2 Flashcards
(209 cards)
0
Q
What indicators are compared against
A
Nutrition care criteria
1
Q
Clearly defined markers that can be observed and measured. Also used to monitor and evaluate progress toward Nutrition outcomes
A
Indicators
2
Q
Percent weight change formula
A
Usual weight - actual weight/
Usual weight
X100
3
Q
Measures body fat reserves measures calorie reserves
A
Triceps skinfold thickness
4
Q
Male TSF
Female TSF
A
- 5mm
16. 5mm
5
Q
Arm muscle area measures ______ (______)
To determine, use:
A
Skeletal muscle mass (somatic protein)
TSF and AC ( Arm circumference)
6
Q
Useful to identify possible protein energy malnutrition
Important to measure in growing children
A
Arm muscle Area AMA
7
Q
Swollen red dry cracked lips may be an indication of
A
Riboflavin pyridoxine niacin deficiencies
8
Q
Serum albumin maintains colloidal osmotic pressure it is a ____ protein And the normal range is
A
Visceral protein (blood and organs) 3.5-5
9
Q
Rises with iron deficiency serum level is controlled by iron storage pool. Can be determined from total iron binding Capacity
A
Serum transferrin
>200 mg/dl (visceral)
10
Q
Short half-life(2-3 days) picks up changes in proteins status quickly;
A
TTHY transthyretin, PAB prealbumin 16-40 mg/dl
11
Q
Circulates with pre-albumin has the shortest half-life (12 hours)
A
Retinol binding protein RBP
Binds and transports retinol
3-6 mg/dl
12
Q
What is the best visceral protein to evaluate nutritional status
A
TTHY transthyretin, PAB prealbumin
13
Q
Iron containing pigment of red blood cells, Erythrocytes are produced in bone marrow
Men
Women
Pregnant
A
Hemoglobin
14-17 gm/dl
12-15
<=11
14
Q
Volume of packed cells in whole blood
Men
women
pregnant women
A
Hematocrit
44%
38%
33%
15
Q
Indicates size of iron storage pool
Female
Male
A
Serum ferritin
10-150ng/ml
12-300ng/ml
16
Q
Related to muscle mass measures somatic protein
Normal range
A
Serum creatinine
0.6-1.4mg/dl
17
Q
Ratio of creatinine excreted over 24 hours compared to height
Estimates lean body mass or somatic protein
___= normal
__-____ mild muscle depletion
A
CHI Creatinine height index
80%
60-80%
18
Q
Related to protein intake. Indicator of renal disease. Normal range
A
BUN blood urea nitrogen
10-20mg/dl
19
Q
Normal BUN:creatinine ratio
A renal patient should keep BUN under
A
10-15:1
<100
20
Q
Measures glomerular filtration renal function. Normal range
A
Urinary creatinine clearance 115+/-20ml/min
21
Q
Measures immunocompetency Decreased in protein energy malnutrition Normal\_\_ Moderate depletion Severe depletion
A
> 2700 cells/cu mm
900-1800
Less than 900
22
Q
Direct measure of toxic effects of lead on heme synthesis increased in lead poisoning
A
Free erythrocyte protoporphyrin
23
Q
Lead depletes iron leading to anemia and displaces calcium in the bone leading to a
A
Zinc deficiency
24
Evaluates clotting adequacy , normal___
Prothrombin time
11-12.5 seconds
85-100% of normal
25
Oral contraceptives Decrease
Folate B6 VitC
26
Loop diuretics deplete
Potassium magnesium calcium sodium chloride
27
thiazide dieretics like lasix or furosemide decrease___ And absorb
Decrease potassium and magnesium increase renal absorption of calcium
28
Methotrexate Decreases
Folate
29
Cyclosporine ( Immunosuppressant) May cause
Hyperlipidemia hyperglycemia hyperkalemia hypertension
30
Isoniazid treats TB depletes ___, Causes____ Don't take with food interferes with____
Pyridoxine ; Peripheral neuropathy; Vitamin D
31
Elavil ( Antidepressant) effects
Sedative effect weight gain increased appetite
32
Vitamin B6 and protein decrease effectiveness of___ Which control symptoms____. Take in the morning with less than 10 g of protein consume most protein in evening meal
Levodopa Parkinson's disease
33
May cause hypertension of taken with an MAOI
Tyramine
34
If on an MAOI restrict
Aged fermented dried pickled smoked spoiled foods(Fermentation relies on protein breakdown to enhance flavor bacteria released form amines) Avoid hard aged cheese sauerkraut some sausages luncheon meats tofu miso limit sour cream yogurt buttermilk
35
If on MAOIs It is okay to eat____. Good advice is to___
