Nutrition Flashcards
1
Q
Definition of Nutrition.
A
Chemicals used by the body for energy to maintain cellular function.
2
Q
How is Energy Measured?
A
Energy is measured in calories (C or kcal)
-The amount of energy that is required to raise 1 kg of water by 1-degree Celcius
3
Q
What are our main Micronutrients?
A
Vitamins and Minerals
4
Q
What are our main Macronutrients?
A
Carbs, Proteins (amino acids), fats (fatty acids)
5
Q
Physiology Process of Oral Intake.
A
- Chewing and Swallowing
- Mechanical and Chemical Breakdown
- Absorption
- Elimination
- Nutrient Metabolism
6
Q
Definition of Malnutrition.
A
Lack of food or ineffective utilization of food to meet metabolic needs.
7
Q
Causes of Malnutrition.
A
Poverty, neglect, acute or chronic illness, mental health, the elderly population
8
Q
Define Failure to Thrive.
A
Inadequate nutrition to support growth and development
9
Q
Define Kwashiorkor.
A
A condition resulting from inadequate protein intake. The lack of protein leads to decreased muscle tone and increased fluid retention.
10
Q
Why does the lack of protein lead to Kwashiorkor?
A
- The lack of protein leads to a depletion of albumin. Albumin helps move small molecules through the blood and maintains fluid shift by; keeping the fluid in the blood from leaking into the tissues. The lack of albumin causes a fluid shift and results in edema!
- The lack of protein also causes abdominal distention due to the decreased muscle tone.
11
Q
Treatment for Kwashiorkor.
A
- Increase caloric intake
- Monitor growth, weight and BMI
- Monitor serum albumin levels and increase protein intake
12
Q
What is Albumin?
A
Albumin is a simple protein present both in animal and plant physiological fluids and tissues. It plays many important roles including maintenance of appropriate osmotic pressure, binding and transport of various substances like hormones, drugs etc. in blood, and neutralization of free radicals.
13
Q
Define Marasmus.
A
Caused by protein AND caloric deficiency. Causing a prominence in bones, decreased subcutaneous fat and loose skin.
14
Q
Treatment for Marasmus.
A
- Administer vitamins and Thiamine
- Administer nutrients and hydrate! However, dumping syndrome should be considered and monitored. The body is not used to caloric intake and might negatively react to the introduction of a bolus.
15
Q
Define Dumping Syndrome.
A
Caused by rapid gastric emptying. Rapid gastric emptying is a condition in which food moves too quickly from your stomach to your duodenum.
16
Q
Define Enteral Nutrition.
A
Utilized for patients who need to increase their caloric intake or who cannot swallow regular food items.
17
Q
Types of PO Feeding Tubes.
A
- Nasogastric (NG)
- Nasojejunal (NJ)
- Gastrostomy Tube (G-tube)
18
Q
Two Types of Nutritional Substitutes for Enteral Nutrition.
A
- Polymeric Enteral Nutritional Substitution
2. Oligometric Nutritional Substitute
19
Q
Polymeric Enteral Nutritional Substitute.
A
A solution made up of proteins, lipids and carbs. All the nutrients are intact and presented in the same form the body would receive them as. These solutions are high-calorie!
20
Q
Oligometric Nutritional Substitute.
A
The nutrients being introduces are already broken down into digestible components and make it easier for the body to use the nutrients quickly, (easily digestible components such as; amino acids and peptides that aid in hydrolyzing nutrients that are within the solution!
21
Q
What are the Three Types of Timed Feeds?
A
- Bolus feeding
- Intermediate feeding
- Continuous feeding
22
Q
Bolus Feeding
A
Mimics normal feeds and is given during regular intervals.
23
Q
Intermittent Feeding.
A
(like bolus but at a slower infusion, e.g. 30-60min)
Intermittent bolus feeding is defined as delivering enteral nutrition multiple times, generally given by gravity or an electric pump.
24
Q
Continuous Feeding.
A
(ideal for recovery; avoids dumping syndrome and osmotic shift)
Continuous feeding is defined as delivering enteral nutrition with constant speed for 24 h via a nutritional pump. Small portions over a period of time.
25
Define Parenteral Nutrition.
