Term
| Diabetes mellitus is a group of chronic diseases when the body does not produce or respond to insulin thus affecting metabolism of what? |
|
Definition
|
|
Term
| Type 1 diabetics are what? |
|
Definition
insulin dependent
-this is immune mediated or idiopathic |
|
|
Term
| What are the symptoms of DM type 1 at diagnosis? |
|
Definition
lean
polydipsia
polyuria
hyperglycemia
electrolyte disturbances
ketoacidosis
length of onset |
|
|
Term
| Does it take a while for pts with DM1 to have symptoms? |
|
Definition
|
|
Term
| What 6 factors contribute to the etiology of DM1? |
|
Definition
genetic
insulin deficiency
islet cell destruction
autoimmune dz
external factors
improvement prior to deterioration |
|
|
Term
| What factors accompany the occurrence of DM2? |
|
Definition
obesity
age
genetics
past medical history
physical activity |
|
|
Term
| In DM2, there are no formation of what? What actually does contribute to glucose intolerance? |
|
Definition
no formation of antibodies.
antibody formation is not involved in glucose intolerance in DM2
-genetics and environmental factors actually do contribute to glucose intolerance. |
|
|
Term
| What are 3 possible defects in DM2? |
|
Definition
Abnormal insulin secretion (or insulin resistance)
Reduced glucose uptake
Increased AM fasting glucose |
|
|
Term
| What is the most common type of diabetes mellitus? |
|
Definition
|
|
Term
| What are the various categories of glucose intolerance? |
|
Definition
other diseases/ steroid use
malnutrition
impaired glucose intolerance
gestational diabetes (high incidence of fetal mortality)
injury and stress of trauma
severe trauma
pancreatitis
cystic fibrosis |
|
|
Term
| For the dx of DM to be made, what is the fasting glucose? what is normal? |
|
Definition
|
|
Term
| What other tests are sued to diagnose DM? |
|
Definition
Plasma glucose > 200 mg/dl with symptoms
Oral glucose tolerance test |
|
|
Term
| What are the goals of DM management? |
|
Definition
to prevent or delay complications
weight control
medical nutrition therapy
glycolated hemoglobin tests
blood glucose levels
lipid levels |
|
|
Term
| What are some complications of DM? |
|
Definition
vasciular
renal
GI
retinopathy
CVD |
|
|
Term
| One of the GI complications of DM2 is gastroparesis, explain what happens? |
|
Definition
Gastroparesis develops bc the nerves are dying
-so the diabetic will not empty their food out well
-the thing you digest the quickest is carbs then protein then fat
-diabetic products are high fat, so if a person with gastroparesis eats these high fat products they will have a lot of vomiting and diarrhea |
|
|
Term
What is the hgb-A1C goal for a non-diabetic?
for a diabetic? |
|
Definition
|
|
Term
With an A1C of 6, blood sugar is ~126.
So, if blood sugar is in the 150 range what will A1C be? |
|
Definition
like 7
for every 27 or 28 increase in the blood glucose level, the A1C will go up. |
|
|
Term
| The management of DM involves a consistent food plan that ha been individualized to lifestyle and calorie requirements via what 2 methods? |
|
Definition
CHO counting
Exchange system |
|
|
Term
| How does CHO counting work? |
|
Definition
15 g CHO = 1 CHO choice
-then determine total CHO per meal |
|
|
Term
| What foods have carbohdrates in them? |
|
Definition
|
|
Term
| What is the diabetic diet now called? |
|
Definition
| consistent carbohydrate diet |
|
|
Term
| How are carbs and calories distributed to various pts? |
|
Definition
| almost everyone is given the same amt of calories, but are given carbs in a specific pattern |
|
|
Term
| What is the mgmt strategy for DM1? |
|
Definition
consistent intake (should not vary more than a half hour from day to day)
timing of meals
insulin adjustments (like when planning on intaking a bunch of sugar)
monitoring of BG levels
multiple injections |
|
|
Term
| What is the mgmt strategy for DM2 pts? |
|
Definition
*these strategies are more related to getting normal blood glucose levels, weight loss, triglyceride level goals
-start off on diet alone, then meds, then injections.
