Dietetics D2 Rd

Front 1

Screening tool - SGA

Back 1

Subjective Global Assessment

Hx, intake, GI symptoms, Fx capacity, physical appearance, edema, wt change

Front 2

Screening tool - MNA

Back 2

Mini nutritional assessment

Evaluates Independence, medications, number of full meals consumed each day, protein intake, FV, fluid, mode of feeding

≥65 yrs

Front 3

Screening tool - NSI

Back 3

Nutrition screening initiative

For elderly

Front 4

Screening tool - GNRI

Back 4

Geriatric nutritional risk index

Serum albumin, wt changes

Front 5

Tricep skin folds measures -

Back 5

TSF

Measures body fat reserves / kcal reserves

Front 6

Arm muscle area measures -

Back 6

AMA

Measures skeletal muscle area (somatic protein)

Important to measure in growing children

Front 7

Waist/hip ratio in men and women

Back 7

WHR

≥1.0 in men

≥0.8 in women

Both are indicative of Android obesity

Front 8

Hair assessment and consideration are?

Back 8

Thin, sparse, dull dry brittle = VitC, protein, deficiency

Easily pluckable = protein deficiency

Front 9

Megestrol acetate

Back 9

Appetite stimulant

Front 10

Dextroamphetamine

Back 10

Appetite suppressant, anorexia, nausea, wt loss

Front 11

Orlistat

Back 11

Decrease fat absorption by binding lipase, vit/min supplement

Front 12

Marinol

Back 12

Appetite stimulant

Front 13

Methylphenidate (Ritalin)

Back 13

Anorexia, nausea, wt loss

Front 14

Lithium carbonate (antidepressant)

Back 14

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.

Front 15

Propofol

Back 15

Administered in oil, consider fat kcals, 1.1 kcals/cc, check TG

Front 16

Vitamin B6 and protein

Back 16

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)

Front 17

Tyramine

Back 17

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

Front 18

Health Risk Appraisal

Back 18

HRA

Survey categorizing a populations' general health status

Questionnaires, calculations that predict risk of disease, educational message to the participant

Front 19

Demographic =?

Back 19

Population by age, ethnic groups, sex, birth rates, deaths

Front 20

Socioeconomic stratification =?

Back 20

Census data, housing statistics

Front 21

PPFP - ?

Back 21

Prepared and perishable food programs

Link sources of unused, cooked and fresh food with social service agencies to serve the hungry

Front 22

Nutritional surveillance - ?

Back 22

Use ht, wt, hct, hgb, serum cholesterol

Linked with: WIC, CDC, EPSDT

Front 23

NSI - ?

Back 23

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

Front 24

NNMRRP - ?

Back 24

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

Front 25

PedNSS - ?

Back 25

Pediatric nutrition surveillance system

Low income, high risk

Birth - 17 yrs (emphasis on birth-5)

Ht, wt, birth wt, hct, hgb, cholesterol, breast feeding

Front 26

PNSS - ?

Back 26

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

Front 27

NHANES - ?

Back 27

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

Front 28

WWEIA - ?

Back 28

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

Front 29

BRFSS - ?

Back 29

≥18 telephone interview to collect ht, wt, smoking, alcohol, food fat frequency, f/v, diabetes, preventable health problems

Front 30

YRBS - ?

Back 30

Youth risk behavior survey

Grade 9-12 - smoking, alcohol, wt control, exercise, eating habits

Front 31

TANF - ?

Back 31

Temporary assistance to needy family

State determines the eligibility of needy families and the benefits and services those families will receive

Front 32

CSFP - ?

Back 32

Commodity supplemental food program

Monthly commodity food packages

Low income women (pregnant, breastfeeding, postpartum) 0-6 yrs, some elderly

Front 33

TEFAP - ?

Back 33

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

Front 34

NSLP - ?

Back 34

National school lunch program

Entitlement program

Meet 1/3 of recommended protein, vitamin A/C, Fe, Ca

Front 35

SBP - ?

