Exam attempt #1 Cont.
Which vitamins/minerals are key for a cirrhosis diet?
- B complex vits - Vitamin C - Vitamin K - Zinc - Mg CHECK VITS/MINS...CONFLICTING INFO *Zinc involved in conversion of ammonia to urea, increased loss in urine *Monitor need for A & D
NHANES survey evaluates what types of data?
- Clinical - Chemical (Hgb, Hct, Chol) - Anthropometric - Nutritional data (24 hour recall, food frequency lists)
How do you calculate FTE?
- Compute by dividing the total # of hours used in operating the foodservice for a period of time by the normal workload hours of one employee. FTE/day (Labor hrs worked/day / 8 hours) FTE/week (divide by 40 hours) FTE/year (divide by 2080 hours)
Nepro is an example of what type of formula?
"Specialized" Renal: Nepro, Novasource Renal Pulmonary: Nutre, Pulmocare, Respalor: high fat, low CHO Liver: Hepatic Aid II, NutriHep Diabetes: Glucerna, DiabetiSource - More specialized = higher cost
How do you calculate meals per labor hour?
# meals produced / # hours worked
The Menu mix (popularity)
# sold of particular item / # of all items sold Items are categorized into high and low menu mix...using the formula based on having popularity greater or less than 70% of total sales
How many FTE's can you hire with a weekly budget of $8640 if the salary is $12/hour?
$8640/$12 = 720 hours 720 hours / 40 (hours in a week) = 18 FTE's
Glycogen storage disease:
- Deficiency of glucose-6-phosphatase in liver; impairs gluconeogenesis and glycogenolysis - Liver unable to convert glycogen into glucose leading to HYPOglycemia - Consistent supply of exogenous glucose with raw cornstarch at regular intervals - High CHO - Low Fat
Likert - management of conflict
(1)Four basic systems of organizational leadership (a) Exploitive, autocratic: job-centered (b) Benevolent, autocratic: job-centered (c) Consultative: employee-centered (d) Participative: employee-centered (2) PARTICIPATIVE - MOST EFFECTIVE; EMPLOYEES WORKED UNDER GENERAL SUPERVISION, THE BOSS DELEGATED AUTHORITY, AND IT WAS EMPLOYEE-ORIENTED; DECISION-MAKING SPREAD EVENLY THROUGHOUT THE ORGANIZATION; FULL INVOLVEMENT OF EMPLOYEES IN SETTING GOALS MAKING JOB-RELATED DECISIONS "Likert likes to participate."
Methods to establish "line items" within budgets:
(5)
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:
(5) NNMRRP National Nutrition Monitoring and Related Research Program
Give 1 cc water/calorie ingested
* 1 cal/cc formula (80-86% water) * 1.5 cals/cc (76-78% H2O) * 2 cals/cc (69-71% H2O)
Peritoneal: Chronic renal failure
* 1.2-1.3 g/kg protein (SBW) * Kcals the same * Sodium (2-3 g) based on BP & Wt * Potassium: generally unrestricted (usually 2-4 g) * ≤ 2000 mg total elemental Calcium * Phosphorus 800-1000 mg * 1-3 L fluid (depending on output) * Extra THIAMIN may be needed *CAPD (continuous ambulatory peritoneal dialysis) 4-5 x per day
IBD: Energy needs
* Energy needs according to "current BMI" - Fat limited only if steatorrhea present - Water soluble and fat soluble vitamins - Iron, folate; assess Ca, Mg, Zn; MCT oil, watch lactose, *frequent feedings - High fat may improve energy balance - Give high fiber when IBD in remission/under control
Lactose intolerance Diet:
* lactose-free; no animal milk or milk products, NO WHEY - Yogurt and small amounts of aged cheese may be tolerated - OK: lactate, lactalbumin
A.) Traditional or classical
- Formal structure that organizes and administers the work activities - COORDINATION is main responsibility of management - Accountable to only ONE superior *Too mechanistic, impersonal, doesn't see group interactions/decision-,making processes - focus on tasks, structure, authority - "Scalar principle" (authority & responsibility flow in a direct line vertically from the highest to lowest echelons)
Budget development
- Gives manager a basis for CONTROL *Usually reviewed MONTHLY
LDH (lactic acid dehydrogenase) levels are increased in:
- Hepatitis - Myocardial infarction - Muscle malignancies
ARDS (acute respiratory distress syndrome), respiratory failure
- Hypermetabolism, increased energy needs, severely underweight - Adequate but not excessive Kcals; avoid excess non-protein kcals - Provide enteral formula containing EPA & GLA (gamma-linoleic acid), and enhanced levels of antioxidant Vits - High Protein (1.5-2.0 g/kg BW, maintain lean body mass) - Maintain stable wt, facilitate weaning from mechanical ventilation, without exceeding capacity to clear carbon dioxide
2.) Contingency approach (Fiedler)
- In highly favorable & highly unfavorable situations = a Task-oriented leader is more effective (group is ready to be led) - In moderately favorable situations = a Relationship-oriented leader tends to be more effective (bc cooperation is more successful than task-oriented leadership)
IDL (pre-beta to beta)
- LDL precursor; found in circulation secondary to catabolism of other lipoproteins
Southeast Asians
- Pork - Few DAIRY products
Yeasts
- Water, energy, acid medium on oxygen
HIPAA (Health Insurance Portability and Accountability Act 1996:
- allows employees to transfer coverage of EXISTING illness to a new employer's insurance plan
Labor costs
- are LESS controllable than food costs
Tertiary prevention:
- as disease progresses, intervention to reduce severity, manage complications, "rehabilitation efforts"
Cirrhosis: Protein deficiencies may lead to?
- ascites - fatty liver - impaired blood clotting *Ascites occurs when blood cannot leave the liver (connective tissue overgrowth blocks blood flow out of liver into vena cava
Net worth ratios
- assess ability to meet LONG TERM DEBT
Liquidity ratios:
- assess ability to meet short term debt or current obligations Use "Current Ratio" to calculate liquidity: Current assets/Current liabilities (Want it to be greater than 1) Solvency ratios: used to examine an operation's ability to meet long-term operations Profit margins: used to analyze finances to determine greatest efficiency in an operation
SNAP
- assist low income with "monthly" benefits; net income must be at or below certain % of poverty level; income limits vary by household size and are adjusted to the cost of living Allocated funds based on the "Thrifty Food Plan"; cost of preparing healthy/low-cost meals
CKD: Potassium
- generally NOT restricted unless serum level is elevated and urine output is < 1 liter / day - Fluid generally unrestricted
Wages:
- hourly earnings of employees covered by the Fair Labor Standards Act
Determining continuation of care: Documentation
- includes a statement of where the patient is now in terms of expected outcomes, date and time a.) indicators measured, results, and method for obtaining the measurement b.) criteria to which the indicator is compared c.) factors facilitating or hampering progress, other positive or negative outcomes d.) further plans for nutritional care, monitoring and follow-up or discharge
Acute viral hepatitis: MNT
- increase fluids & prevent dehydration - care varies depending on symptoms & nutr care - 50-55% CHO to replenish liver glycogen and spare protein - 1.0-1.2 Protein; provide lipotropic agents (to convert fat into lipoproteins for removal from liver) - Moderate to liberal fat intake if tolerated * Small frequent feedings bc of anorexia - Encourage coffee (antioxidant)
Infant mortality rate:
- infant deaths "UNDER 1 year of age" - expressed as the number of deaths per 1000 live births
Pancreatitis:
- inflammation with edema, cellular exudate and fat necrosis - may be due to blockage or reflux of the ductal system; premature activation of enzymes within pancreas leads to autodigestion
Recommend following the DRI for which 3 vit/mins for treatment of Heart disease?
- Folate - Mg - Multivitamin with B12 (200-500 mcg/day)
Food cost: calculated 2 ways
- Food purchases plus foods removed from inventory OR - Beginning inventory minus ending inventory, plus food purchases
Government regulations:
- For schools & LTC facilities Truth-in-menu: - Legislation requires that menus accurately describe foods to be served (Marine lobster, fresh fish) Food Code: - person in charge must be able to identify food allergens and associated symptoms
1.) Operating budget
- Forecast of revenues, expenses, and profit for a specific period of time First step: - Forecast sales or revenue (income) portion - Then budget expenditures (labor, food, operating expenses) related to the projected level of revenue
What are the two types of IBD (Inflammatory Bowel Disease)?
1.) Crohn's disease (Regional enteritis) 2.) Chronic ulcerative colitis (UC)
Nutritional Status and Nutrition-Related Health Measurements:
1.) PedNSS (Pediatric Nutrition Surveillance System) 2.) PNSS (Pregnancy Nutrition Surveillance System) 3.) NHANES (National Health and Examination Survey) 4.) USDA Nationwide Food Consumption Surveys (NFCS)
McClelland's Achievement - Power- Affiliation theory:
1.) People have three needs - Need to achieve - Need for power - Need for affiliation Achievement motive: - desire to do something better/more efficiently - Sales & management positions - Task oriented and can manage themselves Power: - enjoy competition and seek confrontation Affiliation: - desire to be liked by others, joins groups
Menu Development: Steps
1.) Plan dinner MEAT or entree for entire cycle 2.) Luncheon entree of main dishes 3.) Salads, accompaniments and apps 4.) Desserts for both lunch and dinner 5.) Breakfast and other items
Dietary Reference Intakes (DRI) include:
1.) RDA 2.) EAR 3.) Al 4.) UL
Insulin: Bolus (premeal or prandial) types, when to take them, and duration?
1.) Rapid-acting - Aspart (Novolog) - Lispro (Humalog) - Take 5-15 mins before eating - Usual duration 4 hours 2.) Short-acting - Regular (Humulin R) - Take 30-45 mins before meal (burst of insulin to cover the meal just about to be eaten) - One unit covers 10-15 g CHO - Duration 3-6 hours
Burns:
1.) Replace fluid & electrolytes lost 2.) Increase Kcals - based on burn size (recovery period) 3.) 1.5-2.0 g/kg Protein, High Kcals (Secondary period) *Water soluble vitamins (2x RDA) *Vitamin C, Vitamin A (10,000 IU), Vitamin K (if on antibiotics), Zinc, zinc sulfate
Hawthorne studies - Western Electric - Elton Mayo
- involve people in process, they become more productive - Special attention improves behavior (placebo effect) - Work breaks increase productivity
Organizational culture
- is the shared philosophy, beliefs, expectations and attitudes that hold an organization together
Inputs (resources):
- labor - money - materials - facilities - energy
Interface
- line that forms between two immiscible liquids (oil & water)
Ileum resection cont: If ileum cannot recycle "bile salts"
- lipids are not emulsified and leads to malabsorption of fat-soluble vits - malabsorbed fats combine with Ca, Zn, Mg, leading to "soaps" - colonic absorption of "oxalate" increases (renal oxalate stones) - increased fluid and electrolyte secretion; increased colonic motility
Vinegar (acetic acid):
- lowers pH
Cream of tartar (Angel food cake)
- maintains white color by preventing Maillard browning rxn - stabilizes egg white foam (contributes to volume) - contributes to tender crumb NO tartar - tough, yellow, small cake
2.) CDC STEPS
- major federal level grant - Steps to a healthier US focused on community-based health initiatives related to 'obesity'. - Directs funds to address Asthma, Obesity and Diabetes prevention
Conflict resolution: 1.) Dominance & suppression: Avoidance
- manager avoids taking a position - NO-ONE IS SATISFIED - pretends to be unaware that a conflict exists or postpones action repeatedly
Employee rights:
- may join together to bargain as a group - can strike for better working conditions - can join a union whether or not it is recognized by management
Outputs (units of service)
- meals - patient days - consults
Unionization
- means of collective bargaining
Bod pod:
- measures body composition by determining "body density" by measuring the amount of air displaced (as accurate as underwater weighting)
Dispersion systems
- mixture of solids, liquids, gases *Continuous phase: - medium surrounding all parts of the dispersed phase *Dispersed phase: - distributed throughout the colloidal system Classified according to state of matter in each phase of the dispersion Gas in liquid - whipped egg whites (foam) Gas in solid - sponge cake (suspension) Liquid in liquid - mayo (emulsion) Solid in liquid - gravy (sol) Liquid in solid - custard (gel) Change degree of dispersion - apply heat or beat
Conflict resolution: 1.) Dominance & suppression: Smoothing
- more diplomatic - manager minimizes the extent of disagreement and tries to talk one side into giving in
Intermittent drip (pump or gravity)
- more mobility - larger amounts of fluid volume delivered at once, over a 45-60 min period, 3-5 x/d
Herzberg's two-factor theory:
- motivation and maintenance approach - relates to job satisfaction or dissatisfaction 1.) Maintenance (hygiene) factors (satisfiers, dissatisfiers) *Satisfiers (good) *Dissatisfiers (negative & will interfere with work) - do not produce motivation but can prevent motivation from occurring - fair wage, insurance, retirement benefit, supervision - maintain MINIMAL level of need satisfaction Job enrichment is an example of 'motivators'
4.) Operation charts
- movement of HANDS - reduces transportation and re-plan work areas
Bacteria
- need abundant moisture - NEUTRAL foods, 68-113' F - Some >113 F (thermophilic) - Aerobic or Anaerobic *Destroyed by temps of pasteurization (145' F 30 mins) *Danger Zone: 41 - 135 F
Transpyloric
- passed by pyloric valve in stomach - Used in COMATOSE patients or those with no gag reflex
Transfer:
- permits placement of employees in jobs where need for their services is greatest, or in jobs they prefer
5.) Centralized purchasing
- personnel in one office does ALL purchasing for ALL units in that organization *COST-EFFECTIVE & TIME-SAVING
Breakeven point (BE)
- point at which sales revenue (income) will exactly cover 'fixed' and 'variable' costs BE = FC (fixed costs) / SP (selling price) - VC (variable cost)
Disaster menus
- power failure, disruption in water supply - Minimum staffing for preparation and service - multiple days of food supplies available - One gallon of water/person/day for minimum of 3 days *The Joint Commission: requires planned menus that will cover hospitals for 96 hours and residential health care for 72 hours *FEMA: recommends a minimum of 3 days of food supplies for all patients/residents *Refrigerator (unopened): keeps food <40 degrees for 4 hours *Half-full Freezer (unopened): will last 24 hours *Full Freezer (unopened): will hold temperature safely for 48 hours
Age Discrimination in Employment Act 1967:
- prevents discrimination due to AGE
Peter Principle
- promote someone to a level of INCOMPETENCE
Sentinel event indicator
- serious event that requires further investigation each time it occurs; undesirable but avoidable events - Threshold of either 0% or 100% (Never or Always) - 0% food poisoning; Dish-machine area floor is dry 100%; 100% oncology patient are fed within 5 days
1.) Master schedule
- serves as overall plan; days on and off, vacations; basis for developing WEEKLY schedules
Turnover ratios (asset management):
- shows current effectiveness of inventory control; are you efficiently using the assets to produce more income??
Frozen food temp:
0 to -10 F
Procurement decisions: determining needs
1.) Based on # to be served, size portion, amount of waste Edible portion: Portion size x # servings (covert to lbs) Amount to purchase EP / % yield (amount provided by 1 lb of the item)
The USDA Commodity Food Donation/Distribution Program includes which two food assistance programs?
1.) CSFP Commodity Supplemental Food Program 2.) TEFAP The Emergency Food Assistance Program
What are examples of NI (actual problems related to intake)?
1.) Caloric energy balance - Hypermetabolism, hypometabolism, increased energy expenditure 2.) Oral or nutrition support intake 3.) Fluid intake balance - supplements, alcohol, *functional foods 4.) Nutrient balance
Which liver enzyme is decreased in uncontrolled diabetes (with acidosis)?
AST, SGOT - increased with hepatitis
FTE - full time equivalent: ____ is the minimum number of employees needed to staff the facility; counts PRODUCTIVE hours (hrs actually worked)
Absolute FTE
_____ is the accumulation of lipids; structural and compositional changes in the intimal layer of the large arteries.
Atherosclerosis Risks: HTN, obesity, smoking, elevated blood lipids, heredity
____ genetic predisposition to produce excessive IgE antibodies in response to an allergen.
Atopy Atopy refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema).
Tropical sprue (bacterial, viral, parasitic infection) may lead to deficiencies of which two vit/mins?
B12 Folate - due to decreased HCL and intrinsic factor - B12 is bound by intrinsic factor in gastric juice
What lab value is related to protein intake?
BUN - also indicator of Renal disease
Enzymes are inactivated by ____.
Blanching
Erythrocytes are produced in ____.
Bone marrow
What are the four components of Nutrition Diagnostic Reference Sheets?
1.) The problem or nutrition diagnosis label 2.) "Definition of the label to differentiate a discrete problem area" 3.) Etiology 4.) Signs/symptoms - Etiology categories are grouped...by the "cause" of the contributing factor
USDA Nationwide Food Consumption Surveys (NFCS): use "RDA" for comparing intake of nutrients, and diets are rated "poor" if they have less than ____ of RDA for 1 or more nutrients
2/3
What is a healthy BMI range for most elderly adults?
24-29
What is the temperature danger zone range for bacteria?
41-135' F
____ is the basic function of management.
A.) Planning 1.) Objectives 2.) Policies 3.) Procedures 4.) Time span 5.) Emergency preparedness
Refrigerated storage: Temps
< 41 F Fresh fruits/veggies: 40-45 F Meat, dairy, eggs: 32-40 F Fresh eggs in shell (3-5 weeks); raw yolks, whites (2-4 day) Fresh poultry, ground meat, fresh fish, shellfish (1-2 days) Steaks, chops, roasts (3-5 days)
Chilling: temp
< 41' F
Normal HgA1c:
< 5.7% Over 65 yrs: < 7% in healthy, ≤ 8% in frail elderly
HgA1c goal for diabetics?
< 7.0% (at risk for developing diabetes 5.7-6.4%)
BUN:creatinine ratio of ____ indicates a "pre-renal state" in which BUN reabsorption is INCREASED due to "acute" kidney damage
> 20:1
_____ is direct measure of toxic effects of lead on heme synthesis.
FEB Free Erythrocyte Protoporphyrin - Increased in lead poisoning
Which program focuses on helping develop eating habits that improve health, prevent obesity and subsequent chronic dz?
FFVP (Fresh Fruit and Vegetable Program)
_____ inspects canned product manufacturing
FSIS (USDA's)
True or False? Fat should be limited with adult diarrhea:
False - do NOT limit fat intake
Those with gastroparesis should avoid high amounts of ____ & ____ in their diet.
Fiber Fat - Bezoar formation may be due to undigested food or medications
This system uses 5-12 people that are brought together to talk about concerns, beliefs, and problems:
Focus Group - obtain advice, insights and info; contributes ATTITUDINAL data
Alcoholic liver Dz: _____ & ____ deficiencies are most responsible for malabsorption.
Folate & Protein
Which program's goal is to reduce "infant mortality" and improve health of low income women, infants, children, families?
Healthy Start (USDHHS)
Number of NEW cases of a disease over a period of time is known as ____.
Incidence # New cases / total number of people at risk x 100,000
Sweets, desserts, other CHO
CHO 15 Protein & fat vary
How many grams of CHO's, protein, fat, and total kcals are in 1 starch/bread exchange?
CHO: 15 (60 kcals) Protein: 3 (12 kcals) Fat: 1 (9 kcals) Kcals: 80
How many grams of CHO's, protein, fat, and total kcals are in 1 Non-starchy exchange?
CHO: 5 (20 kcals) Protein: 2 (8 kcals) Fat: 0 Kcals: 25
____ helps plan and control an operation. It identifies the MOST CRITICAL activities, to best allocate limited resources
CPM (Critical Path Method):
A high fiber diet may increase the need for which vit/mins? (7)
Ca Mg P Cu Se Zn Fe
To prevent acidic stones - create an alkaline ash: increase cations ___, ___, ___, ___.
Ca Na K Mg By adding: vegetables, fruits, brown sugar, molasses
Paralysis: immobilization decreases ability to absorb ____ and increases nitrogen loss.
Calcium
Absorption of which two vitamins/minerals are adversely affected following a gastrojejunostomy?
Calcium - most rapid absorption in duodenum Iron - requires acid
Which two vit/min supplements are recommended for those with Lactose intolerance?
Calcium & Riboflavin
Canning: if pH is low (≤ 4.5) use boiling water (strawberries, apples) if pH is high (> 4.5) use pressure cooker (carrots, beets, peas)
Calcium compounds - additives used as HUMECTANTS; retain moisture, increase firmness, tenderness
NAFLD treatment?
Can be managed with lifestyle changes
Protection against unfair employer practices:
Cannot interfere with right to bargain collectively; cannot refuse to bargain
____ is unintended wt loss, blood backs up into liver and intestines causing nausea and decreased appetite.
Cardiac cachexia
Parenteral Nutrition PN: options
Catheters 1.) PICC (peripherally inserted central catheter) - used for SHORT or moderate term infusion 2.) CVC - long term central access is through the cephalic, subclavian or internal jugular vein of the superior vena cava
Waist circumference is best for risk and also predicts ____.
Central adiposity (lower torso around abdominal area)
Biochemical balance is the _____.
Change in capacity to "metabolize" nutrients due to medications, surgery, or indicated by lab values
Baking soda (alkaline): creates intense green color due to:
Chlorophyllin *Water-soluble vitamins lost
The inflammation of the gallbladder is known as ____. An infection causes excess water to be absorbed causing cholesterol to precipitate out leading to _____.
Cholecystitis Gallstones (Cholelithiasis)
Which lipoprotein transports dietary triglycerides from gut to adipose cells and is synthesized in intestine from dietary fat?
Chylomicron - lowest density (smallest amount of protein)
To prevent alkaline stones - create an acid ash: increase anions ___, ___, ___.
Cl Ph Su By adding meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye
Diverticulitis MNT:
Clear liquids, low-residue or elemental, gradual return to high fiber
____ - one person represents a group of people to bargain with the employer.
Collective bargaining
Chronic ulcerative colitis (UC) is a disease of the ____, begins in the rectum
Colon
____ disease of exocrine glands - secretion of thick mucus that obstructs glands and ducts; chronic pulmonary disease, pancreatic enzyme def, high perspiration levels, malabsorption.
Cystic fibrosis - use age-appropriate BMI to assess Ht & Wt
____ - first document used in the purchasing process, internal form used to request items from the purchasing manager.
Purchase requisition
NDD1:
Pureed, moderate to severe - "Pudding-like" or spoon thick - Smooth, pureed homogenous, cohesive foods. Blended, whipped, mashed Avoid: gelatin, fruited yogurt, hot cereal with lumps and soup with lumps, ice cream
Isoniazid (treats TB) depletes what vitamin?
Pyridoxine (B6)
The American Red Cross and National Research Council are considered what types of agencies?
Quasi-governmental agencies - receive both federal and private funds
Employment standards: 1.) Job analysis 2.) Job description 3.) Job specification
Questions are next
Roles: 2.) Decision-making/problem-solving:
Queue - queuing theory 1.) Develops the relationships involved in waiting in line 2.) Used in analyzing flow of customers in a cafeteria - balance cost of waiting lines with the cost of preventing waiting lines through increased service
____ measures specific IgE antibodies (alternative to skin test) - blood serum is mixed with food on paper disk.
RAST
Which serum lab value has the shortest half-life (12 hours)?
RBP retinol-binding protein
Which serum lab value circulates with prealbumin?
RBP retinol-binding protein
____ goals for healthy INDIVIDUALS to 'prevent' nutritional deficiency diseases, includes gender, age, life phases.
RDA
____ - infrared waves coming from glowing heat.
Radiation - gas flame, charcoal, electric element, toasting, broiling Microwave: (kinetic energy) - affects only water molecules --Penetrates 2 inches into foods - uneven heat, lack of browning foods
EP (edible portion) cost per pound:
Raw purchase cost (AP as purchased)/ Cooked edible weight (EP) = EP cost/lb.
_____ occurs when aggressive administration of nutrition is given to malnourished patients.
Refeeding syndrome At-risk: - anorexia nervosa, chronic alcoholism, prolonged fasting, unfed 7-10 days, significant wt loss, *phosphorus-deficient PN
____ - based on desire to identify with or imitate the influencer, "how well you are liked".
Referent power (personality, charisma)
_____ hormone stimulates _____ to increase sodium absorption and return BP to normal
Renin aldosterone
_____ are not affected by sales volume (number of people served), not directly evident in day to day activities, required for business to exist even if it produces nothing, cannot be readily changed
Indirect (Fixed) costs - rent, taxes, interest on debt, insurance, depreciation - stay fixed within a range of sales volume
_____ - use of electrical magnetic vibrations to excite the molecules of metal cooking surfaces. The heat is then transferred to food by ____
Induction Conduction
____ is the action that will cause a change in behavior or attitude of another
Influence
Organizational communication channels: Meets social needs of group; also referred to as GRAPEVINE)
Informal channel
Oral glucose-lowering medications: Promotes insulin secretion
Insulin secretagogues: 1.) Sulfonylureas Glipizide (Glucotrol) 2.) Meglitinides Glinides (Prandin)
Unemployment compensation: requirements
Insurance against loss of income a.) Must be employed for specific time b.) Able and willing to work c.) Unemployed through no fault of their own; employers pay tax on payroll * Each STATE HAS OWN LAWS that define benefits in accordance with minimum federal standards
_____ combines evidence-based complementary therapies with conventional (allopathic) treatments to address the social, psychological and spiritual aspects of health and illness.
Integrative medicine
Recruiting sources: Internal & External
Internal - promotions, transfer, rehire External - ads, agencies, unions
The FAO (Food and Agricultural Organization) is considered to be what type of agency?
International agency - wide levels of nutrition by increasing efficiency of production and distribution of foods
How do you calculate "inventory turnover rate"
Inventory turnover rate: Cost of sales (food cost) / Average inventory cost - Measures how often an inventory is consumed and replenished * A turnover rate of 2-4 times per month is desirable - High ratios: indicate a limited inventory is being kept - Low ratios: indicate large amounts of money are tied up in stock
Lactose intolerance is due to a deficiency in _____.
LACTASE
____ is a data-driven approach for improving quality by 'removing defects' and their causes.
Six Sigma Achieving Six Sigma: (6 standard deviations from the mean) - means there is very little variation in a process - helps organizations focus on developing and delivering near-perfect products & services Sigma - is a statistical unit of measurement used to define standard deviation DIMAC approach: - Define, Measure, Analyze, Improve, Control
Income, price of food, time spent on food activities are _____ factors to consider in Assessment
Socioeconomic factors
Seafood analogs
Soy blended with fish, retains flavor, reduces Wt loss
____ - separate items at separate prices
a la carte
Billroth I is known as a _____.
gastroduodenostomy - attaches the remaining stomach to the duodenum
Billroth II is known as a _____.
gastrojejunostomy - attaches it to the jejunum
Resection of which part of the small intestine can cause major complications?
ileal resection - ileum absorbs major portion of fluid in GI tract - Pt have above average needs for water to compensate for excessive losses in stool = Drink at least 1 liter MORE than their ostomy output daily
To increase productivity, ____ the output or ____ the input.
increase output decrease input
CSII (continuous sustained insulin infusion):
insulin pump therapy provides steady, measured continuous dose of BASAL, and a surge (BOLUS) dose of insulin before meals
Job enlargement -
more similar tasks to alleviate boredom
Who is eligible for Medicaid?
payment for medical care for all eligible needy: all ages, blind, disabled, *dependent children
WIC is for ?
pregnant, postpartum, breast-feeding women; infants & children up to age 5
Glucocorticoids, antibiotics:
protein deficits
Benefits: a.) Statutory b.) Compensatory c.) Supplementary
questions on these next..
Impaired nutrient utilization (NC - 2.1):
refers to the problems with the "METABOLISM" of nutrients once they have entered the circulatory system. "Endocrine" functions of the pancreas, liver, pituitary, parathyroid. Potential indicators: thin, wasted appearance, abnormal liver fxn tests, hypo/hyper-glycemia, renal failure, etc.
NFPE: Lips- swollen, red, dry, cracked may be indicative of what three deficiencies?
riboflavin pyridoxine niacin
Decrease bone growth, CHO intolerance:
steroids
Decrease potassium and magnesium, absorb calcium:
thiazide diuretics
WIC priorities are pregnant and breast-feeding women & infants up to ____ year(s).
up to 1 year
NFPE: Hair - thin, sparse, dull dry brittle may be indicative of what two deficiencies?
vitamin C protein deficiency
Job breakdown -
what to do and how to do it - No time limits
Ag-Ab reaction:
when antigen enters body, antibody reacts
Diabetes - fasting plasma glucose (FPG):
≥ 126 or GTT (glucose tolerance test) ≥ 200 or Symptoms of diabetes plus casual plasma glucose ≥ 200 mg/dl HgA1c ≥ 6.5%
Decreased LDL, TG; increase in HDL
Statins (HMG CoA reductase)
____ benefits are payments REQUIRED BY LAW to ensure income in event of unemployment, injury, or death (must be provided)
Statutory
A SWOT analysis is appropriate for what type of planning?
Strategic planning Strengths, Weaknesses, Opportunities, Threats
____ already incurred and cannot be recouped by a new decision or alternative; cost involved in studying merits of a new computer.
Sunk costs
____ units working together may have greater impact than each operating separately.
Synergy
What program do "states" determine the eligibility and the benefits and services provided?
TANF Temporary Assistance for Needy Families
Serum transferrin can be determined from ____.
TIBC Total Iron Binding Capacity
Immunocompetency is measured by?
TLC total lymphocyte count >2700 cells/cu mm - decreased in protein-energy malnutrition
Which serum lab value picks up changes in protein status quickly
TTHY transthyretin, PAB prealbumin
____ - complete meal at set price
Table d'hote
SNAP is operated by the ____.
USDA
The NNMRRP (National Nutrition Monitoring and Related Research Program) is jointly run by the USDHHS and the ____.
USDA
____ - an employee who represents fellow employees as the union representative.
Union steward - does not receive extra pay for serving
Organizational communication channels: From workers up to the Department Head; open-door policy, suggestion boxes, grievance procedures
Upward
Central American/Hispanic/Latin
fruits, vegetables, meat, poultry, fish
Middle Eastern
- bulgur
5.) Process charts
- steps involved in process using SYMBOLS
A WHR of ____ or greater in men, and ____ or greater in women is indicative of android obesity and an increased risk for obesity-related diseases (diabetes, HTN).
Men: 1.0 Women: 0.8
____ is the gold standard for diagnosis and identifying food-induced symptoms.
DBPCFC double-blind, placebo-controlled food challenges
Oral glucose-lowering medications: Often used with Metformin, reduces glucose released by liver overnight and between meals (reduces glucose by preventing GLP-1 breakdown
DPP-4 inhibitors 1.) Saxagliptin (Onglyza)
Step 4:
Define goals and objectives, develop plans, define management system
Which lipoprotein transports endogenous triglyceride from liver to adipose cell?
VLDL (pre-beta)
The Mediterranean diet is rich in ____ & ____.
alpha linolenic acid (W3), monounsaturated fats - olive, canola, soybean oils; walnut, almonds, pecan, peanuts, pistachios
Hepatic failure (ESLD) occurs when the liver cannot convert ____ into ____.
ammonia (NH3) urea *So ammonia accumulates
Methylphenidate (Ritalin)
anorexia, weight loss, nausea
Antibiotics:
decrease vitamin K
Tyramine: Should eliminate ____ and restrict ____ (monoamines).
dopamine tyramine - Restrict: aged, fermented, dried, pickled, smoked, spoiled foods - Avoid: hard/aged chz (cheddar, swiss), sauerkraut, sausage, luncheon meats, TOFU, MISO, chianti wine - Limit: sour cream, yogurt, buttermilk - Cottage chz & Cream chz are okay Best advice: buy, cook, eat fresh foods
HIPAA guidelines: Corrections "at time an entry is in progress":
draw single line through error, then enter the correction, INITIAL, date
____ menu of the day; uses leftovers and food bargains
du jour
BIA (bioelectrical impedance analysis) is used to evaluate ____ & ____.
fat free mass total body water - Usefulness in critical illness may be limited - Fever, electrolyte imbalance, extreme obesity may affect reliability
____ - hour by hour - training - tasks and time.
Work schedule
Chinese
Yin foods raw, cold: fish, veggies, fruits) Yang - bright, hot: hot soup from chicken - RICE is neutral
NSLP (National School Lunch Program): receives funding through ____ & ____, dollars reimburse schools on basis of numbers of meals served.
cash grants & food donations
Gastritis MNT?
clear liquids, advance as tolerated, avoid gastric irritants anorexia, N/V/D
Mineral oil, cholestyramine
decrease absorption of fat, fat-soluble vitamins
If sodium or caffeine are restricted, then lithium excretion ____, leading to toxicity.
decreases
Baking soda & solid sugars result in ___
deep brown colors
HTN is considered to be a blood pressure of? An optimal BP with respect to cardiovascular risk is ?
systolic > 130 or diastolic > 80 or BOTH <120/80 mm Hg (cardiovascular risk)
When developing programs and services which step requires administrative support, realistic budget, staff commitment, support of target population?
Implementation
The Academy of Nutrition and Dietetics is considered to be what type of agency?
Non-governmental agency - It's a Professional organization
What is a normal blood glucose and normal 2hPG glucose?
Normal blood glucose: 70-100 mg/dl 2hPG: < 140 mg/dl
Leadership Grid - Blake, Mouton, McCanse
Plots leader's concern for people (employees) vs. their concern for production)
____ are general decision-making guides, boundaries within you must operate.
Policies
Inappropriate levels of ADH results in ____.
SIADH (Syndrome of Inappropriate Antidiuretic Hormone) - Hyponatremia caused by hemodilution: treated with fluid restriction
What USDA program encourages consumption of milk by children?
SMP Special Milk Program
Which program was designed to "increase their purchasing power"; not for non-food items?
SNAP
Which program is the largest entitlement food assistance program?
SNAP Supplemental Nutrition Assistance Program
CHIP is under the ____ and provides health coverage to uninsured children whose families earn too much income to qualify for Medicaid but too little to afford private coverage.
Social Security Act
For cirrhosis, if edema or ascites are present what nutrient should be decreased?
Sodium - If hyponatremia occurs: fluid restriction of 1-1.5 L/day depending on severity, and moderate sodium intake
UC is associated with which two electrolyte disturbances in the body?
Sodium Potassium Other: - chronic bloody diarrhea, wt loss, anorexia, dehydration, anemia, *Negative nitrogen balance
Pectins and gums are examples of which type of fiber?
Soluble fiber - form soft gel in small intestine - slows passage and delays/inhibits absorption of GLUCOSE & CHOLESTEROL
Peds overweight interventions
Weight MAINTENANCE is usually recommended in overweight children 2-5 years of age with a multicomponent weight management intervention with active participation of the parent Weight LOSS may be recommended when child has serious medical conditions
WIC assesses risk for which factors?
Weight, height, head circumference in infants, Hgb, Hct
____ - compare satisfaction levels to those of other facilities which are considered "best in class".
Benchmarking
Steatorrhea: Normal stool fat is between ___ - ___ grams; and > ____ grams is indicative of malabsorption
2-5 grams (normal) > 7 grams (malabsorption)
Complications of uncontrolled diabetes:
2.) Acute hypoglycemia - insulin reaction (shock); due to insulin excess or lack of eating, slow pulse, cool, clammy skin, hungry, weak, shakiness, sweating Treatment: glucose 1.) Begin with 15 g CHO from glucose tablets, fruit juice (4-6 oz), sugar 2.) Wait 15 mins; if still < 70 mg/dl, give another 15 grams 3.) Repeat and treat until BG is normal
C.) Directing
2.) Communication *Feedback (response) - tells you whether or not the correct message has been received Organizational communication channels: 1.) Downward 2.) Upward 3.) Horizontal 4.) Diagonal 5.) Informal channel
Example: Twenty FTW produced 2700 meals during one 40 hour week. How many meals were produced per labor hour?
20 FTE x 40 hours = 800 hours 2700 meals/800 hrs = 3.38 meals per labor hour
Vegetables need to be processed at a temperature higher than ____ to destroy ____
212' F Botulism Pressure cooker can be used for low acid veggies bc it reaches above 212
Vinegar acidity must be at least ___ % when pickling foods
5%
Before a change in policy can be made it requires that -
50% of the union voting plus one are in favor of the change
In order to lose 1 lb. fat/week, you must reduce ____ kcals/day.
500 Realistic weight loss goals: Up to 2 lbs/week, up to 10% of baseline BW, or a total of 3% to 5% of baseline weight if cardiovascular risk factors are present
Freezing
< 0' F (least damaging to flavor and texture) - preserves nutr value - adding salt to foods being frozen causes loss of flavor and increases RANCIDITY of any item containing fat Dehydrofreezing: - dried to 50% of weight and volume, then frozen
BUN:creatinine ratio of ____ suggests REDUCED BUN reabsorption due to renal damage (may need dialysis)
< 10:1
Deplete thiamin, potassium, magnesium, calcium, sodium:
Loop diuretics
The Loop of Henle is responsible for the balance of ___ & ___.
Water and Sodium
Gallbladder disease treatment:
Low fat diet: Acute 30-45 grams or NPO??? Chronic 25-30% of kcals
DOG
Low profit Low popularity - Consider eliminating item from menu
Resveratrol may help by ____ in those with HTN
Lowering blood pressure
There is also an increased need for ____ because it's excreted after alcohol consumption.
Magnesium
AI recommendations for Male/Female for fiber?
Male: 38 g Female: 25 g
Organizational change theory:
Managers serve as catalysts for change 1.) Conditions necessary to change (transform) a department - leader recognizes there is a need to make a change - leader depicts a future that appeals to the values, needs and aspirations of followers (leader defines a vision) 2.) Successful change requires: unfreeze the status quo, change to a new state, refreeze to make the change permanent
What type of nutrition is given initially to restore and maintain nutrient status SBS?
Parenteral nutrition
Death rates are known as ____.
Mortality
Relief workers: Determining the actual number of employees needed:
Multiply the number of full-time positions by 0.55 (129/236) to get the number of relief workers needed to cover 365 days per year Ex:) If you have 20 full-time positions: 20 x .55 = 11 relief employees 20 + 11 = 31 total employees needed OR 20 x 1.55 = 31
OAA: For someone to receive home delivered meals (Meals on Wheels) they must be considered ____.
Must be HOMEBOUND - OAA also provides counseling, nutrition education, referrals, social interaction
_____ is the reduction of coronary flow to myocardium due to blood clot blocking a narrowed coronary artery.
Myocardial infarction 1.) Angina pectoris - chest pain 2.) Heparin (anticoagulant) - blood clots
_____ is excess fat buildup in liver unrelated to alcohol consumption.
NAFLD (non-alcoholic fatty liver disease) - Steatosis (is abnormal retention of fat (lipids) within a cell or organ), BMI ≥ 35, Type 2 diabetes, metabolic syndrome
Which domain is the nutritional findings/problems that relate to medical/physical condition?
NC 1.) Functional balance 2.) Biochemical balance 3.) Weight balance
What are the three domains of Nutrition diagnostic Labels?
NC (Clinical) NI (Intake) NB (Behavioral-environmental)
Educational readiness: How to teach depends on the ____ & ____ of the learner
NEEDS READINESS - Motivational level affects attention span
Which program provides nutrition education training to teachers and school foodservice personnel?
NET Nutrition Education and Training Program (USDA) - amendment to School Lunch Act
Management of Food and Nutrition Programs and Services: Functions of management -
Plan, Organize, Staff, Direct, Control/evaluate
What We Eat in America (WWEIA) program is the "dietary INTAKE" component of which survey/surveillance?
NHANES
Is WIC an entitlement program?
NOOOOOO WIC is a federal grant program, so not everyone who is eligible will receive benefits bc they have limited amount of funds..
