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101 Cards in this Set

  • Front
  • Back
When does discharge planning begin for a patient?
Day 1 of a hospital stay
What is the cause of most uclers?
Helicobacter (H.) pylori bacteria
What is the recommend diet for an ulcer?
As tolerated, well-balanced, avoid late night snacks
What is the recommended diet for a hiatal hernia?
Small, bland feedings

Avoid late night snacks, caffeine, chili powder, black pepper
What is the recommended diet following gastric surgery?
Frequent, small feedings, fluids before or after meals (to slow passage), restrict concentrated sweets
What is the difference between tropical sprue and non-tropical sprue?
Tropical Sprue - bacterial, viral, parasitic infection

Non-Tropical Sprue = celiac disease
What grains have gluten forming potential?
Wheat, rye, barley, oats
How do oat bran and soluble fibers decrease serum cholesterol?
By binding bile acids converting more cholesterol into bile
What are examples of soluble fiber?
Pectins, gums

Fruits, vegetables, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, bananas
What are the complications of losing the terminal ileum?
Problems absorbing B12, intrinsic factor, bile salts
What happens if the body loses the ability to reabsorb bile salts and how can this happen and what is the recommended diet therapy?
Losing terminal ileum, then they are not available to emulsify fat, which means fat should be given in MCT since they do not require bile salts for absorption.
What are major complications of ulcerative colitis?
Chronic bloody diarrhea, loss of electrolytes
What happens to blood glucose levels during a lactose tolerance test for those tolerant and intolerant to lactose?
Intolerant - blood glucose will rise less than25mg/dal above fasting, showing a flat curve

Tolerant - blood glucose will rise greater than 25 mg/dl, showing a normal glucose curve
What are the recommendations for giving juice to children under 6?
Restrict or dilute fruit juices with high osmolar loads like grape and apple

Limit to 4 oz/day
What are most severe losses for someone with short bowel syndrome?
Loss of ileum, ileocecal valve and loss of colon
What are elevated liver enzymes indicative of?
Tissue damage
Name the 4 enzymes that will be elevated in liver disease.
ALP - alkaline phosphatase
LDH - lactic acid dehydrogenase
AST - aspartate aminotransferase
ALT - alanine aminotransferase
What is a major symptom of acute viral hepatitis and what is the recommended diet?
Anorexia

Recommend small, frequent feedings because of the anorexia
What causes ascites?
When blood cannot leave the liver, the liver expands, pressure forces fluid through into the peritoneal cavity
What causes esophageal varices?
When blood can't enter the liver.

Portal hypertension - blood gets backed up, forces out-pouching of walls
What is the recommended diet for cirrhosis? If varices are present? If edema or ascites is present?
High protein, high calorie, moderate fat

Varices - low fiber

Edema/ascites - low sodium
What disease is caused by a long-term thiamin deficiency (in alcoholics)?
Wernicke-Korsakoff Syndrome
What is the recommended diet for hepatic failure? How about one novel theory?
moderate to high levels of protein

adding BCAA when standard therapy doesn't work, to help with altered neurotransmitters
How is bile secreted after a cholecystectomy?
Bile now secreted from liver directly into intestine
What is one cause of inflammation in pancreatitis?
Premature activation of pancreatic enzymes leads to auto-digestion (pancreatic enzymes digest the pancreas)
What is the recommended diet for pancreatitis?
Elemental (pre-digested) enteral nutrition into the jejunum may be tolerated

Low fat content
Describe the DASH diet and what it's used for.
Lower blood pressure

Whole grains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI
Describe the TLC diet and what it's used for.
Lower cholesterol

Up to 35% kcal from fat
<7% from sat fat
up to 10% PUFA
up to 20% MUFA
<200 mg cholesterol
25-30 g fiber (half soluble)
Stanols/sterols to inhibit cholesterol absorption
Prevent weight gain
Increase physical activity to at least 30 min/day
What are the 3 hormones involved in renal function?
Vasopressin (ADH) - elevates blood pressure

Renin - vasoconstrictor - elevates blood pressure

Erythopoietin (EPO) - stimulates bone marrow to produce RBC
What lab values are decreased in renal disease?
Glomerular filtration rate and creatinine clearance
What lab values are increased in renal disease?
Serum creatinine, BUN
What BUN:creatinine ratio suggests acute kidney damage and what level indicates a need for dialysis?
> 20:1 = acute kidney damage, may be reversible

< 10:1 = reduced BUN reabsorption, may need dialysis
What does the renal solute load measure?
Mostly nitrogen (60%) and sodium (electrolytes)
What is the primary dietary therapy for kidney stones?
High fluid intake to dilute urine and break up stones
What are the signs of nephrotic syndrome?
Albuminuria, edema, malnutrition, hyperlipidemia

Increased synthesis and decreased clearance of VLDL
What is the dietary therapy for nephrotic syndrome?
Modest protein (.8-1 g/kg) and fat restriction
When do you restrict protein in chronic kidney damage?
When GFR falls
What is the recommend diet for hemodialysis patients?
1.2 g protein/kg (at least 50% high biologic value)

30-35 kcal/kg
What is the recommended diet for peritoneal dialysis patients?
1.2-1.3 g protein/kg suggested body weight, more than 50% high biologic value

<60 years old - 35 kcal/kg
>60 years old - 30-35 kcal/kg
What are normal, impaired and diabetic fasting glucose levels?
Normal: 70-100
Impaired: 100-125
Diabetic: >126
What are normal, impaired and diabetic post-prandial glucose levels?
Normal: <140
Impaired: 140-199
Diabetic: >200
What does a normal glucose tolerance blood test look like versus a diabetic curve?
Normal curve: sloped

Diabetic curve: rounded
What is the A1c goal for diabetics?
<7 (normal is <5.7)
What are the goal blood sugar levels for diabetics?
Fasting: 70-130
Post prandial: <180
What are the risk factors for developing gestational diabetes?
BMI >30
History of GDM
What are the exchanges for starch?
CHO: 15
Protein: 3
Fat: 0
Kcal: 80
What are the exchanges for fruit?
CHO: 15
Protein: 0
Fat: 0
Kcal: 60
What are the exchanges for skim, low fat and whole milk?
CHO: 12
Protein: 8
Fat: 3 (skim), 5 (low fat), 8 (whole)
Kcal: 100 (skim), 120 (low fat), 150 (whole)
What are the exchanges for vegetables?
CHO: 5
Protein: 2
Fat:
Kcal: 25
What are the exchanges for lean, medium and high fat meat?
CHO: 0
Protein: 7
Fat: 3 (lean), 5 (medium), 8 (high)
Kcal: 45 (lean), 75 (medium), 100 (high)
What are the exchanges for fat?
CHO: 0
Protein: 0
Fat: 5
Kcal: 45
What are the exchanges for alcohol?
CHO: varies
Protein:
Fat:
Kcal: 100
What are the types of insulin, onset, peak and duration?
Rapid Acting (Humlog, Novolog)
Onset: 10-30 min
Peak: 30-50 min
Duration: 3-5 hours

Short Acting (Humulin, Regular human insulin)
Onset: 30-60 min
Peak: 2-5 hours
Duration: 5-8 hours

Intermediate Acting (NPH, Lente)
Onset: 1-2 hours
Peak: 4-12 hours
Duration: 18-24 hours

Long Acting (Basal, Lantus)
Onset: 30-60 min
Peak: no peak
Duration: 24 hours
What is the dawn phenomenon?
Natural increase in early morning blood glucose and insulin requirements due to increased glucose production in the liver after overnight fast
What is ketoacidosis and what are the signs?
Complication of uncontrolled diabetes

Hyperglycemia due to insulin deficiency or excess CHO intake

Signs: dehydration (due to polyuria-excess urine) and a rapid pulse
How do you treat ketoacidosis?
Insulin and rehydration
How do you prevent postprandial or reactive hypoglycemia?
Goal: prevent marked rise in blood glucose that would stimulate more insulin

Prevent: Avoid simple sugars, 5-6 small meals/day, spread intake of CHO throughout the day
What is the difference between hyperthyroidism and hypothyroidism?
Hyper- excess secretion of thyroid hormone; elevated T3 and T4

Hypo - deficiency of thyroid hormone; low T4, low or normal T3
What is the cause of galactosemia and what is the treatment?
Due to missing enzyme, treated solely by diet (galactose and lactose free)
What is the treatment for urea cycle defects?
Diet - protein restriction based on tolerance to lower ammonia
What is the treatment for phenylketonuria (PKU) and what is one side effect in children?
Restrict substrate phenylalanine (PHE) through low protein, high carb diet

High carb diet may lead to increased dental carries in children
What vitamins will be low in homocystinurias?
Folate, B6, B12 - so need to supplement
What is the recommended diet therapy for skeletal and connective tissue disorders?
Regular, well-balanced diet with vitamin intake to at least DRIs
Describe the characteristics of someone most at risk for osteoporosis?
Elderly, frail, white, women
When should phenytoin be taken in relation to food, what is the medication used for and what is another name for the drug?
phenytoin = Dilatin = anticonvulsant

Taken away from food, at least 2 hours. Hold tube feedings.
Describe a ketogenic diet, the fat:non-fat grams ratio and the necessary supplements.
High fat, very low carb (4:1 fat:non-fat grams)

Supplement: Ca, D, folate, B6, B12
Explain the difference between the 2 types of cerebral palsy and their diets.
Spastic form - difficult stiff movements
Diet: low calorie diet, high fluid, high fiber

Non-spastic (athetoid) form - involuntary, wormlike movements
Diet: high calorie, high protein, finger foods
What is the recommended diet therapy for pressure ulcers, including kcal/kg?
High kcal, high protein, normal Ca, adequate fluids

30-40 kcal/day
What is the difference between macrocytic and microcytic anemia?
Macrocytic - megaloblastic anemia, few large cells, filled with hemoglobin; due to folate or B12 deficiency

Microcytic - hypochromic anemia, small, pale cells; due to iron deficiency
What is the normal value for MCV (mean corpuscular volume) and for MCH (mean, corpuscular hemoglobin)?
MCV = 80-95 fL

MCH = 27-32 pg
What are the 7 most common allergens?
Peanuts, tree nuts, eggs, milk, soy, wheat, shellfish
How is BMR affected by fever?
BMR increases 7% for each degree rise in F temp (normal temp is 98.6F)
What are the results of physiologic trauma?
Hyperglycemia
Hyperinsulinemia
Little or no ketosis
Elevated glucagon
What is the recommended diet therapy for thrush (from oral infections)?
Avoid spicy, acidic, strongly flavored foods
What is iatrogenic malnutrition and what causes it?
Protein-calorie malnutrition, brought on by treatment, hospital, medications
What are the 3 classes of BMI obesity?
Class I = 30-34.9
Class II = 35 - 39.9
Class III = +40
What is the recommendation for overweight children?
2-5 years old, weight maintenance
What do blood cholesterol levels look like for a healthy obese person?
Elevated LDL, normal to low HDL
Who qualifies for bariatric surgery?
Class III obesity or Class II with comorbidities
What is the best treatment for Prader-Willi syndrome?
Control food intake and access to food
Do sugar alcohols like sorbitol promote tooth decay?
No
What are fluoride recommendations for children?
Birth-6 mo: oral supplementation not recommended
6-12 mo: fluoridated water, supplements only if prescribed
1-2 years: fluoridated water, supplements only if prescribed
2-3 years: fluoridated water, fluoride toothpaste
What is achalasia?
Disorder of lower esophageal sphincter motility (does not relax and open upon swallowing)

Causes dysphagia
Is a sodium restriction recommended for pregnant women to control pregnancy-induced hypertension?
No, sodium is needed to maintain normal levels of sodium in plasma during large prenatal expansion of tissues and fluid
What are elemental, chemically defined formulas and when are they used?
Predigested protein or amino acids.

Used with malabsorption, compromised GI function

Ex: Peptamen, Vivonex, Alitraq
What is a transplyoric placement and when is it used?
Passed by pyloric valve in stomach

Used in comatose patients or those with no gag reflex.
What are the water recommendations for enterally fed patients and what is the usual amount of water in formulas?
Give 1 cc water/calorie ingested

1 kcal/cc formulas are 80-86% water
How do you calculate the calories from dextrose in formulas?
ml x % concentration x 3.4
How many calories are in 10% and 20% fat solutions?
10% = 1.1 kcal/ml

20% = 2 kcal/ml
Name some conditions in which TPN may be indicated.
Altered GI function, inability to absorb nutrients, malabsorption, diffuse peritonitis, intestinal obstruction, short bowel syndrome, hypermetabolic states, cancer patients on therapy, GI disorders (peritonitis), fistulas, severely malnourished pre-op patients, acute pancreatitis critical care patients if NPO is expected to last for more than 4-5 days and enteral support is not possible
What is a concern in TPN that may causes sepsis?
Translocation bacteria - not feeding through gut allows walls to break down, bacteria move out, causing sepsis
What does the % indicated about protein in TPN solutions?
% = number of grams of protein in 100ml of solution
What is the max rate of dextrose infusion and why?
4-5 mg/kg/min, to prevent hyperglycemia
How do you transition a patient off of TPN?
Introduce a minimal amount of full-strength enteral feeding at a low rate of 30-40 ml/hr to establish GI tolerance.

When patient can tolerate about 75% of needs by enteral route, stop TPN
What lab values suggest re-feeding syndrome?
Low K, Mg, Phos
Which anemia is also called megaloblastic anemia?
macrocytic anemia
Which anemia contains few large cells, filled with hemoglobin?
macrocytic anemia
Which anemia is caused by iron deficiency?
microcytic anemia
Which anemia is caused by folate or B12 deficiency?
macrocytic anemia
Which anemia contains small, pale cells?
microcytic anemia
Which anemia is called hypo chromic anemia?
microcytic anemia