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RD Exam > MNT > Flashcards

MNT Flashcards

1
Q

Ulcer: what

A

eroded mucosal lesion

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2
Q

Ulcer: txt

A

antacids, antibiotics to treat h.pylori

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3
Q

Ulcer: diet

A

as tolerated

avoid spicy, etoh, caff

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4
Q

Hiatal hernia: what, diet

A

some stomach above diaphragm

small, bland feedings

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5
Q

Dumping syndrome: what

A 
rapidly hydrolyzed cho enters jejunum
water enters for osmotic balance
low blood pressure
cho apsorbed and insulin pumped quickly
hypoglycemia
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6
Q

Dumping syndrome: when

A

after bowel resection

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7
Q

Dumping syndrom: diet

A

small, dry feedings with pro and moderate fat
liquids before/after meal
no hypertonic sweets

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8
Q

Bowel resections (2)

A

Bilroth I - stomach to duodenum

Bilroth II - stomach to jejunum

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9
Q

Bilroth 2: nutrients of concern

A

Ca - low, most uptake in duodenum
Iron - low, needs acid
B12 - low, no intrinsic factor
Folate - low, needs B12 to get into cells

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10
Q

Deficiencies after complete gastrectomy

A 
Iron
B12
Folate
Ca
D
B1
Copper
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11
Q

Test for B12 deficiency

A

Schilling
Pernicious anemia
due to low intrinsic factor and bacteria overgrowth

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12
Q

Gastroparesis: what, when

A

delayed gastric empty

after sx, diabetes, obstruction

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13
Q

Gastroparesis: txt

A

pro kinetics: erythromycin, metoclopramide

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14
Q

Gatroparesis: diet

A

small, frequent meals

no high fiber or fat

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15
Q

Celiac: what

A

reaction to gliadin affecting jejunum and ileum

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16
Q

Celiac: avoid

A

WROB, bran, graham, malt, bulgur, couscous, orzo, thickening agents

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17
Q

Celiac: ok

A

corn, potato, rice, soybean

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18
Q

Celiac: nutrition outcomes

A

anemia, diarrhea, wt loss, steatorrhea, malabsorption (low ADEK)

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19
Q

Diverticulosis: what

A

presence of mucosal sacs in intestinal wall due to structure weakness

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20
Q

Diverticulosis: diet

A

high fiber

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21
Q

Diverticulitis: what

A

inflammation of sacs

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22
Q

Diverticulitis: diet

A

clear liquids, gradual return to high fiber

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23
Q

Inflammatory bowel disease types

A

Crohn’s disease - ileum

Ulcerative colitis - colon

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24
Q

Crohn’s Deficiencies

A

B12 deficiency, iron deficiency

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25
Q

Symptoms of UC

A

bloody diarrhea, wt loss. electrolyte imbalances, neg nitrogen balance

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26
Q

Inflammatory bowel disease diet

A 
energy according to BMI
restrict fat if steatorrhea
Ca, Mg, Zn supplement
fat may improve energy balance
Pro at each meal
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27
Q

Best multivitamin in Inflammatory bowel disease?

A

chewable

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28
Q

Irritable bowel syndrome: goals, recommendations

A

adequate intake with no flare ups
specific to GI issues
food diary to track intake, emotions, symptoms

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29
Q

Lactose intolerance test

A

oral lactose load

test glucose: if under 25mg/dl then lactose intolerant

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30
Q

Lactose intolerant diet

A

no animal milk, products, or whey

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31
Q

Lactose intolerant supplement

A

Ca and riboflaven

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32
Q

Pediatric diarrhea: treatment

A

agressive rehydration and electrolyte replacement

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33
Q

Causes for pediatric diarrhea

A

low fat diet

too many fluids

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34
Q

Chronic pediatric diarrhea recommendations

A

40% of energy from fat

restrict/dilute fruit juice

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35
Q

Steatorrhea test

A

check stool fat
normal is 2-5g
>7 g means malabsorption

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36
Q

SBS: loss of jejunum?

A

ileum can adapt

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37
Q

SBS: loss of ileum complications

A

decreased B12, intrinsic factor, bile salts ->
fat malabsorption, ADEK, Ca, Zn, Mg (makes soaps)
Colonic absorption of oxalate – stones

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38
Q

SBS: loss of colon complications

A

loss of water, electrolytes, no colonic salvage

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39
Q

How much water does SBS need?

