MNT (dietary advice) Flashcards
Nutrition care model
-Initial process that identifies individuals who may be at risk of malnutrition.
-should be conducted within 24 hours of being admitted (joint commision)
-conducted by any member of the healthcare team.
Nutrition assessment
-complete evaluation of an individual’s nutrition status.
-Involves medical history, diet history, anthropometrics, physical exam, labs
Ideal body weight AKA Hamwi method
For females: 100lbs for the first 5 feet + 5 lbs for every additional inch.
For Males:
106 lbs for the first 5 feet + 6 lbs for every additional inch.
Waist circumference
waist greater than 40 inches for males or greater than 35 inches for females is an independent risk factor for chronic diseases
Waist/Hip ratio
Having a waist/hip ratio 1.0 or greater for males or 0.8 or greater for females is an independent risk factor for chronic diseases.
ADIME
Assessment:
-anthropometrics, biochemical data, clinical history, diet history, exam.
Diagnosis: (It’s cool Bro)
A. Diagnostic label dreams
-Intake (NI): Excessive oral intake, decreased energy expenditure.
-Clinical (NC): Altered GI function, chewing/swallowing.
-Behavioral -Environment (NB): Undesirable food choices, food safety, Nutrition related knowledge, deficit
B. PES statement:
-Problem (adjective that describes the issue “altered” “decreased” “Impaired” “Related To”
- Etiology (contributing risk factors) “As evidenced by”
-Signs/symptoms (observable)
-Ex: Unintended weight loss related to decreased appetite as evidenced by weight loss of >5% in 30 days.
C. Intervention
-Action to address the etiology + Improve the clients nutritional status i.e. appetite stimulant, nutrition education, EN/Pn
D. Monitoring and evaluation
-Tracking the progress of the patient, assessing how the patient responded to the intervention + determining what to focus on for future visits with the patient.
Hypertension
- Blood pressure is the amount of pressure that circulating blood puts against blood vessel walls.
- Systolic: The pressure in your blood vessels when your heart beats.
Diastolic: The pressure in your blood vessels when your heart rests between beats. - Hypertension refers to when the amount of pressure that circulating blood puts against blood vessel walls is too high.
- Primary/Essential hypertension Unknown cause
-Secondary hypertension: Known cause, usually related to an underlying disease.
Ideal: Systolic <120/ Diastolic <80
Elevated: Systolic 120-129, Diastolic <80
Stage 1 Hypertension: Systolic 130-139 or Diastolic 80-89
Stage 2:: Systolic 140 or higher, Diastolic 90 or higher.
Hypertension MNT
(SWAP)
(SWAP)
Sodium <2300 mg per day
weight:
Alcohol consumption
Physical activity
Stop Hypertension (DASH) diet and Mediterranean diet.
-Both emphasize fruits and vegetables, poultry and fish.
-DASH diet specifically recommends: moderate sodium, whole grains, low fat dairy, limited alcohol, sweets, and calcium rich foods.
- The MediteRanEan diet recommends nuts, canola oil, olive oil, soybean oil, beans, legumes, moderate wine with meals, grapes (REsveratrol) breads and yogurt,,,
Artherosclerosis (ATHletic SHOEs)
Build up of substances like cholesterol and fats that are referred to as plaque.
Risk factors include:
Hereditary
Smoking
Hypertension
Obesity
Elevated Blood pressure
Coronary artery disease: When atherosclerosis causes plaque to build up in the arteries that carry blood to the heart.
If blood clot forms, it can cuase a MYOCARDIAL INFARCTION/ANGINA/HEPARIN
Dyslipidemia: imbalance in levels of lipids.
Lipoproteins contain both lipids and proteins
Chylomicrons: lowest density, least amount of protein, and are mainly composed of triglycerides.
VEry-low-density- lipoproteins (VLDL): Denser than chylomicrons but smaller in size
Lower density lipoprotein (LDL): BAD smaller and dense than VLDL
High Density Lipoprotein (HDL): GOOD: Densest and smallest of lipoproteins (>than 40 for M, greater than 50 for F).
HDL
Densest and smallest of the lipoproteins
>than 40 for M, >than 50 for F.
