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RD Exam: Domain 2 > Nutrition Planning and Intervention > Flashcards

Nutrition Planning and Intervention Flashcards

1
Q

Nutrition Intervention

A

purposely planned actions designed with the intent of changing a bheavior, risk factor, or condition

  • based on nutiriton dx and provides the bases upon which outcomes are measured and evaluated

four categories:
1) food delivery
2) education
3) counseling
4) coordination of care

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2
Q

Primary prevention programs

A

reduced exposure to a promoter of disease

ex. early screening for DM

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3
Q

Secondary prevention programs

A

recruiting those w/ elevated risk factors into tx program; reduce impact of condition

ex. risk reduction

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4
Q

FTC / NCAHF

A

Federal Trade Commision
National Council Against Health Fraud

fights against health care fraud

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5
Q

Tertiary prevention programs

A

as disease progress, intervention to reduce severity, manage complications

ex. rehab

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6
Q

Ulcer

A

eroded mucosal lesion typically caused by H. pylori

Diet:
- as tolerated
- avoid late night snacks
- omit gastric irritants (e.g. pepper, chili, caffeine, alcohol)

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7
Q

Hiatal hernia

A

protrusion of a portion of the stomach

Diet:
- small, bland feedings
- avoid late night snacks
- omit gastric irritants

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8
Q

Dumping syndrome

A

food moves quickly from stomach to SI

*rapid digestion and absorption of CHO stimulates overproduction of insulin resulting in rapid drop in BGs (reactive hypoglycemia)

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9
Q

Billroth I

A

attaches remaining stomach post-gastrectomy to duodenum

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10
Q

Billroth 2

A

attaches remaining stomach post-gastrectomy to jejunum

*no duodenum, no enzymes to stimulate pancreatic secretion
*affects Ca (absorbed in duodenum) & Fe absorption (requires HCl)

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11
Q

Complete gastrectomy

A

Removal of stomach

*results in Fe, B12 (lack of intrinsic factor + backterial overgrowth), folate (needs B12 for transport + low serum Fe which is a cofactor), Ca, Vit D, B1, and copper deficiencies

Diet:
- frequent small, dry feedings, fluids before/after meals
- 50-60% complex CHO, protein, mod fat

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12
Q

Gastroparesis

A

Delayed gastric emptying / slow movement from stomach to SI

Rx: prokinetics to increase stomach contractility (e.g. erythromycin, metoclopramide)

Diet:
- small, frequent meals
- avoid high fiber and high fat
- avoid gastric irritants

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13
Q

Tropical Sprue

A

chronic GI diesease caused by bac, vir, and para infection that affects absorption

SS: diarrhea, malnutrition, B12 and folate deficiency

Diet:
- B12 and folate supplement
- high cal, high pro

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14
Q

Celiac disease

A

immune reaction to gluten, a type of prolamin

SS: malabsoprtion, macrocytic anemia, weight loss, steatorrhea, Fe deficiency anemia

Diet:
- gluten-free/gliadin-free diet (no wheat, rye, oats, buckwheat, bran, graham, malt, mulgur, couscous, durum, orzo, thickening agents)

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15
Q

Constipation

A

hard to pass

Diet: high fluid, high fiber, exercise

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16
Q

Diverticulosisr

A

presence of mucosal sacs protruding on intestinal wall

diet: high fiber diet

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17
Q

Diverticulitis

A

when mucosal sacts on intestine wall become inflamed

diet: clear liquid, gradual return to fiber, elemental formula

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18
Q

Benefits of soluble fiber

A

1) decrease serum cholesterol by binding bile acids
2) delay gastric emptying by absorbing water and form soft gel to slow passage and glucose and cholesterol absoprtion

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19
Q

AI of fiber

A

M: 38g/day
F: 25g/day

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20
Q

Gastritis

A

Inflammation of stomach

Diet:
-clear liquids advance as tolerated
- avoid gastric irritants

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21
Q

Inflammatory bowel disease (IBD)

A

1) Crohn’s: affects the terminal ileum leading to B12 and Fe deficiency

2) Ulcerative colitis (UC): ulcerative disease of colon leading to bloody diarrhea, electrolyte (Na, K) losses

