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final Flashcards

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USMLE® Step 1 flashcards
1
Q

EN

A
  • tube feeding
  • pertaining to the intestine
  • providing nutrition directly into the GI tract
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2
Q

PN

A
  • pertaining to beside the intestine
  • IV nutrition
  • PPN and CPN
  • TPN is outdated term
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3
Q

when is EN needed

A
  • inability to eat/eat enough
  • impaired digestion, absorption, metabolism
  • gut works
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4
Q

contraindications of EN

A
  • illeus
  • complete obstruction of small or large bowel
  • severe diarrhea without response to medication
  • intractable vomiting
  • high output external fistual
  • hypovolemic or septic shock
  • very poor prognosis
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5
Q

short term access routes

A

nasogastric, orogastric, nasoenteric (if patient is at risk for aspiration, esophageal reflux, or delayed gastric emptying

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6
Q

long term access routes

A

PEG, PEJ (decrease risk of tube feeding related aspiration)

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7
Q

prepyloric feeding

A
  • delivering nutrition into the stomach
  • standard method
  • NG tube, PEG
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8
Q

post pyloric feeding

A
  • delivering nutrition past the pyloric valve, into the small intestine
  • used when gastric emptying is impaired, high risk of aspiration, severe gastric reflux, intestinal surgery history
  • ND tube, jejunostomy
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9
Q

elemental/semi elemental EN formula

A
  • broken down/hydrolyzed macronutrients
  • used for patients with enzyme deficiency, malabsorption, or other conditions resulting in maldigestion
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10
Q

continuous tube feeding

A

administered over 8-24 hours daily
using pump to control feeding rate

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11
Q

intermittent tube feeding

A

administered several times daily, over 20-30 min
using pump to control flow rate, or by gravity drip

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12
Q

bolus tube feeding

A

administration of 250-500 mL of formula several times daily, using syringe to inject feedings through the tube

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13
Q

ASPEN initiation and advnacement of EN

A

initate at 10-40 mL/h
advance by 10-20 mL/h every 6-8 hours to gaol rate

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14
Q

ASPEN goals for non critically and critically ill

A

non critically: meet 80% of needs by 24-48h after initation
critically ill: initate EN within 24-48 h of admission (hemodynamically stable). meet 80% of needs by 72h after initiation

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15
Q

ASPEN gastric residuals for monitoring tube feeding requirement

A

recommends against routine monitoring of gastric residuals
avoid holds on EN when gastric residuals are <500mL without other signs of intolerance

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16
Q

refeeding syndrome

A
  • potentially fatal
  • large risk for malnourished people who begin nutrition support
  • when a patient begins nutrition support, serum P, K, and Mg, will be abnormally low
  • prevented by low initation/advancement of EN. avoid fluid overlead
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17
Q

free water flushes

A
  • flushing the feeding tube to prevent clogs and provide additional fluid requirements
  • min 30 mL every 4 hours for continuous feeding, or before/after intermittent feeding
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18
Q

propofol/diprivan

A
  • medication/sedative for mechanically ventilated critically ill
  • provides 1.1 kcal/mL, goes towards lipids
  • mL/h * 24 hours * 1.1 kcal/mL = kcal/d
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19
Q

nasogastric

A
  • short term
  • nose to stomach
  • used when ok to have nasal placement
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20
Q

nasoenteric

A
  • short term
  • nose to small intestine
  • preferred if patient is at risk for aspiration, esophageal reflux, or delayed gastric emptying
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21
Q

PEG (percutaneous endoscopic gastrostomy)

A
  • long term
  • less expensive, easy to insert, allows for bolus feeds
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22
Q

PEJ (percutaneous gastrojejunostomy)

A
  • long term
  • decrease risk of tube feeding related aspiration, feeding pump required
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23
Q

peripheral parenteral nutrition (PPN)

A
  • administration of large volume, dilute solutions of nutritents into a small peripheral vein in the arm or back of the head
  • short term
  • most often used while awaiting a central line placement
  • risk of vein collapse
  • osmolarity must be <900 mOsm/L
  • inappropriate for fluid restricted patients
  • difficult ot maintain peripheral vein access for more than a few days
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24
Q

central parenteral nutrition (CPN)

