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RD Exam > Domain II: Nutrition Care for Individuals and Groups > Flashcards

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

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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

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3
Q

NSI

A

Nutritional Screening Initiative; elderly

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4
Q

GNRI

A

Geriatric nutrition risk index; serum albumin, weight changes

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5
Q

MST

A

Malnutrition Screening Tool; acute hospitalized adult population, recent weight loss, recent poor dietary intake

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6
Q

NRS

A

Nutrition Risk Screening; medical-surgical hospitalized, % weight loss, BMI, intake, > 70 years

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7
Q

MUST

A

Malnutrition Universal Screening Tool; BMI, unintentional weight loss, effect of acute disease on intake for more than 5 days

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8
Q

IBW Men

A

106 + (6 x additional inches over 5 feet)

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9
Q

IBW Women

A

100 + (5 x additional inches above 5 feet)

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10
Q

% weight change

A

(UBW-ABW)/UBW x 100 %

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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)

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12
Q

Arm muscle area (AMA)

A

good indication of skeletal muscle or somatic protein (important in growing children, protein-energy malnutrition)

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13
Q

BMI Healthy :(

A

18.5-24.9 kg/m2

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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

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15
Q

Three examination techniques for the nutrition-focused physical exam

A

inspection, palpation, auscultation

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16
Q

What is mainly used in diagnosing anemia?

A

serum transferrin

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17
Q

Activity Factor to Know

A
  1. 2 - sedentary
  2. 3 - active
  3. 5 - stressed
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18
Q

Megestrol Acetate

A

appetite stimulant

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19
Q

oral contraceptives

A

decrease folate levels

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20
Q

loop diuretics

A

deplete thiamin, potassium, magnesium, calcium, and sodium

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21
Q

Thiazide diuretics

A

decrease potassium and magnesium; absorb calcium

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22
Q

Methotrexate

A

Chemotherapeutic; decreases folate

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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.

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24
Q

Warfarin, anticoagulants

A

Antagonizes vitamin K (consistent intake is essential)

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25
Q

propofol

A

administered in oil; 1.1 kcal/mL; check TG levels

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26
Q

Cyclosporine

A

Immunosuppressant; may lead to hyperlipidemia, hyperglycemia, hyperkalemia, hypertension

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27
Q

Isoniazid

A

treats TB; depletes pyridoxine, peripheral neuropathy.

Don’t take with food, interferes with vitamin D, calcium supplement may be needed

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28
Q

Elavil

A

antidepressant, may lead to weight gain

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29
Q

Vitamin B6 and protein

A

decreases effect of levodopa. Take in the morning with little protein and have heavier protein meal at night

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30
Q

Medicine: Tyramine

A

may lead to hypertension if taken with MAOI; restrict aged and fermented foods

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31
Q

HRA

A

Health Risk Appraisal; survey categorizing a populations’ general health status

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32
Q

Infant mortality rate refers to

A

infant deaths under 1 year of age, expressed as the number of deaths per 1000 live births

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33
Q

incidence

A

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)

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34
Q

Prevelance

A

total number of people with a disease during a period of time/average number of people x 100,000

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35
Q

nutrition survey

A

examination of a population group at a particular point of time, determines prevalence of condition or characteristic at a specific time

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36
Q

nutritional surveillance

A

Continuous collection of data, detects changes in trends, identifies needs and what kind of intervention is needed

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37
Q

nutrition surveillance based on

A

height, weight, hematocrit, hemoglobin, serum cholesterol

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38
Q

Both the BRFSS and YRBSS

A

can monitor changes in health risk behaviors over time and can better target health promotion efforts to populations most at risk

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39
Q

PedNSS

A

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

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40
Q

PNSS

A

Pregnancy Nutrition Surveillance System
low income, high risk pregnant women
United Stated Department of Health and human Services

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41
Q

NNMRRP

A

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

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42
Q

NHANES

A

National Health and Nutrition Examination Survey
evaluates clinical, chemical, anthropometric, nutrition data
CDC
WWEIA or (NFNS) dietary component of NHANES

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43
Q

NFCS

A

National Food Consumption Surveys
USDA
obtain food intake on individuals and total households in the US
protein, calcium, iron, thiamin, riboflavin, vitamins C, A