normal BG levels
normal lipid levels
weight loss/ maintenance
exercise
behavior modification
fat intake
medications |
|
|
Term
| What is the goal protein intake per day? |
|
Definition
|
|
Term
| What should the fat intake be like? |
|
Definition
limit saturated fat
<30% of total calories
increased MUFA |
|
|
Term
| Which is better for you: MUFAs or PUFAs? |
|
Definition
|
|
Term
| Which is better for the DM pt: sweeteners or sugars? |
|
Definition
|
|
Term
| PUFAs are ____ oil. MUFAs are ____ oil. |
|
Definition
|
|
Term
| How should diabetic pts intake CHOs? |
|
Definition
complex CHOs are better
avoid simple sugars |
|
|
Term
| What is the goal fiber intake for diabetics? |
|
Definition
|
|
Term
| Is sodium usually restricted in diabetics? |
|
Definition
| not usually unless they have a problem with edema and CHF |
|
|
Term
| Is there a need to supplement vitamins and minerals in diabetics? |
|
Definition
| no, but may be a good idea to supplement promium |
|
|
Term
| What are the 3 different types of insulin regimens? |
|
Definition
conventional
intensive insulin therapy (MDIs)
continuous subQ insulin infusion (pump) |
|
|
Term
| The pump is usually used by DM1, if these pts are alert enough to manage their own pump does dietetics step in? |
|
Definition
|
|
Term
| What is the normal response to oral DM agents? |
|
Definition
| initially have a good response then a secondary failure. |
|
|
Term
| What is the usual duration of oral DM meds? |
|
Definition
|
|
Term
| What are the 7 classes of oral DM meds + insulin? these are all different in their modes of action. |
|
Definition
Alpha-Glucosidase Inhibitors
Amylin Analogs
Incretin Mimetics
Biguanides
Meglitinides
Sulfonyureas
Thiazolidinediones
Insulin |
|
|
Term
| What are the benefits of exercise in DM? |
|
Definition
Weight control
improved insulin sensitivity
reduces CV risk factors |
|
|
Term
| There are potential problems when diabetics exercise, so what should they do to avoid problems? |
|
Definition
proper BG monitoring
insulin dose adjustment
CHO loading
-exercising more than 40-60 mins drains the glucose |
|
|
Term
| How can some DM2 pts completely cure their condition? |
|
Definition
|
|
Term
| When a diabetic is CHO loading, what should they be loading with? |
|
Definition
| complex carbohydrates, not simple sugars |
|
|
Term
| What are some acute complications of DM? |
|
Definition
Hyperosmolar Hyperglycemic Nonketotic Syndrome
Hyperglycemia
Hypoglycemia
SOMOGYI Effect
DAWN phenomenon |
|
|
Term
| What are some long-term complications of DM? |
|
Definition
MACROVASCULAR
-Lipid abnormalities
-Hypertension
MICROVASCULAR
-retinopathy
-nephropathy
-neuropathy
Brittle DM- Dawn phenomenon in young children |
|
|
Term
| Why is renal failure one of the worst complications of DM? |
|
Definition
| it is the worst, most restrictive diet to follow. |
|
|
Term
| What is the Somogyi effect? |
|
Definition
when have a reactive hyperglycemia then blood sugar drops.
-then given something for the hypoglycemia which makes them hyperglycemic |
|
|
Term
| What is the Dawn Phenomenon? |
|
Definition
more with DM2
when sugars are really high in the liver
-liver releases glycogen while fasting, so can fix this with 1-2 carbs before going to bed at night |
|
|
Term
| What are the steps involved with the lifetime mgmt of diabetes? |
|
Definition
assessment
goal establishment
implementation
evaluation
documentation |
|
|
Term
| How is a patient managed who has DM prior to pregnancy? |
|
Definition
good control of sugars
have hypoglycemia risks and insulin requirements. |
|
|
Term
| _% of pregnant people get gestational DM, how should this be managed? |
|
Definition
7%
diagnosis
diet
exercise
self-monitoring |
|
|
Term
| What is the goal for growth and development in children with DM? |
|
Definition
3 meals with 2-3 snacks
constant re-evaluation as they grow
these kids can pretty much eat whatever bc their parent monitor their pump and they are constantly re-evaluated |
|
|
Term
| Why is the incidence of DM2 increasing in children? |
|
Definition
|
|
Term
| With DM2 in children what needs to be done? |
|
Definition
lifestyle changes
assess HbA1C levels
may need metformin OHA |
|
|
Term
| What are some contributing factors of DM in the elderly? |
|
Definition
Decreased insulin production VS increased insulin resistance
Medications
Physical activity
Genetics
Other illnesses |
|
|
Term
| What are the symptoms of hypoglycemia? |
|
Definition
3 features of Whipple's Triad.
(1) neuromuscular signs with fasting or exercise
(2) low blood glucose levels associated with clinical signs
(3) reversal of clinical signs with the administration of glucose. |
|
|
Term
| What is the tx of hypoglycemia? |
|
Definition
administration of some sort of carbohydrate
-give them 6-8 small feedings a day
encourage
-encourage a higher protein diet to prevent low drops of sugars |
|
|
Term
| When do people normally go hypoglycemic? |
|
Definition
| 3-4 hrs after eating... may even have dumping syndrome where after they eat they have diarrhea |
|
|
Term
| Do we know the cause to hypoglycemia? |
|
Definition
| no. don't even know if people are true hypoglycemics. |
|
|
Term
| What is the mouth and esophagus used for? |
|
Definition
mastication and swallowing
secretions (salivary and esophageal) |
|
|
Term
| Once you start to swallow, can you sstop? |
|
Definition
|
|
Term
| What is the function of mucous secretions in the esophagus? |
|
Definition
| to make it slick, does not have a protective mechanism |
|
|
Term
| The small intestine is the work horse of the GI tract, what does it do? |
|
Definition
Digestion & absorption
Protein breakdown
CHO breakdown
Fat breakdown
Digestive juices
Hormones
Vitamins, Minerals, & drugs |
|
|
Term
| What does the liver contribute to the GI tract? |
|
