rd exam study DOMAIN II

What is a Laissez Faire Leadership style? and what type of group does it work best with?

"Let it "be; a hands-off approach; the group decides. (only works with highly skilled individuals)

Sophistication levels: Very experiences

"Nutrition experts" Limit audience participation at fist Establish yourself as the expert by citing your credentials Lecture format with audiovisuals

What is the selling price for a hamburger in your cafeteria if you operate with a 45% food cost and the cost of a beef patty and bun are $0.7920?

$1.76

What is the cost per meal if beginning inventory is $8439.52, ending inventory is $7850.76, purchases are $20,401, and 5963 meals were served?

$3.52

Estimated ideal body weight for amputees

(100- % amputation)/ 100 x IBW for original height

HALS

(HIV-associated lipodystrophy syndrome) may develop from therapy: change in body fat distribution, high cholesterol, high TG, insulin resistance Significant loss of LBM can be obscured by edema and HALS

Nutrition Services Inceptive Program

(Older Americans Act) USDA Develop services to foster independent living Cash and commodities to state agencies

What is the formula for %UBW change?

(UBW - ABW) x 100/ UBW

What is the MNT for Addison's Disease?

**Adrenal cortex insufficiency** MNT: High protein, moderate CHO, restrict refined CHO, high NA, unless drugs used to retain Na, monitor high K foods**diet therapy is second, drugs first**

Triboelectric effect

- a type of contact electrification in which certain materials become electrically charged after they come into contact with another different material and are then separated (such as through rubbing). The polarity and strength of the charges produced differ according to the materials, surface roughness, temperature, strain, and other properties. -common examples of combinations that produces significant charges are glass with silk and rubber with fur

Joule

-(J): the SI unit of measure for work and energy, the amount of work equal to the force of one newton (1N) moving an object a distance of 1meter (1m)

How do esophageal varice occur?

--Blood cannot enter the liver-- Connective tissue causes resistance to blood entering the portal vein Increased pressure forces blood back into collateral veins that offer less resistance. (Esophageal, ab, collateral veins enlarge). Due to portal hypertension Causes an outpouch of the wall= Varices

How do ascites occur?

--Blood cannot leave the liver-- Connective tissue block blood flow into vena cava. Liver expands to store up to a L of extra blood Pressure caused by more blood forces fluid to go into the peritoneal cavity High osmolar load pulls more fluid in to dilute, leading to Na and H20 retention= Ascites

absorption spectrum

-An absorption spectrum in the visible region usually appears as a rainbow of color stretching from red to violet interrupted by a few black lines corresponding to distinct wavelengths of absorption

Electroscope

-An electroscope is a device used to detect the presence of charge and it's relative amount. The electroscope is usually constructed with a metal plate or sphere at the top of a metal post with thin foil leaves hanging from the bottom of the post. This setup is typically supported in a flask or some other transparent enclosure. If a charged object is brought near the top of the electroscope, the leaves at the bottom spread apart. The greater the charge, the farther apart they move

How magnets are produced

-An unmagnetized material can become magnetized by insertion into the coils of a temporary magnet known as an electromagnet. -Another way to produce magnetism is to stroke an unmagnetized material with another material which is already magnetized.

Faraday's law of induction

-Any change in the magnetic environment of a coil of wire will cause a voltage (emf) to be "induced" in the coil. No matter how the change is produced, the voltage will be generated. The change could be produced by changing the magnetic field strength, moving a magnet toward or away from the coil, moving the coil into or out of the magnetic field, rotating the coil relative to the magnet, etc. -it serves as a succinct summary of the ways a voltage (or emf) may be generated by a changing magnetic environment. The induced emf in a coil is equal to the negative of the rate of change of magnetic flux times the number of turns in the coil. It involves the interaction of charge with magnetic field.

Transistors

-CONTROL CURRENT FLOW, they serve a variety of functions in circuits and can act as amplifiers, switches, voltage regulators, signal modulators, or oscillators -tiny devices that amplifies, controls, and generates, electrical signals, were invented. They could do much of the work of a much larger vaccum tube.

Electric motors

-Converts electrical energy into mechanical energy to do work, most commonly rotational energy -the components of the simplest motors must include a strong magnet and a current-carrying coil placed in the magnetic field is such a way that force on it causes it to rotate -operation of a motor is based on the principle that a magnetic field exerts a force on a current carrying conductor -can run using DC or AC current

Diamagnetism

-Diamagnetic materials include bismuth, antimony, copper, zinc, mercury, gold, and silver. They can become weakly magnetized, buth their magnetic field is in the opposite direction from the magnetizing field.

Surface reflect light

-Different surfaces reflect light differently -Rough surfaces scatter light in many different directions -Smooth surface reflects the light in one direction -Smooth and shiny, like mirror, reflect allow you to see your image in the surface

Domain Theory

-Electrons orbit the nucleus of an atom. They also spin, revolving around an axis, as they orbit. -The polarity of magnetic field is determined by the direction of electron spin. An atom is magnetized when it has more electrons spinning in one direction than in the other. -Atoms do not act independently but are bound in groups called domains. -When materials are heated they lose there magnetic characteristics. The Curie point is the temperature that a material becomes nonmagnetic.

Induction

-Eletromagnetic induction is the production of voltage that occurs when a conductors interacts with a magnetic field -a conductors can be charged either by moving it through a static electric field or by placing it in a changing magnetic field. -Induction was discovered by Michael Faraday and FARADAY'S LAW govern this phenomenon

Destructive Interference

-If a trough and a crest of the same shape meet, the two pulses will cancel each other out, and the medium will assume the equilibrium position -Destructive interference in sound waves will REDUCE the loudness of the sound

Sonar

-In echo-sounding or echolocation, a system called sonar transmits sound waves to detect and locate objects underwater or measure the distance to the floor of a body of water. -The sound wave pulses are reflected off the object or floor, picked up and timed. Since their speed is known, the distance can be calculated. From the pulses, a picture can be built.

Diffracted

-Light can be diffracted or bend around the edges of an object -Diffraction occurs when light goes through a narrow slit, as light passes thought it, the light bends slightly around the edges of the slit

Magnetic field

-Magnetic field lines always point from the north pole of a magnet to the south pole -expressed in unit called TESLA (T) or GAUSS (G) (1T=10,000 G) -The distance between magnetic fields lines indicates the strength of the magnetic field such that the lines are closer together near the poles of the magnets where the magnetic filed is the strongest. -only the velocity of the charge in a direction PERPENDICULAR to the magnetic field will affect the force exerted, therefore, a charge moving parallel to the magnetic field will have no force acting upon it

Magnetic dipoles

-Magnetic poles always occur in pairs known as Magnetic dipoles -One cannot isolate a single magnetic pole, if a magnet is broken in half, opposite poles appear at both sides of the break point so that one now has two magnets each with a south pole and a north pole.

Semiconductors

-Material with intermediate conduction properties -their properties are similar to insulators in that they have few free electrons to carry the charge but these electrons can be thermally excited into higher energy states that allow them sufficient freedom to transmit electrical charge -the electrical properties of a semiconductor are often improved by introducing impurities, a procedure known as DOPING -two important semiconductor devices are : DIODES and TRANSISTORS

Insulators

-Materials that do NOT ALLOW conduction -good insulators include glass, rubber, and wood, these materials have chemical structures in which the electrons are closely localized to the individual atoms -a charge transferred to an insulator will remain localized at the point where it was introduced because the movement of electrons will be highly impeded

Rotational motion

-Motion when an object moves aroud its centre of mass -One revolution is 360 degree -360 degree= 2pi radian -1 radian=57.3 degree

Paramagnetism

-Paramagnetic materials include aluminum, platinum, manganese, and chromium. They have mild attraction to a magnetic field.

Seismic waves

-Patterns of seismic waves picked up by seismometers can be used to locate distant earthquakes and major explosions and to research the internal structure of the earth -Ex: the "shadows" of S-waves prove that the core of the earth is molten

Explain what happens in the dumping syndrome

-Rapidly hydrolyzed CHO enters the jejunum -Water is drawn in to achieve osmotic balance, causing a decrease in vascular fluid dept and peripheral vascular resistance -BP drops and signs of cardiac insufficiency appear -2 hrs later, CHO is digested and absorbed rapidly. -Blood sugar increases stimulating an over production of insulin, causing a drop in blood sugar below fasting. This is reactive or alimentary hypoglycemia

Heat Capacity

-The ability of a substance to resist a change in temperature -Ex: Water has an extremely high heat capacity and is very resistant to a change in temperature. It takes a great deal of energy transfer to heat up water, buy conversely, it also takes a great amount of energy loss to cool it down

Specific Heat

-The amount of heat required to raise or lower the temperature of 1 gram of a substance by 1 degree Celsius

Spectral lines

-The bands of emitted or absorbed light at these wavelengths are called this -Each elements has a unique line spectrum

refraction

-The bending of a wave as it passes at an angle from one medium to another

Intensity

-The intensity of a sound is the amount of energy that crosses a unit of area in a given unit of time -the intensity level of sound is measured in DECIBELS -normal conversation is about 60 decibels, a power saw is about 110 decibels

Kepler's First Law

-The law describes the shape of planetary orbits. Specifically, the orbit of the planet is an ellipse that has the sun at one of the foci. -the point at which the planet is closest to the Sun is known as PERIHELION -the point as which the planet is farthest from the sun is known as the APHELION

Second Law of Thermodynamics

-The principle whereby every energy transfer or transformation increases the entropy of the universe. Ordered forms of energy are at least partly converted to heat, and in spontaneous reactions, the free energy of the system also decreases. -SPONTANEOUS AND IRREVERSIBLE -no machine is 100% efficient -heat cannot spontaneously pass from a colder to a hotter object

Kepler's Second Law

-The second law pertains to the relative speed of the planet as it orbits -This law says that a line joining the planet and the Sun sweeps out equal areas in equal intervals of time. -This means that the speed of the planet is inversely proportional to its distance from the sun. I.E: the planet moves fastest when it is closest to the sun due to the Sun's gravity

Wave speed

-The speed of any wave depends upon the elastic and inertial properties of the medium through which it travels -The density of a medium is an example of an INERTIAL PROPERTY -Sounds travels faster in denser material, ex: travel 3x as fast through helium than air -speed of light travel slower in denser material, the speed of light is slower in glass than in air

Magnetic flux

-The strength of a magnetic field over a given area -A measurement of the total magnetic field going through a loop -A term used to describe the number of magnetic field lines that pass through an area -When the magnetic flux through a coil is changed, a voltage is produced which is known as INDUCED ELECTROMAGNETIC FORCE

Ohm's Law

-V=IR -most important tool to analyze electrical circuits -states that the current passing through a conductors is directly proportional to the voltage drop and inversely proportional to the resistance of the conductors.

Current-carrying loop

-When a current-carrying loop is placed in a magnetic field, the net force on it is ZERO since the forces on the different parts of the loop act in different directions and cancel each other out -There is however a a NET TORQUE on the loop that tends to rotate it so that the area of the loop is perpendicular to the magnetic field.

Lenz's law

-When an emf is generated by a change in magnetic flux according to Faraday's Law, the polarity of the induced emf is such that it produces a current whose magnetic field opposes the change which produces it. The induced magnetic field inside any loop of wire always acts to keep the magnetic flux in the loop constant. In the examples below, if the B field is increasing, the induced field acts in opposition to it. If it is decreasing, the induced field acts in the direction of the applied field to try to keep it constant. -states that induced emf in a coil acts to oppose any change in magnetic flux

Pascal's principle

-When force is applied to a confined fluid, the change in pressure, is transmitted equally to all parts of the fluid -used in HYDRAULIC LIFT

Transformer

-a device that increases or decreases the voltage of alternating current -a device that magnetically couples two circuits together to allow the transfer of energy between the two circuits without requiring motion -consists of a couple of coils and a magnetic core -A changing voltage applied to one coil, the primary, creates a flux in the magnetic core, which induces voltage in the other coil, the secondary.

Galvanometer

-a device that measures current and is a component of ammeter or a voltmeter -consist of a coil of wire, an indicator and a scale that is designed to be proportional to the current in the galvanometer - instrument that uses an electromagnet to measure electric current -Galvanometers are very sensitive meters which are used to measure tiny currents, usually 1mA or less -in order to create a VOLTMETER using a galvanometer, RESISTORS ARE ADDED IN SERIES to it -to build an AMMETER, a small resistance known as a SHUNT RESISTOR IS PLACED IN PARALLEL with it

Resistivity

-a material's opposition to the flow of electric current -Intrinsic property of a conductor denoted by ρ=R(A/L) -resistivity is a function of temperature, resistivity increases with increasing temperature and decreases with decreasing temperature -At extremely low temperatures resistivity assumes a low and constant value known as residual resistivity

Bohr Model

-a model of the atom developed by niels bohr that shows electrons moving in orbits around the nucleus of the atom -electron would only make instantaneous "quantum leaps" -When electron move from high energy orbital to a lower energy orbital, a quantum of electromagnetic radiation is emitted -an electron to move from a low energy to a higher energy level, a quantum of radiation must be absorbed -particle that carries this electromagnetic force is called a PHOTON. The quantum structure of the atom predicts that only photons corresponding to certain wavelengths of light will be emitted or absorbed by atoms. These distinct wavelengths are measured by ATOMIC SPECTROSCOPY.

Momentum

-a property of a moving object that depends on the object's mass and velocity -tendency of an object to continue to move in its direction of travel, unless acted on by a net external force -Momentum is "conserved"

electromagnet

-a temporary magnet made by coiling wire around an iron core -EX. when current flows in the coil the iron becomes a magnet -the strength of the electromagnet can be increased by adding to the number of turns or loops of current carrying wire -also by varying the current,the strength of the electromagnet can be increased or decreased -another critical factor that affects the electromagnet is the material used inside the coil, specifically the magnetic properties of the material

Cyclotron

-a type of particle accelerator, also uses a perpendicular magnetic field to keep particles on a circular path -After each half circle, the particles are accelerated by an electric field and the path radius is increased. Thus the mean of particles moves faster and faster in a growing spiral within the confines of the cyclotron until they exit at a high speed near the outer edge. -Its compactness is one of the advantages a cyclotron has over linear accelerators.

Energy

-ability to do work (to cause change)

x-ray

-aid in medical field -produced by accelerating electrons in order to collide with a metal target

Kepler's Third Law

-aka HARMONIC LAW -relates the size of the planet's orbital to the time needed to complete it -it states that the square of the planet's period is proportional to the cube of its mean distances from the Sun : P^2=a^3, where P=planet's orbital period, the length of time needed to complete one orbit. a=semi-major axis of orbit

Ampere's Law

-along any closed path through a magnetic field, the sum of the products of the scalar component of B, parallel to the path segment with the length segment, is directly proportional to the net electric current passing through the area enclose by the path

Ammeter

-an ammeter placed in series in a circuit measures the current through the circuit in amperes (A) -typically has a very small resistance so that the current in the circuit is not changed too much by insertion of the ammeter -Ammeters are CONNECTED IN SERIES

quantum theory

-an atom in an excited state has a certain probability in a given time frame for relaxing to a lower state through, for example, the emission of a photon of the same energy as the energy difference between the two states

Alternating Current

-an electric current that reverses direction sinusoidally -"In the US most household current is AC at 60 cycles per second"

Weber's theory of molecular magnetism

-assumes that all magnetic substances are made up of tiny molecular magnets. An unmagnetized material has no magnetic effect because adjacent molecular magnets neutralize the magnetic forces of its molecular magnets -A magnetic substances are composed of tiny molecular magnets, each with a north and south pole. The two poles form a dipole. A magnetized material has most of its molecular magnets lined up. -If a magnet is split in have it becomes two magnets each with a north and south pole. The poles are in the same orientation as the original magnet.

DC motor

-basic DC motor consists of the following components: -A FIELD MAGNET -An ARMATURE with a coil around it that rotates between the poles of the field magnet -A POWER SUPPLY that supplies current to the armature -An AXLE that transfers the rotational energy of the armature to the working parts of the motor -A set of COMMUTATORS and BRUSHES that reverse the direction of power flow every half rotation so that the armature continues to rotate

Ultraviolet radiation

-causes sunburns and would be even more harmful if most of it were not captured in the Earth's ozone layer -naturally transmitted by the sun, artificial UV radiation is created in the form of vacuum UV and extreme UV

Blackbody radiation

-characteristic radiation of an ideal blackbody -i.e: a body that absorbs all of the radiation incident upon it -energy density of this wave should increase as frequency increases

Longitudinal waves

-characterized by the particle motion being PARALLEL to the wave motion -ex: SOUND WAVES ( need a medium to spread while light wave do not )

Transverse waves

-characterized by the particle motion being PERPENDICULAR TO the wave motion -cannot spread in a gas or liquid

Infrared radiation

-comes from the sun and from visible light that is absorbed and then reradiated at longer wavelengths -utilized in night vision googles

Atomic absorption spectroscopy

-continuous spectrum, light consist of all wavelength, pass through the element -The frequencies of absorbed photons are then determined as the electrons increase in energy

Generators

-devices that are the opposite of motors in that convert MECHANICAL ENERGY INTO ELECTRICAL ENERGY -mechanical energy can come from a variety of sources; combustion engines, blowing wind, falling water, or even a hand crank or bicycle wheel -most generators rely upon electromagnetic induction to create an electrical current, these generators basically consists of magnets and a coil -The magnets create a magnetic field and the coil is located within this field. Mechanical energy, from whatever source, is used to spin the coil within this field. As stated by Faraday's Law, this produces a voltage

Conduction

-electrical conduction is the movement of charged particles, electrons, through a medium. -in conducting material, electron loosely attached to atom are capable of carrying an electrical current, and this requires that the atoms of the conducting material be brought into physical contact with the charge source

multimeter

-electrical meter capable of measuring voltage, resistance,and current

First Law of Thermodynamics

-example: Electric energy transformed into light and heat energy -This is the law of the conservation of energy. It states that energy can neither be created, nor can it be destroyed. This means that the total amount of energy in the universe always remains conserved, or constant. However, energy can be changed from one form to another. -light bulb convert 20% of electric energy into light and 80% into heat energy, the reason why light bulb is hot

Wave-particle duality

-exhibition of both wavelike and particle-like properties by a single entity -usually a quantum phenomenon relating to photons, electrons, and protons -Quantum mechanics shows that such objects sometimes behave like particles, sometimes like waves, and sometimes both -All objects exhibits wave-particle duality to some extent, but the larger the object the harder to observe -Ex: sunlight

X-rays

-form of electromagnetic radiation -produced by acceleration electrons to collide with a metal target -behave like particle than wave because of their short wavelength -DO NOT pass through dense material like bone but through softer tissue, where x-ray pass through soft tissue and strike the photographic plate, the plate turns black, creating a contrast between those areas not penetrated by x-ray and those that are

components of laser

-gain medium -energy source, pump, for the gain medium -a resonant optical cavity with a partial transparency in one mirror -the resonant cavity is tuned to a particular frequency such that the photons of the desired laser frequency are coherent and, largely, isolated within the cavity. -A partially transparent mirror on one end of the cavity allows some of the light to exit, thus producing the laser beam

Thermal Energy

-heat, the energy of moving atoms and molecules -total amount of energy associated with the random movement of atoms and molecules in a sample of matter

Ultrasound waves

-high frequency, longitudinal waves used in medical imaging -waves penetrate the human body well and some of the waves reflect off tissue boundaries, the pulse sent back are used to create a picture of the inside of the body

emission spectrum

-in the visible region typically consists of lines of light at certain colors corresponding to distinct wavelengths of emission

Doping

-introduces extra electrons or extra electron acceptors to facilitate the movement of charge -doping to contain extra electrons are N-TYPE -doping to contain extra "holes" are P-TYPE

Conductors

-materials that allow for free and easy movement of electrons -Some of the best conductors are metal, especially copper and silver because these materials are held together with metallic bonds, which involve de-localized electrons shared by atoms in a lattice -If a charge is transferred to a conductor, the electrons will flow freely and the charge will quickly distribute itself across the material in a manner dictated by the conductor's shape -If a static electric field is applied, the mobile electrons reorient themselves to minimize the energy of the system and create an equipotential on the surface of the metal, in the ideal case of infinite conductivity, the highly mobile charge carriers do not allow a net field inside the metal, thus conductors can "shield" electromagnetic fields.

stimulated emission

-may take place when the excited atom is perturbed by a passing photon of the same energy as the excited. In such a case, the atom relaxes to a lower energy by emitting a new photon, resulting in a total of two photons of equals frequency ( and, thus, energy) and equal phase.

Electromagnetic spectrum

-measured using frequency (f) in hertz or wavelength (λ) in meters -The frequency times the wavelength of every electromagnetic wave equals the speed of light (3.0 x 10^8 m/s) -A changing electric field produces a magnetic field, and a changing magnetic field produces an electric field. -Electromagnetic waves are produced when an electric field connects with a magnetic field, the waves are produced by the motion of electrically charged particles. The electric and magnetic fields are perpendicular to each other to the direction of the wave.

actual mechanical advantage

-mechanical advantage of a real machine and takes into consideration factor such as energy lost to friction

Photoelectric effect

-occurs when light shining on a clean metal surface causes the surface to emit electrons -If this energy is greater than the binding energy holding the electron close to nearby nuclei then the electron will move and it also impart kinetic energy to the electron making it move rapidly

Constructive Interference

-occurs when two crests or two troughs of the same shape meet -medium will take on the shape of a crest or a trough with twice the amplitude of the two interfering crests or troughs

Wave Interference

-occurs when two waves meet while traveling along the same medium -The medium takes on a shape resulting from the net effect of the individual waves upon the particles of the medium -light waves same as sound waves, when two light waves of same color, frequency, and amplitude are combined, the interference shows up as fringes of alternation light and dark band, however light waves must come from same source -When two sound waves differing slightly in frequency are superimposed, beats are created by the alternation of constructive and destructive interference, the frequency of the beats is equal to the difference between the frequencies of the interfering sound waves -Two type: CONSTRUCTIVE AND DESTRUCTIVE

Maser

-operate at lower frequencies than lasers, generally rely on the same principles as lasers, although the types of gain media and resonant cavities may differ

Monochromator

-optical devices that send a narrow band of wavelengths of light selected from a wider range of wavelengths -often used in absorption spectrophotometers to supply lights to a sample, absorption spectrophotometers are used to study enzymes, create optical thermometers, and measure the performance of sunglasses, laser protective glasses, and other optical filters, among other things

Heisenberg's uncertainty principle

-place a limit on the accuracy with which one can measure the properties of a physical system -arise from the fundamental wave-particle duality inherent in quantum systems -if we measure the position of a particle with greater and greater accuracy, at some point the accuracy in the measurement of its momentum will begin to fall

radiation

-process of emitting energy -energy is radiated in the form of waves or particles

Radio waves

-produced by antennae whose dimensions must be comparable to the wavelength in order for the antennae to work efficiently and by cosmic phenomena in deep space -used for transmitting data -common example are television, cell phones, and wireless computer

Gamma rays

-produced by sub-atomic particle interaction, such as radioactive decay, but most are created by nuclear reactions in space -most useful in the field of astronomy

Microwaves

-produced by vacuum-based devices such as the magnetron, klystron, traveling wave tube, and gyrotron,anything with a temperature greater than about 10k produces terahertz radiation, however the emission are very weak -the only effective sources of stronger terahertz radiation are the gyrotron, far infrared laser, quantum cascade laser, synchrotron light sources, the backward wave oscillator, the free electron laser, and single-cycle sources used in Terahertz time domain spectroscopy -used to heat food and deliver WI-FI service

Elastic properties

-properties related to the tendency of a medium to maintain its shape when acted upon by force or stress -Sound waves travel faster in solid than they do in liquid than they do in gases

Diffraction grating

-reflecting or transparent element whose optical properties are periodically modulated - device made of thousands of closely spaced slits through which light is passed in order to produce a spectrum -When light is incident on a diffraction grating, light is reflected or transmitted on discrete directions, called DIFFRACTION ORDERS -commonly used in monochromator and spectrophotometers -the angle of deviation of all but one of the diffracted beams depends on the wavelength of the incident light

Efficiency

-relationship between energy input and energy output -Expressed as a percentage, the more efficient a system is, the less energy that is lost within that system -% efficiency=useful energy produced x 100/total energy used

Wave strikes an object

-some of the wave energy is reflected off the object, some of the energy goes into and is absorbed by the object, and some of the energy goes through the object -Ex: sound waves can penetrate walls, however sound waves from air cannot penetrate water, and sound waves from water cannot penetrate the air -Light passes through some materials such as glass but no many other materials.

Capacitance

-the ability of a conductor to store energy in the form of electrically separated charges -measure of the stored electric charge per unit electric potential C=Q/V -unit=farad -in circuit, device called parallel plate capacitors are formed by two closely spaced conductors, when a voltage is applied, electrical charges build up in both the conductors. These charges on the two plates have equal magnitude but opposite sign.

Heat of Fusion

-the amount of heat energy expressed in calories required to change 1 gram of water from a solid to a liquid, or back -The heat of fusion is equal to 80 cal/gram

Heat of Vaporization

-the amount of heat energy required to change 1 gram of water from a liquid to a vapor, or back. -The heat of vaporization is equal to 540 cal/gram

Latent Heat

-the amount of heat energy required to change matter from one state to another -Ex: The amount of temperature change needed to cause evaporation or condensation of water

Calorie

-the amount of heat energy required to change, raised or lower, the temperature of 1 gram of water, by 1 degree Celsius

amplitude

-the amplitude of a sound waves determines its loudness -Loud sound waves have large amplitudes, the larger the sound wave, the more energy is needed to create the wave

Atomic emission spectroscopy

-the electron of an element are excited by heating or by an electric discharge -the frequencies of emitted photons are then determined as the electron release energy

Kinetic Energy

-the energy an object has due to its mass and motion

Gravitational Potential Energy

-the energy an object has when it is in an elevated position

Chemical Energy

-the energy bonds atoms and molecules together -potential energy stored in chemical bonds of molecules.

Work

-the energy expended when the position or speed of an object is moved against an opposing force, measured in JOULES, work is the product of the force on an object and the distance through which the object is moved.

Mechanical Energy

-the energy of moving objects

Nuclear Energy

-the energy of moving the nucleus of an atom - the potential energy stored in the nucleus of an atom

Potential Energy

-the energy stored in an object due to its position

Elastic Potential Energy

-the energy stored in elastic stretchable objects such as rubber bands or springs

Buoyancy

-the force produced by a fluid on a fully or partially immersed object -buoyant force opposed the force of gravity -can determine if an object float. If the material has a lower density then the liquid, it will float, if higher, it will sink. If the same, it will neither sink nor float

Absolute Zero

-the lowest temperature theoretically attainable (at which the kinetic energy of atoms and molecules is minimal) - 0 Kelvin or -273.15 Centigrade or -459.67 Fahrenheit

Temperature

-the measure of the average kinetic energy of the motion of atoms and molecules of a substance -NOT a measure of how much heat a substance contains; instead, it is focused on the increase or decrease of the kinetic energy of the atoms and molecules of a substance -temperature is a measure of hotness, not heat, although we use thermometers to measure temperature, we can't directly measure heat; it must be calculated

Gauss's law of magnetism

-the net magnetic flux out of any closed surface is zero -V*B=0 where V= the del operator and B=magnetic field -If a plane is parallel to a magnetic field, no magnetic field lines will pass through that plane and the flux will be zero, if a plane is perpendicular to a magnetic field, the flux will be maximal -There is NO MAGNETIC MONOPOLE, that means magnets always have a positive and negative pole)

Fahrenheit Scale

-the non-Si technical scale still used in some countries -Water freezes at 32 and boils at 212 on the Fahrenheit scale

Archimedes' Principle

-the principle that states that the buoyant force on an object in a fluid is an upward force equal to the weight of the volume of fluid that the object displaces -useful when determining the volume of an oddly shaped object

Frame of reference

-the principles which describe the relationship between different frames of reference are know as RELATIVITIES -when velocities approach the speed of light, we must use EINSTEIN'S SPECIAL RELATIVITY -2 type of reference frames: INERTIAL and NON-INERTIAL

Pitch

-the property of sound that varies with variation in the frequency of vibration -High pitched sound waves have high frequencies -High notes are produced by an object that is vibrating at a greater number of times per second than one that produces a low note.

Celsius Scale

-the temperature scale in general scientific use -Water freezes at 0 and boils at 100 on the Celsius scale

Heat

-the total kinetic energy of the random motion of a substance's atoms and molecules

Principle of conservation of mass and charge

-the total mass of a system is constant -the total electrical charge of a closed system is constant

Entropy

-the transformation of energy to a more disordered state and is the measure of how much energy or heat is available for work -Entropy approaches a maximum value at equilibrium

ferromagnet

-there are domains where the magnetic dipoles are aligned, however, the domains themselves are randomly oriented. -A ferromagnet can be magnetized by placing it in an external magnetic field that exerts a force to line up the domains -ron, cobalt, nickel (and various alloys) are called ferromagnetic materials. Ferromagnetic materials show a permanent, spontaneous magnetizing effect in the absence of a magnetizing field. -This effect is greatest at absolute zero. It is reduced by temperature. -Ferromagnetic materials with high retentivities, are called hard, and are used for permanent magnets.

Population inversion

-there are more atoms in a particular excited state than in a particular lower-energy state -the material must be "pumped" which can be performed using electromagnetic field (light), pumping to produce population inversion often requires three or more atomic energy levels. The energy difference between levels can be emitted in the form of a phonon. -The abundance of excited atoms due to population inversion allow for a chain reaction to form when photons of the proper frequency are incident.This results in a cascading increase in photon intensity through stimulated emission, this production the coherent, high power light that is used by the LASER or MASER

Non-inertial

-these frames include all other situations in which there is non constant velocity, such as acceleration or rotation.

Inertial

-these frames translate at a constant vector velocity, meaning velocity does not change direction or magnitude -example: travel in a straight line without acceleration -Newton's first law and second law are ONLY in this reference frames

Convection

-transfer of heat by currents within fluid form -liquids and gases only

Conduction

-transmission of heat across something -heat transfer always moves from a higher to a lower temperature -More dense substance usually conduct heat more readily than less dense matter

Microwaves

-used in microwaves ovens to cook food by passing microwaves radiation through the food -used in broadcasting and telecommunications transmissions because of their short wavelength

Voltmeter

-used to measure potential difference -the potential difference across a resistor is measured by a voltmeter placed in parallel across it -an ideal voltmeter has very high resistance so that it does not appreciably alter circuit resistance and therefore the voltage drop it is measuring, -meter that measures the potential difference between two points -Voltmeters are CONNECTED IN PARALLEL ACROSS components.

Radar

-uses electromagnetic waves to identify the speed, altitude, and direction of both fixed objects and objects in motion -radio waves are discharged by a transmitter, a receiver detects the waves reflected off the object, even though the waves are weak, it can be amplified, makes them more useful than sound waves or visible light -Radar used in meteorology to detect precipitation, in air traffic control to monitor location of planes, in police work to detect speeders, and in military operations.

