RD exam

Common insulin regimens

1. Regular + NPH 2 x daily - pre-breakfast: 1/3 REg, 2/3 NPH; pre-supper: equal reg +NPH 2. Regular + NPH pre-breakfast, regular pre-supper, NPH bedtime (to control early AM surge) 3. MDI (multiple daily injections): regular before meals, NPH 1-2X 3. Glargine (lantus) basal insulin at bedtime: rapid-acting as bolus for meals. 4. Insulin pump therapy provides basal or rapid-acting or short-acting insulin pumped continuously; boluses of insulin are given before meals.

How to evaluate PES statment

1. can you resolve or improve the nutrition diagnosis for teh person/group? (intake domain will be more specific to the nutrition professional) 2. is the etiology you selected to "root cause" hat can be addressed with nutrition intervention? or can you at least lessen the signs and symptoms? 3. Will measuring the signs and symptoms indicate the problem is resolved or improved? are the signs and symptoms specific enough that you can monitor and document resolution/improvement? Does the nutrition assessment data support a particular nutrition diagnosis with a typical etiology and signs and symptoms?

evaluating acid base abnormalities (steps)

1. check the pH. is it moving towards acidosis or alkalosis? 2. look for teh cause - is it respiratory or metabolic? - check the pCO2 to tell you if the lungs are working normally. Then check the HC03 to tell you if the kidneys are funcitoning well.

normal range for BUN

6-23 mg/dl. increased in renal disease, and in cases of excessive protein catabolism, gastro-intestinal bleed, and severe dehydration. decreased in individuals with liver failure. affected by intake of dietary protein.

evaporated milk

60% water removed. must contain no less than 7.9% milk fat. brown color due to caramelization of lactose in canning

skim milk

<.5% fat

NAMP

National Association of Meat Purveyors

long-acting insulin

Glargine (lanuts), Determir (levemir) onset 2-4 hours, duration 20-40 hours.

MNT for diverticulosis

High fiber diet - increase volume and weight of residue, provides rapid transit.

heparin

blood clots

Phenobarbital

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

National labor Relations Act - Wagner Act 1935

guaranteed right to organize and join labor unions. gave union the right to be the bargaining agent. created the National Labor Relations Board (NLRB) listens to claims of 'unfair lbor practice'

policies

guides that define scope of permissible activity.

Coronary artery disease (CAD)

hard, narrow arteries from plaque buildup.

high educational level

has some previous knowledge of topic or has broad base to which new information can be added; understands complex ideas and rationales; verbally oriented.

perceived impact

heart disease will impede my ability to work

IMPS

institutional Meat Purchasing Specifications

Type 1 Diabetes mellitus

insulin deficient, depend on exogenous insulin.

chromium deficiency

insulin resistance

Type 2 Diabetes mellitus

insulin resistance with relative insulin deficiency (may need insulin)

shortened cake

layer, pound cakes comparatively large amount of fat; usees chemical leavening. layer cake - baking pwder pound cake - air and steam

retinopathy

leads to blindness

nephropathy

leads to decreased kidney function

avoidance learning

learn to escape from unpleasant consequences. avoid future criticism by improving future performance

round bone

leg

vitamin B12 deficiency

macrocytic, megaloblastic anemia. pernicious anemia - after gastrectomy or removal of ileum. due to lack of intrinsic factor

formative evaluation

made during course of education. helps pinpoint parts mastered and parts not mastered. allows for revision of plans, methods answers "how should we do it?" client must be involved; focus group, pre-test frequent feedback of results guides the rest of the educational process ex: focus group pre-test

MNT for Inflammatory bowel diseases

maintain fluid and electrolyte balance; antidiarrheal agent (sulfasalazine) acute Crohn's flare-ups - bowel rest, parenteral nutrition or minimal residue. acute UC, elemental diet may be needed to minimize fecal volume. energy needs according to current BMI, limit fat only if steatorreha; water soluble and fat soluble vitamins; iron, folate, assess Ca, Mg, Zn; MCT oil (lost in fatty stool), watch lactose, frequent feedings, high fat may improve energy balance. high fiber to stimulate peristalsis when IBD is in remission.

goals for daibetics

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

MNT for COPD

maintain stable weight. Replete but do not overfeed - high calorie, high protein diet (1-1.5 g/kg dry weight, 15-20% cals) 30-45% as fat (oxidation of fat consumes less oxygen than oxidation of CHO), 40-55% as CHO. small, frequent mini-meals and snacks, easy to prepare and eat, nutrient dense supplements (smoothies, meatloaf, muffins with cream cheese, tuna salad, cereal with fruit)

CDC STEPS

major federal level grant; Steps to a Healthier US focused on community-based health initiatives related to obesity. Directs funds to address asthma, obesity and diabetes prevention.

Fair Employment Practice Law

makes it illegal to ask about a candidates's race, religion, sex, national origin, age, marital status (after hire, can ask).

evaluation response

makes judgment about person's feelings; leads to offering advice. not problem solving, seldom helpful.

Nutrition diagnosis - clinical domain (NC)

nutritional findings/ problems that relate to medical/physical condition. 1. functional balance (ex : swallowing) 2. biochemical balance (ex: lab values) 3. weight balance (ex: underweight)

Native American and Alaskan Natives

obesity is epidemic and adds to increased prevalence of heart disease, hypertension; depend heavily on federal food assistance programs

perceived susceptibility

obesity puts me at risk for heart disease?

formal evaluation

objective test - not well suited for clinic or community setting performance test - client asked to complete task based on learning objectives

Blooms Taxonomy

objectives at lower levels must be mastered before more complex learning can take place. Is the level of learning appropriate based on the groups prior learning and present ability?

research introduction

objectives, definitions, background, limitations, order of presentation

rank order (ordinal scale)

observations compared with each other and put in order, perhaps from best to worst, or state of disease from 1-4

understanding response

one of the bet ways to respond, try to recreate the person's message in your own frame of reference. may lead to more client cooperation. helps client feel accepted and safe in expressing their feelings.

large group - lecture

one way flow of information; presents a large amount of material in a short time.

Dumping syndrome

Symptoms - cramps, rapid pulse, weakness, perspiration, dizziness when rapidly hydrolyzed carbs (simple sugars) enter the jejunum, water is drawn in to achieve osmotic balance --> rapid decrease in the vascular fluid compartment and a decrease in peripheral vascular resistance. Blood pressure drops and signs of cardiac insufficiency appear. About 2 hours later, the CHO is digested and absorbed rapidly. Blood sugar rises, stimulating an overproduction of insulin, causing a drop in blood sugar below fasting. This is reactive/alimentary hypoglycemia

Macgregor - attitude of the manager toward employees

Theory X - people inherently dislike work and will avoid it if possible. Authoritarian, work centered; workers prefer to be controlled and directed by pressure; motivation through fear; negative autocratic. theory Y - work is as natural as play or rest; managment should arrange conditions so workers can achieve goals by directing own efforts positive, participative.

upward communications

from workers up tot he department Head; open door policy, suggestion boxes, grievance procedures. provides employees and opportunity to have say in what happens in the organization. management needs to receive vital information from lower levels.

carbon dioxide as leavening agent

froma ction of yeast on sugar, yhielding carbon dioxide and alcohol. from the action of acid on baking soda acids used : sour milk, cream of tartar, molasses

sweeteners in order of sweetness

fructose, invert sugar, sucrose, glucose, sorbitol, mannitol, galactose, maltose, lactose

sources of phytochemicals

fruits, vegetables, legumes, whole grains, nuts, seeds, herbs, spices

GERD

gastro-esophageal reflux disease avoid eating before bed, soda, caffeine, acidic foods small, low fat meals, liquids empty more rapidly.

Atopy

genetic predisposition to produce excessive IgE antibodies in resonse to an allergen.

gluten

gives elastic properties, forms framework, hold in leavening agent; made from gliadin and glutenin through process of hydration and mixing

carb counting

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

Staffing patterns

acute care conventional - 17 minutes per meal or 3.5 meals per labor hour extended care facilities: 5 meals/labor hour cafeteria - 5.5 meals/labor hour school foodservice - 13-15 meals/labor hour

complications of uncontrolled diabetes

acute ketoacidosis acute hypoglycemia Long term - neuropathy, retinopathy, nephropathy

cultured buttermilk

add lactic acid bacteria to skimmed or partly skimmed milk increase baking soda when using buttermilk in place of regular milk in a recipe

stewing

add water or other liquid during cooking

cured cheese

additional whey removed, salt added, ripened

salt (baking)

adds flavor, keeps yeast from sticking

fat (baking)

adds tenderness by coating gluten particles

CSFP commodity supplemental food program

administered by state health agencies monthly commodity canned or packaged foods low income women (pregnant, breast feeding, postpartum, infants and children up to 6 years, some elderly; at nutritional risk

homogenized milk

high pressure breaks fat globules to 1/5 regular size; film of protein surrounds each globule. more susceptible toa ction of lipase, but the pasteurization process destroys lipase

MNT for cirrhosis

high protein (.8-1 g/kg; in stres at least 1.5 g/kg) high calorie - 25-35 cals/kg estimated dry weight or 1.2-1.5 X BEE moderate to low fat 25-50% of calories, MCT if needed; <40 grams fat if malabsorption. Fat is preferred fuel in cirrhosis. Include omega 3. Decrease LCTs if steatorrhea develops. Low fiber carices are present; low sodium if edema or ascites. with hypnatremia, fluid restriction of 1-1.5 liters/day depending on severity and moderate sodium intake. B complex vitamins, C, K, Zn, Mg; monitor need for A and D.

sulfur

part of amino acids cysteine, cystine, methionine. function - transports lipids as acetylcholine. fat in eggs, milk, liver, soybeans.

magnesium

part of chlorophyll. 50% in bone, 50% in cells function - protein and fatty acid synthesis. stabilizes structure of ATP. high protein, calcium, vitamin D, increases need sources - most foods, milk, bread deficiency rare - tremors

diffusion

particles move from more to less concentrated side

Transpyloric (EN)

passed by pyloric valve in stomach; used in comatose patients or ones with no gag reflex.

Third party reimbursement

payment by a third party for service rendered by a health care provider to a patient (Blue Cross, Medicare)

Niacin deficiency

pellegra. dermatitis, diarrhea, dementia beefy, bright, red tongue symmetrical, pigmented rash in sunlight

Conditions that elevate PBI

periods of growth, pregnancy, lactation, fever (7% for each degree rise in temperature), some diseases (cancer and HTN), exercise

neuropathy

peripheral and autonomic; gastroparesis.

Chronic obstructive pulmonary disease (COPD)

persistent obstruction of airflow. symptoms - weight loss, emaciation, anorexia.

proxemics

personal space moves away = discomfort moves closer = seeking more interaction sits behind or next to an object = seeks protection

management concepts

philosophies about how an organization views its customers, and the delivery of products or services. the marketing strategies for services may be different from the marketing mix for goods (product, place, price, promotion)

kinesics

physical communication. eye contact = attentive lowering eyes/look away - preoccupation arms folded across chest - dislike avoidance clenched fists - anxiety, anger; crossing and uncrossing legs = anxiety.

Illegal Immigration Reform and immigrant Responsibility Act 1996

places limitations on persons who remain in the US longer than permitted by their visa and/or who violate their nonimmigrant status.

negotiating techniques

plan strategy in advance - know what you are willing to accept. don't start with hard issues. be direct, clear, calm, patient, tolerant.

manager functions

planning, organizing, controlling, and evaluating

Extracellular water

plasma, lymph, interstitial or intercellular ECW

Leadership Grid - Blake, Mouton, McCanse

plots leader's concern for people (employees) vs their concern fro production. scale of 1-9; 1 is low concern, 9 is high concern.

breakeven analysis graph

plots the costs on the verticle axis and sales (revenue) on the horizontal axis. The graph uses the assumption that there is a linear relationship between sales and total costs (fixed + variable), and the point where they intersect is the breakeven point.

Workman's compensation

administered by state. insurance covering employers liability for the costs of any accident incurred by an employee in connection with their job. must furnish a safe place to, competent supervision, instructions.

propofol

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

osteomalacia

adult rickets. vitamin D deficiency - lack of sunlight or diet intake. reduction in bone density - demineralization. vitamin D, calcium supplements.

BRFSS (behavioral risk factor surveillance system)

adults 18 years and older residing in households with telephones telephone interviews collect info on height, weight, smoking, alcohol use, food frequency for fat, fruits and vegetables, preventable health problems, diabetes (Behaviors)

Chronic ulcerative colitis (UC)

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

Regional enteritis (Crohn's disease)

affects terminal ileum; weight loss, anorexia, diarrhea. B12 deficiency leads to megaloblastic anemia. iron deficiency anemia due to blood loss, decreased absorption

Acute Diarrhea in infants and children

aggressive and immediate rehydration; replace fluids and electrolytes lost in stool (WHO recommends glucose electrolyte solution). as effective as parenteral rehydration and much cheaper, ingredients easily attainable; reintroduce oral intake within 24 hours.

Advocacy

aggressive form of action; plead cause of a group. know facts and arguments for and against the issue. be realistic - usually results in compromise.

Re-feeding syndrome

agressive administration of nutrition to malnourished. at risk: anorexia nervosa, chronic alcoholism, prolonged fasting, unfed 7-10 days, significant weight loss, phosphorus-deficient PN. Starved cells take up nutrients, potassium and phosphorus shift into intracellular compartments. results in hypokalemia, hypophosphatemia and hypomagnesemia. overfeeding PN and dextrose > 5mg/kg/min may lead to hyperglycemia.

milling

air classification is a separation method that improves baking qualities by separating large flour particles from fine particles

Emphysema

air sacs (alveoli) lose elasticity; thin, cachectic, often older. difficulty exhaling; air pocket walls expand, thin out, collapse.

sorbitol

alcohol from glucose; absorbed more slowly than glucose by passive diffusion; converted into fructose; excess may cause diarrhea

Associated malnutrition in alcoholic fatty liver disease

alcohol replaces food in diet. alcohol causes inflammation of GI tract and interferes with absorption of thiamin, B12, vitamin C, folic acid. alcohol interferes with vitmin activation. increased need for B vitamins to metabolize alcohol. increased need for magnesium; excreted after alcohol consumption. malnutrition increases alcohol's destructive effects. Folate and protein deficiencies. Most responsible for malabsorption. Thiamin deficiency - Wernicke-Korsakoff syndrome.

cause of yellowing cake

alkaline batter (excess soda)

saturated fatty acids

all available bonds of carbon chain are filled with hydrogen; solid and hard at room temp

complete proteins

all essential amino acids in sufficient quantity and ratio to maintain body tissues and promote growth; HBVV - high biological value low protein diets - give mostly HBV

straight dough method

all ingredients are added before dough is allowed to rise

Adjusted FTE

also takes into account the benefit days and days off. computed by dividing the total number of hours used in operating for a period of time by the normal workload hours of one employee.

MNT for dumping syndrome

frequent small, dry feedings, fluids before or after meals (to slow passage), restrict hypertonic concentrated sweets, give 50-60% complex CHO, protein at each meal, moderate fat, B12 injections may be needed. Lactose may be poorly tolerated due to rapid transport.

Hypernatremia

associated with dehydration. Serum sodium is the BEST assessment parameter for fluid status

hyponatremia

associated with over-hydration

downward communications

from department head down throught he ranks of workers (chain of command), use procedure manuals, policy statements.

Wholesome Meat Act of 1967

assures consumer that the animal was healthy at the time of slaughter and the meat is fit for human consumption. shown with round purple stamp "USDA inspected and passed"

When to add solid foods

at 4-6 months, when sitting posture can be sustained and extrusion reflex diminishes; begin with iron fortified cereal, then strained vegetables or fruit.

Egg grading

candling - pass an egg in front of bright light to view contents. judges thickness of white, location and condition of yolk. grades AA, A, B

chemical properties of carbs

carbon, hydrogen, oxygen

physical properties of fat

carbon, hydrogen, oxygen

physical properties of proteins

carbon, hydrogen, oxygen, nitrogen (16%) sulfur (cystein, cystine, methionine)

what diet is typically recommended fora patient who has undergone a gastrectomy?

carbs, protein, and fat at each meal, and restriction of fluids with meals.

yellow, orange pigment

carotenoids (least affected by change in pH) insoluble in water little effect in acide or lkaline solution lycopenes - contribute to red color in tomatoes and watermelon and overtones in apricots (antioxidant, phytochemical)

stabilizers

carrageenan, pectin, cellulose, gelatin, vegetable proteins

Non-tropical sprue

celiac disease, gluten-induced enteropathy reaction to gliadin - affects jejunum and ileum (poximal intestine) malabsorption (leads to loss of fat soluble vitamins), macrocytic anemia, weight loss, diarrhea, steatorrhea, iron deficiency anemia.

socioeconomic stratification

census data, housing stats

measures of central tendency

center of any mass of data

ultimate goal of nutrition education

changing behavior.

variables

characteristics that may have different values from observation to observation

When to check gastric residuals in EN

check every 4 hours during the first 24 hours. Then decrease to 6-8 hours unless a patient is critically ill. If the GRV is >250 after the second check, consider a pro-motility agent. If the GRV >500 ml, hold the feeding and assess tolerance. Normal GRV <250 ml

modified starch

chemical modification by acids and enzymes to change viscosity, and ability to gel. physical modification:L pre-gelatinized starch used in instant puddings. used to stabilize frozen gravies: waxy maize, modified cornstarch

Angina pectoris

chest pain

Irritable bowel syndrome (IBS)

chronic abdominal discomfort, altered intestinal motility, bloating. goals - adequate nutrient intake, tailor patter to specific GI issues. Avoid large meals, excess caffeine, alcohol, sugars. Use food diary to track intake, emotions, environment, symptoms, identify food allergies and hypersensitivities. Work with client to alleviate stress during eating.

listening responses

clarification: pose a question after an ambiguous client message used ot make previous message explicit (clear) active or reflective listening - paraphrase or repeat back what was just said.

Transactional leader

clarifies roles and responsibilities; uses rewards and punishments to achieve goals. engage in bargaining relationship with their followers. Leader and follower have separate but related purposes; they are not bound together in pursuit of common goals. leader tells employee what they need to do to obtain rewards, and takes corrective action only when employees fail to meet performance goals.

requirements for bariatric surgery treatment

class III obesity with a BMI of 40 or greater, or a BMI of 35 or greater with co-morbidities.

MNT for Diverticulitis

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

Nutrition indicators

clearly defined markers than can be observed and measured. also used to monitor and evaluate progress towards nutrition outcomes. compared against the nutrition care criteria.

Bolus method (EN)

clinically stable with functional sotmach

sources of saturated fat

coconut oil, palm kernel, cocoa butter, butter, beef tallow, palm oil

cohort studies

cohort of healthy people followed through time to see if they develop a specific disease. sometimes called INCIDENCE studies tracking the frequency of new cases of a disease carried out over a long period of time (longitudinal), and prospective (future oriented).

sponge method

combine liquid with yeast and part of the flour and allow this batter (sponge) to ferment for several hours; add sugar, salt, fat, rest of lour; knead. shortened proofing time

least tender meats

come from most used muscles (flank, brisket)

Tender cuts

come from the least used muscles (loin, backbone) i.e. pork chops, loin

medium tender meats

come from the shoulder (chuck)

Selection process - application, screening

compare skills, knowledge, education with job requirements. pre-employment testing, background and reference checks. interviews.

symptoms of Fe deficiency status post Roux-en-Y

craving ice and reports of chewing large quantities of ice daily.

Cake mixing method

cream fat with sugar, add egg, add sifted dry ingredients in portions, alternating with portions of milk

thiols

cruciferous vegetables (sulfur) - detoxification of carcinogens

mixing method for pastries

cut fat into flour and salt, add liquid

methionine converted to...

cysteine

procedures

daily operations

cirrhosis

damaged liver tissue is replaced by bands of connective tissue which divides liver into clumps and reroutes many of the veins and capillaries. Blood flow through liver is disrupted. Poor food intake leads to deficiencies. Protein deficiencies lead to ascites, fatty liver, impaired blood clotting.

numerical discrete

data with numbers (numvber of clinic visits)

Nutrition care documentation

date and time, pertinent data and comparison with standards; patient's perceptions, values, and motivation related to problem; changes in patient's level of understanding, behaviors, outcomes, reason for discharge.

