MNT II Exam 1 Review _barbie.docx

**MNT II: Exam 1 Review, updated 9-21-2022** 1. Know the medical terms and abbreviations used in the power points - Test questions will primarily use abbreviations, so you have to know them to accurately and correctly answer! o ABD- Abdomen o ARDS- Acute Respirator...

**MNT II: Exam 1 Review, updated 9-21-2022** 1. Know the medical terms and abbreviations used in the power points - Test questions will primarily use abbreviations, so you have to know them to accurately and correctly answer! o ABD- Abdomen o ARDS- Acute Respiratory Distress Syndrome o BG- Blood Glucose o bid- (bis in die) Twice a Day o BMI- Body Mass Index o c- With o c/o- Complains Of o CA- Cancer o CABG- Coronary Artery Bypass Graft surgery o CAD- Coronary Artery Disease o CCU- Coronary Care Unit o CICU- Cardiac Intensive Care Unit o CHD- Coronary Heart Disease o CHF- Congestive Heart Failure o CHI- Closed Head Injury o CKD- Chronic Kidney Disease o COPD- Chronic Obstructive Pulmonary Disease o CVA- Cerebrovascular Accident o CVD- Cardiovascular Disease o DC-Discontinue or Discharge o DNR- Do Not Resuscitate o DOB- Date of Birth o Dx- Diagnosis o EMR- Electronic Medical Record o ER-Emergency Room o ESRD- End Stage Renal Disease o FBG- Fasting Blood Glucose o FX- Fracture o GERD- Gastroesophageal Reflux Disease o HEENT- Head, Eyes, Ears, Nose, Throat o HOB- Head of Bed o HOH-Hard of Hearing o H&P- History & Physical o HTN- Hypertension o Hx- History o I&O-Intake and Output, Input and Output o IBS-Irritable Bowel Syndrome o ICU-Intensive Care Unit o IV-Intravenous o IVF-Intravenous Fluids o LOS- Length of Stay o LTAC-Long-Term Acute Care o MI-Myocardial Infarction o MNT-Medical Nutritional Therapy o MRI- Magnetic Resonance Imaging o NICU- Neonatal Intensive Care Unit o NKA- No Known Allergies o NKDA-No Known Drug Allergies o NP- Nurse Practitioner o NPO- (nil per os) Nothing by Mouth o NSAID- Non-Steroidal Anti-Inflammatory Drug o N/V or N&V- Nausea and Vomiting o OT-Occupational Therapist o OTC- Over The Counter o PA-Physician Assistant o PEG- Percutaneous Endoscopic Gastrostomy o PEM- Protein-Energy Malnutrition o PMH- Past Medical History o PN- Parenteral Nutrition o PO- (per os) By Mouth o PPN- Peripheral Parenteral Nutrition o PRN- As Necessary o pt- Patient o PT- Patient, Physical Therapy, Prothrombin Time o Q, q- Every o QID- Four Times a Day o R/O- Rule Out o r/t- Related To o s- Without o S/P- Status Post o SOB- Shortness of Breath o Sx- Symptoms o TF-Tube Feeding o TIA- Transient Ischemic Attack o TPN- Total Parenteral Nutrition o t.i.d.- Three Times a Day o WNL- Within Normal Limits o YO, yo- Years Old 2. 3. Know the following equations and be able to calculate: - BMI and classifications - IBW, % IBW, how to convert pounds to kilograms - \% Weight change and classifications - Be able to calculate Penn State Formula-you'll be provided the formula, just be able to calculate it. Remember to use kg and cm (instead of pounds and inches) a. Conversion of pounds to kg and inches to cm 1 kg = 2.2 lb 1 inch = 2.54 centimeters b. BMI and classifications BMI (Body Mass Index) = (Weight in kg) / (Height in meters)\^2 - BMI classifications: Underweight (\2% wt. loss in one wk = SEVERE 4. Know general anatomy of Upper and Lower GI tract - Understand how the sphincters work and application of that knowledge into issues a patient may have - Basic anatomy of GI tract digestion - **You Do Not** have to know all the GI hormones and neuropeptides - Have some knowledge of where nutrients are absorbed: i. Especially Vitamin B12, vitamin K and Biotin a. The gastrointestinal (GI) tract is divided into the upper and lower sections. The upper GI tract includes the mouth, esophagus, stomach, and duodenum, while the lower GI tract consists of the small intestine (jejunum and ileum), large intestine (colon), rectum, and anus. - The gastrointestinal (GI) tract is divided into the upper and lower sections. The upper GI tract includes the mouth, esophagus, stomach, and duodenum, while the lower GI tract consists of the small intestine (jejunum and ileum), large intestine (colon), rectum, and anus. b. Sphincters are circular muscles that regulate the passage of contents through the GI tract. Key sphincters include the Upper Esophageal Sphincter (UES), Lower Esophageal Sphincter (LES), Pyloric Sphincter, Ileocecal Valve, and Anal Sphincters. They play crucial roles in preventing backflow and controlling the movement of food and waste. - \*How do sphincters contribute to the overall function of the GI tract?