Potentiometer

-variable resistance device in which the user can vary the resistance to control the current and voltage applied to a circuit -Since the potentiometer can be used to control what fraction of the emf of a battery is applied to a circuit, it is also known as a VOLTAGE DIVIDER -it can be used to measure an unknown voltage by comparing it with a known value -Potentiometers are commonly used to control electrical devices such as volume controls on audio equipment

Friction

-when two materials are brought into contact (or rubbed against each other) electrons may be transferred between them. -If the material are then separated, one will be left with a negative charge and the other will have a positive charge. This is known as the TRIBOELECTRIC EFFECT

Fluoride recommendations by age

0-6mth: Oral supp. not recommended, use fl. water if available 6-12 mth: fl. water; oral supp only if prescribed 12-24 mth: fl water; oral if prescribed. Toothpaste should not be used until the child can spit it out 2-3 years: fl. water or supp recommended, pea sized amount of fl. toothpaste

GFR of 20 ml /min should get how much protein

0.6

a pt with a GFR of 20 ml/min should receive how many grams of protein /kg

0.6

Serum Creatine normal level

0.6-1.4 mg/dL

if a pt GFR is < 50 ml/min what should their protein intake be (in g/kg)

0.8 g/kg

if a GFR is <50 ml /min ...protein should be ?

0.8-1.0

the above pt with nephrosis should receive how many grams of protein per kg

0.8-1.0

according to the diabetic exchange list, when substituting 2% milk for skim milk, you must omit how many fat exchanges

1

a pt gets 4 oz whole milk and 6 graham crackers. what would decrease the glycemic index?

1 T PB in place of 3 graham crackers

a pt receives 4 oz whole milk and 6 graham crackers as a snack. which of the following substitutes would lower the glycemic index: skim in place of the whole, fruit juice in place of the whole milk, 12 saltines in place of the 6 graham crackers, 1 T peanut butter in place of 3 graham crackers

1 T peanut butter in place of 3 graham crackers

a guide for calculating water needs with tube feedings is _cc/_calories

1 cc water/ 1.0 calories

which of the following would be appropriate for a hemodialysis pt on a 60 g protein diet with 75% from HBV protein: 1 egg/2 oz chicken/3 oz beef/ 1/2 c milk, 1 egg/ 2 oz chicken/ 3 slice bread/ 3 oz beef, 2 egg/ 3 oz chicken/ 3 oz beef/ 1 c milk, 1 egg/3 oz chicken/ 2 c milk/ 5 slices bread

1 egg, 3 oz chicken, 2 c milk, 5 slices bread

Water per calorie ingested for tube feed and percent water?

1 ml/ kcal 1 kcal/mL=80-86% water 1.5 kcal/mL=76-78% water 2 kcal/mL= 69-71% water

a diabetic want to exchange his bedtime snack of 8 oz whole milk. what do you suggest: 1 oc cheese and 1/2 c orange juice, 2 graham crackers and 1/2 c orange juice, 1 oz cheese, 2 oz cheese

1 oz cheese and 1/2 c orange juice

which contains more total dietary fiber: 1/2 c raw spinach, 1 oz raisin bran cereal, 1 slice whole wheat toast, 2 T peanut butter

1 oz raisin bran cereal

which of the following should the patient in the above question have for lunch: 4 oz cottage cheese, 1 oz cheddar cheese, 1 oz roast beef, 1 oz cold cuts

1 oz roast beef

What are the 5 data categories under nutrition assessment?

1. Biochemical data 2. Anthropometric measurements 3. Physical examination 4. Food/Nutrition history 5. Client history

List 5 characteristics of critical thinking.

1. Conceptualize 2. Think rationally 3. Think creatively 4. Be inquiring 5. Think autonomously

Name the 3 ways the NCP is used by dietetics professionals.

1. Critically think 2. Make decisions addressing nutrition-related problems. 3. Provide safe, effective & high quality nutrition care

General Order of Program Plan

1. Develop Mission Statement 2. Set Goals 3. Set Objectives

Name the 5 parts of the outside ring in the Nutrition Care Process Model.

1. Economics 2. Social Systems 3. Health Care Systems 4. Practice Settings 5. Education

Name the 3 NCP relationships with the PES statement.

1. Nutrition Diagnosis-Problem 2. Nutrition Intervention-Etiology 3. Nutrition Monitoring & Evaluation-Signs & Symptoms

What are the 5 major requirements schools need to participate in NSLP

1. Nutritional standards 2. eligible children receive free or reduced cost 3. program is nonprofit 4. program is accountable 5. must participate in commodity food program

What is the metabolically active form of vitamin B6? What are its main functions? and what is the typical way we are deficient in the vitamin?

1. Pyradoxal Phosphate (PLP) is the metabolically active form, it mainly functions as a coenzyme in amino acid metabolism and plays a role in Hgb synthesis. Deficiency is rare but typically caused by medication interaction.

Work, Develop, Implement, Evaluate, and Revise, Address

1. Work collaboratively with other campus personnel to develop, implement, evaluate and revise a comprehensive campus professional development plan that addresses staff needs and aligns professional development with identified goals.

if a man normally consuming 2600 calories per day reduces his intake to 1500 calories per day, how much wt will he lose in one week ? in kg

1.0 kg

Hemodialysis diet protein

1.2 g pro/KG

Peritoneal dialysis protein

1.2-1.3 g/KG

__ grams protein, __ cals/kg is the appropriate diet for peritoneal dialysis

1.5 grams protein, 30 cals/kg

# of relief workers suitable

1.55

One way to determine # of relief employees needed is to multiply total employees by ___

1.55

What must School Lunch Program Meet

1/3 RDA for Kcal, protein, vitamin A and C, iron, calcium

When you are in the clinic, you receive a phone call from an individual who states she has diabetes and wants to know how to count quinoa in the exchanges. What is the exchange?

1/3 cup is a starch

What is an example of a serving of starch and how many grams of carbohydrates is it?

1/3 cup of rice or pasta, 1 slice of bread, 1/2 cup do canned or frozen fruit, 1 small fruit. 15grams in a serving

What must School Breakfast Program Meet?

1/4 RDA for calories, protein, Vitamin A and C, iron, calcium

normal hgb for baby?

10 and up

IVFE: Intravenous Fat Emulsion Kcals

10%: 1.1 kcal/mL 20%: 2.0 kcal/mL

BUN: Creatinine ratio. Normal

10-15:1

a tube feed ran from 7 pm to 6 am providing 1800 calories, at 1.6 calories/cc. how may cc/hr were given

100 cc/hr

Indicies of glycemic control: Impaired fasting glucose

100-125

fasting blood glucose levels for pre-diabetes

100-126 mg/dL

The patient has severe acute pancreatitis with nausea and vomiting, and requires 2500 kcals per day. Which regime would the dietitian recommend?

1000 cc of D50 W, 1000 cc of 7% amino acids and 500 cc of 10% lipids

a pt with severe acute pancreatitis experiences nausea and vomiting and requires 2500cal/day. which of the following would you recommend: 3000cc of a 1cal/cc TF via jejunum, 1500cc of a 2cal/cc NGT, 1000cc of D50W, 1000cc of 7% aa, 650cc of 20%lipids, or 1000cc D50W, 1000cc 7% aa, 500cc of 10% lipids

1000cc of D50W, 1000cc of 7% amino acids, 500cc of 10% lipids

how much free water is in 1.5 liters of an enteral feeding that has 1.5 calories per cc

1155 cc

What is the normal GFR?

125ml/min

how many calories are in 1.5 liters of a 25% dextrose solution

1275 calories

how many calories are provided in 1.5 liters of D25W

1275 calories

Holding temperatures: At or above _____. At or below _____.

135 degrees F (57 degrees C) 41 degrees F (5 degrees C)

Comprehensive metabolic panel

14 blood tests, including all the tests in the basic metabolic panel used for screening

a 7 year old on a ketogenic diet requires 1500 calories. which is the appropriate order: 145 g fat/25 g protein/25 g CHO, 95 g fat/40 g protein/25 g CHO, 102 g fat/56 g protein/12 g CHO, 75g fat/32 g protein/43 g CHO

145 g fat/25 g protein/25 g carbohydrate

low-birthweight infant is classified as how many grams?

1500-2500g

burn pt follows a kcal:N ratio of:

150:1

TTHY transthyretin, PAB prealbumin. Normal range

16-40 mg/dl

How many FTEs will it take to staff 12 positions, 8 hours a day, 7 days a week?

16.8

The renal threshold, the point at which the tubules reach their tubular maximum for glucose, is:

160-200 mg/dl

a PN regimen than contains 1 L of D50W and 1 L of 7% Aminosyn provides how many non-protein calories

1700 non-protein calories

TPN of 1L D50W and 1L of 7% aminosyn provides how many non-protein calories

1700kcal

a 60 kg female receives 2700 calories on PN. the calorie to nitrogen ratio is 150:1. how may grams of nitrogen is she getting

18

in PN...850 ml of 5.5% AA will give you ... kcals?

187

pt has heart failure but no CAD or increased CHD risk. his nutritional prescription should be

2 gram sodium

according to the diabetic exchange list, 2 T peanut butter is

2 high fat meats

a 1500 calorie diabetic diet with 45% of the calories from carbohydrate is prescribed. one third of the carbohydrates grams is met with 1/2 cup orange juice, 1 cup milk and: 1 slice toast, 2 slice toast, 2 slice toast and 1/2 cup oatmeal, 1/2 slice toast

2 slice toast

what is a normal wt gain during the first trimester

2-5 lbs

Facilitate, Apply

2. Facilitate the application of adult learning principles and motivation theory to all campus professional development activities, including the use of appropriate content, processes, and context

How many meals were served per labor hour if 34 FTE produced 3800 meals in one 40 hour week?

2.79

in the Dietary Guidelines, what represents the fat included

20-35% calories, <10% saturated fat

What is the best dietary intake assessment in a clinical setting?

24 hour recall

open tube feedings should be disposed of after

24 hours

a standing height should first be obtained when an infant is how many months old

24 months

at what age should children be measured standing up

24 months

an AIDS pt temperature has risen to 102 degrees. his BMR has increased

24%

What is protocol for the time in which all pregnant women would be tested for gestational diabetes?

24-48weeks

a sandwich with two pieces of white bread and 2 oz of turkey provides how many calories

250 calories

What is the median of the following frequency distribution: 1000, 2000, 3000, and 4000?

2500

a pt w/ heart failure but no CAD or inc CHD risk...what is his diet order?

2G sodium

Indicies of glycemic control: Impaired glucose tolerance

2hPG 140-199

Metabolic Syndrom

3+ of the following risk factors are linked to insulin resistance, which increase risk for coronary events -Elevated BP 130/85 -Elevated TG 150 -Fasting serum glucose 110 -Low HDL 40 M, 50 W -Waist measurement 40 M, 35W

Retinol-binding protein. Normal Range

3-6 mg/dl

Allocate, Ensure

3. Allocate appropriate time, funding, and other needed resources to ensure the effective implementation of professional development plans.

The February income statement shows that 2450 meals were served $7616 paid in labor. What is the labor cost per meal for February?

3.11

in TPN, how many kcal/g does dextrose have?

3.4 kcal/g

Calculating Dextrose for PPN and TPN

3.4 kcal/g (ml)(% dextrose)(3.4)

Serum Albumin Normal levels. Abnormalities

3.5-5.0 Low: hypoalbuminemia associated with edema High: Likely due to dehydration

elderly need __ ml water/kg

30

the elderly need how many ml of water per kg

30 ml/kg

which infant is at the greatest risk? 20# hemoglobin 10, 22# hemoglobin 10.5, 19# hemoglobin 11, 30# hemoglobin 9

30# hemoglobin 9

in which would you likely see very low albumin if it is drawn a few days after admission to an acute care facility: anorexia nervosa, 30% full thickness burn, pt with newly diagnosed colon cancer, pt with COPD

30% full thickness burn

Pressure ulcer treatment

30-40 kcal/day 1.2-1.5 g protein stg 1, 2 1.5-2 stg 3, 4 Supplement C, Zn

normal transit time

30-72 hours

how much water does an athlete need if they have lost 2 lbs during a marathon

32 oz

two liters of a 5% dextrose solution provide how many calories

340 calories

how many non-protein calories are provided by 2 liters of a 7% Aminosyn solution and 1 liter of a 10% dextrose in water

340 non-protein calories

The ADA rules that a facility must provide aisles ___" and doors ___" wide. Also, mandates flashing alarm lights for the hard-of-hearing

36,32

In a hospital with 300 patients, it takes 14 minutes to prepare one meal. How many F.T.E. are needed for one week?

36.75

according to the ADA exchange list what is the nutrient content of: 1 c cantaloupe, 1/2 c cereal, 1 c 1% milk, 1 tsp margarine, low sugar jelly, black coffee, 1 slice toast

365 calories 12 protein 57 CHO 7 fat

a newly diagnosed diabetic needs 2200 cals, 50% from carbohydrates. how many CHO choices can he have at each meal if he has 3 snacks with 2 CHO choices each

4

the normal range of hemoglobin A1C is

4 - 6%

according to the diabetic exchange list, which of the following is equivalent to one medium fat meat: 4 oz tofu, 2 oz pork, 2 eggs, 2 T peanut butter

4 oz tofu

what is equivalent to one medium fat meat?

4 oz tofu

if a diabetic pt reduces his caloric intake from 2300 to 1800 calories per day, how much will he lose in one month

4 pounds

What is the normal range for glycated hemoglobin (GHb)? What is the glycated hemoglobin (GHb) goal for diabetics?

4-6% = normal <7% = goal for DM

Implement, Recruitment, Screening, Selection, Induction, Development, Evaluation, Promotion, Dismissal

4. Implement effective, appropriate, and legal strategies for the recruitment, screening, selection, assignment, induction, development, evaluation, promotion, discipline, and dismissal of campus staff

you have determined than an infant should take 340 calories/24 hrs. how many oz of milk should be given to the baby every 6 hrs

4.5 oz

1 FTE = _____

40 hours

infants should be given solid foods at

5-8 months

how many calories in a 300ml of a 5%dextrose solution

51 calories

who has the greatest water, protein, and calorie needs per unit of body wt: 6 month infant, 50 year old male, 16 year old male, 25 year old female

6 month old infant

Eggs can be held in cold storage for

6 months

which level of HgA1c suggest good compliance with dietary recommendations in a diabetic after 3 months of counseling: 6.5, 4.0, 8.2, 10.3

6.5 mg/dl

how many gram of CHO is in 1 english muffin, 1 c skim milk, 1/2 c apple juice

60 g CHO

children and adolescents need what level of physical activity

60 minutes every day

How many total nutrition diagnoses have been labeled?

62

using the previous formula, determine the calories coming from lipids per day

624 calories from lipids

For each rise in F temp above normal, how much does BMR increase?

7%

which drink would a Mormon choose: cola, 7-up, tea, coffee

7-up

A cookie recipe calls for one cup of butter. You will be using shortening instead. How much shortening should you use?

7/8 cup

Indicies of glycemic control: Normal blood glucose

70-100 2hPG: <140

a 140# female on dialysis should have how many grams of protein

70-89 g

A 6'1'' male has bilateral below-knee amputations. What is his adjusted ideal body weight? Weight estimation in amputees: Foot: 2%, Lower leg below knee: 6%, Lower leg, above knee: 9%

73.6 kg

how many grams of protein would you receive on a 1500 calorie diet which is 20% protein

75 grams protein

Protein

75-100 grams of this nutrient given in acute viral hepatitis will promote cell regeneration, provide lipotropic agents to convert fat into lipoproteins for removal from the liver

using the previous formula, determine the protein intake per day in grams

78 grams amino acids

with a CHO:insulin ratio of 16:1 how much insulin is needed with this meal : 1 1/3 c spaghetti, 1 c sauce, 1 c green beans, 1 slice bread, 1 tsp butter, 1/2 c ice cream

8 units

CHI normal levels. Abnormal

80% normal 60-80% mild muscle depletion

infuse a PN a max rate of how many mOsm/L?

800

infuse a peripheral solution at a maximum rate of how many mOsm/L

800

a female 5'7" tall weighs 115#. six months ago she weighed 130#. what is her percent ideal body wt

85%

in a TPN mixture, what volume of the amino acid solutions listed would come closest to providing 185 calories: 1000 ml @ 8.5% aa, 850 ml @ 5.5% aa, 500 ml @ 7.0% aa, 500 ml @ 10% aa

850 ml @ 5.5% amino acids

In a TPN mixture, what volume of the AA solution would come closest to providing 185kcal?

850ml of 5.5% AA (850X .055=46.75 x 4kcal/g=187kcal)

a TPN solution is to be delivered at 50 ml per hr at 3/4 strength. what is the appropriate order: 900 ml formula with 300 ml water, 600/600, 800/400, 300/900

900 ml formula, 300 ml water

The average coefficient of digestibility of protein is:

92%

determine the calorie contribution of carbohydrate from the following parenteral formula. the amounts are per liter. 300 ml 60% dextrose; 500 ml 10% amino acids; 200 ml 20% lipid. total nutrient mixture administered at 65ml/hr for 24 hr

955 calories per day

which of the following wt gains puts pregnant woman at risk: <4#/month in last half of pregnancy, <5#/month in the last half of preg, <6#/month last half of preg, >2#/month in last half of preg

< 4#/month in the last half of pregnancy

how many grams does a low birth weight infant weigh

<2500 grams

Serum Transferrin. Normal levels. Abnormalities

>200 mg/dl High: Iron deficiency

Lab Tests in Renal Disease: 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 reduced BUN reabsorption due to renal damage (may need dialysis)

Waist Circumference

>40 M, >35 F Independent risk factor for disease when out of proportion to total body fat (with BMI 25-34.9)

Steatorrhea

A consequence of malabsorption of fat is

What is a six sigma?

A data driven approach for eliminating defects and reducing variations in any process.

Medical Diagnosis

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

Medical diagnosis

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

Physical incompatibility

A food-drug interaction involving granulation, gel formation, or separation of the enteral nutritional product when food and drug are combined, frequently resulting in clogged feeding tubes and interruption of the delivery of nutrition to the patient. Ex: Mellaril, Thorazine, Robitussin expectorant, Sudafed.

Calcium, magnesium, phosphorous, copper, selenium, zinc and iron

A high fiber diet may increase the need for these minerals

Constipation

A low fiber diet may lead to

Serum Transferring Receptor Test (sTfR)

A measure of iron status that is not affected by inflammatory status

The Joint Commission (TJC)

A peer review organization that evaluates health care institutions and ensures their compliance with established minimum standards.

What is the Nutrition Care Process?

A standardized, consistent structure and framework used to provide nutrition care

LIFO refers to:

A storage procedure. (Last In, First Out)

methotrexate - anti folate drug

A type of chemotherapy for treatment of neoplastic disease. Why is this important?

What is the current charting format recommended for use by dietetics professionals based on the steps of the NCP?

ADIME Assessment Diagnosis Intervention Monitoring Evaluation

What are the liver function tests?

ALP- alkaline phosphate LDH- lactic acid dehydrogenase AST, SGOT- aspartate amino transferase ALT, SGPT- alanine aminotransferase

___ FTE's are the min # of employees needed to staff the facility (counts productive hours/hours actually worked)

Absolute

Oral glucose-lowering medications: Alpha glucosidase inhibitors

Acarbose, Precose Inhibit enzymes that digest carbohydrate, delaying absorption

What is ascites and what disease does it most commonly happen with?

Accumulation of fluid in the paritoneal cavity, and it most commonly happens with cirrhosis

BRFSS; HHS; 18yo or older residing in households with telephones

Acronym for Behavioral Risk Factor Surveillance System, Who runs it, and who is involved?

CSFII; no info; oversampling ofadolescents, older persons, low income persons, pregnant women, A frican American, Mexican American

Acronym for Continuing Survey of Food Intakes of Individuals, Who runs it, and who is involved?

DHKS; USDA; Main meal planner and prepare in households

Acronym for Diet and Health Knowledge Survey, Who runs it, and who is involved?

FITS; no info; infants and toddlers

Acronym for Feeding Infants and Toddlers Survey, Who runs it, and who is involved?

no acronym; National Cancer Institute (NCI) under NIH; adults 18 yo or older

Acronym for Five a Day for Better Health Survey, Who runs it, and who is involved?

NFNS; NHANES plus CSF II; adolescents, older persons, low incomes persons, pregenant women, African American, Mexican American

Acronym for National Food and Nutrition Survey, Who runs it, and who is involved?

NHANES; no info on who runs it; American people

Acronym for National Health and Nutrition Examination Survey, Who runs it, and who is involved?

NNMRRP; DHHS and USDA; US population

Acronym for National Nutrition Monitoring and Related Research Program, Who runs it, and who is involved?

NSI; in response to Healthy People 2000; elderly

Acronym for Nutrition screening initiative, Who runs it, and who is involved?

PedNSS; HHS; low income, high risk children, birth-17yo, emphasis on birth - 5yo

Acronym for Pediatric Nutrition Surveillance System, Who runs it, and who is involved?

PNSS; HHS; low income, high-risk pregnant women

Acronym for Pregnancy Nutrition Surveillance System, Who runs it, and who is involved?

NFCS; USDA; US population

Acronym for USDA National Food Consumption Surveys, Who runs it, and who is involved?

WLPS; HHS; 18 and older trying to lose weight

Acronym for Weight Loss Practice Survey, Who runs it, and who is involved?

YRBS; HHS; grades 9-12

Acronym for Youth Risk Behavior Survey, Who runs it, and who is involved?

1.4

Activity factor for a stressed individual

Oral glucose-lowering medications: Thiazolidinediones

Actos Improve peripheral insulin sensitivity

Nutrition Diagnostic Labels: Intake NI

Actual problems related to intake Energy Balance Oral or nutrition support intake Fluid intake balance Bioactive substances: alcohol, supplements Nutrient balance: focus on single nutrients

ARDS. What, Goals

Acute Respiratory Distress Syndrome, Resp. Fail. May follow COPD Lungs are no longer able to exchange gases Goals: Maintain stable wt, Maintain LBM

adds calories and protein, provides pt with more N. When pt does not tolerate standard protein

Adding BCAA to the diet of someone with ESLD does what. When should they be added?

AI

Adequate Intake- used when insufficient evidence exists for EAR, RDA

Problem

Adjective in the PES statement that describes the human response (aka Diagnostic Label)

Effect of Propofol

Administered in oil, so consider fat calories

What is needed for implementation to be successful?

Administrative Support Realistic budget Staff commitment Support of target population

Osteomalacia. Cause, Effect, Treatment

Adult rickets C: Vitamin D deficiency E: Reduction in bone density- demineralization T: Ca, D supplements

Diarrhea in infants and children: Acute

Aggressive and immediate rehydration Replace fluids and electrolytes lost in the stool. Use a glucose electrolyte solution. This is as effective as TPN, but much cheaper. Reintroduce oral intake within 24 hours

Which of the following is the best indicator of visceral protein status in the hospitalized patient?

Albumin

Why does alcoholic liver disease occur?

Alcohol--> acetaldehyde and H+ H+ replaces fat as fuel in Kreb Cycle Fat accumulates in liver and blood

Contraindications of TPN

Alimentary tract can be used Needed for a short period of time in well nourished Cardiac instability Risks outweigh benefits

Reasons to Use TPN

Altered GI function; Inability to absorb nutrients; Malabsorption; Peritonitis; Obstruction; SBS; Hypermetabolic State; CA pts on therapy; GI disorders; Fistulas; Severe malnourished pre-op pts; Acute Pancreatitis; Critical care pts NPO and expected to last more than 4-5 days and enteral support is not possible

which of the following is not a governmental agency: Health and Human Services, Food and Drug Administration, Food and Nutrition Board, American Heart Association

American Heart Association

which formula is high in calories and low in protein: AminAid, Osmolite, Sustacal, Jevity

AminAid

Which statement is an example of line authority?

An administrative dietitian in a 600 bed hospital.

Grants

An award given of financial or direct assistance

Mini Nutritional Assessment (MNA)

An efficient, innovative, noninvasive method to detect risk for malnutrition using questions and anthropometric measures to determine a malnutrition indicator score

What is WIC not?

An entitlement program: cap on amount of federal dollars allocated

Ideal Mechanical advantage

An ideal mechanism transmits power without adding to or subtracting from it. This means the ideal mechanism does not include a power source, and is frictionless and constructed from rigid bodies that do not deflect or wear.

What short bowel resection has more complications?

An ileal resection is more severe and can lead to absorption issues and emulsification of fats.

What is definition and treatment for glycogen storage disease?

An inborn error of metabolism resulting in deposition of either too much or too little glycogen in tissues; may be due to deficieny in glycogen synthase, glucose-6-phosphate, branching enzyme, myophosphorylase and/or hepatophosphorylase. Treatment- eliminate fructose, sucrose, lactose, galactose

Manifestations of renal disease

Anemia b/c of decreased production of EPO Upset in BP Decreased activation of vitamin D

inflammatory process

Anemia in skeletal and connective tissue disorders, anemia is not diet related but ____

What are some different types of eating disorders?

Anorexia nervosa, Bulimia, Binge Eating, Anorexia Athletica, over-exercise, overeating, night eating, orthorexia, eating disorder not otherwise specified (EDNOS)

Acute Viral Hepatitis: Effect

Anorexia, inflammation, necrosis, jaundice, nausea, fatigue

Treatment of ulcers

Antacids Antibiotics to eradicate H. pylori Rest Diet therapy

Effect of Anticoagulant

Antagonizes vitamin K Avoid Ginkgo, ginger, garlic Avoid high doses of vitamin A and E

States' Rights

Anti-Federalists wanted these state powers protected.

Epilepsy. Effects of drugs

Anticonvulsants (phenytoin, phenobarbital) interfere with Ca absorption. Take folate with drug. Take away from food May need supplements of Ca, D, thiamin Enteral feedings decrease bioavailability from phenytoin, so hold tube feedings for 2 hours

Effect of Lithium Carbonate

Antidepressant Increased appetite, weight gain; Maintain consistent sodium and caffeine intake to stabilize levels. If Na or caffeine are restricted, lithium excretion decreases, leading to toxicity. 2 g Na may not be enough

Effect of Megestrol Acetate

Appetite Stimulant

Effect of Marinol

Appetite stimulant

The school meals initiative updates standards for school meals to assure they:

Are no more than 40% fat

What amino acids are good for healing in burn victims?

Arginine: may improve immune function & wound healing. Glutamine: may enhance the ability of neutrophils to kill some bacteria that translocates.

Diet for ulcers

As tolerated. Avoid late night snacks Omit: gastric irritants- cayenne, black pepper, chili powder, excess caffeine and alcohol

Insulin types: Rapid Acting

Aspart (Novolog), lispro (Humalog) Take 5-15 mins before eating Usual duration 4 hours

Components of nutrition assessment: Cluster

Assessment data is clustered for comparison with characteristics of a suspected diagnosis -Food/nutrition related history -Anthropometrics -Lab/medical tests -Nutrition focused physical findings

Re-feeding syndrome. Who is at risk, why it happens, effects.

At risk: Anorexia, alcoholics, prolonged fasting, unfed 7-10 days, sig. wt loss, phosphorus deficient-PN As starved cells take up nutrients, K and Ph shift into intracellular compartments Results: hypokalemia, hypophosphatemia, hypomag. Overfeeding leads to hyperglycemia

Cerebral Palsy: Non-spatic form

Athetoid form Involuntary, wormlike movement, constant irregular motions leading to wt loss Diet: High kcal, high protein; finger foods

What is the nutrition prescription for PKU?

Avoid all foods with animal protein and high biological value vegetable protein; use low protein bread and cereal products; avoid aspartame.

Alzheimer's Disease Diet

Avoid distractions durin meal time Regular, consistent mealtimes Encourage self-feeding Offer one course at a time

Dysphagia Advanced

Avoid very hard, sticky, crunchy foods Hard f/v, nuts, seeds

Ileum

B12, intrinsic factor, bile salts, and a major portion of fluid are absorbed in this part of the intestine

AIDS Nutrition

BEE x 1.3 for asymptomatic Protein: 1.2-2 if wasted LBM Vitamin/Minerals may be needed to correct deficiency Retrovir causes non-nutritional macrocytic anemia Neutropenic diet may be helpful- avoid raw food

who is at most risk for gestational diabetes: BMI <30, age <25, overweight, BMI >30, history of GSM, conception within 10 months of last pregnancy

BMI >30, history of GSM

Gestational Diabetes Risk Factors

BMI>30 Hx of GDM

What happens when a dieter reaches plateau?

BMR has dropped to reflect weight loss

What causes dental caries?

Bacterial enzymes ferment CHO deposits on plaque; enzymes produce acids that demineralize surface

IBD: Chronic Ulcerative Colitis. Effect

Begins in the rectum, affects COLON Effect: Chronic bloody diarrhea, electrolyte (Na, K) disturbance, wt loss, anorexia, dehydration, anemia

BRFSS

Behavioral Risk Factor Surveillance System Run By: HHS Who it Measures: Adults over 18- reached by phone. Interview collects info on ht, wt, smoking, alcohol, food frequency for fat, f/v, preventable health problems, diabetes

Effects of Nutrient: Calcium

Binds tetracycline

BUN

Blood Urea Nitrogen Related to protein intake Indicator of renal disease

Treatment for Crohn's

Bowel rest, TPN or minimal residue

Aspects of goals

Broad direction, general purpose Ex- Increase the awareness of CHD risk factors

High purine foods

Broth, anchovies, sardines, organ meats. sweetbreads, herring, mackerel

How is the Nutrition Diagnosis documented?

By writing a PES statement to describe the problem, the root cause, and the assessment data that provides evidence for the nutrition diagnosis.