Preparation stage

decides to change and plans the change "I bought a cookbook on low salt cooking"

mineral oil, cholestryramine

decrease absorption of fat, fat soluble vitamins

fetal iron stores

decrease at 3-4 months; need additional iron, preferably from formula or supplemental foods (cereal starting at 4-6 months)

steroid

decrease bone growth, CHO intolerance

methotrexate

decrease folate

oral contraceptives

decrease folate, B6, C

Anemia

decrease in total red cell mass due to fewer red blood cells or to smaller cells with less hemoglobin.

thiazide diuretics

decrease potassium and magnesium, absorb calcium

thiazide diruetics

decrease potassium, magnesium, calcium, sodium

antibiotics

decrease vitamin K

needs assessment - elderly

decreased attention span; audience participation to maintain interest; carefully control questions to stay on topic; prefer written material to control rate of input. 30 minutes sessions, big bold print.

baking at high altitudes

decreased pressure causes gas to expand faster, steam forms earlier expansion may be excessive before heat of oven has coagulated the protein and gelatinized the starch enough to stabilize the structure. to correct: decrease amount of baking powder, increase amount of liquid.

what is the primary advantage of a closed system for tube feedings?

decreased risk of bacterial contamination.

dehydration

decreased water intake, excessive water output. heavy solute load. nausea, dizziness, sunken eyes, fever, hyperventilation, excessive sweating, concentrated urine, dry inelastic skin, increase in solutes (BUN), tachycardia, headache fatigue, decreased appetite, rapid weight loss.

adding bran to flour mix

decreases volume of end product. increase flour and liquid to compensate

Nephrosis/nephrotic syndrome

defect in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through the tubules. albuminuria, edema, malnutrition, hyperlipidemia. (increased synthesis and decreased clearance of VLDL)

Ischemia

deficiency of blood due to obstruction.

Glycogen storage disease

deficiency of glucose 6 phosphatase in liver; impairs gluconeogenesis and glycogneolysis. liver can't convert glycogen into glucose leading to hypoglycemia. provide a consistent supply of exogenous glucose with raw cornstarch at regular intervals, and a high carb, low fat diet.

Hypothyroidism

deficiency of thyroid hormone. T4 low, T3 normal. decreased BMR leading to weight gain. diet - weight reduction.

incomplete proteins

deficient in one or more essential amino acids

Gastroparesis

delayed gastric emptying; caused by surgery, diabetes, viral infections, obstructions. moderate to severe hyperglycemia --> detrimental effects on gastric nerves.

Directing and coordinating function of management

delegation, communication, motivation, leadership must have clear understanding of what they want done; give specific instructions, motivate, provide training, require complete work, establish adequate controls.

Cyclic feeding (EN)

delivered by continuous drip at an increased rate over 8-16 hours, often overnight, by pump (for undernourished, especially older, ambulatory, malnourished patients).

Autocratic leadership

demands obedience, most control use during crisis.

fluoride defeciency

dental caries

crumb structure

depends on ingredients, procedure used, pan shape and size, baking temperature, time elapsed before baking

loop diuretics

deplete thiamin, potassium, mangesium, calcium, sodium

Fat (meats)

deposited around organs muscles, in muscles (marbling). finish- amount of fat cover on carcass

SOPP (standards of Professional Performance)

describes competent level of behavior in the professional role ( 6 domains of professionalism) (provision of services, application of research, communication and application of knowledge, utilization and management of resources, quality in practice, competency and accountability)

population of interest

describes group about which the observations are made

SOP in Nutrition Care

describes in general terms a competent level of nutrition care practice as shown by the NCP method used to think critically and make decisions to provide safe, effective, high quality nutrition care. (diabetes care, oncology nutrition, behavioral health care, nutrition support, management of food and nutrition systems, sports dietetics, and education of dietetics practitioners, pediatric nutrition, and nephrology care.

descriptive research

describes state of nature at a point in time generates hypotheses regarding determinants of a condition or disease provides baseline data and monitors changes over time. establish associations among factors, but does NOT allow causal relationships to be determined.

summative evaluation

designed at planning stage but conducted at end. considered final; purpose may be grading, or evaluation of progress. example: post-test

Delphi technique

designed to probe expert minds in a series of written interviews from which some consensus is sought. participants DO NOT meet. ex: medical research.

milk pasteurization

destroys pathogenic bacteria - 145 F for 30 minutes or 160 F for 15 seconds

Effects of storing eggs in the fridge too long

deterioration affects appearance and use. loss of Co2 makes eggs more alkaline whites become watery, yolks flatten. odors are absorbed

Maslow;s hierarchy of needs

determinants of behavior, motivated by the dsire to satisfy specific needs

WHO World Health Organization

developed RDAs for developing countries

Health belief model

developed to explain why people especially high risk people, fail to participate in programs designed to detect or prevent disease. a person must perceive the severity and their susceptibility to the threat for the threat to be a behavior motivating factor.

community food security inititiave

development of sustainable, community-based strategies to ensure that all have access to culturally acceptable, nutritionally adequate food at all times.

Queue - queuing theory

develops the relationships involved in waiting in line. used in analyzing flow of customers in a cafeteria. balance cost of waiting lines with the cost of preventing waiting lines through increased service.

evaluation of effectiveness of educational plans

did it alter patient knowledge, behavior, or attitude? what is rate of lapse or relapse? timeliness, appropriateness, accuracy? within budget? meet specific targeted needs? quality of presentation? were processes and outcomes documented? what was the degree of growth?

process oriented

did the process produce desired results?

dietary intake assessment

diet history food record 24 hour recall food frequency lists

Diagnosing allergies

diet history, skin tests, elimination diet (omit suspected foods)

thermic effect of food (TEF)

diet-induced thermogenesis (DIT), or the calorigenic effect of food (about 10% of total energy expenditure) energy needed to digest, absorb and assimilate nutrients greater after consumption of carbs and protein than after fat.

DASH diet

dietary approaches to stop hypertension; whole grains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI (not supplements).

WWEIA (what we eat in America)

dietary intake component of NHANES two days of 24 hour dietary recall data with times of eating occasions and sources of foods eaten way from home. USDA conducts over-sampling of adults >/= 60, African Americans, Hispanics

range

difference between the lowest and the highest value in the distribution. subtract lower from higher value based only on extreme values

Waist to hip ratio (WHR)

differentiates between android and gynoid obesity WHR of 1 or greater in men, 0.8 or greater in women is indicative of android obesity and an increased risk for obesity-related disease (diabetes, hypertension).

peritoneal dialysis (PD)

differs from home hemodialysis by filtering and cleaning blood within the body rather than through an outside dialyzer. With peritoneal dialysis, the patient's abdomen is filled with a special solution called dialysate that helps remove waste and extra fluids from the blood. The dialysate contains dextrose, to PD patients have a lower need for CHOs than pts on HD

FEP (free erythrocyte protoporphyrin)

direct measure of toxic effects of lead on heme synthesis. increased in lead poisoning. lead depletes iron leading to anemia, and displaces calcium in the bone leading to a zinc deficiency.

tertiary prevention programs

directed at managing and rehabilitating persons with diagnosed health conditions to reduce complications, improve their quality of life, and extend their years of productivity. ex: nutrition and menu planning classes for post-bariatric surgery patients.

Cystic Fibrosis

disease of exocrine glands - secretion of thick mucus that obstructs glands and ducts; chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption.

morbidity

disease rates mortality is death rates

Achalasia

disorder of lower esophageal sphincter motility, does not relax and open upon swallowing. causes dysphagia - difficulty in swallowing. start with pureed moist thick foods, progress to thick liquids.

Gout

disorder of purine metabolsim. increaseds erum uric acid; deposit in joints causing pain, swelling. diet - low purine may not be effective; may need weight reduction. moderate protein, liberal carbs, low to moderate fat, decrease alcohol, liberal fluid, avoid high purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel). medications (urate eliminatn, colchicine) induce loss of nutrients.

electrolytes

dissociate into ions in water, cations (+); anion (-)

Vasopressin (ADH)

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

derived fats

fat substance derived from a simple or compound fat by hydrolysis or enzymatic breakdown. fatty acid, glycerol, steroid.

HAV (Hep A)

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

kefir

fermented by lactobacillus, adds Co2, about 3% alcohol

supplements during pregnancy

ferrous sulfate - 30 mgs during 2nd and 3rd tri (taken between meals, not with mealk, tea or coffee) folic acid - 400 mcg (added to 200 from foods = 600)

wide span of control

fewer levels and fewer managers are needed used with highly trianed, highly motivated workers.

FTC Federal Trade Commission

fights health care fraud. Internet, TV, radio; bogus weight loss claims

renal functions

filtration- RBCs, protien stay in blood; all else filters through tubules. absorption - 100% glucose, amino acids; 85% water, sodium, potassium excretion - wastes, urea, excess ketones secretion - secretes hormones that control blood pressure, blood components; secretes ions that maintain acid-base balance.

proofing time

final rising of the dough shortened with strong flour, high in protein (bread flour)

crystalline sugar

fixed orderly pattern of molecules or atoms. large crystals = rock candy small crystals = fondant, fudge

nitrites

fixes color, inhibits spores of clostridium botulinum

braising

flour meat, brown cover and simmer in liquid. can be done in oven or on top of range.

carb sources

flour, cereals, fruits, vegetables, dairy

pastry

flour, fat, liquid, salt lard and oil are seach 100% fat; butter and margarine only 80% fat. When subbing butter for lard, need to use more.

osmosis

fluid moves from less to more concentrated side of membrane

Authority, obedience management

focus on production, managing tasks. domination, mastery, control. people are commodities like machines.

case control studies

focus on specific disease those with the disease are compared with a group without the disease, but otherwise similar in characteristics. both groups recall past behaviors, to study how the groups differ.

Cause and effect (fish) diagram - portrait of a problem

focuses on different causes of a problem; categorizes related factors to make their influence more observable. series of connected arrows, each representing an important factor. technique to increase worker involvement in decision making.

Path-Goal theory - Evans, HOuse

focuses on leader's effect on employee's motivation to perform. motivation to behave in a particular manner is the result of an expectation that a behavior will result in a particular goal and how strongly a person desires the goal.

secondary prevention programs

focuses on strategies to stop or slow the progression of disease. It includes screening and detection for early diagnosis, treatment, and follow-up. Secondary prevention activities target those whoa re more susceptible to health problems because of family history, age, lifestyle health condition, or environmental factors.

OtherNational Research council

food and nutrition board (developed RDAs)

physiological (survival) needs

food, clothing, shelter ex: pay, benefits, working conditions, schedule. security and safety ex: insurance, retirement plans, job security

Estimated average requirement (EAR)

for 50% of population, used in planning meals for healthy people, assesses group nutritional adequacy.

recommended breast-feeding

for first 4-6 months, then supplemented by weaning foods for at least up to 12 months.

broiling

form of radiated heat

traditional or classical management

formal structure that organizes and administers the work activities. coordination is main responsibility of management focus on tasks, structure, authority. scalar principle, unity of command. criticisms - too mechanistic; doesn't see group interactions and decision making processes.

moist heat (starch)

forms suspension. when heated, molecules swell, thicken, ecome translucent due to gelatinization.

modified foods

fortified, enriched, enhanced fermented dairy products have probiotics to support GI health fortified margarines contain plant sterols and stanol esters to reduce LDL

isoflavones

found in soy foods. lower elevted cholesterol

Likert - management of conflict

four basic systems of organizational leadership: 1. exploitive, autocratic (job centered) 2. benevolent, autocratic (job-centered) 3. consultative (employee centered) 4. participative (employee centered)

Nutrition Diagnostic reference sheets

four components: the problem or nutrition diagnosis label, definition of the label to differentiate a discrete problem area, etiology, and signs/symptoms. etiology categories are grouped by the cause of teh contributing factor. Such as beliefs/attitudes, physical function, treatment, access, behavior.

derived proteins

fragments from simple and conjugated (peptide)

Eggs - water preparation

poaching, coddling. use high quality egg. vinegar and salt improve shape by hastening coagulation. surface of yolks turn green when overcooked or allowed to cool slowly (ferrous sulfide)

demographic

population by age, ethnic groups, sex, birth rates, deaths

thickening ability of starches in order of effectiveness

potato, waxy corn, waxy rice, waxy sorghum, tapioca, wheat

postprandial glucagon. amylin agonist

pramlinitide (Smylin) - decreases glucagon production.

objectives

predetermined; towards which management directs its efforts. serve as motivators, provide direction.

hypothesis

prediction of a relationship measurable, specifies population being studied, time frame, typeof relationship being examined, defines variables being studied, states level of statistical significance.

steps in interviewing

preparation (collect background info an est. objectives) build rapport collect data closing

phases of budget cycle

prepare requests, evaluate revenue potential, formulate document, send to legislative body, legislative review and authorization, execute the budget (run the program), evaluation and review.

diet history

present patterns of eating. do not ask leading questions

MNT for AIDS

preserve lean body mass, prevent weight loss, prevent HIV wasting. nutrient needs -energy: BEE x 1.3 for asymptomatic -protein: asymptomatic 0.8/kg, up to 1.2-2.0 g/kg if wasted LBM. Vitamin/mineral supplements if needed to correct micronutrient deficiencies. educate about food safety - low bacteria diet (neutropenic); avoid raw foods. HIV infected women should be counseled NOT to breast feed. nutritional supplementation should be discouraged as adjunctive therapy to conventional care. Use of vitamin C or St. John's Wort could result in drug resistance.

benefits of phytochemicals

prevention or treatment of chronic diseases like cancer, heart disease may detoxify drugs, toxins, carcinogens, mutagens may act as blocking agents, preventing active carcinogen from reaching target tissue may reduce risk of CHD by protecting LDL cholesterol from oxidation, reducing synthesis or absorption of cholesterol

Age Discrimination in Employment Act 1967

prevents discrimination due to age

Equal Employment Opportunity Act 1972

prevents discrimination in employment based on race, color, religion, sex, national origin, political affiliation, overseen by EEOC.

Civil Rights act 1964

prevents discrimination on basis of race, color, national origin, prohibits sexual harassment. Overseen by EEOC (Equal Employment Opportunity Commission)

Meat grades

prime, choice, select, standard (determined at slaughter) standard grades have the least marbling; prime the most

Voluntary health agencies

private, non-profit organizations, chartered and licensed by a government agency, funded by contributions from citizens or organizations: American Heart Association

POMR

problem oriented medical record

Nutrition Diagnosis - environment domain (NB)

problems related to knowledge, access to food and safety 1. knowledge and beliefs (ex: disordered eating pattern) 2. physical activity balance and function (ex: inactivity) 3. food safety and access

hydrogenation

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

Erythropoietin (EPO)

produced by kidney; stimulates bone marrow to produce RBC.

pregnancy induced hypertension

progresses from pre-eclampsia to eclampsia. hypertension, edema of face and hands, proteinuria, rapid weight gain after 20th week; may have convulsion. more frequently found in women with lack of prenatal care, poor diets, poor protein and calcium intakes. sodium restriction is NOT recommended for prevention or treatment; sodium needed to maintain normal levels of sodium in plasma during large prenatal expansion of tissues and fluid. proposed association between PIH and calcium deficiency.

MNT for gastroparesis

prokinetics (erythomycin, metoclopramide) increase stomach contractility. small, frequent meals; pureed foods, avoid high fiver, avoid high fat (liquid fat may be better tolerated). bezoar formation may be due to undigested food or medications; treatment includes enzyme or endoscopic therapy.

Primary prevention programs

promote health and protect against exposure to risk factors that lead to health problems. Focuses on reducing or removing risk factors by changing the environment and the community, as well as, family and individual life styles and behaviors. This includes nutrition education and anticipatory guidance to develop and maintain healthful food and exercise behaviors. ex: osteoporosis education classes for postmenopausal women.

NSI (nutrition screening initiative)

promote nutrition and improve nutritional care for the elderly to identify nutritional problems early DETERMINE checklist - identifies factors placing people at nutritional risk increases awareness of factors that influence nutritional health disease, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, needs assistance in self-care, elder above age 80. Level I - screen identifies those who need more comprehensive assessments Level II screen provides more specific diagnositic info on nutritional status(most involved)

Peter Principle

promote someone to a level of incompetence

sensitivity

proportion of afflicted individuals who test positive

specificity

proportion of non-afflicted identified as non-afflicted

marasmus

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

continuous bread making method

reduces processing time not as affected by fermentation time and temperature commercial process that substitutes intense mechanical energy to a large degree for traditional bulk fermentation

myocardial infarction

reduction of coronary flow to myocardium due to blood clot blocking narrowed coronary artery.

strength of flour

refers to capacity to retain leavening depends on quality of gluten bread flour is strong; cake flour is weak

effectiveness

refers to the degree to which we achieve our objectives (producing positive results).

efficiency

refers to the minimization of resources that we must expend to achieve the objectives (producing positive results at the lowest cost).

Job description

reflects required skills and responsibilities. matches applicants to job, orientation and training, employee appraisal.

osteoblasts

reform bone

uncured cheese

refrigerate immeidately (cottage cheese, cream cheese)

FTC (Federal Trade Commission)

regulates content of food ads; enforces truth in labeling; challenges product claims when product crosses state lines.

acid base balance

regulation of hydrogen concentration acid releases hydrogen ions, base takes up hydrogen ions.

needs assessment - adolescents

relate to their interests; consider peer pressure and attitudes toward authority

cobalt deficiency

related to B12 deficiency.

correlations

relationships varying types of data. the closer the points are to the line the stronger teh degree of linear relationship

diastolic blood pressure

relaxation, least pressure.

skills to develop as a group leader

relieve social concerns of the group tolerate silence guide and encourage interactions. know when and how to resume control reinforce 'multi-sides' nature of conversation "how do you feel about that?" exercise control over talkative participants; encourage silent members halt side conversations by engaging distractors help group stay on topic

freezing eggs

remove from shell first; can be frozen whole or in parts. salt, sugar added to yolks as stabilizers.

Adult diarrha

remove the cause; bowel rest, replace lost fluids and electrolytes especially those high in sodium and potassium. when diarrhea stops, begin with low fiber foods, followed by protein foods, fat need not be limited. avoid lactose at first. foods or supplements that contain prebiotic components (pectin, fructose, oats, banana flakes) which favor friendly bacteria. probiotics - sources of bacteria used to reestablish bacterial gut flora.

double blind study

removes bias from research; neither the researcher nor he subject knows which group is receiving the treatment and which the placebo

case report, case study , or case series

report of observations on one subject or more than one subject describes quantitatively the experience of a group of cases with a disease or condition in common helps identify variables important to the etiology, care, or outcomes of a particular condition

Dominance and suppression

repress conflict rather than settle it; creates a win-lose situation. -forcing: "i'm the boss, do it my way" - smoothing: more diplomatic; manager tries to talk one side into giving in. - avoidance - manager avoids taking a position, no one is satisfied. -majority vote : can be effective if members regard the procedure as fair.

Entitlement program

requires payment of benefits to all eligible people as established by law; for a specific population who meet certain income or other eligibility requirements; usually for a finite time - 1 year. SNAP, medicare, NSLP, SFSP, SBP

surveys

research designed to describe and quantify characteristics of a defined population; defined time frame; pinpoints problems

imitation milk

resembles milk but contains neither milk fat nor other important dairy ingredients. made from casein derivatives or soybean protein and vegetable oils.

elastin

resistant to heat, little change in cooking. found in ligaments, cartilage, yellow color

Osteoclasts

resorb and remove bone

contingency or situational leadership - Fiedler

responds to external environment methods that are highly effective in one situation may not work in another. Management must identify which techniques will work in a particular situation at a particular time. most favorable situation = task-oriented, well-liked leader, directing a well-defined job.

RMR

resting metabolic rate - energy expenditure measured under similar conditions, after a short rest and controlled intake of caffeine, alcohol. more frequently measured than the BMR; greater than the BMR (10-20%) mifflin st. joer predicts within 10% of indirect calorimetry

MNT for PKU

restrict the substrate PHE, supplement the product TYR. low in PHE but provide enough to promote normal growth. Phenex-1,2, Pehnyl-Free 1,2 (low PHE formulas) avoid aspartame need for phenylalanine decreases with age, infection. low protein, high CHO intakes may lead to increased dental caries.

respiratory acidosis

retention of carbon dioxide by lungs (decreased ventilation) to compensate, kidneys increase absorption of base

HDL (alpha)

reverse cholesterol transport; moves cholesterol from cells to liver and excretion.

Expectancy theory - Beer Vroom

rewards serve as motivators only under certain circumstances. employees must believe that effective performance leads to certain rewards. employees must feel that rewards offered are attractive.

performance budget

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

literature review

summary of different point of view

HRA health risk appraisal

survey categorizing a populations' general health status (usedin worksites, government agencies as a health education or screening tool) consists of questionnaire, calculations that predict risk of disease, educational message to the participant

System approach

system is an organized whole composed of interdependent parts. two parts 1. an open system interacts with external forces (customers, suppliers, etc). External forces hav an impact on the organization and the organization has in impact on the environment. Makes system open and interactive. 2. impact of changes within an organization - a change in one part affects other parts.

Evidence Based dietetics practice

systematically reviewed scientific evidence used in making food and nutrition practice decisions; integrate best available evidence with professional expertise and client values to improve outcomes.

hypertension

systolic >140, or diastolic >90, or both. may be primary (essential) or secondary due to another disease. classified in stages based on risk of developing coronary heart disease. obesity is major factor in the cause and treatment. optimal BP with respect to cardiovascular risk is <120/80 mm Hg.

