Nutrition Final Exam

Describe control of appetite/hunger (briefly)

-Appetite: Strong desire for food or a pleasant sensation, based on previous experience, that causes one to seek food for taste and enjoyment -Hunger: Sensation that results from lack of food, characterized by a dull or acute pain around the lower part of the chest. A truly hungry person will most likely eat anything and take drastic action to acquire food. -The human body seeks homeostasis in terms of energy balance. Number of kilocalories eaten=number used to produce energy.

List potential causes of GI pain after a bolus tube feeding

-Bolus feedings are frequently poorly tolerated, and clients complain of abdominal discomfort, nausea, fullness, and cramping. Some clients however can tolerate bolus feedings after a period of adjustment in which the volume is slowly increased. Clients on bolus feedings should not recline for at least 2 hours after the feeding. Tubes should be irrigated before and after each feeding to prevent contamination and clogging of the tube.

Briefly describe appropriate interventions for patients with liver disease

-Keys to nutritional treatment of hepatitis and cirrhosis of the liver are abstinence from alcohol and optimum nutrition.

What is the effect of selected antidepressants on appetite?

-MAOIs prevent breakdown of dopamine and tyramine which are necessary for proper nervous system functioning. -Inhibit the body's normal response to hypotension -Pts display unusual combo of hypotension and bradycardia -When eating foods high in tyramine, pt exhibits hypertension

Categorize blood pressure hypertension levels

-Normal: (systolic) <120 and (diastolic) <80 -Elevated blood pressure: (systolic) 120-129 and (diastolic) <80 -Stage 1 hypertension: (systolic) 130-139 and (diastolic) 80-89 -Stage 2 hypertension: (systolic) >140 and (diastolic) >90

List particular nutrients important for wound healing

-Vitamin C, Vitamin A, Calcium, Zinc and Iron

Describe acceptable method(s) for checking proper placement of NG tube placement

-Xray or aspirate GI contents

List strategies to reduce leakage around the GI tube site.

-check the balloon for proper inflation -ensure proper skin disk placement to prevent leakage or buried bumper syndrome (BBS) -use of a proton pump inhibitor -tube securement device -silver nitrate to reduce granulation tissue -Salt-water solutions applied over 7-10 days can also reduce granulation tissue, but it deactivates silver nitrate sticks and should not be used concomitantly

Briefly describe nutrition needs of post-ileostomy patients (hints: fluid, bile salt loss, a particular B vitamin)

-ileostomy patients have decreased fat, bile acid, and vitamin B12 absorption. Drainage for ileostomy patients is 300-500 mL of fluid.

How many pounds of fat is generally produced when an excess of 3500 kcals has been consumed above energy needs

1 pound of body fat

How many hours prior to surgery can a patient have clear liquids?

2

What percentage of hospitalized patients may be malnourished?

50%

Taste _____ may be addressed by serving cold food, providing oral care before meals, using glass for cooking and plastic utensils for eating, adding sauces and marinades and serving alternatives to beef and pork.

Alterations

What nutrient may be depleted with long term use of metformin?

B12→ annual monitoring of B12 recommended

What is the most frequent method used to assess body weight?

BMI- Body Mass Index

Interpret BMI measures; waist circumferences.

BMI: weight (pounds) x 703/height (inches) -Below 18.5 - Underweight -18.5-24.9 - Healthy weight -25.0-29.9 - Overweight -30.0 > - Obese Waist Circumference Risk -Women: >35 -Men: >45

What mineral is poorly absorbed in the presence of many antibiotics?

Calcium, iron, magnesium, zinc to form insoluble compounds which lessen absorption.

___ occur in cancers of the lung, breast, prostate and colon and are more common in older people.

Carcinomas

List the maximum hang time of various tube feedings (e.g. decanted, closed and open systems)

Decanted: 4-8hrs Closed: up to 24-48 hrs Open: up to 24 hrs

List factors that may contribute to aspiration in critically ill patients

Decreased level of consciousness, sustained supine position, tube feedings

___ ___ detours liquids away from mouth ulcerations.

Drinking straws

Patients with head and neck cancer frequently require ___ nutrition.

Enteral

What foods are high in sodium and should be avoided in renal failure, cardiovascular disease and hypertension?

Food high in sodium: burgers, sandwiches, snacks and sweets, pizza, rice, pasta, and grain dishes.

___ of malignancy refers to the extent to which the cells under the microscope resemble normal cells.

Grade

Stage IV cancer involves distant ___.

