MNT 1 Study Guide

Nutrition Assessment
● Which of the following diets have the potential to meet all the pt. nutrient needs? → soft + full
● Mid-arm muscle circumference provides information about → somatic protein status
● Purpose of nutritional screening → ID pts. at nutritional risk.
● Nut. screening should be done (H) within ??? after admittance → 24 hours
● Limitations to 24h recall → not representative, reliance on memory
● Which of the following can be used for assessing bone mineral density + fat v. muscle → dual energy xray absorptiometry
● During the assessment of nutritional status, more objective → eval. biochemical tests
● Measurement of hip-waist ratio → implicated in the risk of developing CVD
● Skin folds → Measure of fat mass
BMI Classifications 40 = morbidly obese
HAMWI Equation
%IBW
M: 106 + 6lb per in
(CW/IBW)x100
W: 100 + 5lb per in
MSJ
(9.99xkg)+(6.25x cm)-(4.92xage) -161(W) + 5(M)
Nourishment + Body Weight
>70% IBW = severely undernourished
70 - 80% IBW = mod. undernourished
80 - 90% IBW = mildly undernourished
Intra-abdominal fat- apple subcutaneous fat - pear
Labs + Fluids
● In pts. with fluid retention, what happens to biochemical indicators for nut. status → they are decreased due to hemodilution
● In urinalysis, which of the following is NOT expected to appear in healthy people ? → none of the above
● Which of the following condition would make serum albumin invalid indicator of visceral protein status
→ all of the above
● Longest half-life → serum albumin
● A biochemical indicator with a ?? half-life it better for recent changes → short
Drug Interactions
● Corticosteroid drugs, like prednisone have nut-related side effects → all of the above
● My grandmother...Lasixs for BP ate a banana → diuretics, like lasixs, can increase excretion of potassium ● How can drugs influence nutrition health → all of the above ● Which of the following is at the lowest risk for drug/nutrient interaction → 40yr old medication for a short period of time
● An excipient is → inactive ingredient
● Decreased serum albumin levels affect meds by → leading to decreased metabolism of the drug by the liver. ● A pt. on warfarin/coumadin should be given what
MNT edu → maintain consistent Vit K
● The GI side effect commonly seen when narcotic drugs are admin → constipation
● NSAIDS may increase → GI bleeding
● Someone may experience drug-diet interaction from the inactive ingredients → true sensitivity - ability of test to indicate abnormality when present. specificity - ability of test to indicate normal when no abnormality is present
High Fiber- w25g/m38g

