme levels, tissue abnormalities, and organ malfunction may be followed by illness and death.
Causes and symptoms
Causes
Poverty and lack of food are the primary reasons why malnutrition occurs in the United States. Ten percent of all members of low income households do not always have enough healthful food to eat. Protein-energy malnutrition occurs in 50% of surgical patients and in 48% of all other hospital patients.
Loss of appetite associated with the aging process. Malnutrition affects one in four elderly Americans, in part because they may lose interest in eating. In addition, such dementing illnesses as Alzheimer's disease may cause elderly persons to forget to eat.
There is an increased risk of malnutrition associated with chronic diseases, especially disease of the intestinal tract, kidneys, and liver. Patients with chronic diseases like cancer, AIDS, intestinal parasites, and other gastric disorders may lose weight rapidly and become susceptible to undernourishment because they cannot absorb valuable vitamins, calories, and iron.
People with drug or alcohol dependencies are also at increased risk of malnutrition. These people tend to maintain inadequate diets for long periods of time and their ability to absorb nutrients is impaired by the alcohol or drug's affect on body tissues, particularly the liver, pancreas, and brain.
Eating disorders. People with anorexia or bulimia may restrict their food intake to such extremes that they become malnourished.
Food allergies. Some people with food allergies may find it difficult to obtain food that they can digest. In addition, people with food allergies often need additional calorie intake to maintain their weight.
Failure to absorb nutrients in food following bariatric (weight loss) surgery. Bariatric surgery includes such techniques as stomach stapling (gastroplasty) and various intestinal bypass procedures to help people eat less and lose weight. Malnutrition is, however, a possible side effect of bariatric surgery.
Symptoms
Unintentionally losing 10 pounds or more may be a sign of malnutrition. People who are malnourished may be skinny or bloated. Their skin is pale, thick, dry, and bruises easily. Rashes and changes in pigmentation are common.
Hair is thin, tightly curled, and pulls out easily. Joints ache and bones are soft and tender. The gums bleed easily. The tongue may be swollen or shriveled and cracked. Visual disturbances include night blindness and increased sensitivity to light and glare.
Other symptoms of malnutrition include:
· anemia
· diarrhea
· disorientation
· night blindness
· irritability, anxiety, and attention deficits
· goiter (enlarged thyroid gland)
· loss of reflexes and lack of muscular coordination
· muscle twitches
· amenorrhea (cessation of menstrual periods)
· scaling and cracking of the lips and mouth.
Malnourished children may be short for their age, thin, listless, and have weakened immune systems.
Diagnosis
Overall appearance, behavior, body-fat distribution, and organ function can alert a family physician, internist, or nutrition specialist to the presence of malnutrition. Patients may be asked to record what they eat during a specific period. X rays can determine bone density and reveal gastrointestinal disturbances, and heart and lung damage.
Blood and urine tests are used to measure the patient's levels of vitamins, minerals, and waste products. Nutritional status can also be determined by:
· Comparing a patient's weight to standardized charts
· Calculating body mass index (BMI) according to a formula that divides height into weight
· Measuring skinfold thickness or the circumference of the upper arm.
Treatment
Normalizing nutritional status starts with a nutritional assessment. This process enables a clinical nutritionist or registered dietician to confirm the presence of malnutrition, assess the effects of the disorder, and formulate diets that will restore adequate nutrition.
Patients who cannot or will not eat, or who are unable to absorb nutrients taken by mouth, may be fed intravenously (parenteral nutrition) or through a tube inserted into the gastrointestinal (GI) tract (enteral nutrition).
Tube feeding is often used to provide nutrients to patients who have suffered burns or who have inflammatory bowel disease. This procedure involves inserting a thin tube through the nose and carefully guiding it along the throat until it reaches the stomach or small intestine. If long-term tube feeding is necessary, the tube may be placed directly into the stomach or small intestine through an incision in the abdomen.
Tube feeding cannot always deliver adequate nutrients to patients who:
· Are severely malnourished
· Require surgery
· Are undergoing chemotherapy or radiation treatments
· Have been seriously burned
· Have persistent diarrhea or vomiting
· Whose gastrointestinal tract is paralyzed.
Intravenous feeding can supply some or all of the nutrients these patients need.
