Nutrition Final
Gastrointestinal surgeries can most profoundly affect nutritional status by impairing?
absorption
What is the most abundant plasma protein?
albumin
What foods affect lower esophageal sphincter pressure?
alcochol, chocolate, fried or fatty foods, peppermint, spearmint
Patients should be advised that which of the following foods contribute to the fluid allowance in fluid-restricted diets? a. Gelatin/Jello b. Popsicles c. Sherbet d. Fruit ice e. Ice cream
all the above
Nutrition therapy, as a treatment for nephrotic syndrome, focuses on____ and ____.
alleviate edema, and prevent PEM (.8-1.0g/kg), <7% sat fat, avoid trans fat, cholesterol <200 mg/day, NA 1000-2000 mg
Your patient presents with acanthosis nigricans. What is this a sign of?
Diabetes
Tom has developed acute renal failure as a result of prostate cancer. He complains of having a metallic taste in his mouth, nausea, fatigue and headaches. What might he be suffering from?
Uremia: nitrogen containing and other waste products in blood.
The part of the grain that remains after being subjected to refining is the ______.
endosperm
The addition of liberal amounts of calcium and vitamin D to commercially available orange juice products by juice processors is most properly termed nutrient ______.
fortification
Anemia after gastrectomy is usually associated with a deficiency of (3 things)?
gastric acid, iron and vitamin B12
Where are omega-3 fatty acid sources found (both animal and plant)? Be prepared to talk to your patient about how to incorporate these foods into their diet.
human milk, shellfish, fish (makeral, salmon, blueifsh, anchovy, herring, lake trout, tuna), flax oil, seeds, walnut oil/seeds, canola oil, soybean oil
What is the "gold standard" for the estimation of resting energy expenditure?
indirect calorimetry -measures REE, measures ox consumption and CO2 production,
The main barrier to gastric reflux is?
lower esophageal sphincter
What are the sources of information used for collecting data for a nutrition assessment?
medical record, physical exam, lab analysis, medical procedures, interview, consultations
Name significant food sources of calcium. What are the consequences of inadequate intakes?
milk, cheese, yogurt, tofu, corn torillas,nuts, seeds, bread, kale, parsley, broccoli
A tool for quickly identifying clients at risk for malnutrition so that they can receive complete nutrition assessment is called a?
mini nutritional assessment
A milk substitute high in fat and low in protein is?
mocha mix
What is the equation for body mass index? Calculate your BMI. In which category did you fall?
BMI: lbs/in ^2 x 703
What are the Seven (7) Diabetes Self-Care Behavior Measures of Diabetes Self-Management Education?
Being active Eating Medication taking Monitoring of blood glucose Problem solving for BG increased and decreased and sick days Reducing risks of diabetes complications Living with diabetes(Psychological adaptation)
What are some of the causes of hypoglycemia in someone with diabetes? Symptoms? What is the 15:15 Rule for treatment of hypoglycemia?
Causes: omitted or inadequate food, increase physical activity errors with meds, erratic or altered absorption of insulin or food SS: cold, clammy, weake trmeo, palpitations Tx: 15:15 give 10-15 fast acting carbohydrate wait 15 min then retest <70 repeat
Discuss the causes of irritable bowel syndrome and how diet modification can be used for treatment.
Causes: stress, anxiety, Tx: no insoluble fiber, liberaly amount of fruits and vegtables, limit or omit spicy foods, eat slowly to avoid swallowing air, avoid alcohol, avoid high sugar, adequate fluid intake
What is the Daily Value for sodium? UL?
DV:2400mg UL: 2300mg
Where does the majority of sodium come from in a typical diet?
processed foods
What are causes of atherosclerosis?
Inflammation, and infection (Plaque is an inflammatory response) shear stress(stress of blood flow along artery walls) smoking(decrease oxygen carrying, increase HR, cell changes, vasoconstriction) Diabetes(promotes vasoconstriction plaque rupture and blood clotting)
Describe dumping syndrome. How is it prevented?
abnormally rapid gastric emptying time, caused by hypertonic gastric content rushing into the intestines after meals. To prevent=small frequent meals, limit fluids during meals, restricted sugars, avoid juices and sodas, sit upright, protein rich foods
What are contributing factors for the development of hypertension?
aging, genetic factors,, obesity, salt intake, alcohol, dietary factors,meds, hormonal disorders
T/F: Hormonal responses to stress include the release of aldosterone and antidiuretic hormone to help maintain blood volume
aldosterone (sodium) and ADH (water) to maintain blood volume by stimulating kidneys to reabsorb more sodium and water
What therapies are used in the management of peptic ulcer disease?
antibiotics to rid of H.pylori, proton pump inhibtor, bismuth subsalicylate and metronidazole, small meals, dont eat 2 hours before bedtime
What is the primary reason why dysphagia is life-threatening?
aspiration
Cardiovascular disease usually involves?
atherosclerosis
Foods high in potassium which may be of concern for renal patients are?
avocado, banana, beet, greens, kiwi, mango, melon, papaya, artichoke, dried bean, pumpkin, milk
What are some lifestyle modifications for the treatment of GERD?
avoid eating bedtime snacks, or lying down right after meals,consume meals 2-3 hours before bedtime, consume small meals and drink liquids between meals, relax during meals and elevate head, prop pillows, avoid tight clothing
What is the appropriate diet therapy for the treatment of calcium oxalate kidney stones
avoid foods high in oxalate, avoid vitamin C, increase calcium but dont take calcium supplements.
