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PPS 923 > Nutrition for the chronically ill > Flashcards

Nutrition for the chronically ill Flashcards

1
Q

What is the nutrition assessment?

A 
A -Anthropometric
B-Biochemical
C-Clinical
D-Dietary Methods
E-Environment
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2
Q

What is Anthropometry?

A

The measurement of physical dimensions and composition of the body. (EX: height, weight, head circumference)

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3
Q

What is the Biochemical aspect of the nutrition assessment?

A

Involves Laboratory methods such as looking at:

  1. Serum proteins - albumin, prealbumin
  2. Hemoglobin
  3. Lipid profile
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4
Q

What is the Clinical aspect of the nutrition assessment?

A
  1. Detects signs and symptoms of malnutrition.

2. Discovered during clinical exam.

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5
Q

What can painful cracks at the corner of the mouth indicate?

A

Riboflavin or niacin deficiency.

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6
Q

What is the dietary methods aspect of the nutrition assessment?

A

Surveys to measure the quantity of food consumed over a period of time.

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7
Q

What are ways to gather dietary method information?

A
  1. 24-hour dietary recall
  2. Food diary
  3. Food frequency questionnaire
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8
Q

What is the environment aspect of the nutrition assessment?

A

Evaluation of environment that may affect nutrition such as:

  1. access to food
  2. Income
  3. Home environment
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9
Q

What are the types of Dysphagia?

A
  1. Oropharyngeal

2. Esophageal

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10
Q

How do we assess for dysphagia?

A
  1. Bedside evaluations

2. Modified barium swallow by speech or occupational therapy.

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11
Q

What are the characteristics of Esophageal Dysphagia?

A
  1. Food or liquid stops in esophagus

2. Solids may be more difficult to swallow than liquids.

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12
Q

Esophageal Dysphagia results from what?

A
  1. Cancer
  2. Esophageal stricture
  3. Muscle disorders of esophagus.
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13
Q

What are the characteristics of Oropharyngeal Dysphagia?

A
  1. Difficulty moving food to back of mouth and initiating swallow.
  2. Symptoms include drooling, coughing, choking, pocketing of food, gurgly voice.
  3. Liquids may be more problematic than solids.
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14
Q

Oropharyngeal Dysphasia results from what?

A
  1. Parkinson’s
  2. Alzheimer’s
  3. Stroke
  4. Cerebral palsy
  5. Cancer
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15
Q

What are the ways we associate the consistency of liquids? (Thick to Thin)

A
  1. Pudding Thick
  2. Honey Thick
  3. Syrup/nectar Thick
  4. Thin
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16
Q

What are the levels of dysphagia diet? (1-5, 1= smallest 5=largest

A 
Level 1: Pureed
Level 2: Minced
Level 3: Ground
Level 4: Chopped
Level 5: Regular
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17
Q

What kind of patients is the Mechanical Soft diet for?

A
  1. patients with poor dentition or poorly fitting dentures.
  2. Debilitated patients with difficulty chewing.
  3. Patients who have undergone head and neck surgery
  4. Patients with dysphasia
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18
Q

How is the meat prepared for mechanical soft diet?

A

Meats are ground if not already in a form which is easily chewed.

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19
Q

What is restricted for the mechanical soft diet?

A
  1. Most raw fruits and vegetables
  2. Nuts
  3. Seeds
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20
Q

What are the characteristics of the pureed diet?

A
  1. requires minimal chewing/swallowing

2. Any food which can be blended to an appropriate consistency can be offered.

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21
Q

What kind of foods are part of the pureed diet?

A 
Strained foods
soft cooked cereals
cream soups
soft desserts
other soft consistent texture foods.
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22
Q

What is specifically suggested for the pureed diet?

A

Between meal feedings.

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23
Q

what kind of patients is the low bacteria diet for?

A

For patients who are immunosuppressed or compromised.

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24
Q

What is the key to the low bacteria diet?

A

Food safety such as throughly washing and cooking.

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25
Q

For patients who have cirrhosis how is their diet designed?

A
  1. to promote liver regeneration, nutritional repletion & prevent hepatic encephalopathy.
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26
Q

For patients who have cirrhosis what is their diet composed of?

A

High calorie, high protein diet unless hepatic encephalopathy develops.

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27
Q

Why would fat as a nutrient be limited in patients with cirrhosis?

A

If steatorrhea develops or if patient is jaundiced.

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28
Q

Why would sodium & fluid be restricted in patients with cirrhosis?