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44
Q

BRFSS

A

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

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45
Q

YRBSS

A

Youth Risk Behavior Surveillance System
grades 9-12
smoking alcohol use, weight control, exercise, eating habits

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46
Q

Health and Diet Survey

A

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

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47
Q

TANF

A

Temporary Assistance for Needy Families

state determines the eligibility and benefits and the services provided

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48
Q

CSFP

A

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

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49
Q

NSLP

A

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

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50
Q

NSBP

A

National School Breakfast Program
entitlement program
provides 1/4 of the recommended intake for protein, vitamins A and C, iron, calcium

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51
Q

WIC

A

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

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52
Q

EFNEP

A

Expanded Food and Nutrition Education Program
USDA
provides grants to universities that assist in community development

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53
Q

SNAP

A

Supplemental Nutrition Assistance Program
largest food assistance program
entitlement program (income based)

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54
Q

CHIP

A

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

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55
Q

Ulcers are mostly caused by

A

H. pyloribacteria

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56
Q

Treatment and diet recommended for Ulcers

A

antiacids, antibiotics; well-balanced diet with foods that do no worsen symptoms, avoid late night snacks

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57
Q

What are the symptoms of Dumping Syndrome

A

cramps, rapid pulse, weakness, perspiration, dissiness

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58
Q

Dumping Syndrome occurs

A

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

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59
Q

Explain Reactive/Alimentary Hypoglycemia

A

Two hours after rapidly hydrolyzed carbohydrates are ingested. Blood sugar rises rapidly caused overstimulation of insulin, causing a drop in blood sugar below fasting.

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60
Q

Billroth I

A

gastroduodenostomy

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61
Q

Billroth II

A

gastrojejunostomy; food bypasses duodenum
we see a decrease in pancreatic enzyme secretion (steatorrhea)
decrease of calcium and iron absorption

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62
Q

Tropical Sprue

A

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

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63
Q

Non-topical sprue

A 
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
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64
Q

Diverticulosis

A

Presence of diverticula (small sacs that protrude through the intestinal sac)
HIGH FIBER DIET

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65
Q

Diverticulittis

A

when diverticula become inflames

clear liquids, low-residue or elemental diet -> gradually return to high fiber

66
Q

Oat bran and soluble fibers

A

decrease serum cholesterol by binding bile acids converting more cholesterol into fiber

67
Q

Soluble fibers

A

delay gastric emptying

fruits, vegetables, legumes, oats, barley, carrots, apples, citrus fruits, strawberries bananas

68
Q

Inflammatory Bowel Disease

A

Crohn’s Disease, Ulcerative Colitis

69
Q

Crohn’s Disease

A

affects terminal ileum, weight loss, anorexia, diarrhea

B12 deficiency leads to megaloblastic anemia

70
Q

Ulcerative Colitis

A

disease of the colon

chronic bloody diarrhea, electrolyte disturbance

71
Q

Lactose Tolerant Test

A

If blood glucose rises < 24 mg/dL above fasting after oral dose of lactose -> intolerant

72
Q

Short Bowel Syndrome

A

consequences associated with significant resections of the small intestine

73
Q

What areas lost are particularly concerning in SBS

A

ileum (distal 1/3), ileocecal valve, colon

74
Q

Ileal resection

A

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
Q

Elevated liver enzyme levels indicate

A

liver tissue damage

76
Q

Major symptom of hepatitis

A

anorexia

77
Q

Nutrition Management of Hepatitis

A

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
Q

Ascites occurs when

A

blood can’t leave liver, connective tissue overgrowth blocks blood flow out of the liver into the vena cava
(sodium, water retention)

79
Q

What occurs when blood can’t enter the liver

A

esophageal varices

80
Q

MNT for Cirrhosis

A 
high calorie
high protein
moderate fat
low fiber if varices is present
low sodium is edema or ascites is present
81
Q

Long term thiamin deficiency in alcoholic liver disease may lead to

A

Wernicke-Korsakoff Syndrome

82
Q

MNT for Hepatic Failure ESLD

A

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
Q

Following a cholecystectomy,

A

bile is secreted directly from the liver to the intestines

84
Q

A common characteristic of pancreatitis is

A

premature activation of enzymes within pancreas leading to auto-digestion

85
Q

Enteral feedings in acute pancreatitis

A

may be tolerated in the jejunum with an elemental formula

86
Q

Chronic pancreatitis

A

provide pancreatic enzymes with meals and snacks to prevent fat malabsorption
MCT’s do not require pancreatic lipase

87
Q

Cystic Fibrosis Therapy

A 
high protein 
high calorie
unrestricted fat
liberal salt
pancreatic enzyme therapy and supplement fat soluble vitamins (especially A and E)
88
Q

What is found in red grapes that is associated with lowering blood pressure

A

resveratrol

89
Q

Which lipoprotein is made in the intestine?