Cottage cheese cream cheese ricotta cheese farmers cheese
| Buy cook eat fresh food
36
Includes all data collection and analysis activities of the federal government related to measuring the health and nutritional status food consumption attitudes about die and health
National nutrition monitoring and related research program (NNMRRP)
37
The national nutrition monitoring and related research program is run by
Jointly run by DHHS and USDA
38
The pediatric nutrition surveillance system and pregnancy nutrition surveillance system is run by
HHS
39
Nationwide food consumption surveys conducted by
USDA
40
Behavioral risk factor surveillance system conducts telephone and reviews in adults 18 years older Is run by
HHS
41
Weight loss practice survey and youth risk behavior survey run by
HHS
42
Diet and health knowledge survey main meal planner and prepare and households; beliefs about food safety food labels knowledge of nutrients run by
USDA
43
The commodity supplemental food program run by the USDA Is offered to__
Low income women pregnant breast-feeding postpartum infants and children up to six years some elderly; at nutritional risk
44
Quarterly distributions of commodity foods by local public or private nonprofit agencies food bank soup kitchens homeless shelters. Supplements diets of low income households
The emergency food assistance program
45
Improve food practices of low income Homemakers with young children. Works with small groups. Teaches skills needed to obtain a healthy diet (how to budget meal planning shop cook)
Extension food and nutrition education program
USDA
( Provides grants to universities that assists in community development)
46
Under title V of the Social Security act, Fosters public health nutrition programs at the state and local levels provides training consultation funding, Women of childbearing age infants children state eligibility requirement
Maternal and Child health block Grant DHHS
47
Develop services to foster independent living; Cash and commodities to state agencies
Nutrition Services incentive program USDA
48
In snap supplemental nutrition assistance program run by the USDA figures are adjusted to reflect cost of food in the____ for____
Thrifty food plan for June of preceding year
49
Hope slow income children ages 3-5 Introduces new foods teaches good food habits child's participation in food activities is important
Headstart DHHS
50
Raising worldwide levels of nutrition by increasing efficiency of production and distribution of foods most directly concerned with food
Food and agricultural organization FAO
51
Together with FAO developed RDAs for developing countries
WHO
52
When evaluating information ask questions based on the ___ checklist
Credibility
Accuracy
Reasonableness
Support
53
Cause of many ulcers
H pylori bacteria
54
Attaches the remaining stomach to the jejunum
Billroth II
55
Remaining stomach is attached to the duodenum
Billroth I
56
In a Billroth to food bypasses the duodenum the secretion of___&___ Is reduced. These hormones normally stimulate the pancreas so there is now little____ causing____
Secretin
Pancreozymin
Pancreatic secretion
Steatorrhea
57
In tropical sprue diarrhea malnutrition and deficiencies of ____may occur due to decreased___
B 12 folate
| HCL intrinsic factor
58
Restricted on a gluten free diet
Wheat rye oats barley bran Graham malt Bulger couscous Durham orzo thickening agents
59
Acceptable for celiac
Corn potato rice soybean tapioca arrowroot carob bean guar gum flax
60
Oat bran and ___fibers decrease serum cholesterol by binding bile acids converting more cholesterol into bile
Soluble
61
Soluble fibers pectins gums delayed gastric emptying absorb water form soft gel in intestines this slows passage and delays or inhibits absorption of glucose and cholesterol found it
Fruits vegetables legumes oats barley carrots apples citrus fruits strawberries bananas
62
A high-fiber diet may increase the need for
Calcium magnesium phosphorus copper selenium zinc iron
63
Crohn's disease ( type of inflammatory bowel disease ) affects the__ And leads to