Definition
|
|
Term
| What is the primary purpose of the large intestine? |
|
Definition
to absorb water
-absorbs some minerals as well |
|
|
Term
| What is the bacterial action of the large intestine? |
|
Definition
| metabolizes fatty acids into short chain fatty acids |
|
|
Term
| Where does dietary fiber do all of it's job? |
|
Definition
in the large intestine,
up until this point it is undugested |
|
|
Term
| Do some secretions protect the large intestine? |
|
Definition
|
|
Term
| There are many reasons for tissue inflammation to be in the mouth, name some reasons |
|
Definition
|
|
Term
| What are the four inflammatory diseases of the mouth? |
|
Definition
gingivitis
stomatitis
glossitis
cheilosis |
|
|
Term
| What can happen if gingivitis gets severe enough? |
|
Definition
| ulcerations can occur and abx are needed to clear up the infection |
|
|
Term
| What is stomatitis caused by? |
|
Definition
chemotherapeutic agents
B vitamin deficiencies
with this, it hurts to eat anything |
|
|
Term
|
Definition
Is the result of a B vitamin deficiency
-have a red swollen tongue
-with full blown glossitis, it looks like they don't have taste buds, tongue looks really smooth |
|
|
Term
|
Definition
splitting in the corners of the mouth
-seen a lot in college age kids bc they aren't eating right |
|
|
Term
| What is the dietary tx with mouth disorders? |
|
Definition
start out with softer foods and non-acidic things
-avoid temperature extremes
-chloriseptic spray is good before mealtime for numbing
-none of this will get any better without good nutrition |
|
|
Term
| Can you give someone with any of these mouth diseases a feeding tube? |
|
Definition
no
-if really severe may give them a peg tube. |
|
|
Term
| Who has issues with poor dentition? |
|
Definition
|
|
Term
| What is a reason for dentures not fitting anymore? |
|
Definition
|
|
Term
| What is done for pts with too little salivary production? |
|
Definition
given artificial saliva
-saliva is important for adequate mastication and formation of a good food bolus |
|
|
Term
| Can develop dysphagia after a stroke, head and neck surgery or long term feeding tube use... who do these pt then need to see? |
|
Definition
a speech therapist
-Susan doesn't like speech therapists |
|
|
Term
| What is the easiest thing for people with dysphagia to swallow? |
|
Definition
pudding and thicker liquids (Pureed)
-with water it goes down to quickly and aspration pneumonia can occure
-so be careful about ordering a clear liquid diet |
|
|
Term
|
Definition
| A DISEASE INVOLVING THE MOTILITY OF THE ESOPHAGUS. AFFECTS THE MUSCLE MOVING THE FOOD DOWN THE ESOPHAGUS |
|
|
Term
| What are the symptoms of achalasia? |
|
Definition
| regurg, chest pain, coughing, problems swallowing |
|
|
Term
| What does surgery for the mgmt of achalasia entail? |
|
Definition
dilitation
-reduce pressure of the lower esophageal sphincter
-botox and meds |
|
|
Term
| What is the dietary mgmt of achalasia? |
|
Definition
fatty foods
alcohol and peppermint/spearmeint lower LES pressure
smaller more frequent meals |
|
|
Term
| What are the symptoms of GERD? |
|
Definition
Heartburn
dysphasia
nausea after eating |
|
|
Term
| With GERD, what kinds of foods should be avoided? |
|
Definition
foods that decrease LES pressure- fat, alcohol, peppermint
-coffee and tea increase acid |
|
|
Term
| What meds are sued to tx GERD? |
|
Definition
lifestyle changes
PPIs and H2 blockers
no aspirin or ibuprofen
-really don't use antacids anymore |
|
|
Term
| With GERD, want to _______ the sphincter. With achalasia, want to ______ the sphincter. |
|
Definition
|
|
Term
| What are 2 side effects of chronic esophagitis? |
|
Definition
asthma
barrett's esophagus
both of these are closely related to esophageal cancer |
|
|
Term
| Chronic esophagitis has the same tx as what? |
|
Definition
|
|
Term
| What is the mgmt of hiatal hernia? |
|
Definition
antacids
weight reduction
don't eat before you lie down flat |
|
|
Term
| How do you get a feeding tube past a hiatal hernia? |
|
Definition
|
|
Term
| How do you manage cancer of the esophagus? |
|
Definition
dietary changes
-then only take fluids and then take them to surgery |
|
|
Term
| What surgery is done on cancer of the esophagus? |
|
Definition
esophegectomy
-body heals the tract pretty quickly
-bc these pts are generally malnourished |
|
|
Term
| With a pt with N/V, need to dig deeper into the cause, what could this cause be? |
|
Definition
|
|
Term
| What are the causes of peptic ulcer dz? |
|
Definition
aspirin and NSAID use
stress ulceration
H. pylori infxn
NSAID use is the most common cause. |
|
|
Term
| What is the therapy of PUD? |
|
Definition
acid suppression through use of PPIs and H2 blockers
start them on 4 blands: 1-4
limit snacking: the more times you eat, the more you're going to stimulate the acid production
limit seasonings: red pepper, really spicy things
-maybe limit chocolate |
|
|
Term
| PUD is a disease of what organ? |
|
Definition
|
|
Term
| What are the 3 gastric surgeries? |
|
Definition
vagotomy
partial/complete gastrectomy
gastric bypass |
|
|
Term
|
Definition
reduces acid secretion
slows gastric emptying
-may result in dumping syndrome
usually done for gastric cancer |
|
|
Term
| With a parital/complete gastrectomy, what would surgeons rather place? |
|
Definition
|
|
Term
| What are the 3 types of gastric bypass surgery? |
|
Definition
Roux-en-Y
-standard for weight loss (50-65%)
-biliopancreatic diversion (60-80% wt loss)
Billroth I
-gastroduodenostomy
Billroth II
-gastrojejunostomy |
|
|
Term
| What can Billroth I and II result in? |
|
Definition
| malabsorption, are only done when absolutely necessary |
|
|
Term
| What is dumping syndrome the physiologic response to? |
|
Definition
| the presence of larger amts of food than normal into the small intestine |
