Domain II, Topic C, Planning and Intervention

Question 1

_________ ____________ is a purposely planned action designed with the intent of changing a behavior, risk factor or condition, for an individual, group, or community. These _____________ influence the etiology or effects of a diagnosis. It is based on the nutrition diagnosis and provides the bases upon which outcomes are measured and evaluated.

Answer 1

Nutrition Intervention, Intervention

Question 2

Four categories of Nutrition Intervention: ____ Delivery; _________, __________, ___________ of ____ with _____ __________

Answer 2

Food Delivery, Education, Counseling, Coordination of Care with Other Providers

Question 3

________: prioritizing nutrition diagnoses, consult EAL and other practice guidelines, determine patient focused outcomes for each diagnosis, confer with caregivers, define time and frequency of care, identify resources needed

Answer 3

Planning

Question 4

______________: Action phase involves communication of the care plan and carrying out the plan

Answer 4

Implementation

Question 5

________ - _____ _________ ________ (EAL Evidence Analysis Library): systematically reviewed scientific evidence used in making food and nutrition pracice decision; integrate best available evidence with professional expertise practice decisions; integrate best available evidence with professional expertise and client values to improve outcome

Answer 5

Evidence Based Dietetics Practice

Question 6

_______ Prevention Programs: reduced exposure to a promoter of disease (early screening for risk factors like diabetes). Health Promotion.

Answer 6

Primary

Question 7

_________ Prevention Programs: Recruiting those with elevated risk factors into treatment program (setting up an employee’s gym). Risk Reduction.

Answer 7

Secondary

Question 8

________ Prevention Programs: As disease progresses, intervention to reduce severity, manage complications, rehabilitation efforts

Answer 8

Tertiary

Question 9

_______ _____ __________ (FTC) : Internet, TV, radio; bogus weight loss claims

Answer 9

Federal Trade Commission

Question 10

________ _______ _______ ______ _____ (NCAHF)

Answer 10

National Council Against Health Fraud

Question 11

When evaluating information in health claims, ask questions based on the CARS checklist:
C__________: check credential of author
A_______: info is current, factual and comprehensive
R_____________: is into fair, balanced and consistent
S______: is supporting documentation cited for scientific statements

Answer 11

Credibility, Accuracy, Reasonableness, Support

Question 12

_______ ________ _______ ______ (POMR)

Answer 12

Problem Oriented Medical Record

Question 13

_______ ________ ________ (PES)

Answer 13

Problem, Etiology, Symptoms

Question 14

______ __________ ____ (SAP)

Answer 14

Screen, Assessment, Plan

Question 15

______ _______ _________ _______ ________ (ADIME)

Answer 15

Assess, Diagnose, Intervene, Monitor, Evaluate

Question 16

______ ________ ___________ and ______________ ___
Permanent legal document; entries written in black pen or typed; complete, clear, concise, objective, legible, accurate; sign, date all entries; entered at the time of actual date, time of entry and the date and time it should have been recorded

Answer 16

Health Insurance Portability and Accountability Act

Question 17

___________ on HIPAA documents;

• Never use white out, thick markers, or remove an original and replace it with a copy
• At time an entry is in progress: draw single line through error, then enter the correction, initial date
• Omitted nformation: Beside original entry: “see addendum,” enter date and initial. Write the addendum in chart sequence, identify it as an addendum and reference the original entry. Sign.
• Correction performed some time after entry: correct minor errors (spelling, one word) with singl line drawn through, make correction, date, time, sign

Answer 17

Corrections

Question 18

_________ plan begins on Day 1 of hospital stay

-_________ note includes summary of nutrition therapies and outcomes

Answer 18

Discharge

Question 19

All _______ information is confidential

Answer 19

Patient

Question 20

GI Disorder _____

• Eroded Mucosal lesion
• Treatment: Antacids, antibiotics to eradicate heliobacter pylori bacteria
• Drug therapy: Cietidine, Ranitidine (H2 blocker); prevents binding of histamine to receptor, decreses acid secretion
• diet: as tolerated, well balanced, avoid late night snacks
• omit: cayenne and black pepper, large amounts of chili powder, avoid excess caffeine and alcohol

Answer 20

Ulcer

Question 21

GI Disorder ______ ______

• Protrusion of portion of the stomach above the diaphragm into the chest
• small, bland feedings; avoid late night snacks, caffeine, chili powder, black pepper

Answer 21

Hiatal Hernia

Question 22

GI Disorder _______ ________

• Follows a gastrectomy (Billroth I, II)
• Cramps, rapid pulse, weakness, perspiration, dizziness
• When rapidly hydrolyzed carbohydrate enters the jejunum, water is drawn in to achieve osmotic balance. This causes a rapid decrease in the vascular fluid compartment and a decrease in peripheral vascular resistance. Blood pressure drops and signs of cardiac insufficiency appear. About two hours later, the CHO is digested and absorbed rapidly. Blood sugar rises, stimulating an overproduction of insulin, causing a drop in blood sugar below fasting. This is reactive or alimentary hypoglycemia.
• Gastric Surgery

Answer 22

Dumping Syndrome

Question 23

________ _ (Gastroduodenostomy) attaches the remaining stomach to the duodenum

Answer 23

Billroth I

Question 24

________ __ (Gastrojejunostomy) attaches the remaining stomach to the jejunum. When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced. These hormones normally stimulate the pancreas, so there is now little pancreatic secretion. Calcium (most rapid absorption in duodenum) and iron absorption (requires acid) are adversely affected

Answer 24

Billroth II

Question 25

______ can be caused by both ___ or ______ deficiency

Answer 25

Anemia, B12, Folate

Question 26

___ deficiency is caused by a lack of intrinsic factor and bacteria overgrowth in loop of intestine being bypassed interfere with ___ absorption (pernicious anemia diagnosed using the Schilling test)

Answer 26

B12, B12

Question 27

______ deficiency: Needs B12 for transport inside the cell; also from poor ______ intake and low serum iron (cofactor in ______ metabolism)

Answer 27

Folate, folate, folate

Question 28

After _______ _______: Frequent small, dry feedings, fluids before or after meals (to slow passage), restrict hypertonic concentrated sweets, give 50-60% complex CHO, protein at each meal, moderate fat, B12 injections may be needed. Lactose may be poorly tolerated due to rapid transport.

Answer 28

Gastric Surgery

Question 29

_____________ is delayed gastric emptying can be caused by surgery, diabetes, viral infections, obstructions - Moderate to severe hyperglycemia: detrimental effects on gastric nerves - prokinetics (erythromycin, metoclopramide) increase stomach contractility - Small, frequent meals; pureed foods, avoid high fiber, avoid high fat (liquid fat may be better tolerated) - Bezoar formation may be due to undigested food or medications; treatment includes enzyme or endoscopic therapy

Answer 29

Gastroparesis

Question 30

________ _____ (bacterial, viral, parasitic infection) - chronic GI disease, intestinal lesions, may also affect stomach - diarrhea, malnutrition, deficiencies of B12 and folate due to decreased HCL and intrinsic factor - antibiotics, high calories, high protein, IM B12 and oral folate supplements

Answer 30

Tropical Sprue

Question 31

___ - ________ _____, ______ Disease, ______ - _______ Enteropathy - Gluten refers to storage proteins (prolamins: gliadin in wheat, secalin in rye, hordein in barley, avenin in oats) - Reaction to gliadin: affects jejunum and ileum (proximal intestine) - Malabsorption (leads to loss of fat - soluble vitamins), macrocytic anemia, weight loss diarrhea, steatorrhea, iron deficiency anemia - Needs gluten restricted diet: NO wheat, rye, oats, barley, bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents - OK: corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax

Answer 31

Non - tropiical sprue, Celiac disease, gluten induced enteropathy

Question 32

___________ sometimes due to an atonic colon (weakened muscles) -high fluid, high fiber diet, exercise

Answer 32

Constipation

Question 33

______________ is the presence of diveticula - Small mucosal sacs that protrude through the intestinal wall due to structural weakness. Related to constipation and lifelong intra - colonic pressures - High fiber diet: increases volume and weight of residue, provides rapid transit

Answer 33

diverticulosis

Question 34

______________: When diverticula become inflamed as a result of food and residue accumulation and bacterial action -Clear liquids, low residue or elemental, gradual return to high fiber

Answer 34

Diveticulitis

Question 35

_____ provides indigestible bulk, promotes intestinal function -Dietary _____: Non - digestible CHOs and lignin, binds water, increases fecal bulk; found in legumes, wheat bran, fruits, vegetables, whole grains

Answer 35

Fiber, fiber

Question 36

___ bran and _______ fibers decrease serum cholesterol by binding bile acids converting more cholesterol into bile

Answer 36

Oat, soluble

Question 37

_______ fibers (pectins, gums) delay gastric emptying, absorb water, form soft gel in small intestine; this slows passage and delays or inhibits absorption of glucose and cholesterol; fruits vegetables, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, bananas

Answer 37

Soluble

Question 38

AI of Fiber: __g M, __g F

Answer 38

38, 25

Question 39

A ____ fiber may increase the need for Ca, Mg, P, Cu, Se, Zn Fe

Answer 39

high

Question 40

A ___ fiber diet may lead to ____________

Answer 40

low, constipation

Question 41

_________: inflammation of stomach; anorexia, nausea, vomiting, diarrhea -diet: clear liquids, advance as tolerated, avoid gastric irritants

Answer 41

Gastritis

Question 42

____________ ____ _______ (IBD) - Regional Enteritis (Chron's disease) - Chronic Ulcerative Colitis (UC)

Answer 42

Inflammatory Bowel Disease

Question 43

________ ________ (Chron's Disease: Affects terminal ileum; weight loss, anorexia, diarrhea - B12 deficiency leads to megaloblastic anemia - Iron deficiency anemia due to blood loss, decreased absorption

Answer 43

Regional Enteritis

Question 44

_______ __________ _______ (UC) - Ulcerative disease of the colon, begins in rectum - Chronic bloody diarrhea, weight loss, anorexia, electrolyte (Na,K), disturbance, dehydration, anemia, fever, negative nitrogen balance

Answer 44

Chronic Ulcerative Colitis

Question 45

Treatment for ____________ _____ _______ - Maintaoin fluid and electrolyte balance; antidiarrheal agent (sulfasalazine) - Acute Chron's flare ups: bowel rest, parenteral nutrition or minimal residue - Acute UC: elemental diet may be needed to minimize fecal volume - Energy needs according to current BMI, limit fat only if steatorrhea; water soluble and fat soluble vitamin; iron, folate; assess Ca, Mg, Zn; MCT oil, watch lactose, frequent feedings. High fat may improve energy balance - Once ____________ _____ _______ is under control, high fiber to stimulate peristalsis

Answer 45

Inflammatory Bowel Disease, Inflammatory Bowel Disease

Question 46

_________ _____ ________ (IBS) - Chronic abdominal discomfort, altered intestinal motility, bloating - Goals: adequate nutrient intake, tailor patter to specific GI issues - Avoid large meals, excess caffeine, alcohol, sugars - Use food diary to track intake, emotions, environment, symptoms - identify food allergies and hypersensitivites - work with client to alleviate stress during eating

Answer 46

Irritable Bowel Syndrome

Question 47

_______ ___________ due to _______ deficiency -Normally _______ splits _______ into glucose and galactose. In its absence _______ remains intact, exerting hyperosmolar pressure. Water is drawn into the intestine to dilute the load causing distension, cramps, and diarrhea. Bacteria then ferment the undigested lactose, releasing carbon dioxide gas.