Terminal ileum
| Weight-loss anorexia diarrhea B12 deficiency leads to megaloblastic anemia
64
Treatment for IBD includes maintain fluid and electrolyte imbalance anti-diarrheal agents (___)
Sulfasalazine
65
Goals in irritable bowel syndrome
Adequate nutrient intake tailor pattern to specific G.I. issues
66
Lactose intolerance is detected by
Breath hydrogen test
67
In lactose intolerance blood glucose will rise
Less than 25 mg/dL above fasting flat curve
68
In chronic nonspecific infantile diarrhea consider ratio of
Fat to carbohydrate calories
69
Significant resections produce major complication
Ileal resection
70
What occurs in the distal ileum
Absorption of B12 intrinsic factor bile salts
71
If the ileum cannot recycle bile salts____ are not___ Leading to___
Lipids are not emulsified
| Mal absorption of fat soluble vitamins
72
In liver disease all four enzymes are elevated. ____ Is decreased in uncontrolled diabetes
ALP,LDH,AST(SGOT),ALT(SGPT)
SGOT. AST
73
How much protein is needed in acute hepatitis
1-1.2 Grams of protein per kilogram
74
Esophageal varices occur due to
Portal hypertension
75
Diet for cirrhosis
High protein .8-1(1.5 In stress) high calorie (25-35 or 1.2-1.5) moderate to low fat 25-40%
76
Alcohol is converted into acetyl aldehyde and excess ____ replaces fat as fuel in the Krebs cycle so fat accumulates in the liver (leading to a fatty liver) and in blood (Raising TG level)
Hydrogen
77
Malnutrition associated with alcoholism ___ deficiency-_____ syndrome
Thiamin- wernick korsakoff
78
In hepatic failure if patient not comatose___-_____ Levels of protein
Moderate to high
79
Calories in hepatic failure
| Calories from fat in hepatic failure%
30 to 35 cal per kilo
| 30 to 35% calories as fat
80
In hepatic failure add____
Branched chain amino acids
81
Treatment of cholecystitis (Inflammation of the gallbladder) ___-___ g fat
Chronic __-__% of cal
30 to 45
| 25 to 30% of calories
82
In chronic pancreatitis use
PERT-Pancreatic enzyme replacement therapy; Orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase. MCT do not require Pancreatic lipase
83
In cystic fibrosis provide age-appropriate doses of water-soluble vitamins and minerals supplement water-soluble forms of____ (_&_)
Fat-soluble vitamins
A
E
84
Thiazide diuretics May induce
Hypokalemia
85
Chylomicrons are synthesized in the
Intestine from dietary fat
86
VLDL LDL HDL IDL are made in
Liver and adipose tissue from endogenous sources
87
Major nutrient reabsorption in the renal system occurs in the
Proximal convoluted tubule
88
In the kidneys the acid-base balance is controlled in the
Distal tubule
89
Water and sodium balance in the kidneys
Loop of Henle
90
The first function of the nephron is filtration red blood cells protein stays in blood all else filters through tubule; Absorption is next ___ percent of glucose and amino acids___% Water sodium potassium
100% 85%
91
What are the three hormones involved in Renal Function
Vasopressin ADH
Renin
Erythropoietin EPO
92
Vasopressin ADH is secreted from the ____ It_____ and Increases water reabsorption from distal and collecting tubules
Hypothalamus
| Elevates blood pressure
93
Hyponatremia caused by hemodilution treated with fluid restriction
SIADH Syndrome of inappropriate antidiuretic hormone
94
Renin is a___ Secreted by the_____ When blood volume decreases
Vasoconstrictor
| Glomerulus
95
Renin Stimulates ___to increased sodium absorption and return blood pressure to normal
Aldosterone
96
A B UN to creatinine ratio of ___indicates prerenal state in which B UN reabsorption is increased due to acute kidney damage
>20:1
97
BUN to creatinine ratio of ____suggest reduced BUN reabsorption due to renal damage (may need dialysis)
<10:1
98
Renal solute load mainly measures
Nitrogen 60% and electrolytes (sodium)
99
Increase urea in blood
Azotemia
100
Nephrosis - nephrotic syndrome Is caused by a defect in capillary____ Which permits escape of large amounts of protein into the filtrate moving through the tubules
Basement membrane of glomerulus
101
Symptoms of nephrosis include
Albuminuria edema malnutrition hyperlipidemia