Short acting (regular) insulin

takes 30-45 minutes before meal (burst of insulin to cover the meal just about to be eaten). one unit covers 10-15 grams CHO; duration 3-6 hours.

sophistication - moderately experienced

teahers, health educators, patients already instructed; emphasize review of material; reorganize it for better use; move on to more complicated concepts.

inferential statistics

techniques that allow conclusions to extend beyond an immediate data set; what is the probability that the results can be applied to a larger group; what can you infer from the results of your study

Health and diet survey

telephone survey of randomly selected adults tracks self-perception of relative nutrient intake levels, use of food labels, knowledge of fats and cholesterol, prevalence of supplement use.

frying

temperature to which fatr can be heated before puffs of smoke occur should be >400 degrees F do not fry tough cuts of meat rancidity involves the uptake of o2 in an unsaturated fatty acid

analytical research

tests hypotheses concerning the effects of specific factors of interest and allows causal associations to be determined includes clinical trials, follow up studies, case control studies

t test

tests significance between the means of two different populations. tests null against alternative hypothesis. if the probability value is equal to less than the level set for significance, the null hypothesis is rejected in favor of the alternative hypothesis.

external validity

tests whether or not a generalizatio ncan be made from th estudy to a larger population

chi square X

tests whether or not there is a real difference between categories. used with attributes that have more than 2 categories. compares the frequency with which we'd expect certain observations to occur with the frequency that actually occurred.

internal validity

tests whether the difference between two groups is real

Food security

the access by all people at all times to sufficient food for an active and healthy life. it is the ready availability of nutritionally adequate and safe foods and an assured ability to acquire them in a socially acceptable manner (without resorting to emergency food programs, stealing, scavenging).

food synergy

the additive influence of foods and consituents which , when eaten, have a beneficial effect on health. group of things working together.

gas exchange analysis

the following are measured or calculated: -fraction of inspired and expired oxygen and carbon dioxide -inspired and expred minute gas valume from these quantities Vo2 and Vco2 can be calculated

alterations in amount of sugar (cakes)

the more sugar, the more time is needed to reach the elevated coagulation temperature of the gluten. as sugar increases, the volume of cake increases up to the point where the volume is so great, and the gluten so weak, that the gluten strands snap and the cake falls in the center (gummy, crystalline appearance).

diabetic gastroparesis

the muscles of the stomach don't work normally, and the movement of food slows or even grinds to a halt as a result of vagus nerve damage related to prolonged elevated glucose levels. foods to avoid: alcohol, carbonated beverages, beans/lentils, corn, high fat foods, gas causing foods.

Diverticulosis

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

gelatinization

the swelling that occurs when starch is heated in water close to the boiling point heat dissociates bonds, water moves in and swells granules friction is created causing paste to thicken

Theory Z (Ouchi)

the value of the company is the people. everyone who will be affected by a decision is involved in making the decision (consensus decision making)

Total nutrient admixtures (TNA)

thee in one systems, include dextrose, amino acids, and lipids.

Correlation coefficient r= 0

there is no linear relationship

Contemplation stage

thinking about making a change "I was looking at the salt content in the foods I have at home"

dripolator

three separate compartments; add boiling water to top and let dripo through; brief contact with grounds; free of bitterness

essential amino acids

threonine, valine, tryptophan, isoleucine, leucine, lysine, phnylalanine, methionine, histidine (TV TILL PMH)

Long term central access (PN)

throught he cephalic, subclavian or internal jugular vein into the superior vena cava.

productivity schedule

time sequencing of events required to produce a meal; employee assignments and menu items; quantity to prepare and the timing (what to do when)

quasi experimental design

time series - series of measurements at periodic intervals BEFORE the program begins and AFTER the program ends. I shows whether measurements before and after the program are a continuation of previous patterns or whether they indicate a noteworthy change.

protein functions

tissue synthesis, maintains growth, regulates body processes. inefficient energy source - nitrogen must be removed first (58% of protein can be converted to glucose)

USDA nationwide food consumption survey (NFCS)

to obtain info on food intake of individuals and total household from entire US evaluate 7 nutrients - protein, calcium, iron, thiamin, riboflavin, vitamins C, A. diets rated good if intakes equaled or surpassed RDA; rated poor if less than 2/3 of RDA for 1 or more nutrients.

cooking cheese

to prevent stringy, curdled-looking cheese products, cook for a short time at moderate temperatures.

causes of poor volume cake

too little baking powder, improper level of sugar or fat

causes of coarse textured cake

too much baking powder or sugar, oven temp too low, inadequate mixing

causes of tough, dry crumb cake

too much flour or egg, too much mixing, too little fat or sugar, over baking

Standards of Practice (SOP) and Standards of Professional Performance (SOPP)

tools for credentialed dietetics practitioners to use in professional development. They are not regulations, but may be used to determine competency. practice-specific SOP and SOPP are generalist, specialty, and advanced levels.

labor cost per meal

total labor expenses/total meals served

manganese

trace mineral function - central nervous system source - whole grains, legumes, nuts deficiency unlikely

fluoride

trace mineral function - teeth bones sources - soil, water

zinc

trace mineral. excess leads to copper or iron deficiency. function - increases taste acuity. Enhances insulin action. stabilizes DNA, RNA. Cell division. sources - meat, liver, eggs, fish, phystates and copper decrease abs.

iron

trace mineral. part of hemoglobin. food iron = ferric absorbable = ferrous stored = ferritin function - oxygen transport sources - heme iron from animal foods, meat, fish poultry. non-heme from cereals, vegetables, poorly absorbed;

iodine

trace mineral. part of thyroxine. sources - seafoods, iodized salt

copper

trance mineral. attached to protein ceruloplasmin. function - hemoglobin synthesis. aids iron absorption. sources - liver, kidney, shellfish

LDL (beta)

transports cholesterol from diet and liver to all cells.

chylomicron

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

VLDL (pre-beta)

transports endogenous triglycerides from liver to adipose cell.

esophagitis

treat by decreasing gastric acidity, reflux. diet - small, low-fat, bland, low fiber; weight reduction?

homocystinurias

treatable. inhertied disorder of amino acid metabolism. characterized by severe elevations of methionine and homocysteine in plasma, and excessive excretion of homocystine in urine. associated with low levels of folate, B6, B12. newly diagnosed patients receive increased doses of folate, pyridoxine (B6), B12. if they don't respond - low protein, low methionine diet.

isoniazid

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

Action stage

tries to make the change "I removed the salt shaker from the kitchen table"

simple fats

triglycerides (3 fatty acids, 1 glycerol). most food fat is a triglyceride.

precursor for serotonin and niacin

trptophan

parallel forms

two separate but similar forms of the same test at the same time. reliability determined by the degree to which the sets of scores coincide.

phenylalanine is converted to...

tyrosine

end stage renal disease (ESRD)

usually associated witha BUN >100 mg/dl, and Cr 10-12 mg/dl. retention of N metabolites - may use Giobenatti diet - 20 grams protein (HBV), increases calories; control edema, prevent deficiencies.

Anaerobic (sous vide) storage

vacuum-packing meat in an oxygen-impermeable film, stored unfrozen at 0 degrees celsius.

nominal (non-ordered)

variables that fit into a category withno special order (gender, race, marital status, present or absent)

p <.01

very significant difference, more reliable results

p < .0001

very, very significant, reliable results

Acquired immune deficiency syndrome (AIDS)

virus debilitates immune system by attacking lymphocytes. diarrhea, malabsorption, nausea, vomiting, weight loss.

rice cookery

vitamins are lost when cooked in excess water or when water is drained off. cook in amount of water that will be absorbed during cooking (1 cup rice = 2 cups water)

Cheese production

warm milk, add lactic-acid bacteria, add enzyme rennet to coagulate casein forming the curd, separate curd from whey (liquid)

loss of colon

water and electrolyte loss, loss of salvage absorption of CHO and other nutrients.

folate

water soluble PABA is precursor function - DNA synthesis, forms RBC in bone marrow, prevents neural tube defects sources - fortified dry cereal, liver, kidney, green leafy vegetables, citrus fruits, lentils, beans

Vitamin B2

water soluble Riboflavin. lost in UV light function - energy release from pmrotein. red cell production sources - liver, kidney, meat, milk.

Vitamin B12

water soluble cyanocobalamin. contains cobalt. bound by intrinsic factor in gastric juice function - coenzyme in protein synthesis. forms RBC. sources - liver, meat, milk, kidney, eggs, fish, cheese

pantothenic acid

water soluble function - coenzyme A - energy synthesis of fatty acids. sources - animal foods, grains, legumes

Niacin

water soluble precursor: tryptophan. Essential in all cells for energy production and metabolism function - metabolism of CHO, protein, fat sources - protein, peanuts, ready to eat cereals, chicken, rice, yeast, milk

Vitamin B6

water soluble pyidoxine. INH - ioniazid (B6 antagonist) function - coenzyme in amino acid metabolism: deamination, transamination sources - meat, wheat, corn, yeast, pork, liver, readyt to eat cereals

Congressional index

weekly update; identifies bill with sponsor and committee.

pediatric overweight interventions

weight maintenance is usually recommended in overweight children 2-5 years of age with a multicomponent weight management intervention with active participation of the parent. Weight loss may be recommended when the child has serious medical conditions.

Master work schedule

werves as overall plan; days on and off, vacations, basis for developing weekly schedules

variable of interest

what researches are observing

colostrum

yellowish transparent fluid secreted from the breast during first few days; meets infants needs during first week; has more protein, less fat and carbs than mature milk; has antibodies.

sophistication - inexperienced

young children, some adults lacking nutrition training; need thorough introduction and background.

Nutrition care outcome indicators

provide information about the type of progress made, when the nutrition problem is resolved, and what aspects of nutrition intervention are not working.

functional foods

provide more benefits than the basic nutritional benefits

fiber

provides indigestible bulk, promotes intestinal function.

Maintenance stage

sustains the change for six months or longer "I found a website that helps me plan family low sodium meals"

anabolism

synthesis of a more complex substance

biotin

synthesized by intestinal bacteria, inactivated by avidin (protein in raw egg white) function - binds calcium, zinc, iron membrane structure sources - liver, kidney, egg yolk, yeast

feedback (response)

tells you whether or note the correct message has been received.

nutrition informatics

the intersection between nutrition information and technology. use of technology in spreading information MIS is an electronic system that manages information

custards

the larger the % sag, the more tender the gel. custard from dehydrated eggs is lower quality.

breakeven point

the point where total costs equal total revenue. any sales in the excess of breakeven point will yield a profit and sales less than the breakeven point will thus be a loss.

Job breakdown

what to do and how to do it - no time limits used in training.

correlation coefficient r = 1

when all points lie exactly on a straight line with a positive slope

correlation coefficient r = -1

when all points lie on a straight line witha negative slope.

Ag- Ab reaction

when antigen enters body, antibody reacts

when to add acid in cooking starches

when cooking is complete, because acid breaks down starch and will give a runny product ex: if lemon juice is added to lemon meringue pie before cooking is complete, filling will be runny.

Diverticulitis

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

roasting

when meat is removed from oven, "carry-over cooking" occurs for about 10 minutes. Internal meat temperature will rise 15-25 F. allow roast to stand 30 minutes before carving

milk in food prep

when milk is heated, whey protein precipitates out on bottom of pan or on surface of milk. to prevent a film from forming, cover or beat the milk to produce a foam. to prevent milk from coat on sides of pan, heat over water to prevent curdling, add an acid slowly and agitate (precipitates casein)

strategies for Type 1 DM

with fixed daily doses of insulin, consistency of CHO is recommended. integrate insulin therapy with usual eating habits. monitor blood glucose and adjust insulin doses for amount of food eaten. with intensive insulin therapy, adjust pre-meal insulin dosages based on total CHO content of each meal, using an insulin to CHO ratio. for planned exercise, reduction in insulin dosage may be best choice. Endurance Athletes: 120-180 mg/dl is guideline during activity.

Intracellular water

within cells, ICW

creaming

work on or more foods until soft and creamy

Scientific management - Taylor

work-centered - workers must work at fastest pace possible and at maximum efficiency; systematic approach to improving worker efficiency. Structure work situation to minimize motivation needed by supervisor. find the best way of performing tasks. focus on physical aspects of the job.

Structured (directed) interview

use checklist or preplanned strategy; gives same information on all; minimizes personal biases.

Fish cookery

use dry or moist heat. more perishable than meat so store at lower temps fresh fish with head attached should have bright red gills and bright shiny skin...reject if gills are dull and gray.

retrospective cohort studies

use existing data set and look back for relationship between exposure factors and outcomes.

yeast dough

use high protein bread flour yeast ferments sugar and releases co2

White pigment

Anthoxanthins or flavones soluble in water colorless in acid yellow in alkaline

NSIP Nutrition Services Incentive Program

AoA Administration on Aging developed services to foster independent living; cash and commoditites to state agencies.

Family and Medical Leave Act 1993

Applies to public agencies and private agencies employing >50 workers. up to 12 workweeks of unpaid, job-protected leave during andy 12 months for : birth or placement of a child for adoption, to care for an immediate family member, or medical leave for a serious health condition. When you return you are guaranteed an equal job, but NOT the same job.

rapid-acting insulin

Aspart (novolog), Lispro (humalog); takes 5-15 minutes before eating, usual duration 4 hours.

when do you evaluate the educational process?

Assessment

NFP - skin

Assessment - pale, dry, scaly Considerations - iron, folic acid, zinc deficiency

NDD3 (Dysphagia Advanced)

Avoid very hard, sticky, crunchy foods, hard fruit and vegetables, nuts, seeds.

altered neurotransmitter theory

BCAA decreased (used by muscles for energy); AAA (aromatic amino acids) increase because damaged liver is unable to clear them. adding BCAA - adds calories and protein; may not reduce symptoms. used when standard therapy does not work and when patient does not tolerate standard protein. standard treatment is lactulose (hyperosmotic laxative that removes nitrogen); neomycin (antibiotic that destroys bacterial flora that produce ammonia).

Standard polymeric enteral formula

Cheapest normal GI function, most provide 1-1.5 cals/cc lecithin may be added as an emulsifier initiated full strength at a rate of 10-40 ml/hour modular: mix individual components, adds flexibility. blenderized: whole food, large bore tube, thick intact protein, high residue. Least expensive formulas: intact protein (not pre-digested),a nd isotonic osmolality is close to that of blood)

Normal ranges for anions

Chloride - 96-106 mEq/L Phosphorus - 3-.4.5 mg/dl

Gallbladder disease

Cholecystitis - inflammation of gallbladder. an infection causes excess water to be absorbed causing cholesterol to precipitate out leading to gallstones - cholelithiasis. treatment - low fat diet: acute 30-45 grams; chronic 25-30% of calories. cholecystectomy - surgical removal of gallbladder; bile now secreted from liver directly into intestine.

Obesity

Class I = 30-34.9 Class II = 35-39.9 Class III= >/= 40 Children: BMI for sex and age >/= 95th percentile early rapid weight loss during diet is water - as liver glycogen is utilized. treatment - diet, exercise, behavior modification.

why does tea inhibit iron absorption

Compounds in tea called tannins can act as chelators, binding to minerals and inhibiting the body's ability to absorb them.

CARS checklist for evaluating information

Credibility - checks credentials of author Accuracy - info is current, factual and comprehensive Reasonableness - is into fair, balanced and consistent Support - is supporting documentation cited for scientific statements

nutrition screening initiative (elderly)

DETERMINE checklist. Disease, Eating poorly, Tooth loss/mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss/gain, Needs assistance in self care, Elder years above age 80

Medicaid

DHHS federal law administered by states. payment for medical care for all eligible needy: all ages, blind, disabled, dependent children.

Headstart

DHHS helps low income children; ages 3-5 introduces new foods, teaches good food habits child's participation in food activities is important

Healthy Start

DHHS reduce infant mortality an improve health of low income women, infants, children, families

Maternal and Child health Block Grant

DHHS under Title V of the Social Security Act. fosters public health nutrition programs at the state and local levels. provides training, consultation, funding. women of child-bearing age, infants, children; state eligibility requirements.

Lab values for anemias

Microcytic Hypochromic: RBCs normal, HGB low, HCT low, MCV low (<80), MCH low, MCHC low (<31) Macrocytic: RBC decreased, HGB low, HCT low, MCV high(>95) , MCH high, MCHC normal (>31)

Fresh produces (grade)

Fancy, Extra #1, #1, combination, #2

MNT for acute kidney injury/acute renal failure

First, IV glucose, lipids, protein. - 1-1.3 g/kg if non-catabolic without dialysis as GFR returns to normal. 1.2-1.5 g/kg if catabolic and/or initiation of dialysis. 20-30 cals/kg, BEE x stress factor (1.2-1.3) during hypermetabolic conditions. low sodium (2-3 grams), replace losses in diuretic phase. 8-15 mg/kg phos. may need phosphate binders. 2-3 grams K based on output, serum K, dialysis. replace fluid output from previous day plus 500 ml.

canned fruits and vegetables (grade)

Grade A - desserts, salads (fancy) Grade B - processed (choice) Grade C- puddings, pies (standard)

synergy

Groups working together to one final product. the groups product (decision) is superior to what the most resourceful individual within the group could have produced by working alone

Osteoporosis treatment

HRT - hormone replacement therapy, weight-bearing exercise, vitamin D (400-800 mg) and calcium (>/= 1200 mg, don't exceed 500-600 mg at one time) supplements, adequate protein, moderate to low sodium, 5 servings of fruit and vegetables.

statins (HMG CoA reductase inhibitors)

decreased LDL, TG; increase HDL

healthy obese

elevated LDL, normal to low HDL

Yohimbe

elevates blood pressure in energy drinks

protein in pregnancy and lactation

71 grams during second half of pregnancy and lactation

proprionate

presevative; mold inhibitor

sophistication - very experienced

"nutrition experts:, limit audience participation at first; establish yourself as the expert; cit credentials; lecture format with audiovisuals.

turnover rate

% of employees leaving the organization within the reporting period. calculated by taking the number of employees leaving the organization during the reporting period by divided by the total number of employees in the organization during the same period, multiplied by 100.

composition of breast milk vs. cows milk

% pro - 7 (human), 20 (cow) %CHO - 38 (human), 30 (cow), %Fat - 55 (human), 50 (cow) breast milk has more lactalbumin

metabolic alkalosis

(ketosis) loss of hydrogen due to loss of acid; or an increased retention of base. to compensate, ventilation decreases to retain carbon dioxide to make carbonic acid

Wheat flours

(listed in order of pro. content, high to low) graham, whole wheat bread (hard wheat) AP (blend of hard and soft wheat) Pastry (soft wheat) cake (soft wheat) enriched instant blending/agglomerated, instantized self rising

mEq =

(mg/atomic weight) * valence Na = 23 AW, 1 valence K = 39 AW, 1 valence Ca = 40 AW, 2 valence Mg = 24 AW, 2 valence Cl = 36 AW, 7 valence

incidence

(number of NEW cases of a disease over a period of time/total number of people at risk) x 100,000

labor turnover rate

(number of employees (separated) terminated and replaced/ total positions in department) x 100

alpha-linolenic

(omega 3) retinal function and brain development; deficiency results in neurological changes - numbness, blurred vision comes mainly from fish oils (EPA eiocosapentaenoic acid, DHA docosahexaenoic acid) walnuts, flaxseed, canola decreases hepatic production of triglycerides (inhibits VLDL syntheiss); little effect on total cholesterol levels

linoleic acid

(omega 6) lack creates excema, poor growth rate, petachiae (red, purple skin spots) if linoleic acid replaces CHO: LDL lowers, HDL increases if linoleic acid replaces saturated fat: total cholesterol lowers, HDL lowers safflower is teh best source

prevalence

(total number of people with a disease during a period of time/ average number of people) x 100,000

calories during pregnancy

+340 second trimester; +452 3rd trimester

low fat milk

.5-2% fat

serum creatinine

.6-1.4 mg/dl related to muscle mass; measures somatic protein may indicate renal disease, muscle wastage.

normal serum creatinine levels

.6-1.5 mg/dl. increased in renal disease and in catabolic states and decreased in very malnourished individuals and those with minimal muscle mass.

dietary protein requirements

.8 grams/kg body weight (10-15% of total energy intake)

strength of correlation

0-0.2 very weak .2-.4 weak,low .4-.7 moderate .7-.9 strong, high .9-1 very strong, very high

RQ for fats

0.7

RQ for protein

0.82

RQ of a mixed diet

0.85

RQ for carbohydrates

1

gel formation

1 T gelatin will gel 1 pint liquid. mix with cold water to soften. Add hot water to disperse.

rate of weight gain during pregnancy

1 lb/month 1st 3 months; 1 lb per week thereafter.

soft dough

1 part liquid 3 parts flour ex: bread

pour batter

1 part liquid, 1 part flour ex: waffles

drop batter

1 part liquid, 2 parts flour ex: muffins

stiff dough

1 part liquid, 4 parts flour ex: pie crust

Budget development

1. controls and coordinates activities. 2. indicates how and at what rate dollars are to be expended 3. consider the following in preparation: expenditures of preceding period, present budget, changes in present budget period, expenditures of present period, budget requests for next period.

