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Nutrition > Nutrition Therapy > Flashcards

Nutrition Therapy Flashcards

1
Q

What can prevent muscle loss during bed rest?

A

Emerging evidence suggests that low-intensity exercise and leucine-supplemented meals may partially and temporarily protect skeletal muscle (English, et al, 2016; Galvan, et al, 2016). Leucine-rich foods include whey protein, milk, beef, chicken, yogurt, peanuts, and soy foods.

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2
Q

What causes most cases of most cases of hypoalbuminemia?

A

Acute and chronic inflammatory responses. Inflammation, infection, dehydration, and illness affect these values.

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3
Q

What are some factors that can lead to low hemoglobin?

A

Low serum levels may occur from iron deficiency anemia, blood loss, hidden gastrointestinal bleeding, or absorption problems (celiac disease, inflammatory bowel disease, etc.)

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4
Q

What do increased/decreased creatinine levels indicate?
(Males: 0.6-1.2 mg/dL; 53-106 µmol/L
Females: 0.5-1.1 mg/dL; 44-97 µmol/L)

A

Increased in renal disease and decreased in malnutrition (i.e., blood urea nitrogen [BUN]/creatinine ratio >15 : 1

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5
Q

Which serum levels can be evaluated for immune function?

A

Zinc, vitamin A, and omega-3 fatty acids play a role Vitamin D

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6
Q

Atrophy of papillae on tongue can be a sign of these vitamin and mineral deficiencies

A

Fe, B vitamins

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7
Q

Conjunctival and corneal xerosis (dryness) can be a sign of this vitamin deficiency

A

Vit A

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8
Q

Hair loss can be a sign of these deficiencies

A

Protein, Zn, biotin. OR Vit A toxicity

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9
Q

Headache can be caused by these vitamin excesses (toxicity)

A

Vitamin D, A

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10
Q

If hair is:
Dull, dry, brittle; OR
Easily plucked (with no pain); OR there is
Flag sign (loss of hair pigment in strips around head)

It can be a sign of this deficiency

A

Protein deficiency. Flag sign can also be caused by copper deficiency.

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11
Q

This vitamin deficiency can cause nosebleeds

A

Vitamin K

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12
Q

Blue sclerae (the white part of the eye) can be caused by this deficiency

A

Iron

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13
Q

Corneal vascularization (bloodshot eyes) and Cheilosis or angular stomatitis (lesions at corners of mouth) are signs of this vitamin deficiency

A

Vitamin B2 (Riboflavin) Deficiency / Ariboflavinosis

*Cheilosis can be caused by other vitamin B deficiencies

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14
Q

Eczematous lesions can be caused by this deficiency

A

Zn

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15
Q

Brittle, fragile nails can be a sign of this deficiency

A

Protein

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16
Q

Enlargement of the heart, tachycardia, and heart failure can all be signs of this deficiency

A

Vitamin B1 (thiamin)

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17
Q

Edema can be caused by these deficiencies

A

Protein, vit B1

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18
Q

Tremor can be caused by this deficiency

A

Magnesium

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19
Q

Which deficiencies can lead to depression?

A

Vit B1, biotin, B12

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20
Q

Any nutrition intervention used to minimize patient morbidity, mortality, and complications

A

nutrition support

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21
Q

What age groups are at the highest risk of nutritional deficiencies?

A

Under age 5, over age 75

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22
Q

What amount of weight and/or means someone is of high risk of nutritional deficiencies?

A

5% weight loss in 1 month
10% loss in 6 months
Length/height for age <5th percentile

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23
Q

What feeding modalities put someone at high risk of nutritional deficiencies?

A

Parenteral nutrition, tube feeding, nothing per mouth (NPO), or clear liquids >3 days

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24
Q

What is the appropriate intervention for malnourished adults with chronic starvation in the hospital?

A

Order meals and snacks according to appetite and preferences; encourage a small snack approximately every 2 to 3 hours. Some individuals may need feeding assistance.

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25
Q

What percentage of adults in the hospital are admitted with some form of malnutrition?

A

40%

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26
Q

What is the appropriate intervention for malnourished adults with sarcopenia (age-related muscle loss)?

A

Oral diet is best, but enteral or parenteral routes may also be needed. Extra dietary protein or amino acids may be useful; whey protein powder is a good source.

