O’Neil 1 Jillian O’Neil KNH 413 02/11/14 Case Study 1 – Peptic Ulcer Disease 1. List all the food items that may contribute to GG’s condition and explain why. Foods: a. “Fast foods with a high fat content” – These products often contain simple carbohydrates in addition to the unhealthy fats. Foods containing a significant amount of fat cause an inflammation among the stomach lining and increase gastritis symptoms. According the Ratini, dietitians would encourage GG’s diet to include complex carbohydrates with healthy fats; in addition, the meals would include a proper combination of healthy fats and proteins with carbohydrates – a concept most fast food restaurants do not provide to clients. Lastly, overall portions are not controlled at fast food chains for the client’s moderation of meals – Ratini also encouraged small meals to ensure proper digestion. b. “Did not stop to eat anything” – a lack of food can cause an imbalance in the client’s digestive tract. In addition, it
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O’Neil 1
Jillian O’NeilKNH 41302/11/14
Case Study 1 – Peptic Ulcer Disease
1. List all the food items that may contribute to GG’s condition and explain why.
Foods:
a. “Fast foods with a high fat content” – These products often contain simple carbohydrates
in addition to the unhealthy fats. Foods containing a significant amount of fat cause an
inflammation among the stomach lining and increase gastritis symptoms. According the
Ratini, dietitians would encourage GG’s diet to include complex carbohydrates with
healthy fats; in addition, the meals would include a proper combination of healthy fats and
proteins with carbohydrates – a concept most fast food restaurants do not provide to
clients. Lastly, overall portions are not controlled at fast food chains for the client’s
moderation of meals – Ratini also encouraged small meals to ensure proper digestion.
b. “Did not stop to eat anything” – a lack of food can cause an imbalance in the client’s
digestive tract. In addition, it is encouraged to eat small meals 5-6 times per day. Skipping
meals will increase the severity and discomfort to clients.
c. “Frozen dinners or fried foods” – these products often contain high amounts of sodium,
fat, cholesterol and simple carbohydrates. In correlation with the food items from “a” and
“b,” this type of meals would increase severity of the condition as well as increase
discomfort for the patient. Foods containing a significant amount of fat – such as fried
foods – may cause an inflammation among the stomach lining and increase gastritis
symptoms. Ratini encourages a lower sodium diet plan coinciding with a healthy fat diet.
In addition, excess sodium could irritate the stomach lining which would ultimately
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increase the gastritis symptoms. Lastly, most of these items would not contain the
adequate fiber GG needs to have a healthy digestive system – such as fruits or vegetables.
d. “Chocolate bars during the day” –It is recommended for clients to avoid simple sugars and
simple carbohydrates as well as sweetened food items. Chocolate bars contain a
significant amount of sugar, simple carbohydrates in addition to caffeine. Consuming
caffeine is also encouraged for patients to avoid because may cause an inability to sleep
well. Lastly, caffeine may cause an increased amount of stomach acid product and thus
damaging the stomach lining overtime and increasing her stomach pain symptoms.
e. “Milk” – dairy products should be limited and taken one hour after a meal. Excess dairy,
or any “nutrient-rich drink” cause trigger symptoms because of the rich emulsions present.
Therefore, it is usually encouraged for clients to consume lactose-free products.
Drinks:
a. “Strong, black coffee throughout the day and into the night” – Decaffeinated beverages are
encouraged because they can cause or irritate symptoms of the condition. It may cause
increased amount of stomach acid product and thus damaging the stomach lining overtime
and increasing her stomach pain symptoms. In addition, drinking liquids throughout the
day isn’t encouraged. Ratini suggests to not eat solids and liquids at the same time; do not
drink during the sixty minutes around a meal – thirty minutes before until thirty minutes
afterwards. Lastly, caffeine intake later in the day and at nighttime can have a great affect
on her inability to sleep well.
b. “Rum and coke at bedtime” – Large amounts of alcohol often irritates the gastritis
symptoms. Not only will the caffeine, from the coke, have a great affect on her inability to
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sleep well; but also, the caffeine will increase stomach acid and thus increase stomach pain
(a symptom of gastritis).
(Ratini, Dumping Syndrome Diet, Parrish, Johnson)
2. List any additional oral intake that may have contribute to GG’s condition and explain
why.
a. “Smoking” - the chemicals from a single cigarette can damage the stomach lining and
increase gastritis symptoms from the tobacco irritations.
b. “Aspirin” – Aspirin reduces prostaglandin, which provides protection to the stomach.
Continuous aspirin use can cause stomach-lining irritation and increase gastritis symptoms
c. “TUMS” – Although antacids can positively influence the body, misuse of antacids can
induce gastritis. Antacids can reduce stomach acid levels and allow vulnerability for
infections which can ultimately cause further gastritis concerns.
