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Clin Med III Unit I > 3 Nutrition Care > Flashcards

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
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2
Q

Digestive end-product of carbohydrates

A

Monosaccharides

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3
Q

What enzyme breaks down carbs?

A

Amylase

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4
Q

Digestive end products of protein

A

Amino acids

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5
Q

Enzyme that breaks down protein

A

Protease

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6
Q

Digestive end products of fat

A

Monoglycerides and fatty acids

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7
Q

What breaks down fat?

A

Lipase and bile

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8
Q

What are the fat-soluble vitamins?

A

A
D
E
K

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9
Q

Vitamin __ is important for vision

A

A

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10
Q

Vitamin ____ aids in Ca absorption

A

D

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11
Q

Vitamin ____ is important for clotting

A

K

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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)
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13
Q

_____ binds to IF

A

B12

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14
Q

______ aids in iron absorption

A

Vitamin C (Ascorbic acid)

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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

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16
Q

Minerals (ie Ca, iron, others) are generally absorbed in…

A

Duodenum

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17
Q

How is vitamin B12 absorbed?

A

Binds to IF in stomach

Absorbed in terminal ileum

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18
Q

Manifestation of thiamine (B1) deficiency

A

Beriberi (peripheral neuropathy +/- HF)

Wernicke-Korsakoff Syndrome (neurologic sequela)

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19
Q

Cheilitis, angular stomatitis, glossitis

A

Riboflavin (B2), Niacin (B3), Pyridoxine (B6) deficiencies

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20
Q

What is Pellagra?

A

Deficiency of Niacin (B3) —> Diarrhea, Dermatitis, Dementia

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21
Q

_____ and ____ both present with macrocytic anemia

A

Folate and Cobalamin (B12)

But B12 also presents with peripheral neuropathy

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22
Q

Manifestation of Vitamin D deficiency

A

Rickets

Osteomalacia

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23
Q

Manifestations of Vitamin A deficiency

A

Night blindness
Bitot spots
Poor wound healing
Dry skin

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24
Q

Manifestations of zinc deficiency?

A

Hypogeusia

Impaired wound healing

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25
Q

Manifestation of iodine deficiency

A

Goiter

Hypothyroidism

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26
Q

Manifestation of calcium deficiency

A

Tetany

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27
Q

Manifestation of Iron deficiency

A

Pallor
Pale conjunctiva
Koilonychia

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28
Q

Petechia/purpura are indicative of what deficiency?

A

Vitamin C and K

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29
Q

Vitamin E deficiency —>

A

Sensory and motor neuropathy

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30
Q

I say tetany, you say…

A

Hypocalcemia

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31
Q

I say koilonychia, you say…

A

Iron

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32
Q

I say night blindness, you say…

A

Vitamin A

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33
Q

I say atrophic glossitis, you say…

A

Vitamin B

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34
Q

I say pellagra, you say…

A

Niacin

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35
Q

I say Beriberi, you say…

A

Thiamine

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36
Q

I say petechia/purpura, you say…

A

Vitamin C & K

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37
Q

For a healthy pregnancy, you should promote what kind of diet?

A

Rich in fruits/veggies, whole grains, low-fat dairy, and a variety of protein

Caloric consumption/weight gain dependent on prepregnancy BMI etc

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38
Q

Folic acid is necessary in early pregnancy to prevent…

A

Neural tube defects

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39
Q

What cautions should be given to pregnant women?

A

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

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40
Q

An infant should be fed solely breast milk or formula for about the first ____ months

A

4-6

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41
Q

Exclusively breastfed infants should receive ______ supplementation

A

Vitamin D

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42
Q

Why do we chart and monitor infant growth patterns

A

Screening for FFT due to inadequate caloric intake, inadequate nutrient absorption, or organic causes

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43
Q

What is the biggest advice for health nutrition in childhood?

A

Avoidance of sweetened foods and beverages**

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44
Q

Dietary guidelines for children older than one year

A

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

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45
Q

Keys to healthy nutrition in adulthood

A

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

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46
Q

An average adult should consume less than _____ mg Na daily

A

<2300 mg

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47
Q

Goals of the MyPlate method

A

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)

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48
Q

Influencing factors for increased nutritional risk in the elderly

A 
Multiple medical problems
Malignancy, dementia
Poly pharmacy
Physiological changes
Decreased functional status
Varying ability to access/prepare food
Social implications (poverty, isolation, depression)
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49
Q

How to approach nutrition in the elderly

A

Liberalize diet, incorporate high calorie foods, add oral nutrition supplements as appropriate

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50
Q

What are the five components of a nutritional assessment?

