Domain II, Topic C, Planning and Intervention Flashcards
_________ ____________ is a purposely planned action designed with the intent of changing a behavior, risk factor or condition, for an individual, group, or community. These _____________ influence the etiology or effects of a diagnosis. It is based on the nutrition diagnosis and provides the bases upon which outcomes are measured and evaluated.
Nutrition Intervention, Intervention
Four categories of Nutrition Intervention: ____ Delivery; _________, __________, ___________ of ____ with _____ __________
Food Delivery, Education, Counseling, Coordination of Care with Other Providers
________: prioritizing 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
Planning
______________: Action phase involves communication of the care plan and carrying out the plan
Implementation
________ - _____ _________ ________ (EAL Evidence Analysis Library): systematically reviewed scientific evidence used in making food and nutrition pracice decision; integrate best available evidence with professional expertise practice decisions; integrate best available evidence with professional expertise and client values to improve outcome
Evidence Based Dietetics Practice
_______ Prevention Programs: reduced exposure to a promoter of disease (early screening for risk factors like diabetes). Health Promotion.
Primary
_________ Prevention Programs: Recruiting those with elevated risk factors into treatment program (setting up an employee’s gym). Risk Reduction.
Secondary
________ Prevention Programs: As disease progresses, intervention to reduce severity, manage complications, rehabilitation efforts
Tertiary
_______ _____ __________ (FTC) : Internet, TV, radio; bogus weight loss claims
Federal Trade Commission
________ _______ _______ ______ _____ (NCAHF)
National Council Against Health Fraud
When evaluating information in health claims, ask questions based on the CARS checklist:
C__________: check credential of author
A_______: info is current, factual and comprehensive
R_____________: is into fair, balanced and consistent
S______: is supporting documentation cited for scientific statements
Credibility, Accuracy, Reasonableness, Support
_______ ________ _______ ______ (POMR)
Problem Oriented Medical Record
_______ ________ ________ (PES)
Problem, Etiology, Symptoms
______ __________ ____ (SAP)
Screen, Assessment, Plan
______ _______ _________ _______ ________ (ADIME)
Assess, Diagnose, Intervene, Monitor, Evaluate
______ ________ ___________ and ______________ ___
Permanent legal document; entries written in black pen or typed; complete, clear, concise, objective, legible, accurate; sign, date all entries; entered at the time of actual date, time of entry and the date and time it should have been recorded
Health Insurance Portability and Accountability Act
___________ on HIPAA documents;
- Never use white out, thick markers, or remove an original and replace it with a copy
- At time an entry is in progress: draw single line through error, then enter the correction, initial date
- Omitted nformation: Beside original entry: “see addendum,” enter date and initial. Write the addendum in chart sequence, identify it as an addendum and reference the original entry. Sign.
- Correction performed some time after entry: correct minor errors (spelling, one word) with singl line drawn through, make correction, date, time, sign
Corrections
_________ plan begins on Day 1 of hospital stay
-_________ note includes summary of nutrition therapies and outcomes
Discharge
All _______ information is confidential
Patient
GI Disorder _____
- Eroded Mucosal lesion
- Treatment: Antacids, antibiotics to eradicate heliobacter pylori bacteria
- Drug therapy: Cietidine, Ranitidine (H2 blocker); prevents binding of histamine to receptor, decreses acid secretion
- diet: as tolerated, well balanced, avoid late night snacks
- omit: cayenne and black pepper, large amounts of chili powder, avoid excess caffeine and alcohol
Ulcer
GI Disorder ______ ______
- Protrusion of portion of the stomach above the diaphragm into the chest
- small, bland feedings; avoid late night snacks, caffeine, chili powder, black pepper
Hiatal Hernia
GI Disorder _______ ________
- Follows a gastrectomy (Billroth I, II)
- Cramps, rapid pulse, weakness, perspiration, dizziness
- When rapidly hydrolyzed carbohydrate enters the jejunum, water is drawn in to achieve osmotic balance. This causes a rapid decrease in the vascular fluid compartment and a decrease in peripheral vascular resistance. Blood pressure drops and signs of cardiac insufficiency appear. About two hours later, the 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.
