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Nutrition and Cystic Fibrosis

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Nutrition and

Cystic Fibrosis

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.

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.)

“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?”

Don’t let those calories get away by not taking

yourenzymes!

“So DON’T let those calories

(and vitamins, minerals,

proteins…)

get away by not taking your

enzymes!”

Good Nutrition Means…

EnergyGrowing

Healthier Lungs Fighting

Infections

“…..because good nutrition means …

energy,

growing and developing,

fighting infections,

and

healthier lungs!”

Which foods are good for you?

Which foods do you take enzymes with?

“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.)

“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.)

Nutrition and

Cystic Fibrosis

Judy Marciel, RN, MSN, CNS, CPNP

Vanderbilt Children’s HospitalCystic Fibrosis Care Center

2003

Special thanks to Solvay Pharmaceuticals for making this project possible with an

unrestricted educational grant.

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 CenterNashville, Tennessee

Phone: (615) 343-76172003

(All clip art images are from Microsoft® Design Gallery http://dgl.microsoft.com/?cag=1)