Domain II: Nutrition Care for Individuals and Groups Flashcards
1
Q
SGA
A
Subjective Global Assessment; Nutrition risk screening tool; history, intake, GI systems, functional capacity, physical appearance, edema, weight change
2
Q
MNA
A
Mini Nutritional Assessment; evaluates independence, medications, number of of full meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding. used for individuals 65 years and older
3
Q
NSI
A
Nutritional Screening Initiative; elderly
4
Q
GNRI
A
Geriatric nutrition risk index; serum albumin, weight changes
5
Q
MST
A
Malnutrition Screening Tool; acute hospitalized adult population, recent weight loss, recent poor dietary intake
6
Q
NRS
A
Nutrition Risk Screening; medical-surgical hospitalized, % weight loss, BMI, intake, > 70 years
7
Q
MUST
A
Malnutrition Universal Screening Tool; BMI, unintentional weight loss, effect of acute disease on intake for more than 5 days
8
Q
IBW Men
A
106 + (6 x additional inches over 5 feet)
9
Q
IBW Women
A
100 + (5 x additional inches above 5 feet)
10
Q
% weight change
A
(UBW-ABW)/UBW x 100 %
11
Q
Percent Weight Loss
A
1-2% weight loss (1 week)
5% weight loss (1 month)
7.5% weight loss (3 months)
10% weight loss (6 months)
12
Q
Arm muscle area (AMA)
A
good indication of skeletal muscle or somatic protein (important in growing children, protein-energy malnutrition)
13
Q
BMI Healthy :(
A
18.5-24.9 kg/m2
14
Q
Waist to Hip Ratios indicative of android obesity and increased risk for obesity-related diseases (diabetes, hypertension)
A
1.0 Men; 0.8 Women
15
Q
Three examination techniques for the nutrition-focused physical exam
A
inspection, palpation, auscultation
16
Q
What is mainly used in diagnosing anemia?
A
serum transferrin
17
Q
Activity Factor to Know
A
- 2 - sedentary
- 3 - active
- 5 - stressed
18
Q
Megestrol Acetate
A
appetite stimulant
19
Q
oral contraceptives
A
decrease folate levels
20
Q
loop diuretics
A
deplete thiamin, potassium, magnesium, calcium, and sodium
21
Q
Thiazide diuretics
A
decrease potassium and magnesium; absorb calcium
22
Q
Methotrexate
A
Chemotherapeutic; decreases folate
23
Q
Medicine: Lithium carbonate
A
antidepressant; increases appetite and leads to weight gain; maintain consistent caffeine and sodium intake. Restricting caffeine and sodium leads to lithium retention which is toxic. Diets over 2 g of sodium may be needed.
24
Q
Warfarin, anticoagulants
A
Antagonizes vitamin K (consistent intake is essential)
25
propofol
administered in oil; 1.1 kcal/mL; check TG levels
26
Cyclosporine
Immunosuppressant; may lead to hyperlipidemia, hyperglycemia, hyperkalemia, hypertension
27
Isoniazid
treats TB; depletes pyridoxine, peripheral neuropathy.