Metastases

Foods high in ___ may help reduce diarrhea

Pectin

Why does Diprovan (Propofol) increase a patient's calorie intake?

Propofol is administered parenterally in a 10% fat emulsion, so it is important to consider the number of calories derived from fat in this medication and include them when assessing the total overall kilocalories the client received

List indicators that a patient is ready to return to oral feeding after a period of NPO

Return of gag reflex Present bowel sounds

____ ____ is common in areas where nitrates and nitrites are prevalent in food (processed meat, high sodium foods, pickled food) and water

Stomach Cancer

Potentiator for AKI

Streptococcus -Post-Streptococcal Glomerulonephritis (PSGN) is a rare complication from a prior group A strep infection. PSGN is a kidney disease that can develop after infections caused by bacteria called group A Streptococcus. These infections include throat and skin infections like strep throat, scarlet fever, and impetigo. PSGN is not a group A strep infection of the kidneys. Instead PSGN results from the body's immune system fighting off the group A strep throat or skin infection. It usually takes about 10 days after the start of symptoms of strep throat or scarlet fever for PSGN to develop. It takes about 3 weeks after the start of symptoms of group A strep skin infection for PSGN to develop.

What is the critical vitamin needed for acute care alcoholism?

Thiamin

Describe appropriate small bowel feeding

Tubing Size: 14 fr Continuous Feeding only No checking residual Standard or polymeric formula

What nutrient may be displaced by ACE inhibitor use?

Zinc- Causes Slow wound healing, loss of sense of smell and taste, lower immunity Sodium- Causes Dehydration, loss of appetite, muscle weakness, poor concentration. Note: Replacement not recommended (depletion due to therapeutic effect).

Cooking meat at high temperatures (grilling/charring) forms heterocyclic aromatic amines and polycyclic aromatic hydrocarbons and increase risk of ___ cancer.

colorectal

Cancer ___ rates are now averaging 69 percent

survivor

What nutrients are displaced with the use of Isoniazid?

Vitamin B6

The overall nutrition goals curing active cancer treatment include resolution of nutrient deficiencies, preservation of lean body mass, minimize nutrition-related side effects of care and achieve/maintain a ___ ___.

Healthy Weight

What are signs/symptoms of diabetes?

-The classic triad of signs and symptoms includes: Polyuria: increased urination Polydipsia: increased thirst Polyphagia: increased appetite -Other s/s include: blurred vision, fatigue, infection, vaginitis, bladder infections, poor wound healing, impotence in men, and kidney disorders

What is an acceptable blood glucose target for a critically ill patient?

-The current recommendation by the American College of Physicians is to maintain blood sugar levels between 140 and 180 mg/dL for clients in both the medical and surgical intensive care units.

List strategies to prevent formation of calcium oxalate kidney stones

-All clients with kidney stones should drink sufficient water, 6 to 8 cups of water per day are recommended. Calcium oxalate is the most common constituent of kidney stones. Some individuals are genetically susceptible to stone formation. A diet excluding foods high in oxalates is frequently prescribed for clients with kidney stones if laboratory analysis shows that removed or passed stone is high in oxalates. Additionally, reducing sodium to 2,300 mg and limiting animal protein in the diet are recommended because excess sodium and protein cause the kidneys to excrete calcium in the urine. Having enough calcium in the diet, 800 mg per day, helps prevent calcium oxalate stones.

Describe cancer cachexia and potential methods to treat (if possible)

-Cancer cachexia results from a complex cascade of physiologic and metabolic derangement which results in a state of malnutrition and wasting. -Treatment is complex and often not possible but may include: -Best choice - aggressive treatment of the cancer -Appropriately treat symptoms interfering with nutritional intake -Reassure client that poor appetite is caused by the cancer and not his or her lack of effort -Encourage available medications to improve the quality of life -In selected clients, supplement with omega-3 fatty acids or protein may be advised

List successful strategies of weight loss and characteristics of successful weight loss programs.

