Test 2

Question 1

MNT energy needs for BPD & CLD

Answer 1

25-50% > control

50-85 kcal / kg BW / d (no growth)

120-130 kcal / kg BW / d (growth)

Question 2

MNT macronut needs for BPD & CLD

Answer 2

protein: provide ≥ 7% kcal

fat & CHO: added to formula after concentrated to 24 kcal / oz–fat provides essential FAs & cals when fluid tolerance & CO2 load is limited–excessive CHOs ↑ RQ & output of CO2

Question 3

resp. quotient (RQ)

Answer 3

ratio–CO2 expired : vol. of O2 inspired

Question 4

MNT fluid needs for BPD & CLD

Answer 4

for fluid balance: restrict Na & fluids & use diuretics

when fluids restricted, use parenteral lipids or cal-dense enteral feedings (formulas >24 kcal / oz)

Question 5

MNT vit & min needs for BPD & CLD

Answer 5

monitor drug-nut interactions

Vit. K for bone development

Vit. A for proper development

adequate stores of Fe, Zn, & Ca due to prematurity

diuretics, bronchodilators, antibiotics, cardiac anti-arrhythmics, & corticosteroids→↑ed urinary losses of min’s, esp. Cl, K, & Ca (resp. acidosis ↑ losses)–def. of Cl or K→muscle weakness & impaired growth

Question 6

MNT macronut needs for COPD

Answer 6

energy needs ↑ed due to labored breathing–NO overfeeding

protein (15-20% kcal)–1.2-1.7 g / kg dry BW / d–encourage BCAAs–long-term steroids→protein catabolism & gluconeogenesis→ - N2 balance

fat (30-45% kcal)–for hypercapnia, severe dyspnea, or ventilation weaning pts—IV form + hyperlipidemia→inflammation

CHO (40-55% kcal)–↑er RQ→produce more CO2→breathing difficulty ↑→exhaustion→ARF

Question 7

MNT vit & min needs for COPD

Answer 7

cor pulmonale + fluid restriction→limit Na & fluids

may need K for diuretics

↑ed losses of Cl, K, & Ca from meds→supp

Mg & Ca for muscle contraction & relaxation

inadequate stores of Fe, Zn, Ca, & P due to prematurity→supp

long-term steroids→osteoporosis risk→Ca supp

smokers: +16 mg / d for 1 pack / d

Question 8

MNT fluid needs for COPD

Answer 8

possible 1° or 2° dehydration

intense sputum & expectoration→body’s hydration ↓→secretion removal ↓ (stay hydrated!)

Question 9

nut-drug interactions for COPD

Answer 9

1. bronchodilators: anorexia & ↓ed K
2. expectorants: xerostomia→caries, loss of teeth, gum diseaes, stomatitis, & glossitis, nut. imbalances, wt loss; loss of taste
3. corticosteroid: K supp; monitor Vit. D, Ca, K, & Mg; avoid St. John’s Wort; monitor pts at risk for Zn def; avoid immune-enhancing supp’s

Question 10

MNT macronut needs for CF

Answer 10

3000-4000 kcal / d

protein: 15-20% kcal / d b/c malabsorption

CHO: 45-65% kcal / d (adjust as needed)

fat: 35-40% kcal / d—include essential FAs & fat-sol. vit’s—limits food volume & improves palatability—may have steatorrhea

Question 11

MNT vit & min needs for CF

Answer 11

H2O-sol. vit’s absorbed better than fat-sol. ones, even those w/ pancreatic enzyme replacement therapy (PERT)

↑ Na b/c losses through sweating, lethargy, vomiting, & dehydration

Question 12

MNT for Ca kidney stones

Answer 12

fluids: 3 L / d

cranberry juice acidifies urine (for UTIs & struvite stones)

black current juice will alkalize urine & prevent uric acid stones

tea, coffee, beer, & wine ↓ risk of stone formation

protein: moderate animal (.8 g / kg BW)

Ca: do NOT restrict (if restricted, bone min. wasting & ↓ed bone min. density→fracture risk ↑)

oxalates: ~60 mg / d

K: ↓-oxalate fruits & veg’s

Mg: inhibits oxalate formation

Phosphate: excess urine phosphate ↑ Ca-phosphate stone risk

Na: 500 mg Vit. C / d–Vit B6 needed in oxalate met.

