MNT - Inman II

What is the diet for an ulcer?

as tolerated, well-balanced, avoid late night snacks

In cirrhosis, what do protein deficiencies lead to?

ascites, fatty liver, impaired blood clotting

Why might an acidic stone occur?

"uric acid stone" high levels of uric acid in your blood and urine consume foods with cations -f/v, brown sugar, molasses

define what one serving of milk products looks like

1 cup of milk or plain yogurt

MNT for Fever and infection

1.excessive fluid loss may lead to dehydration (hyperglycemia, dry, loos inelastic skin); IV feedings of dextrose and water, then diet high in calories and fluids 2. BMR increases 7% for each degree rise in F temp; normal temp 98.6'F

what is the normal stool fat?

2-5 grams

Name overweight BMI

25-<30

Name obesity class I BMI

30-35

What enzymes are included in LFT's?

ALP, LDH, AST (SGOT), ALT (SGPT)

Explain normal blood flow to the liver

Abd veins esophageal veins --> portal vein --> liver --> vena cava collateral veins

define impaired fasting glucose

FPG 100-125

State GFR range and recommended protein for CKD stage 4

GFR 15-29 0.6-0.8 G protein / kg

What is LDL (beta)?

Low-Density lipoproteins -transports cholesterol from diet and liver to all cells *small dense LDL-C associated with increased risk, responsive to diet *larger buoyant LDL not associated with increased risk

T2DM non-insulin medications: biguanides

Metformin (Glucophage): preferred first-line glucose-lowering medication for most patients with T2DM Suppress hepatic glucose production. first line therapy for most with T2DM. Take with food. Check B12 levels. Deficiency can lead to anemia or peripheral neuropathy

What is a major factor in the cause and treatment of HTN?

Obesity

The National Dysphagia Diet NDD

Specifies diet consistency and liquid viscosity.

What is the preferred fuel in cirrhosis?

fat

How is Hepatitis A (HAV) transmitted?

fecal-oral transmission (type most directly connected to food)

Name some renal functions

filtration: RBCs, protein 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

descrive carbohydrate counting

gives flexibility in food choices one choice from the starch, fruit or milk list = 15g of CHO and each is a CHO choice: meal plan outlines the number of CHO choices to be selected for meals and snacks

Parenteral nutrition PN:contraindications

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 outweighs benefits

Define T1DM

insulin deficient, dependent on exogenous insulin

What is the dawn phenomenon?

natural increase in early morning blood glucose and insulin requirements due to increased glucose production in liver after overnight fast 1. increased need for insulin at dawn

What is dietary fiber?

non digestible CHO's and lignin binds water, increases fecal bulk; found in legumes, wheat bran, fruits, vegetables, whole grains

Nutritional care for jejunal resection:

normal balance of carbohydrate, protein, fat; avoid lactose, oxalates, large amounts of concentrated sweets; vitamin, mineral supplements

how many calories must be reduced in order to lose 1 lb. fat/week?

reduce calories by 500 per day

what does a BUN:creatinine ratio of <10:1 suggest?

reduced BUN reabsorption d/t renal damage (may need dialysis)

What is the cause of rapid weight loss when one starts a diet?

water loss - as liver glycogen is utilized

T2DM non-insulin medications: TZD Thiazolidinediones

(Actos) increase insulin sensitivity in muscle. Weight gain

describe what one serving of fat looks like

- 1 teaspoon of oil or solid fat -1 tablespoon of salad dressing

Define what one serving of non-starchy vegetables looks like

- 1/2 cup of cooked vegetables -1 cup of raw vegetables -3 cups of salad or leafy greens -1/2 cup (4 fluid ounces) vegetable juice

MNT for CKD

- 23-35 kcal/kg or BEE x activity factor. Adjust for weight gain or loss. -<2400 mg/day sodium -restrict protein when GFR ml/minute falls stage one and two 0.8-1.4 G protein/kg stage 3 and 4 0.6-0.8 G protein/kg -phosphorus - stage 1 and 2 maintain normal serum level stage 3 and 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, depends on BP and urine output changes

How is lactose intolerance detected?

- breath hydrogen test: hydrogen is produced by colonic bacteria on lactose, absorbed into bloodstream and exhaled in 60-90 minutes -lactose tolerance test: oral does of lactose (up to 50 grams) after a fast. If intolerant to 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 curve).

What occurs with the loss of the colon?

- loss of water and electrolytes, loss of salvage absorption of carbohydrates and other nutrients. -Provide chewable vitamins

MNT for nephrotic syndrome

- modest protein restriction : .8-1.0g/KG; 50% from HBV. Excess protein will be catabolized to urea and excreted -<30% fat, low saturated fat, 200 mg cholesterol -35 calories/kg/day -modest sodium restriction 2-3grams per day - depends on HTN, edema -calcium 1-1.5 g/d, supplement with vitamin D -may need fluid restriction with edema -abnormalities in iron, copper, zinc, calcium - related to protein loss

With a ileal resection, what are some major complications?

- significant resections produce major complications 1. Distal: absorption of B12, intrinsic factor, and bile salts 2. ileum normally absorbs major portion of fluid in GI tract- pts have above average needs for water to compensate for excessive losses in the stool. Drink at least 1 liter more than their stony output daily 3. 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 absorption of oxalate increases leading to renal oxalate stones -increased fluid and electrolyte secretion; increased colonic motility

Define what one serving of starch looks like

-1/2 cup cooked cereal, grain, or starchy vegetable - 1/3 cup of cooked rice or pasta - 1 ounce of a bread product, such as 1 slice of bread - 3/4 - 1 ounce of crackers or grain-based snack foods

Define what one serving of fruit looks like

-1/2 cup of unsweetened canned or frozen fruit -1 small fresh fruit (about 2 1/2 inches in diameter) -1.2 cup (4 fl ounces) or unsweetened fruit juice (100% juice) -2 tablespoons of dried fruit

MNT for adult diarrhea:

-Remove the use; 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 doesn't need to 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

Where does the most digestion take place in the intestine?

-The first 100 cm of intestine (in duodenum and upper jejunum), what remains are small amounts of sugar, starches, fiber, and lipids

Diet for inflammatory bowel disease:

-maintain fluid and electrolyte balance; antidiarrheal agent (sulfasalazine) -energy needs according to current BMI, limit fat ONLY if steatorrhea; water soluble and fat soluble vitamins; iron, folate; assess Ca, Mg, An; MCT oil, watch lactose, frequent feedings. High fat may improve energy balance -Protein at each meal, chewable MV

Explain chronic nonspecific infantile diarrhea (infants and children):

-no significant malabsorption -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 osmolar loads - apple, grape

Define myocardial infarction in relation to Atherosclerosis

-reduction of coronary flow to myocardium d/t blood clot blocking a narrowed coronary artery 1. angina pectoris - chest pain 2. heparin - blood clots

How many carbs, protein, fat and calories in one serving of fat?

0g carbs 0g protein 5g fat 45 calories

How many carbs, protein, fat and calories in one serving of medium-fat protein?

0g carbs 7g protein 5g fat 75 calories

How many carbs, protein, fat and calories in one serving of high-fat protein?

0g carbs 7g protein 8g fat 100 calories

How many carbs, protein, fat and calories in one serving of lean protein

0g cars 7g protein 2g fat 45 calories

Enteral nutrition: give 1 cc water / calorie ingested

1 cal/cc formulas are 80-86% water; 1.5 cals/cc are 76-78% water 2 cals/cc formulas are 69-71% water

describe what one serving of protein looks like

1 ounce of meat or protein source (palm of your hand)

List some of the 2020-2025 Dietary guidelines for Americans

1) Follow a healthy dietary pattern at every life age 2) Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations 3) Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits 4)Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages

Maple syrup urine disease (MSUD)

1)inborn error of metabolism of the BCAAs leucine, isoleucine, valine 2) poor sucking reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of sweat and urine 3) restrict BCAA 45-62 mg/day (may use MSUD powder) 4) provide adequate energy from CHO and fat to spare amino acids 5) include small amounts of milk to support growth; gelatin may be used 6) avoid eggs, meat, nuts, other dairy products caused by deficiency of branched-chain a-ketoacid dehydrogenase which leads to dysfunction of BCAA metabolism of valine, isoleucine & leucine causing them to have increased concentration. increased concentration inhibits transport of tyrosine and tryptophan to the brain which decreases synthesis of dopamine and serotonin

List the steps in program planning

1. Develop a mission statement (philosophy) and needs/problem statement a. what nutrition services can contribute to the health and well-being of the community; what population groups will be served; select and rank the most critical issues; what is the present situation; who says it is a problem; what will happen if nothing is done Example of mission statement: Clinic will work to enhance the health of its clients by reducing the risk of heart disease 2. Set goals- broad direction, general purpose(increase quality and years of life) a. what health problems have nutritional implications b. determine current nutritional high risk groups and the most critical needs Example of goal: increase the awareness of CHD risk factors 3. Set Objectives: Specific measurable (tangible) actions within a time frame example: increase the number of women who can identify two risk factors for CHD by 25% in one year a. more defined than goals; contain specific target dates for completing specific projects. Include expected results in quantitative and qualitative terms within a given time frame b. SMART objectives: specific, measurable, achievable, relevant, time frame c. guidelines for writing 1. Include who, what behavior (measurable or action verb), how much, by whom, when, where 2. action verbs are measurable: exercise, select, list, identify, count, produce 3. not an action verb: appreciate, understand

What is the tx of Hepatic Failure (ESLD)?

1. If not comatose: moderate to high levels of protein, increase up to 1-1.5 gram protein/KG as tolerated. Modest protein intake if protein-sensitive hepatic encephalopathy. 2. 30-35 calories/kg; 30-35% calories as fat with MCT if needed 3. low sodium if ascites; vitamin/mineral supplementation 4. altered neurotransmitter theory: BCAA decrease (used by muscles for energy); AAA (aromatic amino acids) increase b/c 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 5. standard treatment is lactulose (hyper osmotic laxative that removes nitrogen); neomycin (antibiotic that destroys bacterial flora that produce ammonia)

Enteral nutrition specialized formulas

1. Nepro, Novasource Renal - renal 2. nutre, Pulmocare, Respalor: high fat, low carbohydrate - pulmonary 3. Hepatic Aid II, NutriHep - liver 4. Glucerna, DiabetiSource - diabetes 5. the more specialized the formula, the greater its cost

Explain the diet for cirrhosis

1. adequate to high protein .8-1.2g/kg; in stress at least 1.5g/kg 2. high calorie 25-35 kcals/kg estimated dry weight or BEE + 20% 3. moderate to low fat 25-40% of calories, MCT if needed, <30 grams fat if malabsorption. Fat is preferred fuel in cirrhosis. Include omega 3. Decrease LCTs if steatorrhea develops 4. low fiber if varies are present, low sodium (<2gm) if edema or ascites 5. with hyponatremia, fluid restriction of 1-1.5 L/day depending on severity, and moderate sodium intake 6. B complex vitamins, C, K, Zn, Mg; monitor need for A and D; zinc involved in conversion of ammonia to urea, increased loss in urine

how is malnutrition associated with alcoholic liver disease?