Enteral /Parenteral
● Hiatal hernias can → contribute to GERD
● A pt. __ should be elevated at least __ d for
● What is the major difference between gastric and continuous drip and bolus feedings that ___ → head, duodenal ulcers → H.pylori is the primary cause of
30, directly enter the stomach gastric ulcers.
● Which method of TF would be most apprp. for a
● Which of the following is NOT associated with person with no GI blockage but needs LT TF → PEG dyspepsia → being underweight
● Advantages of fiber supp. enteral formulas → all of
● Which of the following surgeries would be used to the above. treat a pt. with GERD → fundoplication
● Modular formulas are used → to increase either kcal ● Which of the following is a condition involving the or protein cells lining the distal esophagus becoming abnormal
● A carb controlled formula → pt with diabetes and premalignant → Barrett's Esophagus
● Enteral is prefered over parenteral → all of the above Achalasia - motility disorder of esophagus where
● Which of the following TF admin would you nerves don't stimulate peristalsis correctly recommend for a pt. who is having nausea and
Dysphagia - Difficulty swallowing, resulting in diarrhea → continuous drip decreased and limited consumption
● A TF pt on continuous drip with high residuals →
Esophagitis - Inflammation, ulceration, erosions, should have their TF admin. at a lower rate scarring CAUSED by GERDS, corrosion, infection,
● When lipid emulsion contraindicated for TPN pt. → b intubation, radiation, NSAIDS and c only
GERDS - Symptoms - chest pain, dysphagia, laryngitis,
● A consequence of abruptly stopping TPN infusion is sore throat. Causes - hiatal hernia, ↓LES pressure (poor
→ hypoglycemia diet + obesity). MNT - ↓fatty foods, no mint or spicy, no
● The best type of TF for pt with ulceration of the alcohol or smoking, Meds - antiacids (can cause esophagus would be → PEG problems denaturing proteins), RX anti-acids, PPI
● A placement of the tube into the __ would make it protein inhibits pump (↓ acid secretion) less likely for the pt. to develop diarrhea → stomach
Gastroparesis - Symptoms - delayed emptying,
● Complications of TPN include → all of the above chemical/neuro factors, diabetes,
● A bolus feeding has the following advantages…
EXCEPT → a bolus feeding results in a decreased
Lower GI likelihood of GI disturbances, like cramping, bloating
● Which of the following enhances the absorption of and diarrhea. dietary iron → Vitamin C
● When a pts sole source of nutrition is parenteral
● Which of the following may reduce the absorption of solution, a lipid emulsion should be admin at least iron → coffee or tea once a week → false
● Which of the following foods provide significant
Enteral Access
Calories
amounts of folate in the diet → fresh fruit and veg
NG= nasogastric dextrose 3.4 kcal/gr ● Blind loop syndrome → a disorder of bacterial
NJ=nasojejunal
amino acid 4.0 kcal/gr overgrowth with malabsorption
PEG= direct access lipid 7.0 kcal/gr
● Which of the following should be included in the
Formulas
Bolus maximum advice given to a patient regarding eating a
Intact- unaltered p, cho, L
60mL syring high-fiber diet → drink at least 2L of water/day hydrolyzed - predigested P
500 mL/ feeding
● The more common cause of antibiotic-induced modular- specific macronut. diarrhea is → clostridium difficile
Refeeding Syndrome
● Which of the following statements is true regarding
● Nutrients are introduced too soon
MCT → MCT are rapidly hydrolyzed and absorbed in
● rapid CHO stimulate insulin, mg shift → fluid the absence of bile acids retention → cardiopulmonary problems
● More common CHO intolerance → lactose
● P, K, Mg shift in cell = low serum levels
● What is a characteristic difference between Crohn's and colitis → one can be continuous throughout the
Upper GI
GI and on is only in the lg. intestine
● Food that can cause a ↓ in the pressure of the LES
● Initial treatment of diarrhea → replacement of fluits
(worsen GERD) include → fatty foods, alcohol and electrolytes
● Which is not true about H-pylori → it is a viral
● Not included in gluten-free diet → wheat, rye, barely, infection found in the intestine oats ● Dietary management of peptic ulcer disease include
● A lifelong low-fiber diet is considered to be the cause
→ all of the above of → diverticulitis
● When a proton pump inhibitor is used to peptic
● Short gut syndrome is associated with → crohn's ulcers, the pt. is at risk for → vitamin B12 disease ● RF, 62 yr old women hospitalized with gastric cancer
● ____ is the preferred fuel for sm. intestine →
→ dumping syndrome glutamine ● Characteristics of antidumping diet include → a and
● When a pt. with crohns disease is experience b only steatorrhea, pt should be monitored for → A and B
● After the assessment of a patient that oral intake is
● Excessive fluid loss would be more of a concern for pt no → what is the next determination to be made → who have had → an ileostomy is the GI tract functional
● GI symptoms are often reduced by following a
● Which condition would most likely require TPN as
FODMAP diet → IBS
MNT → potentially all of the above
● In MNT for IBD, which of the following is LEAST likely
● What type of enteric tube enters at the nose and to be used → lactose-free or reduced lactose diet terminates at the stomach → nasogastric
Anemia
● The following is NOT a potential complication of EN
● How does pernicious anemia differ from folate feeding tubes → thrombophlebitis deficiency → pernicious anemia affects the central
● For the pts. with delayed gastric emptying, nausea and peripheral nervous system and vomiting or other indications of risk of
● Which nut. deficiency of most likely to cause an aspiration, the tube should be placed → nose into anemia that appears microcytic and hypochromic → the duodenum or jejunum
Iron
● In homecare, what is the LEAST recommended admin ● What causes pernicious anemia → B12 for EN → continuous pump
● After absorption, iron is transported by → plasma transferrin Folate supplementation masks B12 deficiency!

