Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Life cycle in Nutrition > Exam 3 Material > Flashcards

Exam 3 Material Flashcards

1
Q

Name the 4 compartments of the 4 compartment model for body composition.

A
  1. Water
  2. Mineral
  3. Protein
  4. Fat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Compare and contrast essential fat, storage fat, visceral fat, and subcutaneous.

A
  1. Essential fat for organ function vs. storage fat for energy reserve
  2. Visceral fat around organs vs. subcutaneous fat under the skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe 3 changes in body composition in adulthood.

A
  1. Maximize bone density by age 30; start gradual loss about age 40
  2. Muscle strength peaks at age 25-30; maintain as age via exercise
  3. Positive energy balance at age 20-64; increase in adiposity with decrease in muscle mass
    - in middle adulthood more fat shifts toward visceral, away from subcutaneous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the set-point theory and how the body responds to over- and underfeeding.

A
  1. Body will defend against weight gain or loss
    - better at preventing weight loss than weight gain
  2. Overfeeding: causes hypophagia (reduced food intake) and higher metabolic rate
  3. Underfeeding: causes hyperphagia (increased food intake) and lower metabolic rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

State how the eating behaviors of adults differ from younger people.

A
  • Adults are less responsive to variation in calorie intake as they age.
  • Depends on other cues such as usual eating schedule, portion served, and emotional eating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Identify disease processes that are associated with obesity.

A
  1. Heart disease
  2. DM 2
  3. Hypertension (HTN)
  4. Stroke (CVA)
  5. Gallbladder disease
  6. Infertility
  7. Sleep apnea
  8. Hormonal cancers (prostate, ovarian, breast, endometrial)
  9. Osteoarthritis
  10. Metabolic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name weight loss goals and calorie intake recommendations for people wanting to lose weight.

A
  1. Encourage gradual weight loss
    - overweight: 0.5-1# / week
    - obese: 1-2# / week
  2. Negative energy balance to limit protein loss, maximize fat loss, esp when combined with exercise (~500 kcal/day)
    - women: not less than 1200 kcal
    - men: not less than 1500 kcal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define the 4 given components of behavior modification, and give examples of each.

A
  1. Stimulus control
    - settings/events that cause eating
    - foods consumed when eating occurs
    - consequences of eating
  2. Problem solving proactively
  3. Cognitive restructuring
    - identify, challenging, and correcting negative thoughts
  4. Self-monitoring
    - food diaries (+/- feelings about eating)
    - weekly weigh ins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 4 categories of dietary modification for weight loss

A
  1. Restricted-energy diets
  2. Formula diets and meal replacement programs
    - —limited long term behavior modification
  3. Extreme energy restriction/fasting
    - —promise quick results, often body water loss
    - —elimination diets: high probability of muscle loss and inadequate micronutrients
  4. Very-Low-Calorie Diets (VLCD): 200-800 kcal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Explain why fad diets or extreme energy restriction are discouraged.

A
  1. Fad diets: promise quick/dramatic results, often body water loss, usually elimination diets, high probability of muscle loss+inadequate micronutrients
  2. VLCD: needs medical supervision!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

State the recommendations for physical activity with weight loss, including time requirements and types of activity.

A
  1. USDA rec: 60-90 min/day for weight loss/maintenance
  2. Combination of aerobic (cardio) and resistance (weight) training
    - aerobic burns kcals stores, fat
    - weight increases muscle mass, increases RMR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Identify patients who are candidates for bariatric surgery.

A
  1. BMI > 40

2. BMI > 35 + complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Classify types of bariatric surgery as restrictive and/or malabsorptive.

A
  1. Restrictive: gastric banding

2. Restrictive+malabsoptive: rou-en-y gastric bypass (RYGB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define weight loss plateau.

A

When weight loss halts and weight remains stable for extended period of time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name the 4 behaviors associated with maintaining weight loss, according to the National Weight Control Registry.

A
  1. Relatively low-fat diet (24% kcal/fat)
  2. Participate in physical activity (60-90 min/day)
  3. Weigh once a week
  4. Eat breakfast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name the caloric content of alcohol, and what constitutes a standard drink (including pure ETOH, beer, wine, and hard liquor).

