MNT Flashcards
Ulcer: what
eroded mucosal lesion
Ulcer: txt
antacids, antibiotics to treat h.pylori
Ulcer: diet
as tolerated
avoid spicy, etoh, caff
Hiatal hernia: what, diet
some stomach above diaphragm
small, bland feedings
Dumping syndrome: what
rapidly hydrolyzed cho enters jejunum water enters for osmotic balance low blood pressure cho apsorbed and insulin pumped quickly hypoglycemia
Dumping syndrome: when
after bowel resection
Dumping syndrom: diet
small, dry feedings with pro and moderate fat
liquids before/after meal
no hypertonic sweets
Bowel resections (2)
Bilroth I - stomach to duodenum
Bilroth II - stomach to jejunum
Bilroth 2: nutrients of concern
Ca - low, most uptake in duodenum
Iron - low, needs acid
B12 - low, no intrinsic factor
Folate - low, needs B12 to get into cells
Deficiencies after complete gastrectomy
Iron B12 Folate Ca D B1 Copper
Test for B12 deficiency
Schilling
Pernicious anemia
due to low intrinsic factor and bacteria overgrowth
Gastroparesis: what, when
delayed gastric empty
after sx, diabetes, obstruction
Gastroparesis: txt
pro kinetics: erythromycin, metoclopramide
Gatroparesis: diet
small, frequent meals
no high fiber or fat
Celiac: what
reaction to gliadin affecting jejunum and ileum
Celiac: avoid
WROB, bran, graham, malt, bulgur, couscous, orzo, thickening agents
Celiac: ok
corn, potato, rice, soybean
Celiac: nutrition outcomes
anemia, diarrhea, wt loss, steatorrhea, malabsorption (low ADEK)
Diverticulosis: what
presence of mucosal sacs in intestinal wall due to structure weakness
Diverticulosis: diet
high fiber
Diverticulitis: what
inflammation of sacs
Diverticulitis: diet
clear liquids, gradual return to high fiber
Inflammatory bowel disease types
Crohn’s disease - ileum
Ulcerative colitis - colon
Crohn’s Deficiencies
B12 deficiency, iron deficiency
Symptoms of UC
bloody diarrhea, wt loss. electrolyte imbalances, neg nitrogen balance
Inflammatory bowel disease diet
energy according to BMI restrict fat if steatorrhea Ca, Mg, Zn supplement fat may improve energy balance Pro at each meal
Best multivitamin in Inflammatory bowel disease?
chewable
Irritable bowel syndrome: goals, recommendations
adequate intake with no flare ups
specific to GI issues
food diary to track intake, emotions, symptoms
Lactose intolerance test
oral lactose load
test glucose: if under 25mg/dl then lactose intolerant
Lactose intolerant diet
no animal milk, products, or whey
Lactose intolerant supplement
Ca and riboflaven
Pediatric diarrhea: treatment
agressive rehydration and electrolyte replacement
Causes for pediatric diarrhea
low fat diet
too many fluids
Chronic pediatric diarrhea recommendations
40% of energy from fat
restrict/dilute fruit juice
Steatorrhea test
check stool fat
normal is 2-5g
>7 g means malabsorption
SBS: loss of jejunum?
ileum can adapt
SBS: loss of ileum complications
decreased B12, intrinsic factor, bile salts ->
fat malabsorption, ADEK, Ca, Zn, Mg (makes soaps)
Colonic absorption of oxalate – stones
SBS: loss of colon complications
loss of water, electrolytes, no colonic salvage
How much water does SBS need?
If ileum resected, need 1 liter more than ostomy output
SBS: nutrition care process
parenteral to enteral early to promote intestinal lining growth
Ileal resection diet, supplement
limit fat, use MCT
Supplement ADEK, Ca, Mg, Zn, B12
Liver functions
store and release blood
filter blood
metabolism and storage of nutrients
fluid and electrolytes
If liver enzymes in blood are high?
liver damage
Liver enzyme levels
AST - 35
ALT - 36
ALP - 120
if above = liver damage
Which hepatitis is most associated with food?