Steps in program planning

1. develop mission statement (philosophy) and needs/problem statement 2. set goals - broad direction, general purpose (increase quality and years of life) 3. set objectives -SMART goals

steps in research

1. identify a relevant and important topic - review literature 2. develop well-considered research question (who, what, how) 3. research question leads to a hypothesis 4. prepare research protocol 5. organize methods and materials 6. collect and analyze data 7. study results and make decisions

community and group nutrition status indicators

1. obtain overview to determine whether nutritional resources are adequate, what groups are potentially at high nutritional risk, how well health needs are being met by existing programs. 2. most nutrition problems are commonly found among groups or areas which are socially, economically, educationally and/or medically deprived. 3. HRA health risk appraisal

Enteral formula calculation

1. select formula and determine calories needed. 2. divide calories needed by cal/ml to determine mls formula needed per day. 3.determine protein content: multiply mls of daily formula by grams of protein per liter. 4. determine daily fluid need: multiply % water in formula x daily formula in mls to determine water contribution of enteral nutrition. Subtract formula water from total fluid requirements to determine water flushes. determine administration rate: divide total mls of formula/day by 24 hours to determine continuous feeding goal rate.

Heart failure etiology

1. weakened heart fails to maintain adequate output, resulting in diminished blood flow so fluid is held in tissues (edema); dyspnea (shortness of breath) 2. reduced blood flow to kidneys causes secretion of hormones that hold in sodium and fluid leading to weight gain.

nutrition for hemodialysis

1.2 g pro/kg SBW(standar body weight), at least 50% HBV <60 y 35 cals/kg, >/= 60 y or obese 30-35 calories/kg >/= 1 L fluid output - 2-4 g sodium and 2 L fluid <1 liter fluid output: 2 grams sodium and 1-1.5 L fluid. Anuria: 2 grams sodium and 1 L fluid 40 mg/kg IBW (2-3 grams) potassium. calcium: individualized with maximum 2 g elemental total. 800-1000 mg phos or <17 mg/kg IBW or SBW vitamins C, B6, folate, B12 supplements: DRI for others. zinc DRI 8-11 mg/day, individualize for Fe and vit. D.

Activity factors

1.2 sedentary 1.3 active 1.5 stressed

Nutrition for Periotoneal dialysis

1.2-1.3 g pro/kg SBW or adjusted BW; >/= 50% HBV <60 years 35 cals/kg (including dialysate) >/= 60 years of age 30-35 calories/kg 2-3 grams sodium - based on blood pressure and weight. potassium generally unrestricted (usually 2-4 grams) </= 2000 mg total elemental calciu including diet and binders. 800-1000 mg phos or 10-15 mg phos/g pro. 1-3 L fluid depending on output, cardiac status. CAPD - continuous ambulatory periotoneal dialysis 4-5x per day VM as for hemodialysis except thiamin (may need extra due to loss)

2002 DRI's for development of fetal nervous system

1.4 g/day linolenic acid (300 mg DHA), 1.3 g/day (lactation)

2% milk

1.5-2.5% fat

Treatment of heart failure

1.digitalis increases strength of heart contraction. 2. diuretics - nutrient loss, glucose intolerance, increased serum uric acid 3. diet: low sodium (2-3 grams), DASH diet, fluid restriction if needed 4. 1.2 g protein/kg (normally nourished, stable); >1.37g/kg (stable, depleted) 5. evaluate thiamin status (loss with loop diuretics). Without thiamin, pyruvate cannot be converted into acetyl CoA for energy, so heart muscle is deprived. 6. DRI for folate, Mg; MV with B12.

serum ferritin

10-150 ng/ml women, 12-300 ng/ml Men indicates size of iron storae pool

BUN (blood urea nitrogen)

10-20 mg/dl (renal protein should keep BUN under 100) indicator of renal disease BUN: creatine ratio should be 10-15:1

Desirable/ideal body weight (women)

100 lbs for 1st 5', add 5 lbs for each additional inch. subtract 5 lbs for each inch under 5'. small frame: subtract 10% large frame: add 10%

Desirable/ideal body weight (men)

106 lbs for first 5', add 6 lbs for each additional inch. subtract 6 lbs for each inch under 5'. small frame: subtract 10% large frame: add 10%

AGA (appropriate for gestational age)

10th - 90th percentile

recommended HGB for pregnancy

11 g/dl

PT (prothrombim time)

11-12.5 seconds; 85-100% of normal anticoagulants prolong PT evaluates clotting adequacy; change in vitamin K intake will alter rate

Urinary creatinine clearance

115 +/- 20 ml/minute measures GFR - glomerular filtration, renal function estimate includes body surface area (height and weight)

#3 can

12 in case 46 oz. 5/3/4 cups 12-15 servings

safe minimum internal temperatures

145 F: pork, beef, veal, lamb, steaks, roast, fish 160 F: ground beef, groudn veal, ground lamb 165 F: turkey, chicken, duck

nutritive value of meats, poultry, and fish

15-23% protein glycogen in liver, glucose in blood thiamin, niacin, riboflavin, iron, copper, trace minerals *pork is a good source of thiamin

personal zone

18"-4', when giving instructions or working closely

calories during lactation

1st 6 months +330, 6-12 months +400

lactation - human milk

20 calories/ounce maternal hormones from pituitary; prolactin stimulates milk production; oxytocin moves milk through ducts

infant formula

20 calories/ounce; need 2.5 oz/lb/day has more protien, more iron than human milk but lacks antibodies. vitamin D requirement is met if infant receives at least one quart of standard vitamin D fortified infant formula per day formula fed infants only need fluoride as a supplement, after 6 months of age, if water supply is inadequate.

BUN:creatinine ratio

20:1 = "pre-renal state" in which BUN reabsorption is increased due to acute kidney damage (may be reversible and may not require dialysis) <10:1 suggests reduced BUN reabsorption due to renal damage (may need dialysis).

MNT for CKD

23-35 kcal/kg or BEE x activity factor. Adjust for weight gain or loss. <2400 mg/day sodium. protein restricted when GFR ml/minute falls. stage 1 and 2 = .8-1.4 g/protein/kg stages 3 and 4 .6-.8 g protein/kg phos: stages 1,2 = to maintain normal serum level; stages 3/4 800-1000 mg/day or 10-12 mg/g protein. potassium generally not restricted unless serum level is elevated and urine output is <1 liter/day fluid generally unrestricted.

#2.5

24 in case 1 lb 13 oz. 3.5 cups 6-8 servings

#2 can

24 in case 1 lb. 4 oz. 2.5 cups 4-6 servings

#300 can

24 in case 14-16 oz. 1/34 cups 3-4 servings

weight gain guidelines for pregnancy

25-35 lbs for normal weight female (BMI 18.5-24.9) 28-40 lbs for underweight female (BMI <18.5) 15-25 lbs for overweight female (BMI 25-29.9) 11-20 lbs for obese (BMI >/= 30) target is at least lower limit for black and very young women, strive to achieve upper end to reduce risk

normal birth weight

2500-4000

dried whole milk

26% fat, does not keep well.

metabolic syndrome

3 or more of the following risk factors are linked to insulin resistance which often increase risk for coronary events 1. elevated blood pressure >/= 130 systolic, and/or >/= 85 diastolic 2. elevated TG >/= 150 mg/dl 3. fasting serum glucose >/= 100 mg/dl Waist measurement >/= 102 cm (40") men; >/=88cm (35" women) 5. low HDL < 40 mg/dl (men), < 50 mg/dl (women)

Peripheral parenteral nutrition protein

3-15% amino acid solutions

TTHY transthyretin, PAB prealbumin

3-6 mg/dl circulates with prealbumin; shortest half-life (12 hours) binds and transports retinol

IV dextrose

3.4 calories/gram to figure calories (ml) (%) (3.4) highest concentration of dextrose used in peripheral nutrition 10%.

Serum albumin

3.5-5.0 g/dl visceral protein (blood and organs) maintains colloidal osmotic pressure hypo-albuminemia associated with edema, surgery levels above normal range likely due to dehydration long half-life, does not reflect current protein intake

recommended HCT for pregnancy

33%

TPN solutions - energy

35-50 calories/kg; up to a 70% dextrose solution. a 10% solution provides 100 g/liter to avoid overfeeding and hyperglycemia, start at </= 20-25 calories/kg. maximum rate of dextrose infusion should not exceed 4-5 mg/kg/minute to prevent hyperglycemia and other complications; increased blood glucose from excess dextrose increases RQ in ventilated patients and increases infectious complications.

Nutrition care outcomes

4 categories food/nutrition related history, lab data and medical tests, anthropometrics, nutrition focused physical finds.

social zone

4-12', most business interactions

breast fed infants need

400 IU vitamin D from birth and .25 mg fluoride/day after 6 months of age if water contains inadequate fluoride

vitamin D milk

400 USP unites added per quart of milk by feeding cow vitamin D, irradiating the milk, or adding the vitamin.

focus group

5012 people brought together to talk about concerns, beliefs, problems obtain advice, insights and information; contributes attitudinal data

#10 can

6 in case 6 lbs. 9 oz. 13 cups 20-25 servings

eggs - nutritive value

80 calories, 6 grams pro., 5 grams fat, vitamins A, D, riboflavin. yolk i more concentrated than white: has more protein (by weight), fat, minerals, vitamins fat is present in an emulsified form color of yolk depends on amount and type of pigment in hen's diet

CHI creatinine height index

80% is normal ratio of creatinine excrete / 24 hours to height estimates lean body mass - somatic protein 60-80% mild muscle depletion

nutritive value of milk

87% water, 3.7% fat, 4.9% CHO (lactose), 3.5% protein (80% casien) good soruce of calcium, phosphorus, riboflavin, viatmins A and D low in iron

AI for calcium for pregnancy and lactation

</= 18 years -1300 mg >18 years -100 mgs

renal damage BUN:Cr ratio

<10:1 suggests the need for dialysis therapy.

body mass index for age percentiles

<10th percentile = underweight 10th-85th percentile = normal weight >85th-90th percentile = overweight >90th percentile = obese

SGA (small for gestational age)

<10th percentile birth weight for gestational age

at risk of adequate weight gain during pregnancy

<16 or >/= 35 years of age; < 12 months between prengancies

very low birth weight

<3.3 lbs (<15000 g); <1000 g ELBW

low birth weight

<5.5 lbs (< 2500 grams)

macronutrient distribution based on DRI's for healthy adults

<7% total cals as satruated fat, trans fat intake should be minimized. encourage fiber intake, sucrose may be substituted for other carbs.

serum transferrin

>200 mg/dl visceral protein serum level controlled by iron storage pool rises with Fe deficiency can be determined from TIBC (total iron binding capacity)

pre-renal BUN:Cr ratio

>20:1 BUN reabsorption is increased due to acute kidney damage. may be reversible and often does not require dialysis therapy.

TLC (total lymphocyte count)

>2700 cells/cu mm measures immunocompetency moderate depletion 900-1800, severe depletion <900 decreased in protein-energy malnutrition

waist circumference

>40 Males, >35 Females is independent risk factor for disease when out of proportion to total body fat ( with BMI of 25-34.9)

LGA (large for gestational age)

>90th percentile

analysis of variance

ANOVA; tool used to evaluate validity asks whether the difference between samples is a reliable one that would be repeated used when several products compete against one another compares the variance between groups with the variance within groups answers: are tehre one or more significant differences ANYWHERE among the samples?

Therapeutic lifestyle change (TLC)

Adult treatment Panel III Up to 355 calories form total fat, <7% from saturated fat, 5-10% PUFA, up to 20% MUFA, <200 mg cholesterol. 25-30 grams fiber (half soluble) stanols and sterols inhibit cholesterol absorption (2-3 g/day) maintain DBW, prevent weight gain. increase physical activity to at least 30 minutes of moderate intensity most days (to expend at least 200 calories)

Difference between Altered GI function and Impaired nutrient utilization

Altered GI looks at problems inside the GI tract including exocrine functions of the liver and pancreas, which changes in digestion, absorption, and/or elimination. Impaired nutrient utilization refers to problems with the metabolism of nutrients once they have entered the circulatory system. This includes the endocrine functions of the pancreas, liver, pituitary, and parathyroid.

Vitamin B1 (thiamin) deficiency

Beriberi, muscle weakness, foot drop, memory loss, tachycardia

Stages of legislative process

Bill/resolution --> Sent to committees which schedule public hearings to hear testimony of bill's sponsors --> markup session where committee revises bill and put into final form --> rules committee for debate --> approval from both houses and the president. Differences between the two houses are worked out in a joint house-senate conference committee --> reconciliation bill Appropriations bill must be passed to provide funding Formulate regulations that interpret and operate the law -federal regulation interprets a law and provides details and rules that put the policy into effect. -regulations are written by staff members of the agencies charged with enforcing the regulations.

Carbohydrate food list

CARBS starch/bread = 15 g CHO, 3 g pro, 1 g fat, 80 cals fruit = 15 g CHO, 60 cals 1% milk = 12 CHO, 8 g pro, 0-3 g fat, 100 cals. 2% milk = 12 g CHO, 8 g pro, 5 g fat, 120 cals whole milk = 12 g CHO, 8 g pro, 8 g fat, 160 Cals sweets/desserts = 15 g CHO, pro/fat/cals varies. non-starchy veg = 5 g CHO, 2 g Pro, 25 cals PROTEINS lean = 7 g pro, 2 g fat, 45 cals medium fat = 7 g pro, 5 g fat, 75 cals high fat = 7 g pro, 8 g fat, 100 cals plant based pro = 7 g pro, CHO/fat/cals varies. FATS = 5 g fat, 45 cals free foods = <20 cals and <5 grams CHO per serving

High fiber diet may increase need for

Ca, Mg, P, Cu, Se, Zn, Fe

OAA Older Americans Act Nutrition Program (formerly ENP ELderly Nutrition Program)

DHHS title III one hot meal each day, 5 days/week, provides 1/3 recommended intake eligibility: all aged 60 and older plus spouse, regardless of income. congregated meals - ambulatroy; transportation essential for rural elderly home delivered meals- meals on wheels - must be homebound counseling nutrition eduction, referrals, social interaction

Prospective payment system

DRG's - diagnostic related groupings. Part of TEFRA (tax equity and fiscal responsibility act) Prospective payment means knowing the amount of payment in advance. Includes Medicare and medicaid patients. basis for payment are the DRG's patients are classified on basis of the ICD - international classification of diseases hospitals paid specific amount per patient based on the diagnosis.

glucagon-like peptide-1 (GLP-1) agonist

Exenatide (byetta) enhacnes insulin secretion, suppresses

Fresh Fruit and Vegetable Program

FFVP introduced children to fresh fruits and vegetables free to children nationwide in selected schools

HIPAA

Health Insurance Portability and Accounting ACT 1996 allows employees to transfer coverage of existing illness to anew employer's insurance plan

LDH lactic acid dehydrogenase (liver function test)

Increased in hepatitis, myocardial infarction, muscle malignancies.

intracellular electrolytes

K+, Mg++, P

IDL (pre-beta to beta)

LDL precursor; found in circulation secondary to catabolism of other lipoproteins.

Assessment of risk (NCEP, AHA)

LDL-C: <100 optimal Total cholesterol: <200 desirable HDL-C: <40 low (M), <50 low (F); >/= 60 high high homocysteine (Hcy) levels are independent risk factors for CHD. Normal TG <150

Specialized enteral formulas

Most expensive Nepro, Novasource Renal - renal Nutre, Pulmocare, Respalor: high fat, low carb - pulmonary Hepatic Aid II, NutriHep - liver Glucerna, Diabetisource - diabetes the more specialized the formula, the greater its cost.

intermediate-acting insulin

NPH (Humulin, Novolin) onset 2-4 hours, duration 10-16 hours

Extracellular electrolytes

Na+, Ca++, Cl, HCO3 (bicarbonate) NaCl is 40% sodium. ONe tsp of salt has 6 grams of NaCl so has 2.4 grams of sodium. sodium is reabsorbed by aldosterone, and retained by steroids.

Strong heart diet study for cardiovascular disease and diabetes

Native American Diets; tried to determine causative factors of obesity something other than intake, perhaps genetics, low physical activity consume 12% fewer calories than the average US population, yet significant increases in heart disease and diabetes

MNT for chronic pancreatitis

PERT - pancreatic enzymes orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase. MCTs do not require pancreatic lipase. Add to mixed dishes, jams, jellies. To promote weight gain give maximum level of fat tolerated without an increase in steatorrhea or pain. if malabsorbing fat soluble vitamins give water soluble forms; parenteral B12? pancreatic bicarbonate secretion may be defective --> may need antacids so PERT therapy will work. avoid large meals with fatty foods, alcohol.

medical foods

PKU formulas free of phylalanine

fat in margarine

PUFA, MUFA, SAT

HIPAA guidelines (health Insurance Portability and Accountability Act)

Permanent legal document; entries written in black pen or typed. complete, clear, concise, objective, legible, accurate. sign, date all entries; entered at the time of actual procedure or service late entries should be identified as such; actual date, time of entry and the date and time it should have been recorded. when diet orders are not chosen correctly, contact the person who wrote order. corrections - never use white-out, thick markers, or remove an original and replace it with a copy. draw single line through error, then enter the correction, initial, date. omitted information:"see addendum," enter date and initial. Write the addendum in chart sequence, identify it as an addendum and reference the original entry. sign.

Eggs - structure

Porous shell - exchanges moisture and gases; covered with bloom that prevents excessive loss and protects contents inner membrane contracts leaving air space in large end air space becomes larger with age good quality indicated by high proportion of thick white yolk is surrounding by vitelline membrane chalazae (yolk anchors) hold yolk in center egg yolk is naturally occurring in oil in water emulsion

PES statement

Problem (diagnostic label), adjective that describes the human response one etiology (cause/contributing risk factors) linked to the problem by words "related to" Assessment of signs (objective data, observable changes) and symptoms (subjective data) linked to etiology by words "as evidenced by" Ex: inadequate vitamin A intake related to knowledge deficit of food sources of vitamin A as evidenced by night blindness

Four P's of marketing

Product, , Place, Price, and Promotion

What food is least likely to cause an allergy?

Rice

fat in butter

SAT, MUFA, PUFA

normal ranges of cations

Sodium - 136-145 mEq/L Potassium - 3.5-5 mEq/L Calcium - 4.5 -5.5 mEq/L magnesium - 1.5-2.5 mEq/L

Blood pressure management

Thiazide diuretics may induce hypokalemia. four modifiable factors in primary prevention and treatment - overweight, high salt intake, alcohol consumption, physical inactivity. salt restriction </= 2400 mg Na (6 g salt); decrease weigt if needed. DASH diet.

ASP After school snack programs

USDA provides healthy snacks schools receive cash subsidies for each snack served same eligibility bases as NSLP

Concerns for parenteral nutrition

Translocation of bacteria; not feeding through gut allows wall to break down, bacteria move out causing sepsis. GALT

Ebb phase

Trauma hypovolemia(decreased volume of circulating blood in the body.), shock, tissue hypoxia

Management by objective (MBO) - Drucker

Type of DEMOCRATIC management that provides control from within. Establish performance goals WITH employees. Gives higher incentive value, overall control achieved through self control by employees, management stresses accomplishments and results. PARTICIPATIVE leadership.

AST, SGOT aspartate amino transferase (liver function test)

UL = 0-35 increased in hepatitis decreased in uncontrolled diabetes with acidosis

ALP alkaline phosphatase (liver function test)

UL = 30-120 increased in liver disease and bone disease decreased in scurvy and malnutrition

ALT, SGPT alanine aminotransferase (liver function test)

UL = 4-36 increased in liver disease

SBP school breakfast program

USDA entitlement program, meals must meet dietary guidelines breakfast must provide on average over each school week: 1/4 daily recommended levels for protein, calcium, iron, vitamin A, vitamin C

WIC Special supplemental nutrition program for Women, INfants, and Children

USDA for pregnant, postpartum, breastfeeding women, infants and children up to 5. provides food for low income mothers at nutritional risk (abnormal weight gain, history of high risk, BW, underweight, overweight, anemia). risk: weight, height, head circumference in infants, hemoglobin, hematocrit provides food nutrition education, referrals to other agencies. Must meet income standards, be at nutritional risk, and in need of foods offered. NOT an entitlement program - cap on amount of fedreal dollars allocated

SFMNP Senior Farmers' market Nutrition Program

USDA grants to states to provide low income seniors with coupons to be exchanged for eligible foods at farmers' markets, roadside stands, community supported agriculture programs (CSA) fresh, nutritious, unprepared fruits, vegetables herbs, and honey may be limited to specific and locally grown foods nutrition education and information is provided (how to select, store, prepare)

Special Milk Program

USDA purpose is to encourage consumption of milk by children objective is to provide subsidy for milk served to children in participating schools, child care centers, summer camps not participating in other federally subsidized meal programs, and free milk to needy

CACFP Child and Adult Care Food Program

USDA supports public and non-profit food service programs for family day care centers, neighborhood houses, homless shelters, non-residential adult daycare centers. reimburses operators for meal costs, provides commodity foods and nutrition education materials must serve meals that meet guidelines; must offer free or reduced price to eligible eligibility standards same as NSLP

NET Nutrition Education Training Program

USDA 1977 amendment to school Lunch Act provides nutrition education training to teachers and school foodservice personnel.

