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RD Exam > Module 2 > Flashcards

Module 2 Flashcards

1
Q

Steps in NCP

A

Assess, Diagnose, Intervene, Monitor & Evaluate

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2
Q

Joint Commission

A

nutrition risk identified in hospitalized patients w/in 24 hrs

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3
Q

Food Frequency Lists

A

quick way to determine intakes on large numbers of people

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4
Q

Measure of Somatic Protein

A

skeletal muscle mass - mid arm muscle area; good for measuring kids

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5
Q

Waist/Hip Ratio

A

difference b/n android & gynoid obesity; >1.0 men, >0.8 women

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6
Q

Hair assessment

A

thin, sparse, dull - protein deficiency

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7
Q

Skin

A

pale, dry, scaly - poor intake iron, folic acid, zinc deficiency

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8
Q

Serum albumin

A

3.5-5.0 - visceral protein (blood & organs); > 5 - dehydration

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9
Q

PAB - pre albumin

A

16-40; short half-life

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10
Q

Serum Creatinine

A

0.6-1.4; somatic protein, renal disease

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11
Q

BUN

A

10-20; protein intake, renal disease

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12
Q

CRP - c-reative protein

A

marker of acute inflammatory stress

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13
Q

Megastrol Acetate

A

appetite stimulant

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14
Q

Loop diuretics

A

deplete K+, mg, ca, Na, Chl; decrease K+, Mg

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15
Q

Lithium Carbonate

A

Maintain consistant Na & caffeine intake; If Na & caffeine restricted, lithium excretion decreases - toxicity

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16
Q

Propofol

A

in oil, consider fat Kcals

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17
Q

Isoniazid (treats TB)

A

depletes pyridoxine, peripheral neuro, interferes w/ vit D.

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18
Q

Vit B6 & Protein

A

decreases effectiveness of levodopa (parkinsons); take in AM w/ <10 gm pro.

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19
Q

Incidence

A

of new cases of a disease over a period of time

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20
Q

Prevalence

A

total # of existing people w/ a disease during a period of time

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21
Q

Food security

A

access to sufficient food for active & healthy life

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22
Q

Nutrition Survey

A

exam of pop group at a particular point in time

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23
Q

Nutrition Surveillance

A

continuous collection of data; use ht, wt, Hct, Hgb, serum cholesterol

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24
Q

NSI - Nutrition Screening Initiative

A

promote nutrition & improve care for elderly; DETERMINE, LEVEL I, LEVEL II

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25
Q

USDA Nationwide Food Consumption Survey (NFCS)

A

eval 7 nutrients, obtain info on food intake from entire US

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26
Q

Behavioral Risk Factor Surveillance System (BRFSS)

A

>18 yrs, w/ telephone

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27
Q

WIC

A

provides food, nutrition education; health exam required; not an entitlement pgm

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28
Q

Extension Food & Nutrition Education Pgm (EFNEP)

A

all education - no food. provides grants to universities that assist in community dev

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29
Q

Elderly Nutrition Pgm (ENP)

A

Congregate Meals, home delivered meals, all ages > 60

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30
Q

Medicare

A

health insurance for people >65; any age w/ ESRD

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31
Q

Medicaid

A

payment for medical care for all eligible needs, all ages, blind, disabled, dependent children

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32
Q

Entitlement Pgm

A

payment of benefits to all eligible people as established by law. Ex. SNAP, Medicare, Medicaid

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33
Q

Nutrition Diagnosis

A

a nutritional problem that dietetics professionals are responsible for treating independently

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34
Q

Three domanins

A

NC - Clinical

NI - Intake (always the priority)

NB - Behavorial/Environmental

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35
Q
A
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36
Q

PES

A

One problem

One etiology

Assessment of signs & symptoms

Ex: Chewing difficulty (P) related to oral surgery (E) as evidence by missing teeth (S)

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37
Q
A
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38
Q

Altered GI Function (NC 1.4)

A

looks at probs inside the GI tract w/ changes in digestion, absorption, +/- elimination

Indicators: abnormal digestive enzyme & fecal fat studies; distention; nausea; vomiting; diarrhea; steatorrhea; constipation; malabsorb; IBD; diverticulitis

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39
Q

Impaired nutrient utilization (NC 2.1)

A

prob w/ metabolism of nutrients once entered the circulatory system. Endocrine functions.

