Nutrition Care for Individuals and Groups Flashcards
Name the affected blood lab values of anemia of chronic disease
Low RBC, Hgb, and Hct
Normal MCV (mean corpuscular volume) and MCHC (mean corpuscular hemoglobin concentration) = normocytic anemia
“normally seen in children”
How does the body compensate during respiratory acidosis?
Blood becomes very acidic since the lungs cannot remove all the CO2 the body produces, so the kidneys will excrete more hydrogen and retain more bicarb
Why would you see kwashiorkor in TPN patients receiving D5W?
*kwashiorkor= severe form of malnutrition; usually seen in children/babies in developing countries who don’t get enough protein/essential nutrients. Signs= fluid accumulation in body’s tissues, usually abdomen.
High dextrose with little protein in the mixture could cause kwashiorkor in TPN patients in 2+ weeks.
A high CO2 and low pH (acidic) is an indication of:
Respiratory acidosis
What is the renal solute load (RSL)?
The amount of nitrogenous waste and minerals that must be excreted by the kidneys. Proteins and electrolytes increase RSL.
What do you give a person after a 90-minute workout?
Fluids + carbs
What should be supplemented in women taking oral contraceptives?
Vitamin B6 and folacin (aka folic acid)
Explain positive and negative nitrogen (protein) balance
+: retention of nitrogen/protein > excretion (times of building and healing– anabolic)
-: excretion of nitrogen/protein > retention (times of sickness– catabolic)
Name the diet therapy that would be seen in epileptic children
Keto
Name a reaction to metabolic acidosis
Metabolic acidosis= build up of acid in the body d/t kidney disease/failure.
Reaction= Hyperventilation (rapid/shallow breathing)
How many kg would be lost in 1 week if a woman decreased her caloric intake from 2400 kcal to 1800 kcal?
1/2 kg per week (see answer sheet for solution)
2400-1800=600 kcal
600 kcal x 7 days = 4200 kcal/week
4200 kcal/3500 kcal/lb = 1.2 lbs per week
1.2lbs/ 2.2 kg/lb= 1/2kg per week
How much formula + water is needed for 3/4 strength TF at 50 ml/hr for 24 hours?
900 cc/d of formula, 300 ml water
See answer sheet for solution
50 ml/hr x 24 hours =1200 cc/d
1200cc/d x 0.75= 900cc/day of formula
1200 cc/d -900cc/d= 300 cc/day of water
Describe MSUD
Maple Syrup Urine Disease: genetic disease in which there is a defect in decarboxylation of BCAA causing thick brown urine.
Diet therapy: Low intake of BCAA (all protein-containing foods)
What is a neutropenic diet?
Low bacteria diet. Fresh fruits and vegetables are omitted
Describe galactosemia
Genetic disease affecting the body’s ability to convert galactose –> glucose.
Diet therapy: decreased galactose (milk products, organ meat, MSG)
List some symptoms of prolonged hyperglycemia in IDDM
- polyphagia (excess eating from increased appetite and excessive hunger)
- weight loss
- ketosis/acidosis (diabetic ketoacidosis– DKA)
- polyuria
- polydipsia (excessive thirst)
POLYPHAGIA: glucose can’t enter cells to be used for energy. This can be due to either low insulin levels or insulin resistance. Because your body can’t convert this glucose to energy, you’ll begin to feel very hungry. The hunger associated with polyphagia doesn’t go away after consuming food.
WEIGHT LOSS: insufficient insulin prevents the body from getting glucose from the blood into the body’s cells to use as energy. When this occurs, the body starts burning fat and muscle for energy, causing a reduction in overall body weight.
DKA: DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones.
POLYDIPSIA/POLYURIA: Polydipsia is caused by high blood glucose levels in people with diabetes. When your blood sugar level levels rise, your kidneys release extra urine in an attempt to flush the excess glucose from your system. In the meantime, the brain urges you to drink more to replace the water the body is lacking.
Define Appropriation Bill
The bill that requests government funding for a community based program
In what phase of a community nutrition program should the budget be reviewed?
In the plan
What foods are in alkaline ash diet?
fruits and veggies
What foods are in the acid ash diet?
Cereals and Meats
Name the maximum time allowed outlined by Medicaid policy between the evening and morning meal
14 hours
Nutrition education programs should primarily be used as:
Change agents: “main goals of community programs are to promote change in a population.”
What diet is desirable for Dumping Syndrome?
