MNT for Neurological Disorders (part 2) Flashcards by perjunke fibers

____ is a chronic condition characterized by recurring seizures

Epilepsy

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Seizures are caused by abnormal electrical activity of a group of ____ in the brain

Neurons

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One commonly prescribed medication for epilepsy is _____

Phenytoin (Dilantin)

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Food drug interactions with phenytoin (Dilantin):

-Decreases absorption of calcium
-May need vitamin D and folate
-Hypoalbuminemia causes drug toxicity
-Continuous tube feeding inhibits the absorption of phenytoin

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If someone is on continuous tube feedings, hold tube feeding for ___-___ hours before and after giving phenytoin (Dilantin)

1-2

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The ____ ____ is used as a last resort in children with intractable seizures

Ketogenic diet

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The classic version of the ketogenic diet has what macro breakdown?

-2-4% carbohydrate
-90% fat
-6-8% protein

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With the classic version of the ketogenic diet, there is a ___:___ ratio of fat to protein and carbohydrates combined

4:1

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The classic version of the ketogenic diet allows around ___-___ grams of carbohydrates per day

10-15

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The ketogenic diet may be ____ for epilepsy

Curative

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What are two types of fat that may be used for the ketogenic diet?

-Long chain triglycerides
-Medium chain triglycerides (promotes ketogenesis faster)

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The long-chain triglyceride version of the diet is calculated to meet…

-75% of estimated energy needs (using DRI)
-DRI for protein
-75% of maintenance fluid needs or 0.75-1.0 mL of fluid per kcal

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With the ketogenic diet, we need to provide a ____ with minerals, as well as ____ and ____ supplements

-MVI
-Calcium
-Magnesium

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For the classic 4:1 long-chain triglyceride version of the keto diet, we should provide ___% of the estimated energy requirements

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How should we calculate fat needs for the classic 4:1 long-chain triglyceride version of the keto diet?

-Kcal needs x 0.9
-Divide by 9 kcal/g to convert to grams of fat

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How should we calculate carbohydrate and protein needs for the classic 4:1 long-chain triglyceride version of the keto diet?

-Kcal needs x 0.1
-Divide by 4 kcal/g to convert to grams of protein and carbohydrates
-Provide DRI for protein and the remaining grams provided as carbohydrates

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Possible early side effects of the ketogenic diet:

-Hypoglycemia
-Stomach upset
-Acidotic dehydration
-Hypokalemia

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Possible late side effects of the ketogenic diet:

-Constipation
-GERD
-Hyperlipidemia
-Acute pancreatitis

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What are two less restrictive ketogenic diet options?

-Modified Atkins diet (30% protein, 5% carb, 65% fat)
-Low Glycemic Index diet (30% protein, 10% carb, 60% fat)

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____ ____ is caused by destruction of the myelin sheaths which protects the nerves and facilitates the transmission of nerve impulses

Multiple Sclerosis

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The etiology of Multiple Sclerosis is unknown, but may be _____

Autoimmune

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Risk factors for Multiple Sclerosis:

-Female gender
-Northern European ancestry
-Smoking
-Geographic location with less sunlight exposure

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The is no known ____ for Multiple Sclerosis

Cure

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Manifestations of MS of variable; many patients have periods of ____ and ____ while others have a more rapid progression

Remission and relapse

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Early deficits seen with Multiple Sclerosis include...

-Diplopia -Paresthesia -Vertigo -Dysarthria -Ataxia -Muscle weakness

Other manifestations of Multiple Sclerosis include...

-Neurogenic bladder -Neurogenic bowel -Cognitive impairment -Inability to speak -Blindness -Tetraplegia

Nutritional implications of Mulitple Sclerosis:

-Decreased ability to obtain and prepare food and feed self during relapses or if disease progresses -Dysphagia due to damaged cranial nerve and muscle weakness

MNT for Multiple Sclerosis:

-Maintain desirable body weight -Maximize nutritional status -Assess vitamin D status and provide supplementation with vitamin D3 if needed -Some evidence that an anti-inflammatory diet may be beneficial -If dysphagia, provide proper food texture and consistency of liquids using IDDSI diets -Enteral nutrition if necessary

MNT for neurogenic bladder that may be caused by MS:

-Provide adequate fluid: distribute fluids evenly throughout day and limit prior to bedtime -Increased intake of cranberry juice and blueberries may reduce incidence of UTI's

MNT for neurogenic bowel that may be caused by MS:

-Provide adequate fiber, prunes, and adequate fluid

____ _____ is a neurodegenerative disease caused by the loss of dopaminergic neurons in the brain

Parkinson's disease

Dopamine is a neurotransmitter involved in voluntary ____ ____

Motor control

Parkinson's disease is ____ and ____

Progressive and disabling

Parkinson's disease most commonly occurs between ages ___-___ years

40-70

The is no known ____ or ____ for Parkinson's

Cause or cure

Manifestations of Parkinson's:

-Muscular rigidity -Bradykinesia -Tremor at rest -Poor balance -GI dysmotility (constipation) -Dysphagia and aspiration -Dementia -Malnutrition -Eventually, become chair or bed-bound

MNT for Parkinson's:

-Optimize dietary intake to maintain muscle mass for strength and mobility -Assess ability to feed self -Dysphagia evaluation -Increase fiber and fluid for constipation -Educate on food-drug breakdown -May need enteral nutrition

What are two commonly used medications for Parkinson's?

-Levodopa (synthetic form of dopamine) -Sinemet (Levodopa + carbidopa)

What are side effects of Levodopa?

-N/V -Constipation -Anorexia -Dry mouth -Ageusia -Dysgeusia -Dyskinesia

Sinemet has ____ GI side effects than Levodopa

Fewer

Amino acids compete with Levodopa for absorption in both the intestine and blood-brain barrier, meaning that high ____ foods decrease absorption of the drug

Protein

MNT for Levodopa:

-Provide most of daily protein needs in the evening -Take with meals (to decrease GI side effects) -Excessive vitamin B6 (>5 mg) decreases effectiveness of drug

___ ____ ____ causes impaired nerve impulse transmission due to permanently damaged areas of the spinal cord

Spinal cord injury

An ____ spinal cord injury permits some voluntary motor activity and sensation below the level of injury

Incomplete

A ____ spinal cord injury allows no motor activity or sensation below the level of injury

Complete

____ is paralysis of only the lower extremities

Paraplegia

_____ is paralysis of all 4 extremities

Tetraplegia

The acute phase of spinal cord injury is the first ____ weeks post injury

What might occur in the acute phase of spinal cord injury?

-Spinal shock (severe hypotension) -Possible respiratory failure -Hypercatabolic (dramatic weight loss, loss of LBM) -Paralytic ileus

Nutrition assessment for someone with spinal cord injury:

-Weight (initially: severe weight loss, LBM; long term: possible weight gain due to less LMB, physical inactivity) -Calculating IBW -BMI is not valid in this population

To calculate IBW for someone with paraplegia, subtract ___-___% of IBW; for tetraplegia, subtract ___-___%

5-10%; 10-15%

Nutritional concerns for individuals with spinal cord injury:

-Inability to obtain food, prepare food, and feed self -Neurologic bowel (constipation) -Obesity -Increased risk for CVD -Osteopenia and osteoporosis -Neurogenic bladder, UTI, nephrolithiasis -Skin breakdown-> pressure injury

Nutritional needs for spinal cord injury should be ____

Individualized

In the acute phase of spinal cord injury, use ____ ____

Indirect calorimetry

If calculating energy needs for the acute phase of spinal cord injury using MSJE, what activity factor and stress factor should be used?

-Activity factor: 1.1 -Stress factor: 1.2

In the rehabilitation phase, paraplegics should get ___ kcal/kg

28 kcal/kg

In the rehabilitation phase, tetraplegics should get ___ kcal/kg

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

2.0

In the rehabilitation phase of spinal cord injury, protein needs are ___-___ g/kg weight as long as there are no infections or pressure injuries

0.8-1.0

Fluid needs for someone with a spinal cord injury is ___-___ mL/kg

30-40

People with spinal cord injury may have increased fluid needs to...

-Prevent kidney stones -Prevent constipation

MNT for the acute phase of spinal cord injury:

-May need enteral nutrition due to intubation (initiate within 24-48 hours of admission to ICU) -If prolonged small bowel ileum post-injury, parenteral nutrition may be indicated

MNT for the rehabilitation phase of spinal cord injury:

-Oral nutrition with high biological value protein, soluble and insoluble fiber, and adequate fluid -Adequate energy to promote healthy body weight -AHA guidelines for CVD prevention -May need adaptive feeding devices

MNT for neurogenic bowel:

-Fiber: 15 g/d -Fluid: 1 mL fluid per kcal + 500 mL/d OR 40 mL/kg BW +500 mL/d