Term
| Systemtic Lupus Erythematosus |
|
Definition
Deficiecies in iron, folate, b12, fiber
Anemia not related to iron intake
symptoms of celiac disease |
|
|
Term
|
Definition
osteclast - resorb and remove bone
osteoblast - reforms bone |
|
|
Term
Osteoporosis
deossification |
|
Definition
:loss of bone tissue
type 1 - postmenapausal
type 2 - age associated
causes: malnutrition, low protein intake, lack of exercise, decline in estrogen
treatment: hrt, weight-bearing exercises, vit D (600iu, 800iu >70), ca 1200mg, protein, low na, fruits and veg
: defective ca absorption |
|
|
Term
|
Definition
Vit D deficiency - lack of sun
demineralization - loss of bone density
treatment: vit d and ca supp |
|
|
Term
|
Definition
:seizures
Meds (anticonvulsants phenobarbital and phenytoin) interfere with ca absorption
:ketones inhibit neurotransmitters - high fat (4:1 fat to non fat grams, low glucose (<30g CHO), mild dehydration needed to prevent ketone dilution.
Need supp - ca, d, folate, b6, b12 |
|
|
Term
| Cerebral Palsy (two types) |
|
Definition
brian damage, lack control over voluntary muscles
- spastic form: limited activity, obese. diet - low kcal, high fluid, high fiber diet.
-non-spastic (athetoid): constant irregular motions - wt loss. Diet- high kcal, high PRO, finger foods. |
|
|
Term
|
Definition
| stroke, undernourished, overwt, immobilization decreases ability to to absorb ca, loss of nitrogen in urine |
|
|
Term
| pressure ulcer/decubitus ulcer |
|
Definition
| low albumin and ca. Diet- high PRO (1.2-1.5), high kcal (30-35), fluids, mvi, vit c (5000mg), zn (220mg) |
|
|
Term
|
Definition
| feilgold diet - no perservatives/artificial flavors |
|
|
Term
|
Definition
| goal - nourishment. regular meals, plesant, finger foods, encourage self feeding, avoid dehydration, prevent wt loss |
|
|
Term
|
Definition
:decrease in totla RBC mass d/t fewer RBC or smaller cells with less hgb.
-microcytic/hypochromic - small, pale, d/t fe deficiency. Associated with chronic infections, malignancied, renal diseases
-macrocytic/megaloblast anemia: few lg cells, filled with hgb, d/t deficiency of folate or b12 (schilling's test for pernicious anemia) |
|
|
Term
|
Definition
Microcytic - RBC may be normal, h/h low, mcv (cell size) small <80 (80-95), MCH (hgb/cell) low/pale (27-32), MCHC (hgb conc.) low <31 (32-36%)
Macrocytic - RBC decreased, h/h low, MCV high >95, MCH high, MCHC normal. |
|
|
Term
|
Definition
ag-ab reaction, IgE mediated reaction to food. Common offenders - nuts, eggs, milk, soy, wheat, fish.
Introduce eggs at 24mo, fish 36mo,
Diagnosis - diet history, skin test, elimination diet, CAP-FEIA blood test - id's kids with milk, fish, peanut allergies, DBPCFC - double blind, placebo-controlled food challenged - id's food induced symptoms, RAST - serum mixed with food (vs. a skin test) |
|
|
Term
|
Definition
| : adverse food reaction caused by a toxic pharmacologic , metabolic, or non-IgE reastion to food or chemical |
|
|
Term
|
Definition
Diet high in kcals and fluid
BMR increases 7% for each degree rise |
|
|
Term
|
Definition
Immediate shock period - catabolism, BMR increases 50-100%
goal- replace fluids/electrolytes
For burns that >20 TBSA - 1.5-2g PRO, BEE x 1.3-1.4, vit c 5000mg, vit a 10000iu, vit k for abx balance, zinc 220mg |
|
|
Term
|
Definition
Ebb - hypermetabolic - catabolism of LBM - negative nitrogen balance.
Release of epinephire - hyperglycemia (insulin resistance), ACTH - releases cortisol - mobilizes AA from muscle. Aldosterone - renal na retention, ADH - h20 retention.
Acute flow - catabolic
Adaptive flow - anabolic
Results - low cardiac output, body temp drop.
Diet- 1.5 - 2 PRO, |
|
|
Term
|
Definition
PRO/KCal malnourishment, cancer cachexia - wasting, TNF tumor necrosis factor.
Treatment: rads - xerostomia (dry mouth), esophagitis, diarrhea, malabsorption, mucositis (inflamm. of mucosal lining of mouth and larnyx)
Chemo - n/v/malabs. anorexia, stomatitis (inflamm. of oral mucosa d/t riboflavin deficiencies) |
|
|
Term
Kwashiorkor
Marasmus
Iatrogenic malnutrition |
|
Definition
:PRO deficiency, low ablumin, low WBC, edema, may appear normal.
:PRO and Kcal starvation, diagnosised by anthropomentrics
:PRO/kcal malnourishment d/t treatment, medication. |
|
|
Term
|
Definition
:distorted body image
refeeding increases cardiac load - go slow
Reccommend 1200-1400kcal or 100-300kcal above current level |
|
|
Term
|
Definition
3500kcal = 1 lb fat
To lose 1 lb/wk = 500kcal less/day
Glucostatic: glucorecptors in the hypothalmus are sensitive to the rate of glucose used - day to day control of feeding behavior.
Lipostatic - body has a set point of adipose reserves - long term wt regulation |
|
|
Term
|
Definition
bacterial enzymes ferment CHO deposits on plaque - enzymes produce acids that demineralize surface.
-low cariogenic foods: high PRO, moderate fat, min fermentable CHO, strong buffers - high mineral content - Ca, P pH>6 - stimulates saliva |
|
|
Term
| Fluoride Reccommendations |
|
Definition
0 - 24mo fluoridated h2o - no toothpaste until child is able to spit.
2-3 fluoridated h2o - pea size toothpaste
0 - 3 supplemental use only if prescribed |
|
|
Term
|
Definition
:inflammation of the mouth (associated with a riboflavin deficiency)
Diet - aviod very hot/very cold items, spices, sour/tart food.
