rd exam study DOMAIN II
What is a Laissez Faire Leadership style? and what type of group does it work best with?
"Let it "be; a hands-off approach; the group decides. (only works with highly skilled individuals)
Sophistication levels: Very experiences
"Nutrition experts" Limit audience participation at fist Establish yourself as the expert by citing your credentials Lecture format with audiovisuals
What is the selling price for a hamburger in your cafeteria if you operate with a 45% food cost and the cost of a beef patty and bun are $0.7920?
$1.76
What is the cost per meal if beginning inventory is $8439.52, ending inventory is $7850.76, purchases are $20,401, and 5963 meals were served?
$3.52
Estimated ideal body weight for amputees
(100- % amputation)/ 100 x IBW for original height
HALS
(HIV-associated lipodystrophy syndrome) may develop from therapy: change in body fat distribution, high cholesterol, high TG, insulin resistance Significant loss of LBM can be obscured by edema and HALS
Nutrition Services Inceptive Program
(Older Americans Act) USDA Develop services to foster independent living Cash and commodities to state agencies
What is the formula for %UBW change?
(UBW - ABW) x 100/ UBW
What is the MNT for Addison's Disease?
**Adrenal cortex insufficiency** MNT: High protein, moderate CHO, restrict refined CHO, high NA, unless drugs used to retain Na, monitor high K foods**diet therapy is second, drugs first**
Triboelectric effect
- a type of contact electrification in which certain materials become electrically charged after they come into contact with another different material and are then separated (such as through rubbing). The polarity and strength of the charges produced differ according to the materials, surface roughness, temperature, strain, and other properties. -common examples of combinations that produces significant charges are glass with silk and rubber with fur
Joule
-(J): the SI unit of measure for work and energy, the amount of work equal to the force of one newton (1N) moving an object a distance of 1meter (1m)
How do esophageal varice occur?
--Blood cannot enter the liver-- Connective tissue causes resistance to blood entering the portal vein Increased pressure forces blood back into collateral veins that offer less resistance. (Esophageal, ab, collateral veins enlarge). Due to portal hypertension Causes an outpouch of the wall= Varices
How do ascites occur?
--Blood cannot leave the liver-- Connective tissue block blood flow into vena cava. Liver expands to store up to a L of extra blood Pressure caused by more blood forces fluid to go into the peritoneal cavity High osmolar load pulls more fluid in to dilute, leading to Na and H20 retention= Ascites
absorption spectrum
-An absorption spectrum in the visible region usually appears as a rainbow of color stretching from red to violet interrupted by a few black lines corresponding to distinct wavelengths of absorption
Electroscope
-An electroscope is a device used to detect the presence of charge and it's relative amount. The electroscope is usually constructed with a metal plate or sphere at the top of a metal post with thin foil leaves hanging from the bottom of the post. This setup is typically supported in a flask or some other transparent enclosure. If a charged object is brought near the top of the electroscope, the leaves at the bottom spread apart. The greater the charge, the farther apart they move
How magnets are produced
-An unmagnetized material can become magnetized by insertion into the coils of a temporary magnet known as an electromagnet. -Another way to produce magnetism is to stroke an unmagnetized material with another material which is already magnetized.
Faraday's law of induction
-Any change in the magnetic environment of a coil of wire will cause a voltage (emf) to be "induced" in the coil. No matter how the change is produced, the voltage will be generated. The change could be produced by changing the magnetic field strength, moving a magnet toward or away from the coil, moving the coil into or out of the magnetic field, rotating the coil relative to the magnet, etc. -it serves as a succinct summary of the ways a voltage (or emf) may be generated by a changing magnetic environment. The induced emf in a coil is equal to the negative of the rate of change of magnetic flux times the number of turns in the coil. It involves the interaction of charge with magnetic field.
Transistors
-CONTROL CURRENT FLOW, they serve a variety of functions in circuits and can act as amplifiers, switches, voltage regulators, signal modulators, or oscillators -tiny devices that amplifies, controls, and generates, electrical signals, were invented. They could do much of the work of a much larger vaccum tube.
Electric motors
-Converts electrical energy into mechanical energy to do work, most commonly rotational energy -the components of the simplest motors must include a strong magnet and a current-carrying coil placed in the magnetic field is such a way that force on it causes it to rotate -operation of a motor is based on the principle that a magnetic field exerts a force on a current carrying conductor -can run using DC or AC current
Diamagnetism
-Diamagnetic materials include bismuth, antimony, copper, zinc, mercury, gold, and silver. They can become weakly magnetized, buth their magnetic field is in the opposite direction from the magnetizing field.
Surface reflect light
-Different surfaces reflect light differently -Rough surfaces scatter light in many different directions -Smooth surface reflects the light in one direction -Smooth and shiny, like mirror, reflect allow you to see your image in the surface
Domain Theory
-Electrons orbit the nucleus of an atom. They also spin, revolving around an axis, as they orbit. -The polarity of magnetic field is determined by the direction of electron spin. An atom is magnetized when it has more electrons spinning in one direction than in the other. -Atoms do not act independently but are bound in groups called domains. -When materials are heated they lose there magnetic characteristics. The Curie point is the temperature that a material becomes nonmagnetic.
Induction
-Eletromagnetic induction is the production of voltage that occurs when a conductors interacts with a magnetic field -a conductors can be charged either by moving it through a static electric field or by placing it in a changing magnetic field. -Induction was discovered by Michael Faraday and FARADAY'S LAW govern this phenomenon
Destructive Interference
-If a trough and a crest of the same shape meet, the two pulses will cancel each other out, and the medium will assume the equilibrium position -Destructive interference in sound waves will REDUCE the loudness of the sound
Sonar
-In echo-sounding or echolocation, a system called sonar transmits sound waves to detect and locate objects underwater or measure the distance to the floor of a body of water. -The sound wave pulses are reflected off the object or floor, picked up and timed. Since their speed is known, the distance can be calculated. From the pulses, a picture can be built.
Diffracted
-Light can be diffracted or bend around the edges of an object -Diffraction occurs when light goes through a narrow slit, as light passes thought it, the light bends slightly around the edges of the slit
Magnetic field
-Magnetic field lines always point from the north pole of a magnet to the south pole -expressed in unit called TESLA (T) or GAUSS (G) (1T=10,000 G) -The distance between magnetic fields lines indicates the strength of the magnetic field such that the lines are closer together near the poles of the magnets where the magnetic filed is the strongest. -only the velocity of the charge in a direction PERPENDICULAR to the magnetic field will affect the force exerted, therefore, a charge moving parallel to the magnetic field will have no force acting upon it
Magnetic dipoles
-Magnetic poles always occur in pairs known as Magnetic dipoles -One cannot isolate a single magnetic pole, if a magnet is broken in half, opposite poles appear at both sides of the break point so that one now has two magnets each with a south pole and a north pole.
Semiconductors
-Material with intermediate conduction properties -their properties are similar to insulators in that they have few free electrons to carry the charge but these electrons can be thermally excited into higher energy states that allow them sufficient freedom to transmit electrical charge -the electrical properties of a semiconductor are often improved by introducing impurities, a procedure known as DOPING -two important semiconductor devices are : DIODES and TRANSISTORS
Insulators
-Materials that do NOT ALLOW conduction -good insulators include glass, rubber, and wood, these materials have chemical structures in which the electrons are closely localized to the individual atoms -a charge transferred to an insulator will remain localized at the point where it was introduced because the movement of electrons will be highly impeded
Rotational motion
-Motion when an object moves aroud its centre of mass -One revolution is 360 degree -360 degree= 2pi radian -1 radian=57.3 degree
Paramagnetism
-Paramagnetic materials include aluminum, platinum, manganese, and chromium. They have mild attraction to a magnetic field.
Seismic waves
-Patterns of seismic waves picked up by seismometers can be used to locate distant earthquakes and major explosions and to research the internal structure of the earth -Ex: the "shadows" of S-waves prove that the core of the earth is molten
Explain what happens in the dumping syndrome
-Rapidly hydrolyzed CHO enters the jejunum -Water is drawn in to achieve osmotic balance, causing a decrease in vascular fluid dept and peripheral vascular resistance -BP drops and signs of cardiac insufficiency appear -2 hrs later, CHO is digested and absorbed rapidly. -Blood sugar increases stimulating an over production of insulin, causing a drop in blood sugar below fasting. This is reactive or alimentary hypoglycemia
Heat Capacity
-The ability of a substance to resist a change in temperature -Ex: Water has an extremely high heat capacity and is very resistant to a change in temperature. It takes a great deal of energy transfer to heat up water, buy conversely, it also takes a great amount of energy loss to cool it down
Specific Heat
-The amount of heat required to raise or lower the temperature of 1 gram of a substance by 1 degree Celsius
Spectral lines
-The bands of emitted or absorbed light at these wavelengths are called this -Each elements has a unique line spectrum
refraction
-The bending of a wave as it passes at an angle from one medium to another
Intensity
-The intensity of a sound is the amount of energy that crosses a unit of area in a given unit of time -the intensity level of sound is measured in DECIBELS -normal conversation is about 60 decibels, a power saw is about 110 decibels
Kepler's First Law
-The law describes the shape of planetary orbits. Specifically, the orbit of the planet is an ellipse that has the sun at one of the foci. -the point at which the planet is closest to the Sun is known as PERIHELION -the point as which the planet is farthest from the sun is known as the APHELION
Second Law of Thermodynamics
-The principle whereby every energy transfer or transformation increases the entropy of the universe. Ordered forms of energy are at least partly converted to heat, and in spontaneous reactions, the free energy of the system also decreases. -SPONTANEOUS AND IRREVERSIBLE -no machine is 100% efficient -heat cannot spontaneously pass from a colder to a hotter object
Kepler's Second Law
-The second law pertains to the relative speed of the planet as it orbits -This law says that a line joining the planet and the Sun sweeps out equal areas in equal intervals of time. -This means that the speed of the planet is inversely proportional to its distance from the sun. I.E: the planet moves fastest when it is closest to the sun due to the Sun's gravity
Wave speed
-The speed of any wave depends upon the elastic and inertial properties of the medium through which it travels -The density of a medium is an example of an INERTIAL PROPERTY -Sounds travels faster in denser material, ex: travel 3x as fast through helium than air -speed of light travel slower in denser material, the speed of light is slower in glass than in air
Magnetic flux
-The strength of a magnetic field over a given area -A measurement of the total magnetic field going through a loop -A term used to describe the number of magnetic field lines that pass through an area -When the magnetic flux through a coil is changed, a voltage is produced which is known as INDUCED ELECTROMAGNETIC FORCE
Ohm's Law
-V=IR -most important tool to analyze electrical circuits -states that the current passing through a conductors is directly proportional to the voltage drop and inversely proportional to the resistance of the conductors.
Current-carrying loop
-When a current-carrying loop is placed in a magnetic field, the net force on it is ZERO since the forces on the different parts of the loop act in different directions and cancel each other out -There is however a a NET TORQUE on the loop that tends to rotate it so that the area of the loop is perpendicular to the magnetic field.
Lenz's law
-When an emf is generated by a change in magnetic flux according to Faraday's Law, the polarity of the induced emf is such that it produces a current whose magnetic field opposes the change which produces it. The induced magnetic field inside any loop of wire always acts to keep the magnetic flux in the loop constant. In the examples below, if the B field is increasing, the induced field acts in opposition to it. If it is decreasing, the induced field acts in the direction of the applied field to try to keep it constant. -states that induced emf in a coil acts to oppose any change in magnetic flux
Pascal's principle
-When force is applied to a confined fluid, the change in pressure, is transmitted equally to all parts of the fluid -used in HYDRAULIC LIFT
Transformer
-a device that increases or decreases the voltage of alternating current -a device that magnetically couples two circuits together to allow the transfer of energy between the two circuits without requiring motion -consists of a couple of coils and a magnetic core -A changing voltage applied to one coil, the primary, creates a flux in the magnetic core, which induces voltage in the other coil, the secondary.
Galvanometer
-a device that measures current and is a component of ammeter or a voltmeter -consist of a coil of wire, an indicator and a scale that is designed to be proportional to the current in the galvanometer - instrument that uses an electromagnet to measure electric current -Galvanometers are very sensitive meters which are used to measure tiny currents, usually 1mA or less -in order to create a VOLTMETER using a galvanometer, RESISTORS ARE ADDED IN SERIES to it -to build an AMMETER, a small resistance known as a SHUNT RESISTOR IS PLACED IN PARALLEL with it
Resistivity
-a material's opposition to the flow of electric current -Intrinsic property of a conductor denoted by ρ=R(A/L) -resistivity is a function of temperature, resistivity increases with increasing temperature and decreases with decreasing temperature -At extremely low temperatures resistivity assumes a low and constant value known as residual resistivity
Bohr Model
-a model of the atom developed by niels bohr that shows electrons moving in orbits around the nucleus of the atom -electron would only make instantaneous "quantum leaps" -When electron move from high energy orbital to a lower energy orbital, a quantum of electromagnetic radiation is emitted -an electron to move from a low energy to a higher energy level, a quantum of radiation must be absorbed -particle that carries this electromagnetic force is called a PHOTON. The quantum structure of the atom predicts that only photons corresponding to certain wavelengths of light will be emitted or absorbed by atoms. These distinct wavelengths are measured by ATOMIC SPECTROSCOPY.
Momentum
-a property of a moving object that depends on the object's mass and velocity -tendency of an object to continue to move in its direction of travel, unless acted on by a net external force -Momentum is "conserved"
electromagnet
-a temporary magnet made by coiling wire around an iron core -EX. when current flows in the coil the iron becomes a magnet -the strength of the electromagnet can be increased by adding to the number of turns or loops of current carrying wire -also by varying the current,the strength of the electromagnet can be increased or decreased -another critical factor that affects the electromagnet is the material used inside the coil, specifically the magnetic properties of the material
Cyclotron
-a type of particle accelerator, also uses a perpendicular magnetic field to keep particles on a circular path -After each half circle, the particles are accelerated by an electric field and the path radius is increased. Thus the mean of particles moves faster and faster in a growing spiral within the confines of the cyclotron until they exit at a high speed near the outer edge. -Its compactness is one of the advantages a cyclotron has over linear accelerators.
Energy
-ability to do work (to cause change)
x-ray
-aid in medical field -produced by accelerating electrons in order to collide with a metal target
Kepler's Third Law
-aka HARMONIC LAW -relates the size of the planet's orbital to the time needed to complete it -it states that the square of the planet's period is proportional to the cube of its mean distances from the Sun : P^2=a^3, where P=planet's orbital period, the length of time needed to complete one orbit. a=semi-major axis of orbit
Ampere's Law
-along any closed path through a magnetic field, the sum of the products of the scalar component of B, parallel to the path segment with the length segment, is directly proportional to the net electric current passing through the area enclose by the path
Ammeter
-an ammeter placed in series in a circuit measures the current through the circuit in amperes (A) -typically has a very small resistance so that the current in the circuit is not changed too much by insertion of the ammeter -Ammeters are CONNECTED IN SERIES
quantum theory
-an atom in an excited state has a certain probability in a given time frame for relaxing to a lower state through, for example, the emission of a photon of the same energy as the energy difference between the two states
Alternating Current
-an electric current that reverses direction sinusoidally -"In the US most household current is AC at 60 cycles per second"
Weber's theory of molecular magnetism
-assumes that all magnetic substances are made up of tiny molecular magnets. An unmagnetized material has no magnetic effect because adjacent molecular magnets neutralize the magnetic forces of its molecular magnets -A magnetic substances are composed of tiny molecular magnets, each with a north and south pole. The two poles form a dipole. A magnetized material has most of its molecular magnets lined up. -If a magnet is split in have it becomes two magnets each with a north and south pole. The poles are in the same orientation as the original magnet.
DC motor
-basic DC motor consists of the following components: -A FIELD MAGNET -An ARMATURE with a coil around it that rotates between the poles of the field magnet -A POWER SUPPLY that supplies current to the armature -An AXLE that transfers the rotational energy of the armature to the working parts of the motor -A set of COMMUTATORS and BRUSHES that reverse the direction of power flow every half rotation so that the armature continues to rotate
Ultraviolet radiation
-causes sunburns and would be even more harmful if most of it were not captured in the Earth's ozone layer -naturally transmitted by the sun, artificial UV radiation is created in the form of vacuum UV and extreme UV
Blackbody radiation
-characteristic radiation of an ideal blackbody -i.e: a body that absorbs all of the radiation incident upon it -energy density of this wave should increase as frequency increases
Longitudinal waves
-characterized by the particle motion being PARALLEL to the wave motion -ex: SOUND WAVES ( need a medium to spread while light wave do not )
Transverse waves
-characterized by the particle motion being PERPENDICULAR TO the wave motion -cannot spread in a gas or liquid
Infrared radiation
-comes from the sun and from visible light that is absorbed and then reradiated at longer wavelengths -utilized in night vision googles
Atomic absorption spectroscopy
-continuous spectrum, light consist of all wavelength, pass through the element -The frequencies of absorbed photons are then determined as the electrons increase in energy
Generators
-devices that are the opposite of motors in that convert MECHANICAL ENERGY INTO ELECTRICAL ENERGY -mechanical energy can come from a variety of sources; combustion engines, blowing wind, falling water, or even a hand crank or bicycle wheel -most generators rely upon electromagnetic induction to create an electrical current, these generators basically consists of magnets and a coil -The magnets create a magnetic field and the coil is located within this field. Mechanical energy, from whatever source, is used to spin the coil within this field. As stated by Faraday's Law, this produces a voltage
Conduction
-electrical conduction is the movement of charged particles, electrons, through a medium. -in conducting material, electron loosely attached to atom are capable of carrying an electrical current, and this requires that the atoms of the conducting material be brought into physical contact with the charge source
multimeter
-electrical meter capable of measuring voltage, resistance,and current
First Law of Thermodynamics
-example: Electric energy transformed into light and heat energy -This is the law of the conservation of energy. It states that energy can neither be created, nor can it be destroyed. This means that the total amount of energy in the universe always remains conserved, or constant. However, energy can be changed from one form to another. -light bulb convert 20% of electric energy into light and 80% into heat energy, the reason why light bulb is hot
Wave-particle duality
-exhibition of both wavelike and particle-like properties by a single entity -usually a quantum phenomenon relating to photons, electrons, and protons -Quantum mechanics shows that such objects sometimes behave like particles, sometimes like waves, and sometimes both -All objects exhibits wave-particle duality to some extent, but the larger the object the harder to observe -Ex: sunlight
X-rays
-form of electromagnetic radiation -produced by acceleration electrons to collide with a metal target -behave like particle than wave because of their short wavelength -DO NOT pass through dense material like bone but through softer tissue, where x-ray pass through soft tissue and strike the photographic plate, the plate turns black, creating a contrast between those areas not penetrated by x-ray and those that are
components of laser
-gain medium -energy source, pump, for the gain medium -a resonant optical cavity with a partial transparency in one mirror -the resonant cavity is tuned to a particular frequency such that the photons of the desired laser frequency are coherent and, largely, isolated within the cavity. -A partially transparent mirror on one end of the cavity allows some of the light to exit, thus producing the laser beam
Thermal Energy
-heat, the energy of moving atoms and molecules -total amount of energy associated with the random movement of atoms and molecules in a sample of matter
Ultrasound waves
-high frequency, longitudinal waves used in medical imaging -waves penetrate the human body well and some of the waves reflect off tissue boundaries, the pulse sent back are used to create a picture of the inside of the body
emission spectrum
-in the visible region typically consists of lines of light at certain colors corresponding to distinct wavelengths of emission
Doping
-introduces extra electrons or extra electron acceptors to facilitate the movement of charge -doping to contain extra electrons are N-TYPE -doping to contain extra "holes" are P-TYPE
Conductors
-materials that allow for free and easy movement of electrons -Some of the best conductors are metal, especially copper and silver because these materials are held together with metallic bonds, which involve de-localized electrons shared by atoms in a lattice -If a charge is transferred to a conductor, the electrons will flow freely and the charge will quickly distribute itself across the material in a manner dictated by the conductor's shape -If a static electric field is applied, the mobile electrons reorient themselves to minimize the energy of the system and create an equipotential on the surface of the metal, in the ideal case of infinite conductivity, the highly mobile charge carriers do not allow a net field inside the metal, thus conductors can "shield" electromagnetic fields.
stimulated emission
-may take place when the excited atom is perturbed by a passing photon of the same energy as the excited. In such a case, the atom relaxes to a lower energy by emitting a new photon, resulting in a total of two photons of equals frequency ( and, thus, energy) and equal phase.
Electromagnetic spectrum
-measured using frequency (f) in hertz or wavelength (λ) in meters -The frequency times the wavelength of every electromagnetic wave equals the speed of light (3.0 x 10^8 m/s) -A changing electric field produces a magnetic field, and a changing magnetic field produces an electric field. -Electromagnetic waves are produced when an electric field connects with a magnetic field, the waves are produced by the motion of electrically charged particles. The electric and magnetic fields are perpendicular to each other to the direction of the wave.
actual mechanical advantage
-mechanical advantage of a real machine and takes into consideration factor such as energy lost to friction
Photoelectric effect
-occurs when light shining on a clean metal surface causes the surface to emit electrons -If this energy is greater than the binding energy holding the electron close to nearby nuclei then the electron will move and it also impart kinetic energy to the electron making it move rapidly
Constructive Interference
-occurs when two crests or two troughs of the same shape meet -medium will take on the shape of a crest or a trough with twice the amplitude of the two interfering crests or troughs
Wave Interference
-occurs when two waves meet while traveling along the same medium -The medium takes on a shape resulting from the net effect of the individual waves upon the particles of the medium -light waves same as sound waves, when two light waves of same color, frequency, and amplitude are combined, the interference shows up as fringes of alternation light and dark band, however light waves must come from same source -When two sound waves differing slightly in frequency are superimposed, beats are created by the alternation of constructive and destructive interference, the frequency of the beats is equal to the difference between the frequencies of the interfering sound waves -Two type: CONSTRUCTIVE AND DESTRUCTIVE
Maser
-operate at lower frequencies than lasers, generally rely on the same principles as lasers, although the types of gain media and resonant cavities may differ
Monochromator
-optical devices that send a narrow band of wavelengths of light selected from a wider range of wavelengths -often used in absorption spectrophotometers to supply lights to a sample, absorption spectrophotometers are used to study enzymes, create optical thermometers, and measure the performance of sunglasses, laser protective glasses, and other optical filters, among other things
Heisenberg's uncertainty principle
-place a limit on the accuracy with which one can measure the properties of a physical system -arise from the fundamental wave-particle duality inherent in quantum systems -if we measure the position of a particle with greater and greater accuracy, at some point the accuracy in the measurement of its momentum will begin to fall
radiation
-process of emitting energy -energy is radiated in the form of waves or particles
Radio waves
-produced by antennae whose dimensions must be comparable to the wavelength in order for the antennae to work efficiently and by cosmic phenomena in deep space -used for transmitting data -common example are television, cell phones, and wireless computer
Gamma rays
-produced by sub-atomic particle interaction, such as radioactive decay, but most are created by nuclear reactions in space -most useful in the field of astronomy
Microwaves
-produced by vacuum-based devices such as the magnetron, klystron, traveling wave tube, and gyrotron,anything with a temperature greater than about 10k produces terahertz radiation, however the emission are very weak -the only effective sources of stronger terahertz radiation are the gyrotron, far infrared laser, quantum cascade laser, synchrotron light sources, the backward wave oscillator, the free electron laser, and single-cycle sources used in Terahertz time domain spectroscopy -used to heat food and deliver WI-FI service
Elastic properties
-properties related to the tendency of a medium to maintain its shape when acted upon by force or stress -Sound waves travel faster in solid than they do in liquid than they do in gases
Diffraction grating
-reflecting or transparent element whose optical properties are periodically modulated - device made of thousands of closely spaced slits through which light is passed in order to produce a spectrum -When light is incident on a diffraction grating, light is reflected or transmitted on discrete directions, called DIFFRACTION ORDERS -commonly used in monochromator and spectrophotometers -the angle of deviation of all but one of the diffracted beams depends on the wavelength of the incident light
Efficiency
-relationship between energy input and energy output -Expressed as a percentage, the more efficient a system is, the less energy that is lost within that system -% efficiency=useful energy produced x 100/total energy used
Wave strikes an object
-some of the wave energy is reflected off the object, some of the energy goes into and is absorbed by the object, and some of the energy goes through the object -Ex: sound waves can penetrate walls, however sound waves from air cannot penetrate water, and sound waves from water cannot penetrate the air -Light passes through some materials such as glass but no many other materials.
Capacitance
-the ability of a conductor to store energy in the form of electrically separated charges -measure of the stored electric charge per unit electric potential C=Q/V -unit=farad -in circuit, device called parallel plate capacitors are formed by two closely spaced conductors, when a voltage is applied, electrical charges build up in both the conductors. These charges on the two plates have equal magnitude but opposite sign.
Heat of Fusion
-the amount of heat energy expressed in calories required to change 1 gram of water from a solid to a liquid, or back -The heat of fusion is equal to 80 cal/gram
Heat of Vaporization
-the amount of heat energy required to change 1 gram of water from a liquid to a vapor, or back. -The heat of vaporization is equal to 540 cal/gram
Latent Heat
-the amount of heat energy required to change matter from one state to another -Ex: The amount of temperature change needed to cause evaporation or condensation of water
Calorie
-the amount of heat energy required to change, raised or lower, the temperature of 1 gram of water, by 1 degree Celsius
amplitude
-the amplitude of a sound waves determines its loudness -Loud sound waves have large amplitudes, the larger the sound wave, the more energy is needed to create the wave
Atomic emission spectroscopy
-the electron of an element are excited by heating or by an electric discharge -the frequencies of emitted photons are then determined as the electron release energy
Kinetic Energy
-the energy an object has due to its mass and motion
Gravitational Potential Energy
-the energy an object has when it is in an elevated position
Chemical Energy
-the energy bonds atoms and molecules together -potential energy stored in chemical bonds of molecules.
Work
-the energy expended when the position or speed of an object is moved against an opposing force, measured in JOULES, work is the product of the force on an object and the distance through which the object is moved.
Mechanical Energy
-the energy of moving objects
Nuclear Energy
-the energy of moving the nucleus of an atom - the potential energy stored in the nucleus of an atom
Potential Energy
-the energy stored in an object due to its position
Elastic Potential Energy
-the energy stored in elastic stretchable objects such as rubber bands or springs
Buoyancy
-the force produced by a fluid on a fully or partially immersed object -buoyant force opposed the force of gravity -can determine if an object float. If the material has a lower density then the liquid, it will float, if higher, it will sink. If the same, it will neither sink nor float
Absolute Zero
-the lowest temperature theoretically attainable (at which the kinetic energy of atoms and molecules is minimal) - 0 Kelvin or -273.15 Centigrade or -459.67 Fahrenheit
Temperature
-the measure of the average kinetic energy of the motion of atoms and molecules of a substance -NOT a measure of how much heat a substance contains; instead, it is focused on the increase or decrease of the kinetic energy of the atoms and molecules of a substance -temperature is a measure of hotness, not heat, although we use thermometers to measure temperature, we can't directly measure heat; it must be calculated
Gauss's law of magnetism
-the net magnetic flux out of any closed surface is zero -V*B=0 where V= the del operator and B=magnetic field -If a plane is parallel to a magnetic field, no magnetic field lines will pass through that plane and the flux will be zero, if a plane is perpendicular to a magnetic field, the flux will be maximal -There is NO MAGNETIC MONOPOLE, that means magnets always have a positive and negative pole)
Fahrenheit Scale
-the non-Si technical scale still used in some countries -Water freezes at 32 and boils at 212 on the Fahrenheit scale
Archimedes' Principle
-the principle that states that the buoyant force on an object in a fluid is an upward force equal to the weight of the volume of fluid that the object displaces -useful when determining the volume of an oddly shaped object
Frame of reference
-the principles which describe the relationship between different frames of reference are know as RELATIVITIES -when velocities approach the speed of light, we must use EINSTEIN'S SPECIAL RELATIVITY -2 type of reference frames: INERTIAL and NON-INERTIAL
Pitch
-the property of sound that varies with variation in the frequency of vibration -High pitched sound waves have high frequencies -High notes are produced by an object that is vibrating at a greater number of times per second than one that produces a low note.
Celsius Scale
-the temperature scale in general scientific use -Water freezes at 0 and boils at 100 on the Celsius scale
Heat
-the total kinetic energy of the random motion of a substance's atoms and molecules
Principle of conservation of mass and charge
-the total mass of a system is constant -the total electrical charge of a closed system is constant
Entropy
-the transformation of energy to a more disordered state and is the measure of how much energy or heat is available for work -Entropy approaches a maximum value at equilibrium
ferromagnet
-there are domains where the magnetic dipoles are aligned, however, the domains themselves are randomly oriented. -A ferromagnet can be magnetized by placing it in an external magnetic field that exerts a force to line up the domains -ron, cobalt, nickel (and various alloys) are called ferromagnetic materials. Ferromagnetic materials show a permanent, spontaneous magnetizing effect in the absence of a magnetizing field. -This effect is greatest at absolute zero. It is reduced by temperature. -Ferromagnetic materials with high retentivities, are called hard, and are used for permanent magnets.
Population inversion
-there are more atoms in a particular excited state than in a particular lower-energy state -the material must be "pumped" which can be performed using electromagnetic field (light), pumping to produce population inversion often requires three or more atomic energy levels. The energy difference between levels can be emitted in the form of a phonon. -The abundance of excited atoms due to population inversion allow for a chain reaction to form when photons of the proper frequency are incident.This results in a cascading increase in photon intensity through stimulated emission, this production the coherent, high power light that is used by the LASER or MASER
Non-inertial
-these frames include all other situations in which there is non constant velocity, such as acceleration or rotation.
Inertial
-these frames translate at a constant vector velocity, meaning velocity does not change direction or magnitude -example: travel in a straight line without acceleration -Newton's first law and second law are ONLY in this reference frames
Convection
-transfer of heat by currents within fluid form -liquids and gases only
Conduction
-transmission of heat across something -heat transfer always moves from a higher to a lower temperature -More dense substance usually conduct heat more readily than less dense matter
Microwaves
-used in microwaves ovens to cook food by passing microwaves radiation through the food -used in broadcasting and telecommunications transmissions because of their short wavelength
Voltmeter
-used to measure potential difference -the potential difference across a resistor is measured by a voltmeter placed in parallel across it -an ideal voltmeter has very high resistance so that it does not appreciably alter circuit resistance and therefore the voltage drop it is measuring, -meter that measures the potential difference between two points -Voltmeters are CONNECTED IN PARALLEL ACROSS components.
Radar
-uses electromagnetic waves to identify the speed, altitude, and direction of both fixed objects and objects in motion -radio waves are discharged by a transmitter, a receiver detects the waves reflected off the object, even though the waves are weak, it can be amplified, makes them more useful than sound waves or visible light -Radar used in meteorology to detect precipitation, in air traffic control to monitor location of planes, in police work to detect speeders, and in military operations.
