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
(48 cards)
<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>
______ treatment is associated with loss of taste and xerostomia (dry mouth), esophagitis, malasorption, diarrhea.
For xerostomia, provide moistened foods.
Also associated with _______ (inflammation of mucosal lining of oropharynx and esophagus) - provide soft, bland choices.
Radiation
Mucositis
Chemica reagents in _______ have toxic effects, and is associated with N/V, anorexia, malabsorption.
Also associated with ________, or cracks in the corners of the mouth due to a RIBOFLAVIN deficiency.
Methotrexate, a drug used to treat cancer, is a _______-antagonist.
Chemotherapy
Stomatitis
Folate-antagonist
__________ is a condition caused by inadequate energy intake in all forms, including protein.
_________ is protein deficiency with adequate energy intake. Protein deficiency results in an edematous appearance (pot-belly).
Marasmus (deficient protein and energy)
Kwashiorkor (deficient protein)
**Iatrogenic malnutrition refers to the protein-calorie malnutrition brought on by _______, _______, and ______.
Iatrogenic: Due to the activity of a physician or therapy
Hospitals, treatment, medication
Therapy for anorexia is _________ and includes weight restoration in combination with psychotherapy.
Therapy begins with:
Immediate concern, which is _________ ______ ______.
Multidisciplinary
Immediate concern is correcting electrolyte imbalance, namely Potassium.
In treatment of anorexia, plan WITH the patient. Focus on _________ and life-sustaining aspects of food, giving the patient a reason to eat.
Regular mealtimes, varied intake, gradually reintroduce feared foods.
Re-feeding increases _______ load - go slowly.
Recommendation is __-__ kcal/kg, but may need to be set at 100-300 kcal above ________ _______ to support adherence.
Health benefits
Re-feeding increases CARDIAC LOAD - go slowly.
Recommendation is 30-40 kcal/kg, but may need to be set at 100-300 kcal above CURRENT INTAKE to support adherence.
Binging and purging syndrome. Usualy close to normal weight.
Associated symtpoms include damage to teeth, throat, esophagus (vomiting), and rectal bleeding (laxative abuse).
_______ are lost through vomiting and diarrhea.
Bulimia
Electrolytes (namely K - hypokalemia)
**Obesity begins at BMI __.
Obesity begins at BMI 30.
Class 1: 30-34.9
Class 2: 35-39.9
Class 3: >40 (morbid)
Rapdi weight loss that occurs in the beginning of ANY diet is _______.
Rapid weight loss in the beginning of a diet is water.
As glycogen is utilized as energy source the water in which it is stored is also released.
_______________ is usually the recommended intervention in overweight children.**
MAINTENANCE
The belief that localized exercise reduces fat stores in the active area - research does NOT support this.
Spot Weight Loss Theory
When a dieter reaches a plateau, their ___ has dropped to reflect the loss.
BMR
Bariatric surgery is appropriate for:
*Class __ obesity (BMI >40)
OR
*Class __ obesity (BMI >35), WITH COMORBIDITIES
Bariatric surgery is appropriate for:
Class 3 obesity (BMI >40)
OR
Class 2 obesity (BMI >35), WITH COMORBIDITIES
Gastric bypass and gastroplasty (stapling) reduce the _______ of food that can be eaten at one time, resulting in early _______.
Reduce the amount of food eaten at one time, resulting in early satiety.
This type of gastric bypass connets the upper portion of the stomach to the jejunum. The lower portion of the stomach is bypassed.
Roux-en-Y gastric bypass
WIth gastric bypass, it is important to monitor for potential __________, as well as deficiencies including ___, ___, ____, and ____. Supplementation is necessary.
Anemia
Deficiencies in K, Mg, Folate, B12
Procedure using tapling to create a small, gastric pouch, leaving only a small opening into the distal (lower) stomach.
Gastroplasty
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.
Fully-reversible.
Does not require iron, folate, B12 supplements.
Gastric banding
Congenital disorder associated with the deletion of chromosome 15.
Ghrelin is elevated.
SUBnormal lean body mass, SUPRAnormal fat mass.
Prader-Willi syndrome
In PWS, GHRELIN levels are elevated, stimulating:
_____ hormone secretion
______, _____
_____ _____ deposition
In PWS, GHRELIN levels are elevated, stimulating:
Growth hormone secretion (stimulates growth)
Appetite, Intake
Fat mass deposition
Prader-Willi syndrome results in:
-
-
-
-
Results in:
Obesity
Hypogonadism
Muscle hypotonia
Failure to thrive
*The best treatment of PWS is:
*To control access to food and intake.
