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RD Exam Module > MNT > Flashcards

MNT Flashcards

1
Q

Thiamine Deficiency

A

Wernicke-Korsakoff syndrome- allcoholic liver disease

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2
Q

Diet for hepatic failure

A

If not comatose: 1-1.5 g pro/kg
30-35 kcal/kg
30-35% fat w MCT oil if needed
Adding BCAA and decreasing aromatic amino acids

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3
Q

Cholecystectomy

A

Surgical removal of gall bladder

Bile secreted from liver directly into intestine

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4
Q

Pancreatitis

A

Inflammation with edema

*premature activation of enzymes within pancreas leads to autodigestion

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5
Q

Acute pancreatitis

A

Put pancreas to rest-withhold all feeding,maintain hydration
Progress as tolerated to low fat diet
Elemental enteral nutrition into jejunum may be tolerated

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6
Q

Chronic pancreatitis

A

PERT- pancreatic enzymes orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase
Parenteral B12 and antacids may be needed
To avoid pain: avoid large meals with fatty foods and alcohol

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7
Q

What is cystic fibrosis

A

Disease of exocrine glands- secretion of thick mucus that obstructs glands and ducts
Chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, and malabsorption result

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8
Q

Treatment for cystic fibrosis

A

PERT with meals and snacks
High protein- 15-20% kcal –> malabsorption due to pancreatic deficiency
High kcal- 110-200% of normal needs
Unrestricted fat
Liberal in salt
Age appropriate doses of water soluble vitamins and minerals
Supplement water-soluble forms of fat soluble vitamins

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9
Q

Fat soluble vitamin concern for cystic fibrosis

A

Vitamin a and e

Mostly a-poorly absorbed even with oral enzymes

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10
Q

Normal levels for:
LDL
Total cholesterol
HDL

A

40 (M) >50 (F)

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11
Q

Diet for atherosclerosis

A

Increase complex cho–> body converts cholesterol into bile; thus decreasing cholesterol levels

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12
Q

HTN

A

> 140 systolic- heart in contraction
90 diastolic- in relaxation
Obesity major factor in cause and treatment

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13
Q

Thiazide diuretics

A

May induce hypokalemia

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14
Q

DASH diet

A

Recommended for HTN

Whole grains, fruits and vegetable, low fat dairy, poultry and fish, moderate sodium, limit etoh, decrease sweets

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15
Q

Heart failure

A

Low na as needed (2-3 g) Dash diet, fluid restriction and needed

  1. 2 g pro stable
  2. 37 g pro depleted
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16
Q

High homocysteine levels

A

Independent risk factors for coronary heart disease

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17
Q

Proximal convoluted tubule

A

Major nutrient resorption

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18
Q

Loop of Henle

A

Water and sodium balance

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19
Q

Distal tubule

A

Acid base balance in kidneys

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20
Q

Vasopressin (ADH)

A

Hormone From hypothalamus

Elevates blood pressure

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21
Q

Renin

A

Hormone that acts as vasoconstrictor

Elevates blood pressure

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22
Q

Erythropoietin (EPO)

A

Hormone stimulated by kidney stimulates bone marrow to produce RBC

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23
Q

Renal disease

A

Decreases globular filtration rate and creatinine clearance (Urine tests)
Increases serum creatinine and BUN (blood test)

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24
Q

Renal solute load

A

Solutes exerted in 1 L urine

*mainly measures nitrogen (60%) and sodium

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25
Q

Renal calculi

A

Kidney stones

1.5-2 L of fluid redesign to dilute urine

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26
Q

Calcium oxalate stones

A

Adequate calcium to bind oxaloacetate

Low oxalate diet (dark leafy Greene, chocolate, strawberries, nuts, beets

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27
Q

Uric acid stones

A

Alkaline ash/ acid ash diet
Prevent acidic stones- alkaline ash by adding cations -vegetables fruits
Prevent alkaline stones- create acid ash: increase anions by adding meat

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28
Q

AKI/ acute renal failure

A

Oliguria-urine output <500ml
Azotemia- increase urea in blood
Associated with trauma

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29
Q

Diet therapy for AKI

A

.6-.75 g pro/kg. increase as GFR returns to normal to 1.2-1.5 g/kg
25-35 kcal/kg

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30
Q

Nephrosis symptoms

A

Albuminuria hyperlipidemia

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31
Q

Nephrosis nutrition therapy

A

Protein restriction .8-1.0 g/kg
Fat restriction- ~30%
35 kcal/g
High complex cho

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32
Q

CKD

A

Moderate/ GFR <25 0.6 pro/kg

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33
Q

ESRD

A

Retention of nitrogen metabolizes
HBV protein
Goal: control edema/prevent deficiencies