A
  1. Caloric content: 7 kcal/g
  2. Standard drink:
    - pure ETOH: 0.6 oz (15 g)
    - beer: 12 oz
    - wine: 5 oz
    - 80-proof distilled spirits: 1.5 oz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the Dietary Guidelines for Americans’ stance on alcohol consumption.

A

If you drink alcoholic beverages, do so in moderation.

  • no more than 1 drink/day for women
  • no more than 2 drink/day for men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define binge drinking, heavy drinking, and excessive drinking for men and women.

A
  1. Binge drinking:
    - Women: 4+ drinks on one occasion
    - Men: 5+ drinks on one occasion
  2. Heavy drinking:
    - Women: >1 drink/day on average
    - Men: >2 drinks/day
  3. “Excessive drinking”:
    - heavy drinking, binge drinking, or both
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Identify when alcohol is associated with health benefits and when it is associated with health risks.

A
  1. Moderate alcohol consumption is associated with health benefits.
  2. Excessive drinking is associated with health risks.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List the 6 groups of people who should not consume alcohol, according to the Dietary Guidelines.

A
  1. Ind who cannot restrict their drinking to moderate levels
  2. Anyone younger than drinking age
  3. Women who are pregnant or who may be pregnant
  4. Ind taking prescription or OTC medications that can interact with alcohol
  5. Ind. with certain specific medical conditions (liver disease, hypertriglyceridemia,pancreatitis)
  6. Ind who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination or in situations where impaired judement could cause injury or death (eg swimming)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe how alcohol causes cellular damage.

A

rapidly absorbed via simple diffusion –> rapidly distributed between intracellular/extracellular compartments–>
crosses plasma membranes–> denatures proteins (large, frequent ETOH damage proteins within and around cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Explain how alcohol tolerance develops.

A

High consumption activates secondary metabolism: microsomal ethanol oxidizing system (MEOS)

  1. pathway used for excessive amount ETOH
  2. treats ETOH as a foreign substance
  3. activation increases alcohol tolerance
  4. requires energy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe how alcohol spills into the bloodstream and causes the effects of drunkenness.

A

Only certain amount of ETOH can be metabolized/hr, this creates a bottleneck effect and ETOH spills into the bloodstream.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name the effect of caffeine on alcohol metabolism.

A
  1. There is no effect on metabolism.

2. It does, however, mask depressant effect of alcohol and is associated with more binge drinking.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Explain why the liver is most harmed by alcoholism.

A
  1. Because ETOH is taken to the liver by portal blood.

2. Gut cells are damaged but have a shorter half-life so they regenerate, liver cells do not repair as readily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Define “functional food.”

A

“A food that has a health benefit beyond basic nutrition”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define “dietary supplement.”

A
  1. a vitamin
  2. a mineral
  3. an herb or other botanical
  4. an amino acid
  5. a dietary substance for use by man to supplement the diet by increasing the total dietary intake (eg enzymes, or tissues from organs or glands)
  6. a concentrate, metabolite, constituent or extract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe when the FDA approves drugs and compare that to when the FDA approves supplements.

A
  1. Drug approval process:
    - Phase 1: discover adverse events in healthy volunteers
    - Phase 2: test for efficacy in small number of patients with target disease
    - Phase 3: determine safety, efficacy, and dosage
    - FDA approval
    - Phase 4: postmarket, lrg populations, long-term effects

2: Supplements:
- No FDA approval process before supplement goes to market
- Once on market, FDA monitors safety
- FDA can take action if supplement demonstrated to be unsafe (warning, legal action, require removal from marketplace)
- 2007 FDA established the Good Manufacturing Practices (CGMPs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Name 4 groups of people who should not use supplements.

A
  1. Pregnant or nursing women
  2. Children
  3. People with liver disease
  4. People taking medications that commonly interact with herbs, like anticoagulants, anticonvulsants, anti-rejection meds, HIV treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

List 3 categories of supplements which are most likely to be contaminated or contain ingredients not listed on the label.