Rinse with luke warm h2o after meals
:treat by decreasing gastric acidity, reflux
Diet- small, low fat, bland, low fiber, wt reduction |
|
|
Term
|
Definition
NDD1: smooth, pureed, cohesive foods, avoid gelatin and lumpy foods
Dysphagia Mechanically altered (NDD2): moist soft text, easily forms bolus, tender ground or diced meats, soft foods.
Dysphagia Advanced NDD3: Avoid hard, sticky, crunchy foods, hard fruit/veg, nuts, seeds.
Liquid consistency: spoon thick, honey, nectar, thin (includes gelatin) |
|
|
Term
PIH - Pregnancy induced hyptention
Hyperemesis gravidarum |
|
Definition
:progression form pre-eclamsia to eclamsia
s/s - HTN, edema, proteinuria, rapid wt gain after 20th wk.
Etiology: poor diet, lack of prenatal care, poor PRO and kcal intakes
*do not restrict Na
:severe N/V acidosis, wt loss
need bed rest, small amounts of CHO |
|
|
Term
|
Definition
:immune system attacks lyphocytes
s/s: n/v/d/wt loss, mal absorption
Goal: preserve LBM, prevent wt loss and wasting
Diet: BEE x 1.3-1.5 for wt gain, 1.2-2 PRO, 20-35% total fat, <10 sat., MVI to meet RDA's, educate on food safety.
HIV+ - no breast feeding
Drug theropies: Retrovir (zidovudine) causes non-nutritive macrocytic anemia.
No supplements or CAM |
|
|
Term
|
Definition
High PRO/kcal, energy needs are genral reccommendations plus stress factors, MVI
:HIV-associated lipodystropy syndrome, may develop from theropy: high CHOL/TRI, insulin resistance, change in body fat distribution |
|
|
Term
|
Definition
Chronic obstructive pulmonary disease: persistent obstruction of airflow through lungs
1. Emphysema (blue bloater): air sacs (alveoli) lose elasticity, thin, cachetic, difficaulty exhaling - air pocket expand, thin out, and collapse |
|
|
Term
|
Definition
Acute respiratory distress syndrome, respiratory failure: lungs are no longer to exchange gases, hypermetabolism, > energy needs, severely underwt.
Diet: 1.5-2g PRO, maintain LBM, provide EN with EPA and GLA (gamma-linoleic acid) and antioxidant vitamins. |
|
|
Term
| Enetral Nutrition - from review |
|
Definition
Initiate full strength at a rate of 10-40ml/hr, advance by 10-20ml/hr every 8-12hrs, as tolerated, until 100% goal rate met.
Elemental/chemically defined formula: predigested protein, AA, glucose, sucrose, small fat, vit/min, electrolytes. High osmolality. |
|
|
Term
EN tubes - from review
H2O in formulas |
|
Definition
bore - opening based on viscosity of feeding (french- size??)
large = #16
small = #8
tranpyloric: passes pyloric valve (PEJ?)
1ml h20/kcal
1kcal/ml = 80-86% free h20
1.5kcal/ml = 76-78% free h20
2kcal/ml = 69-71% free h20 |
|
|
Term
| Perpheral nutrition - from review |
|
Definition
solutions: IV dextrose - 3.4kcal/g
highedt concentration in peripheral = 10%
PRO = 3-15%
IVFE (fat emulsions)
10% = 1.1 kcal/ml
20% = 2 kcal/ml
** solution limited to 800-900 mOsm |
|
|
Term
| TPN and GALT - from review |
|
Definition
Concerns: transloction of bacteria - sepsis,
GALT: gut associated lymphoid tissue: is compromised by bowel rest - gut produces immunoglobulin to defend against pathogens - this doesn't happen with bowel rest - GALT results |
|
|
Term
|
Definition
PRO: 1g nitrogen = 150kcal (6.25g PRO = 1g nitrogen)(**this does not add up??)
1-1.5g PRO/kg/day - 3-15% solution
kcals: 30-35kcal/kg - up to 70% dextrose
(10% provides 100g CHO/L)
GIF: glucose infusion rate
(g dex x 1000g/ml) /
(kgBwt x 1440min/day) = needs to be below 4-5 mg/kg/min to prevent hyperglycemia |
|
|
Term
Transitional feeding
Refeeding syndrome |
|
Definition
decrease PN as EN increases by 25-30ml/hr every 8-12hr. D/C PN when EN = 75% of Estimated needs.
:starved cells take up nutrients, electrolytes (K and phos shift into intracellular compartment) - emptying the bllod supplies - causing cramps, diarrhea, cardiac arrest (K, hyperkalemia), hypophosphatemia, hypomagnesemia. |
|
|
Term
| VMA Vamillymandelic Acid test diet |
|
Definition
:measures catecholamines (a fight or flight hormone produced by the adrenal gland)- assesses pheochromocytoma (a neuroendocrine tumor of the adrenal gland that causes HTN)
- tumor produces catecholamines, most are then converted to VMA (test for VMA to assess tumor)
Diet: may need to restrict tea, coffe, vanilla, chocolate, bananas, citrus fruit |
|
|
Term
|
Definition
: standards of practice in nutrition care - competent level of nutrtion care
:standards of professional performance: behavior in a professional role
:Scope of Dietetic Practice framework - determine whethrer a service is i your scope of practice |
|
|
Term
|
Definition
:decrease in mucus - acid hits our stomach/sm intest.
primary cause- h. pylori, gastritis, stress.
Treatment: abx for h. pylori, antacids, drugs- cimetidine, Rantidine - h2 blocker: prevents binding of hisamine to recptor: decrease acid secretion
Diet: as tolerated, well-balanced, avoid late night snacks, omit: cayenne/black pepper, chili powder, caffine, alcohol. |
|
|
Term
|
Definition
:inflammation of stomach, primary cause h. pylori.
s/s: anorexia/n/v/d
Diet: clear liquids, advance as tolerated, avoid gastric irritants
Concerns: b12 level - supplemental shots, Fe and Ca status |
|
|
Term
|
Definition
:protursion of a portion of the stomach above the diaphragm into the chest - allows esophagus or stomach to move above diaphragm - slides up and down or is stuck above.