Potentiometer
-variable resistance device in which the user can vary the resistance to control the current and voltage applied to a circuit -Since the potentiometer can be used to control what fraction of the emf of a battery is applied to a circuit, it is also known as a VOLTAGE DIVIDER -it can be used to measure an unknown voltage by comparing it with a known value -Potentiometers are commonly used to control electrical devices such as volume controls on audio equipment
Friction
-when two materials are brought into contact (or rubbed against each other) electrons may be transferred between them. -If the material are then separated, one will be left with a negative charge and the other will have a positive charge. This is known as the TRIBOELECTRIC EFFECT
Fluoride recommendations by age
0-6mth: Oral supp. not recommended, use fl. water if available 6-12 mth: fl. water; oral supp only if prescribed 12-24 mth: fl water; oral if prescribed. Toothpaste should not be used until the child can spit it out 2-3 years: fl. water or supp recommended, pea sized amount of fl. toothpaste
GFR of 20 ml /min should get how much protein
0.6
a pt with a GFR of 20 ml/min should receive how many grams of protein /kg
0.6
Serum Creatine normal level
0.6-1.4 mg/dL
if a pt GFR is < 50 ml/min what should their protein intake be (in g/kg)
0.8 g/kg
if a GFR is <50 ml /min ...protein should be ?
0.8-1.0
the above pt with nephrosis should receive how many grams of protein per kg
0.8-1.0
according to the diabetic exchange list, when substituting 2% milk for skim milk, you must omit how many fat exchanges
1
a pt gets 4 oz whole milk and 6 graham crackers. what would decrease the glycemic index?
1 T PB in place of 3 graham crackers
a pt receives 4 oz whole milk and 6 graham crackers as a snack. which of the following substitutes would lower the glycemic index: skim in place of the whole, fruit juice in place of the whole milk, 12 saltines in place of the 6 graham crackers, 1 T peanut butter in place of 3 graham crackers
1 T peanut butter in place of 3 graham crackers
a guide for calculating water needs with tube feedings is _cc/_calories
1 cc water/ 1.0 calories
which of the following would be appropriate for a hemodialysis pt on a 60 g protein diet with 75% from HBV protein: 1 egg/2 oz chicken/3 oz beef/ 1/2 c milk, 1 egg/ 2 oz chicken/ 3 slice bread/ 3 oz beef, 2 egg/ 3 oz chicken/ 3 oz beef/ 1 c milk, 1 egg/3 oz chicken/ 2 c milk/ 5 slices bread
1 egg, 3 oz chicken, 2 c milk, 5 slices bread
Water per calorie ingested for tube feed and percent water?
1 ml/ kcal 1 kcal/mL=80-86% water 1.5 kcal/mL=76-78% water 2 kcal/mL= 69-71% water
a diabetic want to exchange his bedtime snack of 8 oz whole milk. what do you suggest: 1 oc cheese and 1/2 c orange juice, 2 graham crackers and 1/2 c orange juice, 1 oz cheese, 2 oz cheese
1 oz cheese and 1/2 c orange juice
which contains more total dietary fiber: 1/2 c raw spinach, 1 oz raisin bran cereal, 1 slice whole wheat toast, 2 T peanut butter
1 oz raisin bran cereal
which of the following should the patient in the above question have for lunch: 4 oz cottage cheese, 1 oz cheddar cheese, 1 oz roast beef, 1 oz cold cuts
1 oz roast beef
What are the 5 data categories under nutrition assessment?
1. Biochemical data 2. Anthropometric measurements 3. Physical examination 4. Food/Nutrition history 5. Client history
List 5 characteristics of critical thinking.
1. Conceptualize 2. Think rationally 3. Think creatively 4. Be inquiring 5. Think autonomously
Name the 3 ways the NCP is used by dietetics professionals.
1. Critically think 2. Make decisions addressing nutrition-related problems. 3. Provide safe, effective & high quality nutrition care
General Order of Program Plan
1. Develop Mission Statement 2. Set Goals 3. Set Objectives
Name the 5 parts of the outside ring in the Nutrition Care Process Model.
1. Economics 2. Social Systems 3. Health Care Systems 4. Practice Settings 5. Education
Name the 3 NCP relationships with the PES statement.
1. Nutrition Diagnosis-Problem 2. Nutrition Intervention-Etiology 3. Nutrition Monitoring & Evaluation-Signs & Symptoms
What are the 5 major requirements schools need to participate in NSLP
1. Nutritional standards 2. eligible children receive free or reduced cost 3. program is nonprofit 4. program is accountable 5. must participate in commodity food program
What is the metabolically active form of vitamin B6? What are its main functions? and what is the typical way we are deficient in the vitamin?
1. Pyradoxal Phosphate (PLP) is the metabolically active form, it mainly functions as a coenzyme in amino acid metabolism and plays a role in Hgb synthesis. Deficiency is rare but typically caused by medication interaction.
Work, Develop, Implement, Evaluate, and Revise, Address
1. Work collaboratively with other campus personnel to develop, implement, evaluate and revise a comprehensive campus professional development plan that addresses staff needs and aligns professional development with identified goals.
if a man normally consuming 2600 calories per day reduces his intake to 1500 calories per day, how much wt will he lose in one week ? in kg
1.0 kg
Hemodialysis diet protein
1.2 g pro/KG
Peritoneal dialysis protein
1.2-1.3 g/KG
__ grams protein, __ cals/kg is the appropriate diet for peritoneal dialysis
1.5 grams protein, 30 cals/kg
# of relief workers suitable
1.55
One way to determine # of relief employees needed is to multiply total employees by ___
1.55
What must School Lunch Program Meet
1/3 RDA for Kcal, protein, vitamin A and C, iron, calcium
When you are in the clinic, you receive a phone call from an individual who states she has diabetes and wants to know how to count quinoa in the exchanges. What is the exchange?
1/3 cup is a starch
What is an example of a serving of starch and how many grams of carbohydrates is it?
1/3 cup of rice or pasta, 1 slice of bread, 1/2 cup do canned or frozen fruit, 1 small fruit. 15grams in a serving
What must School Breakfast Program Meet?
1/4 RDA for calories, protein, Vitamin A and C, iron, calcium
normal hgb for baby?
10 and up
IVFE: Intravenous Fat Emulsion Kcals
10%: 1.1 kcal/mL 20%: 2.0 kcal/mL
BUN: Creatinine ratio. Normal
10-15:1
a tube feed ran from 7 pm to 6 am providing 1800 calories, at 1.6 calories/cc. how may cc/hr were given
100 cc/hr
Indicies of glycemic control: Impaired fasting glucose
100-125
fasting blood glucose levels for pre-diabetes
100-126 mg/dL
The patient has severe acute pancreatitis with nausea and vomiting, and requires 2500 kcals per day. Which regime would the dietitian recommend?
1000 cc of D50 W, 1000 cc of 7% amino acids and 500 cc of 10% lipids
a pt with severe acute pancreatitis experiences nausea and vomiting and requires 2500cal/day. which of the following would you recommend: 3000cc of a 1cal/cc TF via jejunum, 1500cc of a 2cal/cc NGT, 1000cc of D50W, 1000cc of 7% aa, 650cc of 20%lipids, or 1000cc D50W, 1000cc 7% aa, 500cc of 10% lipids
1000cc of D50W, 1000cc of 7% amino acids, 500cc of 10% lipids
how much free water is in 1.5 liters of an enteral feeding that has 1.5 calories per cc
1155 cc
What is the normal GFR?
125ml/min
how many calories are in 1.5 liters of a 25% dextrose solution
1275 calories
how many calories are provided in 1.5 liters of D25W
1275 calories
Holding temperatures: At or above _____. At or below _____.
135 degrees F (57 degrees C) 41 degrees F (5 degrees C)
Comprehensive metabolic panel
14 blood tests, including all the tests in the basic metabolic panel used for screening
a 7 year old on a ketogenic diet requires 1500 calories. which is the appropriate order: 145 g fat/25 g protein/25 g CHO, 95 g fat/40 g protein/25 g CHO, 102 g fat/56 g protein/12 g CHO, 75g fat/32 g protein/43 g CHO
145 g fat/25 g protein/25 g carbohydrate
low-birthweight infant is classified as how many grams?
1500-2500g
burn pt follows a kcal:N ratio of:
150:1
TTHY transthyretin, PAB prealbumin. Normal range
16-40 mg/dl
How many FTEs will it take to staff 12 positions, 8 hours a day, 7 days a week?
16.8
The renal threshold, the point at which the tubules reach their tubular maximum for glucose, is:
160-200 mg/dl
a PN regimen than contains 1 L of D50W and 1 L of 7% Aminosyn provides how many non-protein calories
1700 non-protein calories
TPN of 1L D50W and 1L of 7% aminosyn provides how many non-protein calories
1700kcal
a 60 kg female receives 2700 calories on PN. the calorie to nitrogen ratio is 150:1. how may grams of nitrogen is she getting
18
in PN...850 ml of 5.5% AA will give you ... kcals?
187
pt has heart failure but no CAD or increased CHD risk. his nutritional prescription should be
2 gram sodium
according to the diabetic exchange list, 2 T peanut butter is
2 high fat meats
a 1500 calorie diabetic diet with 45% of the calories from carbohydrate is prescribed. one third of the carbohydrates grams is met with 1/2 cup orange juice, 1 cup milk and: 1 slice toast, 2 slice toast, 2 slice toast and 1/2 cup oatmeal, 1/2 slice toast
2 slice toast
what is a normal wt gain during the first trimester
2-5 lbs
Facilitate, Apply
2. Facilitate the application of adult learning principles and motivation theory to all campus professional development activities, including the use of appropriate content, processes, and context
How many meals were served per labor hour if 34 FTE produced 3800 meals in one 40 hour week?
2.79
in the Dietary Guidelines, what represents the fat included
20-35% calories, <10% saturated fat
What is the best dietary intake assessment in a clinical setting?
24 hour recall
open tube feedings should be disposed of after
24 hours
a standing height should first be obtained when an infant is how many months old
24 months
at what age should children be measured standing up
24 months
an AIDS pt temperature has risen to 102 degrees. his BMR has increased
24%
What is protocol for the time in which all pregnant women would be tested for gestational diabetes?
24-48weeks
a sandwich with two pieces of white bread and 2 oz of turkey provides how many calories
250 calories
What is the median of the following frequency distribution: 1000, 2000, 3000, and 4000?
2500
a pt w/ heart failure but no CAD or inc CHD risk...what is his diet order?
2G sodium
Indicies of glycemic control: Impaired glucose tolerance
2hPG 140-199
Metabolic Syndrom
3+ of the following risk factors are linked to insulin resistance, which increase risk for coronary events -Elevated BP 130/85 -Elevated TG 150 -Fasting serum glucose 110 -Low HDL 40 M, 50 W -Waist measurement 40 M, 35W
Retinol-binding protein. Normal Range
3-6 mg/dl
Allocate, Ensure
3. Allocate appropriate time, funding, and other needed resources to ensure the effective implementation of professional development plans.
The February income statement shows that 2450 meals were served $7616 paid in labor. What is the labor cost per meal for February?
3.11
in TPN, how many kcal/g does dextrose have?
3.4 kcal/g
Calculating Dextrose for PPN and TPN
3.4 kcal/g (ml)(% dextrose)(3.4)
Serum Albumin Normal levels. Abnormalities
3.5-5.0 Low: hypoalbuminemia associated with edema High: Likely due to dehydration
elderly need __ ml water/kg
30
the elderly need how many ml of water per kg
30 ml/kg
which infant is at the greatest risk? 20# hemoglobin 10, 22# hemoglobin 10.5, 19# hemoglobin 11, 30# hemoglobin 9
30# hemoglobin 9
in which would you likely see very low albumin if it is drawn a few days after admission to an acute care facility: anorexia nervosa, 30% full thickness burn, pt with newly diagnosed colon cancer, pt with COPD
30% full thickness burn
Pressure ulcer treatment
30-40 kcal/day 1.2-1.5 g protein stg 1, 2 1.5-2 stg 3, 4 Supplement C, Zn
normal transit time
30-72 hours
how much water does an athlete need if they have lost 2 lbs during a marathon
32 oz
two liters of a 5% dextrose solution provide how many calories
340 calories
how many non-protein calories are provided by 2 liters of a 7% Aminosyn solution and 1 liter of a 10% dextrose in water
340 non-protein calories
The ADA rules that a facility must provide aisles ___" and doors ___" wide. Also, mandates flashing alarm lights for the hard-of-hearing
36,32
In a hospital with 300 patients, it takes 14 minutes to prepare one meal. How many F.T.E. are needed for one week?
36.75
according to the ADA exchange list what is the nutrient content of: 1 c cantaloupe, 1/2 c cereal, 1 c 1% milk, 1 tsp margarine, low sugar jelly, black coffee, 1 slice toast
365 calories 12 protein 57 CHO 7 fat
a newly diagnosed diabetic needs 2200 cals, 50% from carbohydrates. how many CHO choices can he have at each meal if he has 3 snacks with 2 CHO choices each
4
the normal range of hemoglobin A1C is
4 - 6%
according to the diabetic exchange list, which of the following is equivalent to one medium fat meat: 4 oz tofu, 2 oz pork, 2 eggs, 2 T peanut butter
4 oz tofu
what is equivalent to one medium fat meat?
4 oz tofu
if a diabetic pt reduces his caloric intake from 2300 to 1800 calories per day, how much will he lose in one month
4 pounds
What is the normal range for glycated hemoglobin (GHb)? What is the glycated hemoglobin (GHb) goal for diabetics?
4-6% = normal <7% = goal for DM
Implement, Recruitment, Screening, Selection, Induction, Development, Evaluation, Promotion, Dismissal
4. Implement effective, appropriate, and legal strategies for the recruitment, screening, selection, assignment, induction, development, evaluation, promotion, discipline, and dismissal of campus staff
you have determined than an infant should take 340 calories/24 hrs. how many oz of milk should be given to the baby every 6 hrs
4.5 oz
1 FTE = _____
40 hours
infants should be given solid foods at
5-8 months
how many calories in a 300ml of a 5%dextrose solution
51 calories
who has the greatest water, protein, and calorie needs per unit of body wt: 6 month infant, 50 year old male, 16 year old male, 25 year old female
6 month old infant
Eggs can be held in cold storage for
6 months
which level of HgA1c suggest good compliance with dietary recommendations in a diabetic after 3 months of counseling: 6.5, 4.0, 8.2, 10.3
6.5 mg/dl
how many gram of CHO is in 1 english muffin, 1 c skim milk, 1/2 c apple juice
60 g CHO
children and adolescents need what level of physical activity
60 minutes every day
How many total nutrition diagnoses have been labeled?
62
using the previous formula, determine the calories coming from lipids per day
624 calories from lipids
For each rise in F temp above normal, how much does BMR increase?
7%
which drink would a Mormon choose: cola, 7-up, tea, coffee
7-up
A cookie recipe calls for one cup of butter. You will be using shortening instead. How much shortening should you use?
7/8 cup
Indicies of glycemic control: Normal blood glucose
70-100 2hPG: <140
a 140# female on dialysis should have how many grams of protein
70-89 g
A 6'1'' male has bilateral below-knee amputations. What is his adjusted ideal body weight? Weight estimation in amputees: Foot: 2%, Lower leg below knee: 6%, Lower leg, above knee: 9%
73.6 kg
how many grams of protein would you receive on a 1500 calorie diet which is 20% protein
75 grams protein
Protein
75-100 grams of this nutrient given in acute viral hepatitis will promote cell regeneration, provide lipotropic agents to convert fat into lipoproteins for removal from the liver
using the previous formula, determine the protein intake per day in grams
78 grams amino acids
with a CHO:insulin ratio of 16:1 how much insulin is needed with this meal : 1 1/3 c spaghetti, 1 c sauce, 1 c green beans, 1 slice bread, 1 tsp butter, 1/2 c ice cream
8 units
CHI normal levels. Abnormal
80% normal 60-80% mild muscle depletion
infuse a PN a max rate of how many mOsm/L?
800
infuse a peripheral solution at a maximum rate of how many mOsm/L
800
a female 5'7" tall weighs 115#. six months ago she weighed 130#. what is her percent ideal body wt
85%
in a TPN mixture, what volume of the amino acid solutions listed would come closest to providing 185 calories: 1000 ml @ 8.5% aa, 850 ml @ 5.5% aa, 500 ml @ 7.0% aa, 500 ml @ 10% aa
850 ml @ 5.5% amino acids
In a TPN mixture, what volume of the AA solution would come closest to providing 185kcal?
850ml of 5.5% AA (850X .055=46.75 x 4kcal/g=187kcal)
a TPN solution is to be delivered at 50 ml per hr at 3/4 strength. what is the appropriate order: 900 ml formula with 300 ml water, 600/600, 800/400, 300/900
900 ml formula, 300 ml water
The average coefficient of digestibility of protein is:
92%
determine the calorie contribution of carbohydrate from the following parenteral formula. the amounts are per liter. 300 ml 60% dextrose; 500 ml 10% amino acids; 200 ml 20% lipid. total nutrient mixture administered at 65ml/hr for 24 hr
955 calories per day
which of the following wt gains puts pregnant woman at risk: <4#/month in last half of pregnancy, <5#/month in the last half of preg, <6#/month last half of preg, >2#/month in last half of preg
< 4#/month in the last half of pregnancy
how many grams does a low birth weight infant weigh
<2500 grams
Serum Transferrin. Normal levels. Abnormalities
>200 mg/dl High: Iron deficiency
Lab Tests in Renal Disease: BUN: Creatinine ratio
>20:1: "pre-renal" state in which BUN reabsorption is increased due to acute kidney damage. May be reversible and may not require dialysis <10:1 reduced BUN reabsorption due to renal damage (may need dialysis)
Waist Circumference
>40 M, >35 F Independent risk factor for disease when out of proportion to total body fat (with BMI 25-34.9)
Steatorrhea
A consequence of malabsorption of fat is
What is a six sigma?
A data driven approach for eliminating defects and reducing variations in any process.
Medical Diagnosis
A disease or pathology that can be treated or prevented. It does not change as long as the condition exists
Medical diagnosis
A disease or pathology that can be treated or prevented. it does not change as long as the condition exists
Physical incompatibility
A food-drug interaction involving granulation, gel formation, or separation of the enteral nutritional product when food and drug are combined, frequently resulting in clogged feeding tubes and interruption of the delivery of nutrition to the patient. Ex: Mellaril, Thorazine, Robitussin expectorant, Sudafed.
Calcium, magnesium, phosphorous, copper, selenium, zinc and iron
A high fiber diet may increase the need for these minerals
Constipation
A low fiber diet may lead to
Serum Transferring Receptor Test (sTfR)
A measure of iron status that is not affected by inflammatory status
The Joint Commission (TJC)
A peer review organization that evaluates health care institutions and ensures their compliance with established minimum standards.
What is the Nutrition Care Process?
A standardized, consistent structure and framework used to provide nutrition care
LIFO refers to:
A storage procedure. (Last In, First Out)
methotrexate - anti folate drug
A type of chemotherapy for treatment of neoplastic disease. Why is this important?
What is the current charting format recommended for use by dietetics professionals based on the steps of the NCP?
ADIME Assessment Diagnosis Intervention Monitoring Evaluation
What are the liver function tests?
ALP- alkaline phosphate LDH- lactic acid dehydrogenase AST, SGOT- aspartate amino transferase ALT, SGPT- alanine aminotransferase
___ FTE's are the min # of employees needed to staff the facility (counts productive hours/hours actually worked)
Absolute
Oral glucose-lowering medications: Alpha glucosidase inhibitors
Acarbose, Precose Inhibit enzymes that digest carbohydrate, delaying absorption
What is ascites and what disease does it most commonly happen with?
Accumulation of fluid in the paritoneal cavity, and it most commonly happens with cirrhosis
BRFSS; HHS; 18yo or older residing in households with telephones
Acronym for Behavioral Risk Factor Surveillance System, Who runs it, and who is involved?
CSFII; no info; oversampling ofadolescents, older persons, low income persons, pregnant women, A frican American, Mexican American
Acronym for Continuing Survey of Food Intakes of Individuals, Who runs it, and who is involved?
DHKS; USDA; Main meal planner and prepare in households
Acronym for Diet and Health Knowledge Survey, Who runs it, and who is involved?
FITS; no info; infants and toddlers
Acronym for Feeding Infants and Toddlers Survey, Who runs it, and who is involved?
no acronym; National Cancer Institute (NCI) under NIH; adults 18 yo or older
Acronym for Five a Day for Better Health Survey, Who runs it, and who is involved?
NFNS; NHANES plus CSF II; adolescents, older persons, low incomes persons, pregenant women, African American, Mexican American
Acronym for National Food and Nutrition Survey, Who runs it, and who is involved?
NHANES; no info on who runs it; American people
Acronym for National Health and Nutrition Examination Survey, Who runs it, and who is involved?
NNMRRP; DHHS and USDA; US population
Acronym for National Nutrition Monitoring and Related Research Program, Who runs it, and who is involved?
NSI; in response to Healthy People 2000; elderly
Acronym for Nutrition screening initiative, Who runs it, and who is involved?
PedNSS; HHS; low income, high risk children, birth-17yo, emphasis on birth - 5yo
Acronym for Pediatric Nutrition Surveillance System, Who runs it, and who is involved?
PNSS; HHS; low income, high-risk pregnant women
Acronym for Pregnancy Nutrition Surveillance System, Who runs it, and who is involved?
NFCS; USDA; US population
Acronym for USDA National Food Consumption Surveys, Who runs it, and who is involved?
WLPS; HHS; 18 and older trying to lose weight
Acronym for Weight Loss Practice Survey, Who runs it, and who is involved?
YRBS; HHS; grades 9-12
Acronym for Youth Risk Behavior Survey, Who runs it, and who is involved?
1.4
Activity factor for a stressed individual
Oral glucose-lowering medications: Thiazolidinediones
Actos Improve peripheral insulin sensitivity
Nutrition Diagnostic Labels: Intake NI
Actual problems related to intake Energy Balance Oral or nutrition support intake Fluid intake balance Bioactive substances: alcohol, supplements Nutrient balance: focus on single nutrients
ARDS. What, Goals
Acute Respiratory Distress Syndrome, Resp. Fail. May follow COPD Lungs are no longer able to exchange gases Goals: Maintain stable wt, Maintain LBM
adds calories and protein, provides pt with more N. When pt does not tolerate standard protein
Adding BCAA to the diet of someone with ESLD does what. When should they be added?
AI
Adequate Intake- used when insufficient evidence exists for EAR, RDA
Problem
Adjective in the PES statement that describes the human response (aka Diagnostic Label)
Effect of Propofol
Administered in oil, so consider fat calories
What is needed for implementation to be successful?
Administrative Support Realistic budget Staff commitment Support of target population
Osteomalacia. Cause, Effect, Treatment
Adult rickets C: Vitamin D deficiency E: Reduction in bone density- demineralization T: Ca, D supplements
Diarrhea in infants and children: Acute
Aggressive and immediate rehydration Replace fluids and electrolytes lost in the stool. Use a glucose electrolyte solution. This is as effective as TPN, but much cheaper. Reintroduce oral intake within 24 hours
Which of the following is the best indicator of visceral protein status in the hospitalized patient?
Albumin
Why does alcoholic liver disease occur?
Alcohol--> acetaldehyde and H+ H+ replaces fat as fuel in Kreb Cycle Fat accumulates in liver and blood
Contraindications of TPN
Alimentary tract can be used Needed for a short period of time in well nourished Cardiac instability Risks outweigh benefits
Reasons to Use TPN
Altered GI function; Inability to absorb nutrients; Malabsorption; Peritonitis; Obstruction; SBS; Hypermetabolic State; CA pts on therapy; GI disorders; Fistulas; Severe malnourished pre-op pts; Acute Pancreatitis; Critical care pts NPO and expected to last more than 4-5 days and enteral support is not possible
which of the following is not a governmental agency: Health and Human Services, Food and Drug Administration, Food and Nutrition Board, American Heart Association
American Heart Association
which formula is high in calories and low in protein: AminAid, Osmolite, Sustacal, Jevity
AminAid
Which statement is an example of line authority?
An administrative dietitian in a 600 bed hospital.
Grants
An award given of financial or direct assistance
Mini Nutritional Assessment (MNA)
An efficient, innovative, noninvasive method to detect risk for malnutrition using questions and anthropometric measures to determine a malnutrition indicator score
What is WIC not?
An entitlement program: cap on amount of federal dollars allocated
Ideal Mechanical advantage
An ideal mechanism transmits power without adding to or subtracting from it. This means the ideal mechanism does not include a power source, and is frictionless and constructed from rigid bodies that do not deflect or wear.
What short bowel resection has more complications?
An ileal resection is more severe and can lead to absorption issues and emulsification of fats.
What is definition and treatment for glycogen storage disease?
An inborn error of metabolism resulting in deposition of either too much or too little glycogen in tissues; may be due to deficieny in glycogen synthase, glucose-6-phosphate, branching enzyme, myophosphorylase and/or hepatophosphorylase. Treatment- eliminate fructose, sucrose, lactose, galactose
Manifestations of renal disease
Anemia b/c of decreased production of EPO Upset in BP Decreased activation of vitamin D
inflammatory process
Anemia in skeletal and connective tissue disorders, anemia is not diet related but ____
What are some different types of eating disorders?
Anorexia nervosa, Bulimia, Binge Eating, Anorexia Athletica, over-exercise, overeating, night eating, orthorexia, eating disorder not otherwise specified (EDNOS)
Acute Viral Hepatitis: Effect
Anorexia, inflammation, necrosis, jaundice, nausea, fatigue
Treatment of ulcers
Antacids Antibiotics to eradicate H. pylori Rest Diet therapy
Effect of Anticoagulant
Antagonizes vitamin K Avoid Ginkgo, ginger, garlic Avoid high doses of vitamin A and E
States' Rights
Anti-Federalists wanted these state powers protected.
Epilepsy. Effects of drugs
Anticonvulsants (phenytoin, phenobarbital) interfere with Ca absorption. Take folate with drug. Take away from food May need supplements of Ca, D, thiamin Enteral feedings decrease bioavailability from phenytoin, so hold tube feedings for 2 hours
Effect of Lithium Carbonate
Antidepressant Increased appetite, weight gain; Maintain consistent sodium and caffeine intake to stabilize levels. If Na or caffeine are restricted, lithium excretion decreases, leading to toxicity. 2 g Na may not be enough
Effect of Megestrol Acetate
Appetite Stimulant
Effect of Marinol
Appetite stimulant
The school meals initiative updates standards for school meals to assure they:
Are no more than 40% fat
What amino acids are good for healing in burn victims?
Arginine: may improve immune function & wound healing. Glutamine: may enhance the ability of neutrophils to kill some bacteria that translocates.
Diet for ulcers
As tolerated. Avoid late night snacks Omit: gastric irritants- cayenne, black pepper, chili powder, excess caffeine and alcohol
Insulin types: Rapid Acting
Aspart (Novolog), lispro (Humalog) Take 5-15 mins before eating Usual duration 4 hours
Components of nutrition assessment: Cluster
Assessment data is clustered for comparison with characteristics of a suspected diagnosis -Food/nutrition related history -Anthropometrics -Lab/medical tests -Nutrition focused physical findings
Re-feeding syndrome. Who is at risk, why it happens, effects.
At risk: Anorexia, alcoholics, prolonged fasting, unfed 7-10 days, sig. wt loss, phosphorus deficient-PN As starved cells take up nutrients, K and Ph shift into intracellular compartments Results: hypokalemia, hypophosphatemia, hypomag. Overfeeding leads to hyperglycemia
Cerebral Palsy: Non-spatic form
Athetoid form Involuntary, wormlike movement, constant irregular motions leading to wt loss Diet: High kcal, high protein; finger foods
What is the nutrition prescription for PKU?
Avoid all foods with animal protein and high biological value vegetable protein; use low protein bread and cereal products; avoid aspartame.
Alzheimer's Disease Diet
Avoid distractions durin meal time Regular, consistent mealtimes Encourage self-feeding Offer one course at a time
Dysphagia Advanced
Avoid very hard, sticky, crunchy foods Hard f/v, nuts, seeds
Ileum
B12, intrinsic factor, bile salts, and a major portion of fluid are absorbed in this part of the intestine
AIDS Nutrition
BEE x 1.3 for asymptomatic Protein: 1.2-2 if wasted LBM Vitamin/Minerals may be needed to correct deficiency Retrovir causes non-nutritional macrocytic anemia Neutropenic diet may be helpful- avoid raw food
who is at most risk for gestational diabetes: BMI <30, age <25, overweight, BMI >30, history of GSM, conception within 10 months of last pregnancy
BMI >30, history of GSM
Gestational Diabetes Risk Factors
BMI>30 Hx of GDM
What happens when a dieter reaches plateau?
BMR has dropped to reflect weight loss
What causes dental caries?
Bacterial enzymes ferment CHO deposits on plaque; enzymes produce acids that demineralize surface
IBD: Chronic Ulcerative Colitis. Effect
Begins in the rectum, affects COLON Effect: Chronic bloody diarrhea, electrolyte (Na, K) disturbance, wt loss, anorexia, dehydration, anemia
BRFSS
Behavioral Risk Factor Surveillance System Run By: HHS Who it Measures: Adults over 18- reached by phone. Interview collects info on ht, wt, smoking, alcohol, food frequency for fat, f/v, preventable health problems, diabetes
Effects of Nutrient: Calcium
Binds tetracycline
BUN
Blood Urea Nitrogen Related to protein intake Indicator of renal disease
Treatment for Crohn's
Bowel rest, TPN or minimal residue
Aspects of goals
Broad direction, general purpose Ex- Increase the awareness of CHD risk factors
High purine foods
Broth, anchovies, sardines, organ meats. sweetbreads, herring, mackerel
How is the Nutrition Diagnosis documented?
By writing a PES statement to describe the problem, the root cause, and the assessment data that provides evidence for the nutrition diagnosis.
Oral glucose-lowering medications: Exenatide
Byetta Enhances insulin secretion, supresses postprandial glucagon
CRP
C-reactive protein Marker of acute inflammatory stress. As it declines, indicates when nutrition therapy would be beneficial
Addison's Disease. Cause, Effect, Treatment
C: Atrophy of adrenal cortex. Absence of adrenal hormones (cortisol, aldosterone, androgenic) E: Hypoglycemia, dehydration, wt loss T: High protein, frequent feeding, high Na
Pancreatitis. Cause. Effect
C: Blockage or reflux in the ductal system. Premature activation of enzymes within pancreas lead to autodig. E: Inflammation with edema, cellular exudate, and fat necrosis
Short Bowel Syndrome. Cause. Effect
C: Consequences associated with significant resection of the small intestine E: Malabsorption, malnutrition, fluid/electrolyte imbalances, wt loss
Glycogen Storage Disease. Cause, Effect, Treatment
C: Deficiency of glucose-6-phosphate in liver, impairs gluconeogenesis and glycogenolysis E:Liver can't convert glycogen into glucose, leading to hypoglycemia T: Provide consistency supply of glucose with cornstarch at regular intervals. High CHO, low fat
Cystic Fibrosis. Cause. Effect
C: Disease of exocrine glands E: Secretion of thick mucus that obstructs glands and ducts; Chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption
Maple Syrup Urine Disease. Cause, Effect, Treatment
C: Error in metabolism of BCAAs- leucine, isoleucine, valine E: Poor sucking reflex, anorexia, FTT, irritability, maple syrup odor of sweat and urine T: Restrict BCAA 45-62 g, kcals from CHO and fat to spare amino acids
Heart Failure. Cause, Effect
C: Fails to maintain adequate output Diminished blood flow, so fluid is held in tissues E: Edema, Shortness of breath (dyspnea). Reduced blood flow to kidneys cause secretion of hormones that hold in fluid, leading to wt gain
Complications of uncontrolled diabetes: Acute ketoacidosis. Cause. Effect. Treatment
C: Hyperglycemia due to insulin deficiency or excess CHO intake E:Dehydration due to polyuria, increase pulse, fruity odor of ketones Treatment: Insulin, rehydration
Osteoporosis. Cause, Result, Treatment
C: Malnutrition, lack of exercise, decline in Ca R: Reduction of amount of bone-defective Ca absorb T: Hormone replacement therapy, wt bearing exercise, supplements, adequate protein Elderly, frail white women most at risk
Galactosemia. Cause, Treatment
C: Missing enzyme that would have converted galactose-1-PO4 to glucose-1-PO4 T: Diet only- galactose and lactose free No: Organ meat,milk products, Ca/Na caseinate, dates, bell pepper Okay: soy, hydrolyzed casein, lactate, lactic acid, lactablumin
PKU. Cause, Effect
C: Missing phenylalanine hydroxylase, which converts phenylalanine to tyrosine. E:Phen. accumulates and causes poor intellectual function Detected with Guthrie blood test
Postprandial or Reactive hypoglycemia. Cause, Effect, Treatment
C: Overstimulation of pancreas or increased insulin sensitivity; blood glucose falls below normal 2-5 hrs after eating E: Weak, trembling, extreme hunger T: Prevent marked rise in blood glucose. Avoid simple sugars, 5-6 meals/day, spread out CHO
Homocyinurias. Cause, Effect, Treatment
C: Treatable inherited disorder of aa metabolism. E: Severe elevations of methionine and homocysteine in plasma. Low levels of folate, B6, B12 T: Increased doses of folate, B6, B12 for new dx
Urea Cycle Defects. Cause, Effect, Treatment
C: Unable to synthesize urea from ammonia resulting in ammonia accumulation E: Vomit, lethargy, seizures, coma, anorexia, irritability T: Protein restriction based on tolerance, age, projected growth rate
hormone stimulating release of bile
CCK
Exchanges: Low-Fat Milk
CHO: 12 Protein: 8 Fat: 5 Kcals: 120
Exchanges: Whole Milk
CHO: 12 Protein: 8 Fat: 8 Kcals: 150
Exchanges: Skim Milk
CHO: 12 Protein:8 Fat: 0-3 Kcals: 100
Exchanges: Fruits
CHO: 15 Protein: 0 Fat: 0 Kcals: 60
Exchanges: Starch/Bread
CHO: 15 Protein: 0-3 Fat: <1 Kcals: 80
Exchanges: Vegetables
CHO: 5 Protein: 2 Fat: None Kcals: 25
Nutrition focused physical findings: Teeth- missing, loose, loss of enamel
Calcium deficiency, poor intake
Tables of Food Composition
Calculate intake of nutrients Data from USDA Helpful in dietary surveys to compare intake with recommended levels
No because sodium is needed to maintain normal levels of sodium in the plasms during large prenatal expansion of tissues and fluid
Can a sodium restriction be recommended for a pregnant woman? why or why not?
A job description:
Can be used for employee appraisals
Diverticulitis. Cause, Treatment
Cause: Diverticula become inflamed as a result of food and residue accumulation and bacterial action Treat: CL, low-res or elemental, gradual return to fiber
Celiac disease: Cause, effect
Cause: Rxn to gliadin affects jejunum and ileum. Effect: Malabsorption, macrocytic anemia, wt loss, diarrhea, steatorrhea, iron deficiency anemia
CMS
Centers for Medicare and Medicaid Services Run By: DHHS Medicare- health insurance for people over 65 or anyone with end stage renal disease; employers and employees pay Medicaid- payment for medical care for eligible needy: all ages, blind, disabled, dependent children
Where is the long term central access for TPN?
Cephalic vein Subclavian vein (minimizes risk of phlebitis) Internal jugular vein Into superior vena cava
Effect of Methotrexate
Chemotherapy drug Decreased folate
Nutrition focused physical findings: Hair- Thin, sparse, dull dry, easily pluckable
Chemotherapy, vitamin C, protein deficiency
The program that was designed for non-profit, non-residential daycare facilities is:
Child and Adult Care Food Program
Which group or groups are most at risk for undernutrition?
Children and older adults
Name 3 chemical sanitizers.
Chorine Iodine Quaternary ammonia
Terminal ileum
Chron's disease affects this part of the intestinal tract
B12 and iron deficiency
Chron's disease results in these two vitamin/mineral deficiencies due to the area of the intestinal tract that is affected, and blood loss
Tropical Sprue. Cause, effect, treatment
Chronic GI disease, intestinal lesions. May affect stomach Cause: Bacterial, viral, parasitic infection. Effect: D, malnutrition, Def in B12 and folate due to decreased HCL and IF Treat: Antibiotic, high kcal/pro, IM b12 and oral folate supplements
Colon
Chronic ulcerative colitis affects this part of the intestinal tract
Retinol-binding protein.
Circulates with prealbumin. Shortest half life (12 hours) Binds and transports retinol
What are nutrition indicators?
Clearly defined markers that can be observed and measured. Nutrition care criteria are what indicators are compared against
What is reviewed during nutrition screening?
Client's history, lab results, weight, physical signs
What is the difference in pudding made with egg substitute instead of a whole egg?
Coagulation temperature is lower
What are some medications that can cause taste alterations?
Colace, Lopid, Cisplatin, Flagyl, and Dilantin
Strategies that strengthen local food systems: Food recovery and gleaning programs
Collect excess wholesome foods that would otherwise be thrown away to deliver to hungry people
Glycemic Index
Compares blood glucose response of food to a standard glucose load Foods with low index produce greater satiety Low index: milk, legumes, nuts, pasta, ice cream, yogurt
Nutrition Evaluation
Compares findings with goals or standards. it determines the degree to which progress is being made, and outcomes are being met
Prader Willi Syndrome
Congential disroder; subnormal LBM, lotsa body fat Ghrelin levels are elevated: growth hormone secretion, appetite, intake, fat mass deposition Do not sense satiety; decreased energy requirements Obesity at 2-3, hypogonadism, FTT, short stature Best treatment is to control food intake
a 75 year old female with adequate income would benefit from
Congregate Meals
Steatorrhea
Consequence of malabsorption. Normal stool fat 2-5g, >7=malabsorption Treat: High protein, high complex CHO, fat as tolerated, vitamins, minerals, MCTS (rapidly hydrolyzed in GI tract)
Nutritional Surveillance
Continuous collection of data Identifies problem, sets baseline, sets priorities, detects changes in trends Uses ht, wt, h/h, serum cholesterol On-going system linked to active health programs: CDC, WIC Data identifies needs and kind of intervention needed
What does egg in a recipe function as
Contributes to liquid, progein, contributs to sturcture, reduces tenderness, flavor, flavors a fine texture.
What is OK in a gluten free diet
Corn, potato, rice, soybean, tapioca, arrowroot, carob bean, flax
Anorexia treatment
Correct electrolyte imbalance first Plan with pt: regular mealtimes, varied and moderate intake, gradual intro of feared foods Focus on health benefits of food Increase intake slowly
Northwest Ordinance
Created first govt. territory outside of the U. S. Encouraged westward migration, banned slavery and provided for schools.
CHI
Creatinine height index Ratio of creatinine excreted/ 24 hours to height Estimates lean body mass-somatic protein
What are the three modes of feeding for tubefeedings?
Cyclical, Bolus and Continuous
What are the calories per liter for D5W parenteral solution?
D5W= 5% of 1,000 mL OR 50 g of dextrose/liter 50 g x 3.4 kcal = 170 kcal/liter
which of the following self-assessment tools would be given to clients prior to screening at a congregate meal site: PEACH survey, DETERMINE, NSI Level II screen
DETERMINE checklist
What standards are dietary intakes (24-hr recall, FFQ) compared to?
DRIs/RDAs or a food group system
Cirrhosis. How does it occur
Damaged liver tissue is replaced by bands of connective tissue Divides liver into clumps and reroutes veins and capillaries, causing a disruption ib blood flow
What should be included in documentation?
Date and time, pertinent data and comparison with standards; pt's perceptions, values, and motivation related to problem; changes in pt's level of understanding, behaviors, outcomes; reason for discharge
Effect of Mineral oil, cholestryamine
Decrease absorption of fat, fat-soluble vitamins
Effect of Steroids
Decrease bone growth, CHO intolerance
Effect of oral contraceptives
Decrease folate, B6, C
Effect of thiazide diuretics
Decrease potassium and magnesium Absorb calcium
What do oat bran and soluble fibers decrease, and how?
Decrease serum cholesterol by binding bile acids converting more cholesterol into bile
Effect of Antibiotics
Decrease vitamin K
Effect of Statins (HMG CoA reductase inhibitors)
Decreased LDL and TG Increased HDL
Effect of Phenobarbital
Decreased folic acid, vitamins B6, B12, D, K
Effects of Nutrient: Vitamin B6 and protein on L-dopa
Decreases effectiveness It controls symptoms of Parkinson's disease Take in the morning with less than 10g protein
Effect of Orlistat
Decreases fat absorption by binding lipase
Nephrosis. What. Effect
Defect in capillary basement membrane of glomerulus, which permits escape of large amounts of protein into the filtrate moving through the tubules E: Albuminuria, edema, malnutrition, hyperlipidemia
Thyroid Disorders: Hypothyroidism
Deficiency of thyroid hormone T4 low, T3 low or normal Decreased BMR, leading to wt gain
State of negative fluid balance caused by decreased intake, increased losses, and fluid shifts.
Dehydration
Gastroparesis. Cause, effect, treatment
Delayed gastric emptying Cause: Surgery, diabetes, viral infect., obstruction Effect: Mod- Sev hyperglycemia, detrimental effect on gastric nerves Treat: Prokinetics (eryhtromycin) increase contractility, small frequent meals, pureed, avoid fiber, liquid fat tolerated
Effect of Loop diuretics
Deplete potassium, magnesium, calcium, sodium, chloride
Effect of Isoniazid
Depletes pyridoxine, causing peripheral neuropathy. Don't take with food. Interferes with vitamin D, so Ca supplements are needed (Treats TB)
_______ is a bookkeeping charge that reduces the value of equipment as an asset.
Depreciation
What is a mission statement?
Describes what a company does and how it differentiates from others
2010 Dietary Guidelines for Americans
Designed to prevent chronic disease Written by USDA and HHS Community nutrition programs use these guides when developing plans Focus on reducing kcals and reducing components that contribute to excess kcals- solid fats, added sugars, refined grains
<200
Desirable total cholesterol level
Community Food Security Initiative
Development of sustainable, community-based strategies to ensure that all have access to culturally acceptable, nutritionally adequate food at all times
National Research Council
Develops RDAs Policy of enrichment- increasing nutrients to a higher level than they naturally occur Policy of fortification
How do you calculate dextrose, amino acids and lipids for a TPN?
Dextrose: Ex, D50W: 1000ml x 50g/100ml= 500g Dextrose x 3.4kcal/g Dex= 1700kcal Amino Acids: Ex, 8%: 1000ml x 8g/100ml= 80g x 4kcal/g= 320kcal Lipids: Ex,10%: 500ml * 1.1= 550 kcal
What is serum transferrin mainly used for by the dietitian?
Diagnosing anemia
Prospective Payment Systems-DRG's
Diagnostic Related Groupings Enacted by Congress in TEFRA- Tax Equity and Fiscal Responsibility Act Includes Medicare and Medicaid Pts are classified based on the international classification of disease and the hospitals are paid a certain amount based on the disease Length of time not considered in payment
DHKS
Diet and Health Knowledge Survey Run By: USDA Who it Measures: Main meal planner and preparer in households. Beliefs about food safety, food labels, knowledge of nutrients
high kcal, high pro, finger foods. constant irregular motions leading to weight loss
Diet for athetoid form of cerebral palsy and why?
high pro (1.2-1.5 g/kg), high kcal (30-35/kg), normal Ca, adequate fluids
Diet for decubitus ulcer
low kcal, high fluid, high fiber. limited activity, obese
Diet for spastic form of cerebral palsy and why?
6 small, dry feedings; restriction of hypertonic concentrated sweets;high protein; moderate fat; fluids before or after meals, and B12 injections
Diet recommendations following a gastrectomy include
low cholesterol (<300mg), low fat, wt reduction, inc complex CHO
Diet recommendations for cardiovascular disorders (CAD, IHD)
High calorie, high protein, low fat diet
Diet recommendations for people with all IBDs (not in a flare up) include
DRI
Dietary Reference- nutrient goals to be achieved over time Based on RDA, EAR, AI, UL
Waist/Hip ratio
Differentiates between android and gynoid obesity Men 1.0, Women 0.8 Indicative of android obesity and an increased risk for obesity related diseases
Cerebral Palsy: Spastic form
Difficult, stiff movement; limited activity; obesity Diet: Low kcal, high fluid, high fiber
Heart Failure Treatment
Digitalis to increase strength of heart contraction Diuretics Low Na, DASH diet, fluid restriction if needed 1.2 g protein
Day 1
Discharge plans begin on day ____ of a hospital stay
The age discrimination in employment amended prohibits discrimination agains what group of people?
Discrimination against those 40-70years of age.
DETERMINE
Disease Economic hardship Tooth loss Reduced social contact Multiple medications Involuntary wt loss/gain Needs assistance in self-care Elder years above age 80
Achalasia
Disorder of lower esophageal sphincter motility; does not relax and open upon swallowing Causes dysphagia Start with pureed moist thick food; progress to thick liquids
Gout. Cause, Effect, Diet
Disorder of purine metabolism Increased serum uric acid, deposit in joints causing pain, swelling Diet- low purine may not be effective; wt reduction
What is the proper way to cool a large stockpot of clam chowder?
Divide into shallow stainless steel pans and place them in an ice-water bath.
no, because they rely on food donations
Do emergency food programs, such as a food bank, provide balanced meals?
do not
Do sugar alcohols (sorbitol, xylitol) promote tooth decay?
Yes
Does goat milk contain lactose
no
Does research support the notion of spot weight loss therapy?
Complications of uncontrolled diabetes: Acute hypoglycemia
Due to insulin excess or lack of eating Slow pulse, cool, clammy skin, hungry, weak, shaky, sweaty Treatment: Glucose. Start with 15 g, wait 15 minutes, if still <70 give another 15g
Chronic Kidney Disease. Effects. Treatment
E: Anorexia, weakness, wt loss, N/V Anemia due to eryhtopoietin deficiency T: Stg 1-3, GFR <60 no uremic symptoms 0.8 g/kg Stg 4,5 GFR <25 0.6 g/kg No added salt if edema
Irritable Bowel Syndrome. Effect, Treatment
E: Chronic ab discomfort, altered intestinal motility, bloating T: Avoid large meals, excess caffeine, alc, sugar. Use food diary to track intake, emotion, etc. Work with client to alleviate stress during eating
AIDS. Effect, Goals
E: Diarrhea, malabsorption, n/v, wt loss Goals: Preserve lean bosy mass, prevent wt loss & wasting
Arthritis: Effect, Treatment
E:Normocytic anemia may develop b/c inflammation of arthritis prevents reuse of iron T: Regular, well balanced diet, bedrest, aspirin, wt loss to decrease stress
a family receiving food stamps often runs out of food by the middle of the month. obtain an emergency food voucher for them and refer them to
EFNEP
a poor healthy 19 year old mother is unsure how to feed her 4 year old child. which program may offer her the most help: EFNEP, WIC, HHS, CACFP
EFNEP
where can a pregnant teen learn to cook
EFNEP
water
Early rapid weight loss during diet is ____ as glycogen is utilized
What are some recommendations to prevent chronic disease?
Eat plenty of fruits and vegetables especially dark leafy greens, eat lean proteins, choose whole grains over processed, use oils to replace fats
Identify two physical and/or biochemical manifestations of Kwashiorkor.
Edema, fatty liver, third spacing, and severely depleted serum protein and serum albumin.
What are the 4 outcome criteria for controlling?
Efficient Effective Appropriate Adequate
Treatment for UC
Elemental diet to minimize fecal volume
What organization gives food, but not necessarily healthy food?
Emergency food program (food bank)
Who does food insecurity impact?
Emergency food recipients All ages, ethnicities, locations Working poor Extends to government food assistance recipients, and those with poor health status
Northwest Ordinance
Enacted in 1787, it is considered one of the most significant achievements of the Articles of Confederation. It established a system for setting up governments in the western territories so they could eventually join the Union on an equal footing with the original 13 states
Goiter
Enlargement of thyroid gland due to insufficient thyroid hormone Endemic goiter- inadequate iodine intake Diet- Iodized salt; free of goitrogens- foods of cabbage family like brussel sprouts
Amputation changes for desirable body weight
Entire leg: 16% Lower leg with foot: 6% Entire arm: 5% Forearm with hand: 2.3%
If you are concerned about possible food contamination, it would be safer to eat a steak than a hamburger because of what bacteria?
Escherichia coli
Which foodborne pathogen is more of a concern in ground meat than solid-muscle meats such as steaks?
Escherichia coli
EAR
Estimated Average Requirements for 50% of the population
Nutrition Survey
Examination of a population group at a particular point in time Considered a cross-sectional exam; pin points problems Determines prevalence of condition or characteristic at a specific time
Thyroid Disorders: Hyperthyroidism
Excess secretion of thyroid hormone Elevated T3 and T4 Increased BMR, leading to wt loss
You have found a home recipe that you would like to serve in the hospital cafeteria. What is the best method in developing a large quantity recipe that maintains the quality of the original recipe?
Expand the recipe in increments, evaluate and adjust the recipe at each step.
efficacy not proven
Experimental treatment of hyperactivity is the Feingold diet (no salicylates, artificial colors or flavors). Is it effective?
Health Belief Model
Explains why people, especially high risk people, fail to participate in programs designed to detect or prevent disease Person must perceive the severity and their susceptibility to the threat for the threat to be a behavior-motivating factor
Lewis & Clark
Explored the Louisiana Purchase to gather info about the land, climate, people, etc.
EFNEP
Extension Food and Nutrition Education Program Run By: USDA What it Does: Provides grants to universities that assist in community development. Trains nutrition aides to educate the public. Works with small groups to improve food practices of low income homemakers with young children
International agencies that provide assistance
FAO: Food and Agricultural Organization. Increasing efficiency of production and distribution of food WHO: World Health Organization- developed RDAs for developing countries
Diabetes diagnosis using FBG and OGTT
FBG: >126 mg/dL OGTT: >200 mg/dL
The ___ licenses radio and TV
FCC
The ___ ensures safety of domestic and imported food products, nutrient composition labeling
FDA
Macrocytic, megaloblastic anemia
FEW large cells, filled with hemoglobin Due to deficiency of folate or B12; Schilling test for pernicious anemia MCV and MCH are high
The ___ challenges product claims when a product crosses state lines
FTC
The ___ regulates the contents of food ads, enforcing truth in labeling
FTC
Who monitors for health care fraud?
FTC National Council Against Health Fraud (NCAHF)
True or False: Efficiency is doing the right thing.
False: Doing things right.
Tests that prove diabetes
Fasting plasma >126 -or- GTT >200 -or- Symptoms of diabetes plus casual plasma glucose >200 hgA1c >6.5%
What are some known dietary carcinogen enhancers?
Fat in red meat, polycyclic aromatic hydrocarbons, aflatoxins, safrol.
25-40% kcal, MCT if needed, <40g fat if malabsorption
Fat requirements for cirrhosis
<30% fat
Fat requirements for nephrosis
Exchanges: Fat
Fat: 5 Kcals: 45
What is the storage form of iron?
Ferritin
Gestational Diabetes Risks For Child
Fetal macrosomia (LGA) Fetal hypoglycemia
Strategies for Type I diabetes
Fixed daily dose of insulin Consistant CHO Monitor glucose and adjust insulin For planned exercise, reduction in insulin may be best choice
What are the initial needs of the burn patient?
Fluid and electrolyte repletion.
1.5-2 L/day (high fluid)
Fluid requirements needed daily in renal disorders to dilute urine?
oral supplementation not recommended, use fluoridated water if available
Fluoride recommendations for infants (birth-6mo)
fluoridated water or supplements as recommended; fluoride toothpaste (pea-size amt)
Fluoride recs for children (2-3yrs)
fluoridated water; oral supplements ONLY if prescribed
Fluoride recs for infants (6-12mo)
fluoridated water, or oral supplements if prescribed. toothpaste should not be used if child cannot spit it out
Fluoride recs for toddlers (12-24mo)
What can make a B12 deficiency?
Folic acid can mask a B12 deficiency
Iron, B12, and folate
Following a gastrectomy, patients are at high risk for what three vitamin/mineral deficiencies
Dumping Syndrome Overview
Follows a gastrctomy (Billroth I, II) Holding capacity of stomach is decreased, so food is dumped into the intestines Causes cramps, rapid pulse, weakness, perspiration, and dizziness upon eating
Flow Phase
Follows fluid resuscitation and return of oxygen transport
a mother with 2 daughters ages 8 and 11 does not earn enough money to feed her family, which program would you suggest
Food Stamps
a single man with two daughters ages 10 and 11, is looking for aid. which program might provide assistance: WIC, Food stamps, Child Care Food Program, Headstart
Food Stamps
a father needs help in feeding his children ages 6 and 8. which are the best options: WIC and TANF, Head Start and Food Stamps, Food Stamps and School Lunch , Commodity Foods and WIC
Food Stamps and School Lunch
What is the best dietary intake assessment in a community setting?
Food frequency list. Does not need the dietitian's help
How to teach clients who speak another language
Food models and demonstrations
What are four classes of nutrition interventions that were identified?
Food/Nutrient Provision, Nutrition Education, Nutrition Counseling, Coordination of Care
7%
For each degree rise in F temp of body, BMR rises
Which one of the following terminology is NOT associated with Total Quality Management?
Forecasting methods
FEP
Free erythrocyte protoporphyrin Direct measure of toxic effects of lead on heme synthesis. Increased in lead poisoning Lead depletes iron, leading to anemia, and displaces Ca in the bone leading to a Zn deficiency
Gastrectomy diet
Frequent, small, dry feedings (Fluid before or after meal) Restrict hypertonic concentrated sweets, protein at each meal Lactose may be poorly tolerated B12 injections may be needed
Block Grants
From federal government, given to states for broad purposes as authorized by legislation. Recipients have great flexibility in distributing funds. Ex- CDC STEPS, health initiatives based on obesity
Hormones Involved in renal Function: Vasopressin (ADH)
From hypothalamus (stored in pituitary) Exerts pressor effect; elevates BP Increases water reabsorption from distal and collecting tubules
Altered GI Function vs. Impaired Nutrient Utilization
GI- looks at problems in the GI tract including exocrine functions of liver and pancreas with changes n digestion, absorption, and/or elimination INU- refers to problems with the metabolism of nutrients once they have entered the circulatory system, Includes the endocrine functions of the pancreas, liver, pituitary, and parathyroid
galactose and lactose free
Galactosemia is greated solely by diet. What does this include or not include?
Billroth I
Gastroduodenostomy Attaches remaining stomach to the duodenum
Billroth II and the downside
Gastrojejunostomy Attaches it to the jejunum. When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced. These hormones normally stimulate the pancreas, so now there is little pancreatic secretion, which causes steatorrhea
Where do public health departments get their income from?
General revenue Federal, local, foundation grants
Cancer cachexia
Generalized wasting Connected to cytokines and the tumor-necrosis factor
To prevent EFAD in TPN pts
Give 500 mL of 10% fat 1-2x per week Symptoms: petechiae
Insulin types: Long Acting
Glargine (Lantus), determir (Levemir) Onset 2-4 hours Duration 18-24 hours
FPG >=126 or GTT >=200 or symptoms of diabetes plus casual plasma glucose >=200 mg/dL
Glucose levels for diabetes
maintain normal blood glucose (avg preprandial goal 90-130, peak PG avg <180)
Goal for all diabetics (hint glucose levels)
How do you calculate a net profit/loss?
Gross profit-labor cost-operating cost
500ml of 10% fat emulsion 1-2x/wk
HOw much and what percent lipid should be given to pts on PN to prevent essential fatty acid deficiency?
<7%
HbA1c goal for diabetes
60-90 days
HbA1c measures for long term blood glucose control. how long?
What are some aspiration precautionary measure that should be taken with tubefeedings?
Head of Bed at 30 degrees, hold residuals if they are >/= 250ml, the patients starts vomiting
What program's goals include increasing life span, reducing health disparities, and providing preventative services for all?
Healthy People 2000
A new cereal is going to be marketed and the company wants to do a food preference survey. What would be the best approach?
Hedonic scale
what bacteria may cause gastric ulcers
Helicobacter pylori
An iron-storage disease, caused by a genetic defect, whereby high amounts of iron are absorbed and stored in tissues that do not normally store iron is:
Hemochromatosis
Which hematological index can be used to evaluate iron and protein deficiencies?
Hemoglobin
Alcoholic Liver Disease stages
Hepatic steatosis (fat build up) Alcoholic hepatitis Cirrhosis
What can a high or low albumin mean?
High Albumin: dehydration, TB, Hepatitis, HIV Low Albumin: drinking too much water, burn or wound, chronic debilitating disease, liver dysfunction
What diet is recommended for patients with pressure ulcers?
High Calorie, HIgh Protein, Can add things like ascorbic acid, zinc oxide and MVIs to aid in wound healing.
homocysteine
High _____ levels are independent risk factors for CHD.
What is an independent risk factor for CHD
High homocysteine levels
Pediatric HIV Nutrition Intervention
High kcal/protein Supplements for wt gain HALS can develop
Diet for Cirrhosis
High protein 0.8-10, in stress at least 1.5 High kcal 25-35 Mod- low fat. MCT if needed. Fat is the preferred fuel. Include omega 3s If varcies- low fiber; If ascites- low Na With hyponatremia- fluid restriction; if steat- low LDL
Hepatic Failure. Treatment
High protein and kcals Low Na if ascites Lactulose and neomycin Altered neurotransmitter theory
What are low cariogenic foods?
High protein, moderate fat, minimal concentration of fermentable CHO Strong buffer High mineral content (Ca, P) pH>6 Stimulates saliva Ed- cheddar cheese, nuts, meat
Formula for PPN
Highest concentration of dextrose used in PPN is 10% Protein: 3-15% Fat: 10%, 20% Solution limited to 800-900 mOsm
(ml) (%) (3.4)
How do you figure out the kcals of a IV dextrose solution?
Replete, but do not overfeed: high calorie, high protein
How do you maintain a stable weight in a pt with COPD?
throw out open containers after 24 hours
How do you reduce bacterial contamination in enteral feeding?
Introduce a minimal amount of full strength enteral feeding at a low rate of 30-40ml/hr to establish GI tolerance; when tolerating 75% by enteral route, d/c PN
How do you transition from PN to EN?
1.1kcal/ml
How many kcals are in a 10% solution of intralipid?
1mL/1 kcal ingested
How many mL of water should be given per kcal ingested in enteral feedings?
avoid simple sugars, 5-6 small meals/dya, spread CHO intake throughout day, decrease fat, limit or avoid EtOH
How to manage postprandial or reactive hypoglycemia
as CRP declines
How would someone utilize C-reactive protein (CRP) to indicate when nutritional therapy would be beneficial?
Serum sodium, blood urea nitrogen, serum osmolality and urine specific gravity are laboratory measures of what?
Hydration status
Hyperkinesis Diet
Hyperactivity- ADHD Feingold diet- experimental treatment. No salicylates, artificial color or flavors Efficacy not proven, + results may be due to placebo effect
Results of physiological trauma from injury
Hyperglycemia, hyperinsulemia, little or no ketosis, increase glucagon 1. Catecholamines epi suppress insulin/hepatic glycogenolysis 2. ACTH: releases cortisol which mobilizes aa from muscles 3. Aldosterone: renal Na retention, gluconeogenesis 4. ADH: Renal water reabsorption 5. Hypovolemia: decreased cardiac output, drop in temp 6. Hyperglycemia: Epi suppresses insulin, insulin resistance (decreased cell uptake and use) 7. Fluid and Na retention, K excretion, loss of nitrogen, sulfur, zinc, phosphorus
Effect of Cyclosporine
Hyperlipidemia, hyperglycemia, hyperkalemia, hypertension (Immunosuppressant)
Ebb and flow response to injury
Hypermetabolic, catabolic response following trauma Accelerated catabolism of lean body mass leading to a negative nitrogen balance as protein is catabolized to release glucose for energy
Effects of Nutrient: Tyramine
Hypertension if taken with MAOI Restrict tyramine by avoiding aged, fermented, dried, smoked, or spoiled food. Avoid hard cheeses, lunch meat, tofu, Chianti Limit sour cream, yogurt, buttermilk Ok: Cottage cheese, cream cheese, ricotta cheese, farmers cheese
Ebb Phase
Hypovolemia, shock, tissue hypoxia
Explain the four stages of pressure ulcers
I. intact skin with non-blanchable redness of a localized area; area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue II. partial thickness loss of dermis presenting a shallow open ulcer with a red pink wound bed w/o slough III. full thickness tissue loss; subcutaneous fat may be visible (bone, tendon or muscle not exposed) IV. full thickness tissue loss with exposed bone, tendon or muscle, slough may be present
Nutrition diagnosis
ID and labeling that describes an actual occurrence, risk of, potential for developing a nutritional problem that dietetics professionals are responsible for treating independently. Dx changes as the pt's response changes
which of the following should be included in the diet for celiac disease: I decrease intake of eggs II use of potato and rice flour III IM vitamin B12 and iron IV low calorie, high fat, high protein
II, III use potato and rice flour and IM vitamin B12 and iron
a patient with Crohn's disease needs the following diet: I high fat, high calorie, high protein II low fat only with steatorrhea, vitamin C, B12 III high calorie, high protein according to current BMI IV high residue, low fat fat soluble vitamins V low calorie, low residue, fat soluble vitamins, B12
II, III: low fat only with steatorrhea, vitamin C, B12 and high calorie, high protein according to current BMI
low protein, low methionine
If a pt with homocystinurias does not respond to the increased doses of vitamins reveived, what type of diet is followed?
low
If edema or ascites in cirrhosis, low or high sodium
free of goitrogens (cabbage family)
If one has a goiter, the diet should be free of what?