Oral glucose-lowering medications: Exenatide

Byetta Enhances insulin secretion, supresses postprandial glucagon

CRP

C-reactive protein Marker of acute inflammatory stress. As it declines, indicates when nutrition therapy would be beneficial

Addison's Disease. Cause, Effect, Treatment

C: Atrophy of adrenal cortex. Absence of adrenal hormones (cortisol, aldosterone, androgenic) E: Hypoglycemia, dehydration, wt loss T: High protein, frequent feeding, high Na

Pancreatitis. Cause. Effect

C: Blockage or reflux in the ductal system. Premature activation of enzymes within pancreas lead to autodig. E: Inflammation with edema, cellular exudate, and fat necrosis

Short Bowel Syndrome. Cause. Effect

C: Consequences associated with significant resection of the small intestine E: Malabsorption, malnutrition, fluid/electrolyte imbalances, wt loss

Glycogen Storage Disease. Cause, Effect, Treatment

C: Deficiency of glucose-6-phosphate in liver, impairs gluconeogenesis and glycogenolysis E:Liver can't convert glycogen into glucose, leading to hypoglycemia T: Provide consistency supply of glucose with cornstarch at regular intervals. High CHO, low fat

Cystic Fibrosis. Cause. Effect

C: Disease of exocrine glands E: Secretion of thick mucus that obstructs glands and ducts; Chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption

Maple Syrup Urine Disease. Cause, Effect, Treatment

C: Error in metabolism of BCAAs- leucine, isoleucine, valine E: Poor sucking reflex, anorexia, FTT, irritability, maple syrup odor of sweat and urine T: Restrict BCAA 45-62 g, kcals from CHO and fat to spare amino acids

Heart Failure. Cause, Effect

C: Fails to maintain adequate output Diminished blood flow, so fluid is held in tissues E: Edema, Shortness of breath (dyspnea). Reduced blood flow to kidneys cause secretion of hormones that hold in fluid, leading to wt gain

Complications of uncontrolled diabetes: Acute ketoacidosis. Cause. Effect. Treatment

C: Hyperglycemia due to insulin deficiency or excess CHO intake E:Dehydration due to polyuria, increase pulse, fruity odor of ketones Treatment: Insulin, rehydration

Osteoporosis. Cause, Result, Treatment

C: Malnutrition, lack of exercise, decline in Ca R: Reduction of amount of bone-defective Ca absorb T: Hormone replacement therapy, wt bearing exercise, supplements, adequate protein Elderly, frail white women most at risk

Galactosemia. Cause, Treatment

C: Missing enzyme that would have converted galactose-1-PO4 to glucose-1-PO4 T: Diet only- galactose and lactose free No: Organ meat,milk products, Ca/Na caseinate, dates, bell pepper Okay: soy, hydrolyzed casein, lactate, lactic acid, lactablumin

PKU. Cause, Effect

C: Missing phenylalanine hydroxylase, which converts phenylalanine to tyrosine. E:Phen. accumulates and causes poor intellectual function Detected with Guthrie blood test

Postprandial or Reactive hypoglycemia. Cause, Effect, Treatment

C: Overstimulation of pancreas or increased insulin sensitivity; blood glucose falls below normal 2-5 hrs after eating E: Weak, trembling, extreme hunger T: Prevent marked rise in blood glucose. Avoid simple sugars, 5-6 meals/day, spread out CHO

Homocyinurias. Cause, Effect, Treatment

C: Treatable inherited disorder of aa metabolism. E: Severe elevations of methionine and homocysteine in plasma. Low levels of folate, B6, B12 T: Increased doses of folate, B6, B12 for new dx

Urea Cycle Defects. Cause, Effect, Treatment

C: Unable to synthesize urea from ammonia resulting in ammonia accumulation E: Vomit, lethargy, seizures, coma, anorexia, irritability T: Protein restriction based on tolerance, age, projected growth rate

hormone stimulating release of bile

CCK

Exchanges: Low-Fat Milk

CHO: 12 Protein: 8 Fat: 5 Kcals: 120

Exchanges: Whole Milk

CHO: 12 Protein: 8 Fat: 8 Kcals: 150

Exchanges: Skim Milk

CHO: 12 Protein:8 Fat: 0-3 Kcals: 100

Exchanges: Fruits

CHO: 15 Protein: 0 Fat: 0 Kcals: 60

Exchanges: Starch/Bread

CHO: 15 Protein: 0-3 Fat: <1 Kcals: 80

Exchanges: Vegetables

CHO: 5 Protein: 2 Fat: None Kcals: 25

Nutrition focused physical findings: Teeth- missing, loose, loss of enamel

Calcium deficiency, poor intake

Tables of Food Composition

Calculate intake of nutrients Data from USDA Helpful in dietary surveys to compare intake with recommended levels

No because sodium is needed to maintain normal levels of sodium in the plasms during large prenatal expansion of tissues and fluid

Can a sodium restriction be recommended for a pregnant woman? why or why not?

A job description:

Can be used for employee appraisals

Diverticulitis. Cause, Treatment

Cause: Diverticula become inflamed as a result of food and residue accumulation and bacterial action Treat: CL, low-res or elemental, gradual return to fiber

Celiac disease: Cause, effect

Cause: Rxn to gliadin affects jejunum and ileum. Effect: Malabsorption, macrocytic anemia, wt loss, diarrhea, steatorrhea, iron deficiency anemia

CMS

Centers for Medicare and Medicaid Services Run By: DHHS Medicare- health insurance for people over 65 or anyone with end stage renal disease; employers and employees pay Medicaid- payment for medical care for eligible needy: all ages, blind, disabled, dependent children

Where is the long term central access for TPN?

Cephalic vein Subclavian vein (minimizes risk of phlebitis) Internal jugular vein Into superior vena cava

Effect of Methotrexate

Chemotherapy drug Decreased folate

Nutrition focused physical findings: Hair- Thin, sparse, dull dry, easily pluckable

Chemotherapy, vitamin C, protein deficiency

The program that was designed for non-profit, non-residential daycare facilities is:

Child and Adult Care Food Program

Which group or groups are most at risk for undernutrition?

Children and older adults

Name 3 chemical sanitizers.

Chorine Iodine Quaternary ammonia

Terminal ileum

Chron's disease affects this part of the intestinal tract

B12 and iron deficiency

Chron's disease results in these two vitamin/mineral deficiencies due to the area of the intestinal tract that is affected, and blood loss

Tropical Sprue. Cause, effect, treatment

Chronic GI disease, intestinal lesions. May affect stomach Cause: Bacterial, viral, parasitic infection. Effect: D, malnutrition, Def in B12 and folate due to decreased HCL and IF Treat: Antibiotic, high kcal/pro, IM b12 and oral folate supplements

Colon

Chronic ulcerative colitis affects this part of the intestinal tract

Retinol-binding protein.

Circulates with prealbumin. Shortest half life (12 hours) Binds and transports retinol

What are nutrition indicators?

Clearly defined markers that can be observed and measured. Nutrition care criteria are what indicators are compared against

What is reviewed during nutrition screening?

Client's history, lab results, weight, physical signs

What is the difference in pudding made with egg substitute instead of a whole egg?

Coagulation temperature is lower

What are some medications that can cause taste alterations?

Colace, Lopid, Cisplatin, Flagyl, and Dilantin

Strategies that strengthen local food systems: Food recovery and gleaning programs

Collect excess wholesome foods that would otherwise be thrown away to deliver to hungry people

Glycemic Index

Compares blood glucose response of food to a standard glucose load Foods with low index produce greater satiety Low index: milk, legumes, nuts, pasta, ice cream, yogurt

Nutrition Evaluation

Compares findings with goals or standards. it determines the degree to which progress is being made, and outcomes are being met

Prader Willi Syndrome

Congential disroder; subnormal LBM, lotsa body fat Ghrelin levels are elevated: growth hormone secretion, appetite, intake, fat mass deposition Do not sense satiety; decreased energy requirements Obesity at 2-3, hypogonadism, FTT, short stature Best treatment is to control food intake

a 75 year old female with adequate income would benefit from

Congregate Meals

Steatorrhea

Consequence of malabsorption. Normal stool fat 2-5g, >7=malabsorption Treat: High protein, high complex CHO, fat as tolerated, vitamins, minerals, MCTS (rapidly hydrolyzed in GI tract)

Nutritional Surveillance

Continuous collection of data Identifies problem, sets baseline, sets priorities, detects changes in trends Uses ht, wt, h/h, serum cholesterol On-going system linked to active health programs: CDC, WIC Data identifies needs and kind of intervention needed

What does egg in a recipe function as

Contributes to liquid, progein, contributs to sturcture, reduces tenderness, flavor, flavors a fine texture.

What is OK in a gluten free diet

Corn, potato, rice, soybean, tapioca, arrowroot, carob bean, flax

Anorexia treatment

Correct electrolyte imbalance first Plan with pt: regular mealtimes, varied and moderate intake, gradual intro of feared foods Focus on health benefits of food Increase intake slowly

Northwest Ordinance

Created first govt. territory outside of the U. S. Encouraged westward migration, banned slavery and provided for schools.

CHI

Creatinine height index Ratio of creatinine excreted/ 24 hours to height Estimates lean body mass-somatic protein

What are the three modes of feeding for tubefeedings?

Cyclical, Bolus and Continuous

What are the calories per liter for D5W parenteral solution?

D5W= 5% of 1,000 mL OR 50 g of dextrose/liter 50 g x 3.4 kcal = 170 kcal/liter

which of the following self-assessment tools would be given to clients prior to screening at a congregate meal site: PEACH survey, DETERMINE, NSI Level II screen

DETERMINE checklist

What standards are dietary intakes (24-hr recall, FFQ) compared to?

DRIs/RDAs or a food group system

Cirrhosis. How does it occur

Damaged liver tissue is replaced by bands of connective tissue Divides liver into clumps and reroutes veins and capillaries, causing a disruption ib blood flow

What should be included in documentation?

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

Effect of Mineral oil, cholestryamine

Decrease absorption of fat, fat-soluble vitamins

Effect of Steroids

Decrease bone growth, CHO intolerance

Effect of oral contraceptives

Decrease folate, B6, C

Effect of thiazide diuretics

Decrease potassium and magnesium Absorb calcium

What do oat bran and soluble fibers decrease, and how?

Decrease serum cholesterol by binding bile acids converting more cholesterol into bile

Effect of Antibiotics

Decrease vitamin K

Effect of Statins (HMG CoA reductase inhibitors)

Decreased LDL and TG Increased HDL

Effect of Phenobarbital

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

Effects of Nutrient: Vitamin B6 and protein on L-dopa

Decreases effectiveness It controls symptoms of Parkinson's disease Take in the morning with less than 10g protein

Effect of Orlistat

Decreases fat absorption by binding lipase

Nephrosis. What. Effect

Defect in capillary basement membrane of glomerulus, which permits escape of large amounts of protein into the filtrate moving through the tubules E: Albuminuria, edema, malnutrition, hyperlipidemia

Thyroid Disorders: Hypothyroidism

Deficiency of thyroid hormone T4 low, T3 low or normal Decreased BMR, leading to wt gain

State of negative fluid balance caused by decreased intake, increased losses, and fluid shifts.

Dehydration

Gastroparesis. Cause, effect, treatment

Delayed gastric emptying Cause: Surgery, diabetes, viral infect., obstruction Effect: Mod- Sev hyperglycemia, detrimental effect on gastric nerves Treat: Prokinetics (eryhtromycin) increase contractility, small frequent meals, pureed, avoid fiber, liquid fat tolerated

Effect of Loop diuretics

Deplete potassium, magnesium, calcium, sodium, chloride

Effect of Isoniazid

Depletes pyridoxine, causing peripheral neuropathy. Don't take with food. Interferes with vitamin D, so Ca supplements are needed (Treats TB)

_______ is a bookkeeping charge that reduces the value of equipment as an asset.

Depreciation

What is a mission statement?

Describes what a company does and how it differentiates from others

2010 Dietary Guidelines for Americans

Designed to prevent chronic disease Written by USDA and HHS Community nutrition programs use these guides when developing plans Focus on reducing kcals and reducing components that contribute to excess kcals- solid fats, added sugars, refined grains

<200

Desirable total cholesterol level

Community Food Security Initiative

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

National Research Council

Develops RDAs Policy of enrichment- increasing nutrients to a higher level than they naturally occur Policy of fortification

How do you calculate dextrose, amino acids and lipids for a TPN?

Dextrose: Ex, D50W: 1000ml x 50g/100ml= 500g Dextrose x 3.4kcal/g Dex= 1700kcal Amino Acids: Ex, 8%: 1000ml x 8g/100ml= 80g x 4kcal/g= 320kcal Lipids: Ex,10%: 500ml * 1.1= 550 kcal

What is serum transferrin mainly used for by the dietitian?

Diagnosing anemia

Prospective Payment Systems-DRG's

Diagnostic Related Groupings Enacted by Congress in TEFRA- Tax Equity and Fiscal Responsibility Act Includes Medicare and Medicaid Pts are classified based on the international classification of disease and the hospitals are paid a certain amount based on the disease Length of time not considered in payment

DHKS

Diet and Health Knowledge Survey Run By: USDA Who it Measures: Main meal planner and preparer in households. Beliefs about food safety, food labels, knowledge of nutrients

high kcal, high pro, finger foods. constant irregular motions leading to weight loss

Diet for athetoid form of cerebral palsy and why?

high pro (1.2-1.5 g/kg), high kcal (30-35/kg), normal Ca, adequate fluids

Diet for decubitus ulcer

low kcal, high fluid, high fiber. limited activity, obese

Diet for spastic form of cerebral palsy and why?

6 small, dry feedings; restriction of hypertonic concentrated sweets;high protein; moderate fat; fluids before or after meals, and B12 injections

Diet recommendations following a gastrectomy include

low cholesterol (<300mg), low fat, wt reduction, inc complex CHO

Diet recommendations for cardiovascular disorders (CAD, IHD)

High calorie, high protein, low fat diet

Diet recommendations for people with all IBDs (not in a flare up) include

DRI

Dietary Reference- nutrient goals to be achieved over time Based on RDA, EAR, AI, UL

Waist/Hip ratio

Differentiates between android and gynoid obesity Men 1.0, Women 0.8 Indicative of android obesity and an increased risk for obesity related diseases

Cerebral Palsy: Spastic form

Difficult, stiff movement; limited activity; obesity Diet: Low kcal, high fluid, high fiber

Heart Failure Treatment

Digitalis to increase strength of heart contraction Diuretics Low Na, DASH diet, fluid restriction if needed 1.2 g protein

Day 1

Discharge plans begin on day ____ of a hospital stay

The age discrimination in employment amended prohibits discrimination agains what group of people?

Discrimination against those 40-70years of age.

DETERMINE

Disease Economic hardship Tooth loss Reduced social contact Multiple medications Involuntary wt loss/gain Needs assistance in self-care Elder years above age 80

Achalasia

Disorder of lower esophageal sphincter motility; does not relax and open upon swallowing Causes dysphagia Start with pureed moist thick food; progress to thick liquids

Gout. Cause, Effect, Diet

Disorder of purine metabolism Increased serum uric acid, deposit in joints causing pain, swelling Diet- low purine may not be effective; wt reduction

What is the proper way to cool a large stockpot of clam chowder?

Divide into shallow stainless steel pans and place them in an ice-water bath.

no, because they rely on food donations

Do emergency food programs, such as a food bank, provide balanced meals?

do not

Do sugar alcohols (sorbitol, xylitol) promote tooth decay?

Yes

Does goat milk contain lactose

no

Does research support the notion of spot weight loss therapy?

Complications of uncontrolled diabetes: Acute hypoglycemia

Due to insulin excess or lack of eating Slow pulse, cool, clammy skin, hungry, weak, shaky, sweaty Treatment: Glucose. Start with 15 g, wait 15 minutes, if still <70 give another 15g

Chronic Kidney Disease. Effects. Treatment

E: Anorexia, weakness, wt loss, N/V Anemia due to eryhtopoietin deficiency T: Stg 1-3, GFR <60 no uremic symptoms 0.8 g/kg Stg 4,5 GFR <25 0.6 g/kg No added salt if edema

Irritable Bowel Syndrome. Effect, Treatment

E: Chronic ab discomfort, altered intestinal motility, bloating T: Avoid large meals, excess caffeine, alc, sugar. Use food diary to track intake, emotion, etc. Work with client to alleviate stress during eating

AIDS. Effect, Goals

E: Diarrhea, malabsorption, n/v, wt loss Goals: Preserve lean bosy mass, prevent wt loss & wasting

Arthritis: Effect, Treatment

E:Normocytic anemia may develop b/c inflammation of arthritis prevents reuse of iron T: Regular, well balanced diet, bedrest, aspirin, wt loss to decrease stress

a family receiving food stamps often runs out of food by the middle of the month. obtain an emergency food voucher for them and refer them to

EFNEP

a poor healthy 19 year old mother is unsure how to feed her 4 year old child. which program may offer her the most help: EFNEP, WIC, HHS, CACFP

EFNEP

where can a pregnant teen learn to cook

EFNEP

water

Early rapid weight loss during diet is ____ as glycogen is utilized

What are some recommendations to prevent chronic disease?

Eat plenty of fruits and vegetables especially dark leafy greens, eat lean proteins, choose whole grains over processed, use oils to replace fats

Identify two physical and/or biochemical manifestations of Kwashiorkor.

Edema, fatty liver, third spacing, and severely depleted serum protein and serum albumin.

What are the 4 outcome criteria for controlling?

Efficient Effective Appropriate Adequate

Treatment for UC

Elemental diet to minimize fecal volume

What organization gives food, but not necessarily healthy food?

Emergency food program (food bank)

Who does food insecurity impact?

Emergency food recipients All ages, ethnicities, locations Working poor Extends to government food assistance recipients, and those with poor health status

Northwest Ordinance

Enacted in 1787, it is considered one of the most significant achievements of the Articles of Confederation. It established a system for setting up governments in the western territories so they could eventually join the Union on an equal footing with the original 13 states

Goiter

Enlargement of thyroid gland due to insufficient thyroid hormone Endemic goiter- inadequate iodine intake Diet- Iodized salt; free of goitrogens- foods of cabbage family like brussel sprouts

Amputation changes for desirable body weight

Entire leg: 16% Lower leg with foot: 6% Entire arm: 5% Forearm with hand: 2.3%

If you are concerned about possible food contamination, it would be safer to eat a steak than a hamburger because of what bacteria?

Escherichia coli

Which foodborne pathogen is more of a concern in ground meat than solid-muscle meats such as steaks?

Escherichia coli

EAR

Estimated Average Requirements for 50% of the population

Nutrition Survey

Examination of a population group at a particular point in time Considered a cross-sectional exam; pin points problems Determines prevalence of condition or characteristic at a specific time

Thyroid Disorders: Hyperthyroidism

Excess secretion of thyroid hormone Elevated T3 and T4 Increased BMR, leading to wt loss

You have found a home recipe that you would like to serve in the hospital cafeteria. What is the best method in developing a large quantity recipe that maintains the quality of the original recipe?

Expand the recipe in increments, evaluate and adjust the recipe at each step.

efficacy not proven

Experimental treatment of hyperactivity is the Feingold diet (no salicylates, artificial colors or flavors). Is it effective?

Health Belief Model

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

Lewis & Clark

Explored the Louisiana Purchase to gather info about the land, climate, people, etc.

EFNEP

Extension Food and Nutrition Education Program Run By: USDA What it Does: Provides grants to universities that assist in community development. Trains nutrition aides to educate the public. Works with small groups to improve food practices of low income homemakers with young children

International agencies that provide assistance

FAO: Food and Agricultural Organization. Increasing efficiency of production and distribution of food WHO: World Health Organization- developed RDAs for developing countries

Diabetes diagnosis using FBG and OGTT

FBG: >126 mg/dL OGTT: >200 mg/dL

The ___ licenses radio and TV

FCC

The ___ ensures safety of domestic and imported food products, nutrient composition labeling

FDA

Macrocytic, megaloblastic anemia

FEW large cells, filled with hemoglobin Due to deficiency of folate or B12; Schilling test for pernicious anemia MCV and MCH are high

The ___ challenges product claims when a product crosses state lines

FTC

The ___ regulates the contents of food ads, enforcing truth in labeling

FTC

Who monitors for health care fraud?

FTC National Council Against Health Fraud (NCAHF)

True or False: Efficiency is doing the right thing.

False: Doing things right.

Tests that prove diabetes

Fasting plasma >126 -or- GTT >200 -or- Symptoms of diabetes plus casual plasma glucose >200 hgA1c >6.5%

What are some known dietary carcinogen enhancers?

Fat in red meat, polycyclic aromatic hydrocarbons, aflatoxins, safrol.

25-40% kcal, MCT if needed, <40g fat if malabsorption

Fat requirements for cirrhosis

<30% fat

Fat requirements for nephrosis

Exchanges: Fat

Fat: 5 Kcals: 45

What is the storage form of iron?

Ferritin

Gestational Diabetes Risks For Child

Fetal macrosomia (LGA) Fetal hypoglycemia

Strategies for Type I diabetes

Fixed daily dose of insulin Consistant CHO Monitor glucose and adjust insulin For planned exercise, reduction in insulin may be best choice

What are the initial needs of the burn patient?

Fluid and electrolyte repletion.

1.5-2 L/day (high fluid)

Fluid requirements needed daily in renal disorders to dilute urine?

oral supplementation not recommended, use fluoridated water if available

Fluoride recommendations for infants (birth-6mo)

fluoridated water or supplements as recommended; fluoride toothpaste (pea-size amt)

Fluoride recs for children (2-3yrs)

fluoridated water; oral supplements ONLY if prescribed

Fluoride recs for infants (6-12mo)

fluoridated water, or oral supplements if prescribed. toothpaste should not be used if child cannot spit it out

Fluoride recs for toddlers (12-24mo)

What can make a B12 deficiency?

Folic acid can mask a B12 deficiency

Iron, B12, and folate

Following a gastrectomy, patients are at high risk for what three vitamin/mineral deficiencies

Dumping Syndrome Overview

Follows a gastrctomy (Billroth I, II) Holding capacity of stomach is decreased, so food is dumped into the intestines Causes cramps, rapid pulse, weakness, perspiration, and dizziness upon eating

Flow Phase

Follows fluid resuscitation and return of oxygen transport

a mother with 2 daughters ages 8 and 11 does not earn enough money to feed her family, which program would you suggest

Food Stamps

a single man with two daughters ages 10 and 11, is looking for aid. which program might provide assistance: WIC, Food stamps, Child Care Food Program, Headstart

Food Stamps

a father needs help in feeding his children ages 6 and 8. which are the best options: WIC and TANF, Head Start and Food Stamps, Food Stamps and School Lunch , Commodity Foods and WIC

Food Stamps and School Lunch

What is the best dietary intake assessment in a community setting?

Food frequency list. Does not need the dietitian's help

How to teach clients who speak another language

Food models and demonstrations

What are four classes of nutrition interventions that were identified?

Food/Nutrient Provision, Nutrition Education, Nutrition Counseling, Coordination of Care

7%

For each degree rise in F temp of body, BMR rises

Which one of the following terminology is NOT associated with Total Quality Management?

Forecasting methods

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 Ca in the bone leading to a Zn deficiency

Gastrectomy diet

Frequent, small, dry feedings (Fluid before or after meal) Restrict hypertonic concentrated sweets, protein at each meal Lactose may be poorly tolerated B12 injections may be needed

Block Grants

From federal government, given to states for broad purposes as authorized by legislation. Recipients have great flexibility in distributing funds. Ex- CDC STEPS, health initiatives based on obesity

Hormones Involved in renal Function: Vasopressin (ADH)

From hypothalamus (stored in pituitary) Exerts pressor effect; elevates BP Increases water reabsorption from distal and collecting tubules

Altered GI Function vs. Impaired Nutrient Utilization

GI- looks at problems in the GI tract including exocrine functions of liver and pancreas with changes n digestion, absorption, and/or elimination INU- refers to problems with the metabolism of nutrients once they have entered the circulatory system, Includes the endocrine functions of the pancreas, liver, pituitary, and parathyroid

galactose and lactose free

Galactosemia is greated solely by diet. What does this include or not include?

Billroth I

Gastroduodenostomy Attaches remaining stomach to the duodenum

Billroth II and the downside

Gastrojejunostomy Attaches it to the jejunum. When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced. These hormones normally stimulate the pancreas, so now there is little pancreatic secretion, which causes steatorrhea

Where do public health departments get their income from?

General revenue Federal, local, foundation grants

Cancer cachexia

Generalized wasting Connected to cytokines and the tumor-necrosis factor

To prevent EFAD in TPN pts

Give 500 mL of 10% fat 1-2x per week Symptoms: petechiae

Insulin types: Long Acting

Glargine (Lantus), determir (Levemir) Onset 2-4 hours Duration 18-24 hours

FPG >=126 or GTT >=200 or symptoms of diabetes plus casual plasma glucose >=200 mg/dL

Glucose levels for diabetes

maintain normal blood glucose (avg preprandial goal 90-130, peak PG avg <180)

Goal for all diabetics (hint glucose levels)

How do you calculate a net profit/loss?

Gross profit-labor cost-operating cost

500ml of 10% fat emulsion 1-2x/wk

HOw much and what percent lipid should be given to pts on PN to prevent essential fatty acid deficiency?

<7%

HbA1c goal for diabetes

60-90 days

HbA1c measures for long term blood glucose control. how long?

What are some aspiration precautionary measure that should be taken with tubefeedings?

Head of Bed at 30 degrees, hold residuals if they are >/= 250ml, the patients starts vomiting

What program's goals include increasing life span, reducing health disparities, and providing preventative services for all?

Healthy People 2000

A new cereal is going to be marketed and the company wants to do a food preference survey. What would be the best approach?

Hedonic scale

what bacteria may cause gastric ulcers

Helicobacter pylori

An iron-storage disease, caused by a genetic defect, whereby high amounts of iron are absorbed and stored in tissues that do not normally store iron is:

Hemochromatosis

Which hematological index can be used to evaluate iron and protein deficiencies?

Hemoglobin

Alcoholic Liver Disease stages

Hepatic steatosis (fat build up) Alcoholic hepatitis Cirrhosis

What can a high or low albumin mean?

High Albumin: dehydration, TB, Hepatitis, HIV Low Albumin: drinking too much water, burn or wound, chronic debilitating disease, liver dysfunction

What diet is recommended for patients with pressure ulcers?

High Calorie, HIgh Protein, Can add things like ascorbic acid, zinc oxide and MVIs to aid in wound healing.

homocysteine

High _____ levels are independent risk factors for CHD.

What is an independent risk factor for CHD

High homocysteine levels

Pediatric HIV Nutrition Intervention

High kcal/protein Supplements for wt gain HALS can develop

Diet for Cirrhosis

High protein 0.8-10, in stress at least 1.5 High kcal 25-35 Mod- low fat. MCT if needed. Fat is the preferred fuel. Include omega 3s If varcies- low fiber; If ascites- low Na With hyponatremia- fluid restriction; if steat- low LDL

Hepatic Failure. Treatment

High protein and kcals Low Na if ascites Lactulose and neomycin Altered neurotransmitter theory

What are low cariogenic foods?

High protein, moderate fat, minimal concentration of fermentable CHO Strong buffer High mineral content (Ca, P) pH>6 Stimulates saliva Ed- cheddar cheese, nuts, meat

Formula for PPN

Highest concentration of dextrose used in PPN is 10% Protein: 3-15% Fat: 10%, 20% Solution limited to 800-900 mOsm

(ml) (%) (3.4)

How do you figure out the kcals of a IV dextrose solution?

Replete, but do not overfeed: high calorie, high protein

How do you maintain a stable weight in a pt with COPD?

throw out open containers after 24 hours

How do you reduce bacterial contamination in enteral feeding?

Introduce a minimal amount of full strength enteral feeding at a low rate of 30-40ml/hr to establish GI tolerance; when tolerating 75% by enteral route, d/c PN

How do you transition from PN to EN?

1.1kcal/ml

How many kcals are in a 10% solution of intralipid?

1mL/1 kcal ingested

How many mL of water should be given per kcal ingested in enteral feedings?

avoid simple sugars, 5-6 small meals/dya, spread CHO intake throughout day, decrease fat, limit or avoid EtOH

How to manage postprandial or reactive hypoglycemia

as CRP declines

How would someone utilize C-reactive protein (CRP) to indicate when nutritional therapy would be beneficial?

Serum sodium, blood urea nitrogen, serum osmolality and urine specific gravity are laboratory measures of what?

Hydration status

Hyperkinesis Diet

Hyperactivity- ADHD Feingold diet- experimental treatment. No salicylates, artificial color or flavors Efficacy not proven, + results may be due to placebo effect

Results of physiological trauma from injury

Hyperglycemia, hyperinsulemia, little or no ketosis, increase glucagon 1. Catecholamines epi suppress insulin/hepatic glycogenolysis 2. ACTH: releases cortisol which mobilizes aa from muscles 3. Aldosterone: renal Na retention, gluconeogenesis 4. ADH: Renal water reabsorption 5. Hypovolemia: decreased cardiac output, drop in temp 6. Hyperglycemia: Epi suppresses insulin, insulin resistance (decreased cell uptake and use) 7. Fluid and Na retention, K excretion, loss of nitrogen, sulfur, zinc, phosphorus

Effect of Cyclosporine

Hyperlipidemia, hyperglycemia, hyperkalemia, hypertension (Immunosuppressant)

Ebb and flow response to injury

Hypermetabolic, catabolic response following trauma Accelerated catabolism of lean body mass leading to a negative nitrogen balance as protein is catabolized to release glucose for energy

Effects of Nutrient: Tyramine

Hypertension if taken with MAOI Restrict tyramine by avoiding aged, fermented, dried, smoked, or spoiled food. Avoid hard cheeses, lunch meat, tofu, Chianti Limit sour cream, yogurt, buttermilk Ok: Cottage cheese, cream cheese, ricotta cheese, farmers cheese

Ebb Phase

Hypovolemia, shock, tissue hypoxia

Explain the four stages of pressure ulcers

I. intact skin with non-blanchable redness of a localized area; area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue II. partial thickness loss of dermis presenting a shallow open ulcer with a red pink wound bed w/o slough III. full thickness tissue loss; subcutaneous fat may be visible (bone, tendon or muscle not exposed) IV. full thickness tissue loss with exposed bone, tendon or muscle, slough may be present

Nutrition diagnosis

ID and labeling that describes an actual occurrence, risk of, potential for developing a nutritional problem that dietetics professionals are responsible for treating independently. Dx changes as the pt's response changes

which of the following should be included in the diet for celiac disease: I decrease intake of eggs II use of potato and rice flour III IM vitamin B12 and iron IV low calorie, high fat, high protein

II, III use potato and rice flour and IM vitamin B12 and iron

a patient with Crohn's disease needs the following diet: I high fat, high calorie, high protein II low fat only with steatorrhea, vitamin C, B12 III high calorie, high protein according to current BMI IV high residue, low fat fat soluble vitamins V low calorie, low residue, fat soluble vitamins, B12

II, III: low fat only with steatorrhea, vitamin C, B12 and high calorie, high protein according to current BMI

low protein, low methionine

If a pt with homocystinurias does not respond to the increased doses of vitamins reveived, what type of diet is followed?

low

If edema or ascites in cirrhosis, low or high sodium

free of goitrogens (cabbage family)

If one has a goiter, the diet should be free of what?

< 25 mg/dl

If someone is lactose intolerant and completes a lactose tolerance test, blood glucose will rise how much above fasting

Flat curve

If someone is lactose intolerant and does a lactose tolerance test, will the graph be flat or curved

hypoglycemia

If the liver can't convert glycogen into glucose, this leads to what?

low

If varices are present in cirrhosis, low or high fiber

What is the allergic reaction to a normally harmless food protein?

IgE

What can happen in a jejunal resection?

Ileum can adapt and take over jejunal function

Burns.

