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CNSC Exam > Nutrition in the Older Adult Review > Flashcards

Nutrition in the Older Adult Review Flashcards

1
Q

Pharmacological agents such as histamine-2-receptor antagonists and proton pump inhibitors are commonly prescribed for a variety of GI disorders such as prevention and treatment of gastric ulceration. Prolonged use of these medications may most commonly contribute to the deficiency of. . .

A

Vitamin B12

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2
Q

In order for vitamin B12 to be properly absorbed, it requires adequate ______ ,which decreases with age, to cleave B12 from protein in food. Then free B12 travels to the small intestine where it binds to ____ for adequate absorption

A

gastric acid

intrinsic factor

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3
Q

An 85year old female is admitted to the hospital with a history of stroke, dysphagia, poor apetite with decreased intake x 1 month and 10% weight loss. The patient is evaluated by the speech pathologist who recommends a pureed, HTL diet. What is the most appropriate nutrition intervention ?

A

Initiate nocturnal EN to supplement the oral diet

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4
Q

Medications that cause diarrhea while on EN create a hyperosmolar environment in the GI tract pulling fluid in, creating a laxative effect, these medications include:

A

magnesium, sorbitol, and kayexelate

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5
Q

antibiotics can cause diarrhea because they decrease

A

the amount of beneficial bacteria within the GI tract increasing the risk for CDiff infection

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6
Q

Narcotics such as codeine decrease GI motility and contribute to

A

constipation

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7
Q

long term use of opioids can lead to this type of constipation

A

obstipation

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8
Q

what is appropriate to tell the family regarding nutrition at the end of life: Dying patients rarely feel ____ or ____ due to decreased normal functions, _____ calories are needed at the end of life, patients shouldn;t be made to feel guilty if _________ and decreased ___ and ___ are a natural part of they dying process

A
  1. hunger or thirst
  2. fewer calories
  3. they don’t wish to eat
  4. food and fluid intake
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9
Q

A patient in a persistent vegetative state has made their wishes known regarding artificial nutrition via an advanced directive. The decision to terminate enteral feeding for this patient is based on the ethical principle of

A

autonomy

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10
Q

if a patient is not competent and there is no advanced directive available, which 2 ethical principles are important to consider

A

beneficence and non-maleficence

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11
Q

the ethical principle based on respecting and upholding the patient’s right to self determination

A

autonomy

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12
Q

the ethical principle based on health care providers who actively seek the good of the patient above all other priorities

A

beneficence

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13
Q

the ethical principle of “to do no harm” and relates to health care providers actively seeking to prevent, minimize and relieve needless suffering and pain, avoiding harming the patient

A

non-maleficence

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14
Q

the ethical principle that is related to the fair distribution of resources

A

Justice

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15
Q

A Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) orders should be a contraindication to the provision of artificial nutrition and hydration in any state; true or false

A

false, if indications for ANH exist, ANH should be started even if for a limited time trial

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16
Q

ANH can be withheld or withdrawn in patients with a DNR or DNAR if

A

all concerned parties agree ANH is not meeting the agreed upon goals of the patient

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17
Q

those who forgo ANH experience ____ side effects as the analgesic theory proposes that starvation boosts the production of ketones, thereby having an anesthetic effect

A

decreases

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18
Q

aggressive artificial nutrition and hydration can be _____ during the end of life

A

more harmful and life threatening causing edema, ascites, nausea, vomiting, or pulmonary aspiration/congestion

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19
Q

A patient has an advanced directive stating a desire to forgo medical technology including nutrition and hydration in order to prolong life. The patient is now in an irreversible, vegetative state. in deciding whether or not to continue nutrition and hydration by medical means, the patient’s surrogate decision maker must:

A

honor the patient’s expressed wishes to withdraw nutrition and hydration by medical means

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20
Q

documents that allow individuals to document their treatment preferences and identify a surrogate or proxy decision maker to act in the patient’s state when he or she loses the ability to make decisions.

A

advanced directive

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21
Q

in the absence of an advanced directive, where evidence of an incompetent’s person’s previous expressed wishes not to be kept alive by medical technologies meets state evidentiary standards, the exercise of that choice by a surrogate decision maker must also be honored true or false

A

true

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22
Q

In an older adult who requires long term home EN, which complication is often overlooked

A

decreased urine output/dehyration

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23
Q

a decreased urine output likely indicates what in an older adult

A

inadequate fluid intake /potential for dehydration/AKI

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24
Q

Vitamin D (25,hydroxyvitamin D) deficiency is defined as a serum level of less than _____

