Domain II: Nutrition Care for Individuals and Groups Flashcards

Question

NFPE: Inspection

Answer 1

visual assessment using sight, sense of smell and hearing to observe textures, sizes, colors, shapes and sounds information obtained: obesity, cachexia, fluid status, skin integrity, wound healing, feeding devices, jaundice, ascites

Answer 2

Assessment: thin, sparse, dull dry brittle Considerations: vitamin C, protein deficiency Assessment: easily pluckable Considerations: protein deficiency

Answer 3

Assessment: pale, dry, poor vision Considerations: vitamin A, zinc, of riboflavin deficiencies

Answer 4

Assessment: swollen, red, dry, cracked Considerations: riboflavin, pyridoxine, niacin deficiencies

Answer 5

Assessment: smooth, slick, purple, white coating Considerations: vitamin or iron deficiencies

Answer 6

Assessment: sore, red, swollen, bleeding Considerations: vitamin C deficiency

Answer 7

Assessment: missing, loose, loss of enamel Considerations: calcium deficiency, poor intake

Answer 8

Assessment: pale, dry scaly Considerations: iron, folic acid, zinc deficiency

Answer 9

Assessment: brittle, thin, spoon-shaped Considerations: iron or protein deficiency

Answer 10

gathering data via touch using palms and fingertips information obtained: areas of tenderness, muscle rigidity, fluid retention or pitting edema, skin integrity and moisture, body temperature

Answer 11

listening to bowel using stethoscope on the RLQ (ileocecal valve) -normal bowel sounds are gurgling high-pitched sounds every 5-15 seconds -hypoactive: every 15-20 seconds, paralytic ileus or peritonitis -hyperactive: continuous, high-pitched, tickling sounds, diarrhea or intestinal obstruction

Answer 12

not done by RD, findings recorded in medical record

Answer 13

hydration status, measure fluid balance

Answer 14

3.5-5.0 g/dL visceral protein (blood and organs) maintains colloidal osmotic pressure hypoalbuminemia associated with edema, surgery levels above normal likely due to dehydration long half-life, does not reflect current protein intake

Answer 15

>200 mg/dL visceral protein (transports iron to bone marrow) serum level controlled by iron storage pool; rises with iron deficiency can be determined from total iron binding capacity (TIBC) not useful as a measure of protein status

Answer 16

16-40 mg/dL short half-life; picks up changes in protein status quickly during inflammation, liver synthesizes CRP at expense of PAB limited usefulness in screening or asssessment

Answer 17

3-6 mg/dL circulates with prealbumin; shortest half-life (12 hours) binds and transports retinol

Answer 18

M 42-52%; F 36-48%; Pregnant 33%; newborn 44-64% volume of packed cells in whole blood

Answer 19

M 14-18 g/dL; F 12-16 g/dL; Pregnant >11g/dL iron-containing pigment of RBC erythrocytes are produced in bone marrow

Answer 20

M 12-300 ng/mL; F 10-150 ng/mL indicates size of iron storage pool

Answer 21

M 0.6-1.2 mg/dL; F 0.5-1.1 mg/dL related to muscle mass; measures somatic protein may indicate renal disease, muscle wastage

Answer 22

80% normal ratio of creatinine excreted/24 hours to height estimates lean body mass-somatic protein 60-80% mild muscle depletion

Answer 23

10-20 mg/dL related to protein intake indicator of renal disease BUN:creatinine ratio=normal 10-15.1

Answer 24

115+/-20 mL/min measures GFR-glomerular filtration, renal function estimate includes body surface area (height and weight)

Answer 25

>2700 cells/cu mm measures immunocompetency moderate depletion 9000-1800, severe depletion <900 decreased in protein-calorie malnutrition

Answer 26

marker of acute inflammatory stress as it declines, indicates when nutritional therapy would be beneficial when elevated CRP decreases, PAB increases

Answer 27

direct measure of toxic effects of lead on heme synthesis (leading to anemia) Increased in lead poisoning lead and calcium compete at plasma membrane for transport

Answer 28

11-12.5 seconds; 85-100% normal anticoagulants prolong PT evaluates clotting adequacy; changes in vitamin K intake will alter rate

Answer 29

not for nutritional assessment; useful in measuring intake of toxic metals

Answer 30

Sedentary: BEEx1.2 Active: BEEx1.3 Stressed: BEEx1.5

Answer 31

appetite stimulant

Answer 32

appetite stimulant

Answer 33

appetite suppressant, anorexia, nausea, weight loss

Answer 34

decreased fat absorption by binding lipase; vitamin/mineral supplement

Answer 35

anorexia, weight loss, nausea

Answer 36

avoid grapefruit juice; decreased LDL, TG; increase HDL

Answer 37

malabsorption

Answer 38

decrease fat absorption, fat soluble vitamins

Answer 39

protein deficits

Answer 40

decrease folate, B6, C

Answer 41

deplete thiamin, potassium, magnesium, calcium, sodium

Answer 42

decrease potassium and magnesium, absorb calcium

Answer 43

decrease vitamin K

Answer 44

hyperglycemia, thin skin, hypertension, bone fracture

Answer 45

decrease folate

Answer 46

increased appetite, weight gain; maintain consistent sodium and caffeine intake to stabilize drug levels; if sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity

Answer 47

antagonizes vitamin K (consistent intake essential); avoid gingko, garlic, ginger (may increase bleeding); avoid high dose vitamin A, E

Answer 48

administered in oil, consider fat calories, 1.1 kcal/mL, check TG

Answer 49

decreased folic acid, vitamins B12, D, K, B6

Answer 50

hyperlipidemia, hyperglycemia, hyperkalemia, hypertension

Answer 51

depletes pyridoxine->peripheral neuropathy, don't take with food, interferes with vitamin D, calcium and phosporous

Answer 52

sedative effect, weight gain, increased appetite

Answer 53

vitamin B6 and protein decrease effectiveness, take drug in morning with limited protein compete with drug absorption sites

Answer 54

binds with calcium

Answer 55

hypertension; restrict aged, fermented, dried, pickled, smoked, spoiled foods OK: cottage cheese, cream cheese Good advice: buy, cook, eat fresh foods

Answer 56

may reduce inflammation, antioxidant, in curry powder

Answer 57

income, price of food, time spent on food activities How easily can they get foods from stores nearby? Do their cultural practices support the kind of changes they need to make? Are food sources near their workplace supportive of healthy eating? What media do they watch or use? What are their sources of nutrition and food information?

Answer 58

how ready or willing are they to learn? Assess their situation, their motivational and educational levels?

Answer 59

process that involves being aware of better health and actively working towards that goal. It includes physical health and well-being, mental and spiritual health

Answer 60

1. obtain overview to determine whether nutritional resources are adequate, what groups are potentially at high nutritional risk, how well health needs are being met by existing programs 2. Identify target population and nutritional problem of concern 3. Set parameters of the assessment, collect data, analyze and interpret data, share findings and set priorities 4. Define goals and objectives, develop plans, define management system (personnel, staff, record-keeping) 5. HRA Health Risk Appraisal--survey categorizing a populations' general health status (used in worksites, government agencies as a health education or screening tool) ---consists of questionnaire, calculations that predict risk of disease, educational message to the participant 6. sources of assessment information ---demographic-population by age, ethnic groups, sex, birth rates, deaths, socioeconomic stratification (census data, housing statistics) 7. morbidity (disease) rates, mortality (death) rates ---infant mortality rate: infant deaths under 1 year of age, expressed as # of deaths per 1000 live births 8. incidence: # of NEW cases/total # at risk *100,000 9. prevalence: # with disease/average # of people *100,000 10. identify and evaluate services; is dental health available for all? 11. school nutrition programs, educational attainment, language spoken 12. social welfare programs: number and percent of population receiving public aid

Answer 61

the access by all people at all times to sufficient food f0r an active and healthy life. it is the ready availability of nutritionally adequate and safe foods and an assured ability to acquire them in socially acceptable manner (without resorting to emergency food programs, stealing, scavenging) Food insecurity is prevalent among emergency food recipients. It affects all ages, ethnicities and locations. It impacts the working poor. It extends to government food assistance recipients, and those with poor health status

Answer 62

1. development of sustainable, community-based strategies to ensure that all have access to culturally acceptable, nutritionally adequate food at all times. 2. strategies that strengthen local food systems: a. farmer's markets-increased access to fresh produce b. food recovery and gleaning programs-collect excess wholesome foods that would otherwise be thrown away (from farms, packing houses, caterers, cafeterias, restaurants) for delivery to hungry people c. PPFPs-Prepared and Perishable Food Programs-nonprofit programs that link sources of unused, cooked and fresh foods with social service agencies that serve the hungry

Answer 63

Examination of a population group at a particular point of time 1. considered a cross-sectional exam; pin-points problems 2. determines a prevalence of condition or characteristic at a specific time 3. WIC PC and NCCOR National Collaborative on Childhood Obesity Research

Answer 64

Continuous collection of data 1. identifies problem, sets baseline, sets priorities, detects changes in trends 2. use height, weight, hematocrit, hemoglobin, serum cholesterol 3. on-going system linked to active health program: WIC, CDC EPSDT- Early Periodic Screening, Diagnosis, Treatment 4. data identifies needs and kind of intervention needed

Answer 65

Promote nutrition and improve nutritional care for the elderly to identify nutritional problems early 1. DETERMINE checklist--identifies factors placing people at nutritional risk --increases awareness of factors that influence nutritional health --disease, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, needs assistance in self-care, elder years above age 80 2. LEVEL I screen identifies those who need more comprehensive assessments 3. LEVEL II screen provides more specific diagnostic info on nutritional status

Answer 66

5-12 people brought together to talk about concerns, beliefs, problems obtain advice, insights and information; contributes attitudinal data

Answer 67

includes all data collection and analysis activities of the federal government related to measuring the health and nutritional status, food consumption, attitudes about diet and health jointly run by USDHHS and USDA

Answer 68

Pediatric Nutrition Surveillance System USDHHS 1. low income, high risk children, birth-17 years, emphasis on birth-5 years 2. height, weight, birth-weight, hematocrit, hemoglobin, cholesterol, breast-feeding 3. monitors growth and nutritional status, infant-feeding practices

Answer 69

Pregnancy Nutrition Surveillance System USDHHS 1. low income, high risk pregnant women 2. maternal weight gain, anemia, pregnancy behavioral risk-factors (smoking, alcohol), birth-weight, counts # of women who breastfeed 3. identify and reduce pregnancy-related health risks

Answer 70

National Health and Nutritional Examination Survey CDC 1. ongoing (repeated) survey to obtain info on health of American people 2. evaluates clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometric, nutritional data (24 hour recall, food frequency lists) 3. NHANES III-over sampling of adults >/= 65 with NO upper age limit 4. WWEIA What We Eat in America-dietary intake component of NHANES (also known as National Food and Nutrition Survey NFNS) --two days of 24 hour dietary recall data with times of eating occasions and sources of foods eaten away from home --USDA conducts over-sampling of adults >/= 60, African Americans, Hispanics

Answer 71

1. to obtain info on food intake of individuals and total households from entire US 2. evaluates 7 nutrients-protein, calcium, iron, thiamin, riboflavin, vitamins C, A 3. diets rated good if intakes equaled or surpassed RDA; rated poor if less than 2/3 RDA for 1 or more nutrients

Answer 72

Behavioral Risk Factor Surveillance System USDHHS 1. adults 18 years and older residing in households with telephones 2. telephone interviews collect info on height, weight, smoking, alcohol use, food frequency for fat, fruits and vegetables **can monitor changes in health risk behaviors over time and can better target health promotion efforts to populations most at risk

Answer 73

Youth Risk Behavior Surveillance System USDHHS 1. Grades 9-12. Smoking, alcohol use, weight control, exercise, eating habits 2. prevalence of health risk behaviors among young people **can monitor changes in health risk behaviors over time and can better target health promotion efforts to populations most at risk

Answer 74

Food Safety and Nutrition Survey FDA 1. assess consumers' awareness, knowledge, understanding and reported behaviors related to food safety and nutrition-related topics 2. help to make better informed regulatory, policy, education decisions to promote and protect public health

Answer 75

Temporary Assistance for Needy Families 1. states determine the eligibility and the benefits and services provided 2. helps needy families achieve self-sufficiency, time-limited, helps foster economic security and stability 3. grants funds to states