Thin, wasted appearance, abnorm liver function, pit hormone, hypogly, hypergly, renal or liver failure, IEM

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40
Q

Evidence based dietetics practice

A

reviewed scientific evidence used in making decisions

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41
Q

Discharge Plans

A

begins on day 1 - discharge note includes summary of nutrition therapies & outcomes

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42
Q

Ulcer

A

eroded musosal lesion; h. pylori; antibiotics to fix; diet - as tolerated, well balanced; avoid late night snacks;

Avoid excess caffeine & etoh

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43
Q

Hiatal Hernia

A

protrusion of portion of stomach above diaphragm into chest; heartburn main Sx

small, bland feedings, avoid late night snacks, caffeine, chili powder & b. pepper

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44
Q

Dumping Syndrome

A

follows gastrectomy (Billroth I, II)

cramps, weakness, rapid pulse, dizziness, BP drops,

when sugar enters the jujenum, H2O drawn in to achieve osmotic balance. Causes drop in BP. BG rises - stimulates insulin, causing drop in BG below fasting. “Reactive hypoglycemia”

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45
Q

Deficiencies due to Gastrectomy

A

Iron - bleeding, impaired absorbtion due to loss of acid

B12 - lack of intrinsic factor & bacterial overgrowth - pernicious anemia

Folate - need B12 for transport inside cell; poor intake & low serum iron

  • Small, dry feedings, fluids before/after meals, restrict concentrated sweets, moderate fat, B12 injections -
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46
Q

Gastroparesis

A

delayed gastric emptying

moderate-severe hypergly

prokinetics, increase stomach contractility

small, frequent meals, pureed foods, avoid high fiber

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47
Q

Diverticular Disease

A

Losis - prescence of diverticula; small mucosal sacs that protrude through intestine wall; need high fiber diet

Lisis - when diverticula become inflammed as a result of food & residue accumulation & bacterial action; clear liquids, low-res, or elemental, gradual return to high fiber

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48
Q

Fiber

A

Provides indigestible bulk, promotes intestinal function

Dietary - non digestible CHO & lignin, binds H2O, increase fecal bulk (legumes, wheat bran, fruits, veggies, whole grains)

Soluble - decrease serum CHL by binding bile acids converting more CHL into bile; delay gastric emptying, absorb H2O (fruits, veggies, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, bananas)

25-38 gms/day

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49
Q

IBD

A

regional enteritis (Crohns); affects terminal ileum, wt. loss, diarrhea

B12 efficiency

ulcerative colitis (UC) - chronic bloody diarrhea, electrolyte disturbances, dehydration

Maintain fluid & electrolyte balance

Flare-ups - bowel rest, PN or minimal residue, Vit C given at therapeutic levels

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50
Q

IBS

A

chronic ab discomfort, alt. intestine motility

goals - adequate intake; avoid large meals, exccess caffeine, ETOH, sugars

use food diary

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51
Q

Lactose Intolerance

A

lactase deficiency. when lactose remains intact, H2O is drawn into intestine to dilute the load causing distention, cramps, diarrhea.

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52
Q

Lactose Intolerance Test

A

If intolerant - BG rise <25 above fasting (flat curve). If tolerant - BG > 25 above fasting (normal)

yogurt & some aged cheese may be tolerated

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53
Q

Diarrhea

A

Children - agressive & immediate rehydration w/ fluids & electrolytes

Chronic non-specific infantile - give 40% kcals from fat, balance w/ limited fluids, restrict juices w/ high osmolar load (apple, grape)

Adult - remove the cause; bowel rest, replace lost fluids & electrolytes; BRAC diet (prebiotics); probiotics

Steatorrhea - normal stool fat 2-5g; > 6g indicative of malabsorption

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54
Q

Short Bowel Syndrome (SBS)

A

malabsorption, malnutrtion, fluid & electrolyte imbalance, wt. loss

loss of ileum, ileocecal valve, & loss of colon concerning

jeunal resection - ileum can adapts & take over jejunum functions

55
Q

Ileal resection

A

Distal - absorption of B12, intrinstic factor, bile salts

ileum normally absorbs major portion of fluid in GI tract

if ileumjcan’t recycle bile salts - lipids are not emulslified, leads to malabsorption of fat-soluable vitamins

