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132 Cards in this Set
- Front
- Back
Screening tool - SGA |
Subjective Global Assessment Hx, intake, GI symptoms, Fx capacity, physical appearance, edema, wt change |
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Screening tool - MNA |
Mini nutritional assessment Evaluates Independence, medications, number of full meals consumed each day, protein intake, FV, fluid, mode of feeding ≥65 yrs |
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Screening tool - NSI |
Nutrition screening initiative For elderly |
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Screening tool - GNRI |
Geriatric nutritional risk index Serum albumin, wt changes |
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Tricep skin folds measures - |
TSF Measures body fat reserves / kcal reserves |
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Arm muscle area measures - |
AMA Measures skeletal muscle area (somatic protein) Important to measure in growing children |
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Waist/hip ratio in men and women |
WHR ≥1.0 in men ≥0.8 in women Both are indicative of Android obesity |
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Hair assessment and consideration are? |
Thin, sparse, dull dry brittle = VitC, protein, deficiency Easily pluckable = protein deficiency |
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Megestrol acetate |
Appetite stimulant |
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Dextroamphetamine |
Appetite suppressant, anorexia, nausea, wt loss |
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Orlistat |
Decrease fat absorption by binding lipase, vit/min supplement |
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Marinol |
Appetite stimulant |
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Methylphenidate (Ritalin) |
Anorexia, nausea, wt loss |
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Lithium carbonate (antidepressant) |
Increased appetite, wt gain; maintain consistent sodium and caffeine intake to stabilize levels. If sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity. |
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Propofol |
Administered in oil, consider fat kcals, 1.1 kcals/cc, check TG |
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Vitamin B6 and protein |
Decrease effectiveness of L-dopa (levodopa) which controls symptoms of Parkinson's disease. take drug in morning with limited protein (competes with drug for absorption sites) |
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Tyramine |
HTN if taken with MAOI 1. Eliminate dopamine and restrict tyramine (monoamines). MAOI inhibitors interact release norepinephrine which elevates blood pressure, restrict aged, fermented, dried, pickled, smoked, spoiled foods. Avoid hard, aged cheese (cheddar, Swiss), sauerkraut, sausages, luncheon meat, tofu, miso, Chianti wine. Limited sour cream, yogurt, buttermilk. 3. OK: cottage cheese, cream cheese. Good advice: buy, cook, eat fresh foods |
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Health Risk Appraisal |
HRA Survey categorizing a populations' general health status Questionnaires, calculations that predict risk of disease, educational message to the participant |
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Demographic =? |
Population by age, ethnic groups, sex, birth rates, deaths |
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Socioeconomic stratification =? |
Census data, housing statistics |
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PPFP - ? |
Prepared and perishable food programs Link sources of unused, cooked and fresh food with social service agencies to serve the hungry |
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Nutritional surveillance - ? |
Use ht, wt, hct, hgb, serum cholesterol Linked with: WIC, CDC, EPSDT |
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NSI - ? |
Nutrition screening initiative Promote nutrition and improve nutritional care for the elderly to ID nutritional problems early DETERMINE (>80yrs) Lv1 - Screen IDs those who need more comprehensive assessment Lv2 - Screen provides more specific diagnostic info on nutritional status |
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NNMRRP - ? |
National nutrition monitoring and related research program Incl all data collection and analysis activities of the federal government related to measuring the health and nutritional status, food consumption, attitudes about diet and health Jointly run by DHHS and USDA |
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PedNSS - ? |
Pediatric nutrition surveillance system Low income, high risk Birth - 17 yrs (emphasis on birth-5) Ht, wt, birth wt, hct, hgb, cholesterol, breast feeding |
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PNSS - ? |
Pregnancy Nutrition Surveillance System Low income high risk pregnant women Maternal wt gain, anemia, pregnancy behavioral risk-factors (smoking/alc), birth wt, counts # of women who breast feed |
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NHANES - ? |
National health and nutrition examination survey Ongoing (repeated) survey to obtain info on health of American people Evaluates clinical, chemical (hgb, hct, cholesterol), anthropometric, nutritional data (24 hr recall, food frequency list) NHANES II - oversampling of ≥65 with no age limit |
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WWEIA - ? |
What we eat in America Dietary component of NHANES aka National Food and Nutrition Survey (NFNS) 2 days of 24 hrs dietary recall data with times of eating occasions and sources of foods eaten away from home USDA conducts over-sampling of ≥60 African American, Hispanics |
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BRFSS - ? |
≥18 telephone interview to collect ht, wt, smoking, alcohol, food fat frequency, f/v, diabetes, preventable health problems |
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YRBS - ? |
Youth risk behavior survey Grade 9-12 - smoking, alcohol, wt control, exercise, eating habits |
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TANF - ? |
Temporary assistance to needy family State determines the eligibility of needy families and the benefits and services those families will receive |
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CSFP - ? |
Commodity supplemental food program Monthly commodity food packages Low income women (pregnant, breastfeeding, postpartum) 0-6 yrs, some elderly |
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TEFAP - ? |
The emergency food assistance program Quarterly distribution of commodity foods by local, public, private, non-profit, food banks, soup kitchens, homeless shelters Supplements diets of low income households |
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NSLP - ? |
National school lunch program Entitlement program Meet 1/3 of recommended protein, vitamin A/C, Fe, Ca |
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SBP - ? |
School breakfast program Meet 1/4 recommended protein, Ca, Fe, Vit A/C |
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SFSP - ? |
Summer food service program Entitlement program |
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CACFP |
Child adult care food program Reimburses operators for meal costs, provides commodity foods and nutrition education material |
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FFVP - ? |
Fresh fruit and vegetable program Introduce children to fresh fruits/vegetables |
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WIC - ? |
Women/infant children For pregnant, postpartum, breastfeeding 0-5 yrs Provides food, nutrition, education, referral to other agencies Health exam required Not an entitlement |
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EFNEP - ? |
Expanded food and nutrition education program Does not provide food Provides grants to universities and assist in community development |
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NSIP - ? |
Nutrition services incentive program OAA - older Americans act nutrition program One hot meal per day/5 days/wk provides 1/3 recommended intake
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SNAP - ? |
Largest food assistance program: entitlement |
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CMS - ? |
Centers for Medicare and Medicaid services, DHHS Medicare Medicaid |
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Medicare - ? |
Health insurance 65+ ESRD |
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Medicaid - ? |
Payment for medical care for all eligible needy All ages, blind, disabled, dependent children |
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NET - ? |
Nutrition education training program Provides nutrition education training to teachers and school food service personnel |
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SFMNP - ? |
Seniors farmers market nutrition program Grants to states to provide low income seniors with coupons to be exchanged for eligible foods at farmers markets, stands, community support agriculture programs (CSA) |
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Entitlement programs are ? |
SNAP, Medicare, NSLP, SFSP, SBP (Hint: SNAP-icare-school programs) |
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3 domains of nutrition diagnostics are ? |
NC - nutrition clinical NI - nutrition intake NB - nutrition behavior |
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NC - ? |
Nutrition clinical - nutritional findings/problems that relate to medical/physical condition Functional balance Biochemical balance Weight balance |
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NI - ? |
Nutrition intake Actual problems related to intake |
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NB - ? |
Nutrition Behavior Problems related to knowledge, access to food and food safety Physical activity balance and function Knowledge and beliefs |
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Difference between NC 1.4 and NC 2.1 |
Altered GI function ( NC 1.4 ) looks at problems inside the GI tract including exocrine functions of the liver and pancreas Impaired nutrient utilization ( NC 2.1 ) refers to problems with the metabolism of nutrients once they have entered the circulatory system |
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FTC - ? |
Federal trade commission - internet, TV, radio, bogus weight loss claims |
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When do discharge plans begin? |
Day 1 of hospital stay |
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Ulcer |
Treatment: Antacid to eradicate Helibacter pylori bacteria Eroded mucosal lesion Omit: Cayenne and black pepper, large amounts of chili powder, alcohol and caffeine
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Hiatal Hernia |
Eat small bland feedings, avoid late night snack, caffeine, chili powder and black pepper |
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Dumping syndrome |
Follows a gastrectomy (Billroth I/II) Cramps, rapid pulse, weakness, perspiration, dizziness When rapidly hydrolyzed CHO enters the jejunum, water is drawn in to achieve osmotic balance. This causes a rapid decrease in the vascular l fluid compartment and a decrease in peripheral vascular resistance. Blood pressure drops and signs of cardiac insufficiency appear. About two hours later, the CHO digested and absorbed rapidly. Blood sugar rises, stimulating an overproduction of insulin, causing a drop in blood sugar below fasting. This is reactive or alimentary hypoglycemia. |
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Billroth I |
Gastroduodenostomy - attaches the remaining stomach to the duodenum. |
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Billroth II |
Gastrojejunostomy - Attaches it to the jejunum. When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced. |
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Calcium and Iron are absorbed best in ? |
Ca - most rapid absorption in duodenum Fe - Requires acid |
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B12 deficiency (anemia) |
Lack of intrinsic factor and bacterial growth in loop of intestine being bypassed interfered with B12 absorption (Pernicious anemia diagnosed using the Schilling test) |
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Folate deficiency |
Needs B12 for transport inside the cell; also from poor folate intake and low serum Fe (Cofactor in folate metabolism) |
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Gastroparesis |
Delayed gastric emptying Moderate to severe hyperglycemia Prokinetics (Erythromycin, Metoclopramide) increases stomach contractility |
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Diverticulosis |
Presence of diverticuli - small mucosal sacs that protrude though the intestinal wall due to structural weakness. Related to constipation and lifelong intra-colonic pressures. High fiber helps increase volume and weight residue |
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Diverticulitis |
When diverticula become inflamed as a result of food and residue accumulation and bacterial action Clear liquid, low-residue or elemental, gradual return to high fiber |
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IBD - ? |
Inflammatory bowel disease Regional enteritis ( Crohn's disease ) Affects terminal ileum, wt loss, anorexia, diarrhea B13 deficiency leads to megaloblastic anemia Fe deficiency anemia due to blood loss, decreased absorption |
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Chronic ulcerative colitis (UC) |
Ulcerative disease of the colon, begins in the rectum Chronic bloody diarrhea, wt loss, anorexia, Na/K disturbance, dehydration, anemia, fever, negative N balance |
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Irritable bowel syndrome |
Chronic abdominal discomfort, altered intestinal motility, bloating Goals: Adequate nutrient intake, tailor pattern to GI issues Avoid large meals, excess caffeine, alcohol, sugars Use foods diary |
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Lactose intolerance |
Due to lactase deficiency Lactose tolerance test - oral dose of lactose after a fast. If lactose intolerant of lactose, blood glucose will rise < 25 mg/dL above fasting (flat curve). If tolerant of lactose, the rise would be above 25 mg/dL (normal curve) |
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Probiotic vs Prebiotic |
Probiotic - "good" bacteria Prebiotic - CHO for bacteria |
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Steatorrhea |
>7g of fat in stool (indicative of malabsorption) Normal 2-5g
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Short bowel syndrome |
Consequences associated with significant resection of the small intestine Severity reflects length and location of resection, age of patient, health of remaining tract. Loss of ileum (esp distal 1/3), loss of ileocecal valve, loss of colon are of particular concern |
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Jejunal resection causes the Ileum to? |
Ileum can adapt and take over jejunal functions |
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Ileal resection can cause? |
Major complications 1) distal - absorption of B12, intrinsic factor, bile salts 2) Ileum absorbs major portion of fluids in GI tract, so drink more (at least 1L more) |
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Parenteral nutrition is for ? |
Initially to restore and maintain nutrient status |
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Enteral Nutrition is for ? |
Start early to stimulate growth, increase over time; continuous drip May take weeks to transition to solid |
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Ileal nutrition (if complications occur) |
Limit fat, use MCT (does not require bile salts, need less intestinal surface area) Supplement fat soluble vitamins, Ca, Mg, Zn, parenteral B12 -> monthly injections |
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Fx of liver |
Stores/release blood, filters toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance |
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HAV - gotten by ? |
Fecal, oral transmission |
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HBV - gotten by ? |
Sexually transmitted |
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HCV - gotten by ? |
Blood to blood contact |
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Hepatitis nutrition care |
Increase fluids 1.0-1.2g protein/kg -- high protein prevents fatty liver Moderate - liberal fat intake (limit if steatorrhea) Small frequent feedings d/t anorexia |
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Cirrhosis - ? |
Damaged liver tissue replaced by bands of connective tissue Divides liver into clumps and reroutes veins Blood flow disrupted Protein deficiency leads to ascites, fatty liver, impaired blood clotting |
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Diet for cirrhosis |
High protein 0.8 - 1.0g/kg (1.5g/kg if stress) High kcal 25-35 kcal/kg Moderate - low fat 25-40% of kcal (MCT if needed) |
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Alcoholic liver disease |
Liver injury due to alcohol and metabolic derangements it causes Alcohol converts to acetaldehyde and excess H which disrupts liver metabolism H replaces fat a fuel (in kreb cycle), so fat accumulates in liver (leads to fatty liver) and in blood (raises TG levels) |
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Alcohol interferes with ? |
Thiamin, B12, Vitamin C, Folic acid |
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Pancreatitis |
Inflammation with edema, cellular exudate and fat necrosis Acute - put pancreas at rest, withhold all feedings, maintain hydration (IV) // progress as tolerated with low fat content, elemental feeding may be necessary Chronic - recurrent attacks of epigastric pain of long duration // PERT - pancreatic enzymes orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase. MCTs do not require pancreatic lipase. Add to mixed dishes, jams, jellies |
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Cystic fibrosis |
Disease of the exocrine glands - secretion of thick mucus that obstructs glands and ducts PERT - Pancreatic enzyme replacement therapy with meals and snacks High protein, high kcals, unrestricted fat, liberal salt |
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CVD |
Cardiovascular disease HTN - systolic >140 // diastolic >90 or both Management: DASH diet, restrict Na |
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Mediterranean diet |
Rich in alpha linoleic acid, high in MUFA Olive, fish, poultry eggs, walnuts, fruits, vegetables, almonds |
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Risk factors for metabolic syndrome |
1) BP ≥130 systolic and/or ≥85 diastolic 2) TG ≥150 mg/dL 3) Fasting serum glucose ≥100 mg/dL 4) Waist 40"M/35"F 5) HDL<40 mg/dL M // <50 mg/dL W |
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National Cholesterol Education Program |
NCEP Assess risks Therapeutic lifestyle change from Adult Treatment Panel III |
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Cardiac Cachexia - which 2 amino acids may help? |
Arginine and Glutamine |
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Hormones involved in renal Fx |
Vasopressin (ADH) - Fr hypothalamus, stored in pituitary Exerts pressor effect; elevates BP Renin - Vasoconstrictor |
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BUN:creatinine ratio indications |
>20:1 pre-renal state (may not need dialysis) <10:1 reduced BUN reabsorption (may need dialysis) |
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Nephrosis |
Nephrotic syndrome Protein restriction: 0.8-1.0g/kg Fat: <30%, low saturated fat Abnormalities in: Fe, Cu, Zn, Ca and Pro loss |
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Chronic Renal Failure |
Hemodialysis 1.2g pro/kg SBW <60 yrs old 35kcals/kg >60 yrs old/Obese 30-35kcals/kg |
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Peritoneal dialysis |
1.2-1.3g Pro/kg SBW |
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Dawn phenomenon |
Natural increase in early morning blood glucose and insulin requirements due to increased glucose production in liver after overnight fast |
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Gout |
Disorder of purine metabolism Increased serum uric acid, deposits in joints causing pain/swelling Avoid: Broth, anchovies, sardines, organ meats, sweet bread, Herring, mackerel |
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Inborn error of metabolism |
Galactosemia - due to missing enzyme No: organ meats, msg extender, milk, lactose, galactose, whey, casein, dry milk solids, curds, Ca, Na, caseinate, dates, bell peppers Okay: Soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG |
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PKU |
Phenylketonuria Missing enzyme which converts phenylalanine to tyrosine Detected via Guthrie Blood Test Avoid aspartame Low Pro, high CHO |
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Homocystinuria |
Treatable inherited disorder of amino acid metabolism Severe elevation of methionine and homocysteine in plasma, excessive excretion of homocystine in urine |
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MSUD |
Maple syrup urine disease Inborn error of metabolism of BCAA leucine, isoleucine and valine
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Systemic Lupus Erythematosus (SLE) |
May have anemia but does not correlate with Fe intake May show symptoms of celiac disease |
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Osteoclasts vs Osteoblasts |
Osteoclasts - Resorb and remove bone Osteoblasts - Reforms bone |
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Epilepsy - definition, treatment, interference? |
Seizures, altered consciousness Treatment: May need to supplement VitD, Ca, B1, provide phenytoin from meals and other supplements, Keto Diet helps Interference: Anticonvulsants phenobarbital and phenytoin (Dilantin) interfere with Ca absorption |
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Anemia - Macrocytic, Megaloblastic vs Microcytic, Hypochromic |
Macrocytic, Megaloblastic - Few large cells - Schilling test for pernicious anemia (Deficiency of Folate, B12) Microcytic, Hypochromic - Small, pale cells - Due to Fe deficiency |
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Common allergens |
Peanut, eggs, milk, soy, wheat, shellfish Cow's milk is most common allergens for infants |
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Hold standard for identifying food-induced symptoms |
Double blind, placebo-controlled food challenges DBPCFC |
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Ebb and flow response to injury |
Hypermetabolic, catabolic response following trauma Ebb phase - hypovolemia, shock, tissue hypoxia Flow phase - Follows fluid resuscitation and return of O2 transport Results of physiologic trauma - hyperglycemia, hyperinsulinemia, little-no Ketosis, increase glucagon |
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Neoplastic disease - ? |
Protein-kcal malnutrition, malabsorption, fluid/electrolyte imbalance Provide bland liquids, soft foods, chilled/frozen foods |
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Marasmus - ? |
Protein/kcal starvation Severe fat/muscle wasting |
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Iatrogenic malnutrition - ? |
Protein/kcal malnutrition Brought on by treatment , hospital, medication |
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Prader Willi syndrome - ? |
Chromosome 15 deletion Congenital disorder, subnormal LBM, supranormal Body Fat Ghrelin levels are elevated which stimulates growth hormone secretion, appetite, intake and fat mass deposition |
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Achalasia - ? |
Disorder of lower esophageal sphincter motility, does not relax and open upon swallowing |
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Enteral Nutrition - formula |
Standard polymeric - normal GI Fx Initiate at full strength 10-40 mL/hr
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Enteral Nutrition - elemental/chemically |
Use with malabsorption Pre-digested protein/amino acids, glucose or sucrose, small fat, vitamins, minerals, electrolytes |
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Hang time for open systems? Closed? |
Open - 4 hrs Closed - 24-48 hrs |
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Continuous drip - steady rate over X hrs? |
16-24 |
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Example - view back |
Picture |
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What is peripheral parenteral nutrition? |
Small surface veins Short term therapy with minimum effect on nutritional status |
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Solution - kcals/mL or Gram |
IV dextrose - 3.4 kcals/g Fat emulsion - 10% = 1.1 kcals/cc - 20% = 2.0 kcals/cc |
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Parenteral Nutrition (PN) diagnosis codes |
NC - 1.4 altered GI Fx NC - 2.1 impaired nutrient utilization |
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Transitional feeding minimal amount? |
Introduce a minimal amount at full strength enteral feeding at a low rate of 30-40 mL/hr to establish GI tolerance Decrease PN as you increase enteral rate by 25-30 mL/hr increments every 8-24 hrs to maintain prescribed nutrient levels When enteral reaches 1/3 - 1/2 of needs, taper off enteral feeding |
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What is re-feeding syndrome? |
Aggressive administration of nutrition to malnourished Starved cells take up nutrients, K and P shift into intracellular compartments Results in hypokalemia, hypophosphatemia and hypomagnesemia Overfeeding PN and dextrose > 5 mg/kg/min may lead to hyperglycemia |
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What are the Dietary Reference Intakes? |
DRI = umbrella of nutrient guidelines RDA - Recommended dietary allowance - goals for healthy individuals to prevent nutritional deficiency diseases - incl gender, age, life phases EAR - estimated avg requirement - for 50% of population, used in planning meals for healthy people, assesses group nutritional adequacy AI - Adequate intake - used when insufficient evidence exists for EAR, RDA UL - Upper levels - not associated with adverse side effects in most individuals of a healthy population |
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Healthy people 2020 - focuses on ? |
Focuses on disease prevention by changing behavior |
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3 levels of program intervention |
Primary prevention - Programs: Reduce exposure to a promoter of a disease (early screening) health promotion Secondary prevention - recruiting those with elevated risk factors into treatment program ( setting up an employee gym) risk reduction Tertiary prevention - as disease progresses, intervention to reduce severity, manage complications, rehabilitation efforts |
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What are the steps in program planning? |
1. Develop a mission statement and needs/problem statement 2. Set goals 3. Set objectives SMART - specific, measurable, achievable, relevant, time frame |
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What is nutrition informatics? |
The intersection between nutrition, information and technology |