Nutrition for the Chronically Ill Adult

Question 1

what are the main reasons why nutrition is important?

Answer 1

for the maintenance of health and disease prevention

Question 2

What are the nutrition assessment ABC’s?

Answer 2

Anthropometric, Biochemical, Clinical, Dietary methods, and Environment

Question 3

define anthropometry

Answer 3

the measure of physical dimensions and composition of the body

Question 4

list a few examples of things that can be considered antrhopometric

Answer 4

height, weight, head circumference

Question 5

what is looked at when assessing the biochemical component of a patients nutrition

Answer 5

Laboratory methods/values - such as serum proteins (albumin and prealbumin, hemoglobin, and lipid profile

Question 6

what is the purpose of the clinical aspect of nutritional assessment?

Answer 6

to detect signs and symptoms of malnutrition. These can be found during a clinical examination.

Question 7

give an example of a clinical finding that can be discovered by examination

Answer 7

painful cracks at the corner of the mouth can be a sign of riboflavin or niacin defiency

Question 8

How do you assess a patients dietary methods?

Answer 8

you survey the PT to measure the quantity of food consumed over a period of time through methods such as a 24-hour dietary recall, a food diary, or food frequency questionnaire

Question 9

What aspects need to be assessed to make an observation about a PT’s nutritional environment?

Answer 9

you should looks at aspects such as their access to food, income, home environment (clean water, cooking equipment), etc..

Question 10

Define dysphagia

Answer 10

difficulty swallowing

Question 11

what are the two different types of dysphagia?

Answer 11

oropharyngeal and esophageal dysphagia

Question 12

describe esophageal dysphagia

Answer 12

this is when food or liquid stops in the esophagus. solids are often more difficult to swallow that liquids

Question 13

what can cause esophageal dysphagia?

Answer 13

cancer, esophageal stricture(narrowed esophagus often caused by tumors or scar tissue), muscle disorders of the esophagus

Question 14

describe oropharyngeal dysphagia

Answer 14

difficulty swallowing food to the back of mouth and initiating swallowing. liquids are often more problematic than solids.

Question 15

what can cause oropharyngeal dysphagia?

Answer 15

brain or nerve disorders such as Parkinson’s, Alzheimer’s, stroke, cerebral palsy, and cancer

Question 16

what are the symptoms that can help to identify oropharyngeal dysphagia?

Answer 16

drooling, coughing, choking, pocketing of food, gurgly voice

Question 17

what methods are commonly used to assess for dysphagia?

Answer 17

bedside evaluations or a modified barium swallow completed by a speech or occupational therapist

Question 18

what are the four different classification for consistency of a liquid

Answer 18

puddung thick, honey thick, syrup/nectar thick, and thin

Question 19

how do you thicken up a liquid?

Answer 19

add tasteless powder

Question 20

how many food levels are there for the dysphagia diet?

Answer 20

5

Question 21

what are the five levels of a dysphagia diet?

Answer 21

1-pureed, 2-minced, 3-ground, 4-chopped, 5-regular

Question 22

In what specialty diet are meats ground if not already into a form that is easily chewed and most raw fruits, vegetables, seeds and nuts are restricted?

Answer 22

mechanical soft

Question 23

what kind of PT’s are restricted to mechanical soft diet?

Answer 23

PT’s with poor dentition or poorly fitting dentures, PT’s with difficulty chewing, dysphagia, or PT’s have undergone neck or head srugery

Question 24

List and describe foods used for the pureed diet

Answer 24

since this diet requires minimal chewing/swallowing strained foods, soft cooked cereal, cream soups, soft desserts, etc… are used. Food can also be blended to an appropriate consistency or shaped. between meal feeding is suggested

Question 25

What kind of PT's should be on a low bacteria diet?

Answer 25

PT's who are immunosupressed or comprimised such as PT's who have undergone chemo, radiation, medication (such as antibiotics), or organ transplant

Question 26

define cirrhosis

Answer 26

it is a result of advanced liver disease. It is characterized by replacement of liver tissue by fibrosis (scar tissue) and regenerative nodules (lumps that occur due to attempted repair of damaged tissue).These changes lead to loss of liver function.

Question 27

what is a cirrhosis diet designed to do?

Answer 27

to promote liver regeneration, nutritional repletion, and to prevent hepatic encephalopathy

Question 28

what does the cirrhosis diet consist of?

Answer 28

high calorie, high protein diet (unless there is development of encephalopathy) fat should only be limited if steatorrhea or jaundice develop. sodium and fluid should only be restricted if ascites (fluid in peritoneal cavity) or edema (swelling) present. Alcohol should be avoided in general

Question 29

define hepatic encephalopathy

Answer 29

it is the occurrence of confusion, altered level of consciousness, and coma as a result of liver failure.

Question 30

what is a diet for a PT with hepatic encephalopathy designed to do?

Answer 30

to prevent tissue catabolism, ammonia production, and to promote liver regeneration.

Question 31

what does a diet for a PT with hepatic encephalopathy consist of?

Answer 31

adequate Kcal and protein, sodium and fluid restriction if ascites present, serum potassium levels should be monitored if taking potassium-wasting/sparing diuretics

Question 32

a fat restricted diet is appropriate for what kind of PT's?

Answer 32

gallbladder disease and biliary, pancreatic, and intestinal disorders.

Question 33

why is a fat restricted diet appropriate for a PT with biliary, pancreatic, or intestinal disorder?

Answer 33

maldigetsion, malabsorption, or problems in the transport of fat may occur

Question 34

describe steatorrhea

Answer 34

it is the presence of excess fat in the stools as a result of malabsorption

Question 35

if steatorrhea is present the use of what may be indicated for the PT?

Answer 35

medium chain triglycerides (MCT) oil

Question 36

what is a possible problem that may occur in a fat restricted diet?

Answer 36

impaired absorption if fat soluble vitamins, this could also be a problem if the PT presents with steatorrhea

Question 37

a fat-free diet with MCT oil is indicated for PT's with...?

Answer 37

steatorrhea, chylous ascites, and chylothorax

Question 38

MCT oil is available as...

Answer 38

an oral supplement or for tube feeding

Question 39

what kind of diet can also be promoted for heart health and/or weight control?

Answer 39

fat restricted

Question 40

what is the #1 cause of death in the US?

Answer 40

heart disease

Question 41

heart disease kills an american every __ seconds and costs the U.S $____ billion each year

Answer 41

34, 108.9

Question 42

in a fat restricted diet PT's can have lunch meat and cheese that is <__g fat/oz

Answer 42

3

Question 43

in a fat restricted diet PT's can have frozen entrees with <__g fat/serving

Answer 43

10

Question 44

in a fat restricted diet PT's can have ready to eat cereal with <__g fat/serving

Answer 44

2

Question 45

in a fat restricted diet PT's can have all fruits and juice except

Answer 45

coconut

Question 46

in a fat restricted diet PT's can have all vegetables except when...

Answer 46

it is prepared with more than the allowed amount of fat?

Question 47

in a fat restricted diet PT's can or cannot have milk?

Answer 47

yes, but skim only

Question 48

in a fat restricted diet PT's can or cannot have meat?

Answer 48

yes but lean only and without skin

Question 49

can a PT on a fat restricted diet have bread, rise, and pasta?

Answer 49

yes

Question 50

what are the "life's simple 7" as given by the AHA (american heart association)

Answer 50

1. stop smoking 2. lose weight 3. get active 4. eat better 5. manage BP 6. control cholesterol 7. reduce blood sugar

Question 51

what is the heart healthy recommended amount of sodium (in mg/day)

Answer 51

1500 mg/day

Question 52

what is recommended amount of fish per week for heart health (in ounces)

Answer 52

3.5oz

Question 53

what should saturated fat be limited to (% daily kcals) for heart health?

Answer 53

5-6%

Question 54

who is the TLC (therapeutic life style changes) diet recommended for?

Answer 54

PT's with high LDL (cholesterol), lipid disorders, coronary heart disease or other CV disease, diabetes, and metabolic syndromes

Question 55

in the TLC diet the allowed amount of saturated fat can make up <__% of the total calories eaten

Answer 55

7%

Question 56

how much dietary cholesterol is allowed in the TLC diet?

Answer 56

less that 300 mg/day

Question 57

in the TLC diet the allowed amount of total fat can make up <__% of the total calories eaten

Answer 57

25-30%

Question 58

how much dietary soluble fiber is allowed in the TLC diet?

Answer 58

10-25 g/day

Question 59

how much sodium is allowed in the TLC diet?

Answer 59

2300 mg/day

Question 60

a sodium controlled diet is used for the treatment of...?

Answer 60

CV disease (including HTN), renal diseases, edema, and ascites

Question 61

what is the sodium recommendation for a short term sodium controlled diet?

Answer 61

250-500mg per day

Question 62

what is a more long term restriction for the sodium controlled diet?

Answer 62

1-2 grams per day

Question 63

why must you monitor the use of salt substitutes in a sodium restricted diet?

Answer 63

salt substitutes are often high in K+

Question 64

what does the DASH diet stand for?

Answer 64

Dietary Approaches to Stop HTN

Question 65

what is the recommended daily sodium according to the DASH diet?

Answer 65

2300-1500 mg sodium per day

Question 66

What is a high fiber diet recommended for?

Answer 66

PT's with diverticular disease, irritable bowel syndrome, constipation, and for weight control

Question 67

what kinds of foods are increased in a high fiber diet?

Answer 67

whole grain breads, cereal, fruits, vegetable, and legumes

Question 68

what kinds of fiber food may not be tolerated well in diverticular disease?

Answer 68

nuts and seeds

Question 69

what is the recommended fluid intake to accompany a high fiber diet?

Answer 69

8 cups/day

Question 70

what are the two types of fiber?

Answer 70

soluble and insoluble

Question 71

list some foods that are soluble fiber

Answer 71

Oat Bran, Barley, Nuts, Seeds, Beans, Lentils, Peas, Cucumbers, Celery, and Carrots, psyllium

Question 72

list some foods that are insoluble fiber

Answer 72

Wheat Bran, Seeds, Nuts, Zucchini, Broccoli, Cabbage, Green Beans, Dark Leafy Vegetables, Grapes, Raisins, and Whole Grains

Question 73

what may a renal diet restriction consist of?

Answer 73

restrictions of protein, sodium, potassium, phosphorus, and fluid. However these are usually very individualized

Question 74

what is the protein restriction for predialysis?

Answer 74

0.6-0.8 g/kg

Question 75

what is the phosphorus restriction for predialysis?

Answer 75

<10 mg/kg/day

Question 76

what is the calcium restriction for predialysis?

Answer 76

1-1.5 g/day

Question 77

are sodium, potassium, and fluids generally restricted in predialysis?

Answer 77

no, they are given as tolerated

Question 78

what are the restrictions of hemodialysis(HD) and peritoneal dialysis?

Answer 78

protein is liberalized (1.2-1.8 g/kg), sodium is restricted to 2 g/day, low potassium and phosphorus, and <2000 mg calcium per day

Question 79

diabetes is the __th leading cause of death in the US

Answer 79

7th

Question 80

how many grams of carbs are in to serving?

Answer 80

15g of carbs = 1 serving

Question 81

diabetic recommendation for servings of carbs per meal in females?

Answer 81

3-4 servings per meal

Question 82

diabetic recommendation for servings of carbs per meal in males?

Answer 82

4-5 servings per meal

Question 83

diabetic recommendation for servings of carbs per snack (gender nuetral)?

Answer 83

1-2 servings per snack

Question 84

for what patients do you recommend a high protein, high calorie diet?

Answer 84

PT's with burns or who are malnourished

Question 85

equation for BMI (metric)?

Answer 85

kg/(m squared) - weight/height

Question 86

equation for BMI (not metric)?

Answer 86

[pounds/ (inches squared)] x 703 = wight/height

Question 87

what BMI is considered overweight?

Answer 87

25-29.9

Question 88

what BMI is considered obese?

Answer 88

30