Diet for Hiatal hernia:
Small, BLAND feedings; avoid late night snacks, caffeine, chili powder, black pepper
Roles: 2.) Decision-making/problem-solving:
c.) Delphi technique (consensus of experts) - Designed to probe expert minds in a series of written interviews from which some consensus is sought - Participants DO NOT MEET
NFPE: Teeth -missing, loose, loss of enamel may be indicative of what deficiency?
calcium poor intake
Nephrosis - nephrotic syndrome: Abnormalities in ___, ___, ___, ___ are related to protein loss.
iron copper zinc calcium
NFPE: Skin - pale, dry, scaly may be indicative of what three deficiency?
iron folic acid zinc
NFPE: Nails- brittle, thin, spoon-shaped may be indicative of what deficiency?
iron or protein deficiency
The amount of serum transferrin is controlled by the ?
iron storage pool
____ - cold sterilization (temp of food does not rise much even though large amounts of energy are used)
irradiation FDA approved for: spices, beef, lamb, pork, poultry, wheat, potatoes - To prevent off flavors in meat: irradiate frozen - Kills most harmful bacteria in foods other than milk
____ is a deficiency or inadequate supply of blood to an organ due to an obstruction.
ischemia
Eggs should be introduced at ____ months of age; earliest age of peanut introduction is ___-___ months of age.
24 months 4-6 months
Gestational diabetes: At ___-___ weeks gestation, screen with 50g oral glucose load; glucose ≥ 140 mg/dl indicates need for further testing.
24-28 weeks
Fats:
5 g = 45 kcals
Determining how many servings can be obtained from an uncooked item consider the % lost in preparation:
(1) Subtract the amount that will be lost and convert to ounces (2) Divide by portion size
Nutrition screening and surveillance systems
(5)
Hemodialysis: Chronic renal failure
* 1.2 g/kg protein (SBW), at least 50% HBV * 35 kcals/kg (< 60 yrs) & 30-35 kcals/kg (60 years and older) * 25-35% fat (< 7% saturated) * ≥ 1 L fluid output: 2-4 g Sodium & 2 L fluid * < 1 L fluid output: 2 g Sodium & 1 L fluid * Potassium (2-3 g IBW) * Calcium (individualized with Max of 2 g ELEMENTAL) * Phosphorus (800-1000 mg)
Gestational diabetes: MNT
* 40-45% CHO, 3 small-medium sized meals and 2-4 snacks (two to three hours btw meals) *DRI for CHO during pregnancy: 175 g/day *15-30 g CHO at breakfast, rest divided evenly ***Increases risk of FETAL MACROSOMIA (LGA large for gestational age), FETAL HYPOglycemia at birth, hypocalcemia, hypomagnesemia, neural tube defects *Overweight/obese: modest energy restriction to slow wt gain
Hepatic failure (ESLD): MNT - if not comatose
* Mod to high protein: 1-1.5 g/kg * 30-35 kcals/kg (30-35% kcal as fat, MCT oil if needed) - Low sodium if ascites
Hemodialysis Vitamins: Chronic renal failure
* Vitamins C, B6, folate, B12 supplements * Zinc (DRI): 8-11 mg/day * Iron & Vit D are individualized
Epilepsy - seizures, altered consciousness
*Anticonvulsants: Phenobarbital & Phenytoin (Dilantin) interfere with Calcium absorption - Take Folate (1 mg) with drug - May need Vit D, Calcium, Thiamin supps - Provide "phenytoin" separate from meals/other supps - Enteral feedings decrease bioavailability of phenytoin (hold feedings ≥ 2 hrs)
C.) Budget development
*Controls and coordinates activities: indicates how and at what rate dollars are to be expended 1.) Preparation - expenditures pf preceding period, present budget, changes in present budget period, expenditures of present period, budget requests for next period 2.) Phases of budget cycle: - prepare requests, evaluate revenue potential, FORMULATE DOCUMENT, send to legislative body, legislative review & authorization, execute the budget (run the program), Evaluation & Review 3.) Performance budget - summarizes program activities performed in terms of the cost of specified accomplishments (Ex: what it costs to supervise a food bank, or what is costs to screen 200 children for anemia) 4.) Funding
Goals for diabetics:
*Maintain normal blood glucose (average pre-prandial goal 70-130; peak post-prandial average < 180) *Serum lipid levels: LDL < 100 TG < 150 HDL > 40 (M), >50 (F) *Blood pressure: < 130 (systolic), < 80 (diastolic) *Prevent & treat chronic complications
Cystic fibrosis: MNT
*PERT (with meals & snacks) *High protein *High Kcals *Unrestricted fat *Liberal in salt (additional 2-4 g/day on hot weather) *If fails to grow - BEE x activity factors plus disease coefficients (may need 110-200% of normal energy needs)
1.) Leadership continuum (Tannebaum & Schmidt)
- Developed range of possible leadership behaviors. Each type of behavior is related to the degree of authority used by the manager and the amount of freedom available to subordinates in reaching decisions *Manager may use a variety of approaches as the situation requires. A manager who generally involves others in making decisions, MUST TAKE CHARGE IN A CRISIS
Muslim
- "Halal" foods are permitted - Haram (prohibited foods): - No pork, alcohol, GELATIN, congealed salad) - Overeating, tea, coffee are discouraged - Fasting sunup to sundown during Ramadan (1 month)
Conflict resolution: 1.) Dominance & suppression: Forcing
- "I'm the boss. Do it my way" - No argument, may lead to indirect and destructive expressions of conflict
CSFP Commodity Supplemental Food Program: provides what types of foods?
- "Monthly" commodity canned or packaged foods
Parenteral nutrition (PN)
- "hypertonic" solution delivered through a central venous catheter - used to achieve an 'anabolic state' when patients NPO and EN not possible *Subclavian vein minimizes risk of phlebitis Typical uses - Diagnosis: - Altered GI fxn - Impaired nutrient utilization
Enzymes
- ALL are proteins: activity affected by temperature and pH - Converts starch to sugar in ripening of fruits - blanch veggies before freezing to destroy enzymes
Risk factors for Diabetes mellitus
- Acanthosis nigricans - GAD (glutamic acid decarboxylase antibodies)
Type 2 diabetic: Note
- Achieve glucose, lipid and BP goals - Weight loss if necessary (5-10% in overweight/obese): improve food choices, space meals, exercise - Macronutrient based on DRI's for healthy adults: (< 7% total kcals as saturated fat) - Encourage fiber intake (25-35 g/day) - Sucrose may be substituted for other CHO's DASH principles
Workman's compensation:
- Administered by STATE a.) Insurance covering employers' liability for the costs of any accident incurred by an employee in connection with their job b.) Must furnish a safe place to work, competent supervision, instructions
Academy of Nutrition and Dietetics: 1.) Standards of Practice (SOP) 2.) Standards of Professional Practice (SOPP)
- Are tools for credentialed dietetics practitioners to use in professional development (as guides for self-evaluation and to determine the education and skills needed to advance an individual's level of practice). - They are NOT regulations, but may be used to determine competency
Adrenal cortex insufficiency - Addison's disease
- Atrophy of adrenal cortex; symptoms due to absence of adrenal hormones * High Protein * Frequent feedings (snack btw meals) * High Salt Moderate CHO 2-3 L Fluids Decreased Cortisol: - glycogen depletion, *hypoglycemia Decreased Aldosterone: - sodium loss, potassium retention, *dehydration Decreased Androgenic: - tissue wasting (decreased LBM), weight loss
The distal ileum is responsible for absorption of ____, ____, ____.
- B12 - intrinsic factor - bile salts
Hyperemesis gravidarum
- Bed rest, small amounts frequent CHOs - severe nausea, vomiting, acidosis, wt loss
Prader Willi Syndrome - chromosome 15 deletion
- Control food intake (best treatment) - Ghrelin levels elevated: stimulates growth hormone secretion, appetite, intake, and fat mass deposition - Decreased energy requirements - Obesity at 2-3 years of age, FTT, short stature, hypogonadism, muscle hypotonia - Subnormal LBM, supra-normal body fat
Anorexia nervosa
- Correct electrolyte imbalance: Vit K (immediate concern) - Regular mealtimes, varied & moderate intake, slowly reintroduce feared foods - Focus on health benefits and life-sustaining aspects of food - Recommend initial daily Kcal levels range from 1000-1600 (30-40 kcals/kg), but may need to set 100 to 300 kcals above the current level of intake to support adherence
Management by Objectives MBO -Drucker
- Democratic management that provides control from within - Establish performance goals WITH employees -- giver higher incentive value -- overall control achieved through self-control by employees - management stresses accomplishments and results *Participative leadership
Pregnancy-induced HTN (PIH)
- Progresses from pre-eclampsia to ECLAMPSIA - HTN, edema (face, hands), proteinuria, rapid wt gain after 20th week; may have convulsion - Higher in women with lack of prenatal care, poor diets, poor PROTEIN & CALCIUM intakes *DO NOT RESTRICT SODIUM - Proposed association btw PIH & Calcium deficiency
Conflict resolution: Manager
- Do NOT suppress or resolve all conflict - Manage it to minimize its harmful aspects and maximize its beneficial aspects Methods (3) 1.) Dominance and suppression a.) Forcing b.) Smoothing c.) Avoidance d.) Resolve conflict by majority vote 2.) Compromise - find a middle ground - WEAK method (does not usually lead to a solution that can best help the organization - both parties can live with decision 3.) Integrative problem-solving - conflict converted into a joint problem solving situation - parties openly try to find a solution they can all accept
Spinal cord injury:
- Energy needs are 10% below predicted - 1.5 L fluid per day or higher
Outcome management systems:
- Evaluate effectiveness & efficiency - Data is collected and analyzed so that performance can be adjusted and improved - Findings are compared to past levels of performance and other standards or benchmarks of optimal performance Goal: is to improve quality of services offered
Macrocytic, megaloblastic anemia:
- Few large cells, filled with Hgb - Folate or B12 defic - Schilling test for Pernicious anemia (B12) RBC: decreased Hgb: low Hct: low MCV: HIGH MCH: HIGH MCHC: Slightly decreased or normal TIBC: LOW
Reciprocal approaches:
- Focus on interactions among leaders and their followers rather than on characteristics of the leaders themselves (how leaders and followers influence each other) 1.) Transactional leader: - clarifies roles and responsibilities; uses rewards and punishments to achieve goals 2.) Transformational leader: - agents of change - inspire followers to become motivated to work towards organizational goals rather than personal gain; builds on and extends transactional leadership - cultivation of employee acceptance of the group mission
MNT for Dumping syndrome:
- Frequent small, dry feedings - Fluids before OR after meals (slow passage) - Restrict hypertonic concentrated sweets - Give 50-60% complex CHO - Protein at each meal; moderate fat - LACTOSE may be poorly tolerated due to rapid transport
Chronic pancreatitis: MNT cont..
- Give max amount of FAT tolerated to promote weight gain - Give water soluble forms if malabsorbing fat soluble vits, PARENTERAL B12 - Antacids may be needed so PERT therapy works - Avoid large meals with fatty foods, alcohol
Acid causes loss of color when green vegetables are overcooked or canned:
- H ions come in contact with magnesium in the chlorophyll - Magnesium removed, becomes "Pheophytin" (brown or olive green)
Functional - serves as both line and staff:
- Has limited authority over a segment of activity because of specialized knowledge, units are defined by the nature of the work. - Purchasing may be given to a head purchasing agent who oversees that fxn in all departments
2015-2020 Dietary Guidelines: Key points
- Healthy eating pattern across the lifespan - Limit Kcals from added sugars (< 10% of kcals) & Saturated fats (< 10% of kcals) & trans fats, & reduce Sodium intake (< 2300 mg). - Adults need 150 mins of moderate-intensity PA each week (include strengthening activities on 2 or more days) *Double activity time for additional and more extensive health benefits
Cirrhosis Diet: Kcal Pro Fat Other
- High Kcal: 25-35 kcals/kg estimated dry wt or 1.2-1.5 x BEE - High Protein: .8-1.0 g/kg (1.5 g/kg in stress) - Moderate to low (25-40%), MCT if needed, <40 g if malabsorption - low fiber if varices are present - B complex Vits, C, K, Zn, Mg
Pediatric HIV:
- High Protein - High Kcal (with supps needed for wt gain) - Energy needs: general guidelines plus appropriate stress factors - Multivitamins/mins at doses 1-2x RDA or DRI - Lactose restriction if intolerant
Steatorrhea MNT:
- High protein - High complex CHO - Fat as tolerated - Vitamins (especially fat soluble) - Minerals - MCT (rapidly hydrolyzed in GI tract)
Meat analogs (isolated soy protein, vegetable protein)
- Less fat than meat - About 50% protein - No saturated fat
Cholecystectomy Diet:
- Limit fat for several months to allow liver to compensate - Slowly increase Fiber
CSFP Commodity Supplemental Food Program: helps what populations of people?
- Low income women (pregnant, breast-feeding, postpartum) - Infants and children up to 6 years - Elderly (>60 yrs) - Those "at NUTRITIONAL RISK"
Heart failure: MNT
- Low sodium (2-3 g) - Limit fluids 1-2 L/day - DASH diet - High Protein: 1.1 to 1.4 g/kg protein ABW (normally nourished and malnourished) - Energy: RMR x PA factor (Use indirect calorimetry if available) Sedentary (1.0 - <1.4), Low active (1.4 - <1.6), Active (1.6 - <1.9), Very active (1.9 - <2.5)
COPD (chronic obstructive pulmonary disease)
- Maintain stable wt - High Kcal - High Protein (1-1.5 g/kg dry wt; 15-20% cals) - 30-45% Fat - 40-55% CHO - Small, frequent, mini-meals, snacks, nutr dense supps *Oxidation of fat consumes less O2 than oxidation of CHO
SBS: MNT cont...
- May take weeks or months to transition to food
Roman Catholics
- Meat is not consumed on Fridays during Lent - Fast & abstain from meat on Ash Wednesday and Good Friday
Alkaline ash/acid ash diets
- Minerals not oxidized in metabolism leave an ash (residue) in urine. - Can change composition of diet to change pH of ash in urine. - Now usually done with medication.
2.) Cash budget
- Projects revenues, expenses, showing inflow and output of cash Purpose: - is to determine if funds will be available when needed
Parenteral nutrition (PN): Typically used when
- Moderately to severely 'malnourished' patients expected to have prolonged periods of GI dysfunction - Critically ill hemodynamically stable with paralytic ileus, acute GI bleeds, bowel obstruction *Only 'malnourished cancer' patients on therapy who are anticipated to be unable to ingest/absorb adequate nutrients for 7-14 days - Peritonitis, fistulas - Critical care pts if hypermetabolism is expected to last for more than 5 days and enteral support is not possible (Peritonitis is inflammation of the peritoneum — a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen — that is usually due to a bacterial or fungal infection. There are two types of peritonitis: Spontaneous bacterial peritonitis.)
Nephrosis - nephrotic syndrome: MNT
- Modest Protein restrictions (.8-1.0) (50% HBV) - 35 kcals/day - < 30% fat (low sat fat) * 2-3 g/day sodium (depends on HTN, edema) * Ca 1-1.5 g/day, supplement Vit D
1.) No choice: Nonselective - either cycle or single use
- More accurate forecasting, greater control - Clientele who are unable or have no desire to choose
Food intolerance
- NO antibody production (NON-IgE)
UL (tolerable upper level)
- NOT associated with adverse side effects in most individuals of a healthy population...maximum daily intake unlikely to cause adverse health effects.
Systemic lupus erythematosus (SLE)
- No specific dietary guidelines, tailor to needs - May have deficiency: iron, folate, B12, calcium, fiber - May show symptoms of Celiac Disease - May have anemia (doesn't correlate with iron intake)
SBS: MNT for Jejunal resection:
- Normal balance of CHO, Pro, fat - Avoid lactose, oxalates, large amounts of concentrated sweets - Vitamin/mineral supplements
Span of control (2 types)
- Number of individuals or departments under the direction of one individual 1.) Narrow span - more levels are created; need MORE managers; needed with newly hired personnel 2.) Wide span - fewer levels and LESS managers are needed * used with highly trained, highly motivated workers!!!
Sophistication: Audience "Very experienced":
- Nutrition experts - Limit audience participation at first - ESTABLISH YOURSELF AS THE EXPERT; cite credentials - lecture format/AVs
Total Quality Management (TQM)
- Philosophy where processes are refined with goal of improving performance in response to customer needs and expectations. Described by words: processes, improvement, customer satisfaction a.) Involves continuous improvement of organizational processes, resulting in high quality products and services b.) Three elements (1) Customers/clients - true judges of quality (2) Culture - environment created that establishes quality as a top priority (3) Counting - measurement of what constitutes a high quality service or product and what needs improvement c.) PDCA cycle (Plan, Do, Check, Act) or PDSA (Plan, Do, Study, Act) (1) Problem solving technique for coordinating process improvement (2) Acronym FOCUS outlines process to use: Find a process to improve Organize a team that knows the process Clarify current knowledge of the process Understand causes of process variation Select the process improvement (3.) PDSA Plan to improve (how changes will be made) Do the changes (implement the intervention) S - Check the results (determine the impact) Act to maintain and continue
What are the phases of Budget Cycle?
- Prepare requests - Evaluate revenue potential - FORMULATE DOCUMENT - Send to legislative body - Legislative review & authorization - Execute the budget (run the program) - Evaluation & Review
AIDS (acquired immune deficiency syndrome)
- Preserve LBM, prevent wt loss, prevent HIV wasting BEE X 1.3 for asymptomatic Protein: 0.8 g/kg (asymptomatic), up to 1.2-2.0 g/kg if wasted LBM - low bacteria diet (neutropenic); avoid raw foods HIV infected women should NOT breast-feed HIV employee: keep info confidential, suggest AIDS education programs
Equal Employment Opportunity Act 1972:
- Prevents DISCRIMINATION IN EMPLOYMENT based on race, color, *RELIGION, SEX, national origin, political affiliation - Overseen by EEOC
Title VII of the Civil Rights Act (1964)
- Prevents DISCRIMINATION on basis of race, color, national origin; prohibits *sexual harassment - Overseen by the EEOC (Equal Employment Opportunity Commission) Civil Rights Act of 1991: - expanded protection for victims of discrimination and broadened coverage to include Gov employees - expanded protection and security of individual health information to reduce fraud & abuse
Marasmus
- Protein & calorie starvation - **Albumin normal, no edema - Severe fat & muscle wasting - Triceps skinfold/arm circumference decreased **iatrogenic malnutrition (Pro-Kcal malnutr) - brought on by treatment, hospital, meds **Neoplastic disease - protein-kcal malnutrition, malabsorption, fluid & electrolyte imbalance
ADHD
- Provide wholesome foods at regular mealtimes with small servings followed by refills - If child is underweight: consider high kcal snacks at bedtime
Acute pancreatitis: MNT What type of formula and method of feeding is recommended?
- Put pancreas at rest, withhold all feeding, maintain hydration (IV) - Elemental (pre-digested) EN into JEJUNUM may be tolerated - TF within 48 hours of admission; progress to 6 small meals/day
3.) Leadership effectiveness model (Hersey, Blanchard, Johnson)
- Readiness of followers and recommended leadership styles Readiness: desire for achievement, willing and able to accept responsibility, skills relevant to task Leadership style: - Tell, Sell, Participate, Delegate Low readiness = Tell Low to moderate readiness = Sell Moderate to high = Participate/Followers High readiness = Delegate
Arthritis
- Regular, well-balanced diet with vitamin intake to at least DRI's * Normocytic anemia may develop - RBC (decreased) - Hgb/Hct/TIBC (low) - Not diet related - Inflammation prevents reuse of iron - Anti-inflammatory diet may help osteoarthritis (resembles Med diet)
MSUD: MNT
- Restrict BCAA 45-62 mg/day (may use MSUD powder) - Adequate energy from CHO & Fat to spare amino acids - Small amounts of milk to support growth; gelatin may be used AVOID: eggs, meat, nuts, other dairy products
LAGB laparoscopic adjustable gastric banding:
- Restricts total amount of food eaten at one time - No surgery-induced malabsorption of nutrients - DEFICIENCIES linked to decreased food intake and decreased food tolerance
3.) Capital budget
- Should be completed at same time as operational budget - plant facilities, equipment, cost of improvements and repairs (service, maintenance contracts), expansions, replacements - Includes expenditures whose returns are expected to last beyond ONE YEAR *Payback period - time it takes an organization to recover money invested
GERD
- Small, low fat meals - Liquids empty more rapidly Avoid: - eating before bed, soda, caffeine, acidic foods
Microcytic, hypochromic anemia:
- Small, pale cells - Iron deficiency - associated with chronic infections, malignancies, renal dz RBC: may be normal Hgb: low Hct: low MCV: low MCH: low MCHC: low TIBC: high
Situational Assessment: factors to consider:
- Sophistication (inexperienced, Moderately, Very exper) - economics, time needed, availability; environmental
The National Dysphagia Diet NDD:
- Specifies diet consistency and liquid viscosity
Esophagitis
- Treat by decreasing gastric acidity, reflux - low fat - low fiber - small, bland - Wt reduction?