A 
Food and nutrition related history
Patient history (medical, surgical, social)
Anthropometric measurements
Nutrition-focused PE
Laboratory indicators
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51
Q

Factors affecting oral intake

A 
Anorexia
Poor dentition
Taste disturbances
Heartburn
Dysphagia
N/V/D/C
Abdominal pain
52
Q

Conditions that may have nutritional implications

A

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
Q

Surgical history conditions that may have nutritional implications

A

Major abdominal surgery (bariatric, intestinal resection)

High output fistula or onto my

Trauma

GI hemorrhage

54
Q

Social history conditions that may have nutritional implications

A 
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
Q

What anthropometric measurements should you take as part of a nutritional assessment?

A 
Height 
Weight
BMI
Usual v Ideal body weight
Weight pattern/unintentional weight loss
Body composition
56
Q

What is the goal of a nutrition-focused PE?

A

Target body weight, muscle wasting, fat stores, volume status, and signs of nutrient deficiences

57
Q

Nutrition-focused PE findings:

Edema, ascites

A

Protein

58
Q

Nutrition-focused PE findings:

Sunken dry appearance of orbital area

A

Dehydration

59
Q

Nutrition-focused PE findings:

Temporal muscle wasting

A

Protein - calorie

60
Q

Nutrition-focused PE findings:

Poor wound healing, pressure ulcers

A

Protein, Vitamin C, Vitamin A, Zinc

61
Q

Nutrition-focused PE findings:

Muscle wasting and decreased strength

A

Protein-calorie

62
Q

Nutrition-focused PE findings:

Confusion

A

Thiamine

63
Q

What types of labs would you run during a nutritional assessment?

A 
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
Q

What do we need to know about dietary adjustments for nutritional intervention?

A

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
Q

Concentrated source of kcals, protein, vitamin/minerals

A

Oral nutrition supplements

Available in liquid drinks, shakes, snacks, etc

Can be disease specific and tailored to patient

66
Q

What is nutrition support?

A

Provision of nutrients to individuals who cannot meet their nutrition requirements by mouth

Can be enteral or parenteral

67
Q

When giving a patient nutrition support, which is preferred - enteral or parenteral?

A

Enteral - more physiologic than parenteral

68
Q

Nutrition delivered directly into the GI tract by bypassing oral cavity

A

Enteral nutrition

69
Q

In what types of patients is enteral nutrition appropriate?

A

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
Q

What are the different routes of administration for enteral nutrition?

A

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
Q

What are the two ways in which nutrition can be given during enteral nutrition support?

A

Bolus feeds via stomach

Continuous feeding via small bowel

72
Q

Mechanical complications of enteral nutrition

A

Tube misplacement (ensure radiographic imaging of blindly placed short-term tubes before use)

Tube displacement

Tube obstruction

73
Q

Metabolic complications of enteral nutrition

A

Hyperglycemia

Unstable fluid/Lyme status

74
Q

Intolerance complications of enteral nutrition

A

Emesis

Diarrhea (could be formula but could also be meds (abx) or C diff)

75
Q

Pulmonary complications of enteral nutrition

A

Aspiration

76
Q

Nutrition delivered directly into the vein

A

Parenteral nutrition

A mixture of dextrose, amino acids, lipid emulsion, fluid, electrolytes, vitamins/minerals

77
Q

Parenteral nutrition is appropriate for …

A

Patients at risk of malnutrition who have a non functioning GI tract or when oral intake and EN is not feasible or contraindicated

78
Q

Examples of situations in which you may need to provide parenteral nutrition

A 
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
Q

Which is used more frequently for parenteral nutrition: Peripheral PN or Total PN?

A

Total PN (TPN)

Used in long-term situations (>7 days)

Central venous catheter via PICC (Peripherally inserted central catheter)

80
Q

Complications of Parenteral nutrition

A

Mechanical - catheter-related sepsis, venous thrombus, air embolus, pneumothorax

Metabolic - hyperglycemia, azotemia, lyte abnormalities

Fatty liver (secondary to cholestasis)

81
Q

Primary mode of nutrition support in a patient with non-functioning GI tract

A

Parenteral nutrition (typically TPN)

82
Q

What are the access routes appropriate for a patient expected to need enteral nutrition for <4-6 weeks

A

NG tube, ND tube, or NJ tube

83
Q

Common complications of nutrition support include…

A

Mechanical issues, metabolic/electrolyte abnormalities

84
Q

Individualized therapeutic dietary interventions used in the management of medical conditions

A

Medical nutrition therapy

Common for many different conditions

85
Q

Reflux of gastric contents into the esophagus —> heartburn/indigestion

A

GERD (Gastroesophageal Reflux Disease)

86
Q

Dietary interventions for GERD patients

A

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
Q

What is gastroparesis?

