LWBK759-FM_pi-xx.qxd 10/29/10 6:35 PM Page i Aptara Inc NNuuttrriittiioonn aanndd DDiiaaggnnoossiiss--RReellaatteedd CCaarree 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 LWBK759-FM_pi-xx.qxd 10/29/10 6:35 PM Page ii Aptara Inc 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 copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appear- ing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via e-mail at [email protected], or via Web site at lww.com (products and services). 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. To purchase additional copies of this book, call our customer service department at (800) 638-3030or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com.Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. LWBK759-FM_pi-xx.qxd 10/29/10 6:35 PM Page iii Aptara Inc 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 iii LWBK759-FM_pi-xx.qxd 10/29/10 6:35 PM Page iv Aptara Inc 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. iv LWBK759-FM_pi-xx.qxd 10/29/10 6:35 PM Page v Aptara Inc 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. LWBK759-FM_pi-xx.qxd 10/29/10 6:35 PM Page vi Aptara Inc 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 vi LWBK759-FM_pi-xx.qxd 10/29/10 6:35 PM Page vii Aptara Inc 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 vii LWBK759-FM_pi-xx.qxd 10/29/10 6:35 PM Page viii Aptara Inc 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 viii