< 25 mg/dl
If someone is lactose intolerant and completes a lactose tolerance test, blood glucose will rise how much above fasting
Flat curve
If someone is lactose intolerant and does a lactose tolerance test, will the graph be flat or curved
hypoglycemia
If the liver can't convert glycogen into glucose, this leads to what?
low
If varices are present in cirrhosis, low or high fiber
What is the allergic reaction to a normally harmless food protein?
IgE
What can happen in a jejunal resection?
Ileum can adapt and take over jejunal function
Burns.
Immediate shock period: catabolsim; BMR rises 50-100% First goal: replace fluid and electrolyte loss Recovery period: 1.5-3 g/kg protein, high kcal, Vitamin C, water soluble vitamins, Zn, vitamin K if on antibiotics
Implement, Select, Apply
Implement staff evaluation and development system to improve performance; select & implement appropriate models for supervision and staff development and apply the legal requirements for professional management.
What does Team Nutrition do?
Implements School Meals Initiative for Healthy Children Motivates children to make healthy choices Provides recipes, training, support
obesity
In HTN, what is a major factor in the cause and treatment?
Clinical Domain
In Nutrition diagnosis, this is the domain that includes nutritional findings/problems that relate to medical and physical conditions. It includes functional ( i.e swallowing difficulty), biochemical (i.e increases TG) and weight balance
low in phenylalanine but enough to promote normal growth. phenylalanine (PHE), tyrosine (TYR)
In PKU, the diet is ______? restrit ____ and supplement _____
WITH. regular mealtimes, varied and moderate intake, gradually reintroduced feared foods
In a patient with anorexia nervosa, plan ____ patient: what should be planned?
Wernicke-Korsakoff syndrome
In alcoholic liver disease, long term thiamin deficiency can cause what
Albumin
In ascites, a dilution factor can cause low serum______
throat, rectal bleeding, teeth, esophagus
In bulima nervosa, damage can be done to what?
50-100%
In burns, during the immediate shock period, BMR rises
replace fluids and electrolytes lost
In burns, what should be done first
inc, bind bile acids which lower cholesterol
In cardiovascular disorders, complex CHO should be (inc or dec)? why?
restricted
In chroinc renal insufficiency, when GFR falls, what is the recommendation for protein?
Connective tissue
In cirrhosis, damaged liver tissue is replaced by bands of this which is nonfunctional and divides the liver into clumps, rerouting many of the veins and capillaries
galactose-1-PO4 into glucose-1-PO4
In galactosemia, the enzyme that does what is missing?
glucose-6-phosphatase. gluconeogenesis and glycogenolysis
In glycogen storage disease, there is a deficiency of what enzyme? What does it impair?
high purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackeral)
In gout, what should be avoided in the diet?
inccreased leading to weight loss
In hyperthyroidism, BMR is _____
both elevated
In hyperthyroidism, are T3 and T4 decreased or increased or normal?
decreased leading to weight gain
In hypothyroidism, BMR is _____
T4 low, T3 low or normal
In hypothyroidism, are T3 and T4 decreased or increased or normal?
phenylalanine hydroxylase, tyrosine
In phenylketonuria, what enzyme is missing? What does this convert phenylalanine into?
regular, well-balanced diet with viamin intake to at least DRIs
In skeletal and connective tissue disorders, what is the diet recommendation?
Etiology
In the PES statement, this is linked to the problem by the words related to (aka cause/contributing risk factors)
Symptoms
In the PES, subjective data the patient expresses
Intake Domain
In the nutrition diagnosis, this domain includes actual problems related to intake
Behavioral-Environmental Domain
In the nutrition diagnosis, this domain includes problems related to knowledge, access to food, and food safety
Diabetes
In this disease, AST (SGOT) is decreased when the disease is uncontrolled
Liver disease
In this disease, all four ezymes are elevated (ALP, LDH, AST, ALT)
Prader Willi syndrome. control access to food
In this disease, pt may consume over 5000 kcal/d and still be hungry. Best treatment
Lactose tolerance test
In this test for lactose intolerance, lactose is ingested and a graph of blood glucose is produced.
HCL and intrinsic factor
In tropical celiac sprue, deficiencies of B12 and folate occur to decreased production of these
protein restriction (1,1.5,2 g/kg based on tolerance, age, projected growth rate) due to lower ammonia
In urea cycle defects, what are the protein requirments of the diet and why?
Give an example of a PES statement.
Inadequate oral intake related to chewing difficulties as evidenced by a 10# weight loss in the last month.
Strategies that strengthen local food systems: Farmers Markets
Increase access to fresh produce
Acute Viral Hepatitis. Treatment
Increase fluids to prevent dehydration 50-55% CHO 1-1.2 g pro/kg: cell regeneration, prevent fatty liver Small, frequent feedings b/c of anorexia Mod- lib fat intake Encourage coffee MVI with B complex, C, K, zinc
List the functions of aldosterone.
Increase the resorption of sodium. Increase secretion and excretion of potassium. Increase secretion and excretion of hydrogen. Reabsorb chloride.
Recommended diet for renal patients on dialysis
Increased protein needs, fluid restriction, limit sodium, potassium and phosphorus.
What is the benefit of having a diverse workplace?
Increases the diversity of customers
Name five risk factors for osteoporosis.
Increasing age (post-menopause), female gender, North European heritage; immobility, and reduced calcium in the diet.
High protein diet
Increasing this nutrient in the diet will prevent fatty liver
Glycosylated hemoglobin (HgbA1C) reflects the serum glucose level for what time span?
Indicates serum glucose levels over 100-120 days.
Serum Ferritin
Indicates size of iron storage pool
Cholecystitis. Cause. Effect. Treatment
Inflammation of gallbladder C: Low grade infection E: Excess water is absorbed, causing cholesterol to precipitate out, leading to gallstones- cholelithiasis T: Low fat diet
Gastritis. Effects, Treatment
Inflammation of stomach Effects: anorexia, n/v/d Treat: CL, adv as tolerated, avoid gastric irritants
Stomatitis
Inflammation of the mouth, associated with riboflavin deficiency Avoid very extreme temp foods, spices, sour/tart Rinse with lukewarm water after meals
Diffusion of Innovation
Innovators: Adopt idea rapidly Early adopters: Opinion leaders; well respected Early Majority: Cautious in adopting new idea Late Majority: Skeptical, adopt through peer pressure Laggards: Last to adopt
Least expensive enteral formulas
Intact protein (Not pre-digested) Isotonic (osmolity close to the blood)
If you have two diagnoses from two domians, what should you choose for your PES statement?
Intake dx, because it is more specific to the nutrition professional
Which NG feeding method gives the most mobility?
Intermittent drip (pump or gravity)
Transitional feeing
Intro mini amount of full-strength enteral feed at low rate of 30-40 mL/hr to establish GI tolerance Decrease PN as you increase enteral rate by 25-30 mL/hr increments every 8-24 hours When pt can tolerate 75% of needs enterally, D/C PN
Hematocrit
Iron containing pigment of red blood cells Erythrocytes are produced in bone marrow
What are some different types of anemia?
Iron deficiency anemia, B12 anemia, folic acid anemia, hemolytic anemia, Thalassemia, sickle cell, aplastic anemia.
Nutrition focused physical findings: Nails- brittle, thin, spoon-shaped
Iron or protein deficiency
Gastrectomy deficiency
Iron, B12, Folate. Causes anemia
Nutrition focused physical findings: Skin- pale, dry, scaly
Iron, folic acid, zinc deficiency
What role does renin play in the kidney filtration system?
It acts as a vasoconstrictor, it's secreted by the glomerulus when blood volume decreases; stimulates aldosterone to increase sodium absorption and return blood pressure to normal.
What is the role of aldosterone?
It causes renal sodium retention (it is a corticosteroid secreted by the adrenal glands)
Why is an arm span measurement taken to determine height in a person that is bedridden or unable stand?
It correlates well with height and maturity and is minimally affected by osteoporosis
Breast-feeding is preferred because it provides physical, economical and other advantages. Which is not an advantage of breast-feeding?
It is not always convenient
Fiber
It's main function is to provide bulk and promote intestinal function
Louisiana Purchase
Jefferson secrued the pruchase of this land from the French. It doubled the size of the U. S.
What does JCAHO?
Joint Commision for Accreditation of Health Care Organizations
who resolves differences in bills from the House and Senate
Joint conference committee of the House and Senate
25-35 kcal/kg estimated dry or 1.2-1.5 BEE
Kcal requirements for cirrhosis
<60 yo 35 kcal/kg (including dialysate), >=60 yo 30-35 kcal/kg
Kcal requirements for peritoneal dialysis (based on age).
Exchanges: Alcohol
Kcals: 100
Epilepsy. Diet
Ketogenic diet- high fat, very low CHO Mild dehydration needed to prevent dilution of ketones 4:1 fat to non-fat diet Supplements of Ca, D, B6, B12 MCT are more ketogenic, more rapid metabolism and absorption
List ways in which fluids are excreted or lost from the body.
Kidneys, skin, lungs, GI tract, increased evaporative (large open wounds, draining wounds, fistulas, external bleeding).
the symbol U on a food label indicates
Kosher
Deep and gasping respirations, as developed in acute diabetic ketoacidosis, are called:
Kussmaul respirations
What are the lipid levels of the healthy obese?
LDL high Normal to low HDL
IDL
LDL precursor Found in circulation secondary to catabolism of other lipoproteins
a middle income female needs support for breast feeding. which group will help: Milk Bank, pritikin program, LaLeche, Feingold program
LaLeche
End Stage Renal Disease. Lab values, Effects, Treatment, Goals
Lab: Associated with a BUN >100 and Cr 10-12 Effect: Retention of N metabolites. T: Giovanetti Diet: 20 g protein (HBV); Increase kcals Goals: control edema, prevent deficiencies
Pancreatic enzymes
Lack of these enzymes results in steatorrhea
Adverse effects of enteral feeds
Lactose intolerance Formula hyperosmolality Rapid infusion causes influx of water into gut Bacterial contamination
What happens in lactose intolerance?
Lactose remains intact, exerting hyperosmolar pressure Water is drawn into the intestine to dilute the load- distention, cramps, diarrhea Bacteria ferment undigested lactose, releasing CO2 gas
Enteral bore opening sizes
Large #16: Blenderized whole food Small #8: Ready prepared formula
NHANES III
Large sample of individuals over the age of 65 with no upper limit. Good for study on aging
What influences the severity of SBS
Length and location of resection, age of pt, health of remaining tract. Loss of ileum (especially distal 1/3), loss of ileocecal valve, loss of colon are of particular concern
What is enteral access based on?
Length of time needed Risk of aspiration Pt's Anatomy Clinical Status Normal digestion and absorption
Oliguria is defined as a urine output of _____ .
Less than 500 cc/ 24 hours
What are the different levels of dysphagia?
Level 1- Pureed, Level 2- Mechanical soft, Level 3- Advanced
Elevated
Levels of enzymes in the blood are ________(elevated or decreased) when tissue damage has occurred
Nutrition care of SBS: Ileal
Limit fat, use MCT, Supplement fat sol. vitamins, Ca, Mg, Zn Parenteral B12 followed by monthly injections
What happens if the ileum cannot recycle bile salts (ex- ileal resection)
Lipids not emulsified--> Malabsorption of fat sol. vit Malabsorb fats mix with Ca, Zn, Mg to form "soaps" Colonic absorption of oxalate increases- renal oxalate stones Increased fluid and electrolyte secretion; increase colonic motility
The kitchen closed early due to a tornado drill. The deep fat fryer was not filtered. At dinner the next day, customers were complaining that their eyes were burning and there was an unpleasant odor in the dining room. What happened?
Lipolysis
The cause of an outbreak of a foodborne illness was traced to Brie cheese. What bacterium is probably responsible?
Listeria monocytogenes
The cause of an outbreak of a foodborne illness was traced to unpasteurized milk; symptoms included fever, nausea, headache. The likely source is:
Listeria monocytogenes
what medication is affected by serum sodium levels
Lithium
Hepatic Failure. Cause. Effect
Liver function decreased to 25% or less C: Liver cannot convert NH3 to urea, ammonia accumulates E: Apathy, drowsiness, confusion, coma, asterisix (flapping, jerky motions)
Foods high in iron
Liver, kidney, beef, dried fruit, dried peas and beans, nuts, leafy green vegetables, fortified whole grain products
Arteriosclerosis
Loss of elasticity of blood vessel walls
Radiation side effects and treatments
Loss of taste, esophagitis, diarrhea, malabsorption Xerostomia (dry mouth, so moisten food) Mucositis (inflammation of mucosal lining of oropharynx and esophagus); avoid fresh, raw, uncooked foods. Offer carbonated beverages, frude ades, cold and soft food
What is typically prescribed in a Cardiac diet?
Low Fat, Low cholesterol, low sodium
What type of diet should people with Crohn's disease follow?
Low fiber, low fat diet
legumes, milk, nuts, pasta, ice cream, yogurt
Low glycemic index foods
Refeeding Syndrome
Low serum levels of K, Mg, and Phos with severe, potentially lethal outcome that results from the too-rapid infusion of substrates, particularly CHO, into the plasma with the consequent release of insulin and shift of electrolytes into the extracellular space as glucose moves into the cells for oxidation and there is reduction in salt and water excretion
What are some recommendations that you can make to an oncology patient to help them increase palatability of foods during chemotherapy?
Luke-warm food, don't use strong spices, small frequent meals, high calorie/high nutrient smoothies, don't use metal utensils.
___ has the theory X&Y for manager expectations
MacGregor
IBD treatment- General
Maintain fluid and electrolyte balance Limit fat only if steatorrhea, high fat may improve energy balance; MCT oil All kinds of vitamins
What can happen in an ileal resection?
Major complications Distal- absorption of B12, IF, bile salts Ileum normally absorbs major portion of fluid in GI tract Ileum cannot recycle bile salts
Effect of Chemotherapy
Malabsorption
In developing guidelines for professional practices in ethical decision making: which principle would not be used?
Maleficence
What's the definition of management?
Management is a set of activities directed at an organization's resources to achieve goals efficiently and effectively.
When was the NCP and Model adopted by the ADA House of Delegates?
March 2003
What process in a food service operation includes products, pricing, employees, decor and service?
Marketing
___ ___ is a theory of basic needs and higher human needs (survival, safety, social, self-esteem, self-realization, self-actualization)
Maslow's hierarchy
Block grant areas
Maternal and child health Community services Social services Preventative health services Primary care
Urinary creatinine clearance
Measures GFR
Triceps skinfold thickness
Measures body fat reserve; measures calorie reserves Standard: male12.5mm, female 16.5
Prevalence
Measures how many people have the disease (Total number of people with disease/average number of people) x100,000
Arm Muscle Area
Measures skeletal muscle mass (somatic protein) To determine: Use TSF and Arm Circumference Important to measure in growing children, identifies possible protein energy malnutrition
Serum Creatine
Measures somatic protein; related to muscle mass Excreted by kidneys with little reabsorption With BUN assesses kidney function May indicate muscle wasting
Incidence
Measures the risk of developing the disease (New cases over a period of time/ total number of people at risk) x 100,000
mechanical advantage
Mechanical advantage is a measure of the force amplification achieved by using a tool, mechanical device or machine system. Ideally, the device preserves the input power and simply trades off forces against movement to obtain a desired amplification in the output force. The model for this is the law of the lever. Machine components designed to manage forces and movement in this way are called mechanisms. -two typeS: IDEAL AND ACTUAL
Managed-care Organizations (MCOs)
Mechanism for financing and organizing health care delivery in which providers and payers have predetermined payments for care provided.
_______ diagnosis is a disease of pathology of organs or body systems and does not change as long as the condition exists.
Medical
a TF pt gets diarrhea...prob from?
Medication
Hemoglobin
Men 44%, Women 38%, Pregnant women 33% Volume of packed cells in whole blood
What is the Mifflin-St. Jeor Equation?
Men- (10 x wt in kg) + (6.25 x ht) - (5 x age) + 5 Women- (10 x wt in kg) + (6.25 x ht) - (5 x age) -161
What are some clinical manifestations that can occur in PKU?
Mental retardation, Severe behavioral problems, Neurological abnormalities, Seizures, Eczema
If cells lose acid or accumulate base what condition is occuring?
Metabolic alkalosis (CO2 decrease, H+ decrease, pH increase) lungs lower ventilations (ex. hyperemesis, ingestion of lye)
Oral glucose-lowering medications: Biguanides
Metformin (Glucophage) Enhances insulin action, supresses hepatic glucose production
CAM Categories
Mind-body medicine: yoga. meditation Alternative medicals systems: acupuncture, oriental Lifestyle and disease prevention Biologically based therapy: herbs, orthomolcular meds Manipulative & body-based: Chiropractic Biofield systems: therapeutic touch Bioelectric magnetics
What is a Full Time Equivalent?
Minimum number of employees needed to staff the operation.
The score that occurs most frequently in a frequency distribution is what measure of central tendency?
Mode
Modular vs. blenderized enteral formulas
Modular: Mix individual components; adds flexibility Blenderized: Whole food, large bore tube, thick intact protein, high residue
Dysphagia Mechanically Altered
Moist, soft textured, easily formed into bolus Moist, tender ground or diced meat Soft cooked veg/ fruit or canned fruit No bread, rice, cheese cubes
What is the MNT for spastic CP?
Monitor calorie intake to prevent obesity, high fluid, high fiber to prevent constipation, adequate calcium and vitamin D intake.
Renal Disorders: Renal Calculi. What, Treatment
Most common is kidney stone 1.5-2L to dilute urine Adequate Ca to bind and low oxalate and a low oxalate diet (dglv, chocolate, nuts, beets, strawberries, tea)
most effective tool for getting nutrition education to the community?
My Pyramid
what is the most effective tool for providing nutrition education to the community: RDI's, report Healthy People, My Pyramid/Myplate, The Healthy Eating Index
My Pyramid/ My Plate
which survey is repeated every few years
NHANES
Insulin types: Intermediate-acting
NPH Onset 2-4 hours Duration 10-18 hours Include bedtime snack consisting of CHO and protein
Pregnancy Induced Hypertension
Na restriction not recommended for prevention or treatment; Na needed to maintain normal levels in plasma during large prenatal expansion of tissue and fluid Rapid wt gain after 20th week, edema, proteinuria More frequent in women with lack of prenatal care and poor Ca intake
What are the different accesses for tubefeedings?
Nasogastric, nasoduodenal, nasojejunal, g-tube, j-tube
smooth, pureed (most thick)
National Dysphagia Diet begins with ____ and progresses to ____
Healthy People
National Health Program and Disease Prevention Objectives- Surgeon General- HHS -IDed broad goals and specific objectives for improving health -Focuses on disease prevention by changing behaviors -Healthy wt and diet critical goals
Acronym: NHANES
National Health and Nutrition Exam Survey Run By: National Center for Health Statistics Who it Measures: Ongoing survey to obtain health info about Americans. Evaluates clinical, chemical, anthro, nutritional data, h/h, cholesterol.
NNMRRP
National Nutrition Monitoring and Related Research Program Includes all data collection and analysis activities of the federal government related to measuring the health and nutritional status, food consumption, attitudes about diet and health Jointly run by DHHS and USDA
Acronym: NFCS
Nationwide Food Consumption Surveys Run By: USDA Who it Measures: Obtains info on food intake of individuals and total households from entire US. Evaluates protein, Ca, Fe, Thiamin, Riboflavin, vitamin C, A. Diets rated good if it equals or surpassed RDA. Poor if less than 2/3 RDA for 1 or more nutrient
Strong Heart Diet Study
Native Americans To determine causative factors for obesity, consume 12% fewer calories than the average US population, yet significant increases in heart disease and diabetes Lacking B vitamins and antioxidants
Chemotherapy side effects and treatments
Nausea, vomiting, malabsorption, anorexia Stomatitis- cracks in skin at mouth corners, riboflavin deficiency Methotrexate- anti-folate drug
Paralysis dietary needs
Needs 10% below predicted At least 1.5 L fluid/day
How to teach depends on....
Needs and readiness of the learner
What is the Maslow theory?
Needs exist in a hierarchical order: physiological, safety, belonging/love, esteem, self actualization.
Things to consider when developing a mission statement
Needs of the community, population being served, most critical issues, the present situation, who is saying it's a problem, what will happen if nothing is done
How do you calculate a profit margin?
Net Profit/Sales
Complications of uncontrolled diabetes: Long term
Neuropathy: Peripheral and autonomic; gastroparesis Retinopathy: leads to blindness Nephropathy: Leads to decreased kidney function
What is the potential nutrient deficiency involved when you observe someone with dermatitis, pale, dry, scaly, delayed wound healing, petechial hemorrhages?
Niacin, vitamins A and K, ascorbic acid, essential fatty acids
Identify two key signs of vitamin A deficiency.
Night blindness and keratinization of the skin.
At what point should a women increase her calorie intake during pregnancy?
No increase for the first trimester, 340kcal for the second trimester and 452 for the 3rd
Diarrhea in infants in children: Chronic, non-specific
No significant malabsorption Consider ratio of fat to CHO, volume of ingested liquids Treat: Give 40% kcals as fat, limited fluids; restrict fruit juice with high osmolar load- apple, grape
Systemic Lupus Erythematosus. Treatment
No specific dietary guidelines, tailor to needs
Cerebral Palsy
Non-hereditary brain damage; inadequate control over voluntary muscles
normal <6%, over 65 yo <7% in healthy, <=8% in frail elderly
Normal HbA1c levels (based on age)
Nutrition care of SBS: Jejunal
Normal balance of CHO, Pro, Fat Avoid lactose, oxalates, concentrated sweets V/M supplements
BUN normal range with and without renal disease
Normal: 10-20 mg/dL Renal pt: keep under 100
Mean corpuscular hemoglobin
Normal: 27-32 Microcytic: Low Macrocytic: High
Mean Corpuscular Hemoglobin Concentration
Normal: 32-36% Microcytic: Low <31 Macrocytic: Normal >31
Mean Corpuscular volume. Normal and anemia
Normal: 80-95 Microcytic: Low <80 Macrocytic: High >95
Normal hbA1c
Normal: <5.7% Over 65 and healthy: <7% Frail elderly: <8%
Glucose tolerance test
Normal: sloped Diabetic curve: rounded
Hair analysis
Not used for nutritional assessment Useful in measuring intake of toxic metals
2020 Healthy People Goals Address....
Nutrition & Wt Heart disease and stroke Diabetes Oral health care Cancer Health for Seniors
Define nutrition assessment.
Nutrition Assessment is a systematic process of obtaining, verifying, and interpreting data in order to make decisions about the nature and cause of nutrition-related problems.
"Continually asking the 'why' questions" is a critical thinking skill that falls under which step of NCP?
Nutrition Diagnosis
_______________ is the critical step between nutrition assessment and nutrition intervention.
Nutrition Diagnosis
In the NCPM, which nutrition intervention involves the transfer of knowledge, specific to the knowledge deficit identified in the nutrition diagnosis PES statement?
Nutrition Education
NSI
Nutrition Screening Initiative- Promote nutrition and improve nutritional care for the elderly to identify nutrition problems early Uses DETERMINE checklist- IDs factors that place people at nutritional risk Level 1- people who need more comprehensive assessments Level 2- Potentially greater medical or nutrition problem
Nutrition Diagnostic Labels: Clinical NC
Nutrition findings/problems related to medical/physical condition Functional balance- physical change that prevents desired nutrition results; swallowing, altered GI Biochem balance- change in capacity to metabolize nutrients due to meds, surgery, or indicated by labs Wt balance- chronic or changed wt status
In regards to nutrition screening, what does the Joint Commission mandate?
Nutrition risk is identified in hospitalized patients within 24 hours of admission, but does not mandate the method of screening
AIDS and adjunctive therapy
Nutrition supplements should not be routinely recomm. Herbal should be discouraged Vit. C or St. Johns Wort could result in drug resistance CAM therapies are not inert and may have consequences
Jejunal resection
Nutritional care for this type of resection inclues normal balance of carbohydrates, protein and fat
Ileal resection
Nutritional care of this type of resection includes limiting fat, supplementing fat-soluble vitamins, calcium, magnesium, zinc, and parenteral B12
What is the most influential risk factor contributing to hypertension.
Obesity
What are the critical thinking skills needed for nutrition assessment?
Observe verbal/non verbal cues Determine appropriate data to collect Select tools and procedures and apply in valid, reliable ways Distinguish relevant from irrelevant, and important from unimportant data Validate organize, and categorize data
Reactive Hypoglycemia
Occurs with dumping syndrome. Blood sugar rises rapidly, stimulating an overeproduction of insulin, causing a drop in blood sugar below fasting.
What are the three names you should know when referring to the krebs cycle?
Often called: citric acid cycle or tricarboxylic acid cycle.
congregate meals and home delivered meals fall under what act
Older Americans Act, Title III
<100
Optimal LDL level
Lactose intolerance test
Oral dose of lactose after a fast If intolerant, blood glucose will rise <25 mg/dl above fasting. If tolerance, the rise will be above 25 (normal glucose curve)
Name the three routes by which fluid is supplied to the body.
Oxidative metabolism, oral fluids, solid fluids
Cystic Fibrosis. Treatment
PERT High pro, high kcal, unrestricted fat, liberal in salt Calories to cover RDA for age/sex Supplement water sol. forms of fat sol. vitamins, especially A & E
Pancreatitis Treatment: Chronic
PERT: pancreatic enzymes orally with meals and snacks to minimize fat malabsorption. MCTs do not require pancreatic lipase, so add Give max level of fat tolerated to maintain wt Fat sol. vitamins in water sol. form. Parenteral B12 Avoid large meals with fatty foods, alcohol
Documentation Styles
POMR, PES, and SAP are examples of this that are determined by the facility
More than 2000 additives are used today, as important ingredients of processed and convenience foods. Which of the following additives are meat tenderizers?
Papin and bromelin
Levodopa is used in the treatment of
Parkinson's disease
Medicare: Part A vs. Part B
Part A- hospital insurance Part B- Optional insurance for supplementary benefits
When to use a transpyloric tube?
Passed by pyloric valve in stomach Used in comatose or pts with no gag reflex
The menu planner should study the population to be served. Which of the following data is the least important to study?
Past experience and opinions with that type of foodservice
Identify the type of patient that would require TPN.
Patients with a nonfunctional GI tract.
Third party reimbursement
Payment by a third party for services rendered by a healthcare provider to a pt (Blue cross, Medicare)
Which of the following foods are responsible for the majority of allergic reactions?
Peanuts, eggs, milk
Common allergens
Peanuts, eggs, milk, soy, wheat, shellfish Cow's milk is most common for infants Introduce eggs at 24 months, nuts and fish at 36 months
Foods that contain prebiotic compounds
Pectin Fructose Oats Banana Flakes
Prebiotics
Pectin, fructose, oats, and banana flakes are examples of
What do soluble fibers do?
Pectins, gums Delay gastric emptying, absorb water, form soft gel in SI; slows passage and delays or inhibits absorption of glucose and cholesterol
Acronym: PedNSS
Pediatric Nutrition Surveillance System Run By: HHS Who it Measures: Low income, high risk children, emphasis on birth- 5 years. Checks ht, wt, h/h, cholesterol, breast feeding. Monitors growth and nutritional status, infant-feeding practices
What TPN is used for short or moderate term infusion?
Peripherally inserted central catheter
COPD. What, Treatment
Persistent obstruction of airflow through lungs T: Indirect calorimetry to determine kcal needs. Maintain stable weight. Replete, but do not overfeed
Components of DGA
Physical activity Limit trans fat to less than 1% of kcals Balance kcals consumed with kcals expended Reduce bad foods, Increase good foods Food safety
What are the two components of nutrition intervention?
Planning and implementation
What are the two main components that make up nutrition intervention?
Planning and implementation
Indications for PPN
Post-surgery when enteral feeding is expected to resume within 5-7 days Mild -moderate malnutrition As supplement to enteral
What nutrient is depleted with Furosemide/Lasix use?
Potassium
Oral glucose-lowering medications: Amylin antagonist
Pramlintide (Smylin) Decrease glucagon production
Stages of Change Model
Pre-Contemplation: not interested in change Contemplation: Thinking about it Preparation: Plans the change Action: Tries to make the change Maintenance: Sustains the change
_______ is a transport protein synthesized by the liver and transported in the serum as a complex of retinol-binding protein and vitamin A; a negative acute-phase reactant protein with a short half life.
Prealbumin
What is the difference between a prebiotic and a probiotic?
Prebiotics are non-digestible substances that may promote "good bacteria in intestines. Probiotics are live bacteria that may promote balance of "good" bacteria in gut.
Elemental Formulas Overview and Examples
Predigested protein Absorbed in proximal intestine Used with compromised GI or inability to digest and absorb Ex- Alitraq, Peptamen, Vivonex
Acronym: PNSS
Pregnancy Nutrition Surveillance System Run By: HHS Who it Measures: Low income, high risk pregnant women. Checks maternal wt gain, anemia, pregnancy behavioral risk factors, birth wt, counts # of women who breast feed. IDs and reduces pregnancy-related risk factors
Budget Cycle
Prepare request Evaluate revenue potential Formulate document Send to legislative body Legislative review and authorization Execute budget Evaluation and review
Strategies that strengthen local food systems: PPFPs
Prepared and Perishable Food Programs Non-profit programs that link sources of unused, cooked, and fresh foods with social service agencies that serve the hungry
Monroe Doctrine
President James Monroe's statement forbidding further colonization in the Americas and declaring that any attempt by a foreign country to colonize would be considered an act of hostility
PES Statement
Problem (altered, impaired, increased, risk of) Etiology, cause/contributing risk factor. ("related to") Signs/Symptoms. (Objective data, observable changes, changes the pt expresses) ("as evidenced by"
What are the four components of the Nutrition Diagnostic Reference Sheet?
Problem or nutrition dx label Definition of the label Etiology Signs/Symptoms
Nutrition Diagnostic Labels: Behavioral-environmental NB
Problems related to knowledge, access to food and food safety
Hormones Involved in renal Function: Erythropoietin
Produced by kidneys; stimulates bone marrow to produce RBC
4 "P's" of marketing
Product is acceptable Place is accessible Price is reasonable Promotion tailored to enable attention
Marasmus
Protein and calorie starvation Anthropometric dx; serum albumin normal, no edema Severe fat and muscle wasting
1.2g/kg (at least 50% HBV); 30-35kcal/kg
Protein and kcal requirements for hemodialysis.
Nephrosis. Treatment
Protein controlled 0.8-1.0, 75% from HBV Fat restricted <30% Modest Na restriction
Effect of Glucocorticoids, antibiotics
Protein deficits
0.8-1.0 g/kg, 1.5g/kg
Protein requirements for cirrhosis. in stress?
15-20% kcal, malabsorption due to pancreatic deficiency
Protein requirements for cystic fibrosis. why?