HAV, fecal-oral, oysters danger
Hepatitis diet
fluids 50-55% CHO (protein sparing) 1 - 1.2 G protein restrict fat in steatorrhea small frequent feedings (anorexia) 2gm Na if fluid retention
Cirrhosis: what
damage to liver tissue with connective tissue redirecting blood
When blood cannot leave the liver
ascites blood build up in liver when full, plasma moves to peritoneal plasma pulls in water Na and water retention
When blood cannot enter liver
Varices
blood backs up in portal vein and into collateral veins
enlarge, bleed
Cirrhosis diet
.8-1.2 protein
25-35 kcal
MCT if needed
low fat if malabsorption
Varices diet
low fiber
Ascites diet
low sodium
Alcoholic liver disease: what
hydrogen replace fat as fuel
fat accumulates in liver
Alcoholic liver disease: supplement what?
thiamin, folic acid
Alcohol increases the excretion of what?
Magnesium
ESLD: name, s/s
end stage liver disease
liver less than 25% function
ammonia no longer converted to urea
ESLD: diet
low sodium with ascites
moderate-high protein 1-1.5
Modest protein if sensitive or hepatic encephalopathy
NAFLD: name, risk factors
nonalcoholic fatty liver disease
usually >35 BMI, T2DM, Met syndrome
NAFLD: txt
SLOW wt loss to not increase tag to liver
Med diet, moderate alcohol, coffee as antioxidant, PA 150/week
Can liver regenerate in alcoholic liver disease?
only with good nutrition and no etoh
Pancreatitis: what, enzyme activity?
inflammation of pancreas due to blockage or reflux
activation of digestive enzymes too early
Acute Pancreatitis: diet
as tolerated, slow on fat
elemental formula to jejunum if needed
Chronic Pancreatitis: diet
PERT with meals and snack
MCT (does not need lipase from pancreas)
Antacids
Cystic Fibrosis: what
thick mucus obstructs glands, enzyme deficiency, malab
Cystic fibrosis: diet
PERT, liberal protein, calorie, fat, salt
Cystic fibrosis: supplement
water soluble form of A and E
Zinc
Blood pressure cutoff
over 120 elevated
over 130 stage 1
over 140 stage 2
CVD salt restriction
1500-2300 mg
Med diet rich in…
a-linolenic
monounsaturated
Atherosclerosis:what
accumulation of lipids
structural changes in arteries
Lipoprotein risk
LDL-c - small, dense, responsive to diet
Metabolic syndrome
- insulin resistance AND 3 of the following
- BP over 130
- TG over 150
- Fasting glucose over 100
- Waist over 40/35
- HDL under 40/50
Cholesterol risk
Keep
LDL-C under 100
Total chol under 200
HDL above 40/50 (over 60 is high)
Therapeutic Lifestyle Change (TLC) diet - fat recommendations
35% kcal from fat <7% sat 5-10% PUFA 20% MUFA <200 mg cholesterol
Heart failure: what
weakened heart muscle, not pumping enough blood
Heart failure: symptoms
dyspnea, edema
Heart failure: medicine
digitalis
Heart failure: diet
low sodium (2-3)
DASH
high protein 1.1-1.4
Heart failure: energy recommendations
normal 22kcal/kg
walnut 24kcal/kg
Heart failure: nutrient of concern
Thiamin, lost with loop diuretics, needed for energy pyruvate -> acetyl CoA
Cardiac cachexia: what
unintended weight loss due to blood backup in liver/intestines -> nausea
Cardiac cachexia: diet
low sat fat, trans fat, chol, <2 Na, HIGH kcal
Kidney hormones
vasopressin - increases BP
renin - increases BP
erythropoietin - stimulates RBD in marrow
Renal lab tests
BUN
Creatinine
BUN:creatinine
BUN:Creatinine normal and abnormal
10-20:1
higher than 20 means overcompensation by kidney
under 10 means kidney damage, need dialysis
Renal disease: symptoms
anemia
BP
Low Vitamin D activation
How much fluid needed daily to dilute urine
1.5 - 2 liters
What is ash in urine
minerals not oxidized in metabolism: acidic or alkaline. Change with diet or meds
Acute kidney injury (AKI): causes
burn, injury, obstruction
AKI: symptoms
azotemia, oliguria
AKI: energy recommendation
25-40 kcal/kg, high energy expenditure with kidney decline
Nephrosis: what
glomerulus capillary problem letting protein escape
Nephrosis: diet
35 kcal/kg
2-3 g Na
under 30% fat (hyperlipidemia is symptom)
Chronic kidney disease: diet
23-35 kcal/kg
under 2400 mg Na
Restrict pro when GFR is under 59 (0.6 - 0.8 g)
Those with chronic renal failure may need
dialysis
Protein need with hemodialysis
1.2 g/kg
Protein need with peritoneal dialysis
1.2-1.3 g/kg
Risk factors for DM
acanthuses nigricans, GAD antibodies
Fasting glucose indices
Normal 70-100
Impaired fasting 100-125
Diabetes fasting >125
Glucose toerelance indices
Normal has sloped curve
Impaired 140-200
Diabetic >200
HbA1c ranges
Normal <5.7
Diabetic >6.5
HbA1c measures what?