1. alcohol replaces food in diet 2. alcohol causes inflammation of GI tract and interferes with absorption of thiamin, B12, vitamin C, folic acid - SUPPLEMENT thiamin and folic acid 3. alcohol interferes with vitamin activation 4. increased need for B vitamins to metabolize alcohol 5. increased need for magnesium; excreted after alcohol consumption 6. malnutrition increases alcohol's destructive effects 7. folate and protein deficiencies - most responsible for malabsorption 8. thiamin deficiency - Wernicke-Korsakoff syndrome

GERD - gastro-esophageal reflux disease

1. avoid eating before bed, soda, caffeine, acidic foods 2. small, low fat meals, liquids empty more rapidly

Assessment of energy requirements

1. based on activity factors and BEE (Basal energy expenditure) a. BEE x 1.2 sedentary b. BEE x 1.3 active c. BEE x 1.5 stressed 2. assessment of physical activity levels (PAL) and restrictions EER (estimated energy requirements) for men and women 30 years of age

What is the dietary guidelines for Americans?

1. designed to prevent chronic disease, written by USDA and HHS

Acquired immune deficiency syndrome (HIV/AIDS)

1. diarrhea, malabsorption, nausea, vomiting, weight loss 2. preserve lean body mass, prevent weight loss, prevent HIV wasting 3. encourage physical activity 20 min/day, 3x/week 4. nutrient needs: BEE x 1.3 for asymptomatic, based on DRI a. protein: asymptomatic 0.8g/kg, up to 1.2-2.0g/kg if wasted LBM b. vitamin/mineral supplements if needed, especially calcium and vitamin D c. if diarrhea: soluble fiber, MCT oil, electrolyte replacement beverages 5. food and water safety - low bacteria diet (neutropenic), avoid raw foods 6. HIV infected women should be counseled NOT to breast-feed 7. HIV employee - keep info confidential, suggest AIDS education programs 8. NRTI drugs (nucleotide nucleoside reverse transcriptase inhibitors including Retrovir, zidovudine) can lead to anemia, loss of appetite, low vitamin B12, copper, zinc, carnitine 9. follow appropriate universal precautions; need not wear gloves, gowns or masks with general care unless respiratory or strict isolation is indicated 10. Nutritional supplementation should not be routinely recommended and herbal supplementation should be discouraged as adjunctive therapy to conventional care. use of Vitamin C or St. Johns Wort could result in drug resistance. CAM (complementary alternative medicine) therapies are not inert and may have profound consequences. 11. Pediatric HIV a. high protein, high calorie with supplements needed for weight gain b. energy needs: general guidelines plus appropriate stress factors c. multivitamins/minerals at doses 1-2X RDA or DRI d. lactose restriction if intolerant e. HALS (HIV - associated lipodystrophy syndrome) may develop from therapy 1. high cholesterol, high triglycerides, insulin resistance, changes in body fat distribution f. significant loss of lean body mass can be obscured by edema and HALS

Describe the treatment for Heart Failure

1. digitalis increases strength of heart contraction 2. low sodium (2-3 grams), DASH diet, 1-2 L fluid 3. 1.1-1.4g protein/kg ABW for normally nourished and malnourished 4. energy needs: RMR X physical activity factor -Sedentary 1.0-<1.4 -Low active 1.4-<1.6 -Active 1.6-<1.9 -Very Active 1.9-<2.5 Use indirect calorimetry if available. If not available, estimate RMR at 22 cal/kg for normally nourished, 24 cal/kg for malnourished 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 7. encourage individualized regular physical activity

List the stems of implementing a community program

1. educate: increase awareness, knowledge, options (cognitive learning) a. scientifically sound information explained to client so they understand reasons for changes you are recommending b. to reach large numbers: use media, hotlines, point-of choice or point of purchase (POP) intervention c. in health fairs, evaluate nutritional risk using BMI 2. Enable: reduce barriers that make it easier for people to act a. enabling interventions relate to the 4 "P's" of marketing (price, promotion, place, product) b. the product should be acceptable, the place accessible, the price reasonable, and the promotion tailored to enable attention and acceptance 3. skill development: competencies necessary to make and sustain new eating habits (psychomotor learning) a. one on one counseling, small group sessions, school fitness programs, worksite cafeteria programs b. teaches how to: select appropriate foods, budget for healthful foods, how to obtain Food Stamps if needed, how to develop new eating behaviors.

What is the Rx for acute viral hepatitis?

1. increase fluids to prevent dehydration 2. care varies according to symptoms and nutrition status 3. 50-55% CHO to replenish liver glycogen and spare protein 4. acute hepatitis: 1-1.2g protein/kg: cell regeneration, provide lipotropin agents to convert fat into lipoproteins for removal from liver 5. moderate to liberal at intake if tolerated; <30%cals if steatorrhea 6. small, frequent feedings (4-6) because of anorexia 7. encourage coffee (antioxidant) 8. multivitamin with B complex, C, K, zinc 9. if fluid retention, 2 gmNa

Define fluoride recommendations

1. infants (birth-6 months) oral supplementation NOT recommended. use fluoridated water if available 2. infants (6-12 months) fluoridated water; oral supplements ONLY if prescribed 3. Toddler (12-24 months) fluoridated water, or oral supplements if prescribed Toothpaste should not be used until the child can spit it out 4. Children (2-3 years) fluoridated water or supplements as recommended, fluoride toothpaste (pea-size)

Parenteral nutrition PN

1. infusion of a hypertonic solution delivered through a central venous catheter 2. used to achieve an anabolic state when patients are unable to eat by mouth and enteral feeding is not possible 3. subclavian vein minimizes risk of phlebitis

Nutritional care for SBS

1. parenteral nutrition initially to restore and maintain nutrient status 2. enteral - start early to stimulate growth, increase over time; continuous drip 3. may take weeks or months to transition to food

Peripheral parenteral nutrition: small surface veins

1. short term therapy with minimum effect on nutritional status a. indications - post-surgery (when enteral feeding is expected to resume within 5-7 days), mild to moderate malnutrition, as supplement to enteral 2. solutions a. IV dextrose - 3.4 calories/gram 1. to figure calories (ml) (%) (3.4) 2. highest concentration of dextrose used in peripheral nutrition is 10% b. protein 3-15% amino acid solutions c. IVFR intravenous fat emulsion (Intralipid) 1. 10% 1.1 calories/cc 20% 2.0 calories/cc d. solutions generally limited to 800-900 mOsm

Define MyPlate Food Guidance System

1. shows essential food groups, and offers recommendations on balancing calories, foods to increase and foods to reduce 2. build a healthy plate: make half your plate fruits and vegetables, make at least half your grains whole, use skim or 1% milk, vary protein choices 3. cut back on foods high in solid fats, added sugars, salt

Explain management of HTN

1. thiazide diuretics may induce hypokalemia 2. four modifiable factors in primary prevention and tx: overweight, high salt intake, alcohol consumption, physical inactivity 3. salt restriction 1500-2300 mg sodium/day; decrease weight if needed 4. 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)

Describe end stage renal disease (ESRD) and diet

1. usually associated with BUN >100mg/dl, and Cr 10-12 mg/dl 2. retention of nitrogen metabolites - may use Giovanetti diet - 20 grams protein (HBV), increase calories; control edema, prevent deficiencies

Describe the etiology of heart failure

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

describe what a serving size of alcohol looks like

12 fl oz beer 5 fl oz wine 1 1/2 fl oz hard alcohol

How many carbs, protein, fat and calories in one serving of fat-free, low-fat, 1% milk?

12g carbs 8g protein 0-3g fat 100 calories

How many carbs, protein, fat and calories in one serving of reduced-fat, 2% milk?

12g carbs 8g protein 5g fat 120 calories

How many carbs, protein, fat and calories in one serving of whole milk?

12g carbs 8g protein 8g fat 160 calories

How many carbs, protein, fat & calories are in one serving o breads; cereals; grains and pasta; starchy vegetables; crackers and snacks; beans, peas, and lentils?

15 g carbs 3g protein 1g fat 80 calories

How many carbs, protein, fat and calories in one serving of fruit?

15g carbs 0g protein 0g fat 60 calories

How many carbs, protein, fat and calories in one serving of sweets, desserts, and other carbohydrates?

15g carbs protein varies fat varies calories varies

Name Normal BMI range

18.5-24.9

What is lactose intolerance?

Due to a 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 dissension (swelling), cramps, diarrhea. Bacteria then ferment the undigested lactose, releasing carbon dioxide gas.

T2DM non-insulin medications: glucagon-like peptide-1 (GLP-1) receptor agonist

Exenatide (Byetta) dulaglutide (Trulicity) Semaglutide (Ozempic) slows gastric emptying enhances insulin secretion when glucose is high after eating, suppresses postprandial glucagon secretion, promotes fullness and leads to weight loss

define impaired glucose tolerance

2hPG 140-199

Name obesity class II BMI

35 - <40

How many calories must be lost to = one pound?

3500 calories = 1 lb of body fat

How many carbs, protein, fat and calories in one serving of non-starchy vegetables?

5g carbs 2g protein 0g fat 25 calories

how much iron does the typical American diet contain?

6 mg iron / 1000 calories

Define normal BG

70-100 mg/dl 2hPG (post-prandial) <140 mg/dl

what is normal body temperature?

98.6'F

Name underweight BMI

<18.5

State GFR range and recommended protein for CKD stage 1

> or = to 90 GFR 0.8-1.4g protein/kg

Name obesity class III BMI

>40

What is metabolic syndrome?

A cluster of conditions that occur together, increasing your risk of heart disease, stroke and T2DM Three or more of the following risk factors are linked to insulin resistance, which often increase risk for coronary events 1. elevated BP > or = to 130 systolic, and or > or = to 85 diastolic 2. elevated TG > or = to 150 mg/dl 3. fasting serum glucose > or = to 100 mg/dl 4. waist measurement > or = to 102 cm (40") men; > or = to 88 cm (35") women 5. low HDL <40 mg/dl (men), <50 mg/dl (women)

What is Cystic Fibrosis?

A genetic disorder, mutation of the CFTR protein causing exocrine gland dysfunction - secretion of thick mucus that obstructs glands and ducts; chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption

What is Crohn's disease?

