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Clin Med III Exam 1 > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Role of macronutrients

A

Function to provide energy, promote growth and repair, support normal body structure and function

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2
Q

Macronutrient energy

A

Carb - 4 kcal
Protein- 4 kcal
Fat - 9 kcal

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3
Q

Carbs are broken down by

A

amylase

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4
Q

Sources of carbs

A

grains, fruits, veggies, legumes, dairy

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5
Q

Protein source

A

fish, lean meat, poultry
egg, dairy
legumes
nuts/seeds

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6
Q

Digest proteins

A

protease

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7
Q

Digest fat

A

lipase and bile

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8
Q

End-product of fat

A

monoglycerides and fatty acids

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9
Q

Function of micronutrients

A

support cellular metabolic processes, biochemical reactions, hormone function, nerve impulse propagation and muscle function

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10
Q

water-soluble vitamins

A 
thiamine (b1)
riboflavin (B2)
niacin (B3)
Pantothenic acid (B5)
Pyridoxine (B6)
Biotin
Folate
Cobalamine (B12)
Ascorbic Acid (vit C)
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11
Q

Vit C role

A

aids in iron absorption

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12
Q

Absorption of B12

A

bind to IF in the stomach

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13
Q

Fat soluble vitamins

A

A (vision)
D (Ca absorption)
E
K (clotting)

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14
Q

Major minerals

A 
sodium
potassium
chloride
calcium
phosphorous
magnesium 
(some people can claim pretty minerals)
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15
Q

trace elements

A

iron, zinc, copper, iodine, manganese, chromium, slenium

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16
Q

PPI can interfere with

A

Ca, Fe absorption in stomach

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17
Q

Absorbed in stomach

A

Ca, Fe

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18
Q

Absorbed in stomach, duodenum, jejunum

A

AA, small peptides, monosaccharides, FA

FAT-SOLUBLE VIT (ADEK)

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19
Q

Absorbed in jejunum and ileum

A

water-soluble vitamins

Zinc

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20
Q

Bile salt reabsorption

A

ileum

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21
Q

Vitamin b12 absorption

A

distal ileum

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22
Q

Potassium reabsorption

A

Cecum

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23
Q

Thiamine (B1) deficiency

A

beriberi (peripheral neuropath +/- HF)

Wernicke-Korsakoff syndrome (neuro sequela)

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24
Q

Riboflavin (b2), niacin (b3), pyridoxine (b6) deficiency

A

cheilitis
angular stomatitis
glossitis

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25
Q

Niacin (B3)

A

pellagra (diarrhea, dermatitis, dementia)

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26
Q

Folate deficiency

A

macrocytic anemia

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27
Q

Cobalamin (B12) deficiency

A

macrocytic anemia, PERIPHERAL NEUROPATHY

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28
Q

Peripheral neuropathy

A

Thiamine (b1) and B12

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29
Q

Vitamin D deficiency

A

rickets, osteomalacia

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30
Q

Vitamin A deficiency

A

night blindness***
bitot spots- keratin in conjunctiva
poor wound healing
dry skin

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31
Q

Zinc deficiency

A

hypoguesia

impaired wound healing

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32
Q

impaired wound healing

A

Vit A

Zinc

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33
Q

Iodine deficiency

A

goiter

hypothyroidism

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34
Q

Calcium deficiency

A

tetany (chvotske & trousseau)

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35
Q

Iron deficiency

A

pallor
pale conjunctiva
koilonychia (spoon nails)

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36
Q

Vitamin C and K deficiency

A

Petechiae/Purpura

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37
Q

Vitamin E deficiency

A

sensory and motor neuropathy

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38
Q

Pellagra

A

Niacin (B3)

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39
Q

Blindness

A

Vit A

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40
Q

Wernicke-Korsakoff syndrome

A

thiamine (B1)

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41
Q

Petechia/Purpura

A

Vit C

Vit K

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42
Q

Nutrition in pregnancy

A

fruit/veggies, whole grain, low-fat dairy, variety of protein
carloric consumption depend on prepregnancy BMI
prenatal vitamin
FOLIC ACID - prevents neural tube defect
avoid alc/tobacco

safe food care, pet care
dietitian
gestational DM?

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43
Q

Necessary nutrient in pregnancy

A

folic acid

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44
Q

Nutrition in infancy

A

sole breastmilk/formula first 4-6 months
Vit D supplement in exclusively breastfed infants
chart/monitor growth - FTT

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45
Q

Supplement in breastfeeding babies

A

Vitamin D

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46
Q

milk in children

A

1-2YO: 2 c whole milk/day
2-8 YO: 2-3 c fat-free milk/day
>9 YO: 3 c fat free a day

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47
Q

Sodium consumption in adults

A

<2300 mg Na daily

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48
Q

MyPlate advice

A

whole grains
5+ fruits/veggie servings
fiber 25-35 g/day
protein-rich food

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49
Q

Fiber amount

A

25-35 g/day

50
Q

Nutrition in elderly

A

liberalize diet
incorporate high calorie foods
add oral nutrition supplements if appropriate

