Medical Nutrition Therapy - H. Anemia (p. 23), I. Allergies (p. 23-24), J. Fever and Infection (p. 24), K. Inflicted Trauma (p. 24), L. Neoplastic Disease (p. 25), M. Weight Management (p. 25 Flashcards
<p>A decrease in total red cell mass - due to FEWER RBCs or SMALLER RBCs with less hemoglobin.</p>
<p>Anemia</p>
<p>\_\_\_\_\_\_\_, \_\_\_\_\_ anemia: Small, pale (less HGB) red blood cells. Due to IRON deficiency.</p>
<p>Microcytic (small), hypochromic (pale)</p>
<p>\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_ anemia: Few, large cells, filled with HGB (dark red color). Due to FOLATE or B12 deficiency. </p>
<p>Macrocytic, megaloblastic</p>
<p>A type of megaloblastic anemia caused by vitamin B12 deficiency - impaired absorption of B-12 because of a lack of intrinsic factor (IF).</p>
<p>Pernicious anemia</p>
<p>In microcytic anemia, the MCV (mean corpuscular volume) is \_\_\_\_\_\_, indicating small cell size.
In macrocytic anemia, the MCV is \_\_\_\_\_\_\_, indicating large cells.</p>
<p>Microcytic anemia, MCV is low (95).
*NORMAL MCV: 80-95 fL*</p>
<p>In microcytic anemia, the MCH (mean corpuscular hemoglobin) is \_\_\_\_\_\_\_, indicating pale cells with little hemoblogin.
Macroyctic anemia, the MCH is \_\_\_\_\_\_\_\_, indicating dark, red cells filled with hemoglobin.</p>
<p>Microcytic anemia, MCH is low (32).
*NORMAL MCH: 27-32 pg*</p>
<p>Foods high in iron include:</p>
<p>Foods high in iron:
Liver, kidney, beef, dried fruits, dried peas and beans, nuts, leafy green vegetables, fortified whole grains</p>
<p>The Ag-Ab reaction is when an \_\_\_\_\_\_\_ enters the body, an \_\_\_\_\_\_\_ reacts. This is a natural, protectie mechanism against foreign substances (pollen, flowers).</p>
<p>Antigen, Antibody</p>
<p>Immunoglobulin E (IgE) mediated reaction is a reaction to a normally \_\_\_\_\_\_\_ food \_\_\_\_\_\_.</p>
<p>Immunoglobulin E (IgE) mediated reaction is a reaction to a normally harmless food protein.</p>
<p>*The most common allergens include:
</p>
<p>*
Peanuts
Egg
Milk
Soy
Wheat
Shellfish</p>
<p>Cow's milk protein is the single most common allergen in \_\_\_\_\_\_. </p>
<p>Infants</p>
<p>Double-blind, placebo controlled food challenges (DBPCFC) identifies \_\_\_\_\_\_ induced symptoms. This is the GOLD STANDARD for diagnosis.</p>
<p>Food-induced</p>
<p>RAST test for identifying food allergies done outside of the body. It is the alternative to a \_\_\_\_\_ test. Serum is mixed with food on paper disk and IgE antibodies are measured.</p>
<p>RAST test alternative to a skin test.</p>
<p>\_\_\_\_\_\_\_ is the food LEAST likely to cause an allergy.</p>
<p>Rice</p>
<p>A food \_\_\_\_\_\_\_\_\_ is an abnormal physiologic response, but NO antibody production. NON-IgE.</p>
<p>Intolerance</p>
<p>In fever and infection, excesive fluid loss may lead to dehydration.</p>
<p>Also, *the BMR INCREASES \_\_% for each degree rise in body temperature.</p>
<p>The BMR increases 7% for each degree rise in body temperature.</p>
<p>Burns cause a tremendous increase in need for nutrients. There is a massive loss of \_\_\_\_\_\_, \_\_\_\_\_\_\_, and \_\_\_\_\_.</p>
<p>Massive loss of fluids, electrolytes, and protein.</p>
<p>When treating burns, the first goal is to *\_\_\_\_\_\_\_ \_\_\_\_\_ and \_\_\_\_\_\_.</p>
<p>Then, increase calorie (recovery period) and protein (secondary period) intake (1.5-3.0 g/kg).</p>
<p></p>
<p>May need to supplement water-soluble vitamins, add vitamin C and Zn, and vitamin K if on antibiotics.</p>
<p>*Replace fluids and electrolytes*</p>
<p>Then, increase calorie (recovery period) and protein (secondary period) intake (1.5-3.0 g/kg).</p>
<p></p>
<p>May need to supplement water-soluble vitamins, add vitamin C and Zn, and vitamin K if on antibiotics.</p>
<p>The \_\_\_ and \_\_\_ response is a metabolic response to injury. It is a hypermetabolic, catabolic response to trauma.</p>