AKA regional enteritis - IBD -may involve any part of the intestine but primarily involves distal ileum, colon and anorectal area s/s include weight loss, anorexia, diarrhea deficiencies: B12 deficiency leads to megaloblastic anemia; iron deficiency anemia d/t blood loss, decreased absorption

What is ALP & what does it mean when it's levels are increased or decreased?

ALP = alkaline phosphatase 30-120 U/L Increased: liver or bone disease decreased: scurvy, malnutrition

What is ALT (SGPT) and what does it mean when it's levels are increased?

ALT (SGPT) = alanine aminotransferase 4-36 U/L increased: liver disease

What is AST (SGOT) and what does it mean when it's levels are increased?

AST (SGOT) = aspartate amino transferase 0-35 U/L increased: hepatitis

What is dyslipidemia?

Abnormally elevated cholesterol or fats (lipids) in the blood

Explain Acute diarrhea in infants and children:

Agressive 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

How is alcohol metabolized?

Alcohol (ethanol) is converted to acetaldehyde and excess hydrogen which disrupts liver metabolism 1. hydrogen replaces fat as fuel (in the Kreb's cycle), so fat accumulates in liver, leading to a fatty liver, and in the blood, raising the TG level 2.shift in NADH/NAD ratio inhibits beta-oxidation of fatty acids and promotes triglyceride synthesis

Describe pernicious anemia

B12 deficiency which may be due to lack of B12 in the diet, pernicious anemia or other like malabsorption pernicious anemia: autoimmune condition when IF (necessary for B12 absorption) is attacked by antibodies resulting in no absorption of B12 causing one to become deficient. tx: IM injections of hydroxycobalamin if there is both B12 and folate deficiency MUST treat b12 FIRST!

Name the percentile that indicates obesity for children

BMI for sex and age > or = to 95th percentile

what does the BMR do when the dieter reaches a plateau?

BMR has dropped to reflect loss

What is Non-tropical sprue?

Celiac disease, gluten-induced enteropathy -gluten refers to storage proteins (prolamins: gliadin in wheat, secalin in rye, harden in barley, avenue in oats) -reaction to gliadin: affects jejunum and ileum (proximal intestine)

describe options for bariatric surgery tx

Class III obesity with a BMI of 40 or greater, or a BMI of 35 with co-morbidities Gastric bypass permanently alters the anatomy of the GI tract a. reduce the amount of food that can be eaten at one time and produce early satiety b. RYGB Roux-en-Y SG sleeve gastrectomy (about 80% of stomach removed) LAGB laparoscopic adjustable gastric banding

What is short bowel syndrome (SBS) and some s/s?

Consequences associated with significant resections of the small intestine. malabsorption, malnutrition, fluid and electrolyte imbalances, weight loss

What are the two conditions within inflammatory bowel disease (IBD)?

Crohn's disease and ulcerative colitis

Disorders or oral cavity and esophagus: dental caries

bacterial enzymes ferment carbohydrate deposits on plaque, enzymes produce acids that demineralize surface a. low cariogenic potential foods: high protein, moderate fat, minimal concentration of fermentable CHO, strong buffer; high mineral content (Ca, P), pH>6, stimulates saliva. Low cariogenic: cheese, nuts, meat b. sugar alcohols (sorbitol, xylitol, mannitol) do NOT promote tooth decay c. fluorine - can control caries, supplement starting at 6 months of age if level in water supply is <0.3 ppm 1. fluorosis- (mottled teeth) with excessive fluoride

What is Tropical sprue?

bacterial, viral, parasitic infection d/t chronic GI disease, intestinal lesions, may also affect the stomach

macronutrient distribution for diabetics

based on DRI's for healthy adults <7% total calories as saturated fat, trans fat intake should be minimized encourage fiber intake sucrose may be substituted for other CHO's

what is the spot weight loss theory?

belief that localized exercise reduces fat stores in the active area - RESEARCH DOES NOT SUPPORT THIS NOTION

osteomalacia

bone disorder adult rickets 1) vitamin D deficiency: lack or sunlight or diet intake 2) reduction in bone density: demineralization 3. Vitamin D, calcium Supplements

MNT for acute Crohn's flare-ups:

bowel rest, parenteral nutrition or minimal residue

How many carbs, protein, fat and calories in one serving of plant-based protein?

carbs varies 7g protein fat varies calories varies

What is steatorrhea?

consequence of malabsorption - fat in the stool (>7g is indicative of malabsorption)

Define systolic

contraction of the heart, greatest pressure

How do you prevent alkaline stones?

create an acid ash increase anions (Cl, Ph, Su) by adding meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye

What may low serum albumin be due to in cirrhosis?

dilution factor

In liver disease, enzyme levels are ___.

elevated

What are soluble fibers?

pectins, gums delay gastric emptying, absorb water, form soft Gell in small intestine; this slows passage and delays or inhibits absorption of glucose and cholesterol; fruits, vegetables, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, bananas

What are the phases of the 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

Tx of gastroparesis?

pro kinetics (erythromycin, metoclopramide) increase stomach contractility bezoar formation may be due to undigested food or medications; treatment includes enzymes or endoscopic therapy

Describe functions of erythropoietin (EPO)

produced by kidney -stimulates bone marrow to produce RBC

what effect does glucocorticoids, and antibiotics have?

protein deficits

What is a Hiatal hernia?

protrusion of a portion of the stomach above the diaphragm into the chest

what is the purpose of fiber?

provides indigestible bulk, promotes intestinal fx

when developing a budget for a community, where does funding come from?

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

NDD1

pureed, moderate to severe smooth, pureed, homogenous, cohesive foods. "pudding-like". blended, whipped, mashed. Avoid gelatin, fruited yogurt, hot cereal with lumps and soup with lumps, ice cream

MNT for acute pancreatitis

put pancreas at rest, withhold all feeding, maintain hydration (IV) 1.progress as tolerated to easily digested foods with a low fat content 2. elemental (Pre-digested) enteral nutrition into jejunum may be tolerated

Immunoglobumin E (IgE) mediated reaction

reaction to normally harmless food protein a. common allergens: peanuts, eggs, milk, soy, wheat, shellfish b. cow's milk protein is the most common single allergen for infants c. potentially allergenic foods, such as eggs, and peanuts, should not be restricted beyond 4-6 months of age

MNT for chronic pancreatitis

recurrent attracts of epigastric pain of long duration 1. PERT: pancreatic enzymes orally with meals nd snacks to minimize fat malabsorption from lack of pancreatic lipase. MCTs do not require pancreatic lipase. Add to mixed dishes, jams, jellies. 2. to promote weight gain, give maximum level of fat tolerated without an increase in steatorrhea or pain. 3. if malabsorbing fat soluble vitamins give water soluble forms, parenteral B12? (deficiency of pancreatic protease which splits off vitamin from carrier) 4. pancreatic bicarbonate secretion may be defective; may need antacids so PERT therapy will work 5. in severe prolonged cases, parenteral nutrition may be needed 6. to avoid pain: avoid large meals with fatty foods, alcohol

Describe tx for obesity

reduced caloric intake, exercise, behavior modification 1. realistic weight loss goals: up to 2 lbs./ week, up to 10% of baseline BW, or a Toal of 3%-5% of baseline weight if cardiovascular risk factors are present 2. calorie reduction strategies a. 1200-1500 calories/day for women, 1500-1800 calories/day for men b. energy deficit of approximately 500 to 750 calories per day c. one of the evidence-based diets restricting certain foods types (high fat foods, high carbohydrate foods) in order to create an energy deficit by reduced food intake d. small food-based changes: changes in SSB, sugar-sweetened beverages, can assist with weight management e. meal replacements for weight loss may be recommended if the client has difficulty with portion control 3. physical activity: 150-420 minutes or more per week; for weight maintenance, 200-300 minutes per week

what do osteoblasts do?

reform bone

Define diastolic

relaxation of the heart, least pressure

what do osteoclasts do?

resorb and remove bone

what food is least likely to cause an allergy?

rice

Describe gestational diabetes

risk factors: BMI >30, history of GDM a. at 24-28 weeks of gestation, screen with 50g oral glucose load; glucose > or = to 140 mg/dl indicates need for further testing b. 40-45% CHO, 3 small-medium sized meals and 2-4 snacks c. DRI for CHO during pregnancy is 175g/day (11.6 carb choices) d. 15-30g CHO at breakfast (less well tolerated), rest divided evenly e. increases risk of fetal macrosomia (LGA large for gestational age), fetal hypoglycemia at birth f. overweight/obese: modest energy restriction to slow weight gain

T2DM non-insulin medications: DPP-4 inhibitors

saxagliptin (Onglyza) sitagliptin (Januvia) often used with Metformin. Allows endogenous GLP-1 to stay active longer, reduces glucose released by liver overnight and between meals. Weight neutral

what effect does Elavil (antidepressant) have?

sedative effect, weight gain, increased appetite

Hyperemesis gravidarum

severe nausea, vomiting, acidosis, weight loss a. bed rest, small amounts frequent carbohydrates

How is Hepatitis B (HBV) transmitted?

sexually transmitted

MNT for Arthritis

skeletal and connective tissue disorder inflammation of peripheral joints a. regular, well-balanced diet with vitamin intake to at least DRI's b. bed rest, aspirin, reduce overweight to decrease stress c. normocytic anemia may develop 1. not diet-related, inflammation of arthritis prevents reuse of iron 2. "anti-inflammatory diet" may help osteoarthritis: fresh fruits and vegetables, resembles Mediterranean diet

MNT for systemic lupus erythematous (SLE)

skeletal and connective tissue disorder a. no specific dietary guidelines, tailor to needs b. may have dietary deficiencies of iron, folate, calcium, fiber, B12 c. may have anemia but does not correlate with iron intake d. may show symptoms of celiac disease

What is the diet for a hiatal hernia?

small, bland feedings; avoiding late night snacks, caffeine, chili powder, black pepper

diet for gastroparesis?

small, frequent meals; pureed foods, avoid high fiber, avoid high fat (liquid fat may be better tolerated), avoid caffeine, mint, alcohol (acidic)

microcytic, hypochromic anemia

small, pale sells; due to iron deficiency a. associated with chronic infections, malignancies, Renal disease

what does the renal solute load measure?

solutes excreted in 1 L urine; daily fixed load of 600mOsm 1. mainly measures nitrogen (60%) and electrolytes (sodium)

What is constipation & the diet for it?

sometimes due to an atonic colon (weakened muscles) high fluid, high fiber diet, exercise

When does protein become restricted in CKD?

stages 3 and 4

Describe NAFLD (non-alcoholic fatty liver disease) and it's causes

steatosis, more common with BMI > or = to 35, T2DM, metabolic syndrome excess fat buildup in liver unrelated to alcohol consumption

