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Taryn BerryPUD Case StudyList all the food items that may contribute to GG’s condition and explain why.The fast food, fried food, strong coffee, high fat foods, and chocolate may contribute to her condition because these foods increase acid secretions or irritate the gastric mucosa. Additionally, dairy products are not recommended when a person is symptomatic.Nutrition Therapy & Pathophysiology 2e, 363.List any additional oral intake that may have contributed to GG’s condition and explain why.Alcohol and aspirin decrease mucosal integrity by blocking prostaglandin release, inhibiting prevention of gastric mucosa. Also, smoking can reduce blood supply and mucosal integrity, similar to alcohol and aspirin.Nutrition Therapy & Pathophysiology 2e, 361-363.List the non-oral stimulants (physical or psychological stress) that could contribute to GG’s condition and what she could do to change them.Stress can reduce blood supply and decrease mucosal integrity. Yoga or other relaxation techniques would help her manage her stress.Nutrition Therapy & Pathophysiology 2e, 361.List the symptoms of GG’s gastritis.Persisting stomach pains and burning.Pain subsides after eating and taking antacid medicine and then returns due release of gastrin.Low hematocrit and hemoglobin levels.Nutrition Therapy & Pathophysiology 2e, 361-362.Was a bland diet necessary? Explain and list the principles of the diet plan that you think GG should follow.According to the Academy of Nutrition and Dietetic Nutrition Care Manual, a bland diet is an outdated treatment for PUB. Instead, she should avoid the food, drinks, and non-oral stimulants that are thought to provoke symtpms.What is the mechanism of action of the following medications GG is receiving: Carafate, AlternaGel, and Pepcid?Carafate stick to damaged ulcer tissue and protects it to allow healing.AlternaGel relieves pain from heartburn and peptic ulcer to help with the healing process.Pepcid decreases the amount of acid made in the stomach, thus reducing heartburn.Peace HealthList the nutrient-drug interactions that are associated with these medications.Carafate may potentially have a negative interaction with calcium.AlternaGel may potentially have a negative interaction with citrate.Pepcid may potentially have a negative interaction with magnesium.Peace HealthWhat are GG’s IBW and percent of IBW?Currently: 5’2” and 98 lbsIBW: 100 + (5lbs x 2in)= 110 lbs (Hamwi Method)%IBW: 98lbs/110lbs=89%Estimate her daily energy needs using the Harris-Benedict equation and appropriate stress factor.98lbs/2.2=44.5 kg62 in/0.3937=157.5cmStress factor=1.6655 + (9.56 x 44.5 kg) + (1.85 x 157.5 cm) – (4.68 x 27 years)=1245 kcal x 1.6=1992 or 2000 kcalWhat might be the cause of the LUQ pain along with her usual pain? (HINT: consider the elevated enzymes)As states previously, her drinking irritates the gastric mucosa and decreases mucosal integrity. Additionally, binge drinking puts strain on her liver because it is overworking to process the alcohol. This is most likely the reason she is having LUQ pain in addition to the gastritis pain. In the second set of lab values, glu, BUN, Cr, ser alb, Na, K, Cl, hgb, and hct all dropped. This probably means the GG was:Bleeding.Eating poorly in the hospital.Dehydrated when the first labs were drawn.Over hydrated when the second set of labs was drawn.In the second set of lab values, serum amylase, AST, and ALT all dropped. This probably means that:Enzymes were elevated due to alcohol.Her medications caused them to drop.GG was dehydrates when the first labs were drawn.GG was over hydrates when the second set of labs was drawn.Refer to the two lab tables again, and note that two days after admission, GG’s Alk Phos and CPK remained essentially unchanged. Why?These enzymes are not affected by alcohol or hydration.Her medications caused them to drop.Dehydration when the first lab values were drawn.Over hydrated when the second set of labs was drawn.What diagnostic test(s) (not lab values) indicate (s) that GG has an ulcer?An endoscopy and tissue biopsy with show a visualization of the ulcer and confirmation of H. pylori infection. A urea breath , stool antigen, and serum testing are less invasive ways of testing for a H. pylori infection. The most reliable right now is the breath test.Nutrition Therapy & Pathophysiology 2e, 362.Briefly sketch the anatomical position where GG’s ulcer can be found.Define:H2 antagonist: aka H2 blockers, reduce the production of stomach acid, thus reducing inflammation and allowing ulcers to heal.Proton pump inhibitor: greatly reduce the amount of acid produced by the stomach, thus reducing inflammation and allowing ulcers to heal.Peace HealthWhat is the mechanism of action of the following medications GG is receiving: Nexium, amoxicillin, and clarithromycin?Nexium: this is a proton pump inhibitor that will greatly reduce the amount of acid produced by the stomach, thus reducing inflammation and allowing ulcers to heal.Amoxicillin: this is an antibiotic that will protect bacteria from growing during the healing process.Clarithromycin: this is a probiotic that will help grow beneficial bacteria in the gut. This is often given in combination with an anti-biotic to avoid diarrhea.Peace Health GG was not receiving counsel at the time the major bleeding started. If you had the opportunity to counsel GG just before the bleeding, in what areas would you feel competent to counsel her and in what areas would you refer her to someone else? Investigate the agencies in your area that are available to provide assistant to someone like GG.I would feel confident counseling her on nutrition therapy, food choices that will would reduce irritation, amount of energy intake in order to gain weight, and education on medication-nutrient interactions. Area that I would refer her to another specialist for would be her drinking, smoking, stress, and financial burdens.What is the significance of the dark stool?Dark stool is common when there is internal bleeding in the GI tract, especially when ulcers are present.Peace HealthGive the pathophysiology for the cause of the following abnormal values: BUN, NH3, and WBC.BUN abnormality is due to decreased functionality of the kidneys or indicative of dehydration.NH3 abnormality indicates that the liver is not properly breaking down urea.WBC abnormality is due to the presence of infection. When an infection is present, the WBC levels increase significantly.GG was probably dehydrated on admission since she had been drinking. This means that some of her lab values were probably higher/lower (circle one) than indicated.After admission GG received packed cells and IV fluids. How would that affect the next set of lab values?Because of the alcohol in her system, she would be dehydrate but giving GG packed cells and IV fluids would get most of the dehydration levels back to normal.Define the following terms:Packed cells: This is the amount of red blood cell volume in the blood, indicated in a percentage form.Abdominal tap: fluid is taken out of the belly via a long, thin needle then sent to a lab to find the source of the fluid build up.Perforated ulcer: an untreated ulcer that burns a hole in the intestinal lining, allowing contents to seep out of the intestinal cavity.Fistula: the result of an injury or inflammation/infection. It is an abnormal connection between an organ, vessel, or intestine and another structure.Exploratory Laparotomy: this is a surgery where in intestinal organs and structures are looked at.Billroth I: aka a partial gastrectomy or pyloroplasty is performed with a reconstruction that consists of anastomosis of the proximal end of the duodenum to the distal end of the stomach.Vagotomy: severing the vagus nerve.Peace HealthMedLine PlusNutrition Therapy & Pathophysiology 2e, 364.Sketch a Billroth pare a Billroth I to a Billroth II as to anatomical changes as well as to dietary changes, if any.A Billroth I is performed with a reconstruction that consists of anastomosis of the proximal end of the duodenum to the distal end of the stomach. A Billroth II is the reconstruction that consists of an anastomosis of the proximal end of the jejunum to the distal end od the stomach. Both of these procedures require patients to follow a postgastrectomy diet.Nutrition Therapy & Pathophysiology 2e, 364.Calculate GG’s energy and protein needs.As stated above, her energy needs are 2000 kcal per day.Protein needs are 1.5 g protein/kg body weight. So, 44.5 kg x 1.5=67 g List the principles of a postgastrectomy diet and briefly describe the scientific basis for each principle.This is a diet that tries to avoid dumping syndrome by being high in protein and fat. Simple sugars are avoided to prevent hyperosmolality and hypoglycemia. Lactose is also usually not tolerated. Liquids should not be consumed during meals, to avoid dumping syndrome by quick liquid movements through the small intestines. Five to six small meals is the recommended amount, layin down after each one. Nutritional support is recommended if advancement to solid food is not progressed in a timely manner.Nutrition Therapy & Pathophysiology 2e, 366.Is it possible that GG’s diet will ever change or do you believe she will be on a postgastrectomy diet for the rest of her life? Explain your answer.First, she needs to follow the diet in order for her body to heal properly. Then, I think if she changes her diet by avoiding the foods that cause her pain and find foods that she can tolerate, she should be able to go off of a postgastrectomy diet. It will definitely take a complete lifestyle change but if she is willing to change, she will not have to be on this diet forever.If GG were to be hospitalized for an extended period of time and required a tube feeding via duodenum or jejunum, what characteristics would be appropriate for the tube feeding you would use?A tube feeding would be similar to the nutrients needed in the postgastrectomy diet. This consists of a formula that is high in protein and fat, hydrolyzed, and provides immune support with needed micronutrients for GG’s healing body. Crucial 1.5 and Pivot 1.5 would both be appropriate for this patient.Nutrition Therapy & Pathophysiology 2e, 66.Using the table below, compare several of the enteral nutritional supplement that would be appropriate for GG.ProductProducerCal/mLNon-Pro cal/g NProCHOFatNa mgK mgmOsm/kg waterVol to meet RDA mLG of fiber/LFree H2O/L in mLg/LCrucialNestle1.567:1941346850.8484901000N/A772Pivot 1.5 CalAbbott1.575:1941725133047559515001.8692Abbott Nutrition: of Michigan Hospital and Health Center: “Health Topics A-Z.” Peace Health. 2015. Referenced from Plus. 12 Jan 2015. Referenced from , Sucher, Lacey, Roth. (2012). Nutrition Therapy & Pathophysiology (II ed.): Belmont, CA: Wadsworth. “Patient Food and Nutrition Services Enteral Products Quick Reference for Adults.” University of Michigan Hospital and Medical Center. Referenced from “Peptic Ulcers.” Nutrition Care Manual. Academy of Nutrition and Dietetics. 2015. Referenced from “Pivot 1.5 Cal.” Abbott Nutrition. 2008. Referenced from ................
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