Nutrition Care
during the ebb phase of injury response what occurs? during the flow?
"ebb" phase, characterized by hypovolemia, shock, tissue hypoxia, and decreased metabolic rate. During the "flow" phase, there is fluid resuscitation, and oxygen transport returns.
BMI Calculation using inches and pounds using metrics cm to meters? meter to cm cm to inches kg to pounds? pounds to kg?
(weight (lbs) / height in inches squared x 703. weight in kg/height in M squared centimeters x .01 meters x 100 inches= centimeters/2.54 centimeters= inches x 2.54 kg x 2.2 pounds/ 2.2
name the criteria for pitting edema
0+ no pitting edema 1+ mild pitting edema: 2 mm depression disappears rapidly 2+ moderate pitting edema: 4 mm depression disappears in 10-15 seconds 3+ moderately severe pitting edema: 6 mm depression that lasts more than 1 minute 4+ severe pitting edema: 8 mm depression that lasts more than 2 minutes
IDDSI Framework
0- thin 1- slightly thin 2- mildly thin 3- moderately thick 4- extremely thick 5- minced and moist 6- soft and bite sized 7- regular
waist circuference of men that is considered overweight in men? women?
40 in; 30 in
What is the minimal percentage of nutrient needs that a patient should be able to consume orally before discontinuing parenteral nutrition?
75%
classes of obesity
<18.5: Underweight 18.6-24.9: Normal weight 25-29.9: Overweight 30-34.9: Obesity class I 35-39.9: Obesity class II >40: Obesity class III or morbid obesity
What is the BMI for age in teens and children percentile parameters that define if they are in underweight, healthy weight, overweight, and obese categories
<5th percentile = underweight 5th percentile to 85th percentile = healthy weight 85th percentile to < 95th percentile = overweight At or over 95th percentile = obese
A patient is at risk if he or she has experienced significant unintentional weight change of:
> 2% in the last week > 5% in the last month > 7.5% in the last 3 months > 10% in the last 6 months
Non megaloblastic macrocytic anemia
Abnormally large RBC caused by certain conditions with absorption of nutrients, alcohol abuse, hypothyroidism, bone marrow diseases
A skin condition characterized by dark, velvety patches in body folds and creases is known as___ and is a risk factor for _____
Acanthosis nigricans is a skin condition characterized by dark, velvety patches in body folds and creases. This condition is a risk factor for diabetes.
liver enzymes are elevated during what? low during what?
Any diseases involving liver, muscles, bones malnutrition, scurvy, and diabetes
what nutrient and nutrients would you most expect someone to be deficenent in after gastric bypass
B12, folate, calcium, protein, vitamin D
Diet recommendations for someone with diarrhea
BRAT diet (banana, rise, applesauce, toast) and probiotics
What labs would you expect to be elevated during renal failure? symptoms of nephrotic syndrome?
BUN and creatine; hypertriglyceridemia , edema, malnutrition, albuminemia (HEMA)
Nitrogen balance formula. what does negative nitrogen balance indicate, positive, and zero?
Based on the available data (protein intake and nitrogen output), nitrogen balance can be used to assess the nutritional status of the patient. The formula for nitrogen balance is (protein intake in grams / 6.25) - (urinary urea nitrogen + 4). For example, (80 g protein intake / 6.25) - (26 + 4) = -17.2 = negative nitrogen balance. A negative nitrogen balance indicates erosion of body proteins and is associated with burns, serious injuries, fevers, hyperthyroidism, wasting diseases, and malnourishment. A positive nitrogen balance indicates a net gain of body proteins and is associated with periods of growth (infant, teenager, pregnancy, healing). A zero nitrogen balance indicates protein maintenance and equilibrium, such as in a healthy adult.
decreased_____ and increased____ would indicate starting PN with a patient
CRP and prealbumin. C-reactive protein (CRP) is a marker of acute inflammatory stress, and prealbumin is a marker of nutritional status. When CRP decreases and prealbumin increases, nutrition therapy is indicated.
During what stage of life is the gastrointestinal tract microbiome established and stable? Infancy? Childhood? Adolscence? Adulthood?
Childhood; age 3
who are eligible for the NSLP? age? range of federal poverty level for free and reduced?
