MNT Flashcards
Thiamine Deficiency
Wernicke-Korsakoff syndrome- allcoholic liver disease
Diet for hepatic failure
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
Cholecystectomy
Surgical removal of gall bladder
Bile secreted from liver directly into intestine
Pancreatitis
Inflammation with edema
*premature activation of enzymes within pancreas leads to autodigestion
Acute pancreatitis
Put pancreas to rest-withhold all feeding,maintain hydration
Progress as tolerated to low fat diet
Elemental enteral nutrition into jejunum may be tolerated
Chronic pancreatitis
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
What is cystic fibrosis
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
Treatment for cystic fibrosis
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
Fat soluble vitamin concern for cystic fibrosis
Vitamin a and e
Mostly a-poorly absorbed even with oral enzymes
Normal levels for:
LDL
Total cholesterol
HDL
40 (M) >50 (F)
Diet for atherosclerosis
Increase complex cho–> body converts cholesterol into bile; thus decreasing cholesterol levels
HTN
> 140 systolic- heart in contraction
90 diastolic- in relaxation
Obesity major factor in cause and treatment
Thiazide diuretics
May induce hypokalemia
DASH diet
Recommended for HTN
Whole grains, fruits and vegetable, low fat dairy, poultry and fish, moderate sodium, limit etoh, decrease sweets
Heart failure
Low na as needed (2-3 g) Dash diet, fluid restriction and needed
- 2 g pro stable
- 37 g pro depleted
High homocysteine levels
Independent risk factors for coronary heart disease
Proximal convoluted tubule
Major nutrient resorption
Loop of Henle
Water and sodium balance
Distal tubule
Acid base balance in kidneys
Vasopressin (ADH)
Hormone From hypothalamus
Elevates blood pressure
Renin
Hormone that acts as vasoconstrictor
Elevates blood pressure
Erythropoietin (EPO)
Hormone stimulated by kidney stimulates bone marrow to produce RBC
Renal disease
Decreases globular filtration rate and creatinine clearance (Urine tests)
Increases serum creatinine and BUN (blood test)
Renal solute load
Solutes exerted in 1 L urine
*mainly measures nitrogen (60%) and sodium
Renal calculi
Kidney stones
1.5-2 L of fluid redesign to dilute urine
Calcium oxalate stones
Adequate calcium to bind oxaloacetate
Low oxalate diet (dark leafy Greene, chocolate, strawberries, nuts, beets
Uric acid stones
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
AKI/ acute renal failure
Oliguria-urine output <500ml
Azotemia- increase urea in blood
Associated with trauma
Diet therapy for AKI
.6-.75 g pro/kg. increase as GFR returns to normal to 1.2-1.5 g/kg
25-35 kcal/kg
Nephrosis symptoms
Albuminuria hyperlipidemia
Nephrosis nutrition therapy
Protein restriction .8-1.0 g/kg
Fat restriction- ~30%
35 kcal/g
High complex cho
CKD
Moderate/ GFR <25 0.6 pro/kg
ESRD
Retention of nitrogen metabolizes
HBV protein
Goal: control edema/prevent deficiencies
HD nutrition
1.2 g pro/kg
30-35 cal/kg
2-3 g potassium
800-1000 mg phosphorus
Peritoneal dialysis nutrition
1.2-1.3 g pro/kg SBW
30-35 kcal/kg
Potassium unrestricted
800-1000 mg phosphorus
Exchanges for starch/bread
15 g cho
0-3 g pro
1 or less fat
80 kcal
Exchanges for fruit
15 g cho
60 kcal
Exchanges for skim milk
12 g cho
8 g pro
0-3 g fat
100 kcal
Exchanges for low-fat milk
12 g cho
8 g pro
5 g fat
120 kcal
Exchanges for whole fat milk
12 g cho
8 g pro
8 g fat
150 kcal
Exchanges for vegetables
5 g cho
2 g pro
25 kcal
Exchanges for lean meat
7 g pro
0-3 g fat
45 kcal
Exchanges for medium fat
7 g pro
4-7 g fat
75 kcal
Exchanges or high fat meat
7 g pro
8+ g fat
100 kcal
Exchange for fat
5 g fat
45 kcal
Rapid acting insulin
Aspart novolog lispro humalog
Take 5-15 min before eating
Duration 4 hr
Short acting insulin/ regular
30-45 minutes before meal
1 unit covers 10-15 g
Duration 3-6 hr
Intermediate a ting insulin NPH
Onset 2-4 he
Duration 10-18 hr
Include bedtime snack of cho and protein
Long acting insulin