Diet:
- maintain fluid and electrolytes
- limit fat only if steattorhea (if so, also assess Ca, Mg, Zn since these minerals are lost in fatty stools)
- protein at each meal
- chewable MVit

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22
Q

Irritable Bowel Syndrome (IBS)

A

chronic abdominal discomfort, altered intestinal motility, bloating

Diet: goal is for adequate nutrient intake
- avoid gas-forming foods
- use food diary to track intake and symptoms
- low FODMAP to eliminate sources of discomfort

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23
Q

Lactose intolerance

A

absence of lactase enzyme

*with lactose present:
- water is drawn to intestine to dilute load resulting to distention, cramps, diarrhea
- bacteria ferment lactose & release CO2

can test using:
1) breath hydrogen test
2) lactoce intolerance test

Diet: lactose-free, Ca and riboflavin supplments recommended

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24
Q

Lactose intolerance test

A

take oral dose of lactose after fast

BG = <25 mg/dl above fasting = intolerant
BG = >25 mg/dl above fasting = tolerant

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25
Q

Diarrhea in infants & children

A

Acute Tx: immediate rehydration and replace electrolytes

Chronic Tx: 40% calories as fat, balance with limited fluids; dilute fruit juices

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26
Q

Diarrhea in adults

A

Watery stool

Tx:
- replace fluids and electrolytes
- decrease gastric motility by avoiding clear liquids, caffeine, alcohol, fiber, and foods high in simple sugars
- thicken consistency of stool
- repopulate GI tract with normal flora using prebiotics (fructooligosaccharides like onion, garlic, asparagus) and probiotics (e.g. fermented foods)

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27
Q

Steatorrhea

A

high fat in stool as a result of malabsorption

Diet: high protein, high complex CHO, fat as tolerated, MCT

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28
Q

Short bowel syndrome (SBS)

A

consequences associated with significant resections of the small intestine (especially if ileum)

lead to malabsorption, malnutrition, fluid and electrolyte imbalances, weight loss

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29
Q

Jejunal resection

A

ileum can adapt and take over fuctions

diet after resection:
- normal balance of CHO, PRO
- vit and min supplements

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30
Q

Ileal resection

A
  • will affect absorption of B12, intrinsic factor, and bile salts
  • will impact absorption of fluid since that’s where a majority of fluid is absorbed (diet: increased water needs)
  • if cannot recycle bile salts: lead to malabsorption of fat-soluble vitamins & non-emulsified fat will combine with Ca, Zn, Mg to create soaps which will interfere with absorption of these minerals

diet after resection:
- limit fat
- use MCT since it doesn’t need bile salts
- supplement fat-soluble vitamins
- supplement Ca, Mg, Zn

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31
Q

Liver function tests

A

indicate enzyme levels

in liver disease, enzyme levels (ALP, AST, ALT) are elevated indicating tissue damage

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32
Q

ALP (alkaline phosphatase)

A

upper level: 120

increased = liver disease, bone disease

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33
Q

AST (aspartate amino transferase)

A

upper level: 35

increased = hepatatis

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34
Q

ALT (alanine aminotransferase)

A

upper level: 36

increased = liver disease

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35
Q

Acute viral hepatitis

A

leads to inflammation, necrosis (death of tissue d/t lack of O2), and *anorexia

Hep A: fecal to oral (*most directly connected to food)
Hep B: blood to blood contact

diet:
- increase fluids
50-55% CHO to replenish glycogen
- high protein (1-1.2 g/kg) to prevent fatty liver
- mod to liberal fat
- small, frequent feedings

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36
Q

Cirrhosis

A

scarred/damaged liver tissue replaced by connective tissue that divides liver, rerouting veins and capillaries

blood flow: portal vein -> liver -> vena cava

when blood cannot leave liver –x–> vena cava = *ascites [fluid build-up in abdomen]

when blood cannot enter (portal vein –x–> liver) = *portal hypertension
resulting to varices [enlarged veins]

diet:
- high kcal
- adequate to high pro
- mod to low fat
- if ascites: low sodium
- if varices: low fiber

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37
Q

Alcoholic liver disease

A

liver injury d/t alcohol’s effect on metabolism (alcohol -> acetaldehyde + excess hydrogen, which replaces fat as fuel)

associated w/ malnutrition

diet:
- supplement thiamin (B1) and folic acid
- increased need for B vitamins and Mg