-Dietary therapy (medical nutrition therapy): Weight loss diet should include a reduction in total kilocalories averaging 500 to 750 kcalories per day decrease while maintaining a daily consumption of 1000-1500 kcalories per day. Diets must maintain adequate amounts of all nutrients. -Physical Activity: Initially adults should participate in moderate levels of exercise for 150 minutes, or 2 hours and 30 minutes, each week. A person attempting to lose weight should gradually increase the duration of their exercise with some adults having to participate in 300 minutes of exercise per week to achieve weight loss goals. -Behavior Therapy: Permanent weight loss can result from a permanent change in eating and exercise behaviors. (Self-monitoring, stimulus control, slower eating, reward yourself, cognitive strategies) -Pharmacotherapy: weight-loss medications may be used as part of a comprehensive weight-loss program, which includes diet and physical activity, for clients with a BMI equal to or greater than 30 and no concomitant obesity-related risk factors or diseases. For clients with a BMI equal to or greater than 27 and concomitant obesity-related factors or diseases, medications may also be indicated. -Surgery: Weight-loss surgery is an option for selected clients with clinically extreme or severe obesity (BMI >40 or >35 with comorbid conditions) when less-invasive methods of weight loss have failed and the client is at high risk for obesity-associated morbidity or mortality. -Combined therapy (some or all of the above)

List foods to avoid with GERD

-Dietary treatment for GERD involves: decreasing gastric pressure on the lower esophageal sphincter (small, frequent meals), normal amounts of dietary protein (associated with tightening the cardiac sphincter), and avoidance of foods and behaviors that relax the sphincter like fat and chocolate, peppermint and spearmint, and caffeine, alcohol, and tobacco.

List methods to reduce risk of aspiration in tube fed patients

-Elevating head of bed 30-45 degrees -Using continuous vs bolus feedings -Providing oral care -Use of a prokinetic agent

Identify high potassium foods (to be avoided in end stage renal disease but encouraged on the DASH diet)

-Fruits: apricots, bananas, dates, oranges, grapefruit, mangoes, melons, peaches, pineapples, prunes, raisins, strawberries, tangerines -Vegetables: tomatoes, potatoes, carrots, peas, squash, broccoli, turnip greens, collards, kale, spinach, artichokes, sweet potatoes, beans -Nuts, seeds, and legumes: almonds, filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils

Briefly describe common surgeries for weight loss and initial post op diet for bariatric surgery

-Gastric Band: band placed around upper portion of stomach to decrease stomach size -Electrical Stimulation System: Device placed in abdomen to block nerve activity between the stomach and the brain -Gastric Balloon: Balloon placed in stomach to take up space -Gastric Emptying System: Tube used to empty stomach contents after eating Diet changes: -Eat three to six small meals per day -Eat slowly -Chew food thoroughly -Eat very small quantities -Stop eating when full -Do not eat longer than 30 minutes at a time -Drink most fluids between meals -Select a balanced diet high in lean proteins -Take a chewable multivitamin-multimineral supplement -Exercise regularly

What is the glycemic index? Distinguish between foods that have a high and low glycemic index and potential impact on blood glucose.

-Glycemic index: a measure of how much the blood glucose level increases after consumption of a particular food that contains a given amount of carbohydrate -Generally, eating low GI foods and high GI foods at the same time has the effect of 'averaging' the GI. This is important, as most foods are eaten as part of a meal and this affects the GI value of foods.

List co-morbid conditions associated with obesity

-HTN -Dyslipidemia -T2 Diabetes -Coronary Heart Disease -Gallbladder/liver disease -Sleep apnea and other respiratory problems -Osteoarthritis

What are contributing factors to iatrogenic malnutrition?

-Inadequate tube feeding, patients remaining NPO for longer than 3 days, poor oral intake.

List potential causes of diarrhea in tube fed patients

-Infection -Medications -Fecal Impaction -Diabetes -Cold Formula

Briefly describe hormonal control of blood glucose

-Insulin is the only hormone that lowers blood glucose. -Glucagon increases blood glucose levels and stimulates the breakdown of body protein and fat stores. -Somatostatin acts locally within the Islets of Langerhans to depress the secretion of insulin and glucagon.

