MNT Flashcards
(206 cards)
1
Q
Ulcer: what
A
eroded mucosal lesion
2
Q
Ulcer: txt
A
antacids, antibiotics to treat h.pylori
3
Q
Ulcer: diet
A
as tolerated
avoid spicy, etoh, caff
4
Q
Hiatal hernia: what, diet
A
some stomach above diaphragm
small, bland feedings
5
Q
Dumping syndrome: what
A
rapidly hydrolyzed cho enters jejunum water enters for osmotic balance low blood pressure cho apsorbed and insulin pumped quickly hypoglycemia
6
Q
Dumping syndrome: when
A
after bowel resection
7
Q
Dumping syndrom: diet
A
small, dry feedings with pro and moderate fat
liquids before/after meal
no hypertonic sweets
8
Q
Bowel resections (2)
A
Bilroth I - stomach to duodenum
Bilroth II - stomach to jejunum
9
Q
Bilroth 2: nutrients of concern
A
Ca - low, most uptake in duodenum
Iron - low, needs acid
B12 - low, no intrinsic factor
Folate - low, needs B12 to get into cells
10
Q
Deficiencies after complete gastrectomy
A
Iron B12 Folate Ca D B1 Copper
11
Q
Test for B12 deficiency
A
Schilling
Pernicious anemia
due to low intrinsic factor and bacteria overgrowth
12
Q
Gastroparesis: what, when
A
delayed gastric empty
after sx, diabetes, obstruction
13
Q
Gastroparesis: txt
A
pro kinetics: erythromycin, metoclopramide
14
Q
Gatroparesis: diet
A
small, frequent meals
no high fiber or fat
15
Q
Celiac: what
A
reaction to gliadin affecting jejunum and ileum
16
Q
Celiac: avoid
A
WROB, bran, graham, malt, bulgur, couscous, orzo, thickening agents
17
Q
Celiac: ok
A
corn, potato, rice, soybean
18
Q
Celiac: nutrition outcomes
A
anemia, diarrhea, wt loss, steatorrhea, malabsorption (low ADEK)
19
Q
Diverticulosis: what
A
presence of mucosal sacs in intestinal wall due to structure weakness
20
Q
Diverticulosis: diet
A
high fiber
21
Q
Diverticulitis: what
A
inflammation of sacs
22
Q
Diverticulitis: diet
A
clear liquids, gradual return to high fiber
23
Q
Inflammatory bowel disease types
A
Crohn’s disease - ileum
Ulcerative colitis - colon
24
Q
Crohn’s Deficiencies
A
B12 deficiency, iron deficiency
25
Symptoms of UC
bloody diarrhea, wt loss. electrolyte imbalances, neg nitrogen balance
26
Inflammatory bowel disease diet
```
energy according to BMI
restrict fat if steatorrhea
Ca, Mg, Zn supplement
fat may improve energy balance
Pro at each meal
```
27
Best multivitamin in Inflammatory bowel disease?
chewable
28
Irritable bowel syndrome: goals, recommendations
adequate intake with no flare ups
specific to GI issues
food diary to track intake, emotions, symptoms
29
Lactose intolerance test
oral lactose load
| test glucose: if under 25mg/dl then lactose intolerant
30
Lactose intolerant diet
no animal milk, products, or whey
31
Lactose intolerant supplement
Ca and riboflaven
32
Pediatric diarrhea: treatment
agressive rehydration and electrolyte replacement
33
Causes for pediatric diarrhea
low fat diet
| too many fluids
34
Chronic pediatric diarrhea recommendations
40% of energy from fat
| restrict/dilute fruit juice
35
Steatorrhea test
check stool fat
normal is 2-5g
>7 g means malabsorption
36
SBS: loss of jejunum?
ileum can adapt
37
SBS: loss of ileum complications
decreased B12, intrinsic factor, bile salts ->
fat malabsorption, ADEK, Ca, Zn, Mg (makes soaps)
Colonic absorption of oxalate -- stones
38
SBS: loss of colon complications
loss of water, electrolytes, no colonic salvage
39
How much water does SBS need?
If ileum resected, need 1 liter more than ostomy output
40
SBS: nutrition care process
parenteral to enteral early to promote intestinal lining growth
41
Ileal resection diet, supplement
limit fat, use MCT
| Supplement ADEK, Ca, Mg, Zn, B12
42
Liver functions
store and release blood
filter blood
metabolism and storage of nutrients
fluid and electrolytes
43
If liver enzymes in blood are high?
liver damage
44
Liver enzyme levels
AST - 35
ALT - 36
ALP - 120
if above = liver damage
45
Which hepatitis is most associated with food?
HAV, fecal-oral, oysters danger
46
Hepatitis diet
```
fluids
50-55% CHO (protein sparing)
1 - 1.2 G protein
restrict fat in steatorrhea
small frequent feedings (anorexia)
2gm Na if fluid retention
```
47
Cirrhosis: what
damage to liver tissue with connective tissue redirecting blood
48
When blood cannot leave the liver
```
ascites
blood build up in liver
when full, plasma moves to peritoneal
plasma pulls in water
Na and water retention
```
49
When blood cannot enter liver
Varices
blood backs up in portal vein and into collateral veins
enlarge, bleed
50
Cirrhosis diet
.8-1.2 protein
25-35 kcal
MCT if needed
low fat if malabsorption
51
Varices diet
low fiber
52
Ascites diet
low sodium
53
Alcoholic liver disease: what
hydrogen replace fat as fuel
| fat accumulates in liver
54
Alcoholic liver disease: supplement what?
thiamin, folic acid
55
Alcohol increases the excretion of what?
Magnesium
56
ESLD: name, s/s
end stage liver disease
liver less than 25% function
ammonia no longer converted to urea
57
ESLD: diet
low sodium with ascites
moderate-high protein 1-1.5
Modest protein if sensitive or hepatic encephalopathy
58
NAFLD: name, risk factors
nonalcoholic fatty liver disease
| usually >35 BMI, T2DM, Met syndrome
59
NAFLD: txt
SLOW wt loss to not increase tag to liver
| Med diet, moderate alcohol, coffee as antioxidant, PA 150/week
60
Can liver regenerate in alcoholic liver disease?
only with good nutrition and no etoh
61
Pancreatitis: what, enzyme activity?
inflammation of pancreas due to blockage or reflux
| activation of digestive enzymes too early
62
Acute Pancreatitis: diet
as tolerated, slow on fat
| elemental formula to jejunum if needed
63
Chronic Pancreatitis: diet
PERT with meals and snack
MCT (does not need lipase from pancreas)
Antacids
64
Cystic Fibrosis: what
thick mucus obstructs glands, enzyme deficiency, malab
65
Cystic fibrosis: diet
PERT, liberal protein, calorie, fat, salt
66
Cystic fibrosis: supplement
water soluble form of A and E
| Zinc
67
Blood pressure cutoff
over 120 elevated
over 130 stage 1
over 140 stage 2
68
CVD salt restriction
1500-2300 mg
69
Med diet rich in...
a-linolenic
| monounsaturated
70
Atherosclerosis:what
accumulation of lipids
| structural changes in arteries
71
Lipoprotein risk
LDL-c - small, dense, responsive to diet
72
Metabolic syndrome
* insulin resistance AND 3 of the following
- BP over 130
- TG over 150
- Fasting glucose over 100
- Waist over 40/35
- HDL under 40/50
73
Cholesterol risk
Keep
LDL-C under 100
Total chol under 200
HDL above 40/50 (over 60 is high)
74
Therapeutic Lifestyle Change (TLC) diet - fat recommendations
```
35% kcal from fat
<7% sat
5-10% PUFA
20% MUFA
<200 mg cholesterol
```
75
Heart failure: what
weakened heart muscle, not pumping enough blood
76
Heart failure: symptoms
dyspnea, edema
77
Heart failure: medicine
digitalis
78
Heart failure: diet
low sodium (2-3)
DASH
high protein 1.1-1.4
79
Heart failure: energy recommendations
normal 22kcal/kg
| walnut 24kcal/kg
80
Heart failure: nutrient of concern
Thiamin, lost with loop diuretics, needed for energy pyruvate -> acetyl CoA
81
Cardiac cachexia: what
unintended weight loss due to blood backup in liver/intestines -> nausea
82
Cardiac cachexia: diet
low sat fat, trans fat, chol, <2 Na, HIGH kcal
83
Kidney hormones
vasopressin - increases BP
renin - increases BP
erythropoietin - stimulates RBD in marrow
84
Renal lab tests
BUN
Creatinine
BUN:creatinine
85
BUN:Creatinine normal and abnormal
10-20:1
higher than 20 means overcompensation by kidney
under 10 means kidney damage, need dialysis
86
Renal disease: symptoms
anemia
BP
Low Vitamin D activation
87
How much fluid needed daily to dilute urine
1.5 - 2 liters
88
What is ash in urine
minerals not oxidized in metabolism: acidic or alkaline. Change with diet or meds
89
Acute kidney injury (AKI): causes
burn, injury, obstruction
90
AKI: symptoms
azotemia, oliguria
91
AKI: energy recommendation
25-40 kcal/kg, high energy expenditure with kidney decline
92
Nephrosis: what
glomerulus capillary problem letting protein escape
93
Nephrosis: diet
35 kcal/kg
2-3 g Na
under 30% fat (hyperlipidemia is symptom)
94
Chronic kidney disease: diet
23-35 kcal/kg
under 2400 mg Na
Restrict pro when GFR is under 59 (0.6 - 0.8 g)
95
Those with chronic renal failure may need
dialysis
96
Protein need with hemodialysis
1.2 g/kg
97
Protein need with peritoneal dialysis
1.2-1.3 g/kg
98
Risk factors for DM
acanthuses nigricans, GAD antibodies
99
Fasting glucose indices
Normal 70-100
Impaired fasting 100-125
Diabetes fasting >125
100
Glucose toerelance indices
Normal has sloped curve
Impaired 140-200
Diabetic >200
101
HbA1c ranges
Normal <5.7
| Diabetic >6.5
102
HbA1c measures what?
glycosylated hemoglobin
% hemoglobin with glucose attached
60-90 days
103
Gestational DM risk to infant
macrosomia, hypoglycemia at birth
104
Glycemic index use
no sig effect on A1c longer than 12 weeks
105
CHO exchanges
15 for fruit and starch
12 for dairy
5 for non starchy veggies
106
Bolus insulin types
rapid-acting -
| short-acting
107
Basal insulin types
intermediate - NPH, cloudy
| long-acting - lantus
108
MDI for DM
multiple daily injections: basal and bolus
109
Meformin
1st line DM drug
suppress liver glucose production
check B12
110
SGLT -2
excrete more glucose in urin
111
DPP4
used with met. reduce glucose release from liver
112
Ketoacidosis: symptoms, txt
hyperglycemia, high pulse, dehydration
| Txt: insulin and fluids
113
Hypoglycemia
Rule of 15
| If unresponsive give glucagon
114
Postprandial or reactive hypoglycemia: what, diet
BS tanks after eating due to increased insulin or insulin sensitivity
Diet: 5-6 meals with even CHO, no simple sugars
Keep glucose steady
115
Addison's disease: what, diet
adrenal insufficiency
| diet: high protein, frequent meals, high salt
116
Galactosemia: what, diet
inborn error of metabolism: no enzyme for galactose
Diet: no galactose or lactose
Avoid: organ meat, MSG extenders, bell pepper, dates, whey.
117
Urea cycle disorders: what, concern, restriction
inborn error of met
Can't make urea from ammonia
Seizures
Protein restriction; 1-2g/kg
118
PKU: name, symptom
Phenylketonuria, inborn error of met
| Can't make PHE into Tyrosine
119
PKU: txt
restrict PHE, supplement TYR
120
PKU: diet
low pro, high CHO (may lead to dental caries)
121
PKU: avoid
aspartame
122
Glycogen storage disease: what, diet
liver can't Mae glucose from glycogen -> hypoglycemia
| give cornstarch regularly
123
Homocystinurias: what, risk, txt
protein metabolism error
risk of low folate, B6, B12
Supplement folate, B6, B12 at diagnosis
124
Maple syrup urin disease: what, diet
can't metabolize BCAA (eggs, meat, nuts)
| Restrict BCAA, can have gelatin
125
Arthritis: what, diet, risk
joint inflammation
normal diet or anti-inflammatory
normocytic anemia due to inflammation preventing reuse of iron
126
Osteoporosis types
Type 1: postmenopausal
| Type 2: age related, 70+
127
Most likely to have osteoporotic fractures
white and asian women
128
Osteoporosis causes
malnutrition (pro), low PA, estrogen decline
129
Osteomalacia: what, deficiency, supplement
low bone density
low vitamin D
supplement D and Ca
130
Epilepsy meds
phenobarbital and phenytoin (dilantin)
131
Phenytoin med caution
do not take with food
| Pause enteral feedings 2hrs
132
Epilepsy supplement
D, Ca, thiamin
133
Anomia
forgetting common words. alzheimers
134
Microcytic anemia: what, cause
small, pale RBC. iron deficiency
135
Macrocytic anemia: what, cause
large, red, few RBC. B12 or folate deficiency
136
Ag-Ab allergy reaction
antigen enters, antibody responds
137
IgE allergy response
reaction to normally harmless food protein
138
Most and least common allergen in children
milk most
| rice least
139
Gold standard for allergy diagnosis
double-blind, placebo-controlled food challenge
140
Normal body temp
98.6
141
BMR increase with fever
7% per degree
142
1st step in treating burns
fluid and electrolytes
143
Ebb phase after injury/burn
hypovolemia, shock
144
Flow phase after injury/burn
hyperglycemia, after fluid resuscitation
| Due to catecholamines -> increase in hepatic glycogenolysis
145
Cancer effect on nutrition
taste aversions, meat aversion,
| if thrush may need bland liquids, soft, chilled
146
Hypercalcemia in breast cancer may indicate
metastasis to bone
147
Nutrition recommendations for mucositis with radiation
offer cold and soft food
| avoid fresh, raw, uncooked
148
Exercise in post-menopause may reduce risk of
breast disease
149
Marasmus: what, dx
protein kcal starvation
| Diagnosis made by anthropometrics! triceps, are circumference
150
Protein-calorie malnutrition
iatrogenic malnut - starts in txt, hospital
151
Concerns in anorexia
initial is potassium and other electrlytes
| referring increases cardiac load. go slow
152
Nutrients of concern in bulemia
potassium and chloride
153
How many calories in 1 lb body fat?
3500
| to loss a pound in a week, reduce intake by 500kcal/day
154
Orlistat
obesity
| lipase inhibitor
155
lorcaserin
enhance satiety, serotonin
156
Phentermine/toopiramate
appetite suppressant
157
When to do bariatric surgery
40+ BMI
| 35 BMI with comorbidities
158
Lap band diet
eat slow, no straw, no bubbles, sip
159
Low cariogenic foods
hig protein, mod fat
| meat, cheese, nuts
160
Sign of fluorosis
mottled teeth
161
Stomatitis deficiency and recommendation after meal
inflammation of mouth
riboflavin deficiency
rinse with lukewarm water after food
162
Achalasia: what, risk
lower esophageal sphincter does not relax
| dysphagia
163
NDD 1
pureed, pudding, no lumps
164
NDD2
soft, pancake ok, ground meat
| No bread, rice
165
NDD3
transition to regular
| no crunchy, hard, sticky
166
Pregnancy induced hypertension: symptoms
hypertension, edema, proteinuria, rapid wt+
167
Pregnancy induced hypertension sodium recommendations
stay consistent to maintain plasma
168
HIV/AIDS diet
neutropenic, avoid raw foods
| no breastfeeding
169
Pediatric HIV diet
high pro/kcal, plenty of supplements for wt+
170
COPD diet
small frequent, nutrient-packed mini meals
| easy to prepare and eat
171
How to initiate standard polymeric formula
full strength 10-40 ml/hr
172
Formula for malabsorption?
elemental
173
Formula hang times?
closed 24-48
| open 8
174
Length of feeding to need gastro- or jejumostomy?
3-4+ weeks
175
How much water for enteral feeds?
1 cc/kcal
176
Water in formulas
1 kcal/cc = 83% water
1. 5 kcal/cc = 77%
2. 0 kcal/cc = 70%
177
Normal gastric residuals
less than 250
| if over 500, hold feed and assess motility/tolerance
178
IV Dextrose offers how many kcal?
3.4 kcal/gram
| kcal = ml x % x 3.4
179
IVFE: name, percents
Intralipid
10% 1.1 kcal/cc
20% 2.0 kcal/cc
180
Access time for PICC
short-term
| peripherally inserted
181
Access time for CVC line
long-term
| into superior vena cava
182
Max glucose infusion rate, risk
4-5 mg/kg/min
| over may lead to hyperglycemia, high K, Phos
183
% protein in solution =
grams/100ml
184
Transitional feeding PN to EN
small amount of full strength EN, 30-40ml/hr
| d/c PN when EN is meeting 33-55%
185
Labs in refeeding
low K, Phos, Mg
186
Functional medicine looks at
symptoms and underlying disease
187
Holistic health looks at
mental, physical, spiritual
188
Integrative medicine combines
evidenced-based complementary with conventional/allopathic
189
RDA: what, who, purpose
Recommended dietary allowance
individuals
gender, age, life phase
*prevent deficiency
190
EAR: what, who, purpose
Estimated average requirement
groups
assess for group adequacy
191
What do community nutrition programs use to guide their planning?
Dietary Guidelines for Americans
192
Block grant
federal money to state or local
| flexibility in distributing funds
193
Steps in program planning 1-3
Mission Statement
Goals
Objectives - SMART
194
Program implementation depends on who?
admin, good budget, staff, target population
195
Implementing an enabling program uses:
enable reduces barriers
4 P's of marketing:
product, place, price, promotion
196
Monitoring vs. evaluation
monitor - mausre of nutrition indicator (wt)
| evaluation - compare to goal or standard
197
Outcome categores
Direct nutrition - clinical/health
| Patient centered - health care use and cost
198
Nutrition care outcomes
prove our worth
| food/nut hx, labs, anthropometrics, NFP findings
199
T2D with atherosclerotic CVD should use which meds?
GLP1 receptor agonists or SGLT2 inhibitors
200
What med for pt with T2D and CKD?
SGLT2
201
Acceptable fat source in Crohn's?
MCT from coconut oil
202
How to treat hemochromatosis?
iron chelation
203
Long term goal of chronic hemodyalysis
prevent malnut
204
Braden scale used for
pressure ulcer risk
205
How much protein for pressure uclers
I - 1.1-1.2
| II - 1.2-1.5
206
myotonia
muscle spasms