51
Q

Nutrition assessment

A
  1. Food/nutrition-related hx
  2. Pt hx (medical, surgical, social)
  3. Anthropometric measurements
  4. nutrition-focused PE
  5. lab indicators
52
Q

Factors affecting oral intake

A 
anorexia
poor dentition
taste disturbance
heartburn
dysphagia
N/V/D/C
Abdominal pain
53
Q

Those at higher risk of thiamine deficiency

A

Alcoholics

54
Q

Surgical conditions with nutritional implications

A

ab surgery (bariatric, intestinal resection)
high output fistula or ostomy
trauma
GI hemorrhage

55
Q

Anthropometric measurements

A 
height
weight
BMI
usual vs. ideal body weight
weight pattern/unintentional weight loss*
body composition
56
Q

Nutrition focused PE targes

A 
body weight
muscle wasting
fat stores
volume status
signs of nutrient deficiencies
57
Q

PE for nutrition includes

A 
general (habitus, LOC, function)
Hair, skin, nails
HEENT: temporal mm, eyes, perioral/dentition
Cardiopulm
Abdominal
MSK/Extremity
Neurologic
58
Q

Edema, ascites

59
Q

sunken dry appearance or orbital area

A

dehydration

60
Q

temporal muscle wasting

A

protein

calorie

61
Q

poor wound healing, pressure ulcers

A

protein
vit C
vit A
Zinc

62
Q

Muscle wasting and decreased strength

A

protein

calorie

63
Q

Confusion

64
Q

Labs for nutriction

A 
hydration status
CBC, Iron study, B12, Folate
serum albumin and pre-albumin
CRP/ESR
Glucose
BMP/CMP, Na, K, Ca, PO4, Mg
Vitamins, Minerals, Trace Elements
Acid Base Assessment
65
Q

Nutrition intervention options

A

dietary adjustments
oral nutrition supplements
nutrition support (enteral and parenteral nutrition)

66
Q

Oral supplements

A

concentrated source of kcals, protein, vitamin/minerals

liquid drinks, shakes, snacks, etc.
disease specific
tailored per patient

67
Q

When to give nutrition support?

A

those who cannot meet their nutrition requirement by mouth

68
Q

Types of nutrition support

A

Enteral Nutrition (EN) - Preferred; physiologic- nutrition delivered directly to GI tract bypassing oral cavity

Parenteral Nutrition (PN) - straight into vein

69
Q

Who gets enteral nutrition?

A

those w/ functioning GI tract who can’t meet nutrient requirement by mouth

70
Q

Administration of Enteral

A 
gastric (distends, can be separate feedings)
small bowel (requires continuous)
71
Q

Short term enteral (<4-6 weeks)

A

Nasogastric (NG)
Nasoduodenal (ND)
Nasojejunal (NJ)

*risk of nasal/esophageal erosion

72
Q

Long term enteral (>4-6 weeks)

A

gastrostomy (G-tube)
Jejunostomy (j-tube)
G/J tube

73
Q

Administration in enteral

A

stomach- bolus
small bowel- conntinuous

formula- standard, predigested (malabsorption issue), concentrated, lyte-restricted (kidney disease)

74
Q

Complications of enteral nutrition

A

Mechanical:

  • tube misplacement
  • tube displacement
  • tube obstruction

metabolic:

  • hyperglycemia
  • unstable fluid/lyte status

intolerance
- emesis
- diarrhea
Pulmonary aspiration

75
Q

Who gets parenteral?

A

pts at risk of malnutrition in who have NONFUNCTIONING GI tract or when oral and EN not feasible or contraindicated

76
Q

what does parenteral consist of

A 
dextrose
AA
lipid emulsion
fluid
electrolyte
vit/min
77
Q

Inidications for parenteral

A
  • Prolonged ileus
  • Bowel obstruction
  • Small bowel resection
  • Short gut syndrome
  • High output enterocutaneous fistula
  • IBD
  • GI bleed
  • Ischemic bowel
  • Unable to tolerate EN
78
Q

Access of parenteral

A

peripheral PN (PPN) - infrequent use (<2-3 weeks)

Total PN (TPN): long term (>7days)

  • central venous catheter
  • PICC (peripherally inserted central catheter) - rare use, inflammation
79
Q

Complications of parenteral

A

mechanical:
- catheter-related sepsis, venous thrombus, air embolus, pneumothorax

metabolic:
-hyperglycemia, azotemia, lyte abnormalities
Fatty Liver- secondary to cholestasis

80
Q

Assessment of nutrition suppor

A

tolerability
I&O’s, weight
Labs (glucose, BUN/Cr, Na, Ca, Albumin/pre-albumin, acute phase reactants)
monitor for refeeding syndrome (intracellular shift of lytes- Mg, PO4, K)
Transaminases, bilirubin, triglyceride

81
Q

GERD diet

A

small frequent meals
elevated HOB
avoid eating 3 hrs before bedtime if nocturnal sx
Avoid triggers

