RD exam
Common insulin regimens
1. Regular + NPH 2 x daily - pre-breakfast: 1/3 REg, 2/3 NPH; pre-supper: equal reg +NPH 2. Regular + NPH pre-breakfast, regular pre-supper, NPH bedtime (to control early AM surge) 3. MDI (multiple daily injections): regular before meals, NPH 1-2X 3. Glargine (lantus) basal insulin at bedtime: rapid-acting as bolus for meals. 4. Insulin pump therapy provides basal or rapid-acting or short-acting insulin pumped continuously; boluses of insulin are given before meals.
How to evaluate PES statment
1. can you resolve or improve the nutrition diagnosis for teh person/group? (intake domain will be more specific to the nutrition professional) 2. is the etiology you selected to "root cause" hat can be addressed with nutrition intervention? or can you at least lessen the signs and symptoms? 3. Will measuring the signs and symptoms indicate the problem is resolved or improved? are the signs and symptoms specific enough that you can monitor and document resolution/improvement? Does the nutrition assessment data support a particular nutrition diagnosis with a typical etiology and signs and symptoms?
evaluating acid base abnormalities (steps)
1. check the pH. is it moving towards acidosis or alkalosis? 2. look for teh cause - is it respiratory or metabolic? - check the pCO2 to tell you if the lungs are working normally. Then check the HC03 to tell you if the kidneys are funcitoning well.
normal range for BUN
6-23 mg/dl. increased in renal disease, and in cases of excessive protein catabolism, gastro-intestinal bleed, and severe dehydration. decreased in individuals with liver failure. affected by intake of dietary protein.
evaporated milk
60% water removed. must contain no less than 7.9% milk fat. brown color due to caramelization of lactose in canning
skim milk
<.5% fat
NAMP
National Association of Meat Purveyors
long-acting insulin
Glargine (lanuts), Determir (levemir) onset 2-4 hours, duration 20-40 hours.
MNT for diverticulosis
High fiber diet - increase volume and weight of residue, provides rapid transit.
heparin
blood clots
Phenobarbital
decreased folic acid, Vitamins B12, D, K, B6
National labor Relations Act - Wagner Act 1935
guaranteed right to organize and join labor unions. gave union the right to be the bargaining agent. created the National Labor Relations Board (NLRB) listens to claims of 'unfair lbor practice'
policies
guides that define scope of permissible activity.
Coronary artery disease (CAD)
hard, narrow arteries from plaque buildup.
high educational level
has some previous knowledge of topic or has broad base to which new information can be added; understands complex ideas and rationales; verbally oriented.
perceived impact
heart disease will impede my ability to work
IMPS
institutional Meat Purchasing Specifications
Type 1 Diabetes mellitus
insulin deficient, depend on exogenous insulin.
chromium deficiency
insulin resistance
Type 2 Diabetes mellitus
insulin resistance with relative insulin deficiency (may need insulin)
shortened cake
layer, pound cakes comparatively large amount of fat; usees chemical leavening. layer cake - baking pwder pound cake - air and steam
retinopathy
leads to blindness
nephropathy
leads to decreased kidney function
avoidance learning
learn to escape from unpleasant consequences. avoid future criticism by improving future performance
round bone
leg
vitamin B12 deficiency
macrocytic, megaloblastic anemia. pernicious anemia - after gastrectomy or removal of ileum. due to lack of intrinsic factor
formative evaluation
made during course of education. helps pinpoint parts mastered and parts not mastered. allows for revision of plans, methods answers "how should we do it?" client must be involved; focus group, pre-test frequent feedback of results guides the rest of the educational process ex: focus group pre-test
MNT for Inflammatory bowel diseases
maintain fluid and electrolyte balance; antidiarrheal agent (sulfasalazine) acute Crohn's flare-ups - bowel rest, parenteral nutrition or minimal residue. acute UC, elemental diet may be needed to minimize fecal volume. energy needs according to current BMI, limit fat only if steatorreha; water soluble and fat soluble vitamins; iron, folate, assess Ca, Mg, Zn; MCT oil (lost in fatty stool), watch lactose, frequent feedings, high fat may improve energy balance. high fiber to stimulate peristalsis when IBD is in remission.
goals for daibetics
maintain normal blood glucose (average pre-prandial goal 70-130; peak post-prandial average <180) optimal serum lipid levels: LDL <100, TG <150, HDL >40M, >50F blood pressure goals systolc 130, diastolic <80 prevent and treat chronic complications.
MNT for COPD
maintain stable weight. Replete but do not overfeed - high calorie, high protein diet (1-1.5 g/kg dry weight, 15-20% cals) 30-45% as fat (oxidation of fat consumes less oxygen than oxidation of CHO), 40-55% as CHO. small, frequent mini-meals and snacks, easy to prepare and eat, nutrient dense supplements (smoothies, meatloaf, muffins with cream cheese, tuna salad, cereal with fruit)
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.
Fair Employment Practice Law
makes it illegal to ask about a candidates's race, religion, sex, national origin, age, marital status (after hire, can ask).
evaluation response
makes judgment about person's feelings; leads to offering advice. not problem solving, seldom helpful.
Nutrition diagnosis - clinical domain (NC)
nutritional findings/ problems that relate to medical/physical condition. 1. functional balance (ex : swallowing) 2. biochemical balance (ex: lab values) 3. weight balance (ex: underweight)
Native American and Alaskan Natives
obesity is epidemic and adds to increased prevalence of heart disease, hypertension; depend heavily on federal food assistance programs
perceived susceptibility
obesity puts me at risk for heart disease?
formal evaluation
objective test - not well suited for clinic or community setting performance test - client asked to complete task based on learning objectives
Blooms Taxonomy
objectives at lower levels must be mastered before more complex learning can take place. Is the level of learning appropriate based on the groups prior learning and present ability?
research introduction
objectives, definitions, background, limitations, order of presentation
rank order (ordinal scale)
observations compared with each other and put in order, perhaps from best to worst, or state of disease from 1-4
understanding response
one of the bet ways to respond, try to recreate the person's message in your own frame of reference. may lead to more client cooperation. helps client feel accepted and safe in expressing their feelings.
large group - lecture
one way flow of information; presents a large amount of material in a short time.
Dumping syndrome
Symptoms - cramps, rapid pulse, weakness, perspiration, dizziness when rapidly hydrolyzed carbs (simple sugars) enter the jejunum, water is drawn in to achieve osmotic balance --> rapid decrease in the vascular fluid compartment and a decrease in peripheral vascular resistance. Blood pressure drops and signs of cardiac insufficiency appear. About 2 hours later, the CHO is digested and absorbed rapidly. Blood sugar rises, stimulating an overproduction of insulin, causing a drop in blood sugar below fasting. This is reactive/alimentary hypoglycemia
Macgregor - attitude of the manager toward employees
Theory X - people inherently dislike work and will avoid it if possible. Authoritarian, work centered; workers prefer to be controlled and directed by pressure; motivation through fear; negative autocratic. theory Y - work is as natural as play or rest; managment should arrange conditions so workers can achieve goals by directing own efforts positive, participative.
upward communications
from workers up tot he department Head; open door policy, suggestion boxes, grievance procedures. provides employees and opportunity to have say in what happens in the organization. management needs to receive vital information from lower levels.
carbon dioxide as leavening agent
froma ction of yeast on sugar, yhielding carbon dioxide and alcohol. from the action of acid on baking soda acids used : sour milk, cream of tartar, molasses
sweeteners in order of sweetness
fructose, invert sugar, sucrose, glucose, sorbitol, mannitol, galactose, maltose, lactose
sources of phytochemicals
fruits, vegetables, legumes, whole grains, nuts, seeds, herbs, spices
GERD
gastro-esophageal reflux disease avoid eating before bed, soda, caffeine, acidic foods small, low fat meals, liquids empty more rapidly.
Atopy
genetic predisposition to produce excessive IgE antibodies in resonse to an allergen.
gluten
gives elastic properties, forms framework, hold in leavening agent; made from gliadin and glutenin through process of hydration and mixing
carb counting
gives flexibility in food choices. one choice from the starch, fruit, or milk list = 15 grams CHO and each is a CHO choice; meal plan outlines the number of CHO choices to be selected for meals and snacks.
Staffing patterns
acute care conventional - 17 minutes per meal or 3.5 meals per labor hour extended care facilities: 5 meals/labor hour cafeteria - 5.5 meals/labor hour school foodservice - 13-15 meals/labor hour
complications of uncontrolled diabetes
acute ketoacidosis acute hypoglycemia Long term - neuropathy, retinopathy, nephropathy
cultured buttermilk
add lactic acid bacteria to skimmed or partly skimmed milk increase baking soda when using buttermilk in place of regular milk in a recipe
stewing
add water or other liquid during cooking
cured cheese
additional whey removed, salt added, ripened
salt (baking)
adds flavor, keeps yeast from sticking
fat (baking)
adds tenderness by coating gluten particles
CSFP commodity supplemental food program
administered by state health agencies monthly commodity canned or packaged foods low income women (pregnant, breast feeding, postpartum, infants and children up to 6 years, some elderly; at nutritional risk
homogenized milk
high pressure breaks fat globules to 1/5 regular size; film of protein surrounds each globule. more susceptible toa ction of lipase, but the pasteurization process destroys lipase
MNT for cirrhosis
high protein (.8-1 g/kg; in stres at least 1.5 g/kg) high calorie - 25-35 cals/kg estimated dry weight or 1.2-1.5 X BEE moderate to low fat 25-50% of calories, MCT if needed; <40 grams fat if malabsorption. Fat is preferred fuel in cirrhosis. Include omega 3. Decrease LCTs if steatorrhea develops. Low fiber carices are present; low sodium if edema or ascites. with hypnatremia, fluid restriction of 1-1.5 liters/day depending on severity and moderate sodium intake. B complex vitamins, C, K, Zn, Mg; monitor need for A and D.
sulfur
part of amino acids cysteine, cystine, methionine. function - transports lipids as acetylcholine. fat in eggs, milk, liver, soybeans.
magnesium
part of chlorophyll. 50% in bone, 50% in cells function - protein and fatty acid synthesis. stabilizes structure of ATP. high protein, calcium, vitamin D, increases need sources - most foods, milk, bread deficiency rare - tremors
diffusion
particles move from more to less concentrated side
Transpyloric (EN)
passed by pyloric valve in stomach; used in comatose patients or ones with no gag reflex.
Third party reimbursement
payment by a third party for service rendered by a health care provider to a patient (Blue Cross, Medicare)
Niacin deficiency
pellegra. dermatitis, diarrhea, dementia beefy, bright, red tongue symmetrical, pigmented rash in sunlight
Conditions that elevate PBI
periods of growth, pregnancy, lactation, fever (7% for each degree rise in temperature), some diseases (cancer and HTN), exercise
neuropathy
peripheral and autonomic; gastroparesis.
Chronic obstructive pulmonary disease (COPD)
persistent obstruction of airflow. symptoms - weight loss, emaciation, anorexia.
proxemics
personal space moves away = discomfort moves closer = seeking more interaction sits behind or next to an object = seeks protection
management concepts
philosophies about how an organization views its customers, and the delivery of products or services. the marketing strategies for services may be different from the marketing mix for goods (product, place, price, promotion)
kinesics
physical communication. eye contact = attentive lowering eyes/look away - preoccupation arms folded across chest - dislike avoidance clenched fists - anxiety, anger; crossing and uncrossing legs = anxiety.
Illegal Immigration Reform and immigrant Responsibility Act 1996
places limitations on persons who remain in the US longer than permitted by their visa and/or who violate their nonimmigrant status.
negotiating techniques
plan strategy in advance - know what you are willing to accept. don't start with hard issues. be direct, clear, calm, patient, tolerant.
manager functions
planning, organizing, controlling, and evaluating
Extracellular water
plasma, lymph, interstitial or intercellular ECW
Leadership Grid - Blake, Mouton, McCanse
plots leader's concern for people (employees) vs their concern fro production. scale of 1-9; 1 is low concern, 9 is high concern.
breakeven analysis graph
plots the costs on the verticle axis and sales (revenue) on the horizontal axis. The graph uses the assumption that there is a linear relationship between sales and total costs (fixed + variable), and the point where they intersect is the breakeven point.
Workman's compensation
administered by state. insurance covering employers liability for the costs of any accident incurred by an employee in connection with their job. must furnish a safe place to, competent supervision, instructions.
propofol
administered in oil, consider fat calories, 1.1 cals/cc, check TG
osteomalacia
adult rickets. vitamin D deficiency - lack of sunlight or diet intake. reduction in bone density - demineralization. vitamin D, calcium supplements.
BRFSS (behavioral risk factor surveillance system)
adults 18 years and older residing in households with telephones telephone interviews collect info on height, weight, smoking, alcohol use, food frequency for fat, fruits and vegetables, preventable health problems, diabetes (Behaviors)
Chronic ulcerative colitis (UC)
affect large intestine. ulcerative disease of the COLON, begins in rectum. chronic bloody diarrhea, weight loss, anorexia, electrolyte (Na, K) disturbance, dehydration, anemia, fever, negative nitrogen balance.
Regional enteritis (Crohn's disease)
affects terminal ileum; weight loss, anorexia, diarrhea. B12 deficiency leads to megaloblastic anemia. iron deficiency anemia due to blood loss, decreased absorption
Acute Diarrhea in infants and children
aggressive and immediate rehydration; replace fluids and electrolytes lost in stool (WHO recommends glucose electrolyte solution). as effective as parenteral rehydration and much cheaper, ingredients easily attainable; reintroduce oral intake within 24 hours.
Advocacy
aggressive form of action; plead cause of a group. know facts and arguments for and against the issue. be realistic - usually results in compromise.
Re-feeding syndrome
agressive administration of nutrition to malnourished. at risk: anorexia nervosa, chronic alcoholism, prolonged fasting, unfed 7-10 days, significant weight loss, phosphorus-deficient PN. Starved cells take up nutrients, potassium and phosphorus shift into intracellular compartments. results in hypokalemia, hypophosphatemia and hypomagnesemia. overfeeding PN and dextrose > 5mg/kg/min may lead to hyperglycemia.
milling
air classification is a separation method that improves baking qualities by separating large flour particles from fine particles
Emphysema
air sacs (alveoli) lose elasticity; thin, cachectic, often older. difficulty exhaling; air pocket walls expand, thin out, collapse.
sorbitol
alcohol from glucose; absorbed more slowly than glucose by passive diffusion; converted into fructose; excess may cause diarrhea
Associated malnutrition in alcoholic fatty liver disease
alcohol replaces food in diet. alcohol causes inflammation of GI tract and interferes with absorption of thiamin, B12, vitamin C, folic acid. alcohol interferes with vitmin activation. increased need for B vitamins to metabolize alcohol. increased need for magnesium; excreted after alcohol consumption. malnutrition increases alcohol's destructive effects. Folate and protein deficiencies. Most responsible for malabsorption. Thiamin deficiency - Wernicke-Korsakoff syndrome.
cause of yellowing cake
alkaline batter (excess soda)
saturated fatty acids
all available bonds of carbon chain are filled with hydrogen; solid and hard at room temp
complete proteins
all essential amino acids in sufficient quantity and ratio to maintain body tissues and promote growth; HBVV - high biological value low protein diets - give mostly HBV
straight dough method
all ingredients are added before dough is allowed to rise
Adjusted FTE
also takes into account the benefit days and days off. computed by dividing the total number of hours used in operating for a period of time by the normal workload hours of one employee.
MNT for dumping syndrome
frequent small, dry feedings, fluids before or after meals (to slow passage), restrict hypertonic concentrated sweets, give 50-60% complex CHO, protein at each meal, moderate fat, B12 injections may be needed. Lactose may be poorly tolerated due to rapid transport.
Hypernatremia
associated with dehydration. Serum sodium is the BEST assessment parameter for fluid status
hyponatremia
associated with over-hydration
downward communications
from department head down throught he ranks of workers (chain of command), use procedure manuals, policy statements.
Wholesome Meat Act of 1967
assures consumer that the animal was healthy at the time of slaughter and the meat is fit for human consumption. shown with round purple stamp "USDA inspected and passed"
When to add solid foods
at 4-6 months, when sitting posture can be sustained and extrusion reflex diminishes; begin with iron fortified cereal, then strained vegetables or fruit.
Egg grading
candling - pass an egg in front of bright light to view contents. judges thickness of white, location and condition of yolk. grades AA, A, B
chemical properties of carbs
carbon, hydrogen, oxygen
physical properties of fat
carbon, hydrogen, oxygen
physical properties of proteins
carbon, hydrogen, oxygen, nitrogen (16%) sulfur (cystein, cystine, methionine)
what diet is typically recommended fora patient who has undergone a gastrectomy?
carbs, protein, and fat at each meal, and restriction of fluids with meals.
yellow, orange pigment
carotenoids (least affected by change in pH) insoluble in water little effect in acide or lkaline solution lycopenes - contribute to red color in tomatoes and watermelon and overtones in apricots (antioxidant, phytochemical)
stabilizers
carrageenan, pectin, cellulose, gelatin, vegetable proteins
Non-tropical sprue
celiac disease, gluten-induced enteropathy reaction to gliadin - affects jejunum and ileum (poximal intestine) malabsorption (leads to loss of fat soluble vitamins), macrocytic anemia, weight loss, diarrhea, steatorrhea, iron deficiency anemia.
socioeconomic stratification
census data, housing stats
measures of central tendency
center of any mass of data
ultimate goal of nutrition education
changing behavior.
variables
characteristics that may have different values from observation to observation
When to check gastric residuals in EN
check every 4 hours during the first 24 hours. Then decrease to 6-8 hours unless a patient is critically ill. If the GRV is >250 after the second check, consider a pro-motility agent. If the GRV >500 ml, hold the feeding and assess tolerance. Normal GRV <250 ml
modified starch
chemical modification by acids and enzymes to change viscosity, and ability to gel. physical modification:L pre-gelatinized starch used in instant puddings. used to stabilize frozen gravies: waxy maize, modified cornstarch
Angina pectoris
chest pain
Irritable bowel syndrome (IBS)
chronic abdominal discomfort, altered intestinal motility, bloating. goals - adequate nutrient intake, tailor patter 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. Work with client to alleviate stress during eating.
listening responses
clarification: pose a question after an ambiguous client message used ot make previous message explicit (clear) active or reflective listening - paraphrase or repeat back what was just said.
Transactional leader
clarifies roles and responsibilities; uses rewards and punishments to achieve goals. engage in bargaining relationship with their followers. Leader and follower have separate but related purposes; they are not bound together in pursuit of common goals. leader tells employee what they need to do to obtain rewards, and takes corrective action only when employees fail to meet performance goals.
requirements for bariatric surgery treatment
class III obesity with a BMI of 40 or greater, or a BMI of 35 or greater with co-morbidities.
MNT for Diverticulitis
clear liquids, low-residue or elemental, gradual return to high fiber.
Nutrition indicators
clearly defined markers than can be observed and measured. also used to monitor and evaluate progress towards nutrition outcomes. compared against the nutrition care criteria.
Bolus method (EN)
clinically stable with functional sotmach
sources of saturated fat
coconut oil, palm kernel, cocoa butter, butter, beef tallow, palm oil
cohort studies
cohort of healthy people followed through time to see if they develop a specific disease. sometimes called INCIDENCE studies tracking the frequency of new cases of a disease carried out over a long period of time (longitudinal), and prospective (future oriented).
sponge method
combine liquid with yeast and part of the flour and allow this batter (sponge) to ferment for several hours; add sugar, salt, fat, rest of lour; knead. shortened proofing time
least tender meats
come from most used muscles (flank, brisket)
Tender cuts
come from the least used muscles (loin, backbone) i.e. pork chops, loin
medium tender meats
come from the shoulder (chuck)
Selection process - application, screening
compare skills, knowledge, education with job requirements. pre-employment testing, background and reference checks. interviews.
symptoms of Fe deficiency status post Roux-en-Y
craving ice and reports of chewing large quantities of ice daily.
Cake mixing method
cream fat with sugar, add egg, add sifted dry ingredients in portions, alternating with portions of milk
thiols
cruciferous vegetables (sulfur) - detoxification of carcinogens
mixing method for pastries
cut fat into flour and salt, add liquid
methionine converted to...
cysteine
procedures
daily operations
cirrhosis
damaged liver tissue is replaced by bands of connective tissue which divides liver into clumps and reroutes many of the veins and capillaries. Blood flow through liver is disrupted. Poor food intake leads to deficiencies. Protein deficiencies lead to ascites, fatty liver, impaired blood clotting.
numerical discrete
data with numbers (numvber of clinic visits)
Nutrition care documentation
date and time, pertinent data and comparison with standards; patient's perceptions, values, and motivation related to problem; changes in patient's level of understanding, behaviors, outcomes, reason for discharge.
