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BIOL 1101 ppt fall 2012

BIOL 1101 ppt fall 2012

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  • 1. CHAPTER 26Chronic Disabling Conditions and Rehabilitation Ethan Bergman and Nancy Buergel Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 2. Goals of Supportive Care and Role of the Dietitian Prevention of further disability Restoration of potential function Initial screening to identify clients with nutrition problems potentially leading to malnutrition Evaluate nutritional status of the client by using medical, dietary, and medication histories; laboratory data; and anthropometric measurements Slide 2 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 3. Goals of Supportive Care and Role of the Dietitian – Cont’d Plan developed to care for the client’s short-term and long-term needs  Nutrition education and counseling, involving work with the individual client, family, and other caregivers Periodic evaluation  Make necessary adjustments Slide 3 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 4. Team Approach Method Rehabilitation team specialists include the physician (physiatrist), clinical nutritionist, nurse, occupational therapist, physical therapist, psychologist, speech pathologist, and social worker  Most important member of the team is the client Slide 4 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 5. Social Attitudes Persons have varying special needs Avoidance of these needs manifests itself as obstacles to basic mobility Overprotection robs a person of his or her selfhood and smothers the will to fight against surrounding odds and develop self- acceptance Slide 5 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 6. Economic Problems Care for a person with a disabling injury or severe illness can be a long and costly process  Major area of exploration for the healthcare team is one of financial resources Long-term economic problems may revolve around the client’s employment capabilities or earning capacities  Cost of providing care Slide 6 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 7. Living Situation Disabled persons may need long-term hospital care Independent living with or without an attendant Activities of daily life can be difficult  Can cause problems with food quality, maintaining desirable food temperatures, and maintaining an adequate intake Slide 7 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 8. Psychologic Barriers Every person with physical body trauma struggles with self-image and may withdraw in defeat and exhaustion Changes test both inner strength and physical stamina Positive resolution of many practical and emotional problems requires tremendous psychologic adjustment Slide 8 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 9. Psychosocial Implications of the Inability to Self-Feed Unable to make transition to self-feeding due to an inability to physically move the food to the mouth or the inability to swallow May feel anger, frustration, fear, sadness, and a sense of grief because of inability to complete this fundamental task  May become clinically depressed Slide 9 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 10. Special Needs of Older Disabled Persons By 2050 there will be almost 87 million people 65 years old or older living in the United States  With older age comes an increased number of disabled older adults Slide 10 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 11. Special Needs of Older Disabled Persons – Cont’d About 79% of people age 70 years or older have at least one of seven potentially disabling conditions  Arthritis  Hypertension  Heart disease  Diabetes  Respiratory diseases  Stroke  Cancer Slide 11 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 12. Vocational Rehabilitation After a lifetime of active involvement in a familiar working environment, retirees suddenly lack a sense of stability and identity Supportive activities focus on vocational planning and the effective use of leisure time Slide 12 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 13. Vocational Rehabilitation – Cont’d Vocational programs can help persons find gainful employment after they retire from work Programs can help them find ways of contributing their wisdom and skills to younger workers in their field of specialty Slide 13 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 14. Physical Decline in Aging In persons from 75 to 85 years of age and older, disability increases sharply  Falls and resulting fractures, chronic brain failure, disorders in locomotion, impaired senses of perception, and increased problems with drug reactions and interactions Slide 14 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 15. Physical Decline in Aging – Cont’d In this age-group, minor disabilities often result in major handicaps  Arthritis, cardiorespiratory and cardiovascular insufficiency, depression, sensory deprivation, infections, skin and foot disorders, and nutritional deficiencies from poor dental health and fad diets require nutrition care Slide 15 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 16. Prevention of MalnutritionCalories Excess calories must be avoided to prevent obesity, but sufficient energy for physical activity and tissue metabolism is essential Slide 16 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 17. Prevention of Malnutrition – Cont’dProtein Tissue and organ integrity protects against catabolism, infections, negative nitrogen balance, and pressure sores Optimal quantity (15% to 20% of total calories) and quality Slide 17 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 18. Prevention of Malnutrition – Cont’dCarbohydrates Dietary carbohydrate is the body’s major fuel source Sufficient carbohydrate-rich foods are important to provide the needed energy, as well as to prevent protein catabolism and negative nitrogen balance Slide 18 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 19. Prevention of Malnutrition – Cont’dFat Calorically dense form of energy that supplies essential fatty acids and adds palatability to the diet Slide 19 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 20. Prevention of Malnutrition – Cont’dVitamins and Minerals Optimal intake of vitamins and minerals is needed for metabolic activity and maintenance of tissue reserves Normal Dietary Reference Intake (DRI, including Recommended Daily Allowance [RDA] and Adequate Intake [AI]) standards for age and sex are adequate in most cases  Some states indicate supplementation Slide 20 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 21. Restoration of Eating Ability The disabled person works with the professional team of occupational and physical therapists, nutritionists, and nurses to find adaptive procedures to restore basic eating ability Eating process will require individual attention to the following aspects:  Nature and degree of motor control, eating position, use of adaptive utensils, and support of individual needs Slide 21 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 22. Restoration of Eating Ability – Cont’d Personal food plan must fulfill basic nutritional needs, and amounts must be increased accordingly to additional metabolic demands Slide 22 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 23. Independence in Daily Living Goal is to achieve as much independence in daily living as possible U.S. Department of Health and Human Services, Bureau of Primary Care provides a list of assistive devices Large number of creative devices are available Slide 23 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 24. Rheumatoid ArthritisClinical Characteristics Underlying chronic, systemic, inflammatory disease process usually begins in the young adult years Severe type of autoimmune disorder in which the body’s immune system acts against its own tissue Slide 24 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 25. Rheumatoid Arthritis – Cont’dClinical Characteristics – cont’d Severe type of autoimmune disorder in which the body’s immune system acts against its own tissue – cont’d  Attacks joints of the hands, arms, and feet, causing them to become extremely painful, stiff, and even deformed  Synovium becomes inflamed and secretes more fluid, leaving the joint swollen and fatigued Dramatically affects activities of daily living Slide 25 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 26. Rheumatoid Arthritis – Cont’dMedical Management Emphasis is put on early diagnosis and treatment Use of combinations of disease-modifying antirheumatic drugs (DMARDs) Use of agents that target cytokines Slide 26 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 27. Rheumatoid Arthritis – Cont’d Treatment outcomes should include an analysis of important coexisting illnesses, particularly cardiovascular disease and osteoporosis Slide 27 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 28. Rheumatoid Arthritis – Cont’d Corticosteroids are effective at slowing the progression of rheumatoid arthritis (RA)  Used in 30% to 60% of RA patients  Side effects, including thinning skin, cataracts, osteoporosis, hypertension, and hyperlipidemia Slide 28 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 29. Rheumatoid Arthritis – Cont’dNutritional Management Energy  Varies widely and must be determined on an individual basis • Stress of disease activity, sepsis, fever, skeletal injury, or surgery Slide 29 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 30. Rheumatoid Arthritis – Cont’dNutritional Management – cont’d Protein  Well-nourished adult patient needs about 0.5 to 1 g of protein/kg/day during quiet disease periods  An increase to 1.5 to 2 g/kg/day is needed during active inflammatory disease periods Slide 30 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 31. Rheumatoid Arthritis – Cont’dNutritional Management – cont’d Vitamins and minerals  Standard recommendations for vitamins and minerals are used • Supplementation may be used if needed Slide 31 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 32. Rheumatoid Arthritis – Cont’dNutritional Management – cont’d Special enteral or parenteral feeding  Enteral used to either supplement oral intake or to supply total nutrition support  Parenteral nutrition support is reserved for preoperative and postoperative needs Slide 32 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 33. Osteoarthritis Degenerative joint disease (DJD) encompasses between 60% and 70% of joint diseases overall  Affects approximately 44% of persons over the age of 40 years in the United States Chronic and may progress  Hands, knees, and hips Slide 33 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 34. Osteoarthritis – Cont’d No cure for the disease process, which ultimately destroys cartilage between the rubbing heads of bones in involved joints  Damaged joints can be replaced by arthroplasty, surgical removal of the degenerated joint, and replacement with a joint made of metal or plastic components Slide 34 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 35. Osteoporosis Most common skeletal disorder in the United States Referred to as the “silent disease” because bone loss occurs without symptoms Hip fracture results in significant morbidity and mortality Slide 35 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 36. Osteoporosis – Cont’d