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