Children preschool age through grade 12 Persons 20-years-old or younger who live in residential childcare and juvenile correctional institutions 185% of federal poverty income for reduced-price lunches and 130% for free lunches
The statement "Completion of a malnutrition screening within 24 hours of admission" is an example of a
Clinical quality measures, or CQMs, are tools that help measure and track the quality of health care services provided by eligible professionals, eligible hospitals, and critical access hospitals in our health care system. An example of a measure is the statement "Completion of a malnutrition screening within 24 hours of admission".
Difference between cognitive, affective, and psychomotor objectives
Cognitive objectives measure intellectual processes, such as knowing, perceiving, recognizing, thinking, conceiving, judging, and reasoning. Affective objectives measure feeling, emotion, attitude, appreciation, and value. Psychomotor objectives measure behaviors or physical skills.
An increase in solutes (BUN), tachycardia, and rapid weight loss are signs and symptoms of what?
Dehydration is caused by decreased water intake, excessive water output, and/or heavy solute load (BUN). Signs and symptoms include nausea, dizziness, sunken eyes, fever, hyperventilation, excessive seating, concentrated urine, dry inelastic skin, increase in solutes (BUN), tachycardia, headache, fatigue, decreased appetite, and/or rapid weight loss.
Diet orders may include what?
Dietitians may not be able to write orders if a state's licensure laws prohibit it. If order writing by RDs is not excluded by law, then they can be obtained by the facility's medical staff granting the privilege, which includes a review of credentials and qualifications. Even if the RD writes the diet order, that does not mean the RD doesn't also have to communicate that with the patient's care team. Order writing privileges for dietitians can include things beyond the diet prescription, such as ordering labs or formulating TPN orders.
Which population is most suseptible to vit A toxicity? why?
Elderly; Vitamin A liver storage and plasma levels increase with age. Due to decreased clearance of vitamin A from the blood, the elderly are more susceptible to toxicity. Therefore, of the choices given, the 86-year-old is most susceptible to vitamin A toxicity.
EAR
Estimated Average Requirements (EAR), expected to satisfy the needs of 50% of the people in that age group based on a review of the scientific literature.
What is the minimum amount of time recommended for a newborn baby to be exclusively breastfed?
Exclusive breastfeeding, or breastfeeding only, is recommended for at least the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods beginning at 6 months. Breastfeeding should continue for at least one year as long as mutually desired by mother and child.
Cause of macrocytic megaloblastic anemia
Folate/ B12 deficiency that impairs body ability to make normal RBC resulting in englarged and not enough RBC Folate and B12 ; FB (facebook) uses Macbooks with Megabytes
sickel cell anemia
Genetic Disorder: Autosomal recessive disease (both parents must be carriers). Production of an abnormal form of the hemoglobin (S hemoglobin)- causes red blood cells to become sickel shaped at low oxygen levels
difference is palliative care, curative care, and hospice?
Hospice care focuses on caring for people who are estimated to be within 6 months or less of life expectancy. Its purpose is to make people as comfortable as possible at the end of their lives. Palliative care focuses on reducing symptoms and helping the patient deal with negative impacts the illness is having on their day-to-day life. While hospice care occurs at the end of the lifespan continuum, palliative care can be provided at any time and can occur at the same time as curative care. Curative care is the active medical care and treatment for a medical condition where a cure is considered achievable.
Causes of repiratory alkalosis
Hyperventilation: Anxiety, fear, pain, Fever CVA- stroke
Iron deficiency anemia; who is at risk/diseases/ conditions? treatment?
Infants and children, adolescents, and women of childbearing age/People who have certain diseases and conditions, such as Crohn's disease, celiac disease, or kidney failure/People who don't get enough iron from the foods they eat/People who have internal bleeding Treatment: Iron supplements and dietary changes (eating food rich in iron and vitamin C, which increases iron absorption from food).
Loop Diuretics deplete what? what foods would be good to give then?
Loop diuretics deplete potassium and magnesium, so you should recommend foods high in these, such as a baked potato (potassium) with cheese.
Causes of metabolic alkalosis
Loss of gastric juices, potassium wasting diuretics, overuse of antacids, vomitting,
You review the most recent bloodwork for a patient on a ventilator in the ICU. In the bloodwork, pH is 7.0 and Paco2 is increasing. Based on this information, which of the following is most likely to be occurring?
