Domain II: Nutrition Care for Individuals and Groups: Medical Nutrition Therapy Flashcards by perjunke fibers

An ____ is an eroded mucosal lesion

Ulcer

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What is the typical treatment for GI ulcers?

-Antacids
-Antibiotics to eradicate Helicobacter pylori bacteria

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What are two examples of medications used for treatment of ulcers?

-Cimetidiine
-Ranitidine

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Cimetidine and Ranitidine are what drug class?

H2 blockers

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H2 blockers like Cimetidine and Ranitidine work by preventing the binding of ____ to its receptor, therefore decreasing acid secretion

Histamine

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For someone with an ulcer, diet should be well-balanced and we should recommend avoiding ___-___ ____

Late-night snacking

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For someone with an ulcer, we should also recommend avoiding gastric irritants such as…

-Cayenne
-Black pepper
-Large amounts of chili powder
-Avoid excess caffeine and alcohol

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A ____ ____ is a protrusion of a portion of the stomach above the diaphragm into the chest

Hiatal hernia

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MNT for a hiatal hernia:

-Small, bland feedings
-Avoid late-night snacks
-Caffeine
-Chili powder
-Black pepper

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Dumping Syndrome commonly follows a _____ (Billroth I, II)

Gastrectomy

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What symptoms does Dumping Syndrome cause when beginning to eat?

-Cramps
-Rapid pulse
-Weakness
-Perspiration
-Dizziness

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Dumping Syndrome occurs when rapidly hydrolyzed carbohydrates enter the _____, and excess water is drawn in to achieve osmotic balance

Jejunum

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The water in the jejunum causes rapid ____ in the vascular fluid compartment and a decrease in peripheral vascular resistant

Decrease

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When this occurs during Dumping Syndrome, ____ ____ drops, and signs of cardiac insufficiency appear

Blood pressure

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About 2 hours after signs of cardiac insufficiency occur, the carbohydrates are digested and absorbed rapidly, which causes blood sugar to rise, stimulating an ____ of insulin

Overproduction

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The overproduction of insulin leads to blood sugars to fall below fasting, which is known as ____ or ____ ____

Reactive or alimentary hypoglycemia

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A Billroth I, or a _______, attaches the remaining stomach to the duodenum

Gastroduodenostomy

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A Billroth II, or a _______, attaches the remaining stomach to the jejunum

Gastrojejunostomy

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With a Billroth II (gastrojejunostomy), food bypasses the _____

Duodenum

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When food bypasses the duodenum, the secretion of ____ and ____ by the duodenum is reduced

Secretin, pancreozymin

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Secretin and pancreozymin normally stimulate the ____, so after a Billroth II, there is little pancreatic secretion

Pancreas

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Absorption of ____, which is most rapidly absorbed in the duodenum, and ____, which requires acid for absorption, are adversely affected after a Billroth II (gastrojejunostomy)

Calcium; iron

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A Vitamin B12 (cobalamin) deficiency (common after gastric surgery) is caused by a lack of ____ ____, or ___ ___ in the loop of the intestine that is being bypassed

Intrinsic factor; bacterial overgrowth

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_____ anemia is caused by B12 deficiency

Pernicious

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Pernicious anemia is diagnosed using the ____ test, which looks for intrinsic factor levels

Schilling

____ deficiency is also common after gastric surgery and can also be caused by B12 deficiency because it needs B12 to be transported into the cell

Folate

Folate deficiency and low serum iron, which is a cofactor in folate metabolism, can lead to ____ anemia

Megaloblastic

MNT for s/p gastric surgery:

-Small, frequent meals -Fluids before or after meals (not during) to slow passage -Restrict hypertonic concentrated sweets -50-60% complex carbohydrates -Protein at each meal -Moderate fat intake -B12 injections may be needed -Lactose may be poorly tolerated due to rapid transport

What deficiencies may develop after a complete gastrectomy?

-Iron -B12 -Folate -Calcium -Vitamin D -B1 (thiamin) -Copper

____ is delayed gastric emptying

Gastroparesis

Gastroparesis can be caused by...

-Surgery -Diabetes -Viral infections -Obstructions

Moderate to severe ____ can have detrimental effects of gastric nerves, and may lead to gastroparesis

Hyperglycemia

____ are a class of drug that work to increase stomach contractility and treat gastroparesis

Prokinetics

What are two examples of prokinetic drugs used for gastroparesis?

-Erythromycin -Metoclopramide

MNT for gastroparesis:

-Small, frequent meals -May need pureed foods -Avoid high-fiber foods -Avoid high-fat foods (liquid fat may be better tolerated) -Avoid caffeine (acidic) -Avoid mint (acidic) -Avoid alcohol (acidic) -Avoid carbonation

A _____ might occur with gastroparesis due to undigested food or medication

Bezoar

Treatment for a bezoar include ____ or ____ therapy

Enzyme or endoscopic

____ ____ is a rare digestive disease caused by either bacterial, viral, or parasitic infection

Tropical sprue

Tropical sprue is a chronic GI disease that cases ____ ____, and may affect the stomach as well

Intestinal lesions

Tropical sprue causes symptoms like...

-Diarrhea -Malnutrition

Tropical sprue may also cause deficiencies of ____ and ____ due to decreased hydrochloric acid and intrinsic factor

Folate and B12

____ are typically used for medical treatment of tropical sprue

Antibiotics

MNT for tropical sprue:

-High kcal diet -High protein diet -IM B12 injections -Oral folate supplements

Non-tropical sprue is similar in nature to ____ ____ or ____-___ ____

-Celiac disease -Gluten-induced enteropathy

____ refers to storage proteins (prolamins)

Gluten

What are some examples of prolamins?

-Gliadin (wheat) -Secalin (rye) -Hordein (barley) -Avenin (oats)

Celiac's have a reaction to_____, which affects the jejunum and ileum (proximal intestine)

Gliadin

Celiac disease can cause...

-Malabsorption (leads to loss of fat-soluble vitamins) -Macrocytic anemia -Weight loss -Diarrhea -Steatorrhea -Iron-deficiency anemia

Those with non-tropical sprue, Celiac, or gluten-induced enteropathy need a gluten (gliadin)-free diet which restricts...

-Wheat -Rye -Oats (if harvested and milled with wheat) -Barley -Buckwheat (may be contaminated) -Bran -Graham -Malt -Bulgur -Couscous -Durum -Orzo -Thickening agents

What things are acceptable for a gluten-free diet?

-Corn -Potato -Rice -Soybean -Tapioca -Arrowroot -Carbon bean -Guar gum -Flax -Amaranth -Millet -Teff -Quinoa

Constipation is sometimes due to an ____ colon (weakened muscles)

Atonic

MNT for constipation:

-High-fiber diet -High fluid -Exercise

____ is the presence of diverticula, or small sacs that protrude through the intestinal wall due to structural weakness

Diverticulosis

Diverticulosis is related to ____ and lifelong intra-colonic pressures

Constipation

MNT for diverticulosis is a ___-___ diet to increase volume and weight of residue and provide rapid transport

High-fiber

_____ is when diverticula become inflamed as a result of food and residue accumulation and bacterial action

Diverticulitis

MNT for diverticulitis:

-Clear liquids -Low-residue or elemental -Gradual return to high fiber

____ provides indigestible bulk and promotes intestinal function

Fiber

Dietary fiber includes non-digestible ___ and ___

Carbohydrates and lignans

Dietary fiber binds _____ and ____ fecal bulk

Water; increases

Dietary fiber is found in things like...

-Legumes -Wheat bran -Fruits -Vegetables -Whole grains

Oat bran and ____ fiber decrease serum cholesterol by binding bile acids, converting more cholesterol into bile

Soluble

Soluble fibers ____ gastric emptying, absorb water, and form a soft gel in the small intestine

Delay

Soluble fibers slow the passage of food through the GI tract and inhibit the absorption of ____ and _____

Glucose and cholesterol

What are sources of soluble fiber?

-Fruits -Vegetables -Legumes -Oats -Barley -Carrots -Applies -Citrus fruits -Strawberries -Bananas

Adequate intake of fiber for men is ____ g, and for women, it is ____ g per day

38; 25

A high-fiber diet may increase needs for...

-Calcium -Magnesium -Phosphorus -Copper -Selenium -Zinc -Iron

A low-fiber diet may cause _____

Constipation

_____ is inflammation of the stomach

Gastritis

Gastritis may lead to...

-Anorexia -Nausea -Vomiting -Diarrhea

MNT for gastritis:

-Clear liquids -Advance diet as tolerated -Avoid gastric irritants

What are two inflammatory bowel diseases?

-Crohn's Disease -Ulcerative colitis

Crohn's Disease is also known as ____ ____

Regional enteritis

Crohn's Disease affects the ____ ____

Terminal ileum

Crohn's disease causes symptoms like...

-Weight loss -Anorexia -Diarrhea

Crohn's disease can also cause B12 deficiency, which leads to ____ ____

Megaloblastic anemia

Crohn's disease can also lead to ___-___ anemia due to blood loss and decreased absorption

Iron-deficiency

Ulcerative colitis is an ulcerative disease of the _____

Colon

Ulcerative colitis begins in the ____

Rectum

Ulcerative colitis causes symptoms like...

-Chronic bloody diarrhea -Weight loss -Anorexia -Electrolyte (Na, K) disturbances -Dehydration -Anemia -Fever -Negative nitrogen balance

Treatment for IBD includes maintaining fluid and electrolyte balance, sometimes accomplished with ____-____ agents

Anti-diarrheal

One example of an anti-diarrheal is _____

Sulfasalazine

MNT for acute Crohn's flare-ups:

-Bowel rest -Parenteral nutrition or minimal residue

For acute Ulcerative Colitis, an ____ diet (EN) may be needed to minimize fecal volume

Elemental

For those with IBD, energy needs should be based on current ____

BMI

For those with IBD, fat only needs to be restricted for those experiencing _____

Steatorrhea

MNT for IBD:

-May need supplementation of water-soluble vitamins, as well as iron and folate -Assess Calcium, Magnesium, and Zinc -Watch lactose -Small, frequent feedings -High fat may improve energy imbalance -Protein at each meal -Chewable MVI

Coconut oil derived ____ ____ is an easy-to-oxidize source of energy and may improve bowel damage

MCT oil

When IBD is in remission or under control, a ___-___ diet should be initiated to stimulate peristalsis

High-fiber

____ ____ ____ causes chronic abdominal discomfort, altered intestinal motility, and bloating

Irritable bowel syndrome

The goals for treating IBS:

-Adequate nutrition intake -Tailor patterns to specific GI issues

Those with IBS should avoid...

-Gas-forming foods -Swallowing air during eating

It is recommended that those with IBS should use a ___ ___ to track intake, emotions, environment, and symptoms to determine any trigger foods

Food diary

A ____-____ diet may help eliminate possible sources of discomfort in those with IBS

Low-FODMAP

_____, which contains menthol, a smooth muscle relaxant, may relax the lower esophageal sphincter which can then reduce reflux, cramping, and pain for those with IBS

Peppermint

Lactose intolerance is due to a ____ deficiency

Lactase

Normally, lactase splits lactose into ____ and ____

Glucose and galactose

In the absence of lactase, lactose remains intact, exerting _____ _____

Hyperosmolar pressure

Due to the hyperosmolar pressure caused by lactose, ____ is drawn into the intestine to dilute the load

Water

The excess water drawn into the intestine causes...

-Distention -Cramps -Diarrhea

Bacteria then ferment the undigested lactose, releasing ____ ____ gas

Carbon dioxide

Lactose intolerance is detected by a ____ ____ test

Breath hydrogen

The breath hydrogen test works because hydrogen is produced by ____ ____ on lactose, absorbed into the bloodstream, and exhaled in 60-90 minutes

Colonic bacteria

The lactose tolerance is conducted by providing someone with an oral dose of lactose (up to 50 g) after a fast; if intolerant of lactose, blood glucose will rise < ____ mg/dl above fasting (flat curve), if tolerant, blood glucose will be above that much (normal curve)

MNT for lactose intolerance:

-Lactose-free -No animal milk or milk products -No whey -Calcium and riboflavin supplements are recommended -Yogurt and small amounts of aged cheese may be tolerated

What two products are okay in someone with lactose intolerance?

-Lactate -Lactalbumin

Treatment for acute diarrhea in infants and children requires aggressive and immediate _____ (replace fluids and electrolytes lost in stool)

Rehydration

For infants and children with acute diarrhea, WHO recommends a ____ ____ solution

Glucose electrolyte

A glucose electrolyte solution is as effective as _____ rehydration and much cheaper and ingredients are easily attainable (reintroduce oral intake within 24 hours)

Parenteral

Chronic nonspecific infantile diarrhea causes no significant _____

Malabsorption

For an infant with chronic nonspecific infantile diarrhea, consider the ratio of ____ to ____ calories as well as the volume of ingested liquids (some are inadvertently put on a low fat diet or consume too many fluids or too many calories)

Fat to carbohydrate

MNT for chronic nonspecific infantile diarrhea:

-Provide 40% of calories from fat -Limit fluids -Restrict or dilute fruit juices with high osmolar loads (gapes, apple)

No fruit juice up to age ____, those up to 6 should be limited to 4 ounces per day

For adults with diarrhea, remove the cause and replace lost ___ and ____, especially those high in sodium and potassium

Fluid and electrolytes

In order to decrease diarrhea, ___ ___ needs to be decreased

Gastric motility

MNT for reducing gastric motility:

-Avoid clear liquids -Avoid foods high in lactose, sucrose, and fructose -Avoid caffeine and alcohol -Avoid high-fiber foods

Another way to decrease diarrhea is to _____ the consistency of stool

Thicken

MNT for thickening the consistency of stool:

-Banana flakes -Apple powder -Pectin sources

If an adult is having diarrhea, it is important to repopulate the GI tract with normal ____

Flora

_____ are food components (pectin, fructose, oats, whole grains) that promote the growth of healthy bacteria

Prebiotics

Prebiotics exist in _____

Fructooligosaccharides

Examples of prebiotic foods:

-Onion -Garlic -Banana -Artichoke -Asparagus -Chicory

_____ are sources of bacteria that are used to reestablish bacterial gut flora

Probiotics

Probiotics can be found in ____ dairy foods like yogurt, kefir, and aged cheese

Fermented

Probiotics can also be found in other fermented foods with beneficial live cultures, like...

