L3: Nutritional Care Flashcards
1
Q
1 g of carbohydrates
A
4 kcal
2
Q
1 g of fat
A
9 kcal
3
Q
1 g of protein
A
4 kcal
4
Q
breaks down carbohydrates into monosaccharides
A
amylase
5
Q
breaks down proteins into amino acids
A
proteases
6
Q
breaks down fats into monoglycerides and fatty acids
A
lipase and bile
7
Q
Micronutrients function
A
Support cellular metabolic processes, biochemical reactions, hormone function, nerve impulse propagation and muscle function
8
Q
Water soluble vitamins
A
Thiamine (B1) Riboflavin (B2) Niacin (B3) Pantothenic Acid (B5) Pyridoxine (B6), Biotin Folate Cobalamin (B12, binds IF in stomach, absorbed in ileum) Ascorbic acid (Vit C)
9
Q
B1
A
thiamine
10
Q
B2
A
riboflavin
11
Q
B3
A
niacin
12
Q
B5
A
pantothenic acid
13
Q
B6
A
pyridoxine
14
Q
B12
A
cobalamine
15
Q
Vit C
A
ascorbic acid
16
Q
Aids in iron absorption
A
Vit C
17
Q
Sources of Niacin (B3)
A
Grains, legumes
18
Q
Sources of Folate
A
Leafy vegetables, citrus fruits
19
Q
Sources of cobalamin (B12)
A
dairy, meat, poultry, eggs, fish
20
Q
Thiamine (B1) deficiency
A
Beriberi→ peripheral neuropathy +/- heart failure
Wernicke-Korsakoff syndrome (neuro sequela)
21
Q
Riboflavin (B2), Niacin (B3), Pantothenic Acid (B5) deficiencies
A
Angular cheilitis (fissures at corner of mouth)
Angular stomatitis
Atrophic glossitis
22
Q
Specific to Niacin (B3) deficiency
A
Pellagra→ diarrhea, dermatitis, dementia
23
Q
Folate deficiency
A
Macrocytic anemia
24
Q
B12 (cobalamin) deficiency
A
Macrocytic anemia + peripheral neuropathy
Atrophic glossitis
25
Vitamin K and C deficiency
Petechiae/purpura
26
Fat soluble vitamins
Vitamins A, D, E, K
27
Vitamin A is important for
Vision
28
Vitamin D is important for
calcium absorption
29
Vitamin K is important for
blood clotting
30
Sources of Vitamin A
dark green, yellow/orange fruits/vegetables
31
Sources of Vitamin D
Fortified dairy products, eggs
32
Sources of Vitamin E
vegetable oils, nuts, leafy vegetables
33
Vitamin A deficiency
Night blindness, poor wound healing, dry skin
| Bitot spots→ abnormal squamous cell proliferation and keratinization of the conjunctiva
34
Vitamin D deficiency
Rickets, osteomalacia
35
Vitamin E deficiency
Sensory and motor neuropathy
36
Bitot spots
Vitamin A deficiency
37
Major minerals
```
Sodium
Chloride
Potassium
Calcium
Magnesium
Phosphorus
```
38
Trace elements
```
Iron
Zinc
Iodine
Manganese
Chromium
Copper
Selenium
```
39
Sources of potassium
Bananas, tomatoes, potatoes, oranges, melons, leafy green vegetables
40
Sources of calcium
Dairy produces, leafy vegetables
41
Sources of magnesium
Green leafy vegetables, whole grains, beans, nuts
42
Sources of phosphorus
Dairy, nuts, peanut butter, dried beans, cocoa, beer, cola drinks
43
Sources of Iron
meats, egg yolk, fish, dark green leafy vegetables
44
Sources of zinc
meat, eggs, legumes
45
Iodine deficiency
Goiter, hypothyroidism
46
Calcium deficiency
Tetany
47
Major minerals are absorbed in the _____
duodenum
48
B12 is absorbed in the ____
ileum
49
Iron deficiency
Pallor, pale conjunctiva, koilonychia
| Atrophic glossitis
50
Zinc deficiency
Hypoguesia
| impaired wound healing
51
Supplement _____ in pregnancy
Folate to prevent neural tube defects
52
Avoid ______ foods in pregnancy
```
cured/deli meats
unpasteurized/undercooked products
fish
alcohol
tobacco
```
53
How long does an infant breastfeed/drink formula?
4-6 months
54
Infants exclusively breastfeeding need _____
Vitamin D supplementation
55
Foods to limit/avoid
Avoid processed foods, refined sugars
| Limit trans fat, saturated fat, dietary cholesterol
56
Daily sodium limit is _____
<2300 mg
57
Describe the "MyPlate Method"
Replace refined grains→ whole grains
>5 servings fruits/vegetables daily
25-35 g/day fiber
Protein-rich foods→ seafood, lean meat, eggs, beans, unsalted nuts/seeds, low-fat dairy
58
What are some reasons why the elderly face unique dietary problems?