Low pH is an indicator of acidosis, and increasing Paco2 indicates CO2 is being retained, which is a dysfunction in respiration. Therefore, you would suspect respiratory underventilation is likely to be occurring and causing respiratory acidosis.
what foods need to be decreased for peptic ulcers? Increased?
Nutrition treatment of peptic ulcers includes decreasing alcohol, spices, and caffeine (which includes coffee). Fermented foods, omega-3 and -6 fatty acids, and easy-to-digest foods should be increased.
what is insensible water loss? how much water per day does someone lose to this?
On average, a person loses between 0.8 and 1.2 liters of water per day due to insensible water loss. Insensible water losses include transepidermal diffusion (water that passes through the skin and is lost by evaporation) and evaporative water loss through the respiratory tract—in other words, water lost through skin and breathing.
A client comes to you interested in trying the Dr. Dean Ornish Program for Reversing Heart Disease. What type of dietary pattern does that diet follow, and does it fit the 2005 Dietary Reference Intakes (DRIs) for Energy, Carbohydrate, Fiber, Fat, Fatty acids, Cholesterol, Protein, and Amino Acids?
Protein: 10-35% of total calorie intake Carbohydrate: 45-65% of total calorie intake Fat: 20-35% of total calorie intake The Dr. Dean Ornish Program prescribes 10% of calories from fat, which falls below the recommended range of 20-35%.
The Standards of Professional Performance (SOPP) consist of the following six domains of professional performance for community and public health RDNs
Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources.
hemolytic anemia
RBCs destroyed prematurely (usually live up 120 days)
difference between RDI and RDA
RDA based on nutrient deficiencies but both take into account age, gender, and pregnancy
RDA
Recommended dietary allowance- the daily dietary intake level of a nutrient considered sufficient by the Food and Nutrition Board to meet the requirements of nearly all (97-98%) healthy individuals in each age and gender group and includes pregnancy. It is calculated based on the EAR and is usually approximately 20% higher than the EAR
S.O.A.P. notes (stands for what?)
S (subjective) includes tolerance of diet, what the patient reports (wt changes, appetite, chewing/swallowing problems, food allergies, diet history). O (objective) includes items that are defined, like the diet order, measured ht/wt, lab results, and calculated needs (kcal/protein). A (assessment) pulls information together with the nutritional assessment. P (plan) defines what will be done in regards to the nutritional assessment and includes follow-up plans.
indicators associated with risk of healing for lower extremity amputation
Serum albumin < 3.5 g/dL Total lymphocyte count (TLC) < 1,500 cells/mL Hyperglycemia (fasting glucose > 126 mg/dL) Patients who are having problems with prosthesis fit Any weight gain or loss > 5 lbs
Phosphate range / Consequence of hyper or hypo phosphatemia
Serum phosphorous generally ranges (in adults) from 2.5 to 4.5 mg/dL. hyperphosphatemia is soft-tissue calcification. Hypo- anemia, seizure, weakness, cardiac issues
A nutrition intervention for IBS includes limiting______
Short chain carbohydrates (lactose, fructose, fructans, galactans, and polyols) from the diet. Low FODMAP recommended like (fermentable oligo,di,mono and polyols) limits foods: Fructose: Fruits, honey, high-fructose corn syrup, agave. Lactose: Dairy. Fructans: Wheat, onions, garlic. Galactans: Legumes, such as beans, lentils, and soybeans. Polyols: Sugar alcohols and fruits that have pits or seeds, such as apples, avocados, cherries, figs, peaches, or plums.
Causes of metabolic acidosis
Starvation, dehydration, diarrhea, shock, renal failure, and diabetic ketoacidosis.
T/F foods that include more than 20% the DV for fat, saturated fat, cholesterol, and sodium cannot make health claims
T
Texting patient information to the responsible medical team is a HIPAA violation T or F
T; Texting patient information is a HIPAA violation because texting is not safeguarded and therefore PHI could be exposed to cyberspace.
T/F A food product cannot claim that the product itself helps prevent disease.
T; They can say Diets low in sodium may reduce the risk of high blood pressure." but cant actually say this food reduces low blood pressure
5 steps of MI
The 5 principles of motivational interviewing are to express empathy, develop discrepancy ( building awareness of current state and talking through goals), avoid argumentation, roll with resistance (Rolling with resistance is affirming the client's freedom of choice and telling the client reluctance is normal), and support self-efficacy.