What do the terms major and trace mean when describing the minerals in the body? Is one class more important than the other?
major: essential mineral nutrients the human body requires in large amounts (>100mg) Ex: na, cl, k, ca, po2, mg) Trace: essential minteral nutrients the human body requires in relatively small amounts (<100mg) none is more important than the other
Providing enough, but not an excess of a food is a diet-planning principle known as?
moderation or balance
What is meant by the term "nutrient density"? Give 3 examples each of foods with a high nutrient density and a low nutrient density.
more nutrients and the fewer kcalorie the higher the nutrient density. Ex: milk, egg, fruits are high density, Donuts are low
What are phytochemicals? Give examples.
non-nutrient compounds found in plants. (Whats added to fortified foods) ex: Margarine with plant sterols
What is the protein need for a patient presenting with acute stress?
nonobese: 1.2-2 g/kg obese 2-2.5g/kg burn:2-3g/kg
What is the diagnostic criteria for diabetes (fasting blood sugar)?
normal FBG <100 mg, >125 diabetes 2hr Pg normal <140, >200 Diabetes A1c<5.5%, Diabetes >6.5%
If a food label advertises a product as a "rich or excellent source of fiber", this is an example of a _____ claim
nutrient
What are the four parts of the Nutrition Care Process?
nutrition assessment, diagnosis, intervention, monitoring and evaluation
The initial stage of kidney failure in which urine output is reduced or absent is called?
oliguria
What are the names of the mineral "binders" that may affect calcium absorption from foods?
oxalates: (Beet greens, collard greens, Rhubarb, spinach, swisschard) Phylates: (legumes and grains)
Atrophic gastritis is most commonly found in what group of people?
people with autoimmune disorders
What might the purpose be of a vagotomy?
performed to supress gastric acid secretion
The removal of excess fluids and wastes from the blood using the peritoneum as a semipermeable membrane is called ________
peritoneal dialysis
In a health care facility, who holds the ultimate responsibility for ensuring that all the patient's nutritional needs are met?
physicians
Hyperkalemia is often treated by using?
potassium exchange resins (Bind k in GI tract) ex: kayexalate
Which protein has the longest half-life, reflecting of long-term protein malnutrition?
prealbumin and retinal binding protein??? (CHECK)
What is steatorrhea and why might it occur?
presence of excessive fat in the stools. caused by fat malabsorption (inflammatory bowel disease, AIDs, radiation tx for cancer)
Define probiotics and identify their dietary sources. What are the possible health consequences of probiotics intake, and what has research revealed about their effects on the body?
probiotics are living microorganisms found in foods or supplements. Change conditions of bacterial colonies in the GI tract They alleviate diarrhea, constipation, inflam BS, ulcers, allergies, lactose intolerance Ex: yogurt, milk, icecream, oatmeal, gruel, soft drinks
Name examples of foods that provide a source of High Biological Value protein
protein in form of high quality (eggs, meat, poultry, fish, milk)
What is the Medical Nutrition Therapy for uric acid stones?
purine restricted diet
What is hypogeusia? What mineral is involved in improving sensation of taste?
reduced ability to taste things, Zinc
Discuss the meaning and significance of foods that are refined, enriched, fortified, or whole-grain.
refined: Coarse parts of food are removed. lose many nutrients during processing enriched: the addition to a food of specific nutrients to replace losses that occured during processing Whole grain: have all the nutrients and fiber found in the original grain
What are some consequences of untreated GERD?
reflux esophagitis, esophageal ulcers, scarring of ulcerated tissue, strictures, baretts esophagus, pulmonary disease, damage
What is used to diagnose the cause of dysphagia?
barium swallow study, endoscopy, neurological exam
How can vegetarians conform to the principles of MyPlate?
beans and nuts for protein
Name some foods high in oxalates
beets, celery, spinach, Rhubarb, beet greens
Sources of phosphorus include?
bran, brown rice, buckwheat groats, bulgur, wholegrain breads, corn tortillas, canned lemonade/ice tea, tofu, corn meal
Describe foods that may reduce odors in a patient with a colostomy.
buttermilk, cranberry juice, parsley, yogurt
Which protein is a "marker" of acute inflammation, and becomes elevated only when the body is fighting disease?
c-reactive
Polycystic kidney disease is characterized by the formation of multiple ____ in both kidneys. It is a ______ condition.
cysts, autosomal dominent
What are the lifestyle changes recommended for people with the Metabolic Syndrome?
decrease weight, decrease intake of sugar/refined grains, increase intake of whole grain,, fish weekly, increase in fruit, vegetables, low fat milk, physical activity , drug therapy.
In the oliguria stage of acute renal failure, urine volume is _____ and sodium needs are _____.
decrease, ?
