Exam 2 Flashcards
(119 cards)
1
Q
What is Heart Failure?
A
Chronic, progressive condition in which the heart is unable to pump enough blood
Decreased ejection fraction of <50%
2
Q
Heart Failure
Signs and Symptoms
A
SOB, wheezing/coughing, edema, fatigue, lack of appetite, nausea, confusion, increased HR
3
Q
Heart Failure
Factors that Affect Intake
A
Changes in taste/smell, dietary restrictions, limited energy to buy/prep food, digestive disturbances, cardiac cachexia
4
Q
Heart Failure
Nutritional Guidelines
Basic Guidelines
A
20-25 kcal/kg + AF
PRO: 1.1-1.4 g/kg
5
Q
Heart Failure
Nutritional Guidelines
Classes I-IV and Stages B and C
A
22 kcal/kg ABW + AF (nourished pt)
24 kcal/kg ABW + AF (malnourished pt)
PRO: No Change
Sodium: 1500 mg/day
Sodium Rec for Stages A and B
5
Q
Heart Failure
Nutritional Guidelines
Stage D
A
18 kcal/kg ABW + AF
PRO: no change
Sodium: <3 g/day
Sodium Rec for stages C and D
6
Q
Heart Failure Education Recommendations
A
2-2.5 g Na/day (if malnourished consider no restriction)
1500-2000 mL/day
6
Q
Heart Failure
When is it not appropriate to provide HF education?
Must meet 2 criteria
A
- MST of >2
- BMI <20
- Advanced age (+80)
- Braden Total <12 (wound development score)
7
Q
Heart Transplant
Pre-Transplant Evaluation
A
- Nutrition hx with diet recall
- DEXA-bone density
- Adherence to diet recommendations
- Height, weight, BMI (<35)
- Albumin/Prealbumin Trends
- Hgb A1c 10%
DEXA: immunosuppressants decrease bone density
8
Q
Heart Transplant
Post Transplant Nutrition Recommendations
A
30-35 kcal/kg (in absence of infection)
PRO: 1.5-2 g/kg initially
Carbs: 55-60%
Lipids: 30%
Fluids: 2000 mL
Supplement Electrolytes and Vitamin D
PRO: 1 g/kg in chronic post-transplant stage
9
Q
Heart Tranplant
LVAD
Left Ventricular Assit Device
A
Pulls blood from L-Ventricle through a pump to be oxygenated, sent into aorta, and sent back through the body
10
Q
Heart Transplant
When might an LVAD be used?
A
Can be a bridge to transplant (BTT), improved cardiac fx while waiting for transplant
Can be destination therapy, when the pt is not an appropriate transplant candidate (long-term treatment)
11
Q
Lung Transplant
COPD Nutrition Recommendations
A
Energy: 125-165% greater than BEE
PRO: 1.2-1.7 g/kg
12
Q
Lung Transplant
COPD
Chronic Obstructive Pulmonary Disease
A
Progressive lung disease that causes restricted airflow and breathing problems
13
Q
Lung Transplant
Cystic Fibrosis
A
genetic disease that causes the body to produce thick, sticky mucus that can lead to breathing and digestion problems
14
Q
Lung Transplant
Idiopathic Pulmonary Fibrosis
A
chronic lung disease that causes the lungs to stiffen and thicken with scar tissue, making it difficult to breathe
15
Q
Lung Tranplant
Alpha-I Antitrypsin Deficiency
(AATD)
A
AAT production is reduced, this causes the body’s infection fighting agents to damage alveoli and lining of lungs
16
Q
Lung Transplant
Pulmonary HTN
A
occurs when the blood pressure in the lungs’ arteries is too high
17
Q
Lung Transplant
MNT Goals
A
Limit Na to decrease fluid retention
Ca and Vitamin D adequacy
Adequate fluids
18
Q
Lung Transplant
Pretransplant Evaluation
A
- Nutrition hx
- Adherence to diet recommendations
- adequate caloric intake
- BMI
- Hgb A1c 8%
BMI:
F <30
M <32
19
Q
Lung Transplant
Nutrition Needs Post-Transplant
A
35 kcal/kg OR 130-150% of BEE
PRO: 1.5-2.0 g/kg
Meds: immunosuppressors and increase blood sugars
PRO: decreased to 1 g/kg are corticosteroids are decreased
20
Q
Normal Renal Function
A
- Filters blood, maintains fluid balance, regulates electrolytes, BP regulation
21
Q
Renal Disease
Nephrons
A
Functioning part of kidney
* Filters, reabsorbs, and excretes waste
22
Q
Renal Disease
Renal Corpuscle
A
blood-filtering component of the nephron of the kidney
*Crt is a key lab for diagnosing kidney disease
High Crt = not properly excreting
23
# Renal Disease
Renal Tubule
filters waste and toxins from the blood and returns nutrients and other substances back to the body
24
# Kidney Disease
What is the most common cause of Kidney Disease (2)?
HTN and DM
25
# Kidney Disease
Biochemical Labs to Monitor
* BUN: indicator of kidney fx
* Crt: indicator of proper waste filtering (affected by muscle mass)
* Na (affected by fluid balance)
* K+
* Phosphorous
* Magnesium
* Sodium
| Phos usually high when fx falls below 25%
26
# Renal Disease
How can K+ be treated?
Dialysis, balancing blood sugars, medication (Kayexalate or Lokelma)
27
# Renal Disease
Estimated Needs
| Stage 1-4 Pre-Dialysis
25-30 kcal/kg (20-30 kcal is sedentary & 60+)
PRO: 0.6-0.8 g/kg (50% biological value)
Sodium: 2-3 g/day
Vitamin D3: 2000 mg/day
| Biological value: typically animal protein, utilized more efficiently
28
# Renal Disease
Nutrition Recommendations
| Dialysis
25-35 kcal/kg
PRO:
* HD: 1.2 g/kg
* Peritoneal: 1.2-1.3 g/kg
Sodium: 2-3 g/day
Fluid: 1000 mL + urine output
K+: 2-3 g/day
Phos: 1000-1200 mg/day
| Pt is on CRRT: PRO 1.8-2.5 g/kg
29
# Renal Disease
Acute Kidney Injury
| AKI
* Caused by drop in blood flow (caused by accident, sepsis, dehydration)
* Can be reversed
* Causes accelerated loss of PRO and AA (muscle wasting)
30
# Renal Disease
How quickly does Enteral nutrition need to be started if pt is in ICU with AKI?
within 48 hours
31
# Renal Disease
End Stage Renal Disease
| ESRD
Deterioration of fx to level at which uremia can cause death
| Uremia: urine in blood due to inability to filter waste
32
# Renal Disease
Indications for Dialysis
| AEIOU
Acidosis
Electrolyte Abnormalities
Intoxication
Overload (fluid)
Uremia
| K+ will be too high, main indicator of dialysis
33
# Renal Disease
MNT Goal: Kidney Transplant
optimize nutritional status prior to surgery
34
# Heart Failure
HFpEF
* Diastolic HF
* Heart failure with preserved ejection fraction
* Heart is stiff and unable to relax enough to fill with blood
35
# Heart Failure
HFrEF
* Systolic HF
* Heart failure with reduced ejection fraction
* heart is weak and cannot pump with enough force to get to rest of body
36
# Heart Failure
Most Common type of HF
Left Sided and it affects the lungs
37
# Renal Disease
Acute Care Post-Transplant Nutritional Needs
30-35 kcal/kg
PRO: 1.2-2 g/kg
*wound healing with high PRO and kcal
38
# Renal Disease
Long Term Post Transplant Goals
* Weight control
* Lipid management
* Lifestyle changes (reduced CVD risk)
* Blood Gluc management
* Prevent osteoperosis (1200-1500 mg Ca/day)
39
Metabolic Syndrome
group of risk factors that increase the likelihood of developing heart disease, diabetes, and other health conditions
40
Metabolic Syndrome Risk Factors
* Abd Obesity - waist circumference
* Hypertriglyceridemia >150 mg/dL
* Low HDL
* High BP >130/85
* High Fasting Gluc >110 mg/dL
Low HDL (M: <40, F: <50)
| Waist (M: >40 in, F: >35 in)
41
What kind of Nitrogen balance do you want for HF?
Positive Nitrogen balance
*Positive balance for any condition where higher nutrient needs are required*
42
# GI Conditions
Types of Crohn's Disease
* Illecolitis: affects last part of S.I. and first part of colon
* Illetitis: last part of S.I
* Gastroduodenal: stomach and first part of S.I
* Jejunoilitis: upper half of S.I and jejunum
* Crohn's Colitis: some or all of colon
43
# GI Conditions
Types of Crohn's Remission
* Clinical: symptom free, but inflammation present; Crohn's disease Activity Index (<150)
* Biochemical: stool and blood tests w/in normal limits
* Endoscopic: no visible inflammation
* Histological: "deep remission" biopsies show no active inflammation under microscope
| Biochemical: CRP, fecal calprotectin
44
# GI Conditions
Nutritional Needs in IBD
PRO: 1.2-1.5 g/kg
MCT: >8 tbsp/day
Fiber: feeds butyrate, reducing inflammation
Micros: Iron, B12, D, Ca, Folate, Zinc
45
# GI Conditions
Helpful Diets for IBD
* Mediterranean
* Elemental (100% AA and MCT oil)
* Specific Carb Diet (SCD)
* Anti-inflammatory diet
* GF Diet
46
# GI Conditions
Fiber Recommendations for diverticulosis and diverticulitis
Diverticulitis: low fiber
Diverticulosis: high fiber
47
# GI Conditions
Fiber and IBD
* Low fiber intake is a risk factor for developing Crohn's and UC
* Fiber is an important fuel for gut microbiomes - feeds butyrate producing bacteria
* start with soluble fiber
48
# GI Conditions
Irritable Bowel Syndrome (IBS)
* Affects stomach and intestines
* IBS does not cause changes in bowel tissue or increase the risk of colorectal cancer
* Symptoms: cramping, abd pain, bloating, gas, diarrhea, constipation
49
# GI Conditions
Types of Ulcerative Colitis
* Ulcerative Proctitis: inflammation of rectum
* Ulcertive Pancolitis: affects entire large intestine
* Microscopic Colitis: inflammation of colon, dx with biopsy of intestinal mucosa
50
# Crohn's
Ileocecal Resection
Ileum inflammed or removed
* absorption of fat soluble vitamins and B12 will be affected
51
# GI Conditions
Low - FODMAP Diet
FODMAPS are small chain CHOs that are commonly malabsorbed in S.I
* Pull water into S.I causing bloating in individuals prone to constipation/diarrhea
* 75% of IBS patients benefit from a low FODMAP diet
52
# GI Conditions
IBS-C vs IBS-D
IBS-C: IBS with constipatoin
IBS-D: IBS with diarrhea
53
# GI Conditions
Small Intestinal Bacterial Overgrowth
| SIBO
Accumulation or overgrowth of bacteria in SI
* Common Bacteria: E. Coli, Klebsiella genera, lactobacillus (good)
54
Reasons for Developing SIBO
* Structural or anatomical abnormalitie
* Low stomach acid
* slow/impaired motility
* inflammation of SI
* low loevel of pancreatic fluids
* Chronic alc use
55
Diverticular Disease
Diverticula are outpouches of the bowel wall
* Result from increased colon pressure, low fiber diets, IBS-C, chronic constipation, overuse of NSAIDS/opioids
56
# Diverticular Disease
Diverticulitis
Outpouching with infection or inflammation
* Symptomatic
* fever, sever lower abd pain, N/V
* CT scan
57
# Diverticular Disease
Diverticulosis
Outpouching without inflammation
* typically asymptomatic
* Lower abd pain, cramping, bloating, constipation, diarrhea
* Found on colonoscopy, CT, barium enema
* Treated with antibiotics or surgery
58
MNT Goals of Diverticular Disease
goal is to help promote consistent bowel movements, high fiber diet, low FODMAP diet
59
Gastroparesis
Delayed gastric emptying
* Loss of muscles to move food through digrestion
* Possible vagus nerve damage
* Medications that block nerve signals that activate stomach muscles
60
Gastroparesis Treatment
* Medications to stimulate stomach motility and control N/V
* Gastric Electrical Stimulation
* Enteral Nutrition
* Parenteral Nutrition
61
MNT for Gastroparesis
* Low fiber, low fat
* Seperate beverages from meals
* 6-8 small frequent meals
62
Eosinophilic Esophagitis (EoE)
Chronic immune disease causing eosinophil build up in esophagus lining --> damaging tissue
63
Symptoms of EoE
Dysphagia, impaction, chest pain, reflux
64
MNT for EoE
Six Food Elimination Diet: milk, wheat, egg, nuts, soy, fish, shellfish
65
Short Bowel Syndrome (SBS)
condition resulting from surgical resection or congenital disease of small intestine
* Characterized by inability to maintain PRO-energy, fluid, electrolyte, micro balances
66
Causes of SBS
Surgical Resection of SI due to:
* Crohns, trauma, malignancy, radiation, mesenteric ischemia
Children:
* Necrotizing enterocolitis as infant, congenital intestinal anomalies (mid-gut volvulus, atresias, gastroschisis)
67
Stages of SBS
Acute Stage: intestinal fluid losses, metabolic derangement, intestinal failure, gastric hypersecretion - lasts 3-4 wks
* May require EN or PN + slow initiation of PO
Adaptation Stage: increased intestinal surface area, slowed intestinal transit - lasts 2+ years in adults
* weaning off nutrition support
Maintenance Stage: remaining bowel has maximized absorptive ability - once intestines are done adapting
68
Intestinal Failure
when intestines are unable to absorb enough nutrients or fluid to sustain body's needs
* long term PN support, intestinal rehab, intestinal transplant
69
# SBS
Concerns with Jejunal Resection
Fluid and macronutrient absorption
*ORS used to optimize absorption
70
# SBS
Ileal Resection
Ileum is primary site of B12 absorption, can lead to deficiency
Resection of >100 cm leads to bile acid absorption disruption (malabsorption of fats)
71
# Ileal Resection of SBS
Ileal Brake
unabsorbed lipids that reach ileum results in delayed gastric emptying
72
Ileocecal Valve
Regulates passage of fluids and nutrients from ileum to colon
73
Colon
* Important role in fluid, electrolyte, and short-chain fatty acid absorption
* Helps slow intestinal transit and stimulate intestinal adaptation
74
Management of SBS
Must be tailored individually based on needs
* Dependent on length of bowel remaining, colon vs no colon, ostomy or fistula presence
75
Oral Diet for SBS
Complex CHO, moderate fat, high PRO
Avoid simple sugars and high insoluble fiber
* Soluble may be helpful for loose stools
Adequate hydration
Small, frequent meals
76
Enteral Nutrition for SBS
PEG tube is typically placed to allow for optimal absorption
* GJ tube can be placed if needed
77
Intestinal Failure
inability to sustain body's nutrient and fluid needs
*long term PN needed
Intestinal Rehab program
Intestinal transplant
78
Types of Ostomies
Illeostomy
Jejunostomy
Colostomy
Urostomy
79
Illeostomy
Part of ileum is brought us to surface of abdomen
Used when need to bypass colon or protect distal anastomosis
Stool waste excreted into ostomy bag (liquid)
80
Loop Ileostomy
loop of ileum is brought up to abd wall, temporary and can be reversed
81
End Ileostomy
Permanent if anorectal sphincter and rectum are removed with colon
82
Colostomy
colon is brought to surface of abdomen
Used when need to bypass part of distal colon, rectum, or anus
Solid waste is excreted into colostomy bag
83
Hartmann's Procedure
End loop colostomy brought to abd surface, remaining bowel is oversewn or stapled and left in abd cavity
Reversible
84
MNT for Ileostomy
Low fat, low fiber, low in simple sugars
Small, frequent meals
Avoid foods that can block ostomy (nuts, seeds, corn, fruit/veggie skin, etc)
Avoid acidic, spicy, greasy foods for first few weeks post op
85
Typical Output of Ileostomy
1 L daily
*anything greater than 1500-2000 mL is considered high ileostomy output
HIgh Output: start antidiarrheal, check for infectious diarrhea, add metamucil
86
MNT for Colostomy
Low fat, low fiber, low in simple sugars
Small, frequent meals
Avoid foods that cause ostomy blockage
Avoid acidic, spicy, greasy foods for first few weeks postop
87
Classifications of Overweight/Obesity
| BMI
Overweight: 25-29.9
Obesity Class I: 30-34.9
Class II: 35-39.9
Class III: 40+
88
Clinically Severe, Mobid Obesity
* 200% of IBW or 100lb overweight
* BMI of >40 OR BMI >35 + severe co-morbid conditions
89
Non-Surgical Treatments of Obesity
* Caloric Intake reduced by 500-1000kcal/day (lose 1-2lbs/wk)
* Physical activity
* Behavioral Therapy
* Pharmacotherapy
* Meal Replacement Program
90
MNT for Obesity
* Increased intake of whole grains, fruits, vegetables
* 3 meals/day
* Track intake
* Limit processed foods
* decreased portion sizes, hunger/fullness cues
* mindful eating
* Regular activity
91
PRO recommendations for Obesity
Low fat PRO
Men: 80-100 g/day
Women: 70-90 g/day
*20-30 g/meal
Consider PRO shake: whey PRO, 20-30 g PRO/serving, <5 g sugar/serving
92
# Obesity
Health Benefits for 5-10% weight loss
* Improved blood sugar control
* Reduced BP
* Improved Lipid Profile
* Lower total Chol, LDL, TG
* Higher HDL
93
# Types of Bariatric Surgery
Malabsorptive and Restrictive
Roux-en-Y
SIPS
BPD/DS
94
# Types of Bariatric Surgery
Restrictive
Sleeve gastrectomy, intragastric balloon, LAGB
95
Qualifications for Bariatric Surgery
BMI >35 + 1 co-morbid condition
BMI >40 with out any comorbidities
96
# Obesity
Comorbid Conditions
Obstructive sleep apnea
HTN
HLD
DM
GERD
97
Roux-en-Y Gastric Bypass
Increased malabsorption due to jejunum rerouting
At risk for Ca, Fe, B12, D, folate, and thiamine malabsorption
98
Sleeve Gastrectomy
Restrictive effects from the stomach
*Removal of 80-85% of stomach
No malabsorption
Reduced ghrelin = reduced hunger cues
B12, iron, thiamin, Ca malabsorption
99
Benefits of Sleeve Gastrectomy
No intestinal bypass, internal hernia, dumping syndrome
Less vitamin deficiencies, PRO malnutrition, anemia
Reduced risk of osteroporosis
100
Duodenal Switch (BPD/DS)
75% of stomach removed and 75% of GI tract bypassed
Fat malabsorption is >70% and protein 25%
More malabsorptive than Roux-en-Y and SIPS
For severley obese (BMI >50)
ADEK Supplementation
Iron, Ca, Zinc, B12, folate, ADEK, PRO malabsorption
101
SIPS
| Stomach Intestinal Pylorus Sparing Surgery
Jejunum is connected to stomach sleeve
Can be a primary or revision surgery
Malabsorptive surgery
Hybrid of bypass and sleeve
102
LAGB
| Gastric Band
Restricts amount of food upper stomach can hold (1/2 C)
Needs Frequent Adjustments (use saline solution)
Reversible
Normal nutrient absorption
Nutrients of Concern: Folate, thiamine, B12, Ca
103
Bariatric Surgery Post Op Diet Progression
Night of Surgery: SF Clear liquids (GB1)
4 days Post Op: add protein shakes (GB2)
1 Wk Post op: add in Cottage cheese, Greek yogurt (GB3a)
2 wk post op: high PRO, pureed/soft consistency (GB3b)
4-6 wks post op: High PRO, soft foods (GB4)
104
Nutritional Goals Post Bariatric Surgery
| 0-6 Months
60-70 g PRO/day
<90 g Carbs/day
<850 Kcal/day
105
Bariatric Surgery Nutrition Goals Post Op
| 12+ Months
80-120 g PRO/day
<130 g of Carbs/day
<1300 kcal/day
106
# Bariatric Surgery
Dumping Syndrome
Common in rerouting surgeries
*Sugars/carbs pass through stomach too fast, causing N/V, diarrhea
107
Eating Disorder
ongoing disturbance of eating behavior or behavior intended to control body weight, which impairs physical health and psychosocial fx
108
Anorexia Nervosa
severly restrict food, avoid food, or eat very small amounts
May weigh themselves repeatedly
Distorted body image
109
Restrictive Anorexia Nervosa
limit amount and type of food consumed
110
Binge-Purge Anorexia Nervosa
restrict amount or type of food, also have binge eating and purging episodes
111
# Anorexia Nervosa
Signs and Symptoms
Osteoperosis/Osteopenia
Damage to structure/fx of heart
Dry, yellowish skin
Brittle hair/nails
Low thyroid,/hormone levels, anemia, low K+
Slow HR
Menstrual irregularities
112
Bulimia Nervosa
Cycle of eating large amounts of food (1000+ Kcals) in a certain time frame (2hrs) followed by compensatory behavior
113
# Bulimia Nervosa
Signs and Symptoms
Noticeable fluctuations in weight (+/-)
Stomach cramps
Dental Issues
Evidence of binge eating - disapperance of food, empty wrappers, etc
Evidence of purging behavior (signs/smells of vomiting, frequent bathroom trips, laxatives, etc.)
114
Binge Eating Disorder (BED)
| Most Common in US
Recurrent episodes of eating large quantities (1000+ kcals)
Feeling of loss of control during binge
Experiencing shame, distress, guilt after binge
NOT USING COMPENSATORY BEHAVIOR
115
Orthorexia
Obsession with "healthful" eating to point of damaging well being
Can make malnutrition more likely due to restricting amount/variety of food
116
# Orthorexia
Signs and Symptoms
Compulsive checking of ingredient lists, distressed when "safe" or "healthy" foods unavailable
Cutting out food groups
Body Image concers (may be present)
117
Avoidant Restrictive Food Intake Disorder (ARFID)
involved limitations in amount/types of food eaten
Does NOT include distress aout body shape/size or fear of weight gain
