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My DOMAIN 2: Nut Care for Individuals and Groups > Review DOM 2 > Flashcards

Review DOM 2 Flashcards

1
Q

Nutrition assessment of populations and community needs assessment

population by age, ethnic groups, sex, birth rates, deaths, socioeconomic stratification census data, housing statistics are all included in the

A

demographics

included in community assessments

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2
Q

Type of Inflammatory bowel disease (IBD)

which disease:
* affects terminal ileum
* leads to weight loss, anorexia, diarrhea
* has B12 deficiency which leads to megaloblastic anemia
* and iron deficiency anemia due to blood loss, decreased absorption

A

Regional enteritis (Crohn’s disease)

For acute Crohn’s flare-ups - bowel rest, parenteral nutrition or minimal residue

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3
Q

For which disease to you provide the following treatmetn for?

maintain fluid and electrolyte balance; ____ agent (sulfasalazine)
energy needs according to current BMI, limiting fat only if ____ present
supplement water-soluble and fat-soluble vitamins; ___ and ____ and assess ___, ___, ___
watch _____, frequent feedings. High fat may improve energy balance.
For acute Ulercative cholitis, elemental diet may be needed to minimize fecal volume

A

IBD- Crons, Ulcerative Colotis

maintain fluid and electrolyte balance; antidiarrheal agent (sulfasalazine)
energy needs according to current BMI, limit fat only if steatorrhea
supplement water-soluble and fat-soluble vitamins; iron, folate, assess Ca, Mg, Zn
watch lactose, frequent feedings. High fat may improve energy balance.

ex. of vitamins needed C and B12

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4
Q

disease of exocrine glands

Name of specific disease:

secretion of thick mucus that obstructs glands and ducts; chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption.
Affects transport of chloride across the cell membrane.
May lead to: pulmonary disease, pancreatic enzyme deficiency, and malapsorption

A

Cystic fibrosis

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5
Q

Tx. of Cystic Fibrosis
* PERT: __________with meals and snacks
* high protein 15 - 20% calories - malabsorption due to ______
* carbohydrate 45-55% total _____ high
* liberal ____ to compensate for high energy needs - 35-40% of calories
* additional 2-4 grams ____/day in hot weather, with heavy perspiration
* age-appropriate doses of water-soluble vitamins and minerals
* supplement ____, water-soluble forms of fat-soluble vitamins (A and E)

use age-appropriate BMI to assess height and weight

A

PERT: pancreatic enzyme replacement therapy with meals and snacks
high protein 15 - 20% calories - malabsorption due to pancreatic deficiency
carbohydrate 45-55% total calories high
liberal fat to compensate for high energy needs - 35-40% of calories
additional 2-4 grams salt/day in hot weather, with heavy perspiration
age-appropriate doses of water-soluble vitamins and minerals
supplement zinc, water-soluble forms of fat-soluble vitamins (A and E)
we want to meal plan

noncomplaince with salt recommendation- lab values will show hyponatremia

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6
Q

Cystic Fibrosis

What will happen if a patient in non compliant with PERT

A

daily, large foul smelling stool

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7
Q

Diet order for Billiroth I (gastroduodenostomy) and Billiroth II (gastrojejunostomy)

frequent small, ______, ____ before or after meals (to slow passage)
restrict _____ concentrated sweets
give _____ complex CHO
_____ at each meal
moderate fat
____ injections may be needed
_____ may be poorly tolerated due to rapid transport

A

dry feedings, fluids before or after meals (to slow passage)
restrict hypertonic concentrated sweets
give 50-60% complex CHO
protein at each meal
moderate fat
B12 injections may be needed
Lactose may be poorly tolerated due to rapid transport
dissaccharide may decrease

whey still may be OK

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8
Q

These are examples of:
* 1egg
* fried fish 1 oz
* pork 1 oz
* mozerella 1 oz

A

1 med fat protein choice

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9
Q

One medium-fat protein choice has
__ grams of carbohydrate, 7 grams of protein, __ grams of fat, and 75 calories.

A

0 grams of carbohydrate, 7 grams of protein, 5 grams of fat, and 75 calories.