Preparation stage
decides to change and plans the change "I bought a cookbook on low salt cooking"
mineral oil, cholestryramine
decrease absorption of fat, fat soluble vitamins
fetal iron stores
decrease at 3-4 months; need additional iron, preferably from formula or supplemental foods (cereal starting at 4-6 months)
steroid
decrease bone growth, CHO intolerance
methotrexate
decrease folate
oral contraceptives
decrease folate, B6, C
Anemia
decrease in total red cell mass due to fewer red blood cells or to smaller cells with less hemoglobin.
thiazide diuretics
decrease potassium and magnesium, absorb calcium
thiazide diruetics
decrease potassium, magnesium, calcium, sodium
antibiotics
decrease vitamin K
needs assessment - elderly
decreased attention span; audience participation to maintain interest; carefully control questions to stay on topic; prefer written material to control rate of input. 30 minutes sessions, big bold print.
baking at high altitudes
decreased pressure causes gas to expand faster, steam forms earlier expansion may be excessive before heat of oven has coagulated the protein and gelatinized the starch enough to stabilize the structure. to correct: decrease amount of baking powder, increase amount of liquid.
what is the primary advantage of a closed system for tube feedings?
decreased risk of bacterial contamination.
dehydration
decreased water intake, excessive water output. heavy solute load. nausea, dizziness, sunken eyes, fever, hyperventilation, excessive sweating, concentrated urine, dry inelastic skin, increase in solutes (BUN), tachycardia, headache fatigue, decreased appetite, rapid weight loss.
adding bran to flour mix
decreases volume of end product. increase flour and liquid to compensate
Nephrosis/nephrotic syndrome
defect in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through the tubules. albuminuria, edema, malnutrition, hyperlipidemia. (increased synthesis and decreased clearance of VLDL)
Ischemia
deficiency of blood due to obstruction.
Glycogen storage disease
deficiency of glucose 6 phosphatase in liver; impairs gluconeogenesis and glycogneolysis. liver can't convert glycogen into glucose leading to hypoglycemia. provide a consistent supply of exogenous glucose with raw cornstarch at regular intervals, and a high carb, low fat diet.
Hypothyroidism
deficiency of thyroid hormone. T4 low, T3 normal. decreased BMR leading to weight gain. diet - weight reduction.
incomplete proteins
deficient in one or more essential amino acids
Gastroparesis
delayed gastric emptying; caused by surgery, diabetes, viral infections, obstructions. moderate to severe hyperglycemia --> detrimental effects on gastric nerves.
Directing and coordinating function of management
delegation, communication, motivation, leadership must have clear understanding of what they want done; give specific instructions, motivate, provide training, require complete work, establish adequate controls.
Cyclic feeding (EN)
delivered by continuous drip at an increased rate over 8-16 hours, often overnight, by pump (for undernourished, especially older, ambulatory, malnourished patients).
Autocratic leadership
demands obedience, most control use during crisis.
fluoride defeciency
dental caries
crumb structure
depends on ingredients, procedure used, pan shape and size, baking temperature, time elapsed before baking
loop diuretics
deplete thiamin, potassium, mangesium, calcium, sodium
Fat (meats)
deposited around organs muscles, in muscles (marbling). finish- amount of fat cover on carcass
SOPP (standards of Professional Performance)
describes competent level of behavior in the professional role ( 6 domains of professionalism) (provision of services, application of research, communication and application of knowledge, utilization and management of resources, quality in practice, competency and accountability)
population of interest
describes group about which the observations are made
SOP in Nutrition Care
describes in general terms a competent level of nutrition care practice as shown by the NCP method used to think critically and make decisions to provide safe, effective, high quality nutrition care. (diabetes care, oncology nutrition, behavioral health care, nutrition support, management of food and nutrition systems, sports dietetics, and education of dietetics practitioners, pediatric nutrition, and nephrology care.
descriptive research
describes state of nature at a point in time generates hypotheses regarding determinants of a condition or disease provides baseline data and monitors changes over time. establish associations among factors, but does NOT allow causal relationships to be determined.
summative evaluation
designed at planning stage but conducted at end. considered final; purpose may be grading, or evaluation of progress. example: post-test
Delphi technique
designed to probe expert minds in a series of written interviews from which some consensus is sought. participants DO NOT meet. ex: medical research.
milk pasteurization
destroys pathogenic bacteria - 145 F for 30 minutes or 160 F for 15 seconds
Effects of storing eggs in the fridge too long
deterioration affects appearance and use. loss of Co2 makes eggs more alkaline whites become watery, yolks flatten. odors are absorbed
Maslow;s hierarchy of needs
determinants of behavior, motivated by the dsire to satisfy specific needs
WHO World Health Organization
developed RDAs for developing countries
Health belief model
developed to explain why people especially high risk people, fail to participate in programs designed to detect or prevent disease. a person must perceive the severity and their susceptibility to the threat for the threat to be a behavior motivating factor.
community food security inititiave
development of sustainable, community-based strategies to ensure that all have access to culturally acceptable, nutritionally adequate food at all times.
Queue - queuing theory
develops the relationships involved in waiting in line. used in analyzing flow of customers in a cafeteria. balance cost of waiting lines with the cost of preventing waiting lines through increased service.
evaluation of effectiveness of educational plans
did it alter patient knowledge, behavior, or attitude? what is rate of lapse or relapse? timeliness, appropriateness, accuracy? within budget? meet specific targeted needs? quality of presentation? were processes and outcomes documented? what was the degree of growth?
process oriented
did the process produce desired results?
dietary intake assessment
diet history food record 24 hour recall food frequency lists
Diagnosing allergies
diet history, skin tests, elimination diet (omit suspected foods)
thermic effect of food (TEF)
diet-induced thermogenesis (DIT), or the calorigenic effect of food (about 10% of total energy expenditure) energy needed to digest, absorb and assimilate nutrients greater after consumption of carbs and protein than after fat.
DASH diet
dietary approaches to stop hypertension; whole grains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI (not supplements).
WWEIA (what we eat in America)
dietary intake component of NHANES two days of 24 hour dietary recall data with times of eating occasions and sources of foods eaten way from home. USDA conducts over-sampling of adults >/= 60, African Americans, Hispanics
range
difference between the lowest and the highest value in the distribution. subtract lower from higher value based only on extreme values
Waist to hip ratio (WHR)
differentiates between android and gynoid obesity WHR of 1 or greater in men, 0.8 or greater in women is indicative of android obesity and an increased risk for obesity-related disease (diabetes, hypertension).
peritoneal dialysis (PD)
differs from home hemodialysis by filtering and cleaning blood within the body rather than through an outside dialyzer. With peritoneal dialysis, the patient's abdomen is filled with a special solution called dialysate that helps remove waste and extra fluids from the blood. The dialysate contains dextrose, to PD patients have a lower need for CHOs than pts on HD
FEP (free erythrocyte protoporphyrin)
direct measure of toxic effects of lead on heme synthesis. increased in lead poisoning. lead depletes iron leading to anemia, and displaces calcium in the bone leading to a zinc deficiency.
tertiary prevention programs
directed at managing and rehabilitating persons with diagnosed health conditions to reduce complications, improve their quality of life, and extend their years of productivity. ex: nutrition and menu planning classes for post-bariatric surgery patients.
Cystic Fibrosis
disease of exocrine glands - secretion of thick mucus that obstructs glands and ducts; chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption.
morbidity
disease rates mortality is death rates
Achalasia
disorder of lower esophageal sphincter motility, does not relax and open upon swallowing. causes dysphagia - difficulty in swallowing. start with pureed moist thick foods, progress to thick liquids.
Gout
disorder of purine metabolsim. increaseds erum uric acid; deposit in joints causing pain, swelling. diet - low purine may not be effective; may need weight reduction. moderate protein, liberal carbs, low to moderate fat, decrease alcohol, liberal fluid, avoid high purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel). medications (urate eliminatn, colchicine) induce loss of nutrients.
electrolytes
dissociate into ions in water, cations (+); anion (-)
Vasopressin (ADH)
from hypothalamus (stored in pituitary). exerts pressor effect, elevates blood pressure. increases water reabsorption from distal and collecting tubules. SIADH - syndrome of inappropriate antidiuretic hormone; hyponatremia caused by hemodilution, treated with fluid restriction.
derived fats
fat substance derived from a simple or compound fat by hydrolysis or enzymatic breakdown. fatty acid, glycerol, steroid.
HAV (Hep A)
fecal-oral transmission (type most directly connected to food)
kefir
fermented by lactobacillus, adds Co2, about 3% alcohol
supplements during pregnancy
ferrous sulfate - 30 mgs during 2nd and 3rd tri (taken between meals, not with mealk, tea or coffee) folic acid - 400 mcg (added to 200 from foods = 600)
wide span of control
fewer levels and fewer managers are needed used with highly trianed, highly motivated workers.
FTC Federal Trade Commission
fights health care fraud. Internet, TV, radio; bogus weight loss claims
renal functions
filtration- RBCs, protien stay in blood; all else filters through tubules. absorption - 100% glucose, amino acids; 85% water, sodium, potassium excretion - wastes, urea, excess ketones secretion - secretes hormones that control blood pressure, blood components; secretes ions that maintain acid-base balance.
proofing time
final rising of the dough shortened with strong flour, high in protein (bread flour)
crystalline sugar
fixed orderly pattern of molecules or atoms. large crystals = rock candy small crystals = fondant, fudge
nitrites
fixes color, inhibits spores of clostridium botulinum
braising
flour meat, brown cover and simmer in liquid. can be done in oven or on top of range.
carb sources
flour, cereals, fruits, vegetables, dairy
pastry
flour, fat, liquid, salt lard and oil are seach 100% fat; butter and margarine only 80% fat. When subbing butter for lard, need to use more.
osmosis
fluid moves from less to more concentrated side of membrane
Authority, obedience management
focus on production, managing tasks. domination, mastery, control. people are commodities like machines.
case control studies
focus on specific disease those with the disease are compared with a group without the disease, but otherwise similar in characteristics. both groups recall past behaviors, to study how the groups differ.
Cause and effect (fish) diagram - portrait of a problem
focuses on different causes of a problem; categorizes related factors to make their influence more observable. series of connected arrows, each representing an important factor. technique to increase worker involvement in decision making.
Path-Goal theory - Evans, HOuse
focuses on leader's effect on employee's motivation to perform. motivation to behave in a particular manner is the result of an expectation that a behavior will result in a particular goal and how strongly a person desires the goal.
secondary prevention programs
focuses on strategies to stop or slow the progression of disease. It includes screening and detection for early diagnosis, treatment, and follow-up. Secondary prevention activities target those whoa re more susceptible to health problems because of family history, age, lifestyle health condition, or environmental factors.
OtherNational Research council
food and nutrition board (developed RDAs)
physiological (survival) needs
food, clothing, shelter ex: pay, benefits, working conditions, schedule. security and safety ex: insurance, retirement plans, job security
Estimated average requirement (EAR)
for 50% of population, used in planning meals for healthy people, assesses group nutritional adequacy.
recommended breast-feeding
for first 4-6 months, then supplemented by weaning foods for at least up to 12 months.
broiling
form of radiated heat
traditional or classical management
formal structure that organizes and administers the work activities. coordination is main responsibility of management focus on tasks, structure, authority. scalar principle, unity of command. criticisms - too mechanistic; doesn't see group interactions and decision making processes.
moist heat (starch)
forms suspension. when heated, molecules swell, thicken, ecome translucent due to gelatinization.
modified foods
fortified, enriched, enhanced fermented dairy products have probiotics to support GI health fortified margarines contain plant sterols and stanol esters to reduce LDL
isoflavones
found in soy foods. lower elevted cholesterol
Likert - management of conflict
four basic systems of organizational leadership: 1. exploitive, autocratic (job centered) 2. benevolent, autocratic (job-centered) 3. consultative (employee centered) 4. participative (employee centered)
Nutrition Diagnostic reference sheets
four components: the problem or nutrition diagnosis label, definition of the label to differentiate a discrete problem area, etiology, and signs/symptoms. etiology categories are grouped by the cause of teh contributing factor. Such as beliefs/attitudes, physical function, treatment, access, behavior.
derived proteins
fragments from simple and conjugated (peptide)
Eggs - water preparation
poaching, coddling. use high quality egg. vinegar and salt improve shape by hastening coagulation. surface of yolks turn green when overcooked or allowed to cool slowly (ferrous sulfide)
demographic
population by age, ethnic groups, sex, birth rates, deaths
thickening ability of starches in order of effectiveness
potato, waxy corn, waxy rice, waxy sorghum, tapioca, wheat
postprandial glucagon. amylin agonist
pramlinitide (Smylin) - decreases glucagon production.
objectives
predetermined; towards which management directs its efforts. serve as motivators, provide direction.
hypothesis
prediction of a relationship measurable, specifies population being studied, time frame, typeof relationship being examined, defines variables being studied, states level of statistical significance.
steps in interviewing
preparation (collect background info an est. objectives) build rapport collect data closing
phases of budget cycle
prepare requests, evaluate revenue potential, formulate document, send to legislative body, legislative review and authorization, execute the budget (run the program), evaluation and review.
diet history
present patterns of eating. do not ask leading questions
MNT for AIDS
preserve lean body mass, prevent weight loss, prevent HIV wasting. nutrient needs -energy: BEE x 1.3 for asymptomatic -protein: asymptomatic 0.8/kg, up to 1.2-2.0 g/kg if wasted LBM. Vitamin/mineral supplements if needed to correct micronutrient deficiencies. educate about food safety - low bacteria diet (neutropenic); avoid raw foods. HIV infected women should be counseled NOT to breast feed. nutritional supplementation should be discouraged as adjunctive therapy to conventional care. Use of vitamin C or St. John's Wort could result in drug resistance.
benefits of phytochemicals
prevention or treatment of chronic diseases like cancer, heart disease may detoxify drugs, toxins, carcinogens, mutagens may act as blocking agents, preventing active carcinogen from reaching target tissue may reduce risk of CHD by protecting LDL cholesterol from oxidation, reducing synthesis or absorption of cholesterol
Age Discrimination in Employment Act 1967
prevents discrimination due to age
Equal Employment Opportunity Act 1972
prevents discrimination in employment based on race, color, religion, sex, national origin, political affiliation, overseen by EEOC.
Civil Rights act 1964
prevents discrimination on basis of race, color, national origin, prohibits sexual harassment. Overseen by EEOC (Equal Employment Opportunity Commission)
Meat grades
prime, choice, select, standard (determined at slaughter) standard grades have the least marbling; prime the most
Voluntary health agencies
private, non-profit organizations, chartered and licensed by a government agency, funded by contributions from citizens or organizations: American Heart Association
POMR
problem oriented medical record
Nutrition Diagnosis - environment domain (NB)
problems related to knowledge, access to food and safety 1. knowledge and beliefs (ex: disordered eating pattern) 2. physical activity balance and function (ex: inactivity) 3. food safety and access
hydrogenation
process of adding hydrogen (at the double bond) to unsaturated fatty acids to increase saturation and stability
Erythropoietin (EPO)
produced by kidney; stimulates bone marrow to produce RBC.
pregnancy induced hypertension
progresses from pre-eclampsia to eclampsia. hypertension, edema of face and hands, proteinuria, rapid weight gain after 20th week; may have convulsion. more frequently found in women with lack of prenatal care, poor diets, poor protein and calcium intakes. sodium restriction is NOT recommended for prevention or treatment; sodium needed to maintain normal levels of sodium in plasma during large prenatal expansion of tissues and fluid. proposed association between PIH and calcium deficiency.
MNT for gastroparesis
prokinetics (erythomycin, metoclopramide) increase stomach contractility. small, frequent meals; pureed foods, avoid high fiver, avoid high fat (liquid fat may be better tolerated). bezoar formation may be due to undigested food or medications; treatment includes enzyme or endoscopic therapy.
Primary prevention programs
promote health and protect against exposure to risk factors that lead to health problems. Focuses on reducing or removing risk factors by changing the environment and the community, as well as, family and individual life styles and behaviors. This includes nutrition education and anticipatory guidance to develop and maintain healthful food and exercise behaviors. ex: osteoporosis education classes for postmenopausal women.
NSI (nutrition screening initiative)
promote nutrition and improve nutritional care for the elderly to identify nutritional problems early DETERMINE checklist - identifies factors placing people at nutritional risk increases awareness of factors that influence nutritional health disease, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, needs assistance in self-care, elder above age 80. Level I - screen identifies those who need more comprehensive assessments Level II screen provides more specific diagnositic info on nutritional status(most involved)
Peter Principle
promote someone to a level of incompetence
sensitivity
proportion of afflicted individuals who test positive
specificity
proportion of non-afflicted identified as non-afflicted
marasmus
protein and calorie starvation. anthropometric diagnosis, serum albumin normal, no edema. severe fat and muscle wasting, starved appearance. triceps skinfold, arm muscle circumference decreased
continuous bread making method
reduces processing time not as affected by fermentation time and temperature commercial process that substitutes intense mechanical energy to a large degree for traditional bulk fermentation
myocardial infarction
reduction of coronary flow to myocardium due to blood clot blocking narrowed coronary artery.
strength of flour
refers to capacity to retain leavening depends on quality of gluten bread flour is strong; cake flour is weak
effectiveness
refers to the degree to which we achieve our objectives (producing positive results).
efficiency
refers to the minimization of resources that we must expend to achieve the objectives (producing positive results at the lowest cost).
Job description
reflects required skills and responsibilities. matches applicants to job, orientation and training, employee appraisal.
osteoblasts
reform bone
uncured cheese
refrigerate immeidately (cottage cheese, cream cheese)
FTC (Federal Trade Commission)
regulates content of food ads; enforces truth in labeling; challenges product claims when product crosses state lines.
acid base balance
regulation of hydrogen concentration acid releases hydrogen ions, base takes up hydrogen ions.
needs assessment - adolescents
relate to their interests; consider peer pressure and attitudes toward authority
cobalt deficiency
related to B12 deficiency.
correlations
relationships varying types of data. the closer the points are to the line the stronger teh degree of linear relationship
diastolic blood pressure
relaxation, least pressure.
skills to develop as a group leader
relieve social concerns of the group tolerate silence guide and encourage interactions. know when and how to resume control reinforce 'multi-sides' nature of conversation "how do you feel about that?" exercise control over talkative participants; encourage silent members halt side conversations by engaging distractors help group stay on topic
freezing eggs
remove from shell first; can be frozen whole or in parts. salt, sugar added to yolks as stabilizers.
Adult diarrha
remove the cause; bowel rest, replace lost fluids and electrolytes especially those high in sodium and potassium. when diarrhea stops, begin with low fiber foods, followed by protein foods, fat need not be limited. avoid lactose at first. foods or supplements that contain prebiotic components (pectin, fructose, oats, banana flakes) which favor friendly bacteria. probiotics - sources of bacteria used to reestablish bacterial gut flora.
double blind study
removes bias from research; neither the researcher nor he subject knows which group is receiving the treatment and which the placebo
case report, case study , or case series
report of observations on one subject or more than one subject describes quantitatively the experience of a group of cases with a disease or condition in common helps identify variables important to the etiology, care, or outcomes of a particular condition
Dominance and suppression
repress conflict rather than settle it; creates a win-lose situation. -forcing: "i'm the boss, do it my way" - smoothing: more diplomatic; manager tries to talk one side into giving in. - avoidance - manager avoids taking a position, no one is satisfied. -majority vote : can be effective if members regard the procedure as fair.
Entitlement program
requires payment of benefits to all eligible people as established by law; for a specific population who meet certain income or other eligibility requirements; usually for a finite time - 1 year. SNAP, medicare, NSLP, SFSP, SBP
surveys
research designed to describe and quantify characteristics of a defined population; defined time frame; pinpoints problems
imitation milk
resembles milk but contains neither milk fat nor other important dairy ingredients. made from casein derivatives or soybean protein and vegetable oils.
elastin
resistant to heat, little change in cooking. found in ligaments, cartilage, yellow color
Osteoclasts
resorb and remove bone
contingency or situational leadership - Fiedler
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. most favorable situation = task-oriented, well-liked leader, directing a well-defined job.
RMR
resting metabolic rate - energy expenditure measured under similar conditions, after a short rest and controlled intake of caffeine, alcohol. more frequently measured than the BMR; greater than the BMR (10-20%) mifflin st. joer predicts within 10% of indirect calorimetry
MNT for PKU
restrict the substrate PHE, supplement the product TYR. low in PHE but provide enough to promote normal growth. Phenex-1,2, Pehnyl-Free 1,2 (low PHE formulas) avoid aspartame need for phenylalanine decreases with age, infection. low protein, high CHO intakes may lead to increased dental caries.
respiratory acidosis
retention of carbon dioxide by lungs (decreased ventilation) to compensate, kidneys increase absorption of base
HDL (alpha)
reverse cholesterol transport; moves cholesterol from cells to liver and excretion.
Expectancy theory - Beer Vroom
rewards serve as motivators only under certain circumstances. employees must believe that effective performance leads to certain rewards. employees must feel that rewards offered are attractive.
performance budget
summarizes program activities performed in terms of teh cost of specified accomplishements. Ex: what it costs to supervise a food bank, or what it costs to screen 200 children for anemia.
literature review
summary of different point of view
HRA health risk appraisal
survey categorizing a populations' general health status (usedin worksites, government agencies as a health education or screening tool) consists of questionnaire, calculations that predict risk of disease, educational message to the participant
System approach
system is an organized whole composed of interdependent parts. two parts 1. an open system interacts with external forces (customers, suppliers, etc). External forces hav an impact on the organization and the organization has in impact on the environment. Makes system open and interactive. 2. impact of changes within an organization - a change in one part affects other parts.
Evidence Based dietetics practice
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.
hypertension
systolic >140, or diastolic >90, or both. may be primary (essential) or secondary due to another disease. classified in stages based on risk of developing coronary heart disease. obesity is major factor in the cause and treatment. optimal BP with respect to cardiovascular risk is <120/80 mm Hg.