glycosylated hemoglobin
% hemoglobin with glucose attached
60-90 days
Gestational DM risk to infant
macrosomia, hypoglycemia at birth
Glycemic index use
no sig effect on A1c longer than 12 weeks
CHO exchanges
15 for fruit and starch
12 for dairy
5 for non starchy veggies
Bolus insulin types
rapid-acting -
short-acting
Basal insulin types
intermediate - NPH, cloudy
long-acting - lantus
MDI for DM
multiple daily injections: basal and bolus
Meformin
1st line DM drug
suppress liver glucose production
check B12
SGLT -2
excrete more glucose in urin
DPP4
used with met. reduce glucose release from liver
Ketoacidosis: symptoms, txt
hyperglycemia, high pulse, dehydration
Txt: insulin and fluids
Hypoglycemia
Rule of 15
If unresponsive give glucagon
Postprandial or reactive hypoglycemia: what, diet
BS tanks after eating due to increased insulin or insulin sensitivity
Diet: 5-6 meals with even CHO, no simple sugars
Keep glucose steady
Addison’s disease: what, diet
adrenal insufficiency
diet: high protein, frequent meals, high salt
Galactosemia: what, diet
inborn error of metabolism: no enzyme for galactose
Diet: no galactose or lactose
Avoid: organ meat, MSG extenders, bell pepper, dates, whey.
Urea cycle disorders: what, concern, restriction
inborn error of met
Can’t make urea from ammonia
Seizures
Protein restriction; 1-2g/kg
PKU: name, symptom
Phenylketonuria, inborn error of met
Can’t make PHE into Tyrosine
PKU: txt
restrict PHE, supplement TYR
PKU: diet
low pro, high CHO (may lead to dental caries)
PKU: avoid
aspartame
Glycogen storage disease: what, diet
liver can’t Mae glucose from glycogen -> hypoglycemia
give cornstarch regularly
Homocystinurias: what, risk, txt
protein metabolism error
risk of low folate, B6, B12
Supplement folate, B6, B12 at diagnosis
Maple syrup urin disease: what, diet
can’t metabolize BCAA (eggs, meat, nuts)
Restrict BCAA, can have gelatin
Arthritis: what, diet, risk
joint inflammation
normal diet or anti-inflammatory
normocytic anemia due to inflammation preventing reuse of iron
Osteoporosis types
Type 1: postmenopausal
Type 2: age related, 70+
Most likely to have osteoporotic fractures
white and asian women
Osteoporosis causes
malnutrition (pro), low PA, estrogen decline
Osteomalacia: what, deficiency, supplement
low bone density
low vitamin D
supplement D and Ca
Epilepsy meds
phenobarbital and phenytoin (dilantin)
Phenytoin med caution
do not take with food
Pause enteral feedings 2hrs
Epilepsy supplement
D, Ca, thiamin
Anomia
forgetting common words. alzheimers
Microcytic anemia: what, cause
small, pale RBC. iron deficiency
Macrocytic anemia: what, cause
large, red, few RBC. B12 or folate deficiency
Ag-Ab allergy reaction
antigen enters, antibody responds
IgE allergy response
reaction to normally harmless food protein
Most and least common allergen in children
milk most
rice least
Gold standard for allergy diagnosis
double-blind, placebo-controlled food challenge
Normal body temp
98.6
BMR increase with fever
7% per degree
1st step in treating burns
fluid and electrolytes
Ebb phase after injury/burn
hypovolemia, shock
Flow phase after injury/burn
hyperglycemia, after fluid resuscitation
Due to catecholamines -> increase in hepatic glycogenolysis
Cancer effect on nutrition
taste aversions, meat aversion,
if thrush may need bland liquids, soft, chilled
Hypercalcemia in breast cancer may indicate
metastasis to bone
Nutrition recommendations for mucositis with radiation
offer cold and soft food
avoid fresh, raw, uncooked
Exercise in post-menopause may reduce risk of
breast disease
Marasmus: what, dx
protein kcal starvation
Diagnosis made by anthropometrics! triceps, are circumference
Protein-calorie malnutrition
iatrogenic malnut - starts in txt, hospital
Concerns in anorexia
initial is potassium and other electrlytes
referring increases cardiac load. go slow
Nutrients of concern in bulemia
potassium and chloride
How many calories in 1 lb body fat?