Diet: small, bland feeding, avoid hot spices, lg./fatty meals, late nigh snacks, caffine, alcohol, don't eat before lying down, reduce wt. |
|
|
Term
|
Definition
s/s: cramps, rapid hydrolyzed CHO enter jejunum - water is drawn in for osmotic balance - rapid decrease in peripheral vascular resistance - BP drops, cardic insufficiency. Two hours later: CHO digests/absorbs rapidly - high Blood sugar levels, overproduction of insulin - causing reactive/alimentary hypoglycemia
Diet: 6 small meals, not fluid with meals, restict hypertonic concentrated sweets, eat complex CHO, protei at each meal, moderate fat, may restrict lactose. |
|
|
Term
Gastrectomy:
billroth I
billroth II |
|
Definition
I: attaches remaining stomach to duodenum
II: attaches to the jejunum
When food passes duodenum, secretin and pancreozymin by the duodenum is reduced. Pancreatic secretions are then reduces - mat cause steatorrhea. |
|
|
Term
|
Definition
:Bacterial infection
s/s: D/malabsorption, b12/folate deficiency d/t decreased intrinsic factor and HCL.
MNT: abx, high kcal/PRO, IM B12 and folate suppl. |
|
|
Term
|
Definition
Diverticulosis: presence of diverticula
diet: high fiber
Diverticulitis: diverticula become inflamed.
Diet: clear liquids, low fiber/residue, gradual return to high fiber. |
|
|
Term
|
Definition
Dietary fiber: nondigestible CHOs and lignin, binds water, increase fecal bulk: found in legumes, wheat bran, fruits/veg, whole grains
Soluble fibers: (pectins/gels) delay gastric emptying, absorb water, forms soft gel - slows passage/delay/inhibits absorption of glucose, CHOL; found in fruits/veg, legumes, oats, barley, carrots, apples, citrus fruits |
|
|
Term
| Inflammatory bowel disease - Crohn's |
|
Definition
Crohn's disease: affects terminal ileum; wt loss, anorexia, diarrhea
s/s: B12 deficiency leads to megaloblastic anemia, Fe deficiency d/t blood loss/decreased absorption.
Treatment: maintain fluid and electrolyte balance, energy needs meet BMI needs, limit fat only intolerate, water/fat soluble vitamins suppl.
Acute crohn flare ups; bowel rest, TPN or minimal residue.
Acute UC; elemental diet |
|
|
Term
|
Definition
:chronic abdomial discomfort, altered intestinal mobility, bloating.
Goals: adequate nutrient intake, avoid lg meals, excess caffine, alcohol, sugars, id hypersensitive foods. |
|
|
Term
|
Definition
:lactase deficiency - hyperosmolar pressure.
Detected by: breath hydrogen test; hydrogen is produce by colonic bacteria on lactose, absorbed into the bloodstream 60-90 minutes.
Lactose tolerance test; oral dose, if intolerate blood glucose will rise <25mg/dL above fasting (flat curve)
Diet: no animal milk or milk products (whey has lactose), yogurt and sm amounts of aged cheese okay.
Ca and riboflavin suppl. |
|
|
Term
|
Definition
Acute: replace electrolytes/fluids; WHO recc. glucose electrolyte solution.
Chronic: consider ratio of fat to CHO, volume of liquids.
Give 40% kcal as fat, balance with limited fluids, restrict/dilute fruit juice - hyperosmolar |
|
|
Term
|
Definition
Acute: replace electrolytes/fluids; WHO recc. glucose electrolyte solution.
Chronic: consider ratio of fat to CHO, volume of liquids.
Give 40% kcal as fat, balance with limited fluids, restrict/dilute fruit juice - hyperosmolar |
|
|
Term
|
Definition
remove cause, bowel rest, replace fluids/elec (Na/K), when D stops begin with low fiber foods, followed by protein, fat need not be limited.
Avoid lactose at first, pro/prebiotics may help. |
|
|
Term
|
Definition
Osmotic: strong, particals are pulled with it (ex: lactose), :osmotic solutes are present in the intestinal track and are poorly absorbed.
Secretory: active secretion of electrolytes, and water by the intestinal epithelium (bac or virus - body is trying to flush it out)
Exudative: mucosal(tissue) damage, leading to an outpouring of mucus, fluid, blood/plasma, PRO (crohn's, UC, rads) |
|
|
Term
|
Definition
Medication induced: reduce good bacteria, contributing to increased osmolality, may increase GI motility.
Limited funtional mucosa: inadequate absorbative area resulting in malabsorption - crohn's/SBS.
Steatorrhea: malabsorption of lipid
diet: MCTs - absorbed through portal vein system, replace fat soluble vitamins, Ca, Zn, and Mg |
|
|
Term
|
Definition
Significant resections: 3-5 feet of fuctioning bowel; strictures; malabsorption, malnutrtion, fluid and electrolyte inbalances, wt loss.
Concerns: loss of ileum and ileocecal valve, loss of colon; loss of wter i stool. |
|
|
Term
|
Definition
Distal, concerns: absorption of B12, intrinsic factor, bile salt.
Ileun absorbs most of the fluid in GI.
If Ileum cannot recycle bile salt; liver cannot emulsify lipids - malabsorption of fat soluble vitamins,
colonic absorption of oxalate increases- renal oxalate stones,
> fluid and electrolyte secretion- > colonic motility. |
|
|
Term
|
Definition
TPN initially
EN continuous drip
jejunal; normal CHO, PRO, FAT, small feeding, avoid lactose and concentrated sweets, MVI suppl. |
|
|
Term
|
Definition
| Store, releases blood, filter toxins, metabolizes and stores nutrients, regulates fluid and electrolytes. |
|
|
Term
|
Definition
s/s: inflammation, necrosis, jaundice (blockage of bile ducts), anorexia, N, fatigue.
Type A: fecal/oral transmaission
B: sexuallt transmitted
C: blood to blood contact
Diet: increase fluids high PRO/kcal, moderate fat. 75-100g PRO - cell regeneration, provide liptropic agents to convert fat into lipoproteinsfor removal from liver. Small, frequent feedings b/c of anorexia. |
|
|
Term
|
Definition
Damaged liver tissue is replaced with bands of unfunctional connective tissue - routes vein/capillaries, bad blood flow.