- Gastric Surgery
Dumping Syndrome
________ _ (Gastroduodenostomy) attaches the remaining stomach to the duodenum
Billroth I
________ __ (Gastrojejunostomy) attaches the remaining stomach to the jejunum. When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced. These hormones normally stimulate the pancreas, so there is now little pancreatic secretion. Calcium (most rapid absorption in duodenum) and iron absorption (requires acid) are adversely affected
Billroth II
______ can be caused by both ___ or ______ deficiency
Anemia, B12, Folate
___ deficiency is caused by a lack of intrinsic factor and bacteria overgrowth in loop of intestine being bypassed interfere with ___ absorption (pernicious anemia diagnosed using the Schilling test)
B12, B12
______ deficiency: Needs B12 for transport inside the cell; also from poor ______ intake and low serum iron (cofactor in ______ metabolism)
Folate, folate, folate
After _______ _______: Frequent small, dry feedings, fluids before or after meals (to slow passage), restrict hypertonic concentrated sweets, give 50-60% complex CHO, protein at each meal, moderate fat, B12 injections may be needed. Lactose may be poorly tolerated due to rapid transport.
Gastric Surgery
_____________ is delayed gastric emptying can be caused by surgery, diabetes, viral infections, obstructions
- Moderate to severe hyperglycemia: detrimental effects on gastric nerves
- prokinetics (erythromycin, metoclopramide) increase stomach contractility
- Small, frequent meals; pureed foods, avoid high fiber, avoid high fat (liquid fat may be better tolerated)
- Bezoar formation may be due to undigested food or medications; treatment includes enzyme or endoscopic therapy
Gastroparesis
________ _____ (bacterial, viral, parasitic infection)
- chronic GI disease, intestinal lesions, may also affect stomach
- diarrhea, malnutrition, deficiencies of B12 and folate due to decreased HCL and intrinsic factor
- antibiotics, high calories, high protein, IM B12 and oral folate supplements
Tropical Sprue
___ - ________ _____, ______ Disease, ______ - _______ Enteropathy
- Gluten refers to storage proteins (prolamins: gliadin in wheat, secalin in rye, hordein in barley, avenin in oats)
- Reaction to gliadin: affects jejunum and ileum (proximal intestine)
- Malabsorption (leads to loss of fat - soluble vitamins), macrocytic anemia, weight loss diarrhea, steatorrhea, iron deficiency anemia
- Needs gluten restricted diet: NO wheat, rye, oats, barley, bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents
- OK: corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax
Non - tropiical sprue, Celiac disease, gluten induced enteropathy
___________ sometimes due to an atonic colon (weakened muscles)
-high fluid, high fiber diet, exercise
Constipation
______________ is the presence of diveticula
- Small mucosal sacs that protrude through the intestinal wall due to structural weakness. Related to constipation and lifelong intra - colonic pressures
- High fiber diet: increases volume and weight of residue, provides rapid transit
diverticulosis
______________: 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
Diveticulitis
_____ provides indigestible bulk, promotes intestinal function
-Dietary _____: Non - digestible CHOs and lignin, binds water, increases fecal bulk; found in legumes, wheat bran, fruits, vegetables, whole grains
Fiber, fiber
___ bran and _______ fibers decrease serum cholesterol by binding bile acids converting more cholesterol into bile
Oat, 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
Soluble
AI of Fiber: __g M, __g F
38, 25
A ____ fiber may increase the need for Ca, Mg, P, Cu, Se, Zn Fe
high
A ___ fiber diet may lead to ____________
low, constipation
_________: inflammation of stomach; anorexia, nausea, vomiting, diarrhea
-diet: clear liquids, advance as tolerated, avoid gastric irritants
Gastritis
____________ ____ _______ (IBD)
- Regional Enteritis (Chron’s disease)
- Chronic Ulcerative Colitis (UC)