Autism spectrum disorders:
- Unnecessary food restrictions, possible food aversions, excessive supplementation can place children with ASD at risk
B.) Human relations (behavioral) theory
- Uses behavioral sciences, workers exist in social groups - Employee participation essential in decision-making - improves morals & productivity - "Theory Z" (Ouchi) value of the company is the people
Work schedules (3 types)
- Usually include 8 hour work day, a 30 minute lunch break and one or two 15 minute work breaks 1.) Master 2.) Shift 3.) Production schedule
Type 1 diabetic: Note
- With fixed daily doses of insulin, consistency of CHO is recommended - With intensive insulin therapy, adjust pre-meal insulin dosages based on total CHO content of each meal, using insulin-to-CHO ratio *Endurance athletes: 120-180 mg/dl is guideline during activity - < 10% Saturated fat, Fiber (14 g/1000 kcals), Na <2.4 g
QUESTION: Sophistication: Audience "Inexperienced":
- Young children, some adults lacking nutr training - "Need thorough introduction and background"
Written specifications
- accurate word picture or definition of a product - precise statement of quality; brief, complete, simple - include name, form, quantity, quality, size, grade, brand, style, sieve size
4.) Flexible budget
- adjusted to various levels of operation with "varying levels" of sales or revenues throughout the year (changes in pt or customer count) -- closing a floor for renovation -- gives dollar range for low to high levels of predicted activity
Staff - advisory; specialists
- advise and support the line, but NOT involved in day to day operations - Personnel Director, Consultant Dietitian in a Nursing Home
Acute diarrhea:
- aggressive/immediate rehydration; replace fluids and electrolytes lost in stool (WHO recommends Glucose electrolyte solution) - cheaper than PN rehydration - Oral intake should be reintroduced within 24 hours
Nephrosis - nephrotic syndrome: Symptoms
- albuminuria - edema - malnutrition - hyperlipidemia Increased synthesis & Decreased clearance of VLDL
Family and Medical Leave Act 1993:
- applies to public and private agencies employing > 50 workers - up to 12 workweeks of unpaid, job-protected leave during any 12 months for: birth or placement of a child for adoption, to care for an immediate family member, or medical leave for a serious health condition - when you return you are guaranteed an equal job, but NOT the same job
MacGregor
- attitude of the manager toward employees has an impact on job performance (based on manager's assumptions as to how employees view work) 1.) Theory X - Negative, Autocratic - People inherently dislike work and will avoid it if possible - Workers prefer to be controlled & directed by PRESSURE; motivation through FEAR 2.) Theory Y - Positive, Participative - work is natural like play or rest - Management should arrange conditions so workers can achieve goals by directing own efforts
Alzheimer's disease:
- avoid distractions - regular consistent mealtimes - encourage self-feeding, finger foods may be helpful - offer one course at a time - Lower saturated fats - soft calming background music - avoid dehydration - may need verbal cues to chew and swallow * Anomia (form of aphasia): lost words, unable to recall names of common items
3.) Choice - selective
- better please clientele a.) Static, fixed, set - same menu items every day (restaurant), when clients change daily b.) Single use - catered events c.) Cycle - standing - repetition of menus in designated sequence (1) Hospitals with 2-4 day average patient stay: 1 or 2 week cycles (2) Long term care facility: 3 or 4 week cycle (3) High school lunch programs: two week cycle with four choices (4) Simplifies purchasing, standardizes preparation procedures, gives a more constant and evenly distributed workload d.) Spoken e.) Room service f.) Two tier - upscale menu items prepared for those willing to pay extra
Conflict resolution: 1.) Dominance & suppression: Resolve conflict by majority vote
- can be effective if members regard the procedure as fair
Bolus method
- clinically stable with functional stomach - administered via a syringe or gravity drip over a 4-10 min period
Steatorrhea
- consequence of malabsorption - determine cause and treat
Continuous drip
- constant, steady rate over 16-24 hrs, usually with a feeding pump (for those with COMPROMISED GI fxn or who do not tolerate large volume infusion; decreased aspiration risk) Cyclic/Nocturnal feeding - delivered by continuous drip - at increased rate over 8-16 hours - often overnight, by pump (for under-nourished, especially older, ambulatory, malnourished patients)
Standardized portions
- control costs; keep records of employee meals
Quality Management & Improvement: I. Cost/benefit studies:
- cost/benefit of nutrition education and intervention
Injunction
- court order to prevent someone from doing something
Americans with Disabilities Act 1992:
- covers employers with 15 or more employees Must provide "reasonable accommodations" - remove barriers - have wide aisles (36") and doors (32") - install ramps - lower shelves and phones - rearrange tables and chairs *flashing alarm lights To comply, job descriptions must specify "ESSENTIAL" job functions
What lab tests are associated with renal disease?
- decreased GFR - decreased Creatinine clearance - increased Creatinine - increased BUN
Hypothyroidism
- deficiency of thyroid hormone - T4 low; T3 low or normal - Weight gain (decreased BMR) - Diet (Wt reduction) - Multi-vit, diet rich in fiber, antioxidants, and fluids. - Thyroid hormone therapy (Synthroid) for life
SOPP Standards of Professional Performance:
- describes a competent level of BEHAVIOR in the professional role (6 domains of professionalism) 1. Provision of Services 2. Application of Research 3. Communication and Application of Knowledge 4. Utilization and Management of Resources 5. Quality in Practice 6. Competency and Accountability
SOP Standards of Practice in Nutrition Care:
- describes in general terms a competent level of nutrition care practices as shown by the NCP (problem-solving method used to think critically and make decisions to provide safe, effective, high-quality nutrition care) *For those working in DIRECT patient care. Standards include: Diabetes, oncology, behavioral health care, nutrition support, management of food and nutrition systems, sports dietetics, and education of dietetics practitioners, Peds nutr, and nephrology care
5.) Performance budget
- details what it costs to PERFORM AN ACTIVITY (how much to supervise the cafeteria) - Typical in Government and not-for-profit organizations Ex.) There will be a 50% reduction in infant mortality by implementing vaccination programs in health departments by the end of the 2020 budget cycle.
Maslow's hierarchy of needs:
- determinants of behavior, motivated by the desire to satisfy specific needs 1.) Basic needs: - Physiological (survival needs) - food, clothing, shelter; pay, benefits, working conditions, schedule - Security & safety (insurance, retirement plans, job security) 2.) Higher human needs (motivators) - Social (organized activities) - Self-esteem (job title, praise, rewards, promotions) - Self-realization, JOB ENRICHMENT, advanced training 3.) When basic needs are met, higher needs become motivators
Payback period
- determines the length of time it will take for the cash inflows from a project to equal the initial cash outlay (how much time it will take for an investment to pay back the organization for the investment) - Add up the costs of the service - Add up costs saved by using the new service - Divide costs of service by dollars saved ** Refer to inman example: page 158
Cerebral palsy: Spastic form
- difficult, stiff movement; limited activity; OBESE - Low Kcal - High Fluid - High Fiber
Achalasia
- disorder of lower esophageal sphincter motility, does not relax and open upon swallowing - causes dysphagia - start with pureed moist thick foods, progress to thick liquids
ATP (Adult Treatment Panel) IV
- does NOT focus on specific target levels for LDL, but defines groups for whom lowering LDL would be most beneficial - Recommend heart-healthy lifestyle and Statin therapy *Patient with CVD, LDL of 190mg/dL or higher, DM2 btw ages 40-75, Patients with an estimated 10-year risk of CVD of 7.5% or higher btw ages 40-75
Food broker
- does not own products; connects buyers with sellers
Roux-en-Y (small portion of stomach directly to jejunum)
- dumping syndrome may develop Supps: - Calcium (in divided doses, 1200-1500 mg) - Vit D (3000 IU) - Iron (taken apart from Ca, 45-60 mg) - Increased Protein - Multivitamin/mineral need 100% DRI for: Vit K, Zinc, Thiamin, Folic acid, Copper, Biotin, Iron - additional B12 supps may also be needed
6.) Cross charts
- efficiency of EQUIPMENT PLACEMENT - studies work motions - # of movements between pieces of equipment
Resource allocation
- efficient allocation of people, materials, and equipment to meet the needs of the operating system (can lead to COST SAVINGS).
Separation:
- either voluntary or involuntary termination of an employee An "Exit interview" - can help identify personnel related problems
Procedures: Self-assessment
- employee may become more involved and committed; participation may help clarify their role and reduce role conflict
PT
- evaluates "clotting adequacy", change in vitamin K intake will alter rate
PERT (Program Evaluation and Review Technique) CPT (Critical Path Method)
- evaluation tool used for effective planning and control of the functions of management Critical path (longest pathway through) - determines the minimum time for completion (helps determine labor costs)
Hyperthyroidism
- excess secretion of thyroid hormone - Elevated T3 & T4 - Increased BMR leading to weight loss - Increase KCAL (by 50-60% of estimated needs) - Pro: 1-1.75 g/kg - 1Q milk/day Supps: Vit A, Vit C, B-complex, thiamin, riboflavin, B6, B12
Business marketing
- exchange of goods, services or idea to fill customer's needs or desires
Affordable Care Act 2010:
- expanded healthcare coverage available to employees and their families
Gastrostomy or jejunostomy
- feedings if needed for more than 3-4 weeks PEG - inserts tube into stomach through abd wall PEG/J (catheter in stomach with tip in jejunum is more likely to translocate compared to PEJ
Children 2-3 years:
- fluoridated water or supplements as recommended, fluoride toothpaste (pea-size)
Aseptic canning
- food sterilized outside of can, then aseptically placed in sterile cans which are sealed in an aseptic environment
1.) Block grants
- from federal gov and given to states or local communities for broad purposes - great flexibility in distributing funds - Five federal block grant areas: maternal & child health, community services, social services, preventive health services, primary care
B.) Organizing and staffing: Functions
- identify tasks and activities, divide tasks into positions - establish relationships among all other functions of management
Nasoduodenal or nasojejunal
- if unable to tolerate gastric feedings
Right to work laws:
- illegal to fire an employee who refuses to join union even if contract has a union shop clause - Cannot force employees to join union, UNLESS legal "union shop" exists! - Cannot refuse to bargain collectively with employer
Rate-based indicator (comparative rate indicator)
- incidence that occurs within some rate of frequency; expressed in ratios (numerator/denominator) - What will happen with the BEST care, threshold between 1% and 99% - 95% high-risk patients are assessed within 24 hours
Continuous Quality Improvement (CQI)
- integral part of TQM - is the process of reviewing and improving processes through data collection by use of the "Scientific Method" a.) Emphasizes ORGANIZATION and SYSTEMS rather than individuals b.) Ideal that systems and performance can always improve c.) Uses outcome assessment Quality Improvement (QI): - is systematic analysis using evidence-based guidelines to improve internal practice processes & performance. Locally initiated within an organization or facility.
Transitional feeding:
- introduce minimal amount of FULL-STRENGTH enteral feeding @ low rate of 30-40 ml/hr to establish GI tolerance - begin 'tapering' when enteral feedings provide 33-50% of their nutrient requirements - Decrease PN as you increase enteral rate by 25-30 ml/hr increments every 8-24 hours to maintain prescribed nutrient levels * D/C PN when patient can tolerate about 60% of needs via enteral route
6.) Group or co-op purchasing
- involves union of separate units (hospitals), not related to a single management, for joint purchasing - ECONOMIC ADVANTAGE of large volume purchasing
Value analysis
- is a process of investigating all aspects of a service to discover and eliminate unnecessary costs without interfering with the effectiveness of the service In FS, it is the relationship between the price paid for an item and its usefulness. ***Value analysis lowers costs. Value added increases value to the consumer - Does not interfere with quality Quality/Price = Value - If price goes up the value goes down; if quality goes up the value goes up
Enteral Nutrition: Adverse effects
- lactose intolerance, formula hyperosmolality, rapid infusion causes influx of water into gut, bolus feeding, bacterial contamination
SBS: MNT for ileal resection:
- limit fat, use MCT (does not require bile salts, needs less intestinal surface area) - Supplement fat-soluble vitamins, Ca, Mg, Zn, parenteral B12, followed by monthly injections
Kosher (Judaism)
- no meat and dairy at same meal - no pork, rabbit , *shellfish
Chronic nonspecific infantile diarrhea:
- no significant malabsorption - consider ratio of FAT to CHO calories; volume of ingested liquids - give 40% calories as fat, balanced with limited fluids; restrict or dilute fruit juices with high osmolar loads
2.) Occurrence sampling
- observe random samples (intermittent observations) to determine percentage of TIME WORKING or IDLE
Postprandial or reactive hypoglycemia
- overstimulation of pancreas or increased insulin sensitivity; blood glucose falls below normal 2-5 hours after eating (< 50 mg/dl) - weak, trembling, extreme hunger *Goal: prevent marked rise in blood glucose that would stimulate more insulin - Avoid: simple sugars, 5-6 small meals/day, spread intake of CHO throughout day, RDA for Protein
3.) Fixed budget
- prepared at one level of sales or revenue (no expected major change in patient or customer count during the year) Ex.) School budget for the 2019-2020 school year
Planning: is a key component of Nutrition Intervention
- prioritizing nutrition diagnoses, consult EAL (Evidence Analysis Library) and other practice guidelines, determine patient-focused outcomes for each diagnosis, confer with caregivers, define time and frequency of care, identify resources needed.
Improvement processes use: Criteria
- professionally developed statements that describe health care processes or outcomes. a.) Structure - environmental & personnel factors, policies, budget b.) Process - procedures used, sequence of activities (assessment, documentation in medical record, distribution of food) c.) Outcome (end result) (1) anthropometric, biochemical data (2) "based on survey results, customers are satisfied with meals" d.) Characteristics of Criteria: (RUMBA) - Relevant, Understandable, Measurable, Behavioral, Achievable
2.) Limited choice
- provide choices for some items
Nutrition care outcome indicators
- provide information about the type of progress made, when the nutrition problem is resolved, and what aspects of nutrition intervention are not working.
The Emergency Food Assistance Program (TEFAP):
- provides "quarterly" distributions of commodity foods by local, public or private nonprofit agencies (food banks, soup kitchens, homeless shelters) - Supplements diets of Low income & Elderly American households
Non-commercial (on-site food service)
- provides food as a secondary activity - hospitals, schools, military
The USDA Commodity Food Donation/Distribution Program:
- provides food to help meet 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 programs
3.) Future contracts
- purchase goods at a SPECIFIC price to be shipped LATER
JIT (just-in-time purchasing)
- purchase products as needed for production and immediate consumption by customer, WITHOUT having to store and record in inventory - difficult for purchase of raw materials bc timing and temperature control are vital in food quality & safety
Procedures: Checklist
- rater records PERFORMANCE; does not rate it - Uses list of questions or statement to be answered YES or NO *Avoid: - Halo effect (judge on most noticeable positive trait) - Leniency of error (rate everyone higher than they deserve) - Error of central tendency (rate everyone as average)
Procedures: Critical incident
- record incidents of positive and negative behavior
Chronic pancreatitis: MNT
- recurrent attacks of epigastric pain of long duration *PERT (creon, cotazym) - pancreatic enzymes orally with meals & snacks to minimize fat malabsorption from lack of pancreatic lipase - MCTs do not require pancreatic lipase (add to mixed dishes, jams/jellies)
1.) Motion economy
- reduce motions and time required - use shortest & straightest routes to move materials - movements should be: simultaneous, symmetrical, natural, rhythmic, habitual
Adult diarrhea:
- remove the cause; bowel rest, replace lost fluids and electrolytes (especially Na, K) - when diarrhea stops, begin with low fiber foods, followed by protein foods - avoid lactose at first *Prebiotic components (pectin, fructose, oats, banana flakes) from foods/supps *Probiotics
D.) Contingency and situational leadership: (3 types)
- responds to external environment - Methods that are highly effective in one situation may not work in another - Management must identify which techniques will work in a particular situation at a particular time 1.) Leadership continuum (Tannebaum & Schmidt) 2.) Contingency approach (Fiedler) 3.) Leadership effectiveness model (Hersey, Blanchard, Johnson)
PKU diet:
- restrict the substrate phenylalanine (PHE), supplement the product tyrosine (TYR) - Tyrosine becomes a conditional amino acid - low in PHE, but provide enough to promote normal growth - Avoid aspartame - Need for PHE decreases with age, infection - Low protein, high CHO intakes may lead to dental caries
Expectancy theory - Vroom, Porter, Lawler, Beer)
- rewards serve as motivators ONLY under certain circumstances - employees must believe that effective performance leads to certain rewards Path-Goal Theory - (Evans, House) - focuses on leader's effect on employee's motivation to perform
Commercial operations
- sale of food is primary activity, profit is desired
3.) Pathway chart or flow diagram
- scale drawing showing PATH OF A WORKER during a process
SBS severity:
- severity reflects length & 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 - Most digestion takes place in first 100 cm of intestine (duodenum & upper jejunum): what remains - small amounts of sugar, starches, fiber, LIPIDS
B.) Organizing and staffing: Organizational chart -
- shows how the employee fits into the organization 1.) Shows relationship of positions and functions 2.) Depicts lines of authority shown with SOLID lines 3.) Advisory (staff) positions shown with DOTTED lines 4.) NOT SHOWN: degree of authority at each level, informal relationships
1.) Informal, open market
- small amount is needed quickly - buyer requests quotes on specific items for specific amounts & qualities from one or more sources of supply - Place order after considering: Price, Quality, Delivery
Peripheral parenteral nutrition
- small surface veins in arm - Limited use d/t "hypertonic" solution - Complications: thrombophlebitis, bacterial translocation Indications: post-surgery (when enteral feeding is expected to resume within 5-7 days), mild to moderate malnutrition, as supplement to enteral *IV Dextrose: 3.4 Kcals/g - highest concentration used in peripheral nutr is 10% *Protein: 3-15% AA solutions * IVFE (intravenous fat emulsion - intralipid) - 10% (1.1 kcals/cc) - 20% (2.0 kcals/cc) Solutions generally limited to Osmolarity: 800-900 mOsm/L Normal plasma Osmolarity: 275-290 mOsm/L - LIPIDS are isotonic and do not add to solution osmolarity
2.) Shift schedule
- staffing patterns for a particular operation; positions and hours worked, number of days worked per week, *relief assignments
2.) Formal, competitive bid buying
- submit "written specifications" and quantity needs to vendors who then submit a price - bids are opened together; place order with lowest bid
C.) Systems approach
- system is an organized whole composed of interdependent parts called subsystems (classified according to their purpose: procurement, production, distribution and service, safety and sanitation) - Open system with External forces (change in 1 part affects many other parts) - Considers entire organization when making decisions or allocating resources - Major component of a system (input -transformation - output) involves Linking (decision-making, communication), managing (plan, organize, staff, direct, control) and building function subsystems (production, distribution, service) - Characteristics of Open systems: (interdependency, integration, synergy, dynamic equilibrium, equifinality, permeability to boundaries, interface)
Sophistication: Audience "Moderately experienced":
- teachers, health educators, "patients already instructed" - Emphasize "REVIEW OF MATERIAL"; reorganize for better use; move on to more complicated concepts
Daily food cost report (food cost percentage)
- tells you what percent of the income was spent on the food sold Daily food cost / Daily income = Food cost percentage
3.) Production schedule
- time sequencing of events required to produce a meal; employee assignments and menu items; quantity to prepare and timing (what to do when)
Promotions:
- to a job involving higher pay, status, performance needs - can be an incentive for improved performance - Basic criteria: Merit, Seniority - May cause resentment in those bypassed
PN concerns:
- translocation of bacteria; not feeding through gut allows wall to break down, bacteria move out causing sepsis a.) GALT (gut associated lymphoid tissue) - is compromised by 'bowel rest' or PN. Provides 50% of total body immunity. 70-80% of total body immunoglobulin production is secreted across the GI mucosa to defend pathogenic substances in the GI lumen b.) Refeeding syndrome - intracellular shifts of phosphorus, potassium, magnesium = Hypo for all. Slowly increase PN over a goal rate over 3-4 days. Hypocaloric feeding (20 kcal/kg or 80% of estimated needs) c.) EFAD (essential fatty acid deficiency) - petechiae (red spots) is a symptom
Inventory technology:
- use of bar code to identify products - includes a five digit "manufacturer" ID number and a five digit "product" number Number system: a single digit which identifies the "type" of product Manufacturer Code: Product Code: - unique code assigned by manufacturer Check Digit: - an additional digit used to verify that the barcode has been scanned correctly
Financial ratios:
- use of formulas to analyze an organization's financial position - formulas use data from FINANCIAL STATEMENTS 1.) Compares organization with similar ones 2.) Compares ratios with those projected or with preceding ratios Ratio analysis: is an analysis of financial data in terms of relationships between two items
4.) Prime vending
- use single vendor for majority of purchases
Popularity index:
- used to analyze and PREDICT any items sales; chart day to day variations in demand; as well as each item's popularity in relation to other items ** Forecast future needs!!! # servings of an item / Total # of servings of ALL items in that category that day
1.) Traditional (incremental, baseline)
- uses existing budget as a base and projects changes for the ensuing year in relation to the current budget - usually begins with this year's expenses + an inflation factor -- Gives a slight increase, no change, or slight decrease to various line items, departments or programs Ex.) Increase in budgets for food costs due to increased fuel costs *Control oriented - Prepared at one level of sales or revenue
Bulimia
- usually close to normal weight - low Potassium & Chloride levels
Cryogenic freezing
- very low temperatures using liquid nitrogen or carbon dioxide
Loss of colon results in:
- water & electrolye loss, loss of salvage absorption of CHO and other nutrients
EFNEP: more info on program
- works with small groups; teaches skills needed to obtain a healthy diet (how to budget, meal planning, shop, cook) - carried out by state land-grant universities
NCCIH (National Center for Complementary and Integrative Health)
- yoga, meditation, herbs & botanicals, traditional healing practices
C.) Directing cont.. Leadership styles & techniques:
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If you have a diagnoses from two domains consider "intake" diagnoses as more specific to the nutrition professional
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Next questions will be on these previous 5 systems mentioned:
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Treatment for Crohn's disease & UC:
-Maintain fluid & electrolyte balance; antidiarrheal agent (sulfasalazine)
Liquid Consistency
-Spoon-thick, Pudding-like -Honey-like -Nectar-like; Magic cup -Thin (includes all beverages = water, ice, milk, juices, coffee, tea, gelatin)
What is the normal serum creatinine range?
