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NTR 315 > Exam 3 Review (PPT) > Flashcards

Exam 3 Review (PPT) Flashcards

1
Q

Adolescence

Changes associated with adolescence:

Physical changes associated with puberty:

A

Changes associated with adolescence:

1) Physical Changes,
2) Cognitive / Psychological Changes
3) Nutritional Needs
4) Concerns During Adolescence

Physical changes associated with puberty:
Growth, body Composition, & sexual Maturation.

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2
Q

Physical growth - Peak Growth Velocity

A

Occurs earlier in girls

Girls - age 11.5

Boys - age 14

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3
Q

Body composition;
Pre - Puberty

Puberty

A

Body composition;

Pre - Puberty
• Body fat and muscle

Puberty
• Bone mass
• Body fat
• Lean muscle mass

–

Girls Body fat - girls increases 120% - prepare body for childbearing.

Girls slightly increase body mass.

Boys body fat decrease from 16 to 12 percent. Boys increase in muscle mass.

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4
Q

Tanner Sexual Maturity Ratings – Boys

A

Stage 1-Prepuberty

Enlargement of testes
Pubic hair growth
Spermarche
Growth spurt
Acne
Axillary perspiration
Axillary hair
Facial hair
Voice change

Stage 5 -Adult

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5
Q

Tanner Sexual Maturity Ratings – Girls

A

Stage 1-Prepuberty

Breast development
Pubic hair growth
Growth spurt
Menarche
Acne
Axillary perspiration
Axillary hair

Stage 5 -Adult

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6
Q

Cognitive / Psychological

Early Adolescence - Ages 11-14

Middle Adolescence - Ages 15 - 17

Late Adolescence - Ages 18 - 21

A

Cognitive / Psychological

Early Adolescence - Ages 11-14
• Body image / Sexuality
• Concrete —> Abstract thinking
• Strong peer influence

Middle Adolescence - Ages 15 - 17
• Body image / Sexuality
• Abstract thinking
• Enormous peer influence
• Sense of identity development
• Independence from parents

Late Adolescence - Ages 18 - 21
• Body image established
• Abstract thinking
• Strong peer influence
• Independence from parents
• Serious intimate relationships

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7
Q

Nutritional Needs During Adolescence:

Factors influencing eating behavior:

Eating practices:

A

Nutritional Needs During Adolescence:
Energy, Macronutrients (P,CHO & F), & Vitamins /Minerals (Folic acid, vitamins C, A & D, Ca, Fe & Zn).

Factors influencing eating behavior:
Discretionary income, peer group, schedules, emotions self-concept, personal/social beliefs, & food preferences.

Eating practices: meals away from home, meal skipping, snacking, energy dense foods.

–

Folic acid - DNA synthesis -get from folage
(green leafy vegetables), whole grains, orange
juice

Vitamin C - production of collagen - matrix of
bone

Vitamin A - elongation of bones

Iron - blood volume

Zinc - sexual maturation

Calcium and vitamin D - maximizing bone
growth 865 mg, 1300 mg recommended
Girls are not getting the calcium
reccomendations.
Boys get 1100mg. Not getting enough calcium.
Calcium - sardines, almonds, broccoli

–

○ iron (deficiency symptoms; food sources)
■ Symptoms: anemia (tired and fatigue, lack of oxygen due to decreased red blood cells)
■ sources: lean meat, shellfish, legumes, broccoli, spinach, nuts

○ calcium / vitamin D (deficiency symptoms, food sources)
■ deficiency: osteoporosis, bone fractures
■ sources: bread/grains, vegetables, cheese, soy – not really milk

○ zinc (deficiency symptoms, food sources)
■ sources: meat, fish, seafood, beans, nuts, legumes
■ deficiency: decrease bone and growth development; can be due to high calcium levels (decrease zinc binding/absorption)

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8
Q

Pregnant adolescent:
Energy & Nutrient Needs, and Weight Gain
Poor Outcomes
• Growing adolescent - biological immaturity
• Lifestyle - drugs, smoking, poor diet

Risky behaviors:
Substance abuse: 1) Types; alcohol, tobacco, & marijuana. 2) Influences; peer pressure & family.

A

Texas has higher rate

Poor outcomes - Preterm child

Normal if around 17 years old pregnant

Don’t have maturity to think about child

Pregnant adolescent still growing - take high amount of energy
recommendation

Healthy body weight - gain 25 - 35 percent of body weight -
recommend high end of weight

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9
Q

Sports During Adolescence

Critical Periods for Obesity

A

Sports During Adolescence
Diet prescription; high carbohydrates & adequate protein
Fluid intake; dehydration/overheating, & needs
Supplementation - ergogenic aids

Critical Periods for Obesity:
Prenatal, adiposity rebound, & adolescence.

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10
Q

Risk Factors for Overweight

Health problems as a result of overweight:

A
  • *Risk Factors for Overweight**
    1) At least one overweight parent, 2) low income, 3) condition that limits physical activity, 4) ethnicity/race – African American, & Hispanic/Native American.

Health problems as a result of overweight:
Sleep apnea, asthma, type-2 DM, HTN & heart diseases, psychosocial problems, and orthopedic complications.

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11
Q

Trends in Child and Adolescent Overweight

A

Prevelance
Early – 10%
Mid 12-19 years – 17%

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12
Q

Trends

Highest in male and females of which race

A

Female : Non-hispanic blacks

Males: Hispanics

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13
Q

Assessment for Treatment Overweight

A

Overweight BMI 85th - 94th %ile

No complications = weight maintenance

Complications = weight maintenance and weight loss

Obese BMI > 95th %ile

Weight maintance and weight loss

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14
Q

Eating disorders (ED)

Types of ED & sub-types:

Risk factors of ED:

A

Eating disorders (ED)

Types of ED & sub-types: AN (restricting, binge eating/purging), BN (purging & non-purging), BED, EDNOS.

Risk factors of ED: genetics (family history), relation-ships and social environment including family, school, media, & peers, bullying, anxiety, body image dissatisfaction, trauma & health issues/concerns, food allergies, family illness.

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15
Q

Anorexia Nervosa

A

AN (restricting, binge eating/purging subtypes) is associated with:

Below 85% of normal body weight

Intense fear of gaining weight/ becoming fat

Distorted body image

Amenorrhea for 3 consecutive cycles.

Signs & symptoms: Rapid weight loss, refusal to eat appropriate portions, irritability/ labile mood, food obsessions, calorie counting, excessive exercise, loss of menstrual cycle and others.

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16
Q

Bulimia Nervosa

A

BN (purging & non-purging subtypes) is associated with:

Recurrent episodes of binge eating.

Compensatory behaviors to prevent weight gain.

Behaviors ≥2times/week for at least 3 months

Hyper-focus on body shape and weight.

Signs & symptoms: Rapid weight fluctuations, intense food cravings, secretive food behavior, distorted body evaluation, chipmunk cheeks, depression, scarred knuckles, & others.

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17
Q

Binge Eating Disorder

A

BED is associated with:

Recurrent episodes of binge eating
3 or more of the following:

  • Eating much more rapidly than normal
  • Eating until uncomfortably full
  • Eating large amounts of food when not hungry
  • Eating alone because of embarrassment
  • Feeling disgusted, depressed, or guilty after eating
    Distress regarding binge-eating

Binge episodes at least 2 d/wk for 6 months

No regular use of compensatory behaviors

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18
Q

Signs & symptoms associated with Binge Eating Disorder:

A

Signs & symptoms associated with BED:
Rapid weight gain, food hoarding behaviors, normal or restricted eating in public, preoccupation with food/ eating, significant guilt/ shame with eating, desperate desire to control weight, “Numbing out” while eating, mindless grazing, depression and poor Self-Worth.

Handout of signs & symptoms

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19
Q

EDNOS is associated with :

Eating Disorder Not Otherwise Specificied

A

EDNOS is associated with :

Does not meet full criteria for AN, BN, or BED
Short duration
Insufficient weight loss/ menstrual dysfunction
Erratic/ inconsistent patterns of behavior
“Disordered Eating”

Atypical presentations
Orthorexia Nervosa
Night Eating Syndrome
Chewing and Spitting
Anxiety-/ Depression-Driven Behaviors

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20
Q

Eating Disorders Prevalence:

A
  • In the United States, 5-10% of post-pubertal females struggle with clinical or sub-clinical eating disorders.
  • Conservative estimates for the U.S. suggest prevalence rates of:
    5-10 million women/ girls
    1 million men/ boys
    * Prevalence rates for young female athletes: up to 62%!!!

–

Know prevelance. Percentages. Diagnosable.
Highest in anorexia. Anorexia is most prevelant but EDNOS is MOST.
Bulemia is most common.

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21
Q

Eating Disorders

Goals of therapy:

  1. Medical Stability
  2. Behavior Stabilization
  3. Normal/ Intuitive Eating
A

Goals of therapy:

1. Medical Stability
Prevent Re-feeding Syndrome such as Edema & Electrolyte Imbalances, Cardiac/ Renal/ Hepatic Insufficiency, Most likely with AN – B/P type, Requires slow meal plan increases with medical monitoring

2. Behavior Stabilization
Structured Meal Plan; 3 meals and 2-3 snacks/day, or Weight Restoration, as needed
Cease Compensatory Behaviors

3. Normal/ Intuitive Eating

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22
Q

Eating Disorders

Treatment:

Normal intuitive eating:

A

Treatment: Medical Doctor, Primary Therapist & Family Therapist, Registered Dietitian, Psychologist/ Psychiatrist.

Normal intuitive eating:
All foods “fit” with balance, variety, & moderation
No good foods or bad foods
Normal food combinations
Meals & snacks throughout the day
Value and worth separate from food
Food ritual cessation
Food for appropriate social connection
New skills to replace ED behaviors

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23
Q

Age of Menopause and Life Expectancy

A

Life expectancy has increased (from 40s to 80s)

Age of menopause 50 - 52 years

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24
Q

Stages of reproductive life

A

Birth

Menarche (Age 12 - 14)

Perimenopause (40 - 45)

Menopause (50 - 52)

Postmenopause (after 50)

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25
Q

Changes egg cell numbers over life cycle

A

Most before birth

Declines afterwards

None left at menopause

26
Q

Reproductive Cycle

A

GnRH -> FSH LH -> 17-Estradiol Progesterone -> (negative feedback to GnRH)

27
Q

Peri-menopause/Menopause

A

High GnRH FSH LH -> Low 17-Estradiol Progesterone -> (positive feedback to GnRH)

28
Q

Life cycle hormone fluctuations

A

Estrogen and Progesterone high during teen, drops during perimenopause

29
Q

Estrogen Deficiency

A
30
Q

Post-Menopause

A

Steroid Hormones - Estrone, Andrgens (testosterone)

31
Q

Treatment of Menopausal symptoms

Prescription drugs

Lifestyle approaches.

Hormone replacement
Benefits
Risks

A

Treatment of Menopausal symptoms

Prescription drugs – hormone replacement
- other medications

Lifestyle approaches.

Hormone replacement- estrogen/progesterone
Benefits
reduce hot flashes, decreases vaginal dryness, decreases bone loss
Risks
heart disease/stroke, breast cancer

32
Q

Bone loss in Menopause & Age

Osteoclasts and Osteoblasts

A

Growth - More osteoblasts than osteoclasts

Postmenopause - Less osteoblasts, more osteoclasts

33
Q

Menopause medications

A

Other medications

  1. Hot Flashes / Depression.
  2. Low Dose Antidepressant
  3. Low Bone Density (see Osteoporosis slides)
  4. Bisphosphonates
  5. Hormonal agents
34
Q

Lifestyle approaches
A) Healthy practices

B) Dietary practices

A

Lifestyle approaches

A) Healthy practices - avoid smoking, avoid excessive alcohol, balance, adequate diet, maintain healthy weight, exercise regularly, practice stress reduction

B) Dietary practices - adequate Vitamin D / Ca, low to moderate caffeine, avoid excessive alcohol, phytoestrogens as soy isoflavanones & flaxseed lignans, herbs (inconclusive).

35
Q

Andropause

Definition and treatment

A

Andropause

Gradual decline male hormones (testosterone); - erectile dysfunction & decreased sex drive, loss of muscle mass, anxiety & irritability, sleep disturbance, loss bone density, CVD.

Andropause treatment
Hormone Therapy - Testosterone

  • *Benefits**
    • improved sex drive
    • improved muscle mass / strength
  • *Risks**
    • prostate / breast enlargement
    • erythrocytosis / stroke
    • infertility
36
Q

Bone Mass through life cycle

A

Active Growth until 20s

Peak bone mass 12 - 30

Bone loss 35 until death

37
Q

Bone loss with age is associated with:

Non-modifiable risk factors:

Modifiable risk factors:

A

Bone loss with age is associated with:
1) Loss of estrogen
2) Inadequate intake of Calcium
Bones become porous – risk of bone fractures.

Non-modifiable risk factors:
Older age
Female
Early Menopause
Race
Genetics & family history

Modifiable risk factors:
Nutritional status– body weight, physical activity, & nutrient intake
Smoking
High caffeine intake
Alcohol abuse
Some medications

38
Q

Osteoporosis more prevent amongst what race

A

Prevent in white women

Occurs in individuals with low bone mass

39
Q

Machine used to measure bone density

A

Dual energy X-ray absorptiometry (DEXA)

40
Q

Bone

Trabecular, Cortical

A

Osteoporosis - loss of trabecular bone

41
Q

Boen mass T-scores

A

Below 0 = Normal

Below -1 = osteopenia

Below -2.5 = osteoporosis

42
Q

Warning signs of Osteoporosis

A

Warning signs of Osteoporosis
Any fracture after 40
Loss of height
Back pain
Dowager’s back (kyphosis)
Bone density test T-score below - 2.5.

43
Q

1-Year mortality after hip fracture

A

Mortality rate increases with age

>90 = 50%

44
Q

Meds that Decrease Risk Fracture

A

Meds that Decrease Risk Fracture

Most drugs DECREASE OSTEOCLAST ACTIVTY:

Bisphosphonates - Fosamax, Boniva, Actonel, Reclast

  • *Hormonal** - Estradiol
    - Selective Estrogen Receptor
  • *Modulators as Evista**
    - Calcitonin
    - Parathyroid Hormone

–

Parathyroid Hormone - increases osteoplast activity, synthetitic form - intermitent frequency - injection - releases calcium into the blood - blood calcium increases - Vitamin D goes to liver and
becomes hydroaxlated, Kidney hydroxylates and activates Vitamin D - increases blood calcium - increase calcium reabsorbtion and retention of calcium

45
Q

Lifestyle and Bone Health
Weight Bearing Exercise

Diet – Minerals, protein, vitamins, alkaline diet, & Soy (??)
Sun exposure

Ca supplements:

A

Lifestyle and Bone Health
Weight Bearing Exercise

Diet – Minerals, protein, vitamins, alkaline diet, & Soy (??)
Sun exposure

Ca supplements:
• high % of calcium
• easily absorbable calcium
• supplement between meals
• low dose supplements

–

Calcium carbonate - most common - 40% calcium
- requires acid for absorption - elderly people have
gastritis

Calcium citrate (23%) - contains less calcium but
 requires less acid - good for elderly people - in
 fortified orange juice

Calcium gluconate (9%) - not worth it

46
Q

Theory of Aging

Programmed Cell Death, and Wear & Tear.
Aging rate is: environment, lifestyle, & genetics

The Graying of America

A

Elderly population will increase significantly by 2050.

Over 90 million people 65 years and over

Over 20 million people 85 years and over

47
Q

Physiological changes

Body composition:

Physiological changes
Senses; Vision, Hearing, Taste & Smell

Organ systems;
GIT -
– Oral; xerostomia & dysphagia
– Stomach; atrophic gastritis
– Intestinal; reduced absorption & motility.

Others - Cardiovascular, respiratory, renal, skin, hair, nails, neuromuscular, skeletal, endocrine, & immune System.

A

Physiological changes
1. Body composition
2. Senses
3. Organ systems
Body composition:
– Sarcopenia; Muscle mass, body fat, and BMR
– Weight changes
– Bone loss

Physiological changes
Senses; Vision, Hearing, Taste & Smell

Organ systems;
GIT -
– Oral; xerostomia & dysphagia
– Stomach; atrophic gastritis
– Intestinal; reduced absorption & motility.

