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FNN 401 Final > Neuro > Flashcards

Neuro Flashcards

1
Q

how many diseases affect the NS?

A

600

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2
Q

Disorders of the NS may affect nutrition intake by affecting these 3 areas ?

A
  1. swalling/taste/smell
  2. fine motor skills
  3. strength and balance
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3
Q

the brain makes up ____ % of body weight

A

2%

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4
Q

the brain consumes ___ % of the body’s energy

A

20%

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5
Q

the peaks and grooves of the brain

what % is visible

A

gyri and sulci

30%

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6
Q

what is corpus callosum?

A

communication between hemispheres

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7
Q

this hemisphere controls spatial ability, musicality, arts, creativity

A

right

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8
Q

this lobe deals with pain, touch, taste, temp

A

parietal lobe

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9
Q

this lobe processes visual info

A

occipital lobe

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10
Q

this lobe controls hearing, auditory functions, memory, emotions

A

temporal lobe

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11
Q

this lobe deals with thinking, planning, emotion

A

frontal

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12
Q

what are the 2 classes of functional cells in the NS?

A
  1. neurons - deal with cell to cell transmission
  2. glial cells - surround neurons and provide support for and insulation between them
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13
Q

these cells surround neurons and provide support for and insulation between them

A

glial cells

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14
Q

these cells deal with cell to cell transmission

A

neurons

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15
Q

most neurological disorders from damage of ______

A

neurons or glial cells

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16
Q

what does the cascading effect refer to?

A

in traumatic brain injury, once one neuron dies, those around it may die as well

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17
Q

what is brain plasticity?

A

the ability of other neurons to take on that function

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18
Q

what are 3 classifications of brain injury?

A
  1. open v closed
  2. coup vs. countrecoup
  3. diffuse vs. focal
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19
Q

shaken baby syndrome is an example of

A

diffuse brain injury - large section of the brain is impacted

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20
Q

bullet penetration is an example of

A

focal brain injury - specific location in the brain is affected

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21
Q

What is the primary pathophysiology of TBI?
secondary pathophysiology?

A

primary: lacerations, crushed tissue
secondary: edema, hemorrhage

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22
Q

what are 5 clinical manifestations of TBI?

A

swelling
bleeding
seizure
stroke
coma

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23
Q

what is the most common cause of TBI? 2nd most common?

A
  1. fall
  2. shaken baby syndrome
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24
Q

what is the leading cause of seizure disorder in canada?

A

TBI

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25
Q

1 person is injured every ____ with TBI

A

3 minutes

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26
Q

TBI affects males by ____ %

A

60%

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27
Q

TBI is:

____ x more common than spinal injury
____ x more common than breast cancer
____ x more common than HIV

A

44x
30x
400x

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28
Q

what are 5 mild symptoms and 5 severe symptoms of TBI?

A

mild symptoms:
1. dizziness
2. blurred vision
3. headache
4. light headedness
5. mood changes
6. fatigue

severe symptoms:
1. concussion
2. headaches
3. seizures
4. confusion
5. slurred speech
6. dilated vision

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29
Q

What do we use to evaluate the severity of TBI?

A

the glasgow coma scale

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29
Q

according to the glasgow coma scale, a score of:
___ indicates severe head injury
___ indicates moderate head injury
___ indicates mild head injury

A

<8 = severe
9-12 = moderate
13-15 = mild

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30
Q

how do we diagnose TBI? 3 ways

A
  1. CT scan
  2. X-ray
  3. GCS
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31
Q

Treatment of TBI focuses on these 6 things:

A
  1. blood pressure regulation
  2. mechanical ventilation
  3. fluid resuscitation
  4. stabilization in acute care
  5. promote further rehab
  6. stabilize weight
  7. improve brain recovery
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32
Q

what are 6 nutritional implications of TBI?

A
  1. hypermetabolism
  2. hyperglycemia
  3. insulin resistance
  4. increased gluconeogenesis
  5. lipolysis
  6. protein wwasting
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33
Q

during TBI, nitrogen excretion peaks at _____

A

2 weeks

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34
Q

TBI patients need to be aggressively supported with nutrition, or they can lose 15% of UBW in 1 week.

If the patient is not fed by the end of the first week post injury, mortality rate increases

A
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35
Q

When should you attain full caloric requirements post TBI?

A

by day 7

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36
Q

When should you initiate EN for TBI?

A

24-48 hrs post injury, once the patient is hemodynamically stable

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37
Q

What are some barriers to beginning EN after TBI?

A
  1. delayed gastric emptying with vagal nerve damage
  2. narcotics and paralytics slow transit

may need post pyloric access

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38
Q

what are 3 examples of nutritional diagnoses related to TBI?

A
  1. hypermetabolism
  2. inadequate intake
  3. motor and cognitive impairment
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39
Q

what are the caloric requirements for TBI?

A

highly variable (can be 200% higher) - do indirect calorimetry

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40
Q

what are the protein requirements for TBI?

