Nutrition Flashcards
1
Q
Role of macronutrients
A
Function to provide energy, promote growth and repair, support normal body structure and function
2
Q
Macronutrient energy
A
Carb - 4 kcal
Protein- 4 kcal
Fat - 9 kcal
3
Q
Carbs are broken down by
A
amylase
4
Q
Sources of carbs
A
grains, fruits, veggies, legumes, dairy
5
Q
Protein source
A
fish, lean meat, poultry
egg, dairy
legumes
nuts/seeds
6
Q
Digest proteins
A
protease
7
Q
Digest fat
A
lipase and bile
8
Q
End-product of fat
A
monoglycerides and fatty acids
9
Q
Function of micronutrients
A
support cellular metabolic processes, biochemical reactions, hormone function, nerve impulse propagation and muscle function
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)
11
Q
Vit C role
A
aids in iron absorption
12
Q
Absorption of B12
A
bind to IF in the stomach
13
Q
Fat soluble vitamins
A
A (vision)
D (Ca absorption)
E
K (clotting)
14
Q
Major minerals
A
sodium potassium chloride calcium phosphorous magnesium (some people can claim pretty minerals)
15
Q
trace elements
A
iron, zinc, copper, iodine, manganese, chromium, slenium
16
Q
PPI can interfere with
A
Ca, Fe absorption in stomach
17
Q
Absorbed in stomach
A
Ca, Fe
18
Q
Absorbed in stomach, duodenum, jejunum
A
AA, small peptides, monosaccharides, FA
FAT-SOLUBLE VIT (ADEK)
19
Q
Absorbed in jejunum and ileum
A
water-soluble vitamins
Zinc
20
Q
Bile salt reabsorption
A
ileum
21
Q
Vitamin b12 absorption
A
distal ileum
22
Q
Potassium reabsorption
A
Cecum
23
Q
Thiamine (B1) deficiency
A
beriberi (peripheral neuropath +/- HF)
Wernicke-Korsakoff syndrome (neuro sequela)
24
Q
Riboflavin (b2), niacin (b3), pyridoxine (b6) deficiency
A
cheilitis
angular stomatitis
glossitis
25
Niacin (B3)
pellagra (diarrhea, dermatitis, dementia)
26
Folate deficiency
macrocytic anemia
27
Cobalamin (B12) deficiency
macrocytic anemia, PERIPHERAL NEUROPATHY
28
Peripheral neuropathy
Thiamine (b1) and B12
29
Vitamin D deficiency
rickets, osteomalacia
30
Vitamin A deficiency
night blindness***
bitot spots- keratin in conjunctiva
poor wound healing
dry skin
31
Zinc deficiency
hypoguesia
| impaired wound healing
32
impaired wound healing
Vit A
| Zinc
33
Iodine deficiency
goiter
| hypothyroidism
34
Calcium deficiency
tetany (chvotske & trousseau)
35
Iron deficiency
pallor
pale conjunctiva
koilonychia (spoon nails)
36
Vitamin C and K deficiency
Petechiae/Purpura
37
Vitamin E deficiency
sensory and motor neuropathy
38
Pellagra
Niacin (B3)
39
Blindness
Vit A
40
Wernicke-Korsakoff syndrome
thiamine (B1)
41
Petechia/Purpura
Vit C
| Vit K
42
Nutrition in pregnancy
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?
43
Necessary nutrient in pregnancy
folic acid
44
Nutrition in infancy
sole breastmilk/formula first 4-6 months
Vit D supplement in exclusively breastfed infants
chart/monitor growth - FTT
45
Supplement in breastfeeding babies
Vitamin D
46
milk in children
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
47
Sodium consumption in adults
<2300 mg Na daily
48
MyPlate advice
whole grains
5+ fruits/veggie servings
fiber 25-35 g/day
protein-rich food
49
Fiber amount
25-35 g/day
50
Nutrition in elderly
liberalize diet
incorporate high calorie foods
add oral nutrition supplements if appropriate
51
Nutrition assessment
1. Food/nutrition-related hx
2. Pt hx (medical, surgical, social)
3. Anthropometric measurements
4. nutrition-focused PE
5. lab indicators
52
Factors affecting oral intake
```
anorexia
poor dentition
taste disturbance
heartburn
dysphagia
N/V/D/C
Abdominal pain
```
53
Those at higher risk of thiamine deficiency
Alcoholics
54
Surgical conditions with nutritional implications
ab surgery (bariatric, intestinal resection)
high output fistula or ostomy
trauma
GI hemorrhage
55
Anthropometric measurements
```
height
weight
BMI
usual vs. ideal body weight
weight pattern/unintentional weight loss*
body composition
```
56
Nutrition focused PE targes
```
body weight
muscle wasting
fat stores
volume status
signs of nutrient deficiencies
```
57
PE for nutrition includes
```
general (habitus, LOC, function)
Hair, skin, nails
HEENT: temporal mm, eyes, perioral/dentition
Cardiopulm
Abdominal
MSK/Extremity
Neurologic
```
58
Edema, ascites
protein
59
sunken dry appearance or orbital area
dehydration
60
temporal muscle wasting
protein
| calorie
61
poor wound healing, pressure ulcers
protein
vit C
vit A
Zinc
62
Muscle wasting and decreased strength
protein
| calorie
63
Confusion
thiamine
64
Labs for nutriction
```
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
Nutrition intervention options
dietary adjustments
oral nutrition supplements
nutrition support (enteral and parenteral nutrition)
66
Oral supplements
concentrated source of kcals, protein, vitamin/minerals
liquid drinks, shakes, snacks, etc.