Anemia cont...
Iron Deficiency
● Causes - poor intake, vegan, blood loss, trauma, impaired absorption,
● symptoms - pallor, ↓”energy”, ↓cell metabolism, irritability, mental,pica
Iron Inhibiting foods
Anti-acids, zinc, calcium, wine, coffee, tea, phytates,
Iron Increasing foods vitamin C, empty stomach
Serum Ferritin → stores the iron + present in the blood
TIBC→ capacity of iron to bind to transferrin
Transferrin → (transport protein) ↑during iron def. as body tries to transport more iron through body
Diabetes
● HbA1C → glycosylation of glycation of hemoglobin in red blood cells
● Which of the following contributes to the dev. of type
1DM → auto-antibodies that destroy beta cells
● ___ is not a symptom of type 1 DM → loss of thirst sensation ● It a pt. with type 2 DM receives a nutrition prescription → 50%cho, 20% p, 30% F
● What does insulin promote in regard to the metabolism of lipids → lipogenesis in liver
● What is the recommendation for self-mon of BG for pt,. with type 1 → at least 8x day
● Screening of gestational diabetes should occur → at
24 - 28 week
● “Tight control of blood glucose in ppl w/ diabetes →
A and B only
● Which of the following best describes the current approach to MNT for diabetes → MENT is aimed at the achievement of blood glucose + lipid goals
● For a person with diabetes, protein should be limited if → microalbuminuria is present
● Pts. with diabetes are at increased risk of amputation because → all of the above
● Which of the following increase insulin sensitivity in
Type 2 diabetics → all of the above
● The __ period is a temp time of remission of type 1
DM that occurs shortly after diagnosis → honeymoon ● In pt. with diabetes, alcohol can → A and C
● Which of the following is the best indicator of diabetes control over time → A1C
● For a person with diabetes, hyperglycemia is likely to result from all the following EXCEPT → insufficient food. ● What is recommended for self-monitoring of BG for patients with type 2 diabetes → occasional monitoring is adequate for type 1 DM
Glucose Levels
Glucose / lipid goals
Normal: 70-100 mg/dL
A1c 40
OGTT: > 200mg/dL
TRIGS < 150
A1C > 6.5%
BP 130/80
Complications of Diabetes
● sorbitol → water retention
● glycosylation of proteins
● macro/microvascular damage, neuropathy, GI nerve, limb amputation
Insulin and Diabetes Drugs
● How do sulfonylureas and meglitinides help to lower blood glucose levels → promote beta cell secretion of insulin ● Which insulin peaks in activity 2-3 hours after injection → regular
● If a person with type 1 diabetes has a set insulin regimen of 3 injections per day → they need to consume meals at consistent times with consistent
CHO content.
● Negative side -effects of oral hypoglycemic agents that act as insulin secretagogues → B and C

Insulin regimen
Bolus - mimics pancreatic insulin response.
Long acting - mimics basal pancreatic output (to limit catabolic pathways)
Fixed insulin regime
Adjustable insulin regime
Sulfonylureas - FXN - Improve insulin secretion from pancreatic beta cells.
Biguanides - FXN - reduces hepatic glucose output
Thiazolidinediones (TZD) - FNX - increase insulin sensitivity DPP-4 Inhibitors - FXN- slows the inactivation of incretin hormones, increasing insulin release
Exenatide (Byetta) 2x - FNX - synthetic protein in saliva to stimulate insulin production
Liraglutide (Victoza) 1x - FXN -stimulate insulin production Rapid acting insulin - onset 5-15min/peak 1-2hr/ duration 6-10hr
Short acting insulin- onset 30-60min/peak 2-4hr/ duration 6-10hr
Intermediate Insulin - onset 1-2hr/peak 4-8hr/ duration 10-18h // Long Acting Insulin onset 1-2hr/

Risk Factors and Prognosis in Hypertension hypercholesterolemia, obesity, ETOH intake, end-organ damage, cardiac enlargement, MI, HF, impaired renal fxn, CVA, papilledema
MNT Therapy
● DASH DIET (Ca, K, Na. Mg)
● Wt. management
● Alcohol
● Physical activity
● Omega-3 Fatty acids
Lasixs
Decrease blood volume, causing your kidneys to filter more blood, and pt to pee more. This causes a potassium loss = must replace potassium
AVOID salt: counteracts Lasixs by retaining water.
Homocysteine - an amino acid in the blood. Too much of it is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease (fatty deposits in peripheral arteries).
→ B12 and Folate - Folic acid and other B vitamins help break down homocysteine in the body. Homocysteine levels in the blood are strongly influenced by diet and genetic factors.

Cardiovascular Disease
Heart Healthy Diet (CVD)
CVD Risk Factors - inflammatory markers, blood lipids,
● Balanced Kcal intake with exercise lifestyle, no exercise, age, gender, genetics, presence of ● Diet rich in fruit and vegetables other diseases, blood pressure, diabetes, smoking,diet,
● Whole grain, high fiber foods
Atherosclerosis - rigid, inflexible arteries filled with
● Fish 1x week plaque caused by the process of atherogenesis
●