MNT FInal Flashcards
(34 cards)
What are the risks of strokes? What is the incidence? Modifiable risk factors
#1 risk factor: old age Modifiable risk factors: HTN and smoking Most common cause of disability Third most common cause of death Risks: Old age,hypertension BMI >27 kg/m2 in women Weight gain >11 kg over 16 years in women Waist-to-hip ratio >0.92 in men Diabetes Hypertension Cholesterol in hemorrhagic stroke find out incidence
• What is dysphagia? Describe the different stages or levels of the Dysphagia diet and the consistency of the diet for the 3 levels.
problems swallowing
Level 1 Dysphagia Pureed
This diet consists of pureed, homogenous, and cohesive foods. Food should be “puddinglike.”
Level 2 Mechanical Altered
This level consists of foods that are moist, soft-textured, and easily formed into a bolus.
Level 3 Dysphagia Advanced
his level consists of food of nearly regular textures with the exception of very hard, sticky, or crunchy foods.
• What are the major risks caused by choking/ aspiration?
aspiration pneumonia
rupture
• What are the types of liquid consistencies and examples of allowed beverages/foods?
Liquids can be thickened using: nonfat dry milk, modified thickeners; commercial thickeners to make it different.
Ex: Nectar: thick juice
Honey: runs off spoon like honey
Pudding: stays on spoon
• What cranial nerves affect the ability to eat food?
cranial nerves V, VII and XII
• What foods increase the risk of choking?
Hotdogs
Grapes
Peanut butter
Peanut butter sandwiches on soft bread
Dry crumbly foods such as cornbread or rice
served without butter, jelly, sauce, etc.
Dry meats such as ground beef served without
sauce, gravy
Whole, raw vegetables served in large bite sized
pieces
Whole hard fruits like apples or pears
Candy with large nuts
Hard nuts
• Describe the different types of strokes: embolic, thrombotic and ischemic
Embolic stroke: cholesterol plague is dislodged from proximal vessel, travels to brain and blockes an artery. Most common is: middle cerebral artery (MCA).
Thrombotic stroke: cholesterol plaque ruptures – platelets subsequently aggregate to clog an already narrowed artery.
TIA: brief attacks of cerebral dysfunction of vascular origin with no persistent neurologic dysfunction (usually preclude strokes)
Most strokes incited by thromboembolic event: aggravated by: atherosclerosis, HTN, DM, gout
• When is enteral nutrition necessary? Short-term (NGT) vs. long-term methods (PEG)
PEG may be necessary when pt’s swallowing function is not able to ensure adequate PO intake. Ex: pt only able to eat pureed foods and PO intake meeting < 50% estimated needs
PEG is prefereed for long term 3-4 weeks because of its ease in providing nutrients while causing the patient less anxienty and self consciousness short prep time and stuff
NGT is used for up to 3-4 weeks through nose into stomach for normal gastrointestinal function pts
Describe the ketogenic diet
Ketogenic diet - intractable seizures in children – used when medications fail.
Risks: low blood sugar, upset stomach due to high fat content, constipation, slowed growth, elevated serum cholesterol (resolved when diet ends)
Demanding diet but has successfully treated 1/3 children with intractable seizures
Ketosis – ketones inhibit neurotransmitters that cause seizures
Starts with hospitalized fast for 24 – 72 hours.
Ketonemia tested for with beta-hydroxybutyrate in blood. May take up to 3 months before seizure activity is reduced.
Traditional diet: 3:1 or 4:1 (3-4 gm fat to 1 gram of PRO and CHO)
80% kcal needs from fat
PRO needs for growth calculated (1 gm/kg)
Remainder of kcal from CHO
Majority of diet: fresh meat, eggs, cheese, fish, heavy whipping cream, butter, oils, nuts, seeds
CHO free vitamin/mineral supplements necessary. Plus extra: CA, VIT D, selenium.
Monitor other things: sugar free toothpaste, shampoo, lotions (AVOID)
Monitor wt gain and excess CHO – both can decrease ketosis and cause breakthrough seizures.
Modified: LOW CHO 10 – 20 gm/day. Ratio: 1 gm fat: 1 gm PRO/CHO. Start with 10 gm/day and gradually increase
• Learn the drug-nutrient interactions with phenobarbital.
cyclosporine, doxycycline, estrogens, griseofulvin, metronidazole, ranolazine, voriconazole, “blood thinners” such as warfarin, corticosteroids such as prednisone, calcium channel blockers such as felodipine/nimodipine, among others.
increase metabolism of d &k and folic acid
lower calcium absorbtion
dont do enteral feeding when this yeah
MNT for parkinsons disease
Adequate fiber and fluid to lessen constipation
dietary protein at breakfast and lunch
Ensure nutritionally complete diet
Evaluate dysphagia
• Foods containing L-dopa
fava beans
parkinsons • Nutrient-drug interactions
Minimize Drug–nutrient interactions: L-dopa with protein, pyridoxine, and aspartame
L-dopa – repcurser to dopamine – controls symptoms.
L-dopa interacts with PRO – causes GI upset, nausea, anorexia, loss of smell, constipation, dry mouth.
Pyridoxine – needed for enzyme to break down l-dopa. If too much present, then l-dopa will be metabolized in periphery and won’t make it to CNS to be effective
Strong predictors of poor outcome after head injury
Stress response to injury in early phase
Glasgow Coma Scale determines severity
Level of hyper-metabolism correlates with level of severity
Strong prognostic value for neurologic recovery in head-injured patients (scale evaluating and quantitating the degree of coma by determining best responses to standardized stimuli)
Eye opening (4 Spontaneous–1 None)
Verbal response (5 Oriented–1 None)
Motor response (6 Follows command–1 None)
• What is Glasgow coma scale for?
system for determining the degree of neurologic insult and a patient’s level of con- sciousnessby assessingresponsesto eye opening and motor and verbal response
Strong prognostic value for neurologic recovery in head-injured patients (scale evaluating and quantitating the degree of coma by determining best responses to standardized stimuli
• Know the score and the amount of calories recommended according to severity
A score of 14 to 15 indicates minor headinjury; 9 to 13 corresponds to moderate injury and a less than 8 reflects severe injury
Energy expenditure in TBI is often as much as 40%greater than normal. Patients with a GCS of 4 to 5 often have the highest energ’y expenditure. On the other hand, brain-dead patients or thosewho receivesedativesb. arbiturates.or musculoskeletal blocking agents often have lower-than-predicted energ’y expenditure,averagingabout 14%less
• The most common type of motor system disease
als
• Know the scores of severity and diet therapy
Severity scale: # 1 the most severe (NPO) to #10 (no swallowing problems)
—Prevent malnutrition and dehydration
—Monitor dysphagia
fu ALS progresses, a progressive loss of function in bulbar and respiratory muscles contributes to oral and phanTngeal dysphagia. In late stagesthe respiratory starusis impaired such that the patient is not a good candidate for PEG placement; and al- ternadve placementsmay be required
• What is the vitamin involved? What is the most common cause? What is the name of test to diagnose
b12
vitam]n B12deficienry is malabsorption of the vitamin becauseof inadequateproduc- tion and secretion of IE
schilling test
• What types of people are at higher risk of this disease? What is the vitamin involved?
Occurs mainly in alcoholics
Chronic deficiency of Thiamin
• Calculate IBW and calories needs for the quadriplegic and paraplegic
Tetraplegia (Quadriplegia)
Subtract 10-15% from IBW 23 kcal/kg
Paraplegic
Subtract 5-10% from IBW 28 kcal/kg
Alzheimer’s • Physical and mental changes that cause changes in intake
Dehydration is a problem due to decreased thirst sensation, neglecting to seek water
Wt loss problem – possible increased energy needs due to pacing ando or neglecting to eat or impaired self feeding
Alzheimers • MNT
Saturated FA and alcohol and deficient in antioxidants – promote onset of AD
Unsat FA, vitamins, antioxidants, wine, curcumin and some spices suppress onset by savaging free radicals and preventing oxidative damage
Dehydration is a problem due to decreased thirst sensation, neglecting to seek water
Wt loss problem – possible increased energy needs due to pacing ando or neglecting to eat or impaired self feeding
Limit distractions at meal times; supervise meal times
Foods in different color bowls
Problems with self-feeding and oral intake generally lead to weight loss
Provide nutrient-dense foods and frequent snacks
Eliminate distractions at mealtime
Provide finger foods and cueing
• Nutrition risk factors: Ex) Inadequate intake; Weight loss; Dehydration
Dehydration is a problem due to decreased thirst sensation, neglecting to seek water
Wt loss problem – possible increased energy needs due to pacing and or neglecting to eat or impaired self feeding
