Domain 2 Flashcards
cardiac cachexia
unintended wt loss, blood backs up into liver + intestines, causes nausea and decreased appetite
arginine and glutamine
low sodium, low saturated fat, low cholesterol, high calorie
DASH diet
low fat dairy, poultry, fish, mod sodium, limit alcohol, decrease sweets, calcium (not supplements), whole grains, fruits, veg
ischemia
deficiency of blood due to artery obstruction
temporary
Subjective Global Assessment
screening tool
history, intake, GI symptoms, functional capacity, physical appearance, edema, wt change
NSI
nutrition screening initiative
for the elderly >65yo
amputations adjusted IBW
(100-%amp)/100 x IBW
entire leg=16%
low leg w foot= 6%
arm=5%
forearm w hand= 2.3%
spinal cord injury energy needs
quadriplegic reduce by 10-15% table wt
paraplegic reduce by 5-10% table wt
triceps skinfold thickness
measures body fat reserves
measures caloric reserves
arm muscle area
measures skeletal muscle mass (somatic protein)
important to measure in growing children
waist circumference
> 40 for M or >35 for F risk factor for disease w BMI >25
best for risk factor, central adiposity
waist to hip ratio
> 1 for M or >0.8 for F
indicative of android obesity, diseases
TANF
temporary assistance for needy families
UHHS, state provided
200% poverty line, not receiving cash assistance
child care, transportation, mental health counseling, child abuse prevention, etc
NHANES III
repeated survey, health of Americans
adults >65yo
CSFP
Commodity Supplemental Food Program
USDA
administered by state health agencies
low income women (post partum, BF, pregnant), infants, children up to 6yo, some elderly, some @ nutrition risk
monthly commodity canned or packaged foods
TEFAP
the emergency food assistance program
USDA
supplements diets of low income households
quarterly distributions of commodity foods
NSLP
national school lunch program
USDA
lunch= 1/3 RDA for protein, A, C, Fe, Ca
entitlement program
NSBP
national school breakfast program
USDA
1/4 RDA for pro, vit A, C, Fe Ca
entitlement program
CACFP
child and adult care food program
USDA
reimburse operators of public and nonprofit food service programs
provides commodity foods, ed materials
same eligibility as NSLP
NETP
nutrition education and training program
amendment to school lunch act
provides nutrition education training to teachers and food service staff
Medicare Part A vs B
health insurance for >65 yo
Part A= hospital insurance
Part B= optional insurance
OAA
older americans act nutrition program
UHHS
all >60yo + spouse, regardless of income
provide 1/3 RDA, 1 hot meal x5day/wk
congregate meals= rural
home delivered=homebound, Meals on Wheels
ulcer
causes: H.pylori
txt: antacid, antibiotics
meds: Cimetidine, Ranitidine (h2 blocker)
diet: avoid late night snacks, avoid cayenne, black pepper, chili powder, caffeine, alcohol
hiatal hernia
small, bland feedings, avoid late night snacks; avoid caffeine, chili powder, alcohol
dumping syndrome
causes: post gastrectomy (billroth 1, 2)
sxs: cramps, weakness, dizziness, sweating, rapid pulse; alimentary hypoglycemia; possible steatorrhea
deficiencies: Ca (no absorption), Iron (no acid), B12 (no intrinsic factor, bacterial overgrowth), folate (low iron, no B12)
txt: frequent, small feeding, avoid hypotonic sweets, no fluids w meals, 50-60% complex CHO, pro w each meal, mod fat, B12 injections, avoid lactose
alimentary hypoglycemia
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)
gastroparesis
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
tropical sprue vs. non tropical sprue
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
soluble fibers
absorb water, delays digestion
pectins, gums
fruits, vegetables, legumes, oats, barely, carrots, apples, citrus fruits, strawberries, bananas
Crohn’s disease
IBD
affects terminal ileum
wt loss, anorexia, diarrhea, megaloblastic anemia (B12 deficiency), iron def anemia
txt during flares: bowel rest, parental nutrition, minimal residue
IBD diet txt
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
UC
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
chronic nonspecific infantile diarrhea
40% calories as fat, balanced with limited fluids, restrict/dilute fruit juices (apple, grape)
steatorrhea
stool fat >7g (normal is 2-5g)
high pro, high complex CHO, fat as tolerated, MCT, fat soluble vit
ileal resection
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)
SBS nutrition care
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
jaundice
bile ducts obstructed
hepatitis
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
cirrhosis
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)
Wernicke-Korsakoff syndrome
thiamine deficiency as a result of alcoholism-> liver disease
ESLD
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
asterisix
flapping, involuntary jerking
sign of impending coma due to ESRD (portal systemic encephalopathy)
cholecystitis
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
pancreatitis
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
cystic fibrosis
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
angina pectoris
chest pain
due to atherosclerosis
optimal cholesterol levels
LDL <100
Total cholesterol <200
HDL >40 (M), >50 (F); >60 (HIGH)
TG <150
HTN management
DASH diet, salt restriction, weight loss, physical activity, less alcohol, thiazide diuretics (but cause low K)
management of dyslipidemia, metabolic syndrome
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
heart failure
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
long acting insulin
basal (background)
DLGL
Determir (Levemir), Glargine (Lantus)
onset 2-4 hrs, duration 18-24 hrs
intermediate acting insulin
basal (background)
NPH (Humulin N, Novolin N, ReliOn)
onset 2-4 hrs, duration 10-16 hrs
need bedtime snack of cho + pro
Addison’s disease
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
Gout
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)
Goiter txt
iodized salt
avoid goitrogens (cabbage family)
galactosemia
missing enzyme, cant metab galactose or lactose
diet: avoid galactose and lactose, NO organ meats, dairy, MSG extenders (pure MSG ok)
MCH
mean corpuscular Hgb
color of RBCs
normal= 27-32
MCV
mean corpuscular volume
size of RBC
normal= 80-95
xerostomia
dry mouth
moisten foods with gravies, sauces, water/milk
fever BMR
increases by 7% for each degree
reg temp= 98.6F
hormones for renal function
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
labs in renal disease
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
renal disease leads to
anemia (decreased erythropoietin)
upset in BP
decreased activation of Vit D (kidney not producing active form)
renal calculi
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
acute renal failure/injury
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
nephrosis
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)
CKD
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
ESRD
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
chronic renal failure
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
purine foods
broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel
