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Nutrition Diagnosis and Related Care > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is Heart Failure?

A

Chronic, progressive condition in which the heart is unable to pump enough blood

Decreased ejection fraction of <50%

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2
Q

Heart Failure

Signs and Symptoms

A

SOB, wheezing/coughing, edema, fatigue, lack of appetite, nausea, confusion, increased HR

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3
Q

Heart Failure

Factors that Affect Intake

A

Changes in taste/smell, dietary restrictions, limited energy to buy/prep food, digestive disturbances, cardiac cachexia

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4
Q

Heart Failure

Nutritional Guidelines

Basic Guidelines

A

20-25 kcal/kg + AF
PRO: 1.1-1.4 g/kg

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5
Q

Heart Failure

Nutritional Guidelines

Classes I-IV and Stages B and C

A

22 kcal/kg ABW + AF (nourished pt)
24 kcal/kg ABW + AF (malnourished pt)
PRO: No Change
Sodium: 1500 mg/day

Sodium Rec for Stages A and B

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5
Q

Heart Failure

Nutritional Guidelines

Stage D

A

18 kcal/kg ABW + AF
PRO: no change
Sodium: <3 g/day

Sodium Rec for stages C and D

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6
Q

Heart Failure Education Recommendations

A

2-2.5 g Na/day (if malnourished consider no restriction)
1500-2000 mL/day

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6
Q

Heart Failure

When is it not appropriate to provide HF education?

Must meet 2 criteria

A
  1. MST of >2
  2. BMI <20
  3. Advanced age (+80)
  4. Braden Total <12 (wound development score)
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7
Q

Heart Transplant

Pre-Transplant Evaluation

A
  • Nutrition hx with diet recall
  • DEXA-bone density
  • Adherence to diet recommendations
  • Height, weight, BMI (<35)
  • Albumin/Prealbumin Trends
  • Hgb A1c 10%

DEXA: immunosuppressants decrease bone density

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8
Q

Heart Transplant

Post Transplant Nutrition Recommendations

A

30-35 kcal/kg (in absence of infection)
PRO: 1.5-2 g/kg initially
Carbs: 55-60%
Lipids: 30%
Fluids: 2000 mL
Supplement Electrolytes and Vitamin D

PRO: 1 g/kg in chronic post-transplant stage

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9
Q

Heart Tranplant

LVAD

Left Ventricular Assit Device

A

Pulls blood from L-Ventricle through a pump to be oxygenated, sent into aorta, and sent back through the body

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10
Q

Heart Transplant

When might an LVAD be used?

A

Can be a bridge to transplant (BTT), improved cardiac fx while waiting for transplant
Can be destination therapy, when the pt is not an appropriate transplant candidate (long-term treatment)

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11
Q

Lung Transplant

COPD Nutrition Recommendations

A

Energy: 125-165% greater than BEE
PRO: 1.2-1.7 g/kg

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12
Q

Lung Transplant

COPD

Chronic Obstructive Pulmonary Disease

A

Progressive lung disease that causes restricted airflow and breathing problems

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13
Q

Lung Transplant

Cystic Fibrosis

A

genetic disease that causes the body to produce thick, sticky mucus that can lead to breathing and digestion problems

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14
Q

Lung Transplant

Idiopathic Pulmonary Fibrosis

A

chronic lung disease that causes the lungs to stiffen and thicken with scar tissue, making it difficult to breathe

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15
Q

Lung Tranplant

Alpha-I Antitrypsin Deficiency

(AATD)

A

AAT production is reduced, this causes the body’s infection fighting agents to damage alveoli and lining of lungs

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16
Q

Lung Transplant

Pulmonary HTN

A

occurs when the blood pressure in the lungs’ arteries is too high

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17
Q

Lung Transplant

MNT Goals

A

Limit Na to decrease fluid retention
Ca and Vitamin D adequacy
Adequate fluids

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18
Q

Lung Transplant

Pretransplant Evaluation

A
  • Nutrition hx
  • Adherence to diet recommendations
  • adequate caloric intake
  • BMI
  • Hgb A1c 8%