| Don't take with food, interferes with vitamin D, calcium supplement may be needed
28
Elavil
antidepressant, may lead to weight gain
29
Vitamin B6 and protein
decreases effect of levodopa. Take in the morning with little protein and have heavier protein meal at night
30
Medicine: Tyramine
may lead to hypertension if taken with MAOI; restrict aged and fermented foods
31
HRA
Health Risk Appraisal; survey categorizing a populations' general health status
32
Infant mortality rate refers to
infant deaths under 1 year of age, expressed as the number of deaths per 1000 live births
33
incidence
number of NEW cases of disease over a period of time/total number of people at risk x 100,000 (tells you the risk of developing disease)
34
Prevelance
total number of people with a disease during a period of time/average number of people x 100,000
35
nutrition survey
examination of a population group at a particular point of time, determines prevalence of condition or characteristic at a specific time
36
nutritional surveillance
Continuous collection of data, detects changes in trends, identifies needs and what kind of intervention is needed
37
nutrition surveillance based on
height, weight, hematocrit, hemoglobin, serum cholesterol
38
Both the BRFSS and YRBSS
can monitor changes in health risk behaviors over time and can better target health promotion efforts to populations most at risk
39
PedNSS
Pediatric Nutrition Surveillance System
follows low-income high risk children, birth-17 years with emphasis on birth-5years
United States Department of Health and Human Services
40
PNSS
Pregnancy Nutrition Surveillance System
low income, high risk pregnant women
United Stated Department of Health and human Services
41
NNMRRP
National Nutrition Monitoring and Related Research Program
jointly run by USDHHS and USDA
includes all date collection and analysis activities of the federal government related to measuring health and nutrition status, food consumption, attitudes about diet and health
42
NHANES
National Health and Nutrition Examination Survey
evaluates clinical, chemical, anthropometric, nutrition data
CDC
WWEIA or (NFNS) dietary component of NHANES
43
NFCS
National Food Consumption Surveys
USDA
obtain food intake on individuals and total households in the US
protein, calcium, iron, thiamin, riboflavin, vitamins C, A
44
BRFSS
Behavior Risk Factor Surveillance System
USDHHS
adults 18 +
telephone interviews collect info on Height, weight, smoking, alcohol use, food frequency for fat, fruits and vegetables, preventable health problems, diabetes
45
YRBSS
Youth Risk Behavior Surveillance System
grades 9-12
smoking alcohol use, weight control, exercise, eating habits
46
Health and Diet Survey
FDA USDHHS
telephone survey on random individuals
tracks self-perception of relative nutrient intake levels, use of food labels, knowledge of fats and cholesterol, prevalence of supplement use, awareness of diet and disease
47
TANF
Temporary Assistance for Needy Families
| state determines the eligibility and benefits and the services provided
48
CSFP
Commodity Supplemental Food Program
administered by state health agencies
monthly commodity canned/packaged foods
assists low income women (pregnant, breastfeeding, postpartum), infants and children up to 6 years
49
NSLP
National School Lunch Program
USDA Food and Nutrition Service
entitlement program
provides 1/3 of the recommended intake for protein, vitamins A and C, iron, calcium
50
NSBP
National School Breakfast Program
entitlement program
provides 1/4 of the recommended intake for protein, vitamins A and C, iron, calcium
51
WIC
Women Infants and Children Supplemental Nutrition Program
for pregnant, postpartum, breastfeeding women; infants and children up to age of 5
provides food, education, and referrals
NOT ENTITLEMENT PROGRAM
52
EFNEP
Expanded Food and Nutrition Education Program
USDA
provides grants to universities that assist in community development
53
SNAP
Supplemental Nutrition Assistance Program
largest food assistance program
entitlement program (income based)
54
CHIP
Children's Health Insurance Program
under social security act
expands health care to uninsured children whose families earn too much income to qualify for Medicaid but too little to afford private coverage
55
Ulcers are mostly caused by
H. pyloribacteria
56
Treatment and diet recommended for Ulcers
antiacids, antibiotics; well-balanced diet with foods that do no worsen symptoms, avoid late night snacks
57
What are the symptoms of Dumping Syndrome
cramps, rapid pulse, weakness, perspiration, dissiness
58
Dumping Syndrome occurs
when rapidly hydrolyzed carbohydrates enter the jejunum and water is drawn in to achieve osmotic balance causing blood pressure to drop and signs of cardiac insufficiency to appear
59
Explain Reactive/Alimentary Hypoglycemia
Two hours after rapidly hydrolyzed carbohydrates are ingested. Blood sugar rises rapidly caused overstimulation of insulin, causing a drop in blood sugar below fasting.