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34
Q

HD nutrition

A

1.2 g pro/kg
30-35 cal/kg
2-3 g potassium
800-1000 mg phosphorus

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35
Q

Peritoneal dialysis nutrition

A

1.2-1.3 g pro/kg SBW
30-35 kcal/kg
Potassium unrestricted
800-1000 mg phosphorus

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36
Q

Exchanges for starch/bread

A

15 g cho
0-3 g pro
1 or less fat
80 kcal

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37
Q

Exchanges for fruit

A

15 g cho

60 kcal

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38
Q

Exchanges for skim milk

A

12 g cho
8 g pro
0-3 g fat
100 kcal

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39
Q

Exchanges for low-fat milk

A

12 g cho
8 g pro
5 g fat
120 kcal

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40
Q

Exchanges for whole fat milk

A

12 g cho
8 g pro
8 g fat
150 kcal

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41
Q

Exchanges for vegetables

A

5 g cho
2 g pro
25 kcal

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42
Q

Exchanges for lean meat

A

7 g pro
0-3 g fat
45 kcal

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43
Q

Exchanges for medium fat

A

7 g pro
4-7 g fat
75 kcal

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44
Q

Exchanges or high fat meat

A

7 g pro
8+ g fat
100 kcal

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45
Q

Exchange for fat

A

5 g fat

45 kcal

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46
Q

Rapid acting insulin

A

Aspart novolog lispro humalog
Take 5-15 min before eating
Duration 4 hr

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47
Q

Short acting insulin/ regular

A

30-45 minutes before meal
1 unit covers 10-15 g
Duration 3-6 hr

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48
Q

Intermediate a ting insulin NPH

A

Onset 2-4 he
Duration 10-18 hr
Include bedtime snack of cho and protein

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49
Q

Long acting insulin

A

Glargine lantus determir levemir. Onset 2-4 hr. duration 18-24 hr

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50
Q

Insulin secretagogues

Glucotrol

A

Promote insulin secretion

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51
Q

Biguanides/ metformin/ glucophage

A

Enhance insulin action

Supress hepatic glucose production

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52
Q

Thiazolidinediones/ actos

A

Improve peripheral insulin sensititivity

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53
Q

Postprandial or reactive hypoglycemia

A

Overstimulation of pancreas or increase insulin sensitivity; blood glucose falls below normal 2-5 hr after eating

  • goal is to prevent marked rise in blood glucose that would stimulate more insulin
  • avoid simple sugars/ 5/6 small meals a day and spread cho throughout day
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54
Q

Addison’s disease

A

Absence of adrenal hornones
Hypoglycemia sodium loss and tissue wasting
Diet: High pro frequent feelings high salt

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55
Q

Hyperthyroidism

A

Elevated t3 and t4
Increased BMR leading to weight loss
Diet-increase kcal

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56
Q

Hypothyroidism

A

T4 low, t3 normal
Decreased BMR leading to weight gain
Diet: weight reduction

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57
Q

Endemic goiter

A

Inadequate iodine intake

Diet: iodized salt, free of goiteogens (cabbage family)

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58
Q

Galactosemia

A

Missing enzyme that would have converted galactose-1-PO4 into glucose-1-PO4
treated solely by diet- galactose and lactose free
**no drugs
No organ meats MSG extenders milk whey casein curds dates bell peppers

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59
Q

Urea cycle defects

A

Unable to synthesiZe urea from ammonia
Ammonia accumulation
Diet: protein restriction to lower ammonia

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60
Q

PKU

A

Missing enzyme- phenylalanine hydroxylase- which would convert phenylalanine into tyrosine
Diet: low in phenylalanine, avoid aspartame
Need for phenylalanine decreases with age and infection

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61
Q

Glycogen storage disease

A

Deficiency if go oar 6 phosphatase in liver
Impairs gluconeogenesis and glycogenolysis
Liver can’t convert glycogen ito glucose leading to hypoglycemia

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62
Q

Homocystinurias

A

Treatable Inherited disorder of amino acid metabolism
High excretion of homocysteine in urine
Treat with folate, pyridoxine (B6) and B12