-Kimchi -Miso -Tempeh -Sauerkraut

If needed, adults with diarrhea can stimulate the GI tract with a diet...

-Low in fiber -Low in fat -Lactose-free

Steatorrhea is a consequence of ____

Malabsorption

Normal stool has between 2-5 grams of fat, stool with over ___ g is indicative of malabsorption

MNT for steatorrhea:

-High protein -High complex carbohydrates -Fat as tolerated -Vitamins (especially fat-soluble) -Minerals -MCT (rapidly hydrolyzed in the GI tract)

The consequences of ____ ____ ____ are associated with significant resections of the small intestine

Short bowel syndrome

Short bowel syndrome can cause things like...

-Malabsorption -Malnutrition -Fluid and electrolyte imbalances -Weight loss

The severity of short bowel syndrome reflects the...

-Length and location of resection -Age of patient -Health of remaining tract

The loss of the ____ (especially the distal 1/3), the ___ ____, and the ____ are of particular concerns with short bowel syndrome

Ileum, ileocecal valve, colon

Most digestion takes place in the first ____ cm of the intestine (in the duodenum and upper jejunum); what remains are small amounts of sugar, starches, fiber, and lipids

100

If someone has a jejunal resection, the ____ can adapt and take over the jejunal functions

Ileum

Significant resections of _____ produce major complications

Ileum

The distal ileum is responsible for the absorption of...

-Vitamin B12 -Intrinsic factor -Bile salts

The ileum normally absorbs a major portion of ____ in the GI tract

Fluid

Patients with ileal resection have above-average needs for ____ to compensate for excessive losses in the stool

Water

Those with ileal resection should drink at least ___ ___ more than their ostomy output daily

1 Liter

If the ileum cannot recycle bile salts, lipids are not emulsified; this leads to malabsorption of ___-___ ____

Fat-soluble vitamins

Malabsorbed fats combine with calcium, zinc, and magnesium, leading to the production of ____, which impairs absorption

Soaps

Ileal resection may also increase colonic absorption of ____, leading to kidney stones

Oxalates

Those with ileal resections have ____ fluid and electrolyte secretions as well as increased colonic motility

Increased

Loss of the colon causes loss of...

-Water -Electrolytes -Salvage absorption of carbohydrates and other nutrients

If someone has loss of the colon, provide ___ ___

Chewable vitamins

Someone with short bowel syndrome might initially receive ____ ____ to restore and maintain nutrition status

Parenteral nutrition

In someone with short bowel syndrome, ____ nutrition should be started early to stimulate growth and be increased over time (continuous)

Enteral

It may take ___ or ____ for someone with short bowel syndrome to transition to oral feedings

Weeks, months

MNT for s/p jejunal resection:

-Normal balance of carbohydrates, protein, and fat -Avoid lactose -Avoid oxalates -Avoid large amounts of concentrated sweets -Vitamin and mineral supplements

MNT for s/p ileal resection:

-Limit fat -Use MCT (does not require bile salts, needs less intestinal surface area) -Supplement fat-soluble vitamins, Ca, Mg, Zn -Parenteral B12 followed by monthly injections if more than 100 cm of terminal ileum is removed

Functions of the liver:

-Stores and releases blood -Filters toxic elements -Metabolizes and stores nutrients -Regulates fluid and electrolyte balance

____ ____ is a list of major enzymes found in organs and tissues; enzyme levels in the blood are elevated when tissue damage causes them to leak into the circulation

Enzyme profile

What are 4 liver function tests?

-Alkaline phosphatase (ALP) -Lactic acid dehydrogenase (LDH) -Aspartate amino transferase (AST, SGOT) -Alanine aminotransferase (ALT, SGPT)

Normal range for alkaline phosphatase (ALP) is ____-____ U/L

30-120

Alkaline phosphatase (ALP) is elevated in what conditions?

-Liver disease -Bone disease

Alkaline phosphatase (ALP) is decreased in what conditions?

-Scurvy -Malnutrition

Lactic acid dehydrogenase (LDH) is increased in what conditions?

-Hepatitis -Myocardial infarction -Muscle malignancies

Aspartate aminotransferase (AST) is increased in ____

Hepatitis

Alanine aminotransferase (ALT) is increased in ___ ___

Liver disease

In liver disease, liver enzymes are _____

Elevated

Acute viral hepatitis can cause symptoms like...

-Inflammation -Necrosis of liver -Jaundice -Anorexia -Nausea -Fatigue -Jaundice

Jaundice occurs when ____ ____ are blocked

Bile ducts

Hepatitis A is contracted through the ____-____ route of transmission (this is the type more directly connected to food)

Fecal-oral

Hepatitis B is ____ transmitted

Sexually

Hepatitis C is contracted through ___-___ contact

Blood-blood

Those with acute viral hepatitis should increase their ____ intake to prevent dehydration

Fluid

Care for acute viral hepatitis varies depending on ____ and ____ ____

Symptoms and nutrition status

Those with acute viral hepatitis should get ___-___% of kcal from carbohydrates in order to replenish liver glycogen and spare protein

50-55

Those with acute viral hepatitis should get ___-___ g of protein per kg for cell regeneration and to provide lipotropic agents to convert fat into lipoprotein for removal from the liver

1-1.2

Those with acute viral hepatitis should have ___ to ____ fat intake if tolerated, but those with steatorrhea should get under ____% of kcals from fat

Moderate to liberal; 30

Those with acute viral hepatitis should have small, frequent meals (____-___) because of anorexia

4-6

____ intake should be encouraged for those with acute viral hepatitis due to its antioxidant content

Coffee

Those with acute viral hepatitis should take a ____ with B complex, C, K, and zinc

Multivitamin

If someone with acute viral hepatitis has fluids retention, they should not exceed ___ grams of sodium per day

_____ is damaged liver tissue that is replaced by bands of connective tissue which divide the liver into clumps and reroutes many of the veins and capillaries; blood flow through the liver is disrupted

Cirrhosis

With cirrhosis, a protein deficiency may lead to...

-Ascites -Fatty liver -Impaired blood clotting

What is the normal route of blood flow?

-Esophageal -Veins -Portal vein -Liver -Vena cava

Ascites occurs when blood cannot leave the _____

Liver

With ascites, connective tissue overgrowth blocks blood flow out of the liver into the ___ ___

Vena cava

Since blood flow is backed up, the liver expands (can hold an extra liter of blood); when storage capacity has been exceeded, pressure caused by increased blood volume forces fluid to sweat through the liver into the ____ ____

Peritoneal cavity

The fluid that leaks into the peritoneal cavity is almost pure ____ with a high osmolar load, pulling more fluid in to dilute this load; this leads to ___ and ____ retention

Plasma; sodium and water

Low serum ____ may be due to the dilution factor

Albumin

____ ____ occur when blood can't enter the liver

Esophageal varices

When blood can't enter the liver, it causes ____ ____

Portal hypertension

Connective tissue overgrowth causes resistance to blood entering the portal vein; the increased pressure forces blood back into ____ veins that offer less resistance; esophageal, abdominal, and collateral veins enlarge

Collateral

Someone with cirrhosis needs adequate to high protein; they should get ___-___ g/kg or ___ g/kg when in stress

0.8-1.2; 1.5

Someone with cirrhosis needs a high calorie intake of ____-____ kcal/kg estimated dry weight or basal energy expenditure + 20%

25-35

Someone with cirrhosis should have a moderate to low-fat diet, with fat making up ____-____% of calories

25-40

_____ oil might be needed for someone with cirrhosis

MCT

For someone with cirrhosis who is experiencing malabsorption, they should get under ____ g of fat per day

____ is the preferred fuel in cirrhosis (should include omega 3)

Fat

For someone with cirrhosis, decrease ___ ____ ____ if steatorrhea develops

Long chain triglycerides

If varices are present, someone should follow a ___-___ diet

Low-fiber

If someone has edema or ascites, someone should follow a ___-____ diet (under 2 g)

Low-sodium

With ____, someone should follow a fluid restriction of 1-1.5 L/day depending on severity as well as a moderate sodium intake

Hyponatremia

What vitamins should be supplemented in someone with cirrhosis?

-B complex -Vitamin C -Zinc -Magnesium -Monitor need for vitamin A and D

____ is involved in the conversion of ammonia to urea; in someone with cirrhosis, there is increased loss in urine

Zinc

What is the progression of alcoholic liver disease?

1. Hepatic steatosis 2. Alcoholic hepatitis 3. Cirrhosis

Alcoholic liver disease is liver injury due to alcohol and the ____ derangements it causes

Metabolic

Alcohol is converted into _____ and excess _____ which disrupts liver metabolism

Acetaldehyde; hydrogen

With alcoholic liver disease, hydrogen replaces ___ as fuel in the Kreb's Cycle, so fat accumulates in the liver which then leads to fatty liver and increases triglyceride levels

Fat

The shift in the NADH/NAD ratio with alcoholic liver disease inhibits ___-___ of fatty acids and promotes triglyceride synthesis

Beta-oxidation

In what ways does alcohol/alcoholic liver disease cause malnutrition?

-Alcohol replaces food in the diet -Alcohol causes inflammation of the GI tract and interferes with absorption of B12, vitamin C, folic acid -Interferes with vitamin activation -Increases need for B vitamins in order to metabolize alcohol -Increases needs for magnesium (excreted after alcohol consumption) -Malnutrition increases alcohol's destructive effects

You must supplement ____ and ____ ____ for someone with alcoholic liver disease

Thiamin; folic acid

____ and ____ deficiencies in alcoholic liver disease are most responsible for malabsorption

Protein and folate

A thiamin deficiency with alcoholic liver disease causes ____-____ ____

Wernicke-Korsakoff Syndrome

With hepatic failure (ESLD), liver function is decreased to ____% or less

With hepatic failure (ESLD), the liver cannot convert ____ into urea, so it accumulates

Ammonia

Symptoms of hepatic failure include...

-Apathy -Drowsiness -Confusion -Coma

Coma caused by hepatic failure is called ____ ____ ____

Portal systemic encephalopathy

____, or involuntary jerking motions, is a sign of impending coma in someone with ESLD

Asterixis

Someone with hepatic failure (non-comatose) should have moderate to high protein diet, up to ____-____ g/kg as tolerated

1-1.5

If someone with ESLD should have _____ protein intake if they have protein-sensitive hepatic encephalopathy

Modest

Someone with end-stage liver disease should get ___-___ kcal/kg

30-35

Someone with ESLD should get ___-___% of their kcal from fat, with MCT if needed

30-35

Someone with ESLD should have a ___ ___ diet if they have ascites and should also get vitamin/mineral supplementation as needed

Low sodium

The altered neurotransmitter theory says that with ESLD, ____ are decreased (they are used for energy), and _____ are increased because the damaged liver is unable to clear them

Branched-chain amino acids (BCAAs); (Aromatic amino acids) AAA

Adding ____ to the diet of someone with end-stage liver disease will add calories and protein, but may not reduce symptoms; they are used when standard treatment is not working and when the patient does not tolerate standard protein

BCAAs

Standard treatment for end-stage liver disease is _____, which is a hyperosmolar laxative that removes nitrogen, along with _____, which is an antibiotic that destroys bacterial flora that produce ammonia

Lactulose; Neomycin

Non-alcoholic fatty liver disease causes _____, or fat build-up in the liver that is not related to alcohol consumption

Steatosis

Non-alcoholic fatty liver disease is most common in what populations?

-BMI 35 or over -Type 2 diabetics -Those with metabolic syndrome

Non-alcoholic fatty liver disease can be managed with _____ changes

Lifestyle

What lifestyle changes can be used to treat non-alcoholic fatty liver disease?

-Weight loss (7-10% of starting weight; no rapid weight loss because greater flux of fatty acids to the liver may worsen inflammation and accelerate disease progression) -Healthful eating (Mediterranean diet, moderate alcohol, avoid sugar-sweetened beverages, coffee may help due to antioxidants) -Physical activity (150 minutes of moderate-intensity aerobic activity, plus two strength training sessions each week)

_____ is inflammation of the gallbladder

Cholecystitis

Cholecystitis can be caused by an infection, which causes excess water to be absorbed, causing _____ to precipitate out

Cholesterol

When cholesterol precipitates out, ____ can form

Gallstones

Another term for gallstones is _____

Cholelithiasis

Treatment for cholecystitis includes a ____-____ diet

Low-fat

Someone with acute cholecystitis should get ____-___ grams of fat per day

30-45

Someone with chronic cholecystitis should get ____-_____% of kcals from fat

25-30

A ____ is a surgical removal of the gallbladder

Cholecystectomy

After a cholecystectomy, ____ is secreted from the liver directly into the intestine

Bile

MNT for s/p cholecystectomy:

-Limit fat intake for several months to allow the liver to compensate -Slowly increase fiber to help normalize bowel movement

Pancreatitis causes...

