Nutrition Diagnosis

Instructions:

• Answer 50 questions in 15 minutes.
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• Match each statement with the correct term.
• Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is Fat-Controlled Diet?
Management of malabsorption - chronic pancreatitis - gallbladder disease - Medium chain triglycerides (MCTs) utilized with high intake of CHO and protein - Easy to digest - Restricts - High fat - additional fat in cooking - Enzyme replacement may be
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days
Method of feeding clients who do not have a functioning GI tract - Clinical disease (malabsorption) - surgical intervention - trauma/stress - malignancies - Energy and nutrients provided intravenously - Total parenteral nutrition (TPN) - Infused into


2. What is the long-term nutritional biochemical analysis? What are the values?
High BUN - High serum osmolality - High Na - Weight loss - Thirst
Foods that are easy to chew - digest - and absorb - Used during transition from liquid diets to regular or general diets - Foods low in fiber - Only lightly seasoned - Not appropriate for patients requiring mechanical soft diets
Low serum osmolality - Weight gain - Edema - Excess salt intake
Serum Albumin- (visceral protein status) Normal Value: 3.5-5 g/dl 2.8-3.5- compromised protein status <2.4- possible protein malnutrition


3. How do you manage TPN?

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4. What are the 3 levels of Dysphagia?
Pureed - Mechanically altered - Advanced
High BUN - High serum osmolality - High Na - Weight loss - Thirst
Renal disease or liver disease - Limit protein - Limit potassium - phosphorus - Sodium and Fluid restrictions - Emphasizes high biologic value - Minimum level of CHOs needed to spare protein
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO


5. What is Secondary Nutrition Risk?
Food allergy diet - Common: nuts - eggs - cow's milk - shellfish - wheat - Gluten-restricted diet - Celiac disease (malabsorption syndrome) - Omits wheat - rye - barley - oats - buckwheat - malt - Allows rice and corn - Lactose-restricted - Primary i
Diet hx of high intake - Diarrhea - Constipation - GI distress
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
Caused by disease


6. What are the Anthropometric measures?
Monitor patient's nutritional status - Monitor I&O - Fluid balance - lung sounds - s/s dehydration - etc. - Monitor IV - Change solution bag every 24 hours to decrease infection rate - CVC dressing change q 72 hours - Monitor Blood Chemistry - Fluid
A- Anthropometric approach B- Biochemical Tests C- Clinical Observations D- Diet Evaluations (Kcal - 24 hr recall etc)
Height/length -Weight -BMI -Body Measures (skin fold thickness)
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases


7. Excessive intake
Poor nutrition prevents or delays recovery from injury.
Inadequate Intake
High liver enzymes - Constipation - Diarrhea - CV changes - High intake of supplements/plant foods
Abnormal liver enzymes - Fatty liver - Weight gain/loss - Edema


8. Predicted suboptimal energy intake
Foods liquid at room or body temperature - Clear liquid plus milk - pudding - ice cream - soups - yogurt - Used to provide oral nourishment for patients - Difficulty chewing and swallowing solid foods - Commercial nutritional supplements often used
Reports or observations of energy intake less than needs - Projected change in ability to procure or consume adequate energy - Knowledge deficit - Projected increase in physical activity
Common for this diet to be ordered postoperatively - Permits patient's preferences and situations to be taken into consideration - Also allows for postoperative diet progression at the patient's tolerance
Biochemical parameters indicating excessive nutrient intake - Knowledge deficit - Meds affecting appetite - Nutrition in Patient Care


9. What are Dysphagia 'warning signs'?
High serum vit. A -D -K - B6 - niacin - Physical signs of excess - Diet hx
Food items that minimize elimination patterns by reducing fecal volume - Restricted - High fiber foods - Milk and milk products - Fried foods - Pepper - Alcohol - Heavy seasonings
Collecting food in the mouth - Spitting out food - Inability to control tongue - Coughing before or after swallowing - Choking - Excessive drooling - Regurgitation of food or liquid through nose - mouth or trach tube - Increased time required to eat
High chol - PO4 - GFR <90 - High BUN - Edema - Dx: kidney/liver


10. Inadequate carbohydrate intake

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11. Why is it important to know primary/secondary nutritional risk?
Prevents aspiration - Thickener added to liquids to created required thickness - Nectar/Syrup thick - Consistency of heavy syrup in canned fruit - Least restrictive - Cream based soups and most nutritional supplements - Honey thick - Consistency of h
Diet hx of high intake - Diarrhea - Constipation - GI distress
Poor nutrition prevents or delays recovery from injury.
Abnormal liver function tests - Abnormal levels of nutrient - Weight gain or weight loss - Edema - Nausea - Intolerance


12. Excessive or inappropriate fat intake
Biochemical parameters indicating suboptimal nutrient intake - Estimated intake less than needs - Cultural or religious practices - Knowledge deficit - Meds affecting appetite
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH
High chol - amylase/lipase - liver function tests - Diet hx high fat
Technical complications - Pneumothorax - Septic complications - Local or systemic - Metabolic complications - Most common complication - Most common is hyperglycemia


13. Inadequate vitamin intake
Collecting food in the mouth - Spitting out food - Inability to control tongue - Coughing before or after swallowing - Choking - Excessive drooling - Regurgitation of food or liquid through nose - mouth or trach tube - Increased time required to eat
Low serum vitamin levels - Physical signs of deficiency - Diet hx of low intake
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30
Diet hx of xs fiber intake - GI distress


14. What are the thickened liquids?
Renal disease or liver disease - Limit protein - Limit potassium - phosphorus - Sodium and Fluid restrictions - Emphasizes high biologic value - Minimum level of CHOs needed to spare protein
IV lipid emulsions - Used as a concentrated energy source and to prevent the development of essential fatty acid deficiency - Kcal density of lipid solutions is useful when volume restriction is necessary
Low serum osmolality - Weight gain - Edema - Excess salt intake
Prevents aspiration - Thickener added to liquids to created required thickness - Nectar/Syrup thick - Consistency of heavy syrup in canned fruit - Least restrictive - Cream based soups and most nutritional supplements - Honey thick - Consistency of h


15. Excessive oral food/beverage intake
High AST/GGT - Blood ETOH - diet hx of > 2 drinks/day - liver dx
A- Anthropometric approach B- Biochemical Tests C- Clinical Observations D- Diet Evaluations (Kcal - 24 hr recall etc)
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30
High BGL - Weight gain - High Hgb A1C - diet hx of energy dense food intake - Excess eating away from home


16. What is Soft Diet?
High BUN - High serum osmolality - High Na - Weight loss - Thirst
Foods that are easy to chew - digest - and absorb - Used during transition from liquid diets to regular or general diets - Foods low in fiber - Only lightly seasoned - Not appropriate for patients requiring mechanical soft diets
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases
High BUN - Low GFR - Poor growth - Deranged AA ratios - diet hx high PRO or AA supplement


17. What else do you check with biochemical tests?
Anthropometric data -Clinical data -Dietary intake assessment
Carbohydrate - Dextrose solutions - Available in initial concentrations of 5% to 70% - Mixed with amino acids and other nutrients to form the final solution - Protein - Mixture of essential and nonessential crystalline amino acids - Available wi
Prealbumin- (visceral protein status) Normal Value: 16-40 g/dl Compromised Protein status: 10-15 g/dl Possible protein malnutrition: <10 g/dl
High AST/GGT - Blood ETOH - diet hx of > 2 drinks/day - liver dx


18. What is Full-Liquid Diet?
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support
Foods liquid at room or body temperature - Clear liquid plus milk - pudding - ice cream - soups - yogurt - Used to provide oral nourishment for patients - Difficulty chewing and swallowing solid foods - Commercial nutritional supplements often used
Low serum osmolality - Weight gain - Edema - Excess salt intake


