3 Nutrition Care Flashcards
1
Q
1 gram of each of these macronutrients = ____ kcal
Carbs
Protein
Fat
A
Carbs = 4 kcal Protein = 4 kcal Fat = 9 kcal
2
Q
Digestive end-product of carbohydrates
A
Monosaccharides
3
Q
What enzyme breaks down carbs?
A
Amylase
4
Q
Digestive end products of protein
A
Amino acids
5
Q
Enzyme that breaks down protein
A
Protease
6
Q
Digestive end products of fat
A
Monoglycerides and fatty acids
7
Q
What breaks down fat?
A
Lipase and bile
8
Q
What are the fat-soluble vitamins?
A
A
D
E
K
9
Q
Vitamin __ is important for vision
A
A
10
Q
Vitamin ____ aids in Ca absorption
A
D
11
Q
Vitamin ____ is important for clotting
A
K
12
Q
What are the water-soluble vitamins?
A
Thiamine (B1) Riboflavin (B2) Niacin (B3) Pantothenic Acid (B5) Pyridoxine (B6) Biotin Folate Cobalamin (B12) Ascorbic acid (Vitamin C)
13
Q
_____ binds to IF
A
B12
14
Q
______ aids in iron absorption
A
Vitamin C (Ascorbic acid)
15
Q
_____ function to support cellular metabolic processes, biochemical reactions, hormone function, nerve impulse propagation and muscle function
A
Micronutrients
Vitamins
Major minerals
Trace elements
16
Q
Minerals (ie Ca, iron, others) are generally absorbed in…
A
Duodenum
17
Q
How is vitamin B12 absorbed?
A
Binds to IF in stomach
Absorbed in terminal ileum
18
Q
Manifestation of thiamine (B1) deficiency
A
Beriberi (peripheral neuropathy +/- HF)
Wernicke-Korsakoff Syndrome (neurologic sequela)
19
Q
Cheilitis, angular stomatitis, glossitis
A
Riboflavin (B2), Niacin (B3), Pyridoxine (B6) deficiencies
20
Q
What is Pellagra?
A
Deficiency of Niacin (B3) —> Diarrhea, Dermatitis, Dementia
21
Q
_____ and ____ both present with macrocytic anemia
A
Folate and Cobalamin (B12)
But B12 also presents with peripheral neuropathy
22
Q
Manifestation of Vitamin D deficiency
A
Rickets
Osteomalacia
23
Q
Manifestations of Vitamin A deficiency
A
Night blindness
Bitot spots
Poor wound healing
Dry skin
24
Q
Manifestations of zinc deficiency?
A
Hypogeusia
Impaired wound healing
25
Manifestation of iodine deficiency
Goiter
| Hypothyroidism
26
Manifestation of calcium deficiency
Tetany
27
Manifestation of Iron deficiency
Pallor
Pale conjunctiva
Koilonychia
28
Petechia/purpura are indicative of what deficiency?
Vitamin C and K
29
Vitamin E deficiency —>
Sensory and motor neuropathy
30
I say tetany, you say...
Hypocalcemia
31
I say koilonychia, you say...
Iron
32
I say night blindness, you say...
Vitamin A
33
I say atrophic glossitis, you say...
Vitamin B
34
I say pellagra, you say...
Niacin
35
I say Beriberi, you say...
Thiamine
36
I say petechia/purpura, you say...
Vitamin C & K
37
For a healthy pregnancy, you should promote what kind of diet?
Rich in fruits/veggies, whole grains, low-fat dairy, and a variety of protein
Caloric consumption/weight gain dependent on prepregnancy BMI etc
38
Folic acid is necessary in early pregnancy to prevent...
Neural tube defects
39
What cautions should be given to pregnant women?
Safe food handling and consumption (avoid cured/deli meats, unpasteurized/undercooked products, fish)
Safe pet care (no litter boxes)
Consult with registered dietitian trained in maternal nutrition
May need dietary instruction for gestational diabetes
40
An infant should be fed solely breast milk or formula for about the first ____ months
4-6
41
Exclusively breastfed infants should receive ______ supplementation
Vitamin D
42
Why do we chart and monitor infant growth patterns
Screening for FFT due to inadequate caloric intake, inadequate nutrient absorption, or organic causes
43
What is the biggest advice for health nutrition in childhood?
