1
Q
What is the process of becoming an RD?
A
- complete approved Academy + Dietetics (AND) Didactic 4 year program
- complete a postgraduate AND-approved Dietetic internship
- pass a national registration exam
2
Q
What are the steps involved in the Scientific Method?
A
- Ask a question
- Background research
- Hypothesis
- Test
- Analyze/ Conclude
- Communicate results
3
Q
What are factors to consider when researching?
A
- single or multi center
- retrospective or prospective
- causation or association
4
Q
Lab/ Animal Studies
A
- controlled conditions
- before human research is allowed
5
Q
Case Series/ Reports
A
- not controlled
- early research
- taking patient’s chart notes and applying them to a journal article
6
Q
Case Control Studies (retrospective)
A
-comparing a non-patient group with a patient group’s history and drawing conclusions
7
Q
Cohort Studies (prospective)
A
- large group that is recruited for future years
- comparing the results of the patient and non-patient groups
8
Q
Systematic Review
A
-includes analyzing published and unpublished studies
9
Q
Meta-Analysis Review
A
-includes pooling published studies into a new data set
10
Q
Nutrition Care Process
A
ADIME: Assessment … Diagnosis (PES statement) … Intervention … Monitoring + Evaluation
11
Q
PES Statement
A
P: problem … as related to
E: etiology … as evidenced by
S: signs + symptoms
12
Q
Adult AMDRs
A
Carbohydrates: 45-65%
Proteins: 10-35%
Fats: 20-35%
13
Q
ChooseMyPlate grain portions
A
1 oz is equal to 1 slice bread, 1 cup cereal, 0.5 cup cooked rice + cereal
14
Q
ChooseMyPlate vegetable portions
A
1 cup of raw/ cooked/ juice
2 cups of raw lead greens
15
Q
ChooseMyPlate fruit portions
A
1 cup fruit/ juice
0.5 cup fried fruit
16
Q
ChooseMyPlate dairy portions
A
1 cup milk/ yogurt
1.5 oz natural cheese
2 oz processed cheese
17
Q
ChooseMyPlate protein portions
A
1 oz meat, fish, poultry 0.5 cup cooked dry beans 1 egg 1 T peanutbutter 0.5 oz nuts or seeds 1 t oil
18
Q
DRI AI EAR RDA UL
A
DRI= Dietary Reference Intakes AI= Adequate Intake (used when there is not enough scientific evidence) EAR= Estimated Average Requirement (covers 1/2 the population) RDA= Recommended Dietary Allowance (covers 97-98% of the population) UL= tolerable upper limit (toxicity)
19
Q
Phytochemical HEI DGA DV DRV RDI
A
phytochemical: components of plants that have disease preventing property HEI: healthy eating index DGA: Dietary Guidelines for Americans DV: Daily Value DRV: Daily Reference Value RDI: Reference Daily Intake
20
Q
What are devout Buddhists not allowed to eat?
A
- all meat, fish, + shellfish
21
Q
What are devout Hindus not allowed to eat?
A
- all meat + alcohol with restrictions on fish + shellfish
22
Q
What are devout Jewish Orthodoxes not allowed to eat?
A
- all meat, fish, shellfish, alcohol, leavened products, eggs + dairy
23
Q
What are devout Muslims not allowed to eat?
A
- all meat, alcohol, coffee + tea
24
Q
What are devout Christians not allowed to eat?
A
- only restrictions to meat
25
What are devout Eastern Orthodoxes not allowed to eat?
- all meat, egg/ dairy + fish (shellfish is allowed)
26
What are devout Mormons not allowed to eat?
-alcohol + coffee/ tea
27
What are devout 7th Day Adventists not allowed to eat?
all meat, fish, shellfish, alcohol, coffee + tea
28
What is the percentage of calories that come from fat on a Nutrition Facts Panel?
17%
29
Motivational Interviewing
Facilitates change through:
- empathy
- developing discrepancies
- avoid arguments
- rolling with resistance
- self-eficacy
30
Cognitive Behavioral Therapy
Aims to change the thinking process through lifestyle modification
31
Health Belief Model
Looks at the prevention of disease and its benefits
32
TM
Trans-theoretical Model:
-pre-contemplation: aware of the problem but are not doing anything
-contemplation: thinking about changing
-preparation: preparing but not yet committed
-action
-maintenance: painting the healthy behavior
(relapse can happen at any point during progression)
33
Interviewing Techniques and Questions
- introduce yourself
- maintain privacy
- physical environment
- eye contact (can be considered rude in some cultures)
- time (stay with time parameters)
- ask open ended questions
- active-listenin/ feedback
- avoid giving advice (want the patient to figure out their problems)
- realistic expectations
34
NHANES
National Health and Nutrition Exam Survey
35
Factors that affect the ability to change...