Thoracic spinal fracture can also result in pain; deformity; loss of independence; and reduced function of the cardiovascular, respiratory, and digestive systems Result of the body not forming sufficient new bone or of the body reabsorbing too much bone, or both Slide 36 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 37. Osteoporosis – Cont’d If calcium intake is not sufficient throughout the early years in life or if the body does not absorb sufficient calcium from the diet, bone tissue may suffer  Other causes include hyperparathyroidism, hyperthyroidism, Cushing’s syndrome, immobilization, bone malignancies, certain genetic disorders, and excessive corticosteroid use Slide 37 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 38. Osteoporosis – Cont’d Best line of defense against osteoporosis is prevention Treatment of postmenopausal osteoporosis in women is often managed with estrogen replacement therapy (ERT)  Controversial among different groups Slide 38 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 39. Osteoporosis – Cont’dMedical Management Number of new medications for prevention and treatment of osteoporosis are currently available and approved by the Food and Drug Administration (FDA) Slide 39 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 40. Osteoporosis – Cont’dNutritional Management Peak bone mass occurs around age 30 and needs to be sustained through a healthy diet and physical activity Slide 40 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 41. Osteoporosis – Cont’dNutritional Management – cont’d Well-balanced diet with a calcium intake of at least 1000 mg/day and 5 µg/day of vitamin D for adults 19 to 50 years old  Increase for adults over 50 years old to 1200 mg/day of calcium and 10 μg/day of vitamin D  Tolerable Upper Intake Level (UL) for calcium of 2500 mg/day and for vitamin D of no greater than 50 µg daily for anyone over the age of 1 Slide 41 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 42. Osteoporosis – Cont’dNutritional Management – cont’d Weight-bearing activity such as running tends to cause the most trauma to the bones, stimulating osteoblast activity and boosting bone density and mass Slide 42 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 43. Traumatic Brain Injury Occurs when an outside force impacts the head hard enough to cause the brain to move within the skull or if the force causes the skull to break and directly hurts the brain  May produce a diminished or altered state of consciousness  Results in impaired cognitive abilities or physical functioning Slide 43 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 44. Acquired Brain Injury An injury that is not hereditary, congenital, degenerative, or induced by birth trauma Slide 44 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 45. Traumatic or Acquired Brain InjuryPostinjury Metabolic Alterations There is a primary injury and a resultant set of secondary injuries Brain injury brings an immediate cascade of systemic metabolic and protective responses that affect the entire body and its resources If the process continues unchecked, a sequence of organ failures may follow Slide 45 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 46. Traumatic or Acquired Brain Injury – Cont’dInitial Nutritional Management Immediate goals of the care team are control of the injury, maintenance of oxygen transport, and metabolic support Slide 46 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 47. Traumatic or Acquired Brain Injury – Cont’dInitial Nutritional Management – cont’d Vital to meet the hypermetabolic drain on the body tissue resources for increased energy, protein, and fluid demands  May be delivered via the enteral or parenteral route  Total parenteral nutrition (TPN) and enteral nutrition in combination therapy is commonly used to preserve gut integrity Slide 47 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 48. Traumatic or Acquired Brain Injury – Cont’dRehabilitative Nutrition To develop individual nutrition care plans, the rehabilitation dietitian works closely with other team members Slide 48 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 49. Traumatic or Acquired Brain Injury – Cont’dRehabilitative Nutrition – cont’d Assess the degree of dysphagia, difficulty with chewing and swallowing, level of language deficit and communication, and ability to perform basic activities of daily living skills, including food preparation and eating Slide 49 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 50. Spinal Cord InjuryPostinjury Management Cervical region most vulnerable site for spinal cord injuries (SCIs) Slide 50 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 51. Spinal Cord Injury – Cont’d Four strategies exist for repairing the injured spinal cord  1. Promoting regrowth of the injured nerves by using nerve growth stimulants or substances that suppress inhibitors of neuronal extensions  2. Bridging spinal cord lesions with scaffolds that are saturated with nerve growth factors to promote axon growth Slide 51 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 52. Spinal Cord Injury – Cont’d Four strategies exist for repairing the injured spinal cord – cont’d  3. Repairing damaged myelin in order to restore nerve impulse conductivity in the damaged area  4. Enhancing central nervous system plasticity by enhancing the growth of spared, intact nerve fibers above and below the site of injury Slide 52 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 53. Spinal Cord Injury – Cont’dNutritional Management Protein-energy malnutrition is common in individuals with SCI Enteral feeding tubes placed beyond the pylorus usually