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38
Q

Hepatic failure / End-stage liver disease

A

liver cannot convert ammonia into urea causing build-up

diet:
- if not comatose: mod to high PRO
- high kcal, 30-35% fat

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39
Q

Steatosis / Non-alcoholic fatty liver disease (NAFLD)

A

excess fat build up in liver unrelated to EtOH

can be managed with lifestyle changes: slow wt loss, healthful eating, physical activity

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40
Q

Cholecystitis

A

inflammation of gall bladder

diet:
- low fat
- if cholecystectomy (removal): limit fat intake annd slowly increase fiber

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41
Q

Pancreatitis

A

inflammation of pancreas

common characteristic: premature activation of enzymes within pancreas leading to autodigestion (enzyme destroying own tissue)

diet/tx if acute:
- put pancreas at rest, progress to easily digested foods with low fat
- elemental EN

diet/tx if chronic:
- give pancreatic enzymes orally (PERT) to minimize fat malabsorption
- to avoid pain during eating: avoid large meals with fatty foods

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42
Q

Cystic fibrosis

A

disease of exocrine glands resulting to secretion of thick mucus (could lead to CPD)

*affects transport of chloride across the cell membrane

diet:
- PERT
- high kcal, PRO, unrestricted fat (to meet energy needs, liberal salt
- supplement Zn & water-soluble forms of Vit A & E

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43
Q

Hypertension

A

High blood pressure

*can be managed by diuretics, salt restriction, DASH diet, Mediterranean diet

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44
Q

Stages of hypertension

A

Normal: <120/80 mm/Hg
Elevated: 120-129 / <80
Stage 1: sys 130-139 OR dia 80-89
Stage 2: sys >140 OR dia >90

Notes:
- systolic: contraction, greatest pressure
- diasotlic: relaxation, least pressure

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45
Q

Atherosclerosis

A

progressive narrowing of arteries

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46
Q

Coronary artery disease (CAD)

A

hard, narrow arteries from plaque build-up

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47
Q

Ischemia

A

deficiency of blood d/t obstruction

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48
Q

Arteriosclerosis

A

loss of elasticity of blood vessel walls

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49
Q

Myocardial infarction

A

reduced coronary flow to myocardium d/t blood clot

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50
Q

Dyslipidemia

A

Abnormal levels of blood lipids, includes high TGs and low HDL

*small, dense LDL-C associated with increased risk of CVD

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51
Q

Metabolic syndrome

A

3 or more of the following risk factors are linked to insulin resistance which can increase risk for coronary issues

1) hypertension (>130 and/or >85)
2) hyperlipidemia (elevated TG >150 mg/dl)
3) hyperglycemia (fasting >100 mg/dl)
4) high waist circumference
5) low HDL

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52
Q

Cholesterol Levels

A

can assess risk of CVD

Total cholesterol: <200 mg/dl is desirable
LDL-C: <100 optimal
HDL-C: <40 (M) and <50 (F) is low, >60 is high

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53
Q

Heart healthy diet

A
  • Limit sat fat, cholesterol, sodium; no trans fat
  • promote whole grains, FV, unsaturated fats
  • include 20-30g fiber per day (5-10g soluble fiber)
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54
Q

Heart failure

A

leads to decreased output and fluid being held

diet:
- low Na (e.g. DASH)
- high PRO
- kcal needs (RMR x physical activity factor): 22 kcal/kg if nourished, more if not
sedentary: 1-1.4
low active: 1.4-1.6
active: 1.6-1.9
very active: 1.9-2.5
-possibly thiamin; folate, Mg, mvit w/ B12

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55
Q

Cardiac cachexia

A

complication of heart failure resulting to unintended weight loss

diet:
- low sat fat, cholesterol, trans fat
- limit sodium
- high calorie

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56
Q

Vasopressin / anti-diuretic hormone (ADH)

A

released from hypothalamus and elevates BP and increases reabsorption of water in kidneys

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57
Q

Renin

A

released by kidneys to control BP & increase Na absorption

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58
Q

Erythropoietin (EPO)

A

produced by kidney and stimulates bone marrow to produce RBC

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59
Q

Renal lab tests

A

High creatinine and BUN & BUN/creatinine ratio = impaired kidney fx

ratio of >20:1: may be reversible
ration of <10:1: may need dialysis

Renal solute load: measures nitrogen and electrolytes

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60
Q

Kidney stones / calcium oxalate stones

A

most common renal disorder

diet:
- adequate Ca intake
- low oxalate diet (foods high: dark leafy greens, chocolate, nuts, beets, tea)

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61
Q

Alkaline ash / acidic ash diet

A

minerals not oxidized can leave residue in urine

*to prevent acidic stones: create alkaline ash
- increase cations by adding FV, brown sugar

*to prevent alkaline stones: create acidic ash
- increase anions by adding animal protein

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62
Q

Acute kidney injury

A

sudden shutdown of kidney w/ previously adequate capacity

possibly oliguria (low urine output) and azotemia (increased urea in blood)

*energy expenditure increases as kidney fx declines

diet:
- low Na, K, phos
- replace fluid output

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63
Q

Nephrosis

A

defect in glomerulus permiting escape of large amounts of PRO

symptoms: albuminuria, edema, malnutrition, hyperlipideia

diet:
- restrict fat intake (<30% of kcal)
- modest sodium restriction

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64
Q

Chronic kidney disease

A

kidney damage affecting filtration of blood

diet:
-DASH, Mediterranean, high FV
-adequate energy
-restrict sodium
*if stage 3-5: restrict protein
-fluid unrestricted unless stage 5

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65
Q

Dialysis

A

long term goal is to prevent malnutrition

hemodialysis: 1-1.2g protein/kg SBW

peritoneal dialysis: 1-1.2g protein/kg SBW or adj BW

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66
Q

Diabetes Mellitus

A

Type 1: insulin deficient & dependent on exogenous insulin
- strategies: consistent CHO if fixed daily dose of insulin, reduce insulin for planned exercise

Type 2: insulin-resistant
- strategies: healthy eating and PA

*risk factors:
- acanthosis nigricans from insulin-resistance
- GAD antibodies (glutamic acid decarboxylase)

goal:
*maintain normal blood glucose
- maintain serum lipids & BP

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67
Q

Gestational DM

A

development of DM during pregnancy

risk factors:
- BMI > 30
- history of GDM

increases risk of baby being borth with large birth weight (fetal macrosomia) & fetal hypoglycemia at birth

68
Q

Normal blood glucose level

A

70-100 mg/dl

2h post-prandial: <140 mg/dl

69
Q

Fasting plasma glucose

A

blood test that measure BG after period of fasting

100-125: impaired
>126 = diabetes

70
Q

Glucose tolerance test

A

A blood test to test glucose tolerance

Normal curve: sloped
Diabetic curve: rounded

140-199 = impaired glucose tolerance
>200 = diabetes

71
Q

HgA1C / glycosylated hemoglobin

A

measures % of hemoglobin that has glucose attached over long-term period (60-90 days)

normal: <5.7%
at risk of dev DM: 5.7%-6.4%
goal for those with diabetes: <7%

72
Q

Consistent CHO diet

A

each meal: 3-5 CHO servings
snacks: 0-4 CHO servings

1 starch, fruit, milk choice = 15g CHO = 1 choice
1 non-starch vegetable = 5g CHO = 0.5 choice

73
Q

Bolus insulin

A

taken before meal to cover meal

1) RAPID-ACTING:
- taken 5-15 mins pre-meal, lasts 4 hours
- ex. Novolog, lispro

2) SHORT-ACTING:
- taken 30-45 mins pre-meal, lasts 3-6 hours
- ex. Humulin

74
Q

Basal insulin

A

taken in the background

2) INTERMEDIATE-ACTING:
- onset 2-4 hours lasts 10-16 hours
- *cloudy apperance
Ex. NPH

3) LONG
- onset 2-4 hours, lasts 18-24 hours
- ex. Glargine

75
Q

Metformin

A

first line of therapy for T2DM

suppresses hepatic glucose producrtion and increases insulin uptake in muscles

76
Q

Dawn phenomenon

A

Natural increase in early morning BGS & insulin requirements

77
Q

Acute ketoacidosis

A

complication of uncontrolled DM

hyperglycemia, dehydration, increased pulse, fruity odor

TX: insulin, rehydration

78
Q

Acute hypoglycemia

A

complication of uncontrolled DM

insulin shock, clammy, weak, sweating

TX: glucose
1) begin w/ 15 g CHO glu tablets, fruit juice, sugar
2) wait 15 minutes; if <70 mg/dl, give another 15 g
3) Repeat