The NDD solid conistency outline and liquids consistency outline
The National Dysphagia Diet (NDD) has 3 levels of solid consistency: (Dysphagia Advanced, Dysphagia Mechanically Altered, Dysphagia Puree); and 4 levels of liquid consistency: Thin liquids, Nectar-thick liquids, Honey-thick liquids, and Pudding-thick liquids.
According to the RDA for protein, how many calories of protein should a diet provide for a 195.8-pound adult?
The RDA for protein is 0.8 grams per kilogram of body weight (10-15% of total energy intake) per day. To find the recommended number of protein calories per day for the 195.8-pound adult: Convert pounds to kilograms: 195.80 pounds / 2.2 kilograms = 89 kg Calculate the required protein grams: 89 kg x 0.8 grams protein/kg body weight = 71.2 grams protein Convert grams to calories: 71.2 grams protein x 4 (4 calories/1 gram protein) = 284.8 calories ~ 285 protein calories per day
The Campinha-Bacote model of cultural competence has five constructs- what are they and what do they include
The five constructs of the model are awareness, knowledge, skill, encounter, and desire. The skill construct encompasses collecting cultural data and assessing a client's therapeutic uses of foods. Awareness involves assessing your own cultural background and beliefs. Knowledge involves assessing the client's beliefs and explanations about their illness and/or dietary practices. Encounter involves considering how many face-to-face encounters you have had with the client's culture. Desire involves continuing learning, as culture is continuously evolving and changing.
what are the six stages of change
There are six stages of change: Precontemplation: The client has not given any thought to change. Contemplation: The client has thought about change, but has not taken any action. Preparation: The client has begun to take some steps to change. This is illustrated by the statement the client gives. The client has tried making changes but is having some difficulty. Action: The client has made the change and continued the change for the past 6 months. Maintenance: The client has continued the change for more than 6 months. Relapse: The client has gone back to previous habits.
_____ are diabetic medications not permitted for patients with CHF
Thiazolidinediones (Actos) improve peripheral insulin sensitivity. This oral glucose-lowering medicine can worsen CHF by promoting weight gain and edema; therefore, it is not appropriate for patients with type 2 diabetes mellitus (T2DM) and congestive heart failure (CHF).
UL
Tolerable upper intake levels (UL), to caution against excessive intake of nutrients (like vitamin A) that can be harmful in large amounts. This is the highest level of daily consumption that current data have shown to cause no side effects in humans when used indefinitely without medical supervision
perniscious anemia? what type of anemia/cause?
Type of megaloblastic anemia; causes by lack of B12. Could be causes by lack of intrisic factor with conditions such as atrophic gastritis.
Once BMI is calculated, which of the following pieces of information would help make a more accurate interpretation of someone's weight status?
Waist-to-hip ratio BMI alone does not fully assess body composition. For example, someone can have a large percent of muscle mass, and thus a high BMI. However, it would not be appropriate to interpret their weight status as overweight or obese (depending on the number). Information about body composition is necessary to make an accurate interpretation of weight status. Body composition can be further assessed with waist-to-hip ratio, bioelectrical impedance or other options.
weight gain guidlines based on BMI for pregnant woman
Weight gain guidelines for normal-weight females (BMI 18.5-24.9) is 25-35 lbs, for underweight females (BMI < 18.5), 28-40 lbs, and for obese females (BMI ≥ 30), 11-20 lbs.
what is esophageal varices? what is the cause?
When blood cant enter the liver due to scar tissue or a clot and causes swelling of the veins to esophagus, abdomen, and collateral veins
hypercalcemia occurs with what disease
addison's disease- a disease where the body attacks the adrenal glands aka hypocortisol disease
Takign herbal supplments instead of perscribed medication is what?
alternative medicine
holistic medicine
an approach to health care that emphasizes prevention of illness and takes into account a person's entire physical and social environment and is the broader term for integrative and complementary medicine
crossing and uncrossing legs is a nonverbal example of what during counseling wheras moving a chair far away would be an example of
anxiety; discomfort
Good sources of Potassium?
banana, melons, oranges, apricots, kale, spinach, broc, potatoes, beans
What are good sources of mg?
beans, greens, seeds, whole grains
what types of foods are galactans? fructans?