SFSP summer Food Service Program

USDA school lunch entitlement program, purpose is to initiate, maintain or expand foodservice programs to children when school is not in session objective to to provide meals or snacks to children at participating institutions in poor areas administered by FNS, state educational agencies, public or private nonprofit residential summer camps

Healthy eating index

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

Nasoduodenal or nasojejunal (EN)

Used if unable to tolerate gastric feedings.

Renin

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

respiratory quotients (RQ)

Vco2 carbon dioxide expired / vo2 oxygen consumed used in critically ill to lower RQ, increase fat intake

Vitamin B1

Water soluble. Thiamin. lost as temp or pH rises. heat stable in acid function - oxidation of CHO. Increased CHO need metabolism of pyruvate. sources: grains, wehat germ, pork, liver

direct cost

a cost than can be completely attributed to the production of specific goods or services. ex: goods sold, salary, direct operating

Medical diagnosis

a disease or pathology that can be treated or prevented. It does not change as long as the condition exists.

meal equibalent

a measure of productivity defined as the amount of all food sales divided by the average cost of a typical (prototype) meal.

cookies

a modified shortened cake; higher in fat, lower in sugar and liquid

MNT for Hiatal hernia

a protrusion of a portion of the stomach above the diaphragm into the chest. small, bland feeding; avoid late night snack, caffeine, chili powder, black pepper.

NCP nutrition care process

a standardized, consistent structure and framework used to provide nutrition care. This is different from standardized care, which infers that all patients receive the same care.

normal blood flow

abdominal veins, esophageal veins, collateral veins --> portal vein --> liver --> vena cava

relevance or validity

ability to measure phenomenon it intends to measure

reward power

ability to reward another for carrying out an order, give incentives, praise to reinforce certain behaviors

Conceptual skills

ability to see organization as a whole. importance increases at HIGHER ranks of management.

Human skills

ability to work effectively as a group member. important ALL levels but imperative at LOWER levels of management.

Food intolerance (Non-IgE)

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

essential fatty acids

absence will create a specific deficiency disease

chromium

absorption enhanced by vitamin C, niacin, ultra-trace mineral. function - aids insulin action. glucose metabolism. sources - yeast, oysters, potatoes, liver.

distal ileal resection

absorption of B12, intrinsic factor, bile salts. ileum normally absorbs major portion of fluid in GI tract. patients have above average needs for water to compensate for excessive losses in the stool. Drink at least 1 liter more than their ostomy output daily.

Atherosclerosis

accumulation of lipids; structural and compositional changes in the intimal layer of the large arteries. risks - HTN, obesity, smoking, elevated blood lipids, heredity

control of crystal size

acid (cream of tartar, vinegar), fat (chocolate, milk), protein (milk, egg whites, gelatin) inhibit crystals - keeps crystals small and smooth

affective domain of learning

acquisition of attitudes and values (sujective)

cognitive domain of learning

acquisition of knowledge or subject matter (factual)

psychomotor domain of learning

acquisition of muscular skills (exercises, food prep)

lobbying

activities aimed at influencing public officials and legislators.

Nutrition diagnosis - intake domain (NI)

actual problems related to intake. PRIORITY. 1. caloric energy balance (ex: increased energy expenditure) 2. oral or nutrition support intake ( ex: inadequate/excessive compared with goal) 3. fluid intake balance (ex: fluid restriction or dehydration) 4. Bioactive substance (ex: supplements, alcohol) 5. nutrient balance ( ex: excessive protein intake)

Neoplastic disease- protein-calorie malnutrition, malabsorption, fluid and electrolyte imbalances

altered taste acuity - add flavorings and seasonings. meat aversions may require elimnation of red meat. thrus from oral infections - avoid spicy, acidic, strongly flavoried foods (provide bland liquids, soft foods, cilled or frozen foods) throat or neck cancer - use PEG for feeding cancer cachexia (generalized wasting) connected to cytokines and the tumor necrosis factor (TNF)

simple proteins

amino acids

amino acids

amino group (NH2) - base; carboxyl group (COOH) - acid

non-crystalline sugar

amorphous, glasslike. crystallization is prevented by adding interfering substances (fat, milk) or by increasing the concentration of sugar. corn syrup retards crystallization thus increasing viscosity and chewiness. ex: hard candies, brittles, taffy, marshmallows, gummies

precision

amount of variation that occurs randomly. less random variation results in greater precision in the measurement and greater reliability

loss leader pricing

an aggressive pricing strategy in which a store sells selected goods below cost in order to attract customers who will, according to the loss leader philosophy, make up for the losses on highlighted products with additional purchases of profitable goods.

Simple moving average method

an average of any subset of numbers. The moving average is extremely useful for forecasting long-term trends. You can calculate it for any period of time.

Grant

an award of financial or direct assistance: anyone can apply; usually lasts over a few years. block grants from federal government are given to states or local communities for broad purposes as authorized by legislation. Recipients ahve great flexibility in distributing funds.

bromelin

an enzyme in fresh or frozen pineapple that breaks down protein and prevents gelation

manifestations of renal disease

anemia due to decreased production of erythropoietin upset in blood pressure. decreased activation of vitamin D (kidney produces active form, promotes efficient absorption of calcium by gut)

chronic kidney disease (CKD)

anorexia, weakness, weight loss, nausea, vomiting. anemia due to deficient production of hormone erythropoietin by kidney.

methylphenidate (Ritalin)

anorexia, weight loss, nausea

anticoagulant (warfarin sodium)

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

sodium stearate

anti-caking agent

MNT for Tropical sprue

antibiotics,high calories, high protein, IM B12 and oral folate supplements

Enteral access

anticipatelength of time needed, risk of aspiration, patient's anatomy, clinical status, normal or abnormal digestion and absorption. Hang time open systems 4 hours, closed systems 24-48 hours. Short term acess 3-4 weeks, nasogastric tube, normal GI function.

Elavil

antidepressant sedative effectiveness of L-dopa (levodopa) which controls symptoms of parkinson's disease. take drug in morning with limited protein (competes with drug fro absorption sites)

marinol

appetite stimulant

megestrol acetate

appetite stimulant

dextroamphetamine

appetite suppressant, anorexia, nausea, weight loss

sources low in potassium

apple, cranberry, blueberry, carrot, corn.

medium-chain triglycerides (MCT)

are SFAs between 6 and 12 carbons. naturally found in milk fat, coconut oil, and palm kernel oil

process objectives

are activities that will be implemented to achieve the aims. They correspond with the process evaluation. ex: to increase diabetes awareness in the community, the dietitian will present diabetes classes six times each year"

dependent variables

are outcomes

independent variables

are what you manipulate in your study

conditionally essential amino acids during catabolic stress

arginine, glutamine (Like in heart failure) arginine may be useful in post-burn therapy

consultative

asks for input but makes final decision alone.

ADIME

assess, diagnose, intervene, monitor, evaluate.

NCP steps

assess, diagnose, intervene, monitore/evaluate (ADIME)

Subjective global assessment (SGA)

assesses nutrition status based on history, oral intake, weight change, functional capacity, GI symptoms, physical appearance, and presence of edema, wasting, or dehydration.

NFP - nails

assessment - brittle, thin, spoon-shaped considerations - iron or protein deficiency

NFP - eyes

assessment - pale, dry, poor vision consideration - vitamin A, zince or riboflavin deficiencies

NFP - tongue

assessment - smooth, slick, purple, white coating consideration - vitamin or iron deficiencies

NFP - gums

assessment - sore, red, swollen, bleeding considerations - vitamin C deficiency

NFP - lips

assessment - swollen, red, dry cracked consideration - riboflavin, pyridoxin, niacin deficiencies

NFP - hair

assessment - thin, sparse, dull dry brittle, easily pluckable considerations - vitamin C, protein deficiency

NFP - teeth

assessment- missing, loose, loss of enamel considerations - calcium deficiency, poor intake

cofactor

assists enzymes; minerals

adrenal cortex insufficiency - Addison's disease

atrophy of adrenal cortex; symptoms due to absence of adrenal hormones. decreased cortisol --> glycogen depeletion, hypoglycemia. decreased aldosterone --> sodium loss, potassium retention, dehydration. decreased androgenic --> tissue wasting, weight loss diet - high protein, frequent feedings, high salt.

Billroth II (gastrojejunostomy)

attaches remaining sotmach to the jejunum. when food bypasses the duodenum, the secretion of secretin and pancreozymin by th eduodenum is reduced. These hormones normally stimulate the pancreas, so there si now little pancreatic secretion. Calcium and Fe abs. are adversely affected. can also lead to B12 and folate deficiency

Billroth I (gastroduodenostomy)

attaches the remaining stomach to the duodenum

probing response

attempt to clarify or gain more information

Scalar principle

authority and responsibility flow in a direct line vertically from the highest to lowest echelons.

Alzheimer's disease

avoid distractions (no TV during meals); regular, consistent meal times, encourage self-feeding, offer one course at a time, lower saturated fats, soft calming background music, finger foods may be helpful, avoid dehydration, may need verbal cues to chew and swallow.

T-bone

back and ribs

Dental caries

bacterial enzymes fermented carbohydrate deposits on plaque. Enzymes produce acids that demineralize surface. low cariogenic potential foods: high protein, moderate fat, minimal concentration of fermentable CHO, strong buffer, high mineral content (Ca, P), pH 6, stimulates salive - cheddar cheese, nuts, meat. sugar alcohols (sorbitol, xylitol, mannitol) do NOT promote tooth decay. fluroine- can control caries, supplement starting at 6 months of age if level in water supply is <.3 ppm.

Tropical sprue

bacterial, viral, parasitic infection Chronic GI disease, intestinal lesions, may also affect stomach. diarrhea, malnutrition, deficiencies of B12 and folate due to decreased HCL and intrinsic factor.

Taft Hartley Labor Act - Labor Management Relations Act 1947

balanced powers of labor and management; amended Wagner Act. outlawed the closed shop; limited union shop to one year. government can obtain injunction against strikes that endanger national health or safety. specified unfair labor practices of the union.

BMR

basal metabolic rate measured in morning when reclining, awake, relaxed, at normal body temperature, at least 12 hours after last meal, and several hours after strenuous activity. measures oxygen consumed affected by: sex (women have 5-10% lower BMR), age, body composition, body surface area, endocrine glands (thyroid)

referent power (personality, charisma)

based on desire to identify with or imitate the influencer, how well you are liked.

Food grades

based on quality, firmness, color, maturity, freedom from defects, uniform size, and shape Graded by USDA

whip

beat rapidly to incorporate air to forma foam

funnel sequence

begin with broad open questions and proceed to more restrictive ones

Transtheoretical Stages of Change model

behavior involves series of stages. Determine stage to assess readiness to change.

expert power

belief that influencer has some relevant expertise that the subordinate does not; provides credibility.

spot weight loss theory

belief that localized exercise reduces fat stores in the active area; research does NOT support this notion.

horizontal communication

between departments, or between production and service within the nutrition department.

Landrum Griffin, Labor Management Reporting and Disclosure Act 1959

bill of rights for union members; regulates internal union affairs.

phytochemicals

biologically active, naturally occurring chemical compounds in plant foods, act as natural defense for the plant

neonate

birth to 1 month; can absorb whole, intact protein.

proteolytic enzyme

blend of papaya and salt, tenderizes meat

processed cheese

blend of several natural cheeses (american cheese) emulsifier added (disodium phosphate), processed cheese batter for cooking high moisture contentn (41-50%)

histogram

block diagram whose blocks are proportional in area to the frequency in each class or group. summarizes data from a process that has been collected over time.

catabolism

breakdown; uses and releases energy; creates a constant energy deficit, which must be supplied by food.

research conclusion

breif summary of results; may hae recommendations

coffee

brew at 185-203 F for best flavor. At higher temps, tannin is extracted and coffee is bitter.

Bureaucratic leadership

by the book, follows procedures to the letter.

Basal energy expenditure (BEE)

calculated BMR includes age, sex, body surface area (height, weight) mifflin st. joer

infant nutrient needs (0-6 months)

calories - 520F, 570M protein - 9.1 g water - 125-155 ml/kg (based on age) fat - minimum of 30 g/day

infant nutrient needs (7-12 months

calories - 676F, 743M protein - 11 g water 1.5 ml/kcal fat- minimum of 30 g/day

Egg freshness

can be maintained for 6 months in cold storage with Grade A eggs a fresh egg will sink to the bottom in a pan of cold water and has a dull, rough, shell Old eggs float, fresh eggs sink.

dried eggs

can be vacuum packed in nitrogen gas dried fortified: 70% white, 30% yolk

glycemic index

compares blood glucose response to a food to a standard glucose load. affected by cooking methods and processing of starch. as particle size decreases, the index increases. foods with low index produce greater satiety. low index: legumes, milk, nuts, pasta, ice cream, yogurt glycemic load: weighted average of the glycemic indexes of all foods eaten.

BMI/Quetelet index

compares weight to height weight in kg divided by height squared in meters; or weight in lbs divided by height in inches squared in meters; or weight in pounds divvided by height inches squared x 703. healthy adult 18.5-24.9; healthy for most elderly 24-29

role of sugar in glatinization

competes with starch for water needed for gelatinization. increases translucency, reduces viscosity and gel strength. if too much is used, consistency is thin

polysaccharide

complex sugars starch - glucose chains; 50% of CHO intake cellulose - resistant to digestive enzyme amylase; adds bulk (stimulates peristalsis) pectin - nondigestible; thickening quality; fruits glycogen - animal starch; from glucose; stored in muscle and liver dextrin - intermediate product of starch breakdown

Chlorine

component of lecithin function - transports lipids as acetylcholine. sources - fat in eggs, milk, liver, soybeans

starch

composed of ammylose and amylopectin molecules. amylose responsible for gelation in cooled, cooked pastes

GALT (gut associated lymphoid tissue)

compromised by bowel rest or parenteral nutrition. provides 50% of total body immunity. 70-80% of total body immunoglobulin production is secreted across the GI mucosa to defend against pathogenic substances in the GI lumen.

sweetened condensed milk

concentrate (evaporate) whole milk. add 15-18% sucrose or glucose

strategic planning

concentrates on decisions, not plans. broad technological and competititve aspects; sets direction for organization.

research abstract

condensation of final report; has purpose of study, quesitons asked, scope and method, summary of conclusions

integrative problem solving

conflict is converted into a joint problem solving situation. parties openly try to find a solution the can all accept.

Prader Willi Syndrome - chromosome 15 defection

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

legislative branch

congress, senators, representatives. may introduce and enact a law and can override a veto by the executive branch.

steatorrhea

consequence of malabsorption normal stool fat 2-5 g; >7 g is indicative of malabsorption. determine cause and treat. high protein, high complex CHO, fat as tolerated, vitamins (especially fat-soluble), minerals, MCT (rapidly hydrolyzed in GI tract).

Short bowel syndrome (SBS)

consequences associated with significant resections of the small intestine. malabsorption, malnutrition, fluid and electrolyte imbalances, weight loss. severity reflects length and location of resection, age of patient, health of remaining tract. Loss of ileum (especially distal 1/3), loss of ileocecal valve, loss of colon are of particular concern. most digestion takes place in first 100 cm of intestine, (in duodenum, and upper jejunum) what remains - small amounts of sugar, starches, fiber, lipids.

reliability

consistency or reproducibility of test results

Continuous drip (EN)

constant, steady rate over 16-24 hours, usually with a feeding pump (for those with compromised GI function or who do not tolerate large volume infusion).

nutritional surveillance

continuous collection of data identifies problem, sets baseline, sets priorities, detects changes in trends use height, weight, hematocrit, hemoglobin, serum cholesterol on-going system linked to active health program: WIC, CDC, EPSDT data identifies needs and kind of intervention needed

systolic blood pressure

contraction, greatest pressure

role of kidneys in acid/base balance

control bicarbonate (base). regulate hydrogen ion secretion and bicarbonate reabsorption if kidneys excrete excess bicarbonate - level of base decreases; if kidneys retain bicarbonate - level of base increases

gluconeogenesis

conversion of non-carb sources into glucose (from glycerol and amino acids) creation of new glucose

Self-efficacy

conviction that you can successfully execute the behavior required to produce the outcomes. ex: I can join the gym close to work.

selenium

cooperates with vitamin E. Trace mineral. function - antioxidant. tissue respiration sources - soil, grains, meat, fish, poultry, dairy

waxy starches

corn, rice, sorghum have only amylopectin, no amylose non-gelling; stable to freezing and thawing used in frozen foods

cheese % moisture content

cottage (79), cream, mozzarella (45-55), camberbert, bleu, swiss, cheddar, gorgonzola, parmesan (31).

WIC farmers market nutrition program

coupons to purchase fresh, locally grown foods at farmers' markets

short range or operational planning

coveres perdiod of 1 year or less; usually the operating budget; projected in days, weeks, months.

Americans with Disabilities Act 1992

covers employers with 15 or more employees. must provide "reasonable accommodations" remove barriers, have wide aisle (36") and doors (32"), install ramps, lower shelves and phones, rearrange tables and chairs, flashing alarm lights. To comply, jobs descriptions must specify "essential" job functions

Stomatitis

cracks in skin at mouth corners, riboflavin deficiency.

Anorexia nervosa

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

cut-in

distribute fat into dry ingredients

split halves

divide the test in half. reliability is determined by degree of similarity of results

randomization

dividing people into treatment or control groups without bias

non parametric test

does not depend on a normal distribution

control group

does not receive the treatment or may receive a placebo

Lactose intolerance

due to LACTASE deficiency normally lactase splits lactose into glucose and galactose. In its absence lactose remains intact, exerting hyperosmolar pressure. Water is drawn into the intestine to dilute the load causing distention, cramps, diarrhea. Bacteria then ferment the undigested lactose, releasing carbon dioxide gas. detected by breath hydrogen test - hydrogen is produced by colonic bacteria on lactose, absorbed into bloodstream and exhaled in 60-90 minutes.

Green color under potato skin

due to chlorophyll that develops when potato is exposed to light during storage. may be accompanied by solanine, a natural toxicant.

Galactosemia

due to missing enzyme that would have converted galactose-1-PO4 into glucose-1-PO4. treated solely by diet - galactose and lactose free. NO organ meats, MSG extenders, milk, lactose, galactose, whey, casein, dry milk solids, curds, calcium or sodium casienate, dates, bell peppers. OKAY soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG.

Alimentary pastes

durum wheat- high in gluten after bran and germ are removed, starch is ground to make semolina flour products are flexible after cooking noodles - contain egg yolk or egg solids

Job specification

duties involved, conditions, qualifications (education, experience); written for each job. used in selection and placement of employees (hiring) does not have detailed information as to waht to do or time involved.

Lab tests in renal disease

eGFR, creatinine clearance. serum creatinine, BUN renal solute load

unity of command

each is accountable to only one superior

probability

each segment of the population will be represented in the sample select units from a much larger population. randomization

cross charts

efficiency of equipment placement, studies work motions, shows number of movements between pieces of equipment.

leavening - eggs

egg foam is heated, air expands, egg white stretches and protein coagulates. an acid stiffens an egg white foam by tenderizing the protein and allowing it to extend more easily. egg whites at room temp whip more quickly and yield a larger volume due to LOWER surface tension. sugar also stabilizes an egg white foam.

fluid restriction may cause

elevated BUN and serum sodium levels, poor skin turgor, and decreased urinary output.

participative

emerging trend in management. Encourage workers to participate in decision making. Uses quality circles: small group of employees who meet regularly to identify and solve problems.

Country club managment

employee centered. seeking approval and acceptance. comfortable, friendly atmosphere. high concern for people, low concern for production

positive reinforcement

encourages repetition of a given behavior. should be specific and immediate; meaningful attention from superiors. ex: praise.

outcome-orented

end result or consequence of program, change in attitude, knowledge, ultimate indicator of qality measuring the actual health status of the client, or skills of an employee.

spinal cord injury

energy needsa re 10% below predicted. at least 1.5 L fluid per day. pressure ulcers: 30-40 cal/kg 1.2-1.5 g pro/kg in tage I and II; 1.5-2 g in stages III, IV. normal intake of calcium, adequate fluids. supplement vitamin C (500-1000mgs with stage III or IV, or if deficient.) Zn 15 mg with stages III, IV for 2-3 weeks. daily dietary source of vitamin A.

functions of fat

energy, insulation and padding, dresses gastric secretion so delays emptying. has less oxygen, more carbon than carbohydrate so provides more energy (more carbon atoms for oxidation)

functions of carbs

energy, protein-sparing action - allows most of protein to be used for tissue synthesis - regulation of fat metabolism - a carb restriction leads to ketosis.

tenderness in pie crust

enhanced by using oil, soft fats, or fat cut into very small pieces

ascorbic acid

enhances appearance by preventing browning

goiter

enlargement of thyroid gland due to insufficient thyroid hormone. endemic goiter - inadequate iodine intake. diet - iodized salt; free of goitrogens (contain goitrin which inhibits synthesis of thyroid hormone)

FDA (food and drug association)

ensures safety of some domestic and imported food products

Amputations (weights)

entire leg = 16% body weight lower leg with food 6% body weight entire arm = 5% forearm with hand = 2.3% Estimated IBW = (100- % amputation)/100 x IBW for original height.