Avoidance of sweetened foods and beverages****
44
Dietary guidelines for children older than one year
Variety of nutrient-dense foods from the basic food groups
Little added salt, sugar, or caloric sweeteners
A colorful variety of fruits and vegetables should be offered each day
Whole grains
Milk:
• 1-2 years: whole cow milk
• 2-8 years: fat-free or low-fat milk
45
Keys to healthy nutrition in adulthood
Well-balanced nutrient-rich diet focused on healthy food choices, portion control, food preparation and meal planning and mindful eating
Caloric balance is key to maintaining a healthy body weight
Avoid processed foods, refined sugars and limit trans fat, saturated fat, and dietary cholesterol
46
An average adult should consume less than _____ mg Na daily
<2300 mg
47
Goals of the MyPlate method
Replace refined grains with whole grains
Encourage 5+ servings fruits/veggies daily
Promote adequate fiber (25-35g/day)
Aim for protein-rich foods (seafood, lean meat, eggs, beans, unsalted nuts/seeds, low-fat dairy)
48
Influencing factors for increased nutritional risk in the elderly
```
Multiple medical problems
Malignancy, dementia
Poly pharmacy
Physiological changes
Decreased functional status
Varying ability to access/prepare food
Social implications (poverty, isolation, depression)
```
49
How to approach nutrition in the elderly
Liberalize diet, incorporate high calorie foods, add oral nutrition supplements as appropriate
50
What are the five components of a nutritional assessment?
```
Food and nutrition related history
Patient history (medical, surgical, social)
Anthropometric measurements
Nutrition-focused PE
Laboratory indicators
```
51
Factors affecting oral intake
```
Anorexia
Poor dentition
Taste disturbances
Heartburn
Dysphagia
N/V/D/C
Abdominal pain
```
52
Conditions that may have nutritional implications
Critical illness
Chronic disease
Immunocompromised/malignancy
Eating disorders
GI disorders (pancreatic insufficiency, celiac disease, IBD)
Alcohol use disorder (inc risk of thiamine deficiency***)
Physical disabilities
Medication and complementary/alt medicine use
53
Surgical history conditions that may have nutritional implications
Major abdominal surgery (bariatric, intestinal resection)
High output fistula or onto my
Trauma
GI hemorrhage
54
Social history conditions that may have nutritional implications
```
Food insecurity
Inadequate social support (caregiver, family)
Poor access to medical care
Limited functional status/mobility
Religious practices
Alcohol/tobacco/recreational drug use
Mental health
```
55
What anthropometric measurements should you take as part of a nutritional assessment?
```
Height
Weight
BMI
Usual v Ideal body weight
Weight pattern/unintentional weight loss
Body composition
```
56
What is the goal of a nutrition-focused PE?
Target body weight, muscle wasting, fat stores, volume status, and signs of nutrient deficiences
57
Nutrition-focused PE findings:
Edema, ascites
Protein
58
Nutrition-focused PE findings:
Sunken dry appearance of orbital area
Dehydration
59
Nutrition-focused PE findings:
Temporal muscle wasting
Protein - calorie
60
Nutrition-focused PE findings:
Poor wound healing, pressure ulcers
Protein, Vitamin C, Vitamin A, Zinc
61
Nutrition-focused PE findings:
Muscle wasting and decreased strength
Protein-calorie
62
Nutrition-focused PE findings:
Confusion
Thiamine
63
What types of labs would you run during a nutritional assessment?
```
CBC
Iron studies
B12/folate
Serum albumin and pre-albumin (interpret w/ caution)
CRP/ESR
Glucose
BMP/CMP, Na, K, Ca, PO4, Mg
Vitamins, Minerals, trace elements
Acid Base Assessment
```
64
What do we need to know about dietary adjustments for nutritional intervention?
They provide specialized/modified/altered consistency diets as appropriate to the patient’s condition
```
Examples:
• Clear or full liquid
• Puréed or soft
• Diabetic, heart healthy, renal
• Anti-reflux diet
• Gluten-free
• High fiber or low-residue
• Disease specific
```
65
Concentrated source of kcals, protein, vitamin/minerals
Oral nutrition supplements
Available in liquid drinks, shakes, snacks, etc
Can be disease specific and tailored to patient
66
What is nutrition support?
Provision of nutrients to individuals who cannot meet their nutrition requirements by mouth
Can be enteral or parenteral
67
When giving a patient nutrition support, which is preferred - enteral or parenteral?
Enteral - more physiologic than parenteral
68
Nutrition delivered directly into the GI tract by bypassing oral cavity
Enteral nutrition
69
In what types of patients is enteral nutrition appropriate?
Those with a functioning GI tract who are unable to meet adequate nutrition requirements by mouth
Consider patient’s nutritional status, GI anatomy, gastric/intestinal motility and function, estimated duration of therapy, and disease state
70
What are the different routes of administration for enteral nutrition?