Small meals, decreased CHO. Separating fluids from meals.
What nutrients delay gastric emptying?
protein and fat
Why do bulimic often have tooth decay?
Gastric juices decay teeth from excessive vomitting
What is the best diet for peptic/stomach ulcer disease?
Any diet that is tolerated by the patient
If patients receive incorrect nutritional information from physicians, what is the first step the RD should take?
Consult the physician
List the criteria for enrollment into the Food Stamp Program
Income– income guidelines are based on the Thrifty Food Plan
(one of four food plans USDA develops that estimate the cost of a healthy diet across various price points )
How does exercise affect blood sugar?
Decreased blood sugar
With DM, how is insulin altered on sick days (ie fever)?
Increased insulin
List the most common reasons for weight gain amongst the US adult population
- sedentary lifestyle (#1 reason for weight gain in people 65+ y/o)
- overeating
- modern day conveniences replacing energy expending activities
Name the only circumstance when it is advised for pregnant women to lose weight
Never. RD should counsel the patient on how to slow the rate of weight gain, but NOT how to lose weight.
Name the initial reaction during the acute phase response (trauma)
Hypometabolism (decreased brain glucose consumption)
Name the AA that has been reported to aid healing in TPN patients
Glutamine
It is the most abundant amino acid found in the body. It’s made in the muscles and transferred by the blood into different organ systems. Glutamine is a building block for making proteins in the body. It’s also needed to make other amino acids and glucose.
Describe the feeding guidelines for formula fed newborn infants
6-8, 3 oz feeds/day
When plotting weight and height on growth charts and it appears a patient has decreased several percentiles, it is important to check what first?
- accuracy of plotted points
2. accuracy of wt and ht measurements
Name the most commonly seen indicator of malnutrition in the US
Low iron status levels (low Hgb or Hct)
What is the most accurate way to assess food intake?
Calorie count
What diet is appropriate for congestive heart failure (CHF)?
2 g sodium diet
Name the most appropriate tool for assessing ht and wt in children
National Center for Health Statistics (NCHS) Percentiles
What age do you measure a child’s ht, standing?
2
An HIV pt has a consistent 104 F temp. What % increase in kcals is needed to maintain body weight?
37.8%
Name a culturally acceptable grain for the Middle Eastern population
Bulgur or rice
What is the most important dietary concern with HIV/AIDS patients?
Food safety
Describe one factor that the RD needs to consider when obtaining food preferences from a culture other than her own.
Cultural beliefs about certain foods or eating practices
Describe the treatment for PCOS
Weight control and exercise
Diet Therapy: 30-40% lipids and lower CHO (higher fat compared to normal, 20-35%, to help decrease insulin secretion)
Describe cost-benefit analysis
Measures the amount of money saved due to a program’s outcome
Example: a weight-loss program costs $250 to run, but produces $1000 in reduced medical costs (savings), the cost-benefit ratio is 1:4.
Cost of program: Savings in Costs=Cost-Benefit Ratio
What is the recommended total weight gain for a pregnant woman that is underweight (BMI < 18.5) at baseline?
28-40 lbs
What nutrients are affected when taking Levodopa (typically used for tx of Parkinson’s)?
Protein and B6
Outline the food practices of those whom are Seventh Day Adventists
- no pork, shellfish, or rabbit
- no alcohol
- many avoid caffeine
- no meat broth
What is the main disadvantage of taking antidepressants?
weight gain and increased appetite
Name the food that must be included in a school breakfast funded by the USDA
- milk
- fruits or veggies
- 2 breads or bread+meat
Why would you see decreased serum calcium when serum albumin is low?
albumin is a carrier of calcium.
low calcium levels do not necessarily mean deficiency during low albumin status d/t active calcium not bound to albumin (reason for corrected calcium equation)
Who qualifies for Medicaid?
Those who are indigent (poor), blind, mentally or physically handicapped
Describe the difference between urea and creatinine excretion
Urea: r/t protein intake
Creatinine: r/t muscle mass
Both are waste products during protein metabolism. Can be increased during exercise but also when kidneys are not functioning properly. They are also used to measure how well the kidney is functioning
Name the best type of milk to recommend a breast feeding mom looking to supplement in addition to breast milk
Infant formula w/ iron. Cow’s milk isn’t recommended until 1 years old.
What causes a fatty liver in TPN patients?
Excess dextrose.