102
The diet for nephrosis is restricted in
Fat <30% and protein .8-1.0
103
In chronic kidney disease restrict protein when GFR falls
GFR. Grams
GFR. Grams
Moderate ckd 1,2,3 <25 0.6g
104
End-stage renal disease is usually associated with a B UN greater than ___ and Cr ___
>100
| 10-12
105
In end-stage renal disease there is a retention of nitrogen metabolites-May use______-___g protein hbv increase calories controls edema prevents deficiency (not on dialysis )
Giovanetti diet
| 20g
106
Protein for people on PD
1.2-1.3 G protein/kg sbw or abw; >50%hbv
107
Calorie needs for people less than 60 years old
| Greater than or equal to 60 years old
35 cal per KG including dialysate
| 30 to 35 cal per KG
108
Fasting blood glucose
Normal
Impaired
Diabetes
70-100
100-125
>=126
109
Glucose tolerance test
Normal
Impaired
Diabetes
=200
110
```
Diabetes =
FPG
GTT
Symptoms of diabetes plus causal plasma glucose ____
A1C
```
>= 126
Greater than or equal to 200
>=200
>=6.5%
111
Goals for all diabetics maintain normal blood glucose
Average preprandial goal___
Peak postprandial average___
70 to 130
| Less than 180
112
Risk factor for gestational diabetes
BMI greater than 30 history of GDM
113
At ___weeks of gestation screen at 50 g or glucose load glucose greater than or equal to___ indicates need for further test
24 to 28
| 140
114
DRI for carbohydrate during pregnancy is
175
115
Gestational diabetes increases the risk of
Fetal macrosomia fetal hypoglycemia at birth
116
Rapid acting insulin
NovoLog Humalog take 5 to 15 minutes before eating four hour duration
117
Short acting insulin
| When to take duration time one unit covers
Regular take 30 to 45 minutes before meal One unit covers 10 to 15 g duration 3 to 6 hours
118
Intermediate acting insulin
NPH Onset 2 to 4 hours duration 10 to 18 hours include bedtime snack of carb + protein
119
Long-acting insulin
Glargine (lantus) determir (levemir) Onset 2 to 4 hours duration 18 to 24 hours
120
Insulin secretagogues:_____-Promote__
Sulfinylureas, meglitinides (glucotrol)
| Insulin secretion
121
Biguanides -___(___) Enhance insulin action suppress hepatic glucose production
Metformin - Glucophage
122
Adrenal cortex insufficiency-
Addison's disease
123
In adrenal cortex insufficiency there is atrophy of the adrenal cortex symptoms due to absence of adrenal hormones
Low cortisol:
Low aldosterone:
Low androgenic:
Glycogen depletion hypoglycemia
Sodium loss potassium retention dehydration
Tissue wasting weight loss
124
Diet for Addison's disease and main therapy
High-protein frequent feedings high salt high carbohydrate hormonal replacement
125
In hypothyroidism T4 is __ and T3 is___
Low
| Low or normal
126
In doubt avoid high purine food such as
Broth anchovies sardines organ meats sweetbreads Herring mackerel
127
Galactosemia is due to a missing enzyme that would've converted
Galactose-1-PO4 into Glucose-1-PO4 (Galactose into Glucose)
128
In galactosemia restrict
Organ meats MSG extenders milk lactose galactose way casein dry milk solids current calcium or sodium caseinate dates bell pepper
129
The following are okay in galactose he
Soy hydrolyzed casein lactate lactic acid lactalbumin pure MSG
130
What is an example of a urea cycle defect
OTC Ornithine Transcarbamylase deficiency
131
Phenylketonuria Is caused by the missing enzyme phenylalanine hydroxylase which would have converted phenylalanine into tyrosine it is detected with a___ And treated with a___
Guthrie blood test
| Low phenylalanine diet
132
The need for phenylalanine decreases with____ Because
Age and infection which causes tissue catabolism releasing Phenylalanine into the blood
133
Homocysteinurias Treatable inherited disorder of amino acid metabolism characterized by severe elevations of___&____
Methionine and homocystine
134
Homocystinuria's are associated with low levels of
Folate B6 B12
135
Maple syrup urine disease is an inborn metabolism of the
Branched chain amino acids
136
In maple syrup urine disease restrict BCAA to
45 to 62 mg per day
137
Systemic lupus erythromatosus (SLE) May have deficiencies of____