What are some functions of the liver?

stores and releases blood, filters toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance

What is a performance budget?

summarizes program activities performed in terms of cost of specified accomplishments. Example: what it costs to supervise a food bank, or what it costs to screen 200 children for anemia

What happens to enzyme levels in the blood when tissue damage causes them to leak into circulation?

the enzymes are elevated

What is diverticulosis?

the presence of diverticula- small mucosal sacs that protrude through the intestinal wall d/t structural weakness. Related to constipation and lifelong intra-colonic pressures

Parenteral nutrition PN: concern

translocation of bacteria; not feeding through gut allows wall to break down, bacteria move out causing sepsis a. GALT (gut associated lymphoid tissue) is compromised by bowel rest or 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

What is a chylomicron?

transports dietary triglycerides from gut to adipose cells; synthesized in intestine from dietary fat; lowest density due to smallest amount of protein

What is B12 deficiency?

type of anemia Lack of intrinsic factor and bacterial overgrowth in loop of intestine being bypassed interfere with B12 absorption (pernicious anemia diagnosed using the Schilling test)

What is folate deficiency?

type of anemia needs for B12 transport inside the cell; also from poor folate intake and low serum iron (cofactor in folate metabolism)

Describe RYGB Roux-en-Y

type of gastric bypass reconstructs the small intestine to resemble the letter Y -creates a small gastric pouch connected directly to the jejunum -the dumping syndrome may develop -supplement calcium in divided doses 1200-1500 mg, vitamin D 3000 IU, 45-60mg iron taken apart from calcium, chewing of ice may be a sign of iron deficiency -greater need for protein -for life: multivitamin, multimineral supplement with 100% DRI for vitamin K, zinc, thiamin, folic acid, copper, biotin, iron -may require B12 supplementation in addition to that provided in the MVMN

What is Ulcerative Colitis?

ulcerative disease of the COLON only (large intestine)- begins in the rectum s/s: chronic bloody diarrhea, weight loss, anorexia, electrolyte (Na, K) disturbance, dehydration, anemia, fever, negative nitrogen balance

What is 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 transfer, <2g sodium, high calorie

Enteral nutrition: elemental, chemically defined formula

used with malabsorption 1. pre-digested protein or amino acids, glucose or sucrose, small fat, vitamins, minerals, electrolytes 2. absorbed in proximal intestine, low to no residue, don't need pancreatic enzymes, high osmolality, poor taste 3. used with compromised GI function, inability to digest and absorb 4. Alitraq, Peptamen, Vivonex

Describe functions of renin

vasoconstrictor 1. secreted by glomerulus when blood volume decreases 2. stimulates aldosterone to increase sodium absorption and return blood pressure to normal

what is holistic health?

views mental, physical and spiritual aspects of life closely connected and equally important with regard to treatment approaches

Describe some 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.

Ag-Ab reaction

when antigen enters body, antibody reacts

How does ascites occur?

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 storage capacity has been exceeded, pressure caused by increased blood volume 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. Can cause spleen to swell too

What is diverticulitis?

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

What are some adverse effects following a Billroth I or II?

when food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced. These hormones normaly stimulate the pancreas, so there is now little pancreatic recreation. Calcium (most rapid absorption in duodenum) and iron absorption (requires acid) are adversely affected. B12 and folate anemia

When does jaundice occur?

when the bile ducts are blocked

True or false: women with HIV should be encouraged to breastfeed

FALSE - HIV infected women should be counseled NOT to breast-feed

True or False: It is okay to let babies sleep with bottles

FALSE - infant should not sleep with a bottle - BBTD (baby bottle tooth decay), ECC (Early childhood caries)

Macrocytic, megaloblastic anemia

FEW large cells, filled with hemoglobin a. due to deficiency of folate or vitamin B12; Schilling test for pernicious anemia

State GFR range and recommended protein for CKD stage 3

GFR 30-59 0.6-0.8 G protein/kg

State GFR range and recommended protein for CKD stage 2

GFR 60-90 0.8-1.4 G protein/kg

what is HALS?

HIV associated lipodystrophy syndrome may develop from therapy -high cholesterol, high triglycerides, insulin resistance, changes in body fat distribution

Explain Hypertension

High Blood Pressure -long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease -may be primary (essential) or secondary d/t another disease -optimal BP with respect to cardiovascular risk is <120/80 mm Hg

What major conditions can be involved/occur with or because of Cardiovascular disease (CVD), coronary artery disease (CAD), ischemic heart disease (IHD)

Hypertension, atherosclerosis, dyslipidemia, metabolic syndrome, national cholesterol education program (NCEP), ATP IV, heart failure, cardiac cachexia

IDDSI

Level 0 - white: thin, water Level 1 - Grey: slightly thick level 2 - pink: mildly thick level 3 - yellow: liquidized, moderately thick level 4 - green: pureed, extremely thick level 5 - orange: minced and moist level 6 - blue: soft and bite-sized level 7 - black: regular, easy to chew

normal lab value for hemoglobin

M: 14-18 g/dl F: 12-16 g/dl

normal lab value for hematocrit

M: 42-52% F: 35-47%

Explain the Mediterranean diet, and what condition it may be used for

May be recommended for pts with HTN -rich in alpha linolenic acid, high in monounsaturated fats - olive, canola, soybean oils; walnut, almonds, pecan, peanuts, pistachios -fish, poultry and eggs rather than beef, breads, F/V in abundance, beans, legumes, yogurt, cheese -resveratrol, in skin of red grapes, may lower blood pressure

Dysphagia Mechanically Altered NDD2

Mild to moderate Moist, soft-textured, easily formed into a bolus; moist, tender ground or diced meats, soft cooked vegetables, soft or canned fruits. Soft pancake okay. No bread, rice, cheese cubes

Is cirrhosis reversible?

NOT USUALLY. The growth of connective tissue in liver permanently destroys the liver cells. (once it's scarred, it can't go back)

what is the NCCIH?

National Center for Complementary and Integrative Health includes yoga, meditation, herbs and botanicals, traditional healing practices

Healthy People 2020

National Health Program and Disease Prevention Objectives: DHHS, national health agenda fro the Current decade 1. Identified broad goals and specific objectives for improving health 2. focuses on disease prevention by changing behaviors 3. targets healthy diet and healthy weight as critical goals 4. 2020 goals address nutrition and weight, physical activity, heart disease and stroke, diabetes, oral health, cancer, food safety, and health for seniors 5. example of objective: increase the proportion of adults who meet the objectives for physical activity

What is the National Cholesterol Education Program (NCEP)?

National heart, lung and blood institute, endorsed by American Heart Association (AHA) 1. Assessment of risk mg/dl -LDL-C: <100 optimal -total cholesterol: <200 desirable -HDL-C: <40 low (M) <50 low (F); > or = to 60 high High homocysteine (Hcy) levels are independent risk factors for CHD Normal TG <150 2. Therapeutic Lifestyle Change (TLC) from ATP III Adult Treatment panel III a. up to 35% calories from total fat, <7% saturated fat, 5-10% PUFA, up to 20% MUFA, <200 mg cholesterol b. 25-30g fiber (half soluble) c. stannous and sterols inhibit cholesterol absorption (2-3g/day) d. maintain DBW, prevent weight gain e. increase PA to at least 30 minutes of moderate intensity most days (to expend at least 200 calories)

Alzheimer's disease

Nervous system / neurological disorder a. avoid distractions (no TV during meals); regular consistent mealtimes, 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 b. anomia, form of aphasia: lost words, unable to recall names of common items

Autism spectrum disorders

Nervous system/neurological disorder a. unnecessary food restrictions, possible food aversions, excessive supplementation can place children with ASD at risk

What are the stages of HTN for risks of developing coronary heart disease?

Normal: <120/80 mmHG Elevated: Systolic between 120-129 AND diastolic less than 80 Stage 1: Systolic between 130-139 OR diastolic between 80-89 Stage 2: systolic at least 140 OR diastolic at least 90 mm Hg

Parenteral nutrition PN: typical uses

Nutrition diagnoses: NC - 1.4 altered GI function NC - 2.1 impaired nutrient utilization - moderately to severely malnourished patients expected to have prolonged periods of GI dysfunction -critically ill hemodynamically stable with paralytic ileum, acute GI bleeds, bowel obstruction -only malnourished cancer patients on therapy who are anticipated to be unable to ingest and absorb adequate nutrients for a period of 7-14 days -peritonitis, fistuals -critical care patients if hyper-metabolism is expected to last for more than 5 days and enteral support is not possible

What is the AI?

Part of the Dietary Reference Intakes, DRI Adequate intake: used when insufficient evidence exists for EAR, RDA

What is the EAR?

Part of the Dietary Reference Intakes, DRI Estimated average requirement: for 50% of population, used in planning meals for healthy people, assesses GROUP nutritional adequacy

Define RDA

Part of the Dietary Reference Intakes, DRI Recommended dietary allowances: goals for healthy individuals to prevent nutritional deficiency diseases, includes gender, age, life phases

What is the UL?

Part of the Dietary Reference Intakes, DRI tolerable upper level: NOT associated with adverse side effects in most individuals of a healthy population

What does the severity of SBS reflect?

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

Liquid Consistency

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

What are some positives of oat bran and soluble fibers?

They decrease serum cholesterol by binding bile acids converting more cholesterol into bile.

Dysphagia Advanced NDD3

Transition to regular Avoid very hard, sticky, crunchy foods, hard fruit and raw vegetables, nuts, seeds, dry bread and cereals

Define Healthy Eating Index

USDA's overall measure of diet quality 1) measures how well Americans follow the Guidelines 2) 5 food groups, 4 nutrients (fat, saturated fat, cholesterol, sodium), variety

What is the treatment for Cystic Fibrosis?

Use age appropriate BMI to assess height and weight 1. PERT - pancreatic enzyme replacement therapy with meals and snacks 2. high protein, high calorie, unrestricted fat, liberal in salt a. if growing normally 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 b. protein 15-20% of calories - malabsorption due to pancreatic deficiency c. carbohydrate 45-55% of total calories d. liberal fat to compensate for high energy needs - 35-40% of calories e. additional 2-4 grams salt/day in hot weather, with heavy perspiration f. age-appropriate doses of water-soluble vitamins and minerals g. supplement water-soluble forms of fat-soluble vitamins (A and E)

What are VLDL (pre-beta)?

Very low density lipoproteins -transports endogenous triglyceride from liver to adipose cell

Explain how esophageal varies 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, abd, collateral veins enlarge -due to portal hypertension

What is Hepatic Failure (ESLD)?