A

chylomicron

90
Q

VLDL

A

transports endogenous TG from the liver to adipose cell

91
Q

LDL

A

transports cholesterol from diet and liver to all cells

small dense LDL-C associated with increased risk of HLD

92
Q

HDL

A

reverse cholesterol transport

moves cholesterol from cells to liver for excretion

93
Q

IDL

A

LDL precursor

94
Q

Metabolic Syndrome Risk Factors

A 
3 or more of the following: 
elevated blood pressure
elevated TG
elevated BG
elevated waist circumference 
low HDL
95
Q

Features of the Lifestyle Change from ATP III

A 
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
Q

Vasopressin (ADH)

A

from hypothalamus stores in the pituitary
elevates BP
increases water reabsorption from distal and collecting tubes

97
Q

Renin

A

Vasoconstrictor
secreted by glomerulus when blood volume decreases
stimulates aldosterone to increase sodium absorption and return blood pressure to normal

98
Q

Erythropoietin

A

EPO

produced by kidney, stimulates bone marrow to produce RBC

99
Q

urine tests for renal disease

A

decreased glomerular filtration rate

decreased creatinine clearance

100
Q

blood tests for renal disease

A

increased BUN and creatinine

101
Q

BUN:Cr

A

> 20:1 - acute kidney damage (no dialysis)

>10:1 - renal damage (may need dialysis)

102
Q

Renal solute load

A

solutes excreted in 1 L urine

mainly measures nitrogen and sodium

103
Q

Manifestations of Renal Disease

A

anemia due to decreased production of erythropoietin
upset in blood pressure
decreased activation of vitamin D

104
Q

Symptoms of Nephrosis

A

albuminuria, edema, malnutrition, hyperlipidemia

105
Q

MNT for Nephrosis

A 
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
Q

Anemia in CKD occurs due to

A

lack of production of erythropoietin by the kidney

107
Q

When should protein intake be restricted in CKD?

A

Stage 4 GF 15-29

108
Q

Chronic Renal Failure HD calorie and protein needs

A

1.2 g/kg body weight SBW
< 60 years 35 kcal/kg
> 60 years or obese 30-35 kcal.kg

109
Q

Chronic Renal Failure PD calorie and protein needs

A

1.2-1.3 g/kg body weight
< 60 years 35 kcal/kg
> 60 years 30-25 kcal/kg

110
Q

Diabetes Diagnosis

A

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
Q

Glycosylated Hemoglobin

A

measures % of hemoglobin with glucose attached

goal for diabetics < 7%

112
Q

Risk factors for GDM

A

BMI > 30, history of GDM

50 g oral glucose load between 24-28 weeks ( > 140 mg/dL -> needs further testing)

113
Q

Bolus Insulin

A

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
Q

Basal Insulin

A

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
Q

Explain the Dawn Phenomenon

A

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
Q

Symptoms of DKA and treatment

A

dehydration due to polyuria, increased pulse

treatment: insulin and rehydration

117
Q

Symptoms and treatment of hypoglycemia

A

hunger, shakiness, slow pulse, sweating

treatment: 15g rapid acting CHO, recheck after 15 minutes, repeat if it is still < 70 mg/dL

118
Q

Reactive Hypoglycemia

A

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
Q

Addison’s Disease

A

due to adrenal cortex insufficiency
hypoglycemia, dehydration, tissue wasting, weight loss
diet: high protein, high CHO, liberal in salt, frequent meals

120
Q

Hyperparathyroidism

A

elevated T3 and T4

increased BMR leading to weight loss

121
Q

Hypoparathyroidism

A

T4 low, T3 low or normal

decreased BMR leading to weight gain

122
Q

Galactosemia

A

due to missing enzyme that would have converted galactose into glucose
treated solely by diet, galactose and lactose free