82
Q

Triggering food in GERD

A 
citrus, acidic, spicy/fried
caffeine, coffee, cola
spearmint/peppermint
chocolate
alcohol
83
Q

Sx of gastroparesis

A

N/V, early satiety, postprandial fullness

upper ab discomfort

84
Q

Etiology of gastroparesis

A

etiology of DM (diabetic autonomic neuropathy)

- glycemic control should be optimized in diabetics

85
Q

Gastroparesis diet

A

small frequent low fat/low fiber meals (longer to digest)
Cooked, blendarized, pureed foods and liquids better tolerated

postpyloric enteral nutrition if oral intake insufficiency (ND, NJ)

86
Q

Sx of lactose intolerance

A

bloating, flatulence, diarrhea

87
Q

Diet for lactose intolerance

A

lactose free (no milk, yogurt)
Ca and Vit D supplement?
Lactaid supplements

88
Q

Screening for roux-en-y gastric bypass

A

micronutrients screening:

vit A, D, B1, B12, Folate, Fe , Ca, Zinc

89
Q

Complication of bariatric surgery

A

Dumping syndrome- rapid emptying of food into small bowel

90
Q

Diet for roux-en-y bypass

A

small frequent meals
separate solids from liquids by 30 min
avoid simple sugars

91
Q

Celiac diet

A

eliminate wheat, rye, barley

fresh fish/seafood, meat, poultry, dairy, fruit/veggies, beans, legumes, nuts

identify nutrient deficiency: Fe, Folate, B12, Ca, Zn, Vit D

92
Q

IBD diet

A 
ensure adequate calorie/protein
avoid process/refined foods
may not tolerate lactose
deficiencies: B12, Fe, Ca, Vit D, Zn
Oral/EN supplement as necessary
PN if bowel rest necessary (complicated IBD)
93
Q

Short Bowel Syndrome diet

A

PN in initial period
oral/enteral nutrition - helps augment intestinal adaptation
vit/min supplements as appropraite (b12, vit ADEK, MG, PO4, Zn, Ca)
diet mod

94
Q

Diverticulosis

A

presence of diverticula

95
Q

Diverticulitis

A

inflammation of diverticulum

96
Q

Diverticula diet

A

high fiber died aimed to prevent diverticular disease

97
Q

Diverticulitis diet

A

pending severity
NPO/clear liquid/low fiber/low residue diet

advance to high fiber as tolerated

98
Q

Chronic pancreatitis/pancreatic insufficiency result

A

fat soluble vitamin deficiency (ADEK) - no lipase produced

99
Q

diet for pancreatitis

A

dietary fat restriction

consider pancreatic enzyme replacement therapy

100
Q

At risk of iron deficiency

A 
blood loss***
celiac
H. pylori
Roux-en-Y bypass
PPI use ***
101
Q

Risk of B12 deficiency

A

vegan
roux-en-y
pernicious anemia
terminal ileum chrohn disease, TI resection
celiac
chronic pancreatitis/pancreatic insufficiency
metformin

102
Q

ASCVD diet

A

mediterranean

DASH

103
Q

HTN diet

104
Q

CHF diet

A

low Na

fluid restrict as necessary

105
Q

Mediterranean diet

A

plan-based - veggie, fruit, whole-grain bread, cereal, beans, nuts
olive oil
low to mod fish, poultry, dairy
little red meat

106
Q

DASH diet

A

fruits, veggies, whole grains, low-fat dairy, poultry, fish, nuts, beans
reduce Na, increase K, Ca, Mg
low saturated fat, total fat, cholesterol
reduce sweets, added sugars, sugar sweet drinks

107
Q

Goal of diabetes nutrition

A

optimized A1C, BP, cholesterol

108
Q

DM diet

A

DASH
mediterranean
carb-counting (45% of caloric intake)

109
Q

Renal disease abnormalities

A

sodium/fluid retention
hyperkalemia
hyperphosphatemia

110
Q

renal disease diet

A

individualized protein, Na, K, PO4, Ca (depends on CKD stage/GFR)
DASH
Phos binders

111
Q

Vit K drug intrxn

A

Coumadin (green leafy veggies)

112
Q

Grapefruit juice interaction

113
Q

avoid w/ MAOI

A

tyramine containing foods (chocolate, aged and mature cheeses, smoked and aged meats, hot dogs)

114
Q

Thyroid med interactions

A

administer separate from calcium

115
Q

ACEI/ARBS cause

A

hyperkalemia

116
Q

Diuretics cause

A

hyponatremia
hypokalemia
hypomagnesemia
(Na, K, Mg)

117
Q

Cholestyramine causes

A

fat soluble vitamin deficiency

118
Q

Sulfasalazine, methotrexate causes

A

folic acid deficiency

119
Q

Isoniazid causes

A

vitamin B6 deficiency

120
Q

Metformin causes

A

vitamin B12 deficiency

121
Q

Coumadin concern

122
Q

Statin concern

A

grapefruit juice

Clin Med III Exam 1 (5 decks)

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