make it possible to start nutrition support within 3 to 5 days Slide 53 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 54. Spinal Cord Injury – Cont’dNutritional Management – Cont’d Daily guidelines for energy needs are approximately 23 kcal/kg for quadriplegics and 28 kcal/kg for paraplegics Slide 54 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 55. Spinal Cord Injury – Cont’dRehabilitation Nutrition Designed to restore the client to the best functional capacity possible and to promote independent living  Individual assessment and care of basic energy- nutrient needs and feeding capacities and complications associated with SCI Slide 55 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 56. Spinal Cord Injury – Cont’dBasic Nutritional Needs Sufficient calories to maintain an ideal body weight somewhat below that for a comparative person given in standard weight- height tables for healthy populations Standard multiple vitamin-mineral preparation is often recommended to ensure nutritional adequacy Slide 56 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 57. Spinal Cord Injury – Cont’dAssociated Complications Pressure sores  Loss of pressure sensation around bony prominences, involving decreased blood circulation, skin breakdown, and ulcer formations that are open to infection and difficult to heal Slide 57 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 58. Spinal Cord Injury – Cont’dAssociated Complications – cont’d Hypercalciuria  Imbalance in calcium metabolism with a loss of bone calcium and its increased excretion in the urine Slide 58 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 59. Spinal Cord Injury – Cont’dAssociated Complications – cont’d Kidney stones  Problems of urinary reflux, retention, incontinence, infection, and stone formation  High fluid intake of 2 to 3 L/day must be a part of the overall nutrition care plan Slide 59 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 60. Spinal Cord Injury – Cont’dAssociated Complications – cont’d Neurogenic bowel  Decreased peristalsis and loss of bowel control  Regularly scheduled program for emptying the bowel is necessary Slide 60 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 61. Spinal Cord Injury – Cont’dAssociated Complications – cont’d Depression  Period of depression, even anger, is a normal part of the personal grieving and healing process  Severity and duration depend in large measure on the patient’s personal strengths and resources Slide 61 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 62. Spinal Cord Injury – Cont’dAssociated Complications – cont’d Depression – cont’d  Even subtle improvements in muscle mass and function from nutrition therapy can be a source of strength to the client’s mind and body Slide 62 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 63. Cerebrovascular Accident (Stroke) Causes varying degrees of nerve damage and body paralysis Dysphagia occurs in up to half of patients after a stroke  It is transient with only about 1 in 10 patients having any swallowing problems at 6 months Slide 63 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 64. Cerebral Palsy General term for nonprogressive disorders of muscle control of movements and posture Training and therapy can help to improve function Slide 64 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 65. Cerebral Palsy – Cont’d Many causes  Brain damage that occurs during fetal development or shortly after birth  Premature birth  Low birth weight  Rh or A-B-O blood type incompatibility between mother and infant  Infection of the mother with German measles or other viral diseases in early pregnancy  Bacteria that directly or indirectly attack the infant’s central nervous system Slide 65 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 66. Cerebral Palsy – Cont’d Spastic  Muscles of one or more limbs permanently contracted, making normal movements very difficult or impossible Athetoid  Involuntary writhing movements Ataxic  Disturbed sense of balance and depth perception Slide 66 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 67. Cerebral Palsy – Cont’d An individual may possess more than one type  Research reports indicate increased resting metabolic rates that are approximately 15% higher than those of non–cerebral palsy (CP) control subjects Slide 67 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 68. Cerebral Palsy – Cont’d Mental retardation, with an IQ below 70, occurs in about 75% of persons with CP  Exceptions occur, mostly among those with the athetoid type; some of these individuals are highly intelligent Slide 68 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 69. Cerebral Palsy – Cont’d Early nutrition therapy for CP patients focuses mainly on feeding problems Nutritional status, health, and body growth are most impacted in children with the greatest motor dysfunction  Malnutrition and growth failure are common  Exercise helps promote better nutrition Slide 69 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 70. Cerebral Palsy – Cont’d When oral feeding is interrupted for a prolonged period because of illness or surgery, enteral nutrition support via nasoenteric or gastrostomy tube feeding may be necessary  Other nutritional concerns are food intolerance, food allergies, drug-nutrient interactions, constipation, and reflux Slide 70 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 71. Epilepsy Neuromuscular disorder in which abnormal electrical activity in the brain causes recurring transient seizures  During an epileptic seizure, an unregulated, chaotic electrical discharge occurs Slide 71 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 72. Epilepsy – Cont’d Usually, the disorder starts in childhood or adolescence  Plateaus from ages 15 to 65 years and then rises again among older adults Slide 72 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 73. Epilepsy – Cont’d More drug options than ever before to treat epilepsy Each client needs to be evaluated for the most effective and appropriate means of controlling his or her seizures Factors such as drug side effects must be considered Slide 73 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 74. Epilepsy – Cont’d Vagal nerve stimulation (VNS)  Flat, round battery about the size of a silver dollar is surgically implanted in the chest wall  Therapy works by sending small regular pulses of electrical energy to the brain via the vagus nerve Slide 74 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 75. Epilepsy – Cont’dNutritional Management Helps to ensure an appropriate diet for normal growth during childhood and adolescence and for health maintenance in adulthood Slide 75 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 76. Epilepsy – Cont’dNutritional Management – cont’d If a ketogenic diet is used, the clinical nutritionist is responsible for its calculations and education of staff, patient, and family in its use Slide 76 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 77. Epilepsy – Cont’dNutritional Management – cont’d Special high-fat, low-carbohydrate diet was developed to control epilepsy before current anticonvulsant drugs became widely available in the 1940s The mechanism may involve a threshold level of ketones to be present, which may help control seizures by disrupting nerve transmission at the synapse Slide 77 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 78. Spina Bifida Most commonly occurring type of neural tube defect (NTD), a congenital malformation of the spine that contributes to serious developmental disabilities Congenital defect can often be diagnosed early in the pregnancy by ultrasound scanning or by high levels of alpha fetoprotein Slide 78 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 79. Spina Bifida – Cont’d Folic acid (folate) and vitamin B12 supplementation at time of conception through the first few months of pregnancy reduces a woman’s risk that the baby will develop this devastating neural tube defect Slide 79 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 80. Spina Bifida – Cont’d Spina bifida occulta  Least serious and most common form  Often goes unnoticed in otherwise healthy children Slide 80 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 81. Spina Bifida – Cont’d Myelomeningocele  Most severe form  Child is usually severely disabled  The spinal cord (myelo) and its enveloping membranes (meninges) protrude from the spine in a sac Slide 81 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 82. Spina Bifida – Cont’d Meningocele  Nerve tissue of the spinal cord usually remains intact  Surgical repairs are performed in the first few days of life Slide 82 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 83. Spina Bifida – Cont’dNutritional Management Focuses on growth pattern and individual degree of problems of growth retardation and short stature, low muscle mass and weakness, deformities or paralysis of lower extremities, and reduced ability to control bladder and bowels Slide 83 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 84. Spina Bifida – Cont’dNutritional Management – cont’d Obesity can be a problem  Low basal metabolic rate related to lowered amount of lean body mass  Little physical activity related to the disabled condition and dependency on a wheelchair  Use of food and overfeeding by parents or other caregivers to reward or show love Slide 84 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 85. Down Syndrome Chromosomal abnormality accounts for the mental retardation and characteristic appearance of children with Down syndrome Event is more likely if the mother is over 35 years of age, indicating that defective egg formation, rather than sperm formation, is usually the cause Slide 85 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 86. Down Syndrome – Cont’d Up to 50% have congenital heart defects, which can be surgically corrected These children are usually affectionate, cheerful, and friendly and get along well with family and friends Slide 86 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 87. Down Syndrome – Cont’d Nutrition therapy for individuals with Down syndrome focuses on delayed feeding skills; inappropriate, excessive, or inadequate intakes of food energy and nutrients; and poor eating habits Thyroid disease and celiac disease are common, and development of diabetes may also occur with Down patients Slide 87 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 88. Down Syndrome – Cont’d Encouraging physical activity is important to helping reduce the risk of obesity and diabetes Slide 88 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 89. Parkinson’s Disease Appears to be a genetic influence, in some cases, as well as an environmental influence Degeneration of key parts of the basal ganglia causes a lack of dopamine within this part of the brain, thus preventing the basal ganglia from modifying nerve pathways that control muscle function Slide 89 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 90. Parkinson’s Disease – Cont’d Muscles become overly tense, causing joint rigidity and a general body stiffness, a fine constant tremor even at rest, and slow movements Slide 90 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 91. Parkinson’s Disease – Cont’dMedical Management Medications include those that promote dopamine synthesis  Other