When liver function is decreased to 25% or less liver cannot convert ammonia (NH3) to urea - ammonia accumulates apathy, drowsiness, confusion, coma (PSE- Portal systemic encephalopathy) asterisk (flapping, involuntary jerking motions)" sign of impending coma

what does a BUN:creatinine ratio of >20:1 indicate?

a "pre-renal state" in which BUN reabsorption is increased d/t acute kidney damage (may be reversible and may not require dialysis

What is a cholecystectomy and the tx?

a cholecystectomy is the surgical removal of gallbladder -bile now secreted from liver directly into intestine -limit fat intake for several months to allow liver to compensate. Slowly increase fiber to help normalize bowel movements.

MNT for hemodialysis

a. 1.2 grams protein / kg SBW (standard body weight), at least 50% HBV b. <60 yrs 35kcal/kg, > or = to 60 yrs or obese 30-35 kcals/kg c. 25-35% fat; <7% saturated; <200 mg cholesterol d. > or = to 1 L fluid output: 2-4 g Na and 2 L fluid <1 L fluid output: 2g Na and 1-1.5 L fluid Anuria (failure to produce urine): 2 g Na and 1 L fluid e. 40 mg/kg IBW (2-3 grams) potassium f. calcium: individualized with maximum 2 g elemental totoal g. 800-1000 mg phosphorus or <17 mg/kg IBW or SBW h. vitamins C, B6, folate, B12 supplements: DRI for others I. zinc DRI 8-11 mg/day, individualize for iron and vitamin D

MNT for peritoneal dialysis

a. 1.2-1.3 grams protein/kg SBW or adjusted BW; > or = to 50% HBV b. < 60 yrs 35 kcals/kg (including dialysate) > or = to 60 yrs 30-35 kcals/kg c. 2-3 g Na - based on BP and weight d. potassium generally unrestricted (usually 2-4 grams) e. < or = to 2000 mg total elemental calcium including diet and binders f. 800-1000 mg phosphorus or 10-15 mg phosphorus/g protein g. 1-3 L fluid depending on output, cardiac status h. CAPD - continuous ambulatory peritoneal dialysis 4-5x/day i. VM (venous malformations?) as for hemodialysis except thiamin (may need extra due to loss)

Explain the process of a burn

a. Immediate shock period: catabolism; BMR rises 50-100% 1. replace fluids and electrolytes lost 2. recovery period: increase calories (based on. burn size) 3. secondary period: 20-25% calories as protein (1.5-2 grams protein/kg) (1.2 if burn <10% BSA), high calories a) vitamin C - wound healing, 500 mg X 2 b) water soluble vitamins 2X RDA, Vitamin A 10000 IU c) vitamin K if on antibiotics d) zinc for wound healing if zing deficient, 220 mg zinc sulfate

Parenteral nutrition PN: catheters

a. PICC peripherally inserted central catheter - used for short or moderate term infusion b. CVC long term central access is through the cephalic, subclavian or internal jugular vein into the superior vena cava

what are some indications of renal disease?

a. anemia d/t decreased production of erythropoietin b. upset in blood pressure c. decreased activation of vitamin D (kidney produces active from which promotes efficient absorption of calcium by the gut)

Name some common insulin regimens

a. fixed or conventional therapies: premixed or fixed insulin plan. Basal or intermediate is combined with short or rapid-acting b. MDI (multiple daily injections) basal insulin once or twice daily and rapid-acting bolus before meals (more common) c. CSII (continuous sustained insulin infusion): insulin pump therapy provides steady, measured continuous dose of basal, and a surge (bolus) dose of insulin before meals

epidemiological data

a. interrelationship between host, agent, environment in causing disease b. some evidence that fruits and vegetables are beneficial in overall cancer prevention (carotenoids, vitamin C) c. some evidence that exercise in post-menopausal women decreases risk of breast disease

Parenteral nutrition PN: transitional feeding

a. introduce a minimus amount of FULL-STRENGTH enteral feeding at a low rate of 30-40 ml/hour to establish GI tolerance b. begin tapering when enteral feedings are providing 33-50% of their nutrient requirements c. decrease PN as you increase enteral rate by 25-30 ml/hour increments every 8-24 hours to maintain prescribed nutrient levels d. when patient can tolerate about 60% of needs by enteral route, D/C PN

Define some goals for diabetics:

a. maintain normal blood glucose (average pre-prandial goal 70-130; peak post-prandial average <180) b. optimal serum lipid levels: LDL <100, TG <150, HDL >40M, >50 F c.blood pressure goals systolic <130, diastolic <80 d. prevent and treat chronic complications

What is glycosylated (glycated) hemoglobin (Hb A1c)?

a. measures % of hemoglobin that has glucose attatched b. normal <5.7%; over 65 years <7% in healthy, < or = to 8% in frail elderly c. goal for diabetics <7% (at risk for developing diabetes (pre-dm) is 5.7%-6.4%) d. measure of long term blood glucose control (60-90 days) e. high concentration of glucose forms chemical bond with hemoglobin - the longer the blood glucose is high, the higher the HbA1c

Explain alkaline ash / acid ash diets

a. minerals not oxidized in metabolism leave an ash (residue) in urine b. can change composition of diet to change pH of ash in urine c. now usually done with medication

Define postprandial or reactive hypoglycemia

a. overstimulation of pancreas or increased insulin sensitivity; blood glucose falls below normal 2-5 hours after eating (<50 mg/dl) b. weak, trembling, extreme hunger c. goal is to prevent marked rise in blood glucose that would stimulate more insulin d. avoid simple sugars, 5-6 small meals / day, spread intake of CHO throughout the day, protein at RDA levels

Pregnancy-induced hypertension (PIH)

a. progresses from pre-eclampsia to eclampsia b. hypertension, edema of face and hands, proteinuria, rapid weight gain after 20th week; may have convulsion c. more frequently found in women with lack of prenatal care, poor diets, poor protein and calcium intakes d. 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 e. proposed association between PIH and calcium deficiency

Parenteral nutrition PN: solutions

a. protein: ratio for anabolism is 1 gram nitrogen / 150 calories; 1-1.5 grams protein / kg / day 1. crystalline amino acids 3-15% solution 2. % = number of grams of amino acids / 100 ml A 3% solution has 3 grams of amino acids / 100 ml b. energy 35-5- calories/KG; up to a 70% dextrose solution 1. a 10% solution provides 100g CHO/liter 2. to avoid over feeding and hyperglycemia, start at < or = to 20-25 calories/kg 3. maximum rate of dextrose infusion (glucose utilization rate) should not exceed 4 to 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 c. fat: needed for energy and to prevent essential fatty acid deficiency (EFAD) 1. to prevent EFAD give 500 cc of 10% fat emulsion 1-2X/week 2. symptom of EFAD: petechiae (red spots d. vitamins, electrolytes, water as needed e. TNA, total nutrient admixtures (three in one systems) include dextrose, amino acids and lipids

Enteral nutrition: formula calculation

a. select formula and determine calories needed b. divide calories needed by cal/ml to determine pls formula needed per day c. determine protein content: multiply pls of daily formula by grams of protein per liter d. determine daily fluid need: multiply % water in formula x daily formula in pls to determine water contribution of enteral nutrition. Subtract formula water from total fluid requirements to determine water flushes e. determine administration rate: divide total pls of formula/day by 24 hours to determine continuous feeding goal rate

Describe LAGB laparoscopic adjustable gastric banding

a. small gastric pouch created using a fluid-filled inflatable band b. adjusted to alter the size of the opening (fully reversible) c. restricts total amount of food eaten at one time d. no surgery-induced malabsorption of nutrients. Deficiencies linked to decreased food intake and decreased food intolerance e. eat slowly, sip drinks, no straws, no bubbles

Enteral Nutrition: features

a. tube bore (opening) - based on viscosity of feeding 1. large #16 - slenderized whole foods 2. small #8 - ready prepared formulas, more comfortable b. enteral access 1. anticipate length of time needed, risk of aspiration, patient's anatomy, clinical status, normal or abnormal digestion and absorption 2. hang time open systems 8 house, closed systems 24-48 hours 3. short term access 3-4 weeks, nasogastric tube, normal GI function a. bolus method - clinically stable with functional stomach b. continuous drip - 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 Cycle feeding: delivered by continuous drip at an increased rate over 8-16 hours, often overnight, by pump (for under-nourished, especially older, ambulatory, malnourished patients) c. intermittent drip (pump or gravity) - more mobility d. nasoduodenal or nasojejunal if unable to tolerate gastric feedings e. transpyloric / post-pyloric: passed by pyloric valve in stomach; used in comatose patients or ones with no gag reflex 4. gastrostomy or jejunostomy feedings if needed for more than 3-4 weeks a. PEG inserts tube into stomach through abdominal wall 5. do NOT use blue dye to check tube placement. use X-ray confirmation of tube ti location, or aspirate gastric contents

Define some strategies for T1DM

a. with fixed daily doses of insulin, consistency of CHO is recommended b. integrate insulin therapy with usual eating habits c. monitor blood glucose and adjust insulin doses for amount of food eaten d. with intensive insulin therapy, adjust pre-meal insulin-to-CHO ratio e. for planned exercise, reduction in insulin dosage may be best choice f. endurance athletes: 120-180mg/dl is guideline during activity

Define food intolerance (NON-IgE)

abnormal physiologic response, GI, cutaneous, respiratory symptoms, but NO antibody production

Describe SG sleeve gastrectomy

about 80% stomach removed a. food pathway not altered b. vitamin supplementation, monitor iron, calcium and vitamin D levels

Indicate some risk factors for DM

acanthosis nigricans (gray-brown skin pigments in skin folds) from insulin resistance GADA: glutamic acid decarboxylase antibodies

What are some complications of uncontrolled diabetes?

acute ketoacidosis acute hypoglycemia

What is AKI/ acute renal failure?

acute kidney injury -caused by burns, accident, obstruction, or severe dehydration -sudden shutdown with previously adequate capacity; decreased GFR, inadequate pre-renal perfusion symptoms: oliguria (<500 ml urine), azotemia (increased urea in blood)

what is functional medicine?

addresses the whole person, not just symptoms, and looks at the underlying cause of disease, engaging patient and practitioner in a partnership for therapy

Goals for irritable bowel syndrome?

adequate nutrient intake, tailor pattern to specific Gi issues work with client to alleviate stress during eating

what effect does propofol have?

administered in oil, consider fat calories, 1.1 cals/cc, check TG

What does implementation of a community program require?