19. Excessive fluid intake
Low serum osmolality - Weight gain - Edema - Excess salt intake
Weight Loss - dx: AIDS - TB - AN
Potential to become malnourished
High/low BGL - Meds (steroids) - Diet hx


20. What are the confirmations of tube placement?
A- Anthropometric approach B- Biochemical Tests C- Clinical Observations D- Diet Evaluations (Kcal - 24 hr recall etc)
Pureed - Mechanically altered - Advanced
Before Putting anything in - Radiography - pH of aspirated fluids - Air injection and ausculation - Visual assessment of aspiration
Socioeconomic status -comorbid disease states -Age adults: =< 75 children<5 PHYSICAL -stress and trauma- metabolic demands -mechanical ventilation-unable to eat -therapeutic bowel rest


21. Excessive alcohol intake
High AST/GGT - Blood ETOH - diet hx of > 2 drinks/day - liver dx
Foods clear and liquid at room/body temperature - :Used to help prevent dehydration and keep colon contents to a minimum - -Good source of fluids and water - Inadequate in: - Protein - Fat - Energy - Fiber - Recommended for short-term use (3-5 days
High/low BGL - Meds - Insulin use -
Diet hx of xs fiber intake - GI distress


22. Excessive fiber intake
Diet hx of xs fiber intake - GI distress
Weight status and trends - BUN - creatinine - serum chemistries - proteins - Fluid status - intake and output
Before Putting anything in - Radiography - pH of aspirated fluids - Air injection and ausculation - Visual assessment of aspiration
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support


23. What is Carb-controlled Diet?
CHO 55-60% - protein 10-20% - lipid <30% - fiber 20-35 grams - Evaluate glucose levels - serum lipids - kcalories - diet - insulin/medication
Method of feeding clients who do not have a functioning GI tract - Clinical disease (malabsorption) - surgical intervention - trauma/stress - malignancies - Energy and nutrients provided intravenously - Total parenteral nutrition (TPN) - Infused into
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
Allows body to heal -To prepare diagnostic test -To prepare Surgical Procedure


24. What are the Dietary Evaluations?
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
Diet hx of low fiber intake - Constipation/low stool volume
Kcal count -24 hr recall -Food records
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO


25. Excessive or inappropriate protein intake
Allows body to heal -To prepare diagnostic test -To prepare Surgical Procedure
High BUN - Low GFR - Poor growth - Deranged AA ratios - diet hx high PRO or AA supplement
Ketone breath - Diet hx low CHO - Dx: liver - pancreas - celiac's disease
Low serum osmolality - Weight gain - Edema - Excess salt intake


26. What is Enteral Nutrition based on?

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27. Inadequate oral food/ beverage intake
Low cholesterol - Low Ca - High PTT - Low Cu/Zn/Fe - Weight loss - Dehydration
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH
Inadequate Intake
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term


28. What is Low-Residue Diet?
Food allergy diet - Common: nuts - eggs - cow's milk - shellfish - wheat - Gluten-restricted diet - Celiac disease (malabsorption syndrome) - Omits wheat - rye - barley - oats - buckwheat - malt - Allows rice and corn - Lactose-restricted - Primary i
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
High chol - amylase/lipase - liver function tests - Diet hx high fat
Food items that minimize elimination patterns by reducing fecal volume - Restricted - High fiber foods - Milk and milk products - Fried foods - Pepper - Alcohol - Heavy seasonings


29. Excessive carbohydrate intake
High BUN - Low GFR - Poor growth - Deranged AA ratios - diet hx high PRO or AA supplement
Diet hx of aberrant CHO intake - Steroids - DM - Inborn errors
14 days of admission
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH


30. What is Mechanically Altered Diet?

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31. Inadequate fluid intake
Encourage patient to think/talk about food before meals - Can help stimulate flow of saliva - Aids in formation of bolus - Chewing and swallowing process - Tart or sour foods - Stimulate saliva production - Have patient lick jelly from the lips - puc
TJC requires screenings within 48hrs
Biochemical parameters indicating excessive nutrient intake - Knowledge deficit - Meds affecting appetite - Nutrition in Patient Care
High BUN - High serum osmolality - High Na - Weight loss - Thirst