Vitamin E

fat soluble. tocopherol, one of least toxic vitamins. UL 1000 mgs. Function - antioxidant, resists hemolysis of RBC sources - vegetable oils, whole grains, green vegetables, almonds

NSLP National school lunch program / USDA food and nutrition service (FNS)

entitlement program to improve nutrition of children, especially from low income families; utilize surplus production of foods cash grants and food donations; dollars reimburse schools on basis of number of meals served. implement the dietary guidelines into the lunch and breakfast programs lunch must provide on average over each school week: 1/3 of the RDA

POMR (problem oriented medical records)

entries can be made using the SOAP format

coenzyme

enzyme activators; includes some vitamins. pantothenic acid, thiamin, riboflavin, niacin are needed for energy production.

soy protein/plant sources of protein

equivalent in protein quality to animal protein. legumes are low in methionine, cystine, and tryptophan. methionine missing in most vegetables.

Steps to controlling/evaluating

establish qualitative and quantitative standards. measure performance compare to standard take corrective action if necessary. types: production, quality, quantity.

planning function

establishing organizational objectives and designing procedures for achieving them. policies and procedures form the guidance and methods for meeting established organizational objectives.

development of educational plans/design

evaluate info available and match it to objectives organize into logical sequence develop lesson plan evaluate what you have developed

mini nutrition assessment

evaluates independence, medication therapy, number of full meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding.

concentrated milks

evaporated, sweetened condensed, dried whole milk, dried skim milk

Appraisal of barrieres

ex: I don't like to exercise

food record

exact record of everything eaten in a specific period of time

nutrition survey

examination of a population group at a particular point of time. considered a cross-sectional exam; pin-points problems determines prevalence of condition or characteristics at a specific time.

Chronic bronchitis

excess mucus production, chronic productive cough

hyperthyroidism

excess secretion of thyroid hormone. elevated T3 and T4 increased BMR leading to weight loss. diet - increase calories

causes of fallen center in cake

excess sugar, excess fat, excess baking powder, inadequate mixing, oven temp too low, open door during early baking

MNT for Fever and infection

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

Occupations EXEMPT from minimum wage and overtime requirements

executive, administrative, professional, outside salsepersons.

Impoverished management

exert minimum effort to get work done. Desire to hang on. low concern for people and production.

effect of protein on fluid balance

exerts colloidal osmotic pressure. albumin exerts pressure on blood vessel wall that keeps water within, when albumin drops, the pressure drops, causing fluid to leak out. --> edema, ascites.

cobalt

exists with B12. stored in liver function - maturation of RBC

steam as leavening agent

expands the hollow shell formed by flour and egg. hot oven is requred to raise liquid to boiling quickly. popovers, creampuffs

air as leavening agent

expands when heated before proteins coagulate and retain it. beating, sifting, folding, cream angel cake, sponge cake

Anasarca

extreme, generalized edema and widespread swelling of skin due to effusion of fluid into extracellular space. It is associated with heart, liver, renal failure, and extreme protein/calorie malnutrition

TVP (textured vegetable protein)

fabricated into simulated meat products. mixed with ground meats - extends number of servings, lowering costs. soy protein adds juiciness because of water content.

processing of hot, ready to cook cereals

farina - inner portion of wheat kernel quick-cooking creals have disodium phsphate added (instant oatmeal) - makes cereal alkaline so particles swell faster. avoid on low sodium diets enzyme treated for quicker cooking means the proteins have been split to lessen cooking time.

strategies that strengthen local food systems

farmers markets - increased access to fresh produce food recovery and gleaning programs - collect excess wholesome foods that would otherwise be thrown away for delivery to hungry people PPFPs- prepared and perishable food programs; non-profit programs that link sources of unused, cooked and fresh foods with social service agencies tat serve the hungry.

A patient with COPD would benefit from a higher proportion of energy from ____

fat - overall CO2 production would be lower, requiring less respiratory effort to eliminate it.

Vitamin A

fat soluble, stored in liver; carotene- precursor, provitamin (nutrient changed into vitamin) converted in intestinal mucosal cells toxic level 10,000 IU function - skin, vision sources - yellow, orange fruits, dark green leafy vegetables, cantaloupe, fish, liver, carrots, fortified skim milk, apricots, sweet potato

Vitamin D

fat soluble. cholesterol is precursor, UV light, fat soluble, 7 dehydrocholesterol function - Ca, P metabolism. D3 cholecalciferol --> D2 sources - sunlight, egg yolk, fortified milk, egocalciferol

vitamin K

fat soluble. synthesized by bacteria in lower intestinal tract. no toxicity symptoms function: forms prothrombin in liver: aids blood clotting. given pre-surgery . calcium metabolism sources - spinach, kale, broccoli, green leafy vegetables

MNT for non-tropical sprue

gliadin-free, gluten restricted diet - no wheat, rye, oats (if harvested and milled with wheat), barley, bran, graham, malt, bulgur, couscous, durm, orzo, thickening agents. OK - corn, potato,rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax.

baby friendly hospital inititiave

global effort to increase incidence and duration of breast feeding. hospital must show it implements ten steps to successful breast-feeding. requires a multidisciplinary team.

The nephron

glomerulus - tuft of capillaries held closely by Bowman's capsule- produces ultra filtrate which then passes through tubules. Capsule blocks passage of red blood cells and large molecules like protein. proxmial convoluted tubule - major nutrient reabsorption Loop of Henle - water and sodium balance. Distal Tubule - acid base balance.

monosaccharide

glucose, galactose (simple sugars)

special dietary use

gluten free, weight loss foods

tissue stores of glucose

glycogen from muscle and liver fat from adipose tissue cellular mass (protein stores) gluconeogenesis

needs assessment - middle and upper income adults

goal-oriented; consider activities they can't relate to as a waste of time

Recommended dietary allowances (RDA)

goals for healthy individuals to prevent nutritional deficiency diseases, included gender, age, life phases.

iodine defeciency

goiter

self feeding skills of an 18-month old infant

good pincer control. finger foods allow for independent eating. can consume foods that can be cut into bite size portions and eating with hands. whole milk recommended until age 2.

bulimia

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

Meat grading

grade appears on a shield stated federally graded by Agricultural Marketing Service of the USDA. based on maturity of animal, marbling of fat, color and texture of lean

YRBS (youth risk behavior survey)

grades 9-12; smoking, alcohol use, weight control, exercise, eating habits

conventional foods

grape juice and red wine have resveratrol which reduces platelet aggregation omega 3 fatty acids in fatty fish reduce TG levels tomatoes have lycopene which may reduce prostate cancer risk

acanthosis nigricans

gray-brown skin pigmentation in skin folds

Perceived advantage of change

greater mobility

public zone

greater than 12', verly formal interaction

Vitamin B2 (riboflavin) deficiency

growth failure cheilosis (cracked lips) angular stomatitis (mouth corner cracks, sore throat, magenta tongue)

Managerial attributes that distinguish successful organizations from others

have bias for action be close to your customers autonomy productivity through people management should be hand on and value driven: explain value system to employees.

Medicare

health insurance program for people over 65; of any age with end-stage renal disease; employers and employees pay. Part A- hospital insurance Part B - optional insurance for supplementary benefits (private practice)

strategies for type 2 DM

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

simmer

heat in water to 170-184 F with appearance of bubbles

steam

heat over, not in, water

preparation of crystalline candies

heat sugar and liquid to dissolve; heat further. crystallize under conditions that produce small crystals which have a smooth, creamy feeling

factors affecting stability of swollen starch granules in a paste

heat, acid, and agitation

dry heat (starch)

heated without water. Temperature rises rapidly degrading the starch. starch molecules break into fragments called dextrins (dextinization). color change occurs

motivational interviewing

helps clients recognize and begin to resolve their concerns and problems. the goal is to increase motivation so that clients are able to express the rational for the changes that need to be made. people make behavioral changes only when they are ready to change.

lecithin

helps yolk act as an emulsifier

Vitamin E deficiency

hemolytic anemia

vitamin K deficiency

hemorrhage affected by - mineral oil, antibiotics, anticoagulants

Alcoholic liver disease

hepatic steatosis, alcoholic hepatitis, cirrhosis. liver injury due to alcohol and metabolic derangements it causes. alcohol is converted into acetaldehyde and excess hydrogen which disrupts liver metabolism. Hydrogen replaces fat as fuel (in the Kreb's cycle), so fat accumulates in liver (leading to a fatty liver) and in blood (raising the TG level).

Team management

high concern for both people and production. common stake in purpose (most desirable)

Ketogenic diet (epilepsy)

high fat, very low carb, 4 grams fat: 1 gram non-fat. ketone bodies behave as inhibitory neurotransmitters; mild dehydration needed to prevent dilution of ketones. need supplements of Ca, D, folate, B6, B12. MCTs are more ketogenic, more rapid metabolism and abs. no more than 35 g. CHO at meals.

MNT for constipation

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

milk supply is adequate when

infant gains weight and length, has frequent stools, and 6-8 wet diapers per day

Pediatric HIV

high protein, high calorie with supplements needed for weight gain. energy needs: general guidelines plus appropriate stress factors. multivitamins/minerals at doses 1-2 x RDA or DRI. Lactose restriction if intolerant. HALS (HIV - associated lipodystrophy syndrome) may develop from therapy. high cholesterol, high triglycerides, insulin resistance, changes in body fat distribution. significant loss of lean body mass can be obscured by edema and HALS.

pregnant adolescent

high risk, needs extra iron, calcium, zinc

vacuum brewed

higher temps than recommended

energy expended in physical activity (EEPA)

highly variable. activity thermogenesis (AT)

prgesterone

hormone that develops placenta after implantation

Work schedule

hour by hour - training - tasks and time used in training

Diffusino of innovation

how an innovation, idea, or behavior spreads innovators - adopts an idea readily, usually with input early adopters - opinion leaders in community, well respected. early majority - cautious in adopting a new idea late majority - skeptical, adopt an idea only through peer pressure. laggards - last to adopt the idea.

Transactional vs. tranformational leadership

how leaders and followers influence each other (reciprocal approaches to leadership)

food frequency lists

how often an item is consumed. community setting. quick way to determine intakes on large numbers of people.

research implications

how the information might be applied in practice

paralinguistic

how the message is delivered histations, stuttering = sensitivity, anxiety whispering - difficulty in disclosing

measures of dispersion

how values distributes about the mean

glycerol monostearate

humectant; retains moisture and increases firmness

trans fatty acids -

hydrogens are across from each other; pack as tightly as SFA in membranes; intake can influence membrane fluidity and could be harmful to cell function; found in milk fat (4-8%) margarines, shortenings, frying fats as product of partial hydrogenation of PUFA

cis fatty acids

hydrogens on same side at the double bond; most natural fats and oils

sugar (baking)

hygroscopic - modifies texture by tenderizing. softens gluten and prevents gluten development by absorbing some of the water that gluten needs too much sugar results in coarse cells, thick walls, a shiny crust, and a crumbly product. most of sugar in honey is glucose and fructose.

calcium deficiency

hypcacemia leads to tetany (stiff muscles)

hyperkinesis

hyperactivity, ADHD experimental treatment - feingold diet - no salicylates, artificial colors, artificial flavors. 1. efficacy not proven; positive result may be due to placebo effect. 2. behavior improves with special attention (mind over body) sugar does not cause hyperactivity.

acute ketoacidosis

hyperglycemia due to insulin deficiency or excess carb intake, dehydration due to polyuria, increased pulse, fruity odor of ketones. treatment: insulin, rehydration.

Results of physiologic trauma

hyperglycemia, hyper-insulinemia, little or no ketosis, increase glycogen. catecholamines epinephrine, norepinephrine - hepatic glycogenolysis ACTH - releases cortisol which mobilizes amino acids from muscle aldosterone - renal sodium retention, gluconeogenesis ADH - renal water reabsorption. hypovolemia, decrease cardiac output, drop in body temperature hyperglycemia - epinephrine suppresses insulin, insulin resistance (decreased cell uptake and use) fluid and sodium retention, potassium excretion, loss of nitrogen, sulfur, zinc, phosphorus. provide adequate but not excessive calories (at RMR), 1.5-2.0 g protein/kg, provide anabolic electrolytes, zinc

Ebb and flow response to injury

hypermetabolic, catabolic response following trauma (accelerated catabolism of lean body mass leading to negative nitrogen balance as protein is catabolized to release glucose for energy)

Tyramine

hypertension if taken with MAOI (monoamine oxidase inhibitor) elminate dopamine and restrict tyramine (monoamines). MAO inhibitors interact releasing noepinephrine which elevates blood pressure. Restrict aged, fermented, dried, pickled,smoked, spoiled foods. avoid hard, aged cheese (cheddar, swiss), sauerkraut, some sausages, luncheon meats, tofu, miso, chianti wine. limit sour cream, yogurt, buttermilk. OK: cottage cheese, cream cheese. good advice: buy, cook, eat fresh foods

DBPCFC (double blind, placebo controlled food challenges)

identify food-induced symptoms (gold standard for diagnosis)

Organization function of management

identify tasks and activities, divide tasks into positions, establish relationships among all other functions of management. organizational structure, chain of command. staff - advisory, specialists determining staffing needs

Contraindications of PN

if alimentary tract can be used if needed only for short time in well nourished. during periods of cardiac instability. if risks inherent in process outweigh benefits.

MNT for heptic failure

if not comatose - moderate to high levels of protein, increase up to 1-1.5 gram protein/KG as tolerated. 30-35 calories/kg; 30-35% calories as fat with MCT if needed. low sodium if ascites; vitamin/mineral supplementation.

Hathorne studies - Western Electric, Elton Mayo

if you involve people in the process, they become more productive. productivity due to: employees were given special attention, were involved in an interesting experience, and were well-treated by supervisors. work breaks increased productivity.

jejunal resection

ileum can adapt and take over jejunal funcions. #1 priority after resection is fluid.

Pareto charts

illustrate the relative importance of problems. work on the tallest bar or problem that occurs most frequently; correcting the "vital few" problems will have the greatest impact on quality. 80-20 rule: 80% of a given outcome results from 20% of an input.

mellorine

imitation ice cream butterfat is replaced by hydrogenated vegetable oil

Burns

immediate shock period - catabolism; BMR rises 50-100% replace fluids and electrolytes lost. recovery period - increase calories (based on burn size) secondary period - 1.5-3 grams pro/kg, high calories. vitamin C - wound healing, 500 mg x 2 water soluble vitamins 2x RDA, vitamin A 10000 IU Vitamin K if on antibiotics zinc for wound healing if zinc deficient, 220 mg zinc sulfate.

cyclosporine

immunosuppressant hyperlipidemia, hyperglycemia, hyperkalemia, hypertension

Team Nutrition

implements school meals initiatives for healthy children motivates children to make healthy choices; helps schools meet guidelines provides recipes, training, support

Thiazolidinediones (Actos)

improve peripheral insulin sensitivity

concentric model of organization (circular)

improves representation of dynamics of personnel relationships because functions are centered around individuals, not above and below them. eliminates above and below concepts. presents an organization without loose ends.

phospholipid

in cell membranes; control passage of compounds in and out of the cell. most are lecithins which contain choline (liptropic factor). Healps prevent fat accumulation in the liver. it function in the transport and utilization of fatty acids and cholesterol through the enzyme LCAT (lecithin-cholesterol acyltransferase).

myo-inositol

in plants a phytic acid. related to sugar contains phsphorus vitamin-like factor function - bind calcium, zinc, iron membrane structure sources - outer husks of cereal grains, leafy green vegetables

unmodified cows milk in formula

inappropriate; tough hard curd; hard to digest; less EFA; increased renal solute load.

maple syrup urine disease (MSUD)

inborn error of metabolism of BCAAs leucine, isoleucine, valine. poor sucking reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of sweat and urine. restrict BCAA 45-62 mg/day (may use MSUD powder). provide adequate energy from CHO and fat to spare amino acids. include small amounts of milk to support growth; gelatin may be used. avoid eggs, meat, nuts, other dairy products.

dyslipidemia

include high triglycerides and low HDL

NNMRRP (national nutrition monitoring and related research program)

included all data collection and analysis activities of the fedral gov. related to measuring the health and nutritional status, food consumption, attitudes about diet and health jointly run by DHHS and USDA

Documentation

includes a statement of where teh patient is now in terms of expected outcomes 1. date and time 2. indicatores measures, results, and method for obtaining the measurement. 3. criteria to which the indicator is compared. 4. factors facilitating or hampering progress, other positives or negative outcomes. 5. further plans for nutrition care, monitoring and follow up or discharge.

Planning function of management

includes objectives, policies, procedures, times spans. personnel - screening, update information, orientation, practice drills. procurement, receiving, storage - MOU with vendors, lists of companies, delivery routes, dates and times. security - doors/windows locked when not in use; surveillance cameras. production and service - safe food practices, food checks, only authorized personnel.

gelatin

incomplete protein - no tryptophan, low in methinine and lysine. changes liquid into an elastic solid. acts as foaming agent (marshmallows). keeps sugar and ice crystals small in candy and ice cream by interfering with the union of small crystals to make larger ones.

most effective dietary changes to address both hypertension and hyperlipidemia

increase dietary fiber, and to reduce saturated fat intake. include more high-fiber carbohydrates such as whole grains, and increase their intake of fruits and vegetables. additional strategies include using MUFAs and omega-3 fatty acids.

MNT for Acute viral hepatitis

increase fluids to prevent dehydration. care varies according to symptoms and nutrition status. 50-55% CHO to replenish liver glycogen and spare protein. acute hepatitis: 1-1.2 g protein/kg: cell regeneration, provide lipotropic agents to convert fat into lipoproteins for removal from liver. moderate to liberal fat intake if tolerated; limit fat if steatorrhea. small, frequent feedings because of the anorexia. encourage coffee (antioxidant) multivitamin with B complex, C, K, zinc. increased protein deit prevent fatty liver.

lithium carbonate

increased appetite, weight gain; maintain consistent sodium and caffeine intake to stabilize levels. if sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity.

rich cake

increased fat, sugar, egg; increases keeping quality

Water holding capacity of muscle

increases in change in muslce protein brought about by enzymes i.e. vinegar, salt

Aging meat

increases tenderness

Nutrition diagnosis

indentification and labeling that describes an actual occurrence risk of, or potential for developing a nutritional problem that dietetics professionals are responsible for treating independently. Nutrition diagnosis changes as the patient's response changes

standard deviation

indicates degree of dispersion about the mean value of a distribution. square root of the sum of the squared deviations of each value from the mean, divided by the number of observations.

organizational chart

indicates the relationships among positions and functions within a foodservice department

infant mortality rate

infant deaths under 1 year of age, expressed as the number of deaths per 1000 live births

fluoride recommendations

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

mucositis

inflammation of mucosal lining of oropharynx and esophagus. avoid fresh, raw, uncooked foods, offer cold and soft food.

Arthritis

inflammation of peripheral joints. regular, well-balanced diet with vitamin intake to at leat DRIs. bed rest, aspirin, reduce overweight to decrease stress. normocytic anemia may develop (inflammation prevents reuse of iron) anti-inflammatory diet" may help osteoarthritis: fresh fruits and vegetables, resembles mediterranean diet.

Gastritis

inflammation of stomach; anorexia, nausea, vomiting, diarrhea. diet - clear liquids, advance as tolerated, avoid gastric irritants.

pancreatitis

inflammation with edema, cellular exudate and fat necrosis. may be due to blockage or reflux of the ductal system; premature activation of enzymes within pancreas leads to auto-digestion.

Acute viral hepatitis

inflammation, necosis, jaundice, anorexia, nausea, fatigue. jaundice occurs when bile ducts are blocked.

feedback

info client gives back to you as you are discussing and questioning; lets you know what he knows and what he understands about what you are saying

Congressional Record

information from floor, NO HEARINGS. lists bill with sponsors and action, issued daily when congress is in session.

Parenteral nutrition

infusion of a hypertonic solution delivered through a central venous catheter. used to achieve an anabolic state when patients are unable to eat by mouth and enteral feeding is not possible. subclavian vein minimizes risk of phlebitis. used for altered GI function or impaired nutrient utilization.

alpha glucosidase inhibitors (acarbose, precose)

inhibit enzymes that digest carbs, delaying abs.

Green (chlorophyll) pigment

insoluble in water olive green in acid -pheophytin bright green in alkaline - chlorophyllin (mushy, hemicellulose broken down)

Transformational - agents of change

inspire followers to become motivated to work towards organizational goals rather than personal gain; builds on and extends transactional leadership. Cultivation of employee acceptance of the group mission. leaders and followers raise one another to higher levels of motivation. followers grow and become leaders; leads to low staff turnover, increased morale, and team spirit.

acute hypoglycemia

insulin reaction (shock); due to insulin excess or lack of eating, slow pulse, cool, clammy skin, hungry, weak, shakiness, sweating. treatment: glucose; begin with 15 g CHO from glucose tablets, fruit juice (4-6 oz.), sugar. wait 15 minutes; if still <70 mg/dl, give another 15 grams. repeat and treat until blood glucose is normal.