0.8g/kg, 15-20% kcal
Protein requirements for diabetes
0.8-1 g/kg (75% HBV)
Protein requirements for nephrosis
1.2-1.3g pro/kg SBW or BW (>50% HBV)
Protein requirements for peritoneal dialysis.
increase 1-1.5 g pro/kg as tolerated, low Na if ascites, adequate caloires, vit/min supplement
Protein, sodium, kcal, vit/min requirements for hepatic failure (ESLD)
Iatrogenic malnutrition
Protein-calorie malnutrition Brought on by treatment, hospital, medications
Nutritional problems associated with cancer
Protein-kcal malnutrition, malabsorption, fluid and electrolyte imbalance Altered taste acuity: add flavors and seasonings Meat aversions Thrush from oral infection: avoid spicy, acidic, strongly flavored foods. Provide bland liquids, soft foods, chilled or frozen foods
Exchanges: Plant based protein
Protein: 7 Everything else varies
Exchanges: Lean Meat
Protein: 7 Fat: 0-3 Kcals: 45
Exchanges: Medium-Fat Meat
Protein: 7 Fat: 4-7 Kcals: 75
Exchanges: High-Fat Meat
Protein: 7 Fat: 8+ Kcals: 100
PT
Prothrombin time. 11-12.5 seconds, 85-100% of normal Anticoagulants prolong PT Evaluates clotting adequacy; change in vitamin K intake will alter rate
Hiatal Hernia
Protrusion of a portion of the stomach above the diaphragm into the chest. Heartburn.
According to Bloom's taxonomy, what type of learning is involved when a client demonstrates how to cook a meal unassisted?
Psychomotor
which patient has marasmus? Patient A: male, serum albumin 3.5, transferrin 275, triceps skinfold 3, MAMC 15 Pt B: female, serum albumin 2.6, transferrin 125, triceps skinfold 16.8, MAMC 24.1, TLC 1000 Pt C: m, albumin 4.0, transferrin 450, triceps 17, MAMC 28.1, TLC 3500
Pt A: male, serum albumin 3.5, transferrin 275, triceps skinfold 3, MAMC 15
How to meet the nutrition needs of the homeless
Put WIC clinics at shelters Offer education and training to staff and volunteers at food kitchen
What is the only unreversable action in the krebs cycle?
Pyruvate --> Acetyl CoA
BMI
Quetelet index KG/m^2 Lbs/(inches^2)(703) Healthy adults: 18.5-24.9 Healthy elderly: 24-29
Protein Solution in TPN
Ratio for anabolism 1 g N/150 kcals %= # g protein/100 ml solution
You manage the foodservice department at an LTC facility with a stable census of 350. You notice that over the past few weeks there has been an increase in overtime paid. Which is not a possible cause?
Realistic work schedules
In making decisions, which of the following steps should be taken?
Recognize and analyze the problem, gather data, choose action, take action and follow-up.
RDA
Recommended Dietary Allowances Replaced by DRI
Roux-en-Y Gastric Bypass
Reconstructs SI to resemble the letter Y Connects small gastric pouch to jejunum Dumping syndrome may occur Potential anemia, deficiencies in K, Mg, folate, and B12. Supplementation is necessary
Quasi- governmental agencies that provide assistance
Red Cross National Research Council
Hypogeusia
Reduced acuity of taste sensation as caused by certain drugs.
Myocardial infarction
Reduction of coronary flow to myocardium due to blood clot blocking narrowed coronary artery
Osteoblasts
Reform bone
Insulin types: Short-Acting
Regular insulin Take 30-45 minutes before meal One unit covers 10-15 g CHO Duration 3-6 hours
Altered Neurotransmitter Theory
Related to Hepatic Failure BCAA low and AAA high because liver unable to clear them. Abnormal ratio may bring on the symptoms Add BCAA- provides extra nitrogen, kcals + pro May not reduce symptoms, used when standard therapy does not work
Cholecystectomy
Removal of gallbladder Bile now secreted from liver directly to intestine
Adult Diarrhea.
Remove the cause, bowel rest, replace lost fluids and electrolyes. Begin with low fiber foods, followed by protein foods. Fat need not be limited. Avoid lactose Probiotics and prebiotics may help
Specialized enteral formulas: Renal, Pulmonary, Liver, Diabetes
Renal: Nepro, Suplena Pulmonary: Pulocare, Respalor (High fat, low CHO) Liver: Hepatic Aid Diabetes: Glucerna
vasoconstrictor
Renin is a
What is "weight cycling"?
Repeated bouts of weight loss and gain which appears to result in increased body fatness with the end of each cycle.
Entitlement Program
Requires payment of benefits to all eligible people as established by law for a specific population who meet certain income or other eligibility requirements
Osteoclasts
Resorb and remove bone
If lungs decrease ventilation what condition is occuring?
Respiratory Acidosis (CO2 increase, H+ increase, pH decrease), kidneys compensate by conserving bicarb (ex. emphysema, COPD)
What health risks are associated with dysphagia?
Respiratory infections, aspiration, weight loss, and anorexia
Acute respiratory distress syndrome (ARDS)
Respiratory insufficiency marked by progressive hypoxemia due to severe inflammatory damage causing abnormal permeability of the alveolocapillary membrane. Alveoli fill with fluid which interferes with gas exchange
Pancreatitis Treatment: Acute
Rest pancreas. Withhold feeding, maintain hydration IV Elemental enteral nutrition to jejunum Progress to easily digested food w/ low fat
PKU. Treatment
Restrict phenylalanine, supplement tyrosine Need for pheny. decreases with age and infection Low protein, high CHO intake may lead to increased dental caries
hyperglycemia, hyperinsulinemia, litter or no ketosis, increased glucagon
Results os physiological trauma
HDL
Reverse cholesterol transport Moves cholesterol from cells to liver and excretion
Components of nutrition assessment: Review
Review data for factors that affect nutritional and health status
Nutrition focused physical findings: Lips- swollen, red, dry, cracked
Riboflavin, niacin, B6 deficiency
What food is least likely to cause an allergy?
Rice
Headstart
Run By: DHHS What it Does: Low income children. Introduces new foods and teaches good food habits
Elderly Nutrition Program
Run By: DHHS What it Does: One hot meal 5 days/week, provide 1/3 RDA. counseling, nutrition education, referrals, social interaction Eligibility- All aged 60+ and spouse, regardless of income
Healthy Start
Run By: DHHS What it Does: Reduce infant mortality and improve health of low income women, infants, children, families
Maternal and Child Health Block Grant
Run By: DHHS, Under Title V of Social Security Act What it Does: Fosters public health nutrition programs at the state and local levels. Provides training, consultation, funding. Helps women of child-bearing age, infants, children.
WIC
Run By: USDA What it Does: Provides food for low income mothers at nutrition risk (abnormal wt gain, hx of high risk, LBW, underweight, overweight, anemia) Pregnant, postpartum, bf women, infants up to 5 Health exam required
Commodity Food Donation/Distribution Program
Run By: USDA What it Does: Provides foods to help meet the nutritional needs of children and adults and strengthens agricultural market for products produced by American farmers. Food given to school lunch, elderly feeding, supplemental food program
Child and Adult Care Food Program
Run By: USDA What it Does: Reimburses operators for meal costs at day care centers and neighborhood houses. Provides commodity foods and nutrition education materials. Must serve meals that meet the guideline; must offer free or reduced price to eligible
Nutrition Education Training Program
Run By: USDA What it Does: Trains teachers and school foodservice personel
Summer Food Program
Run By: USDA- FNS, state education agencies, nonprofit summer camps What it Does: Expands foodservice program while school isn't in session. Objective is to provide meals or snacks to children at participating institutions in poor areas
EN w/ protein in form of small peptides and amino acids are good for pt w/
SBS
What liver function test is decreased in uncontrolled diabetes?
SGOT
Scope od dietetic practice framework which includes 3 compnenets, building blocks, that help determine whether a service is within your scope of practice.
SODPF
___ describes in general terms a competent level of nutrition care practice as shown by the NCP
SOP
Standards of professional performance which is a competent level of behavior in a professional role
SOPP
___ describes a competent level of behavior in the professional role
SOPP
How do you calculate a Gross profit/loss?
Sales - cost of goods sold
The bakery has had a lot of complaints about the toughness of bread made yesterday. The cook discovered one of his ingredients still on the counter. Which ingredient would result in tougher yeast bread if omitted?
Salt
What is the recommended method when putting more than 1 oz of product in a recipe?
Scale
Effect of Elavil
Sedative effect, weight gain, increased appetite
Activity factors
Sedentary: BEEx 1.2 Active: BEEx 1.3 Stressed: BEE x 1.5
Lewis and Clark
Sent on an expedition by Jefferson to gather information on the United States' new land and map a route to the Pacific. They kept very careful maps and records of this new land acquired from the Louisiana Purchase.
When reviewing the serum Ca level, what other lab value must be evaluated in light of a depleted serum calcium?
Serum calcium is protein-bound; therefore, when reviewing a serum calcium level, serum albumin must also be reviewed.
RAST Test
Serum is mixed with protein on a paper disk; measured IgE antibodies. Outside the body
TTHY transthyretin, PAB prealbumin.
Short half life (2-3 days); picks up changes in protein status quickly Best visceral protein to evaluate
Avoid
Should a patient with an ulcer avoid or be encourage to each a late night snack?
Gastric Banding
Small gastric pouch created using a fluid-filled inflatable band Adjusted to alter size of the opening (fully reversible) Will not require supplementation
Hiatal Hernia diet
Small, bland feedings, avoid late night snack Avoid caffeine, chili powder, black pepper
Mircocytic, hypochromic anemia
Small, pale cells; due to iron deficiency Associated with chronic infection, malignancies, renal disease. All values except RBC are low
National Dysphagia Diet: NDD1
Smooth, pureed, homogenized, cohesive foods "Pudding like" Avoid gelatin, fruited yogurt, hot cereal and soup with lumps
What 4 nutrients should be limited a patient with CKD's diet?
Sodium, Protein, Potassum, Phosphorus
What does SMART goals stand for?
Specific Measurable Achievable Realistic Timed
Aspects of Objectives
Specific measurable actions Contain target dates, expected results in qualitative and quantitative terms, standards of performance. Serves as motivators Does not include: Appreciate, understand
SMART goals is an acronym for____________
Specific, Measurable, Achievable, Realistic, Timed
Specificity vs. Sensitivity
Specificity: Can it ID a pt without a condition Sensitivity: Can it ID those with a condition
Liquid consistency
Spoon thick: Honey/nectar Thin: all other beverages
lactulose
Standard treatment for someone with ESLD involves what
What does SNL stand for under NCP documentation?
Standardized Nutrition Language
Renal Disorders: Acute Kidney Injury, Acute Renal Failure. Treatment
Start with low protein to prevent dialysis. Advance as renal function improves Adequate kcal to spare protein
What is the contingency approach?
States that the most appropriate structure depends on the technology used, the rate of environmental change, and other dynamic forces.
Function of liver
Stores and releases blood, filters toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance
An infant on TPN recieves insufficient fat emulsion. What will develop?
Stunted growth, hair, and skin changes; essential fatty acid deficiency
Examples of screening tools
Subjective Global Assessment (includes medical history and physical exam) Mini Nutritional Assessment Nutrition Screening Initiative
What is SGA?
Subjective Global Assessment- nutrition screening method that combines the efficient medical record review with direct client involvement. Assesssment is based on client history and physical examination. Clients are subjectively rated as well nourished, moderately nourished or severely malnourished.
Renal Disorders: Acute Kidney Injury, Acute Renal Failure. What, Cause, Effect
Sudden shutdown w/ previously adequate capacity; Decreased GFR C: Burns, accident, Obstruction, severe dehydration E: Oligura (low urine output), Azotemia (increase in urea in blood)
What does not promote tooth decay?
Sugar alcohols: sorbitol, xylitol
Oral glucose-lowering medications: Insulin secretegogues
Sulonylureas, meglitinides (Glucotrol) Promote insulin secretion
Performance budget
Summarizes program activities performed in terms of the cost of specific accomplishments
If a patient is taking over 30mg of iron in a day; what is the recommended supplementation of other vitamins/minerals?
Supplement with 15mg of zinc and 2mg of copper
SNAP
Supplemental Nutrition Assistance Program Run By: USDA What it Does: Least costly of USDA four food plans. Assist low income with monthly benefits. Designed to increase their purchasing power, not for non-food items. Figures adjusted for the cost of food in Thrifty Food Plan each June
500-1000 mg Vit C w/ stage III or IV or if deficent, 220 mg zinc sulfate and daily dietary source of vit A
Supplements for decubitus ulcer
oliguria
Symptom of acute renal failure that is a urine output of <500 mL
azotemia
Symptom of acute renal failure that is inc urea in blood
albuminuria, edema, hyperlipidemia
Symptoms of nephrosis - nephrotic syndrome
Which problem solving tool uses metaphorical thinking to "make the familiar strange and the strange familiar"?
Synectics
General Nutrition care of SBS
TPN initially Enteral- start early to stimuate growth, increase overtime May take weeks or months to transition to food
TANF
Temporary Assistance for Needy Families States determine the eligibility of needy families and the benefits and services those families will receive
Schilling Test
Test to detect defects in vitamin B12 absorption. Patient is given oral dose of radiolabeled cobalamin and an injection of unlabeled vitamin. The vitamin saturates vitamin B12 storage sites so that all of the radiolabeled vitamin absorbed is excreted in the urine w/ approx 24 hrs. If less than the expected amt appears in the urine B12 malabsorption is confirmed
USDA and HHS
The 2005 Dietary guidelines for Americans are writen by the.....
Credibility, Accuracy, Reasonableness, and Support
The CARS checklist when evaluating health information (acronym) stands for
Food Security
The access by all people at all times to sufficient food for an active and healthy life Access to nutritionally adequate food with the ability to acquire them in a safe way
What are direct costs?
The actual labor hours and raw materials needed to produce a product.
What is retrogradation?
The breaking of some of the H bonds holding the gel together in a continuous network and the reformation of other H bonds by the amylose molecules within the gel
What is differential diagnosing?
The determination of which of many problems with similar symptoms is the correct diagnosis for the patient. Making a differential diagnosis requires comparisons and contrasts of all findings.
Describe the ebb and flow phases as they relate to severe injuries.
The ebb phase occurs immediately following an injury and the flow phase follows fluid resuscitation and restoration of oxygen transport.
Several major changes in the production system were announced months ago. Employees had a negative attitude at the time. Now that the equipment is being installed, employees are verbally negative to the changes and uncooperative toward management. What seems to be the problem?
The employees perceive that the equipment does not meet their needs
higher
The longer the blood glucose is high, the higher or lower the HbA1c?
Loss of ileum, loss of ileocecal valve, and loss of the colon
The loss of these parts of the intestine are of particular concern with short bowel syndrome
Black Box Warning
The most serious warning required by the FDA on drug labels; such warnings appear in a box surrounded by a black border at the beginning of the label information.
The degree of saturation for fatty acids is based on which on of the following?
The number of carbon-carbon double bonds
Acute Viral hepatitis
The nutritional therapy recommended for this illness includes increasing fluids, high protein, high calories, and moderate fat.
Diverticulosis. Cause, treatment
The presence of diverticula- small mucosal sacs that go through the intestinal wall due to structural weakness. Cause:Constipation and lifelong intra-colonic pressures Treat: High fiber diet
Nutrition Monitoring
The review or measurement of a selected nutrition care indicator
Problem, Etiology, Symptoms
The three parts of a PES statement are
Aid in healing
Therapeutic amounts of vitamin C are recommended in patients with IBD to
fruits and vegetables (carotenoids, vit C)
There is some evidence that what foods are beneficial in overall cancer prevention?
hyperglycemia. epinephrine suppresses insulin, insulin resistance (dec cell uptake and use). fluid and Na retention, potassium excretion, loss of N, sulfer, Zn, P
These are results of the metobolic reponse to injury.
Chronic bloody diarrhea, weight loss, electrolyte disturbance (Na and K)
These are symptoms of ulcerative colitis
Oat Bran (insoluble), and soluble fibers
These fibers decrease serum cholesterol by binding bile acids which leads to the body converting more cholesterol into bile
Cayenne and black pepper, large amounts of chili powder, excess caffeine and alcohol
These food items should be omitted when a patient has an ulcer
Eophageal varices
These occur when blood can't enter the liver. It is the outpouching of vessel walls
A 37-year-old patient is admitted with chronic alcohol abuse and continues to consume excessive alcohol. Which of the following vitamins should be recommended?
Thiamin and folate
What disease can be caused by alcoholic liver disease?
Thiamin deficiency- Wenicke-Korsakoff Syndrome
Management of Hypertension
Thiazide diuretic may induce hypokalemia Modifiable factors: overwt, high Na, alc, phys inactive DASH diet Mediterranean diet may have a positive effect
Billroth I
This form of a gastrectomy attaches the remaining stomach to the duodenum. It is a less serious surgical procedure
Billroth II
This form of a gastrectomy attaches the remaining stomach to the duodenum. It is a more serious surgical procedure
Diverticulosis
This form of diverticular disease is treated with a high fiber diet
Diverticultitis
This form of diverticular disease is treated with clear liquids, low residue or elimental diet, with a gradula return to a high fiber diet
Tropical Sprue
This is a chronic GI disease of intestinal lesions, thought to be causes by a bacteria. Unlike its counterpart, it can affect the stomach.
Hiatal Hernia
This is a protrusion of a portion of the stomach above the diaphragm into the chest
Non-Tropical Sprue, Celiac Disease
This is a reaction to gluten
Ulcer
This is an eroded mucosal lesion
Short Bowel Syndrome
This is defined as the consequences associated with significant resections of the small intestine
Gastritis
This is inflammation of the stomach. The symptoms are anorexia, nausea, vomiting and diarrhea
Nutrition Diagnosis
This is the identification and labeling that describes an actual occurrence, risk of, or portential for, developing a nutritional problem that dietetics professionals are responsible for treating independently. It changes as the patient's response changes
Water and electrolyte reabsorption
This is the main function of the large intestine or colon
Anorexia
This is the major symptom of acute viral hepatitis
Diverticulosis
This is the presence of diverticula. It is related to constipation and lifelong intra-colonic pressures
cholecystectomy
This is the surgical removal of the gallbladder
Diverticulitits
This is when the diverticula become inflamed as a result of food and residue accumulation and bacterial action
Ascites
This occurs when blood cannot leave the liver
Ileum
This part of the small intestine can adapt and take over jejunal functions is there is a jejunal resection
Dumping Syndrome
This sometimes follows a gastrectomy. It occurs when rapidly hydrolyzed carbohydrate enters the jejunum and water is drawn in to achieve osmotic balance. The CHO is rapidly absorbed and causes symptoms such as cramps, rapid pulse, weakness and perspiration
What does it mean to have a prime supplier or a single source supplier?
This supplier is used for most purchases.
Can eat
Those with Celiac Disease can or cannot eat the following: corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax
Cannot eat
Those with Celiac Disease can or cannot eat the following: wheat, rye, oats, barley, bran, graham, malt, bulgur, couscous, durum, orzo
malnutrition (esp protein), lack of exercise, decline in estrogen. A reduction in amount of bone due to defiective calcium absorption.
Three causes of osteoporosis. What is the result?
Iodine constitutes a significant part of which two hormones?
Thyroxine and triiodothyronine
What happens to the liver enzymes in liver disease
Tissue damage causes them to leak into circulation, and the enzyme levels in blood are elevated
Energy in TPN. Max dextrose
To avoid overfeeding start at 20-25 kcal/kg Max dextrose should not exceed 4-5 mg/kg/min to prevent hyperglycemia; Increased blood glucose from excess dextrose increases RQ in ventilated pts and increases infectious complications
What is the purpose of Biguanides?
To lower blood glucose by decreasing the release of glucose in the liver, making cells more sensitive to insulin and loweing insulin resistance.
alkaline ash - vegs, milk, fruits
To prevent acidic stones, create an alkaline or acidic ash?
acidic ash - corn, meat, fish, fowl, eggs, cereal, plums, prunes, cranberries
To prevent alkaline stones, create an alkaline or acidic ash?
UL
Tolerable upper level not associated with adverse side effects in most individuals of a healthy population
Name the iron transport protein.
Transferrin
Concerns with TPN
Translocation of bacteria; Not feeding through gut allows walls to breakdown; Bacteria move out causing sepsis GALT (Gut associated lymphoid tissue) compromised by bowel rest or TPN. Provides immunity
LDL
Transports cholesterol from diet and liver to all cells
Chylomicron
Transports dietary TG from gut to adipose cells Synthesized in intestine from dietary fat Lowest density due to smallest amount of protein
VLDL
Transports endogenous TG from liver to adipose tissue
Esophagitis
Treat by decreasing gastric acidity, reflux Diet- small, bland, low fat, low fiber, wt reduction
hormone replacement therapy, weight-bearing exercise, vit D and Ca supplements
Treatment for osteoporosis
True or False Standardized care means that all patients receive the SAME care
True
True or False: Nutrition prescription establishes framework for patient goals and intervention strategies.
True
True or False: The central core of the NCP model represents the relationship between the patient/client and dietetics professional.
True
false
True or false, sugar causes hyperactivity?
What is Tryptophan a precursor to?
Tryptophan is a precursor to niacin as well as seratonin.
Chron's disease and chronic ulcerative colitis
Two forms of inflammatory bowel disease
What nutrient is affected when a patient is on MAO inhibitors?
Tyramine (restrict intake)
which government agency would you contact regarding food distrobution
USDA
Healthy Eating Index
USDA's overall measure of diet quality Measures how well Americans follow the guidelines 5 food groups, 4 nutrients (fat, sat fat, cholesterol, Na), variety
who regulates WIC and Food stamps and what is a similar criteria requirement
USDA, both have income criteria
Commodity Supplemental Food Program
USDA, under Commodity Food Donation. Administered by state health agencies What it Does: Monthly commodity canned or packaged food. Low income women (preg, bf, postpartum), infants, and children up to 6 years, some elderly
Your clinic provides nutrition intervention for parents of low-birthweight babies. What guidelines are used to determine low-birthweight?
Under 5.5 pounds
The Emergency Food Assistance Program
Under USDA Commodity Food Donation. Distributed by local, public or private nonprofit agencies Quarterly distributions of supplemental diets for low income households
What is a shop steward?
Union representation on site (non-paid)
TLC Diet
Up to 35% kcal fat, <7% sat, 10% PUFA 25-30 g fiber Stanols and sterols- 2g Exercise DBW
What part of management are strategic and long-range goals apart of?
Upper management
Lab Tests in Renal Disease
Urine test- Decreased glomerular filtration rate, creatinine clearance Blood- Increased serum creatinine, BUN Renal solute load- solutes excreted in 1 L urine, mainly measures nitrogen and electrolytes
% weight change
Used to assess potential nutrition risk. Stresses significance of weight change (Usual-actual)/usual
Gastroplasty
Uses staples to create a small gastric pouch Only a small opening into the distal stomach Liquids-> pureed-> soft-> regular small meals and snacks
Hormones Involved in renal Function: Renin
Vasoconstrictor Secreted by glomerulus when blood volume decreases Stimulates aldosterone to increase Na absorption and return BP to normal
Serum Transferrin
Visceral protein Rises with iron deficiency Can be determined from TIBC- total iron binding capacity
Serum Albumin
Visceral protein in blood and organs Maintains colloidal osmotic pressure Hypoalbumineria= edema Hyperalbuminera= dehydration
Which vitamin is most likely to cause birth defects in the developing embryo if taken in mega doses during pregnancy:
Vitamin A
Nutrition focused physical findings: Eyes- pale, dry, poor vision
Vitamin A, zinc, riboflavin deficiency
Nutrition focused physical findings: Gums- sore, red, swollen, bleeding
Vitamin C deficiency
Nutrition focused physical findings: Tongue- smooth, slick, purple, white coating
Vitamin or iron deficiency
Non- Government agencies that provide nutrition assistance
Voluntary health agencies, ie- American Heart Association Professional organizations- ADA Foundations- Rockefeller foundation: conquest of hunger
to learn about prenatal problems in the community, go to:
WIC
which program teaches good nutrition practices and provides foods with certain nutrients: EFNEP, NET, WIC, MCP
WIC
What happens in the loss of colon?
Water/electrolyte loss, loss of salvage absorption of CHO and other nutrients
WLPS
Weight Loss Practice Survey Run By: HHS Who it Measures: 18 and older currently trying to lose wt. Demographic info on BMI, diet hx, self-perception
If a child is chronically malnourished in what order would the growth parameters be affected?
Weight first, length, then head circumference
What is the greatest nutritional treatment for gout?
Weight loss.
Pediatric Overweight Intervention
Weight maintenance Weight loss may be recommended if they have a serious medical condition
Dietary Reference Intakes which are nutrient goals to be achieved over time
What are the DRIs and what are the goals?
to prevent chronic disease
What are the dietary guidelines designed for?
vitamin C deficiency
What are the possible cause of sore, red, swollen, bleeding gums?
Vitamin A, zinc, or riboflavin deficiencies
What are the possible causes of pale, dry eyes or poor vision?
iron, zinc, or vitamin deficiency
What are the possible causes of pale, dry, scaly skin?
ribolflavin, pyroxidine, or niacin deficiencies
What are the possible causes of swollen, red, dry, cracked lips?
Chemotherapy, vit C, protein deficiency
What are the possible causes of thin, sparse, dull, dry hair?
0.6g/kg, inc to 1.2g/kg if non-catobolic, as GFR returns to normal
What are the protein requirements in acute renal failure?
hypokalemia, hypophosphatemia, and hypomagnesemia
What are the results of re-feeding syndrome in the blood?
dysphagia
What can achalasia cause?
hyperglycemia
What can overfeeding PN and dextrose of >5mg/kg/min lead to?
normal=sloped, diabetic=rounded
What do the glucose tolerance test -blood test curves look like for normal and diabetic?
Standards of practice in Nutrition care
What does SOP stand for?
Indicative of android obesity aased risk and an increased risk of obesity-related diseases (DM, heart disease)
What does a WHR of 1.0 or greater in men, 0.8 in women indicate?
stimulates bone marrow to produce RBC
What does erythropoietin (EPO) do?
hemoglobin, measures % of hemoglobin that has glucose attached
What does glycosylated hemoglobin measure?
new cases; (# of new cases over a period of time/total number of people at risk) x 100
What does incidence mean and what is the equation used to calculate incidence?
# of existing cases; (total # pf people with a disease over a period of time/ average number of people) x 100
What does prevalence mean and what is the equation used to calculate prevalence?
N (60%) and electrolytes (Na)
What does renal solute load measure?
elevates
What does renin do to blood pressure?
skeletal muscle mass
What does the arm muscle area (AMA) measure?
differntiates between android and gynoid obesity
What does the waist/hip ratio (WHR) tell you?
elevates
What does vasopressin do to blood pressure?
Weight Watchers
What fad diet is nutritionally sound, developed by an MD, RD
Hard, aged cheese, sauerkraut, some sausages, luncheon meats, tofu, miso, chianti wine. Limit sour cream, yogurt and buttermilk
What foods should be avoided on a tyramine restriction?
restrict: aged, fermented foods, dried, pickled, smoked, spoiled foods
What foods should be restricted when on a tyramine restriction?
2005 Dietary Guidelines for Americans
What guidelines do community nutrition programs use when developing plans?
estimated average requirement for 50%of the population
What is EAR?
translocation of bacteria; not feeding through the gut allows wall to break down; bacteria move out causing sepsis
What is a concern when adminstering PN?
adequate intake that is used when insufficient evidence exists for EAR, RDA
What is an AI?
ADH (anti-diuretic hormone)
What is another name for vasopressin?
large sample over the age of 65; no upper age limit
What is different about NHANES III?
Obesity which adds to the increased prevalence of heart disease
What is epidemic in the Native American and Alaskan native people?
severe nausea, vomiting; acidosis, weight loss during pregnancy
What is hyperemesis gravidarum?
They depend heavily on federal food assistance programs
What is one reason why obesity is an epidemic in the Native American and Alaskan peoples?
DRIs
What is replacing the RDAs?
visceral (blood and organs) proteins
What is serum albumin a measure of?
80-86%
What is the % of water in a 1kcal/mL formula?
18.5-24.9
What is the BMI range for a healthy adult?
<100 mg/dl
What is the BUN goal for renal patients?
1.2
What is the activity factor for calculating energy requirements of a sedentary individual?
1.3
What is the activity factor used to calculate the energy requirements of an active individual?
BCAA dec (used by muscles for energy); AAA inc because damaged liver is unable to clear them
What is the altered neurotransmitter theory (hint ESLD)?
somatic protein status
What is the arm muscle area a good indicator of?
TTHY transthyretin
What is the best vsceral protein to use in evaluating a pt's protein status?
DASH; wh grains, fruits, vegs, low fat dairy, poultry, fish, mod Na, limit EtOH, dec sweets
What is the diet recommendation for HTN? be specific
Nutrition survey - examination of a population group at a particular point in time; Nutritional surveillance - continuous collection of data
What is the difference between a nutrition survey and a nutritional surveillance?
mortality = death, morbidity = disease
What is the difference between mortality and morbidity?
decreased folate
What is the effect of methotrexate?
decreased folate, B6, C
What is the effect of oral contraceptives in the body?
decreased potassium
What is the effect of thiazide diuretics?
24-29
What is the healthy BMI range for most healthy elderly persons?
high fat, low glucose (CHO) (<30 g)
What is the ketogenic diet?
4-5mg/kg/min
What is the mx rate of dextrose infusion of PN to prevent hyperglycemia and other complications?
BEE x 1.3-1.5 for weight gain
What is the recommended energy intake for a pt with HIV?
1-1.4g protein maintenance; 1.5-2g protein repletion
What is the recommended protein intake for a pt with HIV?
reduction in amount of bone due to defective calcium absorption (deossification)
What is the result of osteoporosis?
bed rest and small amounts of frequent CHOs
What is the treatment for hyperemesis gravidarum?
biochemical analysis
What kind of analysis is the most accurate measure of nutritional status?
attitudinal data
What kind of data do focus groups contribute to?
<40 (M), <50 (F)
What levels are considered low for HDL in male and females?
maintain consistent sodium and caffeine intake to stabilize levels
What should be maintained when taking litium carbonate?
increased serum creatinine and BUN
What two blood tests are used to test in renal disease?
decreased glomerular filtration rate and creatinine clearance rate
What two urine tests are used to test in renal disease? Are the values inc or dec?
normocytic normochromic, or normocytic hypochromic anemia
What type of anemia may develop in skeletal and connective tissue disorders?
low protein, high CHO
What type of diet mya lead to increased dental caries?
High kcals, high protein, and high fluids immediately upon Dx
What type of diet should be recommended to a pt just diagnosed with AIDS?
a comatose pt or ones with no gag reflex
What type of pt is a transpyloric tube used for?
Raw foods ..pt should be educated about food safety and be placed on a low bac or neutropenic diet
What types of food should a pt with HIV/AIDS avoid?
supplement with vit/min with 100% RDA and a basic B-complex supplement
What vit/min supplements should be recommended for a pt with HIV?
vit A
What vitamin is of particular concern in cystic fibrosis because it is poorly absorbed even with enzymes?
BMR has dropped to reflect loss
When a dieter reaches a plateau, what has happened?