A

If ileum resected, need 1 liter more than ostomy output

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40
Q

SBS: nutrition care process

A

parenteral to enteral early to promote intestinal lining growth

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41
Q

Ileal resection diet, supplement

A

limit fat, use MCT

Supplement ADEK, Ca, Mg, Zn, B12

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42
Q

Liver functions

A

store and release blood
filter blood
metabolism and storage of nutrients
fluid and electrolytes

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43
Q

If liver enzymes in blood are high?

A

liver damage

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44
Q

Liver enzyme levels

A

AST - 35
ALT - 36
ALP - 120
if above = liver damage

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45
Q

Which hepatitis is most associated with food?

A

HAV, fecal-oral, oysters danger

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46
Q

Hepatitis diet

A 
fluids
50-55% CHO (protein sparing)
1 - 1.2 G protein
restrict fat in steatorrhea
small frequent feedings (anorexia)
2gm Na if fluid retention
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47
Q

Cirrhosis: what

A

damage to liver tissue with connective tissue redirecting blood

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48
Q

When blood cannot leave the liver

A 
ascites
blood build up in liver
when full, plasma moves to peritoneal 
plasma pulls in water 
Na and water retention
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49
Q

When blood cannot enter liver

A

Varices
blood backs up in portal vein and into collateral veins
enlarge, bleed

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50
Q

Cirrhosis diet

A

.8-1.2 protein
25-35 kcal
MCT if needed
low fat if malabsorption

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51
Q

Varices diet

A

low fiber

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52
Q

Ascites diet

A

low sodium

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53
Q

Alcoholic liver disease: what

A

hydrogen replace fat as fuel

fat accumulates in liver

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54
Q

Alcoholic liver disease: supplement what?

A

thiamin, folic acid

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55
Q

Alcohol increases the excretion of what?

A

Magnesium

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56
Q

ESLD: name, s/s

A

end stage liver disease
liver less than 25% function
ammonia no longer converted to urea

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57
Q

ESLD: diet

A

low sodium with ascites
moderate-high protein 1-1.5
Modest protein if sensitive or hepatic encephalopathy

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58
Q

NAFLD: name, risk factors

A

nonalcoholic fatty liver disease

usually >35 BMI, T2DM, Met syndrome

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59
Q

NAFLD: txt

A

SLOW wt loss to not increase tag to liver

Med diet, moderate alcohol, coffee as antioxidant, PA 150/week

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60
Q

Can liver regenerate in alcoholic liver disease?

A

only with good nutrition and no etoh

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61
Q

Pancreatitis: what, enzyme activity?

A

inflammation of pancreas due to blockage or reflux

activation of digestive enzymes too early

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62
Q

Acute Pancreatitis: diet

A

as tolerated, slow on fat

elemental formula to jejunum if needed

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63
Q

Chronic Pancreatitis: diet

A

PERT with meals and snack
MCT (does not need lipase from pancreas)
Antacids

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64
Q

Cystic Fibrosis: what

A

thick mucus obstructs glands, enzyme deficiency, malab

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65
Q

Cystic fibrosis: diet

A

PERT, liberal protein, calorie, fat, salt

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66
Q

Cystic fibrosis: supplement

A

water soluble form of A and E

Zinc

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67
Q

Blood pressure cutoff

A

over 120 elevated
over 130 stage 1
over 140 stage 2

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68
Q

CVD salt restriction

A

1500-2300 mg

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69
Q

Med diet rich in…

A

a-linolenic

monounsaturated

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70
Q

Atherosclerosis:what

A

accumulation of lipids

structural changes in arteries

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71
Q

Lipoprotein risk

A

LDL-c - small, dense, responsive to diet

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72
Q

Metabolic syndrome

A
  • 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
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73
Q

Cholesterol risk

A

Keep
LDL-C under 100
Total chol under 200
HDL above 40/50 (over 60 is high)

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74
Q

Therapeutic Lifestyle Change (TLC) diet - fat recommendations

A 
35% kcal from fat
<7% sat
5-10% PUFA
20% MUFA
<200 mg cholesterol
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75
Q