Unemployment compensation

insurance against loss of income. must be employed for a specific time, able and willing to work, unemployed through no fault of their own; employers pay tax on payroll. State run.

service marketing

intangibility, perishability, heterogenicity, inseparability services are mostly intangible, they are mostly produced and consumed at the same time so are inseparable and perishable. heterogenicity of service is concerned withthe variation and lack of uniformity in the performance of people.

Descriptive statistics

intend to describe data and summarize the current dataset (mean, median, mode, standard deviation, and standard error of the mean)

Legislative process

interaction between the legislative, executive and judiciary branches.

needs assessment - lower income adults

interests focus on costs and traditional food habits; oriented toward present and towards solving current problems

FAO Food and Agriculture Organization

international agency raising world-wide levels of nutrition by increasing efficiency of production and distribution of foods

research discussion

interpretation of results, comparison with other studies; may be combined with results

epidemiological data for neoplastic disease

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

IVFE (intravenous fat emulsion)

intralipid 10% = 1.1 cals/cc 20% = 2.0 cals/cc

Transitional feedings

introduce a minimal amount of FULL STRENGTH enteral feeding at a low rate of 30-40 ml/hour to establish GI tolerance. decrease PN as you increase enteral rate by 25-30 ml/hour increments every 8-24 hours to maintain prescribed nutrient levels. when patient can tolerate about 75% of needs by enteral route, D/C PN.

primary question

introduces new topics

WIC foods offered

iron fortified formula, cereal, milk, cheese, fruit juice, fruits and vegetables

egg size

jumbo = 30 oz. extra large = 27 oz. large = 24 oz. medium 21 oz. small 18 oz.

high motivational level

keen interest; presence is voluntary; has high expectation as to applicability o subject to his life

NRTI drugs

nucleotide nucleoside reverse tanscriptase inhibitos including Retrovir, zidovudine) can lead to anemia, loss of appetite, low vitamin B12, copper, zinc, carnitine.

metabolic acidosis

kidneys either produce or retain too much hydrogen leading to an increase in production of carbonic acid; or the kidneys may excrete too much base. To compensate, respiration increases to remove carbon dioxide to decrease carbonic acid

Components of diffusion of innovation

knowledge, persuasion, decision, confirmation.

B12 deficiency Following GI surgery

lack of intrinsic factor and bacterial overgrowth in loop of intestine being bypassed interfere with B12 abs.

low educational level

lacks formal education beyond high school; probably not verbally oriented; reinforcement of learning is helpful; allow time for learning.

low lactose milk

lactaid treated with lactase in processing or add the enzyme to regular milk and hold in fridge.

Diet for lactose intolerance

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

SNAP Supplemental Nutrition Assistance Program

largest food assistance program: entitlement assists low income with monthly benefits; net income must be at or below certain % of poverty level; income limits vary by household size and are adjusted to the cost of living. designed to increase their puchasing power; not for non-food items. figures are adjusted to refelct cost of food in Thrifty Food Plan for June of preceding year - least costly of USDA four food plans. SNAP nutrition education program provided to program participants

Free rein (laissez faire)

least control

promoting flaky crusts

leaven fat into coarse particles. fat in pieces melts and flows, leaving a hole where steam collects and pushes upward against the upper surface of the resulting cell. the cell is locked into that extended position, resulting in a flaky crust.

quick breads

leavened with steam, air, and chemical leavening agents. no yeast.

Licensure

legal recognition for dietitians or defines a scope of practice; licensure laws are effective legal recourse for consumer protection from incompetent nutrition practitioners.

intimate zone

less than 18", very close friends, business handshakes

diet requirements for fat

less than 30% of calories

P value

level of significance. the lower the p value, the higher the significance of your results

FCC (Federal Communications Commission)

licenses radio and TV

if ileum cannot recycle bile salts

lipids are not emulsified; leads to malabsorption of fat-soluble vitamins. malabsorbed fats combine with Ca, Zn, Mg, leading to "soaps" colonic abs. of oxalate increases - renal oxalate stones increased fluid and electrolyte secretion; increased colonic motility.

enzyme profile

list of major enzymes found in organs and tissues; enzyme levels in blood are elevated when tissue damage causes them to leak into the circulation.

Hepatic Failure (ESLD)

liver function decreased to 25% or less liver cannot convert ammonia (NH3) into urea - ammonia accumulates. apathy, drowsiness, confusion, coma (PSE - portal systemic encephalopathy) Asterisix (flapping, involuntary jerking motions) = sign of impending coma

Recruitment

locate most qualified person for job. sources - internal (promotions, transfer, rehire), external (ads, agencies, unions).

osteoporosis

loss of bone tissue. Type I postmenopausal (within 15-20 years) Type II - age-associated >70 whiteand Asian women: more osteoporotic fractures than black or Hispanic. causes: malnutrition (especially protein), lack of exercise, decline in estrogen. result is reduction in amount of bone due to defective calcium abs (deossification)

respiratory alkalosis

loss of carbonic acid (increased ventilation). To compensate, kidneys excrete additional base

excess mixing

loss of co2, overdeveloped gluten tunnels from top to bottom, tough, heavy product

arteriosclerosis

loss of elasticity of blood vessel walls.

PedNSS (pediatric nutrition surveillance system HHS)

low income, high risk children, birth - 17 years, emphasis on birth-5 years height, weight, birth weight, hematocrit, hemoglobin, cholesterol, breast feeding monitors growth and nutritional status, infant feeding practices

PNSS (pregnancy nutrition surveillance system HHS)

low income, high risk pregnant women maternal weight gain, anemia, pregnancy behavioral risk-factors (smoking, alcohol), birth weight, counts # of women who breast feed. identify and reduce pregnancy-related health risks

an infant with PKU requires ____

low phenylalanine, high tyrosine

egg substitutes

lower in fat, calories, cholesterol; often higher in sodium. color and flavor differences

role of lungs in acid-base balance

lungs control supply of carbonic acid (CO2, water). amount altered by rate and depth of breathing. hypoventilation - retention of acid; hyperventilation - loss of acid

acute respiratory distress syndrome, respiratory failure (ARDS)

lungs no longer able to exchange gases, hyper metabolism, increased energy needs, severely underweight. meet basic nutritional requirements, maintain stable weight, facilitate weaning from mechanical ventilation, without exceeding capacity to clear carbon dioxide. provide adequate but not excessive calories; avoid excess non-protein calories. provide enteral formula containing EPA and GLA, and enhanced levels of antioxidant vitamins. 1.5-2 g protein/kg BW, maintain lean body mass.

Organizational theory

managers serve as catalysts for change. leaders recognize there is a need to make a change (proactive) leader helps followers recognize this need by raising their level of dissatisfaction. followers are shown that the present situation does not meet their needs or that it conflicts with their values. Leader then depicts a future that appeals to the values and needs of followers (defines vision) successful change requires: unfreeze the status quo, change to a new state, refreeze to make the change permanent.

Compromise

managers try to resolve conflict by finding a middle ground. each party achieves some of its objectives and sacrifices others. may be weak method - does not usually lead to a solution that can best help the organization. solution reached will simply be one that both parties can live with.

PRO (Peer Review Organization)

mandated by TEFRA; watchdog of teh DRG system; formal assessment by physicians of the quality and efficiency of services provided.

low motivational level

mandatory attendance; little interest in topic; may feel there are more important things he should do.

CRP (C-reactive protein)

marker of acute inflammatory stress (not nutritional status!) as it declines, indicates when nutritional therapy would be beneficial when elevated CRP decreased, PAB increases

Five federal block grant areas

maternal and child health, community services, social services, preventive health service, primary care

Fair Labor standards act 1938

may be called Minimum Wage or Wage Hour Law; set minimum wage. for overtime work (over 40 hours in 1 week) must pay time and one half. minimum wage - listed at Bureau of Labor Standards. amendment - Equal Pay Act 1963 - prohibits discrimination on basis of sex. Donated (tolerated) time - compensable; must be paid. Child labor laws regulate work hours and duties of children.

Bacillus cereus

may be present in the outer casing of rice and/or other starchy food items. it is able to form temperature-resistant spores and thus can easily survive cooking and inadequate refrigeration.

Stroke due to brain embolism

may be undernourished or overweight. immobilization decreases ability to absorb calcium and increases nitrogen loss.

The judiciary branch

may discard a law if it considers it in violation of a person's basic rights and freedoms.

reassuring response

may make it difficult to solve the clients problems or discuss it further. client is prevented from working through feelings

curcumin (tumeric)

may reduce inflammation, antioxidant, in curry powder

The executive branch (president)

may veto legislation or sign it into law

Controlling/evaluation

measure present performance against standard performance. ongoing process which determines whether goals have been reached.

continuous scores

measured on a continuous scale

glycosylated (glycated) hemoglobin (Hb A1c)

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

triceps skinfold thickness (TSF)

measures body fat reserves; measures calories reserves standard: male 12.5 mm; female 16.5 mm

direct calorimetry

measures heat produced in respiration chamber (limited usefulness)

indirect calorimetry

measures oxygen consumed and co2 excreted using a portable machine (practical way of measuring which nutrients are being used for energy, and determining caloric needs) useful with athletes, burns

arm muscle area (AMA)

measures skeletal muscle mass (somatic protein) to determine: use TSF and arm circumference standard: male 25.3 cm; female 23.2 cm important to measure in growing children

outcome evaluation

measures the effect on the target population.

protein sources

meat, poultry, fish,e ggs, milk, legumes

immunoglobumin E (IgE)

mediated reaction to normally harmless food protein. common allergens - peanuts, eggs, milk, soy, wheat, shellfish cow's milk protein is the most common single allergen for infants. introduce eggs at 24 months of age, nuts and fish at 36 months.

informal channel (grapevine)

meets social needs of group

folate deficiency

megaloblastic macrocytic anemia diarrhea, fatigue

white sauces

melt fat, add flour (roux, half fat, half flour) remove from heat, add liquid at 170-180 F; add salt add an acid when cooking is complete uncooked flour results in starchy tasting and grainy

Hgb hemoglobin

men 14-17 mg/dl, women 12-14 gm/dl, pregnant < or = to 11 iron-containing pigment of RBCs erythrocytes are produced in bone marrow

Hct hematocrit

men 42-52%, women 35-47%, pregnant women 33% volume of packed cells in whole blood

24 hour recall

mental recall of everything eaten in the previous 24 hours. quick tool to estimate a sample daily intake. Clinical setting.

alchohol

metabolized as a fat - 7 calories/gram to determine calories from alchol (.8)(proof)(ounces) proof = % alcohol x 2

Biguanides

metformin (glucophage) - enhance insulin action, suppress hepatic glucose production.

focus group

method of attaining information about a target group; small group who talk about the beliefs, opinions, problems; contributes attitudinal data

median

midpoint arrange observations from low to high; count the number of values. median is the value at the midpoint. if there is an odd number of number, the median will be the exact center, if there is an even number of numbers, the median is the average of the two numbers closest tot he center.

Alkaline ash/acid ash diets

minerals not oxidized in metabolism leave an ash (residue) in urine. can change composition of diet to change pH of ash in urine. now usually done with medication. to prevent acidic stones - create an alkaline ash by increasing cations (Ca, Na, K, Mg), adding vegetables, fruits, brown sugar, molasses. to prevent alkaline stones - create an acid ash by increasing anions (Cl, Ph, Su) with adding meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye.

diagonal communication

minimizes time and effort expended in organizations. between functions diagnoally placed (ordering clerk in foodservice send requests directly to purchasing department, not through food service channels.)

basal energy expenditure (BEE)

minimum amount of energy needed at rest in fasting (amount needed to carry out involuntary work of the body, activity of internal organs, internal temperature). affected by extremes in environmental temperatures tropical climate 5-20% increase caffeine, alcohol, nicotine stimulate metabolic rate 7-15%

Absolute FTE

minimum number of employees needed to staff teh facility; counts productive hours (hours actually worked).

Phenylketonuria (PKU)

missing enzyme - phenylalanine hydroxylase - which would convert phe into tyrosine; phenylalanine and metabolites accumulate leading to poor intellectual function. detected with Guthrie blood test.

buffer

mixture of acid and base components to protect against a strong acid or strong base major buffer - carbonic acid (H2CO3) adn sodium bicarbonate (Na HCO3)

baking powder

mixture of baking soda (provides co2), dry acid (reacts with soda to release carbon dioxide), and cornstarch (keeps contents dry). Types: tartrate, phosphate, combo old baking powder is more alkaline and causes loss of thiamin in baked goods.

MNT for nephrosis/nephrotic syndrome

modest protein restriction - .8-1 g/kg; 50% from HBV. Excess protein will be catabolized to urea and excreted. <30% fat, low saturated fat, 200 mg cholesterol. 35 cals/kg/day modest sodium restriction 2-3 g/day. calcium 1-1.5 g/day, supplement vitamin D. may need fluid restriction with edema. abnormalities in Fe, Cu, Zn, Ca related to protein loss.

MAP

modified atmosphere packaging air is removed and replaced with gases (Co2, Nitrogen)

NDD2 (Dysphagia mechanically altered)

moist, soft-textured, easily formed into a bolus; moist, tender ground or diced meats, soft cooked vegetables, soft or canned fruits. no bread, rice, cheese cubes.

Informational roles

monitor - searching for information to become more effective disseminator - transmits information to subordinates spokesman - transmits information to people inside and outside

emulsifiers

monoglycerides, diglycerides, lecithin, disodium phosphate. prevent oil and water from separating

written communictation

more formal and authoritative. interpreted more accurately; used when record is required. keep at 8th grade reading level for general population and 6th grade for audiences of lower literacy. Email, pamphlets, posters, handouts

narrow span of control

more levels are created; need more managers; needd with newly hired personnel

oral communication

more personal, encourages two-way communication. most critical barrier: poor listening skills

Job enlargement

more similar tasks to alleviate boredom

nominal group technique - Delbecq

more structured and controlled than an ordinary brainstorming group. has authoritative leader, controlled interactions, closely focused goals, rigid enforced procedures, responses strictly controlled by leader. often sit in horseshoe formation; silent generation of ideas by participants. round robin reporting - leader records ideas. Group RANKS items in priority order; vote for final decision.

calcium

most abundant mineral. regulated by parathyroid hormone. Vitamin D, acid, lactose aid absorption. calcitonin lowers serum calcium by inhibiting bone resorption. function - blood clotting, cardiac function, nerve transmission, smooth muslce contractility sources - dairy, leafy vegetables, legumes

Renal calculi

most common is calcium stone. 1.4-2 L fluid/day needed to dilute urine. Calcium oxalate stones - adequate calcium intake to bind oxalate and a low oxalate (40-50 mg) diet (dark leafy greens, chocolate, strawberries, nuts, beets, tea)

Vitamin C/ Ascorbic acid

most easily destroyed, structure like glucose. antioxidant. needs acid pH. destroyed by heat, alkaline pH, oxidation function - changes proline into hydroxyproline into collagen which strengthens inter cellular substances. wound healing. aids iron abs. sources - citrus fruits, potatoes, papaya, dark green, yellow vegetables.

Participative management

most effective; employees worked under general supervision, the boss delegated authority, and it was employee-oriented; decision-making spread evenly throughout the organization; full involvement of employees in setting goals making job-related decisions

mode

most frequently occurring value; prediction most likely to be right

communication principles

motivation emphasize human factors (feelings, anxieties, concerns) involve learning in active way establish rapport discuss problems descriptively offer alternatives provisionally rather than dogmatically be clear, complete, concise concrete, and correct

The join commission (nutrition screening)

nutrition risk identified in hospitalized patients whithin 24 hours of admission, but does not mandate a method of screening.

work (activity, occurrence) sampling

observe random samples (intermittent observations) to determine percetnage of time working or idle.

Herzberg's two-factor theory

motivation and maintenance approach maintenance (hygiene) factors (satisfiers, dissatisfiers) - if present and seen as good, satisfiers - if lacking or perceived as negative, dissatisfies and will interfere with work. - do not produce motivation but can prevent it. - Ex: fair wage, insurance, retirement benefit, supervision, schedule, working conditions motivators - call forth energy and enthusiasm (enrichment) -achievement, personal accomplishment, recognition, responsibility, participation in decision making, opportunity for growth and a advancement.

Fluorosis

mottled teeth with excessive fluoride

operation charts

movement of hands; reduces transportaiton and re-plan work areas

education plan - targeted setting and clientele

multicultural awareness assume differences until similarites are proven. emphasize description rather than interpretation ore evaluation. cultural communication styles differ spatial relationships vary among cultures/individuals gestures

Myofibrils

muscle composed of bundles of fibers

biotin defciency

muscle pain, dermatitis, glossitis

setting educational goals

must be set in accordance with the process of learning. must be based on previous learning and the characteristics of the group being instructed.

selenium deficiency

myalgia, cardiac myopathy

Meat pigments

myoglobin is main color contributor. myoglobin + oxygen -> red -> brown -> green green colors due to further myoglobin breakdown

NCAHF

national council against health fraud

flour color

natural agents cause oxidation during storage and turn flour from creamy yellow to white. if an oxidizing agent is added - labeled "bleached"

Dawn phenomoenon

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

TPN solutions - fat

needed for energy and to prevent essential fatty acid deficiency (EFAD) To prevent EFAD, give 500 cc of 10% fat emulsion 1-2 x /week symptom of EFAD - petachiae (red spots)

folate deficiency follow GI surgery

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

coercive power

negative side of reward power, ineffective in motivating behavior change, may create resistance. ability to PUNISH another for not carrying out requirements. used to maintain minimum standard of performance.

vitamin A deficiency

night blindness, nyctalopia, is reversible. xerophtalmia - corneal damage, not reversible bitot's spots on conjunctiva, dry, scaly skin (hyperkeratosis)

unstructured (non-directed) interview

no definite checklist; more participation from applicant; "tell me about your last job"; sales, counseling, management.

dried skim milk

no more than 1.5% fat; keeps well.

null hypothesis

no relationship in population of data (any difference is a result of sampling error) aften has "equal to" expressed

chronic nonspecific infantile diarrhea

no significant malabsortption consider ratio of fat to CHO calories. volume of ingested liquids. some are inadvertently placed on a low fat diet or consume too many fluids or too many calories. give 40% calories as fat, balanced with limited fluids; restrict or dilute fruit juices with high loads - apple, grape

Systemic lupus erythematosus (SLE)

no specific dietary guidelines, tailor to needs. may have dietary deficiencies of Fe, Folate, Calcium, Fiber, B12. may have anemia but does not correlate with Fe intake. May show symptoms of celiac disease.

non-probability

no way of forecasting that each element in the population will be represented in the sample. convenience or accidental quota

Disher scoop sizes

no. 6 - 2/3 cup no. 8 - 1/2 cup no. 10 - 3/2 oz/.4 cups no. 12 - 1/3 cup no. 16 - 1/4 cup no. 20 - 1/5 cup no. 24 - 8 teaspoons no. 30 - 2 T. no. 40 - 5 teaspoons no. 50 - 4 teaspoons no. 60 - 1 T no. 70 - 2 teaspoons

dietary fiber

non-digestible CHOs and lignin, binds water, increases fecal bulk; found in legumes, wheat bran, fruits, vegetables, wole grains. Oat bran and soluble fibers decrease serum cholesterol by binding bile acids converting more cholesterol into bile. soluble fibers (pectins, gums) delay gastric emptying, absorb water, form soft gel in small intestine; this slows passage and delays or inhibits abs. of glucose and chol. 38 g for Men, 25 g for women recommended.

cerebral palsy

non-hereditary, brain damage; inadequate control over voluntary muscles leading to spasms. spastic form - difficult, stiff movement; limited activity; obese (low calorie, high fluid, high fiber diet) non-spastic (athetoid) form - involuntary wormlike movement, constant irregular motions leading to weight loss. (high calorie, high protein diet, finger foods)

Indices fo glycemic control

normal = 70-100 impaired fasting = 100-125 impaired glucose tolerance (2hPG) = 140-199 diabetes - fasting plasma = FPG >/= 126 or GTT >/= 200 or symptoms of diabetes plus casual plasma glucose >/= 200 gm/dl; HgA1c >/= 6.5%

Tolerable upper limit (UL)

not associated with adverse side effects in most individuals of a healthy population.

indirect cost

not directly accountable to the cost of an object and include administration, personnel, and security costs.

hair analysis

not for nutritional assessment; useful in measuring intake of toxic metals

p > .05

not very significant difference, not reliable results. has not proved hypothesis

Federal Register

notices of public hearings, proposed and final rules, agency decisions, published weekly; lists changes in USDA food programs.

critical thinking skills needed for nutrition screening

observe verbal/nonverbal cues that can guide effective interviewing methods. determine appropriate data to collect. select tools and procedures and apply in valid, reliable ways. Distinguish relevant from irrelevant and important from unimportant data. validate, organize, and categorize the data.

secondary questions

obtain more info, follow up quesition

esophageal varices

occur when blood can't enter the liver. connective tissue overgrowth causes resistance to blood entering from portal vein. The increased pressure forces blood back into collateral veins that offer less resistance. Esophageal, abdominal, collateral veins enlarge. Due to portal hypertension.

retrogradation

occurs in starches with a high proportion of amylose. after a starch paste has been cooled or chilled, it may become less soluble and recrystallizes to form a solid or rigid gel. It reverts (retrogrades) back to the insoluble form on freezing or aging. the hydrogen bonds that hold the gel together break and reform in an orderly crystalline fashion (gritty texture). ex: stale starch products, separation whena gravy thaws, old pudding accelerated by freezing.

