Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
253 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
3 leading causes of death in north america
|
1. heart disease
2. cancer 3. stroke |
|
|
|
4 components of the DRI
|
EAR, RDA, AI and UL
|
|
|
|
DRI is
|
set of references for healthy people in US and Canada
|
|
|
|
DRI for what countries?
|
US and canada
|
|
|
|
DRI for the sick?
|
no.
|
|
|
|
New DRI differences:
|
Have more specific age groups. (50-70 instead of 51+)
|
|
|
|
We underestimate these food groups that we eat. We actually eat more than we think we do.
|
fats, sweets, grains.
|
|
|
|
we consume how much extra on average?
|
300 kcal per day
|
|
|
|
portion:
|
the AMOUNT of foods you choose to eat
|
|
|
|
serving
|
standard amount to help give advice about how much to eat
|
|
|
|
process of identifying those at high nutrition risk
|
nutrition screening
|
|
|
|
How soon after entry to hospital is nutrition screening done?
|
24-48 hrs
|
|
|
|
high risk individuals for nutritional risk:
|
children
breastfeeding pregnant ill frail elderly infants The poor people in those groups are most at risk. |
|
|
|
2 examples of malnutrition
|
anorexia and obesity
|
|
|
|
primary malnutrition
|
due to diet
|
|
|
|
secondary malnutrition
|
Due to disease, surgery, med etc
|
|
|
|
nutrition care process
|
systematic problem solving method
ADIMe |
|
|
|
ABCD's goes under which step of nutrition care process
|
Assessment
|
|
|
|
ABCD stands for
|
anthropometric
biochemical clinical dietary |
|
|
|
evaluation and interpretation of lab values, social hx, etc
|
Assessment (step 1 of nutrition care process)
|
|
|
|
Where is PES in ADIME?
|
D
|
|
|
|
identification and labeling of ADIME is which letter
|
d
|
|
|
|
is Diagnosis an actual occurrance or risk of one or potential for one?
|
All 3. diagnosis can be actual, risk or potential of developing nutritional problem.
|
|
|
|
P of PES:
|
change in or concern for pts nutritional status
|
|
|
|
E in PES:
|
the factors causing/contributing to the problem
|
|
|
|
data gathered in assessment phase goes under which letter, PES?
|
S.
|
|
|
|
signs are subjective or objective?
|
objective
|
|
|
|
symptoms are subjective or objective?
|
subjective
|
|
|
|
record height to nearest
|
1/4 in
|
|
|
|
what position for measuring height?
|
heels together. heels, butt, shoulders touch wall
|
|
|
|
why do we measure weight?
|
predict energy needs
|
|
|
|
why measure height?
|
to assess body weight for your height
|
|
|
|
% UBW that may mean mild malnutrition
|
85-95%
|
|
|
|
88% UBW =
|
maybe mild malnutrition
|
|
|
|
% ubw = moderate malnutrition
|
75-84%
|
|
|
|
% ubw = severe malnutrition
|
less than 74%
|
|
|
|
is bmi strongly correlated with body fat?
|
yes
|
|
|
|
can bmi be predictor of chronic disease or malnutrition
|
yes
|
|
|
|
BMI of 32 for male = what risk
|
high
|
|
|
|
bmi of 32 for female = what risk
|
very high
|
|
|
|
bmi of 27 for male = what risk??
|
increased risk
|
|
|
|
bmi of 22 for male = what risk?
|
no risk
|
|
|
|
bmi of 22 for female = what risk?
|
none
|
|
|
|
bmi of 38 for female =what risk?
|
very high risk
|
|
|
|
bmi of 27 for female = what risk
|
high risk
|
|
|
|
WHR of what in men = android obesity and increased disease risk
|
1 or greater
|
|
|
|
WHR of what in women? = android obesity and increased disease risk
|
0.8 or greater
|
|
|
|
stipulations for waist circumference:
|
*may not be predictive for less than 60 in
*don't use for bmi greater than 35 |
|
|
|
disadvantage of ht/wt tables
|
no rationale for people gaining weight as they age
|
|
|
|
what can skinfold measurements indicate?