A

If ascites and/or edema is present.

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29
Q

What should completely be avoided if a patient has cirrhosis?

A

Alcohol.

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30
Q

For patients who develop hepatic encephalopathy, how is their diet designed?

A

Designed to prevent tissue catabolism, ammonia production, and promote liver regeneration.

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31
Q

What should be provided in a adequate amount for patients with hepatic encephalopathy?

A

kcal and protein.

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32
Q

What should be restricted if ascites is present in patients with hepatic encephalopathy?

A

sodium and fluid.

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33
Q

What should be monitored and when for patients with hepatic encephalopathy?

A
  1. Serum potassium levels

2. If taking potassium-wasting/sparing diuretics.

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34
Q

When are other appropriate times fat should be restricted in diet?

A
  1. Gallbladder disease
  2. Biliary, pancreatic, and intestinal disorders that results in maldigestion, malabsorption or effects transport of fat.
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35
Q

Under a fat restricted diet when may Medium Chain Triglycerides (MCT) be indicated?

A

When steatorrhea is present, chylous ascites, and chylothorax.

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36
Q

Under a fat restricted diet absorption of what can be impaired?

A

Fat soluble vitamins.

37
Q

How often does a american have a heart attack statistically?

A

every 34 seconds.

38
Q

What does heart disease cost the U.S. each year?

A

$108.9 billion.

39
Q

In a fat restricted diet what foods are allowed?

A
  1. Skim milk, lean meats w/o skin, lunch meat, eggs

2. Cheese <2g fat/serving

40
Q

what are the “life’s simple 7” by the American Heart Association?

A
  1. Stop smoking
  2. lose weight
  3. get active
  4. eat better
  5. manage BP
  6. control cholesterol
  7. reduce blood sugar
41
Q

For a healthy heart what kind of fruits and vegetables are recommended?

A

variety of deeply colored fruits and vegetables.

42
Q

For a healthy heart how much fish is recommended?

A

at least two 3.5 ounce servings per week.

43
Q

How much sodium is recommended for the healthy heart?

A

less than 1500 mg per day.

44
Q

For the healthy heart diet what should you limit your saturated fat intake to?

A

5-6% of total calories.

45
Q

What does the TLC diet stand for?

A

Therapeutic Lifestyle Changes

46
Q

What organization designed the TLC diet?

A

National Heart, Lung, and Blood Institute (NHLBI)

47
Q

What is the TLC diet recommended for?

A

High LDL, Lipid disorders.
Coronary Heart Diseases and other heart diseases.
Diabetes, metabolic syndromes.

48
Q

How much saturated fat is recommended in the TLC diet?

A

<7% total calories.

49
Q

How much Dietary Cholesterol is recommended in the TLC diet?

A

<200 mg/day

50
Q

How much Total Fat is recommended in the TLC diet?

A

25-35% total calories

51
Q

How much soluble fiber is recommended in the TLC diet?

A

10-25 g/day

52
Q

How many calories are recommended in the TLC diet?

A

Adjust to maintain healthy weight.

53
Q

How much sodium is recommended in the TLC diet?

A

2300 mg/day

54
Q

What can the Sodium Controlled Diet help control and what can it be used to help treat?

A
  1. Can control hypertension and loss of body water

2. used in cardiovascular, rental disease, edema, and ascites.

55
Q

What are the sodium restrictions for the Sodium Controlled diet?

A

250 mg & 500 mg for short term use.

56
Q

What kind of sodium restriction do you see for the Sodium Controlled diet?

A

1-2 gram restriction.

57
Q

What is characteristic of the Sodium Controlled diet in the way food is made?

A

Salt is not added to food or used in cooking.

58
Q

What does the DASH Diet stand for?

A

Dietary Approaches to Stop Hypertension.

59
Q

What organization created the DASH diet?

A

National Institute of Health and National Heart, Lung, and Blood Institute.

60
Q

What is the recommended sodium intake for the DASH diet?

A

2300 mg or 1500 mg sodium per day.

61
Q

What kind of foods does the DASH diet emphasize on?

A

Fruits, vegetables, whole grain breads, fat free dairy, lean meats, and nuts.

62
Q

Which patients is the High Fiber diet used for?

A 
Patients with:
Diverticular disease
Irritable bowel syndrome
Constipation 
Weight Control
63
Q

What foods are recommended for the High Fiber diet?