Poor food intake leads to deficiencies; PRO defi leads to ascites, fatty liver, impaired blood clotting.
Diet: High PRO: .8-1 or 1.5 during stress. High kcal: 25-35 or 1.2-1.5 x BEE. Moderate fat: 25-40%, MCT if needed, less for malabsorption.
vaires - low fiber, ascites/edema - low Na, with hyponatermia - fluid restriction - 1-1.5L, vit/min suppl. |
|
|
Term
|
Definition
:blood cannot leave the liver, connective tissue overgrowth blocks the vena cava; liver expands (stores up to an extra L of blood).
-Pressure increases, fluid sweats into the peritoneal cavity. This fluid is pure plasmawith a high osmolar load - so more fluid is pulled in to dilute the load. - Leads to Na and water retention, low serum albumin d/t dilution factor. |
|
|
Term
|
Definition
: when blood cannot enter the liver, connective tissue overgrowth causes resistance to blood from portal vein; increases pressure, forces blood back into collateral veins.
Esophageal, abdominal, collateral veins enlarge *** d/t portal HTN |
|
|
Term
|
Definition
Stages: hepatic steatosis: fatty liver, reversible.
alcoholic hepatitis: hepatomegaly (enlarged liver/inflammation), wt loss, > AST, ALT, bilirubin.
Cirrhosis: Portal HTN, ascites, gi bleeds, hepatic encephalopathy.
: alcohol is converted into acetaldehyde and excess hydrogen which disrupts liver metabolism -
hydrogen replaces fat as fuel - fatty liver and high blood TG levels. |
|
|
Term
| Alcoholic Liver Disease - MNT Concerns |
|
Definition
Alcohol replaces food, inflammation of GI, interferes with absorption of thiamin, B12, vit C, folic acid, interferes with vitamin activation, > needs for b vitamins to metabolize alcohol, > mg; excreted after alc consumption.
** Thiamin deficiency - wernicke - korsakoff syndrome |
|
|
Term
|
Definition
I: mild confusion, decreased attention, sleep disturbance.
II: Lethargy, disorientation.
III: incomprehensible speech, confusion.
IV: coma |
|
|
Term
|
Definition
:< 25% of liver function - cannot convert ammonia to urea - causing apthy, confusion, coma, asterisix (flapping, jerking motions).
Treatment: PRO 1-1.5, low Na if ascites, adquate kcals, vit/min suppl., altered neurotransmitter theory: BCAA decrease, AAA increase - imbalance cause s/s. Try adding BCAA.
Drug: Lactulose: removes nitrogen. Neomycin: abx destroys bacteria that produces ammonia. |
|
|
Term
|
Definition
Cholecystitis: inflammation of Gb - causes water to be absorbed causing CHOL to precipitate out leading to gallstones. ** Cholelithiasis - gallstones - can lead to pancreatitis.
Treatment: Low fat diet, acute 30-45g, chronic 25-30% of kcals.
Cholangitis: inflammation of bile ducts
Cholestasis: sludge in Gb |
|
|
Term
|
Definition
| :inflammation with edema, cellular exudate and fat necrosis. D/t blockage or reflux of ductal system; premature activation of enzymes causing autodigestion within pancreas. |
|
|
Term
|
Definition
:decrease of exocrine glands - thick mucus obstructs glands/ducts; chronic pulmonary disease, panc enzyme deficiency, high perspiration electrolyte levels, malabsorption.
Treatment: PERt, High PRO/Kcal, unrestricted fat, additional a in hot weather, suppl. vit/minerals especially A and E. |
|
|
Term
|
Definition
:decrease of exocrine glands - thick mucus obstructs glands/ducts; chronic pulmonary disease, panc enzyme deficiency, high perspiration electrolyte levels, malabsorption.
Treatment: PERt, High PRO/Kcal, unrestricted fat, additional a in hot weather, suppl. vit/minerals especially A and E. |
|
|
Term
Atherosclerosis
Arteriosclerosis
Mycocardial infarction |
|
Definition
:accumulation of lipids
risks: HTN, Obseity, smoking, heretidy.
:loss of elasticity of blood vessel walls.
:reduction of coronary flow to myocardium d/t blood clots.
- angina pectoris: chest pain
- heparin: prevents blood clots |
|
|
Term
|
Definition
Normal BP 120/80, systolic - canntraction, distolic - relaxtion
HTN: >140/>90, classified in stages based on risk for CHD.
Obesity is the major cause and treatment.
Management: thiazide diurectics may induce hypokalemia,
modifiable factors: overwt, high Na intake, alcohol consumption, physical inactivity.
Na restriction - <2300mg, (6 grams), 1500mg if at risk. |
|
|
Term
|
Definition
Etiology: weakened heart - inadequte output, less blood flow so fluid is held in tissue - edema.
- reduced blood flow to kidneys causing secretions of hormones that retain Na and fluid - leadig to wt gain and adding to the problem. |
|
|
Term
| Lipid Metabolism - lipoproteins |
|
Definition
chylomicrons: made in itestines, transports TG from gut to adipose cells; low density d/t small amount of protein.
VLDL: transports endogenous TG form the liver to adipose cells.
LDL: transports CHOL from diet and liver to cells
HDL: Reverse CHOL transport, moves to liver and excretes. |
|
|
Term
National CHOL Education Program (NCED)
Adult Treatment Panel III
TLC - Theraputic Lifestyle changes |
|
Definition
assessment:
LDL: <100 optimal
Total CHOL: <200 desirable
TG: <200 normal
HDL: <40 (m) low, <50 (F) low.
:every five years, treat DM with high CHOL aggressively, wt control, PA, waist measurements - >40" M, >35" F, |
|
|
Term
|
Definition
glomerulus: capillareis held together by bowman's capsule - ultra filtration -blocks passege of RBC and lg PRO/molecules.
Proximal convoluted tubul - major nutrient reabsorption.
Loop of henle: water and Na balance.
Distal tubule: acid-base balance |
|
|
Term
|
Definition
filtration: RBC and PRO stay
absorption: 100% glucose, aa, 85% water, Na, K, Cl.
excretion: waste, urea, excess ketones.
secretion: hormones that control BP, blood components, ions to maintain acid-base balance.
