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101 Cards in this Set
- Front
- Back
When does discharge planning begin for a patient?
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Day 1 of a hospital stay
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What is the cause of most uclers?
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Helicobacter (H.) pylori bacteria
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What is the recommend diet for an ulcer?
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As tolerated, well-balanced, avoid late night snacks
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What is the recommended diet for a hiatal hernia?
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Small, bland feedings
Avoid late night snacks, caffeine, chili powder, black pepper |
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What is the recommended diet following gastric surgery?
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Frequent, small feedings, fluids before or after meals (to slow passage), restrict concentrated sweets
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What is the difference between tropical sprue and non-tropical sprue?
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Tropical Sprue - bacterial, viral, parasitic infection
Non-Tropical Sprue = celiac disease |
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What grains have gluten forming potential?
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Wheat, rye, barley, oats
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How do oat bran and soluble fibers decrease serum cholesterol?
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By binding bile acids converting more cholesterol into bile
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What are examples of soluble fiber?
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Pectins, gums
Fruits, vegetables, legumes, oats, barley, carrots, apples, citrus fruits, strawberries, bananas |
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What are the complications of losing the terminal ileum?
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Problems absorbing B12, intrinsic factor, bile salts
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What happens if the body loses the ability to reabsorb bile salts and how can this happen and what is the recommended diet therapy?
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Losing terminal ileum, then they are not available to emulsify fat, which means fat should be given in MCT since they do not require bile salts for absorption.
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What are major complications of ulcerative colitis?
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Chronic bloody diarrhea, loss of electrolytes
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What happens to blood glucose levels during a lactose tolerance test for those tolerant and intolerant to lactose?
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Intolerant - blood glucose will rise <25mg/dal above fasting, showing a flat curve
Tolerant - blood glucose will rise >25 mg/dl, showing a normal glucose curve |
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What are the recommendations for giving juice to children under 6?
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Restrict or dilute fruit juices with high osmolar loads like grape and apple
Limit to 4 oz/day |
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What are most severe losses for someone with short bowel syndrome?
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Loss of ileum, ileocecal valve and loss of colon
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What are elevated liver enzymes indicative of?
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Tissue damage
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Name the 4 enzymes that will be elevated in liver disease.
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ALP - alkaline phosphatase
LDH - lactic acid dehydrogenase AST - aspartate aminotransferase ALT - alanine aminotransferase |
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What is a major symptom of acute viral hepatitis and what is the recommended diet?
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Anorexia
Recommend small, frequent feedings because of the anorexia |
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What causes ascites?
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When blood cannot leave the liver, the liver expands, pressure forces fluid through into the peritoneal cavity
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What causes esophageal varices?
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When blood can't enter the liver.
Portal hypertension - blood gets backed up, forces out-pouching of walls |
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What is the recommended diet for cirrhosis? If varices are present? If edema or ascites is present?
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High protein, high calorie, moderate fat
Varices - low fiber Edema/ascites - low sodium |
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What disease is caused by a long-term thiamin deficiency (in alcoholics)?
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Wernicke-Korsakoff Syndrome
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What is the recommended diet for hepatic failure? How about one novel theory?
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moderate to high levels of protein
adding BCA when standard therapy doesn't work, to help with altered neurotransmitters |
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How is bile secreted after a cholecystectomy?
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Bile now secreted from liver directly into intestine
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What is one cause of inflammation in pancreatitis?
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Premature activation of pancreatic enzymes leads to auto-digestion (pancreatic enzymes digest the pancreas)
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What is the recommended diet for pancreatitis?
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Elemental (pre-digested) enteral nutrition into the jejunum may be tolerated
Low fat content |
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Describe the DASH diet and what it's used for.
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Lower blood pressure
Whole grains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI |
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Describe the TLC diet and what it's used for.
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Lower cholesterol
Up to 35% kcal from fat <7% from sat fat up to 10% PUFA up to 20% MUFA <200 mg cholesterol 25-30 g fiber (half soluble) Stanols/sterols to inhibit cholesterol absorption Prevent weight gain Increase physical activity to at least 30 min/day |
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What are the 3 hormones involved in renal function?
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Vasopressin (ADH) - elevates blood pressure
Renin - vasoconstrictor Erythopoietin (EPO) - stimulates bone marrow to produce RBC |
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What lab values are decreased in renal disease?
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Glomerular filtration rate and creatinine clearance
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What lab values are increased in renal disease?
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Serum creatinine, BUN
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What BUN:creatinine ratio suggests acute kidney damage and what level indicates a need for dialysis?
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> 20:1 = acute kidney damage, may be reversible
< 10:1 = reduced BUN reabsorption, may need dialysis |
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What does the renal solute load measure?
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Mostly nitrogen (60%) and sodium (electrolytes)
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What is the primary dietary therapy for kidney stones?
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High fluid intake to dilute urine and break up stones
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What are the signs of nephrotic syndrome?