BMI:
F <30
M <32

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19
Q

Lung Transplant

Nutrition Needs Post-Transplant

A

35 kcal/kg OR 130-150% of BEE
PRO: 1.5-2.0 g/kg
Meds: immunosuppressors and increase blood sugars

PRO: decreased to 1 g/kg are corticosteroids are decreased

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20
Q

Normal Renal Function

A
  • Filters blood, maintains fluid balance, regulates electrolytes, BP regulation
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21
Q

Renal Disease

Nephrons

A

Functioning part of kidney
* Filters, reabsorbs, and excretes waste

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22
Q

Renal Disease

Renal Corpuscle

A

blood-filtering component of the nephron of the kidney
*Crt is a key lab for diagnosing kidney disease

High Crt = not properly excreting

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23
Q

Renal Disease

Renal Tubule

A

filters waste and toxins from the blood and returns nutrients and other substances back to the body

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24
Q

Kidney Disease

What is the most common cause of Kidney Disease (2)?

A

HTN and DM

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25
Q

Kidney Disease

Biochemical Labs to Monitor

A
  • BUN: indicator of kidney fx
  • Crt: indicator of proper waste filtering (affected by muscle mass)
  • Na (affected by fluid balance)
  • K+
  • Phosphorous
  • Magnesium
  • Sodium

Phos usually high when fx falls below 25%

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26
Q

Renal Disease

How can K+ be treated?

A

Dialysis, balancing blood sugars, medication (Kayexalate or Lokelma)

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27
Q

Renal Disease

Estimated Needs

Stage 1-4 Pre-Dialysis

A

25-30 kcal/kg (20-30 kcal is sedentary & 60+)
PRO: 0.6-0.8 g/kg (50% biological value)
Sodium: 2-3 g/day
Vitamin D3: 2000 mg/day

Biological value: typically animal protein, utilized more efficiently

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28
Q

Renal Disease

Nutrition Recommendations

Dialysis

A

25-35 kcal/kg
PRO:
* HD: 1.2 g/kg
* Peritoneal: 1.2-1.3 g/kg
Sodium: 2-3 g/day
Fluid: 1000 mL + urine output
K+: 2-3 g/day
Phos: 1000-1200 mg/day

Pt is on CRRT: PRO 1.8-2.5 g/kg

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29
Q

Renal Disease

Acute Kidney Injury

AKI

A
  • Caused by drop in blood flow (caused by accident, sepsis, dehydration)
  • Can be reversed
  • Causes accelerated loss of PRO and AA (muscle wasting)
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30
Q

Renal Disease

How quickly does Enteral nutrition need to be started if pt is in ICU with AKI?

A

within 48 hours

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31
Q

Renal Disease

End Stage Renal Disease

ESRD

A

Deterioration of fx to level at which uremia can cause death

Uremia: urine in blood due to inability to filter waste

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32
Q

Renal Disease

Indications for Dialysis

AEIOU

A

Acidosis
Electrolyte Abnormalities
Intoxication
Overload (fluid)
Uremia

K+ will be too high, main indicator of dialysis

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33
Q

Renal Disease

MNT Goal: Kidney Transplant

A

optimize nutritional status prior to surgery

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34
Q

Heart Failure

HFpEF

A
  • Diastolic HF
  • Heart failure with preserved ejection fraction
  • Heart is stiff and unable to relax enough to fill with blood
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35
Q

Heart Failure

HFrEF

A
  • Systolic HF
  • Heart failure with reduced ejection fraction
  • heart is weak and cannot pump with enough force to get to rest of body
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36
Q

Heart Failure

Most Common type of HF

A

Left Sided and it affects the lungs

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37
Q

Renal Disease

Acute Care Post-Transplant Nutritional Needs

A

30-35 kcal/kg
PRO: 1.2-2 g/kg
*wound healing with high PRO and kcal

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38
Q

Renal Disease

Long Term Post Transplant Goals

A
  • Weight control
  • Lipid management
  • Lifestyle changes (reduced CVD risk)
  • Blood Gluc management
  • Prevent osteoperosis (1200-1500 mg Ca/day)
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39
Q

