Clinical Manual for Management of the HIV-Infected ... - myCME.com

2–10 | Clinical Manual for Management of the HIV-Infected Adult/2006
P: Plan
Develop a nutritional plan and provide practical
nutrition education for common problems. Some useful
online sources for patient handouts include:
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AIDS Project Los Angeles Nutrition Fact Sheets
Available at http://www.apla.org/programs/
nutrition.html.
Health Resources and Services Administration,
HIV/AIDS Bureau. Health Care and HIV:
Nutritional Guide for Providers and Clients; 2nd ed.
Online manual, also in Spanish. 2002. Available at
http://www.aids-etc.org/aidsetc?page=et-30-20-01.
Table 9. Practical Interventions for Common Nutrition-Related Problems
Problem Suggestions
Weight Loss
(decrease in both
body cell mass
and fat)
• Early identification and ongoing monitoring are key.
• Identify and treat underlying risk factors.
• Try to add calories without adding “bulk” :
• Fat (9 calories/gram): butter, margarine, avocado, cream,
mayonnaise, salad dressing
• Carbohydrate (4 calories/gram): jam, jelly, sugar, icing,
gum drops
• Protein (4 calories/gram): protein powders, cheese, nut
butters, trail mix, powdered breakfast drinks, nonfat dry
milk
Diarrhea • Increase soluble fiber; decrease insoluble fiber.
• Replenish beneficial bacteria (eg, with lactobacilli
preparations).
• Avoid intestinal irritants and stimulants.
• Decrease dietary fat.
Early Fullness • Take small, frequent meals.
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•
Concentrate on solid foods, with liquids between meals.
Eat lower-fat, lower-fiber foods.
Nausea • Take small, frequent meals.
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•
Try dry snack foods.
Avoid fried foods, very sweet foods, spicy foods, and foods
with strong odors.
Changes in Taste • Eat a variety of foods, not only favorite foods.
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•
•
Try protein sources other than red meat.
Marinate foods, use sauces.
Use more and stronger seasonings.
Loss of Appetite • Rely on favorite foods.
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•
•
•
Ask family members and friends to prepare meals.
Eat small, frequent meals.
Keep snacks handy for nibbling.
Eat before bedtime.
♦
Association of Nutrition Services Agencies Available
at http://www.aidsnutrition.org.
Evaluate and treat concurrent medical problems (eg,
diarrhea, nausea, infections, malignancies, depression).
For severe or persistent nutritional problems, or
for specific needs, refer to a nutrition specialist for
evaluation and treatment.
Table 9 lists of common nutrition-related problems and
some simple suggestions that may help resolve them
and help patients maintain adequate nutrition.
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Eat more frequently.
Maximize good days.
Use canned supplements (eg, Ensure, Boost).
For wasting or substantial weight loss, consider referral for
therapies such as appetite stimulants or human growth
hormone.
Decrease or eliminate lactose.
Increase fluids and provide electrolytes (sodium,
potassium).
Treat with pancreatic enzymes.
Wear loose-fitting clothing.
Sit up while eating.
Eat, walk, and eat again.
Try cool, clear beverages, popsicles.
Try ginger-containing foods and drinks.
Keep liquids to a minimum at meals.
Try tart foods.
Use sugar or salt to tone down the flavor of foods.
Try a mouth rinse of 1 teaspoon of baking soda in 1 cup of
warm water before eating.
Eat in a pleasant place, with other people.
Make the most of good days.
Try light exercise to stimulate appetite.
Add extra calories without adding bulk.
Consider appetite stimulants (megestrol, stimulants).