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Food Intake and nutritional lacia after gastrectomy: interrelations between biochemical markstatus after total gastrectomy: results of a nutritional follow-up 300 medications for nclex buy 50 mg thorazine. Maldigestion after Total Gastrectomy is Associated with Pancreatic Insufficiency symptoms of strep buy 100mg thorazine overnight delivery. Review article: the diagnosis and treatment of haematinic deficiency in gastrointestinal disease treatment west nile virus purchase thorazine with mastercard. Clinical Chemistry of Vitamin B12 medicine advertisements buy cheap thorazine 50mg line, In: Advances in Clinical Chemistry, Academic Press, Inc. Signed by the board of examiners committee Examiner Signature Advisor: Dr. Wondyefraw Mekonen for the time and consultation he gave me starting from the beginning of proposal development up to the finalization of this thesis. Yohannes Birhanu for his unreserved contribution in handling the study subjects during data collection period and for his professional advice. I would like to express my deepest gratitude to my advisor professor Fikre Enkusillasie for his valuable guidance and support during statistical analysis of the data. I am extremely grateful to the Department of Medical Physiology, for the indispensable support and coordination in smooth running of this thesis. Finally I would like to thank Debre Birhan University for providing me the opportunity and sponsorship to pursue my graduate study. Endoscopically diagnosed Peptic Ulcer Disease patients were selected for the test; non-peptic ulcer disease patients, hospital staffs and students were recruited as a control group. Conclusion: Peptic ulcer disease was more prevalent among patients with blood group O than other blood group types. Blood group is usually restricted to blood cell surface antigens and generally to red blood cell surface antigens. There are about 270 authenticated blood group antigens which fall into one of 26 blood group systems (Hult, 2013). The antigens are also present in the secretory fluids such as saliva, sweat and semen in the majority of humans (Thrumiaya et al. The antibodies can be detected by the age of three month and reach the maximum level at the age of 5 to 10 years (Svensson, 2011). They are suggested to be stimulated by microbial structures in the normal gut flora, which are very similar to the carbohydrate blood group antigens. The Rh blood groups are so named because of one of the eight Rh antigens (agglutinogen D), which was originally identified in Rhesus monkeys. The Rh negative blood type is relatively uncommon, representing less than 15% of the population (Wagner and Flegel 2004). However, Rh+ cells infused into an Rh negative recipient can give rise to a strong antibody response (Danniel, 2002). Therefore, while this antigens are important for blood transfusion, they do not normally play a role in organ transplantation (Svensson, 2011). Accordingly, blood group A was associated with the development of head, neck and gastric cancers (Kakava et al. Blood O blood was said to have protective nature from venous thromboembolism (Franchini et al. It is an important cause of morbidity and mortality throughout the world affecting the lives of millions of people in their everyday life. In the United States, approximately four million people have peptic ulcers (duodenal and gastric), and 350,000 new cases are diagnosed each year (Schwartz et al. Around 180,000 patients are hospitalized yearly, and about 5000 people die each year as a result of peptic ulcer disease (Aro et al. Poor socio-economic conditions and lack of awareness about the disease, increases the burden of peptic ulcer disease much greater. If an early treatment is not initiated and peptic ulcer disease is not cured, the ulcer can perforate and become a complicated surgical case. Through early detections, simple life style modifications and with the help of modern medical treatment, the problem of peptic ulcer disease can be largely controlled and patients with peptic ulcers can lead a prolonged and healthy life. However, researches done in relation to this problem were very limited in Ethiopia. Thus this research provides valuable information about the association of the disease with blood group distribution and help to create awareness for the people so that they can have preventive means. There are evidences that demonstrated the importance of the H antigen, expressed in gastric mucous membrane, to the attachment of Helicobacter pylori which is identified to be the major cause of peptic ulcer disease (Mattos et al. Under normal condition, a physiologic balance exists between gastric acid secretion and gastric and duodenal mucosal defense systems. The imbalance between defensive factors which include the function of mucusbicarbonate barrier, prostaglandins, mucosal blood flow, cell renewal and migration, antioxidants, and aggressive factors such as hydrochloric acid, pepsin, refluxed bile, leukotrienes leads to formation of peptic ulcer (Amandeep et al. This gel layer is impermeable to aggressive factors such as acid and pepsin under normal condition. But during injury, additional mechanisms help to prevent acid and pepsin from entering the epithelial cells. For example, increased blood flow removes acid that diffuses through the damaged mucosa and provides adequate bicarbonate level in the gel layer superficially to epithelial cells. Additionally, epithelial cells regulate intracellular pH by removing excess of hydrogen ions through the ion pumps in the basolateral cell membrane (Zatorski, 2017). The secretion of bicarbonate into the mucus gel layer is also essential to maintain a pH gradient at the epithelial surface (Baltimore, 2013). Various factors such as prostaglandins, luminal acid, and melatonin can stimulate bicarbonate secretion. Therefore this acid neutralizing base is simultaneously produced with mucus to protect the stomach from its own hydrochloric acid. But, when the protective barrier breaks down during pathological events or under influence of injuring agents, other protective mechanisms are activated. They include intracellular acid neutralization, rapid epithelium renewal, and maintenance of mucosal blood flow (Zatorski, 2017). It has been proved that prostaglandins interact with almost all the mucosal defense mechanisms. Therefore, they have potential to reduce acid output, stimulate mucus and bicarbonate production, as well as increase mucosal blood flow (Baltimore, 2013). Prostaglandins are also responsible for acceleration of epithelial restitution (rapid replacement of sloughed or denuded surface epithelial cells by migration of adjacent cells) and mucosal healing (Wallace, 2000). Furthermore, epithelial cells produce antimicrobial cationic peptides such as cathelicidins and beta defensins to prevent the stomach mucosa from bacterial colonization. Therefore, cationic peptides add antimicrobial character to the innate defensive system with mucosal gel layer, an acid neutralizer bicarbonate and acid repulsive epithelial cells hydrophobic phospholipids (Zatorski, 2017). When there is back diffusion of acid because of damage to mucosal gel layer by different factors, there is a protective increase in mucosal blood flow. These are G cells which secrete gastrin, D cells which secrete somatostatin, enterochromaffin-like cells which secrets histamine and parietal cells. Gastrin, acetylcholine, and histamine stimulate the parietal cell to secrete hydrochloric acid. The mucosal D cell, which releases somatostatin, is also an important regulator of acid secretion. Gastric acid is a fluid formed in the stomach, which plays an important role in digestion of proteins by activating a protein digesting enzyme pepsin. The chief cells synthesize and release the proenzyme pepsinogen, which will be activated by the acid into pepsin. Because of its relatively high molecular size, pepsin cannot permeate the continuous adherent mucus layer within a physiologically meaningful time scale. Nevertheless, luminal pepsin at acidic pH slowly hydrolyzes and erodes the mucus layer. Helicobacter pylori and Peptic Ulcer Disease Helicobacter pylori is well recognized as major cause of gastro-intestinal diseases. The bacteria have evolved several mechanisms to evade primary host defenses such as acidity and peristalsis in order to establish persistent infection within the stomach (Tanih et al.