A

20ng/mL

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25
Q

what is considered an adequate Vitamin D (25 hydroxyvitamin D ) level

A

30 ng/mL

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26
Q

Vitamin D (25,hydroxy vitamin D) deficiency can manifest as

A

muscle weakness

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27
Q

what is the hallmark of frailty seen among older adults

A

sarcopenia

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28
Q

age associated loss of muscle mass and strength is called

A

sarcopenia

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29
Q

a multifactorial syndrome that has various phenotypes in the older adult such as quality of life, vulnerability, and disability with symptoms of 10 lb weight loss in 1 year, unintentional weight loss , self reported exhaustion and weakness is called

A

frailty

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30
Q

What EN complication is the most potentially dangerous in the older adult

A

aspiration

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31
Q

___ and ___ is linked to the development of dysphagia in the older adult which can cause aspiration or oral secretions leading to possible PNA/death

A

sarcopenia/frailty

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32
Q

A 75 year old male with a history of aspiration PNA who was previously deemed unsafe for an oral diet is now experiencing aspiration while receiving continuous EN via his PEG. What long term feeding options are most appropriate

A

PEJ tube

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33
Q

_____ EN feedings are the preferred choice for patients with an increased risk of aspiration as they can minimize the potential of reflux.

A

small bowel feedings

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34
Q

An older adult getting PN may be more susceptible to metabolic complications related to _____ function. Older adults have increased problems with insulin resistance, impaired renal and micronutrient deficiencies

A

impaired cardiac function

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35
Q

which tool includes the assessment of a long term care resident’s ability to maintain adequate nutrition and hydration and is mandated by the center for medicate and Medicaid for certified long term care facilities

A

MDS: minimum data sheet

36
Q

a ______ is completed by an intrer-professional team in a long term care facility to assess all aspects of clinical status and facilitate problem indemnification (triggers) to see if further planning or intervention is necessary

A

MDS: minimum data sheet

37
Q

what vitamin deficiency is most likely to occur in a person who consumes alcohol of a regular basis

A

thiamine

38
Q

what medication is most likely to contribute to hyponatremia in the older adult

A

hydrochlorothiazide diuretic

39
Q

thiazide diuretics can lead to

A

hyponatremia

40
Q

loop diuretics can diminish this electrolyte

A

potassium

41
Q

An 80 year old NH resident with a history of constipation has a newly placed PEG tube. Which EN formula would be an appropriate choice to provide

A

standard 1kcalmL (has adequate fluid)

42
Q

constipation is common in the elderly so adequate ____ should be given when providing enteral nutrition

A

water flushes

43
Q

_____ addition to enteral nutrition can help propel waste through the colon

A

fiber

44
Q

if fiber is added to enteral nutrition formula, how much fluid should be given

A

1ml/kcal

45
Q

concentrated enteral formulas may not be appropriate for the elderly with constipation due to

A

not adequate in fluid

46
Q

An assessment of functional status may aid in determining nutrition risk. What provides assessment of function status?

A

hand grip strength assessment

47
Q

What vitamin consideration is most important in an older adult getting a TNA (3-in-1) PN as well as warfarin?

A

vitamin K

48
Q

vitamin ____ is present in adult MVI preparations and in lipid emulsions which affects anticoagulation therapy so closely monitor______

A

INR

49
Q

EN formulas supplemented with fiber are often used in the older adult population to prevent constipation. Which of the follow is most important if this is chosen?

A

provision of adequate water, at least 1mL/kcal

50
Q

The Plan-Do-Study Act cycle is employed as a _____ model

A

quality improvement problem solving

51
Q

What are the 4 steps of the Plan-Do-Study-Act Cycle

A

Planning phase, implementation phase, study phase, act phase

52
Q

the ___ phase of the Plan-Do-Study-Act cycle is to measure the results of the improvement effort

A

study

53
Q

the ___ phase of the Plan-Do-Study-Act is where the team will determine if changes made should be permanent an includes standardization and documentation of the processes

A

act

54
Q

which classes of medication is used in the older adult population which can contribute to anorexia

A

SSRIs, antiarrhythmics, and NSAIDS (cardiac meds, psych meds and anti rheumatoid meds)

55
Q

An older adult receiving digoxin and PN who is experiencing signs of digoxin toxicity should be assessed for

A

hypokalemia

56
Q

Digoxins are anti-arrhythmia medications often paired with diuretics. Older adults are at risk for this electrolyte derangement when receiving digoxin as their kidney function are diminished and the excretion of this medication relies solely on renal excretion

A

hypokalemia

57
Q

An older adult with poor oral intake over a 2 month period requires specialized nutrition support. What electrolyte abnormalities are associated with aggressive nutrition support ?