*if unresponsive, administer glucagon

79
Q

Reactive hypoglycemia

A

increased insulin sensitivity that BGs fall below normal 2-5 hours after eating

sym: weak, trembling, extreme hunger

*goal: prevent marked rise in BGs that would stimulate more insulin

diet:
- avoid simple sugars
- 5-6 meals/day
- spread CHO throughout the day

80
Q

Adrenal cortex insufficiency / Addison’s diseases

A

atrophy of adrenal cortex, affecting adrenal hormones causing

1) low cortisol –> hypoglycemia
2) low aldosterone –> Na loss, K retention, dehydration
3) low androgenic –> tissue wasting

main therapy: hormone replacement

diet:
- high protein
- frequent feedings
- high salt

81
Q

Hyperthyroidism

A

excess secretion of T3 and T4, increasing BMR –> weight loss

diet: increase kcal

82
Q

Hypothyroidism

A

deficiency of T4 and T3 (or T3 is normal), decreasing BMR –> weight gain

diet: reduce weight

83
Q

Goiter

A

enlarged thyroid gland d/t insufficient hormone

diet: iodized salt; free of goitrogens (e.g. cabbage family)

84
Q

Gout

A

disorder of purine metabolism, increasing serum uric acid

lifestyle changes:
- maintain healthy BW
- mod PRO, lib CHO, low fat
- avoid high purine foods (e.g. anchovies, sardines, organ meats)

85
Q

Urea cycle defects

A

unable to cycle urea resulting in ammonia build up

diet:
* restrict protein to lower ammonia

86
Q

phenylketonuria (PKU)

A

missing enzyme that would have converted phenylalanine into tyrosine

*detected by Guthrie blood test

diet: restrict phenylalanine, supp tyrosine

*children with PKU have increased chances of cavities because intake in CHO is high and PRO is low

87
Q

glycogen storage disease

A

cannot convert glycogen to glucose

88
Q

homocystinurias

A

treatable inherited disorder of AMINO ACID metabolism

diet:
- provide folate, B6, B12
- if don’t respond: low protein, low methionine diet

89
Q

Maply syrup urine disease (MSUD)

A

inborn error of branch chain amino acids (leu, isoleu, val)

diet:
- restrict BCAA
- provide adequate energy from CHO and fat

90
Q

Congenital surcrase isomaltase disease (CSID)

A

diet modification of sucrose, starch and maltose

can supplement with sacrosidase (oral replacement for sucrase) –> do not need to restrict sucrose in diet

91
Q

Arthritis

A

inflammation of peripheral joints

if long-term, may develop normocytic anemia (DO NOT supplement with FE since this is not diet-related)

diet: well-balanced
- anti-inflammatory diet: fresh FVs, Meditteranean

92
Q

Lupus

A

no specific dietary guidelines

may have deficiencies of Fe, folate, Ca, fiber, B12
may have anemia as a result of inflammation & its not correlated with iron intake

93
Q

Osteoprosis

A

loss of bone TISSUE which makes it difficult to susstain ordinary stress

tx:
- hormone replacement therapy
- weight-bearing exercise
- vitamin D and Ca
- take Ca carbonate or Ca citrate

94
Q

Osteomalacia

A

loss of bone DENSITY d/t vitamin D deficiency

tx: vitamin D and Ca

95
Q

Epilepsy

A

seizures

tx: anticonvulsants
- can interfere w/ Ca absorption, so may need supplements

96
Q

Ketogenic diet

A

tx for epilepsy

high fat, very low CHO (4 to 1)
need supp: Ca, D, folate, B6 & B12

97
Q

Cerebral palsy

A

inadequate control lover voluntary muscles

1) SPASTIC form: difficult, stiff, limited activity which
- could result in obesity
diet: low kcal, high fluid, high fiber

2) NON-SPASTIC (athetoid) form: constant irregular motions
- could lead to weight loss
diet: high kcal, high pro, finger foods