\* Sphincters act as gatekeepers, controlling the flow of food and waste through the GI tract. They prevent backflow, which is crucial for maintaining the directional flow of digestion. For instance, the LES prevents stomach acid from entering the esophagus, which is vital for preventing conditions like GERD. c. Digestion occurs in several stages: - In the mouth, mechanical and chemical digestion begins. - The stomach further breaks down food through mixing and chemical processes. - The small intestine is the primary site for enzymatic digestion and nutrient absorption. - The large intestine absorbs water and electrolytes, forming feces. - \*What role does the small intestine play in digestion and nutrient absorption?\* The small intestine is the primary site for enzymatic digestion and nutrient absorption. It contains villi and microvilli that increase the surface area for absorption. For example, pancreatic enzymes and bile are secreted into the small intestine to aid in the digestion of fats, proteins, and carbohydrates. d. Specific nutrients are absorbed at distinct sites within the GI tract: - Vitamin B12 is absorbed in the ileum and requires intrinsic factor for absorption. - Vitamin K is absorbed in the small intestine and synthesized by gut bacteria in the large intestine. - Biotin is absorbed in the small intestine and also synthesized by gut bacteria. - \*Why is the absorption of specific vitamins like B12, K, and Biotin important?\* These vitamins are essential for various bodily functions, including blood clotting (Vitamin K) and energy metabolism (Biotin). Their absorption in specific areas of the GI tract highlights the importance of a well-functioning digestive system. For instance, Vitamin B12 absorption requires intrinsic factor, and its deficiency can lead to anemia. 5. Be able to identify a good or appropriate PES statement for a case study patient - PROBLEM SHOULD BE SOMETHING AS AN RD YOU CAN SLOVE LIKE -- Inadequate oral NI r/t NPO status aeb significant wt. loss ### Good PES Statements: - **GERD**: \"Inadequate oral intake related to pain during swallowing as evidenced by patient reporting difficulty eating solid foods.\" - **Crohn\'s Disease**: \"Inadequate energy intake related to frequent diarrhea as evidenced by patient meeting only 60% of estimated needs.\" - **Celiac Disease**: \"Inadequate nutrient absorption related to gluten intolerance as evidenced by weight loss and nutrient deficiencies.\" 6. Understand digestion and absorption of food and medications and know where each occurs - **Digestion and Absorption**: - **Location**: Digestion occurs in the **stomach** and **small intestine**. - **Nutrient Absorption**: - **Duodenum and Jejunum**: Most nutrients are absorbed here. - **Ileum**: Specific absorption of **vitamin B12** occurs. - **Malabsorption**: Conditions like **Celiac Disease** and **IBD** can lead to malabsorption, causing issues like **steatorrhea** (fat in stool). **Medications with Food/Nutrient Interactions**: - **Mesalamine**: Used for IBD, may interact with nutrients. - **Corticosteroids**: Can increase appetite and affect glucose levels. - **Methotrexate**: A folate antagonist, may require folate supplementation. 7. Know medications that have the most food/nutrient interactions. - **Mesalamine (Asacol)**: - - - **Corticosteroids** (e.g., Dexamethasone, Prednisone): - - - **Methotrexate**: - - - **Other Medications**: - - **Common Micronutrient Deficiencies**: Patients on these medications may experience deficiencies in **Vitamin K, B12, Iron, Vitamin D**, and **Zinc**. 