Answer 76

1. provides foods to help meet nutritional needs of children and adults and strengthens agricultural market for products produced by American farmers 2. food given to School Lunch, elderly feeding, supplemental food programs 3. CSFP and TEFAP

Answer 77

Commodity Supplemental Food Program 1. administered by state health agencies 2. monthly commodity canned or packaged foods 3. improve health of low-income elderly at least 60 years of age 4. states may require that participants be at nutritional risk

Answer 78

The Emergency Food Assistance Program 1. quarterly distributions of commodity foods by local, public or private nonprofit agencies, food banks, soup kitchens, homeless shelters 2. supplements diets of low-income households, short term hunger relief

Answer 79

National School Lunch Program USDA Food and Nutrition Service (FNS) 1. entitlement program to improve nutrition of children, especially from low income families; utilize surplus production of foods 2. cash grants and food donations; dollars reimburse schools on basis of numbers of meals served 3. implements the Dietary Guidelines into the Lunch and Breakfast Programs 4. lunch must provide on average over each school week: 1/3 of the recommended intake for protein, vitamins A and C, iron and calcium 5. grades 9-12: 2 oz meat serving; nuts must be combined and only use for half the requirement 6. graham flour is considered whole grain 7. K-5: 3/4 cup vegetable is one serving 8. 100% full-strength fruit juice may be used as 1/2 of weekly servings of fruit 9. Team Nutrition implements School Meals Initiatives for Healthy Children --motivate child to make healthy choices; helps schools meet Guidelines --provides recipes, raining, support to child nutrition professionals

Answer 80

National School Breakfast Program USDA 1. entitlement program, meals must meet federal Dietary Guidelines 2. breakfast must provide on average over each school week: 1/4 daily recommended levels for protein, calcium, iron, vitamin A, vitamin C

Answer 81

Afterschool Snack Program USDA provides healthy snacks 1. cash subsidies for each snack served, same eligibility bases as NSLP

Answer 82

Special Milk Program USDA 1. provides milk to children in schools and childcare institutions who do not participate in other Federal meal service programs 2. reimburses schools for milk served

Answer 83

Summer Food Service Program USDA School Lunch 1. entitlement program; purpose is to initiate, maintain or expand foodservice programs to children and teens in low-income areas when school is out 2. reimburses providers for meals served at a central site, 18 and younger 3. administered by FNS, state educational agencies, public or private nonprofit residential summer camps

Answer 84

Child and Adult Care Food Program USDA 1. supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless shelters, nonresidential adult daycare centers 2. reimburses operators for meal costs, provides commodity foods and nutrition education materials 3. meals must meet guidelines; must offer free or reduced-price to eligible 4. eligibility standards same as NSLP

Answer 85

Fresh Fruit and Vegetable Program USDA 1. introduces children to fresh fruits and vegetables; help develop eating habits that improve health, prevent obesity and subsequent chronic disease 2. free to children at eligible elementary schools who operate the NSLP

Answer 86

Special Supplemental Nutrition Program for Women, Infants, and Children USDA 1. for pregnant, postpartum, breast-feeding women; infants and children up to 5 2. provides food for low income mothers at nutritional risk (abnormal weight gain, history of high risk, LBW, underweight, overweight, anemia) 3. risk: weight, height, head circumference in infants, hemoglobin, hematocrit 4. provides food, nutrition education, referrals to other agencies 5. health exam is REQUIRED 6. must meet income standards, be at nutritional risk, and in need of foods offered 7. foods provided included: iron-fortified formula, cereal, milk, cheese, fruit juice 8. not an entitlement program: cap on the amount of federal dollars allocated 9. priorities: pregnant and breast-feeding women, infants up to 1 year 10. WIC FMNP Farmers' Market Nutrition Program: coupons to purchase fresh, locally grown foods at farmers' markets 11. EBT electronic benefits transfer card

Answer 87

Expanded Food and Nutrition Education Program USDA 1. provides grants to universities that assist in community development 2. trains nutrition aides to educate the public 3. works with small groups; teaches skills needed to obtain a healthy diet (how to budget, meal planning, shop, cook) 4. does not provide food

Answer 88

USDHHS 1. under Title V of the Social Security Act 2. fosters public health nutrition programs at the state and local levels 3. provides training, consultation, funding 4. women of child-bearing age, infants, children; state eligibility requirements

Answer 89

USDHHS 1. reduce infant mortality, improve health of low-income women, infants, children, families

Answer 90

Nutrition Services Incentive Program AoA Administration on Aging 1. developed services to foster independent living; cash and commodities to state agencies 2. OAA

Answer 91

Older American Act Nutrition Program (formerly ENP Elderly Nutrition Program) USDHHS Title III 1. one hot meal each day, 5 days/week, provide 1/3 recommended intake 2. eligibility: all aged 60 and older plus spouse, regardless of income 3. Congregate Meals-ambulatory; transportation essential for rural elderly 4. Home delivered meals-Meals of Wheels-must be homebound 5. counseling, nutrition education, referrals, social interaction

Answer 92

Supplemental Nutrition Assistance Program USDA 1. largest food assistance programs: entitlement 2. assist low income with monthly benefits; net income must be at or below certain % of poverty level; income limits vary by household size and are adjusted to the cost of living. Nutritional risk NOT a consideration 3. designed to increase their purchasing power; not for non-food items 4. figures are adjusted to reflect cost of food in Thrifty Food Plan for June of preceding year-least costly of USDA four food plans 5. SNAP nutrition education program: provided to program participants 6. EBT electronic benefits transfer

Answer 93

USDHHS 1. helps low income children; ages 3-5 2. introduces new foods, teaches good food habits 3. child's participation in food activities is important

Answer 94

Nutrition Education and Training Program USDA 1. amendment to School Lunch Act 2. provides nutrition education training to teachers and school foodservice personnel

Answer 95

Senior Farmers' Market Nutrition Program USDA 1. cash grants to states to provide low-income seniors (>/=60) with coupons to be exchanged for eligible foods at farmers' markets, roadside stands, community supported agriculture programs (CSA) 2. fresh, nutritious, unprepared fruits, vegetables, herbs and honey 3. may be limited to specific and locally grown foods 4. nutrition education and information are provided (how to select, store, prepare)

Answer 96

receive both federal and private funds 1. American Red Cross 2. National Research Council-Food and Nutrition Board (developed RDAs)

Answer 97

1. Feeding America is the largest domestic hunger relief organization in the US (food banks, shelters, soup kitchens) 2. Voluntary health agencies-private, non-profit organizations, chartered and licensed by a government agency, funded by contributions from citizens or organizations: American Heart Association (AHA) 3. Professional organizations- Academy of Nutrition and Dietetics

Answer 98

1. FAO Food and Agricultural Organization- raising world wide levels of nutrition by increasing efficiency of production and distribution of foods

Answer 99

identification of and labeling a nutritional problem that dietetics professionals are responsible for treating independently. Nutrition diagnosis changes as the patient's response changes. (undesirable overweight status) Diagnosis links assessment to intervention and sets realistic and measurable outcomes the Academy's NCP standardized language is the basis for collecting evidence that nutrition care improves outcome

Answer 100

is a disease or pathology that can be treated or prevented. it does not change as long as the condition exists (type 1 diabetes)

Answer 101

the disruption of normal body functions that is seen in disease

Answer 102

which of many problems with similar symptoms is the correct diagnosis. requires comparisons and contrasts of all findings

Answer 103

nutritional findings/problems that relate to medical/physical condition 1. Functional balance-physical or mechanical change that interferes/prevents desired nutritional results; swallowing difficulty, altered GI function 2. Biochemical balance-change in capacity to metabolize nutrients due to medications, surgery, or indicated by lab values 3. Weight balance-chronic or changed weight status when compared to UBW: underweight, involuntary weight loss, overweight

Answer 104

actual problems related to intake 1. Caloric energy balance: actual or estimated changes in energy (hypermetabolism, hypometabolism, increased energy expenditure) 2. Oral or nutrition support intake: inadequate or excessive compared with goal 3. Fluid intake balance: inadequate or excessive compared with goal 4. Bioactive substances: supplements, alcohol, functional foods 5. Nutrient balance: intake of nutrients compared with desired levels

Answer 105

problems related to knowledge, access to food and food safety 1. Knowledge and beliefs: knowledge deficit, harmful beliefs, disordered eating patter, undesirable food choices 2. Physical activity balance and function: inactivity, excessive exercise, impaired ability to prepare foods 3. Food safety and access

Answer 106

1. One problem (diagnostic label): adjective that describes the human response (altered, impaired, increased, risk of) 2. One etiology (cause/contributing risk factors) linked to the problem by words "related to" (why the problem exists) 3. Assessment of signs (objective data...observable changes) and symptoms (subjective data are changes the patient expresses) linked to etiology by words "as evidenced by" (proof of the problem) Prioritize: select the most important and urgent problem to be addressed

Answer 107

1. Can you resolve or improve the nutrition diagnosis for this person/group? If you have diagnoses from two domains...., consider intake diagnoses as more specific to the nutritional professional...more likely to facilitate a nutrition-directed intervention 2. Is the etiology you selected the "root cause" that can be addressed with nutrition intervention? Or can you at least lessen the signs and symptoms? 3. Will measuring the signs and symptoms indicate if the problem is resolved or improved? Are signs and symptoms specific enough...that you can monitor and document resolution or improvement of the nutrition diagnosis? 4. Does the nutrition assessment data support a particular nutrition diagnosis with a typical etiology and signs and symptoms?

Answer 108

1. resolving the underlying cause of the nutrition problem when possible OR 2. minimizing the symptoms of the nutrition problem

Answer 109

purposely planned actions designed with the intent of changing behavior, risk factor or condition, for an individual, group or community. Based on the nutrition diagnosis and provides the bases upon which outcomes are measured and evaluated. Four categories: food delivery, education, counseling, coordination of care with other providers

Answer 110

an essential element in program planning

Answer 111

prioritize nutrition diagnoses, consult EAL and other practice guidelines, determine patient-focused outcomes for each diagnosis, confer with caregivers, define time and frequency of care, identify resources needed

Answer 112

action phace (communicate and carry out the plan)

Answer 113

1. systematically reviewed scientific evidence used in making food and nutrition practice decisions; integrates best available evidence with professional expertise and client values to improve outcomes 2. What nutritional interventions are most effective for different diseases?

Answer 114

reduced exposure to a promoter of disease (early screening for risk factors like diabetes). Health promotion

Answer 115

recruiting those with elevated risk factors into treatment program (setting up an employee's gym), reduce impact of a condition that has already occurred. Risk reduction, slow progress to restore health

Answer 116

as disease progresses, intervention to reduce severity, manage complications (cardiac/stroke programs) Rehabilitation efforts

Answer 117

1. FTC Federal Trade Commission: internet, TV, radio; bogus weight loss claims 2. NCAHF National Council Against Health Fraud 3. When evaluating information, ask questions based on CARS checklist: Credibility: check credentials of author Accuracy: info is current, factual and comprehensive Reasonableness: is information fair, balanced and consistent Support: is supporting documentation cited for scientific statements

Answer 118

problem-oriented medical record

Answer 119

problem, etiology, symptoms

Answer 120

screen, assessment, plan

Answer 121

assess, diagnose, intervention, monitor, evalute

Answer 122

Health Insurance Portability and Accountability Act 1. permanent legal document; entries written in black pen or typed 2. complete, clear, concise, objective, legible, accurate 3. sign, date all entries; entered at the time of actual procedure or service 4. late entries should be identified as such; actual date, time of entry and the date and time it should have been recorded 5. when diet orders are not chosen correctly, contact the person who wrote order 6. corrections-never use white out, thick markers, or remove an original and replace it with a copy. --At the time an entry is in progress: draw single line through error, then enter the correction, initial and date --For omitted information, beside original entry: "see addendum", enter date and initial. Write the addendum in chart sequence, identify it as an addendum and reference original entry. Sign --Corrections performed sometime after entry: correct minor errors (spelling, one one word) with single line drawn through, make correction, date, time, sign

Answer 123

Day 1 of a hospital stay

Answer 124

1. eroded mucosal lesion 2. treatment: antacids, antibiotics to eradicate Helicobacter pylori bacteria 3. drug therapy: cimetidine, Ranitidine-H2 blocker; prevents binding of histamine to receptor, decreases acid secretion 4. diet: as tolerated, well-balanced, avoid late night snacks 5. omit gastric irritants: cayenne and black pepper, large amount of chili powder, avoid excess caffeine and alcohol