Short acting (regular) insulin
takes 30-45 minutes before meal (burst of insulin to cover the meal just about to be eaten). one unit covers 10-15 grams CHO; duration 3-6 hours.
sophistication - moderately experienced
teahers, health educators, patients already instructed; emphasize review of material; reorganize it for better use; move on to more complicated concepts.
inferential statistics
techniques that allow conclusions to extend beyond an immediate data set; what is the probability that the results can be applied to a larger group; what can you infer from the results of your study
Health and diet survey
telephone survey of randomly selected adults tracks self-perception of relative nutrient intake levels, use of food labels, knowledge of fats and cholesterol, prevalence of supplement use.
frying
temperature to which fatr can be heated before puffs of smoke occur should be >400 degrees F do not fry tough cuts of meat rancidity involves the uptake of o2 in an unsaturated fatty acid
analytical research
tests hypotheses concerning the effects of specific factors of interest and allows causal associations to be determined includes clinical trials, follow up studies, case control studies
t test
tests significance between the means of two different populations. tests null against alternative hypothesis. if the probability value is equal to less than the level set for significance, the null hypothesis is rejected in favor of the alternative hypothesis.
external validity
tests whether or not a generalizatio ncan be made from th estudy to a larger population
chi square X
tests whether or not there is a real difference between categories. used with attributes that have more than 2 categories. compares the frequency with which we'd expect certain observations to occur with the frequency that actually occurred.
internal validity
tests whether the difference between two groups is real
Food security
the access by all people at all times to sufficient food for an active and healthy life. it is the ready availability of nutritionally adequate and safe foods and an assured ability to acquire them in a socially acceptable manner (without resorting to emergency food programs, stealing, scavenging).
food synergy
the additive influence of foods and consituents which , when eaten, have a beneficial effect on health. group of things working together.
gas exchange analysis
the following are measured or calculated: -fraction of inspired and expired oxygen and carbon dioxide -inspired and expred minute gas valume from these quantities Vo2 and Vco2 can be calculated
alterations in amount of sugar (cakes)
the more sugar, the more time is needed to reach the elevated coagulation temperature of the gluten. as sugar increases, the volume of cake increases up to the point where the volume is so great, and the gluten so weak, that the gluten strands snap and the cake falls in the center (gummy, crystalline appearance).
diabetic gastroparesis
the muscles of the stomach don't work normally, and the movement of food slows or even grinds to a halt as a result of vagus nerve damage related to prolonged elevated glucose levels. foods to avoid: alcohol, carbonated beverages, beans/lentils, corn, high fat foods, gas causing foods.
Diverticulosis
the presence of diverticula - small mucosal sacs that protrude through the intestinal wall due to structural weakness. Related to constipation and lifelong intra-colonic pressures.
gelatinization
the swelling that occurs when starch is heated in water close to the boiling point heat dissociates bonds, water moves in and swells granules friction is created causing paste to thicken
Theory Z (Ouchi)
the value of the company is the people. everyone who will be affected by a decision is involved in making the decision (consensus decision making)
Total nutrient admixtures (TNA)
thee in one systems, include dextrose, amino acids, and lipids.
Correlation coefficient r= 0
there is no linear relationship
Contemplation stage
thinking about making a change "I was looking at the salt content in the foods I have at home"
dripolator
three separate compartments; add boiling water to top and let dripo through; brief contact with grounds; free of bitterness
essential amino acids
threonine, valine, tryptophan, isoleucine, leucine, lysine, phnylalanine, methionine, histidine (TV TILL PMH)
Long term central access (PN)
throught he cephalic, subclavian or internal jugular vein into the superior vena cava.
productivity schedule
time sequencing of events required to produce a meal; employee assignments and menu items; quantity to prepare and the timing (what to do when)
quasi experimental design
time series - series of measurements at periodic intervals BEFORE the program begins and AFTER the program ends. I shows whether measurements before and after the program are a continuation of previous patterns or whether they indicate a noteworthy change.
protein functions
tissue synthesis, maintains growth, regulates body processes. inefficient energy source - nitrogen must be removed first (58% of protein can be converted to glucose)
USDA nationwide food consumption survey (NFCS)
to obtain info on food intake of individuals and total household from entire US evaluate 7 nutrients - protein, calcium, iron, thiamin, riboflavin, vitamins C, A. diets rated good if intakes equaled or surpassed RDA; rated poor if less than 2/3 of RDA for 1 or more nutrients.
cooking cheese
to prevent stringy, curdled-looking cheese products, cook for a short time at moderate temperatures.
causes of poor volume cake
too little baking powder, improper level of sugar or fat
causes of coarse textured cake
too much baking powder or sugar, oven temp too low, inadequate mixing
causes of tough, dry crumb cake
too much flour or egg, too much mixing, too little fat or sugar, over baking
Standards of Practice (SOP) and Standards of Professional Performance (SOPP)
tools for credentialed dietetics practitioners to use in professional development. They are not regulations, but may be used to determine competency. practice-specific SOP and SOPP are generalist, specialty, and advanced levels.
labor cost per meal
total labor expenses/total meals served
manganese
trace mineral function - central nervous system source - whole grains, legumes, nuts deficiency unlikely
fluoride
trace mineral function - teeth bones sources - soil, water
zinc
trace mineral. excess leads to copper or iron deficiency. function - increases taste acuity. Enhances insulin action. stabilizes DNA, RNA. Cell division. sources - meat, liver, eggs, fish, phystates and copper decrease abs.
iron
trace mineral. part of hemoglobin. food iron = ferric absorbable = ferrous stored = ferritin function - oxygen transport sources - heme iron from animal foods, meat, fish poultry. non-heme from cereals, vegetables, poorly absorbed;
iodine
trace mineral. part of thyroxine. sources - seafoods, iodized salt
copper
trance mineral. attached to protein ceruloplasmin. function - hemoglobin synthesis. aids iron absorption. sources - liver, kidney, shellfish
LDL (beta)
transports cholesterol from diet and liver to all cells.
chylomicron
transports dietary triglycerides from gut to adipose cells; synthesized in intestine from dietary fat; lowest density due to smallest amount of protein.
VLDL (pre-beta)
transports endogenous triglycerides from liver to adipose cell.
esophagitis
treat by decreasing gastric acidity, reflux. diet - small, low-fat, bland, low fiber; weight reduction?
homocystinurias
treatable. inhertied disorder of amino acid metabolism. characterized by severe elevations of methionine and homocysteine in plasma, and excessive excretion of homocystine in urine. associated with low levels of folate, B6, B12. newly diagnosed patients receive increased doses of folate, pyridoxine (B6), B12. if they don't respond - low protein, low methionine diet.
isoniazid
treats TB depletes pyridoxine, peripheral neuropathy, don't take with food, interferes with vitamin D, calcium, phosphorus
Action stage
tries to make the change "I removed the salt shaker from the kitchen table"
simple fats
triglycerides (3 fatty acids, 1 glycerol). most food fat is a triglyceride.
precursor for serotonin and niacin
trptophan
parallel forms
two separate but similar forms of the same test at the same time. reliability determined by the degree to which the sets of scores coincide.
phenylalanine is converted to...
tyrosine
end stage renal disease (ESRD)
usually associated witha BUN >100 mg/dl, and Cr 10-12 mg/dl. retention of N metabolites - may use Giobenatti diet - 20 grams protein (HBV), increases calories; control edema, prevent deficiencies.
Anaerobic (sous vide) storage
vacuum-packing meat in an oxygen-impermeable film, stored unfrozen at 0 degrees celsius.
nominal (non-ordered)
variables that fit into a category withno special order (gender, race, marital status, present or absent)
p <.01
very significant difference, more reliable results
p < .0001
very, very significant, reliable results
Acquired immune deficiency syndrome (AIDS)
virus debilitates immune system by attacking lymphocytes. diarrhea, malabsorption, nausea, vomiting, weight loss.
rice cookery
vitamins are lost when cooked in excess water or when water is drained off. cook in amount of water that will be absorbed during cooking (1 cup rice = 2 cups water)
Cheese production
warm milk, add lactic-acid bacteria, add enzyme rennet to coagulate casein forming the curd, separate curd from whey (liquid)
loss of colon
water and electrolyte loss, loss of salvage absorption of CHO and other nutrients.
folate
water soluble PABA is precursor function - DNA synthesis, forms RBC in bone marrow, prevents neural tube defects sources - fortified dry cereal, liver, kidney, green leafy vegetables, citrus fruits, lentils, beans
Vitamin B2
water soluble Riboflavin. lost in UV light function - energy release from pmrotein. red cell production sources - liver, kidney, meat, milk.
Vitamin B12
water soluble cyanocobalamin. contains cobalt. bound by intrinsic factor in gastric juice function - coenzyme in protein synthesis. forms RBC. sources - liver, meat, milk, kidney, eggs, fish, cheese
pantothenic acid
water soluble function - coenzyme A - energy synthesis of fatty acids. sources - animal foods, grains, legumes
Niacin
water soluble precursor: tryptophan. Essential in all cells for energy production and metabolism function - metabolism of CHO, protein, fat sources - protein, peanuts, ready to eat cereals, chicken, rice, yeast, milk
Vitamin B6
water soluble pyidoxine. INH - ioniazid (B6 antagonist) function - coenzyme in amino acid metabolism: deamination, transamination sources - meat, wheat, corn, yeast, pork, liver, readyt to eat cereals
Congressional index
weekly update; identifies bill with sponsor and committee.
pediatric 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 the child has serious medical conditions.
Master work schedule
werves as overall plan; days on and off, vacations, basis for developing weekly schedules
variable of interest
what researches are observing
colostrum
yellowish transparent fluid secreted from the breast during first few days; meets infants needs during first week; has more protein, less fat and carbs than mature milk; has antibodies.
sophistication - inexperienced
young children, some adults lacking nutrition training; need thorough introduction and background.
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.
functional foods
provide more benefits than the basic nutritional benefits
fiber
provides indigestible bulk, promotes intestinal function.
Maintenance stage
sustains the change for six months or longer "I found a website that helps me plan family low sodium meals"
anabolism
synthesis of a more complex substance
biotin
synthesized by intestinal bacteria, inactivated by avidin (protein in raw egg white) function - binds calcium, zinc, iron membrane structure sources - liver, kidney, egg yolk, yeast
feedback (response)
tells you whether or note the correct message has been received.
nutrition informatics
the intersection between nutrition information and technology. use of technology in spreading information MIS is an electronic system that manages information
custards
the larger the % sag, the more tender the gel. custard from dehydrated eggs is lower quality.
breakeven point
the point where total costs equal total revenue. any sales in the excess of breakeven point will yield a profit and sales less than the breakeven point will thus be a loss.
Job breakdown
what to do and how to do it - no time limits used in training.
correlation coefficient r = 1
when all points lie exactly on a straight line with a positive slope
correlation coefficient r = -1
when all points lie on a straight line witha negative slope.
Ag- Ab reaction
when antigen enters body, antibody reacts
when to add acid in cooking starches
when cooking is complete, because acid breaks down starch and will give a runny product ex: if lemon juice is added to lemon meringue pie before cooking is complete, filling will be runny.
Diverticulitis
when diverticula become inflamed as a result of food and residue accumulation and bacterial action.
roasting
when meat is removed from oven, "carry-over cooking" occurs for about 10 minutes. Internal meat temperature will rise 15-25 F. allow roast to stand 30 minutes before carving
milk in food prep
when milk is heated, whey protein precipitates out on bottom of pan or on surface of milk. to prevent a film from forming, cover or beat the milk to produce a foam. to prevent milk from coat on sides of pan, heat over water to prevent curdling, add an acid slowly and agitate (precipitates casein)
strategies for Type 1 DM
with fixed daily doses of insulin, consistency of CHO is recommended. integrate insulin therapy with usual eating habits. monitor blood glucose and adjust insulin doses for amount of food eaten. with intensive insulin therapy, adjust pre-meal insulin dosages based on total CHO content of each meal, using an insulin to CHO ratio. for planned exercise, reduction in insulin dosage may be best choice. Endurance Athletes: 120-180 mg/dl is guideline during activity.
Intracellular water
within cells, ICW
creaming
work on or more foods until soft and creamy
Scientific management - Taylor
work-centered - workers must work at fastest pace possible and at maximum efficiency; systematic approach to improving worker efficiency. Structure work situation to minimize motivation needed by supervisor. find the best way of performing tasks. focus on physical aspects of the job.
Structured (directed) interview
use checklist or preplanned strategy; gives same information on all; minimizes personal biases.
Fish cookery
use dry or moist heat. more perishable than meat so store at lower temps fresh fish with head attached should have bright red gills and bright shiny skin...reject if gills are dull and gray.
retrospective cohort studies
use existing data set and look back for relationship between exposure factors and outcomes.
yeast dough
use high protein bread flour yeast ferments sugar and releases co2
White pigment
Anthoxanthins or flavones soluble in water colorless in acid yellow in alkaline
NSIP Nutrition Services Incentive Program
AoA Administration on Aging developed services to foster independent living; cash and commoditites to state agencies.
Family and Medical Leave Act 1993
Applies to public agencies and private agencies employing >50 workers. up to 12 workweeks of unpaid, job-protected leave during andy 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.
rapid-acting insulin
Aspart (novolog), Lispro (humalog); takes 5-15 minutes before eating, usual duration 4 hours.
when do you evaluate the educational process?
Assessment
NFP - skin
Assessment - pale, dry, scaly Considerations - iron, folic acid, zinc deficiency
NDD3 (Dysphagia Advanced)
Avoid very hard, sticky, crunchy foods, hard fruit and vegetables, nuts, seeds.
altered neurotransmitter theory
BCAA decreased (used by muscles for energy); AAA (aromatic amino acids) increase because damaged liver is unable to clear them. adding BCAA - adds calories and protein; may not reduce symptoms. used when standard therapy does not work and when patient does not tolerate standard protein. standard treatment is lactulose (hyperosmotic laxative that removes nitrogen); neomycin (antibiotic that destroys bacterial flora that produce ammonia).
Standard polymeric enteral formula
Cheapest normal GI function, most provide 1-1.5 cals/cc lecithin may be added as an emulsifier initiated full strength at a rate of 10-40 ml/hour modular: mix individual components, adds flexibility. blenderized: whole food, large bore tube, thick intact protein, high residue. Least expensive formulas: intact protein (not pre-digested),a nd isotonic osmolality is close to that of blood)
Normal ranges for anions
Chloride - 96-106 mEq/L Phosphorus - 3-.4.5 mg/dl
Gallbladder disease
Cholecystitis - inflammation of gallbladder. an infection causes excess water to be absorbed causing cholesterol to precipitate out leading to gallstones - cholelithiasis. treatment - low fat diet: acute 30-45 grams; chronic 25-30% of calories. cholecystectomy - surgical removal of gallbladder; bile now secreted from liver directly into intestine.
Obesity
Class I = 30-34.9 Class II = 35-39.9 Class III= >/= 40 Children: BMI for sex and age >/= 95th percentile early rapid weight loss during diet is water - as liver glycogen is utilized. treatment - diet, exercise, behavior modification.
why does tea inhibit iron absorption
Compounds in tea called tannins can act as chelators, binding to minerals and inhibiting the body's ability to absorb them.
CARS checklist for evaluating information
Credibility - checks credentials of author Accuracy - info is current, factual and comprehensive Reasonableness - is into fair, balanced and consistent Support - is supporting documentation cited for scientific statements
nutrition screening initiative (elderly)
DETERMINE checklist. 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
Medicaid
DHHS federal law administered by states. payment for medical care for all eligible needy: all ages, blind, disabled, dependent children.
Headstart
DHHS helps low income children; ages 3-5 introduces new foods, teaches good food habits child's participation in food activities is important
Healthy Start
DHHS reduce infant mortality an improve health of low income women, infants, children, families
Maternal and Child health Block Grant
DHHS under Title V of the Social Security Act. fosters public health nutrition programs at the state and local levels. provides training, consultation, funding. women of child-bearing age, infants, children; state eligibility requirements.
Lab values for anemias
Microcytic Hypochromic: RBCs normal, HGB low, HCT low, MCV low (<80), MCH low, MCHC low (<31) Macrocytic: RBC decreased, HGB low, HCT low, MCV high(>95) , MCH high, MCHC normal (>31)
Fresh produces (grade)
Fancy, Extra #1, #1, combination, #2
MNT for acute kidney injury/acute renal failure
First, IV glucose, lipids, protein. - 1-1.3 g/kg if non-catabolic without dialysis as GFR returns to normal. 1.2-1.5 g/kg if catabolic and/or initiation of dialysis. 20-30 cals/kg, BEE x stress factor (1.2-1.3) during hypermetabolic conditions. low sodium (2-3 grams), replace losses in diuretic phase. 8-15 mg/kg phos. may need phosphate binders. 2-3 grams K based on output, serum K, dialysis. replace fluid output from previous day plus 500 ml.
canned fruits and vegetables (grade)
Grade A - desserts, salads (fancy) Grade B - processed (choice) Grade C- puddings, pies (standard)
synergy
Groups working together to one final product. the groups product (decision) is superior to what the most resourceful individual within the group could have produced by working alone
Osteoporosis treatment
HRT - hormone replacement therapy, weight-bearing exercise, vitamin D (400-800 mg) and calcium (>/= 1200 mg, don't exceed 500-600 mg at one time) supplements, adequate protein, moderate to low sodium, 5 servings of fruit and vegetables.
statins (HMG CoA reductase inhibitors)
decreased LDL, TG; increase HDL
healthy obese
elevated LDL, normal to low HDL
Yohimbe
elevates blood pressure in energy drinks
protein in pregnancy and lactation
71 grams during second half of pregnancy and lactation
proprionate
presevative; mold inhibitor
sophistication - very experienced
"nutrition experts:, limit audience participation at first; establish yourself as the expert; cit credentials; lecture format with audiovisuals.
turnover rate
% of employees leaving the organization within the reporting period. calculated by taking the number of employees leaving the organization during the reporting period by divided by the total number of employees in the organization during the same period, multiplied by 100.
composition of breast milk vs. cows milk
% pro - 7 (human), 20 (cow) %CHO - 38 (human), 30 (cow), %Fat - 55 (human), 50 (cow) breast milk has more lactalbumin
metabolic alkalosis
(ketosis) loss of hydrogen due to loss of acid; or an increased retention of base. to compensate, ventilation decreases to retain carbon dioxide to make carbonic acid
Wheat flours
(listed in order of pro. content, high to low) graham, whole wheat bread (hard wheat) AP (blend of hard and soft wheat) Pastry (soft wheat) cake (soft wheat) enriched instant blending/agglomerated, instantized self rising
mEq =
(mg/atomic weight) * valence Na = 23 AW, 1 valence K = 39 AW, 1 valence Ca = 40 AW, 2 valence Mg = 24 AW, 2 valence Cl = 36 AW, 7 valence
incidence
(number of NEW cases of a disease over a period of time/total number of people at risk) x 100,000
labor turnover rate
(number of employees (separated) terminated and replaced/ total positions in department) x 100
alpha-linolenic
(omega 3) retinal function and brain development; deficiency results in neurological changes - numbness, blurred vision comes mainly from fish oils (EPA eiocosapentaenoic acid, DHA docosahexaenoic acid) walnuts, flaxseed, canola decreases hepatic production of triglycerides (inhibits VLDL syntheiss); little effect on total cholesterol levels
linoleic acid
(omega 6) lack creates excema, poor growth rate, petachiae (red, purple skin spots) if linoleic acid replaces CHO: LDL lowers, HDL increases if linoleic acid replaces saturated fat: total cholesterol lowers, HDL lowers safflower is teh best source
prevalence
(total number of people with a disease during a period of time/ average number of people) x 100,000
calories during pregnancy
+340 second trimester; +452 3rd trimester
low fat milk
.5-2% fat
serum creatinine
.6-1.4 mg/dl related to muscle mass; measures somatic protein may indicate renal disease, muscle wastage.
normal serum creatinine levels
.6-1.5 mg/dl. increased in renal disease and in catabolic states and decreased in very malnourished individuals and those with minimal muscle mass.
dietary protein requirements
.8 grams/kg body weight (10-15% of total energy intake)
strength of correlation
0-0.2 very weak .2-.4 weak,low .4-.7 moderate .7-.9 strong, high .9-1 very strong, very high
RQ for fats
0.7
RQ for protein
0.82
RQ of a mixed diet
0.85
RQ for carbohydrates
1
gel formation
1 T gelatin will gel 1 pint liquid. mix with cold water to soften. Add hot water to disperse.
rate of weight gain during pregnancy
1 lb/month 1st 3 months; 1 lb per week thereafter.
soft dough
1 part liquid 3 parts flour ex: bread
pour batter
1 part liquid, 1 part flour ex: waffles
drop batter
1 part liquid, 2 parts flour ex: muffins
stiff dough
1 part liquid, 4 parts flour ex: pie crust
Budget development
1. controls and coordinates activities. 2. indicates how and at what rate dollars are to be expended 3. consider the following in preparation: expenditures of preceding period, present budget, changes in present budget period, expenditures of present period, budget requests for next period.
Steps in program planning
1. develop mission statement (philosophy) and needs/problem statement 2. set goals - broad direction, general purpose (increase quality and years of life) 3. set objectives -SMART goals
steps in research
1. identify a relevant and important topic - review literature 2. develop well-considered research question (who, what, how) 3. research question leads to a hypothesis 4. prepare research protocol 5. organize methods and materials 6. collect and analyze data 7. study results and make decisions
community and group nutrition status indicators
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. 2. most nutrition problems are commonly found among groups or areas which are socially, economically, educationally and/or medically deprived. 3. HRA health risk appraisal
Enteral formula calculation
1. select formula and determine calories needed. 2. divide calories needed by cal/ml to determine mls formula needed per day. 3.determine protein content: multiply mls of daily formula by grams of protein per liter. 4. determine daily fluid need: multiply % water in formula x daily formula in mls to determine water contribution of enteral nutrition. Subtract formula water from total fluid requirements to determine water flushes. determine administration rate: divide total mls of formula/day by 24 hours to determine continuous feeding goal rate.