Immediate shock period: catabolsim; BMR rises 50-100% First goal: replace fluid and electrolyte loss Recovery period: 1.5-3 g/kg protein, high kcal, Vitamin C, water soluble vitamins, Zn, vitamin K if on antibiotics

Implement, Select, Apply

Implement staff evaluation and development system to improve performance; select & implement appropriate models for supervision and staff development and apply the legal requirements for professional management.

What does Team Nutrition do?

Implements School Meals Initiative for Healthy Children Motivates children to make healthy choices Provides recipes, training, support

obesity

In HTN, what is a major factor in the cause and treatment?

Clinical Domain

In Nutrition diagnosis, this is the domain that includes nutritional findings/problems that relate to medical and physical conditions. It includes functional ( i.e swallowing difficulty), biochemical (i.e increases TG) and weight balance

low in phenylalanine but enough to promote normal growth. phenylalanine (PHE), tyrosine (TYR)

In PKU, the diet is ______? restrit ____ and supplement _____

WITH. regular mealtimes, varied and moderate intake, gradually reintroduced feared foods

In a patient with anorexia nervosa, plan ____ patient: what should be planned?

Wernicke-Korsakoff syndrome

In alcoholic liver disease, long term thiamin deficiency can cause what

Albumin

In ascites, a dilution factor can cause low serum______

throat, rectal bleeding, teeth, esophagus

In bulima nervosa, damage can be done to what?

50-100%

In burns, during the immediate shock period, BMR rises

replace fluids and electrolytes lost

In burns, what should be done first

inc, bind bile acids which lower cholesterol

In cardiovascular disorders, complex CHO should be (inc or dec)? why?

restricted

In chroinc renal insufficiency, when GFR falls, what is the recommendation for protein?

Connective tissue

In cirrhosis, damaged liver tissue is replaced by bands of this which is nonfunctional and divides the liver into clumps, rerouting many of the veins and capillaries

galactose-1-PO4 into glucose-1-PO4

In galactosemia, the enzyme that does what is missing?

glucose-6-phosphatase. gluconeogenesis and glycogenolysis

In glycogen storage disease, there is a deficiency of what enzyme? What does it impair?

high purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackeral)

In gout, what should be avoided in the diet?

inccreased leading to weight loss

In hyperthyroidism, BMR is _____

both elevated

In hyperthyroidism, are T3 and T4 decreased or increased or normal?

decreased leading to weight gain

In hypothyroidism, BMR is _____

T4 low, T3 low or normal

In hypothyroidism, are T3 and T4 decreased or increased or normal?

phenylalanine hydroxylase, tyrosine

In phenylketonuria, what enzyme is missing? What does this convert phenylalanine into?

regular, well-balanced diet with viamin intake to at least DRIs

In skeletal and connective tissue disorders, what is the diet recommendation?

Etiology

In the PES statement, this is linked to the problem by the words related to (aka cause/contributing risk factors)

Symptoms

In the PES, subjective data the patient expresses

Intake Domain

In the nutrition diagnosis, this domain includes actual problems related to intake

Behavioral-Environmental Domain

In the nutrition diagnosis, this domain includes problems related to knowledge, access to food, and food safety

Diabetes

In this disease, AST (SGOT) is decreased when the disease is uncontrolled

Liver disease

In this disease, all four ezymes are elevated (ALP, LDH, AST, ALT)

Prader Willi syndrome. control access to food

In this disease, pt may consume over 5000 kcal/d and still be hungry. Best treatment

Lactose tolerance test

In this test for lactose intolerance, lactose is ingested and a graph of blood glucose is produced.

HCL and intrinsic factor

In tropical celiac sprue, deficiencies of B12 and folate occur to decreased production of these

protein restriction (1,1.5,2 g/kg based on tolerance, age, projected growth rate) due to lower ammonia

In urea cycle defects, what are the protein requirments of the diet and why?

Give an example of a PES statement.

Inadequate oral intake related to chewing difficulties as evidenced by a 10# weight loss in the last month.

Strategies that strengthen local food systems: Farmers Markets

Increase access to fresh produce

Acute Viral Hepatitis. Treatment

Increase fluids to prevent dehydration 50-55% CHO 1-1.2 g pro/kg: cell regeneration, prevent fatty liver Small, frequent feedings b/c of anorexia Mod- lib fat intake Encourage coffee MVI with B complex, C, K, zinc

List the functions of aldosterone.

Increase the resorption of sodium. Increase secretion and excretion of potassium. Increase secretion and excretion of hydrogen. Reabsorb chloride.

Recommended diet for renal patients on dialysis

Increased protein needs, fluid restriction, limit sodium, potassium and phosphorus.

What is the benefit of having a diverse workplace?

Increases the diversity of customers

Name five risk factors for osteoporosis.

Increasing age (post-menopause), female gender, North European heritage; immobility, and reduced calcium in the diet.

High protein diet

Increasing this nutrient in the diet will prevent fatty liver

Glycosylated hemoglobin (HgbA1C) reflects the serum glucose level for what time span?

Indicates serum glucose levels over 100-120 days.

Serum Ferritin

Indicates size of iron storage pool

Cholecystitis. Cause. Effect. Treatment

Inflammation of gallbladder C: Low grade infection E: Excess water is absorbed, causing cholesterol to precipitate out, leading to gallstones- cholelithiasis T: Low fat diet

Gastritis. Effects, Treatment

Inflammation of stomach Effects: anorexia, n/v/d Treat: CL, adv as tolerated, avoid gastric irritants

Stomatitis

Inflammation of the mouth, associated with riboflavin deficiency Avoid very extreme temp foods, spices, sour/tart Rinse with lukewarm water after meals

Diffusion of Innovation

Innovators: Adopt idea rapidly Early adopters: Opinion leaders; well respected Early Majority: Cautious in adopting new idea Late Majority: Skeptical, adopt through peer pressure Laggards: Last to adopt

Least expensive enteral formulas

Intact protein (Not pre-digested) Isotonic (osmolity close to the blood)

If you have two diagnoses from two domians, what should you choose for your PES statement?

Intake dx, because it is more specific to the nutrition professional

Which NG feeding method gives the most mobility?

Intermittent drip (pump or gravity)

Transitional feeing

Intro mini amount of full-strength enteral feed at low rate of 30-40 mL/hr to establish GI tolerance Decrease PN as you increase enteral rate by 25-30 mL/hr increments every 8-24 hours When pt can tolerate 75% of needs enterally, D/C PN

Hematocrit

Iron containing pigment of red blood cells Erythrocytes are produced in bone marrow

What are some different types of anemia?

Iron deficiency anemia, B12 anemia, folic acid anemia, hemolytic anemia, Thalassemia, sickle cell, aplastic anemia.

Nutrition focused physical findings: Nails- brittle, thin, spoon-shaped

Iron or protein deficiency

Gastrectomy deficiency

Iron, B12, Folate. Causes anemia

Nutrition focused physical findings: Skin- pale, dry, scaly

Iron, folic acid, zinc deficiency

What role does renin play in the kidney filtration system?

It acts as a vasoconstrictor, it's secreted by the glomerulus when blood volume decreases; stimulates aldosterone to increase sodium absorption and return blood pressure to normal.

What is the role of aldosterone?

It causes renal sodium retention (it is a corticosteroid secreted by the adrenal glands)

Why is an arm span measurement taken to determine height in a person that is bedridden or unable stand?

It correlates well with height and maturity and is minimally affected by osteoporosis

Breast-feeding is preferred because it provides physical, economical and other advantages. Which is not an advantage of breast-feeding?

It is not always convenient

Fiber

It's main function is to provide bulk and promote intestinal function

Louisiana Purchase

Jefferson secrued the pruchase of this land from the French. It doubled the size of the U. S.

What does JCAHO?

Joint Commision for Accreditation of Health Care Organizations

who resolves differences in bills from the House and Senate

Joint conference committee of the House and Senate

25-35 kcal/kg estimated dry or 1.2-1.5 BEE

Kcal requirements for cirrhosis

<60 yo 35 kcal/kg (including dialysate), >=60 yo 30-35 kcal/kg

Kcal requirements for peritoneal dialysis (based on age).

Exchanges: Alcohol

Kcals: 100

Epilepsy. Diet

Ketogenic diet- high fat, very low CHO Mild dehydration needed to prevent dilution of ketones 4:1 fat to non-fat diet Supplements of Ca, D, B6, B12 MCT are more ketogenic, more rapid metabolism and absorption

List ways in which fluids are excreted or lost from the body.

Kidneys, skin, lungs, GI tract, increased evaporative (large open wounds, draining wounds, fistulas, external bleeding).

the symbol U on a food label indicates

Kosher

Deep and gasping respirations, as developed in acute diabetic ketoacidosis, are called:

Kussmaul respirations

What are the lipid levels of the healthy obese?

LDL high Normal to low HDL

IDL

LDL precursor Found in circulation secondary to catabolism of other lipoproteins

a middle income female needs support for breast feeding. which group will help: Milk Bank, pritikin program, LaLeche, Feingold program

LaLeche

End Stage Renal Disease. Lab values, Effects, Treatment, Goals

Lab: Associated with a BUN >100 and Cr 10-12 Effect: Retention of N metabolites. T: Giovanetti Diet: 20 g protein (HBV); Increase kcals Goals: control edema, prevent deficiencies

Pancreatic enzymes

Lack of these enzymes results in steatorrhea

Adverse effects of enteral feeds

Lactose intolerance Formula hyperosmolality Rapid infusion causes influx of water into gut Bacterial contamination

What happens in lactose intolerance?

Lactose remains intact, exerting hyperosmolar pressure Water is drawn into the intestine to dilute the load- distention, cramps, diarrhea Bacteria ferment undigested lactose, releasing CO2 gas

Enteral bore opening sizes

Large #16: Blenderized whole food Small #8: Ready prepared formula

NHANES III

Large sample of individuals over the age of 65 with no upper limit. Good for study on aging

What influences the severity of SBS

Length and location of resection, age of pt, health of remaining tract. Loss of ileum (especially distal 1/3), loss of ileocecal valve, loss of colon are of particular concern

What is enteral access based on?

Length of time needed Risk of aspiration Pt's Anatomy Clinical Status Normal digestion and absorption

Oliguria is defined as a urine output of _____ .

Less than 500 cc/ 24 hours

What are the different levels of dysphagia?

Level 1- Pureed, Level 2- Mechanical soft, Level 3- Advanced

Elevated

Levels of enzymes in the blood are ________(elevated or decreased) when tissue damage has occurred

Nutrition care of SBS: Ileal

Limit fat, use MCT, Supplement fat sol. vitamins, Ca, Mg, Zn Parenteral B12 followed by monthly injections

What happens if the ileum cannot recycle bile salts (ex- ileal resection)

Lipids not emulsified--> Malabsorption of fat sol. vit Malabsorb fats mix with Ca, Zn, Mg to form "soaps" Colonic absorption of oxalate increases- renal oxalate stones Increased fluid and electrolyte secretion; increase colonic motility

The kitchen closed early due to a tornado drill. The deep fat fryer was not filtered. At dinner the next day, customers were complaining that their eyes were burning and there was an unpleasant odor in the dining room. What happened?

Lipolysis

The cause of an outbreak of a foodborne illness was traced to Brie cheese. What bacterium is probably responsible?

Listeria monocytogenes

The cause of an outbreak of a foodborne illness was traced to unpasteurized milk; symptoms included fever, nausea, headache. The likely source is:

Listeria monocytogenes

what medication is affected by serum sodium levels

Lithium

Hepatic Failure. Cause. Effect

Liver function decreased to 25% or less C: Liver cannot convert NH3 to urea, ammonia accumulates E: Apathy, drowsiness, confusion, coma, asterisix (flapping, jerky motions)

Foods high in iron

Liver, kidney, beef, dried fruit, dried peas and beans, nuts, leafy green vegetables, fortified whole grain products

Arteriosclerosis

Loss of elasticity of blood vessel walls

Radiation side effects and treatments

Loss of taste, esophagitis, diarrhea, malabsorption Xerostomia (dry mouth, so moisten food) Mucositis (inflammation of mucosal lining of oropharynx and esophagus); avoid fresh, raw, uncooked foods. Offer carbonated beverages, frude ades, cold and soft food

What is typically prescribed in a Cardiac diet?

Low Fat, Low cholesterol, low sodium

What type of diet should people with Crohn's disease follow?

Low fiber, low fat diet

legumes, milk, nuts, pasta, ice cream, yogurt

Low glycemic index foods

Refeeding Syndrome

Low serum levels of K, Mg, and Phos with severe, potentially lethal outcome that results from the too-rapid infusion of substrates, particularly CHO, into the plasma with the consequent release of insulin and shift of electrolytes into the extracellular space as glucose moves into the cells for oxidation and there is reduction in salt and water excretion

What are some recommendations that you can make to an oncology patient to help them increase palatability of foods during chemotherapy?

Luke-warm food, don't use strong spices, small frequent meals, high calorie/high nutrient smoothies, don't use metal utensils.

___ has the theory X&Y for manager expectations

MacGregor

IBD treatment- General

Maintain fluid and electrolyte balance Limit fat only if steatorrhea, high fat may improve energy balance; MCT oil All kinds of vitamins

What can happen in an ileal resection?

Major complications Distal- absorption of B12, IF, bile salts Ileum normally absorbs major portion of fluid in GI tract Ileum cannot recycle bile salts

Effect of Chemotherapy

Malabsorption

In developing guidelines for professional practices in ethical decision making: which principle would not be used?

Maleficence

What's the definition of management?

Management is a set of activities directed at an organization's resources to achieve goals efficiently and effectively.

When was the NCP and Model adopted by the ADA House of Delegates?

March 2003

What process in a food service operation includes products, pricing, employees, decor and service?

Marketing

___ ___ is a theory of basic needs and higher human needs (survival, safety, social, self-esteem, self-realization, self-actualization)

Maslow's hierarchy

Block grant areas

Maternal and child health Community services Social services Preventative health services Primary care

Urinary creatinine clearance

Measures GFR

Triceps skinfold thickness

Measures body fat reserve; measures calorie reserves Standard: male12.5mm, female 16.5

Prevalence

Measures how many people have the disease (Total number of people with disease/average number of people) x100,000

Arm Muscle Area

Measures skeletal muscle mass (somatic protein) To determine: Use TSF and Arm Circumference Important to measure in growing children, identifies possible protein energy malnutrition

Serum Creatine

Measures somatic protein; related to muscle mass Excreted by kidneys with little reabsorption With BUN assesses kidney function May indicate muscle wasting

Incidence

Measures the risk of developing the disease (New cases over a period of time/ total number of people at risk) x 100,000

mechanical advantage

Mechanical advantage is a measure of the force amplification achieved by using a tool, mechanical device or machine system. Ideally, the device preserves the input power and simply trades off forces against movement to obtain a desired amplification in the output force. The model for this is the law of the lever. Machine components designed to manage forces and movement in this way are called mechanisms. -two typeS: IDEAL AND ACTUAL

Managed-care Organizations (MCOs)

Mechanism for financing and organizing health care delivery in which providers and payers have predetermined payments for care provided.

_______ diagnosis is a disease of pathology of organs or body systems and does not change as long as the condition exists.

Medical

a TF pt gets diarrhea...prob from?

Medication

Hemoglobin

Men 44%, Women 38%, Pregnant women 33% Volume of packed cells in whole blood

What is the Mifflin-St. Jeor Equation?

Men- (10 x wt in kg) + (6.25 x ht) - (5 x age) + 5 Women- (10 x wt in kg) + (6.25 x ht) - (5 x age) -161

What are some clinical manifestations that can occur in PKU?

Mental retardation, Severe behavioral problems, Neurological abnormalities, Seizures, Eczema

If cells lose acid or accumulate base what condition is occuring?

Metabolic alkalosis (CO2 decrease, H+ decrease, pH increase) lungs lower ventilations (ex. hyperemesis, ingestion of lye)

Oral glucose-lowering medications: Biguanides

Metformin (Glucophage) Enhances insulin action, supresses hepatic glucose production

CAM Categories

Mind-body medicine: yoga. meditation Alternative medicals systems: acupuncture, oriental Lifestyle and disease prevention Biologically based therapy: herbs, orthomolcular meds Manipulative & body-based: Chiropractic Biofield systems: therapeutic touch Bioelectric magnetics

What is a Full Time Equivalent?

Minimum number of employees needed to staff the operation.

The score that occurs most frequently in a frequency distribution is what measure of central tendency?

Mode

Modular vs. blenderized enteral formulas

Modular: Mix individual components; adds flexibility Blenderized: Whole food, large bore tube, thick intact protein, high residue

Dysphagia Mechanically Altered

Moist, soft textured, easily formed into bolus Moist, tender ground or diced meat Soft cooked veg/ fruit or canned fruit No bread, rice, cheese cubes

What is the MNT for spastic CP?

Monitor calorie intake to prevent obesity, high fluid, high fiber to prevent constipation, adequate calcium and vitamin D intake.

Renal Disorders: Renal Calculi. What, Treatment

Most common is kidney stone 1.5-2L to dilute urine Adequate Ca to bind and low oxalate and a low oxalate diet (dglv, chocolate, nuts, beets, strawberries, tea)

most effective tool for getting nutrition education to the community?

My Pyramid

what is the most effective tool for providing nutrition education to the community: RDI's, report Healthy People, My Pyramid/Myplate, The Healthy Eating Index

My Pyramid/ My Plate

which survey is repeated every few years

NHANES

Insulin types: Intermediate-acting

NPH Onset 2-4 hours Duration 10-18 hours Include bedtime snack consisting of CHO and protein

Pregnancy Induced Hypertension

Na restriction not recommended for prevention or treatment; Na needed to maintain normal levels in plasma during large prenatal expansion of tissue and fluid Rapid wt gain after 20th week, edema, proteinuria More frequent in women with lack of prenatal care and poor Ca intake

What are the different accesses for tubefeedings?

Nasogastric, nasoduodenal, nasojejunal, g-tube, j-tube

smooth, pureed (most thick)

National Dysphagia Diet begins with ____ and progresses to ____

Healthy People

National Health Program and Disease Prevention Objectives- Surgeon General- HHS -IDed broad goals and specific objectives for improving health -Focuses on disease prevention by changing behaviors -Healthy wt and diet critical goals

Acronym: NHANES

National Health and Nutrition Exam Survey Run By: National Center for Health Statistics Who it Measures: Ongoing survey to obtain health info about Americans. Evaluates clinical, chemical, anthro, nutritional data, h/h, cholesterol.

NNMRRP

National Nutrition Monitoring and Related Research Program Includes all data collection and analysis activities of the federal government related to measuring the health and nutritional status, food consumption, attitudes about diet and health Jointly run by DHHS and USDA

Acronym: NFCS

Nationwide Food Consumption Surveys Run By: USDA Who it Measures: Obtains info on food intake of individuals and total households from entire US. Evaluates protein, Ca, Fe, Thiamin, Riboflavin, vitamin C, A. Diets rated good if it equals or surpassed RDA. Poor if less than 2/3 RDA for 1 or more nutrient

Strong Heart Diet Study

Native Americans To determine causative factors for obesity, consume 12% fewer calories than the average US population, yet significant increases in heart disease and diabetes Lacking B vitamins and antioxidants

Chemotherapy side effects and treatments

Nausea, vomiting, malabsorption, anorexia Stomatitis- cracks in skin at mouth corners, riboflavin deficiency Methotrexate- anti-folate drug

Paralysis dietary needs

Needs 10% below predicted At least 1.5 L fluid/day

How to teach depends on....

Needs and readiness of the learner

What is the Maslow theory?

Needs exist in a hierarchical order: physiological, safety, belonging/love, esteem, self actualization.

Things to consider when developing a mission statement

Needs of the community, population being served, most critical issues, the present situation, who is saying it's a problem, what will happen if nothing is done

How do you calculate a profit margin?

Net Profit/Sales

Complications of uncontrolled diabetes: Long term

Neuropathy: Peripheral and autonomic; gastroparesis Retinopathy: leads to blindness Nephropathy: Leads to decreased kidney function

What is the potential nutrient deficiency involved when you observe someone with dermatitis, pale, dry, scaly, delayed wound healing, petechial hemorrhages?

Niacin, vitamins A and K, ascorbic acid, essential fatty acids

Identify two key signs of vitamin A deficiency.

Night blindness and keratinization of the skin.

At what point should a women increase her calorie intake during pregnancy?

No increase for the first trimester, 340kcal for the second trimester and 452 for the 3rd

Diarrhea in infants in children: Chronic, non-specific

No significant malabsorption Consider ratio of fat to CHO, volume of ingested liquids Treat: Give 40% kcals as fat, limited fluids; restrict fruit juice with high osmolar load- apple, grape

Systemic Lupus Erythematosus. Treatment

No specific dietary guidelines, tailor to needs

Cerebral Palsy

Non-hereditary brain damage; inadequate control over voluntary muscles

normal <6%, over 65 yo <7% in healthy, <=8% in frail elderly

Normal HbA1c levels (based on age)

Nutrition care of SBS: Jejunal

Normal balance of CHO, Pro, Fat Avoid lactose, oxalates, concentrated sweets V/M supplements

BUN normal range with and without renal disease

Normal: 10-20 mg/dL Renal pt: keep under 100

Mean corpuscular hemoglobin

Normal: 27-32 Microcytic: Low Macrocytic: High

Mean Corpuscular Hemoglobin Concentration

Normal: 32-36% Microcytic: Low <31 Macrocytic: Normal >31

Mean Corpuscular volume. Normal and anemia

Normal: 80-95 Microcytic: Low <80 Macrocytic: High >95

Normal hbA1c

Normal: <5.7% Over 65 and healthy: <7% Frail elderly: <8%

Glucose tolerance test

Normal: sloped Diabetic curve: rounded

Hair analysis

Not used for nutritional assessment Useful in measuring intake of toxic metals

2020 Healthy People Goals Address....

Nutrition & Wt Heart disease and stroke Diabetes Oral health care Cancer Health for Seniors

Define nutrition assessment.

Nutrition Assessment is a systematic process of obtaining, verifying, and interpreting data in order to make decisions about the nature and cause of nutrition-related problems.

"Continually asking the 'why' questions" is a critical thinking skill that falls under which step of NCP?

Nutrition Diagnosis

_______________ is the critical step between nutrition assessment and nutrition intervention.

Nutrition Diagnosis

In the NCPM, which nutrition intervention involves the transfer of knowledge, specific to the knowledge deficit identified in the nutrition diagnosis PES statement?

Nutrition Education

NSI

Nutrition Screening Initiative- Promote nutrition and improve nutritional care for the elderly to identify nutrition problems early Uses DETERMINE checklist- IDs factors that place people at nutritional risk Level 1- people who need more comprehensive assessments Level 2- Potentially greater medical or nutrition problem

Nutrition Diagnostic Labels: Clinical NC

Nutrition findings/problems related to medical/physical condition Functional balance- physical change that prevents desired nutrition results; swallowing, altered GI Biochem balance- change in capacity to metabolize nutrients due to meds, surgery, or indicated by labs Wt balance- chronic or changed wt status

In regards to nutrition screening, what does the Joint Commission mandate?

Nutrition risk is identified in hospitalized patients within 24 hours of admission, but does not mandate the method of screening

AIDS and adjunctive therapy

Nutrition supplements should not be routinely recomm. Herbal should be discouraged Vit. C or St. Johns Wort could result in drug resistance CAM therapies are not inert and may have consequences

Jejunal resection

Nutritional care for this type of resection inclues normal balance of carbohydrates, protein and fat

Ileal resection

Nutritional care of this type of resection includes limiting fat, supplementing fat-soluble vitamins, calcium, magnesium, zinc, and parenteral B12

What is the most influential risk factor contributing to hypertension.

Obesity

What are the critical thinking skills needed for nutrition assessment?

Observe verbal/non verbal cues 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 data

Reactive Hypoglycemia

Occurs with dumping syndrome. Blood sugar rises rapidly, stimulating an overeproduction of insulin, causing a drop in blood sugar below fasting.

What are the three names you should know when referring to the krebs cycle?

Often called: citric acid cycle or tricarboxylic acid cycle.

congregate meals and home delivered meals fall under what act

Older Americans Act, Title III

<100

Optimal LDL level

Lactose intolerance test

Oral dose of lactose after a fast If intolerant, blood glucose will rise <25 mg/dl above fasting. If tolerance, the rise will be above 25 (normal glucose curve)

Name the three routes by which fluid is supplied to the body.

Oxidative metabolism, oral fluids, solid fluids

Cystic Fibrosis. Treatment

PERT High pro, high kcal, unrestricted fat, liberal in salt Calories to cover RDA for age/sex Supplement water sol. forms of fat sol. vitamins, especially A & E

Pancreatitis Treatment: Chronic

PERT: pancreatic enzymes orally with meals and snacks to minimize fat malabsorption. MCTs do not require pancreatic lipase, so add Give max level of fat tolerated to maintain wt Fat sol. vitamins in water sol. form. Parenteral B12 Avoid large meals with fatty foods, alcohol

Documentation Styles

POMR, PES, and SAP are examples of this that are determined by the facility

More than 2000 additives are used today, as important ingredients of processed and convenience foods. Which of the following additives are meat tenderizers?

Papin and bromelin

Levodopa is used in the treatment of

Parkinson's disease

Medicare: Part A vs. Part B

Part A- hospital insurance Part B- Optional insurance for supplementary benefits

When to use a transpyloric tube?

Passed by pyloric valve in stomach Used in comatose or pts with no gag reflex

The menu planner should study the population to be served. Which of the following data is the least important to study?

Past experience and opinions with that type of foodservice

Identify the type of patient that would require TPN.

Patients with a nonfunctional GI tract.

Third party reimbursement

Payment by a third party for services rendered by a healthcare provider to a pt (Blue cross, Medicare)

Which of the following foods are responsible for the majority of allergic reactions?

Peanuts, eggs, milk

Common allergens

Peanuts, eggs, milk, soy, wheat, shellfish Cow's milk is most common for infants Introduce eggs at 24 months, nuts and fish at 36 months

Foods that contain prebiotic compounds

Pectin Fructose Oats Banana Flakes

Prebiotics

Pectin, fructose, oats, and banana flakes are examples of

What do soluble fibers do?

Pectins, gums Delay gastric emptying, absorb water, form soft gel in SI; slows passage and delays or inhibits absorption of glucose and cholesterol

Acronym: PedNSS

Pediatric Nutrition Surveillance System Run By: HHS Who it Measures: Low income, high risk children, emphasis on birth- 5 years. Checks ht, wt, h/h, cholesterol, breast feeding. Monitors growth and nutritional status, infant-feeding practices

What TPN is used for short or moderate term infusion?

Peripherally inserted central catheter

COPD. What, Treatment

Persistent obstruction of airflow through lungs T: Indirect calorimetry to determine kcal needs. Maintain stable weight. Replete, but do not overfeed

Components of DGA

Physical activity Limit trans fat to less than 1% of kcals Balance kcals consumed with kcals expended Reduce bad foods, Increase good foods Food safety

What are the two components of nutrition intervention?

Planning and implementation

What are the two main components that make up nutrition intervention?

Planning and implementation

Indications for PPN

Post-surgery when enteral feeding is expected to resume within 5-7 days Mild -moderate malnutrition As supplement to enteral

What nutrient is depleted with Furosemide/Lasix use?

Potassium

Oral glucose-lowering medications: Amylin antagonist

Pramlintide (Smylin) Decrease glucagon production

Stages of Change Model

Pre-Contemplation: not interested in change Contemplation: Thinking about it Preparation: Plans the change Action: Tries to make the change Maintenance: Sustains the change

_______ is a transport protein synthesized by the liver and transported in the serum as a complex of retinol-binding protein and vitamin A; a negative acute-phase reactant protein with a short half life.

Prealbumin

What is the difference between a prebiotic and a probiotic?

Prebiotics are non-digestible substances that may promote "good bacteria in intestines. Probiotics are live bacteria that may promote balance of "good" bacteria in gut.

Elemental Formulas Overview and Examples

Predigested protein Absorbed in proximal intestine Used with compromised GI or inability to digest and absorb Ex- Alitraq, Peptamen, Vivonex

Acronym: PNSS

Pregnancy Nutrition Surveillance System Run By: HHS Who it Measures: Low income, high risk pregnant women. Checks maternal wt gain, anemia, pregnancy behavioral risk factors, birth wt, counts # of women who breast feed. IDs and reduces pregnancy-related risk factors

Budget Cycle

Prepare request Evaluate revenue potential Formulate document Send to legislative body Legislative review and authorization Execute budget Evaluation and review

Strategies that strengthen local food systems: PPFPs

Prepared and Perishable Food Programs Non-profit programs that link sources of unused, cooked, and fresh foods with social service agencies that serve the hungry

Monroe Doctrine

President James Monroe's statement forbidding further colonization in the Americas and declaring that any attempt by a foreign country to colonize would be considered an act of hostility

PES Statement

Problem (altered, impaired, increased, risk of) Etiology, cause/contributing risk factor. ("related to") Signs/Symptoms. (Objective data, observable changes, changes the pt expresses) ("as evidenced by"

What are the four components of the Nutrition Diagnostic Reference Sheet?

Problem or nutrition dx label Definition of the label Etiology Signs/Symptoms

Nutrition Diagnostic Labels: Behavioral-environmental NB

Problems related to knowledge, access to food and food safety

Hormones Involved in renal Function: Erythropoietin

Produced by kidneys; stimulates bone marrow to produce RBC

4 "P's" of marketing

Product is acceptable Place is accessible Price is reasonable Promotion tailored to enable attention

Marasmus

Protein and calorie starvation Anthropometric dx; serum albumin normal, no edema Severe fat and muscle wasting

1.2g/kg (at least 50% HBV); 30-35kcal/kg

Protein and kcal requirements for hemodialysis.

Nephrosis. Treatment

Protein controlled 0.8-1.0, 75% from HBV Fat restricted <30% Modest Na restriction

Effect of Glucocorticoids, antibiotics

Protein deficits

0.8-1.0 g/kg, 1.5g/kg

Protein requirements for cirrhosis. in stress?

15-20% kcal, malabsorption due to pancreatic deficiency

Protein requirements for cystic fibrosis. why?

0.8g/kg, 15-20% kcal

Protein requirements for diabetes

0.8-1 g/kg (75% HBV)

Protein requirements for nephrosis

1.2-1.3g pro/kg SBW or BW (>50% HBV)

Protein requirements for peritoneal dialysis.

increase 1-1.5 g pro/kg as tolerated, low Na if ascites, adequate caloires, vit/min supplement

Protein, sodium, kcal, vit/min requirements for hepatic failure (ESLD)

Iatrogenic malnutrition

Protein-calorie malnutrition Brought on by treatment, hospital, medications

Nutritional problems associated with cancer

Protein-kcal malnutrition, malabsorption, fluid and electrolyte imbalance Altered taste acuity: add flavors and seasonings Meat aversions Thrush from oral infection: avoid spicy, acidic, strongly flavored foods. Provide bland liquids, soft foods, chilled or frozen foods

Exchanges: Plant based protein

Protein: 7 Everything else varies

Exchanges: Lean Meat

Protein: 7 Fat: 0-3 Kcals: 45

Exchanges: Medium-Fat Meat

Protein: 7 Fat: 4-7 Kcals: 75

Exchanges: High-Fat Meat

Protein: 7 Fat: 8+ Kcals: 100

PT

Prothrombin time. 11-12.5 seconds, 85-100% of normal Anticoagulants prolong PT Evaluates clotting adequacy; change in vitamin K intake will alter rate

Hiatal Hernia

Protrusion of a portion of the stomach above the diaphragm into the chest. Heartburn.

