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RDN Exam > Misc Domain II > Flashcards

Misc Domain II Flashcards

1
Q

amputations - entire leg

A

16% of body weight

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2
Q

amputations - lower leg with foot

A

6% of body weight

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3
Q

amputations - entire arm

A

5% of body weight

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4
Q

amputations - forearm with hand

A

2.3% of body weight

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5
Q

adjusted IBW for amputations

A

(100 - % amputation) / 100 x IBW of original height

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6
Q

spinal cord injury - quadriplegic

A

reduce by 10-15% of table weight

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7
Q

spinal cord injury - paraplegic

A

reduce by 5-10% of table weight

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8
Q

tricep skinfold thickness - TSF

A

measures body fat reserves; measures calorie reserves

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9
Q

tricep skinfold thickness - TSF measurements

A

standard: male 12.5mm; female 16.5mm

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10
Q

arm muscle area AMA

A
  • measures skeletal muscle mass (somatic protein)
  • to determine use TSF and MAC (midarm circumference)
  • important to measure in growing childdren
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11
Q

arm muscle area AMA measurements

A

standard: male 25.3cm; female: 23.2cm

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12
Q

waist/hip ratio - WHR

A

differentiates between android and gynoid obesity

gynecoid type adipose tissue is found predominantly in the lower part of the body (hips and thighs).

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13
Q

waist/hip ratio measurements

A

WHR of 1.0 or greater in man, 0.8 or greater in women is indicative of android obesity and an increased risk for obesity-related diseases (diabetes, hypertension)

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14
Q

hair assessment - thin, sparse, dull dry brittle, easily pluckable

A

vitamin C, protein deficiency

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15
Q

auscultation hypoactive bowel sounds

A

every 15-20 seconds, may indicate paralytic ileus or peritonitis

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16
Q

auscultation normal bowel sounds

A

are gurgling high-pitched sounds every 5-15 seconds

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17
Q

serum albumin range

A

3.5 - 5.0 g/dl

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18
Q

serum albumin

A
  • maintains colloidal osmotic pressure
  • visceral protein
  • hypoalbuminemia
  • levels above normal range likely due to dehydration
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19
Q

serum transferrin

A
  • serum level controlled by iron storage pool; rises with iron deficiency
  • can be determined from TIBC
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20
Q

serum transferrin range

A

> 200 mg/dl

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21
Q

TTHY transthyretin, PAB prealbumin range

A
  • 16-40 mg/dl
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22
Q

TTHY transthyretin, PAB prealbumin

A
  • during inflammation; liver synthesizes CRP at expense of PAB
  • liminted usefulness in screening or assessment
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23
Q

RBP - retinol binding protein range

A

3-6 mg/dl

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24
Q

RBP - retinol binding protein

A
  • circulates with prealbumin; shortest half-life
  • binds and transports retinol
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25
Q

Hct hematocrit range

A
  • men 42-52%
  • women 36-48%
  • pregnant women 33%
  • newborn 44-64%
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26
Q

Hgb hemoglobin range

A

men 14-18 gm/dl
women 12-16 gm/dl
pregnant >=11

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27
Q

Hgb hemoglobin

A

iron containing pigment of red blood cells
erythrocytes are produced in bone marrow

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28
Q

serum ferritin range

A

10-150 ng/ml female
12-300 ng/ml men

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29
Q

serum ferritin

A

indicates size of iron storage pool

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30
Q

serum creatinine range

A

0.6-1.2 mg/dl M
0.5-1.1 mg/dl F

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31
Q

serum creatinine

A
  • related to muscle mass; measures somatic protein
  • may indicate renal disease, muscle wastage
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32
Q

CHI - creatinine height index

A

80% normal
60-80% mild muscle depletion

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33
Q

BUN blood urea nitrogen range

A

10-20 mg/dl

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34
Q

BUN blood urea nitrogen

A
  • related to protein intake
  • indicator of renal disease
  • BUN: creatinine ratio - normal 10-15:1
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35
Q

urinary creatinine clearance range

A

115 +- 20 ml/minute

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36
Q

urinary creatinine clearance

A

measures GFR - glomerular filtration, renal function
- estimate includes body surface area

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37
Q

TLC total lymphocyte count range

A

> = 2700 cells/cu mm
depletion 900-1800
severe depletion <900

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38
Q

TLC total lymphocyte count

A

decreased in protein-kcal malnutrition
measures immunocompetency

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39
Q

CRP c-reactive protein

A

marker of acute inflammatory stress
- as it declines, indicates when nutritional therapy would be beneifical
- when elevated CRP decreases, PAB increases

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40
Q

FEP free erythrocyte protoporphyrin

A

direct measure of toxic effects of lead on heme synthesis (leading to anemia). increased in lead poisoning. lead and calcium compete at plasma membrane for transport

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41
Q

PT prothrombin time

A

11-12.5 second; 85-100% of normal
anticoagulants prolong PT

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42
Q

PPFPs

A

prepared and perishable food programs - nonprofit programs that link sources of unused, cooked and fresh foods with social service agencies that serve the hungry

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43
Q

NNMRRP

A

National nutrition monitoring and related research program

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44
Q

PedNSS

A

pediatric Nutrition Surveillance System

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45
Q

PNSS

A

pregnancy nutrition surveillance system

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46
Q

NFCS

A

USDA nationwide food consumption surveys

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47
Q

NFNS

A

National food and nutrition survey
WWEIA - what we eat in america - dietary intake component of NHANES

