Nutrition & Health Flashcards
What are the five steps to identifying and solving nutrition-related problems?
The five steps are (1) assessment of the patient’s nutritional status and needs, (2) analysis of assessment data to determine nutritional requirements, (3) planning intervention to meet nutritional needs, (4) implementation of the plan, and (5) evaluation of the intervention by ongoing assessment and making appropriate changes.
Describe the ABCD approach to comprehensive nutritional assessment.
Anthropometric measurements of height, weight, head, arm muscle circumferences, and skinfold thickness
Biochemical analysis of body tissues such as blood and urine, which reveals levels of visceral protein, serum albumin, prealbumin, total lymphocyte count, and other assessment parameters
Clinical assessment through medical and social history and physical examination
Dietary intake assessment by data gathering of actual and habitual food consumption
When should a recumbent height be taken?
A recumbent height should be taken when the individual is unable to stand, such as with an infant or comatose or critically ill patient.
In which instances might weight not be a good indicator of nutritional status?
Weight may not be a good indicator with patients with ascites, edema, or dehydration.
What is the most commonly used skinfold measure (for nutritional status)?
Triceps skinfold
What do the two most important biochemical parameters of nutritional status measure?
Visceral protein stores and immune function. Impaired immune system is often associated with a protein deficiency.
What is the main difference between albumin and prealbumin?
Albumin measures long-term protein stores, whereas prealbumin measures short-term changes in visceral protein stores.
Contrast the three methods used to assess dietary intake.
The 24-hour recall reports all food and beverages consumed during the past 24 hours. Food records provide a more realistic picture of a patient’s usual intake because the patient records, usually over a period of 1 to 7 days, all foods and beverages consumed. Kcalorie counts are used in the acute and long-term care setting with the nurse observing food intake.
When might the following diets be appropriately used: clear liquid, full liquid, puréed, mechanical soft, and soft diet?
The basic modification of hospital diets is in texture ranging clear liquid (no milk) full liquid (including milk), soft food and a full regular diet. Post operative patient may progress from clear liquid to regular diets, as tolerated. Mechanically altered soft diets such as pureed diets are designed for patients with chewing or swallowing problems.
If the gut is functioning but oral (PO) intake is poor, which should be started—enteral or parenteral feedings?
Enteral; always use the gut if it is working, less risk for migratory bacteria when nutrition is absorbed through GI system.
Define elemental formulas and share when they should be used.
Elemental formulas are composed of partially or fully hydrolyzed nutrients that can be used for patients with a partially functioning gastrointestinal (GI) tract or those who have impaired capacity to digest foods or absorb nutrients, pancreatic insufficiency, or bile salt deficiency. Hypercaloric formulas contain high calories in a concentrated form for those patients who need high calories and are on a fluid restriction.
What three questions should be considered when choosing an enteral feeding formula?
(1) What are the patient’s digestive and absorptive capabilities? (2) Do the patient’s fluids need to be restricted? (3) Does the patient have high metabolic requirements?
Compare the six tube-feeding routes.
The routes for tube feeding include the following: nasogastric: tube is passed through the nose to stomach; nasoduodenal: tube is passed from nose to duodenum; nasojejunal: tube is passed through nose to jejunum; esophagostomy: tube is surgically inserted into the neck and extends to the stomach; gastrostomy: tube is surgically inserted into stomach; and jejunostomy: tube is surgically inserted into the small intestine.
Contrast the three methods of administering a tube feeding.
Continuous infusion provides controlled delivery of a prescribed volume at a constant rate over a continuous period using an infusion pump. Intermittent infusion delivers the total quantity of formulas needed for a 24-hour period in 2 to 6 equal feedings. Bolus feedings involve infusing volumes by gravity or syringe over a very short period.
What are three possible tube-feeding complications?
Gastrointestinal, mechanical, or metabolic complications
What is the difference between total parenteral nutrition (TPN) and peripheral parenteral nutrition (PPN)?
TPN solutions are delivered in a large-diameter vein, whereas PPN uses a smaller, peripheral vein and cannot provide adequate nutrition alone. This is not used as often as TPN due to many risks.
What are the main components of a TPN solution?
Dextrose, amino acids, electrolytes, vitamins, and trace minerals
Describe the metabolic response to starvation.
The metabolic response to starvation allows the body to use stored carbohydrate, fat, and protein to meet energy needs. Stored carbohydrate—liver glycogen—is used but is available in limited quantities; it can provide energy for only about 8 to 12 hours. Stored fats, such as fatty acids from adipose tissue, are more available for providing energy for longer periods. Because some body cells can use glucose only for energy and proteins provide glucose more effectively than fats, body sources of protein such as lean body mass, vital organ tissues, or other protein substances such as hormones or blood protein components are used to provide branched-chain amino acids (BCAA). As starvation continues, additional sources of fats are used to preserve body protein; this may put the body into a state of ketosis. The basal metabolic rate (BMR) also significantly slows to allow energy to be conserved. Damage to body muscles may hasten death as intercostal muscle damage inhibits respiration.
Explain the ebb phase and flow phase of the body’s response to severe stress.