Metabolic Syndrome

A

group of risk factors that increase the likelihood of developing heart disease, diabetes, and other health conditions

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40
Q

Metabolic Syndrome Risk Factors

A
  • Abd Obesity - waist circumference
  • Hypertriglyceridemia >150 mg/dL
  • Low HDL
  • High BP >130/85
  • High Fasting Gluc >110 mg/dL

Low HDL (M: <40, F: <50)

Waist (M: >40 in, F: >35 in)

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41
Q

What kind of Nitrogen balance do you want for HF?

A

Positive Nitrogen balance
Positive balance for any condition where higher nutrient needs are required

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42
Q

GI Conditions

Types of Crohn’s Disease

A
  • Illecolitis: affects last part of S.I. and first part of colon
  • Illetitis: last part of S.I
  • Gastroduodenal: stomach and first part of S.I
  • Jejunoilitis: upper half of S.I and jejunum
  • Crohn’s Colitis: some or all of colon
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43
Q

GI Conditions

Types of Crohn’s Remission

A
  • Clinical: symptom free, but inflammation present; Crohn’s disease Activity Index (<150)
  • Biochemical: stool and blood tests w/in normal limits
  • Endoscopic: no visible inflammation
  • Histological: “deep remission” biopsies show no active inflammation under microscope

Biochemical: CRP, fecal calprotectin

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44
Q

GI Conditions

Nutritional Needs in IBD

A

PRO: 1.2-1.5 g/kg
MCT: >8 tbsp/day
Fiber: feeds butyrate, reducing inflammation
Micros: Iron, B12, D, Ca, Folate, Zinc

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45
Q

GI Conditions

Helpful Diets for IBD

A
  • Mediterranean
  • Elemental (100% AA and MCT oil)
  • Specific Carb Diet (SCD)
  • Anti-inflammatory diet
  • GF Diet
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46
Q

GI Conditions

Fiber Recommendations for diverticulosis and diverticulitis

A

Diverticulitis: low fiber
Diverticulosis: high fiber

47
Q

GI Conditions

Fiber and IBD

A
  • Low fiber intake is a risk factor for developing Crohn’s and UC
  • Fiber is an important fuel for gut microbiomes - feeds butyrate producing bacteria
  • start with soluble fiber
48
Q

GI Conditions

Irritable Bowel Syndrome (IBS)

A
  • Affects stomach and intestines
  • IBS does not cause changes in bowel tissue or increase the risk of colorectal cancer
  • Symptoms: cramping, abd pain, bloating, gas, diarrhea, constipation
49
Q

GI Conditions

Types of Ulcerative Colitis

A
  • Ulcerative Proctitis: inflammation of rectum
  • Ulcertive Pancolitis: affects entire large intestine
  • Microscopic Colitis: inflammation of colon, dx with biopsy of intestinal mucosa
50
Q

Crohn’s

Ileocecal Resection

A

Ileum inflammed or removed
* absorption of fat soluble vitamins and B12 will be affected

51
Q

GI Conditions

Low - FODMAP Diet

A

FODMAPS are small chain CHOs that are commonly malabsorbed in S.I
* Pull water into S.I causing bloating in individuals prone to constipation/diarrhea
* 75% of IBS patients benefit from a low FODMAP diet

52
Q

GI Conditions

IBS-C vs IBS-D

A

IBS-C: IBS with constipatoin
IBS-D: IBS with diarrhea

53
Q

GI Conditions

Small Intestinal Bacterial Overgrowth

SIBO

A

Accumulation or overgrowth of bacteria in SI
* Common Bacteria: E. Coli, Klebsiella genera, lactobacillus (good)

54
Q

Reasons for Developing SIBO

A
  • Structural or anatomical abnormalitie
  • Low stomach acid
  • slow/impaired motility
  • inflammation of SI
  • low loevel of pancreatic fluids
  • Chronic alc use
55
Q