According to Bloom's taxonomy, what type of learning is involved when a client demonstrates how to cook a meal unassisted?

Psychomotor

which patient has marasmus? Patient A: male, serum albumin 3.5, transferrin 275, triceps skinfold 3, MAMC 15 Pt B: female, serum albumin 2.6, transferrin 125, triceps skinfold 16.8, MAMC 24.1, TLC 1000 Pt C: m, albumin 4.0, transferrin 450, triceps 17, MAMC 28.1, TLC 3500

Pt A: male, serum albumin 3.5, transferrin 275, triceps skinfold 3, MAMC 15

How to meet the nutrition needs of the homeless

Put WIC clinics at shelters Offer education and training to staff and volunteers at food kitchen

What is the only unreversable action in the krebs cycle?

Pyruvate --> Acetyl CoA

BMI

Quetelet index KG/m^2 Lbs/(inches^2)(703) Healthy adults: 18.5-24.9 Healthy elderly: 24-29

Protein Solution in TPN

Ratio for anabolism 1 g N/150 kcals %= # g protein/100 ml solution

You manage the foodservice department at an LTC facility with a stable census of 350. You notice that over the past few weeks there has been an increase in overtime paid. Which is not a possible cause?

Realistic work schedules

In making decisions, which of the following steps should be taken?

Recognize and analyze the problem, gather data, choose action, take action and follow-up.

RDA

Recommended Dietary Allowances Replaced by DRI

Roux-en-Y Gastric Bypass

Reconstructs SI to resemble the letter Y Connects small gastric pouch to jejunum Dumping syndrome may occur Potential anemia, deficiencies in K, Mg, folate, and B12. Supplementation is necessary

Quasi- governmental agencies that provide assistance

Red Cross National Research Council

Hypogeusia

Reduced acuity of taste sensation as caused by certain drugs.

Myocardial infarction

Reduction of coronary flow to myocardium due to blood clot blocking narrowed coronary artery

Osteoblasts

Reform bone

Insulin types: Short-Acting

Regular insulin Take 30-45 minutes before meal One unit covers 10-15 g CHO Duration 3-6 hours

Altered Neurotransmitter Theory

Related to Hepatic Failure BCAA low and AAA high because liver unable to clear them. Abnormal ratio may bring on the symptoms Add BCAA- provides extra nitrogen, kcals + pro May not reduce symptoms, used when standard therapy does not work

Cholecystectomy

Removal of gallbladder Bile now secreted from liver directly to intestine

Adult Diarrhea.

Remove the cause, bowel rest, replace lost fluids and electrolyes. Begin with low fiber foods, followed by protein foods. Fat need not be limited. Avoid lactose Probiotics and prebiotics may help

Specialized enteral formulas: Renal, Pulmonary, Liver, Diabetes

Renal: Nepro, Suplena Pulmonary: Pulocare, Respalor (High fat, low CHO) Liver: Hepatic Aid Diabetes: Glucerna

vasoconstrictor

Renin is a

What is "weight cycling"?

Repeated bouts of weight loss and gain which appears to result in increased body fatness with the end of each cycle.

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

Osteoclasts

Resorb and remove bone

If lungs decrease ventilation what condition is occuring?

Respiratory Acidosis (CO2 increase, H+ increase, pH decrease), kidneys compensate by conserving bicarb (ex. emphysema, COPD)

What health risks are associated with dysphagia?

Respiratory infections, aspiration, weight loss, and anorexia

Acute respiratory distress syndrome (ARDS)

Respiratory insufficiency marked by progressive hypoxemia due to severe inflammatory damage causing abnormal permeability of the alveolocapillary membrane. Alveoli fill with fluid which interferes with gas exchange

Pancreatitis Treatment: Acute

Rest pancreas. Withhold feeding, maintain hydration IV Elemental enteral nutrition to jejunum Progress to easily digested food w/ low fat

PKU. Treatment

Restrict phenylalanine, supplement tyrosine Need for pheny. decreases with age and infection Low protein, high CHO intake may lead to increased dental caries

hyperglycemia, hyperinsulinemia, litter or no ketosis, increased glucagon

Results os physiological trauma

HDL

Reverse cholesterol transport Moves cholesterol from cells to liver and excretion

Components of nutrition assessment: Review

Review data for factors that affect nutritional and health status

Nutrition focused physical findings: Lips- swollen, red, dry, cracked

Riboflavin, niacin, B6 deficiency

What food is least likely to cause an allergy?

Rice

Headstart

Run By: DHHS What it Does: Low income children. Introduces new foods and teaches good food habits

Elderly Nutrition Program

Run By: DHHS What it Does: One hot meal 5 days/week, provide 1/3 RDA. counseling, nutrition education, referrals, social interaction Eligibility- All aged 60+ and spouse, regardless of income

Healthy Start

Run By: DHHS What it Does: Reduce infant mortality and improve health of low income women, infants, children, families

Maternal and Child Health Block Grant

Run By: DHHS, Under Title V of Social Security Act What it Does: Fosters public health nutrition programs at the state and local levels. Provides training, consultation, funding. Helps women of child-bearing age, infants, children.

WIC

Run By: USDA What it Does: Provides food for low income mothers at nutrition risk (abnormal wt gain, hx of high risk, LBW, underweight, overweight, anemia) Pregnant, postpartum, bf women, infants up to 5 Health exam required

Commodity Food Donation/Distribution Program

Run By: USDA What it Does: Provides foods to help meet the 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 program

Child and Adult Care Food Program

Run By: USDA What it Does: Reimburses operators for meal costs at day care centers and neighborhood houses. Provides commodity foods and nutrition education materials. Must serve meals that meet the guideline; must offer free or reduced price to eligible

Nutrition Education Training Program

Run By: USDA What it Does: Trains teachers and school foodservice personel

Summer Food Program

Run By: USDA- FNS, state education agencies, nonprofit summer camps What it Does: Expands foodservice program while school isn't in session. Objective is to provide meals or snacks to children at participating institutions in poor areas

EN w/ protein in form of small peptides and amino acids are good for pt w/

SBS

What liver function test is decreased in uncontrolled diabetes?

SGOT

Scope od dietetic practice framework which includes 3 compnenets, building blocks, that help determine whether a service is within your scope of practice.

SODPF

___ describes in general terms a competent level of nutrition care practice as shown by the NCP

SOP

Standards of professional performance which is a competent level of behavior in a professional role

SOPP

___ describes a competent level of behavior in the professional role

SOPP

How do you calculate a Gross profit/loss?

Sales - cost of goods sold

The bakery has had a lot of complaints about the toughness of bread made yesterday. The cook discovered one of his ingredients still on the counter. Which ingredient would result in tougher yeast bread if omitted?

Salt

What is the recommended method when putting more than 1 oz of product in a recipe?

Scale

Effect of Elavil

Sedative effect, weight gain, increased appetite

Activity factors

Sedentary: BEEx 1.2 Active: BEEx 1.3 Stressed: BEE x 1.5

Lewis and Clark

Sent on an expedition by Jefferson to gather information on the United States' new land and map a route to the Pacific. They kept very careful maps and records of this new land acquired from the Louisiana Purchase.

When reviewing the serum Ca level, what other lab value must be evaluated in light of a depleted serum calcium?

Serum calcium is protein-bound; therefore, when reviewing a serum calcium level, serum albumin must also be reviewed.

RAST Test

Serum is mixed with protein on a paper disk; measured IgE antibodies. Outside the body

TTHY transthyretin, PAB prealbumin.

Short half life (2-3 days); picks up changes in protein status quickly Best visceral protein to evaluate

Avoid

Should a patient with an ulcer avoid or be encourage to each a late night snack?

Gastric Banding

Small gastric pouch created using a fluid-filled inflatable band Adjusted to alter size of the opening (fully reversible) Will not require supplementation

Hiatal Hernia diet

Small, bland feedings, avoid late night snack Avoid caffeine, chili powder, black pepper

Mircocytic, hypochromic anemia

Small, pale cells; due to iron deficiency Associated with chronic infection, malignancies, renal disease. All values except RBC are low

National Dysphagia Diet: NDD1

Smooth, pureed, homogenized, cohesive foods "Pudding like" Avoid gelatin, fruited yogurt, hot cereal and soup with lumps

What 4 nutrients should be limited a patient with CKD's diet?

Sodium, Protein, Potassum, Phosphorus

What does SMART goals stand for?

Specific Measurable Achievable Realistic Timed

Aspects of Objectives

Specific measurable actions Contain target dates, expected results in qualitative and quantitative terms, standards of performance. Serves as motivators Does not include: Appreciate, understand

SMART goals is an acronym for____________

Specific, Measurable, Achievable, Realistic, Timed

Specificity vs. Sensitivity

Specificity: Can it ID a pt without a condition Sensitivity: Can it ID those with a condition

Liquid consistency

Spoon thick: Honey/nectar Thin: all other beverages

lactulose

Standard treatment for someone with ESLD involves what

What does SNL stand for under NCP documentation?

Standardized Nutrition Language

Renal Disorders: Acute Kidney Injury, Acute Renal Failure. Treatment

Start with low protein to prevent dialysis. Advance as renal function improves Adequate kcal to spare protein

What is the contingency approach?

States that the most appropriate structure depends on the technology used, the rate of environmental change, and other dynamic forces.

Function of liver

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

An infant on TPN recieves insufficient fat emulsion. What will develop?

Stunted growth, hair, and skin changes; essential fatty acid deficiency

Examples of screening tools

Subjective Global Assessment (includes medical history and physical exam) Mini Nutritional Assessment Nutrition Screening Initiative

What is SGA?

Subjective Global Assessment- nutrition screening method that combines the efficient medical record review with direct client involvement. Assesssment is based on client history and physical examination. Clients are subjectively rated as well nourished, moderately nourished or severely malnourished.

Renal Disorders: Acute Kidney Injury, Acute Renal Failure. What, Cause, Effect

Sudden shutdown w/ previously adequate capacity; Decreased GFR C: Burns, accident, Obstruction, severe dehydration E: Oligura (low urine output), Azotemia (increase in urea in blood)

What does not promote tooth decay?

Sugar alcohols: sorbitol, xylitol

Oral glucose-lowering medications: Insulin secretegogues

Sulonylureas, meglitinides (Glucotrol) Promote insulin secretion

Performance budget

Summarizes program activities performed in terms of the cost of specific accomplishments

If a patient is taking over 30mg of iron in a day; what is the recommended supplementation of other vitamins/minerals?

Supplement with 15mg of zinc and 2mg of copper

SNAP

Supplemental Nutrition Assistance Program Run By: USDA What it Does: Least costly of USDA four food plans. Assist low income with monthly benefits. Designed to increase their purchasing power, not for non-food items. Figures adjusted for the cost of food in Thrifty Food Plan each June

500-1000 mg Vit C w/ stage III or IV or if deficent, 220 mg zinc sulfate and daily dietary source of vit A

Supplements for decubitus ulcer

oliguria

Symptom of acute renal failure that is a urine output of <500 mL

azotemia

Symptom of acute renal failure that is inc urea in blood

albuminuria, edema, hyperlipidemia

Symptoms of nephrosis - nephrotic syndrome

Which problem solving tool uses metaphorical thinking to "make the familiar strange and the strange familiar"?

Synectics

General Nutrition care of SBS

TPN initially Enteral- start early to stimuate growth, increase overtime May take weeks or months to transition to food

TANF

Temporary Assistance for Needy Families States determine the eligibility of needy families and the benefits and services those families will receive

Schilling Test

Test to detect defects in vitamin B12 absorption. Patient is given oral dose of radiolabeled cobalamin and an injection of unlabeled vitamin. The vitamin saturates vitamin B12 storage sites so that all of the radiolabeled vitamin absorbed is excreted in the urine w/ approx 24 hrs. If less than the expected amt appears in the urine B12 malabsorption is confirmed

USDA and HHS

The 2005 Dietary guidelines for Americans are writen by the.....

Credibility, Accuracy, Reasonableness, and Support

The CARS checklist when evaluating health information (acronym) stands for

Food Security

The access by all people at all times to sufficient food for an active and healthy life Access to nutritionally adequate food with the ability to acquire them in a safe way

What are direct costs?

The actual labor hours and raw materials needed to produce a product.

What is retrogradation?

The breaking of some of the H bonds holding the gel together in a continuous network and the reformation of other H bonds by the amylose molecules within the gel

What is differential diagnosing?

The determination of which of many problems with similar symptoms is the correct diagnosis for the patient. Making a differential diagnosis requires comparisons and contrasts of all findings.

Describe the ebb and flow phases as they relate to severe injuries.

The ebb phase occurs immediately following an injury and the flow phase follows fluid resuscitation and restoration of oxygen transport.

Several major changes in the production system were announced months ago. Employees had a negative attitude at the time. Now that the equipment is being installed, employees are verbally negative to the changes and uncooperative toward management. What seems to be the problem?

The employees perceive that the equipment does not meet their needs

higher

The longer the blood glucose is high, the higher or lower the HbA1c?

Loss of ileum, loss of ileocecal valve, and loss of the colon

The loss of these parts of the intestine are of particular concern with short bowel syndrome

Black Box Warning

The most serious warning required by the FDA on drug labels; such warnings appear in a box surrounded by a black border at the beginning of the label information.

The degree of saturation for fatty acids is based on which on of the following?

The number of carbon-carbon double bonds

Acute Viral hepatitis

The nutritional therapy recommended for this illness includes increasing fluids, high protein, high calories, and moderate fat.

Diverticulosis. Cause, treatment

The presence of diverticula- small mucosal sacs that go through the intestinal wall due to structural weakness. Cause:Constipation and lifelong intra-colonic pressures Treat: High fiber diet

Nutrition Monitoring

The review or measurement of a selected nutrition care indicator

Problem, Etiology, Symptoms

The three parts of a PES statement are

Aid in healing

Therapeutic amounts of vitamin C are recommended in patients with IBD to

fruits and vegetables (carotenoids, vit C)

There is some evidence that what foods are beneficial in overall cancer prevention?

hyperglycemia. epinephrine suppresses insulin, insulin resistance (dec cell uptake and use). fluid and Na retention, potassium excretion, loss of N, sulfer, Zn, P

These are results of the metobolic reponse to injury.

Chronic bloody diarrhea, weight loss, electrolyte disturbance (Na and K)

These are symptoms of ulcerative colitis

Oat Bran (insoluble), and soluble fibers

These fibers decrease serum cholesterol by binding bile acids which leads to the body converting more cholesterol into bile

Cayenne and black pepper, large amounts of chili powder, excess caffeine and alcohol

These food items should be omitted when a patient has an ulcer

Eophageal varices

These occur when blood can't enter the liver. It is the outpouching of vessel walls

A 37-year-old patient is admitted with chronic alcohol abuse and continues to consume excessive alcohol. Which of the following vitamins should be recommended?

Thiamin and folate

What disease can be caused by alcoholic liver disease?

Thiamin deficiency- Wenicke-Korsakoff Syndrome

Management of Hypertension

Thiazide diuretic may induce hypokalemia Modifiable factors: overwt, high Na, alc, phys inactive DASH diet Mediterranean diet may have a positive effect

Billroth I

This form of a gastrectomy attaches the remaining stomach to the duodenum. It is a less serious surgical procedure

Billroth II

This form of a gastrectomy attaches the remaining stomach to the duodenum. It is a more serious surgical procedure

Diverticulosis

This form of diverticular disease is treated with a high fiber diet

Diverticultitis

This form of diverticular disease is treated with clear liquids, low residue or elimental diet, with a gradula return to a high fiber diet

Tropical Sprue

This is a chronic GI disease of intestinal lesions, thought to be causes by a bacteria. Unlike its counterpart, it can affect the stomach.

Hiatal Hernia

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

Non-Tropical Sprue, Celiac Disease

This is a reaction to gluten

Ulcer

This is an eroded mucosal lesion

Short Bowel Syndrome

This is defined as the consequences associated with significant resections of the small intestine

Gastritis

This is inflammation of the stomach. The symptoms are anorexia, nausea, vomiting and diarrhea

Nutrition Diagnosis

This is the identification and labeling that describes an actual occurrence, risk of, or portential for, developing a nutritional problem that dietetics professionals are responsible for treating independently. It changes as the patient's response changes

Water and electrolyte reabsorption

This is the main function of the large intestine or colon

Anorexia

This is the major symptom of acute viral hepatitis

Diverticulosis

This is the presence of diverticula. It is related to constipation and lifelong intra-colonic pressures

cholecystectomy

This is the surgical removal of the gallbladder

Diverticulitits

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

Ascites

This occurs when blood cannot leave the liver

Ileum

This part of the small intestine can adapt and take over jejunal functions is there is a jejunal resection

Dumping Syndrome

This sometimes follows a gastrectomy. It occurs when rapidly hydrolyzed carbohydrate enters the jejunum and water is drawn in to achieve osmotic balance. The CHO is rapidly absorbed and causes symptoms such as cramps, rapid pulse, weakness and perspiration

What does it mean to have a prime supplier or a single source supplier?

This supplier is used for most purchases.

Can eat

Those with Celiac Disease can or cannot eat the following: corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax

Cannot eat

Those with Celiac Disease can or cannot eat the following: wheat, rye, oats, barley, bran, graham, malt, bulgur, couscous, durum, orzo

malnutrition (esp protein), lack of exercise, decline in estrogen. A reduction in amount of bone due to defiective calcium absorption.

Three causes of osteoporosis. What is the result?

Iodine constitutes a significant part of which two hormones?

Thyroxine and triiodothyronine

What happens to the liver enzymes in liver disease

Tissue damage causes them to leak into circulation, and the enzyme levels in blood are elevated

Energy in TPN. Max dextrose

To avoid overfeeding start at 20-25 kcal/kg Max dextrose should not exceed 4-5 mg/kg/min to prevent hyperglycemia; Increased blood glucose from excess dextrose increases RQ in ventilated pts and increases infectious complications

What is the purpose of Biguanides?

To lower blood glucose by decreasing the release of glucose in the liver, making cells more sensitive to insulin and loweing insulin resistance.

alkaline ash - vegs, milk, fruits

To prevent acidic stones, create an alkaline or acidic ash?

acidic ash - corn, meat, fish, fowl, eggs, cereal, plums, prunes, cranberries

To prevent alkaline stones, create an alkaline or acidic ash?

UL

Tolerable upper level not associated with adverse side effects in most individuals of a healthy population

Name the iron transport protein.

Transferrin

Concerns with TPN

Translocation of bacteria; Not feeding through gut allows walls to breakdown; Bacteria move out causing sepsis GALT (Gut associated lymphoid tissue) compromised by bowel rest or TPN. Provides immunity

LDL

Transports cholesterol from diet and liver to all cells

Chylomicron

Transports dietary TG from gut to adipose cells Synthesized in intestine from dietary fat Lowest density due to smallest amount of protein

VLDL

Transports endogenous TG from liver to adipose tissue

Esophagitis

Treat by decreasing gastric acidity, reflux Diet- small, bland, low fat, low fiber, wt reduction

hormone replacement therapy, weight-bearing exercise, vit D and Ca supplements

Treatment for osteoporosis

True or False Standardized care means that all patients receive the SAME care

True

True or False: Nutrition prescription establishes framework for patient goals and intervention strategies.

True

True or False: The central core of the NCP model represents the relationship between the patient/client and dietetics professional.

True

false

True or false, sugar causes hyperactivity?

What is Tryptophan a precursor to?

Tryptophan is a precursor to niacin as well as seratonin.

Chron's disease and chronic ulcerative colitis

Two forms of inflammatory bowel disease

What nutrient is affected when a patient is on MAO inhibitors?

Tyramine (restrict intake)

which government agency would you contact regarding food distrobution

USDA

Healthy Eating Index

USDA's overall measure of diet quality Measures how well Americans follow the guidelines 5 food groups, 4 nutrients (fat, sat fat, cholesterol, Na), variety

who regulates WIC and Food stamps and what is a similar criteria requirement

USDA, both have income criteria

Commodity Supplemental Food Program

USDA, under Commodity Food Donation. Administered by state health agencies What it Does: Monthly commodity canned or packaged food. Low income women (preg, bf, postpartum), infants, and children up to 6 years, some elderly

Your clinic provides nutrition intervention for parents of low-birthweight babies. What guidelines are used to determine low-birthweight?

Under 5.5 pounds

The Emergency Food Assistance Program

Under USDA Commodity Food Donation. Distributed by local, public or private nonprofit agencies Quarterly distributions of supplemental diets for low income households

What is a shop steward?

Union representation on site (non-paid)

TLC Diet

Up to 35% kcal fat, <7% sat, 10% PUFA 25-30 g fiber Stanols and sterols- 2g Exercise DBW

What part of management are strategic and long-range goals apart of?

Upper management

Lab Tests in Renal Disease

Urine test- Decreased glomerular filtration rate, creatinine clearance Blood- Increased serum creatinine, BUN Renal solute load- solutes excreted in 1 L urine, mainly measures nitrogen and electrolytes

% weight change

Used to assess potential nutrition risk. Stresses significance of weight change (Usual-actual)/usual

Gastroplasty

Uses staples to create a small gastric pouch Only a small opening into the distal stomach Liquids-> pureed-> soft-> regular small meals and snacks

Hormones Involved in renal Function: Renin

Vasoconstrictor Secreted by glomerulus when blood volume decreases Stimulates aldosterone to increase Na absorption and return BP to normal

Serum Transferrin

Visceral protein Rises with iron deficiency Can be determined from TIBC- total iron binding capacity

Serum Albumin

Visceral protein in blood and organs Maintains colloidal osmotic pressure Hypoalbumineria= edema Hyperalbuminera= dehydration

Which vitamin is most likely to cause birth defects in the developing embryo if taken in mega doses during pregnancy:

Vitamin A

Nutrition focused physical findings: Eyes- pale, dry, poor vision

Vitamin A, zinc, riboflavin deficiency

Nutrition focused physical findings: Gums- sore, red, swollen, bleeding

Vitamin C deficiency

Nutrition focused physical findings: Tongue- smooth, slick, purple, white coating

Vitamin or iron deficiency

Non- Government agencies that provide nutrition assistance

Voluntary health agencies, ie- American Heart Association Professional organizations- ADA Foundations- Rockefeller foundation: conquest of hunger

to learn about prenatal problems in the community, go to:

WIC

which program teaches good nutrition practices and provides foods with certain nutrients: EFNEP, NET, WIC, MCP

WIC

What happens in the loss of colon?

Water/electrolyte loss, loss of salvage absorption of CHO and other nutrients

WLPS

Weight Loss Practice Survey Run By: HHS Who it Measures: 18 and older currently trying to lose wt. Demographic info on BMI, diet hx, self-perception

If a child is chronically malnourished in what order would the growth parameters be affected?

Weight first, length, then head circumference

What is the greatest nutritional treatment for gout?

Weight loss.

Pediatric Overweight Intervention

Weight maintenance Weight loss may be recommended if they have a serious medical condition

Dietary Reference Intakes which are nutrient goals to be achieved over time

What are the DRIs and what are the goals?

to prevent chronic disease

What are the dietary guidelines designed for?

vitamin C deficiency

What are the possible cause of sore, red, swollen, bleeding gums?

Vitamin A, zinc, or riboflavin deficiencies

What are the possible causes of pale, dry eyes or poor vision?

iron, zinc, or vitamin deficiency

What are the possible causes of pale, dry, scaly skin?

ribolflavin, pyroxidine, or niacin deficiencies

What are the possible causes of swollen, red, dry, cracked lips?

Chemotherapy, vit C, protein deficiency

What are the possible causes of thin, sparse, dull, dry hair?

0.6g/kg, inc to 1.2g/kg if non-catobolic, as GFR returns to normal

What are the protein requirements in acute renal failure?

hypokalemia, hypophosphatemia, and hypomagnesemia

What are the results of re-feeding syndrome in the blood?

dysphagia

What can achalasia cause?

hyperglycemia

What can overfeeding PN and dextrose of >5mg/kg/min lead to?

normal=sloped, diabetic=rounded

What do the glucose tolerance test -blood test curves look like for normal and diabetic?

Standards of practice in Nutrition care

What does SOP stand for?

Indicative of android obesity aased risk and an increased risk of obesity-related diseases (DM, heart disease)

What does a WHR of 1.0 or greater in men, 0.8 in women indicate?

stimulates bone marrow to produce RBC

What does erythropoietin (EPO) do?

hemoglobin, measures % of hemoglobin that has glucose attached

What does glycosylated hemoglobin measure?

new cases; (# of new cases over a period of time/total number of people at risk) x 100

What does incidence mean and what is the equation used to calculate incidence?

# of existing cases; (total # pf people with a disease over a period of time/ average number of people) x 100

What does prevalence mean and what is the equation used to calculate prevalence?

N (60%) and electrolytes (Na)

What does renal solute load measure?

elevates

What does renin do to blood pressure?

skeletal muscle mass

What does the arm muscle area (AMA) measure?

differntiates between android and gynoid obesity

What does the waist/hip ratio (WHR) tell you?

elevates

What does vasopressin do to blood pressure?

Weight Watchers

What fad diet is nutritionally sound, developed by an MD, RD

Hard, aged cheese, sauerkraut, some sausages, luncheon meats, tofu, miso, chianti wine. Limit sour cream, yogurt and buttermilk

What foods should be avoided on a tyramine restriction?

restrict: aged, fermented foods, dried, pickled, smoked, spoiled foods

What foods should be restricted when on a tyramine restriction?

2005 Dietary Guidelines for Americans

What guidelines do community nutrition programs use when developing plans?

estimated average requirement for 50%of the population

What is EAR?

translocation of bacteria; not feeding through the gut allows wall to break down; bacteria move out causing sepsis

What is a concern when adminstering PN?

adequate intake that is used when insufficient evidence exists for EAR, RDA

What is an AI?

ADH (anti-diuretic hormone)

What is another name for vasopressin?

large sample over the age of 65; no upper age limit

What is different about NHANES III?

Obesity which adds to the increased prevalence of heart disease

What is epidemic in the Native American and Alaskan native people?

severe nausea, vomiting; acidosis, weight loss during pregnancy

What is hyperemesis gravidarum?

They depend heavily on federal food assistance programs

What is one reason why obesity is an epidemic in the Native American and Alaskan peoples?

DRIs

What is replacing the RDAs?

visceral (blood and organs) proteins

What is serum albumin a measure of?

80-86%

What is the % of water in a 1kcal/mL formula?

18.5-24.9

What is the BMI range for a healthy adult?

<100 mg/dl

What is the BUN goal for renal patients?

1.2

What is the activity factor for calculating energy requirements of a sedentary individual?

1.3

What is the activity factor used to calculate the energy requirements of an active individual?

BCAA dec (used by muscles for energy); AAA inc because damaged liver is unable to clear them

What is the altered neurotransmitter theory (hint ESLD)?

somatic protein status

What is the arm muscle area a good indicator of?

TTHY transthyretin

What is the best vsceral protein to use in evaluating a pt's protein status?

DASH; wh grains, fruits, vegs, low fat dairy, poultry, fish, mod Na, limit EtOH, dec sweets

What is the diet recommendation for HTN? be specific

Nutrition survey - examination of a population group at a particular point in time; Nutritional surveillance - continuous collection of data

What is the difference between a nutrition survey and a nutritional surveillance?

mortality = death, morbidity = disease

What is the difference between mortality and morbidity?

decreased folate

What is the effect of methotrexate?

decreased folate, B6, C

What is the effect of oral contraceptives in the body?

decreased potassium

What is the effect of thiazide diuretics?

24-29

What is the healthy BMI range for most healthy elderly persons?

high fat, low glucose (CHO) (<30 g)

What is the ketogenic diet?

4-5mg/kg/min

What is the mx rate of dextrose infusion of PN to prevent hyperglycemia and other complications?

BEE x 1.3-1.5 for weight gain

What is the recommended energy intake for a pt with HIV?

1-1.4g protein maintenance; 1.5-2g protein repletion

What is the recommended protein intake for a pt with HIV?

reduction in amount of bone due to defective calcium absorption (deossification)

What is the result of osteoporosis?

bed rest and small amounts of frequent CHOs

What is the treatment for hyperemesis gravidarum?

biochemical analysis

What kind of analysis is the most accurate measure of nutritional status?

attitudinal data

What kind of data do focus groups contribute to?

<40 (M), <50 (F)

What levels are considered low for HDL in male and females?

maintain consistent sodium and caffeine intake to stabilize levels

What should be maintained when taking litium carbonate?

increased serum creatinine and BUN

What two blood tests are used to test in renal disease?

decreased glomerular filtration rate and creatinine clearance rate

What two urine tests are used to test in renal disease? Are the values inc or dec?

normocytic normochromic, or normocytic hypochromic anemia

What type of anemia may develop in skeletal and connective tissue disorders?

low protein, high CHO

What type of diet mya lead to increased dental caries?

High kcals, high protein, and high fluids immediately upon Dx

What type of diet should be recommended to a pt just diagnosed with AIDS?

a comatose pt or ones with no gag reflex

What type of pt is a transpyloric tube used for?

Raw foods ..pt should be educated about food safety and be placed on a low bac or neutropenic diet

What types of food should a pt with HIV/AIDS avoid?

supplement with vit/min with 100% RDA and a basic B-complex supplement

What vit/min supplements should be recommended for a pt with HIV?

vit A

What vitamin is of particular concern in cystic fibrosis because it is poorly absorbed even with enzymes?

BMR has dropped to reflect loss

When a dieter reaches a plateau, what has happened?

Small, bland feedings

When a patient has a hiatal hernia, heartburn is the main symptom. A patient should be encourage to each what type of meals? (Small, large, bland, flavorful)

hypermetabolic states, cancer pt on therapy, GI disorders (peritonitis), fistulas, severley malnourished pre-op pts, acute pancreatitis, SBS, critical pt if NPO is expected to last for more than 4-5 days and if enteral support isnot possible

When adminster would you administer PN to a pt?

Secretin and Pancreozymin

When food bypasses the duodenum, the secretion of these two enzymes is produced resulting in steatorrhea

Portal hypertension

When the blood can't enter the liver, esophagel varices or outpouches occur due to this

directly into intestine

When the gallbladder has been removed, bile is secreted from the liver to where?