-Inflammation with edema -Cellular exudate -Fat necrosis

Pancreatitis may be due to a blockage or reflux of the ____ ____

Ductal system

Pancreatitis causes premature activation of enzymes within the pancreas, leading to _____

Autodigestion

Acute pancreatitis causes a hypermetabolic and hyperdynamic state, leading to increased ____ ____ ____

Basal metabolic rate

MNT for acute pancreatitis:

-Put pancreas at rest by withholding all feedings -Maintain hydration (IV) -Progress as tolerated to easily digested foods with low-fat content -Elemental (pre-digested) enteral nutrition into the jejunum may be tolerated

Chronic pancreatitis causes recurrent attacks of ____ ____ of long duration

Epigastric pain

Someone with chronic pancreatitis should get ____ ____ _____ _____ which is taken orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase

Pancreatic enzyme replacement therapy (PERT)

MCT oil can be used in someone with chronic pancreatitis because they do not require ____ ____ for digestion (can add it to mixed dishes, jams, jellies, etc)

Pancreatic lipase

To promote weight gain in someone with chronic pancreatitis, give maximum level of ____ tolerated without an increase in steatorrhea or pain

Fat

If someone with chronic pancreatitis is malabsorbing fat-soluble vitamins, give them in ___-___ form

Water soluble

Parenteral ____ may be provided to someone with chronic pancreatitis because pancreatic protease (which is low in pancreatitis) splits off the vitamin from the carrier

B12

In someone with chronic pancreatitis, pancreatic ____ secretion may be defective so an antiacid may be given to increase the efficiency of PERT

Bicarbonate

In severe, prolonged cases of chronic pancreatitis, ____ ____ may be needed

Parenteral nutrition

What can be done to avoid pain with chronic pancreatitis?

-Avoid large meals with fatty foods -Avoid alcohol

Cystic fibrosis is a disease of ____ glands

Exocrine

Cystic fibrosis causes secretion of thick ____ that obstructs glands and ducts

Mucous

Cystic fibrosis causes ____ ____ deficiency

Pancreatic enzyme

Those with cystic fibrosis also have high perspiration _____ levels

Electrolyte

Cystic fibrosis can also cause _____ because it affects the transport of chloride across the cell membrane

Malabsorption

For those with CF, use age-appropriate ____ to assess height and weight

BMI

Those with CF may require ____ ___ ___ ____ at meals and snacks

Pancreatic enzyme replacement therapy

Diet for someone with CF should be...

-High protein -High calorie -Unrestricted in fat -Liberal in salt

If someone with CF is growing normally and steatorrhea is controlled, provide calories to cover the ____ for age and sex

RDA

If someone with CF is failing to grow, use BEE x ____ ____ plus disease coefficients

Activity factor

Patients with CF who fail to grow may need ____-___% of normal energy needs

110-200

For those with CF, protein should make up ____-___% of calories because they experience malabsorption due to pancreatic deficiency

15-20

For someone with CF, carbohydrates should make up ___-___% of total calories

45-55

Those with CF need liberal fat intake to compensate for high energy needs; fat should make up ___-___% of total kcal

35-40

Those with CF require a high sodium intake; they need an additional ___-___ g/day in hot weather or with heavy perspiration

2-4

Those with CF should receive age-appropriate doses of ___-___ vitamins and minerals

Water-soluble

What supplements should be provided to someone with CF?

-Zinc -Water soluble form of fat-soluble vitamins (A and E)

____ blood pressure is the greatest pressure and measures during the contraction; ____ is the least pressure and measures during relaxation

Systolic, diastolic

Hypertension may be ____ (essential), or ____ (due to another disease)

Primary, secondary

Hypertension is classified in stages based on risk of developing ____ ____ ____

Coronary artery disease

Normal blood pressure:

<120/80 mm Hg

Elevated blood pressure:

Systolic between 120-129 AND diastolic under 80

Stage 1 hypertension:

Systolic between 130-139 OR diastolic between 80-89

Stage 2 hypertension:

Systolic at least 140 OR diastolic at least 90

____ is a major factor in the cause and treatment of hypertension

Obesity

Thiazide diuretics may be used to treat hypertension; a common adverse effect is _____

Hypokalemia

What are the four modifiable risk factors in primary prevention and treatment of hypertension?

-Overweight -High salt intake -Alcohol consumption -Physical inactivity

For the management of hypertension, salt restriction of under ____ mg/day should is recommended

2300

The DASH diet recommends...

-Whole grains -Fruits -Vegetables -Low-fat dairy -Poultry -Fish -Moderate sodium -Limit alcohol -Decrease sweets -Calcium-rich foods to meet DRI

The _____ diet can also be used for the management of hypertension

Mediterranean

The Mediterranean diet is high in ___ ____ ____ and ____ fats

Alpha-linolenic acid (omega 3); monounsaturated

What are some types of fats that the Mediterranean diet promotes (high omega 3)?

-Olive oil -Canola oil -Soybean oil -Walnuts -Almonds -Pecans -Peanuts -Pistachios

What else does the Mediterranean diet promote?

-Fish, poultry, and eggs rather than beef -Breads -Fruits and vegetables in abundance -Beans and legumes -Yogurt -Cheese -Moderate consumption of wine with meals

____, which is an antioxidant in the skin of red grapes, may help lower blood pressure

Reservatrol

What factors increase the risk of atherosclerosis?

-Hypertension -Obesity -Smoking -Elevated blood lipids -Heredity

Coronary artery disease causes hard, ____ arteries from plaque buildup

Narrow

____ is a deficiency of blood due to obstruction

Ischemia

_____ is the loss of elasticity of blood vessel walls

Arteriosclerosis

A ____ ____ is due to a reduction of coronary blood flow to the myocardium due to a blood clot blocking a narrowed coronary artery

Myocardial infarction

_____ ____ is another term for chest pain

Angina pectoris

____ is a medication that can be given for blood clots

Heparin (blood thinner)

Dyslipidemia describes both...

-High triglycerides -Low HDL

____ are a type of lipoprotein synthesized in the intestine from dietary fat

Chylomicrons

Chylomicrons transport dietary triglyceride from the gut to the ____

Adipose

Chylomicrons are the ____ density lipoproteins and have the smallest amount of protein

Lowest

VLDL (pre-beta) transport ____ ____ from the liver to the adipose

Endogenous triglycerides

LDL (beta) transports ____ from the diet and liver to all cells

Cholesterol

Small dense LDL (LDL-C) is associated with increased risk; it is _____ to diet

Responsive

Larger buoyant LDL is ____ associated with an increased risk

Not

HDL (alpha) does reverse cholesterol transport; it moves cholesterol from the ____ to the ____ for excretion

Cells; liver

IDL (between pre-beta and beta) is an LDL precursor and causes ____ of other lipoproteins

Catabolism

____ ____ is diagnosed based on having 3 or more risk factors; diagnosis is linked to insulin resistance, which often increases risk for coronary events

Metabolic syndrome

What are the risk factors that the diagnosis of metabolic syndrome is made upon?

-Elevated blood pressure (130 or more systolic, and/or 85 or more diastolic) -Elevated triglycerides 150 or more -Fasting serum glucose 100 or more -Waist measurement 40 inches or more in men or 35 inches or more in women -Low HDL under 40 in men or under 50 in women

Optimal LDL level is under ____

100

Optimal total cholesterol level is under ____

200

Low HDL cholesterol for men is under ____ and for women it is under ____

40; 50

HDL cholesterol is high if it is ____ or above

High ____ levels are independent risk factors for CHD

Homocysteine

Normal triglyceride level is under ____

150

The ___ ___ diet is for the prevention and treatment of cardiovascular disease

Heart Healthy

The heart-healthy diet provides under ___% of total calories from saturated fat

The heart-healthy diet provides under ____ mg of cholesterol

200

The heart-healthy diet provides no more than ____ g of sodium

The heart-healthy diet promotes:

-Whole grains -Fruits -Vegetables -Low-fat or fat-free dairy -Unsaturated fats

The heart healthy diet promotes ___-___ g of fiber intake per day, with ___-___ g of soluble fiber

20-30; 5-10

The adult treatment panel (ATP IV) does not focus on specific target levels for LDL, but defines _____ for whom lowering LDL would be most beneficial

Groups

The adult treatment panel recommends a heart-healthy diet and statin therapy for...

-Patients who have atherosclerotic cardiovascular disease -Patients with LDL of 190 or higher -Patients with type 2 diabetes who are between 40 and 75 years of age -Patients with an estimated 10-year risk of cardiovascular disease of 7.5% or higher who are between 40 and 75 years old

____ ____ is when a weakened heart fails to maintain adequate output, resulting in diminished blood flow so fluid is held in tissues (edema); causes dyspnea

Heart failure

With heart failure, there is reduced blood flow to the kidneys which causes secretion of hormones that hold in sodium and fluid, leading to ___ ___

Weight gain

____ is a medication used in heart failure to increase the strength of the heart contraction

Digitalis

Someone with heart failure should limit sodium intake to ___-___ g/day (DASH diet)

2-3

Those with heart failure should also limit fluid intake to ___-___ L/day

1-2

Those with heart failure should get ____-____ g/kg ABW of protein per day for both normally nourished and malnourished patients

1.1-1.4

Energy needs for heart failure is calculated by multiplying _____ by an activity factor

RMR

Activity factor for a sedentary patient with heart failure:

1-<1.4

Activity factor for a low-active patient with heart failure:

1.4-<1.6

Activity factor for an active patient with heart failure:

1.6-<1.9

Activity factor for a very active patient with heart failure:

1.9-<2.5

Use indirect calorimetry to determine RMR; if that is not available, estimate RMR at ____ kcal/kg for normally nourished or ____ kcal/kg for malnourished

22; 24

In someone with heart failure, evaluate ____ status (can be lost with loop diuretics; if low, pyruvate cannot be converted into acetyl CoA for energy, so the heart muscle becomes deprived

Thiamin

What should be supplemented in someone with heart failure?

-DRI for folate and magnesium -MVI with B12

Those with heart failure should be encouraged to do regular ____ ____

Physical activity

____ ____ is unintended weight loss caused by blood that is backed up into the liver and intestines, causing nausea and decreased appetite

Cardiac cachexia

____ and ____ supplementation may help with cardiac cachexia

Arginine and glutamine

What is the MNT for cardiac cachexia?

-Low saturated fat -Low cholesterol -Low trans fat -<2 g sodium -High calorie

The _____ is a tuft of capillaries held closely by Bowman's Capsule; it produces ultrafiltrate which then passes through the tubules

Glomerulus

Bowman's capsule blocks the passage of ____ ____ ____ and large molecules like protein

Red blood cells

The proximal convoluted tubule is the site of major ____ ____

Nutrient reabsorption

The Loop of Henle maintains ____ and ____ balance

Water and sodium

The distal tubule is responsible for maintaining ____-___ balance

Acid-base

What are the 4 renal functions?

-Filtration -Absorption -Excretion -Secretion

The kidneys make sure red blood cells and protein stay in the blood, all else filters through the ____

Tubules

The kidneys absorb ____% of glucose and amino acids, as well as ___% of water, sodium, and potassium

100; 85

The kidneys excrete...

-Wastes -Urea -Excess ketones

What types of things do the kidneys secrete?

-Hormones that control blood pressure -Blood components -Ions that maintain acid-base balance

Vasopressin, also known as ____ ____, is secreted from the hypothalamus and stored in the pituitary gland

Antidiuretic hormone

Vasopressin (ADH) exerts a ____ effect and elevates blood pressure

Pressor

Vasopressin (ADH) increases ____ ____ from the distal and collecting tubules

Water resorption

The syndrome of inappropriate antidiuretic hormone causes (too much vasopressin) causes ______ caused by hemodilution

Hyponatremia

Hyponatremia is treated with a ____ ____

Fluid restriction

Renin is a hormone that causes ____ and elevates blood pressure

Vasoconstriction

Renin stimulates ____ to increase sodium absorption and return blood pressure to normal

Aldosterone

Erythropoietin is a hormone produced by the kidney; it stimulates the bone marrow to produce ___ ___ ___

Red blood cells

In renal disease, someone has decreased ____ and ____ ____

GFR; creatinine clearance

In renal disease, someone has increased serum ____ and ___

Creatinine and BUN

A BUN: Creatinine ratio of over ___indicates a "pre-renal state" in which BUN reabsorption is increased due to acute kidney damage (may be reversible and may not require dialysis)

20:1

A BUN: Creatinine ratio of under ____ suggested reduced BUN reabsorption due to renal damage (may need dialysis)

10:1

Renal ___ ____ describes solutes excreted in 1 L urine; daily fixed load of 600 mOsm

Solute load

Renal solute load mainly measures ___ (60%) and electrolytes (____)

Nitrogen; sodium

Manifestations of renal disease:

-Anemia due to decreased production of erythropoietin -Upset in blood pressure -Decreased activation of vitamin D

The kidneys produce the active form of vitamin D which promotes efficient absorption of ____ by the gut

Calcium

Renal ____ can be prevented by drinking 1.5-2 L of fluid in order to dilute the urine

Calculi

Calcium oxalate stones can be prevented with...

-Adequate calcium intake (RDA from dairy or supplements with meals) to bind oxalates -Low oxalate diet (40-50 mg)

Founds high in oxalates:

-Dark leafy greens -Chocolate -Strawberries -Nuts -Beets -Tea

More calcium oxalate stones are seen in patients with diets that are low in ____

Calcium

Minerals that are not oxidized in metabolism leave an ____ (residue) in the urine

Ash

To prevent acidic kidney stones, create an alkaline ash by increasing cations like calcium, sodium, potassium, and magnesium by adding to the diet things like...

-Vegetables -Fruits -Brown sugar -Molasses

To prevent alkaline stones, create an acidic ash by increasing anions like chloride, phosphorus, and sulfur by adding into the diet things like...