A

PICC
inserted in the arm and threaded into subclavin vein to the vena cava
long term

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25
Q

when to start PN if malnourished, nourished, and when to delay

A
  • malnourished: ASAP
  • nourished: after 7d if unable to recieve 50%+ of estimated requirements by oral or EN
  • delay in patients with severe metabolic instability until the patient’s condition has improved
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26
Q

two in one solution

A
  • includes dextrose and amino acids
  • lipids are separate
  • advantage: greater flexibility in the amounts of dextrose and amino acids. any precipate can be observed
  • disadvantage: requires two administration sets
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27
Q

three in one solution

A
  • total nutrient admixture (TNA)
  • includes dextrose, amino acids, and lipids
  • advantage: requires one administration set
  • disadvantage: opaque, so can’t see precipate. electrolytes and final concentration of amino acids are limited
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28
Q

carb in PN

A

dextrose, 3.4 kcal.g

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29
Q

glucose influsion rate. reccomended? max?

A

(mL solution * % dextrose * 1000) / kg / 1440 = mg/kg/min
recommended: 3-4 mg/kg/min
max: 5 mg/kg/min

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30
Q

when to stop PN and EN

A

stop PN when EN meets >60% of needs for >3d
stop EN when oral meets > 75% of needs for >3d

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31
Q

lipid concentrations

A

10% = 1.1 kcal/mL = 11 kcal/g PN lipid
20% = 2 kcal/mL = 10 kcal/g PN lipid
30% = 3 kcal/mL = 10 kcal/g PN lipid

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32
Q

max lipid dose, stress and non stress

A

stress: 1 g/kg/d or less
non stress: 2-2.5 g/kg/d

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33
Q

lipid dosage equation

A

g lipid / kg

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34
Q

proteins

A

4 kcal/g

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35
Q

dysgeusia and egeusia

A

alters sense of taste and complete loss of taste
foods with strong distinct flavors, hydration

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36
Q

dysphagia

A

diffiuclty swallowing
texture modifed died

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37
Q

GERD

A

chronic digestive disorder that occurs when stomach contents/acid regularly flow back up into the esophagus
- avoid trigger foods

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38
Q

nausea and vomitting

A
  • bland easy to digest foods, smaller portions, clear liquids
  • avoid fatty fried spicy sweet smelly processed
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39
Q

gastritis

A

inflammation of the stomach lining
avoid acidic spciy fatty fried sugary processed

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40
Q

peptic ulcer disease

A
  • sore in the lining of the stomach or duodenum
  • eating a balanced diet, avoid the usual, probiotics
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41
Q

bariatric surgery

A

manage obesity, reduces stomach size
- 3 servings of milk/dairy and meat

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42
Q

dumbing syndrome

A
  • when food moves to quickly from the stomach into the small intestine
  • smaller meals, eat slower, limit sugar, more protein, fiber, fat, limit fluids
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43
Q

gastropareies

A
  • chronic condition that slows or stops the stomach from emptyig food into the small intstine
  • smaller more frequent meals of foods that are easy to digest (soft) and nutrient dense
  • avoid high fiber high fat
  • drink liquids
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44
Q

systole and diastole

A

systolic bp: force exerted on the walls of blood vessels during contraction
diastolic bp: force exerted during relaxations

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45
Q

primary vs secondary hypertension definition

A
  • primary: high bp with no identifiable underlying cause
  • secondary: high bp caused by another medical conditions
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46
Q

normal vs elevated blood pressure

A

normal: <120/80 mmHg
elevated: 120-129/<80 mmHg

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47
Q

stage 1 v stage 2 hypertension blood pressure

A

1: 130-139/80-89 mmHg
2: >140/90 mmHg

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48
Q

diuretics commonly used for hypertension + nutritional implications

A

risk of hypokalemia: loop, thiazide
risk of hyperkalemia, avoid excessive K+: potassium sparing