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63
Q

Maple syrup urine disease

A

Error of metabolism of the BCAA leucine, isoleucine, valine
-restrict BCAA 45-62 mg/day
Avoid eggs neat nuts other dairy products

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64
Q

Systemic lupus erythematosus

A

May have anemia but doesn’t correlate with diet intake

May show symptoms of celiacs disease

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65
Q

Osteoporosis

A

Highest risk old Caucasian women

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66
Q

Osteomalacia

A

Adult rickets

Vitamin d deficiency

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67
Q

Epilepsy

A

Seizures
Anticonvulsants interfere with ca absorption
May need supplements of vitamin D, calcium, and thiamine
Provide phenytoin separate from meals
*ketogenic diet 4:1- ketones prevent seizures
*supplements of Ca, D, folate, B6, B12

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68
Q

Cerebral palsy

A

In non spastic/ athetoid form- high kcal high pro diet, * finger foods *

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69
Q

Feingold diet

A

No salicylates, artificial colorings and flavors
Used for ADHD
Efficacy not proven

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70
Q

Alzheimer’s disease

A

Avoid distractions

May need verbal cues to chew and swallow

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71
Q

Microcytic/ hypochromic anemia

A

Small,pale cells; due to iron deficiency

Low MCV and MCH

72
Q

Macrocytic/ megaloblastic anemia

A 
Few large cells 
Due to deficiency of folate or vitamin b12
Schilling test for pernicious anemia
High MCV and MCH
Filled with hemoglobin
73
Q

Normal range of MCV/ mean corpuscular volume

A

80-95 fL

74
Q

Normal range for MCH/ mean corpuscular hemoglobin

A

27-32 ph

75
Q

Most common food allergins

A

Peanuts eggs milk soy wheat shellfish
Cows milk protein for infants
Introduce eggs at 24 months and fish at 36 months

76
Q

Food least likely to cause allergy

A

Rice

77
Q

Fever and infection

A

In feedings progressed to high kcal high fluids

BMR increases 7% for each degree in F

78
Q

Burns

A

BMR rises 50-100%
Replace fluids and electrolytes first
Increase kcal and protein

79
Q

Ebb and flow response to injury

A

Hypermetabolic
Results hyperglycemia andhyperinsulemia
Catecholamines: epinephrine norepinephrine- hepatic glycogenolysis
Fluid and sodium retention

80
Q

Methotrexate

A

Chemotherapeutic agent that is an anti-folate drug

81
Q

Kwashiorkor

A

Protein deficiency

High mortality rate

82
Q

Marasmus

A

Protein and calorie starvation
Patient looks starved
No edema and serum albumin normal
Arm circumference decreased

83
Q

Iatrogenic malnutrition

A

Protein calorie malnutrition brought on by treatment, hospital, medication

84
Q

Anorexia nervous diet therapy

A

Regular mealtimes
Varied moderate intake
Gradually introduce feared foods
Plan with patient

85
Q

Bulimia

A

Gorging and purging

Damage to teeth throat esophagus and rectal bleeding

86
Q

Kcal in lb

A

3500 kcal in a pound
1 lb per week- decrease of 500 per day
Most initial weight loss is water

87
Q

When dieter reaches plateau

A

BMR has dropped

Increase exercise

88
Q

Healthy obese

A

Elevated LDL

Normal to low HDL

89
Q

Prader Willi syndrome

A

Obesity and ftt
No sense of satiety
Control access to food

90
Q

Dental caries

A

6 cheese, nuts, meat
Sugar alcohols do jot promote tooth decay
Cariogenic: peanut butter and potato chips

91
Q

Stomatitis

A

Inflammation of mouth associated with riboflavin deficiency

Avoid very hot vey cold foods and spices or sour/tart foods

92
Q

Achalasia

A

Disorder of lower esophageal sphincter: doesn’t relax upon swallowing
Causes dysphasia
Start with puréed moist thick foods and progress to thick liquids

93
Q

Pregnancy induced hypertension PIH

A

20th week
Edema
Sodium restriction not recommended

94
Q

Hyperemesis gravidarum

A

Severe nausea during pregnancy

Bed rest

95
Q

AIDS

A

Diarrhea weight loss
Preserve lean body mass
High kcal high protein
May need neutropenia diet- avoid raw foods