Specific gravity: tests concentrating/dilution abailities |
|
|
Term
|
Definition
vasopressin: from hypothalamus, ADH- anti-diuretic hormone; elevates BP - increases water absorption.
Renin: vasoconstrictor, secreted by the golmerulus when blood volume decreases - stimulates aldosterone to INCREASE Na ABSORPTION and return BP to normal.
Erythropoietin EPO: produced by the kidneys - stimulates bone marrow to make RBC. |
|
|
Term
|
Definition
Nephrolitiasis/renal calculi: calcium stones; 1.5-2L fluid to dilute urine.
Ca oxalate stones (salt); calcium intake to bind oxalate and low oxalate (40-50mg) Diet: avoid dark greens, chocolate, tea, strawberries/berries, nuts, beets. |
|
|
Term
|
Definition
:sudden shutdown, decreased GFR, inadequte pre-renal perfusion.
d/t trama, obstruction, severe dehydration.
s/s: oliguria: urine output<500ml, Azotemia: high urea in blood.
Diet: first - TPN, if no Dialysis - .6g PRO/kg increase as GFR returns to normal. 1.2-1.5 if catobolic or Dialysis starts.
25-35kcal/kg, low Na if edema or oligria phase, 8-15mg/kg phos (2/3g), replace fluid from day before plus 500ml. |
|
|
Term
|
Definition
:defect in capillary membrane of glomerulus which permits escape of lg PRO.
s/s: albuminuria, edema, malnut, hyperlipidema.
Diet: reduce PRO - .8-.9, HBV, 35kcals/kg, complex CHO, modest Na restriction, <30% total fat, phos - 12mg/kg, Ca 1-1.5g |
|
|
Term
| Chronic Kidney insufficiency |
|
Definition
s/s: anorexia, weakness, wt loss, N/V, anemia d/t deficient production of erthropoietin.
Diet: kcals based on expenditure for stage 1,2,3. stage 4,5 - 30-35kcal,
PRO restriction when GFR falls,
Ca <2g /day, phos - restrict if serum levels are high >4.6 |
|
|
Term
|
Definition
| Hemodialysis: 1.2 Pro, 30-35kcals, <30% fat, <10% sat, <300mg CHOL, >1L output - 2-4 g Na, <1L output - 2g, 40mg K, 800-1000mg phos or 17mg/kg IBW.' |
|
|
Term
| Indices of Glycemic Control |
|
Definition
normal - 70-100mg/dL
impaired fasting - 100-125
impaired glucose tolerance (2hr post-prandial) 140-199
With DM: fasting plasma glu - >126 or
glu intolereance test - >200
HgA1C >6.5% goal for diabetics, higher for the old and frail. Normal 5.7% |
|
|
Term
|
Definition
Risk: BMI >30, hx of GDM.
s/s: at 24-28 wks - screen with oral 50g glu, if >140 indicates for further testing.
Diet: 40-45% CHO, 3 small meals and snacks, evening snack , const. CHO. |
|
|
Term
| CHO Exchange - CHO Groups |
|
Definition
|
|
Term
| CHO Exchanges - Meat, meat sub, fat, alcohol |
|
Definition
|
|
Term
|
Definition
-Rapid acting - Novolog, Humalog,; take 5-10 minutes before eating, duration 4 hrs.
-Short acting - Regular; take 30-60 minutes before a meal, duration 3-6 hrs
-One unit covers 10-15g CHO
-Intermediate-acting - NPH: onset 2-4 hours, duration10-18 hrs.
-Long-acting - Lantus: onset 1 hour, duration 24 hrs.
-Take bedtime snack - CHO and PRO |
|
|
Term
|
Definition
-Regular and NPH 2x/day (bre and supper)
-Regular and NPH bre, supper, bedtime.
MDI Multiple daily injections: Regular before meals, NPH 1-2x
-Glargine (Lantus) basal insulin at bedtime; rpid acting as bolus for meals.
-Insulin pump therapy provides basal or rapid-actinng or short acting. |
|
|
Term
| Oral Glucose-lowering Meds |
|
Definition
-Insulin secretagogues - sulfonlureas, meglitindes (Glucotrol; promote insulin secretion.
-Biguanides - metformin (Glucophage); enhance insulin action and decrease hepatic glucose production; inhibits gluconeogenesis.
-Thiazolidinediones - (Actos, Avandia); decrease insulin resistance in peripheral tissues.
-Alpha glucosidase inhibitors - (Acarbose, Precose); inhibt enzymes that digest CHO. |
|
|
Term
| Addison's Disease - Adrenal cortex insufficiency |
|
Definition
Atrophy of adrenal cortex; s/s d/t lack of adrenal hormones.
-low cortisol - glycogen depletion, hypoglycemia
-low aldosterone - Na loss, K retention, dehydration
-low androgenic- tissue wasting, wt loss
Diet: high PRO, frequent feedings, high Na |
|
|
Term
Thyroid Disorders
hyper/hypo |
|
Definition
hyperthyroidism: excessive secretion thyroid hormone - increase BMR leading to wt loss - Diet - increase calories
Hypothyroidism: deficiency of thyroid hormone - decreased BMR leading to wt. gain, Diet - wt reduction. |
|
|
Term
|
Definition
Gout: disorder of purine metabolism, increase serum uric acid - joint pain/swelling.
Diet- low purine diet may not be effective, may need wt reduction, moderate PRO, liberal CHO, low to moderate fat, > alcohol, avoid high purine foods (broth, anchovies, sardines, organ meats, herring, mackerel) |
|
|
Term
Inborn errors
galactosemia |
|
Definition
galactosemia: missing enzyme that converts galactose-1-PO4 into glucose-1-PO4.
Treatment/diet: galactose and lactose free; no organ meats, MSG extender, milk, whey, casin, Ca or Na caseinate, dates, bell peppers. OKAY: soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG. |
|
|
Term
Inborn errors
glycogen storage disease |
|
Definition
Glycogen storage disease: deficiency of glucose-6-phosphatase in liver; impairs gluconeogenesis and glycogenolysis - liver can't convert gycogen to glucose -hypoglycemia.
-Diet: consistent supply of glucose with cornstarch, high CHO, low fat. |
|
|
Term
|
Definition
-Dietary reference intakes: nutrient goals to be achieved over time -prevent risks for diseases.