|
|
Term
| What procedures can cause dumping syndrome? |
|
Definition
total or subtotal gastrectomy (no stomach, no holding cell for food before the mall intestine)
pyloroplasty
fundoplication |
|
|
Term
| What are the symptoms of dumping syndrome? |
|
Definition
fullness and nausea
fluid shifts causing flushing, tachycardia, sweating, cramping, diarrhea and hypoglycemia |
|
|
Term
| What is the post-gastrectomy diet to avoid dumping syndrome? |
|
Definition
limits simple carbs (sugar) and complex carbs (bread, fruit)
-beverages are given 30-60 mins after they eat real food. |
|
|
Term
| In the lower GI tract, what are 3 ways in which malabsorption can occur? |
|
Definition
mechanical: missing part of GI tract (adhesions, surgical removal, obstructions)
-<270 M of small bowel is short gut
chemical: inadequate production of amylase or lipase, whipple procedure
solubilization: don't make enough bile salts can have fat malabsorption |
|
|
Term
| What 2 things can cause diarrhea in the lower GI tract? |
|
Definition
diet: lack of appropriate fiber
lactose intolerance: AAs, asians, NAs and age |
|
|
Term
| What kind of diet do people with celiac sprue need to adopt? |
|
Definition
|
|
Term
|
Definition
| Permanent intestinal intolerance to dietary wheat gluten & related proteins that produces mucosal lesions in genetically susceptible individuals |
|
|
Term
| What are some general causes of celiac dz? |
|
Definition
genetics
immune system
environment (bacterial or viral) |
|
|
Term
| What are the symptoms of celiac dz? |
|
Definition
diarrhea (bulky, loos and watery)
weight loss (failure to thrive)
abdominal swelling and bloating with excess gas and abd pain |
|
|
Term
| How is celiac dz diagnosed? |
|
Definition
antibody detection
intestinal bx |
|
|
Term
| What is the tx of celiac dz? |
|
Definition
| gluten free diet: eliminate foods containing wheat, barley, rye and oats |
|
|
Term
| What needs to be supplemented in people with celiac dz? |
|
Definition
calcium
zinc
vitamin D
Mg
Vitamin B12 |
|
|
Term
| Crohn's and UC are inflammatory diseases of what? |
|
Definition
|
|
Term
Where does Crohn's occur?
Is it genetically associated?
What do the lesions become?
Are fistulas and strictures common?
At what age? |
|
Definition
any part of the GI tract
yes
chronic
yes (
any age |
|
|
Term
What is UC confined to?
Are the exacerbations more acute or chronic?
What does it only affect? |
|
Definition
colon and rectum
acute
mucosa of the GI tract |
|
|
Term
| In crohn's, what makes the pts nonresponsive to tx? what do they then need? |
|
Definition
fistula development
multiple resections |
|
|
Term
| What must UC be monitored for? |
|
Definition
progression to cancer
-usually ends in colostomies or colectomies |
|
|
Term
| What is the drug therapy for IBD: Crohn's and UC? |
|
Definition
Steroids and anti-inflammatories
-treated first with drugs, then to surgery and different types of resections |
|
|
Term
| What is the nutritional therapy of IBD? |
|
Definition
TPN is no longer an accepted practice, so is EN
-every pt is different, and pt knows what foods bother them
high calorie, high protein diet
with inflammation: on a low residue diet (no milk or fiber)
when inflammation leaves, are put on a high fiber diet |
|
|
Term
| What are the nutritional risks and deficiencies present in IBD? |
|
Definition
Iron
Folate
Nicotenic acid
Vitamin D
Vitamin K
Calcium
Magnesium
Zinc |
|
|
Term
| When UC pts are really inflamed, what do they have? |
|
Definition
|
|
Term
| Crohn's have lesions everywhere in GI tract, where are they most obviously seen? |
|
Definition
|
|
Term
| What is short bowel syndrome defined as? |
|
Definition
| jejunal + ileal bowel length of 100-200 cm |
|
|
Term
| What are the clinical symptoms of short bowel syndrome? |
|
Definition
fat malabsorption
diarrhea |
|
|
Term
| What is the nutritional mgmt of short bowel syndrome? |
|
Definition
TPN
3 adaptive stages
dietary strategies
many times are allowed to eat for the satisfaction of eating. |
|
|
Term
| With short bowel syndrome you have malabsorption of electrolytes, vitamins and trace elements of what 7 things? |
|
Definition
iron
calcium
magnesium
fat soluble vitamins
zinc
B12
Folate |
|
|
Term
| What are the causes of diverticular dz? |
|
Definition
low fiber diet
constipation |
|
|
Term
| What are the complications of diverticular dz? |
|
Definition
abscesses
fistula
perforation
peritonitis |
|
|
Term
| How much fiber should someone with diverticulosis intake each day? what else should they intake more of? |
|
Definition
|
|
Term
| With diverticulitis, what is the mgmt? |
|
Definition
clear liquids
low residue diet
surgery |
|
|
Term
| When does diverticular dz go from benign to not benign? |
|
Definition
| when the diverticuli start perforating bc all the e. coli and deadly junk on the inside of the GI tract gets into the sterile peritoneum--> can get into other organs and become deadly |
|
|
Term
| ______________ is just treated wih a high fiber diet while ______________ might progress to needing surgery. |
|
Definition
Diverticulosis
diverticulitis |
|
|
Term
| What is irritable bowel syndrome? |
|
Definition
a functional intestinal disorder due to muscle spasms in response to food, gas and stress
symptoms include abd pain, constipation, diarrhea and bloating |
|
|
Term
| What id the nutritional tx of IBS? |
|
Definition
individualized: eat slowly, high fiber, increased water, frequent small meals, decreased fat intake
deal with the stress! |
|
|
Term
| What are foods to avoid in a pt with diarrhea? |
|
Definition
EtOH
caffeine
nicotine
gas producing foods
dairy
spicy food
high fat foods
sorbitol (in meds) |
|
|
Term
| What do you need to ask people who have diarrhea? |
|
Definition
what does it look like?