123
Q

Urea Cycle Defects

A

protein restriction to lower ammonia

124
Q

Phenylketonuria

A

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
Q

Glycogen Storage Disease

A

Deficiency of glucose-6-phosphatase; impairs glyconeogenesis and gycogenolysis
hypoglycemia since liver cant convert glycogen to glucose

126
Q

Treatment for Homocystinurias

A

doses of folate, pyridoxine, B12

127
Q

Ketogenic Diet

A

4 grams of fat: 1 gram of non fat

need supplements of Ca, D, folate, B6, B12

128
Q

Spastic Form of Cerebral Palsy

A

difficult, stiff movement; limited activity; obese

low calorie, high fluid, high fiber

129
Q

Non-spastic form of cerebral palsy

A

involuntary wormlike movement, constant irregular motions leading to weight loss
high calorie, high protein diet; finger foods

130
Q

Pressure ulcers MNT

A

30-40 kcal/kg

  1. 2-1.5 g/kg protein Stage I and II
  2. 5-2 g/kg Stages III and IV
131
Q

Microcytic Anemia

A

small pale cells due to iron deficiency

all labs are low

132
Q

Macrocytic Anemia

A

few large cells filled with hemoglobin
due to deficiency in B12 or folate (Schilling Test)
high MCV and MCH

133
Q

Normal MCV and MCH

A

MCV - 80-95

MCH - 27-32

134
Q

Fever

A

BMR increase 7% for each degree rise in temperature

normal 98.6F

135
Q

Burns Goals

A
  1. replace fluid and electrolytes lost
  2. recovery period increase calories
  3. secondary period 1.5 - 2 g/kg protein
136
Q

Results of physiologic trauma

A

hyperglycemia, hyperinsulinemia, little to no ketosis, increase glucagon

137
Q

Iatrogenic Malnutrition

A

protein-calorie malnutrition brought by treatment, hospital, medications

138
Q

Pediatric Overweight Interventions

A

Weight maintenance

139
Q

Bariatric Surgery Treatment

A

Class III Obesity with BMI 40 or greater

BMI 35 or greater with co-morbidities

140
Q

Achalasia

A

disorder of lower esophageal sphincter causing dysphagia

141
Q

Pregnancy-induced hypertension

A

sodium restriction is NOT recommended

142
Q

Elemental Formulas

A

chemically defined, pre-digested proteins or amino acids, used with malabsorption
used with compromised GI function, inability to digest and absorb

143
Q

Postpyloric transpyloric

A

passed by pyloric valve in stomach

used in comatose patients or ones with no gag reflex

144
Q

IV Dextrose

A

3.4 kcal/g

kcal = mL x % x 3.4

145
Q

10% IVFE

A

1.1 kcal/mL

146
Q

20% IVFE

A

2.0 kcal/mL

147
Q

Common Diagnosis and Problems for Parenteral Nutrition

A

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
Q

PN Concerns

A

translocation of bacteria

bacteria leave the gut and travel to bloodstream causing sepsis

149
Q

Transition Feeds

A
  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
Q

Refeeding Syndrome

A

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
Q

Integrative Medicine

A

combines evidence-based complementary therapies with conventional treatments to address the social, psychological, and spiritual aspects of health and illness

152
Q

Functional Medicine

A

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
Q

Holistic Health

A

views mental, physical, and spiritual aspects of life closely connected and equally important with regard to treatment approaches

154
Q

Healthy People 2020

A

focuses on disease prevention by changing behaviors

155
Q

Three Steps for Developing a Program

A
  1. develop mission statement
  2. set goals
  3. set objectives
156
Q

Four P’s or Marketing

A

product, place, price, promotion

157
Q

Community Needs Assessment Process

A

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
Q

Protein Amount in CHO Exchange List

A 
Starch/Bread = 3 g 
Milk = 8 g 
Meat = 7 g
159
Q

CHO Amounts Non-Starchy Vegetables

A

5 g (3 servings = 1 CHO serving)

160
Q

Fat Amount in CHO Exchange List

A

fat free low fat = 0-3 g
reduced fat = 5 g
full fat = 8 g

RD Exam (4 decks)

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