Inflammatory Bowel Disease
________ ________ (Chron’s Disease: Affects terminal ileum; weight loss, anorexia, diarrhea
- B12 deficiency leads to megaloblastic anemia
- Iron deficiency anemia due to blood loss, decreased absorption
Regional Enteritis
_______ __________ _______ (UC)
- Ulcerative disease of the colon, begins in rectum
- Chronic bloody diarrhea, weight loss, anorexia, electrolyte (Na,K), disturbance, dehydration, anemia, fever, negative nitrogen balance
Chronic Ulcerative Colitis
Treatment for ____________ _____ _______
- Maintaoin fluid and electrolyte balance; antidiarrheal agent (sulfasalazine)
- Acute Chron’s flare ups: bowel rest, parenteral nutrition or minimal residue
- Acute UC: elemental diet may be needed to minimize fecal volume
- Energy needs according to current BMI, limit fat only if steatorrhea; water soluble and fat soluble vitamin; iron, folate; assess Ca, Mg, Zn; MCT oil, watch lactose, frequent feedings. High fat may improve energy balance
- Once ____________ _____ _______ is under control, high fiber to stimulate peristalsis
Inflammatory Bowel Disease, Inflammatory Bowel Disease
_________ _____ ________ (IBS)
- Chronic abdominal discomfort, altered intestinal motility, bloating
- Goals: adequate nutrient intake, tailor patter to specific GI issues
- Avoid large meals, excess caffeine, alcohol, sugars
- Use food diary to track intake, emotions, environment, symptoms
- identify food allergies and hypersensitivites
- work with client to alleviate stress during eating
Irritable Bowel Syndrome
_______ ___________ due to _______ deficiency
-Normally _______ splits _______ into glucose and galactose. In its absence _______ remains intact, exerting hyperosmolar pressure. Water is drawn into the intestine to dilute the load causing distension, cramps, and diarrhea. Bacteria then ferment the undigested lactose, releasing carbon dioxide gas.
Lactose intolerance, lactase, lactase, lactose, lactase
_______ __________ can be detected with a hydrogen breath test
-hydrogen is produced by colonic bacteria on lactose, absorbed into the bloodstream and exhaled in 60 - 90 minutes
Lactose Intolerance
In a _______ ________ test an oral dose of _______ is given after a fast. If intolerant, blood glucose will rise < 25mg/dL above fasting (flat curve) If tolerant, the rise would be above 25 mg/dL (normal curve)
Lactose intolerance, lactose
On a _______ free diet, calcium and riboflavin supplements are recommended; yogurt and small amounts of aged cheese may be tolerated; lactate and lactalbumin are OK
lactose
_____ diarrhea in infants requires 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
Acute
In _______ nonspecifc diarrhea in infants:
- 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 many calories
- give 40% calories as fat, balance with limited fluids; restrict or dilute fruit juices with high osmolar loads (apple, grape)
Chronic
In _____ diarrhea:
- remove the cause; bowel rest; replace lost fluids and electrolytes, especially those high in sodium and potassium
- when diarrhea stops, begin with low fiber foods, followed by protein foods, fat need not be limited
- avoid lactose at first
- foods or supplements that contain prebiotic components (pectin, fructose, oats, banana flakes) which favor friendly bacteria
- probiotics: sources of bacteria used to reestablish bacterial gut flora
Adult
__________ (consequence of malabsorption
- normal stool fat 2 - 5 g; > 7 g is indicative of malabsorption
- determine cause and treat
- high protein, high complex CHO, fat as tolerated, vitamin (especially fat soluble), minerals, MCT (rapidly hydrolyzed in GI tract)
Steatorrhea`
_____ _____ ________ (SBS)
- Consequences associated with significant restricions of the small intestine
- malabsorption,, malnutrition, fluid and electrolyte imbalances, weight loss