Local tissue injury may ing treatment of the chronic acidosis with alkali medicine natural thorazine 50 mg online, also predispose to calcification when the calciuma positive balance for calcium usually does not phosphorus product is normal or only slightly occur medications emts can administer cheap thorazine 50mg overnight delivery, and hypocalcemia treatment 1 degree av block purchase 50mg thorazine with visa, bone pain medications bladder infections discount 100mg thorazine mastercard, and radioelevated. Morecertain proteins involved in prevention of calcifiover, there is no convincing evidence suggesting cation has been demonstrated in macrophages that chronic acidosis can cause defective mineraland smooth muscle cells of blood vessel walls. An increase in the calcium-phosphorus vascular calcification seen in patients with kidproduct in the extracellular fiuid is probably the ney failure. The incithe chemical nature of soft-tissue calcificadence of soft-tissue calcification is high when the tion may vary in different tissues. Thus, the calcium-phosphorus product (each in mg/dL) calcification found in nonvisceral tissue (periarexceeds 70, while soft-tissue calcification is infreticular and vascular calcification) consists of quently noted when the calcium-phosphorus prodhydroxyapatite, with a molar Ca:Mg:P ratio simiuct is below 50. These breakpoints not withstanding, and because of the biological variations in lar to that of bone. These observations suggest that the mechanisms Alkalemia, which often occurs after hemodialyresponsible for the calcification of various tissis, may persist during the interdialytic period sues in uremic patients may be different. The calcification in the eye may produce visible infiammation tion appears as a fine, granular density outlining and local irritation, resulting in the red eye of a portion of the entire artery, giving a radiouremia. This is a transient phenomenon and may graphic appearance of a pipestem due to deposilast only a few days. Recurrence of the red eye tion of calcium within the media and the internal phenomenon is not infrequent, and it becomes elastic membrane of the artery. The lumen of the apparent each time a new calcium deposition vessel is usually not involved. More commonly, confication may first be seen in the dorsalis pedis as junctival calcium deposits are asymptomatic and a ring or a tube as it descends between the first are seen as white plaques or as small punctate and second metatarsals. Calcification can also deposits on the lateral or medial segment of the occur in atherosclerotic plaques in the intima of bulbar conjunctiva. Also, calcium deposits may large vessels whose radiographic appearance is occur within the cornea at the lateral or medial that of discrete, irregular densities. It is possible segments of the limbus, the so-called band kerathat uremic patients are more prone to this type topathy. Slit-lamp examination permits easier of calcification because of the presence of hyperrecognition of these lesions. Vascular calcificamay be found in the lungs, stomach, myocartions are seen in kidney failure patients and in dium, skeletal muscles, and kidney. These calcithose treated with hemodialysis, and they persist fication are usually not evident radiographically, after kidney transplantation. Congestive heart failure, carreported incidence of arterial calcification indiac arrhythmias, and heart block may occur in creases with duration of dialysis treatment. In a patients with calcium deposition in the myocarseries of 135 patients published in 1977, the dium or in and around the conduction system of incidence of vascular calcification increased from the heart or the mitral annulus. Calcification of 27% in those treated for less than 1 year to 83% cardiac valves are not infrequent. Such patients may have ery artery and has been seen in arteries of the reduced vital capacity and reduced carbon monforearm, wrist, hands, eyes, feet, abdominal cavoxide diffusion. The calcification tion has been noted after subtotal parathyroidecmay be very extensive, rendering the artery so tomy in these patients. Extensive pulmonary rigid that the pulse is not palpable and the Korotcalcification may lead to severe pulmonary fibrokoff sounds may be difficult to hear during the sis, pulmonary hypertension, and right ventricumeasurement of the blood pressure. Calcification of the heart and cation may also present difficulties during surlung constitute a major risk factor for increased gery for the creation of arteriovenous shunts or morbidity and mortality in dialysis patients. This may be associated regress; in some patients, improvement or disapwith marked deposition of calcium oxalate in pearance of arterial calcification occurs within soft tissues. Such deposition in the myocardium, months to years after subtotal parathyroidectomy or mitral and aortic valves, can cause cardiomyor renal transplantation. The incidrome characterized by the development of prodence of periarticular calcification varies widely gressive ischemic skin ulcerations involving the among dialysis patients. These calcification were fingers, toes, thighs, legs, and ankles has been absent in 1 