if greasy and floating, probably have fat malabsorption |
|
|
Term
| What foods should be increased with constipation? |
|
Definition
fresh fruits and vegetables
wheat bran
whole grain break and cereals
beans
increase slowly in diet
increased water consumption
avoid laxatives! unless are chronically on laxatives (but think about weening them off laxatives) |
|
|
Term
| How should fiber be increased in a diet? |
|
Definition
| gradually, if increase too quickly will get bloating, gas and diarrhea. |
|
|
Term
| What are the symptoms of viral hepatitis? |
|
Definition
anorexia
weight loss
jaundice |
|
|
Term
| How is viral hepatitis treated? |
|
Definition
rest
adequate fluid
adequate protein and high CHO
moderate fat (limit fat bc will probably have fat malabsorption)
supplementation of water and fat soluble vitamins (bc of fat malabsorption)
calories of 1.5 times basal needs. |
|
|
Term
| What is one of the most common types of liver dz? |
|
Definition
alcoholic liver dz... usually results in poor nutrition
she also said hepatic steatosis (associated with obesity) |
|
|
Term
| What do pts with alcoholic liver dz need lots of? |
|
Definition
| calories... and 60-80 g/day of dry protein |
|
|
Term
| What is the progression of alcoholic liver dz? |
|
Definition
| fatty liver --> liver fibrosis --> cirrhosis |
|
|
Term
| What is the dietary tx of hepatic steatosis? |
|
Definition
weight loss
avoid alcohol
mediterranean diet (anti-inflammatory)
primarily treated with diet |
|
|
Term
| What is the nutritional therapy of someone treated with cirrhosis? |
|
Definition
Protein
-no flare up: normal amt of protein
-with flare-up: 150% of the protein they need to maintain muscle mass
Calories
-no flare up: 25% more calories
-with flare up: 50% more calories
CHO
Fat
-these people have malabsorption of fat.. given MCT (medium chain triglyceride) absorbed directly into lymph in order to get calories from fat
Sodium
Vit/Min
Alcohol
-NONE!
Fluid |
|
|
Term
| hepatic encephalopathy can either be acute or chronic, how is it treated? |
|
Definition
Protein amount & sources
-start low, and increase to what they need
-adjusted by whether or not encephalopathy is progressing
Calories
Fluids
Vit/Min
Lactulose
-given to lower ammonia levels by making them malabsorb and have diarrhea |
|
|
Term
| Pts with hepatic failure will usually also go into what? |
|
Definition
|
|
Term
| What are the 2 gall bladder diseases and their tx? |
|
Definition
cholecystitis and cholelithiasis
surgical
-after 2-3 attacks, will take their gall bladder out
nutritional (limited fat and calories) |
|
|
Term
| How are pts with acute pancreatitis fed? |
|
Definition
enterally: feeding tube into ligament of trietz (transpyloric)
-usually will use products high in MCT oil
-this is new, they used to just give the gut a rest |
|
|
Term
| Chronic panreatitis is more common, what type of pt can move to this? |
|
Definition
|
|
Term
| Chronic pancreatitis is painful, and pts can become what? |
|
Definition
|
|
Term
| Feeding chronic pancreatitis pts is hard, what may have to be used? |
|
Definition
|
|
Term
| If chronic pancreatitis pts do start eating again, what do they have to have? |
|
Definition
|
|
Term
| What is more common a problem, diarrhea or constipation? |
|
Definition
|
|
Term
| What is the most common GI dz? |
|
Definition
diverticular dz
-main cause is constipation and low fiber diet. |
|
|
Term
| What is the nutritional therapy required for glomerulonephritis? |
|
Definition
salt restriction
disease progression: protein, CHO, electrolytes, water |
|
|
Term
| There are multiple causes of nephrotic syndrome, what are some symptoms? |
|
Definition
proteinuria
poor appetites
weight loss |
|
|
Term
| What is the nutritional therapy for nephrotic syndrome? |
|
Definition
protein and calories!
sodium restriction |
|
|
Term
| In acute renal failure, dialysis is required... what are the 2 types of dialysis? |
|
Definition
|
|
Term
| What is the nutritional therapy of acute renal failure? |
|
Definition
Protein: 1.0-2.0 grams/kg of actual/ideal weight
Energy: Begin at < 25 kcal/kg when critically ill then liberalize as needed
Electrolytes:Degree of restriction depends upon treatment |
|
|
Term
| What is the GFR for various stages of chronic kidney dz? |
|
Definition
Stage 1: proteinuria: >90
Stage 2: mild damage: 60-89
Stage 3: moderate: 30-59
Stage 4: 15-29
Stage 5: <15 |
|
|
Term
| What is the nutritional therapy of chronic renal dz? |
|
Definition
Protein
Calories
Fluid
Sodium
Potassium
Phosphorus & Calcium
Vitamins / Minerals |
|
|
Term
| What is the tx of chronic renal dz? |
|
Definition
dialysis
-hemodialysis
-peritoneal dialysis
-ultrafiltration
diet
fluid restriction |
|
|
Term
| What are you worried about with renal transplants? |
|
Definition
immunosuppression
rejection episodes |
|
|
Term
| What nutritional therapy is required with a renal transplant? |
|
Definition
Protein
CHO
Fat
Calories
Sodium |
|
|
Term
| What are the 4 types of kidney stones? |
|
Definition
calcium
struvite
uric acid
cysteine |
|
|
Term
| What is encouraged with cystitis? |
|
Definition
adequate fluid intake
cranberry juice- to coat the lining of the bladder making bacterial colonization more difficult |
|
|
Term
| How does nutrition play a role in cancer development? |
|
Definition
mutations
chemical
radiation
viruses
epidemiological factors: diet, race, occupation |
|
|
Term
| Energy balance and exercise prevents what type of cancer? |
|
Definition
|
|