- socioeconomics
- cultural competency
- communication
- message-framing
- health-literacy
- food preparation
36
Randomized Control Trials
- prospective; expensive
- use of experimental placebo and the standard dose
- compare treated and untreated groups
37
What does MUST stand for?
| What are the 5 steps involved?
Malnutrition Universal Screening Tool
1. BMI Score
2. Unplanned weight loss
3. Acute disease effect score
4. Overall risk of nutrition
5. Management guidelines: 0 low risk ; 1 medium risk; 2> high risk
38
What does MNA stand for?
| What is the score range?
Mini Nutrition Assessment
- 0-7 malnourished
- 8-11 risk of malnutrition
- 12-14 normal nutritional status
39
Medical/ Health History
```
o Digestion/ Absorption
o Metabolism
o Excretion
o Mental Health
o Current + Past Health Status
o Health Factors (surgery/ inabilities/ diseases)
```
40
Medication/ Drug History
o Food can alter medication
| o Medications can alter nutrient
41
Socioeconomic Status
o Age // Education // Income
o Occupation // Household # // Facilities
o Access to food and transportation // Religion
42
o Inspection
o Palpation
o Percussion
o Auscultation
- general observation
- touch
- sound
- listening to body via ear or stethoscope
43
Adult HR
Adult Respiratory Rate
Adult BP
- 60-100 bpm
- 12-16 bpm
-
44
Malnutrition Diagnosis Characteristic
```
o Weight loss
o Inadequate energy intake
o Loss of muscle mass
o Loss of subcutaneous fat
o Fluid accumulation (edema)
o Reduced hand grip strength
```
45
Drug
Drug-Nutrient
Food Drug Interaction
Distribution
o Drug: substance used in diagnosis, treatment, and prevention of disease as a component of medication
o Drug-Nutrient Interaction: changes to a drug caused by a nutrient; vice versa
o Food-Drug Interaction: effect of medication on a nutritional status
o Distribution: once the drug leaves the systematic circulation and travels around the body
46
Unbound Fraction
Cytochrome P450 Enzyme System
Pharmacodynamics
Pharmacokinetics
o Unbound Fraction: part of the drug that produces an effect on a target organ
o Cytochrome P-450 Enzyme System: facilitates drug metabolism in the smooth ER’s phase I absorption
o Pharmacodynamics: study of biochemistry and physiological impacts of a drug
o Pharmacokinetics: study of the time it takes for a drug to travel throughout the body
47
Pharmacogenetics
Excipient
pH drug interactions + absorptions
o Pharmacogenetics: genetic factors and reactants of how well a drug will work
o Excipient: additives in drugs
o pH drug interactions and absorption; specifically, b12: b12 combines with intrinsic factor in stomach. pH increases and the intrinsic factor decreases making absorption harder
48
How drugs may impact nutritional status?
```
o Taste/Smell
o Gastrointestinal
o Appetite
o Organ Toxicity
o Metabolic Effects
```
49
Common Excipients
o Alcohol (ethanol): solvent; CNS depressant; many drug interactions; possible problems for alcoholics
o Lactose: common filler; problems for lactose intolerance
o Mannitol/ Sorbitol: sugar alcoholics; improves taste; may cause diarrhea
o Starch: wheat, corn, potatoes; filler, binder, diluent; concern for celiac disease + allergy
o Vegetable Oil: soy, sesame seed, corn, cotton seed, peanut; fat diluent, fat absorption, lubricant; concern for allergies
50
Anthropometric Assessment Techniques
o Nonambulatory
o Demi Span: in between two fingers to middle of chest
o 1/2 Arm Span: tip of finger to middle of chest
o Ulna Span: usually used in children; wrist to elbow
o Diurnal changes: shift in weight due to time of day and fluid retention
51
IBW
weight= lbs/ 2.2 kg = kg
Height= “ x 2.54cm= cm / 100 = m
-Female: 5 ft= 100# Male: 5 ft= 106#
“ Over 5 ft= 5# “ over 5 ft= 6#
52
IBW range
+/- 10% of IBW.. Round to 1 dp
- Small Frame: subtract 10% from your IBW to get your starting range
- Large Frame: add 10% to your IBW to get your starting range
53
IBW %
actual weight / IBW x 100… Round to 1 dp
| *Greater than 120% is obese!