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10
Q

ex of one plant based protein option:
* 1/2 cup of beans=
* tofu 1/2 cup=
* peanut butter 1 tablespoon =

A

1/2 cup of beans= 1 starch + 1 lean protein
tofu 1/2 cup= 1 medium fat protein
peanut butter 1 tablespoon = 1 high fat protein

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11
Q

ex of combinaiton foods
* plain hamburger (235 kcals)
* Fried fish sandwich (417kcals)
* main salad with dressing (305 kcals)

A

plain hamburger: 2 CHO, 1 med fat prot= 235Kcals
Fried fish sandwich = 2 1/2 CHO, 2 med fat prot, 1 1/2 fat =417kcals
main salad with dressing= 1 CHO, 4 lean prot, 1 fat

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12
Q

HTN

DASH Diet
* emphasizes: whole grains, fruits, vegetables, low fat dairy, ____, ____
* moderate consumption of:
* limit:
* decrease:
* what DRI do we need to meet:

A

Dietary Approaches to Stop Hypertension; whole grains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI (not supplements)

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13
Q

National Health and Nutrition Examination Survey

NHANES ongoing (repeated) survey to obtain info on

CDC

NHANES III for adults 65 and older

A

health of American people

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14
Q

What We Eat in America

WWEIA
* includes ___with times of eating occasions and sources of foods
* who is in charge of conducting over-sampling of adults ≥60, African Americans, Hispanics?

dietary intake component of NHANES

also known as National Food and Nutrition Survey NFNS

A

(1) two days of 24 hour dietary recall
(2) USDA

all about food consumption

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15
Q

Thyroid disorders

*excess secretion of thyroid hormone
* elevated T3 and T4
* BMR leading to weight loss
* increase calories

A

hyperthyroidism

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16
Q

marasmus:
* protein and ___ starvation
* low anthropometric diagnosis/measurements, serum albumin ____, no edema
* severe fat and muscle wasting, starved appearance
* weight loss
* triceps skinfold, arm muscle circumference ____

A

protein and calorie starvation
low anthropometric diagnosis/measurements, serum albumin normal, no edema
severe fat and muscle wasting, starved appearance
weight loss
triceps skinfold, arm muscle circumference decreased

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17
Q

Arm muscle area is useful in identifying

AMA

We want 80% or more

A

potential nutrition protein malnutrition

measures skeletal muscle mass (somatic protein)

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18
Q

Serum creatinine is related to____, measures ___, and may indicate ____ or ____
M: 0.6-1.2 mg/dl
F: 0.5-1.1

released by muscle cells and secreted by the kidney

A

muscle mass
measures somatic protein
may indicate renal disease or muscle wastage
serum creatinine and creatinine clearance measure somatic protien

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19
Q

occurs after a gastrectomy (Billiroth I, II)

Dumping syndrome symptoms (5)

not able to handle dissacharides (lactose)

A

cramps, rapid pulse, weakness, perspiration, dizziness

patient will feel these symptoms along with the feeling of fullness

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20
Q

Dumping Syndrome

Following a complete gastrectomy, which deficiencies can occur
* 7 nutrients:
* decreased pancreatic secretion =

A

-iron, B12, folate, calcium, vitamin D, B1 and copper
- steatorrhea

B12 deficiency= anemia (folate deficiency will follow)

B12 deficency d/t loss of intrinsic factor

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21
Q

Cirrhosis

what is this describing?

Connective tissue overgrowth causes resistance to blood entering from portal vein.
The increased pressure forces blood back into collateral veins that offer less resistance.
Esophageal, abdominal, collateral veins enlarge
occurs when blood can’t enter the liver: portal hypertension

very fragile, can be torn easily

A

esophageal varices

The enlargement of veins will cause out pouching of vessel wall = varicies

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22
Q

two forms of malnutrition

A

marasmus
iatrogenic malnutrition
*when calculating the needs of someone severly under wt use ABW

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23
Q

iatrogenic malnutrition

A

protein-calorie malnutrition
harm brought on by treatment, hospital, medications

24
Q

Gastroparesis is

food sits in stomach too long; stomach muscles can’t move down food

A

delayed gastric emptying due to surgery, diabetes, viral infections, obstructions

25
Q

moderate to severe hyperglycemia causes detrimental effects on gastric nerves and is the symtom for

A

Gastroparesis

may slow gastric emptying w/ long term effects on motility

26
Q

Gastroparesis Tx.
a. prokinetics (_____, metoclopramide) which increase stomach contractility and slows ______
b. small, frequent meals
c. _____ foods
d. avoid high fiber, avoid ____
e. avoid (5)____

A

a. (erythromycin) slow gatric emptying time
b. small, frequent meals
c. pureed foods
d. high fat (liquid fat may be better tolerated)
e. avoid caffeine, mint, alcohol (acidic), carbonation

