Inman Review ALL
Payment by 3rd party for service rendered by healthcare provider to patient (Bluecross, Medicare)
3rd Party Reimbursement
-Found in women with lack of prenatal care, poor diets, poor protein and Ca intake -Proposed association of PIH and Ca deficiency
@ Risk for PIH
Virus debilitates immune system by attacking lymphocytes Symptoms: diarrhea, malabsorption, nausea, vomiting, wt loss
AIDS
GOALS: preserve LBM, prevent wt loss, prevent HIV wasting Energy: BEE x 1.3 (asymptomatic) Protein: 0.8g/kg (no symptoms) 1.2- 2 g/kg ( wasted LBM) MVI to correct deficiency Low bacteria (neutropenic) Diet --> AVOID raw foods
AIDS Nutrition
Acute Respiratory Distress Syndrome -Lungs no longer able to exchange gases, hyper metabolism, high energy needs, severely underweight
ARDS
-Provide adequate but not excessive kcal -Avoid excess non-protein kcal -Provide EN containing EPA + GLA + increase levels of antioxidant vitamins -1.5-2 g/kg pro ( maintain LBM)
ARDS Nutrition
Genetic predisposition to produce an increase IgE in response to allergen
Atopy
Where total cost line crosses the revenue (sales) line; BE increases when cost increases
BE (break even) point graph
occasions loyalty
Behavioristic variables
Gastroduodenostomy
Billroth I
Gastrojejunostomy -Food bypasses duodenum - decrease in pancreatic secretion ( secretion of secretin + pancreozymin decrease) -Ca + Fe abs decreases
Billroth II
BE= the number/amount of money you need to break even BE= FC (fixed costs) / 1 - (vc/sales) vc= variable costs
Break even (BE) point equation (sales)
BE= Total FC (fixed costs) / selling price - variable costs (vc) BE= # average meals sold
Break even (BE) point equations (meals)
Saturated Fatty Acids (SFA), Monounsaturated Fatty Acids (MUFA), Polyunsaturated Fatty Acids (PUFA)
Butter FA Types
Blood test to identify children with milk, egg, fish, peanut allergy
CAP-FEIA
Symptoms: wt loss, emaciation, anorexia Persistent obstruction of air flow
COPD
- Maintain stable weight -Replete but do not overfeed -High kcal and pro (1-1.4 g/kg (15-20% kcals) -30- 45% fat (oxidation of fat consumes less O2 than Ox. or CHO) -40-50% CHO -Small, frequent, mini meals and snacks, easy to prepare and eat, nutrient dense supplements i.e. smoothies, meatloaf, muffins w/cream cheese, tuna salad, cereal w/ fruit
COPD Nutrition
AKA non-tropical sprue + gluten-induced enteropathy -Rxn to gliadin
Celiac Disease
-Excess mucus production -Chronic productive cough
Chronic bronchitis
Hydrogens on the same side of the double bond; Examples: most natural fats and oils
Cis Fat
Simple fat and other component; phospholipid
Compound Fat
Food Safety (low bacteria neutropenic diet); avoid raw foods Banana lower risk than apple
Educate AIDS pts on ________
Type of COPD -Air sacs (alveoli) lose elasticity -Difficulty exhaling -Air pocket walls expand, thin out, collapse Pt = thin, cachetic, often older
Emphysema
-AICA markup method 100 / food cost % = markup factor Markup factor x raw food cost = selling price -HIDDEN cost of 10% may be added to food cost to cover unproductive costs (losses in preparation, cooking, & serving)
Factor Pricing Method
Triglycerides (3 fatty acids + glycerol); most dietary fat are triglycerides
Fat Chemical Elements
Energy, insulation, padding, depresses gastric secretion so delays emptying; has less oxygen and more carbon than CHOs so provides more energy (more carbon atoms for oxidation)
Fat Functions
-Provides indigestible bulk -Promotes intestinal function
Fiber
Change in count
Flexible budget
Most readily controlled item subject to greatest fluctuation
Food costs
Public health departments derive a portion of their income from general revenue (taxes) and federal, local, or foundation grants
Funding
Eat small, low fat meals, liquids empty more rapidly AVOID: -eating before bed -soda -caffeine -acidic foods
GERD Diet
Inflammation of the stomach. Symptoms: Anorexia, N/V/D
Gastritis
Clear liquids advance as tolerated; avoid gastric irritants
Gastritis Diet
SOP: diabetes care, oncology, nutrition support (knowledge) SOPP: Application of research, communication and application of knowledge, quality in practice (behavior)
SOP vs SOPP
All available bonds of carbon chain are filled with hydrogen; solid and hard at room temperature
Saturated Fatty Acids (SFA)
Coconut oil, palm kernel, cocoa butter, butter, beef tallow, and palm oil
Saturated Fatty Acids (SFA) Examples
both a fixed and variable componenet labor, maintenance, utilities
Semi-variable costs
Some lecture plus interaction, beneficial in clinical setting, 3-5 people with similar needs
Small Group
HHS; youth risk behavior survey -Grades 9-12 -Smoking, alcohol use, wt control, exercise, eating habits
YRBS
identify a need that is not being filled (market niche)
1st step marketing
purchasing paper goods
Diagonal communication
Focus on one activity or performance
Performance budget
listening
_____ skills are essential for communication
Polyunsaturated Fatty Acids (PUFA), Monounsaturated Fatty Acids (MUFA), Saturated Fatty Acids (SFA)
Margarine Fatty Acids
1) Add up all costs as percentages 2) Find targeted food costs percentage, subtract TOTAL from 100% 3) Determine selling price: total food cost / desired food cost percentage
Cost of Profit Pricing Method
- Determines whether goal of intervention is worthwhile in terms of cost - Benefits MUST outweigh costs
Cost/Benefit Analysis
Efficiency of equipment placement; studies work motions; shows the number of movements between pieces of equipment
Cross Charts
Double-blind placebo controlled food challenges -identify food-induced symptoms GOLD STANDARD FOR Dx!