A form of nutrition that is delivered into a peripheral vein. Parenteral nutrition does not use the digestive system. It may be given to people who are unable to absorb nutrients through the intestinal tract. The goal is to increase nutritional intake
26
Two Types of Parenteral Nutrition.
I. Total Parenteral Nutrition (TPN)
| II. Peripheral Parenteral Nutrition (PPN)
27
Define Total parenteral nutrition (TPN).
TPN is used for long-term nutritional delivery. It involves the insertion of a central catheter into the superior vena cava, a major vein that carries blood from the head and chest to the heart. Fluids are given into a vein to provide most of the nutrients the body needs.
28
Define peripheral parenteral nutrition (PPN).
Used for short-term nutritional needs. PPN is administered through a traditional, external IV.
29
Complications of TPN and PPN.
- Fluid Overload: Increasing blood volume at a fast rate will cause hemodilution as well as a fluid shift within the body and yielding cellular/organ dysfunction.
- Infection: The insertion of a catheter increases the risk of introduction of bacteria and pathogens
- Electrolyte Imbalances
- Hyperglycemia
- GI dysfunction
30
Define Re-Feeding Syndrome.
Defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding.
-To meet starvation status the body goes without nutritional intake for more than 5 days. The body then shifts to an alternate hormonal and metabolic pathway to use energy
31
What Happens to the Body During Nutrient Deprivation?
The body will start to metabolism proteins and fatty acids to gain energy sources. However, this switch in metabolism causes a rise in serum ketones and decreases the overall pH leading to metabolic acidosis. The decreased pH will cause cellular and organ dysfunction
Furthermore, the depletion of intracellular minerals such as phosphorus, potassium, magnesium and vitamins will yield reduced organ function.
32
What Happens to the Body During Re-Feeding?
Re-feeding is the introduction of food after a period of time without nutrients. During re-feeding there is a surge in glucose levels which increases the secretion of insulin. Causing a fluid shift within the cells, causing a massive hemostatic shift.
- The syndrome occurs because of the reintroduction of glucose. As the body digests and metabolizes food again, this can cause sudden shifts in the balance of electrolytes and fluids.
33
Treatment for Re-Feeding Syndrome.
1. Assess all baseline minerals and vitamins
2. Administer Supplements (Thiamine and B-complex vitamins)
3. Slow rehydration
4. Slow re-feeding to inhibit metabolic shock and glucose/insulin surge
34
Define Rooting (Newborn and Infant Nutrition)
Rooting: When the cheek or lips are touched the infant turns their head towards the stimulus and opens their mouth as they believe it might be food.
35
Define Sucking (Newborn and Infant Nutrition)
Sucking: Involves tongue protrusion and retraction in preparation for oral intake, it is stimulated by the touching of the upper lip.
36
Why are Newborns and Infants susceptible to Dehydration?
Dehydration: newborns and infants are at risk for dehydration due to their high need for fluids. Infants require high fluids and nutrient intake therefore they depend on their mother’s supply of breastmilk.
37
Why are the Elderly at Risk for Lack of Nutrtition?
With age, there is a decrease in saliva
Reduced GI movements
Reduced metabolic efficiency (enzymes, villi, elimination)
Decreased appetite, weight loss, decreased energy, development of lethargy and depression
38
How Long Do Infants Feed On Breastmilk After Birth?
Health Canada promotes breastfeeding exclusively for the first six months and for up to two years.
39
Why is Vitamin D Essentiel for Feeding Infants?
+400 IU of vitamin D/ day should be given in order to ensure adequate vitamin D consumption by the infant. Vitamin D will lead to an increase in calcium. Calcium is necessary for the development of the skeletal system. Vitamin D is required for the body to increase calcium!
40
Four Kinds of Vitamin D Supplements.
Calcium Gluconate (IV or PO), Ca acetate, Ca citrate and Calcitrol (Calcijex)
41
What Occurs When There Is Too Much Vitamin D?
The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), which can cause nausea and vomiting, weakness, and frequent urination. Vitamin D toxicity might progress to bone pain and kidney problems, such as the formation of calcium stones.
42
Complications of Vitamin D Deficiency.
1. Osteoporosis caused by Menopause
2. Thyroid Hormone Deficiency
3. High ETOH or caffeine intake
43
Define Osteoporosis.
A disease that weakens bones to the point where they break easily. Fragile bones cause decrease bone restoration!