(Health Central, Namiot, Ehrlich)
3. List the non-oral stimulants (physical or psychological stress) that could contribute to
GG’s condition and what she could do to change them.
a. “Single Mom” – Although being a recently single mother can pose great stress on GG
and her condition, she can cope with the difficulties by reaching out to her close family
members and friends. Asking for help for simple tasks – including picking her son up
and babysitting for no cost, or helping with groceries – will make GG’s life significantly
“easier” and give her time to manage her condition.
b. “Divorce” – After an eight-year marriage, losing her husband will pose trauma and
stress on GG’s body. Not only is she now lacking financial support, she has to start from
scratch with her finances due to her lack of job skills and education. Separation is
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mentally and physically draining on GG. Although nothing can technically be done in
regards to improving the divorce, GG can focus on the idea her marriage brought her a
son. Doing activities with her son can bring a positive attitude into her life.
c. “Part-Time Job + Accounting Degree” – These two additions to GG’s life can cause her
to be overwhelmed and stress. Previously, she didn’t have job skills or an education;
thus, adding these two factors to her other stress factors can increase her body tension
and induce gastritis symptoms. To deal with this stress, she can focus on time
management – she can have designated time for class and work. In addition, she can set
time slots for the library to dedicate for homework and studying without the distractions
at home. Then once she goes home, she can focus on relaxing and spending quality time
with her son.
d. “Maintain good grades for loan” – This additional stress can be maintained by keeping
up with her studies and not letting herself fall behind. Attending office hours, every
class, and studying hard can help her maintain good grades.
e. “Son Diagnosed with ADHD” – GG has multiple factors influencing her stress level.
She can manage this stressor by organizing her son’s time when she is and isn’t with
him. Keeping him busy and occupied can help him maintain a balanced lifestyle, which
would ultimately aid in decreasing the stress within her life.
f. “Symptoms of Her Condition” – Managing her condition is key to decreasing the
induced stress. By listening to the doctor, she can have a positive life, even with her
condition. She can manage her stress as well as eliminate her intake of alcohol, caffeine,
ASA, cigarettes and high fat foods.
(Information obtained from Case Study #14 Packet)
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4. List the symptoms of GG’s gastritis
GG’s gastritis symptoms include: stomach burning, severe pain in the right lower quadrant 30
minutes after eating, stomach pain, extreme indigestion, severe gastric pain.
(Information obtained from Case Study #14 Packet, Johnson)
5. Was a bland diet necessary? Explain and list the principles of the diet plan that you
think GG should follow.
According to personal conducted research, a bland diet isn’t necessary. Although it is important
to improve dietary choices, total elimination to “start from scratch” is not necessary in this
situation. A helpful diet plan for GG would include 6-8 small meals throughout the day,
increasing digestion duration by increasing protein, consuming a low carbohydrate diet, reducing
beverages consumed during mealtime (decreasing change of aggravating the condition), and to
reduce or eliminate foods containing excess sugar, chocolate, and peppermint. In addition, GG
can reduce the intake and consume small amounts of milk products as well as resting post-meals
to allow proper food digestion. The Canadian Cancer Society promotes the elimination of
consuming food or liquids after 7:00pm to aid in digestion before the average bedtime. Lastly,
gradually increasing fiber in her diet can help slow the absorption of sugars and can help form
stool by binding to the water. In regards to her diet history, total elimination of high fat foods,
processed foods, caffeine, coffee, chocolate, aspirin, alcohol and smoking can greatly improve
her life. Instead, she can consume foods containing low fat and sodium as well as healthy fats,
proper distribution of macronutrients and a high fiber diet. By eliminating most of her foods
from her original diet, she will automatically replace them with healthy options – providing her
with the nutrients necessary for an improved gastritis lifestyle.
(Canadian Cancer Society, WebMD, University of Pittsburg Medical Center)
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6. What is the mechanism of action of the following medications GG is receiving:
Carafate, AlternaGel, and Pepcid?
a. Carafate – Sucralfate is used as a prevention method and as a treatment option for
intestinal ulcers. This drug is responsible for forming a “coating” over the ulcer in
prevention of an additional injury to the area; thus resulting in a quicker recovery.
While Ogbru stated that the mechanism of action for Carafate isn’t “entirely
understood,” researchers have thought it is important for: the sucralfate to bind to ulcer
surfaces to attach a protein, and protect the surface of the ulcer from acid or pepsin.
This medication stops pepsin when stomach acid is present and thus salts from the liver
are bound to the sucralfate as prevention of the lining of the stomach to have damage
from bile acids. Lastly, this medication is found to increase prostaglandin production (a
protector of the stomach lining).
b. AlternaGel – Aluminum hydroxide is often prescribed when a patient has excess
stomach acid. It is used to rapidly lower the stomach acid levels in a patient with
already existing conditions. As an antiacid, this medication’s mechanism of action is to
react with stomach acids and neutralize the levels by increasing the pH. In the intestine,
it is responsible for forming aluminum phosphate by binding with the phosphate ions.
c. Pepcid – Famotidine is responsible for blocking stomach acid production. This
histamine blocker inhibits the histamine actions in the cell and ultimately reduces acid
production.
