Exam 4: Nutrition Flashcards
1
Q
Chyme
A
Liquified acidic food product
2
Q
Bile
A
Released from liver, secretin and cholecystokinin from the small intestine
3
Q
Peristalsis
A
Moves chyme along, gradual decreasing acidity
4
Q
Digestion occurs in the
A
Small intestine
5
Q
Primary site of absorption
A
Small intestine via the villi
6
Q
Active transport
A
Higher concentration lower, carrier moves nutrient across the cell membrane
7
Q
Passive diffusion
A
Particles move from higher to lesser concentration WITHOUT carrier
8
Q
Osmosis
A
Movement of water across a membrane to equalize pressure
9
Q
Pinocytosis
A
Absorbing cell engulfs large nutrients
10
Q
What is needed for cell function as it depends on fluid environemtn
A
Water
11
Q
Essential for metabolism and is water soluble OR fat soluble
A
Vitamine
12
Q
Catalysts for enzymatic run
A
Minerals
13
Q
main source of energy
A
Carbohydrates
14
Q
Carbohydrates is ____ kcal/gram
A
4 kcal/gram
15
Q
necessary for nitrogen balance
A
Proteins
16
Q
proteins are ____ kcal/g
A
4 kcal/g
17
Q
fats are ___ kcal/grams
A
9 kcal/gram
18
Q
Fat soluble vitamins
A
A
D
E
K
19
Q
High doses of fat-soluble vitamins are at risk for
A
Hyper - Vitaminosis
20
Q
Who has a larger percent of their body composed of water? Someone with BM I of 23 or BMI of 48?
A
Someone with a BMI of 23
21
Q
Dietary reference intakes
A
Acceptable range of quantities of vitamins and minerals for each gender and a few group
22
Q
UNderstand factors associates with intake of food and fluids in each society and culture
A
Celebrations
Traditions
Values, beliefs, and attitudes can affect what food is purchased, prepared, and consumed
Development, body composition, activity, pregnancy/lactation, and disease can alter nutritional requirements.
Environment: what is available? Famine? Feast? Food deserts?
23
Q
Infants and toddlers
A
Breastfeeding/formula
24
Q
Infants/toddlers when do they have soft solids
A
6-8 months and supplement with milk and formula
25
Infants/toddlers need a
gradual increase in texture and volume
26
Adolescence needs an ____ to support growth support
Increase in diet to support GS
27
Adolescence needs more
Calcium and iron
28
Females need iron for
Menstruation
29
Males nee iron for
Muscle devleopemnt
30
Pregnancy/lactation need
Additional calories and fluid needs for 2
31
Elderly need
Decrease caloric needs r/t decreased BMR
32
assessment for nutrition
Age
Physical assessment:
Height, Weight (changes?), Fat Distribution, BMI Calculation
Health history/Oral health
Laboratory tests
Primary diagnosis & Comorbidities
Screening tools (e.g. Mini-Nutritional Assessment MNA)
Alternative food patterns & Patient’s general nutrition knowledge
Cultural, Religious, or Personal Food Preferences
Socioeconomic status
Psychological factors
Use of alcohol/illegal drugs
33
Physical signs of nutrition or malnutrition
```
General appearance
Height/Weight
Posture/muscle development/nerve conduction
GI function
CV function
General energy
Hair/Skin/Nails
Lips/tongue/gum/teeth/oral membranes
Eyes
```
34
Antrhopometry
measurement system of the size & makeup of the body
35
BMI measure
weight corrected for height & serves as an alternative to traditional height-weight relationships
36
Alternative food patterns based on
Religion, cultural background, ethics, health beliefs, preference
37
Vegetarian diets
No animal flesh for sure and consists of predominately plant foots
38
Ovolactovegetarian
No meat, but will ear eggs and milk
39
Vegan
Consumes only plant foods, no animal products at all
40
Less common food patterns
Lactovegetarian (no meat/eggs…does eat dairy)
Fruitarian: consumes fruit, nuts, honey, & olive oil
Zen macrobiotic: brown rice & grains, vegetables
41
Factors affecting nutrition include
```
Fluid balance/hydration
Liver Function
Kidney Function
Digestive function
Presence of disease
Medications
Supplements
Diet choices
```
42
Lab tests for nutrition status
Hemoglobin and hematocrit
| Serum Albumin
43
Hemoglobin and hematocrit is dependent on
Plasma volume! They are Concentration!
44
If a patients is hypovolemic, their hemoglobin and hemtocrit will appear
Higher than normovolemic
45
If a patient is hypervolemic, they will have a
Lover level of HgB and Hct
46
Malnutrtion affects serum albumin in
Leading to hypoalbuminemia
47
If albumin is depleted, free floating drug levels will
be elevated, which can lead to drug toxicities
48
Serum ferritin
A protein that STORES iron
49
Serum transferrin
an iron TRANSPORT protein
50
the longer the binding capacity (there is space left) the
Lower the iron levels
51
Absorption of drugs is ____ with food
decreased
52
Some foods can have what effect on drugs
Can be antidotes or deactivate medication
53
Some drugs are also associated with a decrease of
Certain vitamins like iron, B12, calcium, vitamin D,K etc.