Excess dextrose –> hyperinsulinemia–> increased glucose being converted to fat in the liver –> fatty liver
What is the RD’s biggest concern with complications of tube feedings?
Diarrhea (usually will be cause by medications tube fed pt is receiving)
Name the most important anthro indicator of FTT?
Weight for height
What nutrient should be increased during times of decubitus ulcers (bed sores)?
protein
How long can an enteral formula be refrigerated after opening?
48 hrs
what weight is a low birth weight?
< 5.5 lbs (1500-2500 g)
VLBW = < 1500 g
Name the best indicator of proper growth and development in children
regular and consistent increments of growth as reflected on the growth charts
Define complimentary proteins
The various mixing of protein containing foods that provides a total mixture of essential AA when eaten in combination. This help ensure that there is adequate intake of all the essential AA. (ie- beans and rice)
Why should infants not consume honey for the first year of life?
May cause botulism
What aids in the absorption of iron from non-heme sources?
Vitamin C (forms a chelating agent with iron) ie- OJ + iron fortified cereal
What nutrients are more important for HIV/AIDS patients?
protein and cals
What is the most influential factor in hypertension?
obesity (alcohol is also an important factor)
Aside from folic acid, what supplement should be considered when taking Methotrexate?
Methotrexate: chemotherapy drug (also used to treat rheumatoid arthritis and psoriasis)
B12 (cyanocobalamin) if at risk for deficiency
Name the report that provides information for formulation of the “10 leading causes of death in the US”
The Surgeon General Report
“Heart disease, stroke, and cancer are the top 3 and dietary factors play a role in each.”
What is usually the initial problem with HIV/AIDS patients?
Anemia
Describe the difference between the symbol U and the symbol K seen on food packages
U: Union of Orthodox Jews
K: Rabbi Supervised
What medication is affected by sodium consumption?
Lithium (psychiatric medication used for bipolar)
What is an entitlement program?
Qualifications of entitlement programs are based on income or other eligibility requirements
ie- school lunch and food stamps
Entitlement programs consist of government benefits that certain qualified individuals are entitled to by law, regardless of need.
What is the first thing a RD should do in most clinical and management situations?
Assess and Evaluate
on the exam, the answer will usually be assess or evaluate if given the choice on any question
As the outpatient RD, you have a f/u with a diabetic pt. During the appt you educate on carb counting. What would you chart as the intervention?
Comprehensive Nutrition Education (E-2). Pt was educated on CHO counting and demonstrated understanding of the topic.
CHO counting would be considered an advanced topic since previous diabetes education was provided during a previous consult
What is the purpose of the NIH?
Supports nutrition research as it relates to health maintenance, disease prevention and disease treatment
Compare surveys with surveillance programs.
Surveys: conducted once in a given timeframe
Surveillance programs: ongoing or continuous
If a pt didn’t know how to follow a 2 gram Na diet, what would you chart as the nutrition diagnosis?
Food, nutrition and nutrition-related knowledge deficit (NB-1.1).
What is deficient when cracked lips, spoon shaped nails and easily plucked hair is observed?
Cracked lips: B vitamins
Spoon-shaped nails: iron
Pluckable hair: protein
Why would you take iron preparations with meals?
to avoid gastric distress
Which nutrients are absorbed in the duodenum?
iron, calcium, magnesium and chloride
What lab test is used to evaluate hypo- or hyperthyroidism?
T3 and T4 (thyroid hormones)
How much water does the average adult excrete per day?
2 L
Describe the effect temperature has on BMR.
BMR rises 7% for each degree above 98.6 F.
BMR rises 13% for each degree above 37 C.
How does the body compensate during metabolic acidosis?
the lungs excrete more CO2 to raise the pH of the blood.
What is the normal value of the renal solute load and what value determines renal failure?
Normal RSL= > 55 ml/min
Renal failure= 12.5-30 ml/min
Protein requirements during renal insufficiency are 0.6-0.8 g/kg
Name the half-life of transferrin and the normal storage capacity
half life is 8-10 days
Normally saturated 30-40% with iron
What does MCV measure?
size of the RBC
Name the normal values for albumin, its half-life and reasons for a decreased albumin in patients
Normal= >3.5 g/dL
half life is 15-19 days
Decreased:
- post-op
- overhydration
- protein malnutrition
- chronic loss (nephrotic syndrome- kidney disorder that causes the body to excrete too much protein in the urine)
Normal Hgb and Hct values
Hgb: Men; > 14, Women; >12
Hct: Men; >44%, Women; >38%
Symptoms of kwashiorkor
mild muscle and fat wasting, very low albumin, edema and decrease in protein intake
What should be supplemented when taking Isoniazid (INH)?
Isoniazid (INH)- antibiotics for TB
Vitamin B6
Symptoms of marasmus
Severe malnutrition characterized my inadequate energy intake (different from kwashiorkor that’s characterized by inadequate protein intake)
Symptoms: muscle and fat wasting, tricep skin fold (TSF) of 10% or less, slightly low albumin, no edema and decrease in kcal intake
Name the onset time of Regular, NPH, and Glargine insulin
Regular/short acting: 0.5-1 hour onset (lasts for 3-6 hours)
NPH: 2-4 hours onset (lasts 12-18 hours)
Glargine (lantus): 1 hour onset (lasts up to 24 hours)
Describe the 10-State Nutrition Survey
Conducted only 1 time (between 1968-1970)
Limited to low income areas
define morbidity and mortality
morbidity: incidence of illness
mortality: incidence of death
A TF with 1.6 kcals/ml is to run from 10pm to 11 am (13 hrs). What rate is needed to deliver 1800 kcals?
86.5 or 87 cc/hr
1800 kcal/d / 1.6 kcals/cc= 1125 cc/d
1125cc/d/13hrs/d= 86.5 cc or 87 cc /hour
Name the next step after a bill is introduced into Congress
assigned to a committee
Name the population that has an increased incidence of obesity
African-American females age 44-65
How many kcals in 2 pieces of bread and 2 oz of very lean turkey breast?
Bread: 2 exchanges = 30 grams CHO and 6 grams protein + 2 grams fat
[30 x 4] + [6x4] + [2 x 9] = 162 kcals from bread
Meat (turkey): 2 exchanges = 14 grams protein and 2 grams fat
[14 x 4] + [2x9] = 74 kcals from turkey
162+74= 236 kcals
The current tube feeding rate is not meeting the pt’s estimated needs for kcals or protein. What would you chart as the intervention?
Enteral and Parenteral Nutrition (ND-1)
Recommend increasing TF rate to __ ml/hr to meet pt’s estimated needs for kcals and protein.
Define Diagnostic Related Group (DRG)
DRGs assign fixed costs and lengths of hospital stay to specific illnesses.
Also called Prospective Payment System (DRGs stem from Medicare)
Name the primary focus of HANES survey
To continually survey the nutritional status of the US population
List general goals of community based nutrition program
- Meet the needs of the large demographic group within a population
- Address the communities’ largest problems
- Take into consideration the goals of the local government and public officials
A goal would NOT include meeting ALL the needs of the community.
A pt with HIV/AIDs, has a CD4 cell count of 25, an albumin of 1.8 g/dL and a BMI of 15, may have what nutrition diagnosis?
Can chart any of the following:
- Increased protein needs (NI-5.1)
- Evident protein-energy malnutrition (NI 5.2)
- Underweight (NC-3.1)
- Altered nutrition-related lab values (NC-2.2)
________________
CD4 count is used to check the health of the immune system in people infected with HIV (human immunodeficiency virus). HIV attacks and destroys CD4 cells. If too many CD4 cells are lost, your immune system will have trouble fighting off infections
What is the requirement for participation in the school lunch program?
Family income
Describe the objective of HMOs (health maintenance organizations).
Focus on preventative medical care. The main objective is to prevent patients from being admitted to a hospital.
Name the first step when developing an in-service, presentation, or workshop.
Assess the needs and interests of the audience
Describe pernicious anemia and the affected blood lab values.
A decrease in red blood cells when the body can’t absorb enough vitamin B-12 (body needs B12 to make RBC).
Labs:
- low RBC, Hgb, Hct
- High MCV (RBC are too large) and normal MCHC–> macrocytic anemia
Where in the intestinal tract is vitamin K FORMED?
In the colon (by bacterial action)
Name the best test for malnutrition
body weight
What is the protein requirements for someone on hemodialysis?
1.1-1.4 g/kg (ideal is 1.2 g/kg)
Name the affected blood lab values in iron deficiency anemia
Low Hgb, MCV, MCHC–> microcytic anemia
RBC may be normal
Which nutrients are absorbed in the ileum?