-Meat -Fish -Fowl -Eggs -Shellfish -Cheese -Corn -Oats -Rye

___ ____ ____ is a sudden shutdown of the kidney with previously adequate capacity; causes decreased GFR and inadequate pre-renal perfusion

Acute kidney injury

Acute kidney injury can result from...

-Burns -Accidents -Obstructions -Severe dehydration

Symptoms of acute kidney injury:

-Oliguria (<500 ml urine) -Azotemia (increased urea in blood)

With acute kidney injury, at first we should provide...

IV glucose, lipids, protein

Someone with an AKI should get ___-___ g/kg of protein if they are non-catabolic without dialysis as GFR returns to normal

1-1.3

Someone with an AKI should get ___-___ g/kg of protein if they are catabolic and/or if dialysis is initiated

1.2-1.5

Those with AKI should get ____-____ kcals/kg or BEE x ___-___ during hypermetabolic conditions

25-40; 1.2-1.3

Energy expenditure ____ as kidney function declines

Increases

Those with AKI should have a low-sodium diet of no more than ___-___g; must replace loses during diuretic phase

2-3

Those with AKI should get ___-___ mg/kg phosphorus; they made need phosphorus binders

8-15

Those with AKI should get ___-___ grams of potassium based on output, serum potassium, and dialysis

2-3

For someone with AKI, replace fluid output from the previous day plus ____ ml

500

Nephrotic syndrome is also known as ____

Nephrosis

With nephrotic syndrome, there is increased ____ and decreased ____ of VLDL

Synthesis; clearance

Nephrotic syndrome is caused by a defect in the capillary basement membrane of the glomerulus which permits the escape of large amounts of ____ into the filtrate moving through the tubules

Protein

Nephrotic syndrome causes...

-Albuminuria -Edema -Malnutrition -Hyperlipidemia

Those with nephrotic syndrome should get ___-___ g/kg of protein with 50% from high-biological value protein

0.8-1

In someone with nephrotic syndrome, excess protein will be catabolized to ____ and excreted

Urea

Those with nephrotic syndrome should get under ____% of total kcal from fat (low saturated fat)

Those with nephrotic syndrome should get no more than ____ mg of cholesterol

200

Someone with nephrotic syndrome should get ____ kcal/kg per day

Someone with nephrotic syndrome should have a modest sodium restriction of ___-___ g/day, depending on hypertension and edema

2-3

Those with nephrotic syndrome should get ___-___ g/day of calcium, and supplement with vitamin D as well

1-1.5 (1000-1500 mg)

Those with nephrotic syndrome might need ____ restriction if they have edema

Fluid

People with nephrotic syndrome may have abnormalities in what vitamins/minerals, related to protein loss?

-Iron -Copper -Zinc -Calcium

Chronic kidney disease causes...

-Anemia -Weakness -Weight loss -Nausea -Vomiting

Anemia with CKD is due to deficient production of the hormone ____ by the kidney

Erythropoietin

What types of diets are recommended for those with CKD?

-Mediterranean diet -DASH diet -High fruit and vegetable intake

Those with CKD should get ___-___ kcal/kg per day

25-35

Those with CKD should get under ____ mg of sodium per day

2300

For CKD stages 3-5, we should recommend ___-___ g/protein per kg or 0.28-0.43 g/kg with keto acid to meet goal

0.55-0.6

In those with CKD, adjust ____ intake to maintain normal serum levels

Phosphorus

Those with CKD should get ___-___ mg of total elemental calcium per day

800-1000

____ is generally not restricted in CKD unless serum level is elevated and urine output is under 1 L/day

Potassium

____ is generally unrestricted for CKD stages 1-4

Fluid

What types of supplements should be considered in those with CKD?

-Folate -B12 -B complex -Vitamin C -Vitamin D

The long-term goal of chronic renal failure is to prevent ____

Malnutrition

Those on hemodialysis should get ___-___ g/kg SBW of protein per day

1-1.2

Those on hemodialysis should get ___-___ kcal/kg

25-35

Those on hemodialysis should get under ____ g of sodium per day

2.3

Those on hemodialysis should get ___-___% of their calories from fat, with under ___% from saturated fat

25-35; 7

Those on hemodialysis should get under ____ mg of cholesterol per day

200

Fluid intake for someone on hemodialysis should be based on...

-Body weight -Urine output -Residual kidney function

For those on hemodialysis, adjust ____ intake to maintain normal serum range

Potassium

Calcium intake for those on hemodialysis should also be individualized with a maximum of ____ grams of total elemental calcium

Those on hemodialysis should get ____-____ mg of phosphorus per day or under ____ mg/kg IBW or SWB

800-100; 17

Those on hemodialysis might need supplementation of what vitamins/minerals to correct deficiencies?

-B6 (pyridoxine) -Folate -B12

In someone on hemodialysis, supplement vitamin ___ and ___ if deficient

C and D

Vitamin ___ and ___ supplements are not recommended for those with ESRD

A and E

Those on peritoneal dialysis should get ___-___ g/kg SBW/ABW of protein

1-1.2

Those on peritoneal dialysis should get ___-___ kcal/kg

25-35

Those on peritoneal dialysis should get under ____ g of sodium per day

2.3

____ is generally restricted for those on peritoneal dialysis (generally 2-4 grams)

Potassium

Those on peritoneal dialysis should get under ____ mg of total elemental calcium, including diet and binders

2000

Those on peritoneal dialysis should get ___-___ mg of phosphorus of ___-___ mg phosphorus per g of protein

800-1000; 10-15

Those on peritoneal dialysis should get ___-___ L of fluid depending on output and cardiac status

1-3

___ ____ ____ ____ takes place 4-5x per day

Continuous ambulatory peritoneal dialysis

Vitamins and minerals for those on peritoneal dialysis are the same as for those on ____

Hemodialysis

Type 1 diabetics are insulin ____, and depend on exogenous insulin

Deficient

Type 2 diabetics are insulin ____ with relative insulin deficiency (may or may not need exogenous insulin)

Resistant

One risk factor for diabetes in ____ ____ which causes gray-brown pigmentation in skin folds due to insulin resistance

Acanthosis nigracans

Another risk factor is the presence of ___ ___ ___ antibodies

Glutamic acid decarboxylase

Normal blood glucose is ___-___ mg/dl, or under ____ 2 hours post-prandial

70-100; 140

Impaired fasting blood glucose is between ____-____

100-125

Impaired glucose tolerance is indicated by a 2-hour post-prandial glucose of ___-___

140-199

Diabetes can be diagnosed based on...

-Fasting plasma glucose 126 or over, OR -Glucose tolerance test of 200 or over, OR -Symptoms of diabetes plus casual plasma glucose 200 or more -HgA1C of 6.5 or over

Glycosylated hemoglobin A1C measures the percent of ____ that has ____ attached

Hemoglobin; glucose

Normal A1C is under ___%

5.7

Healthy adults over 65 should have an A1C under ___%; frail elderly under ___% and under

7; 8

The A1C goal for those with diabetics is ____%

Those at risk for diabetes have an A1C of ____-____%

5.7-6.4

A1C is a measure of ___-___ blood glucose control (60-90) days

Long-term

When there is a high concentration of ____, it forms chemical bonds with hemoglobin; the longer blood glucose is high, the higher the A1C

Glucose

____ ____ compares the blood glucose response of a food to a standard glucose load

Glycemic index

The glycemic index is affected by cooking methods and the processing of ____

Starch

As particle size of starch decreases, the glycemic index ____

Increases

What are examples of foods with low glycemic indexes?

-Legumes -Milk -Whole grains -Fruits -Vegetables

Glycemic ____ is the weighted average of the glycemic indexes of all foods eaten

Load

The use of ___ ___ as a method for weight loss or weight maintenance is not currently recommended

Glycemic index

What are the treatment goals for all diabetics?

-Maintain normal blood glucose (average pre-prandial goal is 70-130, peak post-prandial average <180) -Optimal serum lipid levels (LDL <100, TG<150, HDL >40M and >50W) -Blood pressure goal of <130 over <80 -Prevent and treat chronic complications

For type 1 diabetics, along with daily doses of insulin, they should have a ___-___ diet

Carbohydrate-consistent

Those with T1D should integrate ____ therapy with their usual eating habits

Insulin

Monitor blood glucose and adult insulin dose for the amount of ____ eaten

Food

With intensive insulin therapy for T1D, adjust pre-meal insulin dosages based on the total ____ content of each meal, using an insulin-carbohydrate ratio

Carbohydrate

For those with T1D, it might be a good choice to ____ insulin dosage for planned exercise

Reduce

For endurance athletes with T1D, maintaining blood glucose of ___-___ mg/dl is the guideline during activity

120-180

For T2D, strategies focus on...

-Healthy eating -Physical activity

Goal for T2D is to achieve ___, ___, and ___ ___ goals

Glucose, lipid, blood pressure

Those with T2D should achieve ___ ___ is needed by improving food choices, spacing meals, and exercise

Weight loss

What are two risk factors for the development of gestational diabetes?

-BMI >30 -History of gestational diabetes

At 24-28 weeks of gestation, screen women with a 50-gram oral glucose load; a blood glucose of ____ or over indicates the need for further testing

140

Those with gestational diabetes should get ___-___% of kcals from carbohydrates through 3 small-medium sized meals and 2-4 snacks

40-45

The DRI for carbohydrates during pregnancy is ____ g/day

175

Those with gestational diabetes should get ___-___ grams of carbohydrates at breakfast (less well tolerated), with the rest of the 175 divided evenly throughout the rest of the day

15-30

Gestational diabetes increases the risk of...

-Fetal macrosomia (LGA, 4000-4500 grams) -Fetal hypoglycemia at birth

Overweight or obese pregnant woman should have a modest ____ ____ to slow weight gain

Calorie restriction

There is no ideal amount of carbohydrates recommended for all individuals with diabetes; the strategy selected should be based on their abilities, preferences, and ____ goals

Treatment

Macronutrient distribution for those with diabetes should be based on ____ for healthy adults (<7% total kcals as saturated fat, trans fat minimized, encourage fiber intake, etc)

DRIs

In diabetics, ____ may be substituted for other carbohydrates

Sucrose

Carbohydrate management approaches include...

-Carbohydrate counting -Plate method for portion control -Carbohydrate exchange list

One choice from the starch, fruit, or milk list is equal to ___ grams of carbohydrates and one carb choice

Foods with ___-___ grams of carbohydrate count as 0.5 carbohydrate serving/choice

6-10

The consistent carb diet provides ___-___ carbohydrate choices per meal, along with ___-___ carbohydrate choices during snacks

3-5; 0-4

Food lists for diabetes macros for starch/bread choice:

-15 g carbs -3 g protein -1 g fat -80 kcal

Food lists for diabetes macros for a fruit choice:

-15 g carbs -60 kcal

Food lists for diabetes macros for a fat-free, low-fat milk choice (1%):

-15 g carbs -8 g protein -0-3 g fat -100 kcal

Food lists for diabetes macros for a reduced-fat (2% milk choice:

-15 g carbs -8 g protein -5 g fat -120 kcal

Food lists for diabetes macros for a whole milk choice:

-15 g carbs -8 g fat -8 g protein

Food lists for diabetes macros for a non-starchy vegetable:

-5 g carbs -2 g protein -25 kcal

Food lists for diabetes macros for 1 oz lean protein source (example: Canadian bacon, poultry, fish, lunch meat):

-7 g protein -2 g fat -45 kcal

Food lists for diabetes macros for 1 oz medium-fat protein source (pork, beef, ricotta, mozzarella, eggs, tofu):

-7 g protein -5 g fat -75 kcal

Food lists for diabetes macros for 1 oz high-fat protein source (peanut butter, cheese, corned beef):

-7 g protein -8 g fat -100 kcal

1 oz/1 choice of plant-based protein provides ____ grams of protein

One fat choice provides ____ grams of fat per serving

One choice of alcohol provides ____ kcal

100

"Free foods" in terms of the food list for diabetes have under ___ grams of carbohydrates and under ___ calories

5; 20

Bolus insulin is taken _____

Premeal (prandial)

What are examples of rapid-acting insulin?

-Aspart (Novolog) -Lispro (Humalog)

Rapid-acting insulin (aspart, lispro) should be taken ___-____ minutes before eating

5-15

The usual duration of rapid-acting insulin is ___ hours

What is one example of a short-acting insulin:

Humulin R

Short-acting insulin (Humulin R) should be taken ___-___ minutes before a meal (it gives a burst of insulin to cover the meal just about to be eaten)

30-45

One unit of short-acting insulin covers ___-___ grams of carbohydrates

10-15

The duration of short-acting insulin is ___-___ hours

3-6

What are three examples of intermediate-acting insulin?

-NPH -Humulin N -Novolin N -ReliOn

The onset of intermediate-acting insulin (humulin N, Novolin N, reliOn) is ___-___ hours

2-4

The duration of intermediate-acting insulin is ___-___ hours

10-16

Intermediate-acting insulin looks ____ in appearance

Cloudy

What are two examples of long-acting insulin?

-Glargine (Lantus) -Determir (Levemir)

The onset of long-acting insulin is ___-___ hours

2-4

The duration of long-acting insulin is ___-___ hours

18-24

Long-acting insulin should be started at ___-___ units/kg and should be taken at the same time each day

0.1-0.2

Fixed or conventional insulin therapies used a premixed or fixed insulin plan; ___ or ___ insulin is combined with ___ or ___ acting insulin

Basal (long acting) or intermediate and short or rapid

With multiple daily injections of insulin, ____ insulin is used once or twice daily as well as ___-___ insulin before meals (more common)

Basal (long-acting); rapid-acting

Continuous sustained insulin infusion requires an ____ ____ that provides steady, measured continuous doses of basal, and a surge (bolus) of insulin before meals

Insulin pump

What is an example of a Biguanide medication used for T2D?

Metformin (Glucophage)

Biguanides (Metformin) suppress ____ ____ production

Hepatic glucose

Biguanides (Metformin) are ___-___ therapy for those with T2D

First-line

Biguanides (Metformin) should be taken with ____

Food

When taking Biguanides (Metformin), check ____ levels; deficiency could lead to anemia or peripheral neuropathy

B12

Biguanides (Metformin) are weight ____

Neutral

There is a ____ risk of hypoglycemia with Biguanides (Metformin)

Low

What are two examples of DPP-4 inhibitors:

-Saxagliptin (Onglyza) -Sitagliptin (Januvia)

DPP-4 inhibitors (Saxagliptin, Sitagliptin) are often used concurrently with ____

Metformin (Biguanide)

DPP-4 inhibitors (saxagliptin, sitagliptin) allow endogenous ____ to stay active longer, which reduces glucose released by the liver overnight and between meals

GLP-1

DPP-4 inhibits like (saxagliptin and sitagliptin) are weight ____

Neutral

What are three examples of SGLT-2 Inhibitors?

-Canagliflozin (Invokana) -Dapagliflozin (Farxiga) -Empagliflozin (Jardiance)

SGLT-2 Inhibitors (-agliflozin) target blood glucose-lowering action in the ____ by blocking a protein that returns glucose to the blood after it is filtered

Kidneys

SGLT-2 Inhibitors (-agliflozin) causes more glucose to be excreted in the ____ and less to be reabsorbed

Urine

Monitor ____ function in those on SGLT-2 inhibitors (-agliflozin)

Kidney

SGLT-2 Inhibitors (-agliflozin) may aid in ____ ____

Weight loss

SGLT-2 inhibitors (-agliflozin) can be considered in patients with ____ and ____

Type 2 diabetes, CKD

What are three examples of GLP-1 receptor agonists?

-Exenatide (Byetta) -Dulaglutide (Trulicity) -Semaglutide (Ozempic)

GLP-1 receptor agonists (-glutide) slow ____ ___

Gastric emptying

GLP-1 receptor agonists (-glutide) enhance ____ secretion when glucose is high after eating

Insulin

GLP-1 receptor agonists (-glutide) suppresses postprandial ____ secretion

Glucagon

GLP-1 receptor agonists (-glutide) promote fullness and lead to ____ ____

Weight loss

What is one example of a Thiazolidinedione drug?

-Pioglitazone (Actos)

Thiazolidinediones (Actos) increase ____ ____ in muscle

Insulin sensitivity

Thiazolidinediones (Actos) may cause weight ____

Gain

What are two examples of sulfonylurea medication?

-Glimepiride (Amaryl) -Glyburide

Sulfonylureas (Glimepiride, Glyburide) are secretagogues that stimulate the ____ to release more insulin

Pancreas

Sulfonylureas (Glimepiride, Glyburide) may cause ____ and ___ ___

Hypoglycemia and weight gain

The _____ phenomenon explains the natural increased in early morning blood glucose and insulin requirements due to increased glucose production in the liver after an overnight fast

Dawn

Due to the dawn phenomenon, there is increased need for ____ at dawn

Insulin

Acute ketoacidosis causes ____ due to insulin deficiency or excess carbohydrate intake

Hyperglycemia

Acute ketoacidosis also causes ____ due to polyuria, as well as increased pulse

Dehydration

Acute ketoacidosis causes a ____ odor on the breath due to ketones

Fruity

Treatment for acute ketoacidosis:

-Rehydration -Insulin

Acute hypoglycemia is due to insulin ____ or lack of ____

Excess; eating

Hypoglycemia causes symptoms like...

-Slow pulse -Cool, clammy skin -Hunger -Weakness -Shakiness -Sweating

The treatment for acute hypoglycemia is ____

Glucose

Protocol for treating hypoglycemia:

-Begin with 15 g carbohydrates from glucose tablets to fruit juice (4-5 oz), sugar -Wait 15 minutes, if still under 70 mg/dl, give another 15 grams of carbohydrates -Repeat and treat until blood glucose is normal

If hypoglycemic and unresponsible, administer ____ which will mobilize glucose from the liver

Glucagon

Long term complications of uncontrolled diabetes:

-Neuropathy (peripheral and autonomic, gastroparesis) -Retinopathy (leads to blindness) -Nephropathy (decreased kidney function)

Postpradial or reactive hypoglycermia is caused by either...

-Overstimulation of the pancreas -Increased insulin sensitivity

With reactive hypoglycemia, blood glucose falls below normal ___-___ hours after eating (<50 mg/dl)

2-5

Symptoms of reactive hypoglycemia:

-Weakness -Trembling -Extreme hunger

The goal with reactive hypoglycemia is to prevent a marked rise in blood sugar that would stimulate more ____

Insulin

To prevent reactive hypoglycemia...

-Avoid simple sugars -Eat 5-6 small meals per day -Spread intake of carbohydrates throughout the day -Protein at RDA levels

Adreanal cortex insufficiency is also known as ____ ____

Addison's Disease

Addison's disease causes ____ of the adrenal cortex; symptoms are due to the absence of adrenal hormones

Atrophy

What three hormones are low with Addison's disease?

-Cortisol -Aldosterone -Androgenic

Low cortisol levels cause...

-Glycogen depletion -Hypoglycemia

Low aldosterone causes...

-Sodium loss -Potassium retention -Dehydration

Low androgenic hormones causes...

-Tissue wasting -Weight loss

MNT for Addison's disease (low adrenal hormones):

-High protein -Frequent feedings -High salt

_____ is the excess secretion of thyroid hormone

Hyperthyroidism

With hyperthyroidism, elevated T3 and T4 causes increased ___ ___ ___, leading to weight loss

Basal metabolic rate

Those with hyperthyroidism have increased ____ needs

Calorie

_____ is the deficiency of thyroid hormone

Hypothyroidism

Those with hypothyroidism have decreased ___ with either normal or low ___; they have decreased basal metabolic rate which leads to weight gain

T4; T3

Those with hypothyroidism might need weight ____

Reduction

A ____ is an enlargement of the thyroid gland due to insufficient thyroid hormone

Goiter

An endemic goiter is caused by inadequate ____ intake

Iodine

MNT for someone with a goiter:

-Iodized salt -Diet free of goitrogens (cruciferous vegetables)

Gout is a disorder of ____ metabolism

Purine

Gout causes increased serum ____ ____, which then deposits in joints and causes pain and swelling

Uric acid

MNT for gout:

-Achieve and maintain healthy body weight -Moderate protein intake -Liberal carbohydrate intake -Low to moderate fat -Decrease alcohol -Liberal fluid -Avoid high purine foods

What are examples of high-purine foods that should be avoided in someone with gout?

-Anchovies -Sardines -Organ meats -Sweetbreads -Meat-based gravies and extracts (vegemite, marmite)

Medications used for gout, such as ___ ___ and ____ induce the loss of nutrients

Urate eliminant, colchicine

____ is the lack of an enzyme that normally would have converted galactose-1-phosphate to glucose-1-phosphate

Galactosemia

Galactosemia is treated solely by diet- ____ and ____ free

Galactose and lactose

What is restricted on a galactosemia diet?

-Organ meats (naturally contain galactose) -MSG extenders -Milk -Lactose -Galactose -Whey -Casein -Dry milk solids -Curds -Calcium or sodium caseinate -Dates -Bell peppers

What is okay on a galactosemia diet?

-Soy -Hydrolyzed casein -Lactate -Lactic acid -Lactalbumin -Pure MSG

A urea cycle defects make the body unable to synthesize ___ from ammonia, resulting in ammonia accumulation

Urea

Symptoms of urea cycle defects:

-Vomiting -Lethargy -Seizures -Coma -Anorexia -Irritability

Someone with urea cycle defects should have a ____ restriction (1, 1.5, 2 g/kg) based on tolerance, age, and projected growth rate in order to lower ammonia

Protein

Those with urea cycle defects can use therapeutic formulas to adjust protein composition to limit ____ production

Ammonia

What is one specific example of a urea cycle defect?

-Ornithine transcarbamylase (OTC) deficiency

____ is caused by a missing enzyme, phenylalanine hydroxylase, which would convert phenylalanine to tyrosine

Phenylketonuria (PKU)

PKU causes ____ and its metabolites to accumulate, leading to poor intellectual function

Phenylalanine

PKU is detected with a ____ blood test

Guthrie

For someone with PKU, restrict the substrate _____ and supplement with ____

Phenylalanine; tyrosine

With PKU, tyrosine becomes a ____ amino acid

Conditional

The PKU diet is low in phenylalanine, but still provides enough to promote normal ____

Growth

What are examples of low phenylalanine formulas?

-Phenex-1,2 -Phenyl-free 1,2

Those with PKU should avoid the artificial sweetener, ____

Aspartame

The need for phenylalanine decreases with...

-Increased age -Infection

A low protein, high carbohydrate diet in those with PKU may lead to ___ ___

Dental caries

Glycogen storage disease is the deficiency of ___-__-___ in the liver

Glucose-6-phosphatase

Glycogen storage disease impairs ____ and ____

Gluconeogenesis and glycogenolysis

With glycogen storage disease, the liver can't convert ____ into ____, leading to hypoglycemia

Glycogen into glucose

For someone with glycogen storage disease, provide a consistent supply of exogenous glucose with ___ ____ at regular intervals

Raw cornstarch

Those with glycogen storage disorders should have a high ____, low ____ diet

Carbohydrate, fat

Homocystinurias is a treatable inherited disorder of ___ ___ metabolism

Amino acid

Homocystinurias is characterized by severe elevations of ____ and ____ in plasma, and excessive excretion of ____ in urine

Methionine, homocysteine, homocysteine

Homocystinurias is associated with low levels of...

-Folate -B6 (pyridoxine) -B12 (cobalamin)

Patients newly diagnosed with homocystinurias receive ____ doses of folate, pyridoxine, and B12

Increased

If someone with homocystinurias does not respond to folate, pyridoxine, and B12, they should be on a low ____, low ____ diet

Protein, methionine

Maple Syrup Urine Disease is an inborn error of metabolism of the ____, which include...

BCAAs; valine, leucine, isoleucine

Symptoms of Maple Syrup Urine Disease:

-Poor sucking reflex -Anorexia -Failure to thrive -Irritability -Sweet burnt maple syrup odor of sweat and urine

With Maple Syrup Urine Disease, restrict BCAAs to ___-___ mg/day (may use MSUD powder)

45-62

For those with Maple Syrup Urine Disease, provide adequate energy from ___ and ____ to spare amino acids

Carbohydrates and fat

With Maple Syrup Urine Disease, you should include small amounts of ____ to support growth (gelatin may be used)

Milk

What should be avoided in someone with Maple Syrup Urine Disease?

-Eggs -Meat -Nuts -Dairy products

Those with Congenital Sucrase Isomaltase Disease require diet modification of...

-Sucrose -Starch -Maltose

Those with Congenital Sucrase Isomaltase Disease can take ____, which is an oral enzyme replacement for sucrase that is taken before and during meals and snacks

Sucrosidase

Those with Congenital Sucrase Isomaltase Disease who take sucrosidase do not need to restrict sucrose in their diet, just ___ and ____

Starch and maltose

Diabetics on sucrosidase need to check blood sugar levels because it converts sucrose into ___ and ___

Fructose and glucose

____ is a condition of inflammation of peripheral joints

Arthritis

Those with arthritis should follow a regular, well-balanced diet with vitamin intake to at least ____

DRIs

Those with arthritis might need to be on bed rest, take aspirin, and reduce weight to decrease ____

Stress

____ anemia may develop in those with arthritis because the inflammation of arthritis prevents the reuse of iron

Normocytic

A ___-___ diet may help those with osteoarthritis; it includes fresh fruits and vegetables and is similar to the Mediterranean diet

Anti-inflammatory

____ is a steroid that may reduce inflammation in those with arthritis

Methylprednisone

There are no specific dietary ____ for those with systemic lupus erythematosus; diet should be tailored to needs

Guidelines

Those with Lupus may have deficiencies of...

-Iron -Folate -Calcium -Fiber -B12

Those with Lupus may have anemia, but it is not correlated to ____ intake

Iron

Those with Lupus may show symptoms of ____ ____

Celiac disease

____ resorb and remove bone

Osteoclasts

____ reform bone

Osteoblasts

____ is the loss of bone tissue

Osteoporosis

Type I osteoporosis is ____ (within 15-20 years)

Postmenopausal

Type II osteoporosis is ___-___ (>70)

Age-associated

___ and ___ women have more osteoporotic fractures than Black and Hispanic women

Asian and white

Possible causes of osteoporosis:

-Malnutrition (especially protein) -Lack of exercise -Decline in estrogen

The result of osteoporosis is a reduction in the amount of bone due to defective ____ absorption (deossification)

Calcium

What are some possible treatments for osteoporosis?

-Hormone replacement therapy -Weight-bearing exercise -Vitamin D supplements (400-800 mg) -Calcium supplements (1200 or more mg; don't exceed 500-600 mg at one time) -Adequate protein -Moderate to low sodium -5 or more servings of fruits and vegetables

Calcium carbonate should be taken ___ ___, while calcium citrate can be taken with or without food

With food

Spread calcium throughout the day to maximize ____

Absorption

_____ is a reduction in bone density (demineralization)

Osteomalacia

Osteomalacia can be caused by a ___ ___ deficiency

Vitamin D

Treatment for osteomalacia includes...

-Vitamin D supplements -Calcium supplements

____ causes seizures and altered consciousness

Epilepsy

What are two examples of anticonvulsants used for epilepsy?

-Phenobarbitol -Phenytoin

Anticonvulsants like phenobarbital and phenytoin (Dilantin) can interfere with ____ absorption (take them apart from food)

Calcium

Those on phenytoin (Dilantin) or phenobarbital should get 1mg of ____ while taking the drug

Folate

Those on phenytoin (Dilantin) or phenobarbital may need supplementation of...

-Vitamin D -Calcium -Thiamin (B1)

Provide ____ separate from meals and other supplements

Phenytoin

Enteral feedings decrease the bioavailability of phenytoin, so hold tube feeds for at least ___ hours

The ____ diet is high fat, very low carbohydrate (4 grams of fat to 1 gram of non-fat)

Ketogenic

____% of calories should come from fat on the ketogenic diet

Those on the ketogenic diet should also get ___g/kg of protein, with the remaining kcal needed for carbohydrates

____ ____ behave as inhibitory neurotransmitters

Ketone bodies

Mild ___ is needed to prevent the dilution of ketones with the ketogenic diet

Dehydration

Those on the ketogenic diet need supplementation of...

-Calcium -Vitamin D -Folate -B6 (pyridoxine) -B12

____ may aid in the absorption of vitamins and minerals for those on the ketogenic diet

Spinach

____ are more ketogenic, and have more rapid metabolism and absorption

MCTs

Cerebral palsy is non-hereditary and causes ____ damage

Brain

Those with cerebral palsy have inadequate control of voluntary muscles, leading to ____

Spasms

The ____ form of cerebral palsy causes difficult, stiff movements; patients have limited activity and are commonly obese

Spastic

MNT for patients with spastic cerebral palsy:

-Low calorie -High fluid -High fiber

The ____ (athetoid) form of cerebral palsy cause involuntary wormlike movements; constant, irregular motions lead to weight loss

Non-spastic

MNT for those with non-spastic (athetoid) cerebral palsy:

-High calorie -High protein -Finger foods

Traumatic brain injuries cause a systemic inflammatory response, which leads to...

-Hypermetabolism -Hyperglycemia -Insulin resistance -Protein wasting

For those with a traumatic brain injury, enteral feedings into the ___ ___ is usually the best option

Small bowel

For those with traumatic brain injury, provide ___% of estimated resting energy expenditure (REE)

140

Those with traumatic brain injury need ___-___ g/kg of protein

1.5-2

What are some long-term effects of a spinal cord injury?

-Obesity -Cardiovascular disease -Pressure ulcers

In the acute phase of a spinal cord injury, energy needs may be ___% below predicted

In the acute phase of a spinal cord injury, protein needs are ____ g/kg

In the rehabilitation phase of a spinal cord injury, protein needs are ___-___ g/kg

0.8-1

Those in the rehabilitation phase of a spinal cord injury need ___ kcals/kg for quadriplegic and ____ kcal/kg for paraplegic

23; 28

Those with spinal cord injuries may develop ___ ____, which slows transit time

Neurogenic bowel

Those with neurogenic bowel should get 1 ml of fluid/kcal plus ____ ml/day

500

Those with pressure injuries who are also malnourished or at risk for malnutrition, provide ___-___ kcal/kg

30-35

Those with a stage I pressure ulcer should get ___-___ g/kg of protein

1.1-1.2

Those with a stage II pressure ulcer should get ___-___ g/kg of protein, along with adequate fluid

1.25-1.5

Those with a stage III/IV pressure ulcer should get ___-___ g/kg of protein depending on the size of the injury and protein loss from draining wound

1.5-2

Those with a pressure injury should have a well-balanced diet, including good sources of...

-Vitamin A -Vitamin C -Zinc -Copper

The ____ scale is used to stage pressure ulcers

Braden

Classifications of each stage of the Braden scale:

-Stage I: upper layer of skin, red and warm to the touch -Stage II: broken skin, open sore -Stage III: damage below skin surface into fat tissue -Stage IV: large wound, may affect muscles and ligaments

For those with ADHD, provide wholesome foods at ___ ____ with small servings followed by refills

Regular mealtimes

Sugar does not cause ____

Hyperactivity

One medication commonly used in those with ADHD is ___

Adderall

Side effects of Adderall:

-Loss of appetite -Nausea -Weight loss

If a child with ADHD is on is underweight, consider high-calorie snacks at ____

Bedtime

Unnecessary food restrictions, possible food aversions, and excessive supplementation can put a child with ___ ___ ___ at risk

Autism spectrum disorder

MNT for those with Alzheimer's disease:

-Avoid distractions (no TV during meals) -Regular, consistent mealtimes -Encourage self-feeding -Offer one course at a time -Lower saturated fats -Soft, calming music -Finger foods may be helpful -Avoid dehydration -Nutrient-dense foods -May need verbal cues to chew and swallow

Those with Alzheimer's may have ____, which is a form of aphasia; causes lost words, unable to recall names of common items

Anomia

What nutrients are associated with dementia?

-Folate -B6 (pyridoxine) -B12

____ is the decrease in total red blood cell mass due to fewer red blood cells or to smaller cells with less hemoglobin

Anemia

____, ____ anemia causes small, pale red blood cells

Microcytic, hypochromic

Microcytic, hypochromic anemia is caused by ___ ___

Iron deficiency

Microcytic, hypochromic anemia is associated with...

-Chronic infections -Malignancies -Renal disease

___, ____ anemia leads to FEW large cells that are filled with hemoglobin

Macrocytic, megaloblastic

Macrocytic, megaloblastic anemia is caused by deficiency of ___ or ____

Folate (B9) or B12

The ____ test is used to test for Pernicious anemia

Schilling

Lab values for microcytic, hypochromic anemia:

-RBC may be normal -Hemoglobin: Low -Hematocrit: Low -Mean corpuscular volume (cell size): Low (<80) -Mean corpuscular hemoglobin (hgb/cell; color): Low -Mean corpuscular hemoglobin concentration: Low (<31)

Lab values for macrocytic anemia (B12, folate):

-RBC: Decreased -Hemoglobin: Low -Hematocrit: Low -Mean corpuscular volume (cell size): High (>95) -Mean corpuscular hemoglobin (hgb/cell; color): High -Mean corpuscular hemoglobin concentration: Normal (>31)

____ causes defective hemoglobin synthesis

Thalassemia

Thalassemia results in ____, ____, short-lived red blood cells

Microcytic, hypochromic

Those with thalassemia may develop ___ ___

Iron overload

Patients with thalassemia should not avoid ___-rich foods

Iron

Thalassemia is managed with...

-Transfusions -Chelation therapy

MNT for thalassemia:

-High protein -B vitamins (especially folic acid/B9)

What foods are high in iron?

-Liver -Kidney -Beef -Dried fruit -Dried peas and beans -Nuts -Leafy, green vegetables -Fortified grain products

A typical American diet consists of ___ mg of iron per 1000 calories

An ___-___ allergic reaction occurs when an antigen enters the body and antibodies react

Ag-Ab

Allergies are an ____ (IgE) medicated reaction to normally harmless food protein

Immunoglobulin

What are the top 9 food allergens?

-Peanuts -Tree nuts -Fish -Shellfish -Wheat -Soy -Eggs -Sesame -Milk

What is the most common allergen in infants?

Cow's milk protein

Potentially allergenic foods, such as eggs and peanuts, should not be ____ beyond 4-6 months of age

Restricted

____ is a genetic predisposition to produce excessive IgE antibodies in response to an allergen

Atopy

Diagnosis of a food allergy is done by...

-Diet history -Skin tests -Elimination diet

The ___-___ blood test is specific in identifying children with milk, eggs, fish, and peanut allergies

CAP-FEIA

Double-blind, placebo-controlled food challenges identify food-induced symptoms; this is the ___ ___ for diagnosis of food allergies

Gold Standard

The ____ is an alternative to the skin test; serum is mixed with food on a paper disk; this measures specific IgE antibodies

RAST

____ is a food that is least likely to cause an allergy

Rice

Food ____ are non-IgE mediated; abnormal physiological response, GI, cutaneous, respiratory symptoms; NO antibody production

Intolerances

With fever and infection, excess fluid loss may lead to dehydration which causes symptoms like...

-Hyperglycemia -Dry, loose, inelastic skin

Treatment for someone with dehydration:

-IV feedings of dextrose and water, then -Diet high in calories and fluids

Basal metabolic rate increases ___% for each degree F rise in body temperature (normal temp 98.6 F)

The goals for someone in critical care/hypermetabolic state:

-Improve outcomes regarding infection rates -Decrease days in critical care -Decrease days on ventilator -Minimize catabolic loss of body protein -Initiate nutrition support (generally) whenever possible -Avoid overfeeding -Control blood glucose (140-180 mg/dl)

Enteral feeding should be initiated for those in critical care within ___-___ hours of admission

24-48

EAL recommends that the average intake within the first week of someone in critical care should be over ___% of total energy needs; consider fish oil supplements and antioxidants with ARDS and acute lung injury

With severe burns, there an immediate shock periods with catabolism; basal metabolic rate increases ___-___%

50-100

The first goal with severe burns is to replace ___ and ___ that were lost

Fluid and electrolytes

During the recovery period from a burn, patients have increased calorie needs based on burn size, which is estimated using the ___ ___ ___ which divides the body surface area into percentages

Rule of Nines

The arm including the hand, the head and neck, and the genitalia each account for ___% of the body's surface area according to the rule of nines

The anterior trunk, posterior trunk, and legs including feet each account for ___% of the body's surface area according to the rule of nines

Those with severe burns should get ___-___% of their calories from protein

20-25

Those with severe burns should also get ___-___ g/kg of protein (___g/kg if burns cover less than 10% of body surface area)

1.5-2; 1.2

Those with severe burns should get ____ mg x 2 of vitamin C per day

500

Those with burns should also get supplementation of...

-Water-soluble vitamins -Vitamin K if on antibiotics -Zinc for wound healing if deficient

If someone with burns is zinc deficient, provide ___ mg of zinc sulfate

220

Trauma causes a ____, fight or flight response

Hypermetabolic

Those with trauma have accelerated catabolism of lean body mass, leading to negative ___ ___ as protein is catabolized to release glucose for energy

Nitrogen balance

What results from physiologic trauma?

-Hyperglycemia -Hyperinsulinemia -Little or no ketosis -Increased glucagon to increase glucose production from amino acids

During trauma, catecholamines like epinephrine and norepinephrine stimulate hepatic ____

Glycogenolysis

Adrenocorticotropic hormone release during trauma causes the release of ____ which mobilizes amino acids from muscle

Cortisol

Aldosterone is also released during trauma, which causes...

-Renal sodium retention -Gluconeogenesis

Anti-diuretic hormone released during trauma leads to renal ____ reabsorption

Water

What are other outcomes of trauma?

-Hypovolemia -Decreased cardiac output -Drop in body temperature -Fluid and sodium retention -Potassium excretion

What minerals are often lost due to trauma?

-Nitrogen -Sulfur -Zinc -Phosphorus

Provide adequate, but not ____ calories for someone during/after trauma

Excessive

In the pre-active stage of dying, there is ____ intake of foods and fluids

Decreased

In the active stage of dying, someone may have an inability to ___, and may have abnormal breathing patterns

Swallow

What are common nutrition-related concerns with cancer patients?

-Protein-calorie malnutrition -Malabsorption -Fluid and electrolyte imbalances

For a cancer patient with altered taste acuity, add...

Flavors and seasonings

Cancer patients with meat aversions may require ____ of red meat

Elimination

MNT for oral thrush:

-Avoid spicy, acidic, or strongly flavored food -Provide bland liquids, soft foods, and chilled/frozen foods

For those with throat and neck cancer, provide enteral feedings through a ____

PEG

Cancer ____, or generalized wasting, is connected to cytokines and tumor necrosis factor (TNF)

Cachexia

____ may be a sign of breast cancer or metastasis to the bone

Hypercalcemia

Radiation therapy can cause side effects such as...

-Loss of taste -Xerostomia (helps to moisten food) -Esophagitis -Diarrhea -Malabsorption -Anorexia

____ is the inflammation of the mucosal lining of the oropharynx and the esophagus

Mucositis

With mucositis, avoid...

-Fresh, raw, uncooked foods (offer cold and soft food instead)

____ agents are chemical reagents that have toxic effects

Chemotherapy

What are some common side effects of chemotherapy?

-Nausea -Vomiting -Malabsorption -Anorexia -Stomatitis (cracks in the corners of the mouth)->caused by riboflavin deficiency

Methotrexate is an anti-_____ drug

Folate

_____ data is an interrelationship between the host, agent, and environment in causing disease

Epidemiological

There is some evidence that ___ and ___ are beneficial in overall cancer prevention (carotenoids, vitamin C)

Fruits and vegetables

There is some evidence that ____ in post-menopausal women decreases the risk of breast disease

Exercise

____ is a term for protein and calorie starvation

Marasmus

Marasmus is based on an ____ diagnosis as there is normal serum albumin and no edema with the condition

Anthropometric

Marasmus causes severe ___ and ___ wasting with a starved appearance

Muscle and fat

With marasmus, ___ ___ and ___ ___ ___ are decreased

Tricep skinfold and arm muscle circumference

____ malnutrition is protein-calorie malnutrition brought on by treatment, hospitalization, or medications

Iatrogenic

Anorexia nervosa causes...