A factor that predisposes people to kidney stone formation is?
dehydration or decrease urine output, obstruction, urine acidity, metabolic abnormalities, renal disease
Food exchange systems were originally developed for people with _____.
diabetes
What are the most common causes of chronic kidney disease?
diabetes and hypertension, hereditary, inflammatory, glomerulonephritis, tumor, PKD
What health care professionals assist with nutrition care?
dieticians, dietic techs, nurses, pharmacists, physical therapists, social workers
What is cystic fibrosis, and how is nutrition therapy used to minimize its symptoms?
disease of exocrine glands, problem with chloride pump, abnormal NACL levels, obstructs ducts, damage tissues and organs Nutrition:high calorie, protein, fat diet. Pancreatic enzyme replacement, frequent meals and snacks, supplement meals for milkshakes, vitamin supp, liberal use of salt
A group of symptoms that results from abnormally rapid gastric emptying and is a common complication of both gastrectomy and gastric bypass surgery is?
dumping syndome
Pain, bloating, or discomfort in the upper abdominal area is termed?
dyspepsia
The consequences of nephrotic syndrome include?
edema( due to fluid shift secondary to albumin loss in the urine) risk of CVD(increase LDL &VLDL, decrease HDL, Increase triglycerides, Blood Coag) susceptibility to infection, rickets in children & PEM (due to loss of antibiotics, vitamin D, binding protein)
Catecholamines-epinephrine and norepinephrine-are responsible for ____ blood glucose Elevated Decreased Absorbing None of the above
elevated
What hormone secreted by the kidneys stimulates the production of red blood cells?
erythropoeiten
The hormone secreted by the kidneys that stimulates the production of RBC is called?
erythropoietin
Your patient is 5'2" tall and weighs 167 pounds. How many units of rapid acting insulin will they need to inject before a meal containing 2 slices bread, 1 cup milk, and a small banana?
every 15g of CHO requires 1 unit of rapid or short acting insulin
The principle goal of nutrition therapy in a patient with acute stress is to (select all that apply) Preserve LBM Maintain immune defenses Overfeed at first to establish nitrogen balance Promote wound healing
everything but overfeed
Give examples of some overt signs of malnutrition - clinical features.
ex-weakness, pallor, headaches
What is Zollinger-Ellison syndrome and what characteristics are associated with this condition?
excessive acid secretion due to gastrin secreting tumors in either duodenum or pancreas
What is the purpose of documentation in the nutrition care process?
facilitates communication among the members of the health care team, serves as a record for future reference
A recommendation for clients with hypertension is a low-sodium diet that contains food that contain which specific minerals?
fiber, potassium, magnesium, and calcium. Fish and omega 3 fatty acids (3000-4000 a day) deccrease inflammation, reduces blood clotting, decreases triglycerides, stablizes heart rhythm, reduces BP
What are the guidelines for a post-gastrectomy diet?
fluids and foods withheld until healing occurs, fluids given IV, ice chips/small sips 24-48 hours afterward, solid food 4-5 days after
List foods and their amounts recommended under the DASH diet.
for 2000 calorie diet Grains 7-8 Veg 4-5 fruits 4-5 milk 2-3 meat 1-2 nuts 4-5 per week fats/oils 2-3 sweets 5 a week
List the sources of water intake and routes of water excretion.
fruits and vegs (90%), meats and cheese (50%) Excretion: urin, skin as sweat, lungs in breathing (vapor), feces, disease conditions and injuries
What foods are emphasized in the DASH diet to lower hypertension?
fruits, vegtables, lowfat milk, with reduced sat fat intake
What foods/practices contribute to high uric acid levels?
gout, purines (Meat, poultry, seafood), animal protein, leukemia, lymphoma, increase fructose corn syrup (juices)
Obesity rates in America continue to climb and with it the risk of chronic disease. What are the leading causes of death where nutrition plays a role?
heart disease, cancers, strokes, diabetes
How can illness lead to malnutrition?
illness can lead to malnutrition by reducing food intake, interfering with digestion and absorption and altering metabolism and excretion
Describe how malnutrition impacts the body's immune response, and how resulting infections can affect the nutrition status?
impairs immune function, Increased risk for infection can worsen malnutrition
What effect may glutamine have on immunity and small intestinal cells?
improve function, provides primary fuel for small intestine epithelial cells, preservation of muscle mass
What are signs/symptoms of dysphagia?
inability to initiate swallowing, coughing, nasal regurgitation, bad breath, gurling noise, hoarse voice, speech disorder
Define the term iatrogenic.
induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures EX: staph, MRSA, VRE, C-Diff
What are the Dietary Guidelines 2010 for sodium?
intake <2300mg/day >51, african americans >2y/o, people >2y/o with increase BP, diabetes, CKD require it to be <1500mg
What happens to glucose levels in response to stress?
it increases glucose levels, causes insulin resistance because stress increases cortisol and cortisol causes this
Intakes of supplemental vitamin C are restricted in patients with chronic renal failure to prevent?
kidney stones
How does ascites differ from other types of fluid retention?
large accumulation of fluid in the abdominal cavity. Liver damage is in critical stage.