Under what conditions would the mean, median and mode be approximately the same value?

When there is a normal distribution of scores

autodigestion, pancreas digests the pancreas

When there is premature activation of enzymes within the pancreas, this leads to what? what does this mean?

Intramuscular B12 and oral folate

When treating tropical sprue, what two vitamins/minerals are supplemented

liver

Where are VLDL, LDL, and HDL made?

intestine

Where are chylomicrons made?

USDA

Where dies the data come from in the tables of food composition?

paased by the pyloric valve in stomach

Where does a transpyloric tube pass through?

hypothalamus (stored in pituitary)

Where does vasopressin come from?

distal tubule

Where in the nephron does acid-base balance occur?

proximal convoluted tubule

Where in the nephron does major nutrient reabsorption take place?

Loop of Henle

Where in the nephron does water and sodium balance take place?

What does the Schilling test determine?

Whether the client has pernicious anemia or not.

Jejunum and ileum (proximal small intestine)

Which parts of the intestine are affected by Celiac Disease

Gliadin

Which protein in gluten do people with Celiac Disease react to?

infection causes tissue catabolism releasing phenylalanine into the blood

Why does infection increase or decrease the need for phyenylalanine?

Important in indicating possible protein-energy malnutrition (PEM)

Why is it important to measure the arm muscle area in growing children?

Desirable body weight formula

Women: 100 + (5lb)(inch) Men: 106 + (6)(inch) Small frame (-10%) Large frame (+10%)

What is a class A fire?

Wood, paper, rags, ordinary combustibles

IBD: Regional enteritis (Crohn's Disease). Effect

Wt loss, anorexia, diarrhea. B12 deficiency may occur since terminal ileum is effected, which leads to megaloblastic anemia. Iron deficiency due to blood loss, decreased absorption

In MacGregor's Theory ___, people inherently dislike work and will avoid it

X

In MacGregor's Theory ___, work is as natural as play or rest

Y

Sophistication levels: Inexperienced

Young children and adults lacking nutrition training; need thorough introduction and background

YRBS

Youth Risk Behavior Survey Run By: HHS Who it Measures: Grade 9-12. Smoking, alcohol use, wt control, exercise, eating habits

How do you calculate adjusted body weight for the obese and underweight?

[(Usually Body Weight- Ideal Body weight) x .25] + IBW

a man with a peptic ulcer should consume

a balanced diet he can tolerate

Flavor is termed organoleptic because it is determined by:

a blending of odor and taste

who is most at risk for protein calorie malnutrition: cancer pt on chemo, pt with gastric ulcers, pt with Crohn's, pt with megaloblastic anemia

a cancer pt on chemotherapy

an infant with milk hypersensitivity could safely consume: soy milk fortified with calcium, goat's milk fortified with folic acid, a modular formula with crystalline amino acids, a casein hydrolysate formula

a casein hydrolysate formula

an example of a "Healthy People" goal is

a decrease in infant mortality

Provide nutritious meals within the federal and state guidelines. This is an example of:

a goal for school foodservice

trauma can place a pt in

a hypermetabolic state

four pts are admitted to your service. who would you address first: recent MI, gastric distress, cancer pt, appendectomy

a pt with gastric distress

The "Determine Your Nutritional Health Checklist" is:

a screening tool for nutritional status

what is not a likely cause of failure to thrive in a child: vegetarian diet, chronic illness, parental food restrictions due to them being overly concerned with obesity, lack of fiber in the diet

a vegetarian diet

War of 1812

a war (1812-1814) between the United States and England which was trying to interfere with American trade with France

osteoporosis is most likely to occur in

a white female

a 7-year old on a ketogenic diet requires 1500 kcals. Which is the appropriate order? a) 145 g fat, 25 g PRO, 25 g CHO b) 95 g fat, 40 g PRO, 25 g CHO c) 102 g fat, 56 g PRO, 12 g CHO d) 75 g fat, 32 g PRO, 43 g CHO

a) 145 g fat, 25 g PRO, 25 g CHO

An AIDS pt's temp has risen to 102 degrees. His BMR has increased: a) 24% b) 36% c) 12% d) 5%

a) 24%

Who has the greatest water, PRO, and kcal needs per unit of body weight? a) a 6-month old infant b) a 50 year old F c) a 16 year old M d) a 25 year old M

a) a 6-month old infant

Which of the following would lower serum cholesterol levels? a) dried beans b) green beans c) yellow beans d) summer squash

a) dried beans

A dietary deficiency of which of the following causes a macrocytic anemia resembling pernicious anemia? a) folacin b) pyridoxine c) vitamin B6 d) vitamin C

a) folacin

What would the lab values listed previously have likely reflected if the pt had been nauseated and had averaged only 400 kcal from primarily starchy foods over the weekend? a) little or no rise in K+, BUN/creatinine ratio <10 b) increased PO4, BUN/creatinine ratio >15 c) typical rise in K+, BUN/creatinine ratio >15 d) metabolic alkalosis, BUN/creatinine ratio <10

a) little or no rise in K+, BUN/creatinine ratio <10

A tube fed patient develops diarrhea. What is the most likely cause? a) medications b) the osmolality is too low c) the strength is too weak d) it is being given at an improper rate

a) medications

In severe cirrhosis with ascites, diet therapy should be: a) restrict sodium b) restrict CHO and fat c) restrict PRO and sodium d) restrict fat

a) restrict sodium

Enteral feeding products that contain protein in the form of small peptides and AA are recommended for pts who have: a) short-bowel syndrome b) undergone gastrectomy c) undergone colectomy d) undergone jejunostomy

a) short-bowel syndrome

Goals for a community nutrition program should be based on: a) the Dietary Guidelines for Americans b) the Nutrition Screening Initiative c) the Healthy People report d) the NHANES III report

a) the Dietary Guidelines for Americans

Which survey is conducted every 10 years? a) the USDA Food Consumption Survey b) HANES c) Ten State Nutrition Survey d) Preschool Children Study

a) the USDA Food Consumption Survey

When measuring a child's somatic protein mass, in addition to the BMI, use: a) upper arm muscle area b) triceps skinfold c) mid-arm muscle circumference d) knee to heigh ratio

a) upper arm muscle area

A diabetic wants to exchange his bedtime snack of 8 oz whole milk. What do you suggest? a. 1 oz cheese and 1/2 C OJ b. 2 graham crackers and 1/3 C OJ c. 1 oz cheese d. 2 oz cheese

a. 1 oz cheese and 1/2 C OJ

A sandwich with two pieces of white bread and two oz of turkey provides how many kcal? a. 250 b. 145 c. 198 d. 290

a. 250 kcal

Which formula is high in calories and low in protein? a. AminAid b. Osmolite c. Sustacal d. Jevity

a. AminAid

A poor, healthy 19 yo mother is unsure how to feed her 4 yo child, Which program may offer her the most help? a. EFNEP b. WIC c. HHS d. CACFP

a. EFNEP

Where can a pregnant teen learn to cook? a. EFNEP b. Child Nutrition Services c. UNICEF d. WIC

a. EFNEP

90% of nutrition diagnoses should be in what domain? a. Intake b. Clinical c. Behavioral-Environmental

a. Intake

Which survey is repeated every few years? a. NHANES b. WHO c. Ten State d. FAO

a. NHANES

Margarine has fatty acids in this order of predominance: a. PUFA, MUFA, SAT b. SAT, MUFA, PUFA c. MUFA, SAT, PUFA d. MUFA, PUFA, SAT

a. PUFA, MUFA, SAT

If you are on a low phosphorous diet, what foods should you most avoid? a. beef b. orange juice c. yogurt d. bread

a. beef

Which mineral is involved in blood clotting? a. calcium b. phosphorous c. iron d. selenium

a. calcium

Which mineral is absorbed through the intestine and transported with ceruloplasmin in the blood? a. copper b. iodine c. sodium d. calcium

a. copper

The following oils can be winterized: a. corn, soy, cottonseed b. olive, corn, soy c. cottonseed, olive d. olive, corn

a. corn, soy, cottonseed

Which is the best source of emulsification? a. eggs b. milk c. salt d. flour

a. eggs

A pt has a rare urea dz where the body is unable to synthesize urea. What might be the result? a. elevated ammonia levels b. elevated BUN c. elevated glucagon levels d. compromised visceral PRO levels

a. elevated ammonia levels

Lactic acid is produced by: a. glycolysis b. gluconeogenesis c. glycogenesis d. lactolysis

a. glycolysis

What section of the intestine is most likely involved in Crohn's dz? a. ileum b. jejunum c. duodenum d. appendix

a. ileum

Sorbitol is: a. less sweet than sucrose and has a lower glycemic index than sucrose b. less sweet than sucrose and has a higher glycemic index than sucrose c. sweeter than sucrose d. sweeter than sucrose and has a lower glycemic index than sucrose

a. less sweet than sucrose and has a lower glycemic index than sucrose

Which pasta contains egg? a. noodles b. spaghetti c. macaroni d. linguini

a. noodles

Fats high in monounsaturated fatty acids include: a. olive and canola b. safflower and corn c. coconut and palm d. soy and peanut

a. olive and canola

A serum sodium level of 115mEq/L may be due to: a. overhydration b. dehydration c. a very high sodium intake d. a sodium intake of 5.5g/d

a. overhydration

Green peas held on the serving line may turn olive green due to: a. pheophytin b. cholorphyllin c. anthoxanthins d. flavones

a. pheophytin

Which of the following has the fewest calories? a. plain hamburger on bun b. chef's salad with dressing c. green salad with Thousand Island dressing and shredded cheese d. fried fish sandwich

a. plain hamburger on bun

If protein intake is doubled, which nutrient needs to be increased? a. pyridoxine b. folic acid c. niacin d. vitamin c

a. pyridoxine

The main function of glycolysis is to provide: a. pyruvate for the TCA cycle b. lactic acid for energy use by muscles c. muscle and liver glycogen d. a substrate for the Cori cycle

a. pyruvate for the TCA cycle

Illness due to Bacillys cereus is due to contaminated: a. rice products and starchy foods b. fruits c. dairy products d. eggs

a. rice products and starchy foods

When on Dicumarol, avoid increasing your intake of: a. spinach b. beets c. corn d. beef

a. spinach

What is an example fo a program that provides food to the needy? a. the Food Bank b. the Food Stamp Program c. the Child Care Program d. WIC

a. the Food Bank

What is the goal of the Dietary Guidelines? a. the prevention of chronic disease b. provide standards for Food Stamp allocation c. provide standards for WIC d. provide standards for EFNEP

a. the prevention of chronic disease

Metabolites of the Kreb's cycle are: a. water, energy, carbon dioxide b. energy and pyruvic acid c. electrolytes and water d. lactic acid and glycogen

a. water, energy, carbon dioxide

The smoke point temperature for fats is:

above 442 degrees F

what is the most important advice to give a pt with a peptic ulcer

abstain from spicy food

an obese person with type 2 DM should

achieve DBW

McClelland's ___-___-___ theory suggests that people have three needs

achievement-power-affiliation

Fill in the blank: Implementation is the _____ phase.

action

what can be done to lower the respiratory quotient of a tube fed pulmonary pt

add fat emulsion to replace some of the carbohydrates

___ FTE's take into account the benefit days and days off

adjusted

The need for ___ is the desire to be liked by others

affiliation

what is included in the study of demographics? I age of individuals II sex of individuals III population statistics IV socioeconomic factors

age of individuals, sex of individuals, and population statistics

based on the DRG's Medicare reimbursement depends on

age of patient and primary diagnosis

immobilized state can lead to low levels of _

albumin and calcium

the immobilized state can lead to low levels of

albumin and calcium

On an egg-free diet, what should one watch for on the label?

albumin, dried egg solids, globulin, ovoglobulin, livetin, and vitellin

symptoms of nephrosis include

albuminuria, hypercholesterolemia

hypertension will decrease with a decrease in: fiber, alcohol, potassium, calcium

alcohol

causes of pancreatitis

alcoholism, biliary tract disease, hypertriglyceridemia (from uncontrolled DM)

hormone responsible for renal sodium reabsorption and potassium excretion is:

aldosterone

what is true about cows milk: it is high in protein, it creates a high solute load, it is low in iron and vitamin C

all are true

who can participate in nutritional screening

all health team members can participate according to policy

if a pt has a biochemical block in the formation of urea, what will accumulate in his blood

ammonia

15, 0, 0

amount of CHO, pro, fat in fruit exchange

0, 7, 8+

amount of CHO, pro, fat in high-fat meat exchange

0, 7, 0-3

amount of CHO, pro, fat in lean meat exchange

12, 8, 5

amount of CHO, pro, fat in low-fat milk exchange

0, 7, 4-7

amount of CHO, pro, fat in med-fat meat exchange

15, varies, varies

amount of CHO, pro, fat in other CHO exchange

12, 8, 0-3

amount of CHO, pro, fat in skim milk exchange

15, 3, <1

amount of CHO, pro, fat in starch/bread exchange

5, 2, 0

amount of CHO, pro, fat in vegetable exchange

12, 8, 8

amount of CHO, pro, fat in whole milk exchange

5

amount of fat in fat exchange

which is not fiber in the diet: cellulose, hemicellulose, amylose, pectin

amylose

Erie Canal

an artificial waterway connecting the Hudson river at Albany with Lake Erie at Buffalo

the immune system reacts to foods that are normally harmless this is

an immunoglobulin E (IgE) mediated reaction

for past 2 months a man who is 6'0" tall has been nauseated and anorexic and has consumed fewer than 500 cals/day, mostly from sweet foods. his albumin of 5.0 g/dl most likely reflects

an increase in albumin due to dehydration

the effectiveness of a group education program for decreasing the number of anemic pregnant women enrolled in a community nutrition program is best indicated by

an increase in hematocrit or hemoglobin levels

when a starved pt begins to eat, they might expect

an increased workload on the heart

lactic acid is a result of

anaerobic glycolysis

macrocytic, megaloblastic anemia

anemia due to deficiency of folate or B12

what type of anemia is likely to be seen in a pt with arthritis

anemia secondary to chronic disease

In reviewing the pts medical record, you note a hemoglobin of 10 g/dl and MCV of 110 cu mm. you should document

anemia with larger than normal erythrocytes

methods of measuring body fat and lean body mass

anthropometrics (skinfold measurements), underwater weighing and bioelectrical impedance analysis

Lignans which are found in flax seed, wheat bran, oats and barley contain both:

anticancer and phytoestrogen properties

An ___ bill attaches funding to legislation

appropriates

which bill requests government funding: budget bill, markup bill, appropriations bill, spending grant bill

appropriations bill

what disease would a low sodium diet be recommended

ascites

a young girl who is HIV positive with Karposi's sarcoma tells you she would like to take vitamin C supplements, what should you tell her

ask her to keep a food diary to see where she is lacking

the first function of the public health nutritionist is

assess the needs of the community

The first step in problem solving is to ___, ___, and ___ the problem

assess, recognize, analyze

how long should a new mother breast feed

at least 12 months

MacGregor's theory X&Y suggests that a manager's ___ impacts an employee's performance

attitude

As a leader, you should be ___ in times of emergency, otherwise, be ___

autocratic, participative

the stasis of pancreatic juice and bile could result in

autodigestion, fat malabsorption, and obstructive jaundice

the diet for stomatitis is

avoid spices, very hot, very cold, sour, tart foods

Which contains more total dietary fiber: a) 1/2 cup raw spinach b) 1 oz raisin bran cereal c) 1 slice ww bread d) 2 T peanut butter

b) 1 oz raisin bran cereal

In which of the following would you likely see very low albumin if it is drawn a few days after admission to an acute care facility? a) anorexia nervosa b) 30% full thickness burn c) pt with newly diagnosed colon cancer d) pt with COPD

b) 30% full thickness burn

In a TPN mixture, what volume of the AA solutions listed would come closest to providing 185 kcals? a) 1000 ml of 8.5% AA b) 850 ml of 5.5% AA c) 500 ml of 7.0% AA d) 500 ml of 10.0% AA

b) 850 ml of 5.5% AA

For the past 2 months, a man who is 6'0'' tall has been nauseated and anorexic and has consumed fewer than 500 kcals/d, mostly from sweet foods. His albumin of 5.0 g/dl most likely reflects: a) adjustment to the new energy intake b) an increase in albumin d/t dehydration c) increased production of albumin by the liver d/t the catabolic state d) retention of albumin d/t the high CHO/low kcal diet

b) an increase in albumin d/t dehydration

What would a vegan not eat? a) coleslaw made with oil and vinegar b) congealed fruit salad c) salad with tofu dressing d) peanut butter

b) congealed fruit salad

Looking at the previous question, what else would you expect to see? a) increased bicarbonate, increased K+, decreased PO4 b) decreased bicarbonate, increased K+, increased PO4 c) decreased bicarbonate, decreased K+, increased PO4 d) increased bicarbonate, increased K+, increased PO4

b) decreased bicarbonate, increased K+, increased PO4

The best way to counsel a pt with anorexia nervosa is to: a) recommend that the pt increase food intake and attend weekly counseling sessions b) emphasize the health benefits associated with weight gain and increase calorie intake c) maintain a no-nonsense attitude to discourage inappropriate behavior d) remain flexible to help the pt set realistic goals

b) emphasize the health benefits associated with weight gain and increase calorie intake

Which is the primary fuel used by resting muscle and at low intensity exercise? a) glucose b) fatty acids c) BCAA d) keto-acids

b) fatty acids

A nutrition surveillance program is designed primarily to: a) verify data from other surveys b) identify the nutritional needs of the population c) indicate the number of people at increased risk for medical condtions d) indicate the causes underlying the nutrition problems identified

b) identify the nutritional needs of the population

In acute hepatitis, you would likely see: a) decreases in SGOT, increase in SGPT b) increase in both SGOT and SGPT c) decrease in both SGOT and SGPT d) increase in SGOT, decrease in SGPT

b) increase in both SGOT and SGPT

A child presents in the 65th percentile height for age. What does this signify? a) overweight b) normal c) underweight d) small for age

b) normal

An AIDS pt should select the following fresh fruit: a) grapes, orange b) orange, banana, pineapple c) apple, grapes, peach d) grapes, pear

b) orange, banana, pineapple

What change should be made in the following menu if it is to be served to Seventh Day Adventists? tomato juice, cottage cheese fruit plate or egg salad sandwich, milk, coffee, tea a) order fortified soy milk b) order decaffeinated beverages c) offer tofu as an alternative to egg salad d) offer a meat analog as an alternative to egg salad

b) order decaffeinated beverages

A patient with liver disease needs adjustments in the intake of: a) protein, fat, sodium b) protein, fluids, sodium c) protein, kcals, sodium d) fluids, kcals, fat

b) protein, fluids, sodium

Milk is packaged in opaque containers to avoid UV destruction of: a) thiamin b) riboflavin c) niacin d) ascorbic acid

b) riboflavin

What elements of the diet vary the most in hepatic disease? a) fat, CHO, K+ b) sodium, fluid, PRO c) sodium, K+, PRO d) fat, sodium, K+

b) sodium, fluid, PRO

Memory loss may be associated with a deficiency of: a) riboflavin b) thiamin c) protein d) electrolytes

b) thiamin

An athlete needs 4000 kcals. The cornflakes nutrient lablel says that one serving provides 25% of the RDA for CHO. How many servings of cornflakes does he need to get his 25%? a) one b) two c) three d) four

b) two

A pt on a clear liquid diet should not be served: a) strawberry flavored gelatin b) vegetable stock c) apple juice d) fruit flavored popsicle

b) vegetable stock

2L of 5% dextrose solution provide how many kcal? a. 170 b. 340 c. 212 d. 195

b. 340 kcal

Which drink would a Mormon choose? a. cola b. 7-up c. tea d. coffee

b. 7-up

A mother with 2 daughters, ages 8 and 11, does note earn enough monfey to feed her family. Which program do you suggest? a. WIC b. Food Stamps c. Child Care Food Program d. Medicaid

b. Food Stamps

A single man with two daughters, ages 10 and 11 is looking for aid. Which program might provide assistance? a. WIC b. Food Stamps c. Child Care Food Program d. Headstart

b. Food Stamps

Which of the following is not a guideline for Medicaid? I. low income II. over the age 60 only III. nutritional need a. I b. II, III c. II d. III

b. II, III

Urea excretion is related to ___, while creatinine excretion is related to ____. a. muscle mass, PRO intake b. PRO intake, muscle mass c. PRO intake, adipose reserves d. PRO intake, Ca intake

b. PRO intake, muscle mass

Butter has fatty acids in this order of predominance: a. PUFA, MUFA, SFA b. SAT, MUFA, PUFA c. MUFA, SAT, PUFA d. MUFA, PUFA, SAT

b. SAT, MUFA, PUFA

Nitrogen equilibrium is associated with: a. a 25 year old pregnant female b. a 25 year old male c. a 15 year old girl d. a 4 year old child

b. a 25 year old male

When a starved patient begins to eat, they might expect: a. constipation b. an increased workload on the heart c. lethargy d. diarrhea

b. an increased workload on the heart

The diet for stomatitis is: a. low fat, high CHO, normal PRO b. avoid spices, very hot, very cold, sour, tart foods c. high PRO, high CHO d. liquids, mostly CHO

b. avoid spices, very hot, very cold, sour, tart foods

An 8 month old baby contracts botulism. What is the likely cause? a. cereal and evaporated milk b. cereal and honey c. cereal and table food d. cereal and fruit juice

b. cereal and honey

An infant's failure to thrive can be seen in: a. their behavior b. comparison with growth charts c. wt for ht d. ht for age

b. comparison with growth charts

Which is permitted on a diet that excludes gluten? a. rye b. corn c. barley d. wheat bread

b. corn

The Schilling test detects defects in the absorption of: a. folic acid b. cyanocobalamin c. pyridoxine d. iron

b. cyanocobalamin

A serum sodium level of 150mEq/L indicates: a. sepsis b. dehydration c. hypertension d. hyperglycemia

b. dehydration

An athlete weighs more than the avg person of his ht. What should you do first? a. put him on a slow weight reduction diet b. examine other anthropometric measurements c. have him increase his exercise d. suggest he drink more water

b. examine other anthropometric measurements

If an IDDM tells you she eats meals on an irregular schedule you should: a. obtain more info about her usual eating habits b. explain that insulin therapy is related to intake c. do nothing if blood sugar levels are okay d. ask her to complete a detailed food record

b. explain that insulin therapy is related to intake

Why would a man who eats very little protein have an albumin of 5.5g/dl? 2. CHO keeps albumin levels elevated b. he is dehydrated c. serum albumin falls quickly with protein deprivation d. it is a sign of protein malnutrition

b. he is dehydrated

The immediate post-stress release of glucagon: a. increases glucose uptake into cells b. increases glucose release into the bloodstream c. increases insulin release d. increases fluid and sodium excretion

b. increases glucose release into the bloodstream

Current research on the relationship between cancer and diet includes all of the following except: a. cancer is assoc with intake of vit A b. it is related to demographic data c. it is related to epidemiologic data d. it is assoc with ascorbic acid

b. it is related to demographic data

The Cori Cycle converts: a. glucose into galactose b. lactate into pyruvate c. lactic acid into glycogen d. glycogen into glucose

b. lactate into pyruvate

Patients with early signs of xerophthalmia should consume? a. chicken, fish, summer squash b. liver, milk, eggs c. oatmeal, almonds, berries d. high fiber cereals, salad greens

b. liver, milk, eggs

Children's diets are found to be low in iron due to emphasis on: a. vegetables b. milk c. fruits d. cereals

b. milk

The BMI for a woman who is 5'7" tall and weighs 148lbs indicates: a. underweight b. normal weight c. overweight d. obese

b. normal weight

Green beans cooked in tomato sauce turn _____ due to ____. a. bright green; cholorphyllin b. olive green; pheophytin c. brown; carotenoids d. black; anthoxanthins

b. olive green; pheophytin

A patient who is iron deficient should consume _______with a good iron source. a. apple juice b. orange juice c. milk d. cheese

b. orange juice

Fats high in polyunsaturated fatty acids include: a. olive and canola b. safflower and corn c. coconut and palm d. soy and peanut

b. safflower and corn

The Year 2010 Healthy People Goals are an outgrowth of a report by: a. ADA b. the Surgeon General, under HHS c. WHO d. FAO

b. the Surgeon General, under HHS

The allowance for Food Stamps is based on: a. the avg cost of food used by a family of the same size b. the USDA Thrifty Food Program c. data from the Congregate Meal Program d. the cost of the Basic Four

b. the USDA Thrifty Food Program

Which of the following should be avoided on a low sodium diet? a. pork loin b. turkey roll c. beef sirloin d. lamb chop

b. turkey roll

To decrease sodium intake, substitute: a. carrots for celery b. unsalted margarine for regular margarine c. diet margarine for regular margarine d. carrots for pepper

b. unsalted margarine for regular margarine

A patient with dehydration exhibits the symptoms of: a. high blood pressure, dizziness b. sunken eyes, decreased renal fx, increased tachycardia c. decreased BUN, decreased serum creatinine d. low blood pressure, low serum sodium

b.sunken eyes, decreased renal fx, increased tachycardia

A patient on home TPN for the past month develops an elevated temperature with possible sepsis. This could indicate:

bacterial translocation

a pt on parenteral support develops sepsis. what is the likely cause

bacterial translocation

The ___ sheet lists assets, cash, inventory, and accounts receivable (what is owed to you) and liabilities

balance

The ___ sheet shows financial condition as of a particular date

balance

Bargaining steps in order: ___,___,&___

bargain, mediate, arbitrate

when counseling an anorexic, the best advice is to

be flexible and help them choose reasonable goals

what would you recommend to a Mexican AMerican on a low fat diet

beans and rice

acidic chyme in the duodenum is neutralized by pancreatic ______

bicarbonate

enhance insulin action

biguanides (metformin that is a Glucophage) do what?

an appropriate source of folate for a female from Central America is : corn, broccoli, black beans, raisins

black beans

a pt on warfarin should avoid

black cohosh

gastric irritants include

black pepper, chili powder, caffeine, alcohol, cocoa

which correlates best with energy intake: lean body mass, triceps skinfold, BMI, body weight

body weight

creatine supplements may be beneficial for the

bodybuilder

When costs increase, the ___ point increases too

breakeven

WIC encourages women to

breastfeed

___ marketing is filling customers needs or desires

business

A PN regimen that contains 1 L of D50W and 1 L of 7% Aminosyn provides how many non-PRO kcals? a) 300 b) 1400 c)1700 d) 2000

c) 1700

A middle income family needs support for breastfeeding. Which group will help? a) Milk Bank b) Pritikin Program c) LaLeche d) Feingold Program

c) LaLeche

What is the most effective tool for providing nutrition education to the community? a) the RDIs b) the report Healthy People c) My Pyramid d) The Healthy Eating Index

c) My Pyramid

Which program teaches good nutrition practices and provides foods with certain nutrients? a) EFNEP b) NET c) WIC d) MCP

c) WIC

The effectiveness of a group education program for decreasing the number of anemic pregnant women enrolled in a community nutrition program is best indicated by: a) improved scores on a nutrition knowledge posttest b) improved scores on a Likert-type attitudinal scale c) an increase in hematocrit or hemoglobin levels d) an increase in the intake of dietary iron

c) an increase in hematocrit or hemoglobin levels

A renal pt has come for dialysis on Monday morning with a serum sodium of 130 mEq/L, a BUN of 100 mg/dl, creatinine 8.0, and a 4 kg weight gain since his last dialysis on Friday morning. His lab indicators were in acceptable ranges on Friday afternoon. What would you expect happened over the weekend? a) consumed too little sodium, too much water, too little PRO b) consumed too little sodium, not enough water, too much PRO c) consumed too much sodium, too much water, too much PRO d) consumed too much sodium, too little water, too little PRO

c) consumed too much sodium, too much water, too much PRO

The data that is most useful in evaluating children is: a) sex and age b) iron and vitamin intake c) energy intake and health history d) height and weight

c) energy intake and health history

If a child is at the 95th percentile weight for height and after one month drops to the 10th percentile, what does it likely signify? a) poor nutrition b) lake of adequate caloric consumption c) error in measurement d) clinical disorder indicating malabsorption

c) error in measurement

A woman who is 5'5'' tall weighs 190 lbs before pregnancy and gains 30 lbs by the beginning of her 2nd trimester. Advise her to: a) maintain her current wt b) begin a wt reduction diet c) gain wt at a decreased rate d) continue to gain wt at the same rate

c) gain wt at a decreased rate

When given as the sole source of energy, isocaloric amounts of which energy substrate would most effectively reduce starvation ketosis? a) corn oil b) MCT oil c) glucose d) essential AA

c) glucose

A PN patient is receiving 45 kcals/kg. What may be the result? a) hypocalcemia b) hyperkalemia c) hypokalemia d) hyperphosphatemia

c) hypokalemia

You are assessing a 4'11'' female patient who weights 160 lbs. She has HTN, high cholesterol, and DM. What do you recommend? a) low sodium b) low CHO c) low kcal d) low fat

c) low kcal

The essential AA tryptophan is most closely r/t: a) folic acid b) riboflavin c) niacin d) pantothenic acid

c) niacin

Asian, Hispanic, and Native Americans have the following in common: a) they consume few green vegetables b) they consume significant amounts of dairy products c) they consume little milk d) they consume few root vegetables

c) they consume little milk

What should a Jewish pt include in his diet to increase the intake of zinc? a) fresh green vegetables b) pork c) turkey d) wheat bread

c) turkey

Which of the following is the appropriate diet for peritoneal dialysis? a. .8g PRO, 35 kcal/kg b. 2.0g PRO, 30 kcal/kg c. 1.5g PRO, 30 kcal/kg d. 1.0g PRO, 35 kcal/kg

c. 1.5g PRO, 30 kcal/kg

Food service employees should was their hands for at least: a. 30 seconds b. 25 seconds c. 20 seconds d. 15 seconds

c. 20 seconds

Food was held at 70'F for a long time in anaerobic conditions. Eight hours after eating it you became ill. What is the culprit? a. Salmonella b. Staphylococcus c. Clostridium perfringens d. Campylobacter jejuni

c. Clostridium perfringens

The most effective nutrition assessment method for large groups is the: a. food diary b. 24 hr recall c. FFQ d. diet history

c. FFQ

An example of a "Healthy People" goal is" a. a decrease in saturated fat consumption b. an increase in iron intake c. a decrease in infant mortality d. an increase in the intake of complex CHO

c. a decrease in infant mortality

To increase potassium intake, consume a snack of: a. cheese and crackers, plums, cranberry juice b. a bagel, milk and an apple c. a grilled cheese and tomato sandwich and strawberries d. tuna salad, a wheat roll, and cola

c. a grilled cheese and tomato sandwich and strawberries

A serum sodium level of 150mEq/L may be due to: a. an increase in the intake of sodium-rich foods b. decreased steroid formation c. an increased level of aldosterone d. a decrease in the intake of sodium-rich foods