Foods high in fat delay gastric emptying (ex: corned beef)

Rice OK to eat

27
Q

Treatment for Diverticular disease

Fiber includes (3 things)

provides indigestible bulk, promotes intestinal function

M: 38 g F: 28 g

A

dietary fiber
oat bran
soluble fiber

oat bran and soluble fiber decrease serum cholesterol by binding bile acids = converting more cholesterol into bile

28
Q

Dietary fiber (oat, bean, bran) functions

increases water absorption from the intestine

nondigestible CHOs and lignin

A

binds water, increases fecal bulk

low fiber diet may cause constipation

high fiber diert may decrease the need for Ca, Mg, P, Cu, Zn, Fe

29
Q

Dietary fiber sources
(4 food sources)

includes oats, beans, and bran cereals

A

a. legumes (cellulose, hemicellulose)
b. wheat bran (cereal grains- cellulose, hemicellulose)
c. fruits, vegetables (cellulose, hemicellulose, pectin)
d. whole grains

30
Q

Soluble fibers functions
* delay gastric emptying
* absorb ___
* form ____ in small intestine
* slows passage and delays or inhibits
absorption of _______

pectins, gums

Fruits, vegetables, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, bananas, corned beef

A

delay gastric emptying
absorb water
form soft gel in small intestine
slows passage and delays or inhibits
absorption of glucose and cholesterol

31
Q

NFPE

The information from the Inspection tells you

A

obesity (fat stores), cachexia, fluid status, skin integrity, wound healing, feeding devices, jaundice, ascites

32
Q

epidemiologic data/research on cancer

interrelationship between ___,____,and____ in causing disease
some evidence that fruits and vegetables are beneficial in overall cancer (____(Vit A),_____(absorbic acid))
Some evidence that exercise in ______ women decreases risk of breast disease

A

host, agent, environment
cartenoids (vit A), vitamin C (absorbic acid)
post menopausal

33
Q

What happens as a result of refeeding syndrome:
* starved cells take up nutrients, ____ and ____ shift into intracellular compartments
* results in:

A

starved cells take up nutrients, potassium and phosphorus shift into intracellular compartments
results in: hypokalemia, hypophosphatemia, and hypomagnesemia

34
Q

Results of physiologic trauma:
* hyperglycemia, _____, little or no ketosis
* increase ____ to increase glucose production from amino acids (release FFA)

A

hyperglycemia, hyperinsulinemia, little or no ketosis
increase glucagon to increase glucose production from amino acids (release FFA)

35
Q

Chronic renal failure- long term goal is to prevent malnutrition

Hemodyalisis supplementation
* (3) to correct deficiencies based on symptoms
* ____and ____supplements if deficient
* ____and ____ supplements NOT recommended

A

Vitamins B6, folate, B12 to correct deficiencies based on symptoms
vitamin D and C supplements if deficient
vitamin A and E supplements NOT recommended

B6= pyridoxine

recommendations same for peritoneal dialysis

36
Q

Peritoneal dialysis protein and kcal needs

A

1 - 1.2 g protein/kg SBW or adjusted BW
25 - 35 calories/kg

CHO may be absorbed during this and continous renal therapy

37
Q

Community resources and nutrition-related programs

Feeding America is the

Non-goverenmental Agency

A

the largest domestic hunger relief organization in the US (food banks, shelters, soup kitchens)

provides food

38
Q

USDA

EFNEP- Expanded Food and Nutrition Education Program
* provides grants to ____
* trains nutrition aides to____
* works with small groups; teaches ____

does not provide food * only education, focus is teaching

(how to budget, meal planning, shop, cook)

A

a. universities that assist in community development
b. educate the public
c. skills needed to obtain a healthy diet

39
Q

One lean protein choice has
0 grams of carbohydrate, __ grams of protein, __ grams of fat, and __ calories.

examples: ground beef, salmon, cottage cheese, canadian bacon, shellfish (lobster)

A

0 grams of carbohydrate, 7 grams of protein, 2 grams of fat, and 45 calories.

40
Q

These are examples of one-
* canadian bacon 1 oz
* cottage cheese 1/4 cup
* turkey 1 oz
* beef 1 oz
* shellfish 1 oz

A

lean protein choice

1 ounce is usually the serving size for meat, fish, poultry, or hard cheese.