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48
Q

BRFSS

A

behavior risk factor surveillance system

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49
Q

YRBSS

A

youth risk behavior surveillance system

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50
Q

FSANS

A

food safety and nutrition survey - FDA

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51
Q

TANF

A

temprorary assistance for needy families

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52
Q

CFDP

A

commodity food donation/distribution program

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53
Q

CSFP

A

commodity supplemental food program

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54
Q

TEFAP

A

the emergency food assistance program

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55
Q

NSLP

A

national school lunch program

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56
Q

NSBP

A

national school bfast program

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57
Q

ASP

A

afterschool snack programs

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58
Q

SMP

A

special milk program

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59
Q

SFSP

A

summer food service program

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60
Q

CACFP

A

child and adult care food program

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61
Q

FFVP

A

fresh fruit and vegetable program

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62
Q

EFNEP

A

expanded food and nutrition education program

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63
Q

NSIP

A

nutrition services incentive program

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64
Q

OAA

A

older americans act nutrition program

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65
Q

NETP

A

nutrition education and training program

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66
Q

SFMNP

A

senior farmers’ market nutrition program

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67
Q

FAO

A

food and agricultural organization

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68
Q

clinical diagnosis (NC)

A

nutritional findings/problems that relate to medical/physical condition

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69
Q

clinical - functional balance

A

physical or mechanical change that interferes/prevents desired nutritional results; swallowing difficulty, altered GI function

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70
Q

clinical - biochemical balance

A

change in capacity to metabolize nutrients due to medications, surgery, or indicated by lab values

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71
Q

clinical - weight balance

A

chronic or changed wt status when compared with UBW: underweight, involuntary wt loss, overwt

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72
Q

intake diagnosis NI

A

actual problems related to intake

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73
Q

intake - caloric energy balance

A

actual or estimated changes in energy (hypermetabolism, hypometabolism, increased energy expenditure)

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74
Q

intake - oral or nutrition support intake

A

inadequate or excessive compared with goal

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75
Q

intake - fluid intake balance

A

inadequate or excessive compared with goal

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76
Q

intake - bioactive substances

A

supplements, alcohol, functional foods

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77
Q

intake - nutrient balance

A

intake of nutrients compared with desired levels

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78
Q

behavioral-environmental diagnosis (NB)

A

problems related to knowledge, access to food and food safety

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79
Q

behavioral-environmental - knowledge and beliefs

A

knowledge deficit, harmful beliefs, disordered eating pattern, undesirable food choices

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80
Q

behavioral-environmental - physical activity balance and function

A

inactivity, excessive exercise, impaired ability to prepare foods

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81
Q

behavioral-environmental - food safety

A

and access

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82
Q

primary prevention programs

A

reduced exposure to a promoter of disease (early screening for risk factors like diabetes). health promotion

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83
Q

secondary prevention program

A

recruiting those with elevated risk factors into treatment program (setting up an employee’s gym), reduce impact of a condition that has already occurred. risk reduction, slow process to restore health

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84
Q

tertiary prevention program

A

as disease progresses, intervention to reduce severity, manage complications (cardiac/stroke programs). rehabilitation efforts.

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85
Q

FTC - health care fraud

A

federal trade commission: internet, TV, radio; bogus wt loss claims

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86
Q

Ulcer drug therapy

A

cimetidine, ranitidine - H2 blockers which prevent the binding of histamine to receptor, decreases acid secretion

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87
Q

what vitamins/minerals are adversely affected by billroth II

A

calcium - most rapid absorption in duodenum and iron absorption (requires acid) are adversely affected
- B12 deficiency, folate deficiency

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88
Q

following a complete gastrectomy what deficiencies happen?

A

iron, B12, folate, calcium, vitamin D, B1, and copper may develop

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89
Q

gastroparesis

A

delayed gastric emptying due to surgery, diabetes, viral infections, obstructions

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90
Q

gastroparesis medications

A

prokinetics (erythromycin, metoclopramide) which increase stomach contractility

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91
Q

MNT for tropical sprue

A

antibiotics, high kcal, high protein, IM b12, oral folate supplements

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92
Q

non tropical sprue what not to eat

A

need gliadin-free - gluten-restricted diet: NO wheat, rye, certain oats, barley, bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents

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93
Q

high fiber diet may increase the need for what minerals

A

Ca, Mg, P, Cu, Se, Zn, Fe

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94
Q

vitamin/mineral deficiencies with Crohn’s disease

A

B12, iron deficiciency

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95
Q

vitamin/mineral deficiencies with UC

A

electrolyte disturbance (Na, K)
negative nitrogen blanace
iron, folate, assess Ca, Mg, Zn
antidiarrheal agent - sulfasalazine

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96
Q

lactose intolerance test

A

if lactose intolerant blood glucose will be <25 mg/dl
supplement with calcium and riboflavin

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97
Q

acute diarrhea in infants and children

A

aggressive and immediate rehydration
reintroduce oral intake within 24 hrs

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98
Q

chronic nonspecific infantile diarrhea

A

no significant malabsoprtion
consider ratio of fat to CHO calories, volume of ingested liquids
give 40% kcal as fat, balanced with limited fluids; restrict or dilute fruit juices with high osmolar loads - apple, grape

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99
Q

ileal resection SBS

A

significant resections produce major complications
distal - absorption of B12, intrinsic factor, bile salts
need more fluids
malabsorption of fat soluble vitamins along with Ca, Zn, Mg leading to “soaps”
colonic absorption of oxalate increases leading to renal oxalate stones

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100
Q

loss of colon SBS

A

loss of water and electrolytes, loss of salvage absorption of carbs and other nutrients. provide chewable vitamins.

