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Inman Key Points > Domain 2 > Flashcards

Domain 2 Flashcards

1
Q

cardiac cachexia

A

unintended wt loss, blood backs up into liver + intestines, causes nausea and decreased appetite

arginine and glutamine
low sodium, low saturated fat, low cholesterol, high calorie

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2
Q

DASH diet

A

low fat dairy, poultry, fish, mod sodium, limit alcohol, decrease sweets, calcium (not supplements), whole grains, fruits, veg

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3
Q

ischemia

A

deficiency of blood due to artery obstruction
temporary

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4
Q

Subjective Global Assessment

A

screening tool
history, intake, GI symptoms, functional capacity, physical appearance, edema, wt change

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5
Q

NSI

A

nutrition screening initiative
for the elderly >65yo

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6
Q

amputations adjusted IBW

A

(100-%amp)/100 x IBW
entire leg=16%
low leg w foot= 6%
arm=5%
forearm w hand= 2.3%

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7
Q

spinal cord injury energy needs

A

quadriplegic reduce by 10-15% table wt
paraplegic reduce by 5-10% table wt

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8
Q

triceps skinfold thickness

A

measures body fat reserves
measures caloric reserves

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9
Q

arm muscle area

A

measures skeletal muscle mass (somatic protein)
important to measure in growing children

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10
Q

waist circumference

A

> 40 for M or >35 for F risk factor for disease w BMI >25
best for risk factor, central adiposity

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11
Q

waist to hip ratio

A

> 1 for M or >0.8 for F
indicative of android obesity, diseases

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12
Q

TANF

A

temporary assistance for needy families
UHHS, state provided
200% poverty line, not receiving cash assistance
child care, transportation, mental health counseling, child abuse prevention, etc

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13
Q

NHANES III

A

repeated survey, health of Americans
adults >65yo

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14
Q

CSFP

A

Commodity Supplemental Food Program
USDA
administered by state health agencies
low income women (post partum, BF, pregnant), infants, children up to 6yo, some elderly, some @ nutrition risk
monthly commodity canned or packaged foods

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15
Q

TEFAP

A

the emergency food assistance program
USDA
supplements diets of low income households
quarterly distributions of commodity foods

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16
Q

NSLP

A

national school lunch program
USDA
lunch= 1/3 RDA for protein, A, C, Fe, Ca
entitlement program

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17
Q

NSBP

A

national school breakfast program
USDA
1/4 RDA for pro, vit A, C, Fe Ca
entitlement program

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18
Q

CACFP

A

child and adult care food program
USDA
reimburse operators of public and nonprofit food service programs
provides commodity foods, ed materials
same eligibility as NSLP

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19
Q

NETP

A

nutrition education and training program
amendment to school lunch act
provides nutrition education training to teachers and food service staff

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20
Q

Medicare Part A vs B

A

health insurance for >65 yo
Part A= hospital insurance
Part B= optional insurance

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21
Q

OAA

A

older americans act nutrition program
UHHS
all >60yo + spouse, regardless of income
provide 1/3 RDA, 1 hot meal x5day/wk
congregate meals= rural
home delivered=homebound, Meals on Wheels

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22
Q

ulcer

A

causes: H.pylori
txt: antacid, antibiotics
meds: Cimetidine, Ranitidine (h2 blocker)
diet: avoid late night snacks, avoid cayenne, black pepper, chili powder, caffeine, alcohol

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23
Q

hiatal hernia

A

small, bland feedings, avoid late night snacks; avoid caffeine, chili powder, alcohol

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24
Q

dumping syndrome

A

causes: post gastrectomy (billroth 1, 2)

sxs: cramps, weakness, dizziness, sweating, rapid pulse; alimentary hypoglycemia; possible steatorrhea

deficiencies: Ca (no absorption), Iron (no acid), B12 (no intrinsic factor, bacterial overgrowth), folate (low iron, no B12)

txt: frequent, small feeding, avoid hypotonic sweets, no fluids w meals, 50-60% complex CHO, pro w each meal, mod fat, B12 injections, avoid lactose