A
  1. Sports performance
  2. Weight loss
    - Fen-Phen
  3. Sexual enhancement
    - contaminated with steroids, Viagra
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Identify 5 strategies to minimize risk when purchasing supplements.

A
  1. Look for USP label (voluntary testing)
  2. Buy from large companies, not online-only
  3. Ask the in-store pharmacist
  4. Know what you are buying and why–research before you go! Don’t rely on people at the store!
  5. Look it up at www.NCCAM.NIH.gov
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Name the average life expectancy and life span for Americans

A

Average life expectancy
-78.5 years (has increased)

Human lifespan
-110-120 years (pretty stable)

Old

  • age 60
  • DRI’s begin to decrease at age 70
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe two basic theories on aging

A

Programmed aging

  • predetermination
  • cells can replicate X number of times before they die
  • tend to die of a diseased process first
  • –hearts disease, cancer, stroke, diabetes

Wear and tear

  • accumulated damage
  • years of damage eventually cause death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Name 3 changes in body composition as adults age

A
  1. Increase fat mass
    - -visceral fat increases from 14% (age 20) to 30% (age 70)
    - -not necessarily gaining weight, just losing muscle
  2. Lose body water
    - -easily dehydrated
    - 61% in your 20’s to 53% in your 70’s
  3. Lose lean body mass
    - -2-3% every 10 years between the ages of 30-70
    - -19% in your 20’s to 12% in your 40’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Define sarcopenia and sarcopenic obesity and describe their consequences

A

Sarcopenia

  • loss of muscle mass, strength, and function
  • no set amount of LBM loss
  • decreased LBM causes an increase in fat

Sarcopenic obesity

  • sarcopenia plus excess fat
  • leads to further decrease in physical activity and thus, more sarcopenia

Consequences
-causes a decrease in metabolic rate, loss of mobility, more risks for falls and chronic death

36
Q

Identify protein needs in older adults

A
  1. 0-1.2 g/kg after age 65
    - best if evenly distributed throughout the day

-Higher protein intake helps preserve lean body mass

37
Q

List 3 benefits to exercise

A
  1. Preserves LBM and prevents/delays sarcopenia
    - –muscle mass holds more water and increases total body water
  2. Decreases total, subcutaneous and visceral fat
    - –may not result in weight loss in older women, but still worthwhile
  3. Maintains functional status
    - –ability to perform self-care
38
Q

Define activities of daily living and instrumental activities of daily living and give examples of each

A

Activities of daily living (ADL)
-basic self-care tasks

Examples

  • eating
  • grooming
  • bathing
  • toileting
  • selective clothing and dressing

Instrumental ADL
-complex skills needed to live independently

Examples

  • managing money
  • shopping
  • using phone
  • take medications correctly
39
Q

Name 2 tools to screen older adults for malnutrition

A
  1. Determine checklist

2. Mini Nutrition Assessment (MNA)

40
Q

Describe the intervention or care provided by senior nutrition centers, assisted living centers, and long-term care

A

Senior Nutrition centers
-provide meals and social interaction

Assisted living centers

  • combine housing and personalized support
  • as needed by resident

Long-term care
-Skilled nursing facilities or nursing homes

41
Q

Describe the relationship between aging, depression, and malnutrition

A

Depression

  • affects 16% of older adults
  • leads to–> significant risk for malnutrition
42
Q

Define dementia, and list the 5 causes of dementia

A

Dementia

  • cognitive impairment
  • serious loss of memory or cognitive function
  • usually a manifestation of an underlying disease

Causes

  1. Vascular
    - –mini strokes
  2. Brain trauma/infection
  3. Substance abuse
  4. Malnutrition
    - –Loss of HCl production in the stomach
    - –HCl needed to cleave B12 from dietary PRO and latch to intrinsic factor
    - –Decreased B12 causes memory loss, decreased hemoglobin, decreased hematocrit, and increased mean corpuscular volume
  5. Degeneration of neurons
43
Q

Describe the pathophysiology for Alzheimer’s disease

A

Pathophysiology
-build up of beta-amyloid plaques and neurofibrillary tangles in the brain

Causes progressive decline
-difficulty learning new information, decreased concentration, and forgetfulness

