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Nutrition > Quiz 2 > Flashcards

Quiz 2 Flashcards

Chapter 12, 17, 22

1
Q

24 Hour Recall

A

Guided interview in which the foods and beverages consumed in a 24-hour period are described

Advantages: method is not dependent on literacy or educational level; interview occurs after food is consumed, the method does not influence dietary choices; results obtained quickly

Disadvantages: Relies on memory; underestimation and overestimation on intakes; data from single day does not represent usual intake

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2
Q

Skin

A

Acceptable Appearance :

Smooth, firm, good color

Signs of Malnutrition:

  • Poor wound healing (vitamin C, zinc, PEM)
  • Bruising or bleeding under skin (vitamins C and K)
  • Dry, rough, lack of fat under skin (vitamin A, B vitamins, essential fatty acids, PEM,)
  • Pale (iron)

Other:

  • Poor skin care
  • DM
  • aging
  • meds
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3
Q

Hair

A

Acceptable Appearance:

Shiny, firm in scalp

Signs of Mal:

  • Dull, brittle, dry, loose
  • Corkscrew hair (vitamin C)
  • falls out (PEM)

Other:

  • Hair loss from aging
  • chemo
  • radiation therapy
  • excess chemicals
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4
Q

Mouth & Gums

A

Acceptable Appearance:

Oral tissue w/o lesions, swelling, or bleeding; red tongue; teeth w/o caries; no issues chewing or swallowing

Signs of Mal:

  • Bleeding gums ( Vit C)
  • Smooth or magenta tongue (B vitas)
  • Poor taste sensation (zinc)

Other:

Meds, periodontal disease ( poor hygiene)

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5
Q

Lips

A

Acceptable Appearance:

Smooth

Signs of Mal:

Dry cracked, or sores in corners of lips ( angular cheilitis, stomatitis) (B vitas)

Other:

Sunburns, windburn, excess salivation from ill fitting dentures.

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6
Q

Anthropomorphic data

A

Part of nutrition screening/ assessment for unintentional weight changes, loss of muscle or subq fat

Height ( or length)

Weight 5% involuntary weight loss in one month or 10% in six month > risk for PEM

Body Mass Index (BMI) ~ Wt(kg)/ Ht (m)2 or Wt(in) x 703/ (Ht)2

Circumference of head, waist, and limbs

H W B C

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7
Q

Effects of Illness on Nutrition Status

A
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8
Q

Protein-energy Malnutrition (PEM)

A

A state of malnutrition

  • Depletion of tissue proteins and energy stores
  • Associated w/ micronutrient deficiencies
  • 10% weight loss in six months suggest risk for PEM
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9
Q

Effects of Illness on Nutrition Status

A

Effects of illness on nutrition status (R I A)

Reduced food intake

Anorexia due to illness; nausea and vomiting; pain with eating; mouth ulcers or wounds; difficulty chewing or swallowing; depression or psychological stress; inability to feed oneself​

Impaired digestion and absorption

Inflammation associated with bowel conditions; insufficient secretion of digestive enzymes or bile salts; altered structure or function of the intestinal mucosa

Altered nutrient metabolism and excretion

Elevated metab rate; muscle wasting; changes in hydration; prolonged immobilization; nutrient losses due to excessive bleeding, diarrhea, or freq urination.

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10
Q

Nutritional Requirements in acute stress

A
  • Protein requirements increase
  • Carbs are 50-60 % of total energy requirements
  • Micronutrients increase, Vit A, B, C, zinc
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11
Q

Metabolic Stress

A
  • Disruption in the body’s internal chemical environment
    • uncontrolled infections
    • extensive tissue damage
      • Deep, penetrating wounds or multiple broken bones
  • May lead to Hypermetabolism (above normal met. rate) or Wasting (loss of muscle tissue)
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12
Q

Hormonal Responses to Stress

A

Catecholamine metabolic effects

  • Epinephrine and Norepinephrine
  • Increase metabolic rate
  • Glycogen breakdown in liver and muscle
  • The release of fatty acids from adipose tissue
  • Glucagon secretion from the pancreas

Cortisol metabolic effects *excess may lead to insulin resistance, contributing to hyperglycemia, suppressed immune responses, increasing susceptibility to infection.

