Thursday night Flashcards
Short chain fatty acids are made from
MIcrobiome and fiber
Which following good source of alpha-linolenic acid
flaxseed oil
berberie to help with blood sugare balance and overgrowth gut which herb
goldenseal
66 yo ct who is aspirating on foods r/t development of parkinsone disease
textured modification - thick liquids
what recommendations for POTS:
5 + smaller meals + 2L H20 /day
smaller amount of water and add sodium to meals.
55 YO CLIENT IS experiencing loss of taste, a recent mole removal is taking months to heal and they recently switched from a vegetarian diet to an omnivore diet,, Which foods would you recommend.
Loss of taste (Zinc)
symptoms presentation: loss of taste, slow wound healing
Dietary circumstances: recent switch from vegetarian to omnivores
A. Oysters, Beef, Crab and Turkey
Identify the steps of the question
Demographics:
Symptoms presentation condition
dietary circumstances
To solve:
identify the likely “culprit” or fix
the micronutrient (deficient or toxic)
The food category (FODMAP, oxalate, Tyramine)
Identify which foods higher/lower in that category
42 yo recurrent migraines, severe headaches recently increased probiotic foods and symptoms got worse.
What interventions should be recommended to help reduce the frequency and intesnity of her migraines.
Supplement Mg, Reducing aged cheeses, smoked meats, fermented products.
Foods high in Tyramine
- Strong aged cheeses (aged cheddar, swiss and parmesan, blue cheeses,
- cured meats,
-smoked and processed meats
-pickled or fermented foods
-sauces (soy sauce, shrimp sauce, fish sause, miso)
-soybeans and soybean products
-snow peas, braod beans,
dried or overripe fruits
-meat tenderizers
-yeast extract spreads
-alcoholic beverages
-improperly stored foods or spoiled foods.
55 yo gout, elevated uric acid levels, what diet (purines)
limit consumption of organ meats, seafood and alcohol.
Big Picture
PPI
ACE inhibitors
statins
ssris
Blood thinners
Metformin
GLP-1 Agonists
Diuretics
PPIs–zole
ACE inhibitors- pril
Statins- …cor
SSRIs…ine/pram
Blood thinners–
MEtformin–
GLP1 Agonists
Diretics- …ide
Things that impacts:
Grapefruit induces CYP3A4 pathway so will clear faster.
Stomach acid: some drugs increase and some decrease
ROOTS:
What is the mechanism? What would be the result of using the intervention if they werent on the medication.
Garlic
goldenseal
hibiscus
metformin for diabetes management should be attentive to their intake of potential deficiencies affecting nerve function and blood sugar regulation? food:
Vitamin B12 deficiency
Thiamine
CoQ10
Salmon, trout, turkey (b12 is mostly animal based)
Statins can lead to muscle related side effects “ statin myopathy”
what reduce risk of statin induces muscle pain
Coenzyme Q10
Fatty fish and nuts
Mary is 72 F with hypertension and on long term therapy with a thiazide diuretic; what should be monitored due to their potential to increase urinary excretiona dn result in depletion of these micronutrients
Magnesium and potassium
ACE inhibitors (regulate blood pressure) be careful of taking which herbal supplement as it may interact with their medication and lead to further reduction of blood pressure
Garlic (improve white blood cell, immune support, kill viruses, cholesterol and BP)
Valerian (calming and help people sleep)
Saw palmetto (aromatase inhibitor, testosterone)
Echinacea (immune system inducing)
- be careful with autoimmune conditions, immunosuppressed people)
Garlic (given for cholesterol and blood pressure)
avoid this herb when taking anticoagulants (blood thinners) due to the potential for increased bleeding risk
Echinacea
increase the breakdown of warfarin and decrease how well warfarin works.
CLient has enduring depression, placed on an MAOI inhibitor which foods should they avoid
Foods high in Tyramine
SSRI for depression, symptoms changed and experiencing confusion, agitation, and their muscles feel rigid. Out of concern for screening for —–condition you ask if they have taken any —–supplements recently and immediately refer to ——-.
Serotonin syndrome; St. John’s Wort, 5-HTP; emergency room
27 year old has severe constipation. What assessment tool has the best possibility of revealing the etiology of her symptoms? where would you chart the infor in the SOAP note?
Medications review; Objective
Medication: Constipation side effects
Calcium channel blockers
beta blockers
opiods
diuretics
antidepressants
anticonvulsants
antacids or other calcium supplements
antichilinergics
antispasmodics
GLP-1
Secondary constipation
Hypoadrenalism
irritable bowel syndrome
diabetes
hypothyroidism
multiple sclerosis
parkinsons disease
dehydration
What supports production and metabolism of :
Dopamine
Serotonin
Melatonin
Gaba
Dopamine (Tyrosine)
-CU, Vitamin C, Iron
Serotonin + melotonin (Tryptophan)
- B6
pounds per kg
2.2 lbs
Talk to me about which foods most frequently cause food poisoning.
- Chicken (salmonella)
- Pork
- beef
- Fruits
Foodborne illness
local health department investigate local events.
state health departments investigate state health.
CDC gets involved if more than one state
Whose at risk
adults 65+
children
pregnant women
What do we do?
meat always goes on bottom
danger zone: temperature can multiply rapidly if left at room temperature
dont leave out for more than 2 hours.
Top five germs that cause illnesses from food eaten in the United States.
-norovirus
-salmonella
-clostriduym
-campylobacter
staphylococcus aureus
less common
–clostridium -botulinum (botulism)
-listeria
E coli
Vibrio
How do you test for pinworms ? Tape
IF YOU CLIENT FROM SCOMBROID POISONING ? WHAT ARE SYMPTOMS AND WHAT LIKELY CAUSED IT?
Red flushing skin and heart palpitations. when fish is left out it causes a histamine response.
Eating salmon
15-30 minutes symptoms
foodborne illness that had a precipitous increase. then gradually decline all within
point source
IMpact of environmental toxicity
PCBs
BPA
lead
PFAs
public health . tulane. edu/blog/environmental-toxins/
Translating research
ant type of marginalization increases allostatic load which contributes to disease. some examples.
socioeconomic status
) wores and rates
Nearly 1 in 3 adults are overweight
more than 2 in 5 adults have obesity
P value
where would we look for one?
Pvalue is the probability of statistical significance.
If the P-value is less than .05 we have statistical significance.
Most common level is .05
the small the p-value the more significant it is.
NNT
N represents the number (bigger number more statistical power)
NNT is a specific number. Number needed to treat
HIPAA
store records for 7 years.
What is in my scope.
scope of practice
We can talk about medications but we dont prescribe medications.
CNS is a certification
2 codes required : ICD 10 and CPT (diagnoses)
E11.-T2DM
E66.0 (O words)
Z71.3 dietary counseling and surveillance- typically used for preventative (do not need a referral)
Z72.4 Inappropriate diet and eating habits (do not need a referral)
CPT codes
97802 intake
07803 follow up
97804 group