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101
Q

nutritional care SBS

A

PN initially to restore and maintain nutrient status then move onto EN

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102
Q

liver function tests ALP

A

alkaline phosphatase
30-120 U/L
increased - liver, or bone disease
decreased - scurvy, malnutrition

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103
Q

liver function tests LDH

A

lactic acid dehydrogenase
increased in hepatitis, myocardial infarction, muscle malignancies

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104
Q

liver function tests - AST, SGOT

A

aspartate amino transferase
0-35 U/L
increased in hepatitis

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105
Q

liver function tests - ALT, SGPT

A

alanine aminotransferase
4-36 U/L
increased in liver disease

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106
Q

HAV

A

fecal oral transmission

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107
Q

HBV

A

sexually trasmitted

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108
Q

HCV

A

blood to blood contact

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109
Q

heptatitis MNT

A

1-1.2 g/pro/kg
50-55% CHO
mod to liberal fat intake if tolerated
small frequent feedings
coffee is okay
multivitamin with B complex, C, K, zinc
if fluid retention, 2 gm Na

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110
Q

MNT for cirrhosis

A

adequate to high pro .8-1.2 g/kg; in stress at least 1.5g/kg
high kcal 25-35 kcals/kg
mod to low fat 25-40% kcal - fat is the preferred fuel in cirrhosis
low fiber if varices are present, low sodium if edema or ascites
B complex vitamins, C, Zn, Mg; monitor need for A and D

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111
Q

alcoholic liver disease MNT

A

supplement thiamin and folic acid
need more B vitamins
increased need for magnesium
thiamin deficiency
protein deficiency

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112
Q

hepatic failure

A

liver cannot convert ammonia (NH3) to urea - ammonia accumulates
- asterixis (flapping, involuntary jerking motions): sign of impending coma

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113
Q

hepatic failure MNT

A

1-1.5 g pro/kg if not comatose and not protein-sensitive
30-35 kcal/kg, 30-35% kcal as fat with MCT if needed
low sodium if ascites; vit/mineral supplementation
increased BCAA

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114
Q

meds for hepatic failure

A

lactulose (hyperosmotic laxative that removes nitrogen); neomycin (antibiotic that destroys bacterial flora that produce ammonia)

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115
Q

MNT for NAFLD

A

wt loss 7-10%, not rapid
healthful eating through Med diet, moderate alcohol, avoiding sugar bevs, coffee may help
physical activity

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116
Q

gallbladder disease

A

low fat diet - acute 30-45 g; chronic 25-30% of kcal
if cholecystectomy - bile now secreted from liver directly to intestine so limit fat intake to allow liver to compensate. slowly increase fiber

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117
Q

acute pancreatitis MNT

A

hypermetabolic state increased BMR
withhold feeding, maintain hydration
progress as tolerated to easily digested foods with a low fat content
elemental (pre-digested) EN into the jejunum may be tolerated

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118
Q

chronic pancreatitis MNT

A

PERT therapy orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase.
MCTs do not require pancreatic lipase
- avoid large meals with fatty foods, alcohol

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119
Q

CF MNT

A

use age-appropriate BMI to assess height and weight
PERT therapy with meals and snacks
high protein, high kcal, unrestricted fat, liberal in salt
age appropriate doses of water-soluble vitamins and minerals
supplement zinc, water-soluble forms of fat-soluble vitamins (A and E)

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120
Q

normal BP

A

< 120/80 mm Hg

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121
Q

elevated BP

A

systolic between 120-129 and diastolic less than 80

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122
Q

stage 1 HPN

A

systolic between 130-139 or diastolic between 80-89

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123
Q

stage 2 HPN

A

systolic between at least 140 or diastolic at least 90 mm Hg

124
Q

HPN MNT

A

thiazide diuretics may induce hypokalemia
<2300 mg sodium/day
DASH diet
decrease wt

125
Q

risks of atherosclerosis

A

hypertension, obesity, smoking, elevated blood lipids, heredity

126
Q

chylomicron

A

synthesized in intestine from dietary fat, transports dietary triglycerides from gut to adipose, lowest density; smallest amount of protein

127
Q

VLDL

A

transports endogenous triglyceride from liver to adipose

128
Q

LDL

A

transports cholesterol from diet and liver to all cells
- small dense LDL-C associated with increased risk, responsive to diet
- larger buoyant LDL is not associated with increased risk

129
Q

HDL

A

reverse cholesterol transport; moves cholesterol from cells to liver and excretion

130
Q

IDL

A

LDL precursor; catabolism of other lipoproteins

131
Q

metabolic syndrome risk factors

A

3 or more of:
elevated blood pressure >=130 and/or >= 85 diastolic
elevated TG >= 150 mg/dl
fasting serum glucose >=100 mg/dl
waist measurement >=40 in men and 35 in women
low HDL <40 for men and <50 women

132
Q

desired labs for metabolic syndrome

A

<100 LDL-C
<200 cholesterol total
>= 60 HDL
<150 TG

133
Q

heart healthy diet

A

saturated fat <7% kcal, <200 mg cholesterol, 2g sodium, no trans fats, include fiber, fruits, veg, low fat dairy, unsaturated fats

134
Q

recommend a heart- healthy lifestyle and statin therapy for

A

pts who have ASCVD, patients with LDL of 190 or higher, pts with type 2 diabetes between the ages of 40 and 75, pts with an estimated 10-yr risk of CVD or 7.5% or higher who are between 40 and 75 yrs old