Fat soluble vitamins
Fat
Cholesterol
Name a serious condition caused by hyperkalemia
Cardiac arrest
Why is calcium absorption decreased in kidney disease?
Decreased active vitamin D formation
What vitamins may be affected with frequent use of laxatives?
Fat soluble vitamins (ADEK)
Describe creatinine
Waste product made by your muscles as part of regular, everyday activity. Normally, your kidneys filter creatinine from your blood and send it out of the body in your urine. If there is a problem with your kidneys, creatinine can build up in the blood and less will be released in urine.
Low value associated with decreased muscle mass.
It is a product of creatine found mainly in the muscle and aids in ATP during anaerobic conditions (absence of O2).
What should be avoided when on MAO Inhibitors? Name some foods high in this.
MAO Inhibitors are used for treatment of depression.
Tyramine (AA) should be avoided.
Foods high in tyramine: cheese, smoked meat, non-fresh meats, chianti wines, broad beans, dry sausage. (fermented foods)
Cottage cheese, cream cheese, yogurt.
Name the half-life of retinol-binding protein
12 hours
Name some metabolic abnormalities seen in refeeding syndrome
- hypophosphatemia
- hypokalemia
- hypomagnesemia
Describe complimentary medicine
Alternative medicine used in conjunction with conventional medicine.
Ie (yoga, acupuncture, chiropractic, and hypnotherapy)
Calculate the BMI of a male who is 155 lbs and 5’10”
[weight (lbs) x 703] / height (in)^2
5 ft = 60 in.
[155 (703)] /70^2 = 108,965/4900= 22.24 (22.3)
A patient is receiving 2 L of D5W; how many kcals would this provide?
2000 ml x 0.05 g/ml= 100 g CHO
100 g CHO x 3.4 kcals/g = 340 kcals
(0.05 g/ml= concentration of dextrose & there are 3.4 kcals/g of dextrose)
What daily caloric intake will result in a weight loss of 2 lbs/month if currently consuming 2000 kcals/d?
3500 kcals = 1 lb 3599 kcals x 2 lbs = 7000 kcals 1 month = 4 weeks 7000 kcals/4 weeks = 1750 kcals/week 1750 kcals/7 days = 250 kcals/day 2000 kcals-250 kcals= 1750 kcals
What is the kcal:N ratio of 1500 kcals and 20% protein?
1500 kcals x 0.2 = 300 kcals /4 kcals/g = 75 g protein
75 g protein / 6.25 protein/g Nitrogen = 12 g N
1500 kcals / 12 g N = 125:1
(N content of protein = ~16% or 6.25 protein/g of Nitrogen)
Name the first step involved when making program changes due to funding cuts
Reassess program
Reading the local newspaper will inform you on what stage of the passage of a bill?
The proposal stage
Name one of the reasons why paraprofessionals are important to utilize in community nutrition programs.
Establish better rapport with low income patients
Medicare policy states an elderly person nutritional status needs to be evaluated every…
90 days
Medicare recipients are not entitled to a yearly physical
When would you contact your congressional representative to gain support in a piece of legislation?
After the bill has been introduced on the floor
Name the most effective way to measure success of a community nutrition program
Meeting program objectives (example of a measurable objective would be a decrease in low-birth weight babies)
When would it be advised for a breast feeding mom to stop breast feeding due to medications?
Never, the mother should first consult with physicians to find out what medications are safe.
(If mom is HIV+, it is recommended to not breast feed)
Name the hormone that stimulated the production of breast milk
Prolactin
Oxytocin stimulates the let-down reflux of milk.
The Child and Adult care Food Program serves what population?
Children and adults in day care facilities
Define colostrum
Milk that’s produced just prior to and after childbirth; so babies are receiving this during the first 24 hours of life.
rich in antibodies.
Name the method of infant feeding promoted by the WIC program
Breast feeding
Describe who is responsible for 1st, 2nd, and 3rd party reimbursement
1st: user or purchaser
2nd: the provider
3rd: insurance company + patient’s family
Name the most effective tool to assess an infant or child’s dietary intake
A 3-day food record
Name the criteria for the Congregate Meals Program (also called Title III)
- 60 years or older
- no income criteria
- only one member of a couple must qualify
Describe the appropriate rate of weight gain during pregnancy
1st trimester: 2-4 lbs total (weight gain is slow during this trimester)
2nd and 3rd trimesters: 1 lb/week
Should a bottle be used to quiet or pacify a crying baby?