Ascites

occurs when blood cannot leave the liver. connective tissue overgrowth blocks blood flow out of liver into vena cava. The liver expands (can store a liter of extra blood, when exceeded the pressure forces fluid to sweat through the liver into the peritoneal cavity. this fluid is almost pure plasma with a high osmolar load, pulling more fluid in to dilute the load, leading to sodium and water retention.

Health care outcomes

of interest to health care providers, and payers. Health and disease outcomes - reduced readmissions, changes in severity, duration, or course of a condition or disease, changes in risk level, maintenance of health. cost outcomes - changes in length of stay, ICU days, number of outpatient visits, treatment procedures, medications, reduced readmissions. patient centered outcomes - changes in indicators that reflec functional level, disability, quality of life.

qualititative research

often precedes other research explores a phenomenon of interest as a prelude to theory development data collection through interviews, observations, questionnaires, may use focus group - Delphi

nutrition needs for the homeless

often too poor to purchase food; have no place to store or prepare it emergency food programs do not provide balaned meals feeding infants is especially difficult federal food programs are less accesible redesign existing services to be more responsive: locate WIC clinics at shelters, offer education and training to staff and volunteers at food kitchens

Starch changes to sugar during storage

old potatoes taste sweeter, cook to a darker brown (maillard reaction), and are softer in texture.

sources of monunsaturated fat

olives, canola, peanut, sunflower

disaster planning

one gallon of water/person/day for minimum of 3 days.

unsaturated fatty acids

one ore more double bonds one double bond = monounsaturated; two or more double bonds - polysunsaturated safflower = most polyunsaturated canola = most unsaturated

cross-sectional studies

one time data collection. sometimes called prevalence study -- ALL of the cases of a specific disease among a group of people in a specific time a snap shot look at one point in time; describes current, not past or future events.

NHANES (national health and nutrition examination survey)

ongoing (repeated) survey to obtain info on health of American people evaluates clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometric, nutritional data (24 hour recall, food frequency lists) NHANES III - ovsersampling of adults >/= 65 with NO upper age limit

dichotomous scores

only two events are possible (heads, tails)

OARS

open ended questions affirmations reflective listening summaries

Tube bore

opening - based on viscosity of feeding. Large #16 - blenderized whole foods Small #8 - ready prepared formulas, more comfortable.

lactose tolerance test

oral dose of lactose (up to 50 grams) after a fast. if intolerant of lactose, blood glucose will rise < 25 mg/dl above fasting (flat curve). if tolerant of lactose, the rise would be above 25 mg/dl (normal cure).

beating

over and over to smooth and incorporate air

eggs -dried heat

overcooking toughens under cooking results in excessive shrinkage when removed from oven

ice crystals - ice cream

overrun is the increase in volume from freezing and whipping (determined by weight; should be 70-80%) homogenization makes ice cream smooth by making it easier to beat in air during freezing. agitation is essential to keep ice crystals small. using whipped cream instead of half and half will create smoother ice cream

postprandial or reactive hypoglycemia

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

normal acid-base balance

pH - 7.4 HCO3 - 24-28 PCO2 - 35-45

iron deficiency

pale tongue, fatigue anemia spoon-shaped nails pale conjunctiva (mucous membranes lining eyelid)

MNT for Short bowel syndrome

parenteral nutrition initially to restore and maintain nutrient status. enteral - start early to stimulate growth, increase over time; continuous drip. may take weeks or months to transition to food. jejunal - normal balance of carbs, protein, fat; avoid lactose, oxalates, large amounts of concentrated sweets; vitamin, mineral supplements. ileal - limit fat, use MCT (does not require bile salts, needs less intestinal surface area), supplement fat-soluble vitamins, Ca, Mg, Zn, parenteral B12 followed by monthly injections.

PBI

protein bound iodine - measures activity of thyroid gland. hormones: thyroxine (T4), triiodothyronine (T3) when PBI elevated, BMR elevated measures energy metabolism, measures level of thyroxine produced not a nutritional assessment parameter

physical and chemical changes in meat cooking

protein coagulates collagen is hydrolyzed to gelatin and softens surface browns due to breakdown f pigments heat changes interior from red to pink to brown to gray (denatures globin, Fe oxidized) increase tenderness of meat by adding vinegar cured meats are pink from nitrites (inhibits botulism)

coagulation -eggs

protein coagulates at 62-70 C (sets a custard) used to bind, gives firmness, stability, coats food, browns, clarifies liquids syneresis (weeping) liquid released from a coagulated product. (when cooked at at too high/low a temp)

glucocoticoids, antibiotics

protein deficits

Emulsification - eggs

protein in egg forms a thin film around droplets of oil; stabilizes emulsion egg yolk yields a stiffer, more stable emulsion than egg white because it has more protien (by weight) yolk is naturally occurring oil in water emulsion. lipoproteins stabilize the emulsion by interacting at the surface of the oil droplets to forma layer

iatrogenic malnutrition

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

enzymes

proteins, organic catalysts that control reaction

USDA commodity food donation/distribution program

provides foods to help meet nutritional needs of children and adults and strengthens agricultural market for products produced by American farmers. food given to school lunch, elderly feeding, supplemental food programs

EFNEP Expanded food and nutrition education program

provides grants to universities that assist in community development. trains nutrition aides to educate the public improve food practices of low income homemakers with young children. works with small groups; teaches skills needed to obtain a healthy diet (budgeting, meal planning, shopping, cooking).

egg (baking)

provides stability, retains leavening agent, distributes shortening by emulsification, introduces air, adds color and flavor

Intermittent drip (EN)

pump or gravity. more mobility.

Surimi

purified and frozen mined fish with a preservative, used in analogs, may have egg white or starch added to create desired structure.

nutrition intervention

purposely planned actions designed with the intent of changing a behavior, risk factor/condition, for an individual, group, or community. based on the nutrition diagnosis and provides the basis upon which outcomes are measured and evaluated. aimed at resolving the underlying cause of the nutrition problem when possible. If it is not possible, then the nutrition intervention is targeted at minimizing the symptoms of the nutrition problem.

acute pancreatitis

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

ability to empathize

put yourself in their shoes. allows you to respond without giving advice. focus instead on their need to talk and express feelings and concerns

TEFAP The emergency food assistance program

quarterly distributions of commodity foods by local, public or private nonprofit agencies, food banks, soup kitchens, homeless shelters supplements diets of low income households

Treatment of neoplastic disease

radiation - loss of taste, xerostomia (dry mouth, so moisten foods adding water or milk, suaces, gravies), esophagitis, diarrhea, malabsorption. May cause mucositis. chemotherapy - chemical reagents which have toxic effects. May cause neaseau, vomiting, malabsorption, anorexia, stomatitis.

Pantothenic acid deficiency

rare. parasthesia in feet

copper deficiency

rare. microcytic anemia, neutropenia. Wilson's disease: low serum copper, genetic absence of liver enzyme

mortality

rate of death; morbidity - state of disease

TPN solutions - protein

ratio for anabolis is 1 gram nitrogen /150 calories. 1-1.5 grams protein/kg/day crystalline amino acids 3-15% solution. % = number of grams of protein in 100 mls of solution. A 3% solution has 3 grams of amino acids / 100 ml.

experimental group

receives the program or treatment

Flow phase

recovery follows fluid resuscitation and return of oxygen transport

Chronic pancreatitis

recurrent attacks of epigastric pain of long duration.

Flavanoids

red, blue, purple - anthocyanins (greatly affected by changers in pH) soluble in water bright red in acid bluish in alkaline

motion economy

reduce motions and time requried

Gastric bypass and gastroplasty

reduce the amount of food that can be eaten at one time and produce early satiety roux-en-y gastric bypass, usually permanent. -reconstructs the small intestine to resemble the letter Y. -creates a small gastric pouch connected directly to the jejunum. -dumping syndrome may develop -potential anemia, and deficiencies of potassium, magnesium, folate and vitamin B12. Supplementation is necessary.

extinction

reduce undesired behavior. absence of reinforcement following undesired behavior (ignore). if extinction is repeated, behavior will eventually disappear.

Zinc deficiency

reduced immune function, alopecia, poor wound healing, hypogeusia.

orlistat

reduces fat absorption by binding lipase; vitmin/mineral supp.

mediterranean diet

rich in alpha linolenic acid, high in monounsaturated fats. olive, canola, soybean oils; walnut, almonds, pecan, peanuts, pistachios. fish, poultry eggs rather than beef, bread fruits and vegetables in abundance, beans, legumes, yogurt cheese. resveratrol, in skin of red grapes, may lower blood pressure.

Vitamin D deficiency

rickets, osteomalacia

gestational diabetes

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

characteristics of a good muffin

round, pebbled top, symmetrical shape, no long, narrow tunnels

sources of polyunsaturated fat

safflower, corn, soybean, cottonseed, sunflower

winterized oil

salad dressings; won't crystallize when cold -oil chilled to 45 degrees; fatty acids with high melting points crystallize and are filtered out -winterized oil is clear, not cloudy -corn, soy , and cottonseed oils are winterized; olive oil is not

pathway chart or flow diagram

scale drawing showing path of a worker during a process

pilot study

scaled down version of the larger investigation; practice implementation, determine whether clinical trial, as planned, is feasible; are goals realistic and attainable? includes every step in the study, but done on a small test group.

SAP

screen, assessment, plan

vitamin C deficiency

scurvy, poor wound healing, bleeding gums, petachiae

phosphorus

second most abundant mineral. part of DNA, RNA, ATP function- phospholipids transport fat through lymph and blood bone, teeth sources - meat, milk, poultry, eggs, fish, cheese deficiency rare

hormones

secretions from endocrine glands. chemical messengers that trigger enzymes. thyroxine - regulates metabolism and rate of oxidation. influences physical and mental growth stimulates liver glycogenolysis, gluconeogenesis - raises blood sugar

Epilepsy

seizures, altered consciousness anticonvulsants phenobarbital and phenytoin (dilantin) interfre with calcium abs. take 1 mg folate daily with drug. may need supplements of vit. D, calcium, thiamin provide phenytoin separate from meals and other supplements. Enteral feedings decrease bioavailability of phenytoin so hold tube feedings >/= 2 hours.

vitamin B6 deficiency

seizures, anemia, dermatities, glossitis, peripheral neuropathy

RAST (alternative to skin test)

serum is mixed with food on paper disk; measures specific IgE antibodies.

Hyperemesis gravidarum

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

HBV (Hep B)

sexually transmitted, HCV: blood to blood contact

needs assessment - very poor

short term planners

Chain of command

shows command relationship from top to lowest level.

line graphs

shows frequency on vertical scale; method of classification on horizontal scale

organizational chart

shows how the employee fits into the organization. shows relationship of positions and functions. depicts lines of authority shown with solid lines advisory staff positions shown with dotted lines. Not shown: degree of authority at each level, informal relationships.

bar chart

shows measurement only on vertical axis. bars arranged horizontally or vertically in ascending or descending order

muffin method of mixing

sift dry ingredients; make well in center. blend liquids and a dd all at once to dry ingredients. mix just enough to dampen

p </= .05

significant difference, results are reliable

arithmetic mean

simple average total the values of all observations and divide by the number of observations

compound fat

simple fat plus other component.

conjugated proteins

simple plus non-protein substance (lipoprotein)

percolator

single container, covred basket with stem; gives stronger and bitter coffee; water is hotter and repeatedly passes through grounds

sweet acidophilus milk

skim milk plus acidophilus bacteria which reduces lactose

filled milk

skim milk, vegetabel fat (coconout oil), water, illegal in some states

curve of normal distribution

slope is convex (bulging outward) at point of inflection, it becomes concae (bulging inward) as slope begins to level off distance between the mean and the point of inflection on either side is equal to the standard deviation. about 2/3 of all observations ina normal distribution lie within 1 SD of eh mean (m/1 SD of the mean) 32% of observations lie outside of the range 95% lie witin about 2SD either side of the mean

gastric banding

small gastric pouch created using a fluid-filled inflatable band. adjusted to alter the size of the opening (fully reversible) will not require folic acid, iron or B12 replacements.

Peripheral parenteral nutrition

small surface veins short term therapy with minimum effect on nutrition status. indications - post-surgery (when enteral feeding is expected to resume within 5-7 days), mild to moderate malnutrition, as supplement to enteral.

microcytic, hypochromic anemia

small, pale cells; due to Fe deficiency. associated with chronic infections, malignancies, renal disease. macrocytic, megaloblastic anemia: FEW large cells, filled with hemoglobin. due to deficiency of folate or vitamin B12; Schilling test for pernicious anemia.

NDD1

smooth, pureed, homogenous, cohesive foods. "pudding like" avoid gelatin, fruited yogurt, hot cereal with lumps and soup with lemps.

higher human needs (motivators)

social (organized activities), self-esteem (job title, praise, rewards, promotions) self-realization, self-actualization (realizing your potential growth using creative talents); advanced training, job enrichment.

renal solute load

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

small group discussion

some lecture plus interaction; beneficial in clinical setting; teacher needs to remain in control; 3-5 people with similar needs; learn from each other

Energy

sources - carbs and protein. 4 kcals/gram, fat 9 kcals/gram. the brain uses glucose exclusively as an energy source; uses ketone bodies during starvation

CAP-FEIA blood test

specific in identifying children with milk, egg, fish, or peanut allergy

research results

specific lab, clinical, objective or subjective findings

Liquid consistency

spoon thick, honey-like, nectar like. thin: includes all beverages (water, ice, milk, juices, coffee, tea, gelatin)

shift schedule

staffing patterns for a particular operation; positions and hours worked, number of days worked per week, relief assignments. ex: trayline, dishwasher

structure of grains/cereals

starchy endosperm rich in protein outer layer of hull and bran scutellum - in germ; has most of the thiamin vitamin E (in germ), thiamin, riboflavin, phosphorus.

homeostasis

state of equilibrium of the internal environment of the body

research methodology

statement of hypothesis, discussion o methods used

TANF (Temporary Assistance for Needy families)

states determine the eligibility of needy families and the benefits and services those families will receive

Decision making/problem solving roles

steps - recognize and analyze problem; determine workable solutions; gather data; choose solutions; take action; follow-up action.

process charts

steps involved in process using symbols

Functions of liver

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

structure of fatty acids

straight hydrocarbon chains terminating in a carboxyl group (COOH) at one end and a methyl group (CH3) at the other end classified by the number of dobule bonds the location of the first double bond, counted from the METHYL END of the fatty acid, is designated by the omega sign. linoleic acid C18:2omega6 indicates taht there are 18 carbons, two double bonds, the first double bond located at the sixth carbon

SWOT analysis

strengths, weaknesses, opportunities, threats.

% weight change

stresses significance of weight change and used to assess potential nutrition risk. [(usual weight-actual weight) / usual weight] x 100

collagen

structural part of tendon that surrounds muscle. in heat, hydrolyzed to gelatin; becomes tender

Job analysis

studies all aspects of job, done by worker and their supervisor. conducted first to collect info for job description.

position (legitimate) power

subordinate acknowledges that the influencer has the right to exert influence due to position (job title).

substrate

substance upon which an enzyme works

disaccarides

sucrose (glucose and fructose), lactose (glucose and galactose), maltose (glucose and glucose)

baker's special eggs

sucrose added to improve foaming ability

acute kidney injury/acute renal failure

sudden shutdown with previously adequate capacity; decreased GFR, inadequate pre-renal perfusion. due to burns, accident, obstruction, severe dehydration. symptoms - liguria (<500 ml urine), azotemia (increased urea in blood)

candies

sugar, water, corn syrup or cream of tartar. product is viscous, shiny, and smooth at start of process then becomes creamy, dull, lighter in color. cools and stiffens rapidly with further beating

mcClellands achievement - power affiliation theory

suggests that all people have 3 needs: need to achieve, for power, and for affiliation. achievement motive is a desire to do something better or more efficiently. People with this need tend to gravitate towards sales and management positions. They are task oriented and can manage themselves. the need for affiliation is the desire to be liked by others. those with a need for power enjoy competition and seek confrontation.

Insulin secretagogues

sulfonylureas, meglitinides (glucotrol) - promotes insulin SECRETION

descriptive statistics

summarizes and describes aspects of a set of data

MNT for Ulcers

ulcer = eroded mucosal lesion treatment = antacids, antibiotics to eradicate helicobacter pylori bacteria drug therapy - cimetidine, ranitidine (H2 blocker); prevents binding of histamine to receptor, decreases acid secretion. diet - as tolerated, well-balanced, avoid late night snacks omit - cayenne and black pepper, large amounts of chili powder, avoid excess caffeine and alcohol (Gastric irritants)

Dietary reference intakes (DRI)

umbrella of nutrient guidelines.

urea cycle defects

unable to synthesize urea from ammonia resulting in ammonia accumulation. vomiting, lethargy, seizures, coma, anorexia, irritability. diet - protein restriction (1-2 g/kg based on tolerance, age, projected growth rate) to lower ammonia; therapeutic formulas to adjust protein composition to limit ammonia production. Ex: OTC ornithine transcarbamylase deficiency.

pre-contemplation stage

unaware or not interested in making a change. "I did not know salt had an effect on my blood pressure"

hyperbilirubinemia

unconjugated bilirubin levels elevated within first week of life as a result of increased breakdown of RBCs or decreased intestinal mobility. Encourage 9-12 feedings per day of human milk or formula to promote hydration and intestinal motility.

hostile response

uncontrolled anger; may antagonize or humiliate client

CHIP Children's Health Insurance Program

under Social Security Act, partnership between federal and state governments expands health coverage to uninsured children whose families earn too much income to qualify for medicaid but too little to afford private coverage.

numerical continuous

underlying continuous scales (blood pressure)

Technical skills

understanding of an proficiency in a specific kind of activity. most important at LOWER levels of management.

cardiac cachexia

unintended weight loss, blood backs up into liver and intestines causing nausea and decreased appetite. Arginine and glutamine may help. Low saturated fat, low cholesterol, low trans fat, <2 grams sodium, high calorie

informal evaluation

unstructured observation of food selection and behaviors

long range planning

up to a 5 year cycle, focus on goals and objectives. requires a mission statement of long range vision.

job enrichment

upgrades job by adding motivating factors increases number of tasks and control the employee has over the job. Maslow and Herzberg motivator (advanced training)

How to check tube placement

use X-ray confirmation of tube tip location, or aspirate gastric contents. do NOT use blue dye to check placement.

Cystic fibrosis MNT

use age-appropriate BMI to assess height and weight. PERT - pancreatic enzyme replacement therapy with meals and snacks. high protein, high calorie, unrestricted fat, liberal in salt. if growth is normal and steatorrhea is controlled - calories to cover RDA for age and sex; if fails to grow - BEE X activity factors plus disease coefficients; may need 110-200% of normal energy needs. Protein 15-20% cals, carbs 45-55% cals, liberal fat to compensate for high energy needs, 35-40% of calories. additional 2-4 grams salt/day in hot weather, with heavy perspiration. age appropriate doses of water soluble vitamins and minerals. supplement water-soluble forms of fat-soluble vitamins (A and E).

sensitivity and specificity

use if protocol involves screening for a particular condition; evaluates the cut off value being used

Nutrition screening

use of preliminary nutrition assessment techniques to identify people who are malnourished or who are at risk for malnutrition. Brief, 5-10 minutes. review client's history, lab results, weight, physical signs. if no emerging nutrition problem exists, document that discharge from nutrition care is appropriate.

meat specifications

useas numbering system for order wholesale cuts

moist heat cooking

used for less tender cuts with more connective tissue (bottom round, chuck, brisket) braising simmer steam stewing

Peripherally inserted central catheter

used for short or moderate term infusion

Dry heat cooking

used for tender cuts - near backbone - loin, sirloin. have less collagen, need less time for cooking frying broiling roasting grilling

Gastrostomy or jejunostomy (EN)

used if needed for more than 3-4 weeks. PEG inserts tube into stomach through abdominal wall.

kneading

used in dough; push, pull turn

folding

used in foams; a down, across, up and across the top motion; rotate bowl

Adequate intake (AI)

used when insufficient evidence exists for EAR, RDA

Elemental, chemically defined enteral formula

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

foam cake

uses air as leavening angel cake: egg white foam sponge cake: yolk foam and white foam chiffon cake: liquid yolks, egg white foam, baking powder, oil

human relations (behavioral) theory

uses behavioral sciences, workers exist in social groups. emplooyee participation in decision-making is essential. improves morale and productivity.

experimental model

uses experimental and control groups target populations are randomly chosen to be in either group. difficult and expensive to run

Gastroplasty

uses staples to create a small gastric pouch, leaving only a small opening into the distal stomach. liquids to pureed to soft foods to regular small meals and snacks.