For short term (<4-6 weeks)
• Nasogastric (NG) tube
• Nasoduodenal (ND) tube
• Nasojejunal (NJ) tube
For long term (>4-6 weeks)
• Gastrostomy (G-tube)
• Jejunostomy (J-tube)
71
What are the two ways in which nutrition can be given during enteral nutrition support?
Bolus feeds via stomach
Continuous feeding via small bowel
72
Mechanical complications of enteral nutrition
Tube misplacement (ensure radiographic imaging of blindly placed short-term tubes before use)
Tube displacement
Tube obstruction
73
Metabolic complications of enteral nutrition
Hyperglycemia
Unstable fluid/Lyme status
74
Intolerance complications of enteral nutrition
Emesis
Diarrhea (could be formula but could also be meds (abx) or C diff)
75
Pulmonary complications of enteral nutrition
Aspiration
76
Nutrition delivered directly into the vein
Parenteral nutrition
A mixture of dextrose, amino acids, lipid emulsion, fluid, electrolytes, vitamins/minerals
77
Parenteral nutrition is appropriate for ...
Patients at risk of malnutrition who have a non functioning GI tract or when oral intake and EN is not feasible or contraindicated
78
Examples of situations in which you may need to provide parenteral nutrition
```
Prolonged ileum
Bowel obstruction
Small bowel resection
Short gut syndrome
High output enterocutaneous fistula
Inflammatory bowel disease
GI bleed
Ischemic bowel
Unable to tolerate EN
```
79
Which is used more frequently for parenteral nutrition: Peripheral PN or Total PN?
Total PN (TPN)
Used in long-term situations (>7 days)
Central venous catheter via PICC (Peripherally inserted central catheter)
80
Complications of Parenteral nutrition
Mechanical - catheter-related sepsis, venous thrombus, air embolus, pneumothorax
Metabolic - hyperglycemia, azotemia, lyte abnormalities
Fatty liver (secondary to cholestasis)
81
Primary mode of nutrition support in a patient with non-functioning GI tract
Parenteral nutrition (typically TPN)
82
What are the access routes appropriate for a patient expected to need enteral nutrition for <4-6 weeks
NG tube, ND tube, or NJ tube
83
Common complications of nutrition support include...
Mechanical issues, metabolic/electrolyte abnormalities
84
Individualized therapeutic dietary interventions used in the management of medical conditions
Medical nutrition therapy
Common for many different conditions
85
Reflux of gastric contents into the esophagus —> heartburn/indigestion
GERD (Gastroesophageal Reflux Disease)
86
Dietary interventions for GERD patients
Small, frequent meals
Elevate head of bed and avoid eating within 3 hours of bedtime if nocturnal symptoms
Avoidance of symptomatic reflux triggering foods (citrus, acidic, spicy, caffeine, coffee, cola, spearmint/peppermint, chocolate, alcohol)
87
What is gastroparesis?
Delayed gastric emptying
Complication of diabetes (diabetic autonomic neuropathy) - one of the reasons glycemic control is so important
88
Sx of gastroparesis
N/V
Early satiety
Postprandial fullness
Upper abdominal discomfort
89
Dietary interventions for gastroparesis
Small frequent low fat/low fiber meals
Cooked, blendarized, puréed foods and liquids better tolerated
If inadequate oral intake, then postpyloric enteral nutrition may be considered
90
Bloating, flatulence, and diarrhea as a result of lactase deficiency
Lactose intolerance
91
Dietary interventions for lactose intolerance
Lactose free diet - avoidance of milk, yogurt, etc
Calcium/vitamin D supplementation
Lactose free alternative foods
Lactation supplements
92
Restrictive/malabsorption bariatric surgery procedure used to maximize weight loss while maintaining nutritional health and preventing micronutrient deficiencies
Roux-en-Y gastric bypass
93
What does chronic management of roux-en-y gastric bypass patients entail?
Screen for and replete micronutrients as appropriate
| • Vit A, D, B1, B12, Folate, Fe, Ca, Zinc
94
Complication of bariatric surgery —> rapid emptying of food into small bowel
Dumping Syndrome
Advise small frequent meals, separate solids from liquids by 30 min, and avoidance of simple sugars
95
Immune disorder triggered by the ingestion of gluten leading to mucosal inflammation and villous atrophy
Celiac disease
96
Sx of Celiac Disease
Bloating, flatulence, diarrhea
Malabsorption is a concern as well
97
Dietary interventions in celiac disease
GLUTEN-FREE DIET
Eliminate wheat, rye, and barley
Fresh fish/seafood, meat, and poultry, dairy, fruit/veggies, beans, legumes, nuts
Identify and treat nutritional deficiencies (Fe, Folate, B12, Ca, Zn, Vit D)
98
Inflammatory disorders of the GI tract that can lead to mucosal inflammation/ulceration
Inflammatory Bowel Disease
Includes both Ulcerative Colitis and Crohn’s Disease
99
What is the main nutritional concern in IBD?
