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Domain 1 > Nutrition Planning & Intervention > Flashcards

Nutrition Planning & Intervention Flashcards

1
Q

Hormones involved in renal function

A

1) vasopressin (ADH): from hypothalamus (stored in pituitary) exerts pressor effect, elevates BP, increases water reabsorption from distal and collecting tubules
2) renin: vasoconstrictor, secreted by glomerulus when blood volume decreases, stimulates aldosterone to increase sodium absorption and return blood pressure to normal
3) erythropoietin (EPO): produced by kidney, stimulates bone marrow to produce RBC

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2
Q

Labs tests in renal disease

A

decreased glomerular filtration rate, creatinine clearance

BUN creatinine ratio of > 20:1 indicates a “pre-renal” state in with BUN reabsorption is incr due to acute kidney damage (possibly no dialysis)

BUN creatinine ratio of < 10:1 suggests reduced BUN reabsorption due to renal damage (may need dialysis)

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3
Q

Renal calculi

A

1.5-2 L/day needed to dilute urine

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4
Q

Nephrosis- nephrotic syndrome

A

defects in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through tubules

1) albuminuria, edema, malnutrition, hyperlipidemia (incr synthesis, decr clearance of VLDL)
2) modest protein restriction: .8-1.0 g/kg; 50% from HBV, excess protein will be catabolized to urea and excreted
3) 30% fat, low sat fat, 200 mg chol

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5
Q

chronic kidney disease (CKD)

A

protein restricted when GFR ml/min falls

Stage 1 & 2: 0.8-1.4 g/kg
Stage 3 & 4: 0.6-0.8 g/kg

Phos

Stage 1 & 2: maintain normal serum level
Stage 3 & 4: 800-1k mg/day or 10-12 mg/g protein

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6
Q

Chronic renal failure: hemodialysis

A

1.2g prot/kg SBW (standard body wt) at least 50% HBV

<60 y 35 kcal/kg, >=60 y/o or obese 30-35 kcal/kg

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7
Q

Chronic renal failure: peritoneal dialysis

A

1.2- 1.3g prot/kg SBW (standard body wt) or adjusted BW, at least 50% HBV
<60 y 35 kcal/kg, >=60 y/o or obese 30-35 kcal/kg

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8
Q

Diabetes mellitus

A

Normal BG: 70-100 mg/dl (post prandial) < 140
Diabetes fasting glucose >=126 or glucose tolerance test >=200

GTT: normal curve is sloped, diabetic curve is rounded

HbA1c goal for diabetics: <7% (normal is <5.7%)

Self management goals:

1) maintain normal BG
2) optimal serum lipid levels (LDL <100, TG<150, HDL>40M >50F)
3) blood pressure goals: systolic <130, diastolic <80
4) prevent and treat chronic complications

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9
Q

Gestational diabetes

A

risk factors:
BMI >30
h/o GDM

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10
Q

Carb counting

A

(review manual)
one choice from starch, fruit or milk list= 15g CHO and each is a choice; meal plan outlines the number of CHO choices to be selected for meals and snacks

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11
Q

Insulin

A

BOLUS:

  • rapid-acting (novolog, humalog): take 5-15 min before eating, usual duration 4 hours
  • short-acting/regular (humilin): take 30-45 min before meal (burst of insulin to cover the meal just abotu to be eaten) one unit covers 10-15g CHO; duration 3-6 hours

BASAL/BACKGROUND:

  • intermediate acting (humilin, novolin, ReliOn): onset 2-4 hours, duration 10-16 hours, cloudy in appearance
  • long-acting (lantus, levemir): onset 2-4 hours, duration 18-24 hours, start at 10 units/day or 0.1-0.2 units/kg, take around the same time every day
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12
Q

Complications

A

DAWN PHENOM: natural increase in the early morning blood glucose and insulin requirements due to increased glucose production in liver after overnight fast (increased need for insulin at dawn)

ACUTE HYPOGLYCEMIA: treat with glucose 15g CHO, wait 15 min

POSTPRANDIAL/REACTIVE HYPOGLYCEMIA: goal is to prevent marked rise in bg that would stim more insulin, avoid simple sugars, 5-6 meals/day, protein at RDA levels

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13
Q

Thyroid disorders

A

Hyperthyroidism: excess secretion of thyroid hormone, elevated T3 and T4, increased BMR, increase kcal

Hypothyroidism: deficiency of thyroid hormone, T4 low, T3 low or normal, decreased BMR leading to wt gain

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14
Q

Urea cycle defects

A

Unable to synthesize urea from ammonia resulting in ammonia accumulation,
diet-protein restriction (1.0, 1.5, 2g/kg based on tolerance, age, projected growth rate)

