Nutrition Final Review Sheet PDF

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NUTRITION FINAL EXAM REVIEW SHEET 2019 1. Difference in Upper and Lower Gastrointestinal tract conditions Upper (mouth, esophagus, stomach) and problems with upper GI tract affect nutrition mostly by affecting food intake and tolerance to particular food or textures *nutrition therapy is used to restore nutritional status that has been compromised by dysfunction/disease disorders include: anorexia dysphagia nausea+vomiting GERD peptic ulcer disease gastroparesis Lower (small and large intestines, rectum, anus) 95% of nutrient absorption occurs in the first ½ of small intestine large intestine absorbs water, electrolytes, and promotes the elimination of solid wastes accessory organs (liver, gallbladder, pancreas) is involved in nutrient digestion *nutrition therapy is used to improve/control symptoms, replenish losses, and promote healing disorders include: altered bowel elimination constipation diarrhea malabsorption disorders lactose malabsorption inflammatory bowel disease celiac disease short bowel syndrome large intestine IBS diverticular disease ileostomies+colostomies accessory organs liver disease pancreatitis gallbladder disease

2. Difference in complications between Type 1 and Type 2 Diabetic complications Type 1 (absence of insulin) *requires exogenous insulin to control blood glucose levels classic symptoms: polyuria, polydipsia, polyphagia TREATMENT: insulin Type 2 (a slowly progressive disease the usually begins as a problem of insulin resistance; often asymptomatic) insulin resistance is strongly linked to obesity many risk factors are characteristics of Metabolic Syndrome (METS): central obesity, insulin resistance, dyslipidemia, hypertension Modifiable risk factors for METS+diabetes: excess body fat, sedentary lifestyle, high-saturated fat diet TREATMENT: lifestyle modifications may be sufficient like regular physical activity, weight loss, healthy diet Acute Complications elevated blood sugar levels can lead to diabetic ketoacidosis abnormally low blood sugar levels due to too much insulin/other glucose-lowering medications Chronic Complications **accelerated blood vessel damage** like small vessel disease atherosclerosis coronary heart disease stroke angina/heart attack diabetic neuropathy: damage to the nerves that can cause numbness/tingling

3. Enteral Nutrition Routes **to be on enteral nutrition must have a partially functioning GI tract** Indications for EN: dysphagia, mechanical ventilation, poor oral intake, critical illness, head/neck surgeries, malnutrition with adequate oral intake Enteral Access depends on anticipated length of time tube feeding will be used Short term 10% loss of admission weight recommended protein intake is 1.5 -2.0 g/kg/day high calorie and high protein formula

14. Read about the Refeeding Syndrome DEFINED: an ill-defined disorder that generally occurs when carbohydrate is reintroduced into the diet of severely malnourished patients the sudden availability of carbohydrate stimulates insulin secretion and increases the need for thiamin and minerals involved in carbohydrate metabolism sodium/fluid retention and thiamin deficiency can cause edema/heart failure and acidosis, hyperventilation, and neurologic impairments, respectively hypophosphatemia, hypokalemia, and hypomagnesemia occurs as cells rapidly remove these minerals from the bloodstream overfeeding carbohydrates in nutritionally debilitated patients can lead to this life-threatening complication for anorexia nervosa patients, lower-than-needed calorie intake is needed to reduce the risk of refeeding syndrome patients who weight plant sources in biological value

30. Asymptomatic HIV/AIDS relationship with Caloric intake Asymptomatic: unintentional weight loss 10% body weight in one year, less calories WHO recommends calorie intakes increase by 10% for asymptomatic clients so that body weight can be maintained high calorie, high protein diet for those experiencing weight loss When HIV is symptomatic, calorie need is estimated to increase 20-30% above normal

31. Hydrolyzed Enteral nutrition in relation to an AIDS patient with a non-functioning GI tract -

hydrolyzed formulas consumed orally may be just as effective as PN in preventing weight loss in patients with severe malabsorption, with no risks associated with PN those with a nonfunctional GI tract, PN is required. *with extra attention to ensure sanitary conditions due to compromised immune systems disease-specific formulas are available

32. Source of the greatest amount of sodium in an American Diet More than 75% of the sodium in a typical American diet comes from processed foods, it is difficult for people who regularly consume process, prepackaged, and restaurant foods to lower their sodium intake breads/rolls, cold cuts/cured meats, pizza, soup, sandwiches, and poultry are identified as the top 6 sources of sodium in a typical American eating pattern

33. Main difference between a DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean Style Eating diet/pattern DASH: -

focused on eating whole “real” foods rather than individual nutrients to lower BP as a result of some combination of nutrients, interactions among individual nutrients, and other food factors lower in sodium/carbohydrates provides major health benefits

Mediterranean Style: moderate in total fat (32-35% of total calories), low in saturated fat (9-10% of total), high in fiber (27-37 g/day), high in unsaturated fatsU characterized by: high intake of olive oil, fruits, nuts, vegetables, cereals; moderate intake of fish and poultry; low intake of dairy products, red meat, processed meats, and sweets; wine in moderation, consumed with meals

34. When following the DASH diet, look up Potassium in relation to lowering Blood Pressure

In the original DASH diet, it is rich in potassium and it lead to a decrease in blood pressure without lowering sodium intake or calories to produce weight loss recommendation 4.7 g/day

35. Pain related to duodenal and gastric ulcers Duodenal ulcers - relieved by food Gastric ulcers - pain made worse by food

36. Etiology difference between Type 1 and Type 2 diabetes Type 1: Type 2: -

characterized by the absence of insulin accounts fo 5-10% of cases; most diagnosed before the age of 18 occurs from an autoimmune response that damages/destroys pancreatic beta cells, leaving them unable to produce insulin interaction between genetic susceptibility and environmental factors, such as viral infection, is thought to be responsible require exogenous insulin non-insulin-dependent diabetes is most often diagnosed after the age of 45 and accounts for 90-95% OF ALL CASES a slowly progressive disease characterized by a combination of insulin resistance and relative insulin deficiency excess weight is strongly linked to type 2 diabetes other risk factors include: physical inactivity, hypertension, first degree relative with diabetes, member of high risk ethnic group, and history of gestational diabetes can initially be managed by exercise and proper diet

37. What happens to sodium and urea in nephrotic syndrome Nephrotic Syndrome: collection of symptoms caused by alterations in the kidney’s glomerular basement membrane that results in large urinary losses of albumin and other plasma proteins Major Features: hypoalbuminemia, hyperlipidemia, edema **Abnormal sodium and water retention occurs at the kidney level that ultimately causes expansion of interstitial volume and edema** sodium restriction begins when fluid retentions occurs; in edema, glomeruli that filter out waste products doesn’t work urea is a product of protein metabolism Although characterized by increased urinary losses of plasma proteins, a high-protein diet is contraindicated because it exacerbates urinary protein losses, promoting further kidney damage

38. Complications related to cancer/mass in the throat -

GI obstruction can cause anorexia, dysphagia, early satiety, nausea, vomiting, pain, diarrhea, leading to weight loss and malnutrition Surgery in the head/neck area can lead to: impaired ability to speak, chew, salivate, swallow, smell, taste; tubefeeding dependency, and the negative impact on nutritional status can be profound

39. Modifiable risk factors of coronary heart disease CHD accounts for more than half of all CVD events in American adults under the age of 75 years Modifiable Risk Factors: smoking, total cholesterol levels, systolic BP, physical activity

40. What does the main complication of atherosclerosis depend on Atherosclerosis: the plaque build up of fatty material on the inner wall of arteries ** SIZE, STABILITY, AND LOCATION of the plaque leading cause of death for people with diabetes

41. Defined standard Hypertension Blood Pressure parameters Normal BP: 120/80 mm Hg Hypertension: 140/90 mmHg (sustained elevated BP)

42. Pharmacologic effects on diverticula disease and irritable bowel syndrome Diverticular Disease:

-

high-fiber diet is recommended to prevent disease based on the theory that soft, bulky stools that are passed easily decreased pressure within the colon avoid nuts, seeds, and popcorn because it may get trapped in diverticula daily intake of probiotics/prebiotics such as yogurt, miso, or kefir, may be helpful

IBS: -

an elimination diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols and gluten-free diet may be helpful soluble fiber has been associated with improved IBS symptoms

43. Behavior modification related to obesity **focuses on changing the client’s eating and exercise behaviors** setting a modest weight loss goal and sustaining that weight loss are far more realistic than striving for thinness Weight Loss Interventions include: comprehensive lifestyle treatment, medication, bariatric surgery Eating Strategies: portion control, replacing sugar-sweetened beverages with water or artificially sweetened beverages leads to a 2-2.5% weight loss over a 6 month period **Behavior Modification** focuses on changing eating and exercise behaviors thought to contribute to obesity and closely monitoring behaviors

44. Use of therapeutic diet Therapeutic diets differ from a regular diet in the amount of one or more nutrients or food components for the purpose of preventing/treating disease/illness the number/timing of meals may also be altered SOME EXAMPLES: high/low fiber, fat restricted, heart healthy, sodium restricted, gluten free, lactose restricted

45. Possible Candidates for enteral nutrition *EN has been the standard of care for providing nutrition support for patients who are unable to consume adequate calories/protein orally but have at least a partially functional GI tract that is accessible and safe to use* Indications for EN: dysphagia, mechanical ventilation, chronic history of poor oral intake, critical illness, head/necl surgeries, and malnutrition with inadequate oral intake

46. Basic facts about Ulcerative Colitis and Crohn's disease Both are a part of Inflammatory Bowel Disease (IBD) CD is more likely than UC to cause nutritional complications such as protein-calorie malnutrition and micronutrient deficiencies Ulcerative Colitis: dietary modifications are based on symptoms/complications when disease is active, symptoms of bleeding/diarrhea are treated with an increased intake of fluid, electrolytes, protein, and calories a low-fiber diet minimizes stimulation to the bowe Crohn’s Disease: primarily affects the small bowel interventions are based on the presence/severity of symptoms, presence of complications, and nutritional status of the patient when active, patient may benefit from a low-fiber diet, limiting fat (if storrhea is present), increasing protein/calories to facilitate healing, restricting lactose, fructose, sorbitol (if diarrhea), adn small, frequent meals

47. Liver detoxifiers -

lIver synthesizes plasma proteins, blood clotting factors, and nonessential amino acids, and forms urea from the nitrogenous wastes of proteins. Triglycerides, phospholipids, and cholesterol are synthesized in the liver, as is bile, an important factor in the digestion of fat Liver is VITAL for detoxifying drugs, alcohol, ammonia, and other poisonous substances

48. American Heart Association 2020 goals regarding Cardiovascular disease **”to improve the cardiovascular health of all Americans by 20% while reducing death from CVD and stroke by 20% New metrics: smoking, BMI, physical activity, diet quality, total cholesterol level, blood pressure, and fasting glucose level

49. Differences in modifiable and non-modifiable risk factors of Coronary Heart Disease Modifiable: smoking, total cholesterol levels, systolic BP, physical activity

NONModifiable: age, ethnicity, genetics

50. Contributing factors of GERD GERD: occurs when gastric contents bac up into the esophagus producing symptoms of indigestion, “heartburn”, regurgitation INCREASING RISK FACTORS: obesity, pregnancy, delayed stomach emptying FACTORS THAT CAN AGGRAVATE: smoking, eating large meals/eating late at night, eating trigger foods (fatty/fat foods), drinking certain beverages (alcohol/coffee), taking certain medications (aspirin)

51. The main function of Iron pills -

reducing fatigue, treating anemia, boosting immunity, among many other health benefits

52. Changes occurring in Metabolic and Respiratory Stress – Stress Response Metabolic Stress: changes in metabolic rate, heart rate, BP, nutrient metabolism Respiratory Stress: occurs when gas exchange between the air and blood is impaired *Both leads to respiratory failure, multiple organ failure, and death

53. Ileostomy and Colostomy -

performed after part or all of the colon, anus, and rectum are removed, usually for treatment of severe IBD, intestinal lesions, obstructions, or colon cancer Potential nutritional problems: arise because large amounts of fluid, sodium, and potassium are normally absorbed in the colon the smaller the length of the remaining colon, the greater the risk for nutritional problems Goals of Nutrition Therapy: to promote healing postoperatively; minimize symptoms; and prevent nutrition deficiencies, dehydration, and electrolyte imbalances initially, only clear liquids that are low in simple sugar are given to decrease the risk of osmotic diarrhea nutrition therapy guidelines focus on minimizing symptoms...