Multiple medical problems
Malignancy, dementia
Polypharmacy→ nausea/vomiting decrease intake
Physiological changes
Decreased functional status
Varying ability to access and prepare food
Social implications→ poverty, depression, isolation
59
Treating elderly dietary issues focuses on....
Optimize medical care, reconcile medications
| Liberalize diet, incorporate high calorie foods, add oral nutrition supplements
60
5 components of a nutrition assessment
1. Food and nutrition related history
2. Patient history
3. Anthropometric measures
4. Nutrition focused exam
5. Labs
61
Alcohol abuse can cause
thiamine deficiency
62
Medical conditions with nutritional implications
Critical illness or chronic disease
Immunocompromised/malignancy
Eating disorders
GI disorders→ malabsorption: pancreatic insufficiency, celiac disease, IBD
Alcohol use disorder→ thiamine deficiency
Physical disabilities
Medication and complementary or alternative medicine use
63
Anthropometric measures
Height, weight, BMI
Usual vs. Ideal body weight
Weight pattern/unintentional weight loss
Body composition
64
Confusion is a sign of _____ deficiency
thiamine
65
Edema, ascites are signs of _____ deficiency
protein
66
Sunken appearance of the orbital area is a sign of _____
dehydration
67
Temporal muscle wasting, muscle wasting decreased strength are signs of _____ deficiency
protein, caloric
68
Poor wound healing/pressure ulcers are signs of _____ deficiency
protein, zinc, Vitamins A, C
69
Labs for a nutrition assessment
```
Hydration status, acid base assessment
CBC, Iron studies, B12, folate
Serum albumin and prealbumin→ interpret with caution, increase with inflammation
CRP/ESR
Glucose
BMP/CMP, Na+, K+, Ca++, PO4, Mg++
Vitamins, mineral, trace elements
```
70
Oral nutritional supplements
Concentrated source of kcals, protein, vitamin/minerals
Liquids/shakes/snacks
Disease specific
Tailored per patient
71
_____ is the preferred nutritional support if nutrition needs can't be met by mouth as is it _______
enteral
| physiologic
72
Refeeding syndrome
Intracellular shift of lytes: Mg, PO4, K
Transaminases, Bilirubin, triglyceride
*monitor while using nutrition support*
73
Post-op diet
clear or full liquid
74
Poor dentition, difficulty swallowing diet
pureed/soft
75
Constipation/diarrhea diet
High fiber
76
Gut rest diet is....
low-residue (fiber)
77
Enteral nutrition routes and formulas
Stomach→ bolus feeds
Small bowel→ continuous feeding
Formula→ standard, pre-digested, concentrated, lyte-restricted
78
Complications of enteral nutrition
lTube misplacement→ confirm placement with xray
Tube displacement or obstruction
Hyperglycemia, unstable fluid/lyte status
Intolerance
Emesis, diarrhea (formula, abx, c diff)
Pulmonary aspiration
79
When does serum ablumin/pre-albumin increase?
With inflammation
80
Indications for parenteral nutrition
```
Prolonged ileus
Bowel obstruction
Small bowel resection
Short gut syndrome
High output enterocutaneous fistula
IBS, GI bleed
Ischemic bowel
```
81
Parenteral nutrition formula includes....
```
Dextrose
amino acids
lipid emulsion
fluid
electrolytes
vitamins/minerals
```
82
Parenteral nutrition complications
Catheter-related sepsis, venous thrombus, air embolus, pneumothorax
Hyperglycemia, lyte abnormalities, azotemia (nitrogen waste in blood)
Fatty liver secondary to cholestasis
83
Food drug interactions: Coumadin
maintain vitamin K+ consistency→ green leafy vegetables
84
Food drug interactions: Statins
Avoid grapefruit juice
85
Food drug interactions: MAO inhibitors
avoid tyramine: chocolate, aged/mature cheeses, smoked/aged meats, hot dogs
86
Food drug interactions: Thyroid meds
administer calcium separately
87
Drug-nutrient implications: ACEI/ARBs
hyperkalemia
88
Drug-nutrient implications: Diuretics
Hyponatremia, hypokalemia, low Mg
89
Drug-nutrient implications: Cholestyramine
Decreased fat soluble vitamins
90
Drug-nutrient implications: Sulfasalazine, methotrexate
folic acid deficiency
91
Drug-nutrient implications: Isoniazid
Vitamin B6
92
Drug-nutrient implications: Metformin
Vitamin B12