0.6 - 1.4 mg/dl
The aw that limits growth is ___ - ____.
0.70 - 0.90 The lower limit for all microorganisms is 0.60 aw
Dietary Guidelines for Americans are revised every ____ years and are designed to prevent _____, written by ____ & ____.
5 years Prevent chronic disease USDA & HHS - community nutrition programs use these guidelines when developing plans
Microorganisms grow well at an aw of ___ - ____.
0.91 - 0.99
Collective bargaining: Steps in order -
1. Bargaining between union steward and management 2. If that fails: MEDIATION- neutral person helps settle differences, decision not binding 3. If that fails: ARBITRATION- hearing to dissolve a dispute during an impasse, decision is usually binding (final step in bargaining)
B.) Organizing & staffing cont: Work simplification procedures
1.) Eliminate unnecessary parts of job and those that add no value 2.) Looks at smallest parts of the job (hand movements, steps taken) 3.) Increases PRODUCTIVITY and decreases COSTS
Strategies to strengthen local food systems (3):
1. Farmer's markets 2. Food recovery and gleaning programs 3. PPFPs (Prepared and Perishable Food Programs) PPFP's work with social service agencies
Managerial Skills:
1. Technical - good understanding in a specific kind of activity - Lower levels of management (most important) - This also includes the expertise to evaluate, train, and respond during crisis situations. 2. Human (interpersonal) - ability to work effectively as a group member - important at all levels BUT imperative at Lower levels of Mgm 3. Conceptual - ability to see organization as a whole - Higher ranks of Mgm (most important) - A systems management approach 4. Hard skills = can be taught, Soft skills = must be developed and nurtured
Grades 9-12 require ____ ounces meat per serving; nuts must be combined and only used for ____ the requirement.
2 ounces Half
How many servings can you get from 9 lbs raw meat with a 30% shrinkage if the serving size is 5 ounces?
1.) (30% shrinkage)(raw 9 pounds) = 2.7 lbs lost in cooking. 9-2.7 = 6.3 lbs remaining Convert to ounces = 100.8 100.8 / 5 ounces = 20.16 portions
Patient needs 2000 calories per day and is restricted to 1500 ml fluid per day. The enteral formula selected has 1.5 cal/ml, 55 g protein/L and is 77% water. 1.) How much formula is required? 2.) How much protein will be provided? 3.) How much additional water is needed? 4.) What is the administration rate?
1.) 1,333 ml formula 2.) 73 g protein (55 x 1.33) 3.) 1026 ml water in formula (1333 x 0.77); 1500-1026 = 474 ml additional 4.) 1333 ml/24 hrs = 56 ml/hr
Determining staffing needs: Staffing patterns:
1.) Acute care conventional - 17 mins per meal or 3.5 meals per labor hour 2.) Extended care facilities (5 meals/labor hr) 3.) Cafeteria (5.5 meals/labor hr) 4.) School FS (13-15 meals/labor hr) - reflect averages and are only used as guides - when determining meals served, consider meal equivalents
Complications of uncontrolled diabetes:
1.) Acute ketoacidosis - hyperglycemia due to insulin deficiency or excess CHO intake, dehydration due to polyuria, increased pulse, fruity odor of ketones Treatment: insulin, rehydration
Note differences between NC - 1.4 & NC - 2.1
1.) Altered GI function (NC - 1.4) looks at problems inside the GI tract including "exocrine" functions of the liver & pancreas, with changes in digestion, absorption, and/or elimination. Potential indicators: abnormal digestive enzyme and fecal fat studies, abd distention, nausea, steatorrhea, etc.
B.) Cost/effectiveness analysis
1.) Assumes the goal of the project is worthwhile 2.) Question to resolve is "which method of intervention" is the most effective (in terms of value) in achieving the goal 3.) Compares "costs of alternative strategies" 4.) Analysis utilizes outcomes research - Shows what works best, for whom, and at what cost - used to predict the level of outcome that can be reasonably be expected from a given intervention - must assess the effectiveness of the nutr intervention against one or more reasonable alternatives and determine the value of health care resources consumed when each alternative is used Ex.) WIC child participants have improved vocabulary scores in school.
Leadership styles (5):
1.) Autocratic - demands obedience - most control - full responsibility 2.) Consultative - asks for input, but makes final decision alone 3.) Bureaucratic - by the book, follows procedures to the letter 4.) **Participative - emerging trend in management - encourage workers to assist in decision making - uses Quality Circles (small group of employees who meet regularly to identify and solve problems - Democratic (accepts decision made by group) 5.) Free rein (laissez-faire) - LEAST control
GAAP (Generally Accepted Accounting Principles) - provide consistency in the preparation and communication of financial statements...examples below Accounting methods: 1.) Cash basis 2.) Accrual basis
1.) Cash basis - recognizes a transaction at the time the cash is TAKEN IN or RELEASED 2.) Accrual basis - recognizes Revenues when "earned" and Expenses when "incurred" (regardless of when the actual cash is received or dispersed) - Used by most businesses Ex.) A service was performed on Jan 1st and paid for on Jan 8th, the transaction is recorded on Jan 1st.
C.) Directing ____ is the distribution of work to qualified people.
1.) Delegation a.) Manager must have clear understanding of what they want done; give specific instructions; motivate; provide training; require complete work; establish adequate controls b.) Barriers to effective delegation - manager's reluctance to delegate -- feel they can do better themselves, feel a loss of power, may be too disorganized to plan ahead, lack of confidence in subordinates
Sources of Assessment information: (2)
1.) Demographic - Population by age, ethnic groups, sex, birth rates, deaths 2.) Socioeconomic Stratification - census data, housing statistics
A.) Cost/benefit analysis
1.) Determines if goal of the intervention is worth the cost 2.) Value of benefits derived from the intervention must outweigh the costs 3.) State Objectives clearly & quantifiably a.) Calculate benefits - any outcome attributable to the project (1) Direct - change in diet or food habits as a result of counseling - change in functioning of body due to altered diet intake (wt change, reduced constipation due to high fiber intake, etc) - Value is determined by measuring the cost of treatment alternatives needed due to absence of improved food habits (2) Indirect - saving of physician's time and other resources due to the prevention or reduction in severity of a dz (decrease in admissions /length of stay) b.) Calculate total costs of program c.) Calculate **Benefit/cost ratio - (more comprehensive than ROI) *ROI - measures the cost of the program versus financial return realized by that program
A.) Steps in program planning:
1.) Develop Mission statement and needs/problem statement - What nutrition services - What population groups will be served - Select most critical issues, etc. 2.) Set Goals - broad direction, general purpose (increase quality & years of life) - What health problems have nutr implications - Determine current nutr high risk groups and the most critical needs 3.) Set Objectives - More defined; specific target dates for completing specific projects. Include *expected results in quantitative & qualitative terms within a given time frame - SMART - Include Who, What behavior (measure or action verb), How much, By whom, When, Where
What are the three steps in implementation?
1.) Educate (Cognitive learning) 2.) Enable - 4 P's 3.) Skill development (psychomotor learning) - Competencies necessary to make & sustain new eating habits
Metabolic Syndrome: Risk factors
1.) Elevated BP (≥ 130, and/or ≥85) 2.) Elevated TG ≥ 150 mg/dl 3.) Fasting serum glucose ≥ 100 mg/dl 4.) Waist circumference: Men 40" & Women 35" 5.) *Low HDL < 40 (men), < 50 women
Marketing process and plan:
1.) FIRST STEP - identify a need that is not being filled (MARKET NICHE) 2.) Marketplace - where service will be offered 3.) Market segmentation - divide market into groups of people with similar needs a.) Demographic variables - age, gender, race, education, income b.) Geographic variables - urban, suburban, climate, resources, cultural value c.) Psychographic - social class, lifestyle (what is important to them and their mode of living), motive (reason customer makes a purchase) d.) Behavioristic - occasions, loyalty
There are four categories of Nutrition Intevention:
1.) Food delivery 2.) Education 3.) Counseling 4.) Coordination of care with other providers
What are three types of Acute viral hepatitis?
1.) HAV - fecal to oral transmission (type most connected with food) 2.) HBV - sexually transmitted 3.) HCV - blood to blood contact
Osteoporosis: Treatments
1.) HRT (hormone replacement therapy) 2.) Weight-bearing exercise 3.) Vit D (400-800 mg) & Calcium (don't exceed 500-600 mg at one time) supplements 4.) Adequate protein, moderate to low sodium, 5 servings of fruits & veggies
What are the types/stages of alcoholic liver disease?
1.) Hepatic steatosis 2.) Alcoholic hepatitis 3.) Cirrhosis *Acetaldehyde (converted from alcohol) & excess Hydrogen which disrupts liver metabolism
Maillard Reaction: (non-enzymatic)
1.) Initial step is combination of a reducing sugar (all simple sugars except sucrose) and an amino acid 2.) This Rxn mostly occurs in an "Alkaline" environment. - Baking soda & solid sugar will result in deep brown colors - Baking powder has an acid 3.) Browning of breads 4.) For more rapid browning: - increase pH (6 or more) - increase temperature - decrease water content
Insulin: Basal Types, when to take them, and duration?
1.) Intermediate-acting: * NPH (Humulin N, Novolin N, ReliOn) * Onset 2-4 hours * Duration 10-16 hours *Cloudy in appearance 2.) Long-acting: * Glargine (Lantus), Determir (Levemir) * Onset 2-4 hours * Duration 18-24 hours
What are examples of NB (problems related to knowledge, access to food and food safety)?
1.) Knowledge and beliefs * disordered eating pattern, undesirable food choices 2.) Physical activity balance and function: - inactivity, excessive exercise, impaired ability to prepare foods 3.) Food safety & access
Strategic Marketing
1.) Long term overall view of marketing in the organization in which resources are allocated and Objectives set AFTER defining the market 2.) Selection and analysis of a target market; creation and maintenance of an appropriate marketing mix
D.) Controlling/Evaluating:
1.) Measure present performance against standard performance a.) Determine whether goals have been reached b.) On-going process c.) Shows strengths and weaknesses, solves problems d.) Steps 1.) establish qualitative and quantitative standards 2.) measure performance 3.) compare to standard 4.) take corrective action e.) Types of control: production, quality, quantity
Work simplification procedures: Examples
1.) Motion economy 2.) Occurrence sampling 3.) Pathway chart or flow diagram 4.) Operation charts 5.) Process charts 6.) Cross charts
Complications of uncontrolled diabetes: Long term
1.) Neuropathy - peripheral and autonomic; gastroparesis 2.) Retinopathy - leads to blindness 3.) Nephropathy - leads to decreased kidney fxn
School lunch menus: (3)
1.) NuMenus - Nutrient Standard Menu Planning, uses USDA approved nutrient analysis software 2.) Assisted NuMenus - nutrient analysis may be done by another school or consultant 3.) Enhanced Food - Based and Traditional Food-Based - computers NOT required
Step 1:
1.) Obtain "overview" to determine whether nutritional resources are adequate, what groups are potentially at high nutritional risk, how well health needs are being met by existing programs
OAA requirements:
1.) One hot meal each day, 5 days/week, provide 1/3 recommended intake 2.) All aged 60 and older PLUS spouse, regardless of income 3.) Congregate Meals - "ambulatory"; transportation essential for rural elderly
Medications for obesity:
1.) Orlistat - lipase inhibitor, take with diet 30% kcals as fat, Vit supps 2.) Lorcaserin - agonist of Serotonin, enhances satiety 3.) Phentermine/topiramate - releases norepinephrine, appetite suppressant
Time span: 3 types of Planning
1.) Short range or operational planning - covers period of 1 year or less; usually the operating budget; projected in days, weeks, months 2.) Long range planning - up to a 5 year cycle, focus on goals & objectives - requires a mission statement of long range vision 3.) Strategic planning - decisions about intended future outcomes, and how success is measured and evaluated - broad technological and competitive aspects; SETS DIRECTION for organization - SWOT analysis: strengths, weaknesses, opportunities, threats - assesses the environment outside and inside the organization
Interview types: 1.) Structured (directed) 2.) Unstructured (non-directed)
1.) Structured (directed) - use checklist or preplanned strategy; gives same information on all; minimizes personal biases 2.) Unstructured (non-directed) - no definite checklist; more participation from applicant; "Tell me about your last job"; sales, counseling, management
Written specifications : (3 types) 1.) Technical 2.) Approved brand specifications 3.) Performance specifications
1.) Technical - indicate quality by objective and impartial test results (graded food items, gauge of metals). Can-cutting 2.) Approved brand specifications - indicate quality by specifying a brand name 3.) Performance specifications - indicate quality by "functioning characteristics" of the product (pH level of detergents, how many dishes washed / minute)
Management theories:
1.) Traditional or classical 2.) Human relations (behavioral) theory 3.) Systems approach 4.) Contingency and situational leadership 5.) Scientific management - Taylor 6.) Management of Objectives MBO - Drucker 7.) Reciprocal approaches 8.) Organizational change theory
Osteoporosis: Those at-risk
1.) Type I postmenopausal (within 15-20 yrs), Type II age-associated > 70 2.) White & Asian women (more osteoporotic fractures) Caused by: - malnutrition (especially protein) - lack of exercise - decline in estrogen
Therapeutic Lifestyle Change (TLC) from ATP III:
1.) Up to 35% kcals from total fat * < 7% saturated fat * 5-10% PUFA * Up to 20% MUFA * < 200 grams Cholesterol 2.) 25-30 grams Fiber (HALF soluble) 3.) 2-3 g/day Stanols & Sterols to inhibit Chol absorption 4.) Maintain DBW, prevent wt gain 5.) Increase PA (30 mins of Mod intensity most days - to expend at least 200 kcals)
C.) Traits
1.) Use of authority, power and influence
E.) Scientific management - Taylor
1.) Work-centered: workers must work at fastest pace possible and at maximum efficiency; SYSTEMATIC approach to improving worker efficiency 2.) Structure work situation to minimize motivation needed by supervisor 3.) Find best way of performing tasks 4.) Focus on PHYSICAL ASPECTS of the job
Renal calculi (kidney stones)
1.5-2.0 L fluid/day needed to dilute urine Calcium oxalate stones (most common type of kidney stone) - Adequate Ca intake to bind oxalate - Low oxalate (40-50 mg) diet (Avoid: dark leafy greens, chocolate, rhubarb, swiss, chard, almonds, miso, tahini, soybeans, bran cereals, strawberries, nuts, beets, tea): Increase Ca = decreased stones
Relief workers: Approximately ____ employees are necessary for everyday coverage of full-time positions.
1.55 employees Full-time employees generally are available an average of only 236 days per year because of days off and benefit days (129 days)
NSLP (National School Lunch Program): 100% full-strength fruit juice may be used as ____ of weekly servings of fruit.
1/2
NSLP (National School Lunch Program): must provide on average over each school week ____ of the recommended intake for ____, ____, ____, ____, ____ levels.
1/3 - Protein, Iron, Calcium, vitamin A, vitamin C
NSBP (National School Breakfast Program): meals must provide on average over each school week ____ daily recommended levels for protein, calcium, iron, vitamin A, vitamin C.
1/4
A normal BUN:creatinine ratio is?
10-15:1
Operating costs
12-18% of budget - utilities (electricity), laundry, cleaning
Physical activity
150-420 mins or more per week Weight maintenance: 200-300 mins/week
HTN: Management/MNT Salt restriction of ____ - ____ mg/day. And what are the recommended diets for HTN?
1500-2300 mg sodium/day DASH diet - Ca to meet DRI, not supps Mediterranean diet - rich in alpha linolenic acid, high in Monounsaturated fats - fish, poultry, eggs, breads, abundance of fruits/veggie, beans, legumes, yogurt, chz - resveratrol in skin of red grapes may lower BP
Example: At the end of a six month period, there are 80 positions in the department. During that time, 18 employees were terminated and replaced. What is the labor turnover rate?
18/80 = 0.225 x 100 = 22.5% turnover
How many risk factors are needed in order to diagnose Metabolic Syndrome?
3 - three or more risk factors are linked to insulin resistance which often increase risk of coronary events
Short term access:
3-4 weeks - Nasogastric tube - Normal GI fxn a.) Bolus method b.) Continuous drip c.) Intermittent drip (pump or gravity) d.) Nasoduodenal or nasojejunal (pancreatitis; decreased aspiration risk - gastroparesis; confirmed by x-ray) e.) Transpyloric (feeding beyond pylorus; decreased N/V)
NSLP (National School Lunch Program): For grades K through 5: _____ cup vegetables is one serving
3/4
Gastric residuals should be checked every ___ hours during the first 24 hours.
4 hours *Then decrease to 6-8 hours unless patient is critically ill *GRV > 250 after the second check, consider a promotility agent *GRV > 500 ml, hold feeding and assess tolerance, reassess risk factors Promotility agents - help enhance the stomach and small and large bowel transit
Marketing process and plan: cont..
4.) Market niche - need you are trying to fill 5.) Position statement - how you would like the marketplace to view your product 6.) Decide on the target market - group of people or places with similar wants/needs with the potential for purchasing your product 7.) Marketing objectives - quantifiable, attainable goals 8.) Marketing strategy - route chosen to reach goals 9.) Product mix - group of items you will offer 10.) Develop the marketing mix (4 P's) a.) Product b.) Place c.) Price d.) Promotion (publicity)
Fluorine should be supplemented starting at ___ of age if level in water supply is < ____ ppm.