DBPCFC
Oat bran and soluble fibers
Decreases CHOL by binding bile acids converting more CHOL to bile
Age Gender Race Education Income
Demographic variables
-Non digestible CHOs and lignin, binds H2O, Increase fecal bulk; found in legumes, wheat bran, fruits, veges, whole grains
Dietary Fiber
-varies directly with changes in sales -directly involved with service to customer China, silver, food, benefits, uniforms, laundry, repairs VARIABLE COSTS
Direct costs
When diverticula become inflamed as a result of food and residue accumulation and bacterial action
Diverticulitis
Clear liquids, low residue or elemental gradual return to high fiber
Diverticulitis Diet
Symptoms: cramps, rapid pulse, weakness, perspiration, dizziness CHO --> jejunum --> Increase in H20 --> decrease in BP -2hrs later- CHO abs rapidly --> BG increases --> insulin increases--> BG decreases (reactive hypoglycemia) Follows gastrectomy
Dumping Syndrome
B12 def= lack of IF + bacterial overgrowth in loop of intestine bypassed, decreased B12 abs (pernicious anemia dx by scilling test) B9 def= needs B12 for transport inside cell; poor B9 intake + low Fe (cofactor in B9 metab)
Dumping Syndrome Anemia
-Freq, small, dry feedings -Fluids before or after meals (slow passage) - Restrict hypertonic conc. sweets -Give 50-60% complex CHO -Pro @ each meal -Mod. fat -May need B12 injections -Lactose maybe poorly tolerated d/t rapid transit
Dumping Syndrome Nutrition
Decrease in gastric emptying d/t surgery, DM, viral infections, obstructions -Prokinetics (erythromycin + metoclopramide), increase in stomach contractility -Mod-severe hyperglycemia --> damages gastric nerve
Gastroparesis
-small, freg meals -pureed foods AVOID: High fiber High fat (liquid fat may be tolerated)
Gastroparesis Diet
Urban Suburban Climate Resources Cultural values
Geographic variables
Storage proteins Prolamins: -gliadin in wheat -secalin in rye -hordein in barley -avenin in oats
Gluten
HIV- Associated lipodystrophy syndrome -May develop from therapy -High chol, TG; insulin resistance; change in body fat distrib.
HALS
-keep info confidential -suggest AIDS edu programs
HIV Employee
Breastfeed
HIV Infected women should not ________
FDA + HHS -telephone survey of randomly selected adults -tracks self perception or relative nutrient intake levels, use of food labels, knowledge of fats and chol, prevalence of supp. use.
Health and diet survey
National Health Program and Disease Prevention; HHS health agenda for decade; focuses on disease prevention by changing behaviors
Healthy People 2020
Protusion of portion of stomach above diaphragm into chest
Hiatal Hernia
-small, bland feedings AVOID: -late night snacks -caffeine -chili powder -black pepper
Hiatal Hernia diet
Process of adding hydrogen (at double bond) to unsaturated fatty acids (USFAs) to increase saturation and stability
Hydrogenation
Severe N + V, acidosis, wt loss during pregnancy TREAT w/ bed rest; small amts of freq carbs
Hyperemesis Gravidarum
FIXED -Not effected by sales volumes -Can't be readily changed Rent, taxes, interest on debt, insurance, depreciation
Indirect costs
24/36
Introduce eggs @ ____ months; fish @ _____ months
-Spoon-thick -Honey-like -Nectar-like -Thin (includes all beverages=water, ice, milk, juices, coffee, tea, gelatin)
Liquid Consistency
Hands on and value driven -explain your value system to employees
Management should be _________ _________.