report but were encountered in up to observed in a small number of patients with 52% of the patients in other series of dialysis advanced kidney failure. The incidence of periarticular calcificain patients after successful kidney transplantation may increase with the duration of dialysis. With better common among patients treated with continuous control of serum levels of phosphorus, this type ambulatory peritoneal dialysis. The patients almost always have vascular calPeriarticular calcification may be detected becification involving the media of the arteries, and cause of the pain induced by the deposition of they usually exhibit X-ray evidence of subperioscalcium or may be noted by routine X-ray examiteal bone resorption. A period of as small discrete radiodensities around the shoulhyperphosphatemia has been present for some ders, wrists, phalangeal joints, hips, or ankles. The Tendosynovitis or tendonitis with abrupt pain lesions may be preceded or accompanied by may develop, presumably caused by deposition severe pain. The synovial or tissue necrosis, tender, slightly erythematous, fiuid of the involved joints is clear with normal subcutaneous nodules may develop, or there may viscosity and number of cells. The ulcers may develop slowly of encapsulated chalky fiuid or pastelike material over several months, or may appear and progress develop adjacent to joints of dialysis patients. Infection may superthe lesions are usually painless, but they may vene, leading to sepsis and death. The original restrict movement of the joint by virtue of their reports of this entity termed it calciphylaxis size. The intake of food with high phosphorus because of an apparent similarity to the calciphycontent may enhance the development of tulaxis described by Seyle in 1962. These lesions often regress argued that the name should be changed to calwith the control of serum phosphorus levels by cific uremic arteriopathy. These lesions may lesions do not respond to treatment with local appear as small macules or papules composed of measures but have healed following subtotal firm calcium deposits which are best detected by parathyroidectomy in most patients. However, in the chemical analysis of small skin biopsy specisome patients, the lesions did not heal after mens. Calcium content of skin is increased in parathyroidectomy, and in others, the lesions most uremic patients and such increments are seem to be aggravated. Subtotal parathysecondary hyperparathyroidism, and vascular calroidectomy is followed by a decrease in the cification appear to play an important role in the calcium content of skin, underscoring the role of genesis of this entity, other factors may also secondary hyperparathyroidism in the genesis of contribute to its emergence and progression. Calcification and the activity of protein C be measured in of the myocardium, coronary arteries, and carpatients with calciphylaxis. It is interesting that diac valves result in congestive heart failure, obesity, especially in white women, predisposes cardiac arrhythmias, ischemic heart disease, and to calciphylaxis, and the relative risk for calciphydeath. Local trauma lesions, soft-tissue necrosis, and difficulties for may be a contributory factor as to site where the kidney transplantation. These paresearch in this exciting area will lead to improvetients have bone pain, increased incidence of ments in care and, thus, to updating of guidelines fractures, bone deformity, myopathy, muscle pain, when such information is available. This evidence base consisted of an eviclinical action plan for the health care practitioner. The Two products resulted from this process: (a) overall guidelines were then graded according to an evidence report which consists of the sumthe strength of evidence supporting the line of mary of the literature (portions of the evidence logic of the rationale statements. The an evidence report, collaborating integrally with key questions were divided into 9 sections: the Work Group. Dialysis evidence model, assess the literature, evaluate the evidence base, review the evidence report, and draft guideline statements. Acid-Base first Work Group meeting in April 2000, and were further modified following the second meetHypothetical guideline statements were then ing in July 2000. As the hypothetical guideline statements A priori criteria were established for determinwere formulated, these questions were redivided ing whether an article identified by the literature into 16 different Guideline areas corresponding searches should be retrieved before the searches to the guidelines set forth in this document. The agreed-upon incluagreed on a systematic process to be followed to sion criteria were: review literature pertaining to the key questions fi Articles must be published as letters or and hypothetical guideline statements. Meeting abstracts were these key questions, information specialists at not included. Abstracts were not included the Evidence Review Team performed database because the space limitations of abstracts literature searches to identify the relevant pubdo not allow evaluation of the quality of the lished medical literature to address the key quesstudy.