Diverticular Disease

A

Diverticula are outpouches of the bowel wall
* Result from increased colon pressure, low fiber diets, IBS-C, chronic constipation, overuse of NSAIDS/opioids

56
Q

Diverticular Disease

Diverticulitis

A

Outpouching with infection or inflammation
* Symptomatic
* fever, sever lower abd pain, N/V
* CT scan

57
Q

Diverticular Disease

Diverticulosis

A

Outpouching without inflammation
* typically asymptomatic
* Lower abd pain, cramping, bloating, constipation, diarrhea
* Found on colonoscopy, CT, barium enema
* Treated with antibiotics or surgery

58
Q

MNT Goals of Diverticular Disease

A

goal is to help promote consistent bowel movements, high fiber diet, low FODMAP diet

59
Q

Gastroparesis

A

Delayed gastric emptying
* Loss of muscles to move food through digrestion
* Possible vagus nerve damage
* Medications that block nerve signals that activate stomach muscles

60
Q

Gastroparesis Treatment

A
  • Medications to stimulate stomach motility and control N/V
  • Gastric Electrical Stimulation
  • Enteral Nutrition
  • Parenteral Nutrition
61
Q

MNT for Gastroparesis

A
  • Low fiber, low fat
  • Seperate beverages from meals
  • 6-8 small frequent meals
62
Q

Eosinophilic Esophagitis (EoE)

A

Chronic immune disease causing eosinophil build up in esophagus lining –> damaging tissue

63
Q

Symptoms of EoE

A

Dysphagia, impaction, chest pain, reflux

64
Q

MNT for EoE

A

Six Food Elimination Diet: milk, wheat, egg, nuts, soy, fish, shellfish

65
Q

Short Bowel Syndrome (SBS)

A

condition resulting from surgical resection or congenital disease of small intestine
* Characterized by inability to maintain PRO-energy, fluid, electrolyte, micro balances

66
Q

Causes of SBS

A

Surgical Resection of SI due to:
* Crohns, trauma, malignancy, radiation, mesenteric ischemia
Children:
* Necrotizing enterocolitis as infant, congenital intestinal anomalies (mid-gut volvulus, atresias, gastroschisis)

67
Q

Stages of SBS

A

Acute Stage: intestinal fluid losses, metabolic derangement, intestinal failure, gastric hypersecretion - lasts 3-4 wks
* May require EN or PN + slow initiation of PO
Adaptation Stage: increased intestinal surface area, slowed intestinal transit - lasts 2+ years in adults
* weaning off nutrition support
Maintenance Stage: remaining bowel has maximized absorptive ability - once intestines are done adapting

68
Q

Intestinal Failure

A

when intestines are unable to absorb enough nutrients or fluid to sustain body’s needs
* long term PN support, intestinal rehab, intestinal transplant

69
Q

SBS

Concerns with Jejunal Resection

A

Fluid and macronutrient absorption
*ORS used to optimize absorption

70
Q

SBS

Ileal Resection

A

Ileum is primary site of B12 absorption, can lead to deficiency
Resection of >100 cm leads to bile acid absorption disruption (malabsorption of fats)

71
Q

Ileal Resection of SBS

Ileal Brake

A

unabsorbed lipids that reach ileum results in delayed gastric emptying

72
Q

Ileocecal Valve

A

Regulates passage of fluids and nutrients from ileum to colon

73
Q

Colon

A
  • Important role in fluid, electrolyte, and short-chain fatty acid absorption
  • Helps slow intestinal transit and stimulate intestinal adaptation
74
Q

Management of SBS

A

Must be tailored individually based on needs
* Dependent on length of bowel remaining, colon vs no colon, ostomy or fistula presence

75
Q

Oral Diet for SBS

A

Complex CHO, moderate fat, high PRO
Avoid simple sugars and high insoluble fiber
* Soluble may be helpful for loose stools
Adequate hydration
Small, frequent meals

76
Q

Enteral Nutrition for SBS

A

PEG tube is typically placed to allow for optimal absorption
* GJ tube can be placed if needed