Heart failure etiology
1. weakened heart fails to maintain adequate output, resulting in diminished blood flow so fluid is held in tissues (edema); dyspnea (shortness of breath) 2. reduced blood flow to kidneys causes secretion of hormones that hold in sodium and fluid leading to weight gain.
nutrition for hemodialysis
1.2 g pro/kg SBW(standar body weight), at least 50% HBV <60 y 35 cals/kg, >/= 60 y or obese 30-35 calories/kg >/= 1 L fluid output - 2-4 g sodium and 2 L fluid <1 liter fluid output: 2 grams sodium and 1-1.5 L fluid. Anuria: 2 grams sodium and 1 L fluid 40 mg/kg IBW (2-3 grams) potassium. calcium: individualized with maximum 2 g elemental total. 800-1000 mg phos or <17 mg/kg IBW or SBW vitamins C, B6, folate, B12 supplements: DRI for others. zinc DRI 8-11 mg/day, individualize for Fe and vit. D.
Activity factors
1.2 sedentary 1.3 active 1.5 stressed
Nutrition for Periotoneal dialysis
1.2-1.3 g pro/kg SBW or adjusted BW; >/= 50% HBV <60 years 35 cals/kg (including dialysate) >/= 60 years of age 30-35 calories/kg 2-3 grams sodium - based on blood pressure and weight. potassium generally unrestricted (usually 2-4 grams) </= 2000 mg total elemental calciu including diet and binders. 800-1000 mg phos or 10-15 mg phos/g pro. 1-3 L fluid depending on output, cardiac status. CAPD - continuous ambulatory periotoneal dialysis 4-5x per day VM as for hemodialysis except thiamin (may need extra due to loss)
2002 DRI's for development of fetal nervous system
1.4 g/day linolenic acid (300 mg DHA), 1.3 g/day (lactation)
2% milk
1.5-2.5% fat
Treatment of heart failure
1.digitalis increases strength of heart contraction. 2. diuretics - nutrient loss, glucose intolerance, increased serum uric acid 3. diet: low sodium (2-3 grams), DASH diet, fluid restriction if needed 4. 1.2 g protein/kg (normally nourished, stable); >1.37g/kg (stable, depleted) 5. evaluate thiamin status (loss with loop diuretics). Without thiamin, pyruvate cannot be converted into acetyl CoA for energy, so heart muscle is deprived. 6. DRI for folate, Mg; MV with B12.
serum ferritin
10-150 ng/ml women, 12-300 ng/ml Men indicates size of iron storae pool
BUN (blood urea nitrogen)
10-20 mg/dl (renal protein should keep BUN under 100) indicator of renal disease BUN: creatine ratio should be 10-15:1
Desirable/ideal body weight (women)
100 lbs for 1st 5', add 5 lbs for each additional inch. subtract 5 lbs for each inch under 5'. small frame: subtract 10% large frame: add 10%
Desirable/ideal body weight (men)
106 lbs for first 5', add 6 lbs for each additional inch. subtract 6 lbs for each inch under 5'. small frame: subtract 10% large frame: add 10%
AGA (appropriate for gestational age)
10th - 90th percentile
recommended HGB for pregnancy
11 g/dl
PT (prothrombim time)
11-12.5 seconds; 85-100% of normal anticoagulants prolong PT evaluates clotting adequacy; change in vitamin K intake will alter rate
Urinary creatinine clearance
115 +/- 20 ml/minute measures GFR - glomerular filtration, renal function estimate includes body surface area (height and weight)
#3 can
12 in case 46 oz. 5/3/4 cups 12-15 servings
safe minimum internal temperatures
145 F: pork, beef, veal, lamb, steaks, roast, fish 160 F: ground beef, groudn veal, ground lamb 165 F: turkey, chicken, duck
nutritive value of meats, poultry, and fish
15-23% protein glycogen in liver, glucose in blood thiamin, niacin, riboflavin, iron, copper, trace minerals *pork is a good source of thiamin
personal zone
18"-4', when giving instructions or working closely
calories during lactation
1st 6 months +330, 6-12 months +400
lactation - human milk
20 calories/ounce maternal hormones from pituitary; prolactin stimulates milk production; oxytocin moves milk through ducts
infant formula
20 calories/ounce; need 2.5 oz/lb/day has more protien, more iron than human milk but lacks antibodies. vitamin D requirement is met if infant receives at least one quart of standard vitamin D fortified infant formula per day formula fed infants only need fluoride as a supplement, after 6 months of age, if water supply is inadequate.
BUN:creatinine ratio
20:1 = "pre-renal state" in which BUN reabsorption is increased due to acute kidney damage (may be reversible and may not require dialysis) <10:1 suggests reduced BUN reabsorption due to renal damage (may need dialysis).
MNT for CKD
23-35 kcal/kg or BEE x activity factor. Adjust for weight gain or loss. <2400 mg/day sodium. protein restricted when GFR ml/minute falls. stage 1 and 2 = .8-1.4 g/protein/kg stages 3 and 4 .6-.8 g protein/kg phos: stages 1,2 = to maintain normal serum level; stages 3/4 800-1000 mg/day or 10-12 mg/g protein. potassium generally not restricted unless serum level is elevated and urine output is <1 liter/day fluid generally unrestricted.
#2.5
24 in case 1 lb 13 oz. 3.5 cups 6-8 servings
#2 can
24 in case 1 lb. 4 oz. 2.5 cups 4-6 servings
#300 can
24 in case 14-16 oz. 1/34 cups 3-4 servings
weight gain guidelines for pregnancy
25-35 lbs for normal weight female (BMI 18.5-24.9) 28-40 lbs for underweight female (BMI <18.5) 15-25 lbs for overweight female (BMI 25-29.9) 11-20 lbs for obese (BMI >/= 30) target is at least lower limit for black and very young women, strive to achieve upper end to reduce risk
normal birth weight
2500-4000
dried whole milk
26% fat, does not keep well.
metabolic syndrome
3 or more of the following risk factors are linked to insulin resistance which often increase risk for coronary events 1. elevated blood pressure >/= 130 systolic, and/or >/= 85 diastolic 2. elevated TG >/= 150 mg/dl 3. fasting serum glucose >/= 100 mg/dl Waist measurement >/= 102 cm (40") men; >/=88cm (35" women) 5. low HDL < 40 mg/dl (men), < 50 mg/dl (women)
Peripheral parenteral nutrition protein
3-15% amino acid solutions
TTHY transthyretin, PAB prealbumin
3-6 mg/dl circulates with prealbumin; shortest half-life (12 hours) binds and transports retinol
IV dextrose
3.4 calories/gram to figure calories (ml) (%) (3.4) highest concentration of dextrose used in peripheral nutrition 10%.
Serum albumin
3.5-5.0 g/dl visceral protein (blood and organs) maintains colloidal osmotic pressure hypo-albuminemia associated with edema, surgery levels above normal range likely due to dehydration long half-life, does not reflect current protein intake
recommended HCT for pregnancy
33%
TPN solutions - energy
35-50 calories/kg; up to a 70% dextrose solution. a 10% solution provides 100 g/liter to avoid overfeeding and hyperglycemia, start at </= 20-25 calories/kg. maximum rate of dextrose infusion should not exceed 4-5 mg/kg/minute to prevent hyperglycemia and other complications; increased blood glucose from excess dextrose increases RQ in ventilated patients and increases infectious complications.
Nutrition care outcomes
4 categories food/nutrition related history, lab data and medical tests, anthropometrics, nutrition focused physical finds.
social zone
4-12', most business interactions
breast fed infants need
400 IU vitamin D from birth and .25 mg fluoride/day after 6 months of age if water contains inadequate fluoride
vitamin D milk
400 USP unites added per quart of milk by feeding cow vitamin D, irradiating the milk, or adding the vitamin.
focus group
5012 people brought together to talk about concerns, beliefs, problems obtain advice, insights and information; contributes attitudinal data
#10 can
6 in case 6 lbs. 9 oz. 13 cups 20-25 servings
eggs - nutritive value
80 calories, 6 grams pro., 5 grams fat, vitamins A, D, riboflavin. yolk i more concentrated than white: has more protein (by weight), fat, minerals, vitamins fat is present in an emulsified form color of yolk depends on amount and type of pigment in hen's diet
CHI creatinine height index
80% is normal ratio of creatinine excrete / 24 hours to height estimates lean body mass - somatic protein 60-80% mild muscle depletion
nutritive value of milk
87% water, 3.7% fat, 4.9% CHO (lactose), 3.5% protein (80% casien) good soruce of calcium, phosphorus, riboflavin, viatmins A and D low in iron
AI for calcium for pregnancy and lactation
</= 18 years -1300 mg >18 years -100 mgs
renal damage BUN:Cr ratio
<10:1 suggests the need for dialysis therapy.
body mass index for age percentiles
<10th percentile = underweight 10th-85th percentile = normal weight >85th-90th percentile = overweight >90th percentile = obese
SGA (small for gestational age)
<10th percentile birth weight for gestational age
at risk of adequate weight gain during pregnancy
<16 or >/= 35 years of age; < 12 months between prengancies
very low birth weight
<3.3 lbs (<15000 g); <1000 g ELBW
low birth weight
<5.5 lbs (< 2500 grams)
macronutrient distribution based on DRI's for healthy adults
<7% total cals as satruated fat, trans fat intake should be minimized. encourage fiber intake, sucrose may be substituted for other carbs.
serum transferrin
>200 mg/dl visceral protein serum level controlled by iron storage pool rises with Fe deficiency can be determined from TIBC (total iron binding capacity)
pre-renal BUN:Cr ratio
>20:1 BUN reabsorption is increased due to acute kidney damage. may be reversible and often does not require dialysis therapy.
TLC (total lymphocyte count)
>2700 cells/cu mm measures immunocompetency moderate depletion 900-1800, severe depletion <900 decreased in protein-energy malnutrition
waist circumference
>40 Males, >35 Females is independent risk factor for disease when out of proportion to total body fat ( with BMI of 25-34.9)
LGA (large for gestational age)
>90th percentile
analysis of variance
ANOVA; tool used to evaluate validity asks whether the difference between samples is a reliable one that would be repeated used when several products compete against one another compares the variance between groups with the variance within groups answers: are tehre one or more significant differences ANYWHERE among the samples?
Therapeutic lifestyle change (TLC)
Adult treatment Panel III Up to 355 calories form total fat, <7% from saturated fat, 5-10% PUFA, up to 20% MUFA, <200 mg cholesterol. 25-30 grams fiber (half soluble) stanols and sterols inhibit cholesterol absorption (2-3 g/day) maintain DBW, prevent weight gain. increase physical activity to at least 30 minutes of moderate intensity most days (to expend at least 200 calories)
Difference between Altered GI function and Impaired nutrient utilization
Altered GI looks at problems inside the GI tract including exocrine functions of the liver and pancreas, which changes in digestion, absorption, and/or elimination. Impaired nutrient utilization refers to problems with the metabolism of nutrients once they have entered the circulatory system. This includes the endocrine functions of the pancreas, liver, pituitary, and parathyroid.
Vitamin B1 (thiamin) deficiency
Beriberi, muscle weakness, foot drop, memory loss, tachycardia
Stages of legislative process
Bill/resolution --> Sent to committees which schedule public hearings to hear testimony of bill's sponsors --> markup session where committee revises bill and put into final form --> rules committee for debate --> approval from both houses and the president. Differences between the two houses are worked out in a joint house-senate conference committee --> reconciliation bill Appropriations bill must be passed to provide funding Formulate regulations that interpret and operate the law -federal regulation interprets a law and provides details and rules that put the policy into effect. -regulations are written by staff members of the agencies charged with enforcing the regulations.
Carbohydrate food list
CARBS starch/bread = 15 g CHO, 3 g pro, 1 g fat, 80 cals fruit = 15 g CHO, 60 cals 1% milk = 12 CHO, 8 g pro, 0-3 g fat, 100 cals. 2% milk = 12 g CHO, 8 g pro, 5 g fat, 120 cals whole milk = 12 g CHO, 8 g pro, 8 g fat, 160 Cals sweets/desserts = 15 g CHO, pro/fat/cals varies. non-starchy veg = 5 g CHO, 2 g Pro, 25 cals PROTEINS lean = 7 g pro, 2 g fat, 45 cals medium fat = 7 g pro, 5 g fat, 75 cals high fat = 7 g pro, 8 g fat, 100 cals plant based pro = 7 g pro, CHO/fat/cals varies. FATS = 5 g fat, 45 cals free foods = <20 cals and <5 grams CHO per serving
High fiber diet may increase need for
Ca, Mg, P, Cu, Se, Zn, Fe
OAA Older Americans Act Nutrition Program (formerly ENP ELderly Nutrition Program)
DHHS title III one hot meal each day, 5 days/week, provides 1/3 recommended intake eligibility: all aged 60 and older plus spouse, regardless of income. congregated meals - ambulatroy; transportation essential for rural elderly home delivered meals- meals on wheels - must be homebound counseling nutrition eduction, referrals, social interaction
Prospective payment system
DRG's - diagnostic related groupings. Part of TEFRA (tax equity and fiscal responsibility act) Prospective payment means knowing the amount of payment in advance. Includes Medicare and medicaid patients. basis for payment are the DRG's patients are classified on basis of the ICD - international classification of diseases hospitals paid specific amount per patient based on the diagnosis.
glucagon-like peptide-1 (GLP-1) agonist
Exenatide (byetta) enhacnes insulin secretion, suppresses
Fresh Fruit and Vegetable Program
FFVP introduced children to fresh fruits and vegetables free to children nationwide in selected schools
HIPAA
Health Insurance Portability and Accounting ACT 1996 allows employees to transfer coverage of existing illness to anew employer's insurance plan
LDH lactic acid dehydrogenase (liver function test)
Increased in hepatitis, myocardial infarction, muscle malignancies.
intracellular electrolytes
K+, Mg++, P
IDL (pre-beta to beta)
LDL precursor; found in circulation secondary to catabolism of other lipoproteins.
Assessment of risk (NCEP, AHA)
LDL-C: <100 optimal Total cholesterol: <200 desirable HDL-C: <40 low (M), <50 low (F); >/= 60 high high homocysteine (Hcy) levels are independent risk factors for CHD. Normal TG <150
Specialized enteral formulas
Most expensive Nepro, Novasource Renal - renal Nutre, Pulmocare, Respalor: high fat, low carb - pulmonary Hepatic Aid II, NutriHep - liver Glucerna, Diabetisource - diabetes the more specialized the formula, the greater its cost.
intermediate-acting insulin
NPH (Humulin, Novolin) onset 2-4 hours, duration 10-16 hours
Extracellular electrolytes
Na+, Ca++, Cl, HCO3 (bicarbonate) NaCl is 40% sodium. ONe tsp of salt has 6 grams of NaCl so has 2.4 grams of sodium. sodium is reabsorbed by aldosterone, and retained by steroids.
Strong heart diet study for cardiovascular disease and diabetes
Native American Diets; tried to determine causative factors of obesity something other than intake, perhaps genetics, low physical activity consume 12% fewer calories than the average US population, yet significant increases in heart disease and diabetes
MNT for chronic pancreatitis
PERT - pancreatic enzymes orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase. MCTs do not require pancreatic lipase. Add to mixed dishes, jams, jellies. To promote weight gain give maximum level of fat tolerated without an increase in steatorrhea or pain. if malabsorbing fat soluble vitamins give water soluble forms; parenteral B12? pancreatic bicarbonate secretion may be defective --> may need antacids so PERT therapy will work. avoid large meals with fatty foods, alcohol.
medical foods
PKU formulas free of phylalanine
fat in margarine
PUFA, MUFA, SAT
HIPAA guidelines (health Insurance Portability and Accountability Act)
Permanent legal document; entries 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 late entries should be identified as such; actual date, time of entry and the date and time it should have been recorded. when diet orders are not chosen correctly, contact the person who wrote order. corrections - never use white-out, thick markers, or remove an original and replace it with a copy. draw single line through error, then enter the correction, initial, date. omitted information:"see addendum," enter date and initial. Write the addendum in chart sequence, identify it as an addendum and reference the original entry. sign.
Eggs - structure
Porous shell - exchanges moisture and gases; covered with bloom that prevents excessive loss and protects contents inner membrane contracts leaving air space in large end air space becomes larger with age good quality indicated by high proportion of thick white yolk is surrounding by vitelline membrane chalazae (yolk anchors) hold yolk in center egg yolk is naturally occurring in oil in water emulsion
PES statement
Problem (diagnostic label), adjective that describes the human response one etiology (cause/contributing risk factors) linked to the problem by words "related to" Assessment of signs (objective data, observable changes) and symptoms (subjective data) linked to etiology by words "as evidenced by" Ex: inadequate vitamin A intake related to knowledge deficit of food sources of vitamin A as evidenced by night blindness
Four P's of marketing
Product, , Place, Price, and Promotion
What food is least likely to cause an allergy?
Rice
fat in butter
SAT, MUFA, PUFA
normal ranges of cations
Sodium - 136-145 mEq/L Potassium - 3.5-5 mEq/L Calcium - 4.5 -5.5 mEq/L magnesium - 1.5-2.5 mEq/L
Blood pressure management
Thiazide diuretics may induce hypokalemia. four modifiable factors in primary prevention and treatment - overweight, high salt intake, alcohol consumption, physical inactivity. salt restriction </= 2400 mg Na (6 g salt); decrease weigt if needed. DASH diet.
ASP After school snack programs
USDA provides healthy snacks schools receive cash subsidies for each snack served same eligibility bases as NSLP
Concerns for parenteral nutrition
Translocation of bacteria; not feeding through gut allows wall to break down, bacteria move out causing sepsis. GALT
Ebb phase
Trauma hypovolemia(decreased volume of circulating blood in the body.), shock, tissue hypoxia
Management by objective (MBO) - Drucker
Type of DEMOCRATIC management that provides control from within. Establish performance goals WITH employees. Gives higher incentive value, overall control achieved through self control by employees, management stresses accomplishments and results. PARTICIPATIVE leadership.
AST, SGOT aspartate amino transferase (liver function test)
UL = 0-35 increased in hepatitis decreased in uncontrolled diabetes with acidosis
ALP alkaline phosphatase (liver function test)
UL = 30-120 increased in liver disease and bone disease decreased in scurvy and malnutrition
ALT, SGPT alanine aminotransferase (liver function test)
UL = 4-36 increased in liver disease
SBP school breakfast program
USDA entitlement program, meals must meet dietary guidelines breakfast must provide on average over each school week: 1/4 daily recommended levels for protein, calcium, iron, vitamin A, vitamin C
WIC Special supplemental nutrition program for Women, INfants, and Children
USDA for pregnant, postpartum, breastfeeding women, infants and children up to 5. provides food for low income mothers at nutritional risk (abnormal weight gain, history of high risk, BW, underweight, overweight, anemia). risk: weight, height, head circumference in infants, hemoglobin, hematocrit provides food nutrition education, referrals to other agencies. Must meet income standards, be at nutritional risk, and in need of foods offered. NOT an entitlement program - cap on amount of fedreal dollars allocated
SFMNP Senior Farmers' market Nutrition Program
USDA grants to states to provide low income seniors with coupons to be exchanged for eligible foods at farmers' markets, roadside stands, community supported agriculture programs (CSA) fresh, nutritious, unprepared fruits, vegetables herbs, and honey may be limited to specific and locally grown foods nutrition education and information is provided (how to select, store, prepare)
Special Milk Program
USDA purpose is to encourage consumption of milk by children objective is to provide subsidy for milk served to children in participating schools, child care centers, summer camps not participating in other federally subsidized meal programs, and free milk to needy
CACFP Child and Adult Care Food Program
USDA supports public and non-profit food service programs for family day care centers, neighborhood houses, homless shelters, non-residential adult daycare centers. reimburses operators for meal costs, provides commodity foods and nutrition education materials must serve meals that meet guidelines; must offer free or reduced price to eligible eligibility standards same as NSLP
NET Nutrition Education Training Program
USDA 1977 amendment to school Lunch Act provides nutrition education training to teachers and school foodservice personnel.
SFSP summer Food Service Program
USDA school lunch entitlement program, purpose is to initiate, maintain or expand foodservice programs to children when school is not in session objective to to provide meals or snacks to children at participating institutions in poor areas administered by FNS, state educational agencies, public or private nonprofit residential summer camps
Healthy eating index
USDA's overall measure of diet quality. measures how well Americans follow the Guidelines. 5 food groups, 4 nutrients (fat, saturated fat, cholesterol, sodium), variety.
Nasoduodenal or nasojejunal (EN)
Used if unable to tolerate gastric feedings.
Renin
Vasoconstrictor secreted by glomerulus when blood volume decreases. stimulates aldosterone to increase sodium absorption and return blood pressure to normal.
respiratory quotients (RQ)
Vco2 carbon dioxide expired / vo2 oxygen consumed used in critically ill to lower RQ, increase fat intake
Vitamin B1
Water soluble. Thiamin. lost as temp or pH rises. heat stable in acid function - oxidation of CHO. Increased CHO need metabolism of pyruvate. sources: grains, wehat germ, pork, liver
direct cost
a cost than can be completely attributed to the production of specific goods or services. ex: goods sold, salary, direct operating
Medical diagnosis
a disease or pathology that can be treated or prevented. It does not change as long as the condition exists.
meal equibalent
a measure of productivity defined as the amount of all food sales divided by the average cost of a typical (prototype) meal.
cookies
a modified shortened cake; higher in fat, lower in sugar and liquid
MNT for Hiatal hernia
a protrusion of a portion of the stomach above the diaphragm into the chest. small, bland feeding; avoid late night snack, caffeine, chili powder, black pepper.
NCP nutrition care process
a standardized, consistent structure and framework used to provide nutrition care. This is different from standardized care, which infers that all patients receive the same care.
normal blood flow
abdominal veins, esophageal veins, collateral veins --> portal vein --> liver --> vena cava
relevance or validity
ability to measure phenomenon it intends to measure
reward power
ability to reward another for carrying out an order, give incentives, praise to reinforce certain behaviors
Conceptual skills
ability to see organization as a whole. importance increases at HIGHER ranks of management.
Human skills
ability to work effectively as a group member. important ALL levels but imperative at LOWER levels of management.
Food intolerance (Non-IgE)
abnormal physiologic response, GI, cutaneous, respiratory symptoms, but NO antibody production.
essential fatty acids
absence will create a specific deficiency disease
chromium
absorption enhanced by vitamin C, niacin, ultra-trace mineral. function - aids insulin action. glucose metabolism. sources - yeast, oysters, potatoes, liver.
distal ileal resection
absorption of B12, intrinsic factor, bile salts. ileum normally absorbs major portion of fluid in GI tract. patients have above average needs for water to compensate for excessive losses in the stool. Drink at least 1 liter more than their ostomy output daily.
Atherosclerosis
accumulation of lipids; structural and compositional changes in the intimal layer of the large arteries. risks - HTN, obesity, smoking, elevated blood lipids, heredity
control of crystal size
acid (cream of tartar, vinegar), fat (chocolate, milk), protein (milk, egg whites, gelatin) inhibit crystals - keeps crystals small and smooth
affective domain of learning
acquisition of attitudes and values (sujective)
cognitive domain of learning
acquisition of knowledge or subject matter (factual)
psychomotor domain of learning
acquisition of muscular skills (exercises, food prep)
lobbying
activities aimed at influencing public officials and legislators.
Nutrition diagnosis - intake domain (NI)
actual problems related to intake. PRIORITY. 1. caloric energy balance (ex: increased energy expenditure) 2. oral or nutrition support intake ( ex: inadequate/excessive compared with goal) 3. fluid intake balance (ex: fluid restriction or dehydration) 4. Bioactive substance (ex: supplements, alcohol) 5. nutrient balance ( ex: excessive protein intake)
Neoplastic disease- protein-calorie malnutrition, malabsorption, fluid and electrolyte imbalances
altered taste acuity - add flavorings and seasonings. meat aversions may require elimnation of red meat. thrus from oral infections - avoid spicy, acidic, strongly flavoried foods (provide bland liquids, soft foods, cilled or frozen foods) throat or neck cancer - use PEG for feeding cancer cachexia (generalized wasting) connected to cytokines and the tumor necrosis factor (TNF)
simple proteins
amino acids
amino acids
amino group (NH2) - base; carboxyl group (COOH) - acid
non-crystalline sugar
amorphous, glasslike. crystallization is prevented by adding interfering substances (fat, milk) or by increasing the concentration of sugar. corn syrup retards crystallization thus increasing viscosity and chewiness. ex: hard candies, brittles, taffy, marshmallows, gummies
precision
amount of variation that occurs randomly. less random variation results in greater precision in the measurement and greater reliability
loss leader pricing
an aggressive pricing strategy in which a store sells selected goods below cost in order to attract customers who will, according to the loss leader philosophy, make up for the losses on highlighted products with additional purchases of profitable goods.
Simple moving average method
an average of any subset of numbers. The moving average is extremely useful for forecasting long-term trends. You can calculate it for any period of time.
Grant
an award of financial or direct assistance: anyone can apply; usually lasts over a few years. block grants from federal government are given to states or local communities for broad purposes as authorized by legislation. Recipients ahve great flexibility in distributing funds.
bromelin
an enzyme in fresh or frozen pineapple that breaks down protein and prevents gelation
manifestations of renal disease
anemia due to decreased production of erythropoietin upset in blood pressure. decreased activation of vitamin D (kidney produces active form, promotes efficient absorption of calcium by gut)
chronic kidney disease (CKD)
anorexia, weakness, weight loss, nausea, vomiting. anemia due to deficient production of hormone erythropoietin by kidney.
methylphenidate (Ritalin)
anorexia, weight loss, nausea
anticoagulant (warfarin sodium)
antagonizes vitamin K (consistent intake essential); avoid Ginkgo biloba extract (GBE), garlic, ginger (may increase bleeding); avoid high dose vitamin A, E.
sodium stearate
anti-caking agent
MNT for Tropical sprue
antibiotics,high calories, high protein, IM B12 and oral folate supplements
Enteral access
anticipatelength of time needed, risk of aspiration, patient's anatomy, clinical status, normal or abnormal digestion and absorption. Hang time open systems 4 hours, closed systems 24-48 hours. Short term acess 3-4 weeks, nasogastric tube, normal GI function.
Elavil
antidepressant sedative effectiveness of L-dopa (levodopa) which controls symptoms of parkinson's disease. take drug in morning with limited protein (competes with drug fro absorption sites)
marinol
appetite stimulant
megestrol acetate
appetite stimulant
dextroamphetamine
appetite suppressant, anorexia, nausea, weight loss
sources low in potassium
apple, cranberry, blueberry, carrot, corn.
medium-chain triglycerides (MCT)
are SFAs between 6 and 12 carbons. naturally found in milk fat, coconut oil, and palm kernel oil
process objectives
are activities that will be implemented to achieve the aims. They correspond with the process evaluation. ex: to increase diabetes awareness in the community, the dietitian will present diabetes classes six times each year"
dependent variables
are outcomes
independent variables
are what you manipulate in your study
conditionally essential amino acids during catabolic stress
arginine, glutamine (Like in heart failure) arginine may be useful in post-burn therapy
consultative
asks for input but makes final decision alone.
ADIME
assess, diagnose, intervene, monitor, evaluate.
NCP steps
assess, diagnose, intervene, monitore/evaluate (ADIME)
Subjective global assessment (SGA)
assesses nutrition status based on history, oral intake, weight change, functional capacity, GI symptoms, physical appearance, and presence of edema, wasting, or dehydration.
NFP - nails
assessment - brittle, thin, spoon-shaped considerations - iron or protein deficiency
NFP - eyes
assessment - pale, dry, poor vision consideration - vitamin A, zince or riboflavin deficiencies
NFP - tongue
assessment - smooth, slick, purple, white coating consideration - vitamin or iron deficiencies
NFP - gums
assessment - sore, red, swollen, bleeding considerations - vitamin C deficiency
NFP - lips
assessment - swollen, red, dry cracked consideration - riboflavin, pyridoxin, niacin deficiencies
NFP - hair
assessment - thin, sparse, dull dry brittle, easily pluckable considerations - vitamin C, protein deficiency
NFP - teeth
assessment- missing, loose, loss of enamel considerations - calcium deficiency, poor intake
cofactor
assists enzymes; minerals
adrenal cortex insufficiency - Addison's disease
atrophy of adrenal cortex; symptoms due to absence of adrenal hormones. decreased cortisol --> glycogen depeletion, hypoglycemia. decreased aldosterone --> sodium loss, potassium retention, dehydration. decreased androgenic --> tissue wasting, weight loss diet - high protein, frequent feedings, high salt.
Billroth II (gastrojejunostomy)
attaches remaining sotmach to the jejunum. when food bypasses the duodenum, the secretion of secretin and pancreozymin by th eduodenum is reduced. These hormones normally stimulate the pancreas, so there si now little pancreatic secretion. Calcium and Fe abs. are adversely affected. can also lead to B12 and folate deficiency
Billroth I (gastroduodenostomy)
attaches the remaining stomach to the duodenum
probing response
attempt to clarify or gain more information
Scalar principle
authority and responsibility flow in a direct line vertically from the highest to lowest echelons.
Alzheimer's disease
avoid distractions (no TV during meals); regular, consistent meal times, encourage self-feeding, offer one course at a time, lower saturated fats, soft calming background music, finger foods may be helpful, avoid dehydration, may need verbal cues to chew and swallow.
T-bone
back and ribs
Dental caries
bacterial enzymes fermented carbohydrate deposits on plaque. Enzymes produce acids that demineralize surface. low cariogenic potential foods: high protein, moderate fat, minimal concentration of fermentable CHO, strong buffer, high mineral content (Ca, P), pH 6, stimulates salive - cheddar cheese, nuts, meat. sugar alcohols (sorbitol, xylitol, mannitol) do NOT promote tooth decay. fluroine- can control caries, supplement starting at 6 months of age if level in water supply is <.3 ppm.
Tropical sprue
bacterial, viral, parasitic infection Chronic GI disease, intestinal lesions, may also affect stomach. diarrhea, malnutrition, deficiencies of B12 and folate due to decreased HCL and intrinsic factor.
Taft Hartley Labor Act - Labor Management Relations Act 1947
balanced powers of labor and management; amended Wagner Act. outlawed the closed shop; limited union shop to one year. government can obtain injunction against strikes that endanger national health or safety. specified unfair labor practices of the union.
BMR
basal metabolic rate measured in morning when reclining, awake, relaxed, at normal body temperature, at least 12 hours after last meal, and several hours after strenuous activity. measures oxygen consumed affected by: sex (women have 5-10% lower BMR), age, body composition, body surface area, endocrine glands (thyroid)
referent power (personality, charisma)
based on desire to identify with or imitate the influencer, how well you are liked.
Food grades
based on quality, firmness, color, maturity, freedom from defects, uniform size, and shape Graded by USDA
whip
beat rapidly to incorporate air to forma foam
funnel sequence
begin with broad open questions and proceed to more restrictive ones
Transtheoretical Stages of Change model
behavior involves series of stages. Determine stage to assess readiness to change.
expert power
belief that influencer has some relevant expertise that the subordinate does not; provides credibility.
spot weight loss theory
belief that localized exercise reduces fat stores in the active area; research does NOT support this notion.
horizontal communication
between departments, or between production and service within the nutrition department.
Landrum Griffin, Labor Management Reporting and Disclosure Act 1959
bill of rights for union members; regulates internal union affairs.
phytochemicals
biologically active, naturally occurring chemical compounds in plant foods, act as natural defense for the plant
neonate
birth to 1 month; can absorb whole, intact protein.
proteolytic enzyme
blend of papaya and salt, tenderizes meat
processed cheese
blend of several natural cheeses (american cheese) emulsifier added (disodium phosphate), processed cheese batter for cooking high moisture contentn (41-50%)
histogram
block diagram whose blocks are proportional in area to the frequency in each class or group. summarizes data from a process that has been collected over time.
catabolism
breakdown; uses and releases energy; creates a constant energy deficit, which must be supplied by food.
research conclusion
breif summary of results; may hae recommendations
coffee
brew at 185-203 F for best flavor. At higher temps, tannin is extracted and coffee is bitter.
Bureaucratic leadership
by the book, follows procedures to the letter.
Basal energy expenditure (BEE)
calculated BMR includes age, sex, body surface area (height, weight) mifflin st. joer
infant nutrient needs (0-6 months)
calories - 520F, 570M protein - 9.1 g water - 125-155 ml/kg (based on age) fat - minimum of 30 g/day
infant nutrient needs (7-12 months
calories - 676F, 743M protein - 11 g water 1.5 ml/kcal fat- minimum of 30 g/day
Egg freshness
can be maintained for 6 months in cold storage with Grade A eggs a fresh egg will sink to the bottom in a pan of cold water and has a dull, rough, shell Old eggs float, fresh eggs sink.
dried eggs
can be vacuum packed in nitrogen gas dried fortified: 70% white, 30% yolk
glycemic index
compares blood glucose response to a food to a standard glucose load. affected by cooking methods and processing of starch. as particle size decreases, the index increases. foods with low index produce greater satiety. low index: legumes, milk, nuts, pasta, ice cream, yogurt glycemic load: weighted average of the glycemic indexes of all foods eaten.
BMI/Quetelet index
compares weight to height weight in kg divided by height squared in meters; or weight in lbs divided by height in inches squared in meters; or weight in pounds divvided by height inches squared x 703. healthy adult 18.5-24.9; healthy for most elderly 24-29
role of sugar in glatinization
competes with starch for water needed for gelatinization. increases translucency, reduces viscosity and gel strength. if too much is used, consistency is thin
polysaccharide
complex sugars starch - glucose chains; 50% of CHO intake cellulose - resistant to digestive enzyme amylase; adds bulk (stimulates peristalsis) pectin - nondigestible; thickening quality; fruits glycogen - animal starch; from glucose; stored in muscle and liver dextrin - intermediate product of starch breakdown
Chlorine
component of lecithin function - transports lipids as acetylcholine. sources - fat in eggs, milk, liver, soybeans
starch
composed of ammylose and amylopectin molecules. amylose responsible for gelation in cooled, cooked pastes
GALT (gut associated lymphoid tissue)
compromised by bowel rest or parenteral nutrition. provides 50% of total body immunity. 70-80% of total body immunoglobulin production is secreted across the GI mucosa to defend against pathogenic substances in the GI lumen.
sweetened condensed milk
concentrate (evaporate) whole milk. add 15-18% sucrose or glucose
strategic planning
concentrates on decisions, not plans. broad technological and competititve aspects; sets direction for organization.
research abstract
condensation of final report; has purpose of study, quesitons asked, scope and method, summary of conclusions
integrative problem solving
conflict is converted into a joint problem solving situation. parties openly try to find a solution the can all accept.
Prader Willi Syndrome - chromosome 15 defection
congenital disorder, subnormal LBM, supranormal body fat. Ghrelin levels are elevated which stimulates growth hormone secretion, appetite, intake, and fat mass deposition. do not sense satiety, decreased energy requirements. obesity at 2-3 years of age, hypogonadism, muscle hypotonia, failure to thrive, short stature. best treatment is to control food intake.
legislative branch
congress, senators, representatives. may introduce and enact a law and can override a veto by the executive branch.
steatorrhea
consequence of malabsorption normal stool fat 2-5 g; >7 g is indicative of malabsorption. determine cause and treat. high protein, high complex CHO, fat as tolerated, vitamins (especially fat-soluble), minerals, MCT (rapidly hydrolyzed in GI tract).
Short bowel syndrome (SBS)
consequences associated with significant resections of the small intestine. malabsorption, malnutrition, fluid and electrolyte imbalances, weight loss. severity reflects length and location of resection, age of patient, 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, (in duodenum, and upper jejunum) what remains - small amounts of sugar, starches, fiber, lipids.
reliability
consistency or reproducibility of test results
Continuous drip (EN)
constant, steady rate over 16-24 hours, usually with a feeding pump (for those with compromised GI function or who do not tolerate large volume infusion).
nutritional surveillance
continuous collection of data identifies problem, sets baseline, sets priorities, detects changes in trends use height, weight, hematocrit, hemoglobin, serum cholesterol on-going system linked to active health program: WIC, CDC, EPSDT data identifies needs and kind of intervention needed
systolic blood pressure
contraction, greatest pressure
role of kidneys in acid/base balance
control bicarbonate (base). regulate hydrogen ion secretion and bicarbonate reabsorption if kidneys excrete excess bicarbonate - level of base decreases; if kidneys retain bicarbonate - level of base increases
gluconeogenesis
conversion of non-carb sources into glucose (from glycerol and amino acids) creation of new glucose
Self-efficacy
conviction that you can successfully execute the behavior required to produce the outcomes. ex: I can join the gym close to work.
selenium
cooperates with vitamin E. Trace mineral. function - antioxidant. tissue respiration sources - soil, grains, meat, fish, poultry, dairy
waxy starches
corn, rice, sorghum have only amylopectin, no amylose non-gelling; stable to freezing and thawing used in frozen foods
cheese % moisture content
cottage (79), cream, mozzarella (45-55), camberbert, bleu, swiss, cheddar, gorgonzola, parmesan (31).
WIC farmers market nutrition program
coupons to purchase fresh, locally grown foods at farmers' markets
short range or operational planning
coveres perdiod of 1 year or less; usually the operating budget; projected in days, weeks, months.
Americans with Disabilities Act 1992
covers employers with 15 or more employees. must provide "reasonable accommodations" remove barriers, have wide aisle (36") and doors (32"), install ramps, lower shelves and phones, rearrange tables and chairs, flashing alarm lights. To comply, jobs descriptions must specify "essential" job functions
Stomatitis
cracks in skin at mouth corners, riboflavin deficiency.
Anorexia nervosa
distorted body image, dramatic weight loss, preoccupation with food and weight gain. therapy is multidisciplinary; weight restoration and psychotherapy. immediate concern - correct electrolyte imbalance (K) plan with patient, regualr mealtimes, varied and moderate intake, gradually reintroduced feared foods. focus on health benefits and life-sustaining aspects of food (reason to eat). re-feeding increases cardiac load (go slowly - overwhelms heart muscles) recommended initial daily calorie levels range from 1000-1600 (30-40 cals/kg) but may need to be set 100-300 calories above the current level of intake to support adherence.
cut-in
distribute fat into dry ingredients
split halves
divide the test in half. reliability is determined by degree of similarity of results
randomization
dividing people into treatment or control groups without bias
non parametric test
does not depend on a normal distribution
control group
does not receive the treatment or may receive a placebo
Lactose intolerance
due to LACTASE deficiency normally lactase splits lactose into glucose and galactose. In its absence lactose remains intact, exerting hyperosmolar pressure. Water is drawn into the intestine to dilute the load causing distention, cramps, diarrhea. Bacteria then ferment the undigested lactose, releasing carbon dioxide gas. detected by breath hydrogen test - hydrogen is produced by colonic bacteria on lactose, absorbed into bloodstream and exhaled in 60-90 minutes.
Green color under potato skin
due to chlorophyll that develops when potato is exposed to light during storage. may be accompanied by solanine, a natural toxicant.
Galactosemia
due to missing enzyme that would have converted galactose-1-PO4 into glucose-1-PO4. 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 casienate, dates, bell peppers. OKAY soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG.
Alimentary pastes
durum wheat- high in gluten after bran and germ are removed, starch is ground to make semolina flour products are flexible after cooking noodles - contain egg yolk or egg solids
Job specification
duties involved, conditions, qualifications (education, experience); written for each job. used in selection and placement of employees (hiring) does not have detailed information as to waht to do or time involved.
Lab tests in renal disease
eGFR, creatinine clearance. serum creatinine, BUN renal solute load
unity of command
each is accountable to only one superior
probability
each segment of the population will be represented in the sample select units from a much larger population. randomization
cross charts
efficiency of equipment placement, studies work motions, shows number of movements between pieces of equipment.
leavening - eggs
egg foam is heated, air expands, egg white stretches and protein coagulates. an acid stiffens an egg white foam by tenderizing the protein and allowing it to extend more easily. egg whites at room temp whip more quickly and yield a larger volume due to LOWER surface tension. sugar also stabilizes an egg white foam.
fluid restriction may cause
elevated BUN and serum sodium levels, poor skin turgor, and decreased urinary output.
participative
emerging trend in management. Encourage workers to participate in decision making. Uses quality circles: small group of employees who meet regularly to identify and solve problems.
Country club managment
employee centered. seeking approval and acceptance. comfortable, friendly atmosphere. high concern for people, low concern for production
positive reinforcement
encourages repetition of a given behavior. should be specific and immediate; meaningful attention from superiors. ex: praise.
outcome-orented
end result or consequence of program, change in attitude, knowledge, ultimate indicator of qality measuring the actual health status of the client, or skills of an employee.
spinal cord injury
energy needsa re 10% below predicted. at least 1.5 L fluid per day. pressure ulcers: 30-40 cal/kg 1.2-1.5 g pro/kg in tage I and II; 1.5-2 g in stages III, IV. normal intake of calcium, adequate fluids. supplement vitamin C (500-1000mgs with stage III or IV, or if deficient.) Zn 15 mg with stages III, IV for 2-3 weeks. daily dietary source of vitamin A.
functions of fat
energy, insulation and padding, dresses gastric secretion so delays emptying. has less oxygen, more carbon than carbohydrate so provides more energy (more carbon atoms for oxidation)
functions of carbs
energy, protein-sparing action - allows most of protein to be used for tissue synthesis - regulation of fat metabolism - a carb restriction leads to ketosis.
tenderness in pie crust
enhanced by using oil, soft fats, or fat cut into very small pieces
ascorbic acid
enhances appearance by preventing browning
goiter
enlargement of thyroid gland due to insufficient thyroid hormone. endemic goiter - inadequate iodine intake. diet - iodized salt; free of goitrogens (contain goitrin which inhibits synthesis of thyroid hormone)
FDA (food and drug association)
ensures safety of some domestic and imported food products
Amputations (weights)
entire leg = 16% body weight lower leg with food 6% body weight entire arm = 5% forearm with hand = 2.3% Estimated IBW = (100- % amputation)/100 x IBW for original height.