Follow-up consults (concurrent care) b) Sub-committee on Specialized Nutrition Support reports to 4 medicine interaction checker discount thorazine 100 mg without a prescription. Institution coding for malnutrition diagnosis and for enteral/ the Nutrition Advisory Board medications causing thrombocytopenia discount 100 mg thorazine otc, which reports to the Medical parenteral treatment in association with specified diagnosis Board treatment hiatal hernia purchase genuine thorazine on-line. Billing for metabolic monitoring ical Directors of various services and these Medical Directors B medicine 2 buy thorazine 100mg otc. Reimbursement for acute care nutrition support36 then report to the Chief Medical Officer. University affiliation and academic role of institution admission that causes at least one extra day of hospitalization 5. Nutrition diagnosing and order writing: value for Agencies Clinics and Referral Agencies. Standards of practice for hospitalized pedienteral nutrition by registered dietitians. Quality performance improvement, indicators, and ogy Program Office, Division of Public Health Surveillance and Informatstandards. The use of focuses on special considerations for the mostly elderly residents in these enteral nutrition in elderly residents has increased significantly facilities. Background because of dementia related to chronic neurologic impairment or, to a lesser extent, cancer. All professionals should References be able to assist residents and their families in the decision about whether to use nutrition support at the end of life or in conditions of terminal disease, including end-stage dementia. Two common forms of advance directives ber of people over 85 with moderate or severe dementia will increase are a living will and a durable power of attorney for health care. An interdisciplinary team care in that the goal of long-term care is not to cure an illness, but to of health professionals provides nutrition support. Residents and allow an individual to attain and maintain an optimal level of functheir families are involved as much as possible in care and treatment decisions. Long-term care encompasses a wide array of medical, social, personal and supportive and specialized housing services needed by 1. Nurses b) Provide initial and periodic assessment of nutrient intake and a) Provide direct resident care nutrition status. Their duties range from delivc) Use specialized seating and orthoses to facilitate the postural ering trays and supplements to assisting with meals and feeding. In general, as the elderly age, their caloric intake g) Provide or recommend active and passive range-of-motion declines17 and they become increasingly frail. Frailty is distinguished exercises and coordination and strength-building exercises to by weakness, immobility, and weight loss caused or exacerbated by facilitate functional self-feeding. Frailty occurs frequently in older residents with h) Evaluate the impact of cognitive impairments on eating and moderate to advanced dementia. It is not known whether it is a result self-feeding ability and address cognitive issues to ensure that of the aging process, malnutrition, or both. Speech pathologists many cases, these conditions lead to increased levels of circua) Perform dysphagia/swallowing evaluations. One effect of increased systemic cytokines is decreased cises to strengthen facial muscles, increase range of motion of serum albumin, which has long been used as an indicator of nutrithe lips and control of the tongue, and facilitate safe oral and tional status. Elements of assessment ensure proper positioning and techniques necessary for safe a) Weight16 swallowing. The purpose of liberalizing restrictive diets is to b) Food/fiuid intake/adequacy promote intake and improve quality of life in anorexic residents (1) the estimated adequate fiuid requirement per 24 hours is who might otherwise be uninterested in therapeutic diets. Two principal considerations in selecting modified uten(4) Elderly residents are more likely than younger adults to be sils are (1) the device should address the problem that interferes deficient in vitamins D, B12, folate, and ribofiavin. There are various utensils and devices (5) Obtain diet history, food allergies/intolerances, food prefto aid in eating: erences, and cultural concerns. Laboratory assays can be j) Covered mug with lid prudently used to confirm suspected nutrition-related problems k) Nosey cut-out tumbler (organ dysfunction, nutrient deficiencies) identified by clinical l) Dysphagia cup diagnosis, observation, history, and physical examination. Nutritional supplements can