Module 2 Flashcards
1
Q
Steps in NCP
A
Assess, Diagnose, Intervene, Monitor & Evaluate
2
Q
Joint Commission
A
nutrition risk identified in hospitalized patients w/in 24 hrs
3
Q
Food Frequency Lists
A
quick way to determine intakes on large numbers of people
4
Q
Measure of Somatic Protein
A
skeletal muscle mass - mid arm muscle area; good for measuring kids
5
Q
Waist/Hip Ratio
A
difference b/n android & gynoid obesity; >1.0 men, >0.8 women
6
Q
Hair assessment
A
thin, sparse, dull - protein deficiency
7
Q
Skin
A
pale, dry, scaly - poor intake iron, folic acid, zinc deficiency
8
Q
Serum albumin
A
3.5-5.0 - visceral protein (blood & organs); > 5 - dehydration
9
Q
PAB - pre albumin
A
16-40; short half-life
10
Q
Serum Creatinine
A
0.6-1.4; somatic protein, renal disease
11
Q
BUN
A
10-20; protein intake, renal disease
12
Q
CRP - c-reative protein
A
marker of acute inflammatory stress
13
Q
Megastrol Acetate
A
appetite stimulant
14
Q
Loop diuretics
A
deplete K+, mg, ca, Na, Chl; decrease K+, Mg
15
Q
Lithium Carbonate
A
Maintain consistant Na & caffeine intake; If Na & caffeine restricted, lithium excretion decreases - toxicity
16
Q
Propofol
A
in oil, consider fat Kcals
17
Q
Isoniazid (treats TB)
A
depletes pyridoxine, peripheral neuro, interferes w/ vit D.
18
Q
Vit B6 & Protein
A
decreases effectiveness of levodopa (parkinsons); take in AM w/ <10 gm pro.
19
Q
Incidence
A
of new cases of a disease over a period of time
20
Q
Prevalence
A
total # of existing people w/ a disease during a period of time
21
Q
Food security
A
access to sufficient food for active & healthy life
22
Q
Nutrition Survey
A
exam of pop group at a particular point in time
23
Q
Nutrition Surveillance
A
continuous collection of data; use ht, wt, Hct, Hgb, serum cholesterol
24
Q
NSI - Nutrition Screening Initiative
A
promote nutrition & improve care for elderly; DETERMINE, LEVEL I, LEVEL II
25
USDA Nationwide Food Consumption Survey (NFCS)
eval 7 nutrients, obtain info on food intake from entire US
26
Behavioral Risk Factor Surveillance System (BRFSS)
\>18 yrs, w/ telephone
27
WIC
provides food, nutrition education; health exam required; not an entitlement pgm
28
Extension Food & Nutrition Education Pgm (EFNEP)
all education - no food. provides grants to universities that assist in community dev
29
Elderly Nutrition Pgm (ENP)
Congregate Meals, home delivered meals, all ages \> 60
30
Medicare
health insurance for people \>65; any age w/ ESRD
31
Medicaid
payment for medical care for all eligible needs, all ages, blind, disabled, dependent children
32
Entitlement Pgm
payment of benefits to all eligible people as established by law. Ex. SNAP, Medicare, Medicaid
33
Nutrition Diagnosis
a nutritional problem that dietetics professionals are responsible for treating independently
34
Three domanins
NC - Clinical
NI - Intake (always the priority)
NB - Behavorial/Environmental
35
36
PES
One problem
One etiology
Assessment of signs & symptoms
*Ex: Chewing difficulty (P) related to oral surgery (E) as evidence by missing teeth (S)*
37
38
Altered GI Function (NC 1.4)
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
39
Impaired nutrient utilization (NC 2.1)
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
40
Evidence based dietetics practice
reviewed scientific evidence used in making decisions
41
Discharge Plans
begins on day 1 - discharge note includes summary of nutrition therapies & outcomes
42
Ulcer
eroded musosal lesion; h. pylori; antibiotics to fix; diet - as tolerated, well balanced; avoid late night snacks;
Avoid excess caffeine & etoh
43
Hiatal Hernia
protrusion of portion of stomach above diaphragm into chest; heartburn main Sx
small, bland feedings, avoid late night snacks, caffeine, chili powder & b. pepper
44
Dumping Syndrome
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"
45
Deficiencies due to Gastrectomy
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 -
46
Gastroparesis
delayed gastric emptying
moderate-severe hypergly
prokinetics, increase stomach contractility
small, frequent meals, pureed foods, avoid high fiber
47
Diverticular Disease
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
48
Fiber
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
49
IBD
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
50
IBS
chronic ab discomfort, alt. intestine motility
goals - adequate intake; avoid large meals, exccess caffeine, ETOH, sugars
use food diary
51
Lactose Intolerance
lactase deficiency. when lactose remains intact, H2O is drawn into intestine to dilute the load causing distention, cramps, diarrhea.