Answer 125

1. protrusion of a portion of the stomach above the diaphragm into the chest 2. small, bland feedings; avoid late night snacks, caffeine, chili powder, black pepper

Answer 126

1. follows a gastrectomy 2. cramps, rapid pulse, weakness, perspiration, dizziness 3. when rapidly hydrolyzed CHO enters jejunum, water is drawn in to achieve osmotic balance. Causes rapid decrease in vascular fluid and a decrease in peripheral vascular resistance. Blood pressure drops and signs of cardiac insufficiency appear. About 2 hrs later, CHO is digested and absorbed rapidly. Blood sugar rises, stimulating an overproduction of insulin, causing a drop in blood sugar below fasting. This is reactive or alimentary hypoglycemia. 4. frequent small, dry feedings, fluids before or after meals, restrict hypertonic concentrated sweets, give 50-60% complex CHO, protein at each meal, moderate fat. Lactose may be poorly tolerated due to rapid transport

Answer 127

Billroth I attaches remaining stomach to duodenum Billroth II attaches it to the jejunum When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced, these hormones stimulate the pancreas, so reduced pancreatic secretion. Calcium (most rapid absorption in duodenum) and iron absorption (requires acid) are adversely affected. Anemia-B12 deficiency-lack of intrinsic factor and bacterial overgrowth in loop of intestine being bypassed interfere with B12 absorption (pernicious anemia diagnosed using the Schilling test) folate deficiency-needs B12 for transport inside the cell; poor folate intake and low serum iron (cofactor in folate metabolism) Following a complete gastrectomy, deficiencies of iron, folate, calcium, vitamin D, B1 and copper may develop B12 injections may be needed

Answer 128

1. delayed gastric emptying: surgery, diabetes, viral infections, obstructions 2. moderate to severe hyperglycemia: detrimental effects on gastric nerves 3. prokinetics (erythromycin, metoclopramide) increase stomach contractility 4. small, frequent meals: pureed foods, avoid high fiber, avoid high fat (liquid fat may be better tolerate), avoid caffeine, mint, alcohol (acidic), carbonation 5. bezoar formation may be due to undigested food or medications; treatment includes enzyme of endoscopic therapy

Answer 129

1. chronic GI disease, intestinal lesions, may also affect stomach 2. diarrhea, malnutrition, deficiencies of B12 and folate due to decreased HCl and intrinsic factor 3. antibiotics, high calories, high protein, IM B12 and oral folate supplements

Answer 130

1. gluten refers to storage proteins (prolamins: gliadin in wheat, secalin in rye, hordein in barley, avenin in oats) 2. reaction to gliadin-affects jejunum and ileum (proximal intestine) 3. malabsorption (leads to loss of fat-soluble vitamins), macrocytic anemia, weight loss, diarrhea, steatorrhea, iron deficiency anemia 4. need (gliadin-free) gluten-restricted diet: NO wheat, rye, oats (if harvested and milled with wheat), barley, (buckwheat may be contaminated with WROB); no bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents 5. OK: corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax, amaranth, millet, teff, quinoa

Answer 131

1. sometimes due to an atonic colon (weakened muscles) 2. high fluid, high fiber diet, exercise

Answer 132

the presence of diverticula-small mucosal sacs that protrude through the intestinal wall due to structural weakness. Related to constipation and lifelong intra-colonic pressures High fiber diet-increase volume and weight of residue, provides rapid transit

Answer 133

when diverticula become inflamed as a result of food and residue accumulation and bacterial action Clear liquids, low residue or elemental, gradual return to high fiber

Answer 134

provides indigestible bulk, promotes intestinal function 1. dietary fiber-nondigestible CHOs and lignin, binds water, increases fecal bulk; found in legumes, wheat bran, fruits, vegetables, whole grains 2. oat bran and soluble fibers decrease serum cholesterol by binding bile acids converting more cholesterol into bile 3. soluble fibers (pectins, gums) delay gastric emptying, absorb water, form soft gel in small intestine; this slows passage and delays or inhibits absorption of glucose and cholesterol; fruits, vegetables, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, bananas 4. AI M 38g, F 25g fiber/day recommended 5. a high fiber diet may increase the need for Ca, Mg, P, Cu, Se, Zn, Fe 6 a low fiber diet may lead to constipation

Answer 135

1. inflammation of stomach: anorexia, nausea, vomiting, diarrhea 2. diet: clear liquids, advance as tolerated, avoid gastric irritants

Answer 136

1. Regional enteritis (Crohn's Disease) a. affects terminal ileum; weight loss, anorexia, diarrhea b. B12 deficiency leads to megaloblastic anemia c. iron deficiency anemia due to blood loss, decreased absorption 2. Chronic ulcerative colitis (UC) a. ulcerative disease of the colon, begins in rectum b. chronic bloody diarrhea, weight loss, anorexia, electrolyte (Na, K) disturbance, dehydration, anemia, fever, negative nitrogen balance 3. Treatment a. maintain fluid and electrolyte balance; antidiarrheal agent (sulfasalazine) b. acute Crohn's flare ups- bowel rest, parenteral nutrition or minimal residue c. acute UC, elemental diet may be needed to minimize fecal volume d. energy needs according to current BMI, limit fat only if steatorrhea; water soluble and fat-soluble vitamins; iron, folate; assess Ca, Mg, Zn; watch lactose, frequent feedings. High fat may improve energy balance. Coconut oil derived MCT is an easy to oxidize source of energy and may improve bowel damage e. protein at each meal, chewable MV f. when IBD is in remission or under control, high fiber to stimulate peristalsis

Answer 137

1. chronic abdominal discomfort, altered intestinal motility, bloating 2. goals: adequate nutrient intake, tailor pattern to specific GI issues 3. avoid gas-forming foods and swallowing air during eating 4. use food diary to track intake, emotions, environment, symptoms 5. low FODMAP diet: eliminate possible sources of discomfort 6. work with client to alleviate stress during eating 7. peppermint (has menthol, smooth muscle relaxant) may relax lower esophageal sphincter, reducing reflux, cramping, pain

Answer 138

1. Normally lactase splits lactose into galactose and glucose. In its absence lactose remains intact, exerting hyperosmolar pressure. Water is drawn into the intestine to dilute the load causing distension, cramps, diarrhea. Bacteria then ferment the undigested lactose, releasing carbon dioxide gas. 2. detected by breath hydrogen test-hydrogen is produced by colonic bacteria on lactose, absorbed into bloodstream and exhaled in 60-90 minutes 3. lactose tolerance test-oral dose of lactose (up to 50 grams) after a fast. If intolerant of lactose, blood glucose will rise <25 mg/dL above fasting (flat curve). If tolerant of lactose, the rise would be above 25 mg/dL (normal curve) 4. diet: lactose-free, no animal milk or milk products, no whey a. calcium and riboflavin supplements are recommended b. yogurt and small amounts of aged cheese may be tolerated c. OK: lactate , lactalbumin

Answer 139

1. acute: aggressive and immediate rehydration; replace fluids and electrolytes lost in stool (WHO recommends glucose electrolyte solution) --as effective as parenteral rehydration and much cheaper, ingredients easily attainable; reintroduce oral intake within 24 hours 2. chronic nonspecific infantile diarrhea-no significant malabsorption --consider ratio of fat to CHO calories, volume of ingested liquids --some are inadvertently placed on a low fat diet or consume too many fluids or too may calories --give 40% calories as fat, balanced with limited fluids; restrict or dilute fruit juices with high osmolar loads-apple, grape

Answer 140

1. remove the cause; replace lost fluids and electrolytes especially those high in sodium and potassium 2. decrease gastric motility: avoid clear liquids and other foods high in lactose, sucrose, fructose; avoid caffeine, alcohol, high fiber 3. thicken consistency of stool: banana flakes, apple powder, pectin sources 4. repopulate GI tract with normal flora --prebiotic components (pectin, fructose, oats, whole grains) which promote growth of healthy bacteria; FOS (fructooligosaccharides) onion, garlic, banana, artichoke, asparagus, chicory --probiotics-sources of bacteria used to reestablish bacterial gut flora; fermented dairy foods (yogurt, kefir, aged cheese); fermented foods with beneficial live cultures (kimchi, miso, tempeh, sauerkraut) 5. stimulate GI tract with low fiber, low fat, lactose-free if needed

Answer 141

consequence of malabsorption 1. normal stool fat 2-5 g; >7 g is indicative of malabsorption 2. determine cause and treat 3. high protein, high complex CHO, fat as tolerated, vitamins (especially fat-soluble), minerals, MCT (rapidly hydrolyzed in GI tract)

Answer 142

1. consequences associated with significant resections of the small intestine 2. malabsorption, malnutrition, fluid and electrolyte imbalances, weight loss 3. severity reflects length and location of resection, age of patient, health of remaining tract. Loss of ileum (especially distal 1/3), loss of ileocecal valve, loss of colon are of particular concern 4. most digestion takes place in first 100 cm of intestine (in duodenum, and upper jejunum), what remains are small amounts of sugar, starches, fiber, lipids 5. jejunal resection-ileum can adapt and take over jejunal functions 6. ileal resection-significant resections produce major complications --distal: absorption of B12, intrinsic factor, bile salts --ileum normally absorbs major portion of fluid in GI tract; patients have above average needs for water to compensate for excessive losses in stool. Drink at least 1 liter more than their ostomy output daily --if ileum cannot recycle bile salts: lipids are not emulsified; leads to malabsorption of fat-soluble vitamins; malabsorbed fats combine with Ca, Zn, Mg, leading to "soaps"; colonic absorption of oxalate increases leading to renal oxalate stones;; increased fluid and electrolyte secretion; increased colonic motility 7. loss of colon: loss of water and electrolytes, loss of salvage absorption of CHO and other nutrients. Provide chewable vitamins 8. nutritional care --parenteral nutrition initially to restore and maintain nutrient status --enteral - start early to stimulate growth, increase over time; continuous dri --may take weeks or months to transition to food --jejunal-normal balance of CHO, PRO, fat; avoid lactose, oxalates, large amounts of concentrated sweets; vitamin, mineral supplements --ileal-limit fat, use MCT (does not require bile salts, needs less intestinal surface area), supplement fat-soluble vitamins (ADEK), Ca, Mg, Zn. Parenteral B12 followed by monthly injections if more than 100 cm of terminal ileum is removed

Answer 143

stores and releases blood, filters toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance --enzyme profile: list of major enzymes found in organs and tissues; enzyme levels in blood are elevated when tissue damage causes them to leak into the circulation Liver Function Tests: ALP (alkaline phosphatase) 30-120 U/L; increased: liver disease, bone disease; decreased: scurvy, malnutrition LDH (lactic acid dehydrogenase); increased: hepatitis, myocardial infarction, muscle malignancies AST, SGOT (aspartate aminotransferase); increased: hepatitis ALT, SGPT (alanine aminotransferase); increased: liver disease NOTE: in liver disease, enzymes levels are elevated

Answer 144

1. inflammation, necrosis, jaundice, anorexia, nausea, fatigue--jaundice occurs when bile ducts are blocked 2. HAV: fecal-oral transmission (type most directly connected to food) HBV: sexually transmitted, HCV: blood to blood contact 3. prescription -increase fluids to prevent dehydration -care varies according to symptoms and nutrition status -50-55% CHO to replenish liver glycogen and spare protein -acute hepatitis: 1-1.2 g PRO/kg: cell regeneration, provide lipotropic agents to convert fat into lipoproteins for removal from the liver -moderate to liberal fat intake if tolerated; <30% cals if steatorrhea -encourage coffee (antioxidant) -multivitamin with B complex, C, K, zinc -if fluid retention, 2 g Na

