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FSHN 450- Unit 1
| Question | Answer |
|---|---|
| 4 moral principles governing behavior of health care professionals | autonomy, non-maleficence, beneficence, justice |
| Nancy Cruzan case | family wanted feeding tube removed, hospital removed |
| feeding should be initiated... | immediately upon achieving medical stability |
| feeding can be discontinued at a later date... | if authorized by the individual/ indicated w/ permanent unconsciousness |
| terminally ill: therapeutic diets should be... | liberalized to all extents (let them enjoy foods they like) |
| over-arching ethical responsibility of the RD | knowing how to achieve what is wanted |
| 1991 patient self-determination act | medicare/medicaid providers must inform patients of their right to prepare advance directives and refuse treatment |
| HIPPA | health insurance privacy and portability act; assures confidentiality of medical records |
| Dx | diagnosis |
| Tx | treatment |
| D/C | discharge |
| 3 benefits of MNT/ parenteral nutrition | prolonged life, improved mental state, prevent further loss of function |
| 4 costs of MNT/ parenteral nutrition | cost, burden to family, prolonged pain/suffering, risk of infection |
| JCAHO | joint commission on accreditation of health care organizations |
| ___% of all hospital patients (__%) elderly are... | 40/60 are malnourished or at risk for malnutrition |
| LOS | length of stay |
| m&m | morbidity and mortality |
| 7 malnutrition indices | nutrition related disease, recent unintended weight loss, BMI <19 or >25, age >75 or <12, biochemical, special diet, recent procedures |
| critical numbers for unintended weight loss | 10% in 6 months or 5% in month |
| dyslipidemia | macrophages become lipid laden and can't fight infection (elevated VLDL and low HDL) |
| overweight BMI | 25-30 |
| stage 1 obesity | 30-35 |
| stage 2 obesity | over 35 |
| two nutrition questions upon admission | are you on a special diet? have you experienced unintended weight loss recently? |
| MNA | mini nutrition assessment- for elderly |
| MNA 6 questions | BMI, weight loss, illness/stress, mobility, dementia/depression, appetite |
| MUST | malnutrition universal screening tool (MNA is better) |
| MUST 3 indices | BMI, weight loss, acute illness (malnutrition universal screening tool) |
| DETERMINE | nutrition screening in elderly (disease, eating poorly, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight loss, need assistance w/ self care, elderly (>80)) |
| 7 nutrition assessment indices | anthropometric, biochemical, drug/diet interactions, procedures, feeding modality, socio/psycho, ability/willingness to change |
| 4 groups at risk for low health literacy | elderly, minorities, immigrants, low income |
| QOL | quality of life |
| health literacy/cancer | later screening, treatment not understood, poor decisions about accepting treatment |
| low health literacy had ___ more___ and ____ longer ____ | 6% more hospitalizations, 2 days longer LOS |
| two widely used health literacy tests | TOFHLA (test of functional health literacy in adults) short (7-10 min) or long (18-22 min), REALM (rapid estimate of adult literacy in medicine) *3 minutes |
| new health literacy test | NVS (newest vital sign) |
| 5 diet interactions: corticosteroids | impaired glucose tolerance, protein loss, calcium loss from bone, sodium retention/edema, potassium losses |
| 2 diet interactions: diuretics | K/Mg/Zn, some may cause K retention |
| how much protein if on corticosteroids | >1.5 g/kg/day |
| low potassium can cause what? and what may it be due to? | cardiac arrhythmias, diuretics |
| what is the "big" drug diet interaction? | anti-coagulant coumadin |
| coumadin | anti-coagulant that interferes w/ vitamin K (must have a constant intake and not sudden large amounts) *new drugs don't have this problem but they're expensive |
| 4 herb/supplement interactions w/ coumadin | ginko, ginger, ginseng, fish oil |
| albumin normal range | 3.5-5 g/dL |
| transferrin normal range | 200-400 mg/dL |
| prealbumin normal range | 20-50 mg/dL |
| hemoglobin/hematocrit cutoffs | F: 12 g/dL, 36% M: 13 g/dL 39% |
| MCV | mean corpuscular volume (HCT x 10/ RBC) |
| normal MCV | 75-98 femtoliters |
| microcytic anemia | <75 fL (iron deficiency) |
| macrocytic anemia | >98 (folate or B12 deficiency) |
| hypersegmentation | >5 segments of the nucleus; preceeds macrocytic anemia |
| hamwai formula females | 100 for 5 feet, 5# per inch over 5 feet |
| hamwai formula males | 106 for 5 feet, 6# per inch over 5 feet |
| BK | below knee |
| AK | above knee |
| kcal non obese | 25-30 kcal/kg |
| kcal obese | 22-25 kcal/kg ideal body weight |
| when to use harris benedict? | not ideal in hospital patients |
| correction of harris benedict for obese individuals | IBW + (OBW-IBW)*.25 **commonly used but controversial |
| ireton jones equation for critically ill patients | sex 1= male 0=female T= trauma, B= burn **ventilator patients |
| Penn State | uses RMR, Ve, Tmax two equations: non obese, obese <60 yrs; obese >60 yrs |
| mifflin- st. jeor | healthy individuals, non ICU hospital |
| critically ill w/ RMR measurement | Penn state |
| which equation: adult weight management | mifflin |
| which equation: kidney disease | KDOQI (23-25 kcal/day) |
| which equation: critically ill non-obese | Mifflin x 1.25 or Penn State |
| which equation: critically ill obese | Penn state or mifflin |
| which equation: critically ill ventilated | ireton jones/ penn state |
| which equation: heart failure | mifflin or harris-benedict |
| which equation: cancer | harris benedict |
| which equation: unintended weight loss | 25-35 kcal/kg |
| normal protein needs | 0.8-1.0 g/kg/day |
| elderly protein needs | 1-1.1 g/kg/day |
| when are protein needs higher? | burn, multiple trauma, systemic infection |
| when are protein needs lower? | kidney, liver |
| hospital protein needs non obese | 1.2-2 |
| hospital protein needs obese | 2 ideal BW for class I/II, 2.5 ideal BW class III |
| surgery/trauma protein | 1.5-2 |
| brain injury protein | 1.5-2.2 |
| acute spinal cord injury protein | 2 |
| what 3 enzymes are increased after heart attacks? | lactate dehydrogenase, alanine amino transferase, aspartate amino transferase |
| gamma glutaryl transpeptidase | GGT very specific to liver |
| LFT | liver function tests |
| amylase and lipase | LFT- if elevated it's due to pancreatitis |
| PT | prothrombin time (liver, drugs, vitamin K) |
| albumin:globulin | increased ratio w/ liver disease (liver breaks down globulins) |
| bilirubin | jaundice, liver function |
| BUN | 10-23 mg/dL (increased in kidney disease, decreased in liver disease) |
| creatinine | .6-1.2 mg/dL increased in kidney disease |
| CRP | c-reactive protein elevated in: trauma, infection, vasculitis, malnutrition inflammation, kidney disease *risk factor for CHD |
| ADL | activities of daily living |
| 3 places for deficiency: | eyes, mouth, tongue |
| muscle depletion areas | scapula area and clavicle |
| mouth cracks | b vitamin deficiency |
| lower lid becomes pale w/ | anemia |
| white of eye turns ___ if ____ | yellow, jaundice |
| cornea spot | vitamin A deficiency |
| spooning | iron deficiency |
| stomatitis | (tongue swelling) deficiency in iron, niacin, riboflavin, B12, folic acid |
| 3 sources of fluids | food, beverage, metabolism |
| 4 losses of fluids | feces, sweat, skin/lungs, urine |
| what would BUN be if dehydrated? | 30 |
| what would BU be with renal disease? | way higher than normal range of 23-25 mg/dL |
| third spacing | fluid sequestering elsewhere (inflammation) or obstruction |
| ascites | accumulation of fluid in abdominal cavity (liver disease) |
| peritonitis | inflammation of membrane around abdominal cavity |
| moderate hypovolemia | 5-10%; electrolyte fluids |
| severe hypovolemia | 10-15% iv fluids |
| body weight hydration | 1st 10: 100 ml/kg, 2nd 10: 20 mL/kg 20mL/kg <50 years 15 mL/kg >50 years |
| kcal intake and water | adult 1 mL/kcal child 1.5 mL/kcal |
| extracellular electrolytes | Na, Ca2+, Cl-, HCO3- |
| intracellular electrolytes | K+, Mg2+, PO43- |
| pH of body | 7.35-7.45 |
| 3 functions of electrolytes | maintain osmotic equilibrium and control fluid shifts, maintain pH balance, maintain electrochemical neutrality |
| fish bone notation | cations, anions, kidney/hydration, ca/gluc/po4 |
| hypokalemia | K <3.5 (diuretics, GI losses) |
| hyperkalemia | K >5.5 K+ sparing diruetics, adrenal insufficiency, antihypertensive drugs |
| hyponatremia | heavy sweat losses Na <135, fluid overload |
| hypernatremia | insensible sweating, excess NaCl administration Na > 145 |
| hypo-bicarbonate | metabolic acidosis <22 mmol/L |
| hypochloremia | <98 mEq/L (vomiting) |
| hyperchlormia | >107 mEq/L (ketoacidosis, kidney failure, excess saline) |
| pCO2 range | 35-45 mm Hg |
| pO2 range | 80-95 mm Hg |
| O2 sat | 95-99% |
| HCOe | 22-26 mmol/L |
| hypoventilation | decrease in pH |
| hyperventilation | increase in pH |
| Hamburg shift | movement of Cl- in and out of RBC to maintain neutrality and changes in bicarbonate |
| ADIME | assessment diagnosis intervention monitoring evaluation |
| PES | problem etiology signs/symptoms (___ R/T ____ AEB ____) |
| for every ___ decrease in pH, there is a corresponding ___ increase in __ | .1, .6-1.2 mEq/L serum K+ |
| hypoxia | increase in anaerobic metabolism |
| acidosis could be due to... | diabetic ketoacidosis, loss of intestinal fluid (HCO3-), renal failure (retention of H+ ions) |
| alkalosis could be due to... | loss of upper GI fluid, ingestion of antacids |
| increase calories in nutrition support= | decrease in water |
| NGT | naso-gastric tube |
| c/o | complaint of |
| PEG | percutaneous endoscopic gastrostomy |
| enzyme in acid base buffering | carbonic anhydrase |
| D/C | discharge |
| d/c | discontinue |
| what is added long term to feeding tubes? | fiber and ultra trace minerals |
| osmolarity of EN | 200 mOsm/L; isotonic (hypertonic not ideal, should be started slowly) |
| 3 modes of administration for EN | continuous, intermittent, cyclic |
| 1 F= | .33 mm |
| who needs low CHO EN? | diabetics (40-45, normally 50-55) |
| who needs low protein EN? | kidney patients (4%) |
| "high nitrogen" EN | 15% or higher protein |
| 1 kcal/mL is __% water | 85% |
| 2 kcal/mL is ___% water | 70% |
| types of EN products (6) | lactose free, milk based, blenderized, polymeric, fiber-containing, disease specific |
| polymeric formulas | nutren1.0 etc. |
| 5 disease specific EN products | diabetes (glucerna), COPD, renal, liver, trauma |
| diabetes EN | high fat, low carb, low glycemic |
| COPD EN | high fat for low RQ |
| renal EN | low protein |
| liver EN | low fat, high BCAA |
| trauma EN | more protein and nutrients known for immune support |
| pediatric EN | high P, Ca, protein |
| bariatric EN | high protein, low calorie |
| critically ill/malabsorbing EN | MCT, amino acids, peptides, sugars |
| modular products EN | not often used since there are products for most disorders |
| 4 issues with EN | access, microbial, metabolic complications, gastric residual volumes |
| gastric residual volume | EN; difficult to measure, indicates if stomach is functioning (not used in Europe) |
| refeeding syndrome | begin to re-synthesize TG, protein, carbs; use up the rest of electrolytes doing this and then the levels drop |
| 2 drugs that stimulate gastric emptying | erythromycin and metaclopromide |
| 4 ways to decrease risk of aspiration EN | 30-40 degree bed, continuous, prokinetic drugs, post-pyloric placement |
| fistula | adhering of 2 epithelial membranes due to inflammation |
| nonocclusive bowel necrosis | lack of oxygen to the gut (occurs with EN in unstable patient) |
| when is TPN required | non functional GI, comatose w/out gag reflex, excessive needs >2000kcal/day, adjunct to chemo |
| infusaport | outpatient, 90 degree needle |
| triluminal catheter | 1 for TPN, 1 saline, 1 antibiotics |
| PPN | used for pre-term babies, high fat (coats vein), low osmolarity to prevent pressure on veins |
| PN kcal CHO | 3.4 |
| PN kcal protein | 4.3 |
| lipids in PN should not exceed | 1g/kg/day |
| CHO name in PN | dextrose monohydrate |
| CHO notation PN | D5W if 5% |
| which 2 vitamins are most important in PN w/ the shortage? | thiamin and folic acid |
| MCT kcal | 7 kcal/g |
| recommendations for vitamins due to shortage PN (4) | multivitamin if tolerated, don't use pediatric products, give thiamin and folate each day, B12 monthly |
| complications of TPN (6) | refeeding syndrome, azotemia, hyperglycemia, hypertriglyceridemia, cholestasis, hepatic steatosis, sepsis |
| Hepatic Steatosis | fatty liver disease (occurs w/ too many kcals/fat during TPN) |
| azotemia | elevated BUN/ammonia |
| cholestasis | gallbladder sludge from not being used during TPN (removal eventually) |
| monitoring TPN | weight daily, electrolytes daily until stable (2-3 days after), biochemical weekly, glucose every 6 hours until stable |
| __% of kids have allergies | 8% |
| ___% of adults have peanut allergy | 1.3% |
| two most common allergies in children | peanut and milk |
| 4 most common allergies in adults | peanut, tree nut, shellfish, wheat/gluten |
| 5 accredited methods to identify food allergy | skin prick test, intradermal, serum IgE, allergen specific IgE, food elimination, oral food challenges |
| total serum IgE | elevated if allergic to something (must be IgE mediated) |
| what to eat w/ food elimination tests | lamb, rice, carrots, apples |
| oral food challenges | done with supervision; very small amounts administered |
| GI tract allergy symptoms (4) | vomiting, diarrhea, abdominal pain, malabsorption |
| skin allergy symptoms (4) | rash, hives, inflammation, angioedema |
| uticaria | hives |
| erythemia | skin inflammation |
| respiratory allergy symptoms (3) | asthma, coughing, rhinitis, sinusitis |
| 6 unproven symptoms of food allergies | behavioral, adhd, eat infections, neurologic, musculoskeletal, migraine |
| otitis media | middle ear infections |
| Children who outgrow peanut allergy display a shift from __ to ___ as tolerance develops | Th2 to Th1 |
| Th2 | increased production of Il4 and Il5 |
| Th1 | production of INF-y |
| OIT | oral immunotherapy |
| oral immunotherapy | provide increasingly greater amounts of heat denatured food antigens major effect is temporary desensitization |
| EPIT | epidermal immunotherapy (antigen applied to skin in effort to develop tolerance) |
| SLIT | sublingual immunotherapy (nanogram amounts of antigen applied under the tongue) |
| rework | reuse of a certain amount of dough from previous batches |
| gluten free | <220 ppm |
| LES | lower esophageal sphincter- pressure higher than intra-gastric |
| GERD | gastro-esophageal reflux disorder |
| 5 possible causes of GERD | hiatus hernia, smoking, birth control, scleroderma, blockage of pylorus |
| hiatus hernia | upper part of stomach protrudes through diaphragm (obesity) |
| scleroderma | breakdown of connective tissue leading to GERD |
| pyrosis | heartburn |
| 4 effects of untreated GERD | ulceration of esophagus, scarring, dysphagia, barrett's esophagus (precancerous overgrowth) |
| two main diagnoses of gerd | endoscopic esophagoscopy, barium swallow |
| 3 medications for GERD | metoclopromide (emptying), antacids, h2 receptor blockers, proton pump inhibitors |
| drug nutrient interaction of H2 receptor blockers | B12 deficiency due to lack of acid for IF |
| surgical treatment of GERD | funduplication |
| 4 general principles of MNT for GERD | low fat, small meals (ish), limit hypertonic solutions, avoid carminitives (gas from stomach; spearmint, peppermint, garlic, onion) |
| what 3 substances to avoid w/ GERD | alcohol, smoking, coffee |
| avoid what after eating w/ GERD | reclining position |
| PP | post prandial |
| DES | diffuse esophageal spasm, esophageal sphincter fails to relax |
| achlasia | dialated esophagus w/ bird beak sphincter |
| diagnosis of DES | EGD, barium swallow |
| EGD | endoscopic gastric duodenoscopy |
| treatment of DES | balloon dilation or botox |
| mnt for des (3) | semi soft foods, small frequent feedings, supportive therapy |
| gastric acidity physiology | gastrin, histamine, and acetylcholine interact in stimulating HCl secretion |
| PUD | peptic ulcer disease |
| causes of peptic ulcer disease | nsaids/steroids, hyperacidity from food poisoning/alcohol, radiation induced inflammation and damage to mucosa, pernicious anemia, H. pylori, trauma |
| how do nsaids work? | inhibit prostaglandin E and this aids in mucosa of stomach/small intestine |
| Zollinger-Ellison syndrome | (ZES) tumor of pancreas and duodenum that leads to PUD |
| procedure for ZES | Whipple (removal of head of pancreas, ducts, duodenum) need elemental tube feed |
| when will pain be felt for gastric vs. duodenal ulcers? | stomach: upon eating; duodenal: 2-3 hours after |
| bleeding ulcers diagnosis | dark stools, coffee grounds vomit |
| two ways to diagnose H. pylori | specific IgG or urease biproducts if given urea |
| triple therapy for gastritis | two antibiotics + proton pump inhibitor/Histamine 2 receptor blocker |
| proton pump inhibitor side effects | connstipation, diarrhea, abdominal pain, dry mouth, MI? |
| histamine 2 receptor blockers | constipation/diarrhea, B12 status |
| bezoars | fibrous clumps from calcium with fiber (antacids) |
| Mg containing antacid side effect | diarrhea |
| calcium and aluminum containing antacids side effect | constipation |
| what deficit is common w/ GERD and PUD? | food and nutrition related knowledge deficit |
| dumping syndrome | stomach emptying too fast (after surgery)- diarrhea |
| treat dumping syndrome | smaller meals, less sugar |
Created by:
melaniebeale
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