- severity reflects length and location of resection, age of patient, health of remaining tract. Loss of ileum (especially distal 11/3), loss of ileocecal valve, loss of colon are of particular concern; most digestion takes place in the first 100 cm of the intestine (in duodenum and upper jejunum) what remains - small amounts of sugar, starches, fiber, lipids
Short Bowel Syndrome
_____ _________ significant resections that produce major complications
-distal: absorption of B12, intrinsic factor, bile salts
-_____ 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
-If _____ 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; renal oxalate stones
-Increased fluid and electrolyte secretion; increased colonic motility
Ileal resection, ileum, ileum,
Loss of _____: water and electrolyte loss, loss of salvage absorption of CHO and other nutrients
colon
Nutritional care after SBS
1) _________ nutrition initially to restore and maintain nutrient status
2) _______ - start early to stimulate growth, increase over time; continuous drip
3) May take weeks or months to transition to food
4) _______ - normal balance of CHO, protein, fat; avoid lactose, oxalates, large amounts of concentrated sweets; vitamin, mineral supplements
5) _____ - limit fat, use MCT (does not require bile salts, needs less intestinal surface area), supplement fat - soluble vitamins, Ca, Mg, Zn, parenteral B12, followed by monthly injections
Parenteral, enteral, jejunal, ileal
Functions of the _____ - stores and releases blood, filters toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance
Liver
______ profile - list of major enzymes found in organs and tissues; enzyme levels in blood are elevated when tissue damage causes them to leak into circulation
Enzyme
________ ___________ (ALP) 30 - 120 U/L
- Increases with liver disease
- Decreases with scurvy
Alkaline phosphatase
\_\_\_\_\_\_ \_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_ (LDH) Increased with: -Hepatitis -Myocardial Infarction -Muscle Malignancies
Lactic Acid Dehydrogenase
_________ _____ __________ (AST, SGOT) 0 - 35 U/L
- Increased with hepatitis
- Decreased with uncontrolled diabetes with acidosis
Alanine Aminotransferase
In _____ disease, enzyme levels are elevated. SGOT is decreased in uncontrolled diabetes
Liver
Symptoms of _____ _____ hepatitis
-Inflammation, necrosis, jaundice, anorexia, nausea, fatigue (1) Jaundice occurs when bile ducts are blocked
Acute Viral
HAV transmitted through _____ matter - oral transmission (type most directly connected to food)
fecal
HBV ________ transmitted
sexually
HCV ____ to ____ contact
blood to blood
Nutrition intervention for _____ _____ hepatitis:
- 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 - 1.2g protein/kg: cell regeneration, provide lipotropic agents to convert fat into lipoproteins for removal from liver
- Moderate to liberal fat intake if tolerated; limit fat if steatorrhea
- Encourage coffee (antioxidant)
- multivitamin with B complex, C, K, zinc
Acute viral
In _________ 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 the liver is disrupted. Poor food intake leads to deficiencies
-Protein deficiencies lead to ascites, fatty liver, impaired blood clotting
Cirrhosis
Normal blood flow runs from the _________, __________, or __________ veins to the ______ vein, to the _____, to the ____ ____
abdominal, esophageal, collateral, portal, liver, vena cava
_______ occurs when blood cannot leave the live
Ascites
_________ tissue overgrowth blocks blood flow out of liver into the vena cava. The liver expands (can store a liter of 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
Ascites
__________ varices occur when blood can’t enter the liver.
- 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.
- Due to portal hypertension
Esophageal
Diet for _________.
- High protein 0.8 - 1.0 g/kg; in stress at least 1.5 g/kg
- High calorie 25 - 35 cals/kg estimated dry weight or 1.2 - 1.5 x BEE
- moderate to low fat 25 - 40% of calories, MCT if needed, less than 40 grams of fat if malabsorption. Fat is prefered fuel in cirrhois. Include omega 3. Decrease LCTs if steatorrhea develops.