Others - Cardiovascular, respiratory, renal, skin, hair, nails, neuromuscular, skeletal, endocrine, & immune System.

48
Q

Nutritional needs;

Micronutrients:
• Bone health –
• Cognition -
• Immunity –

Other health problems/concerns:
Vision Problems, decreased mobility, cognitive Decline

A

Nutritional needs;
Energy, macronutrients, fluids & fiber.

Micronutrients:
• Bone health – Vit. D, K, P & Mg, vitamin C, Ca
• Cognition - Folic acid, B6, B12
• Immunity – Zn, Vitamin C, vitamin D

Other health problems/concerns:
Vision Problems, decreased mobility, cognitive Decline

49
Q

Vision problems; cataracts, glaucoma, & macular Degeneration.
Prevention or Delay of Vision Problems:
Diet high in antioxidants; Vitamins C & E, and carotenoids as lutein / zeaxanthin
Protect eyes from sunlight.
Decreased mobility – arthritis.

A

Vision problems; cataracts, glaucoma, & macular Degeneration.

Prevention or Delay of Vision Problems:
Diet high in antioxidants; Vitamins C & E, and carotenoids as lutein / zeaxanthin
Protect eyes from sunlight.

Decreased mobility – arthritis.

Rheumatoid - autoimmune - attacking your joints,
joints become deformed

Osteoarthritis - degenerative - wear and tear -
most people have this one

–

Cataracts - clouding of the lens

Glaucoma - increased pressure in eye, can cause
damage to optic nerve, fluid plugged up. Seen
more in Black population. Treatable with medicine

Macular Degeneration - Retina - Macula -
photosensitive cells start to degrade - can cause
blindness - 30% of age 65 are affected by this -
seen more in people with inflammatiory diseases
diabetes obestity, and cardivascular disease
atherosclerosis

50
Q

Aging

Osteoarthritis
- Risk factors:

  • Signs and Symptoms:
  • Treatment: medications, supplements, exercise, relaxation, diet & surgery.

Dietary Treatment

Social Impact of Aging: income, dependent living, & depression

A

Osteoarthritis

** - Risk factors:**
Advancing age
Obesity
Female
Injuries / overuse
Maligned bones, rheumatoid arthritis & gout

** - Signs and Symptoms:**
Pain Stiffness, swelling, numbness, decreased mobility, crepitus

  • *Osteoarthritis**
    • Treatment: medications, supplements, exercise, relaxation, diet & surgery.

Dietary Treatment
1) Maintain healthy weight
2) Consume diet high in:
- anti-inflammatory compounds
- antioxidants; phytochemicals, and
vitamins E & C.

Social Impact of Aging: income, dependent living, & depression

51
Q

Nutrition Programs for Aging:

Nutritional Screening Initiative:

Healthy Aging:

A
  • *Nutrition Programs for Aging:**
    1) Older Americans Act
    • nutrition services to low income
    • congregate meals
    • home - delivered meals
      2) Food Stamps
      3) Nutrition Screening Initiative.

Nutritional Screening Initiative: (DETERMINE)
Disease, eat poorly, tooth loss, reduced social support, multiple medicines, involuntary weight loss, needs assistance, economic, >80 years

Healthy Aging:
Be active
Meditate & Relax
Eat well
Stimulate your Brain
Connect with Others

52
Q

Dementia & Alzheimer

Prevalence:
About 6.8 million cases in U.S., at least 1.8 million severe

Alzheimer’s and Vascular Dementia by far most common

About _ million due to Alzheimer’s Disease

Over _ million due to Vascular Dementia

Signs:

A

Prevalence:
About 6.8 million cases in U.S., at least1.8 million severe
Alzheimer’s and Vascular Dementia by far most common

About 4 million due to Alzheimer’s Disease

Over 1 million due to Vascular Dementia

Signs:
– Shrunken brain, amyloid plaques, & tangled fibers

53
Q

Alzheimer

Pathophysiology:
Amyloid plaques between neurons (unusual clumps of beta amyloid protein and bits of degenerating cells)
Neurofibrillary tangles within neurons (twisted filaments largely made of tau protein).
Shrinkage in brain size

Prevalance by age

A

Alzheimer

  • *Pathophysiology:**
  • *Amyloid** plaques between neurons (unusual clumps of beta amyloid protein and bits of degenerating cells)

Neurofibrillary tangles within neurons (twisted filaments largely made of tau protein).