Heart failure: what

A

weakened heart muscle, not pumping enough blood

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76
Q

Heart failure: symptoms

A

dyspnea, edema

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77
Q

Heart failure: medicine

A

digitalis

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78
Q

Heart failure: diet

A

low sodium (2-3)
DASH
high protein 1.1-1.4

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79
Q

Heart failure: energy recommendations

A

normal 22kcal/kg

walnut 24kcal/kg

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80
Q

Heart failure: nutrient of concern

A

Thiamin, lost with loop diuretics, needed for energy pyruvate -> acetyl CoA

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81
Q

Cardiac cachexia: what

A

unintended weight loss due to blood backup in liver/intestines -> nausea

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82
Q

Cardiac cachexia: diet

A

low sat fat, trans fat, chol, <2 Na, HIGH kcal

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83
Q

Kidney hormones

A

vasopressin - increases BP
renin - increases BP
erythropoietin - stimulates RBD in marrow

84
Q

Renal lab tests

A

BUN
Creatinine
BUN:creatinine

85
Q

BUN:Creatinine normal and abnormal

A

10-20:1
higher than 20 means overcompensation by kidney
under 10 means kidney damage, need dialysis

86
Q

Renal disease: symptoms

A

anemia
BP
Low Vitamin D activation

87
Q

How much fluid needed daily to dilute urine

A

1.5 - 2 liters

88
Q

What is ash in urine

A

minerals not oxidized in metabolism: acidic or alkaline. Change with diet or meds

89
Q

Acute kidney injury (AKI): causes

A

burn, injury, obstruction

90
Q

AKI: symptoms

A

azotemia, oliguria

91
Q

AKI: energy recommendation

A

25-40 kcal/kg, high energy expenditure with kidney decline

92
Q

Nephrosis: what

A

glomerulus capillary problem letting protein escape

93
Q

Nephrosis: diet

A

35 kcal/kg
2-3 g Na
under 30% fat (hyperlipidemia is symptom)

94
Q

Chronic kidney disease: diet

A

23-35 kcal/kg
under 2400 mg Na
Restrict pro when GFR is under 59 (0.6 - 0.8 g)

95
Q

Those with chronic renal failure may need

A

dialysis

96
Q

Protein need with hemodialysis

A

1.2 g/kg

97
Q

Protein need with peritoneal dialysis

A

1.2-1.3 g/kg

98
Q

Risk factors for DM

A

acanthuses nigricans, GAD antibodies

99
Q

Fasting glucose indices

A

Normal 70-100
Impaired fasting 100-125
Diabetes fasting >125

100
Q

Glucose toerelance indices

A

Normal has sloped curve
Impaired 140-200
Diabetic >200

101
Q

HbA1c ranges

A

Normal <5.7

Diabetic >6.5

102
Q

HbA1c measures what?

A

glycosylated hemoglobin
% hemoglobin with glucose attached
60-90 days

103
Q

Gestational DM risk to infant

A

macrosomia, hypoglycemia at birth

104
Q

Glycemic index use

A

no sig effect on A1c longer than 12 weeks

105
Q

CHO exchanges

A

15 for fruit and starch
12 for dairy
5 for non starchy veggies

106
Q

Bolus insulin types

A

rapid-acting -

short-acting

107
Q

Basal insulin types

A

intermediate - NPH, cloudy

long-acting - lantus

108
Q

MDI for DM

A

multiple daily injections: basal and bolus

109
Q

Meformin

A

1st line DM drug
suppress liver glucose production
check B12

110
Q

SGLT -2

A

excrete more glucose in urin

111
Q

DPP4

A

used with met. reduce glucose release from liver

112
Q

Ketoacidosis: symptoms, txt

A

hyperglycemia, high pulse, dehydration

Txt: insulin and fluids

113
Q

Hypoglycemia

A

Rule of 15

If unresponsive give glucagon

114
Q

Postprandial or reactive hypoglycemia: what, diet

A

BS tanks after eating due to increased insulin or insulin sensitivity
Diet: 5-6 meals with even CHO, no simple sugars
Keep glucose steady

115
Q

Addison’s disease: what, diet

A

adrenal insufficiency

diet: high protein, frequent meals, high salt

116
Q

Galactosemia: what, diet

A

inborn error of metabolism: no enzyme for galactose
Diet: no galactose or lactose
Avoid: organ meat, MSG extenders, bell pepper, dates, whey.