56
Q

Loss of Colon

A

water & electrolytes loss

57
Q

Nutritional Care of SBS

A

PN

EN - start early to stimulate growth

Jejunal - normal balance of CHO, PRO, Fat, avoid lactose, large amount of concentrated CHO

Ileal - limite fat, use MCT (doesn’t require bile salts), supplement fat-soluable vits; PN B12

58
Q

Acute Viral Hepatitis

A

HAV - fecal, oral transmission

HBV - sexually transmission

HCV - blood to blood contact

acute hep - 1-1.2 gm pro, cell regeneration; helps prevent fatty liver; moderate to liberal fat as tolerated, but limit if steatorrhea

small, frequent meals because of anorexia; encourage coffee(antioxidant)

MV w/ B complex, C, K, zinc

59
Q

Cirrhosis

A

damage to liver tissue; blood flow disrupted

PRO deficiencies lead to ascites, fatty liver, impaired b. clotting

Rx: high Pro (.8-1.0), in stress >1.5 or as tolerated; 25-35 kcals; <40 gm (25-40%) fat; low-fiber if varices present; low Na if edema or ascites

Fluid restriction 1-1.5 liters depending on severity

60
Q

Ascites in Cirrhosis

A

when blood can’t leave liver; liver expands & when storage has been exceeded, pressure caused by Î BV forces fluid through liver into peritoneal cavity

low serum albumin may be due to dilution factor

61
Q

Cirrohsis Malnutrition

A

ETOH causes inflammation of GI tract & interferes w/ absorption of thaimin, B12, Vit C, folic acid

62
Q

Hepatic Failure (ESLD)

A

liver function decreased to < 25%

liver can’t convert ammonia into urea - accumulates (encephalopathy)

If not in coma - high levels of PRO (1-1.5 gm); 30-35 kcals; 30-35% kcals from fat w/ MCT; low Na if ascites

Lactulose (hyperosmotic lax removes Nitrogen); neomycin

63
Q

Gallbladder Disease

A

cholecystitis - infection causes cholelithiasis

cholecystectomy - removal, bile now secreted from liver directly into intestine

Rx - low fat, acute 30-45 gms; chronic 25-30% of kcals

64
Q

Pancreatitis

A

1) inflammation w/ edema; mucous & fat necrosis
2) can be due to blockage or reflux of ductal system
3) acute - bowel rest, IV fluids; progress to low-fat d; elemental EN into jejunum may be tolerated
4) chronic - PERT w/ meals & snacks; max fat tolerated; PN B12; antacids; avoid large meals, fatty foods & ETOH; PN may be needed

65
Q

Cystic Fibrosis

A

disease of exocrine glands - secretion of thick mucus that obstructs glands & ducts; chronic pulm disease

pancreatic enzyme defiiciency; high perspiration electrolyte levels; malabsorption

PERT w/ meals & snacks

high PRO, high KCAL, unrestricted fat, liberal Na (may need 110-200% of normal needs)

PRO 15-20%; CHO 45-55%; FAT 35-40%; addt’l 2-4 gms Na in hot weather

H2O soluable vits & fat soluable vits (A & E)

66
Q

HTN

A

Systolic >140 or diastolic >90 or both

obesity a factor

DASH diet; Na restriction <2400; limited ETOH; increase Ca

thiazide diuretics - may cause hypokalemia

67
Q

Chylomicron

A

transports dietary tri’s from gut to adipose cells

synthesized in intestine from dietary fat

lowerst density from liver to adipose

68
Q

Metabolic Syndrome

A

3 or more:

BP >130 systolic or >85 diastolic

elevated TG >150

fasting BG >110

low HDL <40-50

waist >35-40 inches

69
Q

Therapeutic Lifestyle Change (TLC)

A

up to 35% kcals from fat, <7% from sat. fat, <10% PUFA, <20% MUFA, <200 mg cholesterol

25-30 gm fiber

increase physical activity 30 minutes daily

70
Q

Heart Failure

A

weakened heart fails to maintain adequate output; dimished b. flow; causes kidneys to hold Na & fluid –> wt. gain