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

Parenteral nutrition PN: re-feeding syndrome

aggressive administration of nutrition to malnourished a. at risk: anorexia nervosa, chronic alcoholism, prolonged fasting, under 7-10 days, significant weight loss, phosphorus-deficient PN b. starved cells take up nutrients, potassium and phosphorus shift into intracellular compartments c. results in hypokalemia, hypophosphatemia and hypomagnesemia d. overfeeding PN and dextrose >5 mg/kg/min may lead to hyperglycemia Upon initiation of PN to a malnourished person, monitor glucose, phosphorus and potassium (avoid referring syndrome)

What is a Grant?

an award of financial or direct assistance: anyone can apply; usually lasts over a few years 1. Block grants from federal government are given to states or local communities for broad purposes as authorized by legislation. Recipients have great flexibility in distributing funds. Five federal block grant areas: 1. maternal and child health 2. community services 3. social services 4. preventive health services 5. primary care 2. CDC STEPS major federal level grant; steps to a healthier US focused on community-based health initiatives related to obesity. Directs funds to address asthma, obesity and diabetes prevention

Describe Atherosclerosis

an inflammation process -accumulation of lipids; structural and compositional changes in the intimal layer of the large arteries risks: hypertension, obesity, smoking, elevated blood lipids, heredity

What are some symptoms of CKD?

anorexia, weakness, weight loss, nausea, vomiting

what effect does methylphenidate (Ritalin) have?

anorexia, weight loss, nausea

What is the treatment for an ulcer?

antacids, antibiotics to eradicate helicobacter pylori bacteria

what effect does anticoagulants (warfarin sodium) have?

antagonizes vitamin K (consistent intake essential); avoid Ginko biloba extract (GBE), garlic, ginger (may increase bleeding); avoid high dose vitamin A, E

What is the Tx for Tropical sprue?

antibiotics, high calories, high protein,, IM (intramuscular) B12 and oral folate supplements

what effect does Marinol have?

appetite stimulant

what effect does megestrol acetate have?

appetite stimulant

what effect does dextroamphetamine (Adderall) have?

appetite suppressant, anorexia, nausea, weight loss

What fruit juices have high osmolar loads?

apple and grape

MNT for AKI

at 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 -25-40 cals/kg, BEE x stress factor (1.2-1.3) during hyper metabolic conditions. ENERGY EXPENDITURE INCREASES AS KIDNEY FUNCTION DECLINES -low sodium (2-3 grams), replace losses in diuretic phase -8-15 mg/kg phosphorus. May need phosphate binders -2-3 grams potassium based on output, serum potassium, dialysis -replace fluid output from previous day plus 500 ml

Adrenal cortex insufficiency: Addison's disease

atrophy of adrenal cortex, 70% cases are d/t autoimmune disorder s/s d/t absence of adrenal hormones -dark patches on the skin decreased production of cortisol leads to glycogen depletion and hypoglycemia decreased production of aldosterone leads to sodium loss, potassium retention, and dehydration decreased production of androgenic leads to tissue wasting and weight loss Diet: high protein, frequent feedings, high salt

what effects do statins have?

avoid grapefruit juice; decreased LDL, TG; increase HDL

diet for irritable bowel syndrome:

avoid large meals, excess caffeine, alcohol, sugars use food diary to track intake, emotions, environment, symptoms identify food allergies and hypersensitivities

what effect does calcium have?

binds tetracycline

What is hemodialysis?

blood filtered outside of the body into a machine using dialysate need surgery for fisulta or graft in order to receive dialysis time consuming: 4 hr tx for 3x/wk heparin usually added as well as other drugs or vitamins or minerals to dialysate depending on needs of the pt

How is Hepatitis C (HCV) transmitted?

blood to blood contact

what does the BUN lab test indicate

blood urea nitrogen measures amount of urea nitrogen within your blood states how well your kidneys are working

Define different bolus insulins

bolus = premeal or prandial a. rapid-acting: Aspart (Novolog), Lispro (Humalog) -take 5-15 minutes before eating, usual duration 4 hours b. short-acting: Regular (Humulin R); take 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

what type of stones represent 70% of kidney stones?

calcium oxalate

What is the tx for NAFLD (non-alcoholic fatty liver disease)?

can be managed with lifestyle changes 1. weight loss (7-10% of starting weight). NO rapid weight loss: greater flux of fatty acids to liver may worsen inflammation and accelerate disease progression 2. healthful eating: Mediterranean diet, moderate alcohol, avoid sugar-sweetened beverages, coffee may help (antioxidant) 3. physical activity: at least 150 minutes of moderate intensity aerobic activity, plus two strength training sessions each week

What are some side effects of NRTI drugs (nucleotide nucleoside reverse transcriptase inhibitors) - ex. Retrovir, zidovudine (HIV/AIDS drugs)

can lead to anemia, loss of appetite, low vitamin B12, copper, zinc, carnitine

T2DM non-insulin medications: SGLT-2 inhibitors

canagliflozin (Invokana) dapagliflozin (Farxiga) empagliflozin (Jardiance) target blood glucose-lowering action in kidneys, by blocking a protein that returns glucose to the blood after it is filtered through the kidney more glucose is excreted in urine and less reabsorbed. Monitor kidney fx. Weight loss. Considered for patients with T2DM and CKD

How many carbs, protein, fat and calories in one serving of alcohol?

carbs varies 0g protein 0g fat 100 calories

What are some things to omit when one has an ulcer?

cayenne and black pepper, are amounts of chili powder, avoid excess caffeine and EtOH

Enteral nutrition: gastric residuals

check gastric residuals every 4 hours during first 24 hours. Then decrease to 6-8 hours unless patient is critically ill. If the GRV is >250 after the second check, consider a promotability agent. If the GRV >500 ml, hold the feeding and assess tolerance. Normal GRV is < or = to 250 Actyal intake may be lower than prescribed because of medical procedures and ADL interruptions

tx for chemotherapy

chemical reagents which have toxic effects 1. nausea, vomiting, malabsorption, anorexia 2. stomatitis - cracks in skin at mouth corners, riboflavin deficiency 3. methotrexate - anti-folate drug

Describe Prader Willi syndrome

chromosome 15 deletion 1. congenital disorder, subnormal LBM, supra-normal body fat 2. Ghrelin levels are elevated which stimulates growth hormone secretion, appetite, intake, and fat mass deposition 3. do not sense satiety, decreased energy requirements 4. obesity at 2-3 years of age, hypogonadism, muscle hypotonia, failure to thrive, short stature 5. best treatment is to control food intake

What is Irritable bowel syndrome?

chronic abdominal discomfort, altered intestinal motility, bloating

Drug therapy for an ulcer

cimetidine, Ranitidine - H2 blocker; prevents binding of histamine to receptor, decreases acid secretion

What is the diet for diverticulitis?

clear liquids, low-residue or elemental, gradual return to high fiber

what is integrative medicine?

combines evidence-based complementary therapies with conventional (allopathic) treatments to address the social, psychological and spiritual aspects of health and illness

what causes calcium oxalate stones?

consuming foods that have a high oxalate content. a. adequate calcium intake (RDA from dairy or supplements with meals) to bind oxalate and a low oxalate (40-50 mg) diet (dark leafy greens, chocolate, strawberries, nuts, beets, tea) b. more stones are detected in diets deficient in calcium

Describe budget development within writing a plan for a community

controls and coordinates activities, indicates how and at what rate dollars are to be expended 1. consider the following preparation; expenditures of preceding period, present budget, changes in present budget period, expenditures of present period, budget requests for next period

What are some symptoms of dumping syndrome?

cramps, rapid pulse, weakness, perspiration, dizziness

How do you prevent an acidic stone?

create an alkaline ash Increase cations (Ca, Na, K, Mg), by adding vegetables, fruits, brown sugar, molasses

What is Wernicke-Korsakoff syndrome?

d/t thiamine deficiency Wernicke's encephalopathy: is the acute phase of the degenerative brain disorder that can result in mental confusion, ocular abnormalities, peripheral neuropathy, and ataxia Korsakoff syndrome: is the irreversible chronic phase and presents as a memory disorder that can cause amnesia, disorientation, vision problems, and even lead to a coma

What is cirrhosis?

damaged liver tissue (d/t prolonged HBV or HCV, or EtOH intake) is replaced by bands of connective tissue which divides liver into clumps and reroutes many of the veins and capillaries (becomes fibrotic). Blood flow through liver is disrupted. Poor food intake leads to deficiencies

what effect does mineral oil, cholestyramine have?

decrease absorption of fat, fat-soluble vitamins

what effects do steroids have?

decrease bone growth, CHO intolerance

what effect does vitamin B6 and protein have?

decrease effectiveness of L-dopa (levodopa) which controls symptoms of Parkinson's disease. Take drug in morning with limited protein (competes with drug for absorption sites)

what effect does orlistat have?

decrease fat absorption by binding lipase; vitamin/mineral supp.

what effect does methotrexate have?

decrease folate

what effect does oral contraceptives have?

decrease folate, B6 and vitamin C

Anemia

decrease in total red cell mass d/t fewer RBCs or to smaller cells with less hemoglobin

what effects does thiazide diuretics have?

decrease potassium and magnesium, absorb calcium

what effects do antibiotics have?

decrease vitamin K

what effect does phenobarbital have?

decreased folic acid, vitamins B12, D, K, B6

what does the creatinine clearance lab test indicate?

decreased glomerular filtration rate The creatinine clearance test checks your kidney function by looking at the amount of creatinine in your urine and blood. Creatinine is a waste product that's typically filtered out of your blood by your kidneys. Abnormal levels of creatinine could be a sign of kidney failure.

