NFSC 470 Seminar MNT Review of Clinical Nutrition

1. NFSC 470Seminar MNT Review of Clinical Nutrition

2. What are some signs/symptoms of dysphagia? What labs might be affected?

3. If dysphagia doesn’t resolve and you must recommend a tube feeding, where would you recommend it be placed and why?

5. What are your diet and lifestyle recommendations for someone who has GERD?

6. So… for GERD:

7. What are the nutrition implications of chronic gastritis? In other words, the absorption of what vitamin might be affected, and this would lead to what condition?

8. What are the most common causes of gastric ulcers? What recommendations would you give to your patients with ulcers?

9. The post-gastrectomy diet is designed to decrease risk for dumping syndrome. What are the primary tenets of this diet?

10. What are the signs of fat malabsorption? What are the nutritional implications? What are your dietary recommendations for someone with fat malabsorption, in general??

11. What are your recommendations for someone with lactose intolerance?

12. What is IBD? Name two forms.

13. What are the nutritional recommendations for IBD?

14. What are the dietary recommendations for diverticulosis? Diverticulitis?

15. Describe the nutrition recommendations for someone with a colostomy or ileostomy.

16. What are some causes of hepatic steatosis? What are your nutrition recommendations?

17. What are the biochemical indicators for hepatic steatosis?

18. Ascites is associated with what disease state? What are the nutritional recommendations?

19. Cirrhosis may cause steatorrhea. Why? What’s the MNT?

20. Would you expect a change in lab values for someone with cirrhosis?

21. What are the hallmark lab indicators of acute pancreatitis? Hallmark symptoms?

22. Why would pancreatitis cause steatorrhea?

23. What’s the MNT for acute pancreatitis?

24. For someone with acute pancreatitis who requires a tube feeding, where should it be placed and why?

25. Tell me what could cause elevated blood glucose levels.

26. What’s albumin and why do we look at it when assessing nutritional status?

27. What pair of lab values may indicate dehydration? (Tell me which way they’d be off, either elevated or depressed).

28. What might cause low electrolyte values?

29. What does it mean, in general, if someone has a low Hgb and Hct?

30. What does a high MCV mean, and what dietary factors could cause it?

31. What are the two labs that (in general) together indicate kidney disease?

32. In renal failure, how would you expect the following labs to change? (Indicate up, down, or n/c for no change) ___BUN ___creatinine ___uric acid ___K+ (potassium) ___ PO4 (Phosphorus) ___ Hgb/Hct __albumin

33. What is Hgb A1c and what does it indicate?

34. What are the LDL goals for people with diabetes, and why?

35. What does GFR indicate?

36. What are the dietary restrictions associated with kidney failure? (pre-dialysis)

37. Which one of these changes once dialysis is initiated?

38. List the “desirable” or “optimal” values: • Total cholesterol (for people age 30+) ____________ • LDL cholesterol __________ • HDL cholesterol __________ • TG (triglycerides) __________ • Blood pressure ______________ • Fasting blood glucose (range) ____________ • Serum albumin ___________

39. What type of dietary fiber helps reduce serum cholesterol? How does it do it? What are some good food sources?

40. What is the DASH diet? For whom is it appropriate? What are the main tenets of this diet?

41. Nutrient Saturated fat Polyunsaturated fat Monounsaturated fat Total fat Carbohydrate Fiber Protein Cholesterol Recommended Intake What are the main tenets for the TLC diet? (Therapeutic Lifestyle Changes)

42. Enteral Nutrition • Indications • Patient must have a functioning GI tract • Malnourished patient expected to be unable to eat > • Normally nourished patient expected to be unable to eat > • (anorexia, comotose, head/neck surgery, hypermetabolic, adaptive phase of SBS, upper GI obstruction if TF can be placed beyond it)

43. Contraindications • Intractable vomiting and/or diarrhea • Intestinal obstruction, ileus, or bleed • Early SBS • Fistula • Early short-bowel syndrome • Pt. intolerance • No enteral access/pt. refusal • Pt. expected to eat within reasonable timeframe • Aggressive therapy not warranted

44. Types of formulas • Intact (Standard) • Hydrolyzed (Elemental) • Modular • Kcals: • Standard • Concentrated • Osmolality

45. Routes of Administration • NG • ND • NJ • PEG • PEJ

47. Enteral Calculations Volume: rate (ml/hr) x 24 hours = ml total volume/day Kcals: volume x kcal/ml = kcals Protein: g_ x volume (L) = g prot/day L Water: volume x %free water (plus flushes) = ml/day (Review Homework Problems)

48. Parenteral Nutrition • TPN = Total Parenteral Nutrition • Provision of nutrients intravenously • Central • Peripheral (PPN) • For patients who are already malnourished or have the potential for developing malnutrition and who are not candidates for enteral nutrition

49. Indications for TPN • NPO for extended period (>10 days) • Enteral nutrition support projected to be inadequate for >14 days • Extensive small bowel resections • Radiation enteritis • Intractable diarrhea/vomiting • GI tract obstruction • Severe acute pancreatitis • Fistula

50. B. Contraindications 1. Patients for whom EN would meet requirements 2. Terminally ill patients.