|
under and over nutrition
|
|
|
|
does tricep measurement accurately reflect the body fat?
|
nope. doesn't accurately reflect subcutaneous of entire body.
|
|
|
|
most frequent skinfold measurements?
|
tricep and subscapular
|
|
|
|
how many times do you measure the skinfold?
|
3 times and take ave
|
|
|
|
how to evaluate skin fold?
|
compare with age/sex precentile charts
|
|
|
|
MAC stands for
|
mid upper arm circumference
|
|
|
|
MAC can be used for
|
screening tool and method to determine nut. intervention
|
|
|
|
MAMC stands for
|
mid upper arm muscle cirumference
|
|
|
|
MAMC measures
|
circumference of muscle. includes bone.
|
|
|
|
advantages of MAMC
|
quick. easy.
|
|
|
|
disadvantages to MAMC
|
doens't detect small changes in muscle
|
|
|
|
MAMA stands for
|
mid upper arm muscle area
|
|
|
|
what does MAMA measure
|
muscle and bone area
|
|
|
|
measuring creatine in urine can estimate?
|
muscle mass.
|
|
|
|
these increase creatinine: 7
|
exercise
stress eating meat menstruation infection fever trauma |
|
|
|
somatic protein markers are affected by age how?
|
decreased with age
|
|
|
|
somatic protein markers affected how by renal failure?
|
decreased
|
|
|
|
moderate deficit of muscle mass is a creatinine height index (CHI) is what?
|
60-80%
|
|
|
|
severe deficit of muscle mass is a CHI is what?
|
less than 60%
|
|
|
|
visceral protein markers are
|
proteins in ecf, plasma and organs
|
|
|
|
Half life of albumin
|
3 weeks
|
|
|
|
albumin is a marker of:
|
long term nutrition status
not acute marker. |
|
|
|
indicators of the inflammatory process
|
albumin and prealbumin
|
|
|
|
how does semi starvation affect visceral protein markers?
|
may increase them b/c of muscle breakdown
|
|
|
|
visceral protesin are good markers of nutritional status?
|
not so much. better indicators of injury!
|
|
|
|
visceral protein markers are good indicators of
|
injury!
|
|
|
|
half life of preablumin
|
3 days
|
|
|
|
prealbumin is a good marker for
|
acute nutritionalchanges
|
|
|
|
normal albumin levels
|
3.5-5
|
|
|
|
preablumin is very sensitive to
|
recent diet. Don't use it as only means of detecting malnutrition
|
|
|
|
albumin is a good marker for long term nutritional status in what kind of people?
|
those who aren't under any stress
|
|
|
|
early indicator of malnutrition
|
immune function
|
|
|
|
lymphocyte half life
|
4-6 days
|
|
|
|
most frequent nutritional deficiency in the world?
|
iron
|
|
|
|
when does Hb decline?
|
when Fe stores are exhausted
|
|
|
|
most widely used screening tool for iron status?
|
Hb
|
|
|
|
changes in Hb are paralled by
|
hematocrit
|
|
|
|
chronic infection can decrease
|
Fe
|
|
|
|
normal Hg for females
|
14
|
|
|
|
normal Hg for males
|
16
|
|
|
|
infection can decrease
|
cholesterol
|
|
|
|
cholesterol level of ___ indicates impending death
|
<100
|
|
|
|
which energy estimation over estimates energy needs?
|
Harris benedict
|
|
|
|
physical signs of malnutrition occur most rapidly in: 6
|
skin
hair mucous membranes eyes teeth tongue |
|
|
|
USDA multiple pass method is
|
for getting diet hx info
|
|
|
|
everything a patient reports goes under this letter in SOAP
|
S
|
|
|
|
Nutrition care process is comprised of what?
|
ADIME
|
|
|
|
How to diagnose PMS:
|
-at least 5 symptoms must be present.
-must be severe enough to disrupt social life -present in 3 consecutive luteal phases |
|
|
|
symptoms of PMS occur in __% of women
|
40.
But only __ % of women have the symptoms severe enough to be classified under PMS |
5-10%
|
|
|
PMS symptoms (must have 5)
|
1 fatigue
2 bloating of abdomin 3 swelled feet/hands 4 headache 5 tender breasts 6 anxiety 7 social withdrawl 8 nausea 9 mood swings 10 depression 11 irritability |
|
|
|
How to relieve PMS symptoms:
|
CHO rich foods that increase tryptophan levels
-regular exercise -avoid tobacco -avoid caffeine -avoid excess alcohol -relaxation training |
|
|
|
which supplements appear to decrease PMS symptoms
|
B6
calcium Vit D Magnesium |
|
|
|
What is PPD (premenstrual disphoric disorder)?
|
more severe form of PMS
|
|
|
|
how many people have PM disyphoric disorder? (PPD)
|
Only 3-5%
|
|
|
|
symptoms of PPD 7
|
headaches
tender breasts acne mood swings *always involves a worsening of mood that interferes with quality of life depression food cravinds irritability |
|
|
|
How to treat PPD?
|
same as PMS
(also limit salt) |
|
|
|
low birthweight is associate with
|
higher stroke risk
|
|
|
|
result of undernutrition preconception?
|
decreased fertility
|
|
|
|
result of undernutrition in early pregnancy
|
associated with birth defects
|
|
|
|
result of undernutrition in late pregnancy?
|
low birth weight, fetal growth restriction
|
|
|
|
people with low birth weight had higher risk of
|
type 2 diabetes
CAD hypertension hyperlipidemia *this is not a proven cause effect. It is an observed association. |
|
|
|
strongest predictor of infant birth weight?
|
maternal weight at time of conception and gestational weight gain
|
|
|
|
underweight women have more babies with:
|
low birthwt (lbw) infants, higher fetal and neonatal mortality rates, more complications (ex- C-section), pre-term delivery
|
|
|
|
pregnant obese women have more risk for
|
dm, htn, complications during labor and delivery, post term births, late fetal death, macrosomia and childhood obesity
|
|
|
|
% of pregnancies that occur in overweight women
|
20-40%
|
|
|
|
during the first week after implantation, the embryo gets it nutrients from?
|
endometirum
|
|
|
|
endometirum contributes a large part of the nutrients for how long?
|
8-12 weeks
|
|
|
|
which grows faster? placenta or fetus?
|
placenta does at first
|
|
|
|
what nutrients are stored in the placenta to be used later on?
|
Ca, Fe, protein
|
|
|
|
how much increase in weight for the mother is normal?
|
15-40#
|
|
|
|
what percent of the weight gain in pregnancy is directly from the baby and her fluid?
|
40%
|
|
|
|
wt gain in the actual mother during pregnancy is due to
|
fluid deposits
protein deposits fat stores |
|
|
|
how much does blood vol increase during preg.?
|
20%. How about plasma in particular? (50%)
|
|
|
|
levels in your blood when measured will be ___ during preg?
|
decreased, b/c the vol of your blood increases
|
|
|
|
CO in preg.?
|
increased by 40%
|
|
|
|
stroke vol in preg?
|
increases
|
|
|
|
pulse in preg?
|
increases
|
|
|
|
blood pressure in preg?
|
decrease during first half
|
|
|
|
BMR in preg?>
|
increasee 15% during later half
|
|
|
|
tidal vol in preg?
|
increase
|
|
|
|
blood flow through kidneys in preg?
|
increases 50%
|
|
|
|
gastric empyting in preg?
|
dslowed.
|
|
|
|
gastromobility in preg?
|
decreased
|
|
|
|
fluid absorption in colon in preg?
|
increased, therefore increased constipation
|
|
|
|
early malnutiriton in preg affects?
|
brain and heart.
|
|
|
|
late malnutrition in preg affects...
|
lungs
|
|
|
|
blood lipids in preg?
|
increased
|
|
|
|
glc absorption in preg?
|
increased insulin resistance
|
|
|
|
why need extra antioxidants in preg?
|
b/c of all the extra free radicals produced (by the increased energy production)
|
|
|
|
antioxidant sources?
|
vit c, e, fruits and veggies
|
|
|
|
how much weight should you gain during preg if already obese?
|
15#
|
|
|
|
prolonged labor associated with low or high weight gain in mom?
|
high
|
|
|
|
asphixia in labor associated with low or high weight gain in mom?
|
high
|
|
|
|
perinatal mortality associated with low or high weight gain in mom?
|
low
|
|
|
|
how much wt should you gain in first trimester?
|
3-5#
|
|
|
|
how much wt gain after 1st trimester?
|
0.5-1# a week
|
|
|
|
how much protein wehn preg?
|
additional 25g or 1.1 g/kg(most woman get this)
|
|
|
|
how much CHO when preg?
|
50-65%. min of 175 g
|
|
|
|
what fA to take when preg?
|
omega 3 (DHA and EPA). for better babies
|
|
|
|
best sources of omega 3
|
walnuts, fish, fish oil, egg yolka
|
|
|
|
limit fish when preg to
|
12oz per week
6oz of tuna/albacore |
|
|
|
how much Ca when preg?
|
1300 if under 18
1000 if over may supplement 600 mg for poor diet |
|
|
|
vit d when preg?
|
no increased need (watch out for vegans, and dark skinned)
|
|
|
|
folate when preg?
|
600mcg
400mcg for childbearing ages MUST EAT PRIOR to conception! |
|
|
|
where is folate absorbed from best?
|
50% from food
100% from vits 85% from fortified foods |
|
|
|
B12 in preg?
|
no increase except vegan
|
|
|
|
Vit C in preg?
|
increase to 85 mg
|
|
|
|
VIT E in preg?
|
no change
|
|
|
|
zinc in preg?
|
increased
|
|
|
|
Fe in preg?
|
increased need. Your body also absorbs more though. Fe supplements may have side effects
|
|
|
|
if you do iron supplementation, it ensures what for the baby?
|
iron stores upt o 6 months
|
|
|
|
Fe deficiency in mom can lead to
|
low birth wt
pre term delivery low fe in baby |
|
|
|
anemia in preg is
|
hg<10
|
|
|
|
iodine in preg?
|
increased need met by salt. deficiency leads to hypothyroidism in baby
|
|
|
|
vit a in preg?
|
more of a concern to get too much of it
|
|
|
|
vit k in preg?
|
no increase. babies have little when born
|
|
|
|
The ABCD's go under which letter of SOAP?
|
mostly O
|
|
|
|
an adequate pregnancy diet includes all nutrients sufficiently except...
|
iron
|
|
|
|
when does morning sickness usually end?
|
week 15
|
|
|
|
managing morning sickness?
|
don't eat high fat foods
separate liquids from foods limit seasonings |
|
|
|
pregnancy heartburn caused by?
|
reflux of acid fromthe stomach. sphincter valve relaxes because of hormones and pressur from fetus on stomach.
|
|
|
|
how to decrease pregnancy heartburn?
|
avoid high fat
avoid lots of seasonings don't lay down until 2 hrs after a meal |
|
|
|
how to treat pregnancy constipation?
|
exercise
increase fiber increase fluids don't take laxatives decrease stress can take prescribed stool softeners |
|
|
|
are the pregnancy food cravings due to nutrient deficiencies?
|
nope
|
|
|
|
geophagia
|
compulsive ingestion of clay or dirt
|
|
|
|
pagophagia
|
eating ice or freezer frost
|
|
|
|
how much exercise recommended per week for pregnancy?
|
3-5x, 30 min.
|
|
|
|
potential benefits of exercise during pregnancy?
|
shorter, easier labor
less pain b/c of better oxygen delivery vaginal delivery with fewer surgical interventions |
|
|
|
intake of ___ cups of coffee per day increases risk for ___
|
5-6
miscarriage preterm delivery lbw |
|
|
|
how does caffeine affect fetus?
|
higher sustained levels b/c of infants immature metabolism
can effect heart rate and movement |
|
|
|
preconception effect of alc?
|
may decreases conception chances
|
|
|
|
alc effect during preg?
|
mental/physical defects
stillborn risk lbw |
|
|
|
two microorganisms of concern for preg?
|
listeria monocytogenes
toxoplasma gondii |
|
|
|
foods pregnant women should avoid?
|
sprouts
unpasteurized juices raw milk, soft cheeses undercooked meat/eggs unwashed f/v cat litter |
|
|
|
toxoplasma gondii can cause
|
mental retardation, blindness, seizures, death
|
|
|
|
listeria monocytogenes can cause
|
spontaneous abortion and stillbirth
|
|
|
|
what kinds of fish should preg women avoid?
|
large fish.
shark mackerel sword fish tilefish |
|
|
|
how much of "safe" fish is ok per week during preg?
|
12 oz
|
|
|
|
how is wic funded?
|
federally, but administered by the states
|
|
|
|
2 assumptions for WIC?
|
inadequate intakes and nutrition intervention is critical
|
|
|
|
infant deaths are most related to two tihngs?
|
low birth weight
pre mature births |
|
|
|
pre term babies are ___ x more likely do die in first month
|
40
|
|
|
|
best age range to be pregnant in?
|
15-35
|
|
|
|
teenage pregnancies are associated with
|
lower wt gains
lower nutrient stores inadequate dietary intake |
|
|
|
result of pregnant teen who hasn't yet reached maturation?
|
small pelvie--> delivery complications
lighter baby weights competition for nutrients (teen gets priority) |
|
|
|
calcium for preg teen?
|
1300 mg
|
|
|
|
iron for preg teen?
|
29 mg
|
|
|
|
protein for preg teen?
|
75 g (1.1 g/kg)
|
|
|
|
teen weight gain recommendations
|
<19.8: 35-40#
19.8- 26: 28-40# 26+: 18-25# |
|
|
|
ADOLESCENT PREG RISKS:
|
spontaneous abortion
pre term bith low birth wt |
|
|
|
calcium for preg teen?
|
1300 mg
|
|
|
|
iron for preg teen?
|
27 mg (more than other preg)
|
|
|
|
protein for preg teen?
|
75 g (1.1 g/kg)
|
|
|
|
teen weight gain recommendations
|
<19.8: 35-40#
19.8- 26: 28-40# 26+: 18-25# |
|
|
|
ADOLESCENT PREG RISKS:
|
spontaneous abortion
pre term bith low birth wt |
|
|
|
ABCDs B what do you need to know for preg?
|
hematocrit or Hgb
glucose urinalysis |
|
|
|
ABCDs C what to know for preg?
|
med history
physical exam meds |
|
|
|
ABCDs D what to know for preg?
|
nausea
vomiting food cravings dietary intake constipation diarrhea alc tobacco supplements drug use |
|
|
|
risks for preg. over age 35?
|
small birth wt
gestational diabetes increased risk for mortality for mom and baby preterm baby macrosomic babies increased htn, dm, and csecs for moms over bmi 28 higher risk of early delivery for low wt babies |
|
|
|
multiple fetuses risks?
|
lbw
preterm higher mortality |
|
|
|
weight gain for twins:
|
1/2 pound per week in 1st tri
1.5 # per week in 2-3 tris 35-40 pounds (if underweight, gain upper end of range, and if overweight gain lower end of range) |
|
|
|
weight gain for triplets?
|
50
|
|
|
|
hyperemeis gravidum
|
vomiting (first 22 wks)
loss of more than 5% of ppw is red flag |
|
|
|
PKU =
|
phenylketonuria (can't metabolize pku)
|
|
|
|
enzyme block is mild for phenylalanine =
|
hyperphenylalaninemia (not usually treated in women if they have this, but levels are high enough to damage fetus)
|
|
|
|
hyperphenylalaninemia in mom can result in
|
microcephaly
mental retardation congenital heart defects facial abnormalities |
|
|
|
htn is a major risk factor for
|
maternal and perinatal mortality AND morbidity
|
|
|
|
preeclampsia
|
htn and protein in the urine
|
|
|
|
eclampsia
|
seizures, convulsions in preg.
|
|
|
|
when does gestational htn usually develop
|
after wk 20
|
|
|
|
nutrient potential preventions for eclampsia?
|
calcium and vit c
|
|
|
|
3 symptoms of pre eclampsia
|
htn (140/90)
proteinuria edema |
|
|
|
treatment of pre eclampsia
|
bed rest, hospitalization
termination of pregnancy is the only solution |
|
|
|
when do you restrict sodium in preg?
|
not in eclampsia
possibly in chronic htn |
|
|
|
wt gain for chronic htn?
|
normal
|
|
|
|
pregnancy and gestational dm?
|
placental enzymes inhibit insulin and break it down
|
|
|
|
high glc in mom results in
|
macrosomia
or if in 1st tri, deformations |
|
|
|
most common birth defect in type 1 babies
|
congenital heart defects
|
|
|
|
common defects in type 1 pregs?
|
skeletal, heart and CNS
|
|
|
|
type 1 preg risks?
|
spontaneous abortions higher
|
|
|
|
when is th emost insulin needed in preg?
|
3rd tri
|
|
|
|
gestational dm
|
3-7% of all pregnancies
CHO intolerance of varying severity Usual onset is late 2nd trimester Increases risk of maternal and fetal mortality and morbidity Many can be diet controlled Insulin may be necessary |
|
|
|
screening for DM takes place in gest. dm?
|
btw 24-28 wks
|
|
|
|
best indicator of bld glc in gest dm tests?
|
postprandial test
|
|
|
|
how to treat gest dm?
|
not orally, but injections multiple daily
|
|
|
|
gest dm risks?
|
pre eclampsia
c secs risk of develping dm in next 5 years (mainly based on body weight) |
|
|
|
baby risks of gest dm?
|
htn
obesity glc intolerance dm |
|
|
|
key to healthy gest dm preg?
|
monitor bld sugar/ketones
if you do, you will have regular preg |
|
|
|
longest mom can go w/o eating?
|
10 hr
|
|
|
|
aspartame safe for preg?
|
yes, but not for PKU women
|
|
|
|
min kcal in preg dm?
|
1700-1800
|
|
|
|
carb percents in preg dm?
fat percents? protein precents? |
40-50% carb
30-40 fat 20 protein |
|
|
|
eat most carbs for preg in
|
afternoon
|
|
|
|
exposure to smoking may increase nutrient needs:
|
folate, vit c, zinc, iron
|
|
|
|
single most important environmental factor on fetal development
|
smoking
|
|
|
|
smoking affects fetus:
|
hypoxia to fetus. reduced oxygen binding sites
|
|
|
|
smoking risks
|
spontaneous abortion
fetal growth restriction preterm delivery mortality for baby SIDS lbw ectopic pregnancy placental complications birth defects decrease ability to conceive |
|
|
|
alc affects on fetus
|
growth retardation
abnormalities CNS cardiac genitourinary |
|
|
|
mental retardation caused by alc is __%
|
20%
|
|
|
|
alc related birth defects
|
doesn't qualify as FAS, but has some of the characterisitics
|
|
|
|
can alc cross placenta?
|
yes. it's more concentrated in fetus b/c of small body. also may have prolonged exposure b/c they can't metabolize it as fast
|
|
|
|
amount of alc that hasn't harmed fetus?
|
1-2 drinks per day
|
|
|
|
alc is most detrimental in what tri?
|
early 1st tri
|
|
|
|
alc effect on nutrients?
|
may inhibit absorption of some
|
|
