Nutrition and Diagnosis-Related Care (Nutrition and Diagnosis-Related Care ( Escott-Stump))

1042 Pages·2011·107.29 MB·English

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S E V E N T H E D I T I O N
Sylvia Escott-Stump, MA, RD, LDN
Dietetic Internship Director
East Carolina University
Greenville, North Carolina
Consulting Dietitian
Nutritional Balance
Winterville, North Carolina
2011-2012 President
American Dietetic Association
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Acquisitions Editor: David B. Troy
Product Manager: John Larkin
Marketing Manager: Allison Powell
Creative Director: Doug Smock
Compositor:Aptara, Inc.
Seventh Edition
Copyright © 2012 Lippincott Williams & Wilkins, a Wolters Kluwer business
351 West Camden Street Two Commerce Square
Baltimore, MD 21201 2001 Market Street
Philadelphia, PA 19103
Printed in China
First Edition, 1985 Third Edition, 1992 Fifth Edition, 2002
Second Edition, 1988 Fourth Edition, 1997 Sixth Edition, 2008
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or
transmitted in any form or by any means, including as photocopies or scanned-in or other electronic
copies, or utilized by any information storage and retrieval system without written permission from the
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ing in this book prepared by individuals as part of their official duties as U.S. government employees
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Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via e-mail
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9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Escott-Stump, Sylvia.
Nutrition and diagnosis-related care / Sylvia Escott-Stump. -- 7th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60831-017-3 (alk. paper)
1. Diet therapy--Handbooks, manuals, etc. 2. Nutrition--Handbooks,
manuals, etc. I. Title.
[DNLM: 1. Nutrition Therapy--Handbooks. 2. Nutritional Physiological
Phenomena--Handbooks. WB 39]
RM217.2.E83 2012
615.8(cid:2)54--dc22 2010041550
DISCLAIMER
Care has been taken to confirm the accuracy of the information present and to describe generally
accepted practices. However, the authors, editors, and publisher are not responsible for errors or omis-
sions or for any consequences from application of the information in this book and make no warranty,
expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the
publication. Application of this information in a particular situation remains the professional responsi-
bility of the practitioner; the clinical treatments described and recommended may not be considered
absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and
dosage set forth in this text are in accordance with the current recommendations and practice at the
time of publication. However, in view of ongoing research, changes in government regulations, and the
constant flow of information relating to drug therapy and drug reactions, the reader is urged to check
the package insert for each drug for any change in indications and dosage and for added warnings and
precautions. This is particularly important when the recommended agent is a new or infrequently
employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration
(FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care
providers to ascertain the FDA status of each drug or device planned for use in their clinical practice.
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FOREWORD
This book is a valuable resource for registered dietitians, extensive, succinct compilation of nutrition information.
dietetic interns and students, and other health care profes- The most impressive attribute is that the germane informa-
sionals involved or interested in medical nutrition therapy. tion required by dietitians is presented in a single resource.
Given the increasing time demands confronting health care This greatly simplifies the development of nutrition care
professionals, efficient time management is essential for deliv- plans. Thus, this book provides dietetic practitioners with
ering high-quality patient care. The ever-changing health superb guidance they can use to maintain outstanding prac-
care environment necessitates that registered dietitians effi- tice skills. This book is a resource that can help achieve excel-
ciently and effectively maintain their high level of practice lence in dietetic practice.
skills. Thus, this book remains a key resource for prioritizing
patient care and appropriately planning nutrition therapy. Penny Kris-Etherton, PhD, RD
The guidance provided by Nutrition and Diagnosis-Related Care Pennsylvania State University
is of immense value in charting the clinical course for each
patient, especially for clinical conditions that the practitioner Karen Kubena, PhD, RD
does not routinely treat. This book continues to present an Texas A & M University
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PREFACE
Health care professionals must identify all elements of 2. An individualized drug history review is essential, as
patient care capable of affecting nutritional status and out- only a few medications are listed in this manual.
comes. The registered dietitian must provide nutritional 3. Herbs, botanicals, and dietary supplements are included
care in a practical, efficient, timely, and effective manner because they are often used without prior consultation
regardless of setting. Various environments provide unique with a dietitian or a physician; they have side effects as
and special considerations. The astute dietitian is sensitive well as perceived or real benefits.
to the patient/client’s current status in the continuum of
4. For patient education, the reader must provide appro-
care, meticulously adapting the nutritional care plan.
priate handouts, printed materials and teaching tools to
Communication between staff of different facilities will
prepare the patient for independent functioning. The
save time for screenings and assessments and will promote
nutrition counselor must share relevant information, as
the implementation of strategic interventions. With elec-
deemed appropriate, with the patient and significant
tronic health records, data and summary reports can be
other(s). The educator must identify teachable moments
shared from one practitioner to the next while maintain-
and share what is needed at the time. Follow-up inter-
ing confidentiality.
