Question

Discuss at least 3 evidence-based strategies a nurse can incorporate into the patient care plan to improve the nutritional status for HIV (AIDS) and Cancer patients.

Answer 1

Acquired immunodefficiency syndrome (AIDS) is a serious secondary immunodefficiency disorder caused by retrovirus ,human immunodefficiency virus (HIV). Both diseases are charecterized by progressive destruction of cell mediated (T- cell) immunity with subsequent effects of on humorel (B-cell) immunity because of pivotaL role CD 4+ helper T cells in immune reactions. immunodefficiency makes the patient susceptible to oportunistic infections ,unusual cancers ,and othr abnormalities.There is no cure yet for either HIV or AIDS. However, significant advances have been made to help patients control signs and symptoms and impair disease progression.

Nutritional management is integral to the care of all patients infected with human immunodeficiency virus (HIV). HIV infection results in complicated nutritional issues for patients, and there is growing evidence that nutritional interventions influence health outcomes in HIV-infected patients. During the course of HIV infection, several nutritional issues are likely to arise, including the need for education about the following:

• Healthful dietary principles.

• Maintenance of lean body mass and normal growth in children, and the treatment of wasting.

• Management of metabolic complications due to drug therapies.

• Management of drug and food or nutrient interactions.

• Management of gastrointestinal symptoms that may influence the types and amount of food ingested.

• Appropriate use of herbal and/or nutritional supplements.

• Cultural and ethnic beliefs related to diet and food .

• Role of exercise.

• Relationship between substance abuse and nutrition.

• Food safety.

• Nutrition during pregnancy.

• Access to infant formula and food as an alternative to breast-feeding.

HIV-infected patients may be at nutritional risk at any point in their illness . Severe malnutrition and weight loss, particularly loss of lean tissue, and delayed weight gain and height velocity in children, can affect morbidity and mortality . Fear of developing fat-redistribution syndrome, with central obesity and loss of subcutaneous fat, may prevent patients from beginning or continuing potent antiretroviral therapies . Development of hyperglycemia and lipid abnormalities may increase the risk of diabetes, heart disease, and stroke . The appearance of these metabolic changes may induce patients to cease HAART or to change to less effective antiretroviral regimens.Food and drug interactions are an important issue for effectiveness and tolerability of HAART regimens. The presence of food in the gastrointestinal tract can influence the absorption of several HIV medications such as didanosine, indinavir, saquinavir, and nelfinavir.

Anorexia and oral/gastrointestinal symptoms such as pain, nausea, vomiting, malabsorption , and diarrhea may arise from HIV infection, secondary infections, encephalopathy , or drug therapies. Inability to eat food secondary to complicated medical regimens or fatigue adds to the nutritional risk.

Goals of Nutrition Management of HIV-Related Symptoms

• Reduce severity of symptoms.

• Improve functioning and quality of life.

• Enable adequate food intake and absorption during symptomatic periods.

• Prevent malnutrition and wasting.

• Complement and strengthen medical treatment.

• Increase comfort and reduce pain. • Provide nutrients to compensate for nutrient loss.

• Prevents dehydration in diarrhea fever.

Components of Nutrition Management of HIV-Related Symptoms

• Nutrition assessment

• Nutrition counseling for proper dietary management

• Micronutrient supplementation if necessary and available

Approaches to Symptom Management

• Adapt dietary management to the client’s food habits and diet.

• During counseling, assess how the client is managing symptoms.

Managing Specific Symptoms

• Anorexia:

Eat small amounts of food more often.Stimulate apetite by eating favorite foods.Eat more energy-dense foods. Avoid strong-smelling foods.

• Diarrhea:

Drink lots of fluids, eat small amounts of food more often, and continue to eat after illness.Drink plenty of fluids (soup, fruit juice, boiled water, tea) to avoid dehydration.

-Avoid strong citrus fruits such as oranges and lemons, which may irritate the stomach. Eat foods rich in soluble fiber (millet, bananas, peas, and lentils) to help retain fluids.

-Eat fermented foods such as porridges and yoghurt. Eat easily digestible foods such as rice, bread, millet, maize porridge, potatoes, sweet potatoes, and crackers.

-Eat small amounts of food frequently and continue to eat after illness to recover weight and nutrients lost. Eat soft fruits and vegetables such as bananas, squash, cooked and mashed green bananas, mashed sweet potatoes, and mashed carrots. Eat eggs, chicken, or fish for protein.

-Drink nonfat milk if there is no problem with lactose. Boil or steam foods. Avoid the following foods: Dairy products such as milk Caffeine (coffee and teas) Alcohol Fried foods and extra oil, butter, or lard Gas-forming foods such as cabbage, onions, and carbonated soft drinks

Prevention of diarrhea ;Drink plenty of clean, boiled water. Wash hands with soap and water before handling, preparing, serving, or storing food. Wash hands with soap after using the toilet or latrine or cleaning a child after defecation. Treatment Drink more fluids to prevent dehydration. Prepare rehydration solutions using oral rehydration salt packets or a home-made solution of 1 liter of boiled water, 4 teaspoons of sugar, and ½ teaspoon of iodized salt. Go to a health center if you have symptoms such as severe dehydration (low or no urine output), fainting, dizziness, shortness of breath, bloody stools, high fever, vomiting, severe abdominal pain, or diarrhea for more than 3 days.

• Anemia:

Eat more iron-rich foods such as eggs, meat, fish, and liver; green leafy vegetables such as collard greens and spinach; legumes such as beans, lentils, and groundnuts; nuts; oil seeds; and fortified cereals. Take iron supplements

If available, take one iron tablet a day with food and with vitamin C (tomato or orange juice) to help with absorption. Seek treatment for malaria and hookworm.

• Thrush: Eat soft mashed foods, avoid spicy food, and drink plenty of fluids.

Eat cold foods or foods at room temperature. Avoid spicy, salty, or sticky foods that can irritate mouth sores. Avoid strong citrus fruits and juices that can irritate mouth sores. Avoid sugary foods that cause yeast to grow. Avoid alcohol. Drink plenty of liquids.

• Loss of taste:Enhance the flavor of food with salt, spices, herbs, or lemon. Chew food well and move it around your mouth to stimulate taste receptors.

• Bloating and heartburn: Eat small, frequent meals, avoid gas-forming foods, and eat long enough before sleeping.

• Nausea: Eat small, frequent meals, avoid lying down immediately after eating, and rest between meals.

• Fever: Drink plenty of fluids and eat energy- and nutrient-rich soups and foods. Drink fluids, especially clean boiled water, to prevent dehydration. Bathe in cool water.

• Constipation: Eat high-fiber foods such as maize, whole wheat bread, green vegetables, and washed fruits with the peel. Drink plenty of liquids. Avoid processed or refined foods. Avoid using enemas and medications to cleanse the bowels. Drink plenty of liquids, including boiled water

Nutrition management of HIV-related symptoms can reduce the severity of symptoms, improve nutritional status, and boost immune response.Nutrition management includes assessing the effects of the symptoms on diet and nutritional status, counseling on specific symptoms, and food and/or micronutrient supplementation if needed and available.