8. With the case studies, have a good understanding of why labs are abnormal-is it dehydration, metabolic stress, medication related **1. Medications that Alter Liver Enzymes:** Certain medications can significantly impact liver enzymes: - **Acetaminophen**: Overuse can lead to liver damage. - **Statins**: Used for cholesterol management, they may elevate liver enzymes. - **Antiepileptics**: Such as phenytoin and carbamazepine can also affect liver function. - **Antibiotics** (e.g., tetracycline) can bind with calcium in dairy, reducing effectiveness. - **Warfarin** interacts with vitamin K-rich foods (like leafy greens), affecting blood clotting. - **Proton Pump Inhibitors** (e.g., omeprazole) can hinder absorption of nutrients like vitamin B12 and iron. - **Dehydration**: Leads to elevated creatinine and electrolyte imbalances. - **Metabolic Stress**: Can cause changes in glucose and electrolyte levels. - **Medication Effects**: Certain drugs can alter liver enzymes or kidney function, impacting lab results. - 9. Be able to calculate what PN provides if given an order to assess in a case study scenario **Calculating Macronutrients for Parenteral Nutrition (PN):** **Protein**: - Use the formula: Protein (g)=Total kcal×Protein ratioProtein (g)=Total kcal×Protein ratio - Example: If total kcal is 1900 and protein ratio is 0.15 (15%), then: Protein=1900×0.15=285gProtein=1900×0.15=285g **Carbohydrates (CHO)**: - Use the formula: CHO (g)=Total kcal×CHO ratioCHO (g)=Total kcal×CHO ratio - Example: If CHO ratio is 0.55 (55%): CHO=1900×0.55=1045gCHO=1900×0.55=1045g **Lipids**: - Use the formula: Lipids (g)=Total kcal×Lipid ratioLipids (g)=Total kcal×Lipid ratio - Example: If lipid ratio is 0.30 (30%): Lipids=1900×0.30=570gLipids=1900×0.30=570g 10. Be able to calculate EN for patient a patient within a case study scenario **Calculating Macronutrients for Enteral Nutrition (EN):** **Protein**: - Use the formula: Protein (g)=Volume (mL)×Protein concentration (g/mL)Protein (g)=Volume (mL)×Protein concentration (g/mL) - Example: If using Jevity 1.2 (0.055 g/mL) and volume is 1916 mL: Protein=1916×0.055=105.38gProtein=1916×0.055=105.38g **Total kcal**: - Use the formula: Total kcal=Volume (mL)×kcal/mLTotal kcal=Volume (mL)×kcal/mL - Example: If Jevity 1.2 provides 1.2 kcal/mL: Total kcal=1916×1.2=2299.2kcalTotal kcal=1916×1.2=2299.2kcal - Use the formula: Fluid (mL)=Volume (mL)×Free water percentageFluid (mL)=Volume (mL)×Free water percentage - Example: If free water is 80%: Fluid=1916×0.807=1546mLFluid=1916×0.807=1546mL - \*\*for hospitalized pt. water is not a concern because most are hooked up to an IV 11. Metabolic Stress - Understand which conditions cause metabolic stress - Which labs are affected by metabolic stress **Metabolic stress** is triggered by conditions such as: **Critical Illness** (e.g., ICU patients) **Trauma** (e.g., motor vehicle accidents, gunshot wounds) **Burns** **Severe Inflammation** (e.g., pancreatitis, sepsis) **Major Surgery** (e.g., CABG, GI resection) - **Labs affected by metabolic stress -\> Increased BG, Alb, H&H,** include those indicating increased energy expenditure, gluconeogenesis, and proteolysis, leading to negative nitrogen balance and muscle wasting. - **Nitrogen Balance:** Negative nitrogen balance indicates increased protein catabolism. - **Blood Glucose Levels:** Elevated due to increased gluconeogenesis. - **Urea Levels:** Increased ureagenesis leads to higher urea in blood. - **Electrolytes:** Imbalances may occur due to altered metabolism. 12. Upper GI: - When can eating and po intake affect albumin, which situations - **Eating and PO Intake Affecting Albumin:** Albumin levels can be affected by **malnutrition**, **inflammation**, and **chronic diseases**. Situations like **late dumping syndrome** (1-3 hours post-meal) can lead to rapid insulin release, causing hypoglycemia and affecting protein intake. - Stomatitis - Stomatitis: this is the inflammation of the oral mucosa, often linked to infections like Candida. Symptoms include ulcerations and pain, impacting eating. - Dysgeusia and Ageusia-know the terms - **Dysgeusia and Ageusia:** - **Dysgeusia**: Altered or impaired taste sensation. - **Ageusia**: Complete inability to taste. - Both can result from conditions like chemotherapy or nervous system diseases. - Esophagus ii. GERD 1. Symptoms - Heartburn, dysphagia, increased salivation, belching, and discomfort. 2. Foods to avoid - Chocolate, coffee, mints, garlic, onions, and acidic/spicy foods. Avoid large meals and lying down after eating. 3. Medications for GERD-those with arrows. Be able to identify and what is the mechanism. Nutrient concerns with use of these medications - (e.g., Prilosec, Nexium) block stomach acid production but may lead to nutrient malabsorption (iron, B12, calcium). iii. Dysphagia 4. Complications of dysphagia - Aspiration, malnutrition, dehydration, and weight loss. 5. NDD diet stages, what foods are allowed for each stage - Level 4: Pureed - Level 5: Minced and Moist - Level 6: Soft/Bite Sized - Level 7: Regular 6. Know what IDDSI is generally -- International Dysphagia Diet Standardization Initiative, providing a framework for food texture and liquid thickness. iv. Esophagectomy: nutrition concerns and issues - Start with liquids, progress to soft, nutrient-dense foods. Enteral nutrition may be needed if oral intake is insufficient. - Stomach v. Gastritis, issues - Inflammation of the stomach lining, can be acute (due to infections, NSAIDs) or chronic (often H. pylori-related). - This is the inflammation of the stomach lining, which can be acute (caused by infections or NSAIDs) or chronic (often linked to H. pylori). Symptoms may include stomach pain, nausea, and indigestion. vi. Intrinsic Factor - Essential for B12 absorption; deficiency can lead to anemia. - This is a protein essential for the absorption of vitamin B12 in the intestines. A deficiency can lead to **pernicious anemia**, characterized by fatigue and weakness. vii. Gastroparesis 7. Symptoms - Early satiety, nausea, vomiting, bloating. 8. Causes - Diabetes, nerve damage, or post-surgical complications. viii. Gastrectomy, partial, Roux-en-Y, Billroth I and II 9. Complications - Malabsorption, nutrient deficiencies, dumping syndrome. 10. Nutrition Interventions and issues - High protein and fat diet, monitor for deficiencies, consider supplementation (B12, iron). - Use of Vasopressors ix. Why used - to increase blood pressure in critically ill patients. - Vasopressors are administered to **increase blood pressure** in critically ill patients, particularly those experiencing **hypotension** due to conditions like sepsis or shock. x. Recognize names of vasopressors (know all except Dopamine that is used for Heart Failure) - Norepinephrine, epinephrine, phenylephrine. - Norepinephrine: Often the first-line agent. - Epinephrine: Used in severe cases, especially during cardiac arrest. - Phenylephrine: Primarily used for its vasoconstrictive properties. xi. Use of MAPS - Mean Arterial Pressure Score to assess perfusion. - Use of MAP: The Mean Arterial Pressure (MAP) is crucial for assessing perfusion. A MAP of 65 mmHg or higher is generally considered adequate for organ perfusion. xii. When can you initiate EN? - After hemodynamic stability is achieved, typically when the patient can tolerate oral intake. 13. Lower GI: - PUD, causes, nutrition - Peptic Ulcer Disease can be caused by H. pylori, NSAIDs, and stress. Nutrition focuses on avoiding irritants and promoting healing. - Nutrition related issues and complications with gastrectomy's, supplementation needed - Complications include malabsorption and nutrient deficiencies. Supplementation of vitamins B12, iron, and calcium may be needed. - Two Types of Diarrhea - Differences between the two - Nutritional consequences of diarrhea - Two types are **osmotic** (resolves with fasting) and **secretory** (does not resolve with fasting). Nutritional consequences include dehydration and malnutrition. - Know general causes of malabsorption - If on a low-fat diet, what foods to avoid - Common causes include celiac disease and IBS. Low-fat diets should avoid high-fat foods like butter and oils. - Celiac disease - Symptoms, pathophysiology of what is wrong - Foods to avoid - Symptoms include diarrhea and weight loss. Avoid gluten-containing foods (wheat, barley, rye). - IBS - Signs and symptoms, how is it diagnosed - Symptoms include abdominal pain and bloating. Diagnosed through symptom criteria. The **FODMAP diet** restricts fermentable carbs. - Know FOD MAP Diet - What are FODMAPS - Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. - Examples of FODMAPS foods to avoid - Wheat, garlic, onions, dairy, certain fruits (like apples and pears), and sugar alcohols (like sorbitol). - IBD: - Know differences between UC and Crohn's - Nutrition needs: kcal and protein-won't need to memorize but be able to calculate - Differences between **Ulcerative Colitis** (UC) and **Crohn\'s Disease** include location and symptoms. Nutritional needs may require increased kcal and protein. - Ulcerative Colitis (UC): Affects the colon and rectum; symptoms include bloody diarrhea and abdominal cramps. - Crohn\'s Disease: Can affect any part of the GI tract; symptoms include abdominal pain, diarrhea, and weight loss. - Nutritional Needs: Increased kcal and protein may be necessary due to malabsorption and inflammation. - Vitamin/mineral Supplements that may be needed - Supplements: Vitamin B12, iron, and calcium may be needed. - Medications used to treat IBD and any side effects or concerns - Medications: Include anti-inflammatory drugs, immunosuppressants, and biologics; side effects can include increased infection risk and gastrointestinal issues. - Diverticulosis & diverticulitis - Know differences - Types of diet for each condition - Soluble vs insoluble fiber-differences Differences: - Diverticulosis: Presence of diverticula, usually asymptomatic. - Diverticulitis: Inflammation of diverticula, causing pain and fever. Diet Types: - Diverticulosis: High-fiber diet to prevent complications. - Diverticulitis: Low-fiber diet during flare-ups, gradually reintroducing fiber as symptoms improve. Soluble vs. Insoluble Fiber: - Soluble Fiber: Dissolves in water, helps lower cholesterol (e.g., oats, beans). - Insoluble Fiber: Does not dissolve, aids in digestion (e.g., whole grains, vegetables). - SIBO: - What is it, what increase the risk - SIBO (Small Intestinal Bacterial Overgrowth) - Who is at risk - SIBO occurs when excessive bacteria grow in the small intestine, leading to malabsorption of nutrients. - Small Intestinal Bacterial Overgrowth can lead to malabsorption. Risk factors include certain medications and conditions. - Risk Factors: Conditions like diabetes, Crohn\'s disease, and certain medications (e.g., proton pump inhibitors) can increase the risk. - At-Risk Populations: Individuals with gastrointestinal surgeries, motility disorders, or chronic conditions affecting the gut are more susceptible. - Surgical Ostomies - Nutrition therapy and other tips - Nutrition therapy focuses on hydration, balanced diet, and avoiding high-fiber foods initially. - Nutrition Therapy: Focuses on maintaining hydration and a balanced diet. Initially, high-fiber foods should be avoided to prevent blockages. Tips: - Monitor fluid intake to prevent dehydration. - Gradually introduce foods, starting with low-fiber options. - Consider multivitamin supplementation to address potential deficiencies. - Short Bowel Syndrome - Nutrition concerns with resections - After resections, patients may experience malabsorption, requiring tailored nutrition plans. - Amount of intestine needed for function & Absorption - Intestinal Length for Function: - A minimum of 60 cm of jejunum is typically needed for adequate absorption. - Less than 100 cm of small intestine without the colon often leads to inevitable malabsorption, necessitating parenteral nutrition (PN). - Common Deficiencies: Micronutrient deficiencies (e.g., magnesium, calcium, vitamin B12, zinc) are common due to reduced absorption capacity. +-----------+-----------+-----------+-----------+-----------+-----------+ | **Disease | **What | **What | **Nutriti | **With | **Other | | /Dx** | goes | labs are | onal | this | important | | | wrong | 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