Characteristics and dietary/nutritional needs of patients with COPD

-It has been estimated that clients with COPD used 10 times the amount of calories to breathe than those without pulmonary disease. Research has shown that in individuals with COPD, the presence of lower body mass index (BMI; <20 kg/m2) increases 1 year mortality 4-fold higher when compared to overweight or obese (BMI; >25kg/m2) clients with COPD. Specific nutrients depleted in pulmonary disease include iron, vitamin A, vitamin C, vitamin D, vitamin E, and selenium. An adequate intake of vitamins A and C are essential for helping to prevent pulmonary infections and decrease the extent of lung tissue damage. Low bone density is problematic in many clients with COPD. Among the reasons for this are glucocorticosteroid therapy, reduced physical activity, a history of tobacco use, an inadequate calcium and vitamin D intake, and the pulmonary disease process itself. The COPD client needs to be conscientious regarding fat intake. Fat metabolism generates less CO2 than metabolism of carbohydrates which is a benefit to the client. When choosing fats, the client needs to be advised to consume monounsaturated and polyunsaturated fats while avoiding trans fatty acids and saturated fats. Excess fat intake can lead to weight gain and increased adipose tissue around the midsection, which can increase respiratory effort in the COPD client. Clients with COPD often need fluid restriction. Low serum phosphorus levels or hypophosphatemia are often seen in clients who are respirator dependent.

What is the impact of exercise on blood glucose in people with diabetes who require insulin?

-Monitor blood glucose levels before, during, and after exercising. It is best to exercise 60 to 90 minutes after meals. -If the blood glucose level is >100 before exercise, no additional food is usually needed. -Snacks with an additional 15 to 30 grams of carbs should be ingested for every 30 to 60 minutes of exercise. -Type 1: Exercise can cause changes in insulin requirements in sometimes unpredictable ways or more than 24 hours after the exercise. -Type 2: Physical activity reduces the insulin requirements in persons who use insulin.

Identify cancer promoters

-Obesity - increases risk of cancer of the colon, kidney, pancreas, endometrium, gallbladder, and esophagus -Red and processed meats - increased risk of cancer of the colon, rectum, and prostate -Alcohol - increased risk of cancer of the upper gastrointestinal, liver, and breasts -Salt-preserved foods - increased risk of gastric cancer

What is the first sign of chronic kidney disease?

-Often, the first sign of CKD is sodium depletion. This occurs when the kidneys lose their ability to reabsorb sodium in the tubule. Symptoms associated with sodium depletion include: a reduction of renal blood flow, dehydration, lethargy, decreased GFR, uremia, and deterioration in neurological symptoms, including headaches, disorientation, and, in severe cases, seizures and coma.

What determines the amount of a bolus injection of insulin relative to meal times?

-One carbohydrate exchange (15g carbohydrate)= 1 unit of insulin Basal insulin = long acting given once per day Mealtime bolus insulin = fast acting and helps prevent post-prandial rises in blood glucose and is given before a meal and is withheld if the client is NPO

What are metabolic characteristics of critically ill patients?

-The body responds to life threatening injuries and illnesses with a hypermetabolic response. An abnormal increase in the rate at which fuel or kilocalories are burned is called hypermetabolism. Characteristics of this condition are: increased metabolic rate, negative nitrogen balance, hyperglycemia, and increased oxygen consumption. The metabolic response of the immune system to infection or injury is called the inflammatory response. The signs and symptoms of inflammation include swelling, redness, heat, and pain. C-reactive protein (CRP) is released by the liver during the acute phase of the inflammatory response and alters metabolism, heart rate, blood pressure, body temperature, and immune cell function.

What is the long term consequence of steroids on bone health? Weight? Perhaps blood glucose?

-Oral corticosteroids (OCSs) can reduce bone mineral density (BMD) and produce osteoporosis in adults. -Oral corticosteroids can cause weight gain, and the higher your dose, the more likely you'll experience this side effect. In fact, weight gain is the most common side effect when taking these medications long term -Steroids can make the body more insulin-resistant over time. This means that cells don't respond to the hormone insulin the way they should, or the body isn't making enough insulin. As a result, insulin resistance can occur, as the liver is releasing too much sugar, making the pancreas release more insulin to compensate. Over time, this can cause the pancreas to stop producing insulin, resulting in high blood sugar.If steroids aren't taken for a long time, then blood sugars can return to normal once the steroids are discontinued. However, for people taking steroids long-term, the risk of insulin resistance increases. For those with diabetes, blood sugars often noticeably increase after steroids are administered. Those without diabetes may be unaware that their blood sugars are elevated since they don't typically check their blood sugar levels.

Describe advantages of providing nutrition support in advance to patients who need GI surgery

-Perioperative nutrition therapy of >10 kcal/kg/day for 7 days before surgery is associated with a 50% reduction in nosocomial infections and total complications in patients undergoing major elective GI surgery -Protein depletion is associated with increased risks of infection, shock, and wound dehiscence

What labs must be monitored in diabetic ketoacidosis?

