Test 2 Flashcards
(24 cards)
MNT energy needs for BPD & CLD
25-50% > control
50-85 kcal / kg BW / d (no growth)
120-130 kcal / kg BW / d (growth)
MNT macronut needs for BPD & CLD
protein: provide ≥ 7% kcal
fat & CHO: added to formula after concentrated to 24 kcal / oz–fat provides essential FAs & cals when fluid tolerance & CO2 load is limited–excessive CHOs ↑ RQ & output of CO2
resp. quotient (RQ)
ratio–CO2 expired : vol. of O2 inspired
MNT fluid needs for BPD & CLD
for fluid balance: restrict Na & fluids & use diuretics
when fluids restricted, use parenteral lipids or cal-dense enteral feedings (formulas >24 kcal / oz)
MNT vit & min needs for BPD & CLD
monitor drug-nut interactions
Vit. K for bone development
Vit. A for proper development
adequate stores of Fe, Zn, & Ca due to prematurity
diuretics, bronchodilators, antibiotics, cardiac anti-arrhythmics, & corticosteroids→↑ed urinary losses of min’s, esp. Cl, K, & Ca (resp. acidosis ↑ losses)–def. of Cl or K→muscle weakness & impaired growth
MNT macronut needs for COPD
energy needs ↑ed due to labored breathing–NO overfeeding
protein (15-20% kcal)–1.2-1.7 g / kg dry BW / d–encourage BCAAs–long-term steroids→protein catabolism & gluconeogenesis→ - N2 balance
fat (30-45% kcal)–for hypercapnia, severe dyspnea, or ventilation weaning pts—IV form + hyperlipidemia→inflammation
CHO (40-55% kcal)–↑er RQ→produce more CO2→breathing difficulty ↑→exhaustion→ARF
MNT vit & min needs for COPD
cor pulmonale + fluid restriction→limit Na & fluids
may need K for diuretics
↑ed losses of Cl, K, & Ca from meds→supp
Mg & Ca for muscle contraction & relaxation
inadequate stores of Fe, Zn, Ca, & P due to prematurity→supp
long-term steroids→osteoporosis risk→Ca supp
smokers: +16 mg / d for 1 pack / d
MNT fluid needs for COPD
possible 1° or 2° dehydration
intense sputum & expectoration→body’s hydration ↓→secretion removal ↓ (stay hydrated!)
nut-drug interactions for COPD
- bronchodilators: anorexia & ↓ed K
- expectorants: xerostomia→caries, loss of teeth, gum diseaes, stomatitis, & glossitis, nut. imbalances, wt loss; loss of taste
- corticosteroid: K supp; monitor Vit. D, Ca, K, & Mg; avoid St. John’s Wort; monitor pts at risk for Zn def; avoid immune-enhancing supp’s
MNT macronut needs for CF
3000-4000 kcal / d
protein: 15-20% kcal / d b/c malabsorption
CHO: 45-65% kcal / d (adjust as needed)
fat: 35-40% kcal / d—include essential FAs & fat-sol. vit’s—limits food volume & improves palatability—may have steatorrhea
MNT vit & min needs for CF
H2O-sol. vit’s absorbed better than fat-sol. ones, even those w/ pancreatic enzyme replacement therapy (PERT)
↑ Na b/c losses through sweating, lethargy, vomiting, & dehydration
MNT for Ca kidney stones
fluids: 3 L / d
cranberry juice acidifies urine (for UTIs & struvite stones)
black current juice will alkalize urine & prevent uric acid stones
tea, coffee, beer, & wine ↓ risk of stone formation
protein: moderate animal (.8 g / kg BW)
Ca: do NOT restrict (if restricted, bone min. wasting & ↓ed bone min. density→fracture risk ↑)
oxalates: ~60 mg / d
K: ↓-oxalate fruits & veg’s
Mg: inhibits oxalate formation
Phosphate: excess urine phosphate ↑ Ca-phosphate stone risk
Na: 500 mg Vit. C / d–Vit B6 needed in oxalate met.
MNT for uric acid stones
protein: restrict dietary purines (meat, fish, & poultry) b/c acid production–implement alkaline-ash diet
MNT for cystine stones
maintain alkaline urine pH typically via meds (raise pH to 7.5 via alkaline-ash diet)
avoid excess methionine (fish), which ↑ production of methionine
> 4 L / d of fluids
MNT for struvite stones
long-term antibiotics, surgical removal, & shockwave lithotripsy
MNT for acute renal failure (ARF) / acute kidney injury (AKI)
protein: .5-.8 g / kg (non-dialysis); 1-2 g / kg (dialysis); ≤ 2.5 g / kg for CRRT
energy: 30-40 kcal / kg BW
K: 30-50 mEq / d for oliguria (depends on output, dialysis, & serum K level)–replace losses in diuretic phase
Na: 20-40 mEq / d for oliguria (depends on output, dialysis, edema & serum Na level)–replace losses in diuretic phase
fluids: replace output from previous day (losses due to vomiting, diarrhea, & urine) + 500 mL
MNT for nephritic syndrome
maintain good nut. status & restrict Na for HTN
MNT for nephrotic syndrome
protein: .8 g / kg IBW (50-60% HBV)
energy: 35 kcal / kg IBW (children: 100-150 kcal / kg)
Na: 3 g / d
those at ↑ risk for premature atherosclerosis: cholesterol-lowering diet
MNT for chronic kidney disease (CKD)
manage symptoms (edema, hypoalbuminemia, & hyperlipidemia), ↓ risk of progression to renal failure, & maintain nut. stores–use of statins to correct hyperlipidemia, ↓-Na diet, & diuretics
protein: .8 mg / kg / d (50-60% HBV)
energy: 35 kcal / kg / d
Na: 2-3 g / d
K: restrict when urine output ↓ to 1 L / d
P: take phosphate binders w/ meals
lipids: those at risk for premature atherosclerosis: cholesterol-lowering diet to ↓ total cholesterol, LDL, & TGs (strong link btwn CKD & CVD)
vit’s: H2O-sol. vit’s prescribed
MNT for end-stage renal disease (ESRD)
hemodialysis:
protein: 1.2 g / kg
energy: 35 kcal / kg
fluid: 750-1000 mL / d + urine output
Na: 2-3 g / d
K: 2-3 g / d
P: .8-1.2 g / d
vit’s: active Vit. D (calcitriol)
MNT for end-stage renal disease (ESRD) (cont.)
peritoneal dialysis:
protein: 1.2-1.5 g / kg
energy: 30-35 kcal / kg
fluid: 2000 mL / d + urine output
Na: 2-4 g / d
K: 3-4 g / d
P: .8-1.2 g / d
vit’s: active Vit. D (calcitriol)
5 ↓-K foods
- 1 c blueberries = 129 mg
- 1/2 c raw chopped onions (white, red, or yellow) = 126 mg
- chopped, stir fried sweet bell pepper (red or green) = 120 mg
- 1 med. fresh plum = 114 mg
- 1/2 c raw alfalfa sprouts = 13 mg
5 ↑-K foods
- 1 med. banana = 467 mg
- 1/4 melon cantaloupe = 426 mg
- shredded, boiled bok choy = 315 mg
- 1 med. kiwi = 252 mg
- 2 med. fresh apricots = 207 mg
MNT for cancer
energy: 25-35 kcal / kg BW
protein: 45-60 g / d
fluids: 30-35 mL / kg / d or 1 mL / 1 kcal est. cal needs
anti-oxidants
frequent meals–cal-dense foods–focus on liquids & soft foods–eat easy to prepare & easy to eat foods–avoid dry, rough foods–maintain good oral hygiene–wash all fruits & veg’s
