1. SCI Nutrition Angela DiTucci, R.D.

2. Gastrointestinal Genitourinary Respiratory Neuromuscular NUTRITION Skeletal Cardiovascular Integumentary Metabolic

3. Physical Ability Functional Ability / Capacity Mastication Ability Swallowing Issues

4. Medications High dose steroids Anabolic therapy Bowel Bladder Gastrointestinal Pain Cardiovascular

5. Use of Herb / Botanicals Saint John’s Wort -”Makes you feel good.” -”It’s natural.” Echinacea -”Boosts the immune system.” -”Protects against the common cold and flu.” Garlic -”Lowers cholesterol.”

6. Psycho / Social Issues Depression Self image Food = source of gratification Feeding = important issue in independence and socialization Ability to purchase food and prepare meals Living arrangements / meal arrangements Availability of community resources Alcohol intake

7. Weight Change Acute Phase = Weight loss -Increases risk of pressure ulcer development. -Increases susceptibility to fatigue -Decreased resistance to infection Long-term Phase = Weight gain -Difficulty with lifts, transfers, ADL’s -Increases risk for Diabetes, CHD, HTN -Increases risk of pressure ulcer

8. Bowel Management Fiber Gas Diarrhea Fluid

9. Fluids Digestion and absorption of food Elimination of body waste Regulation of body temperature Distribution of nutrients to body cells Prevention or urinary tract infections 2000 cc – 3000 cc fluid daily

10. Suggestions for Teaching to Increase Fluid Intake Keep a water bottle. If with impaired hand function, work with OT- adaptive straws / cups. Drink 1-2 glasses of water every time the leg bag is emptied. Drink before meals rather than afterwards when full. Do most of the drinking before early evening measurements. Caffeine, alcohol, juices

11. Skin Integrity Risk Factors -Hypoalbuminemia -Weight -Anemia Diet -High quality diets -Protein -Calories-Fluids -Zinc-Vitamin C -Vitamin A-Iron, Folate, B12

12. Impaired Glucose Tolerance Risk Factors Altered body metabolism Decrease in muscle mass and increase in fat Inactivity Aging process

13. Lipid Abnormalities Increased prevalence of Heart Disease Lipid abnormalities Glucose intolerance Increased weight Limited Activity Risk Factors for Lipid Abnormalities Impaired carbohydrate metabolism Reduced activity Increased adiposity Changes in metabolism HDL

14. Osteoporosis Risk Factors Diabetes Steroid Use Smoking Vitamin D Deficiency Excessive Alcohol and/or caffeine use Additional Risk Factors 2 ° SCI Inactivity Changes in Autonomic and nervous systems

15. Osteoporosis Intervention Physical activity- weight bearing or resistance Calcium Vitamin D Smoking cessation (smoking speeds up bone loss) Limit ETOH/Caffeine (also speeds up bone loss)

16. Role of nutrition for the SCI person across the continuum of care. Team approach to the nutritional care of the SCI person.