- Low fiber if varices are present, low sodium iif edema or ascites
- With hyponatremia, fluid restriction of 1 - 1.5 L/day depending on severity, and moderate sodium intake
- B complex vitamins, C, K Zn, Mg; monitor need for A and D
- Zinc involved in the conversion of ammonia to urea, increased loss in urine
Cirrhosis
_________ liver disease - hepatic steatosis, alcoholic hepatitis, cirrhosis
Alcoholic
_____ injury is due to the alcohol and metabolic derangement it causes
Liver
_______ is converted into acetaldehyde and excess hydrogen which disrupts liver metabolism
alcohol
In alcoholic liver disease, _______ replaces fat as fuel in the Kreb’s cycle, so fat accumulates in liver, leading to fatty liver, and in blood, raising the TG level
Shift in ____/___ ratio inhibits beta-oxidation of fatty acids and promotes TG synthesis
Hydrogen, NADH/NAD
_______ causes inflammation of GI tract and interfeeres with absorption of thiamin, B12, vitamin C, and folic acid
Alcohol
_______ interferes with vitamin activation
Alcohol
Increased need for _ vitamins to metabolize alcohol
B
Increased need for _________; excreted after alcohol consumption
magnesium
Malnutrition increases _______ destructive effects
alcohol’s
_____ and _______ deficiencies are most responsible for malabsorption in alcoholic liver disease
Folate and protein
_______ deficiency in Wernicke - Korsakoff
Thiamin
_______ _______ (ESLD)
- liver function decreases to 25% or less
- liver cannot convert ammonia into uream ammonia accumulates
- apathy, drowsiness, confusion, coma (PSE - portal systemic encephalopathy)
- Asterisix (flapping, invoulantary jerking motions) sign of impending coma
Hepatic Failure
Nutrition treatment for _______ failure
- If not comatose: moderate to high levels of protein, increase up to 1 - 1.5 gran protein/kg as tolerated
- 30 - 35 calories/kg; 30-35% calories as fat with MCT if needed
- Low sodium if ascites; vitamin/mineral supplementation
Hepatic
_______ ________________ Theory is designed for hepatic failure: BCAA levels decrease (used by muscles for energy); AAA (aromatic amino acids) increase because damaged liver is unable to clear them
- adding BCAA adds calories and protein; may nt reduce symptoms
- used when standard therapy does not work and when patient does not tolerate standard protein
Altered Neurotransmitter Theory
Standard treatment for _______ failure is lactulose (hyperosmotic laxative that removes nitrogen); neomycin (antibiotic that destroys bacterial flora that produce ammonia)
lactulose
___ - _________ _____ liver disease
- Steatosis, more common with BMI greater than 35, type 2 diabetes, metabolic syndrome
- excess fat buildup in liver unrelated to alcohol consumption
- Can be managed with lifestyle changes
1) 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
2) Healthful eating: mediterranean diet, moderate alcohol, avoid sugar sweetened beverages, coffee may help (antioxidant)
3) Physical activity: at least 150 minutes of moderate intensity aerobic activity, plus two strength training session each week
Non - alcoholic fatty
___________ disease
- Cholecystitis - inflammation of the ___________
1) An infection causes excess water to be absorbed causing cholesterol to precipitate out leading to gallstones - cholelithiasis
Gallbladder,gallbladder
Treatment for ___________ disease
1) low fat diet: acute 30 - 45 grams; chronic 25 - 30% of calories
2) cholecystectomy - surgical removal of the 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
Gallbladder
____________ inflammation with edema, cellular exudate and fat necrosis
-may be due to a blockage or reflux of the ductal system; premature activation of enzymes within pancreas leads to auto-digestion
Pancreatitis
_____ - pancreatitis
- put pancreas at rest, withhld all feeding, maintain hydration (IV)
1) progress as tolerated to easily digested foods with a low fat content
2) elemental (predigested) enteral nutrition into jejunum may be tolerated
Acute
_______ - pancreatitis
- Recurrent attacks of epigastric pain of a long duration
1) PER: Pancreatic enzyme 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
2) To promote weight gain, give maximum level of fat tolerated without an increase in steatorrhea or pain
3) If malabsorbing fat soluble vitamins give water soluble forms
4) Pancreatic bicarbonate secretion may be defective; may need antacids so PERT therapy will work
5) In severe prolonged cases, parenteral nutrition may be needed
6) To avoid pain: avoid large meals with fatty foods, alcohol
Chronic
______ ________
-Disease of exocine glands: secretion of thick mucus that obstructs glands and ducts; chronic pulmonary diseases, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption
Cystic Fibrosis
Nutrition treatment for ______ ________
1) PERT- pancreatic enzyme replacment therapywith meals and snacks