135
Q

heart failure MNT

A

digitalis increases strength of heart contraction
low sodium 2-3 g
dash diet
1-2 L fluid
1.1-1.4 g protein/kg
use indirect calorimetry if available but if not, estimate RMR at 22kcal/kg for normally nourished, 24 kcal/kg for malnourished
- evaluate thiamin status
- DRI for folate, Mg, MV with b12

136
Q

cardiac cachexia MNT

A

arginine and glutamine may help
low saturated fat, low cholesterol, low trans fat, <2 g sodium, high calorie

137
Q

vasopressin

A

ADH, from hypothalamus stored in pituitary
exerts pressor effect; elevates BP
increases water reasborption
SIADH, hyponatremia caused by hemodilution, treated with fluid restriction

138
Q

renin - vasoconstrictor

A

secreted by glomerulus when blood volume decreases
stimulates aldosterone to increase sodium absorption and return blood pressure to normal

139
Q

erythropoietin EPO

A

produced by kidney; stimulates bone marrow to produce RBC

140
Q

lab tests in renal disease

A

decreased GFR, creatinine clearance
increased serum creatinine, BUN
BUN/Cr ratio of >20:1 indicates a pre renal state in which BUN reabsorption is increased due to acute kidney damage
BUN/Cr ration of <10:1 suggests reduced BUN reabsorption due to renal damage - may need dialysis

141
Q

renal calculi MNT

A

1.5-2L fluid to dilute urine with renal calculi
adequate calcium intake to bind oxalate and a low oxalate diet
alkaline / acid ash diet

142
Q

alkaline ash/acid ash diets

A

minerals not oxidized in metabolism leave an ash (residue) in urine
to prevent acidic stones - create an alkaline ash: increase cations (Ca, Na, K, Mg), by adding veg, fruits, brown sugar, molasses
to prevent alkaline stones - create an acid ash: increase anions (Cl, Ph, Su) by adding meat, fish fowl eggs shellfish, cheese, corn, oats, rye

143
Q

acute kidney injury or failure

A

oliguiria or azotemia
1-1.3 g/kg if non catabolic without dialysis
1.2-1.5 g/kg if catabolic and/or initiation of dialysis
25 -40 kcal/kg. energy expenditure increases as kidney function declines.
low sodium
8-15 mg/kg phos
2-3 g potassium
replace fluid output from previous day plus 500 ml

144
Q

nephrotic syndrome MNT

A

0.8-1.0 g/kg; <30% fat, low sat fat, 200 mg cholesterol
35 kcal/kg
modest sodium restriction
calcium 1-1.5 g/day
vitamin D supp
may need fluid restriction
abnormalities in iron, copper, zinc, calcium related to protein loss

145
Q

CKD MNT

A

25-35 kcals/kg
<2300 mg sodium
CKD levels 3-5 need 0.60 g protein/kg
phosphorus - adjust intake
calcium - 800-1000 mg total elemental
potassium generally not restructed
fluid generally unrestricted in CKD 1-4
consider supp of folate, b12, b complex; vit c and D

146
Q

chronic renal failure - hemodialysis MNT

A

1-1.2 g pro/kg
25-35 kcal/kg
<2.3 g sodium
25-35% fat; <7% saturated; <200 mg cholesterol
fluid individualized
calcium, individualized with max 2g
potassium adjust intake
800-100 mg phos
vitamins B6, folate, b12, vit D, C supps
vitamin A and E supps are NOT recommended

147
Q

chronic renal failure - peritoneal dialysis MNT

A

1-1.2 g protein/kg
25-35 kcal/kg
<2.3 g sodium
potassium generally unrestricted
calcium, individualized with max 2g
800-1000 mg phosphorus
1-3L fluid depending on output, cardiac status

148
Q

risk factor for diabetes GADA

A

glutamic acid decarboxylase antibodies

149
Q

normal blood glucose

A

70-100 mg/dl, 2hPG post-prandial <140 mg/dl

150
Q

impaired fasting glucose FPG

A

100-125

151
Q

impaired glucose tolerance

A

2hPG 140-199

152
Q

diabetes fasting plasma glucose

A

FPG >=126

153
Q

diabetes glucose tolerance test

A

GTT >= 200 or symptoms of diabetes plus casual plasma glucose >=200 mg/ddl

154
Q

diabetes HgA1c

A

> =6.5%

155
Q

normal A1c

A

<5.7%; over 65 yrs <7% in healthy, <=8% in frail

156
Q

goal for A1C for diabetics

A

<7.0%

157
Q

prediabetes A1c

A

5.7-6.4%f

158
Q

foods with low glycemic index

A

legumes, milk, whole grains, fruits, veg

159
Q

goal for diabetics blood glucose average

A

average pre-prandial goal 70-130; peak post-prandial average <180

160
Q

gestational diabetes risk factors

A

BMI > 30, history of GDM

161
Q

gestational diabetes screening

A

at 24-28 weeks of gestation, screen with 50g oral glucose load; glucose >=140 mg/dl indicates further testing

162
Q

gestational diabetes MNT

A

40-45% CHO, 3 small medium sized meals and 2-4 snacks; DRI for CHO during preganancy is 175 g/day; 15-30g CHO at breakfast (less well tolerated); increases risk of fetal macrosomia (LGA) or fetal hypoglycemia at birth