ventions are highly recommended to assess successful
Nutrition and Diagnosis-Related Carehas evolved since 1985
behavioral changes by the patient/client.
to supplement other texts and references and to quickly
5. Providers must prioritize key nutritional diagnoses that
assimilate and implement medical nutrition therapy
can be managed within the given time frame. With roles
(MNT.) This guide can be used to help write protocols, to
in ambulatory centers, extended care facilities, subacute
establish priorities in nutrition care, to demonstrate cost-
or rehabilitative centers, private practices, grocery
effective therapies, and to categorize disorders in which
stores, Web-based practices, rehabilitation facilities, and
nutrition interventions can decrease complications, further
home care, the “seamless” continuum affords registered
morbidity, mortality, or lengthy hospital stays. Adequate
dietitians the possibility of lifelong patient relationships,
nutritional intervention often results in financial savings for
a reality that promotes more effective monitoring,
the patient, the family, and the health care system. Indeed,
follow-up, and evaluation.
current knowledge solidifies the role of nutrition as therapy,
6. The Clinical Indicators section for each condition lists
and not just adjunctive support.
tests, disease markers, and common biochemical eval-
The seventh edition updates guidance in MNT, adding
uations reviewed by physicians or dietitians for that
commentary about nutritional genetics and nutrition care
condition. Because few laboratory tests are available in
process concepts for each condition. The format of
nonhospital settings for monitoring nutritional status,
the book continues to promote easy navigation for quick
appetite and weight changes are the most viable
retrieval of information. Appendix A summarizes the nutri-
screening factors. Physical changes and signs of mal-
ents and their major food sources and functions. Appendix B
nutrition are important for assessment and should be
promotes use of the Nutrition Care Process approved for
identified.
the profession of dietetics. Sample forms are included,
including language related to the critical thinking involved 7. A current diet manual and MNT text should be used to
with A-D-I (assessment, nutrition diagnosis, interventions) acquire diet modification lists; comprehensive lists are
and M-E (monitoring and evaluation) as follow-up docu- not included with this book.
mentation. The Nutritional Acuity Level Ranking for dieti- 8. Use of evidence-based guides from American Dietetic
tian services is found in Appendix C. Content previously in Association must be used to provide predictable types of
appendices D and E has been moved into the text. interventions over multiple visits, especially for reim-
Using evidence-based practice guides from the American bursement. Use the www.eatright.org Web site to select
Dietetic Association, and use of this manual can improve current guidelines for practice.
nutrition therapy in any setting. The profession of dietetics 9. Except where specifically noted for children, nutrition
continues to evolve and develop a deeper understanding of therapy plans are for individuals over the age of 18.
the prominence of nutrition in health promotion and dis-
10. Vitamin and mineral supplements are needed in cases
ease management.
of a documented or likely deficiency. However, in large
doses, they may cause food--drug interactions. Plan
meals and nourishments carefully to avoid the need for
ASSUMPTIONS ABOUT THE READER
individual supplements.
11. Use of a general multivitamin--mineral supplement may
For this text, the following assumptions have been made:
be beneficial for many adults; monitor intakes judi-
1.The reader has an adequate background in nutrition sci- ciously from all food and supplemental sources. Ath-
ences, physiology, pathophysiology, medical terminology, letes, women, elderly individuals, and vegetarians tend
biochemistry, basic pharmacotherapy, and interpretation to take vitamin and mineral supplements more often
of biochemical data to understand the abbreviations, than other individuals and may be at risk for overdoses
objectives, and interventions in this book. if not carefully monitored.
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PREFACE v
12. Most evidence points to the benefits of whole foods to 13. Ethics, cultural sensitivity, and a concern for patient
acquire phytochemicals and yet unknown substances. rights should be considered and practiced at all times.
Healthy persons should obtain nutrients from a balanced When available, the wishes and advanced directives of
diet as much as possible. The use of functional food ingre- the patient are to be followed. This may preclude
dients, such as antioxidant foods, is highly recommended. aggressive use of artificial nutrition.
A well-balanced, varied diet uses the US Department of 14. Interesting and varied Web sites have been included for
Agriculture (USDA) MyPyramid Food Guidance System the reader for additional insights into various diseases,
and various ethnic, vegetarian, pediatric, geriatric, or dia- conditions, and nutritional interventions.
betes food guides for menu planning and design.
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ACKNOWLEDGMENTS
Thanks to all reviewers who made valuable suggestions for
changes.
I wish to thank John Larkin, Samir Roy and Shelley
Opremcak, RD, LDN and other colleagues for their valuable
suggestions, insights, and edits. This book is dedicated to my
family and to my students, interns and colleagues.
