MNT Exam questions Flashcards
Calculate IBW.
Men: 106 + (6# per inch over 5 ft)
Women: 100 + (5# per inch over 5 ft)
Underweight: 100-(2# per inch under 5ft)
Calculate %IBW.
(Current WT/Ideal WT) x 100 = %IBW
Calculate BMI.
[(WT in INCHES)/ (HT squared in inches)] x 703
Adjusted BW
(Actual BW – IBW) x .25 + IBW
Amputation: BKA
Below Knee Amp (Lower leg + foot):
5.9% less
Amputation: AKA
Above Knee Amp
16% less
Amputation: foot
1.5% loss
Amputation: arm
5.0% loss
Amputation: hand
0.7% loss
What are normal calorie, fluid, and protein needs?
Calories: 25-30 kcal
Protein: 0.8-1.0 g/kg
Fluid: 1 ml/kcal (25-40ml)
What are the target blood glucoses for a person WITH DM?
Fasting: 80-120
Post-Prandial:
What is the HgbA1c test? What is the optimal range?
A test to identify the average plasma glucose concentration over approximately 3 months.
Optimal range: 6.0 -6.5%
Name 5 common DM medications (oral) and explain how they work in the body:
–Metformin
- First line of drugs
- for obese and overweight pt with normal kidney function
Action:
- suppresses glucose production by the liver.
- increase insulin sensitivity–> this results increased glucose uptake, reduced plasma glucose concentrations, and decreased gluconeogenesis
- helps reduce LDL and TG levels
- not associated with weight gain
Name 5 common DM medications (oral) and explain how they work in the body:
–Sulfonylureas
Action:
-increase insulin release from the beta cells in the pancreas
Name 5 common DM medications (oral) and explain how they work in the body:
–DPP-4 Inhibitors
Action:
- Glucagon increase blood glucose levels, DPP-4 reduces glucagon and blood glucose levels
- It increases incretin levels, which will increase glucagon release –> increase insulin secretion, reduce gastric emptying, and decrease blood glucose levels
Name 5 common DM medications (oral) and explain how they work in the body:
–Meglitinides
Action:
- Binds to the ATP-dependent K channels on the membrane of the pancreas.
- This causes an increase in intracellular concentration of potassium, making the cell membrane more positive
- The depolarized membrane causes the calcium channels to open
- The rise in calcium leads to an increase in fusion of insulin to the cell membrane –> increase the release of (pro)insulin
Name 5 common DM medications (oral) and explain how they work in the body:
–Thiazolidinediones (TZDs)
Action:
- Reduces the amount of fat content in the blood stream by increasing the fatty acid storage in the adipocytes.
- This leads to the increased need for carbohydrates for energy
Explain the mode of action/timespan of the following insulins:
–Lantus
Long-acting insulin
Duration: 22-24 hours
Explain the mode of action/timespan of the following insulins:
–Humalog/Novalog
Rapid-Acting Analogues
Duration: 2-4 hours
Explain the mode of action/timespan of the following insulins:
–Levamir
Long-acting insulin
Duration: 12-22.1 hours based on dosage
Why should people with diabetes eat a high fiber diet?
the insoluble fiber can slow down the absorption of sugar.
A patient with decubitus ulcers has increased needs for what?
Energy and protein
What is dumping syndrome?
Food bypass the stomach too rapidly and enter the small intestine undigested.
What is Crohn’s disease?
An autoimmune disease that causes chronic inflammation of the intestinal tract.
What nutrients/foods should be limited for Crohn’s disease?
Avoid “trigger” foods or foods that can cause abdominal pain.
What lab values are affected by hydration status? How are they affect?
BUN ^ Creatinine ^ Urine Specific Gravity ^ Potassium ^ Na ^ with dehydration Glucose _
What foods should be restricted in dumping syndrome pt?
simple sugars
What nutrient MAY be restricted in hepatic encephalopathy?
How do you know when to restrict it?
What should be the predominant source of this nutrient and what foods are recommended?
Protein
.25-.5 g/kg protein
Plant protein
Prevent increase in Ammonia
What are some consequences of non-compliance for dialysis patients? (what happens when the toxins in the blood build up?
Hyperkalemia- large amounts on potassium in the blood.
Can cause cardiac arrest and death.
What are the general fluid needs of a pre-HD pt? Pt on HD?
Pre-HD: restricted
HD: 1000 ml +output
What are the general protein needs of a pre-HD pt? Pt on HD?
Pre-HD: .6 g/kg
HD: 1.2-1.5 k/kg
What are the fluid needs of a person with CHF? How would you determine if they have CHF?
Fluid needs: 1.4-1.9 L/day or 25 ml/kg
Test: BNP >300, angiography
What is the difference bt diverticulitis and diverticulosis?
Diverticulitis– an inflammation or infection of one or more small pouches in the small intestine.