-Potassium (most important), sodium, chloride, ketones in the urine

List nutrients that must be carefully monitored/provided/restricted in patients on hemodialysis

-Protein = 1.2 grams/kg/day (50% HBV) -Sodium = <1,500mg/day -Potassium = 2,000-3,000mg/day (8-17mg/kg/day) -Calcium = <2,000mg/day from diet and medications -Phosphorus = 800-1000mg/day adjusted for protein. -Fluid = 1000ml/day + Urine output -Calories = <60 years: 35 kcal/kg/day; >60 years: 30-35 kcal/kg/day -Fat = 30-35%; clients considered at highest risk for cardiovascular disease emphasis on <10% saturated fat, PUFA, MUFA, 250-300mg cholesterol/day

Outline sick day management in diabetes

-Secretion of both glucagon and epinephrine increases during illness and contributes to an increase in blood glucose levels. -During illness the individual should be instructed to monitor his or her blood glucose level every 2 to 4 hours. -Increase fluids to decrease the risk of dehydration. -15 grams of carbohydrates should be consumed every 1 to 2 hours.

What nutrients should be monitored with Lithium?

-Sodium and fluid -Decreased sodium intake with decreased fluid intake may lead to lithium retention manifested by slurred speech, decreased coordination, drowsiness, and muscle weakness or twitching -Increased sodium intake and increased fluid intake increase the excretion of lithium, thus worsening signs and symptoms of mania

What is St. John's Wort used for and what are potential interactions?

-St. John's Wort has been favorably compared to pharmaceutical antidepressants. -The major interaction of most drugs with St. John's Wort's is decreasing the efficacy of the drug, which can result in dangerous effects. The medications include: -Oral contraceptives -Warfarin -Digoxin -Indinavir

Identify stages of renal failure based on eGFR

-Stage 1 (Some kidney damage with normal or elevated GFR) = >90 -Stage 2 (Kidney damage with mildly decreased GFR) = 60-89 -Stage 3 (Mild to severe loss of kidney function with decreased GFR) = 30-59 -Stage 4 (Severe loss of kidney function with decreased GFR) = 15-29 -Stage 5 (Kidney Failure) = <15

What steps can restore a healthy microbiome in the gut after extensive use of antibiotics?

-Take probiotics to restore gut flora (A diet rich in probiotics (like what you find in kefir, sauerkraut, kombucha and kimchi) can help good microbes colonize in your gut and keep the unfriendly ones at bay.) -Take prebiotics to feed beneficial bacteria (You can get prebiotics from chicory root, artichokes, leeks, whole grains and foods that are high in resistant starch—a type of starch that resists digestion. It ferments in your digestive tract and feeds the beneficial bacteria in your gut) -Cut back on sugar (A diet high in refined sugar, artificial sweeteners and even natural sugars (including fruit!) can all throw your gut flora out of balance, so you want to limit your sugar intake—especially around antibiotics. Without bacteria to keep them at bay, fungi have the opportunity to get busy during a course of antibiotics. You can attribute a lot of the problems that you experience after antibiotics—like diarrhea and infections down south—to fungal overgrowth, particularly yeast. -One problematic strain of fungus is candida albicans, which is especially prone to going haywire after antibiotics.) -Sip bone broth or take collagen peptides (Make sure you're eating foods that support strong connective tissue, like bone broth and collagen-rich foods. Collagen is the protein that holds your membranes together, and taking collagen peptides will give your cells all of the amino acids they need when it's time to make your intestinal walls stronger and more resilient) -Eat a lot of veggies (The gut microbes that help you digest and absorb your food love vegetables. Makes sense, because they eat the portion of the veggies that humans do not break down, and convert those portions into nutrients that you wouldn't otherwise get.)

Identify lab values for target blood glucose, pre-prandial blood glucose, post-prandial blood glucose (2 hours after a meal); fast glucose and HgbA1C.

-Target blood glucose: <140 mg/dL -Pre-prandial blood glucose: 80-130 mg/dL -Post-prandial blood glucose: <180 mg/dL -Fasting blood glucose: <100 mg/dL -Diabetes: >126 mg/dL -HbA1C: 4-5.6% -Prediabetes: 5.7-6.4% -Diabetes: >6.4%

What foods are allowed/encouraged and not allowed on the DASH diet? What is the maximum sodium level allowed?