98
Q

Traumatic brain injury

A

result to hypermetabolism, hyperglycemia, insulin resistinance, and protein wasting

tx: aggressive nutrition support
- high energy, high pro

99
Q

spinal cord injury

A

long-term issues: obesity, CVD, pressure ulcers

diet: energy needs may be below predicted d/t decreased metabolic activity
adequate fulid
*more kals for paraplegia than quadriplegia

100
Q

Pressure injury

A

often have low serum albumin

diet:
-high kcal if malnourished
-protein needs vary at each stage:
STAGE 1: 1.1 - 1.2g/kg
STAGE 2: 1.25 - 1.5 g/kg
STAGE 3: 1.5 - 2 g/kg
- supp with Vit A, C, Zn, & Cu

101
Q

Braden Scale

A

assess risk of pressure ulcer

I: upper layer of skin, red and warm to touch
II: broken skin, open sore
III: damage below skin into fat tissue
IV: large wound, may affect muscles & ligaments

102
Q

ADHD

A

diet:
- wholesome foods
- regular mealtimes w/ small servings

*Adderrall side effects: lack of appetite, nausea, weight loss

103
Q

Autism

A

unnecessary food restrictions, food aversions, & excessive supplementation = place them at risk

104
Q

Alzheimer’s

A

diet:
- avoid distractions
- regular consistent mealtimes
- encourage self-feeding
- finger foods
- avoid dehydration

105
Q

Microcytic, hypochromic anemia

A

small, pale cells
d/t Fe deficiency

*all lab values are low except for RBC

106
Q

Macrocytic, megaloblastic anemia

A

few large cells, filled w/ Hgb
d/t folate and B12 deficiency

*low everything except high MCV (cell size) and MCH (# of Hgb in cell)

107
Q

Schilling test

A

determines body’s ability to absorb vitamin B12 (pernicious anemia)

108
Q

Ag-Ab allergic reaction

A

response to foreign substance (dust)

109
Q

Immunoglobumin E (IgE) allergic reaction

A

response to food protein

110
Q

DBPCFC (double-blind, placebo-controlled food challenges)

A

gold standard for dx food allergies by looking at food symptoms

111
Q

Food intolerance (non-Ige)

A

abnormal response/symptoms to food, but NO antibodies produced

112
Q

Burns

A

diet:
*replace fluids and electrolytes lost
then focus on recovery by increasing kcal
- 20-25% kcals as PRO
- vit C, B, K(if on antibiotics)
- zinc for wound healing

113
Q

Rule of Nines

A

determines caloric needs of a burn by dividng body SA into %

114
Q

Trauma

A

accelerated catabolism of lean body mass leading to neg N balance

results in:
*hyperglycemia (by epinephrine)
- hyperinsulinemia
- increased glucagon (hepatic glycogenolysis)

115
Q

Neoplastic disease / cancer

A

can lead to protein-cal malnutrition, malabsorption, and fluid and electrolyte imbalance

symptoms: altered taste, meat aversions, thrush

*TX: can affect GI
1) radiation: xerostomia (dry mouth), diarrhea, malabsoprtion, mucositis
diet: moisten food; avoid uncooked - give cold, soft foods
2) chemotherapy: NV, malabsoprtion

116
Q

Marasmus

A

protein and calorie starvation

117
Q

Iatrogenic malnutrition

A

protein-calorie malnutrition caused by tx, hospital, medication

118
Q

Anorexia nervosa

A

tx:
- correct electrolyte (specifically K)
- regular meal times
- varied, moderate intake
- gradually reintroduced feared foods
- focus on reason to eat
- go slowly

119
Q

Bulimia nervosa

A

binge followed by purging

tx:
- encouraged structure intake (every 3-4 hours)
- recognize hunger cues
- all foods are acceptable
- eat slowly
- drink adequate fluids

120
Q

BMI Classes for Obesity

A

Class I: 30 - 34.9
Class II: 35 - 39.9
Class III: > 40

121
Q

Obesity

A

Tx:
- set realistic weight loss goals
reduce 500 kcals/day to lose 1 lb fat/week
- calorie reduction strategies (small-food-based changes, real replacements)
- physical activity

Medication:
1) Olistat - lipase inhibitor
2) Lorcaserin: enhances satiety
3) appetite suppressants