-Reccomended dietary allowance: preventing deficiencies. DRIs replacing RDAs. |
|
|
Term
|
Definition
-Estimated average requirement for 50% of population.
-Adequate intake: used when insufficient evidence exists for EAR/RDA |
|
|
Term
|
Definition
-Upper Level: not associated with adverse side effects in most individuals.
-Acceptable Macronutrient distribution range: PRO 10-35%, CHO 45-65%, FAT 20-35% |
|
|
Term
| Dietary guidelines for Americans |
|
Definition
| Adequate nutrients with kcal needs, limit use of bad, wt management, PA; reduce risk- 30min, manage wt- 60-90min, make healthy choices, food safety. |
|
|
Term
|
Definition
| Identifies broad goals, focuses on prevention, healthy diet and wt., more PA in 50+ yr olds, less leisure time. |
|
|
Term
|
Definition
-Asians: low dairy intake - Ca from tofu, fish pastes
Kosher: no pork/shellfish, no meat and dairy st the same meal.
-Mormons: no caffine/alcohol
-Chinese: Yin; dark, cold foods -fish fruit/veg. Yang; bright, hot -soup |
|
|
Term
pagophagia
polyphagia
hypogeusia |
|
Definition
: to eat ice foods - form of pica.
: eating large amounts of foods.
: diminution of taste |
|
|
Term
Prospective payment systems
TEFRA - Tax equity and fiscal responsibility act
(ICD) International classificationof diseases) |
|
Definition
| DRG's - Diagnostic related groupings, enacted by TEFRA, includes medicare/medcaid pt, :pt diseases are classified (ICD)- hospitals pay specific amount per pt base on disease/diagnosis. PRO - peer review org - watchdog of DRG system |
|
|
Term
|
Definition
| bill - sub/committee - public hearing (testimony) - revise/vote - Rules committee - go to other legislation (senate/house) - same processes - differences are worked out between legislations - president/executive. |
|
|
Term
|
Definition
-FTC federal trade commission: regulates food ads/labeling, challenges claims.
-FDA ensures safety of domestic/imports
-FCC federal communications commission: licenses radio/tm services |
|
|
Term
|
Definition
-Federal register: notices of public hearings, final rules, changes in USDA food programs.
-Congressional record: info from floor - no hearings, issued daily when congress is in session.
-Congressional Index: weekly, identifies bill with sponsor and committee. |
|
|
Term
Government Assistance programs
TANF
USDA Commodities
-CSFP
-TEFAP |
|
Definition
-Temporary assistance for needy families: states determines eligibility, and benefits and services those in need will receive.
-Commodity food donation/distribution program: help meets needs of kids/adults, stengthens agricultural markets, gives to schools, elderly feedings, supplemental programs |
|
|
Term
USDA Commodities
-CSFP
-TEFAP |
|
Definition
-Commodity supplemental food progra: administered by state, monthly commodity foods, to low income women, infants, kids, some elderly - may require nutritional risk.
-The emergency food assistance program: local, public, or private, distru=ibuted quarterly, supplemental diets for low-income households. |
|
|
Term
|
Definition
| National School Lunch Program / Food and Nutrition Service - USDA: entitlement program (requires payment to eligible), federal cash grants and food donations, lunch must provide 1/3 of recommended intake for kcals, PRO, vit A, C, Fe, Ca. |
|
|
Term
|
Definition
| School breafast program, USDA: meet dietary guidelines, must provide 1/4 daily recommended levels for PRO, kcals, Ca, Fe, Vit A, C. |
|
|
Term
ASP
Special Milk Program
SFSP |
|
Definition
-After school snack program, USDA - provides healthy snacks
-Milk program, USDA: encourages milk consuption by children, schools, child care centers, summer camps.
-Summer food service programs, USDA: expand foodservice programs to children when school is not in session. Administered by the FNS, state, public, private, summer camps. |
|
|
Term
|
Definition
| Child and Adult care food program, USDA: supports food service programs for day care centers, neighborhood houses, homeless shelters. Reimbuses operators for meal costs, provides commodity foods, and nutr ed materials. Must meet guidelines and offer free or reduced-price to eligible. |
|
|
Term
|
Definition
Special Supplemental nutrition program for WIC, USDA: For preg, post, breast-feeding, infants, kids up to 5. Provide food, edu, and referrals for low income mothers at nuritional risk.
-Foods provided; fe-fortified formula, cereal, milk, cheese, fruit juice.
**Not an entitilement; budget capped. |
|
|
Term
|
Definition
| Expanded food and nutrition education program, USDA: provides grants to universities that assist in community development, edu the public, improve food practices, teaches skills needed. |
|
|
Term
Maternal and Child Health Block Grant,
Healthy Start
DHHS |
|
Definition
:Under title V of SS Act, fosters public health nutrition programs at the state/local level - provide training and funding.
Who; women of child bearing age, infants, children - state eligibility requirments.
:reduce infant mortality - improve health of low-income women, infants, children. |
|
|
Term
Nutrition Services Incentive Program NSIP
- ENP |
|
Definition
:Older American Act title III -
USDA: fosters independent living, cash and commodities to state.
:Elderly Nutritional Program - DHHS: one hot meal/day x5/wk, provide 1/3 recommended intake. Eligibility: all 60
+ and spouses, regardless of income. Congregate meals, home delivery meals (meals on wheels) |
|
|
Term
|
Definition
| Supplemental Nutrition Assistance Program (food stamps) USDA: entitlement program, monthly benefits, net income must be below poverty level (130%), increases purchasing power. |
|
|
Term
| National Health Planning Resources Development Act, DHHS |
|
Definition
: nationwide system of health planning, promotes PREVENTION of disease and primary care facilities for the poor.
Title IV - established HMO (Health maintenance org.) |
|
|
Term
|
Definition
Centers for Medicare and Medicaid Services, DHHS: -Medicare; insurance for pp over 65, and for any age with ESRD. Part A hospital pays, Part B optional supplementary benefits.
-Mediciad: federal law administered by state, payment for medical care; all ages, blind, disabled, dependent children - provide EPSDT (Early Periodic Screening, Diagnosis, Treatment Program (under 21)
SCHIP State Children's HealthInsurance Program (up tp 19, who aren't insured) |
|
|
Term
|
Definition
Helps low-income children (3-5); introduces new foods and teaches good eating habits.
:Nutrition Education Training Program; amandment to school lunch act - provide training to teachers, foodservice pp. |
|
|
Term
Other Assistant Programs
Quasi-governmental agencies |
|
Definition
Quasi: federal and private funds - National Research Council - Food and Nutrition Board (developed RDAs);
-policy enrichment: increasing nutrients to a higher level.
-policy of fortification: adding nutrients that do not normally occur.
American Red Croos |
|
|
Term
| Other non-governmental agencies |
|
Definition
Voluntary - American Heart Association
Professional - ADA
Foundations, businesses, industries |
|
|
Term
|
Definition
-Grant: an award or financial or direct assistance
-Entitlement program: requires payment of benefits to all eligible pp as established by law (SNAP, not WIC!)
-Block Grants: from federal to states/local communities. 5 areas; maternal and child health, community services, social services, preventive health services, primary care.
-CDC STEPS: federal grant; focuses on obesity, asthma, DM prevention. |
|
|
Term
How consumers make decisions
Stages of Change - transtheoretical model |
|
Definition
-pre-contemplation: unaware or not interested
-contemplation: thinking about changing
-preparation: decides to change and plans on it.
-action: tries to change.
-maintenance: sustains change for 6+ mo. |
|
|
Term
How consumers make decisions
Health belief Model |
|
Definition
| : explains why people fail to participate in programs that prevent diseases - pp must perceive the severity and their susceptibility |
|
|
Term
How consumers make decisions
Diffusion and innovatio |
|
Definition
:how things spread
-innovators: adopt easily
-early adopters: opinion leaders
-early majority: cautious in adopting
-late majority: skeptical, adopt through peer pressure.
-Laggards: last to adopt |
|
|
Term
Program development
mission, goal, objective |
|
Definition
-Mission: what nutrition service can contributeto health and well-being of the community.
-Goal: broad direction, general purpose.
-Objective: specific measurable (tangible actions) SMART GOAL; include who, what behavior (measurable or action verb), how much, by whom, when where. |
|
|
Term
Program development
mission, goal, objective |
|
Definition
-Mission: what nutrition service can contributeto health and well-being of the community.
-Goal: broad direction, general purpose.
-Objective: specific measurable (tangible actions) SMART GOAL; include who, what behavior (measurable or action verb), how much, by whom, when where. |
|
|
Term
Program development
Determine priorities |
|
Definition
-Primary prevention programs: reduce exposure to disease promoter; early screening
-Secondary prevention: recuiting those with risks into treatment
-Tertiary intervention: as disease progresses, intervention to reduce severity. |
|
|
Term
Program development
Budget development |
|
Definition
Phases of budget cycle: prepare request, evealute revenue potential, formulate document, send to legislative, legislative review and authorization, execute the budget (run program), evaluation and review.
Performance budget: summerizes program activities - cost of specifics |
|
|
Term
|
Definition
:disorder of the lower esophageal sphincter: does not relax and open during swallowing - dysphagia
Diet: moist/thick foods - progress to liquids |
|
|
Term
|
Definition
2. Chronic bronchitis (pink puffer): excess mucus production, chronic cough - difficulty eating.
Diet: small, frequent meals/snacks, nutrient dense, meet RDA for vit A,C,E - antioxidents |
|
|
Term
|
Definition
Fat: prevent EFAD, do not exceed 1g/kg/day or 25-30% total kcal
IVFE 2-4% will prevent EFAD |
|
|
Term
| Non-tropical sprue - celiac disease |
|
Definition
:reaction to gluten (specifically gliadin)
Leads to malabsorption (fat soluble vitamins), macrocytic anemia, wt loss, D, steatorrhea, Fe deficiency anemia.
Diet: No wheat, rye, or barley. Oats, bran, graham, malt, bulgur, buckwheat, couscous, durum and orzo may be contaminated.
Okay: corn, potato, rice, soybean, tapioca, arrowroot, flax |
|
|
Term
Gastrectomy:
billroth I
billroth II - concerns |
|
Definition
Anemia: Fe deficiency d/t bleeding, impaired absorption d/t loss of acid.
B12 deficiency: lack of intrinstic factor and bacterial growth.
Folate deficiency: needs B12 for transport, poor folate intake and low Fe serum (cofactor in folate metabolism) |
|
|
Term
Gastrectomy:
billroth I
billroth II - concerns |
|
Definition
Anemia: Fe deficiency d/t bleeding, impaired absorption d/t loss of acid.
B12 deficiency: lack of intrinstic factor and bacterial growth.
Folate deficiency: needs B12 for transport, poor folate intake and low Fe serum (cofactor in folate metabolism) |
|
|
Term
| Inflammatory bowel disease - UC |
|
Definition
Ulcerative colitis: begins in the rectum
s/s: D/anorexia, wt loss, anemia, negative nitirogen balance, electrolyte inbalance, dehydration.
Treatment: maintain fluid and electrolyte balance, energy needs meet BMI needs, limit fat only intolerate, water/fat soluble vitamins suppl.
Acute crohn flare ups; bowel rest, TPN or minimal residue.
Acute UC; elemental diet |
|
|
Term
|
Definition
AI: 38g men, 25g females
high fiber diets may increase need for Ca, Mg, P, Cu, Se, Zn, Fe |
|
|
Term
|
Definition
-ALP Alkaline phosphatase: > with liver/bone disease, < scurvy and malnutrition.
-LDH Lactic acid dehydrogenase: > with hepatitis, mycardial infraction, muscle malignancies
-AST Aspartate amino transferase: > hepatitis, uncontrolled DM with acidosis.
-ALT Alanie aminotransferase: < Liver disease
** All enzymes are increased with liver disease, AST is decreased with uncontrolled DM. |
|
|
Term
|
Definition
Four phases: prodromal: fever, achy joints, rash, flu-like.
Preicteric: N/V, anorexia, extreme fatigue, taste changes.
Icteric phase: jaundice
Convalescent: s/s subsides |
|
|
Term
|
Definition
Treatment: acute; rest panc, withhold feedings, maintain hydration, progress with easily digestable foods, low fat, Elemental EN into jejunum.