The body’s response to stress is represented by the two phases of ebb and flow. The ebb phase encompasses the early reaction of the body that begins immediately after the injury. Reactions include decreased oxygen consumption, hypothermia, and lethargy. Cardiovascular functioning and tissue perfusion are primary medical concerns. About 36 to 48 hours after the injury, the ebb phase evolves into the flow phase. This phase is noted by increased oxygen consumption, hyperthermia and increased nitrogen excretion. Carbohydrate, protein, and triglycerides are catabolized to meet increased metabolic needs. This phase continues until the injury is healed. Nutrients affected during this hypermetabolic phase include proteins, vitamins, and minerals. Intake of fluid and energy is also critical.
Discuss the effects of stress on the metabolism of nutrients.
Effects of stress on nutrient metabolism include (1) for protein, a decreased uptake of amino acids by muscle tissue and increased urinary excretion of nitrogen; (2) for carbohydrates, hepatic glucose production is increased and disseminated to peripheral tissues and insulin levels and glucose utilization are increased; (3) for fats, fat is mobilized from adipose stores and may result in malnutrition leading to multiple organ dysfunction syndrome (MODS) if patients are not fed because of depleted stored fat and body protein; (4) for water/fluid status, increased losses may result from fever, increased urine output, diarrhea, draining wounds or diuretic therapy; (5) for vitamins and minerals, as energy needs increase so do vitamin and mineral needs. Of special concern are vitamin C, vitamin A or beta-carotene, and zinc.
Differentiate among the three forms of protein-energy malnutrition.
Kwashiorkor is an acute state of poor protein intake and stress. Marasmus is manifested by severe loss of fat and muscle tissue as a result of chronic energy deficiency. Marasmus-kwashiorkor mix is a combined form of protein energy malnutrition that develops when acute stress is experienced by someone who has been chronically malnourished.
Define MODS. What are the nutrient needs?
MODS (Multiple organ dysfunction syndrome) is the progressive failure of two or more organ systems at the same time. Nutrient needs during MODS are higher intakes of kcalories and protein.
Discuss the nutritional requirement of patients with burns.
Nutritional requirements of burns include the immediate replacement of fluid and electrolytes based on the age, weight, and extent of burn of the patients, increased macronutrients, especially protein, as well as increased carbohydrates and fats. Vitamin and mineral needs are also elevated, but the amounts needed are not known. In particular, additional vitamin C and vitamin A supplements are often prescribed.
Compare and contrast the following terms: complementary medicine, alternative medicine, and integrative medicine.
Complementary medicine refers to non-Western healing approaches used at the same time as conventional medicine. In contrast, alternative medicine replaces conventional medical treatment, for example, using herbal supplements instead of surgical intervention or chemotherapy to treat cancer. Integrative medicine merges conventional medical therapies with complementary and alternative medicine (CAM) modalities.
List three potential influences of drug-nutrient interactions.
Drug-nutrient interactions have the potential to reduce drug efficacy, interfere with disease control, foster nutritional deficiencies, influence food intake, and/or provoke a toxic reaction.
List three risk factors of drug-nutrient interactions.
Older age, physiologic status, multiple drug intake, hepatic and renal function
Identify four warning signs of dysphagia.
Four warning signs of dysphagia: collecting food under the tongue, in the cheeks, or on the hard palate; choking; drooling; and coughing before or after swallowing.
Characterize gastroesophageal reflux disease (GERD) and briefly describe the appropriate medical nutritional therapy.**
GERD occurs when the lower esophageal sphincter (LES) fails to keep the gastric contents in the stomach; the esophageal mucosa can be damaged and can lead to esophagitis. Appropriate medical nutrition therapy includes avoiding certain foods such as carminatives (oils of peppermint or spearmint, garlic, onion), chocolate, and high-fat foods. For some people, foods such as carbonated beverages, citrus fruit and juices, coffee, herbs, pepper, spices, tomato products, and very hot or very cold foods can be irritating.
What is the combination of factors that may cause peptic ulcer disease (PUD)?
The combination of factors that may cause PUD are hypersecretion of gastric acid, impaired mucosal defense, and the predisposing factors of use of nonsteroidal anti-inflammatory drugs, Helicobacter pylori, smoking, genetic predisposition, and stress.
List four symptoms of dumping syndrome.
Four symptoms of the dumping syndrome could include epigastric fullness; abdominal cramps and/or diarrhea that may occur postprandially and vasomotor symptoms of tachycardia; postural hypotension; and sweating.
Name four grains that should not consumed by patients with gluten sensitivity.
Wheat, oats, rye, and barley
Name the two conditions categorized as inflammatory bowel disease (IBD).
Ulcerative colitis and Crohn’s disease
Explain the difference in medical nutrition therapy between diverticulosis and diverticulitis
Bowel rest with a low fiber diet is recommended during the inflammatory stage (diverticulitis), whereas a high-fiber diet is recommended for diverticulosis.
The following are signs of _______:
Pain while swallowing (odynophagia)
Inability to swallow
Sensation of food getting stuck in the throat or chest
Drooling
Hoarseness
Bringing food back up (regurgitation)
Frequent heartburn
Food or stomach acid backing up into the throat
Unplanned weight loss
Coughing or gagging when swallowing
Avoidance of certain foods because of trouble swallowing
Dysphagia
Briefly describe the roles of the liver in nutrient metabolism.
The liver has several critical roles in basic metabolism and regulation of body functions. Some essential functions include bile production for fat digestion; synthesis of proteins and blood clotting factors; metabolism of hormones, medications, macronutrients and micronutrients; the regulation of blood glucose levels; and urea production to remove waste products of normal metabolism.
What is the earliest form of liver disease?
Fatty liver
