Inman Review ALL

Payment by 3rd party for service rendered by healthcare provider to patient (Bluecross, Medicare)

3rd Party Reimbursement

-Found in women with lack of prenatal care, poor diets, poor protein and Ca intake -Proposed association of PIH and Ca deficiency

@ Risk for PIH

Virus debilitates immune system by attacking lymphocytes Symptoms: diarrhea, malabsorption, nausea, vomiting, wt loss

AIDS

GOALS: preserve LBM, prevent wt loss, prevent HIV wasting Energy: BEE x 1.3 (asymptomatic) Protein: 0.8g/kg (no symptoms) 1.2- 2 g/kg ( wasted LBM) MVI to correct deficiency Low bacteria (neutropenic) Diet --> AVOID raw foods

AIDS Nutrition

Acute Respiratory Distress Syndrome -Lungs no longer able to exchange gases, hyper metabolism, high energy needs, severely underweight

ARDS

-Provide adequate but not excessive kcal -Avoid excess non-protein kcal -Provide EN containing EPA + GLA + increase levels of antioxidant vitamins -1.5-2 g/kg pro ( maintain LBM)

ARDS Nutrition

Genetic predisposition to produce an increase IgE in response to allergen

Atopy

Where total cost line crosses the revenue (sales) line; BE increases when cost increases

BE (break even) point graph

occasions loyalty

Behavioristic variables

Gastroduodenostomy

Billroth I

Gastrojejunostomy -Food bypasses duodenum - decrease in pancreatic secretion ( secretion of secretin + pancreozymin decrease) -Ca + Fe abs decreases

Billroth II

BE= the number/amount of money you need to break even BE= FC (fixed costs) / 1 - (vc/sales) vc= variable costs

Break even (BE) point equation (sales)

BE= Total FC (fixed costs) / selling price - variable costs (vc) BE= # average meals sold

Break even (BE) point equations (meals)

Saturated Fatty Acids (SFA), Monounsaturated Fatty Acids (MUFA), Polyunsaturated Fatty Acids (PUFA)

Butter FA Types

Blood test to identify children with milk, egg, fish, peanut allergy

CAP-FEIA

Symptoms: wt loss, emaciation, anorexia Persistent obstruction of air flow

COPD

- Maintain stable weight -Replete but do not overfeed -High kcal and pro (1-1.4 g/kg (15-20% kcals) -30- 45% fat (oxidation of fat consumes less O2 than Ox. or CHO) -40-50% CHO -Small, frequent, mini meals and snacks, easy to prepare and eat, nutrient dense supplements i.e. smoothies, meatloaf, muffins w/cream cheese, tuna salad, cereal w/ fruit

COPD Nutrition

AKA non-tropical sprue + gluten-induced enteropathy -Rxn to gliadin

Celiac Disease

-Excess mucus production -Chronic productive cough

Chronic bronchitis

Hydrogens on the same side of the double bond; Examples: most natural fats and oils

Cis Fat

Simple fat and other component; phospholipid

Compound Fat

Food Safety (low bacteria neutropenic diet); avoid raw foods Banana lower risk than apple

Educate AIDS pts on ________

Type of COPD -Air sacs (alveoli) lose elasticity -Difficulty exhaling -Air pocket walls expand, thin out, collapse Pt = thin, cachetic, often older

Emphysema

-AICA markup method 100 / food cost % = markup factor Markup factor x raw food cost = selling price -HIDDEN cost of 10% may be added to food cost to cover unproductive costs (losses in preparation, cooking, & serving)

Factor Pricing Method

Triglycerides (3 fatty acids + glycerol); most dietary fat are triglycerides

Fat Chemical Elements

Energy, insulation, padding, depresses gastric secretion so delays emptying; has less oxygen and more carbon than CHOs so provides more energy (more carbon atoms for oxidation)

Fat Functions

-Provides indigestible bulk -Promotes intestinal function

Fiber

Change in count

Flexible budget

Most readily controlled item subject to greatest fluctuation

Food costs

Public health departments derive a portion of their income from general revenue (taxes) and federal, local, or foundation grants

Funding

Eat small, low fat meals, liquids empty more rapidly AVOID: -eating before bed -soda -caffeine -acidic foods

GERD Diet

Inflammation of the stomach. Symptoms: Anorexia, N/V/D

Gastritis

Clear liquids advance as tolerated; avoid gastric irritants

Gastritis Diet

SOP: diabetes care, oncology, nutrition support (knowledge) SOPP: Application of research, communication and application of knowledge, quality in practice (behavior)

SOP vs SOPP

All available bonds of carbon chain are filled with hydrogen; solid and hard at room temperature

