My Experience and Background - PowerPoint PPT Presentation

Loading...

PPT – My Experience and Background PowerPoint presentation | free to download - id: 43b824-ODc4Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

My Experience and Background

Description:

Discuss Medical Nutrition Therapy for ... * Post-operative Diet Progression Protein is always the ... Slide 3 Nutrition Education RNY Surgery as Treatment ... – PowerPoint PPT presentation

Number of Views:114
Avg rating:3.0/5.0
Slides: 37
Provided by: MSo82
Learn more at: http://health.kernan.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: My Experience and Background


1
My Experience and Background
  • Certificate of Adult Weight Management Training
  • I and II
  • Personal Trainer and Yoga Certification
  • American Society for Metabolic and Bariatric
    Surgery Member

1
2
Objectives
  • Nutrition Education and Training for the
  • Diabetic Bariatric Patient
  • Pre-operative Nutrition Assessment
  • Post Operative Nutritional Care and Evaluation

2
3
  • Pre-Operative Care
  • for the
  • Diabetic Bariatric Patient

3
4
Nutrition Education
  • Set priorities
  • Establish goals
  • Create individualized action plans
  • Foster responsibility for self-care

4
5
RNY Surgery as Treatment
  • Surgery should be considered as treatment for
    the obese patient with diabetes, according to the
  • International Diabetic Federation

6
Initial Dietitian Appointment
  • All patients will see Registered Dietitian
  • Providers must be sensitive to the stigma of
    obesity
  • Patients will be provided with nutrition and
  • lifestyle advice

6
7
Tests and Clearances
  • Psychological or Social Worker evaluation
  • Medically Supervised Diet Education
  • Six consecutive months
  • Other testing and clearances
  • sleep study
  • cardiac clearance

7
8
Commitment to changing your total food-life
  • Personal Preference Temptation
  • Time of Eating Familiarity
  • Convenience Availability
  • Social Reasons/Peers Economy
  • Values and Beliefs Sensory factors
  • Reward or Consolation/Comfort

8
9
New Nutritional and Lifestyle Priorities
  • Stop all carbonated beverages
  • Stop all caloric beverages
  • Strict separation of foods and beverages
  • Eliminate/reduce high fat foods (Fried foods)
  • Eliminate sweets

9
10
Focus of Pre-Op Nutrition Counseling
  • Problem solving and behavioral change/modification
  • Changes in appetite and hunger after the surgery
  • Motivation to practice new eating habits
  • Identify head hunger verses heart hunger
  • Setting goals
  • Diet and exercise log

10
11
Focus of Preop Nutrition Counseling
  • Basic nutrition information
  • Nutrition information specific to all surgeries
  • Supplements
  • Dumping syndrome
  • Liver shrinking diet
  • Mindful eating
  • High protein shake options

11
12
LIVER SHRINKING DIET
  • Two Weeks Before All Bariatric Surgeries
  • Purpose
  • Reduces glycogen stores in your liver and causes
    your liver to shrink, this makes laparoscopic
    surgery easier. Sugar and carbohydrates affect
    glycogen stores.
  • Diet
  • Drink 4-6 no sugar added meal replacement shakes
    each day
  • Drink at least 64 ounces (2 quarts) of fluids
    (water preferred)
  • Effective in decreasing side effects
  • Continue recommended vitamin and mineral
    supplements

13
Liver Shrinking Diet and Diabetics
  • Caution Diabetics
  • Please call your physician or endocrinologist to
    inform them of this very low calorie diet (VLCD)
  • Test blood glucose 3-4 times a day
  • Inform them of the calories, protein, and
    carbohydrates (roughly 75g of carbs depending on
    product chosen)
  • Your insulin or oral diabetes medications may
    need to be changed

14
Liver Shrinking Diet Plan B
  • This is a shake and food meal plan that will keep
    the fat extremely low.
  • Your goal is still to lose as much weight as
    possible before surgery.
  • The Meal Plan
  • 2 or 4- 8-11 oz high protein shakes/day
  • 1 meal a day
  • - high protein
  • -no starchy vegetables

15
Exercise- Conservative protocol for all patients
  • Concerns
  • Disability or pain issues with walking or
    exercise
  • Physician recommendations
  • Current routine
  • Short term plans
  • Guidelines
  • Walking
  • Warm up, cool down, breath
  • Low intensity levels at the start
  • Moderate activity will assist patients
  • internal regulation of hunger, appetite and
    satiety

15
16
Special Risks of Exercise for the De-
conditioned Diabetic
  • Risk of dehydration
  • Risk of hypoglycemia
  • Risk of orthopedic stress
  • Intensity levels should start low
  • Warm up is essential--gentle activity
  • Short bouts of exercise are preferable
  • 5-10 minutes each bout

17
Preoperative Nutrition Evaluation
  • Compliance potential
  • Weight and weight changes
  • Eating behaviors and changes

17
18
Pre-op Visit (2 weeks before surgery)
  • Supplies
  • Clear expectations for recovery
  • Pouch comfort
  • Satiety and hunger
  • Documenting food and liquid intake

18
19
  • Post-Op Care
  • for the
  • Surgical Weight Loss
  • Patient

19
20
What is different for the diabetic?
  • There really is no difference.
  • Diabetes may improve quickly within the first few
    weeks even before weight loss.