  • memory loss, confusion, personality and behavior changes
  • loss of independence, weight, and disordered eating
  • loss of bowel and bladder control, weak and contracted limbs
44
Q

Nutritional risk factors for Alzheimer’s disease

A

At a higher risk

  • high fat dairy
  • red meat
  • organ meat
  • butter

At a lower risk

  • salad dressing
  • nuts
  • fish
  • poultry
  • vegetables
  • fruit
  • garlic
  • spices
45
Q

Relate 6 characteristics of Alzheimer’s disease to nutritional implications

A
  1. Reduced attention span
    - -can’t focus on meals
    - -need frequent reminders to eat
    - -need minimal distractions
  2. Forgetfulness
    - -forget to eat
    - -forget to drink
    - -forget they’ve already eaten
  3. Loss of social inhibition
    - -need to be observed when eating with others (stealing food)
  4. Reduced sensation of hunger and thirst
  5. Loss of comprehension
    - -unable to recognize food as edible or non-edible
  6. loss of motor skilss
46
Q

Describe the pathophysiology and 3 marked characteristics of Parkinson’s disease

A

Pathophysiology

  • -progressive loss of dopamine in substantia nigra (basal ganglia)
  • leads to dementia

Characteristics

  • resting tremor
  • muscle rigidity
  • bradykinesia
47
Q

Explain why people with Parkinson’s disease lose weight over time

A

due to low dietary intake

48
Q

List 3 goals of nutritional therapy in Parkinson’s disease

A
  1. Protect neurons
  2. Manage drug-nutrient interactions
  3. Manage nutrition-related side effects
49
Q

Identify the diet that seems to protect against cognitive loss and its major features

A

Mediterranean diet

-High fruits, vegetables, and fats

50
Q

Describe the levodopa-protein interaction and how this should be managed

A

Levodopa

  • travels across the blood brain barrier to make dopamine in the brain
  • protein and L-dopa compete from transport across blood brain barrier

Management

  • tube feeding
  • separate from protein meals
51
Q

Name 3 foods/supplements that should be carefully monitored in people who have Parkinson’s disease

A
  1. Kava
    - interferes with drug therapy
    - hepatotoxic
  2. Fava beans
    - contain natural L-dopa
    - may interefere with drug treatment
  3. Vitamin B6
    - may convert L-dopa before reaches brain
    - do not supplement (whole food okay)
52
Q

List 3 common gastrointestinal problems related to Parkinson’s disease and how each is treated

A
  1. Dysphagia
  2. Gastroparesis
    - -early satiety
    - -Nausea/vomiting
    - -small, frequent meals and high calorie liquids
  3. Constipation
    - -fiber/fluid
    - -physical activity
53
Q

List 6 types of adaptive equipment and when each is useful

A
  1. Cutout cup/nosey cup
  2. straws
  3. nonslip placemat
  4. weighted utensils
  5. universal cuff
  6. plate guard
54
Q

classify foods as appropriate or innappropriate finger foods

A

There is a whole list on her outline. not adding all of them. It’s kinda common sense…?

55
Q

Given an eating-related behavior problem common in people with dementia, list ways to intervene

A

I didn’t add these either…should I? It’s a pretty exhaustive list…

56
Q

Create strategies to increase intake in patients who are not eating

A
  1. Serve calorie dense foods
  2. add calorie boosters
  3. add protein boosters
  4. try bars or supplements (ensure, carnations, etc…)
    - -1-2 kcal/mL
    - -not a meal replacement
    - -little drinks throughout the day
    - -little sips with medication (med pass)
57
Q

Identify the age range associated with bone growth and mineralization, peak bone mass, and bone resorption

A

Bone growth and mineralization
-up to age 30

Peak bone mass
-age 30

Bone resorption

  • age 40
  • speeds up dramatically in women (50 years), men (60 years)
  • more osteoclast activity
58
Q

Define the roles of osteoblasts and osteoclasts

A

Osteoblasts
–build bone

Osteoclasts
–degrade or “crush” bone

59
Q

Describe calcium metabolis, including stimulus for changes in calcium homeostasis, the roles of vitamin D and parathyroid hormone, and their effects