77
Q

Intestinal Failure

A

inability to sustain body’s nutrient and fluid needs
*long term PN needed
Intestinal Rehab program
Intestinal transplant

78
Q

Types of Ostomies

A

Illeostomy
Jejunostomy
Colostomy
Urostomy

79
Q

Illeostomy

A

Part of ileum is brought us to surface of abdomen
Used when need to bypass colon or protect distal anastomosis
Stool waste excreted into ostomy bag (liquid)

80
Q

Loop Ileostomy

A

loop of ileum is brought up to abd wall, temporary and can be reversed

81
Q

End Ileostomy

A

Permanent if anorectal sphincter and rectum are removed with colon

82
Q

Colostomy

A

colon is brought to surface of abdomen
Used when need to bypass part of distal colon, rectum, or anus
Solid waste is excreted into colostomy bag

83
Q

Hartmann’s Procedure

A

End loop colostomy brought to abd surface, remaining bowel is oversewn or stapled and left in abd cavity
Reversible

84
Q

MNT for Ileostomy

A

Low fat, low fiber, low in simple sugars
Small, frequent meals
Avoid foods that can block ostomy (nuts, seeds, corn, fruit/veggie skin, etc)
Avoid acidic, spicy, greasy foods for first few weeks post op

85
Q

Typical Output of Ileostomy

A

1 L daily
*anything greater than 1500-2000 mL is considered high ileostomy output
HIgh Output: start antidiarrheal, check for infectious diarrhea, add metamucil

86
Q

MNT for Colostomy

A

Low fat, low fiber, low in simple sugars
Small, frequent meals
Avoid foods that cause ostomy blockage
Avoid acidic, spicy, greasy foods for first few weeks postop

87
Q

Classifications of Overweight/Obesity

BMI

A

Overweight: 25-29.9
Obesity Class I: 30-34.9
Class II: 35-39.9
Class III: 40+

88
Q

Clinically Severe, Mobid Obesity

A
  • 200% of IBW or 100lb overweight
  • BMI of >40 OR BMI >35 + severe co-morbid conditions
89
Q

Non-Surgical Treatments of Obesity

A
  • Caloric Intake reduced by 500-1000kcal/day (lose 1-2lbs/wk)
  • Physical activity
  • Behavioral Therapy
  • Pharmacotherapy
  • Meal Replacement Program
90
Q

MNT for Obesity

A
  • Increased intake of whole grains, fruits, vegetables
  • 3 meals/day
  • Track intake
  • Limit processed foods
  • decreased portion sizes, hunger/fullness cues
  • mindful eating
  • Regular activity
91
Q

PRO recommendations for Obesity

A

Low fat PRO
Men: 80-100 g/day
Women: 70-90 g/day
*20-30 g/meal
Consider PRO shake: whey PRO, 20-30 g PRO/serving, <5 g sugar/serving

92
Q

Obesity

Health Benefits for 5-10% weight loss

A
  • Improved blood sugar control
  • Reduced BP
  • Improved Lipid Profile
  • Lower total Chol, LDL, TG
  • Higher HDL
93
Q

Types of Bariatric Surgery

Malabsorptive and Restrictive

A

Roux-en-Y
SIPS
BPD/DS

94
Q

Types of Bariatric Surgery

Restrictive

A

Sleeve gastrectomy, intragastric balloon, LAGB

95
Q

Qualifications for Bariatric Surgery

A

BMI >35 + 1 co-morbid condition
BMI >40 with out any comorbidities

96
Q

Obesity

Comorbid Conditions

A

Obstructive sleep apnea
HTN
HLD
DM
GERD

97
Q

Roux-en-Y Gastric Bypass

A

Increased malabsorption due to jejunum rerouting
At risk for Ca, Fe, B12, D, folate, and thiamine malabsorption

98
Q

Sleeve Gastrectomy

A

Restrictive effects from the stomach
*Removal of 80-85% of stomach
No malabsorption
Reduced ghrelin = reduced hunger cues
B12, iron, thiamin, Ca malabsorption