163
Q

food lists for diabetes - starch/bread

A

carbs - 15
pro - 3
fat - 1
kcal - 80

164
Q

food lists for diabetes - fruit

A

carb - 15

165
Q

food lists for diabetes - milk, fat free, low fat

A

carbs - 12
pro - 8
fat - 0-3
kcal - 100

166
Q

food lists for diabetes - milk, reduced fat

A

carbs - 12
pro - 8
fat - 5
kcal - 120

167
Q

food lists for diabetes - milk, whole

A

carbs - 12
pro - 8
fat - 8
kcal - 160

168
Q

food lists for diabetes - sweets, desserts, other CHO

A

carbs - 15
rest varies

169
Q

food lists for diabetes - non-starchy veg

A

carbs - 5
pro - 2
kcal - 25

170
Q

food lists for diabetes - lean protein

A

pro - 7
fat - 2
kcal - 45 (canadian bacon)

171
Q

food lists for diabetes - medium fat protein

A

pro - 7
fat - 5
kcal - 75

172
Q

food lists for diabetes - high fat protein

A

pro -7
fat - 8
kcal - 100

173
Q

food lists for diabetes - plant based

A

pro - 7
rest varies

174
Q

food lists for diabetes - fats

A

fat - 5
kcal - 45

175
Q

food lists for diabetes - alcohol

A

kcal - 100

176
Q

food lists for diabetes - free foods

A

<20 kcal and <5g CHO per serving

177
Q

acute ketoacidosis

A

hyperglycemia due to insulin deficiency or excess carb intake, dehydration due to polyuria, increased pulse, fruity odor of ketones. treatment: insulin, rehydration

178
Q

acute hypoglycemia

A

insulin reaction (shock); due to insulin excess or lack of eating, slow pulse, cool clammy skin, hungry, weak, shakiness, sweating
treatment: glucose
- begin with 15 g CHO, fruit juice (4-6oz), sugar
- wait 15 min; if still < 70 mg/dl, give another 15 grams
- repeat and treat until BG is normal
if unresponsive: administer glucagon

179
Q

postprandial or reactive hypoglycemia

A

overstimulation of pancreas or increased insulin sensitivity; blood glucose falls below normal 2-5 hrs after eating <50mg/dl
- avoid simple sugar, 5-6 small meals per day, spread intake of CHO throughout the day

180
Q

Addison’s disease

A
  • decreased cortisol - glycogen depletion, hypoglycemia
  • decreased aldosterone - sodium loss, potassium retention, dehydration
  • decreased androgens - tissue wasting, wt loss
    diet: high protein, frequent feedings, high salt
181
Q

hyperthyroid

A

elevated T3 and T4
increased BMR leading to wt loss
increase kcal

182
Q

hypothyroid

A

T4 low; T3 low or normal
decreased BMR leading to wt gain
wt reduction

183
Q

goiter

A

enlargement of thyroid gland
inadequate iodine intake

184
Q

gout

A

disorder of purine metabolism
increased serum uric acid - deposits in joints causing pain

185
Q

gout MNT

A

mod pro, liberal carb, low to moderate fat, decrease alc, liberal fluid, avoid high purine foods (anchovies, sardines, organ meats, sweet breads, meat-based gravies & extracts)
meds - urate eliminant, colchicine, induce loss of nutrients

186
Q

galactosemia

A

due to missing enzyme that would have converted galactose 1-PO4 into glucose 1-PO4
- treated solely by diet - galactose and lactose, no drugs
- NO: organ meats (naturally contain galactose), MSG extenders, milk, lactose, galactose, whey, casein, dry milk solids, curds, calcium or sodium caseinate, dates, bell pepper

187
Q

urea cycle defects

A

unable to synthesize urea from ammonia resulting in ammonia accumulation
vomiting, lethargy, seizures, coma, anorexia, irritability
diet - protein restriction to lower ammonia; therapeutic formulas to adjust protein composition to limit ammonia production
example: OTC Ornithine transcarbamylase deficiency

188
Q

phenylketonuria PKU

A

missing enzyme - phenylalanine hydroxylase - which would convert phenylalanine into tyrosine; phenylalanine and metabolites accumulate leading to poor intellectual function
detected w/ Guthrie blood test
diet
- restrict the substrate phenylalanine (PHE), supplement the product tyrosine (TYR), tyrosine becomes a conditional AA
- low in Phe, but provide enough to promote normal growth
- avoid aspartame
- need for phenylalanine decreases with age, infection
- low protein, high CHO intakes may lead to increased dental caries

189
Q

glycogen storage disease

A

deficiency of glucose 6 phosphatase in liver; impairs gluconeogenesis and glycogenolysis
- liver can’t convert glycogen into glucose leading to hypoglycemia
- provide a consistent supply of exogenous glucose with raw cornstarch at regular intervals, and a high carb, low fat diet

190
Q

homocystinurias

A
  • treatable inherited disorder of AA metabolism
  • characterized by severe elevations of methionine and homocysteine in plasma, and excessive excretion of homocystine in urine
  • associated with low levels of folate, B6, B12
  • newly diagnosed patients receive increased doses of folate, pyridoxine, B12
  • if they don’t respond: low protein, low methionine diet
191
Q

maple syrup urine disease MSUD

A
  • inborn error or metabolism of the BCAA’s - leucine, isoleucine, valine
  • poor sucking reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of sweat and urine
  • restrict BCAA 45-62 mg/day
  • provide adequate energy from CHO and fat to spare AA
  • include small amounts of milk to support growth; gelatin may be used
  • avoid eggs, meat, nuts, other dairy products
192
Q

congenital sucrase isomaltase disease CSID

A
  • diet modification of sucrose, starch and maltose
  • if on Sacrosidase (oral enzyme replacement for sucrase), they do not need to restrict sucrose in their diet (just starch and maltose). enzyme is taken before and during meals and snacks
  • diabetics on Sacrosidase need to check blood glucose levels. it converts sucrose into fructose and glucose
193
Q

arthritis

A

normocytic anemia may develop
- inflammation of arthritis prevents reuse of iron
- antiinflammatory diet may help osteoarthritis
- methylprednisolone - steroid that may decrease inflammation

