1. Nutrition and Cystic Fibrosis

2. Nutrition and Cystic Fibrosis: An Educational Flip Chart for People with CF and their Families The purpose of this educational flip chart is to provide a “hands-on” tool (the lamination allows for touching the pictures with the ability to clean the flip chart between use) to teach children, adolescents and adults, about the GI pathophysiology of CF, how enzymes work and why they are so important to take appropriately. The emphasis is on attaining good nutrition to stay healthy! The flip chart can be used for initial education, developmental updates, and when problems or educational needs are identified. Each of the pages of the flip chart is accompanied by a sample script, including salient teaching points. The script should be individualized, incorporating developmental and age-appropriate modifications. The flip chart and script pages are provided in Microsoft PowerPoint  format, but are meant to be printed. A flip chart can then easily be created by laminating and binding the pages. Alternately, the pages may be placed in plastic page covers and then in a binder. If the script page is placed behind the previous education page, it allows the educator to view the script while the patient or family member is viewing the education page.

4. Pointing out the middle illustration “This is the stomach, and this is the small intestines (or gut). When you eat, food goes into your stomach, then into your gut. Behind the stomach is the pancreas. The pancreas makes digestive enzymes which turn foods into nutrition that is absorbed into your blood and then taken to all parts of your body.” Pointing out the top left illustration “In normal digestion, there is a tube from the pancreas to the intestine called the pancreatic duct. Enzymes come from the pancreas through the pancreatic duct to the intestine every time food goes into the intestines.” Pointing out the bottom right illustration “When you have CF, the thick mucus in the pancreatic duct blocks the enzymes from entering the intestines.” (This drawing can also be used to illustrate the fact that bicarbonate-rich pancreatic juices also enter the intestine from the pancreas, and sometimes enough of the bicarbonate is blocked so that an “acid-blocking” medication may be used to help the enzymes work better.)

6. “You have to put enzymes into your stomach whenever food goes into your stomach. In the stomach, the food turns into smaller pieces, and the capsule dissolves and the enzyme beads are released. In the intestines, the powder in the beads is released, and the enzyme powder digests the smaller parts of foods. Then the nutrition and vitamins are absorbed and sent to all the other parts of your body.” “So remember, every time food goes into your mouth, enzymes go into your mouth! They need to end up in your stomach at the same time. Enzymes only last for about 45 to 60 minutes. Food leaves your stomach and you get hungry and have to eat again. Enzymes leave your stomach, and you have to take enzymes again, too.” “And remember to ONLY use the BRAND NAME enzymes that have been prescribed for you by your CF doctor!” “What kind of enzymes do you take?” “What do your enzymes look like?”

7. Don’t let those calories get away by not taking your enzymes!

8. “So DON’T let those calories (and vitamins, minerals, proteins…) get away by not taking your enzymes!”

9. Good Nutrition Means … Energy Growing Healthier Lungs Fighting Infections

10. “ ….. because good nutrition means … energy, growing and developing, fighting infections, and healthier lungs!”

11. Which foods are good for you? Which foods do you take enzymes with?

12. X “Tell (or show) me which of these foods are good for you?” (The teaching point is that a very wide variety of foods are good for people with CF. It is particularly important to emphasize that high fat, high calorie foods that aren’t good for people without CF, are always healthy for people with CF.) X “Which foods should you take enzymes with?” (A glass of milk, and a milk shake were specifically included, because people with CF and their families often do not realize that they have to take enzymes with certain “drinks” (they often don’t realize that certain “drinks” are “foods”). The picture of an apple with a book (maybe snacking on an apple when reading or doing homework), and the bowl of fruit, are meant to point out that certain foods that have no fat, can be eaten without enzymes. Of course the norm should be eating high fat, high calorie foods, but sometimes it’s nice to be able to give a starving 6- year-old a “fruity snack” in the car, or for an adolescent to have a coke with friends without enzymes.)

13. Nutrition and Cystic Fibrosis Judy Marciel, RN, MSN, CNS, CPNP Vanderbilt Children’s Hospital Cystic Fibrosis Care Center 2003 Special thanks to Solvay Pharmaceuticals for making this project possible with an unrestricted educational grant.

14. My hope is that this flip chart will be helpful to CF health care professionals in teaching people with CF and their families about the importance of good nutrition ultimately resulting in better nutrition and better outcomes. I would like to express my sincere thanks to Solvay Pharmaceuticals for making this project possible with an unrestricted educational grant. I am also very grateful to Barbara Blankstein, for her tireless and good-humored assistance in creating this flip chart in Microsoft PowerPoint ® format. Judy Marciel, RN, MSN, CNS, CPNP Vanderbilt Children’s Hospital Cystic Fibrosis Care Center Nashville, Tennessee Phone: (615) 343-7617 2003 (All clip art images are from Microsoft ® Design Gallery http://dgl.microsoft.com/?cag=1)