54
Cachexia
dramatic weight loss/muscle atrophy seen in patients with chronic illness & age-associated failure to thrive syndromes
55
What is common in older population because of decrease sebaceous gland activity
Dry, flake, skin (Xerosis)
56
Mal-nutrition can have what manifestations
Spoon-shaped, brittle nails (koilonychia)
Smooth, “beefy” red tongue (glossitis)
Cracked lips, especially in corners of mouth (cheilosis)
Dull, dry, sparse hair
Poor wound healing
Pallor and pallor conjunctiva
57
Koilonychia
Spoon-shaped, brittle nails
58
Glossitis
Inflammation and swelling of the tongue in part or fully
59
Glossitis is a sign of what deficiency
Decrease in B complex vitamins, iron
60
Cheilosis
Cracked lips, especially in corners of mouth
61
Cheilosis is due to
Decreased iron, B complex vitamins
62
Heart rate and respiratory rate from someone with malnutrition
Increased HR and RR
63
Edema from malnutrition is due to
Osmotic shift with low albumin levels
64
Malnutrition can lead to what effect in extremities
Numbness, burning, tingling (paresthesia)
65
Malnutrition and reflexes
Decrease reflexes fur to slowed neuromuscular run, electrolyte imbalances, altered LOC
66
dysphaGIA
Difficulty swallowing
67
Dysphagia assess for
Drooling, vocal quality, head control/position, wet cough, pocketing of food, dry cough, choking, etc…
68
Causes of dysphaGIA
Myogenic: muscular (aging, MD, polymyositis)
Neurogenic: neurogenic (CVA, CP, MS, ALS, DM Neuropathy, Parkinson’s)
Obstructive: physical blockage (Stricture, Candidiasis, CA lesions, Inflammation, Trauma, Cervical Spondylosis)
Other: Catch-all (GI/Esophogeal resection, Rheumatalogical, Connective Tissue Disorders, Vagotomy)
69
changes with dysphaGIA
Dysphagia Pureed
Everything is pureed to pudding-like consistency
Dysphagia Mechanically Altered
Moist (mashed potatoes instead of rice/couscous)
Soft-textured (hamburger instead of steak, peas instead of celery)
Dysphagia Advanced
Most foods but tougher, harder, and stickier items worked into bite-sized pieces
Steak OK if cut small
Regular/General Diet
70
FLuid changes for dysphaGIA
Thickeners alter the consistency to make swallowing easier and safer (reduce ASPIRATION)
Thickeners are often starch or gum-based powders
71
Fluid consistencies
Thins
Nectar thick (apricot nectar)
Honey thick
Spoon/Pudding thick
72
Advancing diets
Gradual progression of dietary intake or therapeutic diet to manage illness
73
Oral feeding support
Involve entire team: RD, SLP, NAC, Restorative, Patient/Family, OT (what can an OT do???)
Decrease clutter and distractions (low stim)
Upright positioning imperative r/t risk of aspiration
Slow/patient feeding
Small bites
Monitor for pocketing in cheeks
Adaptive devices (built up utensils, plate guards, divided plates, special glasses/cups, long straws)
Chin tilt during swallow
Clearing throat between bites
74
Dignity in dining
```
Clients have the RIGHT, and the facility is legally required to ensure dignity in care and services.
Groomed and dressed for dining
Palatable foods: appearance and taste
Comfortable and supportive physical environment
--Tablecloths
--Music
--Noise control
--Respectful conversations
```
75
Therapeutic diets
```
Clear liquid
Full liquid
Low residue
High fiber
Low sodium
Low cholesterol
Diabetic/Controlled Carbohydrates
Gluten Free
BRAT diet: bananas, rice, applesauce, toast
```
76
Malnourished patient and drug toxicity
Malnourished = decreased in albumin = free floating drugs and drug toxicity
77
Enteral nutrition/enteral feeding means patient has a
Functional GI tract
78
Enteral Nutrition/Enteral Feeding flows into
GI tract; stomach to intestines
79
Enteral Nutrition/Enteral Feeding is because of
Swallow issue, but still able to absorb nutrients
80
Parenteral nutrition (IV) is due to a
NONFUNCTIONAL GI tract
81
Parenteral Nutrition (Intravenous) flows into
Vascular system
82
Parenteral Nutrition (Intravenous) issues
Critical illness
| Extended bowel rest/absorption issues
83
Enteral nutrition (EN): Nutrition directly
into GI tract !
84
Enteral nutrition (EN) is to be started
SLOW
85
Enteral nutrition (EN): can be ... (administration)
Continuous infusion or intermittent bolus
86
Enteral nutrition (EN): flush formula/mesication with
H2O as ordered
87
Nasogastric, jejunal, or gastric tubes are
surgical or endoscopic placement
88
Nasogastric:
nose entry
89
Gastrostomy
: PEG (percutaneous endoscopic gastrostomy) stomach
90
Jejunostomy:
PEJ (percutaneous endoscopic jejunostomy) small intestine
91
Feeding tubes have a risk of
aspiration: greater w/PEG but possible with PEJ.
92
Remember, for tube feeding, NEVER
allow head of bed (HOB) to be flat during feedings or for at least 1 hour after.
93
Tube feeding: Formula can be
Aspirated into the bronchial tree and lungs
94
tube feeding irritation of tissue causes
Inflammation
Pneumonia
Acute respiratory distress syndrome
95
Sarcopenia
Specifically decrease in lean muscle mass
96
Tube feeding: Delayed gastric emptying is a risk for
Aspiration
97
For delayed gastric emptying, administer
Prokinetic medication as ordered to promote peristalsis
98
Measure gastric residual volumes
- -Adults: delayed gastric emptying is a concern if: ≥ 250 mL remains in stomach on 2 consecutive feedings or if > 500 mL for one feeding.
- -Smaller people tolerate lesser volumes due to smaller stomachs. Infants/children, petite adults.