Vitamin E
fat soluble. tocopherol, one of least toxic vitamins. UL 1000 mgs. Function - antioxidant, resists hemolysis of RBC sources - vegetable oils, whole grains, green vegetables, almonds
NSLP National school lunch program / USDA food and nutrition service (FNS)
entitlement program to improve nutrition of children, especially from low income families; utilize surplus production of foods cash grants and food donations; dollars reimburse schools on basis of number of meals served. implement the dietary guidelines into the lunch and breakfast programs lunch must provide on average over each school week: 1/3 of the RDA
POMR (problem oriented medical records)
entries can be made using the SOAP format
coenzyme
enzyme activators; includes some vitamins. pantothenic acid, thiamin, riboflavin, niacin are needed for energy production.
soy protein/plant sources of protein
equivalent in protein quality to animal protein. legumes are low in methionine, cystine, and tryptophan. methionine missing in most vegetables.
Steps to controlling/evaluating
establish qualitative and quantitative standards. measure performance compare to standard take corrective action if necessary. types: production, quality, quantity.
planning function
establishing organizational objectives and designing procedures for achieving them. policies and procedures form the guidance and methods for meeting established organizational objectives.
development of educational plans/design
evaluate info available and match it to objectives organize into logical sequence develop lesson plan evaluate what you have developed
mini nutrition assessment
evaluates independence, medication therapy, number of full meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding.
concentrated milks
evaporated, sweetened condensed, dried whole milk, dried skim milk
Appraisal of barrieres
ex: I don't like to exercise
food record
exact record of everything eaten in a specific period of time
nutrition survey
examination of a population group at a particular point of time. considered a cross-sectional exam; pin-points problems determines prevalence of condition or characteristics at a specific time.
Chronic bronchitis
excess mucus production, chronic productive cough
hyperthyroidism
excess secretion of thyroid hormone. elevated T3 and T4 increased BMR leading to weight loss. diet - increase calories
causes of fallen center in cake
excess sugar, excess fat, excess baking powder, inadequate mixing, oven temp too low, open door during early baking
MNT for Fever and infection
excessive fluid loss may lead to dehydration (hyperglycemia, dry, loose inelastic skin); IV feedings of dextrose and water, then diet high in calories and fluids. BMR increases 7% for each degree rise in F temp; normal temp is 98.6' F
Occupations EXEMPT from minimum wage and overtime requirements
executive, administrative, professional, outside salsepersons.
Impoverished management
exert minimum effort to get work done. Desire to hang on. low concern for people and production.
effect of protein on fluid balance
exerts colloidal osmotic pressure. albumin exerts pressure on blood vessel wall that keeps water within, when albumin drops, the pressure drops, causing fluid to leak out. --> edema, ascites.
cobalt
exists with B12. stored in liver function - maturation of RBC
steam as leavening agent
expands the hollow shell formed by flour and egg. hot oven is requred to raise liquid to boiling quickly. popovers, creampuffs
air as leavening agent
expands when heated before proteins coagulate and retain it. beating, sifting, folding, cream angel cake, sponge cake
Anasarca
extreme, generalized edema and widespread swelling of skin due to effusion of fluid into extracellular space. It is associated with heart, liver, renal failure, and extreme protein/calorie malnutrition
TVP (textured vegetable protein)
fabricated into simulated meat products. mixed with ground meats - extends number of servings, lowering costs. soy protein adds juiciness because of water content.
processing of hot, ready to cook cereals
farina - inner portion of wheat kernel quick-cooking creals have disodium phsphate added (instant oatmeal) - makes cereal alkaline so particles swell faster. avoid on low sodium diets enzyme treated for quicker cooking means the proteins have been split to lessen cooking time.
strategies that strengthen local food systems
farmers markets - increased access to fresh produce food recovery and gleaning programs - collect excess wholesome foods that would otherwise be thrown away for delivery to hungry people PPFPs- prepared and perishable food programs; non-profit programs that link sources of unused, cooked and fresh foods with social service agencies tat serve the hungry.
A patient with COPD would benefit from a higher proportion of energy from ____
fat - overall CO2 production would be lower, requiring less respiratory effort to eliminate it.
Vitamin A
fat soluble, stored in liver; carotene- precursor, provitamin (nutrient changed into vitamin) converted in intestinal mucosal cells toxic level 10,000 IU function - skin, vision sources - yellow, orange fruits, dark green leafy vegetables, cantaloupe, fish, liver, carrots, fortified skim milk, apricots, sweet potato
Vitamin D
fat soluble. cholesterol is precursor, UV light, fat soluble, 7 dehydrocholesterol function - Ca, P metabolism. D3 cholecalciferol --> D2 sources - sunlight, egg yolk, fortified milk, egocalciferol
vitamin K
fat soluble. synthesized by bacteria in lower intestinal tract. no toxicity symptoms function: forms prothrombin in liver: aids blood clotting. given pre-surgery . calcium metabolism sources - spinach, kale, broccoli, green leafy vegetables
MNT for non-tropical sprue
gliadin-free, gluten restricted diet - no wheat, rye, oats (if harvested and milled with wheat), barley, bran, graham, malt, bulgur, couscous, durm, orzo, thickening agents. OK - corn, potato,rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax.
baby friendly hospital inititiave
global effort to increase incidence and duration of breast feeding. hospital must show it implements ten steps to successful breast-feeding. requires a multidisciplinary team.
The nephron
glomerulus - tuft of capillaries held closely by Bowman's capsule- produces ultra filtrate which then passes through tubules. Capsule blocks passage of red blood cells and large molecules like protein. proxmial convoluted tubule - major nutrient reabsorption Loop of Henle - water and sodium balance. Distal Tubule - acid base balance.
monosaccharide
glucose, galactose (simple sugars)
special dietary use
gluten free, weight loss foods
tissue stores of glucose
glycogen from muscle and liver fat from adipose tissue cellular mass (protein stores) gluconeogenesis
needs assessment - middle and upper income adults
goal-oriented; consider activities they can't relate to as a waste of time
Recommended dietary allowances (RDA)
goals for healthy individuals to prevent nutritional deficiency diseases, included gender, age, life phases.
iodine defeciency
goiter
self feeding skills of an 18-month old infant
good pincer control. finger foods allow for independent eating. can consume foods that can be cut into bite size portions and eating with hands. whole milk recommended until age 2.
bulimia
gorging and vomiting syndrome, usually close to normal weight. damage to teeth, throat, esophagus, rectal bleeding, bruised knuckles from purging with fingers, low potassium and chloride blood levels.
Meat grading
grade appears on a shield stated federally graded by Agricultural Marketing Service of the USDA. based on maturity of animal, marbling of fat, color and texture of lean
YRBS (youth risk behavior survey)
grades 9-12; smoking, alcohol use, weight control, exercise, eating habits
conventional foods
grape juice and red wine have resveratrol which reduces platelet aggregation omega 3 fatty acids in fatty fish reduce TG levels tomatoes have lycopene which may reduce prostate cancer risk
acanthosis nigricans
gray-brown skin pigmentation in skin folds
Perceived advantage of change
greater mobility
public zone
greater than 12', verly formal interaction
Vitamin B2 (riboflavin) deficiency
growth failure cheilosis (cracked lips) angular stomatitis (mouth corner cracks, sore throat, magenta tongue)
Managerial attributes that distinguish successful organizations from others
have bias for action be close to your customers autonomy productivity through people management should be hand on and value driven: explain value system to employees.
Medicare
health insurance program for people over 65; of any age with end-stage renal disease; employers and employees pay. Part A- hospital insurance Part B - optional insurance for supplementary benefits (private practice)
strategies for type 2 DM
healthy eating and physical activity. achieve glucose, lipid and blood pressure goals. weight loss if necessary: improve food choices, space meals, exercise.
simmer
heat in water to 170-184 F with appearance of bubbles
steam
heat over, not in, water
preparation of crystalline candies
heat sugar and liquid to dissolve; heat further. crystallize under conditions that produce small crystals which have a smooth, creamy feeling
factors affecting stability of swollen starch granules in a paste
heat, acid, and agitation
dry heat (starch)
heated without water. Temperature rises rapidly degrading the starch. starch molecules break into fragments called dextrins (dextinization). color change occurs
motivational interviewing
helps clients recognize and begin to resolve their concerns and problems. the goal is to increase motivation so that clients are able to express the rational for the changes that need to be made. people make behavioral changes only when they are ready to change.
lecithin
helps yolk act as an emulsifier
Vitamin E deficiency
hemolytic anemia
vitamin K deficiency
hemorrhage affected by - mineral oil, antibiotics, anticoagulants
Alcoholic liver disease
hepatic steatosis, alcoholic hepatitis, cirrhosis. liver injury due to alcohol and metabolic derangements it causes. alcohol is converted into acetaldehyde and excess hydrogen which disrupts liver metabolism. Hydrogen replaces fat as fuel (in the Kreb's cycle), so fat accumulates in liver (leading to a fatty liver) and in blood (raising the TG level).
Team management
high concern for both people and production. common stake in purpose (most desirable)
Ketogenic diet (epilepsy)
high fat, very low carb, 4 grams fat: 1 gram non-fat. ketone bodies behave as inhibitory neurotransmitters; mild dehydration needed to prevent dilution of ketones. need supplements of Ca, D, folate, B6, B12. MCTs are more ketogenic, more rapid metabolism and abs. no more than 35 g. CHO at meals.
MNT for constipation
high fluid, high fiber diet, exercise sometimes due to an atonic colon (weakened muscles)
milk supply is adequate when
infant gains weight and length, has frequent stools, and 6-8 wet diapers per day
Pediatric HIV
high protein, high calorie with supplements needed for weight gain. energy needs: general guidelines plus appropriate stress factors. multivitamins/minerals at doses 1-2 x RDA or DRI. Lactose restriction if intolerant. HALS (HIV - associated lipodystrophy syndrome) may develop from therapy. high cholesterol, high triglycerides, insulin resistance, changes in body fat distribution. significant loss of lean body mass can be obscured by edema and HALS.
pregnant adolescent
high risk, needs extra iron, calcium, zinc
vacuum brewed
higher temps than recommended
energy expended in physical activity (EEPA)
highly variable. activity thermogenesis (AT)
prgesterone
hormone that develops placenta after implantation
Work schedule
hour by hour - training - tasks and time used in training
Diffusino of innovation
how an innovation, idea, or behavior spreads innovators - adopts an idea readily, usually with input early adopters - opinion leaders in community, well respected. early majority - cautious in adopting a new idea late majority - skeptical, adopt an idea only through peer pressure. laggards - last to adopt the idea.
Transactional vs. tranformational leadership
how leaders and followers influence each other (reciprocal approaches to leadership)
food frequency lists
how often an item is consumed. community setting. quick way to determine intakes on large numbers of people.
research implications
how the information might be applied in practice
paralinguistic
how the message is delivered histations, stuttering = sensitivity, anxiety whispering - difficulty in disclosing
measures of dispersion
how values distributes about the mean
glycerol monostearate
humectant; retains moisture and increases firmness
trans fatty acids -
hydrogens are across from each other; pack as tightly as SFA in membranes; intake can influence membrane fluidity and could be harmful to cell function; found in milk fat (4-8%) margarines, shortenings, frying fats as product of partial hydrogenation of PUFA
cis fatty acids
hydrogens on same side at the double bond; most natural fats and oils
sugar (baking)
hygroscopic - modifies texture by tenderizing. softens gluten and prevents gluten development by absorbing some of the water that gluten needs too much sugar results in coarse cells, thick walls, a shiny crust, and a crumbly product. most of sugar in honey is glucose and fructose.
calcium deficiency
hypcacemia leads to tetany (stiff muscles)
hyperkinesis
hyperactivity, ADHD experimental treatment - feingold diet - no salicylates, artificial colors, artificial flavors. 1. efficacy not proven; positive result may be due to placebo effect. 2. behavior improves with special attention (mind over body) sugar does not cause hyperactivity.
acute ketoacidosis
hyperglycemia due to insulin deficiency or excess carb intake, dehydration due to polyuria, increased pulse, fruity odor of ketones. treatment: insulin, rehydration.
Results of physiologic trauma
hyperglycemia, hyper-insulinemia, little or no ketosis, increase glycogen. catecholamines epinephrine, norepinephrine - hepatic glycogenolysis ACTH - releases cortisol which mobilizes amino acids from muscle aldosterone - renal sodium retention, gluconeogenesis ADH - renal water reabsorption. hypovolemia, decrease cardiac output, drop in body temperature hyperglycemia - epinephrine suppresses insulin, insulin resistance (decreased cell uptake and use) fluid and sodium retention, potassium excretion, loss of nitrogen, sulfur, zinc, phosphorus. provide adequate but not excessive calories (at RMR), 1.5-2.0 g protein/kg, provide anabolic electrolytes, zinc
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)
Tyramine
hypertension if taken with MAOI (monoamine oxidase inhibitor) elminate dopamine and restrict tyramine (monoamines). MAO inhibitors interact releasing noepinephrine which elevates blood pressure. Restrict aged, fermented, dried, pickled,smoked, spoiled foods. avoid hard, aged cheese (cheddar, swiss), sauerkraut, some sausages, luncheon meats, tofu, miso, chianti wine. limit sour cream, yogurt, buttermilk. OK: cottage cheese, cream cheese. good advice: buy, cook, eat fresh foods
DBPCFC (double blind, placebo controlled food challenges)
identify food-induced symptoms (gold standard for diagnosis)
Organization function of management
identify tasks and activities, divide tasks into positions, establish relationships among all other functions of management. organizational structure, chain of command. staff - advisory, specialists determining staffing needs
Contraindications of PN
if alimentary tract can be used if needed only for short time in well nourished. during periods of cardiac instability. if risks inherent in process outweigh benefits.
MNT for heptic failure
if not comatose - moderate to high levels of protein, increase up to 1-1.5 gram protein/KG as tolerated. 30-35 calories/kg; 30-35% calories as fat with MCT if needed. low sodium if ascites; vitamin/mineral supplementation.
Hathorne studies - Western Electric, Elton Mayo
if you involve people in the process, they become more productive. productivity due to: employees were given special attention, were involved in an interesting experience, and were well-treated by supervisors. work breaks increased productivity.
jejunal resection
ileum can adapt and take over jejunal funcions. #1 priority after resection is fluid.
Pareto charts
illustrate the relative importance of problems. work on the tallest bar or problem that occurs most frequently; correcting the "vital few" problems will have the greatest impact on quality. 80-20 rule: 80% of a given outcome results from 20% of an input.
mellorine
imitation ice cream butterfat is replaced by hydrogenated vegetable oil
Burns
immediate shock period - catabolism; BMR rises 50-100% replace fluids and electrolytes lost. recovery period - increase calories (based on burn size) secondary period - 1.5-3 grams pro/kg, high calories. vitamin C - wound healing, 500 mg x 2 water soluble vitamins 2x RDA, vitamin A 10000 IU Vitamin K if on antibiotics zinc for wound healing if zinc deficient, 220 mg zinc sulfate.
cyclosporine
immunosuppressant hyperlipidemia, hyperglycemia, hyperkalemia, hypertension
Team Nutrition
implements school meals initiatives for healthy children motivates children to make healthy choices; helps schools meet guidelines provides recipes, training, support
Thiazolidinediones (Actos)
improve peripheral insulin sensitivity
concentric model of organization (circular)
improves representation of dynamics of personnel relationships because functions are centered around individuals, not above and below them. eliminates above and below concepts. presents an organization without loose ends.
phospholipid
in cell membranes; control passage of compounds in and out of the cell. most are lecithins which contain choline (liptropic factor). Healps prevent fat accumulation in the liver. it function in the transport and utilization of fatty acids and cholesterol through the enzyme LCAT (lecithin-cholesterol acyltransferase).
myo-inositol
in plants a phytic acid. related to sugar contains phsphorus vitamin-like factor function - bind calcium, zinc, iron membrane structure sources - outer husks of cereal grains, leafy green vegetables
unmodified cows milk in formula
inappropriate; tough hard curd; hard to digest; less EFA; increased renal solute load.
maple syrup urine disease (MSUD)
inborn error of metabolism of BCAAs leucine, isoleucine, valine. poor sucking reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of sweat and urine. restrict BCAA 45-62 mg/day (may use MSUD powder). provide adequate energy from CHO and fat to spare amino acids. include small amounts of milk to support growth; gelatin may be used. avoid eggs, meat, nuts, other dairy products.
dyslipidemia
include high triglycerides and low HDL
NNMRRP (national nutrition monitoring and related research program)
included all data collection and analysis activities of the fedral gov. related to measuring the health and nutritional status, food consumption, attitudes about diet and health jointly run by DHHS and USDA
Documentation
includes a statement of where teh patient is now in terms of expected outcomes 1. date and time 2. indicatores measures, results, and method for obtaining the measurement. 3. criteria to which the indicator is compared. 4. factors facilitating or hampering progress, other positives or negative outcomes. 5. further plans for nutrition care, monitoring and follow up or discharge.
Planning function of management
includes objectives, policies, procedures, times spans. personnel - screening, update information, orientation, practice drills. procurement, receiving, storage - MOU with vendors, lists of companies, delivery routes, dates and times. security - doors/windows locked when not in use; surveillance cameras. production and service - safe food practices, food checks, only authorized personnel.
gelatin
incomplete protein - no tryptophan, low in methinine and lysine. changes liquid into an elastic solid. acts as foaming agent (marshmallows). keeps sugar and ice crystals small in candy and ice cream by interfering with the union of small crystals to make larger ones.
most effective dietary changes to address both hypertension and hyperlipidemia
increase dietary fiber, and to reduce saturated fat intake. include more high-fiber carbohydrates such as whole grains, and increase their intake of fruits and vegetables. additional strategies include using MUFAs and omega-3 fatty acids.
MNT for Acute viral hepatitis
increase fluids to prevent dehydration. care varies according to symptoms and nutrition status. 50-55% CHO to replenish liver glycogen and spare protein. acute hepatitis: 1-1.2 g protein/kg: cell regeneration, provide lipotropic agents to convert fat into lipoproteins for removal from liver. moderate to liberal fat intake if tolerated; limit fat if steatorrhea. small, frequent feedings because of the anorexia. encourage coffee (antioxidant) multivitamin with B complex, C, K, zinc. increased protein deit prevent fatty liver.
lithium carbonate
increased appetite, weight gain; maintain consistent sodium and caffeine intake to stabilize levels. if sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity.
rich cake
increased fat, sugar, egg; increases keeping quality
Water holding capacity of muscle
increases in change in muslce protein brought about by enzymes i.e. vinegar, salt
Aging meat
increases tenderness
Nutrition diagnosis
indentification 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
standard deviation
indicates degree of dispersion about the mean value of a distribution. square root of the sum of the squared deviations of each value from the mean, divided by the number of observations.
organizational chart
indicates the relationships among positions and functions within a foodservice department
infant mortality rate
infant deaths under 1 year of age, expressed as the number of deaths per 1000 live births
fluoride recommendations
infants (birth-6 months) oral supplementation NOT recommended. Use fluoridated water if available. Infants (6-12 months) fluoridated water; oral supplements ONLY if prescribed. Toddler (12-24 months) fluoridated water, or oral supplements if prescribed. Toothpaste should not be used until the cild can spit it out. Children (2-3) fluoridated water or supplements as recommended, fluoride toothpaste (pea-size).
mucositis
inflammation of mucosal lining of oropharynx and esophagus. avoid fresh, raw, uncooked foods, offer cold and soft food.
Arthritis
inflammation of peripheral joints. regular, well-balanced diet with vitamin intake to at leat DRIs. bed rest, aspirin, reduce overweight to decrease stress. normocytic anemia may develop (inflammation prevents reuse of iron) anti-inflammatory diet" may help osteoarthritis: fresh fruits and vegetables, resembles mediterranean diet.
Gastritis
inflammation of stomach; anorexia, nausea, vomiting, diarrhea. diet - clear liquids, advance as tolerated, avoid gastric irritants.
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 auto-digestion.
Acute viral hepatitis
inflammation, necosis, jaundice, anorexia, nausea, fatigue. jaundice occurs when bile ducts are blocked.
feedback
info client gives back to you as you are discussing and questioning; lets you know what he knows and what he understands about what you are saying
Congressional Record
information from floor, NO HEARINGS. lists bill with sponsors and action, issued daily when congress is in session.
Parenteral nutrition
infusion of a hypertonic solution delivered through a central venous catheter. used to achieve an anabolic state when patients are unable to eat by mouth and enteral feeding is not possible. subclavian vein minimizes risk of phlebitis. used for altered GI function or impaired nutrient utilization.
alpha glucosidase inhibitors (acarbose, precose)
inhibit enzymes that digest carbs, delaying abs.
Green (chlorophyll) pigment
insoluble in water olive green in acid -pheophytin bright green in alkaline - chlorophyllin (mushy, hemicellulose broken down)
Transformational - 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. leaders and followers raise one another to higher levels of motivation. followers grow and become leaders; leads to low staff turnover, increased morale, and team spirit.
acute hypoglycemia
insulin reaction (shock); due to insulin excess or lack of eating, slow pulse, cool, clammy skin, hungry, weak, shakiness, sweating. treatment: glucose; begin with 15 g CHO from glucose tablets, fruit juice (4-6 oz.), sugar. wait 15 minutes; if still <70 mg/dl, give another 15 grams. repeat and treat until blood glucose is normal.
Unemployment compensation
insurance against loss of income. must be employed for a specific time, able and willing to work, unemployed through no fault of their own; employers pay tax on payroll. State run.
service marketing
intangibility, perishability, heterogenicity, inseparability services are mostly intangible, they are mostly produced and consumed at the same time so are inseparable and perishable. heterogenicity of service is concerned withthe variation and lack of uniformity in the performance of people.