-The AHA recommends a diet to help control blood pressure. -Rich in: fruits, vegetables, whole-grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, nontropical vegetable oils -Limited in: saturated and trans fats, sodium, red meat, sweets and sugar-sweetened beverages -2,300 mg

List strategies to slow the progression of CKD (particularly dietary strategies)

-The National Kidney Disease Education Program recommends diet therapy to slow the progression of CKD by: controlling blood pressure, reducing excessive protein intake, and managing diabetes. Aggressive antihypertensive treatment includes reducing sodium intake to no more than 1,500 mg per day and the use of ACE inhibitors or angiotensin receptor blockers (ARB) to slow the rate of progression of nephropathy.

What is the FODMOP diet and what is the indication for its use?

-The low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, accepted as an effective strategy for managing symptoms of irritable bowel syndrome (IBS) in Australia. The targets of restriction are short chain carbohydrates that have been shown to induce IBS symptoms of abdominal pain, bloating, flatus, and diarrhea due to their poor absorption, osmotic activity, and rapid fermentation.

When are potassium restrictions added to patients with kidney failure (or what blood potassium level typically warrants a dietary potassium restriction)?

-The recommended intake of potassium is 2-3 grams per day for most clients. If a client's potassium level is elevated (5-6.5mEq/L), dietary potassium intake should be minimized to less than 2.4 grams per day. When urinary output is 100-500mL and serum potassium is 5.5-6.5, a 40 to 60mEq (about 1,563-2,345 mg K) intake is suggested. In cases of anuria or when serum potassium exceeds 6.5mEq/L, a dietary intake of 20-25mEq/L (about 780 to 975 mg K) is suggested. This suggestion is for the acute, critical care client because of its poor palatability.

List characteristics of nephrotic syndrome

-The result of a variety of diseases that damage the glomeruli capillary walls is called nephrotic syndrome. Signs of nephrotic syndrome include: proteinuria, severe edema, low serum protein levels, anemia, and hyperlipidemia. Usually the higher the hyperlipidemia, the greater the proteinuria. The disease is caused by the degenerative changes in the kidneys' capillary walls, which consequently permit the passage of albumin into the glomerular filtrate. Water and sodium are retained. Edema is sometimes so severe that it masks tissue wasting due to the breakdown of tissue protein stores. The degree of malnutrition is hidden until the excess fluid is removed.

What is the danger of the supplement Chapparal?

-There are several reports of serious poisoning, acute hepatitis, and kidney and liver damage associated with this supplement.

Interpret a lipid profile

-Total cholesterol: <200 mg/dL -Low-density lipoprotein (LDL): <100 mg/dL -High-density lipoprotein (HDL): >60 mg/dL -Triglycerides: <150 mg/dL

What type of diet should patients with recurring gastroparesis follow?

-Treatment of delayed gastric emptying focuses on: eating small, frequent meals; eating slowly, chewing food thoroughly, sitting upright after meals; reducing the fat ingested (which remains in the stomach longer than carbohydrates or protein); decreasing fiber intake; drinking plenty of water (1-1.5L/day), avoiding carbonated beverages and alcohol; avoiding smoking and tobacco smoke; gentle exercise (walking) after meals. If adequate nutrition cannot be provided orally, jejunal feeding may be necessary. In severe cases of gastroparesis, medications may be prescribed and stimulatory techniques may be implemented.

List potential risks for clogged feeding tubes and how to resolve a clogged tube

-Tubes may be cleared by using warm water flushes, adding pancreatic enzymes and/or bicarbonate -Risks: Fiber supplements, thick formulas, and frequent checking of gastric residual volume.

Compare/contrast type 1 and 2 Diabetes

-Type 1: insulin dependent; Clients with this disorder cannot survive without daily doses of insulin -Type 2: non-insulin-dependent; Most of these clients are obese, and weight reduction usually improves their ability to process glucose

Identify common eating disorders including S/S of each

Anorexia Nervosa: -Avoids eating, weighs frequently, rigid food rituals, denies hunger -Depression, low self-esteem, controlling, low sex-drive, insomina -Loss of bone mass, low body temp, dry skin, constipation, fatigue, cold Bulimia Nervosa: -Binge eating 2x/week for 3 months, vomiting, fasting, misuse of meds -Body weight influences self-esteem, withdrawn -Food disappears in large amounts, frequent bathroom visits, swollen cheeks/jaws, tooth decay, calluses on hands Avoidant/Restrictive Food Intake Disorder: -Eating or feeding disturbance manifested by failure to meet nutritional/energy needs Examples: Infant wont transition from liquid → solid food Child with food allergies fears anaphylactic reaction Stroke pt afraid of choking