H=Higher
Artherosclerosis relevant labs
Triglycerides <150
LDL <100
HDL >40 for M, >50 for women.
Total cholesterol <200
Atherosclerosis MNT
Keep low: saturated fat (<7 % of total calories), sodium <2000 mg , cholesterol <200 mg
Keep high: Fiber intake (20-30 g per day with 5-10 being soluble fiber) whole grains, fruit, veggies.
Statins are often prescried, reduce LDL, triglycerides while increasing HDL
Congestive Heart Failure
-Lack of blood supply to meet body requirements.
-Edema, shortness of breath
MNT:
1. Low sodium (2000-3000 mg Na per day) and low fluid (1-2 L fluids)
2. DASH diet
3. PRotein: 1.1-1.4 g/kg
22 cal/kg for nourished
24 cal/kg for malnourished.
4. vitamin and mineral supplementation (Folate, Mg, B12, Thiamine)
5. Digitalis increases the hearts contractions (sweetHEARTs DIGITs)
6. Cardiac cachexia: Involuntary weight loss due to blood being backed up leading to nausea, vomiting, decreased appetite.
a. Low Na (<2000mg), low saturated fat, low cholesterol, high calorie
Kidney functions
SAFE
-secretion: kidneys release hormones that control BP, hormones that produce RBCs, ions that help with acid base balance.
-Absorption: Kidneys reabsorb sodium, potassium, water, glucose + amino acids.
-Filtration: Kidneys filter out waste, leaving red blood cells + protein.
-Excretion: kidneys excrete ketones (when in excess), waste, and urea.
Important Kidney Hormones
- Vasopressin (ADH)
a. synthesized by the hypothalamus and stored in the pituitary gland
b. controls water retention and constricts blood vessels, increasing blood pressure.
c. Syndrome of inappropriate Antidiuretic Hormone (SIADH): Results of excess water retention, resulting in hyponatremia which usually requires a fluid restriction. - Renin
a. secreted by the glomerulus + converts angiotensinogen to angiotensin I
b. Angiotensin I converts to angiotensin II, which releases aldosterone.
A. Decreases loss of sodium through urine, increasing blood pressure. - Erythropoietin (EPO)
a. Secreted by the kidney to act on bone marrow, producing new RBCs
Kidney stones
- Hard deposits that can get lodged in the kidneys
- Most common type: calcium oxalates stones .
MNT:
A. recommend fluid intake between 1.5-2.0 L of fluid a day.
B. Recommend sufficient calcium
C. Recommend low oxalate intake (40-50 mg a day) :
Spinach
Firm tofu
Soy milk
Potatoes
Beets
Raspberries
Navy beans
Almonds
Acute Kidney injury
- Decreased in renal function (burns, dehydration, or physical damage)
- Azotemia: increased amount of urea in the blood.
- Oliguria: decreased amount of urine output (<500ml),
OLiguria LOw urine output - Macronutrients through IV
- protein needs:
nondialysis: 1-1.3 g/kg
Dialysis: 1.2-1.5 g/kg - recommended 25-40 calories/kg
- recommend low sodium, potassium amd phosphorus based on lab values
- Fluids should be replaced from the previous day + 500 ml
Nephrotic syndrome: (AHEM)
- Inflammation of the epithelial cells in the glomerulus that help prevent protein loss.
AHEM
Albuminuria
Hyperlipidemia
Edema
Malnutrition. - Moderate protein (.8-1.0 g/kg), high calorie intake
- IRON, COPPER, ZINC, CALCIUM, VITAMIN D supplementation.
- Recommend low saturated fat.
- Sodium restriction if edema or hypertension present.
- Fluid restriction if edema present.
Chronic Kidney Diseases (stages 1-4)
- Gradual loss in kidneyf unction
- glomerular Filtration Rate (GFR) used as indicator
- Nausea, vomiting, weight loss, anorexia, anemia, tiredness.
- sodium, potassium, phosphorus adjustment based on lab values
- calories should be 25-35 cals/kg.
1,2,3,skip,5,6 skip 8,9
stage 1 >90 ; .8-1.4 g/kg
stage 2 60-89; .8-1.4 g/kg (mild loss)
stage 3 30-59; .6-.8 g/kg
stage 4 15-29; .6-.8 g/kg
End stage kidney failure
Kidney can no longer support the body’s needs.