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49
Q

DASH diet

A
  • effective at reducing BP, even without weight loss
  • flexible balanced meal
  • Variety of fruits, vegetables, whole grain
  • Low fat dairy
  • Fish, poultry, beans, nuts
  • Vegetable oils
  • Limit foods high in sat fat
  • Limit sugar sweetened beverages and added sugars
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50
Q

atherscleorosis risk factors

A
  • additive effect in their predictive power
  • family history
  • over 65 and male
  • smoking
  • physical inactivity
  • diabetes
  • dyslipidemia
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51
Q

5 criteria for metabolic syndrome

A
  • increased waist circumference
  • triglycerides > 150 mg/dL
  • HDL-C <40 for men or <50 for women
  • BP > 130/85 mmHg
  • insulin resistance: FGP > 100 mg/dL
    need 3/5 for diagnosis
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52
Q

importance of identification of metabolic syndrome

A
  • cluster of commonly co-occuring metabolic risk factors
  • increases risk for heart disease, stroke, T2DM
  • other conditions with similar presentation: PCOS, cushings
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53
Q

food-drug interaction with some types of statins

A
  • many drugs are metabolized by CYP34a enzyme in the small intestine
  • chemicals in grapefruit inhibit this enzyme, so higher levels or the drug
  • or necessary transport proteins can be blocked, so too little drug reaches the body
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54
Q

TLC diet

A
  • therapeutic lifestyle changes for CVD prevetion
  • targets LSL, most heavily involved in the development of atherosclerosis
  • weight management, increased PA
  • sat fat < 7% kcal
  • cholesterol < 200 mg/d
  • 10-25 g soluble fiber/d
  • 2 g plant stanols/sterols/d
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55
Q

heart disease

A

plaque builds up in an artery

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56
Q

angina

A

harder for blood to get through

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57
Q

heart attach

A

plaque cracks and a blood clot blocks the artery

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58
Q

cardiac arrest

A

when the heart balfunctions and suddenly stops beating. electrical prblm

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59
Q

peripheral artery disease

A

occlusion of blood flow in noncoronary arteries (lower extremities)

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60
Q

atrial fibrillation

A

irregular heart beat, which can disrupt the flow of blood thru the hearth

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61
Q

heart failure

A

impairement of the ventricles’ capacity to eject blood from the heart or to fill with blood. decreased cardiac output

62
Q

nutrition recommendation for myocardial infarcation

A
  • low fat, low sodium diet with easily digestible foods, prioritizing small, frequent meals
  • once stable, more comprehensive heart healthy diet
63
Q

balloon angioplasty and stents

A
  • special tubing with an attached deflated balloon is threaded up to the coronary arteries
  • balloon is inflated to widen blocked areas where blood flow to the heart has been reduced/cut off
  • often combined with implantation of a stent to help prop the artery open and decrease the chance of another blockage
64
Q

atherectomy

A

similar to angioplasty except the catheter has a rotation shaver on its tip to cut away plaque from the artery

65
Q

coronary artery bypass graft (CABG)

A
  • treats blocked heart arteries by creating new passages for blood to flow to heart
  • takes arteries or veins from other parts of the body and using them to reroute the blood around the clogged artery
66
Q

warfarin drug-nutrient interaction and recommendations

A
  • vitamin K is essential for blood clotting
  • warfarin is an anticoagulant that inhibits the vitamin K cycle
  • patient should have consistent intake of vitamin K
  • sources: green leafy vegetables, brussels sprouts, broccoli, cauliflower, cabbage
67
Q

ejection fraction

A
  • measurement that indicates how well the heart pumps blood out the left ventricle with each beat
  • healthy: 50 -70%
  • heart failure: below 40%
68
Q

cardiac cachexia

A
  • severe PEM associated with long term HF
  • fat and muscle wasting, hypoalbuminemia, edema, decreased immune function, decreased mobility, QOL
  • risk of refeeding syndrome
69
Q

other medications that might increase risk of hyperkalemia

A

ACE inhibitors, angiotensin II receptor blockers (lorsartan/cozaar, avoid grapefruit), aldosterone agonists