Glargine lantus determir levemir. Onset 2-4 hr. duration 18-24 hr
Insulin secretagogues
Glucotrol
Promote insulin secretion
Biguanides/ metformin/ glucophage
Enhance insulin action
Supress hepatic glucose production
Thiazolidinediones/ actos
Improve peripheral insulin sensititivity
Postprandial or reactive hypoglycemia
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
Addison’s disease
Absence of adrenal hornones
Hypoglycemia sodium loss and tissue wasting
Diet: High pro frequent feelings high salt
Hyperthyroidism
Elevated t3 and t4
Increased BMR leading to weight loss
Diet-increase kcal
Hypothyroidism
T4 low, t3 normal
Decreased BMR leading to weight gain
Diet: weight reduction
Endemic goiter
Inadequate iodine intake
Diet: iodized salt, free of goiteogens (cabbage family)
Galactosemia
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
Urea cycle defects
Unable to synthesiZe urea from ammonia
Ammonia accumulation
Diet: protein restriction to lower ammonia
PKU
Missing enzyme- phenylalanine hydroxylase- which would convert phenylalanine into tyrosine
Diet: low in phenylalanine, avoid aspartame
Need for phenylalanine decreases with age and infection
Glycogen storage disease
Deficiency if go oar 6 phosphatase in liver
Impairs gluconeogenesis and glycogenolysis
Liver can’t convert glycogen ito glucose leading to hypoglycemia
Homocystinurias
Treatable Inherited disorder of amino acid metabolism
High excretion of homocysteine in urine
Treat with folate, pyridoxine (B6) and B12
Maple syrup urine disease
Error of metabolism of the BCAA leucine, isoleucine, valine
-restrict BCAA 45-62 mg/day
Avoid eggs neat nuts other dairy products
Systemic lupus erythematosus
May have anemia but doesn’t correlate with diet intake
May show symptoms of celiacs disease
Osteoporosis
Highest risk old Caucasian women
Osteomalacia
Adult rickets
Vitamin d deficiency
Epilepsy
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
Cerebral palsy
In non spastic/ athetoid form- high kcal high pro diet, * finger foods *
Feingold diet
No salicylates, artificial colorings and flavors
Used for ADHD
Efficacy not proven
Alzheimer’s disease
Avoid distractions
May need verbal cues to chew and swallow
Microcytic/ hypochromic anemia
Small,pale cells; due to iron deficiency
Low MCV and MCH
Macrocytic/ megaloblastic anemia
Few large cells Due to deficiency of folate or vitamin b12 Schilling test for pernicious anemia High MCV and MCH Filled with hemoglobin
Normal range of MCV/ mean corpuscular volume
80-95 fL
Normal range for MCH/ mean corpuscular hemoglobin
27-32 ph
Most common food allergins
Peanuts eggs milk soy wheat shellfish
Cows milk protein for infants
Introduce eggs at 24 months and fish at 36 months
Food least likely to cause allergy
Rice
Fever and infection
In feedings progressed to high kcal high fluids
BMR increases 7% for each degree in F
Burns
BMR rises 50-100%
Replace fluids and electrolytes first
Increase kcal and protein
Ebb and flow response to injury
Hypermetabolic
Results hyperglycemia andhyperinsulemia
Catecholamines: epinephrine norepinephrine- hepatic glycogenolysis
Fluid and sodium retention
Methotrexate
Chemotherapeutic agent that is an anti-folate drug
Kwashiorkor
Protein deficiency
High mortality rate
Marasmus
Protein and calorie starvation
Patient looks starved
No edema and serum albumin normal
Arm circumference decreased
Iatrogenic malnutrition
Protein calorie malnutrition brought on by treatment, hospital, medication
Anorexia nervous diet therapy
Regular mealtimes
Varied moderate intake
Gradually introduce feared foods
Plan with patient
Bulimia
Gorging and purging
Damage to teeth throat esophagus and rectal bleeding
Kcal in lb
3500 kcal in a pound
1 lb per week- decrease of 500 per day
Most initial weight loss is water
When dieter reaches plateau
BMR has dropped
Increase exercise
Healthy obese
Elevated LDL
Normal to low HDL
Prader Willi syndrome
Obesity and ftt
No sense of satiety
Control access to food
Dental caries
6 cheese, nuts, meat