54
UBW%
actual weight/ UBW x 100… round to 1 dp
55
BMI
weight in kg / (height in m) 2
56
Amputations
- # x (% x 100) = # + old #= new #
| - then calculate IBW and IBW %
57
BMI Classifications
Underweight 40 kg/ m2
58
```
ADL
Dx
HTN
IBD
IBS
PN
PTA
Rx
TF
```
```
ADL Activities of Daily Living
Dx Diagnosis
HTN Hypertension
IBD Inflammatory Bowel Disease
IBS Irritable Bowel Syndrome
PN Parenteral Nutrition (IV tube)
PTA Prior to Arrival ; Prior to Admission
Rx Prescription
TF Tube Feeding
```
59
```
WNL
AEB
C/O
Ca
GERD
NPO
PO
Pt
R/O
R/T
```
```
WNL Within Normal Limits
AEB As Evidenced By
C/O Complains Of
Ca Calcium ; cancer
GERD Gastroesophageal Reflux Disease
NPO Nothing By Mouth
PO By Mouth
Pt Patient
R/O Rule Out; not 100% sure yet
R/T Related To
```
60
```
Carcinoma
Colostomy
Diverticulosis
Endoscopy
Enteropathy
Esophagitis
```
Carcinoma carcin + toma
(cancerous) (tumor)
Colostomy col + stomy
(large intestine/ colon) (new opening)
Diverticulosis divert + cul + losis
(turning aside) (pouch) (disease)
Endoscopy endo + scopy
(within) (visual examination)
Enteropathy entero + pathy
(small intestine) (disease)
Esophagitis esophagi + itis
(esophagus) (inflammation)
61
```
Ileostomy
Vagotomy
Cholangitis
Cholecystectomy
Cholelithiasis
Cirrhosis
Dysguesia
```
Ileostomy ile + stomy
(ileum) (new opening)
Vagotomy vag + tomy
(vagus nerve) (process of cutting)
Cholangitis cholang + itis
(bile duct) (inflammation)
Cholecystectomy chol + cyst + ectomy
(bile/ gall) (bladder/ bag) (surgical removal)
Cholelithiasis chol + lith + iasis
(bile/gall) (stone) (abnormal condition)
Cirrhosis cirrh + sis
(orange/ yellow) (disease)
Dysguesia dys + gues+ ia
(bad)(taste)(disease/ abnormal condition)
62
Corticosteroids
Strong anti-inflammatory drug that can be used to suppress immune system and prevent rejection for organ transplant. Can also help with low blood pressure.
FOOD: take with food or milk.
-avoid simple sugars
-avoid large quantities of CHO d/t risk for impaired glucose tolerance
-limit citrus intake
EXAMPLE: Prednisone
SUPPLEMENTS: decrease Na
-increase Ca, Vit. D +/or protein
MONITORING: increased appetite; hyperglycemia; hyperlipidemia; wt. gain over long usage.
Avoid alcohol.
63
Diuretics
Prevents body from absorbing too much salt. Treats fluid retention (edema).
FOOD: take on an empty stomach
EXAMPLES: Foursemide (Lasix)
Hydrochlorothiazide (HCTZ)
SUPPLEMENTS: increase Ca, K, + Mg if there is a decrease (individualistic)
64
Anticoagulants
Reduces blood clots.
FOOD: limit Vit. K consumption.
EXAMPLE: Warfarin (Coumadin)
SUPPLEMENT: do not exceed UL for Vit. A or E
-limit supplemental garlic, ginger, ginseng, saw palmetto, gingko, + horse chestnut
65
H2 Receptor Antagonists + Proton Pump Inhibitors (for stomach medications)
Relieves pain and irritation caused by gird. FOOD: take with or without food but with 8 ozs. of water.
-caffeine may cause irritation
EXAMPLES: H2: Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
PPI: Omeprazole (Prilosec)
SUPPLEMENTS: take 2 hours before iron or antacid supplement
-increase B12 absorption on an individualistic level
Avoid alcohol.
Nutrition Assessment
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