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81 Cards in this Set
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The stages of change progress: PCPAMR |
• Precontemplation: individual is unaware of need for change; advice iscounterproductive. • Contemplation: individual is aware of need for change but remains ambivalenttoward change. • Preparation: individual embraces the need for change and is most susceptible toguidance. • Action: individual attempts to implement advice in order to effect change. • Maintenance: individual has implemented change and requires reinforcement tosustain new behaviors. • Relapse: individual fails to sustain new behaviors and requires redirection. |
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During maintenance, relapse reinitiates ________. |
contemplation. |
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Responsible recommendations to consume vitamins in amounts exceeding theirRDA: a. ignore efficacy and risk for toxicity b. balance benefits and risks. c. are not possible. d. are inconsistent with current knowledge. |
b. balance benefits and risks. |
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It is important for nutritionists to understand their client’s or patient’s readiness to changestage because: a. this will insure that the recommendations will help them change. b. it helps the practitioner to know what information, support and/or recommendationswill help them get to the next stage of change and ultimately achieve their desiredgoals. c. it determines what specific lifestyle recommendations are needed. d. it creates less tension in consultations sessions. |
b. it helps the practitioner to know what information, support and/or recommendations will help them get to the next stage of change and ultimately achieve their desired goals. |
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True of False: A professional nutritionist can engage in several activities that can facilitate behaviorchange: • Expression of empathy • Avoidance of argument and defensiveness • Tolerance of resistance • Support for self-efficacy |
TRUE |
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Remember: The challenges to professional nutritionists include recognition that: • People implement behavioral change only when they are ready to change. • A nutritional intervention is a powerful determinant of motivation, resistance anddenial. • Change is effected through stages. • Interventions must be targeted to individuals’ degree of motivation. • Ambivalence blocks motivation. • Resistance and denial prevent the attainment of goals. |
Privileges of the Professional Nutritionist: • Recognition and respect as a learned individual who acts for the public good andcontributes to society. • Freedom to determine standards of conduct and practice from within the professionrather than being subject to externally generated standards and enforcement. • Freedom to exercise professional judgment in the application of the body ofknowledge without external judgment except by one’s peers. • Freedom to earn a living from the practice of one’s profession and to establish thebasis for the economic relationship with those being served without externalinterference. |
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What are some tools for effective listening? |
1. Put the talker at ease 2. Show interest in listening 3. Remove distractions 4. Listen to understand, not to reply 5. Avoid interrupting 6. Stop talking 7. Be patient 8. Control emotions 9. Avoid argument and criticism 10. Ask “friendly” questions 11. Remain nonjudgmental 12. Analyze content of main ideas 13. Stop talking |
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Fun Facts: Standards of practice may be generated by credentialing agencies, professional associations, andstate licensing boards. |
Specific standards or guidelines may exist within an occupational setting,such as a health maintenance organization, hospital, clinic, consultation office, classroom, orother facility. |
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Responsibilities of the Professional Nutritionist: •To establish standards of practice, learning, education, organization and ethicalconduct. • To establish and advance a valid body of knowledge that is applied for the publicgood. • To practice scientific skepticism. • To share knowledge freely among the members of the profession and make itavailable for public scrutiny. • To evaluate information without bias or prejudice. • To disseminate information on the art and science of nutrition to the public. • To maintain professional ability through participation in continuing education. AND... |
• To establish and adhere to a code of behavior (ethics) that may be more demanding thanprevailing civil law. • To refrain from engaging in and openly condemn nutritional practices that have noscientific basis, are fraudulent, or may delay proper care. • To encourage and enforce self-regulation of professional nutritionists. • To contribute to society beyond the practice of the profession by being active in thecommunity. • To do all of the above in good faith, with fairness, integrity, honesty, and a spirit ofcaring and respect for the dignity of those being served. |
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Retrospective methods of determining typical composition of an individual's dietary intake include: (4 answers) |
24 hour-recall method food frequency questionnaire semiquantitative food frequency questionnaire Burke-type dietary history |
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What is the difference between a food frequency questionnaire and a semiquantitative food frequency questionnaire? |
in a semiquantitative food frequency questionnaire food portions are standardized where as in a regular one subjects just record all dietary intakes andthe frequency of consumption (from memory) |
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Does a 24 hour recall include portion sizes? |
Yes, here an interviewer prompts the subject to recall allfood and beverages eaten over the past 24 hours, estimating intake by ounces, cups,spoons, etc. |
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A ________ dietary history during which the subject gives an oral report of the foodand beverages consumed recently |
Burke-type |
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What are the 6 prospective methods of obtaining estimates of dietary intakes? |
1. weighted food record, for which all food and drink that is consumed ismeasured and weighed 2. comprehensive written food record that records everything consumed 3. telephone record obtained during a telephone interview 4. electronic records obtained via videotape, computer program, or electronicweighing scale 5. duplicate portion analysis in which a duplicate portion of food is collected andchemically analyzed 6. direct observation (for example, by video recording and trained observers) |
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Critical to an assessment of an individual's dietary status, an assessment of overall health mustinclude a detailed nutrition history. What are some components that should be covered to obtaining a complete history? |
1. surgical history 2. history of diagnostic procedures 3. existing nutrientdeficiencies 4. psychosocial history 5. past and present diagnoses of nutritional consequence 6. history of chemotherapy or radiation therapy, 7. history of nutrition related problemsincluding recent weight change 8. apparent physical impediments to eating or drinking(edentia, periodontitis, hypogeusia, glossitis, slick tongue, swollen and retracted bleedinggums) 9. current medications and determination of any potential drug/nutrient interactions 10. presence of any signs or symptoms suggestive of vitamin or mineral deficiency. |
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Acomprehensive nutrition history will provide -a detailed picture of nutrient intake -sources ofovernutrition and undernutrition - timing and location of meals and snacks - food preferences,dislikes, intolerances and allergies -supplement use -presence of alcohol or other substance abuse What are two other factors that are equally important but may not seem directly related? |
-motivation to obtain healthy nutritive - financial resources available to obtain and prepare food. |
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______ is a direct marker of protein mass and energy stores and is an important variable forpredicting caloric expenditure and indices of body composition. |
Bodyweight Similarly, height is avaluable measurement allowing use of height/weight indices based on frame size. |
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Body MassIndex (BMI) is calculated by dividing ____ by ________ and is the most widely used weight-height index. |
body weight in kg by height in meters squared |
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BMI of mostadult men and women should be in the range of _____kg/m2. |
19-27 |
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The ratio of waist circumference to hip circumferenceprovides an index of regional body fat distribution. Ideally, women shouldhave a ratio of ____ or less while men should have a ratio of ____ or less. |
women shouldhave a ratio of 0.8 or less men should have a ratio of 0.95 or less. |
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Measurement of the urinary excretion of creatinine and 3-methyl-histidineprovide an estimate of total ________. |
muscle mass |
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A simplemethod of estimating body fat composition is the measurement of ______ skin fold. |
triceps |
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Measurement ofmidarm muscle circumference provides an estimate of ____________. |
body muscle composition. |
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Techniques thatmeasure the dilution of radiolabeled water can provide estimates of __________, as canmeasuring the body content of a stable isotope of potassium. |
body fluid volume |
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Changes in body composition arereflected in metabolic balances: -sodium and chloride balances change with changes in__________ -changes in potassium and nitrogen balances reflect changes in body________. |
-sodium and chloride balances change with changes in extracellular fluid volume changes in potassium and nitrogen balances reflect changes in body total cell mass. |
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he newer techniques of electrical conductivity andbioelectrical impedance are reported to estimate _________. |
lean body mass |
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Blood urea nitrogen (BUN) concentration indicates total body nitrogen content. Because urea isformed in the liver and is excreted by the kidneys, greatly elevated BUN concentration indicates________while very low BUN concentration can signal the presence of ______. |
very high BUN = renal failure very low BUN = liver disease |
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Serum______ concentration is reflective of body protein reserves. |
albumin |
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What low serum measurement is suggestive of: -protein malnutrition -gastrointestinal inflammation -digestive incapacity -edema in extremities -severe acute liver disease -congestive heart failure -eclampsia ofpregnancy -extravascular protein loss due to renal dysfunction. |
Albumin concentrations below 5.5 g/dL |
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True or False: Serum albumin concentrations less than3.5 g/dL often accompany dehydration or hypothyroidism. |
TRUE |
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What measure is a direct proportional to the effort of pumping blood |
Heart Rate in atherosclerosis, heart rateincreases in an effort to pump more oxygen rich blood to the tissues through smaller diametervessels. |
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Blood pressure reflects the status of both heart muscle and the patency of the _________. |
circulatory system |
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Indirect biomarkers of cardiovascular health (and risk of atherosclerosis, coronaryartery disease and myocardial infarction) are provided by measurement of ___________. |
concentrations of total cholesterol LDL-cholesterol HDL- cholesterol total triglycerides |
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What Cholesterol/Triglyceride levels require treatment per the National Cholesterol Education Program of the Public Health Service? |
-total cholesterol - >240 mg/dL -LDL-cholesterol - >160 mg/dL -HDL- cholesterol - <35 md/DL MEN and <50 Women -total triglycerides- >200 mg/dL |
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National Cholesterol Education Program of the Public Health Service lists the following recommended levels: Cholesterol (total) <200 mg/dL LDL cholesterol <130 mg/dL HDL cholesterol >50 mg/dL Triglycerides <150 mg/dL What about the figures between the recommendations and the levels requiring treatment? |
They are borderline |
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The following are biomarkers of ___________. Serum osteocalcin concentration Serum total and bone alkaline phosphatase activity Serum type I collagen propeptide concentration |
BONE FORMATION |
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The following are biomarkers of ___________. Urinary pyridinolines excretion rate Urinary hydroxyproline excretion rate Plasma tartrate-resistant acid phosphatase |
BONE RESORPTION |
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Mineral/Skeletal Status can be assessed by measurement of plasma concentrations of ____, ______, ______ and ______. |
calcium phosphorus magnesium vitamin D. |
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_______ Status usually is determined by measurement of plasma concentrations of sodiumand potassium. What disorders can this measurement help evaluate? |
Electrolyte These measurements also facilitate the evaluation of fluid and electrolytebalance as well as adrenal or renal disorders. |
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Iron Status is reflected in the hematocrit and plasma hemoglobin concentration. Hematocrit is ameasure of________? |
Hematocrit is ameasure of the concentration of red blood cells within the blood (or the proportion of blood volumeconsisting of red blood cells). Hematocrit and hemoglobin are two of themost reliable indicators of the degree of anemia or polycythemia. |
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Serum ________ concentrationdetermines the capacity of the red blood cells to carry iron (total iron-binding capacity);it is formed by the ____ and is responsible for transporting iron obtained from dietary sources and from the breakdown of red blood cells in the spleen. |
transferrin liver Transferrin saturation indicatesrelative iron reserves, as does the serum concentration of ferritin, an important iron-storageprotein. |
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Vitamin Status is reflected in both clinical signs and symptoms and circulating concentrationsof the individual vitamins. In addition, measurement of _________ and ________ can be used in the evaluation of vitamin status. |
prothrombin time mean corpuscular volume |
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Immune System Status is most reliably indicated by the total_________. |
lymphocyte count - the totalnumber of lymphocytes circulating in the blood. Because lymphocytes have limited lifetimes andturn over rapidly, their numbers are very dependent on nutritional status |
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Typical Lymphocyte ranges: 1. mildnutritional depletion = _____ lymphocytes/mm3 2. moderate nutritionaldepletion = ______ lymphocytes/mm3 3. Severe nutrition depletion = less than____ lymphocytes/mm3 |
1. mild nutritional depletion = 1200-1800 lymphocytes/mm3 2. moderate nutritional depletion = 800 -1199 lymphocytes/mm3 3. Severe nutrition depletion = less than 800 lymphocytes/mm3 |
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Malnutrition particularly affects __________, which isindicated by the CD4+ T-lymphocyte count. |
cell-mediated immunity |
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Antioxidant Status is suggested by: 1.antioxidant capacity 2. circulating concentrations ofindividual antioxidants 3. serum ________ concentration and 4. erythrocyte ________ reductase activity. |
malondialdehyde
glutathione |
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True or False: Thirst is a reflection of impending waterinadequacy. |
FALSE! Thirst is a symptom of dehydration, not a reflection of impending waterinadequacy. |
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Examination of capillary refill time or urinaryturbidity can assess___________. |
State of Hydration |
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A history of alcoholism suggests chronicdeficiency of: 1. energy 2. protein 3. 4. 5. 6. 7. |
3. thiamin 4. niacin 5. folate 6. pyridoxine 7. riboflavin. |
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_________ is a decrease in plasma sodium concentration caused by either accelerated lossof sodium or increased water retention. What does this do to osmotic pressure and hydration status? |
Hyponatremia -decreasesplasma osmotic pressure -water moves from interstitial to intracellular fluid resulting in generalcellular swelling. |
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Swelling of _____ cells from Hyponatremia can cause: muscle twitching disorientation hyper irritability convulsions or coma. |
cerebral Swelling of other body cells can cause: muscle twitching general body weakness nausea vomiting abdominal cramps diarrhea. |
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_______ is an increase in plasma sodium concentration caused by either accelerated lossof water or increased sodium retention. What does this do to osmotic pressure and hydration status? |
Hypernatremia increases plasmaosmotic pressure water moves from intracellular to interstitial fluid resulting in general cellulardehydration. |
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Dehydration of ______ cells can cause: dry mucous membranes, skin and tongue sunken eyeballs |
other body Dehydration of cerebral cells can cause restlessness apprehension possibly coma. |
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What disturbances does Hypokalemia have on cardiac muscles? |
arrhythmias rapid weak cardiac rate or heart blockage. |
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Hypokalemia is a ________ in plasma potassium concentration. This condition affects all typesof ________. |
decrease muscle |
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Hypokalemia effects on muscle: _______ muscle disturbances= abdominal distention, vomiting, paralyticileus or decreased vascular tone causing hypotension. _______ muscledisturbances = flabbiness, muscle weakness or shallow respiration. |
Smooth Skeletal |
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True or False: The effects of Hypokalemia and Hyperkalemia on skeletal muscle are the same. |
TRUE - both cause flabbiness, muscle weakness or shallow respiration |
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Hyperkalemia (increase in plasma potassium concentration) can cause cardiacmuscle disturbances such as ____ of cardiac rate; the heart may stop in ______). |
depression diastole |
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_______ may cause: -increasedirritability of skeletal muscle, resulting in twitching of muscle, carpodedal spasms, tetany,spasms of the larynx or epilepsy-like seizures -increased smooth muscle irritability, resulting inspasms of blood vessel walls with numbness and tingling in the fingers - decreased cardiaccontractility, resulting in myocardial infarction. |
Hypocalcemia is a decrease in plasma calcium concentration. |
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_______ may cause: -abdominal distention -bloating -constipation -nausea -vomiting -general lethargy -muscleweakness -lack of normal reflex response - increased cardiac contractility, resulting inincreased cardiac output and elevated blood pressure. |
Hypercalcemia is an increase in plasma calcium concentration. |
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Acid-base imbalances occur when plasma pH is either less than ____ (acidosis) or greater than___ (alkalosis). |
7.35 (acidosis) 7.45(alkalosis) |
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In ________: -the ratio of H2CO3 to HCO3- in plasma is less than 1:20 -symptoms may include central nervous system depression of CNS, delerium, coma,hyperkalemia or hypercalcemia. |
Acidosis = pH less than 7.35 |
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In _____, -the ratio of H2CO3 to HCO3- in plasma isgreater than 1:20 - symptoms may include central nervous system excitation, hyperirritability,disorientation, heightened reflex responses, hypocalcemia or hypokalemia. |
Alkalosis - pH greater than 7.45 |
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_______ occurs when increased blood CO2 concentration in turn elevates plasmaH2CO3 concentration and decreases the ratio of H2CO3 to HCO3- in plasma to less than 1:20. |
Respiratory Acidosis usual cause is pulmonary disease that impairs the ability to excrete CO2. |
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What is the difference between uncompensatedrespiratory acidosis an compensated respiratory acidosis? |
uncompensatedrespiratory acidosis, plasma HCO3- concentration remains in normal range and plasma pHfalls below 7.35. compensated respiratory acidosis, urinary excretion of acid is increased,in turn elevating plasma HCO3- concentration, restoring a 1:20 ratio of the plasmaconcentrations of H2CO3 andHCO3- and returning plasma pH to 7.35-7.45. |
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________ occurs when alterations in metabolism generate increased amounts of nonvolatileorganic acids that lower plasma to pH to below 7.35. |
Metabolic Acidosis increased plasma acidityupsets the equilibrium between H2CO3 and HCO3-, increasing the production of H2CO3 andresulting in a ratio of H2CO3 to HCO3- in plasma of less than 1:20. |
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In Metabolic Acidosis, increased respiratoryexcretion of _____ can compensate for increasing acid production, returning plasma CO2 andHCO3- concentrations, the plasma H2CO3 to HCO3- ratio and plasma pH to normal. |
CO2 |
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__________ occurs when increased pulmonary excretion of CO2 causes decreasedplasma CO2 concentration, leading to depression of plasma HCO3- concentration, a ratio ofH2CO3 to HCO3- in plasma greater than 1:20 and elevation of plasma pH to above 7.45. |
Respiratory Alkalosis Increased excretion of alkaline urine can restore the plasma ratio of H2CO3 to HCO3-to 1:20 andreturn plasma pH to the normal range. |
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____________ occurs when alterations in metabolism generate increased amounts ofalkali, leading to depression of plasma HCO3- concentration, a ratio of H2CO3 to HCO3- inplasma greater than 1:20, decreased plasma CO2 concentration and elevation of plasma pH toabove 7.45. |
Metabolic Alkalosis Decreased respiratory excretion of CO2 can restore the plasma ratio of H2CO3 toHCO3- to 1:20 and return plasma pH to the normal range. |
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Acute or chronic metabolic abnormalities may produce _______ abnormalities that can be inferred from basic laboratory information. |
systemic |
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A defect in the phenylalanine hydroxylase enzyme produceshyperphenylalaninemia. Chronic hyperphenylalaninemia causes mental retardation. Effectivenutritional therapy is based on a diet low in phenylalanine content and high in tyrosinecontent. |
Phenylketonuria (Amino Acid Disorder) |
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A defect in the enzyme fumarylacetoacetate hydroxylase produceshypertyrosinemia. Chronic hypertyrosinemia causes rickets and potentially fatal hepatomegaly. Effective nutritional therapy is based on a diet low in phenylalanine and tyrosine content |
Tyrosinemia type I: (Amino Acid Disorder) |
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A defect in the enzyme keto acid decarboxylase produceshyperleucinemia. Chronic hyperleucinemia causes seizures and may be fatal. Effectivenutritional therapy is based on a diet low in leucine, isoleucine and valine content. |
Maple Syrup Urine Disease: (Amino Acid Disorder) |
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A defect in the enzyme cystathione synthase produces hyperhomocysteinemia.Chronic hyperhomocysteinemia causes cardiovascular disease and mental retardation. Effectivenutritional therapy is based on a diet low in methionine content and supplemented with betaine,folic acid, vitamin B6 and vitamin B12. |
Homocystinuria (Amino Acid Disorder) |
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Defective renal function produces hypercystinuria with secondary urolithiasis. Effective nutritional therapy is based on supplemental bicarbonate and high fluid intake. |
Cystinuria (Amino Acid Disorder) |
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A defect in the enzyme glucose-6-phosphatase producesfasting hypoglycemia and hepatomegaly. Effective nutritional therapy is based on a diet low in fatcontent and providing a high intake of complex carbohydrates. |
Glycogen Storage Disease type Ia: (Carbohydrate Disorder) |
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The most accurate way to assess micronutrient intake is through the use of a: a. 24-hour food intake recall questionnaire. b. 7-day food intake frequency. c. “food frequency questionnaire.” d. stool and urine analysis. |
c. “food frequency questionnaire.” |
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The most accurate assessment of vitamin D status is an assay for the: a. blood level of 25 hydroxy vitamin D3 b. dietary intake of vitamin D3 c. length of sun exposure and dietary intake of vitamin Dd. urinary excretion of vitamin D2 |
a. blood level of 25 hydroxy vitamin D3 |
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One blood test which assesses vitamin B12 status and is included in a complete bloodcount panel is: a. hemoglobin level b. MCV or mean cell or corpuscular volume c. platelet levels d. RBC counts |
b. MCV or mean cell or corpuscular volume |
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A fasting plasma glucose concentration of 50 mg/dL may suggest the presence of: a. diabetes. b. hypoglycemia. c. normal glucose tolerance. d. hyperinsulinemia. |
b. hypoglycemia. |
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The five clinical determinants of metabolic syndrome are: a. Waist circumference, cholesterol, HDL, BMI, fasting plasma glucose (fog) b. Hip to waist ratio, triglycerides, LDL, blood pressure, fbg c. Hip to waist ratio, cholesterol, HDL, BMI, fpg d. Waist circumference, triglycerids, HDL, blood pressure, fpg |
d. Waist circumference, triglycerids, HDL, blood pressure, fpg |