What are the most common anthropometric measures used?
length, height, weight, head cirumference, waist and limb circumference
Which level of the National Dysphagia Diet is for patients with mild dysphagia?
level 3
Describe the events leading to the development of bone disease in patients with CKD
loss of function leads to decrease in vitamin D, decrease in Ca absorption, decrease PO2 excretion, increase in PO4, so theres decrease in ca so Increase in pTH, increase in Ca resorption from bone leading to Increase ca in tissue and bone demineralization
What are the six diet-planning principles?
Adequacy, balance, calorie control, nutrient density, moderation, variety
In which disease might the term"wet vocal quality" be used?
dysphagia
To regulate blood pressure, the kidneys secrete?
renin
List the AHA Guidelines for Women with a history of preeclampsia, PIH, and diabetes during pregnancy (2011)
-1500 mg sodium -sugar limited to 5< serving a week -folic acid, vitamin E, vitamin C and beta carotene should NOT be used, -hormone therapy NOT used -healthy diet consumed supplement arent needed -exercise daily and consume less sat fat <7% -increase fresh veg, fruit,, low fat dairy -restricted alcohol and sodium, -eat oily fish/omega 3 fatty acid 2x a week -with existing HD take omega 3 fatty acids (1000mg/day)
What are the stages in the development of a nutrient deficiency?
1. primary or secondary deficiency caused 2. declining nutrient stores and abnormal functions inside body 3.physical signs and symptoms
What are blood glucose goals for critically ill patients?
144-180mg
Malnutrition has been reported in what percentage of hospitalized patients with acute illness?
15-60%
Burn patient weighing 132 lbs with BSAB of 54% will need how much fluid in the first 8 hours of treatment?
2-4 mL lactated ringersxkg body weightx BSAB 1/2 admin for 1st 8 hours rest over 16 hours EX:60x4=240x54=12960/2=6480
Calculate the carbohydrate allotment (in grams) of someone prescribed a diabetic diet containing 2,100 calories with 50% of calories as carbohydrate.
2100x50%=1050 1050/4=262.5 262.5/15=17.5g
What is the Tolerable Upper Intake Level for sodium?
2300 mg/day
How does a 24-hour recall differ from a food record? Food frequency questionnaire? What are some advantages/disadvantages to these tools?
24 hour recall: It's a guided interview in which the foods and beverages consumed in 24 hours are described in detail. Advantages: Doesn't influence dietary choices, quick, no reading or writing Disadvantages: memory, over and underestimation could omit food Food frequency questionaire: written survey of food consumption during a specific period of time, one year period Advantages: Not influence choice, seasonal variabliltiy, not affected, inexpensive to admin Disadvantages: relies on memory, comon food only serving size, hard to tell, nutrient intakes not accurate Food Record: written account of food consumed during a specified period (several days) Advantages: does not rely on memory, recording improves accuracy, keeps them accountable Disadvantages: writing influences choices, underreporting, requires high motivation
Nutrition screenings should be completed on each client within ___ after admission?
24 hours
What amount of physical activity is recommended under the TLC to lower blood pressure?
30 minutes aerobic
How many grams in one ounce?
30g
How many grams in an ounce? Will the calorie value of one cup of uncooked rice be the same as one cup of cooked rice?
30g=1 oz yes
Approximately how many milliliters in a fluid ounce?
30mL
The symptoms of renal failure may not appear until over _____ of the kidney function is lost.
50%?
1 ounce of meat, poultry, or fish contains approximately ____ grams of protein 1 cup of milk contains ___ grams of protein; ____ of sodium; potassium?
7g. 8g protein,120 na, 400K
Which foods/substances lower LDL cholesterol?
< 7% sat fat, <200 cholesterol, 10-25g soluble fiber, 2g plant sterols
What is considered a normal fasting blood sugar?
<100
What is a normal fasting blood sugar?
<100mg/dL
Uremia develops during the final stages of CKD when GFR is below _____ milliliters per minute and blood urea nitrogen exceeds _____ milligrams per deciliter.
<15, >60
Blood urea nitrogen levels of _____ indicate the development of uremia.
>60
Which non-dairy sources of calcium (foods) would you recommend to your patient who avoids dairy products?
?
Compare and contrast the medical nutrition therapy for acute vs. chronic pancreatitis.
Acute: NPO until tenderness and pain are gone, fluid and electrolytes iV, 3-7 days (mild) pts can have small sips of water, small frequent feedings, low fat, (severe) jejunal tube feedings, high protein and high calorie Chronic: enteric coated [ancreatic enzymes (CREON), small low fat meals, avoid alcohol and smoking
What is ADH? Where does it exert its action? What is aldosterone? How does it work?
ADH: released when blood volume or BP falls too low, or when extracellular fluid is too concentrated, its a water conserving horomone, stimulates kidneys to reabsorb water. aldosterone: angiontensin II stimulates release from adrenal glands. Signals the kidneys to excrete potassium and retain sodium and therefore water
What are the dietary guidelines for someone with AKI and CKD
AKI:protein (not dialysis): .8-1.0g/kg on dialysis:1.0-1.7 calories: 20-35/kg fluids: measure urine and add 400-500 mL na: 2000-3000 K:2000-3000 PO4:8-15mg/kg CKD: (pre-dialysis) GFR <25mL/min Protein: .6-.75g/kg calories the same Na<2400 K: unrestricted ca: 1000-1500 PO4:<10mg/kg increase folic acid, vitamin B6, IRon and Zinc
T/F Grapefruit juice is an acceptable fluid source for prevention of kidney stones.