99
Q

Benefits of Sleeve Gastrectomy

A

No intestinal bypass, internal hernia, dumping syndrome
Less vitamin deficiencies, PRO malnutrition, anemia
Reduced risk of osteroporosis

100
Q

Duodenal Switch (BPD/DS)

A

75% of stomach removed and 75% of GI tract bypassed
Fat malabsorption is >70% and protein 25%
More malabsorptive than Roux-en-Y and SIPS
For severley obese (BMI >50)
ADEK Supplementation
Iron, Ca, Zinc, B12, folate, ADEK, PRO malabsorption

101
Q

SIPS

Stomach Intestinal Pylorus Sparing Surgery

A

Jejunum is connected to stomach sleeve
Can be a primary or revision surgery
Malabsorptive surgery
Hybrid of bypass and sleeve

102
Q

LAGB

Gastric Band

A

Restricts amount of food upper stomach can hold (1/2 C)
Needs Frequent Adjustments (use saline solution)
Reversible
Normal nutrient absorption
Nutrients of Concern: Folate, thiamine, B12, Ca

103
Q

Bariatric Surgery Post Op Diet Progression

A

Night of Surgery: SF Clear liquids (GB1)
4 days Post Op: add protein shakes (GB2)
1 Wk Post op: add in Cottage cheese, Greek yogurt (GB3a)
2 wk post op: high PRO, pureed/soft consistency (GB3b)
4-6 wks post op: High PRO, soft foods (GB4)

104
Q

Nutritional Goals Post Bariatric Surgery

0-6 Months

A

60-70 g PRO/day
<90 g Carbs/day
<850 Kcal/day

105
Q

Bariatric Surgery Nutrition Goals Post Op

12+ Months

A

80-120 g PRO/day
<130 g of Carbs/day
<1300 kcal/day

106
Q

Bariatric Surgery

Dumping Syndrome

A

Common in rerouting surgeries
*Sugars/carbs pass through stomach too fast, causing N/V, diarrhea

107
Q

Eating Disorder

A

ongoing disturbance of eating behavior or behavior intended to control body weight, which impairs physical health and psychosocial fx

108
Q

Anorexia Nervosa

A

severly restrict food, avoid food, or eat very small amounts
May weigh themselves repeatedly
Distorted body image

109
Q

Restrictive Anorexia Nervosa

A

limit amount and type of food consumed

110
Q

Binge-Purge Anorexia Nervosa

A

restrict amount or type of food, also have binge eating and purging episodes

111
Q

Anorexia Nervosa

Signs and Symptoms

A

Osteoperosis/Osteopenia
Damage to structure/fx of heart
Dry, yellowish skin
Brittle hair/nails
Low thyroid,/hormone levels, anemia, low K+
Slow HR
Menstrual irregularities

112
Q

Bulimia Nervosa

A

Cycle of eating large amounts of food (1000+ Kcals) in a certain time frame (2hrs) followed by compensatory behavior

113
Q

Bulimia Nervosa

Signs and Symptoms

A

Noticeable fluctuations in weight (+/-)
Stomach cramps
Dental Issues
Evidence of binge eating - disapperance of food, empty wrappers, etc
Evidence of purging behavior (signs/smells of vomiting, frequent bathroom trips, laxatives, etc.)

114
Q

Binge Eating Disorder (BED)

Most Common in US

A

Recurrent episodes of eating large quantities (1000+ kcals)
Feeling of loss of control during binge
Experiencing shame, distress, guilt after binge
NOT USING COMPENSATORY BEHAVIOR

115
Q

Orthorexia

A

Obsession with “healthful” eating to point of damaging well being
Can make malnutrition more likely due to restricting amount/variety of food

116
Q

Orthorexia

Signs and Symptoms

A

Compulsive checking of ingredient lists, distressed when “safe” or “healthy” foods unavailable
Cutting out food groups
Body Image concers (may be present)

117
Q

Avoidant Restrictive Food Intake Disorder (ARFID)

A

involved limitations in amount/types of food eaten
Does NOT include distress aout body shape/size or fear of weight gain

Nutrition Diagnosis and Related Care (2 decks)

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