MNT 1 Flashcards
What is the impairment of language, affecting the production or comprehension of speech and the ability to read or write?
Aphasia
What is difficulty in performing voluntary, purposeful movements?
Apraxia
What is the inability to coordinate muscle activity during voluntary movement?
Therefore clumsy muscle movement occurs.
Ataxia
What is difficult or unclear articulation of speech?
Dysarthia
What is an inability to monitor and/or control one’s emotions? This commonly occurs after a stroke in the right hemisphere of the brain.
Emotional Lability
What is weakness on only one side of the body?
Hemiparesis
What is paralysis on only one side of the body?
Hemipalegia
What is a change that often occurs after a stroke in the RIGHT hemisphere of the brain? Individuals may have difficulty being aware of things to their left due to visual, sensory, or perceptual loss.
Extinction or Innatention
What are three types of CVA and how are they different?
-Ischemic= a blood clot prevents blood reaching the brain.
-Transcient Ischemic= mini stroke where clot is temporary.
-Hemorrhagic= a vessel or artery burst leaking blood onto surrounding tissues.
Two types of Ischemic stroke and explain. What is the treatment for Ischemic stroke?
- Thrombotic (thrombus blocks blood flow)
- Embolic (debris forms in proximal vessel or heart and lodges in between the small brain arteries.
Anticoagulants, tPA, blood thinners
Two types of Hemorrhagic stroke and explain. What is the treatment for Hemorrhagic stroke?
- Intracerebral (blood spills on brain,damages nerves) -motor, sensory, and conscious
2.Subarachnoid (blood spills in between brain and skull)- headache, vomit, unconscious, fatal
Stop antiplatelet and blood thinners, aneurism clipping, embolism coil, restructuring of vessels/arteries
What is the MNT for CVA?
-Initial: NPO, IV fluid
-Dysphagia screening (SPL) prior to eating, drinking or taking po meds
-EN should be started within 7 days of admission ( Initially use nasogastric, PEG if unable to swallow safely within 2-3 weeks)*
-Critical care recs: start EN -24-72 hours
-Food Rec: Kcals from 25-40kcal/ kg, 1.2-1.5 g protein; depending on wt status and loss of lean body mass
-Fluid 30 to 35ml/kg
-DASH, limit salt, high HDL, low LDL, omega-3
What is HIV? How is it spread? Treatment? What does the treatment have to do with MNT?
- Human Immunodeficiency virus attacks the body’s own CD4 cells (T-helper lymphocytes) involved in fighting infection.
- Blood, sexy stuff, boobies, and needles
- HAART (highly active antiretroviral therapy) or ART (antiretroviral therapy)
- Meds cause long term effects on organs and can change anthropometrics—> HALS (HIV associated lipodystrophy)
-Lipohypertrophy= excess fat on belly or hunchback of notre dam
-Lipoatrophy= peripheral fat wasting
RD should maintain wt (1-1.4g/kg PRO) , monitor NTR-med issues, NTR immune support.
What are 4 HIV stages?
- Acute
- Clinical Latency, Chronic
- Symptomatic
- (Or 3.) AIDS
Explain fluid levels according to IDDSI.
0- Thin
1- Slightly thick
2- Mildly thick (Nectar)
3- Moderately thick (Honey)
4- Extremely thick (Pudding)
Explain food levels according to IDDSI.
3- Liquidised
4- Puréed
5- Minced & Moist
6- Soft & Bite-sized
7- Regular
What are changes to the action of the drug caused by a nutrient?
Drug-Nutrient Interaction
What is the effect produced when certain food or beverages are consumed at same time as a drug alter intended response to medicine, cause drug toxicity, and alter normal nutritional status?
Food-Drug Interaction
What is transformation of the cell produced by the interaction of chemicals, radiation or viruses with DNA? The transformation occurs rapidly but the resultant cell remains dormant for variable period of time.
Initiation
What is cells multiply and escape the mechanism set in place to protect the body from growth and spread of such cells? Neoplasm established.
Promotion (2 stage)
What is tumor cells aggregate and grow leading to fully malignant neoplasm or tumor with the capacity for tissue invasion that may eventually spread to distant tissues and organs, known as metastasis?
Progression (last stage)
What tissue is effected with these cancers?
1. Carcinoma
2. Sarcoma
3. Myeloma
4. Leukemia
5. Lymphoma
- Epithelial
- Supportive, connective, bone
- Plasma cells in bone marrow
- Bone marrow
- Gland/node lymphatic
Cancer top risk factors?
Alcohol, smoking, lifestyle, obesity, genetics, processed meats, HCAs, PAHs
Foods that fight cancer?
Tea, cruciferous vegs, Ca+, Vit D, antioxidants, colors
RD and cancer. MNT?