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27
Q

Intestinal bleeding often causes iron-deficiency anemia among patients with arthritis. This intestinal bleeding is a common side effect of long-term use of ________, either prescribed or OTC, taken to reduce the symptoms of arthritis

A

nonsteroidal anti-inflammatory drugs (NSAIDs)

28
Q

Nutrients affected by NSAIDs

A

Vitamin C
Folate
Vitamin K

NSAIDs increase loss of vitamin C and compete with folate and vitamin K

29
Q

The antibiotics tetracycline and ciprofloxacin (Cipro) deplete these

A

Minerals (Calcium, magnesium, iron, and zinc)

30
Q

Antihyperlipidemics [i.e. Cholestyramine (Questran), colestipol (Colestid)] deplete the following nutrients

A

Fat-soluble vitamins (A, D, E, K), folate, vitamin B12, and iron

*By binding with bile salts and nutrients

31
Q

Oral contraceptives deplete the following nutrients

A

Vitamin B6 and folate

May cause selective malabsorption or increased metabolism and turnover

32
Q

How do monoamine oxidase inhibitors (MAOIs) interact with nutrients to cause adverse effects?

A

MAOIs, such as phenelzine (Nardil) and tranylcypromine (Parnate), may be prescribed to treat depression. These drugs inhibit the enzyme monoamine oxidase, the function of which is to inactivate tyramine found in some foods. Without monoamine oxidase, the level of tyramine increases the release of norepinephrine. Elevations of norepinephrine may cause headache, pallor, heart palpitations, and life-threatening severe hypertension. Patients who take MAOIs should avoid foods and drugs that contain tyramine, such as Chianti wine, aged cheese, and several fermented foods.

33
Q

How does grapefruit “juice up” the effects of drugs?

A

Grapefruit juice blocks the CYP3A4 enzyme in the wall of the small intestine, thus increasing bioavailability of the drugs. The serum drug level is then higher. It is believed that more than one component present in grapefruit juice may contribute to this effect. A single glass (8 oz) of grapefruit juice has the potential to increase bioavailability and enhance beneficial or adverse effects for up to 72 hours after consumption.

34
Q

This food group decreases the absorption of Cipro

A

dairy products

35
Q

Tube feeding: Should I administer the tablet or liquid form of the medication?

A

Whenever possible, use the liquid form of a drug because it bypasses the dissolution process. But be aware that many liquid medications are formulated for pediatric patients; therefore, large volumes must be dispensed to meet the required dose for adults. This often leads to diarrhea as a result of excessive amounts of sorbitol in the adjusted dose.

36
Q

Tube feeding: Only form of the medication available is a tablet. What should I do?

A

If a tablet is the only preparation available, consultation with the pharmacist is mandatory. Some tablets can be crushed if they are simple, compressed tablets designed to dissolve immediately in the gastrointestinal (GI) tract. Keep in mind that crushing the tablet allows it to enter the bloodstream faster. The difference may or may not be clinically significant. Always confirm the type of coating on the tablet with the pharmacy.

37
Q

I’ve checked with the pharmacy and was told the tablet could be crushed. How do I do that?

A

Ideally, medication(s) should be crushed in the pharmacy. But if you must do it yourself, the best technique is to position a unit-dose tablet in a mortar without removing it from the package. Then crush the tablet by tapping it through the package with a pestle (to avoid tearing the package, don’t grind). If the medication isn’t packaged as a unit-dose, place it between two paper medicine cups and pulverize the tablet with the mortar and pestle. Mix the crushed tablet thoroughly with 15-30 mL water (5-10 mL for children), and administer through the feeding tube. Tubing must be flushed with a minimum of 30 mL of room temperature sterile water before and after administration of each medication.

38
Q

Tube feeding:

The pharmacy has the prescribed medications in liquid form. Is there anything special I need to do?

A

Check whether dilution of the medication formulation before administration is required. Hypertonic, irritating, or viscous medications should be diluted in at least 30 mL of water immediately before infusion to avoid gastric irritation and diarrhea. In some cases, 90 mL of water may be necessary for dilution. Adjust water amounts appropriately for pediatric patients and patients on fluid restrictions. Document the amount of water used on the patient’s intake and output records.

39
Q

Tube feeding:

Which tablets that cannot be crushed?

A

Some types of tablets must not be crushed. These include

Buccal or sublingual tablets (e.g., nitroglycerin or isosorbide) are intended to be absorbed by veins under the tongue or in the cheek, thus bypassing the liver (avoiding first-pass effect) and protecting the medication from contact with other drugs, foods, and GI secretions that could affect the medication’s potency or bioavailability.

