Nutrition Flashcards by Mary Potkonjak

Why do term infants lose 5% of birth weight in the first few days of life?

Loss of extracellular water

Suboptimal caloric intake

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How much food do newborns require, how often do they feed?

110 - 115 kcal/kg/day - gain 30g/day

Start at 6 hours, q 3-4 hours

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Colostrum

2-4 days after delivery

High: Protein (IgA), minerals, immune factors

Low: Carbs

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Benefits of breast feeding

Decreases infection, incidence of chronic disease

Decreased PP bleeding, risk of ovarian and breast cancer, delayed ovulation,

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Why is whole cow’s milk not recommended until 1 year of age?

Infants GI tract not developed enough to digest, predisposing to allergy

*Can lead to GI blood loss and iron deficiency

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Contraindications to breastfeeding

Breast cancer

Chemotherapy, some drugs, street drugs

Herpetic breast lesions

Active, untreated TB

CMV, HIV

Galactosemia

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Signs of insufficient feeding of infant

< 6 wet diapers/day after 1 week

< 7 feeds/day

Continual hunger/crying

Continual sleepy

Loss > 10% of weight

Increasing jaundice

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When should solid foods be introduced?

4-6 months

*Introduce individually, 1 week apart*

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Who gets cows milk formula?

Premature

Transitional

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Who gets soy protein based formula?

Galactosemia

Lactose Intolerance

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Who gets protein hydroxylate formula?

Malabsorption

Food allergies

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Who gets amino acid based formula?

Food allergies

Short gut

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Who gets high medium-chain triglyceride oil?

Chylous ascites

Chylothroax

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Do not use 2% milk before ________ or skim milk before ________.

2 years

5 years

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Neonates have a _________ percentage of total body water per weight than adults.

larger, 70-75%

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What are signs of dehydration in an infant?

PARCHED

Pee, pressure

Anterior fontanelle

Refill, capillary

Crying

Heart rate

Elasticity of skin

Dryness of mucous membranes

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Diabetes Insipidus

No ADH - Low urine specific gravity

*appear euvolemic - loss is from intracellular/interstitial spaces

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How do you treat hyper K? (6)

Calcium chloride or gluconate 10% solution - stabilize cardiac membrane

Sodium bicarb, albuterol neb, or glucose + insulin

Kayexalate resin (slow)

Furosemide

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At what age do you supplement Fluoride?

> 6 months if pt. has well water

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What infants get vitamin D deficiency?

Mom has insufficient intake

Inadequate infant sun exposure

Fed on whole cows milk

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What infants get Iron deficient?

Breastfed infants @ 4-6 months

*Preterm should start @ 2 months

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5-week old infant feeding poorly on standard formula switched to whole cow’s milk has an afebrile grand mal seizure and tremulousness.

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Hypocalcemia 2/2 Vitamin D deficiency

Breast milk has ____ iron than cows milk.

The iron in breast milk is _____ bioavailable than in cows milk.

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Less

More

How does one develop Hypervitaminosis A? What are the symptoms?

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Congenital absence of enzymes needed to convert provitamin A carotenoids to vitamin A

Inc. ingestions of carotenoid-containing food

Acute: pseudotumor cerebri = bulging fontanelle, drowsy, CN palsies

Chronic: Poor weight gain, irritable, tender swelling of bones, pruritis, fissures, desquamation

If mom is a strict vegetarian what should you supplement?

**Thiamine** - beriberi weak/irritable, N/V, pruritus, tremor ## Footnote **B12**

What complications are seen with childhood obesity?

**SHADE** **S**CFE **H**TN **A**pnea **D**iabetes **E**mbarrassment

Any child with a rectal temp \> _____ in the **first 6 months** of life should be seen _immediately_.

\> 101.4˚F

At what age may kids start using a cup?

6-9 months

At what age should they begin _brushing teeth_? _First dentist appt_?

1 year 2 years

What are risk factors for anemia? (4)

Low SES BW \< 1.5 kg Whole milk before 6 months Low iron formula/iron rich foods

When is the first hearing screen?

Shortly after birth

How long does a child need to use a car seat?

Until 40 lbs

What vaccines do kids get?

**Hep B** **DTaP** (kids \< 7yo) **H flu B** **Poliomyelitis** **MMR** *live* (CI w/ allergy to neomycin or gelatin) **Varicella** *live* (CI w/ allergy to neomycin or gelatin) **Influenza** CI w/ chicken or egg protein anaphylaxis **Pneumococcus** PCV-7 indicated for \< 2yo **RSV** GA \< 32 wk, \<2yo + chronic lung disease

Belladona, mushrooms, antihistamines, TCAs can show what toxidrome?

**Anticholinergic** Dry mouth/thirst, urinary retention, flushed, dilated pupils, tachy

What toxidrome is caused by organophosphates, mushrooms, black widow spider bites, tobacco?

**Cholinergic** Hypersecretion, fasciculation, weakness, bronchospasm, arrhythmia, convulsions, coma

What toxidrome is caused by _Haloperidol_ and _Metoclopramide_?

**Extra-pyramidal** Tremor, rigidity

What toxidrome is caused by _Salicylates_ (ASA)?

**Hypermetabolic** Fever, tachy, **hyperpnea**, restless, convulsions, **metabolic acidosis**

What toxidrome is caused by Lomotil, heroin, methadone, codeine, Demerol, morphine, etc.

**Opiates** CNS depression, dilated pupils, hypothermia, hypotension

What toxidrome is caused by cessation of EtOH, benzos, barbiturates, and opiates?

**Opiate Withdrawal** Abdominal cramps, diarrhea, lacrimation, sweating, tachy, restless, hallucinations

What toxidrome is caused by amphetamines, cocaine, theophylline, and caffeine?

**Sympathomimetics** Hyperthermia, HTN, tachypnea, dilated pupils, psychosis, convulsions

How are toxic ingestions treated? (3)

Activated charcoal Antidotes Supportive care

How do you treat **APAP overdose**?

N-acetylcysteine (Mucomyst) \*Metabolic acidosis\*

How do you treat TCA overdose?

Intubate Activated charcoal Sodium Bicarb

An **anticholinergic** toxidrome + **widened QRS and flattened T waves** is suggestive of what ingestion?

TCA

How do you treat organophosphate OD?

Atropine Pralidoxime

How do you treat heavy metal OD?

Dimercaprol Succimer, DMSA EDTA

How do you treat iron OD?

Deferoxime

What skeletal injuries suggest abuse? (5)

Spiral fractures in lower extremities Posterior rib fx Metaphyseal "chip" fx Multiple fx Different ages

What can mimic meningitis or sepsis?

Shaken baby syndrome

What do you do if you suspect abuse?

Report to CPS

What 4 ways can neglect present?

FTT Poor hygiene - severe diaper rash Developmental/speech delay Delayed immunizations

If nonorganic FTT (insufficient feeding) is suspected, what do you do?

Admit with unlimited feeding for 1 week \*2oz/24 hr of weight gain is expected

If you suspect neglect, what should you do?

Report to CPS

What are ways in which Munchausen by proxy might present? (6)

Children \< 6, Mom (usually) has some medical knowledge **Vomiting** - ipecac **Chronic diarrhea** - laxatives Recurrent **abscesses** or **sepsis** **Apnea** - choking **Fever** - heat thermometer **Bloody vomiting/diarrhea** - adding to specimen

Nutrition Flashcards

(54 cards)