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Advanced Medical Nutrition Therapy > MNT for Neurological Disorders (part 2) > Flashcards

MNT for Neurological Disorders (part 2) Flashcards

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USMLE® Step 1 flashcards
1
Q

____ is a chronic condition characterized by recurring seizures

A

Epilepsy

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2
Q

Seizures are caused by abnormal electrical activity of a group of ____ in the brain

A

Neurons

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3
Q

One commonly prescribed medication for epilepsy is _____

A

Phenytoin (Dilantin)

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4
Q

Food drug interactions with phenytoin (Dilantin):

A

-Decreases absorption of calcium
-May need vitamin D and folate
-Hypoalbuminemia causes drug toxicity
-Continuous tube feeding inhibits the absorption of phenytoin

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5
Q

If someone is on continuous tube feedings, hold tube feeding for ___-___ hours before and after giving phenytoin (Dilantin)

A

1-2

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6
Q

The ____ ____ is used as a last resort in children with intractable seizures

A

Ketogenic diet

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7
Q

The classic version of the ketogenic diet has what macro breakdown?

A

-2-4% carbohydrate
-90% fat
-6-8% protein

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8
Q

With the classic version of the ketogenic diet, there is a ___:___ ratio of fat to protein and carbohydrates combined

A

4:1

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9
Q

The classic version of the ketogenic diet allows around ___-___ grams of carbohydrates per day

A

10-15

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10
Q

The ketogenic diet may be ____ for epilepsy

A

Curative

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11
Q

What are two types of fat that may be used for the ketogenic diet?

A

-Long chain triglycerides
-Medium chain triglycerides (promotes ketogenesis faster)

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12
Q

The long-chain triglyceride version of the diet is calculated to meet…

A

-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

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13
Q

With the ketogenic diet, we need to provide a ____ with minerals, as well as ____ and ____ supplements

A

-MVI
-Calcium
-Magnesium

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14
Q

For the classic 4:1 long-chain triglyceride version of the keto diet, we should provide ___% of the estimated energy requirements

A

75

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15
Q

How should we calculate fat needs for the classic 4:1 long-chain triglyceride version of the keto diet?

A

-Kcal needs x 0.9
-Divide by 9 kcal/g to convert to grams of fat

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16
Q

How should we calculate carbohydrate and protein needs for the classic 4:1 long-chain triglyceride version of the keto diet?

A

-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

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17
Q

Possible early side effects of the ketogenic diet:

A

-Hypoglycemia
-Stomach upset
-Acidotic dehydration
-Hypokalemia

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18
Q

Possible late side effects of the ketogenic diet:

A

-Constipation
-GERD
-Hyperlipidemia
-Acute pancreatitis

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19
Q

What are two less restrictive ketogenic diet options?

A

-Modified Atkins diet (30% protein, 5% carb, 65% fat)
-Low Glycemic Index diet (30% protein, 10% carb, 60% fat)

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20
Q

____ ____ is caused by destruction of the myelin sheaths which protects the nerves and facilitates the transmission of nerve impulses

A

Multiple Sclerosis

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21
Q

The etiology of Multiple Sclerosis is unknown, but may be _____

A

Autoimmune

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22
Q

Risk factors for Multiple Sclerosis:

A

-Female gender
-Northern European ancestry
-Smoking
-Geographic location with less sunlight exposure

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23
Q

The is no known ____ for Multiple Sclerosis

A

Cure

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24
Q

Manifestations of MS of variable; many patients have periods of ____ and ____ while others have a more rapid progression

A

Remission and relapse

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25
Q

Early deficits seen with Multiple Sclerosis include…

A

-Diplopia
-Paresthesia
-Vertigo
-Dysarthria
-Ataxia
-Muscle weakness

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26
Q

Other manifestations of Multiple Sclerosis include…

A

-Neurogenic bladder
-Neurogenic bowel
-Cognitive impairment
-Inability to speak
-Blindness
-Tetraplegia

27
Q

Nutritional implications of Mulitple Sclerosis:

A

-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

28
Q

MNT for Multiple Sclerosis:

A

-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

29
Q

MNT for neurogenic bladder that may be caused by MS:

A

-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

30
Q

MNT for neurogenic bowel that may be caused by MS:

A

-Provide adequate fiber, prunes, and adequate fluid

31
Q

____ _____ is a neurodegenerative disease caused by the loss of dopaminergic neurons in the brain

A

Parkinson’s disease

32
Q

Dopamine is a neurotransmitter involved in voluntary ____ ____

A

Motor control

33
Q

Parkinson’s disease is ____ and ____

A

Progressive and disabling

34
Q

Parkinson’s disease most commonly occurs between ages ___-___ years

A

40-70

35
Q

The is no known ____ or ____ for Parkinson’s

A

Cause or cure

36
Q

Manifestations of Parkinson’s:

A

-Muscular rigidity
-Bradykinesia
-Tremor at rest
-Poor balance
-GI dysmotility (constipation)
-Dysphagia and aspiration
-Dementia
-Malnutrition
-Eventually, become chair or bed-bound

37
Q

MNT for Parkinson’s:

A

-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

38
Q

What are two commonly used medications for Parkinson’s?

A

-Levodopa (synthetic form of dopamine)
-Sinemet (Levodopa + carbidopa)

39
Q

What are side effects of Levodopa?

A

-N/V
-Constipation
-Anorexia
-Dry mouth
-Ageusia
-Dysgeusia
-Dyskinesia

40
Q

Sinemet has ____ GI side effects than Levodopa

A

Fewer

41
Q

Amino acids compete with Levodopa for absorption in both the intestine and blood-brain barrier, meaning that high ____ foods decrease absorption of the drug

A

Protein

42
Q

MNT for Levodopa:

A

-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

43
Q

___ ____ ____ causes impaired nerve impulse transmission due to permanently damaged areas of the spinal cord

A

Spinal cord injury

44
Q

An ____ spinal cord injury permits some voluntary motor activity and sensation below the level of injury

A

Incomplete

45
Q

A ____ spinal cord injury allows no motor activity or sensation below the level of injury

A

Complete

46
Q

____ is paralysis of only the lower extremities

A

Paraplegia

47
Q

_____ is paralysis of all 4 extremities

A

Tetraplegia

48
Q

The acute phase of spinal cord injury is the first ____ weeks post injury

A

4

49
Q

What might occur in the acute phase of spinal cord injury?

A

-Spinal shock (severe hypotension)
-Possible respiratory failure
-Hypercatabolic (dramatic weight loss, loss of LBM)
-Paralytic ileus

50
Q

Nutrition assessment for someone with spinal cord injury:

A

-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

51
Q

To calculate IBW for someone with paraplegia, subtract ___-___% of IBW; for tetraplegia, subtract ___-___%

A

5-10%; 10-15%

52
Q

Nutritional concerns for individuals with spinal cord injury:

A

-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

53
Q

Nutritional needs for spinal cord injury should be ____

A

Individualized

54
Q

In the acute phase of spinal cord injury, use ____ ____

A

Indirect calorimetry

55
Q

If calculating energy needs for the acute phase of spinal cord injury using MSJE, what activity factor and stress factor should be used?

A

-Activity factor: 1.1
-Stress factor: 1.2

56
Q

In the rehabilitation phase, paraplegics should get ___ kcal/kg

A

28 kcal/kg

57
Q

In the rehabilitation phase, tetraplegics should get ___ kcal/kg

A

23

58
Q

In the acute phase of spinal cord injury, protein needs are ____ g/kg IBW

A

2.0

59
Q

In the rehabilitation phase of spinal cord injury, protein needs are ___-___ g/kg weight as long as there are no infections or pressure injuries

A

0.8-1.0

60
Q

Fluid needs for someone with a spinal cord injury is ___-___ mL/kg

A

30-40

61
Q

People with spinal cord injury may have increased fluid needs to…

A

-Prevent kidney stones
-Prevent constipation

62
Q

MNT for the acute phase of spinal cord injury:

A

-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

63
Q

MNT for the rehabilitation phase of spinal cord injury:

A

-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

64
Q

MNT for neurogenic bowel:

A

-Fiber: 15 g/d
-Fluid: 1 mL fluid per kcal + 500 mL/d OR 40 mL/kg BW +500 mL/d

Advanced Medical Nutrition Therapy (14 decks)

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