6 months of age < 0.3 ppm
HgA1c is the measure of long term blood glucose control of ____-____ days.
60-90 days
Renal solute load: solutes excreted in 1 L urine; daily fixed load of ____. Mainly measures ___ & ____.
600 mOsm Nitrogen (60%) & electrolytes (SODIUM)
NHANES III assesses the oversampling of adults "greater than or equal" to the age of ____ with NO upper age limit.
65 USDA conducts over-sampling of adults 60 and older, African Americans, Hispanics
Medicare applies to people who are over age ____, those with certain disability, and those with end-stage renal disease (of any age).
65 Part A: - Covers hospital stays, skilled nursing facilities, hospice and home health care Part B: - Covers outpatient services, preventative services and medical supplies. RD services covered for "Annual Wellness Visit" 1x every 12 months Part C: - Provided by private insurance that covers Part A and B of Medicare expenses. Covers services not available to Part A&B and prescription drugs Part D: - Covers prescription drugs
NAFLD treatment: A weight loss of ___ to ___% of starting weight is recommended. (AVOID rapid wt loss). What diet is recommended?
7-10% of starting wt Mediterranean diet - Mod alcohol, avoid sugar-sweetened beverages, coffee may help
Thaw in refrigerator; or submerge under running cold water at ____ degrees or LOWER
70' F
Molds form in temps of ___ to ___.
77-86' F - used in curing chz, making soy sauce - grow best in damp, dark conditions, on acid, neutral, sweet foods - Boil to destroy
Marketing analysis
A.) process of identifying a need, assisting potential clients in recognizing that need, and filling that need B.) Marketing channel C.) The product or service - is anything you offer in exchange for money or something else of value
What are the major enzymes found in organs and tissues that are associated with liver fxn? (4)
ALP (alkaline phosphatase) LDH (lactic acid dehydrogenase) AST, SGOT (aspartate amino transferase) ALT, SGPT (alanine aminotransferase) - Enzyme levels elevated in liver disease
Which USDA program provides healthy snacks for school students?
ASP After School Snack Programs - cash subsidies for each snack served, same eligibility bases as NSLP
Inflammation, necrosis, jaundice, *anorexia, nausea, fatigue are associated with what liver condition?
Acute viral hepatitis
____ used when insufficient evidence exists for EAR, RDA.
Adequate Intake (AI) Adequate Intake (AI) is the recommended average daily intake level based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate - used when an RDA cannot be determined.
____ also takes into account the benefit days & days off.
Adjusted FTE
Consistency (key element)
All employees would receive the same discipline for committing the same offense. Disciplinary action - is the result of an employees behavior and NOT personality conflicts Focus on behavior, on observations, and provide alternatives
Oral glucose-lowering medications: inhibit enzymes that digest CHO's, delaying absorption
Alpha glucosidase inhibitors 1.) Acarbose (Precose)
The National Cholesterol Education Program (NCEP), National Heart, Lung and Blood Institute are endorsed by the ____
American Heart Association (AHA)
Oral glucose-lowering medications: Decreases glucagon release, suppresses appetite
Amylin agonist 1.) Pramlintide (Symlin)
Diet for Ulcers includes:
As tolerated, well-balanced, avoid late night snacks Omit: cayenne & black pepper, large amounts of chili powder, avoid excess caffeine & alcohol
Lead depletes iron leading to ____.
Anemia
A ______ is also provided by _____ to Medicare beneficiaries.
Annual Wellness Visit (AWV) ACA (Affordable Care Act)
Tropical sprue: MNT
Antibiotics High Kcal High Protein IM B12 & oral folate supplements
antagonizes vitamin K
Anticoagulant (Warfarin sodium) - maintain consistent Vit K intake
Avoid Ginko biloba extract (GBE), garlic, ginger (may increase bleeding); avoid high dose vitamin A, E
Anticoagulant (warfarin sodium)
Supplementation of which two amino acids may help cardiac cachexia?
Arginine Glutamine - Low Sat fat - Low Chol - Low trans fat - < 2 grams sodium - HIGH KCAL (2x rec Kcal) - High Protein (1.0-1.5 g/kg) - Small/freq high kcal meals
Flapping, involuntary jerking motions known as ____ is associated with hepatic failure and a sign of impending coma.
Asterisix - apathy, drowsiness, confusion, coma, PSE (portal systemic encephalopathy) also associated with hepatic failure
Acute kidney injury, acute renal failure: MNT
At-first: IV Glucose, lipids, protein - Increased Pro (especially on dialysis) - Increased Kcal (25-40 kcals/kg) Energy expenditure increases as kidney function declines - Low Sodium (2-3 g) - 8 to 15 mg/kg Phosphorus (may need phosphate binders) - 2 to 3 g Potassium (based on output, serum K, dialysis) *Replace fluid output from previous day plus 500 ml
II. Process and implementation: ____ - formal study that retrospectively monitors performance. Way to document appropriate care patterns and for identifying areas needing improvement; did performance meet the standards?
Audit
___ the average amount customers spent on a meal.
Average check Sales / number of customers served - Helpful in detecting TRENDS
Anemia can occur following a gastrojejunostomy and cause a deficiency of which two vitamins/minerals?
B12 Folate B12 (lack of intrinsic factor and bacterial overgrowth in loop of intestine being bypassed interferes -- Pernicious anemia) - B12 normally absorbed in ileum Folate (needs B12 for transport; also from poor intake and low serum Iron - cofactor in folate metabolism)
Crohn's disease is associated with which two vit/min deficiencies?
B12 Iron
Homocystinurias is associated with low levels of which three vitamins?
B6 (coenzyme in AA metabolism) B12 (coenzyme in protein synthesis) Folate - Newly diagnosed received increased doses of these 3 vitamins - If they don't respond: LOW Protein, Low methionine diet
Hepatic failure (ESLD): Altered neurotransmitter theory
BCAA decreased AAA increased (aromatic amino acids) - damaged liver unable to clear them - Adding BCAA (adds kcals & protein) may be used when standard therapy is not working or when pt doesn't tolerate standard protein
____ & ___ are chemical preservatives and known as antioxidants for fatty products.
BHA BHT
Landrum-Griffin, Labor Management Reporting and Disclosure Act 1959:
BILL OF RIGHTS for union members; regulates internal union affairs - Union members are entitled to due process - Financial dealings disclosed to the U.S. Department of Labor
What anthropometric measurement is used to evaluate nutritional risk in health fairs?
BMI
Gestational diabetes: risk factors
BMI > 30 History of GDM Hispanic, African Americans, Asian, American Islanders @ increased risk
Review knowledge, attitudes and behavior assessments: BRFSS, YRBSS, Health and Diet Survey
BRFSS & YRBSS - can monitor changes in "health risk behaviors" over time and can better target "health promotion" efforts to populations most at risk
____ shows financial condition as of a particular date. Lists assets and liabilities.
Balance sheet Assets (goods & products owned) - cash, inventory, accounts receivable (amounts owed to you) Liabilities (amounts owed to others) Assets = Liabilities + Capital (equity)
MDI (multiple daily injections)
Basal insulin - once or twice daily & Rapid-acting BOLUS before meals
Oral glucose-lowering medications: Suppress hepatic glucose production, increase insulin uptake into muscles
Biguanides 1.) Metformin (Glucophage)
When developing programs and services which step controls and coordinates activities?
Budget development
Supports public and non-profit food service programs for at-risk afterschool care centers, family day care centers, neighborhood houses, homeless shelters, nonresidential ADULT daycare centers?
CACFP Child and Adult Care Food Program - reimburses operators for meal costs - provides Reimbursable meals, Commodity foods and Nutr education materials - must offer free or reduced-price to those eligible
____ blood test is specific in identifying children with milk, egg, fish, peanut allergy.
CAP-FEIA CA = milk P = peanuts F = fish E = eggs
When evaluating info related to health care fraud/food fads ask questions based on the ____ checklist.
CARS checklist Credibility - check credentials of author Accuracy - info is current, factual and comprehensive Reasonableness - is info fair, balanced and consistent Support - is supported documentation cited for scientific statements
Which lab value estimates lean body mass - somatic protein?
CHI - ratio of Cre excreted / 24 hours to Ht
Fruit:
CHO 15 Kcals 60
Which mineral binds tetracycline? - antibiotic that fights infection caused by bacteria
Calcium - Drink a full glass of water with each dose of tetracycline. Do not take tetracycline with food, especially dairy products such as milk, yogurt, cheese, and ice cream.
Union membership:
Check-off - is the deduction of union dues from pay Union shop - must join union AFTER being hired Open shop - can join union or not Closed shop - must be a member of union first BEFORE hiring *Union and closed shops are illegal in public employment Agency shop - all workers must pay agency fee, but NOT required to join union
Which two H2 blockers are typically used in drug therapy for gastric ulcers?
Cimetidine Ranitidine - prevents binding of HISTAMINE to receptor, decreases acid secretion
____ - negative side of reward power, ineffective in motivating behavior change , may create resistance.
Coercive power - ability to punish another for not carrying out requirements *Used to maintain "minimum standard of performance"
Immunoglobumin E (IgE) mediated reaction to normally harmless food PROTEIN
Common allergens: - peanuts, eggs, milk, soy, wheat, shellfish *Cow's milk protein is the most common allergen for infants
_____ is the development of sustainable, community-based strategies to ensure that all have access to culturally acceptable, nutritionally adequate food at all times
Community Food Security Initiative
_____ benefits or pay for time NOT worked
Compensatory
Mind-body medicine, alternative medical systems like acupuncture and oriental medicine, lifestyle & disease prevention, biologically based therapies (herbs & orthomolecular medicine), manipulative and body-based therapies (chiropractic medicine), biofield systems (therapeutic touch, bioelectric magnetics)
Complementary and alternative medicine (CAM): - NIH (National Institute of Health) categories *NIH funds research for CAM through the NCIH
Documentation on employee behavior includes:
Conduct, performance, appearance, and work availability (part of progressive discipline) a.) Use Punishment as last resort b.) GOAL is to correct the "behavior" and save the employee c.) Be sure employee is aware of severity of the problem as well as the organization's standard (was the employee properly trained) d.) *Corrective discipline should be meted in PRIVATE e.) Compare employee's performance with department standards (not other employees) f.) To reprimand constructively, show the employee how to improve their performance
Meat kept warm on dish sitting on heated pellet is an example of what type of heat transfer?
Conduction Good conductors: - copper, black cast iron, aluminum
Steak on a grill, or meat braising in a steam-jacketed kettle use both ___ & ____
Conduction & Radiation
Once nutrient status is restored for SBS, enteral nutrition should then be started early to stimulate growth and increased over time and feeding should be initiated via____.
Continuous drip (for enteral nutrition)
If thawed in microwave, ____
Cook immediately
Celiac disease: Need (Gliadin-free) Gluten restricted diet: OK to eat -
Corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax No wheat, rye, oats, barley, (buckwheat may be contaminated with WROB); No bran, graham, bulgur, malt, couscous, durum, orzo, *thickening agents
_____ - evaluative dimensions against which an employee's behaviors are measured; performance expectations that the employee strives to attain.
Criteria
Adjusting recipes for different quantities:
Cross multiply
Hyperlipidemia, hyperglycemia, *hyperkalemia, HTN
Cyclosporine (immunosuppressant) - It can prevent organ rejection after transplant in its oral form. It can also treat rheumatoid arthritis and psoriasis.
Monitoring and Evaluation:
Data - is used to create an "outcomes management system". It is collected and analyzed timely, so performance can be adjusted and improved.
_____ is the natural increase in early morning blood glucose and insulin requirements due to increased glucose production in liver after overnight fast.
Dawn phenomenon - increased need for insulin at dawn
CKD Stage 1-4: GFR ____
Decrease protein in stages 3 & 4 when NOT on dialysis (0.6-0.8 g/kg Pro) *Stages 1 & 2: 0.8-1.4 g/kg protein & maintain normal serum level for Phosphorus
A high serum albumin may indicate what?
Dehydration
Organizational communication channels: Minimizes time and effort expended in organizations.
Diagonal - between functions diagonally placed (ordered clerk in FS sends requests directly to purchasing department, not through food service channels)
The _____ are implemented into the types of meals served for Lunch and Breakfast Programs.
Dietary Guidelines
____ amount of increase or decrease in cost when you compare alternative choices; difference in costs between two delivery systems.
Differential costs
Heart failure: ____ increases strength of heart contractions and is typically used for treatment.
Digitalis
_____ varies directly with changes in sales (revenue); directly involved in service to customers
Direct, Variable, Flexible costs Direct: (Cost of Goods sold) - costs associated with direct production of good/service - Labor, cost of goods & materials Variable: (changes with volume of sales) - china, uniforms, dishes, flatware, food Semi-variable: - portion remains fixes and a portion changes with sales volume - Wage, labor, utilities, maintenance
Blue dye:
Do NOT use blue dye to check tube placement. Use X-ray confirmation of tube tip location, or aspirate gastric contents
Organizational communication channels: From Department Head down through the ranks of workers (CHAIN OF COMMAND), use procedure manuals, policy statements.
Downward
Reactive or alimentary hypoglycemia is typically associated with?
Dumping syndrome - CHO digested/absorbed rapidly which stimulates overproduction of insulin
_____ is having high triglycerides and low HDL levels.
Dyslipidemia Hyperlipidemia - refers to high levels of LDL or triglycerides
_____ is the systematically reviewed scientific evidence used in making food and nutrition practice decisions; integrate best available evidence with professional expertise and client values to improve outcomes.
EAL
____ for 50% of population, used in planning meals for 'healthy people', assesses GROUP nutritional adequacy
EAR Estimated Average Requirement
____ is the average dietary intake predicted to maintain energy balance in a "healthy adult" of a defined age, gender, Wt, Ht, and level of physical activity consistent with good health.
EER Estimated Energy Requirements
Which program trains nutrition aids to educate the public and is focused on improving food practices of low income homemakers with young children?
EFNEP Expanded Food and Nutrition Education Program
A BUN > 100 mg/dl & Creatinine of 10-12 mg/dl may indicate ____.
ESRD (end stage renal disease) - May use Giovanetti diet: 20 grams protein (HBV) - Increase Kcals - Control edema, prevent deficiencies
____ refers to the degree to which an exchange helps to achieve your objectives (doing the right thing)
Effectiveness
____ refers to the minimization of resources you must spend to achieve that desired level of exchange (doing things right).
Efficiency
Sedative effect, wt gain, increased appetite:
Elavil (antidepressant)
Food iron is known as ?
Ferric iron
What type of formula should be selected for someone with Malabsorption or with compromised GI fxn?
Elemental (chemically defined) - pre-digested protein, MCT oils, glucose or sucrose, small fat, Vits, Mins, electrolytes - Absorbed in proximal intestine (duodenum) - LOW to NO residue - Don't need pancreatic enzymes - HIGH osmolality - Poor taste - Used with compromised GI fxn - Alitraq, Peptamen, Vivonex ¨Formulas with high osmolality may cause shift of water into intestinal space = rapid transit, diarrhea (Formula with a higher osmolality than that of normal body fluids produces an osmotic effect in the stomach and small intestine; this hyperosmolality draws water into the GI tract to dilute the concentration of the formula. An influx of water into the GI tract may cause diarrhea, nausea, cramping, and distention.)
Acute UC Treatment:
Elemental diet may be needed to minimize fecal volume
A healthy obese person has ____ LDL and ____ HDL.
Elevated LDL Normal to low HDL
____ same or similar output can be achieved by using different inputs or by varying the transformation process.
Equifinality
____ should be selected AFTER the menu is written.
Equipment
Anemia may be a result of renal disease and is due to decreased production of which hormone?
Erythropoietin (EPO) Other renal dz manifestations: - decreased activation of Vitamin D (kidneys produce active form which promote absorption of calcium by gut)
____ hormone is produced by kidney; stimulates bone marrow to produce RBC.
Erythropoietin EPO
Identifying the _____ leads to the selection of a nutrition intervention aimed at resolving the underlying "cause" of the nutrition problem when possible.
Etiology - If this is NOT possible: Nutrition intervention is targeted at "minimizing the symptoms" of the nutrition PROBLEM
PES: The cause/contributing risk factors are which section of the PES?
Etiology - "root cause" - linked to the problem by words "RELATED TO"
B.) Develop plan
Evaluate alternative strategies (cost/effective analysis): - All possible ways to solve the problem - Resources needed to do each alternative - Which alternatives the most 'feasible' - Who needs to be involved in choosing which way is best
Productivity management: _____ is used for measuring efficiency and providing data to enhance decision-making regarding resource allocation.
Evaluation tool
2.) Zero-based budget (ZBB)
Every fxn within an organization is organized for evaluation and starts at zero - NOT this year's expenses plus an inflation factor - Begin at 0 (must justify each expense) PPBS (Planning, Programming, Budgeting System) -for example - past dollar allocations are NOT the basis of projections *Planning oriented & time intensive
What occupations are EXEMPT from minimum wage and overtime requirements?
Executive, administrative, professional, outside salespersons
____ - belief that influencer has some relevant expertise that the subordinate does not; provides CREDIBILITY.
Expert power
The Summer Food Service Program (SFSP): is administered by who?
FNS (Food and Nutrition Service), state educational agencies, public or private nonprofit residential summer camps - SFSP provides meals or snacks to children at participating institutions in poor areas
Which organization/agency monitors internet, radio; bogus weight loss claims?
FTC Federal Trade Commission
True or False? A health exam is NOT required for WIC
False - Health exam is REQUIRED! Also: - Must meet income standards, be at nutritional risk, and in need of foods offered
Which macronutrient is the preferred fuel in cirrhosis>
Fat - Moderate to low fat - include Omega 3 - decrease LCTs if steatorrhea develops High Kcal High Protein
Healthy Eating Index: measures the 5 food groups, variety, and which 4 nutrients?
Fat Saturated fat Cholesterol Sodium * Variety
How many grams of CHO's, protein, fat, and total kcals are in 1 Fat-free or low fat (1%), reduced fat (2%), and whole milk exchange?
Fat-free, low fat (1%): CHO: 12 (48 kcals) Protein: 8 (32 kcals) Fat: 0-3 Kcals: 100 Reduced fat (2%): CHO: 12 Protein: 8 Fat: 5 Kcals: 120 Whole milk: CHO: 12 (48 kcals) Protein: 8 (32 kcals) Fat: 8 (80 kcals) Kcals: 160
Celiac disease can result in malabsorption which leads to loss of _____.
Fat-soluble vitamins - Macrocytic anemia, weight loss, diarhhea, steatorrhea, iron-def anemia
Renal filtration, absorption, excretion, secretion:
Filtration: RBC's, protein stay in blood Absorption: 100% Glucose, amino acids; 85% water, sodium, potassium Excretion: wastes, urea, excess ketones Secretes hormones that control - Blood Pressure, blood components; secretes ions that maintain acid-base balance
Oral contraceptives: can decrease absorption of what 3 Vits?
Folate, B6, vitamin C
Contribution margin (profitability)
Food cost - Selling price
Food cost per meal:
Food cost per month / # meals per month
____ is the most readily controlled item and is subject to the greatest fluctuation.
Food costs
_____ descriptions of approved products that an organization (or a department) would like ALL personnel (who need the product) to use.
Formularies - Volume DISCOUNTS can be obtained
Dehydration:
Fruits 80% water removed; vegetables 95% water removed
_____ addresses the 'WHOLE PERSON', not just symptoms, and looks at the underlying cause of disease, engaging patient and practitioner in a partnership for therapy.
Functional medicine
Urinary creatinine clearance measures ____ & ____.
GFR & renal function - estimate includes body surface (ht & wt)
Oral glucose-lowering medications: enhances insulin secretion, suppresses postprandial glucagon secretion
GLP-1 antagonist 1.) Exenatide (Byetta)
____ is due to missing enzyme that would have converted galactose-1-PO4 into glucose-1-PO4.
Galactosemia - treated solely by diet: Galactose and Lactose free - No organ meats, MSG extenders, milk, lactose, galactose, whey, casein, dry milk solids, curds, calcium or sodium caseinate, dates, bell peppers OKAY: soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG
Cholecystectomy is the surgical removal of ____; so ____ is now secreted from liver directly into intestine.