194
Q

systemic lupus erythematosus

A

SLE
no specific dietary guidelines, tailor to needs
may have dietary deficiencies of iron, folate, calcium, fiber, b12
may have anemia but does not correlate with iron intake
may show symptoms of celiac disease

195
Q

type I osteoporosis

A

potmenopausal within 15-20 yrs

196
Q

type II osteoporosis

A

age associated > 70 yrs

197
Q

osteoporosis MNT

A

HRT - hormone replacement therapy, wt bearing exercise, vitamin D, calcium, adequate pro, moderate to low sodium, 5 or more servings of fruit and veg
- take calcium carbonate with food; calcium citrate with or without food

198
Q

epilepsy meds

A

phenobarbital and phenytoin (Dilantin) interfere with calcium absorption

199
Q

epilepsy MNT

A

take 1 mg folate daily with drug
may need supplements of vitamin D, calcium, thiamin, provide phenytoin separate from meals and other supps
enteral feedings decrease bioavailability of phenytoin so hold tube feelings >=2 hrs

200
Q

ketogenic diet

A

for epilepsy
mild dehydration needed to prevent dilution of ketones
need supps of Ca, D, folate, B6, B12 (spinach may aid in absorption)

201
Q

cerebral palsy spastic form

A

difficult still movement; limited activity; obese
low kcal, high fluid, high fiber diet

202
Q

cerebral palsy nonspastic form

A

athetoid form - involuntary wormlike movement, constant irregular motions leading to wt loss
high kcal, high pro, finger foods

203
Q

traumatic brain injury

A

systemic inflammatory response: hypermetabolism, hyperglycemia, insulin resistance protein wasting
EN into small bowel
provide energy at 140% of estimated REE
1.5-2.0 g pro/kg

204
Q

spinal cord injury

A

long term issues - obesity, CVD, pressure ulcers
acute phase: energy needs may be 10% below predicted, 2g pro/kg
rehabilitation - .8-1.0g pro/kg, 23 kcals/kg for quadriplegic pts, 28 kcals/kg for paraplegia
neurogenic bowel slows transit time: 1 ml fluid/kcal plus 500 ml/day

205
Q

pressure injuries

A

30-35 kcals/kg if malnourished or at risk for malnutrition
stage 1 - 1.1-1.2 g/kg pro
stage 2 - 1.25-1.5 g/kg pro, adequate fluid
stage 3/4 1.5-2.0 g/kg pro
well balanced diet including good sources of vit A, C, zinc, copper

206
Q

braden scale

A

stage I - upper layer of skin, red and warm to touch
II - broken skin, open sore
III - damage below skin surface into fat tissue
IV - large wound, may affect muscles and ligaments

207
Q

ASD

A

autism spectrum disorder
- unnecessary food restrictions, possible food aversions, excessive supplementation can place children with ASD at risk

208
Q

anomia

A

form of aphasia - lost words, unable to recall names of common items

209
Q

nutrients associated with dementia

A

folate, B6, B12

210
Q

microcytic hypochromic anemia RBC

A

RBC may be normal 4.7-6.1 M, 4.2-5.4 F

211
Q

macrocytic anemia RBC

A

decreased <4.7 M, <4.2 F

212
Q

microcytic hypochromic anemia hematocrit

A

low <42% M, <35% F

213
Q

macrocytic anemia hematocrit

A

low <42% M, <35% F

214
Q

MCV microcytic anemia (average cell size)

A

low <80

215
Q

MCV macrocytic anemia (average cell size)

A

high >95

216
Q

MCH microcytic anemia (average cell hemoglobin)

A

low <27 pg

217
Q

MCH macrocytic anemia (average cell hemoglobin)

A

high >32 pg

218
Q

MCHC microcytic anemia

A

low <31

219
Q

MCHC macrocytic anemia

A

normal >31
32-36%

220
Q

thalassemia

A

defective hemoglobin synthesis resulting in microcytic, hypochromic, short-lived RBC. may develop iron overload. do not avoid iron-rich foods. managed with transfusions and chelation therapy
provide high pro, B vitamins (especially folic acid), zinc

221
Q

ag-ab reaction

A

when antigen enters body, antibody reactions
allergic to dust, spring, non food things

222
Q

immunoglobumin E

A

(IgE) mediated reaction to normally harmless food protein
common allergens - peanuts, eggs, milk, soy, wheat, shellfish

223
Q

CAP-FEIA

A

blood test is specific in identifying children with milk, egg, fish, peanut allergy

224
Q

DBPCFC

A

double blind placebo-controlled food challenges - identify food induced symptoms for food borne allergies (gold standard for diagnosis)

225
Q

RAST

A

alternative to skin test - serum is mixed with food on paper disk; measures specific IgE antibodies

226
Q

food least likely to cause an allergy

A

rice

227
Q

food intolerance non-IgE

A

abnormal physiologic response, GI, cutaneous, respiratory symptoms, but NO antibody production; intolerant

228
Q

fever and infection MNT

A

excessive fluid loss may lead to dehydration (hyperglycemia, dry, loose inelastic skin); IV feedings of dextrose and water, then diet high in kcal and fluids
- BMR increases 7% for each degree rise in F temp; normal temp 98.6F