Small, bland feedings
When a patient has a hiatal hernia, heartburn is the main symptom. A patient should be encourage to each what type of meals? (Small, large, bland, flavorful)
hypermetabolic states, cancer pt on therapy, GI disorders (peritonitis), fistulas, severley malnourished pre-op pts, acute pancreatitis, SBS, critical pt if NPO is expected to last for more than 4-5 days and if enteral support isnot possible
When adminster would you administer PN to a pt?
Secretin and Pancreozymin
When food bypasses the duodenum, the secretion of these two enzymes is produced resulting in steatorrhea
Portal hypertension
When the blood can't enter the liver, esophagel varices or outpouches occur due to this
directly into intestine
When the gallbladder has been removed, bile is secreted from the liver to where?
Under what conditions would the mean, median and mode be approximately the same value?
When there is a normal distribution of scores
autodigestion, pancreas digests the pancreas
When there is premature activation of enzymes within the pancreas, this leads to what? what does this mean?
Intramuscular B12 and oral folate
When treating tropical sprue, what two vitamins/minerals are supplemented
liver
Where are VLDL, LDL, and HDL made?
intestine
Where are chylomicrons made?
USDA
Where dies the data come from in the tables of food composition?
paased by the pyloric valve in stomach
Where does a transpyloric tube pass through?
hypothalamus (stored in pituitary)
Where does vasopressin come from?
distal tubule
Where in the nephron does acid-base balance occur?
proximal convoluted tubule
Where in the nephron does major nutrient reabsorption take place?
Loop of Henle
Where in the nephron does water and sodium balance take place?
What does the Schilling test determine?
Whether the client has pernicious anemia or not.
Jejunum and ileum (proximal small intestine)
Which parts of the intestine are affected by Celiac Disease
Gliadin
Which protein in gluten do people with Celiac Disease react to?
infection causes tissue catabolism releasing phenylalanine into the blood
Why does infection increase or decrease the need for phyenylalanine?
Important in indicating possible protein-energy malnutrition (PEM)
Why is it important to measure the arm muscle area in growing children?
Desirable body weight formula
Women: 100 + (5lb)(inch) Men: 106 + (6)(inch) Small frame (-10%) Large frame (+10%)
What is a class A fire?
Wood, paper, rags, ordinary combustibles
IBD: Regional enteritis (Crohn's Disease). Effect
Wt loss, anorexia, diarrhea. B12 deficiency may occur since terminal ileum is effected, which leads to megaloblastic anemia. Iron deficiency due to blood loss, decreased absorption
In MacGregor's Theory ___, people inherently dislike work and will avoid it
X
In MacGregor's Theory ___, work is as natural as play or rest
Y
Sophistication levels: Inexperienced
Young children and adults lacking nutrition training; need thorough introduction and background
YRBS
Youth Risk Behavior Survey Run By: HHS Who it Measures: Grade 9-12. Smoking, alcohol use, wt control, exercise, eating habits
How do you calculate adjusted body weight for the obese and underweight?
[(Usually Body Weight- Ideal Body weight) x .25] + IBW
a man with a peptic ulcer should consume
a balanced diet he can tolerate
Flavor is termed organoleptic because it is determined by:
a blending of odor and taste
who is most at risk for protein calorie malnutrition: cancer pt on chemo, pt with gastric ulcers, pt with Crohn's, pt with megaloblastic anemia
a cancer pt on chemotherapy
an infant with milk hypersensitivity could safely consume: soy milk fortified with calcium, goat's milk fortified with folic acid, a modular formula with crystalline amino acids, a casein hydrolysate formula
a casein hydrolysate formula
an example of a "Healthy People" goal is
a decrease in infant mortality
Provide nutritious meals within the federal and state guidelines. This is an example of:
a goal for school foodservice
trauma can place a pt in
a hypermetabolic state
four pts are admitted to your service. who would you address first: recent MI, gastric distress, cancer pt, appendectomy
a pt with gastric distress
The "Determine Your Nutritional Health Checklist" is:
a screening tool for nutritional status
what is not a likely cause of failure to thrive in a child: vegetarian diet, chronic illness, parental food restrictions due to them being overly concerned with obesity, lack of fiber in the diet
a vegetarian diet
War of 1812
a war (1812-1814) between the United States and England which was trying to interfere with American trade with France
osteoporosis is most likely to occur in
a white female
a 7-year old on a ketogenic diet requires 1500 kcals. Which is the appropriate order? a) 145 g fat, 25 g PRO, 25 g CHO b) 95 g fat, 40 g PRO, 25 g CHO c) 102 g fat, 56 g PRO, 12 g CHO d) 75 g fat, 32 g PRO, 43 g CHO
a) 145 g fat, 25 g PRO, 25 g CHO
An AIDS pt's temp has risen to 102 degrees. His BMR has increased: a) 24% b) 36% c) 12% d) 5%
a) 24%
Who has the greatest water, PRO, and kcal needs per unit of body weight? a) a 6-month old infant b) a 50 year old F c) a 16 year old M d) a 25 year old M
a) a 6-month old infant
Which of the following would lower serum cholesterol levels? a) dried beans b) green beans c) yellow beans d) summer squash
a) dried beans
A dietary deficiency of which of the following causes a macrocytic anemia resembling pernicious anemia? a) folacin b) pyridoxine c) vitamin B6 d) vitamin C
a) folacin
What would the lab values listed previously have likely reflected if the pt had been nauseated and had averaged only 400 kcal from primarily starchy foods over the weekend? a) little or no rise in K+, BUN/creatinine ratio <10 b) increased PO4, BUN/creatinine ratio >15 c) typical rise in K+, BUN/creatinine ratio >15 d) metabolic alkalosis, BUN/creatinine ratio <10
a) little or no rise in K+, BUN/creatinine ratio <10
A tube fed patient develops diarrhea. What is the most likely cause? a) medications b) the osmolality is too low c) the strength is too weak d) it is being given at an improper rate
a) medications
In severe cirrhosis with ascites, diet therapy should be: a) restrict sodium b) restrict CHO and fat c) restrict PRO and sodium d) restrict fat
a) restrict sodium
Enteral feeding products that contain protein in the form of small peptides and AA are recommended for pts who have: a) short-bowel syndrome b) undergone gastrectomy c) undergone colectomy d) undergone jejunostomy
a) short-bowel syndrome
Goals for a community nutrition program should be based on: a) the Dietary Guidelines for Americans b) the Nutrition Screening Initiative c) the Healthy People report d) the NHANES III report
a) the Dietary Guidelines for Americans
Which survey is conducted every 10 years? a) the USDA Food Consumption Survey b) HANES c) Ten State Nutrition Survey d) Preschool Children Study
a) the USDA Food Consumption Survey
When measuring a child's somatic protein mass, in addition to the BMI, use: a) upper arm muscle area b) triceps skinfold c) mid-arm muscle circumference d) knee to heigh ratio
a) upper arm muscle area
A diabetic wants to exchange his bedtime snack of 8 oz whole milk. What do you suggest? a. 1 oz cheese and 1/2 C OJ b. 2 graham crackers and 1/3 C OJ c. 1 oz cheese d. 2 oz cheese
a. 1 oz cheese and 1/2 C OJ
A sandwich with two pieces of white bread and two oz of turkey provides how many kcal? a. 250 b. 145 c. 198 d. 290
a. 250 kcal
Which formula is high in calories and low in protein? a. AminAid b. Osmolite c. Sustacal d. Jevity
a. AminAid
A poor, healthy 19 yo mother is unsure how to feed her 4 yo child, Which program may offer her the most help? a. EFNEP b. WIC c. HHS d. CACFP
a. EFNEP
Where can a pregnant teen learn to cook? a. EFNEP b. Child Nutrition Services c. UNICEF d. WIC
a. EFNEP
90% of nutrition diagnoses should be in what domain? a. Intake b. Clinical c. Behavioral-Environmental
a. Intake
Which survey is repeated every few years? a. NHANES b. WHO c. Ten State d. FAO
a. NHANES
Margarine has fatty acids in this order of predominance: a. PUFA, MUFA, SAT b. SAT, MUFA, PUFA c. MUFA, SAT, PUFA d. MUFA, PUFA, SAT
a. PUFA, MUFA, SAT
If you are on a low phosphorous diet, what foods should you most avoid? a. beef b. orange juice c. yogurt d. bread
a. beef
Which mineral is involved in blood clotting? a. calcium b. phosphorous c. iron d. selenium
a. calcium
Which mineral is absorbed through the intestine and transported with ceruloplasmin in the blood? a. copper b. iodine c. sodium d. calcium
a. copper
The following oils can be winterized: a. corn, soy, cottonseed b. olive, corn, soy c. cottonseed, olive d. olive, corn
a. corn, soy, cottonseed
Which is the best source of emulsification? a. eggs b. milk c. salt d. flour
a. eggs
A pt has a rare urea dz where the body is unable to synthesize urea. What might be the result? a. elevated ammonia levels b. elevated BUN c. elevated glucagon levels d. compromised visceral PRO levels
a. elevated ammonia levels
Lactic acid is produced by: a. glycolysis b. gluconeogenesis c. glycogenesis d. lactolysis
a. glycolysis
What section of the intestine is most likely involved in Crohn's dz? a. ileum b. jejunum c. duodenum d. appendix
a. ileum
Sorbitol is: a. less sweet than sucrose and has a lower glycemic index than sucrose b. less sweet than sucrose and has a higher glycemic index than sucrose c. sweeter than sucrose d. sweeter than sucrose and has a lower glycemic index than sucrose
a. less sweet than sucrose and has a lower glycemic index than sucrose
Which pasta contains egg? a. noodles b. spaghetti c. macaroni d. linguini
a. noodles
Fats high in monounsaturated fatty acids include: a. olive and canola b. safflower and corn c. coconut and palm d. soy and peanut
a. olive and canola
A serum sodium level of 115mEq/L may be due to: a. overhydration b. dehydration c. a very high sodium intake d. a sodium intake of 5.5g/d
a. overhydration
Green peas held on the serving line may turn olive green due to: a. pheophytin b. cholorphyllin c. anthoxanthins d. flavones
a. pheophytin
Which of the following has the fewest calories? a. plain hamburger on bun b. chef's salad with dressing c. green salad with Thousand Island dressing and shredded cheese d. fried fish sandwich
a. plain hamburger on bun
If protein intake is doubled, which nutrient needs to be increased? a. pyridoxine b. folic acid c. niacin d. vitamin c
a. pyridoxine
The main function of glycolysis is to provide: a. pyruvate for the TCA cycle b. lactic acid for energy use by muscles c. muscle and liver glycogen d. a substrate for the Cori cycle
a. pyruvate for the TCA cycle
Illness due to Bacillys cereus is due to contaminated: a. rice products and starchy foods b. fruits c. dairy products d. eggs
a. rice products and starchy foods
When on Dicumarol, avoid increasing your intake of: a. spinach b. beets c. corn d. beef
a. spinach
What is an example fo a program that provides food to the needy? a. the Food Bank b. the Food Stamp Program c. the Child Care Program d. WIC
a. the Food Bank
What is the goal of the Dietary Guidelines? a. the prevention of chronic disease b. provide standards for Food Stamp allocation c. provide standards for WIC d. provide standards for EFNEP
a. the prevention of chronic disease
Metabolites of the Kreb's cycle are: a. water, energy, carbon dioxide b. energy and pyruvic acid c. electrolytes and water d. lactic acid and glycogen
a. water, energy, carbon dioxide
The smoke point temperature for fats is:
above 442 degrees F
what is the most important advice to give a pt with a peptic ulcer
abstain from spicy food
an obese person with type 2 DM should
achieve DBW
McClelland's ___-___-___ theory suggests that people have three needs
achievement-power-affiliation
Fill in the blank: Implementation is the _____ phase.
action
what can be done to lower the respiratory quotient of a tube fed pulmonary pt
add fat emulsion to replace some of the carbohydrates
___ FTE's take into account the benefit days and days off
adjusted
The need for ___ is the desire to be liked by others
affiliation
what is included in the study of demographics? I age of individuals II sex of individuals III population statistics IV socioeconomic factors
age of individuals, sex of individuals, and population statistics
based on the DRG's Medicare reimbursement depends on
age of patient and primary diagnosis
immobilized state can lead to low levels of _
albumin and calcium
the immobilized state can lead to low levels of
albumin and calcium
On an egg-free diet, what should one watch for on the label?
albumin, dried egg solids, globulin, ovoglobulin, livetin, and vitellin
symptoms of nephrosis include
albuminuria, hypercholesterolemia
hypertension will decrease with a decrease in: fiber, alcohol, potassium, calcium
alcohol
causes of pancreatitis
alcoholism, biliary tract disease, hypertriglyceridemia (from uncontrolled DM)
hormone responsible for renal sodium reabsorption and potassium excretion is:
aldosterone
what is true about cows milk: it is high in protein, it creates a high solute load, it is low in iron and vitamin C
all are true
who can participate in nutritional screening
all health team members can participate according to policy
if a pt has a biochemical block in the formation of urea, what will accumulate in his blood
ammonia
15, 0, 0
amount of CHO, pro, fat in fruit exchange
0, 7, 8+
amount of CHO, pro, fat in high-fat meat exchange
0, 7, 0-3
amount of CHO, pro, fat in lean meat exchange
12, 8, 5
amount of CHO, pro, fat in low-fat milk exchange
0, 7, 4-7
amount of CHO, pro, fat in med-fat meat exchange
15, varies, varies
amount of CHO, pro, fat in other CHO exchange
12, 8, 0-3
amount of CHO, pro, fat in skim milk exchange
15, 3, <1
amount of CHO, pro, fat in starch/bread exchange
5, 2, 0
amount of CHO, pro, fat in vegetable exchange
12, 8, 8
amount of CHO, pro, fat in whole milk exchange
5
amount of fat in fat exchange
which is not fiber in the diet: cellulose, hemicellulose, amylose, pectin
amylose
Erie Canal
an artificial waterway connecting the Hudson river at Albany with Lake Erie at Buffalo
the immune system reacts to foods that are normally harmless this is
an immunoglobulin E (IgE) mediated reaction
for past 2 months a man who is 6'0" tall has been nauseated and anorexic and has consumed fewer than 500 cals/day, mostly from sweet foods. his albumin of 5.0 g/dl most likely reflects
an increase in albumin due to dehydration
the effectiveness of a group education program for decreasing the number of anemic pregnant women enrolled in a community nutrition program is best indicated by
an increase in hematocrit or hemoglobin levels
when a starved pt begins to eat, they might expect
an increased workload on the heart
lactic acid is a result of
anaerobic glycolysis
macrocytic, megaloblastic anemia
anemia due to deficiency of folate or B12
what type of anemia is likely to be seen in a pt with arthritis
anemia secondary to chronic disease
In reviewing the pts medical record, you note a hemoglobin of 10 g/dl and MCV of 110 cu mm. you should document
anemia with larger than normal erythrocytes
methods of measuring body fat and lean body mass
anthropometrics (skinfold measurements), underwater weighing and bioelectrical impedance analysis
Lignans which are found in flax seed, wheat bran, oats and barley contain both:
anticancer and phytoestrogen properties
An ___ bill attaches funding to legislation
appropriates
which bill requests government funding: budget bill, markup bill, appropriations bill, spending grant bill
appropriations bill
what disease would a low sodium diet be recommended
ascites
a young girl who is HIV positive with Karposi's sarcoma tells you she would like to take vitamin C supplements, what should you tell her
ask her to keep a food diary to see where she is lacking
the first function of the public health nutritionist is
assess the needs of the community
The first step in problem solving is to ___, ___, and ___ the problem
assess, recognize, analyze
how long should a new mother breast feed
at least 12 months
MacGregor's theory X&Y suggests that a manager's ___ impacts an employee's performance
attitude
As a leader, you should be ___ in times of emergency, otherwise, be ___
autocratic, participative
the stasis of pancreatic juice and bile could result in
autodigestion, fat malabsorption, and obstructive jaundice
the diet for stomatitis is
avoid spices, very hot, very cold, sour, tart foods
Which contains more total dietary fiber: a) 1/2 cup raw spinach b) 1 oz raisin bran cereal c) 1 slice ww bread d) 2 T peanut butter
b) 1 oz raisin bran cereal
In which of the following would you likely see very low albumin if it is drawn a few days after admission to an acute care facility? a) anorexia nervosa b) 30% full thickness burn c) pt with newly diagnosed colon cancer d) pt with COPD
b) 30% full thickness burn
In a TPN mixture, what volume of the AA solutions listed would come closest to providing 185 kcals? a) 1000 ml of 8.5% AA b) 850 ml of 5.5% AA c) 500 ml of 7.0% AA d) 500 ml of 10.0% AA
b) 850 ml of 5.5% AA
For the past 2 months, a man who is 6'0'' tall has been nauseated and anorexic and has consumed fewer than 500 kcals/d, mostly from sweet foods. His albumin of 5.0 g/dl most likely reflects: a) adjustment to the new energy intake b) an increase in albumin d/t dehydration c) increased production of albumin by the liver d/t the catabolic state d) retention of albumin d/t the high CHO/low kcal diet
b) an increase in albumin d/t dehydration
What would a vegan not eat? a) coleslaw made with oil and vinegar b) congealed fruit salad c) salad with tofu dressing d) peanut butter
b) congealed fruit salad
Looking at the previous question, what else would you expect to see? a) increased bicarbonate, increased K+, decreased PO4 b) decreased bicarbonate, increased K+, increased PO4 c) decreased bicarbonate, decreased K+, increased PO4 d) increased bicarbonate, increased K+, increased PO4
b) decreased bicarbonate, increased K+, increased PO4
The best way to counsel a pt with anorexia nervosa is to: a) recommend that the pt increase food intake and attend weekly counseling sessions b) emphasize the health benefits associated with weight gain and increase calorie intake c) maintain a no-nonsense attitude to discourage inappropriate behavior d) remain flexible to help the pt set realistic goals
b) emphasize the health benefits associated with weight gain and increase calorie intake
Which is the primary fuel used by resting muscle and at low intensity exercise? a) glucose b) fatty acids c) BCAA d) keto-acids
b) fatty acids
A nutrition surveillance program is designed primarily to: a) verify data from other surveys b) identify the nutritional needs of the population c) indicate the number of people at increased risk for medical condtions d) indicate the causes underlying the nutrition problems identified
b) identify the nutritional needs of the population
In acute hepatitis, you would likely see: a) decreases in SGOT, increase in SGPT b) increase in both SGOT and SGPT c) decrease in both SGOT and SGPT d) increase in SGOT, decrease in SGPT
b) increase in both SGOT and SGPT
A child presents in the 65th percentile height for age. What does this signify? a) overweight b) normal c) underweight d) small for age
b) normal
An AIDS pt should select the following fresh fruit: a) grapes, orange b) orange, banana, pineapple c) apple, grapes, peach d) grapes, pear
b) orange, banana, pineapple
What change should be made in the following menu if it is to be served to Seventh Day Adventists? tomato juice, cottage cheese fruit plate or egg salad sandwich, milk, coffee, tea a) order fortified soy milk b) order decaffeinated beverages c) offer tofu as an alternative to egg salad d) offer a meat analog as an alternative to egg salad
b) order decaffeinated beverages
A patient with liver disease needs adjustments in the intake of: a) protein, fat, sodium b) protein, fluids, sodium c) protein, kcals, sodium d) fluids, kcals, fat
b) protein, fluids, sodium
Milk is packaged in opaque containers to avoid UV destruction of: a) thiamin b) riboflavin c) niacin d) ascorbic acid
b) riboflavin
What elements of the diet vary the most in hepatic disease? a) fat, CHO, K+ b) sodium, fluid, PRO c) sodium, K+, PRO d) fat, sodium, K+
b) sodium, fluid, PRO
Memory loss may be associated with a deficiency of: a) riboflavin b) thiamin c) protein d) electrolytes
b) thiamin
An athlete needs 4000 kcals. The cornflakes nutrient lablel says that one serving provides 25% of the RDA for CHO. How many servings of cornflakes does he need to get his 25%? a) one b) two c) three d) four
b) two
A pt on a clear liquid diet should not be served: a) strawberry flavored gelatin b) vegetable stock c) apple juice d) fruit flavored popsicle
b) vegetable stock
2L of 5% dextrose solution provide how many kcal? a. 170 b. 340 c. 212 d. 195
b. 340 kcal
Which drink would a Mormon choose? a. cola b. 7-up c. tea d. coffee
b. 7-up
A mother with 2 daughters, ages 8 and 11, does note earn enough monfey to feed her family. Which program do you suggest? a. WIC b. Food Stamps c. Child Care Food Program d. Medicaid
b. Food Stamps
A single man with two daughters, ages 10 and 11 is looking for aid. Which program might provide assistance? a. WIC b. Food Stamps c. Child Care Food Program d. Headstart
b. Food Stamps
Which of the following is not a guideline for Medicaid? I. low income II. over the age 60 only III. nutritional need a. I b. II, III c. II d. III
b. II, III
Urea excretion is related to ___, while creatinine excretion is related to ____. a. muscle mass, PRO intake b. PRO intake, muscle mass c. PRO intake, adipose reserves d. PRO intake, Ca intake
b. PRO intake, muscle mass
Butter has fatty acids in this order of predominance: a. PUFA, MUFA, SFA b. SAT, MUFA, PUFA c. MUFA, SAT, PUFA d. MUFA, PUFA, SAT
b. SAT, MUFA, PUFA
Nitrogen equilibrium is associated with: a. a 25 year old pregnant female b. a 25 year old male c. a 15 year old girl d. a 4 year old child
b. a 25 year old male
When a starved patient begins to eat, they might expect: a. constipation b. an increased workload on the heart c. lethargy d. diarrhea
b. an increased workload on the heart
The diet for stomatitis is: a. low fat, high CHO, normal PRO b. avoid spices, very hot, very cold, sour, tart foods c. high PRO, high CHO d. liquids, mostly CHO
b. avoid spices, very hot, very cold, sour, tart foods
An 8 month old baby contracts botulism. What is the likely cause? a. cereal and evaporated milk b. cereal and honey c. cereal and table food d. cereal and fruit juice
b. cereal and honey
An infant's failure to thrive can be seen in: a. their behavior b. comparison with growth charts c. wt for ht d. ht for age
b. comparison with growth charts
Which is permitted on a diet that excludes gluten? a. rye b. corn c. barley d. wheat bread
b. corn
The Schilling test detects defects in the absorption of: a. folic acid b. cyanocobalamin c. pyridoxine d. iron
b. cyanocobalamin
A serum sodium level of 150mEq/L indicates: a. sepsis b. dehydration c. hypertension d. hyperglycemia
b. dehydration
An athlete weighs more than the avg person of his ht. What should you do first? a. put him on a slow weight reduction diet b. examine other anthropometric measurements c. have him increase his exercise d. suggest he drink more water
b. examine other anthropometric measurements
If an IDDM tells you she eats meals on an irregular schedule you should: a. obtain more info about her usual eating habits b. explain that insulin therapy is related to intake c. do nothing if blood sugar levels are okay d. ask her to complete a detailed food record
b. explain that insulin therapy is related to intake
Why would a man who eats very little protein have an albumin of 5.5g/dl? 2. CHO keeps albumin levels elevated b. he is dehydrated c. serum albumin falls quickly with protein deprivation d. it is a sign of protein malnutrition
b. he is dehydrated
The immediate post-stress release of glucagon: a. increases glucose uptake into cells b. increases glucose release into the bloodstream c. increases insulin release d. increases fluid and sodium excretion
b. increases glucose release into the bloodstream
Current research on the relationship between cancer and diet includes all of the following except: a. cancer is assoc with intake of vit A b. it is related to demographic data c. it is related to epidemiologic data d. it is assoc with ascorbic acid
b. it is related to demographic data
The Cori Cycle converts: a. glucose into galactose b. lactate into pyruvate c. lactic acid into glycogen d. glycogen into glucose
b. lactate into pyruvate
Patients with early signs of xerophthalmia should consume? a. chicken, fish, summer squash b. liver, milk, eggs c. oatmeal, almonds, berries d. high fiber cereals, salad greens
b. liver, milk, eggs
Children's diets are found to be low in iron due to emphasis on: a. vegetables b. milk c. fruits d. cereals
b. milk
The BMI for a woman who is 5'7" tall and weighs 148lbs indicates: a. underweight b. normal weight c. overweight d. obese
b. normal weight
Green beans cooked in tomato sauce turn _____ due to ____. a. bright green; cholorphyllin b. olive green; pheophytin c. brown; carotenoids d. black; anthoxanthins
b. olive green; pheophytin
A patient who is iron deficient should consume _______with a good iron source. a. apple juice b. orange juice c. milk d. cheese
b. orange juice
Fats high in polyunsaturated fatty acids include: a. olive and canola b. safflower and corn c. coconut and palm d. soy and peanut
b. safflower and corn
The Year 2010 Healthy People Goals are an outgrowth of a report by: a. ADA b. the Surgeon General, under HHS c. WHO d. FAO
b. the Surgeon General, under HHS
The allowance for Food Stamps is based on: a. the avg cost of food used by a family of the same size b. the USDA Thrifty Food Program c. data from the Congregate Meal Program d. the cost of the Basic Four
b. the USDA Thrifty Food Program
Which of the following should be avoided on a low sodium diet? a. pork loin b. turkey roll c. beef sirloin d. lamb chop
b. turkey roll
To decrease sodium intake, substitute: a. carrots for celery b. unsalted margarine for regular margarine c. diet margarine for regular margarine d. carrots for pepper
b. unsalted margarine for regular margarine
A patient with dehydration exhibits the symptoms of: a. high blood pressure, dizziness b. sunken eyes, decreased renal fx, increased tachycardia c. decreased BUN, decreased serum creatinine d. low blood pressure, low serum sodium
b.sunken eyes, decreased renal fx, increased tachycardia
A patient on home TPN for the past month develops an elevated temperature with possible sepsis. This could indicate:
bacterial translocation
a pt on parenteral support develops sepsis. what is the likely cause
bacterial translocation
The ___ sheet lists assets, cash, inventory, and accounts receivable (what is owed to you) and liabilities
balance
The ___ sheet shows financial condition as of a particular date
balance
Bargaining steps in order: ___,___,&___
bargain, mediate, arbitrate
when counseling an anorexic, the best advice is to
be flexible and help them choose reasonable goals
what would you recommend to a Mexican AMerican on a low fat diet
beans and rice
acidic chyme in the duodenum is neutralized by pancreatic ______
bicarbonate
enhance insulin action
biguanides (metformin that is a Glucophage) do what?