3500
to loss a pound in a week, reduce intake by 500kcal/day
Orlistat
obesity
lipase inhibitor
lorcaserin
enhance satiety, serotonin
Phentermine/toopiramate
appetite suppressant
When to do bariatric surgery
40+ BMI
35 BMI with comorbidities
Lap band diet
eat slow, no straw, no bubbles, sip
Low cariogenic foods
hig protein, mod fat
meat, cheese, nuts
Sign of fluorosis
mottled teeth
Stomatitis deficiency and recommendation after meal
inflammation of mouth
riboflavin deficiency
rinse with lukewarm water after food
Achalasia: what, risk
lower esophageal sphincter does not relax
dysphagia
NDD 1
pureed, pudding, no lumps
NDD2
soft, pancake ok, ground meat
No bread, rice
NDD3
transition to regular
no crunchy, hard, sticky
Pregnancy induced hypertension: symptoms
hypertension, edema, proteinuria, rapid wt+
Pregnancy induced hypertension sodium recommendations
stay consistent to maintain plasma
HIV/AIDS diet
neutropenic, avoid raw foods
no breastfeeding
Pediatric HIV diet
high pro/kcal, plenty of supplements for wt+
COPD diet
small frequent, nutrient-packed mini meals
easy to prepare and eat
How to initiate standard polymeric formula
full strength 10-40 ml/hr
Formula for malabsorption?
elemental
Formula hang times?
closed 24-48
open 8
Length of feeding to need gastro- or jejumostomy?
3-4+ weeks
How much water for enteral feeds?
1 cc/kcal
Water in formulas
1 kcal/cc = 83% water
- 5 kcal/cc = 77%
- 0 kcal/cc = 70%
Normal gastric residuals
less than 250
if over 500, hold feed and assess motility/tolerance
IV Dextrose offers how many kcal?
3.4 kcal/gram
kcal = ml x % x 3.4
IVFE: name, percents
Intralipid
10% 1.1 kcal/cc
20% 2.0 kcal/cc
Access time for PICC
short-term
peripherally inserted
Access time for CVC line
long-term
into superior vena cava
Max glucose infusion rate, risk
4-5 mg/kg/min
over may lead to hyperglycemia, high K, Phos
% protein in solution =
grams/100ml
Transitional feeding PN to EN
small amount of full strength EN, 30-40ml/hr
d/c PN when EN is meeting 33-55%
Labs in refeeding
low K, Phos, Mg
Functional medicine looks at
symptoms and underlying disease
Holistic health looks at
mental, physical, spiritual
Integrative medicine combines
evidenced-based complementary with conventional/allopathic
RDA: what, who, purpose
Recommended dietary allowance
individuals
gender, age, life phase
*prevent deficiency
EAR: what, who, purpose
Estimated average requirement
groups
assess for group adequacy
What do community nutrition programs use to guide their planning?
Dietary Guidelines for Americans
Block grant
federal money to state or local
flexibility in distributing funds
Steps in program planning 1-3
Mission Statement
Goals
Objectives - SMART
Program implementation depends on who?
admin, good budget, staff, target population
Implementing an enabling program uses:
enable reduces barriers
4 P’s of marketing:
product, place, price, promotion
Monitoring vs. evaluation
monitor - mausre of nutrition indicator (wt)
evaluation - compare to goal or standard
Outcome categores
Direct nutrition - clinical/health
Patient centered - health care use and cost
Nutrition care outcomes
prove our worth
food/nut hx, labs, anthropometrics, NFP findings
T2D with atherosclerotic CVD should use which meds?
GLP1 receptor agonists or SGLT2 inhibitors
What med for pt with T2D and CKD?
SGLT2
Acceptable fat source in Crohn’s?
MCT from coconut oil
How to treat hemochromatosis?
iron chelation
Long term goal of chronic hemodyalysis
prevent malnut
Braden scale used for
pressure ulcer risk
How much protein for pressure uclers
I - 1.1-1.2
II - 1.2-1.5
myotonia
muscle spasms