A

1.2-2.5 g/kg/d

41
Q

what are some 90 nutrition needs the brain needs post TBI?

A
  1. amino acids
  2. protein
  3. omega 3 - help improve neuron function
    enough
  4. glucose
  5. vitamin E
  6. curcumin
  7. F&V
  8. whole grains
  9. choline
  10. glutamine
42
Q

what is the difference between paraplegia and quadriplegia?

A

paraplegia = full or partial paralysis of the lower body

43
Q

how many SCHO are there in ontario each year? canada?

A

ontario - 600
canada = 1500

44
Q

how do people get SCI?

A

trauma and accidents

45
Q

what are 2 complications of SCI?

A
  1. autonomic dysreflexia (overreaction of autonomic nervous system)
  2. spasticity (stiff or rigid muscles, hyperactive reflexes). affects 65-78% of people
46
Q

how do you treat SCI?

A
  1. treat underlying cause
  2. corticosteroids
  3. stabilization
47
Q

nutrition needs for TBI are similar to SCI. this trauma also triggers a systemic inflammatory response

A
48
Q

what are the protein requirements for SCI?

A

2 g/kg/day

49
Q

what are the energy requirements for SCI?

A

we feed 10% below estimate, due to reduced metabolic activity in denervated muscle

50
Q

what is the AF and SF for SCI?

A

AF = 1.1
SF = 1.2

51
Q

what are 5 long term implications of SCI?

A
  1. obesity
  2. cardiovascular disease
  3. digestive issues/fecal incontinence
  4. osteoporosis
  5. pressure ulcers
  6. higher risk of malnutrition and food insecurity
52
Q

who is at increased risk of pressure ulcers?

A

malnourished people
immunocompromised people
smoking
alcohol use
high/low body weight

53
Q

what are common sites for pressure ulcers?

A

where bone is close to skin

side of thigh
heels
butt

54
Q

What are the 4 stages of pressure ulcers?

A
  1. skin is unbroken but inflamed
  2. skin is broken to the epidermis or dermis
  3. ulcer extends to the subcutaneous layer
  4. ulcer extends to muscle or bone
55
Q

what are 5 things to cosnider when considering nutrition for pressure ulcers?

A
  1. size
  2. healing
  3. age
  4. clinical issues
  5. nutritional status
56
Q

what are caloric requirements for pressure ulcers?

A

30-40 cals/day

57
Q

what are protein requirements for pressure ulcers?

A

1.25-3 g/kg/d

58
Q

what are some nutrient recommendations for PU?

A
  1. replace micronutrients as needed
  2. protein supplement (need more arginine and glutamine)
  3. healing vitamins and minerals: vitamin A, C, K, zin, selenium (only do these if defficient)
59
Q

what are 3 nutrition interventions for SCI?

A
  1. get enough energy via indirect calorimetry
  2. rehab concerns
  3. prevent excessive weight gain
60
Q

how to monitor nutrition therapy for SCI?

A
  1. prevent PU
  2. keep energy needs in mind
  3. weight management
61
Q

In canada, a stroke happens every ____ minutes

A

10 minutes

62
Q

what is the difference between:

  1. ischemic stroke
  2. hemorrhagic stroke
  3. TIA
  4. aneurysm
A
  1. ischemic stroke = blood vessel that supplies blood to the brain is blocked by a blood clot. MOST COMMON
  2. hemorrhagic stroke = blood vessel in the brain ruptures. Happens when blood vessel wall is weak from hypertension or aneurysm
  3. TIA = a transient epsiode of ischemia with momentary symptoms consistent with loss of oxygen
  4. = dilation and bulging of smooth muschle in the brain
63
Q

What are 5 moifiable risk factors for stroke and aneurism?

5 non modifiable risk factors?

A

modifiable risk factors:
1. age
2. sex
3. ethnicity
4. genetics
5. previous stroke

nonmodifable risk factors:
1. hypertension
2. CVD
3. DM
4. cigarettes
5. alcohol
6. birth control
7. exercise
8. carotid stenosis
9. hyperlipidemia

64
Q

What impacts HTN the most?

A
  1. diet and waist circumference control
  2. DASH diet
65
Q

What are 4 warning signs of stroke?

A

F = face droop
A = arm weakness
S = speech difficulty
T = time to call 911

66
Q

How do you diagnose a stroke?

A
  1. national instititues of health stroke scale
  2. CT
  3. MRI
  4. PET
67
Q

how do you acutely and chronically treat stroke

A

acutely:
- eliminate clot and restore blood flow
- IV injection of recombinant tissue plasminogen activator release

Chronic measures:
- rehab

68
Q

what are some nutrition implications of strokes?