Rx - digitalis (helps strength of contractions); diuretics (nutrient loss, BG intolerance, increased uric acid)

low Na (2-3g), DASH, fluid restriction, 1.2g PRO, >1.37g if depleted

Thiamin status, DRI folate, Mg, MVI w/ B12

71
Q

Nephron

A

Made up of

1) Bowman’s capsule (produces ultrafiltrate & blocks passage of RBC & proteins)
2) proximal convoluted tubules (nutrient reabsorption)
3) Loop of Henle (H2O & Na balance)
4) Distal tubule (acid-base balance)

72
Q

Renal Functions

A
  1. filtration (RBC, Pro stays in blood)
  2. absorption (100% of glucose, AA, 85% H2O, Na, K+)
  3. excretion (wastes, urea, ketones)
  4. secretion (hormones that control BP, blood components, ions that maintain acid-base balance)
73
Q

Renal Hormones

A
  1. Vasopression (ADH) - hypothalamus/pituitary; elevates BP, increases H2O reabsorption
  2. Renin - vasoconstrictor; glomerulus when BV decreases; stims aldersterone to increase Na absorption & return BP to normal
  3. Erythropoietin (EPO) - kidneys; stimulates bone marrow to produce RBC
74
Q

Renal Tests

A
  1. GFR - decreased, creatinine clearance
  2. Serum Creatinine - increased
  3. BUN:creatinine ration - >20:1 - pre-renal state (BUN reabsorption increased due to AKD; >10:1 - reduced BUN reabsorption due to renal damage
  4. Renal solute load - solutes excreted in 1L urine (measures nitrogen & Na); daily fixed solute load 600mOsm
75
Q

Renal Calculi

A

Ca stones

Rx: 1.5-2.0 L fluid/day - need to dilute urine to decrease concentration

akaline ash / acid ash diet - prevent acidic stone, creates akaline ash in urine, increases cations (Ca, Na, K, Mg); adding fruits / veggies / brown sugar/ molasses

prevent akaline stones - create acid ash; increase anions (Cl, Ph, Su); meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye

76
Q

Acute Kidney Injury/Acute Renal Failure

A

sudden shutdown w/ previous normalcy; due to burns, accident, obstruction, dehydration

Rx: IV glucose, lipids, Pro - if no dialysis, .6-.75gm/kg increase to 1.2/kg, as GFR returns to normal

1.2-1.5gm/kg if catabolic or dialysis

77
Q

Nephrotic Syndrome

A

nephrosis - defect in capillary basement membranes of glomerulus - Pro escapes

causes: albuminuria, edema, malnutrition, hyperlipidemia

protein restriction 0.8-1.0gm/kg - 75% HBV

<30% fat, 10% PUS, 200 mg chl, 35 kcals/kg/day

78
Q

Chronic Kidney Disease

A

anemia due to deficient production of hormone erythropoietin by kidney

Kcals - Stage 1-3 based on EER; Stage 4-5 30-35 kcals

Pro restricted when GFR falls: <60 - 0.8gm/kg; <25 0.6gm/kg

79
Q

ESRD

A

usually associate w/ BUN >100, Cr 10-12

retention of Nitrogen

20 gm HBV, increase kcals, control edema, prevent deficiencies

80
Q

Chronic Renal Failure

A

hemodialysis - 1.2 gm pro; 30-35 kcals, 2-3 gm K+, >1800 mg Ca, >1000 mg Ph

if < 1liter fluid output - 2 gm Na, 1-1.5 L fluid

peritoneal dialysis - 1.2-1.3 gm pro; 30-35 kcals, 2-4 gm Na, K+ unrestricted, <1000 Ph, 1-3 L fluid, may need extra Thiamin

81
Q

DM

A

Type I - insulin deficient - dependent insulin

Type II - insulin resistence w/ relative insulin deficiency - may need insulin

Normal BG - 70-100; <140 post prandial

FBG - 100-125 - impaired

FBG >126 - diabetes

A1C - < 7.0% for diabetics (average for 90 days)

82
Q

Goals for DM

A
  1. maintain normal BG - 70-130 pre-prandial; < 180 post prandial
  2. optimal serum lipids
  3. BP 130/80
  4. prevent/treat chronic complications
83
Q

Gestational DM

A

risk factors: BMI >30

increases risk of fetal macrosomia (large birth wt), fetal hypoglycemia at birth, risk for mother to develop DM post partum