beans, lentils and soy wheat, garlic, onion
____ diabetic meds helps to control the amount of glucose in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver.
biguanides like metformin
foods high in calcium
dairy, greens, salmon
side effects from cirrhosis
decreased, appetite, malnutrition, severe weightloss
A patient has hyperalbuminemia and hypernatremia. What would you infer about his nutritional intake?
dehydrated (hypovolemia)
Diet suggestions for someone who is constipated
dried fruit, bran, increase fluid, increase movement
BMI > 95th percentile has been linked with ____puberty in females
early
foods hi in vit a
greens and orange, yellow pigments, carrots, tomato etc.
foods high in vit k
greens, leafy greens
Which nutrients are needed and limited for each type of dialysis?
hemo- increased protein to 1.2-1.5 g/kg BW low potassium, low phosphorus, and low sodium, fluids restricted Peritoneal- increased protein to above, high potassium, low phosphorus, and low sodium. less fluid restriction but not added
2 types of dialysis?
hemodialysis and peritoneal dialysis
What gives RBCs their red color? lack of Iron and thus hemoglobin would result in?
hemoglobin hypochromic anemia
Causes of respiratory acidosis
hypoventilation
Nutrition screening purposes
identify individuals with, or at-risk for, nutritional problems. It helps provide cost-effective nutrition services to only those individuals identified at risk. It also transfers legal responsibility for care to the nutrition professional.
Thiazolidinediones like actos do what
improve peripheral insulin sensitivity.
Phosphate and Calcium relationship
inversely related
Adolscent girls are most likely to benefit from what supplementation?
iron and calcium supplementation.
you expect to see a patient with increased serum transferrin with what? and why?
iron deficiency; Serum transferrin is a visceral protein that binds and transports iron. During iron deficiency, there is an increase in transferrin because body is trying to up-regulate it
Cause of microcytic hypochromic anemia (meaning and cause)
iron defiiciency; this means the body produces small RBC that lack red pigment.
elevated blood urea nitrogen, creatinine, potassium, magnesium, and/or phosphorous may indicate issues with the______ and thus the patient would need to follow a _______ diet
kidneys such as AKI or renal failure; renal diet of decreased sodium, potassium, and/or phosphorous (sometimes protein depending of stage)
Kate was told by a health practitioner to avoid blue cheese, sauerkraut, sausage, and soy sauce. What type of diet might she be following and why
low tyramine diet for migraines. Tyramine is a protein found naturally in foods, especially foods that are aged, fermented, or stored for long periods of time. Examples of high-tyramine foods include blue cheese, sauerkraut, sausage, and soy sauce.
Steatorrhea. what is it and what types of disorders would you expect with this?
malabsorption disorders like Chrons, IBS, cystic fibrosis, etc
foods high in iron
meat, greens, beans
integrative and complementary medicine
non mainstream therapies alongside conventional medicine
Insulin secretagogues, such as Glucotrol are diabetes meds that do what
promote insulin secretions and work to lower BG
RDI
recommended dietary intake. RDI (Reference Daily Intake) is a population-adjusted RDA based on all ages and sex groups of RDA values. It is numerically identical to the highest RDA value for any group. It was developed for food-labelling purposes. (Note: RDA's differ among groups of people, such as men, women, children, the aged, different races, etc.)
_____is the most sensitive nutrient to sunlight damage
riboflavin
___ class of diabetic meds increase insulin secretion
secretagogues like glucotrol: sulfonylureas are also a type of secretagogue
According to Friedan's Pyramid, addressing which of the following would have the largest impact on improving public health?
socioeconomic factors
Glimepiride or Amaryl are diabetetic meds that do that
stimulates the pancreas to make more insulin, thereby causing the possibility of low blood sugar.--- pt need education of low bg
____ class of diabetic drugs cause the body to increase production of inslulin. These include what drugs
sulfonylureas like Amaryl (glimepiride)
People taking MAO inhibitors should avoid foods containing_____ why? what is MAO inhibitors used to treat?
tyramine ( a monoamine) and byproduct of aa tyrosine. found in aged, smoked, or fermented products. Could cause high blood pressure, headache nausea, etc depression and parkisons disease
Patient history assessment (part A of assessment includes)
weight changes (patterns of loss or gain), dietary intake (duration and degree of changes), GI symptoms (N/V/C/D), and energy/functional capacity (presence of weakness or fatigue).
anemia
you lack RBC to supply body with sufficient oxygen