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15
Q

Phenylketonuria (PKU)

A

missing enzyme phenylalanine hydroxylase which would convert phenylalanine to tyrosine

Restrict phenylalanine, supplement the product tyrosine (tyrosine becomes essential)

Low protein, high CHO intakes may lead to incr. dental caries

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16
Q

Glycogen storage disease

A

Deficiency of glucose-6-phosphatase in liver, impairs gluconeogenesis and glycogenolysis

Provide a consistent supply of exogenous glucose with raw cornstarch at intervals, and a high carb, low fat diet

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17
Q

Homocystinurias

A

treatable inherited disorder of amino acid metabolism

newly diagnosed patients receive increased doses of folate, pyridoxine (B6), B12

Potentially low protein, low methionine diet

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18
Q

Skeletal and connective tissue disorders

A

regular, well-balanced diet with vitamin intake to at least DRIs

19
Q

Nervous system/Neurological disorders

A

provide phenytoin separate from meals and other supplements

Ketogenic diet to treat seizure disorder: high fat, very low carb, 4 grams fat: 1 g CHO; need supplements of Ca, D, folate, B6, B12 (spinach may aid in absorption)

20
Q

Cerebral Palsy

A

Spastic: difficult, stiff movement; limited activity; obese; low cal high fluid high fiber

Non-spastic (athetoid): involuntary wormlike movement; constant motions lead to wt loss; high cal high protein, finger foods

21
Q

Paralysis

A

Pressure ulcers:
1.2-1.5 g protein/kg in stage I, 1.5-2 g protein/kg in II, IV
normal intake of calcium, adequate fluids
supplement Vitamin C (500-1000mg in II IV)
Zn 15mg (22mg zinc sulfate) with stages III IV for 2-3 wks
daily dietary source of vitamin A

22
Q

Anemia

A

Decrease in total red cell mass due to fewer red blood cells or smaller cells with less hemoglobin

MICROCYTIC, hypochromic anemia: small, pale cells, due to iron deficiency, associated with chronic infections, malignancies, renal disease

MACROCYTIC, megaloblastic: FEW large cells, filled with hemoglobin, due to deficiency of folate or B12, schilling test for pernicious anemia

23
Q

Anemia Lab values

A 
NORMAL
RBC: 4.7-6.1 10^12/L (M); 4.2-5.4 10^12/L (F)
Hgb: 14-18 g/dl (M); 12-16 g/dl (F)
Hct: 42-52% (M); 35-47% (F)
MCV: 80-95 fL
MCH: 27-32 pg
MCHC: 32-36%
MICROCYTIC/HYPOCHROMIC: 
RBC: may be normal 
Hgb: low
Hct: low
MCV: low (<80)
MCH: low
MCHC: low (<31)
MACROCYTIC: 
RBC: decreased
Hgb: low
Hct: low
MCV: high >95
MCH: high 
MCHC: normal >31
24
Q

Allergies

A

IgE mediated reaction to normally harmless food protein

common allergies: peanuts, eggs, milk, soy, wheat , shellfish

25
Q

Fever and infection

A

BMR increases 7% for each degree rise in F temp; normal temp 98.6F

26
Q

Inflicted trauma

A

Immediate shock period- catabolism, BMR rises 50-100%
replace fluids and electrolytes lost first
recovery period: increase calories (based on burn size)
secondary period: 20-25% calories as protein

27
Q

Ebb and flow response to injury

A

hypermetabolic, catabolic response following trauma (accelerated catabolism of lean body mass leading to negative nitrogen balance as protein is catabolized to release glucose for energy)

Results of physiologic trauma: hyperglycemia, hyperinsulinemia, little or no ketosis, incr glucagon

28
Q

Neoplastic disease (cancer)

A

Thrush from oral infections: avoid spicy, acidic, strongly-flavored foods

29
Q

Malnutrition

A

Marasmus: protein and calories starvation

Iatrogenic malnutrition: protein-calorie malnutrition: brought on by treatment, hospital, medications

30
Q

Obesity

A

Class 1: 30-34.9
Class II: 35-39.9
Class III: >=40

Weight maintenance is usually recommended in overweight children

Bariatric surgery treatment: class III obesity with a BMI of 40+ or a BMI of 35 with co-morbidities