21
Post-operative Diet Progression
  • Protein is always the priority
  • All vitamins must by chewed or crushed
  • Protein shakes 3 times a day for 7 weeks
  • Stress small bites and chewing
  • Sip all fluids
  • Separate eating and drinking

22
Progression of Recovery Meals
  • Stage I Modified full liquid diet
  • Weeks 1 and 2
  • Mashed cottage cheese, Greek yogurt, blenderized
    soup
  • Most meals are 2-3 bites up to 2 ounces
  • Stage II Soft meal plan
  • Starts on day 15
  • Soft textured foods, which are very easy to chew
    and digest
  • Stage III High protein calorie controlled meal
    plan
  • Begins at week seven post-op
  • Regular consistency foods-chewed very well
  • Always eat the protein first and stop when your
    are full
  • Three meals a day, no snacks, no protein shakes
    or bars

23
Follow Up Appointments for All Bariatric
Surgeries
  • Meal size and frequency
  • Texture of foods
  • Liquid Calories
  • Perceived physical and mental hunger
  • Snacking
  • Fluids- 64 ounces is goal
  • Consistency
  • Activity Levels and Motivation

23
24
Follow up RNY Patients
  • Nausea and Vomiting
  • Dumping syndrome
  • Types of protein
  • Foods
  • Liquids
  • Supplements
  • Vitamins
  • Support group

24
25
HIBERNATION SYNDROME
  • After bariatric surgery, patients may
  • Feel tired and depressed
  • Begin to believe that surgery was a mistake
  • Immediately following surgery, our body starts to
    notice that we are not taking in enough calories
  • Diabetics are especially sensitive to this
    reaction
  • Normally blood glucose was high and now eating
    600-800 calories a day
  • Many feel better by 3 to 4 weeks, when
    soft-solid foods are introduced

26
Dumping Syndrome
  • DUMPING SYNDROME- if a patient eats concentrated
    sweets
  • Undigested simple carbohydrates rapidly passes
    into the intestine.
  • Causes a large amount of water to be pulled into
    the intestine from the bloodstream and usually
    occurs within 30 minutes of eating.
  • Symptoms include mild to severe cramps, sweating,
    rapid pulse, light headiness and weakness
  • Subsides in one to two hours

27
Follow up Gastric Band Patients
  • Relax with meals
  • Length of meals
  • Location of pouch
  • Experience of hunger
  • First adjustment at 6 weeks
  • Changes in food textures

27
28
Follow up Gastric Sleeve
  • Picture a test tube that can only hold a certain
    amount of marbles
  • Look at meal and fluid timing
  • Length of meals

28
29
Normalizing Metabolic Rate
  • Relationship between
  • Age
  • Gender
  • Body composition
  • Body weight
  • Caloric intake
  • Major components of resting metabolic rate
  • Methods to increase Metabolic rate

29
30
Case Study
31
Successful Patients
  • Respect the pouch/band and keep it tight
  • Eat slowly and stop at the first feeling of
    fullness
  • Eat three meals a day ---no snacking
  • Portion control
  • Supplements
  • Maintain these habits for a lifetime

31
32
Emotions
  • I am healthier than I have been in my entire
    life.
  • I no longer feel like I am dieting.
  • I no longer view food as the enemy.
  • I could not have accomplished this with out the
    education, support and non-judgmental attitude of
    the bariatric team.

32
33
A patients journey
  • Dreams
  • Desires
  • Decisions
  • Doing
  • Dedication

33
34
For More Information
  • Center for Weight Management and Wellness
  • www.umm.edu/weightmanagement
  • Main office 410-328-8940
  • Located on 4th floor of North Hospital
  • Mary Beth Sodus, RD/LD, CPT-ACE
  • msodus_at_smail.umaryland.edu
  • 410-328-5877

34
35
  • The future belongs to those who believe in the
    beauty of their dreams
  • -Eleanor Roosevelt

35
36
  • Questions?

36
About PowerShow.com