-Distorted body image -Dramatic weight loss -Preoccupation with food and weight gain

Therapy for anorexia is ____ and includes weight restoration and psychotherapy

Multidisciplinary

The immediate concern with treating anorexia nervosa is to restore ____ imbalances

Electrolyte

For those with anorexia nervosa, focus on health benefits and ___-___ aspects of food

Life-sustaining

Re-feeding someone with anorexia nervosa increases ___ load (go slowly)

Cardiac

The recommended daily calorie intake for someone with anorexia nervosa ranges from ___-___ (__-__ kcal/kg), but may need to be set 100-300 calories above the current level of intake to support adherence

1000-1600; 30-40

___ ___ is characterized by binge eating followed by purging

Bulimia nervosa

What are some symptoms/consequences of bulimia nervosa?

-Damage to teeth, throat, or esophagus -Rectal bleeding (laxative abuse) -Bruised knuckles from purging with fingers -Low potassium and chloride levels

For those with bulimia, encourage ____ intake of three meals and 2-3 snacks daily; eat every 3-4 hours and recognize hunger cues

Structured

For those with bulimia, each meal should include a ___ source, a healthy ___ source, and a ___ ___ source

Protein; fat; complex carb

Those with bulimia should be encouraged to eat ___, and drink adequate water and fluids

Slowly

What are the three BMI classifications of obesity?

-Class I: 30-34.9 -Class II: 35-39.9 -Class III: 40+

In children, if BMI for sex and age is over at the ___ percentile or above, they are classified as obese

95th

There are ____ calories per pound of body weight

3500

To lose 1 lb of fat per week, reduce ____ calories per day

500

Early rapid weight loss during a diet is ___, as liver glycogen is utilized

Water

Treatment for obesity includes...

-Reduced caloric intake -Exercise -Behavior modification

A realistic weight loss goal can be...

-Up to 2 lb per week -Up to 10% of baseline body weight -Total reduction of 3-5% of baseline weight if cardiovascular risk factors are present

For women, calories can be restricted to ___-___ kcal/day, or ___-___ for men

1200-1500; 1500-1800

Calories can be restricted ___-___/day

500-750

Weight loss can also be achieved by following one of the evidence-based diets that restrict certain food types in order to create an ___ ___ by reduced food intake

Calorie deficit

Small, ___-___ changes can also help with weight loss such as changes in sugar-sweetened beverage intake

Food-based

Meal replacements for weight loss may be recommended if the client has difficulty with ___ ___

Portion control

For weight loss, ___-___ or more per week of phsyical activity is recommended; for weight maintenance, ___-___ is recommended

150-420; 200-300

Orlistat is a weight loss medication that works by inhibiting ____

Lipase

Orlistat should be taken with a diet with ___% of calories coming from fat

Those on Orlistat should take ___ supplements

Vitamin

Lorcaserin is a weight loss medication that is an agonist of ____

Serotonin

Lorcaserin works to enduce weight loss by enhancing ____

Satiety

Phentermine/Topiramate work as an ___ ____

Appetite-suppressant

Phentermine/Topiramate cause the release of ____

Norepinephrine

Weight ____ is usually recommended for overweight children 2-5 years of age with a multi-component weight loss management intervention with active participation of the parent

Maintenance

Weight loss may be recommended for children if a serious ____ ____ is present

Medical condition

Research does not support the _ weight loss theory which is the belief that **localized** exercise reduces fat stores in the active area

Spot

When a dieter reaches a plateau, ___ ___ ___ has dropped to reflect the loss

Basal metabolic rate

Someone is "healthy obese" if they have elevated ___ and normal to low ___

LDL; HDL

Bariatric surgery treatment is used for those with...

-Class III obesity with a BMI of 40 or more -BMI of 35 or greater with co-morbidities

Gastric bypass permanently alters the ___ of the GI tract

Anatomy

Gastric bypass reduces the amount of food that can be eaten at one time and produces ___ ___

Early satiety

Roux-en-Y reconstructs the ___ ___ to resemble the letter Y

Small intestine

Roux-en-Y creates a small gastric pouch connected directly to the ___

Jejunum

___ ___ may develop in those with Roux-en-Y due to the lower portion of the stomach being removed

Dumping syndrome

What supplements should be taken by someone after Roux-en-Y?

-Calcium: 1200-1500 mg (divided doses) -Vitamin D: 3000 IU -Iron: 45-60 mg (taken apart from calcium)

What may be a sign of iron deficiency in those s/p Roux-en-Y?

Chewing ice

Patients who have a Roux-en-Y have increased ___ needs

Protein

What supplements must be taken for life in someone with a Roux-en-Y?

-Mulitvitamin/multimineral supplement with 100% DRI for vitamin K, zinc, thiamin, folic acid, copper, biotin, iron -Many require B12 supplementation in addition to that in the MVMM

The sleeve gastrectomy removes ___% of the stomach

80%

With a sleeve gastrectomy, the ___ pathway is not altered

Food

Those with a sleeve gastrectomy should take vitamin supplements, monitor levels of...

-Iron -Calcium -Vitamin D

The laparoscopic adjustable gastric banding creates a small gastric pouch using a ___-___ inflatable band

Fluid-filled

The gastric band is adjusted to alter the size of the opening and is fully ____

Reversible

The gastric band restricts the amount of food eaten at ___ time

One

The gastric band causes no surgery-induced ____ of nutrients; deficiencies are linked to decreased food intake and decreased food tolerance

Malabsorption

Those with the gastric band should eat ____, sip drinks, not use straws, and avoid carbonation

Slowly

Prader-Willi syndrome is caused by a deletion of chromosome ___

Prader-Willi is a congenital disorder that causes subnormal ___ ____ ___ and supra-normal ___ ___

Lean body mass; body fat

With Prader-Willi, ____ levels are elevated which stimulates growth, hormone secretion, increased appetite and intake, and fat mass deposition

Ghrelin

Those with Prader-Willi do not sense ____ and also have decreased energy requirements

Satiety

Those with Prader-Willi may experience...

-Obesity at 2-3 years of age -Hypogonadism -Muscle hypotonia -Failure to thrive -Short stature

The best treatment for Prader-Willi is to control ___ ___

Food intake

Dental ___ are caused by bacterial enzymes that ferment carbohydrate deposits on plaque; enzymes produce acids that demineralize surface

Caries

What are some types of foods that have a low cariogenic potential?

-High protein, moderate fat, minimal concentration of fermentable carbohydrates -Strong buffer -High mineral content (Ca, P) and pH >6 stimulate saliva

Examples of low cariogenic foods:

-Cheese -Nuts -Meat

Sugar ____ (sorbitol, xylitol, mannitol) do not promote tooth decay

Alcohols

Flouride can control caries; supplement starting at 6 months of age if the level in the water supply is under ___ ppm

0.3

____ (mottled teeth) occurs when teeth are exposed to excessive fluoride

Fluorosis

For intants age 0-6 months, fluoride supplemented is ___ ___ ( use fluoridated water if available)

Not recommended

For infants/toddlers 6-24 months, use ___ water (only use oral supplements if prescribed)

Fluoridated

____ should not be used until the child can spit it out

Toothpaste

Children 2-3 years of age should use fluoridated water or supplements as recommended, as well as ___ ___ (pea-sized amount)

Fluoride toothpaste

Infants should not sleep with a bottle due to baby bottle ___ ___ (early childhood caries)

Tooth decay

____ is inflammation of the mouth

Stomatitis

Those with stomatitis should avoid...

-Very hot or very cold foods -Spices -Sour/tart foods -Alcohol

Those with stomatitis should rinse their mouth with ___ ___ after meals

Lukewarm water

One way to deal with esophagitis is by decreasing ___ ___

Gastric acidity

Those that have esophagitis/reflux should have small meals that are...

-Low fat -Bland -Low fiber

____ is painful swallowing

Odynophagia

A ____ is a lump in the throat

Globus

____ is a disorder of lower esophageal sphincter motility (it does not relax and open upon swallowing)

Achalasia

Achalasia causes ___, or difficulty swallowing

Dysphagia

IDDSI categorizes dysphagia diets into 8 levels ranging from __-__

0-7

IDDSI Level 0 is...

Thin like water; can flow through a straw

IDDSI level 1 is...

Slightly thick; can still flow through a straw

IDDSI level 2 is...

-Mildly thick; sippable

IDDSI level 3 is...

-Liquidized: spoon or cup, no lumps -Moderately thick: spoon or drunk from a cup, no lumps, effort with wide straw

IDDSI level 4 is...

-Extremely thick, pureed; eaten with a spoon (not out of cup or with a straw) -Pureed: spoon, no sticky

IDDSI level 5 is...

-Minced and moist -Minimal chewing, biting is not required -Lumps able to be mashed with tongue -Avoid hard, dried, tough food

IDDSI level 6 is...

-Soft, bite-sized -Able to chew bite-sized pieces -Knife is not required

IDDSI level 7 is...

-Regular, easy to chew -Can bite off and chew soft, tender pieces

MNT for GERD:

-Avoid eating before bed -Avoid soda -Avoid caffeine -Avoid acidic food -Small, low-fat meals -Liquids empty more rapidly

Pregnancy-induced hypertension progresses from ___ to ___

Pre-eclampsia, eclampsia

Eclampsia may cause...

-Hypertension -Edema of the face and hands -Proteinuria -Rapid weight gain after the 20th week -May have convulsions

Eclampsia is more frequently found in women with...

-Lack of prenatal care -Poor diets -Poor protein and calcium intakes

A ____ restriction is NOT recommended for prevention or treatment of pre-eclampsia/eclampsia; it is needed to maintain normal levels in plasma during large prenatal expansion of tissues of fluid

Sodium

Sodium intake during pregnancy should not be less than ___ mg/day

2300

There is a proposed association between pregnancy-induced hypertension and ____ deficiency

Calcium

Hyperemesis gravidarum causes...

-Severe nausea and vomiting -Acidosis -Weight loss

Treatment/management of hyperemesis gravidarum:

-Bed rest -Frequent, small amounts of carbohydrates -Correct fluid and electrolyte imbalance

What nutrition side effects can HIV/AIDS cause?

-Diarrhea -Malabsorption -Nausea/vomiting -Weight loss

The nutrition goals for someone with HIV/AIDS include...

-Preserve lean body mass -Prevent weight loss -Prevent HIV wasting

Encourage those with HIV/AIDS to be physically active for ___ mins per day ___ days per week

20; 3

Nutrient needs for someone with HIV/AIDS should be BEE x ___ for those that are symptomatic (based on DRI)

1.3

Protein needs for someone with asymptomatic HIV/AIDS is ____ g/kg, or up to ___-___ if wasted lean body mass

0.8; 1.2-2

Those with HIV/AIDS should get standard doses of ____ if dietary intake is insufficient

Micronutrients

If someone with HIV/AIDS has diarrhea, what can be done?

-Increase soluble fiber -MCT oil -Electrolyte replacement beverages

Those with HIV/AIDS should follow a low-bacteria ____ diet and avoid raw foods

Neutropenic

HIV-infected women should be instructed not to ___-___

Breast-feed

What are 2 examples of nucleotide nucleoside reverse transcriptase inhibitor (NRTI) drugs?

-Retrovir -Zidovudine

NRTI drugs used for HIV/AIDS have adverse effects like...

-Anemia -Loss of appetite -Nausea -Dysphagia

HIV-associated ____ syndrome may develop from treatment

Lipodystrophy

HIV-associated lipodystrophy syndrome causes...

-High cholesterol -High triglycerides -Insulin resistance -Changes in body fat distribution

HIV-associated lipodystrophy and edema can mask significant losses in ___ ___ ___ seen in those with HIV/AIDS

Lean body mass

Increasing dietary ____ can help decrease insulin resistance and reduce the risk of fat deposition

Fiber

Nutritional ____ should not be routinely recommended and herbal supplementation should be discouraged as adjuvant therapy to conventional treatment for HIV/AIDS

Supplementation

Use of Vitamin C or St. John's Wort in someone with HIV/AIDS can result in ___ ___

Drug resistance

___ ___ medicine therapies are not inert and may have profound consequences

Complementary alternative

Those with pediatric HIV should have a diet that is...

-High protein -High calorie with supplements needed for weight gain

Energy needs for those with pediatric HIV should be calculated using general guidelines plus appropriate ___ ___

Stress factors

Those with pediatric HIV should get multivitamins/minerals at doses __-__ times the RDA or DRI

1-2

What are two examples of COPD that cause persistent obstruction of airflow?

-Emphysema -Chronic bronchitis

With emphysema, air sacs (alveoli) lose ____

Elasticity

Those with emphysema are often...

-Older -Thin -Cachectic

Those with emphysema have difficulty ____; air pocket walls expand, thin out, and collapse

Exhaling

With chronic bronchitis, there is excess ____ production and chronic productive cough

Mucous

Symptoms of COPD include...

-Weight loss -Emaciation -Anorexia

It is important for those with COPD to maintain appropriate ____ and ___

Bodyweight and composition

Those with COPD should avoid overfeeding (over ___ kcal/kg) to avoid excessive CO2 production (routine use of high fat, low carbohydrate formula is NOT warranted)

Those with COPD should get small, frequent meals that are easy to ____ and ____, along with nutrient-dense supplements

Prepare and eat

In those with COPD, supplementation with vitamin ___ improved exacerbation outcomes in those with serum 25(OH) D levels of 10 ng/ml or lower

With acute respiratory distress syndrome or respiratory failure, the lungs are no longer able to exchange ____

Gases

Acute respiratory distress syndrome or respiratory failure leads to ____ and increased energy needs

Hypermetabolism

Those with acute respiratory distress syndrome or respiratory failure are generally severely ____

Underweight

Goals for those with acute respiratory distress syndrome or respiratory failure include:

-Meet basic nutritional requirements -Maintain stable weight -Facilitate weaning from mechanical ventilation without exceeding capacity to clear carbon dioxide

For those with acute respiratory distress syndrome or respiratory failure, provide ___ but not excessive calories; avoid excess non-protein calories

Adequate

For those with acute respiratory distress syndrome or respiratory failure, provide enteral formula that contains ___ and ___, as well as enhanced levels of antioxidant vitamins

EPA, GLA

Protein needs for those with acute respiratory distress syndrome or respiratory failure are ___-___ g/kg in order to maintain lead body mass

1.5-2

What are factors related to mental/behavioral health and addiction that are cause for a nutritional consult?