84
Q

CHO Exchanges

A

Starch/bread: 15 CHO; 0-3 PRO; <1 Fat; 80 kcals

Fruit: 15 CHO; 0 PRO; 0 Fat; 60 kcals

Milk: 12 CHO; 8 PRO; 0-3 Fat; 100 kcals

Veggies: 5 CHO; 2 PRO; 0 Fat; 25 kcals

Meat: O CHO; 7 PRO; 0-8 Fat; 45-100 kcals

Fat: 0 CHO; 0 PRO; 5 Fat; 45 kcals

85
Q

Insulin

A
  1. rapid-acting: novolog, humalog: 5-15 minutes before eating, lasts 4 hrs
  2. short-acting: 30-45 minutes before meals; 1 unit = 15 CHO; lasts 3-6 hrs
  3. intermediate (NPH): onset 2-4 hrs; lasts 10-18 hrs
  4. long-lasting: lantus, levemir; onset 2-4 hrs; lasts 18-24 hrs
  5. oral meds: glucotrol, metformin, actos; enhance insulin action, improve insulin sensitivity
86
Q

Dawn Phenomenom

A

increase in early morning BG

increase need for insulin at dawn

87
Q

Acute ketoacidosis

A

hyperglycemia due to insulin deficiency or excess CHO intake, dehydration

Rx: insulin, rehydration

88
Q

Acute hypoglycemia

A

insulin reaction (shock) due to insulin excess or lack of eating

Rx: glucose - start w/ 15g & wait 15 mins, if <70, then give another 15 gm, repeat until BG normal

89
Q

Reactive Hypoglycemia

A

overstim of pancreas or increased insulin sensitiivity; BG falls below normal 2-5 hrs after eating (<50)

weak, trembling, extreme hunger

avoid simple sugars, 5-6 small meals, spread intake of CHO

90
Q

Gout

A

disorder of purine met - increased serum uric acid, deposit in joints, causing pain/swelling

Diet - low purine (no broth, anchovies, sardines, mackerel, herring, organ meats)

may need wt. reduction

91
Q

Inborn Erros of Metabolism

A
  1. Galactosemia - due to missing enzyme that would have converted galactose-1-PO4 to glucose-1-PO4; treated by diet. No galactose or lactose (organ meats, MSG, milk, whey, casein, bell peppers, dates)
  2. Urea Cycle Defects - can’t synthesize urea from ammonia resulting in accumulation; PRO restriction (1.0,1.5,2.0 based on tolerance)
  3. Phenylketonuria (PKU) - missing phenylalanine hydroxylase which would convert phenylalanine (the essential AA) into tyrosine - accumulates and creates poor intellectual function; Rx - restrict phenylalanine (eggs, milk, cheese, meats). Need for tyrosine supplement; avoid aspertame
  4. Maple Syrup Urine Disease - can’t metabolize BCAAs (leucine, isoleucine, valine); result in poor sucking reflect, anorexia; Rx - restrict BCAAs; avoid eggs, meat, nuts other dairy
92
Q

Osteoporosis

A

Type I - post menopausal

most prevelant in white women

Causes: malnutrition, lack of exercise, decline in estrogen

Result: reduction in amount of bone due to defective Ca absorption

Rx: HRT, strength training, Vit D (400-800mg), Ca (1200mg), PRO, 5 servings of F & V

93
Q

Epilepsy

A

Seizures

Phenobarb & Dilantin interfere w/ Ca absorption, may need Vit D, Ca & Thiamin

EN decrease bioavailabity - so hold feedings >2 hrs

Ketogenic diet - high fat, low CHO - creates ketones which inhibit neurotransmitters 4:1 fat:non-fat

Need Ca, D, folate, B6 & B12

94
Q

Celebral Palsy (CP)

A

inadequate control over voluntary muscles (spasms)

Spastic - difficult stiff movement: Rx low kcal, high fluid, high fiber

Non-spastic - athetoid, involuntary wormlike movement, irregular motions (leads to wt. loss); Rx high kcal, high PRO, finger foods