Descriptive statistics
intend to describe data and summarize the current dataset (mean, median, mode, standard deviation, and standard error of the mean)
Legislative process
interaction between the legislative, executive and judiciary branches.
needs assessment - lower income adults
interests focus on costs and traditional food habits; oriented toward present and towards solving current problems
FAO Food and Agriculture Organization
international agency raising world-wide levels of nutrition by increasing efficiency of production and distribution of foods
research discussion
interpretation of results, comparison with other studies; may be combined with results
epidemiological data for neoplastic disease
interrelationship between host, agent, environment in causing disease. some evidence that fruits and vegetables are beneficial in overall cancer prevention (carotenoids, vitamin C) some evidence that exercise in post-menopausal women decreases risk of breast disease.
IVFE (intravenous fat emulsion)
intralipid 10% = 1.1 cals/cc 20% = 2.0 cals/cc
Transitional feedings
introduce a minimal amount of FULL STRENGTH enteral feeding at a low rate of 30-40 ml/hour to establish GI tolerance. decrease PN as you increase enteral rate by 25-30 ml/hour increments every 8-24 hours to maintain prescribed nutrient levels. when patient can tolerate about 75% of needs by enteral route, D/C PN.
primary question
introduces new topics
WIC foods offered
iron fortified formula, cereal, milk, cheese, fruit juice, fruits and vegetables
egg size
jumbo = 30 oz. extra large = 27 oz. large = 24 oz. medium 21 oz. small 18 oz.
high motivational level
keen interest; presence is voluntary; has high expectation as to applicability o subject to his life
NRTI drugs
nucleotide nucleoside reverse tanscriptase inhibitos including Retrovir, zidovudine) can lead to anemia, loss of appetite, low vitamin B12, copper, zinc, carnitine.
metabolic acidosis
kidneys either produce or retain too much hydrogen leading to an increase in production of carbonic acid; or the kidneys may excrete too much base. To compensate, respiration increases to remove carbon dioxide to decrease carbonic acid
Components of diffusion of innovation
knowledge, persuasion, decision, confirmation.
B12 deficiency Following GI surgery
lack of intrinsic factor and bacterial overgrowth in loop of intestine being bypassed interfere with B12 abs.
low educational level
lacks formal education beyond high school; probably not verbally oriented; reinforcement of learning is helpful; allow time for learning.
low lactose milk
lactaid treated with lactase in processing or add the enzyme to regular milk and hold in fridge.
Diet for lactose intolerance
lactose-free; no animal milk or milk products, no whey. calcium and riboflavin supplements are recommended. yogurt and small amounts of aged cheese may be tolerated. OK: lactate, lactalbumin.
SNAP Supplemental Nutrition Assistance Program
largest food assistance program: entitlement assists 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. designed to increase their puchasing power; not for non-food items. figures are adjusted to refelct cost of food in Thrifty Food Plan for June of preceding year - least costly of USDA four food plans. SNAP nutrition education program provided to program participants
Free rein (laissez faire)
least control
promoting flaky crusts
leaven fat into coarse particles. fat in pieces melts and flows, leaving a hole where steam collects and pushes upward against the upper surface of the resulting cell. the cell is locked into that extended position, resulting in a flaky crust.
quick breads
leavened with steam, air, and chemical leavening agents. no yeast.
Licensure
legal recognition for dietitians or defines a scope of practice; licensure laws are effective legal recourse for consumer protection from incompetent nutrition practitioners.
intimate zone
less than 18", very close friends, business handshakes
diet requirements for fat
less than 30% of calories
P value
level of significance. the lower the p value, the higher the significance of your results
FCC (Federal Communications Commission)
licenses radio and TV
if ileum cannot recycle bile salts
lipids are not emulsified; leads to malabsorption of fat-soluble vitamins. malabsorbed fats combine with Ca, Zn, Mg, leading to "soaps" colonic abs. of oxalate increases - renal oxalate stones increased fluid and electrolyte secretion; increased colonic motility.
enzyme profile
list of major enzymes found in organs and tissues; enzyme levels in blood are elevated when tissue damage causes them to leak into the circulation.
Hepatic Failure (ESLD)
liver function decreased to 25% or less liver cannot convert ammonia (NH3) into urea - ammonia accumulates. apathy, drowsiness, confusion, coma (PSE - portal systemic encephalopathy) Asterisix (flapping, involuntary jerking motions) = sign of impending coma
Recruitment
locate most qualified person for job. sources - internal (promotions, transfer, rehire), external (ads, agencies, unions).
osteoporosis
loss of bone tissue. Type I postmenopausal (within 15-20 years) Type II - age-associated >70 whiteand Asian women: more osteoporotic fractures than black or Hispanic. causes: malnutrition (especially protein), lack of exercise, decline in estrogen. result is reduction in amount of bone due to defective calcium abs (deossification)
respiratory alkalosis
loss of carbonic acid (increased ventilation). To compensate, kidneys excrete additional base
excess mixing
loss of co2, overdeveloped gluten tunnels from top to bottom, tough, heavy product
arteriosclerosis
loss of elasticity of blood vessel walls.
PedNSS (pediatric nutrition surveillance system HHS)
low income, high risk children, birth - 17 years, emphasis on birth-5 years height, weight, birth weight, hematocrit, hemoglobin, cholesterol, breast feeding monitors growth and nutritional status, infant feeding practices
PNSS (pregnancy nutrition surveillance system HHS)
low income, high risk pregnant women maternal weight gain, anemia, pregnancy behavioral risk-factors (smoking, alcohol), birth weight, counts # of women who breast feed. identify and reduce pregnancy-related health risks
an infant with PKU requires ____
low phenylalanine, high tyrosine
egg substitutes
lower in fat, calories, cholesterol; often higher in sodium. color and flavor differences
role of lungs in acid-base balance
lungs control supply of carbonic acid (CO2, water). amount altered by rate and depth of breathing. hypoventilation - retention of acid; hyperventilation - loss of acid
acute respiratory distress syndrome, respiratory failure (ARDS)
lungs no longer able to exchange gases, hyper metabolism, increased energy needs, severely underweight. meet basic nutritional requirements, maintain stable weight, facilitate weaning from mechanical ventilation, without exceeding capacity to clear carbon dioxide. provide adequate but not excessive calories; avoid excess non-protein calories. provide enteral formula containing EPA and GLA, and enhanced levels of antioxidant vitamins. 1.5-2 g protein/kg BW, maintain lean body mass.
Organizational theory
managers serve as catalysts for change. leaders recognize there is a need to make a change (proactive) leader helps followers recognize this need by raising their level of dissatisfaction. followers are shown that the present situation does not meet their needs or that it conflicts with their values. Leader then depicts a future that appeals to the values and needs of followers (defines vision) successful change requires: unfreeze the status quo, change to a new state, refreeze to make the change permanent.
Compromise
managers try to resolve conflict by finding a middle ground. each party achieves some of its objectives and sacrifices others. may be weak method - does not usually lead to a solution that can best help the organization. solution reached will simply be one that both parties can live with.
PRO (Peer Review Organization)
mandated by TEFRA; watchdog of teh DRG system; formal assessment by physicians of the quality and efficiency of services provided.
low motivational level
mandatory attendance; little interest in topic; may feel there are more important things he should do.
CRP (C-reactive protein)
marker of acute inflammatory stress (not nutritional status!) as it declines, indicates when nutritional therapy would be beneficial when elevated CRP decreased, PAB increases
Five federal block grant areas
maternal and child health, community services, social services, preventive health service, primary care
Fair Labor standards act 1938
may be called Minimum Wage or Wage Hour Law; set minimum wage. for overtime work (over 40 hours in 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.
Bacillus cereus
may be present in the outer casing of rice and/or other starchy food items. it is able to form temperature-resistant spores and thus can easily survive cooking and inadequate refrigeration.
Stroke due to brain embolism
may be undernourished or overweight. immobilization decreases ability to absorb calcium and increases nitrogen loss.
The judiciary branch
may discard a law if it considers it in violation of a person's basic rights and freedoms.
reassuring response
may make it difficult to solve the clients problems or discuss it further. client is prevented from working through feelings
curcumin (tumeric)
may reduce inflammation, antioxidant, in curry powder
The executive branch (president)
may veto legislation or sign it into law
Controlling/evaluation
measure present performance against standard performance. ongoing process which determines whether goals have been reached.
continuous scores
measured on a continuous scale
glycosylated (glycated) hemoglobin (Hb A1c)
measures % of hemoglobin that has glucose attached. normal <5.7% over 65 years <7% in healthy, </= 8% in frail elderly. goal for diabetics <7% (at risk for developing diabetes 5.7-6.4%) measure of long term blood glucose control (60-90 days) high concentration of glucose forms chemical bond with hemoglobin. the longer the blood glucose is high, the higher the HbA1c.
triceps skinfold thickness (TSF)
measures body fat reserves; measures calories reserves standard: male 12.5 mm; female 16.5 mm
direct calorimetry
measures heat produced in respiration chamber (limited usefulness)
indirect calorimetry
measures oxygen consumed and co2 excreted using a portable machine (practical way of measuring which nutrients are being used for energy, and determining caloric needs) useful with athletes, burns
arm muscle area (AMA)
measures skeletal muscle mass (somatic protein) to determine: use TSF and arm circumference standard: male 25.3 cm; female 23.2 cm important to measure in growing children
outcome evaluation
measures the effect on the target population.
protein sources
meat, poultry, fish,e ggs, milk, legumes
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 single allergen for infants. introduce eggs at 24 months of age, nuts and fish at 36 months.
informal channel (grapevine)
meets social needs of group
folate deficiency
megaloblastic macrocytic anemia diarrhea, fatigue
white sauces
melt fat, add flour (roux, half fat, half flour) remove from heat, add liquid at 170-180 F; add salt add an acid when cooking is complete uncooked flour results in starchy tasting and grainy
Hgb hemoglobin
men 14-17 mg/dl, women 12-14 gm/dl, pregnant < or = to 11 iron-containing pigment of RBCs erythrocytes are produced in bone marrow
Hct hematocrit
men 42-52%, women 35-47%, pregnant women 33% volume of packed cells in whole blood
24 hour recall
mental recall of everything eaten in the previous 24 hours. quick tool to estimate a sample daily intake. Clinical setting.
alchohol
metabolized as a fat - 7 calories/gram to determine calories from alchol (.8)(proof)(ounces) proof = % alcohol x 2
Biguanides
metformin (glucophage) - enhance insulin action, suppress hepatic glucose production.
focus group
method of attaining information about a target group; small group who talk about the beliefs, opinions, problems; contributes attitudinal data
median
midpoint arrange observations from low to high; count the number of values. median is the value at the midpoint. if there is an odd number of number, the median will be the exact center, if there is an even number of numbers, the median is the average of the two numbers closest tot he center.
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. to prevent acidic stones - create an alkaline ash by increasing cations (Ca, Na, K, Mg), adding vegetables, fruits, brown sugar, molasses. to prevent alkaline stones - create an acid ash by increasing anions (Cl, Ph, Su) with adding meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye.
diagonal communication
minimizes time and effort expended in organizations. between functions diagnoally placed (ordering clerk in foodservice send requests directly to purchasing department, not through food service channels.)
basal energy expenditure (BEE)
minimum amount of energy needed at rest in fasting (amount needed to carry out involuntary work of the body, activity of internal organs, internal temperature). affected by extremes in environmental temperatures tropical climate 5-20% increase caffeine, alcohol, nicotine stimulate metabolic rate 7-15%
Absolute FTE
minimum number of employees needed to staff teh facility; counts productive hours (hours actually worked).
Phenylketonuria (PKU)
missing enzyme - phenylalanine hydroxylase - which would convert phe into tyrosine; phenylalanine and metabolites accumulate leading to poor intellectual function. detected with Guthrie blood test.
buffer
mixture of acid and base components to protect against a strong acid or strong base major buffer - carbonic acid (H2CO3) adn sodium bicarbonate (Na HCO3)
baking powder
mixture of baking soda (provides co2), dry acid (reacts with soda to release carbon dioxide), and cornstarch (keeps contents dry). Types: tartrate, phosphate, combo old baking powder is more alkaline and causes loss of thiamin in baked goods.
MNT for nephrosis/nephrotic syndrome
modest protein restriction - .8-1 g/kg; 50% from HBV. Excess protein will be catabolized to urea and excreted. <30% fat, low saturated fat, 200 mg cholesterol. 35 cals/kg/day modest sodium restriction 2-3 g/day. calcium 1-1.5 g/day, supplement vitamin D. may need fluid restriction with edema. abnormalities in Fe, Cu, Zn, Ca related to protein loss.
MAP
modified atmosphere packaging air is removed and replaced with gases (Co2, Nitrogen)
NDD2 (Dysphagia mechanically altered)
moist, soft-textured, easily formed into a bolus; moist, tender ground or diced meats, soft cooked vegetables, soft or canned fruits. no bread, rice, cheese cubes.
Informational roles
monitor - searching for information to become more effective disseminator - transmits information to subordinates spokesman - transmits information to people inside and outside
emulsifiers
monoglycerides, diglycerides, lecithin, disodium phosphate. prevent oil and water from separating
written communictation
more formal and authoritative. interpreted more accurately; used when record is required. keep at 8th grade reading level for general population and 6th grade for audiences of lower literacy. Email, pamphlets, posters, handouts
narrow span of control
more levels are created; need more managers; needd with newly hired personnel
oral communication
more personal, encourages two-way communication. most critical barrier: poor listening skills
Job enlargement
more similar tasks to alleviate boredom
nominal group technique - Delbecq
more structured and controlled than an ordinary brainstorming group. has authoritative leader, controlled interactions, closely focused goals, rigid enforced procedures, 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.
calcium
most abundant mineral. regulated by parathyroid hormone. Vitamin D, acid, lactose aid absorption. calcitonin lowers serum calcium by inhibiting bone resorption. function - blood clotting, cardiac function, nerve transmission, smooth muslce contractility sources - dairy, leafy vegetables, legumes
Renal calculi
most common is calcium stone. 1.4-2 L fluid/day needed to dilute urine. Calcium oxalate stones - adequate calcium intake to bind oxalate and a low oxalate (40-50 mg) diet (dark leafy greens, chocolate, strawberries, nuts, beets, tea)
Vitamin C/ Ascorbic acid
most easily destroyed, structure like glucose. antioxidant. needs acid pH. destroyed by heat, alkaline pH, oxidation function - changes proline into hydroxyproline into collagen which strengthens inter cellular substances. wound healing. aids iron abs. sources - citrus fruits, potatoes, papaya, dark green, yellow vegetables.
Participative management
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
mode
most frequently occurring value; prediction most likely to be right
communication principles
motivation emphasize human factors (feelings, anxieties, concerns) involve learning in active way establish rapport discuss problems descriptively offer alternatives provisionally rather than dogmatically be clear, complete, concise concrete, and correct
The join commission (nutrition screening)
nutrition risk identified in hospitalized patients whithin 24 hours of admission, but does not mandate a method of screening.
work (activity, occurrence) sampling
observe random samples (intermittent observations) to determine percetnage of time working or idle.
Herzberg's two-factor theory
motivation and maintenance approach maintenance (hygiene) factors (satisfiers, dissatisfiers) - if present and seen as good, satisfiers - if lacking or perceived as negative, dissatisfies and will interfere with work. - do not produce motivation but can prevent it. - Ex: fair wage, insurance, retirement benefit, supervision, schedule, working conditions motivators - call forth energy and enthusiasm (enrichment) -achievement, personal accomplishment, recognition, responsibility, participation in decision making, opportunity for growth and a advancement.
Fluorosis
mottled teeth with excessive fluoride
operation charts
movement of hands; reduces transportaiton and re-plan work areas
education plan - targeted setting and clientele
multicultural awareness assume differences until similarites are proven. emphasize description rather than interpretation ore evaluation. cultural communication styles differ spatial relationships vary among cultures/individuals gestures
Myofibrils
muscle composed of bundles of fibers
biotin defciency
muscle pain, dermatitis, glossitis
setting educational goals
must be set in accordance with the process of learning. must be based on previous learning and the characteristics of the group being instructed.
selenium deficiency
myalgia, cardiac myopathy
Meat pigments
myoglobin is main color contributor. myoglobin + oxygen -> red -> brown -> green green colors due to further myoglobin breakdown
NCAHF
national council against health fraud
flour color
natural agents cause oxidation during storage and turn flour from creamy yellow to white. if an oxidizing agent is added - labeled "bleached"
Dawn phenomoenon
natural increase in early morning blood glucose and insulin requirements due to increased glucose production in liver after overnight fast. increased need for insulin at dawn.
TPN solutions - fat
needed for energy and to prevent essential fatty acid deficiency (EFAD) To prevent EFAD, give 500 cc of 10% fat emulsion 1-2 x /week symptom of EFAD - petachiae (red spots)
folate deficiency follow GI surgery
needs B12 for transport inside the cell; also from poor folate intake and low serum iron (cofactor in folate metabolism)
coercive power
negative side of reward power, ineffective in motivating behavior change, may create resistance. ability to PUNISH another for not carrying out requirements. used to maintain minimum standard of performance.
vitamin A deficiency
night blindness, nyctalopia, is reversible. xerophtalmia - corneal damage, not reversible bitot's spots on conjunctiva, dry, scaly skin (hyperkeratosis)
unstructured (non-directed) interview
no definite checklist; more participation from applicant; "tell me about your last job"; sales, counseling, management.
dried skim milk
no more than 1.5% fat; keeps well.
null hypothesis
no relationship in population of data (any difference is a result of sampling error) aften has "equal to" expressed
chronic nonspecific infantile diarrhea
no significant malabsortption consider ratio of fat to CHO calories. volume of ingested liquids. some are inadvertently placed on a low fat diet or consume too many fluids or too many calories. give 40% calories as fat, balanced with limited fluids; restrict or dilute fruit juices with high loads - apple, grape
Systemic lupus erythematosus (SLE)
no specific dietary guidelines, tailor to needs. may have dietary deficiencies of Fe, Folate, Calcium, Fiber, B12. may have anemia but does not correlate with Fe intake. May show symptoms of celiac disease.
non-probability
no way of forecasting that each element in the population will be represented in the sample. convenience or accidental quota
Disher scoop sizes
no. 6 - 2/3 cup no. 8 - 1/2 cup no. 10 - 3/2 oz/.4 cups no. 12 - 1/3 cup no. 16 - 1/4 cup no. 20 - 1/5 cup no. 24 - 8 teaspoons no. 30 - 2 T. no. 40 - 5 teaspoons no. 50 - 4 teaspoons no. 60 - 1 T no. 70 - 2 teaspoons
dietary fiber
non-digestible CHOs and lignin, binds water, increases fecal bulk; found in legumes, wheat bran, fruits, vegetables, wole grains. Oat bran and soluble fibers decrease serum cholesterol by binding bile acids converting more cholesterol into bile. soluble fibers (pectins, gums) delay gastric emptying, absorb water, form soft gel in small intestine; this slows passage and delays or inhibits abs. of glucose and chol. 38 g for Men, 25 g for women recommended.
cerebral palsy
non-hereditary, brain damage; inadequate control over voluntary muscles leading to spasms. spastic form - difficult, stiff movement; limited activity; obese (low calorie, high fluid, high fiber diet) non-spastic (athetoid) form - involuntary wormlike movement, constant irregular motions leading to weight loss. (high calorie, high protein diet, finger foods)
Indices fo glycemic control
normal = 70-100 impaired fasting = 100-125 impaired glucose tolerance (2hPG) = 140-199 diabetes - fasting plasma = FPG >/= 126 or GTT >/= 200 or symptoms of diabetes plus casual plasma glucose >/= 200 gm/dl; HgA1c >/= 6.5%
Tolerable upper limit (UL)
not associated with adverse side effects in most individuals of a healthy population.
indirect cost
not directly accountable to the cost of an object and include administration, personnel, and security costs.
hair analysis
not for nutritional assessment; useful in measuring intake of toxic metals
p > .05
not very significant difference, not reliable results. has not proved hypothesis
Federal Register
notices of public hearings, proposed and final rules, agency decisions, published weekly; lists changes in USDA food programs.
critical thinking skills needed for nutrition screening
observe verbal/nonverbal cues that can guide effective interviewing methods. determine appropriate data to collect. select tools and procedures and apply in valid, reliable ways. Distinguish relevant from irrelevant and important from unimportant data. validate, organize, and categorize the data.
secondary questions
obtain more info, follow up quesition
esophageal varices
occur when blood can't enter the liver. connective tissue overgrowth causes resistance to blood entering from portal vein. The increased pressure forces blood back into collateral veins that offer less resistance. Esophageal, abdominal, collateral veins enlarge. Due to portal hypertension.
retrogradation
occurs in starches with a high proportion of amylose. after a starch paste has been cooled or chilled, it may become less soluble and recrystallizes to form a solid or rigid gel. It reverts (retrogrades) back to the insoluble form on freezing or aging. the hydrogen bonds that hold the gel together break and reform in an orderly crystalline fashion (gritty texture). ex: stale starch products, separation whena gravy thaws, old pudding accelerated by freezing.
Ascites
occurs when blood cannot leave the liver. connective tissue overgrowth blocks blood flow out of liver into vena cava. The liver expands (can store a liter of extra blood, when exceeded the pressure forces fluid to sweat through the liver into the peritoneal cavity. this fluid is almost pure plasma with a high osmolar load, pulling more fluid in to dilute the load, leading to sodium and water retention.