-GFR is less than 15.
BUN >100 mg/dL + Cr 10-12 mL/dL
-Typically need a kidney transplant or dialysis.
Dialysis
(Bro Im Positive zombies Cant Follow Directions)
functions like artifical kidney
1. Hemodyalisis: Blood is pumped out through the arm and filtred through a machine.
a. monitor: vitamin B12, Iron, Pyridoxine, Zinc, vitamin C, folate, vitamin D.
2. perioneal dialysis: A catheter is placed in the patients abdomen their own peritoneal cavity is filled iwth dialysate.
Addison’s disease.
Decreased secretions of aldosterone, cortisol and androgens
1. decreased aldosterone
a. decreased sodium reabsorption - hypernatremia
b. Decreased water retention–dehydration
c. decreased potassium excretion–potassium retention.
Decreased aldosterone necessitates high salt (can you ADD salt to this?) adequate fluids, Be careful of potassium.
cortisol–hypoglycemia
decreased cortisol necessitates consistent meals.
Decreased androgens–muscle wasting–weight loss
decreased androgens necessitates high protein.
Diabetes
Body has issues moving glucose from the blood into the cells, causing glucose to build up in the blood.
-Blood glucose control is determined in large part by two hormones
1. insulin (decrease blood glucose levels)
2. Glucagon (increase blood glucose levels)
-Carbohydrate intake is important to monitor.
Normal glucose range
Fasting plasma glucose 70-100
oral glucose tolerance test <140 mg/dL
Hemoglobin A1C: <5.7 %
Type I diabetes (Autoimmune)
Indicate the presence of GADA
-also known as insulin deficient diabetes ; needs exogenous insulin
-Monitor blood glucose and insulin
-carb counting/consistent carb intake
-Time meals
_decreasing insulin doses or keeping blood glucose a bit higher when planning for exercise may be helpful.
LACK OF INSULIN
Type II diabetes (insulin resistance)
-lack of exercise, smoking, hypertension, obesity
-body produces insulin but tissues dont respond to insulin well.
-ACANTHOSIS NIGRICANS: Associated with high blood insulin; velvety gray brown pigmentation; may or may not need exogenous insulin.
-Reach optimal ranges for glucose (average pre-meal 70-130 mg/dl; Max post meal <180 mg/dl, Lipids (HDL >40 M, >50 F, LDL <100 Trigs <150) and blood pressure (systolic <130, diastolic <80) and maintain optimal levels.
-exercise; weight loss if necessary.
Gestational diabetes
pregnancy
Risk factor: previously having gestational diabetes or having a BMI over 30.
-Both fetal macrosomia (large baby) and fetal hypoglycemia can manifest.
-At week 24-28 glucose test >140 further testing
-strict glucose control
-DRI: 175 g of CHO/day
recommend 15-30 g CHO at breakfast.
-may need insulin
dawn phenomenon
- hormones signal the liver to increase glucose production while sleeping.
- increased morning blood glucose necessitates an increase in insulin
Ketoacidosis
-Insulin deficiency may lead to hyperglycemia
-cells start burning fat for energy which produces ketones.
-ketone buildup makes blood acidic
-excessive urination (polyuria) due to excess glucose in the kidneys attracting water.
-Dehydration
-rapid pulse due to dehydration
Recommend insulin therapy and rehydration.
Hypoglycemia
- Excess circulating insulin and skipping meals are common reasons.
- Symptoms include shaking, sweating, cool skin, decreased pulse, palpitations, hunger, and tiredness.
- consume 15 g glucose tablet or something with carbs ( 4- 6 oz fruit juice)
- Glucagon may be given if unresponsive.
Metabolic syndrome
Having three or more of the following
FBG:> =100mg/dL
TG: >=150
HDl: <=40 M; <50 F
Waist:>=40M, >35 F
BP:>=130 systolic and/or >=85 Diastolic
steatorrhea (stool)
Too much fat in the stool (more than 7 grams)
-associated with fat absorption
-High protein and high complex carbs
MNT: supplement vitamins (fat soluble) and minerals (calcium, magnesium, zinc)
-medium chain triglycerides (MCTs)