c. an increased level of aldosterone

Which of the following is true regarding flour? a. all-purpose is made from soft wheat b. all-purpose has more protein than bread flour c. cake flour has the least and the weakest gluten d. cake flour has less starch than bread flour

c. cake flour has the least and the weakest gluten

Which of the following most affects osmolarity? a. PRO b. sugar c. electrolytes d. fat

c. electrolytes

In metabolic acidosis, which of the following is involved? a. excretion of potassium b. excess Ca retention c. excretion of sodium bicarbonate d. excess Ca loss

c. excretion of sodium bicarbonate

How can you enhance usage of commodity foods from a food donation program? a. teach food donation staff how to use the items b. make a poster on usage c. give each participants recipes using the items d. calculate the amounts of nutrients provided in the donated foods

c. give each participants recipes using the items

Apples stored in a controlled environment would: a. ripen quickly b. last one to two years c. have extended life and improved marketing quality d. only be used as processed fruit

c. have extended life and improved marketing quality

Which fiber is insolube in water? a. pectin b. gums c. hemicellulose d. polysaccharides

c. hemicellulose

Gastric proteolysis requires: a. pyridoxine b. ascorbic acid c. hydrochloric acid d. the intrinsic factor

c. hydrochloric acid

Which of the following would be classfied as NB in the NCP? a. hypermetabolism b. inadequate enteral intake c. impaired ability to prepare foods d. excessive protein intake

c. impaired ability to prepare foods

Cabbage should be cooked: a. covered b. in a small amount of water c. in a large quantity of water d. covered in a small amount of water

c. in a large quantity of water

The kidneys respond to respiratory acidosis by: a. increasing the secretion of magnesium b. exchanging sodium for calcium c. increasing the retention of bicarbonate d. exchanging potassium for hydrogen

c. increasing the retention of bicarbonate

In cereal production, enrichment adds: a. Vitamin A b. Vitamin D c. iron d. iodine

c. iron

Which nutrients are involved in energy metabolism? a. pyridoxine and cyanocobalamin b. copper and zinc c. pantothenic acid and biotin d. folic acid and iron

c. pantothenic acid and biotin

Which of the following may result in hypoalbuminemia? a. amino acid supplementation prior to surgery b. a high protein diet with inadequate water c. providing only a 5% dextrose in water solution after stress d. giving a trauma pt enteral feeding only

c. providing only a 5% dextrose in water solution after stress

Catecholamines have what physiological effect? a. induce diuresis b. cause hypoglycemia c. cause sodium retention d. cause potassium retention

c. sodium retention

Which of the following would be classified as NC in the NCP? a. inadequate vitamin intake b. limited access to food c. swallowing difficulty d. inapprpriate intake of food fats

c. swallowing difficulty

A 5 month old is diagnosed with salmonella. What is the likely cause? a. fruit juice b. milk c. table food d. evaporated milk

c. table food

Coarse texture in a cake is due to: a. too little baking powder b. over-mixing c. too much baking powder or sugar d. over temperature too high

c. too much baking powder or sugar

Which of the following indicates PRO-cal malnutrition? a. a creatinine ht index of 93% b. ht for wt ratio of 89% c. triceps skinfold and arm circumference of 79% d. serum albumin of 4.5; transferring of 410

c. triceps skinfold and arm circumference of 79%

Which of the following amino acids is a precursor for serotonin? a. phenylalanine b. methionine c. tryptophan d. tyrosine

c. tryptophan

what is lacking in the traditional diet for asians living in america

calcium

which of the following is lowest in fat: hamburger, salami, goat cheese, canadian bacon

canadian bacon

which provides the most vitamin A for a mexican: tortillas and refried beans, cantaloupe and squash, cheese, tortillas and milk

cantaloupe and squash

The ___ budget includes equipment, facilities, cost of improvements, and repairs

capital

The ___ budget includes expenditures whose returns are expected to last beyond a year

capital

Large sums of money needed for equipment, improvements, expansion, etc. are listed in the:

capital budget

an athlete complains of weakness, rapid wt gain, and muscle spasms. what may be the cause

carbohydrate loading

potato chips PB

cariogenic foods

research suggest that in order to guard against cancer you should ingest

carotene and vitamin C

The orange color of carrots is stable during cooking because:

carotenoids are heat stable and fat soluble

a child with PKU can eat: spaghetti with tomato sauce, vanilla ice cream, carrots and celery sticks, aspartame-sweetened gelatin

carrots and celery sticks

The protein in milk that precipitates at pH 4.6 is:

casein

an infant formula for lactose intolerance might include

casein hydrolysate, corn oil, glucose, soy protein, corn syrup solids

The ___ ___ budget projects revenues and expenses, showing inflow and output of cash

cash flow

The purpose of the ___ ___ budget is to determine if funds will be available when they are needed

cash flow

catecholamines have what physiological effect

cause sodium retention

When one person or department purchases for every department, it is called:

centralized purchasing

what would you do to decrease fat intake for a hispanic

change beans from refried to boiled

a five month old baby has changed from the 65th to the 95th percentile weight for height, the dietitian should first

check to see if weights have been plotted properly

diet while on MAOI will not include?

cheddar cheese

when instructing a pt on diet therapy needed during intake of a monoamine oxidase inhibitor, which would not be included: milk, cottage cheese and yogurt, yogurt and ricotta cheese, swiss cheese and yogurt, cheddar cheese and swiss cheese

cheddar cheese and swiss cheese

which of the following may help decrease cavities: raisins, carrots, cheese, yogurt

cheese

which is the most appropriate bedtime snack for a diabetic on NPH insulin: apple juice and crackers, graham crackers and diet soda, fresh fruit and crackers, cheese and crackers

cheese and crackers

which of the following would likely be a cause of marasmus: leaving a pt for two weeks on D5W, chemotherapy, following a 20 g protein diet for two months, antibiotic therapy

chemotherapy

What is Chain of Command?

clear and distinct lines of authority within the organization

When food is prepared in a central area and transported to satellite units, it is called a ________ system.

commissary

nuts, eggs, milk, soy, wheat, fish

common allergens

an infants failure to thrive can be seen in

comparison with growth charts

Job specification is used to determine _______.

compensation

___ benefits are pay for time not worked

compensatory

when using anthropometric measurements, the most important factor is

competence of the practitioner and calibration

Appropriate span of control is determined by:

complexity and proximity of the jobs, quality of the people, abilities of the supervisor

a child with cystic fibrosis has had a recent weight loss and several large foul smelling stools each day over the past two months. to evaluate the situation, the first step should be to assess her

compliance with PERT

When a food is cooked from the outside toward the center by direct contact with the pan, the transfer of energy has taken place by:

conduction

what would a vegan not eat: coleslaw, congealed fruit salad, salad with tofu, peanut butter

congealed fruit salad

The ___ ___ is updated weekly and identifies bill with sponsor and committee

congressional index

The ___ ___ includes information from the floor, no hearings lists bills with sponsor and action, and is used daily when congress is in session

congressional record

You have been instructed by the hospital administrator to manage the cafeteria as a break-even operator. Administration will no longer subsidize the budget. You should:

consider branding and HMR

Fill in the Blanks: The nutrition care process is designed to improve the ______ and _______ of individualized patient/client care and the predictability of patient/client outcomes.

consistency; quality

a renal pt has come for dialysis on monday morning with a serum sodium of 130 mEq/L, a BUN of 100 mg/dl, creatinine 8.0, and a 4 kg weight gain since his last dialysis on friday morning. his lab values were WNL on friday afternoon. what would you expect happened over the weekend

consumed too much sodium, too much water, too much protein

Your hospital has recently become involved in a cooperative program between local businesses and the public schools to reduce the drop out rate. As the production manager, you have been told to provide hands-on training for three at-risk students. The students are 16 or 17 years old. You:

contact human resources and review the FLSA restrictions that may apply due to their ages.

an insulin dependent diabetic living alone calls you with symptoms of nausea, vomiting, and anorexia. what do you recommend

continue with insulin and drink anything he can

the main goal for a type 2 obese diabetic with persistent hyperglycemia is

control of serum glucose levels

which food is highest in fiber: cooked dried beans, tomato, wheat bread, lettuce

cooked dried beans

which is permitted on a diet which excludes gluten: rye, corn, barley, wheat bread

corn

an acid ash would be created by ingesting: corn and cranberries, milk, vegetables, fruits

corn and cranberries

which of the following is a medium fat: peanut butter, tuna fish packed in water, corned beef, chicken without skin

corned beef

which would cause the most delay in gastric emptying: lean baked meat, broiled cod, shrimp, corned beef

corned beef

The cost of the raw food and beverages sold is the ___ ___ ___

cost of sales

___-___ studies determine whether the goal of the effort is worthwhile in terms of cost

cost-benefit

___-___ studies compare alternative courses of action

cost-effectiveness

which test measures somatic protein

creatinine clearance and serum creatinine

___ ___ are the efficiency of equipment placement, studies work motion, shows # of movements between equipment

cross charts

A standing height should first be obtained when an infant is how many months old? a) 18 b) 20 c) 22 d) 24

d) 24

What is the best approach for controlling obesity in an otherwise healthy 10-year old girl? a) reduction of caloric intake to allow wt loss of 1-2 lbs weekly b) reduction of energy intake to no less than 1,000 kcal/d c) avoidance of simple sugars and sugar-containing products d) maintenance of wt during continued growth

d) maintenance of wt during continued growth

A nutritional care plan for overweight children should include: a) restrict intake to maintain current weight b) maintain body weight c) reduce weight with caloric reductions of 500 per day d) reduce rate of body weight gain while allowing growth

d) reduce rate of body weight gain while allowing growth

Your pt is on Coumadin. Which foods would you make sure to consistently include in their diet? a) oranges, peaches b) sweet potates c) beef, lamb d) spinach, collard greens

d) spinach, collard greens

Which would you give to a person who is mildly hypokalemic? a. 1 cup blueberries b. 1 cup cranberries c. 1/2 cup applesauce d. 1 piece cantaloupe

d. 1 piece cantalope

Which of the following substitutions will most decrease the sodium content of a biscuit? I. low sodium milk for whole milk II. egg substitute for egg III. low sodium baking powder for baking powder a. I b. I, II c. all of the above d. I, III

d. I, III

What can be done to lower the RQ of a tube fed pulmonary pt? a. add MCT oil to decrease energy required for growth b. change the type of fat to improve oxygen exchange c. add CHO to decrease the RQ d. add a fat emulsion to replace some of the CHO

d. add a fat emulsion to replace some of the CHO

Which statement applies to nutritional screening? a. only a physician makes the referral b. only a dietitian makes the referral c. it is exclusively done by nursing d. all health team members can participate according to policy

d. all health team members can participate according to policy

What correlates best with energy intake? a. lean body mass b. triceps skinfold c. BMI d. body weight

d. body weight

When instructing a patient on diet therapy needed during intake of a monoamine oxidase inhibitor, which would not be included? a. milk, cottage cheese, yogurt b. yogurt, ricotta cheese c. swiss cheese, yogurt d. cheddar cheese, swiss cheese

d. cheddar cheese, swiss cheese

Which is the most appropriate bedtime snack for a diabetic on NPH insulin? a. apple juice and crackers b. graham crackers and diet soda c. fresh fruit and crackers d. cheese and crackers

d. cheese and crackers

Which of the following has the least amount of saturated fat? a. 2% milk b. half and half c. non-dairy creamer d. evaporated skim milk

d. evaporated skim milk

A serum sodium level of 150mEq/L is a sign of: a. very high sodium intake b. very low sodium intake c. hyponatremia d. hypernatremia

d. hypernatremia

Cured meat is pink due to: a. sugar b. salt c. vinegar d. nitrites

d. nitrites

An infant wants a bottle at bedtime. You should counsel the parents to: a. give the bottle only at bedtime b. give the bottle only if the baby insists c. only give milk in the bottle d. only give water in the bottle

d. only give water in the bottle

Energy expenditure of humans can be measured by: a. heat intake b. food intake c. nitrogen output d. oxygen consumption

d. oxygen consumption

Why is an affluent couple (the man with diabetes, 67yo, wife with broekn arm, 50 yo) not eligible for Meals on Wheels? a. she is too young b. thay are affluent c. this program does not cater to special diets d. they can leave the house

d. they can leave the house

Meat graded "US Standard" is the grade given at the: a. time of purchase b. time of delivery c. storage facility d. time of slaughter

d. time of slaughter

Biot-Savart Law

dB = (µ₀ I dI x r ̂ ) / 4πr² -relates magnetic fields to the currents which are their sources.

a tube fed pt receiving bolus feedings develops a distended abdomen. what should you recommend

decrease the rate

according to the previous question, what else would you expect to see

decreased bicarbonate, increased potassium, increased phosphorus

major reason for constipation in the elderly?

decreased gastric motility

what is a major reason for constipation in the elderly

decreased gastric motility

the appropriate diet therapy following a Billroth II is

decreased simple carbohydrates, high protein, moderate fat, B12 supplements

To facilitate the receiving of goods, it is desirable to locate the receiving area near the:

delivery door

Management by objectives is a type of ___ management that provides control from within

democratic

what is a common complication of AIDS

diarrhea

a cholesterol level of 240 mgs needs treatment first with

diet

The recommended medical nutrition therapy for active peptic ulcer disease is:

diet as tolerated; avoid pepper, alcohol and coffee

when assessing nutritional status, what is the most beneficial?

diet intake info, clinical data, laboratory data

iron status is best monitored by:

dietary and lab studies

In 2002 the Institute of Medicine published a new set of definitions for dietary fiber. They suggested the following terms:

dietary fiber and functional fiber

goals for community nutrition program should be based on?

dietary guidelines for americans

which of the following is included in subjective global assessments: standard weight for height, mid-arm circumference, prealbumin, dietary intake

dietary intake

a person with dumping syndrome cannot handle: complex carbs, polysaccharides, disaccharides, amino acids

disaccharides

after a gastrectomy, the diet order should show a decrease in

disaccharides

after gastrectomy the diet order should indicate a decrease in

disaccharides

you discover an incorrect diet order entered in the patients chart, you should

discuss the order with the physician and make suggestions

achalasia

disorder of lower esophageal sphincter motility; does not relax upon swallowing

good advice for a pt with a hiatal hernia is to: increase intake of complex carbs, lower the fat content of diet, don't eat before bed, avoid coffee

don't eat before bed

which of the following would lower serum cholesterol levels: dried beans, green beans, yellow beans, summer squash

dried beans

majority of protein digestion takes place in:

duodenum

high kcal and fluids

during fever and infection, the diet should be

If the benefit is greater than the cost, then the program is ___ ___

economically efficient

which of the following is not a sign of marasmus: severe protein and calorie wasting, wt loss, edema, low anthropometric measurements

edema

antagonizes vit K

effect of anticoagulants

binds tetracycline

effect of calcium

increased appetite, weight gain;

effect of lithium carbonate

hypertension if taken with MAOI inhibitors

effect of tyramine

most common food allergies in infants and children

eggs, fish, milk, peanuts, soy

For what age group is the Nutrition Screening Initiative most appropriate?

elderly

NHANES III increased the number of ______ participants

elderly

A class C fire includes:

electrical equipment, motors and switches

which of the following most affects osmolarity: protein, sugar, electrolytes, fat

electrolytes

a pt has a rare urea disease where the body is unable to synthesize urea. what might be the result

elevated ammonia levels

pt can't make urea...what can be the result?

elevated ammonia levels

an elderly obese pt has been diagnosed with type 2 DM, what would be an appropriate nutrition diagnosis: elevated serum triglycerides, high HDL cholesterol, low blood pressure, low serum insulin

elevated serum triglycerides

the best way to counsel a pt with anorexia nervosa is to

emphasize the health benefits associated with wt gain and increased calorie intake

Span of control refers to the number of:

employees under the direction of one individual

The TQM approach does not:

encourage specialized job and individual effort

The process of learning the beliefs, attitudes and behaviors of a group is:

enculturation

most useful data when evaluating kids?

energy intake and health history

the data that is most useful in evaluating children is: sex and age, iron and vitamin intake, energy intake and health history, height and weight

energy intake and health history

a pt on Lithium decreases his sodium intake to 2 g/day, the effect will be

enhanced activity of the drug

glucophage (metformin) functions by:

enhances insulin action

glucophage/metformin does what

enhances insulin action

Job ___ upgrades jobs by adding motivating factors

enrichment

what outcome would best indicate parental support of a child's wt loss effort in a program for obese pre-teen children

enroll child in physical activity programs

if a pt is about to be discharged when you receive the d/c diet order, you should

enroll him in the Outpatient Clinic and schedule an appointment

if a child is at the 95th percentile weight for height and after one month drops to the 10th percentile, what does it likely signify

error in measurement

A patient is newly diagnosed with renal failure and requires long-term dialysis. He is depressed about having to make major lifestyle changes and is in need of financial assistance. The dietitian's initial objective in the interviewing process should be to:

establish rapport with the patient by getting to know him better before discussing nutrient needs

the best way for you to follow-up on a patient's application of diet instruction is to

evaluate his food diary for one week

a clinical dietitian has successfully met an indicator for 6 months, the next step should be to

evaluate the need to continue monitoring the indicator

what is the best practical way to measure energy balance

evaluate weight gain and weight loss

an athlete weighs more than the average person of his height. what should you do first

examine other anthropometric measurements

cheddar cheese, nuts, meat

examples of low cariogenic potential foods

a side effect of antidepressants is

excess weight gain

in metabolic acidosis, which is involved: excretion of potassium, excess calcium retention, excretion of sodium bicarbonate, excess calcium loss

excretion of sodium bicarbonate

what is the best therapy for wt loss

exercise, diet, behavior modification

In the ___ theory, rewards serve as motivators (under certain circumstances)

expectancy

The ___ theory involves the path-goal theory, that focuses on a leader's effect on employees motivation to perform

expectancy

if an IDDM tells you she eats meals on an irregular schedule, you should:

explain that insulin therapy is related to intake

a pt comes to you with a diet that you know is not good to follow, what should you do

explain why it is not good

if a diet px is incorrect, potentially causing serious complications, the RD should:

express concern about the order to the MD and recommend appropriate changes

a pt suffering from bulimia may have all the following symptoms except: a sore throat, dental problems, extreme wt loss, rectal bleeding

extreme wt loss

The ___ ___ ___ ___ makes it illegal to ask job candidates about race, religion, sex, national origin, age, or marital status

fair employment practice law

Human milk has more _____ than formula or cow's milk

fat

in CF, the most impaired nutrient is _

fat

in cystic fibrosis, the most impaired nutrient is

fat

<10% sat, <=10% poly fat, 60-70% mono fat and CHO, <300 mg chol, encourage fiber

fat, chol, and CHO requirements for diabetes

The high fat content of ice cream helps keep it smooth by decreasing ice crystals. Other ingredients that reduce ice crystals include:

fat, corn syrup, or protein

what is the primary fuel used by resting muscle and at low intensity exercise

fatty acids

The ___ ___ houses notes of public hearings, proposed and final rulings, agency decisions, and is published weekly

federal register

The ___ ___ lists changes in USDA food programs

federal register

what can cause loose stools in a tube fed pt

feeding administered at too rapid a rate, an inadequate amount of intestinal surface area

Poverty and hunger affect some groups more than others. Those most at risk are:

female head of households, children and the rural poor.

macrocytic, megaloblastic anemia

few large cells, filled with hemoglobin is

a spastic quadriplegic requires

fewer calories, increased fluid and fiber

what type of food would you feed to a pt who has athetoid form of cerebral palsy

finger foods like hot dog in a roll

most common food allergies in adults

fish, tree nuts, peanuts, shellfish, wheat

A pathway chart, or a ___ ___, is a scaled drawing showing the path of a worker during a process

flow diagram

immediately following a severe burn, nutritional therapy should include

fluid and electrolyte replacement

why may a pt with ascites be dehydrated

fluid has moved to the interstitial spaces

pt in icu with symptoms of cachexia, ascites, N/V, serum albumin of 2.5, elevated liver function tests-MNT would include:

fluid restriction, 2gm Na+, moderate protein

to restore hydration after continuous endurance activity of 2 hours consume

fluids, sodium carbohydrates

to maintain hydration during continuous endurance physical activity of 4 hours consume

fluids, sodium, carbohydrates

a dietary deficiency of which of the following causes a macrocytic anemia resembling pernicious anemia: folacin, pyridoxine, vitamin B6, vitamin C

folacin

dietary deficiency from __ causes macrocytic anemia resembling pernicioius anemia?

folacin

the most important prenatal supplement is

folic acid

characteristics of the dumping syndrome include

follows a gastrectomy, is secondary to carbohydrate overload, and draws fluid into the intestine

___ cost is the most readily controlled item, subject to the greatest fluctuation

food

the most effective nutrition assessment method for large groups is the

food frequency list

which is a quick diet assessment tool for a large group

food frequency list

rice

food least likely to cause an allergy

the addictive influence of foods and constituents which when eaten have a beneficial effect on health refers to

food synergy

what formula would best meet a pt needs of 2000 calorie, 2 gram sodium feeding

formula with 1 cal/cc and 1 g Na/liter

a vegan with macrocytic anemia needs which of the following: iron-rich foods, fortified soy milk, eggs and wheat bread, meat and green vegetables

fortified soy milk

the test that measures toxic levels of lead on heme synthesis is the

free erythrocyte protoporphyrin test

a strict muslim would not consume

fruited gelatin, shrimp, ham

phytochemicals which may influence the development of tumors are found in

fruits, vegetables, grains

a pt on parenteral nutrition is to be transitioned to enteral feeding. he should receive

full strength enteral feeding at a low rate

One way to determine # of relief employees needed, is to multiply the number of ___-time positions by ___

full, .55

a woman who is 5'5" tall, 190# before pregnancy and gains 30# by the beginning of her second trimester. advise her to

gain weight at a decreased rate

for which of the following diseases is diet therapy the primary treatment: peptic ulcer, diabetes, Wilson's disease, galactosemia

galactosemia

which of the following diseases may lead to anemia: MI, galactosemia, renal failure, DM

galactosemia

how can you enhance usage of commodity foods from a food donation program

give each participant recipes using the food items

sole energy source to reduce starvation ketosis

glucose

when given as the sole source of energy, isocaloric amounts of which energy substrate would most effectively reduce starvation ketosis

glucose

the immediate post-stress release of glucagon increases

glucose release into the bloodstream

the theory of obesity that refers to receptors in the hypothalamus is the

glucostatic theory

what test helps to determine if a diabetic has been following his diet

glycosylated hemoglobin

prevent marked rise in blood glucose that would stimulate more insulin

goal of postprandial or reactive hypoglycemia

increased serum uric acid levels may lead to

gout

What is the formula to calculate nitrogen balance?

grams of protein/6.25 - (urinary nitrogen + 3 to 4g)

which snack would you not give to an infant: yogurt, cheese sticks, graham crackers, grapes

grapes

The ___ ___ is the profit shown after deducting raw food and beverage (cost of sales) from sales (revenue)

gross profit

Policies are:

guides that define the scope of permissible activity.

which of the following would lacto-ovo vegetarian not eat: eggs, halibut, cheese, beans

halibut

Coronary Artery Disease

hard, narrow arteries from plaque buildup

as a public health nutritionist, you notice an increase in the percentage of obese hispanic females in the community, what is the best way to educate them

have a cooking class that they can participate in the cooking and then eat the food they prepared

the mother of an infant who weighed 4.5kg at birth and was was hypoglycemic may

have had gestational diabetes

what is the best way to increase attendance at a nutrition seminar for dentist

have it sponsored by a dental organization

In the ___ study, if you involve people in the process, they become more productive

hawthorne

The ___ study is based on the fact that productivity is due to giving employees special attention and treating them well - this is known as the ___ effect

hawthorne, placebo

why would a man who eats very little protein have an albumin of 5.5 g/dl

he is dehydrated

a PEG feeding would be useful in a pt with

head or neck cancer who will not be able to eat normally for weeks

elevated LDL, normal to low NDL

healthy obese is

a female has a 36" waist to a 40" hip measurement, she is at risk for

heart disease

The factors affecting basal needs include all of the following except:

heart rate

anasarca is extreme generalized edema and swelling of the skin associated with

heart, liver, or renal failure

expected creatinine clearance is estimated by the clients'

height

expected creatinine clearance is estimated from the client's

height

which of the following indicated stunted growth: wt for ht, ht for age, wt for age, wt for length

height for age

an appropriate measurement for iron status in a local community is

hematocrit

what fiber is insoluble in water?

hemicellulose

which fiber is insoluble in water: pectin, gums, hemicellulose, polysaccharides

hemicellulose

which of the infants in the above question have a normal hemoglobin

hemoglobin of 10, 10.5, 11

the diet for hepatic coma is low in protein due to

high ammonia levels

a pt is diagnosed with iatrogenic malnutrition, nutritional therapy should be

high calorie, high protein

What is the MNT for Athetoid (constant involuntary motion)CP?

high calorie, high protein diet to prevent weight loss, finger foods to facilitate independence with feeding.

ketogenic diet

high fat, low carbohydrate diet - the ratio of fat calories to non-fat calories is 4:1 (used as MNT for epilepsy)

cows milk?

high in protein and creates a high solute load. it's low in iron and vitamin C

a child with AIDS needs a high calorie and _______ intake

high protein

pt with a stage II ulcer and albumin of 2.8g/dl-what kind of NCP would be used?

high protein, MVI, zinc, Vit C

LTC pt has normal GI Fx but can't eat. give them what formula?

high protein, high calorie

nutritional therapy for hepatitis includes

high protein, high carbohydrate, moderate fat, high calories

bacon (pork 2 slices, turkey 3 slices), cheese (swiss, american, queso), hot dog, processed sandwich w/ 8g fat or less

high-fat meat and meat substitute examples

compared to human milk, commercially prepared infant formula is

higher in protein and iron but lack antibodies

low levels of folate, pyridoxine and cyanocobalamin are associated with

homocystinuria

If the House and Senate offer different versions of a bill, it goes before a joint ___-___ conference committee where the differences are resolved, ultimately passing the bill

house-senate

30-45 minutes

how long before a meal to take short-acting (regular) insulin

5-15 mintes

how long before eating to take rapid acting insulin

18-24 hours

how long does Lantus work?

10-18 hours; bedtime snack consisting of CHO and protein

how long does NPH insulin last? what should be included when taking it?

10-15 g CHO; 3-6 hr

how much CHO does 1 unit of regular insulin cover? how long does it last?

