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How do you calculate BMI?
Weight in pounds/ heigh in inches squared X703
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Waist Circumference is a good indicator of the risk for what two diseases?
CV and DM2
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A bad waist circumference for women is
>35 inches
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A bad waist circumference for men is
>40 inches
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A good cholesterol level is under
200
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A good LDL level is under
100
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A good HDL level is over
60
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According to Choose my plate how what should be the main make up of a typical dinner
Fruits and veggies should take up the majority with grains an protein making up a smaller portion
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What patients are at risk for malnutrition
- weight
- weight changes
- dysphagia
- food intolerance
- reflux
- abnormal lab values
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What diet do you give a patient with dysphagia?
Thickened liquids, mechanical soft grount and pureed food
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What diet do you give a patient on Hemo/peritoneal dialysis?
Sodium, potassium, phosphorus and fluid and protein
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What diet do you give to a CHF patient?
2 gm sodium, fluid restrictions
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What diet do you give a pt on coumadin?
Avoid foods with high potassium levels
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What are the 4 thicknesses of fluids?
- Thin
- nectar thick
- Honeylike
- spoon thick
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Describe thin liquids and name some examples
- regular liquids, no adjustment needed
- buttermilk, tomatoe juice
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Describe nectar thick liquids and name some examples
falls slowly from a spoon can sip through a straw
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Describe a honey thick liquid and name some examples
- drops from a spoon too thick to sip from a straw
- Example: tomato sauce
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Spoon
- Maintains shape needs spoon too thick to drink
- pudding
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Describe a dysphagia diet level one
- Pureed
- bread- pureed or pre gelled, slurry
- fruits- pureed/well mashed no seeds etc
- Veggies pureed
- Describe a dysphagia diet level 2
- mechanically altered
- soft testured so can form a bolus
- beverages have suspended pulp, bits of texture
- moist well cooked veggies cut in half
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Describe a dysphagia diet level 3
- advanced
- near normal texture
- exclude crunchy sticky or very hard foods
- moist breads, cereals, desserts potatoes soups
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4 conditions where you really want to monitor the patients electrolyte intake...
Edema, HTN, CHF, Renal impairment
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Name a disease that elevates potassium
Renal failure
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Name some drugs that can elevate potassium
beta blockers, potassium supplements, ACE/ARBs
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Name some high potassium foods
green beans, iceburg lettuce, 1 egg, one small banana, one orange, potatoe with skin
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What is the dietary goal cholesterol for cholesterol reduction diet?
<200 mg/qd
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Name some high saturated fat foods
- Meat
- Whole milk/butter/cream
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What do you limit with a cholesterol reduction diet?
- Trans fat
- cholesterol
- sodium
- fat all types
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What are some examples of trans fat foods
margarine, shortening, fried foods, packaged foods made with hydrogenated oils, french fries, doughnuts, baked goods including pastries and pie crust, biscuits, pizza dough, cookies and crackers
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Name two foods that will improve your dietary cholesterol
- Omega-3 fats
- Dietary fiber
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What are some examples of Omega 3 Fats?
Salmon, tuna, mackerel, sardines, walnuts, canola, soybean, flaxseed oil or ground
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What is the recommendation on Dietary Fiber and what can you eat to get it?
- 20-30 grams per day
- fruits, veggies, whole grains, dried beans
- 5 cups of fruit/veggie or 3 ounces of whole grain foods
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Name some conditions that are indications for a low sodium diet
- heart failure
- hypertension
- renal disease
- conditions of fluid retention or swelling
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ADA guidelines on sodium suggest that you limit your sodium intake to how many mg per day?
2000
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what 5 things should you monitor intake of with a patient who has chronic kidney disease
Sodium, Potassium, protein, phosphorus, calcium
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What is Lactose Intolerance
Inability to digest sugar found in dairy
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What causes lactose intolerance
lactase deficiency
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Is lactose intolerance more common in white children or black children
white
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What are the symptoms of lactose intolerance
bloating, flatus, diarrhea, cramps, delayed growth in children
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How soon after eating dairy to lactose intolerance symptoms appear?
30 mins to 2 hours
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What are some secondary causes of lactose intolerance?
Bacterial overgrowth, infectious enteritis, giardiasis, mucosal injury (celiac, IBC, Drug and radiation induced)
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How do you test for Lactose intolerance?
Test for the presence of hydrogen after lactose load (urea breath test)
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Treatment for lactose intolerance includes:
- avoid milk products
- alternatives: yogurt, buttermilk, aged cheese, ingest lactase
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What are some food sources with high vitamin A
Liver, fish oils, fortified milk, eggs
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Who gets deficiencies in vitamin A?
Elderly, achoholism, liver disease, night blindness, dry skin
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Sx of Vitamin A toxicity
skin disorders, hair loss, poss teratogenic
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Vitamin C food sources include:
citrus fruits, strawberries, broccoli, mixed green veggies
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What are some functions of vitamin C in the body
neurotransmitter synthesis, collagen synthesis
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Who is at risk for Vitamin C deficiencies
elderly men, alcholism, college students and sailors
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What happens to pts with Vitamin C deficiencies?
Poor wound healing, bleeding gums, petechiae, scurvey
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What happens with levels of Vitamin C that are too high?
Diarrhea
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What is a food source of Vitamin D?
Fortified milk
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What is the function of Vitamin D in the body
calcium regulation, cell differentiation
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Who is at risk for Vit D deficiencies?
Elderly, those with low sun exposure
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What happens to patients with Vit D deficiencies?
Osteomalacia, ricketts
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What happens with toxic levels of Vit D>?
hypercalcemia, renal calcuil, soft tissue calcium deposits
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What are some food sources of Vitamin K
spinach, broccoli, asparagus
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What cartoon character is �strong to the finish� and is NOT at risk of vitamin K deficiency? Bonus question what vitamin deficiency is this cartoon character at risk of?
- Poppy the sailor man!
- Because he is a sailor traditionally he would be at risk of ricketts because of a vitamin C deficiency however college students have passed sailors as the group of people most at risk for Vit C defic.
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What can Vitamin K deficiency cause?
Bleeding deficiencies effects in factors VII, IX, X and prothrombin
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Is vitamin K fat or water soluble?
Fat
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Riboflavin (B2) is found in what foods?
Meat, fish, eggs, milk, green veggies, enriched foods
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Deficiencies of Riboflavin lead to what manifestations?
Cheilitis, glossitis stomatitis, mucosal edema
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Thiamine (B1) is found in what foods?
Pork, grains, peas, dried beans, brewer's yeast,
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What is Thiamine's function in the body?
CHO metabolism, nerve functioning
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What patient population is at risk for thiamine deficiency?
Poverty, alcoholics
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What are some consequences of thiamine deficiency?
- Beriberi- tingling poor coordination, weakness, edema possible cardiac dysfunction
- Wernikes encephalopathy
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Wernike's encephalopathy- name the deficiency
thamine deficiencies
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Beriberi- name the deficiency
Thamine deficiency
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Chelitis, glossitis, stomatitis mucosal edemal name the deficiency
riboflavin
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Bleeding problems � name the deficiency
Vitamin K
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Osteomalacia name the deficiency
Vitamin D
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Scurvy � name the deficiency
Vitamin C
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Ricketts- name the deficiency
Vitamin D
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night blindness � name the deficiency
Vitamin A
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