<p>Lean body mass is catabolized to release glucose for energy, leading to a negative Nitrogen balance.</p>
<p>Ebb and Flow response</p>
<p><br></br>
The \_\_\_\_ phase follows fluid resuscitation and the return of oxygen transport. It is characterized by increased oxygen<br></br>
consumption, body temperature, and nitrogen excretion, as well as expedited catabolism of carbohydrate, protein, and fat to meet increased metabolic demands.</p>
<p>Flow phase</p>
<p>The \_\_\_ phase begins immediately after injury and is identified by decreased oxygen consumption, body temperature. Associated with hypovolemia and tissue hypoxia. Shock.</p>
<p>Ebb phase</p>
<p>**Results of physiologic trauma include:</p>
<p>-Hyper\_\_\_\_\_\_</p>
<p>-Hyper\_\_\_\_\_\_</p>
<p>-Increased \_\_\_\_\_\_\_</p>
<p>-No ketosis</p>
<p></p>
<p>*Hyperglycemia</p>
<p>*Hyperinsulinemia</p>
<p>*Increased Glucagon</p>
<p>*No Ketosis</p>
<p>\_\_\_\_\_\_\_\_\_\_\_\_, AKA adrenaline, suppresses insulin and causes hepatic glycogenolysis. Works to increase BG levels, similar to GLUCAGON.</p>
<p>Epinephrine</p>
<p>Neoplastic disease, or \_\_\_\_\_, is associated with protein-calorie malnutrition and fluid electrolyte balances.</p>
<p>To combat altered taste acuity: add \_\_\_\_\_</p>
<p>Those with meat aversions: may need to eliminate red meat</p>
<p>With thrush, avoid \_\_\_\_\_, \_\_\_\_, strongly flavored foods. Provide bland, soft, chilled choices.</p>
<p>With throat/neck cancer, use \_\_\_\_\_ feeding.</p>
<p>Cancer cachexia associated with cytokines and TNF (inflammatory cytokines-->wt loss, muscle/fat catabolism).</p>
<p>Neoplastic disease, or CANCER, is associated with protein-calorie malnutrition and fluid electrolyte balances.</p>
<p>To combat altered taste acuity: add FLAVORING/SEASONING</p>
<p>Those with meat aversions: may need to eliminate red meat</p>
<p>With thrush, avoid SPICY, ACIDIC, strongly flavored foods. Provide bland, soft, chilled choices.</p>
<p>Throat/Neck cancer use PEG.</p>
<p>Cancer cachexia associated with cytokines and TNF (inflammatory cytokines-->wt loss, muscle/fat catabolism).</p>
<p>\_\_\_\_\_\_ treatment is associated with loss of taste and xerostomia (dry mouth), esophagitis, malasorption, diarrhea.</p>
<p>For xerostomia, provide moistened foods.</p>
<p>Also associated with \_\_\_\_\_\_\_ (inflammation of mucosal lining of oropharynx and esophagus) - provide soft, bland choices.</p>
<p>Radiation</p>
<p></p>
<p>Mucositis</p>
<p>Chemica reagents in \_\_\_\_\_\_\_ have toxic effects, and is associated with N/V, anorexia, malabsorption.</p>
<p>Also associated with \_\_\_\_\_\_\_\_, or cracks in the corners of the mouth due to a RIBOFLAVIN deficiency.</p>
<p></p>
<p>Methotrexate, a drug used to treat cancer, is a \_\_\_\_\_\_\_-antagonist.</p>
<p>Chemotherapy</p>
<p></p>
<p>Stomatitis</p>
<p></p>
<p>Folate-antagonist</p>
<p>\_\_\_\_\_\_\_\_\_\_ is a condition caused by inadequate energy intake in all forms, including protein.</p>
<p></p>
<p>\_\_\_\_\_\_\_\_\_ is protein deficiency with adequate energy intake. Protein deficiency results in an edematous appearance (pot-belly).</p>
<p>Marasmus (deficient protein and energy)</p>
<p></p>
<p>Kwashiorkor (deficient protein)</p>
<p>**Iatrogenic malnutrition refers to the protein-calorie malnutrition brought on by \_\_\_\_\_\_\_, \_\_\_\_\_\_\_, and \_\_\_\_\_\_.</p>
<p></p>
<p>Iatrogenic: Due to the activity of a physician or therapy</p>
<p>Hospitals, treatment, medication</p>
<p>Therapy for anorexia is \_\_\_\_\_\_\_\_\_ and includes weight restoration in combination with psychotherapy.</p>
<p></p>
<p>Therapy begins with:</p>
<p>Immediate concern, which is \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_.</p>
<p></p>
<p>Multidisciplinary</p>
<p></p>
<p>Immediate concern is correcting electrolyte imbalance, namely Potassium.</p>