  • Protein degradation
    • Inhibits protein synthesis
  • Enhancement of glucagons action on liver glycogen
  • Glucose production from amino acids
  • Release fatty acids from adipose tissue

Glucagon

  • Glycogen breakdown in the liver
  • Glucose production from amino acids
  • The release of fatty acids from adipose tissue

Aldosterone

  • Sodium reabsorption in the kidneys

Antidiuretic hormone

  • Water reabsorption in the kidneys
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13
Q

Metabolic changes in Burn patients

A
  • Hypermetabolism
  • Muscle Bone catabolism
  • Negative nitrogen balance (can lead to wasting)
  • Gluconeogenesis
  • insulin resistance
  • Loss of water and body heat
  • Disrupt liver and GI function, may persist for 1 or more years
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14
Q

Nutrition therapy for Burn patients

A
  • High calorie, high protein diet (1.5-2.0 g/kg)
    • note overfeeding may lead to hyperglycemia, infections, fatty liver
  • Achieve nitrogen balance
  • Preserve lean tissue
  • Maintain appropriate body weight (4-6 hrs after injury enteral feedings along with oral)
  • Supplement with glutamine and arginine
  • Micronutrient to add Vit A, C, zinc
    • promote wound healing and immunity
  • Fluid & Electrolytes monitor closely during recover (urine output & electrolyte levels)
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15
Q

Nutrition for Respiratory Failure

A
  • Patient w/ lung injuries or ARDS are typically hypermetabolic and/or catabolic risk for muscle wasting
    • Provide adequate energy and protein to sustain muscle tissue and lung function w/o overtaxing resp. system
      • Protein for mild or mod. lung injury: 1.0 - 1.5 g /kg bw
      • ARDS 1.5 to 2.0 g/kg bw
    • Fluid restriction to correct pulm. edema
    • Enteral over parenteral nutri.
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16
Q

Prealbumin (Transthyretin)

A

10 - 40 mg/dL

  • Levels may reflect illness or PEM
  • Levels decrease rapidly during PEM, responds quickly to improve protein intake​
    • More Sensitive to short-term changes in health status than albumin or transferrin
  • 2-3 days
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17
Q

Albumin

A

3.5 - 5.0 g/dL

  • Levels may reflect illness or PEM
  • Slow to respond to improvement or worsening of disease
  • Chronic PEM individuals albumin levels remain normal for a long period; levels fall only after prolonged malnutrition
  • Half-life 14-20 days
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18
Q

Transferrin

A

200-360 mg/dL

> 60 yr: 160-340 mg/dL

  • Iron transport protein
  • Levels may reflect illness, PEM, or iron deficiency
  • Slightly more sensitive to changes in health status than albumin
  • half life 8-10 days
19
Q

C-Reactive Protein

A

68 - 8200 ng/mL

The best clinical indicator of acute phase response;

  • ^ CRP levels during an inflammatory response
20
Q

White blood cell

A

4500 - 11,000 cells/ uL

WBC number may indicate immune status, infection, or inflammation

21
Q

Nutrition therapy for COPD

A
  • Correct malnutrition (affects 60 % of COPD Pt’s)
  • Encourage adequate food intake is the main focus
    • NOTE Overweight COPD Pt may benefit from energy restriction and gradual weight reduction due to additional strain on resp. system
  • Frequent meals spaced throughout the day rather than two or three large ones.
    • lower energy content of small meals reduces the carbon dioxide load
    • less abd. discomfort and dyspnea
  • Adequate fluids should be encouraged to prevent secretion thickening
  • For undernourished a High-energy and high-protein diet may be helpful
    • NOTE excessive energy increase C02 and can increase resp. stress
22
Q

Hemoglobin (Iron)

A

Male: 13.0 - 18.0 g/dL

Female: 12.0 - 16.0 g/dL

  • Part of hgb, which carries o2 in blood
  • Part of myoglobin in muscle, which makes o2 available for muscle contraction; necessary for energy metabolism
23
Q

Sodium

A

134 - 145 mEq/L

24
Q

Potassium

A

3.5 - 5.0 mmol/L

25
Q

Calcium

A

2.20 - 2.55 mmol/L

26
Q

Nutrition for Hypertension

A
  • Emphasis on fruits, vegetables, and whole grains, low-fat milk products, poultry, fish, and nuts
    • This plan provides more fiber, potassium, magnesium, and calcium

DASH eating plan

  • Emphasizes vegetables, fruit, and whole grains; includes low-fat milk products; and limits sugars and red meats.
    • works well with sodium restriction (1500 mg/day)
27
Q

Nutrition for Osteoporosis

A
  • Adequate calcium intake during growing years
  • Adequate protein protects bones and reduces the likelihood of hip fractures
  • Vit D needed to maintain calcium metabolism
  • Vit K decreases bone turnover, protect against hip fractures
  • Vit C slows bone losses
  • Magnesium and Potassium maintain bone mineral density
  • Vit A needed in the bone remodeling process, but too much may be associated to osteoporosis
  • DIet rich in fruits, vege, and whole grains are beneficial.
  • DIets contianing too much salt are associated with bone losses.
28
Q