Answer 145

1. damaged liver tissue is replaced by bands of connective tissue which divides liver into clumps and reroutes many of the veins and capillaries. Blood flow through liver is disrupted. Poor food intake leads to deficiencies. 2. protein deficiencies lead o ascites, fatty liver, impaired clotting 3. blood flow: esophageal, veins portal vein->liver->vena cava 4. ascites occurs when blood cannot leave the liver --connective tissue overgrowth blocks blood flow out of liver into vena cava. Liver expands (can store a liter of extra blood). when storage capacity has been exceeded, pressure caused by increased blood volume forces fluid to sweat through the liver into the peritoneal cavity. this fluid is almost pure plasma with a high osmolar load pulling more fluid in to dilute the load, leading to sodium and water retention. --low serum albumin may be due to dilution factor 5. esophageal varices occur when blood can't enter the liver: portal hypertension --connective tissue overgrowth causes resistance to blood entering from portal vein. The increased pressure forces blood back into collateral veins that offer less resistance. Esophageal, abdominal, collateral veins enlarge. 6. diet for cirrhosis --adequate to high protein .8-1.2 g/kg; in stress at least 1.5 g/kg --high calorie 25-35 kcal/kg estimated dry weight or BEE +20% --moderate to low fat 25-40% of calories, MCT if needed, <30 g fat if malabsorption. Fat is preferred fuel in cirrhosis. Includes omega 3. Decrease LCTs if steatorrhea develops --low fiber if varices are present, low sodium (<2g) if edema or ascites --with hyponatremia, fluid restriction of 1-1.5 L/day depending on severity, and moderate sodium intake --B complex vitamins, C, Zn, Mg; monitor need for A and D; zinc involved in conversion of ammonia to urea, increased loss in urine

Answer 146

1. liver injury due to alcohol and metabolic derangements it causes 2. alcohol is converted into acetaldehyde and excess hydrogen which disrupts liver metabolism --hydrogen replaces fat as fuel (in the Kreb's cycle), so fat accumulates leading to fatty liver, and in blood, raising TG levels --shift in NADH/NAD ratio inhibits beta-oxidation of fatty acids and promotes TG synthesis 3. associated malnutrition --alcohol replaces food in diet --alcohol causes inflammation of GI tract and interferes with absorption of thiamin, B12, vitamin C, folic acid, supplement thiamin and folic acid --alcohol interferes with vitamin activation --increased need for B vitamins to metabolize alcohol --increased need for magnesium; excreted after alcohol consumption --malnutrition increases alcohol's destructive effects --folate and protein deficiencies-most responsible for malabsorption --thiamin deficiency-Wernicke-Korsakoff syndrome

Answer 147

liver function decreased to 25% or less 1. liver cannot convert ammonia into urea-ammonia accumulates 2. apathy, drowsiness, confusion, coma (PSE-portal systemic encephalopathy) 3. asterixis (flapping, involuntary jerking motions): sign of impending coma 4. treatment --if not comatose: moderate to high levels of protein, increase up to 1-1.5 g PRO/kg as tolerated. Modest protein intake if protein-sensitive hepatic encephalopathy --30-35 kcal/kg; 30-35% calories as fat with MCT if needed --low sodium if ascites; vitamin/mineral supplementatiion --altered neurotransmitter theory: BCAA decrease (used by muscles for energy); AAA (aromatic amino acids) increased because damaged liver is unable to clear them->adding BCAA-adds calories and protein; may not reduce symptoms; used when standard therapy does not work and when patient does not tolerate standard protein 5. standard treatment is lactulose (hyperosmotic laxative that removes nitrogen); neomycin (antibiotic that destroys bacterial flora that produce ammonia)

Answer 148

1. steatosis, more common with BMI>/=35, T2DM, metabolic syndrome 2. excess fat buildup in liver unrelated to alcohol consumption 3. treatment: can be managed with lifestyle change --weight loss (7-10% of starting weight). NO rapid weight loss: greater flux of fatty acids to liver may worsen inflammation and accelerate disease progression --healthful eating: Mediterranean diet, moderate alcohol, avoid sugar sweetened beverages, coffee may help (antioxidant) --physical activity: at least 150 minutes of moderate intensity aerobic activity, plus two strength training sessions each week

Answer 149

1. cholecystitis-inflammation of gallbladder --an infection causes excess water to be absorbed causing cholesterol to precipitate out leading to gallstones-cholelithiasis 2. treatment --low fat diet: acute 30-45 grams; chronic 25-30% of calories --cholecystectomy-surgical removal of gallbladder; bile now secreted from liver directly into intestine. Limit fat intake for several months to allow liver to compensate. Slowly increase fiber to help normalize bowel movements

Answer 150

1. inflammation with edema, cellular exudate and fat necrosis 2. may be due to blockage or reflux of the ductal system; premature activation of enzymes within pancreas leads to autodigestion 3. acute- hypermetabolic, hyperdynamic state increasing BMR --put pancreas at rest, withhold all feeding, maintain hydration (IV) --progress as tolerated to easily digested foods with low fat content --elemental (pre-digested) enteral nutrition into jejunum may be tolerated 4. chronic-recurrent attacks of epigastric pain of long duration --PERT: pancreatic enzymes orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase. MCTs do not require pancreatic lipase. Add to mixed dishes, jams, jellies --to promote weight gain, give maximum level of fat tolerated without an increase in steatorrhea or pain --if malabsorbing fat soluble vitamins, give water soluble forms, parenteral B12? (deficiency of pancreatic protease which splits off vitamin from carrier) --pancreatic bicarbonate secretion may be defective; may need antacids so PERT will work --in severe prolonged cases, parenteral nutrition may be needed --to avoid pain: avoid large meals with fatty foods, alcohol

Answer 151

1. disease of exocrine glands-secretion of thick mucus that obstructs glands and ducts; chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption. Affects transport of chloride across the cell membrane 2. treatment: use age-appropriate BMI to assess height and weight a. PERT with meals and snacks b. high PRO, high calorie, unrestricted fat, liberal salt --if growing normally and steatorrhea is controlled-calories to cover RDA for age and sex; if fails to grow-BEExactivity factors plus disease coefficients; may need 110-200% of normal energy needs --PRO 15-20% calories-malabsorption due to pancreatic deficiency --CHO 45-55% total calories --liberal fat to compensate high energy needs 35-40% of calories --additional 2-4 g salt/day in hot weather, with heavy perspiration --age-appropriate doses of water-soluble vitamins and minerals --supplement zinc, water soluble forms of fat soluble vitamins (A and E)

Answer 152

1. classification --systolic: contraction, diastolic: relaxation --may be primary (essential) or secondary due to another disease --classified in stages based on risk of developing coronary heart disease Normal: <120/80 Elevated:120-129 and <80 Stage 1: 130-139 or 80-89 Stage 2: >140 or >90 --obesity is a major factor in the cause and treatment 2. management --thiazide diuretics may induce hypokalemia --four modifiable factors in primary prevention and treatment: overweight, high salt intake, alcohol consumption, physical inactivity --salt restriction <2300 mg Na/day; decrease weight if needed --DASH diet-Dietary Approaches to Stop Hypertension; whole grains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI (not supplements) 3. Mediterranean diet --rich in alpha linolenic acid, high in monosaturated fats --olive, canola, soybean oils; walnut, almonds, pecan, peanuts, pistachios --fish, poultry and eggs rather than beef; breads, fruits and vegetables in abundance; beans, legumes; yogurt, cheese, moderate consumption of wine with meals --resveratrol, in skins of red grapes, may lower blood pressure

Answer 153

1. risks: HTN, obesity, smoking, elevated blood lipids, hereditary 2. coronary artery disease: hard, narrow arteries from plaque buildup 3. ischemia: deficiency of blood due to obstruction 4. arteriosclerosis- loss of elasticity of blood vessel walls 5. myocardial infarction- reduction of coronary flow to myocardium due to blood clot blocking narrowed coronary artery --angina pectoris- chest pain; heparin given for blood clots 6. dyslipidemia (includes high TG and low HDL) 7. metabolic syndrome: three or more of the following risk factors are linked to insulin resistance which often increase risk for coronary events: elevated BP; elevated TG; elevated BG; waist measurement M>40, F>35; low HDL

Answer 154

1. Chylomicron: synthesized in intestine from dietary fat, transports dietary TG from gut to adipose, lowest density: smallest amount of protein 2. VLDL (pre-beta): transports endogenous TG from liver to adipose 3. LDL (beta): transports cholesterol from diet and liver to all cells --small dense LDL-C associated with increased risk, responsive to diet --larger buoyant LDL not associated with increased risk 4. HDL (alpha): reverse cholesterol transport; moves cholesterol from cells to liver and excretion 5. IDL (pre-beta to beta): LDL precursor; catabolism of other lipoprotein

Answer 155

LDL-C: <100 optimal Total cholesterol: <200 desirable HDL-C: M <40, F <50; >/=60 high High homocysteine (Hcy) levels are independent risk factors for CHD Normal TG <150

Answer 156

1. Saturated fat <7% of total calories, <200 mg cholesterol, 2g sodium, no trans fat 2. Promote whole grains, fruits, vegetables, low fat or fat-free dairy, unsaturated fats 3. Includes 20-30 g fiber per day and 5-10 g soluble fiber

Answer 157

1. Patients who have ASCVD artherosclerotic cardiovascualr disease 2. Patients with LDL >/= 190 mg/dL 3. Patients with T2DM 40-75 years old 4. Patients with an estimated 10-year risk of CVD of 7.5% or higher 40-75 years old

Answer 158

1. etiology --weakened heart fails to maintain adequate output, resulting in diminished blood flow so fluid is held in tissues (edema); dyspnea (shortness of breath) --reduced blood flow to kidneys causes secretion of hormones that hold in Na and fluid leading to weight gain 2. treatment --digitalis increases strength of heart contraction --low sodium (2-3 grams), DASH diet, 1-2 L fluid --1.1-1.4 g PRO/kg ABW for normally nourished and malnourished --energy needs: RMR x physical activity factor --evaluate thiamin status (loss with loop diuretics). Without thiamin, pyruvate cannot be converted into acetyl CoA for energy, so heart muscle is deprived --DRI folate, Mg; MV with B12 --encourage individualized regular physical activity 3. cardiac cachexia: unintended weight loss, blood backs up into liver and intestines causing nausea and decreased appetite. Arginine and glutamine may help. Low saturated fat, low cholesterol, low trans fat, <2 g sodium, high calorie

Answer 159

1. glomerulus-tuft of capillaries held closely by Bowman's capsule-produces ultrafiltrate which then passes through tubules. Capsule blocks passage of red blood cells and large molecules like protein 2. proximal convoluted tubule-major nutrient reabsorption 3. Loop of Henle-water and sodium balance 4. distal tubule-acid-base balance

Answer 160

1. filtration-RBCs, protein stay in blood; all else filters through tubules 2. absorption- 100% glucose, amino acids; 85% water, sodium, potassium 3. excretion-wastes, urea, excess ketones 4. secretion-secretes hormones that control blood pressure, blood components; secretes ions that maintain acid-base balance

Answer 161

1. vasopressin (ADH)-from hypothalamus (stored in pituitary) --exerts pressor effect; elevates blood pressure --increases water reabsorption from distal and collecting tubules --SIADH-syndrome of inappropriate antidiuretic hormone; hyponatremia caused by hemodilution, treated with fluid restriction 2. renin-vasoconstrictor --secreted by glomerulus when blood volume decreases --stimulates aldosterone to increase sodium absorption and return blood pressure to normal 3. erythropoietin EPO --produced by kidney; stimulates bone marrow to produce RBC

Answer 162

1. decreased glomerular filtration rate, creatinine clearance 2. increased serum creatinine, BUN 3. BUN: creatinine ratio > 20:1 indicates a "pre-renal state" in which BUN reabsorption is increased due to acute kidney damage (may be reversible and may not require dialysis) --BUN:creatinine ratio <10:1 suggests reduced BUN reabsorption due to renal damage (may need dialysis) 4. renal solute load-solutes excreted in 1 L urine; daily fixed load of 600mOsm --mainly measures nitrogen (60%) and electrolytes (sodium)

Answer 163

1. anemia due to decreased production of erythropoietin 2. upset in blood pressure 3. decreased activation of vitamin D (kidney produces active form which promotes efficient absorption of calcium by the gut)

Answer 164

1.5-2 L fluid/day needed to dilute urine 1. calcium oxalate stones --adequate calcium intake (RDA from dairy or supplements with meals) to bind oxalate and a low oxalate (40-50 mg) diet (dark leafy greens, chocolate, strawberries, nuts, beets, tea) --more stones are detected in diets deficient in calcium 2. alkaline ash/acid ash diets --minerals not oxidized in metabolism leave an ash (residue) in urine --to prevent acidic stones-create an alkaline ash: increase cations (Ca, Na, K, Mg) by adding vegetables, fruits, brown sugar, molasses --to prevent alkaline stones-create an acid ash: increase anions (Cl, Ph, Su) by adding meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye

Answer 165

1. sudden shutdown with previously adequate capacity; decreased GFR, inadequate pre-renal perfusion 2. due to burns, accident, obstruction, severe dehydration 3. symptoms-oliguria (<500 mL urine), azotemia (increased urea in blood) 4. at first: IV glucose, lipids, protein 1-1.3 g/kg if non-catabolic without dialysis as GFR returns to normal 1.2-1.5 g/kg if catabolic and/or initiation of dialysis 5. 225-40 kcal/kg, BEE x stress factor (1.2-1.3) during hypermetabolic conditions. Energy expenditure increases as kidney function declines 6. low sodium (2-3 g), replace in diuretic phase 7. 8-15 mg/kg phosphorous. May need phosphate binders 8. 2-3 g potassium based on output, serum potassium, dialysis 9. replace fluid output from previous day plus 500 mL

Answer 166

1. defect in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through the tubules 2. albuminuria, edema, malnutrition, hyperlipidemia (more synthesis and less clearance of VLDL) 3. .8-1.0 g/kg; 50% from HBV. Excess protein will be catabolized to urea and excreted 4. <30% fat, low saturated fat, 200 mg cholesterol 5. 35 kcal/kg/day 6. modest sodium restriction 2-3 g/day-depends on HTN, edema 7. calcium 1-1.5 g/day, supplement vitamin D 8. may need fluid restriction with edema 9. abnormalities in iron, copper, zinc, calcium related to protein loss

Answer 167

1. anorexia, weakness, weight loss, nausea, vomiting 2. anemia due to deficient production of hormone erythropoietin by kidney 3. Mediterranean diet, DASH, high fruit and vegetable intake 4. 25-35 kcal/kg 5. <2300 mg/day sodium 6. CKD 3-5: 0.55-0.6 g PRO/kg, or 0.28-0.43 g/kg with keto acid analogs meet 0.55-0.6 g PRO/kg 7. phosphorous: adjust intake to maintain normal serum level 8. calcium: 800-1000 mg total elemental 9. potassium generally not restricted unless serum level is elevated and urine output is <1 L/day 10. fluid generally unrestricted in CKD 1-4 11. consider supplementation of folate, vitamin B12, B complex if needed; vitamin C and D supplementation if at risk of deficiency

Answer 168

1. 1-1.2 g PRO/kg SBW (standard body weight) 2. 25-35 kcal/kg 3. <2.3 g Na 4. 25-35% fat; <7% saturated; <200 mg cholesterol 5. fluid individualized for body weight, urine output, residual kidney function 6. potassium: adjust intake to maintain normal serum range 7. calcium: individualized with maximum 2 g elemental total 8. 800-1000 mg phosphorous or <17 mg/kg IBW or SBW 9. vitamins B6, folate, B12 to correct deficiencies based on symptoms 10. vitamin D and C supplements if deficient 11. vitamin A and E supplements NOT recommended

Answer 169

1. 1-1.2 g PRO/kg SBW or adjusted BW 2. 25-35 kcal/kg 3. < 2.3 g Na-based on blood pressure and weight 4. potassium generally unrestricted (usually 2-4 g) 5.

Answer 170

insulin deficient, depend on exogenous insulin strategies: 1. with fixed daily doses of insulin, consistency of CHO is recommended 2. integrate insulin therapy with usual eating habits 3. monitor blood glucose and adjust insulin doses for amount of food eaten 4. with intensive insulin therapy, adjust pre-meal insulin dosages based on total CHO content of each meal, using an insulin-to-CHO ratio 5. for planned exercise, reduction in insulin dosage may be best choice 6. endurance athletes: 120-180 mg/dL is guideline during activity

Answer 171

insulin-resistance with relative insulin deficiency (may need insulin) strategies: 1. achieve glucose, lipid, and blood pressure goal 2. weight loss if necessary: improve food choices, space meals, exercise

Answer 172

1. acanthosis nigricans (gry-brown skin pigmentations in skin folds) from insulin resistance 2. GADA glutamic acid decarboxylase antibodies

Answer 173

Normal blood glucose: 70-100 mg/dL, 2hPG (post-prandial) <140 mg/dL impaired fasting glucose: FPG 100-125 impaired glucose tolerance 2hPG 140-199 diabetes-fasting plasma glucose: >/= 126 or glucose tolerance test: >/=200 or symptoms of diabetes plus casual plasma glucose >/= 200 mg/dL; HgA1c >/= 6.5%

Answer 174

1. measures % of hemoglobin that has glucose attached 2. normal <5.7%; over 65 years <7% in healthy,

Answer 175

compares blood glucose response of a food to a standard glucose load 1. affected by cooking methods and processing of starch; as particle size decreases, the index increases 2. foods with low index: legumes, milk, whole grains, fruits, vegetables 3. glycemic load: weighted average of the glycemic indexes of all foods eaten 4. use of index as a method for weight loss or weight maintenance is not currently recommended

Answer 176

1. maintain normal blood glucose (average pre-prandial goal 70-130; peak post-prandial average <180) 2. optimal serum lipid levels: LDL <100; TG <150; HDL >40M >50F 3. blood pressure goals systolic <130, diastolic <80 4. prevent and treat chronic complications

Answer 177

risk factors BMI>30, history of GDM 1. at 24-28 weeks of gestation, screen with 50g oral glucose load; glucose >/= 140 mg/dL indicates need for further testing 2.40-45% CHO, 3 small-medium sized meals and 2-4 snacks 3. DRI for CHO during pregnancy is 175 g/day 4. 15-30 g CHO at breakfast (less well tolerated), rest divided evenly 5. increases risk of fetal macrosomia (LGA large for gestational age, 4000-4500 grams), fetal hypoglycemia at birth 6. overweight/obese: modest energy restriction to slow weight gain

Answer 178

(CHO management approaches include carb counting, the plate method for portion control, and CHO exchange list) One choice from the starch, fruit or milk list =15 grams CHO and each is a CHO choice Foods with 6-10 g CHO provide 0.5 CHO serving Provides a range of 3-5 CHO servings at each meal and 0-4 CHO servings during snacks

Answer 179

1. Bolus: premeal or prandial --rapid acting: Aspart (Novolog), Lispro (Humalog); take 5-15 minutes before eating, usual duration 4 hours --short-acting: Regular (Humulin R); take 30-35 minutes before meal (burst of insulin to cover the meal just about to be eaten). One unit covers 10-15 g CHO; duration 3-6 hours 2. Basal, background --intermediate-acting: NPH (Humulin N, Novolin N, ReliOn); onset 2-4 hours, duration 10-16 hours, cloudy in appearance --long-acting: Glargine (Lantus), Determir (Levemir); onset 2-4 hours, duration 18-24 hours. Start at 10 units/day or 0.1-0.2 units/kg. Take around same time each day

Answer 180

1. fixed or conventional therapies: premixed or fixed insulin plan. Basal or intermediate is combined with short or rapid-acting 2. MDI (multiple daily injections) basal insulin once or twice daily and rapid-acting bolus before meals (more common) 3. CSII (continuous sustained insulin infusion): insulin pump therapy provides steady, measured continuous dose of basal, and a surge (bolus) dose of insulin before meals

Answer 181

1. biguanides: Metformin (glucophage)-suppress hepatic glucose production. First line therapy for most with T2DM. Take with food. Check B12 levels. Deficiency can lead to anemia or peripheral neuropathy. Weight neutral. Low risk of hypoglycemia. 2. DPP-4 inhibitors: saxagliptin (Onglyza), sitagliptin (Januvia), often used with Metformin. Allows endogenous GLP-1 to stay active longer, reduces glucose released by liver overnight and between meals. Weight neutral. 3. SGLT-2 inhibitors: canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance) target blood glucose-lowering action in kidneys, by blocking a protein that returns glucose to blood after it is filtered through the kidney. More glucose is excreted in urine, less reabsorbed. Monitor kidney function. Weight loss. Considered for patients with T2D and CKD. 4. glucagon-like peptide-1 (GLP-1) receptor agonist: Exenatide (Byetta), dulaglutide (Trulicity), semaglutide (Ozempic) slows gastric emptying, enhances insulin secretion when glucose is high after eating, suppresses postprandial glucagon secretion, promotes fullness and leads to weight loss 5. TZD Thiazolidinediones: (Actos)-increase insulin sensitivity in muscle. Weight gain 6. Sulfonylureas: glimepiride (Amaryl) secretagogue stimulates pancreas to release more insulin. May lead to hypoglycemia. Weight gain.

Answer 182

natural increase in early morning blood glucose and insulin requirements due to increased glucose production in liver after overnight fast --increased need for insulin at dawn

Answer 183

1. acute ketoacidosis-hyperglycemia due to insulin deficiency or excess CHO intake, dehydration due to polyuria, increased pulse, fruity odor of ketones. Treatment: insulin, rehydration 2. acute hypoglycemia-insulin reaction (shock); due to insulin excess or lack of eating, slow pulse, cool, clammy skin, hungry, weak, shakiness, sweating. Treatment: glucose; begin with 15g CHO glucose tablet, fruit juice, sugar; if still <70 mg/dL after 15 min repeat; repeat until BG normal; if unresponsive: administer glucagon to mobilize glucose from liver 3. long term-neuropathy (peripheral and autonomic, gastroparesis), retinopathy (leads to blindness), nephropathy (decreased kidney function)

Answer 184

1. overstimulation of pancreas or increased insulin sensitivity; blood glucose falls below normal 2-5 hours after eating (<50 mg/dL) 2. weak, trembling, extreme hunger 3. goal is to prevent marked rise in blood glucose that would stimulate more insulin 4. avoid simple sugars, 5-6 small meals/day, spread intake of CHO throughout the day, protein at RDA levels

Answer 185

1. atrophy of adrenal cortex; symptoms due to absence of adrenal hormones 2. low cortisol: glycogen depletion, hypoglycemia low aldosterone: sodium loss, potassium retention, dehydration low androgenic: tissue wasting, weight loss 3. diet- high PRO, frequent feedings, high salt

Answer 186

excess secretion of thyroid hormone 1. elevated T3 and T; increased BMR leading to weight loss 2. increase calories

Answer 187

deficiency of thyroid hormone 1. T4 low; T3 low or normal, decreased BMR leading to weight gain 2. weight reduction

Answer 188

enlargement of thyroid gland due to insufficient thyroid hormone 1. endemic goiter-inadequate iodine intake --diet-iodized salt; free of goitrogens-cabbage family such as brussels (contain goitrin which inhibits synthesis of thyroid hormone)

Answer 189

disorder of purine metabolism 1. increased serum uric acid; deposit in joints causing pain, swelling 2. achieve and maintain healthy body weight 3. moderate protein, liberal CHO, low to moderate fat, decrease alcohol, liberal fluid, avoid high purine foods (anchovies, sardines, organ meats, sweetbreads, meat-based gravies and extracts) 4. medications (urate eliminant, colchicine) induce loss of nutrients

Answer 190

due to missing enzyme that would have converted galactose-1-PO4 into glucose-1-PO4 1. treated solely by diet-galactose and lactose free 2. NO: organ meats (naturally contain galactose), MSG extenders, milk, lactose, galactose, whey, casein, dry milk solids, curds, calcium or sodium caseinate, dates, bell peppers 3. OK: soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG

Answer 191

1. unable to synthesize urea from ammonia resulting in ammonia accumulation 2. vomiting, lethargy, seizures, coma, anorexia, irritability 3. diet-protein restriction (1.0, 1.5, 2.0 g/kg based on tolerance, age, projected growth rate) to lower ammonia; therapeutic formulas to adjust protein composition to limit ammonia production 4. example: OTC Ornithine transcarbamylase deficiency

Answer 192

1. missing enzyme-phenylalanine hydroxylase-which would convert phenylalanine into tyrosine; phenylalanine and metabolites accumulate leading to poor intellectual function ---detected with Guthrie blood test 2. diet ---restrict substrate phenylalanine (PHE), supplement product tyrosine (TYR). Tyrosine becomes a conditional amino acid. ---low in phenylalanine, but provide enough to promote normal growth: Phenex-1,2, Phenyl-Free 1,2 (low phenylalanine formulas) ---avoid aspartame 3. need for phenylalanine decreases with age, infection 4. low protein, high CHO intakes may lead to increased dental caries

