Nutrition

Front 1

carbs

Back 1

sugars and starches.
in plants and animals as lactose or "milk sugar"
classified as simple (mono or disaccharides) or complex (poly)

Front 2

conversion of carbs

Back 2

to glucose. 90% of carbs are digested, percentage decreases as fiber increases.
the liver stores glucose and regulates its entry into the blood.
Hormones, esp insulin and glucagon are responsible for keeping se glucose levels constant.

Front 3

glycogenesis

Back 3

if muscle or liver glycogen stores are deficient glucose is converted to glycogen and stored.

Front 4

glycogenolysis

Back 4

glycogen is broken down in time of need to supply a ready source of glucose

Front 5

Protein

Back 5

contain nitrogen. Nine amino acids are essentail
-are complete (high quality) or incomplete (low quality) based ont ehir amino acid composition.

Front 6

protein, what happens

Back 6

Broken down into amino acids by pancreatic enzymes in the small intestine. then transported to the liver. Released into bloodstream for use in protein synthesise
excess amino acids are converted to fatty acids, ketone bodies, or glucose and are stored or used as metabolic fuel.

Front 7

nitrogen balance

Back 7

comparison between catabolism and anabolism is measured by compaing nitrogen intake and nitrogen excretion
a positive balance when protein intake is greater than excretion (growth, pregnancy, lactation, recovery from illness)
negative balance, starvation and the catabolism that immediately follows surgery, illness, trauma, and stress

Front 8

RDA protein

Back 8

protein is oxidized to provide 4cal/g. using protein for energy is more expensive physiologically.
RDA--.8g/kg of desirable body wt or about 56g for average woman and 63g for average man.or 46g/56g
10-20% of total cal intake.

Front 9

RDA carbs

Back 9

50-100g is needed daily to prevent Ketosis.
50-60% o diet's total cal.
all carbs provide 4cal/g regardless of source

Front 10

stressed pts: protein

Back 10

.8-1.0 g/kc/actual wt

Front 11

severely stressed pts: protein

Back 11

2-3 g/kg/actual wt

Front 12

water intake daily

Back 12

2000-2500 mL/day for adults
35/ml/kg (25-50yrs)
25ml/kg (50-75)
25mL/kg (75 and older)
adolescents: 40-60 ml/kg
Infants: 100-150 ml/kg

Front 13

interventions for dehydration

Back 13

-replace known losses
-use the higher range of fluid reqs in the estimation of need.
-in cases of fever, add 200ml of water for each degree celsuis that the temp is elevated
-monitor lab values closely and adjust fld needs

Front 14

fat soluble vits

Back 14

vit A, D, E, K

Front 15

Water soluble vits

Back 15

Thiamine, Riboflavin, Niacin, Folic Acid, B12

Front 16

Stress or illness

Back 16

-hypermetabolic response, req more energy
-sympathetic nervous system> catecholamines (epinephrine, dopamine, etc)
-catecholamines> hormone and mediators (cortisol)
-conversion of amino acids for glucose
-skeletal muscle breakdown with amino acids used for energy
-higher levels of stress release more catecholamines.

Front 17

protein requirements: renal failure

Back 17

calories=25mgm/kg/day
protein restriction=.6mgm/kg/day
malnourished=.8mgm/kg/day
on dialysis-increase to 1.2-1.5 mgm/kg/day

Front 18

chronic hepatic disease: protein

Back 18

increase to 1.5 mgm/kg/day
Hepatic encephalopathy, reduce to .5-.8 mgm/kg/day

Front 19

hepatic encephalopathy

Back 19

liver caused mental impairment
Because the shunted blood has bypassed the liver, it contains high levels of amino acids, ammonia, and possibly toxins.

Front 20

3 phases of starvation

Back 20

1-blood glucose levels maintained by production of glucose from glycogen (glycogenolysis), fats and proteins broken down
2--weeks, adipose tissue releases stored fats, fatty acids and glycerol, fatty acids, ketone bodies, primary source of energy.
3--fat reserves are depleted, protein major energy source. skeletal muscles broken down for energy. proteins essential for cells

Front 21

anthropometric data measurement

Back 21

-BMI
-waist circumference
-triceps skinfold measurements
-mid-arm circumference MAC

Front 22

BMI calculation

Back 22

wt (kg)/height (m2)
1 meter=3.28 feet

Front 23

BMI general

Back 23

measure of proportional weight not adiposity.-in absence of a direct emasure of body fat, it is the most satisfactory index based on wt and ht.
-doesn't apply to children, adolescents, pregnant women
-useful for diagnosing obesity b/c it is a more accurate measure of body fat than wt alone.

Front 24

BMI <20, 2-25, 25-27, >27

Back 24

<20, ass with health problems, <16 malnutrition.
20-25: lowest risk for illness.
25-27: ass with health problems for some
>27: ass with increased risk for health problems.

Front 25

BMI limitation

Back 25

-homogenous population--primarily white
-overestimates body fat in very muscular people
-underestimates body fat in some underweight people.

Front 26

assessment of wt status
% of usual weight=current weight

Back 26

85-95%= mild malnutrition
75-84% moderate malnuttion
0=74% severe malnutrition

Front 27

recent weight chance

Back 27

can be expressed as actual kilograms lost/gained or as a percenteage of weight chcange, where:
%wt change=usual wt-actual wt x100
10%--milk wt loss
10-25--moderate

Front 28

biochemical tests: metabolic assessment of nutritional status

Back 28

-protein status
-serum albumin: half-life of 18-20 days
-reflects nutritional status over the past 3 months
-levels may decrease with stress, overhydration, trauma, surgery, liver disease, and renal disease.
-significantly reduced levels of se albumin are ass with increased morbidity
serum transferrin >200
serum prealbumin >30

Front 29

gut defense mechanisms

Back 29

-gut contains 70-80% of the immune tissue of the entire body.
-growth of mucosa depends on presence of food in gut
-food is ingested, salivary and biliary tract secrete antibodies that bind with bacteria and prevent bacterial attachment
-lymphoid tissue within the mucosa and submucosa
-cells of the liver and spleen trap and detox bacteria and endotoxins that penetrate beyond the gut and regional lymphatic tissue

Front 30

enteral nutrition

Back 30

-1kcal/ml
-isotonic
-designed to mimic diet
-100% of vits, minerals, and electrolytes
-concentrated formulas for pts with fluid retention, renal, hepatic cardia
-monitor fld balance b/x as the pts improve, may bcm dehydrated

Front 31

elderly nutrition

Back 31

-inadequate diet due to comorbidities, physical disability inability to chew, polypharmacy,and social isolation, poverty
-total cal, calcium, vit B12, folate intake declines
-osteoporosis

Front 32

pulmonary disease

Back 32

causes of wt loss:
-increased work of breathing
-increase in their daily energy expenditure
-increased resistive load
-reduced respiratory muscle efficiency
-frequent, recurrent respiratory infections

Front 33

Chronic Obstructive Pulmonary Disease COPD

Back 33

-25-50% have some degree of nutritional depletion
-wt loss common, reduced fat reserves and muscle mass
-more severe the greater the wt loss
-greater the wt loss, the smaller the mass of resp muscles and diaphragm
-decreased cell immunity
-altered immunoglobulin production
0impaired cellular resistance

Front 34

poor nutritional intake in COPD

Back 34

-chronic sputum production adn frequent coughing
-SOB
-depression
-flattening of the diaphragm and pressure on teh abdominal cavity during eating
-o2 desaturation during eating, resulting in increased dyspnea
-side effects of meds

Front 35

Total parenteral nutrtion TPN

Back 35

hypertonic, thus administered through a central vein. Medications such as insulin(b/c it contains high glucose) and heparin (prevent clotting at tip of catheter).
-high glucose concentration, why its hypertonic, cannot be stopped suddenly can cause a hypoglycemic reaction.

Front 36

PPN

Back 36

isotonic, peripheral vein.
provide fewer calories and supplement a pt's inadequate oral intake.
10% glucose

Front 37

triceps skin-fold measurement

Back 37

meausre of subcutaneous fat stores

Front 38

midarm circumference

Back 38

measure of skeletal muscle mass

Front 39

midarm muscle circumference

Back 39

measure of both skeletal muscle mass and fat stores

Front 40

protein status: biochemical data

Back 40

determinded by measuring serum albumin and transferrin levels and by a total lymphocyte count.
lymphocyte count reflects immune status and is directly affeected by impaired nutritional states.
albumin is an imortant lab value to assess over a period of time: level doesn't change with increasing age, but malnutrition and disease states cause it to decrease.

Front 41

24 hour urine tests

Back 41

used to measure protein metabolism include urine creatinine excretion and urin urea nitrogen.
urea-breakdown product of amino acids. reflects protein intake and the body's ability to detox and excrete this product.
creatinine: directly proportional to the body's muscle mass, and a dreduction in this reflects severe malnutrition.

Front 42

biochemical data: older adults

Back 42

low se albumin level may be a reflection of aging process rather than a nutritional risk factos. albumin synthesis declines with age.
hemoglobin levels that are lower may only reflect anemia

Front 43

water soluble vitamins

Back 43

absorbed through intestinal wall directly into blood. usually are not stored in body. deficiency symptoms are apt to develop quickly.
amounts consumed over need are excreted in urine, toxicities are not likely.

Front 44

fat soluble vitamins

Back 44

absorbed with fat into the lymphatic circulation. must be attached to a protein to be transported through the blood. stores in liver and adipose tissue.