Diverticulosis– A condition in which small, bulging couches develop in the intestinal tract.
What is the recommendation diet for diverticulitis?
clear liquid, bland diet with little fiber
What is neutropenic diet?
Diet for people with weak immune system.
What foods are restricted when taking Coumadin?
A normal diet with a consistent amount of Vitamin K.
What nutrients should be restricted in pancreatitis?
is this only PO or IV also?
No need for IV unless TG> 400.
It would just be PO. Low fat diet.
Give examples of diet tips for a person with gastroparesis.
- eat smaller meals
- chew food thoroughly
- avoid fibrous foods
- decrease fat
- sit up
How much fluid, sodium, and kcals are provided by the following IVFs: 1/2 NS @ 75 ml/hr
1800 ml fluid, 138.6 ml eg sodium
How much fluid, sodium, and kcals are provided by the following IVFs: NS @ 125 ml/hr
3000 ml fluid, 462 ml eq sodium
How much fluid, sodium, and kcals are provided by the following IVFs: D5W @ 50 ml/hr
1200 ml/d fluid, 60 g dextrose, 204 kcal
How much fluid, sodium, and kcals are provided by the following IVFs: D5 1/2 NS @ 100 ml/hr
2400 ml/d fluid, 120 g dextrose, 184.8 ml eg sodium
What are some of the considerations when estimating calorie and protein needs in an injured patient?
- Severity of the injury
- age
- gender
- location of the injury
- whether the pt can walk or nah
What are the common recommendations for an injured pt?
-Increase protein and calories to promote healing
-Energy:
Normal needs- 25-30 kcal/kg
Elective injury- 28-30 kcal/kg
Severe injury- 30-40 kcal/kg
Extensive trauma/burn- 45-55 kcal/kg
-Protein needs:
Start at 0.8 g/kg and increase based on severity of the inury
What kcal:n ratio is recommended for the healthy person?
150:1
What kcal:n ratio is recommended for an injured person?
80:1
What is the NPC:n ratio recommendation for the most severely stressed patient?
80:1
What is the NPC:n ratio recommendation for a severely stressed patient?
100:1
What is the NPC:n ratio recommendation for an unstressed patient?
150:1
Providing proteins at very high levels may induce complications. At what level might this occur and what are the complications of excess protein?
2.5 g/kg
Complications:
- weight gain since amino acids cannot be stored
- harmful to the liver, brain, nervous system due to the increase in ammonia in the blood
- dehydration
- stress of your kidneys
- increase in calcium loss
Estimate calorie and protein requirements to promote healing.
Maintenance: 25-30 kcal/g and .8-1.0 g pro/kg
Healing: 27-30 kcal/g and 1.0-1.2 g pro/kg
What would be decreased in bedridden patients?
It depends on the reason for them being bed ridden. However, energy would be decreased. In some cases, protein would be, but not often since we do not want to potentially have muscle loss.
What is the best way to assess if a tube feeding is working?
Three ways:
1. Auscultation—involves instilling air into the feeding tube with a syringe while using a stethoscope placed over the stomach to listen for rushing air.
- Bubbling—observing bubbles when the end of the feeding tube is placed under water; the appearance of bubbles is thought to indicate that the feeding tube is misplaced in the respiratory tract.
- Aspirate Appearance—assessing the appearance of aspirate from the tube.
What is the best diet for peptic ulcer disease?
Regular diet;
Protein: 1.2 g/kg in the acute stage and up to 1.5 g/kg in the recovery stage.
Avoid disacch to prevent fermentation and saturated fat
Healthful diet that avoids food that causes discomfort and would increase the acidity in the stomach.
Vitamins/Minerals:
- zinc: essential to maintain the immune system function, as a response to oxidative stress, and to heal wounds.
- selenium: improve infection complications and improve healing
- Vitamin A and Vitamin C
What diet is desirable for dumping syndrome?
- Eat 5-6 small meals a day with fluids being consumed 30 -Increase intake of protein, fiber, and complex CHO (avoid simple CHO)
- Chew food thoroughly.
- Increase potassium and magnesium through oral replacement.
What nutrients delay gastric emptying?
High fiber and high fat foods
What is the result of ketosis?
Ketosis is the state the body goes into id it needs to break down body fat for energy. It marks a raised level of ketones in the blood which can be used by the body as fuel.
What is the diet for a colon resection and what vitamins could be affected?
Postoperative:
- Clear liquid: 1-2 days
- Small meals: 4-6 meals a day
- Low-residue: high fibrous foods
Vitamin B12 can be affected
What should the predominant protein source be with hepatic encephalopathy?
Hepatic encephalopathy is the loss of brain function that occurs when the liver is unable to remove toxins from the blood.
Protein source: plant sources
How much formula and water is needed for 3/4 strength tube feeding at 50 cc/hr for 24 hours?
900 cc from formula
300 cc from water
Explain positive and negative nitrogen balance.
- Positive nitrogen balance: nitrogen intake is greater than nitrogen output
- Negative nitrogen balance: nitrogen output is greater than nitrogen intake
Name a reaction to metabolic acidosis.
Metabolic acidosis occurs when there are too much acid in the body fluid.
Reaction: Shock or death; can cause rapid breathing, confusion or lethargy
Name the affected blood lab values of anemia of chronic disease.
hemoglobin
serum ferritin
hematocrit
A high CO2 and low pH is an indication of:
respiratory acidosis
How does the body compensate during respiratory acidosis?
The body responds by trying to increase the plasma [HCO_3-] to match the increase in PCO2 and thus maintain the PCO2/HCO_3- ratio.
Why would you see Kwashiorkor in TPN patients receiving D_5W (dextrose 5% water)?
Kwashiorkor- severe malnutrition associated with a low protein diet; mainly found in children
–High dextrose with little protein in the mixture could cause kwashiorkor in TPN patients over 2 weeks or longer
What is the kcal:n ratio for 1500 kcal and 20% protein?
125:1
A patient is receiving 2 liters of D5W; how many kcals would this provide?
340 kcal
What vitamins may be affected with frequent use of laxatives?
Vitamin A, D, and E
Name the half-life of retinol-binding protein.
It is a carrier proteins that bind retinol, which plays a crucial role in embryonic development.
12 hours
Name the affected blood lab values in iron deficiency anemia.
Based on the stage:
- Hemoglobin
- Hematocrit
- Serum iron
- Serum ferritin
- Serum transferrin
- TIBC
- MCV
Name the affected blood lab values in pernicious anemia.
i. Vitamin B12
ii. Hemoglobin
iii. IF or Parietal Cell antibodies
iv. Reticulocyte count
v. Homocysteine
vi. MMA
vii. Folic Acid
viii. RBC size
ix. MCV
What nutrients are absorbed in the ileum?
Vitamin B12 (Extrinsic factor) and bile salts
Where in the intestinal tract is Vitamin K formed?
Bacteria in the colon can form vitamin K
Name the best test for visceral protein status.
Serum albumin and thyroxine-binding prealbumin (TBPA)
Name the half-life of prealbumin
About 2 days
Prealbumin is a protein that is made in the liver and released in the blood. It helps carry certain hormones that regulate the way the body uses energy and other substances through the blood.
Which nutrients are absorbed in the jejunum?
B vitamins, folic acids, vitamin C, monosaccharides
Which nutrients have the greatest effect on osmolarity?
amino acids
Which nutrients are absorbed in the duodenum?
Iron
calcium
magnesium
chloride
How much water does the average adult per day excrete?
Output of 500mL***
Describe the role of HC1 in the stomach.
Aids in protein breakdown by increasing the effectiveness of pepsin. HC1 does this by lowering the pH to a level where pepsin is most active and able to break down the protein.
Diet restriction for HTN.
DASH diet:
• Reduce sodium:
Calorie and protein requirements for patients on chemotherapy.
o Calorie: REE x 1.1-1.45 or 30-35 kcal/kg
o Protein: 45- 60 g/day or 1.2-1.5 g/kg
What happens to the body when a person is on a high protein-low CHO diet? How are fluid needs affected?
This would increase the amount of ketones bodies in the blood since your body will have to break down fat for energy.
Fluids would have to be increase to prevent complications associated with excess protein.
What does the S in SOAP mean?
Subjective→ the client’s report on how he/she has been doing since the last visit, and this includes the current visit.
• Statements from the patient
• Caretaker’s observations
• Complaints or concerns
If there is no sufficient time to give a diet instruction to a patient, what can you do to assure that the patient gets and understands the diet information?
I would give the patient written education about the diet that includes tips on how to follow the diet recommendations. If necessary, I would email or mail the information to the patient with my contact information to answer any questions should they arise.
Foods that are gastric irritants.
Black pepper, red or hot pepper, chili powder, caffeine, regular and decaffeinated coffee or tea, alcohol, cocoa, chocolate, cola beverages, citrus fruits and juices, fatty and fried foods, tomato products, and peppermint
A patient with decubitis ulcers has increased needs for?
Energy, protein, and fluids
Foods high in phosphorus.
Milk, chocolate, colas, cheese, yogurt, pudding, cottage cheese, crawfish, oyster, sardines, liver meat, beans, bran cereals, nuts, seeds, whole grain products
**this is especially important for patients on dialysis.
Foods to be restricted for a person with dumping syndrome.
Simple sugars found in sweets, candy, soda, cakes, and cookies
Write a brief description of Crohn’s disease. Include the nutrients that should be increased and decreased.
A type of inflammatory bowel disease. The body’s immune system attacks the GI tract, which may be directed at microbial agents. It is the chronic inflammation of the intestinal tract.
o Nutrients to increase: complex CHO, lipids, water-soluble fiber, and fluids
o Nutrients to decrease: foods and beverages high in simple sugars
Calories in: 1.5 liters of 25% dextrose solution.
1500ml x 25g / 100 ml= 375g dex
375g dex x 3.4 kcal/g = 1275 kcal
Calories in: 0.5 liters of a 50% dextrose solution.
500ml x 50g / 100ml = 250 g dex
250g dex x 3.4 kcal/g = 850 kcal
Calories in: 1.75 liters of a 10% dextrose solution
1750ml x 10g / 100ml = 175g dex
175g dex x 3.4 kcal/g = 595 kcal
Recommendations for a pt with GERD
Avoid acidic foods or foods that can increase the acidity of the stomach
Recommendations for a pt with hiatal hernia
Avoid foods that can cause heart burn, such as foods that are highly acidic or may weaken the lower esophageal sphincter.
Citrus foods, chocolate, tomato-based foods, coffee
Which lab values are affected by hydration status of the patient?
Increased with fluid deficiency: • Hemoglobin • Hematocrit • BUN • Osmolality • Serum Na • BUN:crea ratio • Urine specific gravity
Which lab values are affected if the blood specimen was hemolyzed?
Test results INCREASED by hemolysis:
• Slight change: phosphate, total protein, albumin, magnesium, calcium, alkaline phosphatase (ALP)
- Noticeable change: Iron, alanine transaminase (ALT), creatine kinase (CK), Coagulation tests
- Significant change: Potassium (K+), lactate dehydrogenase (LD), AST (aspartate aminotransferase)
Test results DECREASED by hemolysis:
• Slight change: haptoglobin (2’) and Bilirubin (2’)
• Significant change: Troponin T
Function of the kidneys.
Extract waste from the blood, balance body fluids, and form urine.
How do you decide which TF product to use for a patient? List all of the factors you are considering.
o Ability to walk o GI function o Mental state o Ability to chew o Severity of CKD o Other medical conditions such as diabetes o Patient compliance o Potential duration of tube feeding
Define osmolarity.
The concentration of a solution expressed as the total number of solute particles per liter
Describe the various tests related to iron: Hemoglobin
Concentration of oxygen carrying protein in RBC
Describe the various tests related to iron: Hematocrit
- Measures the percentage of whole blood volume that is made up of RBC
- Dependent on the number of RBC and size
Describe the various tests related to iron: Serum Iron
-Represents the amount of iron in the blood where it is bound to transferrin and available for RBC production
Describe the various tests related to iron: MCV
Mean Corpuscular Volume
-Measures the average size of RBC’s
Describe the various tests related to iron: Serum Ferritin
-Iron stores
Describe the various tests related to iron: Serum Transferrin
-Iron binding protein
Describe the various tests related to iron: Transferrin Saturation
-Indicates extent to which transferrin is saturated with iron represents the amount of iron available to the tissues
Describe the various tests related to iron: Soluble Serum Transferrin Receptors
-Increase with iron deficiency
Describe: Anabolic state
Building of muscle; it is the set of metabolic pathways that construct molecules from smaller units.
Describe: Hypermetabolic state
The physiological state of increased rate of metabolic activity and is characterized by an abnormal increase in the body’s basal metabolic rate.
Describe: Hypometabolic state
a rare state of reduced metabolism with symptoms resembling hypothyroidism
Who can do nutritional screening of a patient?
Nurses, DTR, RD, MD, PA
If a diet order is incorrect in the patient chart, what would you do?
First, make sure that the diet order is indeed incorrect. Seek out a reason for the change in diet. Is the diet incorrect for the right reasons (not on a renal diet anymore because of good lab values)? Depending on the hospital, the RD can change the diet order. However, if the diet is incorrect and the patient has already received the tray, call the kitchen immediately to inform them of the mistake and then talk to the patient about what’s going on. Provide the patient with a new tray
Which things would you look for when assessing nutrition status?
o Physical appearance
o Lab values
o Medical hx
o Family hx
What does the O in SOAP mean?
Objective
• Vital signs and measurements: temperature, blood pressure, pulse, respiration
• Documentation of the physical examination that was done
• Lab results
• Physical examination
• Anthropometric data
What does the A in SOAP mean?
Assessment→ A consolidation of Subjective and Objective information to form a short assessment (similar to a narrative).
• Medical diagnosis
• Etiologies
What does the P in SOAP mean?
Plan → anything that will be done as a consequence of the assessment.
• Action plan the health care provider will do to treat the patient’s concerns.
• Ordering extra labs
• Goal of therapy
• Date of next appointment
• Follow-up instructions to the client