disease specific
tailored per patient
67
When to give nutrition support?
those who cannot meet their nutrition requirement by mouth
68
Types of nutrition support
Enteral Nutrition (EN) - Preferred; physiologic- nutrition delivered directly to GI tract bypassing oral cavity
Parenteral Nutrition (PN) - straight into vein
69
Who gets enteral nutrition?
those w/ functioning GI tract who can't meet nutrient requirement by mouth
70
Administration of Enteral
```
gastric (distends, can be separate feedings)
small bowel (requires continuous)
```
71
Short term enteral (<4-6 weeks)
Nasogastric (NG)
Nasoduodenal (ND)
Nasojejunal (NJ)
*risk of nasal/esophageal erosion
72
Long term enteral (>4-6 weeks)
gastrostomy (G-tube)
Jejunostomy (j-tube)
G/J tube
73
Administration in enteral
stomach- bolus
small bowel- conntinuous
formula- standard, predigested (malabsorption issue), concentrated, lyte-restricted (kidney disease)
74
Complications of enteral nutrition
Mechanical:
- tube misplacement
- tube displacement
- tube obstruction
metabolic:
- hyperglycemia
- unstable fluid/lyte status
intolerance
- emesis
- diarrhea
Pulmonary aspiration
75
Who gets parenteral?
pts at risk of malnutrition in who have NONFUNCTIONING GI tract or when oral and EN not feasible or contraindicated
76
what does parenteral consist of
```
dextrose
AA
lipid emulsion
fluid
electrolyte
vit/min
```
77
Inidications for parenteral
* Prolonged ileus
* Bowel obstruction
* Small bowel resection
* Short gut syndrome
* High output enterocutaneous fistula
* IBD
* GI bleed
* Ischemic bowel
* Unable to tolerate EN
78
Access of parenteral
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
Complications of parenteral
mechanical:
- catheter-related sepsis, venous thrombus, air embolus, pneumothorax
metabolic:
-hyperglycemia, azotemia, lyte abnormalities
Fatty Liver- secondary to cholestasis
80
Assessment of nutrition suppor
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
GERD diet
small frequent meals
elevated HOB
avoid eating 3 hrs before bedtime if nocturnal sx
Avoid triggers
82
Triggering food in GERD
```
citrus, acidic, spicy/fried
caffeine, coffee, cola
spearmint/peppermint
chocolate
alcohol
```
83
Sx of gastroparesis
N/V, early satiety, postprandial fullness
| upper ab discomfort
84
Etiology of gastroparesis
etiology of DM (diabetic autonomic neuropathy)
| - glycemic control should be optimized in diabetics
85
Gastroparesis diet
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
Sx of lactose intolerance
bloating, flatulence, diarrhea
87
Diet for lactose intolerance
lactose free (no milk, yogurt)
Ca and Vit D supplement?
Lactaid supplements
88
Screening for roux-en-y gastric bypass
micronutrients screening:
| vit A, D, B1, B12, Folate, Fe , Ca, Zinc
89
Complication of bariatric surgery
Dumping syndrome- rapid emptying of food into small bowel
90
Diet for roux-en-y bypass
small frequent meals
separate solids from liquids by 30 min
avoid simple sugars
91
Celiac diet
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
IBD diet
```
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
Short Bowel Syndrome diet
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
Diverticulosis
presence of diverticula
95
Diverticulitis
inflammation of diverticulum
96
Diverticula diet
high fiber died aimed to prevent diverticular disease
97
Diverticulitis diet
pending severity
NPO/clear liquid/low fiber/low residue diet
advance to high fiber as tolerated
98
Chronic pancreatitis/pancreatic insufficiency result
fat soluble vitamin deficiency (ADEK) - no lipase produced
99
diet for pancreatitis
dietary fat restriction
| consider pancreatic enzyme replacement therapy
100
At risk of iron deficiency
```
blood loss***
celiac
H. pylori
Roux-en-Y bypass
PPI use ***
```
101
Risk of B12 deficiency
vegan
roux-en-y
pernicious anemia
terminal ileum chrohn disease, TI resection
celiac
chronic pancreatitis/pancreatic insufficiency
metformin
102
ASCVD diet
mediterranean
| DASH
103
HTN diet
DASH
104
CHF diet
low Na
| fluid restrict as necessary
105
Mediterranean diet
plan-based - veggie, fruit, whole-grain bread, cereal, beans, nuts
olive oil
low to mod fish, poultry, dairy
little red meat
106
DASH diet
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
Goal of diabetes nutrition
optimized A1C, BP, cholesterol
108
DM diet
DASH
mediterranean
carb-counting (45% of caloric intake)
109
Renal disease abnormalities
sodium/fluid retention
hyperkalemia
hyperphosphatemia
110
renal disease diet
individualized protein, Na, K, PO4, Ca (depends on CKD stage/GFR)
DASH
Phos binders
111
Vit K drug intrxn
Coumadin (green leafy veggies)
112
Grapefruit juice interaction
statins
113
avoid w/ MAOI
tyramine containing foods (chocolate, aged and mature cheeses, smoked and aged meats, hot dogs)
114
Thyroid med interactions
administer separate from calcium
115
ACEI/ARBS cause
hyperkalemia
116
Diuretics cause
hyponatremia
hypokalemia
hypomagnesemia
(Na, K, Mg)
117
Cholestyramine causes
fat soluble vitamin deficiency
118
Sulfasalazine, methotrexate causes
folic acid deficiency
119
Isoniazid causes
vitamin B6 deficiency
120
Metformin causes
vitamin B12 deficiency
121
Coumadin concern
vitamin K
122
Statin concern
grapefruit juice