<p>In treatment of anorexia, plan WITH the patient. Focus on \_\_\_\_\_\_\_\_\_ and life-sustaining aspects of food, giving the patient a reason to eat.</p>
<p>Regular mealtimes, varied intake, gradually reintroduce feared foods.</p>
<p>Re-feeding increases \_\_\_\_\_\_\_ load - go slowly.</p>
<p>Recommendation is \_\_-\_\_ kcal/kg, but may need to be set at 100-300 kcal above \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ to support adherence.</p>
<p>Health benefits</p>
<p></p>
<p>Re-feeding increases CARDIAC LOAD - go slowly.</p>
<p></p>
<p>Recommendation is 30-40 kcal/kg, but may need to be set at 100-300 kcal above CURRENT INTAKE to support adherence.</p>
<p>Binging and purging syndrome. Usualy close to normal weight.</p>
<p></p>
<p>Associated symtpoms include damage to teeth, throat, esophagus (vomiting), and rectal bleeding (laxative abuse).</p>
<p></p>
<p>\_\_\_\_\_\_\_ are lost through vomiting and diarrhea.</p>
<p>Bulimia</p>
<p></p>
<p>Electrolytes (namely K - hypokalemia)</p>
<p>**Obesity begins at BMI \_\_.</p>
<p>Obesity begins at BMI 30.</p>
<p></p>
<p>Class 1: 30-34.9</p>
<p>Class 2: 35-39.9</p>
<p>Class 3: >40 (morbid)</p>
<p>Rapdi weight loss that occurs in the beginning of ANY diet is \_\_\_\_\_\_\_.</p>
<p>Rapid weight loss in the beginning of a diet is water.</p>
<p></p>
<p>As glycogen is utilized as energy source the water in which it is stored is also released.</p>
<p>\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is usually the recommended intervention in overweight children.**</p>
<p>MAINTENANCE</p>
<p>The belief that localized exercise reduces fat stores in the active area - research does NOT support this.</p>
<p>Spot Weight Loss Theory</p>
<p>When a dieter reaches a plateau, their \_\_\_ has dropped to reflect the loss.</p>
<p>BMR</p>
<p>Bariatric surgery is appropriate for:</p>
<p></p>
<p>*Class \_\_ obesity (BMI >40)</p>
<p>OR</p>
<p>*Class \_\_ obesity (BMI >35), WITH COMORBIDITIES</p>
<p>Bariatric surgery is appropriate for:</p>
<p></p>
<p>Class 3 obesity (BMI >40)</p>
<p>OR</p>
<p>Class 2 obesity (BMI >35), WITH COMORBIDITIES</p>
<p>Gastric bypass and gastroplasty (stapling) reduce the \_\_\_\_\_\_\_ of food that can be eaten at one time, resulting in early \_\_\_\_\_\_\_.</p>
<p>Reduce the amount of food eaten at one time, resulting in early satiety.</p>
<p>This type of gastric bypass connets the upper portion of the stomach to the jejunum. The lower portion of the stomach is bypassed.</p>
<p>Roux-en-Y gastric bypass</p>
<p>WIth gastric bypass, it is important to monitor for potential \_\_\_\_\_\_\_\_\_\_, as well as deficiencies including \_\_\_, \_\_\_, \_\_\_\_, and \_\_\_\_. Supplementation is necessary.</p>
<p>Anemia</p>
<p>Deficiencies in K, Mg, Folate, B12</p>
<p>Procedure using tapling to create a small, gastric pouch, leaving only a small opening into the distal (lower) stomach.</p>
<p>Gastroplasty</p>
<p>Procedure involving the placement of a fluid-filled inflatable band to create a small gastric pouch. This band can be adjusted to alter the size of the opening.</p>
<p>Fully-reversible.</p>
<p>Does not require iron, folate, B12 supplements.</p>
<p>Gastric banding</p>
<p>Congenital disorder associated with the deletion of chromosome 15.</p>
<p>Ghrelin is elevated.</p>
<p>SUBnormal lean body mass, SUPRAnormal fat mass.</p>
<p>Prader-Willi syndrome</p>
<p>In PWS, GHRELIN levels are elevated, stimulating:</p>
<p>\_\_\_\_\_ hormone secretion</p>
<p>\_\_\_\_\_\_, \_\_\_\_\_</p>
<p>\_\_\_\_\_ \_\_\_\_\_ deposition</p>
<p>In PWS, GHRELIN levels are elevated, stimulating:</p>
<p>Growth hormone secretion (stimulates growth)</p>
<p>Appetite, Intake</p>
<p>Fat mass deposition</p>
<p>Prader-Willi syndrome results in:</p>
<p>-</p>
<p>-</p>
<p>-</p>
<p>-</p>
<p>Results in:</p>
<p>Obesity</p>
<p>Hypogonadism</p>
<p>Muscle hypotonia</p>
<p>Failure to thrive</p>
<p>*The best treatment of PWS is:</p>
<p>*To control access to food and intake.</p>