The process of converting unsaturated fatty acids to saturated by the chemical addition of hydrogen is called:

hydrogenation

According to Herzberg, fair wage, insurance, retirement, supervision, scheduling, working conditions, & interpersonal relationships are considered ___ factors

hygiene

In Herzberg's 2-factor theory, maintenances are considered ___ factors

hygiene

Symptoms associated with diabetic ketoacidosis (DKA) include all of the following except:

hypercalcemia

a pt w/ nephrosis will most likely exhibit what 3 things

hypercholesterolemia, albuminemia, edema

a pt with nephrosis will likely exhibit

hypercholesterolemia, albuminemia, edema

What are the RBC characteristics of folic acid deficiency?

hyperchromic (intense red color), macrocytic (larger than normal), megaloblastic (large, immature, abnormal RBC in bone marrow)

the catecholamines released during stress cause

hyperglycemia

what is associated w/ cyclosporine therapy?

hyperlipidemia

which of the following nutrition diagnosis is most likely to be associated with cyclosporine therapy: hyperphosphatemia, hyperlipidemia, hypoglycemia, hypokalemia

hyperlipidemia

an elevated T4 indicates

hyperthyroidism

an alcoholic patient has a low serum albumin, low hemoglobin, high ammonia, abnormal lover function test and ascites. why is he on a 500mg sodium diet

hypoalbuminemia

providing only a 5% dextrose in a water solution after stress may result in

hypoalbuminemia

before discontinuing a parenteral feeding, provide enteral support to prevent

hypoglycemia

quickly stopping a 25% dextrose solution leads to

hypoglycemia

a PN pt is receiving 45 calories/kg. what may be the result

hypokalemia

a concern with parenteral feeding

hypokalemia

pt w/ PN is getting 45 kcal/kg...what could be the result?

hypokalemia

severely malnourished pt recieves TPN @ 125cc/hr-what could this cause

hypophosphatemia

a hospitalized pt who had not eaten for 2 weeks had a 2.3 serum phosphorus level and a 1.3 serum magnesium level, he has

hypophosphatemia and hypomagnesemia

What are the metabolic abnormalitites of refeeding syndrome?

hypophosphatemia, hypokalemia, and hypomagnesemia Administration of dextrose can cause significant hypergylcemia

The first step of the marketing process is to ___ a need that is not being filled

identify

nutrition surveillance program is used primarily to do what?

identify nutritional needs of the population

a nutritional surveillance program is designed primarily to

identify the nutritional needs of the population

what section of the intestine is most likely to be involved in Crohn's disease

ileum

when should you provide nutrition counseling to an AIDS pt

immediately upon diagnosis

which of the following would be classified as NB in the NCP: hypermetabolism, inadequate enteral intake, impaired ability to prepare foods, excessive protein intake

impaired ability to prepare foods

a client who primarily consumes frozen dinners and breakfast cereal because of limited access to transportation most likely would have a nutrition diagnosis of

impaired ability to prepare meals

100-125

impaired fasting glucose level

140-199

impaired glucose tolerance (2hPG)

a pt complains of abdominal distention, mouth lesions, and a 10% wt loss over the past 6 months, the nutrition diagnosis would be

impaired nutrient utilization

normal (>31)

in macrocytic anemia MCHC is

high

in macrocytic anemia, MCH is

high (>95)

in macrocytic anemia, MCV is

decreased

in macrocytic anemia, RBC is

low

in macrocytic anemia, hematocrit is

low

in macrocytic anemia, hemoglobin is

low

in microcytic, hypochromic anemia, MCH is

low (<31)

in microcytic, hypochromic anemia, MCHC is

low (<80)

in microcytic, hypochromic anemia, MCV is

normal

in microcytic, hypochromic anemia, RBC is

low

in microcytic, hypochromic anemia, hematocrit is

low

in microcytic, hypochromic anemia, hemoglobin is

catecholamines epinephrine, norepinephrine - hepatic glycogenolysis and aldosterone - renal sodium retention, gluconeogenesis

in the metabolic response to injury, there is a release of ___ and ____? what do they do?

an 11 month old infant is constipated. the most likely nutrition diagnosis would be

inadequate fluid intake

Galactosemia

inborn error of metabolism in which galactose cannot be broken down into glucose

Maple Syrup Urine Disease

inborn error of metabolism where BCAAs cannot be broken down, so an increase in serum levels increase (especially leucine)

A surveillance team used to indicate how frequently a disease occurs in a population, and the fraction of people free of disease that develop the disease over a period of time is:

incidence

a patient is on a high protein, low carb diet. what advice should you offer?

increase fluid intake

what would you first advise a constipated patient to do

increase fluids and fiber intake

in acute hepatitis, you would likely see

increase in both SGOT and SGPT

a pt consuming around 500kcal per day of mostly sweet foods has an albumin of 5.0g/dl-the albumin level most likely shows...

increased albumin due to dehydration

which of the following would be classified as NI in the NCP: not ready for diet change, altered GI function, involuntary wt loss, increased energy expenditure

increased energy expenditure

fiber, like that found in oats, beans, and bran cereals, results in

increased water absorption from the intestine

if a pt on lithium decreases his sodium...what happens?

increases drug effects

age group has the greatest fluid requirement

infants

CRP is not elevated with malnutrition unless what else is also present?

inflammation

a 35 year old female with type 1 DM received nutrition counseling and started NPH therapy one month ago. today her fasting blood glucose level is 290 mg/dl and cholesterol level is 185 mg/dl. she eats only one meal per day. which need do you address first

instruction about the relationship of diet to blood glucose

Identify the hormone that causes an increase in glycogenesis and lipogenesis:

insulin

Interpersonal: Networks _____ and ______ acting as a liaison.

internally; externally

The nutritionist uses ______ to help people change their lifestyle

interventions

The cost of sales / average inventory cost is the ___ ___ rate

inventory turnover

a normal pregnancy requires supplementation of

iron and folic acid

the efficacy of a low sugar, low artificial flavor diet on hyperkinesis is

is had not been scientifically proven effective

what tube feeding should you provide for a long term care pt who has normal intestinal function but cannot eat

isotonic lactose-free formula

why would you add bicarbonate to a solution for a person with hyperkalemia

it exchanges hydrogen for potassium

why would you add bicarbonate to a solution for a person with hyperkalemia?

it exchanges hydrogen for potassium

a pt with hepatitis needs a high protein intake. besides helping the liver to regenerate what other purpose is served

it helps to prevent fatty liver

a child is below the 5th percentile weight for height. what can be said about the child

it is an indication of recent under-nutrition

which of the following is true about SGOT: increased with hepatitis and DM, increased with hepatitis and decreased with DM, decreased in both hepatitis and DM, decreased in hepatitis and increased in DM

it is increased with hepatitis and decreased with diabetes

current research on the relationship between cancer and diet includes all of the following except: cancer is associated with vit A intake, it is related to demographic factors, it is related to epidemiologic data, it is associated with ascorbic acid

it is not related to demographic factors

The main role of human resource managers in a large institution is to:

keep up-to-date on legislation and act as a resource to department managers

hormones that control blood pressure and blood components are produced in the

kidneys

food staff from a Commodity Distribution program are not allowed to bring foods to a jewish facility. what is the main reason for this

kosher foods are not allowed to be mixed with non-kosher foods

An example of a productivity ratio is:

labor cost divided by meals served

kwashiorkor

laboratory diagnosis, hypoalbuminemia, protein deficiency, high mortality rate, edema and appearance may be normal

following a Billroth II, steatorrhea often results. what is the likely cause

lack of pancreatic secretion diet to less duodenal hormone secretion

Lactose intolerance is caused by:

lactase insufficiency

meats curd with whey won't be tolerated by someone with

lactose intolerance

A manager has no confidence in his leadership abilities. He does not set goals for the group. Productivity and morale are low and work is sloppy. The manager's leadership style is:

laisse-faire

infants born to mothers with diabetes may be

larger than normal, and be hypoglycemia shortly after birth

A simple inventory costing practice that is also fast is the:

latest purchase price

a child is lethargic, irritable with diarrhea. The cause may be

lead poisoning

The contingency approach to leadership states:

leadership style must change to fit the situation

a pork chop is which type of meat exchange

lean

sirloin, tenderloin, beef jerky, cheese (< 3 g fat/oz), egg whites and substitutes, cottage cheese, salmon, tuna, tilapia, smoked fish, game, hot dog (< 3g fat/oz), lamb chop, organ meats, oysters, lean pork, poultry w/o skin, processed sandwich meat (< 3 g fat/oz), sardines, shellfish, veal

lean meat and meat substitute examples

what would be an expected outcome of WIC

less anemia, increased HG and HT levels

Assets = ___ + ___

liabilities, capitol

a pt with DM has not eaten for more than three days. you should

liberalize the diet

___ determined that participative management is the most effective (management of conflict)

likert

asian, hispanic and native Americans all consume --

little milk

what would the lab values have likely reflected if the pt had been nauseated and had averaged only 400 calories from primarily starchy foods over the weekend

little or no rise in potassium, BUN/creatinine ratio < 10

following a cholecystectomy, bile is produced by the

liver

a 6'2" male, large frame, 230# with type II diabetes should

lose 20# slowly following a balanced diet

you are assessing a 4'11" female pt who weighs 160#, she has hypertension, high cholesterol, and DM. what should you recommend

low calories

high protein,moderate fat, minimal concentration of fermentable CHO; strong buffer, high mineral content (Ca, P); pH >6, stimulate saliva

low cariogenic potential foods are (describe)

The plasma lipoprotein richest in cholesterol:

low density (LDL)

In community surveys, a frequent symptom of malnutrition is: scurvy, rickets, low serum albumin, low hemoglobin

low hemoglobin

Factors that may result in nutrition problems in the elderly include all of the following except:

low hemoglobin rate

Medicaid benefits apply to

low income individuals

what is the appropriate diet for heart failure

low sodium

what is the diet for hypertension

low sodium

compared to whole milk, breast milk is --

lower in protein and higher in fat and carb

compared to whole milk, breast milk is

lower in protein, higher in fat and carbohydrate

How do you determine the mEq and what are the atomic weights for sodium and potassium?

mEq = mg/atomic wt X valence Na: 23 (valence = 1) K: 39 (valence = 1)

an appropriate menu for a Kosher meal is : macaroni and cheese with green beans, roast beef, potatoes, vegetables, and cream soup, veal parmesan, noodles, and green beans, crabmeat salad, lettuce and milk

macaroni and cheese with green beans

a common result of treating an AIDS pt with zidovudine is

macrocytic anemia

common result of treating an AIDS pt w/ zidovudine is ?

macrocytic anemia

type and nutritional deficiency pernicious anemia

macrocytic; B12

type and nutritional deficiency of megaloblastic anemia

macrocytic; folic acid or B12

what is the best approach for controlling obesity in an otherwise healthy ten year old girl

maintenance of wt during continued growth

normal range of hemoglobin for males and females

males: 14-18 g/dL females: 12-16 g/dL

a female who eats a wide variety of foods and takes supplemental iron and birth control pills may be

marginally deficient in folic acid

The ___ schedule is the overall plan, days on/off, vacations, - it is the basis for developing the weekly schedule

master

At age 1, cow's milk is the primary source of nutrients; however, it should be limited to 2-3.5 cups because excess:

may displace food necessary to provide iron

corned beef, cheese (4-7 g fat/oz, feta, mozz, red-fat string cheese), egg, fried fish, pork cutlet, shoulder roast, ricotta cheese, ground turkey, poultry w/ skin, sausage (4-7 g fat/oz), veal

med-fat meat and meat substitute examples

If collective bargaining has not been successful, the next step is:

mediation

a tube fed pt develops diarrhea. what is the likely cause: medications, too low osmolarity, too weak strength, being given at an improper rate

medications

a pt with low hemoglobin and low MCV might have

microcytic anemia

type and nutritional deficiency of iron deficiency anemia

microcytic, iron

which is a measurement of somatic protein: albumin, transferrin, mid-arm muscle circumference, triceps skinfold

mid-arm muscle circumference

who is the most appropriate candidate for parenteral nutrition: 12 year old coming for appendectomy, middle aged women who will begin chemo, an elderly lady with emphysema, young man in for gallbladder surgery

middle aged woman who will begin chemotherapy

a pt w/ parkinsons disease on levadopa should

minimize protein at breakfast and lunch and add it to the evening meal

a pt with Parkinson's disease on Levodopa should:

minimize protein at breakfast and lunch and add it to the evening meal

a 9 month old infant being fed iron-fortified , milk-based formula is obese, you should recommend

monitoring wt and intake

a fecal excretion of ___ grams of fat/24 hours is considered fat malabsorption

more than 7 grams/24 hrs

___ ___ reduces motions and time required

motion economy

According to Herzberg, ___ call forth energy and enthusiasm/job enrichment

motivators

According to Herzberg, achievement, personal accomplishment, recognition, responsibility, participation in decision-making, opportunity for growth are ___

motivators

within 2-3 hours of continuous exercise at 60-80% of maximum

muscle glycogen is depleted

when counseling a diabetic with limited education, which would be the most appropriate question to ask in assessing her comprehension level?

name a food that is a fat

dawn phenomenom

natural increase in morning blood glucose and insulin requirements

MacGregor's Theory X is viewed as a ___, ___ management style

negative, autocratic

The ___ ___ is the profit shown after ALL expenses have been deducted from sales

net profit

Folate supplementation is important for all women during childbearing years. Folate is required for cell growth and division and is therefore necessary for fetal and placental development. Which of the following statements explains the importance of folate intakes:

neural tube forms in the first 18 days after conception

pt develops diarrhea after enteral feeding for 5 days-most likely cause?

new meds

folate, pyridoxine (B6) and B12

newly diagnosed patients with homocystinurias receive increased does of what?

essential AA tryptophan is most closely related to ---

niacin

the essential amino acid tryptophan is most closely related to : folic acid, riboflavin, niacin, pantothenic acid

niacin

2 nutrients in negative balance in an immobilized patient

nitrogen and calcium

the only biochemical measurement that reflects both somatic and visceral proteins

nitrogen balance

Nitrogen Balance Formula

nitrogen intake - nitrogen losses Used to estimate protein flux in critically ill patients

a child presents at the 65th percentile height for age, what does that signify

normal

<140 mg/dL

normal 2h PG glucose level

70-100 mg/dL

normal blood glucose level

27-32 pg

normal level of MCH

80-95 fL

normal level of MCV

98.6

normal temp of body

<200mg/dl

normal tirglyceride level

the BMI for a woman who is 5'7" tall and weighs 148# indicates

normal weight

Overproduction is:

not desirable and should be controlled

what should most be encouraged in a Headstart program

nutrition activities related to food

the NHANES study looks at which parameters

nutritional, clinical, biochemical

most influential factor on causing most cases of HTN

obesity

the Prader Willi syndrome is associated with

obesity

which set of conditions is commonly seen in american children

obesity, dental caries, anemia

The first step in a cost-benefit analysis is to state the ___, clearly and measurably

objectives

what change should be made in the following menu if is to be served to Seventh Day Adventist. tomato juice, cottage cheese fruit plate or egg salad sandwich, milk coffee, tea

offer decaffeinated beverages

nutrition intervention with Alzheimer's disease should include:

offer one food at a time, avoid distractions

a pt has been hospitalized for 17 days with multiple injuries following an accident. when should the discharge plan begin

on the first day of admission

an infant wants a bottle at bedtime, you should counsel the parents to

only give water in the bottle

1 hr

onset of Lantus

2-4 hours

onset of intermediate-acting (NPH) insulin

___ ___ are movements of hands, reduces transportation, and re-plan work areas

operation charts

an AIDS pt should select the following fresh fruit: grapes/orange, orange/banana/pineapple, apple/grapes/peach, grapes/pear

orange/banana/pineapple

the diet for galactosemia should exclude

organ meats, MSG

which is the least common symptom in the elderly: osteomalacia, osteoporosis, obesity, hypertension

osteomalacia

which is not a guideline for Medicaid: low income, over the age of 60, nutritional need

over the age of 60 only and nutritional need

what is most associated with incidence of type 2 diabetes

overweight

what hormone moves milk through the mammary ducts

oxytocin

what hormone moves milk through the mammary ducts?

oxytocin

Potential nutrition-related problems with inflammatory bowel disease include all of the following except:

pancreatic enzyme deficiency

Describe the MNT for cystic fibrosis.

pancreatic enzymes given orally with meals and snacks, high-calorie, high-protein diet with liberal intake of fat and sodium, supplementation of fat-soluble vitamins-one to two times the DRI

nutrients involved in energy metabolism?

pantothenic acid and biotin

which nutrients are involved in energy metabolism: pyridoxine and cyanocobalamin, copper and zinc, pantothenic acid and biotin, folic acid and iron

pantothenic acid and biotin

a post-surgical pt with prolonged ileus should be treated with

parenteral nutrition

a pt with short bowel syndrome will likely receive ______ as initial nutrition therapy

parenteral nutrition

a pt is recovering from an ileocecal resection, where 100 cm was removed. what are your recommendations

parenteral vitamin B12, increase fluids, increase protein

In writing a hospital menu:

patient, staff, and public dining areas should have a unified menu.

a child has been identified as being high risk for food allergies, what should be withheld for the first few years: peanut butter and milk, eggs and strawberries, oats and fish, citrus fruits and chocolate

peanut butter and milk

someone on MAOI shouldn't have

pepperoni

which food should someone on a MAOI not eat: cottage cheese, herbal tea, pepperoni, butter

pepperoni

a Crohn's pt who was previously well-nourished has a fever and ileus 7 days PO. which feeding method should you recommend: central venous hyperalimentation, full liquids, peripheral IV infusion, half-strength tube feed

peripheral IV infusion

a pt admitted to the ICU is diagnosed with HIV and progressive infection, which nutrients would be helpful: phosphorus and zinc, sodium and potassium, sodium and chromium, potassium and magnesium

phosphorus and zinc

a 2 year old child with iron deficiency anemia has anorexia, vomiting, wt loss and restlessness. look for

pica and lead poisoning

a hispanic woman needs more calcium in her diet, what do you recommend: milk, plantains, avocados, pinto beans

pinto beans

which of the following has the fewest calories: plain hamburger, chefs salad with dressing, green salad with thousand island dressing and shredded cheese, fried fish sandwich

plain hamburger

food habits of older Americans influenced by:

poor detention, decreased GI activity, decreased HCl, and decreased taste sensitivity

esophageal varices may be caused by

portal hypertension

MacGregor's Theory Y is viewed as a ___, ___ management style

positive, participative

Which mineral can become deficient as a result of diuretic therapy?

potassium

what can be included in a meal for gluten-induced enteropathy

potatoes with butter

Those with a need for ___ enjoy competition and seek confrontation

power

which of the following best reflects protein status: albumin, transferrin, retinol-binding protein, prealbumin

prealbumin

what is the goal of the dietary guidlines

prevention of chronic disease

Raw food costs + direct labor costs is ___ cost

prime

___ ___ are the steps involved in a process using symbols

process charts

According to Herzberg, maintenance factors will not ___ motivation, but may ___ it from occuring

produce, prevent

The marketing mix four P's: ___,___,___,___

product, place, price, promotion

The ___ schedule is the time sequence of events required to produce a meal; employees assignments and menu items quantity to prepare & timing

production

A meal equivalent is a measure of ___ defined as the amount of all food sales divided by the average cost of a typical meal

productivity

Net profit / revenue determines ___

profit margin

The ___&___ statement shows operating results over a period of time

profit, loss

what hormone develops placenta?

progesterone

which hormone is involved in developing the placenta

progesterone

which hormone regulates breast milk production

prolactin

Issuing discount coupons is a means of:

promotion

what has greatest effect on renal solute load?

protein

which has the greatest effect on the renal solute load : potassium, sodium, glucose, protein

protein

marasmus

protein and kcal starvation, anthropometric diagnosis, starved appearance

what nutrients most affect the renal solute load

protein and sodium

iatrogenic malnutrition is

protein calorie malnutrition

an indication for use of a protein hydrolysate infant formula is : prematurity, constipation, phenylketonuria, protein hypersensitivity

protein hypersensitivity

urea excretion is related to ____, while creatine excretion is related to ____

protein intake, muscle mass

a nephrotic syndrome pt with edema has serum albumin level that continues to fall, recognize that

protein is being lost in the urine

what do you restrict in a diet for hepatic encephalopathy

protein sodium fluid

adjust intake of what w/ a liver disease pt

protein, fluids and sodium

a pt with liver disease needs adjustments in the intake of

protein, fluids, sodium

what is restricted in a diet for hepatic encephalopathy

protein, sodium, fluid

Mono and disaccharides do not:

provide 9 kcal/gram

which of the following about nutrition screening in hospitals is true: provides direction for pt care, cost-effective for all pts, has universal criteria, should be performed only when ordered

provides direction for pt care

which condition benefits from the use of indirect calorimetry: postgastrectomy, chemotherapy, pt with third degree burns, post-surgical pt

pt with third degree burns

Closed shop and union shops are illegal in the ___ sector (government jobs)

public

Nutritionists can present views on bills during the ___ ___ or in earlier planning stages

public hearings

which would you recommend for a pt with mild dysphagia: honey, apple juice, nectar, pudding

pudding

mild dysphagia

pudding thick

The position concerned with obtaining the right product at the right time, and for the right price is:

purchasing agent

high doses of which vitamin will interfere with Levodopa

pyridoxine

Two dietitians pose the following question in their research study: "What is the relationship between the number of protein supplements taken daily and the amount of weight gain?" The level of measurement of the variables is:

ratio

which diet is restricted in carbohydrate: reactive hypoglycemia, diabetes, PKU, galactosemia

reactive hypoglycemia

which of the following is an achievable outcome for a wt loss program

reduce by 10% the number of obese adults ages 25-49 within two years of starting the program

what diet diet is appropriate for reactive hypoglycemia?

reduce intake of concentrated carbohydrates, 5-6 small meals

a nutritional care plan for overweight children should include

reduce rate of body weight gain while allowing growth

a new pt with a BMI of 32 and HTN comes to you for counseling. what is your first recommendation

reduce sodium intake

when working with pts who have food allergies in a pediatric GI clinic, what outcome should be measured

reduction of food-related reactions among patients

what is the appropriate advice for a person with anorexia nervosa

regular mealtimes, and varied moderate intake

___ are written by staff members of the agencies charged with enforcing the regulations

regulations

___ workers are employees necessary for everyday coverage of full-time positions

relief

a teenageer was brought to the hospital with CVA and dysphagia. the dietitian should immediatly

request a swallow test

in severe cirrhosis with ascites, diet therapy should be

restrict sodium

intervention by RD conducting nutrition assessment is best determined by ---

results of nutrition screening

intervention by a dietitian conducting nutrition assessment is best determined by:

results of nutrition screening

a tube fed pt develops diarrhea. what needs to be done first

review the osmolality of the feeding

milk is packed in opaque containers to avoid UV destruction of

riboflavin

southeast asian populations would likely consume the following foods

rice, vegetables, small amounts of protein

Gluten can be extracted from dough made from flour and water by:

rinsing with water

which of the following items is appropriate for a Muslim diet: sweet and sour pork, salad with Bacos, pork-fried rice, chicken in wine sauce

salad with Bacos

People with achievement as a motivator tend to gravitate toward ___ and ___ positions

sales, management

Herzberg's two-factor theory are based on ___ & ___

satisfiers, dissatisfiers

which of the following is not associated with anorexia nervosa: food aversions, distorted body image, schizophrenia, constant concern about wt status

schizophrenia

___ management focuses on the physical aspects of a job, not the human aspects

scientific

a single 19 year old female is 6 months pregnant. she has not gained any wt and has not seen a physician. hemoglobin is 9. hematocrit is 30. what is the most important recommendation for her: see a physician immediately, apply for WIC, join a teenage pregnancy support group, begin taking iron supplements

see physician immediately

the ketogenic diet is used to help treat

seizures

___ menu reduces plate waste and cost

select

Unions primarily promote based on ___

seniority

pt with decubitus ulcers will likely demonstrate low

serum albumin

The first step in the control process is to ___ ___ ___

set the standards

what does fecal fat of 12 g indicate

severe at malabsorption

what is the characteristics of marasmus

severe fat and muscle wasting

which foods are most likely to cause an allergic reaction

shellfish, peanuts, wheat

Staffing patterns for a particular operation; portions of hours worked, number of days worked per week, relief assignments are known as ___

shift

Lack of proper handwashing is commonly associated with:

shigella

chemically defined formulas are used for

short bowel syndrome

enteral feeding products that contain protein in the form of small peptides and amino acids are recommended for patients who have: short-bowel, gastrectomy, colectomy, jejunostomy

short-bowel syndrome

which best applies to nutritional screening: follow JCAHO, include nutritional parameters, done after nutritional problems are identified, only done on at risk patients

should include nutritional parameters

Cardiac cachexia is characterized by:

significant loss of lean body mass

Work ___ estimates unnecessary job parts (looks at the smallest parts of the job to increase productivity and decrease cost

simplification

iron deficiency anemia has what cell characteristics

small, pale cells, hypochromic, microcytic

microcytic, hypochromic anemia

small, pale cells; due to iron deficiency is

The use of marketing principles to advance a social cause, idea, or behavior is ___ marketing

social

catecholamines cause ___

sodium retention

what elements of the diet vary the most in hepatic disease

sodium, fluid, protein

What is the function o fluids in a recipe?

solvent for dry ingredients, hydration for gluten to develop, and source of steam as leavening

a child has chronic non-specific diarrhea without malabsorption. an increased intake of what might be the cuase

sorbitol

forms of cerebral palsy

spastic: muscles are stiff and tight athetoid: constant, involuntary writhing motions

The job ___ is written for each job and is a personal qualification

specification

your pt is on coumadin, which foods would you make sure to consistently include in their diet: oranges/peaches, sweet potatoes, beef/lamb, spinach/collard greens

spinach/collard greens

SOP = ___ ___ ___

standards of procedure

SOPP = ___ ___ ___ ___

standards of professional practice

You attend a party with several friends where a variety of hot and cold finger foods were served. The food tasted great, but on the way home, a few of you complained of abdominal cramps. After a day of cramps and diarrhea you feel fine. A possible cause for your symptoms is:

staphylococcus aureus

___ benefits are required by law to ensure the income in the event of unemployment, injury, or death

statutory

The union ___ is an employee who represents fellow employees as the union rep (they do not get extra pay)

steward

a pt on a full liquid diet should not receive: sherbert, strained cereal, pureed fruit, margarine

strained cereal

A patient interviewed by the dietitian reports he develops gas and bloating when milk is consumed. This information should be documented in which section of a SOAP medical record entry:

subjective

a patient with dehydration exhibits the symptoms of

sunken eyes, decreased renal function, increased tachycardia

___ benefits include life and health insurance

supplementary

Ca, D, folate, B6, B12

supplements needed for epilepsy

a cancer pt receiving radiation therapy to the head and neck presents with wt loss, nutrition diagnosis would be

swallowing difficulty

which of the following would be classified as NC in the NCP: inadequate vitamin intake, limited access to food, swallowing difficulty, inappropriate intake of food fats

swallowing difficulty

dehydration due to polyuria, increased pulse, fruity oder of ketones

symptoms of acute ketoacidosis

People with achievement as a motivator are ___-oriented and can manage themselves

task

Sophistication levels: Moderately experienced

teachers, health instructors, patients already instructed Learn what they know and correct if needed Emphasize review of new materials; move on to more complicated concepts

goals for a community nutrition program should be based on

the Dietary Guidelines for Americans

what is an example of a program that provides food to the needy: food bank, food stamp, child care, WIC

the Food Bank

the year 2010 Healthy People goals are an outgrowth of a report by:

the Surgeon General, under HHS

which survey is conducted every 10 years

the USDA Food Consumption Survey

the allowance for Food Stamps is based on:

the USDA Thrifty Food Program

azotemia

the accumulation of abnormal quantities of urea, uric acid, creatitine, and other nitrogenous wastes in the blood

why would child measurements be inaccurate

the child was measured standing up

why might a child with PKU have an increased incidence of dental carries

the diet is high in carbohydrates and low in protein

Medicare is for

the elderly

the breast fed infant is drinking primarily colostrum for how long

the first few days

the best way to justify continuation of WIC would be to show improvement in

the infant morbidity rate

New York City

the largest city in New York State and in the United States

glucose utilization rate

the maximum amount of glucose without causing metabolic complications (such as refeeding syndrome)

decreases

the need for phenylalanine increases or decreases with age, infection?

a homeless pt who is deficient in all nutrients is to be discharged. what organization may help

the social workers group

why is an affluent couple (man with diabetes, 67 years old and wife with a broken arm, 50 years of age) not eligible for Meals on Wheels

they can leave the house

asian, hispanic and native americans have the following in common

they consume little milk

memory loss may be associated with a deficiency of

thiamin

decrease insulin resistance in peripheral tissues

thiazolidinediones do what?

a pt with dysphagia waiting for a swallow test may receive: thick liquids, thin liquids, PPN, PN

thick liquids

osteoporosis mostly affects

those 65 years of age or older

which is apart of the nutritional therapy for IDDM in a lean person: time meals, decreased caloric intake, it is not crucial to maintain calories if avg intake is low, decrease the frequency of feedings

time meals

Roman Catholic dietary laws state that fish is

to be served on Ash Wednesday and Fridays during lent

Americans with Disabilities Act requires employers to make reasonable accommodations for individual employees.An example of an accommodation that employers could be asked to make is:

to provide a lavatory that is wheel chair accessible.

What is the Shilling test used for?

to test for pernicious anemia

VMA test diet measures

total catecholamines

the VMA test diet measures

total catecholamines

PERT: pancreatic enzyme replacement therapy orally

treatment for actue pancreatitis involves doing what with meals and snacks

15 g CHO, wait 15 min, if <70 mg/dL another 15 g, repeat until normal glucose

treatment of actue hypoglycemia

insulin, rehydration

treatment of acute ketoacidosis

Louisana Purchase

treaty between the USA and France where the US bought territory that stretched from the west bank of the MIssissippi River to the Rocky Mountains

what best measures excess calorie reserves: wt, creatinine, triceps skinfold, arm circumference

triceps skinfold

muscle mass is determined using

triceps skinfold and arm circumference

which of the following indicates protein calorie malnutrition: creatinine height index of 93%, height for weight ratio of 89%, triceps skinfold and arm muscle circumference of 79%, serum albumin of 4.5;transferrin of 410

triceps skinfold and arm muscle circumference of 79%

which anthropometric measurements are useful in assessing adults

triceps skinfold, arm muscle circumference, height, weight

what should a jewish pt include in his diet to increase the intake of zinc: fresh green vegetables, pork, turkey, wheat bread

turkey

Number of employees terminated or replaced / # total positions in the department is the ___

turnover

an athlete needs 4000 calories. the cornflakes nutrient label says that one serving provides 25% of the RDA for CHO. how many servings of cornflakes does he need to get his 25%

two

aspart, lispro, humalog

types of rapid acting insulin

whats permitted on a tyramine restricted diet?

uncured cheese like cottage, ricotta

which of the following is permitted on a diet restricting tyramine: hard cheese like cheddar or swiss, uncured cheese like ricotta or cottage, pickled of smoked foods, tofu

uncured cheese like cottage, ricotta

As a manager of a foodservice department, you hear that an employee was very upset with a decision made by a first line supervisor. This employee makes an appointment with the VP over foodservice's. The VP states that he cannot get involved at this time and encourages the employee to talk to you. The principle at work is:

unity of command

when measuring a child's somatic protein mass, in addition to the BMI, use:

upper arm muscle area

a pt who had an ileal resection is placed on a tube feeding and begins to have diarrhea. this may be due to

use of hypertonic formula

You are nearing the summer months and must plan for vacation coverage on the work schedule. You have a staff of 40; all are entitled to vacation time ranging from one to four weeks depending on seniority. You should:

utilize temporary or leased employees

An instrument that measures accurately and consistently is said to be:

valid

A glucometer is checked for accuracy by correlating the readings to serum glucose levels. Repeatedly, the readings are precisely the same. This indicates:

validity

a pt on a clear liquid diet should not be served: strawberry flavored gelatin, vegetable stock, apple juice, fruit flavored popsicle

vegetable stock

do not give __ to a CL pt

vegetable stock

what is 1/4 c low fat cottage cheese equivalent to

very lean meat exchange

give what supplements to a BF baby?

vit D and flouride

a vegan is allergic to milk. which nutrients would you expect might be deficient in her intake

vitamin B12, D

microcytic anemia is commonly seen with what type of vitamin deficiency?

vitamin B6

which supplements should you give to a breast-fed baby

vitamin D and fluoride

What is the formula for calculating the kcal of 500ml of dextrose for a TPN solution?

volume X strength = grams X kcal/g = kcal 500ml X 0.5 = 250grams X 3.4kcal = 850kcal

Current research indicates _________ is a better marker of abdominal fat than _________ .

waist circumference; waist-to-hip ratio

a 11 month old infant is at the 95th percentile weight for age and has been for the past 9 months. what should you do

watch his growth over the next six months

following a colectomy, the absorption of which of the following would be most concern: vit D and E, water and sodium, B vitamins, vit C

water and sodium

athletes should receive: salt pills during summer months, extra protein, carbohydrate loading two weeks prior to an event, water during an event to replace lost fluids

water during an event to replace lost fluid

what is the least useful evaluation tool in a community assessment program

weight for age

what is the most useful for evaluating recent under-nutrition or over-nutrition

weight for height

which of the following would provide the most useful data when conduction nutrition screening on preschool children at a health fair: triceps skinfold, wt for age, wt for stature, stature for age

weight for stature

iron or protein deficiency

what are the possible causes of brittle, thin, spoon-shaped nails?

lantus

what is a type of long-acting insulin?

prevent marked rise in blood glucose that would stimulate more insulin

what is the goal of postprandial or reactive hypoglycemia?

a Rabbi is admitted to the hospital, what question will he ask to the RD

what is the mixture of foods in combination dishes

1g nitrogen/150kcals; 1-1.5 g pro/kg/day

what is the protein ratio for anabolism in PN?

rapid-acting (aspart, lispro, humalog) and short-acting (regular)

what type(s) of insulin provide a burst of insulin to cover meal?

when is breast feeding contraindicated

when the mother has AIDS

enough acid to damage enamel

when the pH in the mouth drops below 5.5,what can occur?

Name a major food source of magnesium

whole grains, nuts, dried beans and peas

an 18 month old child should receive what kind of milk

whole milk

Because some cooking oils turn cloudy when refrigerated oils intended for salad dressing as treated by:

winterization

a pt with chronic pancreatitis should consume oral pancreatic enzymes

with all meals and snacks

iron preparations should be taken

with meals

___ ___ observes random samples to determine % of time working or idle

work sampling

The body mass index (BMI) is measured by:

wt/ht squared

if you have a lactose intolerance, which food could you most likely tolerate: whole milk, skim milk, ice cream, yogurt

yogurt

In a ___-___ budget, it is more planning oriented and cost must be justified

zero-based

If you want to quickly calculate a healthy person's estimated calorie, protein and fluid intake, what would you use?

~25kcal/kg for calories, .8-1g Protein/kg and 1cc/kcal for fluid or 25cc/kg

What is considered significant weight loss?

≥1% to 2% in 1 week ≥5% in 1 month ≥7.5% in 3 months ≥10% in 6 months