32. What is the other biochemical analysis and values?
Serum and urine creatinine and BUN (somatic muscle protein) -ELEVATED if muscle is broken down Normal Values: -Serum Creatinine: 0.5-1.2mg/100ml -BUN: 10-20 mg/ml
Ketone breath - Diet hx low CHO - Dx: liver - pancreas - celiac's disease
Pureed - Mechanically altered - Advanced
Weight status and trends - BUN - creatinine - serum chemistries - proteins - Fluid status - intake and output


33. Inadequate energy intake
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support
Abnormal liver enzymes - Fatty liver - Weight gain/loss - Edema
Low serum osmolality - Weight gain - Edema - Excess salt intake
Serum Albumin- (visceral protein status) Normal Value: 3.5-5 g/dl 2.8-3.5- compromised protein status <2.4- possible protein malnutrition


34. Excessive energy intake
Low HDL - High TSH - High Mg - High PO4 - Diet hx of xs intake - Liver damage - GI distress
Patients who have difficulty chewing or swallowing food - Goal is to provide a diet that meets nutritional needs and prevents aspiration - Causes of dysphagia - Acute: CVA - seizure - trauma - surgery - anoxia - Progressive: dementia - Parkinson's -
Weight gain - Diet hx of energy dense food intake
Anthropometric data -Clinical data -Dietary intake assessment


35. Excessive enteral nutrition infusion
Foods that are easy to chew - digest - and absorb - Used during transition from liquid diets to regular or general diets - Foods low in fiber - Only lightly seasoned - Not appropriate for patients requiring mechanical soft diets
High BUN - High BGL - High liver enzymes - Weight gain - Edema
Monitor patient's nutritional status - Monitor I&O - Fluid balance - lung sounds - s/s dehydration - etc. - Monitor IV - Change solution bag every 24 hours to decrease infection rate - CVC dressing change q 72 hours - Monitor Blood Chemistry - Fluid
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support


36. Excessive parenteral nutrition infusion
Abnormal liver function tests - Abnormal levels of nutrient - Weight gain or weight loss - Edema - Nausea - Intolerance
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases
Elevated BUN:creatinine ratio - Hyperglycemia - Hypercapnia - Elevated liver enzymes - Weight gain - Edema - Meds that reduce energy requirements or impair metabolism
Low chol - alb - prealb - elytes/minerals - vitamins - Weight loss - Low BMI - Diet hx of low intake - fever - dx: Crohn's - AIDS - burns


37. Inadequate parenteral nutrition infusion
Indirect calorimetry measurement - Vitamin/mineral abnormalities in lab values - Inadequate weight gain - or unintentional weight loss Clinical evidence of vitamin/mineral deficiency
Reports or observations of energy intake less than needs - Projected change in ability to procure or consume adequate energy - Knowledge deficit - Projected increase in physical activity
Diet hx of high intake - Diarrhea - Constipation - GI distress
Biochemical parameters indicating excessive nutrient intake - Knowledge deficit - Meds affecting appetite - Nutrition in Patient Care


38. What is Pureed Diet?
Collecting food in the mouth - Spitting out food - Inability to control tongue - Coughing before or after swallowing - Choking - Excessive drooling - Regurgitation of food or liquid through nose - mouth or trach tube - Increased time required to eat
TJC requires screenings within 48hrs
Provides essential nutrients in blenderized form - Clients who are unable to chew or swallow - Can be used long-term
Inadequate Intake


39. What is the short-term nutritional biochemical analysis? What are the values?
Low serum mineral levels - Physical signs of deficiency - Diet hx of low intake - Celiac disease - SBS - IBD
Prealbumin- (visceral protein status) Normal Value: 16-40 g/dl Compromised Protein status: 10-15 g/dl Possible protein malnutrition: <10 g/dl
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Encourage patient to think/talk about food before meals - Can help stimulate flow of saliva - Aids in formation of bolus - Chewing and swallowing process - Tart or sour foods - Stimulate saliva production - Have patient lick jelly from the lips - puc