Distinguish between dietary fat and food sources that are cardioprotective and those that contribute to cardiovascular disease

Cardio Productive Food Sources: Fruits, vegetables, whole-grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, nontropical vegetable oils Cardio Destructive Food Sources: Saturated and trans fats, sodium, red meat, sweets and sugar-sweetened beverages Types of Dietary Fats: Saturated fats- animal fats, butter, lard, coconut oil, palm oils, cocoa butter Trans fats- hydrogenated vegetable oils Omega 3 Fatty Acids- fish, shellfish, flaxseed, soybean, walnut, rapeseed (canola) oils Omega 6 Fatty Acids- Corn oil, safflower oil, sunflower oil Omega 9 Fatty Acids- Olive oil, Avocados, peanuts, almonds

Characteristics of the clear liquid diet and indications

Clear liquids: foods that are see-thru @ room temp (broth, jello, popsicles, water, juice, etc.) Indicated for those who are not allowed to have food (before procedures, surgeries, etc)

Leading cause of heart disease and renal failure in the United States

Diabetes

___ is delayed when high fat foods are consumed which may contribute to nausea and vomiting.

Gastric Emptying

What food is often contraindicated with cardiac medications- particularly calcium channel blockers?

Grapefruit juice→ causes headaches and dizziness RECOMMENDED TO TAKE WITH MEAL OR GLASS OF MILK

List indications/contraindications for TPN use.

Indications: -In a previously healthy individual admitted to an ICU after 7 days of hospitalization when enteral nutrition is not feasible -If there is high nutrition risk and severe malnutrition and if it is not possible to feed enterally, PN should begin as soon as possible, beginning at 80% of estimated energy needs but with adequate protein more than 1.2 grams of protein/kilogram/day. After stabilization, 100% of energy requirements should be provided -If an individual has major GI surgery and it is anticipated that it will not be possible to feed enterally >7 days post surgically, PN should be initiated 5-7 days after the surgery -If an individual is unable to meet >60% energy requirements after 7 to 10 days by enteral route alone Inadequate GI function Contraindications: -Hold PN in the low nutrition risk patient, suggest PN be withheld for 7 days following ICU admission for the patient who cannot maintain volitional intake or receive EN

What dietary strategy is encouraged with administration of Levodopa?

Low protein diet

___ is present in 15%-40% at diagnosis and up to 80% in advanced stages of the disease.

Malnutrition

What is the average number of carbohydrate food portions that should be offered to adult men or women with diabetes at meals and snack times?

Men: -60-75 grams of carbohydrates per meal -4-5 Carb servings each meal and 2 per snack (3 meals and 1 snack) Women: -45-60 grams of carbohydrates per meal -3-4 carb servings per meal and 1-2 per snack

Describe the 5 categories of tube feeding formulas

Modular Supplements: -Limited # of nutrients -Adds a specific nutrient to a patient's diet -Liquid or powder Standard (Polymeric): -Complete formula used when GI tract is functional -Client needs all the essential nutrients in a specified volume -Use only after assessment of client's nutritional needs Elemental: -Easier to absorb -Use with clients with limited GI function or metabolic disorders -Oral or tube Semi Elemental: -Easier to absorb -Use with clients with limited GI function or metabolic disorders -Oral or tube Disease-Specific: -Used for clients with specific metabolic problems (diabetes, kidney, liver disorders) Be able to indicate which category should be selected for various conditions

What is the average kcal requirement for a patient requiring nutrition support?

Non-Critical: 25-35 kcal/kg Critical: 20-30 kcal/kg

List foods that are NOT ALLOWED for patients on hemodialysis

Nuts, peanut butter, seeds, lentils, beans, organ meats, sardines Cola drinks, bran breads or bran cereals HIGH PROTEIN DIET NEEDED TO REPLACE LOST PROTEIN

Given a sample meal and ICR, estimate the amount of insulin needed to bolus to maintain normal glucose level in the post-prandial state

One Carbohydrate exchange (15g carb)= 1 unit of insulin

When should phosphate binders be given to patients who need them?

Phosphate binders may be added to a CKD client's regimen if dietary modification does not produce desired results. This is especially true for clients in stage 3 through 5 of CKD.

The American Cancer Society recommendations for cancer prevention include consuming a ____ diet.