What is 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 (increase synthesis and decrease clearance of VLDL)

Define ischemia in relation to Atherosclerosis

deficiency of blood d/t obstruction

Hypothyroidism

deficiency of thyroid hormone 1. T4 low; T3 low or normal 2. Decreased BMR leading to weight gain 3. diet: weight reduction causes: not enough iodine, Hashimoto's disease (autoimmune) s/s: goiter, cold intolerance, fatigue, brachycardia, waxy appearance on skin

Why might someone with CKD become anemic?

deficient production of hormone erythropoietin by kidney

What is Gastroparesis?

delayed gastric emptying may be d/t surgery, diabetes, viral infections or obstructions

what effect does loop diuretics have?

deplete thiamin, potassium, magnesium, calcium, sodium

what effect does isoniazid (treats TB) INH have?

depletes pyridoxine, peripheral neuropathy, don't take with food, interferes with vitamin D, calcium, phosphorus

MNT for steatorrhea

determine the cause and treat diet: high protein, high complex CHO, fat as tolerated, vitamins (especially fat-soluble), minerals MCT (rapidly hydrolyzed in GI tract

what are some effects of Tropical Sprue?

diarrhea, malnutrition, deficiencies of B12 and folate d/t decreased HCL and intrinsic factor

Explain diagnosis process for an allergy

diet history, skin tests, elimination diet (omit suspected foods) a. CAP-FEIA blood test is specific in identifying children with milk, egg, fish, peanut allergy b. DBPCFC: double-blind, placebo-controlled food challenges- identify food-induced symptoms (GOLD STANDARD FOR DIAGNOSIS) C. RAST (Alternative to skin test): serum is mixed with food on paper disk; measures specific IgE antibodies

what guidelines do community nutrition programs use when developing plans?

dietary guidelines for americans

Cerebral palsy: spastic form

difficult, stiff movement; limited activity; obese Diet: low calorie, high fluid, high fiber diet

Gout

disorder of purine metabolism increased serum uric acid (uric acid is a product of purine metabolism); crystalizes and deposited in joints causing pain, swelling - usually originating in the big toe diet: low purine may not be effective; may need weight reduction 1. moderate protein, liberal carbohydrate, low to moderate fat, decrease alcohol (can contribute to gout attack), liberal fluid, avoid high purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel, red meat) meds: (urate eliminate, colchicine) induce loss of nutrients

Anorexia nervosa

distorted body image, dramatic weight loss, preoccupation with food and weight gain therapy is multidisciplinary; weight restoration and psychotherapy 1. immediate concern: correct electrolyte imbalance (K) 2. plan with patient, regular mealtimes, varied and moderate intake, gradually reintroduced feared foods 3. focus on healthy benefits and life-sustaining aspects of food (reason to eat) 4. re-feeding increases cardiac load - go slowly 5. recommended initial daily calorie levels range from 1000-1600 (30-40 cals/kg), but may need to be set 100-300 calories above current level of intake to support adherence

ATP IV

does not focus on specific target levels for LDL, but defines groups for whom lowering LDL would be most beneficial. Recommend a heart-healthy lifestyle and statin therapy for: -patients who have ASCVD atherosclerotic cardiovascular disease, patients with an LDL of 190 mg/dL or higher, patients with T2DM who are between 40-75 years of age, patients with an estimated 10-year risk of cardiovascular disease of 7.5% or higher who are between 40-75 years of age (the report provides formulas for calculating 10-year risk)

MNT for acute ulcerative colitis flare-ups:

elemental diet may be needed to minimize fecal volume

describe LDL and HDL for healthy obese individual

elevated LDL, norma to low HDL

What condition is the Giovanetti diet used for and what are the criteria?

end-stage renal disease low protein diet 20 grams protein (HBV), increase calories; control edema, prevent deficiencies

Does energy expenditure increase or decrease as kidney function declines?

energy expenditure increases

Goiter

enlargement of the thyroid gland d/t insufficient thyroid hormone a. endemic goiter: inadequate iodine intake 1. Diet: iodized salt; free of goitrogens (contain goitrin which inhibits synthesis of thyroid hormone)

What is an ulcer?

eroded mucosal lesion

EER

estimated energy requirements average dietary intake predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height and level of physical activity consistent with good health

Describe activities/tasks within developing a plan for a community

evaluate alternative strategies (cost/effective analysis): what are all the possible ways to solve the problem, what resources would be needed to do in each alternative, which alternatives are the most feasible, who needs to be involved in choosing which way is best

How often are the dietary guidelines for Americans revised?

every 5 years

Hyperthyroidism

excess secretion of thyroid hormone 1. elevated T3 and T4 2. increased BMR leading to weight loss 3. diet: increase calories causes: too much iodine (plays role in T3 T4 production), Graves disease (autoimmune), toxic nodular goiter s/s: sweaty, goiter, restless, irritable, tachycardia, diarrhea, unable to focus

Define BG defining DM

fasting plasma glucose (FPG) > or = to 126 OR glucose tolerance test (GTT) > or = to 200 OR symptoms of diabetes plus casual plasma glucose > or = to 200 mg/dl; HgA1C > or = to 6.5%

Why might an alkaline stone occur?

favors crystallization of calcium and phosphate - containing stones increase anions, consume meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye

What is dumping syndrome?

follows a gastrectomy when rapidly hydrolyzed carbohydrate enters the jejunum, water is drawn in to achieve osmotic balance. This causes a rapid decrease in the vascular fluid compartment and a decrease in peripheral vascular resistance. Blood Pressure drops and signs of cardiac insufficiency appear. About two 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 or alimentary hypoglycemia.

What are some diet recommendations for folate deficiency?

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.

Describe functions of vasopressin (ADH)

from the hypothalamus (stored in pituitary) 1. exerts pressor effect; elevates blood pressure 2. increases water reabsorption from distal and collecting tubules 3. SIADH - syndrome of inappropriate antidiuretic hormone - hyponatremia caused by hemodilution, treated with fluid restriction

What is a Billroth I?

gastroduodenostomy- attaches the remaining stomach to the duodenum.

What is a Billroth II?

gastrojejunostomy- attaches the remaining stomach to the jejunum

Is fluid restricted with CKD?

generally not, depends on BP and urine output changes

define atopy

genetic predisposition to produce excessive IgE antibodies in response to an allergen

T2DM non-insulin medications: Sulfonylureas

glimepiride (Amaryl) causes pancreas to release more insulin. Weight gain.

Name the components within 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 proximal convoluted tubule: major nutrient reabsorption Loop of Henle: water and sodium balance distal tubule: acid-base balance

Bulimia

gorging and vomiting syndrome, usually close to normal weight 1. damage to teeth, throat, esophagus, rectal bleeding, bruised knuckles, from purging with fingers, low potassium and chloride blood levels

Define Coronary artery disease (CAD) in relation to Atherosclerosis

hard, narrow arteries from plaque buildup

Name some strategies for T2DM

healthy eating and physical activity a. achieve glucose, lipid and blood pressure goals b. weight loss if necessary: improve food choices, space meals, exercise

What are some things that cause alcoholic liver disease?

hepatic steatosis, alcoholic hepatitis, cirrhosis

What is the diet for diverticulosis?

high fiber diet- increases volume and weight of residue, provides rapid transit

What diet would one follow when IBD is in remission or under control?

high fiber to stimulate peristalsis

What are HDL (alpha)?

high-density lipoprotein (good cholesterol) -reverse cholesterol transport; moves cholesterol from cells to liver and excretion

Define acute ketoacidosis

hyperglycemia d/t insulin deficiency or excess carbohydrate intake, dehydration due to polyuria, increased pulse, fruity odor of ketones. Tx: insulin, rehydration

what effect does cyclosporine (immunosuppressant) have?

hyperlipidemia, hyperglycemia, hyperkalemia, hypertension

Describe the 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) a. ebb phase: hypovolemia, shock, tissue hypoxia b. flow phase: follows fluid resuscitation and return of oxygen transport c. Results of physiologic trauma: hyperglycemia, hyperinsulinemia, little or no ketosis, increased glucagon 1) catecholamines epinephrine, norepinephrine: hepatic glycogenolysis 2) ACTH - releases cortisol which mobilizes amino acids from muscle 3) aldosterone- renal sodium retention, gluconeogenesis 4) ADH - renal water reabsorption 5) hypovolemia, decreased cardiac output, drop in body temperature 6) hyperglycemia - epinephrine suppresses insulin secretion, decreased cell uptake and use 7) fluid and sodium retention, potassium excretion, loss of nitrogen, sulfur, zinc, phosphorus d. provide adequate but not excessive calories (at RMR), 1.5-2.0 G protein/kg, provide anabolic electrolytes, zinc

what effect does tyramine have?

hypertension if taken with MAOI (monoamine oxidase inhibitor) 1. eliminate dopamine and restrict tyramine (monoamines). MAO inhibitors interact releasing norepinephrine which elevates blood pressure. Restrict aged, fermented, dried pickled, smoked, spoiled foods. 2. Avoid hard, aged cheese (cheddar, Swiss), sauerkraut, some sausages, luncheon meats, tofu, miso, Chianti wine. Limit sour cream, yogurt, buttermilk 3. OK: cottage cheese, cream cheese. Good advice: buy, cook, eat fresh foods

When a jejunal resection occurs, what does the ileum do?

ileum can adapt and take over jejunal functions

urea cycle defects

inborn error of metabolism 1) unable to synthesize urea from ammonia resulting in ammonia accumulation 2) vomiting, lethargy, seizures, coma, anorexia, irritability 3) Diet: protein restriction (1.0,1.5,2.0g/kg based on tolerance, age, projected growth rate) to lower ammonia; therapeutic formulas to adjust protein composition to limit ammonia production 4) Example: OTC Ornithine transcarbamylase deficiency

Glycogen storage disease

inborn error of metabolism 1. deficiency of glucose-6-phosphatase in liver; impairs gluconeogenesis and glycogenolysis 2. liver can't convert glycogen into glucose leading to hypoglycemia 3. provide a consistent supply of exogenous glucose with raw cornstarch at regular intervals, and a high carbohydrate, low fat diet

homocystinurias

inborn error of metabolism 1. treatable inherited disorder of amino acid metabolism 2. characterized by severe elevations of methionine and homocysteine in plasma, and excessive excretion of homocysteine in urine 3. associated with low levels of folate, B6, B12 4. newly diagnosed patients receive increased doses of folate, Pyridoxine (B6), B12 5. if they don't respond: low protein, low methionine diet

Phenylketonuria - PKU

inborn error of metabolism a. missing enzyme - phenylalanine hydroxylase: which would convert phenylalanine to tyrosine; phenylalanine and metabolites accumulate leading to poor intellectual function b. detected with Guthrie blood test Diet: 1. restrict the substrate phenylalanine (PHE), supplement the product tyrosine (TYR). Tyrosine becomes a conditional amino acid. 2. low in phenylalanine, but provide enough to promote normal growth - Phenex-1,2, Phenyl-Free 1,2 (low phenylalanine formulas) 3. avoid aspartame c. need for phenylalanine decreases with age, infection d. low protein, high CHO intakes may lead to increased dental caries

Galactosemia

inborn error of metabolism due to missing enzyme that wold have converted galactose-1-PO4 into glucose-1-PO4 1. treated solely by diet: galactose and lactose free 2. NO: organ meats (naturally contain galactose), MSG extenders, milk, lactose, galactose, whey, casein, dry milk solids, curds, calcium or sodium casein ate, dates, bell peppers, breast milk 3. OKAY: soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG

what effect does lithium carbonate (antidepressant) have?

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.