117
Q

Urea cycle disorders: what, concern, restriction

A

inborn error of met
Can’t make urea from ammonia
Seizures
Protein restriction; 1-2g/kg

118
Q

PKU: name, symptom

A

Phenylketonuria, inborn error of met

Can’t make PHE into Tyrosine

119
Q

PKU: txt

A

restrict PHE, supplement TYR

120
Q

PKU: diet

A

low pro, high CHO (may lead to dental caries)

121
Q

PKU: avoid

A

aspartame

122
Q

Glycogen storage disease: what, diet

A

liver can’t Mae glucose from glycogen -> hypoglycemia

give cornstarch regularly

123
Q

Homocystinurias: what, risk, txt

A

protein metabolism error
risk of low folate, B6, B12
Supplement folate, B6, B12 at diagnosis

124
Q

Maple syrup urin disease: what, diet

A

can’t metabolize BCAA (eggs, meat, nuts)

Restrict BCAA, can have gelatin

125
Q

Arthritis: what, diet, risk

A

joint inflammation
normal diet or anti-inflammatory
normocytic anemia due to inflammation preventing reuse of iron

126
Q

Osteoporosis types

A

Type 1: postmenopausal

Type 2: age related, 70+

127
Q

Most likely to have osteoporotic fractures

A

white and asian women

128
Q

Osteoporosis causes

A

malnutrition (pro), low PA, estrogen decline

129
Q

Osteomalacia: what, deficiency, supplement

A

low bone density
low vitamin D
supplement D and Ca

130
Q

Epilepsy meds

A

phenobarbital and phenytoin (dilantin)

131
Q

Phenytoin med caution

A

do not take with food

Pause enteral feedings 2hrs

132
Q

Epilepsy supplement

A

D, Ca, thiamin

133
Q

Anomia

A

forgetting common words. alzheimers

134
Q

Microcytic anemia: what, cause

A

small, pale RBC. iron deficiency

135
Q

Macrocytic anemia: what, cause

A

large, red, few RBC. B12 or folate deficiency

136
Q

Ag-Ab allergy reaction

A

antigen enters, antibody responds

137
Q

IgE allergy response

A

reaction to normally harmless food protein

138
Q

Most and least common allergen in children

A

milk most

rice least

139
Q

Gold standard for allergy diagnosis

A

double-blind, placebo-controlled food challenge

140
Q

Normal body temp

A

98.6

141
Q

BMR increase with fever

A

7% per degree

142
Q

1st step in treating burns

A

fluid and electrolytes

143
Q

Ebb phase after injury/burn

A

hypovolemia, shock

144
Q

Flow phase after injury/burn

A

hyperglycemia, after fluid resuscitation

Due to catecholamines -> increase in hepatic glycogenolysis

145
Q

Cancer effect on nutrition

A

taste aversions, meat aversion,

if thrush may need bland liquids, soft, chilled

146
Q

Hypercalcemia in breast cancer may indicate

A

metastasis to bone

147
Q

Nutrition recommendations for mucositis with radiation

A

offer cold and soft food

avoid fresh, raw, uncooked

148
Q

Exercise in post-menopause may reduce risk of

A

breast disease

149
Q

Marasmus: what, dx

A

protein kcal starvation

Diagnosis made by anthropometrics! triceps, are circumference

150
Q

Protein-calorie malnutrition

A

iatrogenic malnut - starts in txt, hospital

151
Q

Concerns in anorexia

A

initial is potassium and other electrlytes

referring increases cardiac load. go slow

152
Q

Nutrients of concern in bulemia

A

potassium and chloride

153
Q

How many calories in 1 lb body fat?