A

Delayed gastric emptying

Complication of diabetes (diabetic autonomic neuropathy) - one of the reasons glycemic control is so important

88
Q

Sx of gastroparesis

A

N/V
Early satiety
Postprandial fullness
Upper abdominal discomfort

89
Q

Dietary interventions for gastroparesis

A

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
Q

Bloating, flatulence, and diarrhea as a result of lactase deficiency

A

Lactose intolerance

91
Q

Dietary interventions for lactose intolerance

A

Lactose free diet - avoidance of milk, yogurt, etc

Calcium/vitamin D supplementation

Lactose free alternative foods

Lactation supplements

92
Q

Restrictive/malabsorption bariatric surgery procedure used to maximize weight loss while maintaining nutritional health and preventing micronutrient deficiencies

A

Roux-en-Y gastric bypass

93
Q

What does chronic management of roux-en-y gastric bypass patients entail?

A

Screen for and replete micronutrients as appropriate

• Vit A, D, B1, B12, Folate, Fe, Ca, Zinc

94
Q

Complication of bariatric surgery —> rapid emptying of food into small bowel

A

Dumping Syndrome

Advise small frequent meals, separate solids from liquids by 30 min, and avoidance of simple sugars

95
Q

Immune disorder triggered by the ingestion of gluten leading to mucosal inflammation and villous atrophy

A

Celiac disease

96
Q

Sx of Celiac Disease

A

Bloating, flatulence, diarrhea

Malabsorption is a concern as well

97
Q

Dietary interventions in celiac disease

A

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
Q

Inflammatory disorders of the GI tract that can lead to mucosal inflammation/ulceration

A

Inflammatory Bowel Disease

Includes both Ulcerative Colitis and Crohn’s Disease

99
Q

What is the main nutritional concern in IBD?

A

Malabsorption

Esp B12, Fe, Ca, Vit D, Zn

100
Q

In healthy adults, the normal length of small intestine is _____

A

~480 cm

101
Q

Surgical resection or disease of small bowel —> disruption of digestive/absorptive surface capacity

A

Short bowel syndrome

Contributes to nutrient malabsorption, diarrhea, dehydration, electrolyte abnormalities

102
Q

Examples of dietary interventions appropriate in short bowel syndrome

A

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
Q

Sac-like protrusions/outpouchings of the colonic wall

A

Diverticulum disease

104
Q

_________ = presence of diverticula

_________ = inflammation of diverticulum

A

Diverticulosis

Diverticulitis

105
Q

Dietary interventions for Diverticular Disease

A

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
Q

How is chronic pancreatitis/pancreatic insufficiency characterized?

A

Exocrine dysfunction (digestive enzyme deficiency) —> protein and fat malabsorption

Risk of fat-soluble vitamin deficiencies (A, D, E, K)

107
Q

Dietary interventions for chronic pancreatitis/pancreatic insufficiency

A

Dietary fat restriction

Consider pancreatic enzyme replacement therapy

108
Q

What are the different causes of Iron deficiency?

A

BLOOD LOSS

Celiac

H. pylori

Roux-en-Y gastric bypass

PPI use

109
Q

Who is most at risk for B12 deficiency?

A 
Vegans
Roux-en-Y gastric bypass patients
Pernicious anemia
Terminal ileum CD or TI resection
Celiac
Chronic pancreatitis/pancreatic insufficiency
Metformin
110
Q

What is the Mediterranean diet?

A

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
Q

What is the DASH diet?

A

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
Q

Nutrition therapy goals for diabetics should be aimed at optimizing…

A

“ABC”

A1C
BP
Cholesterol

113
Q

For diabetics, it’s important to make sure carbohydrates account for no more than _____% of caloric intake

A

45%

114
Q

How does renal disease affect nutrition?

A

Poor excretion can lead to sodium and fluid retention, hyperkalemia, and hyperphosphatemia

115
Q

What are the main dietary interventions in renal disease?

A

Individualized protein, Na, K, PO4, Ca intake (dependent on CKD stage/GFR)

DASH Diet

Phosphate binders

Consult dietitian trained in renal nutrition

116
Q

________ consistency is important to maintain for patients on Coumadin

A

Vitamin K

Don’t have to eliminate green leafy veggies but eat a consistent amount each day

117
Q

What food needs to be avoided by patients on statins?

A

Grapefruit juice

118
Q

Patients taking MAOIs should avoid ______ containing foods

A

Tyramine

Chocolate, aged and mature cheeses, smoked and aged meats, hot dogs

119
Q

Potential drug-nutrient implications:

ACE-I/ARBs

A

Hyperkalemia

120
Q

Potential drug-nutrient implications:

Diuretics

A

Hypo Na, K, Mg

121
Q

Potential drug-nutrient implications:

Cholestyramine

A

Fat soluble vitamins

122
Q

Potential drug-nutrient implications:

Sulfasalazine, methotrexate

A

Folic acid deficiency

123
Q

Potential drug-nutrient implications:

Isoniazid

A

Vitamin B6

124
Q

Potential drug-nutrient implications:

Metformin

A

Vitamin B12

125
Q

Potential drug-nutrient implications:

Coumadin

A

Vitamin K consistency

126
Q

Potential drug-nutrient implications:

Statins

A

Grapefruit juice

Clin Med III Unit I (6 decks)

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