Chronic: PERT(panc enzyme replacement therapy) with food, avoid lg, fatty meals and alcohol, give water soluble forms of fat soluble vitamins, B12, antacids for decreased bicarb., TPN for prolonged cases. |
|
|
Term
|
Definition
DASH: whole grains, fruits/veg, low fat dairy, poultry, fish, moderate Na, limit alcohol, decrease sweets.
PA |
|
|
Term
| Heart Failure - treatment |
|
Definition
Treatment: -digitals; increases strength of heart contration.
-Diuretics, may cause nutrient loss, glucose intolerance, increase uric acid.
- low Na - < 2g, DASH, fluid restrition <2L
- 1.2g PRO/kg
- DRIs for folate, mg, mvi with b12, thiamine (loss with diuretics). |
|
|
Term
National CHOL Education Program (NCED)
TLC diet |
|
Definition
TLC: 35% of kcal from fat, <7% sat, no trans, up to 10% poly, up to 20% mono, <200mg CHOL, 25-35g fiber, include soy, stanols, sterols, balance intake/output.
Drug: after TLC attempt, statins lower < LDL/Tg and > HDL. |
|
|
Term
| Ash diets - kidney stones |
|
Definition
Alkaline ash/acid ash diets: minerals not oxidized leave an ash (residue) in urine; to prevent acidic stones - creat alk ash: cations - Ca, Na, K, Mg - veg, milk, fruits.
To prevent alk stones - create acid ash: anions (Cl, Ph, Su) - corn, meat, fish, fowl, eggs, cereal, plumss, prunes, cranberries. |
|
|
Term
|
Definition
Peritoneal dialysis: 1.2-1.3g PRO, <60 35 kcal, > 60 30-35kcal, 2-4g Na, 800-1000mg phos.
Continuous ambulatory PD (CAPD) - no machine - 4-5x/day
Continuous Cyclical PD (CCPD): with machine, cone at night. |
|
|
Term
|
Definition
Goiter: enlargement of thyroid gland d/t insufficient thyroid hormone.
-Endemic goiter: inadequate iodine intake.
Diet: iodized salt, free of goitrogens (contain goitrin - inhibits synthesis of thyroid hormone - cabbage family |
|
|
Term
Inborn errors-
urea cycle defects
PKU |
|
Definition
Urea Defects: can't synthesize urea from ammonia resulting in ammonia accumulation. s/s: V, seisures, coma, lethargy.
Diet: PRO restriction to lower ammonia production
PKU: missing phenylalanine hydroxylase; converts phenylalanine to tyrosine.
-Detected by "Guthrie blood test.
-Diet: restrict PHE, suppl TYR, avoid aspertame. |
|
|
Term
Inborn errors
homocystinurias |
|
Definition
Homocystinurias: treatable inherited disorder of aa metabolism. s/s severe high levels of methionine and homocysteine in plasma, excessive excretion of homocystine in urine.
Associated with low levels of folate, B6, B12 - increase doses for newly diagnosed, if they don't respond - low PRO, low methionine diet. |
|
|
Term
| Domais of Learning - Cognitive |
|
Definition
: acquisition of knowledge and values - factual.
GOALS: - recall, recognnized, remember
-comprehension, understanding
-analyze, synthesize
-Evaluate |
|
|
Term
| Domais of Learning - Affective |
|
Definition
:acquisition of attitudes and beliefs
Goals: - receiving, awareness, listening
-responding, accepting
-valuing, expressig belief in a new idea
-organizing, understadig, how a new value relates to one currently held.
-Characterization, values internalized to control behavior |
|
|
Term
| Domais of Learning - psychomotor |
|
Definition
:acquisition of muscular skills; manipulative (food prep).
GOALs: -basic reflex movement, fundamental movement.
-Coordination, preceptual ability
-Physical ability, strength, endurance
-skilled movement |
|
|
Term
| Behavior Modification - stages of change |
|
Definition
-Operant conditioning (Skinner): behavior that is rewarded will continue, behavior ignored will reduce or stop, behavior that is punished will be reduced temperarily.
-Modeling: observe the behavior, preform the behavior. |
|
|
Term
| Behavior Modification Methods |
|
Definition
-Positive reinforcement: encourages repetition.
-Avoidance learning: learn to escape from unpleasant consequences.
-Extinction: reduce undesired behavior by ignoring, no reinforcement.
-Punishment: trying to correct a behavior by providing negative consequences. |
|
|
Term
| Developing an educational plan |
|
Definition
| Evaluate information, organize into logical sequence, develop lesson plan (objectives, content, timeframe, activities, method of eval), evaluate what has you have developed, focus on learner, posters, slides, computer programs. |
|
|
Term
| Implemention of educational plan - communication priciples |
|
Definition
| Motivation eases transition, emphasize human factors, involve learner in an active way, establish rapport, discuss problems vs. evaluating them, reflective listening, feedback, empathize, good evironment |
|
|
Term
|
Definition
| Group product is superior to what the most resourceful person within the group could have produced by working alone. |
|
|
Term
| Evaulate educational processes - fomative and summative |
|
Definition
Formative:made during the course of education; "how should we do it?", client must be involved
Summative: conducted at the end; What did we achieve? |
|
|
Term
|
Definition
Formal: objective, preformance test, good for academics
Informal: unstructured observation |
|
|
Term
|
Definition
-preperation; collect bg info, establish objectives.
-Build rapport
-Collect data; questions, recalls
-Closing; summarize, when next contact will be.
- |
|
|
Term
|
Definition
-open/closed
-primary: introduces new topic
-secondary: obtain more info, follow up
-neutral: not leading, no bias
-funnel sequence: begin with board, proceed to more restrictive. |
|
|
Term
|
Definition
: framework for negotiating a treatment plan.
-Listen with sympathy and understand
-Explain your perceptions of the problem
-Acknowledge and discuss similarities and differences
-Recommend treatment that is relevant and practical
-Negotiate treatment |
|
|
Term
| Conducting applied research |
|
Definition
-State a problem (null - no relationship)
-Review lit
-Select methodology and materials
-Organize methods and materials
-Collect and analyze data
-Study results and make decsions
-Publish report
- |
|
|