Sugar alcohols do jot promote tooth decay
Cariogenic: peanut butter and potato chips
Stomatitis
Inflammation of mouth associated with riboflavin deficiency
Avoid very hot vey cold foods and spices or sour/tart foods
Achalasia
Disorder of lower esophageal sphincter: doesn’t relax upon swallowing
Causes dysphasia
Start with puréed moist thick foods and progress to thick liquids
Pregnancy induced hypertension PIH
20th week
Edema
Sodium restriction not recommended
Hyperemesis gravidarum
Severe nausea during pregnancy
Bed rest
AIDS
Diarrhea weight loss
Preserve lean body mass
High kcal high protein
May need neutropenia diet- avoid raw foods
COPD
Obstruction of airflow through lungs
Replete, but do NOT overfeed
ARDS
No lifer able to exchange gases in lungs
Goal:maintain stable weight
Lecithin in TF
May be added as emulsifier
Modular enteral nutrition
Mix individual components
Adds flexibility
Blenderized TF
Requires large bore tube
Least expensive formulas
Intact protein
Isotonic- ph similar to blood
Elemental formula
Used with malabsorption Predigested protein or amino acids Glucose or sucrose Small fat Vitamins minerals and electrolytes
Transpyloric tube
Passed by pyloric valve in stomach
Used in comatose patients or ones with no gag reflex
Water requirements for TF
1 ml/kcal
Open formulas
Throw away after 24 hrs to reduce bacterial contamination
IV dextrose
3.4 kcal/g
IVFE intravenous fat emulsion
10%- 1.1 kcal/cc
20%- 2.0 kcal/cc
PN parenteral nutrition
Achieve anabolic state when patients are unable to eat by mouth and enteral feeding is not possible
When to use PN
Altered GI tract function, inability to absorb nutrients, malabsorption, diffuse peritonitis, obstruction, short bowel syndrome, situ las, acute pancreatitis
Concern of PN
Translocation of bacteria- not feeding through gut allows wall breakdown; bacteria move out causing sepsis
Protein solution PN
Ratio for anabolism is 1 gm nitrogen/ 150 kcal
1-1.6 G protein/kg/day
%- g of protein in 100 ml of solution
Maximum dextrose rate
Shouldn’t exceed 4-5 mg/kg/minute to prevent hyperglycemia
To prevent EFAD
Give 500 cc of 10% fat emulsion 1-2x/week
Symptoms of EFAD- petechiae (red spots)
Transitional feeding
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
Redesign syndrome
Results in hypokalemia hypophosphatemia and hypomagnesemia
EAR
Estimated requirement for 50% of population
AI
Adequate intake- used when insufficient evidence exists for EAR and RDA
UL
Tolerable upper level not associated with adverse side effects
Tables of food composition
Calculate intake of nutrients
Data comes from USDA
2010 dietary guidelines of Americans
Designed to prevent chronic Israel
Written by USDA and HHS
My plate
1/2 plate fruits and vegetables
1/2 grains whole
Use skim or 1% fat milk
Vary protein choices
Healthy eating index
USDA overall measure of diet quality
5 food groups, 4 nutrients, fat sat fat cholesterol sodium, variety
Healthy people
Written by HHS
Identifies broad goals and specific objectives fr improving health
Prevention by changing behaviors
Goal vs. objective
Goal: broad direction general purpose: fewer deaths
Objective: more specific
Southeast Asians
Pork, very few dairy products
Kosher
No meat as dairy at same meal
No pork
No shellfish
Chinese
Yin foods: dark, cold- fish, vegetables, fruits
Yang foods: bright, hot- hot soup from chicken
Seventh day Adventist
Ovolactovegetarian, no caffeine
Central ameri an Hispanic and Latin
Fruits vegetable meat poultry fish
Advantage if vegetarian
Low fat
High fiber
Vegan may lack
Cyanocobalmin
Include b12 fortified breakfast cereal or soy beverages
Third party reimbursement
Payment by a third party for service rendered by a health care provider to a patient
Ex. Blue cross or Medicare
DRG
Diagnostic related groupings
Hospitals paid specific amount per patient based on diagnosis
Length if stay not considered when determining payment
Legislators
May Introduce and enact laws
Consist of congressman senators and representatives