Answer 47

Lactose intolerance, lactase, lactase, lactose, lactase

Question 48

_______ __________ can be detected with a hydrogen breath test -hydrogen is produced by colonic bacteria on lactose, absorbed into the bloodstream and exhaled in 60 - 90 minutes

Answer 48

Lactose Intolerance

Question 49

In a _______ ________ test an oral dose of _______ is given after a fast. If intolerant, blood glucose will rise < 25mg/dL above fasting (flat curve) If tolerant, the rise would be above 25 mg/dL (normal curve)

Answer 49

Lactose intolerance, lactose

Question 50

On a _______ free diet, calcium and riboflavin supplements are recommended; yogurt and small amounts of aged cheese may be tolerated; lactate and lactalbumin are OK

Answer 50

lactose

Question 51

_____ diarrhea in infants requires aggressive and immediate rehydration; replace fluids and electrolytes lost in stool (WHO recommends glucose electrolyte solution) -as effective as parenteral rehydration and much cheaper; ingredients easily attainable; reintroduce oral intake within 24 hours

Answer 51

Acute

Question 52

In _______ nonspecifc diarrhea in infants: - Consider ratio of fat to CHO calories, volume of ingested liquids - Some are inadvertently placed on a low fat diet or consume too many fluids or too many calories - give 40% calories as fat, balance with limited fluids; restrict or dilute fruit juices with high osmolar loads (apple, grape)

Answer 52

Chronic

Question 53

In _____ diarrhea: - remove the cause; bowel rest; replace lost fluids and electrolytes, especially those high in sodium and potassium - when diarrhea stops, begin with low fiber foods, followed by protein foods, fat need not be limited - avoid lactose at first - foods or supplements that contain prebiotic components (pectin, fructose, oats, banana flakes) which favor friendly bacteria - probiotics: sources of bacteria used to reestablish bacterial gut flora

Answer 53

Adult

Question 54

__________ (consequence of malabsorption - normal stool fat 2 - 5 g; > 7 g is indicative of malabsorption - determine cause and treat - high protein, high complex CHO, fat as tolerated, vitamin (especially fat soluble), minerals, MCT (rapidly hydrolyzed in GI tract)

Answer 54

Steatorrhea`

Question 55

_____ _____ ________ (SBS) - Consequences associated with significant restricions of the small intestine - malabsorption,, malnutrition, fluid and electrolyte imbalances, weight loss - severity reflects length and location of resection, age of patient, health of remaining tract. Loss of ileum (especially distal 11/3), loss of ileocecal valve, loss of colon are of particular concern; most digestion takes place in the first 100 cm of the intestine (in duodenum and upper jejunum) what remains - small amounts of sugar, starches, fiber, lipids

Answer 55

Short Bowel Syndrome

Question 56

_____ _________ significant resections that produce major complications -distal: absorption of B12, intrinsic factor, bile salts -_____ normally absorbs major portion of fluid in GI tract -Patients have above average needs for water to compensate for excessive losses in stool. Drink at least 1 liter more than their ostomy output -If _____ cannot recycle bile salts; lipids are not emulsified, leads to malabsorption of fat soluble vitamins; malabsorbed fats combine with Ca, Zn, Mg, leading to soaps; Colonic absorption of oxalate increases; renal oxalate stones -Increased fluid and electrolyte secretion; increased colonic motility

Answer 56

Ileal resection, ileum, ileum,

Question 57

Loss of _____: water and electrolyte loss, loss of salvage absorption of CHO and other nutrients

Answer 57

colon

Question 58

Nutritional care after SBS 1) _________ nutrition initially to restore and maintain nutrient status 2) _______ - start early to stimulate growth, increase over time; continuous drip 3) May take weeks or months to transition to food 4) _______ - normal balance of CHO, protein, fat; avoid lactose, oxalates, large amounts of concentrated sweets; vitamin, mineral supplements 5) _____ - 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

Answer 58

Parenteral, enteral, jejunal, ileal

Question 59

Functions of the _____ - stores and releases blood, filters toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance

Answer 59

Liver

Question 60

______ profile - list of major enzymes found in organs and tissues; enzyme levels in blood are elevated when tissue damage causes them to leak into circulation

Answer 60

Enzyme

Question 61

________ ___________ (ALP) 30 - 120 U/L - Increases with liver disease - Decreases with scurvy

Answer 61

Alkaline phosphatase

Question 62

``` ______ ____ _____________ (LDH) Increased with: -Hepatitis -Myocardial Infarction -Muscle Malignancies ```

Answer 62

Lactic Acid Dehydrogenase

Question 63

_________ _____ __________ (AST, SGOT) 0 - 35 U/L - Increased with hepatitis - Decreased with uncontrolled diabetes with acidosis

Answer 63

Alanine Aminotransferase

Question 64

In _____ disease, enzyme levels are elevated. SGOT is decreased in uncontrolled diabetes

Answer 64

Liver

Question 65

Symptoms of _____ _____ hepatitis | -Inflammation, necrosis, jaundice, anorexia, nausea, fatigue (1) Jaundice occurs when bile ducts are blocked

Answer 65

Acute Viral

Question 66

HAV transmitted through _____ matter - oral transmission (type most directly connected to food)

Answer 66

fecal

Question 67

HBV ________ transmitted

Answer 67

sexually

Question 68

HCV ____ to ____ contact

Answer 68

blood to blood

Question 69

Nutrition intervention for _____ _____ hepatitis: - Increase fluids to prevent dehydration - care varies according to symptoms and nutrition status - 50 -55% CHO to replenish liver glycogen and spare protein - acute hepatitis: 1 - 1.2g protein/kg: cell regeneration, provide lipotropic agents to convert fat into lipoproteins for removal from liver - Moderate to liberal fat intake if tolerated; limit fat if steatorrhea - Encourage coffee (antioxidant) - multivitamin with B complex, C, K, zinc

Answer 69

Acute viral

Question 70

In _________ damaged liver tissue is replaced by bands of connective tissue which divides liver into clumps and reroutes many of the veins and capillaries. Blood flow through the liver is disrupted. Poor food intake leads to deficiencies -Protein deficiencies lead to ascites, fatty liver, impaired blood clotting

Answer 70

Cirrhosis

Question 71

Normal blood flow runs from the _________, __________, or __________ veins to the ______ vein, to the _____, to the ____ ____

Answer 71

abdominal, esophageal, collateral, portal, liver, vena cava

Question 72

_______ occurs when blood cannot leave the live

Answer 72

Ascites

Question 73

_________ tissue overgrowth blocks blood flow out of liver into the vena cava. The liver expands (can store a 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. This fluid is almost pure plasma with a high osmolar load, pulling more fluid in to dilute the load, leading to sodium and water retention. -Low serum albumin may be due to dilution factor

Answer 73

Ascites

Question 74

__________ varices occur when blood can't enter the liver. - Connective tissue overgrowth causes resistance to blood entering from portal vein. The increased pressure forces blood back into collateral veins that offer less resistance. Esophageal, abdominal, collateral veins enlarge. - Due to portal hypertension

Answer 74

Esophageal

Question 75

Diet for _________. - High protein 0.8 - 1.0 g/kg; in stress at least 1.5 g/kg - High calorie 25 - 35 cals/kg estimated dry weight or 1.2 - 1.5 x BEE - moderate to low fat 25 - 40% of calories, MCT if needed, less than 40 grams of fat if malabsorption. Fat is prefered fuel in cirrhois. Include omega 3. Decrease LCTs if steatorrhea develops. - Low fiber if varices are present, low sodium iif edema or ascites - With hyponatremia, fluid restriction of 1 - 1.5 L/day depending on severity, and moderate sodium intake - B complex vitamins, C, K Zn, Mg; monitor need for A and D - Zinc involved in the conversion of ammonia to urea, increased loss in urine

Answer 75

Cirrhosis

Question 76

_________ liver disease - hepatic steatosis, alcoholic hepatitis, cirrhosis

Answer 76

Alcoholic

Question 77

_____ injury is due to the alcohol and metabolic derangement it causes

Answer 77

Liver

Question 78

_______ is converted into acetaldehyde and excess hydrogen which disrupts liver metabolism

Answer 78

alcohol

Question 79

In alcoholic liver disease, _______ replaces fat as fuel in the Kreb's cycle, so fat accumulates in liver, leading to fatty liver, and in blood, raising the TG level Shift in ____/___ ratio inhibits beta-oxidation of fatty acids and promotes TG synthesis

Answer 79

Hydrogen, NADH/NAD

Question 80

_______ causes inflammation of GI tract and interfeeres with absorption of thiamin, B12, vitamin C, and folic acid

Answer 80

Alcohol

Question 81

_______ interferes with vitamin activation

Answer 81

Alcohol

Question 82

Increased need for _ vitamins to metabolize alcohol

Answer 82

B

Question 83

Increased need for _________; excreted after alcohol consumption

Answer 83

magnesium

Question 84

Malnutrition increases _______ destructive effects

Answer 84

alcohol's

Question 85

_____ and _______ deficiencies are most responsible for malabsorption in alcoholic liver disease

Answer 85

Folate and protein

Question 86

_______ deficiency in Wernicke - Korsakoff

Answer 86

Thiamin

Question 87

_______ _______ (ESLD) - liver function decreases to 25% or less - liver cannot convert ammonia into uream ammonia accumulates - apathy, drowsiness, confusion, coma (PSE - portal systemic encephalopathy) - Asterisix (flapping, invoulantary jerking motions) sign of impending coma

Answer 87

Hepatic Failure

Question 88

Nutrition treatment for _______ failure - If not comatose: moderate to high levels of protein, increase up to 1 - 1.5 gran protein/kg as tolerated - 30 - 35 calories/kg; 30-35% calories as fat with MCT if needed - Low sodium if ascites; vitamin/mineral supplementation

Answer 88

Hepatic

Question 89

_______ ________________ Theory is designed for hepatic failure: BCAA levels decrease (used by muscles for energy); AAA (aromatic amino acids) increase because damaged liver is unable to clear them - adding BCAA adds calories and protein; may nt reduce symptoms - used when standard therapy does not work and when patient does not tolerate standard protein

Answer 89

Altered Neurotransmitter Theory

Question 90

Standard treatment for _______ failure is lactulose (hyperosmotic laxative that removes nitrogen); neomycin (antibiotic that destroys bacterial flora that produce ammonia)

Answer 90

lactulose

Question 91

___ - _________ _____ liver disease - Steatosis, more common with BMI greater than 35, type 2 diabetes, metabolic syndrome - excess fat buildup in liver unrelated to alcohol consumption - Can be managed with lifestyle changes 1) weight loss (7-10% of starting weight). NO rapid weight loss: greater flux of fatty acids to liver may worsen inflammation and accelerate disease progression 2) Healthful eating: mediterranean diet, moderate alcohol, avoid sugar sweetened beverages, coffee may help (antioxidant) 3) Physical activity: at least 150 minutes of moderate intensity aerobic activity, plus two strength training session each week

Answer 91

Non - alcoholic fatty

Question 92

___________ disease - Cholecystitis - inflammation of the ___________ 1) An infection causes excess water to be absorbed causing cholesterol to precipitate out leading to gallstones - cholelithiasis

Answer 92

Gallbladder,gallbladder

Question 93

Treatment for ___________ disease 1) low fat diet: acute 30 - 45 grams; chronic 25 - 30% of calories 2) cholecystectomy - surgical removal of the gallbladder; bile now secreted from liver directly into intestine - limit fat intake for several months to allow liver to compensate - slowly increase fiber to help normalize bowel movements

Answer 93

Gallbladder

Question 94

____________ inflammation with edema, cellular exudate and fat necrosis -may be due to a blockage or reflux of the ductal system; premature activation of enzymes within pancreas leads to auto-digestion

Answer 94

Pancreatitis

Question 95

_____ - pancreatitis - put pancreas at rest, withhld all feeding, maintain hydration (IV) 1) progress as tolerated to easily digested foods with a low fat content 2) elemental (predigested) enteral nutrition into jejunum may be tolerated

Answer 95

Acute

Question 96

_______ - pancreatitis - Recurrent attacks of epigastric pain of a long duration 1) PER: Pancreatic enzyme orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase. MCTs do not require pancreatic lipase. Add to mixed dishes, jams, jellies 2) To promote weight gain, give maximum level of fat tolerated without an increase in steatorrhea or pain 3) If malabsorbing fat soluble vitamins give water soluble forms 4) Pancreatic bicarbonate secretion may be defective; may need antacids so PERT therapy will work 5) In severe prolonged cases, parenteral nutrition may be needed 6) To avoid pain: avoid large meals with fatty foods, alcohol

Answer 96

Chronic

Question 97

______ ________ -Disease of exocine glands: secretion of thick mucus that obstructs glands and ducts; chronic pulmonary diseases, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption

Answer 97

Cystic Fibrosis

Question 98

Nutrition treatment for ______ ________ 1) PERT- pancreatic enzyme replacment therapywith meals and snacks 2) High protein, high calorie, unrestriced fat, liberal in salt - if growing normally and steatorrhea is contolled: calories to cover RDA for age and sex; if fails to grow - BEE x activity factors plus disease - Protein 15 -20% calories: malabsorption due to pancreatic deficiency - CHO 45 - 55% total calories - Liberal fat to compensate for high energy needs - 35-40% of calories - Additional 2 - 4 grams salt/day in hot weather, with heavy perspiration - age appropriate doses of water soluble vitamins and minerals - Supplement water soluble forms of fat soluble vitamin A and E

Answer 98

Cystic Fibrosis

Question 99

______________ disease (CVD), ________ ______ disease (CAD), ________ ____ disease (HD)

Answer 99

Cardiovascular, coronary artery, ischemic heart

Question 100

____________ - systolic >140 or diastolic >90 or both - Systolic, contraction, greatest pressure; diastolic, relaxation, least pressure - May be primary (essential) or secondary due to another disease - classified in stages based on risk of developing coronary heart disease - Obesity is a major factor in the cause and treatment - Optimal BP with repect to cardiovascular isk is <120/80 mm Hg

Answer 100

Hypertension

Question 101

Management of ____________ - Thiazide diuretics may induce hypokalemia - four modifiable factors in primary prevention and treatment: overweight, high salt intake, alcohol consumption, physical activity - salt restriction less than or equal to 2400 mg of Na (6 g salt); decrease weight if needed - DASH diet - dietary approach to stop hypertension; whole grains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI (not supplements)

Answer 101

Hypertension

Question 102

_____________ diet - Rich in alpha linoleic acid, high in monounsaturates fats - olive, canola, soybean pils, walnuts, almonds, pecan, peanuts, pistachios - fish, poultry and egggs rather than beef, breads, fruits, and vegetables in abundance, beans, legumes, yogurt and cheese - revetsatrol, in skin of red grapes, may lower blood pressure

Answer 102

Mediterranean

Question 103

_______________: accumulation of lipids; structural and compositional changes in the intimal layer of the large arteries

Answer 103

Atherosclerosis

Question 104

Risks for _______________: Hypertension, obesity, smokin, elevated blood lipids, hereditary

Answer 104

Atherosclerosis

Question 105

_______________ is a form of ________ ______ disease (CAD) where the arteries harden and narrow from the buildup of plaque

Answer 105

Athersclerosis, coronary artery disease

Question 106

________ is a deficiency of blood due to obstruction

Answer 106

Ischemia

Question 107

________________ is characterized by a loss of elasticity of blood vessel walls

Answer 107

Arteriosclerosis

Question 108

_________ __________ reduction of coronary flow to myocardium due to blood clot blocking a narrowed coronary artery 1) angina pectoris - chest pain 2) Heparin - blood clots

Answer 108

Myocardial Infarction

Question 109

___________ includes high TG and low HDL

Answer 109

Dyslipidemia

Question 110

___________ - transports dietary TG from gut to adiose cells; synthesized in intestine from dietary fat; lowest density due to smallest amount off protein

Answer 110

Chylomicron

Question 111

____ (pre-beta)- Transports endogenous TG from liver to adipose cell

Answer 111

VLDL

Question 112

___ (beta) - transports cholesterol from diet and liver to all cells - small dense LDL - C associated with increased risk responsive to diet - larger buoyant LDL not associated with increased risk

Answer 112

LDL

Question 113

___ (alpha) - reverse cholesterol transport; moves cholesterol from cells to liver excretion

Answer 113

HDL

Question 114

___ (pre - beta to beta) - LDL precursor; found in circulation secondary to catabolism of other lipoproteins

Answer 114

IDL

Question 115

_________ ________ - three or more of the following risk factors are linked to insulin resistance which often increase risk for coronary events 1) elevated blood pressure which often increases risk for coronary events 2) elevated TG greater than or equal to 150 mg/dL 3) fasting serum glucose greater than or equal to 100 mg/dL 4) waist measurement greater than or equal to 102 cm (40") men; greater than or equal to 88cm (35") women 5) Low HDL < 40 mg/dL (men), < 50 mg/dL (women)

Answer 115

Metabolic syndrome

Question 116

________ ___________ _________ ________ (NCEP) National heart, lung and blood institute, endorsed by American Heart Association

Answer 116

National Cholesterol Education Program

Question 117

LDL - C < ___ optimal Total cholesterol < ___ desirable HDL - C < __ (M) < __ (F); >= __ high

Answer 117

100, 200, 40, 50, 60

Question 118

High ____________ (Hcy) levels are independent risk factors for CHD

Answer 118

Homocystine

Question 119

Normal triglyceride levels

Answer 119

150

Question 120

___________ _________ ______ (TLC) for CVD from Adult Treatment Panel III - up to 35% calories from total fat, <7% saturated fat, 5 - 10% PUFA, up to 20% MUFA, <200 mg cholesterol - 25 - 30 grams fiber (half soluble) - Stanols and sterols inhibit cholesterol absorption (2-3g) - Maintain DBW, prevent weight gain - Increase physical activity to at least 30 mintes of moderate intensity most days (expend at least 200 calories

Answer 120

Therapeutic Lifestyle Change

Question 121

_____ _________ _____ (ATP) IV: does not focus on specific target levels for LDL, but defines groups for whom lowering LDL would be most beneficial. Recommend a heart healthy lifestyle.

Answer 121

Adult Treatment Panel

Question 122

___ __ therapy recommended for: - Patients who have cardiovascular disease - Patients with an LDL of 190 mg/dL 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 percent or higher who are between 40 and 75 years of age

Answer 122

ATP IV

Question 123

Etiology of _____ _______ 1) weakened heart fails to maintain adequate output, resulting in diminished blood flow so fluid is held in tissues (edema); dyspnea (shortness of breath) 2) REduced blood flow to kidneys causes secretion of hormones that hold in sodium and fluid leading to weight gain

Answer 123

Heart Failure

Question 124

Treatment for _____ _______: 1) Digitalis increases strength of heart contraction 2) low sodium (2-3 grams), DASH diet, 1-2 L fluid 3) 1.1 - 1.4g protein/kg ABW for normally nourished and malnourished 4) Energy needs: RMR x physical activity factor 5) Evaluate thiamin status (loss with loop diuretics). without thiamin, pyruvate cannot be converted into acetyl CoA for energy, so heart muscle is deprived. 6) DRI for folate, Mg; MV with B12 7) Encourage individualized regular physical activity

Answer 124

Heart Failure

Question 125