95
Q

Hyperkinesis

A

ADHD, ADD

no salicylates, artifical colors, flavors

not proven, but result may be placebo effect

96
Q

Alzheimer’s

A

Avoid distractions, need regular consistent meals

may need verbal cues to chew & swallow

97
Q

Anemia

A
  1. Microcytic, hypochromic : small, pale cells - due to iron def. chronic infections, malignancies, renal disease
  2. Macrocytic, megaloblastic: few large cells fille w/ Hgb - due to def. of folate or B12 - Schilling test for pernicious anemia
98
Q

Immunoglobumin E (IgE)

A

mediated reaction to normally harmless food PRO

Common: peanuts, eggs, soy, wheat, shellfish, milk

RAST - allergy skin test

99
Q
A
100
Q

Fever

A

BMR increases 7% for each degree over 98.6

excessive fluid loss leads to severe dehydration

101
Q

Burns

A

immediate shock period

BMR increases 50-100%

replace fluids & electrolytes

increase kcals

PRO 1.5-3.0

102
Q

Response to Injury

A

hypermetabolic, hypovolemia, fluid resusciation, hyperglycemia (epinephrine suppresses insulin, insulin resistance), hyperinsulinemia, increase glucagon

fluid & Na retention, K+ excretion, loss of nitrogen, zinc, Ph

1.5-2.0 PRO, adequate, but not excessive kcals

103
Q

Cancer

A

causes PRO-kcal malnutrtion, malabsorption, fluid/electrolyte imbalance

  1. altered taste (add flavorings)
  2. aversions, thrush (elminations)
  3. thrush (avoid spicy foods, need bland, soft foods, chilled/frozen foods)
  4. xerostomia (dry mouth - moisten foods)
  5. mucositis (avoid fresh, raw uncooked)
  6. chemo - nausea, vomiting, malabsorb
104
Q

Marasmus

A

PRO, kcal starvation

severe fat/muscle wasting

triceps skinfold, arm muscle circumference decreased

105
Q

Iatrogenic Malnutrition

A

PRO/kcal malnutrition

due to treatment, hospital, meds

106
Q

Anorexia

A

disorted body image, dramatic wt. loss

Rx: correct electrolyte imbalance (K+)

plan w/ patient

focus on health benefits of food

107
Q

Bulimia

A

binge & purging

usually close or normal wt

damage to teeth, throat, esophagus, rectal bleeding, bruised knuckles

108
Q

Obesity

A

I - BMI 30-34.9

II - BMI35-39.9

III - >40

3500 kcals/# body fat

healthy obese - elevated LDL, normal to low HDL

109
Q

Bariatric Surgery

A

BMI > 40 or BMI > 35 w/ comorbitity

Bypass - roux-en-y, small gastric pouch, connected to jejunum

dumping syndrome common

potential anemia, B12, K+, Mg, folate deficiencies

110
Q

Prader Willi Syndrome

A

congenital disorder - chromosome 15 depletion

subnormal LBM, supranormal body fat

no sense of satiety, decrease BMR

obesity at 2-3 yrs

111
Q

Achlasia

A

disorder of lower esophagela sphincter motility, does not relax & open

causes dysphagia

pureed moist thick foods, progress to thick liquids

112
Q

AIDS

A

diarrhea, malabsorption, nausea, vomiting, wt. loss

preserve lean body mass, prevent wt. loss, prevent HIV wasting

BEE x 1.3 for asymptomatic

PRO 0.8g/kg - 1.2-2.0 g/kg if wasted LBM; avoid raw food, bacteria, neutropenic diet

PEDS: high PRO, high kcal w. supplements for wt. gain

113
Q

COPD

A

emphysema (alveoli lose elasticity), thin, cachectic, difficulty exhaling

chronic bronchitis (excess mucus production, productive cough)

wt. loss, anorexia, emaciation

Rx: maintain stable wt, replete not overfeed, high kcal, high PRO

1-1.5 g/kg, 15-20% PRO, 30-45% fat, 40-55% CHO

114
Q

Enteral Formulas

A
  1. polymeric - normal GI function; initiated full-strength 10-40ml/hr; least expensive, intact PRO, isotonic (osmolality closest to blood)
  2. elemental - used w/ malabsorp; predigested PRO or AA; absorbed in promixal intestine, low res, compromised GI
  3. specialized - nepro, pulmocare, glucerna; the more specialized the more $
115
Q