an appropriate source of folate for a female from Central America is : corn, broccoli, black beans, raisins
black beans
a pt on warfarin should avoid
black cohosh
gastric irritants include
black pepper, chili powder, caffeine, alcohol, cocoa
which correlates best with energy intake: lean body mass, triceps skinfold, BMI, body weight
body weight
creatine supplements may be beneficial for the
bodybuilder
When costs increase, the ___ point increases too
breakeven
WIC encourages women to
breastfeed
___ marketing is filling customers needs or desires
business
A PN regimen that contains 1 L of D50W and 1 L of 7% Aminosyn provides how many non-PRO kcals? a) 300 b) 1400 c)1700 d) 2000
c) 1700
A middle income family needs support for breastfeeding. Which group will help? a) Milk Bank b) Pritikin Program c) LaLeche d) Feingold Program
c) LaLeche
What is the most effective tool for providing nutrition education to the community? a) the RDIs b) the report Healthy People c) My Pyramid d) The Healthy Eating Index
c) My Pyramid
Which program teaches good nutrition practices and provides foods with certain nutrients? a) EFNEP b) NET c) WIC d) MCP
c) WIC
The effectiveness of a group education program for decreasing the number of anemic pregnant women enrolled in a community nutrition program is best indicated by: a) improved scores on a nutrition knowledge posttest b) improved scores on a Likert-type attitudinal scale c) an increase in hematocrit or hemoglobin levels d) an increase in the intake of dietary iron
c) an increase in hematocrit or hemoglobin levels
A renal pt has come for dialysis on Monday morning with a serum sodium of 130 mEq/L, a BUN of 100 mg/dl, creatinine 8.0, and a 4 kg weight gain since his last dialysis on Friday morning. His lab indicators were in acceptable ranges on Friday afternoon. What would you expect happened over the weekend? a) consumed too little sodium, too much water, too little PRO b) consumed too little sodium, not enough water, too much PRO c) consumed too much sodium, too much water, too much PRO d) consumed too much sodium, too little water, too little PRO
c) consumed too much sodium, too much water, too much PRO
The data that is most useful in evaluating children is: a) sex and age b) iron and vitamin intake c) energy intake and health history d) height and weight
c) energy intake and health history
If a child is at the 95th percentile weight for height and after one month drops to the 10th percentile, what does it likely signify? a) poor nutrition b) lake of adequate caloric consumption c) error in measurement d) clinical disorder indicating malabsorption
c) error in measurement
A woman who is 5'5'' tall weighs 190 lbs before pregnancy and gains 30 lbs by the beginning of her 2nd trimester. Advise her to: a) maintain her current wt b) begin a wt reduction diet c) gain wt at a decreased rate d) continue to gain wt at the same rate
c) gain wt at a decreased rate
When given as the sole source of energy, isocaloric amounts of which energy substrate would most effectively reduce starvation ketosis? a) corn oil b) MCT oil c) glucose d) essential AA
c) glucose
A PN patient is receiving 45 kcals/kg. What may be the result? a) hypocalcemia b) hyperkalemia c) hypokalemia d) hyperphosphatemia
c) hypokalemia
You are assessing a 4'11'' female patient who weights 160 lbs. She has HTN, high cholesterol, and DM. What do you recommend? a) low sodium b) low CHO c) low kcal d) low fat
c) low kcal
The essential AA tryptophan is most closely r/t: a) folic acid b) riboflavin c) niacin d) pantothenic acid
c) niacin
Asian, Hispanic, and Native Americans have the following in common: a) they consume few green vegetables b) they consume significant amounts of dairy products c) they consume little milk d) they consume few root vegetables
c) they consume little milk
What should a Jewish pt include in his diet to increase the intake of zinc? a) fresh green vegetables b) pork c) turkey d) wheat bread
c) turkey
Which of the following is the appropriate diet for peritoneal dialysis? a. .8g PRO, 35 kcal/kg b. 2.0g PRO, 30 kcal/kg c. 1.5g PRO, 30 kcal/kg d. 1.0g PRO, 35 kcal/kg
c. 1.5g PRO, 30 kcal/kg
Food service employees should was their hands for at least: a. 30 seconds b. 25 seconds c. 20 seconds d. 15 seconds
c. 20 seconds
Food was held at 70'F for a long time in anaerobic conditions. Eight hours after eating it you became ill. What is the culprit? a. Salmonella b. Staphylococcus c. Clostridium perfringens d. Campylobacter jejuni
c. Clostridium perfringens
The most effective nutrition assessment method for large groups is the: a. food diary b. 24 hr recall c. FFQ d. diet history
c. FFQ
An example of a "Healthy People" goal is" a. a decrease in saturated fat consumption b. an increase in iron intake c. a decrease in infant mortality d. an increase in the intake of complex CHO
c. a decrease in infant mortality
To increase potassium intake, consume a snack of: a. cheese and crackers, plums, cranberry juice b. a bagel, milk and an apple c. a grilled cheese and tomato sandwich and strawberries d. tuna salad, a wheat roll, and cola
c. a grilled cheese and tomato sandwich and strawberries
A serum sodium level of 150mEq/L may be due to: a. an increase in the intake of sodium-rich foods b. decreased steroid formation c. an increased level of aldosterone d. a decrease in the intake of sodium-rich foods
c. an increased level of aldosterone
Which of the following is true regarding flour? a. all-purpose is made from soft wheat b. all-purpose has more protein than bread flour c. cake flour has the least and the weakest gluten d. cake flour has less starch than bread flour
c. cake flour has the least and the weakest gluten
Which of the following most affects osmolarity? a. PRO b. sugar c. electrolytes d. fat
c. electrolytes
In metabolic acidosis, which of the following is involved? a. excretion of potassium b. excess Ca retention c. excretion of sodium bicarbonate d. excess Ca loss
c. excretion of sodium bicarbonate
How can you enhance usage of commodity foods from a food donation program? a. teach food donation staff how to use the items b. make a poster on usage c. give each participants recipes using the items d. calculate the amounts of nutrients provided in the donated foods
c. give each participants recipes using the items
Apples stored in a controlled environment would: a. ripen quickly b. last one to two years c. have extended life and improved marketing quality d. only be used as processed fruit
c. have extended life and improved marketing quality
Which fiber is insolube in water? a. pectin b. gums c. hemicellulose d. polysaccharides
c. hemicellulose
Gastric proteolysis requires: a. pyridoxine b. ascorbic acid c. hydrochloric acid d. the intrinsic factor
c. hydrochloric acid
Which of the following would be classfied as NB in the NCP? a. hypermetabolism b. inadequate enteral intake c. impaired ability to prepare foods d. excessive protein intake
c. impaired ability to prepare foods
Cabbage should be cooked: a. covered b. in a small amount of water c. in a large quantity of water d. covered in a small amount of water
c. in a large quantity of water
The kidneys respond to respiratory acidosis by: a. increasing the secretion of magnesium b. exchanging sodium for calcium c. increasing the retention of bicarbonate d. exchanging potassium for hydrogen
c. increasing the retention of bicarbonate
In cereal production, enrichment adds: a. Vitamin A b. Vitamin D c. iron d. iodine
c. iron
Which nutrients are involved in energy metabolism? a. pyridoxine and cyanocobalamin b. copper and zinc c. pantothenic acid and biotin d. folic acid and iron
c. pantothenic acid and biotin
Which of the following may result in hypoalbuminemia? a. amino acid supplementation prior to surgery b. a high protein diet with inadequate water c. providing only a 5% dextrose in water solution after stress d. giving a trauma pt enteral feeding only
c. providing only a 5% dextrose in water solution after stress
Catecholamines have what physiological effect? a. induce diuresis b. cause hypoglycemia c. cause sodium retention d. cause potassium retention
c. sodium retention
Which of the following would be classified as NC in the NCP? a. inadequate vitamin intake b. limited access to food c. swallowing difficulty d. inapprpriate intake of food fats
c. swallowing difficulty
A 5 month old is diagnosed with salmonella. What is the likely cause? a. fruit juice b. milk c. table food d. evaporated milk
c. table food
Coarse texture in a cake is due to: a. too little baking powder b. over-mixing c. too much baking powder or sugar d. over temperature too high
c. too much baking powder or sugar
Which of the following indicates PRO-cal malnutrition? a. a creatinine ht index of 93% b. ht for wt ratio of 89% c. triceps skinfold and arm circumference of 79% d. serum albumin of 4.5; transferring of 410
c. triceps skinfold and arm circumference of 79%
Which of the following amino acids is a precursor for serotonin? a. phenylalanine b. methionine c. tryptophan d. tyrosine
c. tryptophan
what is lacking in the traditional diet for asians living in america
calcium
which of the following is lowest in fat: hamburger, salami, goat cheese, canadian bacon
canadian bacon
which provides the most vitamin A for a mexican: tortillas and refried beans, cantaloupe and squash, cheese, tortillas and milk
cantaloupe and squash
The ___ budget includes equipment, facilities, cost of improvements, and repairs
capital
The ___ budget includes expenditures whose returns are expected to last beyond a year
capital
Large sums of money needed for equipment, improvements, expansion, etc. are listed in the:
capital budget
an athlete complains of weakness, rapid wt gain, and muscle spasms. what may be the cause
carbohydrate loading
potato chips PB
cariogenic foods
research suggest that in order to guard against cancer you should ingest
carotene and vitamin C
The orange color of carrots is stable during cooking because:
carotenoids are heat stable and fat soluble
a child with PKU can eat: spaghetti with tomato sauce, vanilla ice cream, carrots and celery sticks, aspartame-sweetened gelatin
carrots and celery sticks
The protein in milk that precipitates at pH 4.6 is:
casein
an infant formula for lactose intolerance might include
casein hydrolysate, corn oil, glucose, soy protein, corn syrup solids
The ___ ___ budget projects revenues and expenses, showing inflow and output of cash
cash flow
The purpose of the ___ ___ budget is to determine if funds will be available when they are needed
cash flow
catecholamines have what physiological effect
cause sodium retention
When one person or department purchases for every department, it is called:
centralized purchasing
what would you do to decrease fat intake for a hispanic
change beans from refried to boiled
a five month old baby has changed from the 65th to the 95th percentile weight for height, the dietitian should first
check to see if weights have been plotted properly
diet while on MAOI will not include?
cheddar cheese
when instructing a pt on diet therapy needed during intake of a monoamine oxidase inhibitor, which would not be included: milk, cottage cheese and yogurt, yogurt and ricotta cheese, swiss cheese and yogurt, cheddar cheese and swiss cheese
cheddar cheese and swiss cheese
which of the following may help decrease cavities: raisins, carrots, cheese, yogurt
cheese
which is the most appropriate bedtime snack for a diabetic on NPH insulin: apple juice and crackers, graham crackers and diet soda, fresh fruit and crackers, cheese and crackers
cheese and crackers
which of the following would likely be a cause of marasmus: leaving a pt for two weeks on D5W, chemotherapy, following a 20 g protein diet for two months, antibiotic therapy
chemotherapy
What is Chain of Command?
clear and distinct lines of authority within the organization
When food is prepared in a central area and transported to satellite units, it is called a ________ system.
commissary
nuts, eggs, milk, soy, wheat, fish
common allergens
an infants failure to thrive can be seen in
comparison with growth charts
Job specification is used to determine _______.
compensation
___ benefits are pay for time not worked
compensatory
when using anthropometric measurements, the most important factor is
competence of the practitioner and calibration
Appropriate span of control is determined by:
complexity and proximity of the jobs, quality of the people, abilities of the supervisor
a child with cystic fibrosis has had a recent weight loss and several large foul smelling stools each day over the past two months. to evaluate the situation, the first step should be to assess her
compliance with PERT
When a food is cooked from the outside toward the center by direct contact with the pan, the transfer of energy has taken place by:
conduction
what would a vegan not eat: coleslaw, congealed fruit salad, salad with tofu, peanut butter
congealed fruit salad
The ___ ___ is updated weekly and identifies bill with sponsor and committee
congressional index
The ___ ___ includes information from the floor, no hearings lists bills with sponsor and action, and is used daily when congress is in session
congressional record
You have been instructed by the hospital administrator to manage the cafeteria as a break-even operator. Administration will no longer subsidize the budget. You should:
consider branding and HMR
Fill in the Blanks: The nutrition care process is designed to improve the ______ and _______ of individualized patient/client care and the predictability of patient/client outcomes.
consistency; quality
a renal pt has come for dialysis on monday morning with a serum sodium of 130 mEq/L, a BUN of 100 mg/dl, creatinine 8.0, and a 4 kg weight gain since his last dialysis on friday morning. his lab values were WNL on friday afternoon. what would you expect happened over the weekend
consumed too much sodium, too much water, too much protein
Your hospital has recently become involved in a cooperative program between local businesses and the public schools to reduce the drop out rate. As the production manager, you have been told to provide hands-on training for three at-risk students. The students are 16 or 17 years old. You:
contact human resources and review the FLSA restrictions that may apply due to their ages.
an insulin dependent diabetic living alone calls you with symptoms of nausea, vomiting, and anorexia. what do you recommend
continue with insulin and drink anything he can
the main goal for a type 2 obese diabetic with persistent hyperglycemia is
control of serum glucose levels
which food is highest in fiber: cooked dried beans, tomato, wheat bread, lettuce
cooked dried beans
which is permitted on a diet which excludes gluten: rye, corn, barley, wheat bread
corn
an acid ash would be created by ingesting: corn and cranberries, milk, vegetables, fruits
corn and cranberries
which of the following is a medium fat: peanut butter, tuna fish packed in water, corned beef, chicken without skin
corned beef
which would cause the most delay in gastric emptying: lean baked meat, broiled cod, shrimp, corned beef
corned beef
The cost of the raw food and beverages sold is the ___ ___ ___
cost of sales
___-___ studies determine whether the goal of the effort is worthwhile in terms of cost
cost-benefit
___-___ studies compare alternative courses of action
cost-effectiveness
which test measures somatic protein
creatinine clearance and serum creatinine
___ ___ are the efficiency of equipment placement, studies work motion, shows # of movements between equipment
cross charts
A standing height should first be obtained when an infant is how many months old? a) 18 b) 20 c) 22 d) 24
d) 24
What is the best approach for controlling obesity in an otherwise healthy 10-year old girl? a) reduction of caloric intake to allow wt loss of 1-2 lbs weekly b) reduction of energy intake to no less than 1,000 kcal/d c) avoidance of simple sugars and sugar-containing products d) maintenance of wt during continued growth
d) maintenance of wt during continued growth
A nutritional care plan for overweight children should include: a) restrict intake to maintain current weight b) maintain body weight c) reduce weight with caloric reductions of 500 per day d) reduce rate of body weight gain while allowing growth
d) reduce rate of body weight gain while allowing growth
Your pt is on Coumadin. Which foods would you make sure to consistently include in their diet? a) oranges, peaches b) sweet potates c) beef, lamb d) spinach, collard greens
d) spinach, collard greens
Which would you give to a person who is mildly hypokalemic? a. 1 cup blueberries b. 1 cup cranberries c. 1/2 cup applesauce d. 1 piece cantaloupe
d. 1 piece cantalope
Which of the following substitutions will most decrease the sodium content of a biscuit? I. low sodium milk for whole milk II. egg substitute for egg III. low sodium baking powder for baking powder a. I b. I, II c. all of the above d. I, III
d. I, III
What can be done to lower the RQ of a tube fed pulmonary pt? a. add MCT oil to decrease energy required for growth b. change the type of fat to improve oxygen exchange c. add CHO to decrease the RQ d. add a fat emulsion to replace some of the CHO
d. add a fat emulsion to replace some of the CHO
Which statement applies to nutritional screening? a. only a physician makes the referral b. only a dietitian makes the referral c. it is exclusively done by nursing d. all health team members can participate according to policy
d. all health team members can participate according to policy
What correlates best with energy intake? a. lean body mass b. triceps skinfold c. BMI d. body weight
d. body weight
When instructing a patient on diet therapy needed during intake of a monoamine oxidase inhibitor, which would not be included? a. milk, cottage cheese, yogurt b. yogurt, ricotta cheese c. swiss cheese, yogurt d. cheddar cheese, swiss cheese
d. cheddar cheese, swiss cheese
Which is the most appropriate bedtime snack for a diabetic on NPH insulin? a. apple juice and crackers b. graham crackers and diet soda c. fresh fruit and crackers d. cheese and crackers
d. cheese and crackers
Which of the following has the least amount of saturated fat? a. 2% milk b. half and half c. non-dairy creamer d. evaporated skim milk
d. evaporated skim milk
A serum sodium level of 150mEq/L is a sign of: a. very high sodium intake b. very low sodium intake c. hyponatremia d. hypernatremia
d. hypernatremia
Cured meat is pink due to: a. sugar b. salt c. vinegar d. nitrites
d. nitrites
An infant wants a bottle at bedtime. You should counsel the parents to: a. give the bottle only at bedtime b. give the bottle only if the baby insists c. only give milk in the bottle d. only give water in the bottle
d. only give water in the bottle
Energy expenditure of humans can be measured by: a. heat intake b. food intake c. nitrogen output d. oxygen consumption
d. oxygen consumption
Why is an affluent couple (the man with diabetes, 67yo, wife with broekn arm, 50 yo) not eligible for Meals on Wheels? a. she is too young b. thay are affluent c. this program does not cater to special diets d. they can leave the house
d. they can leave the house
Meat graded "US Standard" is the grade given at the: a. time of purchase b. time of delivery c. storage facility d. time of slaughter
d. time of slaughter
Biot-Savart Law
dB = (µ₀ I dI x r ̂ ) / 4πr² -relates magnetic fields to the currents which are their sources.
a tube fed pt receiving bolus feedings develops a distended abdomen. what should you recommend
decrease the rate
according to the previous question, what else would you expect to see
decreased bicarbonate, increased potassium, increased phosphorus
major reason for constipation in the elderly?
decreased gastric motility
what is a major reason for constipation in the elderly
decreased gastric motility
the appropriate diet therapy following a Billroth II is
decreased simple carbohydrates, high protein, moderate fat, B12 supplements
To facilitate the receiving of goods, it is desirable to locate the receiving area near the:
delivery door
Management by objectives is a type of ___ management that provides control from within
democratic
what is a common complication of AIDS
diarrhea
a cholesterol level of 240 mgs needs treatment first with
diet
The recommended medical nutrition therapy for active peptic ulcer disease is:
diet as tolerated; avoid pepper, alcohol and coffee
when assessing nutritional status, what is the most beneficial?
diet intake info, clinical data, laboratory data
iron status is best monitored by:
dietary and lab studies
In 2002 the Institute of Medicine published a new set of definitions for dietary fiber. They suggested the following terms:
dietary fiber and functional fiber
goals for community nutrition program should be based on?
dietary guidelines for americans
which of the following is included in subjective global assessments: standard weight for height, mid-arm circumference, prealbumin, dietary intake
dietary intake
a person with dumping syndrome cannot handle: complex carbs, polysaccharides, disaccharides, amino acids
disaccharides
after a gastrectomy, the diet order should show a decrease in
disaccharides
after gastrectomy the diet order should indicate a decrease in
disaccharides
you discover an incorrect diet order entered in the patients chart, you should
discuss the order with the physician and make suggestions
achalasia
disorder of lower esophageal sphincter motility; does not relax upon swallowing
good advice for a pt with a hiatal hernia is to: increase intake of complex carbs, lower the fat content of diet, don't eat before bed, avoid coffee
don't eat before bed
which of the following would lower serum cholesterol levels: dried beans, green beans, yellow beans, summer squash
dried beans
majority of protein digestion takes place in:
duodenum
high kcal and fluids
during fever and infection, the diet should be
If the benefit is greater than the cost, then the program is ___ ___
economically efficient
which of the following is not a sign of marasmus: severe protein and calorie wasting, wt loss, edema, low anthropometric measurements
edema
antagonizes vit K
effect of anticoagulants
binds tetracycline
effect of calcium
increased appetite, weight gain;
effect of lithium carbonate
hypertension if taken with MAOI inhibitors
effect of tyramine
most common food allergies in infants and children
eggs, fish, milk, peanuts, soy
For what age group is the Nutrition Screening Initiative most appropriate?
elderly
NHANES III increased the number of ______ participants
elderly
A class C fire includes:
electrical equipment, motors and switches
which of the following most affects osmolarity: protein, sugar, electrolytes, fat
electrolytes
a pt has a rare urea disease where the body is unable to synthesize urea. what might be the result
elevated ammonia levels
pt can't make urea...what can be the result?
elevated ammonia levels
an elderly obese pt has been diagnosed with type 2 DM, what would be an appropriate nutrition diagnosis: elevated serum triglycerides, high HDL cholesterol, low blood pressure, low serum insulin
elevated serum triglycerides
the best way to counsel a pt with anorexia nervosa is to
emphasize the health benefits associated with wt gain and increased calorie intake
Span of control refers to the number of:
employees under the direction of one individual
The TQM approach does not:
encourage specialized job and individual effort
The process of learning the beliefs, attitudes and behaviors of a group is:
enculturation
most useful data when evaluating kids?
energy intake and health history
the data that is most useful in evaluating children is: sex and age, iron and vitamin intake, energy intake and health history, height and weight
energy intake and health history
a pt on Lithium decreases his sodium intake to 2 g/day, the effect will be
enhanced activity of the drug
glucophage (metformin) functions by:
enhances insulin action
glucophage/metformin does what
enhances insulin action
Job ___ upgrades jobs by adding motivating factors
enrichment
what outcome would best indicate parental support of a child's wt loss effort in a program for obese pre-teen children
enroll child in physical activity programs
if a pt is about to be discharged when you receive the d/c diet order, you should
enroll him in the Outpatient Clinic and schedule an appointment
if a child is at the 95th percentile weight for height and after one month drops to the 10th percentile, what does it likely signify
error in measurement
A patient is newly diagnosed with renal failure and requires long-term dialysis. He is depressed about having to make major lifestyle changes and is in need of financial assistance. The dietitian's initial objective in the interviewing process should be to:
establish rapport with the patient by getting to know him better before discussing nutrient needs
the best way for you to follow-up on a patient's application of diet instruction is to
evaluate his food diary for one week
a clinical dietitian has successfully met an indicator for 6 months, the next step should be to
evaluate the need to continue monitoring the indicator
what is the best practical way to measure energy balance
evaluate weight gain and weight loss
an athlete weighs more than the average person of his height. what should you do first
examine other anthropometric measurements
cheddar cheese, nuts, meat
examples of low cariogenic potential foods
a side effect of antidepressants is
excess weight gain
in metabolic acidosis, which is involved: excretion of potassium, excess calcium retention, excretion of sodium bicarbonate, excess calcium loss
excretion of sodium bicarbonate
what is the best therapy for wt loss
exercise, diet, behavior modification
In the ___ theory, rewards serve as motivators (under certain circumstances)
expectancy
The ___ theory involves the path-goal theory, that focuses on a leader's effect on employees motivation to perform
expectancy
if an IDDM tells you she eats meals on an irregular schedule, you should:
explain that insulin therapy is related to intake
a pt comes to you with a diet that you know is not good to follow, what should you do
explain why it is not good
if a diet px is incorrect, potentially causing serious complications, the RD should:
express concern about the order to the MD and recommend appropriate changes
a pt suffering from bulimia may have all the following symptoms except: a sore throat, dental problems, extreme wt loss, rectal bleeding
extreme wt loss
The ___ ___ ___ ___ makes it illegal to ask job candidates about race, religion, sex, national origin, age, or marital status
fair employment practice law
Human milk has more _____ than formula or cow's milk
fat
in CF, the most impaired nutrient is _
fat
in cystic fibrosis, the most impaired nutrient is
fat
<10% sat, <=10% poly fat, 60-70% mono fat and CHO, <300 mg chol, encourage fiber
fat, chol, and CHO requirements for diabetes
The high fat content of ice cream helps keep it smooth by decreasing ice crystals. Other ingredients that reduce ice crystals include:
fat, corn syrup, or protein
what is the primary fuel used by resting muscle and at low intensity exercise
fatty acids
The ___ ___ houses notes of public hearings, proposed and final rulings, agency decisions, and is published weekly
federal register
The ___ ___ lists changes in USDA food programs
federal register
what can cause loose stools in a tube fed pt
feeding administered at too rapid a rate, an inadequate amount of intestinal surface area
Poverty and hunger affect some groups more than others. Those most at risk are:
female head of households, children and the rural poor.
macrocytic, megaloblastic anemia
few large cells, filled with hemoglobin is
a spastic quadriplegic requires
fewer calories, increased fluid and fiber
what type of food would you feed to a pt who has athetoid form of cerebral palsy
finger foods like hot dog in a roll
most common food allergies in adults
fish, tree nuts, peanuts, shellfish, wheat
A pathway chart, or a ___ ___, is a scaled drawing showing the path of a worker during a process
flow diagram
immediately following a severe burn, nutritional therapy should include
fluid and electrolyte replacement
why may a pt with ascites be dehydrated
fluid has moved to the interstitial spaces
pt in icu with symptoms of cachexia, ascites, N/V, serum albumin of 2.5, elevated liver function tests-MNT would include:
fluid restriction, 2gm Na+, moderate protein
to restore hydration after continuous endurance activity of 2 hours consume
fluids, sodium carbohydrates
to maintain hydration during continuous endurance physical activity of 4 hours consume
fluids, sodium, carbohydrates
a dietary deficiency of which of the following causes a macrocytic anemia resembling pernicious anemia: folacin, pyridoxine, vitamin B6, vitamin C
folacin
dietary deficiency from __ causes macrocytic anemia resembling pernicioius anemia?
folacin
the most important prenatal supplement is
folic acid
characteristics of the dumping syndrome include
follows a gastrectomy, is secondary to carbohydrate overload, and draws fluid into the intestine
___ cost is the most readily controlled item, subject to the greatest fluctuation
food
the most effective nutrition assessment method for large groups is the
food frequency list
which is a quick diet assessment tool for a large group
food frequency list
rice
food least likely to cause an allergy
the addictive influence of foods and constituents which when eaten have a beneficial effect on health refers to
food synergy
what formula would best meet a pt needs of 2000 calorie, 2 gram sodium feeding
formula with 1 cal/cc and 1 g Na/liter
a vegan with macrocytic anemia needs which of the following: iron-rich foods, fortified soy milk, eggs and wheat bread, meat and green vegetables
fortified soy milk
the test that measures toxic levels of lead on heme synthesis is the
free erythrocyte protoporphyrin test
a strict muslim would not consume
fruited gelatin, shrimp, ham
phytochemicals which may influence the development of tumors are found in
fruits, vegetables, grains
a pt on parenteral nutrition is to be transitioned to enteral feeding. he should receive
full strength enteral feeding at a low rate
One way to determine # of relief employees needed, is to multiply the number of ___-time positions by ___
full, .55
a woman who is 5'5" tall, 190# before pregnancy and gains 30# by the beginning of her second trimester. advise her to
gain weight at a decreased rate
for which of the following diseases is diet therapy the primary treatment: peptic ulcer, diabetes, Wilson's disease, galactosemia
galactosemia
which of the following diseases may lead to anemia: MI, galactosemia, renal failure, DM
galactosemia
how can you enhance usage of commodity foods from a food donation program
give each participant recipes using the food items
sole energy source to reduce starvation ketosis
glucose
when given as the sole source of energy, isocaloric amounts of which energy substrate would most effectively reduce starvation ketosis
glucose
the immediate post-stress release of glucagon increases
glucose release into the bloodstream
the theory of obesity that refers to receptors in the hypothalamus is the
glucostatic theory
what test helps to determine if a diabetic has been following his diet
glycosylated hemoglobin
prevent marked rise in blood glucose that would stimulate more insulin
goal of postprandial or reactive hypoglycemia
increased serum uric acid levels may lead to
gout
What is the formula to calculate nitrogen balance?
grams of protein/6.25 - (urinary nitrogen + 3 to 4g)
which snack would you not give to an infant: yogurt, cheese sticks, graham crackers, grapes
grapes
The ___ ___ is the profit shown after deducting raw food and beverage (cost of sales) from sales (revenue)
gross profit
Policies are:
guides that define the scope of permissible activity.
which of the following would lacto-ovo vegetarian not eat: eggs, halibut, cheese, beans
halibut
Coronary Artery Disease
hard, narrow arteries from plaque buildup
as a public health nutritionist, you notice an increase in the percentage of obese hispanic females in the community, what is the best way to educate them
have a cooking class that they can participate in the cooking and then eat the food they prepared
the mother of an infant who weighed 4.5kg at birth and was was hypoglycemic may
have had gestational diabetes
what is the best way to increase attendance at a nutrition seminar for dentist
have it sponsored by a dental organization
In the ___ study, if you involve people in the process, they become more productive
hawthorne
The ___ study is based on the fact that productivity is due to giving employees special attention and treating them well - this is known as the ___ effect
hawthorne, placebo
why would a man who eats very little protein have an albumin of 5.5 g/dl
he is dehydrated
a PEG feeding would be useful in a pt with
head or neck cancer who will not be able to eat normally for weeks
elevated LDL, normal to low NDL
healthy obese is
a female has a 36" waist to a 40" hip measurement, she is at risk for
heart disease
The factors affecting basal needs include all of the following except:
heart rate
anasarca is extreme generalized edema and swelling of the skin associated with
heart, liver, or renal failure
expected creatinine clearance is estimated by the clients'
height
expected creatinine clearance is estimated from the client's
height
which of the following indicated stunted growth: wt for ht, ht for age, wt for age, wt for length
height for age
an appropriate measurement for iron status in a local community is
hematocrit
what fiber is insoluble in water?
hemicellulose
which fiber is insoluble in water: pectin, gums, hemicellulose, polysaccharides
hemicellulose
which of the infants in the above question have a normal hemoglobin
hemoglobin of 10, 10.5, 11
the diet for hepatic coma is low in protein due to
high ammonia levels
a pt is diagnosed with iatrogenic malnutrition, nutritional therapy should be
high calorie, high protein
What is the MNT for Athetoid (constant involuntary motion)CP?
high calorie, high protein diet to prevent weight loss, finger foods to facilitate independence with feeding.
ketogenic diet
high fat, low carbohydrate diet - the ratio of fat calories to non-fat calories is 4:1 (used as MNT for epilepsy)
cows milk?
high in protein and creates a high solute load. it's low in iron and vitamin C
a child with AIDS needs a high calorie and _______ intake
high protein
pt with a stage II ulcer and albumin of 2.8g/dl-what kind of NCP would be used?
high protein, MVI, zinc, Vit C
LTC pt has normal GI Fx but can't eat. give them what formula?
high protein, high calorie
nutritional therapy for hepatitis includes
high protein, high carbohydrate, moderate fat, high calories
bacon (pork 2 slices, turkey 3 slices), cheese (swiss, american, queso), hot dog, processed sandwich w/ 8g fat or less
high-fat meat and meat substitute examples
compared to human milk, commercially prepared infant formula is
higher in protein and iron but lack antibodies
low levels of folate, pyridoxine and cyanocobalamin are associated with
homocystinuria
If the House and Senate offer different versions of a bill, it goes before a joint ___-___ conference committee where the differences are resolved, ultimately passing the bill
house-senate
30-45 minutes
how long before a meal to take short-acting (regular) insulin
5-15 mintes
how long before eating to take rapid acting insulin
18-24 hours
how long does Lantus work?
10-18 hours; bedtime snack consisting of CHO and protein
how long does NPH insulin last? what should be included when taking it?
10-15 g CHO; 3-6 hr
how much CHO does 1 unit of regular insulin cover? how long does it last?