Executive branch
May sign or veto a law
Judiciary
May discard law in violation of rights and freedoms
Where nutritionist and express their cases
Public hearing scheduled by committee or in early planning stages of bill
If house and senate are offered different versions of a bill
It goes in front of a joint conference committee
Appropriations bill
Attaches funding to legislation
FTC
Enforces truth in labeling laws and regulated the content of food advertisements
FDA
Regulates nutrient composition section of label and ensures safety of domestic and imported foods
FCC
Licenses radio and television services
Federal register
Lists public hearings, agency decisions, final rules
Ex. Lists USDA changes in food programs
School breakfast program
Requires breakfast
Meet 1/4 of dietary guidelines
Child and adult care feeding programs
Provides daily snacks to daycare facilities
National school lunch program
Designed to improve nutrition of children
Especially low income families
UtiLize surplus food production
Must meet 1/3 of recommendations
Team nutrition
Helps schools meet guidelines
USDAs food distribution program
Provides foods to help meet nutritional needs of children and adults
Strengthens agricultural market for American farmers
Nutrition assistance programs offered by goverment
Temporary assistance for needy families program
States determine eligibility and benefits and services they will receive
Commodity supplemental food program
HAs nutritional risk guidelines
WIC
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
EFNEP extension food ad nutrition education program
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
Maternal and child health block grant
By DHHS
Only federal program concerned with infants pregnant women as children
State eligibility requirements
Healthy start program
Funded by DHHS funds areas with high infant mortality rates
Elderly nutrition program
HHS
One hit meal each day 5 days a week providing 1/3 recommended intake
Eligibility: over 60 no income required
Meals on wheels
Must be homebound
Medicare
HHS
Anyone over 65
Any age with ESRD
Medicaid
HHS
Federal law administered by states
For all eligible needy
Headstart
HHS
Low Income children ages 3-5
5 federal block grant areas
Maternal and child health, community services, social services, preventative health services, primary care
CDC STEPS
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
Stages of change model
Pre contemplation Contemplation Preparation Action Maintenance
Health belief model
Explain why people, especially high risk people, fail to participate in programs designed to detect or prevent disease
Diffusion of Innovation
A process by which an innovation, an idea, or behavior spreads
Tailor intervention to where they are In process
Primary prevention
Reduced exposure to promoter of disease
Early screening of risk factors
Secondary prevention
Recruiting those with elevated risk factors Into treatment program
Setting up an employee gym
Tertiary intervention
As disease progresses, intervention to reduce severity
Goals vs objectives
Goal- broad direction
Objectives- specific and measurable
Guidelines for writing objectives
Action verb
Include who what behavior when where
Not: appreciate/ understand
Budget development
Controls and coordinates activities
Performance budget
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
Implementation requires:
Administrative support, realistic budget, staff commitment, support of target popularion
4 ps of marketing
Product should be acceptable, place accessible, prose reasonable, and promotion tailored
Nutrition monitoring
Review or measurement f a selected nutrition care indicator
Nutrition evaluation
Compares findings with goals or standards. Determines degree to which progress is being made and outcomes are being met
PCHM
Patient centered medical home
Physician takes responsibility for all aspects of health care and coordinate and communicates with other providers as needed