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Albuminuria, edema, malnutrition, hyperlipidemia
Increased synthesis and decreased clearance of VLDL |
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What is the dietary therapy for nephrotic syndrome?
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Modest protein (.8-1 g/kg) and fat restriction
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When do you restrict protein in chronic kidney damage?
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When GFR falls
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What is the recommend diet for hemodialysis patients?
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1.2 g protein/kg (at least 50% high biologic value)
30-35 kcal/kg |
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What is the recommended diet for peritoneal dialysis patients?
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1.2-1.3 g protein/kg suggested body weight, more than 50% high biologic value
<60 years old - 35 kcal/kg >60 years old - 30-35 kcal/kg |
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What are normal, impaired and diabetic fasting glucose levels?
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Normal: 70-100
Impaired: 100-125 Diabetic: >126 |
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What are normal, impaired and diabetic post-prandial glucose levels?
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Normal: <140
Impaired: 140-199 Diabetic: >200 |
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What does a normal glucose tolerance blood test look like versus a diabetic curve?
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Normal curve: sloped
Diabetic curve: rounded |
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What is the A1c goal for diabetics?
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<7 (normal is <5.7)
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What are the goal blood sugar levels for diabetics?
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Fasting: 70-130
Post prandial: <180 |
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What are the risk factors for developing gestational diabetes?
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BMI >30
History of GDM |
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What are the exchanges for starch?
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CHO: 15
Protein: 3 Fat: 0 Kcal: 80 |
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What are the exchanges for fruit?
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CHO: 15
Protein: 0 Fat: 0 Kcal: 60 |
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What are the exchanges for skim, low fat and whole milk?
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CHO: 12
Protein: 8 Fat: 3 (skim), 5 (low fat), 8 (whole) Kcal: 100 (skim), 120 (low fat), 150 (whole) |
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What are the exchanges for vegetables?
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CHO: 5
Protein: 2 Fat: Kcal: 25 |
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What are the exchanges for lean, medium and high fat meat?
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CHO: 0
Protein: 7 Fat: 3 (lean), 5 (medium), 8 (high) Kcal: 45 (lean), 75 (medium), 100 (high) |
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What are the exchanges for fat?
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CHO: 0
Protein: 0 Fat: 5 Kcal: 45 |
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What are the exchanges for alcohol?
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CHO: varies
Protein: Fat: Kcal: 100 |
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What are the types of insulin, onset, peak and duration?
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Rapid Acting (Humlog, Novolog)
Onset: 10-30 min Peak: 30-50 min Duration: 3-5 hours Short Acting (Humulin, Regular human insulin) Onset: 30-60 min Peak: 2-5 hours Duration: 5-8 hours Intermediate Acting (NPH, Lente) Onset: 1-2 hours Peak: 4-12 hours Duration: 18-24 hours Long Acting (Basal, Lantus) Onset: 30-60 min Peak: no peak Duration: 24 hours |
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What is the dawn phenomenon?
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Natural increase in early morning blood glucose and insulin requirements due to increased glucose production in the liver after overnight fast
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What is ketoacidosis and what are the signs?
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Complication of uncontrolled diabetes
Hyperglycemia due to insulin deficiency or excess CHO intake Signs: dehydration (due to polyuria-excess urine) and a rapid pulse |
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How do you treat ketoacidosis?
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Insulin and rehydration
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How do you prevent postprandial or reactive hyperglycemia?
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Goal: prevent marked rise in blood glucose that would stimulate more insulin
Prevent: Avoid simple sugars, 5-6 small meals/day, spread intake of CHO throughout the day |
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What is the difference between hyperthyroidism and hypothyroidism?
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Hyper- excess secretion of thyroid hormone; elevated T3 and T4
Hypo - deficiency of thyroid hormone; low T4, low or normal T3 |
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What is the cause of galactosemia and what is the treatment?
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Due to missing enzyme, treated solely by diet (galactose and lactose free)
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What is the treatment for urea cycle defects?
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Diet - protein restriction based on tolerance to lower ammonia
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What is the treatment for phenylketonuria (PKU) and what is one side effect in children?
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Restrict substrate phenylalanine (PHE) through low protein, high carb diet
High carb diet may lead to increased dental carries in children |
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What vitamins will be low in homocystinurias?
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Folate, B6, B12 - so need to supplement
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What is the recommended diet therapy for skeletal and connective tissue disorders?
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Regular, well-balanced diet with vitamin intake to at least DRIs
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Describe the characteristics of someone most at risk for osteoporosis?
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Elderly, frail, white, women
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When should phenytoin be taken in relation to food, what is the medication used for and what is another name for the drug?
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phenytoin = Dilatin = anticonvulsant
Taken away from food, at least 2 hours. Hold tube feedings. |
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Describe a ketogenic diet, the fat:non-fat grams ratio and the necessary supplements.
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High fat, very low carb (4:1 fat:non-fat grams)
Supplement: Ca, D, folate, B6, B12 |
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Explain the difference between the 2 types of cerebral palsy and their diets.
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Spastic form - difficult stiff movements
Diet: low calorie diet, high fluid, high fiber Non-spastic (athetoid) form - involuntary, wormlike movements Diet: high calorie, high protein, finger foods |
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What is the recommended diet therapy for pressure ulcers, including kcal/kg?
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High kcal, high protein, normal Ca, adequate fluids
30-40 kcal/day |
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What is the difference between macrocytic and microcytic anemia?
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Macrocytic - megaloblastic anemia, few large cells, filled with hemoglobin; due to folate or B12 deficiency
Microcytic - hypochromic anemia, small, pale cells; due to iron deficiency |
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What is the normal value for MCV (mean corpuscular volume) and for MCH (mean, corpuscular hemoglobin)?
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MCV = 80-95 fL
MCH = 27-32 pg |
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What are the 7 most common allergens?
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Peanuts, tree nuts, eggs, milk, soy, wheat, shellfish
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How is BMR affected by fever?
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BMR increases 7% for each degree rise in F temp (normal temp is 98.6F)
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What are the results of physiologic trauma?
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Hyperglycemia
Hyperinsulinemia Little or no ketosis Elevated glucagon |
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What is the recommended diet therapy for thrush (from oral infections)?
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Avoid spicy, acidic, strongly flavored foods
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What is iatrogenic malnutrition and what causes it?
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Protein-calorie malnutrition, brought on by treatment, hospital, medications
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What are the 3 classes of BMI obesity?
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Class I = 30-34.9
Class II = 35 - 39.9 Class III = +40 |
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What is the recommendation for overweight children?
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2-5 years old, weight maintenance
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What do blood cholesterol levels look like for a healthy obese person?
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Elevated LDL, normal to low HDL
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Who qualifies for bariatric surgery?
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Class III obesity or Class II with comorbidities
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What is the best treatment for Prader-Willi syndrome?
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Control food intake and access to food
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Do sugar alcohols like sorbitol promote tooth decay?
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No
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What are fluoride recommendations for children?
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Birth-6 mo: oral supplementation not recommended
6-12 mo: fluoridated water, supplements only if prescribed 1-2 years: fluoridated water, supplements only if prescribed 2-3 years: fluoridated water, fluoride toothpaste |
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What is achalasia?
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Disorder of lower esophageal sphincter motility (does not relax and open upon swallowing)
Causes dysphagia |
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Is a sodium restriction recommended for pregnant women to control pregnancy-induced hypertension?
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No, sodium is needed to maintain normal levels of sodium in plasma during large prenatal expansion of tissues and fluid
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What are elemental, chemically defined formulas and when are they used?
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Predigested protein or amino acids.
Used with malabsorption, compromised GI function Ex: Peptamen, Vivonex, Alitraq |
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What is a transplyoric placement and when is it used?
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Passed by pyloric valve in stomach
Used in comatose patients or those with no gag reflex. |
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What are the water recommendations for enterally fed patients and what is the usual amount of water in formulas?
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Give 1 cc water/calorie ingested
1 kcal/cc formulas are 80-86% water |
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How do you calculate the calories from dextrose in formulas?
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ml x % concentration x 3.4
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How many calories are in 10% and 20% fat solutions?
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10% = 1.1 kcal/ml
20% = 2 kcal/ml |
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Name some conditions in which TPN may be indicated.
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Altered GI function, inability to absorb nutrients, malabsorption, diffuse peritonitis, intestinal obstruction, short bowel syndrome, hypermetabolic states, cancer patients on therapy, GI disorders (peritonitis), fistulas, severely malnourished pre-op patients, acute pancreatitis critical care patients if NPO is expected to last for more than 4-5 days and enteral support is not possible
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What is a concern in TPN that may causes sepsis?
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Translocation bacteria - not feeding through gut allows walls to break down, bacteria move out, causing sepsis
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What does the % indicated about protein in TPN solutions?
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% = number of grams of protein in 100ml of solution
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What is the max rate of dextrose infusion and why?
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4-5 mg/kg/min, to prevent hyperglycemia
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How do you transition a patient off of TPN?
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Introduce a minimal amount of full-strength enteral feeding at a low rate of 30-40 ml/hr to establish GI tolerance.
When patient can tolerate about 75% of needs by enteral route, stop TPN |
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What lab values suggest re-feeding syndrome?
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Low K, Mg, Phos
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Which anemia is also called megaloblastic anemia?
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macrocytic anemia
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Which anemia contains few large cells, filled with hemoglobin?
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macrocytic anemia
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Which anemia is caused by iron deficiency?
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microcytic anemia
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Which anemia is caused by folate or B12 deficiency?
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macrocytic anemia
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Which anemia contains small, pale cells?
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microcytic anemia
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Which anemia is called hypo chromic anemia?
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microcytic anemia
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