``` Physical activity factors: _________ 1.0 - <1.4 ___ ______ 1.4 - < 1.6 ______ 1.6 - < 1.9 ____ ______ 1.9 - < 2.5 ```

Answer 125

Sedentary, Low Active, Active, Very Active

Question 126

_______ ________: Unintended weight loss, blood backs up into liver and intestines causing nausesa and decreased appetite Arginine and glutamine may help. Low saturated fat, low cholesterol, low trans fat, <2 grams sodium, high calorie

Answer 126

Cardiac Cachexia

Question 127

Structure of the _______ a) __________ - tuft of capillaries held closely by Bowman's capsule - produces ultrafiltrate which then passes through tubules. Capsule blocks passage of red blood cells and larg molecules like protein b) ________ __________ ______ - Major nutrient reabsorption c) ____ of _____ - water and sodium balance d) ______ ______ - acid base balance

Answer 127

Nephron, glomerulus, proximal convoluted tubule, loop of henle, distal tubule

Question 128

_____ functions: __________ - red blood cells, protein stay in blood; all else filters through tubules __________ - 100% glucose, amino acids; 85% water, sodium, potassium _________ - wastes, urea, excess ketones _________ - secretes hormones that control blood pressure, blood components; secretes ions that maintain acid - base balance

Answer 128

Renal, filtration, absorption, excretion, secretion

Question 129

________ involved in renal function a) ___________ (ADH) - from hypothalamus (stored inpituitary) b) _____ - vasoconstrictor C) _____________ (EPO)

Answer 129

Hormones, vasopressin, renin, erythropoietin

Question 130

___________ (ADH) 1) exerts pressor effect; elevates blood pressure 2) Increases water reabsorption from distal and collecting tubules 3) SIADH - Syndrome of Inappropriate Antidiuretic Hormone a) Hyponatremia caused by hemoodilution, treated with fluid restricion

Answer 130

Vassopressin

Question 131

_____ (vasoconstrictor) 1) Secreted by glomerulus when blood volume decreases 2) Stimulates aldosterone to increase sodium absorption and return blood pressure to normal

Answer 131

Renin

Question 132

_______________ (EPO) | 1) Produced by kidney; stimulates bone marrow to produce RBC

Answer 132

Erythropoietin

Question 133

Lab tests in _____ disease a) Decrease glomerular filtration rate, creatinine clearance b) Increase serum creatinine, BUN c) BUN:creatinine ratio of >20:1 d) renal solute load

Answer 133

Renal

Question 134

BUN:creatinine ratio of > 20:1 indicates a "___-_____ state" in which BUN reabsorption is increased due to acute kidney damage (may be reversible and may not require dialysis)

Answer 134

pre renal

Question 135

BUN:creatinine ratio of < __:_ suggests reduced BUN reabsorption due to renal damage (may need dialysis)

Answer 135

10:1

Question 136

_____ ______ load - solutes excreted in 1 L urine; daily fixed load of 600 mOsm 1) Mainly measures nitrogen (60%) and electrolytes (sodium)

Answer 136

Renal Solute

Question 137

Manifestation of _____ disease a) anemia due to decreased production of erythropoietin b) upset in blood pressure c) decreased activation of vitammin D (kidney produces active form which promotes efficient absorption of calcium by the gut)

Answer 137

Renal disease

Question 138

_____ disorders include: a) _____ calculi b) acute _____ _______ c) _________ ________ d) chronic ______ _______ e) ___ _____ _____ _______ (ESRD) f) chronic _____ _______

Answer 138

Renal, renal, kidney injury, nephrotic syndrome, kidney disease, End Stage Renal Disease, renal failure

Question 139

_____ _______ 1) 1.5 - 2 L fluid/day needed to dilute urine 2) calcium oxalate stones a) Adequate calcium intake to bnd oxalate and a low oxalate (40 - 50 mg) diet b) More stones are detected in diets deficient in calcium 3) Alkaline ash / acid ash diets a) Minerals not oxidized in metabolism leave an ash (residue) in urine b) Can change composition of diet to change pH of ash in urine c) Now usually done with medication d) To prevent acidic stones - create an alkaline ash: increase cations (Ca, Na, K, Mg), by adding vegetables, fruits, brown sugar, molasses e) To prevent alkaline stones - create an acid rich ash: increase anions (Cl, Ph, Su) by adding meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye

Answer 139

Renal calculi (kidney stones)

Question 140

_____ ______ ______ 1) Sudden shutdown with previously adequate cpacity; decreased GFR, inadequate pre - renal perfusion 2) Due to burns, obstruction, severe dehydration 3) Symptons - oliguria (<500 mL urine), azotemia (increased urea in blood)

Answer 140

Acute kidney injury

Question 141

Nutrition treatment for _____ ______ ______: 1) IV glucose, lipids, protein - 1 - 1.3 g/kg if non catabolic and or initiation of dialysis 2) 25 - 40 cals/kg, BEE x stress factor (1.2 - 1.3) during hypermetabolic conditions. Energy expenditure increases as kidney function declines 3) Low sodium (2-3 grams), replace losses in diuretic phase 4) 8 - 15 mg/kg phosphorus (May need phosphate binders) 5) 2 - 3 grams potassium based on output, serum potassium, dialysis 6) Replace fluid output from previous day pluss 500 mL

Answer 141

Acute Kidney injury

Question 142

_________ ________ 1) Defect in capillary basement membrane of glomerulus which permits escape of large amounts of protein into the filtrate moving through the tubules 2) Albuminuria, edema, malnutrition, hyperlipidemia (increased synthesis and lower clearance of VLDL) 3) Abnormalities in iron, copper zinc, calcium related to protein loss

Answer 142

Nephrotic Syndrome

Question 143

Nutrition treatment for _________ ________ 1) Modest protein restriction: 0.8 - 1 g/kg; 50% from HBV. Excess protein will be catabolized to urea and excreted 2) <30% fat, low saturated fat, 200 mg cholesterol 3) 35 calories /kg/day 4) Modest sodium restriction (2-3 g /day) 5) Calcium 1 - 1.5 g/day, supplement vitamin D 6) May need fluid restriction with edema

Answer 143

Nephrotic Syndrome

Question 144

_______ ______ _______ 1) anorexia, weakness, weight loss, nausea, vomiting 2) anemia due to deficient production of hormone erythropoiein by kidney

Answer 144

Chronic Kidney Disease

Question 145

_______ ______ _______ 1) 25 - 25 kcal / kg or BEE x activity facto. adjust for weight gain or loss 2) <2400 mg/day sodium 3) Protein restricted when GF mL/minute falls 4) Supplement phosphorus 5) Potassium generally not restricted unless serum level is elevated and urine output is < 1 liter per day 6) Fluid generally unrestricted

Answer 145

Chronic Kidney Disease

Question 146

``` _______ ______ _______ Stage 1 GFR >=90 Stage 2 GFR 60 - 89 Stage 3 GFR 30 - 59 Stage 4 GFR 15 - 29 Stage 1-2 0.8-1.4 g protein/kg Stage 3-4 0.6-0.8 g protein/kg ```

Answer 146

Chronic Kidney Disease

Question 147

_______ ______ _______ Stage 1-2 Supplement Phosphorus to maintain normal serum level Stage 3-4 800-1000 mg/day or 10-12 mg/g protein

Answer 147

Chronic Kidney Disease

Question 148

___ _____ _____ _______ (ESRD) 1) usually associated with a BUN >100 mg/dL and Cr 10-12 mg/dL 2) Retention of nitrogen metabolites - may use Giovanetti diet - 20 grams protein (HBV), increase calories; control edema, prevent deficiencies

Answer 148

End Stage Renal Disease

Question 149

____________ a) 1.2 grams protein/kg SBW (standard body weight), at least 50% HBV b) < 60 years 35 calories/kg c) >= 60 years or obese 30 - 35 calories/kg d) >= 1 liter fluid output: 2 - 4 grams sodium and 2 L fluid e) < 1 liter fluid output: 2 grams sodium and 1 - 1.5 L fluid f) Anuria: 2 grams sodium and 1 L fluid g) 40 mg/kg IBW 2-3 grams) potassium h) Calcium: individualized with maximum 2 grams elemental total i) 800 - 1000 mg phosphorus or < 17 mg/kg IBW or SBW j) vitamin C, B6, folate, B12 supplements: DRI for others k) zinc DRI 8-11 mg/day, individualize for iron and vitamin D

Answer 149

Hemodialysis

Question 150

__________ ________ a) 1.2-1.3 grams protein/kg SBW or adjusted BW; >=50% HBV b) < 60 years of age 35 calories/kg including dialysate >= 60 years of age 30 - 35 calories/kg c) 2-3 grams sodium - based on blood pressure and weight d)Potassium generally unrestricted (usually 2 - 4 grams) e) =< 2000 mg total elemental calcium including diet and binders f) 800 - 1000 mg phosphorus or 10 - 15 mg phosphorus / g protein g) 1 - 3 L fluid depending on output, cardiac status h) CAPD - continuous ambulatory pertioneal dialysis 4 - 5 x per dat i) VM as for for hemodialysis except thiamin

Answer 150

Peritoneal dialysis

Question 151

_______ ________ Type _ - Insulin deficient, depend on exogenous insulin Type _ - Insulin resistance with relative insulin deficiency (may need insulin) Risk factor: acanthosis nigricans (gray brown skin pigmentation in skin folds), GAD (glutamic acid decarboxylase antibodies)

Answer 151

Diabetes Mellitus, 1, 2

Question 152

Normal blood glucose __ - 100 mg/dL Impaired fasting glucose __ - 125 Impaired glucose tolerance ___ - 199

Answer 152

70, 100, 140

Question 153

``` Diabetes Diagnosis Fasting Plasma glucose >= ___ Glucose tolerance test >= ___ Symptoms of diabetes plus casual plasma glucose >= ___ mg/dL HgbA1c >= ___ % ```

Answer 153

126, 200, 200, 6.5

Question 154

____________ (glycated) __________ (HbA1c) a) measures % of hemoglobin that has glucose attached b) normal <5.7%; over 65 years

Answer 154

Glycosylated Hemoglobin

Question 155

Goals for all diabetics a) Maintain normal blood glucose (average pre - prandial goal __ - 130; peak post - prandial average < ___) b) Optimal serum lipid levels: LDL < ___, TG < ___, HDL > __(M) >__ (F) c) Blood pressure goals systolic < ___, diastolic

Answer 155

70, 180, 100, 150, 40, 50, 130 80

Question 156

Strategies for Type _ diabetics a) With fixed daily doses of insulin, consistency of CHO is recommended b) Integrate insulin therapy with usual eating habits c) Monitor blood glucose and adjust insulin doses for amount of food eaten d) With intensive insulin therapy, adjust pre - meal insulin dosage based on total CHO content of each meal, usin an insulin to CHO ratioe e) for planned exercise, reduction in insulin dosage may be best choice f) Endurance athletes: 120 - 18 mg/dL is guideline during activity

Answer 156

1

Question 157

Strategies for Type _ diabetes a) Achieve glucose, lipid and blood pressure goals b) Weight loss if necessary: improve food choices, space meals, exercise

Answer 157

2

Question 158

General nutrition recommendations for _______: - Macronutrient distribution based on DRI's for healthy adults - <7% total calories as saturated fat - Trans fat intake should be minimized - Encourage fiber intake - sucrose may be substituted for other CHO

Answer 158

Diabetes

Question 159

__________ ________ risk factors include BMI >30 and a history of GDM

Answer 159

Gestational diabetes

Question 160

___________ _______ a) at 24 - 28 weeks of gestation, screen with 50 g oral glucose load; glucose >= 140 mg/dL indicates need for further testing b) 40-45% CHO, 3 small medium sized meals and 2 - 4 snakcs c) DRI for CHO during pregnancy is 175 g / day d) 15 - 30g CHO at breakfast (less well tolerated), rest divided evenly e) increases risk of fetal macrosomia (LGA large for gestational age), fetal hypoglycemia at birth f) overweight/obese: modest energy restriction to slow weight gain

Answer 160

Gestational Diabetes

Question 161

________ _____ compares blood glucose response of a food to a standard glucose load 1) Affected by cookin methods and processing of starch; as particle size decreases, the index increases 2) Foods with low index: legumes, milk, whole grains, fruits, vegetables 3) Glycemic load: weighted average of the glycemic indexes of all foods eaten 4) Use of index as a method fro weight loss or weight maintenance is not currently recommended 5) No significant effect on A1c with a low glycemic diet for longer than 12 weeks

Answer 161

Glycemic Index

Question 162

1 serving bread contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 162

15, 3, 1, 80

Question 163

1 serving of fruit contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 163

15, 0, 1, 60

Question 164

1 serving of fat free milk contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 164

12, 8, 0-3, 100

Question 165

1 serving of reduced fat milk contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 165

12, 8, 5, 120

Question 166

1 serving of Whole milk contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 166

12, 8, 8, 160

Question 167

1 serving of sweets contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 167

15, varies, varies, varies

Question 168

1 serving of non starchy vegetables contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 168

5, 2, 0, 25

Question 169

1 serving of lean meat contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 169

0, 7, 2, 45

Question 170

1 serving of medium fat meat contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 170

0, 7, 5, 75

Question 171

1 serving of high fat meat contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 171

0, 7, 8, 100

Question 172

1 serving plant based proteins contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 172

varies, 7, varies, varies

Question 173

1 serving of fat contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 173

0, 0, 5, 45

Question 174

1 serving of alcohol contains __ g CHO, _ g Protein, _ g Fat, __ calories

Answer 174

varies, 0, 0, 100

Question 175

Free foods for diabetics contain < __ calories and < _ g CHO per serving

Answer 175

20, 5

Question 176

_____________ ________ gives flexibility in food choices 1) one choice from the starch, fruit or milk list - 15 grams CHO and each is a CHO choice; meal plan outlines the number of CHO choices to be selected for meals and snacks

Answer 176

Carbohydrate counting

Question 177

Types of _______ 1) Bolus (premeal or prandial 2) Basal (background)

Answer 177

Insulin

Question 178

_____: Premeal or prandial insulin a) Rapid acting: aspart (Noovolog), Lispro (Humalog); takes 5 - 15 minutes before eating, usual duration 4 hours b) short - acting: regular (Humulin R); take 30 - 45 minutes before meal (burst of insulin to cover the meal just about to be eaten). One unit covers 10 - 15 grams CHO; duration 3 - 6 hours

Answer 178

Bolus

Question 179

____, background insulin a) intermediate acting: NPH (Humulin N, Novolin N, ReliOn) onset 2 - 4 hours, duration 10 - 16 hours, cloudy in appearance b) long acting: Glargine (Lantus), Determir (Levemir) onset 2 - 4 hours, duration 18 - 24 hours

Answer 179

Basal

Question 180

Conventional _____ or _____ dose insulin regimen 1) Regular + NPH twice a day - Pre breakfast - 1/3 reg, 2/3 NPH; pre supper - equal Reg + NPH 2) regular + NPH pre breakfast, regular pre supper, NPH bedtime (to control early AM surge)

Answer 180

Split, Mixed

Question 181

_______ _____ __________ (MDI) Basal insulin once or twice daily and rapid acting bolus before meals

Answer 181

Multiple Daily Injections

Question 182

__________ _________ _______ ________ (CSII) insulin pump therapy provides steady, measured continuous dose of basal, and a surge (bolus) dose of insulin before meals

Answer 182

Continuous Sustained Insulin Infusion

Question 183

____ glucose lowering medication include 1) Insulin secretagogues 2) Biguanides 3) Thiazolidinediones 4) Alpha glucosidase inhibitors 5) Glucagon-like peptide - 1 (GLP - 1) agonist 6) Amylin agonist 7) DPP - 4 Inhibitors 8) SGLT - 2 inhibitors

Answer 183

Oral

Question 184

_______ _____________ include sulfonylureas glipizide (glucotrol), meglitinides glinides (prandin)

Answer 184

Insulin secretagogues

Question 185

__________ include metformin (glucophage) and suppress hepatic glucose production, as well as increase insulin uptake in muscles

Answer 185

Biguanides

Question 186

__________________ (Actos) improve peripheral insulin sensitivity

Answer 186

Thiszolidinediones

Question 187

_____ ___________ __________ include acarbose (precose) that inhibit enzymes that digest CHO, delaying absorption

Answer 187

Alpha glucosidase inhibitors

Question 188

________ ____ _______ - 1 (GLP - 1) agonists like exenatide (Byetta) enhances insulin secretion, suppresses postprandial glucagon secretion

Answer 188

Glucagon - like peptide - 1

Question 189

______ _______ include pramlintide (symlin) and decrease glucagon release, suppresses appetite

Answer 189

Amylin agonist

Question 190

___ - 4 __________ include saxagliptin (Onglyza), often used with metformin, reduces glucose released by liver overnight and between meals

Answer 190

DPP - 4 Inhibitors

Question 191

____ - 2 __________ include canagliflozin (Invokana), dapagliflozin (Farxiga), empaglyflocxin (Jardiance) target blood glucose lowering action in kidneys, by blocking a protein that returns glucose to the blood after it is filtered through the kidney

Answer 191

SGLT - 2 Inhibitors

Question 192

____ __________ is a natural increase in early morning blood glucose and insulin requirements due to increased glucose production in liver after overnight fast 1) increased need for insulin at dawn

Answer 192

Dawn Phenomenon

Question 193

Complications of uncontrolled ______ 1) Acute ketoacidosis 2) Acute hypoglycemia 3) Neuropathy 4) Retinopathy 5) Nephropathy

Answer 193

Diabetes

Question 194

_____ ____________: hyperglycemia due to insulin deficiency or excess carbohydrate intake, dehydration due to polyuria, increased pulse, fruity odor of ketones

Answer 194

Acute Ketoacidosis

Question 195

_____ ____________: insulin reaction (shock) due to insulin excess or lack of eating, slow pulse, cool, clammy skin, hungry, weak, shakiness, sweating 1) begin with 15 g CHO from glucose tablets, fruit juice (4-6 oz), sugar 2) wait 15 minutes; if still < 70 mg/dL, give another 15 grams 3) Repeat and treat until blood glucose is normal

Answer 195

Acute hypoglucemia

Question 196

__________ - peripheral and autonomic; astroparesis

Answer 196

neuropathy

Question 197

___________ - leads to blindness

Answer 197

retinopathy

Question 198

___________ - leads to decreased kidney function

Answer 198

nephropathy

Question 199

________ hypoglycemia occurs when a) overstimulation of pancreas or increased insulin sensitivity; blood glucose falls below normal 2 - 5 hours after eating (<50 mg/dL) b) weak trembling, extreme hunger c) goal is to prevent marked rise in blood glucose that would stimulate more insulin d) avoid simple sugars, 5 - 6 small meals / day, spread intake of CHO throughou the da, protein at RDA levels

Answer 199

Reactive

Question 200

_______ _____ Insufficiency, more commonly known as _________ disease a) atrophy of adrenal cortex; symptoms due to absence of adrenal hormones b) decreased cortisol (glycogen depletion, hypoglycemia), aldosterone (sodium loss, potassium retention, dehydration), and androgenic (tissue wasting, weight loss) c) Dier - high protein, frequent feedings, high salt

Answer 200

Adrenal cortex, addison's

Question 201

_______ disorders include | _____ and ____ thyroidism

Answer 201

Thyroid, hyper, hypo

Question 202

_______________ is excess secretion of thyroid hormone 1) elevated T3 and T4 2) Increased BMR leading to weight loss 3) Diet, increase calories

Answer 202

Hyperthyroidism

Question 203

______________ is deficiency of thyroid hormone 1) T4 low, T3 low or normal 2) Decreased BMR leading to weight gain 3) Diet - weight reduction

Answer 203

Hypothyroidism

Question 204

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

Answer 204

goiter

Question 205

An _______ goiter is due to inadequate ______ intake | a) diet - _______ salt; free of goitrogens (contain goitrin which inhibits synthesis of thyroid hormone)

Answer 205

endemic, iodine, iodized

Question 206

____ is a disorder of purine metabolism a) Increased serum uric acid; deposit in joints causing pain, swelling b) diet - low purine may not be effective; may need weight reduction c) Mediations (urate eliminant, colchicine) induce loss of nutrients

Answer 206

Gout

Question 207

Nutrition therapy for ____ includes: Moderate protein, liberal CHO, low to moderate fat, decrease alcohol, liberal fluid, avoid high purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel)

Answer 207

Gout

Question 208

___________ due to missing enzyme that would have converted galactose - 1 - PO4 into glucose - 1 - PO4 1) treated solely by diet - galactose and lactose free 2) NO organ meats, MSG extenders, milk, lactose, galactose, whey, casein, dry milk, curds, calcium or sodium caseinate, dates, bell peppers 3) OKAY soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG

Answer 208

Galactosemia

Question 209

____ _____ _______ 1) Unable to synthesize urea from ammonia resulting in ammonia accumulation 2) Vomiting, lethargy, seizures, coma, anorexia, irritability 3) diet - protein restriction (1.0, 1.5, 2.0 g/kg based on tolerance, age, projected growth rate) to lower ammonia; therapeutic formulas to adjust protein composition to limit ammonia production 4) Example: OTC Ornithine Transcarbamylase Deficiency

Answer 209

Urea Cycle Defects

Question 210

_______________ (PKU) etiology a) missing enzyme - phenylalanine hydroxylase - which would convert phenylalanine into tyrosine; phenylalanine and metabolites accumulate leading to poor intellectual function b) detected with Guthrie blood test

Answer 210

Phenylketonuria

Question 211

_______________ (PKU) diet a) restrict the substrate phenylalanine (PHE), supplement the product tyrosine (TYR). Tyrosine becomes a conditional amino aci. b) Low in phenyl alanine, but provide enough to promote normal growth (1. Phenex 1,2, Phenyl - Free 1,2 (low phenylalanine formulas)) c) avoid aspartame

Answer 211

Phenylketonuria

Question 212

In _______________ (PKU) the need for phenylalanine decreases with age or infection. Low protein, high CHO intakes may lead to increased dental caries

Answer 212

Phenlketonuria

Question 213

________ _______ _______ 1) Deficiency of glucose - 6 - phosphate in liver; impairs gluconeogenesis and glycogenolysis 2) Liver can't convert glycogen into glucose leading to hypoglycemia 3) Provide a consistent supply of exogenous glucose with raw cornstarch at regular intervals, anda high CHO, low fat diet

Answer 213

Glycogen storage disease

Question 214

______________ 1) treatable inherited disorder of amino acid metabolism 2) characterized by severe elevations of methionine and homocystine in plasma, and excessive excretion of homocystine in urine 3) associated with low levels of folate, B6, B12 4) Newly diagnosed patients receive increased doses of folate, pyridoxine (B6), B12 5) If they don't respond: low protein, low methionine diet

Answer 214

Homocystinurias

Question 215

_____ _____ _____ _______ (MSUD) 1) Inborn error of metabolism of the BCAAs leucine, isoleucine, valine 2) Poor sucking reflex, anorexia, FTT, irritability, sweet burtn maple syrup odor of sweat and urine 3) Restrict BCAA 45 - 62 mg/day (may use MSUD powder) 4) Provide adequate energy from CHO and fat to spare amino acids 5) Include small amounts of milk to support growth; gelatin may be used 6) avoid eggs, meat, nuts, and other dairy products

Answer 215

Maple Syrup Urine Disease

Question 216

_________ - inflamation of peripheral joints a) regular well balanced diet with vitamin intake at DRI b) bed rest, aspirin, reduce overweight to decrease stress c) normocytic anemia may develop 1) not diet related, inflammation of arthritis prevents reuse of iron 2) "Anti - inflammatory diet" may help osteoarthritis: fresh fruits and vegetables, resembles Mediterranean diet

Answer 216

Arthritis

Question 217

________ _____ ____________ (SLE) a) no specific dietary guidelines, tailor to needs b) may have dietary deficiencies of iron, folate, calcium, fiber, B12 c) may have anemia but does not correlate with iron intake d) may show symptoms of celiac disease

Answer 217

Systemic Lupus Erythematosus

Question 218

___________ resorb and remove bone; ___________ reform bone

Answer 218

osteoclasts, osteoblasts

Question 219

____________ - loss of bone tissue 1) Type 1 postmenopausal (within 15 - 20 years), Type II age associated >70 2) White and Asian women more than black or Hispanic 3) Causes: Malnutrition (especially protein), lack of exercise, decline in estrogen 4) Result is reduction in amount of bone due to defective calcium absorption (deossification)

Answer 219

Osteoporosis

Question 220

Treatment for ____________; _______ ___________ _______ (HRT), weight bearing execise, Vitamin D (400 800 mg) and calcium (>= 1200 mg, don't exceed 500 - 600 mg at one time) supplements, adequate protein, moderate to low sodium, 5 servings of fruit and vegetables

Answer 220

Osteoporosis, Hormone Replacement Therapy

Question 221

____________ -adult rickets 1) Vitamin D deficiency - lack of sunlight or diet intake 2) Reduction in bone density - demineralization 3) Vitamin D, calcium supplements

Answer 221

Osteomalacia

Question 222

________ - seizures, altered consciousness

Answer 222

Epilepsy

Question 223

_______________ phenobarbitaql and phenytoin (Dilantin) intefere with calcium absorption 1) Take 1 mg folate daily with drug 2) may nneed supplements of vitamin D, calcium, thiamin 3) provide phenytoin separate from meals and other supplements 4) Enteral feedings decrease bioavailibility of pheytoin so hold tune feedings >=2 hours

Answer 223

Anticonvulsants

Question 224

_________ diet - high fat, very low carbohydrate, _ grams fat : _ gram non fat 1) __% calories from fat, _ g protein /kg, remaining calories from CHO 2) Ketone bodies behave as inhibitory neurotransmitters; mild dehydration 3) Need supplements of Ca D, folate, B6, B12 4) MCTs are more ketogenic, more rapid metabolism and absorption

Answer 224

Ketogenic, 4:1, 90, 1

Question 225

________ _____ is non hereditary, brain damage; inadequate control over voluntary muscles leading to spasms

Answer 225

Cerebral Palsy

Question 226

In the _______ form of cerebral palsy: a) difficult, stiff movement; limited activity; obese 1) low calorie, high fluid, high fiber diet

Answer 226

Spastic

Question 227

In the ___ - _______ (athetoid) form: Involuntary worm like movement, constant irregular motions leading to weight loss 1) High calorie, high protein diet; finger foods

Answer 227

Non - spastic

Question 228

In a ______ ____ injury 1) Energy needs are 10% below predicted 2) at least 1.5 L fluid per day 3) Pressure ulcers: 30 - 40 cal/kg a) 1.2 - 1.5 protein/kg in stage I and II; 1.5 - 2g in stages III, IV b) normal intake of calcium, adequate fluids c) supplement vitamin C (500 - 1000 mgs with stage III or IV or if deficient) d) Zn 15 mg (220 mg zinc sulfate) with stages III, IV for 2 - 3 weeks e) Daily dietary source of vitamin A

Answer 228

Spinal Cord

Question 229

_________ _______ ______________ ________ (ADHD) a) Experimental treatment - feingold diet - no salicylates, artificial colors, artificial flavors. Efficacy not proven: positive result may be due to placebo effect b) sugar does not cause hyperactivity c) Provide wholesome foods at regular mealtimes with small servings followed by refills d) Adderall side effects: lack of appetite, nausea, weight loss e) If child is underweight, consider high calorie snacks at bedtime

Answer 229

Attention Deficit Hyperactivity Disorder

Question 230

______ ________ _________ | Unnecessary food restrictions, possible food aversions, excessive supplementation can place children with ASD at risk

Answer 230

Autism Spectrum Disorders

Question 231

__________ _______ a) avoid distractions (no TV during meals); regular consistent mealtimes, encourage self-feeding, offer one course at a time, lower saturated fats, soft calming background music, finger foods may be helpful, avoid dehydration, may need verbal cues to chew and swallow b) anomia, form of aphasia lost words, unable to recall names of common items

Answer 231

Alzheimer's Disease

Question 232

______ | Decrease in total red cell ass due to fewer red blood cells or to smaller cells with less hemoglobin

Answer 232

Anemia

Question 233

__________ ___________ ______ Small, pale cells; due to iron deficiency a) associated with chonic infections, malignancies, renal disease

Answer 233

Microcytic, hypochromic anemia

Question 234

__________ _____________ ______ FEW large cells, filled with hemglobin a) due to deficiency of folate or vitamin B12; Schilling test for pernicious anemia

Answer 234

Macrocytic, megaloblastic anemia

Question 235

``` In __________ or ___________ anemia RBC: may be normal Hgb: low Hct: low MCV: low <80 MCH: low MCHC: low <31 ```

Answer 235

Microcytic, hypochromic

Question 236

``` In __________ anemia: RBC: decreased Hgb: low Hct: low MCV: high >95 MCH: high MCHC: Normal >31 ```

Answer 236

Macrocytic

Question 237

To supplement ____ in anemia, some foods high in ____ include: liver, kidney, beef, dried fruits, dried peas and beans, nuts, leafy green vegetables, fortified whole grain products

Answer 237

Iron, Iron

Question 238

Typical American diet contains _ mg iron / 1000 calories

Answer 238

6

Question 239

Ag - Ab reaction: when _______ enters the body, ________ reacts

Answer 239

Antigen, antibody

Question 240

In allergies there is an ______________ E (IgE) mediated reaction to normally harmless food protein a) common allergens - peanuts, eggs, milk soy, whet, shellfish b) Cow's milk protein is the most common single allergen for infants c) introduce eggs at __ months of age; earliest age of peanut introduction 4 - 6 months of age

Answer 240

Immunoglobumin

Question 241

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

Answer 241

Atopy

Question 242

_______ diagnosis include things like diet history, skin tests, elimination diet (omit suspected foods)

Answer 242

Allergy

Question 243

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

Answer 243

CAP - FEIA

Question 244

______ - double blind, placebo - controlled food challenges, identify food induced symptoms (gold standard for diagnosis)

Answer 244

DBPCFC

Question 245

____ (alternative to skin test) serum is mixed with food on paper disk; measures specific IgE antibodies

Answer 245

RAST

Question 246

____ is food least likely to cause an allergy

Answer 246

Rice

Question 247

____ ___________ (NON - IgE): Abnormal physiologic response, GI, cutaneous, respiratory symptoms, but NO antibody production

Answer 247

Food Intolerance

Question 248

_____ and _________ excessive fluid loss may lead to dehydration (hyperglycemia, dry, loose inelastic ski); IV feedings of dextrose and water, then diet high in calories and fluids -BMR increases 7% for each degree rise in F temp; normal temp 98.6 F

Answer 248

Fever and Infection

Question 249

_____ A) Immediate shock period - catabolism; BMR rises 50 - 100% 1) replace fluids and electrolytes lost 2) Recovery period - increase calories (based on burn size) 3) Secondary period - 1.5 - 2 grams protein/kg (1.2 if ____ <10%BSA), high calories a) vitamin C - wound healing, 500 mg x 2 b) water soluble vitamins 2x RDA, vitamin A 10000 IU c) vitamin K if on antibiotics d) zinc for wound healing if zinc deficient, 220 mg zinc sulfate

Answer 249

Burn, burn

Question 250

___ and ____ response to injury - hypermetabolic, catabolic response following trauma (accelerated catabolism of lean body mass leading to negative nitrogen balance as protein is catabolized to release glucose for energy) a) ___ phase: hypovolemia, shock, tissue hypoxia b) ____ phase: follows fluid resuscitation and return of oxygen transport c) Results of physiologic trauma: hyperglycemia, hyperinsulinemia, little or no ketosis, increased glucagon

Answer 250

Ebb, flow, ebb, flow

Question 251

Hormones involved in __ and ____ response to injury 1) Catecholamines epinephrine, norepinephrine - hepatic glycogenolysis 2) ACTH - releases cortisol which metabolizes amino acids from muscle 3) aldosterone - Renal sodium retention, glucogenesis 4) ADH - renal water absorption 5) Hypovolemia, decreased cardiac output, drop in body temperature 6) Hyperglycemia - epinephrine suppresses insulin, insulin resistance (decreased cell uptake and use) 7) fluid and sodium retention, potassium excretion, loss of nitrogen, sulfur, zinc, phosphorus

Answer 251

Ebb and flow

Question 252

__________ disease 1) Protein calorie malnutrition, malabsorption, fluid and electrolyte imbalances a) altered taste acuity: add flavorings and seasonings b) meat aversions may require elimination of red meat c) thrush from oral infection: avoid spicy, acidic, strongly flavored foods 1) Provide bland liquids, soft foods, chilled or frozen foods d) Throat or neck cancer - use PEG feeding e) Cancer cachexia (generalized wasting) connected to cytokines and the tumor necrosis factor (TNF)

Answer 252

Neoplastic

Question 253

Treatment for __________ disease (cancer) a) Radiation - loss of taste, xerostomia (dry mouth, so moisten food), esophagitis, diarrhea, malabsorption 1) Mucositis - inflammation of mucosal lining of oropharynx and esophagus - Avoid fresh, raw, uncooked foods, offer cold and soft food b) Chemotherapy - chemical reagents which have toxic effects 1) nausea, vomitin, malabsorption, anorexia 2) stomatitis - crack in skin at mouth corners, riboflavin deficiency 3) Methotrexate - anti - folate drug

Answer 253

Neoplastic

Question 254

_____________ data in __________ disease (cancer) a) Interrelationship between host, agent, environment in causing disease b) some evidence that fruits and vegetables are beneficial in overall cancer prevention (carotenoids, vitamin C) c) some evidence that exercise in post menopausal women decreases risk of breast disease

Answer 254

Epidemiologic, neoplastic

Question 255

________ is malnutrition typified by protein and calorie starvation 1) anthropometric diagnosis, serum albumin normal, no edema 2) severe fat and muscle wasting, starved appearance 3) triceps skinfold, arm and muscle circumference decreased

Answer 255

Marasmus

Question 256

__________ malnutrition: protein calorie malnutrition | 1) brought on by treatment, hospital, medications

Answer 256

Iatrogenic

Question 257

________ _______ a) distorted body image, dramatic weight loss, preoccupation with food and weight gain b) therapy is multidisciplinary; weight restoration and psychotherapy

Answer 257

Anorexia nervosa

Question 258

Treatment for ________ _______ 1) Correct electrolyte imbalance 2) Plan with patient, regular mealtimes, varied and moderate intake, gradually reintroduced feared foods 3) Focus on health benefits and life sustaining aspects of food (reason to eat) 4) Re-feeding increases cardiac load - go slowly 5) Recommend initial daily calorie levels range from 1000 - 1600 (30 - 40 cals/kg), but may need to be set 100 - 300 calories above the current level of intake to support adherence

Answer 258

Anorexia nervosa

Question 259

_______ - Gorging and vomiting syndrome, usually close to normal weight 1) Damage to teeth, throat, esophagus, rectal bleeding, bruised knuckles from purgin with fingers, low potassium and chloride blood levels

Answer 259

Bulimia

Question 260

Obesity BMIs Class I __ - 34.9 Class II 35 - ____ Class III >= __

Answer 260

30, 39.9, 40

Question 261

____ calories = to _ lbs body fat

Answer 261

3500, 1

Question 262

For obesity weight loss reduce average caloric intake by ___ calories per day

Answer 262

500

Question 263

_______ treatment - reduced caloric intake, exercise, behavior modification 1) Realistic weight loss goals: up to 2 lbs per week, up to 10% of baseline BW, or a total of 3% to 5% of baseline weight if cardiovascular risk factors are present

Answer 263

Obesity

Question 264

_______ _________ strategies for _______ 1) 1200 - 1500 cal/day for women; 1500 - 1800 cal/day for men 2) Energy deficit of approximately 500 - 750 calories / day 3) One of the evidence based diets restricting certain food types (high fat foods, high CHO foods) in order to create an energy deficit by reduced food intake 4) Small food based changes: changes in SSB, sugar sweetened beverages can assist with weight management 5) Meal replacements for weight loss may be recommended if the client has difficulty with portion control

Answer 264

Calorie Reduction, Obesity

Question 265

Physical activity recommendations for obesity: ___ to ___ minutes per week for loss; for weight maintenance, ___ to ___ minutes per week

Answer 265

150, 420, 200, 300

Question 266

_______ medication approved for long term use (up to 2 years) 1) Orlistat: lipase inhibitor, take with diet 30% cals as fat, vitamin supplements 2) Lorcaserin: aggonist of serotonin, enhances satiety 3) Phentermine / topiramate: Appetite suppressant, releases norepinephrine

Answer 266

Obesity

Question 267

_________ __________ interventions: weight maintenance is usually recommended in overweight children 2 - 5 years of age with a multicommponent weight management intervention with active participation of the parent - Weight loss may be recommended when the child has serious medical conditions

Answer 267

Pediatric Obesity

Question 268

The ____ ______ ____ theory is the belief that localized exercise reduces fat stores in the active area - research does NOT support this notion

Answer 268

Spot weight loss theory

Question 269

When a dieter reaches a plateau, ___ will drop to reflect the weight loss

Answer 269

BMR

Question 270

Bariatric surgery treatment is provided to those with class ___ obesity with a BMI of __ or greater, or a BMI of __ or greater with comorbidities

Answer 270

III, 40, 35

Question 271

_______ ______ permanently alters the anatomy of the GI tract 1) Reduces the amount of food that can be eaten at one time and produces early satiety

Answer 271

Gastric Bypass

Question 272

____ - __ - _ (RYGB) reconstructs the small intestine to resemble the letter Y 1) Creates a small gastric pouch connected directly to the jejunum 2) Dumping syndrome may develoo 3) Supplemental calcium in divided doses 1200 - 1500 mg, vitamin D 3000 IU, 45 - 60 mg iron taken apart from calcium, chewing of ice may be a sign of iron deficiency - Greater need for protein - multivitamin, multimineral supplement with 100% DRI for vitamin K, zinc, thiamine, folic acid, copper, biotin, iron

Answer 272

Roux - en -Y

Question 273

______ ___________ (SG) 1) about 80% of stomach removed 2) food pathway not altered 3) vitamin supplementation, monitor iron, calcium, and vitamin D levels

Answer 273

Sleeve gastrectomy

Question 274

____________ __________ ______ _______ (LAGB) 1) Small gastric pouch created using a fluid filled inflatable band 2) Adjusted to alter the size of the opening (fully reversible) 3) Restrics total amount of food eaten at one time 4) No surgery - induced malabsorption of nutrient. Deficiencies linked to decreased food intake and decreased food tolerance

Answer 274

Laparoscopic Adjustable Gastric Banding

Question 275

______ _____ ________ 1) Chromosome 15 deletion 2) Congential disorder, subnormal LBM, supra - normal body fat 3) Ghrelin levels are elevated which stimulates growth hormone secretion, appetite, intake, and fat mass deposition 4) do not sense satiety, decreased energy requirements 5) Obesity at 2 - 3 years of age, hypogonadism, muscle hypotonia, failure to thrive, short stature 6) Best treatment is to control food intake

Answer 275

Prader Willi syndrome

Question 276

______ ______ bacterial enzymes ferment CHO deposits on plaque, enzymes produce acids that demineralize surface

Answer 276

Dental caries

Question 277

Low __________ potential foods -High protein, moderate fat, minimal concentration of fermentable CHO, strong buffer; high mineral content (Ca, P), PH >6, stimulates saliva

Answer 277

Cariogenic

Question 278

_____ ________ (sorbitol, xylitol, mannitol) do NOT promote tooth decay

Answer 278

Sugar alcohols

Question 279

________ can control caries, supplement starting at 6 months of age if level in water supply is < 0.3 ppm 1) Fluorosis (mottled teeth) with excessive fluoride

Answer 279

Fluorine

Question 280

________ recommendations 1) Infants (birth - 6 months): oral supplementation NOT recommended. Use ___________ water if available 2) Infants (6 - 12 months) ___________ water; oral supplements ONLY if prescribed 3) Toddler (12 - 24 months) ___________ water, or oral supplements if prescribed 4) Children (2 - 3 years) ___________ water or supplements as recommended, ________ toothpaste (pea-size)

Answer 280

Fluoride, fluoridated, fluoridated, fluoridated, fluoridated, fluoride

Question 281

Infant should not sleep with a ______ - ____ ______ _____ _____ (BBTD), _____ _________ ______ (ECC)

Answer 281

Bottle, Baby Bottle Tooth Decay, Early Childhood Caries

Question 282

________ - Inflammation of the mouth (associated with riboflavin deficiency) a) Avoid very hot, very cold foods, spices, sour/tart foods b) rinse with lukewarm water after meals

Answer 282

Stomatitis

Question 283

___________ a) Treat by decreasing gatric acidity, reflux b) diet - small, low fat, bland, low fiber, weight reduction

Answer 283

Esophagitis

Question 284

_________ - disorder of lower esophageal sphincter motility, does not relax upon swallowing 1) Causes dysphagia - difficulty swallowing 2) Start with pureed moist thick foods, progress to thick liquids

Answer 284

Achalasia

Question 285

The ________ _________ ____ (NDD): Specifies diet consistency and liquid viscosity

Answer 285

National Dysphagia Diet

Question 286

National Dysphagia Diet _ Pureed, moderate to severe smoothe, pureed, homogenous, cohesive foods. "Pudding - like". Blended, whipped, mashed. Avoid gelatin, fruited yogurt, hot cereal with lumps and soup with lumps, ice cream

Answer 286

1

Question 287

_________ ____________ ______ (NDD2) Mild to moderate Moist, soft textured, easily formed into a bolus, moist, tender ground or diced meats, soft cooked vegetables, soft or canned fruits. Soft pancake okay. No bread, rice, cheese cubes

Answer 287

Dysphagia Mechanically Altered

Question 288

``` _________ ________ (NDD3) Transition to regular Avoid very hard, sticky, crunchy foods, hard fruit and raw vegetables, nuts needs, dry bread and cereals ```

Answer 288

Dysphagia Advanced

Question 289

______ Consistency Dysphagia Spoon thick, Honey like, nectar like Thin: includes all beverages: water, ice milk, juices, coffee, tea, gelatin

Answer 289

Liquid consistency

Question 290

______ - __________ ______ disease (GERD) 1) Avoid eating before bed, soda, caffeine, acidic foods 2) small, low fat meals, liquids empty more rapidly

Answer 290

Gastro esophageal reflux disease

Question 291

_________ _______ _____________ (PIH) a) Progresses from pre-eclampsia to eclampsia b) Hypertension, edema of face and hands, proteinuria, rapid weight gain after 20th week; may have convulsion c) More frequently found in women wth lack of prenatal care, poor diets poor prootein and calcium intakes d) sodium restriction is NOT recommended for prevention or treatment; sodim needed to maintain normal levels of sodium in plasma during large prenatal expansion of tissues and fluid e) Proposed association between PIH and calcium deficiency

Answer 291

Pregnancy Induced Hypertension

Question 292

___________ __________ - Severe nausea, vomitin, acidosis, weight loss a) Bed rest, small amounts of frequent CHO

Answer 292

Hyperemesis Gravidarum

Question 293

________ ______ __________ ________ (AIDS) 1) Virus debilitates immune system by attacking lymphocytes 2) diarrhea, malabsorption, nausea, vomiting, weight loss 3) Preserve lean body mass, prevent weight loss, prevent HIV wasting

Answer 293

Acquired Immune Deficiency Syndrome

Question 294

Nutrition therapy for ____ 1) Nutrient needs a) Energy BEE x 1.3 for asymptomatic b) Protein: asymptomatic 0.8 g/kg, up to 1.2 - 2.0 g/kg if wasted LBM c) Vitamin/mineral supplements if needed to correct micronutrient deficiencies

Answer 294

AIDS

Question 295

Nutrition Therapy for ____ 1) Educate about food saftey 2) HIV infected women should be counseled NOT to breast feed 3) HIV employee - keep info confidential, suggest AIDS education program 4) Follow appropriate universal precaution; need not wear gloves, gowns or masks with general care unless respiratory or strict isolation indicated

Answer 295

AIDS

Question 296

Nutrition therapy for ____ 1) __________/__________ _______ _____________ __________ (NRTI) including Retrovir, Zidovudine can lead to anemia, loss of appetite, low vitamin B12, copper, zinc, carnitine

Answer 296

AIDS, Nucleotide/Nucleoside Reverse Transcriptase Inhibitors

Question 297

Nutrition therapy for ____ Nutritional supplements should not be routinely recommended and herbal supplementation should be discouraged as adjunctive therapy to conventional care. Use of Vitamin C or St. John's Wort could result in drug resistance. CAM (complementary alternative medicines) are not inert and may have profound consequences

Answer 297

AIDS

Question 298

Pediatric ___ a) High protein, high calorie with supplements needed for weight gain b) Energy needs: general guidelines plus appropriate stress factors c) Multivitamins/minerals at doses 1 - 2 x RDA or DRI d) Lactose restriction if intolerant e) ___ - __________ _____________ ________ (HALS) may develop from therapy 1) High cholesterol, high TG, insulin resistance, changes in body fat distribution f) Significant loss of lean body mass can be obscured by edema and HALS

Answer 298

HIV, HIV - Associated Lipodystophy Syndrome

Question 299

_______ ___________ _________ _______ (COPD) - persistent obstruction of airflow a) Emphysema - air sacs (alveoli) lose elasticity; thin cachectic, often older 1) Difficulty exhaling; air pocket walls expand, thin out, collapse b) Chronic bronchitis - Excess mucus production, chronic productive cough c) symptoms - weight loss, emaciation, anorexia

Answer 299

Chronic Obstructive Pulmonary Disease

Question 300

Nutrition Therapy for ____ 1) Maintain stable weight - replete but do not overfeed: High calorie, high protein diet (1 - 1.5 g/kg dry weight, 15 - 20% cals), 30-45% as CHO 2) Small, frequent, mini meals and snacks, easy to prepare and eat, nutrient dense supplements (smoothies, meatloaf, muffins with cream cheese, tuna salad, cereal with fruit)

Answer 300

COPD

Question 301

_____ ___________ ________ ________ (ARDS) a) Lungs no longer able to exchange gases, hypermetabolism, increased energy needs; severely underweight b) Meet basic nutritional requirements, maintain stable weight, facilitate weaning from mechanical ventilation, without exceeding capacity to clear carbon dioxide c) Provide adequate but not excessive calories; avoid excess non - protein calories d) Provide enteral formula containing EPA and GLA (gamma - linoleic acid), and enhanced levels of antioxidant vitamins e) 1.5 - 2.0 protein/kg BW, maintain lean body mass

Answer 301

Acute Respiratory Distress Syndrome

Question 302

Types of Enteral formulas 1) ________ polymeric 2) _________, chemically defined 3) __________

Answer 302

Standard polymeric, elemental, specialized

Question 303

________ _______ Enteral Formula 1) Lecithin may be added as an emulsifier 2) Initiated at full strength at a rate of 10 - 40 mL/hour 3) Modular: ix individual components, adds flexibility 4) Blenderized: whole food, large bore tube, thick intact protein, high residue isotonic osmolality is close to that of blood)

Answer 303

Standard Polymeric

Question 304

_________, __________ defined Enteral Formulas 1) Used with malabsorption 2) Pre-digested protein or amiino acids, glucoose or sucrose, small fat, vitamins, minerals, electrolytes 3) Absorbed in proximal intestine, low to no residue, don't need pancreatic enzyme, high osmolality, poor taste 4) Used with compromised GI function, inability to digest and absorb 5) Alitraq, Peptamen, Vivonex

Answer 304

Elemental, chemically defined

Question 305

___________ Enteral Formula 1) Nepro, Novasource Renal - renal 2) Nutre, Pulmocare, Respalor: High fat, low CHO - pulmonary 3) Hepatic Aid II, NutriHep - Liver 4) Glucerna, Diabetisource - diabetes 5) The more __________ the formula the greater the cost

Answer 305

Specialized, specialized

Question 306

Tube ____ (opening) 1) Based on viscosity of feeding 2) Large #__ - Blenderized whole foods 3) Small #_ - Ready prepared formulas, more comfortable

Answer 306

16, 8

Question 307

Guidelines for _______ Access 1) Anticipate length of time needed, risk of aspiration, patient's anatomy, clinical status, normal or abnormal digestion and absorption 2) Hang time open systems 4 hours, closed system 24 - 48 hours

Answer 307

Enteral

Question 308

Short Term ______ access (_ - _ weeks) 1) Nasogastric tube, normal GI function 2) Continuous Drip - constant, steady rate over 16 - 24 hours, usually with a feeding pump (for those with a compromised GI function or who do not tolerate large volume infusion) 3) Cyclic feeding - Delivered by continuous drip at an increased rate over 8 - 16 hours, often overnight, by pump (for under - nourished, especially older, ambulatory, malnourished patients) 4) Intermittent Drip (pump or gravity) - more mobility 5) Nasoduodenal or Nasojejunal if unable to tolerate gastric feedings 6) Transpyloric: passed by pyloric valve in stomach; used in comatose patients or ones with no gag reflex.

Answer 308

Enteral, 3 - 4

Question 309

____ Term Enteral feedings (needed for more than _ - _) weeks a) PEG inserts tube into stomach through abdominal wall

Answer 309

Long, 3 -4

Question 310

When checking for ______ tube placement do NOT use blue dye, use x ray confirmation of tube tip location, or aspirate gastric contents

Answer 310

enteral

Question 311

_______ _____ recommendations 1) _ mL water / calorie ingested 2) 1cal/mL formulas are 80-86% water 3) 1.5 cals/mL are 76 - 78% water 4) 2 cals/mL formulas are 69--71% water

Answer 311

Enteral Water, 1

Question 312

Check _______ __________ every _ hours during the first __ hours. Then decrease to 6 - 8 hours unless patient is critically ill. If the GRV is > 250 after the second check, consider a prmotility agent. If the GRV 500 mL , hold othe feeding and assess tolerance

Answer 312

gastric residual volume, 4, 24

Question 313

Adverse effects of ______ nutrition include 1) Lactose intolerance 2) formula hyperosmolality 3) Rapid infusion causing influx of water into gut 4) Bacterial contamination

Answer 313

Enteral

Question 314

mL of enteral formula needed per day = ________ needed / cal/mL

Answer 314

calories

Question 315

Enteral formula protein content = __ of daily formula x grams of _______ per liter

Answer 315

mL, protein

Question 316

Daily fluid need with enteral feeding = % water in formula x daily formula in __ Subtract formula water from total fluid requirements to determine water ______

Answer 316

mLs, flushes

Question 317

Enteral feeding administration rate = Total __ of formula /day / 24 hours

Answer 317

mL

Question 318

__________ __________ _________ (PPN) 1) Used with small surface veins 2) Indications - post surgery (when enteral feeding is expected to resume within 5 - 7 days), mild to moderate malnutrition, as supplement to enteral

Answer 318

Peripheral Parenteral Nutrition

Question 319

__________ __________ Solutions 1) IV dextrose - 3.4 calories / gram a) To figure calories (mL x % x 3.4) b) Highest concentration of dextrose used in peripheral nutrition is 10% 2) Protein 3 - 15% amino acid solutions 3) ___________ ___ ________ (IVFE) a) 10% 1.1 cqalories/mL b) 20% 2.0 calories/mL 4) Solutions generally limited to 800 - 900 mOsm

Answer 319

Peripheral Parenteral Nutrition, Intravenous Fat Emulsion

Question 320

__________ _________ (PN) 1) Infusion of a hypertonic solution delivered through a central venous catheter 2) Used to achieve an anabolic state when patients are unable to eat by mouth and enteral feeding is not possible 3) Subclavian vein minimizes risk of phlebitis 4) Typical Uses: Altered GI function, Impaired Nutrient Utilization

Answer 320

Parenteral Nutrition

Question 321

Note for patients on __________ Nutrition 1) Moderately to severely malnoursihed patients expected to have prolonged periods of GI dysfunction 2) Critically ill hemodynamically stable with paralytic ileus, acute GI bleeds, bowel obstruction 3) Only malnourished cancer patients on therapy who are anticipated to be unable to ingest and absorb adequate nutrients for a period of 7 - 4 days 4) Peritonitis, fistulas 5) Critical care patients if hypermetabolism is expected to last for more than 5 days and enteral support is not possible

Answer 321

Parenteral Nutrition

Question 322

A ____________ ________ _______ ________ (PICC) is a catheter used for short or moderate term infusion

Answer 322

Peripherally Inserted Central Catheter

Question 323

A _______ ______ ________ (CVC) is a long term central access catheter through the cephalic, subclavian or internal jugular vein into the superior vena cava

Answer 323

Central Venous Catheter

Question 324

One primary concern with __________ nutrition is the translocation of bacteria; not feeding through gut allow wall to break down, bacteria move out causing sepsis

Answer 324

Parenteral

Question 325

___ __________ ________ ______ (GALT) occurs in some cases of parenteral nutrition or bowel rest. The gut provides 50% of total body immunity. 70 - 80% of toal body immunoglobulin production is secreted across the GI mucosa to defend against pathogenic substances in the GI lumen

Answer 325

Gut Associated Lymphoid Tissue

Question 326

_________ Protein solution 1) Ratio for anabolism is _ g nitrogen / ___ calories; 1 - 1.5 g protein / kg / day 2) crystalline amino acids _ - __% solution 3) % = number of grams of protein in ___ mL of solution a) A 3% solution has 3 grams of amino acids / 100 mL

Answer 326

Parenteral, 1, 150, 3 - 15, 100

Question 327

__________ Energy Solution a) __ - __ calories/kg; up to a 70% dextrose solution 1) a __% solution provides ___ g CHO/liter 2) To avoid overfeeding and hyperglycemia, start at =< __ - __ calories /kg 3) Maximum rate of dextrose infusion should not exceed _ to _ mg/kg/minute to prevent hyperglycemia and other complications. Increased blood glucose from excess dextrose increases RQ in ventilated patients and increases infectious complications

Answer 327

Parenteral, 35 - 50, 10, 100, 20 - 25, 4 to 5

Question 328

__________ fat solution a) fat needed for energy to prevent _________ _____ ____ __________ (EFAD) 1) To prevent EFAD give ___ mL of 10% fat emulsion 1 - 2 x week 2) Symptom of EFAD; petechiae (red spots)

Answer 328

Parenteral, Essential Fatty Acid Deficiency, 500

Question 329

_____ ________ __________ (TNA) or three in one systems are __________ nutrition solutions that include dextrose, amino acids, and lipids

Answer 329

Total Nutrieny Admixures, Parenteral

Question 330

Contraindications for __________ nutrition 1) If alimentary tract can be used 2) If needed only for short time in well nourished 3) During periods of cardiac instabillity 4) If risks inherent in process outweigh benefits

Answer 330

Parenteral

Question 331

___________ _______ a) Introduce a minimal amount of FULL STRENGTH enteral feeding at a low rate of __ - __ mL/hour to establish GI tolerance b) Begin tapering when enteral feedings are providing 33 - 50% of their nutrient requirements c) Decreaase PN as you increase enteral rate by 25 - 30 mL/hour increments every 8 - 24 hurs to maintain prescribed nutrient levels d) when patient can tolerate about __% of needs by enteral route, DC PN

Answer 331

Transitional Feeding, 30 - 40, 60

Question 332

__ - ______ ________ occurs with aggressive administration of nutrition to the malnourished a) At risk: anorexia, chronic alcoholism, prolonged fasting, unfed 7 - 10 days, significant weight loss, phosphorus - deficient PN b) Starved cells take up nutrients, potassium and phosphorus shift into intracellular compartments c) results in hypokalemia, hypophosphatemia and hypomagnesemia d) overfeeding PN and dextrose > 5mg/kg/min may lead to hyperglycemia

Answer 332

Re - feeding syndrome

Question 333

___________ ________ combines evidence based complementary therapies with conventional (allopathis) treatments to address the social, psychological and spiritual aspects of health and illness

Answer 333

Integrative Medicine

Question 334

The ________ ______ for _____________ and ___________ _____ (NCCIH) provides yoga, meditation, herbs and botanicals, traditional healing practices

Answer 334

National Center for Complementary and Integrative Health

Question 335

_____________ and ___________ ________ (CAM) fall into categories like mind - body medicine, alternative medical systems, acupuncture, oriental medicine, lifestyle and disease prevention, biologically based therapies, herbs and orthomolecular medicine, manipulative and body based systems, chiropractic medicine, biofield systems like therapeutic touch, bioelectric magnetics

Answer 335

Complementary and Alternative Medicine

Question 336

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

Answer 336

Functional

Question 337

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

Answer 337

Holistic

Question 338

_______ _________ _______ (DRI) | - Is an umbrella of nutrient guidelines

Answer 338

Dietary References Intakes

Question 339

___________ _______ __________ (RDA) | -Goals for healthy individuals to prevent nutritional deficiency diseases, includes gender, age, life phases

Answer 339

Recommended Dietary Allowances

Question 340

_________ ________ ____________ (EAR) | - For 50% of population, used in planning meals for healthy people, assesses group nutritional adequacy

Answer 340

Estimated Average Requirement

Question 341

``` ________ ______ (AI) - Used when insufficient evidence exists for EAR, RDA ```

Answer 341

Adequate Intake

Question 342

``` _____ ______ (UL) - Tolerable upper level not associated with adverse side effects in most individuals of a healthy person ```

Answer 342

Upper Limits

Question 343

_______ _________ for Americans - Revised every five years 1) Designed to prevent chronic disease, written by USDA and HHS 2) Community nutrition programs use the guidelines when developing

Answer 343

Dietary Guidelines

Question 344

2015 - 2020 _______ _________ a) Healthy eating pattern across the lifespan: Vegetables from all sub - groups, fruits (especially whole), grains (half whole grains), fat - free or low fat dairy, variety of proteins, oils b) Focus on variety, nutrient density, and amount c) Limit calories from added sugars (<10% of calories) and saturated fats (<10% of calories) and trans fats, and reduce sodium intake (<2300 mg) d) Shift to healthier food and beverage choices e) Support healthy eating patterns for all (home, school, work, communities) f) Adults need 150 minutes of moderate - intensity physical activity each week (include strengthening activities on 2 or more days). Double the activity time for additional an more extensive health benefits

Answer 344

Dietary Guidelines

Question 345

_______ ______ _____ (HEI) - USDA's overall measure of diet quality 1) Measures how well Americans follow the guidelines 2) 5 food groups, 4 nutrients (fat, saturated fat, cholesterol, sodium), variety

Answer 345

Healthy Eating Index

Question 346

_______ ____ Guidance System 1) Shows essential food groups, and offers recommendations on balancing calories, foods to increase and foods to reduce 2) Build a healthy plate: make half your plate fruits and vegetables, make at least half your grains whole, use skin of 1% milk, vary protein choices 3) Cut back on foods high in solid fats, added sugars, salt

Answer 346

MyPlate Food

Question 347

_______ ______ ____ - National Health Program and Disease Prevention 1) Identified broad goals and specific objectives for improving 2) Focuses on disease prevention by changing behaviors 3) Targets healthy diet and healthy weight as critical goals 4) ____ goals address nutrition and weight, physical activity, heart disease and stroke, diabetes, oral health, cancer, food safety, and health for seniors 5) Example of objective a) Increase the proportion of adults who meet the objectives for physical activity

Answer 347

Healthy People 2020

Question 348

A _____ is an award of financial or direct assistance: anyone can apply; usually lasts over a few years

Answer 348

Grant

Question 349

_____ ______ from the federal government are given to states or local communities for broad purposes as authorized by legislation. Recipients have great flexibility in distributing funds. There are five federal block grant areas 1) Maternal and child health 2) Community services 3) Social services 4) Preventative health services 5) Primary care

Answer 349

Block Grants

Question 350

___ _____ Major federal level grant; steps to a healthier US focused on community based health initiatives related to obesity. Directs funds to address asthma, obesity and diabetes prevention

Answer 350

CDC Steps

Question 351

Steps in program planning 1) Develop a _______ ________ (philosophy) and _____ / _______ statement 2) Set _____ 3) Set __________

Answer 351

Mission statement, needs/problem statement, goals, objectives

Question 352

Areas to analyze when developing a _______ statement or a ____ / _______ statement a) what nutrition services can contribute to the health and well being of the community; what population groups will be served; select and rank the most critical issues; what is the present situation; who says it is a problem; what will happen if nothing is done

Answer 352

Mission, needs/problem

Question 353

To ___ _____ in program planning - Develop a broad direction and a general purpose (increase quality and years of life) a) What health problems have nutritional implications b) Determine current nutritional high risk groups and the most critical needs

Answer 353

Set goals

Question 354

To ___ __________ set specific measurable (tangible actions within a time frame Example: Increase the number of women who can identify two risk factors for CHD by 25% in one year. a) More defined than goals; contain specific target dates for completing specifc projects. Include expected results in quantitative and qualitative terms within a given time frame b) SMART objectives: specific, measurable, achievable, relevant, time frame c) Guidelines for writing 1) Include who what behavior (measurable or action verb), how much, by whom, when, where 2) Action verbs are measurable: Exercise, select, list, identify, count, produce 3) Not an action verb: appreciate, understand

Answer 354

Set objectives

Question 355

To _______ a ____ in program planning - Evaluate alternative strategies (cost/effective analysis): what are all the possible ways to solve the problem, what resources would be needed to do each alternative, which alternatives are the most feasible, who needs to be involved in choosing which way is best

Answer 355

Develop a plan

Question 356

In plan development ______ ___________ controls and coordinates activities, indicates how and at what rate dollars are to be expended.

Answer 356

Budget Development

Question 357

Consider the following in ______ preparation -Expenditures of preceding period, present budget, changes in present budget period, expenditures of present period, budget requests for next period

Answer 357

budget

Question 358

Phases of the ______ cycle include - Prepare requests - Evaluate revenue potential - Formulate document - Send to legislative body - Legislative review and authorization - Execute the Budget (run the program) - Evaluation and review

Answer 358

budget

Question 359

Functions of a __________ budget -Summarizes program activities performed in terms of the cost of specified accomplishments Ex: what it costs to screen 200 children for anemia

Answer 359

Performance

Question 360

Budget _______ Public health departments derive a portion of their income from general revenue (taxes), and federal, local or foundation grants

Answer 360

Funding

Question 361

Program ______________ requires administrative support - Realistic budget, staff commitment, support of target population - Areas include educating, enabling, and developing skills

Answer 361

Implementation

Question 362

_________ in program implementation involves : - Increasing awareness, knowledge and options a) Scientifically sound information explained to client so they understand reasons for changes you are recommending b) to reach large numbers: use media, hotlines, point of choice or point of purchase intervention c) In health fairs, evaluate nutritional risk using BMI

Answer 362

Educating

Question 363

________ in program implementation - Reduces barriers that make it easier for people to act a) Enabling interventions relate to the 4 "P's" of marketing b) The product should be acceptable, the place accessible, the price reasonable, and the promotion tailored to enable attention and acceptance

Answer 363

Enabling

Question 364

_____ ___________ in program implementation works with competencies necessary to make and sustain new eating habits (psychomotor learning) a) One on one counseling, small group sessions, school fitness programs, worksite cafeteria programs b) Teaches how to: select appropriate foods, budget for healthful foods, how to obtain Food Stamps if needed, how to develop new eating behaviors

Answer 364

Skill development