31
Q

Prader-Willi Syndrome

A

congenital, subnormal LBM, supra-normal body fat
Ghrelin levels elevated

Best treatment is to control food intake

32
Q

Dental caries

A

sugar alcohols do not promote tooth decay (sorbitol, xylitol, mannitol)

fluoride recommendations: birth-6 months not recommended, 6-12 months fluoridated water, 12-24 months toothpaste not used unless child can spit out

infant should not sleep with a bottle

33
Q

Stomatitis

A

inflammation of mouth (associated with riboflavin deficiency)

achalasia: disorder of the lower esophageal sphincter motility, does not relax upon swallowing, causes dysphagia

National dysphagia diet:
NDD1- pureed, moderate to sever
NDD2- milk to moderate
NDD3- transition to regular

Liquid consistency:
spoon thick, honey-like, nectar-like
thin: includes all beverages: water, ice, milk, juices, coffee, tea, gelatin

34
Q

Disorders of pregnancy

A

pregnancy-related hypertension NOT treated with sodium restriction because they need to maintain normal serum sodium levels

35
Q

Enteral nutrition

A

1) standard polymeric: 1-1.5kcal/cc; initiated at 10-40ml/hour
2) elemental: pre-digested protein or amino acids, small fat, vit, min, electrolytes
3) specialized: renal, pulmonary, liver, diabetes

Access:

  • short-term: nasalduodenal or nasojejunal, transpyloric/ post-pyloric
  • > 3-4 weeks: gastrostomy or jejunostomy PEG tube

Give 1 cc water per kcal

CALCULATION: (post-it)

1) select formula and determine kcal needs
2) divide cal needed by kcal/ml to determine mls formula needed per day
3) determine protein content: multiple mls of daily formula by g of protein per liter
4) determine daily fluid need, multiple % water in formula x daily formula mls to determine water contribution of enteral nutrition, subtract formula water from total fluid requirements to determine water flushes
5) determine administration rate: divide total mls of formula/day by 24 hours to determine continuous

36
Q

Parenteral calculation

A

SOLUTIONS:
1) IV dextrose- 3.4 cal/g
to figure out kcal (ml) (%) (3.4)
highest concentration of dextrose used in PN is 10%
2) protein, 3-15% amino acid solutions
3) IVFE intravenous fat emulsion (intralipid)
10% is 1.1 kcal/cc
20% is 2.0 kcal/cc
solutions generally limited to 800-900 mOsm

37
Q

Parenteral nutrition

A

typical uses:
NC 1.4 altered GI function
NC 2.1 impaired nutrient utilization

Concern: translocation of bacteria, not feeding through gut allows wall to break down, bacteria move out causing sepsis

SOLUTIONS:
1) protein: ratio for anabolism is 1g nitrogen/150 kcal; 1-1.5 g protein/kg/day
crystalline amino acids 3-15% solution
%= number of g of protein in 100mls solution
2) energy: 30-35 kcal/kg up to a 70% dextrose solution
a 10% solution provides 100g CHO/L
to avoid overfeeding and hyperglycemia start at <=20-25 kcal/kg
a max dextrose infusion rate (glucose utilization rate) should not exceed 4-5 mg/kg/min to prevent hyperglycemia
3) fat: needed for energy and to prevent essential fatty acid deficiency (EFAD)
to prevent EFAD give 500cc of 10% fat emulsion 1-2/week
4) vitamins, electrolytes, water as needed

38
Q

Transitioning feeding

A

Begin tapering when enteral feedings provide 33-50% of their nutrient requirements

39
Q

Re-feeding syndrome

A

Results in hypokalemia, hypophasphatemia, and hypomagnesemia

40
Q

Dietary reference intakes

A

RDA: recommended daily allowances, goals for healthy INDIVIDUALS

EAR: estimated average requirement for 50% of population, used in planning meals for healthy people, assesses GROUP nutritional adequacy

AI: adequate intake, used when insufficient evidence exists for RDA or EAR

UL: tolerable upper limit not associated with adverse side effects in most individuals of a healthy population

41
Q

Dietary Guidelines for Americans

A

1) healthy eating across the lifespan: veg from all sub-groups, fruits (especially whole), grains (half whole grains), fat free or low fat dairy, variety of proteins, oils
2) focus on variety, nutrient density, amount
3) limit kcal from added sugard (<10% of cal) and sat fats (<10% of kcal) and trans fats and reduce sodium intake (<2300 mg)
4) shift to healthier food and beverage choices
5) adults need 150 minutes of moderate-intensity physical activity time for additional and more extensive health benefits

42
Q

Healthy People 2020

A

DHHS

focuses on disease prevention by changing behaviors

43
Q

Steps in program planning

A

1) develop a mission statement: needs/problem statement
2) set goals: broad direction, general purpose
3) set objectives: specific, measurable

SMART objectives: specific, measurable, achievable, relevant, time-frame

Domain 1 (3 decks)

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