(Ogbru, WebMD, Drugs, MedicineNet)
7. List the nutrient-drug interactions that are associated with these medications.
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a. Carafate – Although there are a list of medications that should not be taken with
sucralfate, GG’s list of medications do not conflict. In general, other medications
should be taken two hours before the sucralfate. This medication also needs to be
taken on an empty stomach and one hour before the designated meal. In addition
to the listed interactions, sucralfate may also have interactions with dietary
supplements. First, blood calcium levels may increase when taking
supplementation in addition to this drug; the recommendation is to avoid calcium
supplementation. Lastly, sucralfate may interact with the mineral, Phosphorous,
by significantly decreasing the blood levels. Extreme cases may lead to bone pain
– which is the reason for a constant monitoring of calcium and phosphorous
levels.
b. AlternaGel – In addition to multiple drug interactions, Aluminum hydroxide can
alter a patient’s phosphorous levels. The Aluminum and magnesium will form a
“complex” with phosphorous in the body and reduce it’s levels – thus, causing a
decrease in calcium levels. Therefore, it is a concern for GG if she is at an
increased risk for osteoporosis. In addition, it is not recommended to consume this
medication during a meal because it will inactivate thiamine.
c. Pepcid – This drug can interact with Vitamin B12 by reducing its ability to attach to
protein and be properly absorbed. Therefore, most would prescribe B12
supplementation. In addition, Vitamin C and Vitamin E may also be prescribed in
supplementation form because reducing stomach acid levels may allow bacteria to
survive in one’s stomach.
(WebMD, Ogbru, Health Central)
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8. What are GG’s IBW and percent IBW (Appendix A, Tables 7 and 8)?
Height: 5’2” Current weight: 98 pounds
Ideal Body Weight: 100 + 5(2) = 110 pounds
Percent IBW: 98/110 = .8909 * 100 = 89%
(Nelms 48)
9. Estimate her daily energy needs using the Harris-Benedict equation and appropriate
stress factor (Appendix A, Table 17).
Since GG has lost weight, we would use this equation using her ideal body weight of 110 pounds
because weight gain is necessary.
W: 110 pounds / 2.2 = 50 kg H: 5’2” = 62” = 62*2.54 = 157.5 cm A=27
ReferencesAcademy of Nutrition and Dietetics (2013). International dietetics and nutrition terminology
(IDNT) reference manual: Standardized language for the nutrition care process. Chicago, IL: Academy of Nutrition and Dietetics.
Alternagel oral . (n.d.). WebMD. Retrieved February 8, 2014, from http://www.webmd.com/drugs/drug-14353-alternagel+oral.aspx
Antacids (Oral-Local). (2006, July 18).Drugs. Retrieved February 8, 2014, from http://www.drugs.com/mmx/alternagel.html
Dumping syndrome. (n.d.).. Retrieved February 8, 2014, from http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing- side-
effects/dumping-syndrome/?region=on#Prevention_ManagementDumping Syndrome Diet. (n.d.) University of Pittsburg Medical Center. Retrieved February 7,
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http://www.healthcentral.com/static/pp/pdf_guides/nutrient.pdfEhrlich, S. (2013, May 7). Gastritis.University of Maryland Medical Center. Retrieved
February 9, 2014, fromhttp://umm.edu/health/medical/altmed/condition/gastritisHow Does Cigarette Smoking Cause Gastritis? - HealthCentral. (n.d.). Health Central.
Retrieved February 7, 2014, from http://www.healthcentral.com/copd/h/how- does-cigarette-smoking-cause-gastritis.htmlJohnson, K. (2012, July 7). Gastritis: Symptoms, Causes, Treatments, and More. WebMD.
Retrieved February 7, 2014, from http://www.webmd.com/digestive-disorders/digestive-diseases-gastritis
Namiot, A. (2007). Smoking habit and gastritis histology. Advances in Medical Sciences, 52, 191-195. Retrieved February 8, 2014, from http://www.advms.pl/?q=system/files/33_52Namiot.pdf
Ogbru, O. (n.d.). Sucralfate (Carafate).MedicineNet. Retrieved February 8, 2014, from http://www.medicinenet.com/sucralfate/article.htm
Parrish, C. (n.d.) Dietary and Nutritional Recommendations For Patients with Dymping Syndrome. American Neurogastroenerology and Motility Society. Retrieved February 7, 2014, from http://www.motilitysociety.org/patient/pdf/Dumping%20Diet%205%204b%202006.pdf
Ratini, M. (2013, April 15). Dumping Syndrome: Causes, Symptoms, Foods to Avoid, and Treatments.” WebMD. Retrieved February 7, 2014, from http://www.webmd.com/ digestive-disorders/dumping-syndrome-causes-foods-treatments