40. What is 'Diet as Tolerated'?

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41. How long does TJC require resident screenings to be done during admission?
Serum Albumin- (visceral protein status) Normal Value: 3.5-5 g/dl 2.8-3.5- compromised protein status <2.4- possible protein malnutrition
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30
TJC requires screenings within 48hrs


42. What is the assessment of nutritional risk approach? (abcd)
GI problems - Diarrhea - Nausea and vomiting - Cramping - Distention - Constipation - Mechanical complications - Tube displacement - Tube obstruction - Pulmonary aspiration - Mucosal damage
Diet hx of low plant food intake
Inadequate Intake
A- Anthropometric approach B- Biochemical Tests C- Clinical Observations D- Diet Evaluations (Kcal - 24 hr recall etc)


43. Increased nutrient needs

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44. Inadequate protein-energy intake
High/low BGL - Meds - Insulin use -
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Weight status and trends - BUN - creatinine - serum chemistries - proteins - Fluid status - intake and output
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30


45. What is Clear Liquid Diet?
Foods clear and liquid at room/body temperature - :Used to help prevent dehydration and keep colon contents to a minimum - -Good source of fluids and water - Inadequate in: - Protein - Fat - Energy - Fiber - Recommended for short-term use (3-5 days
Inadequate Intake
Weight gain - Diet hx of energy dense food intake
High chol - PO4 - GFR <90 - High BUN - Edema - Dx: kidney/liver


46. What are the Carb and Protein Parenteral Nutrition Solutions?
Carbohydrate - Dextrose solutions - Available in initial concentrations of 5% to 70% - Mixed with amino acids and other nutrients to form the final solution - Protein - Mixture of essential and nonessential crystalline amino acids - Available wi
Before Putting anything in - Radiography - pH of aspirated fluids - Air injection and ausculation - Visual assessment of aspiration
High liver enzymes - Constipation - Diarrhea - CV changes - High intake of supplements/plant foods
High BUN - High serum osmolality - High Na - Weight loss - Thirst


47. What are some tube-feeding complications?
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days
Serum and urine creatinine and BUN (somatic muscle protein) -ELEVATED if muscle is broken down Normal Values: -Serum Creatinine: 0.5-1.2mg/100ml -BUN: 10-20 mg/ml
GI problems - Diarrhea - Nausea and vomiting - Cramping - Distention - Constipation - Mechanical complications - Tube displacement - Tube obstruction - Pulmonary aspiration - Mucosal damage
Monitor patient's nutritional status - Monitor I&O - Fluid balance - lung sounds - s/s dehydration - etc. - Monitor IV - Change solution bag every 24 hours to decrease infection rate - CVC dressing change q 72 hours - Monitor Blood Chemistry - Fluid


48. Inadequate protein intake
Weight Loss - dx: AIDS - TB - AN
Biochemical parameters indicating suboptimal nutrient intake - Estimated intake less than needs - Cultural or religious practices - Knowledge deficit - Meds affecting appetite
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases
Diet hx of low intake


49. What are the feeding modalities?
Diet hx of low fiber intake - Constipation/low stool volume
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases
Weight loss (5% in 1 month; 10% in 6 months) - Increased activity - dx: Parkinsons - cerebral palsy - dementia
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days


50. Symptoms of Intakes - Increased energy expenditure
Indirect calorimetry measurement - Vitamin/mineral abnormalities in lab values - Inadequate weight gain - or unintentional weight loss Clinical evidence of vitamin/mineral deficiency
Weight loss (5% in 1 month; 10% in 6 months) - Increased activity - dx: Parkinsons - cerebral palsy - dementia
Weight status and trends - BUN - creatinine - serum chemistries - proteins - Fluid status - intake and output
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry