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nutritional risk:

The potential to become malnourished because of primary (inadequate intake of nutrients) or secondary (caused by disease or iatrogenic effects) factors,

nutrition therapy:

Definition may be dictated by state laws that license registered dietitians, but typically involves provision of nutrient, dietary, and nutrition education needs by RDs based on a comprehensive nutritional assessment,

iatrogenic:

Inadvertently caused by treatment or diagnostic procedures,

body mass index (BMI):

A measure that describes relative weight for height and is significantly correlated with total body fat content,

somatic protein stores:

Proteins in skeletal muscle,

visceral protein:

Proteins contained in the internal organs,

nutritional support:

Although commonly used in reference to enteral and parenteral nutrition delivery systems, it can refer to any nutrition intervention used to minimize patient morbidity, mortality, and complications,

diet manual:

The reference book (usually in a three-ring binder or on computer) that describes the rationale and indications for using a specific diet, lists the allowed and restricted foods, and provides sample menus,

colonoscopic examination:

Examination of the mucosal lining of the colon using a colonoscope (an elongated endoscope),

barium enema:

Rectal infusion of a radiopaque contrast medium to diagnose obstruction, tumors, or other abnormalities (for example, ulcerative colitis),

paralytic ileus:

Decrease in or absence of intestinal peristalsis,

dysphagia:

The inability to swallow normally or freely or to transfer liquid or solid foods from the oral cavity to the stomach; may be caused by an underlying central neurologic or isolated mechanical dysfunction,

edentulous:

Toothless,

enteral nutrition:

Administration of nourishment via the gastrointestinal tract,

osmolality:

Concentration of electrically charged particles per kilogram of solution,

polymeric formulas:

Solutions that provide intact nutrients (for example, whole proteins and long-chain triglycerides), which require a normally functioning gastrointestinal tract,

isotonic:

Having the same concentration of solute as another solution, therefore exerting the same amount of osmotic pressure as that solution,

hypertonic:

Having greater concentration of solute than another solution,

elemental formulas:

Solutions that provide ready-to-absorb basic nutrients, requiring minimal digestion

parenteral nutrition:

Administration of nutrients by a route other than the gastrointestinal tract, usually intravenously

What are the four steps in the American Dietetic Association's Nutrition Care Process?

a. food and/or nutrient delivery
b. nutrition education
c. nutrition counseling
d. coordination of care

Describe the ABCD approach to comprehensive nutritional assessment.

Anthropometrics, Biochemical tests, clinical observation, diet evaluation

When should a recumbent height be taken?

coma, critical illness, immobile, infants or others who can't stand.

In which instances might weight not be a good indicator of nutritional status?

edema or dehydration reflect fluid status rather than nutrition

What do the two most important biochemical parameters measure?

blood and urine tests

What is the main difference between albumin and prealbumin?

albumin- most useful when used to monitor long term nutrition changes in visceral protein (sometimes normal values are still found amoung patients who are recently malnourished
prealbumin- monitors short term visceral protein status b/co of short half life (2days)

Contrast the three methods used to assess dietary intake.

24hr dietary recall- patient reports all food/drink consumed in the past 24hrs
food records- all consumed itemsrecorded by patient for 1-7 days using household measures.
kcal count- acute or long term care. quantified kcal and protein intakes

When might the following diets be appropriately used: clear liquid, full liquid, mechanical soft, and soft diet?

clear liquid- before/after surgery; hydrates but no energy (fat, protein, carbs)
full liquid- patients who cant chew or swallow SOLID FOOD. more variety and nutritious
mechanical soft- problems chewing/swallowing regular food
soft diet- transition between liquid and regular diets

10. If the gut is functioning but oral (PO) intake is poor, which should be started—enteral or parenteral feedings?

enteral

Define elemental formulas and describe when they should be used.

predigested or hydrolyzed formulas- used for patients with partially functioning GI tract (impaired capacity to digest, absorb, pancreatic insufficiency, bile deficiency)

Compare the six tube-feeding routes.

nasogastric- nose to stomach
nasoduodenal- nose to small intestine
nasojejunal- nose to jejunum (small intestine)
esophagastomy- surgerically placed; neck to stomach
gastrostomy- surgically placed into stomach
jejunostomy- surgically inserted into small intestine

Contrast the three methods of administering a tube feeding.

continuous infusion- preferred. controlled delivery of prescribed volume at a constant rate. requires special equipment, but similar to gastric emptying.
intermittent infusion- delivering total 24hr quantity in 3-6 equal feedings. more normal feeding pattern, but but time consuming to monitor delivery rate. many patients can't tolerate this volume or if it's administered too quickly
bolus feeding- infusing volumes of formula by gravity or syringe over a short period of time. minimal equipment with increased aspiration potential.

What are three types of tube-feeding complications?

GI- diarrhea, N/V, cramping, distention, constipation
mechanical- tube displacement, obstruction, aspiration, mucosal damage
metabolic- dehydration, overhydration, abnormal blood levels of Na, , P, Mg. Rapid weight gain, hyperglycemia.

What is the difference between total parenteral nutrition (TPN) and peripheral parenteral nutrition (PPN)?

TPN- parenteral nutrition delivered into large diameter vein (vena cava)
PPN- small periphery vein (forearm)

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