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25
Q

alimentary hypoglycemia

A

rapid hydrolyzed cho enters jejunum -> water drawn in (osmotic pressure) ->BP drops, cardiac insufficiency -> 2 hrs later CHO absorbed quickly -> BG rises, overproduction of insulin -> low BG (below fasting)

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26
Q

gastroparesis

A

delayed gastric emptying due to diabetes (gastric neuropathy), surgery, viral infections, obstructions

txt: prokinetics (erythromyacin, metoclopramide); small frequent meals, pureed foods, avoid fiber, avoid high fat

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27
Q

tropical sprue vs. non tropical sprue

A

tropical- caused by infection, mucosal and villi destroyed; diarrhea, malnutrition, low B12 & folate
txt: antibiotics, high cal, high pro, IM B12/B9

non tropical- celiac disease, malabsorption, low in fat soluble vit, macrocytic anemia, wt loss, diarrhea, steatorrhea, iron def. anemia
txt: gluten free diet

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28
Q

soluble fibers

A

absorb water, delays digestion
pectins, gums
fruits, vegetables, legumes, oats, barely, carrots, apples, citrus fruits, strawberries, bananas

29
Q

Crohn’s disease

A

IBD
affects terminal ileum
wt loss, anorexia, diarrhea, megaloblastic anemia (B12 deficiency), iron def anemia

txt during flares: bowel rest, parental nutrition, minimal residue

30
Q

IBD diet txt

A

during remission: high fiber (peristalsis)

energy needs according to current BMI, avoid fat if steatorrhea, vitamin supps, MCT oil, watch lactose, frequent feedings, high fat

31
Q

UC

A

ulcerative colitis
IBD
affects colon, begins in rectum
chronic bloody diarrhea, wt loss, anorexia, E-lyte disturbance, dehydration, anemia, fever, neg N balance

txt during flare: elemental diet (liquid formulas) to minimize fecal volume

32
Q

chronic nonspecific infantile diarrhea

A

40% calories as fat, balanced with limited fluids, restrict/dilute fruit juices (apple, grape)

33
Q

steatorrhea

A

stool fat >7g (normal is 2-5g)
high pro, high complex CHO, fat as tolerated, MCT, fat soluble vit

34
Q

ileal resection

A

distal= B12, bile salt absorption issue
excessive water loss via stool (+1 L/day than ostomy output)
if ileum cant recycle bile salts-> malabsorption of fats/fat vits-> lead to “soaps” (fats + Mg, Ca, Zn)-> renal oxalate stones formed -> increased colonic motility (fluid and E-lyte sectection)

35
Q

SBS nutrition care

A

TPN initially, to restore nutrition status
EN early, continuous drip, increase over time
ileal= limit fat, MCT, vit supps (fat soluble, Ca, Mg, Zn, IM B12)
jejunal= normal macro balance, avoid lactose, oxalates, concentrated sweets, vit/min supps

36
Q

jaundice

A

bile ducts obstructed

37
Q

hepatitis

A

acute, viral
Hep A: fecal oral transmission (food)
Hep B: sexually transmitted
Hep C: blood to blood contact
sxs: inflammation, necrosis, jaundice, anorexia, nausea, fatigue
txt: increase fluids, encourage coffee (antioxidant), multivit w B, C, K, Zn, small frequent feedings
diet: 50-55% CHO (spare pro, liver glycogen), 1-1.2 g/kg pro, mod-high fat

38
Q

cirrhosis

A

chronic liver disease
compensated or de-compensated, alcohol induced (high TG)

sxs: low LBM, poor appetite, nausea, early satiety, encephalopathy, ascites (low albumin, Na, high fluids), esophageal varices

diet: 25-40kcal/kg cal, high protein 1.2-1.5g/kg, mod to low fat 20-45% cal
low fiber if varices
low sodium, fluid restriction (1-1.5L/day)
B Complex vit (Zn, Folate, Thiamine)
check for Vit D (other fat soluble vit)

39
Q

Wernicke-Korsakoff syndrome

A

thiamine deficiency as a result of alcoholism-> liver disease

40
Q

ESLD

A

end stage liver disease, hepatic failure
live cant turn ammonia to urea- >NH3 accumulates
sxs: apathy, drowsiness, confusion, coma
liver function <25%
if not comatose: 30-35cal/kg, 30-35% fat, 1-1.5 g/kg pro
low sodium if ascites, vit/min supps

41
Q

asterisix

A

flapping, involuntary jerking
sign of impending coma due to ESRD (portal systemic encephalopathy)

42
Q

cholecystitis

A

inflammation of gallbladder
gallstones (cholelithiasis) get stuck-> lead to inflammation
cause: excess cholesterol (excess bile made)
txt: cholecystectomy (removal of gallbladder)
diet: 30-35 g/kg fat (low fat for acute), 25-30% of cal from fat for chronic
post removal- limit fat until liver adjusts, add fiber slowly to help with BM

43
Q

pancreatitis

A

inflammation of pancreas, inflammation, cellular exudate and fat necrosis
causes: blockage or reflux of ductal system, premature activation of enzymes within pancreas-> autodigestion
sxs: weight loss w reg po intake, stinky BM, steatorrhea

txt for acute: withhold feeding, IV hydration; increase slowly with low fat meals, elemental EN into jejunum

txt for chronic: PERT (may need antacids to help due to no bicarb); MCTs; max fat for wt gain; if malabsorption-> fat soluble vits in water; parenteral B12

44
Q

cystic fibrosis

A

thick mucus that obstructs exocrine glands/ducts
COPD, EPI, high perspiration E-lyte levels, malabsorption
txt: PERT, high pro, high cal, unrestricted fat, high salt (+2-4 g/day); supp vit A&E
failure to grow= 110-200% normal EEE

45
Q

angina pectoris

A

chest pain
due to atherosclerosis

46
Q

optimal cholesterol levels

A

LDL <100
Total cholesterol <200
HDL >40 (M), >50 (F); >60 (HIGH)
TG <150

47
Q

HTN management

A

DASH diet, salt restriction, weight loss, physical activity, less alcohol, thiazide diuretics (but cause low K)

48
Q

management of dyslipidemia, metabolic syndrome

A

Therapeutic lifestyle changes from ATP 3
<35% cal from total fat
<7% sat fat, 5-10% PUFA, 20% MUFA, <200 mg cholesterol
2-3 g stanols/sterols
25-30 g fiber
prevent wt gain, achieve DBM
physical activity= 30 min most days

49
Q

heart failure

A

sxs: edema, dyspnea
increase heart contraction strength
2-3 g sodium, DASH diet
1-2 L fluid
1-1.4 g/kg pro ABW
thiamine status (low w loop diuretics)
Folate, Mg, MV w B12
regular physical activity

50
Q

long acting insulin

A

basal (background)
DLGL
Determir (Levemir), Glargine (Lantus)
onset 2-4 hrs, duration 18-24 hrs

51
Q

intermediate acting insulin

A

basal (background)
NPH (Humulin N, Novolin N, ReliOn)
onset 2-4 hrs, duration 10-16 hrs
need bedtime snack of cho + pro

52
Q

Addison’s disease

A

adrenal cortex insufficiency
decrease cortisol (glycogen depletion, hypoglycemia), aldosterone (sodium loss, potassium retention, dehydration), androgenic (tissue wasting, weight loss)

diet= high cal, frequent feedings, high salt

53
Q

Gout

A

disorder of purine metabolism
increased uric acid -> deposits in joins -> pain, swelling
txt: wt reduction, mod pro, liberal cho, low to mod fat, decrease alcohol, liberal fluid, avoid purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel)

54
Q

Goiter txt

A

iodized salt
avoid goitrogens (cabbage family)

55
Q

galactosemia

A

missing enzyme, cant metab galactose or lactose
diet: avoid galactose and lactose, NO organ meats, dairy, MSG extenders (pure MSG ok)

56
Q

MCH

A

mean corpuscular Hgb
color of RBCs
normal= 27-32

57
Q

MCV

A

mean corpuscular volume
size of RBC
normal= 80-95

58
Q

xerostomia

A

dry mouth
moisten foods with gravies, sauces, water/milk

59
Q

fever BMR

A

increases by 7% for each degree
reg temp= 98.6F

60
Q

hormones for renal function

A

vasopressin/ADH (antidiuretic hormone)
increase BP (increases water reabsorption)
from hypothalamus, stored in pituitary

renin: vasoconstrictor
increase BP
from kidney when blood volume decreases
stimulates aldosterone-> increase Na absorption

erythropoietin: stimulates bone marrow to produce RBC, from kidney

61
Q

labs in renal disease

A

decreased glomerular filtration rate, Cr clearance
increased serum creatinine, BUN
renal solute load- high in N and Na
pre-kidney damage: BUN:Cr >20:1
full renal damage: BUN:Cr <10:1

62
Q

renal disease leads to

A

anemia (decreased erythropoietin)
upset in BP
decreased activation of Vit D (kidney not producing active form)

63
Q

renal calculi

A

kidney stones
diet rec: 1.5-2L water to dilute urine, Ca to bind oxalate, low oxalate diet
prevent alkaline stones: (acidic foods) meat, eggs, seafood, cheese, corn, oats, rye
prevent acidic stones: (alkaline foods) vegetables, fruits, brown sugar, molasses

64
Q

acute renal failure/injury

A

sudden shutdown; due to burns, accident, obstruction, severe dehydration
decreased GFR, oliguria (<500ml urine), azotemia (high urea in blood)
at first= IV glucose, lipids, protein
1-1.3g/kg *noncatabolic w/o dialysis
1.2-1.5g/kg if catabolic/dialysis
25-40kcal/kg if hypermetabolic
needs increase as function declines
2-3g Na, replace loss in diuretic
8-15 mg Phos (LOW, may need binders)
2-3g K (adjust per output/dialysis/serum)
fluids= previous day output +500ml

65
Q

nephrosis

A

nephrotic syndrome
membrane in glomerulus defected-> protein can exit
albuminuria, edema, malnutrition, hyperlipidemia
increased making/decreased clearance of VLDL
pro= 0.8/1g/kg (50% from HBV)
<30% fat, low sat fat, 200mg chol
35kcal/kg/day
2-3g Na
Ca 1-1.5g/day, supp Vit D
Fluid restriction if edema
Abnormal Fe, Cu, Zn, Ca (due to pro loss)

66
Q

CKD

A

chronic kidney disease
anorexia, weakness, wt loss, N/V
anemia (no more erythropoietin)
25-35kcal/kg
<2400mg Na
GFR 60-90: 0.8-1.4g/kg pro; phos to maintain serum levels
GFR 15-60: 0.6-0.8 g/kg pro; phos 800-1000mg/day or 10-12mg/g pro
K unrestricted unless high serum, low urine output
fluid unrestricted

67
Q

ESRD

A

end stage renal disease
BUN >100mg/dl, Cr 10-12mg/dl
retention of N metabolites
Giovanetti diet= 20 g pro, increase cal, control edema, prevent deficiencies

68
Q

chronic renal failure

A

35kcal/kg (30-35kcal/kg if obese or >60yo)
2 g Ca max
800-1000 mg total phos
Vit C, B6, Folate, B12, Zn, Fe, Vit D
glucose lost during dialysis

hemodialysis
1.2g/kg pro (50% HBV)
>1L fluid output= 2-4g Na + 2L fluid
<1L fluid output= 2g Na +1-1.5L or 1L (anuria)
Potassium 2-3 g

peritoneal dialysis
1.2-1.3g/kg pro (50% HBV)
2-3 g Na
1-3 L fluid, depending on output
Potassium 2-4 g *unrestricted
may need extra thiamine

69
Q

purine foods

A

broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel

Inman Key Points (6 decks)

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