70
Q

how does heart failure affect fluid recommendations

A
  • goal is to decrease blood volume (preload) to maintain CO
  • 1-2 L/d fluid restriction for patients with serum Na <130 mEq/L
  • daily weights can help monitor fluid balance
  • education of fluid restriction: what is considered fluids, volumes, controlling thirst
71
Q

how does heart failure affect sodium requirements

A
  • goal is to decrease blood volume (preload) to maintain CO
  • sodium intake < 2000 mg/d
  • 1500 or 1000 mg/d restrictions as needed
  • ana, fatigue, SOB lead to poor oral intake that many patient consume much less than 2000 mg
  • NaCl is 39% sodium
    1 tsp NaCl = 2300 mg
72
Q

insulin

A
  • anabolic hormone that controls metabolic fates of carbs, protein, and lipid
  • T1DM cannot produce it themselves
  • T2DM might need it if lifestyle changes and other medication aren’t enough
73
Q

glucagon

A
  • peptide hormone released from alpha cells when glucose levels fall
  • stimulates breakdown of glycogen (glycogenolysis), production of glucose (gluconeogensis), lipolysis
74
Q

T1DM definiation and cause

A
  • inability of cells to use glucose for energy
  • causes cells to starve
  • results in hyperglycemia
  • immune mediated T1DM results from a cell-mediated autoimmune destruction of B cells
  • more than 50 different gene associations
75
Q

T2DM definition and cause

A
  • body produced insulin, but tissues are insulin resistant
  • polygenic
76
Q

T1DM clinical manifestations

A
  • lipolysis
  • fatty acids transformed to ketones
  • pH decreases: metabolic acidosis/ketoacidosis, Kussmaul respirations
  • K, Na, Mg, P lost
  • hypovolemia: causes weight loss, can lead to hypovolemic shock
77
Q

T2DM clinical manifestions

A
  • insidious onset
  • increased thirst, hunger
  • frequent urination, infections
  • unintended weight loss
  • fatigue, blurred vision
  • slow healing sores
78
Q

how is DM diagnosed

A

A1C > 6.5%
FPG > 126 mg/dL
2-h PG > 200 mg/dL
with symtoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose > 200 mg/dL

79
Q

hemoglobin A1C vs plasma glucose

A

A1C: % glycated hemoglobin, 3 month avg picture of blood glucose levels
plasma glucose: current blood sugar level at a specific point in time

80
Q

normal, prediabetes, and diabetes A1C percentages

A

normal: below 5.7%
prediabetes: 5.7 - 6.4%
diabetes: 6.5% or higher

81
Q

acute complications of DM management

A
  • side effects and complications of insulin therapy: hypoglycemia
  • dawn phenomenon
  • diabetes ketoacidosis (DKA)
  • hyperglycemic hyperosmolar syndrome (HHS)
82
Q

long term complications of DM treatment

A
  • macrovascular and microvascular complication
  • cardiovascular, cerebrovascular, and pheripheral artery diseases
  • retinopathy, nephropathy, neuropathy
83
Q

how many g of carb = 1 carb choice

A

15 g

84
Q

dawn phenomennon

A
  • result of hormones controlling circadian rhythms
  • hyperglycemia occurs between 5 am and 9 am
85
Q

somogyi effect

A
  • low blood glucose overnight (nocturnal hypoglycemia) followed by dramatic increase in the morning (hyperglycemia)
  • eg. took insulin at night but did not have evening snack with enough carb
86
Q

diabetes ketoacidosis (DKA)

A
  • form of life threatening, severe hyperglycemia
  • most common in T1DM
87
Q

hyperglycemic hyperosmolar syndrome (HHS)

A
  • develops more gradually than DKA, so more easily overlooked
  • more common in T2DM
88
Q

What is the specialty certification available for working with people with diabetes?

A

certified diabetes care and education specialist (CDCES)

89
Q

whe

A
90
Q

Why is it important for a dietitian to ask a patient who has DM whether they are taking insulin? How might this information change the nutrition education given?