Question 13

MNT for uric acid stones

Answer 13

protein: restrict dietary purines (meat, fish, & poultry) b/c acid production–implement alkaline-ash diet

Question 14

MNT for cystine stones

Answer 14

maintain alkaline urine pH typically via meds (raise pH to 7.5 via alkaline-ash diet)

avoid excess methionine (fish), which ↑ production of methionine

> 4 L / d of fluids

Question 15

MNT for struvite stones

Answer 15

long-term antibiotics, surgical removal, & shockwave lithotripsy

Question 16

MNT for acute renal failure (ARF) / acute kidney injury (AKI)

Answer 16

protein: .5-.8 g / kg (non-dialysis); 1-2 g / kg (dialysis); ≤ 2.5 g / kg for CRRT
energy: 30-40 kcal / kg BW

K: 30-50 mEq / d for oliguria (depends on output, dialysis, & serum K level)–replace losses in diuretic phase

Na: 20-40 mEq / d for oliguria (depends on output, dialysis, edema & serum Na level)–replace losses in diuretic phase

fluids: replace output from previous day (losses due to vomiting, diarrhea, & urine) + 500 mL

Question 17

MNT for nephritic syndrome

Answer 17

maintain good nut. status & restrict Na for HTN

Question 18

MNT for nephrotic syndrome

Answer 18

protein: .8 g / kg IBW (50-60% HBV)
energy: 35 kcal / kg IBW (children: 100-150 kcal / kg)

Na: 3 g / d

those at ↑ risk for premature atherosclerosis: cholesterol-lowering diet

Question 19

MNT for chronic kidney disease (CKD)

Answer 19

manage symptoms (edema, hypoalbuminemia, & hyperlipidemia), ↓ risk of progression to renal failure, & maintain nut. stores–use of statins to correct hyperlipidemia, ↓-Na diet, & diuretics

protein: .8 mg / kg / d (50-60% HBV)
energy: 35 kcal / kg / d

Na: 2-3 g / d

K: restrict when urine output ↓ to 1 L / d

P: take phosphate binders w/ meals

lipids: those at risk for premature atherosclerosis: cholesterol-lowering diet to ↓ total cholesterol, LDL, & TGs (strong link btwn CKD & CVD)

vit’s: H2O-sol. vit’s prescribed

Question 20

MNT for end-stage renal disease (ESRD)

Answer 20

hemodialysis:
protein: 1.2 g / kg

energy: 35 kcal / kg
fluid: 750-1000 mL / d + urine output

Na: 2-3 g / d

K: 2-3 g / d

P: .8-1.2 g / d

vit’s: active Vit. D (calcitriol)

Question 21

MNT for end-stage renal disease (ESRD) (cont.)

Answer 21

peritoneal dialysis:
protein: 1.2-1.5 g / kg

energy: 30-35 kcal / kg
fluid: 2000 mL / d + urine output

Na: 2-4 g / d

K: 3-4 g / d

P: .8-1.2 g / d

vit’s: active Vit. D (calcitriol)

Question 22

5 ↓-K foods

Answer 22

1. 1 c blueberries = 129 mg
2. 1/2 c raw chopped onions (white, red, or yellow) = 126 mg
3. chopped, stir fried sweet bell pepper (red or green) = 120 mg
4. 1 med. fresh plum = 114 mg
5. 1/2 c raw alfalfa sprouts = 13 mg

Question 23

5 ↑-K foods

Answer 23

1. 1 med. banana = 467 mg
2. 1/4 melon cantaloupe = 426 mg
3. shredded, boiled bok choy = 315 mg
4. 1 med. kiwi = 252 mg
5. 2 med. fresh apricots = 207 mg

Question 24

MNT for cancer

Answer 24

energy: 25-35 kcal / kg BW
protein: 45-60 g / d
fluids: 30-35 mL / kg / d or 1 mL / 1 kcal est. cal needs

anti-oxidants

frequent meals–cal-dense foods–focus on liquids & soft foods–eat easy to prepare & easy to eat foods–avoid dry, rough foods–maintain good oral hygiene–wash all fruits & veg’s