Gallbladder Bile
Dumping syndrome follows after what type of procedure?
Gastrectomy (Billroth I, II) - cramps, rapid pulse, weakness, perspiration, dizziness
_____ is delayed gastric emptying?
Gastroparesis Causes: surgery, diabetes, viral infections, obstructions *Moderate to severe HYPERglycemia may be present
____ records and reports transactions categorized by ACCOUNT NUMBERS.
General ledger - summary of all expenses and revenues for the month by category (meat, fruit, dairy)
_____ is the process that involves being aware of better health and actively working towards that goal. It includes physical health and well-being, mental and spiritual health.
General wellness assessment
Lactose intolerance: Normally lactase splits lactose into ____ & ____ monosaccharides.
Glucose & Galactose In lactase absence, lactose remains intact exerting hyperosmolar pressure. Water is drawn into the intestine to dilute the load causing distention, cramps, diarrhea.
Non-tropical sprue, Celiac disease, gluten-induced enteropathy: is caused by a reaction to ____.
Gluten Gliadin rxn - affects Jejunum and ileum (proximal intestine) - Gluten refers to "storage proteins" (Prolamins: Glutenin & Gliadin = wheat; Secalin = rye; Hordein = barley; Avenin = oats)
IBS (irritable bowel syndrome):
Goals: - adequate nutrient intake - tailor pattern to specific GI issues - avoid large meals, excess caffeine, alcohol, sugars - use food diary to track intake, emotions, environment, symptoms - identify food allergies and hypersensitivities
____ is the enlargement of thyroid gland due to insufficient thyroid hormone.
Goiter *Endemic goiter - inadequate IODINE intake - Diet: iodized salt; daily iodine intake of 150 mcg - Free of goitrogens: raw broccoli, soybeans, cauliflower, peanuts, cabbage, turnips, rapeseed (heating/cooking inactivate goitrogens)
_____ is the disorder of purine synthesis.
Gout - increased serum uric acid; deposit in joints causing pain, swelling Diet: - low purine may not be effective; may need weight reduction - Moderate Protein - Liberal CHO - Low to mod Fat - Liberal Fluid - Avoid high Purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel Meds: - urate eliminant, colchicine (induce loss of nutrients)
The YRBSS (Youth Risk Behavior Surveillance System) assesses the youth from grade levels ____ to ____.
Grades 9-12 - assesses smoking, alcohol abuse, weight control, exercise, and eating habits
PKU (phenylketonuria) is detected with what test?
Guthrie blood test
Pediatric HIV: cont..
HALS (HIV - associated lipidystrophy syndrome) may develop from therapy: - High Chol - High Triglycerides - Insulin resistance, changes in body fat distribution ** Significant loss of lean body mass can be obscured by edema and HALS
MCV (mean corpuscular volume) measurement is based on:
HCT / RBC 80-95 fL
Which lipoprotein "reverses" cholesterol transport and moves cholesterol from cell to liver and excretion
HDL (alpha)
Step 5: Survey categorizing a populations' "general health status" (used in worksites, government agencies as a health education or screening tool)
HRA Health Risk Appraisal - Questionnaire, calculations that predict risk of disease, educational message to the participant
What is an impaired fasting glucose and impaired glucose tolerance?
Impaired fasting glucose (FPG): 100-125 Impaired glucose tolerance: 2hPG 140-199
Which program helps children ages 3 to 5 to support school readiness?
Head Start (USDHHS) - introduces new foods, teaches good food habits - Child's participation in food activities is important
Which assessment performs telephone surveys of "randomly" selected adults; and tracks self-perception of relative nutrient intake levels, use of food labels, knowledge of fats and cholesterol, prevalence of supplement use, and awareness of diet and dz (*high BP & sodium intake)?
Health and Diet Survey
____ is the USDA's overall measure of diet quality.
Healthy Eating Index - measures how well Americans follow the Guidelines
Edema and dyspnea are associated with which cardiovascular dz?
Heart failure
Treatment of ulcers (gastro) typically involve the use of antacids and antibiotics to eradicate _____
Helicobacter pylori bacteria
Iron-containing pigment of red blood cells are known as?
Hemoglobin
MCHC (mean corpuscular hemoglobin conc) measurement is based on:
Hgb / HCT 32-36%
MCH (mean corpuscular hemoglobin) measurement is based on:
Hgb / RBC 27-32 pg
_____ is the protrusion of a portion of the stomach above the diaphragm into the chest.
Hiatal hernia
Diverticulosis MNT:
High fiber diet - because it's related to constipation and lifelong intra-colonic pressures
Constipation MNT:
High fluid High fiber diet Exercise
PLOWHORSE
High popularity Low profitability - Decrease potion size or increase price
STAR
High profit Highly popular - Promote item
PUZZLE
High profit Low popularity - Consider whether to keep menu item or changing selling price
_____ views mental, physical and spiritual aspects of life closely connected and equally important with regard to treatment approaches.
Holistic health
Organizational communication channels: Between departments (Nutrition & Nursing), or between production and service within the Nutrition Department
Horizontal
_____ replaces fat as fuel (in Kreb's), so fat accumulates in liver, leading to FATTY LIVER, and in blood, raising the TG level.
Hydrogen *Shift in NADH/NAD ratio inhibits beta-oxidation of fatty acids and promotes TG synthesis
Edema and surgery are associated with ____?
Hypoalbuminemia
HTN: Management/MNT Thiazide diuretics may induce ____?
Hypokalemia
Re-feeding syndrome results in ____, ____, ____.
Hypokalemia Hypophosphatemia Hypomagnesemia *Overfeeding PN & Dextrose > 5 mg/kg/min may lead to Hyperglycemia
Fever & infection
IV feedings of dextrose and water, then diet high in Kcals & Fluids - BMR increases 7% for each degree rise in F temp; normal temp 98.6' F
Step 2:
Identify "target population" and nutritional problem of concern
Disciplinary action/grievances:
If non-unionized: *Grievances settled informally by employee and supervisor If unionized: *The "contract" states a written formal grievance procedure
Vegetable blends: (incaparina, CSM)
Incaparina - MAIZE, SORGHUM, COTTONSEED FLOUR CSM - corn, soy, non-fat dry milk, vits, mins
_____ - measurement tool that monitors and evaluates important aspects of patient care and management fxns.
Indicators - Serve as flags to direct attention to specific issues. NOT intended to be direct measures of quality, but describes events, complications or outcomes. Based on standards of care - Threshold for evaluation (% number): level at which a stimulus is strong enough to signal need to respond; then begin process to determine why threshold was crossed
____ studies all aspects of job, done by worker and their supervisor.
Job analysis - Conducted FIRST to collect info for job description
____ reflects required skills and responsibilities. It matches applicants to job, orientation and training, employee appraisal.
Job description
____ - upgrades job by adding "motivating factors".
Job enrichment - increases # of tasks and control the employee has over the job - Maslow and Herzberg motivator (advanced training)
____ duties involved, conditions, qualifications (education, experience); written for each job.
Job specification - used in selection and placement of employees (HIRING) - Does NOT have detailed info as to "what to do" or "time involved"
____ "good change" suggests making continuous and small incremental improvements in process on a daily basis, rather than large revolutionary changes.
Kaizen philosophy Focuses on: - teamwork, discipline, improved morale, quality circles and suggestions for improvements
Epilepsy - seizures, altered consciousness
Ketogenic diet - high fat, low CHO, 4 grams fat: 1 gram non-fat - 90% kcals from fat, 1 gram/kg protein - Mild dehydration needed to prevent dilution of ketones - Calcium, Vit D, Folate, B6, B12 (supps needed) - MCTs
Which lipoprotein transports cholesterol from diet and liver to all cells?
LDL (beta) *Small dense LDL-C associated with increased risk, responsive to diet *Large buoyant LDL not associated with risk
What are normal/desirable levels for LDL-C, Total Cholesterol, HDL-C, TG according to NCEP?
LDL-C: <100 Total Cholesterol: < 200 HDL-C: < 40 (M) and < 50 (F) is Low; ≥ 60 high TG: <150 *High Homocysteine (Hcy) levels are independent risk factors for CHD
Taft Hartley Labor Act: Also known as the ____ & amended ____ Act.
Labor Management Relations Act 1947 - Amended Wagner Act Defined unfair union practices: - refusal of collective bargaining - requiring paying wages for services not performed a.) Balanced powers of labor and management b.) Outlawed the CLOSED SHOP; limited union shop to ONE year c.) Government can obtain injunction against strikes that endanger national health or safety d.) Specified *unfair labor practices of the union*
Lactose intolerance is detected by a ______.
Lactose tolerance test - oral dose of lactose (up to 50 grams) after a fast. If intolerant of lactose, blood glucose will INCREASE < 25 mg/dl above fasting (flat curve). If tolerant, the rise would be above 25 mg/dl (normal curve)
Standard treatment for ESLD:
Lactulose, Neomycin, oral Zn - Lactulose: reduces level of ammonia in body; hyperosmotic laxative that removes nitrogen - Neomycin: antibiotic that destroys bacterial flora that produce ammonia
Question: I think i had a question about HIPAA guidelines and how to document late entries:
Late entries should be identified as such; actual date, time of entry and the date and time it should have been recorded Other HIPAA: - permanent legal document written in black pen or typed - complete, clear, concise, objective, legible, accurate - sign, date all entries; entered at the time of actual procedure or service - when diet orders are not chosen correctly, contact the person who wrote order
____ use less human effort, less space, less capital and less time to make products exactly as the customer wants with few defects.
Lean method - use videotaping & stopwatches to capture work being done. Reorganize workflow, duties and practices - Reduce food costs, increase efficiency and customer satisfaction
Lean protein: Medium-fat: High fat:
Lean protein: Pro 7 Fat 2 Kcal 45 Medium-fat: Pro 7 Fat 5 Kcal 75 High fat: Pro 7 Fat 8 Kcal 100
Fiber is found in?
Legumes, fruits and vegetables, wheat bran, whole grains - provides indigestible bulk, promotes intestinal fxn Dietary fiber: nondigestible CHOs and lignin, binds water
Fresh fish should arrive at
Less than or equal to 41 F
Maple syrup urine disease (MSUD) is the inborn error of metabolism of the BCAAs ___, ___, ___.
Leucine Isoleucine Valine - Poor suckling reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of sweat & urine
The NSI has two Levels of screening: which screening level provides more specific diagnostic info on "nutritional status" ?
Level II
Which organ stores and releases blood, filters toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance?
Liver
Esophageal varices occur when blood can't enter the ____.
Liver - increased pressure forces blood back into collateral veins *Low Fiber if varices present
ALP levels are increased in ____ & ____. ALP levels are decreased in ____ & _____.
Liver disease & Bone disease Scurvy & malnutrition ALT, SGPT = Increased with Liver dz
Which type of planning requires a mission statement?
Long range planning - requires a mission statement of long range vision
____ - exchange of ownership: producer, processor, distributor, supplier, customer.
Marketing Channel
Fair Labor Standards Act 1938:
May be called Minimum Wage or Wage Hour Law; sets minimum wage - For overtime work (over 40 hrs/1 week) must pay TIME and ONE-HALF Minimum wage - listed at Bureau of Labor Standards Amendment - Equal Pay Act 1963 (prohibits discrimination on basis of sex) Donated (tolerated) time - compensable - must be paid Child labor laws regulate work hours and duties of children - in FS, students can handle and clean cutters and slicers only if enrolled in food-related programs
____ is a measure of productivity defined as the amount of all food sales divided by the average cost of a typical (prototype) meal
Meal equivalent
A B12 deficiency in Crohn's disease leads to _____.
Megaloblastic anemia - iron deficiency anemia is due to blood loss, decreased absorption
What is the normal hemoglobin (Hgb) range for men & women?
Men: 14-17 gm/dl Women: 12-15 gm/dl Pregnant: greater than/equal to 11
Hct percent range for men & women is?
Men: 42-52% Women: 37-47% Pregnant: 33% Newborn: 44-64%
What is considered an abnormal waist circumference for men & women?
Men: >40 Women: >35 - is independent risk factor for disease when out of proportion to total body fat (with BMI of 25-34.9) - Best measurement for "risk" - Predicts central adiposity
The ____ determines equipment, food, space, personnel needed.
Menu - Menu types are determined by facility's food & dining concept
____ focuses on both the popularity and the contribution to profit of the items. The model segments items into one of four categories, based on its popularity relative to other items (the menu mix), and its contribution to profit. (contribution margin).
Menu engineering
____ is the most important factor when considering food costs.
Menu planning
Homocystinurias: is a treatable inherited disorder of amino acid metabolism characterized by severe elevations of ___ & ____ in plasma and excessive excretion of ____ in urine.
Methionine & Homocysteine Homocystine
A CHI (creatinine height index) of 60-80% indicates?
Mild muscle depletion
Dysphagia Mechanically Altered: NDD2
Mild to moderate Honey-thickness - Moist, soft-textured, easily formed into a bolus; moist, tender ground or diced meats, soft cooked vegetables, soft or canned fruits. Soft PANCAKE okay No: bread, rice, cheese cubes
Foods with low glycemic index:
Milk, whole grains, fruits, vegetables, legumes * Use of index as a method for weight loss or weight maintenance is NOT currently recommended
SG Sleeve gastrectomy
Monitor levels: Iron, Calcium, Vit D
Disease rate is known as ____.
Morbidity
AIDS: cont..
NRTI drugs (Retrovir, Zidovudine) - can lead to anemia, loss of appetite, low Vit B12, Copper, Zinc, Carnitine - Follow universal precautions: need not wear gloves, gown, masks not required with general care unless otherwise indicated - Nutr supplementation should NOT be routinely recommended - Use of Vitamin C or St. Johns Wort could cause drug resistance
This system is used to promote nutrition and improve nutritional care for the elderly to identify nutritional problems early:
NSI Nutrition Screening Initiative
This system uses the DETERMINE checklist?
NSI Nutrition Screening Initiative (elderly) - DETERMINE checklist: identifies factors placing people at nutritional risk Disease. Eating Poorly. Tooth Loss/Mouth Pain. Economic Hardship. Reduced Social Contact. Multiple Medicines. Involuntary Weight Loss/Gain. Needs Assistance in Self- Care. Elder years above age 80
Drug or Nutrient and Effect:
Name the drug or nutrient associated with its effect or vice versa.
How do you calculate Labor turnover rate?
Number of employees (separated) terminated & replaced / total positions in department
Meals per labor hour:
Number of meals produced / Number of hours worked
______ is the identification and labeling that describes an actual occurrence, risk of, or potential for, developing a nutritional problem that dietetics professionals are responsible for treating "independently",
Nutrition Diagnosis - Changes as the patient's RESPONSE changes
Monitoring and Evaluation: ____ compare findings with goals or standards. It determines the degree to which progress is being made, and outcomes are being met. .
Nutrition Evaluation
Monitoring and Evaluation: ____ review or measurement of a nutrition care INDICATOR.
Nutrition Monitoring
What additional services does WIC provide to those eligible other than food?
Nutrition education, referrals to other agencies
_____ are purposely planned actions designed with the intent of changing a behavior, risk factor or condition, for an individual, group or community.
Nutrition intervention - influence the etiology or effects of a diagnosis - It is based on the nutr DIAGNOSIS and provides the bases upon which outcomes are measured and evaluated.
This type of screening is the examination of a population group at a particular point in time:
Nutrition survey
Which system determines "prevalence" of condition or characteristic at a specific time
Nutrition survey
Which system is considered a cross-sectional exam and pin-points problems?
Nutrition survey
This system is a continuous collection of data and identifies problem, sets baseline, sets priorities, detects changes in trends:
Nutritional surveillance
What system uses height, weight, hemoglobin, and serum cholesterol level?
Nutritional surveillance
Which system is an on-going system that is liked to active health programs such as WIC, CDC, and EPSDT (Early Periodic Screening, Diagnosis, Treatment)
Nutritional surveillance
Which system's data identifies needs and kind of intervention needed?
Nutritional surveillance
NSIP (Nutrition Services Incentive Program) is supported by the ____, Title ____.
OAA (Older Americans Act) Title III - Administration on aging agent grant and commodity programs to states to support nutrition services (Nutr education, counseling, social interactions) for older Americans. - Includes congregate (ambulatory) meals and home-delivered (homebound) meals. Meals on Wheels. - developed services to foster independent living; cash and commodities to state agencies
What types of numbers should be posted regarding Emergency preparedness?
OSHA & HAZMAT
____ serve as motivators, provide direction.
Objectives - predetermined
Healthy People 2020 - National Health Program and Disease Prevention
Objectives - DHHS, national health agenda for the current decade 1.) identified broad goals and specific objectives for improving health 2.) focuses on 'disease prevention' by changing behaviors 3.) targets healthy diet & healthy weight as CRITICAL GOALS 4.) 2020 goals address nutrition & weight, physical activity, heart disease & stroke, diabetes, oral health, cancer, food safety, and health for seniors
Nutrition Assessment of populations and community needs:
Obtain and assess community and group nutrition status indicators: Steps are next
Health care outcomes -
Of interest to health care providers, and PAYERS. a.) Health and disease outcomes - reduced readmissions, changes in severity, changes in risk level, health maintenance b.) Cost outcomes - changes in length of stay, ICU days, # of outpatient visits, medications, etc c.) Patient-centered outcomes - changes in indicators that reflect functional level, disability, *quality of life
Enteral access: The hang time for open systems is ____ hours and the hang time for closed systems is ___ to ___ hrs.
Open systems: 4 hours (infant formula); 12 hours (home adult) - "ready to feed" - Increased contamination risk Closed systems: 24-48 hrs - "ready to hang"
Decreased fat absorption by binding lipase; vitamin/mineral supp.
Orlistat - inhibits lipase fxn - used in overweight people who may also have high blood pressure, diabetes, high cholesterol, or heart disease
____ reabsorb and remove bone; ____ reform bone.
Osteoclasts - resorb and remove bone Osteoblasts - reform bone
____ also known as adult rickets and is caused by a ____ deficiency.
Osteomalacia Vitamin D - reduction in bone density (demineralization) - Vit D/Calcium supplements
Determine the problem, etiology, and sign/symptom in the following PES statement: Overweight related to intake of high fat foods resulting in more than 300 extra calories per day as evidenced by a BMI of 30.
Overweight (Problem) related to intake of high fat foods (etiology) resulting in more than 300 extra calories per day as evidenced by a BMI of 30 (sign/symptom).
Seventh Day Adventist
Ovo-lacto-vegetarian - no caffeine, tea, alcohol - no drinking water during meals
During inflammation the liver synthesizes CRP at expense of ____.
PAB
When elevated CRP decreases, ____ increases.
PAB -- As CRP decreases it indicates when nutr-therapy would be beneficial
Roles: 2.) Decision-making/problem-solving:
Pareto analysis - illustrates the relative importance of problems (Most effects have relatively few causes) 1.) Work on problem that is the biggest or occurs most frequently -- Correcting the "vital few" problems will have the GREATEST IMPACT ON QUALITY 2.) 80-20 rule: = 80% of a given outcome results from 20% of an input (80% of sales come from 20% of customers)
Intensive Behavioral Therapy (IBT) benefit in Medicare Part _____. Coverage is granted only in "primary care setting", BMI must be _____, continued treatment contingent on weight loss assessed at the _____ month of treatment. Can only be provided by a physician.
Part B >30 BMI Seventh month
_____ summarizes program activities performed in terms of the cost of specified accomplishments.
Performance budget
Decreased - folic acid, - vitamins B12, D, K, B6
Phenobarbital - used to control seizures. Phenobarbital is also used to relieve anxiety.
PKU (phenylketonuria) is due to the missing enzyme _____ which would convert phenyalanine into tyrosine; so the phenyalanine and metabolites accumulate leading to poor intellectual function.
Phenylalanine hydroxylase
Esophageal varices is due to _____.
Portal HTN
____ - subordinate acknowledges that the influencer has the right to exert influence due to position (job title)
Position (legitimate) power
During Re-feeding syndrome, starved cells take up nutrients ____ & ____ which shift into intracellular compartments.
Potassium & Phosphorus
____ - ability to exert influence
Power 5 types: 1.) Reward power 2.) Coercive power 3.) Position (legitimate) power 4.) Expert power 5.) Referent power
_____ are very common with spinal cord injuries because patients are immobile.
Pressure ulcers * 30-40 kcal/kg * 1.2-1.5 g/kg Protein (Stage 1 & 2) * 1.5-2.0 g/kg (Stages III, IV) * Normal Ca intake, adequate fluids * Vitamin C supps (500-1000 mgs with Stage III or IV, or if deficient) * Zinc (15 mg with Stages III, IV for 2-3 weeks) * Daily dietary sources of Vitamin A (skin)
Total number of people with a disease during a period of time is known as ____.
Prevalence Total # with disease / ave # of people x 100,000
Early screening for risk factors like diabetes is an example of what type of wellness promotion and risk reduction?
Primary prevention - '"Health promotion" - reduced exposure to a promoter of disease
_____ are sources of bacteria used to reestablish bacterial gut flora
Probiotics
PES: The diagnostic label falls under which section of the PES?
Problem - adjective that describes the human response (altered, impaired, increased, risk of)
____ is the chronological sequence of activities, specific guide for daily operations (how to run dish-machine)
Procedures
____ - first functional subsystem, function of acquiring material for production.
Procurement
____ is the efficiency with which a production or service activity converts inputs into outputs, expressed as ratios.
Productivity a.) Inputs b.) Outputs c.) Labor minutes worked per day, trays per minute, consults per labor hour
_____ shows operating results over a period of time.
Profit and loss statement (income statement) - presents the income (revenue), expenses and profit (or loss or break-even) over the course of the budget period *Also known as the Revenue and expense statement
_____ is the most commonly used assessment of overall financial "efficiency".
Profit margin - reflects the portion of sales volume REMAINING after paying all expenses Net profit (profit after ALL expenses have been paid) / Sales dollars (revenue) (x 100 ??)
Erythromycin & Metoclopramide are types of _____ that are used with gastroparesis to increase stomach contractility.
Prokinetics
Seniority is used for -
Promotion, schedules, layoffs
Administered in oil, consider fat calories, 1.1 cals/cc, check TG
Propofol - makes up fat calories so consider when calculating fat intake for PN/TPN calculations
PN solutions:
Protein ratio for Anabolism: 1 g Nitrogen/150 calories; 1-1.5 g protein/kg/day. Catabolism: 1.2-2.0 g/kg - Crystalline AAs: 3-15% solution % = number of grams of protein in 100 mls of solution (3% solution has 3 g AA / 100 ml) Energy: 35-50 kcals/kg; up to a 70% dextrose solution - 10% solution provides 100g CHO/liter - Max dextrose infusion rate: 4 to 5 mg/kg/minute to prevent hyperglycemia/other complications (excess Dex increases RQ in *ventilated patients & increases infectious complications) Fat: - needed for energy and to prevent EFAD (essential fatty acid deficiency) - To prevent EFAD: give 500cc of 10% fat emulsion 1-2x/week or 500 mL of 20% intralipids - Petechiae (red spots) is a symptom of EFAD - Vits, electrolytes (lower that DRI since they are directly infused), water as needed - Monitor: Chromium & Manganese TNA (total nutrient admixures) (three in one systems) include dextrose, AA, lipids
USDA Nationwide Food Consumption Surveys (NFCS) evaluates which 7 nutrients?
Protein, Calcium, Iron, Thiamin, Riboflavin, Vitamin C, Vitamin A
Nutrition care outcomes -
Prove the value of our intervention - Can be linked to nutrition intervention goals - Distinct from health care outcomes bc they represent the nutrition professional's specific contribution to care (outcomes we measure) -- Food/nutrition related history, Lab data and medical tests, Anthropometrics, Nutrition-focused physical findings
Best use of an employee evaluation is to improve their performance by ____.
Providing feedback
Which component of the renal system is responsible for major nutrient reabsorption?
Proximal convoluted tubule
____ - completed by the buyer, "written record" of items ordered and quantities needed. *First control in "receiving" process *Compare invoice against Purchase Order first, then items against invoice
Purchase order a.) Standing orders - eliminate the need to call in daily or weekly orders b.) FOB (free-on-board) - products delivered with all transport charges paid c.) FOB origin - buyer takes ownership at seller's location
____ hormone is a vasoconstrictor and is secreted by glomerulus when blood volume DECREASES.
Renin
Review ebb and flow response to injury: - hypermetabolic, catabolic response following trauma (accelerated catabolism of lean body mass leading to negative Nitrogen balance as protein is catabolized to release glucose for energy) Ebb phase - hypovolemia, shock, tissue hypoxia Flow phase: - follows fluid resuscitation & return of O2 transport
Results of physiologic trauma: - hyperglycemia - hyperinsulinemia - little or no ketosis - increased glucagon Epinephrine, Norepinephrine - hepatic "glycogenolysis" (glycogen to glucose) ACTH (pituitary) - releases Cortisol (adrenal) which mobilizes AA's from muscle Aldosterone - renal sodium retention, "gluconeogenesis" ADH (vasopressin) - renal water reabsorption; made by hypothalamus & stored in posterior pituitary; BP control - Hypovolemia, decreased cardiac output, drop in body temp - Hyperglycemia: Epinephrine suppresses insulin - Fluid & sodium retention, potassium excretion, loss of Nitrogen, Sulfur, Zinc, Phosphorus *Provide adequate but not excessive Kcals @ RMR, 1.5-2.0 g Pro, Provide anabolic electrolytes, Zn
Profit margin: cont
Revenue - includes income from patients, cafe sales, and catering sales Cost of sales - cost of the raw food and beverage sold Gross profit - profit shown after deducting raw food and beverage (cost of sales) from sales (revenue) Net profit - profit shown after ALL expenses have been deducted from sales... Sales - Expenses = Net Profit Refer to example on Inman**
Stomatitis (inflammation of mouth) is associated with ____ deficiency.
Riboflavin - rinse with lukewarm water after meals
Oral glucose-lowering medications: Target blood glucose-lowering action in kidneys, by blocking a protein that returns glucose to the blood after it is filtered through the kidney
SGLT-2 inhibitors 1.) Canagliflozin (Invokana) 2.) Dapagliflozin (Farxiga) 3.) Empagliflozin (Jardiance)
"Risk reduction" is an example of what type of wellness promotion and risk reduction?
Secondary prevention - recruiting those with elevated risk factors into treatment program (setting up an employee gym)
Reduced secretion of which two hormones occurs after a gastrojejunostomy?
Secretin Pancreozymin - these hormones normally stimulate the pancreas, so there is now little pancreatic secretion. - duodenum is bypassed so it doesn't secrete as much
BEE x 1.2 is used for what activity level?
Sedentary x 1.3 (Active) x 1.5 (Stressed)
A _____ menu reduces waste and cost.
Selective menu (type of service) Other factors influencing Food cost: Group buying (purchasing methods) - also reduces costs Receiving control - weigh in and check items against invoice Storage and production control Standardized portions: control costs; keep records of employee meals
____ both a fixed and variable component
Semi-variable costs - A portion of the cost will remain fixed regardless of changes in sales volume - labor, maintenance, utilities - These are divided into fixed and variable components before doing BREAK-EVEN analysis
What serum lab value is responsible for maintaining colloidal osmotic pressure?
Serum Albumin (visceral protein) 3.5-5.0 g/dl
Oat bran & Soluble fibers decrease _____ by binding bile acids converting more cholesterol into bile.
Serum Cholesterol
What serum lab value is related to muscle mass and also measures somatic protein?
Serum Creatinine
What serum lab value indicates the size of iron storage pool?
Serum Ferritin Transferrin level is controlled by iron storage pool
What serum lab value rises when someone is deficient in iron?
Serum Transferrin (visceral protein) >200 mg/dl normal - Transports iron to bone marrow - typically used to diagnose anemia
What serum lab value may indicate renal disease and/or muscle wastage?
Serum creatinine
Step 3:
Set parameters of the assessment, collect data, organize and interpret data. Share findings and set priorities
Signs/Symptoms: The signs are what type of data? The symptoms are what type of data?
Signs: objective data - observable changes Symptoms: subjective data - changes the patient expresses - "as evidenced by"
Short bowel syndrome (SBS): consequences associated with significant resections of the _____.
Small intestine - Malabsorption, malnutrition, fluid & electrolyte imbalances, weight loss
CKD: GFR Stages
Stage 1: GFR ≥ 90 Stage 2: GFR 60-89 Stage 3: GFR 30-59 Stage 4: GFR 15-29 *Stages 3 & 4 (Phosphorus 800-1000 mg/day or 10-12 mg/g protein)
What type of formula should be selected for someone with normal GI fxn?
Standard polymeric - most provide 1-1.5 kcals/cc - Lecithin may be added as emulsifier - Initiated FULL STRENGTH at rate of 10-40 ml/hr - Modular: mix individual components, adds flexibility; individual macronutrients used to increase Kcal, Pro or fats in a standard formula - Blenderized: whole food, large bore tube, thick intact protein, HIGH residue - LEAST EXPENSIVE formulas: intact protein (NOT pre-digested), and ISOTONIC (osmolality is close to that of blood)
Disciplinary action: Steps
Steps taken to correct undesirable behavior 1.) Oral warning - discuss nature, cause, corrective actions; TEMPORARY in record 2.) Written warning - repeat violation or as first action if warranted; PERMANENT in employee record 3.) Suspension - forced leave of absence WITHOUT pay; permanent record 4.) Dismissal
____ benefits for life and health insurance.
Supplementary
_____ implements School Meals Initiatives for Healthy Children.
Team Nutrition - motivate child to make healthy choices; helps schools meet Guidelines - Provides recipes, training, support
Dry storage temp & humidity:
Temp: 50-70 F Humidity 50-60% Fresh fruits/veggies: 85-90% (highest humidity)
Deficiency of which vitamin causes Wernicke-Korsakoff syndrome?
Thiamin - Confusion and loss of mental activity that can progress to coma and death. - Loss of muscle coordination (ataxia) that can cause leg tremor. - Vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping. - Alcohol withdrawal.
Which vit/min should be evaluated with Heart failure?
Thiamin - loss with "Loop diuretics" - without thiamin, pyruvate cannot be converted into acetyl CoA for energy
Alcohol interferes with absorption of which vits/mins (4)
Thiamin B12 Vitamin C Folic acid
Oral glucose-lowering medications: Improves peripheral insulin sensitivity
Thiazolidinediones (TZD) 1.) Actos
SNAP figures are adjusted to reflect cost of food in ______ and this the LEAST COSTLY of USDA four food plans
Thrifty Food Plan for June of preceding year
Maternal and Child Health Block Grant (USDHHS) is under Title ____ of the _____
Title V Social Security Act - fosters public health nutrition programs at the state and local levels; provides training, consultation, and funding - Programs for maternal/women's health, children with special health care needs, perinatal, infant and child health. - State eligibility requirements
Hair analysis is useful for measuring intake of ____.
Toxic metals - NOT FOR NUTRITIONAL ASSESSMENT
Dysphagia Advanced: NDD3
Transition to regular Nectar-thickness; Magic cup Avoid: very hard, sticky, crunchy foods, hard fruit and raw vegetables, nuts, seeds, dry bread and cereals
True or False? A long half-life does NOT reflect current protein intake?
True
____ taken with MAOI will cause HTN.
Tyramine - When MAOI interact they release "norepinephrine" which elevates BP - Tyramine is an amino acid that helps regulate blood pressure. It occurs naturally in the body, and it's found in certain foods. Medications called monoamine oxidase inhibitors (MAOIs) block monoamine oxidase, which is an enzyme that breaks down excess tyramine in the body.
NSLP (National School Lunch Program): is part of the USDA ____
USDA Food and Nutrition Service (FNS)
What survey/surveillance obtains info on food intake of individuals and total households from the entire US?
USDA Nationwide Food Consumption Surveys (NFCS)
OTC (Ornithine transcarbamylase) deficiency occurs when there is a defect in the ____.
Urea cycle - unable to synthesize urea from ammonia resulting in ammonia accumulation - vomiting, lethargy, seizures, coma, anorexia, irritability Diet: - Protein restriction (based on tolerance, age, projected growth rate) to lower ammonia; *therapeutic formulas to adjust protein composition to limit ammonia production
Social marketing
Use of marketing principles to advance a social cause, idea or behavior *Use of "Market Mix" principles (Product, Place, Price, Promotion) designed to influence behavior change to improve societal welfare. Aims to encourage: Cognitive change: - increase awareness of program/product ex.) reading a poster that promotes SNAP Action change: - investment of money, time, energy to make a change ex.) A person pays to speak with a RD about weight loss Behavior change: - continual process of adopting healthy habits ex.) Choosing a diet rich in whole grains Value change: - to persuade communities into choosing one option over another in order to create change for the greater good ex.) Persuade families to have less children for better population control
Budget - food is ____ expense; largest percent spent on meat, fish, poultry.
Variable
Alcohol (1 equivalent): Free foods:
Varies 100 kcals Free foods: < 20 kcals & < 5 g CHO per serving
Hormones involved with Renal fxn: Which hormone is secreted from the hypothalamus and stored in the pituitary?
Vasopressin (ADH) - Increases BP - Increases water reabsorption
Tube bore (opening) is based on the ____ of feeding.
Viscosity Large #16 - blenderized whole foods Small #8 - ready prepared formulas, more comfortable
Cystic fibrosis: Supplement water-soluble forms of fat-soluble vitamins ___ & ___.
Vitamin A Vitamin E
NFPE: Eyes- pale, dry, poor vision may be indicative of what three deficiencies?
Vitamin A Zinc or Riboflavin
Decreased effectiveness of L-dopa which controls symptoms of Parkinson's disease (take drug in morning with limited protein)
Vitamin B6 and protein
NFPE: Gums - sore, red, swollen, bleeding may be indicative of what deficiency?
Vitamin C
A multivitamin containing B complex, ____, ____, ____ is recommended for Acute viral hepatitis.
Vitamin C Vitamin K Zinc
Isoniazid also interferes with which three vit/min?
Vitamin D, Calcium, Phosphorus - don't take with food
NFPE: Tongue - smooth, slick, purple, white coating may be indicative of what?
Vitamin or iron deficiencies Pale tongue - Iron
National Labor Relations Act: is now known as the ____.
Wagner Act 1935 a.) Guaranteed right to organize and join labor unions b.) Gave union the right to be the bargaining agent c.) Created the National Labor Relations Board NLRB - Listens to claims of "unfair labor practice"
What anthropometric measurement differentiates between Android (apple shape - men) and Gynoid (pear shaped - women) obesity?
Waist / Hip Ratio (WHR)
CRP (C-reactive protein) is a marker of ____.
acute inflammatory stress
Calorie reduction strategies:
a.) 1200-1500 kcals/day (W) & 1500-1800 (M) b.) Energy deficit of 500 to 750 kcals/day c.) Restricting high fat/high CHO foods d.) Changes in sugar sweetened beverages can assist in wt management e.) Meal replacement for weight loss & those who struggle with portion control
Managerial attributes that distinguish successful organizations from others:
a.) Have a bias for action - FIX IT, DO IT, SOLVE IT b.) Be close to your customers - learn from them c.) autonomy - be a risk taker; try new ways to get the job done d.) Productivity through people; treat with respect and dignity e.) Management should be hands on and value driven: explain your value system to your employees
Roles: 1.) Informational
a.) Monitor role - constantly searching for info to make the organization more effective b.) Disseminator - transmits info to subordinates c.) Spokesman (interpersonal?) - transmits info to people inside & outside - acts as a figurehead for the organization
Purchasing department: a.) Profit center b.) Cost center
a.) Profit center - assigned both expense and revenue responsibilities (cafe) b.) Cost center - manage expenses, but do not generate revenue (patient)
Roles: 2.) Decision-making/problem-solving:
a.) Steps: - Recognize and analyze problem - determine workable solutions - gather data - choose solutions - take action - follow-up the action
WIC also provides food for low-income mothers at nutritional risk which includes those with?
abnormal weight gain, history of high risk, LBW, underweight, overweight, *anemia
The distal tubule controls ___?
acid-base balance
Implementation:
action phase involves communication of the care plan and carrying out the plan
Oliguria (< 500 ml urine) and azotemia (increased urea in blood) are symptoms of ____.
acute kidney injury, acute renal failure Due to: burns, accident, obstruction, severe dehydration
D.) Implementation: requires
administrative support, realistic budget, staff commitment, support of target population 1.) Educate - increase awareness, knowledge, options (cognitive learning) - To reach large numbers: use media, hotlines, *point-of choice or point of purchase (POP) intervention - In health fairs: evaluate Nutr risk using BMI 2.) Enable - Reduce barriers that make it easier for people to act - enabling interventions relate to the 4 "P's" of marketing - Product (should be acceptable), Place (should be accessible), Price (reasonable), Promotion (tailored to enable attention and acceptance) 3.) Skill development - Competencies necessary to make & sustain new eating habits (psychomotor learning) - one on one counseling, small group sessions, school fitness programs, worksite cafe programs - Teaches how to: select appropriate foods, budget for healthful foods, how to obtain Food Stamps if needed, how to develop new eating behaviors
What types of medication prolong PT (prothrombin time)?
anticoagulants
Megestrol acetate has what effect?
appetite stimulant
Marinol has what effect?
appetite stimulant - It can treat or prevent nausea and vomiting caused by cancer medications when other medications do not work. It can also increase the appetite of people with AIDS.
Which two fruit juices have a high osmolar load and need to be restricted or diluted for chronic nonspecific infantile diarrhea?
apple, grape
Cerebral palsy: Non-spastic form
athetoid form - involuntary wormlike movement, constant irregular motions leading to WT LOSS - High Kcal - High Protein - Finger foods
_____ is the loss of elasticity of blood vessel walls.
arteriosclerosis
Roles: 2.) Decision-making/problem-solving:
b.) Nominal group technique - Delbecq (generate innovative, creative ideas) - More structured/controlled than brainstorming - Authoritative leader - responses strictly controlled by leader - often sit in horseshoe formation (silent generation of ideas by participants) - Round Robin reporting (leader records ideas) - Group RANKS items in priority order; vote for final decision
HIPAA guidelines: Corrections "omitted information"
beside original entry: "see addendum", enter date, initial. Write the addendum in chart sequence, identify it as an addendum and reference the original entry. SIGN.
Acute Crohn's flare-ups Treatment:
bowel rest, PN nutrition or minimal residue
Socioeconomic stratification includes what types of assessment information?
census data housing statistics
HIPAA guidelines: Corrections "performed some time after entry':
correct minor errors (spelling one word) with single line drawn through, make corrections, date, TIME, SIGN.
Roles: 2.) Decision-making/problem-solving
d.) Cause and effect (fish) diagram - what influences the outcome? 1.) focuses on different causes of a problem; categorizes related factors to make their influence more observable 2.) what are the causes of the effects (results) you are seeking? 3.) series of "connected arrows", each representing an important factor 4.) used to increase WORKER INVOLVEMENT in decision-making 5.) Look at example page 146
Freeze-drying
frozen first, then water is evaporated without melting crystals (SUBLIMATION)
Increased appetite, wt gain, maintain constant sodium and caffeine intake to stabilize levels
lithium carbonate (antidepressant)
Foods high in iron:
liver, kidney, beef, dried fruits, dried peas and beans, nuts, leafy green veggies, fortified whole grain products
Fair Employment Practice Law: (adopted by states)
makes it illegal to ask about a candidates race, religion, sex, national origin, age, marital status (after hire, can ask) - Check the personnel department regarding restrictions
Chemotherapy:
malabsorption
Decrease folate:
methotrexate - Chemotherapy and Immunosuppressive drug It can treat cancer of the blood, bone, lung, breast, head, and neck. It can also treat rheumatoid arthritis and psoriasis. Colon cancer & folate def?
Federal/State: Food & nutrition assistance programs
questions to follow: Name the associated program
What is an example of Functional balance?
swallowing difficulty, altered GI fxn
Crohn's disease affects which part of the small intestine?
terminal ileum