A

Function

  • 99% bone/teeth
  • 1% signaling
  • signaling very important

Inadequate Ca intake
-PTH pulls Ca out of bones and into blood for signaling

Vitamin D

  • activated by kidneys
  • increases Ca absorption in gut
  • leads to an increase in serum Ca

Effects

  • bones depleted due to PTH
  • no remodeling
  • more clastic activity than blastic
60
Q

Define osteoporosis and osteopenia and how they are diagnosed

A

Bone mineral density measured via DEXA scan

  • Osteopenia
  • –density of 1-2.5 standard deviations below normal
  • Osteoporosis
  • –bone mineral density greater than 2.5 standard deviations below normal

Dowager’s hump

  • kyphosis
  • caused by low bone mineral density
  • weight of skill crushes the vertebra
61
Q

Identify 9 risk factors for low bone mass and how each causes loss of bone mass

A
  1. Age (>60 years)
  2. Family history
  3. Smoking or EtOH use
  4. Low body weight, small boned
    - –tiny stress fractures heal quickly, build stronger bones
  5. Ethnicity
    - -caucasian and asian (increased risk)
  6. Lactation (increased risk)
  7. Limited weight bearing exercise (no message for strengthening)
  8. Amenorrhea or menopause
  9. Steroid use
    - -inhibits Vitamin D activation
    - -decreases Ca absorption
    - -increases urination of Ca
    - -decrease osteoblast activity
    - -increase osteoclast activity
62
Q

List 5 strategies to avoid low bone mass, including the RDA for calcium and Vitamin D in older adults, and be able to describe why each works

A
  1. Adequate PRO intake
    - –excess Pro speeds up loss
    - –increases Ca urination
  2. Adequate Ca intake
    - –RDA for >70 years: 1200 mg (adults: 1000 mg)
    - –supplement if needed
  3. Adequate Vitamin D intake
    - –RDA for >70 years: 800 IU

4 .Avoid excess Phosphorus

  • –in absence of adequate Ca, stimulates PTH
  • –soda replaces milk consumption
  1. Avoid excess EtOH
63
Q

Name 5 treatments for low bone mass, including mechanism of action

A
  1. Adequate dietary therapy with or without supplements
  2. Estrogen replacement therapy
    - -very effective
    - -not recommended due to increased risk in breast cancer, stroke, heart disease, deep vein thrombosis
  3. Bisphosphonates
    - -inhibit osteoclasts
  4. Calcitonin
    - -blocks PTH effect on osteoclasts
  5. Fall prevention
    - -leading cause of death by injury in >65 year olds
    - Physical therapist can help identify hazards in house
64
Q

8 Steps of an oral exam

A
  1. gloves
  2. ask patient to open and close mouth, watching for discomfort
  3. ask patient to remove any dental devices
  4. observe lips and corners of mouth, pulling lips forward to observe surfaces (remember common signs of vitamin B deficiencies
  5. use penlight to observe corners of mouth and insides of cheeks, condition of gums or ridges (if no teeth): should be pink
    - white patches may be fungal candida or thrush
    - poorly fitting dentures can cause ulcers
  6. look at roof of mouth and under tongue
  7. observe condition of teeth
    - edentulism-amount of teeth missing
    - occlusion- how teeth meet up (top and bottom)
  8. note saliva: if thick, thin, not present
    - xerostomia: dry mouth
65
Q

4 oral health problems and which healthcare professional to refer patient to

A
  1. Candidiasis or thrush-refer to physician for prescription
  2. tooth decay, periodontal disease-refer to dentist
  3. poorly fitting dentures (common after weight loss)-refer to dentist
  4. Xerostomia (dry mouth)- refer to dentist
66
Q

ways to ease xerostomia

A
  1. chewy, crumbly, dry, stick foods can be hardest to swallow
  2. try sour foods, lemonade or seltzer, frozen berries, sugar-free candies to stimulate saliva production
  3. incorporate more moist foods without added spices, fluid intake
  4. sugar-free gum with xylitol
  5. encourage good oral hygiene, avoid alcohol-containing mouthwash
  6. saliva substitues available
67
Q