96
Q

COPD

A

Obstruction of airflow through lungs

Replete, but do NOT overfeed

97
Q

ARDS

A

No lifer able to exchange gases in lungs

Goal:maintain stable weight

98
Q

Lecithin in TF

A

May be added as emulsifier

99
Q

Modular enteral nutrition

A

Mix individual components

Adds flexibility

100
Q

Blenderized TF

A

Requires large bore tube

101
Q

Least expensive formulas

A

Intact protein

Isotonic- ph similar to blood

102
Q

Elemental formula

A 
Used with malabsorption
Predigested protein or amino acids
Glucose or sucrose
Small fat
Vitamins minerals and electrolytes
103
Q

Transpyloric tube

A

Passed by pyloric valve in stomach

Used in comatose patients or ones with no gag reflex

104
Q

Water requirements for TF

A

1 ml/kcal

105
Q

Open formulas

A

Throw away after 24 hrs to reduce bacterial contamination

106
Q

IV dextrose

A

3.4 kcal/g

107
Q

IVFE intravenous fat emulsion

A

10%- 1.1 kcal/cc

20%- 2.0 kcal/cc

108
Q

PN parenteral nutrition

A

Achieve anabolic state when patients are unable to eat by mouth and enteral feeding is not possible

109
Q

When to use PN

A

Altered GI tract function, inability to absorb nutrients, malabsorption, diffuse peritonitis, obstruction, short bowel syndrome, situ las, acute pancreatitis

110
Q

Concern of PN

A

Translocation of bacteria- not feeding through gut allows wall breakdown; bacteria move out causing sepsis

111
Q

Protein solution PN

A

Ratio for anabolism is 1 gm nitrogen/ 150 kcal
1-1.6 G protein/kg/day
%- g of protein in 100 ml of solution

112
Q

Maximum dextrose rate

A

Shouldn’t exceed 4-5 mg/kg/minute to prevent hyperglycemia

113
Q

To prevent EFAD

A

Give 500 cc of 10% fat emulsion 1-2x/week

Symptoms of EFAD- petechiae (red spots)

114
Q

Transitional feeding

A

Introduce minimal amount of enteral feeding at low rate to establish GI tolerance and increase slowly
Decrease PN as EN increases
* once pt can tolerate about 75% of needs by enteral route, DC PN

115
Q

Redesign syndrome

A

Results in hypokalemia hypophosphatemia and hypomagnesemia

116
Q

EAR

A

Estimated requirement for 50% of population

117
Q

AI

A

Adequate intake- used when insufficient evidence exists for EAR and RDA

118
Q

UL

A

Tolerable upper level not associated with adverse side effects

119
Q

Tables of food composition

A

Calculate intake of nutrients

Data comes from USDA

120
Q

2010 dietary guidelines of Americans

A

Designed to prevent chronic Israel

Written by USDA and HHS

121
Q

My plate

A

1/2 plate fruits and vegetables
1/2 grains whole
Use skim or 1% fat milk
Vary protein choices

122
Q

Healthy eating index

A

USDA overall measure of diet quality

5 food groups, 4 nutrients, fat sat fat cholesterol sodium, variety

123
Q

Healthy people

A

Written by HHS
Identifies broad goals and specific objectives fr improving health
Prevention by changing behaviors

124
Q

Goal vs. objective

A

Goal: broad direction general purpose: fewer deaths
Objective: more specific

125
Q

Southeast Asians

A

Pork, very few dairy products

126
Q

Kosher

A

No meat as dairy at same meal
No pork
No shellfish

127
Q

Chinese

A

Yin foods: dark, cold- fish, vegetables, fruits

Yang foods: bright, hot- hot soup from chicken

128
Q

Seventh day Adventist

A

Ovolactovegetarian, no caffeine

129
Q

Central ameri an Hispanic and Latin

A

Fruits vegetable meat poultry fish

130
Q

Advantage if vegetarian

A

Low fat

High fiber

131
Q

Vegan may lack

A

Cyanocobalmin

Include b12 fortified breakfast cereal or soy beverages

132
Q

Third party reimbursement

A

Payment by a third party for service rendered by a health care provider to a patient
Ex. Blue cross or Medicare

133
Q

DRG

A

Diagnostic related groupings
Hospitals paid specific amount per patient based on diagnosis
Length if stay not considered when determining payment