60
Billroth I
gastroduodenostomy
61
Billroth II
gastrojejunostomy; food bypasses duodenum
we see a decrease in pancreatic enzyme secretion (steatorrhea)
decrease of calcium and iron absorption
62
Tropical Sprue
may be bacterial, viral or parasitic infection
Chronic GI disease characterized by intestinal lesions
diarrhea, malnutrition, deficiencies in B12 and folate due to decreased HCL and intrinsic factor
63
Non-topical sprue
```
Celiac disease (reaction to gliadin) that affects jejunum and ileum
leads to malabsorption (leads to loss of fat-soluble vitamins), macrocytic anemia, weight loss, diarrhea, steatorrhea, iron-deficiency anemia
```
64
Diverticulosis
Presence of diverticula (small sacs that protrude through the intestinal sac)
HIGH FIBER DIET
65
Diverticulittis
when diverticula become inflames
| clear liquids, low-residue or elemental diet -> gradually return to high fiber
66
Oat bran and soluble fibers
decrease serum cholesterol by binding bile acids converting more cholesterol into fiber
67
Soluble fibers
delay gastric emptying
| fruits, vegetables, legumes, oats, barley, carrots, apples, citrus fruits, strawberries bananas
68
Inflammatory Bowel Disease
Crohn's Disease, Ulcerative Colitis
69
Crohn's Disease
affects terminal ileum, weight loss, anorexia, diarrhea
| B12 deficiency leads to megaloblastic anemia
70
Ulcerative Colitis
disease of the colon
| chronic bloody diarrhea, electrolyte disturbance
71
Lactose Tolerant Test
If blood glucose rises < 24 mg/dL above fasting after oral dose of lactose -> intolerant
72
Short Bowel Syndrome
consequences associated with significant resections of the small intestine
73
What areas lost are particularly concerning in SBS
ileum (distal 1/3), ileocecal valve, colon
74
Ileal resection
Distal (B12)
leads to fat malabsorption because bile salts are not recycled
Decrease fat intake, use MCT, supplement fat soluble vitamins, Ca, MG, Zn
75
Elevated liver enzyme levels indicate
liver tissue damage
76
Major symptom of hepatitis
anorexia
77
Nutrition Management of Hepatitis
50-55% CHO
1-1.2 g/kg protein
increase protein intake provides lipoproteins which remove fat form liver and prevent fatty liver disease
small, frequent meals
78
Ascites occurs when
blood can't leave liver, connective tissue overgrowth blocks blood flow out of the liver into the vena cava
(sodium, water retention)
79
What occurs when blood can't enter the liver
esophageal varices
80
MNT for Cirrhosis
```
high calorie
high protein
moderate fat
low fiber if varices is present
low sodium is edema or ascites is present
```
81
Long term thiamin deficiency in alcoholic liver disease may lead to
Wernicke-Korsakoff Syndrome
82
MNT for Hepatic Failure ESLD
if not comatose, moderate to high levels of protein (1-1.5 g/kg)
30-35 calories/kg 30-35% calories from fat (MCT if needed)
adding BCAA in diet MAY alter the ratio of AA and BCAA - reduce symptoms
83
Following a cholecystectomy,
bile is secreted directly from the liver to the intestines
84
A common characteristic of pancreatitis is
premature activation of enzymes within pancreas leading to auto-digestion
85
Enteral feedings in acute pancreatitis
may be tolerated in the jejunum with an elemental formula
86
Chronic pancreatitis
provide pancreatic enzymes with meals and snacks to prevent fat malabsorption
MCT's do not require pancreatic lipase
87
Cystic Fibrosis Therapy
```
high protein
high calorie
unrestricted fat
liberal salt
pancreatic enzyme therapy and supplement fat soluble vitamins (especially A and E)
```
88
What is found in red grapes that is associated with lowering blood pressure
resveratrol
89
Which lipoprotein is made in the intestine?
chylomicron
90
VLDL
transports endogenous TG from the liver to adipose cell
91
LDL
transports cholesterol from diet and liver to all cells
| small dense LDL-C associated with increased risk of HLD
92
HDL
reverse cholesterol transport
| moves cholesterol from cells to liver for excretion
93
IDL
LDL precursor
94
Metabolic Syndrome Risk Factors
```
3 or more of the following:
elevated blood pressure
elevated TG
elevated BG
elevated waist circumference
low HDL
```
95
Features of the Lifestyle Change from ATP III
```
up to 35% of calories from total fat
<7% saturated fat
5-10% PUFA
20% MUFA
<200 mg cholesterol
25-30 grams of fiber
2-3 g/day stanols and sterols
prevent weight gain
30 min moderate activity most days (expend at least 200 calories)
```
96
Vasopressin (ADH)
from hypothalamus stores in the pituitary
elevates BP
increases water reabsorption from distal and collecting tubes
97
Renin
Vasoconstrictor
secreted by glomerulus when blood volume decreases
stimulates aldosterone to increase sodium absorption and return blood pressure to normal
98
Erythropoietin
EPO
| produced by kidney, stimulates bone marrow to produce RBC
99
urine tests for renal disease
decreased glomerular filtration rate
| decreased creatinine clearance
100
blood tests for renal disease
increased BUN and creatinine
101
BUN:Cr
>20:1 - acute kidney damage (no dialysis)
| >10:1 - renal damage (may need dialysis)
102
Renal solute load
solutes excreted in 1 L urine
| mainly measures nitrogen and sodium
103
Manifestations of Renal Disease
anemia due to decreased production of erythropoietin
upset in blood pressure
decreased activation of vitamin D
104
Symptoms of Nephrosis
albuminuria, edema, malnutrition, hyperlipidemia
105
MNT for Nephrosis
```
0.8-1.0 g/kg protein
<30% fat
35 kcal/kg/day
2-3 g/day sodium restriction
calcium 1-1.5g/day and Vitamin D supplement
```
106
Anemia in CKD occurs due to
lack of production of erythropoietin by the kidney
107
When should protein intake be restricted in CKD?