Sylvia Escott-Stump, MA, RD, LDN
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COMMON ABBREVIATIONS
AA amino acid DV daily value
abd abdomen, abdominal Dx diagnosis
ABW average body weight D5W 5% dextrose solution in water
ACE angiotensin-converting enzyme EAA essential amino acid
ACTH adrenocorticotropic hormone ECG, EKG electrocardiogram
ADA American Dietetic Association EEG electroencephalogram
Alb albumin EFAs essential fatty acids
Alk phos alkaline phosphatase Elec electrolytes
ALT alanine aminotransferase EN enteral nutrition
amts amounts ESRD end-stage renal disease
ARF acute renal failure ETOH ethanol/ethyl alcohol
(cid:3)(cid:3)
ASHD atherosclerotic heart disease Fe iron
AST aspartate aminotransferase F & V fruits and vegetables
ATP adenosine triphosphate FSH follicle-stimulating hormone
BCAAs branched-chain amino acids FTT failure to thrive
BEE basal energy expenditure FUO fever of unknown origin
BF breastfeeding G, g gram(s)
BMR basal metabolic rate GA gestational age
BP blood pressure GBD gallbladder disease
BS blood sugar GE gastroenteritis
BSA body surface area gest gestational
BUN blood urea nitrogen GFR glomerular filtration rate
BW body weight GI gastrointestinal
bx biopsy Gluc glucose
C cup(s) GN glomerular nephritis
C coffee GTT glucose tolerance test
CA cancer H & H hemoglobin and hematocrit
(cid:3)(cid:3)
Ca calcium HbA hemoglobin A test (glucose)
1c 1c
CABG coronary artery bypass grafting HBV high biological value
CBC complete blood count HBW healthy body weight
CF cystic fibrosis HCl hydrochloric acid
CHD cardiac heart disease Hct hematocrit
CHF congestive heart failure HDL high-density lipoprotein
CHI creatinine-height index HLP hyperlipoproteinemia or hyperlipidemia
CHO carbohydrate HPN, HTN hypertension
Chol cholesterol ht height
(cid:4)
Cl chloride Hx history
CNS central nervous system I infant
CO carbon dioxide I & O intake and output
2
CPK creatine phosphokinase IBD inflammatory bowel disease
CPR cardiopulmonary resuscitation IBS irritable bowel syndrome
CrCl creatine clearance IBW ideal body weight
CRP C-reactive protein IEM inborn error of metabolism
CT computed tomography INR international normalized ratio
Cu copper IU international units
CVA cerebrovascular accident IUD intrauterine device
DAT diet as tolerated IV intravenous
(cid:3)
dec decreased K potassium
decaf decaffeinated kcal food kilocalories
def deficiency kg kilogram(s)
DJD degenerative joint disease L liter(s)
dL deciliter lb pound(s)
DM diabetes mellitus LBM lean body mass
DNA deoxyribonucleic acid LBV low biological value
DOB date of birth LBW low birth weight
DRI dietary reference intakes LCT long-chain triglycerides
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viii COMMON ABBREVIATIONS
LDH lactate dehydrogenase pO partial pressure of oxygen
2
LDL low-density lipoproteins prn pro re nata (as needed)
LE lupus erythematosus Prot protein
LGA large for gestational age PT prothrombin time or physical therapy
LH luteinizing hormone PTH parathormone
lytes electrolytes PUFA(s) polyunsaturated fatty acid(s)
M milk PVD peripheral vascular disease
MAC midarm circumference RAST radioallergosorbent test
MAMC midarm muscle circumference RBC red blood cell count
MAO monoamine oxidase RDA recommended dietary allowance (specific)
MBF meat-base formula RDS respiratory distress syndrome
MCH mean cell hemoglobin REE resting energy expenditure
MCT medium-chain triglycerides RQ respiratory quotient
MCV mean cell volume Rx treatment
(cid:3)(cid:3)
Mg magnesium SFA saturated fatty acids
mg milligram(s) SGA small for gestational age
(cid:5)g micrograms SI small intestine
MI myocardial infarction SIADH syndrome of inappropriate antidiuretic
mm millimeter(s) hormone
MODS multiple organ dysfunction syndrome SIDS sudden infant death syndrome
MSG monosodium glutamate SOB shortness of breath
MUFA monounsaturated fatty acids Sub substitute
N&V nausea and vomiting Sx symptoms
N nitrogen t teaspoon(s)
Na sodium T tablespoon
NCEP National Cholesterol Education Program TB tuberculosis
NCP Nutrition Care Process TF tube feeding; tube fed
NEC necrotizing enterocolitis TG triglycerides
NG nasogastric TIBC total iron-binding capacity
NPO nil per os (nothing by mouth) TLC total lymphocyte count
NSI Nutrition Screening Initiative TPN total parenteral nutrition
O oxygen TSF triceps skinfold
2
OP outpatient UA uric acid
OT occupational therapist UTI urinary tract infection
oz ounce(s) UUN urinary urea nitrogen
P phosphorus VMA vanillylmandelic acid
PCM protein—calorie malnutrition VO maximum oxygen intake
2max
pCO partial pressure of carbon dioxide WBC white blood cell count
2
PG pregnant, pregnancy WNL within normal limits
PKU phenylketonuria Zn zinc
PN parenteral nutrition
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