A
  • carb choices are timed with insulin regimen, prevent blood sugar spikes and crashes
  • insulin affects how the body processes carbs
91
Q

rapid and short acting insulin

A

lispro, aspart, glulisine, regular

92
Q

intermediate and long acting insulins

A

NPH, determir, giargine

93
Q

onset, peak and duration of insulins

A

onset: how quickly the insulin starts to lower blood sugar after injection
peak: time when the insulin is at its max effectiveness
duration: how long the insulin continues to work before its effects wear off

94
Q

15-15 rule

A
  • for hypoglycemia, FPG < 70 mg/dL
  • symptoms: shakiness, dizziness, sweating, hunger, fast heartbeat, confusion, irritability
  • 15 g fast acting carb, recheck blood sugar in 15 min
  • if still under 70 mg/dL, repeat
  • once over, eat meal or snack
95
Q

hypoglycemia and hyperglycemia symptoms

A

hypo: shakiness, loss of consciousness, sweating, hunger, irritability, heartbeat
hyper: thirst, urination, fatigue, light headed

96
Q

insulin carb ratio

A

15 g carb = 1 carb choice = 1 unit insulin
matching insulin with meals

97
Q

blood glucose may increase if

A
  • eats more
  • less active
  • stress
  • too little insulin
  • ill/infection
  • other meds
  • expired and not stored insulin
98
Q

blood glucose may decrease if

A
  • eats less
  • more active
  • too much insulin
  • alc, in the absence of food
99
Q

Explain the differences between ischemic strokes, hemorrhagic strokes, transient ischemic attacks, and aneurysms.

A

ischemic: 80% of all strokes
hemorrhagic: higher mortality
transient ischemic attach (TIA): mini stroke
aneurism: can lead to hemorrhaging

100
Q

major risk factors of strokes

A
  • smoking
  • BMI
  • PA
  • diet
  • total cholesterol
  • bp
  • FPG
  • risk doubles each decade after 55
  • African Americans are 2x more likely than white
101
Q

nutrition intervention for a patient who had a stoke

A
  • difficulty chewing, problems swallowing, reduced ability to feed self, decreased oral intake
  • swallowing assessment, texture modified diets
  • consider EN
  • consider other concurrent diagnoses such as DM or HTM
102
Q

dementia + nutritional concerns

A
  • AD is most common
  • amyloid plaques and tangles in the brain
  • GI side effects of medications
  • self-feeding/meal prep difficulty
  • inadequate intake
  • dehydration
  • weight loss
  • dysphagia, chewing difficulty
  • malnutrition
103
Q

nutrition goals for dementia

A
  • prevent malnutrition
  • maximize nutritional intake
  • minimize unintentional weight loss
  • promote adequate hydration
  • minimize confusion
  • promote enjoyment and quality of life
104
Q

nutritional interventions for dementia

A
  • maximize intake when patient has appetite and is alert
  • texture modification
  • thickened liquids
  • adaptive equipment
  • finger foods
  • extended meal times, meal assistance, encouragement, cues
  • minimize environmental cues
  • liquid supplements/fortified foods
  • caregiver education
105
Q

desirable BMI for dementia

A
  • 22-27
106
Q

classic symptoms of parkinson’s

A

tremor at rest
rigidity
akinesia (loss of movement)
bradykinesia (slowness of movement)
postural instability

107
Q

nutritional concerns of parkinson’s

A
  • drug nutrient interactions
  • medication side effects (dry mouth, constipation, nausea, vomiting)
  • inadequate intake
  • dehydration
  • self feeding problems
  • chewing/swallowing problems
  • choking/aspiration
  • malnutrition
108
Q

drug nutrient interactions for parkinson’s

A
  • dietary proteins may interfere with levels of L-drops. amino acids compete for the same transport protein
  • possible pyridoxine (B6) interaction. may lead to metabolism of L-dopa before it reaches the brain
109
Q

Amyotrophic lateral sclerosis (ALS)

A
  • lou gehrig’s disease
  • progressive destruction of motor neurons that control voluntary movements leading the muscle atrophy
  • no known cure
  • poor prognosis: 3-5 years post diagnosis
110
Q