229
Q

burns MNT

A

20-25% kcal as protein or 1.5-2 g protein/kg
1.2g/kg if burn <10% BSA
vitamin C 500 mg x 2, water soluble vitamins, vitamin K if on antibiotics
zinc for wound healing if zinc deficient, 220 mg zinc sulfate

230
Q

burns - rule of 9s

A

arm including hand head and neck, genitalia 9% each
anterior trunk, posterior trunk, legs including feet 18% each

231
Q

trauma

A

accelerated catabolism of lean body mass leading to neg. nitrogen balance as protein is catabolized to release glucose for energy
hyperglycemia, hyperinsulinemia, hypermetabolic
provide adequate but not excessive kcal - 25-30 kcal/kg ABW, 1.2 - 1.5 g pro/kg

232
Q

stages of death - pre active

A

decreased intake of foods and liquids

233
Q

stages of death - active stage

A

inability to swallow, abnormal breathing patterns

234
Q

treatment cancer

A

radiation - moisten foods
mucositis - avoid fresh, raw, uncooked foods, offer cold and soft food
chemotherapy - methotraxate - antifolate drug

235
Q

epidemiologic data

A

interrelationship between host, agent, environment in causing disease

236
Q

marasmus

A

protein & kcal starvation
serum albumin normal, no edema
starved apperance
triceps skinfold, arm muscle circumference decreased

237
Q

anorexia MNT

A

correct electrolyte imbalance
refeed slowly
recommended initial daily calorie levels range from 1000-1600

238
Q

obesity MNT

A

3500 kcal / pound body fat; to lose 1 lb fat/week, reduce 500 kcal/day

239
Q

obesity meds - orlistat

A

lipase inhibitor - take with diet 30% kcals as fat (fat restriction), vitamin supplements

240
Q

obesity meds - lorcaserin

A

agonist of serotonin, enhances satiety

241
Q

obesity meds - phentermine/topiramate

A

appetite suppressant, releases norepinephrine

242
Q

bariatric surgery treatment can be done on individuals with

A

BMI 40 or greater, or BMI of 35 or greater with comorbidities

243
Q

RYGB

A

roux en y gastric bypass
dumping syndrome may develop
- supplement calcium, vitamin D, iron, greater need for protein
vitamins for life: multivitamin, vitamin K, thiamin, biotin, folic acid, copper, zinc, iron. B12

244
Q

SG

A

sleeve gastrectomy
vitamin supp: monitor iron, calcium, vit D

245
Q

LAGB

A

laparoscopic adjustable gastric banding
deficiencies linked to decreased food intake and decreased food tolerance
eat slowly, sip drinks, no straws, no bubbles

246
Q

low cariogenic potential foods

A

for dental caries
high protein, mod fat, minimal concentration of fermentable CHO, strong buffer; high mineral content (Ca, P), pH >6 stimulates saliva. low cariogenic: cheese, nut, meat

247
Q

sugar alcohols (sorbitol, xylitol, mannitol)

A

do NOT promote tooth decay

248
Q

toddler fluoride rec

A

fluoridated water, or oral supplements if prescribes
toothpaste should not be used until the child can spit it out
infant should not sleep with bottle - BBTD

249
Q

stomatitis

A

inflammation of mouth
rinse with lukewarm water after meals

250
Q

globus

A

lump in the throat

251
Q

odynophagia

A

painful swallowing

252
Q

achalasia

A

disorder of lower esophageal sphincter motility, does not relax and open upon swallowing
causes dypshagia
start with pureed moist thick foods, progress to thick liquids

253
Q

level 0 white

A

thin, water - flow through straw

254
Q

level 1 gray

A

slightly thick, thicker than water, can flow through straw

255
Q

level 2 pink

A

mildly thick - sippable

256
Q

level 3 yellow

A

liquidized, mod thick (liquid)
spoon or cup, no lumps (food begins)
spoon or drunk from cup, no lumps, effort with wide straw

257
Q

level 4 green

A

extremely thick (liquid)
pureed (food)
spoon, not from cup or straw, not sticky, chewing not required
spoon, not sticky

258
Q

level 5 orange

A

minced and moist
minimal chewing,biting not required, lumps mashed with tongue, avoid hard, dried, tough foods

259
Q

level 6 blue

A

soft, bite-sized
able to chew bite-sized pieces, knife not required

260
Q

level 7 black

A

regular, easy to chew
can bite off and chew soft, tender pieces

261
Q

pregnancy induced hypertension

A

progresses from pre-eclampsia to eclampsia
more frequently found in women with lack of prenatal care, poor diets, poor protein and calcium intakes
sodium restriction is NOT recommended for prevention or treatment; sodium needed to maintain normal levels of sodium in plasma during large prenatal expansion of tissues and fluid.
need 2,300 mg sodium per day

262
Q

hyperemesis gravidarum

A

severe nausea, vomiting, acidosis, wt loss,
need bed rest, small amounts frequent carbs, correct fluid and electrolyte imbalance

263
Q

AIDS MNT

A

protein - asymptomatic 0.8 g/kg, up to 1.2-2.0 g/kg if wasted LBM
if diarrhea - soluble fiber, MCT oil, electrolyte replacement beverages
low bacteria diet (neutropenic), avoid raw foods

264
Q

NRTI drugs

A

for aids
retrovir, zidovudine
can lead to anemia, loss of appetite, nausea, dysphagia

use of vit C or st john’s wort could result in drug resistance

265
Q

HALS

A

hiv associated lipodystrophy syndrome may develop from therapy
high cholesterol, high triglycerides, insulin resistance, changes in body fat distribution
significant loss of lean body mass can be obscured by edema and HALS
increase in dietary fiber decreases insulin resistance, reducing risk of fat deposition