May have anemia but does not correlate with iron intake
May show symptoms of___
Iron folate calcium fiber B12
| Celiac disease
138
Epilepsy- anticonvulsants phenobarbital and phenytoin (Dilantin) interfere with
Calcium absorption may need supplements of vitamin D calcium thiamin
139
Enter all feedings decrease bioavailability of phenytoin so
Hold tube feedings greater than equal to two hours
140
A ketogenic diet need supplementation of
Calcium vitamin D folate B6 B12
141
Ratio of fat nonfat grams in a ketogenic diet
4:1
142
Pressure ulcers
calories
protein
30 to 40 cal per kilogram
1. 2 to 1.5 g of protein per kilogram stage1/2
1. 5 to 2 stage 3/4
143
Hyper kinesis hyperactivity ADHD may be treated with the
Feingold diet-No salicylates artificial colors artificial flavors
144
What is the normal range for MCH
27 to 32
HGB/RBC
145
What is the normal range for MCV
80-95
HCT/RBC
146
What is the normal range for MCHC
32 to 36%
HG/HCT
147
Foods high in iron
Liver kidney beef dried fruits dried peas and beans nuts leafy green vegetables fortified whole-grain products
148
Common allergens
Peanuts eggs milk soy wheat shellfish
149
Gold standard for diagnosing allergies
Double-blind placebo-controlled food challenges
150
What food is least likely to cause an allergy
Rice
151
The BMR increases___% for each degree rise in Fahrenheit temperature above 98.6
7%
152
The ebb phase of injury is characterized by
Hypovolemia shock tissue hypoxia
153
The flow days following an injury is characterized by
Flows fluid resuscitation and return of oxygen transport
154
Results of physiologic trauma
Hyperglycemia hyperinsulinemia little or no ketosis increased glucagon
155
In physiologic trauma
___ Releases cortisol which mobilizes amino acids from muscle
___ Renal water reabsorption
___ Renal sodium retention, Gluconeogenesis
ACTH
ADH
Aldosterone
156
Cancer treatment
| _____-Anti-folate drug
Methotrexate
157
Protein calorie malnutrition brought on by treatment hospitalization or medication
Iatrogenic malnutrition
158
Healthy obese have elevated ___normal to low___
LDL
| HDL
159
A Roux-en-Y gastric bypass may cause potential ___and deficiencies of
Anemia
| Potassium magnesium folate B12 supplementation is necessary
160
Prader Willi syndrome is a Congenital disorder caused by
Chromosome 15 deletion
161
And Prader Willison ___levels are elevated which stimulates growth hormone secretion appetite intake and fat mass deposition
Ghrelin
162
___ Can control dental caries supplement starting at___ If level in water supply is less than .3 ppm
Fluorine
| Six months
163
Stomatitis is an inflammation of the mouth associated with
Riboflavin deficiency
164
Disorder of the lower esophageal sphincter motility does not relax and open upon swallowing causes dysphasia
Achalasia
165
Nutrient needs for AIDS
Energy:
Protein:
BEE x 1.3 for asymptomatic
| Asymptomatic 0.8 g per KG up to 1.2 to 2.0 g per KG if wasted LBM
166
Causes non-nutritional macrocyctic anemia
Retrovir (zidovudine)
167
Air sacs lose elasticity been cachectic often older difficulty exhaling air pocket was expand dinner collapse
Emphysema (Type of COPD)
168
Excess mucus production chronic productive cough
Chronic bronchitis (Type of COPD)
169
In ARDS acute respiratory distress syndrome provide enteral formula containing___ And enhanced levels of___
EPA and GLA (gamma linoleic acid)
| Antioxidant vitamins
170
In acute respiratory distress syndrome how much protein is needed
1.5 to 2 g per kilogram body weight maintain Lean body mass
171
Standard polymeric enteral nutrition formulas provide
1-1.5 cal per cc
172
Elemental chemically defined intro nutrition formulas are used with___ They have predigested proteins are amino acids glucose or sucrose small that vitamins minerals electrolytes and are absorbed in_____ They have ___osmolality and poor taste
Malabsorption
Proximal intestine
High
173
Name three examples of elemental formulas
Alitraq
Peptamen
Vivonex
174
Hang time open systems
| Closed system
Four hours
| 24 to 48 hours
175
In cyclic feeding you would use
Continuous drip ( Usually a feeding pump)
176