Amyotrophic lateral sclerosis (ALS) nutritional concerns

A
  • increased energy needs
  • chewing/swallowing difficulties
  • weight loss
  • immobility
  • early PEG placement may be beneficial to allow for early nutritional stabilization
111
Q

nutrition related concerns of multiple sclerosis (MS)

A
  • medication side effects (N/V, dry mouth)
  • meal prep/self feeding issues
  • dysphagia, modified consistency diets
  • constipation/bladder dysfunction (neurogenic bladder)
  • weight loss/malnutrition
  • weight gain due to inactivity
  • weakness
112
Q

MNT for epilepsy

A
  • ketogenic diet
  • effective in 50% of pediatric pts who do not respond to AEDs
  • mechanism of action is not fully understood
  • strict adherence required
  • multivitamin and mineral supplement
  • encourage fluids
113
Q

classic ketogenic diet

A
  • initiation in hospital over 5 days, starting with 2-3 day fast
  • 4:1 or 3:1 ratio of g fat to g protein + carb
  • kcal: 75-90% of RDAs
114
Q

modified Atkins diet

A
  • very CHO restricted (15-20g/d)
  • liberal fat and protein
115
Q

low glycemic index diet

A
  • selected CHO are restricted (40-60 g/d)
  • low GI < 50
116
Q

MCT diet

A

increased ketogenic potential of MCT, included at all meals and snacks

117
Q

phenytoin

A
  • antiepileptic drugs (AEDs)
  • hold TF 2 hours before and after
  • may need Ca, Vit D, and thiamin supplement
  • supplements may interfere with drug absorption, take separated by 2h
118
Q

PCOS definition, etiology

A
  • most common hormonal reproduction problem in women of child bearing age
  • ovary doesn’t produce all of the hormones it needs for eggs to fully mature
  • immature eggs may remain as cysts
  • exact cause is unknown
119
Q

PCOS symptoms

A
  • can affect a women’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, body weight, body hair growth
  • weight gain/obesity, esp around waist
  • increased serum cholesterol, bp
  • increased hair
  • acne oily skin, dandruff
120
Q

PCOS diagnosis

A
  • no single test
  • usually includes serum levels of hormones
  • elevated cholesterol and TGs, elevated glucose
121
Q

PCOS medical treatment and nutrition therapy

A
  • no cure, based on symptoms
  • medications includes drugs for birth control, diabetes, fertility, spironolactone
  • weight management; even 10% wl can make menstruation more regular
  • spacing CHO throughout the day to assist with BG abnormalities
122
Q

thyroid hormones

A
  • controls metabolic rate
  • Thyroxine (T4) is a major hormone
  • Triiodothyronine (T3) is a more active hormone
  • hyposecretion: hypothyroidism
  • hypersecretion: hyperthyroidism
123
Q

hypothyroidism definition and etiology

A
  • clinical state resulting from decreased production/secretion of thyroid hormones
  • iron deficiency is the most frequent cause
  • otherwise, from dysfunction of thyroid or pituitary gland, which produces TSH
124
Q

hypothyroidism clinical manifestations

A
  • reduces BMR
  • intolerance of cold
  • weight gain
  • easily fatigue
  • bradycardia
  • pitting edema of lower extremities
  • slow reflexes and movement
  • increased levels of total cholesterol and LDL
  • increased insulin resistance
  • goiter: primary failure of thyroid or lack of iodine
125
Q

medical treatment and nutrition intervention for hypothyroidism

A
  • administration of exogenous thyroid hormone
  • monitor for signs of overtreatment
  • correct for iron deficiency
  • assess drug-nutrient interactions
  • Fe, Ca, Mg supplements should be taken at least 4 hours before/after levothroxine
126
Q

hyperthyroidism definition and etiology

A
  • excessive secretion of thyroid hormones T3 and T4
  • most commonly caused by Grave’s disease (autoimmune disease)
  • antibody TSI mistakenly targets TSH receptors on thyroid cells
  • organ specific autoimmune disease
127
Q

hyperthyroidism clinical manifestations

A
  • palpitations
  • nervousness
  • sweating
  • hyperdefecation
  • heat intolerance
  • oligomenorrhea
  • wl despite increased appetite
  • drooping eyelids
  • sinus tachycardia
  • exopthalmos (buldging eyes)
128
Q

hyperthyroidism medical treatment and nutrition therapy

A
  • surgical removal of thyroid gland
  • antithyroid drugs
  • radioactive iodine therapy to destroy thyroid glandular tissue
  • ensure adequate intake
  • monitor for drug nutrient interactions
129
Q