44
How does Menopause Induce Osteoporosis?
menopause (hormone changes-low estrogen)
During the menopausal transition period, the drop of estrogen leads to more bone resorption than formation, resulting in osteoporosis. As women age the estrogen levels will decrease. Estrogen contributes to the absorption of calcium, the lack of estrogen leads to the lack of calcium absorption which contributes to the development of osteoporosis.
45
How Does Thyroid Hormone Deficiency Induce Osteoporosis?
Thyroid hormone affects the rate of bone replacement. Too much thyroid hormone (i.e. thyroxine) in your body speeds the rate at which bone is lost. If this happens too fast the osteoblasts may not be able to replace the bone loss quickly enough.
46
How Does Alcohol Induce Osteoporosis?
Excessive alcohol interferes with the balance of calcium, an essential nutrient for healthy bones. Calcium balance may be further disrupted by alcohol's ability to interfere with the production of vitamin D, a vitamin essential for calcium absorption.
47
Treatment for Osteoporosis.
- Vitamin D and calcium supplements
- Biphosphates: Suppress osteoclast activity will cause a decreased rate of bone resorption
1. Alendronate (Fosamax)
2. Risedronate (Actonel)
48
Function of Vitamin C.
Antioxidant; tissue repair, immunologic contribution, collagen production. Deficiency causes 'scurvy'
49
Function of Retionol.
Promotes epithelial cell synthesis
50
Function of Vitamin K.
Blood clotting co-factor. Essential for Prothrombin synthesis! Also contributes to bone-building
51
Function of B-Complex Vitamins.
B-complex vitamins contribute by breaking down carbohydrates and transporting nutrients throughout the body.
52
Breastfeeding Physiology (Hormonal Roles)
The pituitary gland releases the hormones prolactin and oxytocin. Prolactin tells the milk-making glands in your breast to make breast milk. Oxytocin signals the let-down reflex to release the milk.
- Prolactin (anterior pituitary gland) => milk synthesis
- Oxytocin (posterior pituitary gland) => milk excretion ‘let-down’ & ejection
53
Stages of Breastmilk.
1. Colostrum
2. Transitional Milk
3. Mature Milk
54
Define Colostrum Milk.
Colostrum is rich in minerals, such as magnesium, which supports the baby's heart and bones; and copper, zinc and IgA antibodies, which help develop the immune system.
- Low in lactose
- Seen 1-3 days post-delivery
55
Define Transitional Milk.
Transitional milk comes when mature breast milk gradually replaces colostrum. It is made up of lactose, protein and fat!
- It is seen 3-14 days post-delivery
- Appears white
56
Define Mature Milk.
Mature milk is a composition of foremilk and hindmilk. The foremilk is the first portion of liquid being released from the breasts (this portion is higher in free water). The next portion is hindmilk which is made up of fat and nutrients.
- If the baby does not suck on the breast for long enough it might enter failure to thrive due to the lack of nutrients and vitamins.
57
Components of Breastmilk.
- Fat= 56%
- Calories= 70kcal/ 100mL
- Amino acids
- Carbohydrates: Lactose
- Essential minerals, vitamins
- Free water
- Immunity components
- Iron: bioavailability up to 100%
58
What Vitamin Does Breastmilk Lack?
Breastmilk has a low source of Vitamin D which in turn results in low calcium. Therefore vitamin D supplements are required
59
Function of Iron.
Iron is essential for normal cell function, mitochondria energy production and Hgb (hemoglobin) synthesis
Inadequate hemoglobin leads to inadequate oxygenation
60
Kinetic of Iron.
Iron is a protein-bound molecule (It needs protein to bind). Unbound iron is cytotoxic! Too much iron and inadequate protein will lead to an excess accumulation of unbound iron molecules.
-This excess iron appears in the circulation as a form of non-Tf-bound iron and causes organ dysfunction due to the production of ROS.
61
Heme vs Non-Heme Iron
Heme Iron (meat, poultry and fish)=
20%
Non-Heme Iron (legumes, vegetables, fruit, grains, nuts, eggs, tofu) =5%
62
Iron Inducers vs Iron Inhibitors.
1. Inducers: Protein and Vitamin C induce iron absorption
| 2. Inhibitors: Calcium, inhibits iron absorption! (foods high in calcium should be avoided with iron supplements)
63
Define Galactosemia.