be initiated when use of hepatic proteins and total cholesterol to measure nutrioral intake is determined to be inadequate. Nutrition support (enteral and parenteral nutrition) (b) Review need for mechanically altered diet. See Chapter 5 for enteral nutrition management (3) Evaluate for signs and symptoms of dysphagia. Most residents requiring enteral development of pressure ulcers, but attempts to prevent the nutrition have sustained neurologic injury such as stroke or occurrence of pressure ulcers by nutritional intervention have head trauma, or have degenerative neurologic conditions such produced equivocal outcomes. Attenshould be factored into decisions about whether to use enteral tion should focus on adequate nutrition up to 35 kcal/kg/day nutrition, as should specific achievable goals for an individual and 1. Enteral nutrition access is based on the physiology of manganese, copper, and selenium may also be helpful. For less stable residents or those requiring rate via a pump over 16 to 24 hours per day. Usually, 250 to 500 mL of for(1) Diarrhea mula is delivered over 60 to 75 minutes 5 to 8 times per day (2) Constipation as needed to meet estimated nutritional needs. The sched(3) Nausea and vomiting ule simulates the meal pattern and allows more freedom of (4) Abdominal distension, bloating, cramping, and gas activity between meals. This type of feeding is contraindi(5) Aspiration cated in residents at high risk of aspiration. They usually contain 1 kcal/mL, (6) Enteral nutrition is stopped when oral intake is adequate. They are more expenother complications), inability to prepare solutions at the facility, sive than polymeric formulas and should be used for resilack expertise in management, and cost. Most of these formulas tion support is unlikely to benefit residents6 and the fragility of skin are more expensive, so their potential benefit to residents in the elderly complicates venous access. Medications may idents who have gastrointestinal dysfunction (similar to genbe administered via enterostomy tube. The following are suggested products through the feeding tube may result in diargeneral parameters16: rhea, cramping, abdominal distention, and vomiting. The oral/nutritional b) Residents have the right to refuse care, treatment, and servstatus sections contain categories for oral problems; height and ices in accordance with laws and regulations. Initially, upon admission to facility provided to a resident as part of the plan for care, treatment, 2.

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Put weight on the crutch handles and transfers unaffected extremity to the step where crutches are placed symptoms stomach ulcer proven 100mg thorazine. Put weight on the crutch handles and lift the unaffected extremity on the first step of the stairs treatment 247 discount thorazine uk. Put weight on the unaffected extremity and lift other extremity and the crutches to the step medicine 4 you pharma pvt ltd order thorazine 100 mg. Obtain help from another person if the client is immobile symptoms of colon cancer buy generic thorazine line, heavy, or connected to multiple pieces of equipment. Encourage the client to use armrests for support while you lower him or her in to chair. Reposition foot rests; secure the client in a chair with a reminder device if needed. Fluid & Electrolyte Balance Normal body function depends on a relatively constant volume of water and definite concentration of chemical compounds (electrolyte). A part from this the extra cellular fluid contains other fluids, which are usually negligible, considering their concentration in the body. NaCl Na + Cl Intracellular fluid and extra cellular fluid are separated by cell membrane, which is semi permeable. The difference is maintained by the cells, which actively reject certain electrolytes, and retain others. The difference is maintained by cellular action referred as sodium pump, which reject sodium from the cells. Pincytosis 197 Basic Clinical Nursing Skills Substances are transported between cellular and extracellular fluids between biological membranes. Hydrostatic pressure of the blood which forces fluid out through semi permeable membrane 2. The result of the force that promotes the movement of fluid through the capillary is the sum of positive out ward pressure from within the capillaries and the negative hydrostatic pressure and the osmotic pressure in the interstissual spaces. Potasium, magnesium and phosphorous are mainly responsible for osmotic pressure within the cells. Effect of osmosis as applied to different extracellular solute concentration will give isotonic, hyper tonic and