4 phases of a normal swallow

A
  1. oral preparatory phase
  2. oral propulsive phase
  3. pharyngeal phase
  4. esophageal phase
68
Q

define dysphagia and name 8 symptoms

A
  • difficulty swallowing-can affect up to 60% elderly patients in LTC
    1. drooling
    2. choking
    3. coughing during or after meals
    4. inability to suck from straw
    5. gurgly vocal quality
    6. pocketing food
    7. absent gag reflex
    8. chronic upper respiratory infections
69
Q

Role of speech language pathologist in treatment of dysphagia

A

orders barium swallow to diagnose dysphagia, then provides treatment, including exercises and ways to manipulate head, tongue, etc. to aid specific swallowing problem
-then orders a diet texture

70
Q

name and describe the four levels of consistency for liquids

A
  1. thin liquid-water, juice
  2. nectar thick-yogurt smoothie
  3. honey thick-honey
  4. spoon thick-pudding
71
Q

Three dysphagia diets

A

Level 1: pureed, homogenous and cohesive foods. Pudding-like, no coarse textures
Level 2: moist, soft-textured foods that easily form into a bolus. meats are ground or minced no larger than 1/4”
Level 3: nearly regular, but no hard, sticky, or crunchy foods. Moist, bite-sized pieces

72
Q

9 ways to increase oral intake in person on a restricted diet due to dysphagia

A
  1. serve food with strong flavors and odors
  2. make sure whoever is preparing meal is tasting it
  3. garnish with foods appropriate for consistency
  4. use sauces, gravies, syrups
  5. use squeeze bottles to decorate plate
  6. use molds
  7. use a thickener or shaping/enhancing product
  8. layer or swirl foods together (pureed peas and pureed carrots, or shepherd’s pie)
  9. slurries-mix of starch and liquid
    prepare with thickener and juice or milk (whatever goes with food being prepared, ex. brownies mixed with milk)
73
Q

identify risk factors that may trigger dysphagia screening

A
  1. advanced age
  2. diagnoses of CVA
  3. diet order of dysphagia diet
  4. history of dysphagia
  5. history or diagnosis of aspiration pneumonia
  6. tracheostomy
  7. cranial nerve dysfunction (V, VII, IX, X, XII)
  8. altered mental status
  9. nutrition risk
  10. noted drooling or difficulty swallowing solids, medications or fluids
  11. prolonged eating time
  12. pocketing food or medications
  13. choking during or after meals
  14. difficulty managing own secretions
  15. change in vocal quality (wet or hoarse)
  16. facial or tongue weakness
  17. poor head control or posture
  18. observe voluntary cough and dry swallow
74
Q

describe the pathophysiology of 4 disease processes that cause loss of sight in older adults

A
  1. age-related macular degeneration
    - center of retina (macula) degrades
    - composed of lutein and zeaxanthin
    - fruit/veg, zinc may slow ARMD
  2. Glaucoma
    - high pressure inside eye presses on optic nerve
    - increased risk with HTN, DM, CVA
  3. Cataract
    - clouding of lens
    - development delayed by antioxidant intake
  4. Diabetic retinopathy
    - damage to blood vessels due to hyperglycemia
75
Q

explain why loss of sight represents a risk factor for malnutrition

A

sarcopenia: age-related loss of muscle mass can result in loss of sight

76
Q

basic guiding techniques for blind patient

A
  1. if patient is not familiar with surroundings, ask if they would like to be guided
  2. offer your arm for the person to grip just able the elbow (they may prefer to grip your shoulder)
  3. when guiding someone with sight problems, walk slightly in front, making sure pace is appropriate
  4. if steps or stairs, always give warning and state whether they go up or down
  5. explain changes in ground surface
  6. never guide someone into a seat backwards. instead, describe the chair, place your hand on the back, and enable the person to orientate themselves into the seat independently
    7
77
Q

5 ways to identify people who may be deaf or hard of hearing

A
  • facial expressions signaling confusion or inappropriate for conversation
  • turning head or leaning toward speaker
  • inappropriate response to questions
  • no response
78
Q

describe how to effectively communicate with someone who is deaf or hard of hearing