The process of converting unsaturated fatty acids to saturated by the chemical addition of hydrogen is called:
hydrogenation
According to Herzberg, fair wage, insurance, retirement, supervision, scheduling, working conditions, & interpersonal relationships are considered ___ factors
hygiene
In Herzberg's 2-factor theory, maintenances are considered ___ factors
hygiene
Symptoms associated with diabetic ketoacidosis (DKA) include all of the following except:
hypercalcemia
a pt w/ nephrosis will most likely exhibit what 3 things
hypercholesterolemia, albuminemia, edema
a pt with nephrosis will likely exhibit
hypercholesterolemia, albuminemia, edema
What are the RBC characteristics of folic acid deficiency?
hyperchromic (intense red color), macrocytic (larger than normal), megaloblastic (large, immature, abnormal RBC in bone marrow)
the catecholamines released during stress cause
hyperglycemia
what is associated w/ cyclosporine therapy?
hyperlipidemia
which of the following nutrition diagnosis is most likely to be associated with cyclosporine therapy: hyperphosphatemia, hyperlipidemia, hypoglycemia, hypokalemia
hyperlipidemia
an elevated T4 indicates
hyperthyroidism
an alcoholic patient has a low serum albumin, low hemoglobin, high ammonia, abnormal lover function test and ascites. why is he on a 500mg sodium diet
hypoalbuminemia
providing only a 5% dextrose in a water solution after stress may result in
hypoalbuminemia
before discontinuing a parenteral feeding, provide enteral support to prevent
hypoglycemia
quickly stopping a 25% dextrose solution leads to
hypoglycemia
a PN pt is receiving 45 calories/kg. what may be the result
hypokalemia
a concern with parenteral feeding
hypokalemia
pt w/ PN is getting 45 kcal/kg...what could be the result?
hypokalemia
severely malnourished pt recieves TPN @ 125cc/hr-what could this cause
hypophosphatemia
a hospitalized pt who had not eaten for 2 weeks had a 2.3 serum phosphorus level and a 1.3 serum magnesium level, he has
hypophosphatemia and hypomagnesemia
What are the metabolic abnormalitites of refeeding syndrome?
hypophosphatemia, hypokalemia, and hypomagnesemia Administration of dextrose can cause significant hypergylcemia
The first step of the marketing process is to ___ a need that is not being filled
identify
nutrition surveillance program is used primarily to do what?
identify nutritional needs of the population
a nutritional surveillance program is designed primarily to
identify the nutritional needs of the population
what section of the intestine is most likely to be involved in Crohn's disease
ileum
when should you provide nutrition counseling to an AIDS pt
immediately upon diagnosis
which of the following would be classified as NB in the NCP: hypermetabolism, inadequate enteral intake, impaired ability to prepare foods, excessive protein intake
impaired ability to prepare foods
a client who primarily consumes frozen dinners and breakfast cereal because of limited access to transportation most likely would have a nutrition diagnosis of
impaired ability to prepare meals
100-125
impaired fasting glucose level
140-199
impaired glucose tolerance (2hPG)
a pt complains of abdominal distention, mouth lesions, and a 10% wt loss over the past 6 months, the nutrition diagnosis would be
impaired nutrient utilization
normal (>31)
in macrocytic anemia MCHC is
high
in macrocytic anemia, MCH is
high (>95)
in macrocytic anemia, MCV is
decreased
in macrocytic anemia, RBC is
low
in macrocytic anemia, hematocrit is
low
in macrocytic anemia, hemoglobin is
low
in microcytic, hypochromic anemia, MCH is
low (<31)
in microcytic, hypochromic anemia, MCHC is
low (<80)
in microcytic, hypochromic anemia, MCV is
normal
in microcytic, hypochromic anemia, RBC is
low
in microcytic, hypochromic anemia, hematocrit is
low
in microcytic, hypochromic anemia, hemoglobin is
catecholamines epinephrine, norepinephrine - hepatic glycogenolysis and aldosterone - renal sodium retention, gluconeogenesis
in the metabolic response to injury, there is a release of ___ and ____? what do they do?
an 11 month old infant is constipated. the most likely nutrition diagnosis would be
inadequate fluid intake
Galactosemia
inborn error of metabolism in which galactose cannot be broken down into glucose
Maple Syrup Urine Disease
inborn error of metabolism where BCAAs cannot be broken down, so an increase in serum levels increase (especially leucine)
A surveillance team used to indicate how frequently a disease occurs in a population, and the fraction of people free of disease that develop the disease over a period of time is:
incidence
a patient is on a high protein, low carb diet. what advice should you offer?
increase fluid intake
what would you first advise a constipated patient to do
increase fluids and fiber intake
in acute hepatitis, you would likely see
increase in both SGOT and SGPT
a pt consuming around 500kcal per day of mostly sweet foods has an albumin of 5.0g/dl-the albumin level most likely shows...
increased albumin due to dehydration
which of the following would be classified as NI in the NCP: not ready for diet change, altered GI function, involuntary wt loss, increased energy expenditure
increased energy expenditure
fiber, like that found in oats, beans, and bran cereals, results in
increased water absorption from the intestine
if a pt on lithium decreases his sodium...what happens?
increases drug effects
age group has the greatest fluid requirement
infants
CRP is not elevated with malnutrition unless what else is also present?
inflammation
a 35 year old female with type 1 DM received nutrition counseling and started NPH therapy one month ago. today her fasting blood glucose level is 290 mg/dl and cholesterol level is 185 mg/dl. she eats only one meal per day. which need do you address first
instruction about the relationship of diet to blood glucose
Identify the hormone that causes an increase in glycogenesis and lipogenesis:
insulin
Interpersonal: Networks _____ and ______ acting as a liaison.
internally; externally
The nutritionist uses ______ to help people change their lifestyle
interventions
The cost of sales / average inventory cost is the ___ ___ rate
inventory turnover
a normal pregnancy requires supplementation of
iron and folic acid
the efficacy of a low sugar, low artificial flavor diet on hyperkinesis is
is had not been scientifically proven effective
what tube feeding should you provide for a long term care pt who has normal intestinal function but cannot eat
isotonic lactose-free formula
why would you add bicarbonate to a solution for a person with hyperkalemia
it exchanges hydrogen for potassium
why would you add bicarbonate to a solution for a person with hyperkalemia?
it exchanges hydrogen for potassium
a pt with hepatitis needs a high protein intake. besides helping the liver to regenerate what other purpose is served
it helps to prevent fatty liver
a child is below the 5th percentile weight for height. what can be said about the child
it is an indication of recent under-nutrition
which of the following is true about SGOT: increased with hepatitis and DM, increased with hepatitis and decreased with DM, decreased in both hepatitis and DM, decreased in hepatitis and increased in DM
it is increased with hepatitis and decreased with diabetes
current research on the relationship between cancer and diet includes all of the following except: cancer is associated with vit A intake, it is related to demographic factors, it is related to epidemiologic data, it is associated with ascorbic acid
it is not related to demographic factors
The main role of human resource managers in a large institution is to:
keep up-to-date on legislation and act as a resource to department managers
hormones that control blood pressure and blood components are produced in the
kidneys
food staff from a Commodity Distribution program are not allowed to bring foods to a jewish facility. what is the main reason for this
kosher foods are not allowed to be mixed with non-kosher foods
An example of a productivity ratio is:
labor cost divided by meals served
kwashiorkor
laboratory diagnosis, hypoalbuminemia, protein deficiency, high mortality rate, edema and appearance may be normal
following a Billroth II, steatorrhea often results. what is the likely cause
lack of pancreatic secretion diet to less duodenal hormone secretion
Lactose intolerance is caused by:
lactase insufficiency
meats curd with whey won't be tolerated by someone with
lactose intolerance
A manager has no confidence in his leadership abilities. He does not set goals for the group. Productivity and morale are low and work is sloppy. The manager's leadership style is:
laisse-faire
infants born to mothers with diabetes may be
larger than normal, and be hypoglycemia shortly after birth
A simple inventory costing practice that is also fast is the:
latest purchase price
a child is lethargic, irritable with diarrhea. The cause may be
lead poisoning
The contingency approach to leadership states:
leadership style must change to fit the situation
a pork chop is which type of meat exchange
lean
sirloin, tenderloin, beef jerky, cheese (< 3 g fat/oz), egg whites and substitutes, cottage cheese, salmon, tuna, tilapia, smoked fish, game, hot dog (< 3g fat/oz), lamb chop, organ meats, oysters, lean pork, poultry w/o skin, processed sandwich meat (< 3 g fat/oz), sardines, shellfish, veal
lean meat and meat substitute examples
what would be an expected outcome of WIC
less anemia, increased HG and HT levels
Assets = ___ + ___
liabilities, capitol
a pt with DM has not eaten for more than three days. you should
liberalize the diet
___ determined that participative management is the most effective (management of conflict)
likert
asian, hispanic and native Americans all consume --
little milk
what would the lab values have likely reflected if the pt had been nauseated and had averaged only 400 calories from primarily starchy foods over the weekend
little or no rise in potassium, BUN/creatinine ratio < 10
following a cholecystectomy, bile is produced by the
liver
a 6'2" male, large frame, 230# with type II diabetes should
lose 20# slowly following a balanced diet
you are assessing a 4'11" female pt who weighs 160#, she has hypertension, high cholesterol, and DM. what should you recommend
low calories
high protein,moderate fat, minimal concentration of fermentable CHO; strong buffer, high mineral content (Ca, P); pH >6, stimulate saliva
low cariogenic potential foods are (describe)
The plasma lipoprotein richest in cholesterol:
low density (LDL)
In community surveys, a frequent symptom of malnutrition is: scurvy, rickets, low serum albumin, low hemoglobin
low hemoglobin
Factors that may result in nutrition problems in the elderly include all of the following except:
low hemoglobin rate
Medicaid benefits apply to
low income individuals
what is the appropriate diet for heart failure
low sodium
what is the diet for hypertension
low sodium
compared to whole milk, breast milk is --
lower in protein and higher in fat and carb
compared to whole milk, breast milk is
lower in protein, higher in fat and carbohydrate
How do you determine the mEq and what are the atomic weights for sodium and potassium?
mEq = mg/atomic wt X valence Na: 23 (valence = 1) K: 39 (valence = 1)
an appropriate menu for a Kosher meal is : macaroni and cheese with green beans, roast beef, potatoes, vegetables, and cream soup, veal parmesan, noodles, and green beans, crabmeat salad, lettuce and milk
macaroni and cheese with green beans
a common result of treating an AIDS pt with zidovudine is
macrocytic anemia
common result of treating an AIDS pt w/ zidovudine is ?
macrocytic anemia
type and nutritional deficiency pernicious anemia
macrocytic; B12
type and nutritional deficiency of megaloblastic anemia
macrocytic; folic acid or B12
what is the best approach for controlling obesity in an otherwise healthy ten year old girl
maintenance of wt during continued growth
normal range of hemoglobin for males and females
males: 14-18 g/dL females: 12-16 g/dL
a female who eats a wide variety of foods and takes supplemental iron and birth control pills may be
marginally deficient in folic acid
The ___ schedule is the overall plan, days on/off, vacations, - it is the basis for developing the weekly schedule
master
At age 1, cow's milk is the primary source of nutrients; however, it should be limited to 2-3.5 cups because excess:
may displace food necessary to provide iron
corned beef, cheese (4-7 g fat/oz, feta, mozz, red-fat string cheese), egg, fried fish, pork cutlet, shoulder roast, ricotta cheese, ground turkey, poultry w/ skin, sausage (4-7 g fat/oz), veal
med-fat meat and meat substitute examples
If collective bargaining has not been successful, the next step is:
mediation
a tube fed pt develops diarrhea. what is the likely cause: medications, too low osmolarity, too weak strength, being given at an improper rate
medications
a pt with low hemoglobin and low MCV might have
microcytic anemia
type and nutritional deficiency of iron deficiency anemia
microcytic, iron
which is a measurement of somatic protein: albumin, transferrin, mid-arm muscle circumference, triceps skinfold
mid-arm muscle circumference
who is the most appropriate candidate for parenteral nutrition: 12 year old coming for appendectomy, middle aged women who will begin chemo, an elderly lady with emphysema, young man in for gallbladder surgery
middle aged woman who will begin chemotherapy
a pt w/ parkinsons disease on levadopa should
minimize protein at breakfast and lunch and add it to the evening meal
a pt with Parkinson's disease on Levodopa should:
minimize protein at breakfast and lunch and add it to the evening meal
a 9 month old infant being fed iron-fortified , milk-based formula is obese, you should recommend
monitoring wt and intake
a fecal excretion of ___ grams of fat/24 hours is considered fat malabsorption
more than 7 grams/24 hrs
___ ___ reduces motions and time required
motion economy
According to Herzberg, ___ call forth energy and enthusiasm/job enrichment
motivators
According to Herzberg, achievement, personal accomplishment, recognition, responsibility, participation in decision-making, opportunity for growth are ___
motivators
within 2-3 hours of continuous exercise at 60-80% of maximum
muscle glycogen is depleted
when counseling a diabetic with limited education, which would be the most appropriate question to ask in assessing her comprehension level?
name a food that is a fat
dawn phenomenom
natural increase in morning blood glucose and insulin requirements
MacGregor's Theory X is viewed as a ___, ___ management style
negative, autocratic
The ___ ___ is the profit shown after ALL expenses have been deducted from sales
net profit
Folate supplementation is important for all women during childbearing years. Folate is required for cell growth and division and is therefore necessary for fetal and placental development. Which of the following statements explains the importance of folate intakes:
neural tube forms in the first 18 days after conception
pt develops diarrhea after enteral feeding for 5 days-most likely cause?
new meds
folate, pyridoxine (B6) and B12
newly diagnosed patients with homocystinurias receive increased does of what?
essential AA tryptophan is most closely related to ---
niacin
the essential amino acid tryptophan is most closely related to : folic acid, riboflavin, niacin, pantothenic acid
niacin
2 nutrients in negative balance in an immobilized patient
nitrogen and calcium
the only biochemical measurement that reflects both somatic and visceral proteins
nitrogen balance
Nitrogen Balance Formula
nitrogen intake - nitrogen losses Used to estimate protein flux in critically ill patients
a child presents at the 65th percentile height for age, what does that signify
normal
<140 mg/dL
normal 2h PG glucose level
70-100 mg/dL
normal blood glucose level
27-32 pg
normal level of MCH
80-95 fL
normal level of MCV
98.6
normal temp of body
<200mg/dl
normal tirglyceride level
the BMI for a woman who is 5'7" tall and weighs 148# indicates
normal weight
Overproduction is:
not desirable and should be controlled
what should most be encouraged in a Headstart program
nutrition activities related to food
the NHANES study looks at which parameters
nutritional, clinical, biochemical
most influential factor on causing most cases of HTN
obesity
the Prader Willi syndrome is associated with
obesity
which set of conditions is commonly seen in american children
obesity, dental caries, anemia
The first step in a cost-benefit analysis is to state the ___, clearly and measurably
objectives
what change should be made in the following menu if is to be served to Seventh Day Adventist. tomato juice, cottage cheese fruit plate or egg salad sandwich, milk coffee, tea
offer decaffeinated beverages
nutrition intervention with Alzheimer's disease should include:
offer one food at a time, avoid distractions
a pt has been hospitalized for 17 days with multiple injuries following an accident. when should the discharge plan begin
on the first day of admission
an infant wants a bottle at bedtime, you should counsel the parents to
only give water in the bottle
1 hr
onset of Lantus
2-4 hours
onset of intermediate-acting (NPH) insulin
___ ___ are movements of hands, reduces transportation, and re-plan work areas
operation charts
an AIDS pt should select the following fresh fruit: grapes/orange, orange/banana/pineapple, apple/grapes/peach, grapes/pear
orange/banana/pineapple
the diet for galactosemia should exclude
organ meats, MSG
which is the least common symptom in the elderly: osteomalacia, osteoporosis, obesity, hypertension
osteomalacia
which is not a guideline for Medicaid: low income, over the age of 60, nutritional need
over the age of 60 only and nutritional need
what is most associated with incidence of type 2 diabetes
overweight
what hormone moves milk through the mammary ducts
oxytocin
what hormone moves milk through the mammary ducts?
oxytocin
Potential nutrition-related problems with inflammatory bowel disease include all of the following except:
pancreatic enzyme deficiency
Describe the MNT for cystic fibrosis.
pancreatic enzymes given orally with meals and snacks, high-calorie, high-protein diet with liberal intake of fat and sodium, supplementation of fat-soluble vitamins-one to two times the DRI
nutrients involved in energy metabolism?
pantothenic acid and biotin
which nutrients are involved in energy metabolism: pyridoxine and cyanocobalamin, copper and zinc, pantothenic acid and biotin, folic acid and iron
pantothenic acid and biotin
a post-surgical pt with prolonged ileus should be treated with
parenteral nutrition
a pt with short bowel syndrome will likely receive ______ as initial nutrition therapy
parenteral nutrition
a pt is recovering from an ileocecal resection, where 100 cm was removed. what are your recommendations
parenteral vitamin B12, increase fluids, increase protein
In writing a hospital menu:
patient, staff, and public dining areas should have a unified menu.
a child has been identified as being high risk for food allergies, what should be withheld for the first few years: peanut butter and milk, eggs and strawberries, oats and fish, citrus fruits and chocolate
peanut butter and milk
someone on MAOI shouldn't have
pepperoni
which food should someone on a MAOI not eat: cottage cheese, herbal tea, pepperoni, butter
pepperoni
a Crohn's pt who was previously well-nourished has a fever and ileus 7 days PO. which feeding method should you recommend: central venous hyperalimentation, full liquids, peripheral IV infusion, half-strength tube feed
peripheral IV infusion
a pt admitted to the ICU is diagnosed with HIV and progressive infection, which nutrients would be helpful: phosphorus and zinc, sodium and potassium, sodium and chromium, potassium and magnesium
phosphorus and zinc
a 2 year old child with iron deficiency anemia has anorexia, vomiting, wt loss and restlessness. look for
pica and lead poisoning
a hispanic woman needs more calcium in her diet, what do you recommend: milk, plantains, avocados, pinto beans
pinto beans
which of the following has the fewest calories: plain hamburger, chefs salad with dressing, green salad with thousand island dressing and shredded cheese, fried fish sandwich
plain hamburger
food habits of older Americans influenced by:
poor detention, decreased GI activity, decreased HCl, and decreased taste sensitivity
esophageal varices may be caused by
portal hypertension
MacGregor's Theory Y is viewed as a ___, ___ management style
positive, participative
Which mineral can become deficient as a result of diuretic therapy?
potassium
what can be included in a meal for gluten-induced enteropathy
potatoes with butter
Those with a need for ___ enjoy competition and seek confrontation
power
which of the following best reflects protein status: albumin, transferrin, retinol-binding protein, prealbumin
prealbumin
what is the goal of the dietary guidlines
prevention of chronic disease
Raw food costs + direct labor costs is ___ cost
prime
___ ___ are the steps involved in a process using symbols
process charts
According to Herzberg, maintenance factors will not ___ motivation, but may ___ it from occuring
produce, prevent
The marketing mix four P's: ___,___,___,___
product, place, price, promotion
The ___ schedule is the time sequence of events required to produce a meal; employees assignments and menu items quantity to prepare & timing
production
A meal equivalent is a measure of ___ defined as the amount of all food sales divided by the average cost of a typical meal
productivity
Net profit / revenue determines ___
profit margin
The ___&___ statement shows operating results over a period of time
profit, loss
what hormone develops placenta?
progesterone
which hormone is involved in developing the placenta
progesterone
which hormone regulates breast milk production
prolactin
Issuing discount coupons is a means of:
promotion
what has greatest effect on renal solute load?
protein
which has the greatest effect on the renal solute load : potassium, sodium, glucose, protein
protein
marasmus
protein and kcal starvation, anthropometric diagnosis, starved appearance
what nutrients most affect the renal solute load
protein and sodium
iatrogenic malnutrition is
protein calorie malnutrition
an indication for use of a protein hydrolysate infant formula is : prematurity, constipation, phenylketonuria, protein hypersensitivity
protein hypersensitivity
urea excretion is related to ____, while creatine excretion is related to ____
protein intake, muscle mass
a nephrotic syndrome pt with edema has serum albumin level that continues to fall, recognize that
protein is being lost in the urine
what do you restrict in a diet for hepatic encephalopathy
protein sodium fluid
adjust intake of what w/ a liver disease pt
protein, fluids and sodium
a pt with liver disease needs adjustments in the intake of
protein, fluids, sodium
what is restricted in a diet for hepatic encephalopathy
protein, sodium, fluid
Mono and disaccharides do not:
provide 9 kcal/gram
which of the following about nutrition screening in hospitals is true: provides direction for pt care, cost-effective for all pts, has universal criteria, should be performed only when ordered
provides direction for pt care
which condition benefits from the use of indirect calorimetry: postgastrectomy, chemotherapy, pt with third degree burns, post-surgical pt
pt with third degree burns
Closed shop and union shops are illegal in the ___ sector (government jobs)
public
Nutritionists can present views on bills during the ___ ___ or in earlier planning stages
public hearings
which would you recommend for a pt with mild dysphagia: honey, apple juice, nectar, pudding
pudding
mild dysphagia
pudding thick
The position concerned with obtaining the right product at the right time, and for the right price is:
purchasing agent
high doses of which vitamin will interfere with Levodopa
pyridoxine
Two dietitians pose the following question in their research study: "What is the relationship between the number of protein supplements taken daily and the amount of weight gain?" The level of measurement of the variables is:
ratio
which diet is restricted in carbohydrate: reactive hypoglycemia, diabetes, PKU, galactosemia
reactive hypoglycemia
which of the following is an achievable outcome for a wt loss program
reduce by 10% the number of obese adults ages 25-49 within two years of starting the program
what diet diet is appropriate for reactive hypoglycemia?
reduce intake of concentrated carbohydrates, 5-6 small meals
a nutritional care plan for overweight children should include
reduce rate of body weight gain while allowing growth
a new pt with a BMI of 32 and HTN comes to you for counseling. what is your first recommendation
reduce sodium intake
when working with pts who have food allergies in a pediatric GI clinic, what outcome should be measured
reduction of food-related reactions among patients
what is the appropriate advice for a person with anorexia nervosa
regular mealtimes, and varied moderate intake
___ are written by staff members of the agencies charged with enforcing the regulations
regulations
___ workers are employees necessary for everyday coverage of full-time positions
relief
a teenageer was brought to the hospital with CVA and dysphagia. the dietitian should immediatly
request a swallow test
in severe cirrhosis with ascites, diet therapy should be
restrict sodium
intervention by RD conducting nutrition assessment is best determined by ---
results of nutrition screening
intervention by a dietitian conducting nutrition assessment is best determined by:
results of nutrition screening
a tube fed pt develops diarrhea. what needs to be done first
review the osmolality of the feeding
milk is packed in opaque containers to avoid UV destruction of
riboflavin
southeast asian populations would likely consume the following foods
rice, vegetables, small amounts of protein
Gluten can be extracted from dough made from flour and water by:
rinsing with water
which of the following items is appropriate for a Muslim diet: sweet and sour pork, salad with Bacos, pork-fried rice, chicken in wine sauce
salad with Bacos
People with achievement as a motivator tend to gravitate toward ___ and ___ positions
sales, management
Herzberg's two-factor theory are based on ___ & ___
satisfiers, dissatisfiers
which of the following is not associated with anorexia nervosa: food aversions, distorted body image, schizophrenia, constant concern about wt status
schizophrenia
___ management focuses on the physical aspects of a job, not the human aspects
scientific
a single 19 year old female is 6 months pregnant. she has not gained any wt and has not seen a physician. hemoglobin is 9. hematocrit is 30. what is the most important recommendation for her: see a physician immediately, apply for WIC, join a teenage pregnancy support group, begin taking iron supplements
see physician immediately
the ketogenic diet is used to help treat
seizures
___ menu reduces plate waste and cost
select
Unions primarily promote based on ___
seniority
pt with decubitus ulcers will likely demonstrate low
serum albumin
The first step in the control process is to ___ ___ ___
set the standards
what does fecal fat of 12 g indicate
severe at malabsorption
what is the characteristics of marasmus
severe fat and muscle wasting
which foods are most likely to cause an allergic reaction
shellfish, peanuts, wheat
Staffing patterns for a particular operation; portions of hours worked, number of days worked per week, relief assignments are known as ___
shift
Lack of proper handwashing is commonly associated with:
shigella
chemically defined formulas are used for
short bowel syndrome
enteral feeding products that contain protein in the form of small peptides and amino acids are recommended for patients who have: short-bowel, gastrectomy, colectomy, jejunostomy
short-bowel syndrome
which best applies to nutritional screening: follow JCAHO, include nutritional parameters, done after nutritional problems are identified, only done on at risk patients
should include nutritional parameters
Cardiac cachexia is characterized by:
significant loss of lean body mass
Work ___ estimates unnecessary job parts (looks at the smallest parts of the job to increase productivity and decrease cost
simplification
iron deficiency anemia has what cell characteristics
small, pale cells, hypochromic, microcytic
microcytic, hypochromic anemia
small, pale cells; due to iron deficiency is
The use of marketing principles to advance a social cause, idea, or behavior is ___ marketing
social
catecholamines cause ___
sodium retention
what elements of the diet vary the most in hepatic disease
sodium, fluid, protein
What is the function o fluids in a recipe?
solvent for dry ingredients, hydration for gluten to develop, and source of steam as leavening
a child has chronic non-specific diarrhea without malabsorption. an increased intake of what might be the cuase
sorbitol
forms of cerebral palsy
spastic: muscles are stiff and tight athetoid: constant, involuntary writhing motions
The job ___ is written for each job and is a personal qualification
specification
your pt is on coumadin, which foods would you make sure to consistently include in their diet: oranges/peaches, sweet potatoes, beef/lamb, spinach/collard greens
spinach/collard greens
SOP = ___ ___ ___
standards of procedure
SOPP = ___ ___ ___ ___
standards of professional practice
You attend a party with several friends where a variety of hot and cold finger foods were served. The food tasted great, but on the way home, a few of you complained of abdominal cramps. After a day of cramps and diarrhea you feel fine. A possible cause for your symptoms is:
staphylococcus aureus
___ benefits are required by law to ensure the income in the event of unemployment, injury, or death
statutory
The union ___ is an employee who represents fellow employees as the union rep (they do not get extra pay)
steward
a pt on a full liquid diet should not receive: sherbert, strained cereal, pureed fruit, margarine
strained cereal
A patient interviewed by the dietitian reports he develops gas and bloating when milk is consumed. This information should be documented in which section of a SOAP medical record entry:
subjective
a patient with dehydration exhibits the symptoms of
sunken eyes, decreased renal function, increased tachycardia
___ benefits include life and health insurance
supplementary
Ca, D, folate, B6, B12
supplements needed for epilepsy
a cancer pt receiving radiation therapy to the head and neck presents with wt loss, nutrition diagnosis would be
swallowing difficulty
which of the following would be classified as NC in the NCP: inadequate vitamin intake, limited access to food, swallowing difficulty, inappropriate intake of food fats
swallowing difficulty
dehydration due to polyuria, increased pulse, fruity oder of ketones
symptoms of acute ketoacidosis
People with achievement as a motivator are ___-oriented and can manage themselves
task
Sophistication levels: Moderately experienced
teachers, health instructors, patients already instructed Learn what they know and correct if needed Emphasize review of new materials; move on to more complicated concepts
goals for a community nutrition program should be based on
the Dietary Guidelines for Americans
what is an example of a program that provides food to the needy: food bank, food stamp, child care, WIC
the Food Bank
the year 2010 Healthy People goals are an outgrowth of a report by:
the Surgeon General, under HHS
which survey is conducted every 10 years
the USDA Food Consumption Survey
the allowance for Food Stamps is based on:
the USDA Thrifty Food Program
azotemia
the accumulation of abnormal quantities of urea, uric acid, creatitine, and other nitrogenous wastes in the blood
why would child measurements be inaccurate
the child was measured standing up
why might a child with PKU have an increased incidence of dental carries
the diet is high in carbohydrates and low in protein
Medicare is for
the elderly
the breast fed infant is drinking primarily colostrum for how long
the first few days
the best way to justify continuation of WIC would be to show improvement in
the infant morbidity rate
New York City
the largest city in New York State and in the United States
glucose utilization rate
the maximum amount of glucose without causing metabolic complications (such as refeeding syndrome)
decreases
the need for phenylalanine increases or decreases with age, infection?
a homeless pt who is deficient in all nutrients is to be discharged. what organization may help
the social workers group
why is an affluent couple (man with diabetes, 67 years old and wife with a broken arm, 50 years of age) not eligible for Meals on Wheels
they can leave the house
asian, hispanic and native americans have the following in common
they consume little milk
memory loss may be associated with a deficiency of
thiamin
decrease insulin resistance in peripheral tissues
thiazolidinediones do what?
a pt with dysphagia waiting for a swallow test may receive: thick liquids, thin liquids, PPN, PN
thick liquids
osteoporosis mostly affects
those 65 years of age or older
which is apart of the nutritional therapy for IDDM in a lean person: time meals, decreased caloric intake, it is not crucial to maintain calories if avg intake is low, decrease the frequency of feedings
time meals
Roman Catholic dietary laws state that fish is
to be served on Ash Wednesday and Fridays during lent
Americans with Disabilities Act requires employers to make reasonable accommodations for individual employees.An example of an accommodation that employers could be asked to make is:
to provide a lavatory that is wheel chair accessible.
What is the Shilling test used for?
to test for pernicious anemia
VMA test diet measures
total catecholamines
the VMA test diet measures
total catecholamines
PERT: pancreatic enzyme replacement therapy orally
treatment for actue pancreatitis involves doing what with meals and snacks
15 g CHO, wait 15 min, if <70 mg/dL another 15 g, repeat until normal glucose
treatment of actue hypoglycemia
insulin, rehydration
treatment of acute ketoacidosis
Louisana Purchase
treaty between the USA and France where the US bought territory that stretched from the west bank of the MIssissippi River to the Rocky Mountains
what best measures excess calorie reserves: wt, creatinine, triceps skinfold, arm circumference
triceps skinfold
muscle mass is determined using
triceps skinfold and arm circumference
which of the following indicates protein calorie malnutrition: creatinine height index of 93%, height for weight ratio of 89%, triceps skinfold and arm muscle circumference of 79%, serum albumin of 4.5;transferrin of 410
triceps skinfold and arm muscle circumference of 79%
which anthropometric measurements are useful in assessing adults
triceps skinfold, arm muscle circumference, height, weight
what should a jewish pt include in his diet to increase the intake of zinc: fresh green vegetables, pork, turkey, wheat bread
turkey
Number of employees terminated or replaced / # total positions in the department is the ___
turnover
an athlete needs 4000 calories. the cornflakes nutrient label says that one serving provides 25% of the RDA for CHO. how many servings of cornflakes does he need to get his 25%
two
aspart, lispro, humalog
types of rapid acting insulin
whats permitted on a tyramine restricted diet?
uncured cheese like cottage, ricotta
which of the following is permitted on a diet restricting tyramine: hard cheese like cheddar or swiss, uncured cheese like ricotta or cottage, pickled of smoked foods, tofu
uncured cheese like cottage, ricotta
As a manager of a foodservice department, you hear that an employee was very upset with a decision made by a first line supervisor. This employee makes an appointment with the VP over foodservice's. The VP states that he cannot get involved at this time and encourages the employee to talk to you. The principle at work is:
unity of command
when measuring a child's somatic protein mass, in addition to the BMI, use:
upper arm muscle area
a pt who had an ileal resection is placed on a tube feeding and begins to have diarrhea. this may be due to
use of hypertonic formula
You are nearing the summer months and must plan for vacation coverage on the work schedule. You have a staff of 40; all are entitled to vacation time ranging from one to four weeks depending on seniority. You should:
utilize temporary or leased employees
An instrument that measures accurately and consistently is said to be:
valid
A glucometer is checked for accuracy by correlating the readings to serum glucose levels. Repeatedly, the readings are precisely the same. This indicates:
validity
a pt on a clear liquid diet should not be served: strawberry flavored gelatin, vegetable stock, apple juice, fruit flavored popsicle
vegetable stock
do not give __ to a CL pt
vegetable stock
what is 1/4 c low fat cottage cheese equivalent to
very lean meat exchange
give what supplements to a BF baby?
vit D and flouride
a vegan is allergic to milk. which nutrients would you expect might be deficient in her intake
vitamin B12, D
microcytic anemia is commonly seen with what type of vitamin deficiency?
vitamin B6
which supplements should you give to a breast-fed baby
vitamin D and fluoride
What is the formula for calculating the kcal of 500ml of dextrose for a TPN solution?
volume X strength = grams X kcal/g = kcal 500ml X 0.5 = 250grams X 3.4kcal = 850kcal
Current research indicates _________ is a better marker of abdominal fat than _________ .
waist circumference; waist-to-hip ratio
a 11 month old infant is at the 95th percentile weight for age and has been for the past 9 months. what should you do
watch his growth over the next six months
following a colectomy, the absorption of which of the following would be most concern: vit D and E, water and sodium, B vitamins, vit C
water and sodium
athletes should receive: salt pills during summer months, extra protein, carbohydrate loading two weeks prior to an event, water during an event to replace lost fluids
water during an event to replace lost fluid
what is the least useful evaluation tool in a community assessment program
weight for age
what is the most useful for evaluating recent under-nutrition or over-nutrition
weight for height
which of the following would provide the most useful data when conduction nutrition screening on preschool children at a health fair: triceps skinfold, wt for age, wt for stature, stature for age
weight for stature
iron or protein deficiency
what are the possible causes of brittle, thin, spoon-shaped nails?
lantus
what is a type of long-acting insulin?
prevent marked rise in blood glucose that would stimulate more insulin
what is the goal of postprandial or reactive hypoglycemia?
a Rabbi is admitted to the hospital, what question will he ask to the RD
what is the mixture of foods in combination dishes
1g nitrogen/150kcals; 1-1.5 g pro/kg/day
what is the protein ratio for anabolism in PN?
rapid-acting (aspart, lispro, humalog) and short-acting (regular)
what type(s) of insulin provide a burst of insulin to cover meal?
when is breast feeding contraindicated
when the mother has AIDS
enough acid to damage enamel
when the pH in the mouth drops below 5.5,what can occur?
Name a major food source of magnesium
whole grains, nuts, dried beans and peas
an 18 month old child should receive what kind of milk
whole milk
Because some cooking oils turn cloudy when refrigerated oils intended for salad dressing as treated by:
winterization
a pt with chronic pancreatitis should consume oral pancreatic enzymes
with all meals and snacks
iron preparations should be taken
with meals
___ ___ observes random samples to determine % of time working or idle
work sampling
The body mass index (BMI) is measured by:
wt/ht squared
if you have a lactose intolerance, which food could you most likely tolerate: whole milk, skim milk, ice cream, yogurt
yogurt
In a ___-___ budget, it is more planning oriented and cost must be justified
zero-based
If you want to quickly calculate a healthy person's estimated calorie, protein and fluid intake, what would you use?
~25kcal/kg for calories, .8-1g Protein/kg and 1cc/kcal for fluid or 25cc/kg
What is considered significant weight loss?
≥1% to 2% in 1 week ≥5% in 1 month ≥7.5% in 3 months ≥10% in 6 months