A

Whole grain breads and cereals
fruits/vegetables
legumes are increased

64
Q

What may not be tolerated in diverticular disease?

A

Nuts and Seeds

65
Q

What is the recommended fluid intake for people on a High Fiber diet?

A

8 cups/day

66
Q

What are examples of soluble fibers?

A

Oat, Barley, Nuts, Beans, Lentils, Cucumbers, Celery, and carrots.
Also Psyllium

67
Q

What are examples of Insoluble fibers?

A

Wheat, Zucchini, Broccoli, Cabbage, Green Beans, Dark Leafy vegetables, Grapes, Raisins, and Whole Grains.

68
Q

What is special about the Renal Diet?

A

It is very individualized, all parameters may not be restricted for every person.

69
Q

If the patient is in Predialysis what is their diet restricted to?

A 
Proteins restricted (0.6-0.8 g/kg)
Sodium as tolerated
Fluid as tolerated
Phosphorus restricted (<10 mg/kg/day)
Calcium restricted (1-1.5 g/day)
70
Q

If the patient is on Hemodialysis (HD)/Peritoneal Dialysis (PD) what is their diet restricted to?

A 
Protein liberalized (1.2-1.8 g/kg)
Sodium restricted (2 g/day HD)
Low Potassium (2-3g/day HD, 2-4 g/day PD)
Low phosphorus (< 2000 mg/day
Fluid for HD: 500 ml plus daily urine output.
71
Q

How high is diabetes on the list of leading causes of death in the U.S.?

A

7th

72
Q

How much of the U.S. population does diabetes affect?

A

9.3% of U.S. population 29.1 million in 2012

73
Q

What other disease is diabetes associated with?

A 
Blindness
Heart and blood vessel disease
Stroke
Kidney Failure
Amputations and nerve damage
74
Q

What are the main Diabetic Diet Guidelines?

A 
Avoid concentrated sweets
Know sources of carbs
Limit high fat meals
Eat meals at regular times
Be familiar with serving sizes
75
Q

How many grams of Carbohydrates equal a 1 serving?

A

15g

76
Q

What are the recommended servings of carbs for people with diabetes?

A

Females= 3-4/meal
Males = 4-5/meal
1-2 for snacks

77
Q

What are the characteristics of the High Protein, High Calorie diet?

A
  1. Extra portions of meat, milk, and cheese
  2. Large serving sizes
  3. Snacks in between meals 3 times/day
  4. Used in burns and malnourished patients.
78
Q

What do burn patients require in addition to their diet?

A

Vitamin Supplementation
Use of specific amino acids
Need high calorie/high protein diet

79
Q

What signs are monitored in burn patients that may impede intake?

A

Location of Burn
Use of hands
Depression
Inhalation injury

80
Q

What are common supplements for poor intake patients?

A 
Boost Plus/ Boost Breeze
Juven
Burn Shakes
Puddings/Bars
Healthshakes
Carnation Instant Breakfast
81
Q

How much of U.S. adults are obese?

A

1/3

82
Q

What two states tie for #1 in obesity rates?

A

Mississippi and West Virginia with 35.1% of population.

83
Q

What is the obesity rate in Kentucky?

A

33.2%

84
Q

What are the health benefits of weight loss?

A
  1. Decreased cardiovascular risk
  2. Decreased glucose and insulin levels
  3. Decreased BP
  4. Decreased LDL and Increased HDL
  5. Decreased severity of sleep apnea
  6. Reduced symptoms of degenerative joint disease.
85
Q

What are the goals of treatment of Obesity?

A
  1. Prevent further weight gain
  2. Reduce body weight
  3. Maintain lower body weight
  4. Establish short term goals
86
Q

What are the strategies for weight loss?

A
  1. Diet therapy
  2. Behavior modification
  3. Physical activity
  4. Pharmacotherapy
  5. Weight loss surgery
87
Q

What are the guidelines for weight loss?

A

0.5 to 1 lbs per week if BMI 27-35

1-2 lbs per week if BMI > 35

88
Q

What is the characteristics of the Gastric Bypass Diet?

A

Avoid overeating, eat only 3 meals/day
Eat slowly
Include protein source
Omit high calorie foods
Separate consumption of solids and liquids
Practice healthy food preparation techniques
Multivitamins

89
Q

What is the diet progression for the Gastric Bypass Diet?

A
  1. Thin pureed = 2-3 oz of food/meal

2. Calorie controlled post op diet = 4-5oz of food/meal

PPS 923 (4 decks)

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