No - an infant or child should only eat on demand. food should not be used as a reward or to pacify
Define a low cariogenic value food
Foods that are low in sugar
cariogenic= causing tooth decay
Name the NHANES population surveyed
2 mo to 74 years
If an infant has consistently been at the 95th percentile weight-for-age, what would you recommend?
Nothing- you would want to “wait and see”
abnormal growth is <5th percentile to >95th percentile.
Name what needs to be assessed if a formula fed child has low iron status
Assess if child is on an iron-fortified formula
Normal Hgb: 11.2
Name the problematic nutrient that interferes with iron absorption
Calcium
excess milk consumption frequently causes iron deficiency anemia in children
Name the most important anthropometric data when assessing children.
Height and weight
Describe why sugar and food additives do not have proven effects on hyperactive children.
Some studies have proven that giving hyperactive children sugar has a soothing effect
Name the most prevalent nutrition related problems among American children.
obesity, anemia, and dental caries
too much sugar and fat and not enough iron rich foods
Define acculturation
Occurs when one culture adopts cultural habits of another culture (ie Mexicans adopting US eating habits)
Name a calcium rich food that would be acceptable in a Mexican-American diet
Broccoli and cheese
Describe the velocity of linear growth a newborn into teenage years.
Newborns grow at a very rapid rate and slow down with age.
Name the groups of people that use very little milk in their diet.
Mexicans, Asians and Native Americans
Name the food that a lactovegetarian would restrict
Meat, poultry, fish and eggs (milk and dairy products are allowed)
Discuss the reasons why it is important for infants to not drink for a bottle while lying down
May cause ear infections and dental caries (includes not taking a bottle to bed. Sugars from the formula and juice collect on the teeth and in the ear canal providing food for bacteria to grown.)
What is the least amount of weight a woman should gain during pregnancy?
15 lbs
If a women is obese (BMI >29.0) prior to pregnancy, she should gain between 11-20 lbs during pregnancy.
Describe cost-effectiveness analysis
Measures the benefit of a program/service in monetary terms. (ie- $1 per point of cholesterol lowered. Usually, measured per outcome.)
Compare the fat, protein, and CHO in 1 L of human breast milk compared to formula.
Human milk: 45 g fat, 9-11 g protein, 70 g CHO
Formula: 33-36 g fat, 15 g protein, 74-96g CHO
Compare prevalence with incidence
Prevalence: # of cases of a disease at a particular time (ie 10% of the population has AIDS)
Incidence: # of new cases (ie 3000 new cases of HIV were reported in 1992)
Describe the food practices that Roman Catholics may follow
- No meat on Fridays during Lent, Ash Wednesday and Good Friday
- No eating b.w meals on Ash Wednesday and Good Friday
not applicable for people on therapeutic diets or the elderly
Name the food restrictions in Judaism
- no pork/ pork products (ie gelatin)
- fish must have fins/scales (no shellfish, squid, etc)
- no meat/poultry combined with dairy in the same meal (ie pepperoni pizza)
- no foods containing blood
Name the function of the Federal Register
A daily publication (journal) that provides Federal agency regulations, proposed regulations and schedules of Federal Hearings
Name the piece of legislation that provides home delivered meals, congregate meals and nutrition programs for senior citizens
Older American Act (aka Title III)
MoW is not a gov program
Name the purpose of the Dietary Guidelines
to prevent chronic disease (also aid in planning for community nutrition programs)
Describe the population who qualifies for Medicare
People who are 65 years+, who have paid into Social Security 40 quarters (4 quarters= 1 year)/10 years
Name the population who is at greatest risk during pregnancy
Teens
an overweight, underweight, or anemic teen is more at risk than an adult with the same problems
When planning a community nutrition program, with whom is it best to collaborate?
Similar programs and populations (WIC and Head Start often collaborate b/c they both serve the pediatric population)
Name the nutrients needed to be supplemented if a woman who was taking oral contraceptives became pregnant.
Folic acid and B6
Name the nutrient needs that increase during lactation
calories and protein
A pregnant vegan’s diet may lack in which nutrients?
Calcium (dairy), B12 (fish) and Zinc (meat)
Describe the feeding regime for a breast-fed infant
on demand
At what age are table foods recommended to be first given to infants?
4-7 mo
Describe the growth pattern seen in growth retardation.