drugs prolong levadopa availability  Other medications include those that activate specific receptors such as dopamine agonists and those that prolong dopamine availability Slide 91 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 92. Parkinson’s Disease – Cont’dMedical Management – cont’d Neurosurgery is done to restore functional balance in affected nervous tissue  Thalamus, globus pallidus, and subthalamic nucleus Slide 92 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 93. Parkinson’s Disease – Cont’dNutritional Management Main emphasis should be on meeting nutritional needs of the individual, though general concerns include providing enough energy and protein to prevent weight loss and muscle atrophy Slide 93 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 94. Parkinson’s Disease – Cont’dNutritional Management – cont’d Emphasize sufficient fiber and fluid to reduce risk of constipation Other points of emphasis are bowel dysfunction; dysphagia; nausea, vomiting, and anorexia; delayed gastric emptying; hypotension when standing; bradykinesia; depression; and impaired cognitive function Slide 94 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 95. Parkinson’s Disease – Cont’dNutritional Management – cont’d More than 50% of Parkinson’s patients experience dysphagia  Assessment may result in changes to food texture, fluid viscosity, and temperature Unintentional weight loss and body composition changes are common Slide 95 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 96. Huntington’s Chorea Uncommon genetic disease in which degeneration of basal ganglia of the brain results in chorea (rapid, jerky, involuntary movements) and dementia Gene mutation causes an abnormal protein product; insoluble proteins invade nuclei of nerve cells, which eventually shut down function of the cell and may cause cell death Slide 96 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 97. Huntington’s Chorea – Cont’dMedical Management A test is available for young adults whose parents have Huntington’s chorea to learn if they carry the gene and thus have the disorder  95% accuracy Slide 97 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 98. Huntington’s Chorea – Cont’dMedical Management – cont’d Medical management helps to lessen the characteristic chorea, which affects face, arms, and trunk with random grimaces, twitches, and general clumsiness Slide 98 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 99. Huntington’s Chorea – Cont’dNutritional Management Excessive muscular activity requires adequate energy and nutrient intake to prevent malnutrition and excess weight loss  As the disease progresses, patients become cachectic Slide 99 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 100. Huntington’s Chorea – Cont’dNutritional Management – cont’d 1.2 to 1.5 g of protein per kilogram of body weight Advanced disease accompanied by dysphagia, marasmus, and depression may best be supported with an enteral formula Slide 100 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 101. Guillain-Barré Syndrome Rare form of damage to peripheral nerves in which the myelin sheaths covering nerve axons, and sometimes the axons themselves, deteriorate, causing loss of nerve conduction and partial or complete paralysis  Low-grade fever persists, and there may be urinary tract infection, respiratory failure requiring a ventilator, and personality changes Slide 101 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 102. Guillain-Barré Syndrome – Cont’d Acute syndrome is an autoimmune reaction, often following a viral infection or sometimes an immunization Slide 102 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 103. Guillain-Barré Syndrome – Cont’dMedical Management Most people recover completely from Guillain- Barré without specific treatment other than general supportive care Some are left with permanent weakness in affected areas Slide 103 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 104. Guillain-Barré Syndrome – Cont’dNutritional Management During early acute phases, enteral or parenteral nutrition support may be necessary  Crucial not to overfeed the patient  Food consistency and texture may need to be adjusted in early oral feedings to accommodate any chewing and swallowing problems Slide 104 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 105. Guillain-Barré Syndrome – Cont’dNutritional Management – cont’d During early acute phases, enteral or parenteral nutrition support may be necessary – cont’d  Attention to energy and nutrient needs during convalescence is required to restore lost body weight and muscle mass Slide 105 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 106. Amyotrophic Lateral SclerosisMedical Management Most common of the motor neuron diseases Riluzole remains the only drug to slow disease progression, although interventions such as noninvasive ventilation and gastrostomy also extend survival Slide 106 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 107. Amyotrophic Lateral Sclerosis – Cont’dNutritional Management Focus on increased energy intake and adjusting nutrient needs as the disease progresses Weakness of hands and arms, as well as problems with chewing, swallowing, delayed or absent response of gag reflex, and risk of aspiration, will require eating assistance and modification of food textures  Frequent small meals Slide 107 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 108. Multiple Sclerosis Progressive disease of the central nervous system that destroys scattered patches of insulating myelin, the fatty covering of nerve fibers in the brain and spinal cord that protects the neurons and facilitates the