52
Lactose Intolerance Test
If intolerant - BG rise \<25 above fasting (flat curve). If tolerant - BG \> 25 above fasting (normal)
yogurt & some aged cheese may be tolerated
53
Diarrhea
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
54
Short Bowel Syndrome (SBS)
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
Ileal resection
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
Loss of Colon
water & electrolytes loss
57
Nutritional Care of SBS
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
Acute Viral Hepatitis
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
Cirrhosis
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
Ascites in Cirrhosis
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
Cirrohsis Malnutrition
ETOH causes inflammation of GI tract & interferes w/ absorption of thaimin, B12, Vit C, folic acid
62
Hepatic Failure (ESLD)
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
Gallbladder Disease
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
Pancreatitis
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
Cystic Fibrosis
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
HTN
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
Chylomicron
transports dietary tri's from gut to adipose cells
synthesized in intestine from dietary fat
lowerst density from liver to adipose
68
Metabolic Syndrome
3 or more:
BP \>130 systolic or \>85 diastolic
elevated TG \>150
fasting BG \>110
low HDL \<40-50
waist \>35-40 inches
69
Therapeutic Lifestyle Change (TLC)
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
Heart Failure
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
Nephron
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
Renal Functions
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
Renal Hormones
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
Renal Tests
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
Renal Calculi
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
Acute Kidney Injury/Acute Renal Failure
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
Nephrotic Syndrome
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
Chronic Kidney Disease
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
ESRD
usually associate w/ BUN \>100, Cr 10-12
retention of Nitrogen
20 gm HBV, increase kcals, control edema, prevent deficiencies
80
Chronic Renal Failure
**_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
DM
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
Goals for DM
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
Gestational DM
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
CHO Exchanges
**_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
Insulin
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
Dawn Phenomenom
increase in early morning BG
increase need for insulin at dawn
87
Acute ketoacidosis
hyperglycemia due to insulin deficiency or excess CHO intake, dehydration
Rx: insulin, rehydration
88
Acute hypoglycemia
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
Reactive Hypoglycemia
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
Gout
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
Inborn Erros of Metabolism
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
Osteoporosis
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
Epilepsy
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
Celebral Palsy (CP)
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
Hyperkinesis
ADHD, ADD
no salicylates, artifical colors, flavors
not proven, but result may be placebo effect
96
Alzheimer's
Avoid distractions, need regular consistent meals
may need verbal cues to chew & swallow
97
Anemia
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
Immunoglobumin E (IgE)
mediated reaction to normally harmless food PRO
Common: peanuts, eggs, soy, wheat, shellfish, milk
RAST - allergy skin test
99
100
Fever
BMR increases 7% for each degree over 98.6
excessive fluid loss leads to severe dehydration
101
Burns
immediate shock period
BMR increases 50-100%
replace fluids & electrolytes
increase kcals
PRO 1.5-3.0
102
Response to Injury
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
Cancer
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
Marasmus
PRO, kcal starvation
severe fat/muscle wasting
triceps skinfold, arm muscle circumference decreased
105
Iatrogenic Malnutrition
PRO/kcal malnutrition
due to treatment, hospital, meds
106
Anorexia
disorted body image, dramatic wt. loss
Rx: correct electrolyte imbalance (K+)
plan w/ patient
focus on health benefits of food
107
Bulimia
binge & purging
usually close or normal wt
damage to teeth, throat, esophagus, rectal bleeding, bruised knuckles
108
Obesity
I - BMI 30-34.9
II - BMI35-39.9
III - \>40
3500 kcals/# body fat
healthy obese - elevated LDL, normal to low HDL
109
Bariatric Surgery
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
Prader Willi Syndrome
congenital disorder - chromosome 15 depletion
subnormal LBM, supranormal body fat
no sense of satiety, decrease BMR
obesity at 2-3 yrs
111
Achlasia
disorder of lower esophagela sphincter motility, does not relax & open
causes dysphagia
pureed moist thick foods, progress to thick liquids
112
AIDS
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
COPD
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
Enteral Formulas
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
Enteral Access
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
Short-term EN
3-4 weeks, NG tube, normal GI
bolus method
continuous drip - feeding pump, cyclic feedings, gravity
transplyoric
117
Long-term EN
gastrostomy or jejunostomy if more than 3-4 wks
PEG - tube into stomach through ab wall
118
Peripheral Parenteral Nutrition
Peripheral - short-term 5-7 days, supplement w/ EN
119
PN Solutions
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
TPN
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
TPN Solutions
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
Transitional feedings
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
Refeeding Syndrome
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
DRI
dietary reference intake
1. EAR - estimated average requirement for 50% pop
2. AI - adequate intake
3. UL - tolerable upper level
125
2010 Dietary Guidelines for Americans
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
Stages of Change
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
Program Intervention
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
Program Planning Steps
1. Develop mission/philosophy
2. Set goals - broad direction, general purpose
3. Set objectives - specific/measurable actions
129
Implementation of Pgm
1. administrative support
2. realistic budget
3. staff commitment
4. support of target pop
130
Nutrition Monitoring
review or measurement of a selected nutrition care indicator
131
Nutrition Evaluation
compares findings w/ goals or standards
determines degree of process being made
132
Nutrition Care Outcomes
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
PCMH
patient centered medical home
focuses on relationship b/n pt & dr.
dr. takes responsibility of all aspects of pts health & communicates w/ other drs.