Health care outcomes
of interest to health care providers, and payers. Health and disease outcomes - reduced readmissions, changes in severity, duration, or course of a condition or disease, changes in risk level, maintenance of health. cost outcomes - changes in length of stay, ICU days, number of outpatient visits, treatment procedures, medications, reduced readmissions. patient centered outcomes - changes in indicators that reflec functional level, disability, quality of life.
qualititative research
often precedes other research explores a phenomenon of interest as a prelude to theory development data collection through interviews, observations, questionnaires, may use focus group - Delphi
nutrition needs for the homeless
often too poor to purchase food; have no place to store or prepare it emergency food programs do not provide balaned meals feeding infants is especially difficult federal food programs are less accesible redesign existing services to be more responsive: locate WIC clinics at shelters, offer education and training to staff and volunteers at food kitchens
Starch changes to sugar during storage
old potatoes taste sweeter, cook to a darker brown (maillard reaction), and are softer in texture.
sources of monunsaturated fat
olives, canola, peanut, sunflower
disaster planning
one gallon of water/person/day for minimum of 3 days.
unsaturated fatty acids
one ore more double bonds one double bond = monounsaturated; two or more double bonds - polysunsaturated safflower = most polyunsaturated canola = most unsaturated
cross-sectional studies
one time data collection. sometimes called prevalence study -- ALL of the cases of a specific disease among a group of people in a specific time a snap shot look at one point in time; describes current, not past or future events.
NHANES (national health and nutrition examination survey)
ongoing (repeated) survey to obtain info on health of American people evaluates clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometric, nutritional data (24 hour recall, food frequency lists) NHANES III - ovsersampling of adults >/= 65 with NO upper age limit
dichotomous scores
only two events are possible (heads, tails)
OARS
open ended questions affirmations reflective listening summaries
Tube bore
opening - based on viscosity of feeding. Large #16 - blenderized whole foods Small #8 - ready prepared formulas, more comfortable.
lactose tolerance test
oral dose of lactose (up to 50 grams) after a fast. if intolerant of lactose, blood glucose will rise < 25 mg/dl above fasting (flat curve). if tolerant of lactose, the rise would be above 25 mg/dl (normal cure).
beating
over and over to smooth and incorporate air
eggs -dried heat
overcooking toughens under cooking results in excessive shrinkage when removed from oven
ice crystals - ice cream
overrun is the increase in volume from freezing and whipping (determined by weight; should be 70-80%) homogenization makes ice cream smooth by making it easier to beat in air during freezing. agitation is essential to keep ice crystals small. using whipped cream instead of half and half will create smoother ice cream
postprandial or reactive hypoglycemia
overstimulation of pancrease or increased insulin sensitivity; blood glucose galls below normal 2-5 hours after eating (<50 mg/dl) weak, trembling, extreme hunger. goal is to prevent marked rise in blood glucose that would stimulate more insulin. avoid simple sugars, 5-6 small meals/day, spread intake of CHO throughout the day, protein at RDA levels.
normal acid-base balance
pH - 7.4 HCO3 - 24-28 PCO2 - 35-45
iron deficiency
pale tongue, fatigue anemia spoon-shaped nails pale conjunctiva (mucous membranes lining eyelid)
MNT for Short bowel syndrome
parenteral nutrition initially to restore and maintain nutrient status. enteral - start early to stimulate growth, increase over time; continuous drip. may take weeks or months to transition to food. jejunal - normal balance of carbs, protein, fat; avoid lactose, oxalates, large amounts of concentrated sweets; vitamin, mineral supplements. ileal - 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.
PBI
protein bound iodine - measures activity of thyroid gland. hormones: thyroxine (T4), triiodothyronine (T3) when PBI elevated, BMR elevated measures energy metabolism, measures level of thyroxine produced not a nutritional assessment parameter
physical and chemical changes in meat cooking
protein coagulates collagen is hydrolyzed to gelatin and softens surface browns due to breakdown f pigments heat changes interior from red to pink to brown to gray (denatures globin, Fe oxidized) increase tenderness of meat by adding vinegar cured meats are pink from nitrites (inhibits botulism)
coagulation -eggs
protein coagulates at 62-70 C (sets a custard) used to bind, gives firmness, stability, coats food, browns, clarifies liquids syneresis (weeping) liquid released from a coagulated product. (when cooked at at too high/low a temp)
glucocoticoids, antibiotics
protein deficits
Emulsification - eggs
protein in egg forms a thin film around droplets of oil; stabilizes emulsion egg yolk yields a stiffer, more stable emulsion than egg white because it has more protien (by weight) yolk is naturally occurring oil in water emulsion. lipoproteins stabilize the emulsion by interacting at the surface of the oil droplets to forma layer
iatrogenic malnutrition
protein-calorie malnutrition brought on by treatment, hospital, medications
enzymes
proteins, organic catalysts that control reaction
USDA commodity food donation/distribution program
provides foods 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
EFNEP Expanded food and nutrition education program
provides grants to universities that assist in community development. trains nutrition aides to educate the public improve food practices of low income homemakers with young children. works with small groups; teaches skills needed to obtain a healthy diet (budgeting, meal planning, shopping, cooking).
egg (baking)
provides stability, retains leavening agent, distributes shortening by emulsification, introduces air, adds color and flavor
Intermittent drip (EN)
pump or gravity. more mobility.
Surimi
purified and frozen mined fish with a preservative, used in analogs, may have egg white or starch added to create desired structure.
nutrition intervention
purposely planned actions designed with the intent of changing a behavior, risk factor/condition, for an individual, group, or community. based on the nutrition diagnosis and provides the basis upon which outcomes are measured and evaluated. aimed at resolving the underlying cause of the nutrition problem when possible. If it is not possible, then the nutrition intervention is targeted at minimizing the symptoms of the nutrition problem.
acute pancreatitis
put pancreas on rest, withhold all feeding, maintain hydration (IV). progress as tolerated to easily digested foods with a low fat content. elemental (pre-digested) enteral nutrition into jejunum may be tolerated.
ability to empathize
put yourself in their shoes. allows you to respond without giving advice. focus instead on their need to talk and express feelings and concerns
TEFAP The emergency food assistance program
quarterly distributions of commodity foods by local, public or private nonprofit agencies, food banks, soup kitchens, homeless shelters supplements diets of low income households
Treatment of neoplastic disease
radiation - loss of taste, xerostomia (dry mouth, so moisten foods adding water or milk, suaces, gravies), esophagitis, diarrhea, malabsorption. May cause mucositis. chemotherapy - chemical reagents which have toxic effects. May cause neaseau, vomiting, malabsorption, anorexia, stomatitis.
Pantothenic acid deficiency
rare. parasthesia in feet
copper deficiency
rare. microcytic anemia, neutropenia. Wilson's disease: low serum copper, genetic absence of liver enzyme
mortality
rate of death; morbidity - state of disease
TPN solutions - protein
ratio for anabolis is 1 gram nitrogen /150 calories. 1-1.5 grams protein/kg/day crystalline amino acids 3-15% solution. % = number of grams of protein in 100 mls of solution. A 3% solution has 3 grams of amino acids / 100 ml.
experimental group
receives the program or treatment
Flow phase
recovery follows fluid resuscitation and return of oxygen transport
Chronic pancreatitis
recurrent attacks of epigastric pain of long duration.
Flavanoids
red, blue, purple - anthocyanins (greatly affected by changers in pH) soluble in water bright red in acid bluish in alkaline
motion economy
reduce motions and time requried
Gastric bypass and gastroplasty
reduce the amount of food that can be eaten at one time and produce early satiety roux-en-y gastric bypass, usually permanent. -reconstructs the small intestine to resemble the letter Y. -creates a small gastric pouch connected directly to the jejunum. -dumping syndrome may develop -potential anemia, and deficiencies of potassium, magnesium, folate and vitamin B12. Supplementation is necessary.
extinction
reduce undesired behavior. absence of reinforcement following undesired behavior (ignore). if extinction is repeated, behavior will eventually disappear.
Zinc deficiency
reduced immune function, alopecia, poor wound healing, hypogeusia.
orlistat
reduces fat absorption by binding lipase; vitmin/mineral supp.
mediterranean diet
rich in alpha linolenic acid, high in monounsaturated fats. olive, canola, soybean oils; walnut, almonds, pecan, peanuts, pistachios. fish, poultry eggs rather than beef, bread fruits and vegetables in abundance, beans, legumes, yogurt cheese. resveratrol, in skin of red grapes, may lower blood pressure.
Vitamin D deficiency
rickets, osteomalacia
gestational diabetes
risk factors BMI >30, history of GDM. at 24-28 weeks of gestation, screen with 50 g oral glucose load; glucose >/= 140 mg/dl indicates need for further testing. 40-45% CHO, 3 small-medium sized meals and 2-4 snacks. DRI for CHO during pregnancy is 175 g/day 15-30 g CHO at breakfast (less well tolerated), rest divided evenly. increases risk of fetal macrosomia (LGA large for gestational age), fetal hypoglycemia at birth. overweight/obese - modest energy restriction to slow weight gain.
characteristics of a good muffin
round, pebbled top, symmetrical shape, no long, narrow tunnels
sources of polyunsaturated fat
safflower, corn, soybean, cottonseed, sunflower
winterized oil
salad dressings; won't crystallize when cold -oil chilled to 45 degrees; fatty acids with high melting points crystallize and are filtered out -winterized oil is clear, not cloudy -corn, soy , and cottonseed oils are winterized; olive oil is not
pathway chart or flow diagram
scale drawing showing path of a worker during a process
pilot study
scaled down version of the larger investigation; practice implementation, determine whether clinical trial, as planned, is feasible; are goals realistic and attainable? includes every step in the study, but done on a small test group.
SAP
screen, assessment, plan
vitamin C deficiency
scurvy, poor wound healing, bleeding gums, petachiae
phosphorus
second most abundant mineral. part of DNA, RNA, ATP function- phospholipids transport fat through lymph and blood bone, teeth sources - meat, milk, poultry, eggs, fish, cheese deficiency rare
hormones
secretions from endocrine glands. chemical messengers that trigger enzymes. thyroxine - regulates metabolism and rate of oxidation. influences physical and mental growth stimulates liver glycogenolysis, gluconeogenesis - raises blood sugar
Epilepsy
seizures, altered consciousness anticonvulsants phenobarbital and phenytoin (dilantin) interfre with calcium abs. take 1 mg folate daily with drug. may need supplements of vit. D, calcium, thiamin provide phenytoin separate from meals and other supplements. Enteral feedings decrease bioavailability of phenytoin so hold tube feedings >/= 2 hours.
vitamin B6 deficiency
seizures, anemia, dermatities, glossitis, peripheral neuropathy
RAST (alternative to skin test)
serum is mixed with food on paper disk; measures specific IgE antibodies.
Hyperemesis gravidarum
severe nausea, vomiting, acidosis, weight loss. bed rest, small amounts frequent carbohydrates.
HBV (Hep B)
sexually transmitted, HCV: blood to blood contact
needs assessment - very poor
short term planners
Chain of command
shows command relationship from top to lowest level.
line graphs
shows frequency on vertical scale; method of classification on horizontal scale
organizational chart
shows how the employee fits into the organization. shows relationship of positions and functions. depicts lines of authority shown with solid lines advisory staff positions shown with dotted lines. Not shown: degree of authority at each level, informal relationships.
bar chart
shows measurement only on vertical axis. bars arranged horizontally or vertically in ascending or descending order
muffin method of mixing
sift dry ingredients; make well in center. blend liquids and a dd all at once to dry ingredients. mix just enough to dampen
p </= .05
significant difference, results are reliable
arithmetic mean
simple average total the values of all observations and divide by the number of observations
compound fat
simple fat plus other component.
conjugated proteins
simple plus non-protein substance (lipoprotein)
percolator
single container, covred basket with stem; gives stronger and bitter coffee; water is hotter and repeatedly passes through grounds
sweet acidophilus milk
skim milk plus acidophilus bacteria which reduces lactose
filled milk
skim milk, vegetabel fat (coconout oil), water, illegal in some states
curve of normal distribution
slope is convex (bulging outward) at point of inflection, it becomes concae (bulging inward) as slope begins to level off distance between the mean and the point of inflection on either side is equal to the standard deviation. about 2/3 of all observations ina normal distribution lie within 1 SD of eh mean (m/1 SD of the mean) 32% of observations lie outside of the range 95% lie witin about 2SD either side of the mean
gastric banding
small gastric pouch created using a fluid-filled inflatable band. adjusted to alter the size of the opening (fully reversible) will not require folic acid, iron or B12 replacements.
Peripheral parenteral nutrition
small surface veins short term therapy with minimum effect on nutrition status. indications - post-surgery (when enteral feeding is expected to resume within 5-7 days), mild to moderate malnutrition, as supplement to enteral.
microcytic, hypochromic anemia
small, pale cells; due to Fe deficiency. associated with chronic infections, malignancies, renal disease. macrocytic, megaloblastic anemia: FEW large cells, filled with hemoglobin. due to deficiency of folate or vitamin B12; Schilling test for pernicious anemia.
NDD1
smooth, pureed, homogenous, cohesive foods. "pudding like" avoid gelatin, fruited yogurt, hot cereal with lumps and soup with lemps.
higher human needs (motivators)
social (organized activities), self-esteem (job title, praise, rewards, promotions) self-realization, self-actualization (realizing your potential growth using creative talents); advanced training, job enrichment.
renal solute load
solutes excreted in 1 L urine; daily fixed load of 600mOsm mainly measures nitrogen (60%) and electrolytes (sodium)
small group discussion
some lecture plus interaction; beneficial in clinical setting; teacher needs to remain in control; 3-5 people with similar needs; learn from each other
Energy
sources - carbs and protein. 4 kcals/gram, fat 9 kcals/gram. the brain uses glucose exclusively as an energy source; uses ketone bodies during starvation
CAP-FEIA blood test
specific in identifying children with milk, egg, fish, or peanut allergy
research results
specific lab, clinical, objective or subjective findings
Liquid consistency
spoon thick, honey-like, nectar like. thin: includes all beverages (water, ice, milk, juices, coffee, tea, gelatin)
shift schedule
staffing patterns for a particular operation; positions and hours worked, number of days worked per week, relief assignments. ex: trayline, dishwasher
structure of grains/cereals
starchy endosperm rich in protein outer layer of hull and bran scutellum - in germ; has most of the thiamin vitamin E (in germ), thiamin, riboflavin, phosphorus.
homeostasis
state of equilibrium of the internal environment of the body
research methodology
statement of hypothesis, discussion o methods used
TANF (Temporary Assistance for Needy families)
states determine the eligibility of needy families and the benefits and services those families will receive
Decision making/problem solving roles
steps - recognize and analyze problem; determine workable solutions; gather data; choose solutions; take action; follow-up action.
process charts
steps involved in process using symbols
Functions of liver
stores and releases blood, filteres toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance.
structure of fatty acids
straight hydrocarbon chains terminating in a carboxyl group (COOH) at one end and a methyl group (CH3) at the other end classified by the number of dobule bonds the location of the first double bond, counted from the METHYL END of the fatty acid, is designated by the omega sign. linoleic acid C18:2omega6 indicates taht there are 18 carbons, two double bonds, the first double bond located at the sixth carbon
SWOT analysis
strengths, weaknesses, opportunities, threats.
% weight change
stresses significance of weight change and used to assess potential nutrition risk. [(usual weight-actual weight) / usual weight] x 100
collagen
structural part of tendon that surrounds muscle. in heat, hydrolyzed to gelatin; becomes tender
Job analysis
studies all aspects of job, done by worker and their supervisor. conducted first to collect info for job description.
position (legitimate) power
subordinate acknowledges that the influencer has the right to exert influence due to position (job title).
substrate
substance upon which an enzyme works
disaccarides
sucrose (glucose and fructose), lactose (glucose and galactose), maltose (glucose and glucose)
baker's special eggs
sucrose added to improve foaming ability
acute kidney injury/acute renal failure
sudden shutdown with previously adequate capacity; decreased GFR, inadequate pre-renal perfusion. due to burns, accident, obstruction, severe dehydration. symptoms - liguria (<500 ml urine), azotemia (increased urea in blood)
candies
sugar, water, corn syrup or cream of tartar. product is viscous, shiny, and smooth at start of process then becomes creamy, dull, lighter in color. cools and stiffens rapidly with further beating
mcClellands achievement - power affiliation theory
suggests that all people have 3 needs: need to achieve, for power, and for affiliation. achievement motive is a desire to do something better or more efficiently. People with this need tend to gravitate towards sales and management positions. They are task oriented and can manage themselves. the need for affiliation is the desire to be liked by others. those with a need for power enjoy competition and seek confrontation.
Insulin secretagogues
sulfonylureas, meglitinides (glucotrol) - promotes insulin SECRETION
descriptive statistics
summarizes and describes aspects of a set of data
MNT for Ulcers
ulcer = eroded mucosal lesion treatment = antacids, antibiotics to eradicate helicobacter pylori bacteria drug therapy - cimetidine, ranitidine (H2 blocker); prevents binding of histamine to receptor, decreases acid secretion. diet - as tolerated, well-balanced, avoid late night snacks omit - cayenne and black pepper, large amounts of chili powder, avoid excess caffeine and alcohol (Gastric irritants)
Dietary reference intakes (DRI)
umbrella of nutrient guidelines.
urea cycle defects
unable to synthesize urea from ammonia resulting in ammonia accumulation. vomiting, lethargy, seizures, coma, anorexia, irritability. diet - protein restriction (1-2 g/kg based on tolerance, age, projected growth rate) to lower ammonia; therapeutic formulas to adjust protein composition to limit ammonia production. Ex: OTC ornithine transcarbamylase deficiency.
pre-contemplation stage
unaware or not interested in making a change. "I did not know salt had an effect on my blood pressure"
hyperbilirubinemia
unconjugated bilirubin levels elevated within first week of life as a result of increased breakdown of RBCs or decreased intestinal mobility. Encourage 9-12 feedings per day of human milk or formula to promote hydration and intestinal motility.
hostile response
uncontrolled anger; may antagonize or humiliate client
CHIP Children's Health Insurance Program
under Social Security Act, partnership between federal and state governments expands health coverage to uninsured children whose families earn too much income to qualify for medicaid but too little to afford private coverage.
numerical continuous
underlying continuous scales (blood pressure)
Technical skills
understanding of an proficiency in a specific kind of activity. most important at LOWER levels of management.
cardiac cachexia
unintended weight loss, blood backs up into liver and intestines causing nausea and decreased appetite. Arginine and glutamine may help. Low saturated fat, low cholesterol, low trans fat, <2 grams sodium, high calorie
informal evaluation
unstructured observation of food selection and behaviors
long range planning
up to a 5 year cycle, focus on goals and objectives. requires a mission statement of long range vision.
job enrichment
upgrades job by adding motivating factors increases number of tasks and control the employee has over the job. Maslow and Herzberg motivator (advanced training)
How to check tube placement
use X-ray confirmation of tube tip location, or aspirate gastric contents. do NOT use blue dye to check placement.
Cystic fibrosis MNT
use age-appropriate BMI to assess height and weight. PERT - pancreatic enzyme replacement therapy with meals and snacks. high protein, high calorie, unrestricted fat, liberal in salt. if growth is normal and steatorrhea is controlled - calories to cover RDA for age and sex; if fails to grow - BEE X activity factors plus disease coefficients; may need 110-200% of normal energy needs. Protein 15-20% cals, carbs 45-55% cals, liberal fat to compensate for high energy needs, 35-40% of calories. additional 2-4 grams salt/day in hot weather, with heavy perspiration. age appropriate doses of water soluble vitamins and minerals. supplement water-soluble forms of fat-soluble vitamins (A and E).
sensitivity and specificity
use if protocol involves screening for a particular condition; evaluates the cut off value being used
Nutrition screening
use of preliminary nutrition assessment techniques to identify people who are malnourished or who are at risk for malnutrition. Brief, 5-10 minutes. review client's history, lab results, weight, physical signs. if no emerging nutrition problem exists, document that discharge from nutrition care is appropriate.
meat specifications
useas numbering system for order wholesale cuts
moist heat cooking
used for less tender cuts with more connective tissue (bottom round, chuck, brisket) braising simmer steam stewing
Peripherally inserted central catheter
used for short or moderate term infusion
Dry heat cooking
used for tender cuts - near backbone - loin, sirloin. have less collagen, need less time for cooking frying broiling roasting grilling
Gastrostomy or jejunostomy (EN)
used if needed for more than 3-4 weeks. PEG inserts tube into stomach through abdominal wall.
kneading
used in dough; push, pull turn
folding
used in foams; a down, across, up and across the top motion; rotate bowl
Adequate intake (AI)
used when insufficient evidence exists for EAR, RDA
Elemental, chemically defined enteral formula
used with malabsorption pre-digested protein or amino acids, glucose or sucrose, small fat, vitamins, minerals, electrolytes. absorbed in proximal intestine, low to no residue, don't need pancreatic enzymes, high osmolality, poor taste. Used with compromised GI function, inability to digest and absorb. Alitraq, petamen, vivonex
foam cake
uses air as leavening angel cake: egg white foam sponge cake: yolk foam and white foam chiffon cake: liquid yolks, egg white foam, baking powder, oil
human relations (behavioral) theory
uses behavioral sciences, workers exist in social groups. emplooyee participation in decision-making is essential. improves morale and productivity.
experimental model
uses experimental and control groups target populations are randomly chosen to be in either group. difficult and expensive to run
Gastroplasty
uses staples to create a small gastric pouch, leaving only a small opening into the distal stomach. liquids to pureed to soft foods to regular small meals and snacks.