Malabsorption
Esp B12, Fe, Ca, Vit D, Zn
100
In healthy adults, the normal length of small intestine is _____
~480 cm
101
Surgical resection or disease of small bowel —> disruption of digestive/absorptive surface capacity
Short bowel syndrome
Contributes to nutrient malabsorption, diarrhea, dehydration, electrolyte abnormalities
102
Examples of dietary interventions appropriate in short bowel syndrome
Parenteral nutrition support in initial period
Oral/enteral nutrition support to augment intestinal adaptation
Vitamin/mineral supplementation as appropriate (Vit B12, A, D, E, K, Mg, PO4, Zn, Ca)
Diet mods
103
Sac-like protrusions/outpouchings of the colonic wall
Diverticulum disease
104
_________ = presence of diverticula
_________ = inflammation of diverticulum
Diverticulosis
Diverticulitis
105
Dietary interventions for Diverticular Disease
High fiber diet aimed to prevent diverticular disease
Diverticulitis may require NPO/Clear Liquid/Low Fiber diet initially then advance as tolerated to high fiber diet
106
How is chronic pancreatitis/pancreatic insufficiency characterized?
Exocrine dysfunction (digestive enzyme deficiency) —> protein and fat malabsorption
Risk of fat-soluble vitamin deficiencies (A, D, E, K)
107
Dietary interventions for chronic pancreatitis/pancreatic insufficiency
Dietary fat restriction
Consider pancreatic enzyme replacement therapy
108
What are the different causes of Iron deficiency?
BLOOD LOSS
Celiac
H. pylori
Roux-en-Y gastric bypass
PPI use
109
Who is most at risk for B12 deficiency?
```
Vegans
Roux-en-Y gastric bypass patients
Pernicious anemia
Terminal ileum CD or TI resection
Celiac
Chronic pancreatitis/pancreatic insufficiency
Metformin
```
110
What is the Mediterranean diet?
Plant-based diet of vegetables, fruit, whole-grain breads and cereals, beans and nuts
Olive oil
Low to moderate fish, poultry, dairy
Little red meat
111
What is the DASH diet?
High in fruits, veggies, whole grains, low-fat dairy, poultry, fish, nuts, beans
Reduced sodium and increased potassium, calcium, magnesium containing foods
Low sat fat, total fat, cholesterol
Reduce sweets, added sugars, and sugar sweetened drinks
112
Nutrition therapy goals for diabetics should be aimed at optimizing...
“ABC”
A1C
BP
Cholesterol
113
For diabetics, it’s important to make sure carbohydrates account for no more than _____% of caloric intake
45%
114
How does renal disease affect nutrition?
Poor excretion can lead to sodium and fluid retention, hyperkalemia, and hyperphosphatemia
115
What are the main dietary interventions in renal disease?
Individualized protein, Na, K, PO4, Ca intake (dependent on CKD stage/GFR)
DASH Diet
Phosphate binders
Consult dietitian trained in renal nutrition
116
________ consistency is important to maintain for patients on Coumadin
Vitamin K
Don’t have to eliminate green leafy veggies but eat a consistent amount each day
117
What food needs to be avoided by patients on statins?
Grapefruit juice
118
Patients taking MAOIs should avoid ______ containing foods
Tyramine
Chocolate, aged and mature cheeses, smoked and aged meats, hot dogs
119
Potential drug-nutrient implications:
ACE-I/ARBs
Hyperkalemia
120
Potential drug-nutrient implications:
Diuretics
Hypo Na, K, Mg
121
Potential drug-nutrient implications:
Cholestyramine
Fat soluble vitamins
122
Potential drug-nutrient implications:
Sulfasalazine, methotrexate
Folic acid deficiency
123
Potential drug-nutrient implications:
Isoniazid
Vitamin B6
124
Potential drug-nutrient implications:
Metformin
Vitamin B12
125
Potential drug-nutrient implications:
Coumadin
Vitamin K consistency
126
Potential drug-nutrient implications:
Statins
Grapefruit juice