What is cholecystitis?

inflammation of gallbladder -an infection causes excess water to be absorbed causing cholesterol to precipitate out leading to gallstones - aka cholelithiasis

what is stomatitis?

inflammation of mouth (associated with riboflavin deficiency) a. avoid very hot, very cold foods, spices, sour/tart foods b. rinse with lukewarm water after meals

what is esophagitis?

inflammation of the esophagus a. decreasing gastric acidity, reflux; small, low fat, bland, low fiber b. odynophagia is painful swallowing; globes is a lump in the throat c. achalasia - disorder of lower esophageal sphincter motility, does not relax and open upon swallowing 1. causes dysphagia - difficulty in swallowing 2. start with pureed moist thick foods, progress to thick liquids

What is pancreatitis?

inflammation of the pancreas with edema, cellular exudate (a fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation and is deposited in nearby tissues), and fat necrosis -may be d/t blockage or reflux of the ductal system; premature activation of enzymes within pancreas leads to autodigeston

What is gastritis?

inflammation of the stomach s/s: anorexia, nausea, vomiting, diarrhea diet: clear liquids, ADAT, avoid gastric irritants

Describe some symptoms associated with acute viral hepatitis

inflammation, necrosis, jaundice, anorexia, nausea, fatigue

define acute hypoglycemia

insulin run (shock); due to insulin excess or lack of eating, slow pulse, cool, clammy skin, hungry, week, shakiness, sweating Tx: glucose 1. begin with 15g CHO from glucose tablets, fruit juice (4-6 oz), sugar 2. wait 15 minutes; if still <70 mg/dl, give another 15 grams 3. repeat and treat until blood glucose is normal If unresponsive: administer glucagon, will mobilize glucose from liver

Define T2DM

insulin-resistance with relative insulin deficiency (may need insulin)

Define different basal, background insulins

intermediate-acting: NPH (Humulin N, Novolin N, ReliOn ) onset 2-4 hours, duration 10-16 hours, cloudy in appearance long-acting: Glargine (Lantus), Determir (Levemir) onset is 2-4 hours, duration is 18-24 hours. Start at 10 units per day or 0.1-0.2 units/kg. Take around same time each day

What is IDL (Pre-beta to beta)?

intermediate-density lipoprotein -LDL precursor; found in circulation secondary to catabolism of other lipoproteins

What is peritoneal dialysis?

introduced in abdominal cavity via catheter- peritoneum serves as a filtering cavity -less effective, but can be done at night, less expensive -allows for flexibility -commonly causes abdominal infections

Cerebral palsy: non-spastic (athetoid) form:

involuntary wormlike movement, constant irregular motions leading to weight loss Diet: high calorie, high protein; finger foods

What are some deficiencies following a complete gastrectomy?

iron, B12, folate, calcium, Vitamin D, B1 and copper may develop.

what is a renal calculi?

kidney stone

What is LDH and what does it mean when it's levels are increased?

lactic acid dehydrogenase increased: hepatitis, myocardial infarction, muscle malignancies

Enteral nutrition: adverse effects

lactose intolerance, formula hyperosmolality, rapid infusion causes influx of water into gut, bolus feeding, bacterial contamination

What is the diet for lactose intolerance?

lactose-free, no animal milk or milk products, no whey 1. calcium and riboflavin supplements are recommended 2. yogurt and small amounts of aged cheese may be tolerated 3. OK: lactate, lactalbumin

Nutritional care for ileal resection:

limit fat, use MCT (does not require bile salts, needs less intestinal surface area), supplement fat-soluble vitamins (ADEK), Ca, Mg, Zn -Parenteral B12 followed by monthly injections if more than 100 cm of terminal ileum is removed.

what is alcoholic liver disease?

liver injury due to alcohol and metabolic derangements it causes

Indicate foods high in iron

liver, kidney, beef, dried fruits, dried peas and peans, nuts, leafy green vegetables, fortified whole grain products

Osteoporosis

loss of bone tissue 1. Type I postmenopausal ( Within 15-20 years) Type II age-associated >70 years old 2. white and asian woman: more osteoporotic fractures than black or Hispanic 3. causes: malnutrition (especially protein), lack of exercise, decline in estrogen 4. result is reduction in amount of bone d/t defective calcium absorption (deossification) 5. Treatment: HRT- Hormone replacement therapy, weight-bearing exercise, vitamin D (400-800mg) and calcium (> or = to 1200 mg, don't exceed 500-600 mg at one time) supplements, adequate protein, moderate to low sodium, 5 servings of fruits and vegetables

Describe arteriosclerosis in relation to atherosclerosis

loss of elasticity of blood vessel walls

Tx for radiation

loss of taste, xerostomia (dry mouth, so moisten foods adding water or milk, sauces, gravies), esophagitis, diarrhea, malabsorption, (1) mucositis - inflammation of mucosal lining or oropharynx and esophagus - avoid fresh, raw, uncooked foods, offer cold and soft foods

What is the treatment for cholecystitis/cholelithiasis?

low fat diet: acute 30-45 grams; chronic 25-30% of calories

What is one major thing you can do to prevent kidney stones from occurring?

maintain adequate hydration. 1.5-2L of fluid is needed to dilute the urine. When you're hydrated and are consuming oxalic acid from food (is a waste product), oxalic acid (-) and water (+) will bind together and be excreted in the urine and stones don't form When you're dehydrated and water isn't present to bind to oxalic acid, it may bind to calcium (+). if multiple oxalic acids are binding to multiple calcium's it may start to form a crystal, ultimately forming a stone

what effects does chemotherapy have?

malabsorption

what are some effects of non-tropical sprue/ celiacs?

malabsorption (leads to loss of fat-soluble vitamins), microcytic anemia, weight loss, diarrhea, steatorrhea, iron deficiency anemia

Marasmus

malnutrition protein and calorie starvation 1. anthropometric diagnosis, serum albumin normal, no edema 2. severe fat and muscle wasting, starved appearance 3. triceps skinfold, arm muscle circumference decreased

iatrogenic malnutrition

malnutrition protein-calorie malnutrition 1. brought on by treatment, hospital, medications

what effect does Curcumin (tumeric) have?

may reduce inflammation, antioxidant, in curry powder

What is Lorcaserin?

medication approved for long term use (up to 2 years) agonist of serotonin, enhances satiety

what is Phentermine/topiramate

medication approved for long term use (up to 2 years) appetite suppressant, releases norepinephrine

what is orlistat?

medication approved for long term use (up to 2 years) lipase inhibitor, take with diet 30% cals as fat, vitamin supplements

What type of anemia do these lab values indicate? RBC: may be normal Hemoglobin: low hematocrit: low MCV: low MCH: low MCHC: low

microcytic hypochromic small, pale cells; due to iron deficiency

what type of anemia do these lab values indicate? RBC: decreased hemoglobin: low hematocrit: low MCV: high MCH: high MCHC: normal

microcytic, megaloblastic anemia FEW large cells, filled with hemogloin

Complementary and alternative medicine (CAM) -NIH categories

mind-body medicine, alternative medical systems like acupuncture and oriental medicine, lifestyle and disease prevention, biologically based therapies including herbs and orthomolecular medicine, manipulative and body-based systems like chiropractic medicine, bitfield systems like therapeutic touch, bioelectric magnets

What are some effects of gastroparesis?

moderate to severe hyperglycemia: detrimental effects on gastric nerves

Diet for non-tropical sprue/ celiacs?

need (gliadin-free) gluten-restricted diet NO wheat, rye, oats (if harvested and milled with wheat), barley, (buckwheat may be contaminated with WROB); no bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents OK: corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax, amaranth, millet, teff, quinoa

protein-calorie malnutrition, malabsorption, fluid and electrolyte imbalances

neoplastic disease a. altered state acuity: add flavorings and seasonings b. meat aversions may require elimination of red meat c. thrush from oral infections: avoid spicy, acidic, strongly flavored foods (1) provide bland liquids, soft foods, chilled or frozen foods d. throat or neck cancer - use PEG for feeding e. cancer cachexia (generalized wasting) connected to cytokines and the tumor - necrosis factor (TNF) f. hypercalcemia may be a sign of breast cancer, metastatic to the bone

ADHD Attention Deficit Hyperactivity Disorder

nervous system/ neurological disorder Experimental treatment: Feingold diet- no salicylates, artificial colors, artificial flavors. Efficacy not proven: positive result may be due to placebo effect (behavior improves with special attention...mind over body) b. sugar does not cause hyperactivity c. provide wholesome foods at regular mealtimes with small servings followed by refills d. Adderall side effects: lack of appetite, nausea, weight loss e. if child is underweight, consider high calorie snacks at bedtime

Paralysis

nervous system/neurological disorder a. stroke d/t brain embolism, may be undernourished or overweight b. immobilization decreases ability to absorb calcium and increases nitrogen loss c. spinal cord injury 1. energy needs are 10% below predicted 2. at least 1.5 L fluid per day 3. pressure ulcers: 30-40 cal/kg a. 1.2-1.5g protein/kg in Stage And II; 1.5-2g in stages III, IV b. normal intake of calcium, adequate fluids c. supplement vitamin C (500-1000mgs with Stage III or IV, or if deficient) d. Zn 15 mg (220 mg zinc sulfate) with stages III, IV for 2-3 weeks e. daily dietary source of vitamin A

Epilepsy

nervous system/neurological disorder - seizures, altered consciousness a. anticonvulsants phenobarbital and phenytoin (Dilantin) interfere with calcium absorption 1. take 1 mg folate daily with drug 2. may need supplements of Vitamin D, calcium, thiamin 3. provide phenytoin separate from meals and other supplements 4. enteral feedings decrease bioavailability of phenytoin so hold tube feedings > or = to 2 hours b. ketogenic diet: high fat, very low carbohydrate, 4 grams fat:1 gram non-fat 1. 90% calories from fat, 1 gram protein/kg, remaining calories from CHO 2. ketone bodies behave as inhibitory neurotransmitters; mild dehydration needed to prevent dilution of ketones 3. need supplements of Ca, D, folate, B6, B12 (spinach may aid in absorption) 4. MCTs are more ketogenic, more rapid metabolism and absorption

Cerebral palsy

nervous system/neurological disorder -non-hereditary, brain damage; inadequate control over voluntary muscles leading to spasms

what are some long term complications of uncontrolled diabetes?

neuropathy (peripheral and autonomic, gastroparesis), retinopathy (leads to blindness), nephropathy (decreased kidney function)

can NAFLD (non-alcoholic fatty liver disease) be related to alcohol consumption?

no, they're unrelated

Enteral nutrition: standard polymeric formula

normal GI function, must provide 1-1.5 calories / cc 1. lecithin may be added as an emulsifier 2. initiated full strength at a rate of 10-40 ml/hour 3. modular: mix individual components, adds flexibility 4. slenderized: whole food, large bore tube, thick intact protein, high residue 5. least expensive formulas: intact protein (NOT pre-digested), and isotonic (osmolality is close to that of blood)

Is potassium restricted in CKD?

not generally unless serum level is elevated and during output is <1 liter / day