AVOID grapefruit, they increase stone formation
Discuss the vitamin and mineral needs of a patient on hemodialysis and how to decrease the likelihood of nutrient deficiencies.
Calories: < 60y/o =35/kg >y/o=30-35/kg protein=1.2-1.4 fluid:urine output plus 1000mL Na:<2400 K:2000-3000 PO2:800-1000 Ca:<2000
C-reactive protein level in a healthy person should be?
C-reactive protein. protein produced during inflammation. it binds dead or dying cells to activate certain immune responses. Positive acute phase protein, helps clear necrotic cells
Calculate the number of calories for a meal offering 45 grams of carbohydrate, 24 grams of protein, and 8 grams of fat. Add 5 grams of alcohol. Now how many calories does the food item provide?
CHO: 45g*4=180 PRO: 24g-4= 96 FAT: 8g*9=72 ALC:5g*7=35 383 calories total
How many calories are in a gram of carbohydrate, protein, and fat? A gram of alcohol? Is alcohol a nutrient? Why or why not?
CHO= 4kcal/g PRO=4kcal/g FAT=9kcal/g Alcohol=7kcal/g
Protein allowance is restricted to a greater degree in which particular renal condition?
CKD
If left untreated, hypertension can lead to?
CVD kidney failure
How is energy in foods measured? What is the name of the device used to measure the energy value of foods?
Calories, BOMB calorimeter
What is the difference between a covert sign of a nutrient deficiency? An overt sign?
Covert: Hidden, my be detected by lab tests Overt: out in the open, easy to observe
Give examples of inflammatory bowel diseases and discuss symptoms, complications and nutrition therapy.
Crohns: occur in any spot og GUI (ileum and colon) can cause ulceration, fissures, fistulas s/s: diarrhea, abdominal pain, weight loss Complications: narrowing of lumen, strictures, surgical resections, malnutrition, malabsorption of fat,fat soluble vitamins, anemia, Increase for cancer Nutrition:low fiber, small frequent meals, high calories and protein, fluid replacement, fish oil Ulcerative Colitis: involves rectum and extends into the colon, tissue erosion or ulceration s/s: diarrhea, rectal bleeding, abdominal paiin Complications: weight loss, fever, weakness, anemia, dehydration, protein losses Nutrition:replace fluid and electrolyte losses, correction of deficiences due to protien, low fiber diet, bowel rest
What is the Somogyi effect and how is it different from the Dawn Phenomenon? How would the patient treat one or the other?
Dawn Phenomenon: happens as part of the body's normal circadian rhythm to wake you up. GH and cortisol are released to raise glucose. Check 3 AM BG -BG may be normal or increased between 2 Am and 4 am with further elevation overnight Somogyi effect: result of nighttime hypoglycemia which causes the secretion of hormones that stimulate glucose production
What is happening to the patient with type 1 diabetes during an episode of diabetic ketoacidosis?
Develops quickly, due to lack of insulin ketone bodies accumulate making blood acidic. Metabolic acidosis. -Hyperglycemia >250mg, dehydration, nausea, vomiting, fruit breath, rapid deep labored breathing
What is the medical nutrition therapy for diverticular disease? For diverticulitis?
Diverticular disease: increase dietary fiber, bulk forming agents Diverticulitis: antibiotics, meds for pain control, fluid and electrolyte balance, clear liquid diet. Low fiber diet until inflammation and bleeding subside
The DRIs are a set of four nutrient intake values that can be used to plan and assess diets for healthy people. Be able to describe/define each of the four values.
EAR(estimated Average Requirements)=everything averaged not basing on gender or age. RDA( Recommended Dietary Allowances)= Once nutrient requirement is established committee decides what ti recommend to everyone AI(Adequate intake)=Average amount of substance consumed that doesn't have evidence to support UL(Tolerable upper intake levels)
What are functional foods? Give examples.
Functional Foods: Foods that contain bio active components that provide health benefits beyond their nutrient contributions. Ex: whole foods, tomatos oatmeal, modified foods, fortified foods
What is happening to the patient with type 2 diabetes during hyperosmolar hyperglycemic state (HHS or HHNS)?
Evolves slowly, prolonged hyperglycemia >600. Severe dehydration absence of or slight ketosis, confusion /coma
Give examples of legumes. To what food groups do they belong?
Ex: black beans, soybeans, split beans, tofu, kidney beans. In vegetable category
True or False? Your patient has Celiac Disease. You would offer him oatmeal from the menu.
False
At what waist measure do health risks rise in the adult male? Female?
Females= waist 35 in or WTH ratio .8 or > Males= waist 40 in or WTH ratio .9 or >
Explain the concept of empty calorie allowance.
Foods that contribute energy but lack of protein, vitamins, and minerals
What are the causes and characteristics of a woman with gestational diabetes? What are her educational needs in treating and managing her condition? What can happen to her baby if her diabetes isn't managed during pregnancy? What are her risks for the future?