___:passed by ____in stomach; Used in comatose patients or ones with no gag reflex
Transpyloric
Pyloric valve
177
Give 1 cc water / calorie ingested
1 cal/cc formulas are ___% water
1.5 cal/cc
2 cal/ cc
80-86%
76-78%
69-71%
178
Peripheral parenteral nutrition solutions are generally limited to
800 to 900 mOsm
179
Using the subclavian vein parental nutrition minimizes the risk of
Phlebitis (Inflammation of the veins)
180
___ Is compromised by bowels rest or parenteral nutrition. Provides 50% of total body immunity 70 to 80% of total body immunoglobulin production is secreted across the G.I. mucosa to defend against pathogenic substances in the G.I. lumen
GALT Gut associated lymphoid tissue
181
In TPN the ratio for anabolism 1g protein /
150 Calories
182
In TPN the percent for protein equals
The number of grams of protein in 100 mL of solution
183
A 3% solution has (protein)
3 g of amino acids per 100 mL
184
Energy is provided as dextrose __-___ Calories per KG; Up to___% Dextrose solution
35-50
| 70%
185
A 10% dextrose solution provides
100 g carbohydrate per liter
186
Accident rate of dextrose infusion should not exceed___ To prevent___
4-5 mg/kg/minute
| Hyperglycemia
187
Fat 10%
20%
Needed to prevent ___ symptoms:
1.1 cal/cc
2 cal/cc
Essential fatty acid deficiency
Petechiae (red spots)
188
When Patient can tolerate ___needs by enteral route
75%
| D/c pn
189
The refeeding syndrome can cause
Hypokalemia hypophosphatemia hypomagnesemia
190
____:Nutrient goals to be achieved overtime, are replacing the____
Dietary reference intakes DRI
| Recommended daily allowances RDA
191
Use this when there is insufficient evidence existing for EAR or RDA
Adequate intake
192
The 2010 dietary guidelines for Americans are designed to prevent chronic disease and are written by
USDA and HHS
193
Overall measure of diet quality measures how well Americans follow the guidelines (Five food groups 4 nutrients-Fat saturated fat cholesterol sodium) variety
Healthy eating index-USDA
194
Healthy people:_____-Surgeon General-
National health program and disease prevention objectives
| HHS
195
The healthy people national health program and disease prevention objectives by the Surgeon General and HHS focuses on
Disease prevention by changing behavior
196
DRGs Diagnostic related groupings
Prospective payment system
197
The diagnostic related groupings the prospective payment system was enacted by Congress in
TEFRA tax equity and fiscal responsibility act
198
Developed to explain why people specially high-risk people fail to participate in programs designed to detect or prevent disease; a person must perceive the severity in their Susceptibility to The threat for the threat to be a behavior motivating factor
Health belief model
199
What are the three steps in program planning
Develop a mission statement & needs/problem statement
Set goals
Set measurable objectives
200
___ are more defined then___-They contain specific target dates for completing specific project
Objectives are more defined than goals
201
Public health departments derive portion of their income from
General revenue and federal local or foundation grants
202
Implementation requires administrative support, realistic ___, staff commitment and support of____
Budget
| Target population
203
What are the three domains of learning
Cognitive effective psychomotor
204
Enabling interventions relate to the
Make it sound
4P's of marketing
Product acceptable place accessible price reasonable promotion tailored to attention and acceptance
Sound interesting
205
Competencies necessary to make and sustain new eating habits:_____ (___)
Skill development
| psychomotor learning
206
What are four outcome categories
Direct Nutrition outcomes
Clinical and health status outcomes
Patient centered outcomes
Healthcare use and cost outcomes
207
Changes in length of stay ICU days number of inpatient visits treatment procedures medications are examples
Cost outcomes
208
Changes in severity duration or course of a condition or disease changes in risk level maintenance of health are examples of
Health and disease outcomes