Basic Fluid and Electrolyte Balance

A
  • Balance of two-thirds of body fluids inside the cell and one-third outside is vital to cell life
  • In an electrolyte solution, water molecules are attracted to both anions and ca+ions
  • Electrolytes attract water
    • K, Mg, P, S Primarily inside cell
    • Na, Cl, Ca primarily outside cell
      (Both can be found inside and outside of cell, but each can be found mostly on one side of the other.)
  • Water follows electrolytes
    • Crosses membrane towards more concentrated solutes (Osmosis)
  • Cell membrane selectively permeable
29
Q

Osmosis

A
30
Q

Aldosterone

A
  • Hormone released from adrenal glands
  • Signals kidneys to excrete potassium and to retain more sodium
    • Water follows salt
    • lncreases BP
31
Q

Antidiuretic Hormone

A
  • A hormone produced by the pituitary gland
    • In response to dehydration (or sodium concentration in blood)
    • Stimulates kidneys to reabsorb more water and therefore to excrete less
      • Elevates BP (Vasopressin)
32
Q

Factors that Increase Water Needs

A
  • Very young
  • Very old
  • Certain diseases…diabetes
  • Prolonged diarrhea, vomiting
  • Fever
  • Alcohol
  • Caffeine
  • High protein diets
  • Medications
  • Surgery
  • Blood loss
  • Burns
  • Exercise
33
Q

Fluid lossess

A

Normal

  • 2400 mL

Fever

  • 3400 mL

Exercise

  • 6700 mL
34
Q

Water Recommendations

A

Needs will vary

  • Diet
  • Physical activity
  • Environmental temperature
  • Humidity
  • Forced-air environments
    • 3 Hour airplane flight = loss of 1.5 L
  • High altitude
    • 5000 ft and above
    • ^ breathing rate and depth
    • Lower humidity air
    • increases water loss
35
Q

Dehydration

sxs & tx

A

Causes Symptoms

  • Vomiting Dry & warm skin
  • diarrhea Poor skin turgor
  • diuresis Dark & odorous urine
  • decreased intake Low BP
  • decreased IV replacement Weight loss

Care

  • Hydrate
  • daily weights
  • skin care
36
Q

Sodium

A

Upper sodium limits (adults) 2300 mg

Salt sensitive no more than 1,500 mg

Avg intake in US 3400 mg

Salt (sodium chloride) is 40% sodium

  • 1 tsp sale contributes about 2300 mg sodium
37
Q

Foods high in sodium

and its influence on BP

A

1 tbsp Soy Sauce = 1029 mg sodium

1 Container instant lunch = 1330 mg sodium

  • Reduces blood flow through arteries
  • Elevation of BP in response to high salt diet over the years is progressive and damage caused to blood vessels is irreversible
38
Q

Potassium-rich foods and conditions that may require potassium-rich diets

A

Fresh foods are richest sources

  • AI 4700 mg/day

Potatoes, avocados, bananas, cantaloupes, carrots, spinach, strawberries, tomatoes, fish, mushrooms, oranges, pork, beef, and veal.

Deficiency:

Increase BP; Salt sensitivity; Kidney stones; Bone turnover; Irregular heartbeats; Muscle weakness; Glucose intolerance

39
Q

Calcium Rich foods

A

Most abundant mineral in the body

Milk products, Bok choy, Kale, Brocolli, Sardines w/ bones, Almonds, Fortified juices and foods

40
Q

Calciums relationship to the development of Osteoporosis

A

Low blood calcium signals the parathyroid glands to secrete a parathyroid hormone into the blood ⇒ stimulates calcium reabsorption from the kidneys into the blood ⇒ enhances calcium absorption in the intestines ⇒ Stimulates osteoclast cells to break down bone (pulls from bone)

41
Q

Risk factors for Osteoporosis

A
42
Q

Kidney Failure (ESKD) Diet Recommendations

A

Also known as Stage 5 CKD

Nutritional therapy is to maintain appropriate fluid status, BP, and Blood chemistries

  • High protein
  • Low phosphorus, Low potassium, Low sodium (2 to 4 g/day) fluid-restricted diet

Protein intake increases once on dialysis

  • Fifty percent of protein intake should come from biologic sources ( egg, milk, meat, fish, poultry, soy)
  • Restrict phos ( high protein leads to increase phos intake; included in protein products)
  • Add calcium supplements.
43
Q

Nutrition for Pernicious Anemia

&
Iron-deficiency Anemia

A

Pernicious Anemia (Most common form of vitamin B12 deficiency)

  • Natural sources of Vit B12
    • Fish, meat, poultry, eggs, milk (vegans need supplemental B12)

Iron-deficiency Anemia (Most common nutritional disorder in the world)

  • Sources of Iron
    • Meat, fish, poultry, tofu, dried peas and beans, whole grains, dried fruit, iron-fortified food
      • Vita C facilitates absorption of iron (promote consumption!)

Nutrition (3 decks)

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