GDM: Risk = family history of diabetes, obese, ethnic (AA, asian, indian, hispanic, native), give birth to baby weighing > 9lbs Baby: respiratory distress, hypoglycemia, jaundice, hypocalcemia, macrosomnia, shoulder dytocia, childhood obesity -Limit cho intake especially at breakfast, aerobic activity
A food label's %DV for calcium is 18%. This is considered a ___ source for this particular nutrient.
Good/high
Describe the Metabolic Syndrome. What are the features of Metabolic Syndrome?
Group of disorders that substantially increase risk of develops CVD and DM2 Features: When 3 or more of these Hyperglycemia (FPG>100) abdominal obesity hypertriglyceridemia( >150) reduced HDL cholesterol<(40 in men, <50 in women) Hypertension
What are major causes of peptic ulcer disease?
H.pylori and NSAIDS
What is the interrelationship between atherosclerosis and hypertension?
HTN intensifies the stress of blood flow on arterial tissue, provoking a low grade inflam state that may stimulate plaque formation
Compare and contrast the different types of dialysis. Know advantages of one type over another.
Hemodialysis: blood is circulated through a dialyzer where it is bathed by dialysate a solution that removes fluids and wastes. Must visit dialysis center Peritoneal: dialysate is infused into a persons peritoneal cavity and blood is filtered by the peritoneum after several hours the dialysate is drained removing unneeded fluids and wastes. Doesnt need vascular access, fewer diet restrictions, can be scheduled when convient
What Four nutrition assessment methods are used to detect malnutrition in individuals
Historical info, anthropometric measurments, physical examination, lab tests
For patients with intractable vomiting, which method of nutrition support would be most appropriate?
IV nutrition support
Which type of patient should be cautious about consuming probiotics?
Infection in immune compromised individuals (AIDS, cancer, organ transplantation)
Discuss possible diet and lifestyle modifications for the treatment of constipation
Increase Fiber (wheat, bran, fruits, veg), Adequate fluid (1.5-2L), prunes, physical activity
What are modifiable risk factors in CHD?
Increase LDL, increase VLDL(Triglyceride), decrease HDL, hypertension, diabetes, obesity, physical inactivity, cig smoking, alcohol overconsumption, atherogenic diet
A young adult with spoon-shaped, ridged, brittle nails might be deficient in?
Iron
Be prepared to know what foods are appropriate for Level 1, 2, and 3 of the National Dysphagia Diet.
Level 1: pureed, well mashes Ex: Cream of what, slurried muffins, pureed scrambled eggs, pureed meat, slurried crackers Level 2:moist, softened Ex: moist oatmeal, cornflakes or puffed cereal, moist pancakes, ripe bananas, easy to chew meat, minced meat, canned peaches Level 3: moist, bitesized pieces Ex: cereal, pouched or scrambled eggs, soft fruit, chicken noodle soup
Identify the consequences of fat malabsorption and describe dietary recommendations used as treatment.
Losses of food energy, essential fatty acids, fat soluble vitamins (KADE) and minerals (Ca, Mg, Zinc) Tx: dont restrict fat and MCT's may be helpful
What minerals are required to be listed on a food label? What vitamins are required to be listed on a food label?
Minerals: iron and calcium Vitamins: Vitamin A and C
Should a patient with dysphagia need tube feeding, the best choice for enteral formula delivery is? Why?
NG tube?
What ranges of protein intake are recommended for a patient with limited kidney function who is not treated with dialysis? This requires that you know your stages of chronic kidney disease
NOT on dialysis protein is .8-1.0g/kg ON dialysis 1.0-1.7g/kg
What are the functional units of the kidneys called?
Nephrons
What is a nutrient? What are six classes of nutrients?
Nutrient: Chemical substances obtained from food and used in the body to provide energy and other functions. 6 Classes: Water, minerals, vitamins, carbohydrates, proteins, fats
People choose foods for a variety of reasons. Describe six.
Nutrition, cost, body weight, geographic regions, values, ethnic heritage
Define oliguria, anuria, azotemia, and uremia
Oliguria: low urine <400 mL/day Anuria: absense of urine <50mL/day Uremia: nitrogenous and waste products in blood Azotemia: presence of nitrogen wastes in blood, increase CR and BUN
What conditions are likely to impair a person's ability to swallow?
Orophayngeal: affects food from mouth and pharynx to esophagus Esophageal: difficulty passing bolus of food through esophageal lumen and into the stomach
SGA W.I.N.E
PATIENT HISTORY Weight loss Intake (changes in dietary intake) Nausea/vomiting Energy and functional capacity
SGA F.L.E.A
PHYSICAL EXAM Fat loss(Sub Q tissue) Lean Mass (Muscles Wasting) Edema Ascites
What medications might be used to treat esophageal reflux?
PPI (Zole), H2 blockers (tidine) antacids (maalox)
Describe the criteria that are currently used to diagnose diabetes.
Plasme glucose concentration of a blood sample obtained at random time during the day is 200mg or higher with symptoms if hyoerglycemia glucose if 126mg or higher after a fast of at least 8 hours glucose measured 2 hrs after 75 g glucose load is 200 mg or higher HBA level is 6.5% or higher
What are the differences between prerenal, intrinsic or intrarenal, and postrenal factors that contribute to AKI
Pre-renal" decrease in blood volume or pressure, renal artery disorders. Heart disorders Intrarenal:vascular disorders (Dm, sickle, transfusions), obstructions within kidney, renal injury Postrenal: obstructions (ureter/bladder), prostate, renal vein thrombosis, bladder disorders, pregnancy
Which protein is BEST for monitoring quick changes in protein status?