hypotonic solution. When all contributions to osmolality are summed the total serum osmolality ranges from 275 mosm/kg to 290 mOsm/kg. Solutions can be categorized according to how their osmolality compared with that of extracellular fluids. When the osmolality is the same as extracellular fluid, a solution is lebelled isoltonic. One third is distributed to the vascular space and two thirds to the interstissual space. A fluid with a lower or higher osmolality is lebelled hypotonic or hypertonic respectively. Hypotonic fluids are distributed in proportion of fi to the extracellular compartment and fi of intracellular compartment. When 199 Basic Clinical Nursing Skills hypertonic fluids are added to the vascular space, the extracellular osmolality becomes greater than that of intracellular fluid. As a result water moves from the intracellular to extracellular compartment and cells shrink. Decreased fluid intake due to: (a) Inability to swallow (b) Lack of available fluid (c) Lack of thirst sensation 3. Conversely, bases are chemical substances that combine with 201 Basic Clinical Nursing Skills hydroxyl ions in a chemical reaction. The acidity or alkalinity of a solution depends upon the concentration of hydrogen ions and hydroxyl ions. A compound that completely dissociates its hydrogen ions is referred as strong acid. In addition to the carbolic acid, cellular activity produces a substantial quantity of strong acid. Kidney Regulation the kidneys play an important role in maintaining acid base balance + by execration of H and forming hydrogen carbonate. Metabolic Acidosis Cause: Increased acid production Uncontrolled diabetes mellitus Increased alcohol intake 204 Basic Clinical Nursing Skills Excessive administration of drugs. The body can make some nutrients if adequate amount of necessary precursors (building blocks) are available. Essential nutrients are those that a person must obtain through food because the body can not make them in sufficient quantities to meet its needs. The six classes of nutrients are carbohydrates, fat, protein, water, minerals, and vitamins. In addition to meeting physiologic requirements, diet also used to satisfy a variety of personal, social, and cultural needs. The diets of all individuals must consist of foods that are easily attainable and affordable. People can use an infinite variety and combination of foods to form a healthy diet. The 209 Basic Clinical Nursing Skills current philosophy is that no good foods or bad foods exist, and that all foods can be enjoyed in moderation. Dietary Guidelines the purpose of dietary guidelines is to provide a healthy public with practical and positive suggestions for choosing a diet that meets nutritional requirements, support activity, and reduces the risk of malnutrition and chronic disease. These guidelines are not intended as a diet prescription for specific individuals, but serve as a starting point from which people can plan healthy diets. A guideline for healthy diet Guide Line Rationale B Eat a variety of foods No single food supplies all 40-plus essential nutrients in amounts needed variety also helps reduce the risk of nutrient toxicity and accidental contamination B Balance the food you Excess weight increases the risk of eat with physical numerous chronic diseases. Both sugar and starches promote tooth decay B Choose a diet that is A high salt intake is associate with moderate in salt and higher blood pressure sodium 211 Basic Clinical Nursing Skills Therapeutic Nutrition Therapeutic nutrition is a modification of nutritional needs based on the disease condition or the excess or deficit of a nutrition status. Combination diets, which include alterations in minerals, vitamins, proteins, carbohydrates, fats as well as fluid and texture, are prescribed in therapeutic nutrition. Gastrostomy/Jejunostomy Feedings A gastrostomy feeding is the installation of liquid nourishment through a tube that enters a surgical opening (called a gastrostomy) through the abdominal wall in to the stomach. A jejunostomy feeding is the installation of liquid nourishment through a tube that enters a surgical opening (a jejunostomy) through the abdominal wall in to the jejunum. When there is an obstruction the esophagus, they may be come permanent, for example, after removal of the esophagus. Inserting a Nasogastric Tube Purposes To administer tube feedings and medications to clients unable to eat by mouth or swallow a sufficient diet without aspirating food or fluid into the lungs 212 Basic Clinical Nursing Skills To establish a means for suctioning stomach contents to prevent gastric distention, and vomiting.