Plant-based

In the US, more than 20% of cancer deaths are attributed to body fatness, physical inactivity, excess alcohol consumption, and ___.

Poor Nutrition

Describe stages of cancer and dietary/health behaviors that contribute to each (and dietary / health behaviors that may prevent cancer)

Stages: -Acute Stage: diagnosis through recovery -Extended: cancer-free, maintaining remission, or living with cancer; feelings of anxiety or fear often remain -Permanent: Longer-term survival client may have long-term effects from diagnosis or treatment Good nutrition can have a role across each stage. Malnutrition is present in 15%-40% of clients at diagnosis with an increased percentage to 80% in advanced stages of the disease. For any given type of tumor, survival is shorter in clients with significant pretreatment weight loss (more than 10% of usual body weight) Dietary behaviors to decrease cancer risk: -The WHO recommends a diet low in fat, sodium, and sugar and consuming greater than 400 grams, or at least 5 servings, of fruits and vegetables per day to reduce the risk of noncommunicable diseases like cancer. Health Behaviors to decrease cancer risk: -Maintain a healthy weight throughout life. -Adopt a physically active lifestyle. -Consume a healthy diet , emphasizing plant food sources.

Describe interventions for cancer related stomatitis, diarrhea, weight loss, nausea/vomiting.

Stomatitis interventions For mouth ulceration: -Serve soft, mild food. -Serve cream soups and milk. -Serve cold foods. -Introduce drinking straws. -Avoid irritants such as hot items, salty or spicy foods, acidic juices, and alcohol For dry mouth: -Include adequate hydration. -Present foods with lubricants like gravy. -Offer sugarless, hard candy, gum, or popsicles. For swallowing difficulty: -Advise the client to make a conscious act to swallow. -Tilting the head backward or forward may help. -Serve foods that are not sticky and of even consistency. -Refer to a speech therapist as necessary. Diarrhea interventions: -Add pectin containing foods to the client's intake. -Implement a low-fiber diet. -Test for and treat lactose intolerance. -Consult with a dietician about special feedings. Nausea and vomiting interventions: -Offer the client dry crackers before rising. -Schedule meals at the time of the day when nausea is least. -Serve liquids 30 to 60 minutes after solid foods. -Limit fats in the diet to promote gastric emptying. -Teach the client to eat slowly and chew thoroughly. -Suggest the client rest after eating. -Recommend that the client save favorite foods for times of feeling well. -Instrict the client to take antiemetics and analgesics as prescribed. -Advise the client or caregiver to minimize strong cooking odors.

How are dietary supplements monitored/regulated in the US?

The Dietary Supplement Health Education Act created the first regulatory structure for supplements. The FDA provides primary oversight of dietary supplements along with drugs and most foods. Under the provisions of the DSHEA, dietary supplements can be sold unless shown by the FDA to be unsafe, adulterated, or labeled in a misleading manner. Under the DSHEA, a dietary supplement is defined as a product taken by mouth that: - Contains a dietary ingredient: vitamin, mineral, herb, botanical, amino acid, enzyme, tissue; or a concentrate, metabolite, or constituent extract from the ingredients previously mentioned - Is in the form of a supplement (tablet, capsule, soft gel, gelcap, liquid, powder) - Is not represented as a food or sole item of a meal or of the human diet - Regulations spell out the nature of the claims that can be made for a product on the label and its format. The following statements are allowed: -Health claims that have substantial scientific support or, if limited support, the claim must contain qualifying statements. -Nutrient content claims that describe the level of the nutrient or dietary ingredient in a product with an established daily value -Structure/function claims that describe the product's effect on structure or function of the body or on general well-being. These claims must also include the following information displayed prominently on the label ("This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease") - Manufacturers of dietary supplements that make structure/function claims on labels or in labeling must submit a notification to the FDA that includes the text of the structure/function claim no later than 30 days after marketing the dietary supplement.

What nutrients are encouraged on the DASH diet?

The daily nutrient goals of the DASH diet: No more than 27% fat (with no more than 6% saturated fat, and 150 mg cholesterol), 18% protein, 55% carbohydrate, no more than 2300 mg sodium, 4700 mg potassium, 1250 mg calcium, 500 mg magnesium, and 30 g fiber. -Food Groups Encouraged: Grains and grain products, vegetables, fruits, low-fat or nonfat dairy foods, meats, poultry, fish, nuts, seeds, legumes, fats and oils