Prealbumin and retinal binding protein
What is the difference between probiotics and prebiotics? What is the function of prebiotics?
Prebiotics: indigestible substances in food. They stimulate growth or activity of resident bacteria, within the large intestine. Ex artichokes, bananas, garlic, leek
What are the values for normal blood pressure, pre-hypertension, and high blood pressure?
Prehypertension: 120-139/80-89 hypertension: 140/>90
What is the difference between a primary nutrient deficiency and a secondary nutrient deficiency? What tool can provide clues to detecting a primary deficiency? What tool provides clues to secondary deficiencies?
Primary: Nutrient deficiency caused by inadequate dietary intake(Diet history is clue) Secondary: Caused by disease or drug interactions that reduces absorption(Health history is clue)
What is the Hamwi Method?
Quick estimate of desirable body weight. Doesnt account for differences in age or race Men: 106 lbs for the first 5 ft, 6 lbs for each inch after Women: 100lbs for the first 5 ft, 5 lbs for each inch after
What is the respiratory quotient for carbohydrate? Fat? More calories from fat and fewer from carbohydrate theoretically should ______ respiratory requirements.
RQ: fat=.7, protein=.8 carb=1 -Lower
Daniel is a 10-year-old boy that has just been diagnosed with nephrotic syndrome. He is at increased risk of the bone disease _____.
Rickets
Calculate the amount of trans-fat allowed in a 1,600 calorie/day TLC diet; calculate the amount of saturated fat allowed in a 1,600 calorie/day TLC diet.
SAT FAT:1600x.07=112 112/9=12.4g TRANS SAT: 1600x.01=16 16/9=1.8
What is a SGA? What is the difference between: W.I.N.E. F.L.E.A.
SGA: Uses combined results from different assessment methods. -historical infor and physical exam Stages: A=well nourished B=moderately malnourished C=severly malnourished W: weight loss I: intake of diet N: n/v, diarrhea E: energy & functional capacity FLEA: done w/physical exam
What's the #1 cause for COPD?
Smoking tobacco
What is the major function of sodium in the body? Describe how the kidneys regulate blood sodium. Is a dietary deficiency of sodium likely? Why or why not?
Sodium: maintain water balance in body, attracts water, principle cation of extracellular fluid, maintains acid base balance, nerve transmission and muscle contraction. -it travels in the blood until it reaches kidneys, kidneys return to blood the exact amount needed and excretes the rest
What is the #1 reason why people choose the foods they do?
Taste
Describe what vitamins are and what their functions are. Describe what minerals are and what their functions are.
Vitamins: Organic nutrients. they facilitate release of energy in carbs, Fat, and proteins. They can help eyes, lungs, bleeding etc. Minerals: Inorganic nutrients. In bones and teeth do NOT yield energy. Influence fluid balance
Which of the nutrients is most vital to health?
Water
Describe some characteristics of minerals that distinguish them from vitamins.
They are inorganic (retain chemical identity, remain until excreted and cannot be changed). The way they are handled in the body K= like water sol vitamin Ca=like fat soluble vitamin
What are some nutritional implications for the alcoholic client?
Thiamin: needed for metabolism of glucose and alcohol at risk for acute an chronic mental status changes associated with wernicke-korsakoff syndrome Folate: needed for formation of RBC, protein metabolism treats or prevents anemia
A person's lifestyle choices can contribute to death. What is the most prominent factor contributing to death in the U.S.? This is followed by?
Tobacco, chronic diseases and diseases related to diet.
Calculate the amount of total fat allowed in a 1,600 calorie diet based on the TLC diet recommendations.
Total fat 25-35% 1600x.25 =400 400/9=44.4g
T/F IV administration of iron in conjunction with erythropoietin therapy is more effective than oral iron supplementation for improving iron status.
True
T/F: The use of glucocorticoids in the treatment of COPD can increase the risk for osteoporosis
True
TF: Anti-inflammatory medications act by blocking eicosanoid synthesis.
True
T/F: In patients with COPD, it is important that they consume a diet higher in protein and fat and avoid overeating.
True 1-1.5g/kg pt with ARDS 1.5-2.0g/kg
T/F: An important function of the release of catecholamines and cortisol is to mobilize nutrient stores to meet the immediate energy demand of the body
True epinehrine promotes glucagon secretion from the pancrease prompting release of nutrients from storage cortisol enhances muscle protein degradation, raising AA levels in blood and making AA available for conversion to glucose
What is the C.A.G.E. questionnaire used for? What does the acronym stand for? What are "red flags" in the medical history to look for with an alcohol dependent client?
Used for assessing alcohol use -Cut down on drinking -Annoyed by people critizing drinking? -Guilty about drinking? -Eye opener (Ever had a drink to get rid of a hangover) Red Flags: GI bleeding, pancreatities, cirrhosis, hepatits, cardiomyopathy, increase BP, peripheral neuropathy
Calculate the percent weight loss for someone 5'10" who was 160 lbs 6 months ago and is now 139 lbs. Risk category?