Enteral Access

A
  1. length of time
  2. risk of aspiration
  3. anatomy
  4. clincial status
  5. normal/abnormal digestion & absorption
  6. 1cc H2O for each kcal ingested
116
Q

Short-term EN

A

3-4 weeks, NG tube, normal GI

bolus method

continuous drip - feeding pump, cyclic feedings, gravity

transplyoric

117
Q

Long-term EN

A

gastrostomy or jejunostomy if more than 3-4 wks

PEG - tube into stomach through ab wall

118
Q

Peripheral Parenteral Nutrition

A

Peripheral - short-term 5-7 days, supplement w/ EN

119
Q

PN Solutions

A
  1. IV dex - 3.4 kcals; highest concentration of dex used in PN 10%
  2. PRO - 3-15% solutions
  3. IVFE - intralipid; 10% 1.1 kcals, 20% 2.0 kcals
  4. solutions limited to 800-900 mOsm (peripherally)
120
Q

TPN

A

through central venous catheter (minimizes phlebitis)

altered GI function; impaired nutrient utilization

concern - translocation of bacteria, not using gut - wall breaks down, bacteria can cause sepsis

121
Q

TPN Solutions

A
  1. PRO - 1 gm nitrogen/150 kcals; 1-1.5 gm/kg; AA 3-15% (% # of gms in 100 mls)
  2. CHO - 35-50 kcals/kg, up to 70% dex (10% provides 100g CHO/liter); begin at <20-25 kcals/kg; dex infusion <4-5 mg/kg/min to prevent hyperglycemia
  3. Fat - needed to prevent EFAD; to prevent give 500cc of 10% fat emulsion 1-2x/ wk; symptoms of essentail FA defiency - red spots
122
Q

Transitional feedings

A

introduce min amount of full-strength EN at low rate to establish GI tolerance

decrease PN as increase EN by 25-30 ml/hr every 8-24 hrs

when @ 75% EN, d/c PN

123
Q

Refeeding Syndrome

A

aggressive administration of nutrition to malnourished pt.

unfed 7-10 days, significant wt. loss, ETOH, anorexia

starved cells take up nutrients (K+, Ph, Mg) & shift into intracellular compartments

Hypo K+, Ph, Mg

PN & Dex >5mg/kg/min can lead to hypergylcemia

124
Q

DRI

A

dietary reference intake

  1. EAR - estimated average requirement for 50% pop
  2. AI - adequate intake
  3. UL - tolerable upper level
125
Q

2010 Dietary Guidelines for Americans

A

community nutrition pgms use these when dev. plans

  1. balance kcals consumed
  2. physical activity - 30 mins/day to reduce risk chronic disease; 60-90 to maintain BW
  3. limit trans fats
  4. increase fruits, veggies, fiber, whole grains
  5. low-fat diary
  6. make half your plate fruits & veggies, 1/2 grains whole, use skim or 1% milk, vary lean protein
126
Q

Stages of Change

A
  1. pre-contemplation - unaware or uninterested
  2. contemplation - thinking about change
  3. preparation - decide to change
  4. action - tries to change
  5. maintenance - sustains change for 6 months or longer
127
Q

Program Intervention

A
  1. Primary prevention - reduced exposure to a promotor of disease, early screeing
  2. Secondary prevention - recruiting those w/ elevated risk factors into treatment
  3. Tertiary prevention - as disease progresses, intervention to reduce severity
128
Q

Program Planning Steps

A
  1. Develop mission/philosophy
  2. Set goals - broad direction, general purpose
  3. Set objectives - specific/measurable actions
129
Q

Implementation of Pgm

A
  1. administrative support
  2. realistic budget
  3. staff commitment
  4. support of target pop
130
Q

Nutrition Monitoring

A

review or measurement of a selected nutrition care indicator

131
Q

Nutrition Evaluation

A

compares findings w/ goals or standards

determines degree of process being made

132
Q

Nutrition Care Outcomes

A

distinct from health care outcomes b/c they represent the nutrition professional’s specific contribution of care

food/nutrition related Hx, lab data & medical tests, anthropometrics, nutrition-focused physical findings

133
Q

PCMH

A

patient centered medical home

focuses on relationship b/n pt & dr.

dr. takes responsibility of all aspects of pts health & communicates w/ other drs.

RD Exam (4 decks)

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