Prognosis
Up to 10% of a person's body weight can be lost without side effects, but if more than 40% is lost, the situation is almost always fatal. Death usually results from heart failure, electrolyte imbalance, or low body temperature. Patients with semiconsciousness, persistent diarrhea, jaundice, or low blood sodium levels have a poorer prognosis.
Some children with protein-energy malnutrition recover completely. Others have many health problems throughout life, including mental retardation and the inability to absorb nutrients through the intestinal tract. Prognosis for all patients with malnutrition seems to be dependent on the age of the patient, and the length and severity of the malnutrition, with young children and the elderly having the highest rate of long-term complications and death.
Prevention
Breastfeeding a baby for at least six months is considered the best way to prevent early-childhood malnutrition. The United States Department of Agriculture and Health and Human Service recommend that all Americans over the age of two:
· Consume plenty of fruits, grains, and vegetables
· Eat a variety of foods that are low in fats and cholesterols and contain only moderate amounts of salt, sugars, and sodium
· Engage in moderate physical activity for at least 30 minutes, at least several times a week
· Achieve or maintain their ideal weight
· Use alcohol sparingly or avoid it altogether.
Every patient admitted to a hospital should be screened for the presence of illnesses and conditions that could lead to protein-energy malnutrition. Patients with higher-than-average risk for malnutrition should be more closely assessed and reevaluated often during long-term hospitalization or nursing-home care.
Key Terms
Anemia
Not enough red blood cells in the blood.
Anorexia nervosa
Eating disorder marked by malnutrition and weight loss commonly occurring in young women.
Bariatric
Pertaining to the study, prevention, or treatment of overweight.
Calorie
A unit of heat measurement used in nutrition to measure the energy value of foods. A calorie is the amount of heat energy needed to raise the temperature of 1 kilogram of water 1°C.
Kwashiorkor
Severe malnutritution in children primarily caused by a protein-poor diet, characterized by growth retardation.
Marasmus
Severe malnutritution in children caused by a diet lacking in calories as well as protein.
Marasmus may also be caused by disease and parasitic infection.
Micronutrients
Essential dietary elements that are needed only in very small quantities. Micronutrients are also known as trace elements. They include copper, zinc, selenium, iodine, magnesium, iron, cobalt, and chromium.
Resources
Books
· Beers, Mark H., MD, and Robert Berkow, MD, editors. "Malnutrition." Section 1, Chapter 2. In The Merck Manual of Diagnosis and Therapy.Whitehouse Station, NJ: Merck Research Laboratories, 2004.
· Flancbaum, Louis, MD, with Erica Manfred and Deborah Biskin. The Doctor's Guide to Weight Loss Surgery. West Hurley, NY: Fredonia Communications, 2001.
Periodicals
· Alvarez-Leite, J. I. "Nutrient Deficiencies Secondary to Bariatric Surgery." Current Opinion in Clinical Nutrition and Metabolic Care 7 (September 2004): 569-575.
· Amella, E. J. "Feeding and Hydration Issues for Older Adults with Dementia." Nursing Clinics of North America 39 (September 2004): 607-623.
· Bryan, J., S. Osendorp, D. Hughes, et al. "Nutrients for Cognitive Development in School-Aged Children." Nutrition Reviews 62 (August 2004): 295-306.
· Grigsby, Donna G., MD. "Malnutrition." eMedicine December 18, 2003.
· Gums, J. G. "Magnesium in Cardiovascular and Other Disorders." American Journal of Health-System Pharmacy 61 (August 1, 2004): 1569-1576.
· Halsted, G. H. "Nutrition and Alcoholic Liver Disease." Seminars in Liver Disease 24 (August 2004): 289-304.
· Reid, C. L. "Nutritional Requirements of Surgical and Critically-Ill Patients: Do We Really Know What They Need?" Proceedings of the Nutrition Society 63 (August 2004): 467-472.
Organizations
· American College of Nutrition. 722 Robert E. Lee Drive, Wilmington, NC 20412-0927. (919) 452-1222.
· American Institute of Nutrition. 9650 Rockville Pike, Bethesda, MD 20814-3990. (301) 530-7050.
· Food and Nutrition Information Center. 10301 Baltimore Boulevard, Room 304, Beltsville, MD 20705-2351.
Other
· World Health Organization (WHO) Nutrition web site.
Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group The Essay Author is Mary K. Fyke.
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