Domain 2 Flashcards

Question

alimentary hypoglycemia

Answer 1

rapid hydrolyzed cho enters jejunum -> water drawn in (osmotic pressure) ->BP drops, cardiac insufficiency -> 2 hrs later CHO absorbed quickly -> BG rises, overproduction of insulin -> low BG (below fasting)

Answer 2

delayed gastric emptying due to diabetes (gastric neuropathy), surgery, viral infections, obstructions txt: prokinetics (erythromyacin, metoclopramide); small frequent meals, pureed foods, avoid fiber, avoid high fat

Answer 3

tropical- caused by infection, mucosal and villi destroyed; diarrhea, malnutrition, low B12 & folate txt: antibiotics, high cal, high pro, IM B12/B9 non tropical- celiac disease, malabsorption, low in fat soluble vit, macrocytic anemia, wt loss, diarrhea, steatorrhea, iron def. anemia txt: gluten free diet

Answer 4

absorb water, delays digestion pectins, gums fruits, vegetables, legumes, oats, barely, carrots, apples, citrus fruits, strawberries, bananas

Answer 5

IBD affects terminal ileum wt loss, anorexia, diarrhea, megaloblastic anemia (B12 deficiency), iron def anemia txt during flares: bowel rest, parental nutrition, minimal residue

Answer 6

during remission: high fiber (peristalsis) energy needs according to current BMI, avoid fat if steatorrhea, vitamin supps, MCT oil, watch lactose, frequent feedings, high fat

Answer 7

ulcerative colitis IBD affects colon, begins in rectum chronic bloody diarrhea, wt loss, anorexia, E-lyte disturbance, dehydration, anemia, fever, neg N balance txt during flare: elemental diet (liquid formulas) to minimize fecal volume

Answer 8

40% calories as fat, balanced with limited fluids, restrict/dilute fruit juices (apple, grape)

Answer 9

stool fat >7g (normal is 2-5g) high pro, high complex CHO, fat as tolerated, MCT, fat soluble vit

Answer 10

distal= B12, bile salt absorption issue excessive water loss via stool (+1 L/day than ostomy output) if ileum cant recycle bile salts-> malabsorption of fats/fat vits-> lead to "soaps" (fats + Mg, Ca, Zn)-> renal oxalate stones formed -> increased colonic motility (fluid and E-lyte sectection)

Answer 11

TPN initially, to restore nutrition status EN early, continuous drip, increase over time ileal= limit fat, MCT, vit supps (fat soluble, Ca, Mg, Zn, IM B12) jejunal= normal macro balance, avoid lactose, oxalates, concentrated sweets, vit/min supps

Answer 12

bile ducts obstructed

Answer 13

acute, viral Hep A: fecal oral transmission (food) Hep B: sexually transmitted Hep C: blood to blood contact sxs: inflammation, necrosis, jaundice, anorexia, nausea, fatigue txt: increase fluids, encourage coffee (antioxidant), multivit w B, C, K, Zn, small frequent feedings diet: 50-55% CHO (spare pro, liver glycogen), 1-1.2 g/kg pro, mod-high fat

Answer 14

chronic liver disease compensated or de-compensated, alcohol induced (high TG) sxs: low LBM, poor appetite, nausea, early satiety, encephalopathy, ascites (low albumin, Na, high fluids), esophageal varices diet: 25-40kcal/kg cal, high protein 1.2-1.5g/kg, mod to low fat 20-45% cal low fiber if varices low sodium, fluid restriction (1-1.5L/day) B Complex vit (Zn, Folate, Thiamine) check for Vit D (other fat soluble vit)

Answer 15

thiamine deficiency as a result of alcoholism-> liver disease

Answer 16

end stage liver disease, hepatic failure live cant turn ammonia to urea- >NH3 accumulates sxs: apathy, drowsiness, confusion, coma liver function <25% if not comatose: 30-35cal/kg, 30-35% fat, 1-1.5 g/kg pro low sodium if ascites, vit/min supps

Answer 17

flapping, involuntary jerking sign of impending coma due to ESRD (portal systemic encephalopathy)

Answer 18

inflammation of gallbladder gallstones (cholelithiasis) get stuck-> lead to inflammation cause: excess cholesterol (excess bile made) txt: cholecystectomy (removal of gallbladder) diet: 30-35 g/kg fat (low fat for acute), 25-30% of cal from fat for chronic post removal- limit fat until liver adjusts, add fiber slowly to help with BM

Answer 19

inflammation of pancreas, inflammation, cellular exudate and fat necrosis causes: blockage or reflux of ductal system, premature activation of enzymes within pancreas-> autodigestion sxs: weight loss w reg po intake, stinky BM, steatorrhea txt for acute: withhold feeding, IV hydration; increase slowly with low fat meals, elemental EN into jejunum txt for chronic: PERT (may need antacids to help due to no bicarb); MCTs; max fat for wt gain; if malabsorption-> fat soluble vits in water; parenteral B12

Answer 20

thick mucus that obstructs exocrine glands/ducts COPD, EPI, high perspiration E-lyte levels, malabsorption txt: PERT, high pro, high cal, unrestricted fat, high salt (+2-4 g/day); supp vit A&E failure to grow= 110-200% normal EEE

Answer 21

chest pain due to atherosclerosis

Answer 22

LDL <100 Total cholesterol <200 HDL >40 (M), >50 (F); >60 (HIGH) TG <150

Answer 23

DASH diet, salt restriction, weight loss, physical activity, less alcohol, thiazide diuretics (but cause low K)

Answer 24

Therapeutic lifestyle changes from ATP 3 <35% cal from total fat <7% sat fat, 5-10% PUFA, 20% MUFA, <200 mg cholesterol 2-3 g stanols/sterols 25-30 g fiber prevent wt gain, achieve DBM physical activity= 30 min most days

Answer 25

sxs: edema, dyspnea increase heart contraction strength 2-3 g sodium, DASH diet 1-2 L fluid 1-1.4 g/kg pro ABW thiamine status (low w loop diuretics) Folate, Mg, MV w B12 regular physical activity

Answer 26

basal (background) DLGL Determir (Levemir), Glargine (Lantus) onset 2-4 hrs, duration 18-24 hrs

Answer 27

basal (background) NPH (Humulin N, Novolin N, ReliOn) onset 2-4 hrs, duration 10-16 hrs need bedtime snack of cho + pro

Answer 28

adrenal cortex insufficiency decrease cortisol (glycogen depletion, hypoglycemia), aldosterone (sodium loss, potassium retention, dehydration), androgenic (tissue wasting, weight loss) diet= high cal, frequent feedings, high salt

Answer 29

disorder of purine metabolism increased uric acid -> deposits in joins -> pain, swelling txt: wt reduction, mod pro, liberal cho, low to mod fat, decrease alcohol, liberal fluid, avoid purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel)

Answer 30

iodized salt avoid goitrogens (cabbage family)

Answer 31

missing enzyme, cant metab galactose or lactose diet: avoid galactose and lactose, NO organ meats, dairy, MSG extenders (pure MSG ok)

Answer 32

mean corpuscular Hgb color of RBCs normal= 27-32

Answer 33

mean corpuscular volume size of RBC normal= 80-95

Answer 34

dry mouth moisten foods with gravies, sauces, water/milk

Answer 35

increases by 7% for each degree reg temp= 98.6F

Answer 36

vasopressin/ADH (antidiuretic hormone) increase BP (increases water reabsorption) from hypothalamus, stored in pituitary renin: vasoconstrictor increase BP from kidney when blood volume decreases stimulates aldosterone-> increase Na absorption erythropoietin: stimulates bone marrow to produce RBC, from kidney

Answer 37

decreased glomerular filtration rate, Cr clearance increased serum creatinine, BUN renal solute load- high in N and Na pre-kidney damage: BUN:Cr >20:1 full renal damage: BUN:Cr <10:1

Answer 38

anemia (decreased erythropoietin) upset in BP decreased activation of Vit D (kidney not producing active form)

Answer 39

kidney stones diet rec: 1.5-2L water to dilute urine, Ca to bind oxalate, low oxalate diet prevent alkaline stones: (acidic foods) meat, eggs, seafood, cheese, corn, oats, rye prevent acidic stones: (alkaline foods) vegetables, fruits, brown sugar, molasses

Answer 40

sudden shutdown; due to burns, accident, obstruction, severe dehydration decreased GFR, oliguria (<500ml urine), azotemia (high urea in blood) at first= IV glucose, lipids, protein 1-1.3g/kg *noncatabolic w/o dialysis 1.2-1.5g/kg if catabolic/dialysis 25-40kcal/kg if hypermetabolic needs increase as function declines 2-3g Na, replace loss in diuretic 8-15 mg Phos (LOW, may need binders) 2-3g K (adjust per output/dialysis/serum) fluids= previous day output +500ml

Answer 41

nephrotic syndrome membrane in glomerulus defected-> protein can exit albuminuria, edema, malnutrition, hyperlipidemia increased making/decreased clearance of VLDL pro= 0.8/1g/kg (50% from HBV) <30% fat, low sat fat, 200mg chol 35kcal/kg/day 2-3g Na Ca 1-1.5g/day, supp Vit D Fluid restriction if edema Abnormal Fe, Cu, Zn, Ca (due to pro loss)

Answer 42

chronic kidney disease anorexia, weakness, wt loss, N/V anemia (no more erythropoietin) 25-35kcal/kg <2400mg Na GFR 60-90: 0.8-1.4g/kg pro; phos to maintain serum levels GFR 15-60: 0.6-0.8 g/kg pro; phos 800-1000mg/day or 10-12mg/g pro K unrestricted unless high serum, low urine output fluid unrestricted

Answer 43

end stage renal disease BUN >100mg/dl, Cr 10-12mg/dl retention of N metabolites Giovanetti diet= 20 g pro, increase cal, control edema, prevent deficiencies

Answer 44

35kcal/kg (30-35kcal/kg if obese or >60yo) 2 g Ca max 800-1000 mg total phos Vit C, B6, Folate, B12, Zn, Fe, Vit D glucose lost during dialysis hemodialysis 1.2g/kg pro (50% HBV) >1L fluid output= 2-4g Na + 2L fluid <1L fluid output= 2g Na +1-1.5L or 1L (anuria) Potassium 2-3 g peritoneal dialysis 1.2-1.3g/kg pro (50% HBV) 2-3 g Na 1-3 L fluid, depending on output Potassium 2-4 g *unrestricted may need extra thiamine

Answer 45

broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel