MNT for Neurological Disorders (part 2) Flashcards
____ is a chronic condition characterized by recurring seizures
Epilepsy
Seizures are caused by abnormal electrical activity of a group of ____ in the brain
Neurons
One commonly prescribed medication for epilepsy is _____
Phenytoin (Dilantin)
Food drug interactions with phenytoin (Dilantin):
-Decreases absorption of calcium
-May need vitamin D and folate
-Hypoalbuminemia causes drug toxicity
-Continuous tube feeding inhibits the absorption of phenytoin
If someone is on continuous tube feedings, hold tube feeding for ___-___ hours before and after giving phenytoin (Dilantin)
1-2
The ____ ____ is used as a last resort in children with intractable seizures
Ketogenic diet
The classic version of the ketogenic diet has what macro breakdown?
-2-4% carbohydrate
-90% fat
-6-8% protein
With the classic version of the ketogenic diet, there is a ___:___ ratio of fat to protein and carbohydrates combined
4:1
The classic version of the ketogenic diet allows around ___-___ grams of carbohydrates per day
10-15
The ketogenic diet may be ____ for epilepsy
Curative
What are two types of fat that may be used for the ketogenic diet?
-Long chain triglycerides
-Medium chain triglycerides (promotes ketogenesis faster)
The long-chain triglyceride version of the diet is calculated to meet…
-75% of estimated energy needs (using DRI)
-DRI for protein
-75% of maintenance fluid needs or 0.75-1.0 mL of fluid per kcal
With the ketogenic diet, we need to provide a ____ with minerals, as well as ____ and ____ supplements
-MVI
-Calcium
-Magnesium
For the classic 4:1 long-chain triglyceride version of the keto diet, we should provide ___% of the estimated energy requirements
75
How should we calculate fat needs for the classic 4:1 long-chain triglyceride version of the keto diet?
-Kcal needs x 0.9
-Divide by 9 kcal/g to convert to grams of fat
How should we calculate carbohydrate and protein needs for the classic 4:1 long-chain triglyceride version of the keto diet?
-Kcal needs x 0.1
-Divide by 4 kcal/g to convert to grams of protein and carbohydrates
-Provide DRI for protein and the remaining grams provided as carbohydrates
Possible early side effects of the ketogenic diet:
-Hypoglycemia
-Stomach upset
-Acidotic dehydration
-Hypokalemia
Possible late side effects of the ketogenic diet:
-Constipation
-GERD
-Hyperlipidemia
-Acute pancreatitis
What are two less restrictive ketogenic diet options?
-Modified Atkins diet (30% protein, 5% carb, 65% fat)
-Low Glycemic Index diet (30% protein, 10% carb, 60% fat)
____ ____ is caused by destruction of the myelin sheaths which protects the nerves and facilitates the transmission of nerve impulses
Multiple Sclerosis
The etiology of Multiple Sclerosis is unknown, but may be _____
Autoimmune
Risk factors for Multiple Sclerosis:
-Female gender
-Northern European ancestry
-Smoking
-Geographic location with less sunlight exposure
The is no known ____ for Multiple Sclerosis
Cure
Manifestations of MS of variable; many patients have periods of ____ and ____ while others have a more rapid progression
Remission and relapse
Early deficits seen with Multiple Sclerosis include…
-Diplopia
-Paresthesia
-Vertigo
-Dysarthria
-Ataxia
-Muscle weakness
Other manifestations of Multiple Sclerosis include…
-Neurogenic bladder
-Neurogenic bowel
-Cognitive impairment
-Inability to speak
-Blindness
-Tetraplegia
Nutritional implications of Mulitple Sclerosis:
-Decreased ability to obtain and prepare food and feed self during relapses or if disease progresses
-Dysphagia due to damaged cranial nerve and muscle weakness
MNT for Multiple Sclerosis:
-Maintain desirable body weight
-Maximize nutritional status
-Assess vitamin D status and provide supplementation with vitamin D3 if needed
-Some evidence that an anti-inflammatory diet may be beneficial
-If dysphagia, provide proper food texture and consistency of liquids using IDDSI diets
-Enteral nutrition if necessary
MNT for neurogenic bladder that may be caused by MS:
-Provide adequate fluid: distribute fluids evenly throughout day and limit prior to bedtime
-Increased intake of cranberry juice and blueberries may reduce incidence of UTI’s
MNT for neurogenic bowel that may be caused by MS:
-Provide adequate fiber, prunes, and adequate fluid
____ _____ is a neurodegenerative disease caused by the loss of dopaminergic neurons in the brain
Parkinson’s disease
Dopamine is a neurotransmitter involved in voluntary ____ ____
Motor control
Parkinson’s disease is ____ and ____
Progressive and disabling
Parkinson’s disease most commonly occurs between ages ___-___ years
40-70
The is no known ____ or ____ for Parkinson’s
Cause or cure
Manifestations of Parkinson’s:
-Muscular rigidity
-Bradykinesia
-Tremor at rest
-Poor balance
-GI dysmotility (constipation)
-Dysphagia and aspiration
-Dementia
-Malnutrition
-Eventually, become chair or bed-bound
MNT for Parkinson’s:
-Optimize dietary intake to maintain muscle mass for strength and mobility
-Assess ability to feed self
-Dysphagia evaluation
-Increase fiber and fluid for constipation
-Educate on food-drug breakdown
-May need enteral nutrition
What are two commonly used medications for Parkinson’s?