2) High protein, high calorie, unrestriced fat, liberal in salt
- if growing normally and steatorrhea is contolled: calories to cover RDA for age and sex; if fails to grow - BEE x activity factors plus disease
- Protein 15 -20% calories: malabsorption due to pancreatic deficiency
- CHO 45 - 55% total calories
- Liberal fat to compensate for high energy needs - 35-40% of calories
- Additional 2 - 4 grams salt/day in hot weather, with heavy perspiration
- age appropriate doses of water soluble vitamins and minerals
- Supplement water soluble forms of fat soluble vitamin A and E
Cystic Fibrosis
______________ disease (CVD), ________ ______ disease (CAD), ________ ____ disease (HD)
Cardiovascular, coronary artery, ischemic heart
____________ - systolic >140 or diastolic >90 or both
- Systolic, contraction, greatest pressure; diastolic, relaxation, least pressure
- May be primary (essential) or secondary due to another disease
- classified in stages based on risk of developing coronary heart disease
- Obesity is a major factor in the cause and treatment
- Optimal BP with repect to cardiovascular isk is <120/80 mm Hg
Hypertension
Management of ____________
- Thiazide diuretics may induce hypokalemia
- four modifiable factors in primary prevention and treatment: overweight, high salt intake, alcohol consumption, physical activity
- salt restriction less than or equal to 2400 mg of Na (6 g salt); decrease weight if needed
- DASH diet - dietary approach to stop hypertension; whole grains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI (not supplements)
Hypertension
_____________ diet
- Rich in alpha linoleic acid, high in monounsaturates fats
- olive, canola, soybean pils, walnuts, almonds, pecan, peanuts, pistachios
- fish, poultry and egggs rather than beef, breads, fruits, and vegetables in abundance, beans, legumes, yogurt and cheese
- revetsatrol, in skin of red grapes, may lower blood pressure
Mediterranean
_______________: accumulation of lipids; structural and compositional changes in the intimal layer of the large arteries
Atherosclerosis
Risks for _______________: Hypertension, obesity, smokin, elevated blood lipids, hereditary
Atherosclerosis
_______________ is a form of ________ ______ disease (CAD) where the arteries harden and narrow from the buildup of plaque
Athersclerosis, coronary artery disease
________ is a deficiency of blood due to obstruction
Ischemia
________________ is characterized by a loss of elasticity of blood vessel walls
Arteriosclerosis
_________ __________ reduction of coronary flow to myocardium due to blood clot blocking a narrowed coronary artery
1) angina pectoris - chest pain
2) Heparin - blood clots
Myocardial Infarction
___________ includes high TG and low HDL
Dyslipidemia
___________ - transports dietary TG from gut to adiose cells; synthesized in intestine from dietary fat; lowest density due to smallest amount off protein
Chylomicron
____ (pre-beta)- Transports endogenous TG from liver to adipose cell
VLDL
___ (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
LDL
___ (alpha) - reverse cholesterol transport; moves cholesterol from cells to liver excretion
HDL
___ (pre - beta to beta) - LDL precursor; found in circulation secondary to catabolism of other lipoproteins
IDL
_________ ________ - three or more of the following risk factors are linked to insulin resistance which often increase risk for coronary events
1) elevated blood pressure which often increases risk for coronary events
2) elevated TG greater than or equal to 150 mg/dL
3) fasting serum glucose greater than or equal to 100 mg/dL
4) waist measurement greater than or equal to 102 cm (40”) men; greater than or equal to 88cm (35”) women
5) Low HDL < 40 mg/dL (men), < 50 mg/dL (women)
Metabolic syndrome
________ ___________ _________ ________ (NCEP) National heart, lung and blood institute, endorsed by American Heart Association
National Cholesterol Education Program
LDL - C < ___ optimal
Total cholesterol < ___ desirable
HDL - C < __ (M) < __ (F); >= __ high
100, 200, 40, 50, 60
High ____________ (Hcy) levels are independent risk factors for CHD
Homocystine
Normal triglyceride levels
150
___________ _________ ______ (TLC) for CVD from Adult Treatment Panel III
- up to 35% calories from total fat, <7% saturated fat, 5 - 10% PUFA, up to 20% MUFA, <200 mg cholesterol
- 25 - 30 grams fiber (half soluble)
- Stanols and sterols inhibit cholesterol absorption (2-3g)
- Maintain DBW, prevent weight gain
- Increase physical activity to at least 30 mintes of moderate intensity most days (expend at least 200 calories
Therapeutic Lifestyle Change
_____ _________ _____ (ATP) IV: does not focus on specific target levels for LDL, but defines groups for whom lowering LDL would be most beneficial. Recommend a heart healthy lifestyle.