As age increases, increments of linear growth are slowed. (on growth charts, height for age decreases slowly overtime)
Name the most effective tool for assessing the nutritional status of the elderly population
Height and weight
Name the most important foods that can be recommended to infants 6-12 mo with low iron
- iron fortified formula
- Infant cereal
for the first 6 mo, baby gets iron stores from maternal blood. After 6 mo, high iron foods aid in production of baby’s own iron stores
Name the most dangerous ramification of pica seen in children
Pica= Craving and chewing substances that have no nutritional value, such as ice, clay, soil, or paper.
Lead poisoning
List three considerations when planning for a nutrition program for the elderly
- transportation
- food myths (elderly are prone to buying into fad diets)
- lack of exercise
One of your patients is an 8 yo who doesn’t eat much meat, what would be the first thing you would assess?
Iron status (Hgb and Hct); even if child is eating fruits, veggies and milk
What is the normal range of percentiles on growth charts for children?
5-95%
Until what age should children drink whole milk?
2 years old
Name the most appropriate anthropometric parameter that would describe the prevalence of malnutrition amongst the US children
Height for age (stunting)
reflects the cumulative effects of undernutrition and infections since birth, and even before birth. Can be interpreted as an indication of poor environmental conditions or long-term restriction of a child’s growth potential
Name the vitamin that tends to be low in breast milk
Vitamin D
Name the best way to introduce a new food to a group of children.
With an activity (also helpful to get children involved in food prep)
What population’s diet is often deficient in calcium, iron, and vitamin C
teenage girls
Name the best possible way to attract low-income teenagers to nutrition education program
through radio advertisements
Name the basics of the “Plate Method” developed by the USDA
- promotes a variety of foods
- half of the plate are fruits and veggies
- half of the grains should be whole grains
List some common foods eaten by the Mexican-American population
Corn or flour tortilla, refried beans, peppers, burritos, and rice (if trying to reduce cholesterol, recommend boiled beans rather than refried beans)
Name the populations that would most benefit from the use of the Hedonic Scale (dislike extremely to like extremely)
- Children
2. Non-English speaking people
What is the total recommended weight gain for a pregnant woman who was the right weight for height prior to pregnancy?
25-35 lbs
normal height for weight is a BMI of 18.5 to 24.9
List foods that would help increase vegan’s iron intake
baked beans, other dried beans, enriched cereals, raisins, etc
THE MOST COMMON FOOD ANSWER ON THE RD EXAM IS BAKED BEANS
Name the foods that are not acceptable in a vegan diet
animal products (including eggs, milk, fish, poultry, etc)
Name the primary goal of the Food and Agriculture Organization (FAO)
To increase the food supply through agriculture
List some frequently eaten foods by the Native American population
variety of meats, nuts, berries, corn, jerky, maple syrup, tomatoes and squash
(high prevalence of lactose intolerance in this population)
Describe the primary goal of the World Health Organization (WHO)
To improve the nutritional status of infants and pregnant women
List the food limitations of The Church of Jesus Christ of Latter-day Saints populations
No alcoholic beverages, coffee or tea (black or green)
Caffeine containing sodas are permitted.
While talking to an elderly patient on a regular diet, you discover that her dentures are not with her. She is having problems chewing certain foods and cannot tolerate meats at all.
What would you chart as the nutrition diagnosis, the supporting evidence and the intervention?
Chewing difficulty (NC-1.2) r/t missing dentures AEB conversation with pt.
Recommended changing diet to mechanical soft with ground meat.
Name the services that the Expanded Food and Nutrition Education Program (EFNEP) provide.
EFNEP provides nutrition education to those families with children under the age of 19 who are at greatest nutritional risk and are low income.
A pt is admitted with chest pains. After your assessment, you determine the only nutrition-related concern are his labs.
Total Chol= 256
LDL= 180
HDL=30
What is you nutrition diagnosis?
Altered nutrition relation lab values (NC-22) r/t chest pains AEB increased total chol, LDL and decreased HDL.
Normal Values:
Total Chol: <200
LDL: <100
HDL: 45-70 for men and 50-90 for women
List the enrollment criteria for the WIC program
- low income
- nutrition risk
- either pregnant, postpartum (6 mo), lactating (1 yr) or a child < 5 years.
Why would anemia be seen in renal patients?
Kidney are responsible for erythropoietin (making RBCs)
What hormone controls hypertension by reabsorbing sodium in the kidneys?