Saturated fatty acids between 6-12 carbons; naturally found in milk fat, coconut oil, and palm kernel oil
Medium Chain Triglycerides (MCTs)
Olive oil, canola oil, peanut oil, and sunflower oil
Monounsaturated Fatty Acids (MUFA) Examples
Cow's milk
Most common allergen for infants
Dysphagia Mechanically Altered -Moist, soft textured, easily formed into bolus, moist tender ground/diced meat, soft cooked veggies, soft/canned fruits NO: Bread, rice, cheese cubes
NDD1
Dysphagia Advanced AVOID: -very hard, sticky, crunchy foods -hard fruit and veggies -nuts -seeds
NDD3
Nucleotide Nucleoside Reverse Transcriptase Inhibitors (retrovir + zidowdine) -Lead to anemia; loss of appetite; low vit B12, Cu, Zn + carnitine
NRTI Drugs NTR Effect
NOT RECOMMENDED Vit C + St. Johns worth = could result in drug resistance -CAM therapies not recommended (complementary alt med)
Nutr/ Herbal Supplements for AIDS
MI skills; open ended; affirmations; reflective listening; summaries
OARS
Pregnancy Induced HTN -HTN -Edema to face + hands -Proteinuria -Rapid wt gain after 20th week -May have convulsion
PIH
-Na restriction NOT RECOMMENDED for prevention or treatment (Na needed to maintain normal levels during large prenatal expansion of tissues and fluid)
PIH Diet
Pregnancy NTR surveillance system (HHS-health and human services) -low income, high risk, preg. women. -maternal wt gain, anemia, preg behavior risk factors (smoking, alcohol), birth-wt, counts # of women who BF -Identify and reduce pregnancy -related health risks.
PNSS
-Illustrate relative importance of problems -Work on tallest bar problem that occurs most frequently -80/20 rule (80% outcome results from 20% input)
Pareto Charts
Pediatric NTR surveillance system (HHS) - low income, high risk; 0-17 yrs ( emp. 0-5 years) -Ht, wt, birth wt, Hct, hgb, chol, BFing (breast feeding?) -monitors growth and NTR status, infant feeding practices.
PedNSS
-High pro + kcal w. supp. needed for wt gain -Energy + stress factors - MVI @ 1-2x RDA - HALS may develop -sig. loss of LBM can be obscured by HALS + edema
Pediatric HIV Nutrition
Safflower oil, corn oil, soybean oil, cottonseed oil, sunflower oil
Polyunsaturated Fatty Acids (PUFA) Examples
Raw food cost and direct labor -Determine markup ~add food cost % to % direct labor cost ~divide into 100 -Selling price = prime cost x price factor (markup) (Prime cost is Direct labor + Raw food cost)
Prima Cost Method
Requires administrative support, realistic budget, staff commitment, support of target population
Program Implementation
DRGs (Diagnostic Related Groupings); knowing amount of payment in advance; includes Medicare and Medicaid patients; hospitals paid specific amount per patient based on disease regardless of the number and type of services; length of stay NOT considered when determining payment; peer review organization (PRO) (watches system)
Prospective Payment System
social class lifestyle motive
Psychographic variables
Analyzing flow of customers in cafeteria -balancing cost of waiting in line with cost of increase service to prevent "S" > straight
Queuing theory
Specific, measurable, achievable, relevant, time specific
SMART objective
Hydrogens across from each other; past as tightly as SFAs in membranes; intake can influence membrane fluidity and could be harmful to cell function; found in milk fat (4-8%); Examples: margarine, shortening, frying fats (partial hydrogenation of polyunsaturated fatty acids)
Trans Fat
Bacterial, viral, parasitic infection Chronic GI disease, intestinal lesions May also affect stomach Symptoms: diarrhea, malnutrition, def of B12 + B9 d/t decreased HCl + IF
Tropical Sprue
-Antibiotics -High kcal -High pro -IM B12 -Oral B9
Tropical Sprue Treatment
Eroded Mucosal Lesion Treatment: antacids, antibiotics to kill h.pylori bacteria Drugs: Cimetidine, Ranitidine (H2 Blocker); prevents binding of histamine to receptor; decreases acid secretion
Ulcer
-As tolerated; well balance; avoid late night snacks OMIT: cayenne + black peper, large amounts of chili pepper, avoid excess caffeine + alcohol
Ulcer Diet