Adult Treatment Panel
___ __ therapy recommended for:
- Patients who have cardiovascular disease
- Patients with an LDL of 190 mg/dL or higher
- Patients with Type 2 diabetes who are between 40 and 75 years of age
- Patients with an estimated 10 year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75 years of age
ATP IV
Etiology of _____ _______
1) weakened heart fails to maintain adequate output, resulting in diminished blood flow so fluid is held in tissues (edema); dyspnea (shortness of breath)
2) REduced blood flow to kidneys causes secretion of hormones that hold in sodium and fluid leading to weight gain
Heart Failure
Treatment for _____ _______:
1) Digitalis increases strength of heart contraction
2) low sodium (2-3 grams), DASH diet, 1-2 L fluid
3) 1.1 - 1.4g protein/kg ABW for normally nourished and malnourished
4) Energy needs: RMR x physical activity factor
5) Evaluate thiamin status (loss with loop diuretics). without thiamin, pyruvate cannot be converted into acetyl CoA for energy, so heart muscle is deprived.
6) DRI for folate, Mg; MV with B12
7) Encourage individualized regular physical activity
Heart Failure
Physical activity factors: \_\_\_\_\_\_\_\_\_ 1.0 - <1.4 \_\_\_ \_\_\_\_\_\_ 1.4 - < 1.6 \_\_\_\_\_\_ 1.6 - < 1.9 \_\_\_\_ \_\_\_\_\_\_ 1.9 - < 2.5
Sedentary, Low Active, Active, Very Active
_______ ________: Unintended weight loss, blood backs up into liver and intestines causing nausesa and decreased appetite Arginine and glutamine may help. Low saturated fat, low cholesterol, low trans fat, <2 grams sodium, high calorie
Cardiac Cachexia
Structure of the _______
a) __________ - tuft of capillaries held closely by Bowman’s capsule - produces ultrafiltrate which then passes through tubules. Capsule blocks passage of red blood cells and larg molecules like protein
b) ________ __________ ______ - Major nutrient reabsorption
c) ____ of _____ - water and sodium balance
d) ______ ______ - acid base balance
Nephron, glomerulus, proximal convoluted tubule, loop of henle, distal tubule
_____ functions:
__________ - red blood cells, protein stay in blood; all else filters through tubules
__________ - 100% glucose, amino acids; 85% water, sodium, potassium
_________ - wastes, urea, excess ketones
_________ - secretes hormones that control blood pressure, blood components; secretes ions that maintain acid - base balance
Renal, filtration, absorption, excretion, secretion
________ involved in renal function
a) ___________ (ADH) - from hypothalamus (stored inpituitary)
b) _____ - vasoconstrictor
C) _____________ (EPO)
Hormones, vasopressin, renin, erythropoietin
___________ (ADH)
1) exerts pressor effect; elevates blood pressure
2) Increases water reabsorption from distal and collecting tubules
3) SIADH - Syndrome of Inappropriate Antidiuretic Hormone
a) Hyponatremia caused by hemoodilution, treated with fluid restricion
Vassopressin
_____ (vasoconstrictor)
1) Secreted by glomerulus when blood volume decreases
2) Stimulates aldosterone to increase sodium absorption and return blood pressure to normal
Renin
_______________ (EPO)
1) Produced by kidney; stimulates bone marrow to produce RBC
Erythropoietin
Lab tests in _____ disease
a) Decrease glomerular filtration rate, creatinine clearance
b) Increase serum creatinine, BUN
c) BUN:creatinine ratio of >20:1
d) renal solute load
Renal
BUN:creatinine ratio of > 20:1 indicates a “___-_____ state” in which BUN reabsorption is increased due to acute kidney damage (may be reversible and may not require dialysis)