41
Q

Cirrhosis

When a pateint has ascites
* Connective tissue overgrowth blocks blood flow out of the ___
* * They may have low serum albumin due to ___

occurs when blood cannot leave the liver

A

liver into vena cava
* dilution factor

ascities can cause faulse albumin values

42
Q

which disease is being described

defect in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through the tubules
albuminuria, edema, malnutrition, hyperlipidemia/hypercholesterolemia
decrease synthesis and clearance of VLDL
large amount of pro moving through tubules

A

nephrosis

nephrotic syndrome

albuminuria: decrease albumin through urine and loss of protien thriugh urine

43
Q

In community surveys, frequent symptom of malnutrition

A

decreased serum albumin

44
Q

Clinical NC:

nutritional findings/problems that relate to medical/physical condition

Data that you can see

A

Functional balance - physical or mechanical change that interieres/prevents desired nutritional results; swallowing difficulty, altered GI function
Biochemical balance - change in capacity to metabolize nutrients due to medications, surgery, or indicated by lab values
Weight balance - chronic or changed weight status when compared with UBW: underweight, involuntary weight loss, overweight

45
Q

need folate, B6 (pyridoxine), B12 (cyanocobalamin)

treatable inherited disorder of amino acid metabolism
characterized by severe elevations of methionine and homocysteine in plasma, and excessive excretion of homocystine in urine
associated with low levels of folate, B6, B12
protein is the main nutrition concern

A

homocystinuria

46
Q

One starch choice has 15 grams of carbohydrate, 3 grams of protein, 1 gram of fat, and ___ calories.

A

80 calories.

47
Q

ex of one starch choice
* pasta =
* slice of toast=
* cup of brown rice=
* oatmeal =

A

pasta 1/3 cup
1 slice of toast
1/3 cup of brown rice
*oatmeal 1/2 cup

48
Q

One fruit choice has
15 grams of carbohydrate and ___ calories.

A

15 grams of carbohydrate and 60 calories

49
Q

ex of 1 fruit choice

A

1/2 cup of orange juice
raspberries 1 cup
grapes 3 oz
grape juice 1/3 cup

50
Q

One milk choice has ___ grams of carbohydrate and __ grams of protein (all milk)
One fat-free (skim) or low-fat (1%) milk choice has 0 to _ grams of fat and 100 calories per serving
One **reduced fat **(2%) milk choice has 5 grams of fat and ___ calories per serving.
One whole milk choice has __ grams of fat and 160 calories per serving.

A

12 grams of carbohydrate and 8 grams of protein (all milk)
0 to 3 grams of fat and 100 calories per serving
5 grams of fat and 120 calories per serving.
8 grams of fat and 160 calories per serving.

51
Q

ex of 1 milk choice
* fat free milk=
* yogurt=
* evaporated milk=

A

1 cup fat free milk
2/3 cup yogurt
1/2 cup evaporated milk

52
Q

One nonstarchy vegetable choice (½ cup cooked or 1 cup raw) has __ grams of carbohydrate, __ grams of protein, __ grams of fat, and 25 calories.

A

5 grams of carbohydrate, 2 grams of protein, 0 grams of fat, and 25 calories.

53
Q

beets
carrots
cucumber
tomato
spinach
are examples of

A

nonstarchy vegetables

54
Q

Q
One high-fat protein choice has 0 grams of carbohydrate, __ grams of protein, __ grams of fat and 100 calories.

A

0 grams of carbohydrate, 7 grams of protein, 8 grams of fat and 100 calories.

55
Q

One fat choice has how many grams of fat and calories

A

5 grams of fat and 45 calories.

56
Q

free foods are ___ calories and ___ grams CHO per serving

A

< 20 calories and < 5 grams CHO per serving

57
Q

Type 2 Diabetes

Non-Insulin medications (6)
* _____= low risk of hypoglycemia and increases uptake in muscles, taken with food and check B12 levels
* DPP-4 inhibitors
* ______= used for CKD with T2DM
* ______ (GLP-1) receptor agonist= promotes fullness and leads to weight loss
* TZD Thiazolidinediones
* _______: hypoglycemia

A

biguanides= low risk of hypoglycemia and increases uptake in muscles, taken with food and check B12 levels
DPP-4 inhibitors
SGLT-2 inhibitors= used for CKD with T2DM
glucagon-like peptide-1 (GLP-1) receptor agonist= promotes fullness and leads to weight loss
TZD Thiazolidinediones
Sulfonylureas: hypoglycemia

My DOMAIN 2: Nut Care for Individuals and Groups (5 decks)

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