Term
| Fat prevents what type of cancer? |
|
Definition
|
|
Term
| Protein prevents what type of cancer? |
|
Definition
|
|
Term
| Fiber prevents what type of cancer? |
|
Definition
|
|
Term
| How do fruits and vegetables affect cancer? |
|
Definition
| contain antioxidants, phytochemicals |
|
|
Term
| CHO has an effect on what type of cancer? |
|
Definition
|
|
Term
| What else is linked to cancer? |
|
Definition
alcohol
coffee and tea
artificial sweeteners
nitrates |
|
|
Term
| Cancer therapy includes what 5 things? |
|
Definition
Surgery
Radiotherapy
Chemotherapy
Immunotherapy
Marrow Transplantation |
|
|
Term
|
Definition
| alteration of metabolism resulting in subsequent death of the host |
|
|
Term
| What 5 factors lead to unintentional weight loss in cancer? |
|
Definition
decreased nutrient intake from GI fxn related to direct tumor or adverse effects from treatment
obstruction/perforation of GI tract
Intestinal secretory abns
Anorexia (depression, food aversion, early satiety)
Nutritional consequences of tx
-chemo
-radiation
-surgery |
|
|
Term
| What are some metabolic changes induced by cancer? |
|
Definition
protein
fat
glucose
energy expenditure
role of cytokines |
|
|
Term
| What are some nutritional parameters of cancer? |
|
Definition
weight changes
body composition
lab values
nutrient intakes |
|
|
Term
| What are some feeding modalities with cancer? |
|
Definition
|
|
Term
| What nutritional requirements are you worried about with cancer? |
|
Definition
calories
protein
fluid
vitamins and minerals |
|
|
Term
| Besides feedings, what are some other therapies of nutrition in cancer? |
|
Definition
Metabolic Therapy
Macrobiotic Diet
Megavitamin therapy
Herbal therapy
“Cleansing therapies” |
|
|
Term
| What is the ideal appetite stimulant for cancer pts? |
|
Definition
sustained positive effects on appetite
association bw agent use and repletion or maintenance of body cell mass
minimal adverse effects
no negative effects on tx
positive effects on QoL |
|
|
Term
| What are three types of appetite stimulants? |
|
Definition
glucocorticoids
-short-lived effects
-adverse effects
cannabinoids
-increased appetite, decreased nausea
megestrol
-positive effect on appetite
-minimal increase in weight
-better long-term results. |
|
|
Term
| Have fish oils (antcytokine agents) proved effective in cancer pts? |
|
Definition
no
-no differences in appetite or weight change
-no changes of measures of fxn or well-being |
|
|
Term
| Prevention with nutrition remains controversial, what foods are up for debate? |
|
Definition
soy (breast and prostate cancer)
fruits and vegetables (GI and lung cancers)
tomatoes
garlic
vitamin D
alcohol- increases cancer risks
wine- contains compounds in grape skins that can help fight certain cancers
selenium- boosts body's antioxidant activity |
|
|
Term
|
Definition
| safe and effective mode of nutritional support when delivered by strict protocols |
|
|
Term
| What are the indications for parenteral nutrition? |
|
Definition
non-fxnal GI tract
bowel rest
severe malnutrition when pt will be unable to eat for more than 5 days |
|
|
Term
| What are the contraindications for parenteral nutrition? |
|
Definition
tx required for less than 5 days
fxnal GI tract
inability to obtain venous access
prognosis |
|
|
Term
When to initiate PN:
guidelines: ASPEN/CCM vs ESPEN |
|
Definition
|
|
Term
| Summarize the ASPEN/CCM guidelines. |
|
Definition
If EN is not available, and the iCU pt is previously normally nourished, then PN can be started after first 7 days of hospitalization.
-if evidence of protein-calorie malnutrition on admission and EN is not feasible, then PN can be started as soon as adequate resuscitation is performed |
|
|
Term
| Under ASPEN/CCM guidelines, if the pt is expected to undergo major upper GI surgery and EN is not feasible, when should PN be provided? |
|
Definition
-if pt is malnourished, PN should be initiated 5-7 days preoperatively and into the post-op period
-PN should not be INITIATED immediately after surgery, but should be delayed 5-7 days post-op if EN is not feasible
-PN should only be initiated only if the duration of therapy is anticipated to be >7 days, anything less than that will have no effect and could cause harm to the pt. |
|
|
Term
| Late initiation of parenteral nutrition is associated with a ______ recovery and ______ complications as compared with early initiation. |
|
Definition
|
|
Term
| ESPEN says PN should only be used when? |
|
Definition
| when absolutely necessary |
|
|
Term
| What are the physiological limitations of PN? |
|
Definition
atrophy of small bowel mucosa
decreased adaptive capacity
bacterial translocation
increased incidence of sepsis |
|
|
Term
| What are the types of access for PN? |
|
Definition
Central Venous Access:
-subclavian vein preferred site (risk of PTX)
-internal jugular (more uncomfortable)
-groin: greatest risk of infection
-PICC
Implanted central venous catheters:
-for prolonged TPN access
-inserted operatively
-implanted in a subQ tunnel
-most common types: Hickman, Port-a-cath, Groshong |
|
|
Term
| What are some complications of PN? |
|
Definition
Pneumothorax
Artery injury
Catheter malposition
Infection: Local & systemic
Air embolism; catheter embolism
Catheter occlusion
Venous thrombosis |
|
|
Term
| When prescribing for PN, what do you need to assess for? |
|
Definition
nutritional risk
nutritional needs: protein, fat, CHO, fluids, electrolytes, vitamins, minerals and trace elements. |
|
|
Term
| When delivering nutrients to the body's disposal system, what do you NOT want to overload? |
|
Definition
| the body's disposal system. |
|
|
Term
| When delivering protein, what do you need to consider? |
|
Definition
|
|
Term
| When delivering CHO, what do you need to consider? |
|
Definition
200g required for nitrogen utilization
-oxidative limit of 7g/kg/day |
|
|
Term
| When delivering fat, what do you need to consider? |
|
Definition
hyperlipidemia
-limit to <30% total calories |
|
|
Term
| When delivering fluids, what do you need to consider? |
|
Definition
evaluate CHF
pulmonary edema
renal insufficiency
ARDS |
|
|
Term
| what is the composition of proteins when prescribing PN? |
|
Definition
Synthetic crystalline amino acids
Solutions may lack certain AA due to instability
Solutions contain varying amounts of electrolytes
Concentrations depend upon final volumes
Hypertonic solutions |
|
|
Term
| What is the composition of dextrose when prescribing PN? |
|
Definition
5%-70% solution dextrose in water
3.4 kcal per gram
Most abundant component in TPN
Component with the greatest effect on the hypertonicity of the solution |
|
|
Term
| What is the composition of lipids when prescribing for PN? |
|
Definition
Should have < 30% as total calories
Sources are soy or safflower oils
Linoleic acids are precursors to prostaglandins (immunosuppressive, vaso-constrictive)
Structured and fish oil parenteral lipids not approved for use in this country |
|
|
Term
|
Definition
Total Nutrient Admixture
"three-in-one" solutions |
|
|
Term
|
Definition
| amino acids and dextrose with lipids piggybacked into the solution |
|
|
Term
| What vitamins and trace elements is PN composed of? |
|
Definition
Vitamin A
Vitamin D
Vitamin E
Ascorbic acid
Folate
Niacin
Thiamine
Riboflavin
B 6
B 12
Pantothenic acid
Biotin
Vitamin K
Trace Elements:
Zinc
Copper
Chromium
Manganese
Selenium |
|
|
Term
| What vitamins and trace elements is PN composed of? |
|
Definition
Vitamin A
Vitamin D
Vitamin E
Ascorbic acid
Folate
Niacin
Thiamine
Riboflavin
B 6
B 12
Pantothenic acid
Biotin
Vitamin K
Trace Elements:
Zinc
Copper
Chromium
Manganese
Selenium |
|
|
Term
| What can be added into PN? |
|
Definition
Insulin
H2 Blockers
Heparin
Additional vitamins and minerals |
|
|
Term
| Initially, how is PN nutrition administered? then what occurs after tolerance is established? |
|
Definition
over 24 hours
-consider cyclic TPN (in anticipation of home TPN)
--12-26 hr cycles
--usually night infusions |
|
|
Term
| What GI complications can occur with PN? |
|
Definition
Fatty liver
Cholestasis
GI atrophy |
|
|
Term
| What metabolic complications can occur with PN? |
|
Definition
Electrolyte imbalances (Na and K)
Glucose intolerance
Hypertriglyceridemia
Dehydration
Fluid overload
Prerenal azotemia
Mineral imbalances (Ca, Mg, P)
Overfeeding (Hypercapnia)
Essential fatty acid deficiency
Mineral imbalances
Calcium
Magnesium
Phosphorus
Overfeeding
Hypercapnia
Essential fatty acid deficiency |
|
|
Term
| How should these metabolic complication be monitored? |
|
Definition
daily chemistries until electrolytes are stable
fingerstick blood glucose levels 4-6 times daily
fluid balance
live fxn tests weekly
WBC and temperatures daily |
|
|
Term
| How can PN's nutritional values be monitored? |
|
Definition
lab data: prealbumin, total lymphocyte count, serum albumin of limited value
daily weights
nitrogen balance, if available |
|
|
Term
| Enteral Nutrition... if the gut works and can be used safely, use it! |
|
Definition
|
|
Term
| What are the physiologic benefits of enteral nutrition? |
|
Definition
nutrients are metabolize and utilized more effectively
can be used in most cases of gastric and colonic dysfxn, bc small bowel function is maintained. |
|
|
Term
| What are the immunologic benefits of enteral nutrition? |
|
Definition
maintains gut integrity
prevents bacterial translocation from the gut (systemic sepsis and increased risk of multiple organ failure) |
|
|
Term
| What are the biochemical benefits of enteral nutrition? |
|
Definition
many formulas contain glutamine (which is the preferred gut fuel during metabolism)
many formulas contain fiber that stimulate mucosal growth in the GI tract |
|
|
Term
| What are the metabolic benefits of enteral nutrition? |
|
Definition
decreased catabolic response after injury or stress if fed through the GI tract
stimulates production of hormones for gut mucosal growth |
|
|
Term
| What are the safety benefits of enteral nutrition? |
|
Definition
| avoids complications associated with line placement |
|
|
Term
| What are the cost benefits of enteral nutrition? |
|
Definition
|
|
Term
| what are the 2 contraindications of enteral nutrition? |
|
Definition
malfunction of the GI tract
end-stage illness where harm exceeds benefit |
|
|
Term
| What are some examples of malfunctions of the GI tract that would result in the contraindication to enteral nutrition? |
|
Definition
short bowel syndrome with inadequate length of jejunum and ileum present
mechanical obstruction of the GI tract
-sometimes can feed below it, but if too low may need to do IV nutrition
prolonged ileus
severe GI hemorrhage
Intractable vomitting
high output fistula (may be able to feed below it if it is high enough)
pancreatic pseudocyst |
|
|
Term
| Lately, does Susan do enteral feeding for anyone with a pancreatic issue? |
|
Definition
|
|
Term
If are receiving enteral feeding for <4-6 wks, what placement should be used?