Shrinkage in brain size

Prevalance by age

Over 85 years = 45%

54
Q

Alzheimer life course
Progressive disease, usually 7 - 10 yr; course, up to 20 years
Fatal; a leading cause of death in U.S. after heart disease, cancer, stroke.

Alzheimer Common Early Signs

Advanced Alzheimer

A

Alzheimer life course
Progressive disease, usually 7 - 10 yr; course, up to 20 years
Fatal; a leading cause of death in U.S. after heart disease, cancer, stroke.

Alzheimer Common Early Signs
• Forgetful (repeats question, stories; taking medication; leave stove on)
• Trouble balancing checkbook
• Getting lost

Advanced Alzheimer
• Difficulty speaking
• Unable to recognize family
• Loss of bowel and bladder control
• Difficulty swallowing, often causing death due to aspiration pneumonia

55
Q

Dementia is ___ of mind

Not a disease, but descriptive term for collection of symptoms involving significant decline in mental functioning caused by factors affecting the brain

Multiple possible causes

Senile = ___

Human brain:
Weighs __% of body wt; uses __% O2 & glucose

A

Dementia is deprivation of mind

Not a disease, but descriptive term for collection of symptoms involving significant decline in mental functioning caused by factors affecting the brain

Multiple possible causes

Senile = old age

Human brain:
Weighs 2% of body wt; uses 20% O2 & glucose

56
Q

Dementia symptoms:

A

Dementia symptoms:
Decline in Cognitive Functions:
• Intellectual (Problem solving, judgment)
• Memory, Language, & Math
• Orientation (person, place, time)
• Personality change (e.g., anxiety, agitation, hostility)
• Behavior problems (wandering, getting lost, irregular sleep)
• Delusions (people stealing, spouse unfaithful)
• Hallucinations (e.g., people in house)

57
Q

Vascular Dementia

A

Vascular Dementia
History often includes high BP, vascular disease (e.g., type 2 DM), heart attack
Deficits often “focal” or localized
Multi-infarct dementia = multiple small strokes
Can co-occur with Alzheimer’s
2nd most common cause; up to 20% of cases
Stroke most common
Usually sudden onset
Patient may improve or get worse
Worsening usually stepwise

58
Q

Dementia - Other Causes (Many are treatable)

A

Dementia - Other Causes (Many are treatable)
• Medication/Drug reaction
• Metabolic imbalance
• Endocrine abnormality(e.g.,hypoglycemia)
• Nutritional deficiencies (e.g., folate, B12, B6)

59
Q

Risk Factors of Dementia:

A

Risk Factors of Dementia:
• Age
• Genetics & Family History (not definite)
• Smoking (dementia & atherosclerosis)
• Atherosclerosis (plaques in artery wall)
• Alcohol (increased risk for heavy & non-drinkers)
• High LDL cholesterol
• Elevated plasma homocysteine (amino acid)
• Diabetes, stroke & HTN
• Mild cognitive impairment

60
Q

Prevention of Dementia:

A

Prevention of Dementia:
• Control diabetes
• Lower blood pressure
• Lower cholesterol
• Lower homocysteine (Folic acid, B6, B12)
• Control inflammation - long term use of NSAID(s) may prevent or delay onset
• Education
• Intellectual stimulation (e.g., puzzles, social interaction, learn new things)
• Exercise, control weight
• Lower stress

61
Q

Not Dementia

A

Not Dementia
• Age-related cognitive decline
• Mild cognitive impairment
• Depression
• Delirium (confusion, rapidly changing mental state)

62
Q

How Folate, B12, B6 affect homocystine

A

Need folate and B12

Low B6 = hyper homecysteine - bad for alzheimer

B6 - vegetables
B12 – fatty foods

NTR 315 (8 decks)

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