A
  1. impaired chewing, swallowing, self-feeding
  2. dysphasia
  3. individualized nutrition support (texture mod, EN, PN)

maximum nutrition support should begin immediately after admission and then continue through rehab because post stroke is a hypermetabolic phase

69
Q

potential nutrition diagnoses for stroke:

A
  1. inadequate oral intake
  2. inadequate energy intake
  3. inadequate fluid intake
  4. inadequate protein intake
  5. swallowing difficulty
  6. self feeding difficulty
70
Q

what interventions will you do with stroke?

A

EN support if PO is not possible
modify consistency
modify positioning of patient
manage dysphasia

71
Q

when to start EN with stroke?

A

24-48 hours

72
Q

what type of formula should be used for EN with patients with TBI

A

formula with EPA and DHA

73
Q

Why does parkinsons occur?

A

etiology isnt clear BUT
is the result of decreased dopamine producing cells in the substantia nigra of the brain

74
Q

what are 3 things dopamine is responsible for?

A
  1. movement
  2. mood/motivation
  3. learning/memory

Parkinsons

75
Q

____ affects 1% of the population over 70 yrs old

A

parkinsons disease

76
Q

what are 5 contributing factors to parkinsons disease?

A
  1. genetics
  2. oxidative stress
  3. environmental stress
  4. abnormal inflammatory response
  5. protein malformations
77
Q

what is the pathophysiology of parkinsons?

A

we are able to get balanced and coordinated movements with a perfect balance of dopamine (excitory) and gaba (inhibitory). When you lose dopamine

78
Q

What are 5 symptoms of parkinsons?

A
  1. resting tumor
  2. rigidity
  3. bradykinesia or full akinesia (slowness of movement)
  4. shuffling gate
  5. posture instability
  6. depression
  7. anxiety
79
Q

what is the gold standard treatment for PD?

A

levodopa (a dopamine precursor)

80
Q

what do we need to be careful of when taking levodopa (meds for parkinsons)

A

they compete with amino acids at receptor sites and amino acids win. so if we eat protein, levodopa wont get absorbed as well

to stabilize drug effect, have ratio of 5:1 or 7:1 carbs to protein

81
Q

What are 5 nutrition related concerns in parkinsons?

A
  1. dehydration
  2. constipation
  3. gastoparesis
  4. GERD
  5. dysphagia
  6. unintentional weight loss
    decreased functional capacity to self feed
82
Q

A spontaneous, disordered electrical discharge of cerebral neurons is called:

A

seizure

83
Q

What is epilepsy?

A

diagnosed upon 2 or more unprovoked seizures

84
Q

___- % of the population will have a seizure at some time in their life

A

10%

85
Q

what is the etiology of epilepsy?

A
  1. head trauma
  2. CNS infection
  3. drug and alcohol use
  4. CNS tumors

but majority have no known precipitating event

86
Q

what is the difference between a generalized and partial seizure?

A

generalized = both hemispheres of brain

87
Q

what are 3 common medications for epilepsy?

A
  1. gabapentin (neurontin)
  2. valproic acid (depakote)
  3. zonisamide (zonegran)
88
Q

when doing the ketogenic diet, ratio of fat to carbs/protein should be:

A

4:1
or
3:1

89
Q

what % of calories should be from fat?

A

80-90%

90
Q

What are 4 common keto diets?

A
  1. classic ketogenic diet
  2. medium-chain trigs diet (MCT)
  3. low-glycemic index treatment
  4. modified atkins diet (MAD)
91
Q

what is the classic ketogenic diet like?

A

3-4 fat: 1 pro/carb (but start at 1:1 –> 2:1 –> 3:1 –> 4:1)

90% cals from fat

no starchy foods

92
Q

what is the MCT diet like?

A

MCT oil allows for more protein and carbs

only 73% of cals from fat

pros: good for picky eaters, allows for more carbs/proteins

cons: cant use on valproate, expensibe

17% carbs

93
Q

for low glycemic indext treatment, how much fat?

A

60%

94
Q

for MAD ketogenic diet, how many cals from fat?

A

65% (no more than 10% carbs from start)

very restricted carb intake

95
Q

What type of supplementation do you need if on ketogenic diet? 5 things:

A
  1. fibre
  2. multivitamins
  3. calcium
  4. vitamin D
  5. carnitine
96
Q

what are some drug-nutrient interactions with epilepsy drugs?

A
  1. vitamin D
  2. calcium
  3. folate
  4. thiamine
  5. folate
97
Q

what are 3 examples of epilepsy diagnosis?

A
  1. inadequate intake
  2. excessive intake
  3. malnutrition
  4. food-medication interaction
98
Q

what types of labs to look at for epilepsy?

A
  1. lipid profile
  2. liver profile
  3. blood glucose - avoid hypoglycemia
  4. beta-hydroxybutyrate (BHB) - should be > 4 mmol/L
  5. fluid intake

look at growth, anthropometrics, seizure frequency records

99
Q

What is the RD role in initiating keto diet for epilepsy?

A
  1. nutrition education
  2. vitamin/supplement support
  3. grocery shopping/labeling
  4. formula administration

FNN 401 Final (4 decks)

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