Usual BW-CBW/UBWX100 160-139/160
Recall the recommended number of servings per day from each of the food groups under the DASH diet?
Veg and fruit 4-5 a day grains 7-8 dairy 2-3 meat <2/day Nuts, seeds, 1/day fats and oils 2-3/day sweets 5/week
What is the CAPA-Free diet? In which condition is this type of diet used for?
caffine aspirin pepper alcohol PUD
Most kidney stones are made primarily from?
calcium oxalate
What is the 'refeeding syndrome'?
can develop when severely malnourished pt is aggressively fed, go slow and low. Watch for hyperglycemia and electrolyte imbalances
Some of the most highly fortified foods on the market are _______.
cereal, orange juice, margarine
How does smoking contribute to heart disease?
chemicals (nicotine are toxic to endothelial cells, with arterial injury. Chronic inflammation, vasoconstricgtion, enhanced blood coagulation, increase LDL, decrease HDL
What are risk factors associated with CHD? How can they be affected by Therapeutic Lifestyle Change?
cigarette smoking,high LDL, hypertension, diabetes, male gender, increase triglycerides. -Follow TLC w/ decrease cholesterol diet, regular physical activity, decrease weight
What does arterial plaque consist of?
consists of fatty deposits, smooth muscle cells, fibrous connective tissue. -Stable (Doesnt cause complications) -Unstable/vulnerable (thin, fibrous, barrier separating its lipid rich core from arterial lumen)
List calcium's roles in the body. How does the body keep blood calcium constant regardless of intake?
regulates muscle contractions, clotting of blood, transmission of nerve impulse, secretion of hormones, activates protein calmodulin (helps maintain normal BP) Increase CA: thyroid gland secretes calcitonin (inhibits activation of vitamin D), PTH decrease (intestinal absorption of CA and phosphorus slows, increase ca excretion, OSTEOCLAST ACIVITY SLOWS AND BONE HOLD CA Decrease CA: increase PTH secretion (Activation of vitamin D, intestinal absorption of CA nd PO2 enhanced, CA reabrobed in kidney, OSTEOCLAST ACTIVITY STIMULATED
What volume can the gastric pouch eventually expand to following bariatric surgery
roll of quarters, hen egg, size of thumb
What proteins are most widely used in nutrition assessments?
serum proteins (albumin, transferrin, pre albumin, retinol-binding protein)
What dietary interventions would be appropriate for the patient with COPD? List at least four.
small frequent meals, cutup foods, liquids to decrease thickened secretions, avoid foods that increase gas formation, eat slow in calm enviornment, use oxygen at meals
List the roles of water in the body.
solvent component of all body cells, giving structure and form to the body, body temp regulator, lubricant, cushion, medium for digestion of food, transport for nutrients and waste products, maintains blood volume, metabolic reactions
What is the rationale behind the DASH diet in lowering blood pressure?
stays within energy allowance, meet nutrient needs, decrease chronic disease
List some techniques to help patients learn how to compensate for dysphagia.
strengthen jaws,tongue or larynx. Changing head while eating, speech therapist, thickener
What is the treatment of Zollinger-Ellison syndrome?
surgery
How does the body use electrolytes to regulate fluid balance?
they attract water. Water follows electrolytes
Describe current research findings on the use of oats in a gluten-free diet for celiac disease.
they can consume oats but oats grown in US are made with wheat, rye and barley
What kinds of questions would you ask a client when performing a 24-hour recall?
times eaten, amounts consumed, ways food was prepared
What are desirable lipid levels for total cholesterol, LDL-cholesterol, HDL-cholesterol in both men and women, triglycerides?
total <200 LDL<100 HDL >60
Which protein reflects both protein and iron status?
transferrin
Describe bacterial translocation and whether enteral nutrition can play a role in protecting against it.
trophic feedings reduce incidence of bacterial translocation -increased risk in unfed state
T/F: Micronutrients which may play a critical role in immunity and wound healing include zinc,vitamin C, and vitamin A
true
T/F: Omega 3 fatty acids may be beneficial in cases of excessive inflammation by reducing cytokine-induced eicosanoid production.
true
T/F: The quick method for estimating energy needs in the patient under metabolic stress is to calculate weight in kg x 20-30 calories and multiply that by a "stress factor"
true intensive care:1.0-1.1 burns: 1.2-1.4
T/F: Enteral nutrition support is preferred over parenteral nutrition support in patients with normal intestinal function.
true parenteral have increase risk of infection, dont support gut mucosal integrity , hyperglycemia
The metabolic effects of cortisol in the stress response are to (select all that apply) Promote protein degradation Enhance glucagon's action on liver glycogen Promote gluconeogenesis Promote the release of fatty acids from adipose tissue
true?
Which nutrients are needed in supplemental form following gastric bypass surgery? Why?
vitamin B12, vitamin d, calcium, and iron
The kidneys activate which vitamin?
vitamin D
GERD most frequently develops from?
weakening of LES, pregnancy, obesity, asthma, hiatal hernia, meds