Answer 193

1. deficiency of glucose-6-phosphatase in liver; impairs gluconeogenesis and glycogenolysis 2. liver cannot convert glycogen into glucose leading to hypoglycemia 3. provide a consistent supply of exogenous glucose with raw cornstarch at regular intervals, and a high CHO, low fat diet

Answer 194

1. treatable inherited disorder of amino acid metabolism 2. characterized by severe elevations of methionine and homocysteine in plasma, and excessive excretion of homocysteine in urine 3. associated with low levels of folate, B6, B12 4. newly diagnosed patients receive increased doses of folate, pyridoxine (B6), B12 5. if they don't respond: low protein, low methionine diet

Answer 195

1. inborn error of metabolism of the BCAAs leucine, isoleucine, valine 2. poor sucking reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of sweat and urine 3. restrict BCAA 45-62 mg/day (may use MSUD powder) 4. provide adequate energy from CHO and fat to spare amino acids 5. include small amounts of milk to support growth; gelatin may be used 6. avoid eggs, meat, nuts, other dairy products

Answer 196

1. diet modification of sucrose, starch, and maltose 2. if on sacrosidase (oral enzyme replacement for sucrase), they do not need to restrict sucrose in their diet (just starch and maltose). Enzyme is taken before and during meals and snacks 3. Diabetics on Sacrosidase need to check blood glucose levels. It converts sucrose into fructose and glucose

Answer 197

inflammation of peripheral joints 1. regular, well-balanced diet with vitamin intake to at least DRI's 2. bed rest, aspirin, reduce overweight to decrease stress 3. normocytic anemia may develop --not diet related, inflammation of arthritis prevents reuse of iron --"anti-inflammatory diet" may help osteoarthritis: fresh fruits and vegetables, resembles Mediterranean diet 4. methylprednisolone: steroid that may decrease inflammation

Answer 198

1. no specific dietary guidelines, tailor to needs 2. may have dietary deficiencies of iron, folate, calcium, fiber, B12 3. may have anemia but does not correlate with iron intake 4. may show symptoms of celiac disease

Answer 199

osteoclasts: resorb and remove bone osteoblasts: reform bones

Answer 200

loss of bone tissue 1. Type 1 postmenopausal (within 15-20 years), Type II age-associated >70 2. white and Asian women: more osteoporotic fractures than black or Hispanic 3. causes: malnutrition (especially protein), lack of exercise, decline in estrogen 4. result is reduction in amount of bone due to defective calcium absorption (deossification) 5. treatment: HRT-hormone replacement therapy, weight-bearing exercise, vitamin D (400-800mg) and calcium (>/=1200mg, don't exceed 500-600 mg at one time) supplements, adequate protein, moderate to low sodium, 5 or more servings of fruits and vegetables 6. take calcium carbonate with food; calcium citrate with or without food 7. spread calcium throughout the day to maximize absorption

Answer 201

reduction in bone density-demineralization 1. vitamin D deficiency-lack of sunlight or diet intake 2. vitamin D, calcium supplements

Answer 202

seizures, altered consciousness 1. anticonvulsants phenobarbital and phenytoin (Dilantin) interfere with calcium absorption --take 1 mg folate daily with drug --may need supplements of vitamin D, calcium, thiamin --provide phenytoin separate from meals and other supplements --enteral feedings decrease bioavailability of phenytoin so hold tube feedings >/= 2 hours 2. ketogenic diet-high fat, very low CHO, 4 g fat: 1 gram non-fat --90% calories from fat, 1 g PRO/kg, remaining calories from CHO --ketone bodies behave as inhibitory neurotransmitters; mild dehydration needed to prevent dilution of ketones 3. need supplements of Ca, D, folate, B6, B12 (spinach may aid in absorption) 4. MCTs are more ketogenic, more rapid metabolism and absorption

Answer 203

non-hereditary, brain damage; inadequate control over voluntary muscles leading to spasms 1. spastic form-difficult, stiff movement; limited activity; obese --low calorie, high fluid, high fiber diet 2. non-spastic (athetoid) form--involuntary wormlike movement, constant irregular motions leading to weight loss --high calories, high protein diet; finger foods

Answer 204

1. systemic inflammatory response: hypermetabolism, hyperglycemia, insulin resistance and protein wasting 2. enteral feeding into small bowel is often best option 3. provide energy at 140% of estimated REE 4. 1.5-2 g PRO/kg

Answer 205

1. long term issues: obesity, CVD, pressure ulcers 2. acute phase: energy needs may be 10% below predicted, 2 g PRO/kg 3. rehabilitation: .8-1.0 g PRO/kg, 23 kcal/kg for quadriplegic patients, 28 kcal/kg for paraplegia 4. neurogenic bowel slows transit time: 1 mL fluid/kcal plus 500 mL/day

Answer 206

1. 30-35 kcal/kg if malnourished or at risk for malnutrition 2. Stage 1 1.1-1.2 g/kg PRO 3. Stage II 1.25-1.5 g/kg PRO, adequate fluid 4. Stag III 1.5-2.0 g/kg PRO depending on size of injury and protein loss from draining wounds 5. well-balanced diet including good sources of vitamins A, C, zinc, copper 6. Braden scale: Stage I: upper layer of skin, red and warm to touch Stage II: broken skin, open sore Stage III: damage below skin surface into fat tissue Stage IV: large wound, may affect muscles and ligaments

Answer 207

1. provide wholesome foods at regular mealtimes with small servings followed by refills 2. sugar does not cause hyperactivity 3. Adderall side effects: lack of appetite, nausea, weight loss 4. if child underweight, consider high calorie snacks at bedtime

Answer 208

unnecessary food restrictions, possible food aversions, excessive supplementation can place children with ASD at risk

Answer 209

1. avoid distractions (no TV during meals), regular consistent mealtimes, encourage self-feeding, offer one course at a time, lower saturated fats, soft calming background music, finger foods may be helpful, avoid dehydration, nutrient dense foods, may need verbal cues to chew and swallow 2. anomia, form of aphasia: lost words, unable to recall names of common items 3. nutrients associated with dementia: folate, B6, B12

Answer 210

1. decrease in total red cell mass due to fewer RBCs or to smaller cells with less hemoglobin 2. microcytic, hypochromic anemia: small, pale cells; due to iron deficiency; associated with chronic infections, malignancies, renal disease --RBC: may be normal --Hgb: low --Hct: low --MCV: low <80 --MCH: low --MCHC: low <31 3. macrocytic, megaloblastic anemia: FEW large cells, filled with Hgb; due to deficiency of folate or vitamin B12; Schilling test for pernicious anemia --RBC: decreased --Hgb: low --Hct: low --MCV: high >95 --MCH: high --MCHC: normal >31 4. thalassemia: defective Hgb synthesis resulting in microcytic, hypochromic, short-lived RBC. May develop iron overload. Do not avoid iron-rich foods. Managed with transfusions and chelation therapy. Provide high protein, B vitamins (especially folic acid), zinc 6. foods high in iron: liver, kidney, beef, dried fruits, dried peas and beans, nuts, leafy green vegetables, fortified whole grain products 7. typical American diet contains 6 mg iron/1000kcal

Answer 211

1. Ag-Ab reaction: when antigen enters body, antibody reacts 2. Immunoglobin E (IgE) mediated reaction to normally harmless food protein --common allergens-peanuts, eggs, milk, soy, wheat, shellfish --cow's milk protein is the most common single allergen for infants --potentially allergenic foods, such as eggs and peanuts, should not be restricted beyond 4-6 months of age --atopy: genetic predisposition to produce excessive IgE antibodies in response to an allergen 3. diagnosis-diet history, skin tests, elimination diet (omit suspected foods) --CAP-FEIA blood test is specific in identifying children with milk, egg, fish, peanut allergy --DBPCFC-double blind, placebo-controlled food challenges-identify food-induced symptoms (gold standard for diagnosis) --RAST (alternative to skin test) serum is mixed with food on paper disk; measures specific IgE antibodies 4. rice is food least likely to cause allergy 5. food intolerance (Non-IgE): abnormal physiologic response, GI, cutaneous, respiratory symptoms, but NO antibody production

Answer 212

1. Excessive fluid loss may lead to dehydration (hyperglycemia, dry, loose inelastic skin); IV feedings of dextrose and water, then diet high in calories and fluids 2. BMR increases 7% for each degree rise in F temp; normal temp 98.6F

Answer 213

Goals: improve outcomes regarding infection rates, days in CCU, days on ventilator. Minimize catabolic loss of body protein. Initiate nutrition support, enterally whenever possible, within 24-48 hours of admission. Avoid overfeeding. Control blood glucose: 140-180 mg/dL EAL recommends that average intake within the first week be greater than 60% of total energy need. Consider fish oil supplements and antioxidants with ARDS and acute lung injury

Answer 214

1. immediate shock period-catabolism; BMR rises 50-100% --replace fluids and electrolytes lost 2. recovery period: increase calories (based on burn size estimated by Rule of Nines which divides the body surface area into percentages) --Arm including hand, head and neck, genitalia: 9% each --Anterior trunk, posterior trunk, legs including feet: 18% each 3. 20-25% calories as protein (1.5-2 g PRO/kg, 1.2 g/kg if burn <10% BSA) 4. vitamin C 500mg x 2, water soluble vitamins, vitamin K if on antibiotics 5. zinc for wound healing if zinc deficient, 220 mg zinc sulfate

Answer 215

hypermetabolic, flight or fight response 1. accelerated catabolism of lean body mass leading to negative nitrogen balance as protein is catabolized to release glucose for energy 2. Results of physiologic trauma: hyperglycemia, hyperinsulinemia, little to no ketosis, increase glucagon to increase glucose production from amino acids --catecholamines epinephrine, norepinephrine-hepatic glycogenolysis --ACTH- releases cortisol which mobilizes amino acids from muscle --aldosterone-renal sodium retention, gluconeogenesis --ADH-renal water reabsorption --hypovolemia, decreased cardiac output, drop in body temperature --fluid and sodium retention, potassium excretion, loss of nitrogen, sulfur, zinc, phosphorous 3. provide adequate but not excessive calories 25-30 kcal/kg ABW, 1.2-1.5 g PRO/kg

Answer 216

1. pre-active stage of dying: decreased intake of foods and liquids 2. active stage: inability to swallow, abnormal breathing patterns

Answer 217

1. altered taste acuity: add flavorings and seasonings 2. meat aversions may require elimination of red meat 3. thrush from oral infections: avoid spicy, acidic, strongly flavored foods --provide bland liquids, soft foods, chilled or frozen foods 4. throat or neck cancer--use PEG for feeding 5. cancer cachexia (generalized wasting) connected to cytokines and the tumor-necrosis factor (TNF) 6. hypercalcemia may be a sign of breast cancer, metastasis to the bone

Answer 218

1. radiation-loss of taste, xerostomia (dry mouth, so moisten foods adding water or milk, sauces, gravies), esophagitis, diarrhea, malabsorption --mucositis-inflammation of mucosal lining of oropharynx and esophagus; avoid fresh, raw, uncooked foods, offer cold and soft food 2. chemotherapy-chemical reagents which have toxic effects --nausea, vomiting, malabsorption, anorexia --stomatitis-cracks in skin at mouth corners, riboflavin deficiency --methotrexate-anti-folate drug

Answer 219

1.interrelationship between host, agent, environment in causing disease 2. some evidence that fruits and vegetables are beneficial in overall cancer prevention (carotenoids, vitamin C) 3. some evidence that exercise in post-menopausal women decreases risk of breast cancer

Answer 220

protein and calorie starvation 1. anthropometric diagnosis, serum albumin normal, no edema 2. severe fat and muscle wasting, starved appearance 3. triceps skinfold, arm muscle circumference decreased

Answer 221

protein-calorie malnutrition -harm brought on by treatment, hospital, medications

Answer 222

1. distorted body image, dramatic weight loss, preoccupation with food and weight gain 2. therapy is multidisciplinary; weight restoration and psychotherapy --immediate concern-correct electrolyte imbalance (K) --plan with patient, regular mealtimes, varied and moderate intake, gradually reintroduced feared foods --focus kon health benefits and life-sustaining aspects of food (reason to eat) --re-feeding increases cardiac load-go slowly --recommended initial daily calorie levels range from 1000-1600 (30-40 kcal/kg), but may need to be set 100 to 300 calories above the current level of intake to support adherence