-Prescription for antipsychotics (Clozapine, Olanzapine, Risperidone, Quetiapine) -BMI of 18 or below (possible inadequate intake) -Paranoia regarding food resulting in severe food restriction -Suspicion that functional level, social or financial factors are compromising food intake -Alcohol or drug abuse or eating disorder

With antipsychotic medications, determine history of usual weight and any weight grain; if weight gain is ___% above baseline, recommend referral for weight management; a weight gain above ___% is a clinically meaningful gain

5; 7

____ is common among drug addicts because their prime concern is their next drug dose; food may be secondary

Malnutrition

Injection drug use exerts stress on the ___ system, increasing needs for nutritional antioxidants

Immune

Drug addicts may be socially marginalized and ____ (partly due to the cost of drugs)

Impoverished

Cocaine, amphetamines, and ecstasy may be used in Bulimic patients to reduce ___ for desired weight loss or control

Appetite

Nutrition intervention for drug addiction should address the person in a ___ manner with psychosocial support, including family members; group process is known to have positive outcomes for nutrition education

Holistic

Those with a drug addiction should have a moderate or discontinued ____ intake; ingestion releases dopamine and may substitute for the dopamine release previously available from use of many drugs which results in mood fluctuations and weight gain

Sugar

Stable ____ levels are shown to decrease drug cravings and reduce relapse potential

Glucose

Those with a drug addiction should also have moderate or discontinued ____ intake; it reduces mood stability by inducing the fight or flight response

Caffeine

Those with a drug addiction should have a diet that is high in...

-Complex carbohydrates -Protein -Fiber

Those with a drug addiction should have a diet with moderate to low ___ intake

Fat

Those with a drug addiction should get ___ well-spaced meals per day with 1-3 healthy snacks

Energy needs for someone with a drug addiction are ___-___ kcal/kg

30-35

Protein needs for someone with a drug addiction are ___-___ g/kg

1-2

Encourage ____ intake, especially water, between and with meals for those with a drug addiction

Fluid

Standard ____ enteral nutrition formula is used for those with normal GI function

Polymeric

Most standard polymeric formula provides ___-___ kcal/cc

1-1.5

____ may be added to standard polymeric formula as an emulsifier

Lecithin

Standard polymeric formulas are initiated at full strength at a rate of ___-___ ml/hour

10-40

Advance standard polymeric ___-____ ml every 8-12 hours over the next 24-48 hours until goal rate is achieved

10-20

____ enteral products allow you to mix individual components and add flexibility

Modular

_____ formulas are made with whole foods

Blenderized

When using a blenderized formula, a large ___ tube must be used

Bore

Blenderized formulas have thick, intact protein and are high ____

Residue

The least expensive enteral formulas are...

-Intact protein (not pre-digested) -Isotonic (osmolality is close to that of blood)

____ and ___ may be added to standard polymeric formulas to stimulate the production of beneficial bacteria and may help resist C. diff

Fructooligosaccharides (prebiotics) and fiber

____, chemically defined enteral formulas are used in those with malabsorption

Elemental

Elemental formulas contain ___-___ protein or amino acids, glucose or sucrose, LCT and MCT, vitamins, minerals, and electrolytes

Pre-digested

Elemental enteral formulas are absorbed in the ___ ____

Proximal intestine

Elemental formulas are ____ or no-residue

Low

Elemental formulas do not require ___ ___ for absorption

Pancreatic enzymes

Elemental formulas are ____ osmolality and generally have poor taste

High

Elemental formulas are used for those who...

-Have compromised GI function -Have an inability to digest and absorb

What are three examples of elemental formulas?

-Alitraq -Peptamen -Vivonex

What are three examples of specialized enteral formulas?

-Nepro (renal) -HepaticAid II (liver) -Glucerna (diabetes)

The more specialized the formula, the greater the ____

Cost

The tube bore is adjusted based on the ____ of feeding

Viscosity

A large #____ bore tube would be used for blenderized formulas

A small #____ bore tube would be used for ready-prepared formulas; more comfortable

Enteral access should be based on...

-Anticipated length of time needed -Risk of aspiration -Patient's anatomy -Clinical status -Normal or abnormal digestion and absorption

Hang time for open systems is ___ hours

Hang time for a closed system is ___-___ hours

24-48

For short-term enteral nutrition (3-4 weeks) in someone with normal GI function, what type of access should be used?

Nasogastric

The bolus tube feed method is used for clinically stable patients with functioning ___

Stomach

An intermittent drip of enteral feeding is done with either ____ or ____ and allows for more mobility

Pump or gravity

A continuous drip of tube feed uses a constant, steady rate over ___-___ hours, usually with a feeding pump

16-24

Continuous tube feeding is used for what patients?

-Those with compromised GI function -Those who do not tolerate large volume infusion

____ feeding is delivered by continuous drip at an increased rate over 8-16 hours, over overnight, by pump

Cyclic

Cyclic feeding is used for what patients?

-Undernourished patients (especially those who are older, ambulatory, or malnourished)

Use ____ and _____ feedings if a patient is unable to tolerate gastric feedings

Nasoduodenal, nasojejunal

___-___ feedings are used in comatose patients or ones with no gag reflex to prevent aspiration (passed pyloric valve in the stomach)

Post-pyloric

Those who will need enteral nutrition for more than 3-4 weeks should get ____ or ____ feedings

Gastrostomy or jejunostomy

A ____ tube inserts tube into the stomach through the intestinal wall

PEG

Use ___-___ to confirm the tube tip is located in the correct place or aspirate gastric contents (do not use blue dye)

X-ray

Those on enteral feeding should get ____ cc of water per calorie ingested

Most 1 kcal/cc formulas are ___-___% water

80-86

Most 1.5 kcal/cc formulas are ___-___% water

76-78

Most 2 kcal.cc formulas are ____-____% water

69-71

Normal gastric residual volume is ____ ml or under

250

Enteral nutrition should NOT be held for gastric residual volume over ____ml or over in the absence of other signs of intolerance

500

Actual intake of enteral nutrition may be lower than prescribed because of ___ ___ and ADL interruptions

Medical procedures

What are common adverse effects of enteral nutrition?

-Lactose intolerance -Formula hyperosmolality -Rapid infusion causes influx of water into the gut

Steps for formula calculation:

-Select formula and determine calories needed -Divide calories needed by cal/ml to determine mLs of formula needed per day -Determine protein content: multiply mLs of daily formula by grams of protein per liter -Determine fluid needs: multiply % water in formula x daily formula in mLs to determine water content contribution of enteral nutrition; subtract formula water from total fluid requirements to determine water flushes -Determine administration rate: divide total mLs of formula per day by 24 hours to determine continuous feeding goal rate

____ parenteral nutrition uses small surface veins

Peripheral

Peripheral parenteral nutrition is used for ___-___ therapy and has minimal effect on nutritional status

Short-term

Indications of peripheral parenteral nutrition:

-Post-surgery (when enteral feeding is expected to resume within 5-7 days -Mild to moderate malnutrition as a supplement to enteral feedings

IV dextrose in parenteral nutrition is ___ kcal/grams

3.4

The highest concentration of dextrose used in peripheral parenteral nutrition is ____%

Protein (amino acids) makes up between ___-___% of peripheral parenteral nutrition

3-15

Either ____% or ____% of peripheral parenteral nutrition is made up of fat (intravenous fat emulsion, intralipid)

10; 20

10% lipids are ____ kcal/cc

1.1

Generally, peripheral parenteral nutrition solutions are limited to ___-___ mOsm

800-900

Parenteral nutrition is the infusion of a hypertonic solution delivered through a ___ ___ ___

Central venous catheter

Parenteral nutrition is used for achieve an ____ state when patients are unable to eat by mouth and enteral feeding is not possible

Anabolic

ASPEN has set a time frame of ___-___ days in which to achieve intake goals by the enteral route before beginning parenteral nutrition

7-10

Use of parenteral nutrition in critically ill patients has been shown to...

-Increase infectious complications -Increase duration of ICU stays -Increase mechanical ventilation

A _____ line is used for short or moderate-term infusion of parenteral nutrition

PICC (peripherally inserted central catheter)

A central venous catheter is used for long-term central access and is through either the ___, ____, or ____ vein into the ___ ___ ___

Cephalic, subclavian, or internal jugular; superior vena cava

The main concern with central parenteral nutrition is the translocation of ____; not feeding through the gut allows walls to break down allowing bacteria to move out and cause sepsis

Bacteria

Gut-associated lymphoid tissue is compromised by ___ ___ or ___ ____

Bowel rest; parenteral nutrition

Gut-associated lymphoid tissue provides ___% of total body immunity

___-___% of total body immunoglobulin production is secreted across the GI mucosa to defend against pathogenic substances in the GI lumen

70-80

The protein ratio for anabolism is 1 gram of nitrogen / ____ calories

150

Those on parenteral nutrition should get ___-___ grams of protein/kg each day

1-1.5

____ amino acids make up 3-15% of parenteral nutrition solutions

Crystalline

The percentage of protein in parenteral nutrition is the number of grams of protein in ____ ml of solution

100

Those on central parenteral nutrition should get ___-___ kcal/kg

35-50

Those on central peripheral nutrition should get a solution that is up to ___% dextrose

A 10% dextrose solution provides ____ g of carbohydrates per liter

100

To avoid overfeeding and hyperglycemia, start parenteral nutrition at ___-___ kcal/kg or less

20-25

The maximum rate of dextrose infusion (glucose utilization rate) should not exceed ____-___ mg/kg/minute to prevent hyperglycemia and other complications

4-5

Increased blood glucose from excess dextrose increases ___ ___ in ventilated patients and increased ____ complications

Respiratory quotient; infectious

Fat is needed for energy and to prevent ______

EFAD (essential fatty acid deficiency)

To prevent essential fatty acid deficiency, give ____ cc of 10% fat emulsion 1-2x/week

500

One symptom of essential fatty acid deficiency is _____, or red spots on the skin

Petechiae

Provide ___, ___, and ___ to those on TPN as needed

Vitamins, electrolytes, water

___ ___ ___ (3-in-1) includes dextrose, amino acids, and lipids

Total nutrient admixture

Contraindications to parenteral nutrition:

-If alimentary tract can be used -If needed for only a short time in someone who is well-nourished -During periods of cardiac instability -If risks inherent in the process outweigh benefits

For transitional feeding, introduce a minimal amount of full-strength enteral feeding at a low rate of ___-___ ml/hour to establish GI tolerance

30-40

Begin tapering parenteral nutrition when enteral feedings are providing ___-___% of their nutrition requirements

33-50

Decrease parenteral nutrition as you increase enteral rate by ___-___ ml/hour increments every 8-24 hours to maintain prescribed nutrient levels

25-30

When patients can tolerate about ___% of their needs by the enteral route, discontinue parenteral feedings

_____ _____ is a consequence of aggressive administration of nutrition to someone who is malnourished

Re-feeding Syndrome

What populations are most at risk for re-feeding syndrome?

-Those with anorexia nervosa -Those with chronic alcoholism -Those with prolonged fasting -Those unfed for 7-10 days -Those with significant weight loss -Those who are phosphorus deficient/those who are getting phosphorus deficient parenteral nutrition

With re-feeding syndrome, starved cells take up nutrients and ___ and ___ shift into intracellular compartments

Potassium and phosphorus

Re-feeding syndrome results in...

-Hypokalemia -Hypophosphatemia -Hypomagnesemia

Hypokalemia affects...

-Cardiac -Renal -Carbohydrate metabolism -Muscle weakness

Hypophosphatemia causes...

-Cardiac abnormalities -Respiratory failure -Seizures

Hypomagnesemia causes:

-Intracellular metabolism -Cardiac arrhythmias -Hypocalcemia

Those at risk for re-feeding syndrome should have tightly controlled blood sugar between ___-___ mg/dl

140-180

Overfeeding parenteral nutrition and dextrose over ____ mg/kg/min may lead to hyperglycemia

Glucose moves into the cell for oxidation and stimulates insulin which decreases ___ and ___ excreting, increasing the risk of cardiac and pulmonary complications

Salt and water

Upon initiation of parenteral nutrition to a malnourished person, monitor...

-Glucose -Phosphorus -Potassium -Magnesium

____ medicine combined evidence-based complementary therapies with conventional (allopathic) treatments to address the social, psychological, and spiritual aspects of health and illness

Integrative

The National Center for Complementary and Integrative Health promotes things like...

-Yoga -Meditation -Herbs and botanicals -Traditional healing practices

What are the NIH categories for complementary and alternative medicine (CAM)?

-Mind-body medicine -Alternative medical systems like acupuncture and oriental medicine -Lifestyle and disease prevention -Biologically-based therapies including herbs and orthomolecular medicine -Manipulative and body-based systems like chiropractic medicine -Biofield systems like therapeutic touch and bioelectric magnets

Functional medicine addresses the ___ ___, not just the symptoms, and looks at the underlying cause of a disease, engaging the patient and practitioner in a partnership for therapy

Whole person

____ health views mental, physical, and spiritual aspects of life closely connected and equally as important with regard to treatment approaches

Holistic

Domain II: Nutrition Care for Individuals and Groups: Medical Nutrition Therapy Flashcards

(1012 cards)