Saturated Fatty Acids (SFA)

Coconut oil, palm kernel, cocoa butter, butter, beef tallow, and palm oil

Saturated Fatty Acids (SFA) Examples

both a fixed and variable componenet labor, maintenance, utilities

Semi-variable costs

Some lecture plus interaction, beneficial in clinical setting, 3-5 people with similar needs

Small Group

HHS; youth risk behavior survey -Grades 9-12 -Smoking, alcohol use, wt control, exercise, eating habits

YRBS

identify a need that is not being filled (market niche)

1st step marketing

purchasing paper goods

Diagonal communication

Focus on one activity or performance

Performance budget

listening

_____ skills are essential for communication

Polyunsaturated Fatty Acids (PUFA), Monounsaturated Fatty Acids (MUFA), Saturated Fatty Acids (SFA)

Margarine Fatty Acids

1) Add up all costs as percentages 2) Find targeted food costs percentage, subtract TOTAL from 100% 3) Determine selling price: total food cost / desired food cost percentage

Cost of Profit Pricing Method

- Determines whether goal of intervention is worthwhile in terms of cost - Benefits MUST outweigh costs

Cost/Benefit Analysis

Efficiency of equipment placement; studies work motions; shows the number of movements between pieces of equipment

Cross Charts

Double-blind placebo controlled food challenges -identify food-induced symptoms GOLD STANDARD FOR Dx!

DBPCFC

Oat bran and soluble fibers

Decreases CHOL by binding bile acids converting more CHOL to bile

Age Gender Race Education Income

Demographic variables

-Non digestible CHOs and lignin, binds H2O, Increase fecal bulk; found in legumes, wheat bran, fruits, veges, whole grains

Dietary Fiber

-varies directly with changes in sales -directly involved with service to customer China, silver, food, benefits, uniforms, laundry, repairs VARIABLE COSTS

Direct costs

When diverticula become inflamed as a result of food and residue accumulation and bacterial action

Diverticulitis

Clear liquids, low residue or elemental gradual return to high fiber

Diverticulitis Diet

Symptoms: cramps, rapid pulse, weakness, perspiration, dizziness CHO --> jejunum --> Increase in H20 --> decrease in BP -2hrs later- CHO abs rapidly --> BG increases --> insulin increases--> BG decreases (reactive hypoglycemia) Follows gastrectomy

Dumping Syndrome

B12 def= lack of IF + bacterial overgrowth in loop of intestine bypassed, decreased B12 abs (pernicious anemia dx by scilling test) B9 def= needs B12 for transport inside cell; poor B9 intake + low Fe (cofactor in B9 metab)

Dumping Syndrome Anemia

-Freq, small, dry feedings -Fluids before or after meals (slow passage) - Restrict hypertonic conc. sweets -Give 50-60% complex CHO -Pro @ each meal -Mod. fat -May need B12 injections -Lactose maybe poorly tolerated d/t rapid transit

Dumping Syndrome Nutrition

Decrease in gastric emptying d/t surgery, DM, viral infections, obstructions -Prokinetics (erythromycin + metoclopramide), increase in stomach contractility -Mod-severe hyperglycemia --> damages gastric nerve

Gastroparesis

-small, freg meals -pureed foods AVOID: High fiber High fat (liquid fat may be tolerated)

Gastroparesis Diet

Urban Suburban Climate Resources Cultural values

Geographic variables

Storage proteins Prolamins: -gliadin in wheat -secalin in rye -hordein in barley -avenin in oats

Gluten

HIV- Associated lipodystrophy syndrome -May develop from therapy -High chol, TG; insulin resistance; change in body fat distrib.

HALS

-keep info confidential -suggest AIDS edu programs

HIV Employee

Breastfeed

HIV Infected women should not ________

FDA + HHS -telephone survey of randomly selected adults -tracks self perception or relative nutrient intake levels, use of food labels, knowledge of fats and chol, prevalence of supp. use.

Health and diet survey

National Health Program and Disease Prevention; HHS health agenda for decade; focuses on disease prevention by changing behaviors

Healthy People 2020

Protusion of portion of stomach above diaphragm into chest

Hiatal Hernia

-small, bland feedings AVOID: -late night snacks -caffeine -chili powder -black pepper

Hiatal Hernia diet

Process of adding hydrogen (at double bond) to unsaturated fatty acids (USFAs) to increase saturation and stability

Hydrogenation

Severe N + V, acidosis, wt loss during pregnancy TREAT w/ bed rest; small amts of freq carbs

Hyperemesis Gravidarum

FIXED -Not effected by sales volumes -Can't be readily changed Rent, taxes, interest on debt, insurance, depreciation

Indirect costs

24/36

Introduce eggs @ ____ months; fish @ _____ months

-Spoon-thick -Honey-like -Nectar-like -Thin (includes all beverages=water, ice, milk, juices, coffee, tea, gelatin)

Liquid Consistency

Hands on and value driven -explain your value system to employees

Management should be _________ _________.