passage of neuromuscular impulses Slide 108 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 109. Multiple Sclerosis – Cont’d Autoimmune disease Important to rule out other potential contributors to the symptoms such as vascular disease, spinal cord compression, vitamin B12 deficiency, central nervous cord infection such as Lyme disease or syphilis, and lupus Slide 109 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 110. Multiple Sclerosis – Cont’dMedical Management Five disease-modifying drugs approved by the FDA to treat multiple sclerosis (MS) patients  Four of the treatments are used in initial management of the disease to help slow progression and reduce symptoms  Fifth is used for worsening forms when the individual with MS is in relapse Slide 110 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 111. Multiple Sclerosis – Cont’dMedical Management – cont’d The best time to start treatment is early after diagnosis to reduce lesion progression and irreversible damage Slide 111 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 112. Multiple Sclerosis – Cont’dNutritional Management Patients respond to basic nutrition therapy that supplies adequate energy and nutrients to achieve optimal nutritional status Slide 112 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 113. Multiple Sclerosis – Cont’dNutritional Management – cont’d Assistance with symptomatic gastrointestinal problems, elimination, and dysphagia is instituted as needed  Nasoenteric or gastrostomy tube feeding may be needed in advanced stages of the disease to provide enteral nutrition support Slide 113 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 114. Myasthenia Gravis Eventually causes the affected person to become paralyzed as a result of inability of neuromuscular junctions to transmit nerve fiber signals to the voluntary muscles Slide 114 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 115. Myasthenia Gravis – Cont’d Facial muscles are usually affected first, causing drooped eyelids, double vision, and sometimes a lack of facial animation with an absent stare appearance  Weak muscles of the face, throat, larynx, and neck cause difficulties in speaking and eating Slide 115 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 116. Myasthenia Gravis – Cont’dMedical Management Administration of corticosteroids and immunosuppressive drugs Disease is caused by circulating autoantibodies; exchanges of the patient’s antibody-containing blood for antibody-free blood may be helpful in warding off a crisis Slide 116 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 117. Myasthenia Gravis – Cont’dNutritional Management Maintain optimal energy-nutrient intake for muscle strength and good nutritional status Solve any associated eating problems Help counteract drug side effects of nausea and vomiting Slide 117 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 118. Alzheimer’s Disease The disease is a form of progressive dementia in which nerve cells degenerate in the brain and the brain substance shrinks Tremendous social and financial burden Slide 118 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 119. Alzheimer’s Disease – Cont’d No absolute diagnostic test for the disease during life  Assessment instrument, the Mini-Mental State Examination (MMSE) • Assesses six areas of function: orientation, registration, attention and calculation, recall, language, and ability to copy a figure Slide 119 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 120. Alzheimer’s Disease – Cont’d Stage one  Early period of increasing forgetfulness and anxious depression Stage two  Middle period of severe memory loss of recent events, disorientation, and personality changes Slide 120 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 121. Alzheimer’s Disease – Cont’d Stage three  Final period of severe confusion, psychosis, memory loss, personal neglect, inability to leave the bed, feeding problems, full-time nursing care, and finally death from an infection Slide 121 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 122. Alzheimer’s Disease – Cont’dMedical Management Plan should include methods for slowing the decline in cognitive function Treatment of behavior and mood symptoms also important No treatment for the disease itself, except for suitable day-to-day nursing and social care for both the patient and the family Slide 122 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 123. Alzheimer’s Disease – Cont’dNutritional Management Cognitive losses may have profound effects on nutritional intake Slide 123 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 124. Alzheimer’s Disease – Cont’dNutritional Management – cont’d Adequate nutrition throughout the course of the disease is essential to improving physical well-being, helping maximize the patient’s functioning, and improving quality of life  Using skillful individual feeding techniques  Selecting appropriate food consistency  Providing adequate time in which to feed  Focusing on the midday meal, when peak cognitive abilities occur Slide 124 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 125. Health Promotion In disability and rehabilitation, a commonly reported standard is the Functional Independence Measure (FIM)  Objective method of obtaining functional performance information from a patient Slide 125 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
  • 126. Health Promotion – Cont’d Traditional assessment method is determining the patient’s activities of daily living (ADLs) As with any assessment tool, reliability and validity between users is of primary significance Slide 126 Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.