Aldosterone
What is the most important nutrition factor for endurance athletes?
Hydration during the event
What system does lactic acid utilize to give up bound oxygen?
Cori Cycle
Name the normal values for fecal fat, serum sodium and HgbA1c.
fecal fat: 5-7 g/24 hrs
serum sodium: 135-148 mEq/L
HgbA1c: 4.0-6.0% (3-4 month test evaluating blood glucose)
Which nutrients are absorbed in the jejunum?
B vitamins, folic acid, vitamin C, monosaccharides
Name the best type of food for a child with athetoid cerebral palsy
Nutritionally dense foods that can be eaten with their hands.
Which nutrients have the greatest effect on osmolarity?
Electrolytes
Describe alternative medicine
Practices used in place of conventional medical treatments (ie- traditional Chinese medicine, homeopathy, chiropractic and herbalism)
What minerals are subject to drug-nutrient interactions when taking diuretics (Lasix and Furosemide)?
K+, Mg, Zinc, Ca
Name the half-life of prealbumin
2-3 days
What is glutathione peroxidase?
the active form of selenium
needs to be supplemented in TPN patients
Describe the diet in Cystic Fibrosis
Increased protein and 35-40% fat (fat likely to be malabsorbed in CF)
Why would children with PKU have an increased risk of cavities?
PKU diet is high in simple CHO.
PKU is a genetic disorder that causes a buildup of certain AA in the body.
What should be the predominant protein source with hepatic encephalopathy?
foods high in BCAA.
(BCAA supplementation may reduce malnutrition and revert the loss of muscle cell mass that is common in severe liver disease and the breakdown of protein that occurs in people with hepatic encephalopathy (Córdoba 2004; Kachaamy 2011).
Name the disease that alters copper metabolism
Wilson’s Disease (genetic disease)
What is the reason for high fiber and fluids for quadriplegic?
to prevent constipation
What do surveillance measure?
incidence
surveillance is used to assess and I.D. the nutritional related problems in a community
What does the RD need first to release patients records to a physician?
written consent from the patient
A TPN solution contains: 500 ml 20% dextrose, 500 ml 4% protein, 250 ml 20% lipids. Determine the non-protein kcals, total kcals and non-protein kcals:nitrogen ratio.
840 non-protein kcals
920 total kcals
263:1 ratio
SEE ANSWER SHEET
What is the diet for a colon resection and what vitamin could be affected?
Adequate CHO and high fluids.
B12 could be affected
Define regulation
the interpretation of a law
Aside from advice from a RD, what else should an anorexic patient be getting?
psychiatric counseling
What is removed in a gastrectomy?
all or part of the stomach
What is excluded in a Celiac diet?
Wheat, rye, barley and gluten-free oats (oats can be an issue d/t cross-contamination)
What is the max amount of hours prepared formula can be refrigerated?
24 hours
Compare the WIC and Food Stamp Programs
WIC:
- provides nutrition education
- provides vouchers for certain foods
- only serves pregnant/lactating women and infants+children
Food Stamps:
- does NOT provide nutrition education
- provides vouchers for a wider range of foods
- serves people 18+
BOTH are funded by the USDA
List some possible outcomes of WIC services
- increased Hct and Hgb
- less anemia
- less low birth weight babies
- more knowledgeable patients regarding nutrition information
What is produced after a period of long starvation and in uncontrolled diabetes?
Ketones (used in place of glucose for the brain)
What is a result of ketosis?
incomplete fatty acid oxidation and a depletion of Na and K
List the two most common nutrients that are supplemented during pregnancy
Folic acid and iron
Describe what happens when formula is heated in the microwave
There is a risk of burning the infant d/t uneven heating of the milk
List 3 common nutritionally related disease states among the eldery
- obesity
- osteoporosis (greatest risk for elderly white women)
- high BP
What is the best way to assess if a TF is working?
prealbumin
The use of prealbumin has been advocated as a nutritional marker, particularly during refeeding and in the elderly [32]. The main advantage of prealbumin compared to albumin is its shorter half-life (two to three days) (Table 2), making it a more favorable marker of acute changes of the nutritional state.
Name some side effects of carb loading.
weight gain, sore muscles and fatigue
Name the 4 steps in the Nutrition Care Process (NCP)
ADIME
- Assessment
- Diagnosis
- Intervention
- Monitoring and Evaluation
What would be decreased in bedridden patients?
calcium and nitrogen
