Review DOM 2 Flashcards
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
demographics
included in community assessments
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
Regional enteritis (Crohn’s disease)
For acute Crohn’s flare-ups - bowel rest, parenteral nutrition or minimal residue
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
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
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
Cystic fibrosis
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
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
Cystic Fibrosis
What will happen if a patient in non compliant with PERT
daily, large foul smelling stool
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
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
These are examples of:
* 1egg
* fried fish 1 oz
* pork 1 oz
* mozerella 1 oz
1 med fat protein choice
One medium-fat protein choice has
__ grams of carbohydrate, 7 grams of protein, __ grams of fat, and 75 calories.
0 grams of carbohydrate, 7 grams of protein, 5 grams of fat, and 75 calories.
ex of one plant based protein option:
* 1/2 cup of beans=
* tofu 1/2 cup=
* peanut butter 1 tablespoon =
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
ex of combinaiton foods
* plain hamburger (235 kcals)
* Fried fish sandwich (417kcals)
* main salad with dressing (305 kcals)
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
HTN
DASH Diet
* emphasizes: whole grains, fruits, vegetables, low fat dairy, ____, ____
* moderate consumption of:
* limit:
* decrease:
* what DRI do we need to meet:
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)
National Health and Nutrition Examination Survey
NHANES ongoing (repeated) survey to obtain info on
CDC
NHANES III for adults 65 and older
health of American people
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
(1) two days of 24 hour dietary recall
(2) USDA
all about food consumption
Thyroid disorders
*excess secretion of thyroid hormone
* elevated T3 and T4
* BMR leading to weight loss
* increase calories
hyperthyroidism
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 ____
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
Arm muscle area is useful in identifying
AMA
We want 80% or more
potential nutrition protein malnutrition
measures skeletal muscle mass (somatic protein)
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
muscle mass
measures somatic protein
may indicate renal disease or muscle wastage
serum creatinine and creatinine clearance measure somatic protien
occurs after a gastrectomy (Billiroth I, II)
Dumping syndrome symptoms (5)
not able to handle dissacharides (lactose)
cramps, rapid pulse, weakness, perspiration, dizziness
patient will feel these symptoms along with the feeling of fullness
Dumping Syndrome
Following a complete gastrectomy, which deficiencies can occur
* 7 nutrients:
* decreased pancreatic secretion =
-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
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
esophageal varices
The enlargement of veins will cause out pouching of vessel wall = varicies
two forms of malnutrition
marasmus
iatrogenic malnutrition
*when calculating the needs of someone severly under wt use ABW
iatrogenic malnutrition
protein-calorie malnutrition
harm brought on by treatment, hospital, medications
Gastroparesis is
food sits in stomach too long; stomach muscles can’t move down food
delayed gastric emptying due to surgery, diabetes, viral infections, obstructions
moderate to severe hyperglycemia causes detrimental effects on gastric nerves and is the symtom for
Gastroparesis
may slow gastric emptying w/ long term effects on motility
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. (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
Treatment for Diverticular disease
Fiber includes (3 things)
provides indigestible bulk, promotes intestinal function
M: 38 g F: 28 g
dietary fiber
oat bran
soluble fiber
oat bran and soluble fiber decrease serum cholesterol by binding bile acids = converting more cholesterol into bile
Dietary fiber (oat, bean, bran) functions
increases water absorption from the intestine
nondigestible CHOs and lignin
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
Dietary fiber sources
(4 food sources)
includes oats, beans, and bran cereals
a. legumes (cellulose, hemicellulose)
b. wheat bran (cereal grains- cellulose, hemicellulose)
c. fruits, vegetables (cellulose, hemicellulose, pectin)
d. whole grains
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
delay gastric emptying
absorb water
form soft gel in small intestine
slows passage and delays or inhibits
absorption of glucose and cholesterol
NFPE
The information from the Inspection tells you
obesity (fat stores), cachexia, fluid status, skin integrity, wound healing, feeding devices, jaundice, ascites
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
host, agent, environment
cartenoids (vit A), vitamin C (absorbic acid)
post menopausal
What happens as a result of refeeding syndrome:
* starved cells take up nutrients, ____ and ____ shift into intracellular compartments
* results in:
starved cells take up nutrients, potassium and phosphorus shift into intracellular compartments
results in: hypokalemia, hypophosphatemia, and hypomagnesemia
Results of physiologic trauma:
* hyperglycemia, _____, little or no ketosis
* increase ____ to increase glucose production from amino acids (release FFA)
hyperglycemia, hyperinsulinemia, little or no ketosis
increase glucagon to increase glucose production from amino acids (release FFA)
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
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
Peritoneal dialysis protein and kcal needs
1 - 1.2 g protein/kg SBW or adjusted BW
25 - 35 calories/kg
CHO may be absorbed during this and continous renal therapy
Community resources and nutrition-related programs
Feeding America is the
Non-goverenmental Agency
the largest domestic hunger relief organization in the US (food banks, shelters, soup kitchens)
provides food
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. universities that assist in community development
b. educate the public
c. skills needed to obtain a healthy diet
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)
0 grams of carbohydrate, 7 grams of protein, 2 grams of fat, and 45 calories.
These are examples of one-
* canadian bacon 1 oz
* cottage cheese 1/4 cup
* turkey 1 oz
* beef 1 oz
* shellfish 1 oz
lean protein choice
1 ounce is usually the serving size for meat, fish, poultry, or hard cheese.
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
liver into vena cava
* dilution factor
ascities can cause faulse albumin values
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
nephrosis
nephrotic syndrome
albuminuria: decrease albumin through urine and loss of protien thriugh urine
In community surveys, frequent symptom of malnutrition
decreased serum albumin
Clinical NC:
nutritional findings/problems that relate to medical/physical condition
Data that you can see
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
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
homocystinuria
One starch choice has 15 grams of carbohydrate, 3 grams of protein, 1 gram of fat, and ___ calories.
80 calories.
ex of one starch choice
* pasta =
* slice of toast=
* cup of brown rice=
* oatmeal =
pasta 1/3 cup
1 slice of toast
1/3 cup of brown rice
*oatmeal 1/2 cup
One fruit choice has
15 grams of carbohydrate and ___ calories.
15 grams of carbohydrate and 60 calories
ex of 1 fruit choice
1/2 cup of orange juice
raspberries 1 cup
grapes 3 oz
grape juice 1/3 cup
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.
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.
ex of 1 milk choice
* fat free milk=
* yogurt=
* evaporated milk=
1 cup fat free milk
2/3 cup yogurt
1/2 cup evaporated milk
One nonstarchy vegetable choice (½ cup cooked or 1 cup raw) has __ grams of carbohydrate, __ grams of protein, __ grams of fat, and 25 calories.
5 grams of carbohydrate, 2 grams of protein, 0 grams of fat, and 25 calories.
beets
carrots
cucumber
tomato
spinach
are examples of
nonstarchy vegetables
Q
One high-fat protein choice has 0 grams of carbohydrate, __ grams of protein, __ grams of fat and 100 calories.
0 grams of carbohydrate, 7 grams of protein, 8 grams of fat and 100 calories.
One fat choice has how many grams of fat and calories
5 grams of fat and 45 calories.
free foods are ___ calories and ___ grams CHO per serving
< 20 calories and < 5 grams CHO per serving
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
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