A

3500

to loss a pound in a week, reduce intake by 500kcal/day

154
Q

Orlistat

A

obesity

lipase inhibitor

155
Q

lorcaserin

A

enhance satiety, serotonin

156
Q

Phentermine/toopiramate

A

appetite suppressant

157
Q

When to do bariatric surgery

A

40+ BMI

35 BMI with comorbidities

158
Q

Lap band diet

A

eat slow, no straw, no bubbles, sip

159
Q

Low cariogenic foods

A

hig protein, mod fat

meat, cheese, nuts

160
Q

Sign of fluorosis

A

mottled teeth

161
Q

Stomatitis deficiency and recommendation after meal

A

inflammation of mouth
riboflavin deficiency
rinse with lukewarm water after food

162
Q

Achalasia: what, risk

A

lower esophageal sphincter does not relax

dysphagia

163
Q

NDD 1

A

pureed, pudding, no lumps

164
Q

NDD2

A

soft, pancake ok, ground meat

No bread, rice

165
Q

NDD3

A

transition to regular

no crunchy, hard, sticky

166
Q

Pregnancy induced hypertension: symptoms

A

hypertension, edema, proteinuria, rapid wt+

167
Q

Pregnancy induced hypertension sodium recommendations

A

stay consistent to maintain plasma

168
Q

HIV/AIDS diet

A

neutropenic, avoid raw foods

no breastfeeding

169
Q

Pediatric HIV diet

A

high pro/kcal, plenty of supplements for wt+

170
Q

COPD diet

A

small frequent, nutrient-packed mini meals

easy to prepare and eat

171
Q

How to initiate standard polymeric formula

A

full strength 10-40 ml/hr

172
Q

Formula for malabsorption?

A

elemental

173
Q

Formula hang times?

A

closed 24-48

open 8

174
Q

Length of feeding to need gastro- or jejumostomy?

A

3-4+ weeks

175
Q

How much water for enteral feeds?

A

1 cc/kcal

176
Q

Water in formulas

A

1 kcal/cc = 83% water

  1. 5 kcal/cc = 77%
  2. 0 kcal/cc = 70%
177
Q

Normal gastric residuals

A

less than 250

if over 500, hold feed and assess motility/tolerance

178
Q

IV Dextrose offers how many kcal?

A

3.4 kcal/gram

kcal = ml x % x 3.4

179
Q

IVFE: name, percents

A

Intralipid
10% 1.1 kcal/cc
20% 2.0 kcal/cc

180
Q

Access time for PICC

A

short-term

peripherally inserted

181
Q

Access time for CVC line

A

long-term

into superior vena cava

182
Q

Max glucose infusion rate, risk

A

4-5 mg/kg/min

over may lead to hyperglycemia, high K, Phos

183
Q

% protein in solution =

A

grams/100ml

184
Q

Transitional feeding PN to EN

A

small amount of full strength EN, 30-40ml/hr

d/c PN when EN is meeting 33-55%

185
Q

Labs in refeeding

A

low K, Phos, Mg

186
Q

Functional medicine looks at

A

symptoms and underlying disease

187
Q

Holistic health looks at

A

mental, physical, spiritual

188
Q

Integrative medicine combines

A

evidenced-based complementary with conventional/allopathic

189
Q

RDA: what, who, purpose

A

Recommended dietary allowance
individuals
gender, age, life phase
*prevent deficiency

190
Q

EAR: what, who, purpose

A

Estimated average requirement
groups
assess for group adequacy

191
Q

What do community nutrition programs use to guide their planning?

A

Dietary Guidelines for Americans

192
Q

Block grant

A

federal money to state or local

flexibility in distributing funds

193
Q

Steps in program planning 1-3

A

Mission Statement
Goals
Objectives - SMART

194
Q

Program implementation depends on who?

A

admin, good budget, staff, target population

195
Q

Implementing an enabling program uses:

A

enable reduces barriers
4 P’s of marketing:
product, place, price, promotion

196
Q

Monitoring vs. evaluation

A

monitor - mausre of nutrition indicator (wt)

evaluation - compare to goal or standard

197
Q

Outcome categores

A

Direct nutrition - clinical/health

Patient centered - health care use and cost

198
Q

Nutrition care outcomes

A

prove our worth

food/nut hx, labs, anthropometrics, NFP findings

199
Q

T2D with atherosclerotic CVD should use which meds?

A

GLP1 receptor agonists or SGLT2 inhibitors

200
Q

What med for pt with T2D and CKD?

A

SGLT2

201
Q

Acceptable fat source in Crohn’s?

A

MCT from coconut oil

202
Q

How to treat hemochromatosis?

A

iron chelation

203
Q

Long term goal of chronic hemodyalysis

A

prevent malnut

204
Q

Braden scale used for

A

pressure ulcer risk

205
Q

How much protein for pressure uclers

A

I - 1.1-1.2

II - 1.2-1.5

206
Q

myotonia

A

muscle spasms

RD Exam (5 decks)

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