Answer 223

binge eating followed by purging syndrome 1. may present at normal or above normal weight 2. damage to teeth, throat, esophagus, rectal bleeding, bruised knuckles from purging with fingers, low potassium and chloride blood levels 3. encourage structured intake: 3 meals and 2-3 snacks daily; eat every 3-4 hours, recognizing hunger cues 4. at each meal or snack include a protein source, a healthful fat source, and a complex CHO source. All foods are acceptable 5. eat slowly, allow adequate time, drink adequate water and fluids

Answer 224

1. BMI: Class I 30-34.9; Class II 35-39.9; Class III 40+ Children: BMI for sex and age obese >/= 95th percentile 2. 3500 calories/pound body fat; to lose 1# fat/week, reduce 500 kcal/day Early rapid weight loss during diet is water-as liver glycogen is utilized 3. treatment: reduced caloric intake, exercise, behavior modification --realistic weight loss goals: up to 2#/wk, up to 10% of baseline BW, or a total of 3-5% of baseline weight if cardiovascular risk factors are present --calorie reduction strategies ----1200-1500 kcal/day for women, 1500-1800 kcal/day for men ----energy deficit of approximately 500-750 kcal/day ----one of the evidence-based diets restricting certain food types (high fat foods, high CHO foods) in order to create an energy deficit by reduced food intake ----small food-based changes: changes in SSB can assist with weight management ----meal replacements for weight loss may be recommended if the client has difficulty with portion control --physical activity: 150-420 min or more per week; for weight maintenance, 200-300 minutes per week 4. medications approved for long term use (up to 2 years) --Orlistat: lipase inhibitor, take with diet 30% cals as fat, vitamin supplements --Lorcaserin: agonist of serotonin, enhances satiety --Phentermine/topiramate: appetite suppressant, releases norepinephrine 5. pediatric overweight interventions: weight maintenance is usually recommended in overweight children; 2-5 years of age with a multicomponent weight management intervention with active participation of the parent. Weight loss may be recommended when the child has serious medical conditions 6. spot weight loss theory-belief that localized exercise reduces fat stores in the active area-research does NOT support this notion 7. when dieter reaches plateau-BMR has dropped to reflect loss 8. healthy obese-elevated LDL, normal to low HDL

Answer 225

reconstructs the small intestine to resemble the letter Y 1. creates a small gastric pouch connected directly to the jejunum 2. dumping syndrome may develop 3. supplement calcium in divided doses 1200-1500 mg, vitamin D 3000 IU, 45-60 mg iron taken apart from calcium, chewing ice may be a sign of iron deficiency 4. greater need for protein 5. for life: multivitamin, multimineral supplement with 100% DRI for vitamin K, zinc, thiamin, folic acid, copper, biotin, iron. May require B12 supplementation in addition

Answer 226

about 80% stomach removed 1. food pathway not alter 2. vitamin supplementation, monitor iron, calcium and vitamin D levels

Answer 227

1. small gastric pouch created using a fluid filled inflatable band 2. adjusted to alter the size of the opening (fully reversible) 3. restricts total amount of food eaten at one time 4. no surgery-induced malabsorption of nutrients. Deficiencies linked to decreased food intake and decreased food tolerance 5. eat slowly, sip drinks, no straws, no bubbles

Answer 228

chromosome 15 deletion 1. congenital disorder, subnormal LBM, supra-normal body fat 2. Ghrelin levels are elevated which stimulates growth hormone secretion, appetite, intake, and fat mass deposition 3. does not sense satiety, decreased energy requirements 4. obesity at 2-3 years of age, hypogonadism, muscle hypotonia, FTT, short stature 5. best treatment is to control food intake

Answer 229

bacterial enzymes ferment CHO deposits on plaque, enzymes produce acids that demineralize surface 1. low cariogenic potential foods: high protein, moderate fat, minimal concentration of fermentable CHO, strong buffer; high mineral content (Ca, P), pH>6, stimulates saliva. Low cariogenic: cheese, nuts, meat 2. sugar alcohols (sorbitol, xylitol, mannitol) do NOT promote tooth decay 3. fluorine-can control caries, supplement starting at 6 months of age if level in water supply < 0.3 ppm --fluorosis-(mottled teeth) with excessive fluoride 4. infant should not sleep with bottle-BBTD baby bottle tooth decay, ECC early childhood caries

Answer 230

inflammation of mouth 1. avoid very hot, very cold foods, spices, sour/tart foods, alcohol 2. rinse with lukewarm water after meals

Answer 231

1. decreasing gastric acidity, reflux; small, low fat, bland, low fiber 2. odynophagia is painful swallowing; globus is a lump in the throat 3. achalasia-disorder of lower esophageal sphincter motility, does not relax and open upon swallowing --causes dysphagia-difficulty in swallowing --start with pureed moist thick foods, progress to thick liquids

Answer 232

Level 0: White: thin, water; flow through straw Level 1: Grey: slightly thick; thicker than water, can flow through straw Level 2: Pink: mildly thick; sippable Level 3: Yellow: liquidized/moderately thick; spoon or cup, no lumps/spoon or drunk from cup, no lumps, effort with wide straw Level 4: Green: extremely thick/Pureed; spoon, not from cup or straw, not sticky, chewing not required/spoon, not sticky Level 5: Orange: minced and moist; minimal chewing, biting not required, lumps mashed with tongue, avoid hard, dried, tough foods Level 6: Blue: soft, bite-sized; able to chew bite-sized pieces, knife not required Level 7: Black: regular, easy to chew; can bite off and chew soft, tender pieces

Answer 233

1. avoid eating before bed, soda, caffeine, acidic foods 2. small, low fat meals, liquids empty more rapidly

Answer 234

1. progresses from pre-eclampsia to eclampsia 2. HTN, edema of face and hands, proteinuria, rapid weight gain after 20th week; may have convulsion 3. more frequently found in women with lack of prenatal care, poor diets, poor protein and calcium intakes 4. sodium restriction is NOT recommended for prevention or treatment; sodium needed to maintain normal levels of sodium in plasma during large prenatal expansion of tissues and fluids. Sodium intake should not be less than 2300 mg/day 5. proposed association between PIH and calcium deficiency

Answer 235

severe nausea, vomiting, acidosis, weight loss 1. bed rest, small amounts frequent CHO, correct fluid and electrolyte imbalance

Answer 236

1. diarrhea, malabsorption, nausea, vomiting, weight loss 2. preserve lean body mass, prevent weight loss, prevent HIV wasting 3. encourage physical activity 20 min/day, 3x/week 4. nutrient needs: BEEx1.3 for asymptomatic, based on DRI --protein: asymptomatic 0.8 g/kg, up to 1.2-2 g/kg if wasted LBM --standard doses of micronutrients if dietary intake is insufficient --if diarrhea: soluble fiber, MCT oil, electrolyte replacement beverages 5. food and water safety-low bacteria diet (neutropenic), avoid raw foods 6. HIV infected women should be counseled NOT to breastfeed 7. NRTI drugs (nucleotide nucleoside reverse transcriptase inhibitors including Retrovir, zidovudine) can lead to anemia, loss of appetite, nausea, dysphagia 8. nutritional supplementation should not be routinely recommended and herbal supplementation should be discouraged as adjunctive therapy to conventional care. Use of Vitamin C or St John's Wort could result in drug resistance. CAM (complementary alternative medicine) therapies are not inert and may have profound consequences.

Answer 237

may develop from therapy 1. high cholesterol, high TG, insulin resistance, changes in body fat distribution 2. significant loss of lean body mass can be obscured by edema and HALS 3. increase in dietary fiber decreases insulin resistance, reducing risk of fat deposition

Answer 238

high protein, high calorie with supplements needed for weight gain 2. energy needs: general guidelines plus appropriate stress factors 3. multivitamins/minerals at doses 1-2x RDA or DRI 4. lactose restriction if intolerant

Answer 239

persistent obstruction of airflow 1. emphysema-air sacs (alveoli) lose elasticity; thin, cachectic, often older; difficulty exhaling; air pocket walls expand, thin out, collapse --chronic bronchitis-excess mucus production, chronic productive cough 2. symptoms-weight loss, emaciation, anorexia 3. maintain appropriate body weight and composition 4. avoid overfeeding (more than 35 kcal/kg) to avoid excessive CO2 production. Routine use of high fat, low CHO formula is not warranted 5. small, frequent, mini meals and snacks, easy to prepare and eat, nutrient dense supplements (smoothies, meatloaf, muffins with cream cheese, tuna salad, cereal with fruit) 6. Vitamin D supplementation improved exacerbation outcomes in those with serum 25(OH) D levels 10 ng/mL or lower

Answer 240

1. lungs no longer able to exchange gases, hypermetabolism, increased energy needs; severely underweight 2. meet basic nutritional requirements, maintain stable weight, facilitate weaning from mechanical ventilation, without exceeding capacity to clear CO2 3. provide adequate but not excessive calories; avoid excess non-protein calories 4. provide enteral formula containing EPA and GLA (gamma-linoleic acid) and enhanced levels of antioxidant vitamins 5. 1.5-2 g PRO/kg BW, maintain lean body mass

Answer 241

1. Prescription for antipsychotics Clozapine, Olanzapine, Risperidone, Quetiapine: --determine history of usual weight and weight gain --weight gain of 5% above baseline: recommend referral for weight management. Weight gain of 7%: clinically meaningful gain 2. BMI of 18 or below: possible inadequate intake 3. paranoia regarding food or resulting in severe food restriction 4. suspicion that functional level, social or financial factors are compromising food intake 5. alcohol or drug abuse or eating disorder

Answer 242

1. prime concern is the next drug dose. getting food may be secondary 2. may be socially marginalized and impoverished (partly related to cost of drugs) 3. injection drug use exerts stress on immune system, increasing need for nutritional antioxidants 4. bulimia and anorexia are not uncommon. cocaine, amphetamines and ecstasy may be used to reduce appetite for desired weight loss or control

Answer 243

1. address person in a holistic manner with psychosocial support, including family members. group process is known to have positive outcomes for nutrition education 2. moderate or discontinued sugar intake: sugar ingestion releases dopamine. sugar cravings may substitute dopamine release previously available from use of many drugs. this results in mood fluctuations and weight gain. stable glucose levels are shown to decrease drug cravings and reduce relapse potential 3. moderate or discontinued caffeine. caffeine reduces mood stability by inducing the fight or flight response 4. increased complex CHO, protein and fiber with moderate to low fat intake 5. regular 3 well spaced meals and 1-3 healthy snacks 6. 30-35 kcal/kg plus 1-2 g PRO/kg, encourage fluid intake, especially water, between and with meals

Answer 244

1. standard polymeric-normal GI function, most provide 1-1.5 kcal/mL --lecithin may be added as an emulsifier --initiated full strength at rate of 10-40 mL/hr, advance 10-20 mL every 8-12 hours until goal rate is achieved --modular: mix individual components, adds flexibility --blenderized: whole food, large bore tube, thick intact protein, high residue --least expensive formulas: intact protein (NOT predigested) and isotonic (osmolality is close to that of blood) --FOS and fiber may be added to stimulate production of beneficial bacteria and may help resist Clostridium difficile 2. elemental, chemically defined-used with malabsorption --pre-digested protein or amino acids, glucose or sucrose, LCT and MCT, vitamins, minerals, electrolytes --absorbed in proximal intestine, low to no residue, don't need pancreatic enzymes, high osmolality, poor taste --used with compromised GI function, inability to digest and absorb --Alitraq, Peptamen, Vivonex 3. specialized --Nepro (renal), HepaticAid II (liver), Glucerna (diabetes) --the more specialized the formula, the greater its cost

Answer 245

opening-based on viscosity of feeding 1. large #16-blenderized whole foods 2. small #8-ready prepared formulas, more comfortable

Answer 246

1. anticipate length of time needed, risk aspiration, patient's anatomy, clinical status, normal or abnormal digestion and absorption 2. hang time open systems 8 hours, closed systems 24-48 hours 3. short term access 3-4 weeks, nasogastric tube, normal GI function --bolus method-clinically stable with functional stomach --intermittent drip (pump or gravity)-more mobility --continuous drip-constant, steady rate over 16-24 hours, usually with a feeding pump (for those with compromised GI function or who do not tolerate large volume infusion) Cyclic feeding is delivered by continuous drip at an increased rate over 8-16 hours, often overnight, by pump (for undernourished, especially older, ambulatory, malnourished patients) --nasoduodenal or naso jejunal if unable to tolerate gastric feedings --transpyloric/post-pyloric: passed by pyloric valve in stomach; used in comatose patients or ones with no gag reflex --gastrostomy or jejunostomy feedings if needed more than 3-4 weeks; PEG inserts tube into stomach through abdominal wall --do not use blue dye to check tube placement. Use Xray confirmation of tube tip location, or aspirate gastric contents