- MONITOR: Tolerances, food/beverage/nutrient intake, textures, meds, access, impaired metabolic fxs
- Energy:
- 30-35kcal/kg/d repletion
- 25-30 kcal/kg/d inactive, non-stressed
- 35kcal/kg/d stressed
PRO:
- 1.2-1.5 g/kg/d wt. loss, malnutrition
- 1.5g/kg/d hematopoietic, cachexia
Fluid:
- 20-40 ml/kg; 1 ml fl/kcal - Supplement:
- ENU 450 calories, 23g PRO,Boost high calorie
What is dry mouth rezsulting from decreased saliva?
Xerostomia
What is the neutropenic diet?
- For ppl with weakened immune systems
- Avoid raw fruits/veggies/unpasteurized, only well cooked meats, safe cooking
What is a complex, multifactorial syndrome characterized by anorexia and/or unintended loss of appetite, accompanied by generalized host tissue wasting, skeletal muscle atrophy, immune dysfunction, and metabolic derangements?
Cancer Cachexia (cancer cachexia anorexia syndrome)
- Inflammatory state, insulin resistance, skeletal muscle wasting due to pro loss and lipolysis
-Precachexia, Cachexia, Refractory cachexia, death
What is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical device?
Pressure Injuruy/ ulcer/wound/bedsore
What is the Braden Scale?
Skin Assesment
1. Sensory perception
2. Moisture
3. Activity
4. Mobility
5. Nutrition
6. Friction and shear
Nutrients and wound healing.
- Homeostasis-blood clotting; protein, energy, Vit K, Vit C (increased req d/t neutrophil increase)
- Inflammation- protein, energy, Vit C, B-complex vitamins
- Proliferation- filling in wound bed; protein, arginine, energy, Vit A,C,E, B complex, Folate, Iron, Zinc, Copper, Selenium, Manganese
- Maturation- protein, energy, ascorbic acid, Vit A
Wound and Supplementation.
1.Vitamin C: Stage I and Stage II ulcers is 100–200 mg/d and in Stage III and Stage IV ulcers is 1000–2000 mg/d; promotes WBC migration to the wound, collagen synthesis, adjust if renal failure
2. Vitamin A: promotes aggregation of monocytes and macrophages
3. Zinc: Whenever clinical signs of zinc deficiency are present, zinc should be supplemented no further than 40 mg of elemental zinc per day (higher can affect copper);Some evidence supports - dose for zinc supplement is 220 mg/d for 10–14 days; cell replication, growth and protein synthesis
4. Arginine: Stimulates release of GH and IGF, which are linked to improved wound healing. Arginine enhances wound strength and collagen deposition. Speed healing (Stage 2 and above ) when nutritional requirements cannot be met with high kcal and protein supplements
5. Glutamine: Amino acid that aids collagen production and supports immune system
6. Ornithine alpha-ketoglutarate: Amino acid derivative that may improve wound healing time and reduce infections; helps body make protein
Pressure Injury Labs.
- PRO: albumin, prealbumin, transferrin, and retinol binding protein
- CBC shows elevated WBC= infection, inflammation
How does severe pancreatitis affect N balance? Glucose metabolism?
AA pulled from muscle for gluconeogenesis. Adequate protein is necessary for + N balance.
High insulin levels due to reduced glucose uptake and accelerated neoglycogenesis.
Mod-severe acute pancreatitis and EN goals?
Early EN is crucial.
-by use decrease bacteria translocation
- prevent deterioration
-EN cheaper than PN
-antioxidant goals
MNT for chronic pancreatitis
-PERT
-Oral suppl (b12, bones) monitor deficiencies
-monitor glycemic index
-Avoid high fiber bc it can reduces pancreatic fx more
-Limit high sat fat
-Antioxidant therapy
What is PERT?
ESPEN Pancreatic Enzyme Replacement Therapy. Contains amylases, proteases, and lipases to provide relief from GI symptoms and improvements in nutritional absorption/status.
Explain NFPE.
Evaluates muscle mass, fat stores, fluid retention, micronutrient deficiencies, and functional capacity.
What is primary source of energy during starvation?
Fat stores.
Muscle wasting in inflammation, describe. Characterized by the loss of bulk and tone, what areas do a NFPE cover concerning muscle mass?
During inflammation, muscle mass is catabolized to provide AA for gluconeogenesis and protein synthesis.
-Temples, clavicles, deltoids, acromion, interosseous muscles, scapula, quads, patellar region, calves
-mild mod severe
What areas do a NFPE cover concerning subcutaneous fat stores?
-Orbital area, triceps, and iliac crest
-mild mod severe
Characterized by edema, ascites, and masking the loss of muscle/ fat/ weight mass, what areas do a NFPE cover concerning fluid retention?
-Ascites can mask fat stores at iliac crest and rib cage.
-Edema= pitting/ non-pitting (0-4+)
Why are hair, eyes, gums, lips, mouth, teeth, tongue, nails, and skin great indicators for vitamins and mineral deficiencies?
These areas have a high cellular-turnover rate so micronutrient deficiencies would rapidly appear here.