A pregnant woman undergoes an OGTT, and finds out she has elevated BG values. What type of diabetes is this? Why is it important for this to be part of a pregnancy check-up?

A

gestational diabetes
if left untreated, poses risk

130
Q

primary goal of DM treatment

A

maintain blood sugar levels to normal

131
Q

Describe the consistent carbohydrate diet. Is this the same as a low carb diet?

A

Eating a consistent amount of carbs throughout the day, to keep blood sugar levels stable
Not restricting carb intake

132
Q

NCP steps

A
  1. Nutrition assessment
  2. Nutrition diagnosis
  3. Nutrition intervention
  4. Nutrition monitoring and evaluation
133
Q

nutrition screening

A

“On ramp” to the NCP
Anyone who is trained can quickly identify those who may benefit from nutrition care (NCP)
Identifies level of nutrition risk
High risk = complete nutrition assessment by RD
JCAHO requires must be done 24H

134
Q

EBP components

A
  • best available scientific research
  • clinical expertise of the practitioner
  • patient values and preferences
135
Q

methods to obtain height on a patient who cannot stand

A

half arm span x2
knee height w equation

136
Q

calorie count

A

best for assessing actual food intake in an inpatient setting
food weight before/after or % consumed visually estimated
3 day calorie count

137
Q

When are actual(current) body weight (ADW), usual body weight (UBW), and ideal body weight (IBW) used?

A

ABW: most situations, most calculations
UBW: when a person has experienced significant weight fluctuations
IBW: to use with certain protein recommendations validated using IBW

138
Q

% UBW and %wl

A

% UBW = CBW/UBW
% weight loss = (UBW - CBW)/UBW

139
Q

adjusted bw for amputations

A

segment proportion that represents the missing limb is added to the actual body weight
CBW/(1-proportion) x 100

140
Q

somatic protein status

A

muscle stores
creatinine height index (CHI)
nitrogen balance

141
Q

visceral protein status

A

(nonskeletal muscle stores)
albumin
transferrin
transthyretin aka prealbumin
retinol binding protein
c reactive protein
not reliable indicators of nutritional protein status or malnutrition

142
Q

how is metabolism affected by stress

A

everything ramps up
inflammation
increase metabolic rate, energy needs, body temp, blood glucose
primary fuel: protein -> gluconeogensis

143
Q

how is metabolism affected by starvation

A

everything slows down
no inflammation
decrease metabolic rate, energy needs, body temp, blood glucose
- preservation of lean mass, protein stores
- major fuel source: fat -> ketones

144
Q

nutrition diagnosis domains

A

intake*, clinical, behavioral/environmental

145
Q

PES statement relations

A
  • etiology causes problem
  • signs and symptoms provide evidence for etiology and for the problem
  • intervention directed at improving signs and symptoms and aimed at addressing etiology
146
Q

first thing you do in the planning stage of nutrition intervention

A

prioritize nutrition diagnosis

147
Q

nutrition education

A

Instruction or training intended to lead to nutrition-related knowledge
Group classes, individual instruction, written instruction, or via phone or electronic communication
Outpatient setting is more conducive to education
In acute-care setting, more content-focused
Quickly useable content and straight forward instructions

148
Q

nutrition counseling

A

Supportive process, characterized by a collaborative counselor–client relationship
Establishes goal setting and individualized action plans

149
Q

muscle loss sites

A

temple, quads, patellar, calves, clavicle, pectoral, deltoid, dorsal hand

150
Q

fat loss sites

A

obrital, cheek, triceps, biceps, thoracic, lumbar, ribs

Medical Nutrition Therapy (5 decks)

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