Saturated fatty acids between 6-12 carbons; naturally found in milk fat, coconut oil, and palm kernel oil

Medium Chain Triglycerides (MCTs)

Olive oil, canola oil, peanut oil, and sunflower oil

Monounsaturated Fatty Acids (MUFA) Examples

Cow's milk

Most common allergen for infants

Dysphagia Mechanically Altered -Moist, soft textured, easily formed into bolus, moist tender ground/diced meat, soft cooked veggies, soft/canned fruits NO: Bread, rice, cheese cubes

NDD1

Dysphagia Advanced AVOID: -very hard, sticky, crunchy foods -hard fruit and veggies -nuts -seeds

NDD3

Nucleotide Nucleoside Reverse Transcriptase Inhibitors (retrovir + zidowdine) -Lead to anemia; loss of appetite; low vit B12, Cu, Zn + carnitine

NRTI Drugs NTR Effect

NOT RECOMMENDED Vit C + St. Johns worth = could result in drug resistance -CAM therapies not recommended (complementary alt med)

Nutr/ Herbal Supplements for AIDS

MI skills; open ended; affirmations; reflective listening; summaries

OARS

Pregnancy Induced HTN -HTN -Edema to face + hands -Proteinuria -Rapid wt gain after 20th week -May have convulsion

PIH

-Na restriction NOT RECOMMENDED for prevention or treatment (Na needed to maintain normal levels during large prenatal expansion of tissues and fluid)

PIH Diet

Pregnancy NTR surveillance system (HHS-health and human services) -low income, high risk, preg. women. -maternal wt gain, anemia, preg behavior risk factors (smoking, alcohol), birth-wt, counts # of women who BF -Identify and reduce pregnancy -related health risks.

PNSS

-Illustrate relative importance of problems -Work on tallest bar problem that occurs most frequently -80/20 rule (80% outcome results from 20% input)

Pareto Charts

Pediatric NTR surveillance system (HHS) - low income, high risk; 0-17 yrs ( emp. 0-5 years) -Ht, wt, birth wt, Hct, hgb, chol, BFing (breast feeding?) -monitors growth and NTR status, infant feeding practices.

PedNSS

-High pro + kcal w. supp. needed for wt gain -Energy + stress factors - MVI @ 1-2x RDA - HALS may develop -sig. loss of LBM can be obscured by HALS + edema

Pediatric HIV Nutrition

Safflower oil, corn oil, soybean oil, cottonseed oil, sunflower oil

Polyunsaturated Fatty Acids (PUFA) Examples

Raw food cost and direct labor -Determine markup ~add food cost % to % direct labor cost ~divide into 100 -Selling price = prime cost x price factor (markup) (Prime cost is Direct labor + Raw food cost)

Prima Cost Method

Requires administrative support, realistic budget, staff commitment, support of target population

Program Implementation

DRGs (Diagnostic Related Groupings); knowing amount of payment in advance; includes Medicare and Medicaid patients; hospitals paid specific amount per patient based on disease regardless of the number and type of services; length of stay NOT considered when determining payment; peer review organization (PRO) (watches system)

Prospective Payment System

social class lifestyle motive

Psychographic variables

Analyzing flow of customers in cafeteria -balancing cost of waiting in line with cost of increase service to prevent "S" > straight

Queuing theory

Specific, measurable, achievable, relevant, time specific

SMART objective

Hydrogens across from each other; past as tightly as SFAs in membranes; intake can influence membrane fluidity and could be harmful to cell function; found in milk fat (4-8%); Examples: margarine, shortening, frying fats (partial hydrogenation of polyunsaturated fatty acids)

Trans Fat

Bacterial, viral, parasitic infection Chronic GI disease, intestinal lesions May also affect stomach Symptoms: diarrhea, malnutrition, def of B12 + B9 d/t decreased HCl + IF

Tropical Sprue

-Antibiotics -High kcal -High pro -IM B12 -Oral B9

Tropical Sprue Treatment

Eroded Mucosal Lesion Treatment: antacids, antibiotics to kill h.pylori bacteria Drugs: Cimetidine, Ranitidine (H2 Blocker); prevents binding of histamine to receptor; decreases acid secretion

Ulcer

-As tolerated; well balance; avoid late night snacks OMIT: cayenne + black peper, large amounts of chili pepper, avoid excess caffeine + alcohol

Ulcer Diet