Enteric-coated tablets (e.g., bisacodyl [Dulcolax] and ferrous sulfate [Feosol]) are formulated to inhibit release of the active drug until after the tablet has passed from the stomach into the small intestine. Moreover, the tablet’s coating protects the stomach from irritation from the medication. Crushing the tablet would put an end to the protective coating.

Uncoated gastric irritants (including aspirin) remain effective after crushing, but they are more apt to trigger undesirable GI reactions such as cramping and bleeding. Ask for an alternative form or different medication.

Sustained-release or effervescent tablets (e.g., Slow-L, Procan SR, Theolair-SR, Inderal LA) were designed to dissolve and release medication gradually (they contain two or three doses of the medication). As a result, if such a tablet were crushed, the patient would receive an overdose. In addition, the planned beneficial effects would not be maintained throughout the dosing interval.

40
Q

Feeding tube: how do you administer medication that comes in capsules?

A

Capsules should not be crushed, but you can open some and mix the contents with water:

Hard gelatin capsules (e.g., ampicillin and doxycycline) contain a medication in a powdered form. The capsule can be opened (it’s designed to separate in the middle), and the powder mixed thoroughly with water.

Sustained-release capsules (e.g., Slo-bid and Feosol Spansules) release the active medication slowly, over time, through coated beads or pellets inside the capsules. They are designed to dissolve in the GI tract at different rates, lengthening the medication’s duration of action. Obviously, crushing capsules or their contents would damage the timed-release coatings. A better alternative would be a liquid form or a simple compressed tablet that can be crushed (ascertain that dosage frequency is increased appropriately).

Soft gel capsules (e.g., chloral hydrate, some vitamin preparations) can be dispensed through a feeding tube by poking a pinhole in one end and squeezing out the liquid contents. The liquid contents can also be drawn up in a syringe. Neither method should be used if delivering an exact dose is important. Some of the drug will always remain inside the capsule. Dissolve the capsule in 15-30 mL of warm water (5-10 mL for pediatric patients), then administer. The drug-water mixture will also work if you plan ahead—dissolving the capsule can take as long as 1 hour.

41
Q

Use of a clear liquid diet longer than ____ can lead to compromised nutritional status and possible nutrient deficiencies. Therefore, your facility should have a policy that orders for clear liquid diets are valid for only ____

A

24 hours

42
Q

With amyotrophic lateral sclerosis (ALS), some forms of stroke, head and neck cancer, and other conditions in which swallowing is impaired, a diet altered in consistency may be needed to prevent aspiration into the lungs. Signs of ____ include drooling, pocketing of food, choking, gagging, and taking longer than 2 to 10 seconds to swallow food.

A

Dysphagia

43
Q

Edentulous

A

Clinical term for toothless

44
Q

The most common symptoms of food allergies

A

diarrhea, nausea, vomiting, cramping, abdominal distention, and pain.

45
Q

Eggs, milk, wheat, soy, fish, shellfish, peanuts, and tree nuts

A

The major triggers of allergies in adults

46
Q

Food temperatures should be maintained at less than __° F or more than __° F for safe food handling, storage, and holding.

A

40° F

140° F

47
Q

Any _____ food should be discarded if left at room temperature longer than 2 hours.

A

protein-rich (milk, eggs, cheese, meat/poultry/fish)

48
Q

Norovirus, Salmonella, Clostridium perfringens, Campylobacter spp., and Staphylococcus aureus

A

The top causes of food poisoning

49
Q

This kind of medicine refers to non-Western healing approaches used at the same time as conventional medicine (allopathy). For instance, the patient who attempts to lower hypertension takes prescription medications (conventional) but also attends yoga classes (complementary) for physical and psychologic benefits.

A

Complementary medicine

50
Q

Alternative medicine

A

Therapies are used instead of conventional medicine

51
Q

Naturopathic medicine**

A

Based on noninvasive, natural healing to recover from disease and to achieve wellness

52
Q

Integrative medicine

A

Merges conventional medical therapies with TCAM modalities for which safety and efficacy have been demonstrated

53
Q

If medical personnel talk about “enteral nutrition,” they are referring to _____

A

tube feedings

54
Q

Techniques for tube feeding infants and children:
• Wash your hands with soap and water for at least ___ seconds (the time it takes to sing the “Happy Birthday” song twice).
• Flush feeding tube with 1-5 mL of water before and after each feeding and before and after giving medications to prevent the feeding tube from clogging.
• Never add new formula to formula already in the feeding container.
• Change the entire feeding setup every __ hours
• Place only 8 hours of formula or 4 hours of breast milk in the feeding container at any given time.
• Make sure your infant or child has pleasant sensations during feedings: Hold your child during feedings, and allow him or her to suck on a pacifier, sit in a high chair, and be a part of family meals.
• Give medications only in liquid form.
• Elevate the head of the bed____ degrees if the child cannot be held.