134
Q

Legislators

A

May Introduce and enact laws

Consist of congressman senators and representatives

135
Q

Executive branch

A

May sign or veto a law

136
Q

Judiciary

A

May discard law in violation of rights and freedoms

137
Q

Where nutritionist and express their cases

A

Public hearing scheduled by committee or in early planning stages of bill

138
Q

If house and senate are offered different versions of a bill

A

It goes in front of a joint conference committee

139
Q

Appropriations bill

A

Attaches funding to legislation

140
Q

FTC

A

Enforces truth in labeling laws and regulated the content of food advertisements

141
Q

FDA

A

Regulates nutrient composition section of label and ensures safety of domestic and imported foods

142
Q

FCC

A

Licenses radio and television services

143
Q

Federal register

A

Lists public hearings, agency decisions, final rules

Ex. Lists USDA changes in food programs

144
Q

School breakfast program

A

Requires breakfast

Meet 1/4 of dietary guidelines

145
Q

Child and adult care feeding programs

A

Provides daily snacks to daycare facilities

146
Q

National school lunch program

A

Designed to improve nutrition of children
Especially low income families
UtiLize surplus food production
Must meet 1/3 of recommendations

147
Q

Team nutrition

A

Helps schools meet guidelines

148
Q

USDAs food distribution program

A

Provides foods to help meet nutritional needs of children and adults
Strengthens agricultural market for American farmers

149
Q

Nutrition assistance programs offered by goverment

A

Temporary assistance for needy families program

States determine eligibility and benefits and services they will receive

150
Q

Commodity supplemental food program

A

HAs nutritional risk guidelines

151
Q

WIC

A

Administered by USDA
Not an entitlement program
Provides food for low income mothers at nutritional risk
Musically based and dietary based parameters
Health exam required

152
Q

EFNEP extension food ad nutrition education program

A

Provides grants to universities that assist in community development
Trains nutrition aids to educate public
All education- no food
Works with small groups- teaches people to shop and cook

153
Q

Maternal and child health block grant

A

By DHHS
Only federal program concerned with infants pregnant women as children
State eligibility requirements

154
Q

Healthy start program

A

Funded by DHHS funds areas with high infant mortality rates

155
Q

Elderly nutrition program

A

HHS
One hit meal each day 5 days a week providing 1/3 recommended intake
Eligibility: over 60 no income required

156
Q

Meals on wheels

A

Must be homebound

157
Q

Medicare

A

HHS
Anyone over 65
Any age with ESRD

158
Q

Medicaid

A

HHS
Federal law administered by states
For all eligible needy

159
Q

Headstart

A

HHS

Low Income children ages 3-5

160
Q

5 federal block grant areas

A

Maternal and child health, community services, social services, preventative health services, primary care

161
Q

CDC STEPS

A

Major federal level grant
Steps to healthier US focused in community based health initiatives related to obesity
Direct funds address asthma, obesity, and DM prevention

162
Q

Stages of change model

A 
Pre contemplation
Contemplation
Preparation
Action
Maintenance
163
Q

Health belief model

A

Explain why people, especially high risk people, fail to participate in programs designed to detect or prevent disease

164
Q

Diffusion of Innovation

A

A process by which an innovation, an idea, or behavior spreads
Tailor intervention to where they are In process

165
Q

Primary prevention

A

Reduced exposure to promoter of disease

Early screening of risk factors

166
Q

Secondary prevention

A

Recruiting those with elevated risk factors Into treatment program
Setting up an employee gym

167
Q

Tertiary intervention

A

As disease progresses, intervention to reduce severity

168
Q

Goals vs objectives

A

Goal- broad direction

Objectives- specific and measurable

169
Q

Guidelines for writing objectives

A

Action verb
Include who what behavior when where
Not: appreciate/ understand

170
Q

Budget development

A

Controls and coordinates activities

171
Q

Performance budget

A

Summarizes program activities performed in terms of the cost specific accomplishments
Ed
X. What it cost to supervise a food bank or screen 200 children of anemia

172
Q

Implementation requires:

A

Administrative support, realistic budget, staff commitment, support of target popularion

173
Q

4 ps of marketing

A

Product should be acceptable, place accessible, prose reasonable, and promotion tailored

174
Q

Nutrition monitoring

A

Review or measurement f a selected nutrition care indicator

175
Q

Nutrition evaluation

A

Compares findings with goals or standards. Determines degree to which progress is being made and outcomes are being met

176
Q

PCHM

A

Patient centered medical home
Physician takes responsibility for all aspects of health care and coordinate and communicates with other providers as needed

RD Exam Module (1 decks)

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