Back 35

School breakfast program

Meet 1/4 recommended protein, Ca, Fe, Vit A/C

Front 36

SFSP - ?

Back 36

Summer food service program

Entitlement program

Front 37

CACFP

Back 37

Child adult care food program

Reimburses operators for meal costs, provides commodity foods and nutrition education material

Front 38

FFVP - ?

Back 38

Fresh fruit and vegetable program

Introduce children to fresh fruits/vegetables

Front 39

WIC - ?

Back 39

Women/infant children

For pregnant, postpartum, breastfeeding

0-5 yrs

Provides food, nutrition, education, referral to other agencies

Health exam required

Not an entitlement

Front 40

EFNEP - ?

Back 40

Expanded food and nutrition education program

Does not provide food

Provides grants to universities and assist in community development

Front 41

NSIP - ?

Back 41

Nutrition services incentive program

OAA - older Americans act nutrition program

One hot meal per day/5 days/wk

provides 1/3 recommended intake

Front 42

SNAP - ?

Back 42

Largest food assistance program: entitlement

Front 43

CMS - ?

Back 43

Centers for Medicare and Medicaid services, DHHS

Medicare

Medicaid

Front 44

Medicare - ?

Back 44

Health insurance 65+

ESRD

Front 45

Medicaid - ?

Back 45

Payment for medical care for all eligible needy

All ages, blind, disabled, dependent children

Front 46

NET - ?

Back 46

Nutrition education training program

Provides nutrition education training to teachers and school food service personnel

Front 47

SFMNP - ?

Back 47

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)

Front 48

Entitlement programs are ?

Back 48

SNAP, Medicare, NSLP, SFSP, SBP

(Hint: SNAP-icare-school programs)

Front 49

3 domains of nutrition diagnostics are ?

Back 49

NC - nutrition clinical

NI - nutrition intake

NB - nutrition behavior

Front 50

NC - ?

Back 50

Nutrition clinical - nutritional findings/problems that relate to medical/physical condition

Functional balance

Biochemical balance

Weight balance

Front 51

NI - ?

Back 51

Nutrition intake

Actual problems related to intake

Front 52

NB - ?

Back 52

Nutrition Behavior

Problems related to knowledge, access to food and food safety

Physical activity balance and function

Knowledge and beliefs

Front 53

Difference between NC 1.4 and NC 2.1

Back 53

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

Front 54

FTC - ?

Back 54

Federal trade commission - internet, TV, radio, bogus weight loss claims

Front 55

When do discharge plans begin?

Back 55

Day 1 of hospital stay

Front 56

Ulcer

Back 56

Treatment: Antacid to eradicate Helibacter pylori bacteria

Eroded mucosal lesion

Omit: Cayenne and black pepper, large amounts of chili powder, alcohol and caffeine

Front 57

Hiatal Hernia

Back 57

Eat small bland feedings, avoid late night snack, caffeine, chili powder and black pepper

Front 58

Dumping syndrome

Back 58

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.

Front 59

Billroth I

Back 59

Gastroduodenostomy - attaches the remaining stomach to the duodenum.

Front 60

Billroth II

Back 60

Gastrojejunostomy - Attaches it to the jejunum. When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced.

Front 61

Calcium and Iron are absorbed best in ?

Back 61

Ca - most rapid absorption in duodenum

Fe - Requires acid

Front 62

B12 deficiency (anemia)

Back 62

Lack of intrinsic factor and bacterial growth in loop of intestine being bypassed interfered with B12 absorption (Pernicious anemia diagnosed using the Schilling test)

Front 63

Folate deficiency

Back 63

Needs B12 for transport inside the cell; also from poor folate intake and low serum Fe (Cofactor in folate metabolism)

Front 64

Gastroparesis

Back 64

Delayed gastric emptying

Moderate to severe hyperglycemia

Prokinetics (Erythromycin, Metoclopramide) increases stomach contractility

Front 65

Diverticulosis

Back 65

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

Front 66

Diverticulitis

Back 66

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

Front 67

IBD - ?

Back 67

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

Front 68

Chronic ulcerative colitis (UC)

Back 68

Ulcerative disease of the colon, begins in the rectum

Chronic bloody diarrhea, wt loss, anorexia, Na/K disturbance, dehydration, anemia, fever, negative N balance

Front 69

Irritable bowel syndrome

Back 69

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

Front 70

Lactose intolerance

Back 70

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)

Front 71

Probiotic vs Prebiotic

Back 71

Probiotic - "good" bacteria

Prebiotic - CHO for bacteria

Front 72

Steatorrhea

Back 72

>7g of fat in stool (indicative of malabsorption)

Normal 2-5g

Front 73

Short bowel syndrome

Back 73

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

Front 74

Jejunal resection causes the Ileum to?

Back 74

Ileum can adapt and take over jejunal functions

Front 75

Ileal resection can cause?

Back 75

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)

Front 76

Parenteral nutrition is for ?

Back 76

Initially to restore and maintain nutrient status

Front 77

Enteral Nutrition is for ?

Back 77

Start early to stimulate growth, increase over time; continuous drip

May take weeks to transition to solid

Front 78

Ileal nutrition (if complications occur)

Back 78

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

Front 79

Fx of liver

Back 79

Stores/release blood, filters toxic elements, metabolizes and stores nutrients, regulates fluid and electrolyte balance

Front 80

HAV - gotten by ?

Back 80

Fecal, oral transmission

Front 81

HBV - gotten by ?

Back 81

Sexually transmitted

Front 82

HCV - gotten by ?

Back 82

Blood to blood contact

Front 83

Hepatitis nutrition care

Back 83

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

Front 84

Cirrhosis - ?

Back 84

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

Front 85

Diet for cirrhosis

Back 85

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)

Front 86

Alcoholic liver disease

Back 86

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)

Front 87

Alcohol interferes with ?

Back 87

Thiamin, B12, Vitamin C, Folic acid

Front 88

Pancreatitis

Back 88

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

Front 89

Cystic fibrosis

Back 89

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

Front 90

CVD

Back 90

Cardiovascular disease

HTN - systolic >140 // diastolic >90 or both

Management: DASH diet, restrict Na

Front 91

Mediterranean diet

Back 91

Rich in alpha linoleic acid, high in MUFA

Olive, fish, poultry eggs, walnuts, fruits, vegetables, almonds

Front 92

Risk factors for metabolic syndrome

Back 92

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

Front 93

National Cholesterol Education Program

Back 93

NCEP

Assess risks

Therapeutic lifestyle change from Adult Treatment Panel III

Front 94

Cardiac Cachexia - which 2 amino acids may help?

Back 94

Arginine and Glutamine

Front 95

Hormones involved in renal Fx

Back 95

Vasopressin (ADH) - Fr hypothalamus, stored in pituitary

Exerts pressor effect; elevates BP

Renin - Vasoconstrictor

Front 96

BUN:creatinine ratio indications

Back 96

>20:1 pre-renal state (may not need dialysis)

<10:1 reduced BUN reabsorption (may need dialysis)

Front 97

Nephrosis

Back 97

Nephrotic syndrome

Protein restriction: 0.8-1.0g/kg

Fat: <30%, low saturated fat

Abnormalities in: Fe, Cu, Zn, Ca and Pro loss

Front 98

Chronic Renal Failure

Back 98

Hemodialysis

1.2g pro/kg SBW

<60 yrs old 35kcals/kg

>60 yrs old/Obese 30-35kcals/kg

Front 99

Peritoneal dialysis

Back 99

1.2-1.3g Pro/kg SBW

Front 100

Dawn phenomenon

Back 100

Natural increase in early morning blood glucose and insulin requirements due to increased glucose production in liver after overnight fast

Front 101

Gout

Back 101

Disorder of purine metabolism

Increased serum uric acid, deposits in joints causing pain/swelling

Avoid: Broth, anchovies, sardines, organ meats, sweet bread, Herring, mackerel

Front 102

Inborn error of metabolism

Back 102

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

Front 103

PKU

Back 103

Phenylketonuria

Missing enzyme which converts phenylalanine to tyrosine

Detected via Guthrie Blood Test

Avoid aspartame

Low Pro, high CHO

Front 104

Homocystinuria

Back 104

Treatable inherited disorder of amino acid metabolism

Severe elevation of methionine and homocysteine in plasma, excessive excretion of homocystine in urine

Front 105

MSUD

Back 105

Maple syrup urine disease

Inborn error of metabolism of BCAA leucine, isoleucine and valine

Front 106

Systemic Lupus Erythematosus (SLE)

Back 106

May have anemia but does not correlate with Fe intake

May show symptoms of celiac disease

Front 107

Osteoclasts vs Osteoblasts

Back 107

Osteoclasts - Resorb and remove bone

Osteoblasts - Reforms bone

Front 108

Epilepsy - definition, treatment, interference?

Back 108

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

Front 109

Anemia - Macrocytic, Megaloblastic vs Microcytic, Hypochromic

Back 109

Macrocytic, Megaloblastic - Few large cells - Schilling test for pernicious anemia (Deficiency of Folate, B12)

Microcytic, Hypochromic - Small, pale cells - Due to Fe deficiency

Front 110

Common allergens

Back 110

Peanut, eggs, milk, soy, wheat, shellfish

Cow's milk is most common allergens for infants

Front 111

Hold standard for identifying food-induced symptoms

Back 111

Double blind, placebo-controlled food challenges

DBPCFC

Front 112

Ebb and flow response to injury

Back 112

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

Front 113

Neoplastic disease - ?

Back 113

Protein-kcal malnutrition, malabsorption, fluid/electrolyte imbalance

Provide bland liquids, soft foods, chilled/frozen foods

Front 114

Marasmus - ?

Back 114

Protein/kcal starvation

Severe fat/muscle wasting

Front 115

Iatrogenic malnutrition - ?

Back 115

Protein/kcal malnutrition

Brought on by treatment , hospital, medication

Front 116

Prader Willi syndrome - ?

Back 116

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

Front 117

Achalasia - ?

Back 117

Disorder of lower esophageal sphincter motility, does not relax and open upon swallowing

Front 118

Enteral Nutrition - formula

Back 118

Standard polymeric - normal GI Fx

Initiate at full strength 10-40 mL/hr

Front 119

Enteral Nutrition - elemental/chemically

Back 119

Use with malabsorption

Pre-digested protein/amino acids, glucose or sucrose, small fat, vitamins, minerals, electrolytes

Front 120

Hang time for open systems? Closed?

Back 120

Open - 4 hrs

Closed - 24-48 hrs

Front 121

Continuous drip - steady rate over X hrs?

Back 121

16-24

Front 122

Example - view back

Back 122

Picture

Front 123

What is peripheral parenteral nutrition?

Back 123

Small surface veins

Short term therapy with minimum effect on nutritional status

Front 124

Solution - kcals/mL or Gram

Back 124

IV dextrose - 3.4 kcals/g

Fat emulsion

- 10% = 1.1 kcals/cc

- 20% = 2.0 kcals/cc

Front 125

Parenteral Nutrition (PN) diagnosis codes

Back 125

NC - 1.4 altered GI Fx

NC - 2.1 impaired nutrient utilization

Front 126

Transitional feeding minimal amount?

Back 126

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

Front 127

What is re-feeding syndrome?

Back 127

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

Front 128

What are the Dietary Reference Intakes?

Back 128

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

Front 129

Healthy people 2020 - focuses on ?

Back 129

Focuses on disease prevention by changing behavior

Front 130

3 levels of program intervention

Back 130

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

Front 131

What are the steps in program planning?

Back 131

1. Develop a mission statement and needs/problem statement

2. Set goals

3. Set objectives

SMART - specific, measurable, achievable, relevant, time frame

Front 132

What is nutrition informatics?

Back 132

The intersection between nutrition, information and technology