Exam 3 Material

Question 1

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

Answer 1

1. Water
2. Mineral
3. Protein
4. Fat

Question 2

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

Answer 2

1. Essential fat for organ function vs. storage fat for energy reserve
2. Visceral fat around organs vs. subcutaneous fat under the skin

Question 3

Describe 3 changes in body composition in adulthood.

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

• 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

Question 6

Identify disease processes that are associated with obesity.

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

Name 4 categories of dietary modification for weight loss

Answer 9

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

Question 10

Explain why fad diets or extreme energy restriction are discouraged.

Answer 10

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!

Question 11

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

Answer 11

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

Question 12

Identify patients who are candidates for bariatric surgery.

Answer 12

1. BMI > 40

2. BMI > 35 + complications

Question 13

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

Answer 13

1. Restrictive: gastric banding

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

Question 14

Define weight loss plateau.

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

1. Moderate alcohol consumption is associated with health benefits.
2. Excessive drinking is associated with health risks.

Question 20

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

Answer 20

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)

Question 21

Describe how alcohol causes cellular damage.

Answer 21

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)

Question 22

Explain how alcohol tolerance develops.

Answer 22

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

Question 23

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

Answer 23

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

Question 24

Name the effect of caffeine on alcohol metabolism.

Answer 24

1. There is no effect on metabolism.

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

Question 25

Explain why the liver is most harmed by alcoholism.

Answer 25

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

Question 26

Define "functional food."

Answer 26

"A food that has a health benefit beyond basic nutrition"

Question 27

Define "dietary supplement."

Answer 27

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

Question 28

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

Answer 28

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)

Question 29

Name 4 groups of people who should not use supplements.

Answer 29

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

Question 30

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

Answer 30

1. Sports performance 2. Weight loss - Fen-Phen 3. Sexual enhancement - contaminated with steroids, Viagra

Question 31

Identify 5 strategies to minimize risk when purchasing supplements.

Answer 31

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

Question 32

Name the average life expectancy and life span for Americans

Answer 32

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

Question 33

Describe two basic theories on aging

Answer 33

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

Question 34

Name 3 changes in body composition as adults age

Answer 34

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

Question 35

Define sarcopenia and sarcopenic obesity and describe their consequences

Answer 35

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

Question 36

Identify protein needs in older adults

Answer 36

1. 0-1.2 g/kg after age 65 - best if evenly distributed throughout the day -Higher protein intake helps preserve lean body mass

Question 37

List 3 benefits to exercise

Answer 37

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

Question 38

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

Answer 38

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

Question 39

Name 2 tools to screen older adults for malnutrition

Answer 39

1. Determine checklist | 2. Mini Nutrition Assessment (MNA)

Question 40

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

Answer 40

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

Question 41

Describe the relationship between aging, depression, and malnutrition

Answer 41

Depression - affects 16% of older adults - leads to--> significant risk for malnutrition

Question 42

Define dementia, and list the 5 causes of dementia

Answer 42

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

Question 43

Describe the pathophysiology for Alzheimer's disease

Answer 43

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

Question 44

Nutritional risk factors for Alzheimer's disease

Answer 44

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

Question 45

Relate 6 characteristics of Alzheimer's disease to nutritional implications

Answer 45

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

Question 46

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

Answer 46

Pathophysiology - -progressive loss of dopamine in substantia nigra (basal ganglia) - leads to dementia Characteristics - resting tremor - muscle rigidity - bradykinesia

Question 47

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

Answer 47

due to low dietary intake

Question 48

List 3 goals of nutritional therapy in Parkinson's disease

Answer 48

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

Question 49

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

Answer 49

Mediterranean diet | -High fruits, vegetables, and fats

Question 50

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

Answer 50

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

Question 51

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

Answer 51

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)

Question 52

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

Answer 52

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

Question 53

List 6 types of adaptive equipment and when each is useful

Answer 53

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

Question 54

classify foods as appropriate or innappropriate finger foods

Answer 54

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

Question 55

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

Answer 55

I didn't add these either...should I? It's a pretty exhaustive list...

Question 56

Create strategies to increase intake in patients who are not eating

Answer 56

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)

Question 57

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

Answer 57

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

Question 58

Define the roles of osteoblasts and osteoclasts

Answer 58

Osteoblasts --build bone Osteoclasts --degrade or "crush" bone

Question 59

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

Answer 59

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

Question 60

Define osteoporosis and osteopenia and how they are diagnosed

Answer 60

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

Question 61

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

Answer 61

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

Question 62

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

Answer 62

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 5. Avoid excess EtOH

Question 63

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

Answer 63

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

Question 64

8 Steps of an oral exam

Answer 64

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

Question 65

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

Answer 65

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

Question 66

ways to ease xerostomia

Answer 66

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 2. incorporate more moist foods without added spices, fluid intake 3. sugar-free gum with xylitol 4. encourage good oral hygiene, avoid alcohol-containing mouthwash 5. saliva substitues available

Question 67

4 phases of a normal swallow

Answer 67

1. oral preparatory phase 2. oral propulsive phase 3. pharyngeal phase 4. esophageal phase

Question 68

define dysphagia and name 8 symptoms

Answer 68

- 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

Question 69

Role of speech language pathologist in treatment of dysphagia

Answer 69

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

Question 70

name and describe the four levels of consistency for liquids

Answer 70

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

Question 71

Three dysphagia diets

Answer 71

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

Question 72

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

Answer 72

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)

Question 73

identify risk factors that may trigger dysphagia screening

Answer 73

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

Question 74

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

Answer 74

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

Question 75

explain why loss of sight represents a risk factor for malnutrition

Answer 75

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

Question 76

basic guiding techniques for blind patient

Answer 76

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

Question 77

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

Answer 77

- facial expressions signaling confusion or inappropriate for conversation - turning head or leaning toward speaker - inappropriate response to questions - no response

Question 78

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

Answer 78

- 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

Question 79

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

Answer 79

- 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

Question 80

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

Answer 80

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

Question 81

7 ways to manage loss of taste or smell

Answer 81

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

Question 82

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

Answer 82

-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

Question 83

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

Answer 83

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

Question 84

Define the "conscience clause"

Answer 84

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

Question 85

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

Answer 85

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

Question 86

Name the purpose of advanced directives

Answer 86

- 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