for >4-6 wks? |
|
Definition
nasoenteric placement
surgical placement |
|
|
Term
| What are usual placements for the end of an EN tube? |
|
Definition
|
|
Term
| What does PEG stand for, and what kind of feeding is it used for? |
|
Definition
Percutaneous Endoscopic Gastrotomy
Enteral feeding |
|
|
Term
| ___________ are easy to place and are pretty short. |
|
Definition
|
|
Term
| What are the placement issues with a nasoduodenal tube? |
|
Definition
blind placement
fluoroscopic placement |
|
|
Term
| Which feeding tubes have to be surgically placed? |
|
Definition
Percutaneous Endoscopic Gastrostomy
Button Gastrostomy (peds)
Jejunostomy |
|
|
Term
| Where are you usually trying to get the feeding tube to? |
|
Definition
|
|
Term
| What 5 things should be kept in mind when prescribing enteral nutrition? |
|
Definition
Meeting nutrient requirements
GI tract function
Past Medical History
Disease state
Constraints on nutrient delivery |
|
|
Term
| What are the formula types and composition? |
|
Definition
Polymeric
Defined formula
Disease- Specific
Modular |
|
|
Term
| What composes the polymeric enteral formula? |
|
Definition
-complex source of CHOs, protein and fat
-requires normal digestion and absorption
-most are lactose free
-available in a calorically dense form (1.5-2kcal/cc) |
|
|
Term
| What composes the defined formula? |
|
Definition
protein is hydrolyzed to peptides or aas
% of fat may be as MCT or as fish oils
minimal digestion required
may have a high osmolarity
available in a calorically dense form |
|
|
Term
| With the disease specific enteral formula, what diseases does it include? |
|
Definition
renal failure
liver failure
pulmonary dz
malabsorption/GI dz
diabetes
sever trauma/ injury |
|
|
Term
| What is in the renal failure specific formula? |
|
Definition
CRT- continuous renal therapy
-is a dialysis
-gradually increase protein
-give them whatever they need, bc they are just going to filter it out |
|
|
Term
| Why are liver failure specific formulas the last resort? |
|
Definition
|
|
Term
| With pulmonary dz specific formulas, which will you probably be in more contact with? |
|
Definition
ARDS
-there is some controversy around pulmonary specific formulas |
|
|
Term
| What is in the diabetic specific formula? |
|
Definition
high fat
low CHO
moderate protein
"Glucerna", keep in mind gastroparesis problems though
-worried about vomiting and aspiration with tube fed pts. |
|
|
Term
| Is it good to put a critically ill pt on a high fat diet? |
|
Definition
| No, maybe wait til they are out of the ICU |
|
|
Term
| What is the enteral formula for a pt with severe trauma and injury? |
|
Definition
very specific: high protein, extra arginine, zinc and vitamin A for wound healing
-these formulas are pricy, and pts are not sent out of the hospital while on them |
|
|
Term
| What is the modular formula composed of? |
|
Definition
single nutrients
-combined to make a formula customized to each pt.
-may be added to oral supplements or to enteral feedings
-added to enhance healing/recovery |
|
|
Term
| True or False: Enteral feedings should not be started until the GI tract is functional as identified by bowel sounds, bowel movements or “low” gastric residual volumes |
|
Definition
|
|
Term
| True or False: Nothing can be started until hear bowel sounds, pass gas or see stool. |
|
Definition
|
|
Term
| Summarize the Canadian Guidelines. |
|
Definition
EN preferred over PN
EN: 24-48 hrs after admission to the ICU
Does not address the presence or absence of bowel sounds
Initiate a feeding protocol that includes:
-prokinetics
-a higher GRV of 250 mL
-postpyloric feeding tubes |
|
|
Term
| When including a higher GRV of 250 mL what should be started with signs of intolerance? |
|
Definition
|
|
Term
| When are posrpyloric feeding tubes recommended? |
|
Definition
routinely in critical care
for selected pts having persistent elevated GRVs or those at risk for aspiration and pneumonia |
|
|
Term
| When are post pyloric feeding tubes recommended? |
|
Definition
routinely in critical care
for selected pts having persistent elevated GRVs or those at risk for aspiration and pneumonia |
|
|
Term
| When may EN be started after adequate fluid resuscitation? |
|
Definition
| 24-48 hrs following injury or admission to the critical care unit |
|
|
Term
| When may EN be started after adequate fluid resuscitation? |
|
Definition
| 24-48 hrs following injury or admission to the critical care unit |
|
|
Term
| How does the American Dietetic Association stand on evaluating GRVs? |
|
Definition
Monitoring GRVs is an option to assess EN tolerance
-hold EN when GRV>250 mL documented on 2 consecutive occasions
-use promotility agents if pt has gastroparesis or persistently elevated GRVs
-EN infused into the stomach is acceptable for most pts; small bowel feeding preferred with signs of intolerance
DOES NOT address presence of bowel sounds/movements
So:
GRV recs: consensus/imperative
promotility agents: strong/ conditional
small bowel FT: fair/ conditional |
|
|
Term
| read all the other guidelines in the enteral ppt. |
|
Definition
|
|
Term
| True or false: tap water can be used safely to flush feeding tubes and to dilute meds to be given per feeding tube. |
|
Definition
false
-use of sterile water is preferred for safety
-meds should be given mixed in sterile water through feeding tubes |
|
|
Term
| How should medications be given through feeding tubes? |
|
Definition
|
|