Answer 247

lactose intolerance, formula hyperosmolality, rapid infusion causes influx of water into gut

Answer 248

1. select formula and determine calories needed 2. Divide calories needed by kcal/mL to determine mLs formula needed per day 3. determine protein content: multiply mLs of daily formula by grams protein per liter 4. determine daily fluid need: multiply % water in formula x daily formula in mLs to determine water contribution of enteral nutrition. Subtract formula water from total fluid requirements to determine water flushes 5. Determine administration rate: divide total mLs of formula/day by 24 hours to determine continuous feeding goal rate

Answer 249

small surface veins 1. short term therapy with minimum effect on nutritional status --indications- post-surgery (when enteral feeding is expected to resume within 5-7 days), mild to moderate malnutrition, as supplemental to enteral 2. solutions --IV dextrose-3.4 kcal/g; highest concentration used in PPN is 10% --Protein 3-15% amino acid solutions --IVFE intravenous fat emulsion (Intralipid); 10% 1.1 kcal/mL; 20% 2.0 kcal/mL --solutions generally limited to 800-900 mOsm

Answer 250

1. infusion of a hypertonic solution delivered through a central venous catheter 2. used to achieve an anabolic state when patients are unable to eat by mouth and enteral feeding is not possible 3. ASPEN: set time frame of 7-10 days in which to achieve intake goals by the enteral route before adding PN 4. use of PN in critically ill patients has been shown to increase infectious complications, longer ICU stays and increased mechanical ventilation 5. catheters: --PICC peripherally inserted central catheter-used for short or moderate term infusion --CVC long term central access is through the cephalic, subclavian or internal jugular vein into the superior vena cava 6. concern-translocation of bacteria; not feeding through gut allows wall to breakdown, bacteria move out causing sepsis --GALT (gut associated lymphoid tissue) is compromised by bowel rest or PN. Provides 50% of total body immunity. 70-80% of total body immunoglobin production is secreted across the GI mucosa to defend against pathogenic substances in the GI lumen

Answer 251

1. protein: ratio for anabolism is 1 g nitrogen/150 calories; 1-1.5 g PRO/kg/day --crystalline amino acids 3-15% solution --% = # of g Pro in 100 mL of solution 2. energy 35-50 kcal/kg; up to 70% dextrose solution --to avoid overfeeding and hyperglycemia, start at <20-25 kcal/kg --maximum rate of dextrose infusion (glucose utilization rate) should not exceed 4-5 mg/kg/min to prevent hyperglycemia and other complications. Increased BG from excess dextrose increases RQ in ventilated patient and increases infectious complications 3. fat: needed for energy and to prevent essential fatty acid deficiency --to prevent EFAD give 500cc of 10% fat emulsion 1-2x/week --symptom of EFAD: petechiae (red spots) 4. vitamins, electrolytes, water as needed 5. TNA: total nutrient admixtures (three in one systems) include dextrose, amino acids, and lipids

Answer 252

if alimentary tract can be used if needed only for short time in well nourished during periods of cardiac instability if risks inherent in process outweigh benefits

Answer 253

1. introduce a minimal amount of full-strength enteral feeding at a low rate of 30-40 mL/hour to establish GI tolerance 2. begin tapering when enteral feedings are providing 33-50% of their nutrient requirements 3. decrease PN as you increase enteral rate by 25-30 mL/hour increments every 8-24 hours to maintain prescribed nutrient levels 4. when patient can tolerate about 60% of needs by enteral route, D/C PN

Answer 254

aggressive administration of nutrition to malnourished 1. at risk: anorexia nervosa, chronic alcoholism, prolonged fasting, unfed 7-10 days, significant weight loss, phosphorous-deficient PN 2. starved cells take up nutrients, potassium and phosphorous shift into intracellular compartments 3. results in: --hypokalemia: cardiac, renal, CHO metabolism, muscle weakness --hypophosphatemia: cardiac abnormalities, respiratory failure, seizures --hypomagnesemia: intracellular metabolism, cardiac arrhythmias, hypocalcemia 4. tightly controlled blood glucose 140-180 mg/dL 5. overfeeding PN and dextrose >5 mg/kg/min may lead to hyperglycemia; glucose moves into cells for oxidation, stimulates insulin, which decreases salt and water excretion, increasing risk of cardiac and pulmonary complications. Upon initiation of PN to a malnourished person, monitor glucose, phos, potassium, and mag

Answer 255

1. Integrative medicine combines evidence-based complementary therapies with conventional (allopathic) treatments to address the social, psychological, and spiritual aspects of health and illness 2. NCCIH National Center for Complementary and Integrative Health; yoga, meditation, herbs and botanicals, traditional healing practices 3. Complementary and alternative medicine CAM-NIH categories; mind-body medicine, alternative medical systems like acupuncture and oriental medicine, lifestyle and disease prevention, biologically based therapies including herbs and orthomolecular medicine, manipulative and body-based systems like chiropractic medicine, biofield systems like therapeutic touch, bioelectric magnetics 4. functional medicine addresses the whole person, not just symptoms, and looks at the underlying cause of disease, engaging patient and practitioner in a partnership for therapy 5. Holistic health views mental, physical and spiritual aspects of life closely connected and equally important with regard to treatment approaches

Answer 256

umbrella of nutrient guidelines

Answer 257

goals for healthy individuals to prevent nutritional deficiency diseases, includes gender, age, life phase

Answer 258

Estimated Average Requirement for 50% of population, used in planning meals for healthy people, assesses group nutritional adequacy

Answer 259

adequate intake, used when insufficient evidence exists for EAR, RDA

Answer 260

tolerable upper level not associated with adverse side effects in most individuals of a healthy population

Answer 261

revised every 5 years, USDA, DHHS 1. designed to promote health and prevent chronic disease 2. community nutrition programs use these guidelines when developing plans 3. 2020-2025 DGA --follow healthy dietary pattern at every life stage --customize and enjoy nutrient dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations --focus on meeting food group needs with nutrient dense foods and beverages and stay within calorie limits --limit foods and beverages higher in added sugars (<10% of calories/day), saturated fats (<10% of calories/day), and sodium (<2300mg/day) and limit alcoholic beverages (<2 M, <1 F)

Answer 262

USDA's overall measure of diet quality 1. measures how well Americans follow the Guidelines 2. 5 food groups, 4 nutrients (fat, sat fat, cholesterol, sodium), variety

Answer 263

Implementation of DGA 1. shows essential food groups, and offers recommendations on balancing calories, foods to increase and foods to reduce 2. build a healthy plate: make half your plate fruits and vegetables, make at least half your grains whole, use low fat or fat free milk, vary protein choices 3. choose foods and beverages with less added sugars, saturated fat, sodium

Answer 264

DHHS 1. data driven national objectives to improve health and well-being over the next decade 2. Core Objectives: measurable objectives that are associated with targets for the decade. Reflect high-priority public health issues and are associated with evidence-based interventions 3. Leading Health Indicators (LHIs) are a small subset of high-priority objectives selected to drive action toward improving health and well-being Focus on upstream measures, such as risk factors and behaviors, rather than disease outcomes, address issues of national importance, address high-priority public health issues that have a major impact on public health outcomes, are modifiable in the short term (through evidence-based interventions and strategies to motivate action at the national, state, local, and community level), address social determinants of health, health disparities, and health equity, have new data available periodically, preferably annually

Answer 265

1. Develop a mission statement (philosophy) and needs/problem statement 2. Set goals-broad direction, general purpose 3. Set objectives- specific measurable (tangible) actions within a time frame 4. Develop plan-evaluate alternative strategies (cost/effective analysis) 5. Budget development: controls and coordinates activities, indicates how and at what rate dollars are to be expended

Answer 266

what nutrition services can contribute to the health and well-being of the community; what population groups will be served; select and rank the most critical issues; what is the present situation; who says it is a problem; what will happen if nothing is done Mission statement: Clinic will work to enhance the health of its clients by reducing the risk of heart disease

Answer 267

(increase quality and years of life) 1. what health problems have nutritional implications 2. determine current nutritional high-risk groups and the most critical needs Goal: Increase the awareness of CHD risk factors

Answer 268

Objective: Increase the number of women who can identify two risk factors for CHD by 25% in one year. 1. More defined than goals; contain specific target dates for completing specific projects. Include expected results in quantitative and qualitative terms within a given time frame 2. SMART objectives: specific, measurable, achievable, relevant, time frame 3. guidelines for writing --include who, what behavior (measurable or action verb), how much, by whom, when, where --action verbs are measurable: exercise, select, list, identify, count, produce --not an action verb: appreciate, understand

Answer 269

what are all the possible ways to solve the problem, what resources would be needed to do each alternative, which alternatives are the most feasible, who needs to be involved in choosing which way is best

Answer 270

1. consider the following in preparation: expenditures of preceding period, present budget, changes in present budget period, expenditures of present period, budget requests for next period 2. phases of budget cycle: prepare requests, evaluate revenue potential, formulate document, send to legislative body, legislative review and authorization, execute the budget (run the program), evaluation and review 3. performance budget- summarizes program activities performed in terms of the cost of specified accomplishments. Ex: what it costs to supervise a food bank, or what it costs to screen children for anemia 4. funding: public health departments derive a portion of their income from general revenue (taxes), and federal, local or foundation grants --Grant: an award of financial or direct assistance: usually lasts over a few years --Block grants from federal government are given to states or local communities for broad purposes as authorized by legislation. Recipients have great flexibility in distributing funds. Five federal block grant areas: maternal and child health, community services, social services, preventative health services, primary care --CDC STEPS major federal level grant; Steps to a Healthier US focused on community-based health initiatives related to obesity. Directs funds to address asthma, obesity and diabetes prevention

Answer 271

1. educate-increase awareness, knowledge, options (cognitive learning) --scientifically sound information explained to client so they understand the reasons for the changes you are recommending --to reach large numbers: use media, hotlines, point-of choice or point of purchase intervention --in health fairs, evaluate nutritional risk using BMI 2. enable- reduce barriers to make it easier for people to act --enabling interventions relate to the 4 "P's" of marketing --the product should be acceptable, the place accessible, the price reasonable, and the promotion tailored to enable attention and acceptance 3. skill development- competencies necessary to make and sustain new eating habits (psychomotor learning) --one on one counseling, small group sessions --teaches how to: select appropriate foods, budget for healthful foods, how to obtain Food Stamps if needed, how to develop new eating behaviors

Answer 272

review of measurement of a nutrition care indicator

Answer 273

compare findings with goals or standards. It determines the degree to which progress is being made, and outcomes are being met

Answer 274

direct nutrition outcomes clinical and health status outcomes patient-centered outcomes health care use and cost outcomes

Answer 275

provide information about the type of progress made, when the nutrition problem is resolved, and what aspects of nutrition intervention are not working

Answer 276

1. represent results that the practitioner and nutrition care impacted independently 2. can be linked to nutrition intervention goals 3. are measurable with tools and resources available 4. occur in a reasonable time period and can be attributed to the nutrition care 5. are logical and biologically or psychologically plausible stepping stones to other health care outcomes 6. distinct from health care outcomes because they represent the nutrition professional's specific contribution to care (outcomes we measure) Food/nutrition related history (intake), Lab data and medical tests, anthropometrics, Nutrition-focused physical findings

Answer 277

1. health and disease outcomes-reduced readmissions, changes in severity, duration or course of a condition or disease, changes in risk level, maintenance of health 2. cost outcomes-changes in length of stay, ICU days, number of outpatient visits, treatment procedures, medications, reduced readmissions 3. patient-centered outcomes-changes in indicators that reflect functional level, disability, quality of life (Positive changes in nutrition outcomes in turn improve other health outcomes)

Answer 278

1. Documentation includes a statement of where the patient is now in terms of expected outcomes, date and time --indicators measured, results, and method for obtaining the measurement --criteria to which the indicator is compared --factors facilitating or hampering progress, other positive or negative outcomes --further plans for nutrition care, monitoring and follow-up or discharge 2. If care is to be continued, the nutrition care process cycles back as necessary to assess, diagnose and/or intervene as needed