A
  • adequate lighting for lip reading
  • reduce background noise
  • face patient, not wearing mask
  • stop speaking if looking away or taking notes
  • speak at normal volume if deaf, louder if HoH, not too fast
  • announce topic before getting into details
  • wait a little longer than normal for responses
  • dont rely just on nonverbal cues for understanding
79
Q

how to effectively communicate with someone deaf or HoH working with an ASL interpreter

A
  • expect 2-3X as long as usual
  • one sentence at a time max
  • minimize medical terms as much as possible
  • keep talking to patient, not interpreter or family
80
Q

define ageusia, hypogeusia, dysgeusia and hyposmia and how they affect nutritional intake

A

ageusia: absence of taste
hypogeusia: diminished taste
dysgeusia: distorted taste
hyposmia: decreased sense of smell

-affect food choices and meal sizes, enjoyment at meals, clues that food is spoiled, begin cephalic phase of digestion

81
Q

7 ways to manage loss of taste or smell

A

1-no medication available
2-good oral care
3-use stronger flavorings
-garlic, herbs, spices, flavored vinegars, onion, chilies, acid from fruit, concentrated stocks
-use simulated flavors (bacon, cheese, butter) esp. if pt. has gastroesophageal reflux disease (GERD)
4- avoid overcooking
5-metallic taste, use plastic utensils
6- use garnishes, bright colors to trick the eye
7- try 10-day zinc supplement if deficiency is possible: 220 mg ZnSO4 daily x 10days
8-provide education/resources on when to throw out food

82
Q

Describe reasons that artificial nutrition and hydration may be contraindicated in palliative care, advanced dementia and vegetative state

A

-Palliative care: patients experience very little hunger or thirst, IVF cause discomfort (increased urination, fluid build up, GI secretions causing N/V), starvation/dehydration may increase ketone’s anesthetic effect-increase endogenous opioids, treating dry mouth helps with feeling of thirst; no evidence that nutrition support will increase life in terminal illness
-Advanced dementia: no evidence that nutrition support reduces symptoms, improves functional nutrition status or enhances comfort/prolongs survival; PEG does not change aspiration rates (may require physical or chemical restraints); some evidence of higher morbidity/mortality especially after PEG placement
-Vegetative State:
“eyes open unconsciousness”
>1 month-persistant vegetative state
>3 month-permanent vegetative state
-no response to painful stimuli, no evidence of pain due to hunger
-after PEG placement, may need a timeline to stop feedings

83
Q

List and describe 5 ethico-legal concepts related to providing artificial nutrition and hydration

A
  1. Informed consent
    - adequate information in understandable language about treatment including diagnosis and prognosis with or without intervention
    - intact decision-making capacity
    - voluntarism-ability to make the choice without coercion
  2. Decisional Capacity or competence
  3. Surrogate decision-making
    - spouse, adult children, siblings, other relatives
    - dependent on state: friends, same-sex partners
  4. withholding or withdrawing treatment
    - withholding:not starting
    - withdrawing: stopping
    - legally they are identical, withdrawing harder for family
  5. Futility/quality of life-no matter what you do, prognosis is the same
84
Q

Define the “conscience clause”

A

healthcare provider may transfer care if unable to care for patient in accordance with views

85
Q

Describe the legal concepts of informed consent, malpractice/negligence, and abandonment

A
  1. absence of informed consent:
    - consent not obtained for the specific procedure
    - patient not provided with information critical to consent (complication)
    - consent not obtained for the individual doing procedure
    - consent obtained from person with diminished decision-making capability
  2. Malpractice/negligence:
    - practitioner must accept patient and then provide inadequate care constituting a breach of duty, causing damage
  3. abandonment
    - refusal to treat, providing insufficient or delayed treatment, withdrawal of care without adequate notice, premature discharge
86
Q

Name the purpose of advanced directives

A
  • living will-specify patient’s wishes for care
  • Power of attorney- designates person to make decisions of own ability to make decisions is lost
  • healthcare proxy- designates person to make healthcare decisions of ability is lost

Life cycle in Nutrition (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions