Mnt, Exam 1

Front 1

What helps balance out the acidosis or alkalosis in the blood?

Back 1

The lungs (respiratory) and kidneys (metabolic)

Front 2

What do the lungs control?

Back 2

Carbonic acid!
H2CO3

Front 3

What do the kidneys control?

Back 3

Bicarbonate
HCO3

Front 4

What is the normal pH range?

Back 4

7.35 to 7.45

Front 5

If the pH levels are BELOW the normal range (below 7.35), what state is the patient in?

Back 5

Acidosis

Front 6

If the pH levels are ABOVE the normal range (above 7.45), what state is the patient in?

Back 6

Alkalosis

Front 7

With pH questions- what are the two steps?

Back 7

1. Determine acidosis or alkalosis
2. Determine respiratory (lungs) vs. metabolic (kidneys)

Front 8

pCO2 correlates with _______.
HCO3 correlates with _______.

Back 8

pCO2: Lungs
HCO3: Kidneys

Front 9

What foods are high in K+?

Back 9

Potassium is INTRACELLULAR
*Dark leafy greens, citrus, tomatoes, potatoes, oranges, etc.

Front 10

What is water intoxication, why can it be fatal?

Back 10

-Excessive water and intracellular fluid volume= osmolar dilution results
-Cells swell, especially brain cells
-Can cause headache, nausea, vomiting, muscle twitching, convulsions, stupor
-If untreated, can be fatal
-If someone drinks a lot of water that doesn't have a lot of electrolytes...Then it can dilute sodium levels to a point where it is fatal to the body.

Front 11

How is water regulated in the body?

Back 11

Osmo receptors that pick up on concentration changes- High concentration (of particles to water in cell) provokes drive to drink water.

Front 12

What is the role of the brain and water regulation? Kidneys?

Back 12

*Brain: Regulates water through ventromedial and anterior hypothalamus (near pituitary gland, which regulates ADH); high concentration of electrolytes = thirsty.
*Kidneys: Respond to antidiuretic hormone involved (ADH); Renal tubules absorb more water in response to ADH.

Front 13

What are the different compartments in the body where water is held?

Back 13

Intracellular
Extracellular

Front 14

Common causes of respiratory alk.

Back 14

Hyperventilation or excessive exercise

Front 15

Common causes of metabolic acidosis?

Back 15

Uncontrolled diabetes

Front 16

Common causes of metabolic alkalosis?

Back 16

COPD and emphysema

Front 17

What is significant weight change?

Back 17

//

Front 18

What is the maximum age to use growth charts?

Back 18

20 years

Front 19

What are the parameters for degrees of malnutrition?

Back 19

5% of body weight lost within 30 days.
ETC

Front 20

Positive acute phase respondents?

Back 20

C Reactive Protein (CRP)
*It's levels go UP with trauma, stress, etc.
*When trauma/stress goes away, CRP levels go down.

Front 21

Negative acute phase respondents?

Back 21

Albumin, transferrin
*Levels go DOWN with trauma, stress, etc.
*When things go back to normal, levels go back up.

Front 22

If albumin is really low, what might you notice about the patient?

Back 22

Skin exam- Edema or pitting!

Front 23

What labs are drawn for CBC?

Back 23

Complete blood count:
-Red blood cells
-Hemoglobin concentration
-Hematocrit
-Mean cell volume
-Mean cell hemoglobin
-Mean cell hemoglobin concentration
-White blood cell count
-Differential

Front 24

What labs are drawn for BMP?

Back 24

Basic metabolic panel:
-Glucose
-Calcium
-Sodium
-Potassium
-CO2 (carbon dioxide, bicarbonate)
-Chloride
-Blood urea nitrogen (BUN)
-Creatinine

Front 25

What labs are drawn for CMP?

Back 25

Comprehensive metabolic panel:
-Glucose
-Calcium
-Sodium
-Potassium
-CO2 (carbon dioxide, bicarbonate)
-Chloride
-Blood urea nitrogen (BUN)
-Creatinine
-Albumin
-Total protein
-Alkaline phosphate (ALP)
-Alanine aminotransferase (ALT)
-Aspartate aminotransferase (AST)
-Bilirubin

Front 26

What are the differences between macrocytic and microcytic anemia?

Back 26

Macro- person is low in B12 and folate
Micro- iron related!

Front 27

Which labs are indicative of cardiovascular inflammation or increased risk for CVD?

Back 27

Homocystine: marker of inflammation
*To improve homocystine levels, what vitamins/minerals need to be taken?

Front 28

How is albumin used in nutrition assessment?

Back 28

//

Front 29

What is pharmacodynamics?

Back 29

The study of the physiologic and biochemical effects of a drug or combination of drugs.
*Food-drug interaction

Front 30

What is pharmacokinetics?

Back 30

The movement of a drug through the body by absorption, distribution, metabolism, and excretion.
*Movement!!!

Front 31

What is an excipient?

Back 31

A substance added to a drug, such as a buffer, binder, filler, diluent, disintegrant, glidant, flavoring, dye, preservation, suspending agent, or coating.
***Also called inactive ingredient.

Front 32

What can be problematic regarding excipients?
(ppt 16?)

Back 32

Several common excipients have potential for interactions in persons with an allergy or enzyme deficiency.
*Lactose and glucose sensitivities
*Ex: Fat in proprofol puts you to sleep quickly

Front 33

How does a low albumin level affect drug action/absorption?

Back 33

If one has a low albumin there are less binding sites for the drug, more drug in the blood serum

*Most at risk are elderly, less than 3.0

Front 34

What is the best way to administer drugs through a feeding tube?

Back 34

Recommendations to separate phenytoin suspension from tube-feeding formulas are common. Stopping the tube feeding before and after the phenytoin dose is generally suggested, but recommendations vary from 1 to 4 hours intervals. The most common is a 2-hour feeding-free interval before and after the dose of phenytoin is administered.

Front 35

How does grapefruit juice interfere with medication metabolism?

Back 35

A substance found in grapefruit and grapefruit juice can inhibit the intestinal metabolism of drugs (such as calcium channel blockers that are dihydropyridine derivatives and/or some HMG coenzyme A reductase inhibitors such as simvastatin).
**Also inhibits the cytochrome P-450 3A4 enzyme in the intestinal wall responsible for the oxidative metabolism of many orally administered drugs.

Front 36

What can be problematic with tetracycline?

Back 36

Reduces the amount of calcium available for absorption

Front 37

What can be problematic with methotrexate?

Back 37

Used to treat rheumatoid arthritis or cancer- CAUSES A LOWERING OF FOLATE

Front 38

What can be problematic with corticosteroids (prednisone)?

Back 38

Cause insulin resistance and inhibit glucose uptake.

Front 39

What can be problematic with MAOI's?

Back 39

Cause vasoconstriction, headache, high blood pressure, and death.

Front 40

What can be problematic with coumadin?

Back 40

*Coumadin thins the blood.
*Vitamin K interacts with coumadin.
*If patients are taking coumadin, tell them to keep vitamin K levels steady and consistent.

Front 41

What can be problematic with propofol?

Back 41

Puts you to sleep quickly (if taken with fat?)
May provide a significant amount of sodium, so may be contraindicated for patients who need to limit sodium.

Front 42

What can be problematic with narcotics (codeine, morphine)?

Back 42

Constipation or diarrhea

Front 43

What are the steps of a physical assessment?

Back 43

//

Front 44

What are the steps of an abdominal exam?

Back 44

//

Front 45

What is a critical pathway?

Back 45

Certain elements that should occur in a patient's care and the timeframe.

Front 46

What is utilization management?

Back 46

Eliminating or reducing unnecessary tests

Front 47

What is case management?

Back 47

Assessing, evaluating, planning, implementing, coordinating, and monitoring care.

Front 48

What are DRG's?

Back 48

The hospital recieves payment based on patient diagnosis, comordibities, surgeries, age, and gender.

Front 49

What is a managed care company?

Back 49

Mechanism for financing and organizing health care delivery in which providers and payers have predetermined payments for care provided.
*Medicare is NOTTTT considered one, nor Medicaid because it's the government.
*Blue Cross Blue Shield, United, etc.

Front 50

What demographic trends are affecting healthcare?

Back 50

IMMIGRATION

Front 51

Who reimburses for MNT? What disease states will they reimburse for?

Back 51

Medicare reimburses!!!
*Only reimburses for renal (kidneys) and diabetes

Front 52

How much do they pay for initial assessment, follow-up or group session?

Back 52

Initial assessment: $17.92 for 15 mins
Group: $7.09 per member per 30 mins

Front 53

What are the basics of hospital diets?

Back 53

Regular diet (house diet): Usually 1600-2200 kcals, 60-80 g protein, 30-100 g fat, 180-300 g CHO

Soft diet: Transition from liquid to regular. Low in cellulose or connective tissue. Postoperative or GI problems.

Liquid diet: Used for easy digestion or minimal residue- Used briefly.

Front 54

What is palliative care?

Back 54

Encourages the alleviation of physical symptoms, anxiety, and fear while attempting to maintain the patient's ability to function independently.
*Comfort measures for terminally ill patients; Focus on quality of life and communication with family members

Front 55

What is a SOAP note? What information is typically found under each section of a SOAP note?

Back 55

It is a charting/documentation tool.
S- subjective (info provided by patient)
O- objective (factual observations; lab/clinical data)
A- assessment (interpretation of sub & ob info)
P- plan (studies & data needed; MNT goals)