pre renal
BUN:creatinine ratio of < __:_ suggests reduced BUN reabsorption due to renal damage (may need dialysis)
10:1
_____ ______ load - solutes excreted in 1 L urine; daily fixed load of 600 mOsm
1) Mainly measures nitrogen (60%) and electrolytes (sodium)
Renal Solute
Manifestation of _____ disease
a) anemia due to decreased production of erythropoietin
b) upset in blood pressure
c) decreased activation of vitammin D (kidney produces active form which promotes efficient absorption of calcium by the gut)
Renal disease
_____ disorders include:
a) _____ calculi
b) acute _____ _______
c) _________ ________
d) chronic ______ _______
e) ___ _____ _____ _______ (ESRD)
f) chronic _____ _______
Renal, renal, kidney injury, nephrotic syndrome, kidney disease, End Stage Renal Disease, renal failure
_____ _______
1) 1.5 - 2 L fluid/day needed to dilute urine
2) calcium oxalate stones
a) Adequate calcium intake to bnd oxalate and a low oxalate (40 - 50 mg) diet
b) More stones are detected in diets deficient in calcium
3) Alkaline ash / acid ash diets
a) Minerals not oxidized in metabolism leave an ash (residue) in urine
b) Can change composition of diet to change pH of ash in urine
c) Now usually done with medication
d) To prevent acidic stones - create an alkaline ash: increase cations (Ca, Na, K, Mg), by adding vegetables, fruits, brown sugar, molasses
e) To prevent alkaline stones - create an acid rich ash: increase anions (Cl, Ph, Su) by adding meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye
Renal calculi (kidney stones)
_____ ______ ______
1) Sudden shutdown with previously adequate cpacity; decreased GFR, inadequate pre - renal perfusion
2) Due to burns, obstruction, severe dehydration
3) Symptons - oliguria (<500 mL urine), azotemia (increased urea in blood)
Acute kidney injury
Nutrition treatment for _____ ______ ______:
1) IV glucose, lipids, protein
- 1 - 1.3 g/kg if non catabolic and or initiation of dialysis
2) 25 - 40 cals/kg, BEE x stress factor (1.2 - 1.3) during hypermetabolic conditions. Energy expenditure increases as kidney function declines
3) Low sodium (2-3 grams), replace losses in diuretic phase
4) 8 - 15 mg/kg phosphorus (May need phosphate binders)
5) 2 - 3 grams potassium based on output, serum potassium, dialysis
6) Replace fluid output from previous day pluss 500 mL
Acute Kidney injury
_________ ________
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 (increased synthesis and lower clearance of VLDL)
3) Abnormalities in iron, copper zinc, calcium related to protein loss
Nephrotic Syndrome
Nutrition treatment for _________ ________
1) Modest protein restriction: 0.8 - 1 g/kg; 50% from HBV. Excess protein will be catabolized to urea and excreted
2) <30% fat, low saturated fat, 200 mg cholesterol
3) 35 calories /kg/day
4) Modest sodium restriction (2-3 g /day)
5) Calcium 1 - 1.5 g/day, supplement vitamin D
6) May need fluid restriction with edema
Nephrotic Syndrome
_______ ______ _______
1) anorexia, weakness, weight loss, nausea, vomiting
2) anemia due to deficient production of hormone erythropoiein by kidney
Chronic Kidney Disease
_______ ______ _______
1) 25 - 25 kcal / kg or BEE x activity facto. adjust for weight gain or loss
2) <2400 mg/day sodium
3) Protein restricted when GF mL/minute falls
4) Supplement phosphorus
5) Potassium generally not restricted unless serum level is elevated and urine output is < 1 liter per day
6) Fluid generally unrestricted
Chronic Kidney Disease