122
Q

Spot weight loss theory

A

belief that localized exericse reduces fat stores - NOT TRUE

123
Q

Bariatric surgery

A

alteration of GI tract

Tx for Class III obesity or Class II obesity if comorbidities are present

124
Q

Roux-en-Y gastric bypass surgery

A

reconstructs SI; creates gastric pouch to resemble letter Y

***affects secretion of gut hormones –> decreased hunger, increased satiety

concerns:
- dumping syndrome
- supplement Ca, Vit D, Fe
- will need multivitamin/mineral supplement for life

125
Q

Sleeve Gastrectomy (SG)

A

removal of 80% of stomach

***affects secretion of gut hormones –> decreased hunger, increased satiety

monitor Ca, Vit D, Fe

126
Q

Laparoscopic adjustable gastric banding (LAGB)

A

create gastric pouch using a band, fully reversible

diet:
- eat slowly, sip drinks, no straws/bubbles

127
Q

Prader Willi Syndrome

A

congenital disorder, w/ subnormal LBM & supra-normal body fat

**elevated ghrelin: stimulates appetite, intake;
**does not sense satiety

can lead to obesity at 2-3 yeaers of age, hypogonadism (underdeveloped sex organs), failure to thrive, short statue, muscle hypotonia (muscle weakness/floppy)

***best tx: control food intake

128
Q

Dental caries

A

cavities (plaque in teeth, demineralized surface)

diet
- low cariogenic potential foods
- high mineral content (Ca, P)
- w/ ph >6

***sugar alcohols do not promote teeth decay

129
Q

Stomatitis

A

inflammation of mouth

diet:
- avoid very hot, very cold, spices, sour, alcohol
- rinse with lukewarm water after meals

130
Q

Esophagitis

A

inflammation of esophagus, decrease gastric activity

may cause odynophagia (painful swallowing) and achalasia (disorder of lower sphincter) which may lead to dysphagia

diet:
- small
- low fat & low fiber
- bland

131
Q

Dysphagia Diet (IDDSI)

A

color-coded, culturally neutral terms to evaluate and characterize thickened liquids

ranges from level 0 to 7
beverage: level 0 to 4
food: level 3 to 7

0: thin, water
1: slightly thick
2: mildly thick
3: liquidized / mod thick
4: extremely thick / pureed
5: minced and moist
6: soft, bite-sized
7: regular, easy to chew

132
Q

GERD

A

reflux

diet:
- avoid eating before bed
- avoid acidic foods
- avoid soda, caffeine
- small, low fat meals

133
Q

Pregnancy-induced HTN (PIH)

A

high blood pressure during pregnancy

sym: rapid wt gain after 20th week

*Na restriction not recommended (since fluid retention is normal)

134
Q

Acuired immune deficiency syndrome (AIDS/HIV)

A

goals:
- achieve healthy BW & body comp
- prevent nutrient deficiencies
- reduce nutrietion & medication related complications
- prevent onset of other disease
- prioritize food and water safety (low bacteria diet/neutropenic, avoid raw foods)

135
Q

Pediatric HIV

A

diet:
- high pro
- high kcal
- supplements

136
Q

Chronic obstructive pulmonary disease (COPD)

A

persistent obstruction of airflow
1) emphysema - air sacs lose elasticity
2) chronic bronchitis - mucus

diet:
- avoid overfeeding
- small, frequent mini meals and snacks
- vitamin D supplementation

137
Q

ARDS / acute respiratory distress syndrome

A

lungs no longer able to exchange gas

goal: maintain nutritional requirements, stable weight, and lean body mass

138
Q

Drug addiction

A
  • group process (psychosocial support) –> positive outcome

diet:
-moderate/discontinue sugar & caffeine
-increase complex CHO, protein and fiber
-regular, well-spaced meals
- fluid intake between meals

139
Q

Standard polymeric formula for EN

A

for those with NORMAL GI FUNCTION but unable to consume adequate intake

initiate full strength at a rate of 10-40 ml/hr, advance 10-20ml every 8 to 12 hours until goal rate