A

hypophosphatemia, hypokalemia, hypomagnesemia (refeeding syndrome)

58
Q

Elderly patient admissions due to adverse drug reactions can be decreased by recognizing this population has ______ sensitivity to warfarin and opiates

A

decreased

59
Q

Altered medication pharmacodynamics are altered in the elderly as they have a decrease in ____, ____ ____ and _____ leading to medication sensitivity

A

decreased hepatic blood flow
decreased hepatic volume
decreased first pass metabolism
decrease in eGFR

60
Q

the short form mini assessment used in adults 65 and older was derived from the mini nutritional assessment in order to

A

obtain high diagnostic accuracy for detecting nutritional problems in older adults w/ a brief screening tool

61
Q

The Comprehensive Geriatric Assessment (CGA) tool includes: physical medical condition, nutrition status, mental health conditions, functional status, social circumstances and environmental as well as

A

anthropometrics, biochemical markers, meds, and quality of life

62
Q

JD is an 85 year old male whose height is 63”, weight of 45 kg had a weight of 55 kg ten years ago. His weight loss has been non-volitional and gradual. he has no major health problems or changes in oral intake. What describes JD’s weight loss

A

decreased lean body mass tissue from sarcopenia

63
Q

What is the most widely used tool to measure generic health related quality of life

A

SF-36

64
Q

what is one of the most widely used tools to measure health related quality of life

A

SF-36 tool

65
Q

this tool measures activities of daily living

A

Katz ADL

66
Q

this tool measures instrumental activities of daily living (using the telephone, managing finances, meal prep, transportation)

A

Lawton-Brody’s IADL

67
Q

this tool is used to measure functional independence in rehab settings

A

The Functional Independence Measure (FIM)

68
Q 
What body changes occur in older adults over time
\_\_\_\_ bone mineral mass
\_\_\_\_ lean body mass
\_\_\_\_\_\_ fat deposition
\_\_\_\_ total body water
A

decreased bone mineral mass
decreased lean body mass
increased fatty tissue
decreased total body water

69
Q

Sarcopenia, the loss of lean body mass that occurs with aging is also associated with

A

decreased bone density, increased falls, glucose intolerance, decreased heat/cold tolerance, increased risk of malnutrition, increased oxidative stress

70
Q

when using cyclic PN solutions for non-stressed patients age may be an important factor in monitoring for complications because older adults have ______ rates of insulin resistance, ________glycemia, _____ free fatty acids, and ____ fluid requirements

A

increased insulin resistance
hyperglycemia
increased free fatty acids
decreased fluid requirements

71
Q

what is the recommended daily energy intake for patients getting hemodialysis >65 years old and <65 years old

A

> 65 years: 30-35 kcal/kg

< 65 years: >35 kcal/kg

72
Q

A 65 year old who has complications associated with GI surgery was admitted to the ICU with pneumonia & septic shock. After she became hemodynamically stable, she was started on PN due to prolonged ileus. Prior to surgery, she was at her ideal weight. Currently has labs that include albumin 2.2, Cr of 1.0 & urine output is adequate. What best estimates her protein needs for initiation of PN

A

1.5 g/kg/day 2/2 her increased stress level

73
Q

in an afebrile adult with intact skin, insensible fluid loss from the lungs and skin is approimately

A

1,000mL/day

74
Q

An 87 year old female underwent a total abdominal colectomy. Her ileostomy output is 1.5-2 liters a day. Supplementation of which of the following micronutrients should be considered?

A

zinc from stool loss

75
Q

older adults are increased risk of ____, ___, ___ deficiency from decreased intake, decreased absorption when having diarrhea or high ileostomy output

A

fluid, electrolytes and zinc

76
Q

A decrease in food intake in older adults is most likely attributed to

A

decreased taste and flavor sensations

77
Q

which senses are diminished in the older adult population

A 
decreased taste/flavor sensation
decreased hunger
early satiety
fear of incontinence with decr. fluid intake
decreased smell/olfaction
78
Q

A 68 year old with a history of cirrhosis is receiving EN with recent GI surgery. She has worsening hepatic encephalopathy what should be tried first

A

lower blood ammonia with lactulose and or rifaxamin

79
Q

in liver cirrhosis, how much protein is recommended to prevent catabolism and promote gluconeogenesis

A

1-1.5 g/kg/day

80
Q

if a patient with cirrhosis and hepatic encephalopathy fails to respond to medical management how much protein can be restricted to

A

0.6-0.8g/kg

81
Q

branched chain amino acids formula is still debated but considered if

A

severe encephalopathy is not responsive to aggressive medical therapy

82
Q

An 80 year old male living home alone has experienced a 15 pound unintentional weight loss in past year and a half. The clinician assessing his nutrition status finds that he has inadequate intake, what is the leas likely to contribute to his weight loss

A

a liberalized diet

83
Q

decreased oral intake can be related to chronic medical conditions requiring dietary restrictions and numerus medications impairing food intake or alter digestion, absorption, metabolism and excretion true or false

A

true

84
Q

social isolation, economic hardships, decreased functional capacity related to shopping, cooking, dementia, loss of taste and smell with difficulty chewing/swallowing impairs

A

oral intake

85
Q

______ diets make meals more palatable and acceptable for older adults

A

liberalized diets

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