Galactosemia is a condition in which the body is unable to use (metabolize) the simple sugar galactose.
- It is an inherited metabolic disorder (autosomal recessive)
- It is caused by the deficiency of the enzyme GALT (galactose-phosphate uridylyltransferase)
64
Signs and Symptoms of Galactosemia.
- Vomiting
- Poor weight gain
- Fatigue
- Hypoglycemia
65
Complications of Galactosemia.
- Failure to Thrive
- Hypoglycemia
- Jaundice (damage to the liver)
- Cataracts (damages to the eyes)
66
What is Galactose?
Galactose is a simple sugar, it is a metabolized state of lactose
(Lactose= Galactose+ Glucose)
- Galactose is usually broken down by an enzyme called GALT. GALT is responsible for breaking down galactose into glucose to be used by the body. When gault enzyme is lacking it will lead to an accumulation of galactose within the system, yielding health complications. Galactose is poisonous to the body and causes galactosemia in high concentrations.
67
Treatment for Galactosemia.
Soy protein isolate formula with calcium supplements
- Stop milk intake
- Initiate diet restricted in galactose and lactose
68
Define Anemia.
Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Impaired oxygen-carrying capacity leads to hypoxemia-hypoxia.
69
What Causes Anemia?
Each red blood cell contains millions of hemoglobin molecules that transport oxygen. The oxygen binds to heme on the hemoglobin molecule
The lack of heme (iron) will result in a lack of oxygen molecules from binding to the RBC
70
Treatment for Anemia.
- Prevention (diet, maternal vitamins in pregnancy)
| - Iron supplements: Ferrous Sulfate PO/IV/IM
71
Lab Tests for Anemia.
```
Serum iron levels
Ferritin (iron stores) - we used ferritin to understand how much iron is being stored
CBC (complete blood cell count)
Hemoglobin (Hgb)
Hematocrit (RBC volume)
MCHC (amount of Hgb per RBC)
```
72
What Happens When Iron is Low?
Low iron= low ferritin
Caused by an iron deficiency
Consequences: Low Hgb, low RBCs, low oxygenation
73
What Happens When Iron is High?
High Iron= high ferritin
Caused by Hemolytic anemia (destruction of the RBCs, will cause a release of iron. This iron overload is the result of a massive outflow of hemoglobin into the bloodstream)
Consequences: Hypoxemia, Hypoxia
74
What Happens when Iron is low but Ferritin is Normal.
Low Iron but normal ferritin
Caused by hemorrhage (loss of blood)
Consequences: De-compensation
75
What happens when Iron and Feritin are High?
Caused by iron poisoning
| Consequences: Mitochondrial damage
76
How to treat Iron Overdose?
Iron chelation therapy is used to remove excess iron from the body. In order to get rid of excess iron, it needs to be bound to another molecule.
77
What are the three Iron Supplements?
Ferrous Sulfate, Ferrous Fumarate, Ferrous Gluconate
78
Side Effects of Iron Supplements.
Abdominal Pain
Constipation due to decreased peristalsis
Drug-drug-food interaction
79
When is Iron Injected?
If the iron deficiency continues, IV or IM administration of iron is used. The amount of iron required is calculated based on lead body weight and Hgb levels.
80
What are the Types of Iron Dextran Injection?
Monoferric (monofer, Vendor)
| - Allows for fast absorption and has a lower OD risk
81
Define Hemorrhagic Anemia.
Anemia caused by severe blood loss.
- Acute: sudden loss of blood due to acute injury, surgical bleed or childbirth
(10-30% of blood volume loss)
- Chronic: caused by chronic disorders such as; GI ulcers, chronic disease
82
Treatment for Hemmorhagic Anemia.
Blood Products (Packed red blood cells)
Injection of iron medications
Identify the cause
83
Define Allergic Tranfusion Reaction.
An allergic transfusion reaction is when a blood transfusion results in an allergic reaction. Causing hemolysis, hemolysis destroys the RBCs within the circulation and obscures the shape of the red blood cells. Causing an increased level of coagulation an increased risk of clotting
84
Treatment for Allergic Transfusion Reaction.
- STOP infusion
- Treat reaction
- Glucocorticoids
- Antihistamines
- Epinephren
- Administer oxygen
- Monitor vital signs