266
Q

pediatric HIV

A

high protein, high kcal with supplements needed for wt gain
multivitamins at doses 1-2x rda

267
Q

COPD MNT

A

avoid overfeeding more than 35 kcals/kg to avoid excessive CO2 production
routine use of high fat, low carb formula is not warranted
small frequent meals and snacks
vitamin D supp

268
Q

ARDS MNT

A

increased energy needs
adequate kcal
provide EN containing EPA and GLA and enhanced levels of antioxidant vitamins
1.5-2 g pro/kg BW, maintain lean body mass

269
Q

prescription for antipsychotics

A

clozapine, olanzapine, risperidone, quetiapine
determine history of usual wt and wt gain

270
Q

MNT for drug addiction

A

group process
mod or discontinued sugar intake
mod or discontinued caffeine
increased complex carb, pro, fiber with mod to low fat
30-35 kcal/kg plus 1-2 g protein/kg, encourage fluid intake, esp water

271
Q

EN formula standard polymeric

A

initiated full strength at a rate of 10-40 ml/hr, advance 10-20 ml every 8-12 hrs over the next 24-48 hrs until goal rate is achieved

272
Q

elemental chemically defined En formula

A

used with malabsorption
pre-digested protein or AA, glucose or sucrose, LCT and MCT, vitamins, minerals, electrolytes
absorbed in proximal intestine, low to no residue, don’t need pancreatic enzymes, high osmolality, poor taste

273
Q

large #16 tube bore

A

blenderized whole foods

274
Q

small #8 tube bore

A

ready prepared formulas more comfortable

275
Q

hang time open system

A

8 hrs

276
Q

hang time closed system

A

24-48 hrs

277
Q

bolus method

A

clinically stable with functional stomach

278
Q

intermittent drip (pump or gravity)

A

more mobility

279
Q

continuous drip

A

constant, steady rate over 16-24 hours, usually with a feeding pump. for those with compromised GI function or who do not tolerate large volume infusion. clinic feeding is delivered by continous drip at an increased rate over 8-16 hours, often overnight by pump

280
Q

gastrostomy or jejunostomy feedings

A

if needed for more than 3-4 weeks
PEG inserts tube into stomach through abdominal wall

281
Q

1cal/cc formulas

A

80-86% water

282
Q

1.5cal/cc formulas

A

76-78% water

283
Q

2cal/cc formulas

A

69-71% water

284
Q

normal GRV

A

<=250.
EN should not be held for GRVs <500 ml in absence of other signs of intolerance

285
Q

peripheral parenteral nutrition

A

small surface veins
short term therapy with minimum effect on nutrition status
indications post surgery, mild to mod malnutrition
solutions:
- IV dextrose - 3.4 kcal/g
- fat emulsion - 10% 1.1 kcal/cc, 20% 2.0 kcal/cc
solutions generally limited to 800-900 mOsm

286
Q

PN

A

used to achieve an anabolic state when patients are unable to eat by mouth and EN is not possible
set tie frame of 7-10 days in which to achieve intake goals by the EN route before adding PN

287
Q

PN PICC

A

peripherally inserted central catheter - used for short or mod term infusion

288
Q

PN CVC

A

long term central access is through the cephalic, subclavian or internal jugular vein into the superior vena cava

289
Q

PN solutions

A

protein - ratio for anabolism is 1 g nitrogen / 150 kcal
- 1-1.5 g pro/kg/day
energy
- 35-50 kcal/kg
max rate of dextrose infusion should not exceed 4-5 mg/kg/min to prevent hyperglycemia and other complications.
to prevent EFAD give 500cc of 10% fat emulsion 1-2x/week

290
Q

transitional feeding

A

introduce a minimal amount of full-strength EN feeding at a low rate of 30-40 ml/hr to establish GI tolerance
begin tapering when EN feedings are providing 60% of their nutrient requirements

291
Q

refeeding syndrome

A

results in hypokalemia
hypophosphatemia
hypomagnesemia

292
Q

DRI

A

umbrella of nutrient guidelines

293
Q

RDA

A

goals for healthy individuals to prevent nutritional deficiency diseases, includes gender, age, life phases

294
Q

EAR

A

estimated average requirement for 50% of population, used in planning meals for healthy people, assesses group nutritional adequacy

295
Q

AL

A

used when insufficient evidence exists for EAR, RDA

296
Q

UL

A

not associated with adverse side effects in most individuals of a healthy population

297
Q

dietary guidelines for Americans

A

USDA, DHHS
designed to promote health and prevent chronic disease
limit foods and bevs higher in added sugars, saturated fat, and sodium, and limit alcoholic bevs

298
Q

healthy eating index

A

USDA’s overall measure of diet quality

299
Q

myplate plan

A

shows essential food groups and offers recommendations on balancing kcal, foods to increase and foods to reduce

300
Q

healthy people 2030

A

DHHS
national objectives to improve health and well-being over the next decade

301
Q

steps in program planning

A

develop a mission statement
set goals
set objectives
develop plan
budget development

302
Q

direct nutrition outcomes

A

clinical and health status outcomes

303
Q

patient-centered outcomes

A

health care use and cost outcomes

304
Q

health care outcomes

A

of interest to health care providers and payers
health and disease outcomes - reduced readmissions, changes in severity, duration or course of condition or disease
cost outcomes - changes in length of stay, ICU days, etc.
patient centered outcomes - changes in indicators that reflect functional level, QOL

305
Q
A

RDN Exam (14 decks)

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