-Levodopa (synthetic form of dopamine)
-Sinemet (Levodopa + carbidopa)
What are side effects of Levodopa?
-N/V
-Constipation
-Anorexia
-Dry mouth
-Ageusia
-Dysgeusia
-Dyskinesia
Sinemet has ____ GI side effects than Levodopa
Fewer
Amino acids compete with Levodopa for absorption in both the intestine and blood-brain barrier, meaning that high ____ foods decrease absorption of the drug
Protein
MNT for Levodopa:
-Provide most of daily protein needs in the evening
-Take with meals (to decrease GI side effects)
-Excessive vitamin B6 (>5 mg) decreases effectiveness of drug
___ ____ ____ causes impaired nerve impulse transmission due to permanently damaged areas of the spinal cord
Spinal cord injury
An ____ spinal cord injury permits some voluntary motor activity and sensation below the level of injury
Incomplete
A ____ spinal cord injury allows no motor activity or sensation below the level of injury
Complete
____ is paralysis of only the lower extremities
Paraplegia
_____ is paralysis of all 4 extremities
Tetraplegia
The acute phase of spinal cord injury is the first ____ weeks post injury
4
What might occur in the acute phase of spinal cord injury?
-Spinal shock (severe hypotension)
-Possible respiratory failure
-Hypercatabolic (dramatic weight loss, loss of LBM)
-Paralytic ileus
Nutrition assessment for someone with spinal cord injury:
-Weight (initially: severe weight loss, LBM; long term: possible weight gain due to less LMB, physical inactivity)
-Calculating IBW
-BMI is not valid in this population
To calculate IBW for someone with paraplegia, subtract ___-___% of IBW; for tetraplegia, subtract ___-___%
5-10%; 10-15%
Nutritional concerns for individuals with spinal cord injury:
-Inability to obtain food, prepare food, and feed self
-Neurologic bowel (constipation)
-Obesity
-Increased risk for CVD
-Osteopenia and osteoporosis
-Neurogenic bladder, UTI, nephrolithiasis
-Skin breakdown-> pressure injury
Nutritional needs for spinal cord injury should be ____
Individualized
In the acute phase of spinal cord injury, use ____ ____
Indirect calorimetry
If calculating energy needs for the acute phase of spinal cord injury using MSJE, what activity factor and stress factor should be used?
-Activity factor: 1.1
-Stress factor: 1.2
In the rehabilitation phase, paraplegics should get ___ kcal/kg
28 kcal/kg
In the rehabilitation phase, tetraplegics should get ___ kcal/kg
23
In the acute phase of spinal cord injury, protein needs are ____ g/kg IBW
2.0
In the rehabilitation phase of spinal cord injury, protein needs are ___-___ g/kg weight as long as there are no infections or pressure injuries
0.8-1.0
Fluid needs for someone with a spinal cord injury is ___-___ mL/kg
30-40
People with spinal cord injury may have increased fluid needs to…
-Prevent kidney stones
-Prevent constipation
MNT for the acute phase of spinal cord injury:
-May need enteral nutrition due to intubation (initiate within 24-48 hours of admission to ICU)
-If prolonged small bowel ileum post-injury, parenteral nutrition may be indicated
MNT for the rehabilitation phase of spinal cord injury:
-Oral nutrition with high biological value protein, soluble and insoluble fiber, and adequate fluid
-Adequate energy to promote healthy body weight
-AHA guidelines for CVD prevention
-May need adaptive feeding devices
MNT for neurogenic bowel:
-Fiber: 15 g/d
-Fluid: 1 mL fluid per kcal + 500 mL/d OR 40 mL/kg BW +500 mL/d