140
Q

Elemental formula for EN

A

for those with COMPROMISED GI FUNCTION / MALABSORPTION

formula is pre-digested

141
Q

Specialized formula

A

Nepro - renal
Hepatic Aid II - liver
Glucerna - diabetes

142
Q

Hang time

A

length of time enteral formula is safe for delivery

open: 8 hours
closed: 24-48 hours

143
Q

Bolus method

A

for those with functional stomach, clinically stable

144
Q

Intermittent drip

A

pump/gravity (more mobility)

145
Q

Continous drip

A

constant, steady rate over 16-24 hours

  • cyclic feeds: overnight over 8-16 hours
146
Q

Peripheral parenteral nutrition

A

short term therapy w/ minimum effect on nutritional status

use small surface veins

147
Q

PPN: IV dextrose calculation

A

= ml provided x % dextrose x 3.4 kcal/g

*iv dextrose provides 3.4 kcal/g

148
Q

PPN: IVFE (intravenous fat emulsion / intralipid)

A

10% = 1.1 kcal/ml
20% = 2.0 kcal/ml

149
Q

Parenteral nutrition

A

used to achieve anabolic state when PO and EN are not possible

through central venous catheter or PICC

*concern for translocation bacteria

notes for solutions:
- pro: % = number of grams of AA per 100 ml
ex. 3% solution = 3 grams of AA per 100 ml

  • energy: max rate is 4 to 5 mg/kg/minute to prevent hyperglycemia
  • fat: prrevent EFAD, give 500 ml of 10% fat emulsion 1-2x/week
150
Q

Transitional nutrition support

A

from PN:
- intro full-strength at a low rate to establish GI tolerance
- begin tapering when enteral feeds are providing 33-50% of nutrient requirements
- decrease PN as you increase enteral rate by 25-30 ml/hour
- when tolerating 60% of needs, d/c PN

151
Q

Refeeding syndrome

A

aggressive adminsitration of nutrition to those w/ malnutrition

  • causes starved cells to take up nutrients resulting in low K, low Phos, low Mg
    monitor glucose levels
    (if overfeeding PN and extrose, may lead to hyperglycemia)
152
Q

Integrative medicine

A

combo of evidence-based complementary therapies w/ conventional tx to addrress health and illness

153
Q

NCCIH

A

National Center for Complementary and Alternative Medicine

154
Q

Functional Medicine

A

addresses the WHOLE person by engaging pt and practitioner in partnership

155
Q

Holistic health

A

mental, physical, and spirtual aspects of life are equally important w/ regard to tx

156
Q

RDA

A

recommended dietary allowances

goals for healthy INDIVIDUALS

157
Q

EAR

A

estimated average requirement

assesses GROUP nutritional adequacy

158
Q

AI

A

adequate intake

used when insufficient evidence exists for RDA and EAR

159
Q

UL

A

tolerable upper level

  • not associated w/ adverse side effects in most inidividuals of healthy pop
160
Q

DRI

A

dietary reference intake; umbrella of nutrient guidelines (e.g. RDA, UL, etc.)

161
Q

DGA

A

created by USDA & DHHS every 5 years to promote health and prevent chronic disease

2020-2025:
- follow healthy dietary pattern
- customize and enjoy nutrient-dense food
focus on meeting food group needs
-limit:
added sugars (<10% of kcal/day)
saturated fat (10% of kcal/day)
Na (<2300 mg/day)
alcholic beverages (2 for men, 1 for women)

162
Q

Healthy Eating Index

A

measures diet quality and how well Americans follow DGA

163
Q

MyPlate

A

shows essential food groups
balance calories
shows foods to increase and foods to reduce

164
Q

Healthy People 2030

A

broad goals to improve health and well-being

focus: disease prevention by changing behaviors; address social determinants of health

core objectives: measurable, reflect high-priority issues and associated with evidenced-based interventions

leading health indicators (LHI) small subset of objectives selected to drive action

165
Q

Program Planning Steps

A

1) Develop a mission statement
2) Set goals (broad)
3) Set objectives (measurable)
4) Develop plan
5) Budget development

166
Q

Program Intervention Strategies

A

1) educate - increase awareness, knowledge, options

2) enable - reduce barries to make it easier to act
e.g. 4 P’s of marketing (product, place, price, and promotion)

3) skill development - competencies to make and sustain new eating habits
e.g. how to budget

RD Exam: Domain 2 (4 decks)

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