A

20 seconds

24 hours

30 to 45 degrees

55
Q

These formulas (3.8 to 4 kcal/mL) are not nutritionally complete by themselves because they are single macronutrients, such as glucose polymers, protein, or lipids. They are added to foods or other enteral products to change composition when nutritional needs cannot otherwise be met.

A

Modular formulas

56
Q

Feeding through a tube placed in the stomach simulates normal GI function but should be reserved for patients who are ____ Tube placement into the small intestine has less risk of ____ , but elemental formulas are often required for easier absorption, and continuous feedings are better tolerated.

A

Alert with intact gag and cough reflexes

aspiration

57
Q

The high osmolality of a hypertonic formula can lead to GI distress such as intestinal distention and osmotic diarrhea. Diluting tube feedings will lengthen the amount of time necessary before nutritional requirements can be met. Therefore, most formulas are started at full strength but ______ The rate of the feedings can be advanced to meet the desired volume, and then concentration can be gradually increased until kcal and protein needs are met.

Rate and concentration should never be advanced at the same time. If the feeding is not tolerated, rate or concentration can be reduced to ____

A

infused at a lower rate than goal

the last level of tolerance, then gradually increased again.

58
Q

What is the appropriate temperature for a tube feeding?

A

Administer solutions infused by continuous drip chilled

Administer intermittent and bolus feedings at room temperature to decrease incidence of gastrointestinal (GI) side effects

59
Q

What actions can be taken to prevent aspiration with a feeding tube?

A

Check tube placement before administration

Tubes placed into small bowel are associated with decreased risk for aspiration

Head of bed (HOB) should be elevated 30-45 degrees

Consider adding vegetable food coloring to formula to allow for detection of aspirated tube feeding from pulmonary secretions (Remember: This does not protect against aspiration)

60
Q

Tube feeding complications:

What can be done if there is obstipation (obstinate constipation)?

A

Increase fluid supply, fluid balance.

Use nutrient preparation with bulkage.

61
Q

Tube feeding complications:

Regurgitation/aspiration

What to do?

A

Reduce rate of administration. Prefer duodenal tube. Elevate upper part of the body during food intake.

62
Q

Tube feeding complications:

Flatulence

What to do?

A

Reduce/check rate of administration.

Use low-lactose or lactose-free tube feed.

Use low-fat tube feed or MCT-containing tube diet.

63
Q

Tube feeding complications:

Nausea/vomiting

What to do?

A

Reduce/check rate of administration.

Change bypass devices every 24 hours.

Ensure hygienic handling of administration systems. Once opened, bottles containing tube diet may be stored in refrigerator for not more than 24 hours.

64
Q

Tube feeding complications:

Diarrhea

What to do?

A

Patients receiving tube feedings are often also started on liquid medications that contain sorbitol, which can cause diarrhea. Bacterial dysentery as a result of Clostridium difficile is also a common cause of diarrhea. Diarrhea should not be attributed to tube-feeding formulas until other causes have been ruled out.

Reduce/check rate of administration.

Room temperature.

Use isotonic nutrient solution; initially dilute hyperosmolar nutrient solutions.

Use low-lactose or lactose-free tube feed.

Use low-fat tube feed or MCT-containing tube diet.

Administer chemically defined diet and/or perform parenteral nutrition until the absorptive capacity of the small bowel is restored.

Check drug schedule/antidiarrhetics.

Use Antidiarrheals.

65
Q

Parenteral nutrition (PN)

A

Involves the provision of energy and nutrients intravenously

66
Q

hypertonic

A

noting a solution of higher osmotic pressure than another solution with which it is compared

67
Q

The following are complications of ______:

Technical Complications

Pneumothorax
Malposition of catheter
Subclavian artery puncture
Carotid artery puncture
Catheter embolism
Air embolism
Catheter obstruction
Thrombosis
Septic Complications

Catheter-related sepsis
Septic thrombosis
Metabolic Complications

Hyperglycemia
Hyperglycemic hyperosmolar nonketotic dehydration
Hypoglycemia
Hyperkalemia
Hypophosphatemia
Hypocalcemia
A

Parenteral nutrition

Nutrition (8 decks)

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