Stage 4 GF 15-29
108
Chronic Renal Failure HD calorie and protein needs
1.2 g/kg body weight SBW
< 60 years 35 kcal/kg
> 60 years or obese 30-35 kcal.kg
109
Chronic Renal Failure PD calorie and protein needs
1.2-1.3 g/kg body weight
< 60 years 35 kcal/kg
> 60 years 30-25 kcal/kg
110
Diabetes Diagnosis
A1c 6.5% or greater (normal less than 5.7%)
FPG 126 mg/dL (normal < 100 mg/dL)
GTT > 200 mg/dL (normall < 140 mg/dL)
symptoms of diabetes plus casual plasma glucose > 200 mg/dL
111
Glycosylated Hemoglobin
measures % of hemoglobin with glucose attached
| goal for diabetics < 7%
112
Risk factors for GDM
BMI > 30, history of GDM
| 50 g oral glucose load between 24-28 weeks ( > 140 mg/dL -> needs further testing)
113
Bolus Insulin
pre-meal
rapid acting - take 5-15 min before eating; duration 4 hours
short-acting - take 30-45 min before meal; duration 3-6 hours
114
Basal Insulin
background
intermediate-acting: onset 2-4 hours, duration 10-16 hours (requires bedtime snack with CHO and protein)
long-acting: onset 2-4 hours, duration 18-24 hours
115
Explain the Dawn Phenomenon
natural increase in early morning blood glucose and insulin requirements due to increased glucose production in the liver after overnight fast (increased need for insulin at dawn)
116
Symptoms of DKA and treatment
dehydration due to polyuria, increased pulse
| treatment: insulin and rehydration
117
Symptoms and treatment of hypoglycemia
hunger, shakiness, slow pulse, sweating
| treatment: 15g rapid acting CHO, recheck after 15 minutes, repeat if it is still < 70 mg/dL
118
Reactive Hypoglycemia
goal is to prevent marked rise in blood glucose that would stimulate more insulin
avoid simple sugars, 5-6 meals / day, spread intake of CHO throughout the day, protein at RDA levels
119
Addison's Disease
due to adrenal cortex insufficiency
hypoglycemia, dehydration, tissue wasting, weight loss
diet: high protein, high CHO, liberal in salt, frequent meals
120
Hyperparathyroidism
elevated T3 and T4
| increased BMR leading to weight loss
121
Hypoparathyroidism
T4 low, T3 low or normal
| decreased BMR leading to weight gain
122
Galactosemia
due to missing enzyme that would have converted galactose into glucose
treated solely by diet, galactose and lactose free
123
Urea Cycle Defects
protein restriction to lower ammonia
124
Phenylketonuria
missing enzyme that coverts phenylalanine into tyrosine -> accumulation leads to poor intellectual function
restrict PHE phenylalanine
low protein high CHO leads to dental caries
125
Glycogen Storage Disease
Deficiency of glucose-6-phosphatase; impairs glyconeogenesis and gycogenolysis
hypoglycemia since liver cant convert glycogen to glucose
126
Treatment for Homocystinurias
doses of folate, pyridoxine, B12
127
Ketogenic Diet
4 grams of fat: 1 gram of non fat
| need supplements of Ca, D, folate, B6, B12
128
Spastic Form of Cerebral Palsy
difficult, stiff movement; limited activity; obese
| low calorie, high fluid, high fiber
129
Non-spastic form of cerebral palsy
involuntary wormlike movement, constant irregular motions leading to weight loss
high calorie, high protein diet; finger foods
130
Pressure ulcers MNT
30-40 kcal/kg
1. 2-1.5 g/kg protein Stage I and II
1. 5-2 g/kg Stages III and IV
131
Microcytic Anemia
small pale cells due to iron deficiency
| all labs are low
132
Macrocytic Anemia
few large cells filled with hemoglobin
due to deficiency in B12 or folate (Schilling Test)
high MCV and MCH
133
Normal MCV and MCH
MCV - 80-95
| MCH - 27-32
134
Fever
BMR increase 7% for each degree rise in temperature
| normal 98.6F
135
Burns Goals
1. replace fluid and electrolytes lost
2. recovery period increase calories
3. secondary period 1.5 - 2 g/kg protein
136
Results of physiologic trauma
hyperglycemia, hyperinsulinemia, little to no ketosis, increase glucagon
137
Iatrogenic Malnutrition
protein-calorie malnutrition brought by treatment, hospital, medications
138
Pediatric Overweight Interventions
Weight maintenance
139
Bariatric Surgery Treatment
Class III Obesity with BMI 40 or greater
| BMI 35 or greater with co-morbidities
140
Achalasia
disorder of lower esophageal sphincter causing dysphagia
141
Pregnancy-induced hypertension
sodium restriction is NOT recommended
142
Elemental Formulas
chemically defined, pre-digested proteins or amino acids, used with malabsorption
used with compromised GI function, inability to digest and absorb
143
Postpyloric transpyloric
passed by pyloric valve in stomach
| used in comatose patients or ones with no gag reflex
144
IV Dextrose
3.4 kcal/g
| kcal = mL x % x 3.4
145
10% IVFE
1.1 kcal/mL
146
20% IVFE
2.0 kcal/mL
147
Common Diagnosis and Problems for Parenteral Nutrition
Altered GI Function
Impaired nutrient utilization
Malnourished patients with expected GI dysfunction
Critically ill patients that are hemodynamically stable with paralytic Ileus , acute GI bleeds, bowel obstruction
peritonitis, fistulas
critical care patients if hyper metabolism is expected to last more than 5 days when EN is not possible
148
PN Concerns
translocation of bacteria
| bacteria leave the gut and travel to bloodstream causing sepsis
149
Transition Feeds
1. Introduce EN full strength formula at 30-40 mL/hr
2. begin tapering PN feeds when EN provide 33%-50% kcal
3. decrease PN as you increase EN by 25-30 mL/hour increments every 8-24 hours
4. 60% EN - discontinue PN
150
Refeeding Syndrome
occurs after aggressive administration of nutrition to malnourished
starved cells take up nutrients causing phosphorus and potassium to shit to the intracellular compartments leading to hypokalemia, hypophosphotemia, and hypomagnesmia
151
Integrative Medicine
combines evidence-based complementary therapies with conventional treatments to address the social, psychological, and spiritual aspects of health and illness
152
Functional Medicine
addresses the whole person, not just symptoms, and looks at the underlying cause oft he disease, engaging patient and practitioner in a partnership for therapy
153
Holistic Health
views mental, physical, and spiritual aspects of life closely connected and equally important with regard to treatment approaches
154
Healthy People 2020
focuses on disease prevention by changing behaviors
155
Three Steps for Developing a Program
1. develop mission statement
2. set goals
3. set objectives
156
Four P's or Marketing
product, place, price, promotion
157
Community Needs Assessment Process
Determining the community’s health and nutritional needs
Establishing places and/or groups where nutritional needs are not being met
Pinpointing gaps and barriers to services
Distinguishing priorities and selecting resources that exist to deal with the problem
158
Protein Amount in CHO Exchange List
```
Starch/Bread = 3 g
Milk = 8 g
Meat = 7 g
```
159
CHO Amounts Non-Starchy Vegetables
5 g (3 servings = 1